Is Obamacare Unraveling?

By ROBERT LASZEWSKI

Rumors have been circulating in the marketplace all week that the administration was thinking of extending the individual health insurance policies that Obamacare was supposed to have cancelled for as much as three more years.

Those rumors have now come out into the open with Tom Murphy’s AP story on Friday.

He and I agree, and his statement is not a question, rather a rhetorical statement.  It does not take a rocket scientist to analyze what has happened in a very short time.  The initial HBE rollout was and remains a fiasco, which will set the plan back several years. Yes it is possible to enroll if you don't work and can afford to spend over one hour on hold, and/or navigate the HBE websites.  I can only speak to Covered California's health benefit 'Marketplace'.  They should have called it "The Shopping Maul'.  Surely you will feel mauled by the process.  It is a cross between the last day of shopping before Christmas, and 'Black Friday'  

The deadlines were foolish for an unproven system. It was only tested at its launch. Fail Whale there.

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.

Affordable Care Act..Obama admits "THERE MAY BE STRUCTURAL PROBLEMS.

...Hinges No Longer Squeak, They Are off the Doors....  California today announced the expansion of customer service agents for COVERED CALIFORNIA.

CoveredCA is hiring an additional 350 telephone agents to meet the continuing demand to enroll for Covered California. The California Medical Association also reported; Health Reform and Covered California News

The White House is relaxing the employer mandate again 

The Treasury Department on Monday rolled out more tweaks to the health-care law's requirement that all large employers--those with 50 or more workers--provide insurance coverage to their workers. This is the part of Obamacare was supposed to take effect at the start of 2014, but was delayed by the White House this past summer as the White House was facing significant push back from employers.

Covered California is hiring more workers to fix service problems

California's health insurance exchange is racing to fix persistent service problems before it faces another surge of Obamacare applicants eager to beat a March enrollment deadline. The state is drawing on a $155-million federal grant it received last month to improve service ahead of the March 31 sign-up deadline under the Affordable Care Act. The Obama administration is counting on California to deliver another big wave of enrollment to compensate for a shaky rollout nationwide.

350 workers added to Covered California call lines
Hundreds of customer service representatives will be added to Covered California’s phone lines, to help cut wait times and to enroll more state residents into health care plans before a March deadline, state officials announced Monday

California health exchange pulls doctor directory again

California's health insurance exchange pulled its online doctor directory again after some physicians were wrongly listed as accepting patients' coverage plans, spurring a blame game between insurers and providers. A major error was made in the provider directorty for private insurers Covered California published the incorrect list of providers.  Many have not signed up to be providers under California law.  Covered California requires a different set of rules including unique reimbursement rates. Many providers do not even know they are llisted, and when they present themselves to the MDs office they will find the doctor' office unable to accept them.

For 3 million, 'affordable' health care might not be
The lure used to get uninsured Americans to sign up for health law coverage was the promise of generous premium subsidies.The promise comes with a catch for almost 3 million people earning three to four times the federal poverty rate: They may have to pay up to 9.5% of their income toward that premium before the government subsidy kicks in. That could take a substantial bite from their budgets — potentially as much as $600 a month for a family of three earning $58,590 to $78,120. As a result, some middle-class families may decide health insurance is beyond their reach and pay a penalty rather than buy coverage. 

Faith based and Charitable Funding as An Alternative Solution

Have charitable organizations....faith based religious, and other non-profits furnish health care financing...Keep your health care away from government

Affordable Care Act.......The Missing Link....It is not Australopithecus

Houston, we  have a problem  "Failure to Launch"

Despite a goal of access to health care for all, however the hinge on the door for acccess is squeaking. News such as this are appearing in medical news.

Family Planning Clinics In Calif. Squeezed By Health Law KQED - February 10, 2014 Millions Trapped in Health-Law Coverage Gap Wall Street Journal - February 9, 2014 They quit their jobs, thanks to health-care law Washington Post - February 9, 2014 Enrolling in Covered California is not for the weak of heart, or spirit.  For those who were previously uninsured for a variety of reasons the affordable care act raise spirits with the elimination of the fear of not being able to pay for health care. The current system was not sustainable financially, however health care is available taking away the financial morass of insurance companies, bureaucracy and government.  Neither government, nor insurance companies provide health care. Physiciains, nurses, hospitals and many other providers care for patients. A consequence of the change will be the marked reduction in 'free care'. The old model of those fortunate enough to pay for their own care, and providers and hospitals having deep pockets to finance care for the less priveleged of our society. In order to assure health care and security for all the down side is forfeiting freedom. The tyranny of absolute security is freedom. Some of  us understand the concept and the reason for opposition to the affordable care act.  Others see it as an opportunity   for free health care.   Those whol will receive this generosity are often not only uninsured, but also un-empowered, and have little impact, are passive and do not have resources, nor influence to make changes. The U.S. Constitution (    )  guarrantees the pursuit of life, liberty and the pursuit of happiness.  That statement places us in a conundrum.  Does that mean care to avoid illness, or treatment to keep one alive? This is not some ephemeral abstract thought embodied in our founding document. Other constitutional guarrantees in the past have been manipulated to make change The Affordable Care Act in Californa is known as  'Covered California'.  Patients who sign up are screened for eligibilty based on income and household size. Those who's income is greater than........are required to purchase a subsidized health insurance policy or face a fine.  Some of these policies look nice, offered by stable companies, such as Blue Shield, Healthnet, Anthem and their providers are listed under providers for Covered California.  However with a more in depth search you will find they did not receive contracts and are not providers.  (small details).....this will reduce access to providers (and some hospitals). None of this has been adequatly explained  Some who look forward to using Covered California should call their chosen provider and ask if they are a provider for Covered California.   Many of them are not, and some may not even know if they are signed up for it.

Is Sunday a Day of Rest for Social Media ?

Sunday may or may not be a day of rest in social media, depending upon your lifestyle. If you use Social Media for business it may give you time to prepare your social media stream for later in the week, scheduled by an increasing number of social media add ons, such as Hootsuite, Buffer, Hubspot and others.

Sunday may be a time to socialize about Friday and Saturday's movies, dinners, parties, weddings, and other events.

Social media has been accepted and internalized among young people. Everyone has it and is dong it. The line between social and business is evaporating, just as it has in real life.  More deals go down on the golf course, at the coffee shop, restaurants, and during times of transportation.  It's easy enough to bring along all your digital documents and share them on google + or just 'bluetooth' them across the desk or table. Google drive, dropbox, skydrive, amazon and others all provide shareable storage for free or little charge

Physicians can share medical consults and discuss difficult diagnostic challenges anywhere at the clinic, hospital, operating room or from the automobile (smart) that will be driving itself very soon. Powerpoint, Slideshare, Prezi, offer different and imaginative presentation modes. Since  Youtube was bought by Google the two share log ons and also integrate and synchronize via Google plus.  Google continues to add some private and secure modes for video conferences . They call it "Helpouts".  And for MDs it is  HIPAA compliant which allow patient - provider secure and confidential communications In additon to these open social platforms, there are physician specific sites, such as SERMO, and DOXIMITY

Social has merged with business, and more is coming with wifi remote monitoring, coupled with two way interactive video and/or audio conferencing.  House "calls' have truly been reinvented. and are probbably more functional than the 'black bag " visits of yesteryear.

When it comes down to it, we are all connected socially.  Our responsibility remains to our patents, and no matter`how exciting the technology is, will it help you to deliver care, or is it just a  'toy" ?

Not Running A Hospital, Or What is Wrong at Hadassah ?

Hadassah was the alternate name of Queen Esther,  and is also the name of the American Jewish charitable organization of women, founded by Henrietta Szold in 1912.

Hadassah Medical Organization has fallen on hard times.

Only recently has this news been released. A lack of transparency and poor governance have accumulated to question the solvency of Hadassah Medical Organization, which is now $ 1.5 billion dollars in debt.

Pointing fingers at the past will not change the situation, however all should learn the importance of transparency in governance. There should be no shame at failure, only the lack of willingness to be committed to change.

   

Paul Levy, former CEO of a prominent Boston Medical Center shared with us on his blog, Not Running a 
Hospital. The title is quite an allegory, since he is now retired from hospital leadership. Apparently that is 
what has occured at Hadassah Medical Organization. What can global medical interests do to help?