I haven’t been tweeting or commenting much about either (all if we count O’Malley) of the Democratic candidates’ proposed health care plans. You may think that’s odd for someone who spent two years fighting for national health care reform and who devours health care policy information for fun. But truth is I believe – as someone who fought for health care reform – that either candidate’s stance will be just fine. Here’s why:
I know both Clinton and Sanders will protect the best of the Affordable Care Act, but neither will be able to get much done to improve upon it without full control of both the House and Senate.
When I started heading up communications for Health Care for America Now (HCAN), we fielded a lot of frustration and a decent amount of full-on anger from staunch single payer advocates. They didn’t understand why a giant progressive coalition wouldn’t start the fight for change from the farthest left stance possible. What I learned and had to explain time and time again was that there is so much deeply engrained fear of change when it comes to health care in this country that proposing something like single payer to the general public would have been a nonstarter in 2008. Add to that the stranglehold the massively influential medical industrial complex has on 17.5% of our nation’s GDP, and we would have been facing sudden death. There wouldn’t have been a negotiating table at all.
You may not remember (oh, but I do) that candidate Obama spent 80% of his advertising budget in October 2008 on ads featuring his health care plans, and those plans emphasized the middle ground between single payer and the private insurance-dominated status quo. That middle ground included setting up a marketplace where people could comparison shop for health insurance plans, including a public option that would serve to control costs and keep private insurance companies honest (ish).
The public option fell by the wayside in December 2009, an ugly casualty of the reality of how laws make their way through Congress. In other words, I’ve seen how the health care reform sausage is made, and it’s not appetizing.
So while I have come to appreciate the benefits of a single payer system and wish we could get there, I know it’s not a realistic outcome in the short term. I get what Sanders is going for, and I’m down for his optimism. I can respect his desire to get the message across that the system we have now is abusive highway robbery at best and deadly at worst, and we can do better. And I also adore his emphasis on the truth that without campaign finance reform, we’ll never get out from under the shackles of big money buying elections and elected officials. I even can vote for it.
But just like President Obama had to change course once he faced the reality of Congressional pushback so would Sanders. All the Presidential will in the world can’t move a stubborn, bought-and-paid-for Congress.
As for Clinton, she’s intimately familiar with the challenges of making any national health reform improvements, and she’s attempting to convey that on the campaign trail. Personally, I wouldn’t mind hearing her be a little less practical and a little more aspirational, but I get it. She knows the game, and she’s aiming to keep expectations low.
Health care reform was a heavy lift, and I don’t expect it to be as high a priority for the next Administration as it was for this one. I think it will be considered a second tier issue compared to the plethora of other economic and national security concerns we have facing our nation at the moment. As much as I love it, and would gobble up every ounce of coverage, I’m not counting on it taking center stage.
Elect a Republican, however, and you can kiss all that is working for patients (eliminated pre-existing condition exclusions, expanded parental coverage for young adults, women not being charged more than men, Medicaid expansions, mandatory essential services) goodbye. There is no viable GOP health care plan. Never was. Never will be. Repeal and replace is a farce. It’s just repeal and move along.
And that’s why I am not going to spend too much time digging into the details of either Clinton’s or Sanders’ health care proposals. They won’t really matter. The one thing that will is protecting the work we’ve done up until now and keeping it intact so we can make incremental adjustments and improvements until this country finally hits the tipping point and is ready for wholesale change.
I’m excited for that day, but we’re just not there yet. The key now is voting for your preference in the primary and then supporting whoever wins the Democratic nomination in the general. And voting for down-ballot Democrats too.
President Obama didn’t have the luxury of enough members of Congress willing to fight for what he promised and what we truly needed in national health care reform. Politics killed the details of good policy. This time around, back whomever you prefer in the primary, but then vow to give the Democratic nominee both your vote and a Congress to work with.
Because no matter the plans presented on the campaign trail, with that kind of support, he or she just may surprise you.
2015, huh? I know I know. It’s been a bit since I’ve posted anything here, but that doesn’t mean I haven’t been active and active online. I do some of my best work on Twitter so it’s always a good bet you can find something substantive and/or fun there, like the time I got retweeted by @Cheezit. And if you know my affection for those salty little squares, you will appreciate just how amusing that moment happened to be.
Anyway, on the more serious side, I am working on developing a vehicle by which to address the daily inquiries I get about health care reform, insurance companies, the ACA, and our health care system overall. I think we need an outlet to have conversations about what’s happening away from DC, away from the political posturing, and away from the cloud of partisanship. I’ve argued all along that health care shouldn’t be political. I want to build a forum to talk about – and push to the forefront – policy that works, and that means engaging everyone with some expertise who is willing to participate.
I’m fairly certain I know what this project looks like, and the trick now is finding it the proper home. As the pieces continue to fall into place, I’ll keep you posted. In the meantime, happy new year. I think it’s going to be a good one.
In the wake of Robin Williams’ death, we spent a lot of time talking about depression and mental health care on The Stephanie Miller Show this morning. Too often someone cites cost as a reason for not being able to get the help he/she needs. I recommended checking out one new option for access to affordable psychotherapy – Open Path Psychotherapy Collective. Founder Paul Fugelsang writes more about the Collective on The Huffington Post. An excerpt:
We now have more than 900 participating therapists in 42 states, and every month we enroll and connect between 60 and 80 new clients. My original concept has changed a touch, and we’re constantly evolving. For example, instead of taking a fee per session, we’ve chosen to collect a one-time, lifetime membership fee. That $49 allows a client access to our database of therapists anytime he wants to find help. I know people often start and stop therapy depending on need and circumstance. Our model accommodates that reality.
You can listen to the first 13 mins of my full hour here.
Since I’m planning to talk about this during my hour tomorrow morning on The Stephanie Miller Show, I wanted to make sure people had easy access to what I’m referencing.
One anti-health care reform talking point that’s been making the rounds for a good 4 years now is some variation of the following:
Nancy Pelosi said we have to pass the bill [the Affordable Care Act] so we can see what’s in it. Nobody read the bill!
A friend and well-known conservative I follow on Twitter brought it up again this week in reaction to the U.S. Court of Appeals for the DC Circuit ruling against the ACA on a wording technicality:
What I haven’t seen nearly as often (read: ever) is the truth about what the House Speaker at the time actually said. From the transcript of her remarks on March 9, 2010 at that year’s Legislative Conference for National Association of Counties:
“You’ve heard about the controversies within the bill, the process about the bill, one or the other. But I don’t know if you have heard that it is legislation for the future, not just about health care for America, but about a healthier America, where preventive care is not something that you have to pay a deductible for or out of pocket. Prevention, prevention, prevention—it’s about diet, not diabetes. It’s going to be very, very exciting.
“But we have to pass the bill so that you can find out what is in it, away from the fog of the controversy.
In context, what Pelosi says is obvious and not at all what opponents allege. She says we (the people) have heard more about conflict, contention, and politics than the policy content of the bill. But she and her colleagues (a totally different ‘we’) have to pass the bill so that we (the people) can see what the law really says away from the cloud of misinformation that’s been swirling around it.
Here’s the video from the actual event. Not an out-of-context clip. Not a sentence edited down to :10 or less. The speech in its entirety posted online by the National Association of Counties itself. The remarks in question are from 6:57 – 7:40:
It’s baffling to me why no one bothered to take this myth down right off the bat simply by going back to the original source. The official complete version of the speech has 557 views. That one sentence clipped out of context? The first 7 videos of it I found added together have more than 900,000 views. Even the official Youtube channel of outgoing House Majority Leader Eric Cantor posted a :04 version.
Feel free to use this post as a reference next time you hear someone say Nancy Pelosi said no one in Congress read the Affordable Care Act before it passed. Because, simply put, that’s not what she said.
If you’ve been listening to my weekly health care corner on The Stephanie Miller Show or following me on Twitter, you know I’ve been asking questions about California Blue Shield and its Covered California plans. Just coincidentally, I’ve had occasion to use my new Blue Shield insurance a handful of times over the course of the last few months. Nothing serious (thank goodness), but I needed (among other things) an x-ray for a sports-related strain, a routine mammogram, and a primary care visit for a toenail that decided to grow in instead of out. Over the course of my personal interactions, I discovered a handful of issues related to my new health insurance plan. First, Blue Shield’s website listed physicians and facilities as in-network with their PPOs when the physicians and facilities themselves insisted they weren’t. And I heard two different variations on why the physicians and facilities weren’t participating. The first was that they hadn’t been invited to participate. The second was that if they were invited to participate, they were offered reimbursement rates 30% lower than what they had agreed to in the past.
This led me to dig around a bit and speak out a lot, and in response, I got letters like the following from Scott in Humboldt County, CA that reads in part:
My wife and I signed up for the silver plan because the website said our doctor was on it. We were very excited when our rate was dropping from $500+ a month for catastrophic coverage ($6000/person deductible with $30 copay) to $94 a month for a great plan ($1500 deductible with similar copy). However, now that have tried to use it, we have learned that only one clinic in the entire county is truly on the plan. All the other doctors opted out because of the low reimbursement rate, which means if I – or most of the others in the country who are on this program – want to see a doctor in network we have to drive a couple of hundred miles (to the Bay Area).
When I called Blue Shield to confirm what was going on, they told me my doctor indeed was in network. I called his office and they said they definitely were not; the reimbursement rate was too low. I called back Blue Shield and they insisted he was. When I pushed on the rep, she said, “Oh, he’s in a different program, not yours.” I asked then “Why is he listed in my program?” She didn’t know. (I have been told by several people that their doctors are also listed but not on the program.)
You can read the letter (reprinted with Scott’s permission) in its entirety here.
I reached out to Blue Shield corporate to ask about physician participation, reimbursement rates, website “errors,” etc. To their communications department’s credit, they did get back to me quickly and as thoroughly as can be expected. And I do have to thank Jackie – their extremely proactive customer service representative – who reached out to me on Twitter and both followed up on a personal claim issue and handed me off to corporate for an official response to my policy and practices questions.
You can read my back and forth with corporate here. I believe full transparency is important. But if you’re looking for a short executive summary, here’s the gist:
- Contrary to my earlier assumption, Blue Shield says if you buy an individual or family plan (as opposed to a group plan), it will be the same regardless of how you buy it. Buying through the Covered California exchange allows you to get a subsidy (help paying for your premiums) if you qualify, but Blue Shield insists its plan offerings are the same on and off the exchange.
- Blue Shield claims it worked with providers over the past several years to negotiate plans with lower reimbursement rates in exchange for the promise of more patients. This is contrary to everything I’ve heard from doctors themselves. In fact, many of the physicians and facilities I’ve spoken with aren’t looking to beef up their patient load. They simply want to keep the patients they’re already seeing. But since many of those patients have switched to Blue Shield, and Blue Shield is cutting the network by cutting reimbursement rates, physicians aren’t gaining anything but frustrated patients.
- Blue Shield claims it updates its provider directory weekly. This may be true, but it’s not updating weekly with accurate information. You really have to call your doctor directly and ask if he’s in-network. And be aware, he may not even know for sure.
- And finally, there’s this:
It’s also important to note that between the 11 qualified health plans participating in covered California, consumers have access to a broad choice of over 80-90% of the practicing physicians in the state.
That’s great if one person has 11 plans. But telling me that your 11 plans together cover 80-90% of the market does not tell me anything useful as an individual consumer.
Again, I think I got as much out of Blue Shield corporate as I could at this stage, and while they had a lot to write, I’m fairly certain much of what they claim is wrong. I still believe slashing reimbursement rates is an insurance company scam to cut down on expenses while protecting profits. I find it unlikely any physician willingly agreed to a 30% cut.
So what can we do about all this? Well, we can start by giving the state insurance commissioner some muscle.
In November, Californians will be asked to vote for a ballot measure called the Insurance Rate Public Justification and Accountability Act. Right now, CA’s insurance commissioner can review proposed rate hikes, but he can’t do anything about them:
“At the end of the day, the companies can tell us to pound sand,” says Dave Jones, the insurance commissioner in California, one of 13 states where the rate reviews are not binding. “It’s very frustrating. Frankly, our hands are tied behind our back.”
When commissioner Jones found Aetna’s small-employer rate hikes unreasonable in April, the health insurance company ignored the ruling, raising those plans’ annual premiums by an average of 8%, and increasing some as much as 21%. “I have no authority to actually enforce a reasonable rate here,” Jones says. “At the end of the day, the health insurers and HMOs have the ability to set the rates wherever they see fit.”
Expect insurance companies to fight the ballot measure by claiming any additional regulation will force them to leave the marketplace, cut services, etc. But keep in mind, they’re already cutting networks but cutting payments and raising rates indiscriminately. And the ‘poor us’ song and dance loses a bit of its charm when you read this:
A July 2010 report from PricewaterhouseCoopers concluded that the law’s state-based health care exchanges provide private insurers with a lucrative new market in which they stand to gain up to $200 billion in revenue by 2019.
Are you encountering issues with a newly-purchased individual or family health insurance plan? Are you a physician or other health care provider running into health insurance obstacles? I’d love to hear more. Leave me a comment here OR send me a note on Facebook. Be sure to let me know where you live, who your insurer is, and what plan you have.
Let’s see if we can’t continue to get to the bottom of this together.
I made my usual weekly appearance on The Stephanie Miller Show this morning and fielded a lot of questions for which I didn’t have all the information handy. So as promised, here are some explanations and links to help you navigate a few of the issues that came up.
1. My husband and I are married but file taxes separately. Can we get subsidies through the health insurance exchange?
It looks like the answer to that question is no. According to Healthcare.gov, your spouse and you must file a joint tax return in 2014 in order to access the possibility of qualifying for health insurance premium assistance. H/t to @secondgen on Twitter for the link.
2. I am trying to help my sister in Arkansas qualify for a health insurance subsidy but am having difficulty finding the answers I need. What else can I do?
US News and World Report has a good, comprehensive Arkansas health insurance resource page which includes how to reach the Arkansas Insurance Department Consumer Services Division should you still have difficulty finding what you need through Healthcare.gov. In fact, USnews.com has a health insurance guide with a drop-down menu for every state.
3. When I retire, I will have a lower income than I do now. I may qualify for a subsidy. What income do I include when estimating how much I am going to make?
4. Are newly available dental benefits under Medi-cal due to the Affordable Care Act?
Nope. It looks like the good news comes as the result of a state Assembly Bill that restores some dental benefits starting May 1, 2014. You can read more about it here (pdf) and here. The main website for these links is here.