Tag Archives: Obamacare

MEDICARE ADVANTAGE, DRUG PLANS, AND ACA INDIVIDUAL AND FAMILY HEALTH INSURANCE OPENING FOR 2022 ENROLLMENT

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(AETNA AND UNITEDHEALTHCARE RE-ENTER THE ACA INDIVIDUAL AND FAMILY HEALTH INSURANCE MARKET)

By Editor, Agent, Broker

D. Kenton Henry

It is that time of year and, once more, we find ourselves on the cusp of the “Annual Election Period” for Medicare Advantage and Part D Prescription Drug Plans. This is the period when any Medicare recipient may enroll or change their Advantage and / or drug plans for a January 1 effective date. The period runs from October 15th through December 7th.

As if this was not a busy enough time for Medicare insurance product brokers, many of us (like myself) must do “double duty”, during the holidays. This is because the “Open Enrollment Period” for those “Under the Age Of 65“, in need of Individual and Family health insurance, begins November 1 and runs through January 15th. This a one month extension from previous years. However, those wishing to have new coverage effective by January 1 must still enroll by December 15th.

In addition to the extension of the ACA enrollment period, an interesting and positive turn is that Aetna and Unitedhealthcare are re-entering the marketplace in SE Texas for 2022 after a six year hiatus! This brings welcome competition to a market which was vacated by every major carrier – other than BlueCross BlueShield – in January of 2016. While we will not have insight into the details of their health plan options until just before November 1, their names and reputation should garner a lot of attention, not only from consumers but medical providers. It is my hope that more high quality doctors and hospitals will elect to participate in the insurance companies’ provider networks. With Preferred Provider Organization (PPO) network plans eliminated, Health Maintenance Organization (HMO) network plans have been the consumer’s only option since 2016. And with the expansion in the availability of the Advance Premium Tax Credit and Cost Share Reductions, for many, their greatest challenge is no longer being able to afford health insurance but finding their providers in an insurance plan’s network.

And it is the same for me. As an agent / broker with 34 years in medical insurance, my greatest challenge isn’t finding a plan the consumer can afford or the benefits they’re seeking. It’s finding my client’s, and prospective client’s, medical providers participating in a network. While this isn’t a major issue to those new to the area, those of us who have resided here for years, have long established relationships with providers we are reluctant to part with.

I would be extremely pleased if some of the companies in the marketplace elect to offer PPO plans in 2022. But make no mistake, I in no way expect this to happen. The problem for a company considering offering PPO coverage is that if all their peers do not also, they “adversely select” against themselves. In other words, if they are the “only game in town” when it comes to PPO plans, they are going to attract, and garner, an inordinate number of “bad risks”. In other words, insured members with serious pre-existing conditions who need access to a greater number of providers will flock to them vs the insurance company offering access to an HMO network only. They will submit higher and more frequent claims, thereby compounding the potential for “loss” to the insurance company. This is why insurance companies ceased, in unison, offering PPO coverage, in most regions of the United States, in 2016. They want to limit your access to providers, and thereby limit your access to what is likely to be more expensive treatment. Enrolling people in HMO plans is the easiest way to do this. Regardless, my duty, as your agent, is to do my best to find your providers participating in the network of a plan whose benefits meet your needs.

The good news is – two new major carriers will uncertainly increase the number of options available to the consumer in terms of premiums, benefits, and providers. Additionally, several of the insurance companies are lowering copays and deductibles and the Department of Health and Human Services, which oversees the sale of all ACA health insurance, has made it much easier to qualify for a “subsidy” to reduce the policyholder’s share of the premium due, especially for anyone who claimed unemployment benefits any time during 2021.

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MEDICARE IN 2022

In the Medicare related insurance market, increases in variables for 2022 are estimated to be higher than in recent years. Some were not definite as of the end of September. The Part A In-patient deductible is projected to increase but, as of this date, I have no definitive cost. The Part B Out-patient deductible is estimated to be going from $203 to $217 per calendar year and it’s premium is projected to go from $148.50 to $158.50 per month.

There are currently 30 different Part D Drug plans for Texans to choose from. Each covers some drugs but not others. The plan which is best for you is entirely dependent on the drugs you use. Not the drugs your spouse, neighbor, or I use – but the ones you use. The Part D deductible is going from $445 to $480 for the calendar year. A drug plan may choose to have deductible ranging from $0 all the way to$480 before your drugs become available for a copay. With many plans,  the deductible will not apply to Tier 1 and Tier 2 generic drugs. The threshold for entering the “GAP” will occur when the member and plan have paid $4,430. During this time, the member will pay 25% of the cost of their drugs. They will cross over into “CATASTROPHIC COVERAGE” if, and when, the member has personally expended $7,050. At this point, a member will pay $3.95 for a generic drug and $9.85 or 5% of the cost of a brand name drug – whichever is higher.

As a broker for my clients, and prospective clients, my goal is to identify the Medicare Plan, whether Medicare Supplement, Advantage or Part D Drug Plan which is most likely to result in their lowest total out of pocket cost for the calendar year while providing them access to all their providers. The “total cost” is the sum of their premium, any applicable deductible or deductibles, and copays or coinsurance. Our objective is the lowest sum and that plan, or plans, will usually be my recommendation.

To this end, I encourage anyone interested in enlisting my help, to contact me. If you would like me to identify your lowest total cost drug plan for 2022, based on your current or anticipated drug use, email me a list of your Rx drugs and, preferably, the dosages. The latter can make a difference. If you know you want Medicare Advantage, send me a list of doctors and hospitals you feel you must have access to. Please recall that with Medicare Supplement coverage you may obtain treatment from any doctor, hospital, lab, or medical provider, that sees Medicare patients. There are no networks with which to concern yourself. However, with Supplement, unlike most Medicare Advantage plans, you will have to acquire a Part D Prescription Drug Plan to accompany it.  For those using little or only low cost generic drugs, the lowest premium plan for Texans in 2022 will be $6.90 per month.

*(READ FEATURED ARTICLE BELOW ON WASHINGTON’S EFFORTS TO LOWER RX DRUG COST FOR MEDICARE RECIPIENTS)

The name of my insurance agency I opened in 1991, after being in the medical and life insurance industry since 1986, is All Plan Med Quote. It is located in The Woodlands, Texas. In 1995, I created one of the first websites in the country to market health insurance via the internet. It still exists as Allplanhealthinsurance.com. In 2015, I expanded my web presence with TheWoodlandsTXHealthInsurance.com. The primary objective in naming the first two was to convey that (while I work, for the consumer) I am appointed (contracted) with virtually every “A” rated, major and minor insurance company doing business in your geographic region. But the insurance companies do not pay me a guaranteed wage or salary. They compensate me fairly if, and only if, you elect to go through me to acquire their products. But, without my clients, I have no income. So certainly my clients are my priority. Not the insurance companies. And, as my client, you are charged no more by going through me to obtain their product then if you walked through their front door and acquired it directly from them.

Here is a partial list of the companies whose products may, or may not, be appropriate for you, I may introduce to you:

AARP Unitedhealthcare

Aetna

Ambetter

Anthem

BlueCross BlueShield of Texas

Caresource

Cigna

Community Health Choice

Friday

Humana

KelseyCare Advantage

Molina

Mutual of Omaha

Oscar

Scott and White

Unitedhealthcare

Wellcare

D. Kenton Henry Office: 281-367-6565 Text my cell 24/7: 713-907-7984 Email: Allplanhealthinsurance.com@gmail.com

https://thewoodlandstxhealthinsurance.com https://allplanhealthinsurance.com https://healthandmedicareinsurance.com

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*(FEATURE ARTICLE)

Democrats suffer blow on drug pricing as 3 moderates buck party

BY PETER SULLIVAN – 09/15/21 03:11 PM EDT

Democrats’ signature legislation to lower drug prices was defeated in a House committee on Wednesday as three moderate Democrats voted against their party.

Reps. Kurt Schrader (D-Ore.), Scott Peters (D-Calif.), and Kathleen Rice (D-N.Y.) voted against the measure to allow the secretary of Health and Human Services to negotiate lower drug prices, a long-held goal of Democrats.

The vote is a striking setback for Democrats’ $3.5 trillion package. Drug pricing is intended to be a key way to pay for the package. Leadership can still add a version of the provision back later in the process, but the move shows the depth of some moderate concerns.

The three moderates said they worried the measure would harm innovation from drug companies and pushed a scaled-back rival measure. The pharmaceutical industry has also attacked Democratic leaders’ measure, known as H.R. 3, as harming innovation.

The three lawmakers had long signaled their concerns with the drug pricing measure, but actually voting it down in the House Energy and Commerce Committee is an escalation.

A separate committee, the House Ways and Means Committee, did advance the drug pricing measures on Wednesday, keeping the provisions in play for later in the process.

Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.) had implored the three lawmakers to vote in favor of the measure to at least keep the process going. 

“Vote to move forward today,” he said to the moderates in his party. “Vote to continue the conversation.”

Still, Pallone said he is confident that some form of measure to lower drug prices will make it into the final package. The House legislation was already expected to change before the final version, given moderate Democratic concerns in the Senate as well. Senate Democrats are working on their own bill, which is not yet finalized but is expected to be less far-reaching. 

“I know it is going to have drug pricing reform,” Pallone said of the final bill, noting that negotiations with the Senate would continue over the coming weeks. 

Still, the move on Wednesday is a show of force from the moderates. 

Henry Connelly, a spokesman for Speaker Nancy Pelosi (D-Calif.), said Democrats were not giving up on including drug pricing measures. 

“Polling consistently shows immense bipartisan support for Democrats’ drug price negotiation legislation, including overwhelming majorities of Republicans and independents who are fed up with Big Pharma charging Americans so much more than they charge for the same medicines overseas,” he said in a statement after the vote. “Delivering lower drug costs is a top priority of the American people and will remain a cornerstone of the Build Back Better Act as work continues between the House, Senate and White House on the final bill.”

Peters and Schrader both cited concerns about harming drug companies’ ability to develop new drugs, citing the industry’s record during the COVID-19 crisis.

Peters warned that “government-dictated prices” under the bill would cause harm to the “private investment” that backs drug development.

Schrader said the bill would mean “killing jobs and innovation that drives cures for these rare diseases.”

Advocates said the lawmakers were simply beholden to the pharmaceutical industry.

“Reps. Peters, Rice, and Schrader are prioritizing drug company profits over lower drug prices for the American people, particularly for patients with chronic conditions such as diabetes and multiple sclerosis,” said Patrick Gaspard, president of the left-leaning Center for American Progress. “To the contrary of what they contend, their opposition to the drugs proposal threatens the entirety of President Joe Biden’s Build Back Better agenda, which Democrats have campaigned on for years and that they previously voted for.”

Savings from the drug pricing provisions are a key way of paying for other health care priorities in the $3.5 trillion package, including expanding Medicaid in the 12 GOP-led states that have so far refused, expanding financial assistance under ObamaCare, and adding dental, vision, and hearing benefits to Medicare.

The Congressional Budget Office found that H.R. 3 would save about $500 billion over 10 years. Depending on what Senate Democrats can find agreement on, the final drug pricing legislation is expected to be less far-reaching, meaning it will result in fewer savings, though how much less is unclear.

The Senate bill would still allow Medicare to negotiate lower drug prices, but it is expected not to include another provision that would cap drug prices based on the lower prices paid in other wealthy countries. That provision has drawn particular pushback from some moderate Democrats.

Allowing Medicare to negotiate drug prices is extremely popular with voters, with almost 90 percent support in a Kaiser Family Foundation poll earlier this year. Many vulnerable House Democrats support the idea.

https://thewoodlandstxhealthinsurance.com https://allplanhealthinsurance.com https://healthandmedicareinsurance.com

MEDIA WARNS CONSUMERS THEY WILL HAVE LESS HELP SHOPPING FOR 2019 HEALTH INSURANCE

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(BUT THEY DIDN’T ASK ALL PLAN MED QUOTE OF THE WOODLANDS, TEXAS)

Navigators in a boiler room

By D. Kenton Henry Editor, Agent, Broker
29 October 2018

The media is proffering all manner of good news when it comes to the Open Enrollment Period for purchasing 2019 individual and family health insurance, just three days away. The doors open this Thursday, November 1st and will remain so through December 15th. During this time you, the consumer, will be able to review your options and make a decision to renew your existing policy or select a new one to become effective January 1. Whichever, that policy will cover you the coming calendar year.

The feature article appearing below, states there will be ” . . . fewer sources of unbiased advice and assistance to guide them through the labyrinth of health insurance.” To wit, it cites, the budget for insurance counselors, known as navigators, has been cut by 80%, leaving over one-third of navigators in 2,400 counties served by Healthcare.gov, unfunded. Thank you very much, New York Times. Somehow, they neglected to consult with me and my agency, ALL PLAN MED QUOTE. Reading the article in full, one can infer they feel the only meaningful assistance can come from the government (at taxpayers’ expense) and fail to credit the private industry, which has provided counsel and enrollment assistance within the domestic insurance industry some two hundred years plus. One token sentence in the article acknowledges the private industry’s presence to assist the consumer with procuring health insurance. In my estimation, this reflects the media’s general opinion and thesis that the government is the end-all solution to every conceivable personal financial issue. Which, again, in the mind of this editor, is precisely the philosophy, the perpetuation of which got us into this fix in the first place. Moreover, what exactly is that fix?

Current pre-midterm election media coverage informs us premiums have stabilized and are, in many cases, going down in 2019. While that may be true in some localities, the recently released premiums in southeast Texas reflect increases of 20% or more. If you obtain a subsidy, wherein you get a tax credit for a portion of your premium, the subsidy itself may be larger, but the balance may be as well. Also, for those not obtaining a subsidy (the vast majority of us) the increase will be born entirely by ourselves. The situation has made healthcare the number one concern of Americans heading into next week’s midterm elections according to a Fox News Poll.

For the record, ALL PLAN MED QUOTE and I have never been subsidized by taxpayer dollars. As an independent, self-employed broker/agent I am compensated when I successfully enroll someone in health insurance. I am not compensated when I fail at such. That is fine by me. In spite of continual cuts in agent compensation. I prefer autonomy to bureaucracy. My advice and guidance are objective. My goal is to succeed it getting you enrolled in a policy which makes sure you have access to the care and treatment you need, when you need it and are not financially devastated in the process. All this for the lowest possible premium. I do not care which insurance company you contract with, as long as you are satisfied you have obtained the best coverage for your given situation and needs. Ideally, it would also provide you access to all the doctors and medical providers you choose to utilize. Regrettably, that latter objective has become my biggest challenge and is one every insurance agent and counselor faces. To say it can be overcome in every instance would be misleading but I do my best. All 2019 individual and family options are Health Maintenance Organizations (HMO) policies, and this has been so since 2016. The HMO networks are narrow in comparison to what one may typically have experienced with employer-based HMO coverage. However, there are a very few plans (3 in my primary region) which operate very similar to a traditional Exclusive Provider Organization (EPO) policy in that they do cover treatment at a provider outside the network. Benefits are paid up to a limited percentage, and there is no cap on your maximum annual out-of-pocket but―for someone who wants to be assured they can obtain coverage from the provider of their choice―it is better than no coverage whatsoever. If you feel you must learn more about this option, please contact me.

To assist me in these ends, I am appointed with every company providing Patient Protection and Affordable Care Act-compliant health insurance company doing business in Montgomery, Harris, Fort Bend, and Galveston counties. BlueCross BlueShield of Texas (to my knowledge) does business in every corner of Texas, and I have been appointed with them twenty-seven years. In addition to Texas, I am licensed in Indiana, Michigan, and Ohio.

I offer short-term health insurance for those who do not get a subsidy and those who, whether they do or not, cannot afford credible health insurance. However, I do not represent it as covering pre-existing health conditions, as it does not. Nor do I represent it as a substitute for credible, compliant coverage. It is a short-term bridge to a long-term solution.

As always, the Open Enrollment Period will be a very busy and hectic time for anyone in my profession. To make things proceed more smoothly, I would appreciate you visit my quoting site to obtain spreadsheet comparison of your options from all the health insurance companies offering coverage in your county. Attempt to narrow your selection down to those plans you feel most closely approximate the coverage you need. You can search for in-network providers from the search button directly next to the premium quoted. If you are so confident a plan is right for you, please feel free to apply straight from the quote. However, many of you will have questions or appreciate my insight and experience with the plan details and application process. Those in need of a subsidy will find my assistance especially helpful. If this is you, please do not hesitate to contact me.

Again, for quotes and applications, you may go to my website at Http://TheWoodlandsTXHealthInsurance.com and click on “Health” in the top menu.

Alternatively, you may go directly to my spreadsheet quotes and an application by clicking on this link:
https://allplanhealthinsurance.insxcloud.com
*(it is not necessary to log in or register to obtain quotes or apply)

If you already know your interest is a policy from BlueCross BlueShield of Texas, you may go directly to their quoting and application page by clicking here:
https://retailweb.hcsc.net/retailshoppingcart/TX/census?ExpressLinkedAgentId=2V0boERIKNxDSESKunpc/w==

**(if these links do not function from this text, please copy and paste or type in your browser and hit enter)

If you apply for coverage through these links, I will be your agent and available to assist and commit to providing the best of service throughout the year. I bring my entire thirty-two years in medical insurance to bear for this purpose. I look forward to hearing from you and assisting you. Regardless, I hope you succeed in obtaining health insurance which suffices until Congress puts their heads together and provides us with more reasonable options.

D. Kenton Henry                                                                                                              All Plan Med Quote                                                                                                    Office: 281.367.6565                                                                                                     Text my cell @ 713.907.7984                                                                                   Email: Allplanhealthinsurance.com
For the latest in health and Medicare-related insurance, news go to Https://HealthandMedicareInsurance.com

COMMENTS OR QUESTIONS:

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FEATURED ARTICLE 

The New York Times
By Robert Pear
Oct. 27, 2018

Shopping for Insurance? Don’t Expect Much Help Navigating Plans

Affordable Care Act navigators helping patients during an enrollment event in 2016 at Southwest General Hospital in San Antonio.CreditCreditEric Gay/Associated Press
WASHINGTON — When the annual open enrollment period begins in a few days, consumers across the country will have more choices under the Affordable Care Act, but fewer sources of unbiased advice and assistance to guide them through the labyrinth of health insurance.
The Trump administration has opened the door to aggressive marketing of short-term insurance plans, which are not required to cover pre-existing medical conditions. Insurers are entering or returning to the Affordable Care Act marketplace, expanding their service areas and offering new products. But the budget for the insurance counselors known as navigators has been cut more than 80 percent, and in nearly one-third of the 2,400 counties served by HealthCare.gov, no navigators have been funded by the federal government.
“There is likely to be a lot of consumer confusion about the various plan options that may be available this year,” said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute. “It will be a bit of a Wild West — buyer beware!”
“Obamacare health plans,” short-term plans and “Christian health sharing plans” are all displayed on the same page of some shopping sites like Affordable-Health-Insurance-Plans.org, which describes itself as a free referral service for insurance shoppers.
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Consumers may have difficulty sorting through their options after the administration sliced the budget last summer for insurance navigators to $10 million this year, from $36 million in 2017 and nearly $63 million in 2016.
“Navigators play a vital role in helping consumers prepare applications to establish eligibility and enroll in coverage through the marketplaces,” the Department of Health and Human Services says on its website.
But 797 counties served by HealthCare.gov will not have any navigators this year, according to a tabulation of federal data by the Kaiser Family Foundation. That is a sharp increase from 2016, when 127 counties lacked such assistance.
“If you are confused and you want somebody’s help to try to figure out what’s right for you — what’s junk and what is legitimate — there will be fewer people to help you in most states,” Ms. Corlette said.
Federal officials said they were not providing funds for navigators in Iowa, Montana or New Hampshire because no organizations had applied for the money in those states.
Cleveland, Dallas and large areas of Michigan and other states will also be without navigators.
Texas will be hit hard. The state has the largest number and the highest percentage of people who are uninsured, with 4.8 million people, or 17 percent of residents, lacking coverage, according to the Census Bureau.
“North Texas remains one of the most uninsured areas in the country,” said the chief executive of Dallas County, Judge Clay Lewis Jenkins. “The administration’s decision to defund all navigators across North Texas will hurt our ability to enroll individuals in health insurance and result in some working families losing coverage. Only 45 of Texas’ 254 counties have any navigator coverage.”
Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, defended the cuts.
After five years, she said, “the public is more aware of the options for private coverage” available through the marketplace, so “it is appropriate to scale down the navigator program.” In addition, she said, information and assistance are available from other sources, including insurance agents and brokers.
Consumers can sign up for health insurance under the Affordable Care Act starting Thursday. Last year, 8.7 million people enrolled at HealthCare.gov, and three million more selected plans on insurance exchanges run by states.
Consumers can go without insurance next year without fear of a penalty, as Congress repealed the unpopular tax surcharge imposed on people who lack coverage.
Many health policy experts say that federal financial assistance is more important than the individual mandate in inducing people to buy insurance. Those subsidies will still be available to low- and moderate-income people for insurance that complies with the Affordable Care Act and is purchased through the public marketplace. The subsidies cannot be used for short-term policies.
The vast majority of the people we serve, over 90 percent, are motivated to have insurance because they want coverage for their family and themselves,” said Matthew Slonaker, the executive director of the Utah Health Policy Project, a nonprofit. “It’s not because they otherwise would have to pay a penalty.”
Average premiums for the most popular types of insurance purchased by individuals and families will be relatively stable next year and, in some states, will actually decline, the administration says.
Under new standards issued by the administration, navigators this year are encouraged to inform consumers of the full range of coverage options, including short-term plans that do not provide all of the benefits and consumer protections required by the Affordable Care Act.
President Trump has promoted the short-term policies as an inexpensive alternative to the Affordable Care Act, and he said those plans would be “much more widely available” as a result of an executive order he signed last year to overturn restrictions imposed by President Barack Obama.
Democrats have made health care a major theme in midterm election campaigns, and they say the short-term policies show how the Trump administration threatens protections for people with pre-existing conditions.
Short-term policies, which can extend up to 364 days and then be renewed for two additional years, often provide no coverage for pre-existing conditions, prescription drugs, pregnancy, maternity care or the treatment of mental disorders and drug abuse.
Indeed, Mr. Trump said, the short-term plans are cheaper because they are “not subject to any very expansive and expensive Obamacare coverage mandates and rules.”
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But, said Kirsten A. Sloan, a vice president of the American Cancer Society Cancer Action Network: “People may be attracted to short-term plans without understanding that the lower premiums come with less coverage. These plans may not cover the doctors and hospitals and drugs you need if you get sick.”
In another challenge this year, consumers may be deluged with robocalls offering cheap insurance.
Alex Quilici, the chief executive of YouMail, a company that offers software to combat robocalls, said he was seeing a huge increase in health insurance scams.
“Callers say ‘it’s open enrollment’ or ‘we can get you a better deal by looking at all the health insurance plans,’” Mr. Quilici said. “Callers ask for lots of personal information, and the unwitting consumer often gives their birth date, Social Security number and information for everybody in the family, in order to get a great deal. In reality, it’s identity theft or payment theft or both.”
Mr. Quilici’s company has recorded hundreds of robocalls. A typical call says that, with enrollment just “around the corner,” Mr. Trump has created short-term coverage options lasting up to three years, “so you and your family can get a great insurance plan at the price you can afford.”
It is difficult to identify the source of the robocalls, Mr. Quilici said, because callers often falsify information displayed on caller ID.
(A version of this article appears in print on Oct. 27, 2018, on Page A25 of the New York edition with the headline: Shopping for Health Insurance: Many Options but Little Guidance. Order Reprints | Today’s Paper | Subscribe)

The State of Health Insurance for 2017 (or “If It Weren’t For Bad News . . .)

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HEALTH BLOG PIC 1

By D. Kenton Henry, editor

 

We are more than half-way through 2016 and three months away from the scheduled beginning of the 2017 Affordable Care Act (ACA) individual and family health insurance Open Enrollment Period (OEP). All of which finds this broker and many of his clients still reeling from the this year’s OEP which ended in February.

By last September, the rumor was health insurance premiums would not be inflating. That was quite encouraging to myself and to my clients who inquired as to such. However, what was unsaid―and to our shock―was what we learned with the commencement of OEP, November 1. Specifically, all carriers in southeast Texas (my major market) were eliminating Preferred Provider Organization (PPO) plans and forcing all new policyholders to accept Health Maintenance Organization (HMO) plans in their place. Anyone who knows anything about the latter knows that, with this type of plan, the patient must obtain treatment within the network or have no coverage whatsoever. For the young and bulletproof this seemed no great compromise. But to the middle-aged and older, whose health problems are moderate to very serious, it was a huge one. My existing PPO plan clients who were not grandfathered, including myself, were forced by the state’s largest insurance carrier (among others) to accept HMO coverage as a substitute or lose coverage altogether effective January 1, 2016. I scrambled to find acceptable replacement coverage for over 150 of my clients from the 2017 HMO plan options. This endeavor materialized into a “Mission Impossible” style nightmare as the HMO networks made available to them had nothing approaching the larger number of provider doctors and hospitals to which the employees and dependents of large employer plans had access. My clients learned they would be unable to utilize the providers in their current (and now former) PPO plans. It was mostly an exercise in futility attempting to find all of a person’s providers in any one network and, even if that person were so lucky, the inconvenience of getting their Primary Care Physician to refer them to a specialist was another cumbersome hurdle most considered an unwanted liability. After first enrolling in a higher cost Silver Plan offering doctor’s office copays, I myself, before the close of OEP, switched to a lower cost Bronze (non-copay plan) with another company. This after realizing it was virtually impossible for my physician to successfully maneuver the referral process.  I made the decision it was best to take the premium savings involved in the benefit downgrade and have it for the occasional doctor’s visit which I have found to average $150. I save much more than this by having gone with a Bronze plan and―so far―it has worked out for me.

Since the close of OEP my phone rings throughout the week with people pleading with me to get them out of their HMO plan and into PPO coverage so they may see the doctor of their choice. I have only one PPO medical plan I can refer them to. This plan made itself available after the close of OEP but it is a hospital system plan which requires the patient remain in the system or face high out-of-network expenses. Furthermore, if the prospect has not had what the Department of Health and Human Services and ACA call a “Life Changing Event” they cannot change to a new plan at this time and must wait until October to enroll for a January 1 effective date. To add personal insult to injury, the plan does not even allow brokers and agents to be appointed with them for the purpose of doing business. Any business we refer or submit to them is done strictly on a “pro bono” basis. The only good news to be had for the consumer is that premiums not only stabilized but, in the case of those forced to migrate to HMO coverage, may have even gone down. Of course. Why shouldn’t they? The forced migration took client/patients from a position of having the final say on who their provider was to a position of having their providers, and therefore, treatment rationed. Most do not consider the trade off a worthy one. I know I do not. Of all my clients on individual and family PPO plans, forced to exchange such, some were small business owners. Those that had the minimum two W2 employees were able to switch to “Group” (employer based coverage) and maintain a PPO plan and provider network. If you fit this profile, please contact me. I can assist you in acquiring group coverage at any time throughout the calendar year.

My clients ask me if I expect PPO plans to re-enter the individual and family market in 2017. I tell them we will have to wait until the beginning of the OEP October 15th. But I advise them not to bet the ranch on it. If insurance companies do reintroduce PPOs, it will be only to entice policyholders to make a plan switch which would require a new contract (policy) in which brokers and agents would be excluded from compensation. This would be done in an effort to wipe the insurance companies books clean of the liability for our compensation. Their rationale is they can now put a great deal of the cost of enrolling people on the American taxpayer by directing prospective enrollees to the state and federal health insurance exchanges. The lion’s share will be directed to Healthcare.gov.

But what of the financial health and solvency of the insurance companies and their plans? Today’s feature article, from the New York Times (below) describes the push to ration provider access and treatment. Of course, they do not use those words, choosing instead to describe it as a move to “curb” cost in an effort to stabilize premiums. In spite of such, the insurers, for the most part, still struggle for solvency. The article explains that companies overestimated the number of ultimate enrollees and underestimated the cost of providing all the mandated care. To exacerbate their generally thin to negative profit margin, they did not receive all the government subsidies originally promised. Like so many programs, it would appear they cannot approach solvency without tax-payer funded subsidies.

Given all this, most of the insurance co-ops have failed and even major carriers are announcing withdrawal from the market. UnitedHealthcare, the nation’s largest health insurance carrier, has announced it will be pulling out of 90% of its current market in 2017. Anthem seeks to buy Cigna and Aetna seeks to merge with Humana. All this results in far less competition and . . . less competition means higher premiums for the consumer.

Stay tuned to see what the market offers us during this fall’s OEP. I will be focusing more and more on my “Medicare” clients who, much to my regret, were somewhat neglected during last fall’s scramble on my part to find new policies for 150 plus under-age 65 health insurance clients. Medicare recipients will be a priority this fall during their own OEP for Medicare Advantage and Part D Prescription Drug Plans. I hope the market allows me to play an active role in assisting families in obtaining health insurance.  . . . We shall see. Predicting what is going to happen next in terms of what the general public refers to as “Obamacare” is a lot like walking into a swamp. You’re not quite certain if your next step will land in quicksand or on top of an alligator. Terra firma would be a welcome and unexpected change for the consumer and this agent / broker.

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*FEATURED ARTICLE

New York Times

Business Day

Health Insurer Hoped to Disrupt the Industry, but Struggles in State Marketplaces

By REED ABELSON JUNE 19, 2016

Oscar Health was going to be a new kind of insurance company. Started in 2012, just in time to offer plans to people buying insurance under the new federal health care law, the business promised to use technology to push less costly care and more consumer-friendly coverage.

“We’re trying to build something that’s going to turn the industry on its head,” Joshua Kushner, one of the company’s founders, said in 2014, as Oscar began to enroll its first customers.

These days, though, Oscar is more of a case study in how brutally tough it is to keep a business above water in the state marketplaces created under the Affordable Care Act. And its struggles highlight a critical question about the act: Can insurance companies run a viable business in the individual market?

Oscar has attracted 135,000 customers, about half of them in New York State. And some of its efforts with technology have been successful. But for every dollar of premium Oscar collects in New York, the company is losing 15 cents. It lost $92 million in the state last year and another $39 million in the first three months of 2016.

“That’s not a sustainable position,” said Mario Schlosser, chief executive at Oscar.

Companies like Oscar were initially attracted by the potential of millions of new customers added to the individual market by the health law. But the reality has been far messier.

In an effort to attract customers, insurers put prices on their plans that have turned out to be too low to make a profit. The companies also assumed they could offer the same sort of plans as they do through employer-based coverage, including broad networks of doctors and hospitals.

But the market has turned out to be smaller than they hoped, with 12 million signed up for coverage in 2016. Fewer employers have dropped health insurance than expected, for example, keeping many healthy adults out of the individual market.

And among the remaining population, the insurers cannot pick and choose their customers. The law forces them to insure people with pre-existing conditions, no matter how expensive those conditions may be.

As a result, most insurers are still trying to develop a successful business model. Last year, only a quarter of the insurers appear to have made money selling individual policies, according to a preliminary analysis from McKinsey, the consulting firm. Giant insurers like UnitedHealth Group have stopped offering individual coverage through the public exchanges in some states. And most of the new insurance co-ops, which were founded to create more competition, have failed.

A few times a week, Oscar Health serves a catered lunch for employees. The company has attracted 135,000 customers, but it is losing money. Credit Richard Perry/The New York Times

The heavy losses do not necessarily mean that the individual market is ready to implode. Some insurers, including large companies like Anthem, say they remain committed to the market, and some insurers have made money.

But the turbulence is certainly greater than expected. And it may well lead many insurers to seek double-digit percentage rate increases and tighten their networks.

“There was tremendous uncertainty that even the very established companies were flummoxed by,” said Larry Levitt, an executive with the Kaiser Family Foundation, which has been closely following the insurers’ progress.

Over all, insurance companies continue to make profits. The dearth of profits from the individual markets, though, show how challenging it is to make insurance affordable when it is not subsidized by the government or an employer.

The troubles in the individual market also underscore how some of the law’s provisions meant to protect the insurers have not worked as well as desired. Insurers did not receive all the payments they were due under one of the law’s provisions, and another provision, meant to even out the risk among companies to protect those that enroll sicker individuals, has been described as flawed by many health care experts. Federal officials have said they would tweak those formulas.

The companies that have fared best so far are those that have kept the tightest control over their costs, by working closely with low-cost providers or a limited group of hospitals and doctors. Many have abandoned the idea of offering the kind of access available through many employer plans. The successful companies have also avoided the very low prices found in some of the co-ops.

For most of the insurers, though, the math has just not added up, which is the case with Oscar.

In New York State, where Oscar is based, the company recently filed eye-catching requests to raise rates by a weighted average of nearly 20 percent for 2017. Regulators will make a decision in August.

“The market is over all too low in price,” Mr. Schlosser said. “We, like everybody else, have priced in a very aggressive way.”

Many of the big insurers, like Anthem, can rely on their other businesses to generate profits while they wait for this market to stabilize. Oscar does not have that luxury; it is focused on individual marketplaces. (In addition to New York, Oscar operates in California, New Jersey and Texas.)

Other new insurers that sell plans to employers or under government programs like Medicare have been a little more insulated. When Northwell Health, the system in New York previously known as North Shore-LIJ Health System, entered the insurance market, it created a new company. That company, CareConnect, has 100,000 customers, most of them individuals insured through both large and small employers.

“If we only had the individual market, we would have taken undue risk because we would not have understood that market,” said Alan J. Murray, CareConnect’s chief executive. He said the company is close to turning a profit.

Oscar says it plans to begin offering coverage to small businesses, but Mr. Schlosser was adamant that individuals will eventually be buying their own coverage, rather than relying on employers. The company is also racing to incorporate plans with smaller networks.

Bright Health, another start-up, also plans to work closely with health systems to offer consumer-friendly plans.

While Oscar has had to use another insurer’s network in New York, the company’s goal is to form partnerships with systems to create networks that specialize in managing care. The company began experimenting with these networks this year in Texas and California.

“Oscar talks about narrow networks like no one has seen one before,” said Dr. Sanjay B. Saxena, who works with insurers and health systems at the Boston Consulting Group.

Oscar has received $750 million from its investors, and Mr. Schlosser insists that the company understood how long it would take for the new insurance marketplaces to develop, calling these “very, very early days.”

Oscar points to its technological edge as a way to manage patients’ health better than the established insurers. It has created teams, including nurses, who are assigned to groups of patients and can intervene when its data flags a potentially worrisome condition like a high blood sugar level.

Promoting itself as a consumer-friendly alternative to the other insurers also has its risks. While Oscar has loyal customers, others say they are disappointed to find the insurer behaving like everyone else. Cosmin Bita, a real estate broker in New York, switched to Oscar from an insurer that had given him the runaround about whether it would pay for blood tests as part of his annual physical. Although Oscar said when he enrolled that the tests would be covered, he said, he found himself fighting with the company over whether everything was covered.

“The exact same thing happened,” Mr. Bita said.

Oscar executives said the company works hard to keep customers satisfied.

But so far, it has not proved that it has created a better model than the rest of the industry.

As Darren Walsh, a principal at Power & Walsh Insurance Advisors, said: “They haven’t invented a new mousetrap.”

http://healthandmedicareinsurance.com

AS YOU SLEEP THE FUTURE OF YOUR HEALTH INSURANCE SUBSIDY HANGS IN THE BALANCE

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Op-Ed by D. Kenton Henry

While most Americans who receive a health insurance subsidy to offset the cost of the coverage they obtained from the federal website, Healthcare.gov, go quietly about their personal business―the future of that subsidy―and the very future of the Patient Protection and Affordable Care Act (PPACA) or Affordable Care Act (ACA) for short―which gave birth to said subsidies―hangs in the balance. And, for the most part, these same Americans remain blissfully ignorant that the future of their health insurance protection hangs with it also. Apparently sleeping as its fate is to be decided by the 30th of this very month when the Supreme Court releases its decision on King vs. Burwell.

King vs. Burwell contests the financial help available to some enrollees on  the federal insurance exchange in 34 states on the basis that the PPACA was not written to allow for the existence of subsidies provided by the federal exchange. In fact, the plaintiffs argue just the opposite―that only those exchanges established by the states could provide such. Should the court rule in favor of the administration, it will mean the law has survived one more effort to derail it and its future may well be assured. However, If the plaintiffs prevail, that leaves the estimated 6.4 million recipients of the subsidies in the thirty four states which did not with illegally subsidized health insurance. And, without subsidies . . . health insurance reform starts to fall apart. The majority of the recipients will drop their coverage and only the sickest―who bring the most expensive claims to the insurance companies―will remain on their plans. This phenomena is know within the industry as “adverse selection”. In reality, it means that the youngest and the healthiest, regardless of age, will flee their plans like rats off a sinking ship. And the sinking ship will be Obamacare. The law itself. This is because it is estimated that insurance premiums for these 6.4 million will increase an average 256%. A result which will single-handedly insert the substitution “Unaffordable” into the Affordable Care Act―Obama’s signature landmark legislation― sending it into a classic death spiral.

And what does the Supreme Court’s decision hinge on? Four key words: “established by the state”. As in the subsidies are to be available only to income qualified recipients in those exchanges established by the state. The four words are contained in that portion of the law which details how premium subsidies are calculated for health insurance policies. Plaintiffs argue thirty four states never established an exchange. Ergo, how can subsidies be provided for their residents? They argue the wording was constructed to serve as an incentive for the states to create own exchange; the states called the federal government’s bluff and the feds willy-nilly pulled a rabbit out of their head and provided federal exchange subsidies for which no provision within the law was made. To follow their argument to its logical conclusion, the Internal Revenue Service has violated the law by providing tax credits to individuals in these states.

The administration argues that exchanges were created by the states when they effectively opted to let the federal government do it for them. Therefore, their inaction became their action. This allows subsidies to be provided their residents.

As a health insurance broker with twenty-nine years in the industry, I have survived the inevitable ups and downs of the small business owner. I, and my practice, have survived Hillary’s attempt in the early nineties at health care reform and the deterring effect of ever increasing health care costs; the resulting sky-rocketing insurance premiums and the general turbulence of an industry which attempts to manage the costs of a sector which comprises an estimated twenty percent of our nation’s economy. I have survived the Affordable Care Act’s resulting cut in my compensation and the loss of hundreds of clients who were forced off their policies because they did not comply with the law’s mandates. Policies with which, for the most part, my clients were happy. Had they not been, they would have dropped them on their own. I now survive the effect of premiums which have risen on average fifteen percent each of the last two years and, in many cases, much, much more for those clients who do not qualify for the subsidy. The bottom line is, “if you qualify for a significant subsidy, you are probably happy with this law. If you qualify for a relatively small subsidy―or none at all―you are most likely very unhappy with it.” It seems everyone is judging it from the perspective of their own personal welfare. And that is human nature, is it not? And I reluctantly admit, I am no exception. And it is not without guilt I do so.

Because, if the subsidies are revoked, by my estimates, I stand to lose approximately two thirds of the new business I have written in the last two years since ACA plans were forced on the public under threat of penalty. Just last month I experienced the first and slightest increase in income since the act’s passage in March of 2010. My income had been decreasing precipitously since then, mostly due to the “minimum loss ratios” imposed on insurance companies resulting in maximum losses to the agent and broker. But I accepted these; remained committed to my industry and business and have survived. If King v. Burwell is decided in favor of the administration’s adversaries, my clients will let their coverage lapse and the resulting personal effect will be “two steps forward and three steps back”. Hence, the guilt. The guilt born of knowing the worst aspects of this law (unknown to average person) are yet to be implemented and only a minute portion of the resulting costs are currently apparent. Those forthcoming will have a devastating effect on our nation’s treasury which is already eighteen trillion in debt and rising “with a bullet”. I know that progression of this law and its mandates is already forcing rationing of our health care providers and further progression is going to result in ever increasing rationing of health care treatment available to each of us. And yet, for my own sake, I don’t want to experience more losses.

Please do not think I do believe there was no need for health care reform. When two of every five health insurance applications I submitted on behalf of clients was declined due to pre-existing conditions and another not taken due to “waivers” of such (prior to the law’s enforcement) I experienced the angst of my clients and my own.

And so I sit, in front of my computer desktop, on the edge of my seat monitoring each post from SCOTUSBLOG.COM and each editorial from the most liberal to conservative journalist (who knows much less about this law than I) attempting to predict as to which way this imminently pending decision will go. The patriotic conservative within me says, “for the welfare of my nation’s economy, this law should fail.” While the agent, broker, small business man within me who likes to eat, pay his bills, maybe put something away for retirement and doesn’t want to see any more of his clients lose their very necessary and greatly appreciated health insurance coverage says―”Please, oh, please. Let the Supreme Court of this United States of America, in all their supremacy, rule that the authors of the Patient Protection and Affordable Care Act didn’t really mean what they wrote. Let the subsidies stand.”

http://thewoodlandstxhealthinsurance.com

http://allplaninsurance.com

http://healthandmedicareinsurance.com

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Related stories:

THE NEW YORK TIMES

Politics

Four Words That Imperil Health Care Law Were All a Mistake, Writers Now Say

By ROBERT PEAR MAY 25, 2015

http://www.nytimes.com/2015/05/26/us/politics/contested-words-in-affordable-care-act-may-have-been-left-by-mistake.html?ref=us

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MORNING CONSULT Burwell Draws Line On Health Subsidy Fix Jon Reid   |   June 10, 2015  http://morningconsult.com/2015/06/burwell-draws-line-on-health-subsidy-fix/

BULLETIN: Second Round of Obamacare Breaks From The Gate Starting Now!

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HEALTH INSURANCE PREMIUMS 2015

(Announcement by D. Kenton Henry and HealthandMedicareInsurance.com)

Who will end up the winner ― you ― the insured, the insurance companies or Uncle Sam?

As a health insurance broker of 27 years, I and my peers have waiting with baited breath all year to see two things:

First ― will enrollments in 2015 health insurance plans, which begin at midnight tonight, the 15th of November, go more smoothly than last year’s embarrassing debacle that was the glitch plagued Healthcare.gov website which floundered in the death throes of end-stage technology through the entire first year “open-enrollment” period?

Secondly ― what are 2015 premiums and benefits going to look like? By the time you read this, you are about to know. I hope you will be happy with the options available to you, however, I hate to say, I cannot guarantee that. Rumor has it that premiums will be going up at varying rates relative to each of the fifty states. In Texas they are projected to rise an average of 14%  above 2014 rates depending on your age. If this is the case and you have coverage you feel is adequate―along with the option of keeping it―that is exactly what you should do. But if you are like a great number of my clients, who have been told your current plan will terminate 12.31.2014,  your only options are to forego coverage and pay the penalty (excuse me “shared responsibility tax”) when you file your 2015 tax return. Or purchase one of the new compliant plans.

I cannot control the options you will have but I can present, simplify and guide you to your best value in 2015 health insurance coverage. My quoting link will not only determine if you qualify for and calculate the amount of your subsidy (utilizing the same algorithm employed by Healthcare.gov) but, in the event you do qualify, will allow you to seamlessly take advantage of the subsidy and apply for your health plan selection for the reduced (net) premium. It will illustrate all your options from every carrier both on and off the federal exchange.

I am certain that after reviewing your options you will have numerous questions. I encourage you to email or call me with them. I will answer them and once you have decided upon your best value, I can make the enrollment process go as smoothly and comfortably as possible. I intend to work all through the weekend and make myself available to be best of my ability.

It is currently 10 p.m. CST on the 14th. After midnight click on this link to begin exploring your options and know I greatly anticipate working with you and making this transition period in the health insurance consumer market go as smoothly as possible for you.

Sincerely,

Kenton Henry

Broker, Agent, Editor

Email: Quote@allplaninsurance.com

Phone: 281.367.6565

Toll Free: 800.856.6556

CLICK HERE FOR 2015 HEALTH INSURANCE OPTIONS: https://allplanhealthinsurance.insxcloud.com/my-quote/individual-info

*Please return to this page and give us your opinion of your options.

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FEATURE ARTICLES:

NEW YORK TIMES

14 November 2014

Cost of Coverage Under Affordable Care Act to Increase in 2015

By ROBERT PEAR, REED ABELSON and AGUSTIN ARMENDARIZNOV. 14, 2014

“Consumers should shop around,” said Marilyn B. Tavenner, administrator of the Centers for Medicare and Medicaid Services, which runs the federal insurance exchange serving three dozen states. “With new options available this year, they’re likely to find a better deal.” She asserted that the data showed that “the Affordable Care Act is working.”

But Republicans quickly pounced on the data as evidence of the opposite.

“Last year, many who liked their plan were surprised to learn they couldn’t keep it,” said Senator Orrin G. Hatch of Utah, who is in line to become chairman of the Senate Finance Committee. “This year, many who like their plan will likely have to pay more to keep it.”

The new data means that many of the seven million people who have bought insurance through federal and state exchanges will have to change to different health plans if they want to avoid paying more — an inconvenience for consumers just becoming accustomed to their coverage.

A new Gallup Poll suggests that seven in 10 Americans with insurance bought through the exchanges rate the coverage and the care as excellent or good, and most were planning to keep it.

In employer-sponsored health plans, employees tend to stay with the same insurer from year to year. But for consumers in the public insurance exchanges, that will often be a mistake, experts said.

Nashville illustrates the need for people with marketplace coverage to look closely at the alternatives available in 2015.

Marilyn B. Tavenner, administrator of the Centers for Medicare and Medicaid Services, which runs the federal health exchange. Credit Doug Mills/The New York Times

A 40-year-old in Nashville, with the cheapest midlevel, or silver plan, will pay $220 a month next year, compared to $181 a month this year, for the same plan.

The least expensive plan is offered by another insurer, Community Health Alliance, one of the so-called co-op plans created under the federal law. It offers coverage for a monthly premium of $194.

But the lower premium means that consumers will have to pay a much larger annual deductible, $4,000, rather than $2,000. A policyholder who becomes seriously ill or has a costly chronic condition could pay hundreds of dollars in out-of-pocket expenses.

In addition, different health plans often have different networks of doctors and hospitals and cover different drugs, meaning that consumers who change plans may have to pay more for the same medicines.

Another problem for consumers is that if the price for a low-cost benchmark plan in the area has dropped, the amount of federal subsidies provided by the law could be less, meaning that consumers may have to pay more unless they switch.

The data, released by the Centers for Medicare and Medicaid Services, indicates that price increases will be modest for many people willing to change plans. In a typical county, the price will rise 5 percent for the cheapest silver plan and 4 percent for the second cheapest.

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NEW YORK TIMES

Estimate of Healthcare Enrollment Leaves Room to Grow

10 November 2014

WASHINGTON — The Obama administration on Monday offered a surprisingly modest estimate of the number of people who would sign up for health insurance in the second round of open enrollment, which begins on Saturday.

Sylvia Mathews Burwell, the secretary of health and human services, said she was working on the assumption that a total of 9.1 million people would have such coverage at the end of next year.

By contrast, the Congressional Budget Office had estimated that 13 million people would be enrolled next year, with the total rising to 24 million in 2016. In the past, the White House has used the budget office numbers as a benchmark for success under the Affordable Care Act.

This estimate appeared to be part of an effort by federal officials to lower public expectations, so the goal would be easier to meet and to surpass. In addition, the new number could indicate that administration officials believe it will be difficult to find and enroll many of the uninsured while retaining those who signed up in the last year.

“The number we are going to aim for this year is 9.1 million,” Ms. Burwell said on Monday during remarks at the Center for American Progress, a liberal research and advocacy group.

Ms. Burwell’s estimate was at the lower end of the range suggested by health policy experts in her department. In a report issued earlier Monday, the experts estimated that, at the end of next year, 9 million to 9.9 million people would have coverage purchased through insurance exchanges, or marketplaces.

Representative Marsha Blackburn, Republican of Tennessee, said the administration was “trying to manage expectations and rewrite its definition of success ahead of the second open-enrollment period.” Administration officials said they were just being realistic, in the light of experience with other health programs.

President Obama announced in April that eight million people had signed up for health insurance under the Affordable Care Act. Officials said Monday that enrollment had declined to 7.1 million after some people failed to pay their share of premiums and others were found to be ineligible because of unresolved questions about their citizenship or immigration status.

The Department of Health and Human Services estimated that enrollment, including renewals and new customers, would reach 10 million to 11 million by the end of the three-month sign-up period, which closes on Feb. 15.

However, if Ms. Burwell is right, the number would shrink to 9.1 million people at the end of next year. That would still be a 28 percent increase over the number believed to have marketplace coverage today.

Ms. Burwell’s estimate came as a surprise to insurance counselors, agents and brokers working with the Obama administration.

Anne Filipic, the president of Enroll America, a nonprofit group trying to expand coverage, said the goal of 9.1 million “seems reasonable.” She praised the administration for taking what she described as “a pragmatic, analytic approach” to setting a numeric goal.

Federal health officials said they had ended coverage for 112,000 people who could not demonstrate that they were United States citizens or legal immigrants entitled to insurance under the health care law.

In addition, they said, 120,000 households will lose some or all of the insurance subsidies they have been receiving because they could not adequately document their income. These households will face higher premiums.

In making their estimates, federal health officials said, they assumed that 83 percent of the people with marketplace coverage — 5.9 million of the 7.1 million people in “qualified health plans” — would renew their coverage.

The intense political debate swirling around the Affordable Care Act does not make the job of enrolling people any easier, officials said.

Republicans like Tom Cotton in Arkansas and Joni Ernst in Iowa won Senate races in which they emphasized opposition to the health care law, as did successful Republican House candidates like Mia Love in Utah and Ryan Zinke in Montana.

Senator John Barrasso of Wyoming, the chairman of the Senate Republican Policy Committee, said that people were skeptical of the law and “aren’t signing up because they realize it’s not a good deal for them.”

The Supreme Court said on Friday that it would consider a case challenging subsidies paid to more than four million people who obtained insurance through the federal marketplace.

Ms. Burwell said Monday that she did not see the legal challenge as a serious threat to the Affordable Care Act. “As we go into open enrollment,” she said, “nothing has changed.”

Federal health officials said they believed that marketplace enrollment would grow more slowly than projected by the Congressional Budget Office, which sees the total holding steady at 25 million from 2017 to 2024.

Administration officials noted that uninsured people could also get coverage by enrolling in Medicaid or by finding jobs with health benefits.

In a brief analysis of coverage trends, the Department of Health and Human Services said Monday that “most of the new marketplace enrollment for 2015 is likely to come from the ranks of the uninsured,” rather than from people who previously bought insurance on their own outside the exchanges.

“Happy Anniversary Healthcare.Gov!” (Do We Want A Divorce?)

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Op-ed by D. Kenton Henry

BIRTHDAY CAKE

 

Happy anniversary, Healthcare.gov! Today, October 1st, marks the first anniversary of the premier of the originally beleaguered Federally Facilitated “Marketplace” (FFM), the federal government website for the purchase of Affordable Care Act (ACA) compliant health insurance plans in states which did not implement their own. And what of it now?

After a rollout, which was anything but smooth, and a current expenditure of approximately $2.1 billion dollars (after a winning bid of $90 million) the site seems to have solved the majority of its “front- end” issues. These involve opening an account; verifying identity and plan selection. But in light of notice that the time has run out for those who did not succeed in providing adequate proof of income for subsidy (“Premium Tax Credit”) purposes thereby resulting in their loss of coverage or―at least the subsidy―one is left wondering what if anything will change relative to this “back-end” issue for 2015. According to a September 15th article in the New York Times, approximately half a million insured face a forced plan change. “363,000 could lose their premium subsidies due to an inability to verify income, while 115,000 more could have their policies canceled because they have not proven their immigration status. Federal authorities have been working for months to resolve both backlogs.”

My BlueCross BlueShield of Texas clients who have “grand-mothered” plans just received notice dated today that “The health plan you now have will no longer be available and cannot be renewed”. Grand-mothered plans are those which have been modified in anyway, such as a change in deductible, but purchased prior to January 1 of this year when all new policies were required to be ACA compliant. Termination will be effective the end of 12.31.2014 and the client, insured will have until that date to enroll in a new plan for seamless coverage beginning January 1. These policyholders are instructed to log in starting November 15th to review their options and elect new coverage through BlueCross BlueShield. What will the benefits look like and what will be the cost? Well, we won’t know until November 15th. The consensus seems to be that premiums in all but a few locations will be increasing somewhat across the market compared to this year’s ACA compliant plans but at less than the average rate of medical inflation in recent years. (Call me skeptical.) But what about compared to their grand-mothered plan? No way. By the time you add in the additional cost of mandated coverage for benefits such as pediatric dental and vision, maternity and the rest of the “minimum essential health benefits” along with guarantee issue for pre-existing conditions, there is no way these policyholders are going to be pleased with the premiums their new options will cost. If they had thought the marketplace offered better options, they would have elected them for 2014. I am certain the words, “If you like your plan, you can keep your plan. Period.” will be ringing in their ears as they peruse their new options.

On the upside, an estimated 25% additional insurance companies will be providing coverage for 2015 both in and out of the marketplace and state exchanges. This increased competition will give consumerd more options and will hopefully help offset some of the inflationary aspects of mandated coverage in future years.

On the downside, what of the “It’s a penalty … not a tax!” ― now known as the “Shared Responsibility Payment” ― for not having coverage in 2015? That increases to $325 per adult and $162.50 per child or 2% of household income ― whichever is higher. (Family maximum is $975.) It will increase every year hereafter, tied to the rate of inflation beyond 2016.

Additional variables remain to be seen such as “provider selection”. While pressure is being put on insurance companies to increase the number of in-network providers available to the insured, surveys seem to indicate more providers are electing not to join. They feel payments have dropped to low to make it worth their while to participate. Insurance companies are going have to find alternative ways to control costs and since they cannot control the risk they are forced to assume (elative to pre-existing conditions and the mandated “loss ratio”) they are going to ration our providers and our treatment.

On a final note, the enrollment period for 2015 plans will be half as long as for 2014 and will end February 15th. So get ready to be like the sheep, in the Wild Kingdom segment, passing through the anaconda. It’s going to be a tight squeeze! And once again . . . “Happy Anniversary to Healthcare.gov!”

By all means, please contact me if you feel I can make the celebration cake a little more palatable!

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FEATURED ARTICLE:

The New York Times

U.S. to End Coverage Under Health Care Law for Tens of Thousands

By ROBERT PEAR SEPT. 15, 2014

WASHINGTON — The Obama administration said on Monday that it planned to terminate health insurance for 115,000 people on Oct. 1 because they had failed to prove that they were United States citizens or legal immigrants eligible for coverage under the Affordable Care Act. It also told 363,000 people that they could lose financial aid because their incomes could not be verified.

The 115,000 people “will lose their coverage as of Sept. 30,” said Andrew M. Slavitt, the No. 2 official at the Centers for Medicare and Medicaid Services, which runs the federal insurance marketplace.

Some of them may be able to have their coverage reinstated retroactively if they produce the documents that they were repeatedly asked to provide in recent months, Mr. Slavitt said.

At the end of May, the administration said, 966,000 people were found to have discrepancies in their immigration and citizenship records. Most sent in documents as requested. In mid-August, the administration sent letters to about 310,000 people who had failed to respond. They were supposed to submit documents by Sept. 5, but the 115,000 consumers failed to do so, Mr. Slavitt said.

Many consumers and lawyers who work with them said that they had tried to submit immigration and citizenship papers, but that they experienced problems transmitting documents through HealthCare.gov. Other people said they sent the documents by mail to a federal contractor in Kentucky but never heard back from the contractor or the government.

“We heard from lots of consumers who told us they sent in their documents multiple times or tried to upload them through HealthCare.gov,” said Mara Youdelman, a lawyer at the National Health Law Program, an advocacy group for low-income people.

Jenny Rejeske, a health policy analyst at the National Immigration Law Center, which represents immigrants, said: “It is unduly harsh to terminate coverage while there are still technical problems with the federal system for verifying citizenship and immigration status. And there has not been adequate notice to people who speak languages other than English and Spanish.”

Florida leads the list of states whose residents are losing coverage because of immigration and citizenship issues, with 35,100. Federal officials said they were ending coverage for 19,600 people in Texas, 6,300 in Georgia, 5,300 in North Carolina, 5,200 in Pennsylvania, 4,000 in Illinois and 2,400 in New Jersey. The numbers released on Monday are for 36 states using the federal insurance marketplace. They do not include terminations in California, New York and other states running their own insurance exchanges.

Federal subsidies for the purchase of private insurance are a cornerstone of the Affordable Care Act. More than eight out of 10 people who selected health plans through the exchanges from October through mid-April were eligible for subsidies, including income tax credits. But in many cases, the government could not verify the incomes people reported when they applied for subsidized insurance.

This does not mean that they provided false information or were ineligible for assistance. The government tried to verify incomes by checking 2012 tax return information, but consumers may have switched jobs or received pay raises since filing those returns. As a result, officials said, the information in their applications may not match the data in federal files or in sources available to the government.

Mr. Slavitt said that on May 30 there were roughly 1.2 million households (and a total of 1.6 million people) with “data-matching issues.”

Since then, the government said, it has closed cases for 467,000 households with data discrepancies, and 430,000 cases are “currently in the process of being resolved.”

“There are still about 279,000 households with unresolved income-related data-matching issues that haven’t sent in supporting information, representing 363,000 individuals,” Mr. Slavitt said. They will soon receive letters from the government asking for proof of income, and if they do not reply by Sept. 30, they may lose some or all of their subsidies.

They would still be eligible for coverage, but in many cases could not afford it. In some cases, they would also have to repay some or all of the subsidies they received.

It is also possible that some people could receive larger subsidies if their incomes are lower than what they expected when they applied.

(A version of this article appears in print on September 16, 2014, on page A18 of the New York edition with the headline: U.S. to End Coverage Under Health Care Law for Tens of Thousands.)

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CENTER FOR MEDICARE SERVICES DELAYS CUTS TO MEDICARE ADVANTAGE – OR DID THEY?

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OBAMA CUTS TO MEDICARE

In a surprise announcement today the Center For Medicare and Medicaid Services gave notice they are reversing planned cuts to Medicare Advantage Plans for 2015. But after all variables are factored in will the end result be an increase or decrease in reimbursements for Medicare approved procedures next year?

If implemented the cuts would have resulted in 2% lower payments to Medicare providers on top of the 6% cuts for 2014. Instead, the agency says, payments will instead be increased 0.4%. Still, with all variables in play, Aetna anticipates payment reductions and Humana estimates a funding decline of 3%. (See feature article from Reuters below.)

OBAMA CUTS TO MEDICARE II

What is the end result of all this? 2014 reductions already saw the termination of thousands of providers from HMO and PPO Medicare Advantage networks. Further reductions are likely to result in more of the same along with probable increases in premiums and copays for medical procedures. And–if not now–certainly when they are ultimately implemented as mandated by the Affordable Care Act (ACA). Which begs the question: If all these cuts to Medicare Advantage were for the purpose of financing the ACA, what is the long-term impact of delaying them on the financial solvency of the Act? Or was the latter really ever a concern of the administration? Or is it simply the case that concern over the effect of cuts on this fall’s election over-rides the need for the Act to be financially feasible? (In case you were naïve enough to believe feasibility was realistic in the first place.) In light of all the approximately 38 delays and changes in the law since its passage, it is apparent to this author that political expediency rules the day in Washington. In other words, “business as usual”.

– Admin. Kenton Henry

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FEATURE ARTICLE

U.S. insurers still expect cuts in 2015 Medicare payments

By Caroline Humer

Tue Apr 8, 2014 1:40pm EDT

(Reuters) – U.S. health insurers said on Tuesday they still expected cuts in government reimbursements for privately managed Medicare health plans for the elderly next year even after the Obama administration rolled back the steepest reductions.

The government agency that oversees Medicare said late on Monday that on average, reimbursements to insurers for private Medicare plans would rise 0.4 percent, reversing what it said was a proposed cut of 1.9 percent.

The insurance industry and advocates for the elderly had lobbied against the cuts, which were first proposed in February, saying they would reduce benefits for older people.

Republican and Democratic lawmakers had broadly opposed further cuts as well, adding pressure on the administration at a time when President Barack Obama’s healthcare law was also under attack.

After analyzing the final rate notice from the Centers for Medicare and Medicaid Services (CMS) and comparing it with their own models, health insurers said on Tuesday that the 2015 Medicare Advantage payment rates represented a cut to payments from 2014 levels.

Humana Inc, which derives two-thirds of its revenue from administering Medicare Advantage plans, said it expected a funding decline of about 3 percent for 2015 plans from 2014, according to a filing with the Securities and Exchange Commission.

This is slightly better than Humana’s initial forecast for a drop of 3.5 percent to 4 percent in those rates, based on the proposal issued on February 21.

Aetna Inc, which also provides Medicare Advantage plans, said it also anticipated a decline.

“Despite CMS’s actions, Medicare Advantage plans will still face rate decreases for 2015,” Aetna spokeswoman Kendall Marcocci said in a statement. The company is still evaluating the impact, she added.

CMS officials were not immediately available for comment on the insurers’ or analysts’ analyses.

Humana shares fell 1.7 percent on Tuesday. Aetna was little changed, and UnitedHealth Group Inc slipped 0.4 percent.

APPLES-TO-ORANGES

The comments from individual insurers echoed that of industry trade group America’s Health Insurance Plans, which said it was concerned about how the policy will affect the 15 million people who receive privately managed benefits. The balance of the more than 50 million older and disabled people who use Medicare are in a different program run by the government.

“The changes CMS included in the final rate notice will help mitigate the impact on seniors, but the Medicare Advantage program is still facing a reduction in payment rates next year on top of the 6 percent cut to payments in 2014,” AHIP President Karen Ignagni said in a statement.

Wall Street analysts saw an improvement of 2 to 3 percentage points in the government’s funding proposal, but they estimated about a 3 percent cut overall, not an increase of 0.4 percent.

They described an apples-and-oranges comparison between how they calculate the total impact of Medicare reimbursement rates versus how the government does so.

One difference may be that the government analysis did not reflect the 1 percent insurance tax that funds Obama’s Patient Protection and Affordable Care Act, while some analysts included it.

Another factor, some said, is that CMS adjusted its estimates to reflect the worsening health of some Medicare members, while analysts did not.

Analyst Sheryl Skolnick of CRT Capital described the final funding announcement as being “less worse” than anticipated.

“The market was assuming that the final rate would be better than the proposal, and that’s what it got,” Skolnick wrote in a note.

Each year, the government releases its formulas for determining how it will reimburse the insurers for plan members’ procedures and doctor visits. Insurers use this information to decide on the markets where they will offer plans and what benefits they can provide.

(Reporting by Caroline Humer; Editing by Michele Gershberg, Lisa Von Ahn)

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Obamacare Backers Quietly Destroying Their Own Creation

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DR FRANKENSTEIN AND HIS MONSTER

Op-ed by Kenton Henry

The analogy is irresistible and the comparison inescapable. Dr. Frankenstein  experienced an epic epiphany when he realized his good intentions had gone awry and he was responsible for creating a monster which was a threat to the public’s health and welfare.  And now the same realization has dawned on  the White House and Democratic Senate. They ignored all the polls which have always indicated the majority of Americans are not in favor of Obamacare. They ignored the entreaties of the Republicans (not one of whom voted for the Act) to at first repeal; then later, to post-pone the individual mandate. Now, with November’s mid-term elections on the horizon, they are pressing the panic button and back-pedaling in an overtly political attempt to mitigate fallout at the polls. Last week they modified the individual mandate allowing those who like their non-compliant plan to keep their plan through 2016. But what went unnoticed and unreported by the media was their latest move (also last week) to destroy their own creation wherein they modified the hardship exemption. It now allows anyone whose health plan was canceled due to Obamacare to sign a form stating such–and that the act of purchasing ACA compliant coverage would be “hardship”– to opt out of a purchase with no financial repercussions.  The details of the exemption are outlined in our feature article in The Wall Street Journal which concludes the exemption is essentially available to anyone who wants one.

 

In reality, the Democrats are realizing they are falling on their own sword. What was already a case of adverse selection in terms of the risk funneled into the new Affordable Care Act (ACA) compliant  policies, has now been made a case of adverse selection on steroids. This editor’s concern is that the insurance companies will not be able to sustain the new block of compliant policies and will fail minus another massive government bailout. Like banks, they will be deemed “too big to fail” by the administration. For now. Of course, in good time (after Democrats succeed in maintaining control of things), the safety net will be removed and the liberals will rejoice as the companies fail. And left leaning Democrats will have the single-payer system they have long admitted was their prize objective. An accomplishment so necessary for them to control one sixth of our nation’s economy. This in spite of the fact that every major social welfare program this country has implemented is on the fast track to insolvency.

 

As Dr. Frankenstein worked to destroy his own signature creation, the President now works to gut his. And as always . . . for the sake of politics.

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FEATURE ARTICLE:

The Wall Street Journal

ObamaCare’s Secret Mandate Exemption

HHS quietly repeals the individual purchase rule for two more years.

Updated March 12, 2014 6:58 p.m. ET
 

ObamaCare’s implementers continue to roam the battlefield and shoot their own wounded, and the latest casualty is the core of the Affordable Care Act—the individual mandate. To wit, last week the Administration quietly excused millions of people from the requirement to purchase health insurance or else pay a tax penalty. 

This latest political reconstruction has received zero media notice, and the Health and Human Services Department didn’t think the details were worth discussing in a conference call, press materials or fact sheet. Instead, the mandate suspension was buried in an unrelated rule that was meant to preserve some health plans that don’t comply with ObamaCare benefit and redistribution mandates. Our sources only noticed the change this week.

That seven-page technical bulletin includes a paragraph and footnote that casually mention that a rule in a separate December 2013 bulletin would be extended for two more years, until 2016. Lo and behold, it turns out this second rule, which was supposed to last for only a year, allows Americans whose coverage was cancelled to opt out of the mandate altogether.

In 2013, HHS decided that ObamaCare’s wave of policy terminations qualified as a “hardship” that entitled people to a special type of coverage designed for people under age 30 or a mandate exemption. HHS originally defined and reserved hardship exemptions for the truly down and out such as battered women, the evicted and bankrupts.

But amid the post-rollout political backlash, last week the agency created a new category: Now all you need to do is fill out a form attesting that your plan was cancelled and that you “believe that the plan options available in the [ObamaCare] Marketplace in your area are more expensive than your cancelled health insurance policy” or “you consider other available policies unaffordable.”

This lax standard—no formula or hard test beyond a person’s belief—at least ostensibly requires proof such as an insurer termination notice. But people can also qualify for hardships for the unspecified nonreason that “you experienced another hardship in obtaining health insurance,” which only requires “documentation if possible.” And yet another waiver is available to those who say they are merely unable to afford coverage, regardless of their prior insurance. In a word, these shifting legal benchmarks offer an exemption to everyone who conceivably wants one.

Keep in mind that the White House argued at the Supreme Court that the individual mandate to buy insurance was indispensable to the law’s success, and President Obama continues to say he’d veto the bipartisan bills that would delay or repeal it. So why are ObamaCare liberals silently gutting their own creation now?

The answers are the implementation fiasco and politics. HHS revealed Tuesday that only 940,000 people signed up for an ObamaCare plan in February, bringing the total to about 4.2 million, well below the original 5.7 million projection. The predicted “surge” of young beneficiaries isn’t materializing even as the end-of-March deadline approaches, and enrollment decelerated in February.

Meanwhile, a McKinsey & Company survey reports that a mere 27% of people joining the exchanges were previously uninsured through February. The survey also found that about half of people who shopped for a plan but did not enroll said premiums were too expensive, even though 80% of this group qualify for subsidies. Some substantial share of the people ObamaCare is supposed to help say it is a bad financial value. You might even call it a hardship.

HHS is also trying to pre-empt the inevitable political blowback from the nasty 2015 tax surprise of fining the uninsured for being uninsured, which could help reopen ObamaCare if voters elect a Republican Senate this November. Keeping its mandate waiver secret for now is an attempt get past November and in the meantime sign up as many people as possible for government-subsidized health care. Our sources in the insurance industry are worried the regulatory loophole sets a mandate non-enforcement precedent, and they’re probably right. The longer it is not enforced, the less likely any President will enforce it.

The larger point is that there have been so many unilateral executive waivers and delays that ObamaCare must be unrecognizable to its drafters, to the extent they ever knew what the law contained.

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The White House Doubles Down On Republicans Request To Delay The Individual Mandate

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LONELY OBAMACARE NAVIGATOR (2)

Pictured: Navigator Dealing With The Public’s Not So Mad Rush To Enroll

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The White House has doubled down on the Republican’s November request to delay the “Individual Mandate” of the Affordable Care Act.

At least a major portion of it.

The only thing predictable about implementation of the Affordable Care Act is that . . . nothing is predictable. On Wednesday, the Obama Administration played “tooth fairy” to Democrat candidates up for re-election this November and gave American individuals and families with pre-2014 health insurance policies a reprieve on the mandate to purchase ACA compliant coverage for two years through 2016. Last fall the House argued and passed a bill allowing American individuals and families who liked their current health plan – to keep their health plan. As the President had originally promised they could do. But for just one year. Now, in what appears to be an entirely self-serving and purely political move to mitigate a loss of Democratic seats in the up-coming mid-term elections, the Administration Obama says . . . “Errrr – of course! You can keep your plan for two more years!” It is quite apparent the Democrats have correctly determined the backlash from plan cancellations mandated by law could be devastating in terms of their election. Therefore, they speculate, with this aspect of the law deferred they will fair much better at the polls.

As a health insurance broker, I must admit I feel this is something of reprieve for myself and many of my clients. My clients can keep their lower cost plans which, in Texas, average approximately 40% higher than pre-compliant plans (approximately 80% higher in Indiana and Ohio – not to mention a dearth of PPO options as opposed to the restrictive HMO options). As for me, I can cease worrying, for now, about losing clients en masse who would otherwise be forced off their existing plans and might go elsewhere for replacement coverage. I can also anticipate obtaining entirely new clients who choose to elect a new plan in order to cover a pre-existing condition or just to comply with the law. And therein lies the rub. Just because the White House says those who have a plan can keep their plan, does not mean the individual states or the insurance companies will agree to this. And for many, it is far too late – their policies already having been canceled. But–furthermore–this reprieve apparently does not carry over to those who have no coverage whatsoever. They must still acquire coverage by March 31st or be assessed the penalty and locked out of insurance for the remainder of 2014. (Unless, of course, they are also eventually granted clemency by the President.)

And how does your editor feel about this from an actuarial standpoint relative to the insurance companies and the ACA itself? In four words: “Politically Pragmatic Voodoo Economics”. Even Obamacare architect Ezikiel Emanuel, stated Wednesday while on MSNBC, that while he denounced the policy implications of yet another Obamacare delay, “for the political gain, it’s worth it”. Unabashedly self-serving.

If the insurance companies comply, they are once again forced to flex at the last minute and be left with two separate blocks of business. One old block containing less claim’s risk. And one new block where the only motivation to insure oneself will be to transfer personally large risk to the insurance company. This will be in terms of pre-existing conditions which were previously manageable or that arise for the first time. As evidence of this, in an attempt to limit the disruption to the insurance industry precipitated by this latest modification, the Department of Health and Human Services also announced yesterday that the “risk corridor” program (which has been described as a bailout to insurers) would be further modified to channel more money to the insurers in states affected by the change. This only reinforces my opinion that those behind this bill are not economists and never cared about the financial viability of this law. They are, however, very concerned with maintaining their political lives at all cost.

Admin. – Kenton Henry

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FEATURE ARTICLE:

THE NEW YORK TIMES

Politics

Consumers Allowed to Keep Health Plans for Two More Years

By ROBERT PEARMARCH 5, 2014

WASHINGTON — The Obama administration, grappling with continued political fallout over its health care law, said Wednesday that it would allow consumers to renew health insurance policies that did not comply with the new law for two more years, pushing the issue well beyond this fall’s midterm elections.

The reprieve was the latest in a series of waivers, deadline extensions and unilateral actions by the administration that have drawn criticism from the law’s opponents and supporters, many saying President Obama was testing the limits of his powers.

The action reflects the difficulties Mr. Obama has faced in trying to build support for the Affordable Care Act and the uproar over his promise — which he later acknowledged had been overstated — that people who liked their insurance plans could keep them, no matter what.

Under pressure from Democratic candidates, who are struggling to defend the president’s signature domestic policy, Mr. Obama in November announced a one-year reprieve for insurance plans that did not meet the minimum coverage requirements of the 2010 health care law.

The Times would like to hear from Americans who have signed up for health care under the Affordable Care Act.

Wednesday’s action goes much further, essentially stalling for two more years one of the central tenets of the much-debated law, which was supposed to eliminate what White House officials called substandard insurance and junk policies.

The extension could help Democrats in tight midterm election races because it may avoid the cancellation of policies that would otherwise have occurred at the height of the political campaign season this fall.

In announcing the new transition policy, the Department of Health and Human Services said it had been devised “in close consultation with members of Congress,” and it gave credit to a number of Democrats in competitive races, including Senators Mary L. Landrieu of Louisiana, Jeanne Shaheen of New Hampshire and Mark Udall of Colorado.

Kathleen Sebelius, the secretary of health and human services, said Mr. Obama was trying to “smooth the transition” to a new system, using flexibility that exists under the law.

The move reflects the administration’s view that a divided Congress would not be willing to make changes to the law, but lawyers questioned the legitimacy of the action and said it could have unintended consequences in the long run.

“I support national health care, but what the president is doing is effectively amending or negating the federal law to fit his preferred approach,” said Jonathan Turley, a law professor at George Washington University. “Democrats will rue the day if they remain silent in the face of this shift of power to the executive branch.”

Mr. Turley said Mr. Obama was setting precedents that could be used by future presidents to delay other parts of the health care law or to suspend laws dealing with taxes, civil rights or protection of the environment.

Republicans said the move confirmed their contention that parts of the health care law were ill conceived and unworkable.

The number of people with noncompliant coverage is not known. Insurers sent out perhaps 4.5 million cancellation notices last fall, but some of the policyholders have bought new coverage that complies with the law. Administration officials said that the number of people with noncompliant policies would shrink by attrition in the next two years.The health care law sets dozens of federal standards for insurance, requiring coverage of services in 10 specific areas and providing many consumer protections not found in older policies.Under the transition policy announced by Mr. Obama in November, insurers “may choose to continue coverage that would otherwise be terminated or canceled.” Insurers were allowed to renew existing policies even if they did not provide the “essential health benefits” prescribed by law. In addition, the administration said, insurers could continue charging women more than men for those policies and could charge higher premiums based on a person’s health status, in violation of the new law.

A White House official said Wednesday that it would allow insurers to continue existing policies with renewals as late as Oct. 1, 2016, so individuals and small businesses could have noncompliant coverage well into 2017.

Under another policy announced by the administration on Wednesday, certain health plans will be exempt from new fees imposed on insurance companies and on many self-insured group health plans. Labor unions had been lobbying for such an exemption, saying the fees could be “highly disruptive” to Taft-Hartley plans administered jointly by labor and management representatives in construction, entertainment and other industries.

The Times would like to hear from Americans who have signed up for health care under the Affordable Care Act.

Wednesday’s action goes much further, essentially stalling for two more years one of the central tenets of the much-debated law, which was supposed to eliminate what White House officials called substandard insurance and junk policies.

The extension could help Democrats in tight midterm election races because it may avoid the cancellation of policies that would otherwise have occurred at the height of the political campaign season this fall.

In announcing the new transition policy, the Department of Health and Human Services said it had been devised “in close consultation with members of Congress,” and it gave credit to a number of Democrats in competitive races, including Senators Mary L. Landrieu of Louisiana, Jeanne Shaheen of New Hampshire and Mark Udall of Colorado.

Kathleen Sebelius, the secretary of health and human services, said Mr. Obama was trying to “smooth the transition” to a new system, using flexibility that exists under the law.

The move reflects the administration’s view that a divided Congress would not be willing to make changes to the law, but lawyers questioned the legitimacy of the action and said it could have unintended consequences in the long run.

“I support national health care, but what the president is doing is effectively amending or negating the federal law to fit his preferred approach,” said Jonathan Turley, a law professor at George Washington University. “Democrats will rue the day if they remain silent in the face of this shift of power to the executive branch.”

Mr. Turley said Mr. Obama was setting precedents that could be used by future presidents to delay other parts of the health care law or to suspend laws dealing with taxes, civil rights or protection of the environment.

Republicans said the move confirmed their contention that parts of the health care law were ill conceived and unworkable.

But Republicans denounced the change. “The administration’s decision to carve out its union cronies from the Obamacare fee is beyond egregious and will leave others with self-insured plans on the hook to foot the bill,” said Senator John Thune, Republican of South Dakota.

Robert Laszewski, a consultant who works closely with insurers, said the reprieve for noncompliant policies “tends to undermine the sustainability of Obamacare” by reducing the number of people who will buy insurance through the exchanges.

The administration acknowledged that its transition policy could lead to “higher average claims costs” for people who buy insurance that complies with the Affordable Care Act. But health officials said the 2010 law provided several “shock absorbers” to help stabilize premiums.

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Facebook Posting Does Double Duty On This Healthcare Blog

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Healthandmedicareinsurance.com followers – I spent enough time responding to the left on my facebook posting – I thought the effort could serve double duty on this blog.
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Before preparing for my trip, I would first like to respond to Kathy: No, I won’t be lobbying for an expansion of Medicaid in Indiana (or any other state for that matter) that has not already expanded it beyond 100% of the Federal Poverty Level. If Medicaid were expanded, it would be to include individuals up to and including those with an income of 133% of the FPL or a maximum income of $15,521 for 2014. Deserving or not aside – while these individuals currently do not qualify for Medicaid in Indiana or Texas – THEY DO qualify for a subsidy of approximately 88% of their health insurance premium. If they elect the plan recommended by the Department of Health and Human Services (“benchmark” plan) it will be the second lowest cost Silver Plan in their area. They are required to pay no more than $40.41 per month. No, I don’t feel sorry for them. They are certainly already receiving food stamps and government subsidized housing and Medicaid is already in financial trouble in most states without further expansion. (Of course I am aware financial feasibility and a balanced state or federal budget is not your concern.)

The person I feel sorry for is the poor working stiff who is making in the $50 – $60,000 dollar range and actually earning his or her income. They don’t qualify a health insurance premium subsidy. (Food stamps I’m not certain of because our government has made those available to virtually everyone including illegal aliens.) Because this responsible working person doesn’t qualify for a subsidy, they will be forced to pay 100% of the Silver plan premium–with an average annual cost of $4,113–entirely on their own. That amounts to 8% of their annual income (at $50k) before taxes which the entitlement person isn’t paying! That’s the person I feel sorry for! Then try providing them with a plan that has their doctor in the network and the benefits they would really like and their cost and that percentage soars! In summation – you keep lobbying for the entitlement class; I’ll keep lobbying for the working American.

Now to address Scott: Glad to see you are finally making a prediction which I feel is pretty much on target. As I’m the one on the front line signing people up for Obamacare, no one knows better the “adverse selection” (bad risk disproportionately selected for participation) than I. But I remember a few of my predictions you tried to dismiss. First – I said Barrack Obama would be elected in 2008. You said, “no”. In 2010 – I said the Patient Protection and Affordable Care Act (PPACA or ACA for short) would pass. You said, “no way!”. Then, in June of 2012 – I said the Supreme Court is going to find a way to uphold the ACA as “constitutional”. You said, “not to worry!” God! I hate being right. (Almost as much as you hate being wrong!)
Anyway, I’m glad you are finally smelling the coffee which probably got to a stench with your latest health insurance premium increase. And, as such, this begs many questions – two of which I will address at this point:

(1) If the federal government cannot build a functional website, to insure the estimated 30 million uninsured, with 3 years lead time – How long is it going to take them to transition us to a “Medicare like” social welfare health insurance program that insures all 300 million plus Americans. And . . .

(2) If Social Security is on track to insolvency and Medicare is predicted to be insolvent by 2023 (nine years from now, people) – how the hell are they going to finance and subsidize healthcare for everyone? Redistribution. Because it wasn’t fair you’ve been so successful, Scott.

In my next blog post, I will address what I see as the specifics of why these things regarding the ACA are destined to transpire. In the meantime, I’m still going to Washington because the one thing we do know is – the person that never gets in the ring has already lost. The real issues I would like to confront our elected officials with are my suggestions for workable healthcare reform which guarantees coverage for pre-existing conditions while being financially responsible and feasible; term limits (I know, I know – when hell freezes over); amnesty and targeting of conservative groups by the IRS. I know they’ll try to get me back on point (theirs) – but not until I’ve made them say, “next question!”