Tag Archives: Kaiser Health News

6 surprising health items that could disappear with ACA repeal

The Affordable Care Act of course affected premiums and insurance purchasing. It guaranteed people with pre-existing conditions could buy health coverage and allowed children to stay on parents’ plans until age 26. But the roughly 2,000-page bill also included a host of other provisions that affect the health-related choices of nearly every American.

Some of these measures are evident every day. Some enjoy broad support, even though people often don’t always realize they spring from the statute.

In other words, the outcome of the repeal-and-replace debate could affect more than you might think, depending on exactly how the GOP congressional majority pursues its goal to do away with Obamacare.

No one knows how far the effort will reach, but here’s a sampling of sleeper provisions that could land on the cutting-room floor:

CALORIE COUNTS AT RESTAURANTS AND FAST FOOD CHAINS

Feeling hungry? The law tries to give you more information about what that burger or muffin will cost you in terms of calories, part of an effort to combat the ongoing obesity epidemic. Under the ACA, most restaurants and fast food chains with at least 20 stores must post calorie counts of their menu items. Several states, including New York, already had similar rules before the law. Although there was some pushback, the rule had industry support, possibly because posting calories was seen as less onerous than such things as taxes on sugary foods or beverages. The final rule went into effect in December after a one-year delay. One thing that is still unclear: Does simply seeing that a particular muffin has more than 400 calories cause consumers to choose carrot sticks instead?  Results are mixed. One large meta-analysis done before the law went into effect didn’t show a significant reduction in calorie consumption, although the authors concluded that menu labeling is “a relatively low-cost education strategy that may lead consumers to purchase slightly fewer calories.”

PRIVACY PLEASE: WORKPLACE REQUIREMENTS FOR BREAST-FEEDING ROOMS

Breast feeding, but going back to work? The law requires employers to provide women break time to express milk for up to a year after giving birth and provide someplace — other than a bathroom — to do so in private. In addition, most health plans must offer breastfeeding support and equipment, such as pumps, without a patient co-payment.

LIMITS ON SURPRISE MEDICAL COSTS FROM HOSPITAL EMERGENCY ROOM VISITS

If you find yourself in an emergency room, short on cash, uninsured or not sure if your insurance covers costs at that hospital, the law provides some limited assistance. If you are in a hospital that is not part of your insurer’s network, the Affordable Care Act requires all health plans to charge consumers the same co-payments or co-insurance for out-of-network emergency care as they do for hospitals within their networks. Still, the hospital could “balance bill” you for its costs — including ER care — that exceed what your insurer reimburses it.

If it’s a non-profit hospital — and about 78 percent of all hospitals are — the law requires it to post online a written financial assistance policy, spelling out whether it offers free or discounted care and the eligibility requirements for such programs. While not prescribing any particular set of eligibility requirements, the law requires hospitals to charge lower rates to patients who are eligible for their financial assistance programs. That’s compared with their gross charges, also known as chargemaster rates.

NONPROFIT HOSPITALS’ COMMUNITY HEALTH ASSESSMENTS

The health law also requires non-profit hospitals to justify the billions of dollars in tax exemptions they receive by demonstrating how they go about trying to improve the health of the community around them.

Every three years, these hospitals have to perform a community needs assessment for the area the hospital serves. They also have to develop — and update annually — strategies to meet these needs. The hospitals then must provide documentation as part of their annual reporting to the Internal Revenue Service. Failure to comply could leave them liable for a $50,000 penalty.

A WOMAN’S RIGHT TO CHOOSE … HER OB/GYN

Most insurance plans must allow women to seek care from an obstetrician/gynecologist without having to get a referral from a primary care physician. While the majority of states already had such protections in place, those laws did not apply to self-insured plans, which are often offered by large employers. The health law extended the rules to all new plans. Proponents say direct access makes it easier for women to seek not only reproductive health care, but also related screenings for such things as high blood pressure or cholesterol.

AND WHAT ABOUT THOSE THERAPY COVERAGE ASSURANCES FOR FAMILIES WHO HAVE KIDS WITH AUTISM?

Advocates for children with autism and people with degenerative diseases argued that many insurance plans did not provide care their families needed. That’s because insurers would cover rehabilitation to help people regain functions they had lost, such as walking again after a stroke, but not care needed to either gain functions patients never had, such speech therapy for a child who never learned how to talk, or to maintain a patient’s current level of function. The law requires plans to offer coverage for such treatments, dubbed habilitative care, as part of the essential health benefits in plans sold to individuals and small groups.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation. This story from HKN is published under a Creative Commons license.

Who’s affected by insurers’ pullbacks?

Aetna last week joined other health insurers in withdrawing from many of the health exchanges set up under the Affordable Care Act.

The company cited an unsustainable financial situation.

But that motive is being questioned: It was revealed last week that Aetna had earlier warned it would reduce its presence in the exchanges if the Justice Department sued to block its deal to acquire Humana.

The government filed that suit last month.

Regardless, this latest pullback from Obamacare leaves a lot of questions about competitive options in the exchanges, how consumers will be affected and the future of the law.

KHN’s Julie Rovner joined a panel of guests on The Diane Rehm Show on Aug. 18 to discuss the move and how it might affect the presidential campaign.

Made available by Kaiser Health News.

California’s End of Life Option Act takes effect June 9

Starting June 9, terminally ill Californians with six months or less to live can request a doctor’s prescription for medications intended to end their lives peacefully.

If that sounds simple, it won’t be.

California’s End of Life Option Act creates a long list of administrative hurdles that both patients and their doctors must clear.

For instance, you must make multiple requests for the drugs, orally and in writing, and provide a written attestation within 48 hours of taking the medication (you must be able to take the drugs yourself, without help, to qualify).

Two doctors must confirm your diagnosis, prognosis and ability to make medical decisions, and you must prove you’re a California resident.

And more.

“This will not be an on-demand service,” says Sarah Hooper, executive director of the UCSF / UC Hastings Consortium on Law, Science and Health Policy.

“The patient has to jump through a lot of hoops before accessing the prescription. Those hoops are designed to ensure that the patient has really thought about this and is making the decision voluntarily.”

California will be the fifth state to implement an aid-in-dying law, and the Golden State’s version of it is considered the most stringent, says Sean Crowley, spokesman for the advocacy group Compassion & Choices.

Rather than list every requirement, I’m going describe a few potential challenges you might face if you or a loved one is considering asking for these medications — from doctors who are unwilling to write prescriptions to the cost of the medications themselves.

Let’s start with the doctors.

This law is voluntary “every step of the way,” says Democratic state Sen. Bill Monning, co-author of the law.

That means everyone — patients, physicians, health systems and pharmacies — gets to choose whether or not to participate.

Nothing requires patients to take the drugs once they have obtained a prescription.

Since Oregon implemented its law in 1997, more than one-third of people who obtained prescriptions didn’t take the medications, according to data compiled by the Oregon Public Health Division.

“You can still at any point decide, ‘I’m not going to need this. The hospice care is effective. The palliative care is effective,’” Monning says.

But before you can make that decision, you must first get a prescription — and that might take some doing. That’s because not all health care providers will be on board with the new law. It will be up to you to find the ones who are.

“Patients and families should expect that they will have to be a little proactive in asking questions and getting educated about their care,” Hooper says.

For instance, the Kaiser Permanente system will participate, and patients will be paired with a coordinator to guide them through the process, says spokeswoman Amy Thoma.

If your Kaiser Permanente doctor chooses not to participate, which is his or her right under the law, your coordinator will connect you with a physician who does, Thoma says.

But U.S. military veterans who receive health care from the U.S. Department of Veterans Affairs will have to look elsewhere for participating doctors, because federal law prohibits the use of federal money for such a purpose, Hooper says.

Nor will the 48 Catholic and Catholic-affiliated hospitals in California participate, including their doctors and staff, says Lori Dangberg, vice president of the Alliance of Catholic Health Care.

Dangberg insists that those providers will not abandon any patient who chooses to end his or her own life. “We will be with that patient and continue to care for that patient throughout their diagnosis and their dying process,” she says. “We just cannot participate in any action that would intentionally hasten a person’s death.”

If your doctor doesn’t participate, ask him or her to refer you to one who does. If your doctor won’t provide a reference, “call us and we can probably help,” says Crowley of Compassion & Choices. That number is 800-893-4548.

Another potential obstacle is the cost of the drugs. Your insurance might not cover them. California’s law does not require health insurers to cover the medications, Monning says.

In Oregon, Washington and Montana — states where aid-in-dying is legal — some health plans cover the cost and some don’t, he says. He expects the same to occur in California.

Insurers “are currently working on how they will implement this law,” says Nicole Kasabian Evans of the California Association of Health Plans.

If you have questions about coverage, she suggests you contact your insurer directly.

Medi-Cal, California’s version of the federal Medicaid program for low-income residents, will cover the cost of the drugs without relying on any federal money, says state Department of Health Care Services spokeswoman Katharine Weir.

If affordability becomes an issue, Compassion & Choices again urges you to call. “We try to work with people to find a way for them to access the law, through any challenges,” Crowley says.

If you need more step-by-step guidance about the law, tap into these resources:

  • Compassion & Choices has online guides for consumers and doctors at www.EndOfLifeOption.org. You can also call the group’s help line at 800-893-4548.
  • The UCSF/UC Hastings Consortium on Law, Science and Health Policy has a helpful fact sheet at http://bit.ly/248Z2l6.
  • The California Medical Association, which represents doctors, has a detailed, 14-page document at www.cmanet.org/endoflife. You’ll need to register on the site to read the document.
  • Once the law takes effect, or soon thereafter, you will be able to find the forms you and your physician need to sign at the Medical Board of California’s website: www.mbc.ca.gov.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation. Kaiser Health News is national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.