OnwardandUpward

@ Michael the healthcare.gov website is the only way to apply for the tax credit subsidies on health insurance policies, administered by the dept of health and human services. I can see why people might look at all this confusion and difficulty and decide to just forgo the tax credit and buy privately on esurance or something...but for me for example that would be an extra $177 a month, and I really wanted to have insurance this year. I don't like what I'm seeing so far, and haven't much faith in the accuracy or reliability of the programme as yet, but it's the best I can do right now.

But being self-employed if I were sick all year and had no income ( and I don't claim benefits- I always have money set aside to cover those eventualities ) I would be rather annoyed to find myself forced onto Medicaid the next year, rather than being allowed to buy a policy of my choice and see doctors of my choice.

OnwardandUpward

@ Boiler, not sure what you mean?

My current GP isn't taking ACA or Medicaid; which I believe is the choice of all doctor businesses- she says payments for Medicaid are inadequate and too slowly processed, so I hope that will not become the case for policies via ACA if there becomes a bureaucratic backlog.



Manners maketh man.

OnwardandUpward

@ Mrs D, it's all new, so I am hoping bit by bit things get reported and sorted, especially when bits of government are working against each other and issuing conflicting advice- I have two letters conflicting each other both from dept health and human services which I would gladly show to someone in authority to make my point, but who?

Michael

I indicated that I agree with that. I indicated that someone can go directly to a private insurer if they are not eligible for subsidies.

Michael

Is your doctor not taking any ACA plans or just the one that you signed up for? Each doctor has to agree to be part of the network. All plans are ACA compliant including employer provided insurance so unless the insurance company has a different reimbursement for different plans, I can't see why a doctor wouldn't sign up if he is already providing an in network doctor for that insurance company.

Medicare reimburses less than private insurers but almost all doctors take Medicare patients since Medicare is much less of a PITA than private insurers and they would lose about 20% of their clients and over 50% of their income if they didn't take Medicare patients.

Medicaid reimburses less than Medicare but that comprises less than 10% of the population and probably less than 5% of their income so doctors have a choice to not accept Medicaid patients since it doesn't affect their income significantly. In California, Medicaid pays 100% of the cost of patient care so I don't think it is a major issue in California since there is 0% chance of default. However, many states are not as generous and require copays and when someone is poor, the doctor is about 80% guaranteed that the copay will not be paid.

scrubbedexpat099

Generally and there seem to be massive variations

Medicare provides the base rates

Private insurers pay a bit more

ACA pay less.

Medicaid pays a lot less.

Growth is of course in lower reimbursement areas.

Not exactly surprising.

OnwardandUpward

Texas is one of the states least supportive politically of ACA, there have been calls for insurance companies to be required to id ACA patients and their 'metal' level of coverage on insurance cards. It would be quite easy to see my policy as being on the govt website, it's one of only four platinum policies in TX, though I'm not sure how doctors would know unless they or their business manager had checked it out in detail. I haven't been in to register with the new GP yet but I wouldn't be surprised if one of the questions is about whether I receive govt subsidy. I'm in a massive city so I presume I won't have problems finding doctors and hospitals.

Medicaid has a cost recovery program I understand- not sure how aggressively it's pursued in my state- but technically costs of treatment I receive via Medicaid can be recovered from my estate after my death.

I feel like practically I'm as knowledgeable as I can be and done all that I can to try and work with what's on offer right now. I don't feel as overwhelmed as I did- it is what it is! But it's not been at all what I thought when healthcare reforms and providing universal healthcare was first the political agenda, I guess I was expecting it to become less of a for-profit model.

scrubbedexpat099

Why would they care if you get a subsidy?

They do care about their reimbursement rate.

Michael

When you need 60 votes in the senate to pass a bill and with no republican support for ACA and there were 60 democrats and about 10 were moderates and Evan Bayh's wife was on the board of directors of Wellpoint (Blue Cross Anthem) making about $1.5 million per year, you take what you can get.

OnwardandUpward

I received another email from healthcare.gov today reminding me to pay my premium!
( which I did several days ago ) so I presume there are just glitches in the systems for now.

I do wonder how people who are not computer-savvy are applying for healthcare though, or someone who is very sick or mentally impaired say...I still think some of the money wasted on national tv ads telling us how wonderful it all is would be better spent on actual professionals in the flesh helping people resolve problems and process applications.

But my main experience of the whole thing is- don't stress out about it, it's not fixed yet and expect it to be lengthy and have bumps in the road. And save pdfs of any info as you log into it- the websites go down for days at a time then the phone lines get backed up...

Healthcare.gov needs to be split up into at least two sites I think- information and application.

Michael

Texas did everything humanly possible to try to make Obamacare fail. Non profit organizations were setup to assist consumers to sign up for Obmamcare but Texas passed a bill to make it nearly impossible and cost ineffective for those organizations to provide the help. It required additional training for navigators at a cost and restricted navigators from dispersing certain information and doing certain things. Therefore many organizations just closed down.

Texas poised to seek more stringent rules for Obamacare navigators than for those enrolling people for other social benefits - San Antonio Express-News

Each state has an insurance commissioner that approves plans and rates that can be charged for their state. Some insurance commissioners just let the companies charge whatever they wanted and/or disapproved plans that were too cheap hoping that the cost to the consumer would be prohibitive.

All the red states except Kentucky used the federal exchange even though the federal government would pay the states to setup their own exchange.

It is surprising that Obamacare works at all.

OnwardandUpward

The UNITED STATES is a bundle of cultures. Texas is very distinct.
We have the largest population of immigrants and of illegal immigrants.
We have a lot of history.
And some of the most modern technology and culture.

Especially medically as it happens- Houston has the world's largest and most innovative medical center.

I'm not sure how people get to join up the dots between fantastic medical services and paying for them...it is an interesting debate and one we can only hope will ultimately help people.

Michael

Texas also have the highest percentage of uninsured as well as the highest percentage that would benefit from expanded Medicaid but they rejected Medicaid expansion. The state of Texas also spends about $70 billion per year for Health and Human Services (40% of the total budget) and that could have been significantly reduced if expanded Medicaid was approved.

In Florida, the hospital lobby spent a lot of money trying to get the state to accept expanded Medicaid since the hospitals were absorbing a large amount of losses treating the uninsured and passing the costs on to the insured but that effort failed.

The debate isn't about the cost or any other thing you see on TV but about ideological policy.

It's a little surprising that Texas has turned so red since LBJ (civil rights act, start of Medicare and Medicaid, and the Great Society programs) and moderate republican governor John Connally (not a Dixiecrat) were from Texas in the 1960s.

kins

I don't understand what you mean here...

All the ACA does is offers insurance policies from private insurers through a website. That website checks your income and tells you if you qualify for a subsidy, then passes your choice of private insurance policy to the insurance company, which handles collecting premiums, paying claims etc.

So if you buy an Anthem policy through the ACA then it's exactly the same as if you bought an Anthem policy individually. No difference in rates that are paid to the doctor.

Michael

Some insurers are tying to keep the cost down for plans offered through the exchange and those plans may possibly reimburse doctors less than other more expensive plans that they don't offer though the exchange. Since the following link is from Kaiser Foundation (not Kaiser Permanente) which supports ACA, there may be some truth to that but the article is a year old.

Doctors Complain They Will Be Paid Less By Exchange Plans | Kaiser Health News