Saturday, September 5, 2015

Not Getting Better

I have been pending my thoughts on perhaps the best written and researched article on the ACA that was by Trudy Lieberman in Harper's July 2015, Wrong Prescription, The Failed Promise of the Affordable Care Act.

Ms. Lieberman I feel does a generally unbiased account and report to the failings of "Obamacare" and describes it as that which is  wreaking havoc on the middle class. To that end I want to also add the working poor, who while qualify for subsidies which  are reviewed at years end during tax filing.  Which in turn you may end up paying most if not all of those subsidies,  as did I, as I work hourly and my income fluctuates by the hours worked. When I enroll it is based on a average earning of the prior year and in turn that too can decline as this year it may due to potential strike situation.

The problems stem from the large deductibles and large out of cost expenses that it requires thereby negating the preventive care that this plan was to encourage versus emergent care the mantra that claims people were using ER's as primary care providers. Another falsity that in fact was the response by patients sent there by their primary physicians when they contacted them during off hours.. the phrase "go to the ER" is on almost every message left in a Physicians office when closed.  And sure enough the ER's are inundated now which is mentioned in the article via a survey of ER physicians. Shocking, I know.

Then we have confusing policies that even the Physicians don't understand and in turn end up improperly or inadequately screening patients. Why spend that standard 15 minutes with a patient whose only paying a 10 copay versus one paying in full. I can assure you I have the bills that have been sent to me after accepting my insurance, calling ahead to verify the coverage and then in turn be told that it was not covered for "that" specific treatment.  And then there is the matter of meeting the deductible.

The average deductible also has to be met and in the Harper's article it says the average is $5,181 for individuals and $10,545 for families. I would have to go to a Doctor every other day to meet that. And those are the cheapest policies. For higher on the precious mineral scale (silver) it is 3K to 6K respectively.

The confusion about premiums is also an issue of import for most as they are broken up by precious minerals that somehow tell you the kind of care you are to get - bronze, sliver and gold.  That mineral contributes toward the confusing premiums, deductibles, coverage type and out of pocket costs. So for those who earn between 40-80k who do not qualify for subsidies or medicaid (in the states that expanded that program)  are most severely hit.  Which might explain as to why 22% of those who enrolled in 2014 elected to opt out in 2015.

Health care costs are not declining. The explanation for the rise in premiums for next year are being touted as quite high and the Guardian article below comments on this issue. But the excuse is that too many sick people signed up and had the audacity to use their policies and in turn the offset costs were not met. Meaning profit margins declined. But hey words matter or not when it comes to the medical industrial complex.

The Guardian sites Tennessee as the noted state with increase over 36% and Harper's too takes special note of Tennessee and their TennCare program. It concluded that the poorest residents in the state are no better off than prior to the ACA. Ms. Liberman used the story of Teresa Birdsong who enrolled for her blood pressure and diabetes. She then was able to get treatment for both - at a cost. By the time the article was written in June, she had $290 dollars more of costs before her max of $550 was reached. But she still had $230 left from the prior years in bills that did not count to the current maximum out of pocket she was supposed to pay ($550 per the policy) before insurance finally kicked it. So she met the maximum over two years but that does not count as it is annually. She was paying $30/mo to close out last years bills. It is clearly not working as Tennessee elected to not allow for Medicaid expansion which would have offset the costs and provided care but this is about politics not people.

There were many other tales of working people saddled with immense medical debt and that as the current election comes to head and the debate never ends there are the issues of the "Cadillac tax" on high end insurer policies and the device tax. Then there are the incentives and other methods to reign in costs - electronic records, fee for service payments, readmission penalties, and the all time favorites preventive "free" care that is mandated by the plan that is well not free its just spread out in other costs and fees. But the lack of transparency and endless fighting bickering will do little in the future to change any of this for the better and by better I mean the people. We won't being getting better apparently.

Health insurers seek double-digit rate hikes for 2016, report finds

Some states have already approved hikes as high as 36% as firms seek increases for a third of the health insurance plans listed on the Obamacare exchange
Prices for health insurance plans listed on are likely to go up in 2016.

Jana Kasperkevic in New York
The Guardian UK
Saturday 5 September 2015

US insurers have asked for double-digit increases for about third of the health insurance plans listed on the national healthcare exchange, a report has found.

The report found that 7% of plans sold on the exchange have proposed a rate increase of at least 30%, and 14% of the plans have proposed a rate increase of at least 20%.
Rate of uninsured Americans drops among poor and minority groups
Read more

Under the Affordable Care Act (ACA), commonly referred to as Obamacare, the new rates would go into effect come November, at the beginning of the open enrolment period for 2016.

At a July town hall in Tennessee, Barack Obama said that he expected the rates to “come in significantly lower than what’s being requested”.

Yet a month later, a proposed 36% rate hike by BlueCross was approved.

Tennessee’s insurance commissioner Julie Mix McPeak said that the increase for 2016 was necessary to cover the increase in costs related to claims from sick people who signed up for health insurance plans during the first two years of the ACA’s operation.

“Politics, and any opposition to the ACA, doesn’t have anything to do with [the increase],” McPeak told the Wall Street Journal. “Do I wish they were lower? Absolutely, because I know what it means to consumers.”

Since almost nine in 10 Americans shopping for health insurance plans on the ACA exchange receive financial assistance, most of them would not actually see a particularly drastic price increase.

When proposing new rates for 2016, insurers have to justify why they are seeking price increases. It is then up to the state insurance regulators to determine if the rate increases are justified or not.

Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, which oversees the ACA, told CNBC that the law increases competition for consumers, since they can shop around for the best deals.

“Last year, more than half of re-enrolling customers on actively shopped and selected a new plan, something that wasn’t possible for many consumers prior to the ACA due to the risk of being charged a higher premium or denied coverage entirely due to a pre-existing condition,” Albright explained.

“Consumers will find a range of quality, affordable coverage options on the marketplace in 2016.”

The thinking goes that in order to stay competitive, health insurance plans will keep their rate hikes low.

Instead of hoping that competition will keep the rates down, Wisconsin Democrats have introduced a bill designed to do so. Currently, there are six health insurance companies are seeking rate increases between 10% and 33% on the Wisconsin-listed plans. It is unlikely that the bill will pass through the state legislature, which is currently controlled by a Republican majority.

So far, some of the highest reported approved rate hikes have been the 36% rate hike for BlueCross BlueShield in Tennessee, a 26% rate hike for CareFirst insurance plans in Maryland and 25% rate hikes for Kentucky HealthCooperative plans in Kentucky and Moda Health plans in Oregon.

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