Insurers and hospitals complain to Kreidler about new rules

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MKreidlerPhotoBy Carol Ostrom, Seattle Times
APR 23, 2014

This story was produced in partnership with 

Health insurers and hospitals, usually on opposite sides, lined up together Tuesday to give Insurance Commissioner Mike Kreidler an earful about his proposed new rule for insurance-provider networks.

Kreidler proposed the rule after complaints that consumers have been taken by surprise about narrower networks in insurance plans offered in the Affordable Care Act.

Those networks exclude some of the region’s prominent hospitals and medical centers, meaning some consumers don’t have access to providers they expected to use. Continue reading

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Most states to sick with Healthcare.gov for 2015 sign ups

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By Phil Galewitz
KHN

Only two of the 36 states that relied on the federal insurance exchange this year — Idaho and New Mexico — plan to set up their own online marketplaces in time for the next open enrollment beginning Nov. 15.

Both those states had moved to run their own exchanges last year but couldn’t get them working in time for the 2014 enrollment season so they used the federal exchange instead.

No other states have announced similar plans and analysts say none is likely to be able to develop a detailed plan before the deadline in a little more than five weeks.

Election-year politics, tight deadlines and problems with health insurance exchanges in Oregon, Maryland and Hawaii dampened the interest of lawmakers in other states to form their own exchanges, despite the millions in federal funding that would be available under the Affordable Care Act.

The success of the federal exchange website, www.healthcare.gov, in enrolling millions of people after a notoriously rocky rollout also limited demand for state-run marketplaces, experts said. Continue reading

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Health news headlines — April 24th

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Enrollment in Washington exchange tops one million

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Coverage is hereMore than 1 million Washington state residents enrolled in health insurance plans during the open enrollment period that began October 1 and ran through March 31st, Washington state officials said Wednesday.

The staff at the exchange, wahealthplanfinder.org, worked with thousands of customers over the past few weeks to help individuals finalize their applications after the March 31 deadline, many of whom were unable to complete their applications due to technical reasons or experienced other barriers to enrollment, officials said.

The Exchange continues to work with a small percentage of customers to finalize any remaining applications, officials said.

Here is a breakout of the enrollment numbers: Continue reading

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Is bigger better? Idaho hospital battle a microcosm of debate over industry consolidation

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This KHN story was produced in collaboration with wapo

NAMPA, Idaho - When Idaho’s largest hospital system bought the state’s largest doctor practice in 2012, the groups expressed hope that the deal would spark a revolution in delivering better-quality care.

Instead, it ignited a costly legal battle with state and federal regulators and rival hospital systems.

Officials at Boise-based St. Luke’s Health System thought they had the Obama administration on their side because the federal health law encourages hospitals to collaborate with doctors to improve quality and lower costs.

David Pate is president and CEO of St. Luke’s Health System. St. Luke’s is one of dozens of hospitals nationwide to form Medicare accountable care organizations, agreeing to coordinate care with the prospect of qualifying for government bonuses if they hit cost and quality targets (Photo by Phil Galewitz/KHN)

David Pate is president and CEO of St. Luke’s Health System. St. Luke’s is one of dozens of hospitals nationwide to form Medicare accountable care organizations, agreeing to coordinate care with the prospect of qualifying for government bonuses if they hit cost and quality targets (Photo by Phil Galewitz/KHN)

But the Federal Trade Commission filed suit, arguing that St. Luke’s purchase of the 43-physician Saltzer Medical Group in Nampa was anticompetitive and would lead to higher prices for Idaho patients.

A federal judge agreed in January, and his order to dissolve the merger has put this picturesque Boise suburb at the center of a national debate over the consolidation of American medicine.

The decision pushed back against the merger mania gripping the health care industry, raising questions about whether larger health systems really do rein in spending and improve care, or whether they fuel higher prices in the long run.  Continue reading

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Swedish and Country Doctor team up

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 This story was produced in partnership with 

At Swedish Medical Center’s Cherry Hill hospital, the “EMERGENCY” sign glows bright in the dusk above the emergency-room entrance. Some 18,000 people sought help here last year.

Right next to the sign, there’s another one on the building: “After-Hours Clinic.” Operated by Country Doctor Community Health Centers, this clinic — like Swedish’s ER — is open evenings and weekends.

This isn’t competition, but a partnership few would have predicted before the Affordable Care Act, also known as Obamacare. Swedish, a huge, specialty-oriented medical center, has plunked down startup money and a cheap lease to help tiny Country Doctor, whose two clinics were started by idealistic community activists in the late 1960s and early ’70s. Continue reading

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Health news headlines — April 23rd

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New study again finds higher rate of rare neurological birth defects in central Washington

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Washington MapA new study has again found a higher rate of a rare neurological birth defect, anencephaly, in Yakima, Benton and Franklin counties, Washington state health officials said Tuesday.

The study identified seven cases of the birth defect in these three counties in 2013, which translates into a rate of 8.7 per 10,000 births. That rate is similar to the rate seen in 2010-2012 and remains well above the national rate of 2.1 per 10,000 births, health officials said. Continue reading

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How one state is tackling its doctor shortage

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This story was produced in partnership with the 

Michigan’s medical schools, doctors offices and health care networks are tackling a shortage of primary care doctors that is expected to worsen under the Affordable Care Act.

The state and nation have reported a shortage of primary care physicians for a decade, and the millions of newly insured patients are expected to add more pressure.

In addition, health care reform is encouraging consumers to seek primary care more regularly to stay healthy and to keep on top of chronic conditions that can drive up costs. Continue reading

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Qs: Who is responsible for an adult child’s coverage? Must insurers notify smokers of ways to lower premiums?

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Question markBy Michelle Andrews

Q. Do we have to carry our 24-year-old daughter on our health insurance policy? She is employed and has two degrees. We informed her that we would be dropping her at the end of the year because it’s costing us a fortune, and she told us today that we are required by law to cover her. We do not claim her on our taxes. Continue reading

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Health news headlines — April 22nd

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Republicans say no to CDC gun violence research

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Giving the Centers for Disease Control and Prevention money for gun violence research is a “request to fund propaganda,” a Georgia congressman says.

GunBy Lois Beckett
ProPublica, April 21, 2014

After the Sandy Hook school shooting, Rep. Jack Kingston (R-GA) was one of a few congressional Republicans who expressed a willingness to reconsider the need for gun control laws.

“Putgunson thetable, also put video games on thetable, put mental health on the table,” he said less than a week after the Newtown shootings.

He told a local TV station that he wanted to see more research done to understand mass shootings. “Let’s let the data lead rather than our political opinions.”

For nearly 20 years, Congress has pushed the Centers for Disease Control and Prevention (CDC) to steer clear of firearms violence research. Continue reading

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15-minute visits take toll on the doctor-patient relationship

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Patients are more likely to leave frustrated and without the tools they need to take charge of their own health after rushed visits.

Clock by Jay SimmonsBy Roni Caryn Rabin

This KHN story was produced in collaboration with 

Joan Eisenstodt didn’t have a stopwatch when she went to see an ear-nose-and-throat specialist recently, but she is certain the physician was not in the exam room with her for more than three or four minutes.

“He looked up my nose, said it was inflamed, told me to see the nurse for a prescription and was gone,” said the 66-year-old Washington, D.C., consultant, who was suffering from an acute sinus infection.

When she started protesting the doctor’s choice of medication, “He just cut me off totally,” she said. “I’ve never been in and out from a visit faster.” Continue reading

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Health news headlines — April 21st

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Health news headlines — April 20th

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