Tag Archives: health insurance

Obamacare Insurance Exchanges Are Corporatism Disguised as “Competition”

by Whitney Pitcher

Earlier this week, I noted how Cook County board president and Obama mentor Toni Preckwinkle secured a $100 million Obamacare waiver to implement Medicaid expansion in the county a year early and cover a gap in the county budget. The conflicts of interest in Obamacare adds yet another layer as insurance exchanges are in the process of being implemented before the 2014 deadline. The Hill Healtwatch reports:

The fast-approaching deadline gives the administration little time to scrutinize private-sector partners for conflicts of interest.

The purchase of one of these contractors, Quality Software Services, Inc. (QSSI), by UnitedHealth Group, a major healthcare conglomerate, has sparked concerns about a potentially uneven playing field.

QSSI, a Maryland-based contractor, in January won a large contract to build a federal data services hub to help run the complex federal health insurance exchange.

It will be working with several other contractors, including CGI Federal, Inc., to create the technological architecture for the exchange.

The quiet nature of the transaction, which was not disclosed to the Securities and Exchange Commission (SEC), has fueled suspicion among industry insiders that UnitedHealth Group may be gaining an advantage for its subsidiary, UnitedHealthcare.

The article aptly compares these health insurance exchanges to websites like Travelocity or Expedia where consumers can pick and choose the best deals for airline tickets or hotels. With the potential conflict of interest in the health care exchange, it would be akin to Travelocity or Expedia owning American Airlines or Marriot Hotels and thus potentially driving consumers to purchase their product based upon how that company portrays the available options.  As the article goes on to note:

If an insurance company had influence over the information technology architecture used to run the exchange, it could interpret federal standards in a way to exclude competitors or make it more difficult for them to win approval, say some insurance experts. Or it could have an inside track on knowing how to design plans that meet the standards.

The contractors working on the exchange will also have responsibility over payment calculation for risk adjustment.

This program is intended to redistribute funding from plans that attract younger and healthier participants, and thus have lower costs, to plans that attract people with more chronic diseases.

The draft statement of work for the contract shows QSSI will also work on technical requirements to deliver financial management services, such as payment calculation for risk adjustment.

The prospect that a subsidiary of UnitedHealth Group could have a role in calculating the reallocation of federal funds among rival health plans has unnerved some industry insiders.

In mid October, Senator Orrin Hatch sent a letter to DHHS Secretary Kathleen Sebelius asking for a full accounting of who received federal Obamacare contracts and what government officials signed off on those contracts. Sebelius has not responded. Hatch has also asked if Steve Larsen, a former official at HHS played a role in this contract:

Larsen left the Center for Consumer Information and Insurance Oversight, the office tasked with crafting rules for the national exchange, in July to take a job with Optum. It is not clear how long Optum was in consultation with QSSI prior to purchasing it.

Shields Britt, the spokeswoman for HHS, said Larsen would have to comply with stringent rules.

“Former HHS employees are subject to the strict ethics policies put in place at the start of this administration, which are some of the toughest ethics rules ever imposed on executive branch appointees, and those standards certainly apply here,” she said.

Optum, whom Larsen currently works for, is the subsidiary of UnitedHealth Group that bought QSSI, the company who would provide the information infrastructure for the exchanges.How’s that for a revolving door between government and industry? What are those strict “ethical” standards? Those words ring hollow from an administration whose first choice for HHS Secretary, Tom Daschle, was a “policy adviser” (newspeak for lobbyist) at the firm that lobbied for United Health.

The rhetoric behind the Obamacare insurance exchanges is one of competition and consumer choice, but the truth behind it is nothing more than continued corporatism and conflicts of interest.

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Obamacare’s Sobering Vocabulary Lesson

by Whitney Pitcher

Over the last three years, America has been embattled in a health care reform debate, ranging from the legislative debates to the townhalls and Tea Parties and later on to the actual vote and bill signage and Supreme Court decision. In reality though, we were never really discussing health care reform; we were discussing health insurance reform. The difference is huge and will become more and more evident as time progresses. More Americans may receive health insurance coverage as Obamacare is implemented, but that doesn’t mean that they will receive health care. We need to look no further than Medicaid to see the failures when government gets involved in health insurance and health care. Medicaid has been in place for nearly fifty years, but has the potential to greatly expand in states that choose to do so. However, Medicaid is also illustrative of how health care reform is a complete misnomer.

The New York Times finally highlighted the burgeoning doctors’ shortage on Sunday. Even prior to Obamacare’s passage, a doctors’ shortage was anticipated. However, the shortage of doctors more than doubles with the implementation of Obamacare. What do doctors’ shortages do? As the NYT story notes of current doctors shortages (emphasis added):

Experts describe a doctor shortage as an “invisible problem.” Patients still get care, but the process is often slow and difficult. In Riverside, it has left residents driving long distances to doctors, languishing on waiting lists, overusing emergency rooms and even forgoing care.

Yes, the New York Times would follow up a sentence that notes patients would receive care by noting that the doctors’ shortage would influence them to forego care hoping that their readers would miss their attempt at nuance. Medicaid, though, adds an additionally wrench in the physician shortage, as the NYT goes on to say:

Moreover, across the country, fewer than half of primary care clinicians were accepting new Medicaid patients as of 2008, making it hard for the poor to find care even when they are eligible for Medicaid. The expansion of Medicaid accounts for more than one-third of the overall growth in coverage in President Obama’s health care law.

If there is already of shortage of doctors and  Medicaid patients are hard pressed to find a physician that will take them as a patient, where is the reform of health care? It’s almost as if the government has offered to give the entire country their own car, but only gave everyone a set of keys. One of the main reasons that doctors aren’t accepting new Medicaid patients is due to reimbursement rates, which Obamacare is supposed to increase. However, while President Obama was attempting to offset the financial aspect of care on the backs of the taxpayers through projected reimbursement increases, he neglected to address tort reform, which would have decreased medical malpractice insurance for doctors, while only negatively affecting ambulance chasers and the Democratic politicians to whom they donate, not the taxpayers.

Since Medicaid is partial state funded, there is a state specific aspect of this too. Take Illinois for example, where in FY2012, Medicaid was underfunded by $2.1 billion dollars . Additionally, even if funding stayed flat as Governor Quinn projects, payment to providers is projected to average nearly a year’s delay by FY15. The state is already $8 billion behind on their bills overall, prompting the state comptroller to provide emergency funding to a mental health facility reliant on Medicaid funding to prevent the agency from closing its doors.  The expansion of Medicaid as Obamacare is implemented is supposed to make matters worse. Although the Supreme Court decision allows the states to decide whether or not they are going to expand Medicaid, true to form, Illinois Governor Pat Quinn has already indicated he will. With a growing doctors shortage, a limited number of doctors accepting Medicaid, and the potential for facilities to close due to delayed payment, it would be a miracle if a Medicaid patient even got into the doctor!

Let’s pretend though that a new Medicaid patient was able to get into the doctor, but they have a rare illness or are extremely sick and require a great deal of medications. Well, Illinois Medicaid has stated that they now will limit patients to 4 brand name drugs. This comes after last year, when Illinois cut availability of brand name psychiatric drugs. Fifteen other states have limits on brand name prescriptions as well. To be sure, there are a great deal of generic medications, but there are still situations where there are no generics available. Essentially, this is drug rationing.The implementation of Obamacare, which is predicted to double the number of Medicaid recipients in Illinois over the next ten years, will only exacerbate the problems already in place.

Obamacare may end up technically providing some form of “health insurance” to the majority of Americans. However, if past is prologue when it comes to government’s role in medicine, this will not be legitimate health care reform, as people who now may not have health insurance or health care may inevitably end up with health insurance, but with delayed or non-existent care and limits on what medication they may receive.Of course, this is not what was promised by President Obama. Julia may get her free birth control, but she will likely have a heck of time scheduling an appointment for a doctor to prescribe it for her. Moreover, this is being done on the backs of the American taxpayer, or in the case of Illinois, the $2.1 billion Medicaid underfunding  came on the heels of a 67% state income tax increase and a more than 40% increase in state corporate taxes. This is the kind of newspeak that has become commonplace in the Obama administration, but hopefully proponents of government intervention in medicine will learn a sobering lesson. Health care and health insurance are not synonymous.

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