Archive for the ‘Citibank’ Category

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”

 

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”.

 

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

August 9, 2018

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

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

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

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

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

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

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

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

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

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

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

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

Until Next week.

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

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

August 2, 2018

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Until next week,

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

 

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

July 26, 2018

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

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

We all know that:

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

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

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

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

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

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

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

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

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

Until next week.

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

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

June 28, 2018

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Until  we talk again.

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

 

 

Last July, our Post heading was “What would the consequences be if the GOP passes NO legislation to Repeal & Replace? Let’s look at the impact on insurance coverage.” Were we RIGHT?

April 19, 2018

Below is a re-Post of July 27th 2017 with a few comments highlighted in Red. With midterms only 6+ months away, will the decisions made by the GOP last year come back to bite? Read on to see if we were close.

 As I write this post, the Senate has voted to open hearings and take amendments for the Senate’s R&R bill. Basically this is the Senate’s last effort do accomplish anything  for now on Repeal & Replace. Without being pessimistic, I would wager that the smart money will be bet on nothing coming of this.

Regardless of one’s political leaning everyone must agree that action is needed to either replace the ACA (with something better) or make repairs to the ACA (that will keep it alive). I realize that is a big summation but if we are honest then we must conclude that the ACA is failing so one way or another action is needed. Either for the benefit of the millions of Medicare Expansion subsidized enrollees or for the tens-of-millions of premium paying citizens and employers, the ACA needs either fixed or replaced.

So, what would the consequences be if our House & Senate don’t do anything. That is, if they don’t provide or modify the subsidies for the insurers and all of the other ACA issues that need changed to survive or don’t replace the whole darn thing, then we will see a number of absolutely predictable results.

Of course, the Politician’s thoughts will immediately turn to their own future and the 2018 elections (probably have been already) but I want to focus on the impact to all of us, the hard-working premium paying, mortgage paying, car payment making, tax paying citizens. It won’t be good but let’s look at it:

  1. Regardless of whether or not the subsidies of the ACA are paid to insurers we will see: (Correctly so, they’re not paid, yet.)
    a. Premiums for individual plans increase double-digit (20% or more) and be projected to continue for the next few years. It’s happening!
    b. The Counties without an insurer for the individual ACA plans will continue to increase. It’s projected that as many as 1/3 of all counties will have no individual ACA plan available. In the more rural states we could see the number of counties with no individual plans exceed 80% of the counties within those states.
    YEP, that’s what’s happening!
    c. The number of insurers willing to even offer plans anywhere in the country will decline, including those insurers offering plans outside the ACA Exchanges for both group and individual plans. Sadly, for rural areas this is true.
  2. Medicaid enrollment will continue to rise. Even though Medicaid plans provide lower benefits and there are fewer providers, most people don’t realize those facts until it’s too late. Besides, the idea of “free insurance” will become more and more appealing as premiums continue to rise for the tens-of-millions of premium paying citizens that use very little or no healthcare each year. “Why should I pay premium when I never use my plan and those folks are getting it for free?”. Right?
    This is happening plus a few states are trying to expand further.
  3. To summarize: fewer insurers offering fewer choices with few participating providers all at premiums increased each year. That is correct, Madam.
  4. Of course, the result of # 1, 2, and 3 above will lead to another crisis because there won’t be enough money to pay for all of the Medicaid claims and insurer’s subsidies. Which will lead to:
    a. Increased taxes or create new taxes on benefits to generate more funds.
    b. Decrease the benefits at either the plan benefit level or utilization level. That means the IPAB “Independent Patient Advisory Board” or Death Panel will decide what gets authorized and covered and what does not.
    Your 90-year-old mom may need a new hip but will the IPAB authorize it?”
    Luckily, as you read in previous Posts the IPAB is dead, not your 90-year-old mom.

We could go on and on because it is clear that the entire healthcare finance and delivery system will feel the impact of our Congress doing nothing. There is some hope though due to the President’s EOs for AHPs.

One additional concern is the “overly optimistic political corrected” desire to pass a “skinny bill” that would simply repeal the Play or Pay mandates. That could be catastrophic to insurers and to premiums that would need to be increased.

I don’t understand politics and have the scars to prove it but I do try to understand human nature. Human nature will drive most politicians to look out for themselves in their own individual voting district throughout the healthcare debate. This is already occurring in many districts.
Sad thing is that the GOP seems to be immobilized from taking action on R&R  due to the criticisms from people who wouldn’t vote for them regardless of any action taken.

Makes you want to ask, “So, a small percentage of people in your district, who wouldn’t vote for you under any circumstances, are preventing you from doing what’s right for tens of millions of American?” See this example before, haven’t we?
As I said, I don’t understand politics.

Sorry for the negative outlook concerning our Congress and especially its leadership. But, since neither the House nor Senate bills actually repeal the ACA there seems to be little to ignite optimism. And of course, times and circumstances change the immediate need of the population so all help is on hold.

I think we can point to the children’s book “The Emperor’s New Suit” as the beginning of the GOP’s downfall.  You can’t tell people it’s an ACA repeal bill, while leaving the core foundation of the ACA including taxes, and expect the people to embrace it. Reducing the Play or Pay penalties to zero and calling it repeal  does not repeal the Play or Pay core fear of the ACA. It only increases premiums.
I didn’t like that book when I was a kid, and I still don’t!

Well, we’ll see what happens this week and together we will address it.
Because, we’re all in this together, right?
It’s because we suffer with these political blunders together that makes it more frustrating. Together, we are fed up and should do something.
I know – vote.

Until next time.

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

 

Trump Administration releasing new standards for Short-term Medical Plans. Is this good, bad, no big deal? Let’s discuss.

March 8, 2018

President Trump’s administration has released “new rules” which will allow Short Term Medical Plans (STM) to be offered for up to 12 months. This is good news for tens of thousands of Americans but it will cause ACA advocates to go crazy. Which is kind of fun to watch, actually.

In the past I’ve not talked about STMs as they were restricted by the ACA and certain states which prevented STMs from being a long-term or even intermediate term solution for reforming our healthcare issues. STMs had been designed:

  •  As temporary coverage, lasting for a few months. while
  • For workers  between jobs.
  • To provide limited protection.
  • Portions of hospital or doctor bills.
  • Not to be long-term coverage us it made sense to member.

But, premiums have increased 300% over the past 7 years and out of pocket limits on ACA compliant plans have increased to a point where they can cause financial ruin. No one, who avidly or rabidly supports the ACA, wants to admit or acknowledge that the increase premiums are paid primarily by un-subsidized population of American. Stated more clearly, people who don’t received subsidies pay the brunt of these increased costs.

 “We want to open up affordable alternatives to unaffordable Affordable Care Act policies,” said Health and Human Services Secretary Alex Azar. “This is one step in the direction of providing Americans health insurance options that are more affordable and more suitable to individual and family circumstances.”

STMs could add more options at potentially a fraction of the premium of ACA plans. STMs would help healthy folks, strapped financially by ACA plans, in both big city and urban areas but certainly in the rural areas of the country.

Opponents will argue at least three issues for the downside of STMs. The first is that STMs will dilute ACA compliant plans as the premium paying healthy folks seek out and obtain coverage from a lower priced STM. If you were healthy and could slash your health plan premium by 50-75%, would you try it? Heck, Yeah!

Currently, under the ACA, STMs are offered generally for only 90 days at a time then must be renewed. Generally speaking their benefit designs are “crap” as one would honestly describe. One can’t blame an insurer for a low cost “crappy” plan when it knows its customer could use the plan then be gone in less than 90 days. Insurers could never sustain a reasonably designed plan with Rx copays and high limits on coverage because a single episode of care would wipe out reserves.

But, we have not yet seen what the market will demand of STMs when they can be offered for up to 12 months. An insurer then could assume that members would retain coverage for a longer period and thus may be able offer plans a bit richer in benefits while still a fraction of ACA plan prices. We’ll see about this.

There are reports from folks at CMS (Center for Medicare and Medicaid Services) estimate that these STMs might attract up to 200,000 members nationally. That estimate could be dead-on accurate or wildly off. But, since the majority of working Americans receive their benefits through their employer it may in the ballpark.

I said above that opponents would argue three issues. The second is that acquiring coverage requires folks to answer health related questions on the application, and insurers can reject applicants with preexisting medical problems.  ACA plans cannot underwrite applicants and cannot refuse coverage even if an applicant is in an ambulance heading for the hospital. 

The third issue opponents will absolutely hate is the benefit design of these STMs. STMs will certainly not include the Essential Health Benefits or pediatric dental, or maybe even wellness/preventive benefits. STMs will be designed and be appealing to healthy folks

Opponents will argue that citizens will be uninformed about the plan benefits and be buying plans that do not provide the coverage that our citizens require. Opponents will not give these healthy premium paying Americans and credit for wisdom or discernment.

Those are three very important objections and they must be addressed because there will be some states, such as Ca, that will not like STMs and will fight there presence in the state’s market.

But, the primary objectors will be:

  • Rabid ACA supporters who actually want the ACA to morph into single-payer plans, but are intellectually dishonest about their motive.
  •  Insurers who have been collecting huge premiums and reporting record profits will fear losing healthy members who are paying their ACA inflated premiums.

Will STMs be “skinny plans” which applicants need to clearly understand, yes. But, American shoppers are pretty savvy plus they can access insurance professionals to help.

What do critics say, “the proposed regulations for offering ACA non-compliant plans along with the alleged elimination of the individual mandate by Congress could render the Affordable Care Act even less viable”.

 Others will state that these plans won’t include critical benefits such as mental health coverage which in in the news so much lately due to the apparently mentally impaired man in the Florida school shooting.

These objections shouting “buyer beware”, “there are no benefit” these plans will cause death” will be replayed by the liberal media so much you will wish you could listen to a “ZYPPAH” commercial.

One by-product could be that if the ACA compliant plans are impaired, due partially to eroding healthy membership, it might accelerate the death of the ACA or creation of more alternatives. That would take time but if Congress won’t do the job then maybe time and circumstances will.

Robert Lasewski an industry consultant says, “If consumers think Obamacare premiums are high today, wait until people flood into these short-term and association health plans.” He adds, “The Trump administration will bring rates down substantially for healthy people, but woe unto those who get a condition and have to go back into Obamacare.”

Remember what we’ve said in previous Post, the ACA punishes the many to provide benefits for the few. The opponents of these plans fail to understand or at least empathize with the millions of Americans paying huge premiums each month for benefits they don’t or can’t use but get not subsidy. Let’s help those folks once in awhile.

Christopher Condeluci, a benefits attorney who also served as tax counsel to the U.S. Senate Finance Committee states, “While these plans might not be the best answer, people do need a choice, and this new proposal provides needed choice to a certain subsection of the population.”

Comments like that make me realize that I’m not alone in thinking the American people deserve options. They deserve our support and they deserve a break, for once.

To summarize, STMs will:

  • Offer alternative for healthy Americans.
  • Be a fraction or premiums charged by ACA plans.
  • Provide fewer benefits than ACA compliant plans.
  • Include underwriting that could reject applicants request for coverage.
  • Be very profitable for insurers.

But STMs may:

  • Take healthy members away from ACA plans.
  • Leave ACA plans with more unhealthy than healthy members.
  • Cause ACA plan premiums to increase further.
  • Still be profitable for insurers.

The piece by piece dismantling of the ACA is not a perfect scenario. But if you remember, the ACA piece by piece dismantled all of the great aspects of American healthcare plans starting in 2010. If the piece by piece process is the only way that America can be offered better options then it is a worthy endeavor. The ACA can be slowly eliminated which would give us the time to adjust and improve.

What do you think? We’re in this together so let us know.

Until next week.

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

 

 

 

 

 

 

 

 

 

Remember the ACA’s Independent Payment Advisory Board or “IPAB”. The so-called “Death Panel” is dead! Why is no one talking about this?

March 1, 2018

It’s often difficult to remember things that occurred yesterday, let alone 7 years ago, but do you remember when the ACA was signed in 2010 and its provisions started taking “root”? I know, I know, you think I’m wrong  because everyone thinks the ACA took effect in 2014. But, it actually began its insidious spread across American healthcare in 2010 by imposing taxes, fees, reporting requirements, pricing regulations, speculation and the formation of new agencies and processes including the Independent Payment Advisory Board (IPAB). 

Well, IPAB is dead and credit goes to the Tax Cuts and Jobs Act of 2017 that Congress passed and President Trump signed in December 2017. It’s demise received no fanfare, in fact, I’ve only seen one article about it and no TV commentator has mentioned it to my knowledge. Why is that?

Everyone remembers Governor, turned VP candidate, Sarah Palin calling out the IPAB as a “Death Panel”. Heck, even today when commentators speak of Governor Palin they bring up her comments about IPAB. Calling IPAB the “Death Panel” was not a totally inappropriate synonym for the IPAB given the political nature in Washington. But, that does not mean that the concept of IPAB was necessarily evil.

The concept of IPAB is/was not necessarily a bad one, that is until it gets combined with politics and the politicians in Washington.  Its intended goal was to control, lower, and eliminate cost for Medicare and specifically Medicaid. So, if something could lower costs then it would be good. But if its goal was to eliminate services for Seniors…”What would people like you and me call it? “Death Panel”! 

However, IPAB did not have regulatory or enforcement authority. It could only make suggestions to HHS, other governmental agencies and the commercial markets. IPAB could only recommend lower reimbursement levels for specific services, suggest lower frequency of treatments, or treatment protocol of a specific service can be used for treating “this” condition but not “that” condition. IPAB could only make recommendations.

Did you ever wonder why no politicians, from either party, ever talked about IPAB over the past several years. Democrats, especially, did not want their names connected with IPAB. Why was/is that?

The reason is that IPAB was created to be a scapegoat. It was designed to provide political cover for jelly-spined politicians from either party if allowable treatment protocol for medical services were altered, reimbursements to providers lower, or benefits cut back on Medicaid and Medicare recipients.

Stated more directly, if IPAB did its job, the result of which cut benefits or services to Seniors, then politicians could blame the IPAB people or ACA or Government in general and escape blame for themselves. You must admit that’s clever.

Some will remember that in 2013 the IPAB published new recommendations for “lady check-ups” for women over 40 years of age. Specifically, it stated that the frequency for the exams women, over 40, needed could be less frequent than what was in practice and recommended at the time by every healthcare organization in the free world. 

Of course, that news met with loud protests so Secretary Kathleen Sibelius, of Health and Human Services, quickly released statements clarifying that IPAB was an “independent board” and did not speak for the Government and the IPAB suggestions would not be implemented by Medicare or Medicaid. Whew, dodged a political crisis, right?

Again, stated more clearly, IPAB could only suggest ways to reduce costs. But if the IPAB suggestion was not politically expedient or cast dispersion on the ACA then it might reveal potentially harmful  political result, caused by the ACA. Plus, President Obama’s reign in office had not ended so the Dems could not have an independent board established by the ACA actually start reducing benefits to older Americans and especially not to woman.   

The GOP does not get off scott-free here either. The GOP always states that Medicare and Medicaid costs must be lowered so the GOP was/is perfectly willing to allow an independent board make decisions that would be political suicide for any party in the majority. The GOP was also perfectly willing leave the IPAB in place with no acknowledgement what so ever. Hold it in reserve, so to speak.

But, if the GOP is serious about controlling healthcare costs then why eliminate the IPAB in the 2017 Tax Cuts and Jobs Act? Spending trends in healthcare must be controlled, some how, right? Granted healthier life styles and lower utilization is preferable but that ain’t happening. 

Remember the Military Base closures in the 1990s? There were dozens and dozens of Military bases around the country that could have been moved or closed all together as a byproduct of the Cold-war ending. But, to close a base in a politicians district did not help in the politician’s re-election process. So, Congress formed an independent board to identify and suggest to Congress bases and facilities that could be closed. Hundreds of facilities were closed or relocated to reduce cost but the politicians did not have to take direct responsibility for the closure decision. Another scapegoat to the rescue.

The IPAB and its objective is worthy and one might say absolutely necessary given America’s out of control healthcare system. But, when someone is 65+ years old the trend for their healthcare cost-line may already be determined by their life’s previous choices or DNA. So, to reduce or eliminate the service these American most certainly need seems heartless and wrong. However, we need to reduce cost so there in lies our dilemma.

If we’ve seen anything consistently out of Washington it is that it can not solve these kinds of dilemmas. They can’t have reasonable discussions or debate. They can’t introduce creative ideas because politicians refuse to take risks that could end a political career. UGH!

IPAB was a good scapegoat, a good talking point during elections and maybe a good way to make suggestions about healthcare delivery and its costs. But, it’s gone.

We have loads of examples of the hypocrisy of politicians as they dodge responsibility and accountability. Eliminating the IPAB with no fanfare or the slightest public discussion is one we all recognize. Let’s hope the ideas our Posts discussed previously can make a difference some how.

Let me know what you think.
And remember, we are all in this together.

Until next week.

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