Tuesday, April 26, 2016

Health Reform Troubles and the Affordable Care Act

We are now several years into the Affordable Care Act.  There are now facts and figures which reveal troubling tremors in the financial underpinning of health insurance for all patients. No one will be exempt from these market forces.

Some politicians and President Obama (for whom the ACA was renamed "Obamacare") insist on how many millions of Americans are now insured. Yes,  they carry a card, either a blue one with a stripe (Medi-caid) or a private plan.  What many of these newly insured do not know is the card they carry from the ACA is not the same that fully paying patients have in their wallets.  The term "What' in your wallet" may be applied to health insurance cards as it has been to certain credit cards.  The similarities are frightening.

These subsidized plans required providers to sign new contracts with less reimbursement eliminating any incentive to be credentialed for the affordable care act. It required providers to re-program their practises management software to bill different amounts for the ACA and to accept a lower reimbursement for each procedure code.

In some Western states the impact of undocumented workers remains largely unknown. However there are those who want to include the  segment of our population.  I think these immigrants do need to be protected, and not be excluded from the American health system. We have always been a country that welcomes immigrants and usually assimilate them fairly quickly.

Here is what is building.

ACA News

Will Covered California Sell Health Coverage To The Undocumented?
ObamaCare premiums expected to rise sharply amid insurer losses
United’s Departure From Marketplaces Could Impact Consumers’ Costs, Access

United HealthCare has absorbed multiple other companies during the past two years, to insulate itself from competition and have full reign over the market for insurance plans.  These mergers include or  will include the following competitors.

Wikinvest lists these UHG mergers and acquisitions and divestitures in the past ten years

                 This includes former independent health insurers, Oxford, Pacificare,Mid Atlantic Medical                            Services Inc.,Definity Health Corporation (Definity).Uniprise USS, Exante

                 United Health Group has several other companies in their sights Humana and Aetna. Anthem also
                 has eyes on Humana  and Aetna  is bidding on Cigna. As the old  baseball adage goes (So who's                  on first?) 

                 Readers can see more..........


The changes will impact consumers in  different states, according  to market share and other factor such as the amount of care to patients with long standing expensive chronic disease, more advanced because of neglect in the group of the uninsurables. The impact of lifestyle becomes a significant issue for some states where poor nutritional habits affect health and the development of chronic illness, diabetes, obesity, hypertension, the effects of depression, unemployment, environmental hazards.  Social change and erosion of the middle class will impact health as well. 

The longstanding organization of employee based health care is disappearing, and group policies are re-organizing.

Wall Street is ablaze with speculation and the huge increase in share value for many of these companies.

Fortune's headline proclaims,

UnitedHealth-Aetna colossus would overtake Apple on the Fortune 500.
As things develop eventually there may only be several players in the health insurance
market....."too big to fail".  Uncle Sam steps in when all is lost.......and there you have it "UNIVERSAL PAYER"  Who wudda thot ?
So where do patients and providers fit in?
Parts of this article are from Fortune, and reporting from the California Medical Association.
Post a Comment