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Level Funded Health Offers Affordable Care Act Alternative to U.S. Small Business Owners

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CHICAGO, Nov. 12, 2014 /PRNewswire/ -- Is Level Funded Health the new escape hatch from Obama Care for small businesses with healthy employees? It could be. Level Funded Health may just be the answer to many small businesses' concerns over rising health insurance premiums because it... Reported by PR Newswire 39 minutes ago.

Health insurance part of "vicious circle" stifling small business growth

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Dan Frament worked at Walgreens for seven years before starting a small business with his wife, Melissa, in 2012. After they opened Muddaddy Flats, a quesadilla shop in downtown Troy, New York, Dan Frament had a checklist -- from buying kitchen equipment on Craigslist to hiring three workers. Shopping for health insurance wasn't even an option. "I can't afford health insurance for myself and my family, much less get insurance for my employees," he said. "There is just no way to make that work." Still,… Reported by bizjournals 4 hours ago.

Four Americans: How Obamacare Affected Them

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Four Americans: How Obamacare Affected Them Filed under: Health Care, Family Money, Personal Finance, Health Insurance, Financial Education

*Seth Perlman/AP*Lloyd and Shawn Turner signed up for health insurnace under the Affordable Care Act last Decmeber. The timing of the new law couldn't have been better for Shawn, who was diagnosed with cancer after few weeks after her coverage started.

By CARLA K. JOHNSON

CHICAGO -- More than 7 million people have signed up for private health insurance under the system introduced last year for those who were uninsured or had policies considered substandard.

What happened to them since has varied greatly.

Many have been happy with their new insurance, according to polls. Others are encountering a variety of snags -- high premiums, telephone runarounds or difficulty getting care. Together their experiences provide a glimpse of how the largest social program launched since Medicare has worked out for the people involved.

With lessons learned, the program enters its second year with enrollment beginning Saturday.

*Nick of Time*

Shawn Turner didn't realize it when the health insurance program debuted last year, but she would become a dramatic example of its purpose.

A 54-year-old medical transcriptionist in the tiny Illinois village of Cisco, Turner had gotten health benefits through her job for 15 years. "The main reason I worked was to get the health insurance," she says.

Then, last year, she lost coverage when her employer outsourced her work to an Internet-based transcription service. Her husband, Lloyd, who owns an auto body shop, had been on her policy so he lost his insurance, too.

In December, the Turners signed up for a "silver," or medium grade, plan on the new government website listing policies available. They would pay $236 a month and the government would pay the insurance company $830 a month, a subsidy based on their estimated $22,000 income. Their deductible was $750.

A few weeks after her coverage started, she was suddenly doubled over with abdominal pain that sent her to the emergency room. It was uterine cancer.

"I was in shock, just kind of numb," she says.

From late January through July she endured two surgeries and chemotherapy. Blue Cross Blue Shield covered more than $265,000 in medical bills, a sum that otherwise "could have wiped us out I would imagine," she says.

Today, Shawn Turner says, her doctors believe she's cancer free. Her once-lustrous brown hair is beginning to grow back after chemotherapy. She's preparing to look for a part-time job as her strength returns. The Turners were able to keep their small house on the edge of town surrounded by corn and soybean fields.

"We got to keep our livelihood and we didn't become a detriment to society and our hospitals got paid," says Lloyd Turner.

*More for More*

For 10 years, Steve Duchesne, 49, carefully purchased health insurance that covered what he believed his family of five needed -- catastrophic illness and injury -- and that omitted what it didn't, such as full vision care services and treatment for drug abuse.

Now, under the new system, he has more insurance than he's ever had, but at a higher cost, and he's not happy about it.
*Nick Ut/AP*Steve Duchesne isn't happy with the cost of his new health insurance plan under the Affordable Care Act.

The public relations consultant's old plan was canceled because it didn't include all the minimum services required under the new law. His monthly health insurance costs have risen to $1,033 a month for the new policy from $645 a month.

"We're a middle-class family with what I consider a middle-class income for our area," says Duchesne, who lives in Redondo Beach, California. No subsidies were available for a family of five with a household income of more than $110,000.

Duchesne says he's had to drop his adult dental coverage, reduce his contribution to his individual retirement account and cut other household expenses to make up the cost difference.

"The idea the government would destroy my health insurance policy -- one that I was satisfied with, which met our needs and was affordable -- and force us to buy a new product that's 60 percent more expensive, is shocking to me," Duchesne says.

*A Search for a Specialist*

Vince and Patty Mastracco, an enterprising Northern California couple, have always preferred to take care of themselves. He's a self-described "house rat," a real estate agent who loves to show houses and meet new people. She's a food stylist and recipe consultant with a bright collection of camera-friendly blouses ready for her TV cooking appearances.

They purchased their own health policies before the Affordable Care Act and never had difficulty getting care. Last year, they chose a similarly priced "bronze" policy on California's version of the health marketplace.

"I did not expect to be 100 percent happy with the changes, but at the same time I did not expect we would receive less bang for our buck," says Vince, 63.

A mysterious lump on Patty Mastracco's knee led to a maddening search for a bone specialist who would accept their insurance. Four different orthopedists rejected her without much explanation. An MRI showed the lump was probably nothing, but she still wanted a specialist to take a look.
I believe that this is a case where, by design, [our plan] is now being made to resemble an HMO. An inferior HMO.

"To date we still have not identified a doctor that accepts our insurance and will accept her as a patient," says Vince. It's a common pattern with the most economical policies: the insurance companies are paying doctors lower rates so fewer are joining their networks. A recent small national survey conducted by the Urban Institute found that 14 percent of newly insured adults with marketplace plans say they've had trouble finding a doctor.

"I believe that this is a case where, by design, [our plan] is now being made to resemble an HMO," he says, referring to the health maintenance organizations that inspired a patient backlash in the 1990s for limiting care. "An inferior HMO."

The couple will be shopping for a new policy this year, hoping for a better network.

*Perseverance Required*

Pat Barone has the willpower to lose 90 pounds and keep it off. She turned that perseverance into a weight-loss coaching business that has led to speaking engagements and clients on four continents.

But her resolve has been tested by the new health insurance system.

After losing her insurance following a divorce in 2013, Barone, 59, of Madison, Wisconsin, signed up for a new health plan last year that costs her just $50 a month and also covers her 21-year-old son.

But the technical snafus have been endless. In July she began getting requests from the plan's government administrator to send paperwork verifying her citizenship and income or her coverage would be terminated. She got the documents, but the system's website, HealthCare.gov, wouldn't upload them.

"When I finally got someone on the phone, they instructed me to mail the documents in. I did that, but I am being barraged by monthly email, snail mail and phone calls to get my documents filed, or I will lose coverage," Barone says.

The letters, she says, "are kind of demanding and threatening." For now she's decided to take the assurances from operators at the HealthCare.gov telephone help line that she can ignore the warnings. She hopes they're right.

Despite the problems, she says, she's delighted with the coverage. "It's a godsend to those of us who don't have other alternatives," Barone says. "I have used it for preventive care with no problems."
 

Permalink | Email this | Linking Blogs | Comments Reported by DailyFinance 4 hours ago.

Council meeting again Friday at noon; Insurance rate rise in cross hairs

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A special Harrison City Council meeting last Monday night was supposed to see aldermen make a decision on health insurance coverage, but more information received just hours before the meeting instead Reported by Harrison Daily 4 hours ago.

Committee recommends status quo; Boone to pay 80 percent on health insurance

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The Boone County Budget and Finance Committee has recommended that the county continue to pick up 80 percent of health insurance costs for its employees. Reported by Harrison Daily 4 hours ago.

Texas Women’s Foundation, Dallas Women’s Foundation Research Arm, Releases Austin Metro Area Edition of its “Economic Issues for Women in Texas” Report

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Metro Report Examines Economic Security of Women in Bastrop, Caldwell, Hays, Travis and Williamson Counties

Austin, Texas (PRWEB) November 13, 2014

Texas Women’s Foundation, the research and advocacy arm of Dallas Women’s Foundation, today released “Economic Issues for Women in Texas: Austin Metro Area,” serving as a complement to the statewide report released in May. The study examines the economic status of women as well as the critical building blocks necessary for women to achieve economic security. The Austin metro area report examines data from Bastrop, Caldwell, Hays, Travis and Williamson counties. The full report breaks down the differences and commonalities for nine metro areas: Amarillo, Austin, Dallas, El Paso, Fort Worth, Houston, McAllen, San Antonio and Tyler.

“Female-headed households make up 30 percent of all households in the Austin metro areas, but 53 percent of all households in poverty,” explains Roslyn Dawson Thompson, president and CEO of Dallas Women’s Foundation and Texas Women’s Foundation. “We know that when you invest in a woman, there is a powerful ripple effect that benefits her family and community. Simply put, increasing women’s economic security makes financially secure families and communities – and that makes for a stronger Texas economy.”

Women’s earnings are increasingly critical for families’ economic security in Texas. The percentage of families with breadwinning or co-breadwinning mothers has increased in the past 40 years from 34 to 58 percent of all Texas families with children. For many families, when women’s earnings don’t cover basic expenses, they must make tough choices about what kind of care their child will receive, the food they put on the table, and the safety of the home and neighborhood they live.

Depending on whether the employer or household is responsible for the health insurance premium, 64 to 67 percent of jobs in the Austin metro area do not pay enough for a one-parent, one-child family to make ends meet and save a little for a college education and retirement. Even for families with two full-time working adults and two children, who have the benefit of employer-sponsored health premiums, 58 percent of jobs in the Austin metro area still do not pay enough for families to make ends meet and save for college and retirement.

“Our goal is that the study and its metro reports will create a common understanding of the issues Texas women face, help us gain a common language about the challenges and opportunities ahead, and lead all of us – community leaders, elected and appointed officials, nonprofit organizations, donors and partners – to find common solutions to improve economic security for Texas women,” explained Dawson Thompson.

To see the full report and the Austin metro report visit: http://www.texaswomensfdn.org

About Dallas Women’s Foundation
Dallas Women’s Foundation is the largest regional women’s fund in the world. It is a trusted leader in advancing positive social and economic change for women and girls. The Foundation was built on the belief that when you invest in a woman, there is a ripple effect that benefits her family, her community and her world. Dallas Women’s Foundation has researched, funded and demonstrated the ripple effect since 1985 in North Texas, granting more than $21 million since inception and over $3.1 million annually to help create opportunities and solve issues for women and girls. With the support of its donors, the Foundation unlocks resources to improve education and quality of life, give voice to issues affecting women and girls, and cultivate women leaders for the future. For more information, visit http://www.DallasWomensFdn.org, Facebook, Twitter, Instagram, LinkedIn, or Google+.

# # # Reported by PRWeb 3 hours ago.

hCentive Executives Speaking at America's Health Insurance Plans (AHIP) Ops/Tech Conference and Exchange Conference

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RESTON, Va., Nov. 13, 2014 /PRNewswire/ -- hCentive, the leader in healthcare exchange technology, announced that two representatives will be speaking at AHIP Ops/Tech 2014 and the Exchange Conference next week in Phoenix, Arizona. Warren Smith, Associate Vice President of... Reported by PR Newswire 3 hours ago.

Here's How Obamacare Has Affected Americans Like You

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CHICAGO (AP) — More than 7 million people have signed up for private health insurance under the system introduced last year for those who were uninsured or had policies considered substandard.

What happened to them since has varied greatly. Many have been happy with their new insurance, according to polls. Others are encountering a variety of snags — high premiums, telephone runarounds or difficulty getting care. Together their experiences provide a glimpse of how the largest social program launched since Medicare has worked out for the people involved.

With lessons learned, the program enters its second year with enrollment beginning Saturday.

___

NICK OF TIME

Shawn Turner didn't realize it when the health insurance program debuted last year, but she would become a dramatic example of its purpose.

A 54-year-old medical transcriptionist in the tiny Illinois village of Cisco, Turner had gotten health benefits through her job for 15 years. "The main reason I worked was to get the health insurance," she says.

Then, last year, she lost coverage when her employer outsourced her work to an Internet-based transcription service. Her husband, Lloyd, who owns an auto body shop, had been on her policy so he lost his insurance, too.

In December, the Turners signed up for a "silver," or medium grade, plan on the new government website listing policies available. They would pay $236 a month and the government would pay the insurance company $830 a month, a subsidy based on their estimated $22,000 income. Their deductible was $750.

A few weeks after her coverage started, she was suddenly doubled over with abdominal pain that sent her to the emergency room. It was uterine cancer.

"I was in shock, just kind of numb," she says.

From late January through July she endured two surgeries and chemotherapy. Blue Cross Blue Shield covered more than $265,000 in medical bills, a sum that otherwise "could have wiped us out I would imagine," she says.

Today, Shawn Turner says, her doctors believe she's cancer free. Her once-lustrous brown hair is beginning to grow back after chemotherapy. She's preparing to look for a part-time job as her strength returns. The Turners were able to keep their small house on the edge of town surrounded by corn and soybean fields.

"We got to keep our livelihood and we didn't become a detriment to society and our hospitals got paid," says Lloyd Turner.

___

MORE FOR MORE

For 10 years, Steve Duchesne, 49, carefully purchased health insurance that covered what he believed his family of five needed — catastrophic illness and injury — and that omitted what it didn't, such as full vision care services and treatment for drug abuse.

Now, under the new system, he has more insurance than he's ever had, but at a higher cost, and he's not happy about it.

The public relations consultant's old plan was canceled because it didn't include all the minimum services required under the new law. His monthly health insurance costs have risen from $645 a month to $1,033 a month for the new policy.

"We're a middle-class family with what I consider a middle-class income for our area," says Duchesne, who lives in Redondo Beach, California. No subsidies were available for a family of five with a household income of more than $110,000.

Duchesne says he's had to drop his adult dental coverage, reduce his contribution to his individual retirement account and cut other household expenses to make up the cost difference.

"The idea the government would destroy my health insurance policy — one that I was satisfied with, which met our needs and was affordable — and force us to buy a new product that's 60 percent more expensive, is shocking to me," Duchesne says.

___

A SEARCH FOR A SPECIALIST

Vince and Patty Mastracco, an enterprising Northern California couple, have always preferred to take care of themselves. He's a self-described "house rat," a real estate agent who loves to show houses and meet new people. She's a food stylist and recipe consultant with a bright collection of camera-friendly blouses ready for her TV cooking appearances.

They purchased their own health policies before the Affordable Care Act and never had difficulty getting care. Last year, they chose a similarly priced "bronze" policy on California's version of the health marketplace.

"I did not expect to be 100 percent happy with the changes, but at the same time I did not expect we would receive less bang for our buck," says Vince, 63.

A mysterious lump on Patty Mastracco's knee led to a maddening search for a bone specialist who would accept their insurance. Four different orthopedists rejected her without much explanation. An MRI showed the lump was probably nothing, but she still wanted a specialist to take a look.

"To date we still have not identified a doctor that accepts our insurance and will accept her as a patient," says Vince. It's a common pattern with the most economical policies: the insurance companies are paying doctors lower rates so fewer are joining their networks. A recent small national survey conducted by the Urban Institute found that 14 percent of newly insured adults with marketplace plans say they've had trouble finding a doctor.

"I believe that this is a case where, by design, (our plan) is now being made to resemble an HMO," he says, referring to the health maintenance organizations that inspired a patient backlash in the 1990s for limiting care. "An inferior HMO."

The couple will be shopping for a new policy this year, hoping for a better network.

___

PERSEVERANCE REQUIRED

Pat Barone has the willpower to lose 90 pounds and keep it off. She turned that perseverance into a weight-loss coaching business that has led to speaking engagements and clients on four continents.

But her resolve has been tested by the new health insurance system.

After losing her insurance following a divorce in 2013, Barone, 59, of Madison, Wisconsin, signed up for a new health plan last year that costs her just $50 a month and also covers her 21-year-old son.

But the technical snafus have been endless. In July she began getting requests from the plan's government administrator to send paperwork verifying her citizenship and income or her coverage would be terminated. She got the documents, but the system's website, HealthCare.gov, wouldn't upload them.

"When I finally got someone on the phone, they instructed me to mail the documents in. I did that, but I am being barraged by monthly email, snail mail and phone calls to get my documents filed, or I will lose coverage," Barone says.

The letters, she says, "are kind of demanding and threatening." For now she's decided to take the assurances from operators at the HealthCare.gov telephone help line that she can ignore the warnings. She hopes they're right.

Despite the problems, she says, she's delighted with the coverage. "It's a godsend to those of us who don't have other alternatives," Barone says. "I have used it for preventive care with no problems."

___

Associated Press medical writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson Reported by Huffington Post 3 hours ago.

24% Of Millennials "Expect" Student Loan Forgiveness

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24% Of Millennials Expect Student Loan Forgiveness It appears the concept of no consequences is now deeply embedded in the American society. As Student loan debtloads surge ever higher - and opportunities grow ever lower - NBC News reports a rather *stunning 24% of Millennials said they expect their loans will ultimately be forgiven*, according to study released Wednesday by Junior Achievement and PwC US. That *helps to explain why delinquency rates are at record highs* - aside from the massive debtloads and no high-paying jobs - as students see bankers rigging every market in the world with little to no consequence, one can only imagine the lessons being learned.

 

*Heavily delinquent student loans hit a fresh record high of $124.3 billion, up from $121.5 billion in the prior quarter. *

 

NBC explains...

 

As NBC News reports,



That could be a lot of accumulated debt, considering the *average amount of cumulative student debt for undergraduates in the class of 2012 was $26,885,* according to a recent Pew Research report. The average debt for 2013 graduates is expected to be even higher.

 

"It's a scary statistic," said Jack Kosakowski, president of Junior Achievement, which co-sponsored the Ypulse survey. The survey conducted for Junior Achievement, "Millennials & College Planning," *did not address why the students thought their loans would be forgiven*, and it was the first year the question was included in the survey.

 

The report also found that *60 percent of millennials surveyed said financial aid is a deciding factor in their school choice and 21 percent said the cost of college was their family's main financial problem.*



*  *  *

*Given the following, it is hardly surprising they hope and expect for forgivness...*

The following are 18 sobering facts about the unprecedented student loan debt crisis in the United States…

*#1* According to the Wall Street Journal, the class of 2014 is “the most indebted ever“…



As college graduates in the Class of 2014 prepare to shift their tassels and accept their diplomas, they leave school with one discouraging distinction: They’re the most indebted class ever.

 

The average Class of 2014 graduate with student-loan debt has to pay back some $33,000, according to an analysis of government data by Mark Kantrowitz, publisher at Edvisors, a group of web sites about planning and paying for college. Even after adjusting for inflation that’s nearly double the amount borrowers had to pay back 20 years ago.



*#2* In 1994, less than half of all college graduates left school with student loan debt.  Today, it is over 70 percent.

*#3* Approximately 15 percent of graduate and professional school students leave school with student loan debt balances in the six figures.

*#4* At this point, student loan debt has hit a grand total of 1.2 trillion dollars in the United States.  That number has grown by about 84 percent just since 2008.

*#5* According to the Pew Research Center, nearly four out of every ten U.S. households that are led by someone under the age of 40 is paying off student loan debt right now.

*#6* The median net worth of young households that have student loan debt is 20 percent lower than the median net worth of young households that do not have any student loan debt and that are led by someone with only a high school education.

*#7* Among college educated people, the median net worth of young households that do not have student loan debt is seven times higher than the median net worth of young households that do have student loan debt.

*#8* In 2008, approximately 29 million Americans were paying off student loan debts.  Today, that number has ballooned to 40 million.

*#9* Since 2005, student loan debt burdens have absolutely exploded while salaries for young college graduates have actually declined…



The problem developing is that earnings and debt aren’t moving in the same direction. From 2005 to 2012, average student loan debt has jumped 35%, adjusting for inflation, while the median salary has actually dropped by 2.2%.



*#10* According to CNN, 260,000 Americans with a college or professional degree made at or below the federal minimum wage last year.

*#11* Even after accounting for inflation, the cost of college tuition increased by 275 percent between 1970 and 2013.

*#12* Debt for law school students has risen dramatically over the past decade or so…



J.D.s certainly don’t come cheap. It’s almost unheard of to attend law school without taking out significant loans. What’s more, the average debt load is mounting: in 2001-2002, JDs borrowed on average $46,500 at public law schools and $70,000 at private law schools; by 2011, those numbers rose to $75,700 and $125,000, respectively.



*#13* Last year it was being reported that 34.9 percent of all student loan borrowers under the age of 30 are at least 90 days behind on their student loan payments.

*#14* One survey found that 27 percent of those with student loan debt moved back in with their parents after college.

*#15* Another survey found that 70 percent of all college graduates wish that they had spent more time preparing for the “real world” while they were still in school.

*#16* Student loan debt is causing many young Americans to delay getting married.  The following is from a recent NBC News article…



While there is no specific data on student debt-related delays to marriage, a recent study by the Pew Research Center shows that a record number of Americans have never married. The study found the median age at first marriage is now 27 for women and 29 for men. In 1960, the median age was 20 for women and 23 for men.



*#17* Many Americans are not even using most of their student loan money to pay for college.  Instead, many are using much of that money to pay bills or stock the fridge…



Take Ray Selent, a 30-year-old former retail clerk in Fort Lauderdale, Fla. He was unemployed in 2012 when he enrolled as a part-time student at Broward County’s community college. *That allowed him to borrow thousands of dollars to pay rent to his mother, cover his cellphone bill and catch the occasional movie.*

 



 

Tommie Matherne, a 32-year-old married father of five in Billings, Mont., has been going to school since 2010, *when he realized the $10 an hour he was making as a mall security guard wasn’t covering his family’s expenses*. He uses roughly $2,000 in student loans each year to stock his fridge and catch up on bills. His wife is a stay-at-home mother who also gets loans to take online courses.

 

“*We’ve been taking whatever we can for student loans every year, taking whatever we have left over and using it to stock up the freezer just so we have a couple extra months where we don’t have to worry about food*,” says Mr. Matherne, who owes $51,600 in federal loans.

 

Some students end up going deeper into debt. Early last year, when Denna Merritt lost her long-term unemployment benefits, the 49-year-old Indianapolis woman enrolled part-time at the Art Institute of Pittsburgh’s online program, aiming for a degree in graphic design. *She took out $15,000 in federal loans, $2,800 of which went to catch up on unpaid bills, including utilities, health-insurance premiums and cable.*

 

*“Obviously, it’s better not to use it that way if you can help it, because you’re just going to owe that much more later,” *says Ms. Merritt, a former bookkeeper.



*#18* Only 28 percent of Americans know that the U.S. government can garnish wages and withhold tax refunds if student loan debts are not repaid.

It should come as no surprise that the delinquency rate on student loan debt in this country is far higher than the delinquency rate on mortgages, auto loans and credit card debt.

*This is a financial bubble that gets worse with each passing year, and if we continue on our current course it is going to end very, very badly.*

*  *  *

*Now where would they get the idea that forgiveness will happen?*

"The challenges of managing student loan debt can lead some borrowers to fall behind on their loan payments and in some cases even default on their debt obligation," notes the always astute White House... and so it's time to do something about that... by bailing the bad debtors out with US taxpayers money. As we have been vociferously warning, not only has the student loan debt bubble expanded massively (as the easiest credit substitute for real-world working and unemployment) but delinquencies on the 'easily available' credit is soaring with "consequences such as a damaged credit rating, losing their tax refund, or garnished wages." *Consequences, as we have been taught now, are not acceptable for this administration and so President Barack Obama issued an executive action in June aimed at making it easier for young people to avoid trouble repaying student loans*.

*A Federal Government bailout...?*

As Reuters reported,



*President Barack Obama will issue an executive action on Monday aimed at making it easier for young people to avoid trouble repaying student loans*, a White House official said on Sunday.

 

The president will sign an order directing the secretary of education to ensure that more students who borrowed federal direct loans be allowed to* cap their loan payments at 10% of their monthly incomes*, the official said.

 

Federal law currently allows most students to do this already. The president's order will extend this ability to students who borrowed before October 2007 or those who have not borrowed since October 2011, the official said.

 

The administration says* this action will help up to 5 million more borrowers*, although it will not be available until December 2015.



* * *

Welcome to the real world, debt serfs... Reported by Zero Hedge 3 hours ago.

Seven Common Pitfalls of Obamacare Open Enrollment and How to Avoid Them

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Do you know the seven most common pitfalls of enrolling in Obamacare? California health insurance denial and bad faith lawyer Scott C. Glovsky does and he’s sharing how to avoid them.

Los Angeles, California (PRWEB) November 13, 2014

Obamacare Open Enrollment period for 2015 coverage begins on November 15, 2014 and ends on February 15, 2015. Mr. Glovsky is currently litigating class actions against Anthem Blue Cross of California and Blue Shield of California for misrepresentations they made during last year's open enrollment about their networks of providers (BC-549438 CA).· PITFALL #1: CONFUSION OVER THE TYPES OF PLANS

In PPO plans, members can access a limited network of contracted providers or access out-of-network providers. In HMO plans, members must go to doctors within their plan’s network but generally first obtain pre-authorization from their primary-care physician. EPO plans function like PPO plans, but members receive no coverage for out-of-network care.

· PITFALL #2: MISLEADING INFORMATION FROM INSURERS ABOUT THE TYPE OF PLAN

Because insurers have been misleading, simply knowing the difference between the types of health plans is not enough to ensure that the consumer will actually enroll in a desired plan. To safeguard against being misled, consumers should enroll in a new plan either online or by using a paper form instead of enrolling over the phone to prevent the current insurer from rolling them into a new policy by taking no enrollment action.

· PITFALL #3: MISLEADING IN-NETWORK PROVIDER LISTS

Consumers are being misled into thinking that their preferred provider or facility will be in network, only to find out after enrollment that they the provider of facility is actually out of network. Take screenshots of all of the insurer’s web pages confirming the in-network status of providers, request written confirmation from all insurer phone representatives that the providers are in-network before enrolling in a new plan, and keep extensive notes of conversations with plan representatives.

· PITFALL #4: CONFUSING DEDUCTIBLES

A deductible is the amount of expenses that a plan member must pay out-of-pocket before an insurer will pay any expenses. Find out what payments each health plan counts towards the deductible because some health plans do not consider all out-of-pocket payments when calculating whether a member has met their yearly deductible.

· PITFALL #5: HIDDEN DEDUCTIBLES

Some plans have various deductibles for different services. For example, some health plans have a deductible for health care treatment and a separate deductible for prescription drugs.

· PITFALL #6: CONFUSING PRESCRIPTION DRUG FORMULARIES

Since not all insurance plans provide coverage for the same prescription drugs, ask about the different prescriptions that each plan covers before enrollment to ensure coverage for essential medications.

· PITFALL #7: LOSS OF TAX SAVINGS BY ENROLLMENT OUTSIDE OF EXCHANGE

People who purchase health insurance from their state’s health coverage exchange, as opposed to directly from a health insurance provider, may qualify for a tax credit. Since many insurance providers offer the same exact plans (albeit with different names) on and off of the insurance market place exchanges, there is no incentive for people who qualify for a tax credit to purchase a plan outside the exchange marketplaces.

About the Law Offices of Scott C. Glovsky

Scott Glovsky represents individuals and leads class action suits in the areas of health care, health insurance denials, insurance bad faith, false claims and personal injuries.

Mr. Glovsky lawsuits have helped raise the awareness of the importance of health insurers covering mental health care, including treatment for eating disorders, autism and other severe mental illness. His most recent class action lawsuits involve suing Anthem Blue Cross and Blue Shield of California for bait and switch in connection with misrepresenting the providers and hospitals that are within its contracted networks.

The Law Offices of Scott C. Glovsky serves clients in Los Angeles, Pasadena, San Bernardino and throughout California.

Mr. Glovsky welcomes media inquiries and other questions about Obamacare Open Enrollment. He can be reached at sglovsky(at)scottglovskylaw(dot)com or (626) 243-5598.

Learn more about Scott Glovsky’s law practice at http://www.scottglovsky.com. Reported by PRWeb 2 hours ago.

Report: Immigrants Make Up 42 Percent of Obamacare Medicaid Expansion

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Report: Immigrants Make Up 42 Percent of Obamacare Medicaid Expansion People who weren’t even born in America are taking significant advantage of one of Obamacare’s single-most expensive benefits, the expansion of Medicaid, a new report from the Center for Immigration Studies (CIS) shows. In fact, immigrants have accounted for 42 percent of the growth in Medicaid enrollment since Obamacare began being implemented in 2011, the report finds.

“The high rate and significant growth in Medicaid associated with immigrants is mainly the result of a legal immigration system that admits large numbers of immigrants with relatively low-levels of education, many of whom end up poor and uninsured,” report co-author Steven Camarota of CIS says. “This fact, coupled with the extensive supports we provide to low-income residents unavoidably creates very significant costs for taxpayers.”

The report, which Camarota authored with Karen Zeigler, finds that from 2011 to 2013 a whopping 42 percent of Obamacare’s Medicaid expansion went to immigrants and their children rather than to native-born U.S. citizens and their families.

Camarota and Zeigler wrote that it “seems almost certain” that such immigrants and their children “will continue to benefit disproportionately from Obamacare, as they remain much more likely than natives to be uninsured or poor.”

The report finds that the immigrants who are taking advantage of these government benefits are generally those who immigrated to the U.S. legally. That means illegal aliens, who could be granted executive amnesty by President Obama if he moves forward with his plans for such an order, would also likely have access to the Obamacare benefits.

Incoming Senate Budget Committee chairman Jeff Sessions (R-AL) is planning to launch a battle using government funding mechanisms to block President Obama from implementing the executive order. But even as Sessions and other GOP leaders plan to block funding for Obama’s plans, some Republicans from the establishment side of the party, including House Appropriations Committee chairman Rep. Hal Rogers (R-KY), are seeking to push an omnibus spending bill that could include funding for Obama’s planned amnesty and fund the entire government until the end of the 2015 fiscal year in September. 

Sessions and his side of the fight argue that Republicans, who just won big in the midterm elections and took the U.S. Senate majority, would be in effect surrendering the mandate voters gave them to lead the nation to outgoing Senate Majority Leader Harry Reid should they do what Rogers and other establishment Republicans are pushing.

If Rogers and his side of the party succeed, it’s all but certain that Obama’s planned executive amnesty will happen—and the staggering numbers of immigrants getting access to Obamacare’s Medicaid expansion, which helps the unpopular law survive, would likely increase.

For now, however, CIS found that immigrants and their U.S.-born children are gaining access to the Obamacare provision twice as often as American natives. Immigrants have seen an 11 percent increase in Medicaid enrollment under Obamacare, while the rest of the population has seen a 5 percent increase.

The Medicaid increase among immigrants due to Obamacare, the report found, is costing U.S. taxpayers about $4.6 billion per year, and the report found this increase in immigrant Medicaid access is actually helping them gain more access to healthcare than American natives’ access.

“Partly because of increased Medicaid enrollment, the share of immigrants and their children without health insurance declined more dramatically than for natives, from 28 percent in 2011 to 23 percent in 2013 — a five percentage-point decline,” the report found. “Among natives and their children, it fell from 13 percent to 11 percent — a two percentage-point decline.”

The data for the CIS comes from the Current Population Survey’s Annual Social and Economic Supplements and other government sources. Reported by Breitbart 2 hours ago.

Here's What Really Goes On At Planned Parenthood Every Day

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For many, Planned Parenthood is synonymous with one thing: legal abortion. But nationally, abortion makes up only 3 percent of the services the health care provider performs -- and clinical services represent only a portion of the organization's overall work.

"Most people don't have any clue about the breadth of work we do," says Joan Malin, president and CEO of Planned Parenthood New York City, or PPNYC, which has five health centers -- one in Manhattan, Brooklyn, the Bronx, Staten Island and Queens. In 2013, for example, PPNYC provided roughly 88,000 tests for sexually transmitted infections; 26,800 HIV tests; 64,200 family planning visits; 17,800 abortions; and set up some 6,300 clients with public health insurance, according to internal figures. PPNYC opened its doors to The Huffington Post, and its staff members gave us a glimpse of what happens in their offices on a given day, in their own words:

*They provide medical services (yes, that includes abortion).*
Doctors at Planned Parenthood provide thousands of health care consultations a year. (Photo: Courtesy PPNYC)

Dr. Stacy De-Lin, associate medical director, PPNYC:

I work primarily in abortion services, which is a small part of what we do, but it's an important part. The fact that we're based in New York City means we're able to operate without a lot of restrictions -- when a patient comes in, if she wants a same-day procedure, we can offer her that. We're not burdened by issues like waiting periods, or some of the other onerous legislation that occurs in the rest of the country. I always feel like it's important to emphasize how much easier I, as a physician, have it here. I have colleagues who work in areas that require they read information to their patients that they know to be medically untrue -- that [abortion] will cause breast cancer, it will cause depression, increased risk of suicide or possible infertility. Those things are all false.

We have patients from a lot of surrounding areas. The other day I saw a patient and asked her how she was feeling. She said she was very tired. She'd driven from a very rural area in northern New York -- five hours throughout the night -- to get to us.

Outside of the building we do have protestors, but luckily not as bad as other places. Across from our Bronx Center, there is a crisis pregnancy center and we unfortunately have patients who think that's the Planned Parenthood, because they see a sign that says, "Are you pregnant? Come in here!" They're often told they'll be very badly injured, that it will lead to infertility ... [or that] they'll become suicidal. It really makes you understand how much a woman who has decided to terminate a pregnancy is willing to sacrifice, because having heard all of that false information, she'll still come and find us.

"A lot of my job is just reassuring women that abortion is actually one of the safest medical procedures that exists out there."

When patients come in, we have counselors who revisit all of the options with them: adoption, parenthood or abortion. Based on that conversation, and what's most medically appropriate for them, a patient who wants an abortion will chose between either a medication or a surgical procedure. Just over 30 percent of our abortions at this affiliate are medication.

The [surgical] procedures themselves are very quick -- patients are able to leave within a few hours to give time for the anesthesia [to wear off]. Most of the general counseling here is done before I see a patient, but I still spend five to 10 minutes answering any last-minute questions they have. A lot of my job is just reassuring women that abortion is actually one of the safest medical procedures that exists out there.

I'm out and open as an abortion provider, but I have colleagues [elsewhere in the country] who've been asked to leave their jobs, who've had protestors who show up to their houses, so they fear for their children's lives. I feel privileged to work in New York City and for an organization that supports me. I've worked in hospitals before where women with severe lethal fetal anomalies, who were heartbroken, weren't ever given the option of abortion. They were told they had to continue an obviously devastating pregnancy that was not going to result in a healthy child in any way.*They help women get health insurance.*

Nikki Tani, director, entitlement, PPNYC:

Basically anybody that walks into any of our centers who is having financial issues gets sent to us. If someone is told their visit is $175 and the person says, "I don't have that," we screen them for programs that can help. We ask how old they are, if they're a [United States] citizen, and then it's a financially based application depending on what their income is. We also can apply people for health insurance through the portal for the Affordable Care Act. A lot of the women who come here qualify for some kind of Medicaid-based program.

"This is not just a numbers game. There are emotions involved in this."

You could be in the office for 10 minutes, or up to an hour -- it really depends on the person. Some people are a little afraid, because it might be their first time ever applying for Medicaid. They wonder, 'Is this going to stay on my record?' There can be a stigma attached to it for some people. Often times, when people are concerned, it's because they don't really understand what it is, or they've been to an office in the past where people didn't treat them like a human being for applying for such a service. If you've never had health insurance before, you may not understand what monthly premiums mean, what a deductible is -- we go through step by step.

Anyone who comes here will get services no matter what -- their immigration status does not matter. If it's not Medicaid they qualify for, there are other programs or we offer a sliding scale depending on income. On an average day, I could see anywhere from five to 23, 24 patients.

But this is not just a numbers game. There are emotions involved in this. People are so relieved. They just had no idea they could get health insurance, and then they can go to the dentist two days later, because of that.*They serve at-risk men and women on the street. *PPNYC operates a mobile health care unit.Marcella Tillett, associate vice president, Project Street Beat:

We have two sites -- one in the Bronx, one in Brooklyn -- and our mobile health unit, which is a large RV. The people who come to us are not typically comfortable going into a clinic or hospital. They're not always welcome. They may not smell their best. They may not look their best. They're in a hard spot. Our staff is there to look at them as human beings. I would say that 60 to 75 percent of the people we work with -- particularly at the point of initial contact -- are unstably housed, which may mean they're living on the street, they're couch-surfing or floor-surfing. They're finding a place to crash night by night.

On the mobile unit -- which goes out five to six shifts a week -- you can get STI screening and treatment; we distribute clean syringes and teach people how to clean them and use them properly; we provide reproductive health services. We can be out in the South Bronx at two in the morning giving a Pap smear to someone.

"The people that come to us for services are not typically comfortable going into a clinic or hospital. ... They may not smell their best. They may not look their best."

The work we do is grant-funded, from the city, state and federal government as well as private grant funds, which keeps our services at no-cost to the people who receive them. The people we work with really are living in poverty -- [some of our funding requires they be] 435 percent below the poverty level. They have no money to pay for these services.

We also have more in-depth collaborations with a handful of organizations -- shelters, a methadone maintenance clinic that provides medication to people who have an opiate addiction. There's a women's shelter in Brooklyn, for example, that we've had a relationship with for the past four or five years. We started by showing up with our mobile medical unit, but then we started doing things like trainings with staff around STI and HIV training 101. We work with groups of women to talk about risk reduction, encouraging safer sex -- if they're HIV-positive, viral supression. If they're using substances, how are they using those substances? Are they using needles? Are they clean needles? We really look to have a realistic plan for people. You can, as an outsider, say, "Well, you should do XYZ. If you drink, you shouldn't drink. You do crack? You should stop." But that might not be their goal. If they are drinking five times a week, and they say, "I still want to drink," it might be about helping them make a plan around drinking two times a week.* They teach adults about sex and reproductive health. *

Randa Dean, director, adult and professional programs, PPNYC:

Our education department has two branches: youth services and adult and professional programs. Within that, we have programs for adults that are just for their own learning, programs for parents and then programs for professionals working out in the community, who maybe don't work in sexual and reproductive health, but who are getting questions about it -- say librarians, or after-school providers.

"We really want to support parents as the primary sex educators of their children."

More than half of our team is made up of field-based educators. We have a program, called promotoras de salud, that trains key leaders in the community to become adult peer educators as part-time staff. They go out to laundromats, hair salons, community-based organizations to meet people and connect with them. It's focused largely on serving Latina women and their families, who are often disconnected from the health care system for a lot of reasons. They may not know what's available. These services may not be legal in the country they're coming from. They may not know that they can be seen even if they don't know how they're going to pay for the services. The promotoras serve as a link.

We also have the parent education program. We really want to support parents as the primary sex educators of their children, but we know it's hard for parents and caregivers for a lot of reasons -- maybe they never talked to their own parents about it, or they don't know how to start the conversation. Now we have 10 of what we call "adult role models" -- they're part-time -- who conduct workshops in schools, faith-based organizations, community organizations. A lot of it is about encouraging parents to really genuinely listen to their child about what they know and the questions they have, then share the family value around whatever they're talking about. Young people consistently say that the group that most influences their decisions around sex and reproductive health are their parents.

These accounts have been edited and condensed. Reported by Huffington Post 2 hours ago.

Rite Aid Provides Free Support During Affordable Care Act Enrollment Starting Nov. 15

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Rite Aid Provides Free Support During Affordable Care Act Enrollment Starting Nov. 15 CAMP HILL, Pa.--(BUSINESS WIRE)--To help customers prepare for the upcoming Affordable Care Act enrollment period, Rite Aid is once again providing convenient and comprehensive resources to assist them in choosing the best health insurance choices for themselves and their families. Beginning Nov. 15, independent, licensed insurance agents will be available through a dedicated toll free number to enroll customers and provide free consultations with customers to answer questions on the Affordable Reported by Business Wire 2 hours ago.

HMO Providers in the US Industry Market Research Report Now Available from IBISWorld

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Over the five years to 2019, rising aggregate health expenditure is anticipated to outweigh the continued decline of HMO penetration in the employer-sponsored insurance market, to the benefit of the industry. For this reason, industry research firm IBISWorld has added a report on the HMO Providers industry to its growing industry report collection.

(PRWEB) November 13, 2014

A declining share of the employer-sponsored health insurance market has outweighed gains in Medicare Advantage (MA) penetration for the HMO Providers industry. Industry operators provide HMO insurance coverage that supplies clients with physicians and other medical staff primarily engaged in providing a range of outpatient medical services, with a general focus on primary healthcare. In recent years, HMOs have consistently lost ground in the provision of employer-based coverage. Largely a result of this trend, industry revenue is expected to fall at an annualized rate over the five years to 2014.

Alternative to the employer-based market, HMO providers have consistently dominated the MA market. The dominance of HMOs in the MA market is partially related to urbanization trends. According to IBISWorld Industry Analyst Leah Goddard, “This trend is partially explained by the structure of HMOs, as it is easier to create closed provider networks in urban areas, given the range of providers in these locations.” Fortunately for industry operators, more than half of Medicare beneficiaries eligible to enroll in a MA plan live in metropolitan areas.

Over the five years to 2019, industry revenue is forecast to rise. During this period, rising aggregate health expenditure is anticipated to outweigh the continued decline of HMO penetration in the employer-sponsored insurance market. More specifically, total domestic health expenditure is forecast to rise at a sharp annualized rate from 2014 to 2019. “Typically, medical cost inflation is passed onto consumers in the form of increased premium rates; this allows industry operators to maintain profit margins,” says Goddard. However, rising wage costs, an increase in care utilization and the impact of the healthcare reform are still anticipated to damage the industry's profit margins in the years ahead.

For more information, visit IBISWorld’s HMO Providers in the US industry report page.

Follow IBISWorld on Twitter: https://twitter.com/#!/IBISWorld
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IBISWorld industry Report Key Topics

This industry provides HMO insurance coverage that supplies clients with physicians and other medical staff primarily engaged in providing a range of outpatient medical services with a focus generally on primary healthcare.

Industry Performance
Executive Summary
Key External Drivers
Current Performance
Industry Outlook
Industry Life Cycle
Products & Markets
Supply Chain
Products & Services
Major Markets
Globalization & Trade
Business Locations
Competitive Landscape
Market Share Concentration
Key Success Factors
Cost Structure Benchmarks
Barriers to Entry
Major Companies
Operating Conditions
Capital Intensity
Key Statistics
Industry Data
Annual Change
Key Ratios

About IBISWorld Inc.
Recognized as the nation’s most trusted independent source of industry and market research, IBISWorld offers a comprehensive database of unique information and analysis on every US industry. With an extensive online portfolio, valued for its depth and scope, the company equips clients with the insight necessary to make better business decisions. Headquartered in Los Angeles, IBISWorld serves a range of business, professional service and government organizations through more than 10 locations worldwide. For more information, visit http://www.ibisworld.com or call 1-800-330-3772. Reported by PRWeb 2 hours ago.

The Cost of a College Education Continues to Creep Higher

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The Cost of a College Education Continues to Creep Higher Filed under: Student Loans, Family Money, Inflation, College, Education

*Getty Images*

By KIMBERLY HEFLING

WASHINGTON -- Time to stock up on the ramen noodles. The average cost of attending college crept up again this year, the College Board said Thursday.

The average sticker price, with room and board included, for undergraduate students attending a four-year college or university in their home state was $18,943. Out-of-state students at those schools paid, on average, $32,762. At two-year public schools, in-state students paid an average $11,052.

The cost to attend a private, four-year nonprofit college: $42,419, on average, including housing and meal plan.

For-profit schools cost about $15,230, but housing figures weren't available.

Books and transportation costs can add more than $2,000 to the cost of attending college, and that rises even more for commuters.

The highest rate of increase of 3.7 percent was among private, nonprofit colleges. And even though the increases across higher education outpaced inflation, the rates of increase were lower than those students saw five, 10 or 30 years ago, the College Board said.

When adjusted for inflation, students are paying more than triple what students paid 30 years ago to attend a public, four-year institution and about 2.5 times more to attend a private nonprofit or two-year public one.
"The price increases are actually quite moderate this year, but still, what people are paying, and this is before financial aid, is the accumulation of many years of price increases," said Sandy Baum, a co-author of the nonprofit College Board's annual college pricing report. "So, if the price goes up just a little bit this year, people aren't really going to breathe a sigh of relief because the price is already high from their perspective."

Baum said during tough economic times, college costs tend to go up because public institutions receive less in state dollars and private ones see a decrease in endowments and in giving. Other contributing factors are wide ranging from the increasing costs of technology to health insurance for university employees.

Only the wealthiest of Americans are seeing their incomes rise, so most students feel the tuition upticks more, Baum said.

The number of full--time undergraduate students increased by 16 percent in the three years leading up to fall 2010 to 13.7 million, but then declined to 13 million in fall 2013. The number of students taking out student loans and the amount taken out, on average, by students has been declining, the College Board said. It said about 60 percent of students who earned a bachelor's degree in 2012-2013 from public or private, nonprofit schools from which they began their studies graduated with debt, borrowing an average of $27,300.

The breakdown in pricing:

· Sticker prices, on average, for in-state tuition and fees at public four-year schools increased to $9,139 this school year -- a 2.9 percent increase over the 2013-2014 school year. The average out-of-state price tag was $22,958, an increase of 3.3 percent increase. Room and board was $9,804.
· Public two-year schools had a $3,347 published price on average for tuition and fees-- an increase of 3.3 percent. Room and board was $7,705.
· Tuition and fees at private, nonprofit schools rose 3.7 percent to an average of $31,231. Room and board was $11,188.
· For-profit schools saw a 1.3 percent increase in tuition and fees.

Published prices don't necessarily reflect what students actually pay because they don't include grant dollars provided by institutions or government aid such as Pell Grants, the GI Bill and tax credits. This school year, full-time students received an average of about $6,110 in aid at public four-year schools, $5,090 at public two-year ones, and $18,870 at private colleges.

The average in-state prices at four-year schools ranged from $4,646 in Wyoming to $14,712 in New Hampshire.

For out-of-state students, the most affordable tuition of $9,910 was in South Dakota. On the other end, the most expensive was $34,331 in Vermont.
 

Permalink | Email this | Linking Blogs | Comments Reported by DailyFinance 2 hours ago.

HHS Secretary: 'No Questions Will Be Asked' of Families with Mixed Immigration Enrolling in Obamacare

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HHS Secretary: 'No Questions Will Be Asked' of Families with Mixed Immigration Enrolling in Obamacare Health and Human Services Secretary Sylvia Burwell encouraged families with mixed immigration status to sign up for Obamacare to see whether they could get subsidies for purchasing health insurance.

Burwell made her remarks during a Google hangout with bloggers to promote Obamacare to Hispanics, discovered by Red Alert Politics reporter Ashley Dobson.

“With regards to the issue of mixed families, absolutely, mixed families should come. They should seek, try, go on the site," Burwell said, adding, "They’ll find out they can get financial assistance. They may be eligible for different programs for their children or themselves, depending on which members of their family, in terms of what is mixed.” 

“So everyone should come on, and folks should not be scared because … no questions will be asked. This is not about an immigration issue.”

According to the National Immigration Law Center, illegal immigrants are allowed to apply for benefits on behalf of eligible members of their families. Those individuals “are not required to provide information about their citizenship or immigration status and are not required to provide a Social Security number (SSN) if one was not issued to them.”

That allows illegal immigrants to apply for health insurance for their children who were born in the United States. 

Burwell also reminded the audience that DREAMers currently were not covered by the Obamacare exchanges because of an immigration issue — something that the Obama administration was working to fix.

“I think everyone probably knows that this administration feels incredibly strongly about the fact that we need to fix that," Burwell said. "We need to reform the system and make the changes that we need that will lead to benefits in everything from health care to economics to so many things — a very important step that we need to take as a nation." Reported by Breitbart 38 minutes ago.

Health law’s small-business enrollment fell far short of expectations, GAO finds

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Small-business enrollment on new insurance marketplaces set up under the president’s health care law has fallen well short of expectations, according to a government report released Thursday.

The Government Accountability Office cobbled together enrollment totals for the online small-business exchanges, commonly called SHOP exchanges, in states that built their own health insurance portals. Most states defaulted to a federally operated small-business marketplace — a complementary site to the more widely known individual exchange, both of which are slated to relaunch this weekend. Reported by Washington Post 1 hour ago.

HealthPlans.com Survey Reveals Americans’ Health Care Misconceptions and Opportunities

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HealthPlans.com Survey Reveals Americans’ Health Care Misconceptions and Opportunities LOS ANGELES--(BUSINESS WIRE)--HealthPlans.com, one of the most visited independent consumer health insurance sites, according to comScore, today announced the results of a national survey about shopping for health insurance. Reported by Business Wire 1 hour ago.

Second Affordable Care Act Open Enrollment Period Begins November 15th

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WASHINGTON, Nov. 13, 2014 /PRNewswire/ --  Non-profit Enroll America, the nation's largest health care enrollment coalition, is working with the Ad Council to encourage women to sign up for health insurance under the Affordable Care Act during the next open enrollment period, which... Reported by PR Newswire 1 hour ago.

Wonkblog: People with health insurance still can’t afford all the care they need

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As open enrollment season starts, a new survey is providing an important reminder that you need to look just beyond the cost of a health plan's monthly premium to figure out your expected medical costs for the coming year. With things like deductibles and co-pays creeping higher for nearly everyone, many adults are spending a chunk of their income on out-of-pocket costs.** Reported by Washington Post 34 minutes ago.
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