KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Underinsured Enrollees Flood Community Health Centers

Some low-income consumers who bought bronze plans with low premiums but high deductibles are discovering they still can't afford health care and are turning to the community health centers which cannot turn anyone away. Meanwhile, a study finds insurance costs for small businesses are lower through the SHOP exchanges, and South Dakota lifts a $2M cap on employees' lifetime health costs.

Modern Healthcare: Underinsured ACA Enrollees Strain Community Health Centers
Obamacare enrollees are straining the finances of community health centers around the country, some health center leaders say. The issue is that many lower-income patients with insurance coverage through the federal and state exchanges bought bronze-tier plans with lower premiums but high deductibles, coinsurance and copayments and no federal cost-sharing subsidies. When these patients face high out-of-pocket costs for care that falls below the deductible, they can't afford it.  So the centers are subsidizing that care by offering them means-tested sliding-scale fees. When the centers, which are not allowed to turn away patients for inability to pay, try to get the insurers to pay, the claims are usually denied, and the centers have to write it off as uncompensated care (Dickson, 9/25).

The Washington Post: Obamacare’s Small Business Exchanges Offer Cheaper Health Coverage, Study Shows
During the lead-up to the rollout of the health care law a year ago, President Obama was adamant that new insurance marketplaces for small businesses would provide a start-to-finish online shopping experience for employers, where they could compare and buy plans with the click of a mouse. In addition, he said, by placing rates from different insurers side-by-side and offering tax breaks, the marketplaces would provide less expensive plans that what had been available to small companies. ... It appears, based on one new study, that the exchanges are delivering [on the second promise] (Harrison, 9/24).

Kaiser Health News: Debate Grows Over Employer Plans With No Hospital Benefits
As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own. At the center of contention is the calculator -- an online spreadsheet to certify whether plans meet the Affordable Care Act’s toughest standard for large employers, the ‘minimum value’ test for adequate benefits (Hancock, 9/26).

The Associated Press: State Lifts $2M Cap On Employee Health Care Costs
South Dakota can no longer limit how much it pays out in health care coverage over the lifetime of state employees, but officials say for now that shouldn't raise costs. Laurie Gill, the commissioner of the state's Bureau of Human Resources, briefed legislators this week on how changes mandated by the Affordable Care Act will affect the state's health plan. The Affordable Care Act prohibits health care plans from capping the amount of benefits employees incur over a lifetime. South Dakota had capped lifetime expenses at $2 million per individual, meaning any health care costs incurred over that amount weren't covered. The change means the state could end up paying out more, but Tom Steckel, the state's director of employee benefits, said in the past it's been rare for an employee to reach the $2 million limit. Steckel said his office has been looking into how many workers surpassed the cap. So far, he said, he wasn't aware that any had reached it last year (Burbach, 9/25).

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