Backdating ObamaCare Applications Is Not a Suggestion; It’s an Order
HHS is trying to pre-empt patient uproar by unilaterally ordering plans to backdate all exchange applications. People can sign up for a plan on the exchange as late as Dec. 23. If an application winds up in some technology void, or it is passed to the insurer inaccurately or too late to process, that coverage nonetheless begins on Jan. 1…
HHS says the new rules are only suggestions to ensure “a more seamless transition,” but there’s nothing voluntary here. The regulatory fine print reveals that HHS intends to kick insurers off the exchanges if they don’t obey. Having destroyed the old individual market, HHS will only certify the new “qualified health plans” if insurers “adopt policies to prevent disruptions in treatment of episodes of care.”
This means that HHS is also mandating that insurers treat out-of-network doctors and hospitals as in-network providers. Other ObamaCare benefit and redistribution mandates have raised prices, and the White House leaned on insurers to keep premiums down. The only cost-control tool at their disposal was to shrink to narrow low-reimbursement networks that exclude specialists, academic medical centers and children’s hospitals, much like Medicaid…
These disruptions extend to medication and restricted lists of covered drugs. At risk are people using expensive specialty medicines for rare conditions or who require several medicines whose doses must be controlled over time. The new HHS rule commands insurers to refill any prescription, no questions asked. (WSJ editorial)
So, out-of-pocket and premiums are going up for most that won’t get subsidies, now insurance companies can’t narrow their networks or restrict meds. Where’s the cost curve going now?
Seems as if cost-reduction means cost-shifting now.
Hasn’t it always with the government?
At one time, I do believe they actually sought out innovation and private sector solutions.
It’s not as if healthcare providers will continue to provide service at a reduced fee. This just means longer waiting times for low-reimbursing patients.
“The only cost-control tool at their disposal was to shrink to narrow low-reimbursement networks that exclude specialists, academic medical centers and children’s hospitals, much like Medicaid…” Essentially, a bill meant to improve health care is now rationing care and restricting their network to cope with demand.
Plus, the health systems shouldering the burden from a restricted network are placed under duress to provide more with less.
“HHS says the new rules are only suggestions to ensure “a more seamless transition,” but there’s nothing voluntary here. The regulatory fine print reveals that HHS intends to kick insurers off the exchanges if they don’t obey.” Soft language with a hard slap to the face.
This does nothing to control costs. Once the Medicare funds appropriated to subsidize ACA run dry, the costs will accumulate by leaps and bounds.
The fact that they are trying to preempt suggests that they also have a deal of uncertainty regarding the future.
It doesn’t matter that patients suffer from Obamacare. The idea of Obamacare is to support the medical-drug-insurance complex and transfer wealth from losers to winners.
Care of patients is only the vehicle.
Medicare Part D was created to stop smart Amerikans from shopping for drugs in Canada, thus threatening the Amerikan drug oligopolies.
“HHS says the new rules are only suggestions to ensure “a more seamless transition,” but there’s nothing voluntary here. The regulatory fine print reveals that HHS intends to kick insurers off the exchanges if they don’t obey.”
It is truly criminal what they are doing with this law.
I don’t understand how HHS thinks it can, well, do any of the things Obama likes to keep doing like he is king. But specifically treating out of network doctors like in network. To be in a network requires a contract between a doctor and an insurer. You can’t merely say “pretend a contract exists” without defining terms. The doctor could charge $2000 for a wellcheck, does the insurer have to pay that doctor that amount? Or how much they’d pay the doctor if the doctor were in network? If so, the doctor then has a legal right to sue the patient of nonpayment. It is a huge mess you cannot just wave a wand and ignore.
It makes me question if they even understand on the most basic level how the third party payment system works.
I say the insurance companies tell Obama to go fuck himself, ignore these “suggestions” and wait to be kicked off the exchanges. I mean seriously, you really think they’re going to kick insurers off exchanges? Insurers who already have enrolled customers? That is an obvious bluff.
Play that scenario out, an insurer refuses to play ball, they’re kicked off, thousands of policies in the exchange people thought they had signed up for, paid for, get voided. Obamacare has enough problems with the cancellations of pre-obamacare policies, they don’t need to start cancelling exchange policies too. There are so few insurers participating anyways, they can’t afford to lose any.
Insurance companies need to realize they have Obama’s balls in a vice. They have the power to call the shots right now.
The HHS memo did say that the artificial ‘networks’ only applied to patients who were in an acute care episode, but good luck defining that.
Chris is correct that the balance billing issue will be enormous.
Balance billing has been a problem for years, i.e. when a non-network surgeon or anesthesiologist participates in surgery.
But that was somewhat limited to emergencies.
Now people are going to go to the doctor for many other types of care, and no one will know if the doc is in their network or not.
People with exchange policies will be the new Medicaid patients, in terms of doctors wanting desperately to avoid them.