Tag: "ObamaCare"

Colorado Health Exchange Premiums Roughly Equal to Those of High Risk Pool

iStock_000004795595LargeIn 2013, Rebecca Ryan of Fort Collins, Colorado, paid $375 a month to be insured by CoverColorado, the state’s plan for people who are uninsurable. When the state ended that plan on December 31, 2013, 14,000 people became uninsured and had to find ObamaCare plans.

Ms. Ryan went to the state exchange. The least expensive available option was a Kaiser-Permanente HMO that cost about $360 a month. Ms. Ryan says that it had a roughly similar deductible of $5,000 per person and total out-of-pocket costs of $6,350. Unlike Kaiser, however, CoverColorado allowed members to see any provider in the state.

The Kaiser plan did not include Ms. Ryan’s longtime physician. The only exchange plan that did that was a new, untested, Co-op plan that cost $526 a month. When asked, the exchange representative agreed that “they are going to penalize me because I want to keep my doctor.”

Keep in mind that CoverColorado charged individual premiums that were 137 percent of the “industry average,” calculated as weighted average of Colorado’s five largest individual health insurance carriers’ premiums, adjusted for benefit differences.

Ms. Ryan’s experience in the exchange suggests that ObamaCare may have raised Colorado’s average individual premiums by 37 percent.

Are Price Controls Disguised as Bundles the Next Step in Bending the Medical Cost Curve?

Fresh from reimaging health insurance, mainstream health policy analysts have now set their sights on the way that people who provide medical care are reimbursed. Initial indications are that this will not go well for patients. Academics and government agencies seem imbued with the conviction that every medical procedure in America costs twice as much as it should due to “flat of the curve medicine,” and that vast fortunes can be saved simply by chopping reimbursements.

The table below lists Medicare’s 17 most expensive conditions. It is from a paper on reducing costs by changing Medicare payments from patient based payments to “bundled episode payments.” The authors argue that this reform could save $10 billion a year. They implicitly assume that higher average payments per patient “episode of care” in the 306 hospital referral regions that make up the upper 75th percentile of the payment distribution have no value. Given that, if one caps Medicare payments for each “episode of care” at the 25th percentile of the average cost per patient episode, one saves a great deal.

Hits and Misses

Is Paul Krugman a shameful floccinaucinihilipilificator?

PCPs are opting out: choosing less rigorous work for hospitals, concierge practice and retirement.

3D printing breakthrough: Surgeons replace entire skull.

At least three states with their own ObamaCare exchanges may let healthcare.gov take over.

Robert Wood Johnson Foundation ranks each county’s health using 13 factors – only two involve the health-care system.

Ontario, Canada’s largest province, moves to outlaw all gifts from drug-makers to doctors.

How Much Does ObamaCare Rip Off Young Adults?

Five college students.Someone, for example, earning $25K annually in Arizona will pay $2,424 in total monthly premiums for ObamaCare (10% of their annual income) and still be stuck with a $4,000 deductible and a $5,200 cap on their out of pocket costs. The same person in Illinois will pay $3,576 in annual premiums, and in low cost Texas $2,460.

What about the same 30 year old who now earns $30,000 annually — the average salary for a pre-school teacher according to census data? In Arizona, their annual cost for carrying the ObamaCare plan runs $2,772 and their deductible is $5,000. In Illinois, the same person will spend $4,092 for the same health plan, and also have a $5,000 deductible before their full health coverage kicks in.

Scott Gottlieb in Forbes and at AEI.

Headlines I Wish I Hadn’t Seen

risingHealth care spending rose at the fastest pace in 10 years last quarter.

If you make playgrounds safer, kids will have more accidents.

Avik Roy hosts a paean to ObamaCare by Gene Sperling.

ObamaCare has had 38 significant delays.

Fifty-seven million Americans live in states where Tesla cannot legally sell its cars.

Salaries in Colorado’s ObamaCare Insurance Exchange: Half of Employees Earn Over $80,000, Top Fifth Over $100,000

According to the Denver Post: “The exchange also provides a lucrative retirement plan, contributing as much as 10 percent of an employee’s salary for retirement.”

Patty Fontneau, the Executive Director of the exchange, earns “$35,000 to $40,000 more than many of the members of the governor’s Cabinet.”

Currently, most of the money comes from the federal government. But not for long: “Connect for Health Colorado charges a 1.4 percent fee on each policy sold through the exchange. The fee and other revenue sources will begin covering the exchange’s expenses, including salaries, starting next year.”

The article quotes our fellow blogger, Linda Gorman: “This is a bunch of people really responsible for nothing other than getting government grants. These are nice, easy positions from an administration that wanted (the health exchanges) to work.”

New York Might Drive Its ObamaCare Exchange Premiums Up Another 30 Percent

According to the U.S. Department of Health & Human Services’ March enrollment report, New York’s state-run ObamaCare exchange has signed up fewer than half the people who were determined eligible for the exchange when they enquired.

qweWhat is the problem? One seems to be that the provider networks available in the exchange are very narrow.

What the proposed solution? At a recent presentation, exchange officials threatened to impose out-of-network access requirement on insurers who bid to participate in the exchange. If rolled out in the direction the officials appeared to point, this would be an Any Willing Provider (AWP) provision, long a lobbying priority for organized medicine:

The lack of out-of-network benefits for individuals shopping on the exchange has been criticized by some business leaders, physicians and legislators, who say it provides little choice for consumers and hurts doctors who can be bullied by insurers into accepting lower reimbursements. Insurance executives say they need that leverage to keep premiums low and attractive to consumers shopping on the exchange…If out-of-network doctors and hospitals were required to be reimbursed by the insurer, premiums could rise as much as 30 percent, according to the insurance industry.

HHS to Force Insurers to Have Wider Networks

Health plans selling on the federal marketplaces in 2015 must include 30 percent of area “essential community providers,” which are usually health centers and other hospitals serving mostly low-income patients. That’s up from a 20 percent requirement in 2014, the first year of expanded overage under the health care law. (Washington Post)

Perverse incentives problem explained here.

Imperial Presidency

index1The Obama administration has decided that the sequester’s mandatory spending cuts no longer apply to part of ObamaCare.

The health care law provides subsidies to help low-income people cover some of their out-of-pocket costs. Last year, the administration said those subsidies were taking a 7 percent cut because of the sequester, which imposed across-the-board reductions in federal spending.

But now, the White House has changed its mind. It removed the cost-sharing subsidies from its list of programs that are subject to the sequester, eliminating the 7 percent cut for 2015.

The Committee for a Responsible Federal Budget, which noticed the change, said the reversal would likely restore about $560 million to the subsidies — and require $560 million in cuts to other programs to make up for it. (National Journal)

The cost-sharing subsidies are expected to total $8 billion this year and $156 billion over the next decade.

Disillusioned ObamaCare Supporter Would Prefer His Dog’s Health Insurance over His ObamaCare Policy

In the New York Times, veteran reporter Eric L. Wee describes the experience of Nelson, his golden Labrador retriever:

Nelson’s doctors found the bulge in his abdomen on a Monday. An ultrasound and CT scan showed that a mass was crowding out his stomach and kidneys.

Nelson’s health insurance covered 90 percent of the costs after a reasonable $500 deductible. I’m happy he has such good health coverage. He’s my dog. And I’m jealous of him.

My 11-year-old brown Labrador was getting the kind of treatment that I could only dream of. I wanted to go to PetCare. I wanted pet insurance.

Here’s why:

First, we were notified that we would be kicked out of our existing $263-a-month Anthem Blue Cross plan because it didn’t meet the minimum standards of the new law…(Under ObamaCare) the least expensive premium for a couple like us in our 40s would be about $620 a month.

The gulf between my health care world and my dog’s was driven home the other week…I knew from past experience that I probably needed a prescription for antibiotics, so I tried frantically to find a medical facility that would take our new Covered California Anthem Blue Cross bronze plan. When I did, they said it would be three weeks before I could see a doctor.

Around the same time, Nelson developed a skin infection. I got an appointment at the vet’s the next day. They prescribed an antibiotic and did some blood tests.