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Post by snarky on Nov 5, 2013 11:42:41 GMT
HER name is edie...& is a woman. NOT a man like another poster 'thought'...perhaps in a zeal to post negativety instead of facts. 'The Real Reason That The Cancer Patient Writing In Today’s Wall Street Journal Lost Her Insurance By Igor Volsky on November 4, 2013 at 9:08 am woman_talking_to_doctorMonday’s Wall Street Journal features an op-ed from Edie Littlefield Sundby, a stage-4 gallbladder cancer survivor who won’t be able to keep the coverage she currently has. Her insurer, United Healthcare, is pulling out of the individual health care market, forcing Sundby to find new coverage in California’s health care exchange. But the plans available through Cover California don’t offer in-network coverage for all of the care Sundby needs. As a result, she has to choose between her two health care providers if she wishes to remain in-network. “Stanford has kept me alive—but UCSD has provided emergency and local treatment support during wretched periods of this disease, and it is where my primary-care doctors are,” she writes: What happened to the president’s promise, “You can keep your health plan”? Or to the promise that “You can keep your doctor”? Thanks to the law, I have been forced to give up a world-class health plan. The exchange would force me to give up a world-class physician. But Sundby shouldn’t blame reform — United Healthcare dropped her coverage because they’ve struggled to compete in California’s individual health care market for years and didn’t want to pay for sicker patients like Sundby. The company, which only had 8,000 individual policy holders in California out of the two million who participate in the market, announced (along with a second insurer, Aetna) that it would be pulling out of the individual market in May. The company could not compete with Anthem Blue Cross, Blue Shield of California and Kaiser Permanente, who control more than 80 percent of the individual market. “Over the years, it has become more difficult to administer these plans in a cost-effective way for our members,” UnitedHealth spokeswoman Cheryl Randolph explained. “We will continue to keep a major presence in California, focusing instead on large and small employers.” The two insurers were also operating at a tax disadvantage in the state. As California Insurance Commissioner Dave Jones explained, “One of the factors I believe contributed to this decision….is the special tax break that California law gives to Anthem Blue Cross and Blue Shield, which has allowed and continues to allow those two companies to avoid paying $100 million in state taxes a year.” “Aetna and United Healthcare don’t get the special tax break provided to Anthem Blue Cross and Blue Shield, and so they faced a major competitive disadvantage in California.” And then there is the company’s own justification for leaving. “The company’s plans reflect its concern that the first wave of newly insured customers under the law may be the costliest,” UHC Chief Executive Officer Stephen Helmsley told investors last October. “UnitedHealth will watch and see how the exchanges evolve and expects the first enrollees will have ‘a pent-up appetite’ for medical care. We are approaching them with some degree of caution because of that.” Get that? The company packed its bags and dumped its beneficiaries because it wants its competitors to swallow the first wave of sicker enrollees only to re-enter the market later and profit from the healthy people who still haven’t signed up for coverage. Sundby is losing her coverage and her doctors because of a business decision her insurer made within the competitive dynamics of California’s health care market. She’ll now have to enroll in a new plan that offers tighter networks of providers as a way to control health care costs and offer lower premiums. Eleven insurers are participating in Covered California and for the first time they won’t be able to deny coverage to Sundby or any other cancer patients. ' thinkprogress.org/health/2013/11/04/2881581/wall-street-journal-horror-story-cancer-patient-losing-doctors-wrong/ |
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Post by ShivaTD on Nov 5, 2013 12:09:22 GMT
A very interesting story that provides some "meat" to the bones I presented that insurance companies pulling out of the market were based upon overall competitive business analysis as opposed to being because of "Obamacare" per se.
We should also note the "crony capitalism" in California that provides a huge tax break to some insurance companies and not for others which creates a competitive advantage that would result in an insurer pulling out of the market. I really do hate favoritism in the tax codes.
There's on more factor not mentioned. Several insurers added a small percentage of a rate increase to accumulate additional reserves in anticipation of the possible loss in the first year or so of "Obamacare" realizing that those most in need of medical services would be the first to insure. These companies have created huge reserves just because they might need them because they anticipated being one of the insurance companies under "Obamacare" when it implemented.
Other insurance companies choose not to do this which provided them with a slight cost advantage for a couple of years. They didn't plan to be a part of the insurance exchanges and didn't accumulate the cash reserves that would allow them to participate. With "Obamacare's" subsidies now those in the insurance exchanges will have a cost advantage for those that qualify. The company that didn't plan to participate has now lost it's competitive advantage and new it would since 2009. They made profits while they could and now it's time to move on for them. Not an unexpected event form a financial perspective. As noted in the article once the potential sort-falls are over, that those participating in the exchanges anticipated and planned for, these companies are likely to return. Why a "take a short term loss" due to an intentional lack of preparing for it in the short term is the real point if it can be avoided.
All-in-all this issue is really a financial consideration of the insurance companies involved where "Obamacare" changed the rules slightly and different insurance companies planned for that one way or another because it affected them all equally.
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Post by JP5 on Nov 7, 2013 1:27:01 GMT
Typical liberals: blame the insurance companies!
Sorry---but YOU cannot rewrite this woman's story to YOUR liking in YOUR effort to defend Obama. It's HER story. Trying to lessen the negative impact on Obama and his disaster called Obamacare by rewriting a woman's own story of what happened to HER.....is just a wee bit disingenuous, don't ya think? I do believe SHE knows better than YOU do about what happened to her.
Is there NOTHING you guys will stop at to defend Obama and Obamacare?
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Post by ShivaTD on Nov 7, 2013 11:18:25 GMT
Blaming "Obamacare" for a problem with private insurance is what is fundamentally dishonest. "Obamacare" did not set out to reform private insurance and that was never the goal. The purpose of "Obamacare" was to provide insurance, either private or public, to tens of millions of Americans so that they would receive necessary health care services.
This woman had private health insurance before "Obamacare" and she will have private insurance under "Obamacare" so her problem is not related to "Obamacare" but instead is related to private insurance. When we address "Obamacare" we need to focus on those that weren't treated for cancer before "Obamacare" because they didn't have insurance but will be treated for cancer under "Obamacare" because they will have insurance. |
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Post by snarky on Nov 7, 2013 13:07:06 GMT
Typical liberals: blame the insurance companies!
Sorry---but YOU cannot rewrite this woman's story to YOUR liking in YOUR effort to defend Obama. It's HER story. Trying to lessen the negative impact on Obama and his disaster called Obamacare by rewriting a woman's own story of what happened to HER.....is just a wee bit disingenuous, don't ya think? I do believe SHE knows better than YOU do about what happened to her.
Is there NOTHING you guys will stop at to defend Obama and Obamacare? lol... first off i am not a 'lib'...so you are wrong there. i also see that you did not (read COULD NOT) refude any f-a-c-t-s. just a lot of bluster. NObody rewrote her story.... i'm pretty certain you didn't bother to click on the link i provided showing <GASP> highlighted parts to further click on to give f-a-c-t-s & n-u-m-b-e-r-s supporting that her 'story' although a 'story' was a slice of swiss. but thanx for the CONfirmation of the typical rw'er... deny, deflect, distort & bluster. here--- i'll save you the trouble of keeping your head in the sandy tunnelvision vaccuum most fox viewers/ruppy murdoch owned WSJ readers tend to feel most comfy in. & b4 you even try to further deflect the f-a-c-t-s....... i don't have cable so this 'lib' doesn't watch the left leaning biased MSNBC. notice the date....UnitedHealth to cease individual health coverage in California July 2, 2013, 2:57 PM By Russ Britt In case you missed it…. The Los Angeles Times reported Tuesday that UnitedHealth Group Inc.’s UNH -0.25% UnitedHealthcare unit will stop selling individual health insurance policies in California and won’t be participating in the state’s health exchanges. United HealthCare UnitedHealth joins Aetna Inc. AET +0.01% in declining to participate in the most populous state in the nation. UnitedHealth’s decision forces roughly 8,000 customers to find other means of insurance while Aetna will put 50,000 policyholders into someone else’s hands. The Times points out that UnitedHealth had roughly 2% of the state’s individual market while Aetna had 5%. The biggest players in the market will remain: Anthem Blue Cross — part of WellPoint Inc. WLP -0.09% — along with Kaiser Permanente and Blue Shield of California. The three combined control 87% of the market, the Times says. “Our individual business in California has always been relatively small and we currently serve less than 8,000 individual customers across the state,” UnitedHealth spokeswoman Cheryl Randolph said in an email. “Over the years, it has become more difficult to administer these plans in a cost-effective way for our members. We will continue to keep a major presence in California, focusing instead on large and small employers.” Aetna also is expected to focus on insuring employees at large and small companies. Shares of both UnitedHealth and Aetna were down, along with most others in the sector in afternoon trading Tuesday. The exchanges are being set up as part of President Obama’s health-care overhaul to provide coverage for those who currently do not have it. California was the first to set up its exchange. It includes 13 insurers throughout the state, but many areas will only have three companies vying for policyholders. |
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Post by ShivaTD on Nov 7, 2013 13:35:43 GMT
So let's review the facts.
That's a total of 58,000 people that were insured that will need to change insurance providers based upon a business decision by they current providers to pull out of the individual private health insurance business in California.
So up to 7.1 million people in California that didn't have any health insurance, either private health insurance or Medicaid insurance, will be eligible for insurance under the Affordable Care Act.
We're basically comparing a minor inconvenience for up to 58,000 Californians that already had private health insurance with up to 7.1 million Californians that didn't have health insurance of any kind.
With all of this going on we have a single example of just ONE WOMAN that had private health insurance and has a problem with service providers, not treatment for her cancer, because she has to transition from one private health insurance provider to a different private insurance provider.
Seriously folks, I just don't see a serious problem here or any real problem at all. It's not like this ONE WOMAN is going to lose any treatment of her cancer because of "Obamacare" while we have up to 7.1 million Californians that will be treated for their illnesses because under "Obamacare" they can either have private health insurance (with subsidies if they qualify) or will be covered by Medicaid.
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Post by JP5 on Nov 7, 2013 16:44:53 GMT
So let's review the facts.
That's a total of 58,000 people that were insured that will need to change insurance providers based upon a business decision by they current providers to pull out of the individual private health insurance business in California.
So up to 7.1 million people in California that didn't have any health insurance, either private health insurance or Medicaid insurance, will be eligible for insurance under the Affordable Care Act.
We're basically comparing a minor inconvenience for up to 58,000 Californians that already had private health insurance with up to 7.1 million Californians that didn't have health insurance of any kind.
With all of this going on we have a single example of just ONE WOMAN that had private health insurance and has a problem with service providers, not treatment for her cancer, because she has to transition from one private health insurance provider to a different private insurance provider.
Seriously folks, I just don't see a serious problem here or any real problem at all. It's not like this ONE WOMAN is going to lose any treatment of her cancer because of "Obamacare" while we have up to 7.1 million Californians that will be treated for their illnesses because under "Obamacare" they can either have private health insurance (with subsidies if they qualify) or will be covered by Medicaid.
"If you like your insurance, you can keep it.......period."
"If you like your doctors, you can keep them......period."
What does placing...."period" at the end of a sentence mean to YOU? |
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Post by ShivaTD on Nov 7, 2013 20:56:44 GMT
You just don't get it: she was one of MILLIONS who were LIED to by Obama who stated repeatedly:
"If you like your insurance, you can keep it.......period."
"If you like your doctors, you can keep them......period."
What does placing...."period" at the end of a sentence mean to YOU?
The President of the United States cannot make business decisions for a private enterprise.
It was the insurance company that canceled her insurance policy because it decided to withdraw from the individual insurance market in California. The federal government had absolutely nothing to do with the business decision of the insurance company.
As a "Republican" do you believe the US government should be making the business decisions of private enterprise?
Of course Blue Cross of California is still in California and it will pay part of the costs of "out of network" medical service providers. It doesn't pay at the same percentage for an out of network provider but it still pays. I have Blue Cross insurance but it is Blue Cross of Illinois and not Blue Cross of California so I don't know if the exact provisions apply but mine pays 80/20 for "in network" providers and 50/50 for "out of network" providers.
It is also true that the woman stated she could keep her own doctor if she chose to because the doctor was "in network" for one of the remaining companies. She would have had to change where other medical services were provided though but she would receive the same medical care for her cancer. A person can only have one primary care physician and not as many as they want.
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Post by smartmouthwoman on Nov 9, 2013 15:47:12 GMT
Plenty of true life stories here... libs must be so proud to cause American families so much grief. mycancellation.com/ |
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Post by JP5 on Nov 9, 2013 16:58:58 GMT
You just don't get it: she was one of MILLIONS who were LIED to by Obama who stated repeatedly:
"If you like your insurance, you can keep it.......period."
"If you like your doctors, you can keep them......period."
What does placing...."period" at the end of a sentence mean to YOU?
The President of the United States cannot make business decisions for a private enterprise.
It was the insurance company that canceled her insurance policy because it decided to withdraw from the individual insurance market in California. The federal government had absolutely nothing to do with the business decision of the insurance company.
As a "Republican" do you believe the US government should be making the business decisions of private enterprise?
Absolutely not. And as a "Republican" I also do not believe the U.S. government should be trying to put private businesses out of business due to increased regulations or mandates that commands what a private business can...and cannot....do. And for the purpose of putting them out of business!!!! I'm a capitalist; NOT a socialist.
Of course Blue Cross of California is still in California and it will pay part of the costs of "out of network" medical service providers. It doesn't pay at the same percentage for an out of network provider but it still pays. I have Blue Cross insurance but it is Blue Cross of Illinois and not Blue Cross of California so I don't know if the exact provisions apply but mine pays 80/20 for "in network" providers and 50/50 for "out of network" providers.
It is also true that the woman stated she could keep her own doctor if she chose to because the doctor was "in network" for one of the remaining companies. She would have had to change where other medical services were provided though but she would receive the same medical care for her cancer. A person can only have one primary care physician and not as many as they want.
She cannot have both.....like she had. This is the federal government telling citizens what they can....and cannot....have. Liberals and Socialists love it. Capitalists, do not. Once they have control of one's health care.....they have you under their thumb. And that's exactly what they want.
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Post by snarky on Nov 10, 2013 13:01:49 GMT
Plenty of true life stories here... libs must be so proud to cause American families so much grief. mycancellation.com/lol...cons love to deny the facts that <GASP> ins cos have been doing this 'biznez as usual' ie dropping the sickest/costliest policy holders for years. where was their CONcern over the status quo all these years? where was the CONcern when people had to declare bankruptsy over medical bills? where is the alternative healthcare plan that shoulda coulda yet never materialized to counter the dreaded obamacare? zip,zilch,nada,goosegg... & funny how cons don't want american families without health ins to obtain it along with those who have it... yet 'libs' want healthcare/ins for all....including those that would gleefully deny it to them. ahhhh compassionate conservatism where art thou? how many believe that the bleeding heart liber-al jesus shoulda coulda asked for an ins card b4 healing 'eh? Health Care Medicare Chief: Obamacare Isn't Responsible for Insurance Plan Cancellations CMS Administrator Marilyn Tavenner says it was going on long before the Affordable Care Act. Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner prepares to testify before the House Ways and Means Committee. By Sophie Novack October 29, 2013 Centers for Medicare and Medicaid Services administrator Marilyn Tavenner defended President Obama's repeated claim that "if you like your plan, you can keep it" under the Affordable Care Act in a House Ways and Means hearing Tuesday. The claim has been attacked recently, as many people continue to receive cancellation notices from their insurance companies. But Tavenner argues this was going on before the Affordable Care Act.
"Half of the people in the individual market prior to 2010 didn't stay on their policies," she said. "They were either kicked off for pre-existing conditions, they saw their premiums go up at least 20 percent a year, and there were no protections for them. And sometimes they were in plans that they thought were fine until they actually needed to hospitalization, and they found out it didn't cover hospitalization or it didn't cover cancer." The health care law says that any insurance plans already in effect as of March 23, 2010 are "grandfathered" under the law. Consumers can keep those plans without penalty, even if they don't meet all the new ACA requirements, unless the insurance company significantly changes part of the plan.Tavenner says some cancellations are occurring as a result of companies offering new plans, which must then include protections required under the law. These include many measures, such as those that prevent discrimination based on pre-existing conditions or on gender. Tavenner also maintained that premium increases were occurring long before Obamacare. " In fact, we've seen the most premium moderation in the last three years than we've seen probably in 15 or 20," she said. "So what I would tell [individuals] is if their carrier is telling them they're changing the plan and they're offering an increase ... they would need to go take a look at what's available in their state and in their market, which is certainly something that's available to them through the exchange." The hearing, which follows the problem-plagued rollout of the Obamacare website, saw Republicans fiercely attacking the law and Democrats fighting to defend it, with lawmakers often talking more than Tavenner herself. Her appearance will set the table for a hearing Wednesday in which Health and Human Services Secretary Kathleen Sebelius will come before Congress. www.nationaljournal.com/health-care/medicare-chief-obamacare-isn-t-responsible-for-insurance-plan-cancellations-20131029 |
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Post by ShivaTD on Nov 10, 2013 13:04:38 GMT
She cannot have both.....like she had. This is the federal government telling citizens what they can....and cannot....have.
Republicans really do need to read the fine print.
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Post by snarky on Nov 10, 2013 13:11:34 GMT
Republicans really do need to read the fine print.
<pfffttt> some don't even read their own posted articles for the simplest of facts as long as it says obamacare = bad. |
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Post by ShivaTD on Nov 10, 2013 13:20:26 GMT
The woman didn't even lose her insurance because of "Obamacare" based upon what her insurance company stated. The insurance company cited the fact that they didn't have enough policy holders to financially compete in the highly competitive California private health insurance market. Are "Republicans" actually opposed to a private company pulling out of a state where it can't compete?
Of course "Obamacare" could be responsible for this if the private insurance on the exchanges reduced the premium costs for those requiring private health insurance. Then Republicans are arguing against people getting private health insurance with lower premiums. Are "Republicans" actually opposed to people paying less for private health insurance?
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