No one at the hospital ever said Bruce Folken's medical care would suffer if he didn't pay up, but it sure felt that way.
Folken, 62, went to Fairview Ridges Hospital in Burnsville, Minn., on March 23 with high blood pressure, heartburn and a tingling sensation on the left side of his body. The retired sales executive for a greeting card company and part-time tax preparer was terrified he'd had a heart attack or a stroke. The doctors and nurses were great, he says.
Then, while he was alone and "feeling kind of out of it" in an exam room bed, a hospital employee entered. "Do you want to pay now?" she asked. She seemed insistent, Folken says.
I learned that Mitt Romney had won the Nebraska Republican presidential primary last week via a “Breaking News” e-mail alert from POLITICO. It wasn’t the news from the Cornhusker state, however, that caught my eye. It was instead the health insurance industry’s decision to spend our premium dollars on an Internet ad — an ad warning of dire consequences if the Supreme Court doesn’t rule the way insurers want on the constitutionality of Obamacare.
The worst-case scenario for insurers is if the high court strikes down the provision of the law requiring us to buy coverage (the so-called individual mandate), but allows the law’s important consumer protections to go forward.
Giselle Fernandez is only 17 but she has had more than 50 operations since she was born with a rare genetic condition. She regularly sees a host of pediatric specialists, including an ophthalmologist, an endocrinologist and a neurologist at UCLA Health System. Her care has cost hundreds of thousands of dollars so far, and she will need special treatment for the rest of her life.
While UCLA Health System has long prided itself on being at the forefront of treating patients like Giselle, it is now trying to lower sharply the cost of providing that care. By enrolling young patients with complex and expensive diseases in a program called a medical home, the system tries to ensure that doctors spend more time with patients and work more closely with parents to coordinate care. The program has cut emergency room visits by slightly more than half.
The effort is part of a much broader ambition by UCLA Health System to reduce its costs by 30 percent, or hundreds of millions of dollars, over the next five years, according to Dr. David T. Feinberg, the system’s president.
“We have definitely found religion,” Dr. Feinberg said.
More than half of all medical insurance policies sold to individuals now fail to meet the standards of coverage set by the federal health care law under review by the Supreme Court, a new study says.
Even if the law is upheld, employer-provided insurance plans are likely to continue to be more generous, but the law would significantly improve the quality of coverage for individuals in several ways, the researchers concluded.
Insurers would be required, for example, to limit how much people pay toward their own medical bills, even if they have a chronic and expensive condition. Insurers would also have to provide a comprehensive set of benefits, like maternity coverage that is now excluded by some policies, and cover pre-existing medical conditions, which may be excluded under certain policies.
The study was published online Wednesday in Health Affairs, an academic journal. “It really shows why the reforms in the Affordable Care Act are so necessary,” said Sara R. Collins, a vice president of the Commonwealth Fund, a New York research foundation that financed the study.
Health Insurance Cutbacks Squeeze The Insured
May 23rd, 2012 1:08 PM
Spinning the Supreme Court's 'Obamacare' decision
Insurers laying the groundwork to remove consumer protections if mandate is tossed
With the Affordable Care Act Hanging by a Thread, It's Time for Single-Payer
By REED ABELSON
By REED ABELSON