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View Diary: Share Your ACA Success Story! (19 comments)

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  •  Useless Insurance Parasites. (0+ / 0-)

    Obamacare Narrow Networks

    What we’re seeing has been described as a quasi-Medicaid level of doctor access. I would have little problem with plans that “streamline care”. But using Premera as a case in point along with reading about left-out doctors and hospitals all over the nation, I see a pattern of drastically reducing access to care for the sickest patients. This is a method for insurers to subvert the mandated yearly patient out of pocket maximums, (as well as the loss of insurers’ ability to cap lifetime maximum payouts) by making access to expensive care difficult or impractical, especially for the poorest and sickest patients. And by limiting tax subsidies to Exchange plans only, I believe the Democrats wrote their law deliberately to let insurers do this.

    [Update] I see that Paul Krugman praises the Medicaid Model for its “willing[ness] to say no,” a trait that allows Medicaid to control costs better than any medical care institution in this country. I just want to say that I know all about that. When I was a teenager, my mother was hospitalized on Medicaid for acute clinical depression. She was discharged from the hospital during a time when her counselor was on vacation, and while she wasn’t ready. Apparently Medicaid had said no to more hospitalization. My mother committed suicide 3 days later. My personal experience is that when Medicaid says no, people die. Is this the level of care we want for the whole country?

    Action, Action, Action
    Come on, progressives! Is your party so important to you that you don’t care anymore about the principles that led you to join it? Don’t you think you need to fight this? Maybe you should do so for the sake of your party? I would love to spend 24-hours-a-day, 7 days a week in action on this myself. However, besides the fact that I feel powerless, I’m finding that the Exchange plans create in me an urgent need to leave self-employment and venture back into the world of employer provided health insurance. So those of you with a national audience, maybe those of you who have insurance yourself, how about stepping up!

    The author also shows how you can reproduce her data to do your own research.  Just like cotton candy...
    •  In MD, the networks are far from narrow! (1+ / 0-)
      Recommended by:

      I just checked our private practice primary care provider and nephrologist, and several specialists at Johns Hopkins that my wife or I have seen recently, including an ophthalmologist specializing in retinal disease, a transplant surgeon, and a transplant nephrologist.  All of them are in most of the networks available in the Maryland health insurance exchange, and it looks like all except our primary care doctor are in ALL of the networks.

      Bin Laden is dead. GM and Chrysler are alive.

      by leevank on Sun Oct 20, 2013 at 05:24:03 PM PDT

      [ Parent ]

      •  No Uniform Standard for Care (0+ / 0-)

        "Essential Benefits" determined randomly by States.

        All insurance plans sold to individuals and small businesses will have to cover items and services in a minimum of 10 categories defined by the 2010 law, including preventive care, emergency services, pediatric care, including oral and vision care, maternity care, hospital and physician services, and prescription drugs. Self-insured employers are exempt from the essential benefit requirement, but most large employer plans already cover those 10 broad categories.

        Outside the 10 categories, the law leaves specifics up to the regulators who design the essential benefit package. Those might include particular treatments that will be covered or restrictions on such things as the number of office visits, drugs or services that will be covered. The federal law restricts annual dollar limits on coverage and bars lifetime dollar limits.

        States that don’t choose one of the four options for defining an essential benefits package will have one selected for them by federal regulators, who plan to use the benefits offered by the small-group plan with the largest enrollment in the state.

        Friday’s guidance covers only the benefits that must be offered in each state. Rules to be released later will address other aspects of coverage, such as deductibles and copayments for office visits, drugs and other services.

        Something to watch!

        Rather than issue a proposed regulation, the administration chose to advise the states through a bulletin. That does not have the force of law, but neither can it be quashed by Congress, as could a rule. By putting out the choices as a form of guidance, the administration also does not have to provide definitive economic estimates of the proposal or determine its regulatory impact on small businesses.

        A maneuver that sleazy can come to no good.

        I hope this helps elucidate the problem as I see it.

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