Lower Health Insurance Premiums to Come at Cost of Fewer Choices
By ROBERT PEAR
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.
Obamacare’s strange bedfellows
By E.J. Dionne Jr.,
COLUMBUS, Ohio
It was the last thing the Rev. Tim Ahrens expected to do during a chat in his book-lined office at the historic First Congregational Church here: He expressed admiration for Gov. John Kasich.
Ahrens is a progressive social activist whose house of worship has deep roots in the old Social Gospel movement. He has demonstrated and organized against Ohio’s conservative governor and, in 2011, even gave a kind of counter State of the State message outside the Capitol while Kasich was presenting his plans inside.
Yet Kasich, a one-time scourge of labor unions who was a top lieutenant in Newt Gingrich’s revolution in the 1990s, has endeared himself to liberal and low-income Ohioans by insisting, loudly and incessantly, that his state participate in the Medicaid expansion under Obamacare. An unapologetic conservative is fighting the tea party and his own Republican legislature because he thinks the less privileged people of Ohio deserve health coverage.
Thus Ahrens’s surprising confession last week, offered with a rueful smile: “One of the things I admire about John Kasich — yes, I did say ‘admire’ — is that if he connects to an individual who is hurting, he will respond.” And having responded on the Medicaid issue, Kasich has gone all in. “He has not wavered from that place,” said Ahrens, who chairs the Central Ohio Medicaid Expansion Coalition. “He has become a crusader. He will not let go of this.”
Kasich’s witness is important as an expression of his commitment to a form of evangelical Christianity that places a high priority on the poor. The governor told the Wall Street Journal last month of an encounter with a state legislator who disagreed with him on Medicaid. At heaven’s door, Kasich preached, St. Peter is “probably not going to ask you much about what you did about keeping government small. But he is going to ask you what you did for the poor.”
At a moment when the Beltway wing of the GOP is on the verge of shaking the economy to its foundations in an effort to block Obamacare, there’s also a political lesson to be drawn from Ohio and from other states where Republican governors have embraced the expansion of Medicaid, which is a central component of the Affordable Care Act.
Just last week, Rick Snyder, Michigan’s Republican governor, signed a Medicaid expansion bill with an explanation that President Obama himself would endorse. “This is about the health of fellow Michiganders,” Snyder said. In Pennsylvania, Gov. Tom Corbett once excoriated Obamacare but said he’d go along with a modified expansion. Another half-dozen Republican governors have also supported enlarging Medicaid, among them Chris Christie in New Jersey, Jan Brewer in Arizona and Susana Martinez in New Mexico.
These chief executives usually follow the party line in being critical of the health law in principle. But they have responsibilities that the radical ideologues in Washington don’t have — to their local hospitals, to their economies and, yes, to their constituents among the working poor who now lack insurance. They understand the difference between “Obamacare” as a right-wing bogeyman and the Affordable Care Act as a reality.
Tax credit or penalty? What to know about running a business under Obamacare
Posted Sept. 23, 2013, at 5:34 a.m.
Hey business owners: How much time do you spend worrying about health insurance for your workers? A lot? Don’t have time to answer because you’re too busy actually running your business?
You’re probably aware that the Affordable Care Act ushers in big changes for how employers provide health coverage, but you may not know what the health reform law means specifically for your retail store, contracting business, farm or other chosen livelihood. The good news is: You might get a tax credit. The bad news is: You might get hit with a penalty.
Here are the basics:
Employer penalties
One of the most-discussed elements of the ACA is the “employer mandate.” Technically, the law doesn’t require businesses to offer health insurance, but some companies will have to pay a penalty if they don’t offer affordable coverage. That includes businesses with 50 or more “full-time equivalent” employees.” (Not sure what that means? Keep reading.) Those entities will be fined $2,000 per worker, excluding the first 30 employees, if they don’t offer coverage to employees who average 30 or more hours per week.
There’s no penalty for not covering part-time workers.
To avoid the penalty, employers must offer insurance that covers at least 60 percent of employees’ health care expenses. The coverage also must be “affordable,” meaning an individual employee’s premium can’t amount to more than 9.5 percent of their household income. If the coverage isn’t affordable, employees can apply for tax credits to buy insurance on their own through the health insurance marketplace (formerly called an “exchange”) that opens for enrollment on Oct. 1. Employers will either have to fork over $3,000 for each employee receiving the tax credit, or pay $2,000 per employee excluding the first 30 workers (whichever is less).
Do you employ 49 or fewer full-time equivalent employees? Breathe easy; you’re exempt. You don’t have to provide health coverage to your workers, unless you want to.
The penalties take effect in 2015, a year later than originally planned, after business groups complained about the administrative burden.
Your fast-approaching deadline
You must notify your employees in writing by Oct. 1 about the new health insurance marketplace. This applies to all companies covered by the Fair Labor Standards Act — generally those with at least one employee and $500,000 in annual volume, so most businesses — regardless of whether you currently offer health coverage.
To debunk one myth, there’s no fine or penalty under the law for failing to notify employees.
The notification should inform all workers about what the marketplace is, that enrollment kicks off on Oct. 1, that they may be able to buy cheaper insurance through the marketplace, and that if they choose a marketplace plan they may lose any employer contribution to their coverage. You must notify all employees, regardless of full- or part-time status and their insurance situation, and all new workers upon hiring.
So, that’s an item to add to your to-do list, if you haven’t already. Need help? The U.S. Department of Labor has provided some sample notices.
Posted Sept. 22, 2013, at 10:03 a.m.
NEW YORK — State officials behind the launch of President Barack Obama’s health care reform on Oct. 1 say they could weather a federal government shutdown, though the scenario would add new pressure to the political attacks and technical issues that have weighed on the program’s introduction.
Several officials running new state-based insurance exchanges that are due to open for enrollment next month said they expected to have access to funds in the case of a shutdown, which if it happens, would also start on Oct. 1, the beginning of the the fiscal year.
But they were unsure of the consequences for the federal agencies they work with, in part because they have not been briefed by the Centers for Medicare & Medicaid Services, the agency taking the lead in implementing the reform law.
The exchanges are key to the success of Obamacare, as they aim to help millions of uninsured Americans receive benefits by providing government subsidies to buy insurance.
Officials involved in building the online marketplaces have already warned of technical bumps and glitches in the first few weeks after they go live, contributing to a slow start to enrollment.
Independent experts believe that “the effects of a government shutdown on the implementation of the ACA (Affordable Care Act) are likely to be pretty small,” said Paul Van de Water, a policy analyst at the Center on Budget and Policy Priorities, a Washington-based nonprofit think tank.
The main reason, he said, is that the money flowing to the 16 states and the nation’s capital that are running their own health care exchange is what’s called a “permanent appropriation,” enshrined in the 2010 healthcare reform law. Because the funds are not subject to annual appropriations, they will continue to be available to states that need to pay employees and contractors and buy equipment and supplies.
What is even less clear is the ability of the U.S. Department of Health and Human Services to operate a federal data “hub” that underpins both the state-run exchanges and the 34 state exchanges that fall under the purview of the administration.
The possibility of a federal government shutdown became more likely late last week, when congressional Republicans voted to fund the government but not the implementation of Obama’s healthcare law.
The Democrat-controlled Senate is unlikely to go along. If the two chambers cannot agree on a spending bill by Sept. 30, it will trigger a government shutdown the next day.
Scans More Likely if Doctors Have Financial Stake
By NICHOLAS BAKALAR
A new study has found that patients are more likely to have magnetic resonance imaging scans that indicate nothing is wrong if they are referred by a doctor who owns the machine. The scientists conclude that doctors with a financial interest in the machines may be more likely to order M.R.I.s even when clinical findings suggest they are unnecessary.
The researchers reviewed referrals for knee M.R.I. examinations made by two physician groups, one with a financial interest in a scanner, the other without. There were 350 referrals in each group, and none of the patients had had a previous M.R.I. or knee surgery. The study was published online in Radiology.
Of the 700 examinations, 205 had negative results, indicating no abnormalities. But the rate of negatives was 33 percent in patients referred by doctors who owned the machine, compared with 25 percent of patients referred by those without a financial stake in the device.
There were no significant differences between the groups in the age or sex of the patients, or the training or number of years in practice of the doctors. The machines were all in the same 50-mile radius so convenience was eliminated as a possible reason for referral.
“There is a potential for bias in certain settings,” said Dr. Matthew P. Lungren, the study’s lead author and a fellow in radiology at Duke. “The doctor should be transparent and acknowledge his interest. That should be disclosed.
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