As Donald Trump puts his limited energy into showing the world that this presidency thing is way beyond his limited abilities, the insufficient patches to the American health care system lumber into another year. More of the same high-cost but accessible health care is a better deal than what Republicans were offering with their American Health Care and Better Care Reconciliation Acts. But for the millions of people not eligible for subsidies and purchasing their health insurance in the non-group market, the failure of both parties to make health insurance more affordable is unacceptable.

Republicans lawmakers are not the only ones that waited seven (7) years to suggest changes to the Affordable Care Act (aka Obamacare), Democrats did too. And, to add insult to injury, they callously repeated that the number of non-subsidy receivers was so low and, if you thought about it, these people could technically afford high-cost insurance. They also promised to eventually come up with a solution to this minor Obamacare problem. Well, after 7.5 years Democrats have yet to propose one suggestion to the non-subsidy problem for the millions stuck with paying 100% of high-cost health insurance. However, strangely, there is a law that was passed by both Republicans and Democrats that could help these individuals, including me, but by design, does not.

Say QSEHRA, QSEHRA

In December 2016, a nearly unanimous Congress passed the 21st Century Cures Act. This Act includes a provision that allows small employers to offer a flexible benefits plan, called a qualified small employer health reimbursement arrangement (QSEHRA), to help their employees pay health insurance premiums and health care expenses with tax-free dollars. One way a QSEHRA works is an employee purchases an individual policy, pays the premium out of their pocket and submits proof of coverage to the employer who has set up the QSEHRA plan. The employer reimburses the employee for the premium, with tax-free dollars, up to a mandated amount. Or, if the employee has coverage through a spouse’s plan, the employee can receive tax-free reimbursement to cover medical expenses. The QSEHRA regulation changed the way health reimbursement accounts were treated under Obamacare as it was designed to help small employers provide premium and health care cost assistance to their workers when providing health insurance was not financially or administratively possible. Continue Reading...

Tags: Better Care Reconciliation Act, American Health Care Act, QSEHRA

While the health care reform debate stalls in the Republican-majority Senate, individuals health insurance purchasers like me are left wondering what's next. Will Health and Human Services Secretary (HHS), Tom Price, miraculously develop a base level of professionalism and sense of duty to administer the Affordable Care Act (aka, Obamacare), the law of the land, for now, the way it was intended? Will Republicans restore the funds for the risk corridors so that insurers are certain that the government will cover losses they may incur? Will HHS role out a robust national open enrollment program for the exchanges and will they staff the effort appropriately? Or will the Senate, like the House, find a way to pass their awful health care bill, the Better Care Reconciliation Act (BCRA) before the 2018 Open Enrollment on the Exchanges?

We, I, need answers to these questions soon because the fall health plan open enrollment season is just a few months away. My current health insurer has already sent me a good luck because we won't be here for you next year letter. And health insurance companies need answers to these questions now to make decisions about what, if any, plans they will offer to individual health plan purchasers.

Reason To Be Afraid For The Future Of Individual Health Plans

It's so disheartening to witness long-term Republican lawmakers and the White House react so vindictively to their current legislative debacle. After seven years of ranting about the awfulness of Obamacare and promising a better replacement, they delivered bupkis. But don't expect these guys to hang their heads in shame, that's a completely unfamiliar emotion to them. In fact, they can't even call their failure a failure. This is a line from the official statement put out by the Majority Leader's office on the Obamacare repeal vote.

" Regretfully, it is now apparent that the effort to repeal and replace the failure of Obamacare will not be successful."

In other words, Obamacare, which provided health insurance and health care to millions of people, is a failure but the seven-year long Republican effort that created the unpassable Trumpcare is not. The fact that McConnell refuses to acknowledge that Republicans do not have a better alternative to Obamacare that they are all willing to vote for makes me queasy.

And what's even scarier about the future of the individual health insurance market is that where McConnell leaves off in his hypocrisy and projection, Trump picks up with his mean, hateful, nastiness. Since being elected, (gag) Trump has boasted about letting 'Obamacare explode,’ ‘die on its own,’ or ‘fail,’ as he and his fellow Republican liars and obstructionists do everything they can to undermine the law. He threatened explosion when the House wavered in passing their crappy health care reform bill, the American Health Care Act (AHCA); and now he's threatening the same thing now that the Senate's bill is down and out (for now). I think Trump is dumb enough to try this strategy, and with his devil's helper, HHS Secretary Tom Price, things could spiral out of control quickly for people like me. Continue Reading...

Tags: obamacare, American Health Care Act, Better Care Reconciliation Act

We will never know what the private health insurance market would look like today regarding cost and affordability if the Affordable Care Act (aka Obamacare) never became law. However, there is every reason to believe that premiums would be as high if not higher than they are today and that coverage for many people with pre-existing medical conditions that purchase individual plans would be unaffordable or unavailable. But as we contemplate what would have been we should also dread what will be.

Very soon, Republican elected officials will likely pass a health care bill, or tax bill if you prefer, that will return us to the health insurance status quo, but with a twist. The Affordable Health Care Act (AHCA) passed by the House and the Better Care Reconciliation Act (BCRA) proposed by the Senate make the pre-Obamacare health care status quo look not so bad. The BCRA effectively makes individual health insurance plans worthless.

The Better Care Reconciliation Act allows health insurance companies to get away with paying barely half the cost of medical care while charging individual purchasers more than they currently pay in premiums, copays, deductibles, and coinsurance. These provisions in the bill are not just a case of more money for less coverage; they are an attempt to eliminate the individual market for all but the wealthy. Furthermore, these features of the bill are a way for the government to pay less in premium subsidies because people who can't afford these skimpy plans will drop out of the individual market altogether.

This Law (BCRA) Stinks

When Bill Clinton called Obamacare, "the craziest thing in the world," he was referring to the fact that the law offered no financial help to purchase health insurance for millions of individuals. These are people like me that didn't qualify for Obamacare subsidies, Medicaid, Medicare or the employer health insurance tax exclusion. We have to pay 100% of the cost of our health insurance even though most of us are not wealthy. Meanwhile, Obamacare supporters, especially the ones responsible for administering the ACA, downplayed the size of this group or claimed that they would get around to helping us eventually.

After winning the majority of seats in the House and Senate and electing a Republican president, Republican officials seized on Bill Clinton's statement claiming their health care reform bill would eliminate the craziness. Continue Reading...

Tags: obamacare, American Health Care Act, Better Care Reconciliation Act

A recent New York Times article laments the "halfhearted opposition" to the pending passage of the American Health Care Act (AHCA, aka Trumpcare) by powerful groups such as doctors, nurses, hospitals and patient advocates. Health policy experts condemn the "fast-tracking" of the ACHA in the Senate. And the Jeff Sessions' hearings and other Russia collusion noise, crowd out national reporting on the AHCA as the Senate is weeks away from passing their health care reform bill.

The AHCA passed by Congress and currently undergoing revisions in the Senate, rewards the healthy and wealthy and punishes the sick and poor. Some people are appalled and baffled by the impending passage of legislation that brings more inequality into an already unequal system. Isn't it more sensible to provide the most financial assistance to people that need the most health care? Well this is America, where a near majority believes it's okay that the rich can afford better health care than the poor.

The Poor Cost Too Much

Many people think the sick are responsible for their illness(es) due to their engagement in "voluntary health risks" or "changeable behaviors." Never heard these terms before? Me neither. I guess using the term unhealthy lifestyle didn't sufficiently make the point that sickness is a choice, and an expensive one at that.

By some estimates an unhealthy lifestyle cost hundreds of billions of dollars each year in medical care. A recent study contracted by General Electric estimated the cost of cancer care due to an unhealthy lifestyle at around $34 billion per year. Other studies put the annual costs of treating alcohol abuse at an estimated $176 billion, smoking at $137 billion and obesity at $147 billion (2008 number for obesity). These issues—cancer, alcohol abuse, smoking and obesity—costs nearly a half trillion dollars in health care each year.

But cost concerns are not what allow the Republican Congress and Senate to easily take away health insurance from the sick and poor. The truth is that despite the passionate town halls, we don't want the poor to live as long as the wealthy. We would save money if they did not. According to the Congressional Budget Office (CBO) score of the AHCA, that savings is about $3 billion, to start (represents reduction in Social Security payments due to early deaths). Continue Reading...

Tags: AHCA, American Health Care Act, Trumpcare, obamacare

Some people think the original sin of health care and health insurance is government regulation and "patches" like Medicare and Medicaid. Other people think the problem originated from a different government sin—the employer health care tax exclusion. This tax break translates into significant money saved for individuals enrolled in employer-provided health plans. Individuals not enrolled in these plans and who purchase health insurance, do not receive these savings.

So which sin should the country address first, health insurance regulations and patches or health insurance costs equity? The easiest issue to address—equalizing or eliminating the special tax treatment of employer-sponsored health insurance plan payments is a good place to start. But our time-strapped Republican-majority Congress decided to spend the majority of its limited attention tinkering with the political and policy challenges of health care regulations. The Congressional health care reform bill, the American Health Care Act (AHCA), does not equalize or eliminate the employer health care tax exclusion but goes very far in changing health insurance regulations.

These proposed regulatory changes will take hundreds of millions of federal dollars out of the health insurance and health care system if they survive the Senate and reconciliation processes and are signed by the President. Potentially, tens of millions may lose their health insurance coverage and access to health care. People opposed to the AHCA are focusing their energies on protesting at congressional town halls, emailing and writing their representatives and educating the public about its possible impact. It's an uphill battle for these protestors to change the course of legislation, which is why I think they may have more luck at addressing the unequal tax treatment of health insurance premiums that exists between employer-sponsored and individually paid private health insurance.

The AHCA, in a very limited way, does address the employer health care tax exclusion by providing tax credits to individuals that purchase health insurance. However, these credits may not equal the value of the exclusion and the health plans available in the individual market do not equal what employers offer. So, at a minimum, protesters should demand that the AHCA equalize the tax treatment of all health insurance plans. But they shouldn't stop there. AHCA opponents may have more success trying to convince employers to stop providing health insurance or provide only supplemental health insurance. Continue Reading...

Tags: AHCA, American Health Care Act, health insurance

Recently, Congressman Steve Chabot of Cincinnati, Ohio wrote on his blog, "I haven’t seen so much misinformation and hysterics about a piece of legislation in a long, long time—maybe ever" about the passage by the House of the American Health Care Act (AHCA). I guess he was asleep during the passage of the Affordable Care Act (aka Obamacare). But all kidding aside, I strongly suspect that the Senate will continue the House's work to make American health care look more like it did pre-Obamacare. They never thought health care reform was necessary in the first place.

Republicans have the numbers to pass the health care bill they want; still, I can't help but think that a return to the status quo is not in the country's future, at least not long-term. You see, Republicans may think that they are about to accomplish something that's never happened before, taking away a huge federal entitlement program, but not even health insurers are prepared to return to the bad old days. Insurers know they passed the big-changes-are-coming-moment and are in the redefining-and-refining-our-purpose-moment, and if the GOP had consulted them during the health care reform debate, they would know this also.

What Health Insurers See As Their Future

Optimizing value by providing doctors with data analysis services.
Last week Humana's CEO, Roy Beveridge, described the country's third largest health insurer as an IT company focused on data analytics to improve health care value. According to Beveridge, the future of health care may be using data to understand risk better and sharing this data with doctors to improve patient outcomes. Doctors can use this data to determine which patient populations need what care and how often to engage with them.

Focusing in on getting a bigger piece of the (new) pie.
Also, last week, health insurer Aetna, Inc., announced it would pull out of the Obamacare exchanges for next year. In addition, Aetna CEO, Mark Bertolini, reportedly said, the country needs to have a conversation about single-payer health care. However, instead of health insurers competing with the government to offer health insurance, Bertolini envisions health insurers managing the single-payer program for the government, as it does with Medicare and Medicaid.

Enhancing patient access to health care services.
The Blue Cross Blue Shield Association is looking to help the very population the AHCA would possibly harm, the poor and isolated. Recognizing that not everyone has access to reliable transportation to get to non-emergency medical appoints BCBSA is piloting a program to partner with Lyft to provide free rides to its members. Continue Reading...

Tags: obamacare, Single-payer, American Health Care Act, Aetna, Humana, health care data analysis

How bad the American Health Care Act (AHCA), the Republican replacement for the Affordable Care Act (aka, Obamacare), will be for the mentally ill, women, poor people, children, older people, and people needing drug treatment is still unknown. However, everyone expects these groups to receive less financial support in purchasing health insurance and in accessing health care. Meanwhile, the young, healthy and the wealthy have something to smile about if the AHCA becomes law.

But According to Donald Trump, weakening Medicaid and providing skimpier subsidies than Obamacare is just the first step in the rollout of the Republicans' great health care reform plan. For step one of the bill making process, Republicans had to navigate a complicated legislative process called reconciliation, as Paul Ryan likes to remind everyone, including critic, Senator Tom Cotton. So Ryan took this opportunity to do something thoroughly Republican and eliminate the Obamacare-related taxes for the rich and warn the poor that their health care free ride was over.

Don’t Underestimate The Republicans Capacity For Cruelty

After rolling out step one of the American Health Care Act, Republicans in Congress proceeded to make some of the dumbest and most hypocritical remarks in political history. I'm being dramatic but I'm not the only one that attacked Congressman Jason Chaffetz's on Twitter for his dumb iPhone remark, or who was disgusted by Senator Tim Scott's dissing of the Congressional Budget Office (CBO) because he suspects it will reveal the bill as a huge takeaway for the millions who got insurance under Obamacare. And let's just try and forget Paul Ryan's misleading, inaccurate and amateurish PowerPoint presentation where he revealed that he doesn't know the definition of insurance, and his performance on Fox News where he coldly stated that he didn't care about the windfall his bill gives to the rich. Continue Reading...

Tags: American Health Care Act, Paul Ryan, obamacare