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ByTomMurphy The Associated Press Insurers can no longer reject customers with ex- pensive medical conditions thanks to the health care overhaul. But consumer advocates warn that com- panies are still using wig- gle room to discourage the sickest — and costliest — patients from enrolling. Some insurers are ex- cluding well-known can- cer centers from the list of providers they cover under a plan; requiring patients to make large, initial pay- ments for HIV medications; or delaying participation in public insurance exchanges created by the overhaul. Advocates and industry insiders say these practices may dissuade the neediest from signing up and make it likelier that the custom- ers these insurers do serve will be healthier — and less expensive. "It's the same insurance companies that are up to the same strategies: Take in as much premium as possi- ble and pay out as little as possible," said Jerry Flana- gan, an attorney with the advocacy group Consumer Watchdog. Insurers acknowledge that people may see changes in coverage, driven in part by how the overhaul affects insurance. But they say pru- dent business practices, not discrimination against the sick, are key factors behind some of the trends that have raised concerns. They point out that if customers find a plan they don't like, they generally have plenty of additional options to choose from both on and off the exchanges. They also note that the overhaul takes several steps to discourage them from avoiding costly patients. It prevents insurers from marketing or designing a plan that would discour- age someone from apply- ing based on their health. It also calls for insur- ers to chip into a pool that compensates competitors who wind up with a more expensive patient popula- tion. That lowers their in- centive for discouraging the sick from enrolling. "Health plans now guar- antee coverage for individ- uals and families regard- less of health status," said Clare Krusing, a spokes- woman for the trade asso- ciation America's Health In- surance Plans, or AHIP. There are three major ways insurers still might steer sick or expensive pa- tients away from their cov- erage: Narrownetworks Insurers can lower their chances for covering pa- tients with expensive med- ical conditions like cancer and autism simply by lim- iting the number of doc- tors and hospitals in a cov- erage network. That would send those patients search- ing for coverage elsewhere because they don't want to pay expensive, out-of-net- work rates. Narrow insurer net- works might include only 30 percent or less of a mar- ket's hospitals, as opposed to 70 percent or more for a broader network, according to the consulting firm McK- insey & Co. These narrow networks have grown more common in recent years, especially in coverage sold on new public health insurance exchanges created by the overhaul. An Associated Press sur- vey of the nation's top can- cer centers this spring found that patients cov- ered under the health care law could encounter barri- ers to access in many cases. For instance, MD Anderson Cancer Center said it is in- cluded in the networks of less than half of the plans sold on the Houston area's public insurance exchange. Aside from excluding patients, narrow networks also can help insurers form a healthy customer base by lowering the cost of cover- age. A narrow provider net- work gives insurers lever- age to squeeze better rates out of doctors who want to be included in that network in order to get the insurer's business. Better rates lead to lower premiums, and young and healthy people generally shop for insurance based on price. "They're the ones that don't check the provider directory," said Bob Lasze- wski, a former insurance executive turned industry consultant. Insurers say plans with narrow networks are among many coverage choices con- sumers can make when they shop for insurance, and they are not an attempt to dodge the sick. Sticker shock Some plans are requir- ing patients to initially pay 30 percent or more of the bill for drugs that can cost several thousand dollars a month. HIV drugs and mul- tiple sclerosis medications are among them. The overhaul caps the an- nual amounts patients are required to pay for these so-called out-of-pocket ex- penses. Still, some say the higher cost-sharing re- quirements can steer pa- tients that need these med- ications away from enroll- ing. "It's another way to send a message to sicker patients that says, 'If you're taking these medications, we'd rather not sell insurance to you," Flanagan said. Insurers also say custom- ers have options if they find a prescription plan they dis- like. In some markets, a cus- tomer may have more than a dozen choices, some of which might offer better coverage or a lower-cost al- ternative for their prescrip- tions. Waiting game Another way insur- ers might land a healthier population is by playing the waiting game. The nation's largest health insurer, UnitedHealth Group Inc., will dive into the over- haul's public insurance ex- changes with plans to sell 2015 individual coverage in 24 exchanges. That's up from only four in 2014. These exchanges debuted last fall and offer shoppers a chance to compare and buy policies, often with help from an income-based tax credit. UnitedHealth's delayed growth could be a savvy way to avoid some of the sickest patients who likely rushed to sign up for insur- ance in the initial year of the exchanges, said Lasze- wski, the industry consul- tant. That could free United- Health to enter markets and sign up healthier pa- tients after other insurers, most likely nonprofits with deep community roots, have "taken the bullet" the first year, he said. Health insurers are still figuring out plan options for 2015, so there are no signs yet that other insur- ers are following United- Health's example. HEALTH CARE OVERHAUL In su re rs c an d is co ur ag e si ck f ro m en ro ll in g GERRYBROOME‑THEASSOCIATEDPRESS An infusion drug to treat cancer is administered to a patient via intravenous drip at a hospital in Durham, N.C. Insurers can no longer reject customers with expensive medical conditions thanks to the health care overhaul, but patient advocates still see wiggle room for companies to avoid covering the sickest and costliest patients. By Jim Suhr The Associated Press ST. LOUIS Donors have given nearly $700,000 to online fundraising sites set up to collect money for the family of a black 18-year-old and the white police officer who fatally shot him in the St. Louis suburb of Ferguson. The Michael Brown Me- morial Fund has raised al- most $280,000 from more than 9,300 people in 13 days. Two sites supporting police officer Darren Wilson have drawn nearly $410,000 from nearly 10,000 contrib- utors. The donations have come through the site Go- FundMe.com. A look at some key points behind the fundraising ef- forts: BROWN FAMILY: The money collected for the Brown family is meant to defray funeral, burial, travel and living expenses "as they seek justice on Michael's be- half." None of the donations will go toward the family's legal fees, the web page says. WILSON'S SUPPORT- ERS: Public rallies in sup- port of Wilson have been far smaller than the street demonstrations to protest Brown's death. But the con- tributions on the officer's be- half have eclipsed the online donations to the Browns. An early GoFundMe.com page raised $234,900 within eight days and was re- placed by another page that has collected more than $175,000. The combined to- tal is from nearly 9,900 do- nors. According to the page, that money is to be spent on "potential legal fees, reloca- tion and living expenses" of Wilson and his immediate family. FLOOD OF DONATIONS: Since Brown's death, people from New York to Califor- nia have given money to one side or the other. The online fundraising is in addition to other events benefiting ei- ther side, including benefit concerts and T-shirt sales. WHO'S GIVING? Go- FundMe.com allows do- nors to identify themselves. Many contributors to the Browns willingly give their name. Wilson's backers have largely preferred to stay se- cret. Much like the ral- lies on Wilson's behalf that have attracted sign-carri- ers who refused to identify themselves, contributors to Wilson's funds are virtu- ally all anonymous. Many of his supporters have said revealing their names could put them at risk of retalia- tion. In the early days of the unrest after Brown's shoot- ing, black protesters used the refrain "I am Michael Brown." Not long after that, the phrase was co-opted by Wilson supporters, who be- gan identifying themselves as "I am Darren Wilson." THE BACKDROP: With separate criminal and civil- rights investigations under- way, the facts of the con- frontation that led to the shooting remain murky. Po- lice have said the 28-year- old Wilson, a six-year po- lice veteran, was pushed into his patrol vehicle and physically assaulted during a struggle with Brown over the officer's gun. Some wit- nesses have reported seeing Brown's arms up in the air — an apparent sign of sur- render — before the shoot- ing. Wilson, who has not been charged, has been in hiding since the shooting. A grand jury is reviewing the shooting, and the Justice Department is conducting its own investigation. Wil- son has not been charged with any wrongdoing. MEMORIAL FUND Donations near $700,000 in Missouri police shooting The Associated Press OMAHA, NEB. Police who opened fire while disrupt- ing a robbery at a fast-food restaurant in Omaha struck and killed a crew member with the "Cops" television show and the suspect, who was carrying a pellet gun, authorities said Wednesday. Police Chief Todd Schmaderer said witnesses and officers thought the robbery suspect's Airsoft handgun was real, but that it fires only plastic pellets. He said the suspect fired from the pellet gun before officers returned fire. Officers continued firing on the suspect as he exited the restaurant, and that was when the "Cops" crew member was also struck, said Schamaderer. 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