Tag Archives: affordability

People refusing Government Cheese

Americans Protest Obamacare by Refusing Health Insurance Subsidies – US News.

She wanted to keep the catastrophic health insurance plan she once had, which she says fit her needs. But under the Affordable Care Act, the government’s health care reform law, the plan was discontinued because it did not comply with the law’s requirements, and her bills doubled to more than $400 a month. “I wanted a minimal plan and I’m not allowed to have it,” she says. “That seems like an encroachment on my freedom.”

….

Though Brewer could pay less for a plan if she were to accept a subsidy from the federal government, she refuses. “I want to pay my own way,” she says. “I will not take a handout.”

Kudo’s to Grace Brewer and her refusal of Government Cheese. Unfortunately, for many, it is simply impossible to pay afford coverage at all with accepting a subsidy. That said, my experience is very similar to the broker quoted in the article…

Her sentiment is unusual, but brokers say they do hear from clients who are eligible for subsidies – which are based on household income and not assets – but want no part of them.

Yep unusual. Back to Government Cheese….

Share

Victims of Obamacare

Michelle Malkin | » Obamacare’s Annus Horribilis.

Michelle reminds us of all the promised benefits of Obamacare…

Let’s start with premiums. President Candy Land promised that he’d “lower premiums by up to $2,500 for a typical family per year.” But premiums for people in the individual market for health insurance have spiked over the last year. In fact, Forbes health policy journalist Avik Roy and the Manhattan Institute analyzed 3,137 counties and found that individual market premiums rose an average of 49 percent.

A legitimate question to ask is over what period of time did the 49% increase occur. I heard in one of the Fox news business block programs this morning that it was over 5 years. (See bottom of article for clarification) If that’s the case, as a stand alone issue it’s not that bad. There is no doubt there was a large spike in premiums due to Obamacare mandates. Summing up the meaning of “Affordable”…

“Affordable” doesn’t mean what White House truth-warpers says it means — just like everything else they’ve spewed about the doomed federal takeover of health policy in America.

…. and I am in full agreement.

Medicaid cuts…

Analysts on all sides of the debate agree that massive cuts in Medicaid payments to primary care doctors, which take effect on Jan. 1, will reduce patient access. Meanwhile, a Commonwealth Fund survey found that 26 percent of American adults waited six days or more to see a doctor — with only Canada and Norway performing worse. A separate physicians’ staffing company’s poll, reported by the left-wing New York Times, found that patients “waited an average of 29 days nationally to see a dermatologist [,] 66 days to have a physical in Boston and 32 days for a heart evaluation by a cardiologist in Washington.”

Translation: If you like your doctor, it doesn’t mean you’ll get to see your doctor. Tick, tick, tick.

I’m assuming these waiting times are for Medicaid patients?

She then addresses the insurance company bailouts ($1B) and the faltering Health Insurance Coops.

The silver lining?

One silver lining: A total of 16 Senators who voted for the federal health care takeover either failed to win re-election or declined to run for re-election.

Good riddance to them and farewell to Obamacare’s annus horribilis.

Regarding premium increases, I found Avik Roy’s analysis of Obamacare premiums. The linked article does not summarize the results nationwide, but he does mention increases from 2013-2014:

Last November, our team at the Manhattan Institute published a study indicating that Obamacare had increased the underlying cost of individually-purchased health insurance in the average state by 41 percent in 2014, relative to 2013. (emphasis added)

You can check out your own sitation with the interactive map: What Will Obamacare Cost You?

Share

Dilemma over deductibles: The flip/flop in health care..

Dilemma over deductibles: Costs crippling middle class.

Physician Praveen Arla is witnessing a reversal of health care fortunes: Poor, long-uninsured patients are getting Medicaid through Obamacare and finally coming to his office for care. But middle-class workers are increasingly staying away.

“It’s flip-flopped,” says Arla, who helps his father run a family practice in Hillview, Ky. Patients with job-based plans, he says, will say: ” ‘My deductible is so high. I’m trying to come to the doctor as little as possible. … What is the minimum I can get done?’ They’re really worried about cost.” (emphasis added)

The issues is deductibles…

A recent Commonwealth Fund survey found that four in 10 working-age adults skipped some kind of care because of the cost, and other surveys have found much the same. The portion of workers with annual deductibles — what consumers must pay before insurance kicks in — rose from 55% eight years ago to 80% today, according to research by the Kaiser Family Foundation. And a Mercer study showed that 2014 saw the largest one-year increase in enrollment in “high-deductible plans” — from 18% to 23% of all covered employees.

Meanwhile the size of the average deductible more than doubled in eight years, from $584 to $1,217 for individual coverage. Add to this co-pays, co-insurance and the price of drugs or procedures not covered by plans — and it’s all too much for many Americans.

I have to say, I would LOVE to have a plan with deductibles this low. Perhaps the issue is the expectation of the typical American that someone else is supposed to pay for all of their health care.

All that said, I can confidently state that a large portion of my clients have substantially larger deductibles than the averages mentioned above and I can see them delaying medical care.

Moving on the article asks the important question, albeit a bit to generally: “Why is this happening?”

Why is this happening? Many patients and doctors blame corporate greed — a view insurers and business leaders reject. Some employers in turn blame the Affordable Care Act, saying it has forced them to pare down generous plans so they don’t have to pay a “Cadillac tax” on high-cost coverage in 2018. But health care researchers point to a convergence of trends building for years: the steep rise in deductibles even as premiums stabilize, corporate belt-tightening since the economic downturn and stagnant middle-class wages.

“It’s a case of companies trying to offer workers health insurance and still generate profit,” said Eric Wright, a professor of sociology and public health at Georgia State University. “But whenever costs go up for the consumers across the board … it promotes a delay in care.”

Others disagree, saying that when people pay for their care, they shop more intelligently. Chris Riedl, Aetna’s head of product strategy for its national accounts, says her company’s research does not indicate that insured patients are showing up sick in emergency rooms with long-neglected illnesses — which to her means, “intuitively, they’re not avoiding care.”

But many doctors contend it’s only a matter of time before the middle class begins crowding ERs. They say putting off care can be dangerous, exponentially more costly and, if it continues and spreads, can threaten the health of the nation.

Read the whole thing. This is a fairly well rounded article that takes a look from all sides.

 

Share

An Angry Dad’s Reaction to Dr. Gruber

Articles: An Angry Dad’s Reaction to Dr. Gruber.

As you read this, remember a few of the many promises such as:

  • If you like your doctor you can keep your doctor
  • Obamacare will lower premium by $2500 for a family of 4

In it’s entirety….

If you know what’s good for you Jonathon Gruber, you’ll stay the hell away from me. Why? Because you have done the unpardonable in the eyes of any father – you have brought havoc unto the finances of my youngest daughter – and her newlywed husband.
You see, Dr. Gruber, what you did not only harmed millions of Americans – many of them young – you did so based on arrogance. This is you on all of those videos – glibly counting your fellow citizens as fodder for your tortured contrivances that will ruin, or end, their lives in many cases – without any remorse or perspective whatsoever. This is a damnable quality held by many who hang out in the faculty lounge. And you are obviously eaten up with it.
As an MIT professor, it is your place to do so, and our place as unfortunate rubes to just deal with it.
This faux superiority is obviously what was rolling around in your head as you made statements about the “stupidity” of the voters and the “lack of transparency” being a plus – not to mention the need to lie about the loss of coverage options and doctors. These were no accidents. As Trey Gowdy pointed out in the Issa Committee hearing, you said such things over and over again. As Darrell Issa added, these statements were apparently popular with your audiences as well.
I submit that you’re detestable with no business whatsoever making grand plans for your planned utopian society. And yet, due to many flaws in our political system – some escalated in just the past six years – you can and you do. These plans never work, and yet, you are paid grotesque sums of money to dream them up.
As you told the Committee Tuesday – in a Lois Lerner-esque tone — millions of people losing their current coverage was merely “part of the calculation.” Part of the calculation? That’s all this is to you, a mathematical projection?
You arrogant bastard!
These are real lives we are talking about here. And in the case of Congressman Patrick McHenry – whose question prompted your telling response – we’re talking some 473 thousand real lives in his state of North Carolina alone! If the ratios hold, that’s some 12 million nationwide! And that’s before the wave of cancellations that are taking place right now.
Well let me tell you about this damned calculation. My 23 year old daughter, like many others, is facing a tripling, or maybe a quadrupling – or her contribution to her work place provided coverage. Calculate that you smarmy SOB. Yes, I said tripling or maybe quadrupling. The figures are not final yet. She cannot afford this, as the increase alone will swallow about 20% of her take home pay. She is not alone.
And why is this? Well, it is all just part of the calculation. You see, the magnificent bureaucrats who slither to and from government cubicles every day have deemed that the former coverage isn’t up to Obama Care standards. Never mind that the boss liked it, the employees liked it – the doctors and pharmacies liked it – all of this is academic.
Yep, those bureaucrats under Kathleen Sebelius at HHS didn’t like it. You knew this would happen. You admitted it. You and your ilk designed the excuses they could use to consider plans inferior. But hey, just part of the calculation, like you said.
What I would like to know, given that you are this renowned central planner, is can you name any example in world history where such centralized planning over a huge swath of a nation’s economy ever worked out? When have the decisions of a handful of supposedly expert technocrats ever been superior to hundreds of millions of people acting in liberty and in their self-interests?
Never.
Although I suppose you swat this reality aside with the self absorbed idea that if you had been planning – say Cuba, the Soviet economy, etc – it would have all worked. This is the luxury academics have. You can pontificate all day about how things should be done, knowing that you’ve never tried to actually do them yourself.
Until something screwy happens in our politics and society, and suddenly you can do them. You are allowed to design a health care plan that you insist is a utopian dream come true. Sure, there will be some collateral damage – a few lives ruined – but that’s all just part of the calculation. And hey, if we have to lie to get the thing passed, so be it. The ends always justify the means for tyrants.
Of course, this grand scheme of you is crashing and burning, as the daily headlines demonstrate. The rollout was a disaster; more people have lost their current coverage than have signed up as new enrollees, and prices and deductibles are skyrocketing. There are looming doctor shortages of massive proportions. Today less than 35% of physicians consider themselves independent, as compared to over 60% just a few years ago. You and your minions were going to do all of this better than the private sector. Well I’ll say this about the private sector – normally when deductibles skyrocket in private insurance, the premiums come way down and the coverage limits go up.
In other words, doc, you failed. You lied to get your way, you smirked arrogantly about it, and now your scheme is an abject disaster. The only saving grace is that your words, specifically those about the state exchanges, will probably doom ObamaCare in the Supreme Court. If this happens, know full well that your viral video infamy also played a role.
Yes Mr. Professor from MIT, you will probably do more to doom ObamaCare than any other single human alive – and it was your insufferable pomposity that did it. That will be even more satisfying than anything I could do to you.
Share

High deductibles and skipped care

Skipped care a side effect of high-deductible health plans | Local News | The Seattle Times.

Cammi Chase was thrilled to think she had solved the conundrum that is individual health insurance. Thanks to the Affordable Care Act and federal subsidies, last December Chase moved her family from an $800-a-month plan to one that cost about $240.

“I felt like we hit the jackpot,” she said.

But last spring when Chase was struck with an unexpected illness, the Seattle woman was shocked to realize how little her new health insurance plan — a Health Savings Account (HSA) with a deductible of roughly $5,000 — would cover.

Sorry, I’m confused. Why was she shocked? Does she not understand that a plan with a $5000 deductible means that the first $5000 is coming out of her pocket? Does she not realize that $5000 is a large amount of money?

The problem is that most clients can’t or won’t allow themselves to imagine that their health can take a turn for the worse, either via an accident, an unexpected illness or the development of a chronic condition. It just happens to other people. They see the low premium, which of course is a fixed cost, get an insurance card, avoid the penalty and they’re happy. They either believe they won’t become seriously ill or injured in an accident OR they think the insurance plan will change into a better plan if something happens to them.

Reading on, we see that Cammi was “banking that her health would be good”…

“I heard from the rumor mill that an HSA was the way to go because I’m self-insured,” Chase said. “I was really banking that my health would be good.” (emphasis added)

In the spring, after experiencing memory problems and swollen joints, Chase was diagnosed with latent Lyme disease.

“Immediately it included a lot of [doctor’s] visits and a lot of medication and monthly tests and lab work,” Chase said. And most of it wasn’t covered by her plan. “Every time I walk in I pay for the office visit, which is $165 each month.”

Let’s stop a moment here and note she said “most of it wasn’t covered by her plan.” Most likely that is not technically correct. I suspect the following occurred:

  • She received a network discount for the cost of her treatment
  • The amount she paid was applied towards her $5000 deductible

Of course, this situation could have been further complicated if she was seeing out of network doctors, but that’s an issue for another day.

For 2015, she used an agent, which is a path that I (of course) endorse and the result…

A financial person at her doctor’s office referred Chase to Sarah Freeman, a Seattle insurance broker who helped her find a new plan for next year. At $325 a month, the Premera Blue Cross plan she found costs a little more than her current plan, but it will pay more of her bills.

For now the family can afford the higher premiums, Chase said, but “I just hope it doesn’t continue to rise.”

A different broker mentioned in the article comments…

Despite the risks, Feltzs predicted the cheaper plans with higher deductibles will still be popular.

“I sell them all day because those plans do work for people who say they don’t go to the doctor or they rarely go,” said the broker. “They say, ‘I want to avoid the penalty [for being uninsured] and in the event that something does happen, I don’t want to break the bank.’?”

Which is a story I hear everyday as well. In the future I’m going to send this article to clients that are looking at bare bones plans.

One final note, it may seem that I’m being harsh on Cammi. I wish her nothing but the best, especially since Lyme disease can be a very serious condition with expensive medications. She is a very good example of an issue I encounter many times a week.

Share

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?

Share

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.

Share

Obamacare’s winners include older Americans

Obamacare’s winners include older Americans – CBS News.

For many older Americans who lost jobs during the recession, the quest for health care has been one obstacle after another. They’re unwanted by employers, rejected by insurers, struggling to cover rising medical costs and praying to reach Medicare age before a health crisis.

These luckless people, most in their 50s and 60s, have emerged this month as early winners under the nation’s new health insurance system. Along with their peers who are self-employed or whose jobs do not offer insurance, they have been signing up for coverage in large numbers, submitting new-patient forms at doctor’s offices and filling prescriptions at pharmacies.

“I just cried I was so relieved,” said Maureen Grey, a 58-year-old Chicagoan who finally saw a doctor this month after a fall in September left her in constant pain. Laid off twice from full-time jobs in the past five years, she saw her income drop from $60,000 to $17,800 a year. Now doing temp work, she was uninsured for 18 months before she chose a marketplace plan for $68 a month.

Young invincibles need to sign up quickly or the risk pool will be way to lopsided.

Share

What to consider before deciding to go without health insurance

What to consider before deciding to go without health insurance – latimes.com.

Valuable information, except the information regarding why Sarah and her daughter are not eligible for premium assistance in incorrect.

Sarah and daughter are not eligible for a subsidy because her husband’s coverage is deemed “affordable” for him and the plan offers to cover the rest of the family. How much it costs to cover the rest of the family is not relevant to this situation. This is known as the “family glitch”.

If his plan did not offer to cover the rest of the family, then the household income would come into play.

Share

Coverage gap in states that didn’t expand Medicaid

Millions Trapped in Health-Law Coverage Gap – Yahoo Finance.

Bob Miller for The Wall Street Journal Hair stylist Ernest Maiden doesn’t make enough money to qualify for federal subsidies to buy health insurance but also is ineligible for Medicaid.

The 2010 health law was meant to cover people in Mr. Maiden’s income bracket by expanding Medicaid to workers earning up to the federal poverty line—about $11,670 for a single person; more for families. People earning as much as four times the poverty line—$46,680 for a single person—can receive federal subsidies.

But the Supreme Court in 2012 struck down the law’s requirement that states expand their Medicaid coverage. Republican elected officials in 24 states, including Alabama, declined the expansion, triggering a coverage gap. Officials said an expansion would add burdensome costs and, in some cases, leave more people dependent on government.

The decision created a gap for Mr. Maiden and others at the lowest income levels who don’t qualify for Medicaid coverage under varying state rules. The upshot is that lower-income people in half the states get no help, while better-off workers elsewhere can buy insurance with taxpayer-funded subsidies.

This is not an issue with states that expanded Medicaid, of which Colorado is one.

Share

Anthem to raise some premiums as much as 25%

Anthem to raise some premiums as much as 25% – latimes.com.

Thousands of Anthem Blue Cross individual customers with older insurance policies untouched by Obamacare are getting some jarring news: Their premiums are going up as much as 25%.

These increases, 16% on average, are slated to go into effect April 1 for up to 306,000 people — unless California regulators persuade the state’s largest for-profit health insurer to back down.

Amid the fury last fall over canceled health policies, consumer advocates and state officials warned people that holding onto grandfathered policies purchased before the federal healthcare law was enacted in 2010 wouldn’t shield them from significant rate hikes.

The cost of health insurance is not a pretty picture no matter where you look.

Share

Articles: ObamaCare May Devastate the Real Estate and Travel Industries

Articles: ObamaCare May Devastate the Real Estate and Travel Industries.

Check your network and check your doctors. Most Obamacare plans offer restricted networks in state and you are out of network if you are out of state.

Americans are among the most mobile people on earth, but ObamaCare may soon start freezing them in place. Millions are losing their health insurance policies and being forced onto the ObamaCare exchanges, where most plans only provide local medical coverage. As Americans realize they must pay for all non-emergency medical care when they leave their home county, their decisions may have a profound impact on the real-estate market, particularly the second home sector, and on the travel business.

I recently interviewed a woman I’ll call Sue, whose story may become increasingly common. Sue, a 60-year-old retiree, and her husband bought a second home in South Carolina to escape the Connecticut winters. “I had a Blue Cross Blue Shield policy in Connecticut, and I used it with no problem in South Carolina. I found an internist and ophthalmologist and dermatologist down here, and kept the rest of my doctors up north.”

“The price was reasonable. It cost me $450 a month, with a $2,500 deductible. It was slightly more for out of network; there was no co-pay, and I got my prescriptions filled in both states with no problem.”

“Then I got the letter telling me that my policy would no longer exist, because it didn’t comply with the new health care law. They wanted to transfer us into a new plan that doubled my premium to $900 a month. The deductible went up to $3,500, and it covered zero out of network.”

In Colorado, the only companies offering plans with nationwide networks are:

  • Rocky Mountain Health Plans
  • Cigna (only available for purchase in the immediate Denver metro area)
  • Assurant Health

In fact Assurant Health offers plans with nationwide networks in 42 states. HOWEVER, you won’t find them on any Federal or State “Exchange or Marketplace”. That means their plans are not eligible for premium assistance but they are still the same Bronze, Silver, Gold and Platinum plans required by Obamacare.

One issue that bothers me in the above article is this paragraph:

“My husband looked around and finally found a policy that has out of network coverage, but it comes with a very steep price. It’s $900 a month, with a $7,000 deductible and a co-pay on everything. Basically, it’s catastrophic insurance, and I’ll be paying my South Carolina doctors out of pocket.”

The maximum out of pocket per person for any ACA compliant plan is $6350. Either this plan is not ACA compliant (i.e. not a true major medical plan) or Sue is confused about the deductible.

Share