ACA/Obamacare: Access to Insurance Does Not Mean Access to Health-care

“Paul Vondra is just the sort of person the architects of Obamacare had in mind.

The 59-year-old Bellevue resident is a temporary worker contracted through a New Jersey agency to work as a mail clerk for a major local bank. He doesn’t own a car, so he bikes each day to his job in the Strip District.

His agency has offered him a choice of two Affordable Care Act-qualified plans. But Mr. Vondra, who makes less than $25,000 annually and has no dependents, said the cheapest plan carries a monthly premium of $165, or $800 a year, and a yearly deductible of $2,500.

Also, the plan’s co-insurance — the amount he would be responsible for after he has met his deductible — is $4,500, while out-of-pocket hospital costs are capped at $10,000.

“It might as well be $10 million,” he said.

He’s not alone. Officials at local health centers and clinics say they’re seeing more people like Mr. Vondra whose access to insurance has not translated into access to care.”

Annette Fetchko, administrator at the Catholic Charities Free Health Care Center, Downtown, said the center has helped secretaries, security guards, custodians, seasonal construction workers and others who have insurance but who still can’t afford to fill prescriptions or follow through on a doctor’s referral to see a specialist.

As a result, she said, the center has broadened its mission, with a focus on ensuring access to care regardless of insurance status.

“At the end of the day, the underinsured are no different than the uninsured,” she said.” - Affordable Care Act: Access to insurance is no guarantee a person will have access to care, Pittsburgh Post-Gazette, 09/05/2016

Link to the entire article appears below:

http://www.post-gazette.com/business/healthcare-business/2016/09/05/Access-to-insurance-is-no-guarantee-a-person-will-have-access-to-care/stories/201609040115


　

　

　


　

ACA/Obamacare: Same Zebra with the Same Stripes?

‘If there is one thing Republicans and Democrats agree on it’s this: Obamacare represents a radical change in the US health care system. Soon after its passage, some on the left declared that we had created a right to health care for the first time in our history. Some on the right predicted death panels and a march toward socialized medicine.

But what if they are all wrong?

Is it possible that we could spend $2 trillion over the next ten years, create hardship and anxiety for millions of families who already had health insurance they liked, cause buyer’s remorse for millions of newly insured, cause almost every business in America to change its employee benefits and at the end of the day accomplish not much of anything?

Yes that’s possible.

What brings this to mind is a new report by the inspector general at the Department of Health and Human Services. As summarized in The New York Times:

“… the Obama administration and state officials have done little to ensure that new beneficiaries have access to doctors after they get their Medicaid cards….”

“The report … says state standards for access to care vary widely and are rarely enforced. As a result, it says, Medicaid patients often find that they must wait for months or travel long distances to see a doctor.” ‘

‘The same problem arose under Romney Care. When he was governor, Mitt Romney told me that once people were insured, they would go to physicians’ offices rather than hospital emergency rooms. They would get less expensive care and more appropriate care as a result, he said.

There were two problems with that prediction. First, Romney Care didn’t create any new physicians’ offices. Second, the newly subsidized private insurance didn’t pay that much more than Medicaid. Bottom line: patients in Massachusetts are largely going to the same places they went before Romney Care. Emergency room traffic is higher than ever. The traffic to community health centers has changed very little. For reasons I don’t understand, those with newly subsidized private insurance have more difficulty seeing a doctor than patients on Medicaid. And waiting times in Massachusetts are the highest in the country. In Boston, the wait to see a new doctor is about two months!

Under Obamacare, things are likely to be even worse. Not only does the health reform law not create any new doctors, it will shrink the supply of doctor services as more physicians retire early (discouraged by a new raft of rules and regulations) and more of them become hospital employees (where they work nine to five and play golf on the weekends). At the same time the law will greatly expand the demand for care by the relatively healthy. Millions of senior citizens are now entitled to an annual wellness visit (of no medical value according to almost every expert) and everyone with private insurance will be entitled to a long list of preventive procedures (almost all of questionable medical value), with no copayment or deductible.

Giving preventive care to healthy patients is time consuming and it crowds out access by those who have genuine medical problems. In fact a Duke University study estimated that fulfilling the promise of preventive care to all Americans would consume almost the totality of the average doctor’s day.’ - What if Obamacare Doesn't Change Much Of Anything?, Forbes, 10/06/2014

Link to the entire article appears below:

http://www.forbes.com/sites/johngoodman/2014/10/06/what-if-obamacare-doesnt-change-much-of-anything/

Obamacare Provider Networks: The Networks Look Like Medicaid Networks? One has Signed Up for “Medicaid Plus“?

‘Many plans being offered now on the new insurance exchanges sharply limit the number of hospitals where services are covered, according to a new McKinsey & Co. report. Insurers are making a bet that price is more important to consumers than choice, and limiting the number of hospitals and doctors allows them to keep the cost of a plan as low as possible. Many of the new plans offered still are more expensive than current plans because they offer more benefits.’

‘According to the McKinsey report, which looked at federal and state-run insurance exchanges in 20 cities including Los Angeles, Atlanta and Houston, about 60% of health plans offer coverage at a smaller number of hospitals than comparable current individual plans. McKinsey identified 120 health plans in those markets by examining federal and state exchange filings, as well as provider information listed on individual insurer and hospital websites. Some of these new plans limit coverage to one or two large hospitals.

The number of hospitals accepting insurance from a consumer who buys coverage on the exchange could be 60% lower than the number of hospitals in current individual plans, according to the McKinsey report, which included the 20 largest hospitals in each market that it measured.

Consumers can still buy plans on the exchanges that offer coverage at a wide network of hospitals, but they cost significantly more, McKinsey said. In a market where the same insurer offers two separate plans—one with broad hospital access, one with limited options—the more comprehensive coverage costs 26% more, McKinsey said.’

‘Leading research and teaching hospitals, such as Cedars-Sinai, the University of Chicago Medical Center and MD Anderson Cancer Center in Houston, are cut out of most plans sold in their home states. That move "is built on the premise that hospitals are commodities," said Thomas M. Priselac, CEO of Cedars-Sinai Health System, which is available on just one of seven middle-tier plans sold in Los Angeles. "That's just not true."‘

‘Consumers who need complex procedures like heart transplants will still be able to get them because their insurers will contract with hospitals that offer them.

Still, "when you need an organ transplant, it's a matter of life or death—do you want your insurance company calling us, working out a deal?" asked David T. Feinberg, CEO of the UCLA Hospital system, which includes Ronald Reagan. The hospital is included in just two of seven middle-tier health plans sold in the Los Angeles market.’ - Shrinking Hospital Networks Greet Health-Care Shoppers on Exchanges, WSJ, 12/13/2013

Link to entire article appears below:

http://online.wsj.com/news/articles/SB10001424052702304202204579256621005722460


　

　

　

　

　

　

　


　

ACA: Where Choice is Job 57!

“Federal officials often say health insurance will cost consumers less than expected under President Obama’s health care law. But they rarely mention one big reason: many insurers are significantly limiting the choices of doctors and hospitals available to consumers.

From California to Illinois to New Hampshire, and in many states in between, insurers are driving down premiums by restricting the number of providers who will treat patients in their new health plans.

When insurance marketplaces open on Oct. 1, most of those shopping for coverage will be low- and moderate-income people for whom price is paramount. To hold down costs, insurers say, they have created smaller networks of doctors and hospitals than are typically found in commercial insurance. And those providers will, in many cases, be paid less than what they have been receiving from commercial insurers.

Some consumer advocates and health care providers are concerned. Decades of experience with Medicaid, the program for low-income people, show that having an insurance card does not guarantee access to specialists or other providers.” - Lower Premiums to Come at Cost of Fewer Choices, New York Times, 09/23/2013

Link to entire article appears below:

http://www.nytimes.com/2013/09/23/health/lower-health-insurance-premiums-to-come-at-cost-of-fewer-choices.html?ref=politics