WBEZ | Obamacare http://www.wbez.org/tags/obamacare Latest from WBEZ Chicago Public Radio en What Happens if your Insurance Plan Goes Under? http://www.wbez.org/programs/morning-shift/2016-02-02/what-happens-if-your-insurance-plan-goes-under-114673 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/obamacare-thebluediamondgallery.jpg" alt="" /><p><div><p>The deadline to sign up for health coverage under the Affordable Care Act was Sunday night at midnight. Consumers signed up for a variety of plans, but not all of them are created equally.</p><p>In fact, the companies behind some plans may not have the financial wherewithal to keep them operational. Morning Shift talks to Crain&rsquo;s Chicago Business health care reporter Kristen Schorsch about what happens if some of these plans go under.</p></div><div>&nbsp;</div></p> Mon, 01 Feb 2016 10:55:00 -0600 http://www.wbez.org/programs/morning-shift/2016-02-02/what-happens-if-your-insurance-plan-goes-under-114673 Last Chance to Sign Up for Health Coverage http://www.wbez.org/programs/morning-shift/2016-01-26/last-chance-sign-health-coverage-114623 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/Healthcare-Getcoveredamerica.org_.png" alt="" /><p><div>This Sunday is the deadline to enroll in health care coverage in Illinois. We talk with Kathleen Falk, regional director for the U.S. Department of Health and Human Services about what consumers need to know about signing up for a health care plan.&nbsp;</div></p> Tue, 26 Jan 2016 16:33:00 -0600 http://www.wbez.org/programs/morning-shift/2016-01-26/last-chance-sign-health-coverage-114623 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 House calls for the homebound make a comeback http://www.wbez.org/news/house-calls-homebound-make-comeback-113747 <p><p>&nbsp;</p><p style="text-align: center;"><iframe frameborder="0" height="338" scrolling="no" src="http://www.npr.org/templates/event/embeddedVideo.php?storyId=455470438&amp;mediaId=455481394" width="600"></iframe></p><p>Dr. Roberta Miller hits the road at 8 a.m. to see her patients.</p><p>Many are too old or sick to go to the doctor. So the doctor comes to them.</p><p>She&#39;s put 250,000 miles on her Honda minivan going to their homes in upstate New York. Home visits make a different kind of care possible.</p><p>&quot;You can evaluate the person as a whole,&quot; says Miller, who has been a home care physician in Schenectady, N.Y., for more than 20 years. &quot;You see everything that influences their health and well-being: the environment, the surrounding people, the support system, whether they had or didn&#39;t have food.&quot;</p><p>Miller spends about an hour at each house call. Conversation with patients and their family members flows so naturally that it&#39;s easy to miss that she&#39;s also checking vital signs, gently stretching a hand, noting which pill bottles are empty.</p><p>Although Miller&#39;s practice may harken back to the country doctor of decades past, it could be the future of medicine. In 2013, about 2.6 million Medicare claims were filed for patient home visits and house calls. That&#39;s up from 2.3 million visits in 2009 and 1.4 million visits in 1999, according to Medicare statistics.</p><p>The trend is&nbsp;<a href="http://www.aafp.org/afp/2011/0415/p925.html">expected to accelerate</a>&nbsp;as baby boomers grow older. One in 20 people over the age of 65 is homebound in the U.S., according to a&nbsp;<a href="http://archinte.jamanetwork.com/article.aspx?articleid=2296016">study</a>&nbsp;published in July inJAMA Internal Medicine.</p><p>&quot;That&#39;s just the nature of the population we treat,&quot; Miller says. &quot;They&#39;re extremely ill. Homebound patients often have up to 12 or 13 problems, not just one.&quot;</p><p>And they&#39;re often invisible. These people could be living just down the block, and you&#39;d never know it. Many of them never leave their homes.</p><p>Miller&#39;s patients include a 55-year-old woman with ALS who can communicate only with her eyes, a 27-year-old former quarterback left quadriplegic and in a coma after surgery on an Achilles tendon, a 92-year-old woman cared for by her daughter, and a severely depressed man who lives alone.</p><p>After the Affordable Care Act took effect in 2014, Miller saw a spike in new patient requests after Medicare reimbursements increased for people who are disabled or 65 and older.</p><p>&quot;Now we can afford to see them and take care of them. Because they haven&#39;t had medical care, they have multiple medical needs and psychosocial needs,&quot; she says. &quot;It has given us access to a group of people, but more importantly, they have access to us.&quot;</p><p>But reimbursements declined in 2015 because of sequestration. And now Medicaid reimbursements rates are starting to fall as well.</p><p><em>Editor&#39;s note: This is an abbreviated version of a&nbsp;<a href="http://www.npr.org/2015/11/08/448406540/doctor-treats-homebound-patients-often-unseen-even-by-neighbors">story</a>&nbsp;that ran on Sunday, Nov. 8.</em></p><div class="image-insert-image "><a href="http://www.npr.org/2015/11/08/448406540/doctor-treats-homebound-patients-often-unseen-even-by-neighbors" target="_blank"><img alt="" class="image-original_image" src="http://www.wbez.org/system/files/styles/original_image/llo/insert-images/see-more-here_custom-d0f9b8fb9bd953bf8cf1f5b9bcb0a041dc792d31-s800-c85.jpg" style="height: 414px; width: 620px;" title="(Misha Friedman for NPR)" /></a></div></p> Wed, 11 Nov 2015 16:51:00 -0600 http://www.wbez.org/news/house-calls-homebound-make-comeback-113747 Obamacare fans out new apps, allies to persuade the uninsured http://www.wbez.org/news/obamacare-fans-out-new-apps-allies-persuade-uninsured-113577 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/health-enrollment_custom-1ed8caffa24ce8eed18e5730750ba946602accae-s800-c85.jpg" alt="" /><p><div id="res452910804" previewtitle="Aymara Marchante (from left) and Wiktor Garcia talked with Maria Elena Santa Coloma, an insurance adviser with UniVista Insurance, during February 2015 sign-ups for health plans in Miami, Fla."><div data-crop-type=""><img alt="Aymara Marchante (from left) and Wiktor Garcia talked with Maria Elena Santa Coloma, an insurance adviser with UniVista Insurance, during February 2015 sign-ups for health plans in Miami, Fla." src="http://media.npr.org/assets/img/2015/10/29/health-enrollment_custom-1ed8caffa24ce8eed18e5730750ba946602accae-s800-c85.jpg" style="height: 412px; width: 620px;" title="From left, Aymara Marchante and Wiktor Garcia talked with Maria Elena Santa Coloma, an insurance adviser with UniVista Insurance, during February 2015 sign-ups for health plans in Miami, Fla. (Joe Raedle/Getty Images)" /></div><div><div><p>Ten million people still don&#39;t have health insurance two years after the Affordable Care Act went into effect.</p></div></div></div><p>Some never bought a policy. But 20 percent went to the trouble of signing up on<a href="https://www.healthcare.gov/">HealthCare.gov</a>, or one of the state insurance exchanges, and even made payments. Then, those 2 million people let their insurance lapse.</p><p>NPR asked visitors to our Facebook page to&nbsp;<a href="https://www.facebook.com/NPR/photos/pb.10643211755.-2207520000.1446142660./10153909585316756/?type=3&amp;theater">tell us why</a>.</p><p>Many, like Laura Patterson, dropped their coverage when they got good news on the job front.</p><p>&quot;I was a seminary student working part time at a church and I needed health insurance,&quot; she says. &quot;I enrolled for the first half of the year in a plan that I knew, even if I just had a fairly minor accident, I wouldn&#39;t be able to pay all the bills. When I graduated from seminary and got a full-time job as a pastor, I had really great coverage through my church, so I dropped my ACA plan.&quot;</p><p>Others say they dropped their Obamacare health coverage because they found the plans too confusing, too expensive or not worth it.</p><p>Brendan Skwire tells NPR his insurance was too pricey. &quot;Basically, my premiums doubled when my income imploded,&quot; he says. &quot;I simply couldn&#39;t afford to pay the bill.&quot;</p><p>Several people say they were dropped from their health plan&#39;s rolls without warning. Elaine Marie was one of many who tell us they never knew their insurers were seeking more information from them.</p><p>&quot;I was dropped from my plan last year for &#39;not providing additional income information,&#39; &quot; Marie says. &quot;I check my mail regularly, and did not receive notice in the mail, or via email, or through the secure exchange system email.&quot;</p><p>Meanwhile, Vic Higgs of New York says the premiums and copays required in her current Obamacare plan are too expensive, relative to the small amount of medical care she uses each month. She plans to drop the plan in January.</p><p>&quot;I only visit two doctors a year, and only receive one monthly prescription that &mdash; prior to having insurance &mdash; cost me 80 bucks a month,&quot; Higgs writes. &quot;I think paying directly for the doctor visits and prescriptions is cheaper right now than having insurance.&quot;</p><p>As open enrollment begins this Sunday, these are some of the people Uncle Sam is going to try to re-enlist in the health care exchanges.</p><p>In the two years since the Affordable Care Act went into effect, most people eligible who actually wanted health insurance and could afford it have been enrolled.</p><p>The remaining patients who lack insurance will be harder to lure &mdash; and harder to keep, says&nbsp;<a href="http://www.hhs.gov/about/leadership/secretary/sylvia-mathews-burwell/index.html">Sylvia Burwell</a>, secretary of the department of health and human services.</p><p>Burwell says people in this group tend to be young, and live barely above the poverty line. About a third are members of minority groups, and most are men.</p><p>&quot;The remaining uninsured just get harder and harder to reach,&quot; says&nbsp;<a href="http://kff.org/person/larry-levitt/">Larry Levitt</a>, a health reform and insurance markets analyst at the Kaiser Family Foundation.</p><p>There&#39;s little information showing where people go when they leave the exchanges. A<a href="http://news.coveredca.com/2015/10/covered-california-surpasses-two.html">study</a>&nbsp;of the California market found only 15 percent quit and remained uninsured. Levitt says the national figures are probably about the same.</p><p>So what&#39;s the government to do? HHS is trying a variety of strategies.</p><p>The agency plans to use email,&nbsp;<a href="https://www.healthcare.gov/subscribe/">text messages</a>,&nbsp;<a href="https://www.facebook.com/Healthcare.gov/">Facebook</a>&nbsp;and online ads to convince the holdouts to get insurance. It&#39;s also launching some new Web tools that will allow people to&nbsp;<a href="https://www.healthcare.gov/lower-costs/">compare health plans</a>&nbsp;more easily and estimate their cost.</p><p>A new app lets consumers input details of their medical needs, including the names of doctors and medications, to find appropriate plans. The app also allows them to estimate how many visits they expect to have, and prescriptions they expect to use, as well as estimate how much they&#39;re going to spend out of pocket, beyond of their monthly premiums.</p><p>And for the first time, HHS will talk about penalties. People who don&#39;t buy a policy of some sort will face a&nbsp;<a href="https://www.healthcare.gov/fees-exemptions/fee-for-not-being-covered/">$695 charge</a>&nbsp;per adult at tax time next year.</p><p>The agency will get lots of help from private groups in enrolling patients this year. For example, the nonprofit group Enroll America has staff in 14 states and works with community organizations across the country.</p><p>&quot;We do a lot of work with faith leaders across the country,&quot; says&nbsp;<a href="https://www.enrollamerica.org/about-us/who-we-are/anne-filipic/">Anne Filipic</a>, the group&#39;s president. &quot;We work with community colleges and small business owners. We work with restaurant associations and taxi cab associations. Perhaps we&#39;ll go to church on Sunday, and we&#39;ll actually stand up in front of the congregation and share with them the information.&quot;</p><p>Enroll America will be offering its own&nbsp;<a href="https://www.enrollamerica.org/get-covered-america/get-covered-calculator/">Web app</a>&nbsp;to help with the comparison of health plans.</p><p>The hope is that extra clarity will reduce unexpected costs and help keep people like Dave Egbert and his partner Rich Davis motivated to get insured and stay that way.</p><p>Egbert, of Huron, S.D., also contacted NPR via Facebook. He says he and Davis each dropped their coverage because the fees for doctor visits and tests added up unexpectedly. They could pay the premiums, Egbert says, but the overall costs were too much.</p><p>&quot;I couldn&#39;t afford to actually&nbsp;use&nbsp;the health insurance,&quot; he says.\</p><p>&mdash; <a href="http://www.npr.org/sections/health-shots/2015/10/30/452909204/obamacare-deploys-new-apps-allies-to-convince-the-uninsured?ft=nprml&amp;f=452909204" target="_blank"><em>via NPR</em></a></p></p> Fri, 30 Oct 2015 14:38:00 -0500 http://www.wbez.org/news/obamacare-fans-out-new-apps-allies-persuade-uninsured-113577 Jeb Bush has a plan to replace Obamacare; here's what's in it http://www.wbez.org/news/jeb-bush-has-plan-replace-obamacare-heres-whats-it-113341 <p><div style="text-align: center;"><img alt="" src="http://www.wbez.org/system/files/styles/original_image/llo/insert-images/Jeb%20Bush%20is%20the%20latest%20Republican%20to%20offer%20an%20alternative%20to%20Obamacare..jpg" style="height: 465px; width: 620px;" title="Jeb Bush is the latest Republican to offer an alternative to Obamacare. (Sean Rayford/Getty Images)" /></div><div><p>Republicans in Congress and on the campaign trail call for an Obamacare repeal all the time. Plans to replace it are rarer, though. Obamacare is a fantastically complicated policy, and overhauling the health care system would likewise be a complicated business, affecting not only government spending and the economy, but people&#39;s very lives on an intensely personal level.</p><p>This week, presidential candidate and former Florida Gov. Jeb Bush released his own detailed proposal for repealing and replacing the Affordable Care Act. In a&nbsp;<a href="http://www.c-span.org/video/?328700-1/former-governor-jeb-bush-rfl-health-care-policy-address">speech</a>&nbsp;and an&nbsp;<a href="http://www.unionleader.com/article/20151013/OPINION02/151019793&amp;source=RSS">op-ed in the New Hampshire Union Leader</a>, Bush announced his plan is aimed at cutting health care costs. Here&#39;s what his plan would do.</p><p><strong>What are the basics of Bush&#39;s plan?</strong></p><p>Bush&#39;s speech and op-ed decry the &quot;skyrocketing premium costs&quot; he says Obamacare created and argue for giving more power to the states. With those as his major guiding principles, here are the highlights of his plan:</p><ul><li><p>Repeal Obamacare, providing its 17 million participants a &quot;transition plan&quot; away from the program.</p></li><li><p>Give people tax credits to buy catastrophic health care plans.</p></li><li><p>Replace the so-called &quot;Cadillac Tax,&quot; albeit with a&nbsp;<a href="http://www.nytimes.com/2015/10/14/upshot/jeb-bush-has-found-a-part-of-obamacare-to-love.html?rref=upshot">policy</a>&nbsp;similarly imposing higher taxes on expensive health plans.</p></li><li><p>Allow some businesses to contribute toward their workers&#39; health insurance, in lieu of providing that coverage themselves.</p></li><li><p>Eliminate the&nbsp;<a href="https://www.cms.gov/cciio/resources/data-resources/ehb.html">benefits</a>&nbsp;the ACA requires health plans to provide.</p></li><li><p>Increase the maximum amount that people can contribute to their health savings accounts from $3,350 to $6,650.</p></li><li><p>Cap federal health spending to states, creating what appears to be a&nbsp;<a href="http://www.vox.com/2014/7/25/5930699/block-grants-explained">block grant-like</a>Medicaid program.</p></li></ul><p><strong>Would it lower health care costs?</strong></p><p>Bush&#39;s plan would make it cheaper to buy your own insurance, says one expert, but there would be trade-offs &mdash; lower costs could mean fewer benefits.</p><p>&quot;I have no doubt that premiums in the individual market would be lower under Bush&#39;s plan, mainly because there would be less regulation of the benefits those plans have to offer,&quot; said Larry Leavitt, co-executive director of the Kaiser Family Foundation&#39;s Program for the Study of Health Reform and Private Insurance.</p><p>Bush&#39;s plan&nbsp;<a href="http://www.nytimes.com/2015/10/14/us/politics/jeb-bush-offers-health-plan-that-would-undo-affordable-care-act.html">gets rid of</a>&nbsp;the requirement that plans cover certain things (Obamacare&#39;s &quot;essential health benefits&quot;), like maternal care and mental health. Rather, it encourages so-called &quot;catastrophic&quot; health insurance plans &mdash; bare-bones plans that protect people in expensive emergency situations. Those plans tend to not only have lower premiums but also higher deductibles.</p><p>&quot;Bush emphasizes high-deductible plans and [health savings accounts] and wants to encourage those plans. High deductibles do discourage people from using services and lead to lower health spending overall,&quot; Leavitt said.</p><p>The plan also would relax Obamacare&#39;s guaranteed coverage for pre-existing conditions. Instead, it would only guarantee it for people with &quot;continuous coverage.&quot; Defenders say this would stop people from getting coverage only when they are sick, but detractors say this makes it too easy to not be covered, as financial hardship or employment changes can easily interrupt coverage. That provision could likewise lower costs by lowering the number of chronically ill people in risk pools.</p><p>Altogether, the plan looks like it could easily lower health care spending.</p><p>&quot;Do I believe that his plan will cost less than the current status quo under the Affordable Care Act? I believe the answer is yes,&quot; said Mark Fendrick, a professor at University of Michigan&#39;s medical school and public health school.</p><p>But there are a lot of &quot;buts&quot; to tack on here. For one, there&#39;s still a lot we don&#39;t know &mdash; for example, how much the plan might cut spending on low-income Americans&#39; health care, as well as how much those new tax credits would cost compared to what&#39;s in place right now.</p><p>Another thing to consider is where that cost-cutting comes from &mdash; is lower-cost health insurance always better, or is it at some point detrimental to customers?</p><p>&nbsp;</p><blockquote class="twitter-tweet" lang="en"><p dir="ltr" lang="en">Today in NH, I announced my plan to repeal &amp; replace Obamacare. Read about it here: <a href="http://t.co/E3JsN4Aqas">http://t.co/E3JsN4Aqas</a> <a href="http://t.co/6ymKRXI1Vs">pic.twitter.com/6ymKRXI1Vs</a></p>&mdash; Jeb Bush (@JebBush) <a href="https://twitter.com/JebBush/status/653959139153063936">October 13, 2015</a></blockquote><script async src="//platform.twitter.com/widgets.js" charset="utf-8"></script><p>&nbsp;</p><p>Bush&#39;s policies would curb cost growth to an extent, said Sabrina Corlette, senior research fellow at Georgetown&#39;s Health Policy Institute, but she added a caveat: &quot;I would note that they do so on the backs of consumers, rather than tackling some of the more thorny issues such as how we pay providers and suppliers.&quot;</p><p>Moreover, Fendrick said, focusing too intently on costs might be wrongheaded.</p><p>&quot;I did not go to medical school to learn how to save people money,&quot; he said. &quot;So when the first question always is whether we should save money on health care or not, that is largely irrelevant to the bigger question of whether this would make people healthier or not. ... My answer is probably not.&quot;</p><p><strong>OK, so would it make people healthier?</strong></p><p>The unsatisfying answer is that it&#39;s impossible to know. But here&#39;s what we do know: One thing is that the plan would remove Obamacare&#39;s mandate that people get coverage. Removing that, as well as requirements that businesses provide coverage, could easily leave many fewer people insured.</p><p>But does less coverage mean worse health? There&#39;s some evidence of this, but it&#39;s not entirely clear-cut.</p><p>One&nbsp;<a href="http://www.ncbi.nlm.nih.gov/pubmed/18815523">2008 meta-analysis</a>, for example, found that health care access increased self-reported health, the use of preventive services, and lowered mortality.</p><p>But a recent,&nbsp;<a href="http://www.nejm.org/doi/full/10.1056/NEJMsa1212321#t=articleResults">well-known study</a>&nbsp;of Medicaid in Oregon was more mixed &mdash; going on Medicaid was associated with lower rates of depression and better self-reported health (as well as increased financial stability) but no statistical difference in blood pressure or cholesterol. People sought out more diabetes treatment, but improvements in their health also weren&#39;t significant.</p><p>Meanwhile, higher-deductible plans seem to reduce health care usage, as a&nbsp;<a href="http://www.nber.org/papers/w21632?utm_campaign=ntw&amp;utm_medium=email&amp;utm_source=ntw">recent study</a>&nbsp;found. That might be good, in the sense that it might reduce unnecessary doctor visits, but it might reduce necessary ones as well.</p><p>That&#39;s a lot of information, so here&#39;s the upshot: Reasonable people could disagree on this. Leavitt, for his part, stressed that the link between insurance and outcomes is murky. Fendrick, meanwhile, thinks health outcomes would likely be worse under Bush&#39;s plan.</p><p>But here&#39;s one more important point: This question wouldn&#39;t even affect many Americans whose employers would simply continue providing coverage. Rather, Bush&#39;s plan would disproportionately affect lower-income people, according to several nonpartisan experts who spoke to NPR.</p><p>Aside from potentially cutting Medicaid benefits, the size of Bush&#39;s tax credits is adjusted based on age, not income, according to the New York Times.</p><p>&quot;This is not a wise path if one&#39;s priority is to protect Americans facing the greatest economic and health risks,&quot; said Harold Pollack, professor at the University of Chicago&#39;s School of Social Service Administration, in an email.</p><p><strong>What don&#39;t we know?</strong></p><p>Bush&#39;s plan does lay out a lot of information, but a few important parts aren&#39;t specifically explained. For example, it says there would be a &quot;transition plan&quot; for the 17 million people currently covered by Obamacare, but it doesn&#39;t explain what that plan looks like.</p><p>&quot;It would be a huge transition from Obamacare to a plan like this, which would be a huge disruption,&quot; Leavitt said. &quot;If this were to become a reality, there would be a lot more details required about how that transition would work.&quot;</p><p>There&#39;s also the cost. The Bush campaign says it believes the plan would reduce the deficit. But there aren&#39;t enough specifics here to really know what that might look like.</p><p>We do know that repealing Obamacare could be expensive. The Congressional Budget Office&nbsp;<a href="http://www.politico.com/story/2015/06/obamacare-repeal-congressional-budget-office-deficit-119228">estimated earlier this year</a>&nbsp;that repealing the Affordable Care Act would add $353 billion to the deficit. Bush&#39;s plan would mitigate some of these effects, like with his replacement for the Cadillac Tax, but it&#39;s unclear to what degree, as well as how the rest of his plan&#39;s costs and cost-cutting would balance out.</p><p><strong>What is Jeb Bush saying with this plan?</strong></p><p>Wanting to repeal Obamacare doesn&#39;t itself set Bush apart from other Republicans &mdash; calls for Obamacare repeal have been constant since the law passed in 2010.</p><blockquote class="twitter-tweet" lang="en"><p dir="ltr" lang="en">.<a href="https://twitter.com/HillaryClinton">@HillaryClinton</a>&nbsp;and&nbsp;<a href="https://twitter.com/BernieSanders">@BernieSanders</a>&nbsp;would double-down on Obamacare &amp; its failures. My plan:&nbsp;<a href="http://t.co/BZgQcM6YXE">http://t.co/BZgQcM6YXE</a>&nbsp;<a href="http://t.co/HVio8lkrQD">pic.twitter.com/HVio8lkrQD</a></p>&mdash; Jeb Bush (@JebBush)&nbsp;<a href="https://twitter.com/JebBush/status/654028797214371841">October 13, 2015</a></blockquote><p>But the plan does send a couple of political messages about Bush. One is in setting his priorities. Opponents may attack Bush for the plan&#39;s potential effects on lower-income Americans, but it does accomplish other, decidedly conservative economic goals.</p><p>&quot;It&#39;s important to see these replacements not as doing everything the ACA did but as fulfilling other policy aims: less regulation, cutting taxes and reducing federal spending,&quot; Leavitt said.</p><p>Moreover, Bush seems to be staking out a position as the substantive, policy-wonk GOP contender. His detailed repeal-and-replace plan, on top of his other recent tax and energy proposals, for example, could help cement that identity.</p></div><p>&mdash;<a href="http://www.npr.org/sections/itsallpolitics/2015/10/14/448570670/jeb-bush-has-a-plan-to-replace-obamacare-heres-whats-in-it"><em> via NPR</em></a></p></p> Wed, 14 Oct 2015 12:25:00 -0500 http://www.wbez.org/news/jeb-bush-has-plan-replace-obamacare-heres-whats-it-113341 The Supreme Court's new term: here's what to watch http://www.wbez.org/news/supreme-courts-new-term-heres-what-watch-113172 <p><p style="text-align: justify;">The United States Supreme Court opens a new term Monday, and, as always, many of the most contentious issues facing the country &mdash; including abortion, birth control coverage, public employee unions, affirmative action in higher education, voter participation &mdash; are likely to be before the court.</p><p style="text-align: justify;">But there is a difference this term. Chief Justice John Roberts, despite his overall conservative record on the bench, has become a punching bag for candidates vying for the Republican presidential nomination.</p><p style="text-align: justify;"><img alt="" class="image-original_image" src="http://www.wbez.org/system/files/styles/original_image/llo/insert-images/first%20three.JPG" style="height: 749px; width: 250px; margin-left: 10px; margin-right: 10px; float: right;" title="" />Presidential candidates have often criticized the court, pledging that they would appoint a different kind of justice. It&#39;s been more than a half century, though, since politicians have put a chief justice, by name, in the cross-hairs of criticism. What is puzzling about the Roberts critique is that the right hailed this George W. Bush appointee when he was named ten years ago, and Roberts has a consistently conservative record on most issues.</p><p style="text-align: justify;">He has voted with the court&#39;s conservatives to strike down most of the legal limits on campaign spending, opening election campaigns nationwide to a flood of new cash. He has consistently supported an individual&#39;s right to bear arms. He wrote the court&#39;s opinion in the 2013 case&nbsp;<em>Shelby County v. Holder</em>, which struck down the heart of the Voting Rights Act of 1965. He has consistently opposed any sort of racial preferences. Last term, he wrote the leading dissent when the court struck down state laws banning same-sex marriage.</p><p style="text-align: justify;">On only one flashpoint subject has he parted ways with some or all or the court&#39;s most conservative members: Obamacare.</p><p style="text-align: justify;">Yet, in the first two televised debates, Republican candidates took turns pummeling him, characterizing his nomination as a grave mistake, and suggesting that Roberts follows a political path rather than a legal one. If President George W. Bush had appointed someone more conservative than Roberts, said Sen. Ted Cruz, &quot;Obamacare would have been struck down three years ago, and the marriage laws of all fifty states would be on the books.&quot;</p><p><img alt="" class="image-original_image" src="http://www.wbez.org/system/files/styles/original_image/llo/insert-images/last2.JPG" style="text-align: justify; float: right; height: 495px; width: 250px; margin-left: 10px; margin-right: 10px;" title="" /></p><p style="text-align: justify;">Never mind that Roberts actually dissented in the same-sex marriage case.&nbsp;Jeb Bush, whose brother appointed Roberts, was less strident, but suggested nonetheless that Roberts was a &quot;politically expedient&quot; choice because he was a conservative whom the Senate could confirm. And Gov. Mike Huckabee said that he would require anyone he appointed to oppose all abortions and to see religious freedom as the first of all rights.</p><p style="text-align: justify;">Nobody thinks it will be easy for Chief Justice Roberts or the other justices to ignore such talk. But, the job of the chief justice is, among other things, to guard the independence of the judiciary and to preserve the court&#39;s institutional role as a dispassionate arbiter of the nation&#39;s laws and the Constitution.</p><p style="text-align: justify;">Notwithstanding the critique in the GOP debates, the Roberts court is most often a conservative court. But it is closely divided, and last term, for the first time in a decade, the court&#39;s liberals prevailed in the majority of 5-to-4 rulings. They did that by picking off not just Roberts and Justice Kennedy on Obamacare, and Kennedy on same-sex marriage, but other conservative justices in other cases.</p><p style="text-align: justify;">Most experts see those liberal victories, however, as a product of an idiosyncratic mix of cases. This term, the issues play much more to the strength of the court&#39;s conservatives. There are cases that could further cut back affirmative action in higher education, hobble or destroy public employee unions, and make it easier to limit voter participation in elections.</p><p style="text-align: justify;">There is a strong likelihood that the court will revisit the abortion question, as well as the issue of birth control coverage under Obamacare. &quot;The worry is, does what goes around come around,&quot; said Tom Goldstein, Supreme Court advocate and publisher of SCOTUSblog, &quot;and the writing on the wall sure seems to up there that has got the left scared &mdash; bejesus!&quot;</p><p style="text-align: justify;">The court, for instance, for the first time is being asked to determine the meaning of the one-person, one-vote principle in<em>&nbsp;Evenwel v. Abbott.</em> Does it mean that state legislative districts should have the same number of people, or the same number of eligible voters? Does the population count include children, non-citizen immigrants both in the country legally and illegally, and others like those with a criminal record who are thus ineligible to vote? Or does the population count include only those eligible to vote, or even just those registered to vote?</p><p style="text-align: justify;">Virtually all state and local governments currently draw districts based on total population. But if those challenging that practice prevail, it could dramatically shift political power away from districts with lots of children and immigrants, and it would likely give Republicans a big boost in state legislative elections.</p><p style="text-align: justify;">Also likely to come before the court are election cases involving strict voter ID laws and other provisions that make it more difficult to vote.</p><p style="text-align: justify;">The union case,&nbsp;<em>Friedrichs v. California Teachers Association</em>, could also have huge political consequences by crippling public employee unions and possibly all unions. The case pits the practical needs of collective bargaining against the First Amendment. The nation&#39;s labor laws, as the court has interpreted them since 1977, have struck the balance this way. Once a majority of public employees vote to be represented by a union, those who choose not to join do not have to pay for the union&#39;s political activities, but they do have to pay for contract negotiations that they benefit from.</p><p style="text-align: justify;">In short, they must pay their so-called &quot;fair share.&quot; Otherwise they would become free riders on the backs of those who do pay. In two recent cases, four justices, and possibly five, have suggested that requiring such fair share payments violates the nonmembers&#39; free speech rights.</p><p style="text-align: justify;">Waiting in the wings at the high court are two politically incendiary cases: one involving abortion, the other birth control under Obamacare. The abortion test case will likely come from Texas, where the Republican-controlled legislature enacted strict new regulations on abortion clinics, requiring them to make costly renovations, and limiting the ability of doctors to perform abortions. The state maintains that the new law was aimed at protecting the health and safety of women. Abortion providers, backed by major medical organizations, counter that the regulations are unnecessary and that the law is in fact aimed at making abortions difficult to obtain.</p><p style="text-align: justify;">The birth control case is a test of the Obamacare provision that exempts religious organizations from having to pay for birth control coverage in their health insurance plans. While churches, synagogues and the like are totally exempt, religiously affiliated organizations such as universities and hospitals are exempt only if they notify the federal government of their objections. That in turn triggers an independent mechanism to provide the coverage for those employees who want it. Some religious organizations contend that the notification requirement makes them complicit in facilitating birth control coverage and thus violates their religious principles.</p><p style="text-align: justify;">&mdash; <a href="http://www.npr.org/sections/itsallpolitics/2015/10/05/445885201/the-supreme-courts-new-term-heres-what-to-watch?ft=nprml&amp;f=445885201" target="_blank"><em>via NPR</em></a></p></p> Mon, 05 Oct 2015 09:47:00 -0500 http://www.wbez.org/news/supreme-courts-new-term-heres-what-watch-113172 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 Sen. Coats: Shutdown didn't work, but 'Obamacare' should still be delayed http://www.wbez.org/news/sen-coats-shutdown-didnt-work-obamacare-should-still-be-delayed-108997 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/coats.PNG" alt="" /><p><p>Republicans are still sorting through the aftermath of the government shutdown and debt ceiling standoff. While many in the GOP are taking their lumps, some are credited with helping to avoid a government default. One of them is U.S. Senator Dan Coats of Indiana.&nbsp;WBEZ&rsquo;s Michael Puente spoke to Senator Coats earlier today.&nbsp;</p></p> Wed, 23 Oct 2013 17:46:00 -0500 http://www.wbez.org/news/sen-coats-shutdown-didnt-work-obamacare-should-still-be-delayed-108997