Obamacare’s 19 New Californias

If you try to understand Obamacare, you’re guaranteed to get a nation-sized headache. (I tried, and I did.) Federal and state government officials have a mess on their hands, and nearly every statement you can make about the law comes with 17 qualifications. But here’s some health advice for Californians: take two aspirin—and stop thinking of Obamacare as a national story.

The Affordable Care Act created a lot of new health insurance marketplaces, and the secret is that they’re not really federal or state entities. They’re regional.

For the purposes of selling insurance to individuals and small groups, California’s government divided the state into 19 regions, each with different insurance prices and subsidies based on demographic and economic data. If you’ve heard about the “state insurance exchange” in the media, it doesn’t refer to one market. In California, it refers to 19 different regional markets. Obamacare’s impact will differ across Californian communities, often in unpredictable ways. Unless you’re a policy buff, you’re probably best off if you stick to understanding your own market.

The reason for the 19 regions is that the ACA prohibited insurers from using your health as a basis for denying coverage or determining insurance rates. That left insurers with two ways to set your insurance prices—your age and your place of residence. Healthcare costs differ from region to region—both because of differences among hospitals and other health providers and because of health differences among populations. Therefore, insurance premiums will now differ along regional lines.

Why 19 regions? Under Obamacare, every state is required to divide its insurance markets into a minimum number of regions—essentially, one per Metropolitan Statistical Area, or media market. In some states, however, insurers have lobbied for even more regions than required by law, and the federal government has generally signed off on these changes. In California, lawmakers considered plans for as few as six regions before eventually expanding the number to 19 regions. (We’re not the only state with more regions than usual; Texas, determined to be bigger in everything, has 26, and South Carolina, determined to be crazier in everything, has 46, one for each county.)

Via: California Political Review

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Doctors boycotting California's Obamacare exchange

An estimated seven out of every 10 physicians in deep-blue California are rebelling against the state's Obamacare health insurance exchange and won't participate, the head of the state's largest medical association said.

“It doesn't surprise me that there's a high rate of non-participation,” said Dr. Richard Thorp, president of the California Medical Association.

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Independent insurance brokers who work with both insurance companies and doctor networks estimate that about 70 percent of California's 104,000 licensed doctors are boycotting the exchange.

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“We need some recognition that we’re doing a service to the community. But we can’t do it for free. And we can’t do it at a loss. No other business would do that,” he said. Thorp has been a primary care doctor for 38 years in a small town 90 miles north of Sacramento. The CMA represents 38,000 of the roughly 104,000 doctors in California.

California offers one of the lowest government reimbursement rates in the country -- 30 percent lower than federal Medicare payments. And reimbursement rates for some procedures are even lower.

In other states, Medicare pays doctors $76 for return-office visits. But in California, Medicare’s reimbursement is $24, according to Dr. Theodore M. Mazer, a San Diego ear, nose and throat doctor.

In other states, doctors receive between $500 to $700 to perform a tonsillectomy. In California, they get $160, Mazer added.

Only in September did insurance companies disclose that their rates would be pegged to California’s Medicaid plan, called Medi-Cal. That's driven many doctors to just say no.

They're also pointing out that Covered California's website lists many doctors as participants when they aren't.

Via: Washington Examiner

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Is This Paul Krugman’s California?

What is it about California that inspires such insistently cheerful happy talk from New York Times columnist/Princeton professor Paul Krugman?

This spring he claimed that California was in the middle of a roaring comeback. Has he ever been here? Read coverage of our Legislature? Read the Census Bureau’s declaration that the Golden State has the worst effective poverty rate of any state?

His blathering led to a harshly funny response from a professor who actually does know California because he lives here, Victor Davis Hanson, writing for National Review Online.

Now Krugman is at it again, suggesting Covered California is doing so well that it’s a confirmation of the glory that is Obamacare. And once again his blathering has inspired lots of sharp responses, this time including from other East Coast folks.

D.C.-based health-policy blogger Robert Laszewski, for example, notes that the Golden State is on track to have far fewer people covered by insurance than it did before Covered California began accepting applications.

“So, let’s summarize:

“–California has 5.3 million uninsured eligible to buy in the exchange with half estimated to be subsidy eligible.

“–California is cancelling another 1 million people of which Covered California has estimated hundreds of thousands will qualify for a subsidy they can only get if they go to Covered California. At least 80% need to act by December 23 to avoid losing their coverage.

“–The state is spending $250 million in federal money to get people signed up––dramatically more than any other state.

“–The Covered California goal is to sign-up 500,000 to 700,000 subsidy eligible people by March 31.

“Why should we be so impressed with Covered California because they have signed-up 80,000 people so far? Or, even that their goal is to sign-up 500,000 to 700,000 of the state’s 6.3 million people––half subsidy eligible––who are uninsured or having their insurance canceled?”

Via: California Political Review

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Top California hospitals don’t like Obamacare either

President Obama has been claiming that people can keep their favorite doctors under the Affordable Care Act. But anyone who wants a premier hospital in California better do some homework before signing up.

A survey of the state’s top hospitals has revealed that most contract with only one or two insurance companies under Obamacare, even though the Covered California exchange has 11 companies to choose from. And one hospital, Loma Linda University Medical Center, has refused to participate altogether and has no contracts.

Obamacare is driven by low-cost policies. So the reimbursement rate hospitals will receive from insurance companies just isn’t worth it to them. The end result is that the blue ribbon hospitals won’t have a large presence on the exchange, Watchdog.org has learned.

“The more we are learn about the insurance plans on Covered California, the more it becomes clear that the big name hospitals are sitting on the sidelines — some by choice, other by design of the insurers,” said Josh Archambault, senior fellow for the Foundation for Government Accountability and a frequent Obamacare critic. “Consumers get the short end of the stick.”

Watchdog.org looked at the top 15 California hospitals listed in U.S. News & World Report’s 2013-2014 annual report and contacted each one to determine their Obamacare insurance contracts.

See the full list here

Via: Watchdog.org

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Stores selling Obamacare policies popping up across California

As shoppers hunt for holiday bargains this season, they may find something unusual for sale at the mall: Obamacare.

With enrollment deadlines looming, California officials, insurance companies and agents are staking out retail space to sign up thousands of people as part of the Affordable Care Act. These sales tactics reflect how dramatically the healthcare law is changing the insurance industry.

Until recently, most health insurance companies and agents didn't put much time into selling policies to individuals and focused more on catering to employers and large groups in the workplace. But the health insurance mandate and billions of dollars in federal premium subsidies have made individual policies a far more attractive market.

California's health insurance exchange and other government-run marketplaces are rushing to sign up people by Dec. 23, the deadline to have coverage in effect Jan. 1. Open enrollment lasts until March 31.

A state lawmaker and union organizers last week opened a mall store in a predominantly African American area of Los Angeles. In Orange County, insurance agents are signing up dozens of people each week at Laguna Hills Mall, and healthcare giant Kaiser Permanente has rented five retail locations in Northern California to sell exchange policies.

The Covered California exchange has posted solid enrollment since opening Oct. 1, primarily through its website and call centers. It has signed up nearly 80,000 people in private health plans through Nov. 19 and an additional 135,000 people have applied for Medi-Cal, the state's Medicaid program for the poor.

Via: LA Times

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CALIFORNIA'S 'NOVEMBER SURGE' NOT ENOUGH TO OVERCOME THE OCTOBER PURGE

Health care wonks are crowing about a "November surge" in enrollment. Will the November surge will be able to make up for the October purge, i.e. the millions who were dropped from existing plans because of Obamacare's new minimum standards for coverage? In California, there is reason to think it may not.

In a piece posted at Wonkblog Friday, author Sarah Kliff introduced the term  "November surge" into the discussion of enrollment figures. According to Kliff, the uptick in enrollment, especially in California, is reason for optimism:

Some state-based marketplaces had a pretty smooth launch, and are seeing the pace of enrollment speed up daily. California has lead [led] the bunch; the state's enrollments have grown steadily in November and now account for nearly a full third of all health law sign-ups. The state has had its strongest two weeks of enrollment this month.

The enrollment surge in California, and the idea that it was part of a broader pattern, was first reported by LA Times health writer Noam Levey a week ago. Levey's piece was widely quoted, including by Sarah Kliff, but his claims did not stand up to much scrutiny. For instance, Levey claimed that Kentucky was "outpacing" its enrollment estimates. A spokesperson for the state says no such estimates exist.

Both Levey and Kliff fail to ask the most important question. How soon will current enrollment trends balance out the number of people who have been dropped from their insurance as a result of Obamacare grandfathering regulations? In other words, can a November surge make up for the October purge?

Via: Breitbart

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CALIFORNIA DEMS NIX OBAMACARE 'FIX'

The state of California has rejected President Barack Obama's proposed "fix" for individuals whose insurance policies are being canceled this year as a result of the law. 

Last week, the president proposed that insurance companies allow those policies to continue, in an effort to reduce the political damage after he broke his oft-repeated promise that people could keep their plans. 

However, California's regulators refused the change.

California's decision is critical--not only because it has already signed up more customers for Obamacare than the federal government as a whole, but also because it is the flagship for the policy's success. 

It would have been impossible, in any case, for California to implement Obama's "fix," because several insurance companies have withdrawn from the state rather than participating in the restrictive "Covered California" exchange.

Via: Breitbart

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Obamacare: A Fiasco by the Numbers

Three months ago, California had six million people with no health insurance; now thanks to Obamacare’s forced cancellations in the individual market, that number has risen to well over seven million (Associated Press says 7,471,000). Yet despite this, the first six weeks of sign-ups on the state’s insurance exchange are pretty paltry – only 59,000 enrolled in new policies out of the 7.4 million uninsured Californians.  This amounts to less than one percent of the uninsured.

Covered California naturally is trumpeting this number.   “A very proud day for Covered California,” says state director Peter Lee.  But if sign-ups remain at this pace, only 360,000 Californians will have signed up by the end of the enrollment period March 31, 2014.  And even if that number is doubled, it comes nowhere close to the 1.1 million California individual health care policyholders who have been told their health care is being cancelled as of December 31, 2013.

The Covered California sign-ups for just the month of October, 30,830, is lower than the number of people losing their insurance who called the office of Sen. Dianne Feinstein to complain, which Feinstein said is 30,842.  It would appear that people are more interested in complaining to their elected officials about losing their old plan than surfing Covered California’s webpage to find a new plan.

And now President Obama and congressional Democrats are in full retreat before the outraged hoards who have lost coverage and have let the Democrats know how mad there are.  So now the President wants folks to be able to keep their current plans for at least another year, and some Democrats want even longer.

But the Obama “fix” is a dagger into the heart of Covered California, because their whole market scheme depends on the 1.1 million who lost their plans signing up for the new plans in the exchange.  A frightened politician named Dave Jones, who is California’s Insurance Commissioner, wants the plans extended ala Obama to save his hide and that of other pols up for election in 2014, but to do so plays havoc with the Covered California insurance market.

Via: California Political Review

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A Conservative’s Experience Enrolling in Obamacare

With all the hoopla surrounding Obamacare, I decided to call and sign up for its implementation in our state, Covered California. I dialed 1-800-300-1506. Jose answered.

He was polite but rattled when I told him I’d rather talk to him, a human, than trust my most personal information to a problematic state government computer. He attempted several times to get me to sign up online, but I held firm. I did not want to create an online account.

Jose asked for my salary information, my age, and my husband’s information. He asked me for information from our tax returns, and if I was a citizen. Rather than provide my actual income, I used $40,000 as my annual salary, to see if I would qualify for a subsidized plan.

After running a few calculations, Jose suggested I dump my husband, who gets Medicare, from the plan to lower my income, and possibly qualify for government subsidies. “Your annual income is just below the boundary — you may qualify for assistance,”

Then the awkward sales pitch began.

Silver, blue and gold

There are four levels of health plans available, from cheapest to most expensive: Bronze, Silver, Gold and Platinum.

While Jose was explaining the metallurgy of the health plans, the 1982 Bad Company song, “Silver, Blue and Gold,”  popped into my head:

In the beginning
I believed every word that you said
Now that you’re gone
My world is in shreds

Jose skipped right over the Bronze- and Silver-level plans and tried hard to sell me on a Gold-level health plan. He said the Bronze-level health plan had the highest monthly premiums, but was reluctant to tell me what they were.

Via: California Political Review

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