Obama Says Americans Can Keep Their Damn Insurance
WASHINGTON (The Borowitz Report)—Faced with a barrage of new questions about the Affordable Care Act, President Obama cut short a White House press conference today, telling the stunned press corps, “You know what? Everybody can keep their damn insurance.”
Glaring at the reporters, the President continued, “You heard me. If your insurance is crappy, then you just go ahead and keep it—the crappier, the better. Let’s pretend this whole thing never happened.”
A vein in his forehead visibly throbbing, the President added, “You know, I really wish I hadn’t spent the last three years of my life on this thing. I should’ve just gone around invading countries for no reason. That would’ve made everybody happy. Well, live and learn.”
As the reporters averted their eyes from the President, many of them looking awkwardly at their shoes, he concluded his remarks: “All those people out there who want to repeal Obamacare? Well, guess what: I’ll make their day and repeal it myself. Really, it’s my pleasure. But I swear that this is the last time I try to do something nice for anybody.”
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Insurer Cuts Medicare Plan Doctors — Patients Left In Lurch
By Miranda Rosenberg
The Hartford Courant, Nov. 15, 2013
While most Americans have been focusing on the recent problems surrounding the rollout of the new healthcare.gov website, another health insurance story has been largely overlooked. Last month, just as Medicare's open enrollment period was set to begin, UnitedHealthcare dropped thousands of physicians nation-wide, including thousands in Connecticut, from its Medicare Advantage programs without an explanation.
Who are these physicians and why were they dismissed from United's Medicare Advantage plans en masse without being dropped from any of United's commercial programs? Company executives remain notably tight-lipped despite public inquiries from physicians, newspapers and lawmakers. Connecticut's five-member congressional delegation and attorney general have become involved. Based on the information available, it is clear that the company's end goal is to unload its sickest, costliest patients.
Typically insurance companies entice patients to join by including large networks of highly regarded providers. United's doctor drop, however, accomplished almost the exact opposite, wiping out entire services in some areas and removing the most talented physicians from the network.
Many of the physicians in question carry United's premium designation, the company's official recognition of excellence in "quality of care and cost efficiency." In Florida, United dropped an estimated 45 percent of its Medicare Advantage provider network, including the nationally renowned Moffitt Cancer Center in Tampa. United also dropped the only nephrologists in Connecticut's greater New Britain area as well as the entire Yale Medical Group, which represents more than 1,000 physicians on the faculty of the Yale School of Medicine. It is not only specialists that United is targeting — more than a third of the 2,250 physicians dropped in Connecticut are primary care providers.
What does this mean for patients? Thousands of senior citizens now must either find new in-network physicians, enroll with a different company's Medicare Advantage plan, or go back into traditional Medicare before open enrollment ends on December 7th.
Finding a new doctor can be challenging because many doctors, especially primary care physicians, either do not accept new patients or have long waiting times for new patient appointments. Many of our nation's seniors have complicated, ongoing health problems and complex medical histories — they cannot afford to wait months to see a new doctor. Their current physicians are familiar with their health needs; abruptly changing doctors only serves to disrupt their care.
The healthiest patients who rarely need medical care are more profitable for United; these patients may not have developed strong physician-patient relationships. Patients undergoing costly, long-term treatments such as dialysis and chemotherapy, however, are more likely to choose to leave United's Medicare Advantage programs in order to stay in the care of their current physicians.
http://www.pnhp.org/print/news/2013/november/insurer-cuts-medicare-plan-doctors-—-patients-left-in-lurch
By Miranda Rosenberg
The Hartford Courant, Nov. 15, 2013
While most Americans have been focusing on the recent problems surrounding the rollout of the new healthcare.gov website, another health insurance story has been largely overlooked. Last month, just as Medicare's open enrollment period was set to begin, UnitedHealthcare dropped thousands of physicians nation-wide, including thousands in Connecticut, from its Medicare Advantage programs without an explanation.
Who are these physicians and why were they dismissed from United's Medicare Advantage plans en masse without being dropped from any of United's commercial programs? Company executives remain notably tight-lipped despite public inquiries from physicians, newspapers and lawmakers. Connecticut's five-member congressional delegation and attorney general have become involved. Based on the information available, it is clear that the company's end goal is to unload its sickest, costliest patients.
Typically insurance companies entice patients to join by including large networks of highly regarded providers. United's doctor drop, however, accomplished almost the exact opposite, wiping out entire services in some areas and removing the most talented physicians from the network.
Many of the physicians in question carry United's premium designation, the company's official recognition of excellence in "quality of care and cost efficiency." In Florida, United dropped an estimated 45 percent of its Medicare Advantage provider network, including the nationally renowned Moffitt Cancer Center in Tampa. United also dropped the only nephrologists in Connecticut's greater New Britain area as well as the entire Yale Medical Group, which represents more than 1,000 physicians on the faculty of the Yale School of Medicine. It is not only specialists that United is targeting — more than a third of the 2,250 physicians dropped in Connecticut are primary care providers.
What does this mean for patients? Thousands of senior citizens now must either find new in-network physicians, enroll with a different company's Medicare Advantage plan, or go back into traditional Medicare before open enrollment ends on December 7th.
Finding a new doctor can be challenging because many doctors, especially primary care physicians, either do not accept new patients or have long waiting times for new patient appointments. Many of our nation's seniors have complicated, ongoing health problems and complex medical histories — they cannot afford to wait months to see a new doctor. Their current physicians are familiar with their health needs; abruptly changing doctors only serves to disrupt their care.
The healthiest patients who rarely need medical care are more profitable for United; these patients may not have developed strong physician-patient relationships. Patients undergoing costly, long-term treatments such as dialysis and chemotherapy, however, are more likely to choose to leave United's Medicare Advantage programs in order to stay in the care of their current physicians.
http://www.pnhp.org/print/news/2013/november/insurer-cuts-medicare-plan-doctors-—-patients-left-in-lurch
The Hartford Courant, Nov. 15, 2013
While most Americans have been focusing on the recent problems surrounding the rollout of the new healthcare.gov website, another health insurance story has been largely overlooked. Last month, just as Medicare's open enrollment period was set to begin, UnitedHealthcare dropped thousands of physicians nation-wide, including thousands in Connecticut, from its Medicare Advantage programs without an explanation.
Who are these physicians and why were they dismissed from United's Medicare Advantage plans en masse without being dropped from any of United's commercial programs? Company executives remain notably tight-lipped despite public inquiries from physicians, newspapers and lawmakers. Connecticut's five-member congressional delegation and attorney general have become involved. Based on the information available, it is clear that the company's end goal is to unload its sickest, costliest patients.
Typically insurance companies entice patients to join by including large networks of highly regarded providers. United's doctor drop, however, accomplished almost the exact opposite, wiping out entire services in some areas and removing the most talented physicians from the network.
Many of the physicians in question carry United's premium designation, the company's official recognition of excellence in "quality of care and cost efficiency." In Florida, United dropped an estimated 45 percent of its Medicare Advantage provider network, including the nationally renowned Moffitt Cancer Center in Tampa. United also dropped the only nephrologists in Connecticut's greater New Britain area as well as the entire Yale Medical Group, which represents more than 1,000 physicians on the faculty of the Yale School of Medicine. It is not only specialists that United is targeting — more than a third of the 2,250 physicians dropped in Connecticut are primary care providers.
What does this mean for patients? Thousands of senior citizens now must either find new in-network physicians, enroll with a different company's Medicare Advantage plan, or go back into traditional Medicare before open enrollment ends on December 7th.
Finding a new doctor can be challenging because many doctors, especially primary care physicians, either do not accept new patients or have long waiting times for new patient appointments. Many of our nation's seniors have complicated, ongoing health problems and complex medical histories — they cannot afford to wait months to see a new doctor. Their current physicians are familiar with their health needs; abruptly changing doctors only serves to disrupt their care.
The healthiest patients who rarely need medical care are more profitable for United; these patients may not have developed strong physician-patient relationships. Patients undergoing costly, long-term treatments such as dialysis and chemotherapy, however, are more likely to choose to leave United's Medicare Advantage programs in order to stay in the care of their current physicians.
http://www.pnhp.org/print/news/2013/november/insurer-cuts-medicare-plan-doctors-—-patients-left-in-lurch
Risk Calculator for Cholesterol Appears Flawed
By GINA KOLATA
Last week, the nation’s leading heart organizations released a sweeping new set of guidelines for lowering cholesterol, along with an online calculator meant to help doctors assess risks and treatment options. But, in a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs.
The apparent problem prompted one leading cardiologist, a past president of the American College of Cardiology, to call on Sunday for a halt to the implementation of the new guidelines.
“It’s stunning,” said the cardiologist, Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic. “We need a pause to further evaluate this approach before it is implemented on a widespread basis.”
The controversy set off turmoil at the annual meeting of the American Heart Association, which started this weekend in Dallas. After an emergency session on Saturday night, the two organizations that published the guidelines — the American Heart Association and the American College of Cardiology — said that while the calculator was not perfect, it was a major step forward, and that the guidelines already say patients and doctors should discuss treatment options rather than blindly follow a calculator.
Dr. Sidney Smith, the executive chairman of the guideline committee, said the associations would examine the flaws found in the calculator and determine if changes were needed. “We need to see if the concerns raised are substantive,” he said in a telephone interview on Sunday. “Do there need to be changes?”
The problems were identified by two Harvard Medical School professors whose findings will be published Tuesday in a commentary in The Lancet, a major medical journal. The professors, Dr. Paul M. Ridker and Dr. Nancy Cook, had pointed out the problems a year earlier when the National Institutes of Health’s National Heart, Lung, and Blood Institute, which originally was developing the guidelines, sent a draft to each professor independently to review. Both reported back that the calculator was not working among the populations it was tested on by the guideline makers.
Lesson Is Seen in Failure of 1989 Law on Medicare
By CARL HULSE
WASHINGTON — Angry Americans voice outrage at being asked to pay more for health coverage. Lawmakers and the White House say the public just doesn’t appreciate the benefits of the new health law. Opponents clamor for repeal before the program fully kicks in.
The year was 1989, and the law was the Medicare Catastrophic Coverage Act, which was supposed to protect older Americans from bankruptcy due to medical bills. Instead it became a catastrophe for Democratic and Republican lawmakers, who learned the hard way that many older Americans did not want to be helped in that particular way.
Seventeen months after President Ronald Reagan signed the measure with Rose Garden fanfare, a series of miscalculations and missteps in passing the law became painfully evident, and it was unceremoniously stricken from the books by lawmakers who could not see its demise come quickly enough.
The tortured history of the catastrophic-care law is a cautionary tale in the context of the struggle over the new health law, the Affordable Care Act. It illustrates the political and policy hazards of presenting sweeping health system changes to consumers who might not be prepared for them. And it provides a rare example of lawmakers who were willing to jettison a big piece of social policy legislation when the political risks became too grave.
“It has often been said that if you get an entitlement on the books, you can never get rid of it,” said Bill Archer, who pushed to repeal the 1988 law as a senior Republican, from Texas, on the House Ways and Means Committee. “That is an example of a time we did get rid of it.”
Backers of the Affordable Care Act say comparisons to the catastrophic-care debacle are flawed. They say that the new law fills a major health insurance void and that despite its current problems it will never meet the same fate as that undertaking in 1988.
“It is enormously different,” said Ron Pollack, the executive director of Families USA, a liberal consumer advocacy group, who supported both the new health law and the catastrophic-care program. “You had a benefit totally paid for by 40 percent of the Medicare beneficiaries, who overwhelmingly thought there was not a benefit there for them. It is understandable they were upset.”
Others involved with the passage and repeal of the Medicare Catastrophic Coverage Act see clear parallels with the current situation, in which a very vocal segment that views itself as harmed by the new law has joined with highly organized political operations to rally opposition to it.
“When I saw this massive thing, I said, ‘Boy, if this is anything like catastrophic, they are going to be in trouble,’ ” said Brian J. Donnelly, who led the 1989 repeal effort as a Massachusetts Democrat on the Ways and Means Committee. “It is a very good analogy.”
The Shame of American Health Care
By THE EDITORIAL BOARD
Even as Americans struggle with the changes required by health care reform, an international survey released last week by the Commonwealth Fund, a research organization, shows why change is so necessary.
The report found that by virtually all measures of cost, access to care and ease of dealing with insurance problems, Americans fared poorly compared with people in other advanced countries. The survey covered 20,000 adults in the United States and 10 other industrial nations — Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and Britain, all of which put in place universal or near-universal health coverage decades ago. The United States spends far more than any of these countries on a per capita basis and as a percent of the national economy.
For that, it gets meager results. Some 37 percent of American adults went without recommended care, did not see a doctor when sick or failed to fill prescriptions in the past year because of costs, compared with 4 percent in Britain and 6 percent in Sweden. Nearly a quarter of American adults could not pay medical bills or had serious problems paying them compared with less than 13 percent in France and 7 percent or less in five other countries. Even Americans who were insured for the entire year were more likely than adults abroad to forgo care because of costs, an indication of how skimpy some insurance policies are.
When Americans got sick, they had to wait longer than people in most of the other countries to get help. Fewer than half were able to get same-day or next-day appointments with a doctor or nurse; one in four had to wait six days or longer. (Only Canada fared worse on both counts.) But Americans got quicker access to specialists than adults in all but two other countries.
The complexity of the American insurance system is also an issue. Some 32 percent of consumers spent a lot of time on insurance paperwork or in disputes with their insurer over denials of payment for services they thought were covered.
The Bottom Line? Often the Drug Companies’
Marcia Angell is a senior lecturer in social medicine at Harvard Medical School. She is the former editor in chief of The New England Journal of Medicine.
Guidelines for medical treatment promulgated by medical specialty societies greatly influence doctors and public attitudes. The guidelines on cardiovascular risk released last week, if followed, would result in a doubling of the number of Americans taking statin drugs to prevent heart attacks and strokes.
But, as is often the case with specialty societies, the groups behind these new proposals, the American College of Cardiology and the American Heart Association, are heavily dependent on financial support by drug companies to support their meetings.
Moreover, members of their guideline committees often work as paid consultants or speakers for companies whose sales will be affected by the guidelines. About half the members of the committee that wrote the cholesterol guidelines had financial ties to the makers of statins, The Boston Globe reported.
In 2005, a Food and Drug Administration advisory committee said it was O.K. to keep arthritis drugs like Vioxx on the market, despite evidence that their use increased the risk of heart attacks and strokes. But it was later revealed that 10 of the 32 members of the committee had ties to the companies that made the drugs. If their votes were discounted the decision would have gone the other way.
Conflicts of interest are not just a matter of form; they do matter.
New free clinic in Blue Hill to serve uninsured Mainers
Posted Nov. 17, 2013, at 3:26 p.m.
BLUE HILL, Maine — In her last years running Med Now, a private clinic in Ellsworth, Jane Garfield said she saw an increase in the number of patients coming in without insurance.
“The more I saw patients, the more I saw people with no insurance, and I saw that there was no good place providing care to people without insurance,” she said Wednesday.
At one point, she treated a young boy with severe bronchitis whose father was a lobsterman and whose mother didn’t work.
“It was a question of whether or not he would need to be hospitalized,” Garfield said of the child. “The [mother] was in tears because she had no money.”
Garfield was able to treat the child without sending him to the hospital, knowing the family would be paying off medical bills for years to come if she couldn’t.
Her clinic closed in 2012, in part because they were frequently treating patients with no insurance.
Now Garfield is working with other health care professionals in the area to open Peninsula Free Health Services for the uninsured. This free clinic will operate out the of the Congregational Church in Blue Hill once a week on a first-come, first-serve basis providing consultations, prescriptions and referrals as needed.
The new clinic comes at an uncertain time in the health care industry. The Affordable Care Act, which is in the midst of a tumultuous rollout, is meant to make clinics like this one obsolete by making affordable insurance available to everyone.
But the founders of Peninsula Free Health Services feel certain that some will be left behind, at least for the next few years.
“There is a glaring gap in Maine,” said Lynn Cheney, a certified Affordable Care Act navigator. “There are people who can’t get get on Medicaid, and they can’t qualify for affordable care. About 25,000 people in Maine fall into this hole.”
Cheney, a member of the Peninsula Free Health Services board, explained that the Affordable Care Act was designed with the assumption that states would take up the federal government’s offer to expand Medicaid to individuals who earn up to 133 percent of the poverty level. Maine, however, did not opt to expand, so only people who fall below the poverty line qualify for Medicaid. Those with incomes that put them at 133 percent of the poverty line and above, qualify for financial help under the Affordable Care Act. Mainers who hover just above poverty are excluded from federal health care assistance programs.
Affordable Care Act: No tax refund, no penalty?
“How does the government plan to collect the penalty if you don’t have a tax refund?”
South Dakota John
Dear South Dakota John,
You have raised a great question that has a very interesting answer. This tax or penalty is unlike any other that you are required to pay. I’ll call it a penalty, though the Supreme Court’s decision on the individual mandate makes it clear that it is a tax.
First, even if you have no tax refund, the penalty/tax will apply. When you fill out your forms, you will calculate your tax for not having health insurance. So, it will show up in your bottom line – how much you owe or how much you have for a refund. The law states, and I quote: “Any penalty imposed by this section with respect to any month shall be included with a taxpayer’s return . . .” You can read the certified copy of the health reform law yourself, if you are interested. (See page 248 – 249 for the parts I’m quoting.)
So far, it’s just like any other tax you would pay. Then, it takes a twist. For any other tax that you pay, the IRS can charge you penalties and even put a lien on your house or garnish your wages. The Affordable Care Act specifically prohibits any liens or levies for this particular tax. The IRS also cannot charge you a penalty for not paying your Affordable Care Act penalty.
Many have concluded that the penalty is toothless. Insurers have worried that the penalty is too low to motivate people to buy health insurance. Most people cite the $95 figure as the penalty, but that is the minimum. The maximum is up to 1% of adjusted gross income, a mere pittance compared to the cost of health insurance. Why not pay the (much cheaper) penalty – especially if the IRS can’t do much to get it from you?
The real reason to buy health insurance is to avoid having to sell your house, your car, and all that you own and love (think retirement accounts, college funds, rainy day/mad money) if you or a family member became seriously ill.
In the future, there may be other reasons to avoid having a bill pending at the IRS. The IRS currently cannot report your unpaid bill to credit bureaus, but the GAO is reportedly investigating ways to make this happen. This means your credit score would be affected.
In the meantime, make your decision about your health insurance based upon your need for protection from creditors. The Affordable Care Act penalty is a side effect of your decision.
Parents, children need continued coverage of Medicaid
Posted Nov. 18, 2013, at 10:43 a.m.
Thank you to Sen. Roger Katz, R-Augusta, and other thoughtful moderates for working doggedly to help Maine find a way to take the tremendous opportunity to accept the federal dollars already allocated and intended for Maine people to provide health care coverage for Maine’s many uninsured.
Katz raises issues worthy of honest policy discussion. But I ask less-than-moderate others to stop stigmatizing whole populations of people for political gain and to agree not to forfeit the health coverage of 69,500 Maine people and the more than $250 million in federal funds per year for Maine’s health care providers and the economy.
If enough lawmakers are able to reach agreement, Maine will receive 100 percent federal funding to cover about 55,000 adults with Medicaid from Jan. 1, 2014 (or as soon as enacted) through 2016, then ramping slowly down to 90 percent federal funding in 2020. Agreement would also prevent another 14,500 parents raising children at home with income between 100 percent and 138 percent of the poverty level ($19,530 and $25,951 for a family of three) who we now cover from being cut off Medicaid on Jan. 1. For this group, Maine would receive the regular matching rate of 61.5 percent federal dollars.
These parents are the group for whom Gov. Paul LePage wants a “better deal.” But the health reform law clearly states that only people newly eligible in January receive the 100 percent federal funding. We were already covering this group before health reform passed and will not be funded as if the state doesn’t already contribute to them. In this sense, we are being offered the same deal as every other state that was already covering parents at this level — including every other New England state except New Hampshire.
At the Maine Children’s Alliance, we are particularly worried about these 14,500 Maine parents raising children on the edge of the poverty line who are scheduled to be cut off Medicaid on Jan. 1. (Some may receive “transitional” Medicaid for four, six or 12 months following their termination).
Here is how it will work for them after they lose their Medicaid. Take a parent with two children earning slightly above the poverty level — $20,800 per year. Her children are covered by MaineCare, but she is scheduled to be cut off Jan. 1. If she is offered coverage at work that costs less than 9.5 percent of her income ($165 per month), she will not be eligible for a subsidy because employer coverage will be considered available to her. Because her income is below 138 percent of the poverty level (and Congress intended her to be eligible for Medicaid), she will be exempt from the mandate to sign up for coverage due to her hardship.
She will likely be uninsured because, in fact, the typical employee contribution to insurance (averaging about $92 per month) is simply not realistic for someone scraping by near the poverty level.
On the other hand, if she is not offered insurance from her employer, then she will be eligible for a subsidy to help her buy insurance on the new marketplace at healthcare.gov. She would pay about $34 per month for a “silver” plan on the marketplace — a plan that also allows her to obtain some assistance with deductibles and co-payments. But when life hovers around the poverty level, where heat, child care, transportation, food, light and housing are iffy on $1,733 per month anyway, even $34 per month is not a realistic expense. It would only be logical if she is already chronically ill and forced to pay health costs regardless. (Note that the premium adds the incentive to bring in to the marketplace only those low-income parents with chronic illnesses. This will affect the costs of everyone else on that plan.)
President Barack Obama is trying to make up for an exceedingly dumb promise with a moderately dumb compromise.
When Americans first began complaining last month that the Affordable Care Act meant the cancellation of insurance plans that didn’t meet the law’s coverage requirements, Obama responded that the new plans available under the law were better than what they lost.
That response proved to be politically costly, and Obama Thursday reversed himself, saying that insurers will now be able to offer subpar plans until the end of 2014, if state insurance regulators agree.
The trouble with that compromise is that while Obama’s earlier argument may have been tone-deaf, it was also accurate. If it was bad policy a month ago to let insurers skimp on some essential benefits, it’s still bad policy today.
So Thursday’s announcement supposedly honors the promise Obama made when the law was being debated — the pledge that anybody who likes their current plan can keep it.
Except that’s not true. Insurers have said they won’t revive many of the plans they have already canceled, especially given the logistical challenges involved so close to the start of the new policy year. Even if they do, state regulators may decide not to let them. So for an undetermined number of people, the president’s promise will remain broken.
Obamacare: So, what could go wrong next?
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| Busted website, canceled policies, lousy early enrollment numbers. And that could be just the warmup. Because the lesson of the last six weeks is that when it comes to the Obamacare rollout, if it can go wrong, it probably will. The stumble-filled debut of President Barack Obama’s health care law is drawing new attention to the other risks that have been on the radar screen of health care wonks for months. Think health insurance plans sinking under the weight of sick customers, newly insured people being stunned that they still have to spend on health care, and possibly another wave of canceled policies — right before the 2014 elections. They’re mostly worst-case scenarios, and an Obamacare recovery in the next few months could still prevent some of the biggest ones from ever happening. But health care experts are taking all of them a lot more seriously now — because at this point, why wouldn’t they? A complete list of possibilities could be overwhelming, but here are the main ones to watch:
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