The Hill by Justin Sink –

February 14, 2014:

The White House on Friday said it doesn’t know how many enrollees of the 3.3 million reported enrollees in ObamaCare had paid their premiums.

“The contract between an individual and an insurance company is a private contract,” White House press secretary Jay Carney said. “That is something that is determined by the insurance company and the enrollee. Right now, insurance companies, for that reason, have the most up-to-date, comprehensive and reliable information

on the number of people who have paid their premiums.”

The New York Times http://www.trevorturnbull.com reported that around 20 percent of consumers who selected a plan under ObamaCare did not pay and thus failed to obtain coverage. If 20 percent of the 3.3 million who enrolled failed to make a payment, the number of ObamaCare participants would drop by about 600,000, to 2.7 million.

Critics of ObamaCare have accused the administration of inflating their enrollment figures by including people who had not paid their premiums.

But Carney, pointing to the Times report, said a “high percentage of people have in fact paid for their plans”

“I know there is a constant search for less than good news in the HealthCare.gov arena, but if you look at the data reported, it is overwhelmingly positive,” Carney said. “And the predictions of failure and doom and gloom that we saw, understandably, perhaps, given how rocky the start was in October and November, have all come to naught. ”

The White House spokesman said the government was also developing an automated payment processing system that would allow users to immediately pay their premiums — and let the administration to measure how many ObamaCare enrollees had actually gained coverage.

“And there’s an automated payment system that will

be coming online fully in the next several months, which will include in the flow of information, more specific timely data relating to the payment of premiums by enrollees provided by the insurance companies,” Carney said.

Kaiser Health News by Jay Hancock – February 17, 2014: Congratulations. You bought insurance through one of the online Affordable Care Act exchanges, possibly after days or weeks of trying to get the site to work. Don’t relax. Joining the plan is only the first challenge. Now you have to understand it. Policies sold through the online portals — to more than 3 million people so far — cover essential benefits and put a cap on your out-of-pocket medical costs. But you need to follow the rules. And the boilerplate explanation you got from the insurance company may be hard to understand. What do members need to know about these plans that they probably don’t? Carry your membership card everywhere. Make copies. It’ll save huge amounts of hassle if you have an unexpected doctor or hospital visit. Understand your plan’s doctor and hospital network. Insurance companies negotiate participation and payment rates with a network of providers to control costs. “A lot of these exchange plans, in order to stay affordable, have much smaller networks than people cialis online generic are used to,” says Nancy Metcalf, a senior editor for Consumer Reports. For many new members, “just because their friend has a plan and can go to a particular hospital doesn’t mean that they necessarily can.” You can check a plan’s directory — either online or often part of the documents you receive when you enroll — to find out if specific physicians are part of your network. You can call doctors’ offices to confirm, too. Stay in the network! The health law says that, once you join a qualified plan, you won’t pay more out of pocket per year than $6,350 for an individual and $12,700 for a

family. But this applies only to in-network care. Whether you’re in an HMO that pays almost no out-of-network benefits or a PPO that covers some, the pocketbook protections don’t apply if you use a non-network doc or hospital. Non-network providers also frequently bill you far more than what they charge patients in their networks for the same procedure. Try to stay in-network even if it’s for emergency care. Insurance plans do have to pay for non-network emergency visits under the health law. If you’re in a car crash far from home you can’t be picky about which hospital saves your life. But non-network hospitals often

“balance-bill” the difference between what your plan pays and what they charge, which is often much more. Avoid all emergency rooms unless it’s really an emergency. Traditionally, health plans came with a modest copayment for an emergency visit — maybe $150. But many policies sold under the health law, even those in the more expensive “gold” category, not only have ER copays of several hundred dollars but also subject ER charges to the overall deductible. (Copays are flat fees for specific services. Deductibles are what you pay out of pocket before the insurance kicks in.) That means you could be billed for the full cost of an emergency visit — up to the out-of-pocket limit. “This is a huge difference and will really hurt the unsuspecting person,” says John Jaggi, an Illinois insurance broker. “We’re putting a lot more

people into that exposure here.” Broken leg? Head to the hospital. Sprained ankle? Maybe wait until the urgent care center or doctor’s office opens. Pay monthly premiums on time and accurately. “Do not mess around. Pay your premium,” admonishes Karen Pollitz, a consumer specialist at the Kaiser Family Foundation. (KHN is an editorially independent project of the foundation.) “Otherwise that will be the end of you and you won’t get to sign up again

until the next open season.” (Open enrollment for 2014 coverage ends March 31. Open enrollment for 2015 begins Nov. 15.) Even underpaying the premium by a few cents could give the insurance company grounds to kick you off, she said. Insurers allow a brief grace period if you get behind — somewhat longer if you’re receiving premium subsidies — but they will terminate coverage for nonpayment. Register online with your new insurance company. Insurance sites are good for tracking claims. Increasingly they also let you shop around for the best deals on non-emergency treatment. “Your health plan might pay one imaging center half what it pays another imaging center,” Metcalf said. “That’s really important if you’ve got a big deductible.” Save paperwork. Make sure you really owe what doctors and hospitals bill you for. “Now is a good time to become a pack rat,” says Pollitz. “If you’ve got any concern, it really is worth it to make a call and get them to explain what they did.” If you don’t get satisfaction from providers or insurers, try regulators. Check the insurer’s explanation of benefits detailing your claims. It may show a phone number for a consumer assistance program in your state to help deal with medical coverage. Here is a list of consumer assistance programs. This list has contact information for state insurance departments and other regulators. Do read the plan’s summary of benefits and coverage. “Get it and print it out, because that has the details of your plan,” says Metcalf. “How it works. What do you have to pay in order to go to a primary care doctor? Is it

before or after the deductible? “How big is your deductible? How much does it cost to go to the emergency room?” It’s not like reading John Grisham. But the subjects — your health and your money — are really important.

WASHINGTON — The Obama administration announced on Monday that it would postpone enforcement of a federal requirement for medium-size employers to provide health insurance to employees and allow larger employers more flexibility in how they provide coverage.

The delay is the latest in a series of policy changes, extensions and clarifications by the administration, and it drew a new round of criticism from congressional Republicans, whose scorching attacks on the law have become a central theme in many of this year’s midterm election campaigns.

The “employer mandate,” which was originally supposed to take effect last month, had already been delayed to Jan. 1, 2015, and now the administration says that employers with 50 to 99 employees will not have to comply until 2016 — allowing Democrats to

placate business concerns and pushing the issue well beyond this year’s midterm elections.

In addition, the administration said the requirement would be put into effect gradually for employers with 100 or more employees. Employers in this category will need to offer coverage to 70 percent of full-time employees in 2015 and 95 percent in 2016 and later years, or they will be subject to tax penalties. “Today’s final regulations phase in the standards to ensure that larger employers either offer quality affordable coverage or make an employer responsibility payment starting in 2015,” said Mark J. Mazur, the assistant Treasury secretary for tax policy. The purpose of the penalty, he said, is to help offset the cost to taxpayers of providing coverage or subsidies to people who cannot get affordable health insurance at work.

Under the law, employers with fewer than 50 full-time employees are generally viagra online order exempt from the requirement to offer coverage.

The administration described the new policy as a form of “transition relief” to help employers adjust

to requirements of the 2010 health care law. But congressional Republicans jumped on the delay as only the latest maneuver by the Obama administration to sidestep the health care law’s legal requirements for political gain. Republicans denounced the unilateral move as a violation of the law and called on the White House to throw out all of the Affordable Care Act’s coverage mandates. “The White House seems to have a new exemption from its failed law for a different group each month,” said Senator Mitch McConnell of Kentucky, the Republican leader, who is in a competitive race himself. “It’s time to extend that exemption to families and individuals — not just businesses.” But the House Democratic leader, Representative Nancy Pelosi of California, praised the White House, saying the final rules showed “the administration’s commitment to smoothly implement the Affordable Care Act.”

Coming on the heels of a government analysis of the law’s impact on the work force, the delay is likely to breathe new life into the Republican effort to make the

health care law the central issue in the coming midterm elections. Several lines of attack, which started with the disastrous rollout of the Healthcare.gov website in October and propecia online pharmacy shifted to a wave of insurance cancellation notices in November, have largely run their course as the website’s problems came under control and canceled policies were replaced. “Once again, the president is rewriting law on a whim,” said Speaker John A. Boehner. “If the administration doesn’t believe employers can manage the burden of the law, how can struggling families be expected to?” That theme was echoed by many Republicans, who say it is unfair for the White House to grant a dispensation to employers but not to individuals and families.

Democrats see the individual mandate as more important to the operation of the law. But lawmakers from both parties have raised questions about unilateral actions by the president to waive or delay various provisions of the law. J. Mark Iwry, deputy assistant Treasury secretary for health policy, said the administration had broad “authority to grant transition relief” under a section of the Internal Revenue Code that directs the Treasury secretary to “prescribe all needful rules and regulations for the enforcement” of tax obligations. This authority has often been used to postpone the application of new laws that would cause “unreasonable administrative burdens or costs” to taxpayers, Mr. Iwry said.

Under the law, larger employers may be subject to tax penalties if they do not offer “minimum essential coverage” to employees who work at least 30 hours a week, on average. Larger companies have, for many years, been more likely to offer coverage than smaller ones. The Treasury said that companies with 50 to 99 employees accounted for 7 percent of the private sector work force, while businesses with 100 or more workers accounted for 66 percent. Most companies with 100 or more employees already offer health benefits to at least some of their workers. Small businesses with fewer than 50 employees account for nearly 28 percent of private sector employees, but 96 percent of all private employers, the Treasury said. Paul M. Hamburger, a lawyer who advises employers at the Proskauer law firm, said: “The bottom line is that Obamacare is not going away. The administration is providing another one-year delay, until 2016, for some employers. But they have to take the law seriously and figure out ways to comply.

The administration did not provide the relief sought by employers in some high-turnover industries like restaurants and retail.” In response to concerns expressed by lawmakers from both parties, the administration said that local government agencies would generally not have to provide health insurance to “bona fide volunteers”

who work as firefighters or emergency medical technicians. The administration said it was still trying to viagra online cheap figure out how to count the hours worked by certain types of employees, including part-time college instructors who are paid for teaching a certain number of classes or courses. Until guidance is issued, Treasury officials said, colleges may assume that such “adjunct faculty” members spend 75 minutes a week outside the classroom, preparing lectures or grading examinations, for each hour teaching in the classroom.

Federal officials said they were also providing some relief to employers of seasonal employees. Those who normally work a half-year or less will generally not be considered full-time employees, the administration said.

The Huffington Post February 6, 2014
John Geyman

We have heard the promises as the Affordable Care Act (ACA) was being sold to the public, including — you can keep your doctor and insurance if you like it. We now know those promises to be mostly false as the ACA enters its fifth year of implementation.

Under the guise of “competition” and “efficiency,” the ACA has unleashed a new round of disruption throughout the health care system. We are seeing further fragmentation of care, with less continuity of care with patients’ physicians. The physician-patient relationship itself is at risk in a “system” increasingly headed for strangers taking care of strangers.

More than one-half of U.S. physicians are no longer self-employed and now work for organizations, mostly growing hospital systems but also some insurers that are moving into the delivery side of health care. Two examples illustrate the new landscape:

• Several hundred patients at the University of Pittsburgh Medical Center (UPMC) recently received certified letters informing them that they could no longer see their physicians. The reason: their insurance, Community Blue, sold by Highmark, is now both a rival hospital system and an insurer. Patients were cut off from their UPMC physicians even in the middle of cancer therapy. (1)

• United Health Group Inc. is the biggest player in the Medicare Advantage market with almost three million members and 350,000 physicians in its networks. In recent months it has dropped thousands of these physicians from its networks in at least 10 states. At Moffitt Cancer Center in Tampa, Florida, for example, some 2,500 current cancer patients will have to switch plans or find other physicians. (2)

A previous Health Care Disconnects post has described how patients are losing choice of physician and hospital through narrowing networks. (3) People can be in or out of a network at a moment’s notice, a dynamic that almost certainly seems to be driven by money — how can the insurer make more money by ridding its network of higher-cost physicians and patients.

Continuity of care, especially with a primary care physician, has been and should be the foundation of the physician-patient relationship. It facilitates coordination of care by other physicians and providers. But that continuity is now being split apart by market forces from all sides — mergers and consolidation of hospital systems, business decisions of insurers, instability created by evolving accountable care organizations, shortage of primary care physicians, and the lack of inter-operability of electronic medical records, for starters. The challenge of how to coordinate and integrate health care in such a chaotic system increases by the day.

As the supposed signature domestic success of the Obama administration, we have already found that keeping your own physician and insurance plan is difficult, if not impossible. We will soon also find that health care is not more affordable, less

expensive, or better with the ACA.

It

is ironic that much of this could have been fixed before this latest round of health care “reform” kicked in with the ACA in 2009. Under a single-payer financing

system, as embodied in An Improved and Expanded Medicare for All (H.R. 676), we could have a simplified, more efficient, not-for-profit public financing system coupled with a private delivery system, assuring all Americans with a comprehensive set of benefits and full choice of physician and hospital. President Obama recognized this as early as 2003 in this speech to the Illinois AFL-CIO:

‘Phantom Networks’ of Unavailable Doctors Plague Obamacare NewsMax Wednesday, February 5, 2014 11:37 AM By: Melissa Clyne The fears of patients across the country are being realized as they discover their doctors are not participating in the Obamacare health plans, The Los Angeles Times reports. In late January, retiring Oklahoma Sen. Tom Coburn, a Republican who is also a medical doctor, disclosed to MSNBC’s Joe Scarborough that his Obamacare plan did not include the oncologist who has been treating him for prostate generic viagra cheap cancer. In order to continue to receive treatment from the same specialist, Coburn has to pay out-of-pocket. The senator is just one among thousands of patients and doctors

who are experiencing the same problem, characterized as a “phantom network” by a California woman who was thrilled to finally qualify for health coverage under Obamacare after years of being denied due to preexisting conditions only to realize she can’t find doctors participating in

the network. The issue hit home for Maria Berumen when she was referred to a specialist for numbness in her arm, according to The Times. At least four doctors wouldn’t accept her health plan despite the state exchange website and

her insurer listing them as participants in her network. Berumen’s case is not unique, according to her primary care doctor, Ragaa Iskarous, who told The Times she has repeatedly encountered the same situation with other patients over the past month. “This is really driving us crazy,” Iskarous said. Fox News cialis online free trial reported in December that analysts predicted the Obamacare system might resemble Medicaid, warning that because of the low reimbursement rate, doctors might refuse to participate in the networks. “That will leave more and more patients jockeying to see fewer and fewer doctors,” said Merrill Matthews, director of the Council for Affordable Health Insurance. That’s what happened to California resident Danielle Nelson, who was promised “half a dozen times” by her provider, Anthem Blue Cross, that her oncologists would be covered under her Obamacare policy. But when she went to the doctors’ office, a bright orange sign informed her that “Covered California plans are not accepted.” According to The Times, major insurers have drastically cut the number of doctors and hospitals in California’s new health insurance market so that premiums are affordable. The state is being flooded with consumer complaints and lawmakers are working to “swiftly ease some of the problems that have arisen.” “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,” California Insurance Commissioner Dave Jones said. “Network adequacy will be a big issue in 2014 Read Latest Breaking News from Newsmax.com http://www.newsmax.com/Newsfront/obamacare-phantom-networks-doctors/2014/02/05/id/551039#ixzz2saTVDRrf Urgent: Should Obamacare Be Repealed? Vote Here Now!