Time is Running Out for Obamacare

The insurance industry is highly regulated. This makes sense since its actions have such important consequences in our everyday lives.

When the ACA (Affordable Care Act, often called Obamacare) was introduced, I was delighted to hear so much discussion about the health care system. Congressional hearings stretched out over a year. President Obama gave a lengthy speech to Congress explaining his vision and the foundations of the legislation.

After months of public hearings and debate, Democrats accepted more than 160 Republican amendments to the bill. It was an arduous process, but the good news was that people were now talking about and learning more about our health care delivery and financing systems. We knew that the legislation was complex and clearly imperfect, but the insurance industry had been at the table during the process and was clear on the path it needed to follow.

This is in stark contrast to the situation we are facing today. After voting 60 times to repeal the ACA at costs estimated near $100 million one would assume there was a replacement plan ready to be proposed. Since the election, Republicans in the House proposed the AHCA (American Health Care Act). Republican Senators are working in secret on their own version with a goal of passing the bill before the July 4th recess. I don’t see how it can be passed before the recess.

Insurance companies are required to file rates by June 21st for 2018. In California they are filing two sets of rates: one if the rules don’t change and one based on what they perceive might be the new rules!

To expect such an important industry (representing almost 1/6 of our economy) to function under this type of uncertainty is unconscionable. Every American is in some way touched by the health insurance industry. I feel like Congress is playing a game of “chicken” with the healthcare of Americans. While the individual market only effects about 7% of the population, the ACA effects more than just the individual market.

The Trump administration continues to fund the Cost Sharing subsidies that help the working poor, but threatens each month to stop the funding. These subsidies help the middle class families earning up to 400% of the Federal Poverty Level. More uncertainty.

The MediCal/Medicaid population is walking the same tightrope. Community health centers are unable to budget when it is unclear how or if they will be reimbursed for providing care. In Shasta County this is particularly problematic. There are about 65,000 MediCal beneficiaries in Shasta County- 1 out of every 3 citizens. We must acknowledge that we live in a poor community whose long term health is dependent on this program.

Fortunately, we have Partnership Health managing our MediCal population and Shasta Community Health Center as the cornerstone of providers. Both organizations are efficient and proactive. Full disclosure: I serve on the Board of SCHC. In serving on this board, I have become acutely aware of the needs of this population and how it is served.

As of my press deadline, the final Senate bill has not been released. I implore our readers to follow this very closely. In its House form, it was not at all comprehensive and left many issues unaddressed, purportedly with the intent of incremental reform. The problem being that the bill also repealed the ACA. Therefore, it was not incremental reform, it was simply creating chaos in the markets.

While we wait for this to be sorted out, I am reminding our readers of a new California law that is effective 7/1/2017.

This new state law protects individuals from receiving unexpected “surprise or balance” medical bills from an out-of-network doctor when receiving non-emergency services at an in-network facility such as a hospital, clinic, lab, imaging center.

When a patient uses a network facility, they should no longer have the surprise of finding out that one of the providers is not a member of the insurance plan.

When individuals go to an in-network facility for care but receive services from an out-of-network doctor, they only have to pay their in-network cost-sharing amount that counts toward the annual deductible and annual out-of-pocket maximum limits according to their health plan.

If for any reason the out-of-network doctor receives payment that is more than the allowed in-network cost-sharing, the out-of-network doctor must refund the overpayment within 30 days of receipt.

P.S. Blue Shield of California is sponsoring the Wisdom Study, a five-year research study, to improve how women are screened for breast cancer. The two approaches are an annual mammogram and a personalized mammogram schedule based on the woman’s risk. To see if you qualify: wisdomstudy.org

Margaret R. Beck
Margaret Beck  CLU, ChFC, CEBS started her insurance practice in Redding in 1978. As an insurance broker/consultant,  she represents businesses and individuals as their advocate.  She assists in choosing proper products, compliance with complex benefit laws and claims issues once coverage is placed. All information in her column is provided to the best of her knowledge, subject to final regulation by the respective agencies. Questions to be answered in this column can be submitted to info@insuranceredding.com. Beck's column is also published in the Redding Record Searchlight.
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12 Responses

  1. Randall R Smith says:

    There is no easy fix for the present mess.  Entitlement Nation will not tolerate cost saving rationing, nor will life saving techniques be shelved.  Congress can’t agree on the date and the current mentality where shooting them is publicly claimed by some as overdue means we are headed over a tall cliff.  Big Bummer what is coming to the next generation.  Most of the change happened on our watch since Watergate which proved investigation of wrong doing is more important than doing good.

  2. Christian Gardinier says:

    The Mess called Trump care is a pathetic “replacement” for the Affordable Heathcare Act and we can pray that Trump care, or Doug LaMalfa care for those of us in District 1, dies on the vine. However, one of the most concerning actions taken recently regarding the health care of all of us living in California was caused by a Californian! Republicans didn’t do it, a Democrat, Ca. Assembly Speaker Rendon did it by putting SB 562 into political purgatory instead on moving it to committee. Redon’s act the has optics of a collusion between big pharma and insurance. SB 562 saves Californians and the State of California a lot of money and provides a moral, ethical, affordable and equitable pathway for California healthcare! Call, write and Facebook Decomcarts if you think as 70% of Californians do that SB 562 needs to become law!

  3. Common Sense says:

    Margaret, it is quite clear from the way that they have been trying to Secretly Slam this horrendous new Bill through that they ( The Republicans) are much more focused on Destroying anything and everything Obama Did over 8 years-than do something good for ALL-concerning health care.

    That is taking Precedent over a Fair Health Care Bill! Let’s get to work and UN do anything and everything Obama did- that’s the Mantra in the RNC halls!…..we don’t care that it will throw 23 million people off health insurance…..that was clear with the Cheering of the first draft and the “Victory party with beer”…….

    It will be a rude awakening here soon….when Medicaid is cut….when SS is cut…..when your Insurance is GONE.….when other things are cut…..taking away the poor school kids lunches…..taking away the poor Seniors Meals on Wheels……what a shock for those that bought into the Lies…..who they going to blame then?……

    Not sure when the large 4×4 Pickup drivers with the Rebel Flags flying and the Trump stickers will get it….if ever…..but then you can’t teach common sense…..

    Ya’ll…..been Trumped

  4. JeffG says:

    Claimed US debt: $20T

    Unfunded Social Security liabilities: $30T

    Unfunded Medicare liabilities: $50T

    ——

    Total US debt & unfunded liabilities: $100 trillion

     

    US Federal Revenue: $3.3T/year

    US Federal Expenditures: $3.9T/year

    —–

    Annual deficit: $600B

     

    If you could somehow cut military spending to zero ($600B) while simultaneously doubling taxes, it would still take ~30 years for the US to truly become debt free.  Therefore any policy that fails to both raise taxes AND cut benefits will almost certainly lead to inflation, the effects of which are far more regressive than even the most draconian tax scheme.

  5. cheyenne says:

    For all you “the sky is falling” chicken littles and your conspiracy theories the facts are that only two Republicans have to oppose Trump care for it to not pass, at last count there were five Republicans, and probably more coming, that oppose Trump care.  It will not pass.  California will not lose Medicaid expansion and neither will Wyoming, of course we never had it.  All those posts about losing Medicare or SSN are just like “The Feds are coming to take our guns” nothing but conspiracy theories dreamed up by chicken littles.

    What #45 did do, with Democratic support, is make VA employees more accountable.  This is the real draining of the swamp.  While most public employees do a very good job, a few act like their own feudal lord without fear of losing their jobs because of protections the Democrats gave them.  I saw this personally at the school district.  What #45 will do is make public employees about what they know, not who they know.

  6. Common Sense says:

    No one said lose there Bruce…..I said CUT…..as in whacked with an axe…..the Losers under the new bill would be the 20-23 million that have insurance….that would Lose it!…and like you say….there’s a chance it won’t pass….it’s the thought behind it that should get people getting a little more involved……or they will be surprised if they don’t get involved!

    This administration is just about done…..The Russian Ambassador is being sent back to his homeland….his work is done….he was an incredible Spy for Russia…..I am guessing that many didn’t even know he was one…..LOL…..heck one of 45’s business partners was an FBI informant years ago….am guessing he didn’t know that either…..

    They only return Spies when they sense the end is near( or their mission has been accomplished) ….they either bring them home or eliminate them…and Kislyak did too good of a job for the opponents….so he gets to live.

    It’s a whole new battlefield….Cyber Warfare…..They Penetrated our System……this is an act of Warfare…not what most people think of as warfare….but it’s the new frontier….the old days of ships and aircraft and destroyers are not over….they are just second in the defense now….the digital age is the new battlefield….To Date….this goes down as the greatest Penetration of a Political System in History….and as some of the people in the Intelligence community have stated….they will be back….The real question we should be concerned about is….what are we going to do to make sure it doesn’t happen again?

    And thank goodness we have two for sure and up to 5 Republicans that have the coconuts to stand up to such a massacre on the health issue! Great job folks!!….we need More like you guys…..

    The Democrats now have a Real Problem when this all goes down….they don’t have a Real Leader ready to go!…. Time to get to work DNC…..Your chance Dem’s is just around the corner….2018 will be here shortly…..but…Can you DO IT? God Only knows….

  7. JeffG says:

    How can moderates, from either side of the isle, survive today’s polarized political environment?  Anthony Rendon, a Democrat, recently shelved a plan to convert California’s health care system to a single-payer because, get this, it would cost $400 billion yet had no sources of funding (for perspective, California’s entire 2017-2018 budget is less than $180 billion).  In response, progressives labeled him a “reptile” and vowed to launch a recall campaign.

    http://www.capradio.org/articles/2017/06/27/rendon-sparks-uproar-by-shelving-single-payer-bill/

  8. Steve Murray says:

    Nice article Margaret. Thank you for your effort. I’m disgusted with Mitch McConnell and the craven antics of  the Senate and house. The REAL reason for their “repeal and replace” of course is huge tax cuts for the one percenters .  If they cared about the American people they would fix what needs fixing to Obamacare and then become heroes to millions of people. My utmost disgust is reserved for LaMalfa who voted against the well being of a large number of his own constituents. It is really hard to take.

    • Beverly Stafford says:

      Ditto to all you said.  Any senators who comes back from the July break and votes with McConnell and Ryan should be impeached or recalled or shot.  As one person said to her so-called representative at a town hall meetings, “I want the health care you have.”  Sounds fair.  Or barring that, Congress, POTUS, and SCOTUS should have MediCare.

      • K. Beck says:

        It is way past due for the The Governments, all of them, to start living under the same laws we live under. The Federales specifically exempted themselves from what ever they end up dumping on us. If they were forced to have what we have (I include Medicare (which I find not so bad, all in all) and Social Security. Although they all have so much money it wouldn’t really have much of an impact on them. And, how about they all get paid the minimum wage in their resident states? For 35 hours/week, or less.

        Steve Murray: here is someone who disagrees with you:

        http://www.latimes.com/opinion/op-ed/la-oe-pollin-single-payer-healthcare-healthy-california-20170621-story.html

        • Steve Murray says:

          I do not disagree with Mr Pollan, perhaps you meant he would agree with me??

          Anyway I’ve said here before single payer health care is entirely doable here in California. We do have one of the world’s largest, most vibrant economies that could easily support single payer as Mr. Pollen points out in the above link. I say dump the Feds and go our own way…we can do it, and I will support candidates and politicians who believe and support this idea.

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