Thursday, November 26, 2015

ACA/Obamacare: Failed Co-Ops and Unpaid Doctor/Hospital Bills

‘NEW YORK (AP) — The sudden collapse of the largest nonprofit insurance cooperative created by President Barack Obama's health care law is causing headaches in New York, especially for medical providers owed millions of dollars for treating the failed plan's patients.

More than 200,000 people insured through Health Republic Insurance of New York have until Monday to sign up with another company if they want to maintain coverage in December.

State regulators ordered the insurer to shut down at the end of the month because of severe financial problems. They are also investigating what they say were inaccurate financial filings by the company.

The closure - part of a wave of failures of the new co-ops nationwide - has been a big hassle for Health Republic policyholders, who have had to shop around quickly for alternative coverage.

The situation may be worse, though, for doctors, hospitals and other clinicians. They are legally obligated to continue treating Health Republic patients through the end of the month but have been given no assurances they will ever be paid for that care.

"I'm aware of at least two physicians who have gotten checks from Health Republic, and those checks have bounced," said Dr. Joseph Maldonado, president of the Medical Society of the State of New York.

Two groups that represent hospitals, the Health Care Association of New York State and the Greater New York Hospital Association, said their member facilities are already owed at least $150 million, not including care provided in much of November.

Medical practices are likely owed millions of dollars more. A survey of 800 doctors by the medical society found that 43 percent were owed money by the company. Nearly 8 percent reported being owed $25,000 or more. One practice of 22 physicians reported being owed more than $5 million, the society said.’ - Health Co-Op Failure Leaves Doctors Owed Millions,, 11/24/2015

Link to the entire article appears below:



Wednesday, November 25, 2015

ACA/Obamacare: When Insurance Theory Becomes Reality Theater

‘UnitedHealth Group, the largest insurance company in the U.S., on Thursday slashed its earnings outlook, citing new problems related to Obamacare, and told investors it may exit the program's exchanges.

"In recent weeks, growth expectations for individual exchange participation have tempered industrywide, co-operatives have failed, and market data has signaled higher risks and more difficulties while our own claims experience has deteriorated," Stephen J. Hemsley, chief executive officer of UnitedHealth Group, said in a press release.

The release added that, "UnitedHealthcare has pulled back on its marketing efforts for individual exchange products in 2016. The company is evaluating the viability of the insurance exchange product segment and will determine during the first half of 2016 to what extent it can continue to serve the public exchange markets in 2017."

In a conference call with investors, Hemsley offered a sober assessment of the exchanges' future viability. He said that claims data have been getting worse as time has gone on, and there's no evidence pointing toward improvement.

Asked about whether the company could sustain losses past 2016, he was blunt: "No. We cannot sustain these losses. We can't really subsidize a marketplace that doesn't appear at the moment to be sustaining itself."

The year 2017 is significant for insurers, because that's the year when several programs designed to mitigate risk for insurers through federal backstops go away. The hope was that those programs would act as training wheels for Obamacare in its first few years of implementation, but after that, the insurers were supposed to be able to thrive on their own. UnitedHealth's statement suggests otherwise.’ - Nation's largest insurer may exit Obamacare due to losses, Washington Examiner, 11/19/2015


Link to the entire story appears below:

Tuesday, November 17, 2015

ACA/Obamacare: Church and State

‘The latest objection to the Affordable Care Act before the U.S. Supreme Court won't derail President Barack Obama's federal health care law but could carve out an exception for religious nonprofits, attorneys and legal experts said.

The court said Friday it will hear challenges by the Catholic Dioceses of Pittsburgh and Erie and Geneva College, a Beaver Falls school affiliated with the Reformed Presbyterian Church, along with six other lawsuits from religious organizations around the country objecting to provisions in the federal health care law mandating the church and its affiliate agencies provide coverage for birth control or file a form opting out.

"This has nothing to do with the particulars of the issue, and that's why the court took it," said Bruce Ledewitz, a Duquesne University professor who studies religion and law.

"This isn't about abortion. It isn't about conception. It's not about Obamacare, either."

The court will instead consider whether the government has the right to dictate what religious nonprofits can and can't do, Ledewitz said.

Bishop David Zubik of the Pittsburgh diocese said the issue is one of religious freedom.

"The insurance mandate, which is one small provision of the Affordable Care Act, would require us to facilitate access to contraceptives, sterilization and abortifacients contrary to our teaching," Zubik said in a statement Friday. "We are encouraged that the Supreme Court will hear our case and are hopeful that they will rule to protect not only our religious liberty but that of all Americans."‘ - Supreme Court Agrees To Hear Church Groups’ ACA Challenge,, 11/07/2015

Link to entire article appears below:





ACA/Obamacare: Trouble in Paradise -or- The Disconnect Between Hawaii Health Connector and

‘Hawaii residents are taking over an hour on average -- and as long as four hours for non-English speaking people -- to apply for Obamacare health coverage via the federal marketplace,

On Sunday, Obamacare coverage in Hawaii switched to the federal marketplace from the Hawaii Health Connector, the state-based exchange that is ending operations completely in 2016. The Connector is contracted by the state to assist people signing up for insurance under the Affordable Care Act, or Obamacare, but didn't have enrollment numbers as of Friday. A spokesman for the Centers for Medicare & Medicaid Services, which oversees the federal exchange, said the government agency is not releasing enrollment figures at this time.

"Hawaii is at risk of being unable to process all re-enrollments. We are having significant challenges getting people enrolled on," Jeff Kissel, the Connector's executive director, told board members at a meeting Friday. "Even if we put all the people we have on it we're not going to get done by Jan. 31. We told CMS we've got to have a contingency plan."

All of the roughly 40,000 Hawaii residents who got health insurance through the Connector must re-enroll on as policies will not be automatically rolled over to the federal exchange. If a policyholder does not re-enroll, coverage will end Dec. 31. The 2016 enrollment period closes Jan. 31.

One of the major problems hindering enrollment is that automated identity verification is not working on, Kissel said.’

Average enrollment time for individuals is taking about one hour and 15 minutes, while the time for those signing up over the phone through the federal call center is in excess of two hours, he said. - Hawaii Residents Face Long Delays In Applying For Health Coverage,, 11/07/2015

Link to the entire article appears below:

Monday, November 9, 2015

ACA/Obamacare: No Cadillac Plan for You! Tax for You! Maybe Not So Much…..

Reid and Pelosi have been talking since the spring with President Obama about repealing the “Cadillac tax” on employer healthcare benefits, a senior Democratic aide confirmed on Friday.”

“Both Reid and Pelosi have remained relatively quiet on the tax since the bill's passage in 2010. Even as dozens of Democrats signed onto bills in their respective chambers to repeal it, Reid and Pelosi stayed in the background, refraining from public statements on the efforts.

Powerful labor groups such as the AFL-CIO and the American Federation of Teachers vehemently opposed the Cadillac tax from the start. They say repeal needs to happen soon, before employers begin trimming back healthcare benefits.

Aside from the question of how to pay for repeal, the Democrats' biggest roadblock is the Obama administration.” - Reid, Pelosi pushing for repeal of ObamaCare's 'Cadillac tax', the, 11/06/2015

Link to the entire article appears below:

Thursday, November 5, 2015

ACA/Obamacare: Sticker Shock

Wednesday, November 4, 2015

ACA/Obamacare: When the Narrow Network Becomes the Narrowest

“WASHINGTON - Many health plans sold through Affordable Care Act marketplaces in 2015 are so limited that they don't offer patients access to some medical specialists such as endocrinologists, rheumatologists and psychiatrists, a study suggests.

That may be forcing some patients to pay thousands of dollars out of pocket for any care provided by these specialists.

"This translates into huge cost burdens for patients," said Stephen Dorner, lead author of the study, which was published by the Journal of the American Medical Association.”

“To test the extent of narrow networks, researchers at the Harvard T.H. Chan School of Public Health looked at provider directories in a sampling of 135 Silver health plans being sold in the 34 states that relied on the federal marketplace in 2015.

They expected to find plans with only a handful of physicians in some specialties. Instead, they discovered that nearly 15 percent of the plans did not include a single in-network physician for at least one specialty.” - Some ACA Plans May Exclude Specialists, Study Finds, 10/28/2015,

Link to the entire article appears below:

ACA/Obamacare: Broken Obamacare Promises Web Site

A new web site has been developed where one can share stories regarding: loss of a trusted doctor, rate increases, lost access to a reasonably priced prescription, cancellations i.e. if you like your plan you can keep your plan.

The web site is sponsored by “ Independent Women’s Voice is a 501(c)(4) nonpartisan, nonprofit organization for mainstream women, men and families. IWV is the sister organization of the Independent Women’s Forum.”

The web site address is: