Tag Archives: broken promises

Shared Eligibility System: Who IS in charge?

Who’s in charge of the Shared Eligibility System (SES)? Balance of Power: De-glitching Colorado healthcare. Former Connect for Health Colorado Ellen Daehnick, who was terminated as a board member by Governor John Hickenlooper, discusses the enrollment issues, incompetence and general overall accountability issues that exist at Connect for Health Colorado and whomever is in charge of the Shared Eligibility System. Video, and text, at link.

The main topic of discussion is the Shared Eligibility System (SES) and the overall lack of accountability.

In her roughly year-and-a-half on the board of Connect, she says she couldn’t get answers to basic questions like this about the systems like SES, which were implemented to make the exchange work.

“You don’t have a responsible individual or entity, you don’t know who’s at fault, or who has the power to fix the problem,” Daehnick said. “You want to know who has the power to fix this and make it better.”

Apparently no one. It would be really nice if the Democrats would stop protecting the whole Connect for Health, Medicaid, Colorado Peak infrastructure but they continue to live in a fantasyland.

But committee Democrats defended the exchange’s performance as impressive— starting from scratch in a complex regulatory environment, they said.

You can’t make this stuff up. Getting back to the SES and Ms. Daehnick, I agree with every word spoken by her. Governor Hickenlooper better have a damn good reason for “firing” her. SHINE THE LIGHT on the problem Gov.

As a broker I or my clients have encountered numerous problems with Connect for Health (or SES or Medicaid, take your choice). Very few have been directly addressed by a specific person. One way or another we worked it out, but it takes hours of unproductive time and effort. I don’t see how 2016 open enrollment can be any worse.

 

Share

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.

Share

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.

Share

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.

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

An Obamacare supporter’s misadventures with HealthCare.gov

An Obamacare supporter’s misadventures with HealthCare.gov | The Daily Caller.

Our troubles may strike some as trivial and particular, although they wouldn’t if it happened to them. And anyone who wants a successful system – as we do – must understand that these nightmares are happening across the nation to the very people who want Obamacare to work.

This story appears to be the Deliverance version of signing up for Obamacare.

Unfortunately, having dealt with many clients, it’s all to believable.

  • Restricted provider networks
  • Restricted formularies
  • Complicated subsidy eligiblity
  • Possibly higher premiums

All of the above are gifts of Obamacare.

If you don’t qualify for a subsidy or it is very small, my recommendation is:

  • Do NOT use the exchange
  • Contact a broker
  • Purchase directly from the carrier, which will also avoid security issues with the exchange websites.
Share

New low for Obamacare

CNN Poll: Health care law support drops to all-time low – CNN Political Ticker – CNN.com Blogs.

Only 35% of those questioned in the poll say they support the health care law, a 5-point drop in less than a month. Sixty-two percent say they oppose the law, up four points from November.

Nearly all of the newfound opposition is coming from women.

“Opposition to Obamacare rose six points among women, from 54% in November to 60% now, while opinion of the new law remained virtually unchanged among men,” CNN Polling Director Keating Holland said. “That’s bad news for an administration that is reaching out to moms across the country in an effort to make Obamacare a success.”

According to the survey, 43% say they oppose the health care law because it is too liberal, with 15% saying they give the measure a thumbs down because it is not liberal enough. That means half the public either favors Obamacare, or opposes it because it’s not liberal enough, down four points from last month.

Sixty-three percent say they believe the new law will increase the amount of money they personally pay for medical care, which may not be a good sign for a law known as the “Affordable Care Act.”

No fooling. The troubling issues is anyone with a brain could have figured out that higher prices were coming. I’ll stop there.

Share

You better check once, better check twice

Can you keep your doctor? Healthcare.gov can’t tell consumers whether they can keep their doctors | WashingtonExaminer.com.

 Waltman said federal cost-cutting pressures on insurers are forcing them to reduce the number of doctors and other providers in their networks.

The result is that consumers must choose among provider networks with fewer doctors and hospitals.

That means many consumers who join the Obamacare exchanges won’t be able to keep their doctors despite President Obama’s repeated promise to the contrary.

Dave Berman, an independent insurance broker in Indianapolis at the brokerage firm Neace Lukens, said people could become confused if they expect their current insurance firm to offer the same network through Obamacare.

“It’s going to be very confusing to consumers who may be used to an insurance company and not knowing that they are going into a restrictive network,” Berman said

You must, must, must check your network. Not just the insurance company but the netowork that is being offered with the plan being purchased. If you are purchasing a plan from healthcare.gov or a state exchange this is critically important.

 

 

Share

We have a lot of work left to do in the next few days,”

says CMS spokesperson Julie Bataille. – No Thanksgiving Celebrations for Obamacare Website Team as Deadline Nears | TIME.com.

By my calculations there are 5,000,000 people who need to replace their insurance plans, not to mention new applicants that don’t have coverage. The number of days between Dec 1 and Dec 23 is… 23. That means on average, 217,000 people a day need to sign up.

 

NOT GONNA HAPPEN

Share

Students suffer ObamaCare sticker shock as premiums soar, plans get cut

Talk about biting the hand that votes for you: Students suffer ObamaCare sticker shock as premiums soar, plans get cut | Fox News.

Anyone with a brain could have seen this coming. Unfortuantely, that leaves out the lapdog mainstream media… and apparently the students themselves.

The sticker shock didn’t sit well with some students who spoke out against the price hike.

“You’ve haven’t done anything Obama and I am disappointed in you,” one student said. Another told Campus Reform, “We don’t have that money. We can barely afford books.”

The frustration has been felt across the country as colleges and universities have to decide whether to cut coverage or offer sky-high plans that in some cases triple the cost of premiums.

Remind me again students, who did you vote for?

Share

Study: Insurance costs to soar under Obamacare

Study: Insurance costs to soar under Obamacare – CBS News.

New research from the Manhattan Institute estimates that insurance rates for young men will rise by 99 percent. Rates for younger women will rise between 55 percent to 62 percent, according to the right-leaning New York think tank.

The precise impact of the new health law is likely to vary markedly from state-to-state, however. That’s largely because different states have had different requirements for what had to be included in health insurance policies in the past. The Affordable Care Act, commonly known as Obamacare, overrides these rules and sets a federal overlay that demands a wide array of mandatory coverages. The Manhattan Institute has drawn up an interactive map that may help forecast the rise in cost for individuals.

Avik Roy of the Institute and Forbes magazine columnist notes…

“You hear all these excuses from the [Obama] administration — that people are exaggerating the effect of the law,” he says. “But real people are getting notices from their insurers now. My blog is flooded with comments from people saying that they just got a huge premium hike.”

Then there’s the “keep your policy promise…

Additionally, the promise that you could keep your old policy, if you liked it, has proved illusory. My insurer, Kaiser Permanente, informed me in a glossy booklet that “At midnight on December 31, we will discontinue your current plan because it will not meet the requirements of the Affordable Care Act.” My premium, the letter added, would go from $209 a month to $348, a 66.5 percent increase that will cost $1,668 annually.

The conclusion…

“This is a redistribution of wealth from the healthy to the sick, from the young to the old, from the people who have always had insurance to the uninsured,” Roy said.

A standard policy for wellness and catastrophic coverage for an unexpected, unavoidable ailment or accident could have been provided for a fraction of what Obamacare coverage costs, Roy added. “Obamacare forces insurers to offer products that carry all sorts of bells and whistles that most people don’t want but everyone will now need to pay for.”

Of couse the overriding question is: “Why don’t these people have insurance”? And there are a wide variety of answers….

  • Once they see even todays rates, many people decide their fortune telling crystal ball is very clear and they can see the future. Their vision of the future tells them there is no need for insurance. Translated: They don’t see the value.
  • There is certainly a group that can’t afford the premiums
  • The “pre-existing conditions” issue. Keep in mind almost all states have (or had) state risk pools to cover those who couldn’t qualify for private individual plans. Of course affordability could still be an issue.
  • There is a group of people who decide that using the ER is the best way to receive medical care and purposely don’t have insurance.
  • And finally the group that expects the government to provide it.

The solution for all of these people is apparently Obamacare which provides:

  • Extensive up front coverage, although deductibles can be fairly high
  • Guaranteed issue with no medical underwriting
  • The 10 “essential” health benefits
  • Subsidies for applicants with household incomes in the 133% – 400%  range of the Federal Poverty Level (FPL)
  • Does very little if anything at all to lower the cost of medical care
  • Has led to Hospitals buying private practices leading to higher costs of medical treatment. (For example, if your doctor prescribes an MRI, that send you to the hospital he’s associated with. Any idea what the most expensive facility to get an MRI or CT scan is? Yep, you guessed it.
Share

Obamacare limited networks: I thought you could keep your doctor….

Turns Out Obamacare Is Going to Limit Your Choices – Bloomberg.

Once again we’re talking about the Obamacare limited networks. This excerpt pretty much sums it up…

The first time a cute child’s limited policy keeps him out of a top-notch research hospital, that kid’s parents, and the activists for whatever disease he has, are going to turn him into a poster child on the nightly news.

My daughter has been in and out of Children’s Hospital in Aurora seven times. We’re not talking a visit for lab work or a simply out patient procedure. We’re talking 7 visits with multi-night stays. Now I have no idea if Children’s is in the available Colorado Heatlh Marketplace networks or not, but in general, that is the type of facilty that is being left out to control costs.

Share