Category: Affordable Care Act

The ACA after the expiry of the budget reconciliation

 Volume 390, Number  10104
 14 October 2017

WORLD REPORT    After the latest repeal bill was withdrawn and the budget reconciliation has expired, what does the future hold for the ACA?  Susan Jaffe, The Lancet’s Washington correspondent, reports.  

Republicans claim the ACA isn’t working and point to the rising cost of monthly premiums and the various counties across the USA where only one or two insurers offer coverage through the ACA’s online insurance marketplaces.… “[But] they’re not letting it fail, they’re making it fail,” said Stan Dorn, a senior fellow at Families USA, a consumer advocacy group that worked to help pass the ACA. [Continued here]…

High stakes for research in US 2018 budget negotiations

Volume 390, Number  10099
 9 September 2017

WORLD REPORT    As Congress considers how to fund the government next year, scientists hope spending for research will not be curtailed. Susan Jaffe, The Lancet’s Washington correspondent, reports.  

The dramatic defeat of the Republicans’ Affordable Care Act (ACA) repeal legislation still looms over the US Capitol as Congress reconvenes this month for more tough decisions, including many that will affect health and science research programmes.  …The prospects for science funding will depend on competing budget pressures and political fissures. “There are a lot of moving parts and a lot of uncertainty”, said Matt Hourihan, at the American Association for the Advancement of Science. “And while a spending deal [agreement] is certainly possible, it’s hard to see how they get there from here.” [Continued here]…

Counting On Medicaid To Avoid Life In A Nursing Home? That’s Now Up To Congress.

By Susan Jaffe | KAISER  HEALTH  NEWS | July 31, 2017 |This story also ran in 

Ten years ago, a driver ran a stop sign as Jim McIlroy rode into the intersection on his motorcycle. Serious injuries left McIlroy paralyzed from the chest down. But, after spending some time in a nursing home, he returned to his home near Bethel, Maine.

McIlroy does most of his own cooking since Maine’s Medicaid program paid for a stovetop that he can roll his wheelchair underneath to reach the food-prep area. His

Esther Ellis received a new mattress earlier this year from Partners in Care, a nonprofit that runs four of the dozens of sites in California’s Multipurpose Senior Services Program, a Medicaid-funded home services program. (Heidi de Marco/KHN)

new kitchen sink has the same feature. Wheelchair-friendly wood flooring has replaced McIlroy’s wall-to-wall carpeting.

The alterations plus a personal care aide — all paid for by Medicaid — enable McIlroy to stay in his house that he and his wife, who has since died, “worked really hard to own,” he said. The arrangement also saves Medicaid roughly two-thirds of what it would cost if he lived in a nursing home.

McIlroy depends on the federal-state program’s growing support of home-based care services — along with 2 million elderly or disabled Americans who rely on them to live at home for as long as possible.

However, that crucial help could face severe cuts if congressional Republicans eventually succeed in their push to sharply reduce federal Medicaid funds to states. [Continued at Kaiser Health News and USA Today] 

 

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Dismantling the ACA without help from Congress

Volume 390, Number 10093
29 July 2017

WORLD REPORT   If Congress doesn’t repeal the ACA, President Trump’s changes could go a long way to fulfil Republicans’ pledge to scrap it. Susan Jaffe, The Lancet’s Washington correspondent, reports.  [Continued  here]

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Feds To Waive Penalties For Some Who Signed Up Late For Medicare

By Susan Jaffe  | Kaiser Health News | June 6, 2017 | This KHN story also ran on     

[UPDATE: Since this article was published, Medicare officials extended the deadline for applying for an exemption to the Part B late enrollment penalty to Sept. 30, 2018. The announcement came in a fact sheet posted on Oct. 12, 2017.]

Each year, thousands of Americans miss their deadline to enroll in Medicare, and federal officials and consumer advocates worry that many of them mistakenly think they don’t need to sign up because they have purchased insurance on the health law’s marketplaces. That decision can leave them facing a lifetime of enrollment penalties.

Now Medicare has temporarily changed its rules to offer a reprieve from penalties for people who kept Affordable Care Act policies after becoming eligible for Medicare.

“Many of these individuals did not receive the information necessary [when they became eligible for Medicare or when they initially enrolled] in coverage through the marketplace to make an informed decision regarding” Medicare enrollment, said a Medicare spokesman, explaining the policy change.

Those who qualify include people 65 and older who have a marketplace plan or had one they lost or canceled, as well as people who have qualified for Medicare due to a disability but chose to use marketplace plans. They have until Sept. 30 to request a waiver of the usual penalty Medicare assesses when people delay signing up for Medicare’s Part B, which covers visits to the doctor and other outpatient care…

“This has been a problem from the beginning of the Affordable Care Act, because the government didn’t understand that people would not know when they needed to sign up for Medicare,” said Bonnie Burns, a consultant for California Health Advocates, a consumer group. “Once they had insurance, that relieved all the stress of not having coverage and then when they became eligible for Medicare, nobody told them to make that change.”[Continued at Kaiser Health News and NPR]…

US health-care groups voice concerns about replacing ACA

lancet cover 2Volume 389, Number  10071 

25  February 2017 

WORLD REPORT    Few details have emerged regarding a replacement for the US health law.  Susan Jaffe, The Lancet’s Washington correspondent, speaks to stakeholders about the problems they foresee. 

Less than 8 hours after Donald Trump took the oath of office as the 45th President of the USA, he signed an executive order reiterating a popular campaign promise: “It is the policy of my Administration to seek the prompt repeal of the Patient Protection and Affordable Care Act [ACA].”

Californians march against the repeal and replacement of the ACA, Feb 4, 2017 / Getty Images

Yet 5 weeks later, the Trump Administration and the Republican controlled Congress cannot agree on whether to repeal and replace it simultaneously—as the president desires—and what the replacement will be. Tom Price, Trump’s new Health and Human Services Secretary, assured senators during his nomination hearing last month that “nobody’s interested in pulling the rug out from under anybody. We believe that it’s absolutely imperative that individuals that have health coverage be able to keep health coverage…”

…The ACA’s uncertain future has rattled health insurers—initial 2018 policies are due as soon as April—and rippled through the health-care system to worried providers and patients. “Like everyone else, we are waiting for more information to be released by the Administration and Congress”, said Jan Emerson-Shea, a spokeswoman for the California Hospital Association, a state with more than 1·5 million patients enrolled in ACA insurance plans.  [Continued here] …

Biomedical research bill becomes law, but critics raise concerns over long-term implementation

Susan Jaffe | Washington Correspondent for The Lancet | 14 December 2016

The 21st Century Cures Act that President Barack Obama signed into law this week dedicates – but doesnthe-lancet-usa-blog-logo1‘t guarantee – billions of dollars to accelerating the discovery of new drugs and medical devices and getting them to patents more quickly, as well as supporting opioid addiction treatment and reforms in mental health care.

President Barack Obama signs the 21st Century Cures Act, Tuesday, Dec. 13, 2016. (Photo by Susan Jaffe)

The overwhelming support for the law marks a stark contrast from the Affordable Care Act, another landmark health reform bill Obama signed in the second year of his presidency.  Republicans promise to repeal it as soon as the new Congress convenes next month and Donald Trump is sworn in as president. But before the promised elimination of the ACA, Congress took nearly $5 billion from its Prevention and Public Health Fund to pay for most of the law.[Continued here.]

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Clinton versus Trump on health care

lancet cover 2Volume 388, Number  10057 

5  November 2016 

WORLD REPORT   The presidential candidates have different ideas about improving US health care.  Susan Jaffe, The Lancet’s Washington correspondent, reports.

The future of the Affordable Care Act, President Barack Obama’s signature health law, depends largely on the next occupant of the White House. Trump, the Republican candidate for president, wants to repeal and replace the law. Clinton, his Democratic opponent, wants to improve and expand it.  [Continued here] 

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Officials Warn Some Older Marketplace Customers To Switch To Medicare

By Susan Jaffe  | Kaiser Health News | October 14 2016 |  This KHN story also ran in 

Ever since the Affordable Care Act’s health insurance marketplaces opened for business in 2014, the Obama administration has worked hard to make sure Americans sign up. Yet officials now are telling some older people they might have too much insurance and they should cancehealthcare-gov-letterl their marketplace policies.

The federal Centers for Medicare & Medicaid Services is targeting two groups. First the agency is sending emails each month to about 15,000 people with subsidized marketplace coverage. The messages arrive a few weeks before their 6
5th birthday, which is also the age most people become eligible for Medicare. The email reminders will go to enrollees in the 38 states that use the federal marketplace.

“In most cases you won’t want to keep your Marketplace plan because once your Medicare coverage starts, you’ll no longer be eligible for any premium tax credits or other cost savings you may be getting for your Marketplace plan,” the notice says.  “To avoid an unwanted overlap in Marketplace and Medicare coverage … tell us you want to end your Marketplace plan.”

…Beneficiaries shoulder a lot of responsibility, even though there is no requirement they all be told what to do and when. Only the individual can terminate marketplace coverage when he or she becomes eligible for Medicare. Inaction means paying back any coverage subsidies received after they should have joined Medicare.  [Continued in  Kaiser Health News or The Washington Post]

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Democrats back Clinton, progressive platform at DNC in Philadelphia

Susan Jaffe | Washington Correspondent for The Lancet | 29 July 2016

Vermont Sen. Bernie Sanders stressed the need for unity when he addressed the convention on its first day, citing the Democratic party platform as evidence of the gains his supporters have achieved. “It is no secret that Hillary Clinton and I disagree on a number of issues … that’s what democracy is about,” Sanders told the convention. “But I am happy to tell you that at the Democratic Platform Committee, there was a significant coming together between the two campaigns and we produced, by far, the most progressive platform in the history of the Democratic Party.” [continued here] [listen to podcast here]…

Republican Party lays out platform for Election 2016

Susan Jaffe | Washington Correspondent for The Lancet | 15 July 2016

Cleveland, OH – The Republican Party’s platform committee approved a blueprint this week that reflects the core principles of its most conservative wing, describing how a Republican presidential candidate would govern if elected.

gop_platform_committee_071116

                                                                                           Photo:SUSAN JAFFE

Several delegates said they don’t expect the presumptive Republican presidential nominee, Donald Trump, to agree with every point and that’s OK.

“With Mr. Trump, on a lot of these issues, he’s with us,” said Melody Potter, a member of the Republican National Committee from Charleston, West Virginia. “We know for a fact that Hillary Clinton is not with us.”

…Reporters attending the platform committee meetings this week were not allowed to see copies of the roughly 50-page document delegates discussed. But some delegates were willing to mention some health care provisions.  [Continued]  …

US election: what are the candidates’ health-care pledges?

 lancet cover 2Volume 387, Number  10026 
2  April  2016 
WORLD REPORT    Democrats vying for their party’s presidential nomination have more detailed health-care plans than their Republican counterparts.  Susan Jaffe, The Lancet’s Washington correspondent, reports.

Billionaire real estate developer Donald Trump’s unorthodox campaign to become the Republican presidential nominee has dominated the 2016 political race, nearly overshadowing some unconventional contenders on the Democratic side.  The result is a political season that has defied the odds makers.

Former US Secretary of State and Senator from New York, Democrat Hillary Clinton may be well on her way to becoming the first woman in US history to win her party’s nomination for president. Vermont Senator Bernie Sanders, a self-proclaimed socialist, is trailing Clinton in the number of delegates needed to win the nomination. Yet his popular call for “a political revolution” continues to slowly raise his delegate count. [MORE]

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To Sell Medical Students On Joys Of Geriatrics, Send In 90-Year-Olds

By Susan Jaffe  | Kaiser Health News | September 23, 2015 | This KHN story also ran in     nprlogo_138x46

When doctors told Robert Madison that his wife had dementia, they didn’t explain very much. His successful career as an architect hardly prepared him for what came next.

Belle Likover, a 95-year-old retired social worker, told Case Western Reserve medical students that growing old gracefully is all about being able to adapt to one’s changing life situation, including health challenges. Lynn Ischay/Kaiser Health News

     “A week before she passed away her behavior was different, and I was angry because I thought she was deliberately not doing things,” Madison, now 92, told a group of nearly 200 students at Case Western Reserve School of Medicine in Cleveland. “You are knowledgeable in treating patients, but I’m the patient, too, and if someone had said she can’t control anything, I would have been better able to understand what was taking place.”
     Belle Likover recounted for the students how she insisted when her husband was dying of lymphoma that doctors in the hospital not make decisions without involving his oncologist. “When someone is in the hospital, they need an advocate with them at all times,” said Likover, who turns 96 next month. “But to expect that from families when they are in crisis is expecting too much. The medical profession has to address that.”
     Madison and Likover were among six people all over the age of 90 invited to talk to second-year medical students this month. The annual panel discussion, called “Life Over 90,” is aimed at nudging students toward choosing geriatric medicine, the primary care field that focuses on the elderly. It is among the lowest-paid specialties, and geriatricians must contend with complex cases that are time consuming and are often not reimbursed well by Medicare or private insurance. And their patients can have diseases that can only be managed but never cured   [Continued  at Kaiser Health News  and at NPR]
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USA gears up for next round of enrolment under the ACA

lancet cover 224 October  2015

WORLD REPORT    As enrolment begins for the Affordable Care Act’s health insurance, officials cut estimates of how many Americans will get coverage.  Susan Jaffe, The Lancet’s Washington correspondent,  reports.
The past 2 years of President Barack Obama’s landmark health insurance programme haven’lancet 102415t been easy—surviving two Supreme Court challenges, nearly done-in by embarrassing technical glitches, and more than 50 congressional votes attempting to dismantle it. But its troubles are not yet over: enrolling new beneficiaries “is going to be tougher than last year”, warned Health and Human Services (HHS) Secretary Sylvia Mathews Burwell.
Burwell and other Obama Administration officials are damping down enrolment expectations just days before the 3-month sign-up period for 2016 coverage begins on Nov 1.  [Continued here ]
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U.S. House of Representatives possibly “injured” by ACA spending, judge OKs lawsuit

 

The Lancet USA blog logo
 Susan Jaffe | Washington Correspondent for The Lancet | 15th September 2015      
                            lawsuit photo
A new threat to the Affordable Care Act emerged last week when a federal judge decided to allow an unusual lawsuit by Republicans in the U. S. House of Representatives against President Barack Obama, claiming that his Administration violated the U. S. Constitution by spending billions of dollars for the Affordable Care Act that Congress did not approve.  [Continued here]  House of Representatives 091515
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Congressional showdown threatens NIH funding boost

lancet cover 2Volume 386, Issue 9996,  29 August 2015

WORLD REPORT    Bills providing extra funding for the National Institutes of Health while cutting other programmes could a face presidential veto.  Susan Jaffe, The Lancet’s Washington correspondent,  reports.

After years of mostly stagnant funding for the US National Institutes of Health (NIH), two powerful congressional committees that control government spending have approved separate budget bills containing record increases for the agency.
But last month, President Barack Obama’s Office of Management and Budget director Shaun Donovan wrote to the chairman of the Senate Committee on Appropriations warning that he expects the president to veto its bill. Among other reasons, Donovan said it “drastically” cuts money for public health programmes including Medicare for the elderly and Medicaid, serving low-income Americans. And it would deny funds for operating the health insurance exchanges essential to the president’s signature health reform law, the Affordable Care Act. [Continued in full text or PDF ]
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50 Years of Medicare

lancet cover 2Volume 386, Issue 9992,  1 August 2015

WORLD REPORT    In July, 1965, Medicare, America’s landmark national health insurance programme, became law. Today, it covers 55 million people.  Susan Jaffe, The Lancet’s Washington correspondent,  reports.

LBJ Lancet 073015

An American woman thanks President Lyndon Johnson for Medicare, April, 1965.

Richard Troeh joined a very busy solo family medicine practice in 1966 but even with two doctors, their offi ce in Independence, Missouri, seemed just as hectic. The year before, President Lyndon Baines Johnson came to town to sign the Medicare legislation into law at the Truman library. Former President Harry Truman—an advocate of national health insurance since the 1940s—and his wife attended the event and were among the fi rst Americans to receive Medicare cards.
50 years later, the Social Security Amendments of 1965 provide health care for 55 million people older than 65 years or disabled receiving Medicare and nearly 73 million low-income adults, children, pregnant women, and people with disabilities receiving Medicaid, an optional programme also created under the same law.
And in the process, the government programmes have transformed health care in the USA. Medicare is the nation’s largest single purchaser of health care, consuming 14% of last year’s federal budget, or US$505 billion. And it also has a fiercely loyal following that opposes efforts to cut benefits. Speaking earlier this month at the White House Conference on Aging, President Barack Obama drew laughs when he said, “And now we’ve got [protest] signs saying, “Get your government hands off of my Medicare”. [Continued in full text or PDF ] [listen to podcast here]
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New Regulations Would Require Modernizing Nursing Home Care

By Susan Jaffe | July 13, 2015  | Kaiser Health News in collaboration with   nprlogo_138x46

After nearly 30 years, the Obama administration wants to modernize the rules nursing homes must follow to qualify for Medicare and Medicaid payments.

The hundreds of pages of proposed changes cover everything from meal times to use of antipsychotic drugs to staffing. Some are required by the Affordable Care Act and other recent federal laws, as well as the president’s executive order directing agencies to simplify regulations and minimize the costs of compliance.

“Today’s measures set high standards for quality and safety in nursing homes and long-term care facilities,” said Health and Human Services Secretary Sylvia M. Burwell. “When a family makes the decision for a loved one to be placed in a nursing home or long-term care facility, they need to know that their loved one’s health and safety are priorities.”

Officials announced the update as the White House Conference on Aging convenes Monday. The once-a-decade conclave sets the agenda for meeting the diverse needs of older Americans, including long-term care options. This month also marks the 50th anniversary of the Medicare and Medicaid programs, which cover almost 125 million older, disabled or low-income Americans. Medicare and Medicaid beneficiaries make up the majority of residents in the country’s more than 15,000 long-term care facilities. [MORE from Kaiser Health News and NPR]…

Want a good laugh? Head to the hospital.

By Susan Jaffe   KAISER HEALTH NEWS  | July 7, 2015 | This KHN story also ran in wapo

Every month, a group of older adults goes to Washington’s Sibley Memorial Hospital, but they don’t see a doctor or get tests. They’re not sick. They come just for laughs.

Joanne Philleo, 79, enjoys a joke at the monthly “Laugh Cafe” event at Sibley Memorial Hospital. (Amanda Voisard for The Washington Post)

They gather in a room next to the hospital cafeteria for the “Laugh Cafe,” one of the activities offered to local seniors, including the 7,300 members of Sibley’s Senior Association. The price of admission is one joke, recited out loud. Experts say laughing can be good for your health, and everyone in the room strongly agrees.

…The association for those age 50 or older also offers other activities, including French and Italian conversation classes, day trips to museums, a current events group, and — the latest addition — tango lessons. In addition, members receive discounts on hospital parking and at the gift shop, pharmacy and restaurant. In all, more than 10,000 seniors participate.

Sibley is one of several hospitals in the Washington area — along with others across the country — offering social activities and other benefits to help seniors stay healthy and out of the hospital, while encouraging them to visit. Participants do not need to have been patients.

But some experts are concerned that the activities are less about health than about marketing to Medicare beneficiaries, especially those who can go to the hospital of their choice when they need care because they are not enrolled in private insurance plans with limited provider networks.[Continued in Washington Post]…

US Supreme Court upholds ACA subsidies

lancet cover 2

Volume 385, Issue 9988, 4 July 2015

WORLD REPORT    Officials expect to launch the US President’s new health project later this year. But Congress has yet to decide whether to fully fund it. The Lancet’s Washington correspondent, Susan Jaffe, reports.

ACA supporters celebrate outside the Supreme Court following the judgment on June 25 (Bloomberg)

ACA supporters celebrate outside the Supreme Court following the judgment on June 25 (Bloomberg)

Although critics still deride it as Obamacare, President Barack Obama’s Supreme Court victory last week

enshrined the Affordable Care Act (ACA) as one of his greatest domestic accomplishments. The court might have also effectively disarmed the opposition, shifting the debate to next year’s campaign for the presidency as the next chance for critics to try to dismantle the law.

But for 6·4 million Americans who could have lost the health law’s insurance subsidies—the key issue before the court—the historic ruling has a different meaning. “Thank God, I can still get my medical care”, said Jacqueline Clay, a New Jersey woman receiving treatment for breast cancer who turned 61 years of age the day the court upheld the subsidies. “I am not going to die.” [Continued in full text or PDF ]…

When Turning 65, Consumers With Marketplace Plans Need To Be Vigilant In Choosing Health Coverage

By Susan Jaffe  | June 25, 2015 |  Kaiser Health News

BeforKHN logoe the Affordable Care Act, older adults who couldn’t afford to buy their own health insurance would count the days until their 65th birthday, when Medicare would kick in. Now, 10,000 Americans hit that milestone every day, but for some who have coverage through the ACA’s insurance marketplaces, Medicare may not be the obvious next step.

“Consumers eligible for Medicare can keep or renew their marketplace plan,” said Medicare spokesman Alper Ozinal, as long as they don’t also join Medicare. [Continued in Kaiser Health News]…

Planning for US Precision Medicine Initiative underway

lancet cover 2

Volume 385, Issue 9986, 20 June 2015

WORLD REPORT    Officials expect to launch the US President’s new health project later this year. But Congress has yet to decide whether to fully fund it. The Lancet’s Washington correspondent, Susan Jaffe, reports.

While continuing to defend his besieged health-care reform law against lawsuits and repeal threats, US President Barack Obama is championing a new health initiative. This one also has a bold goal: to radically change the medical treatment patients receive in the USA. “I want the country that eliminated polio and mapped the human genome to lead a new era of medicine—one that delivers the right treatment at the right time”, the President said when he unveiled his Precision Medicine Initiative (PMI) in his annual State of the Union address to the nation in January.  …Central to the PMI will be the creation of a research cohort of 1 million US volunteers who agree to provide researchers with biological, environmental, lifestyle, and other information as well as tissue samples….The effort to vastly expand the scope and practice of individually designed treatments based on genetic information could revolutionise medicine, supporters say. But the success of the PMI depends on whether Congress agrees to fund it.  [Continued in full text or PDF ] …

Obamacare, Private Medicare Plans Must Keep Updated Doctor Directories In 2016

By Susan Jaffe  | March 9, 2015 |  Kaiser Health News and also published in

Starting next year, the federal government will require health insurers to give millions of Americans enrolled in Medicare Advantage plans or in policies sold in the federally run health exchange up-to-date details about which doctors are in their plans and taking new patients.

Medicare Advantage plans and most exchange plans restrict coverage to a network of doctors, hospitals and other health care providers that can change during the year. Networks can also vary among plans offered by the same insurer. So it’s not always easy to figure out who’s in and who’s out, and many consumers have complained that their health coverage doesn’t amount to much if they can’t find doctors who accept their insurance. [More from KHN] [More in USA Today]

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Aging In Rural America

For older Americans, accessing high-quality care can be a challenge. For those in rural communities, it’s even harder.

By SUSAN JAFFE  Health Affairs January 2015 Volume 34, Number 1

Care in rural America: Dr. Robert Wergin goes over medications with Sharon Stutzman at the Milford Family Medical Center in rural Nebraska.

In the southeastern Nebraska town of Milford, population 2,100, Dr. Robert Wergin understands it’s not easy for some of his older patients to get to his office. Some may live on isolated farmsteads several miles out of town, and if they don’t drive, their son or daughter—if nearby—may have to take time off from work to bring them to their appointments because there’s no public transportation. Massive snowstorms are nothing special but still cause a wave of cancellations.

 

In addition to these challenges, rural America’s elderly tend to be poorer, have higher levels of chronic disease, and have a dwindling supply of health care providers, compared to their peers in urban communities, explains Brad Gibbens, deputy director of the University of North Dakota’s Center for Rural Health, in Grand Forks. And their support system is shrinking, as more young adults seeking job opportunities head out to urban areas. “The elderly [rural] population tends to stay put because that’s where they’ve lived all their lives, and there isn’t really an economic beacon that’s pulling them to another area,” he says. [Continued in Health Affairs, and PDF here]…

Second round of enrolment begins under Affordable Care Act

image Volume 384, Issue 9956, 15 November 2014 

WORLD REPORT Ahead of the next phase of enrolment for insurance plans, Republicans vowed to target the health law following their election win. Susan Jaffe, Washington correspondent, reports.

Federal health officials promise that last year’s embarrassing enrolment problems will not be repeated when the sign-up season begins on Nov 15 for 2015 health insurance policies offered under the Affordable Care Act (ACA). But even as more insurance companies and millions more Americans enter the second year of the health insurance programme, the opportunity for critics to chip away at it will never be better when Republicans regain control of Congress in January.

…Under the law, all adults are required to have health insurance and, with some exceptions, those without it are penalised. People who don’t get health coverage through their jobs can buy policies through the online state or federal insurance exchanges from Nov 15 to Feb 15. To minimise the delays many experienced last year, federal officials who run the exchanges in 37 states have shortened the application and no longer require shoppers to spend time setting up accounts before they can review the plans.

Although this month marks the second enrolment period, US Department of Health and Human Services (HHS) Secretary Sylvia Matthews Burwell has been eager to stress that it won’t be a rerun of last year. “It’s not year two”, she told reporters recently, because this is the first time the exchanges will be renewing current policies while also handling first-time applications. [MORE full text or PDF ] …