Archive for the ‘Amazon’ Category

Hospitals are now required to publish the rates they charge for services. Will this be helpful for patient’s health, for controlling costs, for lowering premiums? Let’s see.

January 24, 2019

This Federal legislative mandate is another fine example of Government wanting to help, thinking it can help, penalizing business and general community to do something it hadn’t before, then mucking it. It’s a mandate for hospitals to publish the rate they charge for the services it provides. The “no insurance coverage rate” or sticker price if you like.

Anyone who has ever purchased automobile understands what “sticker price” means. Simple, it’s the cost listed on the sticker glued to the car you’re looking to purchase.
Is that what every one pays? No.
Is it the starting point for negotiating. Yes.
Would the provider charge uninsured patients less if asked. Yes

If you are old enough you will remember the rate card nailed to the inside of every hotel room in America. The hotel and lodging industry referred to that as their “rack-rate”. It was mandated that the rate be displayed.

But, every time you looked at the rates on the card you would ask yourself “Does anyone ever pay that much?”. It was the hotel’s “not to exceed” rate but rooms would be priced based on supply and demand.

So, now patients and technically potential patients will get access to what a hospital will charge for the healthcare services, supplies and facility it provides for the treatment the patient seeks.

Of course this won’t be helpful to anyone and adds cost to the venders.

If insurance, Medicare or Medicaid is paying the bill then it will not pay anywhere close to the “rack rate” hospital’s post. In fact, even a person, uninsured, will not paid this amount.

So what good is this mandate?
Technically, a hospital can divulge what a service would cost under the coverage and discounts the member’s plan pays. They all have discounted PPO rates which could be used to divuge cost to a patient.
But insurers won’t like that and in fact would go nuts, then go to court. Insurers guard their negotiated discounts like the United States guards Fort Knox.

Insurers would hate to see their negotiated rates scattered among the internet for all competition to see. It goes along with the Insurer’s resistance to publishing claim experience or loss ratios publicly.

Your humble author has long advocated that Insurers be mandated to provide insured’s the loss ration on their plan for the year even if it be made available only at renewal time. Do you think it would be helpful for an employer, large or small, to be able to see that its loss ration is less than 100%. How  would an employer respond if its loss ration is 55% at the same time the insurer offers a 30% increase at renewal.

Posting rates will do little to improve healthcare outcomes, little to lower out-of-pocket cost and nothing to lower premiums.

So, this new mandate will not:

  • Lower out-of-pocket costs
  • Lower premiums
  • Improve healthcare outcomes

But, politicians can boast that they have done something. Just as the ACA caused a complete disruption to healthcare delivery and financing this mandate will provide a veil behind which insurers can hide. You’ll see.

Let me know what you think because we’re all in this together.

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

What if SCOTUS holds that the ACA is Unconstitutional? What can the GOP put in its place? You hold the solution, here!

January 10, 2019

Several years ago I jotted down a few ideas which, if implemented, would address at least the biggest issues in medical insurance and healthcare delivery: cost and access. With the recent Court decision deeming the ACA unconstitutional we need, that is the GOP, needs to offer betters solutions. The ideas below are a start toward that better solution.

You all know that I am an optimist trapped in a cynic’s body so my hopes of replacing the ACA with a workable solution are real but also guarded. But, what if you/we were asked for input to design a workable solution. Could you do it?

I have expanded the solutions, since jotting down my initial 12 points in prior posts, because I believe that there is an easier and less expensive means to address healthcare financing for the chronically poor, the uninsurable and the chronic uninsured. You may think that I have left a few issues untouched and if so let me know your thoughts.
However, I know that these ideas, if put in place, build the framework to address:

  • Those that want to buy insurance but are un-insurable.
  • Those who want to buy but who can’t afford the premiums charged for insurance.
  • Those who currently buy and pay for their coverage but are finding the increasing premium too much to pay. 
  • Those that don’t want to buy or will wait until they have a problem to buy insurance.
  • Guaranteed acceptance.
  • Pre-existing conditions.
  • How to push premiums lower
  • How to push unit cost of healthcare lower
  • Transparency (Total & Complete Transparency).

So, together we can develop the core outline of what Congress could build if it truly tried to bring about the best reforms for our system. Please give us your input to improve upon these points as well as address issues that we have not addressed or not addressed well.

It may be fun and interesting but who knows we might even make a difference.

Since Americans are used to the ACA mandates of kids to 26, unlimited lifetime, and wellness or preventive let’s leave those in. But,  let’s eliminate the Medical Loss Ratio (MLR) limits since no other industry in the world has its profit margin restricted like insurers are by the ACA. Other than that let’s assume we have a blank canvas upon which we can draw our ideas.

Here are the basic ideas to include in a bill to replace the ACA:

  1. Make health insurance premium 100% tax deductible for anyone who pays it.
  2. Make all fully-insured plans for individuals and families guaranteed issue but with a reasonable Pre-existing period for no prior coverage.
    Example – Pre-ex period: 12 months.
  3. Group plans of 2+ employees remain guaranteed issue with full take-over or “No Loss-No Gain” as it used to be called..
  4. Allow carriers a reasonable corridor for Risk Adjustment Factors (20%). Also, eliminate artificial pricing rules (such as 3:1 ratio) and let insurers determine pricing with their area rating factors based on their data and statistics.
  5. Tort reform: Loser Pays and/or Fixed Attorneys at 15%.
  6. Allow carriers and plans such as Association Health Plans to sell across state lines. (Possibly the most difficult of all.)
  7. Eliminate Essential Health Benefits and allow No new benefit mandates from states or Feds for five years. Allow insurers freedom to build plans as they determine.
  8. Mandate HRAs and MERPs permissible and available to implement on all plans.
  9. All insurers must publish and release statistics and experience data.
    It’s ok and can remain consistent with Hippa.
  10. Universal enrollment forms for all group plans and all individual/family plans.
  11. Health plan commission set at level 7% and does not increase as premium does.
  12. All Providers must post their rates per service. Hospitals must post their outcome statistics as well as infections, error rates, and other outcome data.
  13. State based or plan based re-insurance pools to assist Insurers in controlling premiums. If unlimited lifetime benefits are retained then Insurers and Plans need support to handle the increasing number of mega-claims. 
  14. Providing coverage for those who can’t afford to pay premium regardless of its cost:
  • Eliminate Exchanges. Allow people to be enrolled directly with the Insurer or Plan of Choice.
  • The IRS can maintain these enrollment records and disperse payments to Insurers and do so without adding fees to premiums.
  • That also eliminates the huge fees added to premiums by Exchanges to compensate the Exchanges.
  • Set the income levels for participation in subsidies (even use the current formula).
  • Eliminate the Medicare Expansion as it pushes people toward poverty.
  • Instead, keep these folks covered by the private market and allow them to obtain their coverage from private Insurers and Plans.

I also think we need to build incentives for employers to support wellness plans. If we want to bend the cost curve downward we must address behavior and expectations through affective wellness and benefit structure.

I do address coverage for the poor as I mentioned above. Setting a poverty level which assists folks in need but forces folks into Medi-Cal (Medicaid for outside Cal) is problematic as it may discourage folks from working their way out of their financial circumstances. Besides, those Medi-Cal plans “suck”. You would not want to be covered by one so why push these unfortunate folks into it.

So, this is our starting point. I encourage you to give this some thought and to give us your input. If we offer a worthwhile solution then who knows; we might make a difference. That’s what I mean when I say “We’re all in this together”.

Let me know what you think.
Until next week.

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

It’s that time of year again for “reflection”, and to look forward with the knowledge gained over the past year.

December 27, 2018

The unbearably hectic season of Thanksgiving and Christmas has past, New Year’s Eve is in a few days and frankly most of us are probably worn out or worn down. Face it, life has not gotten easier just because we have smart phones, iPads, the internet and even an economy that continues to boom. No, life is complicated, busy and frustrating as well as rewarding, gratifying and exciting. That’s life in the modern world.

Some people take a little time out of their busy schedules, at this time each year, to think about the year that’s past and consider their hopes for the year to come. In business one must reflect on the past year’s activity or results in order to forecast for the future. Some people do the same for their personal lives.

As you know, I’m an optimist trapped in a synic’s body so this is a most satisfying time of year as I review life insulated by the capsule of time lodged between Christmas and the New Year.
Let’s look at some good and some not so good with these thoughts in mind.

The GOOD
Second Year for Donald Trump to millions was a positive vindication of their honest hope that he could change the negative spiral America had faced for the previous 12 years. Yes, that’s right 12 years.
No Repeal and Replace, but a recent Court decision striking down the ACA as unconstitutional, which will cause more confusion than good. The Media will swarm this as a Trump debacle when in fact it is a result of poor leadership of Rep. Ryan and Senator McConnell. But it does give us a chance to make meaningful corrections. If they follow our  published14 step solution, that is.
Twitter  is a GOOD, even though I don’t know how to use it, but it has allowed the President to get his word out by going around the dishonest liberal press. While not all of the Pres’s tweets have been helpful, Twitter has provided a tool by which he can get his message out.
Snow in Sierras may be a local thing for folks living in the San Joaquin Valley of CA. But last Winter’s extra snow pack and rainfall gave CA a welcome break from the 5+ years of drought.  We pray for another season of snowfall.
Family Health, which is important to each of us, has been relative good for your humble author’s family. Unfortunately though, we do have close friends suffering greatly so we do pray for them. But selfishly, for our immediate family things are good, and  for that I am grateful.

The BAD or at least not so good

Congressional Leadership in Washington (not to mention CA) has been a great source of frustration for most of us over this past year. The GOP leadership is unable to communicate well to the people, makes things unnecessarily complicated and does not act together. In addition, it appears intent to maintain the status queue for what’s been so accurately described as a “swamp”.
Plus, January 2019 will usher back Nancy Pelosi as Speaker of the House. Ugh!
Press both national and local continues to be untrustworthy. Whether a Liberal or Conservative, one must agree that we can’t trust what we read or hear anymore without a bit of concern. It was similar in the Cronkite/Viet Nam era but then news traveled slower. Now, with the internet and people deliberately trying to push “fake news” it is tougher to know the facts let alone the truth. It’s hard to imagine this will get better soon.
Internet which I mentioned above, can be a most amazing tool for our life and health. When you search for goods or services or wish to stay in touch with friends it is incredible. Unfortunately, it can be a tool just as useful for confusion, misinformation, and evil. It’s user beware and we must all be aware.
No R&R, that’s right. With the Court decision mentioned above I predict that the 2019 House and Senate will not get anything meaningful done on repealing and replacing the ACA. That may be a good thing given the mess the GOP tried to force through in 2017. But it won’t be good for premium payers that don’t qualify for subsidy and small business that continues to deal with the high priced metallic plans of the ACA.

Hope for 2019, that’s right hope! I’m betting the economy will continue to go well. There will be more jobs and better pay scales available. We will feel the benefits of the American economy every where.
The biggest obstacle and concern will be the ongoing issues caused a Congress bogged down with hatred, illegal immigration, by Russia, China, Iran and their intent to cause damage to America. With their help we can keep North Korea, Iran and the middle east from spreading terror and disasters. Without their help it could be more terrorist acts and crisis. Plus, it would be helpful for Dems stop obstructing progress and to not worry about President getting a “win” on the border, trade, employment, terror, N. Korea, etc.

But, I am hopeful for several reasons. One, we are all more aware of who we should trust or not. We have a President and Cabinet trying to build America up not tear it down. And America is an engine that produces outcomes desired and envied by the rest of the world.
While others around the world try to tear us down they also know that there’s no place on earth like America.

Plus, you have me writing to you every week, helping you understand the “malarkey” our government and Media is trying to pass off as healthcare reform.

Have a safe and Happy New Year. Together we can make it through anything to build a bright and prosperous future. We may even make healthcare better and cheaper.

Until next week.

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

Another year in which we can all say “Merry Christmas” without fear of persecution. Thank you Mr. President!!

December 20, 2018

It’s five days before Christmas and while the Stockings are not yet hung, I bet most of us are thankful that the “war on Christmas” has been placed on-hold, for another year.

So this week instead of promoting or dissecting some aspect of healthcare reform let’s look for aspects of 2018 and our own lives in America that bring peace and good will to man. Sorry that isn’t PC, should have said “good will to us all”.

I say Thank You to:

  • First Responders who run toward the crisis or danger while we run away. These brave men and women are better civil servants to our Nation than anyone else, especially politicians, can ever brag to be.
  • Military that in spite of a decline in funding and respect over the past 10 years continue to keep us save by stopping the dangers over there from reaching over here. I did not join the military when I was of age, a decision I regret to this day.
  • Law Enforcement officers on a daily bases as they walk or drive into unknown danger without hesitation and without the support of too many in our nation.
    We should all stand each time the National Anthem plays!
  • Teachers who signed up to help educate our future generations and continue do so even when facing the toughest environments. Wouldn’t it be easier to teach if English was the required language, parents would help from home, and Unions cared about kids more than self-preservation?
  • Moms for doing what they do to love their children even when we are unlovable. Giving birth might be the easy part for Moms these days as they too often take on the role of both parents and both bread winners in American homes. Moms are the first responders for our families and they need our help and thanks.
  • Our Churches that stand for the true Word of God and don’t give in to the secular-worldly efforts by too many to cast shadows upon what we all know is right.
  • Co-workers that come to work each day to work as a team toward similar goals of creating good products, good service, and respect for team.

Thank God, above all else, for His gift of the Lord Jesus Christ, for us all. God so love the world that He gave His only Son for us that we might have eternal life. To those of you who are believers you know that a relationship with Jesus Christ does give us an eternal home but also gives us a relationship throughout the year like none other possibly could.

That’s just a few.
To whom or what are you thankful that makes your life safer and better?

Love to hear from you and especially at Christmas we should know that we’re all in this together. 

Merry Christmas to all!! And to all, until next week.

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

 

The Thanksgiving Holiday is not unique to the USA but we may enjoy it more than most. Given the way History is taught in schools, do younger Americans know its origin? Let’s review.

November 15, 2018

Next week is Thanksgiving so let’s take a break from discussing healthcare reform and the ridiculousness of Washington DC to pause for one of our most cherished of traditions.

Why is it that we have this Thanksgiving Holiday? It’s a national holiday and generally grants us a 4-day weekend, at least for many of us. If one searches the internet for Thanksgiving there is a plethora of good info. But why do we celebrate it?

Many Americans are not aware of the reason for some holidays and we are perfectly happy enjoying the time off from work. I say this as someone who is not useful in a kitchen and therefore generally banished from it so Thanksgiving Day has always been a full day of food, parades and football. (Except this year, it’s just food and parades since we can’t watch the NFL until the protests against our National Anthem stop.)
But that’s not the story for today.

Let’s take a brief look at the origin of Thanksgiving; courtesy of Wikipedia and the Internet.

Early thanksgiving observances

Thanksgiving
, or Thanksgiving Day, is a public holiday celebrated on the fourth Thursday of November[1] in the United States. It originated as a harvest festival. Thanksgiving has been celebrated nationally on and off since 1789, after Congress requested a proclamation by George Washington.[2] It has been celebrated as a federal holiday every year since 1864, when, during the American Civil War, President Abraham Lincoln proclaimed a national day of “Thanksgiving and Praise to our beneficent Father who dwelleth in the Heavens,” to be celebrated on the last Thursday in November.[3][4] Together with Christmas and the New Year, Thanksgiving is a part of the broader fall/winter holiday season in the U.S.

The event that Americans commonly call the “First Thanksgiving” was celebrated by the Pilgrims after their first harvest in the New World in October 1621.[5] This feast lasted three days, and—as accounted by attendee Edward Winslow[6]—it was attended by 90 Native Americans and 53 Pilgrims.[7] The New England colonists were accustomed to regularly celebrating “thanksgivings”—days of prayer thanking God for blessings such as military victory or the end of a drought.[8]

Setting aside time to give thanks for one’s blessings, along with holding feasts to celebrate a harvest, are both practices that long predate the European settlement of North America. The first documented thanksgiving services in territory currently belonging to the United States were conducted by Spaniards[9][10] and the French[11] in the 16th century. Wisdom practices such as expressing gratitude, sharing, and giving away, are an integral part of indigenous communities since time immemorial.

Thanksgiving services were routine in what became the Commonwealth of Virginia as early as 1607,[12] with the first permanent settlement of Jamestown, Virginia holding a thanksgiving in 1610.[9] In 1619, 38 English settlers arrived at Berkeley Hundred in Charles City County, Virginia. The group’s London Company charter specifically required “that the day of our ships arrival at the place assigned… in the land of Virginia shall be yearly and perpetually kept holy as a day of thanksgiving to Almighty God.”[13][14] Three years later, after the Indian massacre of 1622, the Berkeley Hundred site and other outlying locations were abandoned and colonists moved their celebration to Jamestown and other more secure spots.

Harvest festival observed by the Pilgrims at Plymouth

Americans also trace the Thanksgiving holiday to a 1621 celebration at the Plymouth Plantation, where the settlers held a harvest feast after a successful growing season. Autumn or early winter feasts continued sporadically in later years, first as an impromptu religious observance and later as a civil tradition.

Squanto, a Patuxet Native American who resided with the Wampanoag tribe, taught the Pilgrims how to catch eel and grow corn and served as an interpreter for them. Squanto had learned the English language during his enslavement in England. The Wampanoag leader Massasoit had given food to the colonists during the first winter when supplies brought from England were insufficient.

The Pilgrims celebrated at Plymouth for three days after their first harvest in 1621. The exact time is unknown, but James Baker, the Plimoth Plantation vice president of research, stated in 1996, “The event occurred between Sept. 21 and Nov. 11, 1621, with the most likely time being around Michaelmas (Sept. 29), the traditional time.”[16]  ] The feast was cooked by the four adult Pilgrim women who survived their first winter in the New World (Eleanor Billington, Elizabeth Hopkins, Mary Brewster, and Susanna White), along with young daughters and male and female servants.[16][17]

So, there you go, a brief history lesson for us all. Can you imagine our Congress declaring a day be set aside for honoring the Almighty who Dweleth in the Heavens in our current political climate? Someone might get burned at the stake.

Over 120 Pilgrims landed on Plymouth Rock but only 53 survived the first year, to celebrate and offer thanks, in the New World.   As we enjoy our Thanksgiving Holiday I hope we all  can benefit by knowing the first years of this celebration were precluded by great hardship and therefore were indeed a blessing for the settlers. They endured much and likely would have all perished if not assisted greatly by the Native Americans living in the region. We each need a little help in our lives from time to time!

There’s a lesson in history for each of us. Unfortunately it is quickly forgotten as the Monday following Thanksgiving arrives. Hey, maybe it will be different this year.
Next week we’re back to healthcare reform, tax reform and the unbelievable mess we call our US government.
Until next week, let’s remember what Thanksgiving is about and that like the Pilgrims in 1621, we’re all in this together.
Until then,
Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf
It means “Walk the Faith”.

Headlines read, “Somebody Needs To Fix It” as we near the mid-terms. They mean healthcare, of course!

October 25, 2018

That’s right, as predicted here, healthcare and insurance coverage is taking center stage in many mid-term races across the Country. The Media is inserting itself with stories that suggest one GOP candidate after another is against covering pre-ex or  for repealing the ACA, or Short-term plans are good and so forth.

The biggest, most threatening and most mis-reported is the candidate’s stance on the coverage for Pre-existing conditions. I have not read or heard of even one candidate that proposes the elimination of guaranteed acceptance or coverage for pre-existing conditions. He or she would be a fool to do so but here’s how the Media spins it. 

Many in the GOP and other so-called Conservatives support the Trump Administration’s actions that:

  • Allow Short-term Medical Plans to extend coverage for up to a year.
  • Allow for  Association Health Plans that allow “affinity” or groups of similar nature to band together for the purpose of buying insurance.

Both of these ideas are opposed by the Democrats and other single-payer big government healthcare proponents who don’t support solutions that might actually work and therefore provide options other than a government-run plan.

That comment is not cynical, by the way, because any debate about these plans includes the usual sound bite rhetoric opposing STPs and AHPs.

But back to the point, the Dems and Media, during these mid-terms, are trying to paint the GOP with the label of “taking away coverage for Pre-ex” because pre-ex is not usually covered by STPs and AHPs and those plans will have some latitude in coverage.

Our citizens will always have access to ACA plans that are GI and cover Pre-ex so the argument should be an easy one to overcome. But it’s not.

The typical scare tactics are being employed:

  • To frighten citizens into believing that their coverage will be taken away.
  • To scare people into thinking that their premiums for their ACA plans will increased simply because of these “evil” STPs and AHPs. 

The good news that:

  • I think most Americans are smarter than the Media or Democrats give credit.
  • Plus, people with Pre-ex conditions most likely already have their coverage.
  • And 85% to 90% of individuals covered under the ACA Exchanges are subsidized therefore costing the member little or nothing to get coverage.

But, the Media needs to talk about something so as it does with so many issues it projects hypotheticals on to an issue that does not exist. Then that hypothetical gets reported by other outlets two or three times and “bingo” it’s a news story that gets legs.

It’s a fact and for certain that our health care system needs fixed. There are easy steps, which we have Posted before, that could lead to better coverage, better access and lower costs if only they would put you and me in charge.

Next week we’ll discuss the coming mid-term election with some specific ideas for people who really want a better-less costly healthcare solution. That’s why we call it the “The Solutions Based healthcare Blog” and because we’re all in this together!

Until next week.

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

We warned you about the Employer Mandate. The Congress is working quickly toward an outcome that makes little sense! let’s see why.

September 20, 2018

You read here on August 16th 2018 how the US House passed out of Ways and Means a bill  which would suspend the employer penalty payments for the period after December 31, 2014 up to January 1st, 2019. Again Yes, you read that correctly. For years, 2015 through 2018 the employers affected by “play or pay” would not be required to make the penalty payments. I’m sure it’s some clever GOP move to throw off logic.

The Bill was voted out of the House last week which means the Senate gets a whack at it. Will it make it into law before the mid-terms? I doubt it but let’s take a look at the brilliance of our House GOP as it stumbles over itself yet again in its efforts to repeal and replace the ACA.

Here are a few high points of what H.R. 3798 would provide:

  • Change the ACA employer coverage mandate threshold for “full-time employee” to 40 hours per week, from 30 hours per week. (May increase uninsured ranks)
  • Keep the ACA employer coverage mandate from applying to any month beginning after Dec. 31, 2014, and before Jan. 1, 2019. (Will employers that complied receive any restitution?)
  • Postpone the start date of the ACA excise tax on high-cost health benefits packages to Dec. 31, 2022, from the Dec. 31, 2021, start date now in effect. (No one likes this tax or even understands who will pay it. Why not just eliminate it?)
  • Repeal an ACA excise tax on indoor tanning services. (Duh, who cares!)
  • Require employers to provide Form 1095 coverage statements to individuals only when individuals ask for the statements, instead of having to send the statements to all employees, recently departed employees and certain dependents every year.
    (This is not a bad idea, but if there is no Individual Mandate and no Employer Mandate why is reporting necessary at all?)

Here are the challenges as stated by experts:

One challenge supporters of H.R. 3798 face is finding new federal revenue, or new federal spending cuts, to offset the effects of ACA employer mandate changes on the federal budget.

Analysts at the Congressional Budget Office estimated in a report posted Tuesday that H.R. 3798 could cut federal revenue by about $12 billion in 2019, and by about $52 billion over the period from 2019 through 2028.

The delay in the effective date of the employer mandate and the change in the definition of full-time worker could cost the government about $46 billion in revenue over the 10-year period starting in 2019, according to the CBO analysts.

Here’s what I said before and I’ll say it again:
Is it even close to being a good idea in the first place or just a political gimmick by politicians so that they have bragging points as they campaign for reelection? We know from the Individual Mandate that they won’t repeal it outright but rather they will  simply reduce the penalty to zero. Jeez, that’s a cowardly way to legislate.

As we asked previously, is the employer “play or pay” mandate a good idea or should it be eliminated? Plus, what effect will it have on the thousands of employers and hundreds of thousands of employees who complied already?

I am a free market, let the private sector resolve it and keep the Government the hell out of it, kind of guy. But, this issue is a complex one because as I mentioned tens of thousands of employers have already taken steps to comply.

Those employers stepped up to do what was required, those employers purchased the plans that complied with the law and spent money that the non-compliant employers did not. It would be unfair for non-compliant employers to avoid the penalty while other employers have already spent untold fortunes with no hope of getting that money back.
Can these employers, who feel they were forced to comply, receive any restitution equal to what they paid to comply?

Remember this example:
If Company A and Company B both bid on the same project they would both include all of their operating and legacy costs in those bids. Therefore, if Company B provides no health plan, because it was and is noncompliant, then its costs might be lower thus allowing it to submit a lower bid and possibly win a project over Company A which does provide benefits.

Personally, I think an employer who provides benefits is probably a better run company and certainly tries to take care of its staff. So, that employer should have an advantage but money is money which means the buyer may take the lower bid. That sucks but happens.

But, the other side of this is the employee’s. Hundreds of thousands of employees have been offered and enrolled on a health plan, possibly for their first time. What happens to them if their employer discontinues a plan because it’s no longer required legally? Many would go without coverage simply due to affordability.

Let’s face it, the ACA has caused premiums to increase astronomically over the past 7 years on individual plans (all plans really). These employees, pushed off an employer sponsored plans, would be required to go into that ACA Individual Plan jungle, and I do mean jungle as it is a “freaking” mess in that market. Would those employees want to pay those high premiums – could they afford those premiums? Probably not.

In addition, the health plan landscape, that is alternatives and access, varies greatly state by state. Many states, like California, are not allowing any of the Trump administration’s new ideas to come to California. California says No AHPs, No to skinny plans on top of what California had already implemented to harm small employers with its stop loss killing legislation known as SB 161.

Again, I would wager that many employers, who bit the bullet and complied, will maintain their plans thus continuing the expense they incur. The elimination of the penalty will make it so that non-compliant employers will be allowed to continue not providing benefits, not spending those funds and may think they have a financial advantage in the market against competitors.

So, against my human nature and all that helps one develop values I don’t think the “Play or pay” mandate should be eliminated for large employers. In fact it should be enforced. The IRS has had difficulty identifying which employers should or should not be Playing and less success in getting noncompliant employers to pay. Big deal – get it done so that the law is applied equally.

So, even though the House will be in recess as you read this, you will be informed. Together we need to stay focused on healthcare issues like this. Can you think of a single big government bureaucracy that has ever not fouled it’s intended objective? No, so when we identify issues that need attention or fixed or eliminated we should shout for it.

That way they’ll 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”.

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”.

 

 

Covered California premiums for ACA Individual plans projected to average 8.7% increase for 2019. Many are cheering but I wonder, have they forgotten the effect of compound interest?

August 9, 2018

That’s right, articles are every where announcing the good news of the projected 8.7% increase in premiums, which is  smaller increase than we’ve seen since the ACA was created. ACA supporters hail this as a sign that the ACA is working, that Insurers are getting used to the ACA requirements and that it’s smooth sailing from here on.

One must remember that the writers of these countless articles expressing glee at the 8.7% probably don’t pay for their own insurance and others are subsidized by the ACA. Otherwise they would scream, “Are you kidding me, another freaking increase”.

It’s almost like they forget the effect of compound interest. What other product or service would one consider an 8.7% increase as good news? It’s been 105 degrees in the San Joaquin Valley for the past 10 days. Would an 8.7% increase in the unit rate on your electric bill be agreeable. Probably, NOT!

Plus, what other goods or services, that you use, have had unit rates increased 300% plus over the past 7 years? So, we see again that the supporters of the ACA are searching and clawing for any tidbit of a subject on which they weave a positive story about the ACA.

For instance, seven years ago, pre-ACA, the insurance rate for a single person 30 years old might have been as low as $100. If you multiply $100 times 8.7% you get $8.70 bring the premium to $108.70.

But in the real world that 30 year old rate is now $300 so when 8.7% is calculated it equals $26.10 bringing the premium a member will be asked to pay up to $326.10. So, the “compounding effect” on premiums in this example yield a huge difference between $8.70 and $26.10. Since the authors of all of the “happy” stories don’t pay premium or are subsidized they exclaim that this is good news.

If you use the premium change of  a 50 year old the impact increases in magnitude. A 50 year old 7 years ago, pre-ACA, might have paid $400 for a decent plan. But now a 50 year old would pay closer to $1,000. Again, 8.7% of $400 equals $34.8 verses $1,000 times 8.7% equaling $87.00 for a $52.20 increase in the difference.

You know what I mean. The problem, as usual, is that the majority of premium paying voting Americans are not paying attention or have assumed the attitude that there is nothing they can do. I can’t blame them for feeling that way because they are busy working, raising their family, paying the electric bills, their cable bills, their car payments etc. and just don’t have the time to even think about this issue.

As I’ve written over the past several months, we are in a period in which people just are not paying attention to much other than their jobs, their families and every day life. That’s why it’s up to us who do pay attention to this and can see what’s happening to raise our voices.

There are things that can be done. In California voters could make a difference by voting for the correct candidate for Governor and Insurance Commissioner. Those two position would yield huge results that could lower premiums, increase options and improve access to providers. You can bet on it so vote on it!

Sorry to post on such a simple subject matter this week but frankly, it just pissed me off. Over the next few Posts we will discuss Rx costs, Insurer subsidies, impact of HRAs, and the power of Employer Driven Plans.

As always, we’re all in this together, so if you get a chance, tell a friend about the best healthcare blog you’ve ever read.

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