Monday, September 23, 2013

And the hits just keep on coming. Here's another significant problem with PACA that will limit exchange patients access to specialists. Sure the rates charged on the exchange will be lower but that is because they are going to offer less. Yet another reason to delay implementation, but all of this is falling on deaf ears in Washington. My guess is that the Republican defunding gamble will fail, the law will go into effect, and when people realize what they are being confronted with, there will be huge pressure on Congress to fix the problems.

There is a reason why airplane manufacturers test plane repeatedly before they put them into service. Tha's how you work out the inevitable bugs. PACA should have been set up in several test markets around the country and tried out for a year rather than being foisted before it was ready on a country that is clearly not ready for it.

Lower Health Insurance Premiums to Come at Cost of Fewer Choices

By ROBERT PEAR

WASHINGTON — Federal officials often say that 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.

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Andrea Morales for The New York Times

Peter L. Gosline, the chief executive of Monadnock Community Hospital in Peterborough, N.H.

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 health care 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 increasingly 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.

Consumers should be prepared for “much tighter, narrower networks” of doctors and hospitals, said Adam M. Linker, a health policy analyst at the North Carolina Justice Center, a statewide advocacy group.

“That can be positive for consumers if it holds down premiums and drives people to higher-quality providers,” Mr. Linker said. “But there is also a risk because, under some health plans, consumers can end up with astronomical costs if they go to providers outside the network.”

Insurers say that with a smaller array of doctors and hospitals, they can offer lower-cost policies and have more control over the quality of health care providers. They also say that having insurance with a limited network of providers is better than having no coverage at all.

Cigna illustrates the strategy of many insurers. It intends to participate next year in the insurance marketplaces, or exchanges, in Arizona, Colorado, Florida, Tennessee and Texas.

“The networks will be narrower than the networks typically offered to large groups of employees in the commercial market,” said Joseph Mondy, a spokesman for Cigna.

The current concerns echo some of the criticism that sank the Clinton administration’s plan for universal coverage in 1993-94. Republicans said the Clinton proposals threatened to limit patients’ options, their access to care and their choice of doctors.

At the same time, House Republicans are continuing to attack the new health law and are threatening to hold up a spending bill unless money is taken away from the health care program.

In a new study, the Health Research Institute of PricewaterhouseCoopers, the consulting company, says that “insurers passed over major medical centers” when selecting providers in California, Illinois, Indiana, Kentucky and Tennessee, among other states.

“Doing so enables health plans to offer lower premiums,” the study said. “But the use of narrow networks may also lead to higher out-of-pocket expenses, especially if a patient has a complex medical problem that’s being treated at a hospital that has been excluded from their health plan.”

In California, the statewide Blue Shield plan has developed a network specifically for consumers shopping in the insurance exchange.

Juan Carlos Davila, an executive vice president of Blue Shield of California, said the network for its exchange plans had 30,000 doctors, or 53 percent of the 57,000 doctors in its broadest commercial network, and 235 hospitals, or 78 percent of the 302 hospitals in its broadest network.

Mr. Davila said the new network did not include the five medical centers of the University of California or the Cedars-Sinai Medical Center near Beverly Hills.

“We expect to have the broadest and deepest network of any plan in California,” Mr. Davila said. “But not many folks who are uninsured or near the poverty line live in wealthy communities like Beverly Hills.”

Daniel R. Hawkins Jr., a senior vice president of the National Association of Community Health Centers, which represents 9,000 clinics around the country, said: “We serve the very population that will gain coverage — low-income, working class uninsured people. But insurers have shown little interest in including us in their provider networks.”

Obamacare Glitches

Here is a classic example of unintended consequences that we have spoken of so often. There is a significant fault in Obamacare that will have a very negative and costly effect on people. This is why the law should be delayed and corrected rather than pursuing the nutty strategy that the Republicans are espousing to defund it.

Boy it really makes me long for Bubba. even though he had his differences with the Republicans, he knew how to govern and how to work with other people. Obama should sit down with him and get some lessons.

'Family glitch' in health law could be painful

Kelly Kennedy, USA TODAY 12:53 p.m. EDT September 23, 2013

It could leave up to 500,000 children without coverage and cost some families thousands of dollars.

WASHINGTON — A so-called "family glitch" in the 2010 health care law threatens to cost some families thousands of dollars in health insurance costs and leave up to 500,000 children without coverage, insurance and health care analysts say.
That's unless Congress fixes the problem, which seems unlikely given the House's latest move Friday to strip funding from the law, which is also called the Affordable Care Act.
Congress defined "affordable" as 9.5% or less of an employee's wages, mostly to make sure people did not leave their workplace plans for subsidized coverage through the exchanges. But the "error" was that it only applies to the employee — and not his or her family. So, if an employer offers a woman affordable insurance, but doesn't provide it for her family, they cannot get subsidized help through the state health exchanges.
That can make a huge difference; the Kaiser Family Foundation said an average plan for an individual is about $5,600, but it goes up to $15,700 for families. Most employers help out with those costs, but not all.
"We saw this two-and-a-half years ago and thought, 'Has anyone else noticed this?'" said Kosali Simon, a professor of public affairs at Indiana University who specializes in health economics. "Everyone said, 'No, no. You must be wrong.' But we weren't, and that's going to leave a lot of people out."
The issue has recently received attention, especially after former president Bill Clinton highlighted it in a recent speech.
"The family glitch is definitely a drafting error that Congress made that needs to be fixed," said Joan Alker, executive director of the Georgetown University Center for Children and Families. "But that seems unlikely."
New rules state that those families will not be penalized for not purchasing coverage, but the point of the law was to make coverage affordable for families.
Other challenges for families remain as the Obama administration and the health care industry gear up for the Oct. 1 opening of the exchanges, websites for each state on which customers can shop for and buy health insurance. The law requires uninsured Americans to buy health insurance; many are eligible for government subsidies to help them for the policies. For example:
• Kids may not receive Medicaid or exchange coverage if their parents aren't eligible and, therefore, don't know to check.
• Undocumented immigrants may not learn their children are eligible for insurance.
The law has already helped children, Alker said, because it "stabilizes Medicaid and CHIP," the insurance program for children.
However, 70% of uninsured kids are eligible for Medicaid and CHIP, but they're not all enrolled, she said.
"There has to be a lot of outreach and education about the importance of getting health care," she said. "These kids could enroll today."
If congressional Republicans were to succeed in cutting funding for the law, the CHIP program would expire in October, said Bruce Lesley, president of First Focus, a bipartisan advocacy group for families.
The Children's Health Insurance Program provides insurance for kids whose family incomes are too high for Medicaid, but whose families still can't afford coverage. The Affordable Care Act extended it for two years, which means as many as 6 million children have health care.
Eliminating money for the law would force states to rethink their children's programs quickly, Alker said.
But even with the funding, not all kids are getting coverage. In fact, two-thirds of kids are eligible for Medicaid or CHIP but not enrolled. Advocates hope that adults signing up for insurance through the health exchanges will find out their kids are eligible, and have said as many as 4 million kids could sign up.
"In Massachusetts, the uninsured rate for kids is lower than 2%," Lesley said, explaining that when Massachusetts implemented "RomneyCare," children were enrolled for insurance in droves. The Massachusetts program became law in 2006 under then-Gov. Mitt Romney, last year's unsuccessful Republican nominee for president.
The Obama administration is working with the YMCA and other organizations to get the word out about children's eligibility, he said.
This can be a particularly big deal for immigrant families, where one parent might be a documented immigrant, a second could be undocumented, and the children could be U.S. citizens.
"Most of the kids are United States citizens," said Jenny Rejeske, a health policy analyst for the National Immigration Law Center. "We know already that many kids in mixed-status families don't have insurance."
Though she said the majority of immigrants are in the country legally, undocumented immigrants may be afraid to seek benefits for their children. Those children, she said, need immunizations and preventive care, in part to keep everybody else's kids healthy, too.
"I feel very confident saying it is safe for mixed-status families to sign up," she said. "The information they give will not be used for immigration enforcement."
The information will go only to the agencies that need to see it, and there are "protections" built in to the Affordable Care Act so families will go sign up their children, she said.
Others who might miss coverage options for kids include veterans receiving care through the VA but who don't have benefits for their families, as well as grandparents receiving Medicare. There is a child-only coverage option that would allow the child to receive subsidized insurance.
Alker said kids also benefit when their parents have coverage because the family is more likely to be financially secure. Medical bills are the leading cause of bankruptcy. She also cited examples, such as maternal depression or healthy pregnancy benefits that affect children as well as adults.
According to a Georgetown policy brief, 11.5 million parents and 6.3 million children were uninsured in 2010. Three-quarters of the parents' incomes fell below the poverty line, and 38% lived in deep poverty. About half of them are white, 29% are Hispanic, and 17% are African American.
Despite their concerns, the analysts said several promising things for families have happened through the law, including:
• Foster kids who have "aged out" of the system can continue to receive insurance through Medicaid until they are 26
• American children of immigrant parents -- even undocumented -- can get insurance subsidies through the new health insurance exchanges, and may be eligible for Medicaid.
• The children and spouses of disabled veterans, who receive their health care through Veterans Affairs, could be eligible for subsidized insurance through the exchange, even if the veteran is not. The same could apply to children who live with retired grandparents who receive care through Medicare.

What is Obama Saying?

Hmmmm, Let's see now, your allowance is going up, but you're not getting more money. How can the President possibly say, “Raising the debt ceiling …does not increase our debt.” Of course it's going to raise the debt because the government is going to run out of money unless we do. I'm beginning to think the the President believes he can say virtually anything that he wants to. The media won't hold him accountable and the American people will just accept it.

The Insiders: The president only adds confusion

By Ed Rogers, Published: September 20 at 4:10 pmE-mail the writer

President Obama addresses members of the Business Roundtable. (Alex Wong/European Pressphoto Agency)

What the president said about the debt ceiling during his Business Roundtable speech was so nonsensical and bewildering it’s actually almost trivial. But nonetheless, it’s irresistible to tease the Democrats about this, especially following House Minority Leader Nancy Pelosi’s gushing, high-profile lecture – aimed at Republicans specifically and Americans generally — about the president’s “brilliance and eloquence,” which she said must be frustrating for those who disagree with the president. But what the president said yesterday was anything but brilliant and eloquent. It’s perhaps one of the most memorable political lines since John Kerry’s infamous, “I actually did vote for [it] before I voted against it” comment during the 2004 campaign.
The president actually said, “Raising the debt ceiling …does not increase our debt.” I’m not sure what he meant, and if White House Press Secretary Jay Carney tried to tidy up that statement maybe I missed it, but with thinking this muddled, it’s probably not the best time for the president to be negotiating with Republicans anyway. Trying to give the president the benefit of the doubt, in this case, he’s technically right. Raising the debt ceiling means that we will increase our debt eventually; we don’t increase it by the full amount the very next day.

Does the president believe the debt doesn’t matter? Will he even acknowledge that we should have less debt rather than more debt?
The president’s comments, combined with his refusal to engage with Congress, just adds to the confusion and the uncertainty. I’m not oblivious to the fact that some Republicans are undertaking a strategy that leads to nowhere and is destined to fail by trying to link the budget and debt ceiling to the defunding of Obamacare, but the president needs to step up and show leadership, not just lob partisan blasts and confusing blunders from the sidelines.
Nothing about what the president is saying or doing is getting us closer to a useful debate and a constructive outcome.

Burning Mad