Archive for October, 2017

Association Health Plans, AHPs, as predicted may soon be reality. But, opposition will be intense and insane. Let’s look closer.

October 26, 2017

As he promised, the President signed an EO directing the Departments of HHS, of Labor, and Treasury to review and implement guidelines allowing for AHPs and for the selling of these AHPs cross state lines.

Be for-warned that the opponents of AHPs, selling cross state lines or any change to the ACA will scream bloody-murder & disaster. They will “cry” that babies will die in their mother’s womb(don’t say it, too easy), that children will go without vaccinations, that women won’t get their lady healthcare, that severe disease won’t be treated and that our streets will be filled with the bodies of citizens denied care. Think that’s too strong? Just watch!

Why would any employer or citizen purchase a health plan that did not fit their needs unless they were forced to, as they are by the ACA. So, let’s take an honest look at AHPs and project what could happen, if the GOP gives us a chance.

AHPs are not a new concept and there are countless examples of where and how they have been successful. In California, for example, there are dozens of examples of successful AHPs, from the pre-ACA era, that provided alternatives for CPAs, Attorneys, Auto Dealers, Chambers of Commerce, Builders Associations, Growers Associations, Engineers, Architects, Plumbers, Contractors, Farmers, even Insurance Agents and you can go on for ever.

Why the confusion or fear? Setting aside the obvious political and ideological opposition let’s look at this logically. There are examples of successful AHPs that are both Fully Insured and Self-funded. But, there are also examples of AHPs that failed which were both Fully Insured and Self-funded.

Why were some successful and some not? The answer, as success always is, is complicated but reasons include burdensome regulations and over-reach by regulators, hundreds of miscellaneous state mandates, poor management or sometimes mismanagement, managed care, PPOs, competition and changing times. But, the fact remains that history shows us how AHPs can work and don’t we all agree that small employers need alternatives to what’s been forced upon them the past 7 years.

Let’s look at some specifics both bad and good. The bad first because it’s possible that:

  • Some AHPs will be created and sold that fail.
  • Some AHPs created may offer less benefit than ACA EHB’s require.
  • Some purchasers may not understand the AHP presented to them.
  • Some Brokers may not understand the AHP they’re presenting.
  • Well designed and managed AHPs could take healthy customers from existing plans.

Now the good, because AHPs:

  • May be created with EHBs but still lower premium cost.
  • May include richer benefits than the ACA plans with EHBs.
  • May result in lower out of pocket for members.
  • Will provide alternatives and more choice.
  • Will be well-managed and properly presented.
  • Not every one requires Pediatric dental or other mandated benefits.
  • Small employers will get choices similar to large employers.
  • Restrictive “state specific” limitations can be over-come.
  • Employers will get better transparency in their plans.
  • May increase enrollments.
  • Brokers will be enabled to do their job!

The last bullet is important because I believe that insurance brokers are better suited to counsel employers than state bureaucrats or ACA enrollers. Brokers, given the chance and products, will help employers select the plan(s) that best suit an employer’s goals of providing a health plan to its employees.

If the Depts. of Labor, HHS, and Treasury do their job well, AHPs will allow employers:

  • Access to Fully Insured and Stop-Loss plans that currently can not be offered due to the ACA’s or local state restrictions.
  • Buy with discounts like other large purchasers can. (Do you think Wal-Mart pays the same price for the goods it sells as your local independent small store?)
  • More competitive pricing from the current plans available.
  • Make plans available to employers where none are available now.

There are many details for us to see worked out by the various departments noted above. Those details and the process to create them will be viciously assaulted by opponents of AHPs and any change to the ACA.

Already, we’ve read statements by one leading Dem Congresswomen Americans will have their pre-existing conditions denied even though there is no evidence to support that claim. Plus, why would a broker present or an employer purchase a plan that hurts the very employees the employer needs for success.

AHPs could lead to some exciting opportunities to improve healthcare in our country. Plans created by innovative TPAs will offer solid benefit packages with lower premiums that include cost controls, transparency, and stability for the next 3-5 years.
Jeez, wouldn’t a little stability be nice.

That’s it for now but we’ll watch this development as it evolves. Let us know what you think. We want to hear concerns as well as platitudes for these AHPs.

Never a better time cause we’re in this together.
Until next week.

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

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