The Healthcare Industry Rules
JUNE 22, 2016
IN THE BEGINNING
The Republican Party’s pre-inauguration pledge to deny President Barack Obama any of his programs worked pretty well for most of these eight years. They have had to stop governing to do that but that didn’t seem to bother them or many throughout America who kept them in office on the national and state levels.
But what they couldn’t prevent was passage of Obama’s very first and signature program: the Affordable Care Act…the one the Republicans belittled by calling it ‘Obamacare’. We heard so much about it that even the President began calling it that.
In an unprecedented series of votes that eventually numbered 84 in seven years, the Republicans tried and failed to get rid of it. It was an embarrassing attempt revealing in its own way how ready the Party was for its present presumptive Presidential candidate.
But here’s a fact: the Affordable Care Act is under attack by the very healthcare industry which won its initial support. And because that industry all but owns Congress, what it wants to do will happen unless a new President and some new members of Congress prove right from the beginning that they will fight or make meaningful changes to continue to help the uninsured…which is what the entire effort is about.
The industry approved the Affordable Care Act because the President abandoned his desire to see a so-called ‘public option’ that like Medicare, might control outrageous cost factors and give the private insurance industry competition which would be very attractive to health consumers. When he abandoned that quest because Congressional leaders told him it was futile, the industry recognized that they would soon be dealing with millions of new customers and signaled its approval. With Congress still somewhat Democratic, the Act passed.
Now the industry finds itself losing money and has decided to take action.
AND NOW…
Earlier this year, United Healthcare, the nation’s largest health insurer, announced that it would pull out of the Obamacare program in New Jersey and most other states at the beginning of next year because they are losing money.
But six months ahead of schedule…and with an indication of what they plan to do …United will no longer provide coverage in one of New Jersey’s largest and best university medical centers or for more than 400 physicians who work at that center – for anyone who purchased healthcare services from Healthcare.gov. – the Obamacare service.
Insurers in 14 cities want increases in 2017 twice as big as 2016
New Jersey regulations require 30 business days notice when a patient’s physician will no longer be part of a managed care network. The regulations call for an insurer to provide four months of a continuity of coverage when the patient is in the midst of ongoing medically necessary treatments. But United is too big to bother with regulations it doesn’t like.
When United’s actions caused complaints to the news media, the proper public relations people at United issued an apology for their actions but did not rescind any changes they had made ‘ahead of schedule’ promising to notify the thousands of patients of its action so they can access new care.
No matter what complaints exist, the industry is well within the law to make any changes of medical or pharmaceutical coverage they care to make at any time. They bought it and paid for it and they own it.
The industry is not embarrassed by its actions. They openly acknowledge that while most patients join some form of coverage thinking that are set for at least a year that is not necessarily the case. While consumers may experience some shock at the total disregard of their needs and concerns, there are absolutely no laws to protect them or to prevent plans from being terminated at any time an insurance company decides to act.
In the situation in New Jersey, Hackensack University Medical Center and its 450-member group of physicians failed to come to an agreement with United Healthcare. While this has no impact on Medicare patients or on those covered by employer healthcare agreements, every other patient is left without coverage until they can find a new way.
There are charges that the insurance field is openly discriminating against those in Affordable Care Act plans but no one seems to be listening.
There are other health plans for people caught in this vice. But little by little the open door in these plans will disappear unless the industry stops losing money and continues them.
The only people who should be listening to the concerns of patients are members of Congress who have the power to act in support of consumers.
We need some able to listen to our voices and not just to the voices of money.