Health Insurance

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Legislation in the Pennsylvania House would prohibit health insurance companies from changing benefits or adding restrictions to coverage plans mid-year.

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People who retire early may be tempted to purchase so-called “skinny” health insurance plans before Medicare kicks in because they’re less expensive, but Pennsylvania’s Acting Insurance Commissioner Jessica Altman told an AARP audience in Penn Hills on Wednesday that they should be careful when considering this type of insurance, as it’s not compliant with the Affordable Care Act.

Katie Blackley / 90.5 WESA

Highmark’s Medicare costumers can continue receiving in-network care from nine UPMC hospitals until the end of 2019, due to a Monday ruling by Commonwealth Court Senior Judge Dan Pellegrini.

Sarah Boden / 90.5 WESA

Parents of 180,000 children across Pennsylvania, including 14,000 kids in Allegheny County, are breathing sighs of relief now that funding for the Children’s Health Insurance Program has been renewed for six years.

Crazypaco / Wikimedia

Highmark health insurance has reached a five-year agreement with UPMC to allow its customers to receive care from select UPMC locations at in-network rates.

Matt Rourke / AP

Congress has adjourned for the year without fully finishing its spending plan—holding off a government shutdown by passing a few months of stopgap funding.

It includes some money for the Children’s Health Insurance Program—something the deadlock had called into serious question.

But Pennsylvania officials say that doesn’t help much.

In the days leading up to the stopgap agreement, they had warned the program would have to end sometime early next year if federal lawmakers didn’t act.

The agreement hands down $3 billion to states.

Presidencia de la Republica Mexicana / flickr

The number of Pennsylvanians enrolled in insurance plans sold through the federal HealthCare.gov marketplace shrank slightly, as state officials accused the Trump administration of trying to undermine the system.

Kathleen J. Davis / 90.5 WESA

U.S. Sen. Bob Casey of Pennsylvania is urging Congress to shift its focus to funding the Children's Health Insurance Program, instead of pursuing the federal tax overhaul bill. 

The insurance plan covers nearly 9 million children nationwide whose parents make too much money to qualify for Medicaid, but too little to afford private insurance. About 180,000 Pennsylvania children are covered by CHIP.

Matt Rourke / AP

 

The open enrollment period for people buying health insurance through the Affordable Care Act comes to a close this Friday—a period half as long as last year’s. Nearly 80 percent of Pennsylvanian consumers selected the “middle-of-the-road” silver plan last year, but this year, costs for silver plans have rocketed.

Sarah Boden / 90.5 WESA

The open enrollment period for people buying insurance through the Affordable Care Act marketplace ends next Friday.

Matt Rourke / AP

The state House has passed a bill to reauthorize the Children’s Health Insurance Program, which covers kids from families who make too much to qualify for Medicaid, but can’t afford other insurance.

The routine bill became controversial this year, because the Senate included language that would have prohibited CHIP from covering transgender kids’ transition surgeries.

The House axed that provision; now the bill returns to the Senate, where lawmakers will have to decide whether to reauthorize CHIP without banning coverage of gender confirmation surgeries.

Liz Reid / 90.5 WESA

Wednesday is the first day of the open enrollment period for Americans to buy health insurance through the Affordable Care Act for 2018.

About 40,000 Allegheny County residents were enrolled in marketplace plans through the exchanges last year, County Executive Rich Fitzgerald said.

“It has been a tremendous benefit,” said Fitzgerald. “Not just for their physical health and their health security, but also on their financial security, families and where they live.”

Andrew Harnik / AP

The window to sign up for individual health insurance through the Affordable Care Act’s online marketplace begins Wednesday, Nov. 1, amid fewer federal resources to help people sign up and increased confusion over the law itself. 

Matt Rourke / AP

Pennsylvania Attorney General Josh Shapiro says he's joining his counterparts in at least a dozen states to sue the Trump administration over its decision to stop paying cost-sharing subsidies to insurers.

Charles Dharapak / AP Photo

Gov. Tom Wolf is urging the Pennsylvania legislature to make birth control coverage a mandate in the state after the Trump administration pledged to roll back Obama-era requirements that most employers cover birth control for employees through their health insurance.

Gov. Tom Wolf / Flickr

Since the latest Republican plan to repeal and replace the Affordable Care Act failed to garner enough support, uncertainty is growing for consumers and insurers as a new enrollment period is set to begin Nov. 1.

“Right now, states are finalizing rates for plans for 2018,” said Teresa Miller, acting secretary of the Pennsylvania Department of Human Services. “Without a bill to stabilize the market,  I think it's possible you could see companies exit the market entirely because they're just fed up with all of the uncertainty and still don't know what the rules for 2018 are.”

Matt Rourke / AP

The Pennsylvania budget crisis continues. Governor Tom Wolf said there will be no cuts or delays in state services if lawmakers can reach an agreement on how to fund the $32 billion budget by October 1st. That means the legislature has nine days to come up with more than $2.2 billion. And now, complicating the conversation, a credit rating agency downgraded Pennsylvania's credit rating.

Gov. Tom Wolf / Flickr

The number of people without health insurance in Pennsylvania continues to decline, reaching what Democratic Gov. Tom Wolf's office says is the lowest uninsured rate on record.

U.S. Census Bureau data released this week shows Pennsylvania's 2016 uninsured rate at 5.6 percent, tied for the 12th lowest rate in the nation.

That's down from 9.7 percent in 2013 and 6.4 percent in 2015. The national uninsured rate was 8.6 percent last year.

The Census Bureau estimates 700,000 Pennsylvanians lacked health insurance last year, about 500,000 fewer than in 2013.

Gov. Tom Wolf / Flickr

Five insurers are seeking an average 9 percent increase in rates for health coverage in Pennsylvania through the federal Healthcare.gov marketplace in 2018, a significant drop from this year's increase.

The state Department of Insurance said Thursday that proposals filed before last week's deadline could still change, and won't be approved until just before open enrollment starts in the fall.

However, Insurance Commissioner Teresa Miller warned that an effort by the Trump administration or Congress to undermine the marketplaces could drive up premiums.

Susan Walsh / AP

Katie Horowitz is making dinner at her home in Morningside. On this night, it’s sautéed spinach with chicken breasts boiled in broth.

“One of the hardest parts of this diet is that you have to cook everything,” Horowitz said. “I have a really busy job, and it’s really challenging to find time.”

Horowitz was diagnosed last year with Crohn’s disease, a chronic inflammatory bowel condition, and is now on a very restrictive diet. She’s been hospitalized several times, and her doctor said she’ll likely need surgery someday.

Megan Harris / 90.5 WESA

 

 


Gynecologist Colleen Krajewski tells anyone who will listen -- intrauterine devices are "the Cadillac of birth control right now.”

HealthCare.gov

Pennsylvanians looking for health insurance have a new option to help them find the right coverage. HealthPlanRatings.org is a plan comparison tool created for the state by nonprofit Consumer’s Checkbook.

Gene Puskar / AP

The uninsured rate in the U.S. is at a record low and studies show Pittsburgh is beating the average.

According to research from the personal finance website WalletHub, Pittsburgh ranks 8th in the nation among the 64 largest cities, with a 6.42 percent uninsured rate. That compares to a national average of 8.6 percent.

University of Pittsburgh health economist Lindsay Sabik said having health insurance doesn’t always lead to access to affordable health care.

Gov. Tom Wolf / Flickr

Gov. Tom Wolf's administration said it will save $214 million over the next three years by changing health benefits and long-term non-paid leave rules for government employees.

“This is the first health plan design change in over 12 years for the state and the changes represent the most significant health plan savings in Pennsylvania in recent history,” said Spokesman Jeff Sheridan.

Much of the savings will be generated through having employees and retirees in PPO plans cover deductibles and make co-pays for some in-network services and prescriptions.

Michael Righl / Flickr

 

Faculty and staff members at the University of Pittsburgh now receive transgender benefits, including behavioral health support, medications and surgery.

The Pittsburgh Post-Gazette reports officials say the change, which was sent to employees last week, is meant to bring the university into compliance with federal rules on sex discrimination in employment.

Insurance giant Aetna will stop selling health insurance through most of the exchanges created by the Affordable Care Act in 2017 because the company said it is losing money in many of those markets.

On Monday, Aetna said it will sell individual insurance policies in only 242 counties in four states, down almost 70 percent from the 778 counties in 15 states where the company markets Obamacare plans this year.

The battle continues to rage between drug companies that are trying to make as much money as possible and insurers trying to drive down drug prices. And consumers are squarely in the middle.

That's because, increasingly, prescription insurers are threatening to kick drugs off their lists of approved medications if the manufacturers won't give them big discounts.

Megan Harris / 90.5 WESA

The needle is in and out in a second. I let my breath return to its normal pace, and I’m given a Tweety Bird bandage as a reward for my maturity.

Twice a day, Angela and Nate Turner of Greenwood, Ind., put tiny strips that look like tinted tape under their tongues.

"They taste disgusting," Angela says.

But the taste is worth it to her. The dissolvable strips are actually a drug called Suboxone, which helps control an opioid user's cravings for the drug. The married couple both got addicted to prescription painkillers following injuries several years ago, and they decided to go into recovery this year. With Suboxone, they don't have to worry about how they'll get drugs, or how sick they'll feel if they don't.

The Justice Department is suing to block two proposed mergers between major health insurance companies, saying the deals violate antitrust laws and would lead to higher health care costs for Americans.

U.S. Attorney General Loretta Lynch explained the decision at a press conference:

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