Affordable Care Act

Alan Cleaver / flickr

The Department of Insurance has issued an emergency rule for licensing people who will help Missouri residents explore their insurance options in the new health marketplace. The federal government is regulating these helpers, also called navigators. A bill signed by Gov. Jay Nixon earlier this month added state regulations for the navigators.

jfcherry / Flickr

The Missouri Department of Insurance has filed an emergency rule for the licensing of people that will help state residents search for health plans on an online marketplace. Legislation signed this year by Gov. Jay Nixon creates state requirements for the helpers, who are called navigators.

People applying for a state license will need to pass an examination. The cost for applying will be $25 for individuals and $50 for an entity. Licenses will be valid for two years. Requirements for a navigator license will include being age 18 or older, living in Missouri or keeping a business in the state. Those wanting to be navigators also should not have committed any acts that would grounds to refuse an insurance producer license.

Alan Cleaver / flickr

For about two decades, Wendell Potter spun carefully crafted public relations messages for Humana and Cigna, the insurance companies where he worked. He recalls convincing consumers that high-deductible insurance plans would be good for everyone; telling them that by paying more, they’d have more skin in the game of their own health.

“I frankly just got so disillusioned and, ultimately, disgusted with what I was doing,” Potter said.

He said through his own research, he knew high-deductible plans were not the best insurance coverage for those with middle-class income.

“The median household income in this country is just barely $50,000,” Potter said. “A family that’s earning $50,000, if they’re in a plan with a high deductible, they face bankruptcy or foreclosure [if something happens]. I’ve talked to a lot of people who have lost their homes and have to declare bankruptcy because they have been in these kinds of plans. They think they have adequate coverage and they don’t.”

In 2008, Potter left the insurance industry and became a consumer advocate. He testified in Congress against high-deductible plans. In 2010, he published a book detailing the ways public-relations practices of the insurance industry affect American health care. 

Now, Potter writes columns and travels around the country to debunk what he calls are “myths” about the Affordable Care Act. The law imposes stricter rules on insurance companies. They can no longer refuse coverage for consumers who have a pre-existing condition, for example. Companies also have to spend at least 80 percent of every dollar of a consumer's premium for patient care and quality improvements, not profits or administrative costs. 

On a recent visit to Columbia, Potter sat down with KBIA's Harum Helmy to chat about health care reform and the insurance industry's response to it. 


roy blunt
TalkMediaNews / Flickr

Missouri’s Roy Blunt was among the Republican Senators signing a letter Wednesday asking President Barack Obama to permanently delay the implementation of the Affordable Care Act.

pinprick / FLICKR

 Update: Gov. Jay Nixon signed SB 262 into law on Friday, July 12. 

A bill that was pushed by the state's insurance agents association could create a barrier in getting Missourians enrolled in time for the new online health insurance marketplace  one of the key parts of the health care reform law.

Will Missouri ever play nice with Obamacare?

Jul 10, 2013
seriouslysilly / Flickr

  This week guest host Harum Helmy explains all the ways Missouri is mucking up the implementation of "Obamacare."


File photo / KBIA

Missouri is facing a shortage of primary care doctors, and the strain could grow as more people soon gain health insurance under the federal health care law.

The state had just under 74 active patient care primary care doctors per 100,000 residents, according to 2010 figures from the Association of American Medical Colleges. That ranked Missouri 35th in the nation and put it behind the national per capita average of more than 79 active primary care doctors per 100,000 residents.

Teddy Nykiel / KBIA

A former health insurance company executive says he left the comforts of a padded career of corporate jets and high rise offices to speak out against unfair insurance practices.

KBIA file photo

Thirty-five MU Health Care employees will see their hours reduced in the coming year. At Boone Hospital Center, seven employees’ hours will be cut, while 13 full- and part-time employees will lose their jobs.

In Boone Hospital’s case, the layoffs came in a system-wide package. The hospital’s parent company, St. Louis-based BJC Healthcare, recently announced it is cutting 160 jobs from its hospitals. This is the first time BJC has ever made system-wide layoffs. June Fowler, vice president for corporate and public communications at the company, said several factors led to the layoffs.

“BJC is experiencing reductions in our reimbursement for the healthcare services that we provide,” Fowler said.  “We’ve also seen a decrease in inpatient hospitalizations.”

Teddy Nykiel / KBIA News

 

Although the Missouri legislative session has ended, the discussion on what to do with the state’s Medicaid program continues.

The Affordable Care Act asks states to expand their Medicaid eligibility to cover those who earn up to 138 percent of the federal poverty level. That’s about $30,000 for a family of four. Missouri’s Republican-majority legislature has refused to expand Medicaid, calling it a broken system. Now, both the state House and Senate have established interim committees to study ways to reform Medicaid.

Teddy Nykiel / KBIA News

  Missouri state lawmakers launched an interim committee Thursday to examine the issue of Medicaid reform. Governor Jay Nixon pushed heavily for the legislature to expand Medicaid this session, and accept hundreds of millions of federal dollars to do so. But Republican legislators were worried about the long-term costs of the move, and no measure was passed. Missouri House Speaker Tim Jones, a Republican member who started the committee, says accepting the federal money wouldn’t fix the problems that are inherent to the Medicaid system.

This week on KBIA’s talk show Intersection, host Ryan Famuliner sat down with State Sen. Kurt Schaefer (R-Columbia), Rep. Caleb Rowden (R-Columbia) and Rep. Chris Kelly (D-Columbia) to discuss the legislative session that ended on Friday. One of the main things on the show’s agenda was, of course, Medicaid expansion – or lack thereof.

Famuliner asked the panelists why the expansion failed to pass. 

Health care reform put on hold as lawmakers wrap up session

May 16, 2013
Jennifer Davidson / KSMU

Rain is drizzling on the roughly 40 people standing in line outside the Good Samaritan Care Clinic in rural Mountain View, Missouri. Some have been standing for hours. At 5:30 pm, the clinic doors swing open, and the patients flood into a clean, bare bones waiting room.

Kellie Kotraba / KBIA News

  

With the Missouri legislative session ending on Friday and a Republican supermajority that still won't budge, the hope to expand Medicaid in Missouri is pretty much dead for FY 2014.

It's so dead that perhaps the only thing that could bring it back to life is, well, interfaith prayers for a miracle.

Health money
Tax Credits / Flickr

Health and Human Services Secretary Kathleen Sebelius today announced another round of funding to help Americans enroll in the Affordable Care Act's new online health insurance marketplace.

About $150 million is now available for community health centers nationwide to hire and train employees who would provide in-person help for the public about their insurance options in the marketplace, which is set to open for enrollment on Oct. 1. 

jfcherry / Flickr

Many Missourians will likely need help navigating the Affordable Care Act's new health insurance marketplace that's set to go online by Oct. 1, but one analyst says there might not be enough time or federal funding to train those who can help.

KOMU News / Flickr

The Affordable Care Act requires employers to provide health insurance to everyone working more than 30 hours a week starting in 2014. This new regulation presents an issue in the academic world, as many adjunct faculty members across the country are having their working hours cut.

Leader Nancy Pelosi / Flickr

Every Friday, KBIA's Health & Wealth Desk talks about the week's most interesting articles and reports on rural health, wealth and society issues. 

'Redneck reality' and rural portrayal in cable television

Entertainment newspaper The A.V. Club muses on A&E's popular reality show Duck Dynasty, saying the show is the 21st century incarnation of old rural-themed sitcoms that once dominated network television. Think Petticoat JunctionThe Beverly Hillbillies, and Hee-Haw. It's an interesting read, but we were especially interested with the author's take on ways the television shows have to negotiate the rural-urban political disparities. 

While the rural-themed programming of days gone by tended to depict the small Southern town as a bucolic haven for good-hearted folk, redneck reality is more apt to acknowledge the social and economic ills of the subcultures it depicts. These shows are sanitized for the protection of viewers with blue-state sensibilities; when they occur at all, political discussions tend to center on generalized platitudes about freedom and family, rather than specifics that might turn off half the potential audience.

 

H/T: The Rural Blog

Did headlines about death rates at rural hospitals tell the wrong story?
The Daily Yonder is killing it with their opinion pieces this week. 

Case in point: A new report made headlines last week, saying death rates are rising at rural, geographically isolated hospitals. But an opinion writer for the Yonder says news reports are not telling the real story of these so-called critical access hospitals:

The patients in the small rural hospital with heart attack, heart failure or pneumonia have become a select population. A large proportion has decided that they are through paying all the human costs of the miracles of modern medicine. They have made the decision to stay in familiar surroundings near home and family. 

The researchers found that 13.3% of the patients at critical access hospitals with one of the three conditions died, compared to 11.4 % of the medical center patients. Given all the terrible tools that modern medical centers have to work with, I’m amazed they only manage a small difference in patient survival over the most basic, little country hospitals in America. 

nomadsoul1 / dreamstime

In his proposed budget, President Barack Obama wants to delay cuts to federal payments to hospitals, keeping the payments intact for an extra year. That could affect the debate over expanding Medicaid in Missouri.

Through what’s called the disproportionate share hospital payments or DSH payments, the federal government gives money to hospitals that provide a lot of free care to patients who are uninsured and can’t afford services. The Affordable Care Act, though, includes significant cuts to DSH payments.

Images of Money / Flickr

The uphill congressional battle to expand Medicaid in Missouri is making rural hospitals that serve areas with high poverty levels really, really nervous. KSMU's Jennifer Davidson has the story.

Nixon open to GOP-backed Medicaid plan, but with changes

Apr 3, 2013
File photo / KBIA

Governor Jay Nixon says he could support the House Republicans’ alternate Medicaid proposal, but only if some crucial changes are made.  He met with the GOP caucus today to discuss his Medicaid expansion proposal and their plans to reform the system.  Nixon told reporters that any proposal still needs to expand Medicaid to 138 percent of the federal poverty level.

Missouri Capitol
File Photo / KBIA

Missouri’s Republican-led House on Tuesday struck down Democrats’ attempts to include Medicaid expansion in the state’s budget.

If that scenario sounds familiar to you, it’s because these rejections have happened a few times before. On Feb. 25, two House committees rejected Rep. Jake Hummel’s (D-St. Louis) bill to expand Medicaid under the terms of the Affordable Care Act. On March 14, the Senate Appropriations committee voted down the Senate Democrats’ version of the expansion bill.

Rep. Jay Barnes (R-Jefferson City) was in one of the committees that struck down Rep. Hummel's Medicaid expansion proposal. Barnes has since introduced his own version of the expansion -- outlined in House Bill 700

Libby Burns / KBIA

This is the second in a two-part discussion about health literacy and the healthcare reform.  

Not knowing what the online health insurance marketplace looks like might be problematic for Missourians. 

As part of the Affordable Care Act, Missouri’s uninsured can choose to buy insurance from the state’s health exchange come October. The exchange is an online marketplace where anyone who isn’t already insured will be able to compare and purchase private insurance plans. Some uninsured Missourians would be eligible for help with the cost, too.  

Missouri has missed the deadline to create its own marketplace or start a state-federal partnership. So, the federal government is setting it up. The problem is, even though the marketplace is supposed to be open for enrollment in about six months, no one knows what it looks like yet.

“We’re losing time that could be useful in helping people understand and prepare [for the exchange],” said Catina O’Leary, the director of Health Literacy Missouri, a nonprofit group that’s working to make health care topics more understandable for Missourians. “It would be really great if we could manage people’s expectations and start training on what they’re going to need to know.”

But here's what we know so far: 

Harum Helmy / KBIA News

On this week's Health and Wealth Update, the first part of a discussion about health literacy and the healthcare reform. 

Harum Helmy / KBIA News

The St. Louis-based nonprofit, nonpartisan group Missouri Foundation for Health held a community forum in Columbia at the ARC Monday night about the state’s Medicaid expansion debate. The foundation’s director for health policy Ryan Barker presented the pros and cons of the expansion to an audience of about 45 people, before opening up the floor to questions.

Amy Mayer / Harvest Public Media

This week, we'll examine the Affordable Care Act's impact on farmers, and hear how one enzyme manufacturer was able to grow its business.

Amy Mayer / Harvest Public Media

Marilyn Andersen raises angora goats and llamas for wool that she spins and weaves in her studio at Two Cedars Weaving in Story City, Iowa. She also has a part-time job coordinating distribution of local produce through a service called Farm to Folk. Neither effort comes with health insurance.

401kcalculator.org

Barring a congressional miracle,  Medicare payments to health care providers throughout the country will see a 2 percent reduction come Friday. That amount might not sound like much, but rural hospitals and their surrounding communities are the ones that would feel most of the pinch.

Marshall Griffin / St Louis Public Radio

Medicaid expansion is dead for now in the Missouri House.  Two separate House committees voted down efforts Monday to expand Medicaid to 259,000 Missourians next year and 41,000 more in later years.

Watch the show and join the conversation on the Intersection website.

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