Thursday, January 16, 2014

The Care Part

As the Affordable Care Act still goes along with many bumps and bruises along the way the idea is that it will all be okay as more Americans will be getting care for those bumps and bruises.

Well on that front we have found that the idea of signing up for healthcare is much like voting - a provenance for the oldsters. What should be across the board enrollment especially what is needed to offset costs via the young, the largest uninsured group, is in fact not happening. It is us or my cohort, the boomer tails. We are those 45-54 who are classifed as the United States biggest problems, too old to work and too young too die. Yep we are just biding our lazy ass time waiting for the big payoff of Medicaid and Social Security. Out of my way young punk I got me some sitting around on my as while you work to pay for it... or however the misconception bullshit that perpetuates as logic or excuse making goes in politics.

Then we have the issues of the subsidies. Well those passed another round in the Courts today and well if you are poor and you know it but not poor enough to be a full on charity case and get Medicaid, the second largest group of enrollees under Obamacare, you will qualify for a federal subsidy.

And then now finally with that precious gem of a card finally in hand you now can get the medical help you could have had the first time, charity care.

Most of the plans offerred through state or federal exchanges have one option of Hospital care and of course Doctors with admitting agreeements at said Hosptials and that is of course the public ones.

Here in Washington State there are out of the 5 options of insurance providers only two that have more than one choice of hospital care. Group Health an HMO with their own crappy hospitals and the other the State run program that has existed all along and has public clinics which you must first go to before actually going to see any provider at the other hospitals that exist in the area. Bet you 5 bucks that regardless you are not going to any of those, consider them last resort over the public and state run University hospital system or aka the "public option"

So I can get insurance now, the same insurance I had before with less choice. I will be going to Harborview/University of Washigton abuse system of health or well nowhere unless pitching a bitch works.

The article below discusses this as it relates to New York. But be certain that is everywhere as the public option is going to the place you tried to avoid even when you didn't have insurance. God help us everyone and Tiny Tim too. Maybe that was why the kid was crippled in the first place, crappy medical care.

Public Hospitals Hope to Attract More Upscale Patients Under Affordable Care Act

JAN. 15, 2014

Todd Obolsky lives in a studio apartment in Manhattan, drives a leased Toyota Corolla and occasionally splurges on experimental cuisine in the East Village. When the Affordable Care Act allowed him to buy insurance for the first time in years, he was so price-sensitive that $30 a month made a difference in which plan he picked.

So the obvious choice was MetroPlus. It offered the best deal at the coverage level he was looking for — about $400 a month for a gold plan, the second-highest of the four levels. “That’s like as high as I can possibly go without living on rice,” he said.

He never noticed that it was the insurance company of New York City’s public hospital system; to a typical shopper on New York’s health exchange, it looks no different from big-name companies, like Empire or United.

But to the Health and Hospitals Corporation, the city’s public hospital agency, it is not merely another insurance plan. The corporation created MetroPlus, and sees it as a powerful opportunity to attract a different class of patients — somewhat higher-income, more educated and more stable — to a system whose historic mission has been to serve the poor, and whose finances have been straining.

Robyn Chapman, an artist, signed up with MetroPlus as well. The hospital system is hoping to attract more affluent patients. Nicole Bengiveno/The New York Times “It’s a potential significant source of additional revenue,” said Alan Aviles, the corporation’s president. While “we won’t necessarily have concierge services; there won’t be a piano in the atrium,” he said he hoped the new customers would find that his hospitals were underrated.

Around the country, a number of public health systems and charity hospitals serving large numbers of poor patients see the health exchanges, created by the states under the act, as a way to widen their customer base. In Los Angeles, L.A. Care, a publicly run health plan, has enrolled about 8,000 people so far via the California exchange. The Henry Ford Health System in Detroit, which has roots in organized labor and the auto industry, has signed up about 4,000 people in its exchange plans.

The University of Arizona Health Plans have attracted only 250 people, said James Stover, their chief executive. But he said they were still trying to sign up young people who were part of the university system, as well as uninsured people on the cusp of Medicaid eligibility, who are partly responsible for the system’s $100 million a year in uncompensated care. “It makes a lot of sense from a mission standpoint to go into the marketplace and try to find coverage for these individuals,” Mr. Stover said.

By Dec. 24, the deadline for receiving coverage on Jan. 1, MetroPlus, one of 10 companies selling exchange plans in New York City, had enrolled 18,397 members, about 32 percent of all those who signed up citywide. Enrollment hit 22,000 last week, the corporation said, and it hopes to reach 40,000 by the end of 2014.

Currently, only 7 percent of the 1.4 million people treated by the city’s public hospitals each year have private insurance, according to the Greater New York Hospital Association. Another 58 percent are on Medicaid or Medicare, and 35 percent are uninsured; half of those are illegal immigrants, who cannot get coverage under the new law.

That patient mix fosters a common belief that the public hospitals are a last resort, or as one Yelp reviewer described Woodhull Medical and Mental Health Center in Brooklyn: “If you were writing for a TV drama about the downtrodden castoffs of society, you could not have conceived of a more appropriate place.”

In the Medicare system’s Hospital Compare ratings, the city’s public hospitals typically score lower in patient satisfaction than private ones. But they compare well on medical measures, like whether they follow protocols for heart attack, pneumonia and surgery patients.

For years, the hospitals corporation has tried to polish its image by contracting with private hospitals and medical schools to staff the public hospitals; for example, many Bellevue doctors come from NYU Langone Medical Center next door. And by attracting more affluent and choosy customers, the corporation hopes, it can also attract doctors into the MetroPlus networks who would not normally associate with public hospitals.

MetroPlus was created in 1985 as a managed-care plan for Medicaid recipients. While there is no guarantee that offering MetroPlus on the health exchange will be profitable, the corporation projects that the exchange plans will bring $120 million a year in revenue to a system now running a $250 million annual deficit.

By this week, 66 percent of its customers were enrolled in the silver plan, suggesting that they had low to moderate incomes and expected to qualify for subsidies. But 10 percent enrolled in gold and 18 percent in platinum, suggesting higher incomes, which surprised MetroPlus officials.

As Mr. Obolsky discovered, MetroPlus offers the lowest premiums on the New York exchange for the top three standardized plans: $359 a month for silver, $396 a month for gold and $443 a month for platinum.

One major reason for the low prices is that MetroPlus will cover patients only at the city’s 11 public hospitals and four private ones — Beth Israel’s two campuses in Manhattan and Brooklyn, St. Luke’s-Roosevelt in Manhattan, and Lutheran in Brooklyn. Except in an emergency, plan members will not be covered at some of the more prestigious hospitals like Mount Sinai and NYU Langone.

Mr. Aviles said that to keep its premiums down, MetroPlus had to offer relatively low reimbursement rates for hospitals. Several hospitals said they were still negotiating with MetroPlus and might join the network.

Mr. Obolsky, 48, a consultant, said he was happy to hear that St. Luke’s-Roosevelt was on the plan, because its campuses were near him on the Upper West Side.

Robyn Chapman, an artist who pieces together a living making and selling comic books, working as a legal assistant and cat sitting, signed up for a silver MetroPlus plan. Her first bill was for $119.42 a month after tax credits.

She had not realized that MetroPlus was run by the city hospital system. But that would not have stopped her, she said, because she was looking mainly for price. She was familiar with one city hospital — Woodhull in Brooklyn — because she had used its clinics for routine medical care at $20 a visit. She said the waiting times there were very long, many patients seemed desperate and some nurses and doctors were “a bit cold, maybe even a little rude.”

She might try a different hospital, but otherwise she said: “I can’t complain. I’m honestly very grateful.”

Mark P. Scherzer, a consumer lawyer and counsel to New Yorkers for Accessible Health Coverage, said he expected MetroPlus would “still be sort of a poorer person’s plan,” with lower prices and lower quality.

Mr. Aviles conceded that for some people, public hospitals would never be acceptable, regardless of how well they delivered care.

“There’s always a headwind in terms of how many hospitals there are in New York City and how many have designer labels,” he said. “In the same way that if you’re affluent and buying a pair of jeans, you may be willing to spend $200 for those jeans because they have a designer label.”

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