Tag Archives: Bob Latta

2018 Rate Review

New for 2018, Marketplace rates for children will rise 20% to 53%, on top of the additional average 20%-30% rate increase insurers in Ohio demand in 2018.

Child rates in the past they have always been 63.5% of the adult base rate until the age of 21. Next year, 0-14 will be 76.5% of the adult base rate, with ages 15 to 20 being 83.3% to 97% of the adult base rate.

The prescription to fix what ails the U.S. healthcare situation is Expanded and Improved Medicare for All, or single-payer, if you prefer the generic.

2018. We all know how it’s going. We are supposed to feel lucky that we can at least still buy health insurance. And after what we witnessed in Congress this year, and how it could have gone, but for one vote, we know we’re damn lucky.

We were warned that rates would go through the roof this year. That’s due to the uncertainty of the government reimbursing insurers for CSRs, the uncertainty over the insurance requirement mandate, the uncertainty of a repeal, as well as the totally understandable (not), predictable, ever-rising, unsustainable, runaway medical and non-negotiable pharmaceutical cost factors, that alone amount to a 7% rate increase in 2018, along with the resumption of the ACA tax on premiums that was halted last year, and some increases in administration costs. We are braced for rates to going up 20 to 40% or more. Hands above our heads, they got us, we’ll pay!

But at least the ACA, warts and all, has survived the Congressional guillotine, and most of the 6% of the U.S. population that comprises the individual insurance market is certainly grateful for another year of being able to buy health insurance.

But what a sneaky thing the child age rating hike is, which raises the rates for all children under the age of 21 by 20% to 53%. CMS snuck that in on December 16, 2016, just after Trump was elected. That, on top of all the “uncertainty,” the rising medical costs blah blah blah, 2018 is going to be a real doozy.

Which is why a typical family may see a rate hike of 29% for themselves, and 71% for their children.

Family in 2000 has been through it all

Take your typical Ohio family – say, John and Pam, who are 55. They have two kids who are 17 and 20. John is an independent contractor and earns $78,000. Pam is an adjunct university professor and earns $21,000. Together they make $99,000 before taxes, just over the 400% Federal Poverty Level that would qualify them for a health insurance subsidy. Their net income after taxes is $78,000.

Having to buy individual insurance, they chose Molina, because that was the only plan in which they could find doctors who would accept them as patients.

Toledo, Ohio is a closed town when it comes to doctors accepting new patients. When it became too costly in 2016, John and Pam had to give up their Medical Mutual PPO insurance and hence their ProMedica doctors that they had been going to for 20 years. Molina was one of the cheapest insurance plans they could buy. But they had to find new doctors, because their long-time doctors didn’t accept Molina insurance.

Mercy doctors were in the Molina network, and they were not as closed as ProMedica doctors.  That’s why they chose Molina over CareSource, another cheap plan, but one with a 90% inaccurate provider network, a network that supposedly included ProMedica doctors, but not really. (ProMedica, when last checked, had only one primary care family practice doctor accepting new patients, but you’d have to call back in a month to schedule an appointment, which supposedly would be scheduled for three months after that.*)

If they had made just two thousand dollars less (see Kaiser subsidy calculator here), John and Pam would have qualified for a $3,334 subsidy this year (undoubtably it would be more than $6,000 in 2018 because the SLCSP which is tied to the subsidy may be 20-30% more, in tandem with the rest of the plans; see rate increases below.) The subsidy would have reduced their health insurance premiums to 10% of their gross income for a silver plan, but alas, they make too much money to qualify.

John and Pam chose a gold plan with a lower deductible because they couldn’t afford the risk, just in case, of having to come up with $7,500+ to meet the deductible before the insurance would kick in.

With an increase of over $6,000 in 2018 for health insurance, their tightest budget, cutting down on food, recreation, transportation and clothing, exceeds their net income. Forget about helping with their kids’ education or even saving for their own retirement, which is coming in 10 short years – in 2018, they are going into credit card debt on their necessary expenses just to be able pay for health insurance.

As it was, in 2016 John and Pam paid 22% of their net income on health insurance, $17,448, at $1,454/month. It was a lot more than they were paying just a few years before. An affordable and reasonable percentage, in keeping with the spirit of the ACA, would be 13% of their take-home, or 10% of their gross. John and Pam make more money than most families in Toledo, but to have 22% of their net income going to pay for health insurance really hurts.

In 2016, John and Pam’s rates were $554.50 each per month, and the kids’ rates were $172.62 each.

But next year, in 2018, John and Pam’s health insurance will go up 39%! It will surpass housing as biggest chunk of their budget, becoming a whopping 31% of their take-home income, $24,240 for the year; $2,040/month. The astronomical but necessary expense squeezes out any money that could ever have been saved for retirement, which they need to fund, and eliminates any possible budget they may have hoped for to help their kids with higher education expenses.

While John and Pam’s health insurance is going up 29%, health insurance for their kids goes up 71%. The family’s health insurance premiums next year will cost $6,792 more than last year!

In the midst of uncertainty and rising medical and unnegotiable pharmaceutical cost factors, what a sneaky rate hike this children’s age rating hike is, and what a scary thing it is for families like John and Pam’s. Thanks, elected officials, for looking out for our best interests. Maybe it’s time to stop the killing and let everyone in on Medicare, expanded and improved.

OTHER OBSERVATIONS

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Toledo is down to five insurers for 2018, listed on the left -- Ambetter, CareSource, Molina, Medical Mutual HMO, and Paramount.

Medical Mutual PPO, United Healthcare, Anthem and Aetna have flown the coup. Also gone is HealthSpan and InHealth, the failed co-op.

Anthem is actually continuing in one tiny, rural county in southern Ohio, with just a few people, just so Anthem can stay in the game, if you call those fair rules, just in case it wants to jump back in, in the next five years. Aren’t they clever at the expense of the public good. But since healthcare is not considered a public good, they can make profit over people all day long, and into the next decade, until they’ve squeezed it dry.

Since all five insurers’ prices are going up about the same, people who receive a subsidy may come out somewhat unscathed. Ironically, the government that caused the uncertainty that led to the increases will be funding the increases via the subsidies. If only the government would take that money that they throw at a multitude of greedy, demanding insurance companies, and allocate it to an expanded and improved Medicare for All, we’d have a pretty nice single-payer system in the U.S., which would go a long way to stimulate our economy. The structure is already in place, and so is the money.

Too bad for the 30% like John and Pam who don’t get a subsidy; their health insurance expense is simply unsustainable. They may have to keep working into their seventies, because there’s no way they can save money for retirement when the insurer gets every red cent.

“You will take the rate hike and be happy, you weak, helpless, but ever so lucky little suckers!” they seem to be saying to us.

Four of the five babies in the photo are crying, because they just can’t get enough money. They realize that only one with a certain je ne sais quoi will win in the end.

We have a miserable rotten, broken healthcare system, and our leaders really dug in this year to make it even worse than that. If we want to survive as a nation, we will eventually have single-payer, as it has been proven to work well in the rest of the civilized world. But apparently not before a lot of greedy pockets are lined and the corporate for-profit ravens pick every last bit of flesh there can be, all the way down to the bone.

See also, June 11, 2017 Rate Review Observations

The preferred prescription to fix what ails our country is  Medicare for All, also available in a generic single-payer form. Money and lives will be saved.

UHCAN’T Find a Doctor

An Open Letter to the Board Members and Partners of Ohio’s UHCAN (Universal Health Care Action Network):

All of Ohio can thank UHCAN (http://uhcanohio.org) for sabotaging our healthcare in the individual market. UHCAN is our watchdog, they get grants to advocate for us, and shame on them for not doing their job.

We have an opioid epidemic in this country and Ohio ranks first. Could Ohio’s 90% inaccurate health insurance provider networks have anything to do with it?

It was recently reported that 715,000 Ohioans gained coverage through the ACA expanded Medicaid, and that 215,000 of them are seeking treatment for opioid addiction. Wow. One third.

We can assume that a good percentage of the Marketplace consumers are also in need of treatment. But when they are faced with a brick wall finding a doctor, after they have signed up for a plan, they are unable to get treatment, so they continue to use, and some of them die.

One year ago, last July, I went to a lot of trouble, all on my own time, to call every PCP doctor listed on every plan sold in my city, Toledo, doctors listed by the insurers as accepting new patients. 308 doctors in total. I discovered that the plans being sold are grossly inadequate, and average of 80% inaccuracies, two in fact had 90% inaccuracies! I made complaints to the insurers, to my elected representatives, to UHCAN, to the Ohio Department of Insurance.

It was a story big enough for the New York Times to report, on December 3, 2016.

Kathleen Gmeiner, a lawyer at UHCAN, was all set to send my complaints to an important contact she had at CMS. Even though she was aware of my complaint for several months, she waited the entire Fall, and then, ready to send the info in December, she was told by the director, Steve Wagner not to bother after all.

She didn’t send it, she tells me now in an email, because:

Once Donald Trump took office it became clear that the new administration was giving states a lot of flexibility and it would be unlikely anyone in the new CMS would aggressively require Ohio to take more steps around network adequacy.

Depression over the newly elected president?

Or was it depression because UHCAN’s grants were about to dry up?

UHCAN couldn’t even do that one thing that I presented to them on a silver platter.

No administration would allow insurance companies to have 90% provider network inaccuracies. To take our healthcare money and squander it away, especially when we have an opioid crisis in Ohio, is not anything the CMS would condone.

How presumptive of UHCAN to decide on their own that our nation’s overseers of medical spending and the administration of Medicaid and Medicare would not care that Americans are getting ripped off by inadequate and misleading, highly inaccurate provider networks. For UHCAN to withhold my information from the CMS is outrageous, unacceptable, and disgusting. And what a waste of grant money!

No wonder Ohio has the worst statistics for drug addiction. Our entire state, including UHCAN is sick. What drugs are they on at UHCAN, that makes them so heartless, that they can’t advocate for the people of Ohio, the sole reason for their existence?  90% inaccurate provider networks; people dying in the streets.

Yet another example of mis-used grant money.  Grants SHOULD be cut going to UHCAN Ohio. Because after all, UHCAN’T even do this one little thing to help Ohioans get healthcare after they buy health insurance!

UHCAN’T find a doctor on provider networks, and here we have an opioid epidemic!

You CAN, and you MUST, do better than this!

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Steve Wagner, director of UHCAN Ohio, on the UHCAN Ohio Facebook page, June 29, 2017, and my comment.

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UHCAN'T be serious, your mission is to achieve high quality, accessible, affordable health care for all Ohioans? Really?

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UHCAN's partners

Look who is UHCAN’s partner — CareSource, with their 90% inaccurate provider networks! Conflict of interest, to say the least.

Dear Bob Latta

Dear Representative Latta,

Thank you for your letter dated April 28 in reply to my letter dated March 7 in regard to healthcare reform. You state that “we need to empower states to deliver health care solutions that lower costs, increase quality, and improve coverage.” Here is why that will never work in Ohio:

The special interests of the health insurance industry are even more cozy with the state of Ohio than it seems they are with Congress, if that could even be possible. It is the lobbyists who control everything in Ohio, from educational luncheons with our legislators, to the wording of laws that are written to control them, to the actual running of the insurance department. It’s so crowded in Columbus with special interests, that there is no room left for the interests of the people who live in Ohio.

I have written to you about these issues several times in the past year, in fact I made an entire website based on these issues, OhioCitizenRateReview.Info.

In case you never read my website, this is what the state of Ohio has done with their empowerment that they’ve had in the past seven years:

1. Ohio lets every rate hike go through no matter what. Every rate hike the insurers want, the insurers get, regardless of how unrealistic it is for the economy of Ohioans.

2. Ohio does this in secret, without “Effective Rate Review”, a “check and balance” that was provided for in the ACA law. With several million dollar grants from the CMS, Ohio was supposed to have set up a transparent system for citizens to be informed and have open discussions about the annual rate hikes the insurers ask for every year. But they don’t. They keep everything as secret as they possibly can.

3. In secret, and without properly addressing my 2015 complaint, Ohio allowed Medical Mutual to eliminate their PPO insurance in the individual market, after granting Medical Mutual rate hikes of 373% over seven years. About 100,000 Ohioans were personally affected by this elimination of Medical Mutual’s PPO, which was the only national network insurance available in Ohio to individuals. This was probably the biggest market share, but Ohio let them do it, without any fanfare, without any discussion, and at the same time, while rewarding Medical Mutual with the state of Ohio’s employee insurance business. Ohio employees get Medical Mutual PPOs, but not the individuals of Ohio.

4. Complaints made to the Ohio department of insurance get buried. So that Ohioans who have problems with insurance companies in the state of Ohio have absolutely no voice and their problems have no resolution.

5. Our provider networks in Ohio are unacceptably inaccurate. This falls under the jurisdiction of Ohio laws as well as federal laws. A new state law was passed last year that was supposed to ensure their accuracy, but Ohio won’t enforce it. Last summer I called all the PCP doctors in the ACA networks in Toledo listed as accepting new patients, 308 doctors, and only 20% were actually accepting new patients. 10% in the “affordable” plans. I informed you, you did nothing. I informed my state representatives, they did nothing. The New York Times reported on it in December. Not a peep from you, but your colleague in Lima, Jim Jordan, spoke out in favor of the flawed directories, saying “It should surprise no one that the Ohio Department of Insurance’s physician directories are so flawed, considering how flawed the Affordable Care Act (ACA) is.”

And now you want to give the state even more control so that they can further pervert our healthcare system for their own personal greedy purpose.

You were elected, Bob Latta, to represent us in Congress. It’s your responsibility to look out for us on a federal level. We didn’t elect you for you to skirt your responsibility and send it back to the states.

We need healthcare to be thought of as a public good, and not a Wall Street money machine. We have a democracy, not a monarchy. Money is not king. You were elected by the people, not appointed by lobbyists who crown you with their favors.

As I wrote in my previous letter, you should be addressing the problems of healthcare costs instead of letting them grow and grow.

It’s absolutely a lie for you to say in your letter that the AHCA will lower premiums by 10% and allow us to keep our doctors. Premiums for those over 50 will go up five times as much as it will cost others, and millions of people will not be able to keep their doctor because they will not be able to afford insurance anymore.

If you can’t give us what we need, or at least enforce the laws that can fix the problems with the ACA, then just leave it alone, so that we can vote you out of office, and elect a Congress who will give us what we need.

Sincerely,

Penny Gentieu

Noblesse Oblige

My Northwest Ohio federal and state senators and representatives, governor, with the lieutenant governor who is also the director of the insurance department, and the state Medicaid director.

We elected these people but King Moola rules.

Please can they throw us some crumbs.

Click on the crowns to read about my representatives. I’m deeply disappointed that they won’t fix the problems that are completely in their control to fix right now, like the highly inaccurate provider networks, and the transparency that the ACA provided for that they won’t abide by, and that they won’t pass an emergency “any willing provider” law so I can take my insurance dollars to my own doctor, and I’m shocked that when they say they are going to give us something better than the ACA, that they only think of the insurance industry, still putting profits over people. King Moola rules. Please, mini Moolas, please please throw us some crumbs!

If you are going to let yourself be crowned by the lobbyists, at least understand the concept of noblesse oblige. It’s like this: the masters must be responsible for those they tame.

Medicare for All NOW!

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Click on this image to see the Kaiser Foundation’s Interactive Map of Tax Credits under the Affordable Care Act vs. the American Health Care Act, sure to make you very sick when you see what our House of Representatives has been up to in the past two months.

My call to Rep. Latta and follow-up letter on March 7.  Please call too — 202-225-6405

Dear Representative Latta,

How is it right that this country further discriminates against certain groups of Americans when it comes to healthcare?

Why aren’t you addressing the real problem which is the amount of money we spend on healthcare and the rate in which it’s going up each year, at an unsustainable rate which has grown to be 18% of the GNP and is actually estimated to be 30% in 2040?

Why are pharmaceutical companies allowed to price-fix generic drugs to jack up prices by 8,000%?  Why are they granted orphan status which permits extremely high prices on mainstream popular drugs like Abilify, Crestor, and Humira, the best-selling medicine in the world?

What about all the hospital mergers, and the secret prices with no transparency, and the double-digit premium price hikes? What about the skinny provider networks with 80% inaccuracies? What about families plagued with medical bankruptcies?

Since everybody needs healthcare at one time or another, why don’t you treat it like a utility that we all need that is publicly regulated, or like the fire department that is paid-for through taxes?

Instead, the House of Representatives does nothing to address any of these problems. You come out with this extremely regressive, insulting, age-discriminating bandaid to the current Affordable Care Act and call it the American Health Care Act.

Under this law, is it fair that people in their fifties and sixties will be paying five times more than others?  Do you think we really have the money to pay that, when health insurance has already gone up for us 350% in the past ten years?

When the median family income in Lucas County is $41,777, how can you think it’s okay for health insurance to cost $25,000?  Or do you think that healthcare is something only for the rich? Of course the average family can’t afford it. So what do you do but take the subsidies that were income based, and you make them age based, across the board, to everyone regardless of their wealth, to continue this medical industry corporate welfare.

Don’t you think that the underlying costs that make health insurance so expensive should be put in check? Have you considered that the high administration costs, adding up to be at least 30% of our total healthcare costs, could be kept down to 5% if we didn’t have hundreds of insurance companies trying to manage our healthcare, instead of just one manager, such as Medicare?

Do you really think that in 2017, Americans do not deserve healthcare? All Americans deserve affordable healthcare, and it will be affordable when people are put first, before special interests. We demand Medicare for ALL.

Sincerely,

Penny Gentieu

Too Much Passing the Buck

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Oliver Stone said on Late Night with Stephen Colbert that the information we are given about what is going on in the world is like a Disney cartoon.

And that is how it was last week with Lt. Governor and Director of the Ohio Department of Insurance, Mary Taylor’s testimony to the Congressional Hearing of the Homeland Security and Governmental Affairs Committee on the state of health insurance, and the propaganda that followed. It’s the same old they-don’t-say-anything, meanwhile letting every premium rate hike go through. How can we get our facts out to the world?

Hello Mary Taylor — we can’t find doctors. Stop squeezing us like geese. You are Lieutenant Governor, not Lieutenant General. We are not your toy soldiers.  We the people will not give up our rights or put down our lives to advance your personal political agenda.

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Barbara R. Sears, Assistant Director
Governor’s Office of Health Transformation:
"I am not involved with the Department of Insurance in my position in the Governor’s Office of Health Transformation (OHT) and cannot speak for the Governor, the Department of Insurance or provide a position from OHT on these issues."
But Barbara Sears, your neighbors who put you in office are hurting!

We can’t find doctors!

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Wishful thinking trying to get a message through to Committee members.

While they fight over politics we can’t find doctors.

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$10,000 per person and we can’t find doctors!

Model with cow, Denmark. Sven Türck (1897-1954)

CMS with new provider network ratings this year:

We can’t find doctors!

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Dear Insurers:

We can’t find doctors!

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Dear ProMedica, Toledo Clinic, and University of Toledo:

We can’t find doctors!

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Dear Governor Kasich:

We can’t find doctors!

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Dear Marcy Kaptur:

We can’t find doctors!

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Dear Senator Brown:

We can’t find doctors!

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Dear Health Journalists:

We can’t find doctors!

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Constituents to Congress:

HELP!

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We can’t find doctors.