Go ahead…. Lie to me…. then have a smoke!


In my commentary last week on the delay of the 2014 employer penalties, I indicated that I expected additional changes in the rules and regulations to follow.    So here is what has happened since the Employer Mandate delay. 



  1. Go Ahead and Lie.     To be eligible to receive a subsidy from the government for individual coverage, you were not allowed to be covered by a qualified employer plan, and you must be below income thresholds.  When applying, the Exchange would verify your coverage option from your employer and your Income from the IRS.    Last week the government announced it would not verify if you had employer coverage or your income.   http://articles.washingtonpost.com/2013-07-05/national/40390077_1_health-insurance-consumer-claims-federal-government



  2. Enjoy that Smoke!   UPI is reporting that a conflict exists in the Affordable Care Act which could raise the cost of coverage for young people while giving additional breaks to smokers who are older and that it could take a year to remedy the issue.    The Affordable Care Act, ACA, mandates that older individuals premiums cannot exceed 3x the premium for younger people.  The ACA does not account for the additional premiums for smokers, thus the conflict.   http://www.upi.com/blog/2013/07/09/Obamacare-Smokers-may-get-break-from-penalties/7251373392294/ 


While this is all good news for consumers and employers alike, probably, you must remember that every dollar spent will be coming from you in other ways.    I have great anxiety about where that burden will fall.  


Mark Gurda
President
Castle Group Health Inc. 


 

Breaking News: Employer Mandate Postponed

July 2nd, 2013 -Bulletin

The White House announced today that the Employer Mandate to provide health insurance to its employees has been postponed until 2015.    

The delay of the employer mandate and it’s revenues is sure to cause other delays.   The delay is significant both economically and politically and puts the issue back on the mid-year elections table for 2014. 

With the individual exchanges months behind, the individual mandate and accompanying insurance requirements that go along with it could possibly be postponed as well.  Where the line in the sand will be drawn by proponents of the legislation is not clear at all.   

Look for the major insurers who have invested heavily in the promised new customers to try and join with the administration to pull this back together.  Also look for States who have been teetering on being compliant with the Medicaid law changes to be re-energized to back away again from implementation, putting the entire bill in jeopardy.  


Mark Gurda
President
Castle Group Health
Northbrook, IL 

Donna Brazile, the poster child for Obamacare Fact Vs Fiction


Over the past couple of years, I have found myself trying to focus more on helping my clients rather than posting online reviews or Op-ed pieces regarding healthcare reform.   The combination of Donna Brazile’s Twitter posts regarding health insurance premiums and the posting of the ‘Essential’ benefits by CMS  is too much to for me to handle, quietly. 

PART 1 – Donna Brazile –  Tag day
  
Donna Brazile is well educated, popular, Democratic strategist.  She headed Al Gore’s 2000 Presidential election campaign and is frequently seen on all the major TV networks as a political expert and she is the current Vice-Chair of the Democratic National Committee.  She gets a perfect 100 score on the political-meter.     Let’s not forget that Obamacare is every bit political as it is law.  Perception means so much and it’s shocking to see how unprepared and informed Brazile is on healthcare reform.   

I don’t want this article to belittle or insult a very bright and successful woman.   I feel bad for her and tens of millions of other Americans who are going to suffer as a result of not understanding the laws that created.
  
   
On Feb 27th – Brazile tweeted the following about her Health Insurance:



  • Q1 What’s on your menu? Just got off the phone with my health care provider asking them to explain why my premium jumped up. No good answer!
  • Q2 Why are your health insurance premiums higher? Price gauging, not . My provider told me it was because of my age. More to come
  • Q3 Starting in 2014, insurers will no longer be able to raise rates as they can right now. #Obamacare
  • Q4 Being a woman will no longer be a pre-existing condition justifying higher rates & being over 40 will no longer be an excuse to price-gouge.
  • Q5 Under Obamacare, the no insurer can charge mature folks more than 3 times as much as they charge twentysomethings. Again, January 1, 2014.
  • Q6 We are living at the end of that era until Jan. 1. And folks like me under 65 will have to endure this until fully kicks in.
  • Q7 So, I am looking forward to the full implementation of so I do not have to fight with my health provider on an ongoing basis.
  • Q8 Starting in 2014, being a woman will no longer be a pre-existing condition that causes higher rates.

So let’s review her misgivings and misunderstandings one-by-one.  


First, there are lots of reasons that prices to go up.  Many of them are because of already implemented or coming healthcare reform.   I assume that Ms. Brazile called her insurance company, not her doctor although she tweeted that she called her doctor.   


1 A.  Prescription costs and utilization of prescriptions result in higher costs.    Increased costs from doctors and hospitals are passed on in higher costs.    And no cost to the customer routine care and birth control adds to the costs.    With the new laws on no copay for birth control or other women’s healthcare issues, if 100 million women save even $10 per month in copay’s, that $12 billion a year in extra payment by insurance company’s.   Add 15% gross margin and you have an additional $13.8 billion in premium charged to the public. 


2A. Price Gouging?  Really?   Isn’t that libelous to call your insurer a price gouger?  How much did your premium go up?    50% ?  100%.    Wait, it was based on your age?    if your birthday is in December, are you just paying your bills late?    If you have group insurance, your group plan was not based on your age.   As a prominent public figure, you have a greater responsibility to use your powers with care.   You have demonstrated a bias with this tweet that is irresponsible at best. 


3A.   A misleading statement.  37 states already possess the ability to roll back excessive increases.   I believe that Ms. Brazile’s State possess that right already.    I guess you deserved that increase.  


4A.   Being a woman has always, and will always, be a preexisting condition.    That said, so is being a man, or a dog, or a fish.   Being a woman has never meant anything except that you have other medical needs than men do.   A person diminishes their argument when they play the “card:”.  


5A.   This is truth.  With Ms. Brazile only 53 years old, her premiums, even if she does have individual insurance would not be more than 3x the premium a 20-something would pay anyway.  More than that, healthcare reform is likely to make the premiums of 20-somethings go up substantially. In December 2012, at a United Healthcare conference in California, estimated rate increases of 80-110% are expected for people under 35 due to healthcare reform changes.    While Ms. Brazile would be correct about the 3x limit, she, as well as others, will most likely be paying more in significantly more in 2014.       


Are the higher prices for insurance a shock to HHS or CMS, or the Obama administration?    I doubt it.  On Feb 22, 2013  Health and Human Services released a new145 page clarification of some of the rules.    In it is reference to plans referred to as “catastrophic” plans that will live outside the normal health plan offerings.  http://www.ofr.gov/OFRUpload/OFRData/2013-04335_PI.pdf  These plans will be specifically for young adults who are priced out of the individual market.      Everyone on the inside already knows that higher prices are coming.   Why this financial shift is acceptable is to so many, is meant for a book, not a blog.  


6A.   There will be changes on January 1, 2014.  100% true.  For those living at poverty, you will receive a significant benefit.   More on that later.    For Ms. Brazile,  she should read her insurance renewal.   Most carriers are notifying their clients that although their rates may be frozen for 12 months, effective January 1, 2014, the carrier reserves the right add surcharges to insurance premiums outside of renewal.   These surcharges will be better defined once HHS and CMS give additional clarification on the rules.      I may be taking liberty with Ms. Brazile’s lack of mentioning a specific year that Obamacare takes full effect.    Some of the effects stretch into the 2020’s.   


7A .  Why is Ms. Brazile arguing with her insurer?    We know from her tweets that she believes that Men should subsidize a womans premium.  We also know that she believes that young people should subsidize her higher premiums.   What about low BMI people subsidizing higher BMI people?   Darn’d low BMI, normal cholesterol and blood pressure folks.  You should not benefit from your luck.   


8A.  One tweet wasn’t enough.   Play the “card” again.   


Sadly, Ms. Brazile is probably well intended.   I see it as a problem when the well-intended use their power and publicity to perpetuate falsehoods.   The undeniable fact is the more that is paid out, the higher the premium.    


PART 2 – Essential Benefits 


The last week of February had the government staffs working overtime before sequestration kicked in.  This included the release and definition of “benchmark” health  plans and “essential’ benefits.  


Link:  http://cciio.cms.gov/resources/data/ehb.html#review


When reading through the rules and definitions, I approach it not as a consumer, but rather what does it cost, and who pays for it.   


Those living in poverty will be eligible for great insurance.   Great insurance does not mean that they will get excellent care.    Many others will find their disposal income significantly reduced to meet the demands and mandates of insurance coverage.   Aside from the common and known rules about no deductible in excess of $2000 with out of pocket limits not to exceed to HSA rules for families, there are new parameters designed to make prices skyrocket.  


Here are a few “Essential” benefits for the poor.    



  • Essential –   Infertility-  you may not be able to feed your family, but the government will mandate that you get free treatment to get pregnant.   And then free delivery too. 
  • Essential – Orthodontics for children-   You may not be able to afford a good balanced meal or school books, but damn if you wont look good compared to those poor kids in England.   
  • Essential –  Lenses AND FRAMES- EACH YEAR for kids –   You working people, with a job and good employer benefits may not be able to get frames but every two years, and you may not be able to go to a decent school but darn tootin if you aren’t going to be able to clearly and stylishly see what’s going on.  

 A basic benefit package for all is essential.   Obamacare is just a huge give away.  Help for a 90 year old who has to choose between food or a copayment on their medication is essential.    This is health plan is not.  Look for strip malls in the poorest neighborhoods to fill with dentists, Eye wear providers, and other ESSENTIAL providers who don’t help you stay healthy.   


Ms Brazile and so many others bought into the belief that the bill would help.   Sadly, you have all been misled.  The educated proponents of this legislation, Ms. Brazile, thought that they would get someone else to pay their share.  Ooops!    

Supreme Court Ruling – best possible outcome for all.

June 28, 2012:

Today, Justice Roberts joined the majority, upholding the key elements of ObamaCare.  I view this decision as the best possible outcome for business and individuals in a democracy. 

While I have not yet had a chance to read the entire 90-page decision,  I do know that Chief Justice Roberts summarized by saying that Congress, the Senate and the President are the divisions of governent that write the rules of law.   The court does not write the rules nor do they act on the wisdom of rules.   

This decision clearly shows that the federal government is allowed to tax you if you don’t have health insurance.   Do you want that?   

The decision says that the governent may tax businesses who don’t provide insurance to employees.  

The deciion shows that the Federal government may not push unfunded mandates on States.   

The decision shows that we the people are responsible for electing officials and that the court will not act to override legal rules of law, as foolish as they may be.  

A victory for the Congress we elected.  A victory for President Obama.   A rallying cry for those opposed that if you want change, and if you want to amend the law that will cost so many, so much, you need to vote.  

Bottom Line:  We the people decide, and that is a victory for all.   Celebrate July 4th with an appreciation for the rights that we the people possess.  

This is a compromise? Birth Control Bailout by oBama


It has been a very long time since I have written a blog post on healthcare reform.   I have found the fallout from healthcare reform to be so overwhelmingly non logical that I just got tired of complaining.  

  • Long Term Care, a key component in passing healthcare reform in 2010,  that’s gone.  Removed as not doable.   Duh!
  • The law to forbid insurance companies from declining or excluding conditions on any child under the age of 18 led to the disappearance of plans for kids without an adult, and raised the cost of coverage for all.  In States that were already progressive, like Illinois, it raised the potential cost to insure a child by more 300%.   
  • The 10 Billion dollar give back by drug companies…. well…. it doesn’t seem like it.   Profits are up in the sector. 
  • Health Insurance companies – Profits also way up, service down.   

That said, today announcement of a compromise by the Obama administration on the issue of forcing religious organizations to provide free birth control to all employees even though it’s against the church belief system seems to represent the worst of Washington.  

NBC News reported today:  

According to a source who has been briefed
on the matter, the White House will announce an “accommodation” to the
contraception rule. The announcement will try to ease the concerns of those with
religious views by not requiring them to pay for contraception.

This effectively means that insurance
companies will pay for the contraception coverage directly. 

According to The Associated Press, women
will still get guaranteed access to birth control without co-pays or premiums no
matter where they work, a provision of Obama’s health care law that he insisted
must remain.

But religious universities and hospitals
that see contraception as an unconscionable violation of their faith can refuse
to cover it, and insurance companies will then have to step in to do so.

My opinion on whether the government should or should not mandate this benefit is not important.  What is important here is the deception by the White House to try and convince the public that they can waive a magic wand, and birth control will be free.    

First, this does not address the impingement of religious rights in that the policy will still have to cover it, and it adds insult to the process by trying to argue in the public forum that the institution wont have to pay for it.   Silly!  Of course they pay for it.   All organizations, whether they pay for it or not will have it blended into their rates.   Insurance simply pools the cost and spreads it out to all.

I want to have hope that our leaders won’t disguise and deceive the public debate in trying to solve problems.  Today is yet another example of the current administration trying to play dumb and claim later that it was the law of unintended consequences.  

You are entitled to your own opinion on the issue, but lets collectively own the fact that the compromise is an attempt to deceive the public on how insurance works.   Today is another indication that it doesn’t matter what it is, just how it looks.  Shame on the administration for today’s “insult to injury” non-compromise.  

A few of the numbers from the bill


Perhaps by morning there will be articles out there with some quick stats on the things you might want to know.   I thought I would put out a few of the stats to start.  



  • Can I get insurance without a pre-ex clause??-  Not until 2014. 
  • High Risk pools ? –  Federal government will fund $5 billion for high risk pools.  Should kick in 2010.  
  • Kids ?  –  To age 26 in all States.    Should kick in 2010. 
  • Did my taxes go up?  –  Payroll tax will increase in 2010 for those earning over $200k.  Income tax surcharge of 3.8%. 
  • Did my Health Savings Account survive?  – Yes.
  • What about employer penalties who don’t provide insurance –  For qualified employers, the penalty has been increased from $750 to $2000 per employee.  Companies with 50 or fewer workers are exempt from the requirement. Part-time workers are included in the calculations, counting two part-timers as one full-time worker.
  • What about individual penalties?  –  If you don’t have insurance, you will pay 2% income tax surcharge up to $325 per person. 
  • What about Expensive health plans surtax?  – Exists,  $10,200 for singles,  $27,500 for families and that doesn’t start until 2018.
  • Flex Spending Accounts –  $2500 annual contribution limit. 
  • Deduction of Medical Expenses – Increase from 7.5% of AGI to 10% excluded.  
  • Creation of Long Term Care insurance fund for to help seniors in need of help with daily tasks such as bathing and dressing.
  • Subsidy for low income – on a sliding scale for households making up to four times the federal poverty level, $88,200 for a family of four. Premiums for a family of four making $44,000 would be capped at around 6 percent of income.
  • No gender based pricing for individual insurance. 
  • Insurance Exchange starts in 2014. No Public Option.
  • No lifetime limits on benefits.  
  • $480 billion in new taxes over the next 10 years. 
  • $500 billion in Medicare cuts over the next 10 years. 

Reform has arrived

I am monumentally disappointed in the passing of this Health Care Reform bill.     Most of the people reading this blog will pay substantially more for the same services so that those who did not pay into the system have guaranteed access.   This bill will surely be modified thousands of times over the next 5 years, but one thing is certain;  costs will increase.   Imagine a surcharge on your mortgage to make sure that those who over extended don’t lose their home equity.   

I am 100% open to being wrong.   I made a huge mistake in voting for a Presidential candidate who promised openness and bipartisanship in formulating a health care bill.    I am hopeful that my losing streak continues.   For now, I am as disappointed in Congress as I was excited when Mr. Obama was elected.
  

 

Bulletin: 12/23/09 – COBRA Subsidy Extended

Update:  On March 2, 2010, Congress passed, and the President signed a 2nd extension of the COBRA subsidy.   The subsidy qualification period has been extended to December 31, 2010.  

President Signs COBRA Subsidy Extension Legislation



  • Extends the premium subsidy eligibility period by two months, so it will end on February 28, 2010, rather than December 31, 2009.
  • Extends the period of the 65 percent COBRA subsidy from nine months to 15 months.
  • Establishes a transition period that applies to individuals who lost subsidies before the effective date of the Act because they received the maximum number of months of subsidies under the original subsidy provisions.
  • Establishes new notification requirements by group health plans or other entities.
  • Clarifies that eligibility and notice requirements for the subsidy are based on eligibility for COBRA due to loss of coverage because of qualifying event (involuntary termination of employment), both of which must occur during the eligibility period.

Becomes effective as if included in the original COBRA subsidy provisions of the American Recovery and Reinvestment Act (ARRA).

Merry Christmas.

Health Reform a Moving Target

It has been weeks since I have published any new articles on health care reform.   I wanted to get out a general update out to those that read my interpretations.   It’s hard to latch on to a general theory or pattern since the House version was dead when it passed, and the Senate version changes more frequently than the weather.  


 


The popularity of health care reform has dropped to its lowest levels since it was first outlined early in the summer. There is an outside chance that it will not pass, but it is my opinion that some form of reform will pass.  Some of the changes are well intended but poorly executed.   The overriding reason that I believe that some form of reform will pass is because it is loaded with taxes in the first few years, which is good for the deficit, and the benefits are not set to kick in until the next Presidential term, leaving the next White House and/or Congress to take away benefits from the “poor and uninsured”.   I quotation the term because reform will not necessarily benefit the poor and uninsured, but you can count on anyone being cut from benefits as being defined as “poor or uninsured”.  


 


Health care reform should contain:



  • Cost containment provisions.
  • Penalties for those that try to beat the system.
  • Subsidies for those that can’t afford care, and then provide them with good CATASTROPHIC coverage, and a sliding scale of benefits for day-to-day expenses, based on income. 
  • Incentives and rewards for those that have played by the rules.   If you try and beat the system by not being insured, you are guaranteed insurance, but at higher costs than someone who has maintained coverage.  
  • Incentives to obtain lower cost coverage.  
  • Pre-ex elimination and guarantee to issue coverage. 
  • Elimination of Discounts based on membership.   As a consumer the cost of your service is based on your provider, not your insurer negotiated discount. 
  • Better Fraud control’s on Medicare. 

What I believe will be in the bill. 



  • No Cost Containment
  • Some disincentive for those that try and beat the system, but not enough to change the economic decision of the individual to choose to try and beat the system. 
  • $50 billion in new taxes to be passed on to the consumer. 
  • No reward for staying insured.
  • No incentive to obtain lower cost care.
  • Elimination of Pre-ex.
  • No change on provider discounts.  
  • A health insurance exchange to create new competition, but most likely won’t be competitive. 
  • “To heck with fraud”, lets just cut everybody.  (sarcasm) – The government can’t seem to manage fraud, or even mount an attempt.   They just will build in the basis that everybody cheats them, so cut everybody. 

I interpret the market reaction to be. 



  • Better access to coverage for those with pre-ex conditions, but at a higher cost to all. 
  • Less incentive for employer paid insurance.   
  • Higher costs from private insurers because of standardized benefit increases and guaranteed access.
  • Much higher costs for young males.  (As much as 100% higher for those under 35.)
  • Lower cost for people age 55 and over.   ( Due to price band implementation changes)
  • Greater burden for State Medicaid programs, which could result in some States dropping Medicaid for the poor forcing a Federal programs to provide coverage.   

In my opinion, the best option is to let the taxpaying and voting members of this society argue in public forum in 2010 what we collectively want.  Then each district can elect someone who represents one path or another, and we collectively come together to solve a serious problem.  



Have a Merry Christmas and Happy Holiday!

Breaking News: House Passes Health Care Reform

At 11:09pm Eastern Time,  the House of Representatives passed sweeping health care reform legislation with HB3962.   The vote was 220- 215 ,  with 39 Democrats voting against Health Care reform.  One republican voted for the bill.   176 Repubilcans opposed the bill.

The bill, over 2000 pages, includes a Public Option.  An amendment passed tonight that banned Abortion coverage being included with any Public Option or private plan where federal subsidies are involved.  Rep. Jan Schakowski argued vehemently for abortion funding , but was unsuccessful in getting that amendment killed.  

President Obama mentioned today that 14,000 people are losing their health insurance every day.   He did not mention that the reason that they are losing insurance is because the economy in contracting, and people are losing their employer based health care.  Perhaps it would be wiser to cut taxes and stimilulate Job growth instead of adding taxing those that still have jobs.  The bill will include appx. $400 billion in new taxes on the health care industry over the next 10 years.   Those taxes start January 1, 2010.  (in 54 days)