Insurance companies threaten to abandon ObamaCare

Update – 4/19, 8:20 p.m. EST: The CEO of America’s largest health care insurer, Stephen Hemsley, announced Tuesday that UnitedHealth will not offer insurance plans on state and federal Affordable Care Act exchanges in most states starting in 2017.

The company announced in November that it had begun to consider dropping out of the subsidized health insurance system for financial reasons.

While UnitedHealth is the biggest overall provider of health insurance in the U.S., it’s market-share among ObamaCare consumers is currently only six percent.

 

Insurance companies are seeking approval to raise premiums for the coming year and are threatening to leave the ObamaCare program if their concerns are not heard.

The major insurance companies are saying that they are losing money on ObamaCare plans and want to leave those marketplaces all together.

“We continue to have serious concerns about the sustainability of the public exchanges,” Mark Bertolini, the CEO of Aetna said in February.

In an attempt to address the costs and strains to the ObamaCare system, the Obama Administration recently introduced a new pay scheme called Comprehensive Primary Care Plus (CPC+).

The five-year plan is being organized by the Centers for Medicare & Medicaid Services (CMS).

“The goal of CPC+ is to improve the quality of care patients receive, improve patients’ health, and spend health care dollars more wisely,” claims the CMS website.

The basic scheme gives doctors more flexibility in primary patient care and rewards them if their patients stay healthy and require cheaper care.

Basically the theory is that if doctors provide better maintenance to their patients, that will reduce costs across the system in the long term.

Doctors admit that the current “fee-for-service” system needs to change, but the jury is still out on whether this new scheme is the answer.

Fee-for-service incentivizes  doctors based on the amount of “care” they provide, whether it is needed or not. This incentive system raises costs of healthcare across the system.

“We’re trying to shift the incentives, to give physicians the freedom to meet the needs of their patients as they see fit,” said Dr. Patrick Conway, the chief medical officer at the Centers for Medicare and Medicaid Services. “In the future, we’d like to see better coordination of care and smarter spending of health care dollars.”

Studies dating back to 2012 show that a third of all money spent on healthcare is wasted.

“Primary care doctors are under so much pressure right now. They just want to be able to practice medicine,” said Dr. Meena Seshamani, director of the administration’s Office of Health Reform. “We’re saying, take care of your patients the way you think is most effective, and you’ll be rewarded for good outcomes.”

 

[Politico] [The Hill]

2 Comments

  1. SHARON

    Why is taking care of all people, especially those who can not afford to Pay such HIGH PRICE for Medical Care so Bad?  How about Congress come up with,  HOW TO LOWER THE COST OF WHAT IS BEING CHARGED BY Health Care System , Hospitals? WHO IN THE H—, CAN PAY YHOSE COSTS?  Then they ruin your credit because , you were hurt…….I  DIDN’T ” BUY” THAT  ACCIDENT, THAT OPERATION, THAT NEED TO USE A HOSPITAL,  OR DOCTOR.!  MAKE IT AFFORDABLE, SO IT CAN BE PAID FOR. 

    1. Richard Lord

      How can doctors deal with patients effectively when 40% of their workday consists of billing, dealing with insurance companies and compliance with federal regulations? 

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