CORRECTION: In second paragraph, people were deemed ineligible for subsidies to help pay their insurance premiums if they could get employer-sponsored coverage; now they are not. A previous version of the story inaccurately described the "family glitch." (1:40 p.m. MDT, Nov. 2, 2022)

Open enrollment for health insurance through CoverME.gov begins today, and consumer advocates said Mainers looking for a new plan, or to change their current coverage, can benefit from a change to the so-called "family glitch."

In previous years, families who could get family health coverage through their employer were deemed ineligible to get subsidies to help pay for marketplace insurance, regardless of the cost to add family members to the employer's plan.

Helen Roy, outreach and education coordinator at Consumers for Affordable Healthcare, said the "glitch" is now gone, so families have more affordable options.

"If what they are paying to put the family on that employer plan is more than 9.12% of their total income, they will be eligible for the premium subsidies," Roy explained.

Eliminating the family glitch is just one change in this year's open enrollment. Roy noted Consumers for Affordable Healthcare can help people find a plan and check on their eligibility for subsidies.

Congress has expanded the subsidies for health-insurance premiums, so folks who purchase plans through the federal exchange will pay no more than 8.5% of their household income on health coverage through 2025.

Roy pointed out having a Consumer Assistant help sort through the insurance options can prevent any surprises down the road.

"Let's look at the plans, figure out which one's going to work best," Roy advised. "Then, once we've got that part nailed down, we'll go in, do your application and your enrollment."

Consumers for Affordable Healthcare has a helpline at 800-965-7476, or people can set up an appointment on the group's website.

More insurers are expanding mental health coverage, wellness incentives and virtual care options, all of which gained popularity during the pandemic. So, people can ask about their options for integrated plans to cover hearing, dental or vision.

Aaron Child, a self-employed arborist in Damariscotta, said an insurance specialist helped him with some confusing terminology.

"I don't know how many people I've spoken with that have picked a plan and go, 'Ahh, I don't know if I did the right thing.' And I tell 'em, you know, 'Make a phone call and be a little bit more sure about what you're doing,'" Child recommended.

Open enrollment is the only time during the year, outside a special enrollment window, when people can sign up for a plan or change their current health coverage. Open enrollment runs Nov. 1 through Jan. 15.

May is Lyme Disease Awareness Month and the latest state data show Wisconsin recently recorded the highest number of Lyme disease cases in state history.

Experts are urging residents to be mindful of the ticks carrying it as they become more active across the state. There are 16 confirmed tick species in Wisconsin and experts are focused on the "black-legged tick," or "deer tick," in the transmission of Lyme disease. Experts recommended taking preventive measures when spending time outdoors like wearing protective clothing and using insect repellent. They added you should perform tick checks and shower after any outdoor activity.

Dr. Xia Lee, public health entomologist at the Wisconsin Department of Health Services, said some ticks, especially younger ones, may be harder to spot.

"Those are usually the ones that we associate with a lot of the cases of Lyme disease or tick-borne diseases, most active in June and July," Lee explained. "This is also reflected in the number of people who go into the emergency department or go into the physician for tick bite-related illness."

The number of reported Lyme disease cases has tripled over the past 15 years, according to state data. Lee noted the Wisconsin Department of Health Services conducts surveillance and tracking of ticks for the public, including a tick identification service and a dashboard reporting ER visits for tick bites.

Deer ticks have spread from northwestern Wisconsin to every county in the state over the past 30 years. Experts said changes in land use, wildlife management and the environment have helped spread the disease.

PJ Liesch, entomologist at the University of Wisconsin-Madison, said the deer tick is a generalist feeder and can be found on many small mammals, in addition to deer. He added the increasing prevalence of the species has led to an emerging health threat.

"They are still spreading outwards," Liesch pointed out. "They seem to be moving into newer areas, in some cases that can be more like suburban backyards, areas where we haven't seen them historically. And they're still potentially expanding and we don't know when they are going to stop."

Liesch stressed if you are bitten by a tick in Wisconsin, there's about a 50-50 chance it is carrying Lyme disease. He emphasized the risk of Lyme disease transmission increases with the duration of tick attachment, which is why prevention and detection are so important.

"That's a pretty high rate of infectivity, kind of a scary number," Liesch acknowledged. "Even if you have a deer tick that is Lyme-positive, if you are checking yourself and making sure they are not attached to you for very long, that's going to greatly reduce the chances of transmission."

Some early symptoms of Lyme disease include fever, headache, fatigue, swollen lymph nodes, joint and muscle pain and a rash. If left untreated, more complicated conditions can develop.


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A new study showed in 2022, more than 240,000 hospitalizations in California could have been prevented with proper outpatient care.

Researchers said most of the patients had poorly-controlled chronic conditions like diabetes, heart disease or COPD.

Rhonda Smith, executive director of the California Black Health Network, which cosponsored the report, said her organization helps patients learn to advocate for themselves.

"I can tell you countless stories that we hear about patients who just are not listened to and then end up being hospitalized or misdiagnosed," Smith explained.

The report showed patients who rely on Medi-Cal or are Black, Native American, or English-language learners are affected the most. The report found the state could save $400 million a year if Medi-Cal members had the same rate of preventable hospitalizations as people with private insurance.

Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network, also a co-sponsor of the report, said the savings would help the state's taxpayers.

"Each preventable hospitalization has a significant cost to the system, and that's the cost that's ultimately borne by all of us, by all health care consumers," Savage-Sangwan emphasized. "We pay for our insurance right? Those rates are determined by how much money is being spent in hospitals, etc., and so it comes at a cost."

The report authors suggested policymakers resist calls to cut Medicaid nationally and to eliminate coverage for undocumented people in California. They also recommended hiring more culturally and linguistically responsive primary care physicians.

A new report from the Commonwealth Fund showed between 8,000 and 12,000 Kentuckians could lose their jobs as a result of the state implementing Medicaid work requirements, which would cause more people to lose health coverage.

Leighton Ku, professor of health policy and management at George Washington University and co-author of the report, said around half of job losses would occur in health care and the other half downstream, in other industries connected to hospitals and doctor's offices. He added many rural health care providers rely heavily on patients with Medicaid to operate, noting without the funds, they will have to make tough choices.

"Health care providers, they have to compensate for that by doing things like laying off staff and by buying less from people who they purchase things from," Ku pointed out. "Whether it's medical equipment or whether that's how they pay the rent for their space."

Rep. Brett Guthrie, R-Ky., heads the committee spearheading the effort to slash $880 billion in federal funding for Medicaid over the next decade. In a recent op-ed, Guthrie argued, "Washington can't afford to undermine the program further by subsidizing capable adults who choose not to work."

The Commonwealth ranks sixth-highest among states in its share of its population covered by Medicaid, according to the Kentucky Center for Economic Policy. Of the 435 congressional districts across the nation, four of Kentucky's rank within the top 100 for the largest share covered by Medicaid.

Ku stressed Kentucky should brace for a billion dollars in economic losses, if health care workers are laid off.

"Relatively speaking, the state of Kentucky gets hurt more than almost any other state in the country," Ku added.

This week, the American Association of American Medical Colleges expressed concern the cuts would limit coverage and access to care for many of the 70 million Americans, including those of its member hospitals, who account for 29% of all Medicaid inpatient days.


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