33 days and counting

October 1st is fast approaching, the day Health Care Reform enrollment is set to open for all of America. The information we've all been waiting for is beginning to trickle out. Agents/Brokers are some of the first to learn what the plans and rates are going to be.

A new Rasmussen poll of over 1,200 American adults showed that 44% of those interviewed are not aware that the Affordable Care Act is the law of the land! Is there any doubt why the government is investing nearly 3/4 of a Billion dollars in ad campaigns to educate/sell people about the facts of life?

This week three of the four carriers offering coverage in the Health Insurance Exchange have held training sessions for agents/brokers - Premera Blue Cross, LifeWise Health and Regence BlueShield (to be known as Bridgespan in the HIX). Group Health is next week.

There are other carriers that will be selling plans outside the HIX but a huge percentage of Americans will be shopping inside the HIX in order to take advantage of the tax credits. In Washington State it is estimated that 800,000 citizens will be shopping for new health insurance inside the HIX. I stand ready to help everyone.

First off, the plan designs, while complicated, look much better than most of us thought. Second, the filed rates (approved by our State Office of Insurance) are yet to be certified/qualified by the Federal government. However we are confident the rates we've seen will be certified by HHS. And the rates are higher that most people have been paying but not nearly as high as rates in other states.

Enrolling to a plan is both easy and difficult. Filling out the form online or on paper should be fairly easy for most of us. Choosing the right plan for your family may prove to be difficult. Even though there are very few insurance carriers offering the new plans, there are more than thirty (30) options. Before you choose, contact a certified agent/broker for assistance. There is no fee, no extra premium for the help of a trained and licensed agent/broker.

By the way, the "navigators" hired by the government are able to only help you complete the application. A navigator cannot opine on the differences between plans and it is illegal for a navigator to help you select the right policy for you and your family.

Wherever you live as you read this, be sure to contact an agent/broker nearby. In Washington State, feel free to contact me, Richard Ek.

What wil hospitals do about deadbeats?

By Dan Cook

August 19, 2013

Leading hospital associations appear to be on a collision course with health insurance providers over payment of insurance premiums.

One of the major concerns insurers have is whether the millions of individuals who buy insurance when the Patient Protection and Affordable Care Act (PPACA) kicks in will be able to send in a premium check promptly every month.

Many of those who will buy coverage through state exchanges and other avenues haven’t had coverage in the past because they couldn’t afford it. Now, PPACA will essentially require these folks to buy insurance or pay a fine. But will they consistently be able to pay?

The Obama administration originally suggested these newly insured should have a three-month grace period prior to having their policies canceled. But under pressure from insurance companies, the cutoff period was sliced to 30 days.
Hospitals don’t like that. So the American Hospital Association, the Federation of American Hospitals and the Association of American Medical Colleges penned a letter to the Centers for Medicare and Medicaid Services arguing for a return to the three-month grace period.

While they began by defending the longer grace period as a compassionate helping hand to “low-income individuals … who may experience temporary difficulty in paying premiums,” they’re also worried about their own pocketbooks.

“CMS’s approach also unfairly burdens providers who treat these patients because they will not get paid by the (insurance company) for covered services and will have to wait to try to obtain direct payment from the patient,” the hospital groups wrote. “The reality is that it will be extremely difficult to collect payment from low-income patients who already are having trouble paying.”

A picture is worth 2,500 pages

Hope 'n' Change: The Planned Failure of ObamaCare

In a rare press conference Friday (August 9, 2013), Barack Obama again defended his crumbling and unpopular health care law, boasting of a handful of goodies in it that people will supposedly enjoy. Those include insurance for "children" up to age 26 under their parents' plan, rebates for unspent premium money, subsidies for those who can't afford insurance (subsidies no longer to be verified against income) and don't forget "free preventive care, mammograms [and] contraception." Ah yes -- "free." Predictably, Obama blamed the GOP for the law's failures, because, "The one unifying principle in the Republican Party at the moment is making sure that 30 million people don't have health care."

Actually, according to the Congressional Budget Office, ObamaCare itself ensures that 30 million people won't have health care. Oops.

The list of problems with the law's implementation only gets longer, too. As we've previously noted, Obama unilaterally delayed the mandate that employers provide health insurance to employees. "I didn't simply choose to delay this on my own," he insisted Friday. "This was in consultation with businesses all across the country." Oh, he gained constitutional authority for delaying enforcement of part of a law after "consultation with businesses." We didn't realize that's how presidential authority was secured, but we imagine if a Republican is elected in 2016, he'll quickly gain support from businesses for scrapping the whole law.

Next, individuals are supposed to be able to buy health insurance over state exchanges on the Internet, similar to Expedia or other travel sites. But development is behind schedule meaning that critical security testing won't begin in a "beta" phase with a few users -- it will happen on opening day for everyone.

Likewise, training for the "navigators" who will help people sign up for these exchanges is not going well. Just three weeks ago, the administration said that 30 hours of training would be sufficient for these people to understand the monstrously complex law, but now they say 20 hours will suffice. We wonder if their training will be anything like what IRS agents received before the 2012 election -- how to delay and frustrate political opponents. Indeed, they'll have access to citizens' sensitive health records, and the order has already gone out to charitable hospitals that treat uninsured people.

Despite all this, James Clyburn (R-SC) boasted, "The fact of the matter is, [Democrats] will be running on ObamaCare in 2014. In fact, we set it up to run on it in 2014."

They may run on it as-is for now, but their real goal is a single-payer government system. Hence the planned shortcomings of the current plan. Senate Majority Leader Harry Reid (D-NV) gave away the game, saying, "Yes, yes. Absolutely, yes," we will eventually scrap an insurance-based health system. "What we've done with ObamaCare is have a step in the right direction, but we're far from having something that's going to work forever," he said. "Don't think we didn't have a tremendous number of people who wanted a single-payer system."

Conservatives must keep up the fight.

55 Health Care Reform Acronyms

As you begin to wade through the health care reform pool of jargon, here are some tips that may make things go better. Remember, a licensed and certified agent, especially this one, is ready and willing to help.

	What it Stands For
ACA	Affordable Care Act
ACO	Accountable Care Organization
ADA	Americans with Disabilities Act of 1990
AHO	Accountable Health Organization
APTC	Advanceable Premium Tax Credit
ARRA	American Recovery and Reinvestment Act of 2009 ("Stimulus Bill")
AV	Actuarial Values
BHP	Basic Health Plan
CHIP	Children’s Health Insurance Program, enacted 1977
CHIPRA	Children’s Health Insurance Program Reauthorization Act of 2009
CMS	Centers for Medicare & Medicaid Services
CO-OP	Consumer Operated and Oriented Plan
ECP	Essential Community Provider
EHB	Essential Health Benefits
EHBP	Essential Health Benefits Package
EHR	Electronic Health Record
ESI	Employer Sponsored Insurance
FEHBP	Federal Employees Health Benefits Program
FFS	Fee-For-Service
FMAP	Federal Medical Assistance Percentage
FPL	Federal Poverty Level
FPL	Federal Poverty Level
FQHC	Federally Qualified Health Center
FR	Federal Register
FT	Full Time
FTE	Full Time Equivalent
GF	Grandfathered Health Plan
HCR	Health Care Reform
HHS	U.S. Department of Health and Human Services
HIE or HIX	Health Insurance Exchange
HIM	Health Insurance Marketplace
HIT	Health Insurance Tax
HIPAA	Health Insurance Portability and Accountability Act of 1996
HRP	High Risk Pools
HRSA	Federal Health Resources and Services Administration
IFR	Interim Final Rule
MA	Medicare Advantage
MAGI	Modified Adjusted Gross Income
MCO	Managed Care Organization
MEC	Minimum Essential Coverage
MedPAC	Medicare Payment Advisory Commission
MV	Minimum Value
OEP	Open Enrollment Period
PEPM	Per Employee Per Month
PMPM	Per Member Per Month
PPACA	Patient Protection and Affordable Care Act
PT	Part Time
PTC	Premium Tax Credit
QHP	Qualified Health Plan
RFP	Request for Proposal
SEP	Special Enrollment Period
SHOP	Small Business Health Options Program
SSA	Social Security Administration
SSI	Supplemental Security Income
TANF	Temporary Assistance for Needy Families program

There's a flag on the field

My letter to the Everett Herald published August 6, 2013

When a football player violates a rule of play the referee throws a flag, calls the infraction and applies the penalty.

When a basketball player elbows a player the referee blows his whistle points to the aggressor and applies the penalty.

When a baseball player gets caught running to the next base and a fly ball is missed or dropped, chances are he'll get thrown out before he retreats to the safe base. He's called out. Rules have been in place for decades and are followed to achieve fairness and maintain order. I get that.

Politics doesn't seem to work that way. Rules are broken, special rules are made up on the spot and the team manager gets to override the referee. And while the players and fans boo and call foul, the game continues. And nobody stops the game. Nobody calls the team manager to task. The fans and players are frustrated and the game loses its appeal. American justice is ignored.

So Congress passes by the slimmest of margins a massive takeover of one-sixth of the economy and forces all Americans to comply with an impossibly complex and confusing set of laws. No, wait, not all Americans must comply: The rule makers get a pass, and the largest contributors to the manager's bank account get a pass. Rules are violated and new ones are written by the manager in favor of his team.

There are flags all over the field and nobody stands up to halt play and apply the penalties. And nobody stops the game. Nobody calls the team manager to task. The masses are frustrated and the faith and confidence of Americans for the rule makers falls like a stone into the muddy waters.

Congress gets exemption from Obamacare via executive order

From the AP article today "Congress' health care examined" by Ricardo Alonso-Zaldivar.  Now Obama administration has decided this issue is too hot to handle so it's thrown it back to the the Congresscritters; telling them it's up to them to decide which employees should have an exemption from participating in the exchanges. However, the govt will still pay 70% of premiums but questions remain about residency definitions and retiree coverage.  Here's the laffer: "During the drawn out debate, Dems insisted their goal was merely to provide uninsured Americans with the same coverage and choices tha members of Congress have." Excuse me but the Congressional benefit plan bears no resemblance whatsoever to Obamacare. And if it did, there would be no debate since there would be no difference. So the OPM offers the following solution: "The new insurance markets start signing up people on Oct 1 for coverage effective Jan 1. OPM said lawmakers must decide the status of their employees before the end of the year." Ready, fire, aim. So what percentage of Congresscritters will enroll in Obamacare ? In the end, doesn't this run totally counter to the Grassley amendment requiring Congressional employees to enroll in Obamacare ? The Grassley amendment doesn't say the choice is optional but, by fiat, Obama's OPM acts as if laws are suggestions and the Executive Branch guidance trumps the law. By Michael Cadger Like • Comment • Follow Michael