Opinion: Help available to find health insurance
By John Williams
The Affordable Care Act, commonly known as Obamacare, is in full swing. Effective Oct. 1, Americans are able to enroll for the state insurance programs for coverage starting Jan. 1.
Two state insurance exchanges exist for South Shore residents; Covered California for California residents and Nevada Health Link for Nevada residents. Both exchanges allow for you and your family to compare health coverage options and choose the one that best fits your needs and budget. Through these exchanges some residents may even be eligible to receive financial assistance to make health care more affordable. This marketplace will help community members to shop online, over the phone and in person to find the right health insurance option for them. Individuals and small businesses can compare different health insurance plans and learn whether they qualify for federal subsidies and tax credits.
John Williams
Additionally, residents will be able to determine if they are eligible for low-cost or no-cost health coverage through Medi-Cal and Medicaid, as these government programs have been expanded to cover more people than in the past.
Barton Health has been proactively working towards being able to assist our residents with getting health care coverage and access to health services. Over the past several months, we have worked to:
1) Contract with insurance companies working with the exchange in California. Barton Health is continuing to connect with insurers in Nevada working with Nevada Health Link to determine coverage options at Barton facilities for Nevada residents.
2) Expand and remodel the Community Health Center (formerly the Community Clinic) to address the anticipated increase in community members seeking preventative and treatment-based health care.
3) Become a Covered California official Community Outreach Partner and Certified Enrollment Entity. By the end of October, Barton will have 19 Covered California certified enrollment counselors on staff to assist community members with in-person support for insurance exchange sign-ups. Appointments with these counselors can be scheduled through our Heath Care Reform hotline at (530) 600.1984.
Americans who do not sign up for health coverage for 2014 will face federal penalties. These penalties equate to $95 or 1 percent of income, whichever is greater. A family will be charged a penalty of $95 per uncovered adult and $47.50 per uncovered child (up to $285 for a family) or 1 percent of the family’s income, whichever is greater. These penalties increase each year for those who are not covered.
Many have asked if care can be given across the state line for exchange coverage. Out-of-state coverage is subject to each individual health plan’s specific policies and network coverage as detailed within the health insurance policy. Each health insurance policy has a specific list of providers that are in the network for covered services. It is important for community members to check with each individual plan offered to confirm that your provider’s services are covered under that plan.
We are proud to be of assistance to our community members, as determining the best health care option for you can be overwhelming. To find out more about the state exchanges, California residents may go online and Nevada residents may go to this website. For your convenience, Barton has created a website with useful information on the reform changes including helpful links, videos and frequently asked questions.
John Williams is president and CEO of Barton Health.
The Affordable Healthcare Act is a great start to attempt to control unregulated healthcare insurance.
I know I’ll be looking into it – mainly because Blue Shield has been screwing me with an average of 30% increases every year for over 12 years now. Last year they increased my policy 50% with the excuse “because we can”.
Doing the math – health insurance increases 100% every three years. This eventually forces most of us who pay our own policies to consider dropping coverage. Health providers like Barton Hospital continue to use the excuse to charge insured ( like myself )for others uninsured then write off the loss anyway. They also make the excuse “because we can”.
It all has to end, and Republicans have never offered any reasonable solution to uncontrolled healthcare costs. So it’s imperative this program goes through to begin a new approach to stopping unregulated healthcare provider and insursnce costs.
John A- You really think this…?
“The Affordable Healthcare Act is a great start to attempt to control unregulated healthcare insurance.”
You don’t know what you are talking about. The government regulates insurance companies always has.
That is what the problem is. An ignorant society that doesn’t grasp how ignorant it is.
You were the one that said we were a Democracy. You must have gone to school in California …
YOU DON’T SEEM TO KNOW MUCH DUDE. KEEP THAT IN MIND – YOU DON’T KNOW MUCH.
McCoy – You are the ignorant one – tell me how healthcare is regulated in California please !
We’de all like to know how that works…….
Again, read the definition of democracy and tell me it isn’t how we govern this country.
It’s ignorant attitudes of people like you who have caused the hatred and division in this country !
OMG ! It’s such a waste of time arguing with someone who gives us nothing to work with.
John, you are a little bit missinformed about health care cost. Though the ACA does do a few minor things to control healthcare it will do very little to stop the ever increaseing cost. The main thing that would help possible is that the insurance companies are now required to pay out at least 85% of the premuim for healthcare, or pay a refund(as of 2014) In the state of California HMOs are regulated by the state. Ask yourself why does lipator cost us 124 a month and new Zealand it cost 7. Why do we pay 3 times more for healthcare here than any other developed nation and are still only ranked 34th in health. Premuims are based upon what the market would bear and what the insurance company pays out to health care providers. Your insurance will still go up considerable every year, now if you make less than 45k a year you may get some help to cover your payment, but only if you get one of the plans thru CoveredCA. If you stick with your current plan you will not get any help to cover premuims. In this portion of El Dorado County your only choices are Blue Cross and Blue Shield(i would stick with Blue Shield over Cross myself)
I am very concerned about what is happening with healthcare premiums. I have already talked to two people who are having their premiums raised by 40% and their coverage decreased by about 50%. How is this “affordable”?
Affordable is a relative term. However for a middle class worker bee like me, who’s been watching my premiums sky rocket for years to the point of thinking of having to drop healthcare all together, the option of Obamacare is a a Godsend. Last year I paid $350 per month for premium plus over $6000 in out of pocket expenses which occurred due to a freak accident. Combining these numbers together, my payments to take care of my health totaled 1/3 of what I earned. That is something that could not happen again this year as it would break me financially. I’m very healthy, own a home and work two jobs. Obamacare will bring my premiums down to under $150 per month with out of pocket costs under $5000 max. That, to me, is both affordable and fair. I’m tired of watching my premiums increase while people who don’t work as many hours as I do get free health care because they either don’t pay their bill or are already subsidized.
Reloman, NO – I’m not the least bit misinformed.
You’re obviously looking at ACA from the conservative side in a negative light. It’s Republican propoganda that the ACA is gonna increase everyone’s premiums.
In reality – when everyone gets onboard the eventual outcome will be true competition for health insurance companies having other gov regulated programs. It will force them to stop overpaying medical providers for services who overcharge at will.
Yea, there are a few restrictions through HMO and what Medicare pays, but generally otherwise they get away with extortion with billing. Even the DOI admits they can’t do much until legislature changes for regulation.
Ultimately ACA should bring medical services back down closer to earth.
Right now companies like Blue Shield allow medical providers to literally dictate their own annual contracts with them at whatever they want – and they simply pass it on to us in premiums. They couldn’t care less – because they still make extrordinarily high salaries in their administrations.
They can also tier you up for no reason and keep you there.(first hand experience )
No regulation – Legislators in their pockets – we all get raped ! “Free Enterprise” has made them Billions !
No, I haven’t yet looked into the Calif plans through ACA , but you can bet I will jump ship from Blue Shield after careful investigation and making sure the limitations aren’t too severe.
I am now willing to have a little less choice for a more reasonable plan.
Doing nothing and letting companies like Blue Shield and medical providers charge what they wish isn’t an option anymore.
John A said, “McCoy – You are the ignorant one – tell me how healthcare is regulated in California please !
We’de all like to know how that works…….
Again, read the definition of democracy and tell me it isn’t how we govern this country”
“Healthcare” has been regulated by the states for generations. Medical insurance has been strictly regulated in California for at least twenty years, probably longer. That’s how long I’ve personally been affected by the state of California’s regulations on my ability to purchase the insurance I’ve wanted. They started requiring all medical insurers to cover conditions whether or not the purchaser wished to have that kind of coverage about then. That’s when it started getting really expensive. Little by little, they started forcing us who purchased the insurance to pay for stuff we did not want. That was thanks to the California legislature, not by a vote of the people.
And again I must remind you; we do not live in a democracy. The USA is a Constitutional Republic.
Learn the difference.
You shouldn’t accuse others of being ignorant when you make statements like that particular post.
Dogula,
Your explanation tells us nothing other than you believe HC has been regulated for 20 years.
Scroll up to my explanation of why it is not regulated and why it’s so expensive and pick it apart if you can.
Call the DOI and ask them why it isn’t regulated ( as I have many times )
What “stuff” have they made you pay for that you didn’t want? Obama and ACA are the first to make HC insurance companies cover conditions they didn’t want to cover before – not California. How long have you lived here ? California had a spectrum of catastrophic policies through platinum Blue Shield coverage for you to pick through for twenty years…… you had plenty of choice other than the extraordinary premiums. And now it’s time to work on that ! This is gonna help you too Dogula !
Do something please other than just argue because you hate Obama and his signature legislation. Offer a solution – throw us a bone ….
Each of the previous posters has offered a kernel of accurate information. Health Insurance is regulated by the department of insurance in each state, in CA also by Dept.of Managed Care.
Premiums are up with ACA, I find most premiums on or off exchange to be comparable to employer sponsored plan premiums. The reason for this is that in 2014 all applicants will be accepted without regard to health conditions, which has been the case in the group market since 1993 (AB1672)
The premium subsidies in ACA are available to most people making up to 400% of Federal Poverty Level, and are comming from the Federal Gov. where does the Fed get it? The answer to that may introduce yet a third option to the Democracy vs Constitutional Republic discussion.
The assumption that all will participate is naive, as the penalty for non par is <5% of premium on average, and some will not be happy with being forced to purchase in any case.
Regarding health-care costs, there ars so many variables in the system that trying to atribute blame or abuse to any group or individual is a fools errand. Controlling costs will take efforts on the part of all and begin with personal responsability and accountability of consumers, providers, and insurers.
California required my carrier to cover a certain number of psychiatric visits whether I wanted that coverage or not. They also required my policy to cover pregnancy, delivery, post-partum care, even though that was not possibly an issue for me. Back in the day, it was possible to purchase a very basic, catastrophic care policy, which is all someone like me needs. I can cover the incidentals, but in case of a disaster, I didn’t want to lose the house. But the state of California made that impossible by legislating required coverages regardless of what the consumer wanted.
Is that factual enough for you, John A?
And to answer your other question, I’ve been in El Dorado County since 1980.
John A does not know what he is talking about, again.
The states regulate the insurance industry inside their boarders. Contracts must meet state approvals and all insurance sales agents are licensed by the states. Period.
Ultimately, If an insurance company excludes pre existing conditions in their contracts for instance it is because the “states” where they operate have let them do so. All contracts provisions are stipulated by the states.
Any lawyers out there want to tell me I am wrong?
Obama lied when he said it is all the insurance industry’s fault. The truth is the large companies through the legal system of bribery, aka Lobbying, collude with government to give us what we have. We don’t have free markets we have crony capitalism. In the end however, Government is the power and that is the essence of the way it works. We the people need to take back government arrest the cronies and bring back free markets.
FREE MARKETS DOES NOT MEAN UNREGULATED MARKETS. Don’t even go there.
CJ McCoy, there has never been FREE MARKETS – greed has a way of stopping that from every happening. Free Market is a theoretical construct that at its core requires humans to act rationally and never act badly (i.e., corrupt). There is quite a bit of empirical research which clearly demonstrates, that both key assumptions are wildly violated in all cases; in other words, can’t happen. So if you were frankly familiar with the studies that clearly demonstrate humans act irrationally when it comes to economic decisions (just look at the Tea Party types that said hitting the debt limit is not that bad) and corruption is inherent when gobs of money are at stake (can you say Lehman Bros), you would not so naively suggest let the Free Markets decide.
Rick
John, you seem to call anyone who does not agree with a conservative or a dupe. What exames have you taken to give you such great insites to insurance issues, I have taken and passed 2 state exams. I understand you truely hate Blue Shield, well that only leaves Blue Cross in this area and they have had and even worst record with increases as a matter of fact the Insurance Commissioner wanted to exclude them from CoveredCA because of their history of increases. BTW CoveredCA will be an HMO and it will not include every Doctor in the state it is very limited. You insist that ACA will lower health care but have not told us how. Your contention that the exchanges will give people a place to shop, well guess what the open market already did that, its was called calling around, much like you would do with your auto insurance.
I dont really have a problem with ACA as a matter of fact I expect to make quite a bit off of it. Its great that it made it so that people with pre existing conditions can get insurance(though health people will be paying higher premuims because of this option) nice that preventative care is covered outside of the deductable though it would have made things cheaper if there was a co pay of say $25.
John you did not even answer why is our health care per capita 3 times most other developed nations, instead you accused me of being against ACA. You probably have no idea and it is easier calling someone a stooge, than gathering more information.
Rick,
There is a “degree” issue as with all things politic that is true, it is intuitive in fact as far as I am concerned. My point is “act in the direction of free markets” that is historically where happiness and harmony lie.
Like I say, from my point of view that is intuitive, i won’t bother arguing minutiae with you, that is far to academic for me, I am a simple person rapped up in the real world of private enterprise, I have to deal with reality every day. I don’t have time for your book based drivel.
CJ, the academic research provides clear evidence your intuition is wrong. Tis why Francis Bacon (father of modern science) noted over 300 years ago, “the quilt of the senses is either of two sorts, it destitutes us or deceives us.” In other words, our biases and perceptions lead us to incorrect infer a relationship that does not exists. That is the problem, people go with their gut that the Free Market will find a “good” equilibrium – in reality when we look closely, intuition is based on bias and perception not evidence. As a scientist, I have to base my understanding on evidence and not biasly rely on false perception because it feels right – when in fact the evidence shows its wrong.
Rick
Rick, you must be a lot of fun at parties huh?
Talk to the hand – no time for you – I got the real world to deal with.
Sounds good CJ, but if being uninformed floats your boat, you can sail around the world non-stop.
Rick
“I don’t have time for your book based drivel.”
*Sigh*
My intuition is telling me you are probably ignorant.
McCoy , You’re way out there and irrational and not worth arguing with. If we had HC insurance regulation we wouldn’t be paying $10k for a simple cardiac stress test, and $600 for simple blood labs that cost about $20 to process.
Reloman – You are slightly more reasonable and I apologize if I have assumed you are a conservative.
What are you ?
Anyway, I too have a lot of experience with Blue Shield. I have numerous times taken them to DOI with complaints for their unfair practices, and negotiated with them many times to get them to approve medication they denied, ordered by some of California’s top physicians. They literally set their own standard of care – even in life-death situations.
They are truly “unregulated” and lately literally arrogant about it – stating “because we can”
Ok, eneough of that.
ACA should ( as I have stated in previous threads )decrease health care costs if everyone gets onboard and is insured. At that point HC insurance companies will have competition from ACA approved insurance and be forced to moderate their premiums. Furthermore, they will be forced to negotiate better contracts with providers and keep rates from skyrocketing 35-50% every year. It all comes from competition in this industry – which to date isn’t there.
Along with that if everyone is insured medical providers ( hospitals) won’t have the excuse to surcharge those of us who have insurance to pay for others that don’t. This has always been the premise of why ACA is needed and how it will work.
Free Enterprise has again demonstrated in this business that greed preveils and we get screwed.
It’s not reasonable to believe that 35-50% premium increases can last much longer before everyone becomes wards of the state.
Your turn …..
Rick, markets function at equilibrium, there is no good or bad involved. There is no value judgment. But more to the point, in perfect markets the sample size is so large any individual is meaningless, bias disappears. Equilibrium in price is the price where suppliers will supply a product at a price where consumers consume the product. It is reality…beautifully pure in fact until man gets involved.
From that simple truth we can then evaluate markets, such as health care, and evaluate mans influence on the market by factors such as regulation or insurance; factors where we divorce market influences from total consumption. As it turns out society will not tolerate, and probably should not tolerate, free market delivery of major medical services. If we did then we would accept poor pregnant mothers dying on the front step of a hospital for lack of money. That is not the fault of free markets, it is a choice we make as a society. If we make that choice, then we also all ultimately agree to finance it as a common, like an environmental common.
Woah. Great comments.
17% GDP is too much to spend on healthcare, especially considering that our system ranks near the bottom in most metrics.
Unlike some people, I think we can do better. And we need to. Bleeding 5% GDP to healthcare costs is unsustainable, and pathetic.
PS Dogula is in denial about this and is dumb.
The proportionate costs of health care to our GDP are to high. Why? The same reason the quality of our health care system is declining as costs are rising.
Knowing the history of the industry I think costs have gone up in direct proportion to increasingly excessive government interference in the system along with the lack of success in tort reform.
But what can we expect? Two pillars of the leftwing Democrats, Trial Lawyers and excessive government regulation.
Democrats are in the pockets of the trial lawyers and stay far away from meaningful tort reform which undermines and adds unnecessary costs to our countries economy, especially in California.
Rates are high because it’s easier, and even more cost effective, to raise rates than it is to promote efficiency. As most doctors realize, investing in a “non-profit” medical facility is like getting a license to print money. Medical providers charge as much as they imagine they’ll get paid – they are able to make money off the discounted rates paid by insurance and Medicare and basically try to charge as much as possible to everyone else. Even insiders will admit that every medical bill is negotiable, but most folks, naively believing in the system, try to pay what they’re charged.
John A. I am more middle of the road much like most of America(I believe). No where in ACA does it state that insurance companies will be forced to negociate with health care providers better. One would hope that they would(so that they could give lower premuim and increase their market share) but that has not proven to be the case in the past. One of the problems with negociating lower heathcare prices is that doctors and hospitols dont have to negociate with the insurance companies, instead they can no longer accept that company. Insurance companies know that as far as health care goes, customers will rather not change Doctors but would rather change insurance companies, even if it is at a higher price. This is a huge negociating advantage for the healthcare providers.
In Other words John A, if your doctor is not on insurance Plan A because he will not get paid what he wants, but he is on Plan B that will pay him what he wants. Will you dump your doctor to get a lower insurance cost or will you eat the higher price because you like and trust your doctor. Most people take plan B.
“Rates are high because it’s easier, and even more cost effective, to raise rates than it is to promote efficiency. As most doctors realize, investing in a “non-profit” medical facility is like getting a license to print money”
Hah! Government DOES have a license to print money. When has government EVER done anything in a more efficient manner than private industry??? When government takes over an industry, as it intends to with medical care, there will be no competition at all. No reason to BE efficient. They can take as much money as they want from the tax-payers. You’ll have no choice.
Reloman, that’s fine …… Like many others, I have resigned to the fact that for the time being -I won’t have the doctor choices I had when paying “extortion premiums” to my current insurance company.
I believe eventually these doctors and hospitals charging too much will realize they have to reduce rates or go out of business.
It’s really not an option for anyone who pays their own health insurance to continue to be paying monthly premiums comparable to mortgage payments for spoiled medical providers who have become accustomed to raping us.
I have absolutely no compassion for some of the doctors I’ve seen getting $750/hour for a 15 minute visit, or the hospitals charging five times the rate for outpatient medical services done at other locations.