It’s ObamaCare Insurance That’s ‘Substandard’
“Substandard” and “cut- rate” is what President Obama calls the health plans that at least 3.75 million Americans have lost, even though they wanted to keep them.
Even as he apologizes for his repeated false promises that “if you like your plan, you can keep your plan,” Obama is now telling Americans another whopper — claiming that the insurance they can get on ObamaCare exchanges is a better deal.
Sorry, the facts tell a different story. Coverage via the exchanges is looking a lot like Medicaid, despite the fancy bronze/silver/gold/platinum labels.
The vast majority of exchange plans won’t allow access to many doctors and hospitals you prefer. Many plans exclude the top-drawer academic hospitals, like Cedars-Sinai in LA, the Mayo Clinic in Minnesota and New York Presbyterian here in the city.
Instead, the law requires exchange plans to cover care at “essential community providers . . . that serve predominantly low-income, medically underserved individuals” [Sec. 1311c(1)C]. That means clinics, public hospitals and hospitals largely serving the Medicaid community.
The law’s authors reasoned that exchange-plan customers should be able to shift back and forth between their plans and Medicaid, as their earnings fluctuate, without changing doctors and hospitals. That’s good for those folks — but bad news for consumers who had access to esteemed hospitals and doctors under their old plans and then got pushed into the exchanges.
Medicaid level care is, to use the president’s word, substandard. For example, a review of the experiences of nearly 900,000 patients undergoing eight different surgical procedures found that Medicaid patients were 50 percent more likely to die in the hospital after surgery than patients with private coverage. This review, by researchers at the University of Virginia, is one of several studies showing that Medicaid patients get worse care than patients with private insurance.
But many of the plans offered on the exchanges are Medicaid with a private label slapped on. The McKinsey Center for US Health System Reform reports that Medicaid insurers are playing a large role in the exchanges.
Just as many doctors refuse to accept Medicaid, they are also refusing to accept exchange insurance. In California, a Blue Cross plan on the exchange covers 47 percent fewer doctors than regular Blue Cross subscribers in California get now. In New York, only a quarter of physicians have decided to take exchange insurance, because the payments are so low.
Why so low? Because insurers know the low-cost plan will be king in nearly every exchange. All the plans offer the same, legally-mandated “essential benefits package.” Customers have no other way to compare than on price.
Yes, the law promised that exchanges would list each plan’s quality rating and disclose which hospitals and doctors it covers. [Sec. 1311d(4)D and Sec. 1311c(1)B]. But so far, the info isn’t listed — because, one suspects, ObamaCare administrators don’t want us to see the truth.
Another problem with exchange coverage: Under ObamaCare’s Section 1311, the health secretary has blanket authority to control how doctors and hospitals treat patients. So Kathleen Sebelius, the woman who says she should be held accountable for the Web site disaster, can set the rules for when your cardiologist uses a stent and when your ob/gyn does a Caesarean. That’s supposedly for “quality,” but to ObamaCare’s authors it really means cost.
This means that, if you enroll in an exchange plan, your care will be standardized by the federal government with an eye to reducing what you consume and how much it costs. Your doctor may have to choose between doing what’s right for you and avoiding a penalty. (Exchange plans can pay only those doctors who obey whatever regulations the secretary imposes.)
This is what the president claims is a “better deal” for the people he’s pushing out of their current health plans: Losing your doctor, shopping blind for a health plan, settling for Medicaid-level care and government controls, all for a premium 41 percent higher than before and with a deductible that’s doubled.
Sounds substandard to me.