Archive | Covered CA

ObamaCare’s Secret Mandate Exemption

HHS quietly repeals the individual purchase rule for two more years.

ObamaCare’s implementers continue to roam the battlefield and shoot their own wounded, and the latest casualty is the core of the Affordable Care Act—the individual mandate. To wit, last week the Administration quietly excused millions of people from the requirement to purchase health insurance or else pay a tax penalty.

  • This latest political reconstruction has received zero media notice, and the Health and Human Services Department didn’t think the details were worth discussing in a conference call, press materials or fact sheet. Instead, the mandate suspension was buried in an unrelated rule that was meant to preserve some health plans that don’t comply with ObamaCare benefit and redistribution mandates. Our sources only noticed the change this week.
  • That seven-page technical bulletin includes a paragraph and footnote that casually mention that a rule in a separate December 2013 bulletin would be extended for two more years, until 2016. Lo and behold, it turns out this second rule, which was supposed to last for only a year, allows Americans whose coverage was cancelled to opt out of the mandate altogether.
  • In 2013, HHS decided that ObamaCare’s wave of policy terminations qualified as a “hardship” that entitled people to a special type of coverage designed for people under age 30 or a mandate exemption. HHS originally defined and reserved hardship exemptions for the truly down and out such as battered women, the evicted and bankrupts.
  • But amid the post-rollout political backlash, last week the agency created a new category: Now all you need to do is fill out a form attesting that your plan was cancelled and that you “believe that the plan options available in the [ObamaCare] Marketplace in your area are more expensive than your cancelled health insurance policy” or “you consider other available policies unaffordable.”
  • HHS is also trying to pre-empt the inevitable political blowback from the nasty 2015 tax surprise of fining the uninsured for being uninsured, which could help reopen ObamaCare if voters elect a Republican Senate this November. Keeping its mandate waiver secret for now is an attempt get past November and in the meantime sign up as many people as possible for government-subsidized health care.
  • Sources in the insurance industry are worried the regulatory loophole sets a mandate non-enforcement precedent, and they’re probably right. The longer it is not enforced, the less likely any President will enforce it.
  • This lax standard—no formula or hard test beyond a person’s belief—at least ostensibly requires proof such as an insurer termination notice. But people can also qualify for hardships for the unspecified nonreason that “you experienced another hardship in obtaining health insurance,” which only requires “documentation if possible.” And yet another waiver is available to those who say they are merely unable to afford coverage, regardless of their prior insurance. In a word, these shifting legal benchmarks offer an exemption to everyone who conceivably wants one.
  • Keep in mind that the White House argued at the Supreme Court that the individual mandate to buy insurance was indispensable to the law’s success, and President Obama continues to say he’d veto the bipartisan bills that would delay or repeal it. So why are ObamaCare liberals silently gutting their own creation now?
  • The answers are the implementation fiasco and politics. HHS revealed Tuesday that only 940,000 people signed up for an ObamaCare plan in February, bringing the total to about 4.2 million, well below the original 5.7 million projection. The predicted “surge” of young beneficiaries isn’t materializing even as the end-of-March deadline approaches, and enrollment decelerated in February.
  • Meanwhile, a McKinsey & Company survey reports that a mere 27% of people joining the exchanges were previously uninsured through February. The survey also found that about half of people who shopped for a plan but did not enroll said premiums were too expensive, even though 80% of this group qualify for subsidies. Some substantial share of the people ObamaCare is supposed to help say it is a bad financial value. You might even call it a hardship.
  • The larger point is that there have been so many unilateral executive waivers and delays that ObamaCare must be unrecognizable to its drafters, to the extent they ever knew what the law contained.

*Modified from a WSJ.com article

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“Junk” Health Plans and Other Obamacare Insurance Myths

Obamacare affects nearly all areas of health care, but the most disruptive provisions of the law affect insurance sold in the individual market. In 2013, at least 4.7 million policyholders across 31 states and the District of Columbia were notified that their current coverage was being discontinued. The number is likely even higher, since data were not available for 19 states.

  • Myth: The canceled health plans were “substandard” policies.
  • Myth: Before Obamacare, there were routine plan cancellations in the individual market.
  • Myth: Pre-existing condition exclusions were rampant before Obamacare.
  • Myth: Obamacare plans are “better” insurance.

Obamacare’s advocates claim that the law and its plethora of new insurance regulations were necessary to better protect consumers in this market. They discount the large disruption of coverage for millions of people by claiming that the plan cancellations were for “substandard” policies and that plans were routinely canceled in this market regardless of Obamacare. Further, they assert that the law will replace these plans with “better” insurance all of which is largely untrue.

  • Myth: The canceled health plans were “substandard” policies.

President Obama has repeatedly referred to the 4.7 million discontinued policies as “substandard.” When the President announced his administrative “fix” that attempted to allow those with canceled plans to keep their existing plans for another year, Senator Tom Harkin (D–IA) said he was still “concerned about people having policies which don’t do anything. They’re just junk policies.”

Typically, “substandard” refers to plans with limited benefits, which are commonly seen as inadequate because they do not protect against catastrophic costs. These types of plans typically cover routine care, but if there were a major medical event, they might pay only up to a certain amount before leaving the enrollee to pay the rest.

Obamacare gradually phased out these types of plans from 2010 to 2013—completely outlawing them by 2014—by prohibiting both annual and lifetime limits on coverage.

Limited-benefit plans are not nearly as prevalent in the individual market as they are portrayed to be. Of the nearly 16 million enrollees in the individual market in 2012, 725,710 individuals were enrolled in plans classified as limited-benefit plans, and slightly more than a million were in student health plans, which also typically have a limited benefit package. Thus, less than 11 percent of the individual market in 2012 had a plan that could reasonably be considered “substandard.”

Limited-benefit plans are mostly offered by employers in the group market. Indeed, of the temporary waivers received by over 4 million plan enrollees from the Obama Administration for Obamacare’s annual limit caps before they were completely phased out, only 3.7 percent were for individual market plans; the rest were given to enrollees in group market plans.

  • Myth: Before Obamacare, there were routine plan cancellations in the individual market.

Many Obamacare defenders blame the discontinued policies on “bad apple insurers,” claiming that it was typical in this market to have plan cancellations and that they are not a result of Obamacare.

For instance, former Obama Administration official Van Jones called the individual marketplace a “‘wild, wild west’ where people were denied coverage for pre-existing conditions and policyholders were continually dropped by insurers offering thin, sketchy coverage.” In addition, President Obama said, “Before the Affordable Care Act, the worst of these plans routinely dropped thousands of Americans every single year.”

But since the enactment of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), insurers have been broadly prohibited from canceling or refusing to renew coverage. One of the few exceptions to that prohibition is if an insurer discontinues a particular plan or type of coverage. In such cases, the insurer must provide the affected individuals the option to enroll in any other applicable coverage that the insurer offers.

That is largely what happened with the 4.7 million plan cancellations that were reported at the end of 2013. The insurers were discontinuing their pre-Obamacare plans and offering policyholders replacement coverage that complied with Obamacare’s wide variety of new mandates and regulations.

  •  Myth: Pre-existing condition exclusions were rampant before Obamacare.

Individuals being denied health insurance or kicked off their plans because of pre-existing medical conditions is often cited by defenders of Obamacare as justification for the law. The President has said that “up to half of all Americans have a preexisting condition.”

However, while the problem did exist, it was on a much smaller scale than depicted. The issue was in the individual market, where about 10 percent of the privately insured purchase coverage. In the group market, where about 90 percent of privately insured Americans are covered, the issue was mostly resolved by HIPAA.

Beginning in 2014, Obamacare enforced a blanket prohibition of pre-existing condition exclusions in the individual market. A consequence of this policy is that it incentivizes people to wait until they are sick to purchase coverage. Thus, the law also included an individual mandate to force all Americans to purchase health insurance or pay a tax penalty.

Since the provisions did not take affect right away, the law created the pre-existing conditions insurance plan (PCIP) to operate from 2010 to 2014. It funded new high-risk pools in each state to provide temporary coverage to those with pre-existing conditions.

The PCIP experience revealed that the number of individuals facing pre-existing condition exclusions was not nearly as large as it was portrayed. The Obama Administration initially estimated that 375,000 people would enroll in the PCIP by 2010, but the highest enrollment total ever to occur over the three-year period was in March 2013: almost 115,000, only about 30 percent of original projections.

  • Myth: Obamacare plans are “better” insurance.

Obamacare does indeed mandate a host of new benefits that every plan must cover and new rules that each insurer must follow, but the result is not just standardization and over-regulation of health insurance; it also increases costs, which is seen in premiums and cost-sharing levels.

For instance, the average deductible for a bronze plan in the 34 states with a federally facilitated exchange is $5,095 a year for an individual, and the average catastrophic plan carries an individual deductible of $6,346. Moreover, 42 states will see significant average premium increases—in many cases, over 100 percent—for individuals purchasing from the exchanges. Therefore, enrollees may not see “better” insurance for their money.

*Modified from a heirtage.org article

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Many Reasons For Inaccuracies In Covered California Directory

Doctors, the insurance industry, and California’s medical establishment are shedding light on why there were so many inaccuracies in the now-removed Physician Directory on the Covered California website.

  • The reasons range from doctors opting out faster than insurance companies can update their lists, long-standing issues with accuracies on insurer’s provider lists, to confusion over whether doctors are required or not to participate.
  • Some doctors said that they are opting out because they said reimbursement rates for patients with Covered California plans are too low.
  • The California Medical Association blames a big part of the inaccuracies on confusion over whether doctors are required or not to participate in Covered California plans. The Association said most of the insurers on the exchange have fine print to their contracts requiring that doctors in their networks accept Covered California policies. As a result, some of those doctors are mistakenly turning patients away.
  • Other insurers, including Anthem Blue Cross and Blue Shield, are giving doctors a choice. And many, particularly independent physicians, are choosing not to participate.
  • Inaccuracies go beyond doctors being listed under Covered California plans they say they’re not accepting. There have also been reports that doctors have been listed as having the incorrect specialties, and that they were fluent in languages they couldn’t speak. One doctor on the list who has been retired for a year.
  • Customers aren’t the only ones complaining. Redwood City based internist Dr. Marie President said she is frustrated, about her inability to check what specialists are available to see her patients. “How do we know where to send them?” President asked.
  • Covered California denies physicians can’t get the information. Spokesman Dana Howard said doctors should check their contracts. Howard said Covered California is reviewing the issue of inaccuracies on the physician list.
  • He said if the agency discovers insurers tried to falsely claim they had a more robust list of providers, regulators will take action to remedy the problem.
  • But California’s insurance regulator, the Department of Managed Health Care (DMHC), said that could be an empty threat because inaccurate lists are not illegal.

*Modified from a CBSlocal.com online article

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Covered California Enrollees Complain Of Bait & Switch

A growing number of people who purchased health insurance through California’s state run exchange are complaining that they were misled about the availability of physicians in the network. Some are calling it a bait and switch.

  • Brent Undridge is one of those complaining. The Castro Valley resident said when he signed up for a Covered California plan back in December, he was led to believe he could continue seeing the same medical group he has been using for the past two decades.
  • But that did not turn out to be the case. I wanted to cry,“I’ve been going there for 26 years, I really like them and want to keep them as my doctors.”
  • Part of that expectation stemmed from President Barack Obama’s oft-repeated promise while campaigning for the Affordable Care Act that “If you like your doctor, you can keep your doctor.” A promise, the President later admitted was not accurate.
  • And it’s expected more Californians could find themselves in the same situation as Undridge as more and more doctors are opting not to accept Covered California patients, because they say reimbursement rates are too low or they can’t handle the additional clientele.
  • Covered California said it is investigating the complaints. The agency’s Dana Howard told KPIX 5: “If we do find that there is a preponderance of misinformation that is taking place,” the insurers will be held accountable.
  • But California’s insurance regulator, the Department of Managed Health Care (DMHC), said that could be an empty threat because inaccurate lists are not illegal. So far, DMHC said it has received about 350 complaints about Covered California insurance plans since the beginning of the year. Most of them from Anthem Blue Cross and Blue Shield customers.
  • Consumers who find their doctor was mistakenly listed at the time they enrolled, should call their insurer and ask it to make good on its promise.

Anthem Statement:

Anthem Blue Cross has made great progress in increasing the accuracy of the provider database and will continue to make improvements. Members who are having issues finding an in-network provider or who have questions about out of pocket expenses incurred should contact Anthem Blue Cross customer service for assistance.

Blue Shield Statement:

The number of complaints is accurate, but offers very little value out-of-context. More than 140,000 Californians selected Blue Shield plans as of December 31 meaning the 140 figure is a fraction of a percent of total enrollees. The high volumes have been challenging for Blue Shield and other plans, but we think it’s a good thing that so many Californians are purchasing health insurance through the exchange and we are working to address the backlog.

*Modified from a cbslocal.com – KPIX 5 article

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ConsumerWatch: Some Doctors Listed By Covered California Not Taking Coverage

Some frustrated enrollees of Covered California are accusing the insurance exchange of false advertising, after they said doctors listed on their website aren’t actually accepting Covered California plans.

  • After signing up, Guda Venkatesh couldn’t wait to pick his new doctors. “The first thing I wanted to do was to get a primary care doctor,” he told KPIX 5 ConsumerWatch. Venkatesh chose an Anthem plan specifically because the Covered California website said the plan had a variety of Stanford doctors near him.
  •  “Except when I started going through the doctors, each one and calling them up, none of them actually accepted the Covered California plan,” Venkatesh recalled. He then showed a three-page list of supposedly in-network doctors, but none accepted his insurance.
  •  Is it a case of false advertising? Anthem said it was a mistake and told KPIX 5, “Like other insurers, (Anthem) will continue to double check its provider lists to improve accuracy.”
  • KPIX 5 went to Covered California to ask if the list is their responsibility. Dana Howard with the exchange said, “Yes, it is our responsibility. However, we do not have an audit that goes on 24/7 to make sure that every bit of information is indeed accurate.”
  • Howard said if you signed up for a plan and it’s not what was advertised, there is still time to switch. Open enrollment continues until March 31st.
  • He said switching insurers is a lengthy and complicated process that should not be attempted online. Enrollees must work with a customer service representative to avoid gaps in coverage.
  • KPIX 5 asked Howard if there are inaccuracies on the website. “Well, there may be,” he said. Before signing up, Howard said it is crucial for enrollees to contact doctors to ensure they will be actually covered.
  • It was something Venkatesh assumed Covered California had done for him. “The premise of Covered California is that you’re able to compare plans and see which one is best for you. But if they are presenting that they have all these doctors in network but they don’t, then it doesn’t work,” he said.

Anthem said it is constantly updating their list of doctors to ensure accuracy. The insurer said in some cases, doctors may not realize they have an agreement to accept patients on some of these new policies.

*Modified from a cbslocal.com – KPIX 5 article

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California health exchange pulls error-ridden physician list–again

Admitting it gave some consumers bad information, California’s health insurance exchange pulled its physician directory for having too many errors. Covered California made the move late Thursday amid growing frustration among both consumers and doctors over inaccurate information about insurance networks in the state marketplace.

  • The exchange yanked its online directory of medical providers in mid-October after acknowledging there were serious problems then with the data. It published an updated list in November.
  • Since Obamacare policies took effect Jan. 1, many enrollees have complained that doctors won’t take their insurance even though the physicians were listed as part of their network on the state website and by their health plan.
  • The exchange said Thursday that “while the combined provider directory was a useful service for many consumers, some enrollees located physicians thought to be in their plan, and subsequently discovered they were not.”
  • The exchange has touted the directory as an important consumer tool because some insurers have sharply limited the number of doctors and hospitals in policies being offered under the federal healthcare law.
  • The state said enrollees who are unsatisfied with their provider network still have time to cancel their coverage and sign up with a different insurer before open enrollment ends March 31. However, that may be little comfort for people who experienced computer errors and long delays to enroll the first time under the Affordable Care Act.
  • Customer service problems continue to plague the exchange and some insurers in light of 625,000 people enrolling through mid-January. Covered California said people waited nearly 52 minutes, on average, to speak with someone at the state’s call center last week.
  • Covered California said it will continue to include online links to insurers’ provider directories. But the exchange directory offered the advantage of enabling people to search for doctors across health plans while shopping for coverage.
  • In an interview last week, officials at the California Medical Assn. said they were still finding flaws in the state’s data, often because of incorrect information from insurers. Health insurance companies, in turn, blame some doctors’ offices for mistakenly turning patients away even though they are under contract for the networks.
  • Many insurers have adopted narrower networks to help hold down premiums on individual policies sold in and outside the exchange.

*Modified from a latimes.com article

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Obamacare enrollees hit snags at doctor’s offices

Many consumers faced hurdles signing up for Covered California health plans. Now they’re having trouble finding in-network doctors. After overcoming website glitches and long waits to get Obamacare, some patients are now running into frustrating new roadblocks at the doctor’s office.

  • A month into the most sweeping changes to healthcare in half a century, people are having trouble finding doctors at all, getting faulty information on which ones are covered and receiving little help from insurers swamped by new business.
  • Experts have warned for months that the logjam was inevitable. But the extent of the problems is taking by surprise many patients — and even doctors — as frustrations mount.
  • The Covered California exchange began enrollment in October without the provider directory it had promised. Delays and glitches ensued for weeks, frustrating many consumers who complained that it was impossible to compare health plans without details on what hospitals and doctors were included. In November, the exchange updated its directory.
  • To hold down premiums under the healthcare law, major insurers have sharply cut the number of doctors and hospitals available to patients in the state’s new health insurance market. Now those limited options are becoming clearer, and California officials say they are receiving more consumer complaints about access to medical providers.
  • Nationwide, about 70% of new insurance plans under the healthcare law feature relatively narrow hospital networks compared with many existing plans, according to consulting firm McKinsey & Co.

Aliso Viejo resident Danielle Nelson said Anthem Blue Cross promised half a dozen times that her oncologists would be covered under her new policy. She was diagnosed last year with non-Hodgkin’s lymphoma and discovered a suspicious lump near her jaw in early January.

But when she went to her oncologist’s office, she promptly encountered a bright orange sign saying that Covered California plans are not accepted. “I’m a complete fan of the Affordable Care Act, but now I can’t sleep at night,” Nelson said. “I can’t imagine this is how President Obama wanted it to happen.”

“It’s a little early for anyone to know how widespread and deep this problem is,” said California Insurance Commissioner Dave Jones. “There are a lot of economic incentives for health insurers to narrow their networks, but if they go too far, people won’t have access to care. Network adequacy will be a big issue in 2014.”

The latest travails come at a crucial time during the rollout of Obama’s signature law. Government exchanges and other supporters of the healthcare law are trying to boost enrollment, particularly among young and healthy people, ahead of a March 31 deadline.

Of course, complaints about outdated provider lists and delays in getting a doctor’s appointment were common long before the healthcare law was enacted. But some experts worry the influx of newly insured patients and the cost-cutting strategies of health plans may further strain the system.

Maria Berumen, a tax preparer in Downey, was uninsured for years because of preexisting conditions. The 53-year-old was thrilled to find coverage for herself and her husband for $148 a month after qualifying for a big government subsidy.

She jumped at the chance in early January to visit a primary-care doctor for long-running numbness in her arm and shoulder as a result of bone spurs on her spine. The doctor referred her to a specialist, and problems ensued.

At least four doctors wouldn’t accept her health plan — even though the state exchange website and her insurer, Health Net Inc., list them as part of her HMO network. “It’s a phantom network,” Berumen said.

It was no surprise to her family doctor, Ragaa Iskarous. She has run into this problem repeatedly with other patients in the last month, the doctor said. “This is really driving us crazy.”

Insurers say they are working hard to resolve customers’ problems as they arise, and they continue to add physicians to augment certain geographic areas and medical specialties.

Looking to head off potential problems, government regulators and patient advocates are pushing for tougher rules to ensure health plans provide timely access to care.

Last week, the California Assembly approved legislation enabling people who lost coverage because of the overhaul to keep seeing their doctors if they’re pregnant or undergoing treatment for cancer or other conditions.

Nelson, the cancer patient in Orange County, and her family lost their previous coverage when Aetna stopped selling individual policies in the state last year. After numerous complaints to her new insurer, Anthem, and to public officials, the company said it would cover visits to her current oncologist through March 31.

Nelson said such a temporary extension doesn’t solve the problem, and as a result, she’s rushing to check out other policies for herself before open enrollment closes in March.

A spokesman for Anthem said the company “continually works to update its provider directories to ensure accuracy” and helps customers with these issues on a case-by-case basis.

“It’s pretty clear insurers responded to greater competition by trying to hold down costs through narrower networks,” said Larry Levitt, senior vice president at the nonprofit Kaiser Family Foundation. “Insurers have made the judgment that people prefer lower premiums to broader networks.”

Health policy experts and some consumer advocates say the trade-offs may pay off. Despite some consumer complaints, the exclusion of some higher-priced hospitals such as Cedars-Sinai Medical Center from nearly all exchange plans is a positive sign, they say.

“The Affordable Care Act often gets accused of not doing enough to control costs,” said Ian Hill, senior fellow at the Urban Institute, a Washington think tank. “Excluding some of the most expensive hospitals and providers who don’t demonstrate high-quality outcomes is one ripple effect that may help.”

The California Medical Assn. credits the exchange for fixing many of the initial problems but maintains that the state’s data are still flawed, often because of incorrect information from health plans. Insurers blame doctor’s offices for frequently giving wrong information.

Scott Marshutz of Dana Point said he picked a Blue Shield PPO plan in the exchange so he and his wife would have greater choice of doctors.

But when he booked an appointment recently with his orthopedic surgeon, the doctor’s office said it wasn’t taking Covered California plans.

“I’m wondering how many other people have experienced this,” he said, “and if it will backfire on the whole system.”

*Modified from a latimes.com article

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Anthem to raise some premiums as much as 25%

Up to 306,000 Californians with older, individual Anthem health insurance policies — unchanged by Obamacare — are subject to the rate increases. Individual customers with older insurance policies untouched by Obamacare are getting some jarring news: Their premiums are going up as much as 25%. 

  • Amid the fury last fall over canceled health policies, consumer advocates and state officials warned people that holding onto grandfathered policies purchased before the federal healthcare law was enacted in 2010 wouldn’t shield them from significant rate hikes.
  • The Affordable Care Act makes it easier for people in this situation to switch coverage because insurers can no longer deny applicants on the basis of preexisting conditions or charge them more because of their medical history.
  • The company said customers do have new options thanks to the healthcare law. “Many of the members affected exchange and may have lower premiums if they decide to switch to an Affordable Care Act-compliant policy.
  • But changing plans isn’t an appealing option for some consumers who like the benefits they have now and worry about losing access to their doctors.

In recent months, state regulators have criticized major insurers for overstating what they expect to pay for patients’ future medical costs in order to support substantial rate increases. Other insurers have met resistance when boosting premiums on grandfathered policies.

But state officials don’t have authority to reject health insurance rate increases. An initiative on the November ballot seeks to change that by giving the insurance commissioner the power to deny excessive increases for health coverage.

Opponents of the ballot measure, including insurers, doctors, hospitals and business groups, say it doesn’t address the underlying reasons for rising premiums.

Critics also worry that stricter rate regulation could undermine the new state exchange, which negotiates rates with health plans as part of the healthcare law.

*Modified from a latimes.com article

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Cost of Generic Drugs Soaring Due to Increased Demand from Obamacare

The pervasive use of generic over brand-name medications was anticipated to be a money-saver, but recently prices are soaring, even up 6,000 percent for some common drugs that were once fairly low-cost. Seventy seven percent of pharmacists said they experienced 26 or more instances of a large increase in the acquisition price of a generic drug within the last six months of 2013.

Generic drugs such as Pravastatin, which treats high cholesterol, and the antibiotic Doxycycline spiked upwards of 1,000 percent in 2013, according to a survey by the National Community Pharmacists Association.

Eighty four percent of pharmacists said price fluctuations prevented them from providing care and remaining in business due to the fact that filling prescriptions resulted in losses when some patients refused their prescriptions because of costs.

The pharmaceutical consulting firm Pembroke Consulting found that within the last year more than a dozen drugs increased ten times their standard rate. Some pharmacists and physicians are pointing a finger of blame at drug companies for the price hikes.

At Costco, for example, at one given time the generic high blood pressure medication Irbesartan was nearly $300 for a 90-day supply of the 150 mg tablet, yet the cost of the same supply of the 300 mg tablet was only $30.

Dan Mendelson, CEO of consulting firm Avalere health, says prices of generic drugs have gone up because demand for them has risen. Since ObamaCare requires all health insurance plans in the exchanges to cover prescription drugs, the new health reform law may increase demand for drugs, causing prices for generic medications to rise even higher in the future.

*Modifed from a breibart.com article

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California’s Obamacare Scandal

Officials say a criminal record should not keep someone from getting a job. “Disclosing the names and criminal records of individuals applying to assist in Covered California’s push to enroll vast numbers in health insurance by March 31, 2014, is likely to discourage participation in this critical program and thus harm the people of California.”

  • Translation: If Californians had the same information as their insurance exchange’s bureaucrats regarding navigators’ criminal records, they’d be scared off — and that would undermine the political goal of high enrollment.

Perhaps Californians should consider themselves lucky that their navigators are required to submit to background checks at all — there is no such requirement in the ACA itself, and in as many as 31 states, no screening is mandated.

In California, however, certified enrollment counselors must pass a fingerprint-based criminal-background check conducted by the state Department of Justice. Applicants with potentially disqualifying convictions undergo individual legal review before a hiring decision is made, and they have the chance to appeal it within 60 days.

The problem is, a background check isn’t worth much unless it’s paired with an assessment process that screens out applicants who pose a risk to the public. In California, an applicant is disqualified only if he or she has “been convicted of or has a pending charge for a crime of moral turpitude that is substantially related to the qualifications, functions, or duties of the job.”

Furthermore, even though applicants are required to self-report prior offenses, records show that 21 prospective certified enrollment counselors who later proved to have criminal convictions failed to do so — and were approved anyway.

The fraud and forgery convictions, though disclosed by the applicants themselves, are the most worrying. Covered California’s Howard tells me, “There isn’t any law that says we should consider financial crimes as something that will follow you through the rest of your life, and therefore you should not have a job. That’s just not appropriate.”

But in some other states’ exchanges, financial crimes such as fraud and forgery are automatically disqualifying. And though no long-term statistics are available, the three-year recidivism rate for people convicted of fraud or forgery in California is a whopping 52.8 percent, according to a brand-new report from the state Department of Corrections and Rehabilitation.

“Somebody with multiple counts of forgery — it is in their nature to commit crime,” says identity-theft expert Robert Siciliano, CEO of BestIDTheftCompanys.com. “They see crime as the path of least resistance to make a living, and it would only make sense that they would gravitate toward a profession with this kind of access.”

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