Tuesday, April 1, 2014

Obamacare (Affordable Care Act) What now ?




Democrats are enthused about the increasing numbers of enrollees in the ACA (Obamacare), and see it as the arbiter of the ultimate ‘success’ of the law.  Republicans are not impressed with the number of enrollees.

Democrats  (President Obama) have reacted to public pressures by delalying mandates, extending enrollment periods and have accomodated insurers and providers in some specific ‘hot button’ issues.  It seems congress only responds to a critical issue when public pressure mounts, as indicated by a public poll.  The numbers vary greatly from week to week, depending on the hot topic and it’s resolution.

What is a health issue has become a political football. Health does not belong in this arena at all. It began with Medicare when congress passed the law establishing Medicare along with other Title IX benefits.  Unfortunately it was passed, and then it was not administered nor modified until a number of crises developed.  Passing a law and then ignoring the challenges it created is typical of our system of governing.

The Affordable Care Act begins and follows the same process. Nancy Pelosi ® a highly visible supporter for the ACA proclaimed “We  won’t know what  is in it, until it is passed.

It is common knowledge now that most legislators did not or could not read through the entire law which is about 1200 pages.  This was followed by  a second but later law (less known) which further elaborated on the ACA.

Republicans want the law amended in major ways or outright repealed.  Most Democrats still support the law, and some are no longer satisfied now that the law has gone into effect.

It remains to be seen if Republicans and Democrats can still open a dialogue as to what changes are necessary, even before Congress makes any further decisions. All of this would have been avoided if each party had accomodated the different opinions.

Congress made decisions based upon recommendations from many authoritative private and public organization who advise CMS and HHS.  These organizations make recommendations to Congress in formation of health law.  Congress then evaluates recommendation and passes law which may not be a true consensus of opinion.  Specific law often is modified by financial considerations.  

Other considerations are how Congress governs health care issues in the midst of other decisions for Defense, Foreign Relations, Science, Education and other departments. At the end of the day when budgetary issues set a limit on  expenditures a decision may be made which eliminates a vital portion of the law that effectively creates a major problem in the implementation of the law.

The next 24 months will expose operational issues, and whether the calculations for risk pools are accurate. This still depends upon how many enrollees actually pay for policies and continue to make premium payments.  Operational issues also include to providers, hospitals, and limited or non-existent access to provider networks..In many areas centers for excellence for cancer, heart disease.

Enrollees will find provider participation differs for Covered California and/or Health.gov for private insurance is not the same for subsidized policies vs private insurance.



The two most features for Obamacare are the elimination of pre-existing conditions as a reason for denial, an unlimited life-time benefits Enrollees must also be aware that some treatments or diagnostic procedures will require review and authorization prior to services.

What is totally neglected in the media and the propaganda from HHS and Health Benefit Exchanges is the fact that"

THE NEXT ENROLLMENT PERIOD BEGINS ON NOVEMBER 1, 2014....ONLY SEVEN (7) months away.

Unless you are a medicaid recipient or have an urgent need, we recommend waiting until November 2014.  By that time some of the operational issues should be more apparent, such as provider networks, copays and deductibles


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