Monthly Archives

August 2017

A 35-year-old Google employee with Stage 4 cancer has a sobering message about not taking life for granted

By | Health Insurance

This Years Rates Going Up As Much As 55%

By | Uncategorized

Insurers seek health care policy clarity as critical deadlines loom

 Health Care FOXBusiness

trumpInsurers face two critical deadlines in September, by which time it appears increasingly unlikely they will have clarity on a number of key issues, including whether the federal government will continue funding key ObamaCare subsidies.

“Unless Congress acts by September 27—when insurance companies must sign contracts with the federal government to sell insurance on the federal exchange in 2018— 9 million Americans in the individual market who receive no government help purchasing health insurance and whose premiums have already skyrocketed may see their premiums go up even more,” Senate Health Committee chair Sen. Lamar Alexander (R-Tenn) said in a statement on Monday.

Alexander said lawmakers will begin hearings in September on stabilizing the insurance marketplace. He has also asked President Donald Trump to continue funding cost-sharing reduction subsidies, or reimbursements for discounted care provided to low-income individuals, until lawmakers develop a working solution to remedy rising health care costs. The White House has been making payment decisions on a month-to-month basis, while insurance companies have sought a more solid commitment, particularly after the president proposed letting ObamaCare “implode” by eliminating the subsidies altogether.

Meanwhile, insurance companies have been searching for ways to deal with the CSR payment quandary. One of the nation’s largest insurers, Anthem (ANTM), warned late last month that without certainty regarding these payments, it could be forced to narrow its participation on the exchanges even further. In the weeks since Anthem issued that warning, it announced its withdrawal from the ObamaCare marketplace in Nevada and a dramatic reduction of participation in Georgia.

Aetna (AET) and Humana (HUM) announced earlier this year they would not offer plans on the individual marketplace for 2018, citing marketplace volatility and the damaging costs of participation.

For the companies choosing to remain, hiking premiums is one of the popular ways to mediate policy uncertainty. Molina Healthcare (MOH) announced earlier this month it would seek a 55% premium increase in the marketplaces where it would remain next year. That number would drop to 30% if cost-sharing reduction subsidies were definitively funded, the company said. Meanwhile, PacificSource Health Plans in Idaho has requested a 45.6% rate increase. In California, monthly health premiums are set to rise by an average of 12.5%, state officials said earlier this month.

Insurers have to submit final premium proposals for 2018 by September 5, the first day of the Senate Health Committee’s hearings. Unless the government makes a decision on CSR payments by then, insurers will be flying blind on how to price plans accurately. They have asked the federal government for $8 billion in payments to fund discounted consumer care over the coming year.

September 27 is the final deadline for insurers to sign contracts for next year’s health care plans.

 

How Far Does $1 Million Go in Retirement?

By | Health Insurance

From Mississippi to California to Hawaii, here’s the purchasing power, state by state.

A million dollars—it has a nice ring to it. But as Dr. Evil learned after spending 30 years cryogenically preserved, it may not be enough—for many people, certainly not enough to comfortably retire on, depending on where and how long they live.
The upshot: If you want to stretch your dollars as far as they can go, you need to head down south.
Where a Million Lasts Longest
 And here is the flip side of that picture, with more states commonly considered retirement destinations, most with the higher costs that go with that.
Where a Million Lasts Longest2

These are conservative figures. They don’t factor in any entertainment or travel, which would make for a pretty grim retirement. Nor do they take into account how inflation might cut into purchasing power as we age. Inflation can take a bigger bite for seniors, because medical costs, which may account for a bigger chunk of expenses, have an inflation rate significantly higher than that for the broad economy.

Health-care costs for retirees will rise at an average annual rate of 5.5 percent over the next decade, according to HealthView Services, which makes retirement health-care cost projection software. To put that in perspective, from 2012 to 2016, the average annual broad inflation rate in the U.S. was 1.9 percent.

The annual expenditure numbers also don’t factor in any return on the pot of money seniors are presumably holding while they live in retirement. Gains there could offset purchasing power lost to inflation.

Still, the data are useful in starting to map the relative power of a fixed sum of savings from one state to another.

For many people, the idea of a million-dollar pot of savings for retirement is a dream. Many survive on less. For others, a million won’t be nearly enough to fund the kind of lifestyle they want when they’re older. It all boils down to your aims—and whether health issues throw you a curve.

Rather than be paralyzed by big numbers, retirees-to-be can focus on tracking the smaller amounts they’re spending today. Getting a grip on your budget and on the basic tenets of investing now is an important first step in figuring out how much you’ll need down the line.

GOP lawmakers ask Trump to trash short-term health plan limits

By | Health Reform
Problem SolvedBy Virgil Dickson  | June 9, 2017

Republican lawmakers have asked the Trump administration to scrap a rule that limits the length a person can stay on a short-term health plan.

In a letter sent Thursday to HHS Secretary Dr. Tom Price, 14 senators claimed people needed more coverage options as insurers exit Affordable Care Act exchanges.

“We must consider solutions that will increase consumer choice in the healthcare markets and, ultimately, decrease healthcare costs,” the senators said in a joint statement. “As health insurers continue to leave the Obamacare exchanges, consumers need more, not fewer, options for health insurance. Reversing this regulation will provide consumers with an important option for health coverage.”

The Obama administration first proposed the rule in June 2016 to prevent people from staying on short-term health plans for more than three months. The administration hoped the cap would encourage healthy people to use the exchanges to find long-term health coverage.

Short-term health plans are designed to fill only very short coverage gaps and do not meet the ACA’s requirements. Although premiums can be cheaper for short-term plans, they can factor in the patient’s health condition, discriminate against patients with pre-existing conditions and the plans often don’t offer prescription benefits.

HealthMarkets, a private insurance agency, reported that short-term sales in 2015 were about 150% higher than in 2013. Insurers had started selling short-term plans as primary health coverage by allowing consumers to continually renew their plans.

 

Where Obamacare Has Become Unaffordable, Short Term Health Insurance Can Help

By | Health Reform, Uncategorized
UnaffordableSeth Chandler, Contributor

Next time you run into someone who minimizes the problems with Obamacare, I want you to introduce them to Fay. She’s a reasonably healthy 60 year old grandmother living in Fayette County, Illinois and earns about 450% of the federal poverty level ($53,460) working for a small employer that does not provide her with health insurance. Right now, if she wants the second lowest silver plan in her area, she needs to pay 28% of her pre-tax income in order to get it — $1,247 per month. Fay just doesn’t have that kind of money and thus lives in fear of medical bankruptcy should something go wrong.

Fay is imaginary, so your introduction will need to be metaphorical. But lots of people like her exist throughout the United States. In one third of the rating areas covered by the federal individual health insurance Exchanges, a 60-year old earning about 450% of the federal poverty level ($53,460) would need to pay at least 20% of their pre-tax income in order to pay for a typical Obamacare health insurance policy. Indeed, in over 70% of the rating areas for which policies are sold on healthcare.gov, the second lowest silver plan would cost at least 15% of a person like Fay’s income. To calibrate these facts, recognize that Congress wrote a law that basically says that someone earning just a bit less that Fay, say $47,400, should pay no more than about 10% of their income to purchase the same policy.

It’s clearly going to get worse. If premiums go up about 20%, which is a pretty conservative estimate for 2018, over 50% of the rating areas will feature health insurance premiums that bust the 20% barrier for people like Fay. And in 91% of the rating areas, people like Fay will be paying over 15% of their pre-tax income if they want health insurance on the Exchanges. And it’s not lavish health insurance either. These policies often have deductibles over $3,500 and out-of-pocket limits over $5,000. That, my friends, is crazy.

Moreover, it’s not just people of ages and incomes highly similar to Fay. There are a lot people who are going to find that the individual health insurance market has, for all practical purposes, collapsed, even as various pundits cheerfully point to the low number of areas in which it has not done so literally.

Let me draw another example from the middle class: Humphrey, a 50 year old from Key Largo, Florida earning a decent 500% of the federal poverty level ($59,400) per year as a self-employed termite exterminator. Humphrey will be deemed too wealthy to qualify for any Obamacare subsidies. He is going to pay the full gross premium, which is $853 per month — over 17% of his pre-tax income. That’s almost twice what he would pay if he killed fewer termites and earned about $48,000 instead.

Again, Humphrey (imaginary) is not alone. In 8% of the studied rating areas, those people are going to need to pay at least 15% of their pre-tax incomes in order to buy a typical Obamacare health insurance policy. Maybe 8%  is below your concern threshold.  But next year, Humphrey will have more company.  If gross premiums go up on average by 20%, about 27% of the studied rating areas will require 50 year olds like him to pay at least 15% of their pre-tax income if they want health insurance.  Again, the idea at the time of Obamacare’s enactment was that people shouldn’t have to spend more than 10% of their income on health insurance.

It didn’t used to be this way. Remember those halcyon days of 2014 when ACA proponents were boasting of how much lower than alleged expectations exchange premiums had come in. If we’d run a similar analysis back then, here’s what we would have found. In fewer than 2% of the rating areas would our 60 year old Fay earning 450% of the applicable federal poverty level have to pay at least 20% of their pre-tax income for a typical policy. And there’d be no rating area anywhere on the federal Exchanges where our 50 year old Humphrey earning 500% of the federal poverty level would have to pay 15% of their pre-tax income for a policy. In fact, there’d only be 7% of areas in which they’d have to pay more than 10%.  In most of the nation, the idea that people shouldn’t have to pay more than 10% of their income to get decent health insurance was arguably in force.  These statistics show that the world of Obamacare in 2017 and 2018 is an entirely different animal than it was back in 2014 when things started out.

We need to consider different Obamacare regulations in light of the changed Obamacare conditions.  We should not just let the ACA blunder on. One of the problems with the ACA — and I am fully aware that this was intended to be one of its virtues — is that it basically ended the unregulated individual health insurance market. That might make some sense if the regulated insurance individual health insurance markets were functioning properly. But when premiums cost this large a percentage of many individuals’ incomes in the regulated market, the destruction of imperfect alternatives becomes less of a virtue and more of a vice. Where Obamacare has effectively failed, there needs to be an alternative — today. Fay and Humphrey’s situations are simply unacceptable.

All of this has a particular policy implication with respect to short term health insurance policies, currently a subject of some controversy. These are policies that have a duration often well under a year and that have limitations and cost sharing requirements that often go far beyond what the ACA permits. In its final months,  the Obama administration tightly regulated their sale. They did so because federal law does not require them to comply with all of the Obamacare rules (no pre-existing condition limits, ceilings on out-of-pocket maximums, essential health benefit requirements, etc.) Among other things, the Obama rules said that short term health insurance policies (also known as temporary health insurance) could be immune from ACA rules only if their duration was three months or less and if tight restrictions existed against “auto-renewals.”

The reason to close off this escape valve was the same advanced by many Democrats in opposing recent Republican health plans that also would have permitted a less regulated market to co-exist with an Obamacare market. These alternative markets — be they regular health insurance or short term health insurance — tend to siphon the healthy away from the regulated market. As such, the regulated market becomes ever more a high risk pool, charging ultra-high premiums and costing individuals and a subsidizing federal government a boatload of money.

The Trump administration is apparently considering relaxation of the recent Obama rules.  Perhaps the “short term” could be longer than the 3 months than is current permitted. Perhaps policies could be renewed more easily. Liberal pundits and organizations such as the Commonwealth Fund have aspersed this possibility. Before others reflexively propagate their criticisms, however, they ought to consider whether letting more people purchase “short term health insurance policies” even with their many imperfections might actually be better than having no insurance at all.  Larry Levitt, for example, a massive ACA supporter from the influential Kaiser Family Foundation, has apparently acknowledged that perhaps short term insurance rules could be more flexible where, as in some few counties, there is no Obamacare insurer at all.

This same argument, however, that concedes the validity of short term health insurance in jurisdictions where Obamacare has literally collapsed applies with almost as much force in the many jurisdictions where, although there is an Obamacare insurer on paper, it has effectively collapsed because none of its policies are really affordable to my Fays and Humphreys of middle age and middle income. A very reasonable rule would relax the restrictions on short term health insurance for persons unable to purchase the second lowest silver plan for less than 15% of their income. Short term policies there could be permitted to last six months and permitted to auto renew.

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Obamacare Is Uninsuring the Insured

By | Uncategorized

The law expanded coverage among the poor at the expense of coverage among the middle class.medicalcosts

by DOUG BADGER

The number of people with individual health-insurance coverage is shrinking.

Despite $146 billion in federal subsidies to low-income households and well-capitalized insurers, 2.6 million fewer people had individual policies in March 2017 than in March 2016, a drop of nearly 15 percent.

The most precipitous decline has occurred among people who pay their own premiums without government help. The number of those with unsubsidized coverage fell by nearly one-fourth between March 2016 and March 2017, from 11 million to less than 9 million. There are now nearly 3 million fewer people with unsubsidized individual coverage than in 2013, the year before the government began doling out Obamacare premium subsidies. If the current trend persists through December, the individual market as a whole will insure fewer people this year than it did in 2014.

And the decline isn’t limited to the individual market. There were 3.6 million fewer people with job-based coverage in December 2016 than in December 2013. While 8.4 million people received Obamacare premium subsidies last year, private coverage increased on net by only 1.7 million between December 2013 and December 2016.

While there are no perfect data, these numbers are far more precise than survey results, the standard source of coverage estimates. They derive from insurance-company regulatory filings compiled by Mark Farrah Associates and on reports issued by the Centers for Medicare and Medicaid Services. The MFA data capture the total number of people enrolled in individual policies through March 2017; CMS tells us how many people had exchange-based individual coverage through February 2017 and how many of them received subsidies. Subtracting the CMS numbers from the MFA data yields the number of people who have unsubsidized individual coverage. Data on the individual and small-group markets through December 2016 come from an analysis by the Heritage Foundation’s Edmund F. Haislmaier and Drew Gonshorowski, who also used the MFA data set. The decline in individual health-insurance coverage is almost never reported (NRO being a rare exception) and contradicts the prevailing Obamacare narrative. A recent New England Journal of Medicine editorial recited the received wisdom: “The ACA’s individual market structure — though not perfect — is sound and has succeeded in greatly expanding coverage. As 2017 began, the market was poised to leave behind the growing pains of the past few years. Then the President and Congress acted to create needless turmoil.”

Virtually every assertion in that passage is false. The individual market is not “sound”; it is contracting as rising premiums are pricing millions out of the market. Nor can it be credited with “greatly expanding coverage”; the individual-market coverage gains achieved by distributing subsidies to some have for the most part been offset by coverage losses in the individual and group markets among unsubsidized consumers. Obamacare was not “poised to leave behind the growing pains” in 2017; it was entirely predictable that those pains would worsen.

And all this “needless turmoil” antedated the Trump administration. He took office during the closing days of the 2017 open-enrollment period. By then, the die was cast.

The narrative nevertheless endures. Believing it requires indifference to millions of people who can no longer afford individual policies and to millions more who may forfeit their policies with the next round of rate hikes. For many of them, Obamacare has been a serial nightmare, producing policy cancellations, skyrocketing premiums and deductibles, and a narrowing choice of doctors before finally leaving them uninsured.

Obamacare is insuring more poor people and uninsuring millions of middle-income people. That suits the Democratic party and many congressional Republicans just fine. They measure social progress in the number of people receiving government assistance. Those struggling to pay their own way evoke little sympathy. Lawmakers of both parties, whose consciences were lacerated by CBO’s theory that millions would “lose” coverage under the GOP’s “repeal and replace” legislation (most of those “losses” the result of people voluntarily dropping insurance once the individual mandate was repealed) are unmoved that millions actually have lost coverage under the law they fought to preserve.

Legislators do, however, grieve over insurance-company losses. The NEJM editorial urged Congress to “bolster insurers’ confidence” through a “permanent reinsurance program” — a new entitlement to corporate welfare.

t is a familiar story: Corporations get bailouts, the poor get benefits, and those in between get the bill. Government will tax people to subsidize insurance companies whose product they themselves can’t afford.

It is of course possible that Congress will set a different course. Republicans won elections by promising relief for Obamacare’s victims. That sentiment faded once they gained power. Perhaps they can revive it. Democrats could bolster their political brand by working to make health insurance accessible to those who used to be able to afford it.

Congress could start by relaxing the federal death grip on the regulation of the individual and small-group markets. Federal regulatory rigidities are driving prices higher and pushing insured people into the ranks of the uninsured. Relinquishing at least some regulatory authority to the states might produce more functional markets, where insurers can offer consumers the coverage they want at a price they can afford.

Members of both parties instead hope to pass a relief package for the insurance industry. Once it becomes clear that insurers will raise their 2018 rates despite the bipartisan largesse, each party will blame the other for the higher premiums.

Should Congress play out that script, the individual market will likely continue to shrink.

Survival of ObamaCare is nothing to celebrate

By | Health Reform

 

Democratic politicians are giddily celebrating that the AffordableObamacare Democrats Care Act – more commonly known as ObamaCare – will remain in place for now, even though it continues to wreak havoc on U.S. health care.

As they toast each other’s success at blocking reforms, let’s consider what they are celebrating:

  • An explosion of health insurance premiums caused specifically by ObamaCare regulations. From the law’s implementation until this year, average health insurance premiums have doubled on individuals and increased 140 percent on families. At the same time, deductibles have also increased by about one-third for individuals and doubled for families, according to eHealth.
  • ten-fold increase in the projected number of people kicked off their chosen health plan, as compared to the initial estimates by the Congressional Budget Office when the law passed.
  • shrinking number of doctors and hospitals accepting ObamaCare insurance, with 32 to 42  percent fewer doctors than those who accept insurance off ObamaCare exchanges – and sometimes down to zero specialists available for stroke and other critical care.
  • A drastic loss of insurance choices for those dependent on ObamaCare exchanges, with about one-third of counties now having only one insurance “choice” and another third having only two. That’s down from 2015, when 65 percent had three or more choices, according to Kaiser Foundation data.
  • A taxpayer burden of $1 trillion for an expansion of Medicaid, the government insurance program for the poorest Americans. Medicaid is only accepted by half of doctors, and data from the U.S. Department of Health and Human Services revealed that half of  doctors signed up to accept Medicaid patients actually do not do so. Studies show that Medicaid delivers worse outcomes than private insurance covering medically similar patients. These worse outcomes include more in-hospital deaths and adverse events, more complications from surgery, shorter survival after treatment and longer hospital stays. This proves once again that giving someone insurance is not the same as access to quality health care.
  • An unprecedented, harmful consolidation of doctor practices and hospitals accelerated by ObamaCare regulations, as reported in the New England Journal of Medicine. This consolidation creates monopolies, thereby eliminating choice and competition. Reducing the cost of health care itself is the critical pathway to broader access to quality medical care, lower insurance premiums and ultimately better health. Consolidation does the opposite and raises prices for patients by over 20 percent, according to the Robert Wood Johnson Foundation. Consolidation raises prices by 34 percent for specialist care, as reported by Cory Capps and others in a studyfor the Northwestern Institute for Policy Research. This amounts to an extra $1,200 to $1,700 per patient per year, according to a study for the Journal of American Medicine Network by James. C. Robinson and Kelly Miller,

Meanwhile, Americans, not politicians, continue to be the victims of the imploding Affordable Care Act. Many of these same politicians insist that yet more government control is the solution, even pushing for a single-payer system.

Advocates of single-payer government health insurance ignore the overwhelming body of peer-reviewed facts that proves U.S. health care has been superior to every centralized system in the world. That means better access to care in our country than in single-payer systems, even for those needing “urgent treatment.”

For example, for people already diagnosed with cancer, 18 percent wait more than two months for physician-requested “urgent treatment” in England through the National Health Service. Britain’s National Health Service also reports that when brain surgery is recommended for patients, 17 percent wait more than 18 weeks.

In America we also benefit by faster availability of medications. In addition, there are factually superior outcomes for Americans from virtually all serious diseases, including cancerheart diseasestrokehigh blood pressure, and diabetes.

Voters must not allow our elected officials to blindly ignore the dismal projections about the unsustainable fiscal burden of taxpayer-funded health care, particularly as the impending explosion of demand for costly medical care that our society faces comes into play in the years ahead.

We must not allow politicians to deny virtually all the fundamentals of basic economics – that incentives, competition, and consumer power drive prices lower.

And finally, we must not allow our government to disregard all the historical proof that free market competition actually works to lower medical care prices without harming patients.

The way to bring down health care prices while maintaining quality and without limiting access is clear-cut. It requires facilitating competition among providers, and incentivizing consumers to seek value. Without recognizing those facts, the world’s best health care will soon be simply a distant memory and all Americans will suffer.

By Scott W. Atlas M.D.Fox News
 Scott W. Atlas is the David and Joan Traitel Senior Fellow at Stanford’s Hoover Institution and the author of “Restoring Quality Health Care: A Six Point Plan for Comprehensive Reform at Lower Cost.”