The high costs of complexity in health care reform
Posted Sept. 19, 2013, at 10:45 a.m.
I have great admiration for the political courage of President Barack Obama and the congressional leaders who were willing to take on health care reform, justifiably called the “third rail” of American politics. Our system cries out for reform. But they made a fatal mistake in allowing the law to be drafted by Congress, which is composed of 535 members with vastly varying values, goals and interests.
Consequently, the resulting law is a conglomeration of ideas from across the political spectrum, thrown together and lacking any coherent conceptual framework. (Congress is usually a better editor than author.) This lack of coherence has resulted in a law that is far too complicated and therefore too expensive to manage, full of holes, will be applied unevenly and unfairly, be full ofunintended consequences, and be easily exploited by those looking to make a quick buck.
It has been credibly estimated that administrative costs make up more than 30 percent of our national health care bill, most of it unnecessary. The waste in this area alone is equivalent to around $400 billion annually. That is more than enough to provide health care to every uninsured person living in our country. Some of these costs result from the slicing and dicing of Americans into ever-tinier and more confusing categories, the inevitable result of applying the principles of insurance to health care.
But the costs go beyond dollars to a lack of basic fairness, and of public understanding and support.
A plurality of the public still views the law negatively. Even many experts are confused by it. The law tries to deal with this confusion by providing a host of federally funded “navigators” to help people find their way through the maze it creates. While this provision will provide many well-paying jobs, it uses health care funds but does not pay for any health care — an example of your health care dollars not at work.
The ways in which the costs and benefits of the law are distributed are patently unfair. Even if it is perfectly implemented, it will leave around 30 million Americans without health care coverage. Some of this was intentional, but some wasn’t. The Affordable Care Act’s architects intended the federal government to expand the Medicaid program and make it more uniform to cover the poorest among us on a fairer basis.
But the Supreme Court found that requiring the states to expand their Medicaid programs would be unconstitutional, thereby gutting that provision. About half the states, including Maine, have declined the Medicaid expansion. They have decided to forgo the 100 percent federal funding (dropping to 90 percent after three years). That has created the anomalous situation where some of the poorest Mainers will receive no help, while those who are slightly wealthier will receive federal subsidies to buy insurance.
Reaping Profit After Assisting on Health Law
By SHERYL GAY STOLBERG
WASHINGTON — Washington’s health care revolving door is spinning fast as the new online health insurance marketplaces, a central provision of President Obama’s health care law, are set to open Oct. 1. Those who had a hand in the law’s passage are now finding lucrative work in the private sector, as businesses try to understand the complex measure, reshape it by pressing for regulatory changes — or profit from it.
That means boom times for what might be called an Obamacare cottage industry, providing work for dozens of former administration and mostly Democratic Congressional officials whose immersion in health policy minutiae, and friendships, make them invaluable to private business.
Dr. Dora Hughes, for example, has a medical degree from Vanderbilt and a master’s in public health from Harvard and never envisioned joining a law firm. But Dr. Hughes, a former Obama administration official, has something Washington lawyers and lobbying shops covet: an insider’s understanding of the new health care law.
After nearly four years as counselor to Health and Human Services Secretary Kathleen Sebelius, she left government last year to work for Sidley Austin, which represents insurers, pharmaceutical companies, device makers and others affected by the law. She is not a registered lobbyist, but rather a “strategic adviser,” although some call that a distinction without a difference.
“Health policy is what I do,” Dr. Hughes said in a recent interview. “It’s what I’ve always done, so I’m not doing anything differently. My work is not based only on relationships or trying to curry favor.”
The health care industry now spends more money on lobbying in Washington than any sector of the economy — more than $243 million last year alone, slightly higher than the $242 million spent by financial, insurance and real estate companies, according to the Center for Responsive Politics here.
Of the “revolving door lobbyists” profiled by the center, those specializing in health care account for 12 percent, more than any other economic sector.
By SHERYL GAY STOLBERG
WASHINGTON — Washington’s health care revolving door is spinning fast as the new online health insurance marketplaces, a central provision of President Obama’s health care law, are set to open Oct. 1. Those who had a hand in the law’s passage are now finding lucrative work in the private sector, as businesses try to understand the complex measure, reshape it by pressing for regulatory changes — or profit from it.
That means boom times for what might be called an Obamacare cottage industry, providing work for dozens of former administration and mostly Democratic Congressional officials whose immersion in health policy minutiae, and friendships, make them invaluable to private business.
Dr. Dora Hughes, for example, has a medical degree from Vanderbilt and a master’s in public health from Harvard and never envisioned joining a law firm. But Dr. Hughes, a former Obama administration official, has something Washington lawyers and lobbying shops covet: an insider’s understanding of the new health care law.
After nearly four years as counselor to Health and Human Services Secretary Kathleen Sebelius, she left government last year to work for Sidley Austin, which represents insurers, pharmaceutical companies, device makers and others affected by the law. She is not a registered lobbyist, but rather a “strategic adviser,” although some call that a distinction without a difference.
“Health policy is what I do,” Dr. Hughes said in a recent interview. “It’s what I’ve always done, so I’m not doing anything differently. My work is not based only on relationships or trying to curry favor.”
The health care industry now spends more money on lobbying in Washington than any sector of the economy — more than $243 million last year alone, slightly higher than the $242 million spent by financial, insurance and real estate companies, according to the Center for Responsive Politics here.
Of the “revolving door lobbyists” profiled by the center, those specializing in health care account for 12 percent, more than any other economic sector.
Antibiotic-Resistant Infections Lead to 23,000 Deaths a Year, C.D.C. Finds
By SABRINA TAVERNISE
Federal health officials reported Monday that at least two million Americans fall ill from antibiotic-resistant bacteria every year and that at least 23,000 die from those infections, putting a hard number on a growing public health threat. It was the first time that federal authorities quantified the effects of organisms that many antibiotics are powerless to fight.
The number of deaths is substantially lower than previous estimates, in part because researchers from the Centers for Disease Control and Prevention stripped out cases in which a drug-resistant infection was present but not necessarily the cause of death. Infectious disease doctors have long warned that antibiotic resistance — in which bacteria develop defenses against antibiotics used to kill them — threatens to return society to a time when people died from ordinary infections.
“They have come up with hard numbers where it has been only guesswork,” said Dr. Stuart B. Levy, a professor of microbiology at Tufts University and the president of the Alliance for the Prudent Use of Antibiotics. “This sets a baseline we can all believe in.”
In 2007, the C.D.C. estimated that about 100,000 people died every year of infections they developed while in hospitals. Most of those infections were believed to be resistant to some antibiotics, but not necessarily the most widely used ones. And it was unclear how many of the deaths were caused by the drug-resistant infections. Monday’s report quantifies that.
Dr. Steven L. Solomon, the director of the C.D.C.’s office of antimicrobial resistance, acknowledged that the report underestimated the numbers, but said that was by design. Researchers were instructed to be conservative and to base their calculations only on deaths that were a direct result of a drug-resistant bacterial infection.
“This is a floor,” Dr. Solomon said. “We wanted the cleanest number, the least subjective number.”
Percentage of Americans Lacking Health Coverage Falls Again
By ROBERT PEAR
WASHINGTON — For the second year in a row, the proportion of Americans without health insurance declined in 2012, even though real household income and the poverty rate were not significantly different from their 2011 levels, the Census Bureau reported on Tuesday.
In 2012, the bureau said, 15.4 percent of people were uninsured, down from 15.7 percent in 2011. The number of uninsured people, 48 million, was not statistically different from the estimate of 48.6 million in 2011.
David S. Johnson, the chief of social and economic statistics at the bureau, said that much of the increase in coverage last year was attributable to government programs. Medicare covered 15.7 percent of the population, compared with 15.2 percent the previous year.
Census Bureau data showed significant changes in coverage over the last 13 years.
From 1999 to 2012, the bureau said, the proportion of people with private health insurance declined to 63.9 percent, from 73 percent, while the proportion with government coverage rose to 32.6 percent, from 24.2 percent.
One of the most popular provisions of the 2010 health care law allows young adults to stay on their parents’ insurance policies until age 26. That provision appears to be having its intended effect.
Among people ages 19 to 25, the proportion who were uninsured declined to 27.2 percent in 2012. Though the bureau said that figure was not significantly different from the 2011 rate, it was down from 29.8 percent two years earlier.
The proportion of children younger than 19 without health insurance declined last year, to 9.2 percent, from 9.7 percent in 2011.
Chris Jennings, the health policy coordinator at the White House, said the census figures showed that President Obama’s policies were “making progress in expanding access to affordable health care.” Mr. Jennings said the progress would accelerate in coming months as millions of Americas gain access to coverage under the 2010 health care law.
Single Payer: Alive and Still Remarkably Well
As the country prepares for open enrollment October 1st in the insurance exchanges of the Affordable Care Act(aka Obamacare), a small group of dedicated artists and politicians in Pennsylvania have been working toward a broader solution. Catalyzed by a study by Professor Gerard Friedman of the University of Massachusetts at Amherst that estimated savings of $17B for Pennsylvania with a single payer approach, State Senator Jim Ferlo and an energetic group of young artists in Pennsylvania, decided they needed a comprehensive statewide system that would offer affordable health care to every citizen in Pennsylvania.
In March 2013, PA Senator Jim Ferlo and Representative Pam DeLissio re-introduced SB400, a bill Ferlo had introduced a year before to little fanfare and support. This time, Ferlo garnered support from a businessman and former Republican legislator, David Steil, as well as the activist group HealthCare4AllPA.
Medicine Is More Than Carrots and Sticks
By DHRUV KHULLAR
“Did you take it out yet?” my supervising physician asked me, referring to the urinary catheter I placed in a patient several days before. “You know they’re keeping tabs on that now?”
I did know. We had recently discussed performance metrics during morning rounds, and were taught that prolonged urinary catheterization caused many hospital-acquired infections. Hospitals were now being penalized for that sort of thing.
Several months before, I had attended a conference where there was a heated discussion about whether to tie reimbursements to how well physicians managed hemoglobin A1c levels – a marker of blood sugar control in diabetic patients. Some argued doctors would pay closer attention to diabetes control. Others thought they would simply select healthier, more compliant patients to make their jobs easier.
Suddenly, a stately gentleman stood up and the room fell silent. I recognized him as one of the most distinguished faculty members at my medical school, a legend that physicians across the state consulted on their most difficult cases.
“What on earth are we teaching these young doctors?” he asked, exasperated.
He stressed that a physician’s responsibilities — to avidly manage diabetes or blood pressure, to promptly remove a urinary catheter, to ensure patient compliance with medications — come not from incentives, but from a sacred duty we assume upon entering the profession. Overemphasizing the former while underemphasizing the latter, he argued, does a disservice to the medical profession and to our patients.
His words struck me because they were so at odds with the language of recent discussions I’d had on quality improvement. I’ve been taught that behavioral economics tells us much about how individuals consciously or subconsciously respond to incentives. If we are able to align incentives to promote safer, higher quality care, then that’s what we’ll get.
But so far, evidence on pay-for-performance incentives has been mixed at best. While incentives can help change simple behaviors and improve productivity of rote tasks, they may actually reduce creativity and dull motivation for the complex tasks and broad thinking required in medicine. Furthermore, incentivizing certain behaviors can sap time and attention away from those not measured. And many aspects of medical care that are evaluated by quality and efficiency metrics — like reducing waits in emergency rooms or shortening hospital stays — are outside an individual doctor’s control.
Obamacare battle moves to college campuses
There will be girls. There will be beer. There will beCornhole. And someone will be dressed in the creepiest Uncle Sam costume you’ve ever seen.
Welcome to the strange new front in the war over Obamacare.
Welcome to the strange new front in the war over Obamacare.
As the Republican dream of repealing President Barack Obama’s health care law in Congress crumbles, the fight over the law’s future shifts from Washington to college campuses, where the new challenge for Obamacare proponents lies in convincing young people to sign up for coverage mandated by the law.
The period to enroll in health insurance exchanges established under the 2010 law begins Oct. 1, which will mark the start of a race to urge Americans to participate. The health exchanges rely heavily on young, healthy Americans who will subsidize the sick and elderly within the pools. Without the healthy, the exchanges could be unsustainable. The Obama administration is devoting millions of public dollars to promote the exchanges, but many conservative groups are actively working to convince people not to join.
That’s where Creepy Uncle Sam comes in.
Generation Opportunity , a Virginia-based group that is part of a coalition of right-leaning organizations with financial ties to billionaire businessmen and political activists Charles and David Koch, will launch a six-figure campaign aimed at convincing young people to “opt-out” of the Obamacare exchanges. Later this month, the group will begin a tour of 20 college campuses, where they plan to set up shop alongside pro-Obamacare activists such as Enroll America who are working to sign people up for the insurance exchanges.
Medicine’s Search for Meaning
By DAVID BORNSTEIN
Every day, we are reminded that the health care system is in crisis. We are going bankrupt. There are too many lawsuits. We practice defensive medicine. We restrict access. But surveys of doctors indicate a problem that penetrates much deeper than this. Today, almost 50 percent of doctors report symptoms of burnout — emotional exhaustion, low sense of accomplishment, detachment.
Medicine is facing a crisis, but it’s not just about money; it’s about meaning.
We often think of medicine as a science, and many doctors do come to think of themselves as technicians. But healing involves far more than knowledge and skill. The process by which a doctor helps a patient accept, recover from, adapt to, or endure a serious illness is full of nuance and mystery. I was often moved by how much my father-in-law — an actor who died from a form of leukemia — drew comfort and even inspiration from the relationship he had with his hematologist (who requested a Shakespeare recitation at each visit).
Great doctors don’t just diagnose diseases, prescribe medications and treat patients; they bring the full spectrum of their human capabilities to the compassionate care of others. That is why doctors, upon entering the medical profession, speak noble words like the Declaration of Geneva (“I solemnly pledge to consecrate my life to the service of humanity…”) or the Oath of Maimonides (“May I see in all who suffer only the fellow human being.”)
Yet by then, considerable damage has already been done. Nearly half of medical students become burned out during their training. Medical education has been characterized as an abusive and neglectful family system. It places unrealistic expectations on students, keeps them sleep-deprived, overstressed, and in a state of fear of making mistakes, and sends the message that doubts or grief should be kept to oneself. While the training formally espouses the ethics of empathy, compassion and altruism, doctors and researchers say that the socialization process — the “hidden curriculum” — teaches something very different: stay detached, objective, even a little cynical. Five out of six doctors say that medicine is in decline and close to 60 percent would not recommend it as a career for their children (pdf)
Yet by then, considerable damage has already been done. Nearly half of medical students become burned out during their training. Medical education has been characterized as an abusive and neglectful family system. It places unrealistic expectations on students, keeps them sleep-deprived, overstressed, and in a state of fear of making mistakes, and sends the message that doubts or grief should be kept to oneself. While the training formally espouses the ethics of empathy, compassion and altruism, doctors and researchers say that the socialization process — the “hidden curriculum” — teaches something very different: stay detached, objective, even a little cynical. Five out of six doctors say that medicine is in decline and close to 60 percent would not recommend it as a career for their children (pdf)
World War O
By GAIL COLLINS
The war against Obamacare: All the rationality of a Justin Bieber fan riot, and all the restraint of “Saw VI.”
On Wednesday, leaders of the House of Representatives announced their plans for a 42nd and 43rd vote to thwart the new health care reform law. If they don’t get their way, they’re threatening to defund the government and crack the debt ceiling.
“The law is a train wreck,” said Speaker John Boehner. The majority leader, Eric Cantor, said someone had to protect middle-class families from “its horrific effects.”
The arrival of Obamacare is worse than an invasion of giant zombies swinging nuclear-tipped crocodiles! Yet it lives! If only we lived in a country where citizens had the power to turn things around by voting lawmakers out of office. Like Uruguay or Latvia.
Seriously, people, why do you think the Republicans have gone so completely lunatic when it comes to this issue? Why do they behave as if, once the health law begins to roll out, it will be cemented in place like an amendment to the Constitution?
True, it would be a pain to repeal the whole thing if it doesn’t work out. But not a pain sufficient to wreak havoc on the global economy like, say, refusing to raise the debt ceiling. Senator Ted Cruz of Texas has been leading the push to shut down the government unless Congress repeals Obamacare. But have you ever heard him vow that if Congress doesn’t repeal Obamacare there will be ... elections and then a new Congress that will repeal Obamacare?
Actually, Ted Cruz has an answer for this. Once the law goes into effect, he told the Web site The Daily Caller, the public will be overwhelmed by its sugary sweetness — “hooked on the subsidies.” It’s the duty of Congress to take it back before people can taste it, just the way New York Mayor Michael Bloomberg tried to whisk away high-calorie Big Gulps.
So, the message is clear. The new health care law is going to be terrible, wreaking havoc on American families, ruining their lives. And they are going to love it so much they will never have the self-control necessary to give it up.
(This is a link to a You Tube video - well worth the 8 minutes it takes to view it. Chock full of facts
-SPC
'This is the line in the sand,' House Republicans say
House Speaker John A. Boehner will link a repeal of Obama's healthcare overhaul to a bill preventing a federal shutdown.
By Lisa Mascaro
6:26 PM PDT, September 18, 2013
| advertisement |
WASHINGTON — House Republicans united Wednesday around a plan to use the threat of a government shutdown as leverage to repeal President Obama's healthcare law, confident the American people are on their side.
House Speaker John A. Boehner (R-Ohio) yielded to his right flank by agreeing to attach the healthcare law repeal to a must-pass bill to keep the government funded past Sept. 30. A vote is expected Friday on a bill that would allow the government to stay open for the next few months.
The measure is all but certain to pass the Republican-led House, but faces rejection in the Senate, where the Democratic majority has shown little interest in undoing Obama's signature domestic achievement.
Without a resolution by Oct. 1, the start of the new federal fiscal year, the government will run out of money to keep federal workers on the job and provide basic services.
Boehner and his leadership team had tried to avoid a prolonged battle over government funding, but the speaker saw no other option after the most conservative House members revolted last week.
"Every member in this room is for defunding Obamacare," Boehner told his colleagues in a private meeting in the Capitol basement, according to a source in the room. "We're going to send it over to the Senate, so our conservative allies over there can continue the fight."
Top Republicans worry the party will be blamed if government services are interrupted, much the way the party suffered during the last shutdowns in the mid-1990s. They were hoping to hold off the fight over repealing the healthcare law until next month, when Obama may be forced to bargain in exchange for the administration's request to raise the debt limit to borrow money to avoid defaulting on the nation's bills.
But many rank-and-file Republicans believe stopping the healthcare law is their constituents' top priority.
"We're doing what the American people are asking us to do," said third-term Rep. Marlin Stutzman (R-Ind.). "I think now is the time. You take the best opportunity that you have."
Rep. Tom Graves (R-Ga.), among those leading the fight, said, "I think over the next 12 days there's going to be a strong argument from the American people saying this is the path forward."
Polls show more Americans oppose the law, the Affordable Care Act, than support it, even as the online health insurance marketplaces are set to open Oct. 1. Obama on Wednesday asked the Business Roundtable, an organization of top business leaders, to use its influence to encourage lawmakers to "not promise apocalypse every three months."
Maine Medicaid debate rolls on in battle of oversized checks
LEWISTON – Gov. Paul LePage came to Central Maine Medical Center on Wednesday to present a $43 million check to the hospital from the state of Maine.
“Uncle Sam” showed up to present a $1.05 billion check to LePage.
“Uncle Sam,” liberal activist Paul Nickerson of Lewiston, wore a costume as part of a stunt that threw a temporary wrench into the governor’s publicity campaign: the presentation of oversized checks – “Publisher's-Clearinghouse”-style LePage told the Sun Journal in Lewiston – to Maine’s hospitals.
LePage has repeatedly said that a policy and political priority is repaying the state’s $183 million share of a $490 million Medicaid debt to Maine’s 39 hospitals. On Wednesday, the governor went about the business of making good on his word.
However, the governor’s victory tour was disrupted by a political and policy priority of Democrats: the expansion of Medicaid, the public health insurance program for the poor, through the federal Affordable Care Act.
As LePage presented the oversized check to officials at Central Maine Medical Center, Nickerson, an activist from the Maine People’s Alliance, brought the check to LePage. The fake check was from the federal government – a reference to the “federal dollars” that Democratic lawmakers and activists say LePage is forgoing through his resistance to expanding Medicaid to more than 60,000 Mainers.
Democrats blast LePage’s opposition to Medicaid expansion; GOP says new bill to broaden eligibility will fail
Posted Sept. 17, 2013, at 5:35 p.m.
AUGUSTA, Maine — Democrats on Tuesday said they’d introduce a new bill to expand Medicaid to cover more than 70,000 Mainers and that the political wind is at their backs to override an inevitable veto by Gov. Paul LePage.
“We feel confident that the momentum is going in the right direction,” said House Speaker Mark Eves, D-North Berwick, at a news conference Tuesday in the State House. Eves and Assistant Senate Majority Leader Anne Haskell, D-Portland, argued fiercely for the benefits of Medicaid expansion. They called on the governor to “stop making excuses to deny and delay health care.”
Under the federal Affordable Care Act, also known as “Obamacare,” the federal government would cover 100 percent of the cost to expand Medicaid for three years before incrementally decreasing the federal contribution to 90 percent. Expansion would cover roughly 50,000 single adults without children with incomes up to 133 percent of the federal poverty threshold, and prevent about 25,000 Mainers from losing coverage on Jan. 1 as a result of the state not accepting the federal dollars.
In May, LePage vetoed a bill that linked Medicaid expansion to repaying Maine’s outstanding Medicaid debt to hospitals. The governor then vetoed legislative Democrats’ second Medicaidexpansion bill, LD 1066, in June. The law had passed with majorities in the Maine House and Senate but amid strong pressure from LePage and GOP legislative leaders, Democrats weren’t able to muster enough Republican support to override the governor’s veto.
Eves, citing internal polling numbers, said public support for the expansion is building and that Democrats would be able to gather the political muscle on both sides of the aisle to override a veto.
House Minority Leader Kenneth Fredette, R-Newport, who opposes the bill, took that statement in stride.
“They said that last year,” he said in an interview.
The question of Medicaid expansion likely will be a flashpoint in the second regular session of the Legislature this winter, leading into the elections next fall, when every seat in the House and Senate, plus the governorship, will be up for grabs.
Republicans are painting the expansion as reckless spending and a burden on taxpayers and say it will push disabled and elderly Mainers to the “back of the line” by focusing on the young and poor. Democrats frame expansion as a moral obligation to provide medical care to those who can’t afford it otherwise. Both sides are using the argument as a political tool to beat up on partisan opponents.
“Medicaid expansion is being brought to us by the same liberal big-spenders who gave us our hospital debt and our annual welfare deficits,” said Assistant House Republican Leader Alex Willette, R-Mapleton, in a prepared statement. “Their welfare spending spree needs to stop. If we’ve learned anything over the past decade or two, it’s that Medicaid is already the costliest, most out-of-control program in state government.”
LEWSITON, Maine — Like a winner of the Publishers Clearing House sweepstakes, Peter Chalke, president and CEO of Central Maine Medical Center, accepted an oversized check for more than $38 million.
The check was handed over by Gov. Paul LePage, a symbolic gesture representing the hospital’s share of more than $490 million of combined state and federal MaineCare debt paid off to almost 40 hospitals statewide on Wednesday.
“I’d like to thank the governor for fulfilling his promise,” to pay down the old debt, Chalke said to the crowd of hospital employees and reporters in the hospital’s main lobby.
LePage made paying back Maine’s hospitals a key legislative goal in the first session of the 126th Legislature. It was a hard-fought victory, but by the end of the session in June, the hospitals were on track to see the debt paid.
The state’s payment of more than $183 million triggered the federal government to pay its share of Medicaid — operated under the name “MaineCare” in the Pine Tree State — which amounted to nearly $307 million.
The Republican governor celebrated his victory accordingly, and promised that as long as he is governor, the state will never owe the hospitals money again.
“This is a promise I made, and it’s a promise I’m keeping,” LePage said. “As governor, It’s embarrassing to watch your hospitals lay people off because you’re not paying the bills. … I’m so proud, and if I never accomplish anything else in life, we paid the hospitals.”
The buoyant atmosphere was interrupted, however, by members of the liberal Maine People’s Alliance, which brought its fight to accept federal dollars for an expansion of Medicaid — a key provision of President Barack Obama’s signature health care reform law — to LePage’s party.
One volunteer, dressed as Uncle Sam, posed in front of LePage’s podium with his own giant check representing the $1.05 billion Maine would receive over three years from Washington if it accepted Medicaid expansion, which the governor vetoed earlier this year.
The expansion would provide publicly funded health care to roughly 70,000 Mainers who make less than 133 percent of the federal poverty threshold, including roughly 25,000 who will lose that coverage on Jan. 1 as a result of not expanding eligibility.
Employers Trim Health Costs By Cutting Coverage For Spouses
When UPS told workers that it would no longer offer health coverage for spouses who had their own job-based insurance, it caused a big stir. But the shipping giant has plenty of company.
So many employers are trying to cut back on health coverage for spouses that it has become a trend. The practice began well before the Affordable Care Act passed, and the connection to the law, in some cases, isn't that direct.
About 12 percent of employers have this provision in their policies, says Tracy Watts, who heads the health care reform team at Mercer, a benefits consulting firm.
Mercer surveyed employers who have some sort of restriction on health coverage of spouses, and found that about half of those employers, or 6 percent, have imposed a surcharge for spouses who could get coverage at their own jobs.
"The other 6 percent exclude spouses who have coverage elsewhere," Watts says. That's the approach UPS is taking.
So is the University of Virginia. Susan Carkeek, the university's head of human resources, says the decision was mostly about simple arithmetic.
"When medical expenses go up, which they have for us, then we have two choices: We can either increase premiums, or we can reduce what we pay out in the way of benefits," Carkeek says.
Benefit Shock? Consumers Will Be Surrpised By What They Find on the New "Obamacare" Health Insurance Exchanges
Will we have rate shock?
It looks to me like consumers will have a choice when they get to look at the health plans available on the new "Obamacare" health insurance exchanges––rate shock or benefit shock.
While there has been lots of focus on the issue of rate shock, I will suggest that just as big an issue may well be benefit shock—that consumers will look at what they will be getting for their premium payments and that they will be surprised at what their out-of-pocket costs will be and before they get anything.
The following chart was prepared by Covered California, the state-run California exchange. This chart does not include specific California plan premiums. What it does show is the net of subsidy cost a single person would pay at the various income points for the second lowest cost Silver plan, as well as the deductibles and co-pays they can expect to see from the standard Silver plan.
Lower income people are eligible for reduced deductibles and co-pays and that is reflected here. While this was prepared for California residents, the reductions in deductibles and co-pays for lower-income people, as well as the net of subsidy premium costs for the second lowest cost Silver plan, are the same in all of the states.
While the benefit plan structures may vary a bit from state to state, this gives us a pretty good idea of what consumers can expect in all of the states (click on chart to enlarge).
It looks to me like consumers will have a choice when they get to look at the health plans available on the new "Obamacare" health insurance exchanges––rate shock or benefit shock.
While there has been lots of focus on the issue of rate shock, I will suggest that just as big an issue may well be benefit shock—that consumers will look at what they will be getting for their premium payments and that they will be surprised at what their out-of-pocket costs will be and before they get anything.
The following chart was prepared by Covered California, the state-run California exchange. This chart does not include specific California plan premiums. What it does show is the net of subsidy cost a single person would pay at the various income points for the second lowest cost Silver plan, as well as the deductibles and co-pays they can expect to see from the standard Silver plan.
Lower income people are eligible for reduced deductibles and co-pays and that is reflected here. While this was prepared for California residents, the reductions in deductibles and co-pays for lower-income people, as well as the net of subsidy premium costs for the second lowest cost Silver plan, are the same in all of the states.
While the benefit plan structures may vary a bit from state to state, this gives us a pretty good idea of what consumers can expect in all of the states (click on chart to enlarge).
No comments:
Post a Comment