Archive for the ‘Chamber of Commerce’ Category

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”.

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”.

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”.

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

October 4, 2018

Two times each year your humble author retreats from his solemn duties to Trek to
E Clampus Vitus, Platrix Chapter #2, that most ancient and honorable group. This is one of those times, kid. Would you like to read just a bit about The History of ECV.

E CLAMPUS VITUS is said by its adherents to be the most ancient of all fraternal orders. It’s founding, as the tale is told, was coeval with the origin of the human race.

It is related that in 1852 Steamboat Jake. a merchant from Yreka, thinking to improve his business by fraternal affiliations, made arrangements through certain Clampers for initiation into the Masons, the Odd Fellows and E CLAMPUS VITUS at one bargain price of $98.50. When the various brethren were assembled at the Hall of Comparative Ovation and Jake, bound and blindfolded was brought to be initiated, the question arose as to which Order should first apply the branding iron. It was agreed that the oldest should have priority.

 The Odd Fellows presented their claim for that honor, stating that their order was created by a charter issued in the form of a golden tablet by the Emperor Titus to his Jewish Legion in the first century A.D.

 The Masons disputed the claim, relating the scholarly history of Reverend Dr. Anderson to prove that the Grand Master Moses often marshalled the Israelites onto a regular and general lodge whilst in the wilderness, and that King Solomon was “Grand Master of the Lodge at Jerusalem”.

 The Noble Grand Humbug of E Clampus Vitus then rose and confounded the rival organizations with proof abducted from the unimpeachable unwritten works of St. Vitus, the final authority in all such matters, that E CLAMPUS VITUS was founded by our Clampatriarch Adam himself in the Garden of Eden, and that the original Staff of Relief, which figures so greatly in the Clamper ritual, was a branch that Adam broke from the Tree of Knowledge and smuggled out with him, hidden beneath his apron, when he was driven from Eden. All present in the Hall agreed that such antiquity was beyond compare.

The seniority of the Clampers was recognized, and Steamboat Jake accordingly was given into the hands for initiation. It is then told that by the time they were through with him he had lost all desire for further fraternal connections.

 The unsurpassable antiquity of E CLAMPUS VITUS has been recognized and proven on many occasions. There are those who claim they can trace it through the times of the Old Testament and the beginnings of the Christian Era when its rites were conducted in the catacombs of Rome and referred to as the “Enigmatical Book of Vitus” and the “Curious Book of the Clampers”. These tales tell how it was spread through Europe by the Frolicking Friars, and carried to the Orient by the indomitable Vituscan Fathers.

According to the Clampers, the introduction of the order into the United States has long been shrouded in mystery and legend. Only recently has the true history been traced by the Royal Platrix Chapter and the Archivist of the West Virginia Lodge. The result of this research supposedly proves by documentary evidence that the secrets and symbols of E CLAMPUS VITUS were imparted by the Emperor of China, Tao-Kwang, Great Hotchot of the Chinese Grand Lodge to Caleb Cushing when the latter visited China in 1844 to negotiate the first treaty between the United States and the Celestial Kingdom. Cushing was specially charged by the Emperor to deliver the secrets and signs of authority to Ephrairn Bee, innkeeper of Bush Creek, Boone County, Virginia, to be disseminated by him at his discretion among the fellow citizens so that the Chinese and American People might henceforth be united by the Bonds of Fraternal Brotherhood as well as by the more formal ties of diplomatic relations. By virtue of his authority, Ephraim Bee traveled about his native state organizing lodges of E CLAMPUS VITUS in villages and county seats. 

It is also said that among others, a number of drummers were taken into the order, with or without authority from Bee. These travelers took the gullible villagers and townsmen along their routes into the Brotherhood, until by 1849, the East and Middle West were dotted with Clamper Lodges. From these Lodges many lusty Clampers went West in the Gold Rush and founded the historic lodges in the mining camps that constituted themselves as guardians of the morals of these communities.Their duty as they saw it was to prevent the preachers and pious wives who followed the 49′ers, from imposing any excess of morality that might hamper the full enjoyment of life. How well the Clampers performed this function is commonly known, despite the lack of written records. This lack of written records is attributed to the circumstance that during the meetings there was never anyone capable of keeping the minutes and that afterwards no one remembered what had taken place.

As E CLAMPUS VITUS mushroomed along with the rapid growth of the gold towns, it declined as rapidly as they did, and, therefore, lived only in the memory of a few ancient dwellers in the mountains and in the annals of the county histories until, in 1930, when a new prophet, a second Ephraim Bee , appeared in the person of Carl Wheat to reorganize the historic organization. 

Members of the Ancient and Honorable Order of E CLAMPUS VITUS have always been adventurers and many have been leaders in conquest of their respective countries. The most noteworthy of that band of stalwarts was Juan Rodriquez Cabrillo, a doughty explorer in the service of the Spanish Empire, who on October 19, 1542, raised the Spanish Flag at a point near the beach city of Hueneme in Ventura County and took possession of the land in the name of the King. Cabrillo is buried on San Miguel island and some Clampers make an annual pilgrimage to his grave. 

Sir Francis Drake was a Clamper but not in good standing because of his piratical exploits until June 15, 1579, when this bold buccaneer reached California in the famous ship, the “Golden Hind”, and anchored in Drakes Bay where he raised the English Flag and took possession for Queen Elizabeth and called the land New Albion.

Then Spain decided to occupy California to protect her colonial possessions, so two courageous Clampers were selected for the expedition: one was Don Gaspar de Portola, and the other was Father Junipero Serra. These men raised the Emperors flag at San Diego on May 17, 1769.

After Mexico revolted from Spain, an admirable Clamper, General Antonio de Santa Ana, ordered the flag of the Mexican Republic raised at Monterey on January 7,1769. 

John Charles Fremont was a Peripatetic Clamper and he raised his ensign as Captain of the United States Topographical Engineers above every camp that he made in California during his expeditions between 1844 and 1846. That flag is now in the custody of the Southwest Museum in Los Angeles. 

On June 14, 1846, a Sonoma group of justly indignant Clampers rebelled against the aggression of Mexican officials. They captured the garrison at Sonoma, issued a clampotent proclamation declaring California to be an independent republic and raised a crudely designed but historic Bear Flag.

 Clampers played an important part in the history of California in the nineteenth century because the American members of this Order worked in unison. Commodore John D. Sloat in command of the Pacific Squadron of the U.S. Navy captured Monterey and on July 7, 1846 he instructed a fellow Clamper William Mervine to raise the flag of the United States above the customhouse. When Fremont learned of Brother Sloat’s coup he ordered the Bear Flag struck at Sonoma and replaced by a 28-star flag of the United States.

It is manifest that Clampers have been leaders throughout the history of California and the flag-raising members of the Order of E CLAMPUS VITUS have contributed glamor and deeds of courage and gallantry to our heritage. It must be noted however that this history has never been proven.

 CREDO QUIA ABSURDUM – BECAUSE ITS ABSURD I BELIEVE
QUOTED FROM E CLAMPUS VITUS, THEN AND NOW, 1852-1979

As for me, I’ve been among the Brethren since 1992 at the Tehachapi Loop.
We return to the Loop this Trek.

How many of you know a Brethren of the Order?

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

Until next week,

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

 

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”.

 

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

September 6, 2018

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Until next week.

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