Archive for July, 2017

What would the consequences be if the GOP passes NO legislation to Repeal & Replace? Let’s look at the impact on insurance coverage.

July 27, 2017

As I write this post, the Senate has voted to open hearings and take amendments for the Senate’s R&R bill. Basically this is the Senate’s last effort do accomplish anything  for now on Repeal & Replace. Without being pessimistic, I would wager that the smart money will be bet on nothing coming of this.

Regardless of one’s political leaning everyone must agree that action is needed to either replace the ACA (with something better) or make repairs to the ACA (that will keep it alive). I realize that is a big summation but if we are honest then we must conclude that the ACA is failing so one way or another action is needed. Either for the benefit of the millions of Medicare Expansion subsidized enrollees or for the tens-of-millions of premium paying citizens and employers, the ACA needs either fixed or replaced.

So, what would the consequences be if our House & Senate don’t do anything. That is, if they don’t provide or modify the subsidies for the insurers and all of the other ACA issues that need changed to survive or don’t replace the whole darn thing, then we will see a number of absolutely predictable results.

Of course, the Politician’s thoughts will immediately turn to their own future and the 2018 elections (probably have been already) but I want to focus on the impact to all of us, the hard-working premium paying, mortgage paying, car payment making, tax paying citizens. It won’t be good but let’s look at it:

  1. Regardless of whether or not the subsidies of the ACA are paid to insurers we will see:
    a. Premiums for individual plans increase double-digit (20% or more) and be projected to continue for the next few years.
    b. The Counties without an insurer for the individual ACA plans will continue to increase. It’s projected that as many as 1/3 of all counties will have no individual ACA plan available. In the more rural states we could see the number of counties with no individual plans exceed 80% of the counties within those states.
    c. The number of insurers willing to even offer plans anywhere in the country will decline, including those insurers offering plans outside the ACA Exchanges for both group and individual plans.
  2. Medicaid enrollment will continue to rise. Even though Medicaid plans provide lower benefits and there are fewer providers, most people don’t realize those facts until it’s too late. Besides, the idea of “free insurance” will become more and more appealing as premiums continue to rise for the tens-of-millions of premium paying citizens that use very little or no healthcare each year. “Why should I pay premium when I never use my plan and those folks are getting it for free?”. Right?
  3. To summarize: fewer insurers offering fewer choices with few participating providers all at premiums increased each year.
  4. Of course, the result of # 1, 2, and 3 above will lead to another crisis because there won’t be enough money to pay for all of the Medicaid claims and insurer’s subsidies. Which will lead to:
    a. Increased taxes or create new taxes on benefits to generate more funds.
    b. Decrease the benefits at either the plan benefit level or utilization level. That means the IPAB “Independent Patient Advisory Board” or Death Panel will decide what gets authorized and covered and what does not.
    Your 90-year-old mom may need a new hip but will the IPAB authorize it?”

We could go on and on because it is clear that the entire healthcare finance and delivery system will feel the impact of our Congress doing nothing.

One additional concern is the “overly optimistic political corrected” desire to pass a “skinny bill” that would simply repeal the Play or Pay mandates. That could be catastrophic to insurers and to premiums that would need to be increased.

I don’t understand politics and have the scars to prove it but I do try to understand human nature. Human nature will drive most politicians to look out for themselves in their own individual voting district throughout the healthcare debate.
Sad thing is that the GOP seems to be immobilized from taking action on R&R  due to the criticisms from people who wouldn’t vote for them regardless of any action taken.

Makes you want to ask, “So, a small percentage of people in your district, who wouldn’t vote for you under any circumstances, are preventing you from doing what’s right for tens of millions of American?”
As I said, I don’t understand politics.

Sorry for the negative outlook concerning our Congress and especially its leadership. But, since neither the House nor Senate bills actually repeal the ACA there seems to be little to ignite optimism.

I think we can point to the children’s book “The Emperor’s New Suit” as the beginning of the GOP’s downfall.  You can’t tell people it’s an ACA repeal bill, while leaving the core foundation of the ACA including taxes, and expect the people to embrace it. Reducing the Play or Pay penalties to zero and calling it repeal  does not repeal the Play or Pay core fear of the ACA. It only increases premiums.

Well, we’ll see what happens this week and together we will address it.
Because, we’re all in this together, right?
Let me know what you think.

Until next time.

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

 

The Cruz Amendment, what would it do for Healthcare Reform? Maybe, just maybe, it would provide options.

July 20, 2017

As I write this Post today, the Senate’s two attempts at HCR are on hold for voting purposes. Initially, the public reason given for the delay is that they are waiting for Senator McCain to be released and back at work. Please join us in wishing the Senator a speedy and full recovery!

Now, we hear that Leader McConnell is pulling the bills back all together.

In the interim let’s discuss the possibilities of the passing the BCRA (Better Care Reconciliation Act), or any Reform or Replace legislature, with the Cruz Amendment (CA) included. The opposition argument against the CA is some what logical and makes for good debate even though the opposition is too scripted and predictable to be conclusive. Their argument is that the CA will cause premiums to increase dramatically on full service standardized or ACA type of benefit plans. What’s wrong with that argument? Plenty!

For one, it makes us accept (or forget) that premiums haven’t already increased dramatically (over 100%) and done so to the point of being unaffordable.

Two, the opponent’s argument conveniently forgets to acknowledge that the ACA Bronze Plans and even Silver Plans leave members with such high out-of-pocket costs that the plans provide no real benefit for basic primary care or for higher cost care such as diagnostic care for most Americans covered by those plans. Who can afford to pay a $6,500 deductible before their plan pays anything?

Three, their argument neglects the fact that insurers are so regulated and handicapped by the ACA that the insurers have skinnied down PPOs to the point that finding a doctor to accept your Bronze/Silver plan is nearly impossible. In addition, by eliminating 50% of the providers in your area the opportunity for you to even receive care is reduced.
You might have a Health Plan Id card in your pocket but you have no providers at which to use it.

The opponents of the Cruz Amendment want you to forget that the ACA has allowed or even forced insurers to offer high-priced, high out-of-pocket, skinny network plans that people would not want to purchase unless they were forced to do so. And could not afford the richer Gold and Platinum plans available.

And don’t forget the subsidies paid to insurers which further drive up the costs of the ACA plans because we all pay those subsidies don’t we. Those subsidies also skew the pricing assumptions that insurers usually make.

Remember that the Cruz Amendment would require insurers to offer standardized HCR metallic-like health plans before they are permitted to make other plans, with less benefits, available. It is not a license for insurers to offer only stripped out benefit plans. It’s a chance for insurers to offer more options from which individuals and small employers can choose.
So, what could the Cruz Amendment create?

The obvious goal is that it could create a menu, with more options, from which Americans could choose the benefits important to them.
For example.

Individuals:

  • Young healthy men or woman(or older) might select benefits with limited  or no maternity coverage.
  • Older men or woman might select plans with richer Rx benefits than younger folks.
  • Young people might be more willing to buy catastrophic coverage with a deductible of $10,000, for example.
  • Certainly, many people would not want to pay for built-in pediatric dental that is forced on current ACA plans.
  • There are dozens of examples of how plans could be built and priced for more choice.

Small Employers:

  • Could purchase low-cost catastrophic plans then implement an HRA to enrich their employee’s benefits. (Thousands of employers would do this.)
  • Provide multiple options so employees can choose from more than a couple options
  • The employer’s HRA plans would provide employees with better choices so that they might include their families. It’s be nice to be able to afford to include their kids on the parents plan.
  • Employers could lower the cost and improve benefits for their employees.

The argument against the Cruz Amendment uses the well-tested tactic of fear to gain support for the opposition. Yet the opponents must rely on our faulty memories to forget that premium have increased by over 100% while out-of-pocket costs have increased and provider access is scarce, since the ACA went into play March 23rd, 2010.

What the Cruz Amendment needs is a solid national promotion campaign with an articulate spokesman to lay out the facts. The GOP must tell America that having more options from which to choose does not guarantee poorer benefits or higher premiums.

I recognize that I am being pretty basic here and that there are a few more details to address such as subsidies for those that need them, Medicare expansion, logical pre-ex provisions and more. But all of that can be resolved when we let competition take hold.

Fortunately these types of health plans and the solutions they bring are part of a solution for which your author has some experience. I challenge anyone to debate this issue with us. That is, if the opponents use facts and real experience.

What do you think?
Remember, we’re all in this together!

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

Why are some Republican Senators suddenly so opposed to their own Senate Healthcare Reform bill? Follow the money!

July 13, 2017

Money, that’s it, that’s the reason why a handful, but growing number, of GOP Senators are opposing the Senate’s current R&R effort. (Please forgive me for referring to it as R&R since we know it’s not either.) But the point is, their opposition is not about their concern for the poor or any other human related issues. It’s about the money attached to Medicare Expansion.

The creators of the ACA understood human nature and politicians so they knew that if the ACA could get states hooked on and depentant upon the billions of Federal dollars committed for ACA enrollees created by the Medicare Expansion then those states, or more appropriately those politicians, would be reluctant to give up those dollars. Actually, the ACA proponents knew that Politicians would be unwilling, actually unable, to give up those Federal dollars; as if those dollars were an addiction.

You’ve read in previous Posts how the Medicare Expansion works. It promised states that the Feds would pay 100% of the costs for those enrollees initially then reduce to 90% after a few years. Meaning the states had to come up with no more than 10% to cover the millions of newly enrolled healthy working age citizens getting their health coverage from Medicaid.

You will remember that Medicaid was originally created for the young, the disabled or pregnant citizen and that the Feds matched the state’s spending on a graduated scale based on each state’s average “prosperity rating”. So richer states like California and New York received only a 50% match while poorer states such as Mississippi received up to 75% match. These figures and factors have applied for years and as you can see are much lower than the Federal match for enrollees under the ACA’s Medicare Expansion.

Bottom line is that  which means a “political” problemthe 31 states, that accepted the Medicare Expansion, are hooked on the higher reimbursements from the ACA.

Some GOP Senators from states that excepted (swallowed) the Medicare Expansion pill now are getting pressure from their home states to keep the funding for Medicare Expansion in place. The reason is that to reduce the matching funding would cause these states a budgeting problem.

The current GOP Senate bill retains the concept of Medicare Expansion but starts to reduce the matching % in 2021. Then, by 2024, (6 years from now) the matching % would level off and be the same % as the state’s Federal match for regular Medicaid enrollees. Seems fair doesn’t it but to Governors of those states hooked on the Federal ACA match it creates a budget issue and therefore they have a “political” problem.

For the past 7+ years the GOP used the “Repeal and Replace” mantra as its campaign slogan which worked and added thousands of Republicans to every level of government office from your local representatives in city, county and state positions to Congress and Senators including a bunch of Governor’s seats. So all of a sudden the success of the GOP to unseat Dems from all of these seats has put many Republicans in a position of responsibility over budgets and caused the GOP a political problem. Now it appears that many have forgotten their pledge to Repeal & Replace the ACA which helped get them elected. Funny how quickly some politicians forget their promises, isn’t it?

Make no mistake about the magnitude of this issue. We’re talking about hundreds of billions of dollars that the states will see reduced over the coming few years. Those state politicians will be faced with citizens (voters) that will fear that ( and be told by Dems) that their public subsidy (premium or benefits paid by Government) are being reduced or eliminated. The Governors and Senators of the Expansion states fear the back-lash from those healthy, often young, able-bodied and often working citizens who are currently covered by Medicaid who that their subsidy will be reduced or eliminated.

Do you think the Dems will exaggerate or try to capitalize on this in their campaigns?

So, that’s it! It’s not about a better healthcare reform package or helping the poor or the disabled. It’s about the money, the money to which these Expansion states are now addicted. Of course the cynic in your author assumes that the politicians in those Expansion states are more concerned about their own re-election than on what’s good for America. I pray that I am wrong about this.

As I write this Post we are hearing that the Senate will introduce a new R&R bill this week that will be “better” than the Senate’s current Better Care Reconciliation Act.
I wonder; Better for Whom?

Let me know what you think.
Also let me know what you think would happen if the GOP does nothing about R&R but simply props up the ACA for another year? Let me know.

You know I believe that we are all in this together and by being together we will overcome any obstacles facing us. However, when one sees politicians act or react for their own benefit it makes a person wonder.

Until next week.

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

What a difference a week can make!

July 6, 2017

We’re not going to talk about healthcare reform this week. There is something about a mid-week holiday that throws off momentum, does it not? So, let’s take a break from the frustration caused by our politicians in Washington DC when they try to honor their promises.

The calendar naturally moves our holiday schedule forward each year so we occasionally see holidays, that are date specific, fall in the middle of the week. Other holidays that are affected are Christmas and also New Year’s, obviously, as well as Valentine’s Day, St Patrick’s Day to name a few.

Years ago, the US Congress decided that certain holidays should always be on a Monday thereby creating a bunch of 3-day weekends for us to enjoy. Examples of this are Memorial Day, Labor Day, and President’s Day to name a few. We all have to admit that it is nice having those 3-day weekends from time to time.

I’m sure the US Congress did this for the benefit of we hard-working citizens because it’s hard to imagine that the Congress needed any additional time off, given its propensity for long recesses.

Anyway, we’ll be back next week to dive head-first into the Senate’s Better “Care Reconciliation Act”. Given the momentum created by the Senate and its health reform bill we have plenty of time to cover everything in detail. Plus we’ll talk about the changes already being made.

Hope you enjoyed the time off and that you had a safe 4th of July celebration.

God Bless America!

Until next week.

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