Archive for the ‘Healthcare Access’ Category

They hope we’ll forget about the taxes still in the ACA. But we can’t, can we?

January 11, 2018

It’s easy to let things slide past us after awhile. Who among us can remember everything for ever and be willing and able to discuss a specific topic regarding of its importance? In the news reports on January 2nd, 2018 there were a scant few reports scattered among the daily news about how the ACA tax on Medical Devices was going live again. After a 2 year pause this tax will once again take affect and be a part of the cost and premiums we pay because it is a tax that the insurers will pay.

But, no one took notice. Nor did anyone start talking about the other taxes still remaining in the ACA. Why do you think no one is talking about these burdensome-premium raising taxes?
Here’s a couple thoughts:

  • In general the Press, both Liberal and Conservative, are focused on what they view as bigger topics such as the DACA issue, budget to keep the government open, Russia-Russia-Russia, is Jerusalem really Israel’s capital, Iran and North Korea, as well as the President’s Tweets, to name a couple.
  • The liberal Press does not want to bring up ACA taxes because it might distract from the get-Trump movement or worse, gain traction in the press and start the GOP in the direction of repealing the taxes.
  • The conservative Press does not want to bring it up because it points to the GOP’s failure to properly address the R&R of the ACA.
  • Democrats don’t want to discuss it for fear of losing the ACA completely even if it’s deleted a little at a time.
  • The GOP does not want to discuss it because it could pressure them to actually do something to solve the healthcare crisis of delivery and finance.
  • What a friggin mess, right?

In addition if the discussion on ACA taxes gets started the GOP may need to defend why it has done nothing about the following taxes:

  • Excise taxes on health insurance providers, pharmaceutical manufacturers and importers in addition to medical device manufacturers and importers.
    • These excise taxes are projected to raise $19 billion in 2020. 
  • An additional 0.9 percent payroll tax on earnings and a 3.8 percent tax on net investment income (NII) for individuals with incomes exceeding $200,000 and couples with incomes exceeding $250,000.
    • The high-income surtaxes are projected to raise $35 billion in 2020.
  • Excise tax on employer-sponsored health benefits whose value exceeds specified thresholds starting in 2020. The so called “Cadillac” tax reduces after-tax incomes the most in percentage terms for middle-income families. 
    • The excise tax on high-cost health plans is projected to raise $3 billion in 2020 with the revenue gain growing rapidly over time, reaching $20 billion by 2026.
  • Excise tax on employers offering inadequate health insurance coverage. The tax applies to employers with 50 or more full-time equivalent employees.
    • The excise tax is projected to raise $20 billion in 2020. 

Maybe these 5 additional taxes, in addition to the tax on the medical devices, answer the question as to why no one is screaming about the premium-increasing taxes remaining in the ACA.Oops, the cynic in me just popped out.

If the GOP had eliminated these taxes in the tax billed just signed then the GOP would have been forced(by CBO calculations) to adjust its calculated outcome. That could have made their job harder. But remember, Congress and Senate members(and staffers) don’t actually pay these taxes because they have their own health plan separate from the ACA. Therefore, how could we expect them to reduce these taxes.

I mean, if it would make their job harder, and all. Gees, we can’t expect them to work 5 full days each week, keep the promises they make, and still reduce our costs. Oh well!

OK, I know the new year is young and there is still time. But the Congress will soon set its full concentrated focus on the mid-term elections of November 2018, Then we can expect to see nothing being done except more speeches and more promises.
Dang, that cynic again.

Anyway, what do you think. Let’s keep an eye on it because we’re all in this together.

Until next week.

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

We didn’t have to stress about saying Merry Christmas, this year. Thank you Mr. President!

December 21, 2017

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

So this week instead of promoting or dissecting some aspect of healthcare reform let’s look for aspects of 2017 and our own lives in America that bring peace and good will to man.

So, thank you to:

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

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

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

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

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

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

 

Skinny Plans, what are they and why do they draw so much criticism? Let’s look at the truth.

December 14, 2017

We have all witnessed this term “skinny” become common for promotion of many facets of our everyday life. Skinny margaritas(I’ve heard of these but never ordered), skinny chicken, skinny shrimp or other skinny menu items, and skinny jeans (which I totally don’t understand), and many-many more common everyday items turned skinny in our everyday life. I apologize, in advance, for discussing anything “skinny” midway between Thanksgiving and Christmas but it is important to address the term as it is being used in the effort to obstruct the needed overhaul of healthcare in America.

But, calling a health plan “skinny” , while descriptive, may be misunderstood my most which opens up the opportunity for opponents to mislead the public about the potential positive impact of these plans. So, let’s look a little deeper.

As we’ve stated many times before, clever names or phrases are often used to criticize an idea then the name quickly becomes the label that misleads the public from the truth. Such is the case with the rhetoric we’re hearing and reading concerning medical plans that are not compliant with the mandated benefits of the ACA.

People started calling these “not 100% compliant” medical plans “skinny” in an effort, I believe, to mislead the public. At the very least the term is being used to draw attention or improve the critic’s own ratings.

Why do critics think that we Americans should not have more plans from which to choose for employer’s or our family’s health plan. Sure, many Americans are uninformed about quality maybe reality, as is evident by the popularity of such shows as the Bachelor or sports like soccer(too much trotting around). But when it comes to healthcare I think people know what they can or can’t afford and what they need or don’t need.

Plus, our citizens can always turn to the thousands of qualified insurance professionals available in every state in America. Insurance agents are well trained and can easily assist Americans in making the best choice for their needs and budget. But, agents need, just like the public needs, these alternatives so that the citizen can make the choice that best fits their own personal need.

So, what are these plans that so many fear will undermine the integrity and financial stability of our nation?
What will a Skinny plan likely not include? They may not include:

  • Pediatric dental and vision for adults.
  • Unlimited brand name Rx.
  • Maternity
  • Pregnancy termination (abortion)
  • Unlimited Office visits
  • Unlimited lifetime benefits
  • GI without reasonable pre-ex policies.
  • All of the 63 MEC benefits
  • Other benefits that increase premium but nobody uses.

What will skinny plans likely offer:

  • Choice of Copays.
  • Telemedicine.
  • Maternity if desired.
  • Wellness (true wellness with incentives).
  • Choice of PPO networks.
  • Higher OOP to lower premium
  • Lower OOP plans for more choice.
  • Alternative Rx plans
  • HSA option with higher HSA allowance.
  • Higher OOP for wasteful healthcare decisions.
  • Lower OOP with incentives for smart healthcare decisions.

There will be dozens, possible hundreds, of plan choices instead of the current 4 choices available! Health plans will be developed ranging from Minimum Essential Coverage to Cadillac rich plans. Employers will be allowed and encouraged to buy minimal plans that can be enriched with HRAs.

The bottom line – at the end of the day – when all’s said-n-done, the objective is that the insurance industry, led by local TPAs, will provide America more choice with better benefits at lower costs. Now what’s wrong with that?

I’m serious, what’s is possibly wrong with that? If you have objective arguments against these options please let us know. And, please don’t argue that these plans will hurt insurers by taking all of the good risks and leaving the bad risks to the insurers. It’s all GI so the risks can go where they think their needs are best served.

But, let me know your thoughts because we’re all in this together.

Until next week.

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

 

Watch for the coming News “onslaught” concerning enrollments on ACA individual plans. Watch for actual enrollment numbers and blame!

December 7, 2017

Most Americans are most likely unaware of the enrollment process going on around the Country as six to eighteen million (number varies depending on source) American go on-line to enroll in the ACA individual plans available through State Exchanges or ACA.gov.

Most are not aware because out of a population of 330 million Americans only 10 million were signed up last year which was less than 3 percent. If one does not qualify for the subsidies offered through the ACA Exchanges then most people wanting an individual plan will sign up directly with an insurer.

During the initial  21 days of enrollments the Media anxiously reported that enrollment figures were ahead of a year ago substantially. But that will not last as today’s reports state that enrollment has slacked off greatly.

The media will ultimately tell us that enrollments are down because President Trump did not authorize the CSR subsidy payments, which caused premiums to increase. That is not true, of course, but the average citizen won’t know the truth. Unless they have followed our Posts.

It will be interesting to see the actual enrollment figures especially if Congress does insert the elimination of the Individual Mandate in the proposed Tax Bill. I bet the Mandate waiver remains which means there will be people not enrolling or canceling coverage because there will no longer be a tax upon them for not enrolling. It would be fascinating if Las Vegas bookmakers were to allow wagering on enrollment figures. My wager would be for fewer than 8 million. So, what should we expect?

On a separate and unrelated topic; today is December 7th. These days most folks go about the day without acknowledging the importance of this date in American or World history. I mentioned this because last month on November 10th we celebrated the Veteran’s Day holiday with a day off, without much fanfare.

I played golf that day (Nov 10th) and commented to a friend “do you remember when we were kids in school acknowledging Veteran’s Day by standing up with a moment of silence at 11am?”. Of course he did and today is December 7th, a day proclaimed by President Roosevelt in a message to Congress in 1941, that would live in infamy after the attack on Pearl Harbor

I mention this subject because I am increasingly concerned that our current population and our legislators will be less able to learn from our nation’s experience and its history if we stop acknowledging that history and those experiences. How will we successfully deal with radical Islamic terrorism, threats from N. Korea and Iran, or the ongoing war that Russia and China wage against the US if we are not willing or unable to remember how we mishandled threats and issues in our Nation’s past.

It also applies to important issues we face as a nation such as the financing and delivery of healthcare. If we are unwilling or unable to look back at insurance “policies” and solutions that worked in the 1980s, and 90s then we will continue to get results such as those delivered by the ACA.  The ACA was suppose to deliver better access and lower costs but does neither. We can still recover but not if we neglect those principles we know to be sound.

This was just something on my mind.

Much to discuss in the coming weeks about the ACA as well as potential changes in healthcare delivery and financing. I fear the trek to improve what our citizens see on both group and individual plans will be slow but we must continue the struggle.
Let me know what you think.

We can’t let up because we’re all in this together.

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

Will “political gimmick” of eliminating the ACA Individual Mandate in the GOP Tax bill cause higher premiums for Americans not subsidized. Yep!

November 30, 2017

Everyone wants lower personal taxes and lowering corporate taxes will create more jobs and higher wages. But political gimmicks to get votes, such as eliminating the Individual Mandate (I Mandate), is another example of weak leadership and the GOP being unable to pull its ranks together. The GOP won’t get another chance to lower or reform taxes yet they once again muddle up the effort with gimmicks.

The Congressional Budget Office has estimated that repeal of the insurance requirement would save the government $338 billion over 10 years. That estimate comes mainly because the CBO projects that fewer people would seek subsidized coverage.

There’s a gimmick for you because there is no evidence or reason to think that people who could get a subsidy won’t sign up for it simply because there is no mandate penalty. If you knew that you qualified for a subsidy for your health insurance why on earth would you not sign up?

CBO estimates the number of uninsured would rise by 13 million during the same 10 year period used for the budget gimmick. The CBO has been so wildly incorrect in its estimates concerning coverage that why would we believe its estimate of 13 million fewer covered. BTW, statistics show that there are approximately 30 million Americans without any coverage while only 10 million covered under the ACA individual exchanges. And that’s with the Mandate in place so the I Mandate makes little impact.

The I Mandate as well as all of the ACA should go away and be replaced but eliminating the I Mandate will definitely put pressure on insurers to increase premiums on their individual plans in or out of the exchanges. If people are not punished by a tax if they don’t get coverage, then allowing people to buy coverage only if they need it will certainly lead to higher premiums.

Business Example:
Let’s assume that my business replaces windows in office buildings.
I get a call to estimate the price to replace a window in an office building. I’m told that the window is on the first floor. I quote $100.
But when I show up to do the work I discover that the window is actually on the tenth floor, not first floor. Do you think my price to install the window will go up?
You bet it would because the risk to install the window has gone up!

So, the result will be higher premiums for people who need good comprehensive health insurance. But there is hope for those of us who are optimist as foolish as I may seem. The GOP’s tax bill does not eliminate the I Mandate until January 2019. That would give the DOL/HHS/IRS time to spell out the guidelines on President Trump’s Executive Order providing for Association Health Plans and for selling cross state lines.
The potential from the President’s EO could bring many new insurers and plans into the market providing more choice and lower premiums to those Americans whose premiums we believe will increase. But that starts the clock ticking to get those new guidelines to the public so that insurers and more likely TPAs can develop the plans we all need.
OK, so I’m trying to be optimistic even though I dislike mucking up the GOP tax bill with gimmicks. If we had our way I’d say just reduce the tax rates and brackets but leave the other “Cr***p” like SALT and medical expense deductions alone. But the GOP leadership can’t seem to keep it simple, defensible and passable. We saw that on R&R didn’t we?
As I write this the Congress is off for yet another holiday break (Thanksgiving) but when you read this the Congress will be back in session and we will see that once again, we’re right!
As is usual in politics, the benefit and cost for 330 million Americans is being adversely impacted by the political and media agenda on 6 million(or fewer) Americans. It could be positive for all with proper leadership on the topics of budget and healthcare.
Let’s keep the pressure up cause we’re all in this together.
Until next week.
Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

 

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

November 21, 2017

We’re Posting two days early as we take a break from discussing healthcare reform and the ridiculousness of Washington DC to pause for one of our most cherished of traditions.

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

Most of us don’t research the reason for any holiday and we are perfectly happy enjoying the time off from work. I say this as someone who is not good help and therefore banished from the kitchen so Thanksgiving Day has always been a full day of food, parades and football. (Except this year, it’s just food and parades since we can’t watch the NFL until the protests against our National Anthem stop.)
But that’s not the story for today.

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

Early thanksgiving observances

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

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

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

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

Harvest festival observed by the Pilgrims at Plymouth

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

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

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

So, there you go, a brief history lesson for us all. Can you imagine our Congress declaring a day be set aside for honoring the Almighty who Dweleth in the Heavens in 2017?

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

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

Charges concerning Sexual Harassment, rampant in the news lately, seem to be every where. It provides me a selfish opportunity to promote TPAs as a career path for women.

November 16, 2017

This Post is not intended to minimize the many stories about the impact of sexual harassment in the workplace. There is no way for most of us to know how being sexually harassed in the work place feels emotionally, spiritually, or physically especially chubby middle-aged guys like me. The stories are disgusting and abhorrent to any sense of normalcy in the workplace. So, this Post supports women in the workplace.

Let me frame the discussion. Your humble author has been married (to a women) for 32 years and I have three terrific daughters. In addition, I have worked at three TPAs in my career and each one of those companies has/had 70-90% female employees. The point is that I have personally witnessed the effort, input and sacrifices that women must make to be in the workforce.

That’s why I decided to write this shamelessly self-serving Post to promote the advantages of TPAs as a career choice for women. I have never heard of a harassment issue in this industry that was not dealt with immediately and appropriately. That’s why I think women should consider applying to and working for TPAs in their local community.

I am friends with many people at a number of TPAs and I have visited or know how many others operate. Without exception every TPA is dependent upon and could not function without the women employed. In my opinion this clearly shows that women are indispensable to these businesses. My opinion also includes other niches within the insurance industry.

Women routinely hold 50% to 90% of the management positions at TPAs including as  President, CEO, Vice-president, General Manager, CFO and other key positions. Women hold management positions in Accounting, Administration, Marketing, Sales, Customer Service, HR, Underwriting, as well as Technology just to name a few. Women also fill the multitude of staff positions which no TPA can live without in every aspect of the business.

At every TPA I know women are key to current operations as well as strategic planning for the future. It pains me to sound a bit sexist but women actually have advantages over men in the insurance industry. They are willing to work hard or harder than many men, they don’t feel entitled, they are more detail oriented, more empathetic to member’s issues and don’t doubt the power of a women’s gut feelings or intuition.

If I could give women career advice I would suggest strongly they investigate the insurance industry and specifically TPAs as career path. There are opportunities  available in all of the areas mentioned above. But maybe most of all, a woman will be appreciated and will be able to make a difference in the lives of many others without fear of harassment or of any inappropriate situation going uncorrected.

Don’t misunderstand, though, it takes a desire to learn the business with all of its regulations, policies, procedures and bureaucratic hassles. TPAs are the backbone for the delivery of employer sponsored benefits to millions of Americans but it is not an easy business, by any means. Maybe that’s why women have an advantage over men.

Forgive me for not focusing on the ongoing dilemma caused by the ACA but I felt it important to reach out to women to let them know they don’t need to put up with any bullsh##t in the workplace. And they won’t at a well managed TPA.

So, that’s it. Let me know what you think.
Concerning harassment, either sexual or any other kind, we are all in this together.

Until next week.

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

 

Rates for the subsidy-eligible ACA Silver Plans projected to increase by an average 34% in 2018. Who does this really affect? Not who you think!

November 9, 2017

The Media as well as private news sites and blogs are making a lot of noise about the projected increase in premiums on ACA health plans for 2018. Clearly, 90% of the US public will be mislead by these headlines and not understand who these premium increase will affect. And who is paying for them. Let’s look closer.

Most reports are trying to blame President Trump’s decision to discontinue the Cost Sharing Reductions (CSRs) as the reason these rates are increasing. I don’t think that’s true and I don’t think 90% of America understand the truth about the plans and citizens for whom these plans apply.

Remember, the CSRs apply only to:

  • Roughly 6 million out of the 10 million Americans covered by individual Silver plans on State Exchanges.
  • These citizens get their premiums and out-of-pocket (OOP) costs subsidized.
  • So their OOP is not effected by increased premiums or the decision to discontinue the CSRs.

A couple other points to remember:

  • Insurers are not obligated to offer individual plans on the Exchanges.
  • If carriers offer similar plans on and off the exchanges then the premiums must be equal.
    • This is a somewhat awkward requirement since On Exchange plans have fees added on to pay the Exchange.
    • That means that Insurer plans Off Exchange, if their plan mirrors an On Exchange plan, must match the price.
    • That means the insurer keeps the cost added in that was due the Exchange.
  • BUT, insurers can offer different plans off the Exchange than on the Exchange with those Off Exchange plans can be priced however the insurer deems is appropriate.

To summarize:

  • Americans can buy their individual plans On or Off Exchange depending on their own needs or desires.
  • Only On Exchange Silver plans qualify for Subsidy for either premium or OOP.
  • Subsidy is based on annual income relative to Federal Poverty lines
  • Insurers are allowed to offer plans Off Exchange that are different from On Exchange plans.

The ACA did change the way individual plans are priced, the benefits offered, how they are sold and how they are underwritten. They are guaranteed acceptance with no denial of any treatment due to previous health history or treatment. The ACA made it possible for anyone, including the least healthy, to buy a policy that covers what ever ails them.
And do so almost when ever they choose.

Remember, an Off Exchange plan is simply a health insurance plan that is available from the insurer direct without the need to go through an official Exchange. It can be different from On Exchange plans both in benefits and premium. Honestly, there are probably only two reasons to shop through the Exchange:

  • One, is if applicant will qualify for subsidy.
  • Two, the applicant does not know or want an agent to be involved. (Foolish)

 In most states there are more plans available Off Exchange than ON. Most advisors will advise that the only reason to use an Exchange is if you will qualify for a subsidy, one must admit that makes sense.

So, the premium increases the press is screaming about affect a small number of citizens who are not responsible for the premium or OOP on the Silver plan they select. That means they are NOT paying for the increases the media is protesting. So, who does?

If the pundits and ACA proponents had their way it would be you, the US tax payer, who pays these increases. Your cost would be paid by the CMS and HHS which are funded by your taxes.

As we projected in earlier Posts, the Media and libs are making a big deal by distorting the facts and misleading the rest of us Americans. Six million Americans  affected, out of 330 million people, and those six million won’t be paying the increases anyway.

So, premium increases on both individual and group plans have little to do with the Presidents decision to discontinue the CSRs. The reasons for the increases are complex but basically the result of the ACA and its punitive restrictive rules.

Those are the facts as I see them. But what do you think, after all, we are all in this together.

Until next week.

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

 

 

 

 

 

 

  

 

 

 

 

 

Tax Reform, may not seem related to Healthcare Reform, but it is. Particularly, the deduction of State taxes on Federal returns. Let’s see why.

November 2, 2017

This Post may seem odd to those in states that have no or very low state income taxes. But the prospect that Congress might pass and President Trump sign a bill causing the elimination of the deductibility of state taxes on Federal returns is a possibility.

Let’s frame the discussion a bit.
For example, California and New York have state income taxes on their residents that are among the highest tax rates in America. Why do these states tax their residents so highly? It’s widely reported that it’s because these states are also the most liberal in entitlement payments to residents. You’ve all read how much is given away to residents in these states with little or no accountability and seemingly little fear for how to pay for the entitlements in the future.

Heck, in CA is seems the Dems seldom say “No” to any give away to residents (legal or not) not to mention the many restrictions on business. These attitudes result in a tax policy that is very burdensome to employers, employees and the folks who pay the majority of the taxes in Ca. and many other states.

To help offset these high state taxes the folks in Ca. and NY (and other states) are allowed to deduct the state taxes they pay from their Federal tax return which eases the pain (tax due) caused by Federal income tax, a bit. It also means that the tax payers in these states get higher deductions than tax payers in other states.

Your humble author lives, works and pays taxes in Ca so eliminating the deduction for state taxes would affect me directly. But is this one of those times when one must look further ahead than just the next tax year and make decisions based on what’s best for the Nation. I don’t mean to sound too honorable because it is my hope that if these deductions are eliminated that then more Ca citizens will stand up against the continual onslaught by Ca’s Legislature against financial fairness and accountability.

So, if more people of means or at least higher income taxes in Ca and NY  stand up and fight against foolish spending, frivolous projects and staggering regulations that kill opportunity for everyone then maybe everyone will have a chance to improve their lives with more jobs with higher wages, better access to healthcare and a chance to change the lives of their children and children’s children.

You know that I am an optimist trapped in a skeptic’s body, but are my ideas naïve? Well, what we have is failing so what do we have to lose if we give it a try.

When I moved to Ca in 1985 it was a different place with opportunity that fueled the ambitions of those willing to try. It also was a state in which one could take an idea, build on it and with luck and toil make it work. Sure, Hollywood and Silicon Valley have created a bunch of Ka-zillionaires but what about the folks that just wanted to start a small business to create jobs for others so they could prosper and live better?

The economy grows because of the small businesses that employ just a few employees, that provide sound benefits and good wages. It can be that way again if we make some well conceived gradual improvements.

So, how is Tax Reform related to Healthcare Reform? If people in Ca and NY (and other states) can’t deduct their “high state taxes” and therefore become frustrated by higher federal taxes, then maybe they’ll start looking for ways to reduce other costs. One area would to make more reasonable decisions about  reforming healthcare financing.  Healthcare premiums and OOP is costing many people more than their taxes.

Anyway, I think it’s possible. Let me know what you think because we’re all in this together.

Until next week.

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

Association Health Plans, AHPs, as predicted may soon be reality. But, opposition will be intense and insane. Let’s look closer.

October 26, 2017

As he promised, the President signed an EO directing the Departments of HHS, of Labor, and Treasury to review and implement guidelines allowing for AHPs and for the selling of these AHPs cross state lines.

Be for-warned that the opponents of AHPs, selling cross state lines or any change to the ACA will scream bloody-murder & disaster. They will “cry” that babies will die in their mother’s womb(don’t say it, too easy), that children will go without vaccinations, that women won’t get their lady healthcare, that severe disease won’t be treated and that our streets will be filled with the bodies of citizens denied care. Think that’s too strong? Just watch!

Why would any employer or citizen purchase a health plan that did not fit their needs unless they were forced to, as they are by the ACA. So, let’s take an honest look at AHPs and project what could happen, if the GOP gives us a chance.

AHPs are not a new concept and there are countless examples of where and how they have been successful. In California, for example, there are dozens of examples of successful AHPs, from the pre-ACA era, that provided alternatives for CPAs, Attorneys, Auto Dealers, Chambers of Commerce, Builders Associations, Growers Associations, Engineers, Architects, Plumbers, Contractors, Farmers, even Insurance Agents and you can go on for ever.

Why the confusion or fear? Setting aside the obvious political and ideological opposition let’s look at this logically. There are examples of successful AHPs that are both Fully Insured and Self-funded. But, there are also examples of AHPs that failed which were both Fully Insured and Self-funded.

Why were some successful and some not? The answer, as success always is, is complicated but reasons include burdensome regulations and over-reach by regulators, hundreds of miscellaneous state mandates, poor management or sometimes mismanagement, managed care, PPOs, competition and changing times. But, the fact remains that history shows us how AHPs can work and don’t we all agree that small employers need alternatives to what’s been forced upon them the past 7 years.

Let’s look at some specifics both bad and good. The bad first because it’s possible that:

  • Some AHPs will be created and sold that fail.
  • Some AHPs created may offer less benefit than ACA EHB’s require.
  • Some purchasers may not understand the AHP presented to them.
  • Some Brokers may not understand the AHP they’re presenting.
  • Well designed and managed AHPs could take healthy customers from existing plans.

Now the good, because AHPs:

  • May be created with EHBs but still lower premium cost.
  • May include richer benefits than the ACA plans with EHBs.
  • May result in lower out of pocket for members.
  • Will provide alternatives and more choice.
  • Will be well-managed and properly presented.
  • Not every one requires Pediatric dental or other mandated benefits.
  • Small employers will get choices similar to large employers.
  • Restrictive “state specific” limitations can be over-come.
  • Employers will get better transparency in their plans.
  • May increase enrollments.
  • Brokers will be enabled to do their job!

The last bullet is important because I believe that insurance brokers are better suited to counsel employers than state bureaucrats or ACA enrollers. Brokers, given the chance and products, will help employers select the plan(s) that best suit an employer’s goals of providing a health plan to its employees.

If the Depts. of Labor, HHS, and Treasury do their job well, AHPs will allow employers:

  • Access to Fully Insured and Stop-Loss plans that currently can not be offered due to the ACA’s or local state restrictions.
  • Buy with discounts like other large purchasers can. (Do you think Wal-Mart pays the same price for the goods it sells as your local independent small store?)
  • More competitive pricing from the current plans available.
  • Make plans available to employers where none are available now.

There are many details for us to see worked out by the various departments noted above. Those details and the process to create them will be viciously assaulted by opponents of AHPs and any change to the ACA.

Already, we’ve read statements by one leading Dem Congresswomen Americans will have their pre-existing conditions denied even though there is no evidence to support that claim. Plus, why would a broker present or an employer purchase a plan that hurts the very employees the employer needs for success.

AHPs could lead to some exciting opportunities to improve healthcare in our country. Plans created by innovative TPAs will offer solid benefit packages with lower premiums that include cost controls, transparency, and stability for the next 3-5 years.
Jeez, wouldn’t a little stability be nice.

That’s it for now but we’ll watch this development as it evolves. Let us know what you think. We want to hear concerns as well as platitudes for these AHPs.

Never a better time cause we’re in this together.
Until next week.

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