Obamacare: Poster child for government bloat, incompetence and inefficiency

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(Photo courtesy Pixabay)

I wonder how many people who are marching in the streets in favor of keeping Obamacare have purchased insurance off the Marketplace.

I have. For the past three years, in fact. And the year before that, I had coverage under the Medicaid expansion, which is the only part of Obamacare that I think is worth fighting to keep. It’s a matter of public health.

My Congresswoman, Cheri Bustos, recently said on the floor that repealing Obamacare won’t “make America great again,” it will “make America sick again.”

She’s great at sound bites. Cheri spent a decade as our local regional health system’s PR queen. She even offered me a job there once as corporate writer.

I’m not going to get into the scare tactics Cheri used in that minute-long speech I linked to above. It makes me sad that our local politicians think we Quad-Citians are fools that just gobble up their spoon-fed gobbledygook.

But I will tell you what my experience with Obamacare has been, speaking both as a health journalist and as one of the “hardworking Americans” Cheri represents in the 17th Congressional District (the one bordering scandal-plagued Aaron Schock’s district).

In 2014, I greatly benefited from Obamacare under the Medicaid expansion. I was working, but had just gotten back into the workplace after taking time off to care for my elderly father. I was being paid $75 per story for Healthline News. It took a while to build a name for myself as a health reporter and attract new, better-paying clients. The Medicaid expansion was a great thing, because it allows working people, with a modest income, to have affordable (free) healthcare.

I had to also apply for food stamps to get it (which I did not want or need, but that was part of “the rules”). One could argue the $12 per month in food stamps that came along with my Obamacare was inconsequential, but $12 per month times 12 months in a year times how many Americans (?) adds up fast. Why force acceptance of a benefit that someone doesn’t even want or believe that they need? That makes no sense and is a waste of money.

My first Marketplace plan offered little more than a monthly bill

The second year, 2015, I was making a little more money, and I purchased a Blue Cross Blue Shield plan off the exchange. Technically, I could have stayed on the Medicaid expansion, and the food stamps, once business write-offs were figured into my 2015 income. But I was proud to be off public assistance (although grateful that I got it when I needed it, and I don’t think anybody should be stigmatized for taking food stamps or Medicaid).

In 2014, I survived what I believe was an attempted homicide (it’s on the books as an assault) that left me with a PTSD diagnosis. The diagnosis was made almost exactly one year to the date of the assault, when I had a flashback of the incident. I immediately reported all I remembered to police, along with some other pertinent information. It’s not unusual for people with PTSD to have memories suppressed for a year or even longer, and it’s also not unusual to recall them around anniversary dates.

The flashback itself led to another horrifying experience – being stripped naked and thrown in the Rock Island County Jail on no charges at all, for two days. Congresswoman Cheri’s husband is our sheriff (he was appointed to the elected position after the previous sheriff was forced to resign in disgrace; it’s widely believed the previous sheriff was framed, allegedly for harassing a woman).

You can read about how and why I ended up in jail here. I’m still waiting for a public apology from the County of Rock Island.

Read more: Officeholders of elected positions in Rock Island County routinely not elected

The hospital system Cheri worked for, by the way, recently opposed construction of a psychiatric hospital in nearby Bettendorf. A board that grants “certificates of need” declined Strategic Behavioral Health’s request after both hospitals claimed we had enough beds with more on the way. This, despite testimony from the Scott County sheriff (on the other side of the river, who said he’s supposed to be running a jail, not a mental hospital), and numerous mental health advocates. Everyone here who is honest who works in mental health knows that our system on both sides of the river are a disgrace that are costing lives, even if they won’t admit it out of fear of losing their jobs. Those who claim otherwise are simply fooling themselves.

No, instead we just throw scared people with PTSD in jail around here and hold them there two days on no charges. Naked. In solitary. And taunt them in ways that will make a great book someday. I’m excited to get started on it!

Is this Rock Island County, or Soviet Russia? I’m still not sure sometimes.

The board that denied the “certificate of need” for the psychiatric hospital includes a retired employee of the hospital system Cheri worked for. His name is Bob Lundin. I always thought he was a nice guy when I did business with him as a reporter for the Quad-City Times. But talk about a conflict of interest. Most news reports never even mentioned he was retired from UnityPoint Trinity, which opposed construction of the hospital along with Davenport’s Genesis Medical System. You can read all about that outrageousness by clicking here. The board is comprised of several people with strong ties to both hospital systems that monopolize our community.

Outrageous.

At any rate, my first year on my own with Obamacare cost me, gosh, about $150 per month I guess. My premium is about double that now. Not much more or less than what people who have coverage through their employer pay, I imagine. I’m just one person, of course. No dependents.

So that first year that I had Obamacare off the exchange, BCBS paid for two psychotherapy visits related to my PTSD diagnosis. I paid the rest, at a cost of $280 per month. You hear about how Obamacare has expanded mental health and addiction treatment access. That’s true to some degree, but it’s a charade in many ways, too. Just look at my situation. President Trump vowed last night to expand access to addiction treatment services. I hope he keeps that promise.

It goes without saying that I did not want Blue Cross Blue Shield for 2016 (although I have them now and so far it’s a great plan). But check out this piece I wrote in October 2015 – Blue Cross Blue Shield tried to enroll me again for 2016 even before open enrollment began. The buck-passing and jacked-up-edness (I just made that word up) involved in that incident was nothing short of hilarious.

Gross incompetence: Marketplace can’t find records of my insurance

The third year I had Obamacare, I purchased United Healthcare Silver Compass, considered a top tier plan, off the marketplace. UHC was a disaster from day one (although UHC was not always directly to blame…the state and federal bureaucracies created screw-ups, too). My pharmacy benefit got screwed up at the state level, but was rectified after I wrote about it. Click here to read that piece. Sadly, not everyone has a platform like I do. I wonder how many people have lost hundreds or even thousands of dollars due to ACA screw-ups, regardless of whether they were performed at the state or federal level.

Now, as I file my taxes for 2016, the exchange is claiming I did not have insurance for October, November or December and will have to pay a penalty. IN FACT, I got an email from the exchange in September (see below) telling me that if I was on target to make more, or less, than I thought I was going to make when I applied for my 2016 Marketplace insurance, that I needed to let them know.

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Because I am honest (to a fault…at least that’s what my brother always said…”David, you tell on yourself”) I called the exchange and told them I was indeed having a better year than I expected. They assured me that I would continue to have the exact same UHC Silver Compass insurance, but that my subsidy would drop considerably. You can make up to $52,000 annually and still qualify for a subsidy.

Well, that’s not exactly what happened. They canceled Silver Compass and gave me a different UHC plan (that was substandard to Silver Compass and nothing but problems…co-pays went up, etc.). And yes, my subsidy plunged. Which was fine. My income was higher than I previously thought.

Let me tell you something else. All those jokes about “the death panels” that never happened? My psychologist had to have regular telephone conferences with the UBH (United Behavioral Health) psychologist to discuss the details of my case, as they felt my twice-weekly cognitive behavioral therapy sessions for my PTSD were unnecessary.

I am involved (as a victim) in two very serious criminal investigations (which I am certain involve all the same villains). I did not like my insurance company knowing my business. To me, this is somewhat akin to the death panels. Whatever happened to HIPAA? Actually, a personal injury lawyer here in Rock Island told me once that “HIPAA is a myth” and, in fact, doesn’t mean a darned thing. I can hear all the hospital employees launching rotten tomatoes at me now…I’m just saying what he said! And he has been known to get people lots of money!

So today the Marketplace told me they have no evidence of me being insured October through December. Therefore, my 1095 statement (which shows your subsidy and proof of insurance, and is required with your tax return) only will show the Silver Compass insurance of January through September. So in theory, I will have to pay a penalty.

Below, you will see the email welcoming me to my new plan in October. All my premiums were paid, each of the 12 months of 2016, and never was I uninsured.

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Yes, Obamacare created jobs. Bureaucracies. More AFSCME employees. More layers of nonsense.

I wonder how many rainforests have been destroyed with all the paperwork associated with Obamacare. UHC pulled out of the 2017 exchange, and now I have BCBS again (and this time, so far, an AWESOME plan, paying 100 percent of my twice-weekly CBT sessions at the psychologist and $0 co-pay on my blood pressure and other meds).

But even though UHC pulled out of the exchange, I recently received a five pound, “Welcome to United Healthcare 2017!” book in the mail.

I could go on and on about the mailings, which never make any sense at all. And I’m a writer. It’s like they’re written in Chinese. Plus, they email you, too. Keeps people employed I guess, on your taxpayer dollar! Inefficient, “job-creating” bloat.

Two parties, two beauties representing 17th, 18th Congressional Districts

Lastly, let me talk to you about the 17th Congressional District. We are a polite people. A simple people. Hard-working people. We don’t talk much about politics. We generally believe what our politicians do simply has to be honest and what they tell us all true (though that confidence is fast, fast eroding around here).

The Quad-Cities is mired in corruption, as you can read here. And here. And here.

The Congressional District right next door to us (the 18th Congressional District) once belonged to Aaron Schock. But the dashing young GOP Congressman now is facing criminal charges for using taxpayer money to decorate his office like Downton Abbey, among other things.

Peoria (the 18th Congressional District) is much like us simple folk in the Quad-Cities and Rockford – hard-working, mannerly, trusting. Too trusting.

Like Shock, our Congresswoman is a beauty – voted 8th most beautiful person on Capitol Hill, in fact! Yes, it’s true! You can read about it by clicking here.

It’s fine to not talk politics out of politeness. But please pay attention to your politicians and what they’re doing. Don’t blindly vote for one politician or another. And hold their feet to the fire. Always. Participate in the process. Dig beneath official news reports, because most of that comes from press release rewrites from the politicians themselves. Local media outlets have been slashed to the bone and don’t do the type of old-fashioned watchdog reporting anymore that is so essential to keeping our corrupt politicians honest.

Please. Ask questions. Call their offices when things upset you. Let them know you’re watching their every move as it pertains to honesty, ethics and being lawful.

I sure do.

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‘Lots of kinks to work out’ understated: One reporter’s Obamacare experience

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(Photo courtesy Pixabay)

There Obamacare goes again.

You may recall that I now have written twice about Obamacare blunders that I have experienced during the past couple of years – pretty significant ones, in fact.

Well, I’m sad to report, that despite repeated assurances (and even a personal phone call from one of the top brass from Blue Cross Blue Shield when this happened last year), that Blue Cross Blue Shield of Illinois appears to be up to their same old tricks.

Not only that, but the exchange itself also is providing misleading, inaccurate information to callers. In fact, I think the bigger issue with the problems I’ve had have been the exchange (probably with the administration of it in the broke state of Illinois, specifically) than with the insurance companies themselves.

Let me explain.

Yesterday (on Thanksgiving Day, when the Blue Cross Blue Shield of Illinois call center was closed) I received an email that read, “Your Blue Cross Blue Shield of Illinois application has been received.” The email even assigned me an application number (for 2017).

Funny thing is, I have not even signed on to the exchange to even begin looking for a policy for 2017. My current insurer is United Health Care (I did have the coveted Silver Compass policy until recently…more on that in a minute).

Last year, Blue Cross Blue Shield did this EXACT same thing – told me I had applied for 2016 (and in 2015 I did have Blue Cross Blue Shield, so such an error back then at least made at least a modicum of sense – I was already in their system). You can read my column last year about Blue Cross Blue Shield by clicking here. They even told me I had been approved in an email that arrived shortly thereafter. In fact, they sent both emails twice.

This morning, I spoke to an extremely courteous Blue Cross Blue Shield representative who assured me this is all going to get work, and he acknowledged my frustration, especially since this has happened twice. He could not have been more professional.

I’ll update this blog when and if I get an explanation.

Last year, someone at the exchange in the D.C. office explained to me that some insurers are attempting unscrupulous marketing tactics, and that maybe that was what was going on.

But they ain’t saints at the exchange either, let me tell ya!

A couple of months back, I got an email from the exchange (Healthcare.gov) saying, “Are you still on track to make $XX,XXX this year? If not, please call (such and such number) to avoid paying extra at the end of the year due to a higher than expected income.”

Well, I have been blessed with lots of good-paying work this year, and yes, I am on track to exceed the amount I listed when I signed up for insurance this time last year. So, I was honest about that, called Healthcare.gov, and the rep ASSURED ME, SEVERAL TIMES that nothing would change with the United Health Care Silver Compass policy that I already had except that my premium was going to nearly double (I pay just over $300 per month for my insurance, which I suppose is in line with people working jobs similar to mine in corporate America, so I don’t really have any complaints about that).

Well, the rep lied. Or had bad information, perhaps. Because I do NOT have the same Silver Compass policy that I had before.

I first found this out when I went to get a prescription filled. My co-pay used to be $5; now it’s $10. Then, when I went to the psychologist, I learned my co-pay had gone from $10 to $30. I see my psychologist (not to be confused with a psychiatrist, which prescribes medications) weekly due to my chronic PTSD diagnosis. I’m very grateful to UHC, actually managed by UBH, United Behavioral Health, for paying for weekly sessions. Of course, the magnitude of what I’ve been through and what led to the diagnosis is pretty heinous and unusual, to say the least.

Then there’s the time that instead of being charged my $5 co-pay, earlier this year during a trip to Walgreen’s (when I still had Silver Compass), I was charged $56 for a medication. I wrote about that several months back too. You can read that column by clicking here.

Be careful out there, folks, if you’re buying insurance off the exchange. It’s still a hot mess. No matter what, in all matters health care in the U.S., you MUST be your own advocate. Never settle when something doesn’t smell right. Ever.

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I’m enrolled for 2016? Really? Except open enrollment does not being until Nov. 1

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This piece originally was written on Oct. 27, 2015, for Healthline Contributors. That site is going dark on Dec. 6, so it is reprinted here with permission.

UPDATED 11:42 a.m. 10/27/15

I want to preface this column by saying I am extremely grateful for the affordable health insurance coverage I obtained for 2015 under the Affordable Care Act. Without the subsidy, as a self-employed person it would be extremely difficult for me to remain insured and be able to eat at the same time.

That said, there is a reason why health care in America is the butt of so many jokes. And as a health reporter, it’s my duty to share with you my own bad experience with the health care system this week.

The night before last, I received two sets of emails, two hours apart, from my current health insurer. Suffice it to say that I am insured by one of the giants.

The emails let me know me that, one, my application for health insurance had been received. And about 20 minutes later, I received emails telling me my application had been approved.

Here’s the rub: I didn’t apply for health insurance for 2016 with this provider. In fact, I have had an ongoing email and telephone dispute with them over some unpaid claims and I have made it very clear I won’t be signing up with them again in 2016.

Regardless of whether they had every right to deny my claims based on fine print I can’t find (and don’t understand), their customer service throughout the entire ordeal has been deplorable. And that’s putting it nicely. Every time I would call I would get a different answer. A time or two, frustrated reps flat-out admitted: “Now wait a second. I’m really confused.” And the phone tree and the transfers? It’s the stuff hilarious commercials about poor customer service are made of.

So when I saw these emails confirming my applications for health coverage for 2016 that I never made, followed by emails telling me my applications had been approved (even assigning me a card number and an explanation of how to pay my first premium), my blood pressure shot through the roof.

When I reached a customer service representative at said gigantic health insurer, she very matter-of-factly, confidently and insistently told me: “You were signed up through the marketplace. The marketplace signed you up.”

I said, “Oh really?”

She then proceeded to give me the 800 number for the marketplace, aka Healthcare.gov.

When I spoke with the agent at Healthcare.gov, she confirmed what I already knew: No application for health coverage for 2016 had been made through the marketplace (let alone two…obviously some sort of computer glitch). But it gets better:

Open enrollment does not even begin until Nov. 1.

She said that perhaps I was confused, that maybe the insurer just had used some misleading marketing practices and that I had received an advertisement. As you can see from the photo with the story, that’s not the case. In fact, they told me twice that I was signed up, and they even assigned a card number and let me know how to pay my premium.

But it gets even better. They signed me up for the same plan I had for 2015 – one they repeatedly had told me has been discontinued for 2016, and have alerted me several times that I would need to choose a different plan for 2016.

I reached out this morning to both representatives listed under “Media Center” for said gigantic insurer, but so far have heard nothing. I’ll give you an update and will be happy to share their explanation if I hear back.

In the end, I’m just going to ignore their emails, I’m not going to send them a dime (I’m already paid up through 2015), and I’ll choose a different provider off of Healthcare.gov when open enrollment begins Nov. 1.

Meanwhile, be careful out there. There obviously are pitfalls in the American health care system. Giant ones.

UPDATE: The senior director of media relations for the company has offered a very sincere apology at 11:36 a.m.: “We screwed up taking care of you, plain and simple. Sorry.”

He even shared with me the explanation he was given (see below). Honesty and transparency go a heck of a long way with me, so I may in fact consider re-enrolling with them come Nov. 1. I’ll keep you posted.

Background
An issue was identified in the App Tracker for renewal transactions for the state of IL. The issue caused welcome emails to be sent in error.

Action

When members call, apologize to the member for any inconvenience that this system error caused. Tell the member that they will receive a communication within the next few days that will give additional information on their 2016 plan and rate.

Resolution

The issue has been identified and a fix is being implemented shortly.

For doctors, EHRs are a four-letter word, study shows

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Research published online tonight in Annals of Internal Medicine shows what doctors already know – EHRs, or electronic health records, are causing physicians to burn out.

Although the study was small – 57 physicians from four states – it showed that they spend almost twice as much time maintaining patients’ electronic health records as they do face to face with the patient.

The study was funded by the American Medical Association and looked at doctors in family practice, internal medicine, cardiology and orthopedics. They practiced in Illinois, New Hampshire, Virginia, and Washington. The study used direct observations as well as self-reported diaries (for time spent working after office hours).

“During the office day, physicians spent 27 percent of their total time on direct clinical face time with patients and 49.2 percent of their time on HER and desk work,” according to the study abstract. “While in the examination room with patients, physicians spent 52.9 percent of their time on direct clinical face time and 37 percent on EHR and desk work. The 21 physicians who completed after-hours diaries reported one to two hours of after-hours work each night, devoted mostly to EHR tasks.”

While I would not consider these findings particularly newsworthy in and of themselves, the topic of EHRs and doctor burnout in general is a hot one.  One of the most interesting stories I ever reported during my three years at Healthline, at least to me, was a story headlined, “Is technology costing doctors time with their patients?” You can read it by clicking here.

From Google Glass to information overload

I had the pleasure of interviewing Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center in Boston, who at the time also served on Healthline’s medical advisory board. He explained that at Beth Israel Deaconess, ER doctors use Google Glass.

When they enter the exam room, the glasses they are wearing scans a bar code on the wall. “Instantly, the patient’s medical information appears in the doctor’s line of vision, and he or she can refer to it while examining and speaking with the patient,” I wrote.

Pretty cool. Of course, Google Glass-wearing doctors are not yet the norm.

He talked about his father dying in the ICU of a Los Angeles Hospital, yet, even with all the data EHRs can collect, “Nobody could tell me how my father was doing.”

At the same time, when his wife was diagnosed with breast cancer, he was able to comb data from 10,000 patients with similar diagnoses to determine the best treatment for her. Of course, not everyone is an IT director at a hospital and has such access, he admitted.

He said then that when it comes to the EHR, “We are in the biplane era. We haven’t invented the jet engine yet, but we’re not in the era of the Wright brothers either.”

Time to stop complaining, start doing, editorial says

In an editorial accompanying the Annals research, Dr. Susan Hingle of the Southern Illinois University School of Medicine, Springfield, said, “Now is the time to go beyond complaining about EHRs and other practice hassles and to make needed changes to the health care system that will redirect our focus from the computer screen to our patients and help us rediscover the joy of medicine.”

I suspect both patients and doctors will agree with that. And organizations such as the American Medical Association and American College of Physicians have various initiatives working toward that goal.

“Many studies have documented lower patient satisfaction when physicians spend more time looking at the computer and performing clerical tasks,” Hingle wrote. “Patient satisfaction can affect health outcomes via adherence to the care plan and can also affect physician and hospital reimbursement, so the stakes are high.”

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Yes, pharma reps likely do have a say in which medications you take

MedsYou probably have seen them in your doctor’s office: Those really nice looking young people in a coat and tie, or a pretty pantsuit, carrying a spiffy briefcase and a bag filled with medicine samples.

They’re pharmaceutical reps. And a new study shows they probably wield just as much influence as the cynical among us always thought they did.

Published today in BMJ, researchers from Yale and the Center for Medicare Services have shown an association between payments to physicians for speaking and consulting fees, food and drink and other perks and written prescriptions for those companies’ drugs – at least when it comes to non-insulin diabetes meds and oral anticoagulants, both common among our booming elderly population.

The study was massive. Researchers examined 46 million Medicare Part D prescriptions written by more than 600,000 physicians to more than 10 million patients. They looked at more than 300 hospital referral regions.

“One additional payment in a region (median value $13) was associated with approximately 80 additional days filled of the marketed drug in the region,” the study concluded. “Payments to specialists and payments for speaking and consulting fees were associated with larger regional changes in prescribing than payments for non-specialists or payments for food and beverages or education.”

We all know what prescription drugs cost. That’s some serious bang for the buck.

Docs got $169 million for these two classes of drugs alone

Just how much money are we talking in terms of the dollars doled out to docs?

Nearly a million payments were given to the physicians in the 300-plus regions in 2013 and 2014. Just for the anti-coagulants, which are used to treat atrial fibrillation (A-fib) and other cardiovascular disorders, payments totaled more than $61 million. For the non-insulin diabetes drugs, approximately 1.8 million payments totaling more than $108 million were showered upon the docs.

Read more: My interview with actor Howie Mandel about his A-fib

How this study, the first of its kind, finally became possible is noteworthy as well. In a word: Obamacare.

“The Open Payments program, enacted as part of the Affordable Care Act, mandated manufacturers of pharmaceuticals and medical devices to report payments to physicians and teaching hospitals to the Centers for Medicare & Medicaid Services (CMS). The resulting data include direct and indirect payments as well as payments in kind, such as the value of food and gifts, and details the manufacturers products associated with the payment.”

Previous studies have shown that doctors do not believe they are influenced by the payments.

Do you think your doctor is prescribing the best drug for you? Or is he or she possibly prescribing a more expensive drug that isn’t necessary, or even a drug that might not be as effective as something else? These are concerns I heard for more than two years as a reporter for Healthline News from patients with all sorts of medical conditions. I hope to someday write a long-form look at such practices as it pertains to HIV medications.

Read more: My infographic report on the cost of HIV medications around the world

Authors admit study has limitations

The study does have limitations, the authors admit.

“Our findings do not necessarily suggest that payments by pharmaceutical manufacturers are harmful for patient care,” they wrote. “Patients may benefit from physicians being made aware of newly approved, effective treatments that may have fewer adverse effects, reduce the need for monitoring tests, or improve adherence. However, our findings support long voiced concerns about the potential influence of even small payments to physicians by pharmaceutical companies, such as for food and beverages.

“This influence on prescribing can potentially negatively affect patients through inappropriate prescribing, or more likely prescribing of more expensive, branded drugs when cheaper, generic alternatives exist. By one estimate, the geographic variance in high cost or low cost drug prescribing cost Medicare $4.5 billion in 2008.”

I always have said I really have no idea whether Obamacare is a good or a bad thing, because I’ve written about it so much I could see it either way. But I will say this: This sort of transparency is good for America any way it comes in our current climate of rampant political and corporate corruption.

“Our study has important limitations,” the authors go on to note. “Firstly, as the study was cross-sectional, we cannot prove the causality that marketing causes prescribing; it is possible that pharmaceutical companies market in regions where prescribing is already higher. Secondly, our results likely underestimate the association between payments by the manufacturers of pharmaceuticals and physician prescribing since we only had data on prescriptions filled, not prescribed, and our analyses were focused solely on Medicare Part D enrollees, who received approximately 25 percent of all the prescriptions written in the United States.”

The researchers report; you decide.

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Read more: My report on how insurers use higher drug costs to discourage sick patients from enrolling