California lawmakers have put forward several bills designed to solve a problem created by the Affordable Care Act. The problem is small provider networks that make it difficult for some people to find a doctor.
The problem stems from the design of Obamacare, which requires insurers to offer a standard package of coverage and to offer insurance to everyone regardless of their health. Unable to adjust costs by limiting coverage or by limiting access, insurers were left with one way to compete on price: limiting provider networks.
In the case of some major California insurers, the networks were initially too small for the number of people in them. Some Californians began to complain that, though they had insurance, they were unable to find a doctor who would see them.
Insurers have been making efforts to expand some of these networks to address the problem. The Sacramento Business Journal reports, "Anthem has added 6,300 doctors to its narrow network since January and now has a total of 38,000 statewide... Blue Shield has added 40 more hospitals and 15,000 doctors to its statewide network in the last year."
But California lawmakers are also trying to address the issue through legislation. Senate Bill 964 adds reporting requirements for Covered California and Medi-Cal plans. The goal is to insure that state regulators can step in if wait times to see a doctor become excessive. In cases where a patient suffers harm as a result of delays, the state would be able toassign penalties to the insurer.
Meanwhile, Assembly Bill 2533 would require insurers to help patients access out-of-network doctors in any case where in-network doctors are not available on a timely basis. The insurers would not be able to charge any additional co-pays for this service.
The insurance industry is strongly against AB 2533. A spokesman for the California Association of Health Plans, the industry's trade group, told the Sacramento Business Journal the bill, "goes in the wrong direction.” That direction, under Obamacare, is toward smaller, tightly managed networks.
"If you are pricing a service for less than it costs you to provide it, you cannot make that up in volume." Richard Thorpe
ReplyDeleteany dollar spent in healthcare is a dollar of income for somebody. This is an indisputable fact. If you want healthcare to cost less, while still being able to consume the same level of services, SOMEBODY has to make less money.
DeleteFor the most part, doctors have been the ones to get hosed so that A) they can continue to treat vulnerable populations because they feel a sense of duty to do so, or B) they get hosed so that insurance companies can continue to keep their profit.
I appreciate a lot of your posts Mick, if it were up to you, what would you want our system to look like? Stay exactly as it was pre-Obama care, or something different?
Eventually we will go to a single payer system, like the rest of the developed countries. This may be far in the future however as the inertia opposing change is great. Remember that the U.S. converted to the Metric System under President Thomas Jefferson! All of our units, pounds, feet, seconds, etc, are defined in terms of the S.I. metric system, we just don't tell the public. Can we convert to the single payer system without telling the public? I doubt it.
DeleteSingle payer:
Delete1. What level of benefits?
Catastrophic only coverage?
Preventative coverage? Who determines what that is?
Cover doctors visits for hemorrhoids?
Cover abortions?
Cover lasik eye care?
Dental?
Eye care?
BC pills?
Viagra?
Who pays for it?
National sales tax?
National income tax like SS?
The wealthy?
The middle class?
How do you have a single payer healthcare system when the government cannot even manage a budget? Really want a VA style fiasco, a typical example of government run healthcare.
Because other countries have it doesn't mean it's a great system or way to follow.
"Really want a VA style fiasco, a typical example of government run healthcare."
DeleteThis is not a fair statement. The VA system, as it was designed, was working pretty well until we went into two wars and basically dumped a tidal wave of acutely ill patients into a system that arguably was designed for primary care. The axiom that government can't do anything at all is a favorite whipping boy statement that is just repeated over and over and over until some people believe it without asking any questions.
A premise i reject is that the government is monolithic beast that we can't control. I think the reality is that the government employes thousands of people who want to do a good job and believe in public service. However, every agency and division of government has to play a game of kissing the ass of congress lest they lose funding. At the congressional level, it's now a favorite past time to perpetually wave a metaphorical gun int he face of agency heads and tell them they better not do their jobs if it means stepping on the toes of some campaign contributor.
You know my spiel Lou, I believe our government is no more and no less dysfunctional than the populous who elects it. Right now, there is a very strong movement by certain groups to flat out make the government fail from within. If you believe this doesn't have any cause and effect relationship with shitty outcomes, I just have to disagree at that point. From our consumption based system that will endlessly spend money in healthcare whether it does any good or not, a single payer system looks like leeches in the dark ages. When you start to compare, however, the outcomes for money spent, other countries are doing a much better job than we are. but, I concede that choice in outcome needs to be considered. If we want better outcomes for money we spend, we can't maintain our system as it is. If we want to be able to consume health care like buying TV's, single payer will never work, especially if responsibility for health is also put on the individuals consuming it
I would almost accept your VA premise except:
DeleteInflation-adjusted federal spending on the Department of Veterans Affairs (VA) has increased 92.2% in the last 10 years, according to the Monthly Treasury Statement, climbing from $73.3 billion in fiscal 2003 (in constant 2014 dollars) to $140.9 billion in 2013.
In fiscal year 2013, VA spending was $140,909,860,000 in 2014 dollars and included things such as medical services, medical support and compliance, medical facilities, housing accounts, compensation and pensions, and insurance funds, to name a few.
You can reject the premise of government and the lack of control however the government has a track record. Why is it that government spending is out of control? Few care as it's not their money as well as the spend it or lose it philosophy of government.
And yes, we get the government we deserve as we as a population continue to elect the hacks in congress and the presidency.
And why is it that other countries are perceived as having better outcomes? Could it be the people they deal with take more responsibility for their own health? But that would mean people couldn't stuff their faces everyday at 10PM.
They've spent more money because they had a massive wave of new, and much sicker veterans to deal with. But again, I'm not sure you're looking at it in a reasonable way. Those are big numbers, but this article http://www.mcclatchydc.com/2013/03/14/185880/millions-went-to-war-in-iraq-afghanistan.html lends a little perspective on what we are dealing with.
DeleteWhen not in war, we stockpile bombs, trucks, small arms weapons and so on. Do we build empty hospitals and other facilities in anticipation of sending over 2 million people to war in a ten year period? We were immediately behind the curve once the fighting started and we have been playing catchup ever since. Is that entirely the fault of a system that was built to do something quite different than what it is doing now?
Government spending is out of control for countless reasons that you and I agree on. Yet, for all the dysfunction of the Clinton/Gingrich years, we had things like higher taxes AND paygo. The predominant theme right now is that everything government does is bullshit, and costly. I believe there plenty of reasonable representatives who believe in stewardship, but again, if the premise is that all government is bullshit, there isn't much room to do something useful.
Your last para there, yeah, that certainly sums up some of it. Tie that to the third para. I believe we have reached a bit of a ridiculous extreme in this country. Too many people, IMO, have an attitude that if they forgo any opportunity to gratify themselves, freedom will die a horrible death. I personally believe I was given quite a few freedoms because others sacrificed and that I owe it to the future to leave something behind. I think a prevailing attitude of many today is that they earned what they have and if they want to just leave a smoldering stink hole in their wake, nobody should tell them a damn thing about it.
I am all for taking care of our veterans. The certainly deserve far more than our government delivers for the dollar. Perhaps it's time for that national conversation on what we can afford and what we are spending. Veterans care isn't negotiable.
DeleteSo much is negotiable and it's time to bring it to a head. We cannot afford this path of spending much longer and the reality gets closer every day.
Paygo should be the law of the land yet, another 4 billion to take care of illegals when we cannot take care of Americans today. How ridiculous is that?
The sad part:
02/13/10 11:00 AM EST
President Barack Obama on Saturday congratulated Congress for restoring a requirement that the federal government spend only what it can afford — a day after authorizing $1.9 trillion more federal debt.
Obama used his weekly radio address to report that he signed into law on Friday night the legislation commonly known on Capitol Hill as “Pay-Go,” which has been used sporadically over the past 20 years by congressional budget-writers. Obama also repeated his call for $20 billion in budget cuts, a freeze in certain government spending, and the creation of a fiscal commission.
They were just kidding.
Nothing erases the six trillion Obama added to the debt. But like other things, I feel like there is some context here. Spending, at the time Obama took over, was on an uncontrolled trajectory. He will never be forgiven for continuing what Bush started with bailouts, and the spending will never be acknowledged as primarily for the benefit of everyone BUT the poor. In real life, none of us here, myself included, would say to someone, "Well, you're 200k in debt, but you're doing great because you got your monthly spending down to only 5K more than you take in instead of 10k." The government doesn't work this way. I don't like that reality, but the other reality is that when you slash everything in sight just of the sake of slashing, you create the situation we have now, which is a stagnant, shitty economy.
DeleteI've noticed that everyone has decided to skip making on comments on the communist report from S&P that I posted talking about inequality. Obama, to some degree, has made this worse. Because he bailed out the banks, because he kept tax cuts in place for awhile longer, and because he has been able to find very meager bits of spending for jobs programs and the hated food stamps, we've avoided the full blown depression of the late 20's/30's. The S&P report makes it clear that nothing has changed on the macro view and that we will still just like this for a very long time. Still, in the midst of all this, the gap in the budget deficit has been narrowing. In the event we elect another Republican, I have no doubt we will again undo all of that.
Still, in the midst of all this, the gap in the budget deficit has been narrowing.
DeleteCould it be the tax increases in the last 4 years? Could it be the excess funds collected from the ACA taxes? Could it be a slight economic recovery?
Tell me it isn't so.
Over the long term, the government spends more than it collects in taxes, leading to an annual deficit and adding to the nation's debt. The U.S. last recorded a surplus for the year in 2001.
DeleteTuesday's report showed federal receipts grew 8% from a year earlier to $2.469 trillion in the first 10 months of the year. Spending increased 1% to $2.930 trillion.
In April, the Congressional Budget Office forecast a $492 billion deficit at the end of the fiscal year. That would be equivalent to 2.8% of gross domestic product, which would mark the smallest deficit since 2007. The deficit has averaged roughly 3.2% of GDP since 1980.
The deficit exceeded $1 trillion from 2009 through 2012. The CBO projects that after narrowing again next year the deficit will begin to expand later in the decade and again top the $1 trillion mark by 2023.
Write to Eric Morath at eric.morath@wsj.com
The debt isn't a problem until the interest rates begin to rise. Imagine 17 trillion at 4%.
DeleteThe deficit is meaningless, the debt has meaning when you start paying interest.
"Could it be a slight economic recovery?"
DeleteEconomies can grow when taxes go up?! Say it isn't so. Just ball busting there. Your point on interest rates is well taken by me. I complained for years that Greenspan had an enormous hand in all of this, and I've been in agreement with everyone else here on the right about what a mess QE is. Nothing can be done about that.
To me, the deficit is not meaningless. You can't begin to pay down debt until you take in more than you spend and then take that money and actually pay down debt. We did this for a couple years under Clinton, and then stopped when Bush became POTUS. To be fair to Bush, he gave the people what they wanted. Though we were doing just fine and were on our way to paying down a big chunk of debt, people were annoyed by the fact that there was a surplus. IMO Lou, the people of my generation and older flat out don't want to pay for the debt that was rung up in our lifetime. I know you weren't trying to pull a Cheney by saying debt isn't a problem until rates are 4%, but it is a problem right freaking now. The majority of solutions I've seen have been to basically cut eveything that doesn't directly benefit rich people. IE, privatize SS and give Wall Street a brand crowd of sheep to fleece, end food stamps, and on and on. For those that own stocks and for those especially who live on investments, the world under Obama has been exceptionally kind, but it has come at the expense of creating massive debt and a mind boggling growth in inequality. Not only has the debt encouraged massive gains to just a select few, but it has simultaneoulsy created an inflation tax on the poor that has only moderately been dampened by things like food stamps. The rich don't see the massive growth of debt as a handout for them.
The solutions currently floated are just partisan plans to end programs that either party hates. I don't blame Bush for everything congress did under him, likewise, I don't blame Obama for everything. But I do agree the time is coming when higher interest rates will be painful. It would be nice if we could be adults before that time and really start to pay down some debt. This won't happen however if the only goal we have is to see how wide we can make the inequality gap before even food stamps can't block a full collapse.
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