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In a liberal pocket, assisted living residents fear Obamacare’s death

From an upscale assisted living center in Seattle, 87-year-old Brendan Wall has some advice for members of Congress eager to repeal the Affordable Care Act: Slow down.

“They haven’t said what they’re going to replace it with or how they’re going to replace it,” said Wall, who taught philosophy and religion for more than 30 years.

“I think it’s a major crisis, and I hope to God they take enough time to think about it and act on it so that the thing will work.”

Wall lives at Merrill Gardens, a complex near downtown Seattle where anxiety runs high over the transition to a new administration in Washington, D.C. And while the evolving drama may not affect him directly, he and other seniors here fret about the Donald Trump administration’s vow to repeal and replace the Affordable Care Act and what it will mean for their children and grandchildren.

Wall and five other residents responded to a Kaiser Health News request for area seniors willing to share their views about health care as Trump takes over and pressure mounts on Capitol Hill to repeal the Affordable Care Act. In a news conference, Trump again called the health law “a complete and total disaster,” and said he intends to move quickly to replace it with something “far less expensive and far better,” though he offered no specifics.

The view from Merrill Gardens offers a snapshot of a larger national debate about the successes and failures of President Barack Obama’s signature legislation. Its residents live in liberal King County, where less than 22 percent of voters chose Trump. But only 125 miles away, in a rural district that voted for Trump, Republican Rep. Jaime Herrera Beutler says seniors’ anxieties over repeal of the Affordable Care Act are misplaced.

“Seniors are right to be concerned about the future of ACA, but not because of congressional Republicans’ plans,” spokeswoman Amy Pennington said in an email. “The law’s fundamental flaws, phony finances and broken promises will cause it to collapse on its own — Medicaid expansion, exchanges and all.”

At Merrill Gardens, residents are more politically engaged than in many parts of the country. They avidly follow the news through local newspapers, TV, the internet and radio.

The group that showed up for an open meeting in the complex’s private dining room ranged in age from early 70s to late-80s. They included retired education, business and health professionals. Loree Wagner, a center spokeswoman, said the organizers did not ask for political affiliation.

“I find this moment especially challenging,” said Dick Kirkendall, 88, a retired University of Washington history professor who specialized in the presidency of Harry S. Truman. “I have a hard time seeing what’s ahead, a harder time than I’ve ever had. I have a harder time knowing what my president is going to do.”

Everyone in the room said they had few complaints about their existing health insurance coverage through Medicare, Medicare supplements, private pensions and Veterans Affairs programs.

But they said they fear that proposed changes — including plans to privatize Medicare and revamp Medicaid and Social Security — will mean less care for their families and the poor.

“My opinion is not to touch Medicare or Medicaid,” said Terry Doucette, 76, a former admitting department manager for a local hospital. “I mean, people are dependent upon it and there needs to be a warning time and coming together in a real thoughtful way, making everything work together, especially for the least fortunate.”

Herrera Beutler said she supports plans to protect Medicare and Social Security for seniors in the future.

In addition to Wall, Kirkendall and Doucette, the group included John Ball, 73, a former developer, Sandra Wiatr, 80, a former school nurse in the Chicago public school system and Dr. Harold Ellner, 89, a retired urologist.

Overall, they sympathized with the frustrations of those who criticized the ACA, which created online health exchanges that expanded coverage to millions, but also saw sharp rises in costs and, in some cases, limited coverage choices.

“The Obama thing had been moving out of control, particularly for middle-class people whose insurance premiums have gone up and their deductibles are unbelievable,” Wall said. “They’re out of this world. I think they had to do something.”

But they also echoed the views of a recent Kaiser Family Foundation tracking poll that found that while one in five Americans support repeal alone, three-quarters either oppose repeal entirely or want to wait until details of a replacement plan are complete. (KHN is an editorially independent program of the foundation.)

The answer is not to scrap the plan that expanded insurance to 20 million people while offering no alternative, said Ball, who only obtained regular insurance when he qualified for Medicare eight years ago. He still lives with consequences of untreated injuries, including a broken clavicle that healed badly after a rugby injury years ago.

“I’m distressed at the proposal that we chuck out the baby with the bath water,” he said. “I’ve seen the backside of no insurance and living with something you hoped wouldn’t be considered a pre-existing condition. I have a pretty strong identification with those people who didn’t have insurance and were suddenly brought into the fold of Obamacare.”

In her work as a school nurse, Wiatr saw many students with asthma whose families couldn’t afford medication inhalers to control the potentially life-threatening disease. When she managed a family practice clinic, she saw people try to cut medical costs at the expense of health.

“There were people who didn’t do lab tests, who took only half of their medication because they couldn’t afford it,” she said. “I am very upset because I think our politicians don’t have a clue how difficult it is for people to receive medication and adequate health care.”

Ellner, the urologist, worked for a local Planned Parenthood clinic after he retired and flatly said he supports a universal, single-payer health system.

“Obamacare seems to have been a way station on the way to universal health care and now it’s not only being challenged, it’s being threatened,” he said.

The situation now calls for compromise and compassion from political leaders, said Doucette. “What I want to do is simply get the hard-headed guys from both parties to meet and really want to do this instead of wanting to win,” she said. “Now, we’ll see what Trump does. He has all these ideas and he thinks everyone else is on a lower level. I would like to see them work together.”

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.  This report is made available by Kaiser Health News under a Creative Commons License.

Frustration runs deep for those forced to routinely change health plans

Andrea Schankman’s three-year relationship with her insurer, Coventry Health Care of Missouri, has been contentious, with disputes over what treatments it would pay for. Nonetheless, like other Missourians, Schankman was unnerved to receive a notice from Coventry last month informing her that her policy was not being offered in 2017.

With her specialists spread across different health systems in St. Louis, Schankman, a 64-year-old art consultant and interior designer, said she fears she may not be able to keep them all, given the shrinking offerings on Missouri’s health insurance marketplace. In addition to Aetna, which owns Coventry, paring back its policies, UnitedHealthcare is abandoning the market. The doctor and hospital networks for the remaining insurers will not be revealed until the enrollment period for people buying individual insurance begins Nov. 1.

“We’re all sitting waiting to see what they’re going to offer,” said Schankman, who lives in the village of Westwood. “A lot of [insurance] companies are just gone. It’s such a rush-rush-rush no one can possibly know they’re getting the right policy for themselves.”

Doctor and hospital switching has become a recurring scramble as consumers on the individual market find it difficult or impossible to stay on their same plans amid rising premiums and a revolving door of carriers willing to sell policies. The instability, which preceded the health law, is intensifying in the fourth year of the Affordable Care Act’s marketplaces for people buying insurance directly instead of through an employer.

“In 2017, just because of all the carrier exits, there are going to be more people making involuntary changes,” said Katherine Hempstead, a senior adviser at the Robert Wood Johnson Foundation, a New Jersey philanthropy. “I would imagine all things being equal, more people are going to be disappointed this year versus last year.”

Forty-three percent of returning consumers to the federal government’s online exchange, healthcare.gov, switched policies last year. Some were forced to when insurers stopped offering their plans while others sought out cheaper policies. In doing so, consumers saved an average of $42 a month on premiums, according to the government’s analysis. But avoiding higher premiums has cost many patients their choice of doctors.

Jim Berry, who runs an internet directory of accountants with his wife, switched last year from Blue Cross Blue Shield of Georgia to Humana after Blue Cross proposed a 16 percent premium hike.

Despite paying Humana $1,141 in premiums for the couple, Berry, who lives in Marietta, a suburb of Atlanta, said they were unable to find a doctor in the network taking new patients. They ended up signing up with a concierge practice that accepts their insurance but also charges them a $2,700 annual membership, a fee he pays out of pocket. Nonetheless, he said he has been satisfied with the policy.

But last month Humana, which is withdrawing from 88 percent of the counties it sold plans in this year, told Berry his policy was not continuing, and he is unsure what choices he will have and how much more they will cost.

“It’s not like if I don’t want to buy Humana or Blue Cross, I have five other people competing for my business,” Berry said. “It just seems like it’s a lot of money every year for what is just basic insurance, basic health care. I understand what you’re paying for is the unknown — that heart attack or stroke — but I don’t know where the break point is.”

To be sure, the same economic forces — cancelled policies, higher premiums and restrictive networks — have been agitating the markets for employer-provided insurance for years. But there is more scrutiny on the individual market, born of the turmoil of the Affordable Care Act.

Dr. Patrick Romano, a professor of medicine at the UC Davis Health System in Sacramento, Calif., said the topic has been coming up in focus groups he has been convening about the state insurance marketplace, Covered California. Switching doctors, he said, “is a disruption and can lead to interruptions in medications.”

“Some of it is unintentional because people can have delays getting in” to see their new doctor, he said. “Some of it may be because the new physician isn’t comfortable with the medication the previous physician prescribed.”

Dr. John Meigs, an Alabama physician and president of the American Academy of Family Physicians, said that whatever the source of insurance, changing doctors disrupts the trust a patient has built with a physician and the knowledge a doctor has about how each patient responds to illnesses. “Not everything is captured in a health record” that can be passed to the next doctor, Meigs said.

There is little research about whether switching doctors leads to worse outcomes, said Dr. Thomas Yackel, a professor of medicine at Oregon Health & Science University in Portland. In some cases, he said, it can offer unexpected benefits: “Having a fresh set of eyes on you as a patient, is that really always a bad thing?”

With the shake-up in the insurance market, access to some top medical systems may be further limited. Blue Cross Blue Shield of Tennessee, which has included the elite Vanderbilt University Medical Center in its network, is pulling out of the individual marketplace in the state’s three largest metro areas: Nashville, Memphis and Knoxville. Bobby Huffaker, CEO of American Exchange, an insurance firm in Tennessee, said so far, no other carrier includes Vanderbilt in its network in the individual market.

In St. Louis, Emily Bremer, an insurance broker, said only two insurers will be offering plans next year through healthcare.gov. Cigna’s network includes BJC HealthCare and an affiliated physicians’ group, while Anthem provides access to other major hospital systems, including Mercy, but excludes BJC and its preeminent academic medical center Barnes-Jewish Hospital.

“These networks have little or no overlap,” she said. “It means severing a lot of old relationships. I have clients who have doctors across multiple networks who are freaking out.”

Aetna said it will still offer policies off the healthcare.gov exchange. Those are harder to afford as the federal government does not provide subsidies, and Aetna has not revealed what its networks will be. In an email, an Aetna spokesman said the insurer was offering those policies to preserve its option to return to the exchanges in future years; if Aetna had completely stopped selling individual policies, it would be banned from the market for five years under federal rules.

Even before St. Louis’ insurance options shrunk, Bremer said she had to put members of some families on separate policies in order for everyone to keep their physicians. That can cost the families more, because their combined deductibles and maximum out-of-pocket payments can be higher than for a single policy, she said.

“Every year our plan disappears,” said Kurt Whaley, a 49-year-old draftsman in O’Fallon, Mo., near St. Louis. After one change, he said, “I got to keep my primary care physician, but my kids lost their doctors. I had to change doctors for my wife. It took away some of the hospitals we could get into.”

Brad Morrison, a retired warehouse manager in Quincy, Ill., said he has stuck with Coventry despite premium increases — he now pays $709 a month, up from $474 — because the policy has been the cheapest that would let him keep his doctor. “That’s the one thing I insisted on,” he said. “I love the guy.”

With Coventry leaving the Illinois exchanges, Morrison is unsure whether his alternatives will include his physician. His bright spot is that he turns 65 next spring. “I’m trying to hold out until I get to Medicare,” he said.

This report originally appeared in Money. It was made available by Kaiser Health News through a Creative Commons license. KHN is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

HealthCare.gov rates to rise in Wisconsin

The U.S. Health and Human Services Department says the cost of its benchmark plan on HealthCare.gov will go up less in Wisconsin than the national average.

Silver plan rates will go up 4.7 percent here, compared with 7.5 percent nationally. 

The rates came out on Oct. 26 on the website established under President Barack Obama’s health care law. Next year’s sign-up session starts Sunday, and potential enrollees are now able to browse plans and prices.

Rates in some states climbed by double digits, but others saw a decline. 

Insurers in many states had underpriced plans and are raising rates because of inflation and higher claims than expected. 

Nationally, about 8 in 10 returning customers will be able to buy a plan for less than $100 a month, after tax credits.

Flashback 2014: Legal challenges threaten to destroy Obamacare

“The court, I fear, has ventured into a minefield,” Justice Ruth Bader Ginsburg warned in June in her 35-page dissent in the Hobby Lobby case. She called Justice Samuel Alito’s majority opinion a decision of “startling breadth.” 

Alito said Hobby Lobby, which has a chain of 500 arts-and-crafts stores, and Conestoga Wood Specialties, a small Pennsylvania furniture company, cannot be forced to comply with the Affordable Care Act mandate that health care plans, at no extra charge, cover contraception for women as part of a range of preventive benefits.

The court, which previously had ruled in favor of “corporate personhood,” said closely held companies — those with a few people owning more than 50 percent — can hold religious views.

The court’s four liberal justices said the decision to extend religious protections to for-profit companies will have untoward effects and, as Ginsburg wrote, closely held corporations can be large or small, public or private. Cargill is a closely held company. So is Koch Industries.

And the court’s 5-4 decision weakened the Affordable Care Act, which said birth control should be covered by insurance in the same manner in which other preventive drugs and treatments are covered.

U.S. Rep. Gwen Moore, D-Wis., was dismayed and disappointed by the decision. “No one should be denied access to health care because of her employer’s religious beliefs,” she said.

U.S. Rep. Mark Pocan, D-Wis., said the ruling “continues a dangerous trend of favoring the rights of corporations over people, but also tramples on health-care decisions made between a woman and her doctor.”

Political challenges to overturn or weaken the Affordable Care Act continued into the fall, before and after the midterms.

Meanwhile, opinion polls showed more negative attitudes than positive attitudes toward Obamacare and, as the health care marketplace opened for a second year, many Americans learned their current plans were being canceled and premiums were on the rise.

“I’ve defended the Affordable Care Act because we needed to do something,” said Madison resident Amy Beadle. “But I’m deeply disappointed in what it offers me, as a consumer. I paid less for insurance before it.”

As Beadle was looking for a new and affordable plan, the U.S. Supreme Court agreed to hear a challenge from the right that threatens the tax credits for millions — including Wisconsinites — buying insurance through the federal exchange.

The challenge, said Ron Pollack of Families USA, is “the most serious existential threat” facing the Affordable Care Act.

Report: 10.3 million gain health coverage on marketplace during 1st enrollment

A new study in the New England Journal of Medicine estimates that 10.3 million uninsured adults gained health care coverage following the first open enrollment period in the federal government’s health insurance marketplace.

The study, dealing with trends in insurance before and after the open enrollment period, finds greater gains in the states that expanded their Medicaid programs under the Affordable Care Act. Wisconsin is not one of those states.

In a news release responding to the report, Health and Human Services Secretary Sylvia M. Burwell said, “This study also reaffirms that expanding Medicaid under the Affordable Care Act is important for coverage, as well as a good deal for states.”

“To date, 26 states plus D.C. have moved forward with Medicaid expansion. We’re hopeful remaining states will come on board and we look forward to working closely with them.”

The findings show that the uninsured rate for adults ages 18-64 declined from 21 percent in September 2013 to 16.3 percent in April 2014.

Factoring in economic factors and pre-existing trends, the researchers say this represents a 5.2 percentage-point change, or 10.3 million adults gaining coverage.

The research finds that the decline in the uninsured was significant for all age, race/ethnicity, and gender groups, with the largest changes occurring among Latinos, blacks, and adults ages 18-34.

Coverage gains were concentrated among low-income adults in states expanding Medicaid and among individuals in the income range eligible for Marketplace subsidies.

The study finds a 5.1 percentage point reduction in the uninsured rate associated with Medicaid expansion, while in states that have not expanded their Medicaid programs, the change in the uninsured rate among low-income adult populations was not statistically significant.

The study also shows that within the first six months of gaining coverage, more adults — about 4.4 million — reported having a personal doctor and fewer adults — about 5.3 million — experienced difficulties paying for medical care.

The study does not include data from before 2012, which means it does not include the estimated 3 million young adults who gained health insurance coverage through their parents’ plans following passage of the Affordable Care Act.

Online…

To read the story, go to http://www.nejm.org/doi/full/10.1056/NEJMsr1406753.

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