Tuesday, April 1, 2014

Obamacare When to enroll and don't panic if you have not....Next enrollment is in November 2014

Obamacare and the Affordable Care Act:   Should you enroll this year?

Probably not. HBEs will be around for a long time. There is no regulation saying there will be no further enrollment each year.  This admonition applies to providers as well as potential enrollees.

Despite pronouncements and media marketing the ACA has no track record.  It is still very early and we have seen how many enrollees have paid and have actually seen a provider.

Perhaps no more than any other misfire, the health.gov website has set back consumer and provider confidence in HIT for at least a decade.

Providers have always been skeptical regarding EHRs, and many who have already implemented systems are planning to replace them as the HHS/CMS deadlines for meaningful use approach approach. The conversion from ICD-9 to ICD-10.                                                                        is also on the horizon.

The requirements for more complexity follow rapidly one upon the other. Mingling with these changes is the affordable care act, which will cause fallout and expected increases in insurance premiums, copays and deductibles.  The expected fall out will take several years to become apparent.

The ‘algos’ will devise statistical anaysis to show how much healthcare spending has been reduced by the affordable care act.

California has been spotlighted by the relatively high numbers of enrollees as compared to most states.  California is one of the states that agreed to expand Medicaid using temporary federal subsidies.  Governor Jerry Brown saw this as an opportunity to grab federal funding for an insolvent state. These federal subsidies will end in 2016, with a complicated analysis of how much of the federal largesse has been spent so that states can repay and excess spending in excess of the federal allotments.

Californians seem to leap before they leap..It is similar to building a ‘bullet” train in the central valley, where the population density is low, for the sake of ‘easy’.  In a state that is insolvent it makes little sense to ‘borrow money’ to expand medi-caid.  Neither has anyone elaborated on what that means?  If eligible for medi-aid do applicants go through an additonal eligibility process at their county public social services agency? Is there a share of cost for those who make more than $ 900.00/month?  Details have not been forthcoming?  Medi-caid operates on a monthly financial status which results in an almost impossible method of accesssing health care. In addition Medi-caid has far fewer eligible providers and reimbursement rates are far lower than the lowest subsidized insurance plans. Coverage is far from uniform between medicaid and subsidized policies.  The devil is in the details.

If your income is in the Medi-caid eligibilty bracket determine what your share of cost will be each month. Usually maintenance allowance is about $900.00 for the first person and increases about $ 400.00 for each eligible beneficiary    This is good catastrophic coverage but if your income is above the poverty threshold expect to pay for your own medications, and doctor visits.  Remember this share of cost is a monthly amount, it is not a truly annual  deductible.    Medi-caid also has a limit on assets for eligibilty.

California, Texas and Florida rank the highest in uninsured. Texas however has refused to expand it’s medicaid program or accept federal subsidies to do so. These are border states, although Florida is not, but has a large immigrant population from Cuba and Central America.   

The American Association of Physicians and Surgeons (AAPS) has listed ten reasons to not enroll in ObamaCare.

Here are their top ten reasons for not enrolling and what you might do instead. Weigh the pros and cons, then decide the cost-benefit balance best for you for you

1. Obamacare Health Insurance cost signifianlhy more-likely more than the penalty (tax) in the first several years.  Most people can expect their monthly premiums to double. This may vary from state to state.

2. Obamacare health insurance policies limit your choice of doctors.

3. Obamacare health insurance policies limit  your choice of hospitals.  Some centers for excellence and national cancer centers are included.

4. Out of pocket costs will skyrocket, Obamacare Health Insurance Policies have double and triple the deductibles, and higher copays you must pay before coverage kicks in.

5. Much of your medical privacy is lost, despite HIPPA, and control of your information is in government hands. (IRS administration of premiums and tax penalties)

6. The

Federal Health Benefit Exchange website is an unfinished tool with no linkage to insurers, and has not yet been demonstrated to be secure.

7. If you use an ‘Obamacare Navigator” their credentials are far less than an insurance broker who is certified, and expercienced in explaining insurance to consumers.

8. Open to question are the protection of Second Amendment rights as medical databases expand and collect information on such things as sexual preferences, and gun ownership

9. Obamacare enrollees are finding it very difficult to cancel or change their plan once enrolled if they find a better plan.

10. Obamacare policies are basically ‘managed care, with limitations on your options and reward incentives for providers to restrict care.


Portions of this article are from an online blog “Health Train Express”  (Gary M Levin MD)
The author has been on the faculty of Loma Linda Universitiy School of Medicine, USC-Doheny, and the new UC Riverside School of Medicine. He owned his own medical corporation, and also has practiced in the U.S. Navy, and the Veteran’s Administration.  His medical experience transsitioned from conventional fee for service, health maintenance organizations, IPAs, and prepaid contract medicine.


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