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Oregon Mess: Subsidies Key Defect In Obamacare

Op-Ed by Paul F. deLespinasse, Ph.D.,
Submitted to the Corvallis Gazette-Times Oct. 17, 2014

Two medical stories are headlined in recent  newspapers.  One is local,  but with national implications.  The other is national,  but with local implications.  A common denominator lies beneath both stories.

In Oregon,  more than ten thousand people got inflated tax credits when buying insurance through the exchange set up under Obamacare.  The excess credits may exceed $100 per month, so some people will have to pay substantial amounts back to the federal government.  

The national news is the death of Thomas Duncan from Ebola and the infection of several people who treated him.   Duncan was sent home, when he first visited a  hospital’s emergency room, despite highly suspicious symptoms.  After giving conflicting answers to embarrassing questions raised by this situation, the hospital has hired a public relations firm and allegedly has prohibited staff members from talking to the press. 


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We Are All Underinsured

The Many Faces of UnderInsurance
by davidgimlett Retired Family Physician and advocate of health care reform (not dated)
For The Health Care Reform Blog

As the Affordable Care Act (ACA) kicks in we are moving into an era where a larger and larger percentage of our population will be unable to afford medical care and we will see an increase in an already high number of medically preventable illnesses and deaths and medically related personal bankruptcies. This will result from lack of control over medical inflation and a tidal shift of medical insurance policies into a lethal pattern of underinsurance. The ACA is predicted to decrease the number of uninsured Americans to about 30 million. (1)  Lack of medical insurance leads to at least 55,000 unnecessary deaths a year in the United States. But inadequate medical insurance also takes its toll and it is likely that this problem will worsen dramatically over the next few years in response to the ACA.

 Definitions of Underinsurance
By the common definition, individuals are considered underinsured if their out-of-pocket expenses are more than 10 percent of their income  (5 percent if they were low-income) or deductibles are more than 5 percent. By current definitions 44 percent (81 million) of adults ages 19–64 were either uninsured or underinsured in 2010. 29 million of these adults were underinsured.


Turnaround pro Hamstreet reflects on Cover Oregon woes and solutions

Elizabeth Hayes
Staff Reporter- Portland Business Journal, Oct 14, 2014

Clyde Hamstreet, the business turnaround artist who took the helm of Cover Oregon last spring as the health exchange was sputtering, gives a detailed assessment of its "technology fiasco" and other problems, along with suggested solutions, in a memo released today.

Hamstreet stepped aside in late July, after the new executive director, Aaron Patnode, took over. He prepared his final overview and recommendations on Aug. 29.

“When my team arrived at Cover Oregon in April the organization was in serious disarray,” Hamstreet wrote. “Rarely, if ever, in my experience as a turnaround professional have I encountered so dysfunctional a leadership and management situation. Several executives and managers held positions they did not have the experience or ability to handle and were, consequently, failing.”


Cover Oregon told top consultant, Clyde Hamstreet, to not submit a written report

by Nick Budnick
OregonLive, October 10, 2014, updated October 11, 2014

A consultant's long-awaited report on the state's health insurance exchange was considered so sensitive that Cover Oregon officials asked him not to turn it in, The Oregonian has learned.

The story becomes yet another example of the secrecy that has often cloaked the troubled exchange due to high legal and political stakes.

Gov. John Kitzhaber recruited high-profile business consultant Clyde Hamstreet to take the reins of Cover Oregon last April, at the height of the health care exchange's chaotic technological failure.

Hamstreet's firm left the project in September after getting paid more than $600,000. But documents and interviews show that officials asked him not to deliver the written report he was contractually bound to produce, apparently thinking it would then remain a secret.

The firm's final report could provide valuable insight because Hamstreet, the corporate turnaround expert who heads the firm, served as interim director of the exchange during a crucial time, when the decision was made to shelve the project and move to the federal exchange instead.


Immigrant Groups Try to Block Termination of Health Plans

by Louise Radnofsky
The Wall Street Journal, Washington Wire (not dated)

Immigrant advocates are accusing the Obama administration of violating antidiscrimination provisions in the federal health-care law by moving to terminate coverage for around 115,000 people who bought coverage through HealthCare.gov who didn’t take additional steps to prove they are legal U.S. residents.

Two immigrant groups filed complaints Tuesday with the Department of Health and Human Services’ Office of Civil Rights asking it to block the action, which is being carried out by other units of the department. The Office of Civil Rights is in charge of enforcing rules in the 2010 law that bar discrimination in the sale of health plans.

The groups say the agency didn’t take adequate steps to tell people who speak languages other than English and Spanish that the health coverage they bought through HealthCare.gov was about to be terminated because the federal government couldn’t verify their immigration or citizenship status.


We need Single Payer/Medicare for all!

by US Sen. Bernie Sanders
Tuesday, September 30, 2014

One year after health insurance markets were opened to the public, Politico asked “some of the country's smartest health-care thinkers” what Obamacare hasn't fixed in the American health care system and what we can do now. Sen. Bernie Sanders shared his idea for a Medicare-for-all, single-payer system.

“The Affordable Care Act has made modest improvements in American health care since it took effect. Twenty million Americans have gained insurance under the law, including young people who can stay on their parents' policies and others who may no longer be denied insurance because of pre-existing conditions. The law also has expanded access to primary care to some 4 million more Americans through community health centers that also provide dental care, low-cost prescription drugs and mental health counseling. 

“But the United States remains, shamefully, the only major country on Earth that does not guarantee health care to all its people as a right. And because of the profiteering of the pharmaceutical industry and private insurance companies, the United States spends almost twice as much per capita on health care as any other nation, while our life expectancy, infant mortality and preventable deaths are higher than most other countries. If our goal is to provide high-quality health care for all Americans in a cost-effective way, we must move toward a single-payer system.


Paying Till It Hurts

Costs Can Go Up Fast When E.R. Is in Network but the Doctors Are Not

Luke Adami with his father, Greg. The Adamis took Luke to a hospital that was in their insurance network. Credit Ozier Muhammad/The New York Times

Luke Adami with his father, Greg. The Adamis took Luke to a hospital that was in their insurance network. Credit Ozier Muhammad/The New York Times

For the New York Times, 9-29-14

hen Jennifer Hopper raced to the emergency room after her husband, Craig, took a baseball in the face, she made sure they went to a hospital in their insurance network in Texas. So when they got a $937 bill from the emergency room doctor, she called the insurer, assuming it was in error.

But the bill was correct: UnitedHealthcare, the insurance company, had paid its customary fee of $151.02 and expected the Hoppers to pay the remaining $785.98, because the doctor at Seton Northwest Hospital in Austin did not participate in their network.