Affordable Care Act

Dear Donald: Here’s How Health Insurance Works

Dear Donald: Here's How Health Insurance WorksDear Donald (I can call you Donald, right?):

I really appreciate that you think there are certain parts of “Obamacare” worth keeping. Like continuing to be able to cover adult children up to age 26 on your health insurance (I’ve got one of those on our health insurance right now) and ensuring that health insurers can’t discriminate or charge higher premiums based on preexisting conditions.

There’s just one teeny, tiny problem. There is no way to keep the preexisting condition part without also keeping the mandate that everyone has some kind of health insurance.

It might be a little complicated for you, so I’ve done my best to bring it down to a first-grade reading level.

An Analogy for How Health Insurance Works

1) Insurance, any insurance, is based on a risk model. The more people in the risk pool, the less impact the truly risky have on the pool.

Think of it this way. If you put five drops of red food coloring in a swimming pool, there’s no change in color. If you put five drops of red … Continue Reading

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ACA Affordable Care Act health insurance healthcare reform Obamacare politics

The Election and the ACA: Why I’m Sad, and Will Be for a Long Time

The Election and the ACA: Why I'm Sad, and Will Be for a Long TimeI’ve been writing this blog on and off for about eight years. And in all that time, I’ve tried to keep it as apolitical as possible. But, at my core, I am a writer. It’s all I’ve ever done for 30 years. And when writers can’t make sense of the world, or don’t know what to do with their feelings, well, they write.

So, spoiler alert, I am devastated by Tuesday night’s results for so many reasons. For an end to women’s reproductive rights. For an end to what I thought was a decent, inclusive country. For an end to a free press. For an end to LGBT rights. For an end to the respect we once had from the rest of the world.

And for the horrific overt racism and homophobia that has been unleashed in this country in just the past few days.

But, since I earn my living as a healthcare writer, the one I’m going to focus on here has to do with the almost-certain death of the … Continue Reading

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ACA Affordable Care Act health insurance health insurance exchanges healthcare reform healthcare system; Medicare politics

Is The ACA As Big A Mess As Everyone Says?

Is The ACA As Big A Mess As Everyone Says?Maybe. But many of the problems the Affordable Care Act (ACA) is now encountering – insurance companies on the exchanges pulling out, large premium increases in some states – are not unexpected given the design of the program.

Major problem? The Patient Protection and Affordable Care Act bill set the penalties for not having insurance too low. Far lower than the cost of the insurance to begin with. So there is little incentive for healthy people to enroll. Without healthy people enrolling, it was only a matter of time before the death spiral began.

It’s a simple equation: Sick people + no preexisting condition restriction – healthy people = high spending that outstrips existing premiums.

To add insult to injury the government was too lenient in allowing people to sign up outside of open enrollment, ie, when they got sick and needed the insurance. Plus, as The New York Times explained in a recent editorial, insurers set premiums too low in the beginning in order to attract enrollees.

Is the ACA dead? Should we scrap … Continue Reading

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ACA Affordable Care Act health insurance

Value-Based Reimbursement: There’s a New Player in Town

Value Based Reimbursement Webinar

 

There’s a new player in town. In case you haven’t heard, his name is VBR – value-based reimbursement. He’s smart. He’s tough. He’s out to break you down and build you up. And if you’re a healthcare provider, there is nowhere to hide.

For several years now I’ve been writing about the “coming” revolution in healthcare reimbursement as the system moves from a fee-for-service approach (ie, the more you do, the more you earn) to one based on cost and outcomes, aka, value. Well, the revolution has begun. Just consider:

➢ On April 1, nearly 70 hospital systems will switch from billing separately for each component of a knee or hip replacement to receiving a bundled payment for all care provided from the time the patient enters the hospital until 90 days after discharge. Just consider the possibilities!

➢ Two weeks ago, the Centers for Medicare & Medicaid Services (CMS), which is driving the value-based revolution, announced a proposal to change the way physicians are paid for drugs administered in their offices (mainly oncology medications).

Today, doctors get the … Continue Reading

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Affordable Care Act healthcare costs healthcare reform healthcare system; Value-based reimbursement

A Letter to a Friend (or, I’m Sorry I Lost My Temper Last Night”)

Sibling RivalrySo I did something last night that I’m not proud of. I got into an argument – complete with raised voices – with a friend. Over health care and the Affordable Care Act (ACA), of course. (Note that he continually called it “Obamacare” in a somewhat sneering tone, which, as those of you who read my blog regularly or know me, know I consider a derogatory term for a very important piece of legislation).

I felt terrible after we left and tossed and turned all night coming up with things I wished I said (not to mention wishing I hadn’t lost my temper).

So I decided to write my friend a letter via this blog.

Dear Friend:

I am really sorry about last night’s discussion, er, argument. I should have remained calmer (I’m blaming it on the martini you made me, which, by the way, was very, very good). So here is a cooler version of responses to some of the points you made.

The government should not be paying for health insurance.

Well, I notice that you are quite … Continue Reading

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Affordable Care Act blog health insurance healthcare costs healthcare reform healthcare system; Obamacare

Why Repealing the Affordable Care Act Won’t Stop Healthcare Reform

So the election is over. The Republicans now control both houses. And several are promising that one of their first jobs is to repeal the Affordable Care Act (ACA). I’m sure there are lots of people jumping up and down with glee.

This reaction reminds me what one doctor told me a couple of weeks ago after I spoke to his group (abdominal surgeons) about healthcare reform (you can read more about the experience here). “This (the ACA) is going to go away and things will return to normal.”

Um, not quite.

Sure, if the ACA goes away we’ll return to more than 40 million uninsured Americans who can’t afford health care. States that have expanded Medicaid will have to pick up the full tab for those expansions (instead of 10% beginning in 2020). Young adults who are still covered on their parents’ policies will now have to buy their own — if they can afford them. Women will once again be discriminated against in terms of premiums and plan designs. People with preexisting conditions will be unable to find affordable health insurance on the individual market. We’ll have no guarantee of a basic set of benefits (for instance, some … Continue Reading

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Affordable Care Act cost health insurance healthcare costs healthcare reform healthcare system;

Doctors Are Angry. I Get That. But . . .

surgeonI knew this would be the toughest audience yet in my three years of teaching/speaking about the US healthcare system and healthcare reform. I even put on a flak jacket at the beginning of my talk as a way of breaking the ice (and protecting myself; I mean, these guys pack scalpels!). And I made it through the two-hour talk and their anger without losing my composure or my sense of humor (thank god for that sense of humor).

Now I’m sitting in the airport waiting for my flight home and find myself tearing up. Not because the doctors were mean or cruel — they weren’t — but because of how much distance there is between  reality and perception, how much anger is out there, how too many people rely only on anecdotes and commentary instead of facts to develop opinions, and how scary it is to look at where we are and where we need to be — and realize that, more and more, it is unlikely we will ever get there given the rhetoric and anger in this country.

The doctors this morning, most of whom have been in practice … Continue Reading

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ACA Affordable Care Act health insurance healthcare costs healthcare reform healthcare system; malpractice insurance Obamacare patient-centered care patient-centered healthcare Uncategorized

Welcome to the Roller Coaster Ride of the Affordable Care Act

I’m behind in the blog, I admit it. Last week I was planning a blog on all the good news about the Affordable Care Act (ACA), including the 10 million people who signed up; the lower-than-expected premiums; the lower-than-anticipated medical inflation predicted for the coming year, the result of which is due, at least in part, to the ACA.

Then came the ruling from a federal circuit court that the government could not provide subsidies for people to buy health insurance in states that did not set up their own exchanges. The ruling comes from a couple of sentences in the huge bill (about 900 pages) that states that the subsidies are available for people who sign up through state exchanges. Of course, that was when we thought the states would all set up their own exchanges (since the feds were paying for it).

How naïve were we?

Today, just 16 states and the District of Columbia run their own exchanges, with residents of the remaining 34 states buying insurance through the federal exchange. That means that about 5 million people who bought health insurance on the federal exchange and received subsidies may find themselves back where they started – … Continue Reading

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ACA Affordable Care Act Obamacare

Help! I’ve Lost My Insurance and I Can’t Get Up!

indexThe serendipity of the universe never ceases to amaze me. A couple of days ago I gave the keynote speech on healthcare reform at the Texas Medical Association’s CME Association’s annual meeting in Austin. A physician in the audience brought up an issue that was trumpeted in the press when the health care exchanges rolled out for open enrollment; namely, that people had lost their insurance and couldn’t see their doctors. I knew that a very small minority of people had actually “lost” their insurance, and that, in most cases, that insurance provided pretty bad coverage at fairly high prices. But I didn’t want to get into it with him, so I just agreed that yes, the Affordable Care Act certainly has flaws, then moved on to the next question.

If only I’d checked the news before my talk. I could have told him about a Kaiser Family Foundation survey of non-group enrollees (ie, they don’t have employer-provided insurance and bought their own insurance, most on the Exchanges). Among the findings:

About  two-thirds of those with non-group coverage are now in ACA-compliant plans, while three in 10 have coverage they purchased before … Continue Reading

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ACA Affordable Care Act health insurance health insurance exchanges healthcare costs healthcare reform healthcare system; Obamacare Obamacare