Two Minute Drill

Obamacare…Did you know? #3

I’m doing a series on things I think you should know about Obamacare. Here is installment #3…

There’s a major glitch or loophole in the healthcare law that actually allows large employers to avoid health-law penalties by offering stripped down plans that are devoid of any hospital benefits. That’s right. No hospital benefits at all. Obamacare regulators created an online calculator to certify whether plans offered by large self-insured employers that pay their own medical claims meet the Affordable Care Act’s toughest standard. The Obamacare calculator is used to test “minimum value” for adequate benefits. Many, including your 2-Minute Drill author, were surprised to read in a recent Kaiser Health News story that the calculator approves these plans lacking any hospital benefits.

ObamaCareGlitchesCartoon

Word is that numerous large, low-wage employers with high turnover that haven’t offered medical coverage in the past — retailers, hoteliers, restaurants and other businesses with high worker turnover and lower pay — are considering driving a truck through this loophole by offering plans without any hospitalization coverage. By doing so, they thus protect themselves from some of the employer mandate penalties that come into play next year. Some of the talking heads in the industry claim the calculator was purposely designed this way by the administration. However, I tend to agree with respected consultant Bob Laszewski.  He’s quoted as saying “That’s baloney. Nobody said we’re going to have health plans out there that don’t cover hospitalization. That was never the intention…I think they just screwed up.”  Stay tuned for more on this.

Obamacare…Did you know? #1

Obamacare…Did you know? #2

Obamacare…Did you know? #2

I’m doing a week-long series “Obamacare…Did you know?”

Last week I talked about how as we move into the open enrollment phase for 2015, more complexities arise and more computer glitches are expected. Read my post Obamacare…Did you know? #1

Judge Slams His Gavel and American Flag Table Reflection.

Just recently a federal judge in Oklahoma ruled that subsidies can’t go to those who purchased health coverage through a federal exchange (most states). This decision adds to a mix of rulings on whether individuals in states utilizing the federal marketplace can legally be provided with premium subsidies. Many expect that this subsidy issue, which is a major component of the Affordable Care Act, will wind up before the U.S. Supreme Court. In July, two U.S. appeals courts issued conflicting rulings on health-law subsidies, raising questions about the fate of tax credits/premium subsidies provided to several million Americans.  While this issue makes its way through the courts, subsidies remain available.

Read more about this in an article on Politico

Stay tuned for more this week on Obamacare…Did you know?

A week-long series of Obamacare…Did you know?

Believe it or not, you can expect the second year of Obamacare to be even more chaotic than the first. Last week we attended a market update meeting related to this year’s open enrollment which begins November 15. The meeting was sponsored by one of the major insurance companies. Any notions we had for a smoother rollout and less disrupted market this year were quickly dispelled. With little more than 6 weeks to the start of open enrollment, it was pretty clear to those of us in attendance that there were still many more questions than answers.

HealthcaredotgovSo, over the next few days, I’m going to provide you with some important “Did you know?” points that I think you need to be aware of. Here’s the first installment:

Did you know…Additional complexities are expected in the enrollment process. Specifically, re-enrollment for those who signed on in the first year, i.e. those who qualified for subsidies in year one must re-qualify. And, more computer glitches are expected. Just yesterday the Wall Street Journal reports that in order to participate in any systems testing, insurance carriers must first agree to confidentiality of the testing process.  Disclosure of testing results is strictly prohibited. There’s essentially a gag order for those carriers. Hmmmm. Color me skeptical but it sure doesn’t foster confidence that things will be improved this year. Also, makes one wonder if keeping it all hush-hush has anything to do with the upcoming mid-term elections.

Read 5 things we need to know before Obamacare enrollment starts again from The Washington Post.

Two More Lawsuits Over Narrow Networks

Despite the fact that narrow networks continue to come under fire, we believe they will remain an integral part of the fabric of health plan options.

Narrow network strategies are employed by carriers as a means to control costs, offer lower-priced health insurance options, and still comply with new provisions of the Affordable Care Act such as medical loss ratio requirements and qualified health plan actuarial values. The rub with narrow networks is that while narrow networks can help lower premiums, they can also limit choice, access and potentially even quality.  Plus, despite lower rates they can ultimately cost individual patients a lot more.

Lawsuit form with a stethoscope

In the cases of these newly reported lawsuits, some docs that were originally listed as participating were dropped from the network. Patients were then faced with very high and unexpected medical bills from the newly out-of-network docs. Some enrollees sued the insurance companies claiming that the carriers failed to let them know that the docs were no longer participating.

For some, narrow networks can be the right choice, e.g. those who focus on monthly premiums above all else. While we believe that to be true, we’ll continue to bang the drum loudly that before selecting a narrow network plan, buyers need to do their homework. Know who is in the network and re-confirm participation before seeking care whenever possible.

Read Consumer Group Sues 2 More Calif. Plans Over Narrow Networks from The KHN Blog.

What’s the best combination of cost and care? Picking the right DOC still trumps all.

Last week I wrote about improving healthcare literacy. It’s an important and worthy goal. However, I always juxtapose this with something a highly respected physician colleague and friend said to me a few years back.  It really resonated with me back then and still does today.

He said that the push for improving the public’s health literacy and increased consumerism is good. The more knowledgeable people can become about their healthcare the better.  However, he also cautioned that the expectations of predicted great gains in cost savings and improved system efficiency from increased consumer knowledge were a bit unrealistic. They needed to be tempered.  Healthcare is so dynamic and so complex that as a physician he had to really work hard to stay on top of best practices, new developments in medicine, the cost and outcome implications of various types of treatment, etc. His point was that if he, as an experienced physician with years of training and treating patients had to work so hard to stay on top of the latest developments and trends, then it is unrealistic to expect that consumers with day jobs and no medical training at all could understand the complexities of our healthcare system.

woman handshaking with doctor after checkup

We know from years of analyzing data and our experience that the most experienced doctors with good teams around them deliver the best possible outcomes – clinical, functional and financial.

So I think the best bet – whether it’s you, your family members, or your employees – is still to do your homework and choose the best and most experienced doctors around.

Last week’s post in case you missed it…

 Health Insurance Literacy: Too Complex For Some?

Health Insurance Literacy: Too Complex for Some?

We can all agree that our healthcare system is difficult to understand. Have you considered the confusion for people who have never had health insurance, or perhaps have not had it for a really long time? According to Drew Altman, president and CEO of the Kaiser Family Foundation, health insurance literacy is something that we as a society should work to improve. Here are some key points regarding the new insurance marketplace and ACA that Altman asks us to consider:

  • 37% of enrollees don’t know the amount of their deductible
  • only 46% of enrollees say they are getting a subsidy, when the official numbers indicate 85% are actually getting them
  • many enrolled have no understanding of basic insurance terms like premium, deductible, copayment, coinsurance, maximum annual out-of-pocket spending, provider network, covered services, annual limits on services or excluded services
  • people with lower incomes are less likely to understand the key elements of insurance (the people who need coverage the most understand it the least)

confusedamericans-randdotorg

Altman also points out that people gaining new coverage are also expected to understand the intricacies of provider networks in the plans they choose, particularly if they have a health problem requiring specialty care. Otherwise, they’ll face high out-of-pocket costs when they visit out of network provider specialists. Understanding how drug coverage works is also important when dealing with tiers. Most of us understand that brand-name drugs cost much more than generics — but what about the folks who don’t know that? We all have a role to play to improve health insurance literacy. Unfortunately, as Altman points out in his article that appeared recently on WSJ’s Washington Wire, A Perilous Gap in Health Insurance Literacy, many of us get tested on our knowledge every time we access our health care plan.

Here are two info graphics that can help you get started with improving the health insurance literacy of the people you know:

We are the 90 by CommunicateHealth.com

The Facts about Health Literacy by Healthcare IT News

 

Compromising on Contraceptives and Religion. Say what?

Recently the Obama Administration compromised to allow waivers for religious organizations to restrict paying for contraceptives on their health plans.

What does that mean for most religious groups that offer health benefits? Unless a group is self funded and writes their own plan, it will be difficult to change things. As we have discussed in earlier blogs posts, 98% of all employers purchase fully insured plans from insurance companies. Insurance companies file their plans and, for the most part, are abiding by the original requirements in ACA on what to cover. Therefore, if a group is fully insured, they cannot just change their plan.

WSJ-Apr222014-AdminOffersContraceptionCompromise

It is possible that the insurance carriers may roll out plans that give these types of groups a chance to change their plan. However, at this point that is not possible and we usually see insurance companies move slowly on these events.

The administration rolled this out to allow for waivers. The carriers will probably wait and see if there are a lot of requests and then decide if they will react.

To read more on this topic, please read Administration Offers Contraception Compromise for Religious Employers, an article that appeared on WSJ Online.

 

Bigger isn’t always better. This study about primary care physician practices proves it.

In primary care, like many other things, bigger isn’t always better. And in the case of primary care physician practices, this study backs it up.

It’s no secret among those who know me well that I have a strong affinity for small businesses and have long held that small and mid-size businesses are the backbone of our country’s economy. In an age of instant gratification where many flip businesses like houses, I find more often than not that it’s the small businesses and their leaders that champion the vision of building and sustaining meaningful companies committed to serving their clients while consistently providing jobs for themselves, their families and others in their communities. And, it’s the small businesses and their leaders that consistently prove to be the innovators.

CommonwealthFund-SmallPrimaryPractices-Aug122014

The study is titled “Small Primary Care Physician Practices Have Low Rates of Preventable Hospital Admissions” and was recently published by The Commonwealth Fund.

This study supports my notion and could also be instructive to you, your family and even your employees when it comes to selecting a Primary Care Physician geared to the combination of the best care AND the best cost…

 “[T]he common assumption that bigger is better should not be accepted without question, at least in practices of 19 or fewer physicians,” the authors conclude. The authors also question the practice of insurers typically paying lower rates to physicians in smaller practices, which typically have no negotiating leverage. Such an approach may well be shortsighted, they say, since the lower preventable admission rates achieved by small practices compared with large groups can mean lower overall costs for patient care…”

Facebook Iconfacebook like buttonTwitter Icontwitter follow buttonVisit Our LinkedIn Profile