KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Woman Challenges Anthem’s Health Law ‘Narrow Network’ In N.H.

And a new proposal from the Centers for Medicare and Medicaid Services would prohibit insurers from selling as full policies bare-bones "fixed benefit" plans, potentially exposing Democrats to midterm criticism.

The Associated Press: N.H. Patient Gets Hearing On Narrow Hospital Network
A Rochester woman will get a hearing after all on her hospital’s exclusion from the narrow provider network for individuals buying health insurance under the Affordable Care Act. State Insurance Commissioner Roger Sevigny agreed yesterday to hear a complaint from Margaret McCarthy, a patient at one of the 10 hospitals that were excluded from Anthem Blue Cross Blue Shield’s new network. Anthem had argued that McCarthy waited too long to ask for a hearing, but Sevigny said her request came less than 30 days after she found out how she would be affected by the new network and scheduled the hearing for May 14 (4/30).

The Fiscal Times: New Obamacare Fix Is Bad News For Democrats
A little-known proposed change to the president’s health care law could result in a new political nightmare for Democrats who are vulnerable in the 2014 midterm elections. says the Centers for Medicare and Medicaid Services (CMS) issued a proposal in March that would prohibit insurers from selling fixed-benefit insurance plans as stand-alone policies. Fixed-benefit plans are so bare bones they don’t even qualify as actual health insurance under the Affordable Care Act’s individual mandate -- so people who are covered by these plans only are still subject to the penalty unless they qualify for an exemption (Ehley, 4/30).

And The Wall Street Journal looks at the uncertain and difficult world of forecasting health care costs --

The Wall Street Journal: Is This The Hardest Job In America?
The health law has reshaped the way insurers do business. Before the law, consumers often had to tell insurers if they had health conditions that might require pricey care, such as diabetes. Insurers could typically boost those consumers' premiums or refuse to cover them. Now, insurers must accept all comers and they get no health information on enrollees. That means that actuaries have little to go on when predicting medical costs -- and setting premiums. What's more, frequent regulatory tweaks from policy makers have forced actuaries to rejigger their projections and strategies on the fly. This is raising the stakes for actuaries, a word traced back to the Latin root for bookkeeper (Mathews, 5/30).

Earlier, related KHN coverage: Health Plans Scramble To Calculate 2015 Rates (Hancock, 4/28).

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