This is
sort of a departure for me.
I work for
Regence Blue Cross/Blue Shield of Oregon. I recently participated in Innovation
Week there, and blogged about it here. While working on that, it occurred to me
that the presentation I recently gave to my team might work well as a blog
post, even without the PowerPoint format. I'm not sure where this would fit in
with work/life balance, but I am giving it a shot.
There is
still a lot of misunderstanding about the Affordable Care Act. When asked about
the Act being in effect a few months ago…
- 12% thought it had been overturned by Congress
- 7% thought it had been overturned by the Supreme Court
- 23% didn’t know
I had my
group go through a quiz together that you can find at http://kff.org/quiz/health-reform-quiz/.
Feel free to take it before continuing here.
My group
did okay. The one that surprised me the most is that a majority of people did
think that health reform law would establish a government panel to make
decisions about end-of-life care for people on Medicare. I thought this one had
been pretty well debunked. Fortunately, it is one of the more interesting
stories, so a large chunk of the presentation was spent going over the topic.
Evolution
of a misconception
1991 – The
Patient Self-Determination Act requires health care providers, including
hospitals, hospices, and nursing homes to provide information about advance
directives to admitted patients.
2003 – The
Medicare Prescription Drug, Improvement and Modernization Act began providing
reimbursements for end-of-life care discussions with terminally ill patients.
2009 – Rep.
Earl Blumenauer (with three Republican cosponsors) proposes standalone bill to reimburse
office visits discussing end-of-life issues, including living wills and advance
directives, every five years for Medicare patients. Proposed in April, the
standalone bill was soon tabled and inserted into the Patient Protection and
Affordable Care Act that was being worked on.
July 16, 2009 – Betsy McCaughey, former
lieutenant governor of New York, called it “a vicious assault on
elderly people” because it required the elderly every five years to be told
“how to end their life sooner.”
July 24, 2009 – McCaughey wrote an op-ed saying
that presidential advisor Ezekiel Emanuel did not believe the disabled should
be entitled to medical care (this was false). Within a few days,
representatives like Rep. John Boehner were being quoted about government-sponsored
euthanasia.
August 7th, 2009 – Sarah Palin first uses the phrase
“death panel” on Facebook.
March 2010
- The provision was removed from PPACA prior to it becoming law.
January 4, 2011 - A proposed Medicare regulation to
pay for end-of-life care consultations was also deleted.
Many of us
with aging parents can imagine the value of our parents having coverage for
periodic talks with their doctor about potential issues and options. Many of us
can probably also imagine those parents getting irritated, feeling threatened,
or saying something about how we will be relieved when they are gone.
There were
multiple factors that contributed to the confusion. We can't ignore politics,
but access to healthcare is an emotional issue, there have been changes and
developments as the law was being worked on and enacted, and healthcare in
general is a complex system with many moving parts.
I was lucky
in that I had examples from personal knowledge of people dealing with various
issues in three of the four states that we cover. (I'm sorry but I have no
stories from Idaho.)
Washington: Politics was an issue for Tara
Dublin, whom you may remember as a popular DJ, but who has been open about her
financial struggles since losing that job. When the Washington exchange opened she signed up
quickly, and tweeted about her happiness to have health care again. She was
abused for this - not just because people who followed her were displeased, but
because there were people specifically looking for positive references to the
new exchanges so they could spew inaccurate vitriol.
Oregon: The constant changes led to some confusion for my
sister Maria. We kept hearing stories of the Oregon exchange not working at all, so she
used the phone number to sign up, but that just led to them sending her
paperwork with her options that she was supposed to complete online. The site
worked perfectly. I still have no idea how. I am curious about what will happen
with the Oracle litigation. Something was going wrong, but it did not have to
prevent signing up. I wonder whether there were people who could have used that
information.
Utah: Finally, a friend in Utah ran into an issue with his signup.
He has a disability that does not completely prevent him from working, but can
hamper it, which I believe is why he was on Medicaid at one point, then he got
off of it. The best option for him at the time of the deadline was to go back
onto Medicaid, but there was a $2000 penalty for re-enrolling.
He was very
upset. He was talking about the government valuing minorities over the
majority, and moving to Australia. Ultimately, the penalty is a quirk
of Medicaid, not the Affordable Care Act, and it probably won't affect that
many people, but when you suddenly need $2000 it hurts. He has calmed down, and
is not emigrating now, but I am not sure that he is completely reconciled to
the law.
My
group does not work directly with creating plans or assisting customers, so
some of this might feel like it is interesting but not directly relevant. The
main thing that we knew was that as we waited for programming to be completed
it led to weeks where there was not a lot for us to work on followed by weeks
of trying to catch up. I hoped the presentation would give us a broader
picture.
For
one thing, I had noticed some changes in some of the plans we were auditing,
with less exemptions and increased coverage for preventive care. These are good
things.
Just
by knowing that we do work in insurance, people may ask us questions, and if we
can give them clear answers and dispel some confusion, that is a good thing.
Most
of all, there are a lot of reasons to feel good about working for a non-profit
corporation. We have heard horrible stories before about insurance companies
dropping customers after a major accident or illness, about letters that falsely
told customers their old plans had been dropped and only provided the most
expensive options as alternatives.
I
remember shortly after Moda bought the naming rights to the Rose Garden there
were two letters to the editor in the Oregonian. One Moda customer had just
received notification that his rates were going up, and another was told that
his medication was no longer covered. It might be coincidence, but it's hard
not to be suspicious.
For
our company, our core values are focused doing well for our members and for
health care. There is no overriding commitment to shareholders, because we have
none. We can feel good about working for Regence.
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