Monthly Archives: June 2013

Is Obamacare on the ropes? Not at all

Is Obamacare on the ropes? Not at all.

Conclusion…

These Obamacare opponents are trying to have it both ways. They created major roadblocks and then complained that implementation is lagging. If they believe Obamacare is in trouble, they largely have themselves to blame.

Health reform is always complex because health care is complex. Just ask the leaders of George W. Bush’s health care team. But reforms can become lifesavers for millions of people. If the past is any guide, Obamacare, once it goes into effect, will be the same.

Probably some truth there. All of that said, there can be little doubt that Obamacare is the opposite of Keep It Simple Stupid.

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Colorado looking at exchange vision benefits by open enrollment

Colorado, California exchanges work on vision benefits | LifeHealthPro.

Vision plan sales efforts have come up this month during board meetings organized by Connect for Health Colorado and by the Covered California exchange.

The Colorado exchange board has adopted a recommendation that calls for the Colorado exchange staff to look into offering access to insured, stand-alone vision plans as early as Oct. 1. The exchange would offer access by providing a website link to a separate stand-alone vision sales website.

“If at any time the time and resources related to this development compromises launch of the marketplace, we will delay this option,” according to a copy of the recommendation posted on the Colorado exchange website.

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Will young invincibles help Obamacare avoid ‘death spiral’?

Will Young People Jeopardize the Success of Obamacare? | Wall St. Cheat Sheet.

Of the 7 million people the Obama administration expects to enroll for coverage in 2014, officials say 2.7 million need to be young adults. (emphasis added)

The danger is the goal isn’t met? From the New Republic’s Jonathan Cohn?

“Health insurance needs lots of healthy people to sign up for coverage. Their premiums cover the big bills for the relatively small number of sick people. So if the exchanges don’t enroll enough young, healthy people, insurers will have to raise everyone’s premiums. In the worst case, this could create what actuaries call a ‘death spiral’: Rising premiums prompt people to drop out, causing premiums to increase even more.”

Obamacare needs young people that receive either no subsidy or a very small one for them to actually serve the purpose of providing a healthy rate base. It’s certainly an open question how enthusiastically these young invincibles will be to sign up for relatively high priced plans. I suspect most of them believe they are going to receive “free” coverage. Won’t they be surprised?

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15 PPACA provisions that will take effect in 2014

15 PPACA provisions that will take effect in 2014 | LifeHealthPro.

  1. Health Insurance Nondiscrimination Requirements
  2. State Heatlh Insurance Exchanges
  3. State Health Insurance Exchagne Tax Subsidies
  4. Employer Mandate Tax Penaltites
  5. Individual Mandate Tax Penalty
  6. Automatic Enrollment
  7. Pre-existing Condition Exclusion Practices Eliminated
  8. Ninety-Day Maximum Waiting Period
  9. Cost_Sharing Limits
  10. Non Annual or Lifetime Limits (some limits may exist)
  11. Wellness Program Health Plan Discount
  12. Coverage for Those in Clinical Trials
  13. Employer Minimum Essential Coverage Reporting
  14. Large Employer Heatlh Information Reporting
  15. Medicaid Expansion (option on state by state basis)

 

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Obamacare: Is a $2,000 deductible ‘affordable?’ – Jun. 13, 2013

Obamacare: Is a $2,000 deductible ‘affordable?’ – Jun. 13, 2013.

A California silver plan has the above benefits plus a $250 emergency room copay. Is that worth $321/mo? The article concludes…

“In many cases, depending on the plan, the coverage will be more comprehensive than what the enrollee currently has,” said Anne Gonzalez, a spokeswoman with Covered California, which is running the state’s exchange.

Of course key question, “Is it worth it?” is yet to be determined.

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Young People Boycott Obamacare?

 Young People Should Say No to Obamacare | National Review Online.

 

 

Indeed, the law will require four out of five young Americans to pay more than they otherwise would for health coverage — yet another form of generational theft from young to old that ought to sour young people on government “help.”

What happens if the young invincibles don’t sign up?

If young people boycott Obamacare, the law of adverse selection kicks in. Too few young people in an insurance pool means fewer healthy people to subsidize the sicker people. Costs and premiums will rise more than expected, which will lead to fewer young people signing up and costs going up even more. In insurance jargon, it’s called a death spiral.

… and a young person’s decision process?

Grace-Marie Turner, head of the free-market Galen Institute, has looked at a typical young person’s decision tree on Obamacare. If someone is 27 years old, single, and making $34,000 a year, he will have to fork over more than $300 a month for a basic health-care package — that’s 50 percent more than he is likely paying now. Obamacare would send him a check for $20 a month through its subsidy program, but he or she will still wind up paying some $1,000 a year of after-tax income for basic health insurance. That’s a lot for someone with a decent job who is trying to save money for a house or to start a family.

Depending on the plan, the premium amount mentioned above seems high. That is about the maximum someone with that income could pay for a Silver plan.

The article also mischaracterizes the guaranteed issue portion of Obamacare:

And whether they are slackers, students, or software engineers, young people are smart enough to figure out that they can easily wait to sign up for coverage until after they get sick. Obamacare requires every insurance company to take anyone on as a customer regardless of any pre-existing conditions.

This is NOT, I repeat NOT true. OK, wanted to get your attention. Yes, Obamacare is guaranteed issue, but plans are only issued during open enrollment. The first years open enrollment is extended so it lasts from October 1st 2013 to March 31st 2014. In future years open enrollment will be from October 1st to sometime in December. Now this is very important:

YOU CANNOT GET COVERAGE OUTSIDE OF OPEN ENROLLMENT. COVERAGE DOES NOT START IMMEDIATELY.

Be careful out there.

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Obamacare Causing Nearly Half Of Small Businesses To Freeze Hiring:

Obamacare Causing Nearly Half Of Small Businesses To Freeze Hiring: Poll.

Small business owners’ fear of the effect of the new health-care reform law on their bottom line is prompting many to hold off on hiring and even to shed jobs in some cases, a recent poll found.

“We were startled because we know that employers were concerned about the Affordable Care Act and the effects it would have on their business, but we didn’t realize the extent they were concerned, or that the businesses were being proactive to make sure the effects of the ACA actually were minimized,” said attorney Steven Friedman of Littler Mendelson. His firm, which specializes in employment law, commissioned the Gallup poll. (emphasis added – Ed)

Really? Attorney Steven Friedman needs to venture out into the real world a little more often.

Forty-one percent of the businesses surveyed have frozen hiring because of the health-care law known as Obamacare. And almost one-fifth—19 percent— answered “yes” when asked if they had “reduced the number of employees you have in your business as a specific result of the Affordable Care Act.”

So if you’re looking for a job, on average a small business isn’t a great place to start.

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“If there is an exchange I’m sure there will be the Blues.”

Says Ana Gupte, an insurance stocky analyst for Dowling & Parners.

Blue Cross-Blue Shield Bets Big On Obamacare Exchanges – Kaiser Health News.

At a closed White House meeting in April, President Barack Obama told corporate insurance bosses “we’re all in this together” on implementing his signature health law. But some insurance companies seem to be more in than others.

At least five Blue Cross and Blue Shield executives sat at the table of about a dozen CEOs with the president, according to those knowledgeable about the session, first reported by the New York Times. Just as significant is who wasn’t there: chiefs of the country’s biggest and third-biggest health insurers, UnitedHealth Group and Aetna.

The article goes on to discuss issues concerning the insurers including the inability to properly understand the risk pool of the actual participants that will sign up.

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Carriers submitting plans for the Colorado individual marketplace

There are 10 carriers that have submitted plans for the Colorado health exchange for the individual market. They are:

  1. All Savers Insurance Company (A United HealthOne company)
  2. Cigna Health and Life Insurance Company
  3. Colorado Choice Health Plans (San Luis Valley HMO?)
  4. Denver Health Medical Plans
  5. HMO Colorado (Anthem)
  6. Humana Health Plan
  7. Humana Insurance Company
  8. Kaiser Foundation Health Plan
  9. New Health Ventures
  10. Rocky Mountain HMO
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Big problem: Shortage of primary care doctors

A looming shortage of primary care doctors appears to be a nationwide problem. These cases showed up in my RSS feed, I’m sure I could find links for almost every state.

 

Minn. Faces Shortage Of Primary Care Doctors

Primary care physicians are more readily available in Minnesota than most of the country, but experts say the state faces a looming shortage and only partly because of the federal health care overhaul that will extend coverage to around 300,000 uninsured residents.

Utah faces shortage of primary care doctors

Utah has a shortage of doctors that practice family medicine, and that shortage could be compounded next year as millions of newly insured patients around the country gain coverage under the health care law.

Shortage Of Primary Care Doctors In Florida

There is a severe shortage of doctors in much of Florida. According to the state Department of Health, 16 mostly small and rural counties have fewer than seven active physicians per 10,000 residents. That compares to 22 active physicians per 10,000 residents in the United States. The state estimates it would take at least 753 primary care physicians to eliminate those shortages.

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Obamacare exacerbates primary care physician shortage

Obamacare: Will it worsen Missouri’s doctor shortage? – CSMonitor.com.

“A lot of folks say that politics is the biggest threat to Obamacare or the Affordable Care Act. I think the second biggest threat is the lack of primary care providers to serve the folks who are going to gain access to coverage,” said Joe Pierle, CEO of the Missouri Primary Care Association that represents community health centers. “We can give everybody health insurance, but if they can’t get in to a doctor, especially in rural Missouri, then we’re really not making much progress.”

I don’t believe this is simply a Missouri problem. How do you create more primary care physicians? Higher pay, better working conditions and more respect.

What are the odds of that?

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Additional Colorado exchange pricing from CCHI

The Colorado Consumer Health Initiative (CCHI) has done some analysis of Colorado exchange pricing filed with the state. Their dressed up conclusion in my opinion…

“Colorado consumers will be pleased they will have a enough health insurance plans from among which to choose, without being overwhelmed by too many choices – it looks like Goldilocks, just right,” said Dede de Percin, executive director of the Colorado Consumer Health Initiative. “Despite doomsday predictions, the state is not seeing ‘rate shock’, so many of the choices will be more affordable, especially with the subsidies.”

Here are some examples of pricing for “one Silver plan” from each of the 10 insurers…

 

Denver Individual Plans

  • 27 year old: $207 to $373 per month
  • 40-year old: $253 to $454 per month

Denver Family Plan (2 parents age 40, children under 18)

  • $756 to $1,360 per month

Durango Individual Plans

  • 27-year old: $207 to $504 per month
  • 40-year old: $253 to $615 per month

Durango Family Plan (2 parents age 40, children under 18)

  •  $756 to $1,840 per month

Fort Collins Individual Plans

  • 27-year old: $197 to $406 per month
  • 40-year old: $240 to $495 per month

Fort Collins Family Plan (2 parents age 40, children under 18)

  • $718 to $1,481 per month

 

Having sold numerous health policies in Colorado, I can assure you this most DEFINITELY WILL BE sticker shock. That said, of course many will be eligible for subsidies to defray the cost. Let’s hear it from CCHI:

Most consumers will not pay these prices since low and middle-income Connect for Health Colorado marketplace consumers will be eligible for advanced premium tax credits based on income.  For example, a 40-year old earning $29,000 a year, paying a premium of $350 per month would be eligible for a subsidy of up to $154 per month and would contribute $196 per month for his or her health plan.

Subsidies are not reduced in a straight line fashion as your income increases. If you are closer to 400% of the Federal Poverty Level (FPL) the amount of subsidy you will receive is substantially reduced. View a FPL spreadsheet vs. number of family members here.

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