Kaiser Health News Original Stories

3. Political Cartoon: 'Open Season'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Open Season'" by Chris Browne.

Here's today's health policy haiku:

COUNTING THE COLLAPSES

Insurance co-ops
seem to be dropping like flies.
Tally is now eight.

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Health Law Issues And Implementation

4. Two More Health Law Co-Ops Face Collapse

The health insurance cooperatives in Oregon and Colorado, which will cease operation at the end of the year, join a list of nonprofit insurers -- entities created by the health law -- which are being shuttered by state regulators in six other states because they face financial distress.

The Washington Post: Two More Obamacare Health Insurance Plans Collapse
Nearly a third of the innovative health insurance plans created under the Affordable Care Act will be out of business at the end of 2015, following announcements Friday that plans in Oregon and Colorado are folding. In just the past week, four co-ops, as the nonprofit plans are known, have decided or been ordered to shut down. Their demise means that eight of the 23 co-ops in existence a year ago will be unavailable to consumers shopping for 2016 coverage through insurance marketplaces created under the ACA. (Levine and Goldstein, 10/16)

The Wall Street Journal: More Health Co-Ops Face Collapse
Health cooperatives are collapsing at such a rapid clip that some co-ops and small insurers are forming a coalition to consider legal action to try to change health-law provisions they blame for their financial distress. Colorado’s co-op and one in Oregon announced Friday that they were folding, joining six others that have already collapsed or said they will unwind operations. The eight co-ops have received nearly $900 million in federal funds that may not be paid back. (Armour, 10/16)

The Hill: ObamaCare Co-Ops At Risk Of Failing After Billions In Loans
The future of an ObamaCare program that was intended to create non-profit insurers is increasingly in doubt, ... Just 15 of the original 23 co-ops remain in operation, and the administration acknowledges that more of them could fail, potentially leaving a strike against President Obama’s signature law. (Sullivan, 10/17)

The Denver Post: State Regulators Shut Down Colorado HealthOP Citing Cash-Reserve Woes
Colorado HealthOP will shut down, leaving 83,000 members scrambling for insurance coverage and taxpayers on the hook for about $72 million in federal loans used to start and support the co-op. The Colorado Division of Insurance dropped HealthOP from the state insurance exchange because it no longer meets state capital-reserve requirements. (Wallace, 10/16)

The Denver Post: I'm A Colorado HealthOP Customer. What Do I Do Now?
Colorado HealthOP ... can't sell 2016 policies on Connect for Health Colorado, the state health insurance exchange. The Colorado Division of Insurance cut the co-op from the exchange because it missed cash-reserve requirements just before the open enrollment period opens nov. 1. Anticipating that co-op customers would have questions, the insurance regulators offered this q&a. (10/16)

The Associated Press: Oregon Insurance Co-Op Health Republic To Close
Health Republic Insurance, one of two nonprofit insurers created in Oregon under President Barack Obama's health care law, announced Friday that it is shutting down. Health Republic will continue to pay claims through the rest of the year but won't sell policies for 2016, the company said. The 15,000 individuals and 800 small businesses that get insurance through Health Republic will have to turn to another insurer. (Cooper, 10/16)

5. Managing Expectations Key To The Goal Administration Set For Health Enrollment

The New York Times examines how the Obama administration set its goal for 2016. Elsewhere, The Associated Press notes that the penalty for not having health coverage rises to $695 next year, a level that could motivate more people to sign up for insurance. Also, The Washington Post looks at a challenge by a group of nuns to the health law's contraception coverage requirement.

The New York Times: Careful Calculus Guides Obama Administration In Health Insurance Projections
[I]t was surprising this week when Sylvia Mathews Burwell, the secretary of health and human services, predicted only slim gains [in health law marketplace enrollment] in the coming year, millions below earlier projections. ... Why did the Obama administration set such a modest goal? It was part of an elaborate numbers game played for several years by proponents and opponents of the health law. On the one hand, administration officials want to manage expectations in a presidential election year, when surpassing the goal will be better for Democrats than falling short. ... On the other hand, health policy experts said, the enrollment goal for 2016 may be realistic. (Pear, 10/16)

The Fiscal Times: Obamacare Falls Short On Sign-Ups While Co-Op System Crumbles
The big health news last week was that the Affordable Care Act appears to be losing steam and the Obama administration is predicting a modest increase at best in the number of Americans who will enroll with private insurers next year. Health and Human Services Secretary Sylvia Mathews Burwell announced on Thursday that an estimated 10 million Americas would be covered by Obamacare by the end of 2016, an increase of roughly 100,000 over the current year’s enrollment. That’s a lot lower than many were expecting. The Congressional Budget Office in June predicted 20 million Americans would be covered by the end of next year. (Pianin, 10/18)

The Associated Press: Bigger Bite For Health Law Penalty On Uninsured
The math is harsh: The federal penalty for having no health insurance is set to jump to $695, and the Obama administration is being urged to highlight that cold fact to help drive its new pitch for health law sign-ups. That means the 2016 sign-up season starting Nov. 1 could see penalties become a bigger focus to motivate millions of people who have remained eligible for coverage, but uninsured. They’re said to be more skeptical about the value of health insurance. (Alonso-Zaldivar, 10/19)

The Washington Post: At The Supreme Court, ‘Little Sisters Of The Poor’ Has A Ring To It
If you are looking for sympathetic plaintiffs to headline a major Supreme Court battle — well, it never hurts to have on deck an order of nuns called the Little Sisters of the Poor. That seems especially true when the subject is the Affordable Care Act’s contraceptive requirement. Out of an avalanche of litigation, those urging the court to take up the latest challenge to Obamacare have rallied around the petition filed by the Little Sisters of the Poor Home for the Aged. (Barnes, 10/18)

6. Ky.'s Medicaid Expansion At Stake In Gov.'s Race, But La. Candidates Are Embracing The Option

Candidates to replace Kentucky Gov. Steve Beshear are divided on whether to keep the popular Medicaid expansion that he implemented. In Louisana, where Gov. Bobby Jindal has been one of the country's most steadfast critics of the federal health law and expansion, all four candidates for governor say they would support implementing it.

The Associated Press: Kentucky Election Puts Medicaid Expansion In Crosshairs
Kentucky, one of the only Southern states to expand Medicaid under President Barack Obama's Affordable Care Act, could become the first state to repeal that expansion depending on the outcome of a closely contested governor's race. Kentucky voters have made it clear they don't like Obama or his policies, with the president's disapproval rating consistently at or above 60 percent in public polls. But when outgoing Democratic Gov. Steve Beshear used Obama's signature law to allow more people to qualify for taxpayer-funded health insurance, about 400,000 people signed up for it. (Beam, 10/16)

The Associated Press: Medicaid Expansion Looks Likely Under La.'s Next Governor
While Gov. Bobby Jindal repeatedly refused to take billions in federal health care money to expand Louisiana's Medicaid program, the men seeking to follow him into office are less reluctant to accept the cash. The four main contenders vying to be Louisiana's next governor on the Oct. 24 ballot all say they'd be willing to extend government-financed health insurance to the working poor, as allowed under President Barack Obama's signature health overhaul. (DeSlatte, 10/17)

Reports examine some of the implications for hospitals in Kansas and Florida, which have not expanded their Medicaid programs.

Kansas City Star: Closing Of Kansas Hospital Adds To Medicaid Expansion Debate
Century-old Mercy Hospital, which had been losing millions of dollars in recent years, shut its doors for good on Oct. 10, leaving the 9,500 residents of Independence unsure who their doctors will be or where those residents will go in a medical emergency. Mercy was the town’s only hospital. ... Generally small and isolated, rural hospitals struggle to provide the latest services and technology. Few doctors want to make their career in rural medicine. ... But in Kansas, there’s another factor to consider in the life and death of rural hospitals: Medicaid expansion. ... With more people covered, hospitals don’t have to write off as many unpaid bills from uninsured patients. Kansas and Missouri are among the dwindling number of states that have turned down expansion. (Bavley and Helling, 10/17)

The Miami Herald: Funding Cut Ahead For Jackson Health, Other Hospitals To Care For Uninsured
Miami-Dade's Jackson Health System, Florida’s leading provider of healthcare for the uninsured, will be hit with another round of budget cuts next year after federal healthcare officials late Thursday stood firm on their promise to no longer fund care for people who otherwise would have health insurance if the state were to fully implement the Affordable Care Act. Jackson officials estimate their hospital system could lose $50 million or about 20 percent of its current funding under a program known as Low Income Pool or LIP, which pays hospitals for uninsured Floridians’ healthcare. The federal Centers for Medicare and Medicaid Services, or CMS, plans to reduce LIP statewide from the current $1 billion to $608 million for the year beginning July 2016. (Chang, 10/17)

News outlets continue to parse a recent report about the effects of a state's decision on Medicaid expansion.

California Healthline: Report: Record Medicaid Growth, Reforms
Medicaid expansion under the Affordable Care Act in 29 states, including California, has driven record enrollment and spending for the program in fiscal year 2015, according to a report by the Kaiser Family Foundation. In California, about 12 million people are enrolled in the Medicaid program, called Medi-Cal. (Vesely, 10/16)