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Posts Tagged ‘health insurance reform’

Federal Government Denies Texas Health Insurance Waiver

Wednesday, February 1st, 2012

affordable texas health insuranceHere’s some news on the Texas health insurance front. Texas had applied for a waiver that would exclude it from the federal government’s law that imposes limits on overhead spending by health insurers. The law in question applies to the Medical Loss Ratio and was instated as part of ObamaCare.

Basically, the federal law mandates that health insurance companies “must spend a minimum of 80 percent of their revenue on payments for policyholders’ health care or improvement to their health coverage plans.” This might sound okay on the surface – more money going toward individual’s health care, and less money going toward executive salaries and overhead. But in reality, “overhead” also includes necessary and important items like employee training, education and liaising with doctor’s to better understand issues related to health. So by mandating an 80/20 medical loss ratio, the government is effectually limiting a health insurance carrier’s ability to perform actions that positively affect not only the company, but the consumer.

The consequence for spending more than 20 percent on such costs is a requirement to provide customers with rebates beginning in 2012. Texas was denied its waiver request because, according to officials from the U.S. Department of Health and Human Services, the state was unable to “prove that there would be destabilization of their insurance marketplace if it complied with this new regulation.”

As a result, it’s possible that Texas health insurance companies will be forced to pay out rebates worth $476 million to policyholders over the next three years.

Again, this sounds positive for consumers. But we’re not convinced that federal mandates are in the long term best interest of the people. By limiting health insurance carriers’ overhead costs, we can expect to see good programs like education and privacy protection reduced, since the law kills a carrier’s incentive to invest in such programs. The short sighted law requires health insurance companies to make business decisions based on federal regulations, rather than what’s best for consumers.

The Economics of Health Care Reform

Monday, January 31st, 2011

texas health insuranceProponents of health care reform have promised that it will provide affordable health insurance in Texas and across the country. There’s no doubt that the new legislation will help certain individuals, but what often goes unsaid is that health care reform will also hurt a large percentage of the people that it’s intended to protect. According to John Goodman of the National Center for Policy Analysis, much of this is owed to the “top down” practice of implementing health care reform.

“Top down” means that reform starts with a goal or an idea, and the individuals in charge attempt to impose this idea onto all the people below. Top down thinking doesn’t consider what the masses want.  It ignores the fact that people will act in their own self interest, rather than in the interests of the government’s collectivist vision.

John Goodman writes:  “Almost everybody in health policy thinks you can have a plan designed by people at the top that will work, even though every doctor, every nurse, every hospital administrator and 310 million patients all have an economic self-interest in defeating the plan.

Below, Goodman notes some examples that he believes will play out, as people act in the interest of their own health and finances.

  • Thirty-two million otherwise uninsured people will try to double their consumption of medical care.
  • Almost everyone with private insurance and all Medicare enrollees will try to increase their consumption of preventive services, promised without deductible or copayment.
  • With no increase in supply, doctors and patients will face a huge rationing problem.
  • There will be up to 900,000 additional emergency room visits and the time price of care (rationing by waiting) will jump substantially
  • Patients whose plans pay below-market rates, including the elderly, the disabled and poor families on Medicaid, will be pushed to the rear of the waiting lines.

Goodman goes on to note that Congress passed a law that encourages middle and upper income families to have more insurance than they want or need. Assuming this segment of society utilizes the insurance they were forced to buy, they’ll in effect make access to health care more difficult for the poorest and most vulnerable segments of society. So whether consumers are looking to purchase health insurance in Texas or anywhere else, the top down methods used to expand our access to health care will actually hinder adoption by the people who need it most.

Steps to Take Now to Prepare for ObamaCare

Wednesday, March 31st, 2010

health care reformNow that health care reform has passed, people want to know how they will be affected and when they will feel these effects.  Some measures will be noticed almost immediately, while others won’t be seen for a few years, or longer.  To prepare consumers for these changes to their health care, moneywatch.com suggests what people can do now to ensure they’re ready for some key measures outlined below.

Expanded Coverage for Dependents

On September 23, 2010, kids will be allowed to remain on their parents’ health plan until their 26th birthday, provided they’re not already covered by their own employer plan.  If a child age 25 or younger has been dropped from your plan, ask your insurer how to get him or her reinstated.  If this causes your premiums to rise significantly, compare the price increase with policies sold on the individual market to ensure you receive the best plan at the best price.

Reducing the Medicare “Doughnut Hole”

Currently, once seniors have spent $2,830 on prescription drugs, they then have to pay the next $3,610 in prescription bills out-of-pocket until coverage kicks in again at $6,440.  This costly gap in coverage is known as the “doughnut hole.”  Now, seniors who fall into the doughnut hole in any calendar quarter this year will receive a $250 rebate check.  Next year, seniors will receive discounts on prescription drugs, and more discounts will be applied until the doughnut hole is closed.  To prepare for this, people should save all Medicare documentation and prescription bills to prove they’re entitled to the rebates.

Cuts to Medicare Advantage Plus

Over the next three to seven years, government subsidies to Medicare Advantage Plus plans, which provide coverage and additional benefits to 11 million seniors, will be cut by $136 billion.  To prepare, seniors are encouraged to keep track of their Medicare renewal period.  Because prices and services could vary significantly from plan to plan as these changes take effect, seniors might need to make a new decision each year about whether to change plans.

Limits on Flexible Spending Accounts

On January 1, 2013, contributions to Flexible Spending Accounts (FSAs) will be capped at $2,000, and reimbursement for non-prescription drugs will no longer be allowed.  If you want to put away more money for medical costs, consider a Health Savings Account (HSA) instead of or in collaboration with your FSA.   HSAs allow you to save pre-tax money for future medical costs, and unlike a use-it-or-lose-it Flexible Spending Account, HSAs roll over from year to year.  To be eligible for an HSA, you simply need to pair it with a high deductible health insurance plan.

New Tax on Investment Income

Starting January 1, 2013, individuals who make more than $200,000 a year—or couples who earn more than $250,000 together—will be hit with a new 3.8 percent tax on investment income like dividends, interest and royalties.  To combat this, people can invest in tax deferred investments like municipal bonds or Roth IRAs.

In addition to the above measures, there are many other changes to be aware of as health care reform rolls out.  Visit moneywatch.com for more details on how to begin planning for the expected changes to your health care and finances.

ObamaCare: Change We Simply Can’t Believe

Monday, March 22nd, 2010

Obama health care reformThe year-long health care reform debate and political maneuvering has finally culminated into the Obama administration passing its health care bill.  And since the 2,700 page bill was too unpopular to pass through traditional legislative means, the Democrats used their majority and a political tactic called reconciliation to jam the bill through Congress without any Republican support. In the final roll call, no House Republican voted for the bill, and 34 House Democrats voted no.

In all my years working in the Texas health insurance industry I cannot recall a more unpopular, ill-conceived and financially irresponsible bill passing through Congress.  The magnitude of this legislation is unprecedented in terms of an American government’s exertion of power over its people and its display of “we-know-what’s-best-for-you” arrogance.  Even worse, the idea that this version of health care reform will improve coverage and access to coverage while reducing costs is simply not true, if not totally comical. How can the government add 35 million people onto the health rolls of the already overburdened emergency rooms and amid a serious doctor shortage without  long waiting lines and rationing?  If this is what change looks like, then Mr. Obama, you can keep it.

All figures of cost savings used by Obama and his administration come from the Congressional Budget Office (CBO), which conducts its analysis in a vacuum.  For example, the CBO must tally all assumptions from the health care bill, reasonable or not, including the ridiculous notion that $500 billion in savings will be gleaned by reducing “fraud and waste” from Medicare.  The government uses this large sum, and several others, to counteract its spending, thereby reducing the stated cost of health care reform.  It’s a way for the government to hide hundreds of billions of dollars of spending from the American public.  Upon removing such gimmicks, the former director of the CBO predicts deficits of $562 billion over the first ten years.  So rather than reduce the federal budget deficit, the overhaul of our nation’s health care system will push us further into a hole from which we may never resurface.  Many pundits feel that this will be the final nail in the coffin that bankrupts our country, and I happen to agree.

Equally as intimidating as this financial burden on us and future generations is the blatant infringement on our personal liberties.  By passing this bill, Congress is effectively mandating that all Americans must purchase health insurance, or be subject to a fine.  Forcing people to buy insurance is unprecedented, and arguably unconstitutional.  Our government has always taxed us on things we do buy, like cigarettes or automobiles, but taxing us on what we don’t buy?  That’s a frightening, slippery slope.

ObamaCare by the Numbers

John Goodman, president and CEO of the National Center for Policy Analysis, pokes some holes in ObamaCare, including the notion that, as Obama has repeatedly stated, people who like their insurance plan can keep it.  But the Lewin Group, a health care and human services policy research and management consulting firm, estimates that 19 million people will lose their employer plan.  And more than eight million seniors are predicted to lose their Medicare Advantage plan, according to the Medicare Chief Actuary.

Another Obama sound bite was that no one earning less than $200,000 would experience any tax increases.  The reality though, according to the Joint Committee on Taxation, is that approximately 73 million people earning less than $200,000 can expect to pay higher taxes to support the health care bill.

And what about reducing cost burdens on individuals and families?  Insurance companies estimate price increases ranging from 54 percent to 111 percent for individuals, and the CBO predicts a $2,100 increase in insurance premiums for the average family.

This isn’t health care reform.  It’s health care overhaul.  And it just might be the biggest abuse of government power I’ve ever seen.

Richard Monello
President/CEO, Custom Health Plans, Inc.

The Federal Government Wants to Mess with Texas

Thursday, February 25th, 2010

texas health insuranceThe Dallas Morning News recently reported that President Obama has proposed for the federal government to regulate all health insurance premiums in an effort to regulate price increases. With Texas health insurance and other states’ premiums continuing to increase as more and more people become uninsured, this proposal suggests that the federal government should review all premiums in order to stop cost increases the government believes are unnecessary. Though price increases must be addressed, should the federal government be the final arbiter of health insurance premiums?

In Texas, the Department of Insurance does not routinely review health insurance premium increases unless a complaint is brought before them. Therefore, it’s argued that Obama’s proposal could protect many insured citizens from unnecessary and inflated health insurance premium costs.  However, each state differs in which health insurance carriers, plans, and benefits are available.  Paired with the fact that health insurance carriers are confined to only sell within state lines, how can the federal government adequately determine if a premium increase is unreasonable for the citizens of a particular state, much less regulate those that are deemed unreasonable?

Rather than spending more money on further regulation, how about some measures that would actually lower health insurance costs?  Measures like deregulating health insurance across state lines, so that market competition can naturally lower costs; or imposing tort reform to cut down on junk lawsuits, like we’ve done here in Texas; or increasing accessibility to health care, through more options like Texas health savings accounts and other consumer driven health plans that empower consumers to take control of their health care costs.

American health care reform cannot happen overnight, but until the right questions are asked, the wrong answers will continue to be proposed.

10 health care reform ideas for Obama

Friday, February 12th, 2010

health care reformRecently President Obama said he wants to meet with both Democrats and Republicans to sift through the best health care ideas from both sides.  He challenged Republicans—who to this point have opposed Obama’s health care bill—saying, “if you have a better idea, show it to me.”  In an attempt to answer the call, former Speaker of the House Newt Gingrich and John Goodman, CEO of the National Center for Policy Analysis, laid out ten ideas for Obama to consider in a recent Wall Street Journal op-ed.

The WSJ article begins by stating that “the best ideas out there are not those that were passed by the House and Senate last year, which consist of more spending, more regulations and more bureaucracy. If the president is serious about building a system that delivers more quality choices at lower cost for every American, here’s where he should start:”

Make insurance affordable – The current taxation of health insurance is arbitrary and unfair, giving lavish subsidies to some, like those who get Cadillac coverage from their employers, and almost no relief to people who have to buy their own. More equitable tax treatment would lower costs for individuals and families. Many health economists conclude that tax relief for health insurance should be a fixed-dollar amount, independent of the amount of insurance purchased. A step in the right direction would be to give Americans the choice of a generous tax credit or the ability to deduct the value of their health insurance up to a certain amount.

Make health insurance portable – The first step toward genuine portability—and the best way of solving the problems of pre-existing conditions—is to change federal policy. Employers should be encouraged to provide employees with insurance that travels with them from job to job and in and out of the labor market. Also, individuals should have the ability to purchase health insurance across state lines. When insurers compete for consumers, prices will fall and quality will improve.

Allow doctors and patients to control costs – Doctors and patients are currently trapped by government-imposed payment rates. Under Medicare, doctors are not paid if they communicate with their patients by phone or e-mail.  Medicare pays by task—there is a list of about 7,500—but doctors do not get paid to advise patients on how to lower their drug costs or how to comparison shop on the Web. In short, they get paid when people are sick, not to keep them healthy.

So long as total cost to the government does not rise and quality of care does not suffer, doctors should have the freedom to repackage and reprice their services. And payment should take into account the quality of the care that is delivered. Once physicians are liberated under Medicare, private insurers will follow.

Inform consumers – Patients need to have clear, reliable data about cost and quality before they make decisions about their care. But finding such information is virtually impossible. Sources like Medicare claims data (stripped of patient information) can help consumers answer important questions about their care. Government data—paid for by the taxpayers—can answer these questions and should be made public.

Eliminate junk lawsuits – Last year the president pledged to consider civil justice reform. We do not need to study or test medical malpractice any longer: The current system is broken. States across the country—Texas in particular—have already implemented key reforms including liability protection for using health information technology or following clinical standards of care; caps on non-economic damages; loser pays laws; and new alternative dispute resolution where patients get compensated for unexpected, adverse medical outcomes without lawyers, courtrooms, judges and juries.

For the full list of GOP proposals to President Obama, click here.  And if you’ve got some ideas of your own, we’d love to hear them; just leave a comment below.