Archive for the ‘Short Term Medical’ Category

A special post Mother’s Day Post. Everyone has or had a Mother and we generally honor them on Mother’s Day. But do you ever wonder what your delivery cost your Mother? Let’s look.

May 17, 2018

I know that you are reading this after Mom’s special day but give me two minutes to enlighten you on the cost to your Mom, at least medical cost, of bringing you in to this world. Now, I can’t address all that you cost your Mom since then but that is another day.

The tipping point for maternity costs, all medical costs really, was 1967 and the Medicare Act. Yep, that grand old bill that 80+ million Americans count on today was the catalyst for an explosion in healthcare costs.

My first daughter was born in 1986. When we visited the hospital where she would be delivered we were ushered into a room with dozens of other hopeful couples. The hospital staff’s goal was to convince us to utilize their hospital when our lucky day arrived. So, they presented all of the terrific features the hospital offered as well promoted their staff as being experienced, caring and loveing what they do.

The hospital administrator presented several option for delivery each having a different price attached as well as easy payment plans, if desired.

  • If you just planned to stop in, pop out the new little one, then go home in less than 22 hours the cost would be $1,800. I remember the 22 hours comment specifically because I remembered thinking, how does someone get in, deliver a child, and get out in 22 hours.
  • Then, for you more traditional types who plan to take your time, labor for 20 hours, then get some rest before you go home and the cost would be $5,600. I remember the $5,600 because it struck me as an arbitrary number and I wondered how many times they actually kept to that estimate.
    Heck, we all know aspirin cost $12-$18, depending on time of day.
  • Now, for you couples who might have a little complication in delivery or just want to choose the day and time of day your baby is born, they offered cesarean or C-section delivery. That was $12,800. For that price they’ll let you stay 3-4 days, teach the Dad how to change a diaper and feed you a steak & lobster dinner on your last night. Got to admit, the steak and lobster was pretty good.

That experience was at a respected hospital in the west San Fernando Valley of California. These prices, as well as last meal, vary greatly as one crosses the country.

I remember people telling me what a delivery would cost in “the old days”. Great friends of ours, who were 30 years older, regaled me with stories of how their first son, born in 1953 cost $250. Plus they paid the nurse $50, just because she was so nice to them.
I’ve had dinner for 4 in the San Fernando Valley that cost more than $250.

We’ve all heard the stories of the doctor getting paid a couple of chickens or a prize pig for his OB work. I can’t imagine the anguish of giving up my prize pig. That’ll make sense for those of you who know my origins.

On the other end of the spectrum there are the unfortunate many who have premature or early delivery or other complications. In 1993, I heard Leonard Schaffer, former CEO of Blue Cross of Ca., state to a group that  Blue Cross of Ca. had a $1 million baby born every week. He did not mean it in any glib sense but only as a fact related to healthcare cost that would be meaningful to the group.

In 2018, babies are as adorable as ever but a lot more expensive. Again, I’m speaking only of delivery, not the other stuff they cost their parents. But as we celebrate or rather celebrated Mother’s Day we should all reflect on this lesson to share with our kids.

Abstinence is the only means to 100% prevent pregnancy. Seriously.
Jeez, that sounded like Smokey the Bear and his forest fire warning. That doesn’t work either.

The point in this post Mother’s Day Post is that we love our Mom’s, or the memories of our Mom’s and this day gives us a chance to pause to be thankful. But also that it’s a great example of how healthcare has changed in both services available and costs. It also amplifies the urgency to solve the crisis in healthcare cost and access.
Plus, because of our Mom, we’re all in this together!

Until next week.

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

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”.

 

Insurers expected to increase ACA premiums sharply this Fall because they did not get their “bail out” funds. Guess who gets the blame?

April 12, 2018

 

Isn’t it interesting that when predictions come true about the failures of the ACA, the Left and the Media go looking for someone to blame? In this case the failure predicted is collapse of ACA State Exchanges with the projected “premium spikes” for the Fall of 2018 and the blame goes to Congress and the President.

But the blame game continues as Insurers, politicians at every level, and the Media lay the blame for the expected premium increase squarely on the Congress and the President. The “blamer’s” logic is that Congress failed to include any funding for bailing out Insurers in the Tax Reduction and Jobs Act in December 2017.

 The “blamers” also are saying that the GOP  had a chance to lower rates with an amendment that a couple Republicans had hoped to attach to the $1.3 billion  spending package passed on March 23, 2018.

Let’s clarify a couple things:

  • The ACA’s re-insurance “subsidy” program paid participating insurers huge taxpayer subsidies from 2014 until the program was scheduled to expire at the end of 2016.
  • The subsidies were designed help get the ACA Exchanges up and running but not remain intact beyond that point. The intent was to cover two issues:
    • One – the claims of high-cost patients for whom the law’s preexisting-conditions provisions provided guaranteed coverage.
    • The extra subsidies were supposed to keep premiums from skyrocketing. Obviously that failed as premium increased astronomically each year since 2010. By the end of 2016, premiums had doubled from pre-ACA levels.
  • The premium spikes you are hearing about will only affect the individual plans in state exchanges, the so-called Obamacare Plans. The premium increase will impact less than 10 million Americans and 90% of those receive subsidies so they pay almost nothing for their coverage and care. 
  • These points are important to remember because the Media will try to stir up activist who will then cry for single payer.

 You know this Post is no fan of the GOP’s efforts to R&R the ACA over the past 12 months, actually past 7 years. Additionally, we predicted delays and Democrat inspired litigation issues as the GOP continues its piecemeal approach to fixing our healthcare finance and delivery system.

We have already witnessed evidence of this by the lawsuits filed against the President’s efforts for Association Health Plans and allowing Short Term Medical plans to extend to 12 months.

Who does this lack of “bail out” impact the most? The Media would try to make you believe that the folks covered will be harmed but as we stated earlier that is untrue since 90% of the folks covered by these Omabacare plans pay nothing or almost nothing for their premium or services that they receive.

So, who else does this impact? The answer is the states that so enthusiastically embraced the ACA and rushed to create their Exchanges back in 2010 through 2014. They knew that their citizens would get the subsidies offered so they anticipated great enrollment numbers and enrollees would be “hooked” on Obamacare and unable to leave. It’s the so-called “blue” states feeling the biggest impact.

Reports indicate that some states are seeking their own solutions. Ironically, this funding issue may actually cause states to adopt realistic changes and better solutions than the ACA could ever provide. Let’s face it, government bailouts, especially bailouts for government initiated programs, seldom resolve issues and generally lead to more and more funding. Lot’s of examples of that over the pass 50 years.

Some reports indicate that a few states (mostly blue) are looking for how a they could restore the individual mandate (IM). Actually, there are many experts,”real experts”, who believe the elimination of the IM will lead to more reliance on Employer sponsored coverage thus reliving that burden on the states where the citizen lives.
Two things come to mind about that.

  • One – Employer sponsored plans tend to be less costly to members and provide richer benefits than the ACA individual plans.
  • But we wonder- Do “blue” states really want their citizens to leave the state-run and controlled plan for an Employer’s plan? The state would lose control/dominance over that member so you decide the state’s motivation.
  • States are in the news about their plight and their possible steps to fund the Insurers themselves. But will any of them really step up? Or is it just talk?
  • It is realistic to see states take steps to utilize the opportunities President Trump set forward with AHPs and 12 month Short term Med Plans. We’ve already seen efforts by Utah, Iowa, and Wisconsin to initiate steps in that direction.
    Of course, the Dems have threatened litigation.

In an election year it’s easy to predict that these issues will get much press, mostly uninformed or lopsided, but that noting will be resolved. As we’ve witnesses in the discussion concerning the Daca folks and immigration, issues are more important than solutions for certain politicians.
This premium spike issue will work for candidates because most or our citizens will not realize that it affects only the Exchange Individual plans (less than 10 Million people) which is less than 3% of our total population.

The states that ramped up their subsidized Exchange Plans as well  as expanded Medicaid eligibility are in a financial bind. As stated by Mila Kofman, executive director of the D.C. health exchange, “States don’t print money, and individual markets, to become stable, need an infusion of federal dollars,”. Doesn’t the verbalization that “states don’t print money” sound a bit creepy coming from a bureaucrat’s mouth?

In 2010 to 2014, many of us predicted that the ACA subsidy program would become an issue, when it became clear to us that the Federal funding for these programs would cease in 2016. Come on…, we all know that States receiving Federal subsidies is like an addiction! Did anyone expect States to wean themselves off the addiction?

You can see now that while the Media gives time for politicians (including a few in the GOP) to complain and lay blame the crisis was predictable and the solutions are available. But, it’s an off-year election year so getting elected and re-elected is more important than real solutions.

What do you think? In this case we truly are all in this together because the assistance the politicians seek for less than 10 million will adversely impact 330 million of us.
Again, that’s 330 million people impacted so, we really are in this together!

Until next week,

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

 

 

How can the average American stay informed about the public issues and policies that impact our lives? It’s not easy folks!

April 5, 2018

I realize the heading to this Post is a bit superficial and maybe beneath our readers standards but in such an important election year the news we see and hear is, too often, either salacious to attract viewers, narrowed by the presenter’s bias, intended to distract from important issues or just plain fake.

The talking heads on TV, both Cable and Network, will pick up a story line planted by someone with an agenda then pontificate upon the subject with what ifs and maybe’s for days. It’s tiresome for viewers, for sure. Then the initial story will be proven false or inaccurate or simply fade away.

We are in a period now in which the news should be full of Big Pharma & Insurer profits and high premiums, weak coverage with few providers and the overall failure of the ACA to accomplish what it was advertised to do. The News should be honestly covering other important issues such as immigration and the Dem’s neglect for Daca, Russian provocations, President’s planned meeting with NOKO leader, the effects of other country’s unfair trade policies  on America, terrorism within our borders, not to mention the unimaginable breach of our privacy by Social Media, to name a few.

What do we get for news instead? On most outlets its the story of Russia-Trump collusion and if that doesn’t work the private affairs of the President before he was in office, some reaching back 20 years or more. Or maybe the less scandalous but equal waste of time; the discussion about the House proposing a balanced budget amendment to the Constitution.

Experience tells us that our government in general and congress specifically understands the news cycles and what steps to take to engage what they desire and avoid what they choose to avoid.
For instance:

  •  Remember the Millions of Dollars in hush money pay by Congress on behalf of Congress members to cover sexual harassment allegations? We all wanted to see a list of those pay outs didn’t we. Have we seen such a list?
  • Remember Lois Lerner and John Koskinen of IRS fame? The GOP was going to uncover that for us so that it could never happen again. Lois Lerner’s testimony is sealed in Congress said to be for her personal safety. What about the safety of our citizens against the first or second most powerful force in America.
  • Unmasking of Americans by the Obama administration. US Ambassador Samantha Powers requested the unmasking of 360 Americans ( that’s right 360) during the last year of the Obama reign. Hear anything about that lately?
  • Catch and Release at the southern border. Sure, the number of crossings went down for several months in 2017 but ICE and the Border teams have no more space for retention or authority to retain those crossing the border.
  • Sanctuary cities and politician’s actions to restrict ICE. What’s being done to protect the legal citizens including those who immigrated legally. We are starting to hear about brave Americans like the those Los Alamitos, Ca who have taken a stand but will it gain notoriety?
  • Plus, the failures of the ACA to deliver better access and more affordable health insurance.

I could go on and you probably have other issues in mind as well. The point is that the average American, which is about 330 million average people, can’t stay up to date and certainly not excited about most of these issues. You’re busy going to work, raising your family, scratching out a living in an increasingly complex world.

The only people who seem to stay active and focused on issues is generally the folks who are impacted, or think they are, by current laws, policies, or morays. The other group that stay focused and mobilized are the folks who make a living off of generating headlines, often with misleading stories, to anger and excite the groups from which they profit.

We see it plainly in the marches recently by kids against guns, by people allegedly for DACA and immigration, against sexual harassment, for gender equality and so forth. Sometimes don’t you wish the policies or programs you support had the energy and outside money that some of these other groups receive.
Frankly, it impossible to maintain the pace to battle for what’s right and for justice.

I guess it’s human nature to be strongly for or against some issue but then run out of gas in the efforts to promote one’s beliefs. Plus, it’s frustrating to see Congress avoid common sense to process the expedient but worse to see Congress avoid common sense for their own benefit.

So it’s ho-hum, nothing’s changed including the frustration many feel. The answer is keep up the fight if you can, try to stay as informed, as you can and participate when you can.
After all, we are all in this together!

Until next week.

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

How “old” is too old for a fellow citizen to receive expensive medical care? Does it matter, if someone else is paying the bill?

March 29, 2018

This question about the age at which a fellow citizen should or should not receive medical treatment, especially the expensive treatments available these days, has been debated since the mid 1980s. The initial catalyst for increase healthcare costs years ago was the Medicare Act in 1967 but costs of care and premium did not really begin to accelerate faster than any other facet in our economy until the 1980s. 

For the past 35 years Insurers as well as the CMS/Medicare/Medicaid have analyzed the cost factors of delivering the healthcare people require or want. But with the advances in technology, medicine, new treatments for many diseases and expected life span into the 80s, controlling or even slowing costs has been a losing battle.

In 1990 the healthcare industry and all Payors acknowledged that the greatest volume of healthcare cost is consumed during the first year of one’s life and the last year of one’s life. When we consider the health issues of many expecting mothers, premature births, drug births as well as the heroic healthcare actions usually taken in the last year of one’s life, it’s easy to agree with that statement.

We need to remember what we’ve Posted before and what hinders cost control:

  • People are living longer and doing so with better standards of living.
  • Unlike any other population on the planet, Americans want (expect) to live forever and think their healthcare should help them achieve that goal.
  • The total cost of healthcare is the unit cost of care multiplied by the number of units of care consumed.
  • Americans want the best healthcare money can buy.
    (as long as it’s someone else’s money is paying the bill).

The last one is snarky to be sure but it’s also key to the issue at hand in this Post. Don’t think for a minute that this statement about “the best healthcare money can buy” is not true. We have all heard someone say that or maybe said it ourselves.

But much has changed since 1990 to our population, to Medicare, to Medicaid, to technology, to premium cost and to the changing opinion that quality of life may be more important than quantity of life.

My opinion on this issue of “how old is too old” has changed over the past twenty years. Partly, if I’m honest, because I’m getting near an age where younger folks might ask “why does he need a particular treatment”. Ouch, that hurts.

But the bigger influence to my opinion are the advances in medicine, in technology, and the life styles Seniors are enjoying these days.

I could list for you dozens of examples of good and poor decisions:

  • My Mother-in-law had knee replacement at age 86. She had always been active and loved to walk to visit friends. She lived to age 96 and was able to enjoy her mobility until the very last year of life. Good or poor decision?
  • A 100 year old lady had knee replacement at age 98. She lives in a nursing home and uses a wheel chair but she can walk if she desires. Good or poor decision?
  • A 90-year-old mother was in a coma after having a major stroke. The doctors said she had brain damage so she needed to be put on a breathing machine or she would probably die. The family said no because they remembered Mom saying that she did not want to live like that. Their mother died peacefully a few hours later.
    Good or poor decision?
  • I’ll tell you about my Mom below.

Many treatments or services are getting common for elderly above 80 years of age. Knee and Hip replacements are common, heart regulators or surgery are common, and cancer treatments are common just to name a few.

Those who face this dilemma about elder care must weigh their decisions hindered by so many unknowns and so many factors. Not the least of these factors is the financial motivation of the doctor or facility. Healthcare providers and facilities get paid by the procedure or days spent regardless of the outcome. So, as hard as it sounds, decision makers must weigh these factors along with the quality/quantity of life for a love one.

According to the U.S. census bureau, Americans aged 85 and older make up the fastest-growing segment of the US population. The number of Americans 100 or older is expected to rise from around 65,000 today to over 208,000 by 2030. 
So, these decisions are going to be more frequent and more difficult to make than ever before.

Many believe that we each should be able to decide when enough is enough. I mean, if one’s quality of life is not good, if one’s siblings and friend are all gone then why should someone endure a painful and depressing last few months on earth?

I wonder how many of our Seniors feel that way today although they do not verbalize it to their families. Even if they are a joy to be with the Senior may feel like they are a burden to their family. I truly wonder what each of us would choose if we could say a good bye to our family then quietly take a pill that painlessly let us drift off to forever. Would you do that?

It’s a tough question both emotionally and spiritually.

But is it a tougher question than deciding if your love one should or shouldn’t receive a particular treatment, regardless of cost, that might or might not provide a quality extension of life. 

My Mother smoked cigarettes for over 50 years then contracted a serious “brand” of lung cancer at age 66. The cancer Docs said a vigorous treatment of chemo and radiation treatment could extend her life by 18 months but without the treatment she would only last about 9 months. She/we elected the treatment which brutalized her body and mind making her feel miserable 20+ hours each day. She died 9 months later, almost to the day of that conversation with the cancer Doc.
Had she known that she would only last 9 months regardless of treatment, she might have altered her decision. She may have chosen to live “normally” without the side effects of the treatment until she past. I’m sorry, that’s a tough story.

The point is these decisions are extremely difficult. The treatments cost insurers and Medicare $billions each year. But each patient and each family may approach it differently with a different set of circumstances. No judgement here, just information for thought.

But, as we discussed before, we can impact healthcare cost and premiums for those years between birth and death if we stop politicizing the subject every damn time.
What do you think? You know that we’re all in this together, right?

Until next week.

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

 

 

Sometimes, don’t we need to take a step back to look at where we could have gone. That’s really true these days for Healthcare Reform!

March 22, 2018

Starting back in 1992 and repeated over the past 10 years we’ve written about the core issues to address in order to control and lower healthcare costs both from premium and from providers. But, as the calendar turns weeks into months and months into years it’s easy to lose sight of the fundamental issues and bedrock ideas, which when implemented, can make a difference.

These days the political discussion in Washington DC stays clear of “repeal & replace” for a number of reasons, mostly partisan reasons, actually. But if you listen carefully and follow closely to can see various congress folks trying to implement their own ideas to address some specific issue important to their own constituents, or their re-election.

Lately, we hear tell of “shoring up the markets” to control premium increases. We hear discussion about financial support in states that heavily adopted public exchanges. We hear about states longing for Medicaid expansion because the ACA is eating their state’s budget alive.

These discussions are really no more than scratching where it itches for those specific congress-folks. The actions those congress-men/women promote don’t really address the inherit problems caused by or neglected by the ACA . So, they won’t be more than a band aide on an elephant’s bruise. You thought I would say something else, didn’t you?

But you know that I am an optimist trapped in a cynic’s body so my hopes of replacing the ACA with a workable solution are still real although I admit guarded.
If you were asked for meaningful input in designing a workable solution. Could you do it? I bet you could and you’d come closer to a workable solution than the ACA did or the GOP has offered to date.

We first published the 12 ideas below in 2006. I think it’s worth dusting off these ideas to see which would still make a difference. What do you think?

  1. Make health insurance premium 100% tax deductible for anyone who pays it.
  2. Make all fully-insured plans for individuals and families guaranteed issue but with a reasonable Pre-existing condition period for no prior coverage.
    Pre-ex period: 12 months would encourage participation.
  3. Group plans of 2+ employees remain GI with No Loss-No Gain Take over.
  4. Allow carriers a reasonable corridor for Risk Adjustment Factors (30%). Also let insurers determine area rating factors based on their data and statistics.
  5. Tort reform: Loser Pays and/or Fixed Attorneys at 20%.
  6. Allow carriers and plans to sell across state lines. (Maybe the AHPs??)
  7. No new benefit mandates from States or Feds for five years plus allow insurers freedom to build plans that the market demands. That the people demand!
  8. Mandate HRAs permissible and available to implement on all plans.
  9. All insurers must publish and release statistics and experience data.
  10. Universal enrollment forms for all group plans and all individual/family plans.
  11. Health plan commission set at level 7% and does not increase as premium does.
  12. Providers must post their rates per service. Hospitals must post their outcomes.

We are all used to the ACA mandates of kids to 26 and wellness or preventive, so let’s leave those in place.
But, let’s eliminate Unlimited Lifetime levels and return to $5M per insured
Also let’s eliminate the Medical Loss Ratio (MLR) limits since no other industry in the world has its profit margin restricted like insurers do. 

Then let’s go crazy and build in incentives for employers to support wellness plans. If we want to bend the cost curve downward we must address member behavior and expectations through real wellness and benefit structure.

With the brief outline above we can provide solutions for:

  • Those that want to buy insurance but are un-insurable
  • Those that don’t want to buy & wait until they have a problem to buy insurance.
  • Guaranteed acceptance
  • How to push premiums lower
  • How to push unit cost of healthcare lower
  • Total transparency of statistics and outcome data.
  •  Improving benefits with lower out of pocket limits.

So, there is a quick review. I encourage you to give this some thought and to give us your input. If we put something together worthwhile then who knows; we might make a difference. There’s an election this Fall, remember.

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

Until next week,

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

People “think” the ACA Individual Mandate and its “penalty” is gone thanks to the Tax Cut & Jobs Act of 2017. But is it and why are so many confused about it?

March 15, 2018

As happens so often, people hear about an action taken by some level of their local, state or Federal Government authority and misunderstand its effect it has on them as well as the timeline for that effect in their life. The ACA Individual Mandate (IM) is addressed in the Tax Cut & Jobs Act of 2017 (TCJA). But two things seem to be confused.

One, its being reported that the IM is “repealed” by the TCJA but what is really more accurate is that the penalty for not having medical insurance coverage is simply being set to zero. As we’ve discussed in previous Posts, every effort to R&R the ACA by the GOP has included setting the penalty for non-compliance to zero. As discussed before, at any time in the future a new Congress, probably Dem but possibly GOP, can reset the penalty for not having coverage to what ever it decides and even higher that the levels within the original IM of the ACA. That should not be defined as “repealed”!

The second issue is that many people think they do not have to worry about a tax penalty for not having medical insurance coverage in 2018? That’s understanding is wrong. The IM and its penalties remain in place for the tax year 2018. In a statement that some called a “finger in the air to Americans” retiring IRS Commissioner Koskinen stated that the IRS will vigorously enforce the ACA IM penalty for tax year 2018. So folks, don’t let your coverage lapse.

We have started to see the next phase of the IM “repeal” as prognosticators predict and promise that the elimination of the IM will lead to a spike in premiums and huge drop in the number of Americans will health insurance. Seriously, do you think folks could tell the difference in their premiums after what they have felt so far over the past 8 years? Well, let’s wait to see shall we?.

My bet is that eliminating the IM will have minimal affect on citizens who do not get their health insurance through their employer. I’m certain that many individual States will take actions on their own to mandate coverage, especially Liberal states with a highly subsidized Exchange. But, even that action will not produce any noticeable change in coverage.

Those states suing about the TCJA or President Trump or taking other steps within their state will be busy for the next 2 years. They will see and probably resist the growth in Association Health Plans, the introduction of selling medical insurance cross state lines, as well as Short Term Medical plans.

So, if you are in the consulting business, are a CPA, or other tax preparer it would be helpful to clarify this issue with your clients and prospects. They may think you are really smart. They may just think ho-hum. But, you will be clarifying for them something that may save them some money.

That’s it for this week. Short Post, I know, but that’s because the subject matter called for no more and also because we’re focused on a few other topics in the weeks to come.

Let me know what you think.
Thanks for your feedback. It confirms for me that we are all in this together.

Until next week.

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