FEDERAL HEALTH BENEFIT EXCHANGES: COVERED CALIFORNIA, BREAKING NEWS

Exchange enrollments at 3.3 million, big jump in January

By Paul Demko 

Posted: February 12, 2014 - 5:15 pm ET

Tags: Costs, HealthCare.gov, Insurance

(Story updated at 6:15 p.m. ET)

Nearly 3.3 million individuals signed up for private insurance plans through the state and federal exchanges during the first four months of the open enrollment period, HHS reported Wednesday. The total represents significant growth in January, but is still less than halfway toward the goal of 7 million enrollments by March 31.

State exchanges enrolled 1.4 million individuals through the end of January, while 1.9 million individuals signed up through the federal exchange, according to figures released by the CMS on Wednesday. The federal exchange, in particular, showed momentum in January: Nearly 40% of total enrollments through the federal HealthCare.gov website occurred last month. 

It's very, very encouraging news,” HHS Secreatary Kathleen Sebelius said on a call with reporters Wednesday.  

However the total numbers only show a small part of the enrollment issues.  Demographics vary widely from state to state in terms of age, health, and gender.

“We're seeing a growing population of Americans who are young, healthy and well covered, and these younger Americans are signing up in greater proportions,” Sebelius said.

A significant number of new enrollees are from those who had pre-existing policies cancelled at the end of 2013.

Catastrophic Options

Hardship Exemptions  (Qualifications)

However, in some states exchange customers continue to skew significantly older. In Ohio and Wisconsin, for example, only 21% of enrollees were between the ages of 18 and 34.

A gender discrepancy is also emerging, with women representing 55% of those seeking coverage. In some states, the gender imbalance is even more pronounced. Women account for 60% of signups in Oregon and 62% of exchange customers in Mississippi.

HHS also issued data for the first time on the type of plans being purchased on the exchanges. More than 60% of state and federal exchange customers opted for silver plans, which are designed to cover 70% of medical costs

Last week, the Congressional Budget Office reduced its estimate for how many people will sign up for coverage in 2014 from 7 million to 6 million, due in part to the rocky rollout of the federal exchange and continued problems with some state marketplaces. 

There is still no data available on how many individuals have actually made their first premium payment. Even after enrollment and premium payment it remains to be seen how many will find a suitable provider. Magnifying this issue in California is massive errors in the provider directory listing providers who will not accept Covered California.

A massive  deception has been built into Covered California. Policies called Blue Shield PPO (Silver  Plan) are not ordinary Blue Shield PPO plans.  Not only that but there is a difference between group PPO plans and Individual Family Plans (IFP).

I contacted a wel established medical group (Inland Empire)  (120 providers)  to inquire about their providers enrolled in Covered California. I was told tthey accept the group Blue Shield PPO, but NOT the IFP. 

This will come as a great shock to those enrolled in many Covered California plans.

Precautionary note:  Check with your chosen provider to ascertain if they accept your specific plan under Covered California. Covered Callifornia is a general term and means very little. Be certain to find if the specific plan that was signed up for is truly available.

Many patients will present to the doctor's office and find they do not have a provider.

Important News:  Covered California is updating it's Provider  Directory.  Check with your chosen provider to corroborate their participation.  Urgent Care Centers are also specific to a planBe certain your chosen provider is aa member of the medical staff of your chosen hospital.

The Health Benefit Exchanges say that enrollment can be changed until March 31.2014.  

Note: This article will be updated weekly.

The Physician's Plight Some doctors back away from Obamacare

In the Press Enterprise

BY LAURIE UDESKY  CHCF Center for Health Reporting  December 20, 2013; 

The Affordable Care Act has placed most physicians in a state of conflict. I don't know any physicians who would not want all their patients to have good health and wellness.  Wellness is always a less expensive alternative and pursuing it adds to the quality of life immediately.

While the Affordable Care Act has these components as part of the basic standard many physicians cannot participate in the roster of providers who will accept patients in Covered California, the state exchange.

Surveying other exchanges may reveal the same situation repeated 50 times.  Much of it depends upon the rates for reimbursement set by insurers, and is individualized by each insurer.

The California Health Care Foundation did a survey of physicians in California and found that 70-80% of physicians who studied the reimbursement plans,  (about 70% of the Medicare rates) decided to not participate in Covered California (the Health Benefit Exchange run by the state. 

Medicare rates have already been decreased almost 50% since 1988.  This in spite of inflation and skyrocketing administrative costs for providers due to increased regulatory requirements in order to be an eligible provider for CMS.

Dr. Steven Larson, the CEO of the Riverside Medical Clinic (140 providers), said he was taken aback when he saw what insurance companies were willing to pay. “The rates were 70 percent of Medicare [reimbursement]. It doesn’t leave room for making a living,” he said. “It’s potentially a huge problem,” said Larson, who also is the chairman of the California Medical Association Board of Trustees.

The clinics serve 300,000 patients under a variety of plans, including many Medicare patients who are not affected by the new exchanges. But the patients who want their care covered under a health exchange plan will now to have to look elsewhere for a doctor.

 In some cases they are trying to decide whether to join. In other cases they are finding that they have been dropped from plans. And many are just trying to get information about whether they are listed in an exchange plan or not.

Covered California maintains that the plans offered through the exchanges include 80 percent of the state’s physicians. “We arrived at the 80 percent by comparing our network to the two largest commercial networks,” said Covered California spokeswoman Anne Gonzales.  This reveals the lack of expertise and knowledge that state health agencies have about health care in the market place. A recent survey of California Physicians showed that 70-80% would not participate.

About a year ago numerous insurers (or Covered California ) sent out letters of intent asking providers if they would participate in the exchanges.  At that time there were no  speciffics as to reimbursement or other provisions, which are left to the insurers as long as their policies conformed to the ACA benefits.

This amounted to asking providers to sign a 'blank check'.

Recent analysis of insurer directories reveal they are inaccurate for many reasons. The directories are prepared annually with many months of lead time. California Medical Association President Dr. Richard Thorp. “Many times when we look at their physician directories, they include names of people who have moved out of state, are retired or dead. ”Some physicians have even  been listed in the exchange after they refused to participate because of the low reimbursement rates.
The challenges to participate in Covered California are as great for providers as it is for patients.

The scenario is unbelievable, except that it is fact.

Health Train Express reviewed California Health Care Foundation statements as well as the California Medical Association. The following are some of the examples:

Insurers are required to notify doctors if they’re included, according to Lisa Folberg, vice president of medical and regulatory policy for the California Medical Association.

That hasn’t always happened in Riverside, according to the executive director of the Riverside Medical Society. “Basically doctors don’t know if they’re in or out of the network,” she said. The society has told doctors to call the plans directly.

If the present situation is confusing, unfortunately the future, despite the government's intention to organize health reform, looks even more grim.  Insurance c ontracts are usually an annual renewal. At any time after the first year and later as the system matures it will be in the purvey of these "guardians of Covered California' to alter the rates.  Debt ceilings, national catastrophe, conflicts will all effect health.

The current GDP incorporates the sixteen percent due to health enterprise.  The ACA has added more levels and administration to an already bloated health system.