The Health Care Blog – Page 520 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The ACA May Kill Me

Nov 2, 2013• 51

By G-Mom

Through a bad roll of the genetic dice, I am the unhappy host for several, rare chronic diseases. Any one of these would render me uninsurable, but the combination of them makes me incurable, and very difficult to treat. The deadliest thing that I can encounter is a well-intentioned but uninformed doctor.

I have currently have excellent insurance through my husband’s job that allows me to see my varied team of treating physicians. Two are in other states, and the rest are all heads of their departments, but none share a hospital or healthcare group. If my husband were to lose his job, I would be placed into the “high-risk-pool,” if there were any slots left, or forced onto the exchanges where my physician options would be cut significantly.

I would likely be forced to pay for healthcare coverage that I cannot use, since many doctors have been unwilling to even attempt to treat me, despite my “Cadillac” insurance plan.

I would likely have to pay cash to see my current team of physicians, which would be a tremendous financial burden on my family and likely end in bankruptcy.

I was cautiously optimistic when I heard of the end of the pre-existing condition exclusions for health insurance, but the current law will not help me at all. It does not expand my insurance options, it will definitely NOT be less expensive than what I have now, and if I am forced to see a well intentioned, overworked and uninformed (or even distracted) doctor, it just might kill me.

BTW: I am NOT disabled, and do not take any form of government assistance. I have owned my own business and paid that higher tax bracket for over 20 years.”

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

Nov 2, 2013• 59

By THCBist

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!

Nov 1, 2013• 20

By THCBist

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.

Can Everybody Please Just Calm Down?

Nov 1, 2013• 18

By ANN MOND JOHNSON

This week, Health and Human Services Secretary Kathleen Sebelius apologized to Americans for the issues with the launch of the Obama Administration’s website, HealthCare.gov. In her testimony, Ms. Sebelius told Congress that we “deserve better.” And with that, the social media world was set on fire with a rage of backlash aimed at the Administration – something that has been growing feverishly for months now.

Yes, we agree that the American public deserves better – but not just from the Administration. They deserve more from the private sector, too. At this point, some of the biggest naysayers of the Fed’s exchange launch have been leaders in our industry. It’s disheartening to watch.

It’s clear by now that the private sector can offer the government a wealth of knowledge and best practices. But for the Administration to truly learn from those lessons and fix the problems, we need to step up and stop undermining this effort.

As a start, there are three things the private sector should do to counteract what much of the media refers to as a complete debacle:

1. First, just calm down.Focus instead on helping clear up the confusion about deadlines, options and the law. For example, we should remind Americans that they can still get insurance, despite all of the issues HealthCare.gov is experiencing. Legally, Americans don’t need insurance until the end of March 2014. And, if they need something sooner, not only may short-term medical insurance be an option, but there are many off-exchange plans available to buy today from multiple carriers. In other words, HealthCare.gov is not the only source of coverage.

Why the Medicare Part D-Obamacare Comparison Is Making Less and Less Sense

Oct 31, 2013• 14

By Dan Diamond

With the possible exception of one phrase — “it’s a marathon, not a sprint” — defenders of Obamacare have repeatedly invoked the same warning.

Don’t be too critical of the Affordable Care Act’s new marketplaces. Medicare Part D had a rocky rollout, too.

“In terms of confusion, lack of knowledge, and misinformation, the current situation with exchanges resembles the situation that prevailed when Part D enrollment opened,” Daniel McFadden, a UC-Berkeley economist and Nobel laureate, told the Wall Street Journal‘s David Wessel earlier this month.

Part D, “at the time that it was passed was actually less popular than the Affordable Care Act,” President Obama said in an NPR interview on Oct. 1, the day the new marketplaces launched.

There are similarities between the two programs, from the political fight over their enactment to the difficulties in making the laws a reality. But the laws differ in some important ways, too, including ones that supporters haven’t fully acknowledged.

So what can we take away from Part D? Here is a quick guide to lessons from the drug plan’s rollout.

The political environment

How it’s similar: Just as Democrats fiercely resisted Republicans’ efforts to enact a Medicare drug benefit, the GOP refused to support the Democrat-led ACA.

How it differs: While Part D is seen as successful today — 90% of seniors were satisfied, according to a 2009 survey — Democrats say that their party deserves some credit.

“We lost the policy fight, and what did we do?” asked Rep. Bill Pascrell (D-N.J.), at a hearing on Capitol Hill on Tuesday. “We went back to our districts and we told our seniors although we voted no, we … will work with the Bush administration to make it work,” Pascrell added.

Will You Be Able to Keep Your Plan? The Economics Behind the Obama Administration’s Latest Problem

Oct 30, 2013• 34

By David Dranove & Craig Garthwaite

By now you’ve certainly seen the headlines: “Obama administration knew millions could not keep their health insurance,” or “Report: Millions will lose health plans as ObamaCare takes hold.”

This is not just the rumblings of right wing media outlets or scare tactics, it is now becoming clear that millions of individuals who used to buy their insurance in the individual market will not be able to keep their old plans. As a result of minimum standard for health insurance “quality,” between 50 and 75 percent of existing individual insurance plans will be canceled.

White House Spokesperson Jay Carney said that these cancellations will only affect “substandard policies that don’t provide minimum services.” But again, the devil here is in the undiscussed details. The “minimum services” bar for the Affordable Care Act is actually very high and as a result the new policies that replace those being canceled can be quite expensive.

For people who are in the unsubsidized portion of the exchanges, or even those who qualify for smaller subsidies, these minimum requirements are going to result in large premium increases. While many people might all believe that these individuals be buying better insurance, this is not the argument used to gain public support for the ACA.

We’ve both been vocal in our support of moving people onto the exchanges and away from employer provided coverage. One reason for that support has been that the exchanges allow a far better matching of individual preferences for health insurance and the products that people can purchase. Certainly that was our basis for our strong support of narrow network plans on the exchanges.

Beyond the size of the network, some people don’t want to pay for generous first dollar coverage. Instead, these consumers are willing to exchange lower premiums for higher deductibles or other forms of cost sharing. Others might not be interested in having coverage for every possible service, but instead might opt for a less generous set of benefits.

They will be thwarted by the ACA.

Why Isn’t There a Healthcare.gov App?

Oct 30, 2013• 6

By THCBist

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.

Questions for Secretary Sebelius

Oct 30, 2013• 5

By Charles Ornstein

Health and Human Services Secretary Kathleen Sebelius will testify before the House Energy and Commerce Committee this morning. Her testimony comes the week after Healthcare.gov contractors testified before the same committee and a day after the head of the Centers for Medicare and Medicaid Services testified before a different House committee.

Here’s what you need to know.

1. Where to watch the hearing, which began at 9 a.m. EST:

Live coverage via C-SPAN.

2. Read Sebelius’ prepared testimony. Politico calls it more of the same:

Sebelius’s eight pages of prepared testimony for the House Energy and Commerce Committee matches nearly word-for-word testimony delivered by CMS Administrator Marilyn Tavenner to Ways and Means on Tuesday.

In both written statements, the officials acknowledge that the website hasn’t met expectations but say the administration is taking major steps to improve it.

Neither testimony includes an apology for the bungled launch—but Tavenner verbally apologized at the hearing Tuesday morning.

Clay Johnson (@cjoh), who advocates for open source information in the federal government, annotated the testimony on Rap Genius, with questions and comments.

3. Get familiar with the background. Sebelius gave an interview to CNN’s Sanjay Gupta last week in which she had this memorable exchange:

Gupta: The president did say that he was angry about this. I mean do you know when he first knew that there was a problem?

Sebelius: Well, I think it became clear fairly early on. The first couple of days, that —

Gupta: So not before that, though? Not before October 1st?

Sebelius: No, sir.

Gupta: There was no concern at that point here in the White House or at HHS?

Sebelius: I think that we talked about having — testing, going forward. And if we had an ideal situation and could have built the product in, you know, a five-year period of time, we probably would have taken five years. But we didn’t have five years. And certainly Americans who rely on health coverage didn’t have five years for us to wait. We wanted to make sure we made good on this final implementation of the law.

And, again, people can sign up. The call center is open for business. We’ve had 1,100,000 calls. We’ve had 19 million people visit the Web site, 500,000 accounts created. And people are shopping every day. So people are signing up and there’s help in neighborhoods around the country, that people can have a one-on-one visit with a trained navigator and figure out how to sign up. So people are able to sign up.

I wondered at the time if Sebelius’ answer left a little wiggle room. I expect Republicans on the committee will pursue this.

4. Digest media reports. You can definitely expect that Sebelius will be asked about a CNN report yesterday that Healthcare.gov’s lead contractor warned the administrator well before the Oct. 1 launch of major problems. Read the documents.

CNBC suggests these six questions for her:

—What did you know, when did you know it, and who told you?

—Did you ever consider not launching Oct. 1?

—Why has no one been fired?

—What does all this cost?

—What contingency plans do you have?

—What are the enrollment numbers?

TPM offers what it calls seven legitimate questions for her.

And the Washington Post says that “the embattled secretary of health and human services will submit to a quintessential station of the Washington deathwatch.” Gotta love Washington.

Charles Ornstein is a senior reporter at ProPublica and past president of AHCJ. An earlier version of this post originally appeared on his tumblr, Healthy buzz.

Mr. President, I Like My Health Insurance. I’d Like to Keep It. Can You Please Help Me Out?

Oct 29, 2013• 79

By Robert Laszewski

How many times have I talked about rate shock, the millions of people who would be getting cancellation letters from their current health plan, and the problem of people having to put up with more narrow networks?

And, how many times have those predictions been met by push back and spin: Today’s policies are just junk and people will be better off finding lower cost health insurance under Obamacare.

I have been in this business for 40 years. I know junk health insurance when I see it and I know “Cadillac” health insurance when I see it.

Right now I have “Cadillac” health insurance. I can access every provider in the national Blue Cross network––about every doc and hospital in America––without a referral and without higher deductibles and co-pays. I value that given my travels and my belief that who your provider is makes a big difference. Want to go to Mayo? No problem. Want to go to the Cleveland Clinic? No problem. Need to get to Queens in Honolulu? No problem.

So, I get this letter from my health plan. It says I can’t keep my current coverage because my plan isn’t good enough under Obamacare rules. It tells me to go to the exchange or their website and pick a new plan before January 1 or I will lose coverage.

First, the best I can get in a Blue Cross network plan are HMOs or HMO/Point-of-Service plans. In the core network those plans offer, I would have to go to fewer providers than I can go to now in the MD/DC/VA market. And, the core network has no providers beyond my area. I can go to the broader Blues network but only if I pay another big deductible for out-of-network coverage.

I Give Up

Oct 28, 2013• 23

By TONY JEWELL

Since October 1, I have logged on to various websites across the Internet to book three flights, make hotel reservations in four cities, buy a pair of boots, some t-shirts and a set of nifty retro Mason jars.

What I haven’t bought: health insurance through healthcare.gov.

Nor have I tried, even after being able to (finally) create an account and see the prices on specific plans offered here in South Jersey, after weeks of frustration.

Here’s why: Given my family’s initial experience in setting up an account and the horror stories that continue to pour out day by day, we simply have no faith that the system will work if we attempt to sign up. And, given the bungling to date, we are not confident our insurance will be there January 1 – even if we are able to Whac-A-Mole our way through the registration process.

Think about it this way: If you really need to get to Miami, would you attempt to buy a plane ticket on a sketchy site that may or may not sell you a ticket that may or may not be waiting for you for a plane that may or may not be there when you get to the airport on the travel day?

Of course not. Nor are we comfortable relying on healthcare.gov, 1-800 numbers, navigators or parchment to sign up for health insurance through the federal exchange at this point.