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I’m Male. A Non-Smoker. And in My Fifties. Can Somebody Please Explain Why I Have to Pay for Maternity Coverage?

A THCB Reader in Maryland writes:

“I realize many individual health insurance policies are being cancelled because they are not in compliance with the ACA’s new requirements. 

Do the new ACA requirements effect all individual plans sold or just those available in the exchanges?

In other words, if I am a self employed, single 50 year old male who does not want maternity, pap smears and mammograms; can I solicit an individual policy outside of the exchanges that meets these needs? For that matter, could I find a policy in the exchanges that meets these needs?”

If you’ve had a bad or good experience attempting to buy health insurance on the state or federal exchanges, we’d like to know about it. Drop us a note.

I Have No Kids. Why Do I Have to Pay More For My Coverage Than People With Children? This Seems Really Unfair!

A THCB Reader from California writes:

“I finally decided to go to the “Covered California” website to see how much a potential premium for my partner and myself would be given several different income scenarios.

First of all, the plan differences are so vast it appears to be a further seperation of classes through healthcare.  I wonder who decided that a $40 doctor co-payments is affordable!  Then you take a look at how the tax credits work and the antiquated undertones that others should pay for children.
I
It is amazing to me that people with kids are going to pay LESS than the coverage my partner and I will.  This isn’t just for one child, it is up to 3 or more! I do not have children but I understand that in a universal healthcare system the larger the pool, the cheaper the cost.  Those savings should also go to those whom have decided not to add additional risk to the system by adding children.  Why is a single persons insurance more than that of a family?  Why are the subsadies so large that it makes it cheaper?

At least charge as much as a single person, not less. Healthcare for all is something that everyone should pay into and the largest economy in the world should offer, but the distribution of costs need to equal the risk.  Kids are expensive choices that people make, why should people who have chosen to not bear the costs pay for others that have?”

Have a question about the Affordable Care Act? Drop us a note. We’ll publish the good ideas.

Why Isn’t There a Healthcare.gov App?

A THCB reader who asked that we not identify him because his company does unrelated contracting work with the government writes in to ask:

“Why isn’t there a Healthcare.gov app? If the problem is that the system is failing because the poorly designed Healthcare.gov web site is being crashed by monster waves of traffic, wouldn’t putting out an app help?

I mean, ‘cmon guys. It’s 2013. Millions of Americans have iPhones, iPads, Androids and god knows what other mobile devices. In theory a freestanding app — even a simple one — that allowed browsing and “print my application” capabilities would help the traffic problem by giving people an alternative way to access the features available at the government web site.

If the problem is in fact the web site and not the data hub, wouldn’t that go a long way to solving the problem? How hard could it possibly be to put something together quickly and get it out there? Why isn’t this being done?

Knowing how this game works, I’m pretty sure the plan was to originally include something like this. Then the vendors and contractors involved quoted an astronomically high price tag that nobody was willing to go for. Then somebody else said something ominous about privacy and an awkward silence broke out at the table. The Healthcare.gov app was put in the “nice to have” – “we’ll get around to it when we can” – “bells and whistles” camp.”

Have a brilliant idea that could help save Healthcare.gov? Somebody has got to do something.  Drop us a note. We’ll publish the good ideas.

.Gov Prices May Not Add Up

A THCB Reader in Michigan writes:

“The rates listed on the Healthcare.gov/Michigan site are inaccurate “estimates.”  Being unable to apply on the website due to glitches, I simply go on the site to view plans for my husband and me.  Based on our locality, “estimates” shown are about $250 – $600 for bronze and silver plans.  We even see some gold plans for about $460.

But when I telephone the insurance companies (Aetna, Humana, BCBSM, HAP) for details and quotes, suddenly the costs of the same plans are $950 – $1750!  Obviously, the “estimates” are disingenuous, probably reflecting prices that are available only to very young adults with no medical history.

An estimate is not an estimate unless it is close to what the final price is expected to be, not one-half or one-third the final price. Insurance companies need to list the estimates on the .gov website by range, rather than a single rate.  For example, if a policy can be sold for as little as $250 or as much as $950 depending on the particulars of each insured, that policy estimate needs to read $250 – $950.  Until insurance companies do this, they are, effectively using a bait-and-switch sales technique, which is illegal.”

If you’ve had a bad or good experience attempting to buy health insurance on the state or federal exchanges, we’d like to know about it. E-mail us at editor@thehealthcareblog.com.

Commentology: What Your Employer Is Secretly Thinking As Obamacare Goes Live Part II

In response to Kip Piper’s recent post, “What Your Employer Is Secretly Thinking As Obamacare Goes Live” Michael Turpin writes:

A very comprehensive article and predominantly spot on. I do have a few alternative views.

Employers are waiting to see if public exchanges are viable alternatives – As a consultant who works with employers every day, the universe of employer sentiments is varied. The preponderance of public exchange options with be narrow network, lower level reimbursement plans that will not be like for like equivalents to employer sponsored open access PPO plans. With low individual mandate penalties and higher costs for younger exchange enrollees due to 3:1 community rate banding, there is concern that the first enrollees will select against the plans and not be offset by younger, healthier participants who will balk at the prospects of higher premiums.

Self insurance will be highly prevalent – The average employer can save as much as 6% by self funding their insured benefits. It is true they take on higher liability but the first 6% is essentially playing with house money because the employer will not pay taxes on insured benefits or insured PPACA taxes. Employers, especially those with young healthy employees, would be better served self insuring to avoid community rate cost old to young shifting and insured premium taxes. Younger consumers use fewer benefits. Average year over year medical trends will likely be low single digits — much lower than the likely community rated increases tendered the first year in the exchanges.

Private exchanges will gain some traction – The IBM decision is only for retiree medical benefits. Walgreens is the first major retailer to adopt a private exchange for actives. A private exchange is to health plans what the 401k was to defined benefit pension plans. A true private exchange pits multiple insurers against one another in a Cost Co type private market where individual enrollees are given an annual stipend to buy benefits. Each enrollee can choose between a range of plans and insurers.

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How the Federal Government Shutdown Is Hurting Healthcare: Agency by Agency

The shutdown could not stop the rollout of the state and federal exchanges.

That’s because the Obama administration, sensing a political fight in the offing with Republicans, wisely prepaid the bill for the insurance exchanges and other key components of the rollout.

On the other hand, the fiscal standoff is having a very real impact on the infrastructure that supports healthcare across the United States.   Agencies from the Centers for Disease and Control to the National Institutes of Health have seen their money turned off. Others have seen their staffing levels sharply reduced with non-essential employees furloughed.

It doesn’t take a wild imagination to imagine potential deadly consequences if something goes wrong. If for example, flu season strikes early or a drug recall  is needed.  Much of the pain will be felt over time.  As the shutdown drags on, you can expect problems that are brewing under the surface to become much more visible …

Here’s a review of what’s happening:

Centers For Disease Control and Prevention
Funding for monitoring of disease outbreaks turned off. Lab operations sharply scaled back. 24/7 operations center to remain online.  With some scientists predicting a severe 2013-2014 flu season, this is cause for concern …

National Institutes For Health
Enrollment in new clinical trials suspended, impacting thousands of patients suffering from serious diseases. No action on grant proposals. Minimal support for ongoing protocols.

Food and Drug Administration
Food safety inspections sharply cut back. Monitoring of imports eliminated.  Oversight of production facilities curtailed, again potentially an issue with flu season on the way.The good news? Because drug approvals are funded by industry “user-fees” FDA approvals of new drugs will continue.

Centers For Medicare and Medicaid Services
Key ACA related operations intact.  The bad news for docs and patients – claims and payment processing expected to continue but with slower service than usual. With purse strings tight, this is likely to become more of a problem as shutdown drags on. In the unlikely event that a shutdown continues for more than a month, the impact on physician practices could be much more serious.

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Washington In Crisis: ONC Announces That It Will Not Tweet Or Respond to Tweets During Shutdown

The U.S. government shutdown continues to claim victims.

The latest is HealthIT.gov, the website designed to help doctors and hospitals make the transition to electronic and make better use of health information technology – a key component of Obamacare’s drive to transform healthcare.

The Health Information Technology Office of the National Coordinator posted a brief announcement on the site informing visitors to HealthIT.gov that “information … may not be up to date, transactions submitted via the website may not be processed and the agency may not be able to respond to inquiries until appropriations have been enacted.”

Officials also sent a tweet saying that the ONC regrets to inform us that while the shutdown continues it will “not tweet or respond to tweets.”

This struck THCBist as slightly odd.

After all, if you’re looking for an inexpensive way to communicate with the public in a pinch, Twitter seems like the perfect choice.  We get that government websites are ridiculously expensive things to run. Blogs are considerably cheaper.  Operating a Twitter account — on the other hand — is almost free.  Our brains were flooded with scenarios.  How much could the ONC possibly be spending on Twitter? And for that matter, didn’t the Department of Defense originally invent the Internet to allow for  emergency communication during times of national crisis? Doesn’t a fiscal insurrection by cranky Republicans qualify?

Fallout for the National Health IT Program

While federal officials have issued repeated assurances that the shutdown will not impact the Obamacare rollout, it does look as though there will be a fairly serious impact on the administration’s health IT program.  If HHS sticks to script, only 4 of 184 ONC employees will remain on duty during the shutdown. That makes it sound like activities are going to have to be scaled back just a bit.

If you’re counting on getting an incentive payment from the government for participation in the electronic medical records program, you may be in trouble — at least until the stalemate is settled.  Although ONC has not yet made an official statement,  presumably because the aforementioned Twitter channel has been disabled, leaving the agency unable to speak to or otherwise communicate with the public, going by the available information in the thirteen-page contingency plan drafted by strategists at HHS, it is unclear where the money will come from.

This could be bad news for electronic medical records vendors counting on the incentive program to drive sales as the Obamacare rollout gets officially underway.

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