ACA Lowest Cost Health Insurance Plan Option For An Individual - 2020/Virginia



ACA Highest Cost Health Insurance Plan Option For An Individual - 2020/Virginia




The Healthcare.gov enrollment period started a week ago, on November 1. Like millions of people who must pay 100% of the health insurance premium insurers charge, I held my breath and prepared for the worst. Due to technological difficulties, I wasn’t able to log on to the site on the first day. No worries, there are benefits to delaying bad news. One is that you become irrationally optimistic.

Although it’s never happened before, I thought, maybe my individual private health insurance premiums would decrease. There are several reasons why they should.

1. Last month I received a $99 refund, aka, medical loss ratio (MLR) rebate, from Cigna (based on Cigna’s 2018 MLR). The MLR rebate provision of the Affordable Care Act “requires health insurers to pay rebates to policyholders if the insurer fails to spend at least 80% to 85% of total premium revenue on medical claims and health care quality improvement activities (as opposed to administrative and marketing expenses and profits).”
2. Cigna is financially strong. It’s 2019 third-quarter profits and revenues were up at $38.6 billion and $35.8 billion, respectively.
3. The federal government’s Health and Human Services Department reports that health care premiums overall are decreasing in 2020.
4. I’ve never needed medical care in my adult life. I’ve never been ill, injured, pregnant, or taken a prescription drug.
5. I’m currently paying an extortionist, unsubsidized monthly premium for my Cigna EPO health plan (per my monthly email reminder).

Tags: health insurance , obamacare, Affordable Care Act

Oscar Health, founded, in 2012, originally set out to develop and sell tech products to established health insurance companies. When that plan did not work, Oscar Health’s founders took the millions of dollars raised from investors and started a health insurance company centered around its custom tech. Six years later, and with a recent $375 million investment from Google’s parent company, Alphabet, Oscar is doubling down on being an health insurance technology company. Or, are they a technology company that sells health insurance? And is Silicon Valley-style tech the missing component in health care reform?

Improving Services And Saving Lives

Oscar’s social media branding approach to health care and real-time data decision tools are a welcome contrast to the everything-but-the-kitchen-sink websites of other health insurers. A system that uses real-time prior authorization for surgeries is a huge improvement over faxing forms and waiting days or weeks for a response from the insurer before you can schedule an appointment. An insurance company that pays claims in real-time, while you’re still at the doctor’s office, is much better than waiting for a bill from the doctor and then waiting for the insurer to pay its portion before you know what you owe.

Innovative technology is good for the health care industry and the trash-talking bros at Oscar (these guys can't get through an interview without a negative comment about their competitors’ antiquated legacy systems) are producing tech that improves the health care experience and has the potential to save lives.

We know that the technology doctors and hospitals use to diagnose and treat patients can save lives, but so can having immediate access to real-time data. A recently reported story on Forbes Online about an Australian cancer patient, Mettaloka Halwala, illustrates how faxing forms can result in medical errors. In Mettaloka’s case, it was a death sentence. Less serious, but still frustrating, administrative errors occur in health care every day. Since 2014, Blue Shield in Los Angeles’s enrollment system, the one used for individual health plan purchasers, has been on the fritz. The enrollment system unexpectedly terminates policies of individuals whose premiums were paid. Customers spend hours on the phone trying to get their insurance coverage reinstated, all while skipping medical appointments and delaying prescription drug refills for days, weeks, and months. Blue Shield in LA’s continual system problems for the most basic of services is one of the worst examples of a major health care industry customer service failure due to inadequate technology.

Big Data, Innovative Tech, And The Human Condition

The rollout of the Affordable Care Act (aka Obamacare) had its technology challenges. But the Act achieved its primary purpose of providing affordable health insurance coverage to the millions of people without coverage. A glitch-free enrollment system, impervious to attack by political rivals, would have been a good start for Obamacare supporters and enrollees, but, what’s more important—affordable coverage or a streamlined health plan enrollment system? The guys at Oscar might think that they are providing both, but are they? Using data analytics, predictive modeling, and artificial intelligence may eventually lead to administrative savings in health care, but other factors can replace those costs. Continue Reading...

Tags: Oscar Health, obamacare, health care technology, Social determinants of health

After weeks of silence, followed by news of Obamacare sabotage, health care reform policy returns to center stage. Last week, Bernie Sanders revealed his Medicare for all plan, and Republican Senators renewed efforts to repeal and replace Obamacare with a plan (Graham-Cassidy-Heller-Johnson (GCHJ) plan) that will leave tens of millions without health insurance. If it seems like American health care reform continues on the road to nowhere, it's because it does.

The Sanders plan is long on moralizing (yes, health care should be a right) and short on concrete ideas to address health care costs. The plan includes all of the usual policy proposals to lower health care costs: administrative simplicity, enhanced negotiating power with prescription drug makers, federal subsidies for health care worker training, incentives for doctors to provide better care, and making rich people and employers pay more of the costs for national health care. The only thing new about the Sanders Medicare for all plan is that now it is official.

The Graham-Cassidy et al plan put out by Republican Senators Bill Cassidy (a doctor), and Lindsey Graham is a lot like other Republican health care reform proposals of late in that it looks to reduce federal funding of health care by replacing current subsidies with smaller block grants. The bill would also reduce the amount of money the federal government gives to states to fund their Medicaid programs. But mostly the bill, if passed, will unabashedly, take health care away from millions who currently have it with no pretense of offering them anything in return. There's more awfulness to read in Cassidy-Graham, but the overarching message is that Americans do not have a right to federally funded health care.

So here we are, again, with two opposing policies on American health care reform. Meanwhile, big pharmaceutical companies continue to introduce drugs approaching or surpassing the half a million-dollar cost mark. Employers persist in maintaining health plans whose costs they cannot manage. Workers' keep on watching health care premiums eat up their small wage increases. Politicians continue to move money around from one powerful health care interest group to another. And Americans continue to fall for the you-can't-put-a-value-on-your-health and the importance of American innovation cons to justify uniquely high-priced American health care.

No Shame In the Health Care Price Game

No one disputes that America has the highest medical care prices in the world. But in typical American fashion, some of us like being at the top of even this list. Defenders of high-cost American health care claim the costs are high because we as a country can afford it, and that that's the price tag for medical and drug innovation. But neither of these claims is necessarily true or right. Tens of millions of Americans cannot afford to pay for health care, and the high price of medical innovation shouldn't go unchallenged.

Last week there was a report about a new cancer drug with a $475,000 price tag. And it seems like just last year we in awe about a new Hepatitis C drugs that cost about $80,000 per patient. Also, just two weeks ago, Texas Medical Center was bragging about its $50 million worth of floodgates protecting it from Hurricane Harvey. Yes, America obviously has a lot of money to invest in medical care, but is it investing it wisely, is the greatest number of people helped by these investments and who gets to make these decisions. Continue Reading...

Tags: Bernie Sanders Medicare for all, Graham-Cassidy plan, obamacare, repeal Obamacare, Medical innovation costs

Don't be fooled. After finally agreeing to pay the August Affordable Care Act (aka Obamacare) cost sharing reduction (CSR) payments to insurers, Trump and corrupt Secretary of Health & Human Services, Tom Price, remain committed to destroying Obamacare. Their goals are to pay less in subsidies that help people purchase individual health insurance plans and pay for medical care, and to scare health insurers away from the exchanges by injecting uncertainty about future subsidy payments.

Unfortunately, and despite the latest CSR payment, Trump and Price's sinister plot to undermine Obamacare is having the intended effect. Because health insurers cannot be certain that this Administration will not stall or stop future subsidy payments, they will increase rates by a higher percentage than they otherwise would have. And when health insurers feel uncertain and are afraid they won't meet their financial objectives, they take it out on everyone. That means health insurance premiums may be higher for everyone next year, even employer-sponsored group health plans.

But that is not all on Trump and Price. Their childish, mean-spirited antics only highlight a fundamental problem with a for-profit, private sector led health insurance industry. You see, American health insurers have always insisted that their profits be assured. Taking a loss in one line of business (selling to individuals) and making it up in another line (employer-sponsored and other group insurance), but still making an overall profit, is viewed as a loss for them. They want all of their lines of business to be profitable all of the time.

Even if Trump and Price admit that the Republican health care reform efforts have failed, that they will now honestly administer the Obamacare law as intended, and promise to make all future CSR payments on time, insurers will still raise rates higher than are needed until they feel comfortable that their profits will continue. How long will they wait until they are comfortable that their profits are not in imminent danger? They will wait as long as they want to, which is forever, and there is nothing we can do about it.

Health Insurers Will Always Inflate Premiums

It is so disingenuous for Obamacare critics to imply that the health insurance market was ok or even better before Obamacare. How they ignore or explain away that purchasing individual health insurance pre-Obamacare was hit or miss or that finding comprehensive and affordable coverage was impossible is beyond my comprehension.

Purchasing individual health insurance pre-Obamacare was a long and difficult experience. First, you had to find a reputable insurer that sold individual plans, and then you had to work with an insurance broker to apply and purchase the policy because you couldn't work directly with the insurer. And that describes the not too bad parts of that old way of purchasing insurance. The fact that tens of millions could not purchase individual health insurance, some because they didn't want to, but many because they were denied or couldn't afford it, tells you everything you need to know about why Obamacare or something like it was bound to happen. Continue Reading...

Tags: CSR, obamacare, Medicaid, health insurance

I finally agree with what health care policy writers have been saying for months—An American Medicaid or Medicare For All program may be imminent. I reach this conclusion not because of the recent failure by the Republican-majority Senate to repeal and replace the Affordable Care Act (aka Obamacare), but due to the comments of many doctors following this failure. Medical providers sense the change in attitudes away from a for-profit, insurance company driven health care system, and they want to make sure that their role is safe from public backlash and government changes.

And to make it clear on where they stand on this impending new health care world, they are reviving their objections to the “provider” label. Although decades old, doctors hate the provider label now more than ever. They find the use of the term condescending because it links them with other medical care professionals like nurses and physician assistants—people not at their level of expertise. But the primary reason many doctors dislike being called “providers” is that they see it as a “commoditization of the doctor-patient relationship” and now you’re messing with their money.

Commoditization refers to the process by which goods become so similar that their only distinguishing characteristic becomes price. The development of tablets and smartphones are an example of commoditization. They all have the same or similar features like touch screen and syncing with other devices, etc. And even though I prefer Apple products and give the company credit for pioneering much of the technology now available on other devices, I know that I could accomplish pretty much the same tasks with a non-Apple tablet, phone or computer and at a much lower cost.

Apple is not afraid of commoditization; it expects and thrives in this type of environment. It sees the competition as good for customers because it pushes the company to innovate more. Doctors, on the other hand, hate the idea of commoditized health care. They don’t want to compete on service or price. In fact, the real reason doctors and hospitals don’t want electronic medical records or to publish their prices has nothing to do with costs but because they are afraid a competitor will “steal” their patients if they had access to this data. And, of course, doctors think that their product (health care services) is unique

To date, we have protected doctors and hospitals from real competition and allowed them to charge whatever they want for their services. A Medicaid or Medicare For All single payer health care system that includes electronic medical records and price transparency will force doctors and hospitals to compete on price. This type of system is good for the public because it’s one of the few ways, other than forced price reductions, to make health care affordable. Doctors and hospitals won’t like this more transparent health care system, but who cares; it’s coming, and they know it. Continue Reading...

Tags: Medicaid For All, Medicare For All, Affordable Care Act, obamacare

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 are right to mock the hypocrisy of elected Republican officials that criticize the Affordable Care Act (aka Obamacare) for leaving millions of individuals uninsured and doing little to address the high cost of health insurance. Instead of creating policies to address these two Obamacare shortcomings, Republicans decided to exacerbate them by withholding funding to insurance companies that all but ensure that premiums will rise even higher and fewer individuals will have health insurance. We are also right to sneer when conservative intellectuals and Libertarians extol the virtues of a so-called free-market health care system where people are free to buy or not to buy any level of health insurance, and from any location they want. When the reality is that health insurers aren't in the habit of offering a la carte health plans. There's also the issue of opaque pricing with “free market health care.” Another issue with conservative and Libertarian views on health care is that half of the purchasers can buy insurance at a significant discount because of the workplace health insurance premium tax exclusion and the other half have no such benefit.

But at some point, and I think the time is now, Obamacare supporters and proponents of single payer or universal health care will have to realistically and publicly address how their proposed policies will deal with the problems of health care costs and affordability. Unlimited health care at any cost paid for by the government is not a realistic option, and no such system exists anywhere in the world. There are and should be limits on the amount of medical care an individual receives if they are not paying for it or if doctors and hospitals determine additional care would have no meaningful impact.

Our current U.S. health care system already places limits on the amount and form of medical care individuals receive. Sometimes these decisions are based on ability to pay the cost of care, and at other times they are based on medical science. However, this approach of rationing medical care won't be sufficient in a Medicare For All style system. Rationing of medical care will have to be front, and center of any government paid health care system. But that is not to say that people will not have access to care the government won't pay for; they are free to purchase health insurance or health care individually.

Some people may believe that a government codified system of medical care rationing harms the poor and favors the rich. Not necessarily. First, the poor won't likely pay anything for their medical care, and they will have access to preventative and continuous care that should improve their health status. Second, the poor won't have to pay for costly medical innovations, one of the real drivers of outrageous U.S. health care costs, but they will benefit from them. And third, the stigma applied to government-provided health care is diminished and so is the incentive for doctors and hospitals to treat the poor differently.

Okay, But Not Now

Right now proponents of government-paid health care for all our engaged in a battle to keep the poor from losing access to medical care. They may feel that they have to accomplish this goal first before they can start the conversation about their ideal health care system. Meanwhile, opposers of government-based health care use the socialists, communists, and hippie-dippy, out-of-control spending argument to make universal coverage look less attractive than the status quo. And I fear they are winning this argument because of a weak counter-argument of a greedy, evil opposition. Continue Reading...

Tags: obamacare, Medical rationing, libertarians, health care reform

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

Before the passage of the Affordable Care Act (aka Obamacare), America had not had a conversation about health care policy in decades. So it's understandable that many elected officials lacked knowledge about America's health care system and assumed it was performing as intended. From what they understood the health care status quo met the needs of the wealthy, professional and middle classes. And the poor, elderly and veterans had government-provided insurance.

But looks can be deceiving; individuals without any group-provided insurance were left to the mercy of the health insurance market. A market that left over 40 million of them uninsured. Obamacare came along and upset the peace of health care policy reform at the best and worst possible time.

It was the best time for an Obamacare-type law because about 40 million Americans did not have health insurance and Obamacare provided coverage to almost 40% of them. And it was the worst time for an Obamacare-type law because the country was and is so divided on most major public policy issues. Major health care reform was introduced in a politically polarized era that became even more polarized when Trump won the presidential election, and the Republicans won a majority of Senate and House seats.

More Than A House Divided

The Republican/conservative health care policy stance is much more splintered than it is among Democrats/liberals. Democrats want Medicare or Medicaid for All, universal health care or single payer. Or maybe they just want more federal funding for the Obamacare exchanges. It depends on which group of Democrats you ask, but at least they all want a health care reform policy that expands coverage to all Americans, Republicans disagree with Democrats on the very definition of universal access to health care. Remember when the Republican Party stupidly referred to health insurance/care access as "freedom?"

But idiotic catchwords aside, Republicans and conservatives also disagree with each other on the policy goals of health care reform. First, there is Senate Majority Leader, Mitch McConnell's (a real life villain) view that replacing Obamacare is the ultimate policy goal. He couldn't care less about the contents of any health bill and its impact on the public. His only health care reform policy objective is to convince enough Republican senators to pass an Obamacare repeal bill quickly. Continue Reading...

Tags: obamacare, Trump

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

Overpricing and overcharging minorities and the poor in hospital ERs; health care specialists are driving up the cost of care; Mylan is waiting out the outrage over its high-cost Epipen and continuing its price gouging, and major health insurance companies settling multi-million dollar Medicare and Medicaid fraud cases with the government. The American health care system is a disaster and a disgrace. Greed and self-interest are its fuel. It's opaque. It's irredeemable.

And, the Affordable Care Act (aka Obamacare) trying to work with and maintain the American health care system, only highlighted all its ills. But at least the Democrats engaged in a comprehensive and intensive effort to improve one of America's biggest problems. Unfortunately, you can't say the same about the Republicans. From the start, and I'll give them credit for not lying about how vile the process would be, Republicans engaged in health care reform sausage making. Their health care reform plan consists of a three-step sausage making process—gut as much of Obamacare (cut taxes) via reconciliation, eliminate health care reform regulations, pass general health care regulation through the normal legislative process.

And like most sausage making, the Republican health care reform work is occurring out of sight. There are no experts to advise on the combination and impact of different policy options. In fact, Republicans in the Senate decided not to send their reform proposals through committees and instead assigned 13 Senators to review the House bill for further tweaking. This not-at-all discriminating approach to health policy reform all but guarantees an unappetizing product for millions. There should be no expectation of a Senate health care reform bill that is much better than the bill signed by the House. In fact, the Senate bill may be even worse than the House bill.

Initially, House Republicans were transparent about their health care reform bill. They made it clear that the Obamacare repeal law, the American Health Care Act (AHCA) was step one of a 3-step process to replace Obamacare. They collaborated with the Health & Human Services Secretary, Tom Price, to sell the proposed law to the public. And, lastly, they waited for the CBO score before deciding not to vote on the legislation. In the end, transparency was political poison for the House, and they resorted to secret meetings and hiding drafts of the revised proposal. The result was a reform bill that was just as bad as the first one but easier to pass politically. Republican senators have no desire to repeat the mistakes of their House colleagues. There will be no false starts on voting and no or little sharing of policy details before the vote, and there will be a vote and the bill will pass.

A Senate version of the AHCA will look a lot like the House version, but with a longer timeline to implement its awfulness. Expect, Continue Reading...

Tags: Mylan, obamacare, AHCA

After spending years studying the Affordable Care Act (aka Obamacare) and related health care reform proposals, I am on a journey to explore the other side. While I've made a point over the years to read the health care reform opinions of Obamacare opponents, I never took seriously their prescriptions. But with the dreaded feeling that the country is on the path to indefinitely postpone the next level of health care reform, I decided to read and reread the writings of those who think our most recent health care reform efforts were a big mistake.

So this past weekend I read a lot of Michael Cannon articles and blogs. Cannon is the Director of Health Policy Studies at the libertarian Cato Institute and an avowed Obamacare hater. Cannon is famous for his many attempts to sabotage the Obamacare law in its early stages by mounting a legal challenge of the subsidies provided to federal exchange enrollees. He also encouraged states not to create their own exchanges (this approach went hand-in-hand with his legal challenge as to whether the federal government could provide subsidies to non-state exchange enrollees). Of course Cannon does not view his fight against Obamacare as sabotage, and although I think it clearly was, I am setting this aside for now.

Today, I'm more interested in understanding the health care reform viewpoint of single payer and universal health care opponents. But not just any opponent, more specifically, I am interested in comprehending the beliefs of the policy wonks, the die hard free market crusaders that oppose government playing any role in providing or paying for health insurance and health care. Consequently, I am reading the works of Michael Cannon and Ron Paul. Free market conservatives draw many negative conclusions about universal health care, including: Continue Reading...

Tags: obamacare, universal health care

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

You chose the wrong job. You're the wrong gender. Your lifestyle choices suck. You should pay for your risks. You're a celebrity and should stay out of the health care debate; also that's not how preexisting condition provisions work. The anti-universal health care set has a rational, in their eyes, retort for every appeal for government-paid health care for all.

Mocking the emotions of Medicare For All supporters is so easy it's been pushed down to the level of millennial reporters. And the formula for attacking their opponents is always the same—a charge of too much emotion and not enough facts. The fact that they know little about how health insurance and risk management works, the history of health insurance plan design and access, and the conflict associated with insurers determining risk while seeking profit is unimportant to them.

There's a wall between supporters of government-sponsored health care and those that oppose it that won't come down with appeals to decency and empathy. Still, a change in public policy is the only solution to addressing health care access and affordability. And while it may appear that policy just tilted for anti-government assisted health care reform with the Republican-majority Congress's vote to make health care less affordable for millions, that may not be a bad thing for two reasons.

One, overall the Affordable Care Act (aka Obamacare) is popular among the majority of Americans despite a vicious sounding minority that demonizes people who need assistance paying for health insurance and health care. If Obamacare "supporters" see the nation returning to pre-Obamacare days when coverage could be denied outright or so expensive as to represent a denial, they may demand to return to the protections offered by Obamacare or even greater protections.

Two, Obamacare supporters should take this as a sign to expand their support for health care reform by supporting policies that may potentially reduce health care costs. Policies that focus on alleviating hunger, especially among children and the elderly, should be at the top of the list. Also, addressing homelessness and mental illness is essential to reducing health care costs. These are issues policy advocates, and elected Democrats should include in any federal budget and hold firm on their passage. Of course, there will be opposition, possibly as strong as is currently for Obamacare, but with proper messaging, voters may come start to realize who want to address their needs and concerns.

Not everyone engages with the health care sector every day or even every year, but hunger, homelessness, mental illness and drug addiction are issues most people encounter regularly. Obamacare proponents have nothing to lose by dissecting and addressing the individual drivers of health care costs; it may even be easier than focusing solely on health insurance, which is too complex for most people to understand. Continue Reading...

Tags: obamacare, Poverty, Medicaid For All

America has always been a nation divided. The country fought over its divisions in a gruesome war, one side lost, and the nation stitched itself together again. But the stitches never healed and America never adopted a unified identity. This lack of identity led to smaller wars, culture wars, including conservative values versus liberal values, and the role of government versus the responsibility of the individual.

And with the election of Donald Trump, America's culture wars has reached fever pitch. So much so that some people believe America is headed for a second Civil War; but if not war, towards defining a new national identity. But don't underestimate America's ability to make minor adjustments and put off making tough decisions. A second American civil war is unlikely, but so is adopting a national identity acceptable to all. More than likely, America will move in the direction of greater universality in some areas because political and social forces at the time pushed us there.

We are currently experiencing a grudging push by some toward universal health care because, despite Trump supporters' hatred of their cultural opposites, many of them need assistance paying for health care. Even conservative columnist, George Will, thinks single payer health care in America is inevitable. This is good news for single payer advocates like me because single payer would improve access to health care. On the other hand, single payer health care will not reduce the cost of health care because America is not ready or willing to address the issues that make American health care so expensive, especially the issue of poverty. Continue Reading...

Tags: obamacare, Poverty, health care reform, American culture

The big health care story last week was Trump threatening, again, to let the Affordable Care Act (aka Obamacare) implode if Democrats did not work with him to pass his health care reform bill. It's a story worth reporting because it clearly shows that Trump just wants to tick health care reform off his to-do list. Something he can brazenly claim is better than Obamacare, even though it won't be, and that he accomplished quickly and through force.

Meanwhile, while Trump was undermining Obamacare with threats, Health & Human Services (HHS) Secretary, the greedy and corrupt, Tom Price, was actively weakening the law. After the Republican health care reform law debacle, Price wasted no time tweaking Obamacare administrative provisions that will most definitely result in fewer people enrolling on the federal exchange. He did this by greatly reducing the annual open enrollment period and placing restrictions on special enrollment periods and requiring documentation for life events such as marriage, birth, and losing workplace health insurance, etc. The new rules also force you to pay the full year's premiums unless you have a life event like new job-based coverage, eligibility for Medicare or Tricare, etc. With this new rule, you cannot stop paying premiums the last few months of the year, as you could under the old Obamacare rules, to save a few bucks. Price and HHS also gave insurers the green light to offer slightly skimpier health plans. Bonus!

But Price's week wasn't done. The former doctor who wants to get rid of Medicare and Medicaid because he believes the reimbursement rates are too low asked doctors for ideas on how they should get paid. Specifically, Price was referring to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which replaced the old system of paying doctors for Medicare services. MACRA is an attempt to move away from paying physicians based on the number of patients they see (fee-for-service model) and towards a system based on value and quality of services. Therefore, MACRA also requires reports on quality and pays physicians extra for meeting quality standards.

Price portrays MACRAs quality standards as so burdensome to doctors that they could lead to burnout and more doctors leaving the profession. He doesn't support bundled payments and likely doesn’t support value-based health care at all. He uses his credentials as a former orthopedic surgeon to claim he knows better than anyone that value is hard to define and therefore, unfair to pay doctors according to value-based standards. Continue Reading...

Tags: obamacare, MACRA, Tom Price

It seems everyone working in the health insurance and health care industries feels entitled to large profits. And they will do or not do just about anything to get their share of the multi-trillion dollar a year health care "market." Doctors thumb their noses at "low" Medicare and Medicaid payments, limiting the number of patients in these programs that they will treat. Health insurers balk at insuring the very sick without government subsidies to reduce their financial risk. Pharmaceutical companies threaten to curb drug innovation unless they are allowed to impose astronomical markups on existing products and enjoy long patent periods. And hospitals do whatever the heck they want to make a buck--different prices for the same care with no transparency or explanation. And these are only four of the big players in the health care market; there are many others elbowing for their share.

Under these conditions, American health care reform that tries to lower costs is dead on arrival. The powerful groups benefitting from our overpriced health care system aren't going to accept a pay cut. Some may suggest incentives to get doctors to accept lower reimbursements, like subsidizing their student debt or even reducing the requirements and the number of years it takes to become a doctor. Others may suggest performance bonuses, like the ACA tried.

There are a lot of good sounding suggestions for lowering health care costs, including drug re-importation, universal use of electronic health records, value-based health care pricing, hospital consolidation, competitive bidding for supplies, focus on tertiary care, etc. You name a health care cost cutting idea, and great minds have already penned it.

One health care cost cutting idea receiving more attention is allowing future American doctors to enroll directly into medical school instead of first getting a 4-year undergraduate degree. Medical students and the country would save a lot of money, and their student loan excuse to demand high salaries falls away. Many countries with similar or better health care outcomes require 5-6 years of schooling to become a doctor versus 8 in the U.S. But American doctors won't easily give up the prestige of being a doctor and, therefore, will continue to demand higher salaries. Continue Reading...

Tags: Medicare For All, obamacare, Affordable Care Act

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

Everyone wants to see the Paul Ryan/Tom Price Affordable Care Act (aka Obamacare) replacement bill, even most Republican lawmakers. But Ryan and Price would rather look like a putz than reveal who will be the primary losers under their new plan. They are also afraid that their fellow Republicans will join the media in ripping their plan apart. They have no desire to be once again the objects of a mocking press, Democrats and Obamacare supporters for their inability to present a Republican, majority-supported Obamacare alternative plan.

After embarrassing leaks describing their reform paralysis at the Republican retreat in Philadelphia earlier this year, and the leaked draft that revealed a proposal to base tax credits on age instead of income, Ryan and Price literally went underground (House basement) to reveal their latest proposal to a select group of lawmakers. There's plenty to mock about this childish approach to drafting legislation. But like all things related to Republican health care reform efforts, this latest hide and seek stunt is about politics and not providing affordable health care. Ryan can't keep putting out bad proposals that the rest of the GOP won't support. At least not publicly. He failed in his promise from years ago to lead the effort to draft an Obamacare replacement bill and is now just a mere figurehead of the process. Health care reform is now a Senate and White House effort with Ryan serving as secretary and spokesperson.

And with Senator Mitch McConnell and Secretary Tom Price leading the effort, we can expect more drastic cuts to federal subsidies and fewer people with insurance coverage than if Ryan had pushed through all of his lackluster reform ideas. McConnell has always wanted to push health care reform back to the states via high-risk pools and other disproved policies. But states have made it clear that they need federal government funds and they like the money Obamacare provided. Therefore, I expect the new Republican health care reform bill to grandfather Medicaid expansion for the states that adopted it. And based on past Ryan/Price proposals and the Trump Joint Congressional speech this week, we can easily assume that the crux of the law includes health savings accounts and tax credits that will mostly benefit the well-off, healthy and young Continue Reading...

Tags: obamacare, obamacare alternative, obamacare subsidies, Tom Price, Paul Ryan

Since the presidential election, Trump supporters and non-supporters have accused one another of being Snowflakes, or overly sensitive. However, recently the term Snowflake is used increasingly to describe Trump supporters. Countless articles in liberal and conservative media publications warn about the dangers of referring to all Trump supporters as racists, misogynists or uninformed. They claim that these negative characterizations are starting to backfire and result in Trump supporters clinging to him even more.

And many Trump voters admit that they are completely turned off by liberal attacks and hurtful characterizations. Not surprisingly, Trump non-supporters refuse to alter their depiction of Trump voters. They find their characterization of Trump voters accurate and their feelings not worth protecting given the potential harm a Trump Administration can cause. Add to this war of words the contentious issue of affordable health insurance and health care, and you get a mini battle between people that claim Obamacare helped them versus people who claim it hurt them. Both camps have its share of Snowflakes with the "Help" combatants referring to the "Hurt" combatants as selfish and heartless, and the "Hurt" section referring to the "Help" warriors as smug.

The "Hurt" group desperately wants to explain its objections to government-mandated health insurance. They don't like being forced to pay higher premiums than they otherwise would to subsidize health insurance for people who can't afford it. Some in this group don't want to subsidize anyone's insurance but most object to subsidizing people they characterize as able-bodied adults who made bad life decisions. A typical social media thread between the two groups has traces of the culture war happening between Republicans and Democrats.

(This is a real, abbreviated thread from a health care Facebook group. I purposefully exclude the name of the group and the contributors): Continue Reading...

Tags: obamacare, health insurance , Snowflakes

There's a lot of speculation about which group of Americans will be hurt the most by impending Republican health care reform legislation. People with preexisting conditions may see these exclusions return in some form. People with life-threatening medical conditions requiring expensive medical care may see the return of annual/lifetime limits. Group health plans may see their tax-favored plans altered and made less attractive. And freelancers and entrepreneurs may be forced to return to traditional employment, if available.

Everyone that is not wealthy enough to pay for health insurance or fortunate enough to have someone else pay for it has a reason to be concerned about Republican changes to the Affordable Care Act (aka Obamacare). And that's because health care reform is just an unwanted political exercise to Republicans. Made necessary by a law, that despite its shortcomings had a larger goal of providing affordable, comprehensive health insurance to all Americans.

Things Are Different Now

Oddly, not repealing Obamacare is more popular than the law itself. A lot has changed since the law's inception in 2010. While Republican lawmakers waited and tried to hasten the law's collapse by ending funding for the risk corridor program, something else happened—lives were saved. Cancer diagnoses that would never have occurred did. People with life altering mental illnesses started receiving treatment that allowed them to be more productive. Various artists obtained insurance for the first time in decades. The Obamacare death spiral that House Speaker Paul Ryan was so hoping for and wrongly claims is upon us didn't happen soon enough.

There are just too many Obamacare success stories getting in the way of the GOP narrative that every single component of the law has been a total failure. Not that Republican lawmakers are not trying to continue to push the narrative of Obamacare as the dumbest law ever passed by the government. They've even gone so far as to claim paid protesters are behind the current, vocal swell of support for the law, and are giving shout-outs to their well-funded and well-organized protesters to counter this support. This Retweet from the Heritage Foundation says it all:

KEEP IT UP & THANK YOU! Conservatives Are Flooding Town Halls, Too. I Know, I’m One of Them. https://t.co/YZNoJK0wdC @DailySignal

— Genevieve Wood (@genevievewood) February 16, 2017

It is official, the corrupt and greedy former orthopedic surgeon, Tom Price is the new head of the Department of Health and Human Services (HHS). What changes he will make to the Affordable Care Act (aka Obamacare) weighs heavily on a lot of minds. Will it be a slow dismantling of the law or full replacement? Will he work with House Speaker, Paul Ryan who promises to have a House plan ready in 2017, possibly by the end of the first quarter of the year? At the moment, who knows what he'll do, but expect a lot of noise over the next month from the GOP about their Obamacare replacement plan.

In fact, the show of the Republican's impending replacement plan has already started, with Paul Ryan as its star. First, he hosted a televised town hall in January, trying to convince America that Obamacare was in a death spiral. His criticism of Obamacare continued on the Charlie Rose show, and every other time he is in front of a television camera or reporters microphone. And just this week the American Action Network (AAN), using footage of Paul Ryan and hinting at his BetterWay plan, ran a television ad claiming Republicans have a plan.

After leaks of a clueless GOP grappling with health care reform at the Republican retreat in Philadelphia last month, Paul Ryan is eager to change the narrative. He is building up his party's Obamacare replacement reveal the only way he knows how, by using his star power and telling a bucket full of lies.

Ryan is not as smart as he wants people to think but unfortunately, he has a reputation for being the smart guy that's not afraid of getting into the weeds of policy. He's hoping that his undeserved reputation as technical but empathetic, will allow Republicans to replace Obamacare with less health care coverage. He doesn't frame his proposal as less than Obamacare. Instead, it is referred to as patient-centered and freedom (from costly mandates for coverage you don't need). Continue Reading...

Tags: obamacare, obamacare alternative, Tom Price, Paul Ryan

Last week's Republican House and Senate retreat in Philadelphia revealed what we already knew; they don't have a plan to replace the Affordable Care Act (aka Obamacare). This week there were reports that some Republicans have given up on repeal and replace and want to “fix” Obamacare instead. Also, this week, shady Congressman Tom Price came one step closer to becoming Secretary of Health & Human Services when the Senate Finance Committee approved his nomination without Democratic support.

It's been a frustrating week for Obamacare supporters concerned about the future of health insurance and health care in America. Every statement about health care reform, even if it is a repeat of what's been said before is scrutinized for new meaning. But for now, we are in limbo, and that is not a bad thing. Things could be worse. We should use this time to put forth some ideas on health care reforml.

Obamacare Could Be Better

Everyone agrees that Obamacare plans could be better—more affordable and there should be more of them. Also, there's majority agreement that some provisions of Obamacare are keepers, like no prohibitions on coverage for preexisting conditions, keeping dependent children on employer-provided plans up to age 26, and receiving subsidies to pay for coverage. But these goodies cost money and require trade-offs. So knowing that Republicans would prefer the government get out of the health insurance business, what suggestions would you give them if they were forced to stay in it. Keeping in mind that you can't get everything you want.

Protests are fine, but how can we improve Obamacare when we know universal coverage is out of the cards in this new Republican reality?

First, agree not to turn Medicaid over to the states via block grant or any other program. States may know their constituents better than the federal government, but equality often comes in a distant second to state budget priorities. We can't trust states to cover everyone who needs Medicaid. We also can't trust them to regulate the quality of care Medicaid recipients receive. Medicaid patients wait longer to see a doctor and get a lower quality of care than patients with private insurance.

Instead of Medicaid block grants or any other state-based Medicaid program, the federal government should run the Medicaid program just like it does with Medicare. Everyone gets the same benefits, and medical providers must meet predetermined quality standards in exchange for higher reimbursement levels.

There is no way for the government, federal or state, to get around paying for health care for the poor. States can assist in this effort by addressing the poverty in their communities, but they should stay out of the health care business for the poor. Continue Reading...

Tags: obamacare, obamacare alternative, obamacare subsidies, Medicare, Medicaid

To borrow a line from Hamilton, the musical, [Republicans are having their] "governing is harder moment" with health care reform. Just this week they added two more health care reform proposals (outlines) to the seven they conjured up since 2009. The latest health care proposals are near opposites of each other and include an Affordable Care Act (aka Obamacare) light plan and a worse than before Obamacare plan with no subsidies, or possibly, insurance for the sick and poor.

The Road To Still No Health Care Reform Bill

Whenever Obamacare opponents provide an Obamacare alternative plan, its contents are 90% Obamacare is an abject failure, and 10% (usually a bulleted list), here's my plan. Because the focus is not on reforming America's complex and pricey health care and health insurance sectors, their plans come up short in money, benefits covered and access, when compared to Obamacare. This opposition-focused exercise that Republicans are engaged in has produced nine proposals so far.

• The Obamacare Replacement Act
• Patient Freedom Act
• The American Health Care Reform Act
• The Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act
• Health Care Choices Act
• A Better Way, To Fix Health Care (Reform Plan)
• The Patients' Choice Act
• Health Care Freedom Act
• Empowering Patients First Act

Tags: obamacare, obamacare alternative, Tom Price

In his January 6, 2017, interview with Vox.com, President Obama said that one of the great disappointments for him regarding the Affordable Care Act (aka, Obmacare) was the difficulty in getting doctors and hospitals to go paperless. His interviewers, Ezra Klein and Sarah Kliff, expressed surprise that the President chose this as one of the great disappointments of such a controversial law. But I get it.

The U.S. is a world technology leader. Home to the world's largest and richest tech companies like Apple, Microsoft, Intel, Google and Facebook. But whether we are the best in tech is a matter of debate. Some believe Israel is tops in tech, claiming it has the brightest software engineers in the world, responsible for creating the best firewall software and other tech innovations. Still, others give a shout-out to Denmark, Finland, Sweden and Estonia, well known for extending tech to all of its citizens who use it in the everyday lives, even more than Americans.

But despite the great things that other countries are doing with tech, I think it is fair to say that that America has the resources and capability to lead the world in health information IT; if we wanted to. And maybe that is the primary reason that electronic health records (EHRs) are still a hope of Obama's.

What Are EHRs And What Are The Benefits and Challenges Of Using Them

Electronic health records are digital records created on a computing device by doctors and other medical care providers and staff about a patient's treatments and care. They have many potential benefits for patients and doctors, including:

• Less paperwork—won't have to provide the same basic information to every new doctor
• Fewer medical errors—doctors can receive warnings and alerts about allergies and prescribed drugs
• Easier remote access that may also expand the use of telemedicine—patients can communicate with providers online and make appointments
• Better diagnosis—doctors have a more complete and up-to-date picture of a patient's medical status
• Less diagnostic testing—doctors can see previously ordered tests and won't duplicate unless necessary

Tags: Electronic health records, EHRs, obamacare

Trump voters don't like the Obamacare subsidies or the Medicaid expansion because they help the undeserving. Consequently, they are okay with repealing and replacing Obamacare with something better, and they believe Trump can provide it because he is a businessman. Yeah, they believe that. And while I play around with the idea that Trump will surprise Republicans by proposing single payer health care so that he can brag about accomplishing something President Obama could not, the realist in me expects a plan similar to the alternative "plans" already offered up by Republicans. And the overarching theme of all of these plans is, personal responsibility and nothing says personal responsibility like putting aside your money to pay for your out-of-pocket health care expenses. You don't need subsidies. You just need a good tax deal to help you better use the money you should have. And that's why Republicans love health savings accounts (HSAs) so much.

Health savings accounts (HSAs) allow individuals to set aside money in tax-favored accounts to pay for medical care and prescription drug expenses. So, in addition to paying health insurance premiums, deductibles, coinsurance and copays, you can put some "extra" money in a tax-free HSA account. Think of HSAs as the health insurance version of the 401(k) retirement savings plan. Before 401(k) plans, employers provided pension plans to workers and their retirement benefits were pretty much guaranteed. Employers typically financed these plans but some plans required small employee contributions—it was an employer responsibility or a shared responsibility between the employer and employee. Then came the 401(k) plan with its risk of losing money, high finance fees, and employee-only or employee-mostly contributions. Responsibility shifted.

And how has the retirement income responsibility shift worked out? Well, just the other day, the Wall Street Journal reported that many supporters and early adopters of 401(k) plans acknowledge that they were mistaken in its benefits. Continue Reading...

Tags: obamacare, obamacare alternative

As the year 2016 comes to an end, many Americans are worried about the future of the Affordable Care Act (aka, Obamacare). Those who want to see the Act survive the likely oncoming assault by Congress and the new Administration are mobilizing to make their repeal objections heard. They are creating or joining social media groups, attending rallies, organizing events and writing campaigns, supporting related non-profits and calling and writing their elected representatives to voice their opposition to repealing the law.

Even some non-supporters of Obamacare have concerns about a full repeal. Many have insurance because of Obamacare, and they like some of the Act's provisions such as prohibiting the denial of insurance or treatment due to a preexisting medical condition. But then there is the hardcore minority who want full repeal of the law even if it means losing their insurance coverage. And one of the main reasons for their discontent with the law is that it provides free or subsidized coverage to the non-working poor. A recent article in The Atlantic captured these sentiments when it quoted two central Pennsylvania, Trump voters:

“but everybody's gotta get out there and get a job to help pay for it.”

“I’m worried about people being willing to work hard and stopping being dependent on the government,” Continue Reading...

Tags: obamacare

Last week, Sarah Kliff wrote an interesting piece about why prescription drug prices in America are so high compared to other industrialized countries. The international comparisons aren't new, but the conclusion that Americans have to choose between high drug prices and innovation is interesting. In a nutshell, Sarah reports that America subsidizes the world's prescription drug costs to incentivize investment in drug innovation by pharmaceutical companies and financial investors.

Sarah's article was a timely piece because also last week, the U.S. Congress passed the 21st Century Cures Act. This Act's been in the making for about two years and is the largest health care reform Act since Obamacare. It is nearly 1,000 pages, with a price tag of over $6 billion. And guess what, it includes lots of stuff about health care innovation as well as reducing approval standards for Big Pharma to bring their drugs to market. And just yesterday, the Senate, with a vote of 85-13, ended debate on the bill.

You can read the entire act here (it's at least worth a quick review).

Most of the Act's provisions, which President Obama will sign in the next few days, are uncontroversial and good. The Act provides more money for drug therapy and cancer research, mental health research and care, state opioid abuse programs and more. But not everyone's happy with the Act, including prominent Democratic Senators, Elizabeth Warren and Bernie Sanders. Both see this bill as a handout to pharmaceutical companies because of the provisions that may allow them to bring products to the market quicker than they can currently and with less attention to drug safety and efficacy.

But even Senators like Al Franken who approved the bill, lament that it does nothing to address high prescription drug prices. And the total elimination of anything to address prescription drug prices in such a relevant and related piece of legislation is more disheartening than Sarah Kliff's high cost or innovation conclusion.

The 21st Century Cures Act could easily have been, The Pharmaceutical Innovation And Price Reduction Act. Continue Reading...

Tags: obamacare, 21st Century Cures Act, prescription drug costs

Donald Trump is the U.S. President-elect, and everyone who writes and cares about health insurance and health care policy in America is eager to learn what he and his Republican colleagues in the House and Senate will do with the Affordable Care Act (aka, Obamacare). Will they repeal it? Replace it? Both? Neither? We can reasonably expect that over the next four years, Trump will sign off on some policy changes to Obamacare and millions may lose their health insurance.

Still, the larger Obamacare repeal and replace questions remain, will Speaker of the House, Paul Ryan, get to institute his Better Way (to Fix Health Care) outline? Or will professional President Obama hater and Senate Majority Leader, Mitch McConnell, get to declare Obamacare a total failure with no need to replace? It's looking increasingly likely that they may both get what they want although not because of any powers of persuasion they have, but because repealing and replacing Obamacare will help some Trump family members and friends.

Before he won the election, Trump said he would repeal and replace Obamacare with "something much better for everybody." He also called Obamacare, "A complete disaster." But after he won the election, he said that there are parts of Obamacare that he likes and wants to keep: allowing children to stay on their parents' health plan up to age 26 and the one about people with preconditions (he meant pre-existing conditions, but he's careless and uninformed). Then last week it was reported that Trump has family and friendship ties to a health insurance start-up, Oscar Insurance, that isn't doing so well. Continue Reading...

Tags: obamacare, Trump, Oscar Insurance

The upper middle class benefits a lot from the current system of access to health insurance.  They are more likely to have jobs that provide health insurance that they can easily afford, and they benefit favorably from the tax treatment of these workplace benefits.  So, it is fair to assume that the majority of these individuals do not support changes to the health insurance and health care status quo.  But the question on many people's minds is whether the unveiled contempt for the professional elite will impact their health care status.

The election of Donald Trump as President of the United States and a majority Republican House and Senate all but ensures changes to health insurance and health care policy in America.  What those changes will be is anyone's guess. Does it mean a cap on pre-tax health insurance premiums that most benefit the upper middle class?  It could since there is bipartisan support for such a change.

But I'm betting it won't be for several reasons. One, Trump supporters have yet to articulate what health care reform should look like. Two, most Trump supporters don't understand health insurance or the health care industry well enough to suggest any meaningful changes to them. And, three, many middle class people rely as much on workplace health insurance and its favorable tax treatment as the elites they hate.

But what is the point of beating the elites in a national election, if you can't also make them suffer?

Will Hate Trump Logic? Continue Reading...

Tags: obamacare, Trump, Upper middle class

There is a lot written about the downsides of fragmented health care. Most stories start out with an example of an extremely ill person, whose condition gets worse as they go from one medical specialist to another and one facility to another, taking one drug after another. The result is usually that the person suffers for a very long time until someone mercifully steps in to help coordinate care or the patient dies. No one is to blame for the person's suffering or death because they did what they were supposed to do. It's only after the fact that we find out that things should have gone better.

The good news is that there are solutions to address the horrible consequences of fragmented health care. Before the production of these solutions, a very sick person had to rely on the kindness and fortitude of family and friends to navigate a system where no one person could or would answer all of their questions. Harvard Business Review has an article here on how to improve fragmented health care. The Affordable Care Act (aka, Obamacare) also works to try and improve the delivery of health care through Accountable Care Organizations (ACOs).

What Is An Obamacare ACO?

According to Jenny Gold, writing in Kaiser Health News online, a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation, "An ACO is a network of doctors and hospitals that share financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending." Currently, Obamacare ACOs are Medicare-based only.

Addressing the physical and mental suffering and costs of fragmented health care is one of the best components of Obamacare, even if it only addresses a small percentage of the insured. But wouldn't it be great if Obamacare addressed the fragmentation of health insurance programs instead of maintaining or add to them?

A Fragmented Health Insurance System Is A Bad Thing.

I'm not claiming that America's fragmented health insurance programs are as bad as fragmented health care. It's not. Still, fragmented health insurance is a big problem in that it separates us into groups with different levels of coverage, at varying rates and ends up costing us all more than if we were in one group. Instead, we are left with at least six groups—Disabled, Old, Poor, Veterans, Traditionally Employed and Individually Employed—each expected to carry its own financial weight. A difficult and unnecessary standard to meet and maintain... Continue Reading...

Tags: obamacare, Fragmented health care, Fragmented health insurance programs

Open enrollment on the healthcare exchanges doesn't start until November 1 but news of projected premium increases of 22% to 25% hit the streets last week. Write ups about the rate increases can be divided into two camps—the beginning of the end of Obamacare and it’s not as bad as you think because... That “because” refers to the fact that the increase, although huge, does not apply to the vast majority of health insurance purchasers. It does not apply to the more the 50% of Americans who get health insurance from their employers or seniors, veterans, the disabled and poor. It also does not apply to about 85% of people who purchase individual policies on the exchanges. It does apply to the millions of people, like me, who do not receive a health insurance premium subsidy.

So one camp want to amplify the harshness of the Obamacare increases, with the Wall Street Journal (WSJ) going as far as to express its condolences to people, like me, who are stuck paying the full premium increase. But with their condolences comes a healthy dose of we told that arrogant President Obama that Obamacare was destined for failure. They don’t really care about the individuals paying high health insurance premiums, just like they never cared about the people paying even more or being denied coverage for preexisting conditions pre-Obamacare.

And then there is the, it’s not as bad as it looks camp. They want to stress how few people have to pay the full increase in premiums without subsidy support and how subsidies will increase in step with premiums for those eligible for them. Some go into the mathematical weeds to prove their point of just how nearly insignificant this non-subsidy group is, with estimates ranging from 1.5 million people to as high as 9 million people. And then there is a very small subset of this camp that unfortunately includes some in the Administration, that claim millions of non-subsidy people are probably eligible for subsidies but just don’t know it. Continue Reading...

Tags: obamacare, obamacare subsidies

The Obamacare marketplace has a big problem—too many sick people and not enough healthy people. The problem is so bad that health insurance companies claim they lost billions of dollars and some are leaving the exchanges. Unless the federal marketplace can enroll more young and healthy people these insurers may never return. Another proposition outlined in a New York Times article by Margaret Sanger-Katz, is for the remaining states to expand Medicaid, which will bring down health insurance premiums for everyone.

In her article, Sanger-Katz refers to a study by the Dept. of Health and Human Services that concluded that marketplace premiums were lower (in the high single digits) in states that expanded Medicaid compared to those that did not. That is great news but it’s not enough to offset premium rate increases in the high double digits. For that we need exactly what the health insurance companies claim they want—a healthier risk pool. Moving employer-sponsored health insurance to the exchanges give us a healthier risk pool that will lower premiums, but there is strong opposition to this.

Employers want to hold onto their health insurance programs because they want to control how much they contribute to them. Health insurers want to maintain these plans because they can better predict their risk and set their rates to ensure they always make a profit. Employees want to keep their employer-sponsored coverage because they don’t want to assume the responsibility of choosing and paying for their own coverage. They also want to keep their employer and government subsidies.

Anyone who thinks that these strong powerful advocates for employer group health insurance are going to suddenly decide it is in the public interest to have one health insurance risk pool is mistaken. Individuals covered by employer health plans make up about half of the insured population. They are over 150 million individuals strong and it will take the other 150 million plus individuals to force change in our health insurance and health care system. And the first thing we other 150 million plus have to do is stop acting like workplace health insurance is more virtuous than other types of health insurance. Continue Reading...

Tags: obamacare, workplace health insurance, Subsidies

If the presidential candidacy of Donald Trump has taught us anything it is that the federal government is a good punching bag and scapegoat. Yesterday, Aetna Chief Executive Officer, Mark Bertolini, took some time on the bag. Bertolini announced that the company “decided to reduce our individual public exchange presence in 2017.” Aetna will pull out of 11 states on the public exchanges but continue to sell individual policies off of the exchanges. The reasons provided for the pull out, in insurance-speak, were an unbalanced risk pool and “inadequate risk adjustment mechanism.”

What Aetna means by “an unbalanced risk pool.” Put plainly, Aetna did not sell enough policies to healthy people with low to no health care expenses to cover the cost of care for the unhealthy people it sold policies to.

What Aetna means by “inadequate risk adjustment mechanism.” The Affordable Care Act risk adjustment programs are technical. There is a state-based risk adjustment and reinsurance program and a federal risk corridor program. Basically, these programs give money to, take it away from or share it among insurance companies to balance out their losses and gains.

Is It Really The Governments Fault…?

Aetna stated that, it might return to the exchanges in the future, “should there be meaningful exchange-related policy improvements.” This shameless blaming of a federal program to increase access to health insurance is a disguise to hide Aetna’s incompetence at predicting and managing risks. Aetna has a history of not anticipating changes in the health care market and of dropping unprofitable policyholders. Continue Reading...

Tags: obamacare, public exchanges, Aetna

Health insurance companies have a reputation for being bullies. Policyholders feel bullied when their medical claims are denied or processed incorrectly. Hospitals and doctors feel bullied when the bills they submit are refused or amended, or when procedures are not covered. Employers feel bullied when their rates go up automatically. In fact, no one is exempt from the bullying tactics of the big bad health insurance company. Their latest victim(s)—all of us!

My Way Or The Highway

Four large health insurers (Aetna and Humana and Anthem and Cigna) are trying to merge into two and the federal government has filed lawsuits to prevent that from happening. Now, the two companies that will surface if the mergers go through (Aetna and Anthem) are threatening to withdraw their plans from the public health care exchanges. It’s hard to know if Aetna and Anthem are threatening to leave the health care exchanges because they are losing money or because of the government lawsuits. But does it really matter.

Aetna and Anthem are both making moves to increase their profits and shareholder wealth. Any savings they receive by increasing their size and bargaining power with hospitals and doctors will stay with them. There will be no premium savings for policyholders, just more money for shareholders. But if these mergers do not happen, their next target is likely to be the exchanges. Because if they can’t realize increased profits by extracting bigger discounts from health care providers and hospitals, they will do it by minimizing losses on the exchanges.

Profits Without Risks

Through the individual mandate we require healthier people who need little or no health care to purchase insurance to offset the costs of care needed by the sick. Healthier people lose money by subsidizing the sick. However, health insurance companies are not willing to subsidize losses they incur on the exchanges with profits they earn from their other lines of business, like Medicare Advantage and Medicaid. Continue Reading...

Tags: obamacare, health insurance mergers, Aetna, Anthem

I don't have a problem with the Affordable Care Act's (aka Obamacare) individual mandate. I am willing to pool my limited resources with others so that we all have health insurance coverage. But I have to admit that I am starting to feel the squeeze of my non-subsidized, high premium, high deductible health plan. So much so that I think I want out of Obamacare. Honestly, I'm not quite there yet but it may not take much more to get me there.

I already pay nearly $4,000 per year in premiums for a plan with a $6,500 deductible and 60% coinsurance and no out-of-network, non-emergency coverage. And yes, it is a Bronze level plan. I did the research and I used the latest decision support tools and based on my age and excellent health status, which includes never taking a prescription drug, this is the best plan for me. But the plan sucks in both terms of coverage and costs. My only other option—pay a penalty and pay any medical expenses I incur out-of-pocket—is an even worse option. I deserve better choices than this.

And to make my situation even more difficult, there is speculation that insurers will drop many of their Bronze-level plans in 2017, forcing me into a higher premium tier. But who cares about me? A $4,000/$6,500 Bronze plan is equivalent to a $5,500/$5,000 Silver plan, right? No. I don't have an additional $1,500 to pay in premiums that I will never get back. My spirit for the greater good has monetary limits and it ends at the Bronze level. Continue Reading...

Tags: obamacare

Politicians at all levels are too afraid to upend a health care system that does not work for all because of the impact that change will have on some. The fact that that "some" consists of about 16 million health care related jobs and 18% of the U.S. economy is reason to think before we act. But with nearly a century to think about and work out a better health care policy, it’s clear that there’s never been a real strategy for revolutionary change. Instead, politicians focus on incremental health care policy changes, like the President’s latest proposal for a limited public health plan option.

On Monday, July 11, 2016, President Obama became the first sitting U.S. President to write an article for publication in a scholarly or academic journal. Published by the Journal of the American Medical Association (JAMA), the article titled, "United States Health Care Reform: Progress to Date and Next Steps," recounts the process of health care reform from 2008 to the present. The article outlines the many legislative actions the President and his administration took to:

• expand health insurance coverage
• provide financial support to health insurance buyers
• improve health care technology and research and
• reform health care payment models

Tags: obamacare, public option health plan

Paul Ryan and the Republicans in the House have taken a beating in the media for their impotent Affordable Care Act (aka Obamacare) alternative plan. The criticism is warranted. After so many years of promising to produce an alternative to Obamacare, the best the Republicans can provide is an outline of a policy. Yet there is learn a lot we can learn from Ryan’s proposal. We can learn about Ryan’s personal views on life and health.

Paul Ryan’s Obamacare alternative was written from the perspective of a healthy and fit person who expects to stay that way.

• If you are really sick and traditional health insurance companies don’t want to insure you, Ryan’s sympathy is with the health insurer.
• If you have a serious health condition requiring lots of medical care, healthy people should not have to subsidize your health care expenses. You should be forced to maintain continuous coverage, at a higher rate, pooled with other seriously ill people.
• If you are currently active and healthy, you should have a policy tailored to your individual health. If you want a skimpy health plan, you can have it.
• If you are currently healthy, you should receive tax credits (or portable payments) that you can save until you need it or use it to pay for dental or vision care.
• If you can afford to set aside thousands of dollars to pay your medical expenses, you should be able to do so with tax-free dollars in a Health Savings Account.

Tags: obamacare alternative, obamacare

Some employers readily provide free health insurance to their employees. Some engage in “tough” negotiations or use innovative financing techniques to gain temporary health insurance savings. However, most employers simply accept annual health insurance cost increases that they then shift to workers. Workers have no control over how their employers manage health insurance costs. Or do they…?

What Could Happen

When the Affordable Care Act (aka Obamacare) became law, its supporters and opponents anticipated the end of workplace health insurance. So far both are wrong... Now there is a new theory cropping up about the impending demise of workplace health insurance. The theory is that employers are doing such a poor job of managing health insurance costs that they are neglecting their fiduciary duty and opening themselves up to potential lawsuits.

This is an intriguing theory and it is not surprising that it is now getting attention. Employees have filed numerous lawsuits over 401(k) retirement plan fees, so suits over high deductible health plans must be the logical next step. Right? Also, the Department of Labor’s new retirement account fiduciary standards requiring brokers to make recommendations that are in the best interest of their clients could easily be extended to health insurance brokers. Right?

It’s not like employees haven’t sued insurers and employers before over health care related issues. Employers have been sued for:

• denying coverage for specific medical care procedures or inadequate health care (e.g., Wal-Mart)
• firing older workers for potentially having higher health insurance costs
• firing workers with high medical expenses

Tags: obamacare, Fiduciary rule

Like many Americans this week I viewed a lot of online video clips of interviews of the late Supreme Court Justice, Antonin Scalia. Scalia had a lot to say about Obamacare and none of it was supportive of the law. He accused the majority of his fellow justices of abusing their position to uphold a law they wanted instead of following the Constitution. Meanwhile his views on Obamacare were not personal, but legally based.

And then there are the other opponents of Obamacare that I am starting to understand more now. These opponents fall into two camps, but really just one. The first camp hates the idea of government-run health care for all Americans. They think a private, market-based system would do a better job. For them, government-run anything means high-costs and poor service. Don’t ask this group to explain how this is any different from the market-based system currently in place. They just know that if the entire system were government-run, things would be worse than they already are. No evidence needed.

The second Obamacare opponent camp is similar to the first in that they also champion a private, market-based system. They are not anti-government like the first camp; they are just pro-market when it comes to any good or service with profit potential. Taking a hugely profitable, shareholder-loving sector like health care out of the market would hurt the economy. These are the folks who spend a lot of time claiming health care is not a right. They also claim that greater competition in the health care market is the answer to controlling health care costs and increasing accessibility. But above all else, health care is a service that must be paid for by the individual.

I don’t agree with Scalia or the anti-government, pro-market Obamacare haters; however, I do acknowledge that they have very strong beliefs.

Scalia was known for his love of the written word and languages. Everyone who’s read the Affordable Care Act agrees that it is no friend of the well-written word. I think Scalia took great offense to what he viewed as a third rate law. And I also believe that he thought President Obama got something he did not deserve—a great law, not in substance but in historical significance. He was an intellectual elitist that hated the idea of an unworthy law credited to an unworthy person. In this sense, his objection to the Affordable Care Act was personal. Continue Reading...

Tags: obamacare, Scalia

Organized labor deserves a lot of credit for its early efforts at getting health insurance and retirement benefits for workers. But labor also has a history of being slow to adapt to economic, social and political changes that challenge its mission. This has led to a slow erosion of labor union membership in the private sector. It has also resulted in attacks on the health and retirement benefits labor fought so hard for.

I applaud labor's support for the Affordable Care Act (aka Obamacare), and its wider support for universal health care. However, ironically, some of labor's biggest concerns these days involve provisions of Obamacare it sees as unfavorable to its members--the perceived threat to multiemployer health care plans and the "Cadillac tax" (an excise tax on high value health plans). Granted, these provisions are not favorable to unions as they currently operate. But that's the public policy point. Union friendly policy makers are less concerned with the role of unions and more concerned about health and retirement plan access and affordability for everyone. I'm concerned that labor's historical reality of focusing on its narrow interests and its members may cause it to miss out on an opportunity to help achieve the universal health and retirement benefits it claims it wants.

There are several health insurance and retirement plan issues unions can support, and that are growing in economic, social and political importance.

Health care price transparency. Doctors, hospitals and insurance companies have given little substantive attention to the need for providing prices for medical care to consumers. Even as consumers are forced to assume a greater share of the cost of care by way of large deductibles, the medical care establishment consistently pushes back on real price transparency.

• Labor unions should advocate for a change to the Employee Retirement Income Security Act (ERISA) to mandate real medical price transparency by insurers and health care providers. ERISA is a federal law that sets standards for private health and retirement plans. Currently, many insurers provide limited tools that give questionable estimates of cost for some care. Providers offer even less assistance and routinely prescribe care without any consideration of its price and if a cheaper alternative is available.

Tags: obamacare, cadillac tax, price transparency, retirement plan fees

I’m feeling quite negative at the moment. It’s a strange and unsettling feeling for me. One thing I am feeling especially negative about is the unaffordability of health insurance, health care and retirement, and the government’s Band-Aid approach to addressing these issues. So far this week I’ve read a series of articles that provide examples of how bad things are and how unlikely they are of getting better. These articles spotlight how the private health insurance, health care and retirement saving systems continue to shut the door on any hope of reform.

• the gap between hospital costs and prices widening
• increasingly unaffordable health insurance premiums and vanishing plans and networks
• the Securities Industry Financial Market Association (SIFMA) coming out against state run retirement plans because there are enough private sector options

• Accountable Care Organizations (ACOs)
• Obamacare
• Automatic IRA
• myRA
• Retirement Savings Contributions Credit (SAVER’s Credit)
• State IRA programs

Tags: MyRA, obamacare, State IRAs, SAVERs Credit

There are a lot of new and exciting health care information technology (IT) companies sprouting up. Most are taking advantage of the many opportunities made possible by the Affordable Care Act, aka Obamacare. These startups are using large amounts of anonymous data from Medicare, Medicaid and private insurance databases and their own sophisticated algorithms to make health insurance and health care easier to purchase and use.

This is all great stuff but health care has an even bigger problem that these data mining and analyzing geniuses can and should address. The problem is health care fraud—a multi-billion dollar a year problem. Technology firms should create algorithms to scan health care claims and financial data to identify and prevent fraud. This type of sophisticated response is needed because health care fraud perpetrators are usually insiders that are very good at crafting and hiding their schemes.

Unfortunately, creating health care fraud detection algorithms may be the easy part for the tech industry. The challenge for these firms is working with the health care industry usual suspects including medical providers, insurers, associations and government regulators.

The health care industry is a special kind of place with several factions fighting hard to protect their members’ interests. There is also the issue of navigating a highly regulated industry and interacting with multiple government agencies. It’s kind of like old school meets new school with old school having more money, a huge head start in regards to understanding the industry and its regulations and established relationships with government policymakers. But if the nation is serious about reducing health care fraud, it is going to need the help of big data analyzing IT firms.

Health Care Fraud Is A Huge Problem Continue Reading...

Tags: obamacare, HIPAA