Obamacare - Patients lose! Insurance Companies and Bureaucrats win!

ObamaCare stinks even with subsidies

By Marc Siegel          March 9, 2015 | 8:22pm

NY Post

 

Last week’s Supreme Court arguments on ObamaCare struck me as a bit irrelevant, and not just because the case won’t impact New York.

The case is about whether federal subsidies are actually legal in states that didn’t set up their own insurance exchanges — but the truth is, ObamaCare is a bad deal even with the subsidies.

Down here in the medical trenches, the harsh reality of the Affordable Care Act continues to play out.

My patients continue to report delays in signing up for ObamaCare policies and are rarely happy with what they end up with. They all have high deductibles and a narrow network of doctors to choose from.

This isn’t their fault — it’s all they can afford. Of course, without the subsidies, my blue-collar patients, many of whom work part-time jobs, wouldn’t be able to afford ObamaCare insurance at all.

Keep in mind that federal subsidies cover 75 percent of ObamaCare premiums nationwide, so if the high court upholds the written language of the law, and not the Obama IRS’s decision to ignore that language, 7.5 million people will likely lose their coverage.

But, again, even with the subsidies, it’s no bargain.

When you use the insurance, you find that you have to pay out-of-pocket for your x-ray, ultrasound or lab work — and keep on paying for tests until you spend enough to cover your $5,000 deductible.

You can’t afford the test, so you delay it.

You also have to pay out of pocket to see your doctor (me) when you’re sick, and even though I may charge you half price for a visit, you find that the prominent dermatologist I’d usually refer you to for your severe psoriasis isn’t part of your new network and won’t give you a discount.

The skin doctor I come up with instead is less prominent and devises a treatment plan that doesn’t work that well.

Here in New York, the law has put in jeopardy the entire way I practice as a primary-care physician. The law is so heavy with restrictions and penalties, and so light with actual improvements to care, that it isn’t working well even with the subsidies.

I spend more than half of my time on any given day on computer documentation, pre-approvals, contesting billing errors by labs or hospitals and choosing unknown specialists from ObamaCare lists to refer patients to.

I see no evidence that the federal subsidies are going to pay for essential health care. Instead, they bolster rising premiums and help keep insurance companies solvent and profitable.

Now here come the Supremes, wading into ObamaCare deep water once again. If they enforce the wording of the law — so that subsidies can’t go to those 7.5 million people in 34 states that refused to set up health exchanges — it should be the straw that breaks the back of the so-called Affordable Care Act.

Or how about this: the final nail in ObamaCare’s coffin.

It will be a happy day for doctors and patients everywhere.

Congress and the president will have to come up with something else.

ObamaCare was falsely conceived. If Washington wanted to provide a health-care safety net for the have-nots, it could’ve hired the doctors and built the clinics to deliver it.

Instead, it built another bloated, self-justifying bureaucracy that makes the insurance companies richer and the doctors and patients poorer.

Here’s hoping that SCOTUS grabs this final straw.

Dr. Marc Siegel is a professor of medicine at NYU Langone Medical Center and a Fox News medical correspondent.

 

Everyone that I know that has been forced into Obamacare tell me their previous insurance was more affordable, they were able to see doctors of their choice, and was much less complicated. The two group of Americans that are “doing okay” with Obamacare are Insurance Companies, and Bureaucrats!

Obamacare….buy a plan….and you most likely will have trouble finding a physician/Health System that can afford to accept you!

Bottom line: Physicians and healthcare systems have to make money to stay open (just like any other business), and Obamacare is a looser with its low reimbursement rates. I find it interesting that USA today will never call the Affordable Care Act “Obamacare” when the article has a negative fib. Just saying……we can all call it Obamacare! 

Some doctors wary of taking insurance exchange patients

Jayne O'Donnell, USA TODAY    7:18 p.m. EDT October 28, 2014

Now that many people finally have health insurance through the Affordable Care Act exchanges, some are running into a new problem: They can't find a doctor who will take them as patients.

Because these exchange plans often have lower reimbursement rates, some doctors are limiting how many new patients they take with these policies, physician groups and other experts say.

"The exchanges have become very much like Medicaid," says Andrew Kleinman, a plastic surgeon and president of the Medical Society of the State of New York. "Physicians who are in solo practices have to be careful to not take too many patients reimbursed at lower rates or they're not going to be in business very long."

Kleinman says his members complain rates can be 50% lower than commercial plans. Cigna and Aetna, however, say they pay doctors the same whether the plan is sold on an ACA network or not. United Healthcare spokeswoman Tracey Lempner says it's up to their physicians whether they want to be in the exchange plan networks, which have "rates that are above Medicaid." Medicaid rates are typically below those for Medicare, which in turn are generally lower than commercial insurance plans. To prevent discrimination against ACA policyholders, some insurance contracts require doctors to accept their exchange-plan patients along with those on commercial plans unless the doctors' practices are so full they simply can't treat any more people. But lower reimbursement rates make some physicians reluctant to sign on to some of these plans or accept too many of the patients once they are in the plans.

"I definitely feel like a bad person who is leeching off the system when I call the doctors' offices," she says. Shawn Smith of Seymour, Ind., spent about five months trying to find a primary care doctor on the network who would take her with a new, subsidized silver-level ACA insurance plan.

Last week, Smith found a practice that would accept her as a patient. Caroline Carney, chief medical officer of MDwise, Smith's insurer, says some doctors "might be participating with us, but just not able to take on new patients. It's at the doctor's discretion."

Jon Fougner, a recent Yale Law School graduate, sued Empire Blue Cross this month because he couldn't find a primary care doctor in his new ACA exchange plan.

Fougner's experience underscores how important it is for consumers to check out doctor and hospital networks for plans before they purchase them -- and to call doctors to make sure they are accepting new patients with their policies.

Among 30 doctors he called, Fougner said, they either weren't taking new patients, weren't in the plan or didn't return calls, or the contact information proved incorrect.

"It's absolutely their right to take whatever plan they want to take," Fougner says of doctors. But he says he found Empire's records are often "erroneous about whether the doctor takes the plan and/or other information essential to seeing the doctor."

Empire declined to comment as the litigation is pending.

Insurers are also moving to smaller networks of doctors and hospitals in their exchange plans. These "narrow networks" help them reduce costs, but they can also lead to problems when consumers look for doctors who will take them.

Among complaints from doctors about how the whole system is working:

• If consumers have a federally subsidized plan, they get a 90-day grace period before plans are canceled if they don't pay their premiums. That means doctors have to pursue patients to pay for their services for most of that time as insurance companies refuse to pay the claims.

• Plans sold on the exchanges with the lowest premiums require consumers to pay the most out of pocket. Many of these customers have insurance for the first time and don't understand how much they have to pay, so doctor's offices have to spend a great deal of time explaining benefits packages, says Ripley Hollister, a primary care doctor in Colorado Springs.

Doctors' offices want it to be clear on insurance cards that a patient has an exchange plan so they know whether they want to accept the plan and whether the person is receiving subsidies — which can reduce out-of-pocket costs — or has high cost-sharing. Doctors in Texas are trying to get the state to require insurance cards to make clear whether the plans were purchased on the exchange and what metal level they are, says Austin King, president of the Texas Medical Association and a head-and-neck surgeon.

Meanwhile, the National Association of Insurance Commissioners is developing a new standard for what is an adequate number of doctors and hospitals in insurance networks. Beginning next year, the Centers for Medicare and Medicaid Services will be certifying that these networks for plans sold on HealthCare.gov are big enough. Under the ACA, consumers who have trouble finding a doctor covered by their exchange plan can file a complaint on HealthCare.gov, CMS says.

There is some good news: The number of counties with two or more insurers is up from 81% for the last open enrollment to 95% this year, which Department of Health and Human Services spokesman Kevin Griffis says "should mean more doctors to choose from."

Obamacare treatment reimbursement means Physicians will be unable to treat Obamacare Patients.....Good Luck everybody!

This story references, and quotes Connecticut Physicians and reimbursements.

In Florida the Medicaid reimbursements are 50% of Medicare reimbursements. Question is; how can private practices accept Obamacare patients at a loss? Does not look good!

Doctors Begin To Refuse Obamacare Patients

The Daily Caller

2:13 PM 08/04/2014

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Obamacare plans have shrunk payments to physicians so much that some doctors say they won’t be able to afford to accept Obamacare coverage, NPR reports.

Many of the eight million sign-ups in Obamacare exchanges nationwide already face more limited choices for physicians and hospitals than those in the private insurance market. But with low physician reimbursement rates, the problem could get even worse.

For a typical quick patient visit, Dr. Doug Gerard, a Connecticut internist, told NPR a private insurer would pay $100 while Medicare would pay around $80. But Obamacare plans are more likely to pay closer to $80, which Gerard says is unsustainable for his practice.

“I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates,” Dr. Gerard told NPR.  ”You have to maintain a certain mix in private practice between the low reimbursers and the high reimbursers to be able to keep the lights on.”

Narrow networks have become a hallmark of many Obamacare exchange plans, as one of few options left to insurance companies that allows them to save money by lowering reimbursement rates and covering fewer providers. In the health-care law’s first year, 70 percent of all Obamacare plan networks were either narrow or ultra-narrow, according to an analysis from consulting firm McKinsey.

But doctors are feeling even more financial pressure due to the changes and many believe there’s a risk that Obamacare insurance will go the way of Medicaid, where patients still struggle to find a doctor after low reimbursement rates led many physicians to stop accepting it. “I don’t think most physicians know what they’re being reimbursed,” Gerard said. “Only when they start seeing some of those rates come through will they realize how low the rates are they agreed to.”

If Obamacare coverage continues on its current track, exchange customers could face a lower level of care than those who buy coverage in the private market.

“I think it could lead potentially to this kind of distinction that there are these different tiers of quality of care,” Connecticut Obamacare chief Kevin Counihan told NPR. ”That’s been something, at least in our state, that we’re trying to work against. And the carriers are, as well.”

The problem is especially bad for private practices like Gerard’s, where physicians’ income is directly tied to reimbursements. But hospitals — especially top-tier ones that treat the most difficult diseases — are also increasingly rejecting the low reimbursement rates. The nation’s best cancer treatment centers are often covered by very few exchange plans in their states; if Obamacare customers end up with a difficult-to-treat cancer, they’re likely to face a lower quality of care right off the bat.

“You get what you pay for,” said Connecticut State Medical Society president-elect Bob Russo. “If you can’t convince [doctors] that they’re not losing money doing their job, then it’s a problem. And they haven’t been able to convince people of that.”

Computers, Family Practice Physicians, Nurse Practitioners, and Physician Assistants...Patients have choices!

Moving past this story below…..Nurses and Physician Assistants will work the Primary Care Management. Physicians will fill the specialty fields. STILL….There will be a physician shortage as America’s population ages and grows!

How computers will replace your doctor

And open the door to a new boom in the nursing industry

By Pascal-Emmanuel Gobry | December 15, 2014

The Week

You've probably read some widespread sillinesses about how technology is moving us toward a world split between "high-skill" and "low-skill" jobs. Worriers claim that people with high-skill jobs will gobble up all of the economic pie, and those with low-skill jobs will be left with mere crumbs. This notion was perhaps best exemplified by economist Tyler Cowen's book Average is Over.

This is nonsense. Because high-skill jobs are in peril, too. And sometimes, their death will make way for a raft of new "low-skill" jobs.

For example, look at the future of the general practitioner of medicine. This is considered the epitome of the high-skilled, secure, remunerative job. Four years of college! Four years of medical school! Internship! Residency! Government-protected cartel membership!

And yet, this profession is going the way of the dodo bird.

To understand why, the first thing you need to understand is that multiple studies have shown that software is better able to diagnose illnesses, with fewer misdiagnoses. Health wonks love this trend, known as evidence-based diagnosis, and medical doctors loathe it, because who cares about saving lives when you can avoid the humiliation of having a computer tell you what to do.

Then you need to look at companies like Theranos, which allow you to get a blood test cheaply and easily at Walgreens, and get more information about your health than you'd get in a typical doctor's visit.

Then look at a company like Sherpaa, whose mobile app provides you diagnoses, helps you get your prescriptions filled, refers you to specialists, and so on. Right now, Sherpaa works with doctors. But there's no reason to think it couldn't eventually work with software (and in the meantime, work with cheaper Indian doctors rather than morbidly expensive American doctors).

But, you say, we won't be able to get rid of the human general practitioner absolutely. People will still need human judgment, and the human touch.

You are right — absolutely right. But the human we need is someone with training closer to a nurse's than a doctor's, and augmented by the right software, would be both cheaper and more effective than a doctor. You might pay a monthly subscription to be able to treat this person as your family "doctor" — although most of your interaction would be with software via an app. They'd be better than a doctor, too — trained in general wellness and prevention, and being able to refer you to specialists if need be.

What room is there left for generalist doctors in that scenario? None. They're the ones who the internet will replace; and it is nurses and other "low-skilled" health workers who will do best out of this shift. And most importantly, it will be great for patients.

ObamaCare architect says you should die at 75…he even says care should be halted at 75!

There are some politicians that call it a “Death Panel”, but we average Americans call it a “brick wall”! Try getting a bureaucrat or the bureaucracy to redress a wrong by our government….well let’s just say you’re not going to win!!!

Who wants to live forever? Doctor and former Obama health adviser says elderly are 'feeble, ineffectual and pathetic' and he hopes he dies when he's 75

·        Physician Ezekiel Emanuel is a former Obama health policy adviser 

·        Rejects the American 'obsession with an endlessly extended life'

·        Writes in essay: 'For many reasons, 75 is a pretty good age to aim to stop'

·        Older brother to Obama's first chief of staff, Chicago Mayor Rahm Emanuel

By Jill Reilly for MailOnline

PUBLISHED: 11:39 EST, 23 September 2014 | UPDATED: 04:41 EST, 24 September 2014

A former Obama health policy adviser has insisted he wants to be dead by his 75th birthday as the elderly are 'feeble, ineffectual and pathetic.'

Physicist Ezekiel Emanuel, architect of Obamacare and brother of former Obama chief of staff Rahm Emanuel, claims that longevity often comes at the expense of quality of life and the desire to live longer is 'misguided.'

Writing in the October issue of The Atlantic, he says: 'There is a simple truth that many of us seem to resist: living too long is also a loss. 'It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. 'It robs us of our creativity and ability to contribute to work, society, the world. 'It transforms how people experience us, relate to us, and, most important, remember us.

'We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic. 

The father-of-three acknowledges that his desire to die in his seventies does not sit well with his family, especially his daughters, but insists he will not change his mind as his years advance.

He says that if parents live to their nineties, their children must give up their retirement time to look after them and the only time they are free is when their parents die - and they are then old themselves.

Emanuel insists in the essay that he is not arguing for euthanasia or assisted suicide at a certain age.

He says that if he was diagnosed with cancer now he would probably have it treated, but when he turns 65 he will have his last colonoscopy and have no screening for prostate cancer at any age.

Emanuel insists that once he turns 75 he will refuse all medical treatment and says he 'die when whatever comes first takes me.'

In the essay, which is published on the website with photos of his family, Emanuel says he will hold a memorial before his death to celebrate his life, but if his survivors want to have one when he has passed away it is not his 'business.'

Emanuel, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, does acknowledge that sometimes age is not a barrier to creativity.

He cites the case of a prominent health economist who recently celebrated his 90th birthday and continues to be 'brilliant', but insists that the man is simply 'an outlier—a very rare individual.'

Emanuel blasts the American obsession with 'exercising, doing mental puzzles, consuming various juice and protein concoctions, sticking to strict diets, and popping vitamins' and says he thinks the mindset is both 'misguided and potentially destructive.'

Emanuel, told ABC's Dr. Richard Besser on This Week: 'I look at the data on disability, I look at the data on Alzheimer's disease, I look at the data on loss of creativity.  

'And 75 seems to be the right moment where the chance of disability, physical disability is low, you're still not in the high Alzheimer's risk of 30 percent or 50 percent and creativity has sort of come to an end.

Emanuel, the director of the Clinical Bioethics Department at the U.S. National Institutes of Health and head of the Department of Medical Ethics & Health Policy at the University of Pennsylvania, helped develop President Obama's health care reform law. 

Emanuel's youngest brother is the president's first chief of staff, current Chicago Mayor Rahm Emanuel.

Their other brother is Hollywood agent Ari Emanuel whose clients have included Rhianna, Justin Timberlake, Ben Affleck and Matt Damon. 

The three brothers were raised in Chicago by their father Israeli-born pediatrician Benjamin and mother Marsha, a nurse who was a descendant of Russian immigrants. 

They also have an adopted sister with cerebral palsy who shuns the limelight.

Obamacare ends Life at age 75...Yep you heard it here first!

Okay…Where do you start with this shit? The guy how wrote the Obamacare law says we “humans” have no right to expect healthcare beyond the age of 75. Nice guy right? Tell your parents or grandparents that it has been nice knowing ‘em ‘cause Obamacare will be happy to have them die! Don’t they make bad movies about this stuff?

Who wants to live forever? Doctor and former Obama health adviser says elderly are 'feeble, ineffectual and pathetic' and he hopes he dies when he's 75

·        Physician Ezekiel Emanuel is a former Obama health policy adviser 

·        Rejects the American 'obsession with an endlessly extended life'

·        Writes in essay: 'For many reasons, 75 is a pretty good age to aim to stop'

·        Older brother to Obama's first chief of staff, Chicago Mayor Rahm Emanuel

      By Jill Reilly for MailOnline

·         

PUBLISHED: 11:39 EST, 23 September 2014 | UPDATED: 04:41 EST, 24 September 2014

A former Obama health policy adviser has insisted he wants to be dead by his 75th birthday as the elderly are 'feeble, ineffectual and pathetic.'

Physicist Ezekiel Emanuel, architect of Obamacare and brother of former Obama chief of staff Rahm Emanuel, claims that longevity often comes at the expense of quality of life and the desire to live longer is 'misguided.'

Writing in the October issue of The Atlantic, he says: 'There is a simple truth that many of us seem to resist: living too long is also a loss. 

'It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. 

'It robs us of our creativity and ability to contribute to work, society, the world. 

'It transforms how people experience us, relate to us, and, most important, remember us.

'We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic. 

The father-of-three acknowledges that his desire to die in his seventies does not sit well with his family, especially his daughters, but insists he will not change his mind as his years advance.

He says that if parents live to their nineties, their children must give up their retirement time to look after them and the only time they are free is when their parents die - and they are then old themselves.

Emanuel insists in the essay that he is not arguing for euthanasia or assisted suicide at a certain age. He says that if he was diagnosed with cancer now he would probably have it treated, but when he turns 65 he will have his last colonoscopy and have no screening for prostate cancer at any age.

Emanuel insists that once he turns 75 he will refuse all medical treatment and says he 'die when whatever comes first takes me.'

In the essay, which is published on the website with photos of his family, Emanuel says he will hold a memorial before his death to celebrate his life, but if his survivors want to have one when he has passed away it is not his 'business.'

Emanuel, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, does acknowledge that sometimes age is not a barrier to creativity.

He cites the case of a prominent health economist who recently celebrated his 90th birthday and continues to be 'brilliant', but insists that the man is simply 'an outlier—a very rare individual.'

Emanuel blasts the American obsession with 'exercising, doing mental puzzles, consuming various juice and protein concoctions, sticking to strict diets, and popping vitamins' and says he thinks the mindset is both 'misguided and potentially destructive.'

Emanuel, told ABC's Dr. Richard Besser on This Week: 'I look at the data on disability, I look at the data on Alzheimer's disease, I look at the data on loss of creativity.  

'And 75 seems to be the right moment where the chance of disability, physical disability is low, you're still not in the high Alzheimer's risk of 30 percent or 50 percent and creativity has sort of come to an end. Emanuel, the director of the Clinical Bioethics Department at the U.S. National Institutes of Health and head of the Department of Medical Ethics & Health Policy at the University of Pennsylvania, helped develop President Obama's health care reform law. 

Emanuel's youngest brother is the president's first chief of staff, current Chicago Mayor Rahm Emanuel.

Their other brother is Hollywood agent Ari Emanuel whose clients have included Rhianna, Justin Timberlake, Ben Affleck and Matt Damon. The three brothers were raised in Chicago by their father Israeli-born pediatrician Benjamin and mother Marsha, a nurse who was a descendant of Russian immigrants. They also have an adopted sister with cerebral palsy who shuns the limelight.

Obamacare closing more and more private practices....Physicians are leaving small communities

Many, many, many physicians have had to close their private practices, and forced to join hospital owned offices. Either that or find a job not in medicine! Gee…thanks Obamacare….What ever happened to “you can keep your Doctor”? He (Obama) knew that it was a load of crap….and so did all the rest of us. The sooner Obamacare is scrapped the better….just another closed-end, expensive, waste of time and money government program that only Socialist covet!

Alaska Physician Shuts Down Practice, Citing Obamacare

From the Daily Caller

9:39 PM 09/21/2014

Sarah Hurtubise Reporter

After a long list of Obamacare failures in Alaska, one physician is shutting down his decades-old practice, charging that the health-care law and other federal programs are “unsustainable” for practicing doctors.

Dr. William Wennen, a plastic surgeon, is closing his Fairbanks practice after 38 years of working in the state. Dr. Wennen blames federal health insurance programs, citing Obamacare, Medicaid and Medicare, for shutting down his practice.

“It is an unsustainable system,” Dr. Wennen wrote to his customers in a letter obtained by The Daily Caller. “I am personally writing off upwards of three quarters of a million dollars annually in free/uncompensated care.”

“My reasons for closing down the office are simply economic,” Wennen wrote. “The governmental agencies that are supplying ‘medical insurance’ to the elderly, the disadvantaged, the indigent and the sick, injured, or disabled have placed an unrealistically low value of worth on physician’s services.”

Medicaid typically has the lowest physician reimbursements of any federal program. Doctors have been protesting pay cuts for services through Medicaid and Medicare. It’s increasingly difficult for customers to actually find health care providers that accept the coverage — especially in private practice, where doctors are more hard-pressed to be profitable than at big-budget hospitals. 

 “Within the last month, Fairbanks has lost three other much respected physicians for the same or similar reasons,” Dr. Wennen wrote. ”I am not the first and certainly will not be the last of the exodus of physicians from active practice because of all of this.”

Dr. Wennen is far from alone in his stark opposition to the health-care law. A recent survey from the Physicians Foundation found that 46 percent of doctors in the U.S. would give Obamacare a “D” or an “F,” the Washington Examiner reported.

For his part, Wennen hopes to continue providing medical care through other avenues, but can no longer afford to keep his practice. Other doctors nationwide have simply refused to accept coverage provided by federal agencies — even private coverage sold through Obamacare exchanges.