The Opinion Pages | Editorial
The Phony ‘Narrow Network’ Scare
Republicans
contend that the Affordable Care Act is a failure because many of the
plans sold on the online health exchanges limit a consumer’s choice of
doctors and hospitals. Many plans do, indeed, limit choice —
deliberately so, to keep premiums down. But a vast majority of consumers
can almost always buy a plan with a broad array of doctors, hospitals
and other providers if they are willing to pay more for the policies.
The
issue is one of priorities: Is it more important to keep premiums low
or to have access to a broad array of doctors to choose from? A poll in February showed that many people, especially the previously uninsured, think lower cost is more important.
There
is no clear definition of what constitutes a “narrow network,” the term
used in public and political discourse, but there are protections built
into the Affordable Care Act and federal regulations that require all
networks to have enough doctors of various types to ensure that services
can be provided “without unreasonable delay.”
Most plans probably have the experts needed, but there are concerns
that in the hectic rollout of the health exchanges the primary emphasis
has been put on enrolling people, not on making sure that all networks
were adequate.
Any shortcomings that have emerged can be addressed with better public education and regulatory fixes.
Some
consumers have been surprised to find that their own doctor may accept
the insurance company they are using but not the particular plan they
have chosen from that insurer’s offerings. Or that a new doctor they
wanted to see, though listed as taking their plan’s insurance, was not
accepting new patients because the practice was already full.
These
problems can be solved by requiring more accurate and up-to-date
information about doctors in the plan, preferably posted on the
government’s website, not just on insurance company websites.
Some
consumers may discover after the fact that a doctor who treated them in
an emergency — a hospital anesthesiologist, for example — is not
covered by their plan. Regulators in other states might well emulate New
York’s pioneering law requiring that patients be told when an
out-of-network doctor will be treating them, and if they are not
informed, they would not have to pay more than their usual co-pays. In
that case, the insurer and the provider would fight to see who absorbs
the cost.
The
technique of using limited networks to control costs has been around
for years. It became especially useful with the passage of health care
reform, which eliminated or made illegal several other cost-control
tactics, such as refusing to insure people with pre-existing conditions.
Left Coast Rising
The
states, Justice Brandeis famously pointed out, are the laboratories of
democracy. And it’s still true. For example, one reason we knew or
should have known that Obamacare was workable was the post-2006 success
of Romneycare in Massachusetts. More recently, Kansas went all-in on
supply-side economics, slashing taxes on the affluent in the belief that
this would spark a huge boom; the boom didn’t happen, but the budget
deficit exploded, offering an object lesson to those willing to learn
from experience.
And
there’s an even bigger if less drastic experiment under way in the
opposite direction. California has long suffered from political
paralysis, with budget rules that allowed an increasingly extreme
Republican minority to hamstring a Democratic majority; when the state’s
housing bubble burst, it plunged into fiscal crisis. In 2012, however,
Democratic dominance finally became strong enough to overcome the
paralysis, and Gov. Jerry Brown was able to push through a modestly
liberal agenda of higher taxes, spending increases and a rise in the
minimum wage. California also moved enthusiastically to implement
Obamacare.
I guess we’re not in Kansas anymore. (Sorry, I couldn’t help myself.)
Needless
to say, conservatives predicted doom. A representative reaction: Daniel
J. Mitchell of the Cato Institute declared that by voting for
Proposition 30, which authorized those tax increases, “the looters and
moochers of the Golden State” (yes, they really do think they’re living
in an Ayn Rand novel) were committing “economic suicide.” Meanwhile, Avik Roy of the Manhattan Institute and Forbes claimed that California residents were about to face a “rate shock” that would more than double health insurance premiums.
What has actually happened? There is, I’m sorry to say, no sign of the promised catastrophe.
If
tax increases are causing a major flight of jobs from California, you
can’t see it in the job numbers. Employment is up 3.6 percent in the
past 18 months, compared with a national average of 2.8 percent; at this
point, California’s share of national employment, which was hit hard by
the bursting of the state’s enormous housing bubble, is back to
pre-recession levels.
On
health care, some people — basically healthy young men who were getting
inexpensive insurance on the individual market and were too affluent to
receive subsidies — did face premium increases, which we always knew
would happen. Over all, however, the costs of health reform came in
below expectations, while enrollment came in well above — more than
triple initial predictions in the San Francisco area. A recent survey by the Commonwealth Fund suggests that California has already cut the percentage of its residents without health insurance in half. What’s more, all indications are that further progress is in the pipeline, with more insurance companies entering the marketplace for next year.
And, yes, the budget is back in surplus.
Ambulance Chaser in the House
Congress’s Next Big Idea? Sue Obama
You’re a member of Congress, and everyone hates you. You’re likely to be a lawyer — the leading profession for federal legislators — and most everyone hates lawyers, with a Pew survey finding that people rank them at the very bottom in contributing something to society. Is there anything you could do to generate more contempt?
Yes — sue somebody! The speaker of the House, John Boehner, has announced that Republicans in the House are likely to file suit against President Obama. They are doing this because he delayed parts of a law, the Affordable Care Act, that they have tried to repeal more than 50 times. If they win, business owners who have been given some breathing room from providing mandatory health care would have to quickly implement the very thing that Republicans say is a job-killing bullet to the economy.
It’s head-spinning, all of it. We’ve finally reached the point where the do-nothing, delay-everything, don’t-even-allow-a-vote-on-measures-a-majority-of-Americans-favor Congress has reached its logical position. They will not legislate. But they will litigate.
“Their big idea has been to sue me,” the president said earlier this month, unable to sustain a giggle. “That’s what they’re spending time on.”
To Boehner, the stunt, brought to you by the talk radio and Fox News wacko-sphere, is no laughing matter. He says the imperial president has governed by executive order, overstepping a Congress that will not govern by any order. Obama has issued 182 executive orders in his presidency, through the end of June. The tyrant.
The sainted Ronald Reagan issued 381 executive orders. The benign Dwight Eisenhower rolled out 484 of them. And Calvin Coolidge — Silent Cal, hero of young fogies in bow ties, asleep at the presidential wheel — signed more than 1,200 executive orders. Sue ’em all, retroactively.
So far, legal experts have reacted to Boehner’s potential lawsuit with the rhetorical equivalent of guffawing until their morning coffee runs out their noses. This might include Chief Justice John Roberts, who has sniffed at another political lawsuit because the plaintiffs lacked standing — that is, someone seeking “relief for an injury that affects him in a personal and individual way,” as Roberts wrote.
Earlier this week, a federal judge appointed by George W. Bush threw out a lawsuit by Senator Ron Johnson of Wisconsin against a health care provision, saying the Tea Party Republican had failed to show how he had been personally harmed by the law.
Glimmers of healthcare politics at meeting of Western Washington docs
Tough talk from Kshama Sawant and others at annual gathering of Western Washington Physicians for a National Health Program.
By Ted Van Dyk
July 23, 2014.
The Western Washington Chapter of Physicians for a National Health Program, which advocates for a universal, comprehensive single-payer national health program, held its annual public meeting last Saturday evening at Kane Hall on the University of Washington campus. The event provided a useful snapshot of things to come in healthcare politics nationally, but also here in Washington State.
The meeting, held before a nearly full house that included numerous practicing doctors and nurses, also provided its share of surprises. Here are some highlights:
There was consensus that a single-payer plan is at least several years away and that state- rather than national-level organizing efforts to institute one would bear the most fruit over the next two years.
The Affordable Care Act (a.k.a. Obamacare) allows states, beginning in 2017, to seek exemptions from its provisions provided they present a credible alternative plan to the U.S. Secretary of Health and Human Services. The meeting’s speakers agreed that between now and 2017 lobbying efforts to enact single-payer alternatives should focus on governors and state legislators. (Such HHS approvals, Rep. Jim McDermott pointed out, would likely occur only during the administration of a President sympathetic to the idea).
There was surprising dissatisfaction expressed toward Obamacare per se. McDermott, the ranking Democrat on the House Ways and Means health subcommittee, said he was "annoyed and disappointed" that President Obama, at the outset of his administration, had refused even to consider a single-payer approach for which many organizations had worked tirelessly in prior years. Dr. Phil Caper, a former senior staff member of Sen. Ted Kennedy's health subcommittee and co-founder of a Maine group which supports a single-payer approach, commended President Obama, Michele Obama and Rep. Nancy Pelosi for their intense efforts to pass the Affordable Care Act. (See video of his talk below.) But he characterized the legislation itself as "bad public policy" because it leaves many without coverage and shifts costs inequitably among various patient groups.
Seattle City Council member Kshama Sawant also was critical of Obamacare, arguing that the administration colluded with drug and insurance companies in framing it. Sawant spoke longest and most avidly at the meeting. (See video of her talk below.) She called on committed single-payer supporters to follow the example of those who sought a $15 minimum wage in Seattle, and bring tireless pressure to bear on Democratic officeholders in particular. She derided fellow City Council members, with the exception of Nick Licata, for bending almost automatically toward special-interest and corporate agendas. She solicited support for the defeat of sitting Washington State House Speaker Frank Chopp in upcoming primary elections.
Obamacare rebates headed to thousands of consumers, employers
By CHAD TERHUNE
California health insurers owe $11.9 million in refunds to thousands of consumers and businesses under requirements of the federal healthcare law.
The rebates announced Thursday by the Obama administration are going out by Aug. 1, and they cover about 490,000 Californians who had individual and employer policies last year.
Nationwide, the annual rebates total $332 million for 6.8 million consumers. The average rebate for a California family is $39, federal data show.
Not all of an insurer's policyholders will get money back, and the amounts will vary. For instance, Anthem Blue Cross said only 15% of its customers in California would receive a refund.
The rebates are required under the Affordable Care Act when insurers fail to spend a minimum of 80% of premiums on medical care for individual and small-business customers.
For larger employers, insurers must spend at least 85% of premiums on medical expenses. Employers that self-insure are not subject to these rules.
In California, more than 70% of the $11.9 million in refunds is owed to employers. In those cases, the companies are expected to share the money with employees based on the percentage workers contribute to their annual premiums.
Anthem Blue Cross, the state's largest for-profit health insurer, said it was mailing out $3.8 million in rebates to small-business customers. The average amount per person is less than $10, Anthem said.
UnitedHealth Group Inc. will refund $1.5 million to small businesses in California while HMO giant Kaiser Permanente owes $1.4 million to individual policyholders in the state, according to federal data.
California health insurers owe $11.9 million in refunds to thousands of consumers and businesses under requirements of the federal healthcare law.
The rebates announced Thursday by the Obama administration are going out by Aug. 1, and they cover about 490,000 Californians who had individual and employer policies last year.
Nationwide, the annual rebates total $332 million for 6.8 million consumers. The average rebate for a California family is $39, federal data show.
Not all of an insurer's policyholders will get money back, and the amounts will vary. For instance, Anthem Blue Cross said only 15% of its customers in California would receive a refund.
The rebates are required under the Affordable Care Act when insurers fail to spend a minimum of 80% of premiums on medical care for individual and small-business customers.
For larger employers, insurers must spend at least 85% of premiums on medical expenses. Employers that self-insure are not subject to these rules.
In California, more than 70% of the $11.9 million in refunds is owed to employers. In those cases, the companies are expected to share the money with employees based on the percentage workers contribute to their annual premiums.
Anthem Blue Cross, the state's largest for-profit health insurer, said it was mailing out $3.8 million in rebates to small-business customers. The average amount per person is less than $10, Anthem said.
UnitedHealth Group Inc. will refund $1.5 million to small businesses in California while HMO giant Kaiser Permanente owes $1.4 million to individual policyholders in the state, according to federal data.
Maine to receive $1.8M in health insurance rebates
By Reuters,
Posted July 24, 2014, at 4:41 p.m.
Health insurers will send out about $330 million in rebates to employers and individuals this summer under President Barack Obama’s health care law, the U.S. Department of Health and Human Services said Thursday.
The law, often called Obamacare, requires insurance companies to refund customers when they spend less than 80 percent or 85 percent of health care premiums they collect for medical care.
The rebates will go to about 6.8 million people, valued at about $80 per family. By Aug. 1, the funds either will be sent directly to consumers or to the employer who provides the health coverage and is required to pass the savings onto employees, the agency said in a report.
Maine will receive $1.8 million in rebates, according to DHHS. In Maine, all rebate checks will be issued to small and large employers. Health insurers in Maine’s individual market — which serves those who buy health insurance on their own rather than get coverage through an employer or government programs — complied with the requirements and won’t issue rebates.
The funds will benefit nearly 20,000 Maine consumers this summer, averaging $149 per family. Employers must pass along the rebates to their employees in some form, such as by lowering premiums or improving coverage.
One Maine insurer, Aetna, through its health and life insurance companies, failed to meet the requirements and will issue rebates.
“The insurance companies are only writing checks because they did not set their rates appropriately,” Mitchell Stein, an independent Maine health policy consultant, said. “It’s a good sign for Mainers that there is only one insurance company that is paying rebates this year. With luck, next year no insurers will need to do so because their premiums were low enough to begin with.”
The national rebate figure is lower than last year, when the insurers were told to send out $500 million under the law. The decline is a trend the government said shows more insurers are charging lower premiums than they would have if the law were not passed.
By Reuters,
Posted July 24, 2014, at 4:41 p.m.
Health insurers will send out about $330 million in rebates to employers and individuals this summer under President Barack Obama’s health care law, the U.S. Department of Health and Human Services said Thursday.
The law, often called Obamacare, requires insurance companies to refund customers when they spend less than 80 percent or 85 percent of health care premiums they collect for medical care.
The rebates will go to about 6.8 million people, valued at about $80 per family. By Aug. 1, the funds either will be sent directly to consumers or to the employer who provides the health coverage and is required to pass the savings onto employees, the agency said in a report.
Maine will receive $1.8 million in rebates, according to DHHS. In Maine, all rebate checks will be issued to small and large employers. Health insurers in Maine’s individual market — which serves those who buy health insurance on their own rather than get coverage through an employer or government programs — complied with the requirements and won’t issue rebates.
The funds will benefit nearly 20,000 Maine consumers this summer, averaging $149 per family. Employers must pass along the rebates to their employees in some form, such as by lowering premiums or improving coverage.
One Maine insurer, Aetna, through its health and life insurance companies, failed to meet the requirements and will issue rebates.
“The insurance companies are only writing checks because they did not set their rates appropriately,” Mitchell Stein, an independent Maine health policy consultant, said. “It’s a good sign for Mainers that there is only one insurance company that is paying rebates this year. With luck, next year no insurers will need to do so because their premiums were low enough to begin with.”
The national rebate figure is lower than last year, when the insurers were told to send out $500 million under the law. The decline is a trend the government said shows more insurers are charging lower premiums than they would have if the law were not passed.
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