You can’t keep your existing health insurance policy, you can’t keep your doctor or maybe a hospital near you; your premiums have skyrocketed, deductibles have gone through the roof, and NOW – you may not get to keep your meds.
God only knows what surprises January will bring.
According to Dr. Scott Gottlieb, former employee of the FDA and the Center for Medicare & Medicaid Services, many drugs may not be covered at all under ObamaCare. You can still buy them but only if you have the money to pay for them. Of course, all that out-of-pocket will not count toward your new deductible.
A study by Avalere Health of 22 insurance carriers in six states looked at the benchmark drugs that Obamacare plans would be tied to and found that the numbers of drugs listed as available ranged from only about 480 to nearly 1,110. And, when it comes to costly molecularly targeted cancer drugs, many plans cover only a select few. And, as for the drugs they will cover, a full 90% of the lower-cost bronze and midlevel silver plans will require up to 40% [avg.] co-pay compared with 29% co-pays in free-market plans.
Drug makers with big portfolios of specialty and primary care drugs, for their part, are going to have to fight the government and insurance companies on a state-by-state level to make sure that the list of drugs available and adopted by states that adopted ObamaCare allow open access to their medicines. The biggest challenge will be in getting new drugs onto existing formularies. The process is likely to be long, slow, and austere and costlier speciality drugs will more than likely never be covered.
In response to the small list of available covered drugs, and the potential for important needed drugs to remain completely uncovered, the Center for Medicare and Medicaid Services is attempting to cover Obama’s butt by telling consumers that you will have the option to appeal formulary decisions in order to force health plans to cover your drug – if you live that long. Of course they don’t tell consumers that this appeals process can take months or years and there is no sure chance of winning.
Health plans are shortening their list of covered drugs – just like they shortened their networks of doctors and hospitals to pay for all those “free” ObamaCare promises – from contraception, and abortion, and screening tests to a leveling of premiums between seniors and young consumers.
Obamacare is a throwback to the old HMO model of the 1990s, which promised a broad package of coverage for primary care benefits like vaccines, and routine doctor visits. But to pay for these benefits, the Obamacare plans skimp on other things – principally the number of doctors and hospitals you’ll have access to, and also, the number of drugs that they will cover.
And, thanks to that wonderful government website, many of the plans being offered in the ObamaCare exchanges don’t even tell you which drugs they will cover if you manage to sign up.
Another problem that consumers will face in January are subsidies they may or may not get to help pay for those inflated premiums and deductibles. As it stands today, bronze plans being offered have the lower premiums but they also have the highest deductibles and unfortunately, those opting for lower premiums with the bronze plans will not be entitled to subsidies.
Unless Obama usurps Congressional power to rewrite the ObamaCare law once again, only Silver plans, those the government considers mid-level, will be entitled to subsidies and then only if you are below 250% of the federal poverty level which means an income of $28,725 for individuals and $48,825 for a family of three.
Another January surprise is scheduled for an estimated 3.5 million poor and ill homebound senior citizens who find that ObamaCare has slashed funding for their health care program, having a disproportionate impact on minorities and those living in underserved rural communities.
The Centers for Medicare and Medicaid Services quietly issued a new regulation on November 22 announcing a 14% cut over the next four years for in funding for the Home Health Care Prospective Payment, a program that puts health care into the homes of seniors suffering from acute or chronic afflictions or who are in need of rehabilitation therapy.
By CMS’s own calculation, 40% or nearly 5,000 home health companies, mainly small businesses, will experience a “net loss” in revenue due to the cuts and go into the red by 2017, putting many out of business. The National Association for Home Care and Hospice calculates the closure of close to 75%, with nearly 500,000 skilled home care workers losing their jobs over the next four years.
2014 is going to be a very scary year in more ways than one.
“One of the greatest delusions in the world is the hope that the evils in this world can be cured by legislation.” Thomas Reed, 1886
