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Affordable Care Act

The Affordable Health Care Act, also known as “Obamacare,” was signed into law in March 2010. The statute represents a major overhaul of the country’s healthcare system — the most substantial since Medicare and Medicaid were initiated in 1965.

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Local News

Washington state is making health exchange work

By Maria L. La Ganga

Los Angeles Times

KENT, Wash. — Mindy Mansfield had health insurance when she worked at a factory that made air flow vents in Cle Elum, a small town in central Washington state. It covered the pills she took for her Type 2 diabetes and the ones she needed to ease her arthritis.

But as she edged toward retirement age after nearly two decades as a machine operator, Mansfield was laid off. She moved in with her older sister in Kent, lost her medical coverage and jettisoned her arthritis medication because “it was just too expensive.”

Washington state healthcare enrollment

People seeking health insurance compare plans at a Washington Healthplanfinder enrollment event in Kent, Wash. (Maria L. La Ganga / Los Angeles Times / November 9, 2013)

Two years of worry about whether she could stay healthy without a safety net were erased in just 20 minutes Saturday — the time it took the 62-year-old to navigate Washington’s online insurance exchange with a little help from “in-person assister” Pearl Rodriguez.

Mansfield was one of 100 uninsured women and men who flocked to an aging community center here on a drizzly afternoon and signed up for insurance coverage under the Affordable Care Act, as Obamacare is formally known. They were part of the Washington Healthplanfinder’s “mobile enrollment tour.”

More than 55,000 people in Washington state enrolled in health coverage in October — most in Medicaid — and about 40,000 more applied for coverage, making the Evergreen State one of the brightest success stories in the rocky national rollout of the federal health law. Here in the home of online shopping giant, officials credit the exchange’s success in part to the Pacific Northwest’s high-tech bent.

Colorado enrolled just over 37,500 people in the same period. New York state — with a population nearly three times the size of Washington’s — had enrolled just more than 48,000 in health plans as of Tuesday, state officials announced. Kentucky enrolled more than 32,000 in its first month. California is expected to release figures this week.

All are among the states that embraced Obamacare and crafted their own insurance exchanges rather than rely on the federal site, which has been riddled with breakdowns.

In addition to the enrollment tour, which brought a long, white trailer filled with workstations, laptops and enrollment assisters to cities throughout the state, Washington Healthplanfinder has wooed young and healthy residents with android and iPhone apps and an appearance Tuesday at the University of Washington by Seattle’s own Chris Walla, guitarist with Death Cab for Cutie.

Early analysis puts “Washington at the top of the pack, with Kentucky doing similarly well,” said Sabrina Corlette, senior research fellow at the Georgetown University Center on Health Insurance Reforms. The 14 states “that went forward with their own exchanges are head and shoulders better than the states with the federal exchanges.”

The goal of Washington Healthplanfinder was to give insurance seekers a smooth online shopping experience, and many on the site’s leadership team are veterans of tech startups.

The Washington healthcare exchange itself “is a startup,” said Richard Onizuka, its chief executive. “And the people that really thought that was exciting and interesting — ‘Oooh, that sounds like a great thing to do’ — those are the people that are here. The people that were, ‘Oh what does that mean? Maybe I won’t have a computer the first day I’m here’ — those are not the people that are here.”

Another important decision Washington insurance exchange officials made early on was to allow insurance seekers to shop for plans without having to go through the lengthy application process first. Not all state exchanges initially had the same anonymous browsing capability., the federal exchange used by more than half of the country, lets people see what plans are available, but “to find out the actual costs for your personal situation,” the site says, “you need to apply.”

“An open browsing function in hindsight is a very good idea,” said Anne Gauthier, senior program director for the National Academy for State Health Policy. “They all have the same goal. Those [states] that went in the direction of the shopper … in October came out ahead.”

Guitarist Walla, who promoted the insurance exchange at the Seattle campus, is one beneficiary of the comparison-shopping capability. Yes, his indie band fills halls these days, but he is still self-employed, recently married and planning to start a family.

“There is no reasonable way without the Affordable Care Act to be able to comparison shop for the plan,” he said. He told students — also known as “young invincibles” and the financial heart of the federal insurance program — “about being uninsured and how terrifying that is, and how for the first time it’s a little bit better than it’s ever been.”

Susan McCarthy, a registered nurse who says she took early retirement because her “knees are shot,” also tapped into the shopping capability. It allowed her to narrow her search to three different health plans, all of which would allow her to cut her current monthly premiums by more than half.

A week ago McCarthy showed up at a public library near Tacoma with a printout of her options in hand. Inside the library entrance was a white board offering a week’s worth of events: “Duct Tape Creations”; “Stuffed Animal Sleepover”; “ACA In-Person Assister. Monday. 11/4. Sign up at the Help Desk.”

But McCarthy left her appointment without enrolling in a plan because she could not find out whether the coverage she wanted allowed her to go to a doctor outside of the network and whether she could see a specialist without a referral.

“It’s a real good deal,” the 57-year-old said, leaning on her cane. “But with this comparison there are a lot more questions. I have to call each insurance company.”

For all its success, the Washington exchange has not been without glitches. On its first day of operation, the website was shut down for five hours and then again overnight for maintenance. Pages were slow to load, or screens would freeze, said spokesman Michael Marchand.

“We had a choice,” he said. “Keeping the site up and troubleshooting with everyone in it, or going into maintenance mode and taking the site off-line to find out what the issues were…. We did that in the first 48 hours. We’ve been stable since then.”

In addition, an estimated 8,000 early applicants were notified that the price they were expecting to pay for their coverage was incorrect, because the site miscalculated the size of the tax credit they were due. The exchange has fixed the error.

And the call center, which received nearly 100,000 inquiries in its first month, was often swamped. That’s why Mansfield came out Saturday to the Kent enrollment event for in-person assistance.

“I started calling on Oct. 1, and oooh, yeah,” she said, “I kept getting, ‘Please call back when the system is working.’ At first, they took my number and said they’d call back and never did. And they were going to send me information and never did.”

But on Saturday, she found all the information she needed.

Insurance seekers began showing up for enrollment help two hours before the event was to begin. They crowded into the community center and the trailer in the parking lot, clutching tax forms and immigration documents.

Mansfield and Rodriguez huddled together over a shiny new laptop in the busy trailer, setting up the older woman’s account. Rodriguez led Mansfield through a series of questions, typing in the necessary information about citizenship, tax filing status, family makeup.

Mansfield pulled out a letter from the Social Security Administration to prove how much money she makes each month. Rodriguez tapped a few more keys, then looked up, smiling.

“You qualify for Washington Apple Health,” she told the uninsured woman, referring to the state’s expanded Medicaid program. And then she shared the best part: “At no cost.”

“That’s it?” Mansfield asked, relieved and incredulous that the process was so fast and easy, and the result so comforting. “Wonderful.”



National & World News

Obama: ‘I am sorry’

obamaWASHINGTON (CNN) — President Barack Obama apologized on Thursday to Americans whose insurance plans are being canceled due to the federal health law he championed even though he said repeatedly they could keep their coverage if they liked.

“I am sorry that they are finding themselves in this situation based on assurances they got from me,” he told NBC News in an exclusive interview.

“We’ve got to work hard to make sure that they know we hear them and we are going to do everything we can to deal with folks who find themselves in a tough position as a consequence of this,” he added.

GOP focuses on overall Obamacare troubles, not just website

Obama’s comments come days after he attempted to clarify what he meant when he repeatedly assured Americans in previous years that they would be able to keep their plans under the Affordable Care Act.

Millions of people have received cancellation notices from their insurance companies in recent weeks.

Administration officials have acknowledged that insurance companies in many cases are dropping coverage that is less comprehensive than so-called Obamacare, and that Americans would be better off in the long run with new insurance.

Key elements of the health law prohibit discrimination for pre-existing conditions and require new plans cover maternity care, mental health and other areas. The program was developed to put comprehensive care within reach of millions of uninsured Americans.

About 95% of legal U.S. residents receive health insurance through private employers or the federal government, the Obama administration says.

Obama’s apology comes a week after similar refrains were made by Vice President Joe Biden and Health and Human Services Secretary Kathleen Sebelius regarding the botched Obamacare online rollout.

While the federal website problems have been a political nightmare for the administration, Republican opponents have seized more aggressively on the policy cancellations, which have become problematic for Democratic politicians as well.


Local News

Hospital sues over being omitted from state’s health care plan

WASHINGTON — President Obama was assured that the healthcare insurance website was ready to launch on Oct. 1, even as private contractors and some administration officials knew the site had failed in early testing, a senior White House advisor said Sunday.

Obama aide Dan Pfeiffer said the president repeatedly asked about the website, a key piece of his 2010 healthcare overhaul legislation, and was told it would meet his expectations.

Along with the president, Pfeiffer hyped the website in the weeks before the troubled launch, promising it would “be a consumer experience unmatched by anything in government, but also in the private sector.”

“We did believe that,” Pfeiffer said on ABC’s “This Week.”

obama — just voteThe “results do not match up to his expectations or the American people’s expectations,” he added. “It’s inexcusable. There is no question about that.”

The site has repeatedly crashed in its first month, and was taken down for repairs much of the weekend. Consumers have faced numerous difficulties trying to sign onto the site, or get adequate information about the new insurance plans.

Obama is facing intense criticism for the problems with the most visible part so far of his signature domestic legislative achievement, as well as questions about whether he oversold how the Affordable Care Act would affect families.

Most significantly, although Obama repeatedly promised that Americans could keep their current insurance plans once the law went into effect, hundreds of thousands of people have received notices that their plans will be canceled or changed due to new minimum standards required under the law.

For more on this LA Times story, click here.

BURLINGTON, Wash. — An unintended consequence of the Affordable Care Act has volunteer firefighters in the cross-hairs. Fire departments across the state rely on those volunteers, but now there’s a question about whether cities will now have to pony up for their health insurance.

The Burlington Fire Department has nine full-time employees and 30 volunteers on the roster. If the department has to pay for those volunteers’ health insurance, it would eat up nearly half of the yearly budget, Fire Chief David Nielson said Friday.

“Volunteers are very critical to how we do it, but also to what we can achieve,” said Nielson.

burlingtonfireHe says big changes could be coming for his long list of volunteer firemen if something doesn’t change.

“The Burlington Fire Department cannot operate without volunteers. They’re valuable employees,” said Nielson.

“I think perhaps the Affordable Care Act just didn’t’ take this into consideration,” said Bryan Harrison, the city administrator for Burlington.

The ACA requires employers with 50 or more employees who work more than 30 hours a week to help pay for their health insurance or face a stiff penalty. But are volunteers legally defined as employees?

“There’s a unique definition in state law and IRS codes that deem a volunteer firefighter, you can compensate volunteer firefighters and they still maintain their status. But by IRS rules they’re an employee so the ACA applies,” said Harrison. “We have to monitor, or I believe in our case, restrict the number of shifts they can actually work for us.”

And that means, at best, Nielson has to get creative with volunteer schedules.

“Limiting the number of hours volunteers can work before we’re obligated to pay them health benefits,” said Nielson. “Clearly the city cannot afford to pay all the volunteers in the Fire Department.”

Harrison said the cost would be too high to offer that benefit to all volunteers.

“If we were to extend full medical benefits to those firefighters, it would be $750,000 that the city hadn’t anticipated. And given the entire fire budget is $1.6 million, that’s a substantial portion of the budget,” said Harrison. “I’m not sure where we’d get that money.”

Fire departments across the country that count on volunteers to protect their communities could be in trouble.

The president of the International Association of Fire Chiefs warned the IRS in a letter that the consequences could be devastating.

“Volunteer fire departments may be unintentionally forced to comply with requirements that could force them to close or curtail their emergency response activities,” said William Metcalf.

Meanwhile, Neilson worries he’ll have a harder time filling his volunteer roster if he can only offer people one 24-hour shift a week.

“We will need more volunteers and we will need to make sure they get all the training they need to stay proficient and current with all the standards they need to meet,” Nielson said.

The rules for firefighter volunteers won’t go into effect until 2015, so the city has some time to figure out a good plan.

Harrison is hopeful that the IRS gives them some relief.

Local News

Nearly 300,000 in state expected to lose current health coverage

SEATTLE — Nearly 300,000 people in Washington are finding out they can’t keep their current health care coverage and need to sign up for a new plan, according to the Washington State Insurance Commissioner’s Office.

That’s sparking outrage in some.

“I’m angry,” Linda Wilson, a small business owner in Seattle, said Wednesday.

A while ago, Wilson said, she received a letter from her insurance carrier notifying her that it was canceling her policy.

“I thought I would get a letter from them saying your rates have gone up,” said Wilson. “It didn’t even occur to me i would get the letter saying you’re canceled.”


Linda Wilson, a small business owner in Seattle, says her insurance carrier notified her that her health care policy was being canceled.

It certainly appears to go against what President Barack Obama said at the launch of the Affordable Care Act, that, “If you like your health care plan, your current insurance, you can keep your current insurance.”

Most cancellations are happening because the insurance companies aren’t meeting the minimum coverage required under Obamacare. The Washington State Insurance Commissioner’s Office says the new plans offer consumers better coverage than they used to have.

But Wilson loved her old plan, and she said that what she is finding now is the new stuff is going to cost at least twice as much.

“The sticker shock is going to be brutal, ” local insurance broker Matt Sanelli said.

There are federal subsidies available to people to offset costs, but with an income cap at $45,000 a year to qualify for subsidies for an individual, Sanelli is worried about his clients.

“People are working their tails off, to afford things for their family, and now all of a sudden they’ve got to decide whether to eat or pay for their health care,” he said.

Wilson said she believes her new health care costs will cut her income by nearly $15,000 a year. She’s still looking for an alternative, but said that unless she finds something more affordable, her plans to hire another employee are on hold.

WASHINGTON — An internal government memo obtained by CNN and written just days before the start of open enrollment for Obamacare warned of a “high” security risk because of a lack of testing of the website.

“Due to system readiness issues, the SCA (security control assessment) was only partly completed,” said the internal memo from the U.S. Center for Medicare and Medicaid Services. “This constitutes a risk that must be accepted and mitigated to support the Marketplace Day 1 operations.”

The memo goes on to explain that the Center for Medicare and Medicaid Services would create a “dedicated security team” to monitor the risk, conduct weekly scans and, within 60 to 90 days after the website went live, “conduct a full-scale SCA test.”

Health Tips: Understanding the Affordable Care ActThe memo did not detail the security concerns. It was written by IT officials at the Center for Medicare and Medicaid Services, and was sent to and signed by the agency’s director, Marilyn Tavenner, who testified on Capitol Hill on Tuesday that she thought the website was ready to go when it began its crash-riddled rollout on October 1.

“We had tested the website and we were comfortable with its performance,” Tavenner told lawmakers, although she added the caveat, “we knew all along there would be, as with any new website, some individual glitches we would have to work out.”

Republican lawmakers referred to the document Wednesday as they raised concerns at a Capitol Hill grilling of Health and Human Services Secretary Kathleen Sebelius, Tavenner’s boss. Sebelius also testified that she thought the website, which has been prone to crashing, was ready to be rolled out on October 1. She compared the early rollout to a sort of early beta test and said the system is secure because data is stored in the same systems used by the Internal Revenue Service and Department of Homeland Security.

For more on this CNN story, click here.

WASHINGTON — The Secretary of Health and Human Services, Kathleen Sebelius, apologized several times in front of lawmakers Wednesday morning for the persistent problems many Americans are facing as they try to access the new affordable healthcare.

Sebelius met with the Energy and Commerce Committee to discuss the latest with, the online national marketplace for health insurance.

In her opening remarks, Sebelius said, “In these early weeks, access to has been a frustrating experience for way too many Americans including many who have waited years, and in some cases their entire life, to have the security of health insurance. I am as frustrated and angry as anyone with the flawed launch of, a website separate of the government one, was also down early Wednesday.

Sebelius went on to say that she is the one to blame for the persistent issues.

Pool“So let me say directly to Americans, you deserve better. I apologize. I’m accountable to you for fixing these problems and I’m committed to earning your confidence back by fixing the site. We’re working day and night and we’ll continue until it’s fixed.”

Since its launch on October 1st, has been crashes for thousands of people. At the time this article was published the website was down. When working, the website has also displayed incorrect information at times and runs extremely slow.

The White House has hired a number of experts to correct the problems but has not issued a timetable on when the site will be fully operational.

For further information on this story, head to CNN’s article.

Local News

New health enrollment numbers released for Washington

healthcare310x177OLYMPIA — Officials with the Washington Healthplanfinder announced Tuesday that nearly 50,000 state residents have enrolled in the expanded health coverage since Oct. 1, despite system-wide problems that have hampered signups and brought plenty of attention to the Affordable Care Act.

Officials with the Washington Health Benefit Exchange said the website has seen 48,995 sign ups since Oct. 1, including a 38 percent increase in sign ups last week. Nearly 500,000 individuals have visited the health benefit exchange site since its implementation, officials said.

The exchange also plans to add 145 new customer support representatives for the next six to eight weeks to deal with an expected increase in customer service calls. The new customer service workers will nearly double the number of total staff members at the exchange. The call center had nearly 80,000 calls this month, with an average wait time of 21 minutes.

Dorothy Teeter, the Director of the Health Care Authority, said Washington continues to see many adults and children register for health care since the ACA was implemented less than a month ago.

“Enrollment trends also remain strong for children and other currently eligible individuals, which is great news in a state that has placed a priority on covering all kids,” Teeter said.

Though the program is seeing success according to state officials, health care enrollment through the ACA — or Obamacare — has been stymied by computer glitches and undergone tough scrutiny in the media and by conservative politicians.