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Worst suspicions realized with Obamacare

Have you been following Lambert and Team’s Obamacare ClusterF^&* series on Corrente? They’re culling the internet and getting personal stories about what it’s like to sign up for the exchanges from around the country.  It ain’t pretty.  Some of their findings:

  • The sign-up procedure appears to be a way of matching your credit score to how much you will pay for a policy.  If you’ve been out of work for some time, have medical bills or have some other unforeseen life event that affected your credit score, expect to pay more for your health care.
  • The exchange policies are thin.  They are mostly in-network policies.  Unfortunately, you can’t always predict whether the guy who treats you in the ER is going to be in your network.  Come to think of it, that time I broke my wrist on vacation in Florida probably wouldn’t be covered so now you’re going to have to think ahead and purchase policies when ever you go out of town for any reason.
  • Cancer treatment may not be covered, or not covered in the way you thought.  You may not get the best treatment or the doctor you want because of the restrictions on the policy.
  • The websites are kludgy and definitely not ready for prime time in some places.

Here’s my overall impression: If you’re covered by your employer, you should consider yourself extremely lucky but be aware that no job is secure these days.  If you’re not covered by your employer, you fall into this “separate but equal” category thing.  Obamacare is supposed to help you get affordable healthcare but you might as well be using the other entrance, drinking from a spigot and barred from the nicer places of business.  They don’t want your kind hanging around.  If this is a *national* healthcare policy, it should be unconstitutional.  The difference is that now the discrimination is based on how you are employed.

On the other hand, there’s a possibility that now a lot more people will know what it feels like to be a discriminated minority.

Hard to believe that Democrats went along with this.

 

34 Responses

  1. What democrats?

  2. One TINY consolation (and consolation isn’t really the right word since this issue packs a world of it’s own problems) is that the Plans aren’t nailed down yet (and the BAD part of that is that we’re being asked to buy products that haven’t been defined yet)

    In other words, companies are still negotiating with hospitals and doctors. Stupid I know….. But some people might with a lottery and have some good hospitals and docs show up by January.

    • That might be true on a very minor level, but I think the major exclusions are a done deal. The idea of these plans is to have narrow networks — that is their inherent structure, that is their inherent goal, that is the new paradigm — so the providers that are going to be added are likely few. http://www.nytimes.com/2013/09/23/health/lower-health-insurance-premiums-to-come-at-cost-of-fewer-choices.html?pagewanted=all

      The insurance co’s have set their rates. They have not done so based on what if we bring in these other quality providers too. They have generally set their provider list. The only way that providers will come in under that structure is if they agree to the reimbursements– which the insurance co’s have REDUCED for these plans.

      For instance, in Cali, UCLA was deliberately excluded. It’s not coming back bar some huge, drastic “negotiating” tactic involving the law.

      This is how Children’s Hospital in Seattle is “negotiating”
      http://capsules.kaiserhealthnews.org/index.php/2013/10/seattle-hospital-sues-state-over-exclusion-from-exchange-plan-networks/

      When you talk to lowly staff at hospitals, they’ll say, oh, I imagine they’re still negotiating, and I think they believe this because it is a shock that, say, their hospital is excluded when they’ve never been excluded (recently) from any plans. When you talk to the insurance company, they say, no they’re out unless they agree to our terms. And given the low reimbursements, these hospitals CAN’T agree to the terms.

      • And I should add that one of the reasons for the narrow provider networks is to effectively EXCLUDE certain treatments from their covered services. This is to keep “costs down”.

      • I usually don’t link to this article because it doesn’t cover the story accurately in general, but it has this quote from Children’s that addresses the fact that the rates have been DISCOUNTED for the plans. This is part of the new paradigm.

        Dr. Sandy Melzer, chief strategy officer at Children’s, said in an interview that the issue comes down to rates. Several insurers wanted to pay Children’s less than they do for current private contracts. He declined to provide details about how big of a cut the payments would have been

        http://www.bizjournals.com/seattle/blog/2013/10/seattle-childrens-sues-insurance.html?page=all

        • I think that quote sums the whole thing up. It’s exactly what I’m talking about. Private contracts mean what your employer has agreed to with the insurance company. If the hospitals can’t charge an exchange victim $70,000 for a hernia operation, well, you just don’t get to use that hospital.
          So, it is affordable as long as you don’t actually need it for, you know, actual services.

          • It’s true. However, I credit the hospitals for the fact that they’ve historically accepted insurance reimbursements and continue to do so for employer plans, and even for plans outside of the Exchanges. They are not excluding everyone. (They can’t, it’s true, because they’d be out of business. But they don’t.).

            But they just say no to these “discounted” rates. Insurers knew they would, and that’s what insurers wanted.

      • It would help so much if you understood the industry, but it’s obvious you don’t. The carriers don’t “bring in” quality providers, nor do they shut them out based on their level of expertise. They negotiate with every provider who asks to be a preferred, or member, provider on the reimbursement rates and caps on services. If they come to an agreement, they are available to the members. The providers have a LOT to do with whether or not they are participants in any plan.

        In my current Blue Shield, quality plan, I have 3 levels of participating providers and it’s my choice if I want the higher priced one where I only get 50% coverage on services. Or, I can go to the lowest level and get 80% covered.

        If they won’t allow a certain procedure, it isn’t that they aren’t allowing diagnostics. If you break your leg, an xray is a quality diagnostic, so they won’t pay for an MRI. I have a very good plan through my employer…recently had xrays on my back for a disc problem. Dr decided he wanted to gift his imaging lab and sent me for an MRI – I got to pay for that out of pocket. This is pre-ACA and SOP.

        There are some real problems with the ACA, but so much of what is being gasped about is already in play, and has been for decades.

        • Oh, and the levels are based on pricing agreements the provider made with the carrier, not years of experience or better doctors (how would carriers ever know how to determine the quality of the doctor?).

    • katiebird, I’m so glad to see you!

  3. Democrats not only went along with it, Nancy Pelosi did a victory lap around the capitol…I never had any faith in an Obama “legacy”…this so proves me right.

    • Nancy Pelosi (D-Slytherin), Harry Reid (D-Supermarket Boxer), and Barack Obama (D-Opportunist) must be walking with a list from the weight of those thirty pieces of insurance lobby silver in their pockets.

  4. I thought I was replying to katiebird but the comment nested differently.
    Sorry.

  5. The biggest complaint I’m hearing is that the procedure to even see what costs and coverage might be require a lengthy and complex sign-up – rather than letting you “shop” and then sign-up.

  6. If republicans wise up and pass a clean funding bill in the House I predict Obamacare will ensure a republican administration in 2017.

    • Ha ha ha! Of course, there will be a Republican President in 2017 voter suppression will make that happen.

    • And if that happens, chances are good the R House, R Senate, and R President will find some way to keep Obamacare in place as close to possible as it is now. Because the Rs and the Os work for the same social class. Maybe the TPs are different, but every “mainstream R” and every O will vote against repealing Obamacare for reasons of social class allegiance. Which was the same reason the Roberts Court invented some legaloidal sophistry to “find” the “penalty” to be a “tax”, so they could excuse upholding the individual forced mandate.

      • So, all the “Obamacare will Destroy America” Republicans will turn around and support the ACA? Ok.

        • Not all of them. Just enough of them. You watch.

          If Rs take the House and Senate and Presidency, they will make sure that just enough Rs support the remaining Ds in order to preserve the Obamacare bailout for Big Insura.

  7. That damn Obama I knew it was his fault! Especially with those ardent Patriots on the otherside willing to work with him and not planning to cause as much destruction to the Nation as possible.

    On ward Righteous Obama-Smashers!!!

    Let’s just adopt the Ryan Budget it will be so good for us, with it’s undefined massive cuts *cough* goodbye medicare and social security *cough* and the Republican Healthcare Plan Die quickly poor people!

    • Say what? Obama Care is awful. So awful its backers will have a harder and harder time defending it as time goes on.

      Who said anything about Republicans? They are awful too. How do we become Ryan budget supporters simply because we see (and are documenting) the atrocities with Obama Care?

      Watch Obama sell out Social Security and Medicare (as he has been trying to do since his election). Then come back and tell me how Republicans are the only ones wanting to shaft the 99%.

      Wrong is wrong, morally or ethically. On that front, the poor, the elderly, the disabled, the veterans, the sick, the children, and on and on have no representation in this government.

    • Just because obamacare is awful doesn’t make us Republicans. It makes us extremely disappointed New Deal liberal Democrats.
      Not sure what political or economic philosophy Grunge-e-gene represents but I’m guessing that infatuation has something to do with it.
      I haven’t got the patience for that crap.

    • Do you support Obama’s Grand Bargain against Social Security and Medicare? Because you know he has one, you loyal Obamaslave you.

  8. The difference is that now the discrimination is based on how you are employed.

    And how old you are. Don’t forget that.

  9. We knew all the Obamacrats and Blue Catfood Democrats would vote for Obamacare. What still disappoints me is how so-called “progressive” and “feminist” D Reps in the House didn’t shoot Obamacare down when they had it in the crosshairs of their sniper rifles two separate times. Did the “feminists” tremble before Obama’s
    “black privilege” as America’s first “black” President? Did Obama threaten to have Kucinich’s wife and/or daughters assassinated on that famous plane ride he took Kucinich on?

  10. I’d like to help a little bit in getting some elements of health insurance cleared up so people can approach their choices without the negativity clouding their view of what is available to them. This is how insurance works now, and has for a fairly long time:

    Insurance has used credit scoring for decades. This is because there actually IS a link between credit scores and the propensity to file claims on everything. In health, it would have a lesser impact because under most circumstances checks are sent directly to the provider, and post-services rendered, which is not the case with property insurances. But, rest-assured, it is not used as a stand-alone – they also look at past claims, age, marital status, smoker/non, education, height/weight, and more. It’s just not new to the ACA.

    Insurance is actually designed to protect the subscribers from catastrophic events, not for the hypochondriac or parent who runs their children to the doctor for every sniffle, and scraped knee. Over the course of my life, I’d guess my premiums paid have totaled less than an aneurism bursting in the brain needing major surgery followed by 2 months stay in intensive care (A LOT LESS). Those who use more than their own premiums every year for incidentals (not chronic illnesses that HAVE to be managed) impact what is available to those with bigger health issues. One of the reasons birth control pills are rarely covered.

    Providers go through an application process, followed by reimbursement negotiations before being put in network. It’s quite the process from beginning to end. And, they have levels based on their charges – P1 level is for the practitioners who charge less and P3 for those who charge most. So, just because someone is in network, doesn’t mean the percentage you pay is the same for each provider. You may start a policy that includes your favorite doctor, and at contract renegotiation time have that provider dropped because they can’t come to a new agreement.

    An example that I think gives a helpful image: 5-6 years ago a large network of providers was in negotiations with our local Blue Cross carrier. They hit an impasse when they couldn’t get BC to agree to the reimbursement level they felt was right. So, they enhanced their negotiation position by going on the radio during the rush hours and encouraging their patients who might have BC through their employers to get their employers to find a new carrier for the employees. Strong arm tactic. BUT! Not all policies are the same. That same provider network continued to take the BC insurance cards from people who worked at Microsoft. The provider actually did have a contract agreement with BC for the reimbursement level they wanted, but ONLY for this group because Microsoft agreed to pay higher premiums for their employees to make sure they had access to this network.

    Just because you have Blue Cross, and your neighbor has Blue Cross does NOT mean that you both have the same coverage if you work for different organizations, so be careful who you get your information from.

    Employers CAN allow bariatric surgery to be covered if they are willing to pay the premium! And, they can deny birth control if they want to – many have for a long, long time.

    Insurance is a really complicated industry. Policies resemble a cafeteria line where you can have whatever coverage you want if you pay the associated premium. Think about how you negotiate your automobile rates – PIP? Uninsured motorist? Rental Car if you have an accident? For you and the other party, or just for them? A Bentley will cost more to insure than a Nissan compact.

    The ACA doesn’t appear to be changing the basics of how this industry runs – it’s made billionaires of the executives for a long time.

    What I’m going to do is look for the coverages I need for myself so I can find what IS there. Once I fully understand my own plan, I can start helping others understand theirs.

    One question I would have if I had children is whether or not the primary policy rules have lightened up. In my state, if both mother and father (does not matter if they are married) have access to insurance, the parent with the birthday that falls first in the calendar year is the primary provider of insurance. So, what if that’s the parent who has access to the lesser coverage? I don’t have the answer. I don’t need the answer. So, I won’t get my knees in a twist over it.

    It only takes a small percentage of abusers to any system to tighten the rules for everyone. I used to get 2 weeks vacation and 2 weeks sick. But, fellow employees made sure they used all 4 weeks – as soon as they accumulated another day of sick, they took it. Now, most companies give 17 days of PTO. If you are sick for 15 days some year, you only get 2 days of vacation. I, personally, don’t find being sick relaxing and rejuvenating.

    There are so many reasons to be upset with our government today. Pick your battles wisely.

    That’s my last word on this topic. I won’t be back.

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