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Obamacare is health care for second class citizens: Example #1

I read with dismay yesterday that Sylvia Burwell, who is taking over from Kathleen Sebelius at HHS, is determined to squash  even a study of single payer health care in order to pacify the Republicans at her confirmation hearing.  Yes, yes, let’s ignore all those little people, aka American citizens, who have lost the employer sponsored health care that made them feel human.  {{rolling eyes}}

So, I thought I would give you an example of what separates the “lucky” eight million who pay for crap exchange policies from, you know, real people.

In 2004, I went to Naples, Fl for a vacation.  As is my habit, I only vacation in the south during hurricane season.  (Been chased off the barrier islands of North Carolina by one)  In this case, it was a category 4, Hurricane Charlie.  We knew it was coming and decided to ride it out at our penthouse on the beach (ahhhh, those were the days when I still had money to do stuff like that).  We watched the hurricane come in and wreck havoc but the next day, the sun shone brightly and I headed down to the beach.  That’s when the busload of orphans started floundering in the surf and I broke my arm while rescuing them.

Ok, not really.  Due to the hurricane, there was a big honking tree on the path to the beach and in my stupid attempt to climb over it, I fell off the trunk and broke my wrist in three places.  There went my plans to go to Universal.

I went to the emergency room in Naples, where they didn’t even offer me an ice pack or a sling for two hours in a very unbusy emergency room.  By the time they x-rayed my arm, it was swelling rapidly.  Thanks Best Health Care in the World! About an hour later, they sent me home with a temporary cast and an appointment to see a surgeon at an outpatient facility so he could reset the wrist under a general anesthetic.  Fun, fun!  I still had more than a week of vacation to look forward.

The next day, I saw the surgeon and woke up to a full arm cast.  Yeah, try to drive home from Kennedy airport to NJ with only one functional arm.

When I arrived in NJ, I saw a different doctor who cut off the whole arm cast 4 weeks later and put my wrist in a smaller cast.  Then I had some physical therapy.

I think my co-pays were minimal, like $15 and my deductible was teensy.  I had a nice employer sponsored insurance policy.

On Obamacare, you do not get health insurance coverage outside of your network, which is minute.  If I went to Florida today and had the same accident, I would be facing a ginormous piles of bills from each doctor, anesthetist and emergency room service, including a charge for the ice pack I never received.  In other words, I am not covered beyond this state.  So, I am really not getting a health care policy that is equal to those of my better employed friends.  I would be strongly cautious of taking a vacation and maybe that’s the point.  If I have to be on Obamacare, maybe I shouldn’t feel entitled to a vacation.

But what if I am visiting Boston next week for a user group meeting (I am) and I have an accident?  Who covers me?

And why couldn’t the ACA be set up to handle not uncommon situations like the one described above?

Sylvia?  Would you like to answer that for the rest of us?

13 Responses

  1. It is really unbelievable. And nothing but lies all the way till now. I heard Obama say at a Health Care forum that the policies would be good anywhere. That you could choose where to go for your cancer treatment. As it turns out though… some people don’t have cancer centers at all in their networks.

  2. And it is designed to vastly increase the ranks of the second class. From what I read over at NaCap, it is designed to incentivise the steady droppage and attrition of employER plans and drive their many millions of employEES into the Ochanges.

    And Ocare should be thought of as a “stub”, like those skeletal starting-out articles on Wikipedia. The long range goal (Obama’s too, I suspect) is to remake Ocare into pure Heritage care. Repeal the employER mandate. Keep the individual mandate.

    Obama will be richly rewarded after office. He may not be socially welcomed, or heavily attended at his high-fee speaker appearances, but he will be financially rewarded.

    • It is regretable that Digby never linked to the Confluence when it might have made a difference to people who had never heard of the Confluence.

  3. Not quite true.

    Whether you are covered outside of your home network on Obamacare depends on your plan. Some plans are still affiliated with what I call “travel networks”. For example, some Blue Cross plans are still affiliated with the BlueCard network, meaning if you travel, say to Florida, you are covered as in-network if you use a BlueCard provider. Some of the other plans are affiliated with other “travel” networks. Typically these travel networks include community hospitals, and not the major orgs like, say, UCLA hospital on the West coast. But yes, the number of plans that have this advantage have shrunk under Obamacare. And on the East coast, the situation is probably worse than on the West coast.

    Regarding ER ONLY, Obamacare stipulates that insurance co’s are required to pay their in-network rate for ER even with out of network hospitals. However, of course, since the out of network hospitals, doctors, labs, x-rays, etc don’t have contracts with the insurance co’s to accept the insurance payout as a final charge, they generally can balance bill you for the difference between what insurance allowed as your bill and what the hospital billed. Obamacare also created rules that made the payout relatively high in the (false) hope that hospitals and providers would accept the insurance reimbursement as final payout.

    A few states (e.g. California) require — for ER only — that hospitals accept insurance payout as their final compensation. I don’t know if that requirement applies to doctors or just hospitals.

    But yes, narrow networks create a huge mess for patients, create a 2-tiered system for treating illnesses like cancer.

    It disgusts me when I see articles talking about insurance costs coming in below CBO expectations. The articles don’t often state that the reason why is the narrow networks, 2 tier care, lousy, junk Exchange plans.

    • Hmmm, maybe you aren’t familiar with the out of network situation we have here in Pittsburgh. Highmark BC/BS can’t even get UPMC (University of Pittsburgh Medical Center), who owns most of the health care facilities in this area, to negotiate with them right here in Pittsburgh. From what I’ve heard from people who work at Highmark, it’s gotten worse since the ACA, forcing Highmark customers to change all of their doctors and stay as far away from UPMC providers and hospitals as possible. UPMC refuses to negotiate with Highmark. Highmark recently had to lay off a significant number of employees in Pittsburgh as a direct result. You don’t even have to go out of state to get socked hard if the ambulance takes you to the nearest, wrong hospital.
      So, you know, I think it’s a huge problem that apparently no one considered very carefully when the bill was rammed through Congress.

      • First, I’m no fan of Obamacare. It has priced me out of insurance. I am lucky enough that my decent insurance was cancelled, so I’m exempt for at least 2 years from having to pay penalty. After that I will likely pay the penalty. It will be less expensive than the insurance, which makes no sense now. Premiums and deductible would have cost about $10,000 this year before I saw a dime of care. After 3 years, I’ll have $30,000 saved for care by not having insurance. In 10 years, well, you know.

        Yes, as I said, some plans still have the travel network, some don’t. You were making sweeping generalizations, which is why I corrected you. The only Exchange blue cross plan in my state DOES include the travel network (Premera). Many plans in many states do still include them.

        I was also speaking of ER situations. Under Obamacare, out of network ERs are required to be covered by the insurer as in-network. It is part of the “10 essential benefits.” The insurance company has to pay the hospital for stabilization care at a rate they would pay in-network But of course, you still get socked with the balance bill because the hospitals have no contract with the insurance.

        It’s a challenge to find a “non-Obamacare-friendly” site that talks about the “10 essential benefits” but I wanted to find one so you would be assured that the info I supplied wasn’t just hype.. Here’s Forbes, they pretty much hate Obamacare: http://www.forbes.com/sites/investopedia/2013/10/11/essential-health-benefits-under-the-affordable-care-act/. Go there and look for the second item, emergency services.

        Like I’ve said, Obamacare is just garbage for me. But I didn’t want people to opt out of emergency care because they read on Riverdaughter that it was off limits if it was out of network. In fact, I think with the high deductible Exchange plans, ER will more likely be used than ever.

        • I think my point is still valid. Before the ACA, my employer based coverage made it so I didn’t see a difference in cost. After ACA, I have a gigantic pile of bills. And from what I’m witnessing, the ACA has exacerbated the negotiation process between hospitals. If you have employer based insurance, this is something you rarely worry about.

  4. As I see it, before Obamacare there were the haves and the have nots-deplorable.
    After Obamacare, we’re all the have nots—abominable.

  5. Allyson Schwartz is not seriously running for PA Governor . She was sent in by powers that be to help sink Den chances in the race for governor …how do we know? Here’s a head line

    Allyson Schwartz ad touts Obamacare in Pennsylvania …

    Everyone knows what a campaign stink bomb O care is and has been since the Dems spent their two year super majority .doing nothing but watching the insurance industry hatch it

    The powers that be decided this year it’s the Dem’s turn to drive the clown car of irrelevance ….and most likely 2016 too.

  6. There is a very recent article at Naked Capitalism detailing how various incentives and disincentives were wired into the Ocare law to precisely and deliberately get employERS to cancel group employEE coverage and dump their every employEE onto the Ochanges.. On purpose. With unanimous Democratic officeholder support at the end.

    And there are still tools who think the Rs ever had any intention of “repealing” Ocare. They plan to “Heritagize” it, just as the Ocrats intended for them to do all along.

    • And there are still tools who think the Rs ever had any intention of “repealing” Ocare.

      Hilarious . They will run against it of course …but will never repeal it…hell it started as a GOP wet dream

      Thank you Mr. Obama for doing the GOP dirty work

      Of course it’s about getting employers off the hook completely …what else would it be about? Health Care?

  7. Insurance CEO: Obamacare consumers need to break the “choice habit”


    One of the harsh realities of the health care overhaul is becoming clearer as people enrolled under the Affordable Care Act (ACA) begin to utilize their coverage: virtually every policy covers only a narrow range of doctors and hospitals, or charges steep premiums for the right to go to any provider.

    ….The private insurance companies that sell policies on the insurance exchanges set up under the ACA are embracing this shift to the leaner and meaner networks, and telling customers that they need to shed their dependence on “lavish” health plans and wake up to the new reality.

    “We have to break people away from the choice habit that everyone has,” Marcus Merz, CEO of PreferredOne, an insurer in Golden Valley, Minnesota, told the New York Times. “We’re all trying to break away from this fixation on open access and broad networks.” Mr. Merz and PreferredOne stand to profit handsomely from the cost-savings from shrinking networks, as the insurer has grabbed about 60 percent of the market on the Minnesota Obamacare exchange…..

    Oh that pesty choice habit fixation we Americans have…the one discovered on the poop deck of the Mayflower

    Weren’t we endlessly told our choice habit would make all this horse shit ” competitive” ?


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