The Medicaid - Obamacare Challenge

Folks on Medicaid have trouble finding a doctor to accept them as a patient. Obamacrap is going to expand Medicaid rolls by 15 million or more in 2014 and that is just the ones who are uninsured now. Doesn't count those who have coverage through their employer and voluntarily drop out when they can get "free" health insurance.

In 2014 those earning 133% of the Federal Poverty Level or less get free health insurance.

That's the good news.

The bad news is, your free health plan is Medicaid.

The worse news is, you may not find a doctor willing to take you as a patient.

MSNBC reports on the challenge of finding a doctor when you have Medicaid.

Children on public insurance are being denied treatment by doctors at much higher rates than those with private coverage, according to an undercover study that had researchers pose as parents of sick kids seeking an appointment with a specialist.

The study results suggest many of the 40 million publicly insured U.S. children are not getting recommended timely treatment for dangerous conditions including asthma, diabetes and depression, she said.

Here are the numbers behind the survey.

The researchers phoned 273 specialty clinics twice, a month apart, seeking an appointment with doctors including dermatologists, allergists, psychiatrists and bone specialists. In one call, the children were said to have private insurance; in the other, they were insured through Illinois' Medicaid program.

Overall, specialists refused to grant appointments for 66 percent of the Medicaid children, versus only 11 percent of privately insured youngsters.

Among 89 clinics that accepted both insurance types, Medicaid children had to wait an average of 42 days for an appointment, versus 20 days for private coverage.

The underlying reason for this should be obvious, even without a study.

In Illinois, Medicaid pays doctors about $100 for office visits like those sought in the study, versus an average of $160 from private insurers, the researchers said.

Other factors against Medicaid patients include "delays in payment and hassles of payment procedures," the researchers said.

The government wants the same level of care but is only willing to pay 60% of the going rate.

The problem is further complicated by the fact that almost every state is in the red when it comes to Medicaid and SCHIP.

Washington borrows 40% of every dollar they spend and yet they want to expand Medicaid rolls by at least a third. What is wrong with this picture? It doesn't take a rocket surgeon to figure out this won't work.

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AMA Backs Off Obamacrap Mandate

The AMA is backing off their earlier support of Obamacrap. The contentious individual mandate is no longer endorsed by the doctor group. According to the Chicago Tribune:

The AMA should "regard the purchase of health insurance to be a matter of individual responsibility to be encouraged by the use of tax incentives and other noncompulsory measures," those opposed to the mandate said in their resolution.

Individual responsibility . . . something that makes the folks in Washington cringe.

Without an individual mandate, the AMA, insurers and employer groups have said, people will wait to buy health insurance until they are sick, and that would lead to a spike in premiums for everybody.

"If large numbers of people wait to purchase health insurance until they are sick, these patient protections will drive up premiums for the insurance pool and force more people to drop coverage," said supporters of the individual mandate, including the American Academy of Family Physicians and at least eight state delegations. "Such cost shifting could lead to the collapse of private insurance markets, leaving government programs as the only recourse for many Americans."

Aha!

Obamacrap must have the individual mandate in order for it to work. Even with the mandate and "100%" participation, rates for almost everyone will at least double beyond current rates. Without the mandate premiums will be even higher.

Think of it like this.

If people can wait until their house is in danger of flooding before buying flood insurance, or they could wait until diagnosed with a terminal illness before buying life insurance, how much more expensive would these items be?

This is not like waiting until you are hungry before buying food.

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UHC/Medco Update: Resolution

On Monday afternoon, I spoke with Lynne H, UHC's Director of Media Relations. As noted last week, I had already discussed the issue with the Communications VP at United Health Group, and the UHC Account Coordinator at Medco. There have been two basic concerns here:

First, the original mis-pricing which cost my co-worker over $100, and

Second, ascertaining the extent of the problem (how many other insureds have been affected?).

Yesterday (the 15th), my co-worker spoke again with the Medco Account Coordinator, who assured her that there is no dispute on their part that this occurred (thanks to the screenshots we kept), but that he had never seen this particular problem before (more on that in a moment).

He went on to confirm that, now that they're aware of the problem, they're looking to correct it going forward, and that they would issue a credit to her charge card for this transaction (which we have confirmed has taken place). He also confirmed something we already knew: that the system does, in fact, know the status of her account (deductible credit, claims paid, plan design, etc), and that it takes these factors into account.

The underlying problem seems to be that the med that showed up with the $33 pricing was, in fact, not available through the Medco mail-order program, and that an alternative (more expensive, natch!) was substituted. According to "the Medco guy," this was an honest mistake, not an attempt to defraud my co-worker.

I'll accept that - we have numerous enough examples of Stupid Carrier Tricks to support such a contention.

Finally, he and his staff will be reviewing their customer service processes; the fact that this took almost 2 weeks, numerous emails and phone calls, and two blog posts to be resolved does not reflect well on their current practices. It didn't help that my co-worker was told to wait 3 days and then call them; this is also not acceptable, and they're working on that, as well.

Here's the thing: I do appreciate the quick response once the powers-that-be at UHC and Medco read the original post. It's humbling for me to know that IB is able to help folks amplify their voices, and that what we say has some authority. On the other hand, just because the Medco guy has never seen this before doesn't mean that it hasn't happened (or doesn't continue to happen). How many folks have run into this and just thrown up their hands in resignation that they've been "screwed by the insurance company again?"

Hopefully, this is a small number of insureds, and the problem will now be a thing of the past.

Thanks to UHC's Tyler M and Lynne H, and Medco's Steven W for their help in resolving this.

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Hearts and Noses

Surprisingly, DC isn't the only place you'll find clowns (amateur or otherwise):



[Hat Tip: David Williams]

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(Un)Healthy Exchanges

Mike Cannon, Director of Health Policy Studies at the Cato Institute (and FoIB), has a thought-provoking proposal:

"A key battleground is whether states will implement the law by creating government bureaucracies that Obamacare euphemistically calls health insurance "exchanges" ... Creating any sort of exchange is unnecessary, wasteful and counterproductive."

But it's in the law we had to "pass to learn what's in it."

Mike proposes a simple, elegant alternative:

"States are under no obligation to create these bureaucracies, however, and many have wisely refused."

Worst-case scenario? HHS "makes them" do so.

Keep in mind, though, that the Exchanges are still several years away, and "(i)f the Supreme Court overturns Obamacare, any money [states spent] creating an exchange would be wasted."

I would add several additional factors:

First, there's a distinct possibility that, come 2014 (when the Exchanges are scheduled to come online) we'll be calling her former HHS Secretary Shecantbeserious.

Second, we've seen how well the ObamaPools© have worked; any takers on whether or not the Exchanges will fare any better?

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Cavalcade of Risk #133 now up

IronMan hosts this week's eclectic collection of risk-related posts. As usual, it's thoughtfully laid out and easy to click through.

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