Sunday Short Cuts

Obamacare enrollees on average have one-third fewer choices when it comes to picking doctors and hospitals than those on regular commercial plans, a new study says.

But its authors claim that’s not necessarily a bad thing. And others in the health-care arena believe the findings are misleading and don’t tell the whole story.

The study from Washington, D.C.-based Avalere Health finds that those under Affordable Care Act plans have roughly 66% of the choices compared with those in commercial plans, and the number of options may vary depending on the type of physician needed.

Under Obamacare, enrollees have access to roughly 58% of the oncologists and cardiologists that commercial plan members have. The average goes up when it comes to hospitals, as those using the public exchanges have access to 76% of those care facilities.

But Avalere Vice President Elizabeth Carpenter says while there generally are fewer providers in an Obamacare network, public exchanges offer a wide range of health plans. If a consumer wants the same variety of doctors and hospitals as a commercial plan, those options are available under Obamacare.

Going with a network that narrows the choices often means savings for the consumer in lower premiums, Carpenter points out.

California’s Med-Cal program, which offers health care to the poor, serves nearly one-third of the state’s residents. It has expanded rapidly — nearly doubling in patients over the past eight years — most recently because of the Affordable Care Act. In an effort to control costs, California has relied heavily on managed care insurance companies to treat patients like Abriha.

The state pays insurers a fixed amount per patient and expects the companies to provide access to doctors and comprehensive care, rather than paying for each medical visit or procedure under a fee-for-service model. But a scathing state audit released last month shows that California is failing to make sure those plans deliver. Like Abriha, many people have insurance cards but often have trouble getting in to see doctors.

Not all of the plans being offered to Texans have large proposed rate increases. But Ben Gonzalez, spokesman for the Texas Department of Insurance, confirmed: "Many of the rate filings we have seen for individual coverage are proposing rate increases for 2016 averaging between 20 and 30 percent."

By comparison, last year's average increases in the individual market were typically between 10 and 20 percent, Gonzalez said.

Williams, too, said it is misguided to focus solely on percentages. She said a hefty percentage increase could simply mean a plan was previously underpriced.

...Some of the sting can be taken out of a rate increase if a consumer receives a federal subsidy to knock down the price of a premium. About 87 percent of those enrolled in marketplace plans received a subsidy in 2015.

Subsidies are determined by calculating a percentage of a consumer's income against the second-lowest-cost silver plan in the marketplace. With those plan costs still in flux - some low-cost plans may go up while others go down - it is likely that for 2016 "many consumers will need to change plans," said Cheryl Fish-Parcham, private insurance program director for Families USA, a national health care advocacy group for consumers.

But let’s look at results: hundreds of thousands of people have insurance coverage they didn’t have before, and Minnesota has the lowest rate of uninsured in state history. In MNsure’s first year, the state’s uninsured rate has dropped by a whopping 40 percent.

There continues to be a discussion in the halls of the State Capitol about ending early the work we’ve started, abandoning our $200 million investment in MNsure and moving to, the federal exchange. This is a bad idea for the people of Minnesota and here is why:

  • Tens of thousands of Minnesotans on MinnesotaCare could lose their coverage. Right now, as a state-based exchange, MNsure is able to identify people at a certain income level who qualify for low-cost, high-quality insurance coverage.
  • People of different incomes would be forced go to different places to receive health benefits.Loss of local control.

  • Inability to take advantage of innovation waivers.

  • Abandon our technology modernization of Minnesota’s public programs.

The bill’s sponsor, state Sen. Ricardo Lara, acknowledges the political risk. But he remains optimistic that the Obama administration, if given the chance to review California’s proposal, would see it as an opportunity to move immigration reform forward before its second term wraps up. Supporters are hoping submit the plan for federal review in 2016, to avoid the uncertainty that would come with a new president the following year.

“We are trying to come up with sensible, progressive policies that help to integrate every Californian,” Lara said. “It just makes common sense.”

The 2010 health care law bans undocumented immigrants from enrolling in Medicaid. And not only are they barred from getting subsidies to buy private insurance on the health insurance exchanges, they can’t buy the Obamacare plans with just their money.

That prohibition especially riles immigrant advocates, who say there’s no reason to ban people from purchasing exchange plans if they can afford it on their own.

Good luck trying to figure out where Gov. Pat McCrory actually stands on expanding Medicaid under the Affordable Care Act and providing health care coverage for 500,000 low income adults in North Carolina with the federal government picking up 90 percent of the cost.

It’s almost impossible to understand McCrory’s position and it has been since not long after he was sworn in as governor in January of 2013.

Just a few weeks after McCrory took office the state Senate rushed a bill to the floor that rejected Medicaid expansion and prohibited the state from setting up its own health care exchange to make it easier for people to buy insurance under the health care law.

HARTFORD, Conn. (AP) - About 1,200 Medicaid recipients in Connecticut will have to find insurance coverage through the state’s health insurance exchange starting Sept. 1 as the state changes eligibility requirements in an effort to balance its books.

The state’s new two-year, $40.3 billion budget, which took effect July 1, reduced the income levels needed for certain people to qualify for Medicaid. About 18,000 more are scheduled to be transitioned to private health insurance plans offered through Access Health CT, on Aug. 1, 2016, according to the state’s Department of Social Services.

...In Connecticut, the new, tougher eligibility requirements impact parents and relative caregivers of children enrolled in the HUSKY program. The state’s eligibility threshold is dropping from 201 percent of the federal poverty level to 155 percent of the federal poverty level, or under $24,692 for a family of two and under $37,586 for a family of four.