Thursday, November 03, 2016

Do you recognize this? I do. It is called the politics of enforcing PRIVATE industry over government programs.

Mercedes Nimmer, who lives outside Madison, Wis., gets help paying for her Obamacare insurance premiums from HealthConnect, a program run by the local United Way organization. 

October 31, 2016
By Phil Galewitz

Madison, Wis. — Having health insurance (click here) is vital for 21-year-old Mercedes Nimmer, who takes several expensive prescription drugs to manage multiple sclerosis. So Nimmer was thrilled to get health insurance last year through the Affordable Care Act’s marketplace and qualify for a federal subsidy to substantially lower her cost....

Is this not a moral country? The cruelest life is when one realizes there isn't anything that can be done to improve self sufficiency. Often that reality is when a hideous disease process sets in as the new reality an American has to live by.

...Yet, the government assistance still left her with a $33 monthly premium, a hefty amount for Nimmer, who makes $11,000 a year as a part-time supply clerk.

Nimmer, though, doesn’t have to worry about even that expense thanks to a United Way of Dane County program that has provided premium assistance to about 2,000 low-income people since 2014. The program, called Health Connect, is funded by a 2013 gift of $2 million from UW Health, a large academic hospital system connected to the University of Wisconsin that also runs its own marketplace health plan....

...HealthConnect is one of several community-based programs across the United States helping thousands of lower-income Americans with their Obamacare marketplace premiums. Similar efforts operate in Texas, Oregon, Washington, North Carolina and South Carolina....

What could be better? Obamacare and help from a private concern to help even more and have a worry free life when it comes to obtaining medications.

...But premium assistance programs have come under fire from insurers. They argue that it is not fair for hospitals, other health providers and disease advocacy groups financed by providers to try to steer people who could be covered by Medicare or Medicaid into marketplace plans with higher reimbursement rates....

There is a three page letter (click here) that lays out why private insurance is a real problem for the insurance companies. The companies are finding more and more people with serious illness, especially kidney disease, on their insurance rolls. These costs are increasing premium costs.

The health insurance companies call this trend "Inappropriate Steering of Individuals Eligible for or Receiving Medicare and Medicaid Benefits to Individual Market Plans."

Have you got that? People like Mercedes Nimmer are a burden to the health care insurance company and they don't want her on their roles. The health care insurance industry wants Mercedes and those like her on Medicare or Medicaid.

Ah, but, there is a problem. Wall Street isn't happy with people like Mercedes Nimmer. Do you believe this? People in need are being singled out by Wall Street as problems to their profit structure.

IN CASE YOU MISSED THE POINT: The health care industry WANTS only HEALTHY people and then only up to the point where they loose that healthy status. THEY WANT PROFITS AND NOT ANYTHING ELSE SHOULD BE A PROBLEM.

Look. If all the health care insurance companies want are healthy individuals on their roles; I say fine. The answer to all this is "Single Payer."

See, the Republicans want the entire USA to be privatized and government dissolved. Anarchy. The Republican presidential candidate is an anarchist. His business model is definitely based in anarchy. Without a doubt.

Mercedes Nimmer is not welcome in the world of private industry. Yet, the Republicans are going to repeal Obamacare and replace it. They want to replace it with vouchers for Medicare patients and private insurance carriers for everyone else. The only problem with the Republican plans for Obamacare is that it doesn't work and the health care insurance industry DOESN'T WANT IT!

Mercedes Nimmer and people like her who receive incredible benefits from Obamacare and the additional private plans that help the impoverished because of their inability to earn a living; are going to be cast from the health care rolls and told to find help elsewhere.


The private plans that help pay for Mercedes monthly payment ARE NOT WELCOME BY THE PRIVATE HEALTH CARE INSURANCE COMPANIES. The health care insurance companies in the USA do not want Mercedes on their benefit plans and god help you if you have kidney disease.

...Nonetheless, insurers are taking action. Aetna, which announced this summer that it was scaling back its marketplace offerings, said that third-party groups steering patients to the individual market had contributed to an unhealthy mix of customers in its marketplace plans.

Blue Shield of California in July filed suit in a state court against CenCal Health, which manages the Medicaid program in Santa Barbara and San Louis Obispo counties.

Blue Shield alleges that CenCal was avoiding millions of dollars in medical care claims by enrolling around 40 of its very ill members in Blue Shield’s individual health plans and paying the premiums on their behalf.

CenCal denied the allegations in lawsuit, saying it paid the patients’ monthly Blue Shield insurance premiums so they could afford private insurance. It has since discontinued the practice.

The geniuses at CenCal thought privatizing their Medicaid patients was a great idea. So they enrolled Medicaid patients into Blue Shield of California. CenCal dumped their most expensive patients at the door step of private industry and paid the premiums. Blue Shield of California DON'T WANT THEM. These Medicaid patients are driving the premiums higher in California.

Got that?

Somehow CenCal thought privatizing was a good thing and a politically correct measure. OR. Someone in leadership saw a chance to drive the costs of Obamacare higher in private exchanges and played politics with their patient's lives.

...United Healthcare filed a lawsuit in federal court in July against kidney dialysis provider American Renal Associates, accusing it of encouraging patients in Florida and Ohio who were eligible for Medicaid or Medicare to move to the insurer’s commercial plans to extract up to 20 times more than the $300 or so that the federal programs pay in reimbursements. American Renal Associates has said the suit is without merit.

The suit alleges that the patients’ premiums were paid by the American Kidney Fund, an advocacy group for patients.

AHIP officials note that the fund is supported by dialysis providers who stand to benefit financially from patients gaining marketplace coverage over payments from Medicaid or Medicare....

Sure dialysis providers will reap higher incomes from private insurers. That sounds right to me. BUT. The private health care insurance companies ARE NOT experiencing higher incomes because they have to pay those dialysis providers. 

Hello, America. Hello. The increased premiums of 2017 is due to manipulation of the market providers within the private payment insurance system.

I think we need a Single Payer system that would have been called "The Public Option" at the very least for those most in need of help and cannot help themselves.

This entire mess is due to politics and the drive for privatizing everything that is the role of government.

The Republicans have it "W"rong.