<p><a href=“http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf412878”>http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf412878</a></p>
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<p>So the individual plans are cheaper than employer insurance, but worse than employer insurance. It would have been interesting to do an apples-to-apples comparison of employer insurance versus private insurance by region, though.</p>
<p>Tpg, fwiw, in the info about special Enrollment Periods, this example is included-</p>
<p>"Misinformation or misrepresentation
Misconduct by a non-Marketplace enrollment assister (like an insurance company, navigator, certified application counselor, or agent or broker) resulted in you:</p>
<p>…Not getting the premium tax credit or cost-sharing reduction you were eligible for"</p>
<p>So that may be a consideration. <a href=“https://www.healthcare.gov/sep-list/”>https://www.healthcare.gov/sep-list/</a></p>
<p>DELETED. (my mistake, i mixed up comments from two different posters. Need coffee.)</p>
<p>So today I ran into my state rep. at a coffee shop I go to. Of course, I started a conversation with him about some of the problems with Obamacare. It became very clear to me that his knowledge of the law is very limited. Although he tried to make it seem he was knowledgeable, you could tell that he knew practically nothing about many of the issues we discuss on this thread everyday. It is scary how uninformed our lawmakers are about this law. I think he was hearing about the issue of networks from me for the first time. Yikes!</p>
<p><a href=“Bloomberg - Are you a robot?”>Bloomberg - Are you a robot?;
<p>^Wow, my dad is taking Gleevec - $350 per pill! He’s got chronic leukemia, but feels fine. He’s 77 and still teaching half-time. He invited me to go to South Africa with him and my mom in August. 
I am thankful for the drug, and the fact that it’s covered by his insurance.</p>
<p>Good article in the New York Times today about the strong trend toward narrowed networks. Why? People want lower premiums. Not just individuals but employers too.</p>
<p><a href=“More Insured, but the Choices Are Narrowing - The New York Times”>More Insured, but the Choices Are Narrowing - The New York Times;
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<p>What we’re seeing is clear: most people are not like GP. GP wants a wider network and is willing to pay for it. Most people are simply not willing to pay for a wider network. They don’t think it’s worth it to them.</p>
<p>The states and the feds are, rightly, monitoring networks to see that customers can know what they are buying (which they couldn’t do, in many cases, for 2014 plans) and that networks are big enough to provide adequate care to the subscribers. That needs to happen. It’s my impression that in general, we don’t need more federal and state regulations. Rather, the existing regulations need to be enforced more vigorously. Surely, for example, insurers were already required to supply accurate provider lists, even though many insurers failed to do so.</p>
<p>Well, it’s not worth it now. But, costs haven’t gone down while networks shrunk. More often than not, they’ve increased. People who pay are paying more for less. Some won’t like it. Obviously.</p>
<p>Is it then your contention that if prices were lower, then people would be willing to pay more for wider networks? There doesn’t seem to be any evidence to support that contention. Premiums vary enormously by region in the US, but everywhere, in the areas with the low premiums and in the areas with the high premiums, subscribers aren’t willing to pay more for wider networks.</p>
<p>The article (and many people’s experiences here) make it clear that most people don’t know how narrow their network is until they try to use it and/or when they get really sick. New subscribers who haven’t had to use the networks much if at all, aren’t reliable indicators of network satisfaction. </p>
<p>Meanwhile, buried in an L. A. Times article today on the state budget is this little nugget. 25% of Californians are on Medi-Cal. And yes, the federal government will chip in for some who are newly eligible under ACA, but it seems it’s going to be difficult to figure out which are which. Who were eligible all along (for whom the state picks up the tab) and who are newly eligible.</p>
<p>CF, it depend on what the perceived value is and that’s going to depend on what they were paying previously. </p>
<p>If I’m renting an apartment for $1000 a month and the landlord says he’s moving me to a studio apt for the same price or more than I was paying for a 2-bedroom I will feel ripped off. On the other hand, I could elect to pay $1500 for 2-bedroom if given the choice initially between that and a $1000 dollar studio. Some will. Some won’t. That’s different.</p>
<p>The issue is what people are willing to pay for now, under the existing structure. Are they now willing to pay more for a wider network? Apparently they are not, right now. As people gain more experience with the networks as they are, maybe some of them will discover that they prefer a wider choice. </p>
<p>OTOH, Kaiser, with its restricted network of doctors, remains popular in California, including with people who use it a lot. My mother-in-law, for example, is healthy for her age, but she is in her late eighties and has to go to the doctor from time to time. She loves her Kaiser.</p>
<p>Update on EPO network restrictions…</p>
<p>From the additional information I’ve been able to gather it SEEMS that BS EPO networks will let you see any doc in an EPO network. The difficulty for the friend (which started this whole process) is that if you live in one of the counties that is designated EPO but is surrounded by PPO’s then you basically are restricted to your geographic area. You can see from this map <a href=“https://www.blueshieldca.com/producer/ifp/products/networks.sp”>https://www.blueshieldca.com/producer/ifp/products/networks.sp</a> that a number of EPO counties are such access islands. </p>
<p>If the state regulators wanted to fix this problem I’d suggest the following</p>
<ol>
<li><p>Make the restrictions absolutely clear. Force the issuing insurance company to put this in large type across all application material.</p></li>
<li><p>EPO counties must be clustered. A minimum number must be contiguous…no islands.</p></li>
<li><p>Make each and every ‘navigator’ identifiable and responsible for incorrect/incomplete information. (brokers lose business if they misinform clients…or at the very least will fight the fight with/for you). Make all CC representative then take on the fight for clients who have been negatively affected by the incorrect information.</p></li>
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<p>The local urgent care provider which accepts the BS plan as well as Healthnet PPO was SRO when I visited. I’m going to guess there are not enough providers in this geographic area to handle the influx of patients who chose the cheaper plan. </p>
<p>One of my docs called a week in advance to confirm an appointment (they used to call the day before). When I questioned this change in policy they said - we are giving you the chance to cancel early if needed so we can open the spot to someone else. It already takes 4 weeks to get a non urgent appointment. It is crunch time ppl.</p>
<p>As for the willingness to pay a higher premium for larger networks…yes…we will be doing just that. It is a 60% greater premium than we are currently paying, and it will still have a greater OOP cost. However, as I’ve previously stated, we are in the blessed position of being able to pass the entire additional cost onto our customers.</p>
<p>I didn’t realize that Santa Cruz County had such a small population. Only a quarter of a million people! All the other EPO counties are low-population counties, too. </p>
<p>Dietz, Blue Shield could put up an EPO in Monterey County, and that would make a Santa Cruz/Monterey/San Benito cluster. I suspect, though, that you want one of the big Silicon Valley counties instead, and you wouldn’t be satisfied with three rural counties together.</p>
<p>Dietz, please send your 127 thoughts to the commissioner and anyone else who can exert pressure. A short intro para and those bullets. </p>
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<p>Except for the fact that most of these thoughts are of no use to the masses of SC County. Sure college students living out of area is a focus of cc, but the vast majority of residents of Santa Cruz County do not have college students, much less have them attending college out of the area. (young adults living/working out of the area presumably have coverage by the employer’s plan – or will – as soon as the Prez stops inhibiting ACA from full implementation.) </p>
<p>Most people will prefer the lower premium brought about by the highly restricted access. (And as a state taxpayer, I sure appreciate the lower costs.)</p>
<p>Look, I knew someone would say our input doesn’t matter. One way or another, GP has said it multiple times. But you don’t assume “someone else” will magically take care of complaining/suggesting for you. </p>
<p>It’s not just about college students. It’s anyone with a legit and defensible need (ie, not just “I want”) to have med care outside a small defined area. SC sure looks orphaned, to me. I get the design concept- limit the list, focus care locally. But the main segment of EPO land does allow a mobility not available in SC. This needs triage.</p>
<p>Yes, someone considering EPO should scrutinize the details. Yes, it’s hard to accept, “Golly, gosharoonie, I didn’t know.” But dietz uncovered a severe limitation in documentation and to the “catch area.” </p>
<p>Diets, the Santa Cruz newspaper may be interested in this story which affects many of its readers. A little publicity will do more than a complaint to a bureaucrat.</p>