Category: Affordable Care Act

Want a good laugh? Head to the hospital.

July 7, 2015

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

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

July 4, 2015

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)

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

June 25, 2015

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

Before 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

June 20, 2015

Volume 385, Issue 9986, 20 June 2015

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

June 20, 2015

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

January 5, 2015

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

November 15, 2014

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 ] …

Diabetes, obesity, and the Affordable Care Act

June 9, 2014

Diabetes & Endocrinology, 9 June 2014

Under the new health law, Americans with chronic disorders cannot be denied health insurance. Susan Jaﬀe reports from Washington, DC.

Before President Barack Obama’s landmark health law took effect, obtaining affordable health insurance could be difficult for Americans with diabetes or obesity, if not impossible. Insurers that didn’t turn diabetic patients away could charge higher rates because these individuals had a pre-existing health problem, or they could exclude coverage for certain treatments for diabetes or other chronic disorders. Now such practices are prohibited under the Patient Protection and Affordable Care Act (ACA)…but some insurers’ “bad habits” still linger. [MORE]…

Challenges loom for US health law as new insurance begins

May 2, 2014

Volume 383, Issue 9928, 3 May 2014

WORLD REPORT Millions of Americans met the mid-April extended deadline to enrol in coverage under the Affordable Care Act; now the real test of the law begins. Susan Jaﬀe reports from Washington, DC.

Just a few days after April’s extended enrolment deadline, President Barack Obama announced that some 8 million Americans had signed up for health insurance under his health-care law, exceeding the predictions dampened by a rocky rollout 6 months ago that prompted jokes on late-night talk shows, fuelled the opposition, and ultimately led to the resignation of his Health and Human Services secretary, Kathleen Sebelius, the nation’s top health official.

“The repeal debate is and should be over”, Obama proclaimed, referring to the 54 times Republicans in the US House of Representatives have voted to repeal or modify the law. “The Affordable Care Act [ACA] is working.”

But even the programme’s supporters say the next few months will be crucial to its success. [MORE] [PDF]…

The Affordable Care Act’s insurance programme takes effect

January 10, 2014

Volume 383, Issue 9912, 11 January 2014

WORLD REPORT Coverage kicked in for millions of Americans on Jan 1 under the Affordable Care Act while officials urged others to enrol before the 2014 sign-up deadline.Susan Jaﬀe reports from Washington, DC.

The Obama Administration faces what might be its most daunting challenge under the law: making sure an untested programme functions—will newly insured patients be able to get medical treatment or fill prescriptions?—while continuing to encourage people to sign up before the March 31 deadline for 2014 coverage, guaranteeing that the upgraded online sign up system keeps pace with demand, and fighting the latest lawsuit and political attack as the 2014 mid-term election campaign heats up. [MORE] [PDF]…

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By Susan Jaffe | November 1, 2013, 11:57 am

Older adults and their caregivers have complained for years that Medicare, which now covers 52 million Americans, does not provide dental benefits.
For some adults with Medicare, the online insurance exchanges created by the Affordable Care Act may offer an alternative. MORE

Dental Coverage on the Insurance Exchanges

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By Susan Jaffe | October 15, 2013 | Kaiser Health News produced in collaboration with

The seven-week enrollment period for next year’s Medicare prescription drug and managed-care plans begins Tuesday, but seniors shouldn’t simply renew their policies and assume the current coverage will stay the same. There’s a likely payoff for those who pay close attention to the details.[More in KHN] [More in USA Today]

Seniors Cautioned To Pay Close Attention To Details As Enrollment Begins In Medicare Plans

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By Susan Jaffe | October 11, 2013, 6:24 pm

Shirley Mierzejewski was “very upset” when she found out her Medicare health insurance premiums will nearly double next year.

“I cannot afford that, I cannot,” said Ms. Mierzejewski, 77, who lives in Euclid, Ohio, and works part time as a receptionist at a local college. She has a private Medicare Advantage policy from Anthem, which provides drug and medical coverage.

“So I started thinking about the marketplaces,” she said, referring to the online insurance exchanges created by the Affordable Care Act. “Maybe I could find something cheaper there.”

While thousands of Americans are trying to sign up for insurance on the exchanges, Medicare counselors like Semanthie

Brooks, who spoke at the meeting Monday in Euclid, are trying to steer seniors away. They worry that Ms. Mierzejewski and other older adults may not realize that Medicare is a pretty good deal compared to exchange policies and may try to buy one anyway.

…To clear up confusion in Montgomery County, Md., officials held meetings at six centers for the elderly. “They want to know if they are better off in the exchange than in Medicare,” said Leta Blank, director of the Montgomery County State Health Insurance Assistance Program. “Everyone is looking for a less expensive way to get health care.”

So in a year in which the insurance market is being turned upside down, here are some shopping tips for people with Medicare and caregivers. MORE

Q & A: Medicare and the Insurance Exchanges

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By Susan Jaffe | Sept.13, 2013 | KAISER HEALTH NEWS in collaboration with

After reassuring seniors that Medicare is not part of the new health insurance marketplaces, administration officials have a warning for anyone who may have other ideas: selling marketplace coverage to people who have Medicare is illegal.

Federal officials are eager to get the word out that seniors and disabled individuals enrolled in Medicare Part A — which covers hospitalization and limited nursing home care and is free for most beneficiaries – do not need to buy a marketplace plan, because they are already meeting the insurance requirements.

And no one needs to sell them one, either, according to information on a new “Medicare & the Marketplace” government webpage and in a “frequently asked questions” flyer officials recently distributed to Medicare counselors and other seniors advocates. MORE

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Susan Jaffe, Kaiser Health News produced in collaboration with

August 25, 2013 – While the Obama administration is stepping up efforts encouraging uninsured Americans to enroll in health coverage from the new online insurance marketplaces, officials are planning a campaign to convince millions of seniors to please stay away – don’t call and don’t sign up.

“You hear programs on the radio about the health care law and they never talk about seniors and what we are supposed to do,” said Barbara Bonner, 72, of Reston, Va. “Do we have to go sign up like they’re saying everyone else has to? Does the new law apply to us seniors at all and if so, how?” [More in KHN] [More in USA Today]

No Shopping Zone: Medicare Is Not Part Of New Insurance Marketplaces

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Volume 382, Issue 9892, 17 August 2013

WORLD REPORT Despite delaying some provisions of the Affordable Care Act, the US Government says it is on target to begin enrolling millions of Americans in the law’s new health coverage. Susan Jaﬀe reports.

Less than 7 weeks before millions of Americans begin enrolling in the new health insurance plans offered under President Barack Obama’s landmark Affordable Care Act (ACA), critics claim that his Administration isn’t ready and will preside over a monumental failure and a waste of taxpayer dollars.

…While federal officials continue to fend off Republican attacks on the law (unabated despite Obama’s re-election and the Supreme Court’s ruling upholding most of the law) they are also trying to complete work on the system needed to help Americans choose and enroll in an insurance plan and to determine their subsidy eligibility. …“Let me be clear”, US Health and Human Services (HHS) Secretary Kathleen Sebelius told reporters on Aug 5. “We are on target and ready to flip the switch on Oct 1.” [MORE] [PDF]

Obama Administration races to meet key ACA deadline

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By Susan Jaffe | June 28, 2013 | KAISER HEALTH NEWS

The Commission on Long-Term Care held its first meeting Thursday on Capitol Hill with some members acknowledging that their late start adds to their challenges in offering Congress recommendations on how to finance the expensive services for seniors and disabled Americans.

The panel is hobbled with a meager budget and staffing, and it is facing a three-month deadline for its report. Speakers at the meeting reminded the commission that the effort is daunting.

The commission heard a litany of statistics from four experts who explained how the nation’s growing population of seniors will become more dependent on long-term care services. But the rising cost of those services threatens to deplete individuals’ savings and add to the nation’s budget problems because of the expenses borne by Medicare and Medicaid. MORE

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By Susan Jaffe | June 21, 2013 | KAISER HEALTH NEWS in collaboration with

Within days, the company that handles an average of more than 60,000 calls daily about Medicare will be deluged by new inquiries about health insurance under the Affordable Care Act.

The six Medicare call centers run by Vangent, a company based in Arlington, Va., will answer questions about the health care law from the 34 states that opted out of running their own online health insurance marketplaces or decided to operate them jointly with the federal government.

The Department of Health and Human Services estimates that Vangent’s call centers will receive 42 million calls about the federal marketplaces this year, a daily average of up to 200,000; plus answer 2,400 letters and 740 e-mails, and host 500 Web chats daily. Customer service representatives will take consumers through the process — from shopping for a plan to enrolling.

Running the 800-Medicare call centers may provide valuable experience, but Vangent’s track record reveals that it was slow to adapt when changes in the Medicare program caused dramatic spikes in demand.

“It’s going to be huge,” said Bonnie Burns, a training and policy specialist at California Health Advocates. “The number of calls they are likely to get will probably dwarf anything they saw in Medicare.” MORE

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Volume 381, Issue 9882, Pages 1975 – 1976, 8 June 2013

WORLD REPORT Health and science agencies in the USA have been operating on reduced budgets, enforced by sequestration, for just over 3 months Susan Jaﬀe reports from Washington, DC.

The automatic budget cuts known as sequestration that the US Congress approved in 2011 were intended to be so onerous that they would never happen. Lawmakers would surely find a more reasonable way to save at least US$1·2 trillion over the next decade before the cuts would begin in 2013. Instead, Republicans and Democrats could not agree on an alternative, and the first wave of cuts, totalling $85 billion through to September, 2013, are phasing in for most non-defence US Government operations. Everything from White House tours to the most promising cancer research have been limited by a lack of funding.

..Many services provided by the US Department of Health and Human Services (HHS) are affected, including programmes at the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC), and medical research funded by the National Institutes of Health (NIH). Even the Affordable Care Act (ACA)—President Barack Obama’s landmark health reform law—will feel the impact, with supporters worried that enrolment for next year’s new health insurance coverage will have a difficult start in October. [FULL STORY AS PDF]

US sequester hits health and science programmes

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By Susan Jaffe | KAISER HEALTH NEWS | December 4th, 2012 , 5:30 a.m.

If young adults can’t afford health insurance policies available in 2014 under the health care law, state insurance officials are worried they won’t buy them. And that could drive up the cost of insurance for the mostly older, sicker people who do purchase coverage. MORE

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Volume 380, Issue 9855, Pages 1727 – 1728, 17 November 2012

WORLD REPORT Implementation of the Patient Protection and Aﬀordable Care Act is unlikely to run smoothly despite the Nov 6 election result. Susan Jaﬀe reports from Washington, DC.

Just 3 days after President Barack Obama’s re-election preserved his signature legislative achievement, the Patient Protection and Aﬀordable Care Act (ACA), his administration reset a deadline for states to take a crucial step toward implementing it. The delay in the wake of the health law’s dramatic aﬃrmation—ﬁrst by the US Supreme Court and then at the polls—is another reminder that the way forward may still encounter obstacles, even if the most serious threat was eliminated on Nov 6. [MORE] [PDF]

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Volume 380, Issue 9848, Pages 1133 – 1134, 29 September 2012

WORLD REPORT Comprehensive domestic health-care reform is one of the top defining issues in the campaign, overshadowing global health. Susan Jaffe reports from Washington, DC.

President Barack Obama and his rival Republican Mitt Romney would agree that the American health-care system is unsustainable, providing some of the world’s most expensive and yet fragmented care. But as they campaign for the presidency, the two candidates offer profoundly different solutions.

“The Affordable Care Act helps make sure you don’t have to worry about going broke just because one of your loved ones gets sick”, said Obama, describing his signature legislative achievement at a recent campaign stop in Colorado. “I don’t think a working mom in Denver should have to wait to get a mammogram just because money is tight”, he continued. “That’s why we passed this law. It was the right thing to do.” [more, as PDF]

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Volume 380, Issue 9846, 15 September 2012

WORLD REPORT Additional new health benefits for women began under the US Affordable Care Act last month, which experts hope will remain after the Nov 6 election. Susan Jaffe reports from Washington, DC.

Republican presidential candidate Mitt Romney promises to dismantle President Barack Obama’s landmark health-care reform law if elected. But as the presidential campaign progresses, various provisions of the law continue to kick into gear…. [more]
Panel: Abortion and the Aﬀordable Care Act

In the ﬁnal days of the congressional health reform debate, abortion coverage nearly derailed the legislation…. [more]

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MEDICARE TIP SHEET July 17, 2012 Published by Association of Health Care Journalists

Don’t look only to Washington policymakers for strategies to control medical costs and improve care for our aging population. New pilot projects that could accomplish these goals, which are at the heart of health reform, are being tested in communities across the country. In this tip sheet, reporter Susan Jaffe provides an overview of projects sponsored by the Center for Medicare and Medicaid Innovation, directs journalists to helpful resources and supplies an extensive list of potential story ideas. [access requires AHCJ membership or available on request here]

Latest Innovations in Medicare

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MEDSCAPE MEDICAL NEWS July 11, 2012

By Susan Jaffe

Washington, DC — As expected, the Republican-controlled US House of Representatives voted today 244 to 185, mostly along party lines, to repeal the Affordable Care Act (ACA) — for the 31st time. And once again, President Barack Obama promised to veto the legislation repealing his landmark health law should it reach his desk, which is unlikely, given the Democrat-controlled Senate. However, Republicans have several other strategies available to delay or block implementation of the law. MORE

Repeal Isn’t Only Way to Block Health Law, Says House GOP

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