The Obama administration will consider the new federal insurance marketplace a success if 80 percent of users can buy health-care plans online, according to government and industry officials familiar with the project. The goal for how many people should be able to make it through the insurance exchange is an internal target that administration officials have not made public. It acknowledges that as many as one in five Americans who try to use the Web site to buy insurance will be unable to do so.
After years of the federal government encouraging hospitals to grow, that message has changed to instead stress efficiency, meaning hospitals now have to start cutting operating costs that have risen in recent years. That's why hospital systems, such as Franciscan Alliance, Indiana University Health and St. Vincent Health, all plan to make large spending cuts. The federal government now wants hospitals to provide quality care to patients but for a lower price. That means making do with fewer employees, reducing supply and equipment costs and making sure patients don't have unnecessary tests or get readmitted for the same condition.
Cardiologist Eric Topol says he knew medicine had reached a turning point when patients started emailing him the results of do-it-yourself electrocardiograms. With the help of a smartphone, a software application and a portable device that reads a person's heart rhythm, anyone can get an instant EKG reading on their phone screen. "I am getting emails from people saying, 'I'm in atrial fibrillation—what do I do?' " Dr. Topol says, referring to a type of irregular heartbeat. "Whoa! The first time I saw that in the subject line of an email, I said, the world has really changed."
Health insurers across America woke up Friday to confront a looming administrative nightmare. For more than a year or longer, they meticulously crunched the numbers for their 2014 health plans, conforming them to the new mandates of the Affordable Care Act (ACA). They navigated the labyrinths of Obamacare's regulations, including the 10 essential benefits required for all plans, and they applied new rules that governed how they could calculate their costs. Then they sent these plans to state regulators. Hosts of state actuaries throughout the country reviewed the calculations, approving some, requiring revisions for others.
Last year, while doing book research in New Haven, Connecticut, we met a social worker who told us about a twenty-eight-year-old man with diabetes. He had been living in a vacant, boarded-up house; to avoid being seen there, he entered through the marshes behind the home. His shoes were full of holes, but he couldn't afford to replace them. He also sometimes went several days without fresh food. As a result of his bad diet, he struggled to control his diabetes; after a lifetime of poor insulin control, he was starting to lose circulation in his feet.
Six weeks after the troubled rollout of the Michigan Health Insurance Marketplace, the Obama administration may be facing a new challenge: consumer anger at high deductibles in plans that were supposed to be the most affordable. In southeast Michigan, deductibles in most of the 14 bronze plans listed on the marketplace — those with lower premiums — top $5,000 for a single person and $10,000-$12,000 for a family. Insurance won't kick in until those out-of-pocket costs are met. "(People) are saying 'I can afford to buy health care, I just can't afford to get sick,' " said Allen Zuppke, a Southfield insurance broker who helps consumers weigh risks, costs and options in buying health insurance.