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New Lines of Attack Form Against the Affordable Care Act

August 20, 2024/in Healthcare News/by admin

The Affordable Care Act is back under attack. Not as in the repeal-and-replace debates of yore, but in a fresher take from Republican lawmakers who say key parts of the ACA cost taxpayers too much and provide incentive for fraud.

Several House Republican leaders have called on two watchdog agencies to investigate, while Sen. Chuck Grassley (R-Iowa) fired off more than half a dozen questions in a recent letter to the Centers for Medicare & Medicaid Services.

At issue are the ACA’s enhanced subsidies, put in place during the covid-19 pandemic as part of economic recovery legislation. Grassley said in a recent news release that the subsidies “left Obamacare, a program already riddled with problems, wide open to new waste, fraud and abuse.”

While potential fraud in government programs has always been a rallying cry for conservatives, the recent criticisms are a renewed line of attack on the ACA because repealing it is unlikely, given that more than 21 million people enrolled in marketplace plans for this year.

“I see what’s happening right now as laying the groundwork for the big fight next year,” said Debbie Curtis, a vice president at consulting firm McDermott+.

The enhanced subsidies are set to expire in late 2025. Without them, millions of Americans would likely see their premiums go up.

But the debate will also likely draw in other issues, including Trump-era tax cuts, which also must be addressed next year. Also potentially in play are other aspects of the ACA, including a special year-round enrollment period and zero-premium plans for low-income consumers.

Much of what eventually happens will depend on the makeup of the Senate and House, as well as control of the White House, after the November elections.

“The fate of the enhanced tax credits is dependent on the Democrats holding some majority in Congress and/or winning the presidency and is also tied inextricably to the Trump tax cut expiration,” said Dean Rosen, a partner at Mehlman Consulting and a former senior Republican congressional staffer. That’s because both sides have incentive to extend all or part of the tax cuts, but each will want some kind of compromise on other issues as well.

The growing outcry by Republicans about the subsidies goes hand in hand with a controversial recent report from a conservative think tank that estimates millions of people — or their brokers — may be misstating their incomes and getting the most generous ACA subsidies.

The Paragon Health Institute report estimates that the number of people who enrolled in ACA coverage for this year who projected they would earn between 100% of the federal poverty level and 150% — amounts that qualify them for zero-premium plans and smaller deductibles — likely exceeds the number of people with that level of income, particularly in nine states.

It recommends several changes to the ACA, including letting the enhanced subsidies expire, increasing repayment amounts for people who fail to project their incomes correctly, and ending the Biden-backed initiative that allows very low-income people to enroll in ACA coverage year-round rather than having to wait for the once-a-year general open enrollment period.

The Paragon report was cited by both Grassley and the House GOP lawmakers in their letters to government overseers. It also notes what they consider a related concern: ongoing problems of unscrupulous, commission-seeking agents enrolling people in ACA coverage or switching their plans without their permission, often into highly subsidized plans. KFF Health News uncovered the enrollment and switching schemes in the spring.

Some critics, though, question how the Paragon analysis was done.

For instance, Paragon’s findings rely on two unrelated data sets from different years. Combining them makes many people who are eligible for subsidies appear to be ineligible, said Gideon Lukens, a senior fellow and director of research at the Center on Budget and Policy Priorities. “The analytic approach is not careful or sophisticated enough to provide accurate or even meaningful results.”

Paragon President Brian Blase, a former senior Trump administration official and a co-author of the report, said it used publicly available data that others could use to confirm its results.

Paragon’s recommendations also drew mixed reactions.

Sabrina Corlette, a co-director of the Center on Health Insurance Reforms at Georgetown University, said they “would make coverage less affordable, disproportionately affecting low-income people, and that’s the opposite of the goals of the ACA.”

Another ACA expert, Joseph Antos of the conservative American Enterprise Institute, agrees with one of the recommended fixes: changing the structure of the subsidies to limit zero-premium plans.

“Giving health insurance away is the problem,” said Antos, who said it is probably contributing to the unauthorized switching by some rogue brokers, who know if they sign someone up for a free plan without their permission, they’re unlikely to get caught for a while because the person won’t get monthly bills.

Another potential solution to people misstating their income is that “the seven or eight states that still haven’t expanded Medicaid should do that,” Antos said. The expansion would open Medicaid eligibility to more people who earn less than the poverty level, reducing the incentive to overestimate their income to qualify for ACA subsidies.

Among other things, the subsidies are larger now for low-income enrollees. For example, families at the poverty level or just above it ($30,000 to $45,000 for a family of four) can currently qualify for coverage with no monthly premium, whereas before they would have had to pay 2% to 4% of their annual income toward such a plan.

President Joe Biden has pushed to make the subsidies permanent and has often touted the record enrollment in ACA plans under his watch. Across all income groups, nearly 20 million people out of 21 million ACA enrollees this year got at least some subsidy, according to a KFF report.

Subsidies, also called premium tax credits, are generally paid directly to health insurers, and applicants must estimate their income for the coming year to qualify.

Those who incorrectly project their incomes — possibly because they work irregular retail hours, are self-employed and give a best guess of business, or get an unexpected raise or a new job — must pay back all or part of the subsidy, on a sliding scale linked to income.

The cost of the enhanced subsidies has been sharply criticized by some GOP leaders after the Congressional Budget Office recently estimated that making them permanent would add $335 billion to the federal budget deficit over 10 years.

Democrats have pointed to another recent CBO report estimating extending the Trump-era tax cuts would add $4.6 trillion to the deficit over 10 years.

The enhanced subsidies “cost a lot less than that and it’s actually helping people,” Curtis said.

Ultimately, “every health care debate comes down to money,” said Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit that includes KFF Health News. “There is a trade-off here. Millions of people have gotten coverage and more affordable premiums due to these enhanced subsidies, but extending them would cost the government a lot of money.”

Despite the attention paid by some GOP lawmakers to the fraud concerns, many political observers say they don’t think they will play a direct role during the election campaigns of either party.

“For Republicans, they’ll stay away from health care period. It is not a winning campaign issue for them,” Curtis said. “With Harris’ campaign, we will see a continued drive for affordable coverage being key, particularly drug costs. In neither party will you hear much about the importance of extending the enhanced subsidies. It’s too complicated.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

The Supreme Court Just Limited Federal Power. Health Care Is Feeling the Shockwaves.

July 23, 2024/in Healthcare News/by admin

By Stephanie Armour

A landmark Supreme Court decision that reins in federal agencies’ authority is expected to hold dramatic consequences for the nation’s health care system, calling into question government rules on anything from consumer protections for patients to drug safety to nursing home care.

The June 28 decision overturns a 1984 precedent that said courts should give deference to federal agencies in legal challenges over their regulatory or scientific decisions. Instead of giving priority to agencies, courts will now exercise their own independent judgment about what Congress intended when drafting a particular law.

The ruling will likely have seismic ramifications for health policy. A flood of litigation — with plaintiffs like small businesses, drugmakers, and hospitals challenging regulations they say aren’t specified in the law — could leave the country with a patchwork of disparate health regulations varying by location.

Agencies such as the FDA are likely to be far more cautious in drafting regulations, Congress is expected to take more time fleshing out legislation to avoid legal challenges, and judges will be more apt to overrule current and future regulations.

Health policy leaders say patients, providers, and health systems should brace for more uncertainty and less stability in the health care system. Even routine government functions such as deciding the rate to pay doctors for treating Medicare beneficiaries could become embroiled in long legal battles that disrupt patient care or strain providers to adapt.

Groups that oppose a regulation could search for and secure partisan judges to roll back agency decision-making, said Andrew Twinamatsiko, director of the Health Policy and the Law Initiative at Georgetown University’s O’Neill Institute. One example could be challenges to the FDA’s approval of a medication used in abortions, which survived a Supreme Court challenge this term on a technicality.

“Judges will be more emboldened to second-guess agencies,” he said. “It’s going to open agencies up to attacks.”

Regulations are effectively the technical instructions for laws written by Congress. Federal agency staffers with knowledge related to a law — say, in drugs that treat rare diseases or health care for seniors — decide how to translate Congress’ words into action with input from industry, advocates, and the public.

Up until now, when agencies issued a regulation, a single rule typically applied nationwide. Following the high court ruling, however, lawsuits filed in more than one jurisdiction could result in contradictory rulings and regulatory requirements — meaning health care policies for patients, providers, or insurers could differ greatly from one area to another.

One circuit may uphold a regulation from the Centers for Disease Control and Prevention, for example, while other circuits may take different views.

“You could have eight or nine of 11 different views of the courts,” said William Buzbee, a professor at Georgetown Law.

A court in one circuit could issue a nationwide injunction to enforce its interpretation while another circuit disagrees, said Maura Monaghan, a partner at Debevoise & Plimpton. Few cases are taken up by the U.S. Supreme Court, which could leave clashing directives in place for many years.

In the immediate future, health policy leaders say agencies should brace for more litigation over controversial initiatives. A requirement that most Affordable Care Act health plans cover preventive services, for example, is already being litigated. Multiple challenges to the mandate could mean different coverage requirements for preventive care depending on where a consumer lives.

Drugmakers have sued to try to stop the Biden administration from implementing a federal law that forces makers of the most expensive drugs to negotiate prices with Medicare — a key cog in President Joe Biden’s effort to lower drug prices and control health care costs.

Parts of the health care industry may take on reimbursement rates for doctors that are set by the Centers for Medicare & Medicaid Services because those specific rates aren’t written into law. The agency issues rules updating payment rates in Medicare, a health insurance program for people 65 or older and younger people with disabilities. Groups representing doctors and hospitals regularly flock to Washington, D.C., to lobby against trims to their payment rates.

And providers, including those backed by deep-pocketed investors, have sued to block federal surprise-billing legislation. The No Surprises Act, which passed in 2020 and took effect for most people in 2022, aims to protect patients from unexpected, out-of-network medical bills, especially in emergencies. The high court’s ruling is expected to spur more litigation over its implementation.

“This really is going to create a tectonic change in the administrative regulatory landscape,” Twinamatsiko said. “The approach since 1984 has created stability. When the FDA or CDC adopt regulations, they know those regulations will be respected. That has been taken back.”

Industry groups, including the American Hospital Association and AHIP, an insurers’ trade group, declined to comment.

Agencies such as the FDA that take advantage of their regulatory authority to make specific decisions, such as the granting of exclusive marketing rights upon approval of a drug, will be vulnerable. The reason: Many of their decisions require discretion as opposed to being explicitly defined by federal law, said Joseph Ross, a professor of medicine and public health at Yale School of Medicine.

“The legislation that guides much of the work in the health space, such as FDA and CMS, is not prescriptive,” he said.

In fact, FDA Commissioner Robert Califf said in an episode of the “Healthcare Unfiltered” podcast last year that he was “very worried” about the disruption from judges overruling his agency’s scientific decisions.

The high court’s ruling will be especially significant for the nation’s federal health agencies because their regulations are often complex, creating the opportunity for more pitched legal battles.

Challenges that may not have succeeded in courts because of the deference to agencies could now find more favorable outcomes.

“A whole host of existing regulations could be vulnerable,” said Larry Levitt, executive vice president for health policy at KFF.

Other consequences are possible. Congress may attempt to flesh out more details when drafting legislation to avoid challenges — an approach that may increase partisan standoffs and slow down an already glacial pace in passing legislation, Levitt said.

Agencies are expected to be far more cautious in writing regulations to be sure they don’t go beyond the contours of the law.

The Supreme Court’s 6-3 decision overturned Chevron U.S.A. v. Natural Resources Defense Council, which held that courts should generally back a federal agency’s statutory interpretation as long as it was reasonable. Republicans have largely praised the new ruling as necessary for ensuring agencies don’t overstep their authority, while Democrats said in the aftermath of the decision that it amounts to a judicial power grab.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Benefits of Group Health Insurance Plans

May 28, 2024/in Health and Wellness, Healthcare News/by admin

Group health insurance policies offer several advantages over individual plans. Many employers provide supplemental health plans, which include dental, vision, and pharmacy coverage, either separately or as a bundle.

Among the leading benefits of group plans are lower premiums and the ability to include family members and dependents. This option, available at an additional cost to members, can be a lifeline for families with sole providers or those facing high prices for alternative or individual health plans.

Group health insurance plans provide numerous tax benefits to employers and employees. The money employers pay towards monthly premiums is tax-deductible, and employees’ premium payments can be made pre-tax, thereby reducing their total taxable income.

Small businesses may also qualify for the small business healthcare tax credit. The credit benefits an employer with fewer than 25 full-time employees who pay average wages of less than $50,000 a year. The employer offers a qualified health plan through the Small Business Health Options Program (SHOP) Marketplace and pays at least 50% of the cost of health care coverage for each employee (but not for family or dependents).

Who Can Sign Up for Group Health Insurance?

Understanding the eligibility criteria for group health insurance is crucial. Generally, an employee must be on the payroll, and the employer must pay payroll taxes to be eligible. However, there are exceptions. Independent contractors, retirees, and seasonal or temporary employees are usually not eligible. Similarly, employees on unpaid leave may not be covered until they return to work. Explicit knowledge of these criteria can help employers and employees make informed decisions.

Group health insurance coverage must also be offered to an employee’s spouse and dependent children until age 26, though employers may choose to expand the age definition for child dependents. Employers may also opt to extend health benefits to unmarried partners of the same or opposite sex.

How to Enroll in Group Health Insurance

Enrollment in a group health care plan your employer provides is generally available at the beginning of employment. Employees often must wait until the annual open enrollment period to join if the enrollment deadline is missed. Some employers may wait up to 90 days before new employee health insurance is available. Employees do not pay premiums during this time, but you won’t have access to health care coverage.

Many group health insurance plans offer different tiers and/or supplemental coverage, such as dental, vision, and/or pharmacy. These options are initially elected when an employee enrolls and may be changed and updated during future open enrollment periods. In the event of a significant life event such as a marriage, the birth of a child, or a spouse’s loss of employment, you may be able to enroll these new dependents in your group health insurance plan outside the open enrollment period.

Where to Find Group Health Insurance Plans

The most common way to get group health insurance coverage is through an employer. If your employer doesn’t offer health insurance due to the company’s small size or you are unsatisfied with your employer’s coverage options, you may seek coverage through a membership organization.

Group Health Insurance for the Self-Employed

According to a 2020 report from the U.S. Small Business Administration Office of Advocacy, approximately 25.7 million small businesses in 2017 were considered “non-employers,” or businesses with no paid employees. If your business has no employees, you’re considered a small group of one.

Even though you’re self-employed, you may be able to buy group health insurance for your company in certain states. Check with your state’s insurance department to determine whether your state allows group policies to be sold to groups of one.

What to Do If You Lose Your Group Health Benefits

You will likely lose your employer-sponsored group health insurance if you lose your job. However, you and your dependents may be able to keep this coverage through continuation coverage.

In 1985, Congress passed the Consolidated Omnibus Budget Reconciliation Act (COBRA), which allows employees who lose their jobs to buy group health coverage for themselves or their families for a limited time. Under COBRA, the same group insurance plan with the same benefits must be made available to the terminated worker; however, the former employee must pay the total cost—including whatever the employer has previously covered—of the plan.

Continuation coverage is often much more expensive than an individual health insurance plan, so consider the price, benefits, and provider network carefully before temporarily keeping coverage through continuation coverage instead of moving to an individual plan.

March 2024 Health Observances

February 28, 2024/in Health and Wellness, Healthcare News/by admin

Throughout the year, health observances raise awareness for various conditions and remind consumers to stay on top of their health. Hospitals, healthcare nonprofits, patients, media outlets, and even influencers celebrate these days, weeks, and months. Here is a list of the health observances taking place this month:

Traumatic Brain Injury Awareness Month
Brain Injury Association of America
www.biausa.org/public-affairs/public-awareness/brain-injury-awareness

National Colorectal Cancer Awareness Month
Colorectal Cancer Alliance
www.ccalliance.org/about/awareness-month

National Kidney Month
National Kidney Foundation
www.kidney.org/content/national-kidney-month

National MS Education and Awareness Month®
National Multiple Sclerosis Society
msfocus.org/Get-Involved/MS-Awareness-Month

National Nutrition Month
U.S. Department of Housing and Urban Development
www.hud.gov/program_offices/public_indian_housing/programs/ph/nnw/Nutrition

Workplace Eye Wellness Month
American Academy of Ophthalmology
www.aao.org/newsroom/observances

March 3, 2024
World Birth Defects Day
Brain Injury Association of America
www.worldbirthdefectsday.org/

March 9, 2024
World Kidney Day
www.worldkidneyday.org/2023-campaign

March 10-16, 2024
National Sleep Awareness Week
National Sleep Foundation
www.thensf.org/sleep-awareness-week

March 11-17, 2024
Brain Awareness Week
www.brainawareness.org/

March 15, 2024
World Sleep Day
worldsleepday.org

March 18-24, 2024
National Drug and Alcohol Facts Week
National Institute on Drug Abuse
nida.nih.gov/research-topics/national-drug-alcohol-facts-week

Bold Changes Are in Store for Medi-Cal in 2024, but Will Patients Benefit?

January 1, 2024/in Healthcare News/by admin

By Bernard J. Wolfson

California’s safety-net health program, Medi-Cal, is on the cusp of major changes that could rectify long-standing problems and improve health care for the state’s low-income population.

Starting Jan. 1, Medi-Cal, California’s Medicaid program, implemented new standardized contracts with its 22 managed care health plans, which collectively cover 99% of enrollees. The new contracts tighten enforcement of quality measures, especially for women and children; require the health plans to report publicly on the performance of medical providers ― and in some cases other insurers ― to whom they delegate care; and mandate that plans reveal the number of enrollees who don’t have access to primary care and invest more to plug the gap. They also commit plans to better integration of physical and mental health care and greater responsiveness to the cultural and linguistic needs, sexual orientation, and gender identity of members.

To realize these promises, state regulators will have to be tougher than they have been in the past.

But that might be difficult, because the changes are happening at the same time as a number of other initiatives that could compete for staff attention and confuse some enrollees.

Beginning next year, over 700,000 immigrants without permanent legal residency will become eligible for full Medi-Cal coverage. In addition, an estimated 1.2 million beneficiaries in 21 counties will need to change health plans after the state last year rejiggered the constellation of insurers and multiple counties switched the way they deliver Medi-Cal. Some counties will have only one plan left. Where there is more than one, enrollees who are losing their plan will have to choose a new one.

Kaiser Permanente, the Oakland-based managed care giant, will start a new direct contract with the state in 32 counties, largely an administrative shift that should not disrupt care for most enrollees. And thousands of Medi-Cal enrollees in residential care will be switched into managed care plans for the first time, as the state accelerates its move away from traditional, direct-pay Medi-Cal.

All of this is happening amid the so-called unwinding, in which over 900,000 people have been shed from Medi-Cal thus far, and disenrollments are expected to continue until next summer. The unwinding follows the termination of pandemic-era protections.

“My head is spinning thinking about all of that going on at the same time,” says John Baackes, CEO of L.A. Care Health Plan, the state’s largest Medi-Cal plan, with nearly 2.6 million members. “Our call center is stacked to the gills.”

Tony Cava, spokesperson for the Department of Health Care Services, which oversees Medi-Cal, says the new contracts, signed by all the Medi-Cal managed care plans, will provide for “quality, equitable, and comprehensive coverage,” emphasizing prevention and “offering services that address long-term care needs throughout a member’s life.”

And in a groundbreaking move, the new contracts also require health plans for the first time to reinvest a portion of their profits ― between 5% and 7.5% ― in the communities where they operate.

They also provide a number of carrots and sticks, which include withholding a small percentage of payments to health plans with a chance for them to earn it back by reaching quality and health equity benchmarks. And profitable health plans that don’t meet expectations will have to reinvest an additional 7.5% of their profits in the community. This is all on top of increased fines that regulators can levy on poorly performing health plans.

The new Medi-Cal contracts also enshrine key elements of CalAIM, a $12 billion, five-year experiment, already underway, in which health plans aim to provide a range of social services for the neediest Medi-Cal members, including housing assistance and medically tailored meals, on the grounds that poverty and related social inequities are often the root of health problems. So far, however, the rollout has been slow.

Abbi Coursolle, senior attorney in the Los Angeles office of the National Health Law Program, says the requirement for health plans to report publicly on the care provided by their subcontracted medical providers should increase accountability, helping enrollees better navigate Medi-Cal.

“This is a step forward that advocates have been paying attention to for over a decade,” Coursolle says. “There’s so much ping-ponging people back and forth between the health plan and the provider group. That dilutes accountability so much.”

Another big change for Medi-Cal is the elimination of the so-called asset limit test for a certain subset of enrollees, including people who are aged, blind, disabled, in long-term care, or on Medicare. In addition to meeting income requirements, people have had to keep the total value of their personal assets below certain thresholds to qualify for Medi-Cal. The assets that are counted include savings, certain investments, second homes, and even second cars.

Until last year, those limits were so low ― $2,000 for an individual ― that people had virtually no ability to accumulate savings if they wanted to be on Medi-Cal. In mid-2022, however, the limit was raised to $130,000, which meant that for the majority of people subject to the test, assets were no longer a barrier to eligibility. In 2024, the asset test will be eliminated altogether.

But given last year’s change, the total elimination will likely generate only a few thousand new Medi-Cal enrollees. Still, it should save people the bureaucratic headache of having to prove they’re below a certain asset threshold.

If you want to learn more about the asset limit test, the DHCS has an FAQ on the subject on its website (dhcs.ca.gov).

If you wonder whether you are among the 1.2 million Medi-Cal members who need to change health plans, and you haven’t already received communication on the subject, the department has an online tool to tell you the plans that will be available in your county as of Jan. 1.

Nearly half the people who need to switch plans are Health Net members in Los Angeles County who are being transferred to Molina Healthcare as part of a compromise agreement the state struck last year to avoid becoming mired in lawsuits by angry health plans that lost out in a bidding competition.

If you need to change plans and you’re lucky, your doctors may be in the new plan. Make sure to check. If they are not, you may be able keep them for up to a year or long enough to finish a course of treatment that is already underway. The DHCS provides a fact sheet outlining your rights to continuity. You can also contact your current health plan for additional information or ask your county Medi-Cal office. The Health Consumer Alliance (1-888‑804‑3536, or healthconsumer.org) is another source of information and assistance, as is Medi-Cal’s managed care ombudsman (1-888-452-8609, or MMCDOmbudsmanOffice@dhcs.ca.gov)

Despite the state’s best intentions, an acute shortage of medical professionals could be a big obstacle. “As these coverage expansions are happening, and as this innovation is happening, it is being built on a health workforce that is already strained,” says Berenice Nuñez Constant, senior vice president for government relations at AltaMed Health Services, one of the state’s largest community clinic groups.

Labor shortage or not, the health plans must deliver on their contractual obligations. Anthony Wright, executive director of the advocacy group Health Access California, says, “On some level, this is about holding the plans accountable for what they are promising and getting tens of billions of dollars for.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

October is Breast Cancer Awareness Month!

October 2, 2023/in Health and Wellness, Healthcare News/by admin

Did you know? Each year, breast cancer affects one in eight women in the United States and 2.3 million women worldwide.

Breast Cancer Awareness Month aims to promote breast cancer screening and prevention, as well as fundraising. Known best for its pink theme color, Breast Cancer Awareness Month was created to help:

Support those diagnosed with breast cancer, including metastatic breast cancer
Educate people about breast cancer risk factors
Communicate the importance of regular screening, starting at age 40 or an age that’s appropriate for your personal breast cancer risk
Fundraise for breast cancer research

As part of the national health observation, October 13 is nationally recognized in the United States as Metastatic Breast Cancer Awareness Day. About 30% of early-stage breast cancers eventually metastasize (spread to parts of the body away from the breast), and the day is intended to drive awareness of the need for more research about metastatic disease.

Additionally, in 2021, U.S. President Joe Biden designated October 17 to October 23 Men’s Breast Cancer Awareness Week. Although breast cancer is much more common in women, roughly 2,710 American men are expected to be diagnosed with breast cancer each year, of which an estimated 530 cases are expected to result in death. While some men, trans men, and non-binary people choose to call their cancer chest cancer, general lack of awareness and stigma are common barriers to male breast cancer detection and care, making this week of observation especially important.

*This information is provided by Breastcancer.org.
Donate to support free resources and programming for people affected by breast cancer.

We invite you to browse the following links to learn more about Breast Cancer Awareness Month and the ways to you can help spread awareness and lend support:

Learn more about breast cancer

Things to do this Breast Cancer Awareness Month

https://www.breastcancer.org/

https://www.nationalbreastcancer.org/breast-cancer-awareness-month/https://www.komen.org/about-komen/our-impact/breast-cancer/breast-cancer-awareness-month/

Everything Old Is New Again? The Latest Round of Health Policy Proposals Reprises Existing Ideas

August 1, 2023/in Healthcare News/by admin

By Julie Appleby

Forget “repeal and replace,” an oft-repeated Republican rallying cry against the Affordable Care Act.

House Republicans have advanced a package of bills that could reduce health insurance costs for certain businesses and consumers, partly by rolling back some consumer protections. Rather than outright repeal, however, the subtler effort could allow more employers to bypass the landmark health insurance overhaul’s basic benefits requirements and most state standards.

At the same time, the Biden administration seeks to undo some of the previous administration’s health insurance rules, proposing to retighten regulations for short-term plans.

Health policy experts aren’t surprised. Most of the GOP policy ideas have long drawn Republican support, have raised concern from Democrats about reduced consumer protections, and could fall under the theme: Everything old is new again.

Association Health Plans. Self-insurance. Giving workers money to buy their own individual coverage instead of offering a group plan. These are the buzzwords and, ultimately, revolve around one issue, said Joseph Antos, a senior fellow at the American Enterprise Institute, a Washington, D.C.-based think tank. “The real problem is the rising cost of health care. Always has been,” he said. And that problem, he added, is larger than the proposed solutions.

“It’s not clear that this kind of an approach would substantially help very many people,” Antos said.

The latest round of rules and legislation comes as the ACA — passed in 2010 — is now cemented in the system. More than 16 million people enrolled in their own plans this year, and millions more are getting coverage through expanded Medicaid in all but 10 states, leading to an all-time-low uninsured rate.

But even with enhanced subsidies for ACA health plans, initially approved in the American Rescue Plan and extended through 2025 by the Inflation Reduction Act, some people still struggle to afford deductibles or other costs, and employers — especially small ones — have long wrestled with rising insurance costs and the ability to offer coverage at all.

So, what is on the table in Washington? First, a caveat: Little is likely to happen in an election year.

While the Biden administration’s proposed regulations on short-term plans are likely to go into effect, either this year or early next, the GOP’s House-passed legislation — dubbed the CHOICE Arrangement Act, for Custom Health Option and Individual Care Expense — is unlikely to win favor in the Democratic-controlled Senate. If Republicans were to retake the Senate and White House, though, it illustrates the health policy direction they could take.

Here are the broad issues on the radar:

From the President’s Desk: Limits on Short-Term Policies

These types of plans have been sold for decades, often as a stopgap measure for people between jobs.

They can be far less expensive than more traditional coverage because short-term plans vary widely and “run the gamut from comprehensive policies to fairly minimal policies,” said Louise Norris, an insurance broker who regularly writes about health policy.

The plans don’t have to cover all the benefits required of ACA plans, for example, and can bar coverage for preexisting medical conditions, can set annual or lifetime limits, and often don’t include maternity care or prescription drugs. Despite notices warning of such policies’ limitations, consumers may not realize what isn’t covered until they try to use the plan.

Concerned that people would choose this option instead of more comprehensive and more expensive insurance offered through the ACA, President Barack Obama’s administration set rules limiting the policy terms to three months.

President Donald Trump’s administration loosened those rules, allowing plans to again be sold as 364-day policies, and adding the ability for insurers to renew them for up to three years. Now President Joe Biden, whose representatives have called such plans “junk insurance,” proposes reining those in again, restricting policies to four months, at most.

The Biden proposal cites estimates from the Congressional Budget Office and the Joint Committee on Taxation that about 1.5 million people are enrolled in such plans.

Michael Cannon, director of health policy studies at the Cato Institute, a Washington, D.C.-based libertarian think tank, decried the proposed rule in an opinion piece published by The Hill. He wrote that the Biden proposal removes an important lower-cost alternative and could leave some consumers facing “sky-high medical bills for up to one year” if their policies expire between open enrollment periods for ACA plans.

The real fight comes down to defining “short-term,” said John McDonough, a professor of public health practice at the Harvard T.H. Chan School of Public Health in Boston, who worked on the original ACA legislation.

Progressives and Democrats support the view that “short-term” should end after four months and “then people go into an ACA plan or Medicaid,” he said. “Republicans and conservatives would like this to be an alternative permanent coverage model for folks, some of whom legitimately know what they are getting and are willing to roll the dice.”

Association Health Plans, Self-Insurance, and Other Workplace Issues

Meanwhile, the House-passed CHOICE Arrangement Act, among other things, would allow more self-employed people and businesses to band together to buy Association Health Plans, which are essentially large group plans purchased by multiple employers.

These can be less expensive because they don’t have to meet all ACA requirements, such as covering a specified set of benefits that includes hospitalization, prescription drugs, and mental health care. Historically, some also have had solvency issues and state regulators have investigated claims of false advertising by certain association plans.

Another piece of the legislation would help more small employers self-insure, which also allows them to bypass many ACA requirements and most state insurance rules.

Both proposals represent a “chipping away at the foundation edges of the ACA structure,” said McDonough.

The package also codifies Trump-era regulations allowing employers to provide workers with tax-free contributions to shop for their own insurance, so long as it is an ACA-qualified plan, a benefit known as an individual coverage Health Reimbursement Account.

The CHOICE Arrangement Act “will go a long way toward reducing insurance costs for employers, ensuring that workers continue to have access to high-quality, affordable health care,” said Rep. Tom Cole (R-Okla.) in prepared remarks as the bill went before the House Committee on Rules in June.

Giving workers a set amount of money to buy their own coverage allows employees to choose what works best for them, supporters say. Critics warn that many workers may be unprepared to shop and that the effort by some employers might prove discriminatory.

”Firms may find strategies to shift sicker workers to HRAs, even with guardrails in the legislation meant to prevent this,” according to a blog post from the Center on Budget and Policy Priorities.

Not so, said Robin Paoli, executive director of the HRA Council, a nonprofit advocacy organization whose members include insurers, employers, and other organizations that support such individual accounts.

Employers have some discretion in choosing which groups of employees are offered such accounts, often based on geography, but cannot create a group made up solely of “people over 65, or a class of sick people,” said Paoli. “The rules absolutely prohibit discrimination based on age or health condition.”

The other two ideas — associations and the self-insured proposal — have drawn opposition from the National Association of Insurance Commissioners, which wrote to House leaders that the package “threatens the authority of states to protect consumers and markets” because it affects the ability of states to regulate such plans.

Current law allows businesses in the same industry to band together to buy coverage, essentially creating a larger pool that then can, theoretically, wield more negotiating clout and get better rates.

The House legislation would make changes to allow more self-employed people and businesses that aren’t in the same industry to do the same.

Some policy experts said expanding access to association plans and self-insurance to smaller businesses might adversely affect some workers by drawing healthier people out of the overall market for small-group insurance and potentially raising premiums for those who remain.

“The big picture of what these bills do is allow [employers and] insurance companies to get out from under the ACA standards and protections and offer cheaper insurance to younger and healthier employee groups,” said Sabrina Corlette, a researcher and the co-director of the Center on Health Insurance Reforms at Georgetown University.

But attorney Christopher Condeluci, who worked with GOP lawmakers in drafting the legislation, takes a different view. The entire GOP package, he said, represents “improvements to the status quo” that are needed because small businesses and individuals are confronting “health costs continuing to rise” and “out-of-pocket costs continuing to increase.”

AI May Be on Its Way to Your Doctor’s Office, But It’s Not Ready to See Patients

June 1, 2023/in Health and Wellness, Healthcare News/by admin

By Darius Tahir

What use could health care have for someone who makes things up, can’t keep a secret, doesn’t really know anything, and, when speaking, simply fills in the next word based on what’s come before? Lots, if that individual is the newest form of artificial intelligence, according to some of the biggest companies out there.

Companies pushing the latest AI technology — known as “generative AI” — are piling on: Google and Microsoft want to bring types of so-called large language models to health care. Big firms that are familiar to folks in white coats — but maybe less so to your average Joe and Jane — are equally enthusiastic: Electronic medical records giants Epic and Oracle Cerner aren’t far behind. The space is crowded with startups, too.

The companies want their AI to take notes for physicians and give them second opinions — assuming they can keep the intelligence from “hallucinating” or, for that matter, divulging patients’ private information.

“There’s something afoot that’s pretty exciting,” said Eric Topol, director of the Scripps Research Translational Institute in San Diego. “Its capabilities will ultimately have a big impact.” Topol, like many other observers, wonders how many problems it might cause — like leaking patient data — and how often. “We’re going to find out.”

The specter of such problems inspired more than 1,000 technology leaders to sign an open letter in March urging that companies pause development on advanced AI systems until “we are confident that their effects will be positive and their risks will be manageable.” Even so, some of them are sinking more money into AI ventures.

The underlying technology relies on synthesizing huge chunks of text or other data — for example, some medical models rely on 2 million intensive care unit notes from Beth Israel Deaconess Medical Center in Boston — to predict text that would follow a given query. The idea has been around for years, but the gold rush, and the marketing and media mania surrounding it, are more recent.

The frenzy was kicked off in December 2022 by Microsoft-backed OpenAI and its flagship product, ChatGPT, which answers questions with authority and style. It can explain genetics in a sonnet, for example.

OpenAI, started as a research venture seeded by Silicon Valley elites like Sam Altman, Elon Musk, and Reid Hoffman, has ridden the enthusiasm to investors’ pockets. The venture has a complex, hybrid for- and nonprofit structure. But a new $10 billion round of funding from Microsoft has pushed the value of OpenAI to $29 billion, The Wall Street Journal reported. Right now, the company is licensing its technology to companies like Microsoft and selling subscriptions to consumers. Other startups are considering selling AI transcription or other products to hospital systems or directly to patients.

Hyperbolic quotes are everywhere. Former Treasury Secretary Larry Summers tweeted recently: “It’s going to replace what doctors do — hearing symptoms and making diagnoses — before it changes what nurses do — helping patients get up and handle themselves in the hospital.”

But just weeks after OpenAI took another huge cash infusion, even Altman, its CEO, is wary of the fanfare. “The hype over these systems — even if everything we hope for is right long term — is totally out of control for the short term,” he said for a March article in The New York Times.

Few in health care believe this latest form of AI is about to take their jobs (though some companies are experimenting — controversially — with chatbots that act as therapists or guides to care). Still, those who are bullish on the tech think it’ll make some parts of their work much easier.

Eric Arzubi, a psychiatrist in Billings, Montana, used to manage fellow psychiatrists for a hospital system. Time and again, he’d get a list of providers who hadn’t yet finished their notes — their summaries of a patient’s condition and a plan for treatment.

Writing these notes is one of the big stressors in the health system: In the aggregate, it’s an administrative burden. But it’s necessary to develop a record for future providers and, of course, insurers.

“When people are way behind in documentation, that creates problems,” Arzubi said. “What happens if the patient comes into the hospital and there’s a note that hasn’t been completed and we don’t know what’s been going on?”

The new technology might help lighten those burdens. Arzubi is testing a service, called Nabla Copilot, that sits in on his part of virtual patient visits and then automatically summarizes them, organizing into a standard note format the complaint, the history of illness, and a treatment plan.

Results are solid after about 50 patients, he said: “It’s 90% of the way there.” Copilot produces serviceable summaries that Arzubi typically edits. The summaries don’t necessarily pick up on nonverbal cues or thoughts Arzubi might not want to vocalize. Still, he said, the gains are significant: He doesn’t have to worry about taking notes and can instead focus on speaking with patients. And he saves time.

“If I have a full patient day, where I might see 15 patients, I would say this saves me a good hour at the end of the day,” he said. (If the technology is adopted widely, he hopes hospitals won’t take advantage of the saved time by simply scheduling more patients. “That’s not fair,” he said.)

Nabla Copilot isn’t the only such service; Microsoft is trying out the same concept. At April’s conference of the Healthcare Information and Management Systems Society — an industry confab where health techies swap ideas, make announcements, and sell their wares — investment analysts from Evercore highlighted reducing administrative burden as a top possibility for the new technologies.

But overall? They heard mixed reviews. And that view is common: Many technologists and doctors are ambivalent.

For example, if you’re stumped about a diagnosis, feeding patient data into one of these programs “can provide a second opinion, no question,” Topol said. “I’m sure clinicians are doing it.” However, that runs into the current limitations of the technology.

Joshua Tamayo-Sarver, a clinician and executive with the startup Inflect Health, fed fictionalized patient scenarios based on his own practice in an emergency department into one system to see how it would perform. It missed life-threatening conditions, he said. “That seems problematic.”

The technology also tends to “hallucinate” — that is, make up information that sounds convincing. Formal studies have found a wide range of performance. One preliminary research paper examining ChatGPT and Google products using open-ended board examination questions from neurosurgery found a hallucination rate of 2%. A study by Stanford researchers, examining the quality of AI responses to 64 clinical scenarios, found fabricated or hallucinated citations 6% of the time, co-author Nigam Shah told KFF Health News. Another preliminary paper found, in complex cardiology cases, ChatGPT agreed with expert opinion half the time.

Privacy is another concern. It’s unclear whether the information fed into this type of AI-based system will stay inside. Enterprising users of ChatGPT, for example, have managed to get the technology to tell them the recipe for napalm, which can be used to make chemical bombs.

In theory, the system has guardrails preventing private information from escaping. For example, when KFF Health News asked ChatGPT its email address, the system refused to divulge that private information. But when told to role-play as a character, and asked about the email address of the author of this article, it happily gave up the information. (It was indeed the author’s correct email address in 2021, when ChatGPT’s archive ends.)

“I would not put patient data in,” said Shah, chief data scientist at Stanford Health Care. “We don’t understand what happens with these data once they hit OpenAI servers.”

Tina Sui, a spokesperson for OpenAI, told KFF Health News that one “should never use our models to provide diagnostic or treatment services for serious medical conditions.” They are “not fine-tuned to provide medical information,” she said.

With the explosion of new research, Topol said, “I don’t think the medical community has a really good clue about what’s about to happen.”

Judge’s Decision Would Make Some No-Cost Cancer Screenings a Thing of the Past

April 4, 2023/in Healthcare News/by admin

By Julie Appleby and Michelle Andrews

A federal judge on Thursday overturned a portion of the Affordable Care Act that makes preventive services, such as some cancer screenings, free to enrollees, a decision that could affect health insurance policyholders nationwide.

The decision from the U.S. District Court for the Northern District of Texas could open the door for insurers or employers to reinstate copayments for some of those preventive services, although many may be reluctant or unable to do so, at least immediately.

The ruling by U.S. District Judge Reed O’Connor builds on a September judgment in which he also said the ACA requirement that employers cover preexposure prophylaxis treatment to prevent HIV violates the Religious Freedom Restoration Act.

His ruling is the latest shot in the legal battle over the ACA. “Previous cases threatened the very existence of the law and fundamental protections. This decision does not do that,” said Larry Levitt, KFF executive vice president for health policy. But “it strikes down a portion of the law, albeit a very popular one, that is used by a lot of people.”

It is almost certain to be appealed, possibly by both sides: the conservative groups that brought the case and had hoped the decision would be broader, and the Biden administration, which supports the ACA.

“The stakes are really high,” because the ultimate decision could affect millions of Americans, said Andrew Twinamatsiko, associate director of the health policy and the law initiative at the O’Neill Institute at Georgetown University.

“Americans should have peace of mind there will be no immediate disruption in care coverage,” said Matt Eyles, president and CEO of AHIP, the health insurance industry’s leading lobbying group.

Now, the Department of Justice must decide whether to seek an emergency order putting the ruling on hold during the appeal process.

The decision could affect the no-copay screenings and similar preventive services that most insured Americans have as part of their health plans. But consumers may see little impact initially.

“The word prevention appears a couple hundred times in the ACA,” said Timothy Jost, law professor emeritus at Washington and Lee University School of Law, who closely follows the ACA. “Part of the idea of the ACA was we thought to try to prevent disease or at least identify it earlier when it’s more curable.”

Making such care free to enrollees was a way to encourage screening for disease.

But O’Connor’s ruling said one of the ways those no-cost services are selected — by the U.S. Preventive Services Task Force, a nongovernmental advisory group — is unconstitutional. In his September opinion, O’Connor wrote that members of the task force, which is convened by a federal health agency, are actually “officers of the United States” and should therefore be appointed by the president and confirmed by the Senate.

The judge said his decision specifically does not apply to no-copay contraceptives or vaccines, which are selected by other agencies, although the conservative groups that brought the case had sought their inclusion as well.

Mammograms are among those preventive services that may be in a special category because they, too, are recommended by one of those other agencies, so experts at KFF say they will probably continue to be covered without patient cost sharing, even with this ruling.

O’Connor issued a summary judgment in the case in September. At the time, the decision applied only to the employers that brought the case.

Thursday’s ruling expands that to all employers and insurers nationwide.

For now, consumers, especially those who buy their own coverage through the ACA marketplace, are likely to continue to get no-cost preventive care in many plans, experts said.

That’s because most such plans run on the calendar year and enrollees have essentially signed contracts “which will cover those services through the end of the year,” said Jost.

Still, depending on the outcome of the appeals, over time each insurer will likely weigh the pros and cons of reinstituting such patient cost sharing.

They will start to make “business decisions to either continue to cover without cost or to impose cost sharing,” said Twinamatsiko at Georgetown.

In job-based plans, through which most insured Americans get their coverage, initial impact may also be muted.

Eighty percent of human resources directors said they would not restore cost sharing for preventive care, according to a recent nonscientific survey of 25 human resources directors at companies with a collective total of about 600,000 workers.

Doing so could upset employees, noted Paul Fronstin, director of health benefits research at the Employee Benefit Research Institute, which ran the survey. And fully covering enrollees’ preventive care, without requiring copayments, is relatively inexpensive. In a separate study, he found that even one of the more costly preventive care treatments — the nearly $14,000-a-year PrEP, to prevent HIV — adds only 0.4% to annual employer spending on health care. Even if an employer were to add a 20% copayment for the worker, it would reduce overall spending by less than one-tenth of 1%, according to the study.

Outside of a few employers that might want to restrict no-cost coverage on religious grounds for treatments like PrEP, James Gelfand said, he doubted many companies would reinstitute copayments. Gelfand is president of the ERISA Industry Committee, which represents large, self-insured employers.

Services endorsed by the U.S. Preventive Services Task Force were selected because they work and “can prevent more acute conditions later,” which are far more costly, said Gelfand.

While most of the task force’s recommendations are noncontroversial, a few have elicited an outcry from some employers, including the parties to the lawsuit, who argue they should not be forced to pay for services or treatments they disagree with, such as HIV-prevention drugs.

O’Connor’s ruling upheld the contention by plaintiff Braidwood Management, a Christian for-profit corporation owned by Steven Hotze, which objects to providing free PrEP to its 70 employees, saying it runs afoul of its religious beliefs to do so.

The judge agreed, saying that forcing Braidwood to provide such free care in its self-insured plan violates the Religious Freedom Restoration Act.

The ruling eliminating preventive coverage without cost sharing for PrEP on religious grounds shows “clear bias,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute.

Some states have passed laws that will continue to require coverage of ACA-mandated preventive services even if the federal protections are eliminated.

At least 15 states have laws requiring insurers that sell individual plans to cover the preventive services that the ACA requires, according to an analysis by researchers at Georgetown’s Center on Health Insurance Reforms.

Like the ACA, those state laws mandate the coverage at no cost to consumers.

In some of the states, workers in group insurance plans regulated by the state — called “fully insured” plans — also receive those protections, the analysis found.

Those state laws do not apply to the 65% of covered workers nationwide whose employers pay their health care claims directly rather than buy insurance for that purpose.

Overall, preventive services can lead to better outcomes, said Lisa Lacasse, president of the American Cancer Society Cancer Action Network.

Millions of people get screened for breast, colorectal, lung, or cervical cancer each year, she said, adding there is evidence showing any kind of copayment or deductible deters people from getting such testing.

Lacasse said she hopes insurers will continue not to charge copays because such a sharp change midyear would be disruptive, and that enrollees should keep going in for preventive care.

“If you have a screening, you should move forward with that,” she said.

This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Millions of Californians Are at Risk of Losing Medi-Cal Coverage

March 1, 2023/in Healthcare News/by admin

By Phil Galewitz and Angela Hart

States are preparing to remove millions of people from Medicaid as protections put in place early in the covid-19 pandemic expire.

The upheaval, which begins in April, will put millions of low-income Americans at risk of losing health coverage, threatening their access to care and potentially exposing them to large medical bills.

In California, where about 15.2 million people are enrolled in its Medicaid program, known as Medi-Cal, up to 3 million could lose coverage because they no longer qualify or fail to reenroll, state officials forecast.

This month, the state is launching a massive media campaign via radio, social media, and billboards to alert Medi-Cal members that they must apply to renew their coverage this year. In coming months, the state will enlist federally funded navigators and other community health workers to help people update their contact information and ease the reenrollment process — or to shepherd them into new coverage, if their income exceeds Medicaid’s eligibility limits.

The outreach campaign is backed by $25 million in state funds, with material provided in 19 languages.

Still, state health officials worry that people may get left behind and that the state’s all-time low 7% uninsured rate could spike.

“We acknowledge that this is going to be a bumpy road,” California Health and Human Services Secretary Mark Ghaly said. Federal health insurance subsidies will help prevent people from falling through the cracks, he said.

Almost three years ago, as covid sent the national economy into free fall, the federal government agreed to send billions of dollars in extra Medicaid funding to states on the condition that they stop dropping people from their rolls.

But legislation enacted in December will be phasing out that money over the next year and calls for states to resume cutting off from Medicaid people who no longer qualify.

Now, states face steep challenges: making sure they don’t inadvertently disenroll people who are still entitled to Medicaid and connecting those who no longer qualify to other sources of coverage, such as subsidized health plans on the Affordable Care Act marketplaces.

Even before the pandemic, states struggled to stay in contact with Medicaid recipients, who in some cases lack a stable address or internet service, do not speak English, or don’t prioritize health insurance over more pressing needs.

Ordinarily, people move in and out of Medicaid all the time. States, which have significant flexibility in how they run their Medicaid programs, typically experience significant “churn” as people’s incomes change and they gain or lose eligibility.

The so-called unwinding will play out over more than a year.

The Biden administration has predicted that 15 million people — 17% of enrollees — will lose coverage through Medicaid or CHIP, the closely related Children’s Health Insurance Program, as the programs return to normal operations. While many of the 15 million will fall off because they no longer qualify, nearly half will be dropped for procedural reasons, such as failing to respond to requests for updated personal information, according to federal estimates.

Millions of people losing Medicaid coverage will be eligible for free or low-cost coverage through the ACA marketplaces, but choosing a plan is complicated. Unlike Medicaid, so-called Obamacare plans often include deductibles and copayments — though some people, depending on income, can get financial help to lower those expenses.

People who lose Medicaid coverage — in the more than 30 states covered by the federal marketplace — will have until July 31, 2024, to sign up for ACA coverage, CMS announced on Jan. 27. It’s unclear whether the state-based marketplaces will offer the same extended open-enrollment period.

California will move some people who lose Medicaid eligibility to a subsidized private plan on the state’s marketplace, Covered California. Enrollees will have to agree and pay a premium if they don’t qualify for a free plan. But for those who don’t qualify for a zero-premium private plan, the premium could be as low as $10 a month, said Jessica Altman, executive director of Covered California. (Altman’s father, Drew Altman, is president and CEO of KFF. KHN is an editorially independent program of KFF.)

“We want to make it easier to say yes to coverage,” Altman said.

The state will initially try to verify enrollees’ income automatically using data from government databases, such as from the Internal Revenue Service. During the yearlong unwinding, current enrollees could still qualify if the databases show their income is no more than 20% above the thresholds for Medi-Cal eligibility, said Tony Cava, a Department of Health Care Services spokesperson. For example, a California parent in a family of three would still qualify with an income of up to $41,168.

Medi-Cal members who aren’t renewed automatically will be sent a form requesting updated information, due within 60 days. People who do not complete the process will have their coverage terminated.

Medi-Cal members will have 90 days to appeal after being disenrolled.

Federal law bars states from disenrolling anyone solely because mail was returned as undeliverable until the state has made a “good faith effort” to contact the person another way, such as by phone or email.

The federal government recently expanded subsidies for some people buying coverage through Obamacare exchanges, and those could cushion the blow for people losing Medicaid in the unwinding.

States will give Medicaid recipients at least 60 days to respond to requests for information before dropping them, said Jack Rollins, director of federal policy at the National Association of Medicaid Directors.

States are enlisting Medicaid health plans, doctors, hospitals, state insurance marketplaces, and an assortment of nonprofit groups, including schools and churches, to reach out to people at risk of losing coverage. But even in states taking the boldest actions to keep people covered, Medicaid officials worry what the next year will bring.

“We have no illusion that this will be beautiful or graceful, but we will be doing everything we can not to lose anyone in the process,” said Dana Hittle, Oregon’s interim Medicaid director.

Oregon plans to allow children to stay on Medicaid until age 6 and to give everyone else up to two years of eligibility regardless of changes in income and without having to reapply. No other state provides more than one year of guaranteed eligibility.

Oregon is also creating a subsidized health plan that would cover anyone who no longer qualifies for Medicaid but has an annual income below 200% of the federal poverty level, which amounts to about $29,000 for an individual, state officials said. The program will have benefits similar to Medicaid’s at little or no cost to enrollees.

Rhode Island will automatically move people who are no longer eligible for Medicaid — and with annual incomes below 200% of the poverty rate — into an Obamacare plan and pay their first two months of premiums.

Nevada has developed a mobile app to communicate with members, but only 15,000 members have signed up so far. Nevada has about 900,000 members.

Altman said Covered California does not have estimates on how many people would transition out of Medi-Cal and onto the state Obamacare exchange, but she said California’s efforts will go far in helping the state reach its goal of universal health coverage.

“This is when we really need to be protective of the gains that we have made, and do everything we can to reach Californians to support them in navigating our health care system,” she said.

KHN correspondents Daniel Chang in Florida and Katheryn Houghton in Montana contributed to this report.

This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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