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These Are The Lives That Obamacare Helped Save

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As President Barack Obama nears the end of his second term, his hallmark piece of legislation, the Affordable Care Act, has a precarious future ahead of it.

The overall perception of the law has been mixed at best, thanks to botched website rollout and recent premium increases. But the legislation has also come with some serious benefits. It allows young adults to stay covered under their parents’ insurance plans until age 26, forces insurance companies to cover those with pre-existing conditions, covers preventative health care and ends lifetime limits on essential coverage. Thus far, the law has helped roughly 20 million people gain health coverage.

In order to understand just how transformative the law has been for some Americans, HuffPost Rise spoke with two families that have felt the positive impact of the Affordable Care Act firsthand.Stacey Lihn’s daughter Zoe was born with hypoplastic left heart syndrome, a congenital heart defect that required her to have her first open-heart surgery at just 15 hours old. Before the age of 5, Zoe underwent two more open-heart surgeries, and Lihn started coming to terms with a scary realization.

“When we received Zoe’s diagnosis, I had coverage under my employer’s’ plan, but we had a lifetime cap on our policy,” Lihn said. “It’s very expensive. Obviously having three open heart surgeries before the age of 5, she was going to hit that lifetime cap and likely at a very young age.”

Fighting back tears, Lihn described how she considered giving her parents guardianship of Zoe so the little girl could continue to get health coverage.

“And when the Affordable Care Act was passed it was such a relief. It would be affordable and there wasn’t a cap on how much medical care she could receive,” she said, referring to a provision of the law that prohibits the use of lifetime dollar limits on essential health care.

Today, Zoe is a healthy 6-year-old, but her mother, who captivated America with her daughter’s story at the 2012 Democratic National Convention, still fears for her well-being every day.

“I’m extremely concerned about a complete repeal of the Affordable Care Act” she said. “I fear that [Zoe] … at 6 years old, is going to have to be confronted with [the question of] ‘Why am I not being cared for anymore? Why can’t I go to the doctor if I don’t feel good?’ And not being able to protect her in that way and having her realize her own mortality because of an election is terrifying.”Jeff Jeans was another victim of the United States’ complicated health insurance system. In 2011, Jeans’ small real estate business went under, so he lost health insurance coverage. Shortly afterward, he found out he had throat cancer. But without insurance, the cost of treatment was going to be a hurdle.

“I think we lost our insurance in January or February and I lost my voice in September [or] October,” he said. “You know, you don’t think you have cancer. That’s the last thing you probably think of, especially when I was only 49 years old.”

After going more than a year without health insurance, Jeans purchased a pre-existing condition insurance plan through the individual marketplace that was created with Obamacare.

“The very day my policy kicked in, they gave me radiation. They gave me chemotherapy,” he said.

Jeans, who had previously been a staunch conservative and even canvassed for Presidents Ronald Reagan and George H. W. Bush, wasn’t fond of the Affordable Care Act before he received his diagnosis. He’s since had a change of heart.

“When we owned our business and they first passed the Affordable Care Act, I told my wife that we would shut the doors of our business and shutter it before I would comply with this law. And that was the law that ended up saving my life,” he said.

Now a devoted Obamacare supporter, Jeans runs a Facebook group called Obamacare Saved My Life, where he shares health care-related articles and information about the ACA.

Despite stories like these, an Obamacare repeal remains a very real possibility. While repealing and replacing the law will be tough, President-elect Donald Trump has stated that he is dedicated to the cause. And with Republican majorities in both the House and Senate, conservatives may finally have the backing to take down the critical law, a decision that could leave people like Jeans and Lihn in limbo.

The video above was produced by Ingela Travers-Hayward, Rebecca Halperin and Katrina Norvell, edited by Sherng-Lee Huang and shot by Johnny Coughlin, Chelsea Moynehan and Mike Ciecierski.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 1 hour ago.

Would you wear a Fitbit for work? Employers giving them out to staff, but some worry about data privacy

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Fitness trackers – those sleek devices often strapped to wrists – are starting to become almost as common as employee badges at some companies. But how much do they help workers? How much do they help the companies that offer the wearables to their employees? Companies say they offer them to make work more fun, improve workers’ health, boost employee productivity or save money on health insurance costs. Some employees and advocacy groups, however, worry that fitness... Reported by S.China Morning Post 46 minutes ago.

Dr. Botelho Asks President Obama, Michelle Obama, Hillary Clinton and Bernie Sanders to Unite in Signing New Year’s Pledges to Address What’s Unfair about Healthcare

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Dr. Botelho Invites Individuals, the Mass Media and Organizations with Large Social Reach to 1) Join the Million Online March before Dec 31st by Signing up with Facebook and Twitter and 2) Help Build Story Movements to Address What’s Unfair about Healthcare.

Charlotte (PRWEB) December 28, 2016

Dr. Tom Price (new DHHS Head) will use the free market and six principles to reform healthcare. But what’s missing from TrumpCare? Equality and Equity.

And what else is missing? The people’s voices and their stories about unfair healthcare. Dr. Botelho insists that we must have public hearings about the proposed changes before Trump repeals ObamaCare and removes individual mandates for health insurance. Access to healthcare will get worse. Trump's policies will cause almost 21 million people to lose their insurance coverage.

Inverse Care Law for Injustice
High-income families get easy access to excellent healthcare services with the best outcomes. Low-income families get inadequate access to healthcare services with the worst outcomes. The people who need the most get the least, and the people who need the least get the most. We have a plutocratic healthcare system.

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane." Martin Luther King Jr.

But equal access to healthcare does not assure equitable outcomes. Equality does not equal equity. Dr. Botelho adapted MLK’s quote to address equity.

“Of all the forms of injustices, inequities are the most damaging to our health, our well-being and our evolving human consciousness.”

Gender and Health Equity is the attainment of the highest level of health and well-being for all people. The word gender is added to explicitly emphasize both women's and LGBT rights because they are often overlooked or minimized.

Dr. Botelho proposes this New Year’s Pledge. "We, the people, pledge that our government to use justice, equality and liberty to implement Gender and Health Equity in all policies for the greater good of all."

Dr. Botelho invites the Mainstream Mass Media to ask President Obama, Michelle Obama, Hillary Clinton and Bernie Sanders to sign this New Years’ Pledge for Gender and Health Equity.

To complement this pledge, Dr. Botelho invites health organizations to take this professional pledge: "We, as healthcare professionals, pledge to use our limited resources to:· Enhance person-centered and family-centered healthcare
· Strive toward gender and health equity

To complement this pledge, Dr. Botelho proposes this New Year’s Resolutions for the people. "We will tell our stories about what's most unfair about healthcare as a way to make our government accountable to the people." Share stories about unfair healthcare on Facebook in 2017.

Dr. Botelho believes mass media support, political advocacy and engaged citizens will create the network power to launch story movements, provided that people have ongoing opportunities to tell their stories about unfair healthcare. Dr. Botelho feels that this cascade of events will disrupt Trump’s control of the media. Story movements will force President Trump to listen to the voices of the people.

JOIN MILLION ONLINE MARCH by using Facebook and Twitter
Help launch story movements to address what's unfair about healthcare. Sharing our stories will generate dialogues about how to:
1. Move beyond political fundamentalism (either/or thinking) and dysfunctional polarizations
2. Open closed hearts and minds in order to maximize the upsides and minimize the downsides of individual values (liberty and freedom) and community values (equity and equality)
3. Put creative solutions on the frontburner and political ideology on the backburner

DEADLINE: Dec 31st 2016. Reported by PRWeb 15 hours ago.

The Assistance Fund Financial Assistance Program Offers Aid to Patients with Primary Biliary Cholangitis

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The Assistance Fund Financial Assistance Program Offers Aid to Patients with Primary Biliary Cholangitis ORLANDO, Fla.--(BUSINESS WIRE)--The Assistance Fund helps primary biliary cholangitis patients with copays, health insurance premiums & incidental medical expenses through its Primary Biliary Cholangitis Financial Assistance Program Reported by Business Wire 9 hours ago.

Year in Review 2016: Higher premiums and executive turnovers in health care

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Health insurance was a hot topic locally and nationally in 2016, as premiums for individual plans saw big hikes once again. And health care professionals remain uncertain and wary about the future of the Affordable Care Act as a new administration takes power in Washington, D.C. Maryland experienced its fourth consecutive round of large premium price increases for individual health plans this year. In September, the Maryland Insurance Administration approved double-digit percent rate increases for… Reported by bizjournals 4 hours ago.

Dubai residents voice their woes over mandatory health insurance

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Calls for reasonable premiums as Dubai residents scramble ahead of deadline Reported by Khaleej Times 19 hours ago.

Dubai residents concerned over mandatory health insurance

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Calls for reasonable premiums as Dubai residents scramble ahead of deadline Reported by Khaleej Times 19 hours ago.

Idaho doctor living his goal: medical care for the needy

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The idea to start the clinic, which provides free medical services to those without health insurance, came to Glenn Jefferson when he attended a national leadership conference as chief of staff for St. Joseph Regional Medical Center. Reported by Seattle Times 20 hours ago.

Dubai extends mandatory health insurance deadline

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Confusion, costly premiums a fast approaching deadline for health insurance had sent Dubai visa holders scrambling for last-minute decisions. Reported by Khaleej Times 15 hours ago.

How a health insurance provider became Tampa Bay's top stock performer in 2016

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Ever since Health Insurance Innovations Inc. became a public company in 2013, its stock price rarely topped $15 a share, and was well below $10 a share for all of 2015 and most of this year. That changed after the 2016 election, when its products gained visibility as an attractive alternative to Affordable Care Act health plans that could disappear under a Trump administration, and the new CEO talked up the company’s story to a broader investor base. Health Insurance Innovations (NASDAQ: HIIQ)… Reported by bizjournals 10 hours ago.

Colorado insurance cost hikes rising more sharply than national average

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Colorado employers once again will see health-insurance costs rise more steeply than businesses elsewhere in the country in 2017 — and will, for the most part, require employees to shoulder a higher burden of those costs in the new year, according to an annual survey released Thursday. Average rate increases for Colorado employers will hit 7.6 percent next year — a modest drop from the 8 percent hike of the past two years, according to a Lockton Mountain West Benefit Group survey of 280 companies… Reported by bizjournals 8 hours ago.

The GOP might not repeal Obamacare until after the 2020 election

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The GOP might not repeal Obamacare until after the 2020 election With the election of Donald Trump, Republican lawmakers finally have a repeal of the Affordable Care Act, better known as Obamacare, in their sights.

Despite holding control of the presidency and the legislature, a repeal of Obamacare may not come as soon as "day one" like leaders like Paul Ryan and Mitch McConnell have said.

According to Bloomberg's Sahil Kupar, there is no consensus among Republicans as to when a repeal should take place, but GOP staffers are floating the idea of waiting until after the 2020 presidential election.

A number of the plans put forth so far by Republicans would feature a "repeal and delay" mechanism, in which a law is passed that "repeals" the ACA, but only goes into effect after a given period of time. This, the thinking goes, would give lawmakers enough time to craft a replacement and also avoid possible political fall out from a repeal.

Additionally, given that over 20 million people have gotten health insurance through various provisions of the ACA, pulling the rug out from under these Americans could be politically dangerous for Republicans.

The original "repeal and delay" plan that was floated in November would have delayed the repeal date until 2019, after the first mid-term election.

Obviously this move would carry significant risks. Politically, Trump could lose his re-election bid, thus denying the GOP a chance at repeal. From the market side, a long delay could cause insurers to pull out of the individual insurance market in anticipation of the move, destabilizing coverage for millions and causing prices in the market to soar.

Bloomberg also reported that Republicans are planning to present the current Obamacare law as failing on its own, thus making repeal more palatable despite the coverage increases.

Counter to this narrative, however, the Department of Health and Human Services reported last week that 6.4 million people have signed up for Obamacare exchange plans since open enrollment began on November 1— the quickest sign-up pace in the history of the exchanges.

Granted, premiums have increased significantly for 2017 and there are still too few young people on the exchanges, but the number of people signing up for the plans is not collapsing.

While the GOP could delay repeal anywhere between two to four years, the biggest challenge will be coming up with a replacement plan and while there have been a number of plans floated — from Paul Ryan's Better way to Trump's HHS pick Tom Price's Empowering Patient's First Act — a consensus replacement has yet to be reached.

*SEE ALSO: Trump's pick for budget chief loves gold and bitcoin*

Join the conversation about this story »

NOW WATCH: Watch Yellen explain why the Federal Reserve decides to raise rates Reported by Business Insider 7 hours ago.

These 8 Business Apps Are Going to Crush It In 2017

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Of course, there are a ton of cool, slick, fun and potentially great applications for businesses. But this list is about a select few that are ready to explode this coming year. In a very good way. They've all been around for a while. They all have a strong customer base and growing communities. And they're all positioned for huge growth, particular among small- and medium-sized companies.

Your company should look at these seriously, if only because so many others are already doing so. Full disclosure: some of these applications are made by companies that are clients of The Marks Group. How can they not be?

*Insightly CRM*

Every business should have a customer relationship management system. A good CRM application ensures that nothing falls through the cracks, everyone is on the same page and you are building a database of good information that can be used for communication, sales and customer service for future years. There are many great, affordable CRM systems available. My company sells a few. We don't sell Insightly (our plate is already full), but I like it a lot. It's inexpensive. Scalable. Easy to use. The companies I know that use it love it, and Insightly sees a large, unserved market of small companies who need what they sell. If implemented properly, Insightly will ensure that you and your employees are in close contact with everyone that's important for your business.

*Xero*

Here's a fact: your accounting system will be cloud-based within the next few years. Many people enjoy the online version of QuickBooks, and I can't blame them. But Xero (and a few others) is giving QuickBooks a run for the money. It's fast, inexpensive, easy to set up, mobile-ready and full of accounting features. Plus, it integrates with dozens of third party products -- from payment to billing to customer service to CRM to reporting -- that turn this application into the foundation for your entire business platform. Xero has been growing significantly since it launched in the U.S. a few years ago and is already a powerhouse in New Zealand, Australia and the U.K. I predict a big year for this application.

*Gusto*

Human Resources management applications are booming, and if your company has more than five people, you're going to want to consider this to be a key technology for your business. Gusto automates the hiring process with all the forms you need (including custom ones you build), enables employees to self-enroll in benefit plans, manages contractors, handles paid time off and administers health insurance...oh, and it does your payroll -- all in a very user-friendly format. Like the other categories, there is plenty of competition, but Gusto is popular, powerful and growing.

*Entryless*

Remember those days when someone would send you a scanned invoice and you would save it on your computer because there wasn't much else you could do with it? That's all changed. Popular accounts payable automation applications like Entryless can now, using Optical Character Recognition technology, read and extract any data on a scanned invoice that's emailed to you, port it over to a format for you to review and approve and then automatically bring it into your accounting system or pay it online. Entryless cuts overhead, eliminates people processing and reduces data entry problems. My prediction is that most companies will be using technology like this within the next few years.

*Facebook Live*

Live streaming is not just fun and games anymore. Facebook is investing billions in its video platform, and thousands of businesses are jumping on the train. With Facebook Live, you can broadcast, to the world, all sorts of content that will help promote your business. Provide training. Offer certification. Demonstrate products. Interview an executive. Show an event. You can do this live or record something in advance, edit it and stream it later. The video will always be there on your Facebook page, so it'll help attract fans. And you can take that same video to use on other platforms, like YouTube. Have a video content plan for 2017 and, if you're active on Facebook, deliver it there.

*Carbonite*

For a while, I was mostly ambivalent about backup software. Until ransomware came along. Now this type of malware is predicted to be our biggest security challenge of 2017. Ransomware not only infects everything on your network (and in the cloud), but also locks up all your files and requires a ransom paid in e-currency (i.e. bitcoin) to unlock it. An infection can bring your business to a standstill for days or longer. I'm recommending that our clients get Carbonite and set it up to do online backups for every device throughout the day. That way, if a ransomware infection happens and your files get locked, you can just restore the last good backup and get back to work. It's a very good antidote to a very big security issue.

*Microsoft Office 365*

If you're like 99 percent of my clients, you're probably using 20 percent of Office 365. That's kind of crazy, isn't it -- considering that you own this amazing application and are barely using it. This year, my company is getting re-trained on Office 365, and I strongly recommend you do the same. The new features and applications in this suite -- Teams, Delve, Skype, Bookings, Business Intelligence, Outlook Customer Manager, Sway, etc. -- are quickly pulling Office 365 way ahead of its competitors and creating a fully integrated, cloud and mobile platform that is providing everything a business needs to run. And more is on the way: bots, artificial intelligence, developer tools, automation, reporting. It's all part of Microsoft's plan to provide fast, mobile and productive applications to its customers, and my prediction is this plan will succeed mightily.

*PayPal*

Getting paid is getting more complicated. Many companies have to worry about taking various credit cards and accepting mobile payment services. No one is dominating the field, and no one really knows which service -- Apple Pay, Google, Samsung -- will ultimately become the most popular. But there's one way to simplify it all. PayPal is positioned for both online and brick-and-mortar payments. It works with credit cards and mobile payment services. It's easy to set up at a very similar cost. It integrates with its own point of sale software applications as well as many others. It's secure, safe and fast. I'm predicting that many businesses will find themselves migrating to this platform if only for its ease and the reduced complexity it offers.

A version of this column originally appeared on Inc.com.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 5 hours ago.

2016 Health Care Year in Review

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Coauthored by David Squires

This was a tumultuous year in health care and elsewhere. Wherever we looked, the improbable and unbelievable became true and believable: from Brexit to a President-elect Trump to alleged foreign sabotage of our political institutions. Historians will dissect the remnants of these events for decades. For us, for now, let's focus on health care, which is plenty.

*Trump (and the Republicans) emerge ascendant.*

President-elect Donald Trump will take the oath of office on January 20, 2017, joined by Republican majorities in both houses of Congress, 68 of 99 state legislative chambers, and 31 of 50 governorships.

The Republican Party's commitment to repealing and replacing the Affordable Care Act could not be clearer, but stubborn political realities and technical issues are already forcing Congress to consider delaying the effective date of any repeal by up to four years. Though Republicans can accomplish a repeal without any help from Democrats (using the budget reconciliation process), patching together a replacement package will require eight Democratic votes in the Senate. That will be a challenge, as will managing the transition and finding consensus among divided Republicans on how or whether to cover the more than 20 million Americans who will likely lose insurance if the ACA is repealed.

Next year is likely to be fascinating for national health policy, both technically and politically. More important, the lives of tens of millions of Americans will be deeply affected by what the new Republican majority tries to do--and is able to accomplish.

*Uninsured rate hits historic low.*

During 2016, the proportion of Americans lacking health insurance reached an historic low: 8.9 percent. Since 2010, the number of Americans without insurance has fallen by more than 20 million. The result: fewer medical bill problems and more accessible and affordable care for patients, and less uncompensated care for providers.

*Premium increases and insurer exits raise concerns about ACA marketplaces.*

This was a turbulent year for the individual health insurance market. A number of high-profile insurers exited the marketplaces created under the Affordable Care Act. Double-digit premium increases in some marketplaces added to concern about their stability. However, the impact of these premium spikes on marketplace customers was dampened by federal subsidies that absorbed the costs for more than 80 percent of purchasers. And some of the premium growth likely reflected one-time adjustments to the expiration of time-limited federal programs (reinsurance, risk corridors) that had buffered insurers against unpredicted health expenditures among their new customers. While fears of marketplace collapse are overblown, these developments do signal the need for reforms in the ACA, should it survive the swelling efforts to repeal it.

Another point to keep in mind: in the employer-sponsored insurance market, where the majority of Americans get their insurance, premium growth has actually slowed since the passage of the Affordable Care Act.

*With MACRA looming, value-based payment spreads.*

The Centers for Medicare and Medicaid Services issued the final regulation implementing the Medicare Access and CHIP Reauthorization Act (MACRA) in 2016. MACRA will transform how Medicare pays clinicians and accelerate trends toward value-based payment, which is designed to pay for the value rather than the volume of services. As of early 2016, 30 percent of Medicare payments were tied to "alternative payment models," as were 25 percent of private insurers' payments. Whether the new administration will be as committed to payment reform as the departing one remains to be seen.

*The Innovation Center takes off the gloves.*

One player driving this payment transition assumed a more prominent role in 2016. The Center for Medicare and Medicaid Innovation (CMMI), created under the ACA, has broad authority to experiment with how our largest public insurance programs pay for services. This year, they took a fair amount of heat for making providers' participation in some of their payment experiments mandatory rather than voluntary, and were forced to abandon one demonstration reducing payments for medications under Part B of Medicare.

Rep. Tom Price (R-Ga.), Mr. Trump's nominee for Secretary of Health and Human Services, has been a vocal critic of CMMI and its mandatory payment demonstrations. He seems likely to scale back some of its programs, and a repeal of the ACA could eliminate CMMI altogether. However, a Secretary Price might also find some of CMMI's broad authorities to be useful once he settles into his new office.

*Bipartisan bill reforms FDA, increases R&D.*

The 21st Century Cures Act, a rare bipartisan initiative, was passed by Congress and signed by President Obama in 2016. The bill increases funding for the National Institutes of Health, including for pioneering cancer and genomic research, and reforms and boosts funding for the Food and Drug Administration's approval process for pharmaceuticals and medical devices. The new law also dedicates $1 billion over the next two years to fight the opioid scourge devastating much of the country. Little-heralded features of the law promote interoperability among electronic health records, and consumers' access to their own digital health records.

*Insurer mergers prompt an antitrust reckoning.*

Four of the country's largest insurers are trying to become two, but not if the current Justice Department has anything to say about it. In July 2016, U.S. Attorney General Loretta Lynch sued to block the Humana-Aetna and Anthem-Cigna mega-mergers, arguing that they would reduce competition and raise prices for consumers.

*Outrage over drug pricing yields smoke, but no fire, at least not yet.*

Sovaldi, Daraprim, Epipen--a spate of drug-pricing stories continued to grab headlines in 2016. Resulting congressional inquiries yielded numerous verbal floggings for drug company executives, but no concrete action to quell Americans' rising anger over their out-of-pocket spending for pharmaceuticals. President-elect Trump has pledged to control drug prices. Polls show that large majorities of the American public favor having Medicare negotiate drug prices, allowing drug reimportation from Canada, and other aggressive policies to reduce the growth in pharmaceutical spending. However, with Republicans in the majority, and pharma's lobbying muscle undisputed, the prospects of new legislation to deal with drug costs remain uncertain at best in 2017.

*Americans' lives are shortening.*

Finally, we learned this month that our life expectancy is going in the wrong direction. Though the change was small--a decline of about one month--it is just the latest evidence of disturbing deterioration in the general health of Americans, particularly working-class whites. The idea that for the first time in U.S. history our children may be less healthy than we are is deeply alarming, and should make improving the health of Americans a major national priority.

Here's hoping for a happy, productive, and HEALTHIER new year.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 6 hours ago.

CareSource buys downtown parking lot

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CareSource bought a downtown Dayton parking lot and is leasing an additional parking lot near where it is planning to construct a new building. The health insurance company bought the East Second Street parking lot, which is near where it is planning a new seven-story, 250,000-square-foot building to help house 900 employees with the growing company's workforce. That lot, and one it is leasing, will be used for staging during construction of the new building and for access to what will be a rear… Reported by bizjournals 1 hour ago.

When city retirement pays better than the job

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James Mussenden doesn’t bring up his pension in casual conversation. No point getting his golf partners’ blood boiling.

The retired city manager of El Monte collects more than $216,000 a year, plus cost-of-living increases and fully paid health insurance.

“It’s giving me an opportunity to do a... Reported by L.A. Times 13 hours ago.

Republican talk of dismantling Obamacare means insurers likely to bolt

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By J.B. Silvers, Case Western Reserve University
There's a joke among insurers that there are two things that health insurance companies hate to do - take risks and pay claims. But, of course, these are the essence of their business!Yet, if they do too much of either, they will go broke, and if they do too little, their customers will find a better policy. This balancing act isn't too hard if they have a pool sufficient to average out the highs and lows. I speak with some experience as the former CEO of one of these firms.Employee-sponsored insurance has fit this model fairly well, providing good stability and reasonable predictability. Unfortunately, the market for individuals has never worked well.Generally, this model forces insurers to take fewer risks so that they can still make money. They do this by excluding preexisting conditions and paying fewer claims. In such a market, fewer people are helped, and when they are able to get insurance, they pay a lot more for it than if they were part of an employee-sponsored plan.The Affordable Care Act changed all of this. Companies were required to stop doing these bad things. In exchange for taking on substantially more risk of less healthy patients, they were promised more business by getting access to more potential customers.The federal government offers subsidies to help pay the premiums for consumers whose income falls below a certain level. The law also stipulates that all people must be covered, or they face a penalty. This so-called individual mandate also guaranteed business for the insurance companies, because it led healthy people into the risk pool.To entice insurers into the market, the ACA also offered well-established methods to reduce risk. For example, it built in protections for insurers who enrolled especially sick people. It also provided back-up payments for very high-cost cases and protected against big losses and limited big gains in the first three years.These steps worked well in establishing a stable market for Medicare drug plans when this program started under President Bush in 2006. Competition there is vigorous, rates are lower than estimated and enrollees are satisfied. In other words, the market works well.
President Bush speaks on his Medicare Prescription Drug Benefit plan at the Asociacion Borinquena de Florida Central, Wednesday, May 10, 2006, in Orlando, Florida.
AP Photo/Pablo Martinez Monsivais

*Congress did not honor the deal*But when the time came to pay up for risk reduction in the Obamacare exchanges, Congress reneged and paid only 12 percent of what was owed to the insurers. So, on top of the fact that the companies had to bear the risk of unknown costs and utilization in the start-up years, which turned out to be higher than they expected, insurers had to absorb legislative uncertainty of whether the rules would be rewritten.It is no wonder that this year they have dramatically increased premiums, averaging 20 percent, to compensate for the extra risk they didn't factor into the original lower rates. In contrast, underlying health costs are rising at about 5 percent.
Is the ACA here to stay? In this June 25, 2015 file photo, demonstrators cheers after the Supreme Court decided that the Affordable Care Act (ACA) may provide nationwide tax subsidies.
AP Photo/Jacquelyn Martin, File

*Repeal and replace?*And now comes the reality of the "repeal and replace" initiatives from the Republicans. If the uncertainty of this market was large before with the ACA, it is almost unknowable under whatever comes next. Thus the initial exit of some latecomers, including United Healthcare, and undercapitalized minor entrants, such as nonprofit co-ops, is almost certain to become a flood of firms leaving the exchanges. They have little choice since the risks are too large and the actuarially appropriate rates are still not obvious given the political turmoil and changing rules.Some in Congress seem to think that passing the "repeal" part immediately but delaying its implementation for two or three years will somehow leave everything as it is now. But this naïve notion misses the fact that the riskiness of the Obamacare individual insurance exchange markets will have been ramped up to such a level that continuing makes no sense.Even if a company reaches break-even in the "delay" years, it will lose when the repeal is effective. If the premium subsidies now available to lower-income enrollees go away immediately and the mandate to sign up for an insurance plan disappears, then the number of people purchasing individual policies on the exchanges will drop like a rock. In fact, it is clear that even debating this scenario is likely to be self-fulfilling, since insurers must decide on their participation for 2018 by the late spring of 2017. Look for many to leave then.
But what will happen in 2018? The homepage for healthcare.gov as seen in October 2016.
AP Photo/Pablo Martinez Monsivais, File

*When risks are too high, just exit*It is easy to leave a market when things look bad. The health plan I oversaw, although top-rated by JD Powers, was losing huge amounts when I took over. Part of the turnaround we put into place was to withdraw from a number of counties where most of the losses were occurring. The same will be the case in the ACA exchanges.It is easy to predict that this induced uncertainty from Congress will effectively kill the exchanges even if it delays the implementation of repeal. As a result, all of the individuals who have benefited from coverage and subsidies will lose out. They will either not be able to gain insurance because of a preexisting condition, or they will not be able to afford the higher premiums.When they leave the market, it is also easy to guess that the political and economic price will be substantial in terms of patient access, provider uncompensated care costs and employment in the health sector - a major job creator. It is hard to predict these costs, but they could be into the billions of dollars. And, the health of millions could be jeopardized.Is there any way out of this dilemma for those who don't like Obamacare? Clearly the first principle, since all of the solutions suggested rely on private insurers, is to reduce the level of risk for them - the opposite of what we are doing now! Even House Speaker Paul Ryan's proposals rely on private firms which will be loath to trust the game they are asked to play because of the dramatic changes to the rules.If we want them to continue to do the good things required by the ACA, we can't make it so uncertain. What this means is that the mechanisms designed to reduce risk and a stable set of operating arrangements must be reaffirmed as core principles of all reform and replace efforts. This shouldn't be hard for market-oriented Republicans, if they can leave behind their political baggage. Blind talk of repeal with no clear way to build confidence among the private insurers, which will be needed in the replace phase, leads to market failure.Like the dog that finally caught the car it had been chasing and doesn't know what to do, what comes next for the administration and Congress is not clear. But we shouldn't fool ourselves to think it will be easy or painless. Otherwise, it may be that the great experiment trying to establish a viable market for individual insurance - ironically long a conservative objective - will end in the chaos of what came before.

J.B. Silvers, Professor of Health Finance, Case Western Reserve UniversityThis article was originally published on The Conversation. Read the original article.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 11 hours ago.

Republican Talk Of Dismantling Obamacare Means Insurers Likely To Bolt

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By J.B. Silvers, Case Western Reserve University
There's a joke among insurers that there are two things that health insurance companies hate to do - take risks and pay claims. But, of course, these are the essence of their business!Yet, if they do too much of either, they will go broke, and if they do too little, their customers will find a better policy. This balancing act isn't too hard if they have a pool sufficient to average out the highs and lows. I speak with some experience as the former CEO of one of these firms.Employee-sponsored insurance has fit this model fairly well, providing good stability and reasonable predictability. Unfortunately, the market for individuals has never worked well.Generally, this model forces insurers to take fewer risks so that they can still make money. They do this by excluding preexisting conditions and paying fewer claims. In such a market, fewer people are helped, and when they are able to get insurance, they pay a lot more for it than if they were part of an employee-sponsored plan.The Affordable Care Act changed all of this. Companies were required to stop doing these bad things. In exchange for taking on substantially more risk of less healthy patients, they were promised more business by getting access to more potential customers.The federal government offers subsidies to help pay the premiums for consumers whose income falls below a certain level. The law also stipulates that all people must be covered, or they face a penalty. This so-called individual mandate also guaranteed business for the insurance companies, because it led healthy people into the risk pool.To entice insurers into the market, the ACA also offered well-established methods to reduce risk. For example, it built in protections for insurers who enrolled especially sick people. It also provided back-up payments for very high-cost cases and protected against big losses and limited big gains in the first three years.These steps worked well in establishing a stable market for Medicare drug plans when this program started under President Bush in 2006. Competition there is vigorous, rates are lower than estimated and enrollees are satisfied. In other words, the market works well.*Congress did not honor the deal*But when the time came to pay up for risk reduction in the Obamacare exchanges, Congress reneged and paid only 12 percent of what was owed to the insurers. So, on top of the fact that the companies had to bear the risk of unknown costs and utilization in the start-up years, which turned out to be higher than they expected, insurers had to absorb legislative uncertainty of whether the rules would be rewritten.It is no wonder that this year they have dramatically increased premiums, averaging 20 percent, to compensate for the extra risk they didn't factor into the original lower rates. In contrast, underlying health costs are rising at about 5 percent.*Repeal and replace?*And now comes the reality of the "repeal and replace" initiatives from the Republicans. If the uncertainty of this market was large before with the ACA, it is almost unknowable under whatever comes next. Thus the initial exit of some latecomers, including United Healthcare, and undercapitalized minor entrants, such as nonprofit co-ops, is almost certain to become a flood of firms leaving the exchanges. They have little choice since the risks are too large and the actuarially appropriate rates are still not obvious given the political turmoil and changing rules.Some in Congress seem to think that passing the "repeal" part immediately but delaying its implementation for two or three years will somehow leave everything as it is now. But this naïve notion misses the fact that the riskiness of the Obamacare individual insurance exchange markets will have been ramped up to such a level that continuing makes no sense.Even if a company reaches break-even in the "delay" years, it will lose when the repeal is effective. If the premium subsidies now available to lower-income enrollees go away immediately and the mandate to sign up for an insurance plan disappears, then the number of people purchasing individual policies on the exchanges will drop like a rock. In fact, it is clear that even debating this scenario is likely to be self-fulfilling, since insurers must decide on their participation for 2018 by the late spring of 2017. Look for many to leave then.*When risks are too high, just exit*It is easy to leave a market when things look bad. The health plan I oversaw, although top-rated by JD Powers, was losing huge amounts when I took over. Part of the turnaround we put into place was to withdraw from a number of counties where most of the losses were occurring. The same will be the case in the ACA exchanges.It is easy to predict that this induced uncertainty from Congress will effectively kill the exchanges even if it delays the implementation of repeal. As a result, all of the individuals who have benefited from coverage and subsidies will lose out. They will either not be able to gain insurance because of a preexisting condition, or they will not be able to afford the higher premiums.When they leave the market, it is also easy to guess that the political and economic price will be substantial in terms of patient access, provider uncompensated care costs and employment in the health sector - a major job creator. It is hard to predict these costs, but they could be into the billions of dollars. And, the health of millions could be jeopardized.Is there any way out of this dilemma for those who don't like Obamacare? Clearly the first principle, since all of the solutions suggested rely on private insurers, is to reduce the level of risk for them - the opposite of what we are doing now! Even House Speaker Paul Ryan's proposals rely on private firms which will be loath to trust the game they are asked to play because of the dramatic changes to the rules.If we want them to continue to do the good things required by the ACA, we can't make it so uncertain. What this means is that the mechanisms designed to reduce risk and a stable set of operating arrangements must be reaffirmed as core principles of all reform and replace efforts. This shouldn't be hard for market-oriented Republicans, if they can leave behind their political baggage. Blind talk of repeal with no clear way to build confidence among the private insurers, which will be needed in the replace phase, leads to market failure.Like the dog that finally caught the car it had been chasing and doesn't know what to do, what comes next for the administration and Congress is not clear. But we shouldn't fool ourselves to think it will be easy or painless. Otherwise, it may be that the great experiment trying to establish a viable market for individual insurance - ironically long a conservative objective - will end in the chaos of what came before.

J.B. Silvers, Professor of Health Finance, Case Western Reserve UniversityThis article was originally published on The Conversation. Read the original article.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 10 hours ago.

'Minister's village stay will be constructive only if programmes are implemente

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*MLC Kota Srinivas Poojary said the hype created following the proposed village stay of the Social Welfare Minister H Anjaneya in Kalthodu village in Murur will be constructive only when the minister ensures that the development programmes announced by him are executed effectively.*

He told reporters that the minister's stay in the house of one Marli of Koraga community in Kalthodu village in Murur is laudable. But just a visit will not solve the problems of the community. Earlier, the minister had stayed in the house of one Baby in Padupanamburu village in Moodbidri on April 14, 2015.

Though he had announced several development programmes after the stay, none of them have been implemented. Projects worth Rs 10 crore have been announced by the minister during the period of eight months. The tendering process also has not been taken up, he regretted.

The MLC challenged the minister that the projects announced after the village stay by him should be completed within six months. If he fails to ensure effective implementation of the programmes announced by him, people will not trust him and his village stay anymore, he cautioned.

He said funds have not been released in the past three years to provide drinking water facilities in Koraga colonies. Rs 2.11 crore was released to provide basic facilities in Koraga colonies from 2008 to 2013, Rs 1.76 lakh for self-employment programme and Rs 7 lakh to develop the land allotted by the government respectively. A total of Rs 4.82 lakh was released for digging individual wells, the MLC said.

He said Koragas are unable to construct houses and the amount assured by the government is insufficient owing to the inflation. The issue was raised in the KDP meeting and a decision has been taken to hike the amount to Rs 4.50 lakh and ensure the responsibility of constructing the houses to Nirmiti Kendra. More than 500 members of Koraga community are in the waiting list.

More than 1,000 Dalit families have been residing in private land and are unable to procure the title deeds. He urged the minister to instruct the deputy commissioner to acquire the land and offer title deeds to Dalits. There are nearly 2,600 Koraga families with 11,133 population. Health allocations have not been released in the past three years.

He sought permanent health insurance, where the Koraga community people should be entitled to the reimbursement of all medical expenses and the government should take care of the medical expenses in the lifetime of each Koraga individual. Reported by Deccan Herald 5 hours ago.

I’m a former health insurance CEO and here’s why the GOP’s health care ideas won’t work

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There’s a joke among insurers that there are two things that health insurance companies hate to do – take risks and pay claims. But, of course, these are the essence of their business! Yet, if they do too much of either, they will go broke, and if they do too little, their customers will find a bett... Reported by Raw Story 10 hours ago.
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