Obamacare HIV problems

Hundreds of people with HIV/AIDS in Louisiana trying to obtain coverage under President Barack Obama’s healthcare reform are in danger of being thrown out of the insurance plan they selected in a dispute over federal subsidies and the interpretation of federal rules about preventing Obamacare fraud, Reuters reports

“Some healthcare advocates see discrimination in the move, but Blue Cross and Blue Shield of Louisiana says it is not trying to keep people with HIV/AIDS from enrolling in one of its policies under the Affordable Care Act, also known as Obamacare.

“The state’s largest carrier is rejecting checks from a federal program designed to help these patients pay for AIDS drugs and insurance premiums, and has begun notifying customers that their enrollment in its Obamacare plans will be discontinued.

“The carrier says it no longer will accept third-party payments, such as those under the 1990 Ryan White Act, which many people with HIV/AIDS use to pay their premiums.

“In no event will coverage be provided to any subscribers, as of March 1, 2014, unless the premiums are paid by the subscriber (or a relative) unless otherwise required by law,” Blue Cross Blue Shield of Louisiana spokesman John Maginnis told Reuters. The dispute goes back to a series of statements from Centers for Medicare and Medicaid Services (CMS), the lead Obamacare agency. In September, CMS informed insurers that Ryan White funds “may be used to cover the cost of private health insurance premiums, deductibles, and co-payments” for Obamacare plans. In November, however, it warned “hospitals, other healthcare providers, and other commercial entities” that it has “significant concerns” about their supporting premium payments and helping Obamacare consumers pay deductibles and other costs, citing the risk of fraud. The insurers told healthcare advocates that the November guidance requires them to reject payments from the Ryan White program in order to combat fraud, said Robert Greenwald, managing director of the Legal Services Center of Harvard Law School, a position Louisiana Blue still maintains. Continue reading “Obamacare HIV problems”

Millennial skepticism over Obamacare

The Harvard Institute of Politics survey released Wednesday has garnered a lot of attention for its findings about Millennials’ views of Obamacare, in addition to their opinions on President Obama himself, reports The Atlantic.

“Between 56 and 57 percent of the 18- to-29-year-old respondents didn’t approve of the Affordable Care Act or Obamacare (depending on how the question was asked); 40 to 44 percent thought their quality of care would get worse under the new law; and 50 to 51 percent said they expected costs to increase.

“This has led to a giant round of Oh my God, Obamacare is going to be a giant failure because young people hate it, won’t enroll, and the insurance plans will go into death spirals. Well, no. Ryan Cooper argues this morning that Millennials “will come around on Obamacare.” But do they even need to? More than half the Millennials in the IOP study said they’d at least consider to signing up for Obamacare exchange insurance if and when they are old enough to need it.

“According to the survey, 22 percent said they’d definitely or probably enroll in Obamacare, and another 29 percent said they were 50-50 on whether they’d enroll or not. Only 45 percent said they definitely would not enroll. The whole survey sample was asked those questions, according to topline data provided by the pollsters. Sounds dismal—until you see that only 22 percent of those surveyed individuals were uninsured! Another way of looking at the data: 22 percent of people in a sample that was 22 percent uninsured said they would definitely or probably sign up for Obamacare. And 29 percent of people in a sample that was 35 percent covered by their parents’ insurance said they were 50-50 on enrolling if and when eligible. That paints a very different picture than just focusing on the large percentage who think their costs will go up while their quality of care goes down. Obamacare’s long-term health depends on whether people who are already insured support the program, but their opinion matters much less in the short term. Continue reading “Millennial skepticism over Obamacare”

Child care costs outpace family income

In 2012, the cost of child care in the U.S. grew up to eight times faster than family income, according to a new study of the average fees paid to child care centers and family child care homes, reports NPR.

“Child care is an increasingly difficult financial burden for working families to bear,” said Lynette M. Fraga, executive director of Child Care Aware of America, a nonprofit research and advocacy group. “Unlike all other areas of education investment, including higher education, families pay the majority of costs for early education.”

“According to the new findings, some families are spending more on child care than on food or rent, as NPR’s Jennifer Ludden reports for our Newscast unit:

“In most states, average child care center fees for an infant are higher than a year’s tuition and fees at a public college. …

“Factor in two kids, and the study finds average fees higher than the median rent in all states, and higher than the average food bill in all regions.”

In compiling its report, Child Care Aware of America looked at the costs of child care centers, including those run by religious organizations and family care homes. The findings don’t include other options such as nannies, or friends and relatives who look after children. To compare the costs of caring for two children, the organization used data from the price of care for an infant and a 4-year-old. The study ranked U.S. states according to the affordability of child care (as a share of median income for single or married parents), not by the overall cost of child care.

“The dollar cost of center-based care for infants was actually highest in Massachusetts” at nearly $16,500 yearly, according to the report, “compared to just over $13,450 per year in Oregon; however, as a percentage of median income for married couples with children, care was least affordable in Oregon.” Oregon was also found to be the least affordable state for center-based care for a married couple with a 4-year-old, ahead of New York, Minnesota and Vermont. The overall price of raising kids has also risen, according to government figures. Parents who had a child in 2012 can expect to pay $241,080 to raise him or her for the next 17 years, as Eyder reported for The Two-Way this past summer.The high numbers may cause parents to groan, but Child Care Aware of America says it doesn’t see cheaper child care as the sole solution.”

 

More at: http://www.npr.org/blogs/thetwo-way/2013/11/04/243005358/child-care-costs-already-high-outpace-family-income-gains?ft=1&f=1001

Caregivers live longer

The common wisdom in the fields of medicine and social work has held that those who care for a long-term seriously disabled person have their lives shortened as a consequence. Compensating anecdotes are often rendered about increased empathy, fulfillment, and so on. But the overriding narrative is generally rather grim.

Now a new study tells the opposite story, as reported in the American Journal of Epidemiology: a large new study shows that caregivers live as long or longer than non-caregivers, although the kind of care (which seems crucial in such a discussion) it not directly discussed in the abstract available online.

“Previous studies have provided conflicting evidence on whether being a family caregiver is associated with increased or decreased risk for all-cause mortality. This study examined whether 3,503 family caregivers enrolled in the national Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study showed differences in all-cause mortality from 2003 to 2012 compared with a propensity-matched sample of non-caregivers. Caregivers were individually matched with 3,503 non-caregivers by using a propensity score matching procedure based on 15 demographic, health history, and health behavior covariates.

“During an average 6-year follow-up period, 264 (7.5%) of the caregivers died, which was significantly fewer than the 315 (9.0%) matched noncaregivers who died during the same period. A proportional hazards model indicated that caregivers had an 18% reduced rate of death compared with non-caregivers (hazard ratio = 0.823, 95% confidence interval: 0.699, 0.969). Subgroup analyses by race, sex, caregiving relationship, and caregiving strain failed to identify any subgroups with increased rates of death compared with matched non-caregivers. Continue reading “Caregivers live longer”

Artists and Obamacare

It’s not yet clear how many people purchased insurance through the exchanges created under the Affordable Care Act that opened up yesterday.But one of the things we’ve been hearing from a lot of creative people

is that the ACA has made it easy to be, or to contemplate being, an artist.

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As discussed in ThinkProgress,”Being a writer, or a visual artist, or a musician, or an actor, has always been an economically risky choice where a few people succeed in dramatic terms, a larger number figure out middle-class existences doing what they love at least part of the time, and others struggle to do what they love. The ACA, and the ability to purchase more affordable insurance as an individual, doesn’t change that economic calculus. But it does help minimize a risk factor that can make it impossible to attempt careers as artists at all.

“It’s been interesting to hear all of the different ways the ACA has mattered to artists. Writer Kameron Hurley explains that not having decent insurance meant that, until she passed out and started convulsing, she decided she couldn’t afford to pay for the tests that ultimately revealed she had Type 1 Diabetes–a condition that then meant that she had to race to stay continuously insured, even if it meant taking low-paying temp work, less she go uninsured long enough for her diabetes to be considered a “pre-existing condition” that wouldn’t be covered in a future plan. Continue reading “Artists and Obamacare”

How the health law delay could help adjuncts

In many ways, the White House’s surprise announcement that it would delay the employer mandate provision of the Affordable Care Act by one year, until January 2015, is good news for colleges and universities struggling to figure out just who will be covered under the law. imgresInsideHigherEd says that “It gives institutions more time to decide how they’ll count adjunct instructors, whose credit hour-based schedules don’t fit neatly into the law’s existing metrics for qualifying for coverage.

“And while the announcement could lead to good news for adjuncts who have had their hours limited by colleges worried about the new provision taking effect, there was little celebration Wednesday. Colleges said that they were studying the situation, but no one was pledging to lift limits or restore hours to anyone.

“But in other ways, it adds a new layer of confusion onto what is already a complicated situation, particularly for those colleges that already have announced plans to limit adjuncts’ course loads to avoid having to provide them with health insurance as full-time employees. Questions remain as to whether institutions will temporarily backtrack on their plans, and if that’s even possible, given the timing of the announcement, so far into summer when planning for fall courses is already under way.

“I think that the government has poorly served institutions by announcing this delay so abruptly and so relatively close to the date of implementation,” said David Baime, senior vice president for government relations and research of the American Association of Community Colleges – one of many organizations that’s asked the federal government to issue long-promised specific guidelines as to what constitutes a full-time employee in higher education under the law. (In January, the Internal Revenue Service asked higher education officials to use “reasonable” means of calculating faculty hours worked.)

“At the same time, Baime added, “We hope that colleges will take this additional time given to them to evaluate their approach to policies in this area and, even more importantly, ask the government exactly what’s expected of them as institutions.”

Read more: http://www.insidehighered.com/news/2013/07/05/colleges-consider-how-delay-employer-insurance-rule-will-impact-plans-cap-adjuncts#ixzz2YEWkxKsk
Inside Higher Ed

Insurance gender-identity discrimination

In America’s increasingly expensive health care system, the costs of not having adequate insurance coverage are both financial and physical,reports the Center for American Progress.  Without coverage, many people must choose between struggling to pay exorbitant medical bills or going without the care they need.images-4

“Similar to millions of other Americans, many transgender people lack health insurance coverage. But even when they are able to find coverage, the promise of more secure access to care and protection from unaffordable medical bills often rings hollow. This is because the majority of U.S. health insurance plans deny coverage for medical procedures and treatments seen as specific to transgender people.

“This brief provides an overview of insurance discrimination against transgender people; the impact of the Affordable Care Act on insurance discrimination; and how some state insurance regulators are taking action to stop gender-identity discrimination in insurance.

“Currently, most private insurance plans, as well as many state Medicaid programs, incorporate plan language that specifically targets transgender people by excluding, for example:

  • “All services related to sexual reassignment”
  • “Sex transformations”
  • “Any treatment or procedure designed to alter an individual’s physical characteristics to those of the opposite sex”
  • “Care, services or treatment for … gender dysphoria or sexual reassignment or change … including medications, implants, hormone therapy, surgery, medical or psychiatric treatment”

These categorical exclusions are based on the false premise that the health care services that transgender people need are not medically necessary and are never needed by nontransgender people. In fact, however, the health care services denied to transgender people under these exclusions are frequently needed by nontransgender people as well.”

 

Story continues at: http://www.americanprogress.org/issues/lgbt/report/2013/05/02/62214/why-gender-identity-nondiscrimination-in-insurance-makes-sense/

Now we can talk about mental illness

This doesn’t get talked about much, but the Affordable Care Act guarantees coverage for people with mental health problems – care that would have been eliminated if the republicans had their way. Psychiatric illnesses are surprisingly common, yet receive little attention because they are stigmatized, misunderstood, and definitely not especially photogenic.

Think about this:  20 percent of American adults suffer from a diagnosable mental illness. That’s more than 40 million potential voters. So when you think about it, things like depression, bi-polar disorder, PTSD,  or addiction are not issues that affect anonymous strangers. These conditions face many around us at work, school and  home, even though those who struggle with mental illness often do so in silence.

Not long ago the Los Angeles Times carried a piece entitled “Mental health care at stake in 2012 vote.” It said that “Just to provide a little context, according to the American Cancer Society’s latest numbers, about 12 million Americans are living with some form of cancer; 400,000 Continue reading “Now we can talk about mental illness”