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

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

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