Articles on the implementation of ObamaCare.
“The Affordable Care Act changed the rules on how health insurance plans dealt with pre-existing conditions, outlawing the practice of turning away patients with expensive conditions or charging them a drastically higher cost for coverage. But an editorial alleges some health insurance companies operating on the new marketplaces created by Obamacare may have found a loophole that allows them to discourage sick patients from enrolling in a specific plan.
The change has to do with how drugs are categorized in health systems. From the editorial published online at the American Journal of Managed Care:
“For many years, most insurers had formularies that consisted of only three tiers: Tier 1 was for generic drugs (lowest copay), Tier 2 was for branded drugs that were designated “preferred” (higher co- pay), and Tier 3 was for “nonpreferred” branded drugs (highest copay). Generic drugs were automatically placed in Tier 1, thereby ensuring that patients had access to medically appropriate therapies at the lowest possible cost. In these three-tier plans, all generic drugs were de facto “preferred.” Now, however, a number of insurers have split their all-generics tier into a bottom tier consisting of “preferred” generics, and a second tier consisting of “non-preferred” generics, paralleling the similar split that one typically finds with branded products. Copays for generic drugs in the “non-preferred” tier are characteristically much higher than those for drugs in the first tier.””
“The government’s own watchdogs tried to hack into HealthCare.gov earlier this year and found what they termed a critical vulnerability – but also came away with respect for some of the health insurance site’s security features.
Those are among the conclusions of a report being released Tuesday by the Health and Human Services Department inspector general, who focuses on health care fraud.”
“A survey of American physicians released this week paints a restless picture of the nation’s doctors—especially when it comes to Obamacare.
“The system is broken and I am out of here as soon as I can,” one doctor wrote. “I am tired of being used, abused, and lied to. Has anyone here woken up to the fact that we are always the last ones to be considered in the equation of change?”
Roughly 20,000 of 650,000 doctors responded to the Physicians Foundation’s survey, and voluntary surveys are prone to finding those with strong opinions. But of those strong opinions, 46 percent of doctors gave the Affordable Care Act (ACA) a “D” or “F,” while only 25 percent gave it an “A” or “B.””
“A significant benefit of the Affordable Care Act is the opportunity to receive money-saving tax credits upfront to reduce the overall cost of health insurance.
But hundreds of thousands of consumers could owe more money for federal income taxes come April if they received advance payments of the premium tax credit for health insurance. Some married couples could owe $600 or $1,500 or $2,500 or even more.”
“The Obama administration has spent at least $3.7 billion to build and promote online marketplaces under the Affordable Care Act, but it can’t prove exactly where it all went, according to an audit released Monday.
Federal investigators said the Centers for Medicare and Medicaid Services (CMS) does not properly track certain data that public officials need in order to determine whether the healthcare law is working.
The government tracks its healthcare spending in an outdated records system that cannot easily respond to data requests such as salaries or public relations contracts in certain departments. Instead, officials rely on manually prepared spreadsheets that can take months to produce.”
“The Obama administration has dragged its feet on revoking Obamacare coverage for people who can’t prove U.S. citizenship or legal residency, allowing some of the estimated 11 million illegal immigrants in the U.S. to continue enjoying taxpayer-funded benefits, a Republican senator charged Monday.
“The Obama administration is bending over backwards to give Obamacare to illegal immigrants but won’t protect hardworking American citizens who are losing their health care coverage,” said Sen. David Vitter, Louisiana Republican and an outspoken critic of President Obama’s health care law.”
“The Obama administration, which is scrambling to prepare a new push to enroll Americans in health coverage under the federal health law, is reassessing how many more people will sign up, Health and Human Services Secretary Sylvia Mathews Burwell said Wednesday..
About 7.3 million people are enrolled in health plans being sold through marketplaces created this year by the Affordable Care Act, according to federal figures.”
“Health and Human Services Secretary Sylvia Mathews Burwell told reporters Wednesday that officials are “continuing, step by step” in their effort to get HealthCare.gov ready to open for its second year of business in 50 days’ time but steered clear of specific commitments that have haunted officials who preceded her.
In her first on-the-record question session with reporters since taking the top job at HHS, Ms. Burwell got several inquiries about whether the department’s preparations to fix and revamp the site were on schedule, and answered all of them without making the kinds of comments that people could hold against her later.
“Right now, what we are doing is prioritizing,” she said. “Every day we are continuing, step by step.””
“Officials at Cover Oregon have realized the number of people affected by tax credit errors is much larger than previously thought — meaning they may owe money at tax time.
Early this month, The Oregonian revealed the existence of the erroneous formula, which had to do with the tax credits used by qualified individuals to reduce their premiums. Cover Oregon first noted the formula was wrong in January, but correcting it took a back seat to fixing the exchange’s technological problems, officials said.”
“Insurers Cigna and Blue Shield of California misled consumers about the size of their networks of doctors and hospitals, leaving enrollees frustrated and owing large bills, according to two lawsuits filed this week in Los Angeles.
“As a result, many patients were left without coverage in the course of treatment,” said Laura Antonini, staff attorney for Consumer Watchdog, a Santa Monica-based advocacy group that filed the case.
Both cases allege that the insurers offered inadequate networks of doctors and hospitals and that the companies advertised lists of participating providers that were incorrect. Consumers learned their doctors were not, in fact, participating in the plans too late to switch to other insurers, the suits allege, and patients had to spend hours on customer service lines trying to get answers. Both cases seek class action status.”