July 4th is a “uniquely American date” as the Celebration of our Independence. Let’s look at it’s history.

Let’s take a day off from our normal healthcare reform discussions.

Next week we celebrate the 4th of July which at its core is why we have the freedoms we enjoy and for which so many have fought. No where in the course of history on this planet has any nation achieved what the USA has or is trying to retain. So, let’s take a moment to remember why we have the freedoms to debate and disagree.
Please enjoy the brief history and interesting facts to follow:

Have you ever wondered why we celebrate the Fourth of July or the risk our original Founders took to make July 4th significant to us? Many people think we celebrate the Fourth of July because it is the day we received our Independence from England on July 4th 1776.  Not true because it would be another 7 years before we would gain our independence because the war with England to gain independence did not end until 1783.

When the original 13 colonies were first settled, and before we were called the United States, England pretty much allowed the colonies to develop freely without much interference. But starting around 1763 Britain decided that they needed to take more control over the colonies(which means money) and that the colonies needed to return revenue(taxes) to the mother country. England’s reasoning was that it provided protection to the colonies so the colonies needed to pay for their defense.

But the colonies did not agree and felt that since they were not represented in Parliament (Congress) that they shouldn’t have to pay taxes to England, which gave origin to the phrase “no taxation without representation”. But England continued to tax which led the colonies to form the First Continental Congress with the intent to persuade the British government to recognize the rights of the colonies. Of course England did not so a war was declared, which we call the American Revolution.

Most folks forget that the American Revolution (the war) lasted for nearly 10 years. Failing to get satisfaction at first, the leaders of the 13 colonies organized a second Continental Congress. It is this group that adopted the final draft of the Declaration of Independence. The first draft of the Declaration of Independence was written by Thomas Jefferson, it was revised by Ben Franklin, John Adams, and Thomas Jefferson before it was sent the Continental Congress for approval.

The Declaration was finished and ready for signature on July 2nd but was not voted upon and approved until 2 days later. All thirteen colonies stood behind the Declaration of Independence and adopted it in full on July 4, 1776.

The Fourth of July is known as Independence Day because that is the day that the Second Continental Congress adopted the full and formal Declaration of Independence. Even though we had declared that we were independent, the American Revolution was still being fought, which meant that we were still not independent.

After the war ended in 1783 the Fourth of July was celebrated for its importance and shortly thereafter became a holiday. We celebrate the Fourth of July as the most patriotic holiday celebrated in the United States.

Maybe our political leaders from both parties and at every level of government from local school boards to the US House and Senate would be wise to remember how it is that we celebrate the 4th of July to this day.
Below are some interesting facts you might enjoy.

Let’s all remember why we love the USA as well as how brave and wise our Founders must have been.

Did you know:
The Fourth of July commemorates the adoption of the Declaration of Independence. It was initially adopted by Congress on July 2, 1776, but then it was revised and the final version was adopted two days later.

• As Thomas Jefferson penned the Declaration, Britain’s army was on its way toward to New York Harbor. It began:
  “When in the course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature’s God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.“
• The Declaration of Independence was signed by 56 men representing the 13 colonies. The moment marked the beginning of all-out war against the British. The American Revolutionary War is said to have started in 1775, however. The Declaration was signed more than two years after Boston officials refused to return three shiploads of taxed tea to Britain, fueling colonists to dump the tea into the harbor in what became the infamous Boston Tea Party.
• Several countries used the Declaration of Independence as a beacon in their own struggles for freedom. Among them, France. Then later, Greece, Poland, Russia and many countries in South America.
• “Yankee Doodle,” one of many patriotic songs in the United States, was originally sung prior to the Revolution by British military officers who mocked the unorganized and buckskin-wearing “Yankees” with whom they fought during the French and Indian War.
• The “Star Spangled Banner” wasn’t written until Francis Scott Key wrote a poem stemming from observations in 1814, when the British relentlessly attacked Baltimore’s Fort McHenry during the War of 1812. It was later put to music, though not decreed the official national anthem of the United States until 1931.
• We’ve grown up: In 1776, there were about 2.5 million people living in the newly independent United States, according to the U.S. Censure Bureau. Today there over 330 million  citizens in the US so let’s hope all of us as Americans will celebrate Independence Day.

We hope you enjoyed the brief respite from the frustrating conversations concerning the reform of the US healthcare system. I wish to thank the folks at LiveScience for their research and insight.

Next week will be off in honor of Independence Day.
Maybe then we can get back to thinking America first because we are all in this together!!

Until  we talk again.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf
It means “Walk the Faith”.

 

 

Will elimination of the Individual Mandate hurt or help. Will Insurers benefit, they always seem to. But, how will our citizens benefit? Maybe it’s time to implement reasonable Pre-ex standards.

Jeez, I hate long titles, don’t you? But, sometimes one can’t help it.
Most Americans are not aware that there are 20 GOP-led states suing the Untied States to eliminate portions of the Affordable Care Act. Specifically, the suit argues the Individual Mandate is unconstitutional since the penalty for non-compliance has been reduced to zero.

Opponents of the suit fear that this will lead to the elimination of certain critical
protections. Their fears are that the provisions within the ACA that guarantee access to coverage as well coverage for pre-existing conditions, without exception. These two provisions are critical for individuals seeking coverage. But, they were also a catalyst leading to the huge-unprecedented increases in premium levels. Not the only reason for premiums increasing but certainly a big part of it.

The Press is being a little misleading about this or at least jumping ahead to conclusions that can’t honestly be made. Many reports state that if the GOP lead suit is successful then it “may” also cause similar issues for people covered on small group plans. I don’t agree with those conclusions because small employer plans were already regulated in every state to be GI and full take-over for previous coverage.

In small employer plans, pre-ACA, an employee signing up for his/her employer’s plan was provided guaranteed issue (GI) and if the employee had coverage within the previous 90 days was granted full take over. Full take over means no pre-existing conditions would be denied.

An important additional provisions was that small group plans, pre-ACA, included very reasonable provisions for new enrollees with no previous coverage. Generally these provisions stated that if a new enrollee, with no coverage in previous 90 days, had been treated for something in the past 6 months, the new plan would not pay for treatment for that condition until covered on the new plan for 6 months. Smart pre-ex provision that help control premiums and it prevented people from “gaming” the system.

We have discussed GI with reasonable Pre-ex provisions in a number of previous Posts, so you know what should be considered. Without a mandate, with teeth, the Insurers will be “gamed” if GI remains in place for individuals. Why pay for something now if the law says you can buy it later when you need it?

Maybe the result of the battle will be that Individual and Small Group Plans will remain GI but return to the reasonable pre-ex provisions most states mandated for the past 20 years. Specifically, if you sign up now, but had no coverage within the past 60 days, then you are accepted for coverage, except the plan is not required to pay for that which you’ve received treatment during the past 6 months until you have been cover for 6 month on the new plan.

If the new plan is replacing a current plan then the new plan is GI with full take over of coverage for all benefits covered under the new plan. Simple, smart, protects all Americans equally while providing protection for Insurers, too. It also protects those Americans, who always maintain their coverage, from those few Americans who try to “game” the system. The “gamers” cost Insurers but they also cost the rest of us since our premiums include an actuarial estimate for the Insurers cost of providing coverage to the “gamers”.

A reasonable provision for GI and Pre-ex conditions is an example, once again, of why we’re all in this together.

Until next week.

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

 

 

Premiums projected to increase by double-digit again in 2019. The only visible actions we see on healthcare premiums is to cast blame.

The headlines about premium increases are not getting the attention that the they produced just 2 years ago. Why is that? Projections across the country are for premiums for Exchange Plans will increase by 8-10% in the West to 19% to 59% in the East. Our minimal math skills tell us that these increases are not good but when compounded on previous increases then premiums reach staggering levels.

Why are Insurers increasing these premiums? Data which we’ll discuss below reflect 2017 as the best year for insurers since they signed on to the Exchanges.

But the blame game is in full swing and that may be partly why the headlines don’t command the attention they did in previous years. The American people are a lot smarter about these news stories than most politician give them credit. When citizens see Insurers cast blame and politicians cast blame and no one doing anything to help; they become skeptical if not down right cynical about the news. That cynicism is something with which I can relate.

The biggest “excuse” and most “blame” is that the Trump administration has refused to make the subsidy payments to insurers that the Obama administration had made in prior years. Remember those subsidy payments? The ones that allow members below certain income levels to pay little or no premium as well as lower the out-of-pocket cost for members. The burden of these payments was not authorized by Congress, say the GOP folks, plus the original ACA called for states to be weaned off Federal subsidies.

But now the bill comes due and everyone has their hands in their pockets as they pass the check around the table to see who will bite. Reminds me of a friend of mine.

Let’s talk about the insurers which are crying poverty. They state that the ACA requires them to accept all enrollees without consideration of current or past health status and cover any pre-existing health issues. In 2014, this was a valid concern. No one could accurately project what the cost of guarantee coverage with no pre-existing waivers would be, without a crystal ball. But, the Insurers sold policies, paid claims that were probably astonishing, received their subsidy payments then raised premiums again and again, anyway.

Now Insurers are looking at year 5 of the ACA. Insurers have increased premiums several hundred percent over the past 7 years and while their membership count maybe the same or even lower overall their revenues are much higher.

A recent article by the Kaiser Family Foundation included excellent analysis finding that Insurers in 2017 had their best financial year selling individual market health insurance since the Affordable Care Act began requiring guaranteed access to coverage for people with pre-existing conditions in 2014.

This analysis finds insurers posted their strongest performance in the individual market using two different financial indicators:

• The average share of health premiums paid out in claims (or medical loss ratio) fell to 82 percent in 2017 from 96 percent in 2016 and 103 percent in 2015.
• Average premiums collected in excess of claims (or gross margins) reached $79 in 2017 per member per month, up from $14 in 2016 and -$9 in 2015.

One can look at the reports by many Insurers that show enrollment down, some by as much as 40%, yet revenues have sky rocketed. Can you imagine if your business serviced 40% fewer clients but your revenues were higher than ever? Hard to digest isn’t it?

Anyway, the point is that the press can see that putting the “Premiums to increase dramatically” stories on Page One no longer compete with the other stories of the day. And I don’t even want to get started on what the other news is that they focuses upon, give me a break.

If you’re on a group plan sponsored by your employer you’ll be better off than if you were on your own. If your employer provides an HRA to tie with your group plan you will be in great shape. With employment numbers soaring it means that more people could be covered by employer sponsored plans. That’s good.

I hate the frog in the hot water analogy but that’s a bit of what we have here. Next week we’ll discuss the efforts by 19 state’s Attorneys General to void the “No pre-ex” portion of the ACA with actions that state “if the individual mandate is out then the no pre-ex is gone” which presents an interesting argument. Can’t wait.

These are confusing political times but we must remain committed because we are all in this together.

Until Next week.

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