Archive | Health Care Bill Impact on Business

Why Obama Should Be Freaked Out Over Obamacare

President Obama said Monday he’s “frustrated” by the disastrous launch of an online computer marketplace for Obamacare. It’s worse than we know, this is the easy part, and millions of Americans could be hurt.

Here are five reasons why frustration isn’t enough. He should be frightened.

  • 1. It’s worse than his team has let on. The White House has tried to position the failed first days of Obamacare as mere hiccups caused by the site’s popularity. Obama called them “kinks.” An administration spokesman told the Washington Post on Sunday that the “main driver of the problem is volume.” This is intentionally misleading.

The White House has heard complaints from insurance companies, consumers, and health policy experts about issues embedded deeply in the online system. For example: inaccurate information provided to people about federal tax credits; low-income people erroneously told they don’t qualify for Medicaid; and insurance companies getting confusing information about who has signed up.

The administration refuses to say how many people have enrolled through the federal exchange, the key metric for determining how well the online service is working in states that didn’t set up their own exchanges. There are two possible explanations for the Obama administration’s unconscionable lack of transparency. Their process is so screwed up that they don’t have the data, which would be embarrassing. Or they have the data – and it’s embarrassing.

  • 2. This is the easy part. Finding and motivating people to take action online is the founding strength of Team Obama. This is what they do best. Managing a complex law is a different matter, and it’s fair to question whether the president and his team are up to it.

How do you convince healthy young Americans to pay for insurance they may not need in order to fund the program? Do companies shed workers and working hours to avoid coming under the law? Are people with cheap catastrophic plans forced to pay more in the exchanges? Tricky questions likes these will soon make the hard art of website design look like fingerpainting. “The online federal health care exchange, the heart of the Obamacare project, is such a rolling catastrophe that it may end up creating a major policy fiasco immediately rather than eventually,” wrote Ross Douthat in a New York Times column titled, “Obamacare, Failing Ahead of Schedule.”

  • 3. It reflects poorly on the president. Nobody expects the chief executive to be reviewing computer code or hosting East Room “hackathons.” But this falls on him. The CEO of a corporation or country is uniquely responsible for making sure the team is on task, and he or she is ultimately responsible if it’s not. In Obama’s case, did he demand thorough updates on the progress of the site? If so, did he ask the right questions? Did he put the right people on the job in the first place? Given the horrid first days of Obamacare, the answer to at least one of those questions must be “no.” 
  • 4. It reflects poorly on government. The public’s faith in government is at a record low, just as Obama is fighting Republicans on several fronts over the size and power of the federal bureaucracy. His administration needs to rapidly improve the online exchanges to stand any chance of convincing, say, young Americans to pay for insurance they don’t think they need. Beyond Obamacare, the Democratic Party’s reputation for competency is as stake.  The cost of the site is already $394 million, a massive amount compared to private-sector CMS work, and sure to grow.
  • 5. It could hurt Americans. For decades, politicians in both parties pledged to ease one of the leading causes of anxiety in the post-industrial age, the lack of affordable health care. Nearly 50 million Americans are uninsured, or about 15.4 percent of the population. Millions more are underinsured. Obamacare, enacted three years ago over the objections of Republicans, may or may not be the answer. But, as the White House likes to remind Republicans, it’s the law and it deserves a shot.

“The Affordability Care Act is not just a website,” Obama said Monday, “it’s much more.” True to a point, but the website is critical to the law’s purpose: helping millions of Americans bargain for better health care. Dismissing the extent of the problem and reminding voters that Republicans fought the law — which is essentially all Obama did in his Rose Garden remarks — is a deflection, which shouldn’t be confused with implementation or governing.

*Modified from a NationalJournalonline.com article

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Are they signing up for Obamacare, or for Medicaid (MediCal)?

How many people have tried to sign up for Obamacare? How many have completed the process? Those numbers are important, but let’s keep something else in mind here — there’s another important number that a lot of publications are failing to separate out. That is, how many people are enrolling in the private insurance plans within the Obamacare exchanges — as opposed to those applying who report very low incomes and get steered into the Medicaid program?

  • In terms of getting more people insured, it might seem like a minor detail. But the private insurance exchanges, a centerpiece of Obamacare, need a very large number of people to sign up if they are to be viable insurance pools. By the Obama administration’s estimate, they need about 7 million people to sign up for the exchanges nationwide. (They also estimate they need 2.7 million of those to be young/healthy types, a separate but related issue.) There is a separate goal of enrolling another 8 million poor people in Medicaid.
  • Yesterday, The Washington Post suggested that at least 185,000 people have signed up for Obamacare:. That sounds promising for the program even if it’s still well short of the pace needed to meet the goals. And then Oregon has just reported 56,000 enrollments. So isn’t everything going just fine?
  • In fact, no. When you see state enrollment numbers, you have to ask yourself this question: How many of those people are actually becoming Obamacare private insurance exchange customers, as opposed to people who (1) were always eligible but are just signing up for Medicaid for the first time, and (2) people who are newly eligible for Medicaid under the expanded coverage thresholds in some states?
  • In Oregon, that 56,000 number you’re hearing today is all Medicaid. Their online exchange doesn’t even work yet. Something similar is happening in many other states as well. Minnesota, for example, said it had 3,800 applicants. But when you scratch the surface, only 406 of these are Obamacare exchange applicants — again, most of the signups were low-income customers who were steered to Medicaid instead.  
  • California, has put 600,000 new people on Medicaid, but their last hard number of actual, completed applications for the exchanges was under 17,000. That’s over a week old, but I’m still skeptical when I see them say that 100,000 “are in some stage of applying for insurance on the marketplaces.” Why all those weasel words? Have those people completed applications — in which case California is doing great — or have they merely entered their zip code and started looking at plans? California may not release any reliable numbers on their exchange enrollment until next year.
  • Are these numbers going to add up to viable health insurance exchanges? A very sober assessment yesterday on the Corner, noting among other things that the slow trickle of signups, from the insurers’ perspective, is a true nightmare and even worse than if no one was signing up at all. If only “highly motivated consumers” are spending the hours it takes to get through right now, the exchanges are filling up with the people most likely to be very sick or old.

*Modified from a conservativeintel.com article

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Obamacare: Who will ignore law’s requirements?

Millions of Americans may be wrestling with computer glitches to try to sign up for Obamacare — but many people eligible just won’t bother and will pay a price for it. Some will flout the mandate to buy coverage on ideological grounds, a health insurance version of civil disobedience.

  • Some will opt for the penalty because it’s cheaper than paying for insurance, even with subsidies — as long as they don’t get sick and have to pay their own medical bills. And some are so confused about the president’s health care law that they may not even realize they have to pay a penalty — or a tax, as the Supreme Court called it — until they get slapped with the fine when they file their 2014 tax returns. And sign-up rates may be affected, too, if the technical problems on the exchange websites persist.

The new health exchanges need younger and healthier people to balance out the risk and prevent spiraling insurance costs. The mandate is one way of nudging them in. Here’s a look at who may opt out — and why they’ll do it.

The Card-Burners

  • In reality, there are no “Obamacare cards,” but some conservative groups, notably FreedomWorks, are using the imagery to promote resistance to the law, especially among younger and healthier people. “My guess is they need about 40 percent of the people in the exchanges to be young, healthy adults under 35,” Dean Clancy, vice president of public policy for FreedomWorks, said in an interview. “If they don’t get that, the premiums will go up in the second year. Insurance companies may back out because they can’t get enough people to sign up, … and the whole thing will collapse.”

The Calculators

  • Most people who sit out Obamacare will be motivated by math, not politics. These people — mostly the so-called young invincibles — would rather take their chances that they won’t need costly health care, pay the 95 bucks and not spend money on insurance. “The main reason the people will skip the exchange is not ideological but financial,” he said. “This sticker shock will be our best friend in the fight,” he said, referring to the cost of insurance in the exchanges.
  • Pro- and anti-Obamacare forces agree that much of people’s decisions on whether to sign up will boil down to dollars and cents. Individuals won’t know until they check out the exchanges — and access the troubled websites — exactly what their particular coverage options are and what those would cost.

The Confused

  • Many experts, including people interviewed at Intuit and H&R Block, expect that a large chunk of the people who pay the tax just won’t know the rules. “I would say a huge portion of the population is confused or ignorant of what will happen,” Clancy said. “I think a lot of people will drift along passively, unaware that the mandate applies to them.”

What Next?

  • The $95 penalty number is well-known — but it’s only part of the story. It’s actually $95 or 1 percent of taxable income, whichever is more. (The income penalty would be based on earnings over the so-called filing threshold — the amount earned before someone owes taxes.) For someone making $40,000 with standard deductions, it would mean about $300 more in taxes (or $300 less of a refund).
  • “I think that the $95 has been really well communicated, … but what has not been communicated as well is the 1 percent, and that is what we heard from clients this year and was really eye-opening,” said Meg Sutton, senior adviser on tax and health care services at H&R Block. By 2016, the tax will be higher — $695 or 2.5 percent of income, whichever is more.
  • The CBO broke down its projection of 6 million penalty payers by income. About 30 percent will have incomes too high for federal subsidies. Forty percent will have incomes between 200 percent and 400 percent of the federal poverty line, which makes them eligible for the middle range of subsidies. The remaining 30 percent will make less than 200 percent of poverty and would qualify for the highest subsidies — but low-income groups can be hard to reach and skeptical of government assistance.
  • “I think a lot of people will factor in things like, ‘Well, I ought to have health insurance,’ or, ‘I have kids and want to make sure they’re covered.’ … Or, ‘Oh I haven’t had health insurance for years, but I’m getting older and having health problems,’” Intuit’s Williams said. “So you can envision all sorts of rationales that economists may or may not get to that are personal. … All of that is an art, not a science.

*Modified from a Politico.com article

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Health care law deadline updated

You’ll have to get health coverage by Valentine’s Day or thereabouts to avoid penalties for being uninsured, the Obama administration confirmed Wednesday. That is about six weeks earlier than a March 31 deadline often cited previously.

  • The explanation: Health insurance coverage typically starts on the first day of a given month, and it takes up to 15 days to process applications. You still have to be covered by March 31 to avoid the new penalties for remaining uninsured. But to successfully accomplish that you have to send in your application by the middle of February. Coverage would then start Mar. 1.
  •  The Jackson Hewitt tax preparation company first pointed out the wrinkle with the health care law’s least popular requirement. An administration official confirmed it. The official was not authorized to speak publicly and insisted on anonymity.
  • It’s the latest bit of confusion involving complex requirements of President Obama’s health care law, known as the Affordable Care Act. Adjustments to the law have ranged from the momentous to the mundane. The biggest one was a one-year delay of a requirement that larger employers offer coverage, announced this summer. More recently, the administration has postponed some Spanish-language capabilities of its enrollment website, as well as full functionality on the site small businesses use to sign up.
  • Brian Haile, senior vice president for health policy at Jackson Hewitt, said government agencies initially had different interpretations of the enrollment deadline. The Health and Human Services department, which is taking the lead in implementing the law, kept referring to a March 31 deadline. The Internal Revenue Service, which handles the financial aspects, suggested that the deadline had to be in February.
  • ‘‘There were inconsistencies,’’ said Haile, adding it took several inquiries by Jackson Hewitt in the last few weeks to clear up the uncertainty. The health care law was designed to cover the uninsured through a mix of government-subsidized private insurance and a major expansion of the Medicaid safety net program.

The rollout of online insurance markets this month has been snarled by technical glitches that frustrated many consumers. House Republicans are still pressing their demand for a delay of ‘‘Obamacare’’ provisions, if not its total repeal, as a condition for lifting the partial government shutdown now in its second week.

Starting next year, the law requires virtually all Americans to have insurance or face a tax penalty, triggered after a coverage gap of three months. The penalty starts as low as $95 for 2014, but escalates in subsequent years.

*Modified from a Boston Globe article.

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Study: Premiums for Young People to Rise in all 50 States

Health insurance premiums for young people will rise in all 50 states under Obamacare, with an average increase of 260 percent, according to a study released Thursday. Forty-four out of 50 states saw a three-digit percent increase.

  • According to a study released by the American Action Forum, post-Obamacare premiums will average $187.08 per month, up from $62 per month in 2013, a 202 percent increase.  Overall, states averaged an increase of 260 percent. The report, written by Sam Cappellanti, a health care policy analyst at the AAF, points to numerous policies within Obamacare as the reason for higher premiums, most importantly “guaranteed issue” and “community rating.”
  • The group analyzed plans for a 30 year-old male non-smoker as the model for the so-called “young invincible.”  After analyzing each bronze-tier plan for a 30-year-old single male, every state saw an increase.  Only those who earn up to 133 percent of the poverty line will have a financial incentive to join the health exchange.  An individual with an income of $15,281.70 would receive a subsidy to cover 100 percent of their health care premiums.
  • Moving up the income bracket creates disincentives for the young to enroll.  Those making $20,107.50, or 175 percent of the poverty line, will still face a $449 premium, which is three times higher than the penalty they would incur in 2014 ($103.57) if they did not purchase insurance. An individual earning $37,342.50 will receive no subsidy at all and will face a minimum premium of $2,839, as opposed to a $275.92 penalty in 2014.
  • “Premium subsidies will do little to defray increased rates for young people, while penalties for noncompliance appear paltry when compared to the costs associated with coverage,” the study said.
  • Guaranteed issue is the portion of the law that restricts health insurers from denying coverage on the basis of preexisting conditions.  The study notes that the policy forces insurers to pay more for high-risk individuals and enables others to apply for coverage after they get sick, making premiums go up for everyone else.
  • Community rating under Obamacare mandates that insurance companies charge the same premium to individuals regardless of health history and current health status.
  • “In a guaranteed issue and community rating system, healthy individuals are perversely incentivized to wait to enroll in coverage until there is a true need,” the study said. Other factors driving up premiums are the Health Insurance Tax (HIT) and fees insurance companies must pay in the exchange, which are likely to be passed onto the consumer.
  • The policies work together to create what Cappellanti calls a “death spiral,” making premiums jump “exponentially” in 2014. “In response to rising costs, young healthy enrollees opt out of coverage, seeing the investment as financially disadvantageous given their low medical costs,” the study said. “The insurance risk pool becomes disproportionately older and sicker, further increasing prices and driving insurers out until the system becomes unsustainable.”

*Modified from a Freebeacon.com article

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Exchange Conflicts Come Into Sharper Focus

The polarizing effects of the Affordable Care Act have become even sharper since the launch of public health insurance purchasing exchanges on Oct. 1.

Those effects were highlighted by a panel of experts convened by Employee Benefit News for a web seminar titled, “It’s Oct. 2, Now What? Catching Up on ACA Implementation.”

  • Some of the conflicts center around the search for evidence that public exchange rates present either a great bargain for individuals, or no savings at all. However, explorers have found wide rate variations not only from state to state, but within state. For example, a 35 year-old male nonsmoker from Massachusetts shopping for an entry-level Bronze Plan was found to have options ranging from $192.66 a month to $375.83. Nearby Connecticut, in comparison, had premiums start higher for this applicant profile but cap at a lower ceiling with a premium range of $241.85 to $299.93.
  • Moreover, anyone attempting to gauge what kind of bargains are available through the exchanges should ensure they are making like comparisons, according to web seminar panelist Rodger Bayne, president of Benefit Indemnity Corporation. “Quotes might be cheaper because of the Bronze rates, with lower premiums but higher out-of-pocket costs,” he observed. “Certainly there will be some disputed claims and concerns about what’s best.”
  • Other envisioned conflicts stem from lack of employer compliance with employee notification requirements. These could arise if, for example, an employee without coverage receives medical treatment from a provider who might then be on the hook for uncompensated care. If that provider discovers the employee was not properly notified about the exchanges and his coverage options, there could be the makings of a lawsuit.
  • “We believe that, over time, providers holding bad debt will join with employees and that this will become a civil court issue,” according to Randy Spicer, health services consultant for the National Restaurant Association. To help members comply with ACA notifications and avoid such liability, the association has created an online Compliance Portal which assists with notification delivery and recordkeeping. The group is also exploring whether to make the Portal available to non-member organizations.
  • On other fronts, attorney Anusha Rasalingam, a partner with Friedman & Wolf, notes that Obama administration rulings on ACA implementation have alienated labor unions. At issue is the status of multiemployer plans as qualified health plans on the exchanges. However, efforts to have multiemployer plans included in the exchanges were rejected last month by the Labor Department and Department of Health and Human Services.

*Modified from a Benefitnews.com article

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What Does New Health Law Mean For Me?

Beginning today October 1st, individuals will begin selecting health insurance plans that will become effective January 1, 2014. These are some questions and answers to clarify the process. 

I already have health coverage at my job. What happens to me?

  • Changes may not affect you much if you’re one of the 171 million Americans with coverage through your job or your spouse’s job. You might be able to use new health-insurance exchanges opening Tuesday, but you probably wouldn’t be eligible for a subsidy.

I heard some companies that offer health coverage are making changes—is that true?

  • Yes. The law already mandates allowing people to keep children on their plans up to age 26. Plans with very limited benefits offered by some companies—particularly in retail, restaurants and agriculture—are generally being phased out. A few firms are giving workers a fixed sum and letting them choose their own plan from what’s called a private exchange. This isn’t the same as the health law’s exchange.

I’ve been buying my own health coverage. What now?

  • On Tuesday, you’ll see new private insurance plans through insurance exchanges in most parts of the country. Singles making less than $46,000 a year, couples making less than $62,000 and families with slightly higher income levels may be eligible for subsidies to pay for coverage.

What kinds of policies are they selling on these exchanges?

  • Policies must cover certain preventive care and can’t have lifetime caps. Also, your premium won’t be based on your medical history—good news if you’ve been sick. Healthy people who previously could buy inexpensive policies may pay more. Plans are labeled gold, silver or bronze depending on how much they cover.

Do I get to keep my doctor?

  • If you’re buying a new policy on an exchange or switching insurers, you’ll likely find they have different networks of providers. Some of the lowest-priced policies are likely to have smaller networks.

What if I’ve been going without coverage?

  • Some of the 46 million uninsured Americans may be subject to a penalty starting at $95 next year if they don’t have coverage starting Jan. 1. You can go to the new insurance exchanges to shop for plans, or if your income is below 138% of the federal poverty level, you may qualify for Medicaid, depending on your state.

Those of us on Medicare?

  • If you’re one of 49 million in the Medicare program, with or without a supplemental insurance plan, you’ll continue to enroll the same way. The law cuts spending by billions of dollars over a decade—largely by reducing payments to hospitals and doctors and increasing incentives for more-efficient care—but it doesn’t directly affect benefits. Supporters say this will strengthen Medicare. Opponents say seniors will find it harder to access their benefits if providers are squeezed.

*Modified from a WSJ.com article

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Ten states where Obamacare wipes out existing health care plans

Here are the ten states where consumers may like their health care plans, but they won’t be able to keep them.

1) California: 58,000 will lose their plans under Obamacare. The first bomb dropped in California with a mass exodus from the most populated state’s Obamacare exchange. Aetna, the country’s largest insurer, left first in July and was closely followed by UnitedHealth. Anthem Blue Cross pulled out of California’s Obamacare exchange for small businesses as well. *Fifty-four percent of Californians expect to lose their coverage, according to an August poll.

2) Missouri: Patients of the state’s largest hospital system — which spans 13 hospitals including the St. Louis Children’s Hospital — will not be covered by the largest insurer on Obamacare exchanges, Anthem BlueCross BlueShield. Anthem covers 79,000 patients in Missouri who may seek subsidies on Obamacare exchanges, but won’t be able to see any doctors in the BJC HealthCare system.

3) Connecticut: Aetna, the third largest insurer in the nation, won’t offer insurance on the Obamacare exchange in its own home state, where it was founded in 1850. The reason? “We believe the modification to the rates filed by Aetna will not allow us to collect enough premiums to cover the cost of the plans and meet the service expectations of our customers,” said Aetna spokesman Susan Millerick.

4) Maryland: 13,000 individuals covered by Aetna and its recently-purchased Coventry Health Care won’t be able to keep their insurance plans if they want Obamacare subsidies on the exchanges. Aetna and Coventry canceled plans to offer insurance in the exchange when state officials wouldn’t allow them to charge premiums high enough to cover costs.

5) South Carolina: 28,000 people were insured by Medical Mutual of Ohio, SC’s second-largest insurance company, until it decided to leave the state entirely in July due to Obamacare’s “vast and quite complex” new regulations. Company spokesman Ed Byers said Medical Mutual’s patients would be switched over to United Healthcare plans instead.

6) New York: Aetna pulled out of New York’s exchange in late August in an effort to keep their plans “financially viable,” said Aetna spokeswoman Cynthia Michener.

7) New Jersey: 1.1 million Aetna customers are at risk in New Jersey, where the leading insurer also won’t be a part of the exchange. Just 2,600 patients purchase individual plans with the company, but any looking to take advantage of subsidies on the exchange for unaffordable employer-based insurance won’t be able to do with Aetna.

8) Iowa: Wellmark Blue Cross and Blue Shield, Iowa’s largest health insurer, decided not to offer plans in the Obamacare exchange. It sells 86 percent of Iowa’s individual health insurance plans.

9) Wisconsin: Two of the three largest insurers in the state won’t offer plans on the exchange. United Healthcare and Humana patients will have to get a new health insurer to buy insurance on Obamacare exchanges.

10) Georgia: Just five insurers are participating in Georgia’s Obamacare exchange. Medical Mutual of Ohio left Georgia and Indiana as well as South Carolina, due to Obamacare regulations. Aetna, along with Coventry, also decided against participating in the George health exchange.
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*Modified from a DailyCaller.com article

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Insurers limiting doctors, hospitals in health insurance market

THE DOCTOR CAN’T SEE YOU NOW! In recent months, the top priority for state officials and insurers has been affordable premiums. A smaller panel of doctors and hospitals generally yields lower rates because insurers can negotiate better discounts. Insurers in California’s new health insurance exchange are holding down premiums by limiting choices, raising concerns that patients will struggle to get care.

  • Major insurers have limited the number of doctors and hospitals available in California’s new health insurance market. Cedars-Sinai Medical Center, for example, is available only on two lower-priced Health Net plans in the state-run market. To hold down premiums, major insurers in California have sharply limited the number of doctors and hospitals available to patients in the state’s new health insurance market opening Oct. 1.
  • New data reveal the extent of those cuts in California, a crucial test bed for the federal healthcare law. These diminished medical networks are fueling growing concerns that many patients will still struggle to get care despite the nation’s biggest healthcare expansion in half a century. Consumers could see long wait times, a scarcity of specialists and loss of a longtime doctor. “These narrow networks won’t work because they cut off access for patients,” said Dr. Richard Baker, executive director of the Urban Health Institute at Charles Drew University of Medicine and Science in Los Angeles.
  • To see the challenges awaiting some consumers, consider Woodland Hills-based insurer Health Net Inc. Across Southern California the company has the lowest rates, with monthly premiums as much as $100 cheaper than the closest competitor in some cases. That will make it a popular choice among some of the 1.4 million Californians expected to purchase coverage in the state exchange next year.
  • But Health Net also has the fewest doctors, less than half what some other companies are offering in Southern California, according to a Times analysis of insurance data. In Los Angeles County, for instance, Health Net customers in the state exchange would be limited to 2,316 primary-care doctors and specialists. That’s less than a third of the doctors Health Net offers to workers on employer plans. In San Diego, there are only 204 primary-care doctors to serve Health Net patients.
  • Health Net says price will probably matter most to the uninsured and people who buy their own health insurance now, so it built a narrow network to serve those “value seekers.” “We have more than enough doctors for our projected enrollment through 2014, and we have time to adjust if it becomes necessary,” Health Net spokesman Brad Kieffer said. “We continue reaching out to providers, and we are bringing more on board.”
  • Other major insurers have pared their list of medical providers too, but not to Health Net’s degree. Statewide, Blue Shield of California says exchange customers will be restricted to about 50% of its regular physician network. In response, California officials have been pressing Health Net and other insurers to add more doctors since companies filed their initial rosters in May. The state exchange, Covered California, says it will monitor enrollment closely once it begins next month and it’s prepared to step in if problems arise.
  • Rather than mere head count, officials say they are scrutinizing what capacity physicians have to accept new patients. And to assist consumers, California will enable people to search for specific doctors online during enrollment to determine what, if any, health plans they will be part of in Covered California. “Does the doctor have room for one more patient or 40 patients? It’s about available seats,” Lee said. “We want to make sure every network has enough doctors.”
  • In recent months, the top priority for state officials and insurers has been affordable premiums. A smaller panel of doctors and hospitals generally yields lower rates because insurers can negotiate better discounts with providers who receive more patients.
  • Insurers and some consumer advocates think people are willing to trade some choice in order to pay less. More employers have been adopting these narrower networks in recent years to trim their own healthcare bills. The California Medical Assn., which represents more than 37,000 doctors statewide, thinks the state is underestimating the difficulties ahead.
  • The differences in network size are noticeable across Southern California. Health Net has 920 physicians in Orange County, compared with more than 2,500 for Blue Shield, according to company data. Health Net has fewer than 800 doctors in San Diego County, while nearly 3,000 physicians are available in an Anthem Blue Cross plan.
  • In addition to doctors, some big-name hospitals may be left out. A spokesman for Cedars-Sinai Medical Center said the hospital has received many calls from patients who were worried about keeping their access to the hospital and its affiliated doctors in the new health plans next year. Cedars-Sinai is available only on two lower-priced Health Net plans in the state-run market, according to the hospital and insurer. Anthem Blue Cross says that it’s the only insurer that includes UCLA Medical Center and other UC facilities statewide.
  • Newly released data show the pricing power of these tighter networks. In Los Angeles County, Health Net is consistently the lowest-cost option for a mid-level Silver plan across various age groups. A family of four in Norwalk earning $65,000 annually would pay $384 a month for a Health Net policy, after taking into account a federal subsidy based on their income. For a policy with identical benefits, Blue Shield was next at $477 a month and Kaiser was the most expensive at $602.

*Modified from a LATimes.com article

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