Health Insurance Exchanges Explained
Last week's election may have settled the fate of the federal Affordable Care Act, but its implementation after months of uncertainty has caught many of the players unprepared.
Late last week, the federal government extended the deadlinefor states to decide what they want to do about health exchanges. Those are the new marketplaces where individuals and small businesses will be able to shop for health insurance.
But with one of the deadlines still approaching at the end of the week, this seemed as good a time as any to revisit what an exchange is, anyway.
Real Danger of “Obamacare”: Insurance Company Takeover of Health Care
By Nomi Prins
Thoughts: Nomi Prins blog, Nov. 10, 2012
It's understandable that car insurance rates can change when you move. One neighborhood might have more accidents or burglaries than another.
But health insurance?
Joan Swope, 62, moved recently from Cathedral City, just down the road from Palm Springs, to nearby Palm Desert.
She informed her insurer, Anthem Blue Cross, of the change of address. A few weeks later, Anthem responded with a notice stating that, because of the move, Swope's monthly premium on her individual policy will increase to $524 from $418.
That's a more than 25% rate hike. For a move of less than 10 miles.
"It's ridiculous," Swope told me. "I'm going to the same doctor. I'm going to the same facilities and the same drugstore. Nothing has changed."
Nothing except her ZIP Code. And in the actuarial world of insurance, that's a sufficiently life-altering event to justify an extra $1,272 in annual payments — on top of a $5,000 deductible.
http://www.latimes.com/business/la-fi-lazarus-20121113,0,3029654,print.column
Thoughts: Nomi Prins blog, Nov. 10, 2012
Election rhetoric shuns the big picture in favor of the bigger platitude. Now that The Show is over, we are left with the equivalent of a Sunday morning hangover following a binge of promises and lies. We leave the theatre of political spectacle on steroids for the real world of unstable economy, a globally and publicly subsidized financial sector, and increased costs of living on everything from food to education to health-care; outpacing declining median incomes. The average cost for health insurance for a family is $15,745 per year vs. a median income of $50,502, or about half post-tax take-home pay.
“Obamacare” is the name commonly used for the Patient Protection and Affordable Care Act (PPACA) of 2010. The very moniker is indicative of how name-and-image-centric our world has become; Medicare was never called “Johnsoncare” when President Johnson signed it into law in 1965 and Johnson was not exactly a man of small-personality. At any rate, Obamacare or the PPACA ranks as one of the most misrepresented issues from the campaign, by both sides of the ever-slimming aisle.
The Tea-Party Conservative types get it embarrassingly wrong when they call it a “government takeover of health care.” Likewise, Progressive Obama-supporters are deluded in accepting it as the most sweeping healthcare reform since Medicare. (Side note: I wish the word ‘sweeping’ could be retired from politics until it actually means -sweeping.)
Here’s why. The PPACA does nothing to restructure the health insurance industry, anymore than the Dodd-Frank Act restructures the banking industry. This means everything else it attempts to do, positive or negative, will be vastly overshadowed by an industry accelerating to morph itself into a acquisition machine in order to circumvent anything that even smells like a restriction, including laws that exist and ones to come.
How? By doing the same thing energy and telecom companies did after they were deregulated in 1996, and that banks did after they were summarily deregulated (after moving that way for decades) in 1999. They are merging, consolidating, eliminating competitors, and controlling their domain. They are manufacturing power.
Investment bankers are roaming the world to exploit this hot new opportunity. That’s one reason insurance companies don’t even call themselves that anymore. Now, they are ‘managed health care’ companies. Call yourself a managed health care company, and you can buy everything from other insurance companies to hospitals to clinics to doctors. The more consolidation, the more fees bankers rake in, and the more premiums and medical reimbursements and health care procedures, each company can control.
The result of 1996 energy deregulation was a glut of crime-spawned bankruptcies like Enron. Likewise WorldCom led a pack of telecom degenerates in the production of tens of billions of dollars worth of accounting fraud. The final repeal of Glass-Steagall ignited a merge-fest of investment and commercial banks, their linkages ensuring that taxpayers, whose deposits have been protected since the New Deal, provide a safety-net upon which they can mint toxic assets loosely based on over-leveraged home mortgages, and engage in risky, speculative activity; big banks don’t go bankrupt when they fabricate values or lose big on stupid bets, they get federally subsidized in all sorts of ways.
You know who else is similarly too big to fail? The insurance industry. UnitedHealth Group, the nation’s largest health insurer covers 50% of the insurable population in over 30 states. Blue Cross-Blue Shield, covers 100 million people through a constellation of 38 sub-companies. They, and other insurance companies are growing in breadth. When companies consolidate, the result is less transparency, less competition, and more possibility for fraud and shady behavior. Every. Single. Time.
Friends in Congress Have Helped Drug Compounders Avoid Tighter Rules
By ERIC LICHTBLAU and SABRINA TAVERNISE
WASHINGTON — Despite two decades of dire health warnings and threats of federal intervention, the specialty drugmakers at the center of the nation’s deadly meningitis outbreak have repeatedly staved off tougher federal oversight with the help of powerful allies in Congress.
Over the years, industry friends like Tom DeLay, the former House Republican leader from Texas, have come to its defense. Even Senator Edward M. Kennedy, regarded as the strongest health care advocate in Congress in recent times, dropped efforts to impose new safeguards.
But the pharmacists known as compounders are now facing their biggest regulatory threat as they confront questions on Wednesday and Thursday at Congressional hearings on the deadly outbreak. The question is whether Congress will move to oversee the niche industry more aggressively.
“A lot of the blame for the meningitis situation lies at Congress’s door,” said Larry D. Sasich, a research pharmacist who has written about compounders’ safety record. For specially mixed drugs that fall into a gray area of federal law, he said, “the protections for your cat or dog are stronger than for your wife and children.”
By Washington standards, the industry’s financial clout is not terribly large. The main trade group, the International Academy of Compounding Pharmacists, has spent $1.1 million on lobbying in the past decade, while major players in the business have given at least $300,000 to candidates since 2008, according to data from the Center for Responsive Politics, a research group in Washington.
But by positioning itself as a more affordable, community-based alternative to huge drug manufacturers, compounders have attracted broad support from politicians. They have become popular among proponents of hormone therapy to slow aging and advocates for the autistic, who often distrust the traditional pharmaceutical industry, and rely on compounders’ tailor-made blends.
If history is a guide, it often takes a disaster to get real change in the law.
Patient trapped in health insurance rate hike
A patient's move from one Southern California community to another nearby triggers a 25% rate hike by Anthem Blue Cross despite no change in her care.
David Lazarus
November 13, 2012
But health insurance?
Joan Swope, 62, moved recently from Cathedral City, just down the road from Palm Springs, to nearby Palm Desert.
She informed her insurer, Anthem Blue Cross, of the change of address. A few weeks later, Anthem responded with a notice stating that, because of the move, Swope's monthly premium on her individual policy will increase to $524 from $418.
That's a more than 25% rate hike. For a move of less than 10 miles.
"It's ridiculous," Swope told me. "I'm going to the same doctor. I'm going to the same facilities and the same drugstore. Nothing has changed."
Nothing except her ZIP Code. And in the actuarial world of insurance, that's a sufficiently life-altering event to justify an extra $1,272 in annual payments — on top of a $5,000 deductible.
http://www.latimes.com/business/la-fi-lazarus-20121113,0,3029654,print.column
No comments:
Post a Comment