Promoted from the Ricochet Member Feed by Editors Created with Sketch. Obamacare Is Unaffordable, Restricts Patient Choice, and Shows How NOT to Implement a New Policy

 

Unaffordable:

For months, the Obama administration has heralded the low premiums of medical insurance policies on sale in the insurance exchanges created by the new health law. But as consumers dig into the details, they are finding that the deductibles and other out-of-pocket costs are often much higher than what is typical in employer-sponsored health plans.

Until now, it was almost impossible for people using the federal health care website to see the deductible amounts, which consumers pay before coverage kicks in. But federal officials finally relented last week and added a “window shopping” feature that displays data on deductibles.

For policies offered in the federal exchange, as in many states, the annual deductible often tops $5,000 for an individual and $10,000 for a couple.

Insurers devised the new policies on the assumption that consumers would pick a plan based mainly on price, as reflected in the premium. But insurance plans with lower premiums generally have higher deductibles.

In El Paso, Tex., for example, for a husband and wife both age 35, one of the cheapest plans on the federal exchange, offered by Blue Cross and Blue Shield, has a premium less than $300 a month, but the annual deductible is more than $12,000. For a 45-year-old couple seeking insurance on the federal exchange in Saginaw, Mich., a policy with a premium of $515 a month has a deductible of $10,000.

In Santa Cruz, Calif., where the exchange is run by the state, Robert Aaron, a self-employed 56-year-old engineer, said he was looking for a low-cost plan. The best one he could find had a premium of $488 a month. But the annual deductible was $5,000, and that, he said, “sounds really high.”

By contrast, according to the Kaiser Family Foundation, the average deductible in employer-sponsored health plans is $1,135.

Restricts patient choice:

Americans who are buying insurance plans over online exchanges, under what is known as Obamacare, will have limited access to some of the nation’s leading hospitals, including two world-renowned cancer centres.

Amid a drive by insurers to limit costs, the majority of insurance plans being sold on the new healthcare exchanges in New York, Texas, and California, for example, will not offer patients’ access to Memorial Sloan Kettering in Manhattan or MD Anderson Cancer Center in Houston, two top cancer centres, or Cedars-Sinai in Los Angeles, one of the top research and teaching hospitals in the country.

Experts say the move by insurers to limit consumers’ choices and steer them away from hospitals that are considered too expensive, or even “inefficient”, reflects the new competitive landscape in the insurance industry since the passage of the Affordable Care Act, Barack Obama’s 2010 healthcare law.

It could become another source of political controversy for the Obama administration next year, when the plans take effect. Frustrated consumers could then begin to realise what is not always evident when buying a product as complicated as healthcare insurance: that their new plans do not cover many facilities or doctors “in network”. In other words, the facilities and doctors are not among the list of approved providers in a certain plan.

Under some US health insurance plans, consumers can elect to visit medical facilities that are “out of network”, but they would probably incur high out of pocket costs and may need referrals to prove that such care is medically necessary.

The development is worrying some hospital administrators who see the change as an unintended consequence of the ACA.

“We’re very concerned. [Insurers] know patients that are sick come to places like ours. What this is trying to do is redirect those patients elsewhere, but there is a reason why they come here. These patients need what it is that we are capable of providing,” says Thomas Priselac, president and chief executive officer of Cedars-Sinai Health System in California.

 A case study in how not to implement a new policy:

It may have been a debacle, but there is one upside to the glitch-plagued rollout of the health care website: It’s become a powerful case study for crisis management consultants and their clients of what not to do.

In Chicago, H + A International, a communications firm, delivered its customers a 15-point diagnosis of the administration’s handling of the crisis. That led one of its clients to temporarily halt the introduction of a new software product for engineers at a recent trade show of 30,000 people.

In San Francisco, Singer Associates, a public relations company, used the Obama crisis to prevail upon major real estate and environmental remediation clients to beta test their online programs before launching them. Sam Singer, the president, said, “A lot more clients are now asking for an extra set of eyes on things before they roll them out.’’

And in Boston, the CHT group, with clients in industries ranging from health care to electronics, published a guide titled “Obamacare and Health Insurance Exchanges: A PR Makeover’’ with tips large and small – from holding more news conferences to creating an infographic explaining the benefits of the new law — for what the White House should have done to tamp down the fallout.

Far from the world of government and politics, the botched launch of Healthcare.gov has become an instant classic. It has replaced such notorious bungles as New Coke and the BP oil spill as a real time example in the crisis management world of how not to respond when everything goes wrong. Experts are eagerly cashing in on the administration’s missteps, offering critiques in private interactions with clients, as well as publishing blog posts and op-eds on the basic rules of crisis management that were not followed.

Your tax dollars at work.

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  1. James Gawron Thatcher
    James GawronJoined in the first year of Ricochet Ricochet Charter Member

    Pej,

    President Obama’s repeated false claims about keep your plan & keep your Doctor was a text book case of fraud that the FTC would have already been prosecuting if this had been in the private sector.

    This nonsense of hard information about deductibles & subsidies being withheld from prospective clients is a text book case of bait & switch. If this web site was in the private sector it already would have been rated as a dangerous site to stay away from. It would already be under investigation.

    Only in the magical ACA universe of good intentions trumping incompetent corrupt criminal behavior could this happen.

    Regards,

    Jim

    • #1
    • December 12, 2013, at 3:20 AM PST
    • Like
  2. civil westman Inactive

    From bitter experience, I learned that patients do not pay deductibles if they are not collected up front. Period (to quote dear leader). I cannot imagine that the shysters who wrote Obamacare were not aware of that fact. It is possible that some hospitals will be either chronically starved for funds or bankrupted by this fact alone.

    Add in this fact: a patient stops paying premiums; the insurance company must continue to pay claims for three months. Then, the doctors and/or hospitals must give unreimbursed care for two more months!! Just imagine what happens when large numbers of people decide to pay their premiums now and then – let the accountants figure that one out – and don’t pay their deductibles, even if they could afford them. An image of British NHS hospitals is beginning to come into focus.

    • #2
    • December 12, 2013, at 7:01 AM PST
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  3. crizzyboo Inactive

    No, our tax dollars at play.

    • #3
    • December 12, 2013, at 7:31 AM PST
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  4. James Gawron Thatcher
    James GawronJoined in the first year of Ricochet Ricochet Charter Member
    civil westman: From bitter experience, I learned that patients do not pay deductibles if they are not collected up front. Period (to quote dear leader). I cannot imagine that the shysters who wrote Obamacare were not aware of that fact. It is possible that some hospitals will be either chronically starved for funds or bankrupted by this fact alone.

    ….

    Civil,

    Insurance and scientific Health Care are two of the most, if not The most, sophisticated innovations of modern society. It is as if we have decided to let the Post Office run Insurance and the DMV run Health Care. Madness.

    Thank you for the opinion of a pro. Every single Doctor that I have talked to has told me of a facet of Obamacare that is absolutely fundamentally flawed. The Doctors who are political liberals who voted for Obama are no exception. Many of them can not speak about it without curse words flowing from their normally gentle mouths.

    Regards,

    Jim

    • #4
    • December 12, 2013, at 7:45 AM PST
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  5. civil westman Inactive

    Thanks, Jim.

    I retired once and it didn’t take, so I work part-time. Since I have always lived modestly and below my means, I can re-retire any time. I would work for free for individuals who asked and whom I thought deserving. Their thanks would be sufficient compensation. I will not work for one day, however, on principle, for Medicaid payment rates – which the exchange products will pay – without the benefit of any “thank you.” It would be as though I went into the grocery store, filled the cart with $100 worth of groceries, put down a $10 bill, walked out and said, “What do you want? I paid.” That, of course would be theft. The proportions are about right, by the way. Medicaid pays around 10% of what commercial insurance pays, and let me tell you, there is never a thank you from the entitled.

    • #5
    • December 12, 2013, at 8:13 AM PST
    • Like
  6. ST Inactive

    Obama loves ObamaCare because it is working as designed to nudge us into communism. Nudge next is amnesty. After we make 20 million+ 3rd world refugees US citizens with the right to vote – alles kaputt. Which is the plan btw. When will the intelligentsia figure this out? 

    P.S. At some point they’ll double back for our guns. They’ve got us focusing on the handshake heard around the world to help us forget about Fast & Furious.

    • #6
    • December 12, 2013, at 9:00 AM PST
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  7. James Gawron Thatcher
    James GawronJoined in the first year of Ricochet Ricochet Charter Member
    civil westman: Thanks, Jim.

    I retired once and it didn’t take, so I work part-time. Since I have always lived modestly and below my means, I can re-retire any time. I would work for free for individuals who asked and whom I thought deserving. Their thanks would be sufficient compensation. I will not work for one day, however, on principle, for Medicaid payment rates – which the exchange products will pay – without the benefit of any “thank you.” It would be as though I went into the grocery store, filled the cart with $100 worth of groceries, put down a $10 bill, walked out and said, “What do you want? I paid.” That, of course would be theft. The proportions are about right, by the way. Medicaid pays around 10% of what commercial insurance pays, and let me tell you, there is never a thank you from the entitled. 

    Civil,

    The incentives are wrong, so very wrong. The poor have a better chance of getting quality health care right now. Once the ACA kills the whole system the poor will get their fair share of terrible health care. A little of that can kill you.

    Regards,

    Jim

    • #7
    • December 12, 2013, at 9:25 AM PST
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  8. RushBabe49 Thatcher

    I am just waiting to see what happens to the “high”-deductible health plans my employer currently offers as their only type of health plan for their employees. How are they going to explain to them that their premiums will now double, and their lowest-offered deductible will now be $5K per person and $10K per family? I am certain that once the employer mandate takes effect, that is what will happen; our company is in denial, and my coworkers don’t know what is coming down the pike. I do. It should be interesting.

    • #8
    • December 12, 2013, at 9:26 AM PST
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