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Welcome to Wonkbook, Wonkblog's morning policy news primer by Puneet Kollipara (@pkollipara). To subscribe by e-mail, click here. Send comments, criticism or ideas to Wonkbook at Washpost dot com. To read more by the Wonkblog team, click here. Follow us on Twitter and Facebook. (Photo by Mike Segar/Reuters) Wonkbook's Number of the Day: 70 percent. That's the latest estimate of the mortality rate in the Ebola outbreak in West Africa, the World Health Organization announced. Wonkbook's Chart of the Day: Oil prices are falling, and fast. Wonkbook's Top 5 Stories: (1) Obamacare October surprises and a lower sales bar; (2) Ebola treatments for U.S. patients; (3) attorney general nomination update; (4) security threats of climate change; and (5) new help for long-term jobless. 1. Top story: With a month to go, why the Obama administration won't oversell Obamacare in year two Team Obama's year-two strategy: Underselling Obamacare. "The Obama administration vastly oversold how well Obamacare was going to work last year. It's not making the same mistake this year. Gone are the promises that enrolling will be as easy as buying a plane ticket on Orbitz. The new head of HHS is not on Capitol Hill to promise that HealthCare.gov is on track. And no one is embracing Congressional Budget Office projections of total sign-up numbers.Sobered - and burned - by last fall's meltdown of the federal website, the administration is setting expectations for the second Obamacare open enrollment period as low as possible. Officials say the site won't be perfect but will be improved." Jennifer Haberkorn in Politico. Explainer: 5 things we need to know about Obamacare before enrollment begins. Jason Millman in The Washington Post. Source: Westhill Healthcare Consulting Jakarta fraud prevention review</d

1. It's Smart to Prepare for a Breach How many data breaches from 2014 can you name? The freshest one in your mind is probably the Sony hack, but there were also attacks on Home Depot, Staples, Dairy Queen, P.F. Chang's the list goes on. Credit.com Co-Founder and Chairman Adam Levin recently wrote about the most important lessons you can learn from the Sony hack, encouraging consumers and companies to prioritize data security and behave with the knowledge that your personal information and correspondence could be exposed at any time. Prepare for the possibility of fraud by monitoring your credit, regularly reviewing account activity and knowing what to do if your personal information has been stolen. Do what you can to strengthen your data security, but know that so much of it is beyond your control, so the best thing you can do is know how to react to a breach. 2. Communication Is Crucial to Getting Debt-Free as a Couple We published several success stories about getting out of debt, but some of the most memorable involved couples working together to conquer their finances. The stories had similar themes: Ellie Kay married her husband without knowing about his $40,000 of consumer debt, and Ja'Net Adams was unaware her husband took out student loans to pay for college. Both families eventually hit breaking points where they realized debt was holding them back, and they needed to make drastic changes to get rid of it. Getting out of debt is never easy, and the more people who are involved, the more complicated it can be. At the same time, having someone to work through the challenges with you can be extremely helpful. Adams' and Kay's stories highlight two crucial elements of getting debt free: staying committed to a plan and remaining open and honest about the process' progress and challenges. Those lessons apply to any personal finance goal, whether you're planning with a family or on your own.

On May 17, 2014, The Fiscal Times reported that the government is: "paying incorrect subsidies to more than 1 million Americans for their health plans in the new federal insurance marketplace and has been unable so far to fix the errors, according to internal documents and three people familiar with the situation." A 7-page slide presentation created by HHS confirms that one-in-four people who have signed up for Obamacare have "data discrepancies." Reports are that some two million people's health care coverage may be at risk. Out of some 8.8 million persons who have signed up for coverage, about 5.5 million are in the federal insurance exchange receiving reduced rates, or benefits, to pay for their health insurance policies. The sliding scale subsidized policies are priced based on income, family size, and geographical location of the individual. Under the law, only citizens and legal immigrants are entitled to subsidized coverage. The presentation shows that the data errors involve information concerning details on income, citizenship and immigration status.

According to the Centers for Medicare and Medicaid Services, healthcare costs are expected to rise by 5.8% each year until 2022, which is going to make for a pretty serious hike in your expenses. Instead of getting frustrated and giving in, though, put your thinking cap on. If you're willing to roll your sleeves up and do a little research, you can find plenty of ways to reduce your medical costs. Here are six of them. 1. Use Urgent Care Facilities Instead of the Emergency Room It's a pretty decent bet that there's an urgent care facility near where you live that you can use in lieu of the emergency room. It won't cost you as much, and many such facilities offer extended hours. Don't wait for the next time an emergency occurs - do an Internet search now to find suitable locations and note their hours of operation. 2. Improve Your Health One of the simplest ways to decrease your medical costs is to improve your health. If you're overweight, join a gym or create a home workout program and adjust your diet to include more fresh fruits and vegetables. Still smoking cigarettes? Buy a patch or join a support group and quit. Got friends who encourage you to party it up on the weekends? Find yourself some new ones or convince them to participate in healthier activities. Concrete steps like these can get you more fit and less likely to need medical attention. 3. Get Generic Prescription Medication Whenever your doctor prescribes any medication, be sure to ask for a generic option. You can save as much as 85%, according to the Food and Drug Administration, which also points out that you don't sacrifice anything in quality by avoiding brand name meds. 4. Pay Your Bill Upfront If you have the means to do so, offer to pay your medical bill upfront for a negotiated discount. This is a shrewd and under-used method to reduce your medical costs. See the billing department at the hospital or your doctor's office for details. 5. Use Your Smartphone A variety of mo

SACRAMENTO, California - Aetna Inc. discontinue selling individual health insurance policies in California, just weeks after opting out of the exchange that is being established as part of the national health care reforms, a state regulator said last month. California Insurance Commissioner Dave Jones said he was disappointed in Aetna's decision because consumers need more choices. The decision does not affect people who have Aetna insurance through their employer. "This is not good news for California consumers," Jones said in a statement. "A competitive market with more choices for consumers is important, as we implement the Affordable Care Act and health insurance coverage is a requirement." In California's individual health insurance market, Aetna is a quite small player. According to 2011 figures compiled by the California HealthCare Foundation, Aetna has about 5 percent of the state's individual health market. By comparison, Anthem Blue Cross, Blue Shield and Kaiser share 87 percent. Aetna says it has about 58,000 individual enrollees in the state and expects to have about 49,000 by the end of the year. It plans to withdraw from the state at the end of the year but will continue to offer small and large group plans, as well as Medicare, dental and life insurance products. Those in search of to buying their own health insurance will be directed to Covered California, the state's new health insurance exchange starting Oct. 1. Aetna was not among 13 insurance carriers that will sell individual coverage to millions of Californians through the exchange. According to Jones' office Under state law, Aetna will not be allowed to sell individual policies in California for five years once it leaves that market. http://www.westhillinsuranceconsulting.com/blog/ http://www.westhillinsuranceconsulting.com/

Westhill Healthcare Consulting is one of the internet's oldest sites that offer consumer information on reasonably priced health and medical coverage since it was published during early 90's. It is the most-trusted independent site, respect and loyalty was earned trough the years of hard work. All the information on this site is projected to the general consumer audience. Westhill Healthcare Consulting is not selling insurance and is not an insurance agency Your concern is our business, as service to our visitors, we provide health insurance quotes from carefully chosen partners who are in the business of selling health insurance, and who meet Westhill Healthcare Consulting strict standards. It is the referrals that pay us and in turn this is what we use to pay the cost of publishing this site. http://www.westhillinsuranceconsulting.com/blog/

Tips for navigating Obamacare http://www.westhillinsuranceconsulting.com/blog/westhill-consulting-tips-for-navigating-obamacare/ Think hard before your drop insurance entirely Tambe said that might not make good business sense despite some companies might be tempted to abolish insurance benefits completely and let employees go to marketplaces to get coverage. The problem is insurance purchased on the marketplace will be more expensive for individuals. Then the company will risk talent leaving the company for a competitor who offers them the less expensive option if the company isn't willing to compensate by raising their salary. "It may work to keep costs down but you'll have a hard time keeping talented folks," he said. Other federal programs could help you For households making under 400 percent of the Federal Poverty Level, the ACA grants subsidies available on the public marketplace under certain circumstances. Additionally there are current efforts for Ohio to spread out the Medicaid program to households making less than 138 percent of the poverty level. This in turn if acted out would make more people eligible for those programs. Not all individuals will qualify for subsidy even though most Americans will be eligible to obtain coverage through the exchange. Employer-sponsored coverage may affect an employee's ability to meet the criteria for the subsidy. If there are many employees qualify for federal assistance, it will be reasonable to let them use those plans, particularly since employees being offered insurance by an employer aren't allowed onto the marketplace if their employer is offering insurance deemed affordable, or 9.5 percent of their wage rate based on 130 hours per month for single coverage. "A lot of folks qualify for these things, and there's no penalty to employers," Tambe said. Know the paperwor

Hep C Cure Costs Pose Challenge for Medicare By Richard Knox NPR   Walter Bianco has had hepatitis C for 40 years, and his time is running out. "The liver is at the stage next to becoming cirrhotic," the 65-year-old Arizona contractor says. Cirrhosis is severe scarring, whether from alcoholism or a chronic viral infection. It's a fateful step closer to liver failure or liver cancer. If he develops one of these complications, the only possible solution would be a hard-to-get liver transplant. "The alternative," Bianco says, "is death." Previous drug treatments didn't clear the virus from Bianco's system. But it's almost certain that potent new drugs for hep C could cure him. However, the private insurer that handles his medication coverage for the federal Medicare program has twice refused to pay for the drugs his doctor has prescribed. Doctors are seeing more and more patients approaching the end-stage of hep C infection. "There isn't day that goes by when I don't have a story very similar to Mr. Bianco's," says Dr. Hugo Vargas of Mayo Clinic in Scottsdale, Ariz., his liver specialist. Researchers estimate that 3 to 5 million Americans carry the insidious hep C virus. The biggest concentration is among those born between 1945 and 1965.

Here's some cheerful news: States and the federal government are doing little to stop a costly form of Medicaid fraud, according to a government report released last week. Medicaid, the federal-state health insurance program for poor Americans, now covers more than half its members through what's known as Medicaid managed care. States pay private companies a fixed rate to insure Medicaid patients. It has become more popular in recent years than the traditional "fee for service" arrangement, in which Medicaid programs reimburse doctors and hospitals directly for each service they provide. Despite the growth of managed care in recent decades, officials responsible for policing Medicaid "did not closely examine Medicaid managed-care payments, but instead primarily focused their program integrity efforts on [fee-for-service] claims," according to the Government Accountability Office, the investigative arm of Congress. The managed-care programs made up about 27 percent of federal spending on Medicaid, according to the GAO. The nonpartisan investigators interviewed authorities in California, Florida, Maryland, New Jersey, New York, Ohio, and Texas over the past 12 months. STORY: No Background Checks Needed for Home Health Workers in 10 States Funded jointly by the federal government and the states, Medicaid provided health insurance to about 72 million low-income Americans at a cost of $431 billion last year, according to the report. By the Medicaid agency's own reckoning, $14.4 billion of federal spending on Medicaid constituted "improper payments," which include both overpayments and underpayments. That's 5.8 percent of what the federal government spends on the program. The $14 billion figure doesn't tally what states lose to bad payments. The fraud risk for managed care is twofold. Doctors or other health-care providers could be bilking the managed-care companies, which pass on those fraudulent costs to the government.

The typical cost of health care for a family of four with employer-based insurance this year is $23,215, according to a new report from the Milliman actuarial firm. The bad news first: That amount has more than doubled in the past 10 years. The goodish news: That cost grew just 5.4 percent between 2013 and 2014, the slowest growth rate since Milliman started keeping track in 2002. That $23,215 figure isn't what the employee pays, though. Employers pay about 60 percent of those costs ($13,520), while workers pay the rest through payroll deductions ($5,908) and out-of-pocket costs ($3,787). The employee share of the costs have been rising faster - increasing 73 percent since 2007 - than the employer contribution, which has grown 52 percent over the same period. The Milliman numbers are for family coverage under preferred provider plans, so it excludes the increasing prevalence of consumer-driven health plans, in which employees handle a higher share of the costs. Don't blame the four-year-old Affordable Care Act for these changes, though. Milliman says Obamacare has barely had any impact so far on these large employer plans, but that's about to change. The actuarial firm cites Obamacare's impending excise tax on "Cadillac" plans - valued at at least $27,500 for family coverage starting in 2018 - as a factor that will force employers to scale back health plans. Milliman points to other factors that will push down cost increases. Higher out-of-pocket costs are fueling efforts around health-care price transparency, and that's making consumers become better health-care shoppers. Conversely, an improving economy and an increase in expensive specialty drugs will pressure costs to rise.

Wal-Mart endorsed ObamaCare in 2009 and helped drag the bill through U.S. Congress, and so far it hasn't recanted. By holding back economic growth and incomes, perhaps the law is expanding the retailer's customer base. Another plus-at least for management-is that Wal-Mart can jettison its employees into the ObamaCare insurance exchanges. The Associated Press reported Tuesday that the largest U.S. private employer is dropping health benefits for some 30,000 workers, or about 5% of its part-time workforce. Earlier health-plan eligibility triage in 2011 had removed tens of thousands of Wal-Mart workers from the balance sheet, so this latest purge was probably inevitable. Wal-Mart cites its inability to manage higher-than-anticipated health expenses. Perhaps- wasn't ObamaCare supposed to bring those costs down? Obviously the company is also responding rationally to ObamaCare's incentives. With a subsidized government alternative now open for business, and since corporations aren't liable for a penalty for not covering people who work fewer than 30 hours a week on average, cost-control logic says to send such coverage ballast over the side. Other retail and grocery chains including Target, Home Depot and Trader Joe's have already done the same. ObamaCare's critics predicted that such insurance dumping was inevitable, and the only question now is how many and how fast other companies partake of the new all-you-caneat entitlement buffet. Get whatever you like, the bill's on taxpayers. The disruptions will be concentrated in industries with large numbers of low-skilled and low-income workers, like restaurants, hospitality and, yes, retail. The irony is that even as Wal-Mart drops insurance because it is too costly, President Barack Obama is claiming credit for lowering health costs. He boasted the other day that the law gave every U.S. family "a $1,800 tax cut" by supposedly reducing the rate of employer-premium growth. Obama

As we grow older, our responsibilities add up. Having a health insurance should be one of the priorities that we should think of. By the time you are old enough to fend for yourself, you are then required to get an insurance. However, many young adults are still confused on its importance. 1. It may be Illegal When you are living in the United States, Affordable Care Act (ACA) compels you to purchase insurance. Going without insurance for three months would force you to pay a penalty of $325 or 2% of your monthly income, whichever is higher. In developing countries, uninsured individuals have the option to purchase from private companies but laws are already drafted for completion. In cities like Jakarta, Indonesia and Bangkok, Thailand, more than half of their unemployed population goes uninsured. 2. If you are a full-time employee, your employer should provide you with insurance Most companies require employees work for set period before benefits can be provided. It usually takes 3-6 months in a probationary period before regularization, by which insurance is given. It is in any law in any states and government to mandate to every employer to provide employee benefits. 3. Your parents may still be able to cover you Individuals under the age of 26 can still be listed under their parents' coverage. They can still cover even a modest premium cost. 4. You can do it alone If you are not insured under your parents' plan or purchasing insurance under your employer is not an option, you have the choice to purchase your own insurance from trusted private companies. If you are buying online, just make sure you

I. The Anti-Kickback Statute One purpose of the anti-kickback statute is to protect patients from inappropriate medical referrals or recommendations by health care professionals who may be unduly influenced by financial incentives. Section 1128B(b) of the Social Security Act (the Act) makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce, or in return for, referrals of items or services reimbursable by a Federal health care program. When remuneration is paid purposefully to induce or reward referrals of items or services payable by a Federal health care program, the anti-kickback statute is violated. By its terms, the statute a scribes criminal liability to parties on both sides of an impermissible "kickback" transaction. Violation of the statute constitutes a felony punishable by a maximum fine of $25,000, imprisonment up to 5 years, or both. Conviction will also lead to exclusion from Federal health care programs, including Medicare and Medicaid. OIG may also initiate administrative proceedings to exclude persons from the Federal health care programs or to impose civil money penalties for fraud, kickbacks, and other prohibited activities under sections 1128(b)(7) and 1128A(a)(7) of the Act. II. Remuneration From Laboratories to Referring Physicians Arrangements between referring physicians and laboratories historically have been subject to abuse and were the topic of one of the OIG's earliest Special Fraud Alerts. 1 In that Special Fraud Alert, we stated that, "[w]henever a laboratory offers or gives to a source of referrals anything of value not paid for at fair market value, the inference may be made that the thing of value is offered to induce the referral of business.

Starting a business is risky enough in the best of circumstances. Most new ventures fail, and the prospect of forgoing a salary is enough to keep many would-be entrepreneurs from taking the plunge. But think about how much harder it would be if your child had a health condition, and you couldn't get her insurance if you struck out on your own. That's less of a problem in the U.S. than it was a few years ago, thanks to Obamacare, but until recently it was a very real conundrum. So does the extension of publicly provisioned health insurance prompt more people to start companies? That's the question asked by a paper released earlier this year by Gareth Olds of Harvard Business School. Olds analyzed Census data from before and after the passage of the Children's Health Insurance Program in the U.S. in 1997 to assess its impact on entrepreneurship. CHIP, or SCHIP as it was previously known, provides publicly funded health insurance to children whose families don't qualify for Medicare, but whose incomes still fall below a cutoff (typically around 200% of the federal poverty line). His results suggest that the policy did significantly increase business creation by those families affected. The self-employment rate for CHIP recipients increased from just under 15% of those eligible to over 18%. That amounts to an a 23% increase. The rate of ownership of incorporated businesses - a better proxy for sustainable, growth entrepreneurship - increased even more dramatically, from 4.3% to 5.8%, an increase of 31%. What about all the other factors that might skew this sort of analysis? Olds used several quasi-experimental statistical methods in his research to control for such variables. The basic intuition behind his methods is that a family just above the CHIP cutoff isn't all that different from a family just below it. Whether you make 199% of the poverty line or 201% doesn't matter for much, except whether or not you'll be able to enroll in the program.

CMS created the Zone Program Integrity Contractor (ZPIC) program to investigate allegations of Medicare claim fraud in the country's seven traditional Medicare program claim processing zones. Kathleen King, a GAO director, testified that the ZPICs say they helped Medicare save about $250 million in 2012. CMS does not know how quickly ZPICs are conducting investigations, King said. The GAO is looking into the possibility that the ZPICs could save Medicare more money by acting more quickly, according to King. Hearing witnesses also talked about another Medicare fraud prevention program -- an automated Fraud Prevention System that came to life in 2011. The system is supposed to use "predictive modeling" -- data sifting tools -- to identify suspects for the ZPICs to investigate. During the first year of operation, the system generated only about 5 percent of the ZPICs' leads, King said. CMS says the system is now the primary source of the ZPICs' leads, but details are scarce, she added. Dr. Shantanu Agrawal, director of the CMS Center for Program Integrity, said the Fraud Prevention System stopped, prevented or identified $115.4 million in improper payments during the first two full years of operation. Savings increased in the second year, Agrawal said. King said one problem is that the Fraud Prevention System does not give CMS any way to suspend paying questionable Medicare claims while investigations are still under way.