Making Health Insurance More Portable: GOP’s Plans for Insurance

In an article dated February 28, 2017, the author discussed a GOP plan to make health insurance more portable by allowing consumers to take their plans with them if they move, retire, or change jobs.  Although a popular idea for many, it does present some structural concerns due to the  setup of insurance markets and networks.

From NPR, “What If You Could Take It With You? Health Insurance, That Is”

Except from the article:

“To be truly portable, consumers must be offered plans regardless of their health status, age or other considerations. Before the health law was enacted, insurers could reject people with medical conditions. But the ACA prohibits insurers from redlining sick people or charging them higher premiums. Although popular in opinion polls, those Obamacare provisions may face some changes under the GOP plans.”

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New Genetic Testing Bill: Potential for Progress or Potential for Discrimination?

According to a recent article published in The Atlantic, the House Committee on Education and the Workforce recently approved H.R. 1313, a bill that would allow employers to pressure their employees to undergo genetic testing and share the results as part of an employer’s “workplace wellness program.” If an employee opts not to share the results, he or she could be forced to pay significantly more for health insurance.

Proponents of the bill note that it simply builds on programs already in place from the Affordable Care Act; however, critics are worried that the bill will take away many of the privacy, discrimination and insurance protections of the Genetic Information Non-Discrimination Act (“GINA”).

From The Atlantic, “The GOP’s New Bill Would Seriously Disrupt Genetics Research”

Excerpt from article:

“‘People are already being discriminated genetically without mandatory genetic testing—that’s what sexism and racism is . . . . This [bill] would result in a higher resolution of discrimination and more individualized ways of targeting people.’ The dark mirror of personalized medicine is personalized discrimination.”

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Relocating to Afford Medical Treatment

A recent CNN.com article follows two stories about families forced to relocate because of the lack of care their disabled children receive under Florida’s Medicaid program. Families and patients’ rights organizations have brought multiple cases against the state for poor management of the program. The spokesman for Florida’s Agency for Health Care Administration stated that the problems occurred prior to the state’s transition to a managed care system; under the new system the problems have been resolved. However, parents are not willing to take that risk and are moving to states where providers will not refuse to see them due to delayed insurance payments and where life-saving medicines are easily accessible for their disabled children.

From Cnn.com, “Health care refugees: Family flees Florida to save daughter’s life”

Excerpt from article:

Like nearly half of all children in Florida, Abby has Medicaid, the state-run health insurance. Her parents say that instead of being helpful, Florida Medicaid refused to pay for lifesaving medicines and took so long to pay some of her health care providers that at times, they refused to treat her.

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To Treat or Not to Treat? The Debate on Incidental Medical Findings

In an article dated August 29, 2016, doctors and researchers debate whether they should disclose to patients minor abnormalities that are incidentally found during an imaging procedure (such as an MRI or CT scan). On the one hand, researchers say that doctors are going “overboard” on disclosing low-risk findings that lead to overtreatment and unnecessary worry by the patient.   However, on the other hand, a decision not to follow up on an incidental finding can have serious consequences. For one patient, kidney cancer was incidentally found and led to early treatment that arguably saved his life. Although the professionals disagree on whether to treat or not to treat, most agree that guidelines are needed to help doctors make the difficult decision.

Excerpt from article:

Often there is “little benefit” to patients knowing about minor, low-risk findings, and it can have significant financial, psychological and clinical consequences, they say.  Failure to follow up incidental findings can come back to haunt some patients, other experts say. . .

To read full article: When a Medical Test Leads to Another, and Another

Americans are Increasingly Turning to Medicaid for Long Term Care Coverage

Currently, about 62% of nursing home beds in the U.S. are paid for by Medicaid. Many elderly individuals cannot afford to pay for such long term care—the average total cost of long term care received from age 65 to death is $91,100 for men and up to double that amount for women, based on the presumption that women live longer. Low income individuals rely on Medicaid to pay for these expenses and other middle-class individuals are forced to spend down their assets to qualify for Medicaid coverage for their long-term care.

Medicaid was created to provide health insurance to low-income individuals, and not to cover long term care for the majority of the elderly population. Yet, it has evolved into a “safety net” for millions of Americans who cannot afford to pay for their long-term care.  As the baby boomer generation continues to age, Medicaid spending on long term care is expected to rise by almost 50% by 2026, putting pressure on a system that was not designed to carry such a burden.

State and federal officials are working to control Medicaid costs. Some states, for example, are contracting with managed care companies to provide long term care services to Medicaid beneficiaries. However, many health advocates are concerned that these managed care companies, which traditionally provided only medical care, will restrict the coordination of care for the elderly.  California most recently announced that it will hold informational hearings to discuss possible resolutions to the increasing cost of long term care.

 Sources: http://www.npr.org/sections/health-shots/2016/08/03/488385286/medicaid-safety-net-stretched-to-pay-for-seniors-long-term-care

Tags: Long Term Care Coverage, Burdened Medicaid System, Lower and Middle Class Americans

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Will the Threat of Decreasing Insurance Participation in ACA Exchanges Require Government Intervention?

United Healthcare, the largest health insurance provider in the country, recently announced that it is considering the possibility of ending its participation in the healthcare insurance exchange networks established under the Affordable Care Act.   According to UnitedHealthcare, the company’s earnings are down, due, at least in part, to its participation in the exchange networks and, as a result, the company will, at the very least, decrease its marketing efforts in connection with the networks.  While United Healthcare is the largest insurance provider yet threatening to pull its plans from the exchange programs, more than a dozen smaller health insurers have already dropped out of the programs, having previously covered approximately 800,000 individuals.

Experts opine that if this trend continues,  the lower number of plans available to consumers on the exchange networks could defeating the goals of the Affordable Care Act.  State and federal governments may be forced to intervene to ensure the continued viability of the exchange networks. Such invention could include a federal insurer bailout program, making participation on the exchange a prerequisite to offering plans elsewhere in the state, or mandating that private insurers offering insurance through Medicare and Medicaid offer plans on the exchanges.

Sources: http://www.forbes.com/sites/merrillmatthews/2015/11/30/will-the-government-force-health-insurers-to-sell-in-obamacare-exchanges/

http://www.hngn.com/articles/152202/20151119/unitedhealthcare-considers-quitting-obamacare-cites-unsustainable-conditions.htm

State Senator Wants to Increase Availability of Medical Marijuana in New York

Currently, the Department of Health (“DOH”) has authorized three medical marijuana licenses for the entire state of New York. State Senator Diane Savino has been pushing DOH to issue additional licenses believing insurance companies and customers would benefit from more locations to fill marijuana prescriptions. She asserts that marijuana is a cheap alternative to many costly drugs and that each drug substituted is one less co-pay to be paid.

Read more here.

Taxpayers are Illegally Funding Abortions

Other than carve outs for pregnancies caused by rape, incest, or where the life of the mother is in jeopardy, the Affordable Care Act prohibits the use of taxpayer funds for abortions. However, a recent report issued by the Government Accountability Office asserts that taxpayers are illegally funding abortions. The report reviews 18 issuers of health plans offered through the exchanges. All 18 issuers offer abortion services, but only three were found to be in compliance with the law. The non-complying plans offered no restrictions or limitations on abortion services even though the health-care law requires that issuers must estimate and segregate the cost of an abortion from premiums collected by the plan.

Read more here.

Government Questions Eligibility for Health Insurance Subsidies

Since June 1st, hundreds of thousands of people have been contacted by the government regarding their eligibility for subsidized health care.  Of the eight million people who signed up for healthcare through the government exchanges, two million provided information that differed from information in government records. The Obama administration has been asking those individuals for additional documentation such as birth certificates, social security cards, and driver’s licenses.  The government will use the documents to correct irregularities in areas including income, citizenship, and immigration status.  Consumer advocates worry that many people who fail to provide the information will be forced to repay the subsidies next April.

Representative Diane Black, Republican of Minnesota, attributes the problem to the government’s having enrolled people “before the systems were in place to accurately confirm eligibility.” Others such as Representative Joseph Crowley, Democrat of New York, say such criticism stems from Republicans’ “unending zeal to undermine the Affordable Care Act.”

In any event, the government has put thousands on notice that they “need to follow up as soon as possible” and if they don’t send the needed documents, they risk losing their marketplace coverage.

Read more here.

Many Professional Investors are Flocking to Health-Care Stocks

The Affordable Care Act coupled with the aging baby boomer population has caused some professional investors to begin looking into Health-Care stocks.  They believe industries related to medical devices and pharmaceuticals will see large upticks in their stock because the Affordable Care Act has brought more customers into the market.  However, some investors are weary about focusing too much attention on the Affordable Care Act when there is a growing global market. Others fear that the Affordable Care Act may actually cut into the medical industry’s profits making health-care stocks a bad pick altogether.

Read more here.