Tag Archives: Health Care Access

ObamaCare: It’s not Working, It’s Winning

Professional health insurance agents have a front row seat to the carnage that ObamaCare is creating as it rolls out on top of Americans.   We are the referees on the field.  Over the next year, as our small business clients receive their 2014 cancellation notices, which every single one of them will, the pain inflicted is going to be hard to watch and a constant moving target to overcome.   Nonetheless, we will fight to continue to deliver a winning result.

I’ve always thought of my “game” as another way of casually addressing my profession, a profession that I take very seriously.   I have worked very hard for over 30 years to ensure the financial health and access to health care for all of my clients.   There is an army of agents in this country who have remained very involved in health care legislation over the years to protect our clients from what is happening now.  Because of this ongoing commitment to be involved on a daily basis, we also know this law better than anyone.   No professional agent has been surprised by anything that has unfolded in the past 2 years as issues come to light.  The complete and total destruction of access to affordable health care is in process.   Continued financial health is being ripped from the hands of all of my clients.

As the dismantling continues and public outcry ensures, the administration makes minor gestures to settle the roar to a rumble.   Moves to extend coverage on non-grandfathered plans, delaying the penalties of the employer mandate and blaming the chaos on the computer system are nothing more than distractions.

I truly believe that President Obama, his administration and their followers think this is a real “game” in the true sense of the word.  Their primary goal is not to expand coverage to the masses or reduce the cost of health insurance.   If it were, they would hang their heads in shame, not to be seen in public for years.     Their goal is to win.  They are out banging their chests in victory because they are winning the game.

Where there are winners, there are losers.   Insurance agents see the effect of the bullying that has been perpetrated on the losing public every day.  The scene plays out over and over with every phone call and every visit.   An insured comes in because their plan has been cancelled and they need to replace it with an “ObamaCare approved metallic plan”.   In most instances, the new market presents a plan of options that include twice the premium, twice the out-of-pocket risk and an overall reduction in benefits.

Consumers who have long become accustomed to dozens of choices in health care options, are shocked to find only 4 basic choices in this new world.   It is truly heartbreaking as I watch the client walk in and go through the phases of denial.   Their shock and anger are quickly turned into acceptance as I pat their hand and assure them that I am showing them all of their choices.  There is no longer anywhere to go for reasonable options.  At least we are around to show them the entire market.  (Exchanges only show you exchange plans)

When I get to the point in the conversation where I have to tell them that more than half of the top rated physician and hospital groups are no longer included within their plan, they shrug their shoulders in complete and total surrender.   They complete the application process and move on with their day.    The problems they are about to face as they enter the exchange or overloaded insurer online systems is not their biggest problem.   The technical problems are just convenient cover for the myriad of real problems.   Their real problem is that they are living in a country that is retreating and accepting the beating that has been unleashed on them.  This isn’t only redistribution of wealth; it’s retaliation on the successful middle class.

As I move around my business circles, I am amazed by how many people think this is all just going to go away and be fixed.   American’s who think people are going to stand up and fight this national plague need to think again.   No one is fighting this!  Every single person that goes through process this gives up.  They have no choice but to accept the increases in premium, thousands of dollars more in out-of-pockets costs and in most of my cases, a complete loss of access to the care that they and their children deserve.

If you are in the “sit back and do nothing while it implodes” crowd, you are in the same surrender mode.   Have you considered what an implosion looks like?   You need only to understand that many of the winners will lose their jobs, face a reduction in hours or be forced in and out of MediCaid as the Exchanges find their sweet spot.   Thousands will find themselves on a medical access seesaw.   At that point, we will all be on the losing team.

Has anyone stopped to consider what the effect of this complete surrender to a government imposed hardship is going to do to the working class people in this country?   My clients are the majority.  These are not people asking for handouts from the Exchanges or MediCaid.   These are the people who make those programs solvent.   They are too busy working to fight.

This President and his followers are nothing more than schoolyard bullies, dancing in the end-zone as the rest cower en masse.   They got their win and they don’t care about the pain they are inflicting on the multitudes or the type of transformation of America they are causing.     

Mr. President.  Congratulations on your win.  What are you going to do next?

Bending the Cost Curve: Improving Medication Adherence

It may not seem obvious to most, but NOT taking your medication contributes to one of the largest reasons for increased national health care costs.  According to the a 2011 NEHI study, improving patient medication adherence could reduce wasteful spending by $290 Billion.  Of the 187 million Americans taking one or more prescriptions, it is estimated one-half do not take medications as prescribed.

Not taking medication costs over $100 billion in excess hospitalizations.   The most expensive offenders are diabetics and hypertension patients.  A non adherent diabetic spends more than twice as much one that properly manages their disease as instructed.  They also run a 30 percent chance of hospitalization each year compared to 13 percent by their adherent counterpart.

Poor adherence to medication occurs for many reasons.  High out of pockets costs, lack of care coordination and follow up as well as co-morbidities such as severe or persistent mental illness.   Often medications are not taken as prescribed simply due to lifestyle, culture and belief systems.

Solutions revolve around improving care coordination and enhancing patient engagement and education.  With the rapid increase and improvement in the area of HIT (Health Information Technology), managed care programs have really jumped on the bandwagon agressively by reaching out to high risk members to ensure medication adherence and education.   At a very minimum, we see all insurers offering assistance through programs for patients that want to participate responsibly toward better health.

In the end, each individual must become responsible for themself in this area of medication adherence.   We must spread the word that not doing so will continue to escalate the rise in health care costs.

Bending the Cost Curve: ER Overuse

NEHI (New England health Institute) recently published a paper outlining the results of their research that not only points out $700 Billion in needless health care spending annually, but offer solutions to health care providers and the consuming public on how to reverse this trend.

$38 billion is attributed to overuse of ER departments.   This translates to 56 percent of all emergency room visits. This particular assertion hit home for me as a long time insurance agent because it has always been our number one customer service call.  Insureds looking for payment on $1,500 to $5,000 non emergency services rendered by the emergency room. Of course the study isn’t concerned with the bill getting paid but about eliminating the charge completely from the annual national health care expenditure.

The problem is that patients don’t understand the cost.  Even if you are simply using the ER for an ear infection, you are incurring an average charge that is $580 over the cost of the a normal office visit.   The study found that use of the ER for non emergency purposes spreads across all age groups regardless of the level or type of insurance. 

Patients admit they use the emergency room because it is a place to receive immediate care, instant access to all diagnostic tests and feedback before you leave the building.  This instant reassurance isn’t something you can get in one office visit.  The solution hovers around addressed those points.  That is why we see Urgent Care offices popping up in close vicinity to ERs.   Even markets and pharmacies are opening walk in clinics.  Insurance companies offering 24 hour nurse lines are standard but perhaps not used enough.   Even Doctors On Call, allowing phone access to a doctor 24 hours a day has become a popular part of our product line.  The alternatives are there, educatingthe public on the problem, it’s costs, and the solutions are the task everyone can work on now.

Emergency rooms are expensive to setup and and maintain.  They are full of expensive equipment and personel and done so based on expanding demand for services.  Once you hit the emergency room, defensive medicine is going to push those expensive assets into use.  Until the public gets involved and recognizes how society as a whole is pushing up the health care bill, prices aren’t going down anytime soon.