SHBP Protest Groups Misguided

Georgia SHBP protest groups are misinformed and misguided. Teachers Rally Against Group Insurance Changes shbp protest(T.R.A.G.I.C.) formed a Facebook group in early January to express their frustration in changes to the GA State Health Benefit Plan. Obamacare is at the root of their complaints, but they refuse to concede this point and would rather direct their efforts toward the governor’s office.

Members and supporters of SHBP protest groups are certainly vocal but completely misguided in their efforts. They have not connected the dots between changes in the SHBP and Obamacare. TRAGIC and their supporters also fail to accept responsibility for the choices they made during last falls open enrollment.

  • The 2013 SHBP package was not ACA compliant
  • SHBP 2014 was required to be updated to meet Obamacare mandates
  • SHBP fall open enrollment clearly outlined benefit changes for 2014
  • Covered participants of SHBP had a choice of accepting the change or purchasing coverage in the open market

My wife and I are covered under the SHBP. We were given handouts at employee meetings and links to the state website where SHBP plan options were delineated. Yet no one complained at that time. SHBP protest groups did not spring up until AFTER the benefits were active on January 1, 2014.

Did they fail to read the handouts or visit the choices site?

One must assume the whiners never bothered to study the plans and weigh options outside the SHBP. The plan cannot be changed at this point. There is no going back. The Obamacare plans are not popular among individuals who have tried to use the exchange which is part of the reason why enrollment goals have not been met. For the 2 million or so that have selected a plan, estimates that 60 – 80% have yet to pay their first premium.

Over 65 million visitors to healthcare.gov but only 2 million have “signed up” for a plan they are required by law to have. Perhaps fewer than 500,000 have paid for their purchase.

Had the SHBP protest groups followed a similar process and studied the plans many of them may have refused to accept the plan designs and sought other coverage.

But they didn’t.

SHBP covered participants don’t get a Mulligan. Barring a Special Election Period because of a qualifying event, they will need to learn to live with their choice.

We reviewed the plans during open enrollment. We understood there were changes. Premiums were higher. Benefits were lower. Higher deductibles and more out of pocket.

We also considered our health care needs, our budget and looked at options OFF the exchange. (Most SHBP plan participants are not eligible for a subsidy so exchange plans should not even be a consideration).

So what can you do if you are in the SHBP to minimize your cost for health care?

  • Maximize your HRA dollars and go through the wellness steps at BeWell
  • If you have not read your plan, do it now.
  • Go to the BCBSGA/shbp site and look up everyone of your providers.
  • Print it out, especially participating urgent care facilities
  • Register with Express Scripts. Look up all your meds
  • Consider changing to generics
  • Evaluate 90 day mail order options
  • Consider ordering from a Canadian pharmacy such as Blue Sky

Rather than treating your health insurance plan like an “all you can eat” buffet, learn to manage your dollars. The sooner you master this skill the better off you will be. The current plan design is the future of health insurance. Protest groups like TRAGIC will not be able to roll back the calendar to the old days so get over yourself. If you spent as much time educating your members on ways to save money on health care everyone would be better off.

Many chronic health conditions can be effectively managed with a healthier lifestyle. Diet and exercise can do wonders for hypertension, high cholesterol, back pain and type II diabetes.

You can change the way you manage and pay for your health care, or you can join a Georgia SHBP protest group and be miserable. Your choice.

How Obamacare Works

Do you want to know how #Obamacare works? Who is helping to pay your premiums? Why are old, sick people happy about Obamacare? Who is really benefiting from Georgia ACA health insurance?

Because the law forces insurers to cover those with pre-existing conditions, insurers need to attract a critical mass of young and healthy individuals with lower medical costs into the exchanges to offset the cost. But the Obama administration has yet to release demographic data on those who have picked a plan through the exchanges.

But in a filing with the Securities and Exchange Commission, Humana disclosed to investors, “as a result of the December 2013 federal and state regulatory changes allowing certain individuals to remain in their previously existing off-exchange health plans, the Company now expects the risk mix of members enrolling through the health insurance exchanges to be more adverse than previously expected.”

Washington Post

If Obamacare is to work, young, healthy people need to sign up for coverage. Why so many scofflaws? Do they not understand how Obamacare works? Are they like the war protesters in the 60’s and 70’s?

Some are already seeing the benefit of ACA health insurance in Georgia and taking full advantage of the new plans. Several of my clients are taking expensive medication that normally runs over $1000 per month. We helped them find a plan that pays 100% of their medical and prescription drug expenses for the year after they pay the first $950.

One client got a much needed new hip for $3500. All her rehab, medication and follow up doctor visits are no charge for the rest of the year.

Still confused about how Obamacare works? A late night comedian answers your questions. Click the link below.

 

Obamacare Cancels Policies on 650,000

On December 31, 2013 650,000 participants in the GA SHBP (state health benefit plan) lost their old health insurance plan. Why? Because Obamacare cancels policies when they don’t meet federal requirements. obamacare cancels policies

The Georgia State Health Benefit Plan provides health insurance for all state employees. Municipal groups and school systems can opt into the SHBP or establish their own plan. TRAGIC, a group started by Ashley Cline, vows to fight the state over their loss of coverage. Teachers Rally Against Group Insurance Changes (TRAGIC) is a Facebook group that has made numerous calls to the Governor’s office and plans a rally at the capitol steps on February 18, 2014 to make their frustrations known.

In spite of the presidential promise over the last four years that you can keep your plan, the fact remains. Obamacare cancels policies.

As pointed out in my earlier post, their cause is noble but misdirected. The loss of their prior plan was mandated by Obamacare and had nothing to do with the new TPA (Blue Cross), the Governor or the Department of Community Health that awarded the contract to Blue Cross.

I tried to explain this to the group and to Mrs. Cline but my counsel fell of deaf ears. Now they are back in the news again.

Cline said the plan to call was the first action step for the group and was posted this week.

“This week we’re going to contact the governor in force … we’re also going to turn our sights toward contacting the nine-member board who makes these decisions,” Cline said. “Our goal is to impact decision in the future.”

Cherokee Tribune

The contract with Blue Cross is for 3 years. The plan design is sanctioned by ACA. The benefits they had prior to 1/1/14 are too costly to continue in light of the new ACA mandated Essential Health Benefits and other provisions the federal government believes you should have. If your plan isn’t one the government likes then your policy is cancelled because it isn’t an Obamacare design.

The Cherokee county school district, and any other district that does not like the SHBP plan design should develop their own plan that complies with ACA rules.

Jamie Lynn Wills, mother of two and a teacher in Cherokee County, said she’s just starting to see the impact of the changed health insurance plan.

“The biggest impact so far, is that I can no longer take my children to see their doctor,” Wills said. “I just lost it on the phone, I broke into tears. It’s an emotional thing because they know my children. The doctor was there when one of my daughters was born. She knows my children inside-out.”

Wills said her family was “so attached” to their pediatrician, and now they can’t see her again.

Actually, that Ms. Willis is misinformed.

She and her family members are free to use any doctor they wish. If they use a non-par doctor they will simply pay more for the services.

In making the switch to an Obamacare plan design Blue Cross priced the benefits based on a limited POS network. During the open enrollment period in October, 2013 employees were given summaries of the 3 new plans so there should not have been any surprises on January 1, with one exception.

The materials we received indicated the plan would use a much broader Blue Cross PPO network.

That was a misrepresentation.

My wife and I also have coverage through the SHBP. We selected a Bronze plan and made sure our doctors were in the PPO network.

They were, but they are not in the POS network actually used by Blue Cross. Wonder how that happened?

We know that Obamacare cancels policies and we can roll with the punches. Our medical needs are minimal and changing a few doctors is not an issue for us but I do understand the frustration expressed by Ms. Willis and others in their group. Communication about the new plan design during open enrollment was sketchy at best. Neither Blue Cross nor the consultant for our school system were helpful or knowledgeable. No doubt we would have been in worse shape had we not known the questions to ask and how to properly evaluate the new plans.

I empathize with the members of TRAGIC but they are not the only ones impacted by Obamacare. This scene will continue to play out in the private sector as employees review their new benefit levels and try to use their plan over the next few months. The SHBP impacts not only teachers, but 650,000 Georgia citizens that lost their old plan due to Obamacare.

Obamacare is here to stay and with it comes leaner health insurance plans with higher deductibles and higher premiums. If employers and employees are willing to pay even higher premiums they can get some semblance of their old coverage back, but I doubt many can afford that move. It is time to accept the fact that Obamacare cancels policies.

TRAGIC – Teachers Rally Against Georgia Insurance Changes

The Facebook page TRAGIC  (Teachers Rally Against Georgia Insurance Change) is a noble cause but totally misdirected. The group started by Ashley Cline are upset (rightly so) because of changes in the Georgia State Health Benefit Plan (SHBP) that came to light on 1/1/2014.

Mrs. Cline is upset with the state for the plan changes. If she doesn’t like the plan she should petition her school board to get their own plan, separate from the SHBP. Marching on the state capital (as they plan to do) is a waste of time and effort.

Actually, benefit changes were announced during open enrollment in October, 2013 but the reality of the changes didn’t hit this group of (mostly) teachers until last week when some of them actually tried to use their plan.

TRAGIC is upset over benefit changes in the SHBP. They want to blame the Governor and believe their protests will restore their “old” benefit plan.

It won’t.

Higher premiums, higher deductibles, higher out of pocket, elimination of copay’s and skinny doctor networks are a direct result of Obamacare. The benefit reductions they are experiencing today were set in motion 4 years ago with the signing of ACA.

Teachers Rallying Against Georgia Insurance Changes (TRAGIC) already has some 4,000 members who have signed a petition to oppose the state’s health insurance.

The new insurance plan affects not only teachers but an estimated 650,000 state employees.

Teachers said the plan they were forced to sign up for has higher premiums and fewer benefits.

CBS Atlanta

Actually, no one was forced to sign anything. Coverage was offered during open enrollment. Members could sign up for coverage or not.

Having gone through the enrollment process myself, I can say there was no coercion. I will also say that details on the plan were sketchy at best and incomplete.

In some cases we were totally misled.

Our benefit package indicated the plan would use the BCBSGA PPO network. Two weeks ago we discovered the PPO network would not be used but instead our plan had the much smaller and more restrictive POS network.

Fewer doctors. Fewer hospitals.

We also found out that the Rx benefit (administered by Express-Scripts) was NOT part of the health insurance plan. As a completely separate benefit drug claims do not accrue toward the major medical deductible or the out of pocket maximum.

This is where the wrath of TRAGIC should be directed.

Instead they are taking out their frustrations on the Governor’s office in hopes of restoring United Healthcare, the former TPA for SHBP.

Changing benefit administrators won’t bring back the old plan with copay’s and lower deductibles. TRAGIC is in denial about the real culprit.

Obamacare.

TRAGIC is encouraging teachers and state workers to call the governor’s office and express their concerns about the healthcare plan.

“It’s just another attack on teachers from the state government,” said John Carter, a middle school band teacher. “That’s all it is. It is a cash grab, and there’s no other way to put it.  It’s balancing our state budget on the backs of our teachers.”

No, it isn’t.

It is all about Obamacare.

TRAGIC needs to come out of the ether.

 

The Baby Daddy and Obamacare

Who is the baby daddy? In many cases it is #Obamacare. If you bought a subsidized Georgia health insurance plan from the baby daddyObamacare  exchange working taxpayers are funding at least a portion of your cost of your premiums. When you bring a baby into the world you need to tell the insurance company and Obamacare.

Why?

Because Obamacare is your baby daddy.

With regular private insurance, parents just notify the health plan. Insurers will still cover new babies, the administration says, but parents will also have to contact the government at some point later on.

Yahoo News

Working taxpayers, by way of the federal government, are providing tax breaks (premium subsidies) so you can afford to have health insurance. Since we are paying some of your bills we need to know when you have a baby (or adopt). We are your baby daddy.

Such changes affect financial assistance available under the law, so the government has to be brought into the loop.

That new baby may mean your taxpayer funded subsidy amount will change. Your gross premiums will increase. That is a given. But your net (after subsidy) may also increase.

But wait. There’s more.

It’s not just having a new baby that could create bureaucratic hassles, but other life changes affecting a consumer’s taxpayer-subsidized premiums. The list includes marriage and divorce, a death in the family, a new job or a change in income, even moving to a different community.

When you sign up for Obamcare the federal government needs to know more about your (formerly) private life. This includes marriage, divorce, children turning 19, moving to a new zip code  . . .

The role of the baby daddy is much expanded.

Insurers say computerized “change in circumstance” updates to deal with family and life developments were supposed to have been part of the federal system from the start.

But that feature got postponed as the government scrambled to fix technical problems that overwhelmed the health care website during its first couple of months.

“It’s just another example of ‘We’ll fix that later,'” said Bob Laszewski, an industry consultant who said he’s gotten complaints from several insurer clients. “This needed to be done well before January. It’s sort of a fly-by-night approach.”

No surprises here. Just more examples of incompetence in the Obama administration.

Just like many real life baby daddy’s, the Obama administration wants no part of actually taking care of matters. Big on promise, short on follow through.

Typical baby daddy.

Do You Have High Medical Bills?

High medical bills? Are you having trouble paying for your prescription drugs? Does the high medical billsreceptionist at your doctor’s office know you on a first name basis? Do you get Christmas cards from your hospital? Are high medical bills going unpaid because of deductibles, copay’s and coinsurance?

You can get a health insurance plan to cover your high medical bills.

 

Trouble Paying Prescription Drugs?

Many people, even those with “good” health insurance, have trouble paying for their medication. Rx deductibles, copay’s and coinsurance mean every time you fill a prescription you have to pay more.

Sometimes you don’t have any more and may decide to skip your much needed medication because you can’t afford it.

If you only had to pay for your prescription drugs one time and there was no charge after that for the rest of the year, would that help?

 

Are You Spending More Time at the Doctors Office?

Is your car on “autopilot” when it comes to seeing the doctor? Are you in the doctor’s office more than the grocery store?

Are doctor copay’s eating you alive?

Maybe you need a plan that makes it easier to budget your medical bills for the year. This is a health insurance policy that cap’s your out of pocket expenses at less than $1000 per year. Once you hit your out of pocket maximum you stop paying your high medical bills and the insurance carrier takes over.

No more surprise high medical bills.

How simple is that?

 

Does Your Hospital Have a Bed With Your Name On It?

Do nurses on the 4th floor know you on sight? Can you find the emergency room with your eyes closed? How about the radiology department or the infusion therapy clinic?

Infusion therapy can run $6,000 or more per treatment. Renal dialysis averages $3,000. At 3x per week that is $9,000 you are spending just to stay alive.

What if you had a health insurance plan where, for less than one drip session or dialysis treatment you could satisfy your out of pocket maximum for a year?

 

The “All In One” Health Insurance Plan

Georgia Insurance Shop has such a plan and it is available to anyone without regard to pre-existing medical conditions.

The plan is simple. No moving parts.

You pay the first $950 of your medical charges for the year. Your health insurance plan pays the rest.

How easy is that?

Shop and compare now by clicking this link. Instant quotes in 3 minutes or less. No hassle application can be completed in less than 5 minutes.

Stop wasting time at healthcare.flub.

Get real health insurance to pay your high medical bills.

Health Insurance Health Care – Not The Same

If you are like most people you equate health insurance with health care. Not even close. You can fund health care with health obamacare health insuranceinsurance but just because you have health insurance does not mean guarantee unfettered access to health care.

 

ACA  Health Insurance and Health Care

The Affordable Care Act is a misnomer on so many fronts.

There is nothing affordable about Obamacare health insurance.

Just because you have an ACA health insurance policy does not mean you will have access to health care.

as California’s Medicaid program is preparing for a major expansion under President Obama’s health care law, Dr. Mazer says he cannot accept additional patients under the government insurance program for a simple reason: It does not pay enough.

NY Times

Georgia did not expand Medicaid. Politics aside, the reason was economics.

Georgia has a balanced budget.

Washington does not.

Georgia does not have the money to expand Medicaid. Even if Georgia citizens had access to Medicaid there is no guarantee they would also have health care.

Medicaid for years has struggled with a shortage of doctors willing to accept its low reimbursement rates and red tape, forcing many patients to wait for care, particularly from specialists like Dr. Mazer.

Yet in just five weeks, millions of additional Americans will be covered by the program, many of them older people with an array of health problems. The Congressional Budget Office predicts that nine million people will gain coverage through Medicaid next year alone. In many of the 26 states expanding the program, the newly eligible have been flocking to sign up.

In the Medicaid expansion states, about 70% of Obamacare enrollee’s are going on Medicaid. Most of the new Medicaid enrollee’s are older and sicker than the general population.

This is not unique to Medicaid.

ACA Obamacare Health Insurance, Older, Sicker

Young people are not flocking to buy Obamacare health insurance. Higher premiums under Obamacare, especially for young people is a negative. Many are covered under their parents plan until they turn 26. Obamacare made it possible for “young adults” to be classified as children, even if they are living on their own, or even married.

Makes you wonder if anyone in DC thought this out.

If Obamacare is to work the health insurance carriers need young, healthy people.

Instead it is the older, sicker people signing up for ACA health insurance.

obamacare means higher premiums

Your Doctor, Your Choice

Georgia Insurance Shop specializes in finding affordable health insurance OFF the exchange.

Most Obamacare plans offered on the exchange in Georgia are HMO’s. Limited doctor and hospital networks. In some cases you only have one hospital and it may be 50 miles away or more.

When you buy OFF the exchange here is what happens.

You can almost always keep your doctor.

Unless you buy from Blue Cross or Kaiser, you will have access to a national PPO network.

Lower deductibles, less out of pocket. One popular health insurance plan has a low $950 deductible. After that all your expenses are covered at 100% for the balance of the year.

Shop and compare health insurance now.

Our 5 minute, no hassle health insurance application gives you access to instant health insurance, and unfettered access to health care.

Obamacare Georgia Insurance Exchange

On Oct. 1, a little more than 100 days from now, the government will open the Georgia  insurance exchange, a marketplace on the Internet where individuals may shop for health insurance. The Georgia insurance exchange is designed chiefly for people who don’t have insurance through their employers.                       obamacare georgia insurance exchange

For many of those who can’t afford the premiums, the government will offer taxpayer funded subsidies to help pay for insurance.

How will it work?

The Georgia insurance exchange will be a website that enables you to apply for insurance for yourself and your family and lets you compare prices and options.

Key ingredients

The most important factors in this calculation are your age, where you live, how much you earn and whether you smoke.

  • Age: Health risks are lower for younger people; so are insurance rates.
  • Home area: Rates are lowest in metro Atlanta and highest in South Georgia.
  • Income: The government will pay part of the insurance cost on the exchange if your income falls between 100 percent and 400 percent of the federal poverty rate.
  • Smokers are at higher risk of illness, so their insurance costs more.

 

The color key

Each plan is classified as platinum, gold, silver or bronze. Platinum and gold cost the most but provide the best coverage. Each plan’s “metal” designation is based on the percentage of health care expenses it would cover, on average, for a large group of people. Bronze plans cover 60 percent of expenses, leaving the consumer to pay the remaining 40 percent; silver plans generally cover 70 percent, and gold plans 80 percent. (Platinum covers 90 percent, but most insurers won’t offer many platinum plans on the Georgia insurance exchange because they will be so costly.)

 To study the likely costs of plans on the Georgia insurance exchange, the AJC selected one proposed plan from the gold, silver and bronze tiers offered by Blue Cross and Blue Shield of Georgia. (Seven companies applied to sell insurance on the Georgia insurance exchange, but these examples are limited to selected plans on Blue Cross’ filing.) Note that insurers may offer more than one plan within each “metal tier” with co-payments and deductibles that will vary. Here is the cost-sharing information related to the selected plans:

  • Gold plan: $750 deductible, 0 percent coinsurance
  • Silver plan: $2,000 deductible, 20 percent coinsurance
  • Bronze plan: $6,300 deductible, 0 percent coinsurance

The prices, which are premiums per month, assume that the consumer lives in metro Atlanta and is a nonsmoker.

 

COMMENT: Prices for Obamacare plans will be significantly above current premiums. Shop and compare now.

 

CONSUMER PROFILE: 26-year-old single person (2013 rates for comparable plan)

  • Gold: $355    (N/A)
  • Silver $267    ($120)
  • Bronze: $201    ($97)

Subsidy examples

Income: $12,000 a year (just above federal poverty line). This person would be expected to contribute about $240 a year toward a silver plan. A subsidy projected at about $2,800 would pick up the remainder of the cost.

Income: $35,000. This person is unlikely to get a subsidy since the cost of a silver plan (about $3,000) would be less than 9.5 percent of her income – what this consumer would be expected to contribute given his or her income level.

 

Prices for Obamacare plans will be significantly above current premiums. Shop and compare now.

 

CONSUMER PROFILE: Husband is 32, wife is 30, 1-year-old daughter (2013 rates)

  • Gold: $1,024    (N/A)
  • Silver: $771    ($423)
  • Bronze:$580    ($345 )

Subsidy examples

Income: $20,000 (just above the poverty line). The family would be expected to pay $400 toward for a silver plan.A subsidy projected at about $8,500 would cover the rest.

Income: $60,000 (about 300 percent of poverty line). Family would be expected to pay $5,700 a year toward a silver plan and could get a subsidy of about $3,200 to cover the rest of the cost.

 

Prices for Obamacare plans will be significantly above current premiums. Shop and compare now.

 

CONSUMER PROFILE: Husband is 47, wife is 42, kids are 25, 20 and 16  (2013 rates)

  • Gold: $1,790    (N/A)
  • Silver: $1,348    ($824)
  • Bronze: $1,014    ($668)

Income: $28,000 (at poverty line). The family would be expected to pay $560 toward a premium and could get a subsidy of about $15,000 a year to cover the rest of the cost.

Income: $84,000 (300 percent of poverty). Family would be expected to pay about $8,000 a year for a silver plan and could get a subsidy of about $7,600 to cover the rest.

 

Prices for Obamacare plans will be significantly above current premiums. Shop and compare now.

 

CONSUMER PROFILE: Husband and wife are both 62 (2013 rates)

  • Gold: $1,994     (N/A)
  • Silver: $1,500    ($1038)
  • Low Bronze: $1,130    ($843)

Subsidy examples

 If this couple’s income is $16,000 a year (at the poverty line) it would be expected to pay $320 a year toward a premium and could get a subsidy of about $17,000 to cover the rest of the cost of a silver plan.

If this couple’s income is $47,000 a year (300 percent of poverty line) it would be expected to pay about $4,500 toward a plan and could get a subsidy of about $13,000 to cover the rest of the cost of a silver plan.

Subsidy calculators

The Kaiser Family Foundation’s subsidy calculator helps you determine the amount, if any, the government might pay toward your insurance bill. Another option is the state of Colorado’s exchange site. See “Calculate your savings” at bottom left of the home page.

http://www.ajc.com/news/news/the-insurance-exchange/nYMGb/

Georgia Hospital Closing

Calhoun Memorial Hospital is closing. The loss of this Georgia hospital is a combination of the failing economy and financial strain caused by uninsured patients and increased number of Medicaid patients.

A handful of other rural hospitals in the state also may be teetering on the brink, with rising levels of uninsured patients and with Medicaid continuing to pay low rates for services.

HomeTown Health, an organization of rural hospitals in Georgia, says a half-dozen facilities could follow Calhoun Memorial’s move and shut down in the coming months.

Georgia Health News

Providers that accept Medicaid patients receive roughly 20% less than Medicare pays for the same services and Medicare pays about 15% less than private insurance carriers. With more patients relying on Medicaid doctors and hospitals feel the squeeze and have to take action.

Hospitals that accept any kind of federal funds cannot refuse Medicaid patients but doctors and other medical providers are not obligated to treat Medicaid patients.

The 25-bed “critical access’’ Calhoun Memorial is the first rural Georgia hospital to close since Telfair Regional Hospital in McRae, in south-central Georgia, closed in 2008, Lewis said Monday.

Earl Whiteley, CEO of Calhoun Memorial, cited the increase in charity care that the Calhoun County hospital incurred as a major reason for the hospital’s demise.

He told GHN on Monday that indigent charity care rose from $834,000 in 2008 to $1.8 million last year.

“You just can’t continue to give away free care,’’ Whiteley said.

Tell that to the low information voters that gave Obama another 4 years.

Whitley said part of the financial crisis is due to the loss of indigent care funds under Obamacare. Those patients were supposed to be covered under Medicaid expansion but Georgia, like most other states, do not have the money to pay their share of the cost of Medicaid.

Prior to Friday’s action, the Calhoun hospital authority had sold an assisted living facility and its nursing home. The hospital had stopped admitting patients, so there were none left to transfer to other hospitals. A medical clinic will remain open in Arlington, Whiteley said.

The economic impact on Arlington and Calhoun County will be profound, with up to 100 employees losing jobs.

With the closing of this Georgia hospital, local residents will have to drive about 45 minutes to the nearest hospital.