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That, I wasn’t aware of. </p>
<p>If you’ve proof, I’d like to see it.</p>
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<p>Could you please provide some links to support this statement?</p>
<p>GP, I’d like your definition of </p>
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<p>I am under the impression they introduced a 3rd category that had to do with people not liking their new policy being allowed to buy catastrophic insurance or go without one when their insurance got cancelled and they did not like new choices?</p>
<p>On a side note, a doctor was telling us this story about how catastrophic insurance worked and why it is a really bad one (at least based on his story). Another doctor friend of his who had such an insurance had an emergency, was airflighted, given specific care, was billed 85,000. His deductible was 20,000 and insurance paid the hospital 65,000 since there is no negotiated price for the treatment provided.</p>
<p>Turns out his treatment, under medicare or other types of regular insurance would have been discounted to 15,000 from the listed price of 85,000. The doctor is being asked to pay up 20,000 and he asked the hospital why they need his 20k since they were paid 4 times what they would have normally collected. They told him since he is a doctor with privileges the law prevents them from waiving the fee (I don’t know what this is exactly but supposedly they are not allowed to waive charges under specific rules) but they will bill him a small amount each month into perpetuity so that they fulfill the rules.</p>
<p>Concierge may be just a band aid. GP may get a c-doc he likes (assuming he likes those available.) But he’s insisting insurer networks are too narrow and will get even smaller- so what happens if he needs more care? And anyone could be taking a risk with deductibles on a catastrophic plan.</p>
<p>As far as mortality rates go, I thought we already covered how countries may report differently. Plus, there is a lot more to be factored in, other than just a final number. It’s not only care available or skin color. </p>
<p>x-post</p>
<p><a href=“Pros and Cons of Concierge Medicine - WSJ”>http://online.wsj.com/news/articles/SB10001424052702303471004579165470633112630</a></p>
<p>ACA Permits Concierge Practice Membership.</p>
<p>The new face of concierge medicine is a low fee, low-cost treatment options with no insurance billing whatsoever. On the cusp of the ACA mandating most Americans to have health insurance, a rise in doctors who don’t take insurance might seem ironic. However, there is a little-known provision in the ACA that permits a concierge practice membership to count as ACA-compliant insurance, as long as it is paired with a catastrophic medical policy to cover emergencies, according to an article in the Wall Street Journal. To read the entire Wall Street Journal article, click here.</p>
<p>Concierge medicine is also being pursued by large companies like Expedia to establish clinics at their headquarters as a means of reducing overall healthcare costs.</p>
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<p>There may or may not be intentional discrimination. My point is simply that there are racial disparities in access to health care and in quality of care, even when you control for income, education, etc. And these are correlated with worse outcomes for African-Americans in a number of areas, infant mortality and maternal mortality among the most egregious. Cardinal Fang is absolutely right that the incidence of the kinds of complication that lead to maternal mortality is no higher for black women than for white women. However, black women have a much higher case-fatality rate, that is, they’re much more likely to die from the same condition. Most people who have studied this have concluded that lack of access to pre-natal care and lack of access to quality care during delivery and post-partum are among the likeliest causes, though there could be other factors as well, such as higher rates of co-morbidity and pre-existing conditions which increase the likelihood that the triggering complication becomes fatal.</p>
<p>You point to low rates of maternal mortality among Hispanics in the U.S. No responsible research I’ve seen has suggested this is due to “easy and sufficient access” to health care. Quite the contrary. Public health researchers call this the “Hispanic paradox”–despite generally poor access to quality medical care relative to non-Hispanic whites, Hispanics actually have slightly better outcomes in both infant mortality and maternal mortality than non-Hispanic whites. And no one’s quite sure why. There’s some evidence that foreign-born Hispanics have better outcomes than U.S.-born Hispanics, leading some to speculate that there’s a “salmon effect”–only the strongest survive the rigors of in-migration, and they tend to have healthier babies and better survive the risks of childbirth. But pretty much all the research ends with “more research needed.” </p>
<p>IMO, there could also be specific locational factors at play here. Blacks and Hispanics generally don’t occupy the same physical spaces in the United States, and our health insurance options and health care delivery systems are not uniform across the entire country, or within any state, or within particular neighborhoods within any given metropolitan area. Half the nation’s Hispanic population lives in California and Texas; those two states account for only about 10% of the nation’s black population. Massachusetts (4.8 maternal deaths per 100,000 live births in 2010) and Minnesota (5.0 deaths per 100,000) have maternal mortality rates well below the national average; they also are two of the states with the lowest rates of uninsured.</p>
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<p>Well, it would have to be the ‘Hispanic paradox’ wouldn’t it? Maternal outcomes grossly better than that of black mothers yet no palatable reason why. That positive outcomes for Hispanics are called paradoxical, while poor outcomes for blacks are suggested as possibly due to systemic discrimination is yet another paradox but a pretty predictable one. </p>
<p>Lot of thoughtful speculation in your post, bclinctock but I pass on whatever conclusions you’ve come to. I’d have to believe, for instance that Texas, long a whipping boy for stinginess, is a better place for a hispanic mom-to-be than many, many locations in the US are for expecting blacks. I can’t swallow it, myself.</p>
<p>Re the concierge issue: You have to pay attention as to how “catastrophic” coverage is defined. Before ACA it was quite possible to buy a policy with a deductible of $20K (as in TexasPG’s example) – or $50K - or $100K – and of course the higher the deductible, the cheaper the policy. (When my son was in college I had a plan that probably had around a $100K deductible that cost $85/year — of course that was meant to supplement my basic plan, back in the days when regular health insurance plans had a cap on how much they would pay out in a given year).</p>
<p>But under ACA, “catastrophic” now refers to plans that have deductibles that equal the maximum patient responsibility under a plan – $6350 for an individual, $12,700 for a family. I certainly can see the potential for savings, especially for a family – but it is not always going to come out that way. The “catastrophic” plans simply aren’t priced all that much lower than the lowest-cost bronze. </p>
<p>Those with HSA plans might be interested in this article: <a href=“http://www.hsaadministrators.info/news/10/”>http://www.hsaadministrators.info/news/10/</a> (answering the question of whether or not the funds in the HSA account can be used to pay concierge fees --the answer is, "it depends:)</p>
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<p>By definition, a Bronze plan has an actuarial value of 60%. It looks to me like it’s impossible within the confines of the ACA to write a catastrophic policy with an actuarial value less than about 50%, without failing to cover something that is required. That means a catastrophic policy will be about 5/6 the cost of a bronze policy, a savings but not a huge savings.</p>
<p>I don’t see much difference between a catastropic plan and bronze plans and if one wants to couple it with a concierge practice I’ve no problem with that - though I don’t think it is any cheaper - likely more money. </p>
<p>Here is a good synopsis regarding who should insure themselves this way. <a href=“http://blog.taxact.com/catastrophic-plan-vs-full-coverage/”>http://blog.taxact.com/catastrophic-plan-vs-full-coverage/</a></p>
<p>What would concern me is the scope of the concierge practice. For instance, when I got sick in November, I had no idea what was wrong with me. After weeks running back and forth to my PCP, it was suggested it was time to go to gynecologist. After weeks of going to that doctor with no answer to what was wrong - though my doctor had a hunch - it was suggested I needed to see a urologist. So more tests and an invasive procedure and that doctor dismissed gyno’s hunch (though at least bladder cancer was ruled out.) My condition cannot be formally diagnosed until certain diseases are ruled out first. </p>
<p>But I was still sick and my gyno still believed his hunch was right, so he said I needed to see a Uro-gynecologist. She made the diagnosis and prescribed needed treatment - but since it is a chronic condition (no cure and the treatment I am on now may stop working,) I will need to see this doctor for the rest of my life. I don’t imagine many concierge practices have a uro-gyno on staff. Ditto with my friend who just was diagnosed with MS - only her specialist is a neurologist. She is going to need constant medical attention from this doctor for the rest of her life. Same for my friend who has Lyme Disease. She has a host of specialists who treat her - as it effects so many different things and there can be co-infections from Lyme. None of us were ill before we came down with our diseases and catastrophic plans do not cover chronic illnesses. My cost so far has been around $18K, but because I have insurance I only have paid approx $500 in co-pays ( if that.) And $15K was pre diagnosis. </p>
<p>I cannot imagine a concierge practice could possibly have on staff a slew of different specialists. Now, it’s possible that there are concierge practices which specialize (I believe there are quite a few in Manhattan) so for instance - I could become a member of a Urologist concierge practice, but that would be after I went though everything to get diagnosed in the first place and there would have to be someone who treats what I have (most uro’s do not, nor do they know a lot about my condition.) However, I would also need a PCP, a regular gyno, an ophthalmologist and a dermatologist (the specialists I have now) and who know what other kind of specialist I might need to see down the road! </p>
<p>But if that is the route some people chose to go, it’s fine by me. I do not, however, believe that choice would be good for low and middle income people at all. JMHO though. </p>
<p>TatinG, I read the WSJ article, Pros and Cons of Concierge Medicine (Nov. 10, 2013) by Jen Wieczner, after a bit of Googling to find an ungated version. It does not say that people can buy a catastrophic plan plus a concierge plan, if the people are otherwise not entitled to buy a catastrophic plan.</p>
<p>Then I read the second article you quoted, by Googling the excerpt you supplied. Its authority for the ACA permitting someone to buy a catastrophic plan coupled with a concierge plan is the WSJ article. But, as I’ve said, the WSJ article says nothing of the sort.</p>
<p>The WSJ does say that some insurers-- Cigna was mentioned-- have themselves built insurance policies bundling a higher deductible regular insurance plan and a concierge practice. But nowhere does the WSJ say that people in general are permitted to buy a catastrophic plan and supplement with a concierge plan. Maybe that should be the law. But it doesn’t seem to be the law right now.</p>
<p>Just to clarify – the WSJ article says: </p>
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<p>“Bundled with” does NOT mean that the individual buys a catastrophic policy off the exchange while at the same time signing up for a concierge practice. Rather, it seems to refer to the elements of a product offered by a medical group or insurance company which meets all ACA requirements.</p>
<p>In other words, in theory a medical group could set up a concierge practice and contract with an insurance company for group coverage for all its patients – and perhaps the fees for the concierge contract could also include the insurance policy payment – and if all of that bundled-together package met the ACA requirements, it might be legal. (My words like “in theory” and “might” are because there are all sorts of state and federal regulations that would come into play – but the main point is that the “bundling” is done by the organization which markets the plan, not something that an individual cobbles together).</p>
<p>Agree that a bronze can equate to better support than catastrophic, for not much more in premiums, with a possibly better deductible. When I noodled around with some hypotheticals, a low earning single person may get a decent deal on Silver, with the lowest deductibles of all. But it’s hard to come up with universal statements without checking a variety of options for different ages and incomes, family size, etc. </p>
<p>From healthcare.gov: “People 30 and over with a “hardship exemption” may be buy a catastrophic plan.” There are 14 hardship exemptions. <a href=“https://www.healthcare.gov/exemptions/”>https://www.healthcare.gov/exemptions/</a></p>
<p>And the article further says that Cigna is selling such a plan: a concierge practice together with a catastrophic plan, where "catastrophic"is the usual ACA definition, a ~$6K maximum out-of-pocket rather than something like $20K max o-o-p.</p>
<p>Not that it really matters, but I thought there may be some readers who might be interested in seeing how their tax dollars are being spent.</p>
<p>“Calif. tax preparers paid bounty for every Obamacare sign-up”</p>
<p>“At least 79 tax service providers, including offices of major companies like Liberty Tax Service and Jackson Hewitt Tax Service, are listed as certified Obamacare enrollment entities in the state of California, according to state exchange records.”</p>
<p><a href=“Calif. tax preparers paid bounty for every Obamacare sign-up | The Daily Caller”>Calif. tax preparers paid bounty for every Obamacare sign-up | The Daily Caller;
<p>Anthem listed 1,000 doctors as being on the Covered California plan when they weren’t.</p>
<p><a href=“Insurer Admits Nearly 1,000 Doctors Wrongly Placed On Covered California Provider List - CBS San Francisco”>http://sanfrancisco.cbslocal.com/2014/04/21/insurer-admits-nearly-1000-doctors-wrongly-placed-on-covered-california-list/</a></p>
<p>Yes, heaven forbid we make it easy for people to enroll by putting certified enrollers where a lot of people are going to be in late March. </p>
<p>Not a show stopper for me.
I do worry about waste in many projects. But some things are reasonable/customary “cost of doing business.” Fwiw.</p>
<p>Btw, there shouldn’t be any confusion on this point: I think CA should be ashamed of some of their poor management of all this.</p>