Your More Affordable 2014 Health Insurance Exchange Plan is Likely to Work Like an HMO or Medicaid

By Kenton Henry

If you have ever been covered on an employer’s group health insurance plan, you may have had to select your medical providers from a Health Maintenance Organization (HMO). If you were enrolled in a plan of this type – it was probably because it was your only option or because you were young and thought yourself bullet proof. And the reason is – most older people would not elect an HMO if given a choice. Because if your plan utilizes one – you either see a provider within the network or you have no coverage at all. Most older people know that when your health problem is anything more than a common runny nose (which is all young people believe they’re ever going to suffer from) – a person wants to be able to select their own doctor or hospital.

 
Has your income ever been at the poverty level or below? If so then you probably qualified for Medicaid. That’s the government’s health plan administered by the states for the poor. And if you were covered by Medicaid, you know how difficult it was to find doctor’s to take Medicaid, get into an appointment or see a specialist.

 
Now comes Obamacare. And when the premiums for the new health care compliant plans become available for individuals and families to choose from October 1 for a January 1 effect date – be prepared for sticker shock. Without going into projections of an unknown quantity, suffice it to say, the word on the insurance street is the cost of these plans is going to make people in most states “have a cow”!

 
So naturally, you’re going to review the lowest cost plans – the bronze or “catastrophic” options and hope they meet your needs. And when you do – you best hope you ARE young and bullet proof because you are probably going to find your selection of providers is going to be what you had available in a larger group plan HMO divided by 10 . . . or more. Be prepared to wait a long time for appointments and heaven forbid you need to see a specialist or a special procedure because–if you do–you are probably going to have to get the President to issue another of his executive orders to make it happen.

 
And what if you’re not young and bullet proof? Get used to rationing. Because Obamacare doesn’t like specialists and who do you want to see when you have a serious problem? Who do you think is going to authorize a more sophisticated (expensive) procedure? I love my family doctor but when he thinks I need a more expensive procedure – he refers me to a neurologist or an orthopedic surgeon, etc. But be prepared for your new health plan pre-certification department to tell you – “There must be a pill for that.”

 
In conclusion, you’d better hope you qualify for the subsidy so you can add all or a portion of your premium to the national debt. If not . . . be prepared to pay Cadillac prices for what at best will be an Oldsmobile.

 
(For more a perhaps more objective take on this – go to:
THE WALL STREET JOURNAL; BUSINESS AUGUST 14, 2013:
Many Health Insurers to Limit Choices of Doctors, Hospitals
By Anna Wilde Mathews @ http://online.wsj.com/article/SB10001424127887323446404579010800462478682.html

 

http://allplaninsurance.com

The Chameleon Which Is The Affordable Care Act

08.14.2013

The Affordable Care Act, like a chameleon, is capable of changing its color or otherwise morphing to fit the pragmatic motives of its creator.

As I have said before, the Patient Protection Affordable Care Act (PPACA) (or ACA for short) is law. Therefore, of late, I have attempted to focus on the reality of it and its ramifications for all of us whether we are currently uninsured, covered by our employer’s plan or have our own individual or family health insurance plan. The primary purpose of this blog is to educate and inform– not to editorialize. If the latter were my objective, I would establish a separate blog where I would rant and rave ad infinitum about all I see wrong with the Act and big government in general. But it is not, so writing for The MedPlus Messenger, I try to remain objective and minimize expression of my feelings. But it is difficult. Increasingly so. Each day I try to put more lipstick on this pig but each day I awaken to more news the White House has selectively chosen another segment of the ACA not to implement in 2014 pursuant to the law.
Yesterday’s headlines broke news that the caps on insured’s out-of-pocket (OOP) maximums–set to go in effect in 2014–have been delayed until 2015. This potentially doubles (or worse) the liability of an insured and benefits the insurance company by allowing it to avoid covering expenses above the current OOP’s. Do you believe that is the objective of the White House? To benefit the insurance companies? And I thought the whole reason for the ACA was to better protect the patient, consumer, insured member. After all, it is the Patient Protection … … … Act is it not?
So what was the motive behind the White House’s reprieve for insurance companies? “General Math” provides the answer. I.e.:
Lower patient out-of-pockets = higher insurance premiums
Higher insurance premiums = less participation in coverage and greater backlash against the ACA

 

Greater backlash = trouble for the Democrats in the 2014 mid-term elections
Conclusion = this reprieve was politically motivated

 

Reader and followers – if you can argue this to a different conclusion – please feel free to do so here for my erudition and that of the rest of us.

 
Admin – Kenton Henry
*******************************************************************
Feature Articles:
Washington Times
By Tom Howell Jr.
Tuesday, August 13, 2013
President Obama has granted yet another part of his health care law a delay, quietly announcing a one-year grace period before imposing a strict limit on consumers’ out-of-pocket medical expenses.
The delay means some health care plans in the group market will have until 2015 to begin paying for all expenses exceeding $6,350 for an individual’s out-of-pocket spending, or $12,700 for a family.
________________________________________
SPECIAL COVERAGE: Health Care Reform
________________________________________
Language on the delay has been posted on the Labor Department’s website since February, but it did not surface in the political arena until The New York Times reported on it Tuesday.
Mr. Obama used the limits as a key selling point when he pushed the Affordable Care Act through Congress in 2010. Now, Republicans are using the delay as part of last-ditch bids to dismantle the law before key implementation dates this fall.
“Burying this announcement online in a ‘maze of legal and bureaucratic language’ shows little concern for the promises with which this law was sold,” said House Speaker John A. Boehner, Ohio Republican, borrowing language from the Times article. “What else in the law isn’t working that we don’t yet know about?”
The Obama administration also announced in a pre-July Fourth blog posting that it was delaying the mandate that requires employers with at least 50 full-time employees to provide them with health care coverage.
For the Obama administration, the setbacks are ill-timed and leave officials trying to convince consumers that the delays don’t signal an inability to carry out other parts of the law.
Erin Shields Britt, spokeswoman for the Department of Health and Human Services, said the health care law is still implementing historic consumer protections from “the worst insurance company abuses, by banning discrimination based on pre-existing health conditions, ending lifetime and annual limits on what an insurance company will cover, and capping out-of pocket spending to protect Americans and their families.”
“The February guidance builds on these landmark consumer protections by requiring that health plans limit out-of-pocket spending for major medical coverage for the first time, in 2014, on time,” she said. “This single limit will apply to additional benefits in 2015.”
The newly reported delay arose because some employers and insurers use separate companies to administer major-medical coverage and drug benefits, resulting in separate out-of-pocket limits.
Because of this fractured landscape, parties needed time to streamline their data systems . The rule says that, for the first plan year after Jan. 1, 2014, the annual limit on out-of-pocket expenses will be satisfied if a group health plan that uses more than one service provider complies with the cap on major medical coverage and maintains a similar cap on the non-major medical coverage.
Even as it delays some parts, the administration has said the individual mandate requiring most Americans to have coverage remains in effect. Officials also are working feverishly to implement by Oct. 1 state-by-state health care exchanges where those without employer-based coverage can buy insurance with the help of tax credits.
A recent inspector general report suggested that Health and Human Services is months behind in setting up the federal data hub that will allow federal and state agencies to synchronize information about consumers on the exchanges.
Senate Minority Leader Mitch McConnell, Kentucky Republican, wrote to the Obama administration Monday to suggest that it delay the rollout of the exchanges.
Conservative lawmakers are waging a rhetorical war against Obamacare ahead of a spending showdown on Capitol Hill in September.

**************************************

Forbes

Pharma & Healthcare |

8/13/2013

Yet Another White House Obamacare Delay: Out-Of-Pocket Caps Waived Until 2015

WASHINGTON, DC – MARCH 18: U.S. President Barack Obama (L) speaks as Assistant Attorney General of Justice Department’s civil rights division Thomas Perez (R) listens during a personnel announcement March 18, 2013 at the East Room of the White House in Washington, DC. Perez has succeeded Hilda Solis as the U.S. Secretary of Labor. (Image credit: Getty Images via @daylife)

First, there was the delay of Obamacare’s Medicare cuts until after the election. Then there was the delay of the law’s employer mandate. Then there was the announcement, buried in the Federal Register, that the administration would delay enforcement of a number of key eligibility requirements for the law’s health insurance subsidies, relying on the “honor system” instead. Now comes word that another costly provision of the health law—its caps on out-of-pocket insurance costs—will be delayed for one more year.

According to the Congressional Research Service, as of November 2011, the Obama administration had missed as many as one-third of the deadlines, specified by law, under the Affordable Care Act. Here are the details on the latest one.

Obamacare contains a blizzard of mandates and regulations that will make health insurance more costly. One of the most significant is its caps on out-of-pocket insurance costs, such as co-pays and deductibles. Section 2707(b) of the Public Health Service Act, as added by Obamacare, requires that “a group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish lifetime limits on the dollar value of benefits for the any participant or beneficiary.” Annual limits on cost-sharing are specified by Section 1302(c) of the Affordable Care Act; in addition, starting in 2014, deductibles are limited to $2,000 per year for individual plans, and $4,000 per year for family plans.

Move up http://i.forbesimg.com t Move down

Obamacare Increases Costs of College Health Plans by as Much as 1,112% Avik Roy Contributor

There’s no such thing as a free lunch. If you ban lifetime limits, and mandate lower deductibles, and cap out-of-pocket costs, premiums have to go up to reflect these changes. And unlike a lot of the “rate shock” problems we’ve been discussing, these limits apply not only to individually-purchased health insurance, but also to employer-sponsored coverage. (Self-insured employers are exempted.)

These mandates have already had drastic effects on a number of colleges and universities, which offer inexpensive, defined-cap plans to their healthy, youthful students. Premiums at Lenoir-Rhyne University in Hickory, N.C., for example, rose from $245 per student in 2011-2012 to between $2,507 in 2012-2013. The University of Puget Sound paid $165 per student in 2011-2012; their rates rose to between $1,500 and $2,000 for 2012-2013. Other schools have been forced to drop coverage because they could no longer afford it.

According to the law, the limits on out-of-pocket costs for 2014 were $6,350 for individual policies and $12,700 for family ones. But in February, the Department of Labor published a little-noticed rule delaying the cap until 2015. The delay was described yesterday by Robert Pear in the New York Times.

Delay needed to align ‘separate computer systems’

Notes Pear, “Under the [one-year delay], many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors’ services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.”

The reason for the delay? “Federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs. In many cases, the companies have separate computer systems that cannot communicate with one another.”

The best part in Pear’s story is when a “senior administration official” said that “we had to balance the interests of consumers with the concerns of health plan sponsors and carriers…They asked for more time to comply.” Exactly how is it in consumers’ interests to pay far more for health insurance than they do already?

It’s not. Unless you have a serious, chronic condition, in which case you may benefit from the fact that law forces healthy people to subsidize your care. To progressives, this is the holy grail. But for economically rational individuals, it’s yet another reason to drop out of the insurance market altogether. For economically rational businesses, it’s a reason to self-insure, in order to get out from under these costly mandates.                         Patient groups upset

While insurers and premium-payers will be happy with the delay—whose legal justification is dubious once again—there are groups that grumbled. Specifically, groups representing those with chronic diseases, and the pharmaceutical companies whose costly drugs they will use. “The American Cancer Society American Cancer Society shares the concern” about the delay, says Pear, “and noted that some new cancer drugs cost $100,000 a year or more.” But a big part of the reason those drugs cost so much is because manufacturers know that government-run insurers will pay up.

“The promise of out-of-pocket limits was one of the main reasons we supported health reform,” says Theodore M. Thompson of the National Multiple Sclerosis Society National Multiple Sclerosis Society. “We have wonderful new drugs, the biologics, to treat rheumatoid arthritis,” said Patience H. White of the Arthritis Foundation. “But they are extremely expensive.”

The progressive solution to expensive problems? More subsidies. But subsidies don’t reduce the underlying cost of care. They only excuse the high prices that manufacturers and service providers already charge.

It’s one of the many aspects of Obamacare that should be repealed, if we are to combat the rate shock that the health law imposes on tens of millions of Americans. But that will require Republicans to come up with a smarter strategy than shutting down the government.

***************************************************************************************************

http://allplaninsurance.com

What is Coming with Your Health Insurance Between Now and January 1!

Just Practical Information On What is Coming with Your Health Insurance Between Now and January 1!

08.12.2013
This is not an editorial. Today’s post is simply non-political, practical information regarding coming changes in health insurance between now and 2016 and beyond. The Patient Protection and Affordable Care Act (PPACA) is law and is on schedule to be fully implemented (for all but groups of 50+) January 1, 2014. For this reason it is my responsibility to inform my clients – and followers of this blog – of what they can expect in the coming months. Specifically, their insurance options and the mechanics involved in transitioning to health plans that provide minimum “essential benefits” that are in compliance with the PPACA. In this post, I will be addressing individuals and families which includes the self-employed and those who have a personal policy because their employer does not provide coverage. All others, including those covered by group plans for less than 50 employees will be addressed in subsequent posts.
First – those of you who currently have a personal or family policy will be allowed to keep your policy until your policy anniversary in 2014. You should check your anniversary date or–if you are my client–call me. Many companies have changed your anniversary date to December 1. This allows you to keep your current plan until December 1, 2014. After that, you must convert to a health care “compliant” plan which will be described below. I can simplify and assist you in this process when the time comes.
If you do not currently have health insurance you must purchase a health policy to be effective January 1 or pay a penalty on your tax return for 2014 and beyond. Another reason you may want to purchase a plan is if you have previously been unable to acquire a policy which covers your pre-existing health condition(s). Your new compliant plan must cover them and health issues will not factor into your cost.
When October 1 arrives (the earliest date you may apply for compliant coverage) I will provide you a link where you will enter your estimated income for 2014. It will instantly tell you whether you qualify for a subsidy. If you do – you are going to want to choose from and apply for plan options in your state health insurance exchange. If your state has not established a state exchange (as is the case in Texas) – you will select from plans in the Federal Health Insurance Exchange. If you do not qualify for a subsidy (which is the case if your income is 400% or greater than the Federal Poverty Level*) – you are probably going to choose a policy offered outside an exchange and direct from an insurance company. The reason being, it is anticipated these plans will offer the same benefits at a lower cost. I can assist you with this option as well.
Below, I will offer further and detailed information on exchanges, plan options and more. Please do not hesitate to call me for clarification or to discuss this information.

Admin. – Kenton Henry

*
FEDERAL POVERTY LEVEL GUIDELINES 2013
http://allplanhealthinsurance.com
*************************************
STEP 1:
Note these key dates and deadlines in your calendar:
If your employer offers health insurance, get key dates from your HR department. These are key dates if you’re planning to buy health care through your state’s Marketplace, which is available through a web site, a call, or an in-person visit.
• Oct. 1, 2013: First day you can enroll in a health plan on your state’s Marketplace
• Dec. 31, 2013: Last day you can enroll in a health plan and have your coverage start Jan. 1, 2014
• Jan. 1, 2014: First day you have insurance coverage if you buy a plan in the Marketplace — if, of course, you buy before this date
• March 31, 2014: The last date you can enroll in a plan on your state’s Marketplace to be covered for part of 2014
*************************************
Requirements:
* Be a citizen or legal resident.
• Buy your coverage through your state’s or Federal new health insurance Marketplace, also called an “Exchange”.
• Make about $11,490 to $45,960 a year if you are single – or $23,550 to $94,200 a year if you are in a family of four.
If you make less than the lowest amount, you may be eligible for Medicaid. Medicaid will cost you less than you’d save with a tax credit.
Unfortunately, if your state is not expanding Medicaid based on the guidelines in the Affordable Care Act, you may not be able to enroll in Medicaid or be able to get a tax credit. It’s possible that if you make less than $11,490 in 2013, which is the poverty level, you may not qualify for Medicaid if you live in a state that isn’t expanding Medicaid.
In general, you’re not eligible for the tax credits if you could get coverage through a workplace. However, the coverage offered by your employer must be considered affordable. If your company offers a plan that costs more than 9.5% of your income, or that does not cover at least 60% of the cost of covered benefits, you can look for a more affordable plan through your state’s Marketplace and may receive tax credits to lower your costs.
********************************
Insurance Exchanges
State Didn’t Set Up a Marketplace? Relax
You may have heard that not all states will have their own health insurance Marketplace, also called an Exchange. If your state doesn’t set up a Marketplace, what does that mean for you?
Rest assured that no matter which state you live in, you can buy insurance through a Marketplace starting October 2013.
The way you use the Marketplace will be similar in every state. You’ll access a web site, or call, or see someone in person. And you’ll have tools to compare health plans.
But Marketplaces won’t all be the same in every state. There are three ways your state’s Marketplace can be managed — and this affects your choice of health plans and coverage.
1) State-run Marketplaces
Seventeen states are creating their own Marketplaces. These states will have a lot of local control.
Each state will decide which insurance companies can sell policies on its Marketplace.
States also choose the core benefits each plan has to offer. They can set extra requirements for health plans, like benefits that are more generous or more affordable limits on your out-of-pocket costs.
The state is also in charge of getting people to use the Marketplace.
*Indiana and Ohio will have their own State Exchange. Residents of these states should call Kenton Henry @ 800.856.6556
2) Partnerships Between a State and the Government
A few states are teaming up with the federal government to develop Marketplaces.
The federal government:
• Sets up the Marketplace web site and in-person sites
• Decides which health plans will be sold in the partner state
• Sets the benefit levels
• Runs the Marketplace
The states:
• Monitor health plans
• Help people find the best insurance for their needs *(Call Kenton Henry @ 800.856.6556)
• Handle complaints
Federal-run Marketplaces
Some states decided not to set up their own Marketplaces. In those states, the federal government will step in to run the marketplaces directly. It will make all the decisions: how the Marketplace will work, what plans are sold, and how to promote the Marketplace. Each state is considered separately and has its own Marketplace web site. (Texas residents call Kenton Henry @ 800.856.6556)
**********************************************
Your Insurance Choices in a Marketplace: FAQ

A health insuranceMarketplace, also known as an Exchange, is a one-stop shop for affordable insurance in your state. Your state’s Marketplace has tools to make it easy for you to compare your choices and pick the best for your needs.
On a state Marketplace site, health plans are grouped by levels of coverage — how much the plan will pay for your health care and what services are covered.
Each level is named after a type of metal:
• Bronze
• Silver
• Gold
• Platinum
Bronze plans offer the least coverage and platinum plans offer the most.
How do the bronze, silver, gold, and platinum levels differ?
The metal plans vary by the percentage of costs you have to pay on average toward the health care you receive.
Here are the percentages of health care costs you pay for each type of plan:
• Bronze plan: 40%
• Silver plan: 30%
• Gold plan: 20%
• Platinum plan: 10% of your health care costs.
The way you pay your portion of these costs is in deductibles and copayments or co-insurance.
In general, the more you are willing and able to pay each time for health care service or a prescription, the lower your premium. A premium is your monthly payment to have insurance.
As an example, when you compare the bronze and platinum plans:
With a bronze plan: You pay the most each time you see your doctor or get a medicine. This is also called having higher “out-of-pocket” costs. But in a bronze plan you pay the least premium each month.
With a platinum plan: You pay the least each time you see your doctor or get a medicine. But in a platinum plan you pay the highest premium each month.
How does coverage from a metal plan compare to my current insurance?
The bronze through platinum coverage levels are new. So you probably don’t know how the benefits of the plan you use today compare to them. The coverage level you have now depends on whether you bought your plan:
• From an employer: Your coverage level is likely between a gold and platinum level.
• On your own: Your coverage level is likely between a bronze and silver level.
Having a sense of how the insurance you’re used to compares with the new plans will help you decide on a plan. You should compare the out-of pocket costs you are currently paying, the services provided (including prescription drugs), and anticipated changes in your health.
If you shop for insurance on your state’s Marketplace, you’ll see the health plans organized in this way:
• 1st by metal level: Bronze, silver, gold, or platinum
• 2nd by brand, such as Blue Cross, Cigna, Humana, Kaiser, United, and others
• 3rd by type of health plan, such as HMO, PPO, POS, or high-deductible plans with a health savings account.
The type of health plan affects how much choice you have in providers, the amount of paperwork you have, and your out-of-pocket costs.
**************************************
Tax Penalty At-a-Glance: Who Will Pay The Penalty & How Much Is It?
By law, you need to have health insurance by 2014. If you already get insurance through your employer or your partner’s employer, you’re all set. But what happens if you don’t follow this requirement from the Affordable Care Act?
If you can afford health insurance and don’t buy it, you’ll pay a fine when you file your 2013 income taxes in April 2014.
For the first year of the new law, 2014, the fine for not having insurance is the lowest it will be. After that, it goes up steeply in 2015 and again in 2016.
In 2014: There are two ways the government calculates what you owe. You have to pay whichever amount is higher.
• One way is to charge you $95 for each adult and $47.50 for each child, but not more than $285 total per family.
• The other way is to fine you 1% of your family income. If your family makes $50,000 a year, the fine will be $500.
In 2015: There will still be two ways to calculate what you owe. You have to pay whichever amount is higher.
• One way is to charge you $325 for each adult and $162.50 for each child, but no more than $975 total per family.
• The other way is 2% of your family income. If your family makes $50,000 a year, the fine will be $1,000.
In 2016 and beyond: There will still be two ways to calculate what you owe. You have to pay whichever amount is higher.
• One way is to charge you $695 for each adult and $347.50 for each child, but no more than $2,085 per family.
• The other calculation is 2.5% of your family income. If your family makes $50,000 a year, the fine will be $1,250.


http://allplanhealthinsurance.com

Democrats Can See Their Hometowns From the Steps of the Capitol!

08.09.2013

Sarah Palin was made the butt of jokes – which were later extended to include Republican Paul Ryan – when she proclaimed Medicare recipients would be subjected to “death panels” if the Affordable Care Act’s Independent Payment Advisory Board (IPAB) or Medicare’s cost cutting board remained part and parcel to the statute.

Now it seems even Howard Dean and other notable Democrats are concurring. Like the President, these Democrats are attempting to excise key components of a statute (already law) by repealing the board’s power. In light of next year’s mid-term’s their effort appears politically motivated. Perhaps the Senators and Representatives cited in today’s Feature Article can see their hometowns from the steps of the Capitol Building! It seems they are more concerned with their political lives than the welfare of their constituents. Otherwise, why did they pass the bill with this liability to their constituents in it in the first place? Oh–I forgot–they had to pass it before they could read it!

Admin. – Kenton Henry

*********************************

Feature Article:

The Hill

ObamaCare ‘death panel’ faces growing opposition from Democrats

By Elise Viebeck – 08/08/13 05:00 AM ET

ObamaCare’s cost-cutting board — memorably called a “death panel” by Sarah Palin — is facing growing opposition from Democrats who say it will harm people on Medicare.

Former Democratic National Committee Chairman Howard Dean drew attention to the board designed to limit Medicare cost growth when he called for its repeal in an op-ed late last month.

Dean was quickly criticized by supporters of the Independent Payment Advisory Board        (IPAB) who noted his ties to the healthcare industry as an adviser to a major D.C. lobbying firm.

But the former Vermont governor is not the only Democrat looking to kill the panel.

A wave of vulnerable Democrats over the past three months has signed on to bills repealing the board’s powers, including Sen. Mark Pryor (Ark.) and Reps. Ron Barber (Ariz.), Ann Kirkpatrick (Ariz.), Kyrsten Sinema (Ariz.) and Elizabeth Esty (Conn.).

All five are considered vulnerable in next year’s election, highlighting the stakes and the political angst surrounding the healthcare measure.

The four House Democrats faced criticism from their party in July after voting with Republicans to delay ObamaCare’s individual and employer mandates — moves widely interpreted as political positioning ahead of 2014.

Two of the lawmakers explained their opposition by suggesting the board would limit care for Medicare patients.

But the National Republican Congressional Committee (NRCC) blasted the four Democrats for “desperately trying to jump off the ObamaCare train.”

The cost-cutting board has been dogged with controversy over the last three years.

Major healthcare interests like the American Medical Association, the American Hospital Association and the pharmaceutical lobby have supported IPAB repeal, saying the panel would cut providers’ pay arbitrarily.

Public awareness of the board shot up last year when Palin called it a “death panel,” connecting the IPAB to her previous attacks on a proposal to encourage end-of-life planning in the Affordable Care Act.

“Though I was called a liar for calling it like it is, many of these accusers finally saw that ObamaCare did in fact create a panel of faceless bureaucrats who have the power to make life and death decisions about healthcare funding,” Palin wrote on Facebook.

This claim experienced a revival on the right after Dean published his op-ed, which argued that the board would ultimately ration care for Medicare patients.

“The IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them,” Dean wrote in The Wall Street Journal.

“Getting rid of the IPAB is something Democrats and Republicans ought to agree on.”

The piece quickly went viral, prompting conservative bloggers and Fox News hosts to cheer: “Dean confirms that Sarah Palin was right!”

The IPAB is designed to kick in when Medicare cost growth grows above a specified rate. It is charged with making recommendations on how to reduce Medicare spending, and its proposals are required to be fast-tracked through Congress.

The Affordable Care Act prevents the IPAB from making recommendations that would directly ration care. But critics say reducing provider reimbursements would have the same result by making it difficult for healthcare professionals to make money in Medicare.

While it’s unlikely the board will be convened soon, Medicare cost growth is not high enough to trigger its work, and any nominees would face long confirmation fights in the Senate, Dean’s op-ed renewed focus on bills to repeal the IPAB.

The Senate and House measures currently have 32 and 192 co-sponsors, respectively, including 22 Democrats in the House. Co-sponsors include lawmakers like Rep. John Barrow (D-Ga.), a longtime GOP target.

But calls for repeal are not taking up the whole debate.

Dean’s piece also drew strong arguments in favor of the panel from supporters like Peter Orszag.

The former White House budget director said the IPAB is necessary in light of Medicare’s transition to new payment models that are meant to lower costs while improving care.

It’s preferable to the “old way,” which saw Congress “simply slash Medicare payments” to providers, Orszag wrote in a column for Bloomberg.

“The point of having such a board — and here I can perhaps speak with some authority, as I was present at the creation — is to create a process for tweaking our evolving payment system in response to incoming data and experience, a process that is more facile and dynamic than turning to Congress for legislation,” he wrote.

In the meantime, the Democratic National Campaign Committee (DCCC) is warding off criticism of the anti-IPAB Dems with a push to turn the ObamaCare tables on the GOP.

The committee pointed to evidence Wednesday that resisting the healthcare law could hurt Republicans in the next election.

A new poll commissioned by the Service Employees International Union found that undecided voters prefer an anti-repeal Democrat over a pro-repeal Republican in a generic match-up.

“Instead of fighting old political battles on healthcare, polling shows that Americans want Republicans to work with Democrats to implement Obamacare and move on to focus on creating good jobs,” said Emily Bittner, a spokeswoman with the DCCC.

“The public strongly disapproves of Republicans’ plan to give insurance companies free rein over our health care.”

***********************************************

http://allplaninsurance.com/medicare/medicare-supplement.htm

Polls Clearly Indicate the Affordable Care Act Losing Popularity

07.30.2013

Polls clearly indicate that the Patient Protection and Affordable Care Act is losing popularity with not only Democrats and Republican politicians but the American public in general. In spite of the fact that no real costs of the Affordable Care Act to employers have been realized (other than those spent in attempts to decipher it through paid consultants or in house benefits directors and actuaries) popularity for the law continues to diminish. Much of this disenchantment could stem from the fact that more of us are realizing we really may lose our current health coverage and–perhaps more importantly–our providers. Others realize part-time employment may become the norm as employers attempt to avoid the mandate they provide health insurance to full time employees, i.e., those working 30 or more hours per week. It is a highly unpopular mandate with labor unions which have always supported a minimum 40 hour work week as the definition of full-time employment. It seems only logical many employers will restrict workers to less than 30 hours in attempt to avoid providing health insurance coverage. Another unintended consequence of government’s attempts to improve things.

Admin. – Kenton Henry

******************************

Featured Articles (Reprints June 30th and 26th Editions of the National Association of Health Underwriter’s Washington Update)

Is Health Reform Losing Its Base?

It is no secret that public support for health reform has always been mixed at best and that many Republicans have strongly disliked this law from the start. Now it seems like moderate Democrats are joining the pessimistic about health reform crowd. A recent poll conducted by the Washington Post and ABC News showed that moderate Democrats (who were previous PPACA supporters) are becoming lukewarm about the health reform law. When the law was initially passed in 2011, 74% of moderate and conservative Democrats were in favor of the law. Now, that number is down to 46%. Even more notable is that support is 11 points lower than what it was last year at this time. Liberal Democrats on the other hand still strongly support the law, with 78% of them still loving it to be exact. Among the public at large, 42% support and 49% oppose the law, retreating from an even split at 47% last July. On average, 56% of Democrats now support the law, according to the poll, down 10% from last year.
The same day these polling results were released, President Obama gave a speech out of Knox, Illinois on the economy. While the focus of the speech was the nation’s economy, President Obama unsurprisingly, given the magnitude of its economic impact, brought up the health reform law and tried again to raise support. This time, the president noted that the law is in fact working in the states that embrace it. Many of the states that have decided to fight the law are not seeing as many positive results. He cited states such as California and New York as proof that the law is driving costs down. The president also said that we are “well on our way” to full implementation of the law and that once implemented, the law’s benefits will provide security to middle class families.

*****************************

Legislation and Policy

Republicans Divided Over Threat To Defund ACA.
Many outlets, mostly out of the beltway, focus on the political machinations surrounding funding for the Affordable Care Act. The reports highlight a growing rift among factions of the Republican party: those who are pushing to defund the law using a spending bill, and those who believe the move, which could ultimately result in a government shutdown, would be politically dangerous.
Roll Call (7/30, Dennis, Fuller, Subscription Publication) reports that “with 60 Republicans already pushing…to defund Obamacare in any spending bill,” Speaker John Boehner “may not be able to cobble together a House majority” to stave off a government shutdown without courting Democrats. The article notes, though, that “several prominent Republicans” have spoken out against the effort, as this threat “would surely backfire on Republicans if they carry it out.”
FOX News (7/30) reports on the “divide” in the GOP, saying that the “aggressive” push to defund the Affordable Care Act is “increasingly pitting Republicans against Republicans.”
Indeed, several Republicans have spoken out against defunding the law. Politico (7/30, Arkin) reports that in an appearance on MSNBC Monday, House Deputy Whip Tom Cole (R-OK) warned that “shutting down the government to defund Obamacare is a ‘suicidal political tactic.’” Cole is quoted as saying, “Shutting down the government is a suicidal political tactic. Eventually it will be reopened, but the president will not have capitulated and you will have discredited yourself and along the way you will have hurt the American people.”
The Washington Examiner (7/30, Carroll) reports on another high profile Republican who is against defunding the Affordable Care Act, Oklahoma Senator Tom Coburn, who called the efforts “dishonest” and “hype.”
Also reporting on Republican opposition to the tactic are MSNBC (7/30, MacDonald) and the Tulsa (OK) World (7/30, Greene).
However, many Republicans are still pushing for the tactic, led Monday by Texas Senator Ted Cruz. Politico (7/30, Kopan) reports that in an interview with Glenn Beck Monday, Cruz argued that Republicans have the opportunity to can defund the ACA, but “‘scared’ Republicans are standing in the way.” Cruz said, “What I can tell you is there are a lot of Republicans in Washington who are scared. They’re scared of being beaten up politically.”
The Washington Examiner (7/30, Spiering) reports that Senator Marco Rubio (R-FL) “defended” the proposal, saying, “With all these problems why would anyone want to continue with this failed experiment? Only in Washington do people double down on their mistakes.”
Other outlets reporting on Republicans who support fighting for defunding the ACA include the Huffington Post (7/30, Schlanger), the NBC News (7/30, Hunt) website, the Deseret (UT) News (7/30, Askar), The Hill (7/30, Baker) “Healthwatch” blog, The Hill (7/30, Jaffe) “Ballot Box” blog, and the Washington Examiner (7/30, Spiering).
As one of the few Democrats inserting himself into the intra-GOP rift, Politico (7/30, Everett) reports that on Monday, Senate Majority Leader Harry Reid said, “If Republicans force us to the brink of another government shutdown for ideological reasons, the economy will suffer. I would suggest to any of my Republican colleagues that has this idea: Give a call to Newt Gingrich. … Ask him how it worked. It was disastrous for Newt Gingrich, the Republicans and the country.”
Commentary Considers GOP Rift Over Defunding ACA. In addition to accounts of the Republican rift over defunding the Affordable Care Act, several outlets carry analyses and opinion pieces reacting to the debate. Despite some maintaining sympathies for the Republican cause, all conclude that the tactic is certain to fail at the least, and potentially dangerous for the party at the most.
Well-known conservative blogger Jennifer Rubin, in her Washington Post (7/30) “Right Turn” blog, quotes various Republican leaders who are speaking out against the tactic, including Senator Richard Burr (R-NC), who called it “the dumbest idea I’ve ever heard.” Rubin concludes that it is a “certainty” that “the GOP is not going to defund Obamacare on its namesake’s watch.”
Sean Sullivan, in his Washington Post (7/30, Sullivan) “The Fix” blog, calls Cruz’s decision to call his GOP colleagues “scared” for not going along with his plan “a perilous move.” While he is confirming his “conservative bona fides,” Sullivan writes, Cruz is also highlighting his “willingness to be an antagonist at virtually every turn.”
Brent Budowsky, in a piece for The Hill (7/30) “Pundits Blog,” writes that as many Republicans agree, “threatening to shut the government down over healthcare is profoundly unwise policy for America and profoundly unwise politics for the GOP.”
Avik Roy offers a lengthy analysis of the tactic in his Forbes (7/30) “Apothecary” blog, saying that a one year delay of the ACA’s central provisions may be better than a complete repeal.
On the MSNBC (7/30) website, Geoffrey Cowley criticizes Senator Marco Rubio (R-FL) for doubling down on the “kill-it-at-all-costs rhetoric,” seeking to blame President Obama for a potential government shutdown.
Dennis Byrne, a Chicago writer, calls the plan “more than stupid,” in the Chicago Tribune (7/30). He argues that the tactic “will surely fail,” and could very well “cost the GOP in the 2014 elections, possibly including control of the House.” The only way to repeal the law, he concludes, is to “turn the spotlight on what they’d replace it with.”
Similarly, in an editorial, the Baton Rouge (LA) Advocate (7/30) criticizes Republicans for continuing to oppose the Affordable Care Act without coming up with a viable alternative. The paper argues that any sort of GOP-sanctioned replacement “requires legislative initiative, not just opposition.”
Syndicated columnist Jules Witcover writes in the Baltimore Sun (7/30) that despite continued unpopularity, the Affordable Care Act “will nevertheless prevail.”
House To Vote This Week To Repeal Part Of ACA For 40th Time.
The Hill (7/30, Baker) “Healthwatch” blog reports that this week, the House will vote “for the 40th time to repeal part of ObamaCare.” The bill, sponsored by Representative Tom Price (R-GA), restricts the IRS from implementing any part of the law. The article points out that this is part of the GOP’s “effort to keep up the negative pressure” following the employer mandate delay.
Republicans Seek To Change ACA’s Definition Of Full-Time Employment.
CQ (7/30, Attias, Subscription Publication) reports on the “ongoing debate” over whether Congress should revise the Affordable Care Act’s definition of full time employment. So far, “Republicans and business representatives” have voiced their support for “an effort to change the definition to 40 hours a week,” but Democrats aren’t behind it.
The Delmarva (MD) Daily Times (7/30, Gaudiano) also reports on the effort to change the full-time employment threshold.
ACA Call Center Under Fire For Not Offering Health Benefits To All Workers.
FOX News (7/30) reports that a call center set up to offer Affordable Care Act assistance in Contra Costa, California, is making news for not offering health insurance to all of its employees. The state’s budget “only allows for half of the customer service agents hired to work full-time,” which many in the community find “disappointing.”
Feds’ Marketing Of ACA To Young People May Violate Age Discrimination Act.
The Daily Caller (7/29, Howley) reports that the Obama Administration’s public relations campaign touting “the benefits of enrolling in Obamacare” to young people “appears to violate the federal Age Discrimination Act,” which “states that no program that receives federal money can discriminate with respect to age.” The Daily Caller notes that the “campaign-style demographic targeting” would “at least initially have the discriminatory effect of not equally promoting subsidized health care to older participants whose participation would not be as favorable for Obamacare’s convoluted apparatus.”


http://allplanhealthinsurance.com

Can we really say we didn’t see the cuts to Medicare Part B coming? (These are described in the Houston Chronicle, our feature article below.) Last year the administration made the decision to cut $716 billion from Medicare over the next ten years. $156 billion of this is predicted to come from Medicare Advantage. If you are a Medicare Advantage policyholder, did this news somehow fail to appear in your “Annual Notice of Change” which arrived last October? If so–could this be because we were in the middle of a Presidential election and cuts to your Medicare Advantage Plan might not have helped someone’s re-election? Fortunately for me, I have always encouraged my clients to enroll in Medicare Supplement to fill in their gaps in Medicare if it was at all affordable.
Admin. – Kenton Henry

*OBAMACARE CUTS

****************************************************
Feature Article:
Houston Chronicle Medicare Part B, life and death
By Michael Hazel | July 19, 2013 | Updated: July 21, 2013 7:04pm
Across Texas, seniors with serious medical conditions could soon lose access to the medical treatments they need.
Right now, in an effort to trim federal spending, lawmakers are considering cuts to Medicare Part B, the component of Medicare that covers cancer treatments and other medicines that are administered by physicians. Lawmakers must reject this proposal and work to balance the budget without restricting access to medical care.
Under Medicare Part B, health care providers purchase drugs that require administration by the provider and are later reimbursed by Medicare, after administering the treatments in their office, according to a preset formula.
For almost a decade, physicians have been reimbursed the average sales price (ASP) of each medicine plus an additional 6 percent. That extra 6 percent helps to cover costs related to the shipping, handling and storage of the drugs, in addition to health care providers’ other overhead and administrative costs.
The federal “sequester,” which took effect in April, has in effect reduced Medicare Part B’s payment formula for drugs from ASP, plus 6 percent, to ASP, plus 4 percent. Now, some lawmakers want to cut that reimbursement rate even further. Such reductions could mean big problems for Medicare patients.
Medicare patients in Texas are understandably worried. John Peterson, a patient at Texas Oncology who’s been battling leukemia for 12 years, is concerned about future treatments. “I have a lot of exotic drugs that we have Medicare pick up the cost … it’s been a life saver,” Peterson told News Channel 25 in Waco. He fears Part B reductions will make continuing treatments at his current cancer center impossible.
Such reservations are not unfounded. Further Medicare Part B cuts could very well force cancer clinics to start closing. According to the Community Oncology Alliance, approximately 240 oncology clinics have closed in the past four and a half years and another 400 are struggling financially.
“Without adequate reimbursement, providers will close their doors, forcing patients to either forgo treatment or be relocated to inpatient facilities, many outside their communities or region,” reports the National Patient Advocate Foundation.
Such closures are particularly problematic in states like Texas, because our state is home to so many rural residents. With fewer community clinics available, rural Texans will have to travel far distances to other centers or hospitals for treatment. For those suffering from life-threatening illnesses, unnecessary travel is exactly what they should be avoiding.
Treating patients in hospitals instead of doctors’ offices is also far more expensive. Milliman, a respected actuarial firm, found that a chemotherapy patient who receives treatment at a hospital costs Medicare about $600 more per month than a patient who is seen at a physician’s office.
For Texans like John Peterson, Medicare Part B is a matter of life and death. It’s unacceptable that politicians in Washington are considering further reductions to the program’s payments for Part B drugs.
Texas’ representatives should make certain that patients can continue to access the medical care they need.

Michael Hazel is the incoming president of Texas Nurse Practitioners.


http://allplanhealthinsurance.com

House to Vote on Affordable Care Act Individual and Employer Mandates

07.17.2013

Currently we have over 800,000 veterans awaiting decisions on their disability claims. The back log is so great–according to the most recent numbers available–the average wait time for a veteran is 15 months in Chicago, 16 months in New York and a year and a half in Los Angeles. Social Security’s disability program, which helps support 11 million Americans, will run through its trust fund in 2016, two years earlier than predicted. Couple this with the prediction Social Security, the fund that finances benefits for 44 million senior citizens and their survivors, will be exhausted by 2035 and Medicare, the health care program for those age 65 and over, will be have depleted its funds by 2024. Now consider a law has been passed which mandates health coverage for every American. Its objectives are largely, and initially, funded via subsidies from the federal government (you the tax payer). Can you possibly believe this is feasible given their track record? Given a federal debt of almost 17 trillion dollars? How long do you believe it will take before all private insurance companies are forced to withdraw from participation to be replaced by a single payer federally administrated program which can’t possibly be any more financially feasible than our government’s disability program, Social Security or Medicare?

Admin. – Kenton Henry

http://allplanhealthinsurance.com

****************************************************************

Today’s Feature Articles:

Legislation and Policy

House Votes To Target ACA Individual, Employer Mandates.

Coverage of the Obama Administration’s decision to delay the Affordable Care Act’s employer mandate continues Wednesday, the same day the House is set to vote to further capitalize on the weak position they believe the move has put Democrats in. Most reports, some national in scope, focus on the House votes to delay both the employer and individual mandates, while others focus on the implications of both of these provisions.

McClatchy                          (7/17, Kumar) reports that on Wednesday, the Republican-ruled House is expected to vote to delay key parts of the Affordable Care Act, a move that “is the latest in a sweeping legislative and political campaign to weaken the 2010 law and raise even more opposition in the eyes of an already skeptical nation, especially as it heads into 2014 elections that will decide control of the Congress and set the stage for the 2016 campaign for the White House.” The back-to-back votes will determine “whether to delay insurance mandates for both employers and individuals.”

The Washington Times

(7/16, Howell) reports that “President Obama has threatened to veto” the bills. Meanwhile, “the votes will force Democrats to align with the president or distance themselves from the overhaul in the wake of its recent stumbles.” In addition, it has put the “Office of Management and Budget in the awkward position of threatening, in the case of the employer mandate, to kill a bill that would reflect the White House’s own decision-making.”

CNN

(7/16, Walsh) reports that “most House Democrats are expected to oppose two House Republican bills on Wednesday that would delay key provisions of Obamacare,” according to House Democratic Whip Steny Hoyer (D-MD).

The Hill

(7/17, Baker) “Healthwatch” blog reports that the bill to delay the individual mandate “would cut the deficit, but would cause insurance premiums to rise,” according to the Congressional Budget Office.

Implications Of Employer Mandate Delay Still Unclear. The AP

(7/17, Alonso-Zaldivar) reports on the “domino effect” that is currently “undercutting” the Affordable Care Act: the Obama Administration’s delaying of the law’s employer mandate could “weaken” the individual mandate, because the requirement that companies report health insurance details for employers has also been pushed back. As the article explains, “without employers validating who’s covered, a scofflaw could lie, and the government would have no easy way to check.” The piece calls this yet “another incentive for uninsured people to ignore a new government requirement that for many will cost hundreds of dollars.”

****************************************************************

Not All Insurers Game for State Exchanges: The Consumer Impact

By Kate Rogers

Published July 11, 2013

FOXBusiness

As more insurers decide to pack up and leave certain states as health exchanges start to take form, experts say consumers are going to be left  feeling the pain.

Over the last few weeks, several departure announcements have sent a ripple through the health insurance industry, as companies weigh whether or not they want to play ball under Obamacare. So far, California has experienced the biggest migration  with Aetna (AET), UnitedHealthcare (UNH) and Cigna (CI) leaving the state’s exchange, Covered California.

Aetna also reportedly sent out a note to select customers last week, warning that the Patient Protection and Affordable Care Act is “changing health insurance.” Recipients were customers across the country with non-grandfathered health plans, meaning their plan was not in effect on March 23, 2010 and wouldn’t carry over under new state and federal exchange regulations under ACA.

“This includes adding preventative care and essential health benefits. The ACA also ends medical underwriting. Due to these and other changes, many people will pay more for their health insurance coverage in 2014 than they do today,” the letter stated according to the carrier.

Wellmark Blue Cross/Blue Shield also decided not to list on the individual exchange in Iowa for 2014, due to a lack of information available in the state, according to a spokesperson for the Iowa Insurance Division.

Fifteen states and the District of Colombia are in the process of creating their insurance exchanges before the 2014 deadline; when individuals must purchase insurance or face a fine for failing for comply with the individual mandate. The employer mandate has been pushed back to 2015, and some in the GOP including House Majority Leader Eric Cantor, (R-VA), are calling for the individual mandate to be rolled back as well.

More or Less Competition for Consumers?

Some experts say the recent departures hint consumers will have limited health-insurance choices thanks to the regulatory burdens of the law. Basic supply and demand dictates that with fewer insurers to choose from, consumers will have limited options and potentially higher prices, says Michael Cannon, director of Health Policy Studies at the CATO Institute.

A similar “exodus” occurred within the first six months of the implementation of the Affordable Care Act, Cannon says, when child-only care was enacted. Seventeen major insurers dropped child-only coverage, in an attempt to skirt the law’s new regulations and increased costs. The same may begin to take shape in the individual market.

“The program says you can’t charge higher premiums to the sick, so you have a situation where only low-risk consumers would be charged a premium much higher than their regular costs, so only people who buy it would be those who really needed it,” he says.

The employer mandate rollback is also a factor in the situation, says Grace-Marie Turner, founder of the Galen Institute, a health and tax policy research organization, as employers will now be incentivized to drop coverage and push their employees into the exchanges until 2015.

“It’s using employers to push more people into the exchanges,” Turner says.

Fewer insurers in state exchanges mean less competition, bottom line, she adds. “The whole point is we want more players, and more competition.”

Why California Matters

What happens in California is a big deal for the future of the Affordable Care Act, says Taylor Burke, associate professor and program director, MPH in Health Policy, at George Washington University.

“It’s an exit out the individual market, but [the insurers] only represent 8% of the individual market companies in the state,” Burke says. “California has the 7th largest economy on the globe, so whatever happens in California is a big deal for the stand up of the state exchanges.”

He points to two main reasons insurers leave a state: they don’t like the price points being offered in the exchanges nor the coverage they would have to offer under Obamacare’s 10 essential health benefits.

“In California, you can make the argument that there would be less choice, but if they stay in the market, their prices would be off the charts,” he says. “It would be a thing on the shelf, a high-ticket item that you couldn’t afford anyway.”

And if insurers take too long to make the decision, that may impact them negatively as well, he says.

“No one will want to buy their product. There’s a lot of hemming and hawing, but if the price point is too high, no one will buy it.”

But can consumers blame the insurer for higher prices? Turner says no, it’s the nature of the law’s regulations.

“Insurers can’t help the demands on the benefits they will have to cover—it will absolutely be more expensive,” she says. “It’s like going to buy a car with every accessory in the books—heated seats, fancy wheels, satellite radio, and saying you can’t charge more for it.”

What Insurers are Deciding

Robert Zirkenbach, spokesman for America’s Health Insurance Plans (AHIP), says each individual company will have to make their own decisions about which states to participate in as exchange bids come in.

“It will be based on a variety of reasons, but plans are offering coverage on the exchange, some will be outside the exchange—there will be options for consumers,” Zirkenbach says. “It will depend on the state and regulatory environment.”

He says the AHIP wants competition among insurers to keep consumer prices in check.  “Choice and competition is a good thing—when states have been setting up their exchanges, we are trying to encourage this,” he says.

The National Association of Insurance Commissioners says insurers who are leaving these markets are likely doing so because they have core businesses in other segments, including the large group market.

“The carriers we have seen exiting the individual market are not major players in that market segment, and therefore we don’t anticipate a major disruption of coverage for a large portion of the market,” a spokesperson said in an email statement. “Each insurance company is making decisions regarding its participation in exchanges based upon a number of factors.  Some are opting to participate in the exchanges, while others are not; however, nearly all of the requirements that apply to policies sold on the exchange also apply to policies sold outside the exchange, so insurers will not be avoiding a lot of requirements by opting out of the exchanges.”

Welcome to The MedPlus Messenger Blog!

THE MEDPLUS MESSENGER

VOL I, ISSUE 1, 16 JULY 2013

THE MEDPLUS MESSENGER blog is for the dissemination and discussion of information regarding health, Medicare and life insurance legislation; laws; trends; products and related topics. It is intended to be of use to the general public; clients and prospective clients of ALL PLAN MED & LIFE QUOTE the parent company of ALLPLANINSURANCE.COM: http://allplaninsurance.com; ALLPLANHEALTHINSURANCE.COM; ALLPLANINTERNATIONALHEALTHINSURANCE.COM and IndianaHealthInsurance4U.com.

ADDRESSING: HEALTH AND MEDICARE RELATED INSURANCE ISSUES INCLUDING THE AFFORDABLE CARE ACT (ACA); COMPLIANCE WITH THE AFFORDABLE CARE ACT; STATE AND FEDERAL HEALTH INSURANCE EXCHANGES; CURRENT BEST VALUES IN HEALTH INSURANCE; IMPACT OF THE ACA ON EMPLOYERS; DECLINATION DUE TO PRE-EXISTING CONDITIONS; MEDICARE AND MEDICARE RELATED INSURANCE (MEDIGAP); PART D PRESCRIPTION DRUG PLANS

While The MedPlus Messenger has existed for sometime as an industry and marketing newsletter–today is the first time we have existed and published as a blog. The reasons for this are numerous but the greater ones are: the tremendous amount of confusion, on the part of the public, regarding the ACA and its implementation; the diverse opinions and perspectives on it; apprehension as to its effects on the quality of health care; the cost of insuring for medical expense and the options for doing so available to employer groups, individuals and families and Medicare recipients. Only through intelligent discourse of these topics can our subscribers transition through implementation into optimal utilization of health care, as well as protection against the cost for such, with as little inconvenience as possible. Only by discussing your concerns, , perspective, frustrations and opinion can Allplanhealthinsurance.com better meet your needs in this rapidly changing marketplace. Already the availability of health insurance has become an entitlement by law and its issue and administration may well be on the brink of falling within the exclusive confines of another federal program. For these reasons, not only are your insights and questions welcomed but your disagreements and protests encouraged as well.    

OUR MISSION:

It has and will remain the goal of Allplaninsurance.com to provide the most objective health, Medicare related, life and dental insurance quotes–along with the very best of service to the our policyholders. We serve residents of all fifty states (US) and the international community. We see it as our responsibility to monitor the state of the national and international insurance and the political process as it relates to such. It is our objective and, we feel–our duty–to inform the public of such matters. ALL PLAN MED & LIFE QUOTE has been based in The Woodlands, Texas since 1991.

THE MEDPLUS MESSENGER is not copyrighted and articles and analysis presented in THE MEDPLUS MESSENGER may be reproduced at your discretion. However, articles and analysis should not be construed as representing the policy, endorsement or opinion of ALL PLAN MED & LIFE QUOTE, or its agents, unless so stated. Although carefully verified, data are not guaranteed as to accuracy or completeness. ALL PLAN MED & LIFE QUOTE cannot be held directly responsible for any direct or incidental loss incurred by applying any of the information in this publication.

DIRECT QUESTIONS OR SUGGESTIONS TO FIELD OFFICES:

TEXAS & ALL OTHERS: 800.856.6556; quote@allplaninsurance.com

CALIFORNIA: 800.200.5278; insurnet@snowcrest.net

NEW YORK: 888.766.6932; sonny@onestopinsuranceshopping.com

IMPORTANT PHONE NUMBERS AND LINKS:

THE AFFORDABLE CARE ACT, SECTION BY SECTION (U.S. Department of Health and Human Services Website): http://www.hhs.gov/healthcare/rights/law/index.html

CENTERS FOR MEDICARE & MEDICAID SERVICES: 1.800.633.4227: http://www.medicare.gov

U. S. (Federal) Pre-Existing Condition Health Insurance Plan:  https://www.pcip.gov/

The United States Senate: http://www.senate.gov/general/contact_information/senators_cfm.cfm

Texas Department of Insurance: 800.252.3439: http://www.tdi.state.tx.us/

Texas Health Insurance Risk Pool (for those uninsurable by private health insurance):

888.398.3927; TDD 1.800.735.2989: http://txhealthpool.com/

New York Department of Insurance: 800.342.3736: http://www.ins.state.ny.us/

Illinois Department of Insurance: 217.782.4515: http://www.idfpr.com/

Indiana Department of Insurance: 317.232.2410: http://www.state.in.us/idoi/

California Department of Insurance: 916.322.3555: http://www.insurance.ca.gov/

United States Treasury Health Savings Account Guidelines:  http://www.treasury.gov/

Doctor Comparison:  http://www.bcbstx.com/bluecompare/tour/index.html

National Association of Health Insurance Underwriters:  http://www.nahu.org/

VISIT OUR WEB SITES AT:

http://allplaninsurance.com

http://allplanhealthinsurance.com

http://allplaninternationalhealthinsurance.com

http://indianahealthinsurance4u.com

*************************************************************************************

TODAY’S ISSUE OF DISCUSSION:

The Affordable Care Act (ACA) and its current state of implementation; the impact of such on health insurance premiums and the delayed Employer Mandate.

*************************************************************************************

FEATURE ARTICLES:

Op-Ed:

The ensuing articles demonstrate that efforts to implement the Affordable Care Act remain behind schedule and the mechanisms in place to ensure such were never for this herculean task. It is logical to conclude this is, in large part, due to the burden of  comprehending the content and demands of two thousand plus pages of the act itself and nine thousand plus pages of accompanying regulations. Both the public and private sector responsible for implementation are obviously overwhelmed with massive work this requires. This, along with the greatly underestimated costs of implementation and regulation, does not bode well for a smooth and efficient transition into compliance. Even less assured is  the long term solvency of the ever-decreasing number of participating health plans or the feasibility of guaranteed health care.

Due to the minimal penalties for failing to purchase health insurance during the next two years, it is predicated participation by those currently choosing to be uninsured will be negligible. When compared to the cost of insuring which is predicted to increase in many cases by as much or more than 100%–it is reasonable to conclude most will simply choose to pay the penalty. This will disprove the assumption that a huge influx of young, healthy insured members will subsidize the cost of insuring the older, and generally less healthy, individuals which the was the main premise on which feasibility arguments were based.

We can see from recent legislative action that portions of the bill which would impede implementation have been suspended. This, at worst, appears politically motivated and, at best, an effort to make certain as many as possible sign up for individual and family coverage through an exchange. Whether or not you are in favor of the latter is probably dependent on whether you would like to see a “single payer” health insurance system in place as, I feel, this will be the ultimate result of the exchanges and their plan mandates. In the meantime, The ACA is law. Suspension of portions of a passed act inconvenient to implementation of the act itself is unprecedented to my knowledge and there appears no legal basis for doing so.

The featured articles below begin with an overview of the distinction between “Minimum Essential Coverage” and “Essential Health Benefits” and conclude with recent abatements in enforcement of certain portions of the law. That these abatements, suspensions, moratoriums are convenient is unquestionable. The question remains, “for whom?”

Kenton Henry

Administrator, Editor: The MedPlan Messenger

********************************

OVERVIEW MINIMAL REQUIRED COVERAGE AND PENALTIES FOR NON-COMPLIANCE

Beginning in 2014, the Affordable Care Act includes a mandate for most individuals to have health insurance or potentially pay a penalty for noncompliance. Individuals will be required to maintain minimum essential coverage for themselves and their dependents. Some individuals will be exempt from the mandate or the penalty, while others may be given financial assistance to help them pay for the cost of health insurance.

What type of coverage satisfies the individual mandate?

“Minimum essential coverage”

What is minimum essential coverage?

Minimum essential coverage is defined as:

  • Coverage under certain      government-sponsored plans
  • Employer-sponsored      plans, with respect to any employee
  • Plans in the individual      market,
  • Grandfathered health      plans; and
  • Any other health      benefits coverage, such as a state health benefits risk pool, as      recognized by the HHS Secretary.

Minimum essential coverage does not include health insurance coverage consisting of excepted benefits, such as dental-only coverage.

How does “Minimum Essential Coverage” differ from “Essential Health Benefits”?

Essential health benefits are required to be offered by certain plans starting in 2014 as a component of the essential health benefit package.  They are also the benefits that are subject to the annual and lifetime dollar limit requirements.

This is different than minimum essential coverage, which refers to the coverage needed to avoid the individual mandate penalty.  Coverage does not have to include essential benefits to be minimum essential coverage.

What is the penalty for noncompliance?

The penalty is the greater of:

  • For 2014, $95 per      uninsured person or 1 percent of household income over the filing      threshold – whichever is greater
  • For 2015, $325 per      uninsured person or 2 percent of household income over the filing      threshold – whichever is greater
  • For 2016 and beyond,      $695 per uninsured person or 2.5 percent of household income over the      filing threshold –whichever is      greater

There is a family cap on the flat dollar amount (but not the percentage of income test) of 300 percent, and the overall penalty is capped at the national average premium of a bronze level plan purchases through an exchange.  For individuals under 18 years old, the applicable per person penalty is one-half of the amounts listed above.

Beginning in 2017, the penalties will be increased by the cost-of-living adjustment.

Who will be exempt from the mandate?

Individuals who have a religious exemption, those not lawfully present in the United States, and incarcerated individuals are exempt from the minimum essential coverage requirement.

Are there other exceptions to when the penalty may apply?

Yes.  A penalty will not be assessed on individuals who:

  1. cannot afford coverage      based on formulas contained in the law,
  2. have income below the      federal income tax filing threshold,
  3. are members of Indian      tribes,
  4. were uninsured for      short coverage gaps of less than three months;
  5. have received a      hardship waiver from the Secretary, or are residing outside of the United      States, or are bona fide residents of any possession of the United States.

*Further Clarification of the Applicable penalty
The individual one-time penalty under ACA in 2014 will be $95 per adult, or one percent of your income, whichever is greater. So say your annual income is $50,000, you’d pay $500. For every uninsured child, the penalty is $47.50. The family maximum is $285.
Coverage is assessed on a monthly basis, So if you were uninsured for six months, you’d owe half the otherwise applicable penalty.”
She said that the government has given a wide window – from Oct. 1, 2013 to March 31, 2014 – for enrollment this time, but from next year on there will only be a three-month window to sign up.
Will people take the gamble and skip coverage, hoping that their youth or good health will protect them?
If the state of Massachusetts, which passed a landmark health care law in 2006, which became the blueprint for the 2010 ACA, is any indication the number of people who will refuse to get some form of coverage will be low.
In Massachusetts, “there’s a culture of coverage. Most people want to comply with the law.”

********************************************

FORBES

Pharma & Healthcare |

7/06/2013 @ 6:25PM |290,284 views

Not Qualified For Obamacare’s Subsidies? Just Lie — Govt. To Use ‘Honor System’ Without Verifying Your Eligibility

If you thought the delay in the employer mandate was bad news for Obamacare, just wait. On Friday, Sarah Kliff and Sandhya Somashekhar of the Washington Post discovered that the Obama administration had buried in the Federal Register the announcement that the government won’t be able to verify whether or not applicants for Obamacare’s insurance exchange subsidies are actually qualified for the aid, in the 16 states that are setting up their own exchanges. Instead, until at least 2015, these states will be able to “accept the applicant’s attestation [regarding eligibility] without further verification.”

Without employer mandate, Feds to rely on applicant ‘attestations’

If you’ve been following the latest news around Obamacare, you know that on Tuesday evening, just before the Independence Day holiday, the White House announced that it would be delaying the implementation of the health law’s employer mandate—requiring all firms with more than 50 employees to provide health coverage to their workers—until 2015.

I, and several others at the time, said “wait a minute.” According to the law, you aren’t eligible for Obamacare’s subsidies if your employer has offered you what the government considers “affordable” coverage. But if employers are no longer going to report whether or not they’ve offered “affordable” coverage, how can the government verify whether or not workers are eligible for subsidies?

***********************************************

DELAYED EMPLOYER MANDATE THE LATEST CHANGE FOR INCREASINGLY UNSTEADY HEALTH-CARE LAW

July 4, 2013 | Washington Post

The Obama administration has postponed one of the fundamental provisions of the health-care reform law, responding to mounting concerns from business owners who would have been required to start providing health coverage to their employees next year. On Tuesday evening, Treasury Department officials announced the government would not penalize businesses that fail to provide health insurance next year, delaying what is known as the “employer mandate” component of the law until 2015. Starting then, firms with more than 50 employees will be required to provide at least a minimum level coverage to their workers or pay a steep fine to the federal government. Officials made the decision to push the requirement back after fielding a flood of complaints from business owners about its implementation. “We have heard concerns about the complexity of the requirements and the need for more time to implement them effectively,” Mark Mazur, assistant secretary for tax policy, wrote in a blog post announcing the postponement, later adding that the administration plans to use the additional time to “consider ways to simplify the new reporting requirements” for business owners. The newly delayed mandate has been a major point of contention for small business owners and lobbyists since it was approved as part of the Affordable Care Act in 2010. Many warned that it would cause administrative nightmares for small employers and discourage those near the cutline from expanding beyond 50 workers. Meanwhile, some firms have started scaling back their payrolls to get underneath the cap. “Small companies have told us they are confused by the law and are simply finding it difficult to comply with, no matter when it goes into effect,” Rep. Sam Graves, chairman of the House Small Business Committee, said in an email to The Washington Post. “Instead of providing relief for businesses, this simply kicks the can down the road.” A White House official said the added time would help small business owners adapt to the changes, arguing that the law will still drive down prices for coverage on Main Street. “This allows employers the time to .?.?. make any necessary adaptations to their health benefits while staying the course toward making health coverage more affordable and accessible for their workers,” Valerie Jarrett, an adviser to Obama, wrote in a blog post on Tuesday. This latest delay is the most consequential in a series of setbacks for the president’s signature law, which has shown signs of fragility as the initial deadline for full implementation approaches at the end of the year. In April, the administration announced it would delay for one year a key cost-cutting feature of the law’s new small business health insurance marketplaces. Initially, the exchanges were supposed to allow employers to choose different plans for different workers; now, for the first year, they must select only one plan from a single carrier for their entire business. More recently, the Government Accountability Office announced that federal and state officials have fallen well behind schedule setting up the marketplaces, which are scheduled to open for enrollment in October. “This is simply the latest evidence that implementation of this terrible law is going to be difficult if not impossible, and the burden is going to fall on the people who create American jobs,” Amanda Austin, director of federal public policy at the National Federation of Independent Business, said in a statement. The NFIB, a small business lobbying group, has pushed back against the health care law since it was making its way through Congress, later spearheading an effort to repeal the legislation that ended at the hands of the Supreme Court. The group has since focused on repealing some of the provisions it considers most detrimental to businesses on Main Street, including the employer mandate and a new tax on insurers. Instead of delayed, Austin argued the mandate should be eliminated altogether. “Temporary relief is small consolation,” she said. “We need a permanent fix to this provision to provide long term relief for small employers.” – See more at: http://congress.org/2013/07/04/delayed-employer-mandate-the-latest-change-for-increasingly-unsteady-health-care-law/#sthash.JwCb3wWY.dpuf

************************************************************************************************************************

Now is a good time to remind you, if you do not like the options and laws as they apply to insurance consumers, the time to vote your opinions is nigh. For a continually updated list of legislative and state-wide candidates, or to view more election information such as where to vote, visit: http://www.sos.state.tx.us/elections/index.shtml

To let your opinion be known to your Senators go to: http://www.senate.gov/general/contact_information/senators_cfm.cfm

_____________________________________________________________________________________

ALL PLAN MED & LIFE QUOTE and ALLPLANINSURANCE.COM sincerely appreciate your participation.

Please take care and voice your concerns and opinion here.

Sincerely,

Kenton Henry

Administrator; Editor

PHONE: 800.856.6556

http://allplanhealthinsurance.com