<p>Experiences and info gathered today…so not good…</p>
<p>I need to see an orthopedist. I’ve never done so. Called 3 different ones in my area. The first, the very very first question was…what is your insurance plan…we do not accept any Covered California plans. Then I asked if they took individual plans and not one of the three could answer the question. One receptionist referred to something called a ‘multi-plan’ and supposed off exchange plans which start with X and M (?) in the identifier. This person indicated these were some sort of plan identifier which is not technically from the exchange, but behaves the same way…and they don’t take those either. They only take employer plans!!! For right now it’s not a problem since we are still a group BS PPO.</p>
<p>BUuuuuuuttttt…we will not be a group come next enrollment cycle and from this mornings experience, at that time we will basically have no doctors…so…I thought I’d spend some time delving into the individual off exchange market. So, Healthnet no longer sells plans through the Farm Bureau…they can’t because of the ACA. Okay, down one option out of the gate. BS offers only EPO plans (no individual market PPO option). Healthnet offers PPO plans and to get the same network (assuming the web info is correct) we will need to increase our monthly premium from the current $1400 to around $2200…on and the more expensive plan has a higher deductible.</p>
<p>So…now it’s off to see what slights of hand we can accomplish to remain a group…Coming up with some creative ideas…what if we hire a Medicare recipient. They can then legally decline the insurance option but might they count as the third vital non spouse employee? (BS and Kaiser only require that 65% of the group join the plan…2 our of 3 joining would get us to about 67%) Or, what if we got the firm we currently use as a contractor to hire US and then pay ourselves through them. No cost to them since we could increase what we pay them. (god I hate recursive problems). But wait, there’s more, we could establish a whole new legal entity which has small minority memebers who get healthcare coverage, but they are friends, and um… arrangements could be made…oh the opportunities for creativity are large.</p>
<p>I do hope the mom and pop group cancellation notices will go out in October (to give 60 days notice) as planned. Then again, maybe we’ll get another reprieve for …(take a guess) reasons to postpone those notices past November.</p>
<p>“The subsidized are getting subsidies because they’re poor. If you think getting a subsidy is such a great thing, you need only give up a big chunk of your income.”</p>
<p>You missed the entire point, didn’t you?</p>
<p>Dietz, my head is spinning from the labyrinth you are attempting to navigate. It is unbelievable you are being forced to deal with this crap. </p>
<p>Dietz, this may make it better, or may make it worse, but… probably there will be more insurers next year in the California exchanges. And whatever the networks are this year, probably they’ll be different next year. </p>
<p>The Independent article that Tatin referred to in his post earlier today is a very liberal community paper in my town. The Sansum Clinic is the largest full-service outpatient clinic in town and it was a shock to many when they announced that they would not see Blue Shield patients in the individual market. As I have said many times, Blue Shield’s network in my region is abominable. </p>
<p>I have a question for our resident statistician</p>
<p>dstark: When we (h and I ) along with the thousands of other H and W small groups are kicked out of our plans and enroll via an exchange - will we then be counted among the success stories? Keep the calculator and pom poms handy I’m sure the ‘enrollment’ numbers will increase again this time around. B-) </p>
<p>I’m probably different than the majority of people in that I’ve been working with the intimate, diaper dirty, details of keeping us insured for the past two decades. I know this crappage and am starting the defensive maneuvers 8 months in advance. Most folks (other than fellow posters) are not aware of the intimate details. I have this image from Night of the Living Dead…where all the zombies are walking in a daze…insurance card in hand…trying to knock down a bolted front door. </p>
<p>For those comparing it to Medicare or SS…those were brand new systems which started small, and initially affected a small population. They were added too, modified and built upon after experience was gained and first steps had proven solid. This is like taking a big hammer and smashing the existing structure and then trying to reglue, re regulate, repatch as best as one can when the increasingly large number of leaks and failures make themselves known.</p>
<p>We are lucky to the the ability, time, smarts, support people and yes finances to somehow make it work. To those not so lucky…well…it sure FEELS so DARN warm and fuzzy that we, the good, have elected to give you, the down trodden, this gift of other peoples resources. Marketers have always been good at what they do, and for the most part, we the people have believed them.</p>
<p>You’ve been on this thread long enough to know that what many of us differ on is the basic intent. Whether what reigns should be GP getting Cedars and keeping his well-employed-guy rates low. Marie Antoinette didn’t understand the bread riots. </p>
<p>LF: So the intention is what matters, not the actual result? The qualifier for programs, policy and governance should be ‘intention’ and not results? That is a Jenga tower if there there was one.</p>
<p>That said, there is not doubt that as a populace we can be lead by a ring through the nose which is fabricated from good intentions.</p>
<p>Okay, I just can’t resist…since ACA is really an embodiment of Utilitarian Philosophy, can we bring the father of this movement to future session on the subject. Although dead, he is still available…</p>
<p>See? Dietz, I say we differ on the intent and you turn it into the notion results don’t matter. Subtle but significant shift. Just as likely to be led by that same nose ring. Naysayers are not magically savvy. I’m sorry you don’t like your insurance options. I am happy for those who are gratified to have coverage. In between, the thread has argued an awful lot about crystal balls and individual media tales. </p>
<p>But LF: shifting the problem doesn’t result in any actual gains. Saying that ‘I don’t like my insurance options’ is completely misstating the concern/problem I presented. What good is insurance if you do not have access? Isn’t that the definition of a junk plan? So yes, lucky me who previously had the opportunity to pay a rather hefty (and continually rising) premiums for access to healthcare, now gets to pay a heftier premium with basically no access to care. And, a whole group who previously paid no premiums, now pay - an albeit low subsidized premium- and also have the same access problem. Actually, the newly covered via CC probably don’t have the squiggle room available to those in our situation.</p>
<p>Why would one be gratified to have coverage but no reasonable care options? If I put myself in the position of a newly CC insured individual who makes 3 calls to 3 providers only to be told…sorry…no soup for you…how does that make my position any better. Also, please read my original post on this subject. We’re not talking Picasso Cedar Sinai. These are small practices running on a small profit margin. Those that have the skills to figure out the system will still be accessing Cedar Sinai, Stanford, CPMC etc. And we will be doing it with greater out of pocket cost and yes, grumbling about the situation. But, those without the skills to figure this out will be walking around with a pretty card in their wallet. Also, what I presented was not a ‘media tale’, it was first hand experience.</p>
<p>If you’re talking about newly insured success stories, then no. You won’t be counted as a success story. </p>
<p>Do you anticipate enrolling on the individual exchange? I would have expected you to enroll off-exchange. Or do you have other employees, and you think you might go to the SHOP exchange, which I hope is better next year because it was more or less useless this year?</p>
<p>CF: Our situation is complicated in that there are too many unknowns (or at least not understoods by yours truly).</p>
<p>We are currently under group insurance. H and W businesses, and sole proprietors (the guy who plays the guitar at the local pub) qualified for group plans pre ACA. The rules have changed. None of these individuals continue to qualify as a group. In order for H and I to keep group status we will need to find a third body to be part of our business setup. There are many questions as to who this third body can/can’t be and how they must be compensated in order to qualify us as a valid group. It will most likely take a major reorganization of our business structure (oh the lawyers are counting the schekles as I type). </p>
<p>Yesterday I decided to find out what options were available to H and I outside of this group coverage arena. We do not qualify for subsidies and therefore would not go through the CC exchange. And, frankly after finding out the very large limitations and issues with the exchange plans, I’d figure out a way to avoid them even if we were.</p>
<p>What I did not know, hand no inkling off and frankly now has me very very concerned is that the individual policies sold by companies off exchange seem to have the exact same limitations, constraints and lack of access as the exchange policies.</p>
<p>At this point, we do not qualify for SHOP, I’m working with our broker to figure out what we can/should/might do to maintain group status. Failing that, we will probably be forced to buy the Healthnet plan which has the most expansive network. This one, as I posted earlier will run us (H, I and one dependent kiddle at that point) over $2200/month. And, it has a huge deductible and copay. So if I sound grumpy, I am. Yes, we are able to make it work because coverage and access is vitally important to my own mental health. However, we are very closely looking at our business and will make changes based on tax and now health insurance issues.</p>
<p>So, the funny thing is…while the ACA was supposed to unchain the masses from employer healthcare concerns, at least in this case - it has had the opposite effect. If either H or I were still employed by a company which had great plans no way in heck would we change. I wonder how many folks who may have retired early or left the workforce for private endeavors will now think long and hard before doing so. At this point, if you have employer sponsored health insurance hang on with your bare, sweating and cramping fingers for all your worth. :(( </p>
<p>Dietz, you’ve posted that in your area (Santa Cruz County, right?) all of the individual insurers offer care that anyone would say was inadequate (or, all the insurers but Healthnet?). That is, the problem is not that there is some expensive provider that you like that is not available; rather, no plan pays for a hospital and also doctors that practice in that hospital. If that is true, it’s egregious. It’s not just a little bit bad. It’s terrible for anyone who goes to the hospital.</p>
<p>And because it’s so terrible, I naively think it’s going to have to be changed next year. Any plan that doesn’t offer any hospital with doctors in it is hopelessly, illegally in violation of black letter law. And any plan that doesn’t have any doctors in a particular specialty, and won’t pay for out-of-network doctors at in-network prices, is also hopelessly in violation. I don’t see how insurers will be able to continue to get away with that.</p>
<p>The primary purpose was not to unchain the masses from employer insurance, though hopefully that will eventually happen. The purpose was to assist those who already are unchained to find insurance they could afford. Ten or twelve million people are now covered. By my lights, that’s a success.</p>
<p>Now please don’t say that I’m saying there are no problems. I am not saying that. Access is undoubtedly a problem for some people in some places. This should get better next year if insurers expand and new insurers enter the marketplace, as they are indicating they will. </p>
<p>My hands- and those of some others here- are tied because we’re trying to respect the posting restrictions. So let me put it this way- you earn more than would get you a subsidy. I’ve been on CC long enough to understand this isn’t much different than middle class squeeze for college costs. But, as in FA threads, the more a family earns, the more they are expected to contribute. We still understand how hard that can make it.</p>
<p>But the need for healthcare reform didn’t come out of thin air. It wasn’t to penalize hard-working folks like you. It was meant to respond to those who couldn’t afford, in the first place, even the rates you were paying before. For some of us, our understanding starts there. </p>
<p>For now, I’ll skip to provider issues. Remember, I saw zero change to my network. Solid PPO. Different state. I get it. But what California has left people with is horrendous (and possibly illegal.) I don’t see “throw the baby out with the bath water.” I say: make a monstrous, wretched noise in CA. </p>
<p>And just as we don’t know yet, how widespread doc refusals are, we also don’t know how evenly that appt-setting challenge applies to all- all neighborhoods, all SES. Yes some deductibles are high. But at least there is something there for the guys who, before, had nothing. It’s still a gap- but also a hedge.</p>
<p>It’s not perfect, no. Some are getting squeezed. Many on this thread have come around to seeing the ultimate alternative, SP, may have been better. But the huge noise, the complaining, the blocking, was done then, powerfully, by naysayers. I wish the same energy could be put into demanding corrections for what’s happening in CA. Not just advocating throwing ACA out.</p>
<p>The network problems aren’t the same in all parts of California. First of all, in areas with Kaiser, which I think is most areas, people can pick Kaiser and know that they are solidly covered for everything, even if there are some providers they can’t see.</p>
<p>But also, in my area, at first, Anthem was saying that they weren’t covering Sutter hospitals and doctors, which is most of the hospitals and doctors. But then some time at the end of January, Anthem quietly said that they’d reached an agreement with some of the doctors, including the huge practice that I go to. So in some areas, some of the network problems are quietly disappearing.</p>
<p>I still think that we need to make sure that all insurers are obeying the law in all parts of California. But it’s not as bad as it’s being painted. And California has to deal with issues that other states aren’t dealing with, namely provider monopolies.</p>
<p>(We do have a monopoly, but also an insurance commissioner dedicated to health-related matters. A lieut governor who’s been engaged in health issues for decades. And an interesting tradition of complaining- loudly and often.)</p>
<p>Although this is very complicated at the core it’s pretty simple. It moves money from one population group to another using health insurance as a delivery system. Sorry Dietz. </p>
<p>Really, it moves money from TWO population groups to TWO other population groups. It moves money from the extremely rich to the poor via premium subsidies, and it moves money from the well to the sick via guaranteed issue. The latter is how all insurance works.</p>