Train Wreck: O-Care Premiums To Skyrocket | Some Of Best Cancer Hospitals Off-Limits| Doctors Stuck With Unpaid Bills | Where Do I Find A Doctor

By William Warren

 Another day, another string of stories detailing the failures and problems of Obamacare.

The Hill reports, “Health industry officials say ObamaCare-related premiums will double in some parts of the country, countering claims recently made by the administration. The expected rate hikes will be announced in the coming months amid an intense election year, when control of the Senate is up for grabs. The sticker shock would likely bolster the GOP’s prospects in November and hamper ObamaCare insurance enrollment efforts in 2015. The industry complaints come less than a week after Health and Human Services (HHS) Secretary Kathleen Sebelius sought to downplay concerns about rising premiums in the healthcare sector. She told lawmakers rates would increase in 2015 but grow more slowly than in the past. ‘The increases are far less significant than what they were prior to the Affordable Care Act,’ the secretary said in testimony before the House Ways and Means Committee. Her comment baffled insurance officials, who said it runs counter to the industry’s consensus about next year. ‘It’s pretty shortsighted because I think everybody knows that the way the exchange has rolled out … is going to lead to higher costs,’ said one senior insurance executive who requested anonymity. The insurance official, who hails from a populous swing state, said his company expects to triple its rates next year on the ObamaCare exchange.”

The Hill points out, “[I]nsurance officials are quick to emphasize that any spikes would be a consequence of delays and changes in ObamaCare’s rollout. They point out that the administration, after a massive public outcry, eased their policies to allow people to keep their old health plans. That kept some healthy people in place, instead of making them jump into the new exchanges. Federal health officials have also limited the amount of money the government can spend to help insurers cover the cost of new, sick patients. Perhaps most important, insurers have been disappointed that young people only make up about one-quarter of the enrollees in plans through the insurance exchanges, according to public figures that were released earlier this year. . . . These factors will have the unintended consequence of raising rates, sources said. ‘We’re exasperated,’ said the senior insurance official. ‘All of these major delays on very significant portions of the law are going to change what it’s going to cost.’ ‘My gut tells me that, for some people, these increases will be significant,’ said Bill Hoagland, a former executive at Cigna and current senior vice president at the Bipartisan Policy Center. Hoagland said Sebelius was seeking to ‘soften up the American public’ to the likelihood that premiums will rise, despite promises to the contrary. Republicans frequently highlight President Obama’s promise on the campaign trail to enact a healthcare law that would ‘cut the cost of a typical family’s premium by up to $2,500 a year.’ ‘They’re going to have to backpedal on that,’ said Hoagland, who called Sebelius’s comment a ‘pre-emptive strike.’ ‘This was her way of getting out in front of it,’ he added. . . . Either way, there will be a slew of bad headlines for the Obama administration just months before the election. ‘It’s pretty bad timing,’ said one insurance official.”

As the article mentions, President Obama, and other Democrats, said time and again about Obamacare that “This law will lower premiums.” And he predicted that his plan would “cut the cost of a typical family's premiums by up to $2500 a year.”

Meanwhile, the law continues to cause chaos throughout the health care industry. Kaiser Health News reports, “Doctors groups fear their members won’t get paid because of an unusual 90-day grace period for government-subsidized health plans and are urging physicians to check patients' insurance status before every visit. ‘This puts the physician and their patients in a very difficult situation,’ said Dr. Ardis Dee Hoven, president of the American Medical Association (AMA), which advised physicians Wednesday about how to minimize their risk. ‘If a patient is being treated for a serious illness, that requires ongoing care,’ she said. ‘The physician is having to assume the financial risk for this. That’s the bottom line.’ If an enrollee in a subsidized plan falls behind on their premium payments, the Affordable Care Act requires insurers to cover their medical bills for 30 days. But for the next 60 days, insurers may ‘pend,’ or hold off paying the claims -- and ultimately, deny them if the patient doesn't catch up on his premiums. That means doctors don’t get paid for their services.  If the insurer ends up canceling the policy after 90 days, doctors can bill patients directly but may face difficulty collecting. ‘The doctors get left holding the bag on pending claims,’ said Robert Laszewski, a former insurance executive and consultant.”

The AP writes, “Cancer patients relieved that they can get insurance coverage because of the new health care law may be disappointed to learn that some the nation's best cancer hospitals are off-limits. An Associated Press survey found examples coast to coast. Seattle Cancer Care Alliance is excluded by five out of eight insurers in Washington state's insurance exchange. MD Anderson Cancer Center says it's in less than half of the plans in the Houston area. Memorial Sloan-Kettering is included by two of nine insurers in New York City and has out-of-network agreements with two more. Doctors and administrators say they're concerned. So are some state insurance regulators. In all, only four of 19 nationally recognized comprehensive cancer centers that responded to AP's survey said patients have access through all the insurance companies in their state exchange. Not too long ago, insurance companies would have been vying to offer access to renowned cancer centers, said Dan Mendelson, CEO of the market research firm Avalere Health. Now the focus is on costs. ‘This is a marked deterioration of access to the premier cancer centers for people who are signing up for these plans,’ Mendelson said. Those patients may not be able get the most advanced treatment, including clinical trials of new medications. And there's another problem: It's not easy for consumers shopping online in the new insurance markets to tell whether top-level institutions are included in a plan. That takes additional digging by the people applying.”

And then CNNMoney has the story of Terri Durheim from Oklahoma and her struggles finding doctors and hospitals that will accept her new Obamacare insurance. “Terri Durheim and her family now have health insurance, thanks to Obamacare. What they don't have are local doctors and hospitals who will take it. This worries the Enid, Okla., resident since she has a teenage son with a serious heart condition. They now have to find a pediatric cardiologist in Oklahoma City, more than an hour away. And if there's an emergency ... ‘obviously we'd have to pay out of pocket and go here in town, but that defeats the purpose of insurance. I'm truly grateful we have insurance. It's reasonable and affordable, but it's not doing me a lot of good,’ said Durheim, who just had to drive 90 minutes to Stillwater, Okla., for a CAT scan for herself. ‘It's so frustrating.’ Like Durheim, many Americans who've enrolled on the Obamacare exchanges are realizing they have access to a relatively limited set of doctors and hospitals. In many areas, the largest hospitals are not participating and many doctors are not accepting the coverage. That's by design. To keep premiums down for silver and bronze plans, insurers narrowed the networks of doctors and hospitals, often excluding the priciest and most specialized providers. ‘The unavoidable truth is that health care costs are growing faster than people's income,’ said Sara Collins, a vice president for the health care coverage and access program at the Commonwealth Fund. ‘Narrow networks are a reflection of that.’ . . . Compounding the problem is that many enrollees had a tough time getting the list of providers in particular plans in the exchanges. Some had technical trouble accessing the information, while others found the lists were inaccurate or incomplete. That's what happened to Durheim, who owns a small appliance store with her husband.”

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