Access to health care services is not equal in the United States. Your health plan determines the type of care you receive. The health plans in the employer, individual, and Medicaid markets are separate and they are not equal. The ACA moved us in direction of more equality for all residents regardless of the market type of the health plan. Current Republican proposals under President Trump will widen the gap in disparity between group plans and individual plans. We need to move in a direction the guarantees access to the same level of health care services regardless of whether you work for government, a large employer, have your own individual plan, or are awarded Medicaid because of your income. It is time to dismantle the flawed ‘separate but equal’ assumption of health insurance in the United States.
The big headline in August was that Aetna would not be expanding their Obamacare individual and family plans in 2017. The smaller headline from a week earlier was that Aetna was seeking approval to become a Medi-Cal manage care health insurance provider in California. Just like other health insurance companies have found, welfare pays better than work when it comes to health insurance.
Anthem Blue Cross of California Medicare Advantage dual eligibility with Medi-Cal Special Needs Plans May 30, 2015 This guidance is generally applicable for all health insurance companies that offer Medicare Advantage Special Needs Plans for dual eligible beneficiaries. Dual Eligibles (Duals) are individuals who are entitled to benefits from both the federal Medicare and state-run […]
As of May 1, 2014, limited dental services will be included for adults, 21 years and older, that are on Medi-Cal. Adult dental Medi-Cal services were removed during the California budget crisis in 2009. Some counties may require adults to enroll in a dental manage care plan while others will offer a Fee-For-Service program. The Denti-Cal adult services will be the same whether they are obtained through a plan or through a Denti-Cal participating dentist or clinic. The challenge for adults in rural counties will be finding a dentist that accepts Denti-Cal.
Individuals and families who have enrolled in health plans through Healthcare.gov, or a state exchange like Covered California face new challenges as they report income and household changes. Families reporting changes to household size and income may also be triggering changes to their health plan. These changes may result in the entire family becoming eligible for Medicaid, being shifted into a different Enhanced Silver plan or losing the Advance Premium Tax Credit all together.
The Affordable Care Act is failing families on two major issues that need immediate resolution. The employer sponsored health insurance regulation has left many spouses without affordable coverage and household income limits are placing children in Medicaid programs. Together, these two ACA regulations are unfairly fracturing the health insurance coverage for many families and need immediate changes.
California in 2010 had 101,854 nursing facility residents, 68% on Medi-Cal, in 1,229 facilities. Cuts could force many to move.
Significant in Aetna’s press about their purchase of Coventry is their statement, “Coventry will increase our presence in Government business.” Medicaid will mean big dollars to insurance companies under the ACA.
I have determined that the United States will constantly have retarded progress towards fixing our problems because many states are more interested in protecting their own turf than working as a unified body.
All of this is further evidence that the ACA is prompting large health insurance companies to position themselves to make the most of healthcare reform from either the private market or through government contracts.