Judul : New Jersey Health Insurance Exchange
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New Jersey Health Insurance Exchange
>>hi i'm nancy blattner at caldwell university we believe that all citizens should be informed about the importance issues that
New Jersey Health Insurance Exchange, affect their daily lives, that's why we're proud to support programming produced by the caucus
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>>welcome to caucus i'm steve adubato, affordable care act has changed nearly every aspect of healthcare in our country, here in the studio to dicuss the best ways to navigate this new, and for many, challenging healthcare system, we have
cecilia zalkind who's joined us on capital report many times on our sister program, she is the executive director of advocates of new jersey, dr. vin mitta, who is a medical director at oscar health insurance, dr. bruce
chung family medicine physician and founder of city care family practice and finally j.p. mcdavid is a wellness and fitness consultant who is currently using the healthcare exchange, i want to thank all of you for joining us
and try to make sense of the current healthcare environment, doctor let me ask you, the healthcare exchange, is it confusing or very manageable? or something in between? >>something inbetween, but a lot of room to imporve as
well, the... >>what is it by the way? >>the healthcare exchange is a outgrowth of the affordable healthcare act, obamacare as it's known by many, and the purpose is to offer safe transparent conveinient place to
purchase insurance, and it's geared currently towards individuals who want to purchase insurance, or small groups, and there's a variety of choices on the exchange, different health plans to choose to- choose to offer a plan on the
exchange can post details about their plan, their rates, their benefits that they offer, and the goal is to offer a arena where members can make an informed choice about which plan is the right fit for them. >>so right now, someone
watching they obviously heard about the affordable care act, obamacare, however someone chooses to describe it, they go, they do what? they go on healthcare.gov? is that what you did? >>my financial advisor
suggested something, i got kicked out of my insurance company with obamacare when i came in, and i went a couple months with no insurance, i've been self employed for about 40 years and have been searching through all the different
ways of getting insurance and oscar popped up and i looked at it and it fit the criteria, but it was an online experience for me. >>to be clear, you were got ill? >>i got ill after, yeah about two weeks after...
>>okay, after? >>yeah >>but you go on the exchange talk about navigating it, because for many, you're smiling as i say it... >>well it's the search, i mean we all want the best quality for the lowest price
especially self employed i mean everything every dollar counts, so you're looking for the best plan the best company for the best price, so you check them all out >>the best deductible is what you're looking for?
>>deductibles, premiums, copays... >>and you felt confident that you had enough information to do that >>yeah, well you didn't have a choice, you had to have insurance, you have to have it, cause something might
happen... >>but you felt confident that you were making the best choice? >>yeah. >>okay, so here's the thing cecilia, as people watching right now, is it a fact someone might say oh well
it's overwhelming to me, ok fine, but is it not a fact, cecilia, that more and more americans are going to have to get enough information to go on that exchange and make the best choice they can make? >>yes, i think having that
out-reach and ease of information and enrollment is critical to making this work, you know we see this from the perspective of... >>describe your organization i don't wanna assume just because you've been on our other programs that people
will know what acnj is so go ahead. >>well we're a child advocacy organization in newark, we do not provide direct services but we work on policy issues, and ensuring that children have access to health insurance
has been the big goal of ours, and we've been involved in many iterations of that from 15 years ago when family care, our state child health insurance program was first initiated so our goal is looking at those low income families
with children who need to ensure not only that their children are insured but they are too... >>so how does the exchange come into this? >>well i think the exchange has been helpful in the sense its providing
information, but more importantly in enrolling parents, we have a child health insurance program, that covers children low income through medicade, higher pay for others, but over the years it has covered parents and then
dropped parents, so before the affordable care act parents were not covered and we've seen over the years that if parents do not have healthcare coverage they are less likely to insure their children, so one thing immediately that
the affordable care did was it provided an entree for families where the parent could not only get insurance for themselves but learn about the options for their children, and we've seen a substantial drop in the number of uninsured children
>>you have seen that? >>yes. >>and doctor let me ask you this, your area is family medicine? >>family practice, yes >>so when patients come in with coverage through the insurance, how informed are
they and do they have a realistic expectation as to what their covered for and not? by and large >>well mostly, by and large they do not, so j.p. is a perfect example of someone who is a independent contractor, a self employed
person and for many years those patients could not afford insurance, you go to a lot of different... >>cause we're not with a group, they're not with a employer, >>they don't work with an employer, and if you go to
them as an individual it's way too expensive, so those people would pay cash at my practice... >>right, >>so now all of a sudden the exchange opens up, they can pay a lesser amount of premiums and get the care
that they need; however, there can be different deductibles depending on how much you pay, and that's the part that most patients don't understand, is that initially many of their services that they're trying to obtain won't be covered
by their insurance, but will have to be out of their pocket through the deductible, so there needs to be some education about that so they don't blame their doctor for having, you know, paying too much... >>because that's beyond your
control? >>right, it's beyond my control, they sign up for the program deductible and when they come with their first visit, maybe you haven't seen the doctor in 15 years, you come in they've been saving their
problems for many years, come in for their physical now i have 20 problems, so you try to them, but many of those problems won't be covered by their deductible and they say well now i've got insurance didn't cover anything, so they're very
angry at me, they may be angry at oscar, they're angry at obamacare... >>or whomever right? it could be any insurance company >>right. >>cause by the way let's make it clear there are
i believe four or five if i'm wrong on this you'll help me doctor, i believe four or five companies that are on the exchange right now in new jersey, that are eligible to sell insurance is that a fair assessment? >>that's a fair assessment
and to doctor chung's point there is a lot of confusion around the deductibles the cost shares, what's paid for and what's not... >>why? >>well a couple reasons, one is this is a new population that hasn't had
insurance in the past and so it's a new product, the second reason is that insurance is complicated, and... >>by the nature of it? >>well at oscar we would argue that it's unnecessaryily complicated
and that there's a lot of things we could do to maybe simplify the entire proce... >>okay take a step back, sorry for interrupting, deductable premium, help me help all of us who just struggle with those terms themselves, what are they?
>>sure, it's a great question, the premium is the amount that you pay on a monthly basis to get coverage from a health insurer... >>so, for example... >>you may pay 350 dollars a month maybe it's 200 it
depends... >>whatever the number is >>whatever that number is >>every month >>every month regardless of whether you see a doctor or not... >>doesn't matter, that's my premium
>>that's your premium... >>got it, >>exactly, yo're deductible is a- is the number that is part of your plan and it determines how much you have to pay before the insurance plan comes in and starts covering services for you,
and so if a patient with a thousand dollar deductible sees doctor chung the first 1000 dollars of service would be covered by the member before the healthplan would kick in and start covering services, there are variations of that
unfortunately, which lends to the complexity of certain services that are... >>and why are there variations? >>so in some cases like oscar, for example, we cover a number of services without applying it to the
deductible so generic drugs, office visits, telemedicine services are all covered without applying to the deductible... >>they don't go against the deductible? >>correct, they don't go against the deductible, and
so it's our belife, and with a number of other health insurers that core primary care services things that are associated with a catastrohic illness that you couldn't predict, should be covered before your deductible because the
purpose is to ensure a wholistic, thoughtful accessible primary care experience... >>but everyone has their own approaches, and to what degree do you feel that you understand the deal? >>think a general
understanding, but it doesn't become real until it slaps you in the face you know you go see the doctor and you get the bill and i go what do you mean you didnt' cover that? you're supposed to cover that, or in my case...
>>tell everyone, if you don't mind, if you don't want to talk about it don't. >>it's okay, i just picked up this strange tb infection in my hand which is rare and the deductible was covered... >>it was a skin disease? >>a skin, yeah instantly
cause i went to the emergency room and next thing i know my deductibles have been covered, but when i was getting the plan, i would look at what's a deductible that i can manage with how much money i make. how much is the premium, and it's
all, you know dollars and cents to what's the best deal >>so interesting cecilia, we've been more- the more we've been doing these programs, and i've been hosting these programs, the more it's becoming clear to me that insurance, now i'll
put myself in this category i've not wanted to think about it, i wanted to say that's a part of my life, our family's life that i know as a reality a necessity i can't avoid it, it's irresponsible, right, you can't, you shouldn't, but i
don't want to know that much it's a terrbile, terrible approach, but we can no longer, those of us that fall into that category, we don't have that option anymore, we have to learn, we have to understand, we'll never be experts per se, but we have
to be very informed consumers >>well i think that's right. i think the benefit of the affordable care act, is it offers insurance to people who have never been able to access it before, the challenge is then you are the consumer of your own
insurance, right so i'm an employer as well, i have an agency of 17 people, we provide health insurance to our employees... >>so what did you have to do? so we run a small not for profit, we have to make decisions about our employees
what di you have to do? >>well i'll say the last five or six years have been a huge challenge, [laughter] right, we as a small non- profit, we made a commitment years ago, our board made the commitment that we were going
to pay full health benefits without a employee contribution because we could not offer competitive salaries with corporate america, and we've we have tried to maintain that commitment, but we face... >>that's more challenging?
>>yeah, we faced three years in a row where our health premium went up 25 percent that's huge, you know, we're dependent on foundation grants, we're, you know, we don't accept... >>i'm sorry you're talking about public television or
you're talking about your organization? >>yes both of us, so you know the challenges, that's a challenge so a couple of years ago we went through a process and decided to not offer the premium plan, so our employees have the basic
but it does not allow them, for example, to go out of state... >>but here's the point though each person has to know the situation, they have to be more informed, and by the way has the exchange come into play yet?
>>not for us yet... >>but it may? >>it may,you know, we've had three years where our insurers come back and said we'll maintain you with a slieght increase... >>but here's the thing is it fair to say doctor the
exchange is likely to come into play more and more with more americans? >>i think so... >>because? >>well, because many people lose their jobs as the economy goes down so they need another way to get their
insurance, and then... >>how about competitive pricing? >>competitive pricing between >>is the exchange a place where competitive pricing is likely to come more and more into play? >>i don't think so because
i think the government does a lot of subsidy... >>i would disagree i... >>keep talking about this go ahead >>i think it's interesting that when someone signs up on the exchange the main items that they see are the
price and the network, and the benefits that are associated with them so a lot of our members that do sign up of course many of them do come to us because of the benefits that we offer and the telemedicine services and all those things, but
price is the big driver especially for a product that you don't plan to use, and if it's something... >>yeah i didn't plan to get sick doctor, right? >>it's true, exactly you don't plan to, and so if you're not planning to then
price is important. >>and by the way let's talk about the technology part. how much is technology driving the cost associtated with healthcare, and overall quality of healthcare that's delivered, you keep mentioning the telemedicine
piece of this, what does it mean? >>well at oscar what it means is any member of ours can speak to a doctor within 15 minutes on the phone by requesting it via our mobile app or via our website, and we view that as a win-win for
both us and for the member it saves the member from unneccessarily going to the emergency room or an urgent care center for a quick conversation, something that can be taken care of over the phone and for us we view it as an opportunity to
prevent unneccesary visits. >>doctor chung, you believe that face to face communication between the doctor and patient is critical, talk about it, and talk to your colleague. >>right well i think as far as patient like this that
comes into a family doctor's office the most important thing that they can do is make a relationship with their doctor, so the first thing is someone gets into the plan, they go through all the administrative parts of joinging affordable
healthcare plan, they should find a doctor that they like a doctor that has an office that has availability for them to be seen, a doctor that will sit down with them on their first visit get to know them, build a trust between the doctor and
patient, so that as your problems move on, whether it's a skin rash, or it's your high blood pressure, not that you have it... >>whatever you have, you can build a relationship... >>and why can't technology establish that?
>>well, technology is ok, but, you know, oscar's only one aspect of it, you have a small problem like, a rash and you call the doctor at oscar, he can't see the rash >>or any other, just to be clear, or any other place that provides that service.
>>well, i think nothing can replace a human interaction with a doctor, >>yeah, you need both. >>are you saying that? >>no, absolutely not, i think human interaction is crucial and i firmly believe that with your point that all of
these different technologies need to be woven together so that it ensures that continuous connected experience for the member and for us when a member does have a telemedicine call, we put that information both on the website for the member
as well as send it to their primary care doctor so that they have the information so that if they do call about a rash the next time they go to see you, you can pull that up and see... >>there's history? >>and i've used both, yeah
yeah, i've done the phone and i've also gone to the doctor... >>and by the way, i said this in a previous program and i'll say it again, i'm happy right now, litterally as we're doing this program i had something, i promised
we're going to do a program on this, what did i say i'm actually drawing a blank on what it's called, what oh vertigo, that's right i intentionally try to forget it i experienced vertigo, and my mother had it for years and
she goes, and i said oh ma how bad can it be? and then i got it, i go oh that's what you're talking about, and it's a dizzy, you know what it is right? >>i'm not telling any doctors right, how serious it is and so i said you know what?
and i went to see an ent specialist whom i knew whose been texting during the day today because vertigo does make you very dizzy and there's certain medication and he tex, in between shows he said to me tell me what you're feeling, do we need to
talk? pick up the phone, i thought to myself, he's not saying come into the office i would love to see him, but i can't because i'm here, he's where he is, there was a lot of value in that, am >>i making a too much of that >>no, i think that's really
important, i do. i think that's all part, i think that's part of the relationship... >>but i have a relationship with him >>that's great, the doctor called you back, that's the other thing,
>>but i also have a relationship with him, i want to make that clear, there's history there, and it doesn't matter, is telemedicine changing the doctor-patient communication and relationship? >>i would argue that it's
leveraging it... >>leveraging it? >>technology makes those interactions more timely, you have those interactions when you need to, like in the case of vertigo... >>sure >>and it links them all
together, so that you have a continuous understanding of a patient's healthcare history, and so telemedicine is just the first step in that, but we've view all the techonology inovations that we have, such as getting notifications from the er
when a memeber hits the emergency room, as an opportunity to put the right information in front of the doctor at the right moment because you're right, that final interaction is a human to human one and that's the crucial part, and for oscar
it's about making that human to human interaction as powerful as possible. >>let's talk about children.. >>i definitely agree that oscar has done that, when you look at their website it's a very friendly and the patient that we see that have oscar
they kind of know us already because they've seen our profiles on the internet they've seen our face, they know our offices, other insurance companies say, you know, big aetna, you get a book, here's a book go see your doctor...
>>well listen everyone has their own strengths and people can decide for themselves in terms of the four or five, if you will insurance companies that are on the exchange in new jersey but cecilia let me ask you this, there are children that
you are particularly concerned about, talk about what we have found in terms of the chronic conditions that childr- let's talk about asthma, how does that even enter into this discussion? fees of the post aca and the exchange?
>>well you know i've two answers to that, one because we've done some intense work on absenteeism in newark, we're just finishing a report on that, and asthma is a huge issue... >>absenteeism in school? >>in school...
>>very high percentage in urban areas >>very high percentage, so part of our advocacy for the program is to move away from healthcare that's provided at the emergency room when there's a crisis, to more preventive care that a family
gets earlier on for their child, and i think that's happening, but what we've seen and what we've heard in our look in absenteeism in school, is that it, we may have moved away from the emergency room, but we're not quite at the preventive care
yet, so using asthma as an exapmle what we heard from parents is, a parent has the healthcare provider, their child is diagnosed with asthma, they have the acute response, so they go to school with the inhaler... >>right
>>so if a child has an attack in school, they have the inhaler to use, they may have a nebulizer at home that they can use, but in terms of that preventive care, that that child should be on, so that those attacks don't take place, the parents we talked
not many knew about that, and didn't- either didn't understand or had not been explained to them fully, by their healthcare provider so i think we've made a lot of progress in moving awat from emergency room care, i think that's very positive
but in terms of children and preventive care i think we still have a ways to go. >>so let's talk about this, cecilia raises a great point to what degree is or does the new healthcare environment, the landscape that we're talking about
today and the exchange, provide information about prevention and wellness, i mean do you see it that there? >>yeah, drastically in the last 10-12 years i mean they >>you see it? >>oh yeah, i mean that's
what i teach, preventive health... >>the sections right there where you find it there, and that's something that you see as well across the board? >>i do agree because what will happen is someone will join an insurance plan and
then they'll say the first thing is go to your doctor for your physical, and then they come in, otherwise they would never come in, because it costs too much, there's some problem about coming in, but as soon as they get their plan, go see
doctor for a physical >>not only that they pay for gym memberships, they pay for i mean they really they send a fit bracelet recently, they really do try to help start the preventive >>legislation's helped that too, before...
>>what do you mean? >>the affordable healtcare act has mandated that preventive care is covered by the insurance plan, and >>isn't it the, doctor respectfully, is it defined specifically in the legislation as to what
preventive care really means? >>it is, they define the method by which a service is defined... >>for example? >>as preventive care and so all of prenatal care while visits for a woman during her pregnancy are considered
preventive care, a annual cholesteral and diabetes screening is considered preventive care, certain types of studies based on your age and other risk factors... >>gotta be covered >>have to be covered...
>>so you know so... >>and have to be free >>hold on, so you're saying that on the exchange those services those some of those tests have to provided, have to be covered, and have to be free? >>that's exactly correct,
and it can be complicated >>that's the other area that's the most complicated for patients is they'll come in for their physical or their first initial visit, and they may have other problems, and deciding which one's going to be covered
which part is part of their deductible is very confusing for them... >>well how would they know that doctor? >>they don't know even doctors don't know >>hold on, wait wait wait wait wait wait wait wait,
>>well we know what their problems are but we may not know which is covered and which may be part of their deductible. >>so let me ask you something in your office, i'm always fascinated by physicians' offices and how you're set up
do you have someone dedicated to do nothing but navigate this landscape? >>yes, so in our office we have three doctors and then eight other staff, so eight other staff, the majority of their work is allowing us to survive by interacting
with insurance companies, you know collecting... >>wow. >>the demographic information from the patients, making sure we document everything, make sure the bill goes to the insurance company, and then the back and forth
argument about what's going to be part of the deductible what's the part going to be paid, which code is correct, >>but respectfully, if it's so clear cut, then why is there a such spirited debate? >>which part is clear cut? the deductible
and it's confusing, which >>we got a minute left. >>is this just the wat it is and the way it's gunna be? >>this is the way it is, but this is not the way it should be, or the way it has to be >>where we going then? minute left, go ahead where we going
>>there's a huge opportunity to simplify this interaction both with members and with doctors and with members we and a lot of other health insurers have done a ton of work to simplify what it is covered, what is not, what a deductible is on our website
on our mobile app, and have the ability to ask smart questions to your insurer and get those answers in a timely fashion, very response to customer service, very thoughtful design, and the layout of what exactly is our health insurance product
on the physician side 20-30 percent of physician time is spent recovering revenue from insurers that should be paid in the first place, for us we view it as a huge opportunity for cost saving, simplify their lives, we save money, they save money
as well, and so it's not the way it needs to be, i think technology's a huge way to fix it. >>put it this way and we will continue to do our part to help inform the public, all of you, who are trying to navigate the healthcare
landscape, thank you you all very much. >>thank you >>the preceeding program has been a production of the caucus educational corporation, celebrating over 25 years of broadcast excellence,
and thirteen for wnet, njtv, and whyy, funding for this edition of caucus new jersey has been provided by: barnabas health, the russell berrie foundation and by the mental health
transportation provided by: air brook limousine, serving the metropolitan new york new jersey area, produced in partnership with tristar studios >>think of five people in your live including yourself at least one is struggling
with a mental health condition, and heroine and perscription drug overdoses are among the leading causes of accidental death in the united states, the mental health association in new jersey is a leader in advocacy, training, and
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