Never Saw that Coming…

Yeah, right… 🙂

Thirty-four percent fewer healthcare providers are available to Obamacare patients — backing up “anecdotal reports that exchange networks contain fewer providers than traditional commercial plans,” a new report says.

According to an analysis by Avalere Health, the Washington-based advisory firm, the Obamacare networks offer an average of 42 percent fewer heart and cancer doctors — along with 24 percent fewer hospitals and 32 percent fewer primary care physicians for patients to choose from.

Less Choice, Higher Premiums. 🙂

Preliminary 2016 premiums for benchmark silver plans in exchanges grew by 4.4 percent in major metropolitan areas in 11 states, including the District of Columbia, according to analysis by the nonpartisan Kaiser Family Foundation. While this is much lower than the numbers being tossed around the Senate floor, it’s a sharper increase than last year, which saw premiums climb by 2 percent nationwide.

An Avalere Health analysis released this month found similar results. Silver plans on exchanges (the plans of choice for more than two-thirds of enrollees) are expected to increase 5.8 percent in the eight states that Avalere examined.

In a House Ways and Means subcommittee meeting Wednesday, lawmakers pointed to instances where insurers were seeking drastic increases. For example, in Maryland, two of eight options in the individual market are seeking more than a 30 percent increase, and a third option is seeking a 26.7 percent premium hike.

“Many of the proposed increases are eye-poppingly huge,” said subcommittee Chairman Peter Roskam.

“These rates are premised on the assumption that the court will side with the government. If the court signs with the challengers, all bets are off,” Levitt said. “There’s no doubt that we’d see some insurers pulling out of the market and the ones that stay would raise rates significantly next year.”

And they did. I wonder if that really why? 🙂

But most importantly, the Affordable Care Act’s restrictions on out-of-pocket costs by patients do not apply to healthcare services outside the plan’s network.

“Out-of-network care does not accrue toward out-of-pocket maximums, leaving consumers vulnerable to high costs if they seek care from a provider not included in their plan’s network,” said Elizabeth Carpenter, Avalere’s vice president. “Patients should evaluate a plan’s provider network when picking insurance on the exchange.

Overall, however, the limited choices are seen as a way of keeping patient costs down, said Dan Mendelson, the firm’s CEO.

“Plans continue to test new benefit designs in the exchange market,” he said. “Given the new requirements put in place by the ACA, network design is one way plans can drive value-based care and keep premiums low.”

Republicans and other health professionals have long charged that Obamacare has reduced healthcare coverage and choices for Americans.

“The American people are not happy on this birthday,” Sally Pipes, president and CEO of the Pacific Research Institute, told Newsmax TV as the law marked its fifth anniversary in March.

The report was based on a study of large healthcare networks in Florida, California, Texas, Georgia, and North Carolina, Avalere said. (Newsmax and more)

Forbes: June 2015

Texas Blue Cross stands out. The health plan commented in its federal government rate filings that it covered 730,833 Obamacare individuals in 2014 with premium of $2.1 billion and claims totaling $2.5 billion––for a medical loss ratio of 119%. The plan further commented that, after the “3Rs” reinsurance adjustments, they lost 17% to 20% of premium in 2014–that would be about $400 million. And, they are only asking for a 20% rate increase.

While we won’t see all of the rates in all of the states for a few months, some state regulators have begun to make the 2016 rate actions public:

• CareFirst Blue Cross of Maryland is asking for a 34% rate increase on its PPO plan and a 26.7% rate increase for its HMO. CareFirst has an 80% market share in the Obamacare exchange and only 30% of the eligible Maryland market has signed up on the exchange.

• In Oregon, where less than 35% of the eligible have signed up on the exchange, the biggest insurer with 52% of the market, Moda, has asked for a 25.6% increase. Lifewise, with a 19% market share, has asked for a 38.5% increase.

• Blue Cross Blue Shield of Tennessee, with a 165,000 members making up 70% of the Obamacare exchange is asking for a 36.3% increase. The second biggest player, Humana HUM +1.18%, is asking for a 15.8% increase. Less than 40% of the eligible exchange market signed up in Tennessee.

• Georgia is the second biggest Obamacare market for Humana, having enrolled 254,000 people out of a total market of 479,000, and Georgia “maybe its biggest misstep”. Its CEO has said about Georgia, “We can’t have one business being subsidized by another business.” Humana is asking for 2016 individual plan rate increases from 14.8% to 19.44%.

• In Iowa, with the lowest enrollment rates in the country, and where its biggest Obamacare insurer went broke last December, Wellmark Blue Cross, which only sells off the exchange, is asking for a 43% increase on its Obamacare compliant policies. Coventry, which has 47,000 Obamacare customers, is asking for an 18% increase for its on-exchange business.

• The Kansas insurance department has not made its rate increases public yet but has said that plans will increase by as much as 38%. Less than 40% of the eligible have so far enrolled.

• Pennsylvania is not encouraging with market leader Highmark asking for increases ranging from 13.5% to 39.65% and the Geisinger HMO asking for increases from 40.6% to 58.4%. Pennsylvania enrolled 50% of the potential exchange market in 2015.

So let the politicking of your health continues.

We are from the Government, we are here to Help you…  🙂

Political Cartoons by Gary Varvel
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