Underinsured ACA Enrollees Strain Community Health Centers

[eridani]

http://www.kaiserhealthnews.org/daily-report.aspx

Obamacare enrollees are straining the finances of community health centers around the country, some health center leaders say. The issue is that many lower-income patients with insurance coverage through the federal and state exchanges bought bronze-tier plans with lower premiums but high deductibles, coinsurance and copayments and no federal cost-sharing subsidies. When these patients face high out-of-pocket costs for care that falls below the deductible, they can't afford it. So the centers are subsidizing that care by offering them means-tested sliding-scale fees. When the centers, which are not allowed to turn away patients for inability to pay, try to get the insurers to pay, the claims are usually denied, and the centers have to write it off as uncompensated care (Modern Healthcare, Dickson, 9/25).

Comment by Don McCanne of PNHP: One of the advantages of reform that ensures that everyone would have health care coverage is that safety-net institutions, such as community health centers (CHCs), could be assured that payments would be made for the services they provide, ending the continual struggle of funding these institutions. As it turned out, reform will still leave 31 million uninsured, perpetuating this problem. But at least those now insured will no longer stress the budgets of the CHCs. Or will they?

Those purchasing the cheapest plans on the exchanges - the bronze plans - have an average of only 60 percent of their health care costs covered. This requires very high deductibles which are not affordable for many of the low-income individuals purchasing these plans. Because of high deductibles which are difficult to collect after services are rendered, many health care providers are requiring payment upfront. Many would-be patients end up walking away because of the lack of funds.

Where are these people to turn? The CHCs of course. They cannot turn patients away, so they see them. When the CHCs then bill the bronze plan insurers, the charges are below the deductibles and so the claims are denied. They can then turn to the patients to try to collect means-tested fees that would apply to the deductibles, but such efforts are often futile, and so the CHCs end up writing off the charges as uncompensated care.

This is the plight of the underinsured and of the providers who care for them. With low actuarial value plans and often-inaccessible narrow networks, underinsurance has become ubiquitous. It is one of the most serious flaws in health care financing today, not only for the exchange plans but now also for a rapidly growing percentage of employer-sponsored plans.

This is just one of thousands of major flaws in our financing system. It just isn’t right. We can fix this by changing to a single payer national health program. Let’s do it. Now.

[daredtowork]

1. And there is always deprivation of mandated insurance by omission

Been without Medi-Cal since Sept. 2 simply because my Social Services case worker wouldn't put me back in the Medi-Cal database after I tried to earn some money for necessities and this cause everything at Social Services to auto-default to "shut off". The Social Services case worker has no incentive to fix my Medi-Cal situation, and there are no consequences if he doesn't fix it. Appealing is supposed to create some indirect ding on his record, but it doesn't address the situation any faster.

I have been going without medications, appointments, etc. since Sept. 2. In an emergency, I would be effectively "uninsured" wherever I went to get my problem addressed. My understanding is once I get Medi-Cal re-established, whoever treated me within 3-months can get back-billed, but still this hassle.

The ACA was a great first step, but there are far too many layers of complications and misdirects to allow stuff like this to happen. We need to just cut to the chase and do what we've been trying to "approach" - implement some sort of universal health care. Don't leave any "cracks" for people to fall through.

[jwirr]

16. As someone who has used many of our social programs for many years I can warn anyone that once

on the one thing we try never to do is - get off.

I worked with developmentally disabled clients in a workshop. They did not get paid enough to pay for their own medical needs so one of the things we did is monitor their hours so they did not make too much and get kicked off.

Welfare users once did that with AFDC so that they did not lose Medicaid for their families. One of the worst parts of being poor is that they limited what you can do to get ahead. I realize that the congress does not want someone who is rich to be on assistance but there is a long way between poor and rich.

[daredtowork]

24. Yes it's verty tricky

I was confused by the whole situation because I could not imagine that there would be no way to acquire basic necessities. It's bad enough that the whole welfare system implodes when you try to - but to cut you off from Medi-Cal, too? The very thing that's enabling you to work? The wrongness is just so astounding. It almost requires Lewis Carroll to imagine it.

[drm604]

2. And unless there's some kind of miracle this November

we won't be able to fix any of this any time soon.

[woo me with science]

6. Where on earth did you get the idea

that there are any plans to fix this?

[drm604]

10. I don't have that idea.

There's no way any fixes will get done, as I stated.

[eridani]

13. Not at tje national level. But there is a lot of activity on single payer at the state level n/t

[indivisibleman]

3. I was wondering about this.

I think people that haven't had insurance before the ACA don't realize how much high deductibles can hit you. We have a plan that is comparable to a silver to plan and still get hit with a fair amount of deductibles. If you get an aca plan don't go lower than the silver level.

[Habibi]

9. The ACA plans that I've seen

have deductibles that far exceed anything I had to pay while on Healthy NY, the erstwhile health plan for low-income New Yorkers. I managed to luck out and get Medicaid this year, but that won't be the case next year. Not looking forward to paying $300+ for the premium, with a ~$2000 deductible and higher co-pays than Healthy NY.

[Yo_Mama]

23. "Siver" plans still leave many unable to access health care

A $2,500 deductible is way out of reach for many, and it can be higher.

It's not just the bronze plans.

And the BS about "shop-around" doesn't work for many - in many rural areas, you get your choice of one or two insurers. In my county in GA it's one.

[StandingInLeftField]

29. Tell me about it...

"Silver" plan through a new company "Consumer's Choice" here in South Cackalackey. $435.00 per month with a $3000.00 deductible. Really just the same as no insurance at all. Yea, I can see the Doc for $25.00 but that's all I can do….

[flamingdem]

4. Very important

the Bronze plans just don't work other than catastrophic coverage and even then the costs are too high for many.

[DAMANgoldberg]

5. There is a health clinic here that has experienced this first hand...

They had to close one location, cut back to 3 days in another, and only have 1 staff doctor, no medical records personnel, and only 8 total staffers including executives. And this in a state whose governor refuses to expand Medicaid, even to the determent of their own party faithful. The person behind much of this effort is running for US Senate and must go down hard. I will vote to make sure that happens. If this becomes a wave election for the Progressives, then we can go down the path to single payer or Medicaid/Medicare for all.

In my plan, private insurance would still be available to either speed up the process, bypass the general clinics, or for elective surgeries, but everyone will have basic and hospital care as a birthright. I would allow the use of the Minute Clinic or similar establishments for non-emergency care, cost savings, and convenience.

DISCLAIMER: A current user of linked clinic.

[eridani]

12. Single payer allows for private insurance to cover anything not covered by single payer

It's like the fire department, where everyone gets the same fire engines. This doesn't mean, though, that people like Bill Gates can't buy expensive alarm and sprinkler systems in addition.

[DAMANgoldberg]

25. Thanks for the reply.

BTW, if Single Payer and/or Medicare/Medicaid for all are a similar concept, why favor one over the other? Just asking.

[eridani]

26. The plan would be for Medicare and Medicaid to be folded into a universal system n/t

[DAMANgoldberg]

27. Thanks for the reply.

Now I am a bit more informed about the subject than I was a few minutes ago. Learning is Fundamental and Fun!

[woo me with science]

7. The corporate mandate was the goal.

The only "fixing" planned seems to move in the opposite direction.

Obama administration quietly approves new Obamacare loophole benefiting insurance companies.
http://www.democraticunderground.com/10024970298

[Cali_Democrat]

18. Why did Bernie vote for the ACA?

Bernie Sanders on the Affordable Care Act:

Bernie wrote this the day the Supreme Court upheld the law:


The Supreme Court on Thursday upheld the Affordable Care Act. Sen. Bernie Sanders welcomed the ruling. "Today is a good day for millions of Americans who have pre-existing conditions who can no longer be rejected by insurance companies. It is a good day for families with children under 26 who can keep their children on their health insurance policies. It is a good day for women who can no longer be charged far higher premiums than men.

"It is a good day for 30 million uninsured Americans who will have access to healthcare. It is a good day for seniors who will continue to see their prescription drug costs go down as the so-called doughnut hole goes away. It is a good day for small businesses who simply cannot continue to afford the escalating costs of providing insurance for their employees. It is a good day for 20 million Americans who will soon be able to find access to community health centers.

"It is an especially good day for the state of Vermont, which stands to receive hundreds of millions of dollars in additional federal funds to help our state achieve universal health care.

"In my view, while the Affordable Care Act is an important step in the right direction and I am glad that the Supreme Court upheld it, we ultimately need to do better. If we are serious about providing high-quality, affordable healthcare as a right, not a privilege, the real solution to America's health care crisis is a Medicare-for-all, single-payer system. Until then, we will remain the only major nation that does not provide health care for every man, woman and child as a right of citizenship.

http://www.sanders.senate.gov/newsroom/recent-business/a-good-day

Bernie Sanders' recent statement on the ACA: “This is a big, big deal.”

There was a surge in signups for health coverage in advance of Monday’s midnight deadline to enroll under the Affordable Care Act. “Ten million people today have health care who previously did not,” Sen. Bernie Sanders told Ed Schultz in a radio interview on Tuesday.

“This is a big, big deal.” Even more Americans would be covered, Sanders said, if 23 states would accept expanded Medicaid services available under the Affordable Care Act. The coverage would come at no additional cost to the states for three years. And even more people would be covered and get better care at less cost if the United States provided Medicare-like coverage for all Americans.

Sanders hopes Vermont will show the rest of the country the advantages of universal health care like the rest of the major countries in the world.

http://www.democraticunderground.com/10024765617

Sanders: Single Payer Never Had A Chance

Sen. Bernie Sanders (I-VT) reminded the progressive media gathered on Capitol Hill today that single-payer health care reform was dead before it started in the Senate.

"It would have had 8 or 10 votes and that's it," he said, addressing a topic central in the minds of many who the bloggers and left wing talk show hosts gathered for the 4th annual Senate Democratic Progressive Media Summit in Washington reach everyday.

Sanders is among the few in the Senate not afraid to say he supports government-run, universal health care. But his calls for such a program have gone unanswered, much to the chagrin of progressives who still feel it is the best way to solve the nation's health care crisis.
Sanders said it was still possible for single-payer to come to the U.S. eventually -- but he said the road will not begin in Washington. If a state like California or Vermont ever instituted a single-payer system on its own, Sanders said, it would eventually lead to national adoption of universal coverage.

http://talkingpointsmemo.com/dc/sanders-single-payer-never-had-a-chance

[woo me with science]

19. Divide, divide, divide.

Not too many good choices left after Obama traded away the public option. But...you already knew that, because you have used this particular ineffectual and divisive attempt at "gotcha" before.

Gee, what could be the answer?
http://www.democraticunderground.com/10024699337#post2

Bernie Sanders introduces bill for single payer
http://www.democraticunderground.com/10024158597

Yeah, they told us they would fix it later. Turns out this is what they meant:

Obama administration quietly approves new Obamacare loophole benefiting insurance companies.
http://www.democraticunderground.com/10024970298

Divide, divide, divide, as per usual. You carry on by yourself, now...

[Cali_Democrat]

21. I seem to recall you having a Bernie For Prez picture in your sig line....

Wuh happened?

He sold out, eh?

It's pretty darn easy to correct your disinformation and revisionist history. Obama never traded away the public option.

The public option never even made it out of committee:

http://www.nytimes.com/2009/09/30/health/policy/30health.html?_r=2&

[BrotherIvan]

8. It is possible to get supplemental plans that cover the deductible

I heard they are more affordable and actually better coverage with a bronze+supplemental than a silver plan. I hate my insurance and know it is probably not worth the paper it's written on. My insurance company has basically told me so.

[leftstreet]

15. How shitty is the ACA if people need deductible insurance?

[BrotherIvan]

17. Very

My previous plan tripled in the few years lead up to the roll out. Since I never use my insurance anyway, I could not justify paying 50% of the cost of my rent for it. I went to an ACA plan and was told it did not cover anything out of state or out of the country, including hospitalization. It is worthless crap. I was in a near fatal car accident a few months ago and because I was miraculously unscathed, my trip to the hospital to make sure was part of the deductible. Out of pocket. So that means in order to actually use my insurance, I need to pay $10k a year of premiums + deductible.

And the best part is, though I pay automatically the first of the month, they always claim never to have gotten it and send a letter to cancel. Every. single. month.

I know a lot of people are excited at the thought of being insured. But when it comes time to actually use it, they will likely realize how bad it is and remember that insurance companies are the biggest scumbags in the world. But yay!

[woo me with science]

22. No shit.

Er....lots of shit, I mean.

We are ruled by corporatists and warmongers. Representative government, my ass.

[woo me with science]

11. kick

[Le Taz Hot]

14. Couldn't possibly be.

As we are told time and again on DU, it's the most wonderfulest thing since Medicare. Nevermind about the MILLIONS who are falling through the cracks.

[woo me with science]

20. Oh, those profit statements!

They managed to MANDATE that *every single American* purchase an outrageously overpriced corporate product for their *entire lives.*

Think about that. What a coup for the one percent. This sort of mandate to buy is unprecedented.

The mandate was the goal all along, and it was planned to profit the insurance companies, period. They knew from the outset that it was nothing that people on either side really wanted, and that is why it was never presented honestly and why we got the Kabuki theater of the negotiations. Not only did our Democratic president make a backroom deal, he lied to the American people and claimed that he had never campaigned on a public option after the deal had been made, just as he had lied to Americans that he would not support a mandate.

It was a brilliant, bipartisan scam.

There is no way in hell that they ever would have been able to sell what was passed to the American people had they gone about it honestly. Not to Democrats, because of opposition to the corporate model, and not to Republicans, because of the government mandate. But fire up one side with the promise of universal coverage, and fire up the other side with the threat of government health care, and you can pass a "COMPROMISE" that nobody wants....except the corporations that will rake in the dough. The mandate on the corporate product was the goal all along.

I remember, just before this passed, watching some pundit on TV discussing polls showing that Democrats hated the plan, and Republicans hated the plan. His conclusion was (I am not making this up), "This must mean they are charting a good middle course."

What a brilliant con. These corporatists, they are very slick at what they do.

[Fumesucker]

28. On Nov 19, 2008 I said this on DU..

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=4494168&mesg_id=4494251

None of this surprises me in the slightest, it was obvious from the time of the 2008 election that the private mandate was where American politics was headed, there's just too much damn money involved for it to be otherwise.