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Letters To The Editor: The Health Insurance Affordability Gap; What’s Ahead For The Health Law; Doctor Burnout; Medicare Advantage Payment Rates

Apr 10, 2014

Letters to the Editor is a periodic KHN feature. We welcome all comments and will publish a selection. We will edit for space, and we require full names.

 

A recent story, For A Family With Job-Based Insurance, Premium Subsidies Fall Far Short Of Promises (Platt, 4/31), drew a number of comments. Here is a sampling: 

David Lawrance, M.D.; Boulder, Colo.

I empathize with the Platt's insurance plight, but I don't quite see things the way Ms. Platt does. She saves $1,200 a year in premiums through the purchase of an exchange plan. Her daughter, who has a rare autoimmune disease and who appears to be 18 or older, is able to remain on her father's plan -- an Affordable Care Act benefit. And, she will be able to purchase an exchange plan despite her preexisting condition when she turns 26, another ACA benefit. "Affordable" may be a misnomer. "Sustainable" would be more accurate.

Christine Mytelka; Carmel, Ind.

I really feel for [Kathie Platt]. They should change the law to make sure families such as [hers] are not penalized by faux affordable insurance. I had an idea - not sure if it can work for [her] next school year, but here it is: Is there a private school nearby that your husband can switch to, ideally one that does NOT provide "affordable health insurance?" At that point, [the] family would qualify for subsidized coverage on the exchange. (Change of jobs is a qualifying event that would allow [the Platts] to enroll right then, not have to wait till next year).

Another story, What Happens Next On The Health Law? (Appleby, Carey and Galewitz, 3/31),triggered ideas from readers about other issues to watch for as the health law goes forward.

Glenn E. Miller, agent and adviser, Glenn Miller Insurance; Medford, Ore.

...In Oregon, we obviously have our own unique problems with our exchange. But it is helpful to see a national and regional perspective, and I suspect that will be more important as the real costs begin to come in. One question: Apparently part of the law requires people who have low income early in the year to go on Medicaid. In my experience, these people are self-employed and have "seasonal" businesses, but they budget accordingly, had been paying for their health insurance before and had no expectation for any help other than a subsidy. With all the confusion surrounding the ACA and its exchange problems, this has really blindsided me and quite a few of my clients. For healthy people, spending one quarter on Medicaid probably won't make much difference. But, for those with ongoing issues, it creates another problem of uncertainty in knowing if they will be able to keep their current providers, many of whom [say] they cannot afford to do Medicaid due to low reimbursement rates.

Deni Deasy Boekell, director of oncology market access, Kantar Health; Chester Springs, Pa.

Regarding 'what's next' in healthcare reform, I would like to see how the people in the health exchanges actually experience care. Is it what they expected? Are they surprised at narrow networks, out-of-network costs or deductibles, or even their actual premiums? More importantly, will they continue to pay the premium and stay in the exchanges?

Readers also responded to Burnt Out Primary Care Docs Are Voting With Their Feet (Rabin, 4/1).

Brant S. Mittler M.D., J.D.; San Antonio, Texas

Great article on physician dissatisfaction but it fails to put people like Dr. [David] Blumenthal in the hot seat and ask him whether he was responsible for what is being reported and why it happened. The ivory-tower academics like Blumenthal were the architects of all that is described, yet they escape criticism. That's because your reporters always want ... good relationships with the politically powerful and don't ask hard questions. Nobody has sympathy for what the media have spent the last 40 years portraying as rich, greedy, incompetent doctors. But the public should know that doctors didn't bring about a system that gives patients eight minutes at most to tell their doctors what's on their mind.

Karen O'Donnell RN, BSN, CEN; Wake Forest, N.C.

Your article [about] stressed-out physicians, concierge medicine and doctors leaving their practices is old news... It is way past time to think outside the box and develop a new paradigm in health care. There is no possible way that family medicine/internal medicine doctors can be responsible for providing patient care that is safe, effective and provides good patient outcomes. Given the current turbulence that we call "health care" and [that we] now are providing millions more people the advantage of health insurance via the Affordable Care Act, why not develop ways that are effective in delivering safe care? I encourage all of you who are reading my comments think about [a "team"] concept...with the physician as the lead and consultant, and advanced practice nurse and registered nurses actually delivering the hands on care, utilizing the physician's expertise as needed. And why not put a pharmacist on that team to lend their knowledge as to which medications would be the most therapeutic? Now is the time for health care professionals to adopt Medicare payment for nurse practitioners, allow nurses to practice within their education and scope...and provide for our patients what we all want -- optimum and safe health care outcomes.

In addition, readers also offered their thoughts regarding this Medicare Advantage story,Decoding The High-Stakes Debate Over Medicare Advantage Cuts (Hancock, 4/7).

Michael W. Hamilton, executive director, Alabama Durable Medical Equipment Association; Birmingham, Ala.

Why on earth should taxpayers pay for extra profit for insurance companies? The intent of Advantage plans was to use HMO expertise to offer more benefits for the same or lower costs. Instead, the insurers have been subsidized as much as 14 percent for years. It's high time the original intent be restored. Pay Advantage plans the average cost for standard Medicare beneficiaries, and let them offer whatever extra benefits they can at no extra cost to taxpayers.

James Moulton, Abington, Pa.

I have an advantage plan. It is harder this year to get a doctor to accept it. The advantage plan I had last year was cancelled and replaced by another one I could not afford by Aetna. So, I bought a plan run by Coventry. It is better in some ways -- [it] has a dental plan [and] co-pays are cheaper, but I am in [the] donut hole already because of a medicine that my doctor wanted me to take. It is sad to see money taken from these plans to add to Obamacare. Most people I know have an advantage plan.

Meanwhile, a number of readers drew on either their professional backgrounds or first-hand experiences to offer the following perspectives. Regarding the story: What Went Wrong With Minnesota’s Insurance Exchange (Stawicki and Richert, 4/12).

Donald Wechsler; Peoria, Ariz.

Nothing new here. MNsure encompasses one more permutation of circumstances leading to failed IT projects. From the viewpoint of a retired IT project manager, rarely is the technology per se at fault. Most software project problems are people/process problems. Why don’t those uninformed about software development projects go out and hire those who know? As we clearly understand now, it’s to everyone’s benefit.

On a subject related to this article, Nearly 1 Million More Sign Up For Obamacare Plans In February (Galewitz, 3/11).

William R. Proud; Woodstock, Ga.

The one thing that I don't see anyone cover though is how many folks discontinue coverage each month. I was in the business of getting people to subscribe to my services each month and while sales were important, net gain in customers was what kept us in business and employed. People who enroll minus people who terminate coverage (and their reasons for doing so) is the real story. The government may not have this data but I promise you the insurance companies have the information. Ask them what their monthly "churn" numbers are and they will know exactly what you are talking about.

And, regarding the article, Washington State Officials Want To Lift Veil On Health Care Pricing (Stiffler, 2/5).

Marion R. McMillan M.D., Synergy Spine and Surgery Center; Seneca, S.C.

Many physicians previously in private practice have chosen to sell their practices to hospitals in tough economic times to guarantee a paycheck. Some of the rest of us have chosen to embrace free-market solutions that attract and retain patients by providing innovative healthcare solutions that provide high quality, price transparency and affordable pricing alternatives... These facilities offer below market all-inclusive cash prices for outpatient surgery services by board certified physicians, and post these prices online to empower consumers to spend their health care dollars wisely. Response has been brisk, and we believe this model is poised for success in the current health care market climate.

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