Docs frustrated with PPACA.

Doctors aren’t thrilled about the way the health care landscape is changing.

In the face of health reform and other regulatory pressures, a survey reveals that a big proportion of doctors wish they could turn back time and choose a different career path. Forty percent of doctors said they wouldn’t become a physician again given the chance to rethink their career, according to research from the Physicians Practice, which surveyed 1,172 physicians.

Of those who said they wouldn’t become a physician again, 32 percent felt there was too much third-party interference in their practice operations. When asked to indicate the largest barrier to good health care for their patients, 37 percent of physicians identified a lack of adequate insurance coverage and 19 percent said they don’t have enough time to adequately educate patients on better health strategies.

Meanwhile, just 35 percent of respondents said they support the Patient Protection and Affordable Care Act or support it with minor changes.

PPACA has been a sore subject for many doctors, as research continues to find that PPACA could deepen the doctor gap. The influx of millions of newly insured Americans who gain coverage under PPACA next year, on top of the already growing physician shortage, will have profound implications for patient access to medical care, industry insiders warn.

“We are at a critical juncture,” Dr. Steven Wartman, president and CEO of the Association of Academic Health Centers, said earlier this year. “As the 2014 deadline for most Americans to have health insurance approaches, the health care workforce is not ready, and we are quickly running out of time.”

The Doctor Patient Medical Association has argued that PPACA will have little positive impact on patients’ access to medical care and will only create red tape for doctors.

Similarly, 45 percent of physicians surveyed by the Physicians Practice said that the re-election of President Obama “bodes poorly for the future of health care.”

Though the survey focused on the frustrations of doctors, the majority — at 60 percent — said they’d choose their career again. The survey also found that 46 percent of physicians said they will continue to practice the same way they do today over the next five years. Fourteen percent of those surveyed plan on retiring in that same time frame.

By  September 10, 2013

Health insurance tax faces challenge.

The health insurance industry and business allies are stepping up their  campaign to repeal another new Obamacare tax this fall — one that they argue  will hit consumers smack in the health care part of their wallet.

As Congress returns from recess, expect to hear more about the health  insurance tax, or HIT, as it’s known, a levy in the health care law to raise  $116 billion through 2023. That money, in turn, is  America’s Health Insurance Plans, the U.S. Chamber of Commerce,  an insurance brokers association and other groups launched a digital advertising  and social media campaign last month to stir opposition to the tax, especially  in states of the lawmakers who might do something about it.

The campaign will formally launch inside the Beltway later this month, after  having attracted several additional trade groups to the initial coalition.

The ads focus on the tax but not the health care law itself. The message is  that the tax counters the goals of health reform by making insurance more  expensive, and therefore less affordable. The cost is expected to be passed on  to consumers.

But the tax is also a large piece of the funding for the insurance expansion  — which, in turn, will create millions of new customers for insurers, many with  government subsidies.

The health insurance tax won’t hit the premiums of people who work for many  large employers — which cover a great majority of working Americans. Most big  employers already offer coverage through something called self-insurance —  meaning they actually use their own dollars to pay the medical bills and use the  insurers to administer the health plans. The employer, not the insurer, carries  the risk.

The tax does apply to insurance companies that pick up the tab, including the  private Medicare Advantage plans and those that will be sold to individuals on  the new state-based Obamacare exchanges. It applies to most small-business  plans, which are less likely to self-insure.

Author: (bnorman@politico.com

 

America’s biggest employers, from GE to IBM, are increasingly moving retirees to insurance exchanges.

(Bloomberg) — America’s biggest employers, from GE to IBM, are increasingly moving retirees to insurance exchanges where they select their own health plans, an historic shift that could push more costs onto U.S. taxpayers.

Time Warner Inc.  said Sunday it would steer retired workers toward a privately run exchange, days after a similar announcement by International Business Machines Corp. General Electric Co. last year said it, too, would curb benefits in a move that may send some former employees to the public insurance exchanges created under the 2010 Affordable Care Act.

While retiree health benefits have been shrinking for years, the newest cutbacks may quickly become the norm. About 44% of companies plan to stop administering health plans for their former workers over the next two years, a survey last month by consultant Towers Watson & Co.  found. Retirees are concerned their costs may rise, while analysts predict benefits will decline in some cases.

“Things are going to change dramatically,” said Ron Fontanetta, a partner at New York-based Towers Watson, which advises GE and other large companies. “Over the next two to three years, we see a much more aggressive rethinking of what employers are going to provide.”

The adjustments come as insurers have increased access the past few years to Medicare Advantage plans that provide benefits beyond the U.S. government health program for the elderly. Additionally, the health-care law promises to make it easier for those younger than 65 to buy insurance that’s guaranteed and subsidized by taxpayers.

Private Exchanges

The private exchanges are designed to join with companies to find the best deals for the former workers. The public exchanges established under ‘Obamacare,’ set to open Oct. 1, were created to provide insurance for millions of uninsured Americans. In both cases, enrollees will be able to select from a menu of private health plans.

Companies argue that many retirees can find more choice and a better deal on the exchanges, said John Grosso, head of the retiree health task force at Aon Hewitt LLC, a Chicago-based consultant. Instead of taking a one-size-fits-all company plan, a healthier retiree might find a less expensive policy with a higher deductible, or one that saved money by favoring generic drugs, he said in a telephone interview.

Less healthy workers or those who need more comprehensive coverage may not fare as well, Grosso said.

‘Gold-Plated’ Plans

“Some of them may not be as well off because they had a really gold-plated plan, but others who are paying a meaningful contribution to their own plan now can right-size the coverage,” he said.

At the same time, retirees have expressed concern that subsidies provided by companies in private exchanges may not keep up with rising medical costs, potentially putting them at financial risk in the future. And an influx of retirees could put added pressure on public exchanges that provide taxpayer-supported subsidies.

Retirees aren’t the only ones feeling the pinch. Last month, United Parcel Service Inc. told workers it would no longer provide health care for 15,000 spouses who can get benefits through their own employer. The company cited rising medical costs in general as well as the added expenses and new insurance options created by the health law.

IBM’s Decision

IBM said last week it will shift about 110,000 Medicare-eligible retirees to Tower Watson’s Extend Health, the largest private Medicare exchange. Former workers will find more options than the business could provide through its own plan, IBM, the third-largest U.S. employer according to data compiled by Bloomberg, said in a statement e-mailed Sept. 7. Caterpillar Inc. and DuPont Co. also have moved Medicare-age retirees onto the Extend exchange.

For most, coverage will come “at the same or lower cost” than they pay now. The Armonk, New York-based company will still make contributions to a tax-free health retirement account for the workers.

IBM capped its subsidies to retirees in the 1990s and “didn’t make this change to save money,” Doug Shelton, a spokesman, said in an e-mail. “It does not reduce our costs.” Rather, the company is making the change to help former workers, whose premiums and out-of-pocket charges are projected to triple by 2020 under the current plan, Shelton said.

Some unions now angry about PPACA.

WASHINGTON (AP) — When President Barack Obama helped push the Patient Protection and Affordable Care Act (PPACA) through Congress, he counted labor unions among his strongest supporters.

But some unions leaders have grown frustrated and angry about what they say are unexpected consequences of PPACA — problems that they say could jeopardize the health benefits offered to millions of their members.

The issue could create a political headache next year for Democrats facing re-election if disgruntled union members believe the Obama administration and Congress aren’t working to fix the problem.

“It makes an untruth out of what the president said, that if you like your insurance, you could keep it,” said Joe Hansen, president of the United Food and Commercial Workers International Union. “That is not going to be true for millions of workers now.”

The problem lies in the unique multiemployer health plans that cover unionized workers in retail, construction, transportation and other industries with seasonal or temporary employment. Known as Taft-Hartley plans, they are jointly administered by unions and smaller employers that pool resources to offer more than 20 million workers and family members continuous coverage, even during times of unemployment.

The union plans were already more costly to run than traditional single-employer health plans. PPACA has added to that cost — for the unions’ and other plans — by requiring health plans to cover dependents up to age 26, eliminate annual or lifetime coverage limits and extend coverage to people with pre-existing conditions.

“We’re concerned that employers will be increasingly tempted to drop coverage through our plans and let our members fend for themselves on the health exchanges,” said David Treanor, director of health care initiatives at the Operating Engineers union.

Workers seeking coverage in the state-based marketplaces, known as exchanges, can qualify for subsidies, determined by a sliding scale based on income. By contrast, the new law does not allow workers in the union plans to receive similar subsidies.

UPS ending health coverage for some spouses.

(Bloomberg) — United Parcel Service Inc.’s decision to drop health benefits for 15,000 of its workers’ spouses may be a sign of the future, as U.S. businesses grapple with rising medical bills and the added burdens of the Affordable Care Act.

The nation’s fourth-largest employer said yesterday that beginning Jan. 1 it will no longer offer health coverage to spouses who can get it through another company. UPS cited the ACA as part of its impetus, saying it would increase costs and provide other insurance options for spouses.

The shift is a sign of corporate America’s increasing willingness to make deep changes to benefits once taken as a given by U.S. workers. The health care overhaul, estimated to boost expenses for businesses by 2% to 4% next year, is adding to the momentum that already spurred higher deductibles and surcharges for covering dependents.

“The feeling is, drastic times call for drastic measures,” says Rich Fuerstenberg, a partner at New York-based benefits consultant Mercer Inc. “What employers are adopting today are strategies that were considered crazy or out of the mainstream just a few years ago.”

The benefits change will only affects workers in the U.S., according to a memo to employees published yesterday by Kaiser Health News. Spouses who don’t work or lack employer-provided insurance will still be covered by the Atlanta-based company’s health plan, as will children of workers, according to the memo. The change won’t affect 250,000 Teamsters union workers or employees in other countries.

Study: Navigators, Nonprofits Least Likely Sources of Health Insurance Guidance.

Across the country, the federal government is bestowing millions of dollars on a navigator program and an array of non-profits to help guide people through the new health insurance marketplaces. But a new nationwide survey raises questions about how readily consumers will turn to these groups for advice on health coverage.

The study, conducted by HealthPocket.com, a nonpartisan web site that compares and ranks health plans for individuals, families and small businesses, found that navigators and non-profits are the least likely sources for information about health insurance to which consumers will turn. According to the survey, consumers are far more likely to look to their doctors and pharmacists for advice, and even more likely to stand pat with the insurance they already have and not seek any sort of advice at all.

“The financial viability of the new health insurance exchanges is closely tied to the enrollment of younger, healthier individuals, and administration officials have stated that they would like to get 2.7 million enrolled from this age segment,” said Bruce Telkamp, CEO of HealthPocket, based in Sunnyvale, Calif. But “given that only 3 percent of consumers in the critically important 18 to 34 year age group indicated that they will use navigators or nonprofits as a primary source of advice, the administration will need to rely heavily on marketing channels outside of the navigator program and nonprofit outreach to meet its enrollment goals.”

Navigator is the term used by the Affordable Care Act to describe the health insurance councilors and customer service personnel who will help people enroll and sort through their health plan options on the new exchanges. Last week, the Obama administration announced it was awarding another $67 million in grants to non-profits and other community-based organizations to hire and train navigators. These awards come on top of the $150 million in government monies provided in July to nearly 1,200 community health centers nationwide for the same purpose.

 

Obamacare Navigators get $67 million in grants.

CHICAGO (AP) — President Barack Obama’s administration has announced $67 million in awards to organizations that will help people sign up for insurance under the new health care law.

Health and Human Services Secretary Kathleen Sebelius announced Thursday the Navigator grant awards to 105 organizations in states that are letting the federal government run their online insurance marketplaces.

The Navigator program will be particularly important to the health law’s success in some Republican-led states that aren’t doing any state-directed outreach to the uninsured.

The grant winners don’t have much time to hire and train outreach workers. Enrollment for the health law’s new coverage options starts Oct. 1, and benefits kick in Jan. 1.

Navigators must complete a training program developed by the federal government and pass an exam.

PPACA navigators to earn $20-$48 an hour.

In About-Face, Aetna Backs Away from State-Based Exchanges.

 
 

At least one big insurer is rethinking its plans to sell healthcare policies through the state and federal online marketplaces next year.

Aetna has dropped plans to offer health policies through the insurance exchanges in Ohio and its home state of Connecticut, the company revealed last week.

The Buckeye and Nutmeg state exchanges are the latest to join a growing list of local markets in which the carrier has reversed course and decided not to participate. Since June, it has also backed off plans to sell coverage via the exchanges in six other states, including California, Georgia, Maryland, New York, Tennessee and Texas.

In the case of Connecticut, at least, the decision was made “reluctantly,” according to a letter to the state’s Insurance Department signed by Bruce Campbell, Aetna’s senior actuary. “Please be assured this is not a step taken lightly, and was made as part of national review of our Exchange strategy,” Campbell wrote.

As in some other states, Aetna abandoned its plans after Connecticut regulators questioned the rates it proposed to offer through the state’s exchange, known as Access Health CT or AHCT. Three insurers will still offer individual coverage through AHCT, including Anthem, ConnectiCare and the nonprofit HealthyCT.

“The good news today is that consumers and businesses will retain several, high quality choices, and today’s decision also shows we at AHCT are doing our best to hold rates down,” Kevin Counihan, the chief executive of AHCT, said in a statement. “Our goal is clear: we want to bring affordable, quality health care to Connecticut’s residents and small businesses.”

The story is similar in Maryland, where the insurer said the state’s requirements for rate reductions would force it to operate at a loss. “Unfortunately, we believe the modifications to the rates filed by Aetna and Coventry would not allow us to collect enough premiums to cover the cost of the plans,” Aetna said in a letter to insurance commissioner Therese Goldsmith. Eight other carriers will continue to offer individual policies through Maryland’s web-based insurance market.

In Ohio, Aetna said it’s withdrawing from the individual exchange market for 2014, but plans to continue offering its individual products from its Coventry subsidiary on the exchange. The carrier also said it will continue to provide its individual product in Ohio’s off-exchange market.

Aetna’s decision will leave 12 companies offering 200 individual health insurance plans on the Ohio exchange.

Detroit Looks to Obamacare to Cover Pensioners’ Health Care.

Detroit is hoping to lean on the Affordable Care Act to pick up its massive  retiree health care tab as it tries to dig it out of bankruptcy.

The Motor City is reportedly considering shifting its unfunded $5.7 billion in health-care costs of  retired workers that aren’t yet eligible for Medicare to the health insurance  exchanges that are set to hit the market next year under Obamacare.

The $9 billion in pension liabilities to 21,000 retirees is the greatest cost  to the city, which is currently $18 billion in debt, according to the Detroit  Free Press.

If the current pension health-benefits are cut, the majority of retirees will  either receive care via Medicare if they are at least age 65, or through online  insurance exchanges. Those who are at or below 400% of the federal poverty limit  will be eligible for subsidies.

“It will actually be discriminatory,” says Gary Burtless, labor expert at the  Brookings Institute. “Suppose you are a retiree and you believe you had access  to Detroit-provided health insurance plans, but your family income is over  four-times the poverty line.  You will not get any subsidy and will have to  pay for the full cost of the plan without any help of the government, in any  form, whatsoever.”

He adds that Detroit retirees are lucky in one sense, since they are Social  Security-eligible. In some states, including Massachusetts, public workers  cannot collect Social Security benefits because they do not pay into the system.  With that said, Detroit retirees depending on a pension might be forced to claim  Social Security benefit early, and thus reducing their payments.

But what may be good news for Detroit retirees who are eligible for the  health-care subsidy, is bad news for taxpayers, who are helping pay for this  coverage for an unnamed amount of pensioners in the city who are not yet  Medicare eligible, says Michael Tanner, Cato Institute senior fellow.

“It’s a shift of the cost to these [retired] workers and to the taxpayers at  large,” Tanner says. “If Detroit went to Congress and asked them to pay for  their plans, Congress would say, ‘no.’ They are getting a bailout from  taxpayers.”

The average pension check, per month for a retiree in Detroit is under $1,200  according to the Detroit Free Press. Using the Kaiser Family Foundation’s subsidy calculator, a single,  63-year-old worker receiving a $1,200 check per month, or $14,400 pre-tax per  year, would be at 125% of the federal poverty level.  This worker seemingly  does not smoke, and has no children or other family members on the health-care  plan.

Kaiser’s calculator has the unsubsidized annual premium for our fictional  worker at $3,018, and the worker paying $288 for care per year.

Other cash-strapped cities and municipalities are watching the situation in  Detroit closely, as it may provide financial options to unfunded pension  systems, says Tanner.

“This is being talked about in a number of cities,” he says. “The fact is  that Detroit will have to cut its health-care plans and this is a way of  shifting those costs.”

And if Detroit pulls this off successfully, Burtless thinks many other cities  will follow suit.

“If Detroit pulls this off, why shouldn’t other cities and states not evade  their responsibilities and commitment?”

Whether this is the solution the city opts for will all depend on its  bankruptcy restructuring plan, Tanner says. City Emergency Manager Kevyn Orr has  discussed a potential $120 allowance for retirees who were set to receive full  health-care benefits before the Chapter 9 filing, says Steven Kreisberg,  director of collective bargaining at Detroit’s AFSCME union.

Kreisberg says if the shift occurs, it will bring a reduction in benefits for  retirees.

“The ACA has various ranges of coverage, but it will depend on what the  retirees are willing to pay,” he says. “You are moving from a situation where  employees earned the right to retiree health care to [a situation] where that  will be completely withdrawn.”

Solutions to the city’s pension and retiree benefits are still very much in  the “discussion” phase, says Kreisberg.

“It’s a significant loss,” he says. “The coverage employees had was seamless  from employment to retirement and was very comprehensive. “

 

The benefits and pitfalls of buying insurance on health-care exchanges.

The benefits and pitfalls of buying insurance on health-care exchanges. 

As the state health insurance marketplaces, also called exchanges, get set to launch in October, many people have questions about the coverage that will be offered there. Here are a few that were posed to me recently:

Q. Are there unintended consequences of shopping through an exchange? For example, are the benefits of a plan with a lower monthly premium less comprehensive than the benefits of an expensive plan? And are there plans available only to people who qualify for subsidies, so that once income increases, the consumer must switch to a different plan?

A. All plans sold on the exchanges must cover 10 so-called essential health benefits, including prescription drugs, emergency and hospital care, and maternity and newborn care.

For the most part, the plans will differ not in which benefits they cover but in the proportion of costs that consumers will be responsible for paying.

There will be four basic types of plans: Platinum plans will pay 90 percent of the cost of covered medical services, on average; gold plans will pay 80 percent; silver plans will pay 70 percent; and bronze plans, 60 percent. Premiums will vary based on those percentages, so platinum plans generally will be pricier than bronze ones.

Individuals and families with incomes up to 400 percent of the federal poverty level ($45,960 for an individual and $94,200 for a family of four in 2013) may be eligible for federal tax credits to help pay premiums.

Consumers “can use the premium subsidy to purchase any plan,” says Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.

If your income increases during the year, you may no longer qualify for the same level of assistance, but you won’t have to switch plans. However, you may have to repay any overpayments that were made to insurers if your projected income turns out to be higher than your actual income. On the other hand, if your income falls, you may be eligible for a larger tax credit. That’s why it’s important to report any income changes to the exchange promptly.

A second type of subsidy available on the exchanges will reduce the amount that people owe in co-payments, deductibles and other out-of-pocket costs. The cost-sharing subsidy is available to individuals and families with incomes up to 250 percent of the poverty level ($28,725 for an individual and $58,875 for a family of four in 2013). To qualify for this subsidy, you must buy a silver plan, Park says. If your income changes, however, you won’t be responsible for any overpayments.

 

Once the exchanges open, how much will an insurer be allowed to increase premiums annually? And are those increases based on claims?

Premium increases are driven by many factors, including medical costs and the health of the people covered by a particular plan.

The Affordable Care Act discourages insurers from imposing unreasonable premium increases in a couple of ways. Insurers in the small-group and individual markets that want to raise premiums by 10 percent or more must submit data, projections and other information to justify the increase to state or federal regulators, who review the requests and make the information available to the public at. Asking insurers to justify why they want to increase rates should act as a deterrent to unreasonable increases, experts say.

But the law doesn’t give regulators new authority to refuse rate increases, says Timothy Jost, a law professor at Washington and Lee University in Lexington, Va. It does, however, provide funding for states to beef up their rate-review processes.

The Department of Health and Human Services says that increased scrutiny of insurance rates has led to a decrease in rate increases, says Jost, “and that’s probably true.”

In addition, the law requires insurers to spend at least 80 percent of the money they collect in premiums on medical claims and quality improvements rather than on administrative activities such as marketing. If they exceed that limit, they must rebate the excess to consumers. Insurers will return $500 million to 8.5 million consumers — about $100 per eligible family — by mid-August of this year for overcharges in 2012, according to the Obama administration. Rebates may come in various ways, including a check or a reduction in the following year’s premium.

 

My parents are legal immigrants over 65 but not yet eligible to buy into Medicare because they haven’t lived in the United States for five years. Will they be able to buy health insurance on the federal exchange?

Yes, legal immigrants will be able to shop for coverage on the exchanges, where they may be eligible for premium tax credits if their income is no more than 400 percent of the federal poverty level ($62,040 for a couple in 2013). Immigrants living in the United States illegally, on the other hand, are not permitted to buy coverage on the exchanges even if they wish to pay the entire premium out of pocket.

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