But experts say the national numbers actually don’t mean very much.

“These are really state-based markets,” says Caroline Pearson, vice president at , a consulting firm based in Washington D.C. Because each insurance market is run within each individual state, big numbers in some states can’t make up for shortfalls in others.

Still, much of the debate has centered around 6 million — the nationwide number the  estimated would sign up for insurance through the federal and state health exchanges. (That’s indeed about how many have , the Obama administration confirmed Thursday.)

Insurers hope that at least  of those enrollees will be between the ages of 18 and 34. The theory is that those younger people will also be healthier, and offset the costs of people older and sicker.

” ‘Six million’ and the ‘percent of young adults’ are easy numbers for politics, and politics sometimes struggles with the more nuanced issues that really matter for the underlying policy,” says Pearson, explaining at least some of the fixation on national numbers.

Meanwhile, Seth Chandler, who teaches insurance law at the , says some states are doing quite well at signing people up, “such as California, New York, Connecticut, Vermont.”

California alone has enrolled more than  in private health plans, and New York .

But at the same time, Chandler says, other states are lagging seriously behind, “including the big state of Texas, and states such as Louisiana, Arizona, Mississippi, and Oklahoma.

“The fact that New York doesn’t experience problems in its health insurance market, and insurers aren’t being squeezed there,” he says, “does nothing whatsoever to help insurers and people in Texas, Louisiana, and elsewhere where — it looks like, at least,— too few people are enrolling [to enable us] to have confidence in the success of the marketplace.”

And it’s not just an issue of the total number of people signing up in each state, or whether they’re young or old. Karen Ignagni, who leads the insurance trade group , says the real issue is the balance of healthy to sick individuals. She said in a  last week that health plans are already seeing an influx of sicker people, thanks to new rules that bar health plans from discriminating people who have preexisting health conditions.

“We see a number of people who have gotten into the program, in January in particular, who are using a number of health care services,” she said. “That’s to be expected. No one in our industry thought it would be any different. We thought the people who needed services immediately would be the first to be motivated to sign up.”

The big question, says Ignagni, is whether the last minute  that appears to be taking place now will be big enough, and full of the right kind of people.

“We thought the people who were healthier, who didn’t feel like they needed services immediately, would be [signing up] at the end of the process,” she said. “And we’re hoping that hypothesis is going to be true.”

But there’s yet another factor the overall numbers don’t take into account: the expectations of insurance companies when they set their premiums for this first year.

“Was the pricing any good to begin with?” asks Chandler, the Houston law professor. “Were they too conservative in their estimates of the population? Were they too liberal? There are all these factors that we do not know yet that are going to determine as much as the raw enrollment numbers how insurers react for 2015.”

In other words, the bottom line on what happens to individual insurance markets in each state after this first open enrollment season is going to depend on a lot more than just one or two numbers.

This <a target="_blank" href="/news/obamacares-national-enrollment-looks-ok-but-states-matter-more/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

2014 is the first year most Americans will have to either have health insurance or face a tax penalty.

But most people who are  of the penalty think it’s pretty small, at least for this first year. And that could turn into an expensive mistake.

“I’d say the vast majority of people I’ve dealt with really believe that the penalty is only $95, if they know about it at all,” says Brian Haile, senior vice president for health policy at . “And when people find out, they’re stunned. It’s much, much higher than they would expect.”

In fact, “the penalty is the maximum of either $95 or 1 percent of taxable income in 2014,” according to Linda Blumberg, a senior fellow at the . “For people with higher incomes it can be much more sizable than $95.”

Blumberg says that even for people with more moderate incomes, it’s important to remember that the flat fee penalty will be assessed for every family member who lacks health coverage.

“So if it’s a two-adult household and both are uninsured, it’s twice $95; $190,” he says. “Then if there are any children in the family that are uninsured, the penalty for each of them is half of the $95.”

The flat fee penalty maxes out at $285 next year. To help people figure out what they might owe, the , jointly run by the Urban Institute and the Brookings Institution, just posted an . And Jackson Hewitt has its own “How much is my tax penalty?” .

Haile says it’s important to remember that even if most of the family has insurance, having just one uninsured member can trigger the penalty.

“If you’ve got someone who comes home to live it could cost you much more than a spare bedroom,” he says. “If you claim that child as a dependent, or could claim that child as a dependent, then you suddenly become liable for penalties if that child lacks minimum essential coverage.”

The 1 percent penalty, for those hit with that, also has a cap, but the penalty can still get pretty big. The cap is tied to the cost of the . This year’s top penalty could be about $3,600 for an individual, and $11,000 for a family of four.

If you’re uninsured and earn enough to be potentially liable for penalties, you have to sign up for coverage by the end of this month in order to avoid them.

“Your only chance to buy insurance, unless you have a special qualifying event, is during this open enrollment period,” Haile says, “which makes March 31 an incredibly important date for avoiding the penalty. If you want to avoid the penalty, you need to get in and sign up for coverage now.”

That’s much different than how things were before the law’s implementation. But the Urban Institute’s Linda Blumberg says it’s due to the new rule that protects people with pre-existing health conditions.

“Now the insurance companies can’t say no, even if you’ve had serious health problems in the past, or have a serious health problem today. They can’t deny you,” she says. “And because of that, people are restricted to obtaining coverage during the open enrollment period or during some other open enrollment period where they’ve had a change in their family status or income.”

Indeed, changes to family status — a birth, divorce, or job change — will allow you to buy or . And if you’re eligible for Medicaid or your kids are eligible for the Children’s Health Insurance Program, you can .

There are also lots of exemptions from the penalty itself, Blumberg points out, even for people who remain uninsured. The biggest is having income below the .

This year that’s roughly $10,000 for a single person and $13,000 for a head of household. If you don’t have to file income taxes, you won’t have to pay a penalty. You also can get an exemption if the cheapest available insurance would cost more than 8 percent of your income, if you have unpaid medical debt, or for any of several other  listed on the Ìý·É±ð²ú²õ¾±³Ù±ð.

But for most people with incomes above the poverty line, time is running out to either get insurance or prepare to pay up instead.

This <a target="_blank" href="/news/skipping-health-insurance-could-cost-a-lot-more-than-95/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

With a bit more than a month left for people to sign up for health insurance plans set up under the Affordable Care Act, the federal website known as healthcare.gov finally seems to be working smoothly — in 36 states.

But what’s happening in the 14 states that are running exchanges?

Some are doing quite well, thank you. California, for example, said that enrollment has already exceeded its projection for the entire enrollment period, which ends March 31.

Other states, however, are having trouble, some of it severe.

Oregon, for example, has only just gotten its website this week, and it’s still not fully open to the public. Until now, Oregon had been using paper applications.

So what makes a state health exchange successful?

, who helped launch the exchange program for the federal government and now consults for states and others working to implement the health law, says the states doing best are generally the ones doing the least — at least when it comes to their websites.

“The states that said, ‘This is complicated, we’re going to focus on the most essential issues,’ those were the states that tended to do better,” he says.

Among places in that category, according to Ario, are not just California, but also Kentucky, New York and Connecticut.

Too Ambitious?

In contrast, Ario says, many of the states that are now struggling may simply have overreached.

“Unfortunately states that I once touted as the leaders — Maryland, Oregon, Minnesota,” are among those bringing up the rear, he acknowledges. “This is a complicated undertaking, and so people who tried to do too much in [the first year], I think, had some problems with that.”

Maryland and Minnesota haven’t had the same problems as Oregon, but their have both been worked only , and enrollment has lagged. Just as with the federal website, part of the problem has been on the information technology side.

We’ve seen in some states that some vendors have not been able to deliver, and states have struggled with the IT implementation,” said , who advises states for the Robert Wood Johnson Foundation.

Vexing Vendors

In Maryland, fixing the exchange has been complicated by the fact that two of its IT vendors are . Massachusetts and Vermont have both had , the vendor that was found responsible for most of the messy rollout of the federal site, .

But experts say blame for failure — and credit for success — doesn’t all belong to the outside IT contractors. It’s also due in large measure to how well those contractors worked with state officials. Audrey Haynes oversees Kentucky’s largely successful exchange, She says one key to making it work was putting the exchange in the same department that runs Medicaid.

“Anyone knows that Medicaid has to have a pretty super IT department that supports it,” she said at a sponsored by the Robert Wood Johnson Foundation. “So we have a lot of experience … at bringing up large IT structures.”

And where do state exchanges go from here? Republican members of Congress from and are asking the federal government to investigate the limping exchanges in those states. That’s because both received millions of federal dollars to set up their health insurance marketplaces.

In principle, says consultant Joel Ario, figuring out what went wrong is not a bad idea. “I certainly think we want to look carefully at what happened and learn some lessons here. I don’t think anybody’s going to find any improprieties here, because they’re going to think it was all well-intentioned activity.”

And in the long run, once the states that are lagging work out their IT problems, they will probably end up, much like California, doing better than the states being run by the federal government. Heather Howard says that’s because states running their own exchanges also have more resources for consumer outreach.

“They have consumer assistance infrastructure, grants out to community-based organizations, and they’re building and doing a lot more marketing,” Howard says. “And their consumers are hearing much more about the options.”

All of which merely underscores something important about the health law that hasn’t changed: What’s available to you depends very much on where you live.

This <a target="_blank" href="/news/quick-update-of-state-insurance-exchanges-still-a-mixed-bag/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

With less than eight weeks to go before the official launch of the under the federal health law, backers of the law are to encourage people to sign up.

But there’s another effort gearing up this month as well. Opponents of the health care law are making one last-ditch effort to run Obamacare off the rails before it gets fully implemented.

Probably the most aggressive effort is coming from , a conservative advocacy group. It’s urging people, particularly young people, not to sign up for health insurance.

“They can skip the exchange, pay the fine, and in doing that, do what’s best for them financially, and we hope help hasten the collapse of Obamacare,” said Dean Clancy, the group’s Vice President for Policy.

FreedomWorks has also created a bit of civil disobedience theater as part of its campaign — inviting people to . Of course there is no such thing as an Obamacare card. But that’s not a problem. FreedomWorks is making its own, and distributing them.

“We’re going to be holding burnings around the country,” said Clancy. “Without burning anything down,” he’s quick to add. “It’s all peaceful and lawful.”

Clancy says the idea is to harken back to the days of the Vietnam War, when protesters burned their draft cards – that got many sent to prison.

“The individual mandate at the heart of Obamacare is a lot like a military draft,” he said. And if enough young people resist the health law the way they resisted the war, “then Washington will get the signal, we’ll be able to reopen this law, and we’ll be able to push for patient centered reforms that really help people get the coverage they need.”

FreedomWorks isn’t the only conservative group aiming squarely at the young demographic considered so key to making the health law work, though. (Young people are necessary to ensure the exchanges aren’t overloaded with older, sicker patients.)

Another GOP advocacy group called the — YG stands for young guns — is out with that’s been airing on youth-oriented programs like Saturday Night Live.

It pokes fun at the Obama administration’s efforts to promote the law by showing a frustrated group of advertising executives around a table, trying to figure out how to sell a product that’s not very popular.

YGNetwork spokesman Chris Bond says the ad is “simply drawing attention to the fact that they’re using taxpayer money in this cynical marketing effort rather than fixing the law so that it doesn’t hurt Americans.”

But not all the effort to stop the law in its tracks is being aimed at the young. , the advocacy arm of the Heritage Foundation, is launching a nine-city starting later this month.

Dan Holler, the group’s spokesman, says time is of the essence.

“On Oct. 1 open enrollment starts for the Obamacare exchanges,” he said. “And on Jan. 1 there’s a ton of money that starts flying out the door. And up until now, most of the conversation about Obamacare has been, ‘this is going to happen at some point in the future.’ The future is now on this.”

Unlike many of the other groups, however, Heritage isn’t urging people not to enroll in the exchanges. It’s concentrating on getting grassroots support to get Congress to .

“Right now there’s a viable legislative strategy to go ahead and halt the implementation of Obamacare,” Holler said. “And we want to drive that as hard and as far as we possibly can. And the town halls are an effort to do just that.”

And what does the Obama administration think of all these efforts to interfere with the law’s rollout? Not a lot, at least according to Health and Human Services Secretary Kathleen Sebelius.

“I don’t think we’re going to spend a lot of time and effort trying to estimate who they may discourage from getting health insurance to provide security for themselves and their family,” she told reporters on a conference call Monday. “I think it’s a pretty dismal effort underway.”

The administration does have backup, though. Groups like will be out countering the Republican efforts, says spokesman Eddie Vale.

“When Republican members are having town halls we will have local people come to them to ask why they keep trying to take away their health care,” he said. “When Heritage or are doing their events, we will of course send people out to those.”

And Vale wonders about the irony, in particular, of the FreedomWorks card burning effort.

“They’re asking people literally to play with fire and burn Obamacare documents while at the same time telling these very same people that they shouldn’t have health care,” he said.

For the record, FreedomWorks officials not to burn themselves while they’re burning their cards.

This <a target="_blank" href="/news/anti-obamacare-forces-ramp-up-campaign-to-stop-implementation/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

Of all the contentious claims about the Affordable Care Act, few have been more contentious than over the impact it’s having on employers.

It’s hard to Ìý´Ç°ù  without seeing a story about some boss cutting workers’ hours or saying they won’t be doing any more hiring because of the health law.

But is the law really having an impact on the economy?

Not surprisingly, it depends whom you ask.

Opponents of the law point to anecdotes in industries with a lot of low-wage workers, .

They also point to employer surveys like one from the . It found that nearly one in five small businesses said they were reducing hiring to try to stay under the 50-worker threshold that exempts companies from a requirement in the Affordable Care Act that full-time employees be offered health insurance. Another 16 percent said they planned to adjust hours so fewer workers would be eligible for health insurance.

But now the law’s supporters, including the White House, are fighting back.

They’re putting out  showing that part-time employment is no higher during this economic recovery than during other recent economic recoveries.

That includes people working part time who’d rather be working full time. That data shows that most of the people involuntarily working part time are in that situation due to state and federal budget cuts, not the health law. They’ve also pointed out that weekly hours have risen since the health law was passed, including in the restaurant industry.

So who’s right?

It’s entirely likely that both sides are. One of the White House talking points is that  would be impacted by the Affordable Care Act requirements. Those are typically people who don’t have health coverage and who work more than 30 hours a week for companies with more than 50 employees.

That’s not a big enough group, they point out, to really affect the economy on a macroeconomic level. And it’s not.

But one percent of the workforce is more than a million people, more than enough to make for a lot of anecdotes. There’s also the issue that the administration and its allies are looking back at what’s happened so far, while opponents are looking mostly forward at what may happen in the future.

Still, there are efforts on Capitol Hill to address one point of contention: The law defines full-time work as more than 30 hours per week, rather than the traditional 40.

Sens. Susan Collins R-Maine, and Joe Donnelly, D-Ind., have introduced the ,” which they say would “ensure that the definition of full-time employee and full-time equivalent in the ACA is consistent with the traditional full-time 40-hour work week.” A similar bill has been .

The prospects for the legislation, however, are not good.

One reason is that Congress is so gridlocked and Republicans are so dug in against the law that even when  there is little likelihood of it happening.

And on this issue there’s no consensus that changing the definition of a full-time work week would actually change employers’ incentives.

University of Chicago economist Casey Mulligan, , suggested that such a change could create its own set of disincentives, with a 39-hour-a-week job with no insurance potentially paying more than a 40-hour-a-week job with employer insurance, because of subsidies available for health insurance in the new health exchanges.

This <a target="_blank" href="/news/definition-of-full-time-becomes-a-sticking-point-in-obamacare/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

The Obama administration is countering criticism that the new health insurance exchanges will be , though it’s doing so a bit quietly.

At a White House briefing Thursday for health reporters, in which senior administration health officials spoke on the condition that they not be named, and in a , the administration insisted that in most states at least, competition will be far greater than it is today — with 120 companies having applied to offer insurance.

For example, in three-quarters of the states where the federal government is running the marketplaces, at least one new insurer has applied to enter the individual market. And nearly two-thirds of the new insurance entrants to the individual market in federally run exchanges are in states where one insurance company now dominates the market.

The officials stressed how much better competition will be than it is in the current market for individual coverage. In 2012, one insurer covered more than half of all people in the individual market in 29 states. In 11 more states, two insurers covered 85 percent or more of the individual market enrollees.

The federal government will be fully in charge of the exchanges in 19 states. It will partner with states in 15 states. The remaining 17 states will run their own marketplaces.

“We’re very encouraged,” one senior official said, that there will be “products on the shelves” when the marketplaces open for enrollment on .

The officials also provided the first preview of something that has gotten relatively little notice so far: Multistate plans that are overseen by the Office of Personnel Management. That task was given to OPM because it oversees the , which covers more than 8 million federal workers, including many plans that offer coverage nationwide.

Under the health law, at least two multistate plans are supposed to be offered nationwide in order to boost competition by 2017. OPM officials said they are reviewing more than 200 proposals so far and they expect multistate plans to be offered in at least 31 states in 2014. Multistate plans will be available to both individuals and small businesses, officials said.

This <a target="_blank" href="/news/white-house-there-will-be-competition-in-insurance-exchanges/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

The news that U.S. scientists seems almost certain to rekindle a political fight that has raged, on and off, since the announcement of the creation of.

“The issue of legislation on human cloning is about to get hot again,” says Hank Greely, director of the at Stanford Law School.

But it’s a fight that has, over the past decade and a half, produced a lot of heat and light and not a lot of policy.

Human Cloning

In fact, for all the arguing about the issue that’s happened in Washington over the years, human cloning is still technically legal, at least in much of the country.

“There are already 60 countries in the world that have laws on their books banning human reproductive cloning, and this prohibition is also in a number of international agreements” says Marcy Darnovsky, executive director of the, which is devoted to the responsible use of new genetic and reproductive technologies. “But in the U.S., we have not managed to put such a law on the books at the federal level.”

At least 15 states ban cloning, either for reproductive purposes or research or, in come cases, both, according to the

But Congress has mostly fought issues of bothÌý²¹²Ô»å to a draw.

“What we saw the last time cloning was in the headlines was that the discussion really got mired in the abortion controversy,” Darnovsky said.

The House passed bills banning all forms of cloning in 2001 and 2003; the Senate failed to act in both cases.

“All the other issues got completely swamped,” she said. “And I really hope that doesn’t happen this time.”

But both the issues of cloning — for research and reproduction — and embryonic stem cell research have been mired in the abortion controversy from the start.

Stem Cell Research

About the only law that has been able to pass is language that gets added to the funding bill for the Department of Health and Human Services every year since the mid-1990s — the so-called, named for its original House sponsors, Reps. Jay Dickey, R-Ark., and Roger Wicker, R-Miss. It bars the use of federal funds for research that could destroy or harm a human embryo.

The Clinton administration decided that federal funding of embryonic stem cell research using cell lines derived from embryos destroyed with private funds

President Bush put that policy into force but available to researchers.

“I have concluded that we should allow federal funds to be used for research on these existing stem cell lines, where the life-and-death decision has already been made,” he said in a televised address to the nation.

Meanwhile, over the years Congress to expand federal funding of embryonic stem cell research, under specific ethical guidelines, as well as legislation to ban cloning intended to make a baby. None, however, was able to pass both the House and Senate and get the president’s signature.

When he came into office in 2009, President, while maintaining guidelines such as not paying women for their eggs.

“The majority of Americans, from across the political spectrum, and from all backgrounds and beliefs, have come to a consensus that we should pursue this research,” he said.

FDA Rules

But Congress remains deadlocked over the bioethical issues — which is not to say that there is no federal regulation.

Jonathan Moreno, a bioethicist at the , points out that the has, from the start, said it would closely regulate anything it deemed to be human cloning, whether reproductive or therapeutic.

“Once you start talking about putting many of the products of these cells into people, then you get into an area where the FDA is very interested,” he said.

Meanwhile, Darnovsky of the Center on Genetics and Society says she hopes this new development might break the legislative logjam.

“This development, if it turns out to be replicable, will mean that there will be cloned human embryos in labs around the country,” she said. “And we really need to make sure that no unscrupulous person would ever try to use those to produce a cloned human being.”

Congress, however, has been unable to pass much of anything this year. It’s unclear yet if this will rise to the level of must-pass.

This <a target="_blank" href="/news/cloning-stem-cells-long-mired-in-legislative-gridlock/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

The Obama administration’s actions this week on emergency contraception have left many women’s health groups sputtering with anger.

But what really has some of the President Barack Obama’s usual allies irritated is the fact that the moves are in direct contrast to speeches he made in just the past week.

Recall that on Tuesday the Food and Drug Administration defied a federal judge’s order to make the morning-after pill available over-the-counter to women of all ages by . On Wednesday, the Justice Department  the federal judge’s ruling.

Yet only last Friday, Obama became the first sitting president to address Planned Parenthood’s .

His spirited defense of reproductive rights included this statement: “We shouldn’t have to remind people that when it comes to a woman’s health, no politician should get to decide what’s best for you.”

And on Monday, he said this to the : “[I]n all the sciences, we’ve got to make sure that we are supporting the idea that they’re not subject to politics, that they’re not skewed by an agenda, that, as I said before, we make sure that we go where the evidence leads us.”

But now, many women’s health advocates say the administration isn’t putting its actions where the president’s rhetoric has been.

“It doesn’t square and that is what’s so disappointing,” said Nancy Northup. She’s president and CEO of the , one of the groups involved in the emergency contraception lawsuit against the administration that’s prompted this week’s activity.

“There couldn’t be a clearer record than there is in this case that emergency contraception is safe and effective for all ages, that we had not one but two administrations who continued to put what they judged as the politics of the issue about contraception ahead of what’s doing right for the public health,” she said.

Health and Human Services Secretary Kathleen Sebelius  to remove the age restrictions in 2011. She said she was worried that the youngest teens wouldn’t understand how to use the product safely.

But that’s not a concern for the nation’s pediatricians, who support full over-the-counter access to the drug.

“We get derailed over and over again in people’s ethical and moral concerns about whether teens should be sexually active, and not that this is a safe drug that can be and should be available to all women of reproductive age,” said Dr. Cora Breuner. She’s a professor of pediatrics at the University of Washington and co-author of the American Academy of Pediatrics  on Emergency Contraception.

Women’s health advocates say even the steps the FDA did take this week — to lower the age for sale of the drug without a prescription from 17 to 15 — doesn’t do much, because they still have to show identification.

“15- and 16-year-olds are much less likely to have an actual government ID with your birth date on it,” said Susan Wood, a public health professor at George Washington University and a former . “So that … doesn’t really expand access to that age group very much.”

In fact, what really worries the women’s health groups is that idea that this fight that has already gone on for more than 10 years, now could stretch out years longer.

This <a target="_blank" href="/news/womens-health-groups-angered-by-administration-morning-after-pill-policies/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

One of the more popular provisions of the federal health law requires that women be given much freer . That includes not only the pill, but implants and IUDs as well.

But what happens if there are not enough doctors to prescribe those contraceptives?

That’s exactly what worries some reproductive health advocates, as efforts are underway to rewrite rules governing the training of the nation’s family doctors.

The proposed new rules, they say, drop existing requirements that family medicine residents be required to undergo training in contraception and counseling women with unintended pregnancies.  are now running  to make sure the rules remain.

Revising The Rules

Family physicians are what used to be known as general practitioners, or GPs.

“My youngest patient hasn’t been born yet, and the oldest I take care of is 94,” says Jeff Cain, president of the American Academy of Family Physicians and a family doctor in Denver.

For the majority of women, particularly outside major cities, it’s family doctors, not obstetrician-gynecologists, who provide for their reproductive health needs.

“The main people who staff community health centers, as well as large swaths of rural America, are family doctors,” says Linda Prine, a family physician from New York.

To become a family doctor, however, medical residents must complete a wide-ranging and rigorous three-year training program approved by the Accreditation Council on Graduate Medical Education.

Every seven years, the ACGME guidelines for each specialty are revised; it’s now time for a .

Prine, who is also the medical director of the Reproductive Health Access Project, helped lead a push the last time around to require all family medicine residents to learn to provide all forms of prescription contraceptives, including placing IUDs and implants, and to counsel patients with unintended pregnancies on their options.

“The language was put in so that we would be assured that family doctors were prepared to provide health care for their patients,” she says.

But now that requirement appears to be going away.

“The feedback we’ve gotten over the years is that a lot of the curricular requirements were too specific,” says Peter Carek, a professor of family medicine at the Medical University of South Carolina and chairman of the committee that’s rewriting the requirements for family medicine residents.

“So in general what we’ve tried to do as a committee is to at least in as many areas as we could, pull back some of those specific requirements and give them more general requirements to follow,” he says.

Criticism

Reproductive health advocates say there’s a big problem with leaving contraception training up to each program: Many residency programs these days are run by religious hospitals that don’t believe in contraception.

“The way it works right now, the residency is required to at least send the residents off-site to another place, say, a family planning clinic where they can learn how to provide birth control,” Prine says. “If these regulations change and there’s no wording whatsoever about the need to provide contraception, the residency programs would no longer be obliged to send their residents somewhere where they would get this education.”

If you think that  isn’t becoming the norm, think again.

“We took a look recently and found that of the 25 largest health systems in the United States, 13 were religiously sponsored; that includes 11 Catholic systems,” says Lois Uttley, who heads the nonprofit group MergerWatch, which works to protect women’s access to reproductive health care when secular hospitals merge with religious ones. “So that means the likelihood of a patient encountering a Catholic restriction on contraception is pretty high and growing.”

Draft Document

Family medicine officials, however, say they are aware of the concerns from reproductive health advocates.

“The American Academy of Family Physicians and family medicine educators really remain committed to ensuring that women’s health is a core educational part of training family physicians,” says Cain, the AAFP president. “That includes family planning and maternity care.”

Cain says that while the new program standards may not spell out the contraceptive training requirements the way the current ones do, he expects they will be included in a frequently asked questions part of the document that will still carry the same weight.

In any case, he points out, “the truth is this is a draft document right now. We want to make sure the wording in the document reflects the intended outcome.”

Both Cain and Carek say they are taking under serious consideration all the comments they have been hearing about the standards so far.

The last day for the public to comment is Thursday.

This <a target="_blank" href="/news/new-guidelines-may-drop-birth-control-training-rule/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

Since the Supreme Court made the  under the federal health law optional last year, states’ decisions  along party lines. States run by Democrats have been opting in; states run by Republicans have mostly been saying no or holding back.

But now Arkansas – at the suggestion of the federal government – has suggested a : Enroll those newly eligible for Medicaid in the same private insurance plans available to individuals and small businesses.

And some think that could shake things up. A lot.

The Arkansas proposal was crafted as much out of political necessity as from substantive desire, says Andy Allison, the state’s Medicaid director.

“I think this is likely to be the only way that expansion or coverage for this population could occur,” he says.

There are two reasons for that. One is that the state has a Democratic governor (Mike Beebe, now serving his second term), but a heavily Republican state legislature, which has  on expanding Medicaid.

A second reason is that few adults currently qualify for Medicaid in Arkansas. And those who do have to be really poor, says Allison: “We cover just at 17 percent of the poverty level for those who are parents and we don’t cover childless adults unless they have a disability.”

For the record, 17 percent of poverty is less than $2,000 a year. Expanding Medicaid under the Affordable Care Act to 133 percent of poverty — about $15,000 — could potentially add as many as 250,000 Arkansans to the rolls.

But what was a political nonstarter gained new life when someone suggested the idea of enrolling those new people in the same private plans individuals and small businesses will be purchasing — the , called exchanges.

So far the state has gotten a  from the U.S. Department of Health and Human Services. That’s caught the attention of several other Republican-run states that had been holding out on the Medicaid expansion, including Ohio, Florida, and even Texas.

But experts insist the proposal is hardly as new as some have suggested.

“The authority to use Medicaid funds to buy insurance has been in the law since it was first enacted,” said , a law professor and Medicaid expert at the George Washington University.

Still, when the Arkansas arrangement first went public about a month ago, there was some immediate hand-wringing about its potential cost.

“We have to … recognize that it will cost more,” said , a Boston University health economist. “You don’t get something for nothing.”

But Frakt concedes that paying somewhat more — how much more remains a subject of contention — might not be all bad.

“One of the basic critiques of the Medicaid program is they pay providers too little and that’s why too few of them participate,” he said.

So putting people in private plans with higher provider payments could help address those access problems.

Meanwhile, Medicaid watchers say proposals like the one in Arkansas could solve other problems — for the new Medicaid recipients and for the others who will be buying coverage in the new exchanges.

One potential problem the private plans could address is called . It happens when a person’s income is near the threshold between qualifying for Medicaid and qualifying for .

Imagine, says Rosenbaum, someone working 30 hours a week in the summer, whose hours are cut back so they qualify for Medicaid part of the year, then expanded, pushing them back out of the program.

“And you get a letter saying, ‘Now you’re earning more money, so now you have to leave your plan. You and your kids have to leave your doctors; you have to pick a new plan.’ And then in winter, if your hours drop back down, you get another letter saying, ‘Oh, sorry, you have to leave your plan, [and] your doctors,’ ” she says. “Those people could be forced to change plans multiple times a year.”

Rosenbaum says enrolling Medicaid beneficiaries in plans in the exchange instead could protect as many as 28 million people a year from churning if their income does get too high.

“Your plan will stay your plan, your doctors will stay your doctors,” she said. Basically the “bank of Medicaid” and the “bank of the exchange” will have a conversation with each other about who pays the bills. And your premium may be a little bit different and your co-pays may be a little bit different, but your healthcare won’t be interrupted.”

And it’s not just those on Medicaid who could benefit.

Many of the new Medicaid enrollees will be relatively healthy, relatively young people with relatively low insurance costs. They could help bring premiums down for those in the exchanges who are older and sicker.

“It’s the woman who’s 32 working at Wal-Mart with a couple of kids who we really need in the exchange,” Rosenbaum says. “And so if we buy her in and keep her in, it’s going to be that much better off for the 55-year-old woman who is sick and unable to work and needs coverage through the exchange because of a lot of health conditions. “

Still, one of the fundamental appeals of putting new Medicaid enrollees in private plans remains political.

“I think in states where the resistance to the Medicaid expansion was based primarily on ‘This is a big government program that we can’t make any bigger,’ finding a way to do the expansion through private coverage will open a door to a conversation that was otherwise not taking place,” said Alan Weil of the 

What remains a key issue for many states, however, is that the federal government hasn’t yet said exactly how much states can spend on the private plans — only that what they spend to enroll Medicaid beneficiaries in the plans should be “comparable” to what they would have spent otherwise.

Health and Human Services Secretary Kathleen Sebelius says officials will spell out more details on that issue “in the very near future.”

This <a target="_blank" href="/news/arkansas-medicaid-plan-born-of-necessity-shakes-things-up/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

But experts say the national numbers actually don’t mean very much.

“These are really state-based markets,” says Caroline Pearson, vice president at , a consulting firm based in Washington D.C. Because each insurance market is run within each individual state, big numbers in some states can’t make up for shortfalls in others.

Still, much of the debate has centered around 6 million — the nationwide number the  estimated would sign up for insurance through the federal and state health exchanges. (That’s indeed about how many have , the Obama administration confirmed Thursday.)

Insurers hope that at least  of those enrollees will be between the ages of 18 and 34. The theory is that those younger people will also be healthier, and offset the costs of people older and sicker.

” ‘Six million’ and the ‘percent of young adults’ are easy numbers for politics, and politics sometimes struggles with the more nuanced issues that really matter for the underlying policy,” says Pearson, explaining at least some of the fixation on national numbers.

Meanwhile, Seth Chandler, who teaches insurance law at the , says some states are doing quite well at signing people up, “such as California, New York, Connecticut, Vermont.”

California alone has enrolled more than  in private health plans, and New York .

But at the same time, Chandler says, other states are lagging seriously behind, “including the big state of Texas, and states such as Louisiana, Arizona, Mississippi, and Oklahoma.

“The fact that New York doesn’t experience problems in its health insurance market, and insurers aren’t being squeezed there,” he says, “does nothing whatsoever to help insurers and people in Texas, Louisiana, and elsewhere where — it looks like, at least,— too few people are enrolling [to enable us] to have confidence in the success of the marketplace.”

And it’s not just an issue of the total number of people signing up in each state, or whether they’re young or old. Karen Ignagni, who leads the insurance trade group , says the real issue is the balance of healthy to sick individuals. She said in a  last week that health plans are already seeing an influx of sicker people, thanks to new rules that bar health plans from discriminating people who have preexisting health conditions.

“We see a number of people who have gotten into the program, in January in particular, who are using a number of health care services,” she said. “That’s to be expected. No one in our industry thought it would be any different. We thought the people who needed services immediately would be the first to be motivated to sign up.”

The big question, says Ignagni, is whether the last minute  that appears to be taking place now will be big enough, and full of the right kind of people.

“We thought the people who were healthier, who didn’t feel like they needed services immediately, would be [signing up] at the end of the process,” she said. “And we’re hoping that hypothesis is going to be true.”

But there’s yet another factor the overall numbers don’t take into account: the expectations of insurance companies when they set their premiums for this first year.

“Was the pricing any good to begin with?” asks Chandler, the Houston law professor. “Were they too conservative in their estimates of the population? Were they too liberal? There are all these factors that we do not know yet that are going to determine as much as the raw enrollment numbers how insurers react for 2015.”

In other words, the bottom line on what happens to individual insurance markets in each state after this first open enrollment season is going to depend on a lot more than just one or two numbers.

This <a target="_blank" href="/news/obamacares-national-enrollment-looks-ok-but-states-matter-more/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

2014 is the first year most Americans will have to either have health insurance or face a tax penalty.

But most people who are  of the penalty think it’s pretty small, at least for this first year. And that could turn into an expensive mistake.

“I’d say the vast majority of people I’ve dealt with really believe that the penalty is only $95, if they know about it at all,” says Brian Haile, senior vice president for health policy at . “And when people find out, they’re stunned. It’s much, much higher than they would expect.”

In fact, “the penalty is the maximum of either $95 or 1 percent of taxable income in 2014,” according to Linda Blumberg, a senior fellow at the . “For people with higher incomes it can be much more sizable than $95.”

Blumberg says that even for people with more moderate incomes, it’s important to remember that the flat fee penalty will be assessed for every family member who lacks health coverage.

“So if it’s a two-adult household and both are uninsured, it’s twice $95; $190,” he says. “Then if there are any children in the family that are uninsured, the penalty for each of them is half of the $95.”

The flat fee penalty maxes out at $285 next year. To help people figure out what they might owe, the , jointly run by the Urban Institute and the Brookings Institution, just posted an . And Jackson Hewitt has its own “How much is my tax penalty?” .

Haile says it’s important to remember that even if most of the family has insurance, having just one uninsured member can trigger the penalty.

“If you’ve got someone who comes home to live it could cost you much more than a spare bedroom,” he says. “If you claim that child as a dependent, or could claim that child as a dependent, then you suddenly become liable for penalties if that child lacks minimum essential coverage.”

The 1 percent penalty, for those hit with that, also has a cap, but the penalty can still get pretty big. The cap is tied to the cost of the . This year’s top penalty could be about $3,600 for an individual, and $11,000 for a family of four.

If you’re uninsured and earn enough to be potentially liable for penalties, you have to sign up for coverage by the end of this month in order to avoid them.

“Your only chance to buy insurance, unless you have a special qualifying event, is during this open enrollment period,” Haile says, “which makes March 31 an incredibly important date for avoiding the penalty. If you want to avoid the penalty, you need to get in and sign up for coverage now.”

That’s much different than how things were before the law’s implementation. But the Urban Institute’s Linda Blumberg says it’s due to the new rule that protects people with pre-existing health conditions.

“Now the insurance companies can’t say no, even if you’ve had serious health problems in the past, or have a serious health problem today. They can’t deny you,” she says. “And because of that, people are restricted to obtaining coverage during the open enrollment period or during some other open enrollment period where they’ve had a change in their family status or income.”

Indeed, changes to family status — a birth, divorce, or job change — will allow you to buy or . And if you’re eligible for Medicaid or your kids are eligible for the Children’s Health Insurance Program, you can .

There are also lots of exemptions from the penalty itself, Blumberg points out, even for people who remain uninsured. The biggest is having income below the .

This year that’s roughly $10,000 for a single person and $13,000 for a head of household. If you don’t have to file income taxes, you won’t have to pay a penalty. You also can get an exemption if the cheapest available insurance would cost more than 8 percent of your income, if you have unpaid medical debt, or for any of several other  listed on the Ìý·É±ð²ú²õ¾±³Ù±ð.

But for most people with incomes above the poverty line, time is running out to either get insurance or prepare to pay up instead.

This <a target="_blank" href="/news/skipping-health-insurance-could-cost-a-lot-more-than-95/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

With a bit more than a month left for people to sign up for health insurance plans set up under the Affordable Care Act, the federal website known as healthcare.gov finally seems to be working smoothly — in 36 states.

But what’s happening in the 14 states that are running exchanges?

Some are doing quite well, thank you. California, for example, said that enrollment has already exceeded its projection for the entire enrollment period, which ends March 31.

Other states, however, are having trouble, some of it severe.

Oregon, for example, has only just gotten its website this week, and it’s still not fully open to the public. Until now, Oregon had been using paper applications.

So what makes a state health exchange successful?

, who helped launch the exchange program for the federal government and now consults for states and others working to implement the health law, says the states doing best are generally the ones doing the least — at least when it comes to their websites.

“The states that said, ‘This is complicated, we’re going to focus on the most essential issues,’ those were the states that tended to do better,” he says.

Among places in that category, according to Ario, are not just California, but also Kentucky, New York and Connecticut.

Too Ambitious?

In contrast, Ario says, many of the states that are now struggling may simply have overreached.

“Unfortunately states that I once touted as the leaders — Maryland, Oregon, Minnesota,” are among those bringing up the rear, he acknowledges. “This is a complicated undertaking, and so people who tried to do too much in [the first year], I think, had some problems with that.”

Maryland and Minnesota haven’t had the same problems as Oregon, but their have both been worked only , and enrollment has lagged. Just as with the federal website, part of the problem has been on the information technology side.

We’ve seen in some states that some vendors have not been able to deliver, and states have struggled with the IT implementation,” said , who advises states for the Robert Wood Johnson Foundation.

Vexing Vendors

In Maryland, fixing the exchange has been complicated by the fact that two of its IT vendors are . Massachusetts and Vermont have both had , the vendor that was found responsible for most of the messy rollout of the federal site, .

But experts say blame for failure — and credit for success — doesn’t all belong to the outside IT contractors. It’s also due in large measure to how well those contractors worked with state officials. Audrey Haynes oversees Kentucky’s largely successful exchange, She says one key to making it work was putting the exchange in the same department that runs Medicaid.

“Anyone knows that Medicaid has to have a pretty super IT department that supports it,” she said at a sponsored by the Robert Wood Johnson Foundation. “So we have a lot of experience … at bringing up large IT structures.”

And where do state exchanges go from here? Republican members of Congress from and are asking the federal government to investigate the limping exchanges in those states. That’s because both received millions of federal dollars to set up their health insurance marketplaces.

In principle, says consultant Joel Ario, figuring out what went wrong is not a bad idea. “I certainly think we want to look carefully at what happened and learn some lessons here. I don’t think anybody’s going to find any improprieties here, because they’re going to think it was all well-intentioned activity.”

And in the long run, once the states that are lagging work out their IT problems, they will probably end up, much like California, doing better than the states being run by the federal government. Heather Howard says that’s because states running their own exchanges also have more resources for consumer outreach.

“They have consumer assistance infrastructure, grants out to community-based organizations, and they’re building and doing a lot more marketing,” Howard says. “And their consumers are hearing much more about the options.”

All of which merely underscores something important about the health law that hasn’t changed: What’s available to you depends very much on where you live.

This <a target="_blank" href="/news/quick-update-of-state-insurance-exchanges-still-a-mixed-bag/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

With less than eight weeks to go before the official launch of the under the federal health law, backers of the law are to encourage people to sign up.

But there’s another effort gearing up this month as well. Opponents of the health care law are making one last-ditch effort to run Obamacare off the rails before it gets fully implemented.

Probably the most aggressive effort is coming from , a conservative advocacy group. It’s urging people, particularly young people, not to sign up for health insurance.

“They can skip the exchange, pay the fine, and in doing that, do what’s best for them financially, and we hope help hasten the collapse of Obamacare,” said Dean Clancy, the group’s Vice President for Policy.

FreedomWorks has also created a bit of civil disobedience theater as part of its campaign — inviting people to . Of course there is no such thing as an Obamacare card. But that’s not a problem. FreedomWorks is making its own, and distributing them.

“We’re going to be holding burnings around the country,” said Clancy. “Without burning anything down,” he’s quick to add. “It’s all peaceful and lawful.”

Clancy says the idea is to harken back to the days of the Vietnam War, when protesters burned their draft cards – that got many sent to prison.

“The individual mandate at the heart of Obamacare is a lot like a military draft,” he said. And if enough young people resist the health law the way they resisted the war, “then Washington will get the signal, we’ll be able to reopen this law, and we’ll be able to push for patient centered reforms that really help people get the coverage they need.”

FreedomWorks isn’t the only conservative group aiming squarely at the young demographic considered so key to making the health law work, though. (Young people are necessary to ensure the exchanges aren’t overloaded with older, sicker patients.)

Another GOP advocacy group called the — YG stands for young guns — is out with that’s been airing on youth-oriented programs like Saturday Night Live.

It pokes fun at the Obama administration’s efforts to promote the law by showing a frustrated group of advertising executives around a table, trying to figure out how to sell a product that’s not very popular.

YGNetwork spokesman Chris Bond says the ad is “simply drawing attention to the fact that they’re using taxpayer money in this cynical marketing effort rather than fixing the law so that it doesn’t hurt Americans.”

But not all the effort to stop the law in its tracks is being aimed at the young. , the advocacy arm of the Heritage Foundation, is launching a nine-city starting later this month.

Dan Holler, the group’s spokesman, says time is of the essence.

“On Oct. 1 open enrollment starts for the Obamacare exchanges,” he said. “And on Jan. 1 there’s a ton of money that starts flying out the door. And up until now, most of the conversation about Obamacare has been, ‘this is going to happen at some point in the future.’ The future is now on this.”

Unlike many of the other groups, however, Heritage isn’t urging people not to enroll in the exchanges. It’s concentrating on getting grassroots support to get Congress to .

“Right now there’s a viable legislative strategy to go ahead and halt the implementation of Obamacare,” Holler said. “And we want to drive that as hard and as far as we possibly can. And the town halls are an effort to do just that.”

And what does the Obama administration think of all these efforts to interfere with the law’s rollout? Not a lot, at least according to Health and Human Services Secretary Kathleen Sebelius.

“I don’t think we’re going to spend a lot of time and effort trying to estimate who they may discourage from getting health insurance to provide security for themselves and their family,” she told reporters on a conference call Monday. “I think it’s a pretty dismal effort underway.”

The administration does have backup, though. Groups like will be out countering the Republican efforts, says spokesman Eddie Vale.

“When Republican members are having town halls we will have local people come to them to ask why they keep trying to take away their health care,” he said. “When Heritage or are doing their events, we will of course send people out to those.”

And Vale wonders about the irony, in particular, of the FreedomWorks card burning effort.

“They’re asking people literally to play with fire and burn Obamacare documents while at the same time telling these very same people that they shouldn’t have health care,” he said.

For the record, FreedomWorks officials not to burn themselves while they’re burning their cards.

This <a target="_blank" href="/news/anti-obamacare-forces-ramp-up-campaign-to-stop-implementation/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

Of all the contentious claims about the Affordable Care Act, few have been more contentious than over the impact it’s having on employers.

It’s hard to Ìý´Ç°ù  without seeing a story about some boss cutting workers’ hours or saying they won’t be doing any more hiring because of the health law.

But is the law really having an impact on the economy?

Not surprisingly, it depends whom you ask.

Opponents of the law point to anecdotes in industries with a lot of low-wage workers, .

They also point to employer surveys like one from the . It found that nearly one in five small businesses said they were reducing hiring to try to stay under the 50-worker threshold that exempts companies from a requirement in the Affordable Care Act that full-time employees be offered health insurance. Another 16 percent said they planned to adjust hours so fewer workers would be eligible for health insurance.

But now the law’s supporters, including the White House, are fighting back.

They’re putting out  showing that part-time employment is no higher during this economic recovery than during other recent economic recoveries.

That includes people working part time who’d rather be working full time. That data shows that most of the people involuntarily working part time are in that situation due to state and federal budget cuts, not the health law. They’ve also pointed out that weekly hours have risen since the health law was passed, including in the restaurant industry.

So who’s right?

It’s entirely likely that both sides are. One of the White House talking points is that  would be impacted by the Affordable Care Act requirements. Those are typically people who don’t have health coverage and who work more than 30 hours a week for companies with more than 50 employees.

That’s not a big enough group, they point out, to really affect the economy on a macroeconomic level. And it’s not.

But one percent of the workforce is more than a million people, more than enough to make for a lot of anecdotes. There’s also the issue that the administration and its allies are looking back at what’s happened so far, while opponents are looking mostly forward at what may happen in the future.

Still, there are efforts on Capitol Hill to address one point of contention: The law defines full-time work as more than 30 hours per week, rather than the traditional 40.

Sens. Susan Collins R-Maine, and Joe Donnelly, D-Ind., have introduced the ,” which they say would “ensure that the definition of full-time employee and full-time equivalent in the ACA is consistent with the traditional full-time 40-hour work week.” A similar bill has been .

The prospects for the legislation, however, are not good.

One reason is that Congress is so gridlocked and Republicans are so dug in against the law that even when  there is little likelihood of it happening.

And on this issue there’s no consensus that changing the definition of a full-time work week would actually change employers’ incentives.

University of Chicago economist Casey Mulligan, , suggested that such a change could create its own set of disincentives, with a 39-hour-a-week job with no insurance potentially paying more than a 40-hour-a-week job with employer insurance, because of subsidies available for health insurance in the new health exchanges.

This <a target="_blank" href="/news/definition-of-full-time-becomes-a-sticking-point-in-obamacare/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

The Obama administration is countering criticism that the new health insurance exchanges will be , though it’s doing so a bit quietly.

At a White House briefing Thursday for health reporters, in which senior administration health officials spoke on the condition that they not be named, and in a , the administration insisted that in most states at least, competition will be far greater than it is today — with 120 companies having applied to offer insurance.

For example, in three-quarters of the states where the federal government is running the marketplaces, at least one new insurer has applied to enter the individual market. And nearly two-thirds of the new insurance entrants to the individual market in federally run exchanges are in states where one insurance company now dominates the market.

The officials stressed how much better competition will be than it is in the current market for individual coverage. In 2012, one insurer covered more than half of all people in the individual market in 29 states. In 11 more states, two insurers covered 85 percent or more of the individual market enrollees.

The federal government will be fully in charge of the exchanges in 19 states. It will partner with states in 15 states. The remaining 17 states will run their own marketplaces.

“We’re very encouraged,” one senior official said, that there will be “products on the shelves” when the marketplaces open for enrollment on .

The officials also provided the first preview of something that has gotten relatively little notice so far: Multistate plans that are overseen by the Office of Personnel Management. That task was given to OPM because it oversees the , which covers more than 8 million federal workers, including many plans that offer coverage nationwide.

Under the health law, at least two multistate plans are supposed to be offered nationwide in order to boost competition by 2017. OPM officials said they are reviewing more than 200 proposals so far and they expect multistate plans to be offered in at least 31 states in 2014. Multistate plans will be available to both individuals and small businesses, officials said.

This <a target="_blank" href="/news/white-house-there-will-be-competition-in-insurance-exchanges/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

The news that U.S. scientists seems almost certain to rekindle a political fight that has raged, on and off, since the announcement of the creation of.

“The issue of legislation on human cloning is about to get hot again,” says Hank Greely, director of the at Stanford Law School.

But it’s a fight that has, over the past decade and a half, produced a lot of heat and light and not a lot of policy.

Human Cloning

In fact, for all the arguing about the issue that’s happened in Washington over the years, human cloning is still technically legal, at least in much of the country.

“There are already 60 countries in the world that have laws on their books banning human reproductive cloning, and this prohibition is also in a number of international agreements” says Marcy Darnovsky, executive director of the, which is devoted to the responsible use of new genetic and reproductive technologies. “But in the U.S., we have not managed to put such a law on the books at the federal level.”

At least 15 states ban cloning, either for reproductive purposes or research or, in come cases, both, according to the

But Congress has mostly fought issues of bothÌý²¹²Ô»å to a draw.

“What we saw the last time cloning was in the headlines was that the discussion really got mired in the abortion controversy,” Darnovsky said.

The House passed bills banning all forms of cloning in 2001 and 2003; the Senate failed to act in both cases.

“All the other issues got completely swamped,” she said. “And I really hope that doesn’t happen this time.”

But both the issues of cloning — for research and reproduction — and embryonic stem cell research have been mired in the abortion controversy from the start.

Stem Cell Research

About the only law that has been able to pass is language that gets added to the funding bill for the Department of Health and Human Services every year since the mid-1990s — the so-called, named for its original House sponsors, Reps. Jay Dickey, R-Ark., and Roger Wicker, R-Miss. It bars the use of federal funds for research that could destroy or harm a human embryo.

The Clinton administration decided that federal funding of embryonic stem cell research using cell lines derived from embryos destroyed with private funds

President Bush put that policy into force but available to researchers.

“I have concluded that we should allow federal funds to be used for research on these existing stem cell lines, where the life-and-death decision has already been made,” he said in a televised address to the nation.

Meanwhile, over the years Congress to expand federal funding of embryonic stem cell research, under specific ethical guidelines, as well as legislation to ban cloning intended to make a baby. None, however, was able to pass both the House and Senate and get the president’s signature.

When he came into office in 2009, President, while maintaining guidelines such as not paying women for their eggs.

“The majority of Americans, from across the political spectrum, and from all backgrounds and beliefs, have come to a consensus that we should pursue this research,” he said.

FDA Rules

But Congress remains deadlocked over the bioethical issues — which is not to say that there is no federal regulation.

Jonathan Moreno, a bioethicist at the , points out that the has, from the start, said it would closely regulate anything it deemed to be human cloning, whether reproductive or therapeutic.

“Once you start talking about putting many of the products of these cells into people, then you get into an area where the FDA is very interested,” he said.

Meanwhile, Darnovsky of the Center on Genetics and Society says she hopes this new development might break the legislative logjam.

“This development, if it turns out to be replicable, will mean that there will be cloned human embryos in labs around the country,” she said. “And we really need to make sure that no unscrupulous person would ever try to use those to produce a cloned human being.”

Congress, however, has been unable to pass much of anything this year. It’s unclear yet if this will rise to the level of must-pass.

This <a target="_blank" href="/news/cloning-stem-cells-long-mired-in-legislative-gridlock/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

The Obama administration’s actions this week on emergency contraception have left many women’s health groups sputtering with anger.

But what really has some of the President Barack Obama’s usual allies irritated is the fact that the moves are in direct contrast to speeches he made in just the past week.

Recall that on Tuesday the Food and Drug Administration defied a federal judge’s order to make the morning-after pill available over-the-counter to women of all ages by . On Wednesday, the Justice Department  the federal judge’s ruling.

Yet only last Friday, Obama became the first sitting president to address Planned Parenthood’s .

His spirited defense of reproductive rights included this statement: “We shouldn’t have to remind people that when it comes to a woman’s health, no politician should get to decide what’s best for you.”

And on Monday, he said this to the : “[I]n all the sciences, we’ve got to make sure that we are supporting the idea that they’re not subject to politics, that they’re not skewed by an agenda, that, as I said before, we make sure that we go where the evidence leads us.”

But now, many women’s health advocates say the administration isn’t putting its actions where the president’s rhetoric has been.

“It doesn’t square and that is what’s so disappointing,” said Nancy Northup. She’s president and CEO of the , one of the groups involved in the emergency contraception lawsuit against the administration that’s prompted this week’s activity.

“There couldn’t be a clearer record than there is in this case that emergency contraception is safe and effective for all ages, that we had not one but two administrations who continued to put what they judged as the politics of the issue about contraception ahead of what’s doing right for the public health,” she said.

Health and Human Services Secretary Kathleen Sebelius  to remove the age restrictions in 2011. She said she was worried that the youngest teens wouldn’t understand how to use the product safely.

But that’s not a concern for the nation’s pediatricians, who support full over-the-counter access to the drug.

“We get derailed over and over again in people’s ethical and moral concerns about whether teens should be sexually active, and not that this is a safe drug that can be and should be available to all women of reproductive age,” said Dr. Cora Breuner. She’s a professor of pediatrics at the University of Washington and co-author of the American Academy of Pediatrics  on Emergency Contraception.

Women’s health advocates say even the steps the FDA did take this week — to lower the age for sale of the drug without a prescription from 17 to 15 — doesn’t do much, because they still have to show identification.

“15- and 16-year-olds are much less likely to have an actual government ID with your birth date on it,” said Susan Wood, a public health professor at George Washington University and a former . “So that … doesn’t really expand access to that age group very much.”

In fact, what really worries the women’s health groups is that idea that this fight that has already gone on for more than 10 years, now could stretch out years longer.

This <a target="_blank" href="/news/womens-health-groups-angered-by-administration-morning-after-pill-policies/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

One of the more popular provisions of the federal health law requires that women be given much freer . That includes not only the pill, but implants and IUDs as well.

But what happens if there are not enough doctors to prescribe those contraceptives?

That’s exactly what worries some reproductive health advocates, as efforts are underway to rewrite rules governing the training of the nation’s family doctors.

The proposed new rules, they say, drop existing requirements that family medicine residents be required to undergo training in contraception and counseling women with unintended pregnancies.  are now running  to make sure the rules remain.

Revising The Rules

Family physicians are what used to be known as general practitioners, or GPs.

“My youngest patient hasn’t been born yet, and the oldest I take care of is 94,” says Jeff Cain, president of the American Academy of Family Physicians and a family doctor in Denver.

For the majority of women, particularly outside major cities, it’s family doctors, not obstetrician-gynecologists, who provide for their reproductive health needs.

“The main people who staff community health centers, as well as large swaths of rural America, are family doctors,” says Linda Prine, a family physician from New York.

To become a family doctor, however, medical residents must complete a wide-ranging and rigorous three-year training program approved by the Accreditation Council on Graduate Medical Education.

Every seven years, the ACGME guidelines for each specialty are revised; it’s now time for a .

Prine, who is also the medical director of the Reproductive Health Access Project, helped lead a push the last time around to require all family medicine residents to learn to provide all forms of prescription contraceptives, including placing IUDs and implants, and to counsel patients with unintended pregnancies on their options.

“The language was put in so that we would be assured that family doctors were prepared to provide health care for their patients,” she says.

But now that requirement appears to be going away.

“The feedback we’ve gotten over the years is that a lot of the curricular requirements were too specific,” says Peter Carek, a professor of family medicine at the Medical University of South Carolina and chairman of the committee that’s rewriting the requirements for family medicine residents.

“So in general what we’ve tried to do as a committee is to at least in as many areas as we could, pull back some of those specific requirements and give them more general requirements to follow,” he says.

Criticism

Reproductive health advocates say there’s a big problem with leaving contraception training up to each program: Many residency programs these days are run by religious hospitals that don’t believe in contraception.

“The way it works right now, the residency is required to at least send the residents off-site to another place, say, a family planning clinic where they can learn how to provide birth control,” Prine says. “If these regulations change and there’s no wording whatsoever about the need to provide contraception, the residency programs would no longer be obliged to send their residents somewhere where they would get this education.”

If you think that  isn’t becoming the norm, think again.

“We took a look recently and found that of the 25 largest health systems in the United States, 13 were religiously sponsored; that includes 11 Catholic systems,” says Lois Uttley, who heads the nonprofit group MergerWatch, which works to protect women’s access to reproductive health care when secular hospitals merge with religious ones. “So that means the likelihood of a patient encountering a Catholic restriction on contraception is pretty high and growing.”

Draft Document

Family medicine officials, however, say they are aware of the concerns from reproductive health advocates.

“The American Academy of Family Physicians and family medicine educators really remain committed to ensuring that women’s health is a core educational part of training family physicians,” says Cain, the AAFP president. “That includes family planning and maternity care.”

Cain says that while the new program standards may not spell out the contraceptive training requirements the way the current ones do, he expects they will be included in a frequently asked questions part of the document that will still carry the same weight.

In any case, he points out, “the truth is this is a draft document right now. We want to make sure the wording in the document reflects the intended outcome.”

Both Cain and Carek say they are taking under serious consideration all the comments they have been hearing about the standards so far.

The last day for the public to comment is Thursday.

This <a target="_blank" href="/news/new-guidelines-may-drop-birth-control-training-rule/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

‘s Shots blog.

Since the Supreme Court made the  under the federal health law optional last year, states’ decisions  along party lines. States run by Democrats have been opting in; states run by Republicans have mostly been saying no or holding back.

But now Arkansas – at the suggestion of the federal government – has suggested a : Enroll those newly eligible for Medicaid in the same private insurance plans available to individuals and small businesses.

And some think that could shake things up. A lot.

The Arkansas proposal was crafted as much out of political necessity as from substantive desire, says Andy Allison, the state’s Medicaid director.

“I think this is likely to be the only way that expansion or coverage for this population could occur,” he says.

There are two reasons for that. One is that the state has a Democratic governor (Mike Beebe, now serving his second term), but a heavily Republican state legislature, which has  on expanding Medicaid.

A second reason is that few adults currently qualify for Medicaid in Arkansas. And those who do have to be really poor, says Allison: “We cover just at 17 percent of the poverty level for those who are parents and we don’t cover childless adults unless they have a disability.”

For the record, 17 percent of poverty is less than $2,000 a year. Expanding Medicaid under the Affordable Care Act to 133 percent of poverty — about $15,000 — could potentially add as many as 250,000 Arkansans to the rolls.

But what was a political nonstarter gained new life when someone suggested the idea of enrolling those new people in the same private plans individuals and small businesses will be purchasing — the , called exchanges.

So far the state has gotten a  from the U.S. Department of Health and Human Services. That’s caught the attention of several other Republican-run states that had been holding out on the Medicaid expansion, including Ohio, Florida, and even Texas.

But experts insist the proposal is hardly as new as some have suggested.

“The authority to use Medicaid funds to buy insurance has been in the law since it was first enacted,” said , a law professor and Medicaid expert at the George Washington University.

Still, when the Arkansas arrangement first went public about a month ago, there was some immediate hand-wringing about its potential cost.

“We have to … recognize that it will cost more,” said , a Boston University health economist. “You don’t get something for nothing.”

But Frakt concedes that paying somewhat more — how much more remains a subject of contention — might not be all bad.

“One of the basic critiques of the Medicaid program is they pay providers too little and that’s why too few of them participate,” he said.

So putting people in private plans with higher provider payments could help address those access problems.

Meanwhile, Medicaid watchers say proposals like the one in Arkansas could solve other problems — for the new Medicaid recipients and for the others who will be buying coverage in the new exchanges.

One potential problem the private plans could address is called . It happens when a person’s income is near the threshold between qualifying for Medicaid and qualifying for .

Imagine, says Rosenbaum, someone working 30 hours a week in the summer, whose hours are cut back so they qualify for Medicaid part of the year, then expanded, pushing them back out of the program.

“And you get a letter saying, ‘Now you’re earning more money, so now you have to leave your plan. You and your kids have to leave your doctors; you have to pick a new plan.’ And then in winter, if your hours drop back down, you get another letter saying, ‘Oh, sorry, you have to leave your plan, [and] your doctors,’ ” she says. “Those people could be forced to change plans multiple times a year.”

Rosenbaum says enrolling Medicaid beneficiaries in plans in the exchange instead could protect as many as 28 million people a year from churning if their income does get too high.

“Your plan will stay your plan, your doctors will stay your doctors,” she said. Basically the “bank of Medicaid” and the “bank of the exchange” will have a conversation with each other about who pays the bills. And your premium may be a little bit different and your co-pays may be a little bit different, but your healthcare won’t be interrupted.”

And it’s not just those on Medicaid who could benefit.

Many of the new Medicaid enrollees will be relatively healthy, relatively young people with relatively low insurance costs. They could help bring premiums down for those in the exchanges who are older and sicker.

“It’s the woman who’s 32 working at Wal-Mart with a couple of kids who we really need in the exchange,” Rosenbaum says. “And so if we buy her in and keep her in, it’s going to be that much better off for the 55-year-old woman who is sick and unable to work and needs coverage through the exchange because of a lot of health conditions. “

Still, one of the fundamental appeals of putting new Medicaid enrollees in private plans remains political.

“I think in states where the resistance to the Medicaid expansion was based primarily on ‘This is a big government program that we can’t make any bigger,’ finding a way to do the expansion through private coverage will open a door to a conversation that was otherwise not taking place,” said Alan Weil of the 

What remains a key issue for many states, however, is that the federal government hasn’t yet said exactly how much states can spend on the private plans — only that what they spend to enroll Medicaid beneficiaries in the plans should be “comparable” to what they would have spent otherwise.

Health and Human Services Secretary Kathleen Sebelius says officials will spell out more details on that issue “in the very near future.”

This <a target="_blank" href="/news/arkansas-medicaid-plan-born-of-necessity-shakes-things-up/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">