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OBAMACARE.
Posted on 10/03/2014 8:26:34 AM PDT by wagglebee
Californians with health insurance obtained through the Obamacare exchange are continuing to find themselves being turned away when they seek out many top health care specialists and hospitals, according to the latest report in an ongoing investigation by the Los Angeles Times.
The Obama Health Care exchange (called Covered California within the state) has the power to exclude insurance plans in the exchange based on rate increases. The problem is the plans often need to raise rates to ensure access to high-level life-saving care. Because plans are worried about being booted from doing business in the state exchanges, they have slashed costs by dramatically reducing access to highly effective–and therefore more expensive–doctors and medical centers.
In a September 28, 2014, piece, “Obamacare doctor networks to stay limited in 2015″, reporters Chad Terhune, Sandra Poindexter, Doug Smith chronicle the result:
“The state’s largest health insurers are sticking with their often-criticized narrow networks of doctors, and in some cases they are cutting the number of physicians even more, according to a Times analysis of company data.”
Narrow networks are one way insurers are attempting to keep premiums unrealistically low.
Another way people are being denied access is through pushing insurance plans that normally only allow the use of in-network providers—what most people used to call “closed-panel Health Maintenance Organizations (HMOs)” (although their label has now changed):
In addition to shedding doctors, California’s biggest insurers have promoted more restrictive policies known as EPO, or exclusive-provider organization, plans. Unlike a more generous PPO [“Preferred Provider Organization”], an EPO typically does not provide any coverage for out-of-network providers. Consumers would be responsible for the full charges if they left their network.
California officials seem pleased with the reduction in health care access despite rampant consumer complaints, because it means less money devoted to saving lives and preserving health. From the LA Times piece:
Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, said …”It’s been a low priority for insurance companies to maintain these provider directories, and states really aren’t pushing back on narrow networks….”
“Covered California endorses the industry’s narrow network strategy as a way to keep premiums affordable. The state has credited it for helping produce two straight years of lower-than-expected premiums for individual coverage. Rates for 2015 are expected to increase 4.2%, on average.”
While many are quick to blame profit-driven insurers, the real culprit is likely the Obamacare provision under which exchange bureaucrats must exclude insurers who offer policies deemed to allow “excessive or unjustified” health care spending by their policyholders. Insurers are quoted as having their eye on managing rates hikes – despite the fact that these rate hikes are often necessary to maintain access to the best docs and hospitals.
The LA Times article explained:
Health Net has proposed the most dramatic change for 2015, the data show. It’s dumping the PPO network . . . and switching to a plan with 54% fewer doctors and no out-of-network coverage, state data show…. Health Net said its cutbacks were necessary to avoid even steeper rate hikes and it’s confident the smaller network will be sufficient.
Under the Federal health law (Obamacare), state insurance commissioners are to recommend to their state exchanges the exclusion of “particular health insurance issuers … based on a pattern or practice of excessive or unjustified premium increases.” The exchanges not only exclude policies in an exchange when government authorities do not agree with their premiums, but the exchanges must even exclude insurers whose plans outside the exchange offer consumers the ability to reduce the danger of treatment denial by paying what those government authorities consider an “excessive or unjustified” amount.
Under Obama Administration regulations, any plan with a year-to-year premium increase exceeding 10% is to be treated as suspect.
This means that insurers who hope to be able to gain customers within the exchanges have a strong disincentive to offer any adequately funded plans that do not drastically limit access to care. So even if you contact insurers directly, outside the exchange, you are likely to find it hard or impossible to find an adequate individual plan. (See documentation at www.nrlc.org/medethics/healthcarerationing.)
When the government limits what can be charged for health insurance, it restricts what people are allowed to pay for medical treatment. While everyone would prefer to pay less–or nothing–for health care (or anything else), government price controls prevent access to lifesaving medical treatment that costs more to supply than the prices set by the government.
Many experts predict that when the exchanges are opened to employees of all businesses in 2017, many employers will end their present coverage and force their workers into the constricted exchange plans. Just as most businesses have gradually moved away from “defined benefit” pension plans under which retirees were guaranteed a certain income, replacing them with “defined contribution” programs under which employees must instead rely on their own contributions to their 401(k) retirement plans while receiving some matching contributions from employers, experts predict most businesses will stop offering their employees health insurance directly, instead providing them a lump sum they can use toward the cost of exchange health plans.
So the dramatic cutbacks in access to those specialists and medical centers that provide expensive care for hard-to-treat, challenging illnesses and injuries are likely to spread beyond the health plans for individuals and small businesses now most directly affected to include the insurance plans covering almost all Americans.
“As more and more insurers exclude top-level medical centers like Johns Hopkins, M.D. Anderson, and UCLA Medical Center, such go-to facilities for advanced care will have no economic option but to shrink to shells of their current capacities,” says Burke Balch, JD, director of National Right to Life’s Powell Center for Medical Ethics.
Balch warns, “If Obamacare’s rationing proceeds unabated, within five to ten years we can expect most of America’s top-rated specialists either to retire or to move overseas to locales like the Cayman Islands, Singapore, and Malaysia, which are already attempting to assume the leadership role in cutting-edge medicine once held by the United States. Unless changes in Congress and the Presidency make possible the adoption of Senator Pat Roberts’ (R-KS) ‘Repeal Rationing in Support of Life Act’ [www.nrlc.org/communications/releases/2014/release040114/] or similar legislation, the time may not be too distant when Americans needing advanced medical care had better have their passports – and their bank accounts – ready.”
You can follow up-to-date reports here: powellcenterformedicalethics.blogspot.com
LifeNews Note: Jennifer Popik is a medical ethics attorney with National Right to Life. This column originally appeared in its publication National Right to Life News Today.
In other words, only the wealthy will have good health care.
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Simple- Obama will just ORDER THEM to serve Obamacare patients!
See? Easy when you are a totalitarian.
Yup. Socialism at its best — before: most people had decent health care; after: everyone has bad health care.
only the wealthy will have good health care.
And of course our government employees - THE OBAMA ADMINISTRATION and friends.
I that man wasn’t black and a progressive he would be impeached and in jail for treason. He was the perfect storm.
Actually, you are probably correct. They will give the doctors incentives if they do and make it painful if they don’t.
Of course, that’s what happens in Communist regimes. What was unique about the US will be gone, because the free market is left out of the equation and replaced with Government waste and paperwork...and unionized workers, a la the NHS.
Isn’t Socialism great? Everyone gets equal misery so the useless bureaucrats and government workers can have high-paying jobs for creating no wealth?
You can’t compel a Doctor to see people for next to nothing.
Socialism always fails.
This should become a campaign ad for all GOPers the Dems should get all the credit and blame for Obamacare.
And a New Congress could force this implementation immediately and destroy the Demonrat Party as we know it.
Many experts predict that when the exchanges are opened to employees of all businesses in 2017, many employers will end their present coverage and force their workers into the constricted exchange plans
What I think is funny (not ha ha funny, but shake your head funny) is that Obamacare has not even really kicked in yet.
Wait until those of us on company health plans kick in. Remember, the only folks affected right now are the uninsured and the self insured.
We haven’t even seen the start of Act II yet.
Healthcare, the vaccines, are only meant for the EXEMPT.
The other Americans??
Obola: “Let them eat EV-68”.
all together now: that was the elite's plan all along
now that deadly disease has been unleashed upon the US by the fraud in the WH, the elite's plan is ensured to be affective in depopulating their primary enemy, the middle-class. Oh sure, there will be many collateral deaths in the process.
Unless you make it expensive. There is always that angle.
“Wait until those of us on company health plans kick in. Remember, the only folks affected right now are the uninsured and the self insured”
Problem is, by the time that happens, a republican will be president, and the msm will gleefully fall all over themselves to blame the republicans for not implementing obamacare correctly
The Small business portion of this kicks in next November. So that means the education of the masses will have to start with their open enrollments starting in what, August to September?
Its almost a shame most of us will be dead with Ebola and we will miss the riots and marches.
The goal is for the hospitals to fail and for the federal government to have to swoop in and save them. Thereby in effect running the hospitals. The regardless of what laws are in place, or what plans are available, you will only receive care of what the government wants you to receive and when they want you to receive it. Wealthy or not, you will be beholden to the government to survive. This will only make the government more powerful and regardless of Democrat or Republican, they will endorse it. At that point it will take 100 years to bring our health care system back to what it is.
That depends on how authoritarian the government wants to become, until the system becomes hollowed out and collapses. It could be made a condition to have a license to practice medicine to accept Obamacare patients. Regulatory agencies could single out resistors and their families and make public examples of them. If the doctor decides to quit practicing all together, the state passes a law that there is a public debt that must be paid off first, etc. Marxists can be really nasty.
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