WBEZ | health insurance http://www.wbez.org/tags/health-insurance Latest from WBEZ Chicago Public Radio en Obamacare Sign-Ups Could Get a Bump as Higher Penalties Kick-In http://www.wbez.org/news/obamacare-sign-ups-could-get-bump-higher-penalties-kick-114179 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/penalties.JPG" alt="" /><p><div id="res459739754"><div data-crop-type=""><img alt="Martha Lucia (from left), Bienvendida Barreno and Jorge Baquero discuss health insurance options with agents from Sunshine Life and Health Advisors at a Miami mall last month." src="http://media.npr.org/assets/img/2015/12/14/obamacare_custom-211fe6448b7716e7d597a0f19ac51939e75d887e-s800-c85.jpg" style="height: 412px; width: 620px;" title="From left: Martha Lucia Bienvendida Barreno and Jorge Baquero discuss health insurance options with agents from Sunshine Life and Health Advisors at a Miami mall last month. (Joe Raedle/Getty Images)" /></div><div><p><em>Editor&#39;s update:&nbsp;Kevin Counihan,&nbsp;CEO of the federal health insurance marketplaces, announced late Tuesday that the deadline for signing up for a health plan under the Affordable Care Act has been extended by two days &mdash; until 11:59 PST December 17. &quot;Unprecedented demand and volume&quot; of consumers contacting HealthCare.gov and the exchange&#39;s call center forced the extension, he says.&nbsp;Hundreds of thousands of people were able to enroll successfully, but well&nbsp;over 1 million consumers were not able to enroll in the past two days and, instead, left contact information for later enrollment. Several states, including New York and Minnesota, have announced similar extensions.</em></p><p>This is the last week to choose a health plan under the Affordable Care Act if you want insurance coverage to begin by Jan. 1. And officials who have spent the past two years using the carrot of persuasion to get people to buy insurance through the state or federal exchanges say the time has come for the stick.</p><p>That stick is a hefty fine.</p><p>Penalties for failing to buy insurance will roughly double. A family of four that makes $250,000 a year could&nbsp;<a href="https://www.healthcare.gov/fees/estimate-your-fee/">face a fine</a>&nbsp;when tax time rolls around in 2017 that approaches $10,000 if they don&#39;t get coverage for 2016.</p><p><a href="https://www.cms.gov/About-CMS/Leadership/cciio/Kevin-Counihan.html">Kevin Counihan</a>, CEO of the federal insurance exchange HealthCare.gov, says he thinks the high fines will induce people who didn&#39;t have insurance before to at least shop around before deciding to skip coverage again.</p><p>Counihan, who was director of marketing for the Massachusetts health exchange 10 years ago, says it was when the fines approached $1,000 that sign-ups jumped.</p><p>&quot;It got people&#39;s attention,&quot; he tells Shots. &quot;And there seemed to be more of a discussion in their head about whether it made sense to pay the penalty and not get something for it.&quot;</p><p>Research bears out Counihan&#39;s theory. A&nbsp;<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408001/">study</a>&nbsp;published in the&nbsp;<em>American Economic Review&nbsp;</em>in March showed that as fines got higher in Massachusetts, more people opted to buy insurance &mdash; and the overall medical well-being of that population improved.</p><p>In 2016, an individual who doesn&#39;t buy insurance will owe&nbsp;<a href="https://www.healthcare.gov/fees/fee-for-not-being-covered/">at least $695</a>. The minimum fine for 2015 is $325. The 2016 penalties could reach the thousands &mdash; from as much as 2.5 percent of a person&#39;s income, up to as much as the average annual price of a &quot;bronze plan,&quot; the lowest-cost health plan available on the insurance exchange.</p><p>The Department of Health and Human Services, which runs HealthCare.gov, tried to make as many people aware of the fines last year as it could, without giving too much of a sting to those who didn&#39;t buy plans. The agency allowed people who owed money because they didn&#39;t have insurance in 2014 to sign up for 2015 insurance during a&nbsp;<a href="https://www.healthcare.gov/blog/tax-penalty-special-enrollment-period-for-2015-health-coverage/">special enrollment period.</a></p><p>Counihan says people shouldn&#39;t plan on another such reprieve.</p><p>&quot;We&#39;re not offering that this year,&quot; he says. &quot;The deadline for enrollment is Jan. 1. That&#39;s a solid deadline.&quot;</p><p>If you want insurance that kicks in on Jan. 1, however, you have to enroll this week.</p><p>That means insurance navigators &mdash; the people who help consumers choose a health plan &mdash; are busy explaining the fees to consumers.</p><p><a href="https://www.whitman-walker.org/staff/katie-nicol/">Katie Nicol</a>&nbsp;is senior manager of public benefits and insurance navigation at Whitman-Walker Health, an LGBT-focused health center in Washington, D.C. She oversees 11 full-time navigators, and says many of the clinic&#39;s clients are shocked to hear how big the penalties are going to be for 2016.</p><p>&quot;People understand generally that there&#39;s a penalty,&quot; Nicol says. &quot;But the majority of the time they don&#39;t know what that means &mdash; definitely not the amount of money that it is. There is a bit of shock of realizing, &#39;Wow, if I don&#39;t do this, I will likely be responsible for over $600 in penalties.&quot;</p><p>Many of Whitman-Walker&#39;s patients qualify for Medicaid. But because the health center is located in a rapidly gentrifying neighborhood, it also has many clients who are young and single professionals. Doctors, nurses, and pharmacists at the clinic refer all of their patients without insurance to in-house navigators to help them pick a health plan and enroll.</p><p>These navigators try to explain&nbsp;all&nbsp;the costs a patient will face, depending on whether they choose insurance and what type.</p><p>&quot;It&#39;s not just about the penalty,&quot; Nicol says. &quot;It&#39;s also [about whether] you need prescriptions, if you need medical care. It&#39;s almost doing a cost-benefit analysis.&quot;</p><p><a href="http://publichealth.gwu.edu/departments/health-policy-and-management/leighton-ku">Leighton Ku</a>, who directs the Center for Health Policy Research at George Washington University, says the stakes in 2016 go beyond any one individual&#39;s costs.</p><p>&quot;There&#39;s information that clearly shows that the creation of the insurance mandates and the tax penalties bring more people into the insurance market,&quot; Ku says. &quot;That helps bring insurance costs down.&quot;</p><p>Bringing down the overall costs of health plans will take time, however, he says. In the meantime, the monthly premiums for&nbsp;<a href="http://www.npr.org/sections/health-shots/2015/10/27/451993763/exchange-plans-may-have-higher-costs-no-out-of-network-coverage">health plans</a>&nbsp;that take effect on Jan. 1 have gone up &mdash; an average of about 7.5 percent over the monthly premiums in 2015.</p></div></div><p>&mdash;<em> <a href="http://www.npr.org/sections/health-shots/2015/12/15/459735623/obamacare-sign-ups-could-get-a-bump-as-higher-penalties-kick-in?ft=nprml&amp;f=459735623">via NPR</a></em></p></p> Wed, 16 Dec 2015 13:31:00 -0600 http://www.wbez.org/news/obamacare-sign-ups-could-get-bump-higher-penalties-kick-114179 Looking at Violence in America with a Financial Lens http://www.wbez.org/news/looking-violence-america-financial-lens-114164 <p><div id="res459739514" previewtitle="Ambulances lined up following two explosions near the finish line of the Boston Marathon on April 15, 2013."><div data-crop-type=""><img alt="Ambulances lined up following two explosions near the finish line of the Boston Marathon on April 15, 2013." src="http://media.npr.org/assets/img/2015/12/14/gettyimages-166670675_custom-699c9514041c52ed49383c2ae11e6fba8f4e3454-s800-c85.jpg" style="height: 412px; width: 620px;" title="Ambulances lined up following two explosions near the finish line of the Boston Marathon on April 15, 2013. (Aram Boghosian for The Boston Globe via Getty Images)" /></div><div><p>Pain, grief and emotional loss follow mass shootings in America, and there are also other costs that add up to&nbsp;<a href="http://www.motherjones.com/politics/2015/04/true-cost-of-gun-violence-in-america" target="_blank">violence&#39;s financial toll</a>. It&#39;s Ted Miller&#39;s job to crunch numbers on social ills like mass shootings. He&#39;s a&nbsp;<a href="http://www.pire.org/staffmember.aspx?cid=306">health economist</a>&nbsp;with the Pacific Institute for Research and Evaluation.</p></div></div><p>For example, when then-U.S. Rep. Gabby Giffords was shot in a 2011 incident that left six people dead and 13 injured (including Giffords), her medical costs alone were well over $500,000, he says.</p><p>&quot;I haven&#39;t calculated [the incident&#39;s cost] totally, but we would figure that each death was worth about $7 million,&quot; Miller tells NPR&#39;s David Greene. &quot;The way we look at that is we have interviews where people have been asked how much they would pay to reduce their chance of being killed or injured in a violent incident. People actually pay that. When you look at housing prices, we pay more for housing in safe neighborhoods.&quot;</p><div><hr /></div><p><strong><span style="font-size:20px;">Interview Highlights</span></strong></p><p><strong>On what goes into the calculations</strong></p><p>We&#39;re looking at the value of a human life, not the cost of a human life. We look at the wage loss, we look at the household work loss, we look at the value people place on their pain and suffering, loss,<a href="http://www.wbez.org/news/how-terrorist-attacks-can-change-nations-psyche-114090" target="_blank"> quality of life</a>. Fatality is a lot cheaper (medically) than surviving. Makes a real difference if you have insurance.</p><p>The Boston Marathon is interesting because people who were uninsured who were injured in that bombing, who were from Massachusetts, could even after the fact buy health insurance, whereas people who are not from Massachusetts couldn&#39;t.</p><p><strong>On the difference, in medical cost terms, between dying and surviving</strong></p><p>The pain, suffering, loss, quality of life and lost wages is far larger if you die than if you live. Although some people will live as quadriplegics, some people will live with severe traumatic brain injury. There are people who, when you ask them, say that&#39;s a fate worse than death.</p><p><img alt="" class="image-original_image" src="http://www.wbez.org/system/files/styles/original_image/llo/insert-images/AP_360696474530.jpg" style="height: 167px; width: 310px; float: right; margin-left: 10px; margin-right: 10px;" title="Former U.S. Rep. Gabby Giffords was severely wounded in a 2011 shooting that killed six in Tucson. She pushes for raising awareness around the issue of gun violence against women on state and federal levels. (AP Photo/Charles Krupa)" /></p><p><strong>On serving the public health</strong></p><p>I think of my numbers as giving people the numbers they need to save lives.</p><p>Let me take the example of the cost of a bicycle helmet. I&#39;ve looked at the savings from bicycle helmets. That&#39;s resulted in laws being passed in some places. For a lot of legislatures, [it] builds a legislative case. When we say a child seat returns more in medical costs savings alone than the cost of the seat, that makes it easier to pass a law requiring kids to be in child seats going back to when we didn&#39;t have those laws.</p><p><strong>On the financial cost of the <a href="http://www.wbez.org/news/tally-mass-shootings-us-114040" target="_blank">shootings in San Bernardino, Calif.</a></strong></p><p>Probably about $125 million for San Bernardino. [The shooters left 14 people dead and 21 others wounded.] Perhaps more telling is the total cost of firearm injury is $235 billion a year. So $125 million is less than a day&#39;s firearm injuries on average.</p><p>&mdash; <em><a href="http://www.npr.org/2015/12/15/459673828/looking-at-violence-in-america-with-a-financial-lens?ft=nprml&amp;f=459673828" target="_blank">via NPR</a></em></p></p> Tue, 15 Dec 2015 09:44:00 -0600 http://www.wbez.org/news/looking-violence-america-financial-lens-114164 Insurers offer narrower networks on health exchanges http://www.wbez.org/programs/marketplace/2015-11-05/insurers-offer-narrower-networks-health-exchanges-113654 <p><div><div id="story-content"><p>When open enrollment began on the nation&#39;s healthcare exchanges on November 1, many people who bought insurance for 2015 found that the 2016 plans they had to choose from have narrower networks of hospitals.</p><p>In addition, premiums might be significantly higher. Insurers have asked the federal government for permission to increase premiums by as much as 40 percent or more.</p><p>All of this is happening because health insurers say that people who have signed up for coverage under the Affordable Care Act have been sicker than expected.</p><p>&quot;You&#39;re seeing the health plans take on more risk than they actually anticipated,&quot; Barbara Otto said, who heads the Chicago-based non-profit Health and Disability Advocates, which works to educate people about their health insurance choices on the exchange.</p><p>&quot;Anecdotally, we&#39;re hearing a lot from different health plans that they are seeing large populations of people with chronic conditions enrolling,&quot; Otto said, adding that a lot of these new patients had not had health insurance for years. In Illinois, most patients signed up with a silver tier PPO plan offered by Blue Cross and Blue Shield of Illinois, said Otto.</p><p>A PPO, preferred provider organization, is an insurance plan that offers patients relative freedom to choose doctors and hospitals. Patients pay more of the costs for providers outside of the PPO&#39;s network, and less for those inside the network. PPOs are less restrictive than HMOs, health maintenance organizations.</p><p>Blue Cross and Blue Shield of Illinois&#39; PPO plan offered a cheap price (with subsidies) and a large network of hospitals, including prestigious academic medical centers.</p><p>While this was great for patients, Blue Cross and Blue Shield of Illinois said the plan was the highest in cost for them. So, the insurer decided to no longer offer it on the insurance exchange for 2016. Instead, it is offering to renew patients in an alternative PPO with a narrower network. The insurer would not comment for this story.</p><p>Otto said she fears a lot of confusion during the upcoming enrollment period. &quot;People are going to go into the marketplace thinking that they&#39;re purchasing this broader PPO network, when in fact what they&#39;re getting is a very narrow product,&quot; Otto said. Health insurance educators will have to do a lot of heavy lifting, she said.</p><p>&quot;The phenomenon of narrow networks is not an Illinois, or Chicago-based phenomenon,&quot; said Larry Van Horn, associate professor of management and the executive director of health affairs at Vanderbilt University, who researches healthcare management and economics.</p><p style="text-align: center;"><img alt="" class="image-original_image" src="http://www.wbez.org/system/files/styles/original_image/llo/insert-images/Martha%20Lucia.jpg" style="height: 362px; width: 620px;" title="Martha Lucia, left, sits with Rudy Figueroa, an insurance agent from Sunshine Life and Health Advisors, as she picks an insurance plan available in the third year of the Affordable Care Act at a store setup in the Mall of the Americas on November 2, 2015 in Miami, Florida. (Joe Raedle/Getty Images)" /></p><p>Insurers are trying to control costs by funneling more patients to fewer hospitals, Van Horn said. &quot;To negotiate better rates, they&#39;ve got to be able to focus more patients into a particular facility, such that they have more bargaining power at the negotiation table.&quot;</p><p>And there are advantages to this, Van Horn said. &quot;In return for trading off choice, patients, subscribers get lower prices,&quot; he said. Patients who are willing or able to pay more will have access to more choices.</p><p>But, many patients may not realize exactly what they are giving up, said Robert Wachter, interim chair of the Department of Medicine at the University of California in San Francisco. In their efforts to control costs and premiums by narrowing networks, both Wachter and Van Horn said insurers are preferring cheaper community hospitals, and increasingly eschewing big, expensive academic research hospitals.</p><p>While that may be fine for most patients, because community hospitals can take care of the majority of patients&#39; needs, problems arise when patients need more advanced care than community hospitals are able to provide, Wachter said. Care such as an organ transplant.</p><p>&quot;I hear from patients that, &#39;well, I joined a plan, and I didn&#39;t really read the fine print, and now I have something serious and I&#39;d love to see one of your specialists, and I know that I can&#39;t get there. Is there any way to work around the system?,&#39;&quot; Wachter said.</p><p>Major medical centers are more expensive, he said, they have to do more. &quot;Some of it is that we&#39;ve got to create an environment that is ready to do a heart transplant at a moment&#39;s notice or take care of a patient with a massive trauma. Those sort of things cost money to create capacity that you may not be using every minute,&quot; Wachter said.</p><p>As more patients are taken away from major medical centers by insurance plans looking to control costs, Wachter said a threat is emerging for these academic hospitals and their ability to survive. To combat the trend, Wachter said many large medical centers are taking on more doctors and expanding their own networks, so that they too have greater leverage in negotiating with insurance companies.</p><p>In the meantime, Barbara Otto is worried about next year&#39;s insurance plans in Illinois. Yes, there may be plans with premiums that are still affordable enough for most patients, especially those needing subsidies, but at what cost, she wonders.</p><p>&quot;We may be creating different tiers of healthcare, based on what you can pay,&quot; Otto said. &quot;Which in a way defeats the whole idea, which is opening up access to care for everyone.&quot;</p></div></div><p>&mdash; via Marketplace</p></p> Thu, 05 Nov 2015 12:31:00 -0600 http://www.wbez.org/programs/marketplace/2015-11-05/insurers-offer-narrower-networks-health-exchanges-113654 Blue Cross ends its broad PPO, narrowing network for patients http://www.wbez.org/news/blue-cross-ends-its-broad-ppo-narrowing-network-patients-113605 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/bcbs_flickr.JPG" alt="" /><p><p>Evanston-based NorthShore University HealthSystem is signing on with Aetna health insurance, after Blue Cross &amp; Blue Shield of Illinois decided to discontinue its broad PPO plan. As a result, NorthShore estimates it could lose 18,000 patients.</p><p>Patients with the Blue Cross &amp; Blue Shield&rsquo;s Blue Precision plan will still be able to visit their doctor at NorthShore.</p><p>Blue Cross is narrowing its network because of higher costs, which Dr. Joel Shalowitz of the&nbsp;Kellogg School of Management at Northwestern University&nbsp;said is becoming a more common practice with insurance companies. He said insurers have lost a lot of money on the health exchange.</p><p>&ldquo;Insurers are scrambling to find out how they can save money next year. The government did promise that it would cover shortfalls, but it&rsquo;s come up very short on fulfilling that promise,&rdquo; said Shalowitz, Northwestern University clinical professor of health industry management.</p><p>&ldquo;A lot of it has to do with budget negotiations, but it was also going to come from savings from plans that would cross subsidize the losing plans,&rdquo; he explained.</p><p>Cost-cutting options are limited with government regulations on how much insurance companies can charge.</p><p>&ldquo;The only thing left is to limit their networks if they want to save money,&rdquo; Shalowitz said.</p><p>People who currently have the Blue Cross PPO through small group, business or employer plans will not be affected by the change. But according to Shalowitz, that means more vulnerable people will bear the burden.</p><p>&ldquo;We&rsquo;re not focusing on the people who have, but the people who don&rsquo;t have,&rdquo; he said.</p><p>Some patients might re-enroll under a higher cost plan to stay with their doctor, or, a cheaper plan with higher out-of-pocket costs. Some patients might switch doctors and travel farther to stay in network.</p><p>Blue Cross says the Blue PPO will be discontinued in 2016 for individual and family buyers.</p><p>&ldquo;This is part of an overall national trend to move away from PPO plans that come with high costs to consumers and offer little in the way of coordinated care,&rdquo; the company said in a statement.</p><p>Blue Cross said members have been notified of a replacement plan and that enrollment is open through the end of January.</p><p><em>Susie An is a WBEZ reporter. Follow her <a href="http://twiiter.com/soosieon">@soosieon.</a></em></p></p> Mon, 02 Nov 2015 18:41:00 -0600 http://www.wbez.org/news/blue-cross-ends-its-broad-ppo-narrowing-network-patients-113605 New protections for transgender patients are coming http://www.wbez.org/news/new-protections-transgender-patients-are-coming-113584 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/A poster from a 2013 rally in Washington, D.C. supporting equal health and livelihood of trans people..jpg" alt="" /><p><p><img alt="" id="1" src="http://www.marketplace.org/sites/default/files/styles/primary-image-766x447/public/8604815836_71ec0d624a_z.jpg?itok=afd2pRX-" style="height: 362px; width: 620px;" title="A poster from a 2013 rally in Washington, D.C. supporting equal health and livelihood of trans people. Friday marks the deadline for the Obama administration to finalize rules that will include protections for transgender patients. (flickr/Ted Eytan)" typeof="foaf:Image" /></p><div><div><div>For years, transgender adults have faced discrimination in healthcare so hostile it&rsquo;s almost laughable. Almost.</div><div>&nbsp;</div></div></div><p>&ldquo;A trans-woman broke her arm playing softball,&rdquo; said Mara Keisling, executive director the National Center for Transgender Equality. &ldquo;The insurance company refused to pay for it because if she hadn&rsquo;t been transgender she wouldn&rsquo;t have been playing softball. There&rsquo;s just a million stories like that.&rdquo;</p><p>The U.S. Department of Health and Human Services is finalizing specific provisions of a rule under the Affordable Care Act that broadens civil rights protection.</p><p>This is the first federal law to prohibit discrimination on the basis of sex in healthcare, which means hospitals, nursing homes, health insurers and doctors are barred from discriminating against transgender Americans&nbsp;&mdash;&nbsp;as well as others based on sex.</p><p>This new rule puts the entire industry on notice. It&rsquo;s now illegal to discriminate against people based on their sexual orientation, just like it&rsquo;s been illegal to deny care to people based on age, religion or race.&nbsp;Friday is the deadline for the Obama Administration to finalize new rules.</p><p>HHS&rsquo;s Jocelyn Samuels said that means insurers can no longer categorically deny services. For example, take gender transition care.&nbsp;</p><p>&ldquo;If an insurer said, &#39;we will not cover any services related to gender transition, we will treat that as a denial of access to coverage&#39;&nbsp;&mdash;&nbsp;that is prohibited by the ACA,&rdquo; she said.</p><p>Once the final rule is in place, University of Michigan Law Professor Sam Bagenstos, a former assistant attorney general for civil rights under the Obama Administration, said he can imagine scenarios where an insurer covers some services, but gender transition remains expensive.</p><p>&ldquo;It gets gray pretty quickly,&rdquo; he said. &ldquo;I think the real question is how much is HHS going to feel willing to say in the abstract about these questions.&rdquo;</p><p>While this likely opens the doors to more lawsuits, Keisling of the National Center for Transgender Equality noted this gives people legal standing for the first time.</p><p>&ldquo;When they go to the doctor and the doctor says, &#39;I don&rsquo;t feel comfortable,&#39; they know they have the ability to say, &#39;I am a human being and you have to treat me. I have a legal right to get medical care,&#39;&rdquo; Keisling said.</p><p>Keisling estimates there are some 1 million transgender Americans, some of whom have stopped seeking medical care due to bad experiences in the past.</p><p>&mdash; <a href="http://www.marketplace.org/topics/health-care/new-protections-transgender-patients-are-coming" target="_blank"><em>via Marketplace</em></a></p></p> Mon, 02 Nov 2015 09:37:00 -0600 http://www.wbez.org/news/new-protections-transgender-patients-are-coming-113584 Health care tax rules trip up some immigrants http://www.wbez.org/news/health-care-tax-rules-trip-some-immigrants-111785 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/Immigrant-Obamacare.jpg" alt="" /><p><p>The deadline&rsquo;s coming to file tax returns, and aside from the usual headache, this year it&rsquo;s proving particularly thorny for undocumented immigrants. That&rsquo;s because, for the first time, there are penalties under the Affordable Care Act for those lacking health insurance.</p><p>But the law is complex, and when it comes to people living in the U.S. illegally, many are getting slapped with fines they shouldn&rsquo;t have to pay.</p><p>Adalberto Martinez, a mechanic at an auto body shop in Chicago, is one of them. Like many undocumented immigrants, Martinez pays income taxes, using an IRS-issued taxpayer identification number, called an ITIN. But this year, he noticed something different when he sat down with his tax preparer.</p><p>&ldquo;They told me that there&rsquo;s a box where you have to answer whether you have insurance or not,&rdquo; he explained in Spanish. &ldquo;So she put down that I didn&rsquo;t have insurance. She didn&rsquo;t explain to me exactly why, just that there was a box there and I didn&rsquo;t have insurance.&rdquo;</p><p>Afterwards, Martinez found he was hit with a $200 fine for not having health coverage in 2014. The official name for the penalty was the &ldquo;shared responsibility payment.&rdquo;</p><p>Most lawful U.S. residents are required to have health coverage under Obamacare, and those who don&rsquo;t will have to pay the penalty. But under the law, undocumented U.S. residents, like Martinez, are exempt from all that. But Martinez&rsquo;s story is not unique.</p><p>&ldquo;We&rsquo;ve heard from at least 10 to 15 organizations that have been hearing this issue in the community,&rdquo; said Luvia Quinones, health policy director at the Illinois Coalition for Immigrant and Refugee Rights.</p><p>Quinones said it&rsquo;s not clear how many undocumented immigrants may have improperly paid the fine, but she said thousands in Illinois could be at risk.</p><p>&ldquo;We know that in the state of Illinois, there&rsquo;s about 310,000 undocumented, uninsured individuals in addition to about 70-80 thousand DACA youth that are eligible also to get their work permit,&rdquo; she said.</p><p>DACA youth, also known as DREAMers, are immigrants that arrived in the U.S. as children and obtained temporary relief from deportation under President Obama&rsquo;s Deferred Action for Childhood Arrivals program. They have valid Social Security numbers, which could be used to file tax returns. This puts them at particular risk for mistaken penalties, because while their Social Security numbers may suggest that they are lawful U.S. residents, and therefore subject to the health care penalty, Obamacare explicitly excludes them from the health coverage requirement.</p><p>Quinones said in some cases, she believes immigrants are being entrapped in fraudulent schemes by unscrupulous tax preparers who are pocketing the penalties themselves. An advisory from the IRS indicates that the federal agency is aware and concerned about these reports as well.</p><p>But often, Quinones said, these instances are mistakes, where tax preparers are unclear about the new law.</p><p>That&rsquo;s what Graciela Guzman found when she was forced to tackle the issue. As a health care navigator at Primecare Community Health, a bilingual clinic in the city&rsquo;s Wicker Park neighborhood, she helps people enroll in health insurance plans.</p><p>Technically, Guzman&rsquo;s job has nothing to do with taxes, but recently patients whom she&rsquo;d told were ineligible for health coverage under Obamacare started showing up at her clinic. They&rsquo;d prepared their tax returns, and they were mad at her.</p><p>&ldquo;Like, &lsquo;you told me I was not going to get penalized,&rsquo;&rdquo; Guzman recalled them saying. &ldquo;Like, &lsquo;you educated us and you said we are not going to get penalized, and we got penalized. Why?&rsquo;&rdquo;</p><p>Guzman realized lots of tax preparers were making mistakes, so she and her colleagues decided to educate them.</p><p>On a recent weekday afternoon, she canvassed Fullerton Avenue in the Belmont-Cragin neighborhood on foot, carrying a bag of informational flyers.</p><p>&ldquo;We&rsquo;ll hit a new corridor every two or three days,&rdquo; she said. &ldquo;We&rsquo;ll probably hit 10 to 15 income tax places per corridor, so we&rsquo;ve probably hit about 120 income tax places.&rdquo;</p><p>Guzman pops into tax preparers&rsquo; offices, as well as check cashing sites, speaking briefly in Spanish to explain her purpose, and to leave a stack of papers. The sheets detail, in English and in Spanish, how undocumented immigrants should claim an exemption from the penalty.</p><p>Guzman said the penalty can be a hardship for many people at her clinic. It&rsquo;s at least $95 per adult who&rsquo;s not insured. But in most cases it&rsquo;s a lot more, depending on the family&rsquo;s income.</p><p>&ldquo;A penalty of $300-$400, it can absorb half if not more of what they would have gotten back in refund,&rdquo; she said.</p><p>So why has it been so hard to get it right? One reason is that none of the information you provide on your tax return is an absolute indicator of your residency status. Not everyone who files taxes using an ITIN is undocumented; conversely, not everyone with a Social Security number is a lawful U.S. resident.</p><p>There are different opinions on how tax preparers should handle this.</p><p>&ldquo;If they are using services of a tax preparer, they should tell preparer directly that immigration status is that of someone not in the U.S. legally,&rdquo; said Enrique Lopez, a CPA in Chicago. In fact, Lopez said that his office will refuse to file a tax return for a client who does not disclose his or her residency status.</p><p>But others worry that this might backfire.</p><p>&ldquo;I think not only is it going to create more fear in the community, but it could also affect the likelihood of undocumented individuals or DACA youth wanting to file taxes,&rdquo; said Quinones.</p><p>Instead, Quinones recommended that tax preparers keep things general. Instead of asking whether a client is undocumented, he or she could ask if the client qualifies for any of a number of exemptions that fall under the same <a href="http://www.irs.gov/instructions/i8965/ch02.html#d0e1463">code</a>. That way, someone who&rsquo;s undocumented can indicate that they are exempt without disclosing the specific reason why.</p><p>As for Martinez, he was able to go back to his tax preparer and file a tax return amendment. He hopes he&rsquo;ll get his $200 back. In the meantime, he said he&rsquo;s doing a little outreach himself.</p><p>&ldquo;I started telling people,&rdquo; he said, through a translator. &ldquo;My cousin in Indianapolis, he came to Chicago, and he told me they charged him $300. I told him, &lsquo;Hey cousin, you need to find out what happened &lsquo;cause they shouldn&rsquo;t have charged you.&rsquo;&rdquo;</p><p>Meanwhile, immigrant advocates and others are warning the public that anyone who pays the penalty directly to a tax preparer, by cash or otherwise, may be a victim of fraud. The IRS recommends filing a <a href="http://www.irs.gov/pub/irs-pdf/f14157.pdf">form </a>to report the activity. Consumers may also file a complaint with the &nbsp;<a href="http://illinoisattorneygeneral.gov.">Illinois Attorney General</a>.</p><p>In cases where someone has improperly paid the penalty to the IRS, they can file a tax amendment to get the money back. Get Covered Illinois advises anyone with questions about the health care requirement or the tax penalty to call its hotline at 866-311-1199.</p><p><em>Ivan Favelevic and Aurora Aguilar assisted with language translation for this story.</em></p><p><em>Odette Yousef is WBEZ&#39;s North Side bureau reporter. Follow her </em><a href="https://twitter.com/oyousef"><em>@oyousef</em></a><em> and </em><a href="https://twitter.com/wbezoutloud"><em>@WBEZoutloud</em></a><em>.</em></p></p> Mon, 30 Mar 2015 09:49:00 -0500 http://www.wbez.org/news/health-care-tax-rules-trip-some-immigrants-111785 Immigrants face barriers on health care site http://www.wbez.org/news/immigrants-face-barriers-health-care-site-109698 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/ACA immigrants_web.jpg" alt="" /><p><p>More than two months after the Obama administration declared <a href="https://www.healthcare.gov/">healthcare.gov</a> working &ldquo;smoothly for the vast majority of users,&rdquo; immigrants who try to sign up are still encountering serious glitches.</p><p>On Wednesday, federal officials <a href="http://www.hhs.gov/news/press/2014pres/02/20140212a.html">trumpeted</a> the fact that more than 1 million people signed up for private insurance in January, with Illinois accounting for nearly 89,000 of those enrollees. With fewer than 40 days until the deadline to enroll without incurring a penalty, much of the attention has turned to so-called &ldquo;young invincibles,&rdquo; a term for young, healthy people who will likely have lower health care costs.</p><p>There&rsquo;s no similar focus on immigrants, WBEZ has found, who continue to face significant hurdles with identity and citizenship verification, and faulty determinations of eligibility for Medicaid. In Illinois, the task of finding and navigating around those barriers often falls to scrappy enrollment specialists who work directly with those clients at community health centers. On top of their jobs, they are finding themselves tasked with bringing the glitches to the attention to state and federal authorities, and lobbying for them to be fixes.</p><p>Illinois, which is one of seven states to engage in a state-federal partnership, relies on the federal site to handle the enrollment function for plans offered on the state&rsquo;s insurance marketplace. Under the Affordable Care Act, immigrants are required to have insurance if they reside lawfully in the U.S. &ndash; even if they are not citizens.</p><p>&ldquo;Since November I have frequently made visits, and every time I made a visit I&rsquo;ve stayed at least 3-4 hours,&rdquo; said Zejna Belko, a 51-year old Bosnian immigrant who described her attempt to enroll in the healthcare exchange with the help of enrollment counselors at the Hamdard Center on Chicago&rsquo;s far North Side. &ldquo;We&rsquo;ve also had individuals from other agencies try to help us out.&rdquo;</p><p>Belko, who&rsquo;s lived in the U.S. with a green card for 16 years, said she&rsquo;s spent up to 30 hours working with enrollment specialists. Still, they haven&rsquo;t even been able to start her application because the system cannot verify her identity. So far, Belko has twice mailed identifying documents, such as copies of her green card and social security card, to the Department of Health and Human Services, to no avail.</p><p>&ldquo;My blood pressure rises,&rdquo; she said through a translator. &ldquo;I get very frustrated and angry because I&rsquo;m an honest person and I&rsquo;m not hiding anything, and I don&rsquo;t understand what the problem is. I just want to get health care coverage.&rdquo;</p><p>In a small health center in Wicker Park, Graciela Guzman said she sees these cases all the time. Most frequently, the issues with identity verification is done via checking an applicant&rsquo;s credit history &ndash; something Guzman said many newer immigrants don&rsquo;t yet have.</p><p>&ldquo;They haven&rsquo;t been here long enough to be considered &lsquo;bankable,&rsquo;&rdquo; she said. &ldquo;Like a lot of them have been paid by cash. Maybe they don&rsquo;t have banks. Maybe they don&rsquo;t own property. So the system has a harder time just finding them.&rdquo;</p><p><strong>The Morning Shift: How an ACA enrollment specialist is helping immigrants in Chicago</strong></p><p><iframe frameborder="no" height="166" scrolling="no" src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/134626873&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_artwork=true" width="100%"></iframe></p><p>Guzman works with a team of five enrollment specialists at <a href="http://www.primecarechi.org/">PrimeCare Community Health</a>, a small clinic based in St. Elizabeth&rsquo;s Hospital in Chicago&rsquo;s Wicker Park neighborhood. About half of their clients are immigrants. Her team encounters hurdles to enrollment so frequently, they&rsquo;ve managed to cobble together a complicated flow sheet of workarounds. For identity verification problems, they&rsquo;ve found that calling the federal Health Insurance Marketplace Call Center, and later uploading or mailing a client&rsquo;s identification documents, usually helps to get an application started</p><p>But there are other barriers. Through trial and error, they found success in ignoring the site&rsquo;s directions to fill out information completely, and instead repeatedly clicking &ldquo;continue and save&rdquo; when they get an error on citizenship verification. The most significant challenge, however, appears not to have a workaround.</p><p>&ldquo;Most of our clients receive incorrect eligibility determinations, that tell them that they&rsquo;re eligible for Medicaid,&rdquo; said Guzman.</p><p>This is the case for lawful permanent residents whose incomes would qualify for Medicaid, but who are barred from enrolling in that program because they&rsquo;ve lived in the U.S. less than five years. Once the site directs an enrollee to apply for Medicaid, it does not allow them back onto the private healthcare exchange, where these clients should be.</p><p>&ldquo;We have brought this to the attention of our federal counterparts,&rdquo; said a state spokesman, &ldquo;and we believe they have been working to address it by adding new questions to <a href="https://www.healthcare.gov/">healthcare.gov</a> late last week that will allow people to get through to the Marketplace once they have been issued a denial.&rdquo;</p><p>In other words, immigrants are advised to apply for Medicaid even when they know they are ineligible for it, just to receive a denial. But since Medicaid eligibility was expanded under the Affordable Care Act, a backlog in applications has led to significantly longer processing times.&nbsp;</p><p>Guzman and her team of so-called &ldquo;navigators&rdquo; say, as they discover glitches, they&rsquo;ve relayed them to state and federal officials. So far, they have enrolled more than 600 immigrants to the healthcare exchange. In addition to the discoveries they&rsquo;ve made about getting through the technical difficulties, the team is also working out ways to handle the unexpected emotional impact of the job.</p><p>&ldquo;On our days off, we&rsquo;re constantly thinking about patients, which is like ludicrous,&rdquo; said Martin Jurado, who works with Guzman at PrimeCare. &ldquo;I don&rsquo;t think anybody else does that. You know? Somebody that you&rsquo;ve barely met, you barely know, yet you know everything about their life, what they&rsquo;re going through, and you&rsquo;re carrying that, and a lot of people didn&rsquo;t tell you that, starting off the bat.&rdquo;</p><p>Guzman found that <a href="http://guzmangraciela.wordpress.com/">blogging </a>helps her process their experiences. She writes of frustrations with the healthcare exchange website, but also about clients that stick in her head.</p><p>&ldquo;People really weren&rsquo;t hearing the complexity of the website, they weren&rsquo;t hearing people&rsquo;s fears and difficulties in getting through the website,&rdquo; she said. &ldquo;And so we wanted to share some of what&rsquo;s going on.&rdquo;</p><p>Together, she said, they have come to realize they are witnessing a moment: droves of people are coming out of the shadows because the law requires them to &ndash; and they&rsquo;re coming with needs that extend far beyond just health care.</p><p>&ldquo;We get them comfortable and primed, hopefully, for enrollment,&rdquo; she said, &ldquo;but then they&rsquo;ll turn around and kind of like almost offhandedly be like, &lsquo;so you helped me with this, can you help me with housing? Can you help me with food stamps? I have some domestic stuff going on, where do I go?&rsquo;&rdquo;</p><p>Guzman said she believes they&rsquo;re on the frontier of a new phase. She, Jurado, and the rest of their team will stick around after the crush of enrollment ends March 31st, helping people change or update their health plans. But she said they&rsquo;ll also continue to serve as access points to community resources when immigrants don&rsquo;t know where to go.</p><p><em>Odette Yousef is WBEZ&rsquo;s North Side Bureau reporter. Follow her <a href="https://twitter.com/oyousef" style="text-decoration:none;">@oyousef</a> and <a href="https://twitter.com/WBEZoutloud" style="text-decoration:none;">@WBEZoutloud</a></em></p></p> Thu, 13 Feb 2014 12:29:00 -0600 http://www.wbez.org/news/immigrants-face-barriers-health-care-site-109698 Limbo on Illinois health marketplace disappoints consumer and business advocates http://www.wbez.org/news/limbo-illinois-health-marketplace-disappoints-consumer-and-business-advocates-107582 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/health market_060613_lw.jpg" alt="" /><p><p>Illinois&rsquo; new health insurance marketplace will be run jointly with the federal government for the foreseeable future, which has disappointed consumer advocates.</p><p>The marketplace, also known as the insurance exchange, is where people without health insurance will go to shop under the Affordable Care Act or Obamacare. States had the option to pass legislation establishing state-run marketplaces, or leave it to the feds.</p><p>Several such bills made their way through the Illinois General Assembly without passing by the end of the legislative session in May. As it stands, Illinois&rsquo; marketplace will be jointly run with the federal government for the foreseeable future.</p><p>&ldquo;We&rsquo;re not gonna have the ability to really have any oversight of the federal exchange,&rdquo; said Jim Duffett, Executive Director of the Illinois Campaign for Better Healthcare. He says the bill would have established a regulatory board representing a broad swath of consumer interests including small businesses, communities of color and people with disabilities, calling the proposed body &ldquo;a very broad-based independent pro-consumer board.&rdquo; It would also have given the state the ability to regulate rates.</p><p>The bill, HB 3227, was passed in the Illinois state senate, but never came to a vote in the house. While it could still progress in the fall legislative veto session, the current limbo means the exchange will be run jointly with the federal government in 2014 based on previous legislation. The future of the exchange in 2015 remains unclear.</p><p>Healthcare and small business advocates had also hoped for a bill to pass this year.</p><p>Danny Chun, spokesperson for the Illinois Hospital Association (IHA), says hospitals supported HB 3227 because they, too, would have had representation on the regulatory board. And IHA supports requiring the insurance industry to cover the costs of managing the marketplace, another provision of the stymied bill. But he said he was not too worried.</p><p>&ldquo;The marketplace is happening,&rdquo; Chun said. &ldquo;Just because they didn&rsquo;t pass it in the spring session doesn&rsquo;t mean the issue isn&rsquo;t going to be called again.&rdquo;</p><p>The Illinois Chamber of Commerce supported a different version of the bill, but had hoped another version would pass this session -- one without the same requirements for insurance companies to fund the exchange.</p><p>&ldquo;Ultimately what ended up passing the Senate we were neutral on,&rdquo; said Laura Minzer, head of the healthcare council for the ICC. &ldquo;But it reflected a lot of the provisions and the principles we wanted to see captured.&rdquo;</p><p>Other key legislation did pass the Illinois General Assembly, including a bill to expand Medicaid in Illinois to low-income adults and a bill to establish licensed Illinois Insurance Navigators. Navigators will help consumers make their way in the new marketplace.</p><p>Beginning January 1, 2014, all Americans will be required to get health insurance or pay a fine. At least 17 states have already opted to create their own insurance exchanges, while 26 states will likely leave it to the federal government. Illinois is among the seven that are currently planning a jointly-run exchange. The federal marketplace, including the one in Illinois, is set to open October 1.</p><p><em>Lewis Wallace is a WBEZ Pritzker Journalism Fellow. Follow him <a href="http://twitter.com/lewispants" target="_blank">@lewispants</a>.</em></p></p> Fri, 07 Jun 2013 07:55:00 -0500 http://www.wbez.org/news/limbo-illinois-health-marketplace-disappoints-consumer-and-business-advocates-107582 Supreme Court will hear arguments over Obama health care plan http://www.wbez.org/story/supreme-court-will-hear-arguments-over-obama-health-care-plan-94022 <img typeof="foaf:Image" src="http://llnw.wbez.org//story/photo/2011-November/2011-11-14/RS3620_Doctors with Patient_Getty_David McNew.jpg" alt="" /><p><p>WASHINGTON (AP) — The Supreme&nbsp;Court said Monday it will hear arguments next March over President Barack Obama's health&nbsp;care overhaul — a case that could shake the political landscape just as voters are deciding if Obama deserves another term.</p><p>The decision to hear arguments in the spring allows plenty of time for a decision in late June, just over four months before Election Day. This sets up an election-year showdown over the White House's main domestic policy achievement.</p><p>The justices announced they will hear more than five hours of arguments, an extraordinarily long session, from lawyers on the constitutionality of a provision at the heart of the law and other related questions about the act. The central provision in question is the requirement that individuals buy health insurance starting in 2014 or pay a penalty.</p><p>The last time the court allotted anywhere near this much time for arguments was in 2003, for the consideration of the McCain-Feingold campaign finance reform. That case consumed four hours of argument.</p><p>The 2010 health&nbsp;care overhaul law aims to extend insurance coverage to more than 30 million Americans, through an expansion of Medicaid, the requirement that individuals buy health insurance starting in 2014 or pay a penalty and other measures.</p><p>A White House spokesman said, "We are pleased that the court has agreed to hear this case."</p><p>"We know the Affordable Care Act is constitutional and are confident the Supreme&nbsp;Court will agree," communications direct Dan Pfeiffer said in a statement.</p><p>Senate Republican Leader Mitch McConnell of Kentucky called the law an "unprecedented and unconstitutional expansion of the federal government into the daily lives of every American."</p><p>"In both public surveys and at the ballot box, Americans have rejected the law's mandate that they must buy government-approved health insurance, and I hope the Supreme&nbsp;Court will do the same," McConnell said.</p><p>Republicans have called the Patient Protection and Affordable Care Act unconstitutional since before Obama signed it into law in March 2010. But only one of the four federal appeals courts that have considered the health&nbsp;care overhaul has struck down even a part of the law.</p><p>The federal appeals court in Atlanta said Congress exceeded its power under the Constitution when it adopted the mandate. The federal appeals court in Cincinnati upheld the entire law, as did appellate judges in Washington, DC, in recent days.</p><p>The case could become the high court's most significant and political ruling since its 5-4 decision in the Bush v. Gore case nearly 11 years ago effectively sealed George W. Bush's 2000 presidential election victory.</p><p>In addition to deciding whether the law's central mandate is constitutional, the justices will also determine whether the rest of the law can take effect even if that central mandate is held unconstitutional. The law's opponents say the whole thing should fall if the individual mandate falls.</p><p>The administration counters that most of the law still could function, but says that requirements that insurers cover anyone and not set higher rates for people with pre-existing conditions are inextricably linked with the mandate and shouldn't remain in place without it.</p><p>The court also will look at the expansion of the joint federal-state Medicaid program that provides health&nbsp;care to poorer Americans. Florida and the 25 other states say the law goes too far in coercing them into participating by threatening a cutoff of federal money. The states contend that the vast expansion of the joint federal-state Medicaid program and the requirement that employers offer health insurance violate the Constitution. No appeals court has agreed.</p><p>"The court recognized the seriousness of these vitally important constitutional challenges by allocating an extraordinary amount of time for oral argument," Florida Attorney General Pam Bondi said</p><p>Lastly, the justices might not settle the fight over the constitutionality of the law at all if they agree with a decision by the federal appeals court in Richmond, Va. Those appellate judges said arguments over the law's validity are premature because a federal law generally prohibits challenges to taxes until the taxes are paid. The appeals court reasoned that the penalty for not purchasing insurance will not be paid before federal income tax returns are due in April 2015.</p><p>The administration agreed to seek prompt Supreme&nbsp;Court review of the health&nbsp;care overhaul, though it had options for trying to delay the court's consideration of the law until after the election. The Justice Department passed up the chance to ask the appeals court in Atlanta to reconsider its decision. It is common for the Justice Department to seek review by the full appeals court when a three-judge panel rules against the government.</p><p>Early on, at the district court level, rulings followed political affiliation. Judges appointed by Democratic presidents upheld the law, while Republican appointees struck it down.</p><p>But party lines blurred at two federal appeals courts. In Atlanta, Judge Frank Hull, a Clinton appointee, joined with a Republican colleague in striking down the mandate. In Cincinnati, Judge Jeffrey Sutton, a Bush appointee, was the deciding vote in upholding the law. And in the District of Columbia, Senior Judge Laurence Silberman, named to the bench by President Ronald Reagan, and Senior Judge Harry Edwards, a Carter appointee, voted together to uphold the law.</p><p>Legal experts have offered a range of opinions about what the high court might do. Many prominent Supreme&nbsp;Court lawyers believe that the law will be upheld by a lopsided vote, with Republican and Democratic appointees ruling in its favor. Still others predict a close outcome, with Justice Anthony Kennedy, a Republican who sometimes joins his four Democratic colleagues, holding the deciding vote.</p><p>Compounding the speculation over the outcome is the backdrop against which a decision is expected, the final few months of the presidential campaign.</p></p> Mon, 14 Nov 2011 16:25:00 -0600 http://www.wbez.org/story/supreme-court-will-hear-arguments-over-obama-health-care-plan-94022 New law aims to help Illinoisans quit smoking http://www.wbez.org/story/new-law-aims-help-illinoisans-quit-smoking-91243 <img typeof="foaf:Image" src="http://llnw.wbez.org//story/photo/2011-August/2011-08-30/cigarette_Flickr_Raul Liberwirth.jpg" alt="" /><p><p>A new Illinois law requires insurance companies to offer coverage for services meant to get smokers to kick the habit. Gov. Quinn signed the law on Monday.</p><p>The American Lung Association in Illinois enthusiastically backed the law. It said the law could be a tremendous help to tens of thousands of tobacco users who want to quit smoking but can't afford the services they need to make that happen.</p><p>A vice president at the state association, Kathy Drea, argued that getting smokers to quit not only improves the health of individuals. She said it reduces the several billion dollars that smoking-related diseases cost Illinois as a whole each year.</p><p>The smoking-cessation programs that insurance companies would be required to offer coverage on include various medical treatments and counseling by physicians.</p></p> Tue, 30 Aug 2011 15:25:00 -0500 http://www.wbez.org/story/new-law-aims-help-illinoisans-quit-smoking-91243