Category Archives: Exchanges

Copper, or Cop Out?

The recent bipartisan health care bill, posted here, is an attempt to save the cost-sharing reimbursements that the Orangutan ended last week, and that the White House (the adult day care center) has not endorsed.

This is what Health Care.gov says about these copper plans, with commentary from Don McCanne of Physicians for a National Health Plan.

HealthCare.gov
ACA Catastrophic Plans
Catastrophic health insurance plans have low monthly premiums and very high deductibles. They may be an affordable way to protect yourself from worst-case scenarios, like getting seriously sick or injured. But you pay most routine medical expenses yourself.
Deductibles — the amount you have to pay yourself for most services before the plan starts to pay anything — are very high. For 2017, the deductible for all Catastrophic plans is $7,150.
According to Dr. McCanne, the bill will extend CSR’s for two years in exchange for concessions from Sen. Patty Murray.
One of those concessions, Dr. McCanne says is  to allow anyone to purchase on the exchange the catastrophic plans that are currently available only to individuals under 30 or those who qualify for certain hardship exemptions. These plans are sometimes referred to as copper plans, indicating that they have an actuarial value below the other metal tier plans (bronze, silver, gold, and platinum).
The appeal of these plans, he adds, is that their premiums are very low, but that is because their actuarial value is only 50 percent – they cover an average of about half of health care costs.
For 2017, the deductible for these plans is $7,150.
He believes that the concept that we can take beneficial policies and detrimental policies and combine them to come up with a reasonable compromise is a fallacy. Bad policies are bad policies, and they cannot be neutralized by political accommodations.
His solution is a national health plan.
Otherwise, it is either copper or a cop-out.
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Fallout of the End of ACA Subsidies

Joe Paduda today gave a very succinct and clear-minded assessment of the fallout of the ending of the ACA subsidies, also known as Cost-Sharing Reimbursement (CSR) payments.

Here is Joe’s article.

It makes perfect sense that what the Orange man said yesterday will do more damage to health care than his false and misleading pronouncements of the past year that the ACA is failing and doing harm.

It is you, sir, who are doing harm. To the poor, to minorities like those in Puerto Rico despite your morning mea culpa, to African-Americans and Latinos,  to women, to international agreements and organizations,  and to our credibility with our allies and adversaries.

 

Executive (Dis)order

The signing this morning of an executive order by the Orangutan will have, in the opinion of some of the bloggers and politicians, spell disaster for the nation’s health care system.

It will, if carried into action, likely siphon healthy people from the Affordable Care Act-compliant market, continuing a pattern of regulatory actions under the Trump administration that have undermined the ACA.

The rationale for such a move that has been given is that since Congress has not been able to repeal and replace the ACA, an executive order will, piece by piece.

Coupled with the recent budget move to eliminate the CHIP program for children’s health (New York State faces dire consequences if Congress does not act on CHIP), and cut backs to Medicare and Medicaid, the intent here is to privatize health care for some, and eliminate it for others, and to get government out of health care providing altogether.

There are provisions in this order for greater competition, short-term coverage, and lower premiums with less coverage. Why this is better is beyond me, unless the Orangutan is seeking to destroy health care so that single-payer will be the only option.

Cutting healthy people out of the ACA means leaving sick people to struggle with a health care law that many say needs to be fixed, not repealed and replaced. But because the Tea Party ranted and raved before it was enacted, and the Orangutan and the GOP campaigned on getting rid of it, they had no choice but to sabotage it if they could not do so through legislation.

I predict that we will soon see the total collapse of our health care system thanks to this stupid, overreaching, and ill-advised Executive Order. I even read today that the Vice President had to remind the Orangutan to sign the darn thing, something that almost slipped what is left of his so-called mind.

Welcome to Crackerbox Palace.

Insurers Jacking Up Premiums Ahead of End of CSRs

An article in Healthcare Finance News.com on Friday, said that insurers are factoring in the end of the cost-sharing reduction payments into their rate increases from 2 to 23 percent, according to a report from the Kaiser Family Foundation.

The article states the following:

“Insurers in 20 states and the District of Columbia have filed premium rate requests for the federal exchange ahead of an August 16 deadline, many on the assumption that cost-sharing reduction payments will not be paid and that the individual mandate will either not be enforced or weakly enforced, according to a Kaiser Family Foundation report released Thursday.”

According to Kaiser, silver premiums would have to increase by 19 percent on average to compensate for the loss of CSR payments.

Susan Moore, the Associate Editor for Healthcare Finance News.com, also said that insurers are building uncertainty into their rates, filing under multiple scenarios involving CSRs and the individual mandate.

The threat from the POTUS to Mitch McConnell to push him to repeal and replace the ACA means that if POTUS does get his way, CSR’s would end and so would the individual and employer mandates. Also, the health insurance tax return in 2018 will add 3 percent to premiums.

You can read the rest of the article yourselves, but consider this. Isn’t time to end this nonsense of charging people insurance premiums that are constantly rising just so that a bunch of greedy health insurance companies and their Wall Street investors profit from people’s health?

When are we going to wise up and put and end to this game of playing with people’s health and forcing many into bankruptcy because they have severe medical issues?

When are we going to realize that health care is a human right, and not a commodity that can be marketed like consumer goods?

Medicare for All will end this constant round of rate increases and shenanigans the health insurers perpetrate on the American people.

Another Scheme to Delay the Inevitable, part 2

Last week, I reported on an effort to create payer-provider partnerships, and said that it was another scheme to delay the inevitable move towards a Medicare for All, single-payer system.

Thanks again to Dr. Don McCanne for this week’s article from Modern Healthcare, on yet again another delaying tactic. This time it is from Congress, and while it purports to be “bipartisan”, it really isn’t, because they are very partisan in Congress today; partisan to the health care industry’s profit-making off of sick people.

Without further ado, here is the article in full:

http://www.modernhealthcare.com/article/20170803/NEWS/170809957

IT IS HIGH TIME TO STOP WASTING TIME, WASTING ENERGY AND THE PATIENCE OF THE AMERICAN PEOPLE WITH “SOLUTIONS” THAT ONLY MAKE THINGS WORSE, NOT BETTER. IT IS TIME TO EXPAND MEDICARE TO EVERYONE, WITH NO BUY-IN, AND BE DONE WITH IT.

 

 

Blocked Aetna-Humana Merger Reveals True Reason for Pullout from ACA

In an article yesterday in Business Insider, the recently blocked merger between Aetna and Humana is the reason given for Aetna’s sudden decision to leave the ACA exchanges.

Contradictory statements from Aetna in response to this decision, as to their ability to profit from the merger or not profiting from the exchanges, does not hide the fact that the bottom line is this:

The laws of Capitalism are incompatible with the goals of providing health care to everyone, even with all the fancy commercials and advertisements from the insurance companies that they are there for you.

BS!

They are not there for you, unless you are a top executive of the company, or a stockholder or shareholder, or investor. As the article states, this merger would have led to a consolidation of the health care industry to only three mega companies.

Do you want to wait until there is only one, a la the 1970’s movie, “Rollerball”, where corporations have dominated whole industries and replaced nations, or do you want to provide health care to all, no matter what their ability to pay, or if it makes a profit for some greedy bastards?

The choice is up to you.

Here is the link to the entire BI article:

http://www.businessinsider.com/aetna-humana-merger-reason-for-leaving-obamacare-2016-8