Victims Get Hospital Bills

In modern literature we do not have a mechanism to cause the reader to pause and contemplate the words they just read. We have the ellipsis and in the Bible there is the word Selah. None of which seem sufficient so I chose to put it as a heading. We have all been victims of others poor decisions. It doesn’t matter the degree of the infraction, in one way or another it costs us something. Consider this. Even if the shooter was caught alive from the Las Vegas shooting the victims would still receive hospital bills for the injuries they sustained. That is a literal instance of adding insult to injury. Never mind the missed days of work, the need for therapy both physical and emotional. The hospital has bills to pay, and guess who’s paying them? Reminder: this is a health/life insurance blog. If you have health insurance coverage through your employer or you have an individual health plan then you are in position to satisfy your obligations. If you are not insured then the tragedy (and we all face tragedies) is exacerbated by your lack of preparation. The Open Enrollment Period starts November 1^st and ends December 15^th.

Families Must Pay for Funerals

Current death toll 58. Joe Rogan, remember Joe Rogan from the original Fear Factor and analyst for UFC fights, has donated all his earnings from his next show (he’s also a comedian) to the families affected by the Las Vegas massacre. Bet you didn’t think about the reality of funeral services, flower arrangements and burials, did you? What about life after death? Not in a mystical/spiritual sense. I’m talking about the people that are going to continue to live even after you die. The people you love and take care of right now, that would be stranded if you were suddenly removed from their lives. I don’t want to be morbid I only want to have an honest conversation with you about the realities of this life we live. We’re going to continue to go to concerts and festivals. If we stop being social then the terrorists have won. Their objective is to cause us to change the way we live. But does that mean we carelessly go about our lives? Absolutely not! We need to use wisdom. Wisdom teaches us to be proactive. One course of action we can take is to plan for the inevitable. Whether it is by the hand of a gunman or on a bed surrounded by the people we love we should be prepared. It is a disgrace for a family to have to pass a hat or sell dinners to raise money to bury a loved one. GoFundMe is not the solution. That is the modern-day version of the hat being passed. Preparation, read life insurance and health insurance, allows us to live with peace of mind knowing that we have taken care of our responsibilities. It allows us to freely enjoy our moments without the concern of danger.

My Favorite Watch

I enjoy technology. All my devices are on my home network but I also have my network secured. There are products available that you can use to monitor your home remotely. I can tell which door was opened and at what time. I can even see how long that door was left open. There are even devices that will let you know if you left the stove on. Have you ever been sitting in the airport and wondered if you forgot to turn off the stove-don’t cook the morning of your first day of vacation. You can turn off your stove remotely in the event you are in the airport and forgot to turn it off. But what happens to the children of a father that was killed in Las Vegas that night who all want their father’s watch to remember him by but he didn’t take the time to prepare a will? That is a recipe for chaos and family dysfunction. Like the stove being left on the lack of forethought could cause our houses to burn down. I have loads of anecdotal evidence of that occurring.

Let’s not waste a crisis. We have observed hours of news coverage and will see as much as we can handle in the coming days or weeks. There will be memorials erected for the victims and legislation passed because of the actions of the person who committed that heinous crime. But will we only be observers? We need to use this as a catalyst to spur us to action. Allow the tragedy to provide perspective opposed to generating fear. Take tangible steps to prepare for what could happen.

The post Carefree Days first appeared on GGC Group.

Health insurance is a lot like that in many ways. People understand they are better off having it but their eyes glaze over when an in-depth discussion is broached on the subject. Herein lies the problem when having debates about “healthcare”. You cannot have a substantive discussion about policy if all the interlocutors do not have a baseline of knowledge to argue around. That is no slight to those who do not have “substantive knowledge” of healthcare. I would not be offended if two mechanics were discussing the differences between Chevy and Mopar. All I know is the necessity of having a vehicle, especially in Houston and I enjoy driving them. But I don’t have a working knowledge of engines to be able to argue which is  better to purchase to accomplish my objectives.

Let me add another layer to this morass of confusion-I bid you come deeper into the weeds. We are not discussing “healthcare reform” although that is the moniker. What we in fact are discussing in our current politics is healthcare insurance regulations. We’re just talking about how to pay the bills. We haven’t touched the ideas of controlling costs and improving quality. Our chief concern at this stage is access. That’s why there is so much talk of how many people will lose coverage if this or that bill is passed. How much money should be spent on Medicaid, read access for the poor. Will people with pre-existing conditions be charged higher premiums or denied outright-access for the sick. Will there be monies to reduce the costs of insurance premiums and deductibles and co-payments? The answer to that question is affordability. And if it is not affordable then I won’t be able to. . .you guessed it-ACCESS!

The Mandate

Is there still a penalty for not having insurance? According to Healthcare.gov there is a $695 fee per adult for not having a qualified health plan (QHP). A QHP includes the ten essential health benefits the ACA legislates every plan must cover. The purpose of the mandate is to encourage everyone to obtain health insurance. The estimated effect of most people being covered is the cost of insurance going down. Why would the cost go down? I’m glad you asked. All insurance is based on actuarial values. Simply put, the insurance company projects 20% of the people who are covered will spend 80% of the money coming from premiums collected. If the pool was 10 people according to the numbers I just quoted 2 individuals would use the insurance and the other 8 people will not. Those 2 people (the insurance carriers estimate) will use 80% of the money that was collected from those 10 people.

So, what happens when the pool goes from 10 people to 10,000 people? That’s a lot more premium dollar being collected thus reducing the risks the insurance company must bear. If their risks are lessened we can then assume the cost of said risk is lower subsequently the plan premiums would be lower. Remember I mentioned we were talking about health insurance regulations and not healthcare reform? Case in point. The cost of the service is not being considered. The cost of prescription drugs is not on the table at this point. The price of the insurance to have access to healthcare is what we are currently addressing.

Again, the purpose of the mandate is to get everyone in the pool. The new law does not repeal the mandate. The legislation as presented restructures how the penalty is collected. Under the current law the penalty is collected when you file taxes. Under the proposed law the penalty is assessed when the person tries to purchase insurance. What!

For example, Bill decides the premiums are too high in 2017 so he does not enroll in a health plan. 2018 he is a year older and a bit wiser so he decides to shop for coverage again. The insurance company asks if Bill had insurance in 2017. He replies negatively. The insurance carrier can charge Bill a higher premium because he did not have continuous coverage. Under the ACA mandate the penalty payments were placed in a fund to help pay for the subsidies the law allows. Under repeal-replace the penalty dollars go to the insurance carriers. This is not a statement of political position this is a presentation of facts.

Pre-existing Conditions

If you want to. No really! Under the current law insurance carriers cannot charge a higher premium or deny coverage to anyone with a pre-existing condition. Under repeal-replace the law gives discretion to the states to create rules of how the insurance carriers can determine who is covered.

Can we backtrack to another conservative idea we have not discussed lately? Do you remember the idea of selling insurance across state lines was put forth as a means of reducing premiums? The idea was that a carrier based in Arkansas would set their prices and then sell the same plan in California for the same price creating competition which would drive down costs nationwide. Simple right. But, Chevy’s don’t have hemispherical combustion chambers. In other words, it’s not that simple.

We don’t have to be data analysts to know there is a reason the cost of living is higher in California than it is in Arkansas. I don’t have the numbers, but I would venture to guess a doctor isn’t paid as much nor do they have as many doctors in Arkansas as they do in California. Do I need to go any further to get my point across?

Now, let’s add the new layer of giving freedom to the states to create their own laws about health insurance plans. We will never be able to create parity from state to state to use one state’s system as an example because the legal environment will be different in each state. Not to mention the cost of living and other factors we have yet to put on the table. It appears in our efforts to simplify things we are only complicating them further. If Arkansas decides to put in their law that the insurance companies cannot discriminate based on medical history and freedom loving Texans choose to eschew onerous regulations then will the sick Texans migrate to Hot Springs?

Enrollment Window

One last thing. I won’t belabor this point. The enrollment period is from November 1^st until December 15^th. You better decide about your healthcare before you complete your Christmas shopping. That’s all I got to say about that.

The post Hurricane Who? The Wheels of Repeal-Replace Are Still Rolling first appeared on GGC Group.

The thing about throw blankets is that they not only look nice but they also provide warmth. They are great for covering your legs while you are watching a movie. But have you ever tried taking a nap under a throw blanket? Its deficiencies are immediately apparent. It’s too short. CMS issued new regulations in lieu of the 2018 coverage year. Yes, this is still a blog about health care insurance. Let’s take a look at how these new regulations will affect us and by the end I reckon you will reach the same conclusion about the regulations and the subsequent plans that will be offered. . . their too short.

Enrollment Periods. There are two classes of enrollment periods. There is the open enrollment period where everyone that is interested can sign up for individual coverage and there are special enrollment periods that allow people to get coverage outside of open enrollment. Both of these classes are revised in these new regulations. I thought conservatives didn’t like regulations?! I’m just saying. “Nothing to see here, please move along.”

The open enrollment period has been abbreviated by 6 weeks. Last year the open enrollment was from November 1^st to January 31^st. The new open enrollment season is November 1^st to December 15^th. The logic, limit the amount of time people have to choose so they will not hold out until they get ill to get insurance. I hate to sound cynical and I am trying to remain impartial but are we referring to cold and flu season in January? Are people who weren’t going to purchase health insurance rethinking that decision in January so they can get a Z-pack? Maybe so. Either way that window has closed, so while you are budgeting for Christmas you better make up your mind about your health insurance too.

In reference to special enrollment periods (SEP) they are putting greater restrictions on the qualifications to obtain an SEP. The reasons for an SEP remain the same:

1. Moved to a new coverage area
2. Just married/divorced
3. Loss qualified health coverage

The difference now, you must prove that you qualify before you can sign up. Let me see your papers. The objective, again, is to prevent people from obtaining coverage after they have received a diagnosis. The carriers lost a lot of money paying bills for sick people. A lot of irony in that sentence. It cripples the profit model when individuals game the system by not paying premiums until they get sick. Tragically, there is a segment of the population that does not believe/understand that you should be insured whether you need healthcare at the moment or not. Shortened enrollment period and more strict rules to qualify for a special enrollment period is an effort to curtail the chicanery.

Actuarial Value. Most people reading this cannot pronounce “actuarial”. And that’s not a slight on anyone’s intelligence, it’s a comment on how little that word is used in our everyday lives. I am not going to talk about risk analysis, coinsurance, deductibles or the mandated actuarial values under the ACA. May objective in this blog is to distill this information for my readers-moonshine. The new regulations are allowing the carriers to offer plans that cost less but also pay less of the bill. For the young and healthy this means there will be plans offered that will be for more affordable than previously. This also means if you the consumer is not well informed you will sign up for that cheaper plan unwittingly. I was intentional in choosing the word “cheaper” because it connotes, of lesser quality. Bottom line: premiums will be lower, coverage will be less. To borrow from our initial analogy, the blanket will be a little short.

Pay what you owe. It’s not uncommon for people to stop paying premiums toward the latter part of the year. Did I mention Christmas and budgeting earlier? To crack down on individuals who choose to buy Christmas gifts instead of paying their insurance premiums, the government has included in their regulations a provision for insurance companies to collect the back payments from people prior to enrolling in a new plan. Let’s look at an example.

Jerry purchases insurance in November of 2017 that starts January 2018. He pays premiums all of 2018 until the month of October. He decides to use that premium money for Halloween costumes, Thanksgiving dinner and Christmas respectively. That’s 3 months of nonpayment. At the last minute, he enrolls in an insurance plan for the 2019 plan year. Before he can complete the enrollment, he is notified he is not able to because he has an outstanding balance from the previous year. The objective, again, is to encourage people to get coverage when they are supposed to and keep it. The problem with this logic is, irresponsible people with limited funds will not have the money to pay the previous balance and the new premium. In general terms, the irresponsible ones are the young healthy people the insurance carriers need in the risk pool. You ever heard of hustling backwards?

On Overstock.com you can get a blanket for $35-40. For a throw blanket, $25-30. Under the ACA/Obamacare throw blankets were disallowed. That explains why many people felt President Obama did not keep his promise, “If you like your plan you can keep it.” Under the just released regulations some of the shorter stuff is being allowed again. Changes to actuarial values and essential health benefits will allow the carriers to sell plans that are less comprehensive but will be easier on the pocket. For the population of people who are relatively healthy those plans will be great. But for those who choose “throw blanket” coverage and need to use the services, they will get a rude awakening at the doctor’s office. You can try taking a nap with a throw blanket but I’m sure you will wake up because your feet are cold.

The post Throw Blankets for Sale first appeared on GGC Group.

Sick People Insurance-Healthy People Insurance. I know that bullet is dripping with sarcasm but you have to hear me out. The AHA-no I’m not calling it the AHCA as they would like because we all know healthcare is one word. Microsoft Word does not underline healthcare when I don’t put a space. My opinion, the marketing people did not want the acronym to be AHA for the obvious reason, AHA! They wanted it to be patriotic and easy to understand, thus the compromise was to break up the word healthcare. We see you.One of the shortfalls of the ACA is the insurance carriers were overwhelmed by sick people at the beginning of the program. They did not estimate that so many Americans had health issues. Let’s think about that for a second. The problem prior to the ACA was that people did not have access to healthcare because they did not have the funds. The government issues a law that allows for access. When people go to the doctor it is discovered they are sick. Aren’t we glad people are getting the attention they so desperately needed? Yes, someone has to pay the bill. Would we rather a higher mortality rate so insurance carriers can pay their executives higher bonuses? Let’s be honest. That’s where the extra dollars would go. The AHA solution is Sick People Insurance. The new law does not repeal the ACA provision that insurance carriers cannot discriminate against people with pre-existing conditions. But for those who are sick, it provides funds for a high-risk pool. This insurance will remove the sickest among us from the healthy population on the insurance rolls. Subsequently, costs would go down because the risk would be lessened for the carriers. So, is one automatically sent to the high-risk pool when they receive a cancer diagnosis? Or, are you relegated to that pool when it is time for renewal? Let’s not trifle with details. On it’s face the high-risk pool is an option that can function as a cost containment measure.

Taxes are repealed. Obamacare was partially funded by taxes on the highest earners. You’ve heard the line, “. . . we just want everyone to pay their fair share.” Well, the ACA made an effort to do that. Those taxes are repealed in the legislation as it is written. How will the “tax credits” be funded in the AHA? That question has yet to be answered. Let’s cross our fingers.

Defund Planned Parenthood. Again, let’s keep it politically neutral. This is not a comment on the morality of abortion and the role of taxpayer dollars in reference to the woman’s right to choose or the life of the unborn. This is a comment about syntax. The word abortion/abortions is mentioned 32 times in a 123 page bill. The law is essentially about improving access to healthcare insurance via tax credits. But somehow the culture war is front and center in this legislation. Planned Parenthood is not mentioned by name but, “is an essential community provider. . .that is primarily engaged in family planning services, reproductive health, and related medical care; and provides for abortions.” On page 2 Planned Parenthood is called a “prohibited entity” and on page 3 the definition previously quoted is written.

Penalty reiterated. I’m going to try my hardest to not take you too far into the weeds of insurance dorkdom. The objective of the ACA was to cover every person. The purpose was to spread the risk i.e. healthy and sick pay insurance premiums. Thus, the risk is distributed. Taking 2% of a family’s income apparently was not enough of a motivator for the average uninsured person.The AHA solution is to fashion the penalty after the Medicare penalty. We are standing on the edge of an unkempt field that has not been cut for years. Under Medicare if you do not elect to take Part B or D insurance when you are first eligible then you are penalized for every month you do not have those two parts of Medicare. The penalty is assessed when you decide to sign up. The AHA penalty operates in the same way. The insurance carriers by law can charge consumers a 30% mark up when they come to purchase insurance after a “lapse” in coverage. The justification for the mark up is the consumer is a higher risk after the “lapse” in coverage. This penalty is for a year. After which, I’m assuming if the person was sick, then he/she would be moved to the high-risk pool. Trifling with those darn details again.

Tax Credit. Obamacare provided subsidies to those who qualified to reduce the cost of healthcare insurance. The monies were technically called APTC. Which means Advanced Premium Tax Credit. For simplicity’s sake, the government paid a tax credit prior to you filing your taxes in the form of a payment to the insurance carrier of your choice. The AHA includes a tax credit component as well. This tax credit, unlike the ACA, is not based on income but on age. The younger you are the less “credit” you get. The amount of credit you receive is solely based on your age. Here is a sub-bullet. Under the ACA the carriers were restricted on how much they could vary premiums by a ratio of 3 to 1. Essentially, an elderly person can only be charged 3 times the amount a young person is charged. Under the AHA, that multiplier is increased to 5. Consequently, the “tax credit” for an older person is not 5 times that of a younger person. Ol Satan has raised his ugly head in those details again.

Medicaid Expansion. How big do you want Medicaid to be? In order to get a basic understanding of this we need to know what and who qualifies for Medicaid. Medicaid is healthcare for low income people, to put it simply. Prior to the ACA-Obamacare the only citizens that were eligible for Medicaid were pregnant mothers, impoverished children, the elderly and the disabled. Under Obamacare the qualifications were “expanded” to include those who are beneath 100% FPL. See how quickly we got in the weeds? That means if your income is below the Federal Poverty Level you were eligible to receive Medicaid benefits. Under the new law the dollars given to the states to manage the Medicaid population are no longer based on the number of eligible individuals but is bloc granted. Translation: the states are given a set dollar amount and they have to work with what they get regardless of the size of the population.

In summary, this is a decent attempt by leadership to get a hold of our monster of a healthcare system. I’m really having a hard time keeping this apolitical at this point. But I’m a professional. Some of the solutions offered are viable. Others not so much. We will see if our legislative process will weed out the measures that are untenable. I will keep you posted as we learn more.

The post AHA! first appeared on GGC Group.

We read all the headlines about the failed effort to repeal and replace. Some of us rejoiced, others lamented. Regardless of your political ideology we agree our healthcare industry is crippled in our country. Lawmakers have an obligation to do something to improve the choices that are available. In some counties, here in Texas there is only one insurance company on the exchange. That is contrary to an objective of the law, which was to provide choices.

Secretary Tom Price, MD was asked in an Appropriations meeting what steps HHS was going to take considering the defeat of the American Healthcare Act. His responses were telling. It is obvious he did not wish to say anything that would further destabilize the insurance markets.

1. Mandate remains. That’s right! Don’t mistake the excitement. I am not in favor of the government taking my hard-earned dollars. However, I am in favor of sensible means to encourage people to take care of their responsibility. Love it or hate it the penalty encourages people who would not otherwise purchase insurance. And for the obstinate, dollars are collected to pay the bills for those who cannot pay or neglected to pay.
2. What about the money? Will the government continue to fund the subsidies you ask? In a word, yes. When asked regarding the subsidies Secretary Price expressed concerns about destabilizing the market. He also mentioned that more insurers would leave the market if the federal funding was not in place. In fact, the CEO of Molina said that premiums would rise by at least 25% if the government did not fund the program.

• Cheaper Prices. One potential “good” thing is there is a chance the insurers would be allowed greater flexibility in the kinds of plans they can offer. Remember “good” is relative. Under current interpretation of the ACA/Obamacare there are ten essential health benefits that every plan must include. Every plan is a comprehensive plan. That is one variable that has driven up the costs of insurance. There is no such thing as a “skinny plan” under the current law. My skinny friends and I quietly take offense. That’s why cheaper, less comprehensive options were phased out after 2010. Secretary Price has said he will determine what is “essential” leaving the door open for lower cost plans, that cover less.

Now if they would just negotiate with the pharmaceutical companies, fund a high-risk pool (sick people insurance), expand Medicaid into the states that haven’t and throw the carriers a bone so they will expand their networks, then we might have a decent system. And if it was that easy it would already be done. In the meantime, let’s keep our ears peeled to be abreast of the situation. “You know we got to find a way. . . to bring some loving here today!”

The post “What’s Going On!” Marvin Gaye’s Commentary on Healthcare first appeared on GGC Group.