I’m happy that I’m probably going to be wrong about what I’ve written about Arkansas’ private option plan. I thought there would be a good chance that the private option and thus Medicaid expansion would be nixed in Arkansas because it has a strong majority coalition but an extremely fragile super-majority coalition in 2013 and 2014. The November elections tossed out a few marginal supporters and replaced them with Teabaggers who out-teabag Lipton, and the outgoing governor who championed the private option with an incoming governor who was non-committal about the entire thing.
I thought that meant the end of the private option after this year. I was wrong as the Arkansas Times explains that I was wrong in both the essence, and a critical detail as it looks like the Arkansas private option will get slightly less punitive and slightly better for people making under 100% of the federal poverty line.
He (the governor) is asking the legislature to fund the private option for two more years, and he’s asking for a legislative task force that would lead the way on an overhaul of the state’s health care system in 2017.
But there was also little piece of policy news buried in the bill filed yesterday by Hutchinson’s nephew (and previously outspoken opponent of the private option) Sen. Jim Hendren. If passed, Hendren’s bill would make a couple of tweaks to the existing private option. It would halt co-pays and the Health Independence Account program on private option beneficiaries below the poverty line, and it would nix future transitions of certain populations now on traditional Medicaid over to the private option.
Medicaid co-pays for people making under 100% of the federal poverty line tend to be nominal. Usually it will be $2 or $3 for office visits and prescriptions and up to $8 for emergency room visits that don’t result in admissions. Most states don’t enforce the co-pays and will reimburse providers for co-pays that weren’t paid. It is a massive administrative burden for little gain in either reduced costs per service or utilization reduction. Arkansas has tight eligibility requirements for Legacy Medicaid, so that population is probably sicker and more expensive than the current private option population. Keeping current Medicaid beneficiaries on Medicaid is an interesting choice as Arkansas pays a significant percentage of their care, while the Feds pick up the entire cost of care for current private options members, and will pay a higher percentage in the future. However, it also lowers the overall medical expense of the entire Exchange risk pool in the state, so it could lower net premiums.
Overall, I was wrong, and I am very glad to be wrong about Arkansas this week.
humanoid.panda
Among other things, that is I think good news re: King. Hard to see how Roberts puts Republican governors in a place where they have to screw more powerful constituency that the one covered by Medicaid.
Iowa Old Lady
@humanoid.panda: Is it disturbing that we all see King as a political decision on the SC part? I’m not saying we’re wrong.
Another Holocene Human
The only good welfare is white people welfare, part XXXLVII.
Lee
Well you can take solace as you were not as wrong as the person who came up with ‘peak wingnut’.
Baud
@Iowa Old Lady:
It’s disturbing that so many people in red states have to worry for the next five months about it. FWIW, I’m not handicapping the outcome one way or the other.
Mary G
This makes me happy; perhaps some Republicans are realizing that if they take healthcare away from people, it won’t win them votes. But do any of them have that much sense?
Pogonip
I like being wrong in cases like this, too.
Could someone please put up an open thread, preferably with a pupdate attached? I have a general question. ( Maybe my general question will be answered by Major X 5! Hee.)
humanoid.panda
Since this is a slow thread, I was hoping Richard could help me with a question about the architecture of the ACA that was bothering me for a long while. The medical loss ratio of the ACA stipulates that 80% of all insurance costs should be used for medical purposes, with 20% going for profits and overhead. That is billed as a cost saving device. However, something bothers me about it. In essence, it seems the program is structured like a costs plus contract: the higher the amount insurance company for its procedures, the more money it gets to keep. I.e if the insurance plan can either pay for procedure A, costing 1000 dollars, and procedure B, costing 10,000 dollars, doesn’t it have an incentive to chose procedure B, allowing it to hike premiums next year and having the 20% it keeps become more valuable?
What am I missing?
Scamp Dog
I’m sure Richard will have the genuine right answer, but I’m guessing that it’s generally better when deciding on any individual procedure to go for the lower cost, unless they’re right on the 80% boundary and are dead sure about how things will play out in designing (and getting approval for) the rate-benefit structure for the coming year.
Baud
@humanoid.panda:
I think the rule is 80 percent of premiums, not 80 percent of costs.
Keith P
I’ve read this headline maybe 5 times, and every time, I read “Happily Wong” and think “Huh?”
dp
Another question for Richard about ACA. Do the ACA substantive requirements for health insurance — no exclusion of pre-existing conditions, mandatory preventive care coverage, etc. — apply to all health insurance, or just to insurance bought on an exchange, like healthcare.gov? I bought my policy through the exchange, even though I don’t qualify for subsidies, primarily because of this concern, and because I don’t trust health insurers, for some reason. ;-)
Violet
Yet another question for Richard. Twice now, I’ve had the “provider” on the Explanation of Benefits (EOB) sent by my insurance company listed as some group I’ve never heard of, have not interacted with and who certainly didn’t provide me any kind of healthcare.
Upon investigation it turns out that this so-called “provider” is a Middleman Bill Processing Company. The actual provider sends the bill to this Middleman company, who then applies the discount, does the billing, and then sends it to the insurance company. Middleman Bill Processing Company shows up as the provider on the EOB.
What this also means is that the actual charges by the actual provider are obscured. I have no idea what the real Amount Billed is. The discount is not given. It’s all completely invisible. I got into an argument with the actual provider’s billing office because their billing rep thought I should be able to see this info. I could not.
So my question is: How is this legal or is it legal? How is it allowed for the “Provider” to be some anonymous Middleman Bill Processing Company? How is it legal to hide the actual charges made by the actual provider so the patient doesn’t know what the charges are? This practice is new in the last couple of years–never saw it before that–so is it a new way that the health insurance companies are scamming patients? Hiding costs? What is up with it? It seems really, really wrong.
Gex
Generally speaking, it is good news when a thing I think about Arkansas turns out not to be true. Apparently I do not have a high opinion of the state.