The RFI is not a serious attempt at gathering comments on how to stabilize the health insurance markets across the country. Trump and Price have already set in motion the slow dismantling of regulations that kept the ACA markets relatively stable. This is a thinly veiled attempt to generate regulation gutting suggestions that will further destroy meaningful health insurance for Americans. I can guarantee that any real suggestions that would work to contain health care costs, which are the real driver of ever escalating health insurance premiums, will be ignored.
First, let me clear that I support the concept of a single payer plan for health insurance coverage. It has worked relatively well for Medicare beneficiaries and a similar concept could be mirrored nationwide. However, proponents of Senate Bill 562, the single payer legislation, are long on promises and short on details. If we have learned anything from the launch of Covered California to serve as the market place for ACA health insurance it is that the best laid plans are far harder to execute than anyone could imagine.
If you are going to be spending an extended period of time outside of your plan area, for work, vacation, or going to college, carefully review your plan’s Evidence of Coverage to make sure the BlueCard Program is part of the covered benefits. I was surprised to learn that both Blue Cross and Blue Shield HMO plans included the BlueCard Program for 2017.
Before I start gathering coverage information, I create a table with preferred or “must have” providers, hospitals, and drugs in rows, with the available health plans across the top columns. I then mark which health plan has the providers in-network and if the drugs are covered and at which Tier.
Forcing either the health plans or the providers to post a list of costs for routine services is a very low impact way of adding consumer information to the health care market. The government is not telling the providers what they should charge. The government is not telling the health insurance companies what they should pay the providers. A law mandating a simple fee schedule like Kaiser Permanente has published will create price transparency and allow consumers to compare valuable health care cost information across a variety of health plans and providers. This will ultimately slow down the rate increases as providers compete not only on patient satisfaction, but on price as well.
However, I still don’t understand why the costs for services for Southern California Kaiser members are so much lower than prices for Northern California members. Does Kaiser just have more members in Southern California to spread the fixed costs of supplying the services over? Kaiser charges 29% more for a colonoscopy in Northern California than Southern California. Are more people getting colonoscopies in Southern California so the volumes of patients help drive down the costs?
Secretary Price’s positions on health insurance and health care are indefensible. They are cruel. They will devastate the lives of many women and children. I can only hope that voters wake up and take note of how Price and his Republican colleagues are hell bent on denying health care services to their children and neighbors and vote these people out of office. Women in America are not safe as long as Secretary Price is in charge of HHS.
But if you don’t have an account, are trying to help a family member or friend, or are just checking to see if you current mental health provider might be covered in a new health plan, you will have to swim in the sea of confusion for finding the doctor or counselor. Some of the health plans have great online directories and others really suck. Here is an overview of what I learned.
The similarities between Medicare Advantage plan and the ACA plans through the Marketplace are straight forward. Individuals are enrolling in private ACA health insurance and the federal government is subsidizing part of the cost of the health insurance to make it affordable. One of the main differences is how the federal government reimburses the insurer. Medicare beneficiaries receive an indirect subsidy to purchase a Medicare Advantage plan according to county they live in and based on historical health care cost data. Individuals and families enrolling in a health plan through an Affordable Care Act exchange receive a subsidy based on their income.
HHS has already launched a new page aimed at touting their latest attempts to revise the Affordable Care Act. Providing Relief Right Now for Patients links to initiatives HHS hatchet man Price has started to improve (gut) the ACA. The page states, “We are going through every page of regulations and guidance related to the Affordable Care Act to determine whether or not they work for patients and whether or not they are making our health care system better.”