Tag Archives: Barack Obama

That Giant “Sucking Sound” Is Your Providers Exiting Your Preferred Provider Network!

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Op-Ed by Kenton Henry, Administrator

I have just completed my Affordable Care Act (ACA) training and certification in order to offer ACA compliant plans to my clients, and the public in general, beginning October 1. However, even in this final hour with only eight days until the new plans are to be available – the insurance companies have still not released the premiums the insure will pay for these options. “Any day now” is what I am being told. However, I will share with you a thing or two I do know based on what I have studied.

Most of it came as no surprise to me. One major company (whose name I cannot divulge as the information they provided was yet to be approved by the Department of Health and Human Services (HHS) who will be in charge of the Federal-Run Exchange–Marketplace–in Texas, Indiana and Ohio–where I have clients) previewed plans. The lowest plan deductible available was $1,500. All plans will be limited to a maximum out-of-pocket of $6,350 per individual and $12,700 per family. While older people will probably find a $1,500 deductible acceptable in terms of affordability, I am not certain how twenty year olds are going to feel about that. I certainly don’t think that and higher deductible options will be an incentive for them to enroll even with the convenience of doctor’s office co-pays and prescription drug cards. I can almost guarantee you that unless they receive a subsidy – they won’t be signing up.

Beyond that, the benefits sounded perfectly acceptable until I came to the part about “special care centers”. It turns out, at least with this company (which happens to be a very large, conspicuous player in the Texas health insurance market we’ll just refer to as company XYZ)when you are in need of a special surgical procedure such as a hip or knee replacement: “You may only receive one by going to an ‘XYZ Approved Hip and Knee Replacement Center'”. I have had a hip replacement and had it at the relatively young age of 49 and I don’t know about you but I didn’t want just anyone performing mine. I still had dreams of remaining very active and athletic to the point of partaking in very aggressive martial arts training among other activities such as mountain biking. Fortunately, I have been able to do so but would I had I gone to some “Preferred” (discount) provider who agreed to accept lesser fees for greater patient volume?

To underscore my concern relative to an obvious attempt to ration our selection of providers, if not the procedures themselves, I received an email today informing me the primary Medicare Advantage Plan I enrolled my clients in last year is having an inordinate number of Primary Care Physicians drop out of its network and that I should be prepared to re-shop their Advantage Plan. The problem is, if this very large nationally recognized plan is experiencing this kind of “provider drop-out” – what can I expect from smaller companies with less capital? Again, I have had to delete their name as the information was proprietary and for “agent use only” but the letter they sent their clients is attached below. If you are one of my current Medicare clients I placed with this plan – you may have already read this. Otherwise, I apologize for breaking the news to you like this.

Our feature article appeared in today’s New York Times (September 23rd) and describes how patient options will be restricted as a result of the ACA. Think about it. If the insurance companies have no choice in who they insure and must cover any and all pre-existing conditions . . . and if they are informed by the Department of Health and Human Services their profit and, more specifically, the ratio of claims they must pay relative to the premium they take in, i.e., 80% to 20% – how else can they manage losses except to restrict access to procedures, providers and what your providers are paid? Something had to give.

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Letter to Medicare Advantage Clients

Update to Physician Network Changes

At  ————- , we manage the physician networks for our plans to help meet the evolving needs of health care consumers. This includes adjusting the size and composition of our physician network as we strive to meet the specific needs of Medicare Advantage and/or Medicaid plan members.

As a result, in the coming months, select physicians for one or more of your Medicare Advantage and/or Medicaid members will no longer participate in our Medicare and Medicaid plan networks. Please note: these changes do not affect members enrolled in Medicare Supplement or commercial plans.

Member transitions
We know that members are impacted when we make changes to our network, and are taking steps to support members with smooth transitions to new care providers as appropriate to help ensure continuity of care.

We will be sending letters to affected members to notify them of care providers that will no longer participate in the —————– Medicare and Medicaid plan network as early as January 1, 2014 (network changes for New Jersey Medicaid plans have an October, 2013 effective date.) When appropriate, letters will suggest new care providers for members to consider for their ongoing care. Members are encouraged to call the number on their member ID card if they need help with identifying a new care provider.

In some plans, members may choose to continue seeing their current care providers on an out-of-network basis, in accordance with their out-of-network benefits. These changes have no impact on plan benefits, and members undergoing a treatment plan will be able to continue seeing out-of-network care providers consistent with federal requirements.

Provider directories
These network changes will be reflected in our online provider directory as of October 1, 2013. It is highly encouraged to refer to the online provider directory in all cases to confirm care provider network and panel status for all potential enrollees, as changes may not be reflected in previously printed and/or downloaded directories.

It is important to note that when searching for an in-network provider on the online directory, a provider’s “Accepting New Patients” status must indicate “OPEN“, even if the potential enrollee is an existing patient.

Talking points for member inquiries
Please refer to the Physician Network Changes – Frequently Asked Questions for Member Discussions that provide additional information and may be used in the event you receive any member inquiries.

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Lower Health Insurance Premiums to Come at Cost of Fewer Choices

By ROBERT PEAR

Published: September 22, 2013

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.                        

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.

Dr. Bruce Siegel, the president of America’s Essential Hospitals, formerly known as the National Association of Public Hospitals and Health Systems, said insurers were telling his members: “We don’t want you in our network. We are worried about having your patients, who are sick and have complicated conditions.”

In some cases, Dr. Siegel said, “health plans will cover only selected services at our hospitals, like trauma care, or they offer rock-bottom payment rates.”

In New Hampshire, Anthem Blue Cross and Blue Shield, a unit of WellPoint, one of the nation’s largest insurers, has touched off a furor by excluding 10 of the state’s 26 hospitals from the health plans that it will sell through the insurance exchange.

Christopher R. Dugan, a spokesman for Anthem, said that premiums for this “select provider network” were about 25 percent lower than they would have been for a product using a broad network of doctors and hospitals.

Anthem is the only commercial carrier offering health plans in the New Hampshire exchange.

Peter L. Gosline, the chief executive of Monadnock Community Hospital in Peterborough, N.H., said his hospital had been excluded from the network without any discussions or negotiations.

“Many consumers will have to drive 30 minutes to an hour to reach other doctors and hospitals,” Mr. Gosline said. “It’s very inconvenient for patients, and at times it’s a hardship.”

State Senator Andy Sanborn, a Republican who is chairman of the Senate Commerce Committee, said, “The people of New Hampshire are really upset about this.”

Many physician groups in New Hampshire are owned by hospitals, so when an insurer excludes a hospital from its network, it often excludes the doctors as well.

David Sandor, a vice president of the Health Care Service Corporation, which offers Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas, said: “In the health insurance exchange, most individuals will be making choices based on costs. Our exchange products will have smaller provider networks that cost less than bigger plans with a larger selection of doctors and hospitals.”

Premiums will vary across the country, but federal officials said that consumers in many states would be able to buy insurance on the exchange for less than $300 a month — and less than $100 a month per person after taking account of federal subsidies.

“Competition and consumer choice are actually making insurance affordable,” Mr. Obama said recently.

Many insurers are cutting costs by slicing doctors’ fees.

Dr. Barbara L. McAneny, a cancer specialist in Albuquerque, said that insurers in the New Mexico exchange were generally paying doctors at Medicare levels, which she said were “often below our cost of doing business, and definitely below commercial rates.”

Outsiders might expect insurance companies to expand their networks to treat additional patients next year. But many insurers see advantages in narrow networks, saying they can steer patients to less expensive doctors and hospitals that provide high-quality care.

Even though insurers will be forbidden to discriminate against people with pre-existing conditions, they could subtly discourage the enrollment of sicker patients by limiting the size of their provider networks.

“If a health plan has a narrow network that excludes many doctors, that may shoo away patients with expensive pre-existing conditions who have established relationships with doctors,” said Mark E. Rust, the chairman of the national health care practice at Barnes & Thornburg, a law firm. “Some insurers do not want those patients who, for medical reasons, require a broad network of providers.”

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.”

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http://allplanhealthinsurance.com

A Timely Warning! Do Not Underestimate Your Income In Order To Qualify For Health Insurance Subsidy! (inadvertantly or otherwise)

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Attention! All potential visitors to your state’s insurance “Marketplace” (formerly health insurance exchange) should heed this warning as the time approaches when you may go there to apply for coverage. Do not underestimate your 2014 (and subsequent tax years) income or you could owe a “sizable” refund to the government. This will occur if you accept their subsidy based on an income later proven to be larger than what you estimated for subsidy purposes.

 
As today’s feature article explains by example:
If a family of four receives a year-end bonus that puts them over the 400% (of the Federal Poverty Level) income threshold – they could owe a repayment of more than $7,000!

 
Admin. – Kenton Henry
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FEATURE ARTICLE:

 
Los Angeles Times

Consumers could be surprised at tax time due to federal health law

By Chad Terhune
September 9, 2013, 1:00 p.m.
Some families may end up owing Uncle Sam a sizable refund if they accept government help on buying health insurance next year under President Obama’s Affordable Care Act.
A study published Monday in Health Affairs estimates that 38% of families that qualify for federal premium subsidies might have to repay some portion if changes in their household income aren’t reported to the government.
These subsidies are a crucial part of the federal healthcare law intended to help make insurance more affordable for lower- and middle-income people. Individuals earning less than $46,000 a year, and families below $94,000 annually may qualify for these premium tax credits.
But a raise, bonus or other unexpected income during the year could alter a person’s eligibility and subsidy amount, triggering a repayment when the person files income tax forms for 2014. Some policy experts worry that experience could sour people on the healthcare expansion.
“There’s the potential for some sizable repayments,” said Ken Jacobs, the study’s lead author and chairman of the UC Berkeley Center for Labor Research and Education.
“Even if a small number of people owe a lot of money back that could generate fear of taking the subsidies. You don’t want to scare people from enrolling,” Jacobs added.
At particular risk of refunds, researchers said, are people who are near the eligibility cutoff for the subsidies. The tax credits are on a sliding scale basis up to 400% of the federal poverty line.
For instance, a family of four in California that receives a year-end bonus that puts them over that 400% income threshold could be required to repay more than $7,000, according to Jacobs.
The subsidy repayments are capped for lower-income people under the law.
The study said prompt notification of income changes so the subsidies can be adjusted could reduce the number of people who owe repayments by as much as 41%. Also, the size of the typical repayment could be cut by as much as 60%, according to the study.
“Timely reporting will make a very big difference,” Jacobs said.
In most cases, the federal government will pay the monthly subsidy directly to the customer’s private health insurer and the policyholder will pay any remaining premium.
In Washington, D.C., Jacobs said, the district’s exchange has set the default subsidy to 85% of the full amount to give people some financial cushion against receiving too much throughout the year. Even in that case, he said, consumers can still elect to take the full amount if they want.
Peter Lee, executive director of Covered California, said the state’s health exchange will work hard to educate residents about how the subsidies work and the importance of promptly reporting changes in income to avoid surprises later on.
“We don’t want to be on the paternalistic side of saying, ‘We think you should save more to the end,'” Lee said. “But we do want to reach out and let people know what the risks are. It is a big deal.”


http://allplanhealthinsurance.com

The Chameleon Which Is The Affordable Care Act

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08.14.2013

The Affordable Care Act, like a chameleon, is capable of changing its color or otherwise morphing to fit the pragmatic motives of its creator.

As I have said before, the Patient Protection Affordable Care Act (PPACA) (or ACA for short) is law. Therefore, of late, I have attempted to focus on the reality of it and its ramifications for all of us whether we are currently uninsured, covered by our employer’s plan or have our own individual or family health insurance plan. The primary purpose of this blog is to educate and inform– not to editorialize. If the latter were my objective, I would establish a separate blog where I would rant and rave ad infinitum about all I see wrong with the Act and big government in general. But it is not, so writing for The MedPlus Messenger, I try to remain objective and minimize expression of my feelings. But it is difficult. Increasingly so. Each day I try to put more lipstick on this pig but each day I awaken to more news the White House has selectively chosen another segment of the ACA not to implement in 2014 pursuant to the law.
Yesterday’s headlines broke news that the caps on insured’s out-of-pocket (OOP) maximums–set to go in effect in 2014–have been delayed until 2015. This potentially doubles (or worse) the liability of an insured and benefits the insurance company by allowing it to avoid covering expenses above the current OOP’s. Do you believe that is the objective of the White House? To benefit the insurance companies? And I thought the whole reason for the ACA was to better protect the patient, consumer, insured member. After all, it is the Patient Protection … … … Act is it not?
So what was the motive behind the White House’s reprieve for insurance companies? “General Math” provides the answer. I.e.:
Lower patient out-of-pockets = higher insurance premiums
Higher insurance premiums = less participation in coverage and greater backlash against the ACA

 

Greater backlash = trouble for the Democrats in the 2014 mid-term elections
Conclusion = this reprieve was politically motivated

 

Reader and followers – if you can argue this to a different conclusion – please feel free to do so here for my erudition and that of the rest of us.

 
Admin – Kenton Henry
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Feature Articles:
Washington Times
By Tom Howell Jr.
Tuesday, August 13, 2013
President Obama has granted yet another part of his health care law a delay, quietly announcing a one-year grace period before imposing a strict limit on consumers’ out-of-pocket medical expenses.
The delay means some health care plans in the group market will have until 2015 to begin paying for all expenses exceeding $6,350 for an individual’s out-of-pocket spending, or $12,700 for a family.
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SPECIAL COVERAGE: Health Care Reform
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Language on the delay has been posted on the Labor Department’s website since February, but it did not surface in the political arena until The New York Times reported on it Tuesday.
Mr. Obama used the limits as a key selling point when he pushed the Affordable Care Act through Congress in 2010. Now, Republicans are using the delay as part of last-ditch bids to dismantle the law before key implementation dates this fall.
“Burying this announcement online in a ‘maze of legal and bureaucratic language’ shows little concern for the promises with which this law was sold,” said House Speaker John A. Boehner, Ohio Republican, borrowing language from the Times article. “What else in the law isn’t working that we don’t yet know about?”
The Obama administration also announced in a pre-July Fourth blog posting that it was delaying the mandate that requires employers with at least 50 full-time employees to provide them with health care coverage.
For the Obama administration, the setbacks are ill-timed and leave officials trying to convince consumers that the delays don’t signal an inability to carry out other parts of the law.
Erin Shields Britt, spokeswoman for the Department of Health and Human Services, said the health care law is still implementing historic consumer protections from “the worst insurance company abuses, by banning discrimination based on pre-existing health conditions, ending lifetime and annual limits on what an insurance company will cover, and capping out-of pocket spending to protect Americans and their families.”
“The February guidance builds on these landmark consumer protections by requiring that health plans limit out-of-pocket spending for major medical coverage for the first time, in 2014, on time,” she said. “This single limit will apply to additional benefits in 2015.”
The newly reported delay arose because some employers and insurers use separate companies to administer major-medical coverage and drug benefits, resulting in separate out-of-pocket limits.
Because of this fractured landscape, parties needed time to streamline their data systems . The rule says that, for the first plan year after Jan. 1, 2014, the annual limit on out-of-pocket expenses will be satisfied if a group health plan that uses more than one service provider complies with the cap on major medical coverage and maintains a similar cap on the non-major medical coverage.
Even as it delays some parts, the administration has said the individual mandate requiring most Americans to have coverage remains in effect. Officials also are working feverishly to implement by Oct. 1 state-by-state health care exchanges where those without employer-based coverage can buy insurance with the help of tax credits.
A recent inspector general report suggested that Health and Human Services is months behind in setting up the federal data hub that will allow federal and state agencies to synchronize information about consumers on the exchanges.
Senate Minority Leader Mitch McConnell, Kentucky Republican, wrote to the Obama administration Monday to suggest that it delay the rollout of the exchanges.
Conservative lawmakers are waging a rhetorical war against Obamacare ahead of a spending showdown on Capitol Hill in September.

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Forbes

Pharma & Healthcare |

8/13/2013

Yet Another White House Obamacare Delay: Out-Of-Pocket Caps Waived Until 2015

WASHINGTON, DC – MARCH 18: U.S. President Barack Obama (L) speaks as Assistant Attorney General of Justice Department’s civil rights division Thomas Perez (R) listens during a personnel announcement March 18, 2013 at the East Room of the White House in Washington, DC. Perez has succeeded Hilda Solis as the U.S. Secretary of Labor. (Image credit: Getty Images via @daylife)

First, there was the delay of Obamacare’s Medicare cuts until after the election. Then there was the delay of the law’s employer mandate. Then there was the announcement, buried in the Federal Register, that the administration would delay enforcement of a number of key eligibility requirements for the law’s health insurance subsidies, relying on the “honor system” instead. Now comes word that another costly provision of the health law—its caps on out-of-pocket insurance costs—will be delayed for one more year.

According to the Congressional Research Service, as of November 2011, the Obama administration had missed as many as one-third of the deadlines, specified by law, under the Affordable Care Act. Here are the details on the latest one.

Obamacare contains a blizzard of mandates and regulations that will make health insurance more costly. One of the most significant is its caps on out-of-pocket insurance costs, such as co-pays and deductibles. Section 2707(b) of the Public Health Service Act, as added by Obamacare, requires that “a group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish lifetime limits on the dollar value of benefits for the any participant or beneficiary.” Annual limits on cost-sharing are specified by Section 1302(c) of the Affordable Care Act; in addition, starting in 2014, deductibles are limited to $2,000 per year for individual plans, and $4,000 per year for family plans.

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Obamacare Increases Costs of College Health Plans by as Much as 1,112% Avik Roy Contributor

There’s no such thing as a free lunch. If you ban lifetime limits, and mandate lower deductibles, and cap out-of-pocket costs, premiums have to go up to reflect these changes. And unlike a lot of the “rate shock” problems we’ve been discussing, these limits apply not only to individually-purchased health insurance, but also to employer-sponsored coverage. (Self-insured employers are exempted.)

These mandates have already had drastic effects on a number of colleges and universities, which offer inexpensive, defined-cap plans to their healthy, youthful students. Premiums at Lenoir-Rhyne University in Hickory, N.C., for example, rose from $245 per student in 2011-2012 to between $2,507 in 2012-2013. The University of Puget Sound paid $165 per student in 2011-2012; their rates rose to between $1,500 and $2,000 for 2012-2013. Other schools have been forced to drop coverage because they could no longer afford it.

According to the law, the limits on out-of-pocket costs for 2014 were $6,350 for individual policies and $12,700 for family ones. But in February, the Department of Labor published a little-noticed rule delaying the cap until 2015. The delay was described yesterday by Robert Pear in the New York Times.

Delay needed to align ‘separate computer systems’

Notes Pear, “Under the [one-year delay], many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors’ services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.”

The reason for the delay? “Federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs. In many cases, the companies have separate computer systems that cannot communicate with one another.”

The best part in Pear’s story is when a “senior administration official” said that “we had to balance the interests of consumers with the concerns of health plan sponsors and carriers…They asked for more time to comply.” Exactly how is it in consumers’ interests to pay far more for health insurance than they do already?

It’s not. Unless you have a serious, chronic condition, in which case you may benefit from the fact that law forces healthy people to subsidize your care. To progressives, this is the holy grail. But for economically rational individuals, it’s yet another reason to drop out of the insurance market altogether. For economically rational businesses, it’s a reason to self-insure, in order to get out from under these costly mandates.                         Patient groups upset

While insurers and premium-payers will be happy with the delay—whose legal justification is dubious once again—there are groups that grumbled. Specifically, groups representing those with chronic diseases, and the pharmaceutical companies whose costly drugs they will use. “The American Cancer Society American Cancer Society shares the concern” about the delay, says Pear, “and noted that some new cancer drugs cost $100,000 a year or more.” But a big part of the reason those drugs cost so much is because manufacturers know that government-run insurers will pay up.

“The promise of out-of-pocket limits was one of the main reasons we supported health reform,” says Theodore M. Thompson of the National Multiple Sclerosis Society National Multiple Sclerosis Society. “We have wonderful new drugs, the biologics, to treat rheumatoid arthritis,” said Patience H. White of the Arthritis Foundation. “But they are extremely expensive.”

The progressive solution to expensive problems? More subsidies. But subsidies don’t reduce the underlying cost of care. They only excuse the high prices that manufacturers and service providers already charge.

It’s one of the many aspects of Obamacare that should be repealed, if we are to combat the rate shock that the health law imposes on tens of millions of Americans. But that will require Republicans to come up with a smarter strategy than shutting down the government.

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http://allplaninsurance.com

Obama About To Do Another Side-Step?

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08.01.2013
Obama About To Do Another Side-Step?
Op-Ed

Do you remember when the snidely Governor of Texas, played by actor Charles Durning, in the movie, The Best Little Whorehouse in Texas, croon’s …
” Ooh … I love to dance the little sidestep / Now they see me, now they don’t / I’ve come and gone / And ooh, I love to sweep around a wide step / Cut a little swath / And lead the people on!”?
This is exactly the image I have of the President so often but–most recently this morning–on hearing his plans to meet again with the federal Office of Personnel Management. The purpose will be to address their concerns about being forced to abandon their Cadillac federal health plans to enter the Federal Health Insurance Exchange like so many of the rest of us. While this mandate became law when the Senate surprisingly went along with the House vote to do so – now that the time for them to enroll in the exchange is rapidly approaching – they are beginning to balk. (I guess they didn’t read the bill till it was passed!) Now it seems they would like, at the very least, for their premiums to be subsidized by the taxpayers to the tune of (a minimum) 75% as is currently the case. This in-spite of the fact that low paid interns and aides can apply for a regular subsidy (just like you and I) while Rank and File Senators and Representatives receive $174,00 in annual salary; Senate Majority and Minority Leaders $193,400; and The Speaker of the House $223,500. Doesn’t your heart just bleed for them?
Rumor has it the President has promised to see what he can do about it and meet with them again soon. Hence, I hear the words …
” Ooh I love to dance a little sidestep, now they see me now they don’t-I’ve come and gone and, ooh I love to sweep around the wide step, cut a little swathe and lead the people on.
I’m a poor boy, come to greatness. So, it follows that I cannot tell a lie.”
Admin. – Kenton Henry
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FEATURED ARTICLE:

POLITICOPro
Lawmakers, aides may get Obamacare exemption
By JOHN BRESNAHAN and JAKE SHERMAN | 4/24/13 9:49 PM EDT
Congressional leaders in both parties are engaged in high-level, confidential talks about exempting lawmakers and Capitol Hill aides from the insurance exchanges they are mandated to join as part of President Barack Obama’s health care overhaul, sources in both parties said.
The talks — which involve Senate Majority Leader Harry Reid (D-Nev.), House Speaker John Boehner (R-Ohio), the Obama administration and other top lawmakers — are extraordinarily sensitive, with both sides acutely aware of the potential for political fallout from giving carve-outs from the hugely controversial law to 535 lawmakers and thousands of their aides. Discussions have stretched out for months, sources said.
A source close to the talks says: “Everyone has to hold hands on this and jump, or nothing is going to get done.”
Yet if Capitol Hill leaders move forward with the plan, they risk being dubbed hypocrites by their political rivals and the American public. By removing themselves from a key Obamacare component, lawmakers and aides would be held to a different standard than the people who put them and aides would be held to a different standard than the people who put them in office.

Democrats, in particular, would take a public hammering as the traditional boosters of Obamacare. Republicans would undoubtedly attempt to shred them over any attempt to escape coverage by it, unless Boehner and Senate Minority Leader Mitch McConnell (R-Ky.) give Democrats cover by backing it.
There is concern in some quarters that the provision requiring lawmakers and staffers to join the exchanges, if it isn’t revised, could lead to a “brain drain” on Capitol Hill, as several sources close to the talks put it.
The problem stems from whether members and aides set to enter the exchanges would have their health insurance premiums subsidized by their employer — in this case, the federal government. If not, aides and lawmakers in both parties fear that staffers — especially low-paid junior aides — could be hit with thousands of dollars in new health care costs, prompting them to seek jobs elsewhere. Older, more senior staffers could also retire or jump to the private sector rather than face a big financial penalty.
Plus, lawmakers — especially those with long careers in public service and smaller bank accounts — are also concerned about the hit to their own wallets.
House Minority Whip Steny Hoyer (D-Md.) is worried about the provision. The No. 2 House Democrat has personally raised the issue with Boehner and other party leaders, sources said.
“Mr. Hoyer is looking at this policy, like all other policies in the Affordable Care Act, to ensure they’re being implemented in a way that’s workable for everyone, including members and staff,” said Katie Grant, Hoyer’s communications director.
Several proposals have been submitted to the Office of Personnel Management, which will administer the benefits. One proposal exempts lawmakers and aides; the other exempts aides alone.
When asked about the high-level bipartisan talks, Michael Steel, a Boehner spokesman, said: “The speaker’s objective is to spare the entire country from the ravages of the president’s health care law. He is approached daily by American citizens, including members of Congress and staff, who want to be freed from its mandates. If the speaker has the opportunity to save anyone from Obamacare, he will.”
Reid’s office declined to comment about the bipartisan talks.
However, the idea of exempting lawmakers and aides from the exchanges has its detractors, including Rep. Henry Waxman (D-Calif.), a key Obamacare architect. Waxman thinks there is confusion about the content of the law. The Affordable Care Act, he said, mandates that the federal government will still subsidize and provide health plans obtained in the exchange. There will be no additional cost to lawmakers and Hill aides, he contends.

No Joke! – IRS Employee’s Union Wants No Part of ACA Exchange Coverage

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07.26.2013

No Joke! – IRS Employee’s Union Wants No Part of ACA Exchange Coverage
Op Ed:
In an ultimate case of hypocrisy (which would be hysterical were it not foretelling a travesty of monumental proportions about to be inflicted on the American people) the Union of IRS employees wants no part of the Obamacare and the Affordable Care Act (ACA)! The Union urges its members to write their congressmen expressing reservation about being forced out the Federal Health Benefits Program and into the insurance exchanges scheduled to be up and functional by October 1. The Federal Health Benefits Program is the “Cadillac” health plan we have always heard federal employees enjoy at our expense. In the meantime, many of us will be forced to give up our current health insurance and providers to acquire what they dictate is right for us. The very representatives who passed and will enforce the legislation and mandates say it is good enough for you and me while not wanting to accept it for themselves. They want no part of the very thing they are forcing down our throats!
We cannot make this up people! And you’re not outraged? Or are you?
(For more details, please see our first feature article below.)

Admin. – Kenton Henry
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FEATURE ARTICLES:
Washington Examiner
IRS employee union: We don’t want Obamacare
BY JOEL GEHRKE | JULY 26, 2013 AT 11:45 AM
TOPICS: ANALYSIS BELTWAY CONFIDENTIAL

National Taxpayer Employee Union officials are giving members a form letter expressing concern…
IRS employees have a prominent role in Obamacare, but their union wants no part of the law.
National Treasury Employees Union officials are urging members to write their congressional representatives in opposition to receiving coverage through President Obama’s health care law.
The union leaders are providing members with a form letter to send to the congressmen that says “I am very concerned about legislation that has been introduced by Congressman Dave Camp to push federal employees out of the Federal Employees Health Benefits Program and into the insurance exchanges established under the Affordable Care Act.”
The NTEU represents 150,000 federal employees overall, including most of the nearly 100,000 IRS workers.
Like most other federal workers, IRS employees currently get their health insurance through the Federal Employees Health Benefits Program, which also covers members of Congress.
House Ways and Means Committee Chairman Dave Camp offered the bill in response to reports of congressional negotiations that would exempt lawmakers and their staff from Obamacare.
“Camp has long believed every American ought to be exempt from the law, which is why he supports full repeal,” Camp spokeswoman Allie Walkersaid.
“If the Obamacare exchanges are good enough for the hardworking Americans and small businesses the law claims to help, then they should be good enough for the president, vice president, Congress and federal employees,” she also said.
“The NTEU represents Internal Revenue Service employees who have the responsibility to enforce much of the health insurance law, especially in terms of collecting the taxes and distributing subsidies that finance the whole system,” said Paul Kersey, director of Labor Policy at the Illinois Policy Institute.
“IRS agents will also collect data and apply penalties for those who fail to comply with many of Obamacare’s requirements,” Kersey said.
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Polls Identify Americans’ Disapproval Of ACA.
In continuing coverage, the Washington Times (7/26, Sherfinski) “Inside Politics” blog reports on a Fox News poll which shows that 53% of respondents would choose to repeal the Affordable Care Act, given the choice between keeping the law in entirety or overhauling it. The piece also reports on a separate poll, from CBS News, which found that “fifty-four percent disapprove of the law and 36 percent approve of it.”
The National Journal (7/26, Shepard, Subscription Publication) reports on the findings from the new United Technologies/National Journal Congressional Connection Poll which found that “opponents of President Obama’s health care law overwhelmingly believe the Affordable Care Act will worsen the quality of their care.” Further, more of the law’s supporters than not “don’t think it will improve their health care.”
Klein Extols Opportunities Brought By ACA. Washington Post blogger and MSNBC political analyst Ezra Klein writes about the coming “opportunity to change American health-care forever,” in a piece for Bloomberg News (7/26). He explains that the Affordable Care Act “carries the potential for both huge profits and huge social benefits,” as long as “Washington can stop bickering over the politics long enough to pay attention.”
Wonkblog Explores Former Republican Alternative To ACA. The Washington Post (7/26, Matthews) “Wonkblog” reports on a former Republican plan to “replace” the Affordable Care Act, proposed in 2009 by Sen. Tom Coburn (R-OK) and Rep. Paul Ryan (R-WI). Known as the Patients’ Choice Act, the law was “a credible way of covering almost all Americans,” picking up 13 co-sponsors in the House and seven in the Senate. After describing the central aspects of the bill, pointing out its similarities with the ACA.
Papers Offer Opposite Opinions On Repealing ACA. In an editorial, the Colorado Springs (CO) Gazette (7/26) encourages Republicans to work to defund the Affordable Care Act, because “most Americans don’t want” it. The paper argues that “perhaps nothing would give our country’s economy a greater jump-start than” stopping the law “in its tracks.”
However, in an opposing editorial, the Ogden (UT) Standard-Examiner (7/26) asks Congress to “respect” the Affordable Care Act. Although the paper has “problems” with the law, it argues that implementation “should not be hijacked through the inappropriate use of a filibuster, or the House refusing to vote for its funding.”

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Christie Slams ACA At GOP Governors’ Meeting.
The Newark (NJ) Star-Ledger (7/26, Portnoy) reports that in a discussion with fellow Republican Governors in Aspen, Chris Christie of New Jersey on Thursday called the Affordable Care Act a “sad legacy” for President Barack Obama. During the talk, Christie said that while he has expanded Medicaid under the law, “he twice vetoed health exchanges.” Criticizing the law, Christie said, “This is what happens when you use Parliamentary maneuvers to jam an absolute sea change in American life down the throats of the American people with bare majorities and not one Republican vote.”
Jindal, Walker Say ACA Is Not Workable. In an op-ed for the Wall Street Journal (7/26, Jindal, Subscription Publication), Louisiana Gov. Bobby Jindal and Wisconsin Gov. Scott Walker write that the ACA is not workable and predict chaos as the Oct. 1 deadline for health insurance exchanges to launch. The Governors argue that while delaying implementation off the ACA is a good idea, outright repeal of the law would be better.
New Jersey Policy Analyst Discusses ACA Benefits. NJ Today (7/26) carries video of an interview with New Jersey Policy Perspective Senior Policy Analyst Raymond Castro, who discusses the benefits of the Affordable Care Act to “New Jersey residents and business owners.” In the interview, Castro drew attention to the law’s subsidies, available to those purchasing insurance on the state’s exchange, calling them “the most important part of the reform.” Castro also pointed out that New Jersey stands to “save a lot of money” under the ACA, as the Federal government will take over a large chunk of costs.
Panels Answer ACA Questions In Utah And Alabama. The Salt Lake (UT) Tribune (7/26) reports that on Thursday, a “panel of Utah health care advocates, experts and state policy leaders answered questions” about the Affordable Care Act in “a televised town hall” event. The article links to recorded versions of the event.
Alabama Live (7/26, Berry) reports that the Chamber of Commerce of Huntsville/Madison County held a panel Thursday morning to inform “several dozen professionals” how the Affordable Care Act “will impact their small businesses in Madison County.” Led by Small Business Administration Alabama District Director Tom Todt, the Affordable Care Act 101 seminar “featured an overview of the Small Business Health Care Tax Credit, Small Business Health Options Program (SHOP) and Employer Shared Responsibility for Employee Health Coverage.”

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White Castle Considering Upping Part-Time Hires Due To ACA.
The Huffington Post (7/26) reports that in response to the Affordable Care Act’s employer mandate, White Castle “is considering hiring only part-time workers in the future,” its Vice President Jamie Richardson said in an interview Thursday. Richardson insisted, though, that “the restaurant chain has no intention of firing members of its current full-time staff or reducing benefits.”
The Los Angeles Times (7/26, Lopez) reports that in an interview with NPR Wednesday, Richardson further outlined his plan to deal with ACA implementation, saying, “As we look to the future, when the new healthcare law takes effect, we are considering at that point, for new hires, letting those people know upfront, ‘Hey, at this point we’re only able to hire part-time team members.’”
Brooks-LaSure Speaks At Senate Hearing On ACA. Bloomberg BusinessWeek (7/26, Clark) reports on Wednesday’s Senate Committee on Small Business and Entrepreneurship hearing on concerns about the Affordable Care Act. According to the article, “the big questions…didn’t have easy answers.” Will, when asked whether “all health exchanges will be up and running as scheduled on Oct. 1,” HHS Deputy Director Chiquita Brooks-LaSure “said she expects all exchanges will be up and running.”
Survey: Business Owners In New England More Optimistic About ACA. The Boston Globe (7/26, Reidy) reports that a new survey out of Deloitte LLP shows that “mid-size companies in New England seem to be more optimistic about containing health care costs than their national counterparts.” Overall, 60% of executives “cited rising health care costs as a major obstacle to US growth,” while only 46% did in New England.

http://allplaninsurance.com

What will my health insurance premiums go to January 1?

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07.23.2013
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What will your health insurance premiums be come January 1? If you are covered by a small business (less than 50 employees)group plan – projections are you can expect your company’s premiums to increase by a minimum of 8%. If you are not covered by an employer group plan, you will be forced to buy from a federal, state or partnership (between the two) exchange or directly from the private market. While premiums are predicted to go down in as many as 10 states, that leaves 40 where potentially they will not. The question remains – what will your premiums go to? The federal exchange which–will be the source for plans in 34 states which are not creating their own exchange–is yet to release their premiums for the plans which must be available by October 1st. The word is that you better qualify for a subsidy or you are looking at rates at least 30% higher for those currently covered.
As our feature article details, the debate still continues as to how accurate and complete is the information we are being fed as to what our costs will be.
Admin. – Kenton Henry
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Feature Article:
GOP: Obama administration selective with health law data
By Tom Howell Jr. – The Washington Times
Congressional Republicans on Monday accused the Obama administration of withholding data on insurance premiums because it would undermine positive trends the White House touted last week while promoting the health care law.
Citing news reports, three senior GOP senators and the chairmen of House health-related committees said the administration has collected premium filings for 34 states that will use a federally run or federal-state partnership exchange — a market where those without employer-based insurance can buy coverage with the help of government subsidies — but it will not release the information until September as it negotiates the final rates.
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SPECIAL COVERAGE: Health Care Reform
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“We believe it is essential that the U.S. Department of Health and Human Services provide transparent pricing as soon as possible for the millions of Americans who will be impacted by this law,” they said in a letter to HHS Secretary Kathleen Sebelius, arguing many Americans’ premiums will rise under the Affordable Care Act.
They also accused the Obama administration of negotiating rates in secret, something the Wall Street Journal editorial page described as “running Obamacare as a black-ops mission.”
Supporters of the law have been buoyed by news out of New York, where officials last week said premiums on the state’s health care exchange in 2014 will be about 50 percent lower than last year’s direct-pay rates for individuals.
The Obama administration then released a report showing that, on average, premiums would drop by 18 percent in about 10 states and the District of Columbia. Those states have made information available for the individual market in 2014, when their health exchanges open under “Obamacare.”
Since then, Republicans have cited states where early data suggest that premiums will rise.
“Instead of selectively highlighting provisions and data that paint a rosy picture, we encourage the administration to give the American people as much information as possible so they can plan and prepare, and so that we can continue the necessary oversight,” the senior Republicans said in their letter.

http://allplanhealthinsurance.com

House to Vote on Affordable Care Act Individual and Employer Mandates

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07.17.2013

Currently we have over 800,000 veterans awaiting decisions on their disability claims. The back log is so great–according to the most recent numbers available–the average wait time for a veteran is 15 months in Chicago, 16 months in New York and a year and a half in Los Angeles. Social Security’s disability program, which helps support 11 million Americans, will run through its trust fund in 2016, two years earlier than predicted. Couple this with the prediction Social Security, the fund that finances benefits for 44 million senior citizens and their survivors, will be exhausted by 2035 and Medicare, the health care program for those age 65 and over, will be have depleted its funds by 2024. Now consider a law has been passed which mandates health coverage for every American. Its objectives are largely, and initially, funded via subsidies from the federal government (you the tax payer). Can you possibly believe this is feasible given their track record? Given a federal debt of almost 17 trillion dollars? How long do you believe it will take before all private insurance companies are forced to withdraw from participation to be replaced by a single payer federally administrated program which can’t possibly be any more financially feasible than our government’s disability program, Social Security or Medicare?

Admin. – Kenton Henry

http://allplanhealthinsurance.com

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Today’s Feature Articles:

Legislation and Policy

House Votes To Target ACA Individual, Employer Mandates.

Coverage of the Obama Administration’s decision to delay the Affordable Care Act’s employer mandate continues Wednesday, the same day the House is set to vote to further capitalize on the weak position they believe the move has put Democrats in. Most reports, some national in scope, focus on the House votes to delay both the employer and individual mandates, while others focus on the implications of both of these provisions.

McClatchy                          (7/17, Kumar) reports that on Wednesday, the Republican-ruled House is expected to vote to delay key parts of the Affordable Care Act, a move that “is the latest in a sweeping legislative and political campaign to weaken the 2010 law and raise even more opposition in the eyes of an already skeptical nation, especially as it heads into 2014 elections that will decide control of the Congress and set the stage for the 2016 campaign for the White House.” The back-to-back votes will determine “whether to delay insurance mandates for both employers and individuals.”

The Washington Times

(7/16, Howell) reports that “President Obama has threatened to veto” the bills. Meanwhile, “the votes will force Democrats to align with the president or distance themselves from the overhaul in the wake of its recent stumbles.” In addition, it has put the “Office of Management and Budget in the awkward position of threatening, in the case of the employer mandate, to kill a bill that would reflect the White House’s own decision-making.”

CNN

(7/16, Walsh) reports that “most House Democrats are expected to oppose two House Republican bills on Wednesday that would delay key provisions of Obamacare,” according to House Democratic Whip Steny Hoyer (D-MD).

The Hill

(7/17, Baker) “Healthwatch” blog reports that the bill to delay the individual mandate “would cut the deficit, but would cause insurance premiums to rise,” according to the Congressional Budget Office.

Implications Of Employer Mandate Delay Still Unclear. The AP

(7/17, Alonso-Zaldivar) reports on the “domino effect” that is currently “undercutting” the Affordable Care Act: the Obama Administration’s delaying of the law’s employer mandate could “weaken” the individual mandate, because the requirement that companies report health insurance details for employers has also been pushed back. As the article explains, “without employers validating who’s covered, a scofflaw could lie, and the government would have no easy way to check.” The piece calls this yet “another incentive for uninsured people to ignore a new government requirement that for many will cost hundreds of dollars.”

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Not All Insurers Game for State Exchanges: The Consumer Impact

By Kate Rogers

Published July 11, 2013

FOXBusiness

As more insurers decide to pack up and leave certain states as health exchanges start to take form, experts say consumers are going to be left  feeling the pain.

Over the last few weeks, several departure announcements have sent a ripple through the health insurance industry, as companies weigh whether or not they want to play ball under Obamacare. So far, California has experienced the biggest migration  with Aetna (AET), UnitedHealthcare (UNH) and Cigna (CI) leaving the state’s exchange, Covered California.

Aetna also reportedly sent out a note to select customers last week, warning that the Patient Protection and Affordable Care Act is “changing health insurance.” Recipients were customers across the country with non-grandfathered health plans, meaning their plan was not in effect on March 23, 2010 and wouldn’t carry over under new state and federal exchange regulations under ACA.

“This includes adding preventative care and essential health benefits. The ACA also ends medical underwriting. Due to these and other changes, many people will pay more for their health insurance coverage in 2014 than they do today,” the letter stated according to the carrier.

Wellmark Blue Cross/Blue Shield also decided not to list on the individual exchange in Iowa for 2014, due to a lack of information available in the state, according to a spokesperson for the Iowa Insurance Division.

Fifteen states and the District of Colombia are in the process of creating their insurance exchanges before the 2014 deadline; when individuals must purchase insurance or face a fine for failing for comply with the individual mandate. The employer mandate has been pushed back to 2015, and some in the GOP including House Majority Leader Eric Cantor, (R-VA), are calling for the individual mandate to be rolled back as well.

More or Less Competition for Consumers?

Some experts say the recent departures hint consumers will have limited health-insurance choices thanks to the regulatory burdens of the law. Basic supply and demand dictates that with fewer insurers to choose from, consumers will have limited options and potentially higher prices, says Michael Cannon, director of Health Policy Studies at the CATO Institute.

A similar “exodus” occurred within the first six months of the implementation of the Affordable Care Act, Cannon says, when child-only care was enacted. Seventeen major insurers dropped child-only coverage, in an attempt to skirt the law’s new regulations and increased costs. The same may begin to take shape in the individual market.

“The program says you can’t charge higher premiums to the sick, so you have a situation where only low-risk consumers would be charged a premium much higher than their regular costs, so only people who buy it would be those who really needed it,” he says.

The employer mandate rollback is also a factor in the situation, says Grace-Marie Turner, founder of the Galen Institute, a health and tax policy research organization, as employers will now be incentivized to drop coverage and push their employees into the exchanges until 2015.

“It’s using employers to push more people into the exchanges,” Turner says.

Fewer insurers in state exchanges mean less competition, bottom line, she adds. “The whole point is we want more players, and more competition.”

Why California Matters

What happens in California is a big deal for the future of the Affordable Care Act, says Taylor Burke, associate professor and program director, MPH in Health Policy, at George Washington University.

“It’s an exit out the individual market, but [the insurers] only represent 8% of the individual market companies in the state,” Burke says. “California has the 7th largest economy on the globe, so whatever happens in California is a big deal for the stand up of the state exchanges.”

He points to two main reasons insurers leave a state: they don’t like the price points being offered in the exchanges nor the coverage they would have to offer under Obamacare’s 10 essential health benefits.

“In California, you can make the argument that there would be less choice, but if they stay in the market, their prices would be off the charts,” he says. “It would be a thing on the shelf, a high-ticket item that you couldn’t afford anyway.”

And if insurers take too long to make the decision, that may impact them negatively as well, he says.

“No one will want to buy their product. There’s a lot of hemming and hawing, but if the price point is too high, no one will buy it.”

But can consumers blame the insurer for higher prices? Turner says no, it’s the nature of the law’s regulations.

“Insurers can’t help the demands on the benefits they will have to cover—it will absolutely be more expensive,” she says. “It’s like going to buy a car with every accessory in the books—heated seats, fancy wheels, satellite radio, and saying you can’t charge more for it.”

What Insurers are Deciding

Robert Zirkenbach, spokesman for America’s Health Insurance Plans (AHIP), says each individual company will have to make their own decisions about which states to participate in as exchange bids come in.

“It will be based on a variety of reasons, but plans are offering coverage on the exchange, some will be outside the exchange—there will be options for consumers,” Zirkenbach says. “It will depend on the state and regulatory environment.”

He says the AHIP wants competition among insurers to keep consumer prices in check.  “Choice and competition is a good thing—when states have been setting up their exchanges, we are trying to encourage this,” he says.

The National Association of Insurance Commissioners says insurers who are leaving these markets are likely doing so because they have core businesses in other segments, including the large group market.

“The carriers we have seen exiting the individual market are not major players in that market segment, and therefore we don’t anticipate a major disruption of coverage for a large portion of the market,” a spokesperson said in an email statement. “Each insurance company is making decisions regarding its participation in exchanges based upon a number of factors.  Some are opting to participate in the exchanges, while others are not; however, nearly all of the requirements that apply to policies sold on the exchange also apply to policies sold outside the exchange, so insurers will not be avoiding a lot of requirements by opting out of the exchanges.”