Category

Health Reform

Why I don’t want an HMO even if the government pays more than half cost!

By | Health Reform

out-of-network-emergency-1200-1-768x432HMOs are basically a version of socialized medicine — making health care look low cost to consumers but adding an elaborate behind-the-scenes rationing scheme to control costs.

For example: You can see only doctors who have been hired by the HMO. The doctors can get financially punished for providing “too much” care. The plans pay for only certain drugs.

HMO’s are not new.  In fact, in 1996 HMOs accounted for almost a third of the employer market.  But then horror stories of limited networks, bureaucratic hassles and care denials spread, and by 2014 the HMO market share plunged to 13%.

Over those same years, PPOs — preferred provider organizations — took off. These plans offer much better coverage if you stay in network, and still provide benefits for out-of-network doctors. Consumers get to choose their doctor…and the best doctors are available through PPOs.

In today’s ObamaCare exchanges, PPO plans are an endangered species. Those enrolling in Houston last year had a choice of 19 PPOs; this year, they have none.

Since HMOs only contract with a certain number of doctors and hospitals in any one particular area, and insurers won’t pay for healthcare received at out-of-network providers, the biggest disadvantages of HMOs are fewer choices and potentially, higher costs. The problem with fewer choices – you might be locked out of seeing the best doctors are getting care from the best hospitals.  Other drawbacks to HMOs include needing to obtain a primary care referral before seeing a specialist, and annual limits on the number of office visits, tests, and certain treatments – like colonoscopies and mammograms.

The biggest problem with HMOs?  If you need an out-of-network care provider you have to pay for them yourself…and depending on the provider the costs could force you into medical bankruptcy.  Imagine getting into an accident requiring emergency care in an area that will not accept your HMO coverage.  What choice do you have at that critical time but to accept the treatment?  Now imagine that as you are recovering you find out your insurance will not cover the expensive healthcare you needed.  That’s the REAL risk of an HMO – limited coverage that leaves you responsible for astronomical unforeseen medical expenses.

We have alternatives to HMO’s – Call us 1-800-257-1723 or click here to schedule an appointment. 

Senate Plans to End Obamacare Mandate in Revised Tax Proposal

By | Health Reform
Article Excerpt from the NY Times.  By THOMAS KAPLAN andJIM TANKERSLEYNOV. 14, 2017
Senator Orrin G. Hatch, Republican of Utah, delivered opening remarks Tuesday during a Senate Finance Committee hearing. CreditTom Brenner/The New York Times

Senator Orrin G. Hatch, Republican of Utah, delivered opening remarks Tuesday during a Senate Finance Committee hearing. CreditTom Brenner/The New York Times

WASHINGTON — Senate Republicans have decided to include the repeal of the Affordable Care Act’s requirement that most people have health insurance into the sprawling tax rewrite, merging the fight over health care with the high-stakes effort to cut taxes.

Repealing the mandate, a longstanding Republican goal, would save hundreds of billions of dollars over the next decade. That would free up money that is earmarked to expand middle-class tax cuts.

 

2018 Update – How To Be Legally Exempt from the Obmamcare Penalty

By | Health Reform

2017 TaxesTax filers want to pay attention to the rules involving the Affordable Care Act on their 2017 tax returns, even as President Trump and Congress eye changes in the healthcare law.

In a reversal, the Internal Revenue Service (IRS) has indicated that it will not accept electronically filed tax returns where the taxpayer does not address the health coverage requirements of the Affordable Care Act (ACA). This is in contrast to the 2017 filing season when the IRS took the position that it would accept and process tax returns where a taxpayer is silent on coverage. The tax agency said, at that time, that the treatment was consistent with their previous policy.

However, for the 2018 tax season, that will not be the case. According to the IRS, electronically filed tax returns will not be accepted “until the taxpayer indicates whether they had coverage, had an exemption or will make a shared responsibility payment.” Additionally, paper tax returns “may be suspended pending the receipt of additional information and any refunds may be delayed.”

The IRS said, about the change in position, that “[t]his process reflects the requirements of the ACA and the IRS’s obligation to administer the health care law.”

Earlier this year, President Trump signed an executive order giving the Department of Health and Human Services and “other executive departments and agencies” the authority and discretion to roll back certain aspects of the ACA. This year, Republicans in Congress have so far been unsuccessful in their attempts to repeal and replace – or even just repeal – ACA. That means that ACA remains good law.

Taxpayers that don’t have coverage must claim a waiver, exemption (typically based on hardship), file for a low cost christian sharing – This one has rates as low as $45 a month for a Bronze sharing option – Use this link to get a quote and learn more http://www.chministries.org/default.aspx?mem=278378 – or be subject to a penalty called the shared individual responsibility payment. For the 2017 tax year, that penalty is equal to 2.5% of your adjusted gross income (AGI), or $695 per adult and $347.50 per child, up to a maximum of $2,085, whichever is higher. That amount will be figured and reported on your 2017 tax return, payable in 2018.

You Might Be Exempt

If the lowest-priced plan available to you, through either a Marketplace or Job-based plan, would cost more than 8.16% of your household income you might be exempt from having to enroll in a qualified insurance plan.  Learn more by clicking here.

If you are outraged by the high cost of Obamacare and don’t have a serious pre-existing medical condition – call us today at 1-800-257-1723 or click here now to schedule an appointment.  Let us show you a better way to insure yourself and your family.

How Christian Ministry Healthcare Sharing Programs Work and a Smart Approach to Using Them

By | Health Insurance, Health Reform

Christian Sharing MinistriesHealth care sharing ministries aren’t legally insurance companies, they don’t technically offer “coverage contracts,” instead they promise to shift monies from one member to another to “share” costs.

“Health insurance is an actuarial contract,” says James Lansberry, Samaritan’s executive vice president and also president of the Alliance of Health Care Sharing Ministries, a trade organization. “People buy policies and health insurance promises to pay out claims and makes contracts with doctors and hospitals. They are regulated by the department of insurance in whatever state they’re in.”

By contrast, Lansberry says, “health-care sharing ministries make no promises or guarantees. We are faith-based ministries that deal with what has happened rather than what might happen. Members share in each other’s bills after they have already occurred.”

After incurring a medical expense deemed eligible under the sharing organization’s guidelines, members submit these bills or “needs” to the ministry, which manages the redistribution of members’ monthly payments to the appropriate households. Samaritan simply instructs members to send their monthly share checks directly to other members in need, whereas the other two programs collect and redistribute monthly contributions.

Members are in turn responsible for paying their medical bills directly. “Hospitals and doctors treat them as self-pay patients,” Lansberry says. “We encourage them to negotiate discounts on their bills.”

In addition to members needing to negotiate their own discounts on healthcare, there are these issues:

  • Exclusion of pre-existing conditions
  • NO guarantee they will pay as promised
  • When they do pay it is not in a lump sum; it is an unreliable payment stream over an unspecified period of time
  • Medical care can be difficult to get because Christian Sharing is set up as reimbursement – so if you can’t afford to pay for care upfront many providers will not accept you as a patient

But I WANT to Join A Christian Sharing Ministry

If you want to participate in a Sharing Ministry we suggest to our clients that they back up their participation with real insurance.  Here’s how we set that up:

  • Put the family on on one of our pre-qualified Short Term Medical Plans (or smarter still – combine the Short Term Medical Plan with our Fixed Benefits-Gap-Living Benefits Program).  It is REAL Insurance, and its AFFORDABLE and we have a 12 month program available for 2018.
  • Purchase Christian Healthcare Ministries. It is Christian Sharing but at a much lower cost.

Under this structure you and your family have real insurance coverage AND SHARING — so you have best of both worlds not just the faith based promise.

To learn more call us at now at 1-800-257-1723.  We’ll be happy to design a program that fits your personal goals!

White House Executive Order – Now’s the time for Short Term Medical Insurance

By | Health Insurance, Health Reform
The White House
For Immediate Release

171012164525-trump-executive-order-1024x576Presidential Executive Order Promoting Healthcare Choice and Competition Across the United States

EXECUTIVE ORDER

– – – – – – –

PROMOTING HEALTHCARE CHOICE AND

COMPETITION ACROSS THE UNITED STATES

By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:

Section 1. Policy. (a) It shall be the policy of the executive branch, to the extent consistent with law, to facilitate the purchase of insurance across State lines and the development and operation of a healthcare system that provides high-quality care at affordable prices for the American people. The Patient Protection and Affordable Care Act (PPACA), however, has severely limited the choice of healthcare options available to many Americans and has produced large premium increases in many State individual markets for health insurance. The average exchange premium in the 39 States that are using www.healthcare.gov in 2017 is more than double the average overall individual market premium recorded in 2013. The PPACA has also largely failed to provide meaningful choice or competition between insurers, resulting in one-third of America’s counties having only one insurer offering coverage on their applicable government-run exchange in 2017.

(b) Among the myriad areas where current regulations limit choice and competition, my Administration will prioritize three areas for improvement in the near term: association health plans (AHPs), short-term, limited-duration insurance (STLDI), and health reimbursement arrangements (HRAs).

(i) Large employers often are able to obtain better terms on health insurance for their employees than small employers because of their larger pools of insurable individuals across which they can spread risk and administrative costs. Expanding access to AHPs can help small businesses overcome this competitive disadvantage by allowing them to group together to self-insure or purchase large group health insurance. Expanding access to AHPs will also allow more small businesses to avoid many of the PPACA’s costly requirements. Expanding access to AHPs would provide more affordable health insurance options to many Americans, including hourly wage earners, farmers, and the employees of small businesses and entrepreneurs that fuel economic growth.

(ii) STLDI is exempt from the onerous and expensive insurance mandates and regulations included in title I of the PPACA. This can make it an appealing and affordable alternative to government-run exchanges for many people without coverage available to them through their workplaces. The previous administration took steps to restrict access to this market by reducing the allowable coverage period from less than 12 months to less than 3 months and by preventing any extensions selected by the policyholder beyond 3 months of total coverage.

(iii) HRAs are tax-advantaged, account-based arrangements that employers can establish for employees to give employees more flexibility and choices regarding their healthcare. Expanding the flexibility and use of HRAs would provide many Americans, including employees who work at small businesses, with more options for financing their healthcare.

(c) My Administration will also continue to focus on promoting competition in healthcare markets and limiting excessive consolidation throughout the healthcare system. To the extent consistent with law, government rules and guidelines affecting the United States healthcare system should:

(i) expand the availability of and access to alternatives to expensive, mandate-laden PPACA insurance, including AHPs, STLDI, and HRAs;

(ii) re-inject competition into healthcare markets by lowering barriers to entry, limiting excessive consolidation, and preventing abuses of market power; and

(iii) improve access to and the quality of information that Americans need to make informed healthcare decisions, including data about healthcare prices and outcomes, while minimizing reporting burdens on affected plans, providers, or payers.

Sec. 2. Expanded Access to Association Health Plans. Within 60 days of the date of this order, the Secretary of Labor shall consider proposing regulations or revising guidance, consistent with law, to expand access to health coverage by allowing more employers to form AHPs. To the extent permitted by law and supported by sound policy, the Secretary should consider expanding the conditions that satisfy the commonality‑of-interest requirements under current Department of Labor advisory opinions interpreting the definition of an “employer” under section 3(5) of the Employee Retirement Income Security Act of 1974. The Secretary of Labor should also consider ways to promote AHP formation on the basis of common geography or industry.

Sec. 3. Expanded Availability of Short-Term, Limited‑Duration Insurance. Within 60 days of the date of this order, the Secretaries of the Treasury, Labor, and Health and Human Services shall consider proposing regulations or revising guidance, consistent with law, to expand the availability of STLDI. To the extent permitted by law and supported by sound policy, the Secretaries should consider allowing such insurance to cover longer periods and be renewed by the consumer.

Sec. 4. Expanded Availability and Permitted Use of Health Reimbursement Arrangements. Within 120 days of the date of this order, the Secretaries of the Treasury, Labor, and Health and Human Services shall consider proposing regulations or revising guidance, to the extent permitted by law and supported by sound policy, to increase the usability of HRAs, to expand employers’ ability to offer HRAs to their employees, and to allow HRAs to be used in conjunction with nongroup coverage.

Sec. 5. Public Comment. The Secretaries shall consider and evaluate public comments on any regulations proposed under sections 2 through 4 of this order.

Sec. 6. Reports. Within 180 days of the date of this order, and every 2 years thereafter, the Secretary of Health and Human Services, in consultation with the Secretaries of the Treasury and Labor and the Federal Trade Commission, shall provide a report to the President that:

(a) details the extent to which existing State and Federal laws, regulations, guidance, requirements, and policies fail to conform to the policies set forth in section 1 of this order; and

(b) identifies actions that States or the Federal Government could take in furtherance of the policies set forth in section 1 of this order.

Sec. 7. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect:

(i) the authority granted by law to an executive department or agency, or the head thereof; or

(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

DONALD J. TRUMP

THE WHITE HOUSE,

October 12, 2017.

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.

At Health Life Dental Insurance we have perfected the art of using short term medical – We offer a layered approach and can provide ONE YEAR of Coverage without Pre-existing Conditions on Short Term Medical. In addition, we combine our STM with Guaranteed Renewable Additional coverages to reduce or completely eliminate your of pocket expenses.   Furthermore, these coverages can provide Preventive Care, Office Visits, Testing Copays and even Lump Sums of Cash for Chronic and Critical illness to protect you from medical bankruptcy.   Click here to learn more and get your quote.

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.”

Health insurance before Obamacare

By | Health Reform

Does anyone remember what health insurance was like before Obamacare? I do and so does George Will, renowned syndicated columnist and Pulitzer Prize winning author.

On the Feb. 21, 2010, edition of ABC’s This Week, conservative columnist George Will — a critic of the plan backed by President Barack Obama and congressional Democrats — cited poll figures about Americans’ satisfaction with their own health coverage.

“When we started this healthcare debate a year ago, 85 percent of the American people had health insurance, and 95 percent of the 85 percent were happy with it,” Will said during the show’s roundtable discussion. “So there was no underlying discontent that you now postulate to drive this radical change.”

Eight surveys taken in 2008 and 2009 that asked Americans whether they were satisfied with their health coverage confirmed this data. The Census Bureau stated that in 2008 255.1 million Americans had health insurance and 46.3 million did not.

The sources of this insurance were generally employer provided plans, individual plans, Medicare, VA healthcare, Medicaid, the CHIP program, Cobra for short-term coverage and colleges and universities that offered some healthcare insurance for students.

Approximately half of the 46.3 million uninsured consisted of young healthy people who did not see the need to buy health insurance (which is still true today) and the other half were made up of people from the lower economic levels that could not afford insurance but who were likely eligible for Medicaid but did not apply.

So, what happened, why the crisis? Why create a new health insurance system when the current one was not broken? The answer is President Obama.

The public record is full of articles and video clips dating back to his days in Chicago when he was a community organizer and as a state legislator that he envisioned a single payer healthcare system.

He recognized that the country would not approve of a single payer system replacing the market-based system, so upon being elected President, he conjured up the strawman: “Our healthcare system is broken.”

With the support of the liberal media, he set out across the country denouncing health insurance and promising a new system, the Affordable Health Care Act, which would guarantee coverage for everyone, which included keeping your doctor, your hospital, lowering premiums, guaranteeing coverage for pre-existing conditions and allowing children to stay on their parents plans up to age 26.

As you know, much of that was untrue. The system we have now is in the process of complete collapse thanks to the mandated essential services in Obamacare.

If we are ever going to correct this atrocity on the American public we must first begin by demanding Congress repeal Obamacare in total, no tweaking, no attempt to fix a little bit or modify it.

It must be replaced with a market-based system similar to what we had before. It is not impossible. First, we must get the government out of our healthcare insurance system. Health insurance should be like your retirement plan, you own it and it goes with you when you change jobs. We must be able to buy health insurance across state lines like car insurance (the state insurance commissioners won’t like that), we need to expand health savings accounts and allow those who purchase their private health insurance to deduct the cost on their income tax returns just as employers do for their employee plans.

We must have tort reform to eliminate frivolous lawsuits that drive up the cost of malpractice insurance for doctors and hospitals and we must establish a federal cap on medical malpractice claims while not limiting damages for necessary medical treatment.

The only way to eliminate this burden on the American people is for you to demand action from your congressional representative in the House and Senate.

Roger F. Casale
LTC, U.S. Army (Retired)
Peachtree City, Ga.

Trump, start fixing health insurance markets without Congress

By | Health Reform

The House GOP may have abandoned its attempt to replace the Affordable Care Act (for now), but the market for individuals and small employers to purchase health insurance remains deeply dysfunctional and in urgent need of reform. By rolling back a recently-issued insurance regulation and waiving some of the ACA’s penalties, the Trump administration can shift the bulk of the insurance market onto a well-functioning track while better-targeting subsidies at those in the greatest need.

Insurers have struggled to finance their obligations under the ACA. As a result, networks have narrowed, premiums have soared an average of 75 percent, and annual deductibles above $12,000 are now common for family plans. Four of the five largest insurers have sharply cut back on their exchange participation, and there are currently only 12 million enrollees — 11 million fewer than were initially estimated for 2017.

President Trump has promised to reverse the increase in healthcare premiums and reduce the number of Americans uninsured without adding to the deficit.  In order to do this, it is necessary to increase the efficiency of health insurance markets and to better target the ACA’s subsidies at individuals who are unable to afford their expected costs of care.

Although the congressional GOP was prevented by budget reconciliation rules from improving insurance regulations, Secretary Price can do so — and should treat the exchanges as de facto high risk pools, by allowing the sale of more flexible and affordable plans outside of them.

The ACA sought to make health insurance affordable for those with pre-existing conditions by requiring insurers to make plans available on the same terms to the sick and the healthy.  By fixing premiums many times above the healthcare costs that the healthy expect to incur, but well below the levels that the chronically ill are sure to need, it has established a dynamic whereby insurers endeavor to avoid selling plans to the sick  and the healthy try to avoid purchasing them.

The ACA’s mix of carrots (subsidies) and sticks (taxes), however, has proven inadequate either to attract appealing insurance plans and or to induce healthier individuals to buy them. As a result, the enormous cost of subsidizing the care of those with pre-existing conditions has become concentrated in the premiums of the 5 percent of Americans who still feel obliged to purchase health insurance on the individual market.

This dysfunction has arisen by conflating two separate functions: insuring the healthy against the risk of illness or accidents, and subsidizing the chronically ill for costs that they already know they will face. Yet, by forcing all to buy equivalent plans from the exchange, the ACA has prevented the healthy from purchasing plans to insure themselves at a cost proportionate to the risks that they face, and failed to ensure that subsidies are well-focused on the smaller pool of individuals who truly need them.

Most Americans do not want subsidies, they just want reasonably-priced insurance plans.  A remnant of this survives in the short-term insurance market, which was exempt from the ACA’s regulatory reforms.  These offer actuarially-priced plans starting at $20/month, with premiums varying according to individual choice of cost-sharing arrangements.

Until a regulation hastily-issued by the Obama administration on Oct. 31, a week before the election, these plans were gaining popularity as a viable source of affordable coverage — despite the requirement that individuals enrolled in them still pay the penalty for non-enrollment in the ACA’s exchanges.  This regulation reduced the maximum duration of coverage under these plans from 364 days to 3 months, and prevented insurers from guaranteeing the renewability coverage to enrollees.

The Trump administration should reverse this course by repealing these restrictions on short-term insurance, and by waiving the mandate penalty for individuals enrolled in such plans.  They could then operate as a well-functioning insurance market for the vast majority of individuals uncovered by employers or public entitlements.  The exchanges should be allowed to continue offering subsidized coverage — but with a much-diminished pool of enrollees, this subsidy would become much better-focused on the small subset of beneficiaries who truly need it.

This approach would remedy the core ill of the insurance market without new spending, new legislation, or unprecedented executive action.  As plans become available on terms that are attractive to the healthy, the number uninsured would likely fall.  The exchanges would shrink to become high-risk pools.  Only temporary risk-corridors to support exchange plans may be required to ensure a smooth transition, as they likely will be to stabilize the marketplace under any course.

But a stable and predictable risk profile of enrollees, essentially reinsured by the Federal government, would ensure that exchange plans could profitably be tailored to the distinctive care management needs of the chronically ill population — as has been the case with Medicare’s Special Needs Plans.

As a result, Americans would be able to retrieve the affordable pre-ACA plans that met their needs — but individuals with pre-existing conditions would be able to enjoy exchange plans that more fully to live up to their promise too.

BY CHRIS POPE, OPINION CONTRIBUTOR –

Chris Pope is a senior fellow in health policy at the Manhattan Institute, which is celebrating its 40th anniversary this year.