Thursday, December 19, 2013

Sugar Daddy - Part II

Last month, Bob posted on the "news" that some hospitals, looking to bolster potential losses, have begun considering "supporting premium payments and cost-sharing obligations with respect to qualified health plans purchased by patients in the Marketplaces." The idea is that the hospitals (or other providers) would somehow subsidize their patients' premiums in order to make sure they remained insured, and therefore more likely to pay (or have someone pay) their bills.

Before we address the latest news on this front, I'm not convinced that this will be any great boon for the providers: after all, if they pay for low-end plans, where are their patients going to come up with the $4,600 and up "cost-sharing" funds? Or are they going to pop for Gold or Platinum plans, with lower out-of-pocket risk but substantially higher premiums?

In the newest twist, "A Better LA, a decade-old Los Angeles nonprofit, said last week it was signing up 50 low-income people for health plans in California's health-insurance marketplace." In this case, it's not the providers footing the premiums, but a charity. The plan allegedly has the blessing of the state's Exchange folks, but that doesn't mean that it's clear sailing: "A spokesman for Covered California ... [said] that individuals should ask their own lawyers if the payment would violate any other statute or code."

Here's a question: if you can't afford even subsidized insurance, how are you paying those legal fees?

Meanwhile, the hospitals seem intent on "fulfilling the law's mission of extending coverage to millions of Americans, said Melinda Hatton, the American Hospital Association's general counsel." Yes, I can just feel the warm fuzzies. Such altruism is so rare these days.

On the other hand, critics argue that it's "a conflict of interest for hospitals and drug companies to pay patients' premiums and cost-sharing for the sole purpose of increasing utilization of their services and products." That comes from AHIP's Karen Ignagni.

Um Karen? Here's some free advice about glass houses and stones: don't. Remember, you guys were all in on the ObamaTax before you flip-flopped (unconvincingly, I might add). So lecturing another industry about conflicts of interest, when yours stood to make a great deal by forcing people to buy your product, is more than a bit self-serving.

And of course, Ms Shecantbeserious would like to have it both ways: in October, she told a Congresscritter that "she didn't consider plans sold through the insurance exchanges to be federal health-care programs, and so weren't subject to rules that prevent health providers from giving subsidies or rebates to enrollees."

But the next week, one of her minions said that HHS "would "discourage" hospitals and other commercial entities from paying premiums. It asked insurers to reject such payments and warned that it would take further action if necessary."

One can only imagine how the carriers were quaking in their boots at the implied threat.

As for me, well, I think that it's a great example of unintended consequences, and puts the lie to "Affordable Care Act."

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