Archive for the ‘American Healthcare Act’ Category

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”.

Post Election Review: What’d we gain and what’d we lose. By “we” I mean the average premium paying American citizen!

November 8, 2018

It’s only 12 hours post Election Day as I write this so everyone is still playing nice and watching for the “first dig of the spur” from the other side. When you read this, in 24 hours, I wager that the language used in the political discussions will already have turned back to negative, divisive or worse.

Will the House be nothing but subpoenas, investigations, impeachment, and obstruction?
Will the Senate, as well as other conservative voices reciprocate.
Will anything meaningful for America get done before the 2020 election?
Will we see nothing but gridlock and scapegoating?
I’ll let you fill in the answers to those questions!

Here are a couple random thoughts both Nationally as well as here in good ol’ California.

  • I doubt that the Employer Mandate will be eliminated which we have discussed in previous Posts. That is not a bad outcome because the GOP tinkering with the ACA was not helping.
  • Will the Individual Mandate be re-instated?
    Probably not, even though it should be.
  • Will anything positive be done to improve the ACA’s adverse rating methodology and burdensome fees and taxes added to it?
    Probably not!
  • Will “Single Payer” or “Medicare for All” advance anywhere in the Country or in  any State?
    Probably not, though it will get a lot of press coverage.
  • Will the truth about coverage for “Pre-ex conditions” come out showing that the Dems and the Media were fear-mongering the issue?
    Probably Yes, but people will need to listen closely to hear the truth!
  • Will premiums start to go down on ACA compatible plans?
    Definitely not!

 

What about the Golden State: California?

  • Will AHPs or STPs be allowed to exist and help the tens of millions who could benefit from them?
    Nope, not without a insurrection?
  • Will Insurers be allowed to restrict small employers access to HRAs with subtle threats to insurance brokers?
    We’ll see but I know one Insurer that for sure will not be restricting HRAs.
  • Will Californians see their premiums continue to increase at each renewal?
    Yep, but the Media will state that the increases are lower due to the good-work of the ACA. We’ve discussed that  effort in subterfuge before, too.
  • Should employers continue to sponsor group health plans for their employees
    Absolutely and do so with the Employer Driven method proven so effective.

Am I concerned about the future for healthcare financing and delivery in California?
I have been concerned about this issue since 1985 so I will continue to be concerned but I will not give up hope. Sooner or later (probably later) the status will become so unbearable that the solutions will be so amazingly clear that even the Dems in California can see it.

Let’s allow them to think that independent-competitive insurance plans operating in a less government regulated environment is their idea! Maybe that will do it.

Regardless, we’re all in this together, so keep the faith and keep watching for more “common sense solutions” as we venture forth together.

Until next week.

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

California Voters have a chance to lower healthcare costs plus improve access. But it will take the proper “Vote” in the Mid-term election on Nov 6th.

November 1, 2018

California voters have a chance to start taking back control of the crazy out-of-control,  high-premium, low-benefit healthcare system in California. Premium increases exceeding 300%, since 2010, have literally destroyed our citizen’s access to the healthcare we need.

We all know that the health plans offered in California are the among the most expensive in the land with killer high out of pockets and “way too skinny” PPO networks.
That’s not News, so why is that important?
Because, with your vote November 6th, you have a chance to set in motion for the real possibility of changing the healthcare delivery and plans available in Ca.
Be sure to VOTE!

To lower premiums, improve benefits, increase access to more providers and get more health plan options – Voters just need to vote:

 Insurance Commissioner  –  Steve Poizner

For Governor  –     John Cox

It’s that simple, REALLY!

Then, we can begin introducing the solutions that you have read about in previous Posts. Can you imagine a California in which you have:

  • Dozens of high quality health plans available.
  • Plans with benefits that fit your need – not the Government’s.
  • Rich plan benefits or narrow plan benefits.
  • Plans with huge provider lists.
  • Plans with narrow provider lists.
  • Premiums that are affordable and 50% lower!
  • Reasonable reimbursement for providers.
  • Transparency and better control.
  • Most of all: available when you need it!

I know what you’re thinking. How can two elected positions create such possibility for change? The truth is that it will take effort and a little time but my bet is that Ca. citizens would start seeing a difference within nine to fifteen months after these men take office.

Reports are projecting insurer premiums for 2019. Estimates are that premium may increase from 15% to as much as 100% depending on the state or region of the country. In Ca. we will see increases on employer sponsored group plans in the range of 10% to above 50% with further push toward Silver and Bronze plans.

Of course, we all know that the premiums we pay for Silver and Bronze don’t usually buy much in first dollar benefits and leave huge out of pocket risks. If they do provide copays then those copays range from $50 to $250 which of course means people defer their medical care.

Regardless if you are Republican, Democrat, Independent, Libertarian or Green; we all have been hurt by the changes brought about by the ACA. This Fall’s election, the so-called mid-terms, provide Ca. citizens a chance to make a difference.

And isn’t that something we all crave, “a chance to make a difference”?

I could spend another 10,000 words outlining the potential improvements that might become reality if we vote wisely November 6th.
But I’ll save that for future Posts.

Certainly we can all agree that elections provide a time when truly “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”.

Recent Headlines suggest that High-Deductible Health Plans have “Fallen from Grace”. Is that true? Many Insurers hope so!

October 18, 2018

A number of stories have been published in recent weeks making the statement that “HDHP Fall From Grace in Employer-Based coverage”. Some of these stories rely on reports from the Kaiser Health Foundation (KHF) and articles from KH News (KHN).

KHF is a reliable source for health care and health insurance data; and your humble author has cited their data in numerous posts. The notion that HDHPs are getting less popular seems to stem from a survey conducted by the National Business Group on Health (NBGH) which predicts that the percentage of employers offering HDHPs will drop from 39% this year to 30% next year.

One factor cited for this forecast is that employers ( specifically larger employers) are being pushed to offer richer health plans in order to recruit and maintain a sufficient workforce. The great economy and historically low unemployment rates are making it harder for larger employers to find and hire the staff they need and will need to keep up with the growing economy.

We usually associate a growing economy with prosperity for more Americans but this time the economy and the jobs created by it is outpacing large employer’s ability to stay staffed. This issue is not being reported too heavily but it could lead to American businesses falling behind in filling orders and improving revenues. This kind of employment environment has never occurred in a peace-time economy.

The phrase “Employer Driven Health Plans” was trademarked many years ago as one firm in California pioneered the practice of putting Employers in the driver’s seat of their health plan, By integrating an HRA with a HDHP (usually HD but any plan really) the Employer can provide the benefits it desires or requires at a lower cost that traditional plans.
So, I offer a contrarian view for two reasons.

One, the forcast is based heavily on large employers and less on small employers who are growing just as fast as larger employers. If an employer with 10 employees adds one employee to staff that is 10% but if a larger employer( example 500 EEs) adds 10% it is a bigger number of Americans employed. While it is easier to survey large employers than small employers, the result stays the same, American businesses are hiring and need good benefits to compete for staff.

Two, it does not include the huge potential for Employer Driven Health Plans (EDHP) utilizing HRAs. Employers can continue buying HDHPs , which keeps premium costs lower, but then implement an HRA to improve the benefits employees desire.
Ever heard of  a plan “Turning Bronze into Platinum”? Well, that’s what EDHPs were created to do for employers.

Fact is:

  • Employers, both large and small, can provide richer benefits to their employees at lower cost using EDHPs than the standard or conventional plans available.
  • EDHPs can be more attractive to potential and current employees thus accomplishing the goal desired to attract and maintain good staff.
  • EDHPs not only lower cost and improve benefits but will also improve the quality of care received.
  • EDHPs also provide greater access to  that quality care  we all seek by making more providers available than are currently available on many plans.

Larger employers have utilized HDHPs on a greater percentage than small employers but not by implementing the concept of EDHP.

Smaller employers have had less access to EDHPs over the past 10 years due to the unlawful restrictions that many insurers have implemented. But due to a recent anti-trust lawsuit Insurers are no longer threatening brokers about using EDHPs.

This should mean that more small employers will see an EDHP proposal as an option when selecting its next health plan.

Brokers, consultants, Insurers and Employers should not give up on HDHPs as a potential solution to meet the health plan requirements for their staff. Employers should be presented every plan possible in the region to fulfill the RFP it presented, including an EDHP.

The result will be a resurgence in HDHPs with an increased level of satisfaction by both the sponsoring employer and covered member.

Employers just need to find a good TPA to present the EDHP options to them. If their broker/consultant does not present them with a proposal from an experienced TPA administering EDHPs then the employer needs to find a new consultant.

EDHPs are possibly the best example of why and how we are all in this together.

BTW, be sure to vote on November 5th.
Until next week.

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

 

Autumn is a Season for two things: Elections and partisan promotion of the ACA’s Health Plan Exchanges. Boy, do facts get skewed for both!

October 11, 2018

I know my title was remiss by not including football and the World Series both of which are far more fun than mid-term elections or the ACA open enrollment period. Remember, this is a healthcare blog so I will stay on message.

I don’t want to address the facts, stats, and promises politicians make at election time but I do want to point out a few corrections or misunderstandings (make that mis-information) that ACA supporters use to promote the Government run Health Exchanges at Open Enrollment (OE). You see Autumn or rather the Fall season signals the coming Open Enrollment period for Government run Exchanges so the proponents of the ACA, which includes most of the Media, many Think Tanks and Foundations and all Democrats work to sell the Government run program to our citizens.

How do they do that? They start with some statistics reported in a manner that supports their position even if it requires a skewing of the facts, which we’ve witnessed in the past. As your humble author has written before, the media has often delivered a biased lopsided view of the current status of the health plans that we all require. They write of Out of Pocket costs, of higher deductibles, of pre-existing conditions, of premium increases, of provider access and even lack of choices in a manner that suits their agenda.

Which is to scare the common sense out of people so that single-payer government-run healthcare sounds like a good idea.

Recent reports are cheering the modest increases in premiums this Fall. For example, Covered California is bragging that the premiums for SHOP, the exchange for small employers, are increasing only 8.3%. We’ve discussed this issue before and revealed the real facts concerning the status of premiums.

First, what other good or service in your life is increasing its cost by 8.3% this year. And, if it did, would you be satisfied with the benefit of that good or service?

Second, the 8.3% increase is multiplied times a rate that has already been increased by as much as 300% over the past 7 years. We’ve discussed the impact of compound interest before, haven’t we?

But, proponents (Democrats and media) have to try to sell their product and to do so requires a real “sales job”.

Another set of facts released deal with the increase in “plan deductible”. The data clearly shows that the deductibles we have on our plans has been steadily increasing. For Employer sponsored plans statistics reveal that:

  • 85% of members have a deductible on their plan
    (10 years ago it was 59%. In 2000 it was less that 25%)
  • the average plan deductible selected by applicants is $1573 up from $1505 a year ago. That’s a 5% increase in deductible in addition to increased premium.
  • 25% of Employer plans offer a deductible of $2,000 or higher.
    (These employers need to add an HRA for their EEs)
  • Plan deductible is just a portion of Out of Pocket costs which is an issue for many and we’ve discussed in many Posts.

What do all of these statistics have in common? They are driven by increasing premiums which is the predictable outcome of an overly regulated government-run healthcare system.

As we’ve discussed before 152 million Americans (close to 60%)  get their health plan from their Employer. So, we should ask a few questions in order to maintain a solid fact-based rational for this mess.

  • Q: Why do Employers spend any money to provide a health plan?
    A: To attract and maintain a competitive workforce.
  • Q: Do Employers want to offer a health plan with huge OOP?
    A: No, they want to provide the richest plan possible.
  • Q: What is the primary reason driving Employers to provide plans with higher deductibles and OOP?
    A: Premium costs! Employer premium costs have tripled in past 7 years!
  • Q: Would Employers offer richer plans if they were affordable?
    A: Absolutely, they want to retain the best workforce possible and rich benefit plans help assure that goal!

Remember, current data shows that there are more open jobs available than people seeking a job. That means competition for employees.

Sometimes, I wonder why an Employer would purchase its group benefit plan through a Government run Exchange. There are probably a couple of reasons.
The Employer:

  • May believe it is too small to get a private group plan.
  • May not be able to meet participation  guidelines of private plans.
  • May not have a good insurance broker to guide it.
  • May be uninformed or mis-led to believe an Exchange is the only option.

Almost anything can be packaged and promoted to sound appealing.
For example: let’s say that you are selling cars but only offer your cars in the color white. However, your competitors offer cars in many different colors including white. Would you need to promote your cars in a manner that made potential customers think that your cars in white were better than the competitors cars in various colors?
Of course you would or else you go out of business.
However, if you were being subsidized by the government then you could say almost anything to compete.

We’ve discussed in previous Posts that the media will be increasingly bold in its attacks on pre-ex, premium leveling off, OOP on plans as well as unexpected OOP, choice and many other areas to support candidates in the mid-terms coming in November. We need to continue to be aware and make others aware so that these scare tactics do not work!

That’s why we’re all in this together! To help one another.

Until next week.

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

Why do California’s state politicians dislike Californians so much? Gov. Brown just signed legislation that guarantees Ca’s citizens will see no relief from rising health plan premiums.

September 27, 2018

Some things are just too crazy to understand such as why California’s legislature and Governor continue to put forth healthcare related legislation that guarantees the good premium-paying citizens of CA will get no relief.

The legislation that the Governor just signed, SB 910 and SB 1375, put a “ban” of the health plans referred to as Short-term medical plans as well as on Association health Plans both of which came about as a result of the Trump Administration’s efforts to lower healthcare cost and increase alternatives. The proponents of the bills Gov. Brown just signed applaud that this moves CA one step closer to universal coverage which to them means “state run healthcare”.

As we’ve discussed in previous Posts, the efforts in healthcare related legislation by CA’s liberal politicians cause more pain, both physical and financial, to 90% of the population just to move toward their stated goal of government run healthcare. One piece of legislation after another, over the past 10 years, has reduced access to care, raised cost of insurance and increased out of pocket cost for patients. I could list numerous pieces of legislation that punish the majority but did nothing to benefit the people the Legislators claim to help.

SB 161 is a good example of these bad bills. In legislative hearings the proponents of SB 161 openly stated that their goal was to eliminate competition for the group plans of Covered California. So SB 161 was created to restrict small employers from gaining access to lower cost group health plans that utilize self-insurance and stop loss policies. The result – small employers lost access to competitive group health plans and of course we all know that Covered Ca’s group plans suck.

This time, the CA legislature’s goal is to block both Short-term medical plans (STPs) (what liberals refer to as junk insurance) as well as Association Health Plans (AHPs).  Democratic Senator Ed Hernandez, who authored the afore mentioned SB 161 has also authored SB 910 and SB 1375 which ban STPs and AHPs respectively. Remember that both of these health plan options are designed to offer more choice, that means potentially better alternatives than the ACA’s metallic plans provide.

The opponents of these innovative and competitive types of coverage claim that because these plans are exempt from some of the Affordable Care Act rules these plans will “cherry pick” healthy citizens. That these STPs and AHPs would leave the un-healthy citizens on the current plan offerings of the ACA, which we all know suck.

BTW, by suck I mean:

  • Too expensive
  • Too high out of pocket limits.
  • Too much risk for “unexpected” costs as we’ve discussed.
  • Too skinny provider networks
  • Too few options for individuals and families

The Liberals claim that the STPs and AHPs are bad because:

  • They can underwrite which means they can accept or reject applicants.
    (While not all are accepted this does bring premiums down)
  • That members with pre-existing conditions might see their claim denied.
    (Folks with Pre-ex could remain on the ACA compliant plan of their choice)
  • They don’t need to cover ‘essential health benefits which Liberals always highlight includes mental health and maternity care.
    (Not everyone needs maternity care, pediatric dental, or mental health benefits so AHPs and STPs can cover what folks really care about at lower premiums)

The real story is that California’s liberal legislature has convinced itself, and any new politician that joins them, that CA needs “universal coverage” run by the State of Ca. Can you imagine how horrific a state run plan would be for everyone including those citizens with pre-existing conditions. (Who the Libs say they care about)

Have you ever tried to fight the Government when it makes a mistake? It’s impossible to get help, a correction, satisfaction or relief.

But, if your private plan’s Insurer mucks something up you can get relief or at least an explanation. Plus, you have a regulatory body such as the Dept. of Insurance or Dept. of Manage care to step in, if needed. Insurers try to avoid intercession by regulators.

Who would you rather fight: the State Government Bureaucracy that does not give a hoot about us as individuals or an Insurer that lives in fear of the DOI?
You know the answer!

The sad fact is that we are all being penalized as the CA tries to implement its vision of state run health care. As stated many times, 90% of us are paying increasing premiums while getting decreasing benefit and the legislation the Governor just signed won’t make it better for the 90% of us.
Enough on that!

As a random thought, have you noticed the press and liberal candidates increasing the fear mongering about pre-existing conditions. As we predicted a month ago,  every article about health care includes a paragraph or two about the GOP’s desire to cut off your coverage for your pre-existing conditions. These statements would be laughable if it weren’t so darn serious.

As I’ve stated, no Conservative or Republican would dare take Guarantee Issue and Coverage for Pre-ex away from us. Remember, these people want re-elected more than anything. Why would they do something stupid like that? Plus, the Insurers have learned to be profitable in the new era, very profitable.

OK, next week you’ll read about E Clampus Vitus as I venture to my Fall Trek. I hope you will enjoy reading about the history of the Clampers.

Always remember, 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”.

Higher Out of Pocket cost for healthcare services seems to be a surprise to some. Question for you: Who hasn’t expected that? Let’s explore this.

September 13, 2018

Over the past few months we’ve seen a steady increase in articles and news headlines with stories about how people have experience higher Out of Pocket (OOP) than they ever expected. The stories, and there will be more before election day, actually highlight many of the fundamental flaws in the ACA that we have been discussing for years.

But, their tactics are clever, if not devious, as the authors carefully imply the cause of these flaws is a result of the GOP and the Trump Administration’s tinkering with the ACA. Of course the GOP changes have nothing to do with higher OOP and higher premium of the Obama administration’s signature healthcare bill, The Affordable Care Act. Stills sounds awkward calling it the affordable care act, doesn’t it?

First question that comes to mind is: “who could be surprised that higher premiums, higher deductibles, skinny networks, and record Insurer profits would lead to higher OOP for members?” I have no doubt the stories and the examples about which they write are 100% true. But, none of us should be surprised because it is election season.

Of course, the GOP has tinkered around the edges of the ACA which the authors can use as side notes to imply a cause. But, there is not one change by the GOP that would have led to more OOP than the ACA plans provided for prior to January 2017.

There has been no change to the metallic plan structure or minimum claim payout requirements legislated by the GOP. Unfortunately, we could have really used some legislative fixes to actually improve or eliminate the ACA but that’s an old story which we have discussed over the past 2 years.

So, what causes the surprise of the higher Out of Pocket.

  • Number one issue that always surprises folks is the high deductible plans with naturally higher OOP. When we shop for our health plans aren’t we all are surprised and dismayed by the cost and benefits?
  • We’re surprised that for the premium we pay the plans provide no benefit for RX or Office Visit copay until after the higher deductible is met. Many have stated that the Bronze plans actually encourage folks to defer of seeking healthcare.The metallic plans suck for sure but the OOP is foreseeable if not predictable.
  • The biggest shock comes from services provided outside the PPO network (OON) of the member’s plan. Members may try to use PPO Docs but sometimes it’s not possible because the PPO networks have been cut down so much. The shock comes from the OON provider’s invoice due when providers “balance bill” the patient for services outside of the PPO network. Those charges can be huge and generally not predictable. A patient may have an emergency situation or complex health treatment which will absolutely with 100% certainty result in unexpected charges due to OON providers.

A recent survey by the Kaiser Health Foundation compared the level of “worry” Americans have with their ability to pay various costs they incur.
The survey reveals the percentage of folks concerns about their ability to pay their bills.  The respondents who stated they were Somewhat Worried to Very Worried is staggering yet predictable:

  • 67% concerned about unexpected medical bills.
  • 53% concerned about health insurance deductibles.
  • 46% concerned about gasoline or transportation costs.
  • 45% concerned about RX costs. (Seems low doesn’t it)
  • 43% concerned about their utility and electric costs.
  • 42% concerned about their monthly health insurance premium.
  • 41% concerned about their rent or mortgage.
  • 37% concerned about affording food.

Of the 8 categories we see 4 of the largest concerns are healthcare related.
The bigger issue should be that those 4 categories do not occur independently. We pay premium to be covered and majority of IFP Plans (Individual or Family Plans) are Bronze or Silver so we have larger OOP for both Rx and most medical services. Then add the Out of Network balance billing concern and we have a potential and predictable catastrophic event. But, that’s no surprise is it?

Most Bronze plans have deductibles of $5,000 or higher with no first dollar Rx  benefit and OOP of $7,000 or higher. If a Bronze Plan is what a member can afford then OOP costs can be somewhat projected, in the absence of out of network care. I think most Americans would agree that the high premiums they pay for even a Bronze plan, with its high OOP, is not acceptable. Particularly healthy Americans who, as we have discussed in prior discussions,  pay a large “surcharge” to compensate for the UN-healthy.

We appreciate KHF’s efforts to report results and surveys concerning healthcare costs and delivery. They do a good job of compiling and reporting results and area specific trends. But what we see in many reports is the presenter adding commentary concerning unrelated but politically expedient issues.

Lately, the most added unrelated-issue is the impact members would experience if the GOP eliminates Guarantee Issue and coverage for Pre-existing conditions. It would be suicide for the GOP to eliminate GI and Pre-ex coverage but it wouldn’t be the first time the GOP shot themselves in the foot. Even if the court rules on the GOP case in favor of the 19 states suing the ACA , the GOP will continue to provide for GI and Pre-ex. If the GOP does not maintain GI and Pre-ex then the next two election cycles will be a disaster for them.

We discussed if previous posts that as we approach the mid-term elections we will see an increase in stories designed to cause fear for our citizens who may have ongoing healthcare conditions. Fear mongering politics is sad but it’s true.

So, what are we to do? Just as we’ve discussed before; we stay informed and prepared so we can correct people when they are citing information that you know is wrong. We must be prepared to help our fellow citizens be informed so that they do not succumb to the fear tactics that work so well on the uninformed.

We can do this because; we’re all in this together!

Until net week.

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

 

Let’s break down the enrollment numbers on America’s healthcare and where folks get their coverage. You’ll be surprised!

August 23, 2018

In previous Posts we have discussed how the media headlines are often misleading if not downright wrong and one may wonder how often intentionally. Your humble author has repeatedly pointed out the confusing and misleading articles that refer to premium increases, access to care, unit costs of care, individual vs. employer sponsored plans as well as Medicaid to name a few.

Let’s look at the numbers for how we Americans are covered. We will look at the coverage numbers for ER-employer sponsored, NG– non-group, Mcaid-Medicaid, Mcare-Medicare, OPub-other public coverage and Unins-uninsured. Plus, we’ll see the change from 2013 to 2016 which will support many of the statements we’ve made in the past.

Statistics for the United States:
Coverage     2013           2016                Difference

Pop    313,401,200      320,372,000        6,970,800

ER      155,696,900      157,381,500        1,684,600
NG       13,816,000        21,884,400        8,068,400
MCaid   54,919,100        62,303,400        7,384,300
Mcare   40,876,300        44,550,200        3,673,900
O Pub     6,295,400        6,192,200         – 103,200
Unins   41,795,100        28,051,900     -13,743,200

As I study these numbers a few things stick out like a skunk at the Rose Parade.

  • Employer sponsored plans at 157 million, cover half of all Americans. Actually, I think the percentage is higher than the report suggests.
    Can you imagine the confusion and the anger and the mess if a single payer plan forced 157 million of us on to a Medicare for all plan? It would be worse that the roll out of the ACA was, is and will be if not corrected.
  • The overall population increased by 7 million while the employer sponsored and non-group increased by almost 10 million. That means responsible Americans and employer sponsored plans picked up a big part of that increase.
  • The uninsured population is still a huge number. The ACA proponents use talking points like no pre-existing conditions, open access and only 9% etc but the fact is 28 million is a darn big number. Plus, with premiums as high as they are it’s likely we won’t see a better percentage covered.
  • Medicaid grew dramatically which is due to what’s called Medicare expansion. Remember, these folks reported low income levels which honestly can not afford the premium cost of individual plans. All of those 7.3 million folks are having their benefits (premium and claims) paid by the faithful American tax-payer.
  • Medicaid recipients involve 50% more people covered than Medicare. Remember that Medicaid is primarily healthy-under age-65 working age citizens. Disabled American’s would be under Medicare so the Medicaid population is a number that should concern us all, plus it’s what the Medicare for all folks will push.

Now, you can see what we mean when we point out the biased misleading press about the impact of premium increases to the ACA “public plans”. The non-group population is 22 million of which roughly 10 million people are enrolled in the public exchanges. That’s less than 3% of our national population are enrolled  in the exchanges yet the ACA proponents use those plans when they shape their message to the uninformed. Not cool!

We should not forget that 85-90% of the folks covered by the public plans have their premium as well as their plan’s out of pocket paid for them. That means these folks are not effected by premium increases. I remind you of that fact not for critique but as reminder that when the press speaks and writes of the premium increases it seldom points out that these folks are not affected.

Let’s give the employer sponsored group a hearty “well done”. Employers generally sponsor plans that are richer that the individual plans, provide better access to providers, have been guarantee issue with no pre-ex if covered before for years, and pay for the majority of the premium.

When employers implement court-case tested HRAs then benefits are vastly improved over the standard metallic plans we all hate. BTW, California has and will continue to see the advantage of TPA administered HRAs thanks to the Court ordered injunction secured in one TPA’s anti-trust suit against a major insurer. All employers can now implement an HRA program without restriction of fear of insurer backlash. Again, thank you to the TPA who settled this for us all. But I digress!

I initially planned to include the numbers for California in the above chart. But, it would only irritate out of state readers because California enrollments are a huge percentage of the national numbers. That would tick me off if I lived in a state other than California.

With mid-term election just around the corner we will hear endless diatribes about the value of Medicare for All otherwise known as Single-payer. Don’t fall victim to misinformation as candidates make promises that they know they can’t keep. Remember “if you like your doctor you can keep your doctor” so that you don’t get pulled into the confusion.

The Congress will be back in session in a couple weeks and with mid-term elections only weeks away expect to hear a lot of “Cr*p” that will never get a word said after the election, regardless of outcome.

We’ll keep an eye and ear on it so that we don’t get fooled again. When we’re properly informed they will realize that we’re all in this together.

Until next week.

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

 

 

 

 

Will the GOP succeed in suspending penalty payments for the ACA’s Employer “Play or Pay” Mandate? Is it a wise move?

August 16, 2018

As you read this in August I’ll need to remind you that during the week of July 23rd the House Ways and Means committee voted 22-15 to approve the Bill H.R. 4616 which would suspend the employer penalty payments for the period after December 31, 2014 up to January 1st, 2019. 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 can advance now but since the House is in its Summer recess for 5 weeks it won’t go to far. But, will it have a chance once the House is back in session and in light of the activity everyone will focus upon this Fall namely the mid-term elections? Doubtful.

But is it 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.

I won’t continue with that issue but instead focus on the simple question – is the employer “play or pay” mandate a good idea or should it be eliminated? And what effect will it have on the thousands of employers and hundreds of thousands of employees who have participated 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 noncompliant employers to avoid the penalty while other employers have already spent untold fortunes with no hope of getting that money back.

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 noncompliant 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.

For 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.

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 freakin 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.

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”.