Kaiser Health News
Start Shopping: Enrollment Begins Nov. 1 for Most Obamacare Insurance Plans
Julie Appleby, KFF Health News
Tue, 31 Oct 2023 09:00:00 +0000
For millions of Americans who buy their own health insurance through the Affordable Care Act marketplace, the end of the year brings a day of reckoning: It's time to compare benefits and prices and change to a new plan or enroll for the first time.
Open enrollment starts Nov. 1 for the ACA's federal and state exchanges. Consumers can go online, call, or seek help from a broker or other assister to learn their 2024 coverage options, calculate their potential subsidies, or change plans.
In most states, open enrollment lasts through Jan. 15, although some states have different time periods. California's, for example, is longer, open until Jan. 31, but Idaho's runs from Oct. 15 to Dec. 15. In most states enrollment must occur by Dec. 15 to get coverage that begins Jan. 1.
Health policy experts and brokers recommend all ACA policyholders at least look at next year's options, because prices — and the doctors and hospitals in plans' networks — may have changed.
It Could Be Another Record Year
ACA plans are now well entrenched — an estimated 16.3 million people signed up during open enrollment last year. This year may see even larger numbers. Enhanced subsidies first approved during the height of the covid pandemic remain available, and some states have boosted financial help in other ways.
In addition, millions of people nationwide are losing Medicaid coverage as states reassess their eligibility for the first time since early in the pandemic. Many of those ousted could be eligible for an ACA plan. They can sign up as soon as they know they're losing Medicaid coverage — even outside of the open enrollment season.
Another important caution: Don't wait until the last minute, especially if you are seeking help from a broker. Consumers this year will be asked to certify that they voluntarily agreed to brokers' assistance and that their income and other information provided by brokers is accurate.
It's a good protection for both parties, said broker Joshua Brooker, founder of PA Health Advocates in Pennsylvania. But brokers are concerned the requirement could cause delays, especially if clients wait until right before the end of open enrollment to apply.
“Brokers will need to stop what they are doing right at the end before they click ‘submit' and wait for the consumer to sign a statement saying they reviewed the policy,” Brooker said.
Premiums Are Changing
While some health plans are lowering premiums for next year, many are increasing them, often by 2% to 10%, according to a Peterson-KFF Health System Tracker initial review of rate requests. The median increase, based on a weighted average across its plans for each insurer, was 6%.Â
Premiums, and whether they go up or down, vary widely by region and insurer.Â
Experts say that's a big reason to log on to the federal website, healthcare.gov, in the 32 states that use it, or on to the insurance marketplace for one of the 18 states and the District of Columbia that run their own. Changing insurers might mean a lower premium.
“It's very localized,” said Sabrina Corlette, research professor and co-director of the Center on Health Insurance Reforms at Georgetown University. “People should shop to maximize their premium tax credit, although that might require not only changing to a new insurance plan, but potentially also a new network of providers.”
Most people buying their own coverage qualify for the tax credit, which is a subsidy to offset some, or even all, of their monthly premium. Subsidies are based partly on the premium of the second-lowest-priced silver-level plan in a region. When those go up or down, possibly from a new insurer entering the market with low initial rates, it affects the subsidy amount.
Household income is also a factor. Subsidies are on a sliding scale based on income.
Subsidies were enhanced during the pandemic, both to increase the amount enrollees could receive and to allow more families to qualify. Those enhancements were extended through 2025 by President Joe Biden's Inflation Reduction Act, passed last year.
Online calculators, including one at healthcare.gov, can provide subsidy estimates.
You May Qualify for Lower Deductibles and Copays
In addition to the premium subsidies, most ACA enrollees qualify for reduced deductibles, copayments, and other types of cost sharing if their income is no more than 2.5 times the federal poverty level, or about $75,000 for a family of four or $36,450 for a single-person household.
ACA plans are grouped into colored tiers — bronze, silver, gold, and platinum — based largely on how much cost sharing they require. Bronze plans offer the lowest premiums but usually the highest copayments and deductibles. Platinum plans carry the highest premiums but the lowest out-of-pocket expenses for care.
Cost-sharing reductions are available only in silver-level plans and are more generous for those on the lower end of the income scale. New this year: To help more people qualify, the federal marketplace will automatically switch eligible people to a silver plan for next year if they are currently enrolled in a bronze plan, as long as the enrollee has not made an adjustment in coverage themselves.
There are safeguards built in, said insurance expert and broker Louise Norris, so that people are auto-enrolled in a plan with the same network of medical providers and a similar or lower premium. Additionally, nine of the states that run their own marketplaces — California, Colorado, Connecticut, Maryland, Massachusetts, New Jersey, New Mexico, Vermont, and Washington — have enhanced their cost-sharing reduction programs by extending eligibility or increasing benefits.
Some 26-Year-Olds Will Get to Stay on Parents' Plans Longer
Happy birthday! Existing federal marketplace rules allowing adult children to stay on their parents' plans though the calendar year in which they turn 26, rather than lose coverage on their 26th birthday, were codified into regulation.
States that run their own markets can set similar rules, and some already allow for longer periods on a parent's plan.
Networks May Still Be Small
Insurance plans often try to reduce premiums by partnering with a limited set of doctors, hospitals, and other providers. Those can change year to year, which is why insurance experts like Norris say enrollees should always check their plans during open enrollment to ensure their preferred physicians and medical centers are included in the network.
It's also a good idea, Norris said, to look closely for changes in prescription drug coverage or copayments.
“The general message is, don't assume anything and make sure you check to see who is in the network,” Norris said.
Last year, the Biden administration set rules requiring health plans to have enough in-network providers to meet specific driving time and distance standards. A proposal to limit how long patients wait for a routine appointment has been delayed until 2025.
What We Still Don't Know
A few things remain uncertain as the end of the year approaches. For example, the Biden administration proposed this summer to reverse a Trump-era rule that allowed short-term insurance plans to be sold for coverage periods of up to a year.
Short-term plans are not ACA-compliant, and many have fewer benefits and can set restrictions on coverage, including barring people with health conditions from purchasing them. As a result, they are far less expensive than ACA plans. The Biden proposal would restrict them to coverage periods of four months, but the rule isn't final.
Also pending: a final rule that would allow people to sign up for ACA coverage if they were brought to the U.S. as children by parents lacking permanent legal status — a group known as “Dreamers.”
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By: Julie Appleby, KFF Health News
Title: Start Shopping: Enrollment Begins Nov. 1 for Most Obamacare Insurance Plans
Sourced From: kffhealthnews.org/news/article/aca-obamacare-open-enrollment-marketplace-plans/
Published Date: Tue, 31 Oct 2023 09:00:00 +0000
Did you miss our previous article…
https://www.biloxinewsevents.com/an-arm-and-a-leg-john-green-vs-johnson-johnson-part-2/
Kaiser Health News
KFF Health News’ ‘What the Health?’: Newly Minted Doctors Are Avoiding Abortion Ban States
Thu, 09 May 2024 19:30:00 +0000
The Host
Julie Rovner
KFF Health News
Julie Rovner is chief Washington correspondent and host of KFF Health News' weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.
A new analysis finds that graduating medical students were less likely to apply this year for residency training in states that ban or restrict abortion. That was true not only for aspiring OB-GYNs and others who regularly treat pregnant patients, but for all specialties.
Meanwhile, another study has found that more than 4 million children have been terminated from Medicaid or the Children's Health Insurance Program since the federal government ended a covid-related provision barring such disenrollments. The study estimates about three-quarters of those children were still eligible and were kicked off for procedural reasons.
This week's panelists are Julie Rovner of KFF Health News, Lauren Weber of The Washington Post, Joanne Kenen of the Johns Hopkins University schools of nursing and public health and Politico Magazine, and Anna Edney of Bloomberg News.
Panelists
Anna Edney
Bloomberg
Joanne Kenen
Johns Hopkins University and Politico
Lauren Weber
The Washington Post
Among the takeaways from this week's episode:
- More medical students are avoiding applying to residency programs in states with abortion restrictions. That could worsen access problems in areas that already don't have enough doctors and other health providers in their communities.
- New threats to abortion care in the United States include not only state laws penalizing abortion pill possession and abortion travel, but also online misinformation campaigns — which are trying to discourage people from supporting abortion ballot measures by telling them lies about how their information might be used.
- The latest news is out on the fate of Medicare, and a pretty robust economy appears to have bought the program's trust fund another five years. Still, its overall health depends on a long-term solution — and a long-term solution depends on Congress.
- In Medicaid expansion news, Mississippi lawmakers' latest attempt to expand the program was unsuccessful, and a report shows two other nonexpansion states — Texas and Florida — account for about 40% of the 4 million kids who were dropped from Medicaid and CHIP last year. By not expanding Medicaid, holdout states say no to billions of federal dollars that could be used to cover health care for low-income residents.
- Finally, the bankruptcy of the hospital chain Steward Health Care tells a striking story of what happens when private equity invests in health care.
Also this week, Rovner interviews KFF Health News' Katheryn Houghton, who reported and wrote the latest KFF Health News-NPR “Bill of the Month” feature, about a patient who went outside his insurance network for a surgery and thought he had covered all his bases. It turned out he hadn't. If you have an outrageous or incomprehensible medical bill you'd like to share with us, you can do that here.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: The Nation's “The Abortion Pill Underground,” by Amy Littlefield.
Joanne Kenen: The New York Times' “In Medicine, the Morally Unthinkable Too Easily Comes to Seem Normal,” by Carl Elliott.
Anna Edney: ProPublica's “Facing Unchecked Syphilis Outbreak, Great Plains Tribes Sought Federal Help. Months Later, No One Has Responded,” by Anna Maria Barry-Jester.
Lauren Weber: Stat's “NYU Professors Who Defended Vaping Didn't Disclose Ties to Juul, Documents Show,” by Nicholas Florko.
Also mentioned on this week's podcast:
- KFF Health News' “Medical Residents Are Increasingly Avoiding States With Abortion Restrictions,” by Julie Rovner and Rachana Pradhan.
- CNBC's “Abortion Bans Drive Away up to Half of Young Talent, New CNBC/Generation Lab Youth Survey Finds,” by Jason Gewirtz.
- The Washington Post's “Texas Man Files Legal Action To Probe Ex-Partner's Out-of-State Abortion,” by Caroline Kitchener.
Credits
Francis Ying
Audio producer
Emmarie Huetteman
Editor
To hear all our podcasts, click here.
And subscribe to KFF Health News' “What the Health?” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.
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Title: KFF Health News' ‘What the Health?': Newly Minted Doctors Are Avoiding Abortion Ban States
Sourced From: kffhealthnews.org/news/podcast/what-the-health-346-abortion-ban-residency-decline-may-9-2024/
Published Date: Thu, 09 May 2024 19:30:00 +0000
Kaiser Health News
Medical Residents Are Increasingly Avoiding States With Abortion Restrictions
Julie Rovner, KFF Health News and Rachana Pradhan
Thu, 09 May 2024 12:01:00 +0000
Isabella Rosario Blum was wrapping up medical school and considering residency programs to become a family practice physician when she got some frank advice: If she wanted to be trained to provide abortions, she shouldn't stay in Arizona.
Blum turned to programs mostly in states where abortion access — and, by extension, abortion training — is likely to remain protected, like California, Colorado, and New Mexico. Arizona has enacted a law banning most abortions after 15 weeks.
“I would really like to have all the training possible,” she said, “so of course that would have still been a limitation.”
In June, she will start her residency at Swedish Cherry Hill hospital in Seattle.
According to new statistics from the Association of American Medical Colleges, for the second year in a row, students graduating from U.S. medical schools were less likely to apply this year for residency positions in states with abortion bans and other significant abortion restrictions.
Since the Supreme Court in 2022 overturned the constitutional right to an abortion, state fights over abortion access have created plenty of uncertainty for pregnant patients and their doctors. But that uncertainty has also bled into the world of medical education, forcing some new doctors to factor state abortion laws into their decisions about where to begin their careers.
Fourteen states, primarily in the Midwest and South, have banned nearly all abortions. The new analysis by the AAMC — a preliminary copy of which was exclusively reviewed by KFF Health News before its public release — found that the number of applicants to residency programs in states with near-total abortion bans declined by 4.2%, compared with a 0.6% drop in states where abortion remains legal.
Notably, the AAMC's findings illuminate the broader problems abortion bans can create for a state's medical community, particularly in an era of provider shortages: The organization tracked a larger decrease in interest in residencies in states with abortion restrictions not only among those in specialties most likely to treat pregnant patients, like OB-GYNs and emergency room doctors, but also among aspiring doctors in other specialties.
“It should be concerning for states with severe restrictions on reproductive rights that so many new physicians — across specialties — are choosing to apply to other states for training instead,” wrote Atul Grover, executive director of the AAMC's Research and Action Institute.
The AAMC analysis found the number of applicants to OB-GYN residency programs in abortion ban states dropped by 6.7%, compared with a 0.4% increase in states where abortion remains legal. For internal medicine, the drop observed in abortion ban states was over five times as much as in states where abortion is legal.
In its analysis, the AAMC said an ongoing decline in interest in ban states among new doctors ultimately “may negatively affect access to care in those states.”
Jack Resneck Jr., immediate past president of the American Medical Association, said the data demonstrates yet another consequence of the post-Roe v. Wade era.
The AAMC analysis notes that even in states with abortion bans, residency programs are filling their positions — mostly because there are more graduating medical students in the U.S. and abroad than there are residency slots.
Still, Resneck said, “we're extraordinarily worried.” For example, physicians without adequate abortion training may not be able to manage miscarriages, ectopic pregnancies, or potential complications such as infection or hemorrhaging that could stem from pregnancy loss.
Those who work with students and residents say their observations support the AAMC's findings. “People don't want to go to a place where evidence-based practice and human rights in general are curtailed,” said Beverly Gray, an associate professor of obstetrics and gynecology at Duke University School of Medicine.
Abortion in North Carolina is banned in nearly all cases after 12 weeks. Women who experience unexpected complications or discover their baby has potentially fatal birth defects later in pregnancy may not be able to receive care there.
Gray said she worries that even though Duke is a highly sought training destination for medical residents, the abortion ban “impacts whether we have the best and brightest coming to North Carolina.”
Rohini Kousalya Siva will start her obstetrics and gynecology residency at MedStar Washington Hospital Center in Washington, D.C., this year. She said she did not consider programs in states that have banned or severely restricted abortion, applying instead to programs in Maryland, New Hampshire, New York, and Washington, D.C.
“We're physicians,” said Kousalya Siva, who attended medical school in Virginia and was previously president of the American Medical Student Association. “We're supposed to be giving the best evidence-based care to our patients, and we can't do that if we haven't been given abortion training.”
Another consideration: Most graduating medical students are in their 20s, “the age when people are starting to think about putting down roots and starting families,” said Gray, who added that she is noticing many more students ask about politics during their residency interviews.
And because most young doctors make their careers in the state where they do their residencies, “people don't feel safe potentially having their own pregnancies living in those states” with severe restrictions, said Debra Stulberg, chair of the Department of Family Medicine at the University of Chicago.
Stulberg and others worry that this self-selection away from states with abortion restrictions will exacerbate the shortages of physicians in rural and underserved areas.
“The geographic misalignment between where the needs are and where people are choosing to go is really problematic,” she said. “We don't need people further concentrating in urban areas where there's already good access.”
After attending medical school in Tennessee, which has adopted one of the most sweeping abortion bans in the nation, Hannah Light-Olson will start her OB-GYN residency at the University of California-San Francisco this summer.
It was not an easy decision, she said. “I feel some guilt and sadness leaving a situation where I feel like I could be of some help,” she said. “I feel deeply indebted to the program that trained me, and to the patients of Tennessee.”
Light-Olson said some of her fellow students applied to programs in abortion ban states “because they think we need pro-choice providers in restrictive states now more than ever.” In fact, she said, she also applied to programs in ban states when she was confident the program had a way to provide abortion training.
“I felt like there was no perfect, 100% guarantee; we've seen how fast things can change,” she said. “I don't feel particularly confident that California and New York aren't going to be under threat, too.”
As a condition of a scholarship she received for medical school, Blum said, she will have to return to Arizona to practice, and it is unclear what abortion access will look like then. But she is worried about long-term impacts.
“Residents, if they can't get the training in the state, then they're probably less likely to settle down and work in the state as well,” she said.
——————————
By: Julie Rovner, KFF Health News and Rachana Pradhan
Title: Medical Residents Are Increasingly Avoiding States With Abortion Restrictions
Sourced From: kffhealthnews.org/news/article/medical-students-residents-spurning-abortion-ban-states/
Published Date: Thu, 09 May 2024 12:01:00 +0000
Did you miss our previous article…
https://www.biloxinewsevents.com/paid-sick-leave-sticks-after-many-pandemic-protections-vanish/
Kaiser Health News
Paid Sick Leave Sticks After Many Pandemic Protections Vanish
Zach Dyer
Thu, 09 May 2024 09:00:00 +0000
Bill Thompson's wife had never seen him smile with confidence. For the first 20 years of their relationship, an infection in his mouth robbed him of teeth, one by one.
“I didn't have any teeth to smile with,” the 53-year-old of Independence, Missouri, said.
Thompson said he dealt with throbbing toothaches and painful swelling in his face from abscesses for years working as a cook at Burger King. He desperately needed to see a dentist but said he couldn't afford to take time off without pay. Missouri is one of many states that do not require employers to provide paid sick leave.
So, Thompson would swallow Tylenol and push through the pain as he worked over the hot grill.
“Either we go to work, have a paycheck,” Thompson said. “Or we take care of ourselves. We can't take care of ourselves because, well, this vicious circle that we're stuck in.”
In a nation that was sharply divided about government health mandates during the covid-19 pandemic, the public has been warming to the idea of government rules providing for paid sick leave.
Before the pandemic, 10 states and the District of Columbia had laws requiring employers to provide paid sick leave. Since then, Colorado, New York, New Mexico, Illinois, and Minnesota have passed laws offering some kind of paid time off for illness. Oregon and California expanded previous paid leave laws. In Missouri, Alaska, and Nebraska, advocates are pushing to put the issue on the ballot this fall.
The U.S. is one of nine countries that do not guarantee paid sick leave, according to data compiled by the World Policy Analysis Center.
In response to the pandemic, Congress passed the Emergency Paid Sick Leave and Emergency Family and Medical Leave Expansion acts. These temporary measures allowed employees to take up to two weeks of paid sick leave for covid-related illness and caregiving. But the provisions expired in 2021.
“When the pandemic hit, we finally saw some real political will to solve the problem of not having federal paid sick leave,” said economist Hilary Wething.
Wething co-authored a recent Economic Policy Institute report on the state of sick leave in the United States. It found that more than half, 61%, of the lowest-paid workers can't get time off for an illness.
“I was really surprised by how quickly losing pay — because you're sick — can translate into immediate and devastating cuts to a family's household budget,” she said.
Wething noted that the lost wages of even a day or two can be equivalent to a month's worth of gasoline a worker would need to get to their job, or the choice between paying an electric bill or buying food. Wething said showing up to work sick poses a risk to co-workers and customers alike. Low-paying jobs that often lack paid sick leave — like cashiers, nail technicians, home health aides, and fast-food workers — involve lots of face-to-face interactions.
“So paid sick leave is about both protecting the public health of a community and providing the workers the economic security that they desperately need when they need to take time away from work,” she said.
The National Federation of Independent Business has opposed mandatory sick leave rules at the state level, arguing that workplaces should have the flexibility to work something out with their employees when they get sick. The group said the cost of paying workers for time off, extra paperwork, and lost productivity burdens small employers.
According to a report by the National Bureau of Economic Research, once these mandates go into effect, employees take, on average, two more sick days a year than before a law took effect.
Illinois' paid time off rules went into effect this year. Lauren Pattan is co-owner of the Old Bakery Beer Co. there. Before this year, the craft brewery did not offer paid time off for its hourly employees. Pattan said she supports Illinois' new law but she has to figure out how to pay for it.
“We really try to be respectful of our employees and be a good place to work, and at the same time we get worried about not being able to afford things,” she said.
That could mean customers have to pay more to cover the cost, Pattan said.
As for Bill Thompson, he wrote an op-ed for the Kansas City Star newspaper about his dental struggles.
“Despite working nearly 40 hours a week, many of my co-workers are homeless,” he wrote. “Without health care, none of us can afford a doctor or a dentist.”
That op-ed generated attention locally and, in 2018, a dentist in his community donated his time and labor to remove Thompson's remaining teeth and replace them with dentures. This allowed his mouth to recover from the infections he'd been dealing with for years. Today, Thompson has a new smile and a job — with paid sick leave — working in food service at a hotel.
In his free time, he's been collecting signatures to put an initiative on the November ballot that would guarantee at least five days of earned paid sick leave a year for Missouri workers. Organizers behind the petition said they have enough signatures to take it before the voters.
——————————
By: Zach Dyer
Title: Paid Sick Leave Sticks After Many Pandemic Protections Vanish
Sourced From: kffhealthnews.org/news/article/paid-sick-leave-post-pandemic-state-laws/
Published Date: Thu, 09 May 2024 09:00:00 +0000
Did you miss our previous article…
https://www.biloxinewsevents.com/forget-ringing-the-button-for-the-nurse-patients-now-stay-connected-by-wearing-one/
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