We Told You So (How Obamacare Is Cleaning Up Health Care Financing)

[riqster]

Last edited Tue May 21, 2013, 04:59 PM - Edit history (1)

My crappy little blog had this story for 13 months before the New York Times reported it: http://bluntandcranky.wordpress.com/2013/05/20/we-told-you-so-how-obamacare-is-cleaning-up-health-care-financing/

Snip" Recently the New York Timed came out with a story that said pretty much the same thing as this blog said last year (nice of them to finally catch up). Short version: ObamaCare requires these medical con artists to clean up their acts and stop fleecing the rest of us, and shines a bright light into the shadows where the ripoffs have hitherto occurred. Specifically, ObamaCare requires health care providers to charge the uninsured the same as they charge the insured. That, people, is a big deal, because it makes their cost-shifting scams illegal."

[zipplewrath]

1. Everyone is insured

I'm confused. I thought everyone had to be insured. So who is it that now must be required to be charged the same as everyone else? Not much of a restriction on the insurance companies now that the law says there aren't suppose to be the unisured, except for those who can't afford either insurance, or health care. Doesn't do them much good. If they could afford the bills, they could afford the insurance.

[riqster]

2. The problem is actually a shell game that has been played by Providers for years.

They come up with artificially high prices that they know the uninsured cannot pay. When the phony bills aren't paid, the providers write off the amount as a loss: a way of cooking their books.

Insured people aren't charged those rates, because the insurers won't pay them. ObamaCare just put a stop to that little bit of fraud.

[BenzoDia]

10. Ah, thanks for that bit of info. That makes a lot of sense. nt

[zipplewrath]

11. Okay but

Seems a bit like closing the barn door after the horse is gone. Everyone is now supposed to be insured, so there is no more game to play. They closed a loophole for a class of people that aren't suppose to exist.

[BenzoDia]

12. What he's saying is that providers are taking phantom losses.

If he's correct, it's the providers exploiting a loophole not the uninsured.

edit:
Provider says the cost of treating an uninsured person is $10k, but in reality it's $1k. When the uninsured doesn't pay, the provider writes it down as a $10k loss when they should have wrote it down as a $1k loss. They're making their profits look smaller than they are.

[zipplewrath]

14. Right, but

They were taking phantom by treating the uninsured and then inflating the value of that treatment. So they've said you can't do that anymore.

But there aren't suppose to be any uninsured anymore. So there is no treatment to inflate.

It's akin to passing more stringent regulation on buggy whips.

[BenzoDia]

16. Gotcha. There will be people who don't comply with the law and still go to the hospitals.

Also, there are religious exceptions as well.

I believe that other countries (and Massachusetts) who require citizens to buy insurance don't have 100% compliance.

[riqster]

13. Not everyone is supposed to be insured now

Do some reading: the ACA is being implemented over a long period of time. http://www.healthcare.gov/law/timeline/full.html

[zipplewrath]

19. But the mandate starts in 2014

The only people who aren't going to be insured are those vastly too poor to pay anything anyway. So I'm not sure what good this loop hole closure does. The population is so small the hospitals have little incentive to over charge them. Realize that previously the uninsured/under insured population was probably 3 times what they are now predicting (we'll see if it pans out that way).

[riqster]

20. Please read the details. nt

[a kennedy]

23. Here's a little story of how this works......broke my ankle....

at a fundraiser for melanoma cancer. My sister died 2 years ago, and this fundraiser was a golf outing with silent auction items to raise money. I was walking from a wood floor to carpeting, fell, and twisted my ankle, because my shoe "stuck" on the carpeting. An accident. When I went to the doctor my ankle indeed was broken and they asked what happened I told them it was an accident, and my insurance requested the information of what happened. I refused to tell them the name and address of the golf course as I didn't want them to be required to pay my doctor and follow up therapy bills, and possibly lose this golf course for the charitable golf outing. So I am paying the $1400 medical charges myself.....these could have probably been anywhere from $4000 to $7000 if insurance was involved. My friend is in the insurance business and indicated similar situations had these amounts. I have insurance and my medical bills would have been covered if I gave them the name and address of the golf course, I didn't so I had to pay for it myself. Just shows the inflated prices they DO charge insurance companies. I'm still paying the bill off.....have $800.00 to go, I'm paying 100.00 a month.

[pnwmom]

27. Not till next year. This part has already taken affect.

And the bill also expands Medicaid and provides subsidies to make health insurance affordable to others who couldn't afford it before.

[leftstreet]

3. That makes no sense

Specifically, ObamaCare requires health care providers to charge the uninsured the same as they charge the uninsured.

[riqster]

4. D'oh! Typo

[Hoyt]

5. Most providers "charge" the same now, it is what they accept that's important.

Now if the law says something like hospitals can't hold uninsured responsible for more than the average Medicare and other insurers allow, it is a big deal.

[riqster]

6. No, providers can and do charge up to 5X the amount

Paid to insurers, so as to increase the amount they "write off".

Follow the link- it links to a NYT story that provides detail.

[Hoyt]

7. Article shows insured and uninsured get charged the same. Then,

hospital writes off the difference between their "charge" and what the insurance "allows." The poor uninsured is not covered by an insurance company contract, so the hospital doesn't have to writeoff any of the charge (although it is only fair to do so because the "charges" are BS).

[pnwmom]

28. I know someone without insurance and I saw her bill. They scared her to death

with their charges. It was only after she wrote to them and said she couldn't possibly ever pay that much that they agreed to reduce them. Someone else might have tried to pay, or got less of a reduction. It's a racket and those without insurance have been suffering the most.

[Kingofalldems]

8. That's Communism pure and simple

And Muslinism too.

[Gravitycollapse]

9. Obamacare has done absolutely nothing for me...

And the millions of others with preexisting conditions. You want to talk about being fleeced?

Check how much I spend on medication a month.

[Puzzledtraveller]

15. I'm a medicaid worker

I'm a caseworker and I do SNAP and Medicaid. We will be doing both the HBE and the application process as it applies to expanded Medicaid. I think a lot of people are still going to be without health insurance. There is still a long way to go. You would be surprised just how little we know how this is going to work.

[JoePhilly]

17. My 17 year old neice, who had cancer at 2, now gets full coverage.

Before Obamacare, no insurance company would cover her for anything more than basic kid illnesses and sports injuries.

After the cancer treatments at 2, she's had various medical problems as a result. One in particular such problem is regular kidney stones. No insurance company would cover the drugs or treatment she's needed. My sister and her husband have had to pay full cost for the treatments.

Until Obamacare. Now she's covered.

Later in life, if she has fertility issues, or other problems, including a recurrence of cancer, she's covered.

That would not have been the case before Obamacare.

[BenzoDia]

18. Mind if I ask if she was covered by in Pre-existing condition insurance pool or standard insurance?

[JoePhilly]

21. Its through their standard insurance.

My sister and her husband had standard insurance for their family, but it rarely covered anything for my niece that was more than colds, flus, and sports injuries. Her other issues, the kidney stones, bad headaches, and other things that might be related to the chemo treatment she had when she was 2 were not covered. Claims for those would be denied.

The cancer she had was a nerve cancer that is usually fatal because it almost always occurs in the brain and has almost no symptoms until its too late. In her case, the cancer was on the nerves near her pancreas. For some reason, it caused her to get high fevers for apparently no reason. After a ton of tests they found the cancer, and fortunately they caught it early enough to treat. The survival rate for this cancer is usually under 10%. She took powerful chemo and other drugs for about 4 months. And she survived. But one of the major risks of the treatment will be other medical issues later in her life.

This is the part of Obamacare that applied to her ...

http://www.healthcare.gov/law/features/rights/childrens-pre-existing-conditions/index.html

Prior to Obamacare, their insurance company would deny various treatments based on her earlier cancer.

After Obamacare was passed, they could no longer do that. They have to cover these treatments.

This part of the preexisting condition element of Obamacare, the part for children, went into effect right away. That same protection will ultimately roll out to everyone.

[Gravitycollapse]

24. The law was passed how many years ago? Almost 4.

And preexisting conditions for adults still aren't covered. They won't be until January.

Do you realize how long a wait that is? How much money we've lost? How many times I've simply not gone to see a doctor because the cost was too high?

The provisions under Obamacare left it so that the insurance companies could hold us upside-down and shake the last bit of change out of our pockets.

[JoePhilly]

25. Ummm ... I guess the wait could have been longer ... right?

I mean, the law could have not passed at all, and instead of a 4 year wait, it could be much longer, or even never happen.

You asked if I know how long a wait 4 years is? The answer to that question should be obvious to you.

My niece was without coverage for 10+ years. I can tell you that the old system cost my sister a small fortune from when my niece was 2 until this law passed when she was about 12 or 13.

Again, that's a 10+ year wait for her. And without the law, she'd still be waiting.

btw ... the insurance companies were already holding you (and my niece) upside down long BEFORE Obamacare was ever proposed ... is that not correct?

Would it be better if all of it went into effect from the start? Absolutely.

Did Obamacare make your situation worse? No.

[Gravitycollapse]

26. So because I'm no worse off, that means Obamacare was a success...

What happened with your niece is great and all. And I'm very happy for you guys.

But that is cold comfort for the fact that myself, and millions of Americans like me, have zero insurance and have to pay absurd amounts of money out of pocket for medical care.

[JoePhilly]

30. It has been a success for many but not yet for all.

You seem to be angry SPECIFICALLY about Obamacare.

If we were to REMOVE Obamacare completely tomorrow, your situation would be exactly the same as it was before Obamacare. Which means Obamacare is not the problem.

The only effect Obamacare has on you is that its shortening your wait for coverage. A wait that could have been indefinite otherwise.

The real problem is a Republican ideology, an ideology that still holds too much sway in our government, that would just as soon have you and my niece wait forever, or until death, which ever comes first.

[Gravitycollapse]

31. You can't blame every failure on the Republicans. Obama had the nation behind him...

He had the capacity to put into place a single payer system. Instead, he gave us this watered down garbage with clauses placing giant portions of the new law on hold for almost half a decade.

No, I'm not thankful that it could be worse.

[BenzoDia]

29. Thanks for sharing. That's wonderful!

I had forgotten that children with preexisting conditions were covered earlier than adults.

[riqster]

22. More links for those who doubt:

http://www.tampabay.com/opinion/editorials/editorial-hospital-pricing-hurts-uninsured-most/2120320

http://www.bloomberg.com/news/2013-03-11/uninsured-americans-get-hit-with-biggest-hospital-bills.html

http://www.jhsph.edu/news/news-releases/2007/anderson-hospital-charges.html

Note the progression over time. In 2007, there was an acknowledgement, but no action. Earlier this year, much the same. Now, the rule is taking effect. That's progress, peeps.