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Topic: Anyone ElseTerrified about Repeal of ACA Bill

Forum: Employment, Insurance, and Other Financial Issues —

Employment, insurance, and financial concerns are common. Meet others here to discuss and for support.

Posted on: Jul 15, 2017 09:35AM

sfar wrote:

Just wondering how people are coping with the constant threat to our health care coverage due to our pre-existing conditions. I've always believed that you need to take action when you're feeling stressed and threatened and this health insurance issue is driving me crazy. I have contacted my senators but both of them are on the same page with me. When I tried to contact the moderate "on the fence" GOPs, they don't accept email from people outside of their state. It just seems so out of our control right now and I hate that feeling. Any thoughts or ideas?




Dx 2/24/2016, IDC, Right, 2cm, Stage IIA, Grade 3, 0/1 nodes, ER+/PR+, HER2+ (FISH) Surgery 3/30/2016 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 4/20/2016 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 4/20/2016 Herceptin (trastuzumab) Radiation Therapy 9/12/2016 Whole-breast: Breast Hormonal Therapy 10/17/2016 Arimidex (anastrozole)
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Oct 8, 2019 10:44PM - edited Oct 9, 2019 08:57AM by ksusan

Actually, a ton of insurance companies pay less than Medicare. As a provider, I'm on a number of panels that have worse reimbursement.

Mutant uprising quashed. Dx 1/2015, IDC, Right, Stage IIA, 1/1 nodes, ER+/PR+, HER2- Dx 1/2015, DCIS, Left, Stage 0, Grade 3, 0/2 nodes Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lymph node removal: Sentinel; Mastectomy: Left, Right Radiation Therapy Whole-breast Chemotherapy Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Oct 8, 2019 10:46PM marijen wrote:

Maybe there should be a cap on salaries and profits.

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Oct 8, 2019 10:50PM marijen wrote:

Health Care Health Care RSS Feed

For all of the quality care it delivers, the U.S. health care system is one of the most dysfunctional sectors of the U.S. economy. The government spends nearly 50 cents of every dollar spent on health care, most consumers are almost entirely insulated from the cost of their decisions, and employers decide what kind of health insurance their employees get.

But while the U.S. health care system begs for reform, the Patient Protection and Affordable Care Act only exacerbates all of the current problems, promising to devolve into a price-controlled system rationed and micromanaged by bureaucrats.

IPI believes there are much better options: reform the tax treatment of health insurance; remove the state and federal mandates and regulations that make coverage more expensive; pass medical liability reform; and promote policies that create value-conscious shoppers in the health care marketplace.

September 24, 2019 Medicare Has Tried Price Controls--and Failed

by Merrill Matthews

Democrats want to impose price controls on prescription drugs, even though Medicare's long history of price controls shows that they don't control spending.

September 24, 2019 GOP, Progressives, Insurers - All Cast Skeptical Eye at Pelosi Drug Plan

by Merrill Matthews

House Speaker Nancy Pelosi (D-Calif.) formally released her long-awaited drug-pricing bill last week, and very few individuals and organizations endorsed it outright.

September 23, 2019 Where Trump and Pelosi Can Come Together on Drug Prices - and Where They Can't

Trump's motivation combined with some degree of real agreement on policy issues suggest that lawmakers could find a way to craft legislation aimed at controlling drug prices. But there are still plenty of reasons to think the effort will go nowhere.

September 20, 2019 Pelosi Drug Pricing Scheme 'Most Radical Government Takeover of Health Care System Yet'

by Erin Humiston

House Speaker Nancy Pelosi's drug pricing scheme slaps government price controls on Medicare Parts B and D, financially punishes any drug manufacturer that cannot accept the government-imposed price, and puts Washington's financial interests before the well-being of actual patients.

September 17, 2019 Health Care Consumerism Is Expanding, and Liberals Won't Like It One Bit

by Merrill Matthews

Can patients act like consumers in the health care marketplace? Liberals say no, conservatives, and new evidence, say yes.

September 4, 2019 Drug Importation Is About Politics, Not Safety

by Erin Humiston

A new IPI publication says the revived effort to legalize the importation of prescription drugs has bipartisan support, but the practice remains just as dangerous as ever, since the lawmakers who hope to benefit from the scheme's political expediency simply cannot guarantee the safety of imported drugs.

September 4, 2019 Drug Importation is About Politics, Not Safety

by Merrill Matthews

Importing prescription drugs from Canada or other countries is no safer today than it was more than a decade ago.Importation proponents used to say "show us the bodies" of people harmed by importation. Sadly, today we can.

August 6, 2019 Can You See Any Doctor Under Medicare for All?

by Merrill Matthews

Important distinction: The right to see any doctor doesn't mean the right to see a doctor soon.

July 30, 2019 Congress Considers Bill Targeting Hospital Consolidation

by Merrill Matthews

IPI's Merrill Matthews says the GOP-sponsored bill increases bureaucracy, imposes price controls and is not free market.

July 22, 2019 Don't Let Budget Talks Threaten Medicare Part D

by Merrill Matthews

Overhauling Medicare's Part D drug benefit would be a colossal — and costly — mistake.

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Oct 8, 2019 11:49PM Lumpie wrote:

Trump administration plans to delay any changes if the ACA loses in court

Oct. 6, 2019

If a federal appeals court invalidates the Affordable Care Act in the coming weeks, the Trump administration, which has consistently tried to overturn the law, might be expected to celebrate. But instead, current and former administration officials say, the White House — with no viable plans for replacing critical health benefits for millions of Americans — intends to ask the court to put its ruling on hold. And the administration may try to delay a Supreme Court hearing on the highly charged matter until after the 2020 election.

https://www.washingtonpost.com/health/the-trump-ad...

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 8, 2019 11:59PM - edited Oct 9, 2019 12:03AM by Lumpie

Just to provide perspective, the Institute for Policy Innovation was founded by Dick Armey. It's board includes Republican party officers, an oil and gas executive and a private equity executive. Funders appear to have included the Kochs. These backgrounds likely inform the organization's advocacy and policy positions.

IPI is an ALEC (American Legislative Exchange Council) member.

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 9, 2019 12:58AM marijen wrote:

This does not appear to be a bad thing

ALEC Primary Objective:

Significantly expand the reach of ALEC to new audiences and build up a network of concerned citizens who can help advance the principles of limited government, free markets and federalism.

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Oct 9, 2019 02:13AM Lumpie wrote:

Not suggesting that it is bad. Merely that it informs their positions.

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 9, 2019 07:26AM DogMomRunner wrote:

marijen- it depends on who those “concerned citizens” are. My guess is it will be those who already support their (ALEC) agenda.

Lumpie- my guess is that (even)Trump knows invalidating the ACA without an immediately available plan to replace it is risky right before an election. However, if they win in 2020 they will consider it a mandate to get rid of the ACA.

You ain't run far enough to say My legs have failed You ain't gone far enough You ain't worked hard enough You ain't run far enough to say It ain't gonna get any better. Nathaniel Rateliff Dx 4/24/2019, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/8 nodes, ER-/PR-, HER2+ (FISH) Surgery 5/17/2019 Lumpectomy: Left; Lymph node removal: Left, Sentinel Targeted Therapy 6/6/2019 Herceptin (trastuzumab) Chemotherapy 6/6/2019 Taxol (paclitaxel) Radiation Therapy 9/22/2019 Whole-breast: Breast
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Oct 9, 2019 09:57AM marijen wrote:

Their Agenda is in line with Capitalism and Limited Government. I think the ALEC articles are LOGICAL. Especially this one posted previously.

What Medicare-for-All Supporters Won't Tell You

by Merrill Matthews | Publications | IPI Ideas

https://www.ipi.org/ipi_issues/detail/what-medicar...

I do hope they can put together something that doesn’t have those CRAZY high premiums and out of pocket expenses that the ACA came with.


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Oct 9, 2019 12:42PM Yogatyme wrote:

Yes, health care is certainly driven by the insurance companies (and big Pharma) and it is getting worse for patients and providers. Have you seen the profits of most of the companies, not to mention the salaries of CEO’s of hospitals? I am a retired provider and my experience was that Medicare allowed a reasonable reimbursement rate, as did BC/BS and Tricare. The others were lousy!! As a Medicare patient, I have to say all I have paid out of pocket has been $89.00. This included genetic testing, 4 mammograms, 1MRI, oopherectomy & US, biopsy, BMX along w numerous office visits. People are resistant to a Universal healthcare plan with some valid reasons, but what we are doing now simply is not working. I am appalled by the number of bankruptcies secondary to outrageous medical bills. And those poor folks who take critical medications every other day bc they can’t afford to take them daily.....insulin was $21.00 a vial, suddenly went to about $200.00/vial. This takes them closer to kidney failure and the cost of dialysis. Penny wise and pound foolish. A former colleague just today told me about talking w insurance company about seeing a pt more frequently to hopefully keep her out of the hospital....denied. Of course she ended up in the hospital so the costs of her care increased exponentially!! Grrrrr! A few times when insurance companies denied pre-authorization, I asked for the persons name and stated that I was documenting that they were now the provider of record and I would not take any responsibility for pt care outcome. Amazing how I got the pre-authorization! They want to make all the decisions about care but put all the responsibility on the provider, so if someone gets sued, it’s the provider, not the insurance company.

Yogatyme Surgery 3/3/2019 Prophylactic ovary removal Dx 7/19/2019, IDC: Papillary, Right, <1cm, Stage IA, Grade 2, 0/5 nodes, ER+/PR+, HER2- Surgery 8/13/2019 Mastectomy: Left, Right
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Oct 9, 2019 01:23PM mac5 wrote:

YogaTyme,

It’s now the beginning of decision time for Medicare recipients.

I was trying to do some comparison shopping.

Found out that Medicare Advantage Plans no longer have to pay at least what Medicare pays. They can pay less and selectively chose what is covered.

I also found out that this year you have to pass a medical test to be able to purchase a “Medigap” policy.

Is this the medical “rationing” we were afraid of? Sounds to me like the Insurance Companies are trying not to pay

Dx 7/20/2010, DCIS/IDC, Left, 2cm, Stage IIIB, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Dx 9/5/2019, ILC, Both breasts, 6cm+, Stage IV, metastasized to lungs, Grade 1, ER+/PR+, HER2-
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Oct 9, 2019 02:02PM Yogatyme wrote:

mac5, my experience as a provider is exactly what you are learning. The Medicare Advantage plans pay much less than traditional Medicare and therefore, many providers don’t accept them b/c of it. They advertise that you can see any doc that accepts Medicare......absolutely not true. If the provider is not “in network” w them you cannot see them. For example, I had colleagues who accepted Medicare but not United Health Care (bc of poor reimbursement rates) so could not see pts with Medicare Advantage through UHC. I have not heard about the medigap issue. I have traditional Medicare and a supplement through Mutual of Omaha. Rx drug plan (part D) through express scripts. Depending on your state, I would encourage you to check out Mutual of Omaha. I had a BC/BS supplement for a year and the premium was about $130.00/mo. Exact same coverage w Mutual of Omaha is $83.00/mo. They are a member owned company, so can offer better premium rates. AARP endorses UHC and they are doing seniors no favor. Never forget, insurance companies are in the business of collecting premiums and denying claims.

Yogatyme Surgery 3/3/2019 Prophylactic ovary removal Dx 7/19/2019, IDC: Papillary, Right, <1cm, Stage IA, Grade 2, 0/5 nodes, ER+/PR+, HER2- Surgery 8/13/2019 Mastectomy: Left, Right
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Oct 9, 2019 03:30PM Hopeful82014 wrote:

My understanding is that at certain, clearly defined decision points in one's Medicare participation, anyone can enroll in a Medigap policy without "medical underwriting" which is what mac5 was referring to, here: "l also found out that this year you have to pass a medical test to be able to purchase a "Medigap" policy."

IF one chooses to purchase a Medigap policy outside of those windows of opportunity, yes, there will be medical underwriting, meaning one could be denied coverage OR the premium could be higher. This is not, however, new.

Dx IDC
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Oct 9, 2019 03:48PM marijen wrote:

New Rules in 2020

Medigap Plan F 2020 Rules: MACRA explained MACRA is legislation that changes Medicare Supplement plans. Find out how it affects you!

by Lisandro Bustos+ on Mar 14, 2019 | 12 Comments Tweet


The Medicare Access and CHIP Reauthorization Act (MACRA) is a law that will change Medicare Supplement plans in all states, which becomes effective January 1, 2020. MACRA is a federal law that will change who can buy Medigap Plans F, High F, and C. As of 2020 only beneficiaries that are not newly eligibles will be able to keep Plan F, High F and C.

What's new with Medigap?

Due to MACRA, on January 1, 2020:

  • Medicare Supplement plans with Part B deductible coverage (Plans C, F and high deductible F) cannot be purchased by "newly eligible" Medicare recipients.
  • The following guaranteed issue plans will be accessible for "newly eligible" Medicare recipients: Plans D, G, and high deductible G (which is brand new!)
What is the meaning of "newly eligible" Medicare recipients?

People who are 65 years of age or become first eligible for Medicare because of age, disability or end-stage renal sickness on or after January 1, 2020 are considered "newly eligible". If you already have Medicare part A and B and are reading this in 2019, then you are NOT considered "newly eligible" and the MACRA rules do not apply to you.

How are present enrollees in Plans C, F, and High Deductible F influenced by these changes?

Current enrollees (those qualified for Medicare before January 1, 2020) with Plan C, F, or High Deductible F are able to keep their plan. What's more, they can keep on purchasing Plans C, F, and High Deductible F after January 1, 2020. Current enrollees will likewise have the capacity to purchase the new Plan High Deductible G on or after January 1, 2020.

Learn More about Medigap Get a Medigap Quote

What will happen to Guaranteed Issue Medigap?

Medicare Supplement Plans D and G will be two of the guaranteed issue plans for "newly eligible" beneficiaries on or after January 1, 2020. As stated before, current enrollees can stay with their purchased Plans C, F, and High Deductible F. Even after 2020, People who don't fall inside the category of "newly eligible" will still have the capacity to buy Plans C, F, and High Deductible F for the first time as well. So when you hear rumors that "plan F is going away" those statements are misleading because Medigap plan F will always be available to current enrollees.

Since MACRA is coming in 2020, which Medigap Plan should I purchase now?

You want to select the gap plan that best meets your needs now and in the future. For most of our clients, Medicare Supplement Plan G is usually the best short and long-term fit but this isn't true for everyone in every area. You can get prices and enroll in Medigap Plan F and G here. If you want to discuss your specific case, give us a call at 800-930-7956.

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Oct 13, 2019 02:18PM Lumpie wrote:

It's a good deal for most older Americans, but Medicare is neither free nor easy

"I turned 64 last month and started researching Medicare in anticipation of joining the program's 60 million users. I knew next to nothing about it. I still know next to nothing about it. But I am learning.

"I naively thought that I could present a Medicare card to whatever doctor, hospital or pharmacy I chose and get the service or drugs I required. That is not the case.

"Please consider this column the first of many bites at the Medicare apple. The subject is so massive and complicated that it is best approached piecemeal."

https://www.washingtonpost.com/business/economy/it...

{Author reflects on his experience gaining an understanding of Medicare as a person approaching {age-related} eligibility.}

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 13, 2019 02:34PM Lumpie wrote:

PhRMA: Pelosi Bill Would Mean 'Lights Out' for Drug Startups Drug lobby, feeling heat from Capitol Hill, ramps up its rhetoric

...the bill doesn't specifically take money from drug companies' R&D budgets. Rather, "if it comes out of industry, we think a large share of it would come from R&D expenditures, because in general, there are fixed costs and there are discretionary costs, and R&D expenditures are the most discretionary expenditures a company can make," he said.

Not everyone agrees with the idea that the Pelosi bill would hurt small-cap startup companies. "Most of the money to fund preclinical trials (phase 1 and 2) [is] from the National Institutes of Health; this will not be affected by the legislation," Gerard Anderson, PhD, professor of health policy and management at Johns Hopkins University in Baltimore, said in an email. And the bill's price negotiation provisions "will only affect the best-selling drugs, so if it is a drug in a small market it will not be affected ... I can see that [these companies] will be concerned but it is unlikely to affect them."

Rep. Lloyd Doggett (D-Texas), chairman of the House Ways & Means Health Subcommittee, took issue with PhRMA's criticism of the Pelosi bill. "To describe this narrow bill as producing 'nuclear winter' makes one wonder what cataclysmic term would be applied to genuinely comprehensive negotiation legislation," Doggett said in a statement. "This grim term better describes the fallout from monopoly prices which patients are suffering."

https://www.medpagetoday.com/publichealthpolicy/he...


"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 14, 2019 09:39PM Lumpie wrote:

Tennessee's Opening Bid for a Medicaid Block Grant Tennessee has begun the process of asking the federal government for a block grant for its Medicaid program. Negotiations between state officials and CMS will shed light on how much the Trump administration is willing to concede in order to claim the block-grant mantle.

October 9, 2019
DOI: 10.1056/NEJMp1913356

https://www.nejm.org/doi/full/10.1056/NEJMp1913356...

{NEJM allows access to two articles per month without subscription.}

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 14, 2019 09:41PM Lumpie wrote:

Proposals to Redesign Medicare Part D — Easing the Burden of Rising Drug Prices

Amid concerns about high drug prices, policymakers are considering options for modifying the Medicare Part D prescription-drug benefit to reduce spending by beneficiaries and taxpayers. The redesigns being considered shift spending and benefit phases in various ways.

October 10, 2019
N Engl J Med 2019; 381:1401-1404
DOI: 10.1056/NEJMp1908688

https://www.nejm.org/doi/full/10.1056/NEJMp1908688...

{Includes recorded interview. NEJM allows access to two articles per month without subscription.}

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 14, 2019 09:43PM Lumpie wrote:

Medicare Drug-Price Negotiation — Why Now . . . and How A targeted bargaining strategy using tried and tested arbitration techniques could help Medicare balance drug innovation and affordability. Such negotiation could lower excessively high prices, even as parts of the market where competition works well are left alone.

October 10, 2019
N Engl J Med 2019; 381:1404-1406
DOI: 10.1056/NEJMp1909798

www.nejm.org/doi/full/10.1056/...
{Includes recorded interview. NEJM allows access to two articles per month without subscription.}
"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 22, 2019 05:50PM Yogatyme wrote:

I just heard on NBC nightly news that 1/3 of rural communities have NO EMS services. This is an outrage.

Yogatyme Surgery 3/3/2019 Prophylactic ovary removal Dx 7/19/2019, IDC: Papillary, Right, <1cm, Stage IA, Grade 2, 0/5 nodes, ER+/PR+, HER2- Surgery 8/13/2019 Mastectomy: Left, Right
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Oct 22, 2019 11:49PM Lumpie wrote:

A Commonwealth Fund study looked at eight health insurance reform options and the potential impact on the industry.

A range of healthcare reforms, from incremental improvements to the Affordable Care Act (ACA) to a single-payer system, could result in national health spending savings but might require certain tradeoffs to be effective, according to a new study.

The Commonwealth Fund and the Urban Institute released a report Wednesday morning 10/16/2019 examining eight health insurance reform plans and the potential impact on the industry.

While study's authors acknowledge that the optimal levels of provider payment rates in both a public option and single-payer system remain unknown, the rates would have to be carefully determined as they have a large impact on government healthcare costs.

https://www.urban.org/sites/default/files/2019/10/...

{Lengthy, detailed report - 81 pages}

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 24, 2019 11:58PM Lumpie wrote:

Belatedly responding to Hopeful82014's10/9 post about signing up for Medigap: for those under 65, the availability of Medigap plans depends on state laws. Many states do not allow those under 65 to sign up for Medigap plans. Which means that if you are under 65 and become eligible for Medicare, you have two choices: traditional Medicare with no Medigap which leaves you liable for 20% out of pocket costs or a Medicare Advantage plan. Those who have access to a retiree or spouse's plan may have more/better options. Triage Cancer offers a guide to these provisions: triagecancer.org/statelaws (scroll about 1/3 of the way down the page).

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 25, 2019 12:10AM Lumpie wrote:

'A Government-Sanctioned Shakedown of the Uninsured' In Coffeyville, Kansas, the judge has no law degree, medical debt collectors get a cut of the bail, and patients' lives fall apart

https://www.medpagetoday.com/publichealthpolicy/ge...

ProPublica October 16, 2019

{Profoundly troubling.}

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 25, 2019 12:16AM - edited Oct 25, 2019 12:17AM by Lumpie

Why Are Insurance Executives Treating Our Patients? Kevin Campbell, MD, believes that peer-to-peer consults waste time and harm patients

"...these reviewing MDs are actually compensated for NOT approving procedures."

https://www.medpagetoday.com/blogs/campbells-scoop...


"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 25, 2019 12:29AM Lumpie wrote:

Verma Takes Heat at House Hearing on ACA 'Sabotage' House oversight subcommittee doesn't hold back with criticism of CMS administrator

Verma stated "that the president has said he will have an alternative plan if the ACA is invalidated." DeGette {asked} ... "do you have a copy of the plan that will replace the ACA....?" Verma said she would not "get into any specifics."

https://www.medpagetoday.com/publichealthpolicy/he...


"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 25, 2019 01:09PM Lumpie wrote:

Rates for the most common ACA health plans drop for a second year

The average price for the most common type of health insurance sold through the Affordable Care Act's federal marketplace will drop by about 4 percent for next year, extending a reversal of steep rate increases that daunted HealthCare.gov in its early years.

The 4 percent price drop is not for everyone; it is the average for premiums in 2020 for the popular level of coverage on which federal subsidies are based. The figure is calculated for both a typical 27-year-old and for a family of four. This premium drop comes after a smaller decrease for 2019.The rates announced Monday are for the 39 states that are in the federal insurance marketplace or rely on the government's HealthCare.gov computerized enrollment system.

The data also shows that the number of insurance companies willing to sell ACA health plans has rebounded after widespread defections for a few years.

...the draw of the marketplaces has remained fairly sturdy. According to the most recent federal figures, 10.6 million consumers had ACA health plans as of early this year — a decline of less than 1 percent from a year before.

The next sign-up period, Nov. 1 through Dec. 15, comes as a New Orleans-based federal appeals court is expected to issue its opinion soon in a lawsuit challenging the ACA's constitutionality.

https://www.washingtonpost.com/health/rates-for-th...

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 25, 2019 05:02PM Lumpie wrote:

House Drug Pricing Bill Advances Out of Committee The biggest health care news this week was the approval by the House Ways and Means Committee of H.R. 3, the Lower Drug Costs Now Act — Speaker Pelosi's drug pricing bill. The bill advanced along party lines, with opponents citing a recent report from the Congressional Budget Office (CBO) that said the plan would harm drug innovation and reduce the number of new drugs coming to the market. To address this concern, some Democrats are considering investing savings from H.R. 3 into the National Institutes of Health (NIH) to fund drug research. However, pharmaceutical industry lobbyists argue that NIH cannot replace private sector research and development.

The CBO score also showed that the plan would save Medicare $345 billion over the next decade, as a result of a provision that would allow the government to directly negotiate lower drug prices with private companies in Medicare's Part D drug program. The bill will now head to the full House floor for a vote in the coming weeks. President Trump has not indicated whether he would support the bill, and Paige Winfield Cunningham of the Washington Post reports that Speaker Pelosi and President Trump are still working on a drug pricing deal. She writes, "Were the pair to arrive at any agreement on drug prices, it would be in the face of enormous odds."

Meanwhile, on the Senate side, Senators Grassley (R-IA) and Wyden (D-OR) have introduced their own drug pricing plan — this one bipartisan. Their legislation would impose an out-of-pocket cap for beneficiaries and cap drug price increases at the rate of inflation. The Grassley-Wyden bill has the support of the President and has been described as "middle ground" by lawmakers. With the government funding deadline coming up in just a few weeks, this fall is sure to be busy in Washington.


https://www.congress.gov/bill/116th-congress/house...

https://www.congress.gov/bill/116th-congress/senat...

Related press:

https://www.washingtonpost.com/news/powerpost/palo...

https://www.washingtonpost.com/news/powerpost/palo...

https://www.politico.com/newsletters/prescription-...

{Synopsis above courtesy of National Coalition for Cancer Survivorship.}

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 25, 2019 05:10PM Lumpie wrote:

With the ACA's open enrollment starting November 1, Kaiser Family Foundation has a helpful fact sheet outlining health plan options and what's covered through the ACA.

Thanks to the financial help that nearly 9 out of 10 HealthCare.gov customers receive, 1 out of 3 marketplace customers will have a plan available in 2020 with a premium of less than $10 per month, according to new data released this week by the Centers for Medicare and Medicaid Services (CMS). The vast majority will have a plan available for less than $100 per month. However, many consumers are not aware their premium costs could be that low.

Get America Covered created a chart outlining a knowledge gap among consumers between what they consider an affordable premium and what they expect coverage to actually cost

https://www.kff.org/health-reform/fact-sheet/aca-o...

https://www.getamericacovered.org/news-press


"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 25, 2019 05:17PM Lumpie wrote:

State Border Splits Neighbors Into Medicaid Haves And Have-Nots

Patricia Powers went a few years without health insurance and was unable to afford regular doctor visits. So the Missouri resident, who lives near St. Louis, had no idea that cancerous tumors were silently growing in both of her breasts.

If Powers lived just across the Mississippi River in neighboring Illinois, she would have qualified for Medicaid, the federal-state health insurance program for low-income residents that 36 states and the District of Columbia decided to expand under the Affordable Care Act. But Missouri politicians chose not to expand it — a decision some groups are trying to reverse by getting signatures to put the option on the 2020 ballot.

In early 2016, she discovered a place ...where health services cost less than $30. The doctor found a walnut-sized lump in her right breast, and a mammogram found a tumor the size of a grain of rice in her left. Powers kept thinking she could have found the cancer earlier, if only she had insurance. That would have meant less treatment and lower costs for taxpayers, who ended up footing the bill anyway. Research shows breast cancer in its earliest stage can cost half as much to treat as in later stages.

"Even if you didn't care about the human cost, you should care about the economic cost," ... "Treating a disease at its first stage is always going to be much cheaper than treating it at its advanced stage."

https://www.npr.org/sections/health-shots/2019/10/...


"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right
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Oct 25, 2019 05:58PM Lumpie wrote:

Health Insurance That Doesn't Cover the Bills Has Flooded the Market

David had had a massive heart attack. The Diazes' plan was nothing like the ones consumers have come to expect under the 2010 Affordable Care Act, which bars insurers from capping coverage, canceling it retroactively, or turning away people with preexisting conditions. ...dozens of ... customers say they were tricked into buying plans they didn't realize were substandard until they were stuck with surprise bills. Six months after David's surgery, the Diaz family got a particularly big surprise bill—an error, Marisia thought when she saw the invoice. But when she called her insurer, she was told she'd have to pay the full amount: $244,447.91. HIIQ ...promot{ed} short-term plans and other limited forms of insurance that didn't have to comply with the new rules for comprehensive plans. In an interview with Fox News a few years later, {a rep} argued that these policies offered the same benefits at half the cost. Had Diaz gone to the ACA marketplace, the family would have qualified for subsidies, but {the HIIQ rep} didn't mention that... the broker {said} the policy had an impressive coverage limit of "three-quarters of a million dollars" after a maximum $7,500 deductible. Emergencies such as this were what insurance was for. When Marisia called the claims department, the representative {said} the insurer wouldn't be paying anything beyond ... $4,000 ... And the listed maximum total payout of $750,000 was misleading: It didn't mean the Diazes' bills would be covered up to that amount after they paid the deductible; it just meant that if Marisia underwent, say, 150 surgeries, she could get $5,000 for each, leaving her to cover millions of dollars in additional bills. {According to the Diazes' attorney} "Creating an exception to the requirements of Obamacare is what gave rise to this kind of stuff," he says. "This is what you get—you get people like Mrs. Diaz and her family." The FTC has investigated HIIQ and certain brokers. Litigation is pending. The debt is never far from {Marisia's} mind. "I wake up thinking about it...I go to bed thinking about it. It doesn't go away." The family switched to a comprehensive, ACA-compliant insurance policy in December 2017. With government subsidies, it costs less than they were paying for junk insurance.

Source: Bloomberg September 17, 2019

https://www.bloomberg.com/news/features/2019-09-17...

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Radiation Therapy Whole-breast: Breast Surgery Lumpectomy: Right Surgery Lumpectomy: Right

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