Princess Health and Health-insurance companies ask state for rate increases averaging 17 percent; failure of non-profit insurer blamed. Princessiccia

Princess Health and Health-insurance companies ask state for rate increases averaging 17 percent; failure of non-profit insurer blamed. Princessiccia

health insurance health reform insurance coverage insurance exchange obamacare

Gusty 13:25 Add Comment

Department of Insurance website

Health insurers want rate increases averaging 22.3 percent in 2017 for individual policies in Kentucky. Counting small-group plans, the overall increase would be 17 percent, "continuing a national trend of hefty hikes as insurers adapt to a market reshaped by President Barack Obama's signature health care law," Adam Beam reports for The Associated Press.

"But the rate increases, if approved by state regulators, do not guarantee double-digit increases in the monthly premiums people have to pay," Beam notes. "The base rate is one of many factors companies use to determine how much someone pays in a monthly premium. Other factors include age, where a person lives and whether the person smokes."

Read more here: http://www.kentucky.com/news/politics-government/article79766917.html#storylink=cpy

Read more here: http://www.kentucky.com/news/politics-government/article79766917.html#storylink=cpy

The average requested increases for individual policies range from 7.6 percent for Aetna Health Inc. to 33.7 percent for Louisville-based Humana Inc., which said recently that it was losing money on Obamacare plans and is working on a merger with Aetna (to which Missouri objected this week). Baptist Health Plan wants 26.68 percent more, Anthem Health Plans 22.9 percent, and CareSource 20.55 percent, all on average.

�The Department of Insurance will fully investigate all proposed rate increase requests to make sure they are warranted,� Commissioner Brian Maynard said in a release. �Insurance rate increases are not specific to Kentucky; states across the nation are dealing with this issue.�

The department said some of the rate increases "appear to be attributed to the failure of the Kentucky Health Cooperative Inc.," a non-profit that was created under the reform law to provide more competition but then was not fully funded by Congress.

"The co-op went bankrupt and was placed into liquidation earlier this year, leaving other insurance companies to cover the more than 51,000 former co-op customers," the department noted. "Many of those customers were high-risk, and Kentucky�s remaining insurers appear to project that those high-risk customers will affect the risk pool." Anthem spokesman Mark Robinson told AP that the expectation of insuring co-op customers was responsible for its rate request.

UnitedHealth Group Inc. said recently that it would stop selling exchange policies in Kentucky, leaving many counties with only one insurer on the exchange. The only company that seeks to sell individual policies statewide is Anthem. It will be the only choice on the exchange in 54 counties.

However, Indianapolis-based Golden Rule Insurance Co., a United subsidiary, will sell "in all counties, off the exchange," the department said. Golden Rule, which still won't sell exchange policies, is seeking a rate increase of 65 percent.

Anthem, Aetna and Baptist will also offer non-exchange policies. Aetna plans to sell in only 10 counties: Jefferson, Fayette, Kenton, Campbell, Boone, Oldham, Trimble, Henry, Owen and Madison. Baptist will sell in 38 counties off the exchange and 20 on the exchange. Humana will sell on the exchange in nine counties (Bourbon, Bullitt, Clark, Fayette, Jefferson, Jessamine, Oldham, Scott and Woodford) and off the exchange in nine (Boone, Bullitt, Campbell, Gallatin, Grant, Jefferson, Kenton, Oldham and Pendleton). CareSource will sell in 61 counties, all on the exchange.

Consumers in Fayette, Jefferson and Oldham counties will have five insurers to choose from on the exchange. Jessamine, Woodford, Bullitt, Henry, Madison and Trimble counties will have four. Thirteen counties will have three choices, and 44 will have two. An Excel spreadsheet listing the policies for each county is available at www.uky.edu/comminfostudies/irjci/Kyhealthinsbycounty2017.xlsx.

The filings are online at insurance.ky.gov/ratefil/default.aspx. Rates must be approved within 60 days of each filing, or no later than July 11.

The administration of Gov. Matt Bevin is dismantling the Kynect health-insurance exchange and will use the federal exchange, HealthCare.gov, as a portal for enrollment in exchange policies.

Princess Health and Health-insurance stocks fall in reaction to federal judge striking down one Obamacare subsidy; ruling is stayed pending appeal. Princessiccia

Princess Health and Health-insurance stocks fall in reaction to federal judge striking down one Obamacare subsidy; ruling is stayed pending appeal. Princessiccia

health insurance health reform insurance deductibles insurance exchange obamacare

Gusty 18:34 Add Comment

"Shares of Humana, Aetna and other health insurance companies tumbled on Thursday, as a federal judge ruled that Affordable Care Act subsidies could not be dispensed without congressional approval," Boris Ladwig reports for Insider Louisville. "Humana�s shares slid 2.5 percent, and Aetna�s dropped 3.26 percent. Insurers Anthem and UnitedHealth Group also booked declines."

District Judge Rosemary Collyer of the District of Columbia ruled that Congress had never provided money for the subsidies to people who buy health insurance through Kynect and other exchanges. "Without subsidies, fewer people would be able to afford to purchase health insurance, which means insurance companies would lose customers," Ladwig explains.

Collyer, an appointee of George W. Bush, allowed the program to continue while the Obama administration appeals her ruling to the D.C. Circuit Court of Appeals. The Supreme Court appears likely to decide the issue.

The suit by House Republicans involved only cost-sharing subsidies, not the income-tax credits that apply to monthly premium payments. The Obama administration funded the cost-sharing with money from the tax-credit account.

The cost-sharing subsidies are available to people with incomes between 100 and 250 percent of the federal poverty level � between $24,300 and $60,750 for a family of four. "Several million Obamacare customers receive cost-sharing subsidies, but the exact figure is unknown," Jennifer Haberkorn reports for Politico. "As of the middle of the last Obamacare enrollment period, 57 percent of people who signed up for coverage through the federal exchange on HealthCare.gov receive them. . . . If the subsidies are ultimately struck, it would reinforce claims from opponents of the health law that the Obamacare insurance plans are not actually affordable."

Princess Health and Humana leaving some state health-insurance exchanges to cut its Obamacare losses. Princessiccia

Princess Health and Humana leaving some state health-insurance exchanges to cut its Obamacare losses. Princessiccia

health insurance health reform insurance exchange obamacare

Gusty 07:40 Add Comment

Humana Inc. said last week that it may leave some state health-insurance exchanges to cut its losses, and then left two, in Alabama and Virginia. "Humana also continues to reel after losing a large Medicare Advantage employer account," Bob Herman reports for Modern Healthcare. "Those factors and others forced the first-quarter profit at the Louisville, Ky.-based insurer to fall 46 percent to $234 million."

Humana said it would probably raise exchange-policy premiums "heavily and ditch some on- and off-exchange policies in 'certain statewide' markets," Herman reported. Later, Zachary Tracer of Bloomberg News reported that the company wouldn't sell Affordable Care Act policies in Alabama and Virginia in 2017.

"Humana is a relatively small player in the ACA, with about 554,300 individual members from the exchanges as of March 31," Tracer noted. "About 12.7 million people picked ACA plans for this year in the government-run markets. The company offers Obamacare plans in 15 states," including Kentucky.

"Humana did not hold an investor call because of its pending merger with Aetna," Herman reported. "If Humana ditches some ACA marketplaces, it would be the second major investor-owned insurer to back away" from them, following United Healthcare. That company "said last month it was losing money and would largely exit the 34 states where it sells plans," report Amrutha Penumudi and Caroline Humer of Reuters.

Princess Health and Feds find security flaws in Kynect; state says no data breaches; problems also found in federal exchange. Princessiccia

Princess Health and Feds find security flaws in Kynect; state says no data breaches; problems also found in federal exchange. Princessiccia

electronic health records health insurance insurance exchange Kynect privacy

Gusty 14:41 Add Comment

State health-insurance exchanges in Kentucky, Vermont and California had "significant weaknesses" in protecting their electronic information from hackers, the Government Accountability Office said in a report last month.

"These included insufficient encryption and inadequately configured firewalls, among others," said the report from the investigating arm of Congress. "In September 2015, GAO reported these results to the three states, which generally agreed and have plans in place to address the weaknesses."

Ricardo Alonso-Zaldivar and Frankfort-based Adam Beam of The Associated Press report, "Vermont authorities would not discuss the findings, but officials in California and Kentucky said this week that there was no evidence hackers succeeded in stealing anything."

The report said the federal Centers for Medicare and Medicaid Services, which oversees the exchanges, had not fully implemented its oversight of their security and privacy protections.

"The GAO report examined the three states' systems from October 2013 to March 2015 and released an abbreviated, public version of its findings last month without identifying the states," AP reports. "Thursday, the GAO revealed the states' names in response to a Freedom of Information [Act] request from the AP. According to the GAO, one state did not encrypt passwords, potentially making it easy for hackers to gain access to individual accounts. One state did not properly use a filter to block hostile attempts to visit the website. And one state did not use the proper encryption on its servers, making it easier for hackers to get in. The report did not say which state had what problem."

Steve Beshear, who was governor until early December, told AP through a spokeswoman that "because of the time required to fix the technical issues, not all those issues had been addressed" when Republican Gov. Matt Bevin took over. "It is important to note that there were never any security breaches of any kind, and no one's information was ever compromised."

Doug Hogan, spokesman for the Cabinet for Health and Family Services, told AP the fixes "are in various stages of completion and implementation" and security is "of the utmost importance" to the Bevin administration.

Bevin is dismantling Kentucky's exchange, which Beshear branded as Kynect, and planning to transfer the 93,000-plus people who used it to buy federally subsidized policies to the federal exchange, Healthcare.gov.

"But Kentuckians' information might not be any safer on the federal exchange," AP reports. "According to the GAO report, Healthcare.gov had 316 security incidents between October 2013 and March 2015. Such incidents can include unauthorized access, disclosure of data or violations of security practices. None resulted in lost or stolen data, but the GAO said technical weaknesses with the federal system 'will likely continue to jeopardize the confidentiality, integrity and availability of Healthcare.gov.'"

Princess Health and At top legislative Republican's invitation, Democrats embrace Obamacare, or at least Kynect and Beshear's Medicaid expansion. Princessiccia

Princess Health and At top legislative Republican's invitation, Democrats embrace Obamacare, or at least Kynect and Beshear's Medicaid expansion. Princessiccia

elections governor health insurance insurance exchange Kynect legislation Medicaid obamacare Patient Protection and Affordable Care Act politics

Gusty 16:01 Add Comment

By Melissa Patrick
Kentucky Health News

With a verve for Obamacare most had not publicly demonstrated, state House Democrats passed bills March 22 to preserve the Kynect health insurance exchange and the state's expansion of the federal-state Medicaid program.

The almost entirely party-line votes were a response to Republican Senate President Robert Stivers, who had challenged the House to act on the bills so the public will know where legislators stand on health reform.

The Senate is not expected to pass House Bills 5 and 6, but may use them as a device for debate of an issue on which Republicans seem to think they have had the upper hand. Democrats appear to think otherwise.

"This is a political issue, we all know that," House Speaker Greg Stumbo said. "The president of the Senate wanted to challenge us to talk about it, so I think we ought to talk about it because . . . Kynect is working."

(The debate begins four minutes into the following KET video. The continuation of the debate can be seen here.)

Kynect, where Kentuckians can sign up for Medicaid or buy federally subsidized health insurance, was established under executive order with federal grant money by then-Gov. Steve Beshear, a Democrat. It is paid for by a 1 percent assessment on all insurance policies sold in the state. The fee formerly funded a pool for high-risk insurance, which health reform made unnecessary.

Gov. Matt Bevin and other Republicans say Kynect is not necessary because the federal exchange, used by most states, does the same thing. "We will still be providing Kentuckians with access to care," said Rep. Addia Wuchner, R-Florence. "It will be as easy as going to a different website."

Democrats say using the federal exchange will leave Kentuckians without enough of the assistance needed by people who are unfamiliar with health insurance. More than 400,000 Kentuckians have used Kynect to sign up for Medicaid and about 100,000 have used it to get health insurance, many with the help of Kynect-paid "Kynectors."

Rep. Darryl Owens, D-Louisville, the bills' sponsor, said many people in Kentucky don't have access to the Internet and that many who do are not "tech savvy." He said that a decrease in the number of helpers, who are available to meet clients after hours and at convenient locations, will create additional barriers to access for many Kentuckians.

Rep. Kelly Flood, D-Lexington, told the House about one of her constituents who learned in the middle of a family medical crisis that they had been dropped from Medicaid. Flood said the woman told her she could not "reach that wonderful Kynector who used to tell me what was going on."

The Kynector later told her that "she had been swamped with others like her who wanted to know what was happening to the stability of their health care that they had just secured," Flood said. "It is so much more complicated than just going to a new website. I am wanting us to understand the people whose lives are on the line."

The state, completing a plan put in place by the Beshear administration, recently shifted Medicaid users of Kynect to a new system called Benefind that handles most public-assistance programs.

Emily Beauregard, executive director for Kentucky Voices for Health, told Greg Stotelmyer of Public News Service that the wait times on Benefind are two hours and 6,000 to 7,000 calls are going unanswered each day. Advocates have said that the average wait time on Kynect is two minutes.

Cabinet for Health and Family Services spokesman Doug Hogan told Stotlemyre that there had been "difficulties" with the transition and the cabinet is "working diligently with the contractor to correct problems and make the system perform as was intended."

The House voted on the bills separately but the main debate touched on both Kynect and Beshear's expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level. The federal government is paying for the expansion until next year, when states will begin paying 5 percent, rising to the law's limit of 10 percent in 2020.

Bevin and other Republicans say that is not sustainable, and he is negotiating with federal officials to change Medicaid to save money and add more personal responsibility, such as premiums, co-payments and deductibles.

Rep. Joni Jenkins, D-Louisville, chair of the House Budget Subcommittee on Human Services, said most Kentuckians who get insurance through Kynect and expanded Medicaid work in low-income jobs and without the program cannot afford insurance.

"With all of this great news -- more people covered, profitable hospitals, more jobs, better health care and wellness -- I believe the evidence is overwhelming that Kentucky must keep Kynect and expanded Medicaid," Jenkins said.

At times the debate was more about federal health reform in general than about the specifics of Kynect or Medicaid expansion.

Rep. Jim Gooch, a Providence insurance agent who recently became a Republican, said many Kentuckians have been helped by Obamacare, others have been hurt. He said many can't afford their co-payments and deductibles, and he said President Obama lied when he said people could keep their old health plans and doctors if they wanted after the reform law passed in 2010.

Another insurance agent, Rep. Jeff Greer, D-Brandenburg, argued the other side. He said the Patient Protection and Affordable Care Act had brought many people their first affordable health insurance, especially those with pre-existing conditions, and relieved many farmers of the need to to work another job to get insurance.

"What I see is that we have something that is working, and I'm in a field where I see it work and yet we want to dismantle it and go to something that we're not sure is gong to work or not, Greer said. "I just don't get it."

House Minority Leader Jeff Hoover, R-Jamestown, said using the federal exchange "will not cause a single policy to be canceled or a single person to lose coverage." He said 36 other states now use the federal exchange "seamlessly."

Hoover and other Republicans said the debate was overdue, referring to Beshear's executive actions that the legislature was unable to block.

The Kynect bill passed 52-46, followed by a 54-44 vote for the Medicaid expansion, with Republican Reps. Jim DuPlessis of Elizabethtown and Jim Stewart of Flat Lick joining the Democrats. Reps. Gerald Watkins, D-Paducah, and David Floyd, R-Bardstown, did not vote on either bill.

All House seats are on the November ballot. House Democratic Caucus Chair and state party Chair Sannie Overly was asked how a vote for Obamacare might affect the election. "I think that House Bill 5 and 6 are simply a message to others that we stand by our commitment to providing access to healthcare to all Kentuckians," she said. "We've seen that our constituents support making sure that their friends and neighbors and relatives have access to health care."

To the same question, Rep. Robert Benvenuti, R-Lexington, said, "I think the voters have already thoughtfully evaluated that and cast a strong vote for Gov. Bevin, so I do think it will come up again in these November elections."

Princess Health and Bills to preserve Kynect and Medicaid expansion head for votes in Democratic House despite a likely death in Republican Senate. Princessiccia

Princess Health and Bills to preserve Kynect and Medicaid expansion head for votes in Democratic House despite a likely death in Republican Senate. Princessiccia

elections General Assembly health insurance insurance insurance exchange Kynect legislation legislature Medicaid politics

Gusty 18:41 Add Comment

By Melissa Patrick
Kentucky Health News

Bills to continue the Kynect health-insurance exchange and the state's current expansion of the federal-state Medicaid program passed out of the House Health and Welfare Committee March 17, starting a series of legislative votes on health reform that once seemed unlikely.

House Speaker Greg Stumbo said he expects the bills to pass the Democratic-majority chamber, even though Republicans in the fall elections could cast votes as support for "Obamacare," the federal reforms under which then-Gov. Steve Beshear created Kynect and expanded Medicaid.

�There�s never really been a debate on this issue,� Stumbo said. �There�s not been a true letting of the facts, if you will.�

Six days earlier, Senate President Robert Stivers had more or less dared Stumbo to move the bills, whose sponsor had said he did not expect them to pass the Republican-controlled Senate, in order to "have a full, fair debate on the issue" and see where legislators stand on it.

House Bill 5 would require the state to keep operating Kynect, which Gov. Matt Bevin is starting to dismantle or transform. In his campaign, Bevin vowed to abolish the exchange, saying it did nothing that the federal exchange does not. Recently his administration announced that it would continue operating a state-based exchange but use the federal exchange for enrollments.

"They're being pushed into what everyone calls Obamacare, and they don't want that," Stumbo told reporters.

House Bill 6 would keep the current expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level. Bevin is negotiating with federal officials to change the program, saying it will not be sustainable once the state has to start paying part of the cost.

Rep. Darryl Owens

The committee approved the bills along party lines. Their sponsor, Rep. Darryl Owens, D-Louisville, said he filed them because "It is important for people to understand that there are those of us in this legislature that want to continue expanded Medicaid, that want to continue Kynect."

The exchange is paid for by a 1 percent assessment on all insurance policies sold in the state. The fee formerly funded a pool for high-risk insurance, which reform made unecessary. Approximately 1.4 million Kentuckians use Kynect, all but about 100,000 of them on Medicaid.

Kynect was started with federal grants. Rep. Robert Benvenuti, R-Lexington, argued that the state must include that $273 million when considering its cost. "I think most people in this room, most people in Kentucky, pay federal taxes as well, so this whole notion that there is a great federal money tree in which we can go pick off of and build things is just not correct," he said.

Owens replied, "I'm not saying it's a money tree, I'm just saying it's a grant that the federal government gave the states if they wanted to develop their own system," Owens said. "And I think the thing we miss when we talk about that is we have a great system; we have the best system in the country."

Rep. Tim Moore, R-Elizabethtown, whittled the definition of Kynect down to a business that advertises and markets Medicaid and health insurance to Kentuckians, and asked, "How do you spend that kind of money to go out and build a marketplace for soliciting folks to do what would be in their own interest anyway?"

Cara Stewart of the Kentucky Equal Justice Center said the marketing has value because it has created a brand that Kentuckians recognize and trust, allowing them to know where to go to get health insurance. She said Kynect runs seamlessly to help Kentuckians shop and enroll in coverage for both Medicaid and federally subsidized insurance plans, unlike Bevin's approach.

She said later that it now takes two minutes to reach customer service on Kynect and two hours on Benefind, which is operated by the state Department of Community Based Services. "We are radically changing the quality of service to Kentuckians," she said.

Rep. Tim Moore

Moore said he was glad the bills would be voted on because Kynect and the Medicaid expansion had been created through "dictatorship," not "the will of the people." Beshear acted under a state law that requires the government to get as much federal money as possible for Medicaid, and he used his broad executive powers under the state constitution to transform the high-risk pool into Kynect.

Moore said Bevin's election showed public opinion on the issue. However, a poll in November, after the election, showed Kentuckians supported the Medicaid expansion by 3� to 1 and keeping Kynect by 2 to 1.

Democratic Rep. David Watkins, a retired physician from Henderson who voted for both bills, said, "It is kind of sad that our citizens don't pay attention to what our politicians are saying because they do have consequences."

Democratic Rep. Joni Jenkins of Louisville, chair of the House Budget Subcommittee on Human Services, said her panel's hearings convinced her that the state needs to keep it. She said there is value in having one system for Kentuckians to access health insurance, and to have Kynectors, who not only help people access health insurance, but also help them access health services.

Emily Beauregard, executive director for Kentucky Voices For Health, said after the meeting that navigating health insurance is difficult, especially for those who have never had it. "We need to help connect people to a source of care and help them understand how to use their benefits and that's what we've been able to do through Kynect," she said. "Coverage alone is not going to solve Kentucky's health issues."

Benvenuti said after the meeting, "There are various ways to get people to health care and creating a huge governmental system that is duplicative of the federal system is simply not the best use of our dollars."

As for Medicaid, Benvenuti said, "We've got to create a system where everybody who gets health care through an expansion population, or however you want to define it, has skin in the game and is responsible ultimately for their own health care."

Princess Health and Customers of exchanges such as Kynect are more likely to get prescriptions than other private health-insurance customers. Princessiccia

Princess Health and Customers of exchanges such as Kynect are more likely to get prescriptions than other private health-insurance customers. Princessiccia

drugs health insurance insurance exchange obamacare Patient Protection and Affordable Care Act pharmaceuticals prescription drugs

Gusty 04:22 Add Comment

"People enrolled in health plans through the Affordable Care Act exchanges are ramping up their use of prescription medications more rapidly than those in employer or government-sponsored plans, according to a new report from Express Scripts, the largest prescription drug benefits company," Carolyn Y. Johnson reports for The Washington Post, which headlined the story "A new sign Obamacare is helping the people who really need it."

"In 2015, people in the exchanges increased their number of prescriptions filled by 8.6 percent, four times the rate of people who receive insurance through commercial plans outside of the exchanges," Johnson writes. However, "The overall amount spent was much lower per person -- $777.27 compared to $1060.75" for commercial plans.

"The rapid uptake of the prescription drug benefit suggests there was a significant unmet medical need for many people gaining insurance through the exchanges, some of whom could have preexisting conditions and may not have previously had access to medicines," Johnson reports. "Before 2014, insurance companies could refuse coverage or charge much higher premiums for people with pre-existing conditions."

Express Scripts handles about a third of the prescriptions paid for by plans sold through the exchanges, including Kynect in Kentucky.