| In an earnings call last week, Walmart announced that its workers were signing up for health insurance en masse. The news was bad for the company’s shareholders, since the added $500 million it will cost to cover them will eat into expected profits. But it also means that many more low-income families have health insurance now than did last year. The change didn’t come because of a more generous company policy. Walmart has long offered health insurance to its full-time workers for relatively low premiums — about $18 every two weeks for its lowest-paid workers. It came because many more workers decided to take advantage of the offer. It’s early yet to be sure of a strong trend, but the Walmart experience mirrors evidence from early polls and the historical experience of Massachusetts, which enacted a law similar to the Affordable Care Act in 2006. More people may be signing up for employer-based coverage than did before. When we talk about the effect of the Affordable Care Act on health insurance, we often focus on people who were shut out of the market before, either because a prior illness made insurance inaccessible to them or because a high premium put coverage out of their financial reach. What Walmart’s experience reminds us is that there were also uninsured people who simply chose not to buy coverage before there was a law requiring them to do so. Now they may be changing their minds.This increase, if it is permanent, is going to cost... |
Showing posts sorted by date for query uninsured. Sort by relevance Show all posts
Showing posts sorted by date for query uninsured. Sort by relevance Show all posts
Friday, August 22, 2014
Why More, Not Fewer, People Might Start Getting Health Insurance Through Work
Friday, May 16, 2014
Learn When an Accident in a Parking Lot Is Compensable
Learn When an Accident in a Parking Lot Is Compensable
New Jersey Institute for Continuing Legal Education
Wednesday, June 18, 2014 4pm-8pm
Law Center, 1 Constitution Square, New Brunswick, NJ 08901
t. 732-249-5100 f. 732-249-1428 www.njicle.com
- Learn about the most important recent case law decisions from a panel of Compensation Judges and leading attorneys. The lead attorneys, John R. Tort, Jr. and Lewis Stein, who tried and participated in the appeal of Hersch v. County of Morris will discuss the recent NJ Supreme Court "Off-Premises" (Coming and Going Rule) decision.
- Understand why state tort law claims for failure to warn of chemical dangers are not preempted by OSHA’s HazCom standard. Attorney Steven H. Wodka, who participated in the appeal of ATRM v OSHA & DOL, et. al,will provide insight into the 3rd Circuit Court of Appeals recent decision and what new claims may be anticipated.
- Gain an understanding of coverage issues involving Workers’ Compensation insurance policies and the operation of the Uninsured Employers Fund.
- Acquire information of the new rules and procedures for obtaining Medicare conditional payment information, and the new regulations onhow to appeal a Medicare determination involving reimbursement /debt owed the Centers for Medicare and Medicaid Services (CMS).
Saturday, December 28, 2013
N.Y. Workers’ Comp Board to Transition Established UEF Claims Management to Triad Group
The New York State Workers’ Compensation Board recently announced it will transition the management of established Uninsured Employers’ Fund (UEF) claims to the Triad Group, LLC effective Jan. 13, 2014.
Triad Group, based in Troy, N.Y., is a professional service organization providing comprehensive claims management. These claims consist of established claims where liability has been determined, and medical, and/or indemnity payments must be made. Triad will perform all claim-related functions and legal representation. Claimants who have such UEF claims, and all parties of interest, including health care providers and legal representatives, will receive individual written notice of the change in claim administrator. The Workers’ Compensation Board said the transition of claim management should have no impact on claimants receiving workers’ comp benefits. Claimants who are receiving biweekly indemnity benefits will continue receiving benefits on the same schedule currently in place. For medical and transportation reimbursement requests after Jan. 13, 2014, Form C-257, Claimant’s Record of Medical and Travel Expenses and Request for Reimbursement, must be sent to Triad for processing with a copy to the Workers’ Compensation Board. For medical services provided on or after Jan. 13, 2014, in established cases only, health care providers should send new medical reports, bills and authorization requests to Triad, and a copy to the... [Click here to see the rest of this post] |
Thursday, December 19, 2013
Growth in U.S. Health Care Spending Slows
It is a sweeping trend that should mean bigger paychecks for middle-class households and hundreds of billions of dollars in savings for the government. Yet only one in 20 Americans is aware of it. Nationally, spending on health care is growing at the slowest pace ever recorded. Annual spending on health care often grew more than 10 percent a year during the 1970s and ’80s. Growth dipped in the 1990s, only to rise again, but starting in the early 2000s, the rate began falling. It is now just about 4 percent a year. Yet in the latest New York Times/CBS News poll, just 5 percent of all Americans — and 3 percent of uninsured respondents — said that health care spending has moderated. Half of respondents said that costs have been going up at a faster rate lately. That might be in part because Americans are paying more out of pocket for their health care. For instance, deductibles — the amount a covered individual has to pay for health care before the plan kicks in to cover the remaining costs — have become more common and more expensive. The percentage of Americans enrolled in a health plan with a deductible of at least $1,000 has climbed to 38 percent in 2013 from 18 percent in 2008, according to a recent survey by the Henry J. Kaiser Family Foundation. And over the same period, the average deductible has increased to $1,097 from $735. Normally, that moderation in health spending would mean households would receive higher wages: Businesses... |
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Thursday, December 5, 2013
President Obama Statement on the Benefits of the Affordable Care Act
Thanks to Monica, thanks to everybody standing behind me, and thanks for everybody out there who cares deeply about this issue. Monica’s story is important because for all the day-to-day fights here in Washington around the Affordable Care Act, it’s stories like hers that should remind us why we took on this reform in the first place.
And for too long, few things left working families more vulnerable to the anxieties and insecurities of today’s economy than a broken health care system. So we took up the fight because we believe that, in America, nobody should have to worry about going broke just because somebody in their family or they get sick. We believe that nobody should have to choose between putting food on their kids’ table or taking them to see a doctor. We believe we’re a better country than a country where we allow, every day, 14,000 Americans to lose their health coverage; or where every year, tens of thousands of Americans died because they didn’t have health care; or where out-of-pocket costs drove millions of citizens into poverty in the wealthiest nation on Earth. We thought we were better than that, and that’s why we took this on. (Applause.)
And that’s what’s gotten lost a little bit over the last couple of months. And our focus, rightly, had to shift towards working 24/7 to fix the website, healthcare.gov, for the new marketplaces where people can buy affordable insurance plans. And today, the website is working well for the vast majority of users. More problems may pop up, as they always do when you’re launching something new. And when they do, we’ll fix those, too. But what we also know is that after just the first month, despite all the problems in the rollout, about half a million people across the country are poised to gain health care coverage through marketplaces and Medicaid beginning on January 1st -- some for the very first time. We know that -- half a million people. (Applause.) And that number is increasing every day and it is going to keep growing and growing and growing, because we know that there are 41 million people out there without health insurance. And we know there are a whole bunch of folks out there who are underinsured or don’t have a good deal. And we know the demand is there and we know that the product on these marketplaces is good and it provides choice and competition for people that allow them, in some cases for the very first time, to have the security that health insurance can provide.
The bottom line is this law is working and will work into the future. People want the financial stability of health insurance. And we’re going to keep on working to fix whatever problems come up in any startup, any launch of a project this big that has an impact on one-sixth of our economy, whatever comes up we’re going to just fix it because we know that the ultimate goal, the ultimate aim, is to make sure that people have basic security and the foundation for the good health that they need.
Now, we may never satisfy the law’s opponents. I think that’s fair to say. Some of them are rooting for this law to fail -- that’s not my opinion, by the way, they say it pretty explicitly. (Laughter.) Some have already convinced themselves that the law has failed, regardless of the evidence. But I would advise them to check with the people who are here today and the people that they represent all across the country whose lives have been changed for the better by the Affordable Care Act.
The other day I got a letter from Julia Walsh in California. Earlier this year, Julia was diagnosed with leukemia and lymphoma. “I have a lot of things to worry about,” she wrote. “But thanks to the [Affordable Care Act], there are lots of things I do not have to worry about, like…whether there will be a lifetime cap on benefits, [or] whether my treatment will bankrupt my family…I can’t begin to tell you how much that peace of mind means...” That’s what the Affordable Care Act means to Julia. She already had insurance, by the way, but because this law banned lifetime limits on the care you or your family can receive, she’s never going to have to choose between providing for her kids or getting herself well -- she can do both.
Sam Weir, a doctor in North Carolina, emailed me the other day. “The coming years will be challenging for all of us in family medicine,” he wrote. “But my colleagues and I draw strength from knowing that beginning with the new year the preventive care many of our current patients have been putting off will be covered and the patients we have not yet seen will finally be able to get the care that they have long needed.” That’s the difference that the Affordable Care Act will make for many of Dr. Weir’s patients. Because more than 100 million Americans with insurance have gained access to recommended preventive care like mammograms, or colonoscopies, or flu shots, or contraception to help them stay healthy -- at no out-of-pocket cost. (Applause.)
At the young age of 23, Justine Ula is battling cancer for the second time. And the other day, her mom, Joann, emailed me from Cleveland University Hospital where Justine is undergoing treatment. She told me she stopped by the pharmacy to pick up Justine’s medicine. If Justine were uninsured, it would have cost her $4,500. But she is insured -- because the Affordable Care Act has let her and three million other young people like Monica gain coverage by staying on their parents’ plan until they’re 26. (Applause.) And that means Justine’s mom, all she had to cover was the $25 co-pay.
Because of the Affordable Care Act, more than 7 million seniors and Americans with disabilities have saved an average of $1,200 on their prescription medicine. (Applause.) This year alone, 8.5 million families have actually gotten an average of $100 back from their insurance company -- you don’t hear that very often -- (laughter) -- because it spent too much on things like overhead, and not enough on their care. And, by the way, health care costs are rising at the slowest rate in 50 years. So we’re actually bending the cost of health care overall, which benefits everybody. (Applause.)
So that’s what this law means to millions of Americans. And my main message today is: We’re not going back. We’re not going to betray Monica, or Julia, or Sam, or Justine, or Joann. (Applause.) I mean, that seems to be the only alternative that Obamacare’s critics have is, well, let’s just go back to the status quo -- because they sure haven’t presented an alternative. If you ask many of the opponents of this law what exactly they’d do differently, their answer seems to be, well, let’s go back to the way things used to be.
Just the other day, the Republican Leader in the Senate was asked what benefits people without health care might see from this law. And he refused to answer, even though there are dozens in this room and tens of thousands in his own state who are already on track to benefit from it. He just repeated “repeal” over and over and over again. And obviously we’ve heard that from a lot of folks on that side of the aisle.
Look, I’ve always said I will work with anybody to implement and improve this law effectively. If you’ve got good ideas, bring them to me. Let’s go. But we’re not repealing it as long as I’m President and I want everybody to be clear about that. (Applause.)
We will make it work for all Americans. If you don’t like this law -- (applause) -- so, if despite all the millions of people who are benefitting from it, you still think this law is a bad idea then you’ve got to tell us specifically what you’d do differently to cut costs, cover more people, make insurance more secure. You can’t just say that the system was working with 41 million people without health insurance. You can’t just say that the system is working when you’ve got a whole bunch of folks who thought they had decent insurance and then when they got sick, it turned out it wasn’t there for them or they were left with tens of thousands of dollars in out-of-pocket costs that were impossible for them to pay.
Right now, what that law is doing -- (baby talks.) Yes, you agree with me. (Laughter.) Right now, what this law is doing is helping folks and we’re just getting started with the exchanges, just getting started with the marketplaces. So we’re not going to walk away from it. If I’ve got to fight another three years to make sure this law works, then that’s what I’ll do. That’s what we’ll do. (Applause.)
But what’s important for everybody to remember is not only that the law has already helped millions of people but that there are millions more who stand to be helped. And we’ve got to make sure they know that. And I’ve said very clearly that our poor execution in the first couple months on the website clouded the fact that there are a whole bunch of people who stand to benefit. Now that the website is working for the vast majority of people, we need to make sure that folks refocus on what’s at stake here, which is the capacity for you or your families to be able to have the security of decent health insurance at a reasonable cost through choice and competition on this marketplace and tax credits that you may be eligible for that can save you hundreds of dollars in premium costs every month, potentially.
So we just need people to -- now that we are getting the technology fixed -- we need you to go back, take a look at what’s actually going on, because it can make a difference in your lives and the lives of your families. And maybe it won’t make a difference right now if you’re feeling healthy, but I promise you, if somebody in your family -- heaven forbid -- gets sick, you’ll see the difference. And it will make all the difference for you and your families.
So I’m going to need some help in spreading the word -- I’m going to need some help in spreading the word. I need you to spread the word about the law, about its benefits, about its protections, about how folks can sign up. Tell your friends. Tell your family. Do not let the initial problems with the website discourage you because it’s working better now and it’s just going to keep on working better over time. Every day I check to make sure that it’s working better. (Laughter.) And we’ve learned not to make wild promises about how perfectly smooth it’s going to be at all time, but if you really want health insurance through the marketplaces, you’re going to be able to get on and find the information that you need for your families at healthcare.gov.
So if you’ve already got health insurance or you’ve already taken advantage of the Affordable Care Act, you’ve got to tell your friends, you’ve got to tell your family. Tell your coworkers. Tell your neighbors. Let’s help our fellow Americans get covered. Let’s give every American a fighting chance in today’s economy.
Thank you so much, everybody. God bless you. God bless America. (Applause.)
Tuesday, November 26, 2013
NJ Workers Compensation Rates 2014
Revision of Rates and Rating Values – Effective January 1, 2014
The Commissioner of Banking and Insurance (“Commissioner”) has approved a 3.6%
increase in rates and rating values applicable to New Jersey workers compensation and employers
liability insurance effective January 1, 2014 on a new and renewal basis. The rating components of the increase are summarized below.
PREMIUM AND LOSS EXPERIENCE
Analysis of data for the latest two complete policy years and the latest calendar-accident
year, following adjustment to present premium and benefit levels, using paid and incurred losses
separately, indicates a premium level adjustment factor of 0.979 (-2.1%) due to experience.
A trend factor of 1.055 (+5.5%) is included to recognize changing exposures and losses.
The Commissioner of Banking and Insurance (“Commissioner”) has approved a 3.6%
increase in rates and rating values applicable to New Jersey workers compensation and employers
liability insurance effective January 1, 2014 on a new and renewal basis. The rating components of the increase are summarized below.
PREMIUM AND LOSS EXPERIENCE
Analysis of data for the latest two complete policy years and the latest calendar-accident
year, following adjustment to present premium and benefit levels, using paid and incurred losses
separately, indicates a premium level adjustment factor of 0.979 (-2.1%) due to experience.
A trend factor of 1.055 (+5.5%) is included to recognize changing exposures and losses.
BENEFIT CHANGES
Effective January 1, 2014, the maximum weekly benefit with respect to all types of injuries,
except permanent partial disabilities, will be changed from $826 to $843. The minimum weekly benefit will be changed from $220 to $225. In cases involving permanent partial disabilities, the present maximum weekly benefits ranging from $220 to $826, varying on the basis of duration of disability, will be changed to $225 and $843, respectively. The minimum weekly benefit for permanent partial injuries will remain at $35. The effect of the changes to the minimum and maximum weekly benefits results in a premium level adjustment factor of 1.007 (+0.7%) due to benefits.
EXPENSES
There is need for decreases in the provisions for Loss Adjustment Expense, the Security
Fund and Bureau Expense. The changes to the expense provisions result in a premium level adjustment factor of 0.996 (-0.4%).
OVERALL PREMIUM/RATE LEVEL CHANGE
The combined effect of the above adjustment factors results in an indicated premium level
adjustment factor of 1.036 (+3.6%). The rate level adjustment is also an increase of +3.6%.
CATASTROPHE PROVISIONS
A Terrorism Premium Charge of $0.03 per unit of exposure applies to all policies except
for the exclusions in 3:9-2 and 3:9-5 of the Manual. Upward deviation from the $0.03 rate is
permissible.
A Catastrophe (Other than Certified Acts of Terrorism) Premium Charge of $0.01 per
unit of exposure applies to all policies except for the exclusions in 3:9-9 and 3:9-12 of the Manual.
CLASSIFICATION RATES
The adjustment of classification rate relativity is based on the policy experience for 2006
through 2010, as reported through the Statistical Plan. The changes in the rates for the individual
classifications including those in the Admiralty and Federal Employers Liability Act coverage are
supported by, and derived from, the experience.
There are 572 classifications in the Manual effective January 1, 2014 including the codes to
accommodate Federal employments. Eight classifications carry no rate assignment. Of the remainder, 381 will experience increased rates, the rates for 167 classes will decrease, and 16 are unchanged. There are no changes to the annual policy charges for private estate or residence employees as set forth in 3:5-12 of the Manual.
In order to comply with the decision of the Commissioner, changes in manual rates for any
classification have been limited to an increase of 15% from last year’s rate. The increase percentage applicable to non "F" classifications when coverage is provided under the United States Longshore and Harbor Workers Compensation Act remains unchanged at 50%.
MINIMUM PREMIUM FORMULA
The minimum premium multiplier is increased from 100 to 150 and the maximum
minimum premium is increased from $850 to $900. The change to premium resulting from the new
rating values in the minimum premium formula is minimal and does not impact the overall rate level.
Special minimum premiums applicable to private residence classifications and to classifications subject to Maritime or Federal Employers Liability Act coverage are not affected.
SURCHARGES
New Jersey law mandates application of separate policyholder surcharges to finance the
Second Injury and Uninsured Employers’ Funds. Based on the Department of Labor and Workforce
Development’s estimate of 2014 Fund requirements, the policyholder surcharge percentages effective January 1, 2014, on a new and renewal basis to be applied to the modified premium are:
Second Injury Fund 6.56%
Uninsured Employers’ Fund 0.00%
Effective January 1, 2014, the maximum weekly benefit with respect to all types of injuries,
except permanent partial disabilities, will be changed from $826 to $843. The minimum weekly benefit will be changed from $220 to $225. In cases involving permanent partial disabilities, the present maximum weekly benefits ranging from $220 to $826, varying on the basis of duration of disability, will be changed to $225 and $843, respectively. The minimum weekly benefit for permanent partial injuries will remain at $35. The effect of the changes to the minimum and maximum weekly benefits results in a premium level adjustment factor of 1.007 (+0.7%) due to benefits.
EXPENSES
There is need for decreases in the provisions for Loss Adjustment Expense, the Security
Fund and Bureau Expense. The changes to the expense provisions result in a premium level adjustment factor of 0.996 (-0.4%).
OVERALL PREMIUM/RATE LEVEL CHANGE
The combined effect of the above adjustment factors results in an indicated premium level
adjustment factor of 1.036 (+3.6%). The rate level adjustment is also an increase of +3.6%.
CATASTROPHE PROVISIONS
A Terrorism Premium Charge of $0.03 per unit of exposure applies to all policies except
for the exclusions in 3:9-2 and 3:9-5 of the Manual. Upward deviation from the $0.03 rate is
permissible.
A Catastrophe (Other than Certified Acts of Terrorism) Premium Charge of $0.01 per
unit of exposure applies to all policies except for the exclusions in 3:9-9 and 3:9-12 of the Manual.
CLASSIFICATION RATES
The adjustment of classification rate relativity is based on the policy experience for 2006
through 2010, as reported through the Statistical Plan. The changes in the rates for the individual
classifications including those in the Admiralty and Federal Employers Liability Act coverage are
supported by, and derived from, the experience.
There are 572 classifications in the Manual effective January 1, 2014 including the codes to
accommodate Federal employments. Eight classifications carry no rate assignment. Of the remainder, 381 will experience increased rates, the rates for 167 classes will decrease, and 16 are unchanged. There are no changes to the annual policy charges for private estate or residence employees as set forth in 3:5-12 of the Manual.
In order to comply with the decision of the Commissioner, changes in manual rates for any
classification have been limited to an increase of 15% from last year’s rate. The increase percentage applicable to non "F" classifications when coverage is provided under the United States Longshore and Harbor Workers Compensation Act remains unchanged at 50%.
MINIMUM PREMIUM FORMULA
The minimum premium multiplier is increased from 100 to 150 and the maximum
minimum premium is increased from $850 to $900. The change to premium resulting from the new
rating values in the minimum premium formula is minimal and does not impact the overall rate level.
Special minimum premiums applicable to private residence classifications and to classifications subject to Maritime or Federal Employers Liability Act coverage are not affected.
SURCHARGES
New Jersey law mandates application of separate policyholder surcharges to finance the
Second Injury and Uninsured Employers’ Funds. Based on the Department of Labor and Workforce
Development’s estimate of 2014 Fund requirements, the policyholder surcharge percentages effective January 1, 2014, on a new and renewal basis to be applied to the modified premium are:
Second Injury Fund 6.56%
Uninsured Employers’ Fund 0.00%
Monday, November 25, 2013
Illinois Employer to Pay $10K Penalty for Lack of Workers’ Comp Insurance
| An uninsured employer in Illinois has pled guilty to a Class 4 felony for refusing to obtain workers’ compensation insurance, the Illinois Workers’ Compensation Commission announced. John Linek, individually and as president of SMS Logistics of Chicago, has been ordered to pay a $10,000 penalty for refusing to obtain workers’ compensation insurance. The IWCC’s Insurance Compliance Unit had been requesting compliance with the Act from this trucking firm since 2010. In August 2013, the Compliance Division obtained a felony conviction against Ahmed Ghosien, d/b/a Ghosien European Auto Werks in Hometown. Ghosien pled guilty to a Class 4 felony for failing to obtain workers’ compensation insurance. The IWCC’s Insurance Compliance Unit worked with the Cook County Sheriff’s Office and the Cook County State’s Attorney’s Special Prosecutions Division to obtain the conviction. Again, the Insurance Compliance Unit had worked on the case since 2010. Both of these individuals were given many opportunities to obtain insurance before charges were filed, but they persistently refused, the IWCC said. |
Sunday, November 24, 2013
Obamacare Has a Friend in the Health Care Industry
In the LA Times today, Noam Levey writes that Obamacare has an ace in the hole: the insurance industry. Sure, they have their gripes:
But since 2010, they have invested billions of dollars to overhaul their businesses, design new insurance plans and physician practices and develop better ways to monitor quality and control costs.This is really a crucial point. Like it or not, the entire health care industry has spent the past three years gearing up for the rollout of Obamacare. At this point, they're committed—and doubly so since the Republican Party very clearly has no real alternative for them. This means that all the doom-mongering on Fox... |
Wednesday, November 20, 2013
ObamaCare's Union Favor
The Affordable Care Act's greatest hits keep coming, and one that hasn't received enough attention is a looming favor for President Obama's friends in Big Labor. Millions of Americans are losing their plans and paying more for health care, and doctors are being forced out of insurance networks, but a lucky few may soon get relief.
Earlier this month the Administration suggested that it may grant a waiver for some insurance plans from a tax that is supposed to capitalize a reinsurance fund for ObamaCare. The $25 billion cost of the fund, which is designed to pay out to the insurers on the exchanges if their costs are higher than expected, is socialized over every U.S. citizen with a private health plan. For 2014, the fee per head is $63. The unions hate this reinsurance transfer because it takes from their members in the form of higher premiums and gives to people on the exchanges. But then most consumers are hurt in the same way, and the unions have little ground for complaint given that ObamaCare would not have passed in 2010 without the fervent support of the AFL-CIO, the Teamsters and the rest. The unions ought to consider this tax a civic obligation in solidarity with the (uninsured) working folk they claim to support. Instead, they've spent most of the last year demanding that the White House give them subsidies and carve-outs unavailable to anyone else. But don't expect ObamaCare favors unless you helped to re-elect the President. In an aside in a Federal Register... |
Sunday, November 17, 2013
California sends misinformation to 246,000 new Medicaid enrollees
LOS ANGELES -- California has mistakenly sent letters to 246,000 low-income residents, warning they may need to find new doctors next year under the state's newly expanded Medicaid program.
The error frustrated counties and community health centers, which have repeatedly assured patients they can keep their providers when the Affordable Care Act takes effect in 2014. The patients are part of the state's "bridge to reform" program, which was designed to cover uninsured, poor Californians until they became eligible for Medicaid, known as Medi-Cal here. The program launched in 2011 and more than 600,000 people across the state enrolled in county-based health coverage. Many of them formed relationships with doctors and started seeking regular care. But county and clinic administrators said the incorrect mailing this month has put the counties' efforts in jeopardy. The mix-up occurred as people are scrambling to figure out how the health law impacts them, and as private policy holders have been receiving letters canceling their insurance plans. "The whole key to the success is that people seamlessly transition to Medi-Cal," said Sean South, an associate director at the California Primary Care Association. "It is vitally important that we don't confuse them." But that's what happened when the incorrect letters started going out on Nov. 1, said clinic and county officials. Patients immediately began calling and showing up with questions about the letter, said Eva Serrano, a... |
Monday, November 11, 2013
Worried About Costs And Unaware of Help, Californians Head Into New Era of Health Coverage
Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org
As uninsured Californians head into a new era of health coverage, they're worried about costs and unaware of the help they'll get from the government, a new survey finds.
The survey, by the Kaiser Family Foundation, found that three out of four Californians who earn modest incomes and could buy government-subsidized private coverage believe, wrongly, that they're not eligible for federal assistance or they simply don't know if they qualify.  "This has been, for so long, a political debate," said Anthony Wright, executive director of Health Access, a Sacramento-based consumer advocacy group. "We're just starting to move it into a practical reality. Now that the benefits are close at hand, there is a concerted effort to educate people about what their benefits are." California is one of two dozen states preparing to dramatically expand Medicaid, the federal-state insurance program for the poor, yet the survey found only half of newly eligible low-income Californians presume they will qualify. The nonpartisan Kaiser Family Foundation surveyed some 2,000 uninsured Californians from mid-July until the end of August, a summertime lull before a burst of... |
Monday, September 23, 2013
State Politics and the Fate of the Safety Net
Only 2% of acute care hospitals nationwide are safety-net facilities, but they provide 20% of uncompensated care to the uninsured. Because most are in low-income communities, they typically generate scant revenue from privately insured patients. The Medicaid Disproportionate Share Hospital (DSH) program was established to help defray their costs for uncompensated care. Currently, Medicaid DSH disburses $11.5 billion annually to the states, which have considerable latitude in allocating these funds. Some states carefully target their DSH payments to hospitals providing large volumes of uncompensated care, but others, such as Ohio and Georgia, spread their payments broadly, transforming the program into a de facto subsidy of their hospital industry. Because the Affordable Care Act (ACA) was expected to dramatically expand insurance coverage, safety-net hospitals were expected to need less DSH money. Therefore, to reduce the cost of expanding Medicaid, the ACA reduced Medicaid DSH funding by $18.1 billion between fiscal years 2014 and 2020. To allow time for coverage expansion to take effect, the cuts are back-loaded — starting at $500 million (4% of current national DSH spending) in 2014 but reaching $5.6 billion (49% of current spending) in 2019. The DSH cuts are so deep in part because Congress assumed that all... |
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Monday, September 16, 2013
State files charges against city business
The state Department of Labor & Industry on Friday filed criminal charges against a Wilkes-Barre business, alleging it failed to maintain worker's compensation insurance. Kus Tire Inc. at 10 Carey Ave. is charged with 100 felony counts of failing to procure worker's compensation insurance, court records say. A message left seeking comment at Kus Tire was not immediately returned. According to a criminal complaint, the business, headed by Bernard Kusakavitch, failed to have the insurance for 100 days - from Sept. 10, 2008, through Sept. 17, 2008, and again from Oct. 1, 2011, through Dec. 31, 2011. As a self-insured employer, the business was not exempt from possessing the coverage, the charges say. The complaint said an employee, Walter Booth Jr., was injured Sept. 12, 2008, and subsequently petitioned for benefits from the Uninsured Employers Guaranty Fund, which provides benefits to injured employees of uninsured employers. According to the complaint, Workers' Compensation Judge Joseph B. Sebastianelli awarded Booth benefits on May 31, 2011. Investigators filed a summons against the business Friday. The matter is scheduled for a preliminary hearing before Magisterial District Judge Rick Cronauer at 9 a.m. Oct. 31. jhalpin@citizensvoice.com comments powered by Disqus |
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Tuesday, August 27, 2013
No Shopping Zone: Medicare Is Not Part Of New Insurance Marketplaces
Medicare is integrated with many aspects of state workers' compensation programs. From medical fee setting to reimbursement for conditional payments under the Medicare Secondary Payer Act. Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org
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While the Obama administration is stepping up efforts encouraging uninsured Americans to enroll in health coverage from the new online insurance marketplaces, officials are planning a campaign to convince millions of seniors to please stay away – don't call and don't sign up.
"We want to reassure Medicare beneficiaries that they are already covered, their benefits are not changing and the marketplace doesn't require them to do anything," said Michele Patrick, Medicare's deputy director for communications. To reinforce the message, she said the 2014 "Medicare & You" handbook – the 100-plus-page guide that will be sent to 52 million Medicare beneficiaries next month -- contains a prominent- notice: "The Health Insurance Marketplace, a key part of the Affordable Care Act, will take effect in 2014. It's a new way for individuals, families, and employees of small businesses to get health insurance. Medicare isn't part of the Marketplace." Still, it can be easy to get the wrong impression. "You hear programs on the radio about the health care law and they never talk about seniors and what we are supposed to do," said Barbara Bonner, 72, of Reston, Va. "Do we have to go sign up like they're saying everyone else has to? Does the new law apply to us seniors at all and if so, how?" Enrollment in health plans offered on the marketplaces, also called exchanges, begins Oct. 1 and runs for six months. Meanwhile, the two-month sign-up period for private health plans for... |
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Wednesday, August 21, 2013
Pa., N.J. Insurers Gearing Up For Obamacare Business
Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org
This story was produced in partnership with
With new federal rules and mandates, you’d think that health insurers would be beating the loudest drum in the repeal-the-Affordable Care Act band.
But they’re not, and there are a couple of reasons why.
The first is pretty obvious. Millions of uninsured people will be flooding the online exchanges when they open nationwide on Oct. 1, presenting companies with a tremendous opportunity to build their roles and revenues.
But that may not be the only reason. Even insured workers may soon be allowed to pick plans over online marketplaces, upending the traditional model of employers knowing best.
In any event, “the direct-to-consumer health insurance market is growing,” says Joel Cantor, a professor of health policy at Rutgers University. “Under the Affordable Care Act, 15 to 16 million people will be in that market for health insurance in the next year or so. That is a significant increase.”
Until the ACA was passed in 2010, health insurance was pretty much a business-to-business transaction. Insurers sold plans to employers acting as proxies for their employees. Once the ACA became law, insurers started refocusing their marketing strategies on consumers.
Many insurers in Pennsylvania and New Jersey are preparing to launch marketing efforts to educate consumers. Most of New Jersey’s large insurers, including Aetna, Horizon Blue Cross and Blue Shield, and AmeriHealth, will be in the state’s...
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Monday, August 12, 2013
The 10 Top Workers Compensation Blog Posts This Month (July-Aug 2013)
The 10 Top Workers Compensation Blog Posts This Month
(July-Aug 2013)
In order of popularity
Jul 25, 2013,
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Jul 20, 2013,
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Jul 18, 2013,
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Aug 2, 2013,
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Jul 17, 2013,
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Jul 14, 2013,
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Aug 5, 2013,
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Jul 26, 2013,
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Jul 12, 2013,
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Jul 28, 2013,
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