Eliminating President Obama’s Cost Sharing Reduction (CSRs) payments. Is it legal, constitutional, and a good idea? Let’s discuss.

October 19, 2017

Our intent was to continue discussing President Trump’s EO providing for the formation of Association Health Plans. But, in the interest of fair discussion, maintaining topical subjects and allowing more details from HHS, Treasury and IRS to develop, let’s discuss the President’s Executive Order discontinuing the Obama era subsidy payments to insurers. Is President Trump’s action legal or even a good idea?

First of all, how else does anything get done in Washington to correct any issues let alone the problems caused by the ACA if steps aren’t taken to initiate action by Congress. It seems that our Congress can only take action when there is a crisis or deadline. It is certain that Congress, particularly the GOP, does not have the stones to take on the opposition to changing the ACA without some catalyst to make them do so.

Which brings us to the Cost Sharing Reduction payments, the subsidies paid to insurers for low-income citizens out-of-pocket cost, which President Obama initiated. The Courts have already ruled that these payments are unconstitutional. 

The money for the subsidies was never appropriated by Congress, but President Obama paid insurers anyway.  The payments were ruled illegal by a Federal Appeals Court last year, but the order was stayed pending congressional action.

It’s estimated that about 6 million enrollees in the exchanges qualify for the cost-sharing payments this year, costing the federal government about $7 billion in 2017.  Insurance companies are required to fund the payments to reduce deductibles and co-insurance even if they are not reimbursed by the federal government.

If this were not the case then any President could initiate payments out of the US Treasury for any project a President desired. For example, President G.W. Bush could have pulled funds to start and continue the war in Iraq.

President Trump would be free to start writing checks to pay for the new border wall between the US and Mexico without the approval or appropriations from Congress. I’m sure most Libs would love that. In a country where the citizen’s freedoms are set for in the Constitution do we want our leaders to be free to pick the laws he/she wants to ignore or follow? 

So, if President Trump can’t decide unilaterally to pay for the border wall then how could President Obama decide to make payments to insurers unilaterally?

Consider some perspective. These CSRs are intended to cover the out-of-pocket costs such as deductibles, copays, and co-insurance  for low-income citizens covered on individual plans through an ACA authorized state exchange.

Also for perspective it’s important to remember that only about 10 million Americans are actually covered by the individual exchanges. As stated above, experts calculate that the CSRs affect about 6 million citizens.

So, once again a big hub-bub is created in the media for 6 million folks in a country of 330 million about payments estimated to $7 Billion. It might also be interesting for Americans in 48 states to know that about 3 million of the 6 million people receiving the CSRs reside in California and New York.

The point isn’t that these people don’t need and deserve assistance. Nor is the point that citizens from two of the most liberal states in America require around half of all these payments. The point is that the actions taken by the Obama administration to make these payments was/is unconstitutional. Even though those 6 million good Americans may deserve this help, don’t we need to follow the law. Why didn’t the Obama administration do the right thing and shouldn’t we expect Congress to do the legal thing.

Maybe the states should make these payments to insurers out of their own state treasuries. The payments might then be accounted for and more closely monitored. But, certainly the citizens of these states would be acutely aware of the impact.

Sure, I realize the GOP did not vote for the ACA and now the issue flares up during the GOP’s leadership which seems unfair and certainly untimely. The Obama team was masterful in its timing of many aspects of the ACA which is worth an entire Post on its own. 
But, the GOP had 7+ years to develop a workable replacement and failed to do so.

Next step? We’ll discuss further but first, stick to the facts and the constitution. Second, write and present a realistic replacement plan that provides solutions for all Americans including low income citizens, employees, employers, patients, providers,  that provide more alternatives, better choices and lower costs as its focus.
Simple, right? We’ve already outlined it in previous Posts.

Let me know what you think.
I enjoy the feedback especially since we’re all in this together.

Until next week.

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

 

Is Healthcare Reform dead? Maybe, but the President promises to sign Exec Orders allowing for health plans to be offered through Associations. It could be that now is a good time to discuss selling cross state lines.

October 12, 2017

It sounds as though President Trump may sign executive order(s) this week or next that would permit the forming of association health plans (AHPs) that would provide plans for employers and/or individuals. Years ago we called them Multiple Employer Trust (MET) or Multiple Employer Welfare Arrangement (MEWA) and so forth. They provided affordable competitive alternatives that could be easily sold across state lines.

If AHPs, METs and MEWAs are well managed then why not give employers more alternatives to lower cost and improve benefits? We’ll discuss AHPs in more detail next week after President Trump signs and releases the details of his Executive Orders allowing for AHPs.

The President states that his Order will allow for selling cross state lines which is the topic of today’s post.

When discussing the prospect of selling health insurance cross state lines, during the heat of HCR earlier this year, there were objections to this idea, some reasonable. Now, given the status of HCR in Washington DC and the probability of no significant reform, maybe we should kick this around a bit, and debate the reasonable objections.

One objection, to selling cross state lines, was a fear that sub-standard benefit plans might be offered which if sold to unsuspecting employers could lack benefits, ;eave people hanging with large medical bills and cause problems. Clearly, some folks have gotten comfortable with the pre-set benefit designs of ACA even with their increase cost and inflexible nature of only having 4 “flavors” from which to choose.

The opponents of selling cross-state lines were/are afraid that carriers would build plans in one state with stripped-out benefits and lower cost then sell those plans in another state. The purchaser might think they are buying a “gold or silver” plan but under closer scrutiny would be getting something less.

The goal of lowering cost and providing alternatives to the rigid expensive metallic plans is appealing but one must admit than when more alternatives are available the potential for confusion is there.

The opponents other reasonable objection is that if lower cost plans are offered cross-state lines that it might imperil the financial stability of in-state plans. Examples of in-state plans could be plans associated with the Blue Shield and Blue Cross organizations but one could add many HMOs which tend to be landlocked so to speak. These in-state plans often have large market share and wield political clout within their state’s legislature.

If plans with large market share, such as the Blues or HMO, experience group migration to lower cost plans, offered by AHPs or plans from other states, then their revenues could be reduced. But, would their profitability be impaired? The fact is that well designed, properly presented and purchased lower cost plans could pull groups away from large in-state plans. In business that’s called competition, isn’t it?

Another obstacle, maybe the biggest, cited by opponents is that you have 50 independent state insurance commissioners most of which don’t want to relinquish any control over the plans in their state. It’s a turf thing. Some of these Insurance Commissioners, especially ones from large liberal states, do not want to see any plans compete with their state’s ACA Exchange. They will resist AHPs and selling cross state lines.

Shouldn’t we consider the idea of selling across stateliness as a chance to increase competition and lower cost? Clearly, it would allow smaller insurers, that are excellent companies but not household names, compete with the huge carrier names we all recognize.

One step that would be easy and helpful is to expand the ERISA Preemption which would allow small employers to get access to great self-funding plans.

Self-funded plans are regulated by ERISA and managed by the Department of Labor. Insurance commissioners only get to rule over the “fully insured” insurers in their states so ERISA plans will be largely free from the heavy burdens many states put on fully insured plans.

However, many states have recently enacted bills to “kill” self-funded plans and prevent smaller employers, with 100 or fewer employees, from getting access to these plans. These state by state “option killing” rules would need to be addressed.

For example, California established arbitrary rules, under Senate bill 161, that mandate how self-funded plans can be priced. Proponents of SB161 admitted that the purpose of this stifling legislation was to prevent smaller employers access to stop-loss plans by making the prices too high thus forcing smaller employers to buy the Exchange.
It was a double blow to employers however because employers did not go to the Exchange because it is not competitive yet were/are blocked from competitively priced self-funded plans.

ERISA and its State Preemption capabilities could be expanded to make it easier for fully insured plans to market across state lines. It could reduce the burdensome processes and long approval times by insurance commissioners and allow more flexibility.

We have all heard the statistics that 1/3 of the counties in the United States have only one insurer offering plans. Expanding ERISA could give the folks living and working in those counties some well deserved relief.

How could insurers offer lower cost fully insured plans yet still offer benefits comparable or richer than the benefit mandates of Platinum, Gold, Silver, etc.?
It’s easy and affordable. It should have been done already and could be accomplished tomorrow with the right vision.

Next week we’ll discuss the details of the President’s Executive Order concerning AHPs and just how to make these affordable (lower cost) alternatives compliant!

Let me know your ideas for selling cross state lines OR your reservations about doing so. I’d love to get your input.

We might as well air this option out a bit because we’re all in this together.
Until next week.

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

 

The calendar once again makes its call. For me – Platrix Chapter 2, “Queen of the Cow Counties” No one can resist the call.

October 5, 2017

Two times each year your humble author retreats from his solemn duties to Trek to
E Clampus Vitus, Platrix Chapter #2, that most ancient and honorable group. This is one of those times, kid. Would you like to read just a bit about The History of ECV.

E CLAMPUS VITUS is said by its adherents to be the most ancient of all fraternal orders. It’s founding, as the tale is told, was coeval with the origin of the human race.

It is related that in 1852 Steamboat Jake. a merchant from Yreka, thinking to improve his business by fraternal affiliations, made arrangements through certain Clampers for initiation into the Masons, the Odd Fellows and E CLAMPUS VITUS at one bargain priceof $98.50. When the various brethern were assembled at the Hall of Comparative Ovation and Jake, bound and blindfolded was brought to be initiated, the question arose as to which Order should first apply the branding iron. It was agreed that the oldest should have priority.

 The Odd Fellows presented their claim for that honor, stating that their order was created by a charter issued in the form of a golden tablet by the Emperor Titus to his Jewish Legion in the first century A.D.

 The Masons disputed the claim, relating the scholarly history of Reverend Dr. Anderson to prove that the Grand Master Moses often marshalled the Isrealites onto a regular and general lodge whilst in the wilderness, and that King Solomon was “Grand Master of the Lodge at Jerusalem”.

 The Noble Grand Humbug of E Clampus Vitus then rose and confounded the rival oraganizations with proof abducted from the unimpeachable unwritten works of St. Vitus, the final authority in all such matters, that E CLAMPUS VITUS was founded by our Clampatriarch Adam himself in the Garden of Eden, and that the original Staff of Relief, which figures so greatly in the Clamper ritual, was a branch that Adam broke from the Tree of Knowledge and smuggled out with him, hidden beneath his apron, when he was driven from Eden. All present in the Hall agreed that such antiquity was beyond compare.

The senority of the Clampers was recognized, and Steamboat Jake accordingly was given into the hands for initiation. It is then told that by the time they were through with him he had lost all desire for further fraternal connections.

 The unsurpassable antiquity of E CLAMPUS VITUS has been recognized and proven on many occasions. There are those who claim they can trace it through the times of the Old Testament and the beginnings of the Christian Era when its rites were conducted in the catacombs of Rome and referred to as the “Enigmatical Book of Vitus” and the “Curious Book of the Clampers”. These tales tell how it was spread through Europe by the Frolicking Friars, and carried to the Orient by the indomitable Vituscan Fathers.

According to the Clampers, the introduction of the order into the United States has long been shrouded in mystery and legend. Only recently has the true history been traced by the Royal Platrix Chapter and the Archivist of the West Virginia Lodge. The result of this research supposedly proves by documentary evidence that the secrets and symbols of E CLAMPUS VITUS were imparted by the Emperor of China, Tao-Kwang, Great Hotchot of the Chinese Grand Lodge to Caleb Cushing when the latter visited China in 1844 to negotiate the first treaty between the United States and the Celestial Kingdom. Cushing was specially charged by the Emperor to deliver the secrets and signs of authority to Ephrairn Bee, innkeeper of Bush Creek, Boone County, Virginia, to be disseminated by him at his descretion among the fellow citizens so that the Chinese and American People might henceforth be united by the Bonds of Fraternal Brotherhood as well as by the more formal ties of diplomatic relations. By virtue of his authority, Ephraim Bee traveled about his native state organizing lodges of E CLAMPUS VITUS in villages and county seats. 

It is also said that among others, a number of drummers were taken into the order, with or without authority from Bee. These travelers took the gullible villagers and townsmen along their routes into the Brotherhood, until by 1849, the East and Middle West were dotted with Clamper Lodges. From these Lodges many lusty Clampers went West in the Gold Rush and founded the historic lodges in the mining camps that constitiuted themselves as guardians of the morals of these communities.Their duty as they saw it was to prevent the preachers and pious wives who followed the 49′ers, from imposing any excess of morality that might hamper the full enjoyment of life. How well the Clampers performed this function is commonly known, despite the lack of written records. This lack of written records is attributed to the circumstance that during the meetings there was never anyone capable of keeping the minutes and that afterwards no one remembered what had taken place.

As E CLAMPUS VITUS mushroomed along with the rapid growth of the gold towns, it declined as rapidly as they did, and, therefore, lived only in the memory of a few ancient dwellers in the mountains and in the annals of the county histories until, in 1930, when a new prophet, a second Ephraim Bee , appeared in the person of Carl Wheat to reorganize the historic organization. 

Members of the Ancient and Honorable Order of E CLAMPUS VITUS have always been adventurers and many have been leaders in conquest of their respective countries. The most noteworthy of that band of stalwarts was Juan Rodriquez Cabrillo, a doughty explorer in the service of the Spanish Empire, who on October 19, 1542, raised the Spanish Flag at a point near the beach city of Hueneme in Ventura County and took possession of the land in the name of the King. Cabrillo is buried on San Miguel island and some Clampers make an annual pilgrimage to his grave. 

Sir Francis Drake was a Clamper but not in good standing because of his piratical exploits until June 15, 1579, when this bold bucaneer reached California in the famous ship, the “Golden Hind”, and anchored in Drakes Bay where he raised the English Flag and took possession for Queen Elizabeth and called the land New Albion.

Then Spain decided to occupy California to protect her colonial possessions, so two courageous Clampers were selected for the expedition: one was Don Gaspar de Portola, and the other was Father Junipero Serra. These men raised the Emperors flag at San Diego on May 17, 1769.

After Mexico revolted from Spain, an admirable Clamper, General Antonio de Santa Ana, ordered the flag of the Mexican Republic raised at Monterey on January 7,1769. 

John Charles Fremont was a peritatetic Clamper and he raised his ensign as Captain of the United States Topographical Engineers above every camp that he made in California during his expeditions between 1844 and 1846. That flag is now in the custody of the Southwest Museum in Los Angeles. 

On June 14, 1846, a Sonoma group of justly indignant Clampers rebelled against the aggression of Mexican officials. They captured the garrison at Sonoma, issued a clampotent proclamation declaring California to be an independent republic and raiseda crudely designed but historic Bear Flag.

 Clampers played an important part in the history of California in the nineteenth century because the American membersof this Order worked in unison. Commodore John D. Sloat in command of the Pacific Squadron of the U.S. Navy captured Monterey and on July 7, 1846 he instructed a fellow Clamper William Mervine to raise the flag of the United States above the customhouse. When Fremont learned of Brother Sloat’s coup he ordered the Bear Flag struck at Sonoma and replaced by a 28-star flag of the United States.

It is manifest that Clampers have been leaders throughout the history of California and the flag-raising members of the Order of E CLAMPUS VITUS have contributed glamor and deeds of courage and gallantry to our heritage. It must be noted however that this history has never been proven.

 CREDO QUIA ABSURDUM – BECAUSE ITS ABSURD I BELIEVE
QUOTED FROM E CLAMPUS VITUS, THEN AND NOW, 1852-1979

As for me, I’ve been a “clamper” since 1992 at the Tehachapi Loop.
How many of you are Brothers of the Order?

Next week, we’re back to common sense ideas for healthcare reform. Promise!
Until then remember, we’re all in this together.

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

 

Graham-Cassidy Healthcare reform bill: sure, it’s dead but was it just AHCA 3.0? Let’s look closer.

September 28, 2017

Not living nor making my living with in the political pressure constant in Wash DC it’s hard to look at this new GOP effort, the Graham-Cassidy bill, without a healthy bit of skepticism.

Why is that? Have you ever witnessed some one make a decision based upon desperation or a willingness to “settle”? We all have. It’s common in personal relationships, it’s frequent in business decisions, and it’s compulsory in politics.

The Graham-Cassidy bill GCB) looks and feels a lot like a political effort to avoid “doing nothing” and facing constitutes after having made the promise to “repeal & replace” the ACA. If you were a GOP legislator up for re-election in 2018, especially in the House, do you want to go home  at the end of the year to face those who trusted you when you said “Obama-care must be repealed”? Of course you wouldn’t, no sane person would. But, we’re talking about politicians not sanity.

Here are a couple of points from GCB for reference:

  • Says it repeals the Individual mandate but truthfully only reduces penalty to zero. If you don’t want to buy, don’t worry, no penalty.
  • Says it repeals the Employer mandate but truthfully only reduces penalty to zero. If you don’t want to provide coverage, don’t worry, no penalty.
  • Maintains guarantee issue with no pre-ex while reducing penalty to zero for no coverage. Like the other GOP attempts this adds the burden to premium calculations and to premium payers.
  • Eliminates only the medical device tax while leaving all the others such as the Cadillac tax. Why not eliminate all the taxes.
  • Maintains Medicaid expansion and its subsidies but does so in a block grant manner.
  • Converts Federal subsidies given to states into Block grants so states can use as they please. Giving states flexibility sounds great but this may create chaos between states.
  • Gives states freedom to determine Essential Health Benefits and how block grant funds are to be spent. This sounds good except for the poor souls in liberal states like NY and Ca. who will see those funds spent on more freebies and no accountability.

There are countless other provisions that are a mirror of the two previous failed GOP attempts but I won’t burden you with this.

So, the language you will hear from supporters will be:

  • This is our last chance to get rid of the evil Obama-care.
  • If we don’t do something now then we won’t have another chance.
  • Doing something is better than doing nothing
  • Choice is clear, you’re either for Socialism or federalism.

If this effort fails the GOP folks can return to their districts and tell their supporters that “I tried but we just did not have enough votes” “Re-elect me again and we will continue our fight to repeal the evil liberal OB-care”.

Then, what are we suppose to do, vote for a Democrat or not vote. This is political baloney at its worst or best depending on your perspective.

If the GCB passes its initial vote in the Senate it will still face an incredible battle in the House. Plus remember that the House GOP is in a worse pickle that the Senate so they will try to flavor the baloney to their best interest.
I actually give it a 60/40 probability of passing the initial Senate vote.

OK, enough huh? Let’s watch this debate (debacle) unfold. It does not need to be this way but the swamp has not yet been drained, as they say.

Until next week, we’re all in this together.

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

PCORI – is this a worthwhile expense on your health plan or another example of Government bureaucracy and waste?

September 21, 2017

Evaluating the benefit of PCORI, the Patient Centered Outcomes Research Institute, relative to the impact on healthcare costs and efficacy of current treatment protocols may be impossible. One’s opinion may well be determined by your baseline feelings about redundant government programs, government bureaucracy, or even political positions.

One could also add data security to the list of concerns. More about that below.

Honestly, it is hard to justify the added expense to health plan costs or the benefit to healthcare practitioners and their patients. If the goal is to study comparative outcomes for current practice protocols then how will the analysis be delivered. One problem is that the PCORI has no authority to implement any findings nor to direct healthcare practitioners to modify their practices. Another problem may be human nature, that being, Doctors wanting to practice in their own experienced manner.

We all want affordable high-quality healthcare with the latest and most effective technology. There’s no argument there. But, given the history of what happens in the private sector when government intercedes don’t we have the obligation to investigate and challenge the established bureaucracy?

There are already at least two notable government agencies that experts say could incorporate the PCORI objectives with in their current structure. One is the National Institutes of Health and another is the Agency for Healthcare Research and Quality,

The Agency for Healthcare Research and Quality has the stated mission of “making health care safer, higher quality, more accessible, equitable, and affordable”. It is considered small by federal government standards with a budget of about $440 million. Believe that, small at $440m? Anyway, the mission for the AHRQ sounds like something we want so why couldn’t it dish out the $3.5 Billion expected to be awarded by PCORI?

Plus, the GAO (Government Accountability Office) states that the PCORI won’t go through a review by any independent outside entity until 2020, after the program has run it’s course, awarded an expected $3.5 billion and PCORI is no longer operative.

So, one must ask, is PCORI a worthwhile venture or just another government program scheduled to end but destined for in perpetuity?

After reviewing many of the awards given to date it is easy to lean toward the obvious: that PCORI has both great waste and great potential, depending on one’s fiscol perspective.
Let’s look at a couple PCORI awards:

  • One project looks at how doctors can create a “Zone of Openness” with patients which was part of $61 million in awards. Were you wondering about your doctor’s “Zone of Openness” the  last time you were waiting to see the doctor, dressed in your paper robe, sitting on that awkward metal bench covered in butcher block paper?
  • $14 million for a study on the appropriate dose for aspirin being taken to prevent heart attacks. Too much and you could bleed to death. How long have doctors been practicing this treatment protocol and they don’t know the correct dose?
  • $500,000 went to AHIP (America’s Health Insurance Plans) to “build and maintain support from health plan leaders” and to “identify important gaps in availability of health insurance administrative data”.
    A spokesman for AHIP stated that sharing health plan data is “complex” and “requires a significant amount of review and expertise from the industry”.
  • $249,000 went to Society of General Internal Medicine for a 2 year program, as stated “to help us develop a better understanding of the attitudes and knowledge of our membership”.
  • I’m not kidding!

Will we see any demonstrative results from the $3.5 billion in research awards expected to be doled out? Good question! Supporters say that we will see the results in articles published in medical journals and through presentations , seminars and other public dissemination. Since the PCORI has no authority the information obtained will not be sent out as directives to be followed. That part may be good.

In fact, some legislators and professional groups are concerned that the government, particularly CMS, may try to use the PCORI results to limit or restrict healthcare services to citizens covered by Medicare and Medicaid. That means our senior folks covered by Medicare and Medi-cal. We were told about this potential issue in 2009, remember. 

Will doctors change due to PCORI?

  • Some who belong to large practice groups might if directed to by their group.
  • If payments for services rendered are reduced as a result of  procedures deemed ineffective by PCORI then doctors may change. 
  • Unless there are consequences, either financial or legal, doctors may not modify their current practices simply because of a result of a PCORI award.

My initial opinion was that PCORI was another example of over-reach by the government adding cost to premiums as well as costing taxpayer billions of wasted dollars and unneeded oversight. After doing my research and preparing for this Post, I have found no reason to modify my initial opinion.
Hey, maybe my opinion is just like the results of the billions spent on PCORI; nothing changes!

One other thought has lingered with me since 2010. The ACA also mandated that all health plans submit their data to the CMS and PCORI for the purpose of analysis. By data I mean every individual’s personal & private information including SS#s, employment & health status, and specific information on every healthcare service incurred.

So, how has that data been protected and by whom? The list of entities that have had data breaches is endless and includes cities, states, nations, government agencies, many insurance carriers, and thousands of other private businesses.
Here is a short list with the estimate of records stolen :

  • US Office of Personnel & Management -22 Million
  • Yahoo 1st time -500 Million
  • Yahoo 2nd time -1 Billion
  • Equifax – 143 Million (this is recent and huge!)
  • E-bay -145 Million
  • Anthem -80 Million
  • Target -40 Million
  • Home Depot -56 Million
  •  Sony – 77 Million
  • What are the odds that your personal info was not part of at least one of these?
  • Do you think the health records of our citizens stored at CMS are an attractive target to hackers?

As I said, it was a lingering thought!

Well, you can give it some thought and ask yourself some questions. Have you read or heard anything about PCORI in the past 2 years. Probably not because one of the operative guidelines of PCORI is to be invisible and not draw attention.

Geez, does that makes sense; a government bureaucracy created to analyze comparative treatment outcomes but do so without making any news?

That’s it for now. Let me know what you think or if you’ve seen any data that shines a positive light on PCORI. I want to be fair in our review.

Next week we’ll look at the Graham-Cassidy Healthcare reform bill now being urgently pushed by the GOP. The Senate has until Sept 30th to get it started with only 51 votes.

Until next week, let’s work together and stay positive.

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

 

 
 

Two things that unite us as Americans: One is the start of the Football Season. The Other is Catastrophic events like 911 and hurricanes.

September 14, 2017

This week’s Post about PCORI, established in 2010 by the ACA, was printed, polished and ready to go until about 6am this Monday morning. That’s when I started watching the news that was showing the various memorial services to 911 on the East coast. It reminded me again of how united and how resilient the people of the United States are when times are tough.

Recently, we have all been saddened and heartened with the stories from Hurricanes Harvey and Irma. The pictures and interviews display how Americans of every race and origin willingly help out other Americans of every race and origin when the time comes.

The 911 memorials today may become a bit smaller in years to come but if and when the next event occurs we know that Americans will not hesitate to jump into the fight to help others when needed.
To quote the famous philosopher and great fiddle player Mr. Charles Daniels: “you just go ahead and lay your hands on a Pittsburgh Steelers’ fan and I think you’ll finally understand”.  Which means, that Packers fans and Cowboy fans or Dolphin fans alike will step up to help a fellow American when outsiders bring trouble to the United States.

As I watched a few of the speeches this morning it made me start to think about how, as Americans, we are resilient and we are resolved to the actions needed to protect ourselves and others from future harm. Americans will do what needs to be done if given good leadership and good planning.

However, over the past 16 years, plus the 10 years prior to 911, it seems that politicians often forget this aspect of our citizens and instead start thinking about their next election. Political correctness, identity politics, and a complacent culpable media add to the danger we face.

But this week instead of PCORI, the ACA, the media or politicians I want to focus on the core strengths we have as Americans. Those strengths that led our ancestors to leave their original homes to traverse across great oceans and  mountain ranges to build the greatest country the world has ever known.

The past 4 weeks have shown us how we come together when times are tough. The memorial ceremonies for 911 show us how we come together as a nation when attacked. Now, we just need to maintain that steadfast resolution on a day-to-day basis. Help your neighbor when they need it, forgive that careless driver that cut you off this morning, and continue to pray, praise and donate to our fellow Americans who need our help.

Let me finish with a thought about the idea that the football season being a factor of unity. Some may disagree (probably soccer fans) but for six months each year three hundred of million American come together to root for their favorite team or teams. Whether its high school, college, the NFL or even Pee-wee or arena one must admit that we are avid fans. Heck, look how many people watch the Super Bowl each year (without any rioting in the stands).
So, back your favorite team which I know for all of us is Team USA.

Next week, we’re back to common sense solutions for healthcare, OK?
And remember, we’re all in this together.
Until next week,

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

Promoting “polls” that suggest a change in “favorable vs. unfavorable” opinions is the new technic to support the ACA. Can we trust these polls?

September 7, 2017

You’ve probably seen them, too. Polls that show the “favorable” opinions about the ACA increasing dramatically. Since the introduction of the failed House and Senate bills to replace the ACA more articles are stating that opinion polls are showing the “favorable” attitude about the ACA increasing.

Who in the world did these polls approach. And I do mean “in the world”, because if anyone likes the ACA better now than before January 2017, they must have been people from other world counties. Another likely scenario would be that the polled population was previously uninsured who are now covered by either Medicare expansion or a state exchange with full or nearly-full subsidy.

Who could find the ACA more favorable after 7 years of:

  • Double digit premium increase (100%+ in many areas)
  • 50% fewer providers in the PPOs
  • Crappy benefits with higher out of pockets
  • Limited number of insurers

The answer is that no one would find the ACA more favorable unless:

  • You paid premium before but now it’s paid for you.
  • You were uninsurable before and had no coverage.
  • Had no coverage before but what the heck – its free now.
  • You are Harry R or Nancy P or Z Emanuel or J Gruber.
  • Or one of their relatives (even that’s unlikely, though).

The key to the outcomes in these kind of polls is often the format in which questions were formulated to meet the desired outcome of the pollster. In a sensitive issue such one’s health care it is easy to ask a yes-no question in a manner that leads the subject to the answer desired.
For instance: if I asked you “Do you think it’s fair for insurers to decline an applicant for coverage?” you could easily say NO. But, would your answer change if you knew that the applicant had several opportunities to enroll before but chose not to until just recently after a negative diagnosis was received?

Our citizens are smarter than politician think, or want for that matter, so they know what should be done. However, if they are polled with questions impossible to answer then it skews the outcome. As Ms. Vido, in My Cousin Vinny, said “It’s a bullshit question”. By that, as she goes on to explain – “It’s a trick question. No one could answer that question.” So how are we to believe these polls?

Or let’s say you were asked – “Sir, do you still beat your kids?”. Of course you don’t because you never have but you must answer yes or no. The point is that professional pollsters conducting polls for entities with certain agendas can make the American public seem like it supports or does not support an issue based on the specific outcome desired.

So, don’t you find it difficult to believe that any American would answer that he/she is more favorably inclined toward the ACA today than they were 1 or 2 years ago? Unless, it was because they were among the citizens outlined above.

I know I can be a skeptic or even a cynic, as I’ve mentioned before, but some things are beyond giving the benefit of the doubt.

Now, if you were to ask people the following questions you could be sure of people’s true opinions:

  • Do you think premiums increasing 100% per year is reasonable?
  • Do you think insurers should be subsidized by the government.
  • Do you think PPOs with half the Doctors carved out provide good service?
  • Do you think the premium you pay should be tax-deductible?
  • Do you think people who choose not to enroll should be GI with no Pre-ex later?
  • Do you want your plan to cover pediatric dental if you are a single 50 yr. old male?
  • Do you think healthy working-age people should get their coverage for free?
  • Do you think the Congress should have been better prepared to offer a replacement plan for the ACA?
  • Do you think calling the House or Senate’s bill a “repeal” was an assault on your intelligence?

I guess I got on to another rant there for a moment but you get my meaning. It is very difficult to believe that tens-of-millions of our hard-working premium-paying citizens would find the ACA more favorable today than they did a year or two ago.
But, what do you think?

Until next week, just remember that we’re all in this together.

Please keep praying for the folks in south Texas and Louisiana. They have a long haul ahead.

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

Compassion with Action: why are the people of the United States never properly acknowledged for their compassion. And more importantly the actions they take to help others both home & abroad!

August 31, 2017

Is it a dopey question or do I identify a fact that all Americans know is true. This week we’re taking a break from healthcare reform out of respect for those suffering and assisting in the catastrophe of South Texas and Louisiana. I want to acknowledge and praise the great people of the United States for their consistent history of being there when others need help. Our people are always willing to help but seldom are they properly acknowledged.

Over the past 100 years, you can’t name a catastrophic event across the globe in which Americans did not lead the efforts to help the poor souls suffering from it. Often our own US media does not acknowledge our citizen’s efforts and too frequently it’s because of political reasons. Also, we don’t often hear other nations acknowledge our nation’s compassion and heroic actions to assist.

To name just a couple; the relief in Indonesia and SE Asia for tsunamis victims, earth quakes in Italy, Pakistan or Turkey, drought, starvation and disease in Africa, volcanoes all over, and of course the countless times our military has stepped in to provide relief, protection or freedom. That’s the short list but you know what we mean.

But at home, here in the US, we consistently rise up to help each other as well. We saw the American spirit during countless hurricanes and tornadoes, earth quakes in Ca, perennial blizzards and sub-zero temperatures in the northern states, Spring floods in the mid-west and east coast, wild fires across the West, poverty in rural  areas and inter-cities, and of course national crisis such as 911.

The point is that it’s the honest hard-working compassionate American citizen that steps up to lend a hand. Politicians usually just make speeches and pass out money, or at least low-interest loans, and too often try to take credit or cast blame.

But when you look close its the average citizen stacking sandbags, handing out food, water and blankets, donating desperately needed money and materials, and wading through waist-high flood-water to reach fellow citizens stranded by circumstances.

It’s hard not naming scapegoats and culprits while looking at these natural or man-made disasters. But not today, because we want to praise the good folks of our United States of America who are always willing to step up when the need is greatest.

Everyone cares, it’s human nature to care. But people taking action when action is needed is what makes the citizens of the United States so great and why the rest of the world relies so heavenly on us.

People who put others ahead of self and sacrifice their own comfort to help others are the backbone of the United States. I don’t wish to imply that people around the world in the UK, Europe, Asia and further aren’t willing.  But if one looks at the ledger of history and does a tally from where the most aid and comfort comes, one will see that the United States of America is the leader by far. Both in volume and percent of aid America sets the example to which all others should strive.

Anyway, this was on my mind. I hope you agree.

Next week, God willing, we’ll be back to offering our thoughts on the repeal, reform or repair of the American healthcare finance and delivery system.

Until then, please donate your time or treasure and say a prayer each day for all those in need. They are in Texas and Louisiana now but there are also people in need right there in your own neighborhoods.

It’s always true; but Hurricane Harvey is life’s proof that we’re definitely all in this together!

Until next week.

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

 

We should not let Congress dismiss the concept of “Skinny Plans”. They may be just what every small employer in America needs. Here’s why!

August 24, 2017

The term “skinny plans” was being floated, promoted, applauded and battered about in Washington DC several weeks ago but politicians and pundits alike were missing the key point. And as usual, attaching a name that promotes a negative connotation to a reasonable idea has caused the facts to get obscured.

No one has pointed out the potential advantage Skinny Plans bring for tens of millions of Americans who get their health insurance through their employment. Nor has anyone promoted how this idea of a “basic coverage” could provide the means for small and medium size employers to provide better benefits at lower costs. Certainly lower cost than is available through ACA qualified Metallic Plans.

Employers could utilize these so-called Skinny Plans as platforms upon which to build plans with better benefits than ACA Platinum Plans but at lower cost than ACA Silver or Bronze plans.
Are you kidding?

Nope, it’s been done before and “skinny plans” could provide the be-all save-all solution to the crisis facing every small employer: the prohibited cost of providing a health plan for its employees.

The rhetoric surrounding the healthcare reform debate and specifically this issue of Skinny Plans ignores the fact mentioned earlier that the majority of Americans get their health insurance provided to them by their employer.

Small and medium size employers provide group health plans for their employees for a number of reasons. It’s critical to remember that the most compelling reason why employers bare this cost is that they must provide a group health plan in order to compete for and retain good employees. Without good employees no employer can stay competitive nor will it stay in business.

So, how can these Skinny Plans be helpful for employers? It’s pretty simple actually!
Employers will implement an HRA (Health Reimbursement Arrangement) to enrich the benefits of the Skinny Plan or provide benefits not covered by the Skinny Plan. It’s been done for years for employers and was perfected in California.

A qualified TPA can lead any employer through the process of choosing a Skinny Plan (or ACA Bronze plan now), which lowers the premium costs 30-50%, then implement the HRA with the extra benefits the employer wishes to provide.

The key to the HRA Plan’s success (by success we mean reducing the employer’s costs while providing rich benefits) is that most people in America don’t actually use much healthcare in a given year. A few years ago, the Kaiser Foundation released an extensive study demonstrating that 85% of covered people incur less than $1,000 per in in healthcare expenses per year. Look around you at the people you know and you will see that their study’s outcome makes sense.

In addition, the data analysis from a prominent TPA, in California, proves that fewer than 5% of any group of people will incur enough charges in a calendar year to meet the high deductible plans sold as Bronze plans today. Interesting, isn’t it?

So, the result of buying a Skinny Plan and adding an HRA is:

  • Premium costs would be 30-50% lower.
  • Employers will only incur HRA claim costs if a claim is incurred.
  • Employers can offer richer benefits with HRAs.
  • All employees, and their dependents, will enjoy richer benefits.
  • Employees are better able to afford adding dependents to their plan.
  • Providers will get paid by TPA on behalf of the employers.
  • Providers will then be happy which is important for members.
  • The TPA will make it easy for employers & employees.

Starting in 1996, way before the ACA, small employers in Ca. enjoyed success with this type of health plan and actually saw their healthcare costs reduced and stabilized.

The Skinny Plan with HRA concept will work so don’t be fooled by the opponents who argue that Skinny Plans will increase premiums for everyone else. They will not!
The viability of the Skinny Plan idea is in the small and medium size employer market so they would be available only in employer sponsored group plans.

The individual plans have been causing all of the hoopla for the media with the need and affects of guarantee issue and no pre-ex on premiums and insurers. So, if you hear the doom and gloom rhetoric from opponents of the Skinny Plans don’t be alarmed because now you know there is a solution, an employer driven solution, actually.

Plus, let’s be honest, the GOP probably won’t be able to get anything passed anyway.
Sorry for that editorial comment. But, if the GOP does fail with its R&R effort then it could circle back around with a simple bill, to amend the ACA, that would allow insurers to offer Skinny Plans. I know, its simple, right?

We know this approach will work because it worked so well lowering premiums in California that a number of carriers tried to restrict Employer’s access to HRAs forcing one TPA to take legal action. We’ll talk more about that in the future.

Let me know what you think because as you’ve heard, we’re all in this together!

Until next week.

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

Have you ever felt the need for a good rant? I mean a real kick-in-the-a__ good old fashion rant.

August 17, 2017

If one thinks about our politicians and how they should fix our healthcare finance and delivery system it can lead a person to a good rant. I’m sure you agree.
But first, let’s make sure we’re all on the same page here. So, just for clarity’s sake, let’s define what I mean when I say “rant”.

Definition: Rant

VERB
  1. speak or shout at length in a wild, impassioned way:
    “she was still ranting on about the unfairness of it all”
NOUN
  1. a spell of ranting; a tirade:
    “his rants against organized labor”
There, now we can read on without fear of missing the point of my tirade, diatribe and fulmination. Besides, sometimes don’t you just need to say “WTF”?
I’ve promised before that we could resolve the whole healthcare reform issue in 45 minutes if you just put me in a room with 4 other people I know and let us map out the steps to increase access, improve benefits and lower the cost of healthcare without leaving any citizen behind. OK, Maybe 90 minutes.
I realize that sounds brash and vain but in the absence of political pressures I believe that statement is 100% true.  Give us a policy wonk to write it all up in proper form and it would be done.
We know that won’t happen, of course? So, let’s take a few moments to identify some of the dopiest, self-serving, and even cruel aspects of what we have witnessed from our politician’s approach to helping America improve its healthcare financing and delivery system.
7&1/2 Years – Just by stating 7 & 1/2 years you know exactly what I mean. If you had over 7 years to plan something would you have a better action plan than the GOP did on Repeal & Replace? Of course you would because you aren’t a politician with no accountability.
Think of what one can achieve given 7&1/2 years:
* Graduate from High School and finish 4 years of college.
* Meet, court, and marry the mate of your dreams.
* Plus get divorced if you follow the national averages for marriage.
* Give birth to 4 kids-one at a time. Crazy but achievable.
* Join the military and do 3 tours in some hell hole location.
* Find your dream job, tire of it, quit and move to another state.
* Vote for your Congress-person 3 times
* Note for your Senators once
Overall outcome – Our country is getting screwed by the vary people we elect to make our lives better and safer!
Individual mandate – to appease the insurance industry for forcing it to accept anyone regardless of health without any wait for covering pre-existing conditions this mandate was promised to get every citizen covered. But, instead of making it workable the penalty was set so low that no one worried about it. The result, as expected, was that only the very sick and people who would have bought insurance anyway actually bought insurance. Then to make it worse add a rule so that people who did not buy could buy later after the Doctor delivered a costly diagnosis.
Overall outcome – premiums for individual plans increased over 100% since 2013.
3:1 Premium ratio – The promise was that changing this ratio from the traditional 5:1 ratio that insurers would lower the cost of premium for older folks in their 50s and 60s. The problem was, of course, that with GI and no pre-ex the insurers naturally increased the rates they thought they needed to cover the folks in their 50s & 60s. Then the simple affect of 3:1 math  kicked in increasing the premiums on the least costly, least likely to use their plans and on those most likely to go without coverage. That being young healthy people in the 20s and early 30s.
Since the penalty for no coverage was less than a month’s worth of Starbucks for some people and the youngsters knew that they could buy insurance later, if they needed to, anyone could have projected the result.
Overall outcome – premiums increase for younger folks as well as older folks.
Insurer Subsidies – Since insurers were being forced to accept everyone, regardless or health or previous coverage, and pay for almost everything, and I mean everything, this provision was included to “insure” the insurers that they could make money in the new world of ACA. Of course, insurers rely on actuaries and actuaries need to CYA which meant that they would price and build plans with the premiums they thought they would need. In addition they developed the idea to slash 50% of the doctors fro their PPOs to further reduce the potential for members to incur claims.
Overall outcome – Premiums increase as though there were no subsidies promised. Plus, now insurers are unsure if President Trump is going to release the subsidy payments so rates are being increased even more.
* Footnote: many health insurers are showing huge profits and the price of their stock has increase 30-50%. Check out the rise in stock price over the past 2 years for UHC, Anthem, Aetna, and Centene. Insurers have increased premiums and changed their plans/networks so much that it can be argued that they don’t actually need the subsidies.
We should call this a “corporate entitlement program”.
Subsidies in State Exchanges – the concept of a market place where individuals could shop for the best coverage for their families sounds like a noble idea. But, when you pair that with premium subsidy for enrollees who have incomes higher than Medicaid enrollees the idea loses its merit. It is reported that 90% of citizens covered in State Exchanges have their premium paid by the ACA. This causes several problems. The insurers can theoretically charge whatever they desire because they know the ACA is paying for it. But at the same time insurers must overcome the GI and no Pre-ex provisions. Add to that, limited choices, few insurers participating, narrow networks, and poor marketing to really damage a good idea.
Overall outcome – Covered members are “hooked” on their subsidy yet get very little choice in their coverage. Many states have no insurers while states with functioning Exchanges offer very limited choices. On top of that the premiums for these plans continue to increase by double digit.
SB 161 – this is a California law but other states have similar legislation. SB 161 effectively eliminates Self-funding with Stop Loss re-insurance as an option for employers with fewer than 100 EEs. Self-funding could be effective at maintaining rich benefits and  lowering cost for both employer and employee but SB 161 eliminates that potential. California implemented SB 161 specifically to eliminate competition to its ACA Exchange for group plans, called Covered California. Very few employers have purchased their group plans through Covered California so the effect was detrimental to small employers.
Overall outcome – Employers with fewer than 100EEs lost because they no longer have self-funding as a reasonable alternative for the increasing cost of fully insured plans. The insurers no longer worry about the competition to their plans from employers self-funding with stop loss. Big loss for small employers!!Expanding Medicaid – since we’ve written about this so recently I won’t bore you with too much. Medicaid expansion was promised to be the means for poorer citizens to get coverage because they could not afford to pay premium regardless of the price of the premium. It was designed as an entitlement program. Clearly this has affected the Repeal and Replace efforts of a spineless Congress as well as Governors unwilling to give up the 90% Medicaid reimbursement..
Overall outcome – it has made it politically risky and therefore impossible for the GOP to keep the promises it made over the past 7+ years. It means that middle-class Americans are screwed for the foreseeable future, doomed to see their benefits erode as their premiums and out of pocket costs increase.

I could go on for a while, maybe for hours, but you can see by the subject matter that things are mucked up. I always get some good feedback to our Posts so if you can add anything to my list I will appreciate it.
Alright, that’s my rant. I can’t say I feel any better but I know I’m not alone in my opinions or emotions.
I know we’re all in this together so I hope it helped you a little.
Until next week.
Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf