Thursday, October 31, 2013

For The Young And Healthy, Health Insurance Is A Hard Sell

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For The Young And Healthy, Health Insurance Is A Hard Sell

More From Shots - Health News HealthPolio Has Not Returned To South Sudan, After AllHealthToo Many Texts Can Hurt A Relationship, But <3 Always HelpsHealth CareFor The Young And Healthy, Health Insurance Is A Hard SellShots - Health NewsCongress Moves Closer To Changing Medicare Pay For Doctors

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Saturday, October 26, 2013

PR Experts: Obamacare Message (Not Just The Site) Needs Fix

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PR Experts: Obamacare Message (Not Just The Site) Needs Fix

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Friday, October 25, 2013

Clinics Close As Texas Abortion Fight Continues

Listen to the Story 5 min 42 sec Playlist Download Transcript   Enlarge image i

In July, abortion rights advocates marched in Austin, Texas, to protest legislation that could shut down all but five abortion clinics and restrict abortion rights throughout the state.

Tamir Kalifa/AP

In July, abortion rights advocates marched in Austin, Texas, to protest legislation that could shut down all but five abortion clinics and restrict abortion rights throughout the state.

Tamir Kalifa/AP

The fight over abortion in Texas is being played out in federal court, where abortion rights activists are challenging a new state law.

The measure bans abortions at 20 weeks, adds building requirements for clinics and places more rules on doctors who perform abortions. Some clinics have shut down, saying they can't comply with the law set to go into effect Oct. 29.

Abortion rights activists call the new law a dramatic change that will affect all clinics across the state, including a huge Planned Parenthood facility in Fort Worth that opened in June.

It's a $6.5 million center with three surgical suites and 19,000 square feet of space, built specifically to meet the building standards that activists saw coming.

"You know, we did not think the laws would come as quickly as they did," says Ken Lambrecht, president and CEO of Planned Parenthood of Greater Texas.

He says three nurses are required to be in the clinic when abortions are performed. The law also mandates the size of operating rooms, the type of ventilation systems and the width of the hallways.

"You could fit at least two gurneys in this hallway, and it's the size of many hospital corridors," he says. "And it's certainly not necessary for the procedure."

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Lambrecht says there's no medical basis for the new law. He thinks the law is intended to increase costs and shut down clinics, most of which do not meet the new building codes.

Abortion rights groups are challenging the law. At a hearing this week, the state's attorney argued that Texas has the right to regulate clinics and has an interest in protecting the rights of the unborn.

"If the woman chooses to proceed with the abortion, she should have the best care and best environment possible," says state Rep. Jodie Laubenberg, who sponsored the measure.

She says the law is designed to make abortions safer.

"Why would anyone argue against making it a better place and a better environment?" she asks. "If a clinic closes, that is their choice. We're not forcing anyone to close."

Laws like the one in Texas have passed in more than a dozen states. As a result, clinics have closed in states from Virginia to Ohio, and in Texas.

Another provision threatening to close clinics requires doctors to have admitting privileges at a hospital within 30 miles of a facility.

But hospitals do not have to grant admitting privileges. Some say doctors must live in the local community. Others require them to admit a certain number of patients. Some don't approve of abortion.

The doctor in Fort Worth does have privileges, but the hospital is too far from the clinic. That means the brand new Planned Parenthood center there would also have to stop performing abortions.

Across the vast Texas plains, more than 300 miles from Fort Worth, is the city of Lubbock, in the northwest part of the state. It's just an hour from the New Mexico border, and it's home to a much smaller Planned Parenthood clinic. The facility recently stopped scheduling appointments.

Annie Jones recently had an abortion. She's a single mother working and going to school in Lubbock, and she has a 2-year-old daughter, Molly.

Jones, who is 28, says she decided to have an abortion because it was best for her family.

"I knew that if I decided to have the second child, I would be doing it a disservice," she says. "I'd be doing my daughter a disservice because I wouldn't be able to care for them in the way that they deserved."

At least three Texas clinics have closed since the law passed, and Jones is worried that this center could close, too.

"I think that the people who are passing the bills ... are trying to legislate morality, and they see abortion as wrong," she says.

For abortion opponents, passing the measure after a filibuster was a big victory. When Republican Gov. Rick Perry signed the bill, he said it would further what he called "the culture of life in Texas."

"It is our responsibility and duty to give voice to the unborn � the individuals whose survival is at stake," Perry said.

But abortion rights activists say the right to an abortion was decided 40 years ago.

Angela Martinez, director of the Lubbock clinic, says if her facility closes, women seeking abortions would have to travel more than 300 miles.

"We are the only clinic in West Texas who sees patients and performs abortions," Martinez says. "It's frustrating for me. It's frustrating for my staff, just because ... we want to be available."

Just outside the clinic on a recent crisp morning, a few protesters stand holding signs. Krysten Haga says she sees the law as a first step, not as the end of this debate.

"I'd like to see abortion completely banned in the United States," Haga says. "That's ideally what we're looking for � is for abortion to not be an option at all."

A federal judge is expected to rule soon whether part of the new Texas law will go into effect next week.

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Administration: A Month Needed To Fix Obamacare Enrollment Site

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Administration: A Month Needed To Fix Obamacare Enrollment Site

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Pennsylvania Governor Talks Up Plan To Expand Medicaid His Way

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Wednesday, October 23, 2013

FDA Asks Dog Owners For Help With Illnesses Linked To Jerky

More From Shots - Health News HealthA Toddler Remains HIV-Free, Raising Hope For Babies WorldwideHealthWhy Postponing Insurance Mandate Is No Easy Fix For ObamacareHealthFDA Asks Dog Owners For Help With Illnesses Linked To JerkyHealth CareStates' Refusal To Expand Medicaid May Leave Millions Uninsured

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Tuesday, October 22, 2013

Online Insurance Brokers Stymied Selling Obamacare Policies

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Monday, October 21, 2013

5 Questions Kathleen Sebelius Must Answer

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If A Tech Company Had Built The Federal Health Care Website

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Friday, October 18, 2013

Why Scientists Are Trying Viruses To Beat Back Bacteria

More From Shots - Health News HealthWhy Scientists Are Trying Viruses To Beat Back BacteriaHealthTo Prevent HIV Infection, Couples Try Testing Together HealthPainkiller Overdose Deaths Strike New York City's Middle ClassHealthHow The GOP's Shutdown Over Obamacare Fell Short

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Obamacare Fight Leads Sen. Roberts To Turn Against Old Friend Sebelius

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Wednesday, October 16, 2013

To Reduce Patient Falls, Hospitals Try Alarms, More Nurses

More From Shots - Health News HealthFamily Caregiving Can Be Stressful, Rewarding And Life-AffirmingHealth CareTo Reduce Patient Falls, Hospitals Try Alarms, More NursesHealthHitches On Health Exchanges Hinder Launch Of Insurance Co-opHealthBioethicists Give Hollywood's Films A Reality Check

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Friday, October 11, 2013

FAQ: Where Medicaid's Reach Has Expanded — And Where It Hasn't

This is one of several explainers to help consumers navigate their health insurance choices under the Affordable Care Act, or as some call it, Obamacare. Click here for answers to other common questions. Have a question we missed? Send it to health@npr.org. We may use it in a future on-air or online segment.

Could I be eligible for Medicaid now?

The Affordable Care Act greatly expanded the number of people who qualify for Medicaid, the state-run health insurance program for people with low incomes. Previously, it was difficult for anyone other than pregnant women, parents and children to qualify. The law expands eligibility in ways that will allow many more people, including single and childless men or women, to qualify.

How do I know if I'm eligible for Medicaid?

The law extends eligibility to all adults under the age of 65 whose modified adjusted gross incomes fall below just under $16,000 for individuals and $32,500 for a family of four.

In states that decided not to participate in the Medicaid expansion, the rules are different and vary from state to state. About half of the states opted out of the Medicaid expansion, which is something that the U.S. Supreme Court gave them permission to do. In those states, the income cutoff to be eligible for Medicaid is generally much lower than what was set in the Affordable Care Act, so fewer people will qualify. And if you're a childless adult, you're most likely not eligible in states that rejected the Medicaid expansion.

To find out the income cutoff in your state, check out the tables here.

Or, just try signing up for coverage at your health insurance exchange. The exchange will calculate if you are eligible for Medicaid in your state, and if you are, direct you to the proper state agency to get signed up. (Click here for our FAQ on how to navigate the exchanges).

How do I know if my state has expanded Medicaid?

The following states have said yes to the Medicaid expansion:

Arizona, Arkansas, California, Colorado, Connecticut, Delaware, D.C., Hawaii, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Dakota, Oregon, Rhode Island, Vermont, Washington, West Virginia

The following states have said no to the Medicaid expansion or not yet decided:

Alabama, Alaska, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, Wyoming

This list is current as of Sept. 30, 2013. Check here for updates.

What if my state didn't expand Medicaid?

If your income is too high to qualify for Medicaid under your state's rules, you can still try enrolling at an insurance exchange. You may not qualify for subsidies, though. The subsidies are for people whose income falls between 100 percent of the federal poverty level ($11,490 for an individual) and 400 percent ($45,960).

If you make too much to qualify for Medicaid but too little to qualify for subsidies on the exchange, then you are exempted from the new mandate to carry health insurance. (See our FAQ on the individual mandate here.)

If that's your situation � you're poor and still have no health insurance � you can still seek health care with other safety net providers, such as federal community health centers and free clinics run by local nonprofits.

See other Frequently Asked Questions on the Affordable Care Act:

Understanding The Health Insurance Mandate And Penalties For Going Uninsured All About Health Insurance Exchanges And How To Shop At Them A Young Adult's Guide To New Health Insurance Choices What Retirees And Seniors Need To Know About The Affordable Care Act How Obamacare Affects Employers and How They're Responding

Additional coverage from NPR Member Stations:

California (KQED, San Francisco) California (KPCC) California (KXJZ Capital Public Radio, Sacramento) Colorado (Colorado Public Radio) Massachusetts (WBUR, Boston) Minnesota (Minnesota Public Radio) Georgia (WABE, Atlanta) New York (WNYC) Oregon (Oregon Public Broadcasting) Pennsylvania (WHYY newsworks.org) Texas (KUHF) Texas (KUT, San Antonio)

This FAQ was produced through a collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente.

Share Facebook Twitter Google+ Email Comment More From The Affordable Care Act, Explained HealthFAQ: Where Medicaid's Reach Has Expanded � And Where It Hasn'tHealthFAQ: How Obamacare Affects Employers And How They're RespondingHealthFAQ: What Retirees And Seniors Need To Know About The Affordable Care ActHealthFAQ: A Young Adult's Guide To New Health Insurance Choices

More From The Affordable Care Act, Explained

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FAQ: Where Medicaid's Reach Has Expanded — And Where It Hasn't

This is one of several explainers to help consumers navigate their health insurance choices under the Affordable Care Act, or as some call it, Obamacare. Click here for answers to other common questions. Have a question we missed? Send it to health@npr.org. We may use it in a future on-air or online segment.

Could I be eligible for Medicaid now?

The Affordable Care Act greatly expanded the number of people who qualify for Medicaid, the state-run health insurance program for people with low incomes. Previously, it was difficult for anyone other than pregnant women, parents and children to qualify. The law expands eligibility in ways that will allow many more people, including single and childless men or women, to qualify.

How do I know if I'm eligible for Medicaid?

The law extends eligibility to all adults under the age of 65 whose modified adjusted gross incomes fall below just under $16,000 for individuals and $32,500 for a family of four.

In states that decided not to participate in the Medicaid expansion, the rules are different and vary from state to state. About half of the states opted out of the Medicaid expansion, which is something that the U.S. Supreme Court gave them permission to do. In those states, the income cutoff to be eligible for Medicaid is generally much lower than what was set in the Affordable Care Act, so fewer people will qualify. And if you're a childless adult, you're most likely not eligible in states that rejected the Medicaid expansion.

To find out the income cutoff in your state, check out the tables here.

Or, just try signing up for coverage at your health insurance exchange. The exchange will calculate if you are eligible for Medicaid in your state, and if you are, direct you to the proper state agency to get signed up. (Click here for our FAQ on how to navigate the exchanges).

How do I know if my state has expanded Medicaid?

The following states have said yes to the Medicaid expansion:

Arizona, Arkansas, California, Colorado, Connecticut, Delaware, D.C., Hawaii, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Dakota, Oregon, Rhode Island, Vermont, Washington, West Virginia

The following states have said no to the Medicaid expansion or not yet decided:

Alabama, Alaska, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, Wyoming

This list is current as of Sept. 30, 2013. Check here for updates.

What if my state didn't expand Medicaid?

If your income is too high to qualify for Medicaid under your state's rules, you can still try enrolling at an insurance exchange. You may not qualify for subsidies, though. The subsidies are for people whose income falls between 100 percent of the federal poverty level ($11,490 for an individual) and 400 percent ($45,960).

If you make too much to qualify for Medicaid but too little to qualify for subsidies on the exchange, then you are exempted from the new mandate to carry health insurance. (See our FAQ on the individual mandate here.)

If that's your situation � you're poor and still have no health insurance � you can still seek health care with other safety net providers, such as federal community health centers and free clinics run by local nonprofits.

See other Frequently Asked Questions on the Affordable Care Act:

Understanding The Health Insurance Mandate And Penalties For Going Uninsured All About Health Insurance Exchanges And How To Shop At Them A Young Adult's Guide To New Health Insurance Choices What Retirees And Seniors Need To Know About The Affordable Care Act How Obamacare Affects Employers and How They're Responding

Additional coverage from NPR Member Stations:

California (KQED, San Francisco) California (KPCC) California (KXJZ Capital Public Radio, Sacramento) Colorado (Colorado Public Radio) Massachusetts (WBUR, Boston) Minnesota (Minnesota Public Radio) Georgia (WABE, Atlanta) New York (WNYC) Oregon (Oregon Public Broadcasting) Pennsylvania (WHYY newsworks.org) Texas (KUHF) Texas (KUT, San Antonio)

This FAQ was produced through a collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente.

Share Facebook Twitter Google+ Email Comment More From The Affordable Care Act, Explained HealthFAQ: Where Medicaid's Reach Has Expanded � And Where It Hasn'tHealthFAQ: How Obamacare Affects Employers And How They're RespondingHealthFAQ: What Retirees And Seniors Need To Know About The Affordable Care ActHealthFAQ: A Young Adult's Guide To New Health Insurance Choices

More From The Affordable Care Act, Explained

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FAQ: Understanding The Health Insurance Mandate And Penalties For Going Uninsured

This is one of several explainers to help consumers navigate their health insurance choices under the Affordable Care Act, or as some call it, Obamacare. Click here for answers to other common questions. Have a question we missed? Send it to health@npr.org. We may use it in a future on-air or online segment.

So I have to carry health insurance?

Yes, just about everyone is required to have insurance as of Jan. 1, 2014, or else they'll be liable for a tax penalty. That coverage can be supplied through your job (including COBRA or a retirement plan), public programs such as Medicare, Medicaid or the VA, or an individual policy that you purchase.

What is the penalty for not having health insurance?

The penalty for not having health insurance, at least for 2014, is up to $95 per adult and $47.50 per child or 1 percent of your taxable income � whichever is greater. It does go up substantially in a couple of years, eventually to a maximum of 2.5 percent of taxable income. The amount you owe will be pro-rated to reflect the number of months you were without coverage.

If you owe the penalty, it is assessed on your 2014 income tax form that's due April 15, 2015. And that's how the government finds you � it asks on your income tax form if you had health insurance. People who have it will get some sort of certificate of coverage from their health insurers. If your income is so low that you do not file a tax return, you are exempt from paying the penalty.

Can I go to jail if I don't have health insurance?

No, you can't go to jail for not paying the penalty; the government can't even garnish your wages. The most the IRS can do is withhold your tax refund.

What if I don't have health insurance and I get sick or have to go to the emergency room?

If you don't have insurance, you'll get a bill, just as it's always been. If you can't pay, the hospital or other health care provider will still try to collect from you, although there are some provisions of the law aimed at discouraging some of the most aggressive collection tactics that have been used in the past. If they don't collect, the health care provider would have to eat the cost. That's why hospitals were so anxious to have most people covered by insurance, so they could stop having to provide so much free care to people who couldn't pay.

Can I wait until I get sick to sign up for insurance?

No. You can't just sign up when you're sick and facing big medical bills. Otherwise that's what everyone would do. The exchanges under the Affordable Care Act have been designed pretty much the same way most employer insurance plans are: There's an open season every year when you can buy or change plans, and that's generally the only time you can buy or change plans. This year's open season is a lengthy one � it runs from Oct. 1 to March 31, 2014. In future years it will begin in October and end in December of each year.

Is there anybody who doesn't have to have insurance?

Yes, the government has identified exemptions. Individuals who cannot afford coverage because the cost of premiums exceed 8 percent of their household income or those whose household incomes are below the minimum threshold for filing a tax return are exempt. People experiencing certain hardships, including those who would have been eligible for Medicaid under the health law's new rules but whose states chose not to expand their programs, also are exempt.

Other exempt groups include prisoners, Native Americans eligible for care through the Indian Health Service, immigrants who are in the country illegally, people whose religion objects to having insurance coverage, members of a health care sharing ministry and individuals who experience a short coverage gap of less than three consecutive months.

If you are seeking an exemption for incarceration, membership in an Indian tribe or health care sharing ministry, you can apply through the health insurance exchanges or make a claim when you file taxes. If you are claiming economic hardship or a religious exemption, you must get an exemption certificate from the online insurance exchange. If you are claiming that coverage is unaffordable, that you are in the United States without proper documentation or that you have a coverage gap of less than three months, you can make the claim when you file your 2014 taxes in 2015.

See other Frequently Asked Questions on the Affordable Care Act:

All About Health Insurance Exchanges And How To Shop At Them A Young Adult's Guide To New Health Insurance Choices What Retirees And Seniors Need To Know About The Affordable Care Act How Obamacare Affects Employers And How They're Responding Where Medicaid's Reach Has Expanded � And Where It Hasn't

Additional coverage from NPR Member Stations:

California (KQED, San Francisco) California (KPCC) California (KXJZ Capital Public Radio, Sacramento) Colorado (Colorado Public Radio) Massachusetts (WBUR, Boston) Minnesota (Minnesota Public Radio) Georgia (WABE, Atlanta) New York (WNYC) Oregon (Oregon Public Broadcasting) Pennsylvania (WHYY newsworks.org) Texas (KUHF) Texas (KUT, San Antonio)

This FAQ was produced through a collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente.

Share Facebook Twitter Google+ Email Comment More From The Affordable Care Act, Explained HealthFAQ: Where Medicaid's Reach Has Expanded � And Where It Hasn'tHealthFAQ: How Obamacare Affects Employers And How They're RespondingHealthFAQ: What Retirees And Seniors Need To Know About The Affordable Care ActHealthFAQ: A Young Adult's Guide To New Health Insurance Choices

More From The Affordable Care Act, Explained

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FAQ: Understanding The Health Insurance Mandate And Penalties For Going Uninsured

This is one of several explainers to help consumers navigate their health insurance choices under the Affordable Care Act, or as some call it, Obamacare. Click here for answers to other common questions. Have a question we missed? Send it to health@npr.org. We may use it in a future on-air or online segment.

So I have to carry health insurance?

Yes, just about everyone is required to have insurance as of Jan. 1, 2014, or else they'll be liable for a tax penalty. That coverage can be supplied through your job (including COBRA or a retirement plan), public programs such as Medicare, Medicaid or the VA, or an individual policy that you purchase.

What is the penalty for not having health insurance?

The penalty for not having health insurance, at least for 2014, is up to $95 per adult and $47.50 per child or 1 percent of your taxable income � whichever is greater. It does go up substantially in a couple of years, eventually to a maximum of 2.5 percent of taxable income. The amount you owe will be pro-rated to reflect the number of months you were without coverage.

If you owe the penalty, it is assessed on your 2014 income tax form that's due April 15, 2015. And that's how the government finds you � it asks on your income tax form if you had health insurance. People who have it will get some sort of certificate of coverage from their health insurers. If your income is so low that you do not file a tax return, you are exempt from paying the penalty.

Can I go to jail if I don't have health insurance?

No, you can't go to jail for not paying the penalty; the government can't even garnish your wages. The most the IRS can do is withhold your tax refund.

What if I don't have health insurance and I get sick or have to go to the emergency room?

If you don't have insurance, you'll get a bill, just as it's always been. If you can't pay, the hospital or other health care provider will still try to collect from you, although there are some provisions of the law aimed at discouraging some of the most aggressive collection tactics that have been used in the past. If they don't collect, the health care provider would have to eat the cost. That's why hospitals were so anxious to have most people covered by insurance, so they could stop having to provide so much free care to people who couldn't pay.

Can I wait until I get sick to sign up for insurance?

No. You can't just sign up when you're sick and facing big medical bills. Otherwise that's what everyone would do. The exchanges under the Affordable Care Act have been designed pretty much the same way most employer insurance plans are: There's an open season every year when you can buy or change plans, and that's generally the only time you can buy or change plans. This year's open season is a lengthy one � it runs from Oct. 1 to March 31, 2014. In future years it will begin in October and end in December of each year.

Is there anybody who doesn't have to have insurance?

Yes, the government has identified exemptions. Individuals who cannot afford coverage because the cost of premiums exceed 8 percent of their household income or those whose household incomes are below the minimum threshold for filing a tax return are exempt. People experiencing certain hardships, including those who would have been eligible for Medicaid under the health law's new rules but whose states chose not to expand their programs, also are exempt.

Other exempt groups include prisoners, Native Americans eligible for care through the Indian Health Service, immigrants who are in the country illegally, people whose religion objects to having insurance coverage, members of a health care sharing ministry and individuals who experience a short coverage gap of less than three consecutive months.

If you are seeking an exemption for incarceration, membership in an Indian tribe or health care sharing ministry, you can apply through the health insurance exchanges or make a claim when you file taxes. If you are claiming economic hardship or a religious exemption, you must get an exemption certificate from the online insurance exchange. If you are claiming that coverage is unaffordable, that you are in the United States without proper documentation or that you have a coverage gap of less than three months, you can make the claim when you file your 2014 taxes in 2015.

See other Frequently Asked Questions on the Affordable Care Act:

All About Health Insurance Exchanges And How To Shop At Them A Young Adult's Guide To New Health Insurance Choices What Retirees And Seniors Need To Know About The Affordable Care Act How Obamacare Affects Employers And How They're Responding Where Medicaid's Reach Has Expanded � And Where It Hasn't

Additional coverage from NPR Member Stations:

California (KQED, San Francisco) California (KPCC) California (KXJZ Capital Public Radio, Sacramento) Colorado (Colorado Public Radio) Massachusetts (WBUR, Boston) Minnesota (Minnesota Public Radio) Georgia (WABE, Atlanta) New York (WNYC) Oregon (Oregon Public Broadcasting) Pennsylvania (WHYY newsworks.org) Texas (KUHF) Texas (KUT, San Antonio)

This FAQ was produced through a collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente.

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Tuesday, October 8, 2013

Houston Gears Up For Obamacare, Despite GOP Opposition

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Medicaid Looks Good To A Former Young Invincible

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The Religious Alternative To Obamacare's Individual Mandate

Listen to the Story 7 min 43 sec Playlist Download Transcript   Private Vs. Public Health Care Options

No matter what happens in Congress, the Affordable Care Act deadlines are still in effect. On Tuesday, public exchanges will open for business. Already, several companies are making changes to how they provide health care to their employees.

Host Arun Rath speaks with NPR's Julie Rovner about those changes and the difference between public and private options. You can hear their conversation � and the full story on the health care sharing ministries � at the audio at the top of the page.

The Affordable Care Act requires nearly every American to have health insurance or pay a penalty, beginning Jan. 1. The so-called "individual mandate" has been controversial ever since the law was passed.

But for people who fall into a few select categories, the mandate doesn't apply. Like Native Americans who get health coverage through the Indian Health Service, or people who are incarcerated.

Another exception is for members of "health care sharing ministries," a way for individuals with a "common set of ethical or religious beliefs" to share medical bills.

Sharing Health Burdens

The sharing ministries are not insurance: there's no guarantee that a given bill will be covered. Instead, it's like a co-op, where members decide what procedures to cover, and then all pitch in to cover the cost as group.

"It's a group of people, in this case Christians, who band together and agree that they want to share one another's burdens," says Andrea Miller, medical director for the largest Christian health-insurance alternative, Medi-Share.

She says members put aside a certain amount of money every month, which then goes to other Christians who need help paying their medical bills. Medi-Share's monthly fees vary, but its website advertises that family options "average less than $300 a month."

There are a few requirements to fulfill before participating, Miller says. The first is that you have to be Christian. "Second, you need to agree to living a Christian lifestyle, including no smoking, including not abusing alcohol or drugs," she says.

To constitute as a health care sharing ministry � and therefore be exempt from the Affordable Care Act requirements � the nonprofit has to have been in existence since 1999 (Medi-Share has existed since '93). The ministries also have an independent accounting firm conduct a publicly available annual audit.

Footing The Bill

Tens of thousands of Americans belong to Christian health sharing ministries, including Fred Bennett of Chattanooga, Tenn.

Bennett and his wife, Beth, have belonged to a health care sharing ministry for 19 years. They've always been healthy, but in the last few years, as they've entered their 60s, they started to have medical trouble.

"In '04, my wife was rushed to the hospital with E.coli in her kidneys and, actually, it spread to all of her body," he says.

She recovered, but the hospital bill was staggering. After six days in the hospital, most of which was spent in intensive care, the cost came to about $70,000.

Shots - Health News 'How Much Will Obamacare Cost Me?' Try Our Calculator

And that bill was just the beginning for the Bennetts.

"She hasn't had many claims, but unfortunately, I had a stretch of five or six years there that things were pretty rough," Bennett says, including multiple surgeries and a heart attack.

The medical bills reached tens of thousands of dollars, but for each incident, the Bennetts paid only their $250 deductible. The rest was paid by fellow Christians through Medi-Share.

Of course, the same would have been true if they had normal health insurance. But Bennett says he prefers the health sharing ministry because the ministry doesn't pay for procedures he thinks are immoral, like abortions.

"The part I liked about it was that I wouldn't have to be having some of my premiums spent to take care of someone who wasn't taking of themself, physically or spiritually, either one," he says.

What's Not Covered

While the federal health law includes an exemption for health sharing ministries, some states have sued to try to keep them out. The concern is that consumers shopping for insurance will be confused about what ministries really guarantee in the way of coverage.

"We do not share in every medical need that a person has," Miller of Medi-Share says. "Some of the things we don't share in are related to lifestyle issues, such as an abortion. But others of them are related to things that the members have agreed that they would rather pay for themselves."

For example, she says, members tend to pay for their own preventative care (with the exception of very young children). There are also some restrictions on pre-existing conditions.

At Medi-Share, Miller works with a steering committee of health share members who discuss what kind of care is covered by the guidelines. "Any significant change in the guidelines is something that has to be passed by all the members," she says.

In August, CNBC reported that members whose claims are rejected have the right to file an appeal. In the current fiscal year, 76 percent of the bills submitted to Medi-Share were considered eligible, and all of those were covered, Medi-Share told CNBC.

Spiritual Support

Bennett of Tennessee points out that because all the members decide what to share the cost of, health ministries often cover things insurance rarely does, like adoption fees and funeral costs. Plus, he says, his health sharing ministry gives him a service he could never get from an insurance company.

"The night before my surgery, the lady who'd helped me locate the right providers and everything called me back and said, 'Would it be OK if I prayed with you for your surgery tomorrow?'"

Three days later, she called back to ask how the surgery went.

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Questions Rise As Health Care Exchange Draws Near

Enrollment in the Affordable Care Act health exchanges is set to begin Oct. 1. But many eligible Americans still have questions.

Tell Me More reached out to listeners via Facebook and Twitter in an attempt to help answer their questions about the law. Host Michel Martin spoke with Mary Agnes Carey, a senior correspondent at Kaiser Health News � a news service not affiliated with Kaiser Permanente.

On searching for other affordable care options

Listener Caitlin Stevenson: "When the Affordable Care Act goes into effect, if I'm already covered by an employer's health plan, am I still eligible to shop for more affordable care? The plan that my job offers costs more than $350 a month for my husband and me � that's more than a car payment! Will we � healthy adults, 26 and 31— be able to find a plan that costs less than this?"

Carey answers: "Anyone can shop on the exchange. The question here is whether or not they can qualify for a subsidy of purchased coverage. ... In order to qualify for a subsidy, two things have to happen. No. 1: The ... health insurance offered by her husband's employer has to cost more than 9.5 percent of their household income or the plan, if it covers at least 60 percent of the covered medical expenses. [What] I mean is that if it pays for 60 percent of the medical expenses, they could not get into the exchange. So it either costs more than 9.5 percent of the income or it doesn't pay for 60 percent of the covered services. If one of those things happen, they might be able to qualify for a subsidy."

On options for graduating students

Graduate student Lorrie Guess: "I obviously don't know yet if I'm going to have a job that offers me coverage and I don't want to pay a fine if I don't buy the coverage in case I get a job that offers me health insurance. On the other hand, I don't want to buy coverage only to get a job that ends up covering me and then find out that I'm paying for no reason."

Carey answers: "Well here's a couple of ideas. No. 1, is there any way to extend her student health insurance for a period of time after graduation as she decides where she's going to go and what job she has and whether or not she has coverage? That's one thing. Secondly, while the enrollment period for the first year of the Affordable Care Act ends at the end of March, there are things called qualifying life events � you lose your insurance at work, you get married, you have a child. I think graduating from college would be one of these. ... [And she] could get coverage on her parents' health insurance plan for a period of time. As we know, the Affordable Care Act allows that up to age 26."

On mental health options

Carey says, "As part of the Affordable Care Act ... there will be more coverage of mental health services. ... And also there has to be parity between what a plan offers on health services and what they offer on mental health services. But this is an area where I would urge caution, for people to look at and see how parity is defined, how it's implemented in a particular policy. Because this has been a concern � the mental health parity law passed a few years ago, [and while] some of the regulations have come through with it others have not. But it's definitely an area worth watching for people that are enrolling in the exchange coverage."

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Lessons About Insurance In The Obamacare Data Dump

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Exchange Shopping Starts Now, But No Need To Rush

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Monday, October 7, 2013

Would A Federal Shutdown Delay Health Care Exchanges?

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How A Tax On Medical Devices United Political Rivals

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