#FullRepeal Daily Digest

NPR: Patients With Low-Cost Insurance Struggle To Find Specialists

• Understandably, a lot of [Dr. Sawhney's] patients picked lower-cost plans, she says, "and we're running into problems with coverage in the same way we were when they were uninsured."
• One of her patients is a Chinese immigrant to Houston who purchased a Blue Cross Blue Shield HMO silver plan. Soon after, he was diagnosed with stomach cancer. Sawhney found an oncologist to coordinate his treatment, but she and the oncologist ran into trouble trying to schedule chemotherapy and radiation. "The process just isn't as easy as we thought it would be," she says.
• That's because the two largest hospital chains in Houston, Houston Methodist and Memorial Hermann, are not in that plan's network. Neither is Houston's premier cancer hospital, MD Anderson Cancer Center.
• ...Zhang says he cannot refer patients with these narrow plans to the specialists he thinks are best, and that's a problem if the cancer is particularly complicated. "You have limited options. So you're like a second-class citizen, you know. That's my feeling, you have this insurance and you cannot see certain doctors," he says.
• "The (insurance) agent said that a lot of doctors will accept that insurance — but when I got sick I found out nobody wants that kind of insurance."
• The biggest irony, she added, is that even Harris Health, the county-wide public hospital system in Houston, doesn't take all the new marketplace plans. Yet Sawhney can still send uninsured patients there for cancer treatment. As people learn that some doors are closed, she worries people will decide insurance isn't worth the money.
• [RELATED] Washington Post: New challenge for Obamacare: Enrollees who don't understand their insurance plans
  • Nonprofit organizations across the country are being swamped by consumers with questions. Many are low-income, have never had insurance and have little knowledge of the health-care system. The rampant confusion poses a potential hurdle for the success of the health law: If many Americans don’t understand how health insurance works, that could hurt their ability to use their benefits — or to keep their coverage altogether.
  • “So what you’ve got is an insurance industry that did not do a good job in gearing up for a population that has never had health insurance before, an Obama administration that did a horrible job on the back end, resulting in a flood of calls to insurer call centers, and a population that is low-income and is not health-insurance literate. Put those things in a bag and you’ve got a problem,” said Robert Laszewski, a health industry consultant who has been critical of the Affordable Care Act.
  • Linda Cole, a restaurant cook in Shirlington, Va., has been confused about her plan since she signed up in January. She has not been able to find a primary-care doctor; she sent a note with her premium payment asking her insurer “if I could get a booklet sent to my house.” She did not hear back. She returned for help to the Arlington Free Clinic, where she used to be a client.

The Telegraph: The NHS – Britain's national religion  - doesn't have a prayer Britain can't afford the ever-expanding NHS – it must charge for some services or cap the insatiable demands made on it by an ageing  population

• To see the awful truth, look no further than the Office for Budget Responsibility’s annual “Fiscal Sustainability Report”, published yesterday. On present trends, the OBR concludes, healthcare spending will rise from 6.4 per cent of GDP in 2018/19 to 8.5 per cent 45 years into the future. This might not seem so bad, given the demographic pressures. Unfortunately, the OBR’s estimate relies on some fairly heroic assumptions about the scope for productivity improvement [e.g. the estimate assumes an unrealistic productivity gain trend; doesn't take into account the growing demand]
• A possibly better approach [than tax increases and increased NHS spending] is the one suggested in a survey of NHS professionals by the Nuffield Trust. Almost half of them predicted that, such were the strains, that people would be forced to pay for some services within 10 years.
• This is part-privatisation, and no doubt where we will end up. Throwing ever greater sums of public money at healthcare is not, and cannot be, the way forward even if the political consensus for it could be found. Demand is a bottomless pit. If provision is seen to be effectively free at the point of delivery, it can never be sated.

CATO: Is Obamacare Working?

• It is still unclear, though, how much of the credit for the drop in the number of uninsured should go to Obamacare. Unemployment has declined from 7.2 percent to 6.1 percent over the same period, meaning that at least some previously unemployed Americans have found work. Since health insurance remains largely tied to employment in this country, job gains should naturally translate into insurance gains. Neither survey [The Commonwealth Foundation estimated that the uninsured rate dropped from 20 percent to 15 percent and Gallup found a decline from 18 percent to 13.4 percent] breaks this down.
• In hindsight, we should have realized that if you are essentially giving something away — 91 percent of Obamacare enrollees either are receiving subsidies or are on Medicaid — people will take it. But before we go too far with the mea culpas, it is important to point out that we remain far short of universal coverage. Even with this “success,” the uninsured rate will still be roughly where it was in 2001.
• Nor do the new numbers tell us anything about the quality of coverage that people are receiving. Gallup, for example, did not differentiate between private insurance and Medicaid. Using Commonwealth Fund data on proportions of enrollees who were previously uninsured and official government enrollment figures, it appears that roughly 49 percent of the newly insured are being covered through Medicaid. We also know that the decline in uninsured residents has been three times as large in Medicaid-expansion states as in states that rejected Medicaid expansion.
• First, while the administration has still not released data about precisely who has signed up for insurance on the Obamacare exchanges, independent surveys show that not enough enrollees are healthy young men, who are needed to balance the older, sicker, and disproportionately female population that has signed up.
• Second, Obamacare’s costs continue to escalate. While the Congressional Budget Office has effectively given up on estimating the program’s long-term costs — at least until the Obama administration stops unilaterally rewriting the Affordable Care Act — the program’s overall costs continue to rise.
• Third, 2015 insurance premiums look as if they will show substantial increases. Most insurers are just beginning to submit rate-hike requests to their state administrators, but so far we are generally seeing increases in the range of 10 to 20 percent, or higher. For example, just this week, Louisiana insurers requested premium increases ranging from 15.5 percent to 24 percent.
• Fourth, even Obamacare supporters acknowledge that many previously insured Americans have been forced to change policies. Many of the new policies are more expensive and, more important, have much smaller networks of providers.