Showing posts with label health exchanges. Show all posts
Showing posts with label health exchanges. Show all posts

Thursday, November 21, 2013

Obamacare IS working...especially in McConnell's Kentucky!

California, the most populous state in America, is on track to hit its Obamacare enrollment targets for 2014!

"But," said MSNBC host Chris Hayes, "the most fascinating Obamacare success story comes from the state of Kentucky. It is the only state in the South both expanding Medicaid and operating a fully state-based exchange."

The irony of Kentucky being Sen. Majority Leader Mitch McConnell's home state was not lost on Hayes. McConnell "just happens to be up for re-election next year, a race he will now have to run from a state where health reform is working."


All In With Chris Hayes
November 19, 2013 | MSNBC

Wednesday, November 20, 2013

Media myths of Obamacare's 'failure'

I've been seeing different figures for the private insurance market, and those "losing" their private insurance because of Obamacare. Yesterday I quoted the figure of 19 million Americans who have individual, private health plans. Here Michael Hiltzik sets us straight [emphasis mine]:

[T]he market for individual policies is about 30 million people. Of those, more than 20 million are uninsured.For virtually all of them, Obamacare is an unalloyed blessing. The Congressional Budget Office estimates that about 81% of all individual policy-holders will be eligible for income-based insurance subsidies. The uninsured population skews poorer than the total individual market, so an even higher proportion of them are likely to be subsidized. The Affordable Care Act also forbids insurers to base the cost and availability of insurance on pre-existing conditions, which has kept millions of people out of the individual market.

What about individual policy-holders? They number somewhere between 8.5 million and 9.5 million. The vast majority of these customers - two-thirds - spend less than a year in the individual market, according to a 2004 study published in Health Affairs. The study found that most people use individual insurance to bridge between periods of coverage from employers or public programs like Medicaid. If three-quarters of the individual customers will be eligible for insurance subsidies, that leaves 2.1 million to 2.4 million Americans paying the full freight.

The last piece of the puzzle, and the murkiest, is how many of this last group will be paying higher prices for lesser coverage - the emblematic Obamacare "victims." Even if it's all of them, at most they account for less than 1% of the country.

But plainly they're not all paying more for less. We know this because the individual market is where people have been getting ripped off by overpaying for inadequate coverage - "junk" insurance in many cases. It's where premiums are driven up and coverage constrained by pre-existing conditions. Those practices are eradicated by the Affordable Care Act.

Kevin Drum of Mother Jones posits that one-third of these customers may be charged more for less, which sounds reasonable, if perhaps a little high. I've heard from dozens of readers who claim to be in that group. But my experience, which I'd guess is matched by most of my journalistic colleagues, is that most of them aren't examining their options very well. They're not calculating their costs beyond their premiums - the free services mandated by Obamacare they're not getting today, for instance. They're not factoring in the rate increases on their existing plans they've been hit with in the past, and would face again, but will be limited under Obamacare.

As I said before, what's fueling a lot of this public disappointment with Obamacare is the 149 million Americans who aren't affected by it all, who don't need the exchanges right now, yet who pass judgment on it based on ignorant or biased media reports. Also, as Hiltzik notes above, a majority of the folks in the individual market only use private insurance as a "bridge;" so they rarely keep their plans very long. And most private health plans are offered with terms of only one year anyway, then prices and conditions always change.

Hiltzik describes the group who is indeed being affected, sometimes for the worst: those whose private insurers chose not to renew their old plans with the same prices and conditions to comply with the ACA grandfathering rules, i.e. those infamous "cancelled" plans:

The bottom line is that we're down to about one-quarter of one-percent of the country being paraded around to set the agenda for everyone else - fewer than 2 million people. Compare that with the number of people who are being denied health insurance in 21 states that have refused to expand Medicaid, as the Affordable Care Act allows them to do largely at federal expense. (Four other states are still thinking it over.)

This group numbers about 5 million, and in every case they're being deprived of health coverage by Republican governors or legislatures, or both. That should tell you that the Republicans who are carrying on about Obamacare's "failure" really don't have your welfare in mind, any more than the characters hawking diet plans on late-night TV really want you to get thin.

Regardless of the political fallout, 2014 midterm elections, or Obama's popularity, Hiltzik's conclusion is spot-on:

The fact is that Obamacare is here to stay. Its customer protections are worth real money to tens of millions of consumers, and it's vastly expanding the insurance market. The politicians claiming that they're only out to "fix" a broken program are playing you for suckers, and not for the first time.


By Michael Hiltzik
November 19, 2013 | Los Angeles Times

By Jonathan Cohn
November 18, 2013 | New Republic
URL: http://www.newrepublic.com/article/115625/obamacare-policy-cancellations-media-mythology-republican-spin

By Jonathan Chait
November 18, 2013 | New York Magazine
URL: http://nymag.com/daily/intelligencer/2013/11/obamacare-hyperventilation-to-continue-forever.html

Monday, November 11, 2013

Obamacare: Another conservative-lite idea

As I've said before, Obamacare was not what real liberals and progressives wanted: single-payer. In today's op-ed, Zelizer laments that, and warns liberals against "half-baked" liberal policies that are really just conservative-lite ideas.

Obamacare is the classic example. It was first proposed by the uber-conservative Heritage Foundation in the early 90s, then supported by uber-conservative economist Milton Friedman and Republican Speaker of the House Newt Gingrich, among 25 conservative leaders, then implemented on the state level by a Republican governor.  

The only problem is that the conservative party in the U.S. has gone farther to the Right since the 90s.  Now its "best & brightest" like Rush Limbaugh believe that the answer is to get rid of health insurance altogether. We should return to the 19th century. Idiots!

Before Obamacare, Obama never even put the single-payer option on the table. Congress never voted on it. Obama began with closed-door negotiations with insurance companies and drug makers to see what they'd agree to. Obamacare is what we got. Now their revenues are hitting all-time highs and projected to rise in 2014 as well, so don't cry for them.

Nevertheless, there are those on the Right today who ridiculously view Obamacare as a big, elaborate socialist conspiracy to usher in single-payer health care. Talk about a disconnect!  On one side, we have dissatisfied liberals lamenting that Obama missed a once-in-a-generation chance to change the healthcare game. On the other side, we have dissatisfied conservatives who say the liberals are pulling a fast one to get what they want eventually. Eventually, in some distant future.... It's as if paranoid conservatives have more faith in the inevitability of liberal ideals than liberals do!

There are two variants on this conspiracy theory, as far as I can pick up. The first variant goes: expanding Medicaid for the poor is just one more step toward single-payer, since the government already pays for more than half of all healthcare in America.  The second one goes: Obamacare is intended to be such a disaster that Americans will throw up their hands, decide private insurance is a mess, and demand single-payer instead.  

I'll give both versions more time than they deserve, if only because millions of talk radio/Tea Party Republicans really believe in them. As for expanding Medicaid, conservatives can breathe a partial sigh of relief, because their Republicans governors already blocked Medicaid expansion to 8 million Americans in their respective states. There is a problem here though, and it's real. GOP governors also refused to set up their own health insurance markets, thus shifting the burden to the federal Healthcare.gov website. This is delaying people getting health insurance who want it, and they might just give up entirely. 

Rick Moran summed up the self-defeating idiocy of Republicans' spiteful, partisan refusal to establish state health insurance exchanges:

[W]hile conservatives think the Obamacare exchanges are overregulated and oversubsidized, they are actually closer to the right-of-center vision for health care reform than the Obamacare Medicaid expansion, which is happening no matter what transpires with Healthcare.gov. So if the exchanges fail and the Medicaid expansion takes effect (and, inevitably, becomes difficult to roll back), we’ll be left with an individual market that’s completely dysfunctional and a more socialized system over all.

The second variant on this conspiracy theory might end up being true... but only by accident, not by design. I mean, do conservatives really believe that Obama is such a secret, selfless socialist ideologue that he has intended all along for his signature piece of eponymous legislation to be a total failure -- a failure that would define his presidential legacy? Talk about taking one for the team!  

Furthermore, if conservatives really believe Obamacare was designed to fail, then... why do they take such glee at every opportunity to declare it a failure?  Aren't they playing right into Obama's diabolical hands?  But ah, says the tinfoil hat crew, Obama didn't intend for it to fail so soon. Because he's so darn incompetent, see? He can't even screw up right. They say Obama intended for us to get good and used to Obamacare first, so that it could fail several years from now, just when we were about to... so that we would... you see then.... Oh, I can't follow this wacky line of reasoning any further.  


By Julian Zelizer
November 11, 2013 | CNN

Tuesday, November 5, 2013

Don't blame ACA for 'cancelled' health plans

Some medical insurance companies have already been fined for sending out misleading cancellation notices to their customers that don't even mention cheaper options available through new ACA exchanges. 

This was always the weakest aspect of Obamacare: depending on private health insurers to play nice.  They don't. They won't. Especially under ACA, consumers must remain savvy, well-informed and stick up for their rights.  

Meanwhile, health insurance companies keep adjusting their earnings numbers for 2013 upward -- largely thanks to Obamacare. So don't cry for them -- or cry "socialism!"  Please.

Anyhow, some customers have complained -- or more often, others have repeated complaints they heard from FOX or talk radio -- that they were satisfied with their individual insurance plan that was cancelled because their insurer declined to upgrade their plan to comply with Obamacare, or else insurers raised the price to comply. 

Two responses here. First, individual health insurance policies typically last one year anyway, and then insurers raise prices and change conditions when offering renewal -- this was the way long before Obamacare. The HHH's grandfathering rule for Obamacare stipulated that, to be grandfathered, plans couldn't be changed after March 23, 2010, and prices could only rise with the medical rate of inflation. Pretty strict, admittedly.

So Obama should not have promised you could keep your current plan if you liked it -- because insurers have never let you keep your plan the way it was if you liked it. Insurers always raise prices and/or decrease coverage. 

Over the past few decades, insurance costs have gone up while coverage has gone down. That was the trend before Obamacare.  That was what Republicans such as John Boehner and Mitch McConnell preferred.

Now in 2013, and projected again in 2014, the rate of medical inflation is going down, a heartening reverse of a long-term trend. 

Second, it's impossible to say for certain in every case, but I would bet that most of those people have not had a catastrophic event or even an ambulance ride under their current plan. Obamacare requires insurers to cover them in almost every instance to avoid medical bankruptcy, the #1 cause of personal bankruptcy in the U.S.  

And let's face it: currently, if you're an individual consumer, the primary reason for having health insurance is to avoid unpayable, unexpected medical bills that could ruin you. It really is insurance in the same sense as earthquake or life insurance: it only saves you in the worst-case scenario; the rest of the time it seems like a nuisance.

I predict that when all the dust settles and the website starts working, most consumers will realize they're getting a better deal.


By Juan Williams
November 5, 2013 | FoxNews

Liar! Pinocchio! Deceiver!

With all the charges flying against President Obama in the on-going effort to stop ObamaCare it’s time for a reality check.

Having failed to kill the Affordable Care Act in Congress by shutting down the government the opposition is currently taking delight in charging the president will lying to the public when he said anyone who likes their current healthcare plan will be able to keep it under the new law.

It turns out that some people in the individual care market – about 5 percent of the overall insurance market -- are having their insurance policies cancelled. 

It is estimated that half of those folks will get better coverage for a lower price. Some people will even get subsidies to help them pay the lower price.

But some people losing their current policies [and being offered better coverage] are going to have to pay a higher price. Taking crocodile tears to a new level, ObamaCare opponents are now rushing to their defense and calling the president a liar.

These critics include Republican politicians who did not vote for ObamaCare; these are Republican governors who refuse to set up exchanges to reach their own citizens; these are people oppose expanding Medicaid to help poor people getting better health care; these are people who have never put any proposal on the table as an alternative fix for the nation’s costly health care system that leaves tens of millions with inadequate medical coverage and tens of millions more totally uninsured. 

The fact is if you are one of the estimated 2 million Americans whose health insurance plans may have been cancelled this month, you should not be blaming President Obama or the Affordable Care Act. 

You should be blaming your insurance company because they have not been providing you with coverage that meets the minimum basic standards for health care.

Let me put it more bluntly: your insurance companies have been taking advantage of you and the Affordable Care Act puts in place consumer protection and tells them to stop abusing people.

The government did not “force” insurance companies to cancel their own substandard policies. The insurance companies chose to do that rather than do what is right and bring the policies up to code. 

This would be like saying the government “forces” chemical companies to dispose of toxic waste safely rather than dumping it in the river. 

Or the government “forces” people to drive with intact windshields and working brake lights.

How dare they “force” drivers to pay money to get those things fixed if they are broken?

One of the most popular and important provisions of the Affordable Care Act is setting basic minimum standards of medical insurance coverage. Here are some of those standards:

- Your insurance company is no longer allowed to cancel your policy if you get sick

- Your insurance company cannot deny you coverage or charge you more if you have a pre-existing health condition

- Your insurance company must allow you to keep your children on your plan until they turn 26 years old or get a job that provides health insurance.

- Your insurance company cannot impose lifetime caps on your health coverage.

- And perhaps most relevant to current discussion about insurance companies canceling substandard policies, your insurance company must cover what are called “essential health benefits.”

What are “essential health benefits?”


“Essential health benefits must include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.”

That’s right.

If you are rushed to the hospital in an ambulance, the ACA says your insurance company has to pay for the ambulance ride. 

If your son or daughter has a bout with depression or suffers from panic attacks, the ACA says your insurance company needs to pay for their medicine and treatment from a mental health professional.

People should be angry that their insurance companies were not paying for these humane, common sense benefits all along. 

It baffles me that people are directing their anger at the ACA which rights these terrible wrongs.

The Hartford Courant newspaper reports that the CEO of Aetna insurance made $36 million last year plus several millions more in stock options. 

They also report that the CEO of Cigna cleared a cool $12.5 Million plus stock options. 

The American health insurance industry is one of the most profitable in the history of the world. Before the ACA, they made money by finding any excuse, any loophole to deny coverage to the sickest and most vulnerable people in our society.

Rather than being vindictive and canceling policies under the pretext of ObamaCare, the insurance companies should be thanking their lucky stars that they do not have to contend with a public option or a single payer system. That is what the law allows in every other modern industrialized democracy.

Friday, August 23, 2013

Rush: Get rid of health insurance

In continuation of my post the other day about the Tea Partyers' idea that's so old it's new again -- no health insurance for anybody -- here's Rush Limbaugh, riding the crest of this wave of insanity:

How many times have I detailed for you how much money I save not using insurance.  I just go to doctor, go to hospital, negotiate the price, and walk out of there and pay for it.  A lot of people can do this. You don't have to have tons of money to be able to do this, take installment plan payments like everybody else does.  But everybody's so conditioned that they can't get treated unless they've got health insurance.  Everybody's like sheep in this, can't even have an average doctor visit without insurance.  I think it is a crying shame.  I think it is literally a disservice to the people of this country what's been done, attitudinally.  There is, I would say, easily a huge majority, vast majority, of people who believe that without health insurance they're gonna die. That's why it's such a big deal to people. 

[...]  I don't know what it's like to be conscious every day and my foremost fear being my health insurance and whether or not I've got it and am gonna keep it or what have you.  But for a lot of people it's everything.  It's the only thing.  And that exists, the reason people think that way, can't really blame 'em, 'cause every day of their lives they are told that food or that beverage is gonna kill 'em or give them this disease or that disease or their genetics incline them to alcoholism or Parkinson's or whatever.

I don't even know where to begin with such utter bullshit.

Fact: Medical bills are the #1 cause of personal bankruptcy in the U.S.  Fact: 45 million Americans do not have health insurance (and it's not because they're happy shopping around and paying in installments). Fact: you can't bargain for a product when you don't even know what product you need (this is health care in a nutshell). Fact: most hospitals do not have price lists. That's right, even if you offer to pay in cash, they can't tell you the price until well after the fact. Trust me, I've been there. Fact: you can't plan or save for catastrophic injuries and unexpected illnesses, you just can't.  And for this very reason, for such economic instances, smart people invented insurance.


Ah, the good ole' days of family medicine.
Earlier this year, a week in the hospital for my infant child cost more than $30,000, while our insurance paperwork was still in process. Bill collectors were harassing us 3-4 times a day until the paperwork cleared weeks later. ($30,000 is a down payment on a house in most places in America).  There's no time to negotiate or shop around when your child is dying, believe me.  

Rush is such an isolated, aloof, childless, Ivory-Tower gazillionaire that he's completely lost touch with America.  This guy is living in a different country, a different stratosphere.  I can't believe the nerve of him.  I can't believe his listeners don't stone him to death.

If this doesn't prove to you once and for all that Rush Limbaugh and his horde of talk-radio imitators trying to make fast buck by talking irresponsible nonsense are not on the Little Guy's side, and in fact know nothing about the Little Guy's troubles, then I don't know what will.  Just because these hucksters say they like NFL football and fast food doesn't make them one of us.

This is Rush telling poor sick people, "Let them eat cake."  Off with his head!  


The Rush Limbaugh Show | August 23, 2013

Friday, May 10, 2013

Obama reveals hospitals' real prices. Now what??

There goes that socialist Obama Administration again!:

The database released on Wednesday by the federal Centers for Medicare and Medicaid Services lays out for the first time and in voluminous detail how much the vast majority of American hospitals charge for the 100 most common inpatient procedures billed to Medicare. The database -- which covers claims filed within fiscal year 2011 -- spans 163,065 individual charges recorded at 3,337 hospitals located in 306 metropolitan areas.

This time Obama had the gall to publicly release information about the real prices that hospitals and doctors charge for medical procedures.  So that people, can, like, you know, compare prices and stuff.

If that sounds like something out the free market, you're right. But that doesn't matter, because it was OBAMA who publicized the information!  He always has a diabolical ulterior motive!  We just don't know what it is yet....

Seriously though, I know from personal experience that the prices hospitals charge are totally wacko. Recently my young child spent five days in the hospital while our registration for new health insurance, retroactive to Jan. 1, was still in process.  She's perfectly fine now, thank Allah, but we subsequently received a hospital bill for $31,000.  Bill collectors immediately started to call the house several times a day, every day, and all we could tell them was the same thing the insurance company told us: the paperwork is still in process; later the hospital could re-submit the claim.  

After our health insurance finally kicked in and the claim was processed, the hospital told us over the phone that our share would be about $3,000, but a few months have passed and still no bill for $3,000.  Meanwhile the hospital's billing office asked us to submit an application for a discount, which we did.  I suspect that $3,000 remaining charge will simply disappear, but if not.... Thankfully, I can afford to pay it, but for most poor families an unexpected medical emergency like that would ruin them.  

Indeed, medical bills are the #1 cause of personal bankruptcy in the U.S.

This case illustrates why health care can never be a free market.  First, the patient has no clue what he needs to buy.  If you're in critical condition and the doctor says, "We're going to stick this tube down your throat," you're not going to second-guess him... and meanwhile bargain or threaten to "take your business elsewhere."  No, you just do whatever he says, immediately. (This is assuming you're conscious at the time; otherwise the doctor just does it.)  

As a medical "consumer," you rarely have an actual choice.  Without information/knowledge, prices and choice there cannot be a competitive free market.  

The most that such information provided by Obama can do is help a patient after the fact who asks his provider, "Why did you charge me so much, when Hospital X down the road charges one-tenth as much for the same thing?"  But a patient is in a pretty weak bargaining position ex post facto.

This case also illustrates why everybody needs to be insured.  You cannot plan for the unplanned that costs who-knows-how-much.  And you're in no condition to bargain when you're critically ill.  That's why people buy insurance.  But for any kind of insurance scheme to work, the insurance pool has to be large enough to spread out risk and expense over many customers/insured.

Usually it's the 49 million poorer Americans who have no health insurance. The sick irony is that those people who are least able to pay are the ones asked to pay the full, "real" price of medical treatment.  Of course they often cannot pay.  So the hospital's actual cost for that treatment, whatever it really is, gets passed onto those who can pay, i.e. to health insurance companies.  It's a terribly messed-up "system."

Again, let me remind you that Obamacare opts to work primarily through this existing labyrinth of private health insurance.  This is the same system that Republicans think is not broken so we don't need to fix it.  Obamacare's most unpopular aspect -- the individual mandate -- requires people to participate in this "free-market" system.  It sets up new healthcare exchanges where people can buy private health insurance.  This is all as the Heritage Foundation, Newt Gingrich and Mitt Romney said it should be, before Obama took their suggestion and they decided they hated it.  

Whereas many liberals like myself want us to have a single-payer system, aka Medicare for all, to keep down costs and ensure universal coverage. But our compromiser-in-chief didn't opt for that route, he never even tried.  


By Jeffrey Young and Chris Kirkham
May 8, 2013 | Huffington Post

Monday, October 1, 2012

Conservatives should back Obamacare

The health care individual mandate to cure the "free rider" economic problem, and pro-market health exchanges were both Republican ideas supported by Republicans in Congress... until Obama proposed them.  Then suddenly these ideas became Big Gubument Socialism.

Obamacare is hated by Republicans today mainly for things it doesn't include -- like death panels, and mandated coverage of abortions.  But they also focus to their detriment on contraceptive coverage that most women, Repub and Dem alike, want covered by private insurance.  Meanwhile, true liberals like moi don't like Obamacare because it's not a single-payer system, and there is no public option (aka "Medicare for all") to provide real competition with private insurance and show which would provide the best outcomes for the lowest price.

Concludes Kleinke:

The real problem with the health care plan — for Mr. Romney and the Republicans in general — is that political credit for it goes to Mr. Obama. Now, Mr. Romney is in a terrible fix trying to spin his way out of this paradox and tear down something he knows is right — something for which he ought to be taking great political credit of his own.


By J.D. Kleinke
September 29, 2012 | New York Times

Friday, October 16, 2009

Krugman: Insurance industry's overreach helps reform?

A Hatchet Job So Bad It's Good

By Paul Krugman

October 15, 2009 | New York Times

[....]

As I said, the individual mandate probably should be stronger than it is in the Finance Committee's bill. But there's a reason the mandate was weakened: fear that too many people would balk at the cost of insurance, even with the subsidies provided to lower-income individuals and families. So why not address that cost?

Aside from making the subsidies larger, which they should be, there are at least two changes to the legislation that would help limit costs. First, health exchanges — special, regulated markets in which individuals and small businesses can buy insurance — can be made stronger, in effect giving small buyers a better bargaining position. Second, the public option — missing from the Finance Committee's bill — can be brought back in, giving private insurers some real competition.

The insurance industry won't like these changes, but that matters less than it did a week ago.

There's also another point, which House Speaker Nancy Pelosi has stressed. Part of the opposition to a strong individual mandate comes from the sense that Americans will be forced to buy policies from a greedy insurance industry. Giving people, literally, another option — the right to buy into a public plan instead — would defuse that opposition.

[Indeed, BaucusCare, if passed by Congress as is, would be a corporate socialist giveaway to the insurance industry by mandating that every American buy private health insurance or else pay a tax penalty. -J]

Even with stronger exchanges and a public option, health reform would probably increase, not reduce, insurance industry profits. But the insurers wanted it all. The good news is that by overreaching, they may have ensured that they won't get it.