ELLEN DEGENERES: It’s doing very, very well. I think it surprised — it had a rough start, but you’ve got 5 million people that have signed up so far. Which is an enormous number of people have signed up, so it’s successful. … Well, people are starting to applaud here. I think that everyone’s very grateful that you did this. And I think it is important for people to sign up and to — it’s just better to be covered.
We’re starting to get indications from insurers that premiums on the exchanges will go up significantly in 2015. Here are four reasons why. …
4. Obamacare’s design gave insurers an incentive to ‘underprice’ in 2014
One last point. The various mechanisms that Obamacare’s exchanges use to keep insurers on board—what industry wonks call the “three Rs” of risk adjustment, reinsurance, and risk corridors—have been exploited by some insurers to offer prices that, while still high, are relatively lower than their competitors. Obamacare incentivizes insurers to do this, because they know that in the early years of the exchanges, they’ll be reimbursed by taxpayers for doing so.
This is why Sen. Marco Rubio (R., Fla.), among others, has been sounding the alarm about a taxpayer-funded “bailout” of Obamacare-participating insurers. But as time goes on, the incentive that insurers have to use these tactics recedes. In 2015, many insurers who tried to underprice their premiums relative to their costs are planning to bring rates more in line with what they’re actually spending on health claims. That’s going to drive prices upward.
If a person with subsidized insurance falls behind in paying the premiums, the Affordable Care Act requires insurers to cover his medical bills for 30 days.
But for the next 60 days, insurers can hold off paying those claims — and ultimately, deny them if the patient doesn’t pay the premiums in full. An insurer’s denial means doctors don’t get paid for their services. If the insurer ends up canceling the policy after 90 days, doctors can bill patients directly but may face difficulty collecting.
“This puts the physician and their patients in a very difficult situation,” said Dr. Ardis Dee Hoven, president of the American Medical Association, which about how to minimize their risk.
“If a patient is being treated for a serious illness that requires ongoing care, the physician is having to assume the financial risk for this,” she said. “That’s the bottom line.”
Terri Durheim and her family now have health insurance, thanks to Obamacare. What they don’t have are local doctors and hospitals who will take it.
This worries the Enid, Okla., resident since she has a teenage son with a serious heart condition. They now have to find a pediatric cardiologist in Oklahoma City, more than an hour away.
And if there’s an emergency … “obviously we’d have to pay out of pocket and go here in town, but that defeats the purpose of insurance. I’m truly grateful we have insurance. It’s reasonable and affordable, but it’s not doing me a lot of good,” said Durheim, who just had to drive 90 minutes to Stillwater, Okla., for a CAT scan for herself. “It’s so frustrating.”
Like Durheim, many Americans who’ve enrolled on the Obamacare exchanges are realizing they have access to a relatively limited set of doctors and hospitals. In many areas, the largest hospitals are not participating and many doctors are not accepting the coverage.
The hospital bills are hitting Larry Basich’s mailbox.
That would be OK if Basich had health insurance. But he doesn’t.
Thing is, he should be covered. Basich, 62, bought a plan through the state’s Nevada Health Link insurance exchange in the fall. He’s been paying monthly premiums since November.
Yet the Las Vegan is stranded in a no-man’s-land where no carrier claims him, and his tab is mounting: Basich owes $407,000 for care received in January and February, when his policy was supposed to be in effect. Instead, he’s covered only for March and beyond.
Basich has begged for weeks for help from the exchange and its contractor, Xerox. But Basich’s insurance broker said Xerox seems more interested in lawyering up and covering its hide than in working out Basich’s problems. Nor is Basich the only client facing plan-selection errors through the exchange, she added.
Cancer patients relieved that they can get insurance coverage because of the new health care law may be disappointed to learn that some the nation’s best cancer hospitals are off-limits.
An Associated Press survey found examples coast to coast. Seattle Cancer Care Alliance is excluded by five out of eight insurers in Washington state’s insurance exchange. MD Anderson Cancer Center says it’s in less than half of the plans in the Houston area. Memorial Sloan-Kettering is included by two of nine insurers in New York City and has out-of-network agreements with two more.
Doctors and administrators say they’re concerned. So are some state insurance regulators.
In all, only four of 19 nationally recognized comprehensive cancer centers that responded to AP’s survey said patients have access through all the insurance companies in their state exchange.