But you’re going to repeal it anyway because you don’t give a fuck about your state.
Sen. Cotton states, "I'm not here to deny that Obamacare has helped Arkansans." #CottonTownHall
— Channing Barker (@ChanningBarker) February 22, 2017
by DougJ| 92 Comments
This post is in: Open Threads
But you’re going to repeal it anyway because you don’t give a fuck about your state.
Sen. Cotton states, "I'm not here to deny that Obamacare has helped Arkansans." #CottonTownHall
— Channing Barker (@ChanningBarker) February 22, 2017
This post is in: Proud to Be A Democrat
Well, no shit, really:
Former House Speaker John Boehner predicted on Thursday that a full repeal and replace of Obamacare is “not going to happen.”
Boehner, who resigned in 2015 amid unrest among conservatives, said at an Orlando health care conference that the idea that a repeal-and-replace plan would blitz through Congress is just “happy talk.”
Instead, he said changes to former President Barack Obama’s signature legislative achievement would likely be relatively modest.
***On Thursday, Boehner said the talk in November about lightning-fast passage of a new health care framework was wildly optimistic.
“I started laughing,” he said. “Republicans never ever agree on health care.”
“Most of the framework of the Affordable Care Act … that’s going to be there,” Boehner concluded.
I don’t care if he and I think it isn’t going to happen, it could, and that is what matters. Keep beating them up. Keep showing up at town halls and jeering them. Keep talking to cardboard cutouts when they are too chickenshit to show up to town halls. Keep organizing, keep yelling, keep beating them about the head and neck. They need to pay an even higher political price for trying to take away your health care than the Democrats did trying to help you gain access to health insurance and health care.
Fuck these people. They’re running scared, and instead of letting up, keep the pressure on and keep nipping at their heels as they try to escape. Sherman didn’t say “well, we’re close to Atlanta, that’s good enough. I think they know we’re serious.” He knew the only thing the confederates would understand was brute force. And these descendants of those assholes are the same god damned way. Keep throwing molotov cocktails and burn the shit down. No one ever told me in basic training it was a bad thing to shoot the people who are trying to kill you in the back as they run. Fuck ’em. Let’s take back the House, the Senate, and the statehouses.
by DougJ| 215 Comments
This post is in: Good News For Conservatives
A purported cyber hack of the daughter of political consultant Paul Manafort suggests that he was the victim of a blackmail attempt while he was serving as Donald Trump’s presidential campaign chairman last summer.
The undated communications, which are allegedly from the iPhone of Manafort’s daughter, include a text that appears to come from a Ukrainian parliamentarian named Serhiy Leshchenko, seeking to reach her father, in which he claims to have politically damaging information about both Manafort and Trump.
Attached to the text is a note to Paul Manafort referring to “bulletproof” evidence related to Manafort’s financial arrangement with Ukraine’s former president, the pro-Russian strongman Viktor Yanukovych, as well as an alleged 2012 meeting between Trump and a close Yanukovych associate named Serhiy Tulub.
by David Anderson| 65 Comments
This post is in: Anderson On Health Insurance
Some very interesting news in Kansas that I don’t know how to interpret:
Per @emma_sandoe, Kansas’ House just voted 85-40 in favor of expanding Medicaid.
— Sarah Kliff (@sarahkliff) February 22, 2017
The argument that is being advanced is that even at a 90% Federal match, there is a Medicaid expansion package that will reduce Kansas state expenditures so it helps the state legislature dig out of the Brownback inspired fiscal hole without raising taxes and without being heartless bastards. And that argument seems to have worked in at least the House.
Here is what I don’t know yet:
So what the hell is going on in Kansas as this seems slightly unbelievable in a good way. And who do we need to call to encourage good votes in the Senate?
by David Anderson| 31 Comments
This post is in: Anderson On Health Insurance
My wife had scheduled an elective but needed surgery for late December, 2016 (just days before I left her with the kids to go to North Carolina**). We had good insurance through my former employer. The individual deductible after the health incentive bonus is $600 and then there is a 20% co-insurance for the next $10,000 in expenses. By a rough estimate it is 83% to 85% actuarial value coverage. It is somewhere between a Gold and a Platinum plan. Up to the surgery, she had spent less than $50 in deductible so she still had a lot of deductible to satisfy before the co-insurance kicked in.
Any an-patient surgery for a non-bundled case will produce at least three sets of claims. The first claim is the surgeon’s professional claim. It compensates the surgeon for their skill and time. The second claim is the anesthesiologist for their skill and time as well as the good drugs. The third claim is the facility fee from the hospital. It is the rent for the operating room, recovery room and then room and board. This is the simplest billing situation. There are numerous situations where the claim situation will be far more complex.
And now let’s see where this split system produces a very patient unfriendly experience that has a root cause of increasing cost sharing obligations.
The week before the surgery, the surgeon’s office pre-authorized the diagnosis and procedure codes. They also received an estimate of how much cost sharing my wife was subject to and the split between deductible and co-insurance. Before the operating room reservation would be confirmed, the billing manager told my wife that she would have to pay her estimated cost-sharing for the surgeon’s professional claim. This was deductible plus some co-insurance. My wife was surprised and asked why. She was told that with increasing deductibles the surgeon’s office does not want to chase patients for co-pays and deductibles that they won’t see. My wife pulled out a credit card and made the payment.
A week later, she checks into the hospital, gets her surgery and is released the next afternoon.
All is good and then we get into claim processing cycle heck.
In the middle of January when I am home for a week from Duke, we get the first bill from the anesthesiologist. The topline number looks fine, and I expected to see only the co-insurance apply. Instead all of her deductible was applied and then co-insurance was applied to the increment. This is odd.
My wife asked me to look into it. I happened to have worked at the insurer in question for years and I know a couple of things about claims. I saw that the anesthesiologist belonged to a group that tends to cycle their claims quickly. They submit claims multiple times a week. My guess is the claim arrived by Christmas Eve sat over Christmas then hit payables to generate a partial payment to the provider and an Explanation of Benefits for us within fifteen business days.
The surgeon is not obligated to bill quickly. He belongs to a group that tends to both bill slowly and bill complexly. Any claim that he submitted for my wife’s surgery either had not arrived or had not worked its way through the pre-payment cycle when the anesthesiologist claim was initially satisfied. The claims system never saw that my wife paid her cost sharing to the surgeon before the surgery. So the claims system applied the full deductible to the anesthesiologist bill.
We called UPMC and we called the surgeon and we called the anesthesiologist. Everyone agreed that this scenario was the one that was most likely to have occurred. The anesthesiologist’s office wanted us to pay the inflated bill in full and they would refund us eventually when their claim got adjusted. We declined that gracious offer to float them interest free cash. Instead, we were told to wait for the surgeons’ bill to clear claims.
On Tuesday, I’m again in Pittsburgh for the week. We received the hospital facility explanation of benefits and bill. It again had her deductible satisfied and then co-insurance kicking in for the rest. I was somewhat amused. My wife was very frustrated. Again, we were hitting timing problems. The two technical charges were most likely getting backed out and reconciled so for a time, her cost-sharing bucket had been emptied out as the professional charges were getting cleaned up manually. During this window, her hospital claim went through and was charged the rest of her deductible again. Each of her claims hit maximum deductible the first time through.
These timing issues are not unusual. All claims were received and then processed initially within sixty days of service. That is well within typical expectations. Most commercial contracts will allow providers to submit their initial claim for a service within at least a six month window. Claims will usually take at least a week to process internally and can sit for months if there is something odd going on. All claims in and out within sixty days is the system operating under normal specifications.
We will be able to resolve the problem without too much more frustration because I used to be a claims system plumber. I know where things can go loopy. Most people don’t have a claims system plumber of any sort much less the specific claims system in question in their immediate families.
This is not patient friendly.
The root cause of this failure is the lack of provider trust that they will get paid all of their contracted amount in an environment of higher individual cost sharing obligations. If they perform a service and don’t get paid, they are out either the time and effort to collect or they are completely out of some increment of the money. Their fix (which is completely rational from their perspective) is to require pre-payment of the estimated individual cost-sharing ahead of time. If the patient does not pay, they are not performing the surgery. If they underpay slightly, the surgeon is out very little money and if they overpay, the surgeon cuts a check in sixty days.
This would work, well enough, if there was a guarantee that both the surgeon’s technical claim was subitted ten minutes after the surgery was completed and that it was guaranteed to pay first. Deductible and out of pocket accumulators would be properly credited and every other related bill would be paid correctly with the appropriate cost sharing attributed.
There is no way under the current fee for service model that this can be guaranteed. Most of the time, it won’t matter or it won’t be noticed but weird stuff will happen that is patient unfriendly.
This problem is resolved under bundle payment systems where the provider is taking on performance and cost risk. It could also be managed better if the surgeon in an acute care episode was forced to act as the general contractor. They would take on no performance or financial risk but they would be charged with coordinating both care and the financial arrangements with the other billing and service providers. At that point all of the associated claims would hold until the general contractor claim went through even if the order of arrival was random.
But as long as we are in a system of higher deductibles and cost-sharing and a system where there is significant incurred but not reported claims that just have not arrived yet, it will be patient unfriendly.
** I had to include this line in order to get her permission to tell this story
High deductible plans, IBNR and non-patient centered carePost + Comments (31)
This post is in: Open Threads, Republican Venality, Republicans in Disarray!, World's Best Healthcare (If You Can Afford It), Get Angry
Voter to @SenTomCotton: My husband is dying. We can't afford health insurance. What kind of insurance do you have? https://t.co/iYFiZtwJ1F
— CNN (@CNN) February 22, 2017
Sen. Cotton states, "I'm not here to deny that Obamacare has helped Arkansans." #CottonTownHall
— Channing Barker (@ChanningBarker) February 22, 2017
… Or, at the very least, eager to let the “healthcare industry” kill them, in the name of profit.
GOP lawmaker: No guarantee everyone will keep insurance under GOP's ObamaCare replacement https://t.co/unkd8UpdKU pic.twitter.com/4rieIpX7MY
— The Hill (@thehill) February 21, 2017
8 years after Grassley claimed health care reform could "pull the plug on grandma," he hears from the other side. https://t.co/Y9qPW4RR5I
— Sahil Kapur (@sahilkapur) February 22, 2017
If the Democrats can’t hang this cruel mess around every single Repub candidate’s neck, we don’t deserve to regain the majority in 2018.
I understand lying. I understand misdirection. But this, my God — it's just using words for their own sake. pic.twitter.com/tpfb20QkOh
— Richard M. Nixon (@dick_nixon) February 22, 2017
Individual responsibility in this instance means "You're screwed, if you're poor" https://t.co/b0KOJjGZKS
— Dan Pfeiffer (@danpfeiffer) February 22, 2017
Freedom's just another word for … restricting access to health care coverage & hastening death https://t.co/6k2dlQ6EOT
— Michael Cohen (@speechboy71) February 22, 2017
As a side benefit, with any luck, the Repubs will be tearing at each other, hoping to pin the blame on all those other rotten, thieving GOP congresscritters…
So… who’s right? Trump says he’ll send Congress a health care plan; Tom Price is telling Republicans he won’t. https://t.co/g51nOBC44s
— Sahil Kapur (@sahilkapur) February 22, 2017
Trump seems to have much better instincts than congressional GOP does about what actions are likely to mobilize voters against you.
— Josh Barro (@jbarro) February 21, 2017
The people most upset about Trump's immigration actions can't vote; he cannot depend on this insulation on health care changes.
— Josh Barro (@jbarro) February 21, 2017
by Alain Chamot (1971-2020)| 26 Comments
This post is in: On The Road, Open Threads, Readership Capture
Folks,
We’re trying a new feature here, so let’s see how it goes for the next week or so before it’s fully automated.
This post is for Balloon Juicers who are on the road, travelling, etc. and wish to share notes, links, pictures, stories, etc. from their escapades. As the US mainland begins the end of the Earth day as we measure it, many of us rise to read about our friends and their transient locales.
So, please, speak up and share some of your adventures, observations, and sights as you explore, no matter where you are.
Have at ’em, and have a safe day of travels!