Tuesday, March 8, 2016

The Law, the Rule the Money

When I find myself actually agreeing with the Conservative end of the spectrum then I know I have hit the proverbial brick wall.  And when it comes to the "un" Affordable Care Act I have to wonder what exactly is affordable when it comes to care.

The act is largely a massive scale law that was enacted when Mitt Romney was the Governor of Massachusetts (remember that? it sort of explain Massachusetts frankly as both highly overrated and utterly full of bullshit).  And when it was analyzed it was found not to be the panacea it was promised to be.  The analysis from both conservative and liberal bastions of the political spectrum found by this MassCare Gov (liberal single payer advocacy group):

Four years after full implementation of the law, Massachusetts has not achieved universal coverage, although one-half to two-thirds of the previously uninsured now have some type of insurance policy. Most of the gains in coverage have come from expansions in publicly subsidized insurance. This largely represented a shift of patients from the state’s former Free Care Pool, which compensated hospitals and community health centers directly for care of the uninsured, to private insurance plans, which is a more costly way to provide care. The reform did not lead to a sustained increase in employer-sponsored coverage, but did slow declining employer coverage. Instead of dropping coverage, employers in Massachusetts have increased cost sharing, shifting costs on to employees, leading to rapidly rising underinsurance after health reform. The use of high-deductible plans more than tripled for residents with private insurance, and good insurance coverage at small businesses all but disappeared over a few short years after reform.

And lo and behold here we are just at the same time frame finding the same.  This is one bill that needs utter repeal as it is utter garbage. 

Health Law Insurance Plans to be Rated by Network Size




WASHINGTON — The Obama administration, responding to consumer complaints, says it will begin rating health insurance plans based on how many doctors and hospitals they include in their networks.
At the same time, the maximum out-of-pocket costs for consumers under the Affordable Care Act will increase next year to $7,150 for an individual and $14,300 for a family, the administration said. Consumer advocates said those costs could be a significant burden for middle-income people who need a substantial amount of care.
Under new rules to be published Tuesday in the Federal Register, insurers will still be allowed to sell health plans with narrow networks of providers. But consumers will know in advance what they are getting because the government will attach a label indicating the breadth of the network for each plan sold on HealthCare.gov.
About 12.7 million people signed up or had their coverage automatically renewed in the third annual open enrollment season, which ended on Jan. 31.
Many health plans offered in the public marketplaces provide a limited choice of doctors and hospitals, and some insurers narrowed their networks this year by excluding some doctors and dropping popular teaching hospitals.
Consumers have grumbled about the changes, and some say they have had difficulty finding medical specialists. But cost-conscious consumers have gravitated to these plans because they tend to offer lower premiums than health plans providing a greater choice of doctors and hospitals.
Consumers can already find out which health plans include a specific doctor. But until now they had no reliable way to determine if a health plan had a large or small network of providers. The new ratings will indicate how the breadth of a health plan’s network compares with that of other plans in the same geographic area.
“This could be really helpful for a lot of consumers,” said Sabrina Corlette, a consumer advocate and professor at the Health Policy Institute of Georgetown University.
Consumers have also complained about the out-of-pocket costs for many health plans under the Affordable Care Act.
“For many people, $7,000 of costs can be a huge impediment to actually receiving care,” especially if patients incur those costs in a month or two at the start of a year, said Marc M. Boutin, the chief executive of the National Health Council, a coalition of advocacy groups for people with chronic diseases.
Out-of-pocket costs, as defined by the government, include deductibles and co-payments, but not the premiums that people pay for insurance. Each insurer sets limits on out-of-pocket costs for its health plans, and the limit cannot be higher than the maximum specified by the government. The maximum for an individual will exceed $7,000 next year for the first time. It will go up by $300 in 2017, after an increase of $250 this year.
Consumer groups say this rate of increase is unsustainable. Moreover, they say, high out-of-pocket costs have deterred some people with insurance from using expensive prescription drugs.
Ben Wakana, a spokesman for the Department of Health and Human Services, said that in setting the new ceiling on out-of-pocket costs, the administration had used a formula laid out in the Affordable Care Act. Before the law was adopted, he said, people with cancer or other serious illnesses could be bankrupted by hundreds of thousands of dollars in medical bills, and the law provides new protections.
People with low incomes can obtain discounts that reduce their deductibles and other out-of-pocket costs if they choose midlevel silver plans. Slightly more than half of the people with marketplace coverage received such “cost-sharing reductions” last year.
Ms. Corlette, the Georgetown University professor, said that in writing the new rules, “the administration was walking a very delicate line, pushing forward with consumer protections while trying to keep insurers onboard and participating in the marketplaces.”
In some markets, consumers can choose from dozens of health plans. In a move intended to simplify the shopping experience, the Obama administration has devised six model health plans that it describes as standardized options. Federal officials specify the amount of deductibles, co-payments and other charges for doctors’ services, hospital care, X-rays, laboratory tests and prescription drugs.
The standard features will make it easier for consumers to compare plans, officials said, and the government will highlight these plans in some way on HealthCare.gov. But the government is not requiring insurers to offer the standardized options or limiting their ability to offer other plans in 2017.
Another new requirement is meant to guarantee “continuity of care” for certain patients. If a health plan drops a doctor from its network without cause, the insurer must allow patients in “an active course of treatment” to continue seeing the doctor for up to 90 days. This protection would apply, for example, to patients receiving chemotherapy or radiation therapy for cancer and to women in the second or third trimester of pregnancy.
Under the new rules, consumers using the federal marketplace will be able to get help year-round from insurance counselors financed by the government. The counselors, known as navigators, help people sign up in the annual open enrollment period. The administration is expanding their duties to include teaching people how to use insurance, appeal denials of coverage and obtain exemptions.

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