DOUBLE TROUBLE: CO Health Exchange Runs into Billing Snafu; Fontneau Directly Sells Health Plans

A recently-published article in Health News Colorado exposed a billing snafu at the Colorado Healthcare Exchange.  Apparently, somehow some Coloradans signed up for both public and private health insurance.  We still can’t figure out how this could happen given the process that the exchange claims to have in place.  Essentially, everyone who goes to the exchange signs up for Medicaid.  Those who do not qualify for Medicaid are then kicked to private health insurance plans.  So, how some sign up for both is a total mystery to us.  The only attempt at an explanation is here:

“The problem with double-enrollment comes later. Medicaid managers can reevaluate if people qualify. If they do, the Medicaid eligibility then goes back to the date on which the person first applied. Under federal rules, Reece said if a person has coverage under both public and private plans, private plans would have to pick up the tab for the first month. After that, it’s unclear who will have to pay any claims.”

So, after people are denied from Medicaid, its managers can go back and approve them?  If that’s the case, is there a problem with the initial process denying qualifying people from Medicaid?  Naturally, the exchange folks are saying the equivalent of “move on, nothing to see here”, except that this is a big freaking problem, according to some (including an exchange board member). From the article:

But Steve ErkenBrack, president of Rocky Mountain Health Plans and an exchange board member, said this is a “major, major issue.”

“One person could be a million-dollar claim,” ErkenBrack said. “This has required everyone to reach out of their comfort zones. How do we make sure members aren’t going to get caught in limbo and that their coverage will be there?”

Marc Reece, associate director of the Colorado Association of Health Plans, the group that represents insurance companies throughout the state, echoed ErkenBrack’s concerns both during the exchange meeting and in an interview afterwards.

While this is all a big deal, the article did offer some humor in one of the pictures it featured.  Apparently, we were wrong when we suggested that health exchange head Patty Fontneau was overpaid.  We knew she was the CEO, but we didn’t know she also moonlighted as an insurance salesman at the 16th Street Mall location.  See the photo to the right. Either she’s playing Undercover Boss or this is a really lame attempt at a photo-op.

Our take? Fontneau’s time would be better spent unraveling this billing mess than selling insurance on the 16th Street Mall.  Is it time for an audit yet?

 

MOUNTING FAILURE: Doctor Shortages In Colorado Mark Latest Fallout From Obamacare

Obamacare has become a well-documented failure, with accelerated doctor shortages in Colorado becoming the latest prophesy to be fulfilled.

The Denver Business Journal reports

Newly insured patients are pouring into Colorado’s safety-net health clinics, but in some cases, sparkling new exam space sits empty because there aren’t enough doctors to care for the influx of patients.

The jump in patients who now have Medicaid coverage or other forms of insurance under the federal Affordable Care Act is accelerating provider shortages around the state.

To President Obama and Sen. Mark Udall, flooding the Medicaid rolls may have sounded like a good idea to ensure future generations of Democrat voters.  However, without a strategy to recruit more doctors to care for these new patients, the effort to get them insured was in vain.

Look, trying to reform the healthcare system to create lower costs and greater access to care is an admirable goal.  It is also a goal that, believe it or not, Republicans and Democrats share.  Where they differ (greatly) is in their methodology.

Unfortunately for Obama and Udall, in the game of real life, you don’t get any points for effort.  All that matters is whether or not you succeed.  Their takeover of our healthcare system is what we would call the opposite of successful, and the evidence to support that keeps mounting.

In the past, Udall has expressed concern about rural doctor shortages.  Now, because of his vote for Obamacare, that shortage has spread to metro-areas as well.

 

GUEST POST: Medicaid: Does It Work?

John Hickenlooper pushed to increase Colorado’s Medicaid coverage. Extravagant promises appeared.

Proponents promised greater Medicaid coverage would improve recipients’ health. It would even out health outcomes across society, some said.

In fourteen counties more than one-fourth of all county residents have now signed up for Medicaid. Suppose Medicaid worked well. These folks would be healthier than the rest of the state, right?

So, did having lots of people on Medicaid make people healthier?

ZERO BENEFIT

Nope. They’re almost 20% less healthy in total. Here’s how we know.

Colorado has a measure of healthiness called the “illness burden.” All Coloradans average an illness burden rating of 1. Some people are sicker (higher numbers). Some are healthier (lower numbers). Every Colorado county has an illness burden number. [Colorado All Payer Claims Database for 2012]

These counties’ residents have an average illness burden of 1.19. Only one county (Saguache) has a rating on the healthy side (less than 1.0). That’s with 31% of residents in these counties on Medicaid.

Dive down a bit. Only three counties’ Medicaid patients are healthier than the statewide Medicaid average. The more people on Medicaid, the worse the system seems to work for them. Democrats want to cram even more people into a creaking system. Swell.

Closing the gap? No joy there either. These counties’ privately insured are 3.4% less healthy than the statewide private coverage average. Those having Medicaid are 7.6% less healthy.

Medicaid works exactly opposite to Hickenlooper’s promises.

This is a big deal. Colorado will spend two billion extra dollars (over FY 2012) offering Medicaid to more people. For this pile of cash we ought to get more, shouldn’t we?

Sure, there may be other factors causing these counties to look sickly. But Colorado’s Medicaid failure echoes a formal study of Medicaid’s impact in Oregon.

Oregon had a lottery for Medicaid. Some Oregonians “won” Medicaid. Some missed out in the lottery. Winners’ Medicaid coverage “generated no significant improvement in measured physical health outcomes.”

Two billion bucks in Colorado for this? Add on the latest proposed $13 million fee you pay on unsubsidized private insurance. 

Set aside purported financial mumbo jumbo claims about Medicaid expansion. They rely on fairy gold deficit federal spending. Purported benefits vanish in the cold light of reality. Deficits must eventually be paid. [Gory details here.]

__

High Medicaid counties: Alamosa, Baca, Bent, Conejos, Costilla, Huerfano, Las Animas, Montezuma, Montrose, Otero, Prowers, Pueblo, Rio Grande, Saguache. Assumption: Current high Medicaid coverage replicates 2012 coverage.

 

TAXATION WITHOUT REPRESENTATION: Latest on Obamacare in Colorado

The Colorado legislature has been unable to audit the Colorado health exchanges, yet, at the same time the health exchange can raise a tax on all health insurance plans—including those plans bought through an employer and outside the exchange.  We are quickly approaching a situation where the average Coloradan is getting taxed by an organization it cannot hold accountable.  On top of this, Coloradans cannot opt of health insurance without paying a penalty, meaning it’s impossible to avoid paying a tax despite having no voice or representation with the organization levying it.

As reported by Health News Colorado:

A $13 million tax on all Coloradans with health insurance would pay half the operating costs at the state health exchange next year and in 2016 under the newest financial projections.

The proposed tax would affect at least 875,000 people and includes Coloradans who get their insurance through their employers or outside the exchange. [the Peak emphasis]

Perhaps state Sen. Owen Hill said it best:

“Not only is this not fair. It really is against the law. We have a law here in Colorado that says you can’t increase taxes without a vote of the people,” said Sen. Owen Hill, R-Colorado Springs, who sits on the exchange’s legislative oversight committee.

How do they justify such an outrageous tax?  By vaguely saying all people are better off when people have insurance since emergency rooms will no longer have to pass the costs of treating the uninsured onto people with insurance.  Yet, this ignores the fact that most of the expansion of health insurance has been gained through Medicaid, and Medicaid is notorious for such a low reimbursement rate to doctors that doctors either limit the number of Medicaid patients they have, or refuse them outright, saying they lose money on every Medicaid patient they see.

On top of this, a Harvard study recently revealed people on Medicaid end up going to an ER 40% more than those without.  If Medicaid doesn’t pay enough to reimburse doctors, how are they going to cover ER expenses which are much higher?  And since ERs can’t refuse to treat Medicaid patients, who do you think will end up subsidizing their visits?  Yep, looks like we’re back in the same boat as before, if not worse off, and on top of that, we have a new tax that we have no say over.

It gets worse. Connect for Health Chief Financial Officer is expecting 20% of the 120,000 that allegedly enrolled to not pay, or opt of their insurance in the coming year.  Unfortunately for them, because of the bill liberal Sen. Udall passed (and would pass again) they’ll have no ability to find other insurance until November.

 

FACT CHECK: Executive Director of CDHCP Claims Medicaid Expansion Will Reduce ER Visits

A Denver Post story today details how Obamacare wasn’t so much about making private insurance affordable as expanding government-run healthcare:

In Denver, 2½ times as many people enrolled in the taxpayer-funded Medicaid program from October through the first quarter of 2014 as those who signed up for private insurance through the state exchange, state figures show. [the Peak emphasis]

State Sen. Kent Lambert argues this will end up as unfunded mandate by the Federal government, as Colorado in the future will have to come up for the funds to support this expansion of Medicaid.

It’s a huge burden on taxpayers,” Lambert said. “Colorado made a decision, the governor made a decision under Democratic leadership to expand the criteria for Medicaid to a much larger population, and the federal government also expanded Medicaid.” [the Peak emphasis]

The Hickenlooper administration believes this is false, as the expansion of Medicaid will result in fewer ER visits and more preventive care:

Susan Birch, executive director of the Colorado Department of Health Care Policy and Financing, said the Medicaid expansion will not impact the state budget but will help get costs under control.

Taxpayers are paying for these people in emergency rooms and jails,” she said. “It’s far cheaper to coordinate care and keep asthma under control, keep diabetes from resulting in amputation.” [the Peak emphasis]

In the immortal words of Lee Corso, “Not so fast my friend!”  According to a Harvard study reported on by The Washington Post back in January, the expansion of Medicaid actually does the opposite, it results in more ER visits:

As the health-care law expands Medicaid to cover millions more Americans, a new Harvard University study finds that enrollment in public program significantly increases enrollees’ use of emergency departments.

The research, published Thursday in the journal Science, showed a 40 percent increase in emergency department visits among those low-income adults in Oregon who gained Medicaid coverage in 2008 through a state lottery. [the Peak emphasis]

Not only will Colorado be on the hook to the tune of over $70 million next year to cover the Medicaid patients, according to the Joint Budget Committee, but we can now expect emergency rooms to be even more crowded.  The worst of both worlds.

Peak Fact Check Verdict™: You’re full of it.

 

DEATH BY NUMBERS: Bad News After Bad News on Obamacare Buries Udall

Remember that iconic scene in “Cool Hand Luke” when Paul Newman has to dig a ditch in the prison yard just to fill it back in? Just a complete exercise in futility.  We’re guessing Senator Mark Udall and President Obama have, and that it tickled them so much they decided to model their trillion-dollar Obamacare after it.

In a new Forbes article this week it was revealed a full 89% of enrollees in the Obamacare exchanges had been previously insured.  A law meant to expand insurance is really a funhouse of mirrors, where Udall and Obama cut 335,000 Coloradans’ health insurance, and then declare the law a success when those same people turn around and sign up for more costly health plans on the Obamacare exchanges.

In further humiliating news, it was revealed yesterday during House testimony that legislative analysts are expecting more people in Colorado to pay a health care fine then have to sign-up for the can’t-keep-my-doctor plans of Obamacare:

The legislative analysis guessed that about 254,700 adults in Colorado would pay federal fines next year for not getting coverage. That’s more than the 249,000 Coloradans projected to enroll in either Medicaid or a private health insurance plan. [the Peak emphasis]

Let’s keep the numbers rolling.  Ed Sealover over at the Denver Business Journal reports even though over a 100,000 people have been added to Medicaid doesn’t mean they’ll get to see a doctor anytime soon.

Adams, Denver and Arapahoe counties have the third-, fourth- and fifth-worst ratios of Medicaid enrollees to doctors who accept the lower-reimbursement insurance, all with less than one primary-care physician taking the insurance for every 2,400 enrollees.

And those numbers are likely to be exacerbated further as more people sign up for Medicaid. [the Peak emphasis]

The problem with Medicaid is the reimbursement rate is so low that most doctors usually lose money on each Medicaid patient they see.   When Medicaid patients don’t have access to doctors they end up going to ERs, increasing the number of people who use an ER by almost 40%!  Wasn’t Obamacare supposed to do away with the traffic jam that happens in ERs?

Meanwhile only 23% of the young healthy ones needed to sign up to keep premiums from rising have signed up.  #ThanksSenUdall

 

AILING: Colorado’s Exchange Signs Up Just 4% of Goal

UPDATE: The Associated Press reported that Connect for Health Colorado’s enrollee goal is 136,000 by the end of March 2014, and revised sign-ups in October to 3,700.  So, make that just 2.7% of goal.  Heckuvajob, guys.

Last week, we reported that Colorado’s Obamacare exchange had signed up just 3,400 enrollees compared to 34,000 Medicaid enrollees.  That’s one enrollee in the exchange for every ten in Medicaid, for you mathematicians at home.  This week, healthcare number crunchers, Avalere Health, published estimates on participation in the state level exchanges based on a proprietary formula its consultants devised.  According to Avalere’s estimates published in the Washington Post, Colorado’s sign-ups represent just four percent of its 2014 goal.

The national program’s disastrous launch is well documented, with much of the blame for low enrollment numbers placed squarely on its technical failures.  But according to Connect for Health’s “Metrics” webpage, the Colorado exchange website is working well over 99% of the time. The metrics page showed that the site had 364,000 unique visitors.  If even just 20% of its visitors had signed up, Colorado would have already made its 2014 numbers.  So, what’s the problem?

Could it be (gasp) that Coloradans think the healthcare exchange options are BS because they have higher deductibles, higher premiums, and fewer care options?  Is Colorado proving to be a harbinger state once again?   Once the national site is fixed, will Americans actually sign up for the national exchange or will they sit on the sidelines like Coloradans?  Fortunately for the Obama administration, the technical issues have dominated the conversation.  The fundamental debate begins the day the Obamacare website is functional.  Although, who knows when that will happen.

 

PeakFeed: Obamacare’s Massive Medicaid Expansion in CO

Is Obamacare enabling private healthcare insurance or just a massive expansion of Medicaid? Republican strategist Karl Rove shows its the latter.  Rove appeared yesterday on Fox News to discuss warnings that Obamacare signups would be woefully low.

He cautioned that those evaluating the numbers should look at the difference in numbers between those who are enrolled in Medicaid vs. those who are enrolled in Obamacare.  The former put no money into the pot and the latter do. As an example, he highlighted that 34,000 of Colorado’s enrollees have been filtered to Medicaid and just 3,400 have enrolled in Obamacare.

Nationally, Team Obamacare predicted that there would be seven million in Medicaid and 11 million in the exchanges, according to Rove.  If that’s the case, their ratio is a little off.  Did Colorado budget for all of these new Medicaid enrollees?  Just asking….

 

GRIDLOCK ON HICK’S WATCH: Return To Budgeting Business As Usual In State Budget Debate

UPDATE: Was Republican opposition to the budget busting long bill “sour grapes”? Oh contraire mon frere. Per a press release from Senate Republicans:

Denver- Today, Senate Democrats passed Senate Bill 213 on a party line vote, asking voters to approve a one billion dollar tax increase without reforms that improve student achievement.

“Just one week after Senate Democrats approved a historic budget that increases government spending at three times the rate of inflation, the voters will be faced with a one billion dollar tax increase,” said Assistant Senate Minority Leader Mark Scheffel (R-Parker) and member of the Senate Education Committee. “We need a student centered system that emphasizes improving student outcomes and instilling teacher accountability instead of perpetuating the present system that merely asks for more money without solving the problem.”

This year’s budget is set to be the first in a number of years not receiving a bipartisan blessing. Governor Hickenlooper and legislative Democrats’ left-wing agenda outside the budget process has no doubt poisoned the bipartisan well, but it doesn’t mean there aren’t clear reasons to oppose this year’s budget.

Sorry, Singleton, “sour grapes” are not the reason Republicans are opposing this year’s spending monstrosity.

It’s unfortunate for Governor Hickenlooper, as he has loved to trot out the line about Colorado’s bipartisan budget process. Here’s how Hickenlooper characterized last year’s bipartisan budget:

“The budget provides a comprehensive and thoughtful allocation of taxpayer dollars,” Hickenlooper said at the signing ceremony. “The support that both parties in both houses gave to the budget demonstrates that we’re trying to find the right compromise.”

Does the lack of support from one party then demonstrate the lack of compromise in this year’s budget, Governor?

Aside from political reasons, here’s five reasons why Republicans will and should oppose this year’s budget:

continue…

 

NO “MAGIC WAND”? Despite Hickenhoover’s Claims, Medicaid Waivers Given To Other States To Cut Costs

We had high hopes for Tim Hoover. After helping lead the way on ending the mainstream media honeymoon for Governor Hickenlooper, with tough articles on his wasteful spending and inability to make decisions, Hoover has suddenly swallowed Hick's talking points on Medicaid reform.

In Hoover's coverage of the Medicaid debate, his pieces increasingly read more like Op-Eds than real reporting.

Well Hickenhoover, we have a few examples you might want to dig into to better inform your (normally solid) reporting. 

Governor Hickenlooper keeps using the phrase "there is no magic wand," and the press dutifully reports it without analysis, as if that alleviates the need to look into the option of a federal Mediaid waiver.

Despite Hick's protestations that a waiver is not possible, reality provides a stark contrast. 

A year ago Democrat Governor of Washington state, Christine Gregoire, had a Medicaid waiver approved by the federal government. 


That waiver essentially converted Medicaid into a block grant program, or capped federal matching funds, that will allow Washington state to better manage the ballooning costs to state government. 

A similar waiver was also approved for Rhode Island in 2009. According to a report by the Common Sense Policy Roundtable on Medicaid reform, since the implementation of the waiver, projected Medicaid spending declined from $3.8 billion to $2.7 billion. 

In Colorado in the last ten years Medicaid spending has more than doubled from $2.3 billion in '00-01 to $4.9 billion '10-11.

With Medicaid spending growing out-of-control, other budget items, mostly education, are getting axed. 

The bill requesting a Medicaid waiver is being sponsored by state Senator Greg Brophy (R-Wray), who told the Peak: "Either we reform Medicaid or we continue to cut funding for education. This isn't a philosophical argument; it's the recognition of a math problem."

On education cuts, Hickenlooper has said he is "not happy" and "[doesn't] see a way to get around it."

Well, Governor, a Medicaid waiver would be one way. 

Senate Minority Leader Bill Cadman has said Medicaid spending is a "tumor" on the state budget. 

As Medicaid waivers in other states have proven to turn that tumor from malignant to benign, why is the press and Governor Hickenlooper so seemingly opposed to exploring that option?

 
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