Confusion over doctor lists is costly for Obamacare enrollees in state
Fustration and legal challenges over the network of doctors and hospitals for Obamacare patients have marred an otherwise successful rollout of the federal healthcare law in California.
Limiting the number of medical providers was part of an effort by insurers to hold down premiums. But confusion over the new plans has led to unforeseen medical bills for some patients and prompted a state investigation.
More complaints are surfacing as patients start to use their new coverage bought through Covered California, the state’s health insurance exchange.
“I thought I had done everything right, and it’s been awful,” said Jean Buchanan, 56. The Fullerton resident found herself stuck with an $8,000 bill for cancer treatment after receiving conflicting information on whether it was covered.
Kaitlyn Krasselt and Jayne O’Donnell, USA TODAY4:02 p.m. EDT June 29, 2014
Federally funded programs will add at least 2,300 new primary care practitioners by the end of 2015, but the funding for at least one of those programs is set to expire at the same time, contributing to a massive shortage of doctors available to treat patients — including those newly insured through the Affordable Care Act and Medicare.
The U.S. is expected to need 52,000 more primary care physicians by 2025, according to a study by the Robert Graham Center, which does family medicine policy research. But funding for teaching hospitals that could train thousands more of these doctors expires in late 2015.
Population growth will drive most of the need for family care doctors, accounting for 33,000 additional physicians, the study says. The aging population will require about 10,000 more. The Affordable Care Act is expected to increase the number of family doctors needed by more than 8,000, the study says.
Farzan Bharucha, a health care strategist with consulting firm Kurt Salmon, says the ACA should have focused more on the primary care shortage “because we already knew there was a problem — and we knew implementation of ACA would potentially make it worse.”
Health and Human Services spokeswoman Erin Shields Britt says continuing to build the primary care workforce will take time, but she notes President Obama’s budget working its way through Congress has several new ways to expand the primary care workforce, which includes nurse practitioners and pediatricians. The ACA, she says, significantly increases the number of primary care providers in underserved areas and increases Medicare and Medicaid payment for services delivered by primary care practitioners.
Health care costs have risen to $23,215 a year for the typical family of four that gets insurance through work, according to a new report from Milliman Inc., Seattle-based consultants and actuaries.
Although employers pay the largest portion of that health tab at 58 percent (or $13,520) per year, an increasing share of costs has shifted to workers and their families, the Milliman report notes. Workers pay health costs through payroll deductions ($5,908 annually) and out-of-pocket expenses ($3,787).
Health policy analyst Edmund Haislmaier says employees actually end up paying all of the costs because their health plans cut into cash wages.
“If that money wasn’t spent on the employee’s health plan, it would be available for higher wages or more retirement savings,” Haislmaier, asenior research fellow with The Heritage Foundation, told The Foundry.
Health care costs for Americans continue to rise, but the overall annual rate of increase for a family of four is at its lowest since Milliman began calculating costs in 2002. In almost every year for the past 10, the growth rate for family health spending has slowed, the report says.
“That’s because of what’s going on in the way employers and families buy health care and how health care is delivered,” Haislmaier said. “It’s not just fluctuations in the economy or new laws and regulations.”
So far, Milliman finds, “emerging reforms” required by the Affordable Care Act, or Obamacare, have had little direct impact on the cost of care for the typical family of four “because this family tends to be insured through large group plans.”
The report points to a combination of factors, some of which increase health spending, such as specialty drugs, while others decrease health spending, such as cost control measures taken by providers.
However, Obamacare’s upcoming tax on “Cadillac” plans (valued at $27,500 or more for a family of four) will prompt employers to scale back those large group plans to avoid penalties, the report notes.
Here’s what the Obama administration wants you to know about health insurance premiums under Obamacare: On average, people who selected subsidized insurance plans through the federally-run insurance exchange paid $82 a month, out of their own pockets, for health insurance. People who selected “silver” health plans—the most popular tier of coverage offered in the exchange—paid less: $69 per month, on average. Almost 70 percent of the people who signed up for subsidized plans through the federal exchanges are paying less than $100.
Those are the average premium prices that the Obama administration highlights in a press release touting a new government report on Obamacare and health premiums.
But there are several things to remember about those figures.
One is that they’re incomplete. The data released by the administration doesn’t account for premiums in the 14 states that ran their own exchanges this year.
Another is that those averages conceal an awful lot of variation. Even with the federally run exchange covering the majority of states, Obamacare varies quite a bit from state to state. Out of pocket insurance costs in Mississippi averaged about $23 a month, but came in at $148 in New Jersey. About a third of people buying subsidized coverage through the federal marketplace were paying more than $100. And the report focuses on the majority of participating individuals who bought subsidized coverage: 14 percent of people whoselected plans in the federal exchange through the end of open enrollment got no tax credits at all.
That’s another thing to remember: The administration’s premium averages are based on out-of-pocket costs after the law’s tax credits and subsidies are factored in. Those subsidies end up offsetting quite a bit of the cost of insurance under Obamacare. But if you strip away the subsidies, individual market health insurance has, on average, become significantly more expensive in the wake of Obamacare, according to a newly published analysis by the Manhattan Institute.
Relying on a 3,137 county comparison of the five cheapest individual plans available prior to Obamacare with the five cheapest plans through the exchanges, the study by health policy fellow Yevgeniy Feyman found that, on average, premiums were up 49 percent under Obamacare. Again, that’s an average, and it masks some variation—in New York, which had unusually restrictive, badly designed health insurance market rules prior to Obamacare, premiums are actually down quite a bit—but it indicates that the overall trend for unsubsidized premiums is up.
The difference, then, is being made up by federal subsidies. According to the administration’s report, those subsidies are carrying 76 percent of the total cost of subsidized insurance plans selected in the federal exchange. The out-of-pocket average is $82. But the actual average premium price, without subsidies, is $346.
To the extent that insurance is relatively cheap, it’s because taxpayers are footing a big chunk of the bill. Obamacare didn’t reduce the price of insurance; if anything it raised it—and then used tax revenues to cover the difference.
That’s frequently how subsidies work—they lower the out-of-pocket price tag, but, by separating consumers from meaningful price signals, they also distort markets in ways that drive up the overall cost, leaving the public to pick up the ever-growing tab.
LIFE IS NOT ONE HUGE HOSPITAL June 18, 2014 Rituparna Basu https://ari.aynrand.org/blog/2014/06/18/life-is-not-one-huge-hospital-2
Advocates of universal coverage seek to create a society in which, if you can’t afford health insurance, the government forces others to provide it for you. What is the moral defense for treating some people as slaves to the needs of others? At the American Medical Association’s JAMA Forum, Austin Frakt presents one argument (citing other scholars):
[T]here is a “social obligation to protect opportunity.”
From this, a lot follows. One’s opportunity is threatened by poor health. In sickness, one cannot learn or earn as efficiently, let alone enjoy the same length or quality of life. Therefore, protecting opportunity implies protection of access to health care services that promote and preserve health. And, it’s hard to argue with the notion that such access should be protected equally.
I have two comments:
First, “protecting opportunity” is a euphemism for destroying people’s opportunities. If the government forces Joe to spend a portion of his income footing Sandra’s medical coverage, Joe’s ability to pursue his own opportunities, such as the longest, highest-quality life for himself, is impeded. In practice, the “social obligation to protect opportunity” means the government sacrifices people who have earned opportunities to pursue better lives for themselves, for the sake of those who have not earned them.
Second, it’s true that life can be harder for Sandra when she’s sick compared to when she is healthy. But why does this impose an obligation on others to support her? In fact, it doesn’t. Other people’s medical needs, no matter what challenges they present these individuals, do notimpose an obligation on you.
I’m reminded of a passage from Ayn Rand’s “Apollo 11,” in which Rand memorably summarizes her response to the notion that need is a first mortgage on the time, efforts and lives of others:
Poverty is not a mortgage on the labor of others — misfortune is not a mortgage on achievement — failure is not a mortgage on success — suffering is not a claim check, and its relief is not the goal of existence — man is not a sacrificial animal on anyone’s altar nor for anyone’s cause — life is not one huge hospital.
Nothing justifies treating people as if they are the servants of others. Universal coverage is immoral.
Thousands to Be Questioned on Eligibility for Health Insurance Subsidies
By ROBERT PEARJUNE 15, 2014
WASHINGTON — The Obama administration is contacting hundreds of thousands of people with subsidized health insurance to resolve questions about their eligibility, as consumer advocates express concern that many will be required to repay some or all of the subsidies.
Of the eight million people who signed up for private health plans through insurance exchanges under the new health care law, two million reported personal information that differed from data in government records, according to federal officials and Serco, the company hired to resolve such inconsistencies.
The government is asking consumers for additional documents to verify their income, citizenship, immigration status and Social Security numbers, as well as any health coverage that they may have from employers. People who do not provide the information risk losing their subsidized coverage and may have to repay subsidies next April.
Federal subsidies for the purchase of private insurance are a cornerstone of the Affordable Care Act. More than eight out of 10 people who selected health plans through the exchanges from October through mid-April were eligible for subsidies, including income tax credits. So far this year the federal government has paid out $4.7 billion in subsidies, and the amount is expected to total $900 billion over 10 years.
Since June 1, the government has notified hundreds of thousands of people that “the information in your application doesn’t match what we found in other records.” Accordingly, the notice says, “you need to follow up as soon as possible and provide more documents to make sure the marketplace has the correct information.”
“If you don’t send the needed documents,” it says, “you risk losing your marketplace coverage or help you may be receiving to pay for such coverage.”
Report: N.J. residents pay highest premiums on U.S. marketplace for health insurance
JUNE 17, 2014, 7:32 PM LAST UPDATED: TUESDAY, JUNE 17, 2014, 7:32 PM BY LINDY WASHBURN STAFF WRITER THE RECORD
New Jersey residents who bought health insurance on the federal marketplace paid the highest premiums in the nation, even after the tax subsidies provided under the Affordable Care Act, a report released Tuesday by the federal government said.
The average premium after tax credits was $148 a month, compared with $82 a month in the 36 states that relied on the federal marketplace. Not included in the report are states with their own exchanges, among them California and New York.
The report analyzed 2014 premiums. Next year’s premiums are to be submitted to the state Insurance Department later this month.
“It will be critical that any increases be kept to a minimum,” said Raymond Castro, an analyst with New Jersey Policy Perspective. The new rates will apply not only to those eligible for subsidies, but also to those who buy individual plans outside the marketplace.
This year, New Jersey had less competition than most other states for customers who bought coverage through the marketplace. Only three insurance companies issued plans, compared with as many as 11 companies in other states, the report said. That tended to make premiums higher in New Jersey.
Surprise! The Government Now Can’t Even Guess How Much Obamacare Ultimately Will Ultimately Cost. Genevieve Wood June 06, 2014
It’s no secret Obamacare is unaffordable. But now we also know that even the Congressional Budget Office can’t predict how much more this disastrous law will cost.
According to a footnote from a Congressional Budget Office report released in April but reported this week by Roll Call, the law’s true costs and long-term fiscal impact are simply impossible to track.
That’s a change in tune for the CBO, which originally reported in 2010 that Obamacare would pay for itself and over the course of a decade would decrease the deficit,
So what’s changed? Well, thanks to the constant modifications to the law, the only thing predictable about Obamacare’s provisions is that they’re unpredictable. Many of the “savings” and “revenue” (read: mandates and tax increases) originally proposed to pay for this redesign of one-sixth of the U.S. economy, whether Medicare cuts or employer mandates, have been waived, stalled or simply not implemented, making a defensible revised forecast impossible. The changes occurred because it became clear such measures were both politically unpopular and realistically unaffordable.
There are other reasons it’s virtually impossible to even guess how much Obamacare will ultimately cost. We learned this week that more than 2 million people—a whopping quarter of those enrolled in Obamacare—who signed up for insurance via Obamacare’s health care exchanges have discrepancies in their records and paperwork. Apparently the government has inaccurate or inadequate information regarding the income levels of more than 1 million people who signed up and can’t verify the immigration or citizenship status for more than 900,000. That means some current enrollees may not be eligible for Obamacare subsidies and may lose their coverage or may have been given too generous a subsidy and eventually will have to pay the government back.
Serco, Inc., a government contractor hired to track down and verify the missing information, released a statement saying, “Current system access and functionality…limits the ability to resolve outstanding inconsistencies.” That means the government’s websiteis again was not up to par and much of the work to resolve the data discrepancies will require hands-on work to figure out who among these 2 million people should be getting insurance and subsidies through the exchange and who should not. In other words, there will need to be a significant number of extra staffers brought onto fix this mess. Guess the Obama administration finally is delivering on those “job creation” promises—too bad it’s at the taxpayers’ expense.
Not all the bad news regarding the spending train wreck that is Obamacare emanates from Washington. Many of the statesthat chose to set up their own exchanges spent hundreds of millions of federal dollars to do so—and yet ended up with exchanges that don’t work.
As we approach the next enrollment period in November, lawmakers in those states are frantically trying to figure out whether they can get more dollars from Washington to fix their problems or if they are going to have to use their own state funds. State Rep. John Delaney, a Democrat in Maryland, worries his state will have to divert dollars from education, fixing potholes and other programs to fix its broken exchange. “You can’t just print money in the states,” he said,
That’s right. But the printing presses in Washington have been overused for some time as well—and states that gladly jumped on the Obamacare bandwagon and took the bait shouldn’t be let off the hook by Congress.
So to sum up, the CBO can’t calculate Obamacare’s future costs, confusion about enrollees’ actual salaries could lead to wildly varying numbers on how much it costs this year, and there’s no telling how much money some states ultimately will weasel out of Washington to set up Obamacare.
Talk about a monstrosity of a government program.
What we do know for sure is that Obamacare will cost far more than President Obama and all those who voted for it in Congress told us it would. Which most of us realized all along.
Genevieve Wood advances policy priorities of The Heritage Foundation as senior contributor to The Daily Signal.
As Healthcare Paradigm Shifts, NJ Hospitals Face Uncertain Future
New Jersey hospitals are in a bind. Some of them may close in the next few years, experts say, unless they find a way to transform themselves into healthcare systems that focus on keeping patients healthy in an outpatient setting, while dealing with the reality that most revenue is still based on in-hospital services they provide.
Hospitals must have cash reserves and an operating margin of at least 3 percent or they may face a financial crisis, according to current and recent hospital executives.
“If you’re not in a system that has that financial foundation, I don’t know how you manage the next three to five years,” said Judith Persichilli, recently retired president of Catholic Health East-Trinity Health, a national hospital system.
The hospitals that survive this transition period will look very different from the hospitals of the recent past. They will have fewer beds, more links with primary-care and medical specialty providers, and more partnerships with other hospitals in which each hospital only provides specific services.
That was the verdict of a panel assembled yesterday by the New Jersey Health Care Quality Institute in Ewing. (Kitchenman/NJSpotlight)
Hospitals Look to Health Law, Cutting Charity By ABBY GOODNOUGHMAY 25, 2014
Hospital systems around the country have started scaling back financial assistance for lower- and middle-income people without health insurance, hoping to push them into signing up for coverage through the new online marketplaces created under the Affordable Care Act.
The trend is troubling to advocates for the uninsured, who say raising fees will inevitably cause some to skip care rather than buy insurance that they consider unaffordable. Though the number of hospitals tightening access to free or discounted care appears limited so far, many say they are considering doing so, and experts predict that stricter policies will become increasingly common.
Driving the new policies is the cost of charity care, which is partly covered by government but remains a burden for many hospitals. The new law also reduces federal aid to hospitals that treat large numbers of poor and uninsured people, creating an additional pressure on some to restrict charity care.
Federal health-care subsidies may be too high or too low for more than 1 million Americans
By Amy Goldstein and Sandhya Somashekhar, Published: May 16 E-mail the writers
The government may be paying incorrect subsidies to more than 1 million Americans for their health plans in the new federal insurance marketplace and has been unable so far to fix the errors, according to internal documents and three people familiar with the situation.
The problem means that potentially hundreds of thousands of people are receiving bigger subsidies than they deserve. They are part of a large group of Americans who listed incomes on their insurance applications that differ significantly — either too low or too high — from those on file with the Internal Revenue Service, documents show.
Income discrepancies have been flagged, but the government has been unable to fix the problems.
The government has identified these discrepancies but is stuck at the moment. Under federal rules, consumers are notified if there is a problem with their application and asked to upload or mail in pay stubs or other proof of their income. Only a fraction have done so, according to the documents. And, even when they have, the federal computer system at the heart of the insurance marketplace cannot match this proof with the application because that capability has yet to be built, according to the three individuals.
So piles of unprocessed “proof” documents are sitting in a federal contractor’s Kentucky office, and the government continues to pay insurance subsidies that may be too generous or too meager. Administration officials do not yet know what proportion are overpayments or underpayments. Under current rules, people receiving unwarranted subsidies will be required to return the excess next year.
The inability to make certain the government is paying correct subsidies is a legacy of computer troubles that crippled last fall’s launch of HealthCare.gov and the initial months of the first sign-up period for insurance under the Affordable Care Act. Federal officials and contractors raced to correct most of the technical problems hindering consumers’ ability to choose a health plan. But behind the scenes, important aspects of the Web site remain defective — or simply unfinished.
At Forbes.com, Wanda Buckley writes about how Obamacare has affected her health insurance:Her insurance policy, which she liked, was cancelled because the government decided it was not good enough.
Obamacare is forcing her to buy coverage she doesn’t want or need (which is why, in part, her premiums have doubled).
Obamacare outlaws her ability to buy a plan tailored to her needs and lifestyle.Buckley describes herself as the government’s “pawn” — a characterization which is spot on, applying to every American under today’s health care system.
The government today does not see us as individuals with the right to make choices about our own health care. Instead, over the last hundred years, the government has increasingly forced us to make different choices.
This is why, for example, under Obamacare:
Buckley must buy maternity coverage even though she’s had a hysterectomy, pediatric coverage even though her children are adults, and substance abuse coverage even though she consumes only two drinks a year. The government has, for more than 60 years, decided that non-users of certain medical services must subsidize the users (read more, here).
Young people must overpay for health insurance. The government has, for decades, decided that young people should be footing the medical bills of those older (read more, here).
Almost everyone must buy coverage. The government has decided that people shouldn’t be able to circumvent the myriad wealth redistribution schemes it orchestrates through health insurance (read more, here).
The consequence of the government dictating the health care choices we should be making is that individuals like Wanda Buckley are seen, not as individuals whose interests and desires are to be respected, but as pawns whose lives the government can dispose of for its own schemes.
Obamacare’s Killer Burden on Nurses Amy Dertz 12:01 AM ET
The Affordable Care Act means more and sicker patients are entering hospitals, and less comprehensive and timely health care.
As the first enrollees in the Affordable Care Act begin seeking care at my hospital, I wonder how my practice as a Registered Nurse will change. We’re told the goal of the new law is to remodel healthcare in the United States into a system that promotes wellness and prevention, rather than just providing care to sick people. This seems like a great objective, but I worry that the switch may compromise the quality of the care our patients receive.
As a bedside RN working at an acute care hospital in Oakland, California, I care for an incredibly diverse patient population. Most of my patients have had health insurance through employer-based programs, private purchase, or Medi-Cal. Most have interacted with the health care system prior to being admitted to my hospital.
Now, I will take care of patients who are new to health care. Some haven’t had care in a long time (or ever). Some may have pre-existing conditions that enabled insurance companies to refuse them coverage. As they enter my care, their needs may be more complicated.
Own a small business? Brace for Obamacare pain
By JENNIFER ROBISON
LAS VEGAS REVIEW-JOURNAL
Local business owners might be hoping the Affordable Care Act’s insurance mandates cover sticker shock.
The law’s employer coverage mandate doesn’t take effect until 2015, but early plan renewals are starting to roll in. And for some businesses, the premium jumps are positively painful.
Local insurance brokers are reporting spikes ranging from 35 percent to 120 percent on policies that renew from July to December. The increases are especially acute among employers with workforces made up of younger, healthier men. That’s because Obamacare prohibits offering lower rates to healthier groups. It also narrows the allowed premium gap between older and younger enrollees.
“It’s like if there were no more safe-driver discounts with State Farm,” said local insurance broker Frank Nolimal of Assurance Ltd. “Everybody has the same rate, whether you have three DUIs, or you’re a (nondrinking) churchgoing Mormon.”
The changes put as many as 90,000 policies across Nevada at risk of cancellation or nonrenewal this fall, said Las Vegas insurance broker William Wright, president of Chamber Insurance and Benefits. That’s more than three times the 25,000 enrollees affected in October, when Obamacare-compliant plans first hit the market.
Some workers are at higher risk than others of losing company-sponsored coverage. Professional, white-collar companies such as law or engineering firms will bite the bullet and renew at higher prices because they need to compete for scarce skilled labor, Nolimal said.
But moderately skilled or low-skilled people making $8 to $14 an hour working for landscaping businesses, fire-prevention firms or fencing companies could lose work-based coverage because the plans cost so much relative to salaries.
Employees who keep their coverage might see leaner take-home pay, which could hurt the economy.
Nolimal said one business client whose monthly premiums will rise from $160 to $340 in June plans to shift most of the increase onto his employees.
“Just like when you see gasoline prices going up an extra dime a gallon, it takes money out of the economy for things like buying a new stereo or having dinner out on the town,” Nolimal said.
The premium hikes could have political implications, as well. Nolimal estimated that as many as 85 percent of small-group plans will renew in November and December. Because new premiums go out 60 days before coverage takes effect, those price hikes will hit mailboxes in September and October — just before November’s elections.
That may be why Wright said Nevada lawmakers seemed keenly interested in hearing what he and other brokers had to say during a recent visit to Washington.
He said lawmakers were “very receptive” to the idea that Nevada officials should embrace a federally established transition period that would let businesses keep their existing plans for at least one more year to blunt the effect of today’s higher costs.
Nevada Insurance Commissioner Scott Kipper said March 25 that he doesn’t have the discretion to allow noncompliant plans to stay in place, based on advice from Nevada Attorney General Catherine Cortez Masto. That decision mirrored a fall conclusion that it would be illegal to reinstate the first wave of canceled plans.
But Wright said he has an opinion from a national law firm that says the small-group situation is different, because it involves policies not yet canceled. He said he and other brokers will work over the next few weeks to sway the commissioner.
GOP foolish to think ObamaCare is fixable By Betsy McCaughey April 30, 2014 | 10:37pm
Rep. Cathy McMorris Rodgers (R-Wash.), the No. 4 House Republican, is walking back comments attributed to her that ObamaCare can’t be repealed. But she’s not the only one suggesting Congress merely make changes within the framework of the health law. Senate Minority Leader Mitch McConnell (R-Ky.) says the goal is to get the law “fixed.” It seems many GOP lawmakers still haven’t read the law, or they’d know the framework is corrupt.
Even Sen. Rand Paul (R-Ky.) speculated Friday that repeal is unlikely because it will be “difficult to turn the clock back.”
Nonsense. Even by the most inflated administration claims, some 8 million people have signed up for exchange plans, out of a nation of 318 million. ObamaCare is repealable, and should be replaced with a plan to cover the uninsured and reduce costs.
ObamaCare’s authors paid lip service to these goals but had an ulterior motive: forging a permanent Democratic majority. The law creates a huge infrastructure for enrolling millions of people not just in insurance but also for food stamps, housing assistance and other welfare programs — and registering them to vote.
