“We only provide you with “access” to health care. Don’t bother us with details about how to pay for it. Stop being not rich. That’s your problem, ya know. Stop being poor and middle class. “
“We only provide you with “access” to health care. Don’t bother us with details about how to pay for it. Stop being not rich. That’s your problem, ya know. Stop being poor and middle class. “
Some Republicans looking to scrap the Affordable Care Act say monthly health insurance premiums need to be lower for the individuals who have to buy insurance on their own. One way to do that, GOP leaders say, would be to return to the use of what are called high-risk insurance pools, for people who have health problems.
But critics say even some of the most successful high-risk pools that operated before the advent of Obamacare were very expensive for patients enrolled in the plans, and for the people who subsidized them — which included state taxpayers and people with employer-based health insurance.
Craig Britton of Plymouth, Minn., once had a plan through Minnesota’s high-risk pool. It cost him $18,000 a year in premiums.
Britton was forced to buy the expensive coverage because of a pancreatitis diagnosis. He called the idea that high-risk pools are good for consumers “a lot of baloney.”
“That is catastrophic cost,” Britton said. “You have to have a good living just to pay for insurance.”
The argument in favor of high-risk pools goes like this: Separate the healthy people, who don’t cost very much to insure, from people who have preexisting medical conditions, such as a past serious illness or a chronic condition. Under GOP proposals, this second group, which insurers expect to use more medical care, would be encouraged to buy health insurance through high-risk insurance pools that are subsidized by states and the federal government.
Republican Speaker of the House Paul Ryan made the case for high-risk pools on public television’s “Charlie Rose” show in January.
“By having taxpayers, I think, step up and focus on, through risk pools, subsidizing care for people with catastrophic illnesses, those losses don’t have to be covered by everybody else [buying insurance], and we stabilize their plans,” Ryan told the TV host.
Minnesota’s newest congressman, Rep. Jason Lewis, a Republican representing Burnsville and Bloomington, recently endorsed high-risk pools on CNN.
“Minnesota had one of the best … high-risk insurance pools in the country,” Lewis said. “And it was undone by the ACA.”
It’s true that the Affordable Care Act banned states’ use of high-risk pools, including the Minnesota Comprehensive Health Association, or MCHA. But that’s because the MCHA was no longer needed, the association’s website explains; the federal health law requires insurers to sell health plans to everybody, regardless of their health status.
Supporters of the MCHA approach tout a return to it as a smart way to bring down the cost of monthly premiums for most healthy people who need to buy insurance on their own. But MCHA had detractors, too.
“It’s not cheap coverage to the individual, and it’s not cheap coverage to the system,” said Stefan Gildemeister, an economist with Minnesota’s health department.
MCHA’s monthly premiums cost policyholders 25 percent more than conventional coverage, Gildemeister pointed out, and that left many people uninsured in Minnesota.
“There were people out there who had a chronic disease or had a preexisting condition who couldn’t get a policy,” Gildemeister said.
And for the MCHA, even the higher premiums fell far short of covering the full cost of care for the roughly 25,000 people who were insured by the program. It needed more than $173 million in subsidies in its final year of normal operation.
That money came from fees collected from private insurance plans — which essentially shifted a big chunk of the cost of insuring people in the MCHA program to people who get their health insurance through work.
Gildemeister ran the numbers on what a return to MCHA would cost. Annual high-risk pool coverage for a 40-year-old would cost more than $15,000 a year, he says. The policyholder would pay about $6,000 of that, and subsidies would cover the more than $9,000 remaining.
University of Minnesota health policy professor Lynn Blewett said there is a better alternative than a return to high-risk pools. It’s called “reinsurance.” In that approach, insurers pay into a pool that the federal government administers, using the funds to compensate health plans that incur unexpectedly high medical costs. It’s basically an insurance program for insurers.
The big question is whether lawmakers will balk at the cost of keeping premiums down for consumers — whatever the approach, Blewett said.
“The rub is, where that funding is going to come from?” she said. “And is the federal government or the state government willing to put up the funding needed to make some of these fixes?”
The national plan Ryan has proposed would subsidize high-risk pools with $25 billion of federal money over 10 years. The nonpartisan Commonwealth Fund estimates the approach could cost U.S. taxpayers much more than that — almost $178 billion a year.
Researchers at the consulting firm McKinsey & Company say reinsurance would likely cost about a third of what the high-risk pool option would.
This story is part of NPR’s reporting partnership with Minnesota Public Radio and Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. It is reprinted here with permission.
MADISON, Wis. — Having health insurance is vital for 21-year-old Mercedes Nimmer, who takes several expensive prescription drugs to manage multiple sclerosis. So Nimmer was thrilled to get health insurance last year through the Affordable Care Act’s marketplace and qualify for a federal subsidy to substantially lower her cost.
Yet, the government assistance still left her with a $33 monthly premium, a hefty amount for Nimmer, who makes $11,000 a year as a part-time supply clerk.
Nimmer, though, doesn’t have to worry about even that expense thanks to a United Way of Dane County program that has provided premium assistance to about 2,000 low-income people since 2014. The program, called HealthConnect, is funded by a 2013 gift of $2 million from UW Health, a large academic hospital system connected to the University of Wisconsin that also runs its own marketplace health plan.
“Oh my gosh, this is a big deal for me to get this help,” Nimmer said, noting the insurance is vital to cover her medications. The money she saves from the assistance program goes to help pay for gas to get to work, she said.
HealthConnect is one of several community-based programs across the United States helping thousands of lower-income Americans with their Obamacare marketplace premiums. Similar efforts operate in Texas, Oregon, Washington, North Carolina and South Carolina.
But premium assistance programs have come under fire from insurers. They argue that it is not fair for hospitals, other health providers and disease advocacy groups financed by providers to try to steer people who could be covered by Medicare or Medicaid into marketplace plans with higher reimbursement rates.
The federal government has banned hospitals from directly subsidizing patients’ health insurance premiums. But America’s Health Insurance Plans, the industry’s lobbying group, wants the Obama administration to prohibit all premium assistance programs that are funded directly or indirectly by hospitals and other providers with a financial interest in the patient’s care.
“In many cases these practices are harming patients and undermining the individual market by skewing the risk pool and driving up overall health care costs and premiums,” AHIP said in Sept. 22 letter to Andy Slavitt, the acting administrator of the Centers for Medicare & Medicaid Services. The letter notes specific concerns about plans assisting patients requiring kidney dialysis. It says one insurer saw its spending on those patients rise from $1.7 million in 2013 to $36.8 million in 2015 when the number of patients with serious kidney disease rose from 28 to 186.
AHIP officials also said patients could face consequences if the third-party groups stop paying premiums or the government determines patients are receiving a federal subsidy for which they are not eligible.
America’s Health Insurance Plans wants the Obama administration to prohibit all premium assistance programs that are funded directly or indirectly by hospitals and other providers.
In response, CMS says it is considering new rules for third-party payment programs.
Nonetheless, insurers are taking action. Aetna, which announced this summer that it was scaling back its marketplace offerings, said that third-party groups steering patients to the individual market had contributed to an unhealthy mix of customers in its marketplace plans.
Blue Shield of California in July filed suit in a state court against CenCal Health, which manages the Medicaid program in Santa Barbara and San Louis Obispo counties. Blue Shield alleges that CenCal was avoiding millions of dollars in medical care claims by enrolling around 40 of its very ill members in Blue Shield’s individual health plans and paying the premiums on their behalf. CenCal denied the allegations in lawsuit, saying it paid the patients’ monthly Blue Shield insurance premiums so they could afford private insurance. It has since discontinued the practice.
UnitedHealthcare filed a lawsuit in federal court in July against kidney dialysis provider American Renal Associates, accusing it of encouraging patients in Florida and Ohio who were eligible for Medicaid or Medicare to move to the insurer’s commercial plans to extract up to 20 times more than the $300 or so that the federal programs pay in reimbursements. American Renal Associates has said the suit is without merit.
The suit alleges that the patients’ premiums were paid by the American Kidney Fund, an advocacy group for patients.
AHIP officials note that the fund is supported by dialysis providers who stand to benefit financially from patients gaining marketplace coverage over payments from Medicaid or Medicare.
The nonprofit American Kidney Fund has helped more than 6,400 people with their marketplace premiums. The fund’s officials said it’s not trying to steer people away from government coverage but trying to help those who otherwise couldn’t afford coverage.
“It is critically important to emphasize that people with disabilities in general — and with end-stage renal disease in particular — should not be broadly excluded as a class from the insurance marketplace if they are unable to afford their health insurance premiums,” LaVarne Burton, the fund’s CEO, said in a statement.
Some patient advocates, like those at HealthConnect in Wisconsin, say third-party payers have an important role in helping low-income customers afford their coverage. UW Health said in a statement that HealthConnect helps all providers, including UW Health, by reducing the number of uninsured patients and potentially helping people seek care earlier in their illness.
The program pays an average of $109 monthly per person in premium assistance. For every dollar spent, HealthConnect generates $2.26 in federal subsidies, said Krystal Webb, a spokeswoman for United Way of Dane County.
United Way said it structured HealthConnect to avoid a conflict of interest. Eligible people first buy their policy, which can be any of several silver-level plans on the federal marketplace. After that, they can apply for a HealthConnect subsidy. The program is administered by United Way, and UW Health plays no role in patients’ choice of health plan, although its marketplace plan, Unity Health, refers people who may be eligible there.
Despite AHIP’s concerns, some health insurers in Dane County say HealthConnect is filling a need, according to interviews with several plans. “We support United Way’s HealthConnect efforts as a way to provide affordable insurance options to the residents of Dane County,” said a spokesman for Dean Health Plan, one of the larger marketplace plans in the county.
In Texarkana, Texas, Christus St. Michaels Health System donated $200,000 last year to an assistance program serving 138 people with marketplace coverage. The program is run by a local government agency called the Ark-Tex Council of Governments, and Christus has no control over who enrolls or what plan they choose.
“Our mission is to help the poor and this is certainly one of the ways to do that, and it gives people the opportunity to have health coverage when they normally wouldn’t,” said Mike Hargrave, the hospital’s manager of employee assistance and community outreach services. People with incomes between 100 and 150 percent of the federal poverty level (about $11,880 to $17,820 for an individual) are eligible.
Hargrave doesn’t deny the hospital could benefit when more people gain insurance, but he notes other hospitals in the region benefit, too.
The insurance industry is also troubled by premium assistance programs funded by anonymous donors since they could be hospitals looking to protect their identity, said AHIP spokeswoman Clare Krusing.
For example, PremiumHealth.org, run by United Way of the Greater Triangle in North Carolina helps more than 850 people with incomes between 100 percent to 175 percent of the federal poverty level in Durham, Orange and Wake Counties.
An anonymous donor provided $1.2 million in funding for the program, said Melanie David-Jones, a senior vice president for United Way. She would not say why the donor wished to remain anonymous.
Noel Pitsenbarger, 48, of Durham, said the program made it possible for him to have health insurance this year by covering the $200-a-month premium for his Blue Cross Blue Shield of North Carolina policy. With insurance, he said, he got a colonoscopy, physical exam and help paying for several medications. And it saved him from having to pay a $1,000 bill after he cut his finger and had to go to the emergency room.
“It’s been extremely beneficial,” he said.
The Snopes.com web site investigates rumors that are bouncing around the internet. Some of the rumors are old. Some were in the news. When the rumors are false, they tend toward the ridiculous end of the spectrum usually involving some right-wing craziness about black helicopters coming to take away their bibles and guns or forcing all of us to submit to microchip implants.
Here are some of the latest. Remember, some of these are not new, but Snopes posts an alert when the page is updated in some way. Have fun informing yourself about the crazy stuff people come up with — or are actually doing.
FACT CHECK: Is NASCAR unveiling a new LGBT Stars and Gay Bars flag for racing fans?
NEWS: News of the death of actor Andy Griffith, who passed away in 2012, began recirculating online in July 2015.
FACT CHECK: Does a photograph document that Walmart stores were ordered to remove Made in the USA signs because the company is ashamed of the U.S. ?
FACT CHECK: Did President Obama sign an executive order authorizing the opening of an ISIS-sympathetic youth center in Dearborn?
NEWS: Two scientists have suggested that Comet 67P could harbor a form of alien life.
NEWS: What appeared to be a spate of arsons at Southern black churches following the Charleston massacre was likely a product of confirmation bias.
NEWS: Various news outlets report that Seattle sixth graders can obtain IUDs without parental consent but cannot buy soda at school.
FACT CHECK: Did thousands of Christian couples file for divorce to protest the Supreme Court s ruling on gay marriage?
FACT CHECK: Did Pope Francis announce during a sermon that God had instructed him to change the Ten Commandments?
NEWS: A June 2015 Facebook post claims a woman’s neighbor died of suffocation due to e-cigarette use, but the claim has neither been substantiated nor reported upon in the news.
FACT CHECK: Was a Philippine baby recently born with stigmata, attracting visits from thousands of devout Christians?
FACT CHECK: Is a petition seeking the arrest of a woman who cut the limbs off a muzzled dog accurate and current?
FACT CHECK: Did Sen. Dianne Feinstein say she is unsympathetic to veterans who experience symptoms of PTSD because they deserve it?
FACT CHECK: Was a girl electrocuted while using earbuds plugged into an iPhone that was being recharged?
FACT CHECK: Did a pithy criticism of Obamacare originate with Donald Trump?
NEWS: Nobel Prize winner Dr. Ivar Giaever said that President Obama was dead wrong on climate change.
NEWS: Former President George W. Bush was paid $100,000 to speak at a charity fundraiser for wounded veterans in 2012.
NEWS: The Environmental Working Group reported that they found asbestos in four brands of children s crayons.
NEWS: Report of robbers flinging eggs at car windshields to impair drivers vision and force them to stop.
FACT CHECK: Did President Obama admit during remarks he delivered at the Pentagon that the United States was training ISIL ?
FACT CHECK: Is a new transgender tampon arriving in stores soon?
NEWS: A Change.org petition satirically demands the restaurant and gift shop chain Cracker Barrel be renamed Caucasian Barrel.
And there you have them: the wonderful and the weird for this week. Enjoy.
Also, I do not necessarily agree nor disagree with the Snopes findings for any of these. If you disagree with them, don’t contact me. Contact Snopes directly.
One of the great myths put forward by the Tea Party crowd is the idea of poor women wanting babies so they can live off the pubic assistance each child provides; despite the fact that public assistance benefits are often poverty level, at best.
Yet those same people block every effort — birth control, safe and legal abortion, family planning counseling — to help those women prevent unwanted children. It’s one of the confounding paradoxes of right-wing thinking: we don’t want poor people having babies but we’ll do everything we can to make sure that they are saddled with children they — and taxpayers — cannot afford.
Obamacare is making a difference in this regard, as this Chicago Tribune article points out:
Health economists say the financial barrier to birth control drives up unintended pregnancies and, ultimately, the taxpayer burden.
The monthly co-pay for pills, though typically under $50, adds up. And the cost of an IUD, arguably the most effective method on the market, can reach $1,000.
It’s too early to tell how cheaper contraceptives may be affecting the birth rate. Years of research show the stakes remain high, no matter where you stand politically, when it comes to broader access to birth control.
A poor woman in the United States is five times as likely as an affluent woman to accidentally become pregnant and have a baby, the Brookings Institution recently found.
Unintended pregnancies, in general, cost taxpayers $21 billion a year, according to the Guttmacher Institute, a nonprofit reproductive health organization. That averages out to a cost of about $366 per every American woman of child-bearing age.
State programs show a stunning connection between increased birth control availability and decreased teen pregnancy.
Between 2007 and 2012, for example, Colorado saw the highest percentage drop in birth rates among teens 15 to 19 in the country, according to a CDC report. Its teen birth rates over that period dropped 39 percent, compared to 29 percent nationwide.
Health officials said a simple public program sparked the change: 30,000 IUDs, offered for free (or close to it) by the state’s family-planning clinics.
The best babies are babies born into families where they are planned, wanted and able to be raised by parents ready for the challenges both personal and financial.
Not feeling well right now.
So all I will say for now is this: what a relief. I know many people who rely on this law, flawed as it may be.
My COBRA runs out next month, so I would like it to be there for me, too.
The Supreme Court on Thursday upheld the nationwide tax subsidies underpinning President Barack Obama’s health care overhaul, rejecting a major challenge to the landmark law in a ruling that preserves health insurance for millions of Americans.
The justices said in a 6-3 ruling that the subsidies that 8.7 million people currently receive to make insurance affordable do not depend on where they live, as opponents contended.
The outcome was the second major victory for Obama in politically charged Supreme Court tests of his most significant domestic achievement. And it came the same day the court gave him an unexpected victory by preserving a key tool the administration uses to fight housing bias.
Obama greeted news of the decision by declaring the health care law “is here to stay.” He said the law is no longer about politics, but the benefits millions of people are receiving.
Declining to concede, House Speaker John Boehner of Ohio said Republicans, who have voted more than 50 times to undo the law, will “continue our efforts to repeal the law and replace it with patient-centered solutions that meet the needs of seniors, small business owners, and middle-class families.”
Republicans: trying to destroy Obama until the bitter end.
Playing politics with the GOP on Capitol Hill is increasingly looking like playing with a petulant 8-year-old who acts as if she has information you want when she really has nothing:
There was a time when it was House Republicans who wouldn’t talk up an Obamacare “contingency” plan until the Supreme Court decision on King v. Burwell was released. Despite assurances from Speaker John Boehner and majority leader Kevin McCarthy earlier this year that “there will be an alternative, and you’re going to get to see it,” it took a while for the party to deliver on its pledge to reveal that masterful “alternative” that it was drawing up.
Such a long while, in fact, that it still hasn’t happened. Before Supreme Court justices voted on the case — presumably the Friday after oral arguments were heard in March — it was in the GOP’s interests to signal to the Court as glaringly as possible that there would be no crisis should it strike down subsidies for ACA beneficiaries in some 30-odd states. Once the Court’s decision was made, written, and sealed for release sometime this month, it was no longer necessary for Boehner, McCarthy and the rest of the House leadership to pretend that it had settled on a strategy to restore order to health insurance markets without antagonizing anti-ACA dead-enders within the party. Because as far as we can tell, no such conceived strategy has effectively threaded that needle.
Now, as Bloomberg reports, Republican senators are retreating into the muddier waters of their House counterparts: playing the “we’ll let you know the plan when we have to” game. As with Richard Nixon and his “secret plan” to end the Vietnam War in 1968, the hot plan is ready to go, but for now they’ll keep it a closely guarded secret.
Got that? They have a plan detailing how they will accomplish yanking away newly-acquired health care to millions of Americans, disrupting the lives of all those people, but they’re not telling anyone.
Sometimes I fear we were doomed as a Democracy the moment President Nixon’s people dreamed up the Southern Strategy of wooing disaffected high school dropouts among white Christian conservatives in the South by pandering to the basest instincts of a demographic that is so stupid they scream nonsense such as “Get the government out of my Medicare!”
Another sign that we need single-payer health care:
More than a quarter of adults who bought health insurance on exchanges created under Obamacare skipped important doctor visits and medical tests because they could not afford to pay, a study published Thursday by Families USA found. Among low- and middle-income adults, the proportion of people who avoided care was even higher, at nearly one-third.
More than 14 million people in the United States gained health insurance through Obamacare, landmark legislation officially known as the Affordable Care Act that was passed in 2010. Nearly 12 million people signed up for health coverage plans on exchanges created under Obamacare, according to the website ACAsignups.net.
But more than half of the adults who bought such plans had deductibles of $1,500 or more, Families USA, a Washington nonprofit organization focused on health care, found. A deductible is the cumulative amount a person has to spend on health care before his or her insurance company starts to pay. Despite receiving tax credits to help offset the cost of coverage, these deductibles were prohibitively expensive.
“Simply having health insurance is no guarantee that consumers can afford to pay for health care,” the report noted. When people decided to forgo medical care, fees that would have to be paid out-of-pocket were a major contributing factor, the report, which surveyed adults with lower- and middle-income levels, found. The report did not include people who had health insurance through Medicaid or those who had health insurance through their employers.
Overall, the Affordable Care Act made health insurance and health care itself more affordable, in part by subsidizing the cost through tax credits to those who qualify. But for some Americans, it was not affordable enough, the report showed. Of adults who were insured for a full year, 25.2 percent did not get necessary medical care, including tests, treatments and medications. Of lower- to middle-income adults, 32.3 percent reported not getting care they needed.
It’s all well and good that people can actually sign up for health insurance they would not otherwise have. But it’s kind of pointless if those people have deductibles so high they don’t even go to the doctor.
If you think you don’t have to care, you should. One of the main points of the fight over Obamacare was to get as many people as possible onto health insurance of some sort so that the taxpayers don’t keep footing the bill for uninsured people who get sick or have accidents. It was also to get people going to the doctor so that potentially serious problems might be caught before a minor problem turns into a more serious (and more expensive) ailment.
We will eventually need single-payer health care. If our leaders can get over the health care gridlock that almost consumed Obamacare, and manage to get the health establishment on-board. That might be a tough job. One of the chief reasons health care costs are out of control is not so much waste by each consumer — although that plays a part — as much as it is the simple fact that there is a lot of money to be made on health care and a lot of vested interests don’t want to see that gravy train disappear.