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When your overriding goal is "bending the cost curve," and you don't care about making private health insurers even more of a power in the delivery of health case, this is the result.  Like providing universal coverage by simply telling people to buy private health insurance, keeping down costs by reducing coverage is a simplistic and anti-consumer.  And it moves the needle further away from single payer.  Not to mention even having a public option.

Federal officials often say that health insurance will cost consumers less than expected under President Obama’s health care law. But they rarely mention one big reason: many insurers are significantly limiting the choices of doctors and hospitals available to consumers.

. . . .

Consumers should be prepared for “much tighter, narrower networks” of doctors and hospitals, said Adam M. Linker, a health policy analyst at the North Carolina Justice Center, a statewide advocacy group.

“That can be positive for consumers if it holds down premiums and drives people to higher-quality providers,” Mr. Linker said. “But there is also a risk because, under some health plans, consumers can end up with astronomical costs if they go to providers outside the network.”

. . . .

“Doing so enables health plans to offer lower premiums,” the study said. “But the use of narrow networks may also lead to higher out-of-pocket expenses, especially if a patient has a complex medical problem that’s being treated at a hospital that has been excluded from their health plan.”

. . . .

Outsiders might expect insurance companies to expand their networks to treat additional patients next year. But many insurers see advantages in narrow networks, saying they can steer patients to less expensive doctors and hospitals that provide high-quality care.

Even though insurers will be forbidden to discriminate against people with pre-existing conditions, they could subtly discourage the enrollment of sicker patients by limiting the size of their provider networks.

“If a health plan has a narrow network that excludes many doctors, that may shoo away patients with expensive pre-existing conditions who have established relationships with doctors,” said Mark E. Rust, the chairman of the national health care practice at Barnes & Thornburg, a law firm. “Some insurers do not want those patients who, for medical reasons, require a broad network of providers.”

http://www.nytimes.com/...

While right now this is a factor in the public exchanges, one has to wonder how long until this model is applied in the private exchanges increasingly being used by employers.  It's is analogous to employers switching from pensions to 401ks.  Employers benefit, employees take on more costs, or less coverage, and more risk.  Over time this may make a mockery of the president's promise that if people like their coverage, the can keep it.  They may not have the same coverage, or the implicit promise that they won't have to pay more for it will be violated.  

This is what happens when you try to build on the existing private health insurance system to provide coverage, rather than moving to a public one.  More and more people will be in an HMO-type plan.  With higher costs for keeping the same coverage, and massive costs if they want to go out-of-network.

This is not how the Democratic Party should go about providing universal coverage.  But unfortunately, this has become the party of Max Baucus, not of Harry Truman.

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Comment Preferences

  •  Tip Jar (16+ / 0-)

    "When dealing with terrorism, civil and human rights are not applicable." Egyptian military spokesman.

    by Paleo on Mon Sep 23, 2013 at 06:28:32 AM PDT

  •  Dollars are only useful as a relative measure (4+ / 0-)

    And then they are only useful if their availability is not artificially restricted. Congress rationing the availability of dollars is the bane of our existence. Congress using the currency as a tool to manipulate the citizenry is an evil that needs to be addressed.
    Would we put up with inches being restricted to determine whether or not we can be dressed?
    Would we put up with print being restricted to determine who gets to read and write? Oh, wait, that's also been done and accounts for why 30% of U.S. adults are functionally illiterate.

    There's no need for dumbing down when there's no smartening up.
    Sometimes the binary model is appropriate.

  •  This is going to make a lot of people unhappy (9+ / 0-)

    when they discover that, contrary to the President's promises, they won't be able to keep their doctor, but they will be forced financially to change to a network doctor.  

    I think that much of the unhappiness with the ACA is going to be with people who had - and liked -- their insurance prior to the bill. Prior to the ACA, most people who actually HAD insurance liked it.  The President overpromised what the ACA would mean for these people.  He told them that the system could add millions of uninsured, many of whom were going to be more expensive (because they had pre-existing conditions) without affecting the insurance they had and liked.  That's proving not to be true -- as this article indicates, for many people who had insurance, what they are going to get after the ACA is fully implemented is either (1) higher costs; (2) reduced choices of doctors and hospitals; or (3) some combination of the two.  It had to be that way.  You can't add millions of uninsured people to the insurance rolls -- and subsidize their premiums -- without somebody paying the bill.

    As I've said before, whether you like the ACA is going to depend largely on where you stood before it was passed.  If you weren't insured, if you had a pre-existing condition, you'll likely love it.  If you had insurance you liked in 2009 (as the majority of  people who had insurance did) and you did not want anything to change, you probably won't.

    •  This could be a political time bomb (4+ / 0-)
      Recommended by:
      CitizenOfEarth, greenbell, VClib, Johnny Q

      that Democrats ignore at their peril.

      "When dealing with terrorism, civil and human rights are not applicable." Egyptian military spokesman.

      by Paleo on Mon Sep 23, 2013 at 07:04:22 AM PDT

      [ Parent ]

      •  I read the entire article (0+ / 0-)

        it was more pro exchange and an indictment of for-profit healthcare than the opposite.

        "Holds down premiums and drives people to higher-quality providers" That's like me getting a Porsche for what you are happy to pay for a Hyundai. If I can get a better deal on the exchange than Kaiser Permanente (Not Likely) I'll move my group without hesitation.

    •  So what is your solution? One that can pass an... (8+ / 0-)

      insane, America-hating congress I mean.

      Tax and Spend I can understand. I can even understand Borrow and Spend. But Borrow and give Billionaires tax cuts? That I have a problem with.

      by LiberalCanuck on Mon Sep 23, 2013 at 07:10:19 AM PDT

      [ Parent ]

    •  Wait a minute...Obamacare is only for people who (6+ / 0-)

      are uninsured or people who cannot afford to buy insurance in the individual insurance market.  

      "Republicans are the party that says that government doesn't work, then they get elected and prove it."-- PJ O'Rourke

      by nocynicism on Mon Sep 23, 2013 at 07:42:05 AM PDT

      [ Parent ]

    •  The fundmental problem (3+ / 0-)
      Recommended by:
      Paleo, VClib, Tonedevil

      with any health care reform plan is people who have insurance like it by and large.  The polling on this has been consistent forever.  

    •  Networks have existed for 20 years (10+ / 0-)

      Almost all health plans have them and the trend will be toward steering people to providers that negotiate favorable rates.   This is simply the way things are going and will have little to do with the ACA.  

      The whole "choose you own doctor" canard is based on a misunderstanding of what "choice" means.   There are very few aspects of life in which you can choose anything you want without regard to cost, and medical care is certainly no exception.  

      See my earlier diary on this subject:

      http://www.dailykos.com/...
       

      •  Depends on the size of the network, doesn't it? (1+ / 0-)
        Recommended by:
        greenbell

        With a lot of employer-provided health insurance, the networks are very broad - most doctors and hospitals are included.  

        What this article is saying is that some insurers, to keep prices down, are significantly narrowing the networks, so far fewer doctors -- presumably ones that agree to low reimbursement rates -- will be included.  

      •  Private insurance has always done this (3+ / 0-)
        Recommended by:
        Sylv, Jojos Mojo, Mortifyd
        the trend will be toward steering people to providers that negotiate favorable rates
        We now have subsidized (and a bit more regulated) private insurance but it still private insurance. They have always done this. Nothing new here.
        •  It appears new from what I can see (2+ / 0-)
          Recommended by:
          Willa Rogers, Johnny Q

          If I look at the 2013 BCBS provider networks in MN there are three and the plans tend to offer you different levels of cost for tier one and tier 2 and different levels of costs for the 3 networks - considerable choice.  

          On the ACA plans the network for the most affordable plan is more restricted than any of the 3 traditional networks and to get a broad network you appear to have to choose a high deductible plan which tends to make "affordable" a bit unaffordable for some.  

          I may be wrong about how I am interpreting this but it's very confusing.  

          I mean fine sell the ACA, but people also have to have enough information to know that choosing an ACA plan may have some surprising costs if the provider network is much different from the network they assume they will be getting.

          If people come to believe these are poverty plans with little choice of physicians, the ACA will fail with the middle class.

          •  It's not new, at all... (1+ / 0-)
            Recommended by:
            virginislandsguy

            It might seem new to some people because they aren't familiar with this aspect of the industry, but it's been going on for as long as I remember. My mom is a retired nurse and gramps is a retired doc.  I remember them talking about this when I was little and that was well over 30 years ago.

            Insurers have been negotiating with providers for the lowest possible prices for a very long time. They hold access to the insurer's patient pool over the doc's head as leverage for lower negotiated prices. The insurer gets a lower price and the doc gets access to that patient pool, which is frequently from a very large local employer. Not negotiating with them means that clinic loses a HUGE number of potential patients.

            "Reality divorced the wingnuts after the wingnuts were discovered to be fucking goofy." - DWG

            by Jojos Mojo on Mon Sep 23, 2013 at 10:26:36 AM PDT

            [ Parent ]

            •  New and newer (1+ / 0-)
              Recommended by:
              Johnny Q

              I totally get that there are provider networks and insurance companies have been restricting them and going to tiered price levels.  

              What I am pointing out is that some of these ACA plans may have an even more restricted provider network.  Again, I'm not sure that is the case.   I'm just saying that appears to be the case with the BCBS plans I've seen so far in my state.  

              It's something to watch.  There's no point in trying to hide the bugs in the bill if there are some because real people will be hurt and it will backfire.    

              The ACA cannot succeed if it fails with the middle of the middle class.

              •  They might be more restrictive recently than... (0+ / 0-)

                ...previously, but that is just where the industry has been heading for a loooooong time. It's not due to the ACA. It's entirely due to insurers negotiations with providers and which providers were willing to play ball.

                As I posted down thread, the intentional shrinking of networks by insurers is self-limiting. If they don't have enough (or any) providers, they won't have any consumers purchasing their plans. No one paying for premiums makes for a pretty unsuccessful insurance company.

                "Reality divorced the wingnuts after the wingnuts were discovered to be fucking goofy." - DWG

                by Jojos Mojo on Mon Sep 23, 2013 at 12:12:13 PM PDT

                [ Parent ]

                •  But will they CHOOSE to make them self-limiting (0+ / 0-)

                  to avoid offering ACA plans to people they don't really want to insure anyway?  It's just a question I have about if this is a way they can game the system to offer ACA plans but really discourage people from buying them.  

                  •  Insurers don't want to discourage people from... (0+ / 0-)

                    ...purchasing their products.They want the exact opposite. That's why they fought so hard for the individual mandate.

                    When insurers negotiate with healthcare providers, they're not negotiating about specific plans. They're negotiating reimbursement rates for all patients being treated by that provider who have that insurance.

                    "Reality divorced the wingnuts after the wingnuts were discovered to be fucking goofy." - DWG

                    by Jojos Mojo on Mon Sep 23, 2013 at 12:37:21 PM PDT

                    [ Parent ]

                    •  Yes but (0+ / 0-)

                      They may want the young healthy folks signing up and young people may not much care about their provider network because most need only routine care.   It's the people with preexisting conditions like cancer, heart disease, etc. who may need some choice of specialists.  These people they may not want and if they restrict the network they may discourage them from buying an ACA plan.  Again, I don't know.  I've just not seen this question adequately addressed.  

    •  if you like your existing insurance you can keep (3+ / 0-)
      Recommended by:
      Tonedevil, Will in Chicago, Cedwyn

      it!  Just got a letter from my insurer saying so.

    •  Obamacare largely does not affect existing (2+ / 0-)
      Recommended by:
      Cedwyn, Tonedevil

      health plans aside from allowing offsprings of up to 26 years to enroll under their parents' plans, and the elimination of lifetime spending caps.

      There is no provision of Obamacare which forces insurers to limit their network.

      •  Ah, but is there a provision that makes them (0+ / 0-)

        provide truly adequate networks?  If the ACA provider networks are inferior to the ones provided on the regular plans then people will figure this out eventually.  I don't know if this is the case, but it's a question I have about the ACA.  Were the provider networks considered in how the bill was written?

  •  My old employer is moving retirees (7+ / 0-)

    who currently get retiree medical from the company to the ACA exchanges. So we should know in early Oct how this affects them. Including lower/higher costs and whether the numbers of doctors available is reduced/expanded. It's a large US Tech company with over 100,000 US workers -- and double that US size before they started offshoring jobs.

    Retirees are a very vocal group with an active online forum. Many are very nervous at this point.


    No longer Hoping for Change. Now Praying for a Miracle. 🍞 & 🎪

    by CitizenOfEarth on Mon Sep 23, 2013 at 06:54:52 AM PDT

  •  While you're certainly allowed (22+ / 0-)

    you're disappointment, please don't get carried away.

    As for this:

    And it moves the needle further away from single payer.
    Uh-uh. No.

    You know why Republicans have been so successful in advancing their aims these past few decades? Among other things, it's because they understand playing for the long term. Us, if we don't get 100% of what we want on the very first go, we go all to pieces. Their side can accept a 30% victory for what it is, and work with that. The rhetoric changes. The framing in the popular discussion changes. Their side is that much stronger. They pick themselves up and they keep right on going.

    I was disappointed in the HCR outcome, too. I wanted single payer in 2010, and I still want it. But I recognize that the ACA--after all, a pretty sweeping victory in certain respects--was only a first step. Why do you think the RW has gone totally nuts, and is fighting it so hard? Oh, they aren't deluded. They know.

    Again, this is only a first move towards cost-effective universal healthcare. Most progressives in this venue don't regard it as a be-all and end-all, neither should you. In the years and decades ahead, it will only become fashionable politically to regulate for-profit health insurance corporations. "Free market" healthcare will die an agonizing and much-deserved death.

    Mark my words.

    It's here they got the range/ and the machinery for change/ and it's here they got the spiritual thirst. --Leonard Cohen

    by karmsy on Mon Sep 23, 2013 at 06:55:53 AM PDT

  •  Single payer would be better (17+ / 0-)

    but you get the best deal you can. Single payer would never have passed. Is the ACA better than what we had before? In my opinion, yes.

    •  I agree. President Obama didn't have the (5+ / 0-)
      Recommended by:
      Deep Texan, TBug, dzog, Kimbeaux, Cedwyn

      votes.   If you remember that even in the house we only had the votes for a less than "robust" plan that would only cover 3 million people...he just didn't have the votes.  Remember how many blue dogs we had at the time.

      "Republicans are the party that says that government doesn't work, then they get elected and prove it."-- PJ O'Rourke

      by nocynicism on Mon Sep 23, 2013 at 07:51:30 AM PDT

      [ Parent ]

  •  Ya got to crawl before ya can walk (7+ / 0-)

    Here we go again, we all get that universal health coverage would be the best, like a Medicare for all.  Well a Medicare for all still costs the consumer money, it ain't free by a long shot.  There are some providers that do not provide services to Medicare, that is the way it is.  You work around that by being a savvy consumer and asking who the providers are.  If you are going to purchase any kind of insurance through the exchange or other, check it out.  You would not buy a care with no motor, why would you purchase insurance without a provider?

  •  Hmm, a GOP response to the ACA on DKos.... (12+ / 0-)

    Will wonders never cease.

    But I guess it is a good idea to welcome Republican objections so they can be factually answered and knocked down.  Redstate doesn't allow truthtellers on their site, so we should allow the occasional RS diary here as a way of delivering the message to them.

    Although, I think they are impervious to fact no matter where they hear it.

    Tax and Spend I can understand. I can even understand Borrow and Spend. But Borrow and give Billionaires tax cuts? That I have a problem with.

    by LiberalCanuck on Mon Sep 23, 2013 at 07:09:11 AM PDT

  •  I recently had two rounds of wonderful care and (11+ / 0-)

    some surgery at my local tiny rural area hospital, (just across the river) which I started going to after an emergency room visit at the giant hospital complex that gave me such an extraordinary lack of care it nearly killed me. Guess which one of these places I will not have access to if things keep going this way?

    a mockery of the president's promise that if people like their coverage, the can keep it
    Now, for $1150/month I can keep what I had with COBRA, (due to circumstances beyond control, known as hubby being laid off from the job with the best local insurance) if I choose to do that. But seriously- we're workin' for a livin' 'cause we're not rich. Why should my State be allowed to restrict access to my nearest and possibly better choice of hospital because some insurance company wants them to?

    I was a medical secretary in the days when they invented HMOs and I've seen how they brainwashed people into paying their premiums and yet paying again by the invention and growth of the co-pay. Baloney. And nothing should be "out of network." The doctors I worked for were the last holdouts, and they finally had to cave when no HMO would send them patients unless they joined too. It used to be a crime for insurance to interfere. (Then again it used to be a crime to speculate on the market with pension funds but that's another story.)

    This country bonded together to protect the Commonwealth, i.e. the welfare of all. Is not Health a big factor in the pursuit of Happiness? Can't we just make insurance men as middlemen Illegal and make the best of human knowledge and care available to all as a human right?

    We are all pupils in the eyes of God.

    by nuclear winter solstice on Mon Sep 23, 2013 at 07:15:54 AM PDT

    •  In a perfect world, your plea would resonate ... (1+ / 0-)
      Recommended by:
      nuclear winter solstice

      ... throughout the country. Unfortunately, the world we actually live in is populated by Republicans and Blue Dogs and corporate interests and wealthy sociopaths. So while you may be an anecdotal case of restricted options, I lay that on the scale beside the 2 million new health care recipients in California alone, projected to enroll in the state's ACA Medicaid expansion. For most of these people, emergency room care has been their only option up until now. Like most new massive regulatory realignments, the ACA is likely to break a few eggs on its way to making an omelet. That doesn't mean it isn't ultimately a positive change for the country.

      On balance, I don't think there is a compelling argument by the doom-and-gloomers that we were better off without the ACA, or that we could have had single-payer in one massive legislative leap, if only the president or congressional Dems hadn't "given in" to Max Baucus. Both are fallacious assertions that ignore reality - both then and now - in order to criticize the most important socially progressive policy change since Medicare. Progressives should be looking for ways to build upon this achievement, not grousing about its imperfections.

      ---

      "God is an ever-receding pocket of scientific ignorance" - Neil deGrasse Tyson

      by dzog on Mon Sep 23, 2013 at 08:43:32 AM PDT

      [ Parent ]

      •  dzog - who is going to care for the 2 million (1+ / 0-)
        Recommended by:
        nuclear winter solstice

        new Medi-Cal (our Medicaid) patients in California? In many metro areas in California the overwhelming majority of physicians will not accept Medi-Cal patients.

        "let's talk about that"

        by VClib on Mon Sep 23, 2013 at 09:19:51 AM PDT

        [ Parent ]

        •  this is a separate issue from (2+ / 0-)
          Recommended by:
          dzog, Jojos Mojo

          the ACA itself. Back in 2008 less than 3 out of 5 doctors were accepting Medi-Cal patients. This is not an insurance or ACA problem. Until doctors stop trying to get the best price for their labor (necessary for most just to pay off their student loans) many doctors will turn away "low value" or "high overhead" patients.

          Sure, setting a single rate through a single payer model would pretty much solve that, but where are the votes?

          47 is the new 51!

          by nickrud on Mon Sep 23, 2013 at 09:37:22 AM PDT

          [ Parent ]

          •  wrong. The same doctors that I worked for had (2+ / 0-)
            Recommended by:
            greenbell, Johnny Q

            another interesting go-round one time in the early '90s when all of a sudden we were inundated with new patients, all of whom had either VT or NH medicaid. We couldn't handle it time-wise at all, and even if we could, our office visits were already at an acceptable price: $30.00 for an office visit when you actually got 15-20 minutes of sit-down time with the doctor. For this same visit, Medicare paid $24.00 and we either billed the patient the rest or just ate it if we knew the patient couldn't pay, but was't poor enough for medicaid to pay the rest. For a Medicaid visit, we got paid $8.00 for the same thing. The practice couldn't live on all medicaid patients but had a policy of not turning them down. Turned out we were the last practice in the whole area to start not taking new medicaid patients, which was why everyone showed up on our doorstep. After 6 weeks of this we threw in the towel and started turning people away to the ER, and boom there we went the first time around.

            Where are the votes for single payer???  Well that was one of the reasons I voted for Kucinich.  If I'm not going to get what I want from a "D"emocrat, then I might as well vote for the candidate I want. AARP deliberately kept him off the stage and Obama kept single-payer off the table.

            We are all pupils in the eyes of God.

            by nuclear winter solstice on Mon Sep 23, 2013 at 11:55:57 AM PDT

            [ Parent ]

            •  my point exactly (1+ / 0-)
              Recommended by:
              nuclear winter solstice

              you can run on 24 but not on 8. That's what I just said.

              Many, if not most doctors are capitalists at heart. They were just raised that way. And the ones who aren't are buried under hundreds of thousands of dollars of debt or have partners that are. So they don't take money losers.

              47 is the new 51!

              by nickrud on Mon Sep 23, 2013 at 11:58:57 AM PDT

              [ Parent ]

    •  Your state is not limiting your access. Your (5+ / 0-)
      Recommended by:
      skrekk, Miss Blue, Sylv, Jojos Mojo, Cedwyn

      insurance company is.  

      Unless, of course, you can demonstrate that your state has regulations limiting the hospitals the insurance companies choose to cover.

      Socialist? You keep using that word. I do not think it means what you think it means.

      by Kimbeaux on Mon Sep 23, 2013 at 08:45:40 AM PDT

      [ Parent ]

      •  Well the big bucks insurance company that I used (1+ / 0-)
        Recommended by:
        Johnny Q

        to have and can now pay COBRA prices for did let me pick all my doctors and hospitals and stuff, but now my choices are either COBRA or the state insurance exchange.

        CONCORD — Anthem Blue Cross Blue Shield, the only insurer approved to offer policies on the health insurance exchange created under the Affordable Care Act, has narrowed to 14 the number of hospitals for the ACA plans that will be offered beginning Oct. 1.
        MY particular favorite which is only a 20 minute drive away is not on the list. I could drive an hour to the auxiliary location of the giant complex I already mentioned that doesn't know me and screwed up my care so badly I nearly died on the way out the door. My doctor that I like that Obama says I can keep is associated with the little hospital across the river. Does this look like I have a real choice?

        We are all pupils in the eyes of God.

        by nuclear winter solstice on Mon Sep 23, 2013 at 12:05:12 PM PDT

        [ Parent ]

  •  this law has been promoted in a very disingenuous (8+ / 0-)

    manner.

    People talk up a few anecdotes of people getting slightly better coverage right now and convey the impression that this is how the law will be like for everyone. Then they just airily dismiss outright all the detrimental parts like the "Cadillac tax, " also they make unsupported blanket claims about details of the policy that have yet to be worked out. The administration has delayed so much of the implementation of the law, or interpreted it in very subtle and complex ways that will make big differences in the ultimate outcome (the delay of the employer mandate being a key example).

    They also fail to note when things which were big selling points of the bill, like Bernie Sanders' community health clinics, are surreptitiously defunded (this was part of the fiscal cliff deal) or otherwise eliminated.

    A lie of omission is still a lie. And it's just not honest to sell the law in this way.

    I hear a lot of complaining that people are so reluctant to embrace the ACA because the Republicans are spreading disinformation. That's certainly true, but you can't blame the law's reception entirely on the GOP.

    The Republicans engage in constant disinformation regarding Social Security too (and have since its inception), but it doesn't work. Why? Because that program is designed too well. It is simple and its benefits are very clear. The mechanism by which it is funded is designed to encourage people to feel they have a stake in it and so they will defend it to the death.

    It's so popular that it's virtually untouchable. Bush tried to privatize it and suffered one of the biggest defeats of his presidency. Obama has put tremendous effort and political capital into trying to cut it for nearly 3 years and he still hasn't managed it.

    It's really unfair to blame people for not understanding this law. It's not that they're too stupid to realize a good deal when they see it. People are plenty smart when it comes to their own finances.

    People are confused because the law is so byzantine and convoluted, and its benefits are so unclear and by no means as widely available as its proponents would like everyone to believe, and because so much of it is left up to the states or to the next administration to implement.

    "In America, the law is king." --Thomas Paine

    by limpidglass on Mon Sep 23, 2013 at 07:17:21 AM PDT

  •  today's Portland Oregon newspaper (0+ / 0-)

    bristles with angry letters from folks who claim their medical costs are going up under Obamacare-mandated changes.

    “The answer must be, I think, that beauty and grace are performed whether or not we will or sense them. The least we can do is try to be there.” ― Annie Dillard, Pilgrim at Tinker Creek

    by 6412093 on Mon Sep 23, 2013 at 07:19:14 AM PDT

    •  So does Redstate. So what? I've read as many.... (4+ / 0-)

      diaries and comments from people who feel the ACA saved them from ruin.

      Tax and Spend I can understand. I can even understand Borrow and Spend. But Borrow and give Billionaires tax cuts? That I have a problem with.

      by LiberalCanuck on Mon Sep 23, 2013 at 07:23:39 AM PDT

      [ Parent ]

      •  I feel like those who had insurance and good (0+ / 0-)

        coverage before the ACA are the angry ones, and the ones who didn't have coverage, or crappy coverage, or pre-existing conditions are the ones happy about the law because they actually, ya know, have insurance. So if this anecdotal evidence that is mounting is any indication, we will see who is a status-quo, I have mine, non-communal, solitary type people vs. the have-nots who've been scraping by due to bad luck, and want to live in a more humanitarian, more socialized community. At least this is how it appears to me. Time will tell and also show people's true colors!

    •  And costs would have been going up regardless... (10+ / 0-)

      And have been skyrocketing for years.  Folks act that rates would have stayed the same or dropped if the ACA wasn't ever passed - that's so bloody disingenuous a claim and an easy tip off to a political agenda.  

      Glenn Greenwald promotes far-right fringe extremist group The Oath Keepers - https://twitter.com/ggreenwald/statuses/377787818619064320

      by Jacoby Jonze on Mon Sep 23, 2013 at 07:33:04 AM PDT

      [ Parent ]

      •  Actually, no. Dems have claimed there would be (2+ / 0-)
        Recommended by:
        Willa Rogers, Johnny Q

        lower premiums with ACA. There have been some diaries here on dkos making that claim within the past month. One about exchanges in CA with lower cost plans. I don't have the link but I'm sure you can search for it.


        No longer Hoping for Change. Now Praying for a Miracle. 🍞 & 🎪

        by CitizenOfEarth on Mon Sep 23, 2013 at 08:36:02 AM PDT

        [ Parent ]

        •  I feel the good guys are losing control (0+ / 0-)

          of the perceived narrative, if middle class folks with decent plans see their costs jump a few thousand a year and the companies specifically blame Obamacare.

          “The answer must be, I think, that beauty and grace are performed whether or not we will or sense them. The least we can do is try to be there.” ― Annie Dillard, Pilgrim at Tinker Creek

          by 6412093 on Mon Sep 23, 2013 at 01:53:31 PM PDT

          [ Parent ]

  •  Nice of you... (10+ / 0-)

    to forget about all the people this law will enable coverage for who had no chance of coverage before this.

    I am 60 - too young for Medicare.  For the past 7 years I've been employed by a company that does not provide insurance.  My gross wages per month were less than the cheapest quote I could get for health insurance.  This fact applied to every other person my age I know in the same circumstances plus a few who are my age but unemployed.  Several girlfriends of mine have husbands who receive their care through the VA, leaving the wives with nothing.

    I have 3 employed children who also receive no health benefits through their employers.  They make more than coverage costs, but they would have nothing left of their wages for housing, savings, school, etc.

    While I am in WI and will still get nothing thanks to our shit GOP tea-bagging Governor, many of my friends have already gotten coverage/rate estimates from the exchanges in their states as have my children.  ALL will now have affordable health plans with better than decent coverage.

    So yeah, your argument falls on deaf ears as far as I'm concerned.

    Your flag decal won't get you into heaven anymore. John Prine -8.00,-5.79

    by Miss Blue on Mon Sep 23, 2013 at 07:25:40 AM PDT

  •  You must have missed something! (17+ / 0-)

    Employers have been buying policies with narrow provider networks for a long time now, and the number who do so has been increasing.  They've been doing it because it's cheaper.  There is NOTHING that would prevent them from continuing to do so if the Affordable Care Act had never been enacted.  So I completely fail to understand how this is all the fault of the Affordable Care Act.

    Bin Laden is dead. GM and Chrysler are alive.

    by leevank on Mon Sep 23, 2013 at 07:27:54 AM PDT

    •  And how many... (8+ / 0-)

      have dropped that benefit completely?  The diarist fails to mention any of that.

      Your flag decal won't get you into heaven anymore. John Prine -8.00,-5.79

      by Miss Blue on Mon Sep 23, 2013 at 07:30:29 AM PDT

      [ Parent ]

    •  it has been getting worse every year (4+ / 0-)
      Recommended by:
      TBug, Miss Blue, virginislandsguy, leevank

      gone are the days of employer provided insurance that actually covered your needs.

      -You want to change the system, run for office.

      by Deep Texan on Mon Sep 23, 2013 at 07:55:22 AM PDT

      [ Parent ]

    •  the "Cadillac tax" comes out of employers' pockets (5+ / 0-)
      Recommended by:
      Paleo, VClib, Willa Rogers, Johnny Q, denise b

      and provides an incentive for them to buy cheaper and crappier health insurance plans. That is the fault of the ACA.

      The implementation of the employer mandate (which is supposed to prevent employers from dumping their employees onto the exchanges) has been delayed. That is the fault of the administration.

      The employer mandate's legality has recently been challenged in court. It will be very interesting to see how SCOTUS rules on it, once it gets there. (I suspect the Roberts court will strike it down).

      "In America, the law is king." --Thomas Paine

      by limpidglass on Mon Sep 23, 2013 at 08:23:59 AM PDT

      [ Parent ]

      •  Bullshit (3+ / 0-)

        Employers have been cutting plans or dropping them entirely for over 2 decades, LONG before the ACA, Obama, or anyone else ever pushed seriously for this.

        Your flag decal won't get you into heaven anymore. John Prine -8.00,-5.79

        by Miss Blue on Mon Sep 23, 2013 at 09:23:32 AM PDT

        [ Parent ]

        •  Miss Blue - but what about the Cadillac Tax issue? (5+ / 0-)

          I always thought that a penalty for providing really comprehensive insurance was a bad idea. It would not be surprising to see employers who offered the best health insurance to scale it back and avoid the Cadillac Tax.

          "let's talk about that"

          by VClib on Mon Sep 23, 2013 at 09:51:21 AM PDT

          [ Parent ]

          •  Does anyone know how much (1+ / 0-)
            Recommended by:
            Cedwyn

            the 'Cadillac Plans' would have to be scaled-back to avoid the tax? It seems the devil is in the details. If the scale-back is modest, then this is a tempest in a teapot. I honestly don't know what the magnitude of scale-back is here.

            There was only one joker in L.A. sensitive enough to wear that scent...and I had to find out who he was!

            by virginislandsguy on Mon Sep 23, 2013 at 11:21:58 AM PDT

            [ Parent ]

            •  The "Cadillac Plans" excise tax applies ONLY ... (2+ / 0-)
              Recommended by:
              Miss Blue, virginislandsguy

              to plans costing more than $10,200 for an individual, or $27,500 for a family.  Those are truly gold-plated plans.  I have no idea what justifies such costs, but I took a look at the total cost (employee share and government share combined) of the higher cost BC/BS plan offered by the federal government, which includes the vast majority of health care providers in the country.  It costs $7,054.56 per year for an individual and $15,933.60 for a family.  There isn't a single plan in the federal employees program that costs anywhere close to the level that would make it a "Cadillac Plan."

              I have a feeling that the employers that are using this as an excuse for cutting back their coverage for typical employees are just looking for a reason to blame something other than their own greed.  The real "Cadillac Plans" are the ones that exclusively cover top executives, and pay for such things as an annual complete work-up at someplace like Johns Hopkins or Mayo Clinic, complete with your own personal escort to take you from one appointment to the next one.  I was sitting in a waiting room at a Johns Hopkins clinic once when one of these guys showed up with his escort, and I wondered how one can manage to figure out how to run a major corporation if they can't manage to navigate a large hospital by themselves.

              Bin Laden is dead. GM and Chrysler are alive.

              by leevank on Mon Sep 23, 2013 at 01:28:26 PM PDT

              [ Parent ]

  •  Headline Wrong: ACA NOT Cutting Coverage (15+ / 0-)

    This is a very misleading post, and the headline even more so.  

    ACA expands coverage requirements for insurers, does not cut them.  

    Now insurers on the exchange are like any PPO, if your doctor is not on the network you are not covered. When you shop for insurance you are implicitly deciding which doctors and hospitals you can use.  There is nothing different here.

    Insurers will compete on price, but also on how what hospitals and physicians are part of the network.

    Yes lowered price plans may not cover every hospital or insurer.

    But people are not forced to buy insurance on the exchange and certainly not the lowest cost one.  They can continue their prior insurance as long as it has not been discontinued.  They will not receive subsidies if the insurance is not on the exchange.

    •  Thank you! (6+ / 0-)

      This diary might as well be on Redstate.  

      Your flag decal won't get you into heaven anymore. John Prine -8.00,-5.79

      by Miss Blue on Mon Sep 23, 2013 at 07:32:03 AM PDT

      [ Parent ]

    •  But some are shrinking the provider network (3+ / 0-)
      Recommended by:
      Paleo, Willa Rogers, Johnny Q

      You do have to look at that seriously.  If you had a  pretty good plan and the ACA plans significantly shrink the network AND provide ZERO coverage if you have to use an out of network provider, that's a risk and will people fully understand that when lured into plans where they get the tax credit?  

      By writing a complicated law they've allowed the insurance companies to do some gaming on the provider side and it's not that simple for people to fully understand the difference in the plans when the provider end of it is NOT being covered very well by the media or anyone for that matter.

      •  Shrinking provider networks are self-limiting... (4+ / 0-)

        If an insurer limits their provider network too far, they're shooting themselves in the foot. No one will purchase their plans and the lack of consumers buying their policies makes for a pretty unsuccessful insurance company.

        "Reality divorced the wingnuts after the wingnuts were discovered to be fucking goofy." - DWG

        by Jojos Mojo on Mon Sep 23, 2013 at 10:48:35 AM PDT

        [ Parent ]

      •  I your existing plan decides to shrink the network (3+ / 0-)
        Recommended by:
        Jojos Mojo, Cedwyn, Will in Chicago

        then it is just the free market at work. Obamacare has nothing to do with that. Obamacare does not encourage or discourage existing health plans to change their networks. They are doing it on their own.

        •  I'm not sure about that (2+ / 0-)
          Recommended by:
          Willa Rogers, Johnny Q

          If the insurance companies believe the ACA is not profitable enough for them then they may seek ways to limit the cost of the plans or discourage people from purchasing ACA plans by providing a restricted network.  I don't know if that is the case, I just haven't gotten a convincing answer on how the bill addresses provider networks and out of network costs.  If it doesn't address them at all then that might be something that needs to be fixed.  

          •  Wait, what bill? (0+ / 0-)

            Is there a new one just introduced, or do you mean the ACA, which is law?

            Insurers will ALWAYS seek to make their situation as profitable as possible, but shrinking their networks to an unworkable level isn't in their financial interest. Remember, if they aren't using 85% of the premiums paid to them on care, they are required to refund it to the purchasers. There's literally no incentive for them to limit themselves in that way. The networks are entirely based on which docs/clinics will negotiate with that specific insurer and nothing else.

            Insurers don't want to discourage people from purchasing plans. They want MORE consumers paying premiums. That's specifically what they lobbied for during all the negotiations while the legislation was being drafted. That's what the individual mandate is about.

            You are confusing aspects of the ACA with the normal machinations of the healthcare industry.

            "Reality divorced the wingnuts after the wingnuts were discovered to be fucking goofy." - DWG

            by Jojos Mojo on Mon Sep 23, 2013 at 12:23:54 PM PDT

            [ Parent ]

  •  ObamaCare gives protection to people (9+ / 0-)

    who need emergency care out of network. The amount one can be charged for that is now limited.

    Also, before ObamaCare, insurance companies could keep whatever they did not spend on care. Now they have to spend 80 percent on care.

  •  Really glad you brought this up - BCBS example! (3+ / 0-)

    The provider network is my biggest concern.  The plans I'm seeing being offered by BCBS in MN provide a very good plan IF you can be content with providers only in the 11 county area which is problematic for anyone who travels or particularly here in MN for people who use Mayo Clinic for serious illness.  It appears that there is ZERO coverage for any out of network provider and the out of pocket maximum is in their own words UNLIMITED.  So, that is scary because you don't always know when you might have to use an out of network provider.

    Now you can get their nation wide network covering most providers but then you are forced into the plan with a $3000 deductible before anything but the basic preventive stuff is covered.   So you pretty much have to add $3000 to your premium costs if you plan to actually be sick or injured.

    In any case, people may really get fooled on the providers and get hit with whopping expenses they don't expect.

    •  Good point. So on that " 11 county area " coverage (1+ / 0-)
      Recommended by:
      Johnny Q

      plan, you are pretty much screwed is you are away on vacation or other travel scenario and wind up needing medical attention. I had not considered that.


      No longer Hoping for Change. Now Praying for a Miracle. 🍞 & 🎪

      by CitizenOfEarth on Mon Sep 23, 2013 at 08:13:30 AM PDT

      [ Parent ]

      •  It's confusing and that's a problem for the sales (3+ / 0-)

        effort and you don't want the sales effort to obscure real risks for people.  I think most of us have gotten used to the idea that if you want out of network coverage it may cost more but usually there is still an out of pocket cap so I'm curious about the plans that have NO out of pocket cap for out of network.  But then, maybe I'm missing something but then if I am that just reinforces the point that it is confusing!

  •  Truman failed; Hillary failed; Baucus succeeded (3+ / 0-)
    Recommended by:
    Miss Blue, Jeff Simpson, Jojos Mojo

    The ACA has flaws but it enshrines the idea that healthcare for all is a government responsibility.

    That is the key breakthrough which every other civilized country has already made - and which we needed to make.

  •  The irony of this diary is that it was Truman (1+ / 0-)
    Recommended by:
    Justanothernyer

    who was President when health insurance became a deductible expense (in 1951), something which more than anything else established third party private insurers as the primary providers of health insurance, and solidified the employer-based system of health insurance we have today.

    Also ironic is the notion of criticizing the ACA for imperiling people's private insurance, when the diarist's ideal outcome, single payer, would completely eliminate private insurance.  And is the diarist not aware that one of the main complaints people have had with single payer is that there aren't enough doctors and that access to service is somewhat constrained due to the very nature of single payer, which is to ration care to keep costs down?

    "Those who have wrought great changes in the world never succeeded by gaining over chiefs; but always by exciting the multitude." - Martin Van Buren

    by puakev on Mon Sep 23, 2013 at 09:04:58 AM PDT

  •  depends on where you are coming from (2+ / 0-)
    Recommended by:
    Miss Blue, Willa Rogers

    but if one is not insured and low income, ACA represents a tremendous relief and is a huge deal.

    i can say i was at first concerned because i would like to stay with my current oncologist. and all plans available to me were HMOs.

    it turns out this is not a problem because the group is part of one of the HMO plans.

    count me in as tremendously relieved with the rollout of ACA. even if my oncologist was not on any of the plans, i would be happy to get the insurance available to me.

    i recently went to a presentation on ACA, and the speakers indicated that for most people who have insurance already, especially through their employer, ACA would have no immediate effect on them on their coverage, their plans, their costs.

  •  Heavily restricted networks can work very well (3+ / 0-)
    Recommended by:
    Jojos Mojo, Cedwyn, Theodore J Pickle

    Here in CA, the lowest cost insurer has always been Kaiser- thanks to their restrictive network. Healthy San Francisco is able to function with such an affordable premium because they use a restricted network of hospitals and clinics.
    So don't knock the concept of restricted networks. Sometimes people are fooled by the illusion of 'choice' and by the cachet of big name teaching hospitals. There are people around here who insist on going to Stanford Hospital, even if they live 50 miles away, when their local county hospital could be perfectly adequate.

    •  Agreed. "Big name" hospitals aren't (0+ / 0-)

      ...always better. It entirely depends on the patients' needs and where those needs can best be met.

      Local community hospitals or clinics are frequently an entirely appropriate place to seek treatment. When it isn't, the docs in those facilities typically have no problem shipping a patient to a different location that is better equipped to meet their needs.

      "Reality divorced the wingnuts after the wingnuts were discovered to be fucking goofy." - DWG

      by Jojos Mojo on Mon Sep 23, 2013 at 11:51:59 AM PDT

      [ Parent ]

    •  That totally depends on your medical condition (2+ / 0-)
      Recommended by:
      Willa Rogers, Johnny Q

      and your county.  

      I mean yeah if you are in a large metro and your county hospital is a level 1 trauma center and is affiliated with a great medical school and provides a broad range of specialists that's cool.  If you live in a rural county or a downscale middle sized city that might not be the case at all.  

      •  Key grafs from the NYT piece: (2+ / 0-)
        Recommended by:
        greenbell, denise b
        Even though insurers will be forbidden to discriminate against people with pre-existing conditions, they could subtly discourage the enrollment of sicker patients by limiting the size of their provider networks.

        “If a health plan has a narrow network that excludes many doctors, that may shoo away patients with expensive pre-existing conditions who have established relationships with doctors,” said Mark E. Rust, the chairman of the national health care practice at Barnes & Thornburg, a law firm. “Some insurers do not want those patients who, for medical reasons, require a broad network of providers.”

        In other words, if County Hospital doesn't do kidney transplants, then the insurer has self-selected and cherry-picked healthier patients by default.

        Paleo, thanks for the diary. As someone who's trying to get uninsured friends and family to enroll in the Exchanges, this info is crucial to me, as opposed to the multitude of GOP-said-a-thing-about-Obamacare diaries.

      •  Which is why I wrote that it... (0+ / 0-)

        ...entirely depends on the patient's needs and where they can best be met. Not all "big name' facilities are where patients' needs are best met.

        "Reality divorced the wingnuts after the wingnuts were discovered to be fucking goofy." - DWG

        by Jojos Mojo on Mon Sep 23, 2013 at 12:45:34 PM PDT

        [ Parent ]

  •  The president never had any business (0+ / 0-)

    saying that if you liked your plan or your doctor you could keep them.

    Insurance policies run for a fixed term. Next year what you get offered could be quite different. Plans can drop providers from their networks or they can drop out themselves. And as we all know from experience, the plans we get at work can change completely from one year to the next.

    So none of us ever were guaranteed to be able keep our plans or our doctors beyond the current policy term. We've only ever had limited choices, subject to changes beyond out control.

    •  You won't lose plan or doctor because of ACA (0+ / 0-)

      You are missing the point.  The ACA bill was being attacked because opponents were arguing that it would make you lose your plan or doctor.'

      The opponents were/are wrong.  If you like your plan ACA will not force you to drop it or change it.  Plans existing before the passage of ACA are grandfathered and are not subject to most ACA requirements like pre-existing conditions.

      Any plan that has your doctor will still have your doctor after ACA.

      Plans under the exchange are optional,only required if you want to get the subsidy.

      If your doctor is no longer covered by your pre-existing plan this decision has nothing to do with the ACA.

      And if your plan is a popular one, then it should continue even if it is not part of the exchange.  There may be some uncompetitive plans that are dropped after ACA but the primary rationale will be that better plans are now available.

      •  Maybe so (0+ / 0-)

        Maybe not. I'm not sure that the ACA won't affect what plans the insurers offer in the future. I'm pretty sure that for some people it will affect what their employers will offer them in the future. It already has.

        This law is going to cause ripples in the entire health care system. We don't know what they are yet.

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