Wednesday, March 19, 2014


Sorry that appointments. Other commitments and also weak legs have kept me from the Library. Thus no comments on the agenda. I may go Thursday morning. If so, I will make a brief post before the meeting

Thanks to anonymous I did look up the Certified ACA Navigator. Well I have learned something about the Certified ACA Navigators. As expected they are established by the ACA act to help sell the exchange programs to those who do not or cannot understand the process.

I learned that:
“The federal government awarded more than $2 million in grant money to fund the outreach efforts of health care “navigators” in New Jersey.

The navigators are social service agencies that will help enroll New Jerseyans in subsidized health insurance plans and Medicaid starting Oct. 1. That's when the online health insurance exchange — being created by Washington under the Affordable Care Act — will go live, allowing consumers to shop for coverage that will be a requirement for most on Jan. 1.

Experts have said hundreds of thousands of New Jersey's nearly 1 million uninsured residents could get coverage through the ACA, but it will be tough getting the word out in poor communities or places where English is not widely spoken. That's where navigators come in.

"These are great groups to conduct the enrollment assistance work, but we need more of them," she said.
Ray Castro, of the New Jersey Policy Perspective, said the navigator grants will help, but "the amount of federal money New Jersey is receiving only represents about 10 percent of how much we think is needed to ensure the most New Jerseyans possible benefit from health care reform. Without additional resources, many of the 900,000 uninsured New Jerseyans who are eligible for help in the marketplace may not even know about this opportunity."
Joel Cantor, director of the Center for State Health Policy at Rutgers University, said the navigator grant recipients are an "interesting group of what appears to be really in the trenches organizations." He said it is "nice to see that the total dollar amount is higher than the anticipated $1.5 million. This bodes well for efforts to help hard-to-reach populations enroll."

Among the navigator grant winners is“– The Urban League of Hudson County: $565,000 for a health insurance enrollment program in partnership with the urban leagues of Bergen, Morris and Union”.

I hope that the “navigators” will be able to advise the true costs of the various policies available, and exactly what they provide.

As I have written any insurance is better than none, but insurance that compromises healthcare or does not deliver what is expected is a sham. That is a problem with much of the exchange policies.

In almost all cases everywhere the policies offered under “exchange sponsorship” are different from the other policies the carriers offer. In most cases their provider network is much more restricted that that in their previous policies including the ones cancelled because they did not meet ACA specifications.

An example, and that was in the news today, many of the better hospitals for certain disabilities   that one would expect to have access are excluded in the agency policies. In New York, Sloan Kettering Institution one of the best places for treating all forms of cancer is only on the provider list of 2 of the 9 carriers offering policies in the state. In Connecticut the Yale University Hospitals were not on the provider list of any of the original insurers.

That means that the policy holder may be forced to go to less qualified hospitals and perhaps be treated by doctors with inferior experience. The same type restrictions have been applied in many specialties.

Similarly in many Insurer Approved Formularies the patient is restricted to 'similar acting" drugs; not often the best for the condition being treated. But, they save the carrier money and improve  profits.

The idea is good but a better formula than limiting services to accommodate funds available must be found before universal health care can be successful. At present it is like making the passing grade in school to fit the level of the poorest student in the class. Then we all suffer from degradation.


  1. This was in response to yesterday's blog but the point is pertinent to today's

    Olive Lynch said...

    Doc -- for those of us who don't qualify for assistance, the insurance numbers are unaffordable.

    My example.

    premium = $1,200 a MONTH (my age and coverage needs)
    with a $4500 deductible

    that means
    14,400 for insurance
    4,500 out of pocket before insurance pays

    That means $28,900 out of pocket for "insurance".

    Almost $30,000 is more than 30% of my net income.

    And this is "affordable"? -- maybe if you're an illegal with free care or someone on welfare.

    Putting money in your own fund, paying as you go, and paying the penalty (tax) is a cheaper alternative, which I am going to take.

    This is NOT insurance. It's extortion.

    Socialism doesn't work -- I don't care what anyone says. Those being bled for taxes, rising costs for everything -- the well is dry. It's not sustainable.

  2. For in reason, all government without the consent of the governed is the very definition of slavery.
    - Jonathon Swift

  3. I wasn't going to comment but Lynch's example is so ridiculous I couldn't stop my fingers from typing.

    Out of 19 plans that are offered to me (61 single in Union County) on the one she appears to have picked is THE most expensive. Again, the top plan out of nineteen.

    That plan has ZERO deductible and very low co-pays. The $4,500 is the MAXIMUM out of pocket, ie worst case scenario.

    Finally, 14.4 + 4.5 = 18.9 NOT 28.9.

    Maybe Ms Lynch needs to speak with one of those certified ACA reps. But then she might loose her libertarian card.

    I don't mind complaining about the ACA but at least try to get the facts straight.

    PS It takes all of about 60 seconds to see what plans are available for your case. Works like a charm. Try it.

  4. Anon 8:57 You are probably right about the plan Olive is talking about, but one of my points is that the cheaper plans (Bronze) have higher out of pocket expenses if used, varies by carrier. They are also quiet restrictive in available "providers" and "allowable medications". The later is important because the gov't or insurer is dictating treatment not the doctor even if you see one.

    Each person is an individual and what works for one may not for others. But now there are penalties against doctors if they adopt a course of treatment that works but is not approved.

  5. To 8:57am

    Sorry about the addition typo -- but still, $18,500 is a lot of money before you get coverage for a SINGLE PERSON.

    I did not go to the exchange, but I went to the SAME health care insurance provider I've had for the last 2 years. Those were the numbers they gave me for the same coverage for the SAME doctor accessibility that I have now, and I still would have the $4500 effective deductible. The cheapest plan they had was $800/month, with higher deductibles.

    I have special medical needs, and my doctors are out of network for the other, cheaper plans available -- so they would not work for me.

    I refuse to use the government's website, primarily because they ask for personal information UP FRONT. No other insurance company asks for personal information up front before offering a quote. Why should I give it to the government when I am just shopping for coverage?

    Big brother government is here -- and ACA is just one of those vehicles that we are slowly losing our freedoms, rights and privacy. I was not going to put my personal information into their system.

    I'm not a libertarian. I'm a middle of the road democrat. I voted for Obama, but I've never liked the ACA, I never felt it would work, it would end up costing everyone more offering fewer/poorer services.