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Valued Social Butterfly
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Re: INSURED - GREAT, BUT WHERE? THE FIGHT OVER SOME OF THE SICKEST -

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Message 1 of 8

@rker321 wrote:

Gail,

The only solution that I can see about everything that you have posted is to simple have a Single Payer system. 

It will become extremely complicated an all the people involved in any of the issues that you have told us. Would simply not be there.

We need stability and complete coverage. period.

I really don't se any other solution.


This scenario shows how complicated health care coverage gets when you are working with risk factors in a private marketplace especially considering those who are some of the sickest.  In this case, as we are currently set up, these patients might be making the wrong decision if a transplant is in their future and they choose private insurance rather than Medicare.  Not because the insurers would refuse the care but because their supporting charity would not pay for the patients share of the cost.

 

As far as a single payer system goes, figure up how much it would all cost, how the funds will be collected and who will be paying, because most likely only about half of our populace could pay, then figure out what will be covered and I guess, we are good to go -

 

Remember I posted about H.R. 676 re-introduced by Congressman Conyers (D - MI) last year and you thought it was too extensive in coverage.

Everybody needs something and they all want it covered.

 

 

 

* * * * * * It’s Always Something - Roseanne Rosannadanna
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Re: INSURED - GREAT, BUT WHERE? THE FIGHT OVER SOME OF THE SICKEST -

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Message 2 of 8

Gail,

The only solution that I can see about everything that you have posted is to simple have a Single Payer system. 

It will become extremely complicated an all the people involved in any of the issues that you have told us. Would simply not be there.

We need stability and complete coverage. period.

I really don't se any other solution.

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Re: INSURED - GREAT, BUT WHERE? THE FIGHT OVER SOME OF THE SICKEST -

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Message 3 of 8

The rest of the story . . . . 

 

KHN 02/14/2017 Judge Upends Efforts To Limit Charity Funding For Kidney Patients' Insurance

 

And we all wonder why health insurance premiums are so high.

* * * * * * It’s Always Something - Roseanne Rosannadanna
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Re: INSURED - GREAT, BUT WHERE? THE FIGHT OVER SOME OF THE SICKEST -

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@afisher wrote:

KISS-  a Non-profit fronts for people who want to steer people with ESRD away from Medicaid because of reimbursement rates.    

 

For the Record:   The insurance companies were the ones complaining, not HHS.   http://www.forbes.com/sites/brucejapsen/2016/08/07/how-obamacare-costs-are-hammering-insurers/2/#7ed...


What does KISS mean?

 

It is both Medicare and Medicaid -

My post does mention the reimbursement rates which the providers receive; lower from Medicare and Medicaid and higher from the exchange insurers.

My post also talks about the Insurers - the exchange insurers want to know why they cannot refuse coverage to these patients based on their kidney condition.

 

They can and do refuse coverage to people who are eligible for Medicare (and Medicaid) but these insurance denials are written into Obamacare.

 

A person less than 65 years old with ESRD does not HAVE to go on Medicare; it is an option.

In fact, I don't think that anybody less than 65 years old even with a disability has to go on Medicare - remember there is a 24 mo waiting period for them (but not ESRD or ALS) to even have the choice to go on Medicare - where do they go in the meantime - the marketplace exchange is an option.

 

Now that Obamacare has stopped all health related denials of coverage and premiums are subsidized according to their income and in this case, the non-profit is helping to or paying all of any premium which the patient may have to pay, it has given some very sick people a way to stay privately insured.

 

It was HHS who made the rule back in December 2016 to help out the Exchange Insurers - I am sure you can see why.

It was the dialysis providers who brought the lawsuit.

 

This "who pays the Premium" has come up before because many non-profits are doing it - like the Ryan White Fund (HIV) but this is the 1st one that has gone to court for a ruling because HHS got involved..

 

I think the ruling will come down in favor of the providers.  What do you think?

We should be hearing shortly.

* * * * * * It’s Always Something - Roseanne Rosannadanna
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Re: INSURED - GREAT, BUT WHERE? THE FIGHT OVER SOME OF THE SICKEST -

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KISS-  a Non-profit fronts for people who want to steer people with ESRD away from Medicaid because of reimbursement rates.    

 

For the Record:   The insurance companies were the ones complaining, not HHS.   http://www.forbes.com/sites/brucejapsen/2016/08/07/how-obamacare-costs-are-hammering-insurers/2/#7ed...

PRO-LIFE is Affordable Healthcare for ALL .
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Re: INSURED - GREAT, BUT WHERE? THE FIGHT OVER SOME OF THE SICKEST -

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@Frozenoem

 

Boy are you office topic -

 

This is about Medicare and the ACA and how and where these ESRD folks should get their care.

 

Since they are less than 65 years old, they can opt for either coverage via a private insurer on the Marketplace exchange or Medicare.

 

HHS wants them to be within Medicare but cannot force them to sign up.

Providers want them to stay with private insurers on the Marketplace exchange.

 

Should it be the patient's choice? 

 

 

* * * * * * It’s Always Something - Roseanne Rosannadanna
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Re: INSURED - GREAT, BUT WHERE? THE FIGHT OVER SOME OF THE SICKEST -

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Message 7 of 8

More than 43,956 could die with ACA repeal per year

 

Unfortunately or fortunately at work and thou shalt not steal thy employers bandwidth during normal business hours.

 

Why do I keep recalling the GOP line about, death panels for ACA recipient's is it because the GOP and Trump with the repeal will be killing their constituents.

 

My faith in an insurance run by the state is minimal, they'll probably take the money and use it for what they want.

 

Like NC GOP governor took monies from Natural disaster funds to cover the "Bathroom Bill" before his posterior was voted out. And oopsie before a hurricane hit.

 

Just stocked up on my med's presently covered under ACA and Martins Point for all of $18.50 vs. $3000 on BC/BS with co-pay or $600 per month on mere Martins Point Gold plan. Care to guess what amount I prefer to pay. Why I even managed to get my just in case Ana Kit refilled and not for $600, thankfully.

 

Frozen

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INSURED - GREAT, BUT WHERE? THE FIGHT OVER SOME OF THE SICKEST -

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Message 8 of 8

Yep,  it gets real complicated . . . . when real people with problems, government, money, providers and insurers all come into play.

 

Reuters 01/12/2017 - U.S. judge blocks rule on financial assistance for dialysis patients

 

So this story plays out the scenario between Medicare, Medicaid, Non-Profits who help people buy coverage for care, Providers and Marketplace Insurers.  It could have the same implications with people with other debiliatating conditions which involve all these insurance pieces but this one is doubly complicated.

 

This involves a rule issued by HHS last month which would have prevented dialysis patients from using charitable assistance to buy private health insurance.

 

1.  People who have End Stage Renal Disease must have dialysis -

 

2.  Dialysis Providers and other people, you might too,  donate money to a non-profit agency who's mission it is to lend support to people with this condition, including helping them get health care coverage on the Obamacare Exchange Marketplace by supplimenting their out of pocket premium cost.

 

3.  Remember Insurers under the ACA rules cannot deny coverage based on health conditions so these patients do have a choice as to how they want to get coverage.

 

4.  HHS, in an effort to help Exchange insurers balance out their risk between the sick and the healthy, issued a rules last month, requiring dialysis providers to disclose to insurers any charitable assistance their patients are receiving for their care.

 

5.  The dialysis providers, turned around and said "NO" and filed a lawsuit.  They reasoned that if they did that, insurers could use that information to refuse coverage to their patients.  You see HHS didn't or couldn't just say all these people have to go on Medicare, in the rule.

 

6.  Because of the high cost of dialysis, which treats end-stage kidney disease, many patients receive financial assistance from charities, including helping them pay their insurance premiums.

 

7.  In announcing its rule, HHS said it believed financial assistance was being used to steer patients eligible for Medicare or Medicaid to sign up instead for private insurance on the federal Affordable Care Act's marketplaces, which pays providers more.

 

8.  Such steering could harm patients by making it harder for them to get kidney transplants, the ideal treatment in many cases, HHS said. Charitable non-profits like the  American Kidney Fund do not pay for transplants or post-transplant care, the agency said.   To be fair here, although Medicare will pay their part of the cost for the transplant and post-transplant care for people in Medicare, their coverage of the continued rejection meds (immunosuppressive drugs) does end and the patient is on their own to get these, perhaps through again, private coverage, after Medicare stops covering them, depending upon the insurance status of the patient.

https://www.medicare.gov/coverage/transplants-kidney-adults.html 

and 

https://www.medicare.gov/coverage/prescription-drugs-outpatient.html

 

9.  HHS also said this steering to private health insurers could hinder the functioning of the ACA's marketplaces. (risk factor of sick to healthy, meaning higher premiums)

 

10.  The dialysis companies said in their lawsuit that many patients prefer private insurance because it provides better coverage, and that the new rule would let insurers discriminate against them.  They said HHS's true motive was not to protect patients, but to entice insurers to stay on the ACA exchanges, which some have fled due to rising costs.

 

This should be on the reality show "What Would You Do?"

* * * * * * It’s Always Something - Roseanne Rosannadanna
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