Friday, March 2, 2018

Behold the GOP's Health Care Profit Driven Vision

It's time to take a look at the never-ending nightmare of GOP health care meddling, and how the U.S. system keeps picking the pockets of the Amercian people for their ghoulish bottom line. Hail corporate profits!

GOP ACA Repeal now based on GOP's own Axing of Individual Mandate: Can they get away with this? And get this; “Scott Walker, avowed Obamacare opponent, passes law to shore it up”: yet he also signed off on letting state AG Brad Schimel join the Texas lawsuit to repeal the ACA. Doh!!!
Twenty state attorneys general have filed a new lawsuit that — like the many lawsuits before it — aims to take down the Affordable Care Act ... The suit makes a new legal argument that relies on Congress's recent repeal of the individual mandate penalty. This lawsuit starts from Congress's recent decision to ax Obamacare's penalty for not carrying health insurance, reducing the fine from $695 to $0 — essentially getting rid of the provision.

In previous rulings, the brief argues, the Supreme Court has stated that this mandate is crucial to making the Affordable Care Act work. With the individual mandate penalty killed, the lawsuit argues that the entire law is no longer workable and ought to be struck down.

Or, as the lawsuit itself puts it: "Once the heart of the ACA—the individual mandate—is declared unconstitutional, the remainder of the ACA must also fall."
GOP's Medicare Advantage Con for Profit: The privatization of Medicare promoted through Medicare Advantage has gamed the system, costing $1 billion. This is the GOP's baby, and yet no one is shouting this from the mountaintop:
The U.S. Justice Department recently has been dealt heavy blows in its quest to recover millions in allegedly fraudulent Medicare Advantage payments to UnitedHealth Group. The federal government ditched most of its False Claims Act lawsuit

The federal government will only litigate whether the data used to secure more than $1 billion in Medicare Advantage payments was invalid. 

The Justice Department has opened several investigations into the upcoding practices in the Medicare Advantage program. UnitedHealth, Aetna, Health Net, Humana and Cigna's Bravo Health are all under federal scrutiny for potential upcoding issues. Risk scores were created to incentivize plans to cover all seniors ... several whistle-blower lawsuits in recent years that allege health plans have been inflating the scores to collect more funds. The lawsuit claimed UnitedHealth collected payments from false claims that it treated patients for conditions they didn't have, for more severe conditions than they had, conditions that had already been treated, or diagnoses that didn't meet the requirements for risk adjustment.
Insurer Denials to Treat Americans Back Again...: Without the ACA's built-in protections to provide Americans with complete health care coverage, insurers are already denying claims without even looking at them. It didn't take long, did it? Anyone see a problem?
Two leading Senate Democrats asked Aetna to hand over information about its prior authorization process, citing concerns that their practices may have violated federal law ... during a deposition that he never reviewed patient medical records when deciding whether to pay for treatment.

Wyden and Murray said Aetna's behavior in the California case "appears to violate safeguards put in place by the Affordable Care Act," which require insurers to allow beneficiaries to review their file.Aetna has acknowledged that six state regulators are looking into its prior authorization practices

The critique comes as congressional Democrats worry expansion of insurance plans that don't comply with Affordable Care Act coverage protections will lead to a higher number of similar cases. The Trump administration has lifted the time-limit on short-term plans, a move that critics say will pit these plans in direct competition with traditional insurance. "These junk plans skirt key consumer protections included in the Affordable Care Act that bar insurance companies from ignoring appeals, denying care or charging people more because of their age, gender, or because of a pre-existing condition," the senators' release said.

GOP's Rube Goldberg "Group" Insurance Plan to Raise Rates, Reduce Coverage and Promote Junk Policies: Nuff said...
As many as 4.3 million people are projected to leave the individual and small group insurance markets to enroll in association health plans over the next five years ... premiums in the ACA individual and small group would rise as much as 4% between 2018 and 2022, according to healthcare consulting firm Avalere Health ... projected that another 130,000 to 140,000 people would become uninsured in five years, compared to current law. 

The Trump administration in early January proposed a rule that would allow more small businesses and self-employed workers to band together to buy insurance under association health plans ... but many health policy experts have argued that association plans not required to offer the same benefits and consumer protections as ACA-compliant plans ... with fewer healthy members to balance out the cost of the sicker, older enrollees, Avalere said.
It's Back - That "Preexisting Condition" Killer Gets Trump Endorsement: It's called a "short-term" plan...that could last forever. Republicans are again, trying to separate the deserving healthy from the burdensome sick, just like Jesus would have done:
According to the proposed rule on short-term plans, plans that don't fully comply with the law's coverage mandates ... people can re-apply for these policies. They would not be automatically renewed since they would have to face screenings for chronic and pre-existing conditions. Should enrollees pass these underwriting screens, they could hold the short-term plans for as long as they want, which critics say pits these plans directly against traditional insurance. They also pose higher out-of-pocket costs for enrollees and some exclude coverage mandated by the ACA, such as maternity care ... do include annual coverage caps.
Going Back to our Future-Preventable Deaths Return with a Vengence: No, Health care was not better before the Affordable Care Act. In fact, it was a killer:
Little by little, the Trump administration is dismantling elements of the Affordable Care Act and creating a health care system that looks more like the one that preceded it. But some states don’t want to go back and are working to build it back up.

Congress and the Trump administration have reduced Obamacare outreach, weakened benefit requirements, repealed the unpopular individual insurance mandate and broadened opportunities for insurers to offer inexpensive but skimpy plans to more customers.

Last week, the administration released its latest proposal along these lines, by changing the definition of so-called short-term plans that don’t need to follow any of the Obamacare requirements, including popular rules that plans include a standard set of benefits, or cover people with pre-existing conditions. Taken together, experts say, the administration’s actions will tend to increase the price of health insurance that follows all the Affordable Care Act’s rules and increase the popularity of health plans that cover fewer services. The result could be divided markets, where healthier people buy lightly regulated plans that don’t cover much health care, lower earners get highly subsidized Obamacare — and sicker middle-class people face escalating costs for insurance with comprehensive benefits.

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