The battle of the anecdotes: Gird yourself for Obamacare’s newest fight

January 7, 2014June 12, 2015 admin

By Sarah Kliff

Below is an interesting piece by Sarah Kliff on how the Affordable Care Act is changing the American health-care system — and being changed by it. At this stage, the report card for the program depends largely on who you ask.

Fliers promoting the Get Covered Illinois health insurance marketplace sit in a box at the Bureau County Health Department offices in Princeton, Illinois, U.S., on Wednesday, Dec. 18, 2013. Todays deadline for Americans to sign up for Obamacare health coverage effective Jan. 1 was extended until midnight tomorrow as heavy traffic to the online enrollment system caused a queuing system to be activated.

If you want to believe Obamacare is going great, you should call up Linda Browne. She’s a 62-year-old retired accountant from California who already has an appointment to see her new primary-care doctor at Kaiser Permanente, the new health insurer she signed up with through Covered California.

“I thought I would have to wait a long time,” Browne says. “But when I called, they said she had an appointment Wednesday for a physical.”
If you’d prefer to believe Obamacare is going terribly, then Michael D. Scott has got a story for you. He’s a 36-year-old Texan who turned up at a pharmacy last week trying to fill a $700 prescription for anti-seizure medication — only to find the technicians had no record of his enrollment.
“I’m stuck,” says Scott, who takes the prescription to treat a genetic condition called Ehlers-Danlos syndrome. “I’m going to have to start buying a couple days’ worth on my own if they can’t figure things out. It’s disappointing.”

Both Browne and Scott signed up for health insurance through the Affordable Care Act. Browne has had the law work pretty well; Scott has spent hours on the phone with customer service representatives (actually, he spent one hour and 37 minutes on his last call — yes, he timed it). And stories like theirs are about to become central to the next Obamacare fight, what I like to think of as the battle of the anecdotes.

The battle of the anecdotes is all-but-guaranteed because access to health care is really difficult to measure, even more so than the number of people who have enrolled or how well HealthCare.gov is functioning. With enrollment, for example, HealthCare.gov can track all the people who pick a private insurance plan, as can the 14-state based insurance exchanges. That’s how we know 2.1 million people have selected private insurance plans (although we don’t know how many have paid their first month’s premium, which is due, for January coverage, by this Friday).

The federal government can gauge how well HealthCare.gov is working by tracking how long it takes pages to load, or how many enrollment files — known as ‘834s’ — contain errors. And the call centers know, too, how long customers have to wait to get a person on the line.

But when it comes to access to health care, there’s no analogous metric. Our health-care system is really fragmented. Since HealthCare.gov shoppers are buying private coverage, and not a government plan, we have no central clearing house to understand whether more shoppers are having an experience like Scott in Texas — or like Browne in California.

Nonprofit institutions do study these types of questions. The Commonwealth Fund, for example, regularly looks at how long patients in different countries have to wait to see a primary-care doctor or a particular surgeon. But these surveys take months to conduct and analyze, meaning that we will probably have to wait until late 2014 or early 2015 to get a sense of what access looks like under the Affordable Care Act.

Enter the anecdote, which can be great to understand how new policy programs are impacting the way that Americans receive health care. But they can also be a really terrible way to gauge whether Obamacare is going great — or is a complete disaster. One or two stories don’t do a great job of capturing the experience of the millions of Americans who have signed up for health plans.

And even the anecdotes themselves can be nuanced, portrayed in different ways to make Obamacare seem great, or horrible. Take Browne: She called for an appointment in her new network the morning of Jan. 2. But she couldn’t get through to a real, live person until that afternoon; she kept getting a message that said “all circuits are busy.”

(more…)

Race Is On to Pin Blame For High Health-Care Costs

March 3, 2010 J Roberts

Who’s to blame for rising healthcare costs, insurers or providers, such as doctors or hospitals? Depending who you ask, either side places the blame on the other. Whether it’s insurers’ trying to meet the bottom line and remain profitable or physicians and hospitals attempting to increase revenue and improve their margins, one thing is for certain: Healthcare costs continue to rise.

Read on to determine where the blame lies.

By AVERY JOHNSON

A battle over who to blame for rising health-care costs is escalating, as groups seek to pin the problem on each other and say none of the health-care legislation under consideration does enough to solve it. U.S. spending on health care reached $2.5 trillion in 2009, according to federal estimates. It is expected to jump to $4.5 trillion in 10 years.

Insurers contend that they must pass on ever-higher bills from hospitals and doctors. Hospitals say they are struggling with more uninsured patients, demands by doctors for top salaries, and underpayments from Medicare and Medicaid.

And doctors say they are strong-armed by insurance monopolies and hampered by medical malpractice costs.

In the rush to point fingers, few solutions are emerging.

“It’s always someone else’s fault,” said Robert Laszewski, president of health-care consulting firm Health Policy & Strategy Associates. “There is not an incentive for these people to cooperate because the game they are all playing is getting a bigger piece of the pie.”

The issue has come into sharp relief as WellPoint Inc. has sought to defend its plan to raise some prices in California by up to 39%.

In a hearing Wednesday on Capitol Hill, WellPoint Chief Executive Angela Braly singled out dominant hospital systems for demanding 40% rate increases and drug companies for roughly 20% profit margins.

A WellPoint spokeswoman said that at least one hospital had asked for a 220% payment increase.

Many Democrats have cited lack of competition among insurers as a driver of higher prices. On Wednesday, the House of Representatives voted to repeal a longstanding insurance-industry exemption from federal antitrust laws. The bill now heads to the Senate, where its future is less certain.

Doctors complain of a lack of competition among insurers, as well.

A report by the American Medical Association this week argues that 500 insurance-company mergers in the past 12 years have led to markets dominated by one or two health plans.

This year, two insurers control 70% of the market in 24 states, up from 18 last year, the report said.

“There is no other company for doctors to go to” when an insurer comes to them with terms that they find unfavorable, said AMA President James Rohack. But insurers say is it doctors and hospitals that have gotten too powerful through consolidation.

A study published Thursday in the journal Health Affairs appears to back up their point, saying that insurers are weakened in their negotiations by their inability to exclude prominent doctors and hospitals from networks.

Authors from the Center for Studying Health System Change, a nonpartisan research group, conducted 300 interviews with California doctors and hospital and insurance executives in late 2008.

The study said two big networks of providers now dominate the northern part of the state: Sutter Health owns two dozen California hospitals and medical centers, and Catholic Healthcare West runs 33 hospitals.

In addition, the study said, doctors who are increasingly banding together for negotiating power are commanding yearly double-digit payment increases.

Hospitals and doctors shot back that the study was largely anecdotal and said integration improved efficiency.

Catholic Healthcare West said it took on $1.5 billion in bad debt from government underpayments last year; its size, it added, makes it possible to achieve some savings.

Sutter Health said increases in its reimbursement rates from private insurers have been in the single digits.

“We are doing our best to keep costs down because these health-care premium increases are not sustainable,” said Bill Gleeson, vice president of communications a Sutter Health.

Hospital costs: Pull back the curtain

February 23, 2010February 25, 2010 J Roberts

Read how one state’s governor is not only reviewing insurance rates, but also hospital rates as he and the state look for ways to curtail excessive increases.

If nothing else, Governor Patrick’s proposal for state review of both hospital and insurance rates should start an overdue discussion of how to keep health cost increases from smothering economic growth in the state.

The course advocated by the state’s payment reform commission last year – a move away from fee-for-service payments – may be the long-term solution. But in the meantime, both employers and individuals are facing increases well in excess of the national rate of medical inflation. Forcing both insurers and hospitals to lay out their contract proposals before a rate-oversight body would at least end the shadow play that has kept the public in the dark about wide differences in hospital costs.

Also, Patrick’s proposed requirement that insurers at least offer small businesses a plan with a network lacking some higher-cost hospitals would ensure that companies have that more affordable option. In the past, consumers and their employers have been wary of plans that lack access to marquee hospitals, but years of spiraling health costs have probably changed some minds. Let the debate, or “conversation,’’ as Patrick calls it, begin.

Help With Medical Bills

February 1, 2010February 1, 2010 J Roberts

Read what others who have serious medical illnesses and conditions are doing to help relieve some of the financial burdens associated with high cost treatment and medical care. Like the services mentioned in the below article, Medical Cost Advocate can assist you with reducing your high dollar medical claims.

By M.P. MCQUEEN

A diagnosis of cancer or other serious disease can be devastating to one’s financial as well as physical health — even for people with insurance. But there are a handful of programs that can help ease the monetary burden.

The programs, run mainly by nonprofit and charitable groups, offer financial aid to patients with specific life-threatening or chronic diseases to help cover the cost of co-payments, deductibles and other medical expenses. Patients usually must meet specific income and treatment guidelines.

Patients typically are referred to the programs by the financial counseling or patient-advocate offices of big hospitals and treatment centers. But you also can seek them out online.

Cutting Cancer-Care Costs

The CancerCare Co-Payment Assistance Foundation (at 1-866-552-6729 or CancerCareCopay.org) helps eligible patients cover the cost of insurance co-payments for treatment of specific cancers. The program, founded in April 2008, now lists seven diagnoses eligible for assistance: breast cancer, colorectal cancer, head and neck cancer, non-small cell lung cancer, pancreatic and renal cancer and glioblastoma.

Some diseases have a $10,000 annual limit on aid, others have a $5,000 limit, says John Rutigliano, chief operating officer of nonprofit CancerCare. Most people who qualify receive between $2,500 and $5,000.

He says these days more employees are bearing a larger share of the cost of care, with higher co-pays and deductibles.

Since the CancerCare program began, about 7,000 people have applied for co-pay assistance, and about 80% of them have received aid. Half of those who received aid were on Medicare and the other half were privately insured.

The foundation rejects less than 7% of applications, mostly because applicants’ income exceeds guidelines. The cutoff for assistance is 400% of the federal poverty level — slightly above $43,000 for an individual and $58,000 for a family of two.

Nancy Francisco of Crystal Falls, Mich., received financial help from CancerCare when she was diagnosed with glioblastoma, a type of malignant brain tumor, early in 2009.

Mrs. Francisco, a 45-year-old registered nurse and electronic medical records technician, became disabled as a result of the illness and treatment. Her husband is her full-time caregiver. She continued her health-insurance coverage under her former employer’s Cobra plan, but out-of-pocket expenses for treatment exceeded $10,000. CancerCare helped her with a $10,000 grant, says the mother of three, which helped cover co-pays for chemotherapy and IV transfusions.

“I couldn’t believe there was help,” says Mrs. Francisco, who learned of the program from her hospital social worker and pharmacist, who also helped her fill out the application.

Other Options

Other groups offering financial assistance for the treatment of cancer and other diseases: HealthWell Foundation HealthWellFoundation.org, which helps with co-pays and premiums for patients with group and individual insurance, Medicare and Medicaid. The Leukemia & Lymphoma Society’s Co-Pay Assistance Program (leukemia-lymphoma.org) helps with private-insurance premiums.

Too little focus on health costs

November 12, 2009November 13, 2009 J Roberts 1 Comment

Concord Monitor – Online

The following editorial describes the one key component that seems to be missing from the national debate on Healthcare reform: Rising costs.

Most people agree that reform of our nation’s health care system is needed. Not everyone is covered by health insurance or covered well, exposing them to financial catastrophe if their health goes awry. Quality of health care varies from region to region, and from provider to provider. And costs are staggering.

A recent study showed health insurance premiums in New Hampshire have increased over 90 percent from 2000 to 2008. By comparison, wages rose just 21 percent over the same period.

Ask business people in New Hampshire to name their top challenges and they’ll tell you that at or very near the top of the list is paying for the rising cost of health care and health insurance for their employees. This has been a constant refrain for years from our members across the state, from every industry type, and from every size enterprise.

It’s remarkable, therefore, that health care reform under consideration by our congressional delegation in our nation’s capitol seems very likely to add to health care costs, not reduce them. What happened to “bending the cost curve” and eventually lowering it?

Pick your source – the Congressional Budget Office, the Lewin Group, the Centers for Medicaid and Medicare Services, and others – they conclude that health care reform legislation under consideration will, incredibly, increase costs, not lower them.

Lots of attention is being paid to expanding government programs like Medicaid, or creating new ones like a “public option” insurance plan, to cover more uninsured and underinsured individuals. Unfortunately, the federal government’s long track record of grossly under-funding health care providers for their cost of caring for individuals in existing government programs like Medicaid and Medicare makes many employers understandably concerned about expanding them or creating new ones.

More under-funding from the federal government means more cost-shifting to the business community in the form of higher health insurance premiums. How is this reform?

Too little attention is being paid to moving these massive federal programs away from the current fee-for-service payment structure which often rewards health care providers for providing more care, but not necessarily better care, because they get paid more.

Not enough attention is being paid to rewarding providers for lower utilization and improved health outcomes for patients. Too little attention is being paid to reforming our legal system so doctors move away from practicing defensive medicine in order to lesson the odds of being sued.

Until the great health care reform debate shifts emphasis away from its focus on expanding government health care programs or creating new ones, and toward reforming payment incentives, there will be no bending of the cost curve. The curve will continue to rise, and employers will find it increasingly difficult to provide a critical benefit for their employees, and compete in the global economy.

Health Costs Are Crushing Small Businesses

November 3, 2009November 4, 2009 J Roberts

WSJ. – The Magazine from the Wall Street Journal

By MARY LANDRIEU

Read about Senator Landrieu and her commitment to small business owners to make health care more affordable to the 27 million small businesses in this country. As a service provider to many small companies, Medical Cost Advocate is all too familiar with the many challenges faced by small businesses in navigating the health care maze. Small business owners should reach out to consumer directed health care service providers as self service allies for their employees.

After years of struggling with costs that were eating into his bottom line, David White, a small business owner in Maine, recently dropped health insurance for himself and his employees. It was a nerve-wracking decision. “I just hope my people or I don’t get sick,” he told a small business advocacy group.

Louise Hardaway wasn’t willing to take the same risk. Health-care costs forced her to close her small business in Tennessee. Factor 4 Life was, ironically, a business that helped people navigate the health-insurance system!

Unfortunately, these stories are not unique. As chairwoman of the Senate Committee on Small Business and Entrepreneurship, I hear about a lot of business owners hit hard by health-care costs. These costs not only eat into profits, they prevent small businesses from hiring more workers.

Small firms, defined as less than 500 employees, pump almost a trillion dollars into the economy each year, create two-thirds of our nation’s new jobs annually, and account for more than half of America’s work force. But too much of their money is going toward high health premiums that are increasing faster than the prices of the products and services they provide—four times faster than the rate of inflation since 2001, according to the Kaiser Family Foundation.

Nationwide, small firms will spend $156 billion on health premiums this year. In place of those high premiums, small business owners could employ 10 million additional workers—the entire state of Michigan—at minimum wage for a year.

Unless something is done, annual health-care costs for small firms over the next 10 years are expected to more than double to reach $339 billion in 2018. As those costs increase, the burden will get heavier and force many of them to lay off workers. The Small Business Majority, an advocacy group, estimates that over the next decade about 943,000 small business jobs will be lost.

Today, there are already 14.9 million people unemployed in America. We don’t need to add to those ranks, instead we need to help small businesses create more jobs. The path we are on now is unacceptable and unsustainable.

Small businesses want to provide health coverage to their workers, but when faced with cutting employees or cutting insurance, the insurance is the first to go. In 1993, 61% of all small companies offered health coverage. Today that number is less than 38%.

Employers who can afford to provide health coverage are providing it because they are competing with big businesses that offer quality health-care choices for top talent. Businesses not offering coverage are often small, low-wage firms that can’t afford it. There are 27 million small businesses in America, 22 million of which are sole proprietorships. And it is often sole proprietors that have trouble affording health insurance.

Insurance premiums for sole-proprietors are up 74% since 2001. This has made health insurance even harder to afford. And while big firms can deduct health premiums on their federal tax returns, under current tax rules sole proprietors often cannot. This forces them, on average, to pay nearly $2,000 more a year in taxes than they otherwise would have to pay. That is money they could use to buy new computer equipment or other things necessary to keep a business running efficiently.

The additional tax burden that sole proprietors have to pay has not yet been addressed by proposed health-care reforms. To keep our economy healthy we must keep our small businesses healthy, and that begins with stable, affordable health insurance.

I am committed to working with my Senate colleagues and the Obama administration to ensure that the health-care reforms our small businesses desperately need are passed. Small businesses—and all Americans—can’t go another pay check without meaningful reform.

Ms. Landrieu, a Democrat, is a U.S. senator from Louisiana.