Monday, April 17, 2017

ACA/Obamacare: Before and After the Waiver of Pre-existing Conditions and the Advent of Community Rating

“As Republicans continue to debate the specifics of their plan to repeal and replace the Affordable Care Act (ACA or ObamaCare), two provisions have taken center stage: “Guaranteed Issue,” the requirement that insurers offer policies to all applicants, and “Community Rating,” the requirement that they offer all policies at the same price, regardless of risk factors like health, lifestyle, or even gender.

These rules were obviously designed to allow people with pre-existing conditions to purchase health coverage, and to equalize the premiums paid by everyone. But as nice as that sounds, the experience of different states shows that these rules don’t benefit many consumers and aren’t the best way to foster functional and fair insurance markets.”

“Before the ACA, everyone was guaranteed a policy in every state. First, employer-based or group carriers could not deny you coverage due to a pre-existing condition. Second, if you kept continuous coverage and followed the requirements of the 1996 Health Insurance Portability and Accountability Act (HIPAA), you had the right to buy an individual insurance policy with no exclusions for pre-existing conditions.

HIPAA required that a carrier could not raise your rates nor drop you if you developed a condition after the policy was in place. Sadly, the architects of the ACA misled people about these protections, saying they didn’t exist, and many people still believe that today.”

“While guaranteed issue and community rating may sound nice in theory, in reality, they don’t work out as intended. Unfortunately, these rules can create bad incentives. By raising the cost of insurance for healthy people, these rules can discourage some people from buying insurance until they become sick, when they will still be guaranteed a policy.”

“Before the ACA, 43 states allowed the sale of “true insurance.” Rates were based on your potential of claims, so carriers could inquire about your health conditions, occupation, and lifestyle choices. This provided an incentive to practice a healthy lifestyle because your premium would be lower if you did. Most applicants received very affordable rates since most people are healthy. Unlike the proponents of the ACA claimed, scores of common conditions like mild allergies and even elevated blood pressure and cholesterol were accepted. In fact, 87 percent of applicants received coverage, even with their pre-existing conditions.

Others who had delayed applying until they developed a serious condition or were expecting an expensive claim were offered a guaranteed plan through a carrier or through a high-risk pool. High-risk pools offer a variety of plans from different insurers to high-risk customers at subsidized rates. Those rates were typically up to 150 percent of standard rates and were funded partially through a state tax on carriers, the premiums of enrollees, and an occasional grant from the federal government.


These higher rates were only charged to a few people, and they were similar rates to what everyone is now paying under the ACA. As more people buy private plans before they develop a serious condition, rates will remain low and fewer people will be buying in the subsidized high-risk pools.” - Obamacare’s pre-existing condition rules sound nice but don’t work, 04/10/2017, 

thehill.com


Link to the entire article appears below:

http://origin-nyi.thehill.com/blogs/pundits-blog/healthcare/328174-obamacare-misled-americans-about-pre-existing-conditions-now






Friday, April 7, 2017

ACA/Obamacare: Cross Subsidy as a Hidden and Inefficient Tax

“But the great puzzle of health care policy: Just why is it, to accommodate this worthy goal, must your and my health care and insurance be so deeply regulated and so thoroughly dysfunctional? As one small example, why does a 20 minute skin check with the resident of my dermatologist generate a phoney baloney bill for over $1000, meaning a cash and carry market for such a simple, elastically demanded, and perfectly predictable service is impossible?

Why, in order to provide for the unfortunate, do we not simply levy taxes, and pay for charity care, and leave the rest of us alone? Regular Americans have jobs, buy houses, buy TVs, cars, and smartphones, negotiate the complexities of 401(k) and IRA plans, cell phone contracts, frequent flyer programs; hire the complex professional services of contractors, car mechanics, lawyers and accountants, and deal with the insane complexity of our tax system.”


“I think the answer is relatively simple. Our political system is allergic to the word "tax." Instead of straightforwardly raising taxes in a non-distortionary way (a VAT, say), and providing charity care or subsidies -- on budget, please, where we can see it -- our political system prefers to fund things by forcing cross subsidies.

Medicare and medicaid don't pay what the service costs, because we don't want to admit just how expensive that service is. So, large hospitals make up the difference by overcharging you and me instead. The poster child (though not really a cost driver) is emergency room care. The government passed a law saying hospitals must provide emergency room care for free. But money does not grow on trees, so again you and me (via private insurance) must get overcharged to cross-subsidize. The ACA tried to force young healthy wealthy (not getting subsidies) to vastly overpay for insurance, to cross subsidize the poorer and sicker.

This might seem like a wash. OK, if instead of paying taxes, it makes you feel good to pay business class prices for health insurance, what the heck. Economically, a cross-subsidy works the same as a tax. In fact, we do have Europe-size taxes and subsidies, we just hide them.

But it's not a wash. Cross-subsidies are dramatically less efficient than taxes. Choosing cross-subsidies over taxes is indeed the second original sin of health care and insurance regulation. Cross-subsidies cannot stand competition.

If as now you and I are grossly overpaying for health care and insurance, to cross-subsidize others, a competitive market would come along and peel us off. A local skin-check clinic could offer that service for $50.

Low prices, efficiency, and innovation in the provision of services like health care come centrally from competition, and especially disruptive competition. With no competition -- especially no entry by new doctors, hospitals, clinics, insurance companies -- costs spiral up. As costs spiral up, the cost of the charity care spirals up. As that spirals up, the size of the cross-subsidies spirals up. As that spirals up, the need to restrict competition spirals up.”



“Bottom line: Much of the pathology of health care and health insurance comes from this second original sin, choosing cross-subsidies rather than straightforward taxes. Cross-subsidies require the government to stop competition, so an initially clever way of hiding taxes eventually builds into a monstrously inefficient system. (That's a key point. Initially, it is about the same. But the cross subsidy system gets more and more inefficient over time.)

We would be far better off to admit this; raise explicit taxes enough to provide the charity end of our care, and let health insurers and care givers compete for the rest of us, as airlines, computer makers, and everyone else does. The politician's job is to explain to people that what they pay more in taxes they will more than make up in lower health care and insurance costs.” - The second original sin of healthcare regulation, John Cochrane, 04/05/2017


Link to the entire essay appears below:

http://johnhcochrane.blogspot.com/2017/04/the-second-original-sin-of-healthcare.html


 

 


 


Friday, March 31, 2017

ACA/Obamacare: The 3 1/2 Page Replacement [S.222] for the 2,700 Page Obamacare Legislation. No way! Way!

“U.S. Senator and physician Rand Paul introduced S. 222, the Obamacare Replacement Act, to provide Congress with a health care plan grounded in broadly supported conservative reforms that is ready for an immediate vote after Obamacare is repealed. Dr. Rand Paul’s proposal would expand access to higher-quality, lower-cost health care for more Americans, regardless of medical history.

The Obamacare Replacement Act empowers the American people to: 1.) Choose inexpensive insurance free of government dictates; 2.) Save unlimited amounts in a health savings account (HSA) and have wider options for using those funds; 3.) Buy insurance across state lines; and 4.) Join together in voluntary associations to gain the leverage of being part of a large insurance pool." - Rand Paul Introduces His Own Obamacare Replacement Plan – Read All 4 Pages Here! cscmediagroupus.com, 03/08/2017

Link to the entire article appears below:

http://www.cscmediagroupus.com/robert-zerfing/rand-paul-obamacare-replacement


Note: You can download all three and one-half pages of S.222 near the end of the article.

Monday, March 27, 2017

ACA/Obamacare: The Alternative Cash-only, No Insurance, Price-displaying Business Model of Health-Care

“How does Clinica Mi Pueblo offer these medial services at the “most affordable prices possible”? Here’s how: the clinic operates on a cash-only basis, with transparent prices that are listed both on the clinic’s website and on the wall at each clinic. Further, the clinic accepts no insurance, and it will not submit insurance claims on patients’ behalf. If patients have insurance, they can easily take the paperwork the clinic provides and file an insurance claim on their own. Reducing the costly, time-consuming mountain of paperwork associated with insurance, Medicare and Medicaid is one of the main reasons that cash-only medical clinics can keep their costs down and prices so low and affordable. That’s the same business model that keeps surgery costs so low/affordable at the Surgery Center of Oklahoma, the “free market-loving, price-displaying, state-of-the-art, AAAHC accredited, doctor owned, multi-specialty surgical facility in central OK” that has been featured on CD many times over the years.

So how does the cash-only, no insurance, price-displaying business model of the Clinica Mi Pueblo compare to medical coverage under Obamacare? Well, deductibles for individuals enrolled in the lowest-priced Obamacare health plans will average more than $6,000 in 2017, and families enrolled in bronze plans will have average deductibles of more than $12,000. Importantly, the deductible is the amount of money patients must personally pay out of pocket for health services before Obamacare insurance policies cover any medical costs. And what about the monthly Obamacare premiums? A 40-year-old unsubsidized bronze Obamacare plan patient will pay slightly more than $350 per month this year for their “health coverage” with a deductible of more than $6,000. And that’s supposed to somehow be “affordable” health care? In contrast, spending $350 per month out-of-pocket at Clinica Mi Pueblo, instead of going toward an Obamacare plan that provides almost no actual medical care, would actually purchase quite a lot of actual medical services.

Bottom Line: For routine medical care (annual physicals, flu shots, routine office visits, X-Rays, ultrasounds, MRIs, blood tests, etc.) most Americans, especially younger, healthier patients, would be much better off with a cash-only medical clinic like Clinica Mi Pueblo than with Obamacare, no? Under Obamacare, a 40-year-old American pays more than $4,200 per year in premiums. The out-of-pocket limit for an Obamacare plan is $7,150 this year but that doesn’t include the monthly premiums, so an individual could pay more than $11,000 out-of-pocket this year before his or her health plan would start to pay 100% of the costs of covered benefits. Only in some fantasy world of Big Government progressives and collectivists would that ever be considered an “affordable” health care system!” - An antidote for Obamacare: Cash only medicine with transparent pricing and no insurance — the future of medicine?, AEI, 03/26/2017

Link to the entire article appears below:

https://www.aei.org/publication/an-antidote-for-obamacare-cash-only-medicine-with-transparent-pricing-and-no-insurance-the-future-of-medicine/


 

Friday, March 3, 2017

ACA/Obamacare: Healthcare Supply-Side and The Story of Telemedicine v. The Angels of Mercy

“The goal of health care reform is to provide better health care to everyone at a lower cost, year after year. The solution is not to provide a better third-party-payer system — e.g., health insurance or government-provided health insurance — but instead to allow technological development and entrepreneurship to improve the current business model through groundbreaking innovations that empower consumers, improve quality and cut prices. We have seen it happen in many industries, such as transportation, room and board, and tech.

Of course, special interests benefiting from the old model do not appreciate being challenged. As a result, rather than make it easier for new models to thrive by ensuring that rules and regulations do not stifle innovation, politicians often choose to protect established industry players at the expense of consumers.”

“Some services strive to do something even more impactful by making health care more affordable and accessible, yet they are held back by outdated rules and hostile competing industries. Take, for example, telemedicine — the use of modern communications technology, such as videoconferencing and using smartphones, to facilitate patient care. It has the potential to help millions of Americans struggling to pay the skyrocketing costs of health care. But instead, some politicians are siding with their campaign contributors in the health care industry and not the constituents they supposedly are in office to serve.”

“The California State Board of Optometry used taxpayer dollars to engage in a public relations campaign against one telemedicine startup. Indiana enacted a law last year to prevent the use of online eye exams. Georgia and South Carolina have also enacted bans, and the Virginia Legislature just sent a bill to the governor's desk that would do the same.

All of this is done not to safeguard patients but to protect older and more expensive business models. This is highly unfortunate. Telemedicine not only can help reduce health care costs but also has the potential to greatly expand access to care — something politicians claim to care about. Yet many states nevertheless prevent doctors licensed in other states from offering telemedicine services to their residents. This makes it more difficult for poorer citizens living in medically underserved areas to achieve the same access to care that their wealthier neighbors can discover by traveling out of state.” - Cronyism Thwarts Telemedicine and Other Innovations, mercatus.org, 02/23/2017

Link to the entire article appears below:

https://www.mercatus.org/commentary/cronyism-thwarts-telemedicine-and-other-innovations


 

 

 


 


Saturday, February 25, 2017

ACA/Obamacare: So You Think ACA is Too Expensive to Maintain…Try Medicare on for Size

"The Trump Administration has promised to deliver to the American people a healthcare plan that is, in President Trump’s own words, “much less expensive and far better” than Obamacare. But While Obamacare is expected to spend over $900 billion from 2018 to 2027, focusing solely on the Obama administration’s signature achievement ignores bigger fiscal challenges; Namely, the Medicare program.

Our insurance program for the elderly and disabled – Medicare – is expected to cost $900 billion in 2024 alone. From 2018 to 2027, this comes to a whopping $8.5 trillion—an order of magnitude larger than the cost of the ACA. Beyond the topline price tag are a number of endangered programs.

Medicare’s hospital insurance trust fund, commonly known as Part A, is expected to run out of money in the next 10 years. This would mean an immediate reduction in benefits when the money runs out—2028, according to the program’s actuaries. Meanwhile, the funds that Medicare uses to pay for physician services (Part B) and prescription drug benefits (Part D) are consistently growing as a share of revenue". - Repeal & Replace: Missing the Medicare Forest for the Obamacare Trees, realclearhealth.com, 02/24/2017

Link to the entire article appears below:

http://www.realclearhealth.com/articles/2017/02/24/repeal__replace_missing_the_medicare_forest_for_the_obamacare_trees_110464.html?utm_source=RCP+Morning+Note&utm_campaign=8da8cfe47f-EMAIL_CAMPAIGN_2016_11_11&utm_medium=email&utm_term=0_a4db5f2336-8da8cfe47f-84790497