Waiting … and Waiting …
Average time to get five kinds of appointments for new patients in 2013, from a survey of 15 metropolitan areas.
Federal audit faults California exchange for lax enrollment practices
Federal auditors found that California's health insurance exchange was lax at times in verifying consumers' eligibility for Obamacare coverage.
The report issued Tuesday by the Inspector General's Office at the U.S. Department of Health and Human Services also cited the federally-run exchange and Connecticut's insurance marketplace for similar deficiencies.
Auditors said lax internal controls may have limited the exchanges' "ability to prevent the use of inaccurate or fraudulent information when determining eligibility of applicants for enrollment."
However, auditors added that these deficiencies didn't necessarily mean a person was improperly enrolled under the Affordable Care Act.
The federal review only covered the first three months of open enrollment, from October to December, and focused on a sample of 45 applicants in California.
The Covered California exchange agreed with some of the criticisms and disputed others in a response to the audit.
Confusion over doctor lists is costly for Obamacare enrollees in state
Frustration and legal challenges over the network of doctors and hospitals for Obamacare patients have marred an otherwise successful rollout of the federal healthcare law in California.
Limiting the number of medical providers was part of an effort by insurers to hold down premiums. But confusion over the new plans has led to unforeseen medical bills for some patients and prompted a state investigation.
More complaints are surfacing as patients start to use their new coverage bought through Covered California, the state's health insurance exchange.
"I thought I had done everything right, and it's been awful," said Jean Buchanan, 56. The Fullerton resident found herself stuck with an $8,000 bill for cancer treatment after receiving conflicting information on whether it was covered.
"How am I going to come up with that much money?"
Insurers insist that pruning the network of doctors is a crucial cost-cutting measure and a major reason that so many Californians could find affordable coverage in the health law's first year.
"These narrow networks are making a huge difference in terms of affordability," said Mark Morgan, president of Anthem Blue Cross, a unit of industry giant WellPoint Inc. "We found in convincing numbers that people value price above all else."
But regulators, lawmakers and consumer advocates are pushing back to ensure patients know what they're giving up in return for lower rates — and don't run into unnecessary roadblocks to care.
This month, the California Department of Managed Health Care began investigating whether two major insurers, Anthem Blue Cross and Blue Shield of California, are violating state law related to inaccurate provider lists and offering timely access to treatment.
Healthcare debate lacks factual arguments against Obamacare
Americans have always been a politically contentious lot. But one topic seems to produce more pure vitriol than any other: the Affordable Care Act.
I posted an item on my Times blog, the Economy Hub, citing new statistics indicating that the act has materially reduced the ranks of the uninsured, kept premiums moderate and seemed likely to keep rate increases modest next year. I sought agreement that, given these developments, "Obamacare is working."
I didn't get it. What I got instead was an unexampled outpouring of angry, vulgar and bitter emails, almost none of them bearing even the slightest attempt to counter my statistics with alternative facts.
Here's one: The subject line advised me to perform an anatomical act on myself not physically plausible or suitable for repetition in print. The text read:
"Also, I hope you get cancer and die. Painfully."
This message may have been more extreme than others in my inbox, but not by much. All for suggesting that a government program is actually succeeding in improving access to healthcare for millions of Americans who didn't have it before. Plainly, something is at work here other than the wholesome give-and-take of political debate.
Healthcare reporters and bloggers I queried in an informal poll confirmed that the ACA elicits unusual fervor among their readers. One who writes for a progressive website says that "Obamacare is only in second place when it comes to hate tweets. No. 1 is Benghazi."
What accounts for the pungent rancor? Here's a rundown:
Evidence supports single payer
By Ellen Oxfeld
Rutland (Vt.) Herald, July 2, 2014
Rutland (Vt.) Herald, July 2, 2014
In his recent column on health care (June 29), John McClaughry criticizes Vermont’s road map to universal health care as laid out in Act 48. This road map hopes to create a publicly financed health care system, in which health care is a guaranteed public good for all Vermonters The target date for implementation is 2017.
According to Mr. McClaughry, the recent VA scandals, in addition to evidence from Canada and other countries where health care is universal and publicly funded, shows that such systems will result in “rationing, wait lines, maddening bureaucracies, inefficient work rules, demoralized doctors and nurses, shabby facilities, obsolete technology, and declining quality of care.”
So, what is the actual evidence? According to the Commonwealth Fund’s 2014 report on 11 industrialized nations (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States), the United States ranked last on issues of access, efficiency, and equity. An interesting feature of this study is that it showed that even higher-income and insured Americans were often unable, as compared to those in other countries in similar positions, to get needed treatment. This may be due to the fact that even with insurance coverage, many Americans face high out-of-pocket costs.
Ironically, the United Kingdom ranked first in the recent Commonwealth Fund report. Their system is actually government owned and operated. However, we should be clear that Act 48 does not contemplate a government-owned health care system at all. Rather it proposes functioning much like our current Medicare system does, using publicly raised funds to pay providers, who remain in the private sector. (It is also important to point out that according to Act 48, the new publicly financed plan, Green Mountain Care, will function as a secondary payer or wraparound for those who are already on Medicare).
In any event, this recent data, and numerous other studies of comparative health care systems, leaves one wondering on what basis John McClaughry can assert that countries with publicly funded health care systems deliver worse care. He certainly cannot demonstrate that these systems are more expensive — as health care costs in the United States are the highest in the world. (According to the Fund’s report, we spend about twice as much per capita as the average for the comparison countries, and the same ratio holds true if one looks at health care spending as a percent of GDP). Over 60 percent of personal bankruptcies in the United States are due to health care expenses.
Finally, what about the issue of the VA? Independent surveys actually show that those who get into this system give high marks on the quality of care they receive. But gaining admittance is not easy. One has to prove that one’s ailment was a result of one’s military service. Furthermore, as Sen. Bernard Sanders has pointed out, more than 2 million more veterans are in need of care now, due to the wars in Iraq and Afghanistan. Certainly, these numbers mean that more investment is needed to guarantee timely care for all these veterans. But how does this prove that publicly funded health care is inefficient? This recent scandal seems to say more about our propensity to engage in costly military adventures overseas, and then to forget that we have to care for veterans when they return home.
The Hobby Lobby case proves the necessity of single-payer healthcare
By Michael Hiltzik
Los Angeles Times, July 1, 2014
Is there anything more absurd than the American way of delivering healthcare coverage?
Most Americans receive coverage through their employers. In the wake of Monday's Hobby Lobby decision by the Supreme Court, businesses accounting for about 52% of all privately employed workers now have the option to discriminate among their employees and among the healthcare benefits they offer, based on their owners' religious beliefs.
The U.S. reliance on employers to provide coverage on this scale is unique among major industrialized nations. In those countries, as Jonathan Cohn observes, "the government takes on this responsibility directly, by creating its own insurance program or regulating insurers as if they were public utilities." This is essentially a definition of single-payer healthcare.
The alternative produces ludicrous results such as the Hobby Lobby decision.
It was hoped that the Affordable Care Act, which was at the center of that decision, would begin decoupling American healthcare from the tyranny of employer sponsorship. Americans who are out of work, or whose employers can't or won't provide them with healthcare benefits, now can buy coverage on their own, with government financial assistance if necessary.
This was a first halting step toward single-payer, which is more the norm in the developed world and plainly the most efficient and effective way of achieving universal coverage.
But it wasn't enough of a step: The ACA still leaves most health coverage in the hands of employers. And it strengthens the hands of private health insurers in administering coverage and setting prices and terms for the doctors and hospitals providing care. The law was one step forward toward single-payer, and about three-quarters of a step back.
The Hobby Lobby decision underscores the patchiness of the ACA, by granting employers a huge loophole to avoid the law's mandates -- in this case, the mandate that coverage include reproductive services for women without deductibles or co-pays. At the center of the case were the evangelical Green family, owners of the Hobby Lobby retail crafts chain, and the Hahn family, Mennonites who own a wood furnishings firm. They asserted that the ACA's birth control mandate offended their religious sensibilities; the court ruled that these sensibilities outweigh the ACA's coverage standards.
As it happens, Justices Samuel A. Alito Jr. and Anthony M. Kennedy, in their majority and concurring opinions, respectively, implicitly acknowledged the wisdom of single-payer healthcare as a way forward.
They did so by advising the government to grant the business owners relief by establishing what is in effect a single-payer regime for the birth control methods at issue. (These are two "morning after" drugs and two forms of IUDs that the businesses term "abortifacients," meaning they cause abortions.)
http://www.pnhp.org/print/news/2014/july/the-hobby-lobby-case-proves-the-necessity-of-single-payer-healthcare
Los Angeles Times, July 1, 2014
Is there anything more absurd than the American way of delivering healthcare coverage?
Most Americans receive coverage through their employers. In the wake of Monday's Hobby Lobby decision by the Supreme Court, businesses accounting for about 52% of all privately employed workers now have the option to discriminate among their employees and among the healthcare benefits they offer, based on their owners' religious beliefs.
The U.S. reliance on employers to provide coverage on this scale is unique among major industrialized nations. In those countries, as Jonathan Cohn observes, "the government takes on this responsibility directly, by creating its own insurance program or regulating insurers as if they were public utilities." This is essentially a definition of single-payer healthcare.
The alternative produces ludicrous results such as the Hobby Lobby decision.
It was hoped that the Affordable Care Act, which was at the center of that decision, would begin decoupling American healthcare from the tyranny of employer sponsorship. Americans who are out of work, or whose employers can't or won't provide them with healthcare benefits, now can buy coverage on their own, with government financial assistance if necessary.
This was a first halting step toward single-payer, which is more the norm in the developed world and plainly the most efficient and effective way of achieving universal coverage.
But it wasn't enough of a step: The ACA still leaves most health coverage in the hands of employers. And it strengthens the hands of private health insurers in administering coverage and setting prices and terms for the doctors and hospitals providing care. The law was one step forward toward single-payer, and about three-quarters of a step back.
The Hobby Lobby decision underscores the patchiness of the ACA, by granting employers a huge loophole to avoid the law's mandates -- in this case, the mandate that coverage include reproductive services for women without deductibles or co-pays. At the center of the case were the evangelical Green family, owners of the Hobby Lobby retail crafts chain, and the Hahn family, Mennonites who own a wood furnishings firm. They asserted that the ACA's birth control mandate offended their religious sensibilities; the court ruled that these sensibilities outweigh the ACA's coverage standards.
As it happens, Justices Samuel A. Alito Jr. and Anthony M. Kennedy, in their majority and concurring opinions, respectively, implicitly acknowledged the wisdom of single-payer healthcare as a way forward.
They did so by advising the government to grant the business owners relief by establishing what is in effect a single-payer regime for the birth control methods at issue. (These are two "morning after" drugs and two forms of IUDs that the businesses term "abortifacients," meaning they cause abortions.)
http://www.pnhp.org/print/news/2014/july/the-hobby-lobby-case-proves-the-necessity-of-single-payer-healthcare
Letter to the editor: Medicare for all simplifies health care
In his June 22 articles (“When college athletes get hurt, whose wallets should feel the pain?” and “USM ‘doing responsible things’ for athletes”), Mark Emmert explores the questions “Who pays?” and “Is it fair?” for injured University of Maine athletes. He interviews UMaine officials, caregivers, injured athletes and outside experts.
Any uninsured student entering UMaine must pay $3,000 for health care coverage, in addition to tuition. For serious injuries, like those Emmert describes, the athlete pays $10,000 for deductibles that generate seemingly endless mountains of bills.
UMaine buys insurance that kicks in after the deductible, paying $124,000 for it. UMaine pays $340,000 to provide injured athletes “free rehabilitation services.” Is UMaine doing enough for its athletes? Is it fair to other UMaine students to add a share of the $464,000 to their tuition?
We could establish a less complex, fairer and cheaper option than the one Emmert describes at UMaine. Health policy experts, economists, physicians and Congress people urge us to provide everyone with “improved Medicare for all.” Medicare for All is simple – from your first breath to your last one, you have access to private care, with choice of physician, hospital and rehabilitation facility.
Morning Views
The Risks of Hospital Mergers
n retrospect, it looks as if Massachusetts made a serious mistake in 1994 when it let its two most prestigious (and costly) hospitals — Massachusetts General Hospital and Brigham and Women’s Hospital, both affiliated with Harvard — merge into a single system known as Partners HealthCare. Investigations by the state attorney general’s office have documented that the merger gave the hospitals enormous market leverage to drive up health care costs in the Boston area by demanding high reimbursements from insurers that were unrelated to the quality or complexity of care delivered.
Now, belatedly, Attorney General Martha Coakley is trying to rein in the hospitals with a negotiated agreement that would at least slow the increases in Partners’ prices and limit the number of physician practices it can gobble up, albeit only temporarily.
The experience in Massachusetts offers a cautionary tale to other states about the risks of big hospital mergers and the limits of antitrust law as a tool to break up a powerful market-dominating system once it is entrenched.
One purpose of the 1994 merger, as the president of Mass General acknowledged in 2010, was to take away the ability of insurance companies to demand lower prices from one hospital with the threat that they could just send patients to the other. After the merger, insurers had to take both of them or neither.
The bargaining power of the merged institutions was starkly displayed in 2000 when the Tufts Health Plan refused to pay Partners what it considered unjustifiably high prices. Partners promptly announced it would no longer accept Tufts insurance and created an uproar among members of the Tufts plan who wanted to retain access to the two prestigious hospitals. Faced with defections that could destroy its viability, Tufts quickly caved in.
The current case in Massachusetts arose when Partners sought to acquire a hospital and an affiliated physician group southeast of the city. Partners is already the largest provider system in Massachusetts, with about 6,000 doctors and some 2,800 licensed beds in its academic medical centers and community hospitals. A special agency created by the Legislature to monitor health care costs, known as the Health Policy Commission, concluded that the acquisition of South Shore Hospital and related doctors would be likely to drive up total medical spending in the region by $23 million to $26 million a year and possibly much more. It referred the matter to the state attorney general, who has no power to restrict prices but can file an antitrust suit to block a merger and can use that threat to win broader concessions.
On June 24, after months of negotiations, a final agreement between Partners and Attorney General Coakley was filed in a Massachusetts court. The judge has set a public comment period that will end later this month.
Mountainous Backlog Stalls Medi-Cal Expansion in California
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