Healthcare utilization drops but healthcare costs increase. What’s up with that? That’s right, Americans used less healthcare but costs increased?

February 15, 2018

As you can imagine (or at least hope) there are groups that closely study the results of American’s consumption of healthcare and the cost of delivering that care. The Health Care Cost Institute (HCCI) is one of those groups. The following is a short summary of HCCI’s recent study as well as facts about healthcare. It’s very interesting and supports the ideas and actions supported by your humble author in earlier Posts.

HCCI’s annual Health Care Cost and Utilization Report analyzes health care spending and utilization from 2012 to 2016 for people up to age 65 with employer-sponsored health insurance. That means HCCI analyzed actual utilization data from employer group plans.

One of the many interesting facts identified by HCCI’s analysis is, Americans consumed (used) the same amount or less health care in 2016 than they did in 2015. However, rising prices caused overall spending in 2016 to grow faster than any time in the last five years. 

Niall Brennan, president of HCCI, states;
“It is time to have a national conversation on the role of price increases in the growth of health care spending,” said Niall Brennan, MPP, president of HCCI. “Despite the progress made in recent years on value-based care, the reality is that working Americans are using less care but paying more for it every year. Rising prices, especially for prescription drugs, surgery, and emergency department visits, have been primary drivers of faster growth in recent years.” (HCCI Press release)

Here are some of HCCI’s facts & conclusions:

  • While the number of emergency room visits rose just slightly, the average price for an emergency room visit grew steadily over the five-year study for a 31.5 percent cumulative increase, driving the increase in outpatient spending.
  • The average price of surgery went up as well, pushing up spending for both inpatient and outpatient care.
  • The average price for surgical admissions increased by nearly $10,000 or 30 percent over the five-year study period, despite a -16 percent cumulative decline in utilization.
  • The price for outpatient surgery rose more than 19 percent.
  • Over the five-year study period, prescription drug spending had cumulative growth of 27 percent, despite a flat or decreasing trend in generic drug prices and despite a decline in utilization of brand prescription drugs.
    *The increased spending was driven by double-digit price increases from 2012 to 2016 for brand prescription drugs.
  • Total spending on primary care office visits fell by almost 6 percent over five years due to a decline in the number of visits.
    *This was offset by a 31 percent spending increase on office visits to specialists and a 23 percent increase in visits for preventive care, changes that could be partly attributable to changes in billing practices or in the way people seek care.

“While consumers, especially those with employer-sponsored insurance, may not feel the direct impact of these charges via out of pocket payments, they ultimately pay through increased premiums and decreased benefits,” added Mr. Brennan.

Are these conclusions realistic – Yes!

  • Since 2011, HCCI has tracked, independently analyzed, and reported health care spending, utilization, and prices each year in its Health Care Cost and Utilization Report using de-identified claims data of people up to age 65 with employer-sponsored health insurance.
  • For this report, HCCI analyzed data from roughly 4 billion claims of nearly 40 million individuals. Claims data came from four of the largest health insurance providers in the U.S. representing about 26 percent of the employer-sponsored insured population. 

Isn’t it interesting that as utilization of healthcare services goes down the overall cost of health care goes up for both employees and employers?

Makes one ask: Why is it that when the Government gets involved costs go up and its the average tax-paying premium-paying citizen who bares the brunt of that cost increase.

  • It happened with Medicare and Medicaid.
  • It happens with military costs.
  • It happens with roads, bridges and all other infra-structure costs.

Why would we be surprised that the Government mandated Affordable Care Act would increase the costs on that which it sought and still alleges it controls?

It almost makes me want to re-print a couple dozen of our previous posts that describe how to lower cost while increasing coverage and access to healthcare. But, I won’t.

We want to thank the Health Care Cost Institute for its reporting and for the effort it makes to gather the information it reports. Americans would be doomed were it not for organizations that watch over our nation to report back to us.
Lord knows we can’t depend on the Press  any more, to do that! Sorry, that’s the cynic in me!

In the weeks to come, as we look at various efforts to create alternatives to the ACA, we will include additional statistics concerning healthcare utilization and spending. The statistics and utilization figures we have captured for years could help build solutions that lower costs to employers, employees and members while increasing benefits and access.

It isn’t that hard!

Let me know if the stats above shock you or infuriate you. I look forward to seeing what comes out of the many States that are trying to overcome the ACA. We’re in this together so let’s shout out when we see something that makes sense.

Until next week.

Mark Reynolds, RHU
559250-2000
mark@reynolds.wtf

Some States are taking steps to “develop” lower cost health plans that will help lower costs and improve access. But, they face opposition!

February 8, 2018

In previous Post, we discussed President Trump’s Exec Order allowing health plans to be created that would lower cost with benefits people really want but not be compliant with the ACA. A few states are moving in that direction. The plan development from these states is just getting started, for sure, but already there are promises from pro-ACA advocates to sue any State or Insurer that implements such plans.

We’ve seen litigious threats and real lawsuits, in other efforts to bring common sense ideas back to life. Limiting “immigration” or “visa” permits from certain countries, increasing border security, and even lowering taxes have all come under siege and litigation by the left. The Left continually tries to thwart  President Trump’s  efforts to improve the economy, increase jobs available, improve security, and well, Make America Great Again.

So, why should we be surprised that the pro-ACA advocates would threaten lawsuits against states when the State’s leadership is trying to increase health plan alternatives, lower cost and improve access to providers.

The good news should be reported that the various state leaders out in front in these attempts to improve healthcare delivery and finance are doing so with the right ideas and ideals in mind.

These state leaders are seeking plans and ideas that:

  • Include complete transparency. Transparency where the consumer could see the actual cost of treatment. Patients and their Doctors should be able consider the effectiveness as well as the cost to benefit of any treatment.
  • Change the treatment practice of ordering multiple tests to avoid potential liability. Treatment should focus on healing the patient not avoiding lawsuits.
  • Create a free market environment that allows providers and pharma to make a profit but avoid the outrageous pricing scenarios we see today.
  • Allow small employers to “partner” with insurers. This means allow employers to purchase coverage for catastrophic events and self insure the healthcare under a certain value, for example $10,000. This can be done using currently available HRAs.
  • Allow for employers to “incentivize” their employees to make better choices. Today employers fear being sued if they encourage their folks to stop smoking or lose 20 lbs. with a health plan that gets richer as the employee gets healthier.
  • We must stop federal government interference in the local marketplace. The rules and restrictions of the ACA are driving up the costs and the one-size-fits-all policies just don’t work.
    * For employers in some states, such as California, we might need some Federal assistance in the form of ERISA.
  •  Most agree that it is important to develop ways to help insurers provide coverage to the individuals who are driving the majority of the costs.
    * Let’s face it, the statistics prove that less than 5% of any group will incur more than $5000 (or even $10,000) in medical charges each year.
    * But, in that 5% of the population, the medical charges can be huge, catastrophic as they say, and there is little the citizen-patient can do about the cost of his/her treatment. So, insurers honestly need assistance to finance these charges.

The point is that we are watching state regulators look at realistic ways to improve access and lower cost without penalizing our citizens for their healthcare usage.

Remember this fact, the enrollment in ACA individual plans at the close of this year’s open enrollment is only about 8 million enrollees. The plans we’re discussing above could be considered as alternatives by 50 to 100 million employees currently in small group plans around the country.

But, these new ideas will be criticized and litigated simply because they conflict with and/or weaken the ACA. If 50 million of our fellow citizens could get access to enroll in these lower cost plans, would that not be a good deal. We might make America’s healthcare great again. Sorry for that.

Anyway, we should be glad that there are creative people developing ideas and even real plans that will increase access to more providers, provide the benefits people really want, and lower cost in both premium and out of pocket. As we said in previous Posts, you won’t see or hear much about it in the Media so we’ll have to watch for it ourselves.

But then, we’re all in this together, so let’s keep watching together.
Let me know what you think.

Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

Alex Azar is sworn in as our new Secretary of Health & Human Services. Who is Mr. Azar and what can we expect.

February 1, 2018

Alex Azar is a Yale educated attorney who just may be uniquely qualified to lead the HHS at this time with the objectives laid out by President Trump.  Mr. Azar has practiced law in the real world as well as being the General Counsel for the HHS under President George W. Bush from 201-2005.

Mr. Azar was Deputy Security of HHS from 2005 until leaving in 2007 toward the end of the Bush administration. After serving at HHS for nearly 7 years, he was hired by Eli Lilly Co in 2007 to be a spokesman and lobbyist before ultimately being named Vice-President of US Managed Healthcare Services organization for Eli Lilly.

One unique fact about Mr. Azar is that he has never been a politician. Dating back nearly 40 years, every appointed & confirmed Secretary at HHS has been a career politician either Governor or Senator. Obviously, being a career politician does not really prepare one to make the decisions and take the actions that are needed to give our citizens the best services from an organization called Health & Human Services. Let’s face it; for most politicians the primary goal always seems to be serving for themselves.

There in lies a unique factor that may prove positive since Mr. Azar has not been be-holding to anyone for an election, a trait he has in common with President Trump. In addition, Mr. Azar was employed at Eli Lilly, a big pharmacy and healthcare company for roughly 10 years. That is important to note because we all know pharmacy costs continue to increase dramatically and nobody seems to be able or willing to control them.

It is also critical to acknowledge that the delivery of pharmacy benefits is a complicated function. In the Rx delivery business you have AWP (Average Wholesale Price), MAC (Maximum Allowable Cost, public plans such as Medicare or Medicaid, private plans such as your Anthem or Aetna plan, dispensing fees, and don’t forget rebates all of which make delivering your Rx very complicated.

Plus, the retail cost of an Rx in the US is much-much higher than in other countries including our neighbors in Canada and Mexico. In fact, people in Canada and Mexico can often purchase their personal prescriptions for 10% of what we pay in the US.  That’s right, what you might pay $100 for in Oregon or Maine is available for $10 in Mexico.
Now, who can understand or make sense of that?

The Rx delivery business is more complicated and potentially more abused than any other aspect of healthcare in the US. With healthcare cost increasing double-digit and premiums increasing sometimes by triple-digit it may serve the public well to have the Head of HHS understand the Rx business as well as how the HHS works.

President Trump publicly tasked Mr. Azar ( directed him actually) to reduce Rx cost dramatically. President Trump also publicly instructed Mr. Azar to continue with the objective of replacing the ACA with a better healthcare financing and delivery system.

How’s that for directions from your boss on your first day on the job?

So, Mr. Azar:

  • Is not a politician.
  • Beholding to no one – except the President.
  • Understands big Pharma and its:
    • R & D processes
    • Patent protection and effect on Generic vs. Brand
    • Profit margins
  • Delivery of Rx through private and public plans.
  • Law & business experience
  • Works for a President that:
    • Wants to lower cost
    • Improve access
    • Make a difference in people’s lives
    • Doesn’t give a darn about the way it has always been done!

In 2010 through 2014 we heard from and about the Secretary of HHS constantly because she was continually making announcements about the rules or regulations being developed for the ACA. On and on it went with restrictive-obtrusive-costly and damaging rules to make the ACA be what the Liberals wanted.

I suspect that we won’t hear that much from or about Mr. Azar except when the Liberal cry out about the piece by piece incremental changes to ACA. If Mr. Azar can reduce Rx costs, which is a huge “if” due to the power in Pharma, then we will all benefit.
But, we should not be overly optimistic about seeing Rx cost drop too quickly.

Can you imagine how hard it would be to make Northrop Grumman, McDonald Douglas or Lockheed Martin  reduce their costs 40% to 50% for the guns, airplanes and missiles our military requires to keep us safe. Believe it or not, that is a reasonable example of the battle Mr. Azar will have as he tries to lower Rx costs in America.
And, I am not exaggerating.

I am optimistic, though, about Mr. Azar’s chances of making a difference. He is experienced with the HHS, understands how Big Pharma works, plus he has a Boss (The President) who is demanding lower cost, better access, and better efficiency. These factors could make it possible to see the changes America needs and deserves.

There is much more we could discuss about Mr. Azar such as his positions on AHPs, selling across state lines, insurer subsidies and so forth. But given that he was just sworn in 20 minutes ago, I think it would be wise to simply watch to see where he starts and what he can do.

The Department of Health & Human Services affects us all, more than most realize, so we are definitely all in this together.
But what do you think?

Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

 

The News is focused on Congress’s CR efforts. Good news is that the CR includes a few ACA taxes. Let’s take a look.

January 25, 2018

As your humble author drafts this Post the CR passed by the House was just passed by Democrats (and Republicans) in the Senate. The so-called Schumer Shutdown, as the White House named it, is created confusion, a lot of finger-pointing and pain for millions of Americans.
But, American premium payers do get relief from 3 ACA taxes.

The CR, which is actually being attached as an amendment to H.R. 195 (Federal Register cost-reduction bill), will allow the federal government to continue with normal operations until Feb. 16. The reference to “normal operations” seems a bit ironic doesn’t it given the manner in which the US Congress works?

If you recall, a couple weeks ago we discussed some of the taxes still imbedded in the ACA and a few taxes that had been deferred over the past couple years.

The CR being voted upon currently addresses the taxes we discussed. It does not “repeal” them or permanently eliminate them, of course. The GOP can’t seem to actually deal with “permanent elimination” of anything in the ACA.

Let’s look at those taxes in the bill:

  • Postpone reinstatement of the ACA Medical Device tax for two years.
  • Postpone reinstatement of the ACA health insurer fees for two years.
  • Postpone the start date of the Cadillac tax or a tax on high-cost employer-sponsored health benefits packages, for two years.

It is good news to see these taxes deferred but it’s impossible to understand why the GOP can’t or won’t eliminate them permanently.

I think the honest reason for these actions, or lack of, lies with the basic problem inherit in our legislative representatives. I won’t expand on those thoughts because it becomes too negative and down right depressing.

Democracy is the best form of government in the world but it is the most difficult to maintain, as history as shown. For a democracy to survive, let alone thrive, it requires an informed voting public. That requires an open, free, and non-partisan Press. I won’t expand on that point either for the same reasons as mentioned prior.

As we discussed in earlier Posts, there will be much to discuss in the coming months concerning Healthcare Reform but for now let’s watch as the Democrats play their hand in the Continuing Resolution.

Whether one is a Republican, Democrat or Libertarian the activities in Washington DC are frustrating. But, one thing is clear and that is we’re all in this together.

Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

Association Health Plans – A chance to make a difference! The Department of Labor is asking for input. A positive step.

January 18, 2018

Association Health Plans (AHP), which we’ve discussed here before, may soon be in the news again. The DOL has released some initial guidelines on which it is requesting comments. As you may recall, your humble author has opined that AHPs present an opportunity to lower the cost of premiums as well as healthcare costs while increasing the number of options available for small employers and their employees.

You may not hear much about AHPs in the liberal Press outlets and maybe not on regular TV at all because it is a complex subject but also because liberals fear it furthers the dismantling of the ACA.

In fact the only outlets which may cover the ongoing discussion will be consumer oriented free market websites and blogs. Cable business shows will provide short segments but for detail we’ll need to stay tuned to trust-worthy entities such as SPBA (Society of Professional Benefit Advisors) or directly from the DOL or other government sites.

But, we’ll watch and discuss the progress of these regulations here and look for the best ideas being pushed forward. Today will be a view from 10,000 feet but we will fly lower in the weeks to come.

The guidelines will expand the existing DOL ERISA regs to incorporate the objective of allowing small employers to band together to create a larger unit which can be treated as a single employer.
In other words, by banding together, small employers with 2-50 EEs, can shop for and consider health insurance plans just like large employers. It increases their buying power. Wouldn’t you, as an individual, like to have the purchasing power of an employer the size Walmart, Microsoft, Boeing, or Amazon. I would.

Let’s start with some a couple of the DOL guidelines released:

  • Broadening the criteria under ERISA section 3(5) for determining when employers may join together in an employer group or association that is treated as the “employer” sponsor of a single multiple-employer “employee welfare benefit plan” and “group health plan” as those terms are defined in Title I of ERISA.
    (I know, a bit technical)
  • Redefines the term “group or association of employers” under ERISA more broadly, in a way that would allow more freedom for businesses to join together in organizations that could offer group health coverage regulated under the ACA as large group coverage.
  • Treating the AHP as the “employer sponsor” of a single plan. The regulation would facilitate the adoption and administration of such arrangements.

I’ll stop right there with the technical mumble jumble because the last point a key point.

By allowing small employers to be treated a like a large employer, because the small employer is member of an AHP, will increase the purchasing power along with the number of options available to the small employer.

There is much more to review such as:

  • Will individual employers within an AHP be able to purchase stop-loss coverage?
  • How will EHBs be addressed?
  • How does an AHP sign up its initial member employers?
  • Can a small employer’s initial premiums be set for each single employer or must premiums be the same for all member employers?
  • Will AHPs overcome the stop-loss killing regulations set in force in California?

So, there is much to review. I look forward to your input as the AHP guidelines are constructed.

It is important to remember that while the AHP approach provides a huge potential to reduce cost and improve access, we can not go away from guarantee access and providing responsible provisions for participant’s pre-existing conditions.

We’re all in this together so let me know what you think.
Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

They hope we’ll forget about the taxes still in the ACA. But we can’t, can we?

January 11, 2018

It’s easy to let things slide past us after awhile. Who among us can remember everything for ever and be willing and able to discuss a specific topic regarding of its importance? In the news reports on January 2nd, 2018 there were a scant few reports scattered among the daily news about how the ACA tax on Medical Devices was going live again. After a 2 year pause this tax will once again take affect and be a part of the cost and premiums we pay because it is a tax that the insurers will pay.

But, no one took notice. Nor did anyone start talking about the other taxes still remaining in the ACA. Why do you think no one is talking about these burdensome-premium raising taxes?
Here’s a couple thoughts:

  • In general the Press, both Liberal and Conservative, are focused on what they view as bigger topics such as the DACA issue, budget to keep the government open, Russia-Russia-Russia, is Jerusalem really Israel’s capital, Iran and North Korea, as well as the President’s Tweets, to name a couple.
  • The liberal Press does not want to bring up ACA taxes because it might distract from the get-Trump movement or worse, gain traction in the press and start the GOP in the direction of repealing the taxes.
  • The conservative Press does not want to bring it up because it points to the GOP’s failure to properly address the R&R of the ACA.
  • Democrats don’t want to discuss it for fear of losing the ACA completely even if it’s deleted a little at a time.
  • The GOP does not want to discuss it because it could pressure them to actually do something to solve the healthcare crisis of delivery and finance.
  • What a friggin mess, right?

In addition if the discussion on ACA taxes gets started the GOP may need to defend why it has done nothing about the following taxes:

  • Excise taxes on health insurance providers, pharmaceutical manufacturers and importers in addition to medical device manufacturers and importers.
    • These excise taxes are projected to raise $19 billion in 2020. 
  • An additional 0.9 percent payroll tax on earnings and a 3.8 percent tax on net investment income (NII) for individuals with incomes exceeding $200,000 and couples with incomes exceeding $250,000.
    • The high-income surtaxes are projected to raise $35 billion in 2020.
  • Excise tax on employer-sponsored health benefits whose value exceeds specified thresholds starting in 2020. The so called “Cadillac” tax reduces after-tax incomes the most in percentage terms for middle-income families. 
    • The excise tax on high-cost health plans is projected to raise $3 billion in 2020 with the revenue gain growing rapidly over time, reaching $20 billion by 2026.
  • Excise tax on employers offering inadequate health insurance coverage. The tax applies to employers with 50 or more full-time equivalent employees.
    • The excise tax is projected to raise $20 billion in 2020. 

Maybe these 5 additional taxes, in addition to the tax on the medical devices, answer the question as to why no one is screaming about the premium-increasing taxes remaining in the ACA.Oops, the cynic in me just popped out.

If the GOP had eliminated these taxes in the tax billed just signed then the GOP would have been forced(by CBO calculations) to adjust its calculated outcome. That could have made their job harder. But remember, Congress and Senate members(and staffers) don’t actually pay these taxes because they have their own health plan separate from the ACA. Therefore, how could we expect them to reduce these taxes.

I mean, if it would make their job harder, and all. Gees, we can’t expect them to work 5 full days each week, keep the promises they make, and still reduce our costs. Oh well!

OK, I know the new year is young and there is still time. But the Congress will soon set its full concentrated focus on the mid-term elections of November 2018, Then we can expect to see nothing being done except more speeches and more promises.
Dang, that cynic again.

Anyway, what do you think. Let’s keep an eye on it because we’re all in this together.

Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

Enrollment period for ACA Individual plans is over. All the effort and stress for 8 million citizens.

January 4, 2018

We talked a bit about the craziness surrounding the open enrollment period for individual plans on previous occasions. Now the open enrollment period is over and the media will quiet down.

But, the other 300+ million Americans adversely impacted by these individual plans should continue to raise hell! As we’ve discussed in previous posts the entire private sector healthcare system of finance and delivery is suffering because of ACA imposed rules, metallic plans, burdensome regulations, and liberal press bias.

We should not begrudge these 8 million Americans, in fact it’s just the opposite, I wish the number included every American not covered by an employer sponsored plan or Medicare/Medicaid. If the reports are correct there could be another 20 to 25 million Americans on individual plans but choose not to for one reason or another.

The fact remains that Democrats inflicted us all with the ACA in an effort to take over private healthcare so that the government would then control 100% of the health finance and delivery system in America. But, they failed.

Their failure is not due to efforts by the GOP which we’ve all seen to be dysfunctional, pitiful and weak. No, the ACA’s failure is due to the character and spirit of free markets and the American people.

But, once again, the efforts by Liberals cause the many to pay extra for the few. In this case, the many have seen their premiums increase 300%, their doctors disappear off PPOs, and the number as well as quality of the health plans offered reduced.

We see similar punitive results in the liberal assault on so-called climate change. Their efforts here are another example in which the people who can least afford it bear the brunt of the cost. We all want clean water, clean air and blue shies. But, the regulations demanded by liberals raise the cost for Americans struggling to get by while the governments in India, China, and other polluting countries just skip on by.

I start out 2018 with this rather negative post not because I think the future is bad or that we are doomed to the same crappy health plans forever. I begin 2018 with this message because I know we all need reminded and that while you and I are busy living our lives there are others who won’t give up the fight.

I think 2018 will bring continual reminders about the need to change or repeal the ACA. But since the Congress and Senate seem incapable of pulling it together the changes we need will likely come in piece meal bills and directives.

So, don’t begrudge the 8 million mentioned above because many of them could not qualify for or afford coverage before the ACA. The ACA would never have gotten a foothold and could have been avoided had the GOP implemented GI back in 2002-2003 when they implemented HSA and HRA plans. It could have been simple!

I think change is coming and is in the works as you read this. Let’s not forget the potential for Association Health Plans and the ability to sell across state lines were put into motion in 2017.

We have reason to be angry but we also have reason to have hope. Let’s watch for the incremental glacial movements in 2018 that will bring relief to the millions of premium paying citizens of America.And I’ll keep you updated along the way.
Happy New Year.

Let me know what you think because you know we’re all in this together!

Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf.

It’s that time of year again. Time for “reflection”, and to look forward with the knowledge of the past year.

December 28, 2017

The unbearably hectic season of Thanksgiving and Christmas has past, New Year’s Eve is in a few days and frankly most of us are probably worn out or worn down. Face it, life has not gotten easier just because we have Smart phones, ipads, the internet and even an economy that is blossoming. No, life is both complicated-busy and frustrating as well as rewarding-gratifying and exciting.

So, some people take at least a little time out of their busy schedules, at this time each year, to think about the year that’s past and their hopes for the year to come. In business one must reflect on the past year’s activity or results in order to forecast for the future. Some people do the same for their personal lives although admittedly I fall short in this area.

As you know, I’m an optimist trapped in a synic’s body so this is a most satisfying time of year as I review life from that capsule of time lodged between Christmas and the New Year.
Let’s look at some good and some not so good with these thoughts in mind.

The GOOD
Inauguration of Donald Trump to millions was a positive event filled with honest hope that he could change the negative spiral America had faced for the previous 12 years. Yes, that’s right 12 years.
No Repeal and Replace, which I include as a GOOD because the replacement bill offered by the House was a wreck and would have made healthcare finance and delivery even worse. Plus, it would have given the Dems too much ammunition to use in the Media. ( Ironic isn’t it that the anti-gun left needs ammunition)
Twitter  is a GOOD, even though I don’t know how to use it, but it has allowed the President to get his word out by going around the dishonest liberal press. While not all of the Pres’s tweets have been helpful, Twitter has provided a tool by which he can get his message out.
Snow in Sierras may be a local thing for folks living in the San Joaquin Valley of CA but the extra snow pack and rainfall gave CA a welcome break from the 5+ years of drought. It may have also helped slow the Bark Beetle in its march to destroy more of the magnificent trees  in the Sierra Forests (129 million to date).
Family Health, which is important to each of us, has been relative good for your humble author’s family. Unfortunately though, we do have close friends suffering greatly so we do pray for them. But selfishly, for our immediate family things are good, and  for that I am grateful.

The BAD or at least not so good

Congressional Leadership in Washington (not to mention CA) has been a great source of frustration for most of us over this past year. The GOP leadership is unable to communicate well to the people, makes things unnecessarily complicated and does not act together. In addition, it appears intent to maintain the status queue for what’s been so accurately described as a “swamp”.
Press both national and local has become increasingly untrustworthy. Whether a Liberal or Conservative, one must agree that we can’t trust what we read or hear anymore without a bit of concern. It was similar in the Cronkite/Viet Nam era but then news traveled slower. Now, with the internet and people deliberately trying to push “fake news” it is tougher to know the facts let alone the truth. It’s hard to imagine this will get better soon.
Internet which I mentioned above, can be a most amazing tool for our life and health. When you search for gods or service or wish to stay in touch with friends it is incredible. Unfortunately, it can be a tool just as useful for confusion, misinformation, and evil. It’s user beware and we must all be aware.
No R&R, that’s right I predict that the current House and Senate will not get anything meaningful done on repealing and replacing the ACA. That may be a good thing given the mess the GOP tried to force through last year. But it won’t be good for premium payers that don’t qualify for subsidy and small business that continues to deal with the high priced metallic plans of the ACA.

Hope for 2018, that’s right hope! I’m betting the economy will continue to go well. There will be more jobs and better pay scales available. We will feel the benefits of the American economy every where.
The biggest obstacle and concern will be the ongoing issues caused by Russia or China and their intent to cause damage to America. With their help we can keep North Korea, Iran and the middle east from spreading terror and disasters. Without their help it could be more terrorist acts and crisis.

But, I am hopeful for several reasons. One, we are all more aware of who we should trust or not. We have a President and Cabinet trying to build America up not tear it down. And America is an engine that produces outcomes desired and envied by the rest of the world.
While others around the world try to tear us down they also know that there’s no place on earth like America.

Plus, you have me writing to you every week, helping you understand the malarkey our government is trying to pass off as healthcare reform.

Have a safe and Happy New Year. Together we can make it through anything to build a bright and prosperous future. We may even make healthcare better and cheaper.

Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

We didn’t have to stress about saying Merry Christmas, this year. Thank you Mr. President!

December 21, 2017

It’s four days before Christmas and while the Stockings are not yet hung, I bet most of us are thankful that the “war on Christmas” has been placed on-hold, at least for this year.

So this week instead of promoting or dissecting some aspect of healthcare reform let’s look for aspects of 2017 and our own lives in America that bring peace and good will to man.

So, thank you to:

  • First Responders who run toward the crisis or danger while we run away. These brave men and women are better civil servants to our Nation than anyone else, especially politicians, can ever brag to be.
  • Military that in spite of a decline in funding and respect over the past 10 years continue to keep us save by stopping the dangers over there from reaching over here. I did not join the military when I was of age, a decision I regret to this day.
  • Law Enforcement officers on a daily bases as they walk or drive into unknown danger without hesitation and without the support of too many in our nation.
    We should all stand each time the National Anthem plays!
  • Teachers who signed up to help educate our future generations and continue do so even when facing the toughest environments. Wouldn’t it be easier to teach if English was the required language, parents would help from home, and Unions cared about kids more than self-preservation?
  • Moms for doing what they do to love their children even when we are unlovable. Giving birth might be the easy part for Moms these days as they too often take on the role of both parents and both bread winners in American homes. Moms are the first responders for our families and they need our help and thanks.
  • Churches that stand for the true Word of God and don’t give in to the secular-worldly efforts by too many to cast shadows upon what we all know is right.
  • Co-workers that come to work each day to work as a team toward similar goals of creating good products, good service, and respect for team.

Thank God, above all else, for His gift of the Lord Jesus Christ, for us all. God so love the world that He gave His only Son for us that we might have eternal life. To those of you who are believers you know that a relationship with Jesus Christ does give us an eternal home but also gives us a relationship throughout the year like none other possibly could.

That’s just a few. To whom or what are you thankful that makes your life safer and better?

Love to hear from you and especially at Christmas we should know that we’re all in this together. 

Merry Christmas to all!! And to all, until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

 

Skinny Plans, what are they and why do they draw so much criticism? Let’s look at the truth.

December 14, 2017

We have all witnessed this term “skinny” become common for promotion of many facets of our everyday life. Skinny margaritas(I’ve heard of these but never ordered), skinny chicken, skinny shrimp or other skinny menu items, and skinny jeans (which I totally don’t understand), and many-many more common everyday items turned skinny in our everyday life. I apologize, in advance, for discussing anything “skinny” midway between Thanksgiving and Christmas but it is important to address the term as it is being used in the effort to obstruct the needed overhaul of healthcare in America.

But, calling a health plan “skinny” , while descriptive, may be misunderstood my most which opens up the opportunity for opponents to mislead the public about the potential positive impact of these plans. So, let’s look a little deeper.

As we’ve stated many times before, clever names or phrases are often used to criticize an idea then the name quickly becomes the label that misleads the public from the truth. Such is the case with the rhetoric we’re hearing and reading concerning medical plans that are not compliant with the mandated benefits of the ACA.

People started calling these “not 100% compliant” medical plans “skinny” in an effort, I believe, to mislead the public. At the very least the term is being used to draw attention or improve the critic’s own ratings.

Why do critics think that we Americans should not have more plans from which to choose for employer’s or our family’s health plan. Sure, many Americans are uninformed about quality maybe reality, as is evident by the popularity of such shows as the Bachelor or sports like soccer(too much trotting around). But when it comes to healthcare I think people know what they can or can’t afford and what they need or don’t need.

Plus, our citizens can always turn to the thousands of qualified insurance professionals available in every state in America. Insurance agents are well trained and can easily assist Americans in making the best choice for their needs and budget. But, agents need, just like the public needs, these alternatives so that the citizen can make the choice that best fits their own personal need.

So, what are these plans that so many fear will undermine the integrity and financial stability of our nation?
What will a Skinny plan likely not include? They may not include:

  • Pediatric dental and vision for adults.
  • Unlimited brand name Rx.
  • Maternity
  • Pregnancy termination (abortion)
  • Unlimited Office visits
  • Unlimited lifetime benefits
  • GI without reasonable pre-ex policies.
  • All of the 63 MEC benefits
  • Other benefits that increase premium but nobody uses.

What will skinny plans likely offer:

  • Choice of Copays.
  • Telemedicine.
  • Maternity if desired.
  • Wellness (true wellness with incentives).
  • Choice of PPO networks.
  • Higher OOP to lower premium
  • Lower OOP plans for more choice.
  • Alternative Rx plans
  • HSA option with higher HSA allowance.
  • Higher OOP for wasteful healthcare decisions.
  • Lower OOP with incentives for smart healthcare decisions.

There will be dozens, possible hundreds, of plan choices instead of the current 4 choices available! Health plans will be developed ranging from Minimum Essential Coverage to Cadillac rich plans. Employers will be allowed and encouraged to buy minimal plans that can be enriched with HRAs.

The bottom line – at the end of the day – when all’s said-n-done, the objective is that the insurance industry, led by local TPAs, will provide America more choice with better benefits at lower costs. Now what’s wrong with that?

I’m serious, what’s is possibly wrong with that? If you have objective arguments against these options please let us know. And, please don’t argue that these plans will hurt insurers by taking all of the good risks and leaving the bad risks to the insurers. It’s all GI so the risks can go where they think their needs are best served.

But, let me know your thoughts because we’re all in this together.

Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf