The CEO of L.A. Care Health Plan recently blogged about walking into an Apple store in downtown Los Angeles and discovering the sales associate who assisted him was a client. L.A. Care is a purveyor of both Medicaid managed care plans and Obamacare plans sold on the Covered California health insurance marketplace. He was aghast when the sale associate said she was covered through Medi-Cal, the California Medicaid program.
Category: Public Insurance
The Family Glitch
Obamacare law says that health insurance at work is “affordable” if the employee has to pay no more than 9.5% of his wages for self-only coverage. If it is affordable, neither the worker nor his family is entitled to subsidized insurance in the (Obamacare) exchanges. The Biden administration wants to change that rule administratively (without Congress) to deem health insurance “unaffordable” if the premium for the entire family is greater than 9.5% of wages.
Can Medical Associations Gut the No Surprises Act?
The Arizona Medical Association (ArMA) is considering a state ballot measure to remove a key provision of the No Surprises Act (NSA), in order to boost fees of out-of-network physicians. The NSA is a federal law protecting patients from surprise medical bills, which went into effect January 2022. Balance billing is the term in industry parlance for surprise medical bills. Balance billing occurs when out-of-network physicians (who patients could not avoid) charge fees higher than what their health plans reimburse. Prior to the NSA, patients were responsible for any portion of out-of-network fees their insurers did not pay. The ArMA does not wish to gut so-called patient protections. However, the ballot measure would result in higher fees and higher premiums for consumers nonetheless. More on this below.
Surprise medical bills are unfair to patients and health plans alike. Health plans try to steer patients to providers who have agreed to specific terms and have negotiated fee agreements with a network. Selecting network providers reduces patient cost-sharing and in some health plans out-of-network care is not covered at all. Thus, patients have a strong financial incentive to seek care within their network.