Major insurers in some states are proposing up to 51 percentpremium increases for health plans sold under the Affordable Healthcare and Patient Protection Act, commonly referred to as Obamacare. Despite single digit increases for 2015, insurance companies are seeing their costs jump and are demanding to be compensated with dramatically higher rates.
When Insurance plans proposed 2015 rates last summer, they had only a little information about the health of the new customers they expected to sign up during the fall Obamacare expansion. Big insurers tended to ask for increases of less than 10%, while some smaller insurers tried to under-cut pricing by the major’s to take market share, according to theWall Street Journal.
Under Obamacare, insurers must file proposed premium rates with their local state regulator and the federal government by June. But some states have already started publicly disclosing the premium requests. Due to the high utilization costs from people newly enrolled under Obamacare, the 2016 insurance premiums are about to skyrocket.
According to states that have released rate requests, New Mexico’s market leader Health Care Service Corp. is asking for an average premium spike of 51.6 percent; Tennessee’s top insurer BlueCross BlueShield of Tennessee wants an average spike of 36.3%; Maryland’s market leader CareFirst BlueCross BlueShield is requesting an average spike of 30.4%; and Oregon’s top insurer, Moda Health, is seeking a 25% spike.
A number of states are quietly considering merging their healthcare exchanges under ObamaCare amid big questions about their cost and viability.
Many of the 13 state-run ObamaCare exchanges are worried about how they’ll survive once federal dollars supporting them run dry next year.
Others are contemplating creating multi-state exchanges as a contingency plan for a looming Supreme Court ruling expected next month that could prevent people from getting subsidies to buy ObamaCare on the federal exchange.
The idea is still only in the infancy stage. It’s unclear whether a California-Oregon or New York-Connecticut health exchange is on the horizon.
But a shared marketplace — an option buried in a little-known clause of the Affordable Care Act — has become an increasingly attractive option for states desperate to slash costs. If state exchanges are not financially self-sufficient by 2016, they will be forced to join the federal system, HealthCare.gov.
One-quarter of people with healthcare coverage are paying so much for deductibles and out-of-pocket expenses that they are considered underinsured, according to a new study.
An estimated 31 million insured people are not adequately protected against high medical costs, a figure that has doubled since 2003, according to the 2014 national health insurance survey by the Commonwealth Fund.
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Rising deductibles — even under ObamaCare — are the biggest problem for most people who are considered underinsured, according to the 22-page report.
“The steady growth in the proliferation and size of deductibles threatens to increase underinsurance in the years ahead,” the report warns.
The data is an early warning sign for the Obama administration, which has promised that the millions of people who gained insurance under the president’s law would have affordable access to healthcare.
The survey found that millions of people are paying into the insurance system but are largely unable to reap the benefits.
People who purchase the lowest-quality health insurance are also less likely to see a doctor when they are ill or injured because they fear their high out-of-pocket costs.
“People who have high deductibles do tend to skimp on healthcare,” the study’s lead author, Sara Collins, told reporters.
When people do see a doctor, the costs accumulate quickly.
Half of underinsured adults and 41 percent of privately insured adults with deductibles of $1,000 or higher were paying off accumulated medical bills of $4,000 or more, the report found.
MAY 14, 2015, 11:38 PM LAST UPDATED: THURSDAY, MAY 14, 2015, 11:45 PM
BY LINDY WASHBURN AND DUSTIN RACIOPPI
STAFF WRITERS |
THE RECORD
Pushback came from many sides Thursday as Democratic lawmakers in Trenton unveiled a plan to corral high out-of-network charges and protect consumers from surprise medical bills when they go to the hospital.
A chain of Hudson County hospitals called the bill “a massive gift to large insurance companies.” The state medical society said it would have “a dangerous and deleterious effect on health care quality in New Jersey.” It labeled a provision that would have an arbitrator settle billing disputes “an insult.”
Hundreds of millions of dollars is at stake as the measure seeks to limit the amount hospitals and doctors can charge for their services. The measure calls for full written disclosure of expected charges for hospital patients and creation of a database to set the limits on what out-of-network providers can charge insurance companies. It would prevent patients from being charged more than the in-network rate for any service when they chose an in-network hospital and doctor for their care.
The savings — to patients, insurers, and those who pay for insurance coverage, including state and local governments and school systems — could be enormous. Opponents, however, say it could drive hospitals and doctors out of business.
MAY 13, 2015, 8:18 PM LAST UPDATED: WEDNESDAY, MAY 13, 2015, 8:24 PM
BY LINDY WASHBURN
STAFF WRITER |
THE RECORD
Consumers would be protected from surprise medical bills when they go to the hospital under a measure to be unveiled Thursday in Trenton by a group of powerful Democratic lawmakers.
Out-of-network charges to insurers would be capped. And in an unprecedented push for transparency, the state would publish a list of the average prices for almost every service, based on data the insurers would be required to submit. When hospitals or doctors and insurers disagree on the appropriate amount for an out-of-network bill, the measure calls for “baseball arbitration” — a state-appointed arbitrator to choose one side’s final offer.
The financial stakes are enormous, and a high-powered offensive from those whose revenues or income would be diminished by the measure is expected, including specialist physicians and hospitals.
“I think it’s going to be a fight,” for passage, said Assemblyman Gary S. Schaer, a Passaic Democrat who chairs the Assembly Budget committee and helped draft the “The Out-of Network Consumer Protection, Transparency, Cost Containment and Accountability Act,” to be introduced today at a noon news conference.
But he pointed to the high-ranking Democrats who drafted the legislation, including state Sen. Joseph Vitale, chairman of the Senate Health Committee, and Assemblyman Craig Coughlin, chairman of the Assembly committee in charge of health insurance, both Wood-bridge Democrats — as well as Assemblyman Troy Singleton of Mount Laurel. Schaer is chairman of the Assembly Budget Committee.
Most lawmakers are expected to agree, he said, that “significant remedial action needs to be undertaken to tackle this issue, which contributes a lot to the rise in health-care costs,” as well as bankruptcies among state residents.
An important way insurance companies control costs is by negotiating contracts with hospitals, doctors, and other health-care providers who agree to accept their reimbursement and become part of their network. Some health plans include coverage for care received from providers who are not part of the insurer’s network.
The out-of-network charges billed by some New Jersey hospitals are among the highest in the country, and insurers say that they drive up premiums for everyone. In addition, patients who receive care from hospital-based physicians – over whom they have no choice – often are surprised to learn that they were out-of-network providers and charge much more than expected.
MAY 10, 2015, 2:55 PM LAST UPDATED: MONDAY, MAY 11, 2015, 12:28 AM
BY LINDY WASHBURN
STAFF WRITER |
THE RECORD
A Franklin Lakes couple did everything possible last fall to stick to their insurance company’s rules when their baby was born.
To keep out-of-pocket costs to a minimum, they chose an obstetrician and a hospital that were part of their health insurance plan. When Brenda Cristiano required a C-section after a long labor, they thought they were covered.
But a few weeks later, they received a bill from the anesthesiologist — for $1,852.
It turns out that no anesthesiologist practicing at The Valley Hospital in Ridgewood, where GianLuca was born on Oct. 15, accepts Cigna, their insurance plan. So even though the Cristianos used an in-network hospital and in-network obstetrician, they could not avoid out-of-network charges.
It happens over and over again: Hospital-based physicians — whom patients are powerless to choose — do not participate in some or all of the insurance plans a hospital accepts and end up demanding additional payment from patients for their fees. Surprise medical bills from anesthesiologists, emergency-room doctors, pathologists and radiologists, among others, have led to complaints and appeals and forced consumers to pay thousands more than they expected.
Many consumers wind up deeply in debt when they are billed out-of-network rates, said Chuck Bell, director of programs at Consumers Union, the publisher of Consumer Reports. “Patients are trying hard to play by the rules, to use provider directories and stay within the network,” he said. “It seems that the system is not fair. It does not make it easy for patients to do that.”
These concerns are driving an effort by some New Jersey lawmakers, who plan to submit legislation this week to overhaul the way out-of-network providers and their bills are regulated in New Jersey. Nationwide, nearly one in three Americans with private insurance received a surprise medical bill, in which their health plan paid less than they expected, in the last two years, a Consumer Reports survey found. Of those, nearly one in four received a bill from a doctor whom they didn’t expect to bill them.
The Cristianos went to the hospital to have a baby, and inadvertently stumbled into a crossfire of competing interests, including those of doctors, the facility and their insurance company. For the businesses involved, the stakes are high. Mutual mistrust abounds. Patients are left unprotected, accepting care from physicians whose network status and fees they do not know. The one thing all agree upon is that there has to be a better way.
Anthony Cristiano, a financial services executive, has been sued over his failure to pay the bill from Bergen Anesthesia Group — and he’s hired his own lawyer to fight back.
“The fact that this organized monopoly of … doctors has the local hospital and the residents of Bergen County hostage needs to stop,” Cristiano said. “Valley should be required by law to have a medical specialist on staff, or available” who accepts every insurance plan the hospital does, he said. Otherwise, he said, it “cannot be called an in-network hospital.”
Megan Fraser, Valley’s spokeswoman, said the hospital does not require physicians who practice at its facilities to participate in the same insurance networks the hospital does. However, she said the hospital does “encourage our doctors to negotiate with the plans in which Valley participates and suggest that they be transparent with their patients regarding what plans they do and do not participate in.”
Bergen Anesthesia Group did not respond to repeated requests for an interview, but the head of the state doctors’ association said the issue was “much more complicated than it seems on the surface.”
Doctors don’t have the bargaining clout with insurance companies that a hospital like Valley does, said Lawrence Downs, chief executive of the Medical Society of New Jersey, because insurance companies know the hospital is essential to their network. In contrast, “the terms and conditions the anesthesiologists are offered may be very poor,” he said. “They may not meet the financial needs of the group, or the terms may be objectionable. They have no ability to negotiate that — they are not part of the hospital.”
The health law was supposed to reduce pressure on emergency care facilities. It hasn’t.
Peter Suderman|May. 4, 2015 2:40 pm
In September, 2009, President Obama gave a prime time speech to the joint Congress making the case for the health care law that would come to be known as Obamacare. Much of the speech was devoted to explaining and justifying the law’s major components. Subsidies, he argued, were necessary to ensure that health coverage would be affordable enough that people would actually buy it. The individual mandate requiring most people to maintain coverage was necessary to ensure that free-riders didn’t take advantage of the law’s regulations and subsidies to wait until sick before purchasing coverage.
“Such irresponsible behavior costs all the rest of us money,” Obama said. “If there are affordable options and people still don’t sign up for health insurance, it means we pay for these people’s expensive emergency room visits.”
Nearly six years later, the mandate is in force, and the subsidies are offsetting a hefty chunk of the premiums for most of the people who’ve gained private coverage through the law’s exchanges. Millions of people have been covered by the law; last month, Gallup reported that the national uninsurance rate had dipped to its lowest point since 2008.
And yet in the time since Obamacare’s major coverage expansion has kicked in, the number of emergency room visits has not gone down. Nor has it held flat. Instead, it appears to be growing, perhaps quite a bit, according to a survey of nearly 3,000 ER doctors notedin The Wall Street Journal.
Premiums are rising rapidly and the young and healthy are bailing out
By Sean Parnell – – Thursday, March 26, 2015
The Supreme Court decision in King v. Burwell, the case challenging the Obama administration’s decision to award tax credits for health insurance sold through federally established exchanges, could turn on the question of whether a ruling that ends the tax credits on federal exchanges might cause something known as a “death spiral” in health insurance markets.
The good news is the answer is probably no, but the bad news is that’s only because the death spiral has probably already started.
A death spiral generally occurs when insurers are forced to raise premiums sharply to pay promised benefits. Higher premiums cause many of the healthiest policyholders, who already pay far more in premiums than they receive in benefits, to drop coverage.
When healthy policyholders drop coverage, it leaves the insurer with little choice but to raise premiums again because they now have a risk pool that is less healthy than before. But another premium increase means many of the healthy people who remained now drop their policies, too, and this continues until the only people willing to pay the now-very-high premiums are those with serious medical conditions.
The death spiral isn’t just a theory. Eight states learned this the hard way in the 1990s when they enacted two policies known as “community rating” and “guaranteed issue,” requiring health insurers to sell coverage to anyone who wanted it at the same price.
This quickly set off a death spiral because people knew they could wait until they were sick or injured to buy insurance, and premiums rose sky-high as healthy people exited the individual insurance market while the sick remained.
March 28, 2015, 11:13 AM Last updated: Saturday, March 28, 2015, 11:15 AM
By DONNA GORDON BLANKINSHIP
Associated Press
SEATTLE (AP) — The federal health care overhaul is leading some colleges and universities to get out of the health insurance business.
Experts are divided on whether this change will be good or bad for students. Some call it an inevitable result of health care reform and a money-saver for students since insurance in the marketplace is usually cheaper than the college plans. Others worry that more students will go without health insurance since their premiums won’t be folded into the lump sum they pay for school, and they say college health plans offer more coverage for the money than other options.
The main driver of colleges getting out of the insurance business is a provision in the Affordable Care Act that prevents students from using premium tax subsidies to purchase insurance from their college or university, according to Steven M. Bloom, director of federal relations for the American Council on Education, a Washington, D.C., group representing the presidents of U.S. colleges and universities.
Add to that the provision that allows young people to stay on their parent’s health insurance plans until age 26, plus the expansion of Medicaid in some states and the rising cost of student insurance. The result is cheaper health insurance available for students off campus.
But Bloom worries more schools will decide to drop insurance coverage..
Reader says starting in 2018 the BoE and the Village will start having to pay a 40% tax on top of those benefits just because they are so valuable
But let’s raise taxes more to pay to subsidize all of the annual increases in healthcare premiums for our BoE and Municipal employee, right? While they pay a minimum amount out of pocket for what are classified as “platinum” plans under the ACA, the rest of us are paying for both our own health care coverage and then subsidizing public workers – how on earth is this fair? And starting in 2018 the BoE and the Village will start having to pay a 40% tax on top of those benefits just because they are so valuable, worth well over $22,000 according to divorce settlement findings on the value of the health plans. Why are Village taxpayers footing all of the annual increase, which was almost $700K (+12% compared to 2013) just for our municipal employees in 2014? This taxpayer give away has to stop, as this article says, we’re already have the fifth-highest average property tax bill in the nation and pay well over 2% of our property value annually in property taxes… we’re literally being taxed to death to pay for essentially free health care benefits. This has to stop.
Gruber billing referred to Vermont attorney general
APRIL BURBANK, Free Press Staff Writer 4:26 p.m. EST February 23, 2015
Vermont officials ignored “obvious signs” of problematic billing by health care economist Jonathan Gruber, the state auditor said in a memo released Monday.
Gruber’s invoices lacked important details and claimed dubious numbers of work hours as he prepared economic models for a single-payer health care system — but state officials failed to scrutinize the invoices, Auditor Doug Hoffer wrote.
Hoffer said he was referring the matter to Attorney General William Sorrell.
Gruber said Monday he had no comment. Gov. Peter Shumlin’s spokesman, Scott Coriell, referred a request for comment to Administration Secretary Justin Johnson.
“We don’t believe that the work was overstated, in part because we were dealing with Dr. Gruber on a daily basis, and he was doing the work that we asked him to do,” Johnson said.
Feds sent incorrect tax information to 800,000 people on ObamaCare
By Peter Sullivan and Sarah Ferris – 02/20/15 10:26 AM EST
The administration sent the wrong tax information to 800,000 people who have enrolled in ObamaCare, officials announced Friday.
The information used to calculate subsidies was wrong on about 20 percent of tax forms, an error that could delay tax refunds for thousands of people.
Administration officials stressed that the vast majority of HealthCare.gov customers received the correct forms, and White House spokesman Josh Earnest said the issue impacted “a very small fraction of people.”
But the tax glitch quickly provided new ammunition for Republicans, who continue to argue that the healthcare law is fatally flawed.
“Surprise, surprise, the Obama administration still does not have its act together,” Rep. Marsha Blackburn (R-Tenn.), vice chair of the House Energy and Commerce Committee, wrote in a statement.
She said the new problems offer more proof that the IRS should be kept out of healthcare, and pledged to redouble her efforts to repeal the ObamaCare insurance penalty entirety.
“The Obama administration has built a healthcare law so complex, so confusing, and so costly that even they don’t know how to properly administer it,” Rep. Diane Black (R-Tenn.) added in a statement just minutes after the error was disclosed.
Democrats seek relief from health law penalties
By RICARDO ALONSO-ZALDIVAR, Associated Press
WASHINGTON (AP) — The official sign-up season for President Barack Obama’s health care law may be over, but leading congressional Democrats say millions of Americans facing new tax penalties deserve a second chance.
Three senior House members told The Associated Press that they plan to strongly urge the administration to grant a special sign-up opportunity for uninsured taxpayers who will be facing fines under the law for the first time this year.
The three are Michigan’s Sander Levin, the ranking Democrat on the Ways and Means Committee, and Democratic Reps. Jim McDermott of Washington, and Lloyd Doggett of Texas. All worked to help steer Obama’s law through rancorous congressional debates from 2009-2010.
The lawmakers say they are concerned that many of their constituents will find out about the penalties after it’s already too late for them to sign up for coverage, since open enrollment ended Sunday.
That means they could wind up uninsured for another year, only to owe substantially higher fines in 2016. The fines are collected through the income tax system.
This year is the first time ordinary Americans will experience the complicated interactions between the health care law and taxes. Based on congressional analysis, tax preparation giant H&R Block says roughly 4 million uninsured people will pay penalties.
The IRS has warned that health-care related issues will make its job harder this filing season and taxpayers should be prepared for long call-center hold times, particularly since the GOP-led Congress has been loath to approve more money for the agency.
“Open enrollment period ended before many Americans filed their taxes,” the three lawmakers said in a statement. “Without a special enrollment period, many people (who will be paying fines) will not have another opportunity to get health coverage this year.
“A special enrollment period will not only help many Americans avoid making an even larger payment next year, but, more importantly, it will help them gain quality health insurance for 2015,” the lawmakers added.
So far, administration officials have deflected questions about whether an extension will be granted. Health and Human Services Secretary Sylvia M. Burwell has authority to grant special enrollment periods under certain circumstances.
Administration officials are refusing to say whether they have an ObamaCare backup plan if the Supreme Court torpedoes the law.
But Republicans don’t believe them.
GOP lawmakers on the Senate Finance Committee repeatedly pressed Health and Human Services (HHS) Secretary Sylvia Mathews Burwell on the issue. But Burwell on Wednesday did not budge during a tense back-and-forth, with a half-dozen Republicans claiming that the administration must have a “plan B.”
“I’m asking, is there a contingency plan? Not what is the plan, but is there a plan?” Sen. Tim Scott (R-S.C.) asked.
The case, which begins oral arguments next month, could make billions of dollars of healthcare subsidies disappear in 37 states. And with such high stakes, two former HHS officials said they are confident the administration is preparing a backup plan.
“Of course, they have one, they should all resign if they don’t,” said Tom Scully, an HHS official under former President George W. Bush. “And they certainly should not discuss it either.”
Former HHS Secretary Michael Leavitt, who left office in 2009, agreed. He added that he isn’t surprised that senior officials would rather face a day of bad headlines than signal weakness to the Supreme Court.
“If the court thought they had a plan, they might think, they felt like their case was weak,” Leavitt, who also served as governor of Utah, said in an interview.
Wednesday’s heated exchange was dominated by Senate Finance Committee Chairman Orrin Hatch (R-Utah) and Senate Majority Whip John Cornyn (R-Texas), both of whom signed an amicus brief in support of the plaintiff earlier this year.
“You’re a highly intelligent, charming person, but you’ve refused to answer our questions, and to me, that doesn’t strike me as trying to work with Congress, but rather contemptuous of Congress’s responsibilities,” Cornyn told Burwell.
Sen. Dan Coats (R-Ind.) added that he believes it is “irresponsible” if the administration is not making plans for the “what-ifs” of the case, which will likely be decided in June.
White House Seeks to Limit Health Law’s Tax Troubles
By ROBERT PEARJAN. 31, 2015
WASHINGTON — Obama administration officials and other supporters of the Affordable Care Act say they worry that the tax-filing season will generate new anger as uninsured consumers learn that they must pay tax penalties and as many people struggle with complex forms needed to justify tax credits they received in 2014 to pay for health insurance.
The White House has already granted some exemptions and is considering more to avoid a political firestorm.
Mark J. Mazur, the assistant Treasury secretary for tax policy, said up to six million taxpayers would have to “pay a fee this year because they made a choice not to obtain health care coverage that they could have afforded.”
But Christine Speidel, a tax lawyer at Vermont Legal Aid, said: “A lot of people do not feel that health insurance plans in the marketplace were affordable to them, even with subsidies. Some went without coverage and will therefore be subject to penalties.”
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