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MA and cost controls

In 2012 this bill, An Act Improving the Quality of Health Care and Reducing Costs Through Increased Transparency, Efficiency and Innovation. was passed as the next step in reform and addresses cost control measures that are not part of the national conversation.

Healthblawg offers a synopsis:

1.    The health care cost growth rate may not exceed growth of the “gross state product” (GSP) for five years, and must be between the GSP and .5% below the GSP for the next five.

2.    Certification programs for Patient Centered Medical Homes andAccountable Care Organizations.

3.    Transparency and accountability for cost and quality.

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What Glenn Kessler–and I–Missed Earlier In Emilie Lamb’s Claim: That She SAYS Obamacare Caused Her Hospital and Doctors to Stop Gratuitously Forgiving Her Medical Expenses Above $1,000. That’s Palpably False. [UPDATED.]

“I was diagnosed with lupus when I was 27. Lupus is an autoimmune disorder. It’s dramatically affected my life. I voted for Barack Obama for president. I thought that Obamacare was going to be a good thing. Instead of helping me, Obamacare has made my life almost impossible. Barack Obama told us we could keep our health insurance if we liked it. And we can’t. I got a letter in the mail saying that my health insurance was over, that it was gone.  It was canceled because of Obamacare. My premiums went from $52 a month to $373 a month. I’m having to work a second job to pay for Obamacare. For somebody with lupus, that’s not an easy thing. If I can’t afford to continue to pay for Obamacare, I don’t get my medicine; I don’t get to see my doctors. I am very disappointed in Barack Obama as a president. He made promises he didn’t keep. And that’s disheartening.”

–Tennessee resident Emilie Lamb, 40, in an ad sponsored by Americans for Prosperity

I posted yesterday about the odd claims in this ad and about Glenn Kessler’s exchange with her in which she told him exactly WHY she was so happy with her old policy, which, she indicated, had a $25,000 cap on annual benefits, and no limit on out-of-pocket costs, and that it would only cover generic medications. The reason: That her hospital, Vanderbilt Medical Center in Nashville, and her Vanderbilt-affiliated specialists, were forgiving her payments, including for intravenous medications provided multiple times weekly, above $1,000 annually.

Kessler said she told him that in 2007, before she was diagnosed with lupus, she “fell off a horse, requiring seven surgeries at Vanderbilt Medical Center.”  And that one surgical bill was for $125,000, but that “after negotiations with CoverTN, the hospital agreed to reduce the charges to below $25,000. In the end she barely paid anything in hospital costs after her accident.”  She said, “Really after that, I was not worried about something catastrophic”–something that would exceed the $25,000 cap.

Kessler continued:

To put her [lupus] expenses in context, the American College of Rheumatology says that average cost per patient with lupus is between $14,000 and $28,000, though patients with one form of lupus have significantly higher costs – ranging from $29,000 to $63,000.

And then he provided more details from his communication with Lamb:

Once Lamb was required to go on Obamacare, she discovered she qualified for a $15-a-month subsidy, which could be applied to nearly 40 different options. She chose one of the more expensive options—a Platinum plan – because it limited out of pocket expenses to $1,500, as her doctor fees and blood tests would be higher under the Obamacare plans. She also considered a plan with a lower premium, but it would have meant higher out of pocket expenses. “Instead of paying $6,000 a year, I would have been paying $10,000 a year” with the plan with a lower premium, she said.

I titled my original post: Emilie Lamb was subsidized by her doctor’s largesse and by federal taxpayers and full-coverage-insurance policyholders.  She still will be.  She should acknowledge that, publicly. But today I reread Kessler’s post after I reread my own, and I realized that her claim is this: that pre-Obamacare, she had been subsidized by her doctors’ and her hospital’s largesse, but that because of Obamacare her doctors and her hospital were now requiring her to pay her full out-of-pocket costs–all her medical costs that are not covered by her new insurance plan.

The chance that this true is zero.  Its sheer absurdity is why, upon first reading or hearing her complaint, it doesn’t immediately register that that is its sum and substance.  She’s saying that when she had a policy that had no caps on out-of-pocket expenses, and an annual cap of $25,000 (probably well below her annual medical bills each year), her doctors and her hospital were willing to forgive all but $1,000 of those bills each year.  But that now that she has a policy that has no annual cap and has a $6,000 out-of-pocket cap-so that the hospital and doctors will receive much more of the amounts they bill than they were before–they’ve told her that she now has to pay in full that $6,000 a year. And that she chose a platinum plan rather than a lower-cost plan that has a $10,000 cap on out-of-pocket expenses because her suddenly uncooperative hospital and doctors would require her to pay the full $10,000 in annual out-of-pocket expenses rather than just the full $6,000 in full annual out-of-pocket expenses for the platinum plan.  Because of Obamacare.

No matter that Obamacare has a maximum annual out-of-pocket cap of about $6,500.

Because of Obamacare, her hospital and doctors said they would require full out-of-pocket payments from her rather than forgive the now-much-smaller amounts above $1,000 a year that her insurance plan will cover.  So because of Obamacare she chose a platinum plan rather than a gold or bronze one that was the same cost as her cancelled one.  No, she didn’t chose the platinum plan out of fear that her old tin plan would leave her bankrupt or unable to access the care she needs if her hospital and doctors suddenly withdrew their largesse.  Uh-uh. Because of Obamacare she suddenly needed a platinum plan.  So she bought one.  Even though paying for it makes her life almost impossible.

Reader Urban Legend posted this comment to my earlier post:

Besides the fact that her policy was crap, it appears there are numerous bronze or silver plans available in Tennessee to a 40-year-old for between $150 and a little over $200 (in Davidson County, Nashville, presumably the most expensive county in the state) . That is the overwhelming majority of plans, and that is without any tax credit assistance. Plans near $373 for someone that age are gold or platinum plans, some with $0 deductibles and out-of-pocket maxes at $1500 or less.

And presumably her employer is continuing to contribute the same amount as before. She was happy with her old plan, but would not have been happy with one for about the same cost as that old plan and that has better benefits, so that more of her medical bills will be paid by her insurer.  Her hospital and her doctors now want her to pay her full medical bills that are not covered by her insurance, and they didn’t before Obamacare.

Her hospital and doctors must be Republicans.  She shouldn’t have told them she voted for Obama, thinking that the ACA would help her.  They sure showed her!

And to think she had thought Obamacare would help her–by requiring her hospital and her doctors to provide free lifetime healthcare for her, saving her $1,000 a year.

Lamb, it turns out, was, like Julie Boonstra, a guest of her Tea Party Republican congressional representative at the State of the Union address.  And, like Boonstra, she’s a pretty cheap date.

—-

UPDATE: Here’s an exchange between reader EMichael and me this morning, 3/2, in the Comments to this post:

EMichael:

I wonder what the financial effects on the hospital and doctors who are forgiving her debts?

And who pays for that forgiveness?

Another thought, I wonder if Ms Lamb has already been hit by the IRS for this past debt forgiveness, or will be hit now that she has gone public?

ME:

Hi, EMichael.  My earlier post on her did make the point that it’s the federal government (in very substantial financial assistance to hospitals for the very purpose of helping them cover the uninsured or the underinsured–an important purpose of the ACA), and her doctors, and people who do have comprehensive insurance, that have been footing her very large medical expenses.  In this current follow-up post, I make the point–which I originally missed and which Kessler missed–that she makes, in essence, a key claim to Kessler that surely is false: that her hospital and her doctors have told her they will no longer forgive her uninsured bills that total more than $1,000 a year, and that their reason is Obamacare.

And if THAT is false, and her hospital and her doctors have told her no such thing, then she was flagrantly lying by saying that she was happy with her old plan.  If she was happy with her old plan, which had NO cap on out-of-pocket expenses and a total annual cap of $25,000, because she felt she could continue to rely on the generosity of her hospital and doctors to forgive all but $1,000 a year, why would she have been unhappy with a bronze or gold plan that would have paid her hospital and doctors more than her old plan did?  Why did she believe that she now would have to pay out-of-pocket expenses of $10,000 annually under a plan that would have cost her and her employer–who presumably is still contributing the same amount as last year–the same as her cancelled plan did last year, and instead chose a platinum plan whose premiums are causing her to take a second job and making her life almost impossible in order to have to pay $6,000 a year rather than $10,000 a year in out-of-pocket expenses?  Why is she suddenly no longer comfortable relying on the special $1,000 annual cap that her hospital and doctors were providing her, and why is she claiming that Obamacare is at fault?

I’m going to email Kessler and ask that he inquire further about this.  If Lamb refuses to answer, maybe he can ask the Vanderbilt Medical Center whether they’re now refusing to forgive out-of-pocket expenses because of Obamacare, and, if so, what it is in the ACA that has caused them to make that decision. If Kessler won’t do it, I’ll ask PolitiFact or even Greg Sargent to do it.

This is serious stuff.  This woman has so little concern for others who have serious chronic illnesses that she’s willing to baldly lie in exchange for a free trip to Washington.  Wow.  I mean, really.  Wow.

I’ll add that I’m pretty sure that the IRS does not consider a hospital’s or doctor’s forgiving of medical costs to a patient who cannot pay those costs taxable income. I certainly hope it doesn’t. It’s basicly a gift of medical services. But Ms. Lamb pretty much personifies the ultimate in chutzpah by claiming falsely that Obamacare has, rather than helped her, instead made her life almost impossible by causing her hospital and doctors to stop forgiving her uninsured medical bills of more than $1,000 a year because under Obamacare those uninsured medical bills will be much lower and because she chose to pay more in order to reduce those uninsured medical bills to $6,000 a year rather than to $10,000 a year–now that, thanks to Obamacare, she has access to private healthcare plans.

Several commentators have noted that the AFP ads curiously stage only middle-aged women who have chronic life-threatening illnesses, and who make “reasonable judgments” that they were harmed, based upon flatly false beliefs or representations.

So here’s what I suggest to the Democrats: Have a middle-aged woman who has a chronic life-threatening illness ask in an ad why the AFP keeps portraying middle-aged women who have chronic life-threatening illnesses as deeply ignorant, seriously math- or logic-challenged, or just plain easily manipulated.  In fact, of course, these women are knowingly propagating a fraud about what they, of all people, know is, for many, many others a life-or-death, or bankruptcy matter.

They’re con artists, pure and simple.

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The News – Just Click on the Link “For the Rest of the Story”

– Governor Nathan Deal of Georgia called on Congress to repeal The Emergency Medical Treatment and Labor Act, a 1986 law requiring hospitals to provide emergency health care treatment to anyone who needs it. It requires hospitals to provide stabilizing care to anyone regardless of race, nationality, or ability to pay. Calling it an onerous law, Governor Deal says “it is costing way too much money and just let poor people die.” In case you have forgotten. Gov. Nate Deal is one of those Governors who rejected the PPACA expansion of Medicaid which would cover those too poor to pay. One other aspect of the PPACA which is not mentioned often, is it begins to cut payments to hospitals for uncompensated healthcare by patients as they would be covered either through the individual exchanges or Medicaid. Governor Deal has placed Georgia hospitals between a rock and a hard place by rejecting the Medicaid Expansion leaving many no other recourse but to close.

“If they really want to get serious about lowering the cost of health care in this country, they would revisit another federal statute that has been there for a long time,” Deal said. “It came as a result of bad facts, and we have a saying that bad facts make bad law.” Governor Nathan Deal of Georgia

Seems the elderly Governor also blamed Meteorologists for failing to notify him of the coming ice storm recently. Unless he is loaded, thank goodness for Medicaid as it is the only provision which will supply Nursing Home care in case he becomes disabled to to Alzheimer disease.

Me: Maybe Governor Deal and the Louisiana State Representative Josh Miller whose life was saved (at 23 years of age and uninsured) and made more mobile through Medicaid and Medicare to discuss how to cut benefits for the uninsured? They both want to do so.

ht. Crooks and Liars   Georgia’s Republican Gov. Wants to Save Money by Not Allowing People to Receive Emergency Care!

 

– A stunning new report indicates the U.S. Navy knew that sailors from the nuclear-powered USS Ronald Reagan took major radiation hits from the Fukushima atomic power plant after its meltdowns and explosions nearly three years ago. If true, the revelations cast new light on the $1 billion lawsuit filed by the sailors against Tokyo Electric Power. Many of the sailors are already suffering devastating health impacts, but are being stonewalled by Tepco and the Navy.

Me: It was bad enough getting shot at and almost blown up, now you are expected to be radiated while on a humanity mission.

ht. Crooks and Liars   Report: Navy Knew USS Regan was Seriously Contaminated by Fukushima during a humanity visit to assist

 

– Goldberg: But if you open a shop on Main Street open to the general public then you have to really serve the general public and you can’t say I’m not going to serve these people but I’m going to serve those people. And a lot of the people—

Bream: Why not? Why not? I mean this is America, we all have freedoms. Why would you do business with somebody, no matter what your personal issue was that they had with you, why would you wanna force them to do business with you? Why not just go down the street and spend my money with somebody who supports me and is kind to me and wants to help me and provides these services for me.

Goldberg explained to her why the blacks that staged the Greensboro sit-ins were real American heroes.

Me: Maybe a little dose of the sixties may enlighten them? Where is the WABAC Machine when you need it Mr. Peabody?

ht. Crooks and Liars  Fox Anchorblonde; Why Can’t Businesses Discriminate Against Gays?

 

– ABC is reporting that Senate GOP-ers have blocked the veterans bill from moving forward to a vote. The bill needed 60 votes to proceed, but the final tally was 56-41.

Although agreement on the need to expand benefits for veterans is usually a bipartisan issue, it was the amount of spending in the bill in which Republican senators had a problem.

Me: This is a part of the you broke them, you fix them ideology. If you are going to have a war, then you owe them or do not go to war.

ht. Crooks and Liars  Patriotic GOP Blocks Veterans Benefits Bill!

 

– Exxon Mobil’s CEO has joined a lawsuit to stop construction of a water tower near his home that would be used to in the fracking process to drill for oil.

While fracking — hydraulic fracturing of rock to release pockets of oil — has raised complaints from environmentalists around the country, Chairman and CEO Rex Tillerson’s opposition to a project in his own neighborhood is interesting, given how deeply Exxon Mobil is involved in the process.

Tillerson appeared at a Town Council meeting in Bartonville, Tex., the wealthy enclave near his Dallas home last November to join in the protest over the water tower, The Wall Street Journal reports.

Me: No oil tankers going by his house either, I’ll bet.

ht: Hullabaloo/Bradblog   Speaking of letters … by digsby

 

– Do you hear that deafening silence? That’s the sound of the sky-is-falling inflation bears’ embarrassment by events that have totally contradicted their every prediction. The destruction of the middle class, the rise in income inequality, and continued wage declines have produced an extremely low-inflation economy, much to the chagrin of conservative “experts.”

It’s almost as if allowing obscenely rich people to have all the money, and creating a world in which companies requiring little startup capital and employing only 53 people can make $13 billion, might produce deflationary economic results with little circulation and growth.

Who knew? Aside from anyone with an ounce of sense, that is?

Me:  Still hasn’t stopped banks from hiking interest rates in anticipation of that first dollop of ketchup.

ht. Hullabaloo, David Atkins   The inflation bears get another sharp stick in the eye, courtesy WhatsApp

 

– Over the years I’ve posted about the direct through line from racism to anti-abortion zealotry, using the manipulation of religion, particularly the Southern evangelical churches, to get the job done. Today, they are pushing a “religious liberty” strategy to roll back abortion rights and allow discrimination against gay people.

Here, Ian Millhiser goes back to the Jim Crow era to show how religious “liberty” was used as an excuse for racism in the first place:

[W]hile LGBT Americans are the current target of this effort to repackage prejudice as “religious liberty,” they are hardly the first. To the contrary, as Wake Forest law Professor Michael Kent Curtis explained in a 2012 law review article, many segregationists justified racial bigotry on the very same grounds that religious conservatives now hope to justify anti-gay animus. In the words of one professor at a prominent Mississippi Baptist institution, “our Southern segregation way is the Christian way . . . . [God] was the original segregationist.”

ht. Hullabaloo digsby  Using religious “liberty” as an excuse to hate on others is as American as apple pie

 

– You wouldn’t know it from the political conversations happening in the United States and Australia, but the world’s scientists are speaking loud and clear. The debate is over, and it’s long past time to act:

Two of the world’s most prestigious science academies say there’s clear evidence that humans are causing the climate to change.

The time for talk is over, says the US National Academy of Sciences and the Royal Society, the national science academy of the UK.

The two released a paper, Climate Change: Evidence and Causes, written and reviewed by leading experts in both countries, lays out which aspects of climate change are well understood and where there is still uncertainty and a need for more research.

ht. Hulabaloo “thereisnospoon

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