Archive for the ‘affordable care act’ Category

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

October 4, 2018

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 price of $98.50. When the various brethren 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 Israelites 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 organizations 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 seniority 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 discretion 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 constituted 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 buccaneer 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 Peripatetic 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 raised a crudely designed but historic Bear Flag.

 Clampers played an important part in the history of California in the nineteenth century because the American members of 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 among the Brethren since 1992 at the Tehachapi Loop.
We return to the Loop this Trek.

How many of you know a Brethren of the Order?

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

Until next week,

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

 

Mid-term elections and YOUR coverage for Pre-existing Conditions: what do they have in common?

September 6, 2018

I realize that the mid-term elections are two months away and most of us hate the campaign adds and the rhetoric but we should prepare now for the “mis-information” we will see and hear concerning what the GOP plans to do to coverage for Pre-existing conditions. We’ve discussed before how difficult it is to decipher the facts vs. fiction or the truth vs. campaign promises (Bullsh#t). That is just not easy for folks to do.

The Dems have focused on a number of issues on which to campaign this year. The GOP strategists probably thought that healthcare and the ACA would not be one of the issues on which the Dems would campaign but they were wrong and the Dems are taking advantage of the thickheaded dopey actions taken by the GOP to dismantle the ACA.

The single effective tool the Dems will use is the scare people/voters about losing their coverage for Pre-existing conditions. The Dems historically and routinely use Medicare as a scare tactic but this issue of covering or not covering pre-existing health conditions may be more effective than scare tactics about Medicare. Not kidding!

Articles and short excepts are every where which make the accusation that the GOP’s scheme is to change the ACA so that Insurers won’t be forced to cover pre-existing conditions. These articles also carefully link eligibility and guaranteed acceptance to this issue to make folks believe that Insurers will no longer be required to accept all applicants and the Insurers will be able to deny coverage for conditions existing prior to coverage.

This tactic of weaving un-true facts into the voters minds is common from the Dems. In this instance I think the idea for this tactic started after they realized that Short-term Policies (STP) extending for up to a year would be popular among health Americans and STPs do not pay for pre-existing conditions and can qualify an applicant with a health questionnaire. In addition, Association Health Plans (AHP) have gotten traction in some states.

It is assumed, and I agree, that the STPs and AHPs have the potential to attract healthy people of all ages which could leave the standard ACA compatible plans with a higher percentage of unhealthy people. Why should anyone dispute this assumption and in fact we should support it.

The fact is healthy people have been subsidizing the unhealthy with their higher premiums for seven years. In addition the Insurers would have been subsidized for their losses but in reality the Insurers have made huge financial gains because of the ACA.

What company couldn’t be profitable if you could charge anything you wish, for a product that has huge out of pocket costs and the customer is forced to buy it. Plus, millions of customers have their premium and out of pocket subsidized as well.

So, back to Pre-ex. I have seen nothing in any of the bills floating around that eliminates guarantee issue or full Pre-ex, not one. If you have please send it to me.

The week of August 20th a group of tem GOP Senators offered a bill that they named “Ensuring Coverage for Patients with Pre-existing Conditions Act”. Catchy name isn’t it, just rolls off the tongue, doesn’t it? Why would the GOP name its bill that if it diluted the coverage for people with pre-ex?

Immediately articles started popping up quoting “healthcare experts” citing that the GOP was trying to dilute the ACA’s guidelines for covering pre-existing conditions as well as guarantee acceptance. I’ve read the bill and I see nothing that comes close to supporting that accusation. In fact, it states clearly that Insurers and health plans can not decline applicant nor can they not cover pre-existing conditions.

But you understand the Media and the Internet. Somebody, somewhere, regardless of their expertise or even if they have read the bill, says that it denies coverage  and the mis-information is off and running. A second entity states that “reports are coming in that the GOP is trying to deny Pre-ex” then another only now its plural and says “multiple reports are stating that the GOP wants to deny your pre-ex”.

Whew, it’s no wonder that folks can be misled or at least confused.
First, shouldn’t one ask themselves:

  • Why would the GOP offer legislation two months before a key election that the Dems could use to scare folks with existing health conditions?
  • Why would they name it the “Ensuring Coverage for Patients with Pre-ex Conditions” if it did not ensure coverage for patients with pre-ex?
  • Statistics and common sense tells us that everyone either has a family member that has a pre-existing condition or they have a pre-ex themselves. Why would the GOP alienate that many people two months before an election.
  • Is it possible that this information that places a negative spotlight on the GOP be “fake”?
  • What would Mark have to say about this? Just kidding with that one.

We discussed it many times. There are so many people with professional or at least private motivation that continually spew out false information. Some inadvertently but the majority of the false information is designed to achieve the originator’s objective.

We just need to watch for it and ask the question that steers our common sense to know which is which.

That’s easy though because we’re all in this together.

Until next week.

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

 

Labor Day: our National tribute to America’s workers. It’s history tells much about America! Let’s take a look.

August 30, 2018

History of Labor Day

Admit it though, you like Labor Day for the extra day off, me too. But it’s interesting and fun to explore just why it is that we get that day off. At least some of us do.
I want to thank the US Dept of Labor and its historical tribute to Labor Day.

Labor Day: What it Means

Labor Day, the first Monday in September, is a creation of the labor movement and is dedicated to the social and economic achievements of American workers. It constitutes a yearly national tribute to the contributions workers have made to the strength, prosperity, and well-being of our country.

Labor Day Legislation

The first governmental recognition came through municipal ordinances passed in 1885 and 1886. From these, a movement developed to secure state legislation. The first state bill was introduced into the New York legislature, but the first to become law was passed by Oregon on February 21, 1887. During 1887 four more states — Colorado, Massachusetts, New Jersey, and New York — created the Labor Day holiday by legislative enactment. By the end of the decade Connecticut, Nebraska, and Pennsylvania had followed suit. By 1894, 23 more states had adopted the holiday, and on June 28, 1884, Congress passed an act making the first Monday in September of each year a legal holiday in the District of Columbia and the territories.

Founder of Labor Day

More than a century after the first Labor Day observance, there is still some doubt as to who first proposed the holiday for workers.

Some records show that Peter J. McGuire, general secretary of the Brotherhood of Carpenters and Joiners and a co-founder of the American Federation of Labor, was first in suggesting a day to honor those “who from rude nature have delved and carved all the grandeur we behold.”

But Peter McGuire’s place in Labor Day history has not gone unchallenged. Many believe that Matthew Maguire, a machinist, not Peter McGuire, founded the holiday. Recent research seems to support the contention that Matthew Maguire, later the secretary of Local 344 of the International Association of Machinists in Paterson, N.J., proposed the holiday in 1882 while serving as secretary of the Central Labor Union in New York. What is clear is that the Central Labor Union adopted a Labor Day proposal and appointed a committee to plan a demonstration and picnic.

The First Labor Day

The first Labor Day holiday was celebrated on Tuesday, September 5, 1882, in New York City, in accordance with the plans of the Central Labor Union. The Central Labor Union held its second Labor Day holiday just a year later, on September 5, 1883.

In 1884 the first Monday in September was selected as the holiday, as originally proposed, and the Central Labor Union urged similar organizations in other cities to follow the example of New York and celebrate a “workingmen’s holiday” on that date. The idea spread with the growth of labor organizations, and in 1885 Labor Day was celebrated in many industrial centers of the country.

A Nationwide Holiday

Women's Auxiliary Typographical UnionThe form that the observance and celebration of Labor Day should take was outlined in the first proposal of the holiday — a street parade to exhibit to the public “the strength and esprit de corps of the trade and labor organizations” of the community, followed by a festival for the recreation and amusement of the workers and their families. This became the pattern for the celebrations of Labor Day. Speeches by prominent men and women were introduced later, as more emphasis was placed upon the economic and civic significance of the holiday. Still later, by a resolution of the American Federation of Labor convention of 1909, the Sunday preceding Labor Day was adopted as Labor Sunday and dedicated to the spiritual and educational aspects of the labor movement.

The character of the Labor Day celebration has undergone a change in recent years, especially in large industrial centers where mass displays and huge parades have proved a problem. This change, however, is more a shift in emphasis and medium of expression. Labor Day addresses by leading union officials, industrialists, educators, clerics and government officials are given wide coverage in newspapers, radio, and television.

The vital force of labor added materially to the highest standard of living and the greatest production the world has ever known and has brought us closer to the realization of our traditional ideals of economic and political democracy. It is appropriate, therefore, that the nation pays tribute on Labor Day to the creator of so much of the nation’s strength, freedom, and leadership — the American worker.

If you’ve read this far then I congratulate you because you now know more about America’s labor Day holiday than most of your friends do.

Many of our holidays demonstrate for all to witness how we have evolved over the past 250 years, how we change even though it is sometimes slow and painful and how historically Americans both fight and defend one another.

So, it’s clear to see that we truly are all in this together.

Until next week.

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

 

 

Lot’s of talk about the suspension of the ACA’s Risk Adjustment Payments to Insurers. Is this critical or just another scapegoat?

August 2, 2018

I’d bet you lunch, anywhere in town, that 99% of Americans have no idea what this risk adjustment program (RAP) is or what it does or why it was implemented by the ACA. I’d also wager that 99% of Americans are unaware of the inequities and issues the RAP created.

So, for the 99% of us – what the heck is this Risk Adjustment Program?
The idea was hatched, during the creation of the ACA, as Insurers voiced their fears that Insurers would be inundated with new applicants who had no prior coverage and whose potential healthcare cost (in other words amount of new claims) was impossible to determine. Couldn’t blame the Insurers for their concern, especially when it could be $$billions of dollars in claims on members who had no previous coverage. Plus, the ACA needed a way to entice Insurers to the table.

So, to offer some comfort for planning, the ACA created a complex formula primarily applying to individual plans, that was supposed to level the playing field, so to speak. If one insurer got hit with an inordinate amount of claims while other Insurers did not then the RAP was designed to equal out the pain.

For example: suppose there are just two Insurers offering and accepting applicants in an area, Insurer #1 and Insurer #2. Also, to make the example easier to understand let’s assume that both Insurers  end up covering 1,000 individuals. But, for what ever reason, Insurer #1’s members are all healthy people under 40 years old while Insurer #2’s members are all above 40 years old with a bunch of 60+ and the entire lot is unhealthy.

Obviously, the claim costs for Insurer #2 would be expected to be much higher than Insurer #1. If the claims experience for #2 exceeds 100%, thus loses money, then the loss would have been shared by #1 making payments into the RAP program. Theoretically, every plan should have had this potential cost factored into its plans so that it was a pass through.

Now, the Courts has ruled that the ACA’s RAP payment methodology is flawed which has caused any movement by the Feds to issue RAPs to be suspended. Actually, I don’t think this is a bad think for a couple reasons. One is that Government methodology in almost every initial program is often flawed but seldom corrected. This provides a chance for correction.

Another reason why this halt may be good is that some Insurer’s planning and pricing for initial their plans may have been skewed in an attempt to “game” the RAP.  Your humble author can report on this matter directly. I had conversations with more than one Insurer representative concerning this matter. It was widely agreed that pricing individual plans for the ACA was extremely difficult but more than once I heard “it really does not make a difference because if we’re priced too low and lose money the Gov will make us whole”

The first couple times I heard that sentiment it confused me. I thought, “How could an Insurer not be worried about underpricing their plan?”. The it hit me.

The ACA was designed to be an entitlement plan. Most folks agree that it is an entitlement for the people subsidized under the state run Exchanges. But, did you ever consider that it was an entitlement for the Insurers, too?

How else could the ACA convince Insurers to offer Individual plans with GI and no pre-ex to people who had no prior coverage or worse had been decline for previous coverage.

Now, 7 years in to the ACA and we can see a clearer picture. The big Insurers, you know them, are making money, even though they plead poverty, because they have increased their premiums 300% to as much as 900% in some areas. But, small Insurers and regional Insurers have not done so well because the RAP may have taken money from them to give to the bigger national Insurers.

Of course the battle cry, incited by the ACA supportive Press, is printing headlines about premiums increasing because of the Trump administration’s decision to suspend RAP payments. We should remember:

  1. The Trump Team did not make the decision, the Court did. The Trump folks may not be supportive of the ACA or these RAPs but the Court decided that the RAP methodology was flawed.
  2. The carriers are raising rates anyway, often just because the ACA provides cover, and ACA supporters depend on un-informed readers forgetting that premiums have already been increased a zillion percent.
  3. Finally, as stated above, it’s good to suspend a government program once in a while, at least, to verify its accuracy if not its effectiveness.

We’ll hear more about this as we head toward the Fall and the mid-term elections.

But, you and I won’t be fooled because we’re all in this together.

Until next week,

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

 

Wait- Are the ACA’s State Exchange Plans working for everyone or not? Well, that depends on what you read and the author’s perspective!

July 26, 2018

We’re constantly reminded that one must be cautious about believing what one reads or hears about the success or failures of the Affordable Care Act (ACA). Never more true than what has been printed and dispersed over the past month or so concerning the ACA Exchanges being managed by various states. Hear are a few samples of the confusion:

  • We hear enrollment is down in the exchanges but that Insurers are supporting these ACA plans more than ever.
  • We hear premiums are up double-digit “again” yet the enrollment of subsidized members dropped 3%.
  • We also hear that the Individual Mandate (IM) has been “repealed” while premiums increase double-digit yet enrollment for members on non-subsidized plans has remained constant or increased a bit.

We all know that:

  • Premiums have increased over the past 7 years and are projected to increase again in 2019.
  • Some people will pay for their insurance, themselves, because they know they need it for their family and it’s the right thing to do.
  • Some people won’t take steps to keep themselves covered even though it costs them little if anything to do so.

I could go on and on, but the gist is that right now people who support the ACA, regardless of facts available, are searching for justification for the ACA. You’ve read it here before that the 80% to 90% of the folks enrolled on the ACA Exchanges get subsidized for their premium and out-of-pocket costs. Yet their enrollment drops.
How can that be?

On the other hand, the enrollment for Americans not subsidized for premium or out-of-pocket expenses remains constant or increased slightly. Who are these people and why are they acting like they are responsible citizens? It’s too bad the ACA has not assisted these hard-working folks by controlling premiums as well as improving benefits and increasing access to quality providers and care.

Over the past 9 months, since the “repeal” of the IM, supporters of the ACA have predicted dire consequences. These experts projected that millions would go uninsured, that thousands would put-off care, and our citizens would feel catastrophic results.
Whoops, that didn’t happen. Makes one wonder, doesn’t it?

So to summarize, analysis of actual enrollment shows that people responsible for their own expenses remain enrolled, paying ever-increasing premiums, while many who receive subsidies dropped off their coverage, even though their out-of-pocket remained unchanged.

Is there any chance that this is another example of why entitlement programs ultimately fail, always? Maybe it’s the old proverb: Teach a man to fish and he’s never hungry again, give a man a fish and he just makes a mess and your house smells like dead fish for a week. I improvised but you get the picture.

As we’ve discussed in previous Posts, the ACA caused higher premiums with lower benefits for 300 million so that 10 million can be insured at little or no cost to the insured. And from those previous Posts we all know that there are better ways to make coverage affordable with better benefits and greater access to care. If not for politicians we could get it done.

To the average citizen the headlines are misleading as is much of the text in the articles. Supporters of the ACA try to make lower enrollment and Insurer satisfaction sound good to the uninformed ear.  BTW, why are Insurers involved with these subsidized plans so happy these days? That’s an easy one.

But we know the truth, don’t we, based on experience and also because we know that we’re all in this together.

Until next week.

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

Are Politicians and the Press trying to make Folks nervous about losing the ACA guidelines on “pre-existing conditions”? Should they be? Let’s discuss it.

July 19, 2018

According to a Poll by the Kaiser Family Foundation, about 65% of likely voters say a candidate’s support for continued protections for people with pre-existing health conditions is either the “single most important factor” or “very important” to their vote in the upcoming midterms elections.
That’s significant and important!

The KFF Poll also reports that 57% of the voters in the poll say that they or someone in their household has a pre-existing condition of some sort. Critically important!

Additionally, 76% of the public say it is “very important” that the law continue to prohibit insurers from denying coverage because of a person’s medical history. Finally, 72% say it is “very important” that the law continue to keep insurers from charging sick people more for coverage. 

Once again, I say thank you to the KFF team for compiling these numbers which demonstrate how important the issue of “pre-ex” is to our citizens. I would add that this issue has always been the foundation on which every healthcare reform project has either thrived or failed. It’s really a no-brainer so why are the Press and certain Politicians stoking the fire of fear in our citizens.

In 1992, California’s healthcare reform bill, referred to locally as Ab 1672, provided for guarantee issue (GI) and full take-over for small group plans. It included a “pre-ex” clause for new enrollees who had no coverage during the previous 60 days. If a new enrollee had not had coverage in the previous 60 days then anything for which the new member had received treatment  in the previous six months would not be covered by the new plan until the member is covered under the new plan for six months. At that point coverage was full for any benefits covered under the plan. Pretty reasonable, right?

I remember the hysteria in the Press as well as brokers and industry pundits about how much premiums would increase due the GI and no pre-ex. Here’s what happened. Premiums increased initially about 6% to as much as 12% during the first year or so. Then in the second, third and fourth year the insurers actually started reducing premiums. No one organized any parades nor did the Press praise the results about the premiums coming down, but we in the industry knew it and employers appreciated it.

The failure of Ab 1672 was that it did not address individual and family plans (IFP), those plans not sponsored by employers. That error or purposeful neglect of leadership is where the crisis began yet no one in California had the vision or courage to address it.

So, let’s fast forward to the bantering we here today by the Press and Politicians as they try to scare up support for themselves and chip away at the efforts being made to improve healthcare pricing, benefits, and access.

As we continue, remember that the problem they’re projecting is for the State Exchange members covered by Individual and Family Plans (IFPs). We know that only about 8 million Americans have coverage on these plans but that 80-90% of those receive subsidies making their coverage be free or nearly so. But the fear is legitimate and fare; but the hysteria is not helpful.

There is a rather simple solution but it won’t happen because no Politician is going to take the risk and endure the public criticism of providing a workable solution.

So, I will.
A few simple steps:

  1. IFPs continue to be GI with its timely enrollment guidelines unchanged.
  2. New enrollees, not covered by any IFP or group plan for the preceding 60 or 90 days, would not have coverage for any pre-existing condition for which treatment had been received with in the previous 6 months. 
  3. Once the new enrollee is covered continually for 6 months then coverage is provided for all benefits provided by the plan. 
  4. During the period in which pre-existing conditions are not covered the enrollee would have coverage for all other benefits under the plan.
    Example: If pre-ex is treatment for diabetes but the enrollee breaks a leg or develops cancer during fist 6 months on plan, the broken leg and cancer is covered.

The time frames above could be adjusted but the result would be significant:

  1. It would encourage continuous enrollment, without a IRS implemented fine as demanded by the ACA, especially if one has an on-going condition which according to the KFF poll 57% of families do.
  2. It would stabilize premiums. The current mandates and guidelines of the ACA actually push premiums higher. Plus, Insurers have no incentive to control premium and as long as Insurers get reimbursed for 85% of covered enrollees the Insurers won’t have any incentive to control premiums in the future.
  3. Citizens would no longer need to fear being without coverage or not being able to acquire coverage and best of all, premiums would be lower.

That’s pretty easy.
Next, we add in the new Association Health Plans approved by President Trump and  we would see a revival of stability, faith and confidence in our healthcare delivery and finance system.

Of course we still need to deal with the core cost issues such as smoking, obesity and drug usage to really get the job done. But that’s for another day.

If we could encourage a healthy life style that is rewarded by a health plan while addressing the Unit Cost of Care” we will have made our healthcare system great again.
Sorry, that’s a dopey closing statement, but we could get it done.

That is if, we’re all in this together.
Until Next week.

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

Why are so many Americans deferring healthcare or going broke because of it? Wasn’t the ACA supposed to fix that problem?

July 12, 2018

The easy-simple-uncomplicated-straight forward solvable answer is that premiums have increased so much that people can’t afford premiums for anything but bronze plans. That means out of pocket cost for a single person of as much as $8,000 plus premium.

There is a solution to this and it will help all employers control costs while maintaining a healthy-loyal staff while reducing cost for both employer and employee.

Health Reimbursement Arrangements (HRAs) are a popular type of employer sponsored plan that can be used to reimburse an individual for qualified medical expenses and certain types of health insurance. HRAs are funded by the employer, and cannot be funded via employee salary reductions. Technically, HRAs are not a health plan, as we commonly think of plans, but rather they are an ACA and IRS supported method for employers to reimburse their employees for healthcare expenses. And they work!

In fact, HRAs worked so well for small employers that certain Insurers in California
threaten punitive actions against brokers to prevent brokers from showing HRAs to their clients.

The Court in a recent anti-trust lawsuit in California decided in favor of the Plaintiff and small employers when it issued an injunction preventing the Insurer from restricting access to these employer/employee friendly programs called HRAs. For years, Insurers in California threatened broker’s commissions and contracts if their clients implement HRAs. That is, until one TPA had seen enough. Now, Insurers no longer threaten brokers to restrict HRAs; but more about that in a future post.

The regulations and guidance issued under the Affordable Care Act, make it difficult for HRAs to be offered on a stand-alone basis, other than for retiree-only groups. The most common means for implementing HRAs, and the safest for employers, is to integrate the HRA with a group health plan that already complies with the standards of the ACA.

The Trump Administration issued an Executive Order that directs the DOL and the Departments of Treasury and Health and Human Services to consider proposing regulations or revising guidance to increase the usability of HRAs It also directs them consider means to expand employers’ ability to offer HRAs, and to allow HRAs to be used in conjunction with non-group coverage.

HRAs are under-utilized in today’s market so the Trump EO may be a shot of adrenaline to insurance brokers to look at HRAs as a creative way to help their clients lower cost and improve benefits.

The point is that HRAs have a 15 year track record of proven results for small employers that demonstrates how HRAs can work effectively to reduce costs. That 15 year track record also shows why it is that HRAs improve benefits every time they are implemented. The track record was accomplished in CA and we all know that CA is one of the most expensive states for healthcare premium and unit cost.  That’s a pretty good state to set an impressive track record.

The HHS may expand HRAs in a manner to give larger employers the freedom to reimburse employees for premiums on their individual plans (non-group) through an HRA. This idea of “premium reimbursement for individual plans” may prove disruptive to the group market as often happened with defined contribution plans over the past 20 years. If employers commit to provide a benefit plan then employers will benefit if they choose to maintain the integrity of the “group” plan to assure proper pricing in future years.

We’ll keep an eye on the market but in the interim, every employer with 2 employees to 2,000 employees should demand that their broker present them with an HRA option. That’s not advice, its common sense!

HRAs work for everyone, including Insurers, which once again proves that we’re all in this together.

Until next week.

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

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

June 28, 2018

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.

June 21, 2018

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.

June 14, 2018

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