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Re: ACA approval at 37 percent as new enrollment period commences

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Re: ACA approval at 37 percent as new enrollment period commences

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Re: ACA approval at 37 percent as new enrollment period commences

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Re: ACA approval at 37 percent as new enrollment period commences

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CEOs to revolt against ACA over Obama admin's attack on wellness programs

Posted by Olog-hai on Sat Nov 29 13:41:50 2014, in response to Universal Health Care is HERE in these USA! Apply Now. www.healthcare.gov, posted by SMAZ on Tue Oct 1 13:19:06 2013.

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CEOs Could Be Getting Ready To Revolt Against Obamacare

By Sharon Begley
November 29, 2014 7:52 AM

Leading U.S. CEOs, angered by the Obama administration's challenge to certain "workplace wellness" programs, are threatening to side with anti-Obamacare forces unless the government backs off, according to people familiar with the matter.

Major U.S. corporations have broadly supported President Barack Obama's healthcare reform despite concerns over several of its elements, largely because it included provisions encouraging the wellness programs.

The programs aim to control healthcare costs by reducing smoking, obesity, hypertension and other risk factors that can lead to expensive illnesses. A bipartisan provision in the 2010 healthcare reform law allows employers to reward workers who participate and penalize those who don't.

But recent lawsuits filed by the administration's Equal Employment Opportunity Commission (EEOC), challenging the programs at Honeywell International and two smaller companies, have thrown the future of that part of Obamacare into doubt.

The lawsuits infuriated some large employers so much that they are considering aligning themselves with Obama's opponents, according to people familiar with the executives' thinking.

"The fact that the EEOC sued is shocking to our members," said Maria Ghazal, vice-president and counsel at the Business Roundtable, a group of chief executives of more than 200 large U.S. corporations. "They don't understand why a plan in compliance with the ACA (Affordable Care Act) is the target of a lawsuit," she said. "This is a major issue to our members."

"There have been conversations at the most senior levels of the administration about this," she added.

Business Roundtable members are due to meet Obama in a closed-door session on Tuesday, where they may air their concerns.

It is not clear how many members of the group, whose companies sponsor health insurance for 40 million people, are considering any action. It is also not clear if the White House can stop the EEOC from challenging wellness programs.

A threat of a corporate backlash comes at a time when Obama faces criticism even from his Democrats' ranks that he had devoted too much political capital to healthcare reform.

Such action could take the form of radical changes in health benefits that employers offer. It could also mean supporting a potentially game-changing challenge to Obamacare at the Supreme Court next year and expected Republican efforts to eviscerate the law when they take control of Congress in 2015.

Carrots and Sticks

Obamacare allows financial incentives for workers taking part in workplace wellness programs of up to 50 percent of their monthly premiums, deductibles, and other costs. That translates into hundreds and sometimes thousands of dollars in extra annual costs for those who do not participate.

Typically, participation means filling out detailed health questionnaires, undergoing medical screenings, and in some cases attending weight-loss or smoking-cessation programs.

One of the arguments presented in the lawsuit against three employers is that requiring medical testing violates the Americans with Disabilities Act.

That 1990 law, according to employment-law attorney Joseph Lazzarotti of Jackson Lewis P.C. in Morristown, N.J., largely prohibits requiring medical tests as part of employment.

"You can't make medical inquiries unless it's consistent with job-necessity, or part of a voluntary wellness program," he said.

The lawsuits are based on the view that it is no longer voluntary if employees face up to $4,000 in penalties for non-participation, loss of insurance or even their jobs.

Employers, however, see the lawsuits as reneging on the administration's commitment to an important part of the healthcare reform.

On Nov. 14, Roundtable president John Engler sent a letter to the Labor, Treasury and Health and Human Services cabinet secretaries who oversee Obamacare asking them to "thwart all future inappropriate actions against employers who are complying with" the law's wellness rules, and warning of "a chilling effect across the country."

Asked for a response to the letter, an administration official told Reuters that it supported workplace health promotion and prevention "while ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status."

Undermining Obamacare

In practical terms, large corporations have several ways to undermine Obamacare if they decide to.

One is to support legal challenges to the subsidies given to low-income individuals who buy health insurance on the federal exchange established under the law. Neither the Business Roundtable nor any of its CEO members have done this so far. The Supreme Court is expected to hear oral arguments in the case in 2015.

Another option is to make top executives available for hearings on repealing or diluting Obamacare. "We never did this before," said the person familiar with the executives' thinking. "But they could turn up the noise. I don't think the White House would want the CEOs turning on them and supporting these efforts on the Hill."

The nuclear option would be to radically change employer-sponsored health insurance. Large corporations are highly unlikely to eliminate it, but they might give workers a fixed amount of money to buy coverage on a private insurance exchange. That would allow employers, almost all of which pay workers' medical claims out of their earnings, to cap their healthcare spending.

(Reporting by Sharon Begley; Editing by Michele Gershberg and Tomasz Janowski)

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Re: CEOs to revolt against ACA over Obama admin's attack on wellness programs

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Re: CEOs to revolt against ACA over Obama admin's attack on wellness programs

Posted by italianstallion on Sat Nov 29 17:05:21 2014, in response to Re: CEOs to revolt against ACA over Obama admin's attack on wellness programs, posted by AlM on Sat Nov 29 14:03:26 2014.

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ACA "glitch" keeps subsidies out of reach for lower-income families (ACA especially anti-family)

Posted by Olog-hai on Wed Dec 3 00:25:09 2014, in response to Universal Health Care is HERE in these USA! Apply Now. www.healthcare.gov, posted by SMAZ on Tue Oct 1 13:19:06 2013.

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Obamacare 'Glitch' Puts Subsidies Out Of Reach For Many Families

By John Ydstie
December 02, 2014 3:54 AM ET

Don Benfield of Taylorsville, N.C., makes $11 an hour working for a mobile-home parts business, selling things like replacement doors and windows.

Benfield, 51, doesn't have health insurance.

"I haven't had health care insurance in years, simply because I haven't been able to afford it, especially with food prices, how they went up," he explains.

Benfield's employer does offer health insurance coverage, even though, with fewer than 50 employees, the business is not required to.

"The insurance here through work is $43 a week, which with my rent and other payments and everything, we haven't been able to afford," he says. "If I put my wife on the insurance, it shoots up to $120."

The Affordable Care Act is expected to provide around $10 billion in subsidies this year to make health insurance affordable for low- and middle-income people. But a quirk in the law is denying subsidies to a significant number of low-income people, especially those with families.

Benfield has run up against this quirk. To cover only himself, Benfield would have to pay a little more than $2,200 a year. He says he can't afford that, but that's an affordable amount according to Obamacare regulations, and that means Benfield could not get subsidies if he tried to get coverage on the Obamacare exchange.

The situation only gets worse if Benfield decided to add his wife to his employer policy. Adding her would nearly triple the annual cost, driving it up to $6,200 a year, almost a quarter of their family income.

Benfield's situation illustrates a flaw in the Affordable Care Act, says Linda Blumberg, a health policy expert at the Urban Institute.

"A lot of people refer to this as the family affordability glitch," Blumberg says. "All of the assessment of whether or not employer-based coverage is affordable is based on worker-only coverage, and doesn't take the cost of family coverage into account."

That's remarkable, says Blumberg, since most people want to buy family coverage, not simply coverage for the family breadwinner.

Not getting subsidies makes a huge difference. Without them, the benchmark insurance plan on the Obamacare exchange would be more than $10,000 a year for Benfield and his wife. But if they were allowed to get Obamacare subsidies, they'd pay only around $1,200.

Suzanne Shugart and her family face a similar situation in McPherson, Kan. Her husband works for a cabinetmaker, earning around $32,000 a year. He can get health insurance through his employer for a little more than $50 a month, just for himself.

That's also affordable coverage, according to Obamacare rules, so Shugart's family isn't eligible for subsidies in the online marketplace. But the employer's family coverage is too expensive for them, says Shugart.

"If he were to increase it to a family plan, which would include me, it goes up to about $380 a month, which is nearly our mortgage payment," Shugart says.

She and her husband can't afford that, she says. Luckily, their children qualify for insurance through a state plan.

"That's how we've lived for the last eight years," Shugart says. "He has insurance through work and the kids have state insurance, and I just live on hope and a prayer that nothing bad will happen."

If Shugart's family could get subsidized coverage on the Obamacare exchange, the premium for a benchmark plan would be a little more than $200 a month, making coverage for her much more affordable.

Blumberg says it's likely that in a more amenable political environment, the family glitch would be fixed, with Congress adding more focus on the affordability of family coverage.

"But I think that because of the political volatility around this law, there was never an opportunity to sit down and say, 'OK, let's make a policy change here that takes this into account,' " she says.

Blumberg says Democrats have been hesitant to open debate on the law at all, because of fear it would be eviscerated during the legislative process. With the Republican takeover in Congress, the chance of eliminating the family glitch seems unlikely to improve anytime soon.

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Re: A Glitch? ZOMG ANTI-FAMILY!!!

Posted by Nilet on Wed Dec 3 01:03:48 2014, in response to ACA "glitch" keeps subsidies out of reach for lower-income families (ACA especially anti-family), posted by Olog-hai on Wed Dec 3 00:25:09 2014.

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Re: ACA "glitch" keeps subsidies out of reach for lower-income families (ACA especially anti-family)

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Re: ACA ''glitch'' keeps subsidies out of reach for lower-income families (ACA especially anti-family)

Posted by italianstallion on Wed Dec 3 09:54:39 2014, in response to ACA "glitch" keeps subsidies out of reach for lower-income families (ACA especially anti-family), posted by Olog-hai on Wed Dec 3 00:25:09 2014.

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Re: ACA ''glitch'' keeps subsidies out of reach for lower-income families (ACA especially anti-family)

Posted by Fred G on Wed Dec 3 10:49:00 2014, in response to ACA "glitch" keeps subsidies out of reach for lower-income families (ACA especially anti-family), posted by Olog-hai on Wed Dec 3 00:25:09 2014.

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ACA exacerbating shortage of primary care physician coverage

Posted by Olog-hai on Mon Dec 8 15:59:11 2014, in response to Universal Health Care is HERE in these USA! Apply Now. www.healthcare.gov, posted by SMAZ on Tue Oct 1 13:19:06 2013.

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Health law impacts primary care doc shortage

By Kelli Kennedy
Dec. 7, 2014 8:50 PM EST

When Olivia Papa signed up for a new health plan last year, her insurance company assigned her to a primary care doctor. The relatively healthy 61-year-old didn't try to see the doctor until last month, when she and her husband both needed authorization to see separate specialists.

She called the doctor's office several times without luck.

"They told me that they were not on the plan, they were never on the plan and they'd been trying to get their name off the plan all year," said Papa, who recently bought a plan from a different insurance company.

It was no better with the next doctor she was assigned. The Naples, Florida, resident said she left a message to make an appointment, "and they never called back."

The Papas were among the 6.7 million people who gained insurance through the Affordable Care Act last year, flooding a primary care system that is struggling to keep up with demand.

A survey this year by The Physicians Foundation found that 81 percent of doctors describe themselves as either over-extended or at full capacity, and 44 percent said they planned to cut back on the number of patients they see, retire, work part-time or close their practice to new patients.

At the same time, insurance companies have routinely limited the number of doctors and providers on their plans as a way to cut costs. The result has further restricted some patients' ability to get appointments quickly.

One purpose of the new health law was connecting patients, many of whom never had insurance before, with primary care doctors to prevent them from landing in the emergency room when they are sicker and their care is more expensive. Yet nearly 1 in 5 Americans lives in a region designated as having a shortage of primary care physicians, and the number of doctors entering the field isn't expected to keep pace with demand.

The Association of American Medical Colleges projects the shortage will grow to about 66,000 in little more than a decade as fewer residency slots are available and as more medical students choose higher-paying specialty areas.

For now, experts say most patients are receiving the care they need, even if they have to drive farther, wait longer or see a nurse practitioner or physician assistant rather than a doctor.

More importantly, many are getting care for the first time. The surge also has forced many doctors to streamline their practice and rely more on mid-tier professionals instead of seeing every patient themselves.

"Family doctors are seeing a pretty significant increase in requests for appointments from new patients," said Dr. Wanda Filer, a primary care doctor in York, Pennsylvania, and president of the American Academy of Family Physicians.

In response, the academy of more than 115,000 doctors say they're adding new physicians to their practices, relying more on nurse practitioners and physician's assistants, adding evening and weekend appointments. Despite the demand, Filer said most patients can get same-day appointments with someone on their team.

Dr. Laura Byerly has seen a surge of more than 2,000 new patients since January at her chain of health clinics in Hillsboro, Oregon, about 30 minutes west of Portland. Many had sporadic or no medical care for many years.

She hired new primary care doctors, receptionists and nurses whose sole role is to see new patients and prepare the chart for the first visit with the doctor. They even opened a new clinic so patients who used to drive 45 minutes for a visit could now see a doctor five minutes from home.

"The new patients required a significant amount of work to understand just what medications they should be on, what are their active diagnoses, what studies are needed now, and just who they are and what their life is like," said Byerly, who is the medical director of the Virginia Garcia Memorial Foundation health clinics.

Dr. Jack Chou takes patients only during open enrollment. Otherwise, it's a six to nine-month wait at his Los Angeles-area practice, where most of the new patients were covered through Medicaid expansion.

"The initial visit takes much longer because we're trying to learn about patients who had fragmented care or no care at all," said Chou. Despite the staffing struggles, "it's actually a godsend for some of my patients."

While most doctors are successfully juggling the influx, there have been cases like that of the Papas, in which consumers call multiple doctors only to find they are not in network or the doctors are not taking new patients.

Insurance agent Anthony Halby heard similar complaints from his clients in Grass Valley, California, a Sierra foothill community about an hour east of Sacramento. He said half a dozen consumers wanted him to switch their health plans as soon as the second round of open enrollment started earlier this month. They told him the plan they chose last year made it extremely difficult to find primary care doctors.

Only two insurance companies in the Gold Rush-era town offer coverage through the state exchange, and just four or five primary care doctors out of about 135 signed up with one insurer.

The other insurer has more doctors, but most are considered out of network. That means patients who use them will pay 60 percent of the bill, he said.

"Coverage does not equal access," said Halby, who instead recommends his clients choose a plan outside the exchange that has a much broader provider network but also will not come with the government premium subsidies given to most of those who buy insurance through the exchange. "I tell people this up front: The premiums are going to be higher because there's no subsidy. However, I'm going to guarantee you can keep your doctor."

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Re: ACA exacerbating shortage of primary care physician coverage

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Re: ACA exacerbating shortage of primary care physician coverage

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Half of Medicaid-accepting docs can't offer appointments for new enrollees—ACA strikes again

Posted by Olog-hai on Tue Dec 9 16:28:04 2014, in response to Universal Health Care is HERE in these USA! Apply Now. www.healthcare.gov, posted by SMAZ on Tue Oct 1 13:19:06 2013.

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Half of Doctors Listed as Serving Medicaid Patients Are Unavailable, Investigation Finds

By Robert Pear
Dec. 8, 2014

Large numbers of doctors who are listed as serving Medicaid patients are not available to treat them, federal investigators said in a new report.

“Half of providers could not offer appointments to enrollees,” the investigators said in the report, which will be issued on Tuesday.

Many of the doctors were not accepting new Medicaid patients or could not be found at their last known addresses, according to the report from the inspector general of the Department of Health and Human Services. The study raises questions about access to care for people gaining Medicaid coverage under the Affordable Care Act.

The health law is fueling rapid growth in Medicaid, with enrollment up by nine million people, or 16 percent, in the last year, the department said. Most of the new beneficiaries are enrolled in private health plans that use a network of doctors to manage their care.

Patients select doctors from a list of providers affiliated with each Medicaid health plan. The investigators, led by the inspector general, Daniel R. Levinson, called doctors’ offices and found that in many cases the doctors were unavailable or unable to make appointments.

More than one-third of providers could not be found at the location listed by a Medicaid managed-care plan.

“In these cases,” Mr. Levinson said, “callers were sometimes told that the practice had never heard of the provider, or that the provider had practiced at the location in the past but had retired or left the practice. Some providers had left months or even years before the time of the call.”

About 8 percent of providers were at the locations listed, but said they did not participate in the Medicaid health plan with which they were supposedly affiliated. Another 8 percent participated in Medicaid, but were not accepting new patients.

“When providers listed as participating in a plan cannot offer appointments, it may create a significant obstacle for an enrollee seeking care,” Mr. Levinson said. “Moreover, it raises questions about the adequacy of provider networks. It suggests that the actual size of provider networks may be considerably smaller than what is presented by Medicaid managed-care plans.”

Investigators called 1,800 providers listed by more than 200 health plans under contract with Medicaid in 32 states. In all cases, insurers confirmed that the doctors were supposed to be taking Medicaid patients.

Among the providers who offered appointments, the median wait time was two weeks. (The number of providers above the median is the same as the number below it.)

“Over a quarter of providers had wait times of more than one month, and 10 percent had wait times longer than two months,” the report said.

The delays can have significant implications for patients.

“For example,” the report said, “a number of obstetricians had wait times of more than one month, and one had wait times of more than two months for an enrollee who was eight weeks pregnant. Such lengthy wait times could result in a pregnant enrollee receiving no prenatal care in the first trimester of pregnancy.”

Primary care providers, such as family doctors, internists and gynecologists, were less likely to offer appointments than specialists, the report said. But specialists tended to have longer wait times, with a median wait of 20 days, compared with 10 days for a primary care provider.

Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services, agreed with recommendations in the report to ensure access to care for Medicaid beneficiaries and to correct errors in provider directories. “Inaccurate provider directory data may unnecessarily delay an enrollee from selecting a provider,” she said.

Dr. Rachel Z. Chatters, a pediatrician in Lake Charles, La., who cares for hundreds of Medicaid patients, said it was difficult to find doctors for them when they became adults. In addition, Dr. Chatters said in an interview on Monday, “It’s nearly impossible to find specialty care for Medicaid patients of any age with diabetes, asthma, sickle cell anemia and certain other chronic illnesses.”

James Golden, director of managed-care plans at the federal Medicaid agency, said he was developing new rules and standards to ensure timely access to care for Medicaid patients.

In an earlier report, the inspector general said that state standards for access to care varied widely and that enforcement was spotty.

The National Association of Medicaid Directors, representing state officials, urged the Obama administration not to establish “overly prescriptive federal standards.” Federal officials should recognize “the realities of a state’s geography,” the “variation and nuances in state health care marketplaces” and the shortage of doctors in some regions, the association said in a letter to the administration.

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Re: Half of Medicaid-accepting docs can't offer appointments for new enrollees—ACA strikes again

Posted by mtk52983 on Tue Dec 9 16:45:09 2014, in response to Half of Medicaid-accepting docs can't offer appointments for new enrollees—ACA strikes again, posted by Olog-hai on Tue Dec 9 16:28:04 2014.

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Re: Half of Medicaid-accepting docs can't offer appointments for new enrollees—ACA strikes again

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Harvard professors who once touted ACA now angry because it's hitting their pocketbooks

Posted by Olog-hai on Mon Jan 5 18:28:42 2015, in response to Universal Health Care is HERE in these USA! Apply Now. www.healthcare.gov, posted by SMAZ on Tue Oct 1 13:19:06 2013.

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Health Care Fixes Backed by Harvard’s Experts Now Roil Its Faculty

By Robert Pear
Jan. 5, 2015

For years, Harvard’s experts on health economics and policy have advised presidents and Congress on how to provide health benefits to the nation at a reasonable cost. But those remedies will now be applied to the Harvard faculty, and the professors are in an uproar.

Members of the Faculty of Arts and Sciences, the heart of the 378-year-old university, voted overwhelmingly in November to oppose changes that would require them and thousands of other Harvard employees to pay more for health care. The university says the increases are in part a result of the Obama administration’s Affordable Care Act, which many Harvard professors championed.

The faculty vote came too late to stop the cost increases from taking effect this month, and the anger on campus remains focused on questions that are agitating many workplaces: How should the burden of health costs be shared by employers and employees? If employees have to bear more of the cost, will they skimp on medically necessary care, curtail the use of less valuable services, or both?

“Harvard is a microcosm of what’s happening in health care in the country,” said David M. Cutler, a health economist at the university who was an adviser to President Obama’s 2008 campaign. But only up to a point: Professors at Harvard have until now generally avoided the higher expenses that other employers have been passing on to employees. That makes the outrage among the faculty remarkable, Mr. Cutler said, because “Harvard was and remains a very generous employer.”

In Harvard’s health care enrollment guide for 2015, the university said it “must respond to the national trend of rising health care costs, including some driven by health care reform,” otherwise known as the Affordable Care Act. The guide said that Harvard faced “added costs” because of provisions in the health care law that extend coverage for children up to age 26, offer free preventive services like mammograms and colonoscopies and, starting in 2018, add a tax on high-cost insurance, known as the Cadillac tax.

Richard F. Thomas, a Harvard professor of classics and one of the world’s leading authorities on Virgil, called the changes “deplorable, deeply regressive, a sign of the corporatization of the university.”

Mary D. Lewis, a professor who specializes in the history of modern France and has led opposition to the benefit changes, said they were tantamount to a pay cut. “Moreover,” she said, “this pay cut will be timed to come at precisely the moment when you are sick, stressed or facing the challenges of being a new parent.”

The university is adopting standard features of most employer-sponsored health plans: Employees will now pay deductibles and a share of the costs, known as coinsurance, for hospitalization, surgery and certain advanced diagnostic tests. The plan has an annual deductible of $250 per individual and $750 for a family. For a doctor’s office visit, the charge is $20. For most other services, patients will pay 10 percent of the cost until they reach the out-of-pocket limit of $1,500 for an individual and $4,500 for a family.

Previously, Harvard employees paid a portion of insurance premiums and had low out-of-pocket costs when they received care.

Michael E. Chernew, a health economist and the chairman of the university benefits committee, which recommended the new approach, acknowledged that “with these changes, employees will often pay more for care at the point of service.” In part, he said, “that is intended because patient cost-sharing is proven to reduce overall spending.”

The president of Harvard, Drew Gilpin Faust, acknowledged in a letter to the faculty that the changes in health benefits — though based on recommendations from some of the university’s own health policy experts — were “causing distress” and had “generated anxiety” on campus. But she said the changes were necessary because Harvard’s health benefit costs were growing faster than operating revenues or staff salaries and were threatening the budget for other priorities like teaching, research and student aid.

In response, Harvard professors, including mathematicians and microeconomists, have dissected the university’s data and question whether its health costs have been growing as fast as the university says. Some created spreadsheets and contended that the university’s arguments about the growth of employee health costs were misleading. In recent years, national health spending has been growing at an exceptionally slow rate.

In addition, some ideas that looked good to academia in theory are now causing consternation. In 2009, while Congress was considering the health care legislation, Dr. Alan M. Garber — then a Stanford professor and now the provost of Harvard — led a group of economists who sent an open letter to Mr. Obama endorsing cost-control features of the bill. They praised the Cadillac tax as a way to rein in health costs and premiums.

Dr. Garber, a physician and health economist, has been at the center of the current Harvard debate. He approved the changes in benefits, which were recommended by a committee that included university administrators and experts on health policy.

In an interview, Dr. Garber acknowledged that Harvard employees would face greater cost-sharing, but he defended the changes. “Cost-sharing, if done appropriately, can slow the growth of health spending,” he said. “We need to be prepared for the very real possibility that health expenditure growth will take off again.”

But Jerry R. Green, a professor of economics and a former provost who has been on the Harvard faculty for more than four decades, said the new out-of-pocket costs could lead people to defer medical care or diagnostic tests, causing more serious illnesses and costly complications in the future.

“It’s equivalent to taxing the sick,” Professor Green said. “I don’t think there’s any government in the world that would tax the sick.”

Meredith B. Rosenthal, a professor of health economics and policy at the Harvard School of Public Health, said she was puzzled by the outcry. “The changes in Harvard faculty benefits are parallel to changes that all Americans are seeing,” she said. “Indeed, they have come to our front door much later than to others.”

But in her view, there are drawbacks to the Harvard plan and others like it that require consumers to pay a share of health care costs at the time of service. “Consumer cost-sharing is a blunt instrument,” Professor Rosenthal said. “It will save money, but we have strong evidence that when faced with high out-of-pocket costs, consumers make choices that do not appear to be in their best interests in terms of health.”

Harvard’s new plan is far more generous than plans sold on public insurance exchanges under the Affordable Care Act. Harvard says its plan pays 91 percent of the cost of care for a typical consumer, while the most popular plans on the exchanges, known as silver plans, pay 70 percent, on average.

In many states, consumers have complained about health plans that limit their choice of doctors and hospitals. Some Harvard employees have said they will gladly accept a narrower network of health care providers if it lowers their costs. But Harvard’s ability to create such networks is complicated by the fact that some of Boston’s best-known, most expensive hospitals are affiliated with Harvard Medical School. To create a network of high-value providers, Harvard would probably need to exclude some of its own teaching hospitals, or discourage their use.

“Harvard employees want access to everything,” said Dr. Barbara J. McNeil, the head of the health care policy department at Harvard Medical School and a member of the benefits committee. “They don’t want to be restricted in what institutions they can get care from.”

Although out-of-pocket costs over all for a typical Harvard employee are to increase in 2015, administrators said premiums would decline slightly. They noted that the university, which has an endowment valued at more than $36 billion, had an unusual program to provide protection against high out-of-pocket costs for employees earning $95,000 a year or less. Still, professors said the protections did not offset the new financial burdens that would fall on junior faculty and lower-paid staff members.

“It seems that Harvard is trying to save money by shifting costs to sick people,” said Mary C. Waters, a professor of sociology. “I don’t understand why a university with Harvard’s incredible resources would do this. What is the crisis?”

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Re: Harvard professors who once touted ACA now angry because it's hitting their pocketbooks

Posted by AlM on Mon Jan 5 19:11:18 2015, in response to Harvard professors who once touted ACA now angry because it's hitting their pocketbooks, posted by Olog-hai on Mon Jan 5 18:28:42 2015.

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Re: Harvard professors who once touted ACA now angry because it's hitting their pocketbooks

Posted by LuchAAA on Tue Jan 6 04:33:15 2015, in response to Harvard professors who once touted ACA now angry because it's hitting their pocketbooks, posted by Olog-hai on Mon Jan 5 18:28:42 2015.

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Re: Harvard professors who once touted ACA now angry because it's hitting their pocketbooks

Posted by LuchAAA on Tue Jan 6 04:38:02 2015, in response to Harvard professors who once touted ACA now angry because it's hitting their pocketbooks, posted by Olog-hai on Mon Jan 5 18:28:42 2015.

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Re: Harvard professors who once touted ACA now angry because it's hitting their pocketbooks

Posted by RIPTA42HopeTunnel on Tue Jan 6 05:43:11 2015, in response to Re: Harvard professors who once touted ACA now angry because it's hitting their pocketbooks, posted by AlM on Mon Jan 5 19:11:18 2015.

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Workers pay more for, and get less from, health insurance; ACA strikes again

Posted by Olog-hai on Thu Jan 8 02:08:07 2015, in response to Universal Health Care is HERE in these USA! Apply Now. www.healthcare.gov, posted by SMAZ on Tue Oct 1 13:19:06 2013.

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Workers paying more for health insurance, but getting fewer benefits

By Noam Levey
January 7, 2015 5:41 PM

Although the Affordable Care Act has not led to soaring insurance costs, as many critics claimed it would, the law hasn't provided much relief to American workers either, according to a new study of employer-provided health benefits.

Workers continue to be squeezed by rising insurance costs, eroding benefits and stagnant wages, the report from the nonprofit Commonwealth Fund found.

Nationwide, the average contribution an employee made to an insurance premium in 2013 and the average deductible together represented 9.6% of the median income of American households with members under age 65.

That is up from 8.4% in 2010 and nearly double the 5.3% that households were paying for employer-provided health coverage in 2003.

"Workers are paying more but getting less protective benefits," the report's authors noted. "Although the Affordable Care Act offers a platform from which to build, securing a more affordable future will likely require action beyond those reforms, focusing on costs of care, particularly for the privately insured."

Insurance offered by employers is the primary source of health coverage in America, providing benefits to about 150 million people.

Although attention has been focused on new insurance marketplaces created by the health law to serve people without employer coverage, the law was also designed to preserve the employer system.

Supporters of the law hoped it would also modulate skyrocketing costs, which had dramatically pushed up premiums and cost-sharing through the 2000s.

The new Commonwealth report, which parallels other recent studies, indicates that healthcare insurance cost growth has slowed in recent years.

The overall price of an employer-provided family health plan, which includes the share paid by employers and the share paid by employees, increased 6% annually on average from 2003 to 2010, according to the report.

By contrast, annual growth from 2010 to 2013 averaged only 4.9%.

The employees' share of premiums also grew more slowly after 2010, increasing on average by 5.9% annually compared with 7.2% a year from 2003 to 2010.

Commonwealth Fund President David Blumenthal, who previously worked in the Obama administration, noted the health law may have contributed in part to the slowdown.

The law requires insurers to curtail administrative costs and provides new incentives to hospitals to improve quality and efficiency.

But experts give more credit for the smaller cost increases to the economic slowdown, which cut demand for health services, and increasingly aggressive efforts by employers to shift costs onto workers through higher deductibles and co-pays.

"There are a lot of things going on," said Paul Fronstin, senior research associate at the Employee Benefit Research Institute, which tracks employer coverage.

The Commonwealth Fund report found the burden of healthcare costs on employees was particularly pronounced in lower-income states.

The combined average employee premium and deductible exceeded 10% of the median working-age household income in 17 states in 2013, according to the study. In Texas and Florida, the total was more than 12%.

In California, the premium and deductible represented 9.7% of the median household income, up from 5.3% in 2003.

The lowest burden on employees was in Hawaii, a state that has historically had relatively low insurance costs and high rates of coverage. The combined cost of an employer-provided plan was 6% of median household income.

But the employee's share of healthcare costs grew in every state over the last decade.

"All states have lost ground from an employee perspective," said Cathy Schoen, one of the report's authors.

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Re: Workers pay more for, and get less from, health insurance; ACA strikes again

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People being forced to pay back ACA subsidies for stupid "reasons"—ACA strikes again

Posted by Olog-hai on Sat Feb 14 12:21:25 2015, in response to Universal Health Care is HERE in these USA! Apply Now. www.healthcare.gov, posted by SMAZ on Tue Oct 1 13:19:06 2013.

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I have to pay back my Obamacare subsidy

By Tami Luhby
February 13, 2015: 6:01 PM ET

Janice Riddle got a nasty surprise when she filled out her tax return this year.

The Los Angeles resident had applied for Obamacare in late 2013, when she was unemployed. She qualified for a hefty subsidy of $470 a month, leaving her with a monthly premium of $1 for the cheapest plan available.

Riddle landed a job in early 2014 at a life insurance agency, but since her new employer didn't offer health benefits, she kept her Obamacare plan. However, she didn't update her income with the California exchange, which she acknowledges was her mistake.

Now, she has to pay back the entire subsidy, which is forcing her to dip into her savings.

"I was blindsided that the subsidy has to be paid back," said Riddle, adding she didn't even use the coverage, which she had until she qualified for Medicare in October. "I'm in shock…but I have no choice. Do I want to argue with the IRS or the Obama administration?"

Like Riddle, many Americans on the exchange will likely have to pay back some or all of their subsidies. Between 4.5 million and 7.5 million taxpayers received subsidies for insurance premiums when they signed up for coverage on Obamacare exchanges, federal officials said. These folks had to forecast their 2014 income when they applied. Those who underestimated their earnings either will receive smaller tax refunds or will owe the IRS money.

Some enrollees, however, had a change in circumstances — such as a raise, new job, marriage or baby — during the year that could affect their subsidy level. Obamacare enrollees were supposed to contact their exchange so it could revise their premium. Some people, however, did not know they had to notify the exchange or simply didn't bother.

Also, just because someone qualified for a certain subsidy at the beginning of the year doesn't mean they are ultimately entitled to it. It's the total annual income that matters, so if an enrollee got a big raise mid-year, his entire subsidy may have to be repaid.

Early data is in from some tax preparers. Some 53% of Jackson Hewitt clients who received subsidies have to repay part or all of it, with the largest being $12,000, said Mark Steber, chief tax officer. The rest overestimated their income so they are getting even larger refunds. One taxpayer is collecting an additional $7,500.

Some Obamacare enrollees who have to pay back their subsidies are now thinking twice about enrolling for 2015.

Erica Cherington, 32, was "very happy" to enroll in Obamacare last year so she could address some health issues. She only had to pay $89 a month for a Horizon Blue Cross Blue Shield plan, thanks to a $284 monthly subsidy. She let herself be automatically re-enrolled for 2015.
During 2014, however, the Newark, N.J., resident landed a new job with a higher salary. Now, she has to pay back $600 of her subsidy.

To avoid this happening again, Cherington called the federal exchange to update her income, which she hadn't done when she changed jobs. Her revised monthly premium: $156 a month.

A case manager who handles disability payments, Cherington is now considering dropping her coverage and paying the penalty instead.

"It's not really affordable," she said of her new premium. "I don't know if I'll be able to keep it."

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Re: People being forced to pay back ACA subsidies for stupid ''reasons''—ACA strikes again

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