Monthly Archives: October 2014

Obamacare Enrollment Increases come from where?

Can you say Medicaid expansion? The Real Story on How Much Obamacare Increased Coverage.

What we’ve learned is that the Obamacare gains in coverage were largely a result of the Medicaid expansion and that most of the gain in private coverage through the government exchanges was offset by a decline in employer-based coverage. In other words, it is likely that most of the people who got coverage through the exchanges were already insured.

With low reimbursement rates, can Medicaid insured’s expect the same level of coverage as those who have coverage that is paying providers substantially more?

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Do the math, a Dr. Shortage is coming

Why the Doctor Can’t See You: Newsroom: The Independent Institute.

The introductory portion of the article documents how preventive care alone has the ability to create full employment for doctors. In other words, demand exceeds supply…

When demand exceeds supply, doctors have a great deal of flexibility about who they see and when they see them. Not surprisingly, they tend to see those patients first who pay the highest fees. A New York Times survey of dermatologists in 2008 for example, found an extensive two-tiered system. For patients in need of services covered by Medicare, the typical wait to see a doctor was two or three weeks, and the appointments were made by answering machine.

However, for Botox and other treatments not covered by Medicare (and for which patients pay the market price out of pocket), appointments to see those same doctors were often available on the same day, and they were made by live receptionists.

As physicians increasingly have to allocate their time, patients in plans that pay below-market prices will likely wait longest. Those patients will be the elderly and the disabled on Medicare, low-income families on Medicaid, and (if the Massachusetts model is followed) people with subsidized insurance acquired in ObamaCare’s newly created health insurance exchanges.

John Goodman concludes…

I predict that in the next several years concierge medicine will grow rapidly, and every senior who can afford one will have a concierge doctor. A lot of non-seniors will as well. We will quickly evolve into a two-tiered health-care system, with those who can afford it getting more care and better care.

In the meantime, the most vulnerable populations will have less access to care than they had before ObamaCare became law.

They call it Obamacare.

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Doctors grade Obamacare

Why doctors give Obamacare a failing grade | TheHill.

  •  You can keep your doctors – NOT
  • Medicaid, not so great
  • Deluge of paperwork and reporting requirements

So what grade would doctors give Obamacare?

The Physicians Foundation made shockwaves last month when it released its 2014 Survey of America’s Physicians. The survey’s top-line finding: Of the 20,000 doctors surveyed, almost 50 percent stated that Obamacare deserves either a “D” or an “F.” Only a quarter of physicians graded it as either an “A” or a “B.”

Let’s take a closer look as to how Obamacare has affected Medicaid. Many of my (potential) clients are delighted if they qualify for Medicaid or if their children qualify for CHP+. Perhaps CHP+ offers better services than Medicaid for adults but I’m doubtful.

No matter which option they chose, Obamacare forced my patients to make trade-offs between pricing, access, and quality of care.

Obamacare’s Medicaid expansion exacerbated this patient crisis. Arizona, the state in which I practice, expanded Medicaid in 2013 under the assumption that it would give the poor better access to medical care. Yet many of the new Medicaid enrollees—perhaps as many as 80 percent of them, according to one recent study—were merely forced off their private insurance plans and into Medicaid.

Several of my patients experienced this first-hand. They have found that Medicaid offers sub-standard health care compared to the private insurance they used to have. Their choice of doctors has been severely curtailed, even more so when it comes to specialists. Often they resort to the local emergency room rather than waiting weeks to get medical attention in a doctor’s office. An Oregon study revealed a 40 percent increase in ER visits among new Medicaid enrollees.

Unsurprisingly, patient health suffers when illnesses and diseases remain untreated, hence Medicaid’s persistently poor ratings on patient health. Unfortunately, my patients were forced into this broken system without a second thought.

Perhaps it was without a 2nd thought or perhaps it was with malice. The government creates a problem and then only they can fix it. Of course, with their recent displays of incompetence, they may have overplayed their hand.

Let me also comment on Medicaid. Under Medicaid, reimbursement to doctors is much less than that of regular insurance or even Medicare. I don’t care how you slice and dice it, from a big picture point of view, if the doctors don’t believe they are being fairly paid, the qualify of care dispensed is going to decrease.

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Obamacare’s enemies are still math and reality

Unable to Meet the Deductible or the Doctor – NYTimes.com.

Patricia Wanderlich got insurance through the Affordable Care Act this year, and with good reason: She suffered a brain hemorrhage in 2011, spending weeks in a hospital intensive care unit, and has a second, smaller aneurysm that needs monitoring.

But her new plan has a $6,000 annual deductible, meaning that Ms. Wanderlich, who works part time at a landscaping company outside Chicago, has to pay for most of her medical services up to that amount. She is skipping this year’s brain scan and hoping for the best.

“To spend thousands of dollars just making sure it hasn’t grown?” said Ms. Wanderlich, 61. “I don’t have that money.”

About 7.3 million Americans are enrolled in private coverage through the Affordable Care Act marketplaces, and more than 80 percent qualified for federal subsidies to help with the cost of their monthly premiums. But many are still on the hook for deductibles that can top $5,000 for individuals and $10,000 for families — the trade-off, insurers say, for keeping premiums for the marketplace plans relatively low. The result is that some people — no firm data exists on how many — say they hesitate to use their new insurance because of the high out-of-pocket costs.

Insurers must cover certain preventive services, like immunizations, cholesterol checks and screening for breast and colon cancer, at no cost to the consumer if the provider is in their network. But for other services and items, like prescription drugs, marketplace customers often have to meet their deductible before insurance starts to help.

While high-deductible plans cover most of the costs of severe illnesses and lengthy hospital stays, protecting against catastrophic debt, those plans may compel people to forgo routine care that could prevent bigger, longer-term health issues, according to experts and research.

“They will cause some people to not get care they should get,” Katherine Hempstead, who directs research on health insurance coverage at the Robert Wood Johnson Foundation, said of high-deductible marketplace plans. “Unfortunately, the people who are attracted to the lower premiums tend to be the ones who are going to have the most trouble coming up with all the cost-sharing if in fact they want to use their health insurance.”

Indeed.

This is a real problem. Many members of the middle class, and certainly lower class are living pay check to pay check and adding the cost of coverage to their monthly bills is stressful to their financing. THEN, add the cost of meeting the deductibles and their lifestyle “breaks”.

My brother recently broke his arm and has no insurance. He may qualify for Medicaid or he may not. If he doesn’t, even if he received a subsidy, most likely he could not consistently pay his premiums and certainly would have significant issues meeting a deductible. I don’t know the solution. Most of my Boulder friends would say “Single Payer.”  Me, I’m for price discovery and getting insurance out of day to day medical expenses. Also, an inexpensive accident plan would have solved my brother’s problem, assuming he could consistently pay that premium.

For example, Ms. Wanderlich needs a brain scan. How much would it cost if she could shop around? I have no idea. Heck, it may cost $300 or it may cost $3000.  An internet search shows the cost of a CT brain scan lies between $825 and $4800. Let’s say that everyone who really needed a brain scan actually got one. If there was price discovery, perhaps the cost would be lower due to higher utilization of the equipment.

Also, the public needs to shop around for these services. Even if they have insurance, it should become common place to shop around.

Another family experience. Many years ago my wife needed an MRI. We were within $500 – $800 dollars of meeting our deductible, then there was 100% coverage. We found a cost of $850 or so, but the facility was an hours drive away. In Boulder, we found a price of $1200 and the facility was 15 minutes away. Since our exposure was $800 either way, we selected the more expensive facility. If circumstances had been different, that is the money was coming out of our pocket, we would have driven an hour.

There are no easy answers, but Government bureaucracy and incompetence, which is very much on display these days, are not part of the solution.

 

A big h/t to Michael Smith at the Facebook page, Fans of Best of the Web today for the title of this post.

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Fixing the Covered California Obamacare Exchange

California spends $13.4 million to fix Obamacare service woes – LA Times.

California’s health insurance exchange hired two outside firms for $13.4 million to address long wait times for consumers calling about their Obamacare coverage..

Covered California said it will pay $9.8 million to Faneuil Inc. and $3.6 million to Maximus Inc. to add more call-center capacity during the next open enrollment season starting Nov. 15.

“We had call response times that were far too long,” said Peter Lee, the exchange’s executive director. “We were swamped.”

Many consumers and insurance agents have complained about the exchange’s shoddy customer service and long hold times. In August, the exchange answered 1% of calls within 30 seconds, far short of its 80% goal.

The average wait time was under five minutes Thursday, according to the exchange.

Let me get this right, the Covered California has a 5 minute wait time and we’re not even in open enrollment? Best of luck for open enrollment.

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Obamacare was supposed to reduce deficits

CBO Projections Indicate Obamacare Will Raise Deficits by $131 Billion | The Weekly Standard.

In all, therefore, CBO projections indicate that Obamacare will increase deficit spending by $131 billion from 2015-24.  That’s a $311 billion swing from the extrapolated 2012 numbers, a $240 billion swing from the actual 2012 numbers, and a $255 billion swing from what we were told when Obamacare was passed.

Polling has consistently shown that Americans do not believe that Obamacare, with its roughly $2 trillion in new federal spending, would somehow reduce deficit spending.  To the contrary, they believe it would send deficits soaring.  Still, it’s good to know that even the CBO, which has been one of Obamacare’s few friends in this regard, now seems to think Obamacare would increase deficits by over $100 billion.

It seems relatively safe to say that Obamacare — which Democrats passed over unanimous Republican opposition with just three votes to spare in the House and without a single vote to spare in the Senate — wouldn’t have passed had it been scored as a deficit bill.  It likewise wouldn’t have passed if its 10-year price-tag had been doubled, if people had been told they couldn’t keep their insurance or their doctors, or if they’d been told Obamacare would provide taxpayer funding of abortion-on-demand.

Are you surprised? I know I’m not.

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