Are quality and choice sacrificed in health-care exchanges?

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By now, everyone’s heard of the health insurance exchanges, created as part of President Obama’s Affordable Care Act. In theory, they’re supposed to make health insurance available for people who previously could not afford insurance, who were not insured because
of pre-existing conditions or
were not offered workplace coverage.

TO SAY THERE is a lot of confusion surrounding these exchanges and their implementation is an understatement. There have been reported delays in accessing the exchanges on federal websites, and no one within the federal government can give an accurate count of how many people have signed up for insurance through the exchanges.

In Augusta, two insurance companies have entered the exchange market: Blue Cross Blue Shield and Humana.

First, to avoid further confusion: University Hospital is a BCBS provider for all of its commercial products, including products offered to active members of the State Health Benefit Plan. However, University was informed Oct. 11 that it was not included on the public exchange product offered by BCBS. University was the only Augusta hospital excluded despite being recognized as the sixth-ranked hospital in the state for quality by U.S. News & World Report. And University is not alone – eight of the top-10 hospitals in Georgia were excluded from the BCBS network.

What this means is a narrowing of consumer choices all over the state, including Augusta. In addition to our U.S. News & World Report quality ranking, University has been named the National Research Corporation Consumers’ Choice Award winner for overall quality for 15 years in a row. We also hold the Blue Cross Blue Shield Distinction Center Plus recognition in hip replacement, knee replacement and spine surgery, signifying we have displayed great expertise and efficiency in these areas. These are just a few of many quality distinctions we hold throughout the region.

THERE IS NO question that University is a quality leader when it comes to taking care of our patients. We believe new enrollees on the exchange should have access to the same level of care our community has become accustomed to receiving from University.

There were no negotiations with BCBS or discussions with us regarding rates. When we called to ask if we could be included in the network, we were told that the exchange had been set for the next year. This represents a total departure from the relationship we have had with BCBS in the past. If this is a glimpse of the future under the new Affordable Care Act, we all should plan on narrower choices of providers with little regard for quality.

The good news – if there is any here for those who would prefer University – is that Humana’s public exchange includes University Hospital in its network, and according to its family premium is priced significantly less expensive ($595.16 for Humana, vs. $718.64 for BCBS coverage—a 20.7 percent difference).

THE IMMEDIATE impact of the creation of these exchanges has been a narrowing of choices for consumers. For patients in our community currently enrolled in BCBS commercial products, University remains a network provider. For those who are making choices on the new public exchange, the BCBS option has narrowed your choices and excluded the community’s top quality provider.

(The writer is chief executive officer and president of University Health Care System in Augusta.)

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deestafford 10/20/13 - 12:29 am
This is not about health care. It's about the left taking more

and more power. The whole obamacare is designed to fail so the sheeple and the compliant media will begin screaming that it's clearly obvious that insurance companies and multiple payers don't work. We must have a single payer...the government. Afterall, it works so well in the rest of the industrialized world.

The left has been waiting a hundred years for the chance to implement socialized medicine and they finally got the opportunity when the country was hoodwinked into believing the Obama was the one they had been waiting for. Wait a minute, did he say at a 2008 rally after winning the election, "We are the ones you've been waiting for."? Obamacare could not pass by regular order. Harry Reid had to do it through reconciliation and other shananigans.

Bodhisattva 10/20/13 - 04:17 am
Send your complaints to:

Governor Nathan Deal
Office of the Governor
203 State Capitol
Atlanta, GA 30334

Insurance Commissioner Ralph Hudgens
Two Martin Luther King, Jr. Drive
West Tower, Suite 704
Atlanta, Georgia 30334
Main Telephone: 404-656-2070
Toll Free: 800-656-2298
Fax: 404-657-8542

Riverman1 10/20/13 - 08:21 am
University Hospital is owned

University Hospital is owned by Richmond County and run via the foundation. They make huge profits. I'd examine their finances carefully. At least one county owned hospital near Augusta gives the county almost enough to fund its entire government. Follow the money.

TrukinRanger 10/20/13 - 10:06 am
More bias..

This is another example of bias directed at the ACA and another reason why our health care system was in need of repair. First of all, any major implementation like ACA is going to have issues- especially when the #1 access point is via the internet. When a good chunk of the country is trying to access the servers for ACA at once there is going to be problems. The internet and servers in particular are limited to the number of people that can access it at once. When you have the people going in to actually buy healthcare and add in all those going to the site just to nose around a bit without buying it will bog the system down and cause computers to crash. Eventually when everyone calms down a bit it will get better. As for the government not able to tell you how many people have signed up- well, that will take time too. We are only a couple weeks in this and they cannot give those answers yet. When there are errors in the application process, whether it is because the applicants did not submit all the correct info, or those same servers kept crashing it's hard to tell anything. Also, they cannot tell you how many have bought insurance until after the first premiums have been paid. Between now and the beginning of next year when applicants have paid the premiums and all questions concerning their application have been answered then we can get numbers. As for BCBS not being included- that sounds like a BCBS problem, not the ACA. If hospitals, doctor's offices, pharmacies, and insurance companies weren't so greedy then rates wouldn't be so high. With all of this said, if you already have health insurance from your workplace then you're not at risk because of the ACA - it would be your insurance company that is at fault.

allhans 10/20/13 - 11:45 am
Does the exchange require

Does the exchange require payment in advance when you sign up? I would think that would be so since all insurance companies have always done so.
I think folks are in for a lot of surprises when they use this exchange.

member 10/20/13 - 05:23 pm
Riverman, go ahead and spill the beans.......

Since you know so much about University Finances, why don't you just tell everyone how much the "huge profits" are? Being a county hospital their Income sheets are public knowledge and if you have as much knowledge as you want to imply, you'd know where to pull up the forms that include the details including salaries of all involved. It's all easy to see... you always comment with generalizations without real facts, if the profits are huge, post it.......

Bizkit 10/20/13 - 07:26 pm
I don't think anyone has to

I don't think anyone has to sabotage the ACA. Is that what you call Obama doing as he micromanages the implementation of the law because of fears of a negative impact with upcoming elections-he is sabotaging his own law. Gosh-gee willikers Batman.

Bizkit 10/20/13 - 07:36 pm
Well I think the Augusta

Well I think the Augusta Chronicle needs to have a full front page article on the bona fide sabotage of the ACA "Obamacare" by no other than President Barak Obama. Wow now that's news worthy-Yep "The Tea Party group characterized as radical jihadist failed in their attempt to prevent the implementation of part of the ACA, but the Chronicle reports President Barak Obama has sabotaged his own law by changing the implementation of several mandated parts of the law. We can only surmise the public will similarly rebel and label this saboteur a radical jihadist so as not to be hypocritical. Of course.

Truth Matters
Truth Matters 10/20/13 - 08:59 pm
Bod gets 3 Thumbs down for

Bod gets 3 Thumbs down for posting the contact info for the gov, insurance commissioner, and a link to the article where the insurance commissioner brags about sabotaging the ACA.

Some people just do not want to know the truth no matter how it is delivered.

Thanks for your post, Bod.

Little Lamb
Little Lamb 10/20/13 - 09:13 pm
Blowin’ in the Wind

The answer, my friend, to the question posed in the headline of this advertorial, is, “Who knows?” The web-based exchanges are erroneous when they are not non-functioning.

I would not trust a quote I found on the Georgia exchange, which is run by the federal government.

prov227 10/21/13 - 12:31 am
How about a 139% increase in rates in 2014?

That's what BCBS of GA is sending out to its subscribers (in order to be ACA/ObamaCare compliant). Our letter says the increase will gain us about the same coverage under the "silver" with fewer hospitals and doctors. Wake up, America. Thy silver is dross.

Fiat_Lux 10/21/13 - 05:11 pm
You're not going to live as long as your parents

and your children aren't likely to live as long as you do.

This is a gigantic catastrophe for the United States. We will go from being the very best providers of medical care in the world to something resembling a third world country's care in a matter of just a few years. The ability and knowledge will still be there, but unless you are firmly latched onto the government dole-teat, you won't be able to afford to get decent care.

Or own your own home. Or buy a car. Or pay to send your kids to college. Or afford any alternative to public indoctrination schools except home schooling your kids. Forget about picking your own care provider. Even Italy will look more reassuring.

It was nice while it lasted. I'm glad my parents aren't going to have to endure this disaster and I'm sad my family will.

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