Thursday, March 24, 2011

PPACA at 1

March 23, 2011

It has been a full year since the Patient Protection and Affordable Care Act was signed into law. A lot has changed in the last year. Were any of those changes good for you?

In the last twelve months:
* Insurance Rates have increased.
* Changed and new policies now cover preventive care without copays or coinsurance.
* Children, Only policies were taken off the market.
* People who have significant preexisting conditions and who have been uninsured for over six months can purchase coverage.
* The Democrats lost the House of Representatives and a large number of state houses.

Confusion and uncertainty have dominated the last year. Polls show that a majority of Americans dislike the PPACA, but a majority also dislikes the Republican’s plan to repeal the law. Much like Iraq, the public doesn’t want to be here, but is afraid to leave without a plan.

A Plan. The government doesn’t have any idea how to reform the payment and delivery of healthcare. The people in charge do not appear to be up to the task. And, do all of our so-called leaders have clean hands? Are we being provided an accurate view of the problem and the possible solution?

Vice-President Biden sent an email today to me and millions of other Democrats. He was eager to celebrate this anniversary. The bulk of the email was the story of a young child born with significant health problems. According to our VP, the family is no longer worried about the child’s future due to the passage of this legislation.

I am glad this child’s parents are no longer worried. Of course, if the child is really that disabled, he would qualify for SSI benefits and his health would be covered by the government or the parent’s policy. Nothing changed.

Only in government is over-promising and under-delivering a given.

It has been a year. The Doc-Fix and the 1099 Problem are still unresolved. The Individual Mandate might not be constitutional. The Democrats and the President are stalling in the hope that the PPACA will become accepted, if not loved. The Republicans made a faint attempt at repeal and then returned to their #1 focus, abortion. Regulations and rules are now in the hands of the bureaucrats. The final result may be as clean and organized as the tax code.

The PPACA link in today’s blog is the current amended version of the legislation as of December 10, 2010. Millions have been squandered by insurance companies and major employers attempting to comply with the ever-changing regulations. Those costs will be passed along to you in higher prices for insurance, food, and other necessities.

We can only hope that there will be more clarity and an actual plan by this time next year.


Sunday, March 13, 2011

A Clean Bill Of Health

Before we begin this next installment of Health Insurance Issues With Dave, we must briefly mention New Hampshire State Representative Martin Harty. When confronted by constituent Sharon Ormond about planned cuts in local mental health, Representative Harty opined that “there are too many defective people”. He went on to express his wish that we could ship the disabled, the retarded, and people with physical disabilities to Siberia.

Yes, Representative Harty is a fershimmeled 91 year old. Yes, he will serve one, and only one, term. I bring this up to again note that the moment health care is placed into the hands of politicians; the good, the bad and the Harty’s, medical treatment is politicized.


I had my annual physical this week. I ran in Tuesday morning and had my blood drawn. On Wednesday I spent over a half an hour with Dr. Ken Goodman who performed a thorough exam and an EKG. Let me brag for a second. The results were excellent. The costs for all of this, however, may surprise you.

I haven’t seen this year’s bills yet, but I have last year’s. Last year the Cleveland Clinic billed me and Medical Mutual of Ohio $802.78. MMO has a contract with the Clinic, so they only paid $417.13. I was left with a bill of $32. That is my policy. Technically, preventive care exams are completely covered on my policy, but the Cleveland Clinic always runs a blood test that isn’t part of the package. So I am always left with a small charge.

Many of my clients have similar coverage. Many, but not all. The new law, the Patient Protection and Affordable Care Act, has changed that. All non-grandfathered health insurance policies now cover preventive care completely. How will that impact your policy?

In the simplest of terms, we are adding $417 to $803 of claims and the cost to process the paperwork to your policy. That is up to $67 per month. You and I understand that that will have an impact on your premium. It is true that only a fraction of Americans will take advantage of their free physicals. So you can get yours and hope that all of your friends skip theirs.

The federal government operates in a parallel universe. Their numbers are far different. The Department of the Treasury released interim final rules and regulations on July 19, 2010. This link takes you to thirty plus pages of the Federal Register. Section 5 details Costs and Transfers.

The government determined that individuals with employer-sponsored insurance have, on average, $264 in covered preventive care services. Of that, $240 was paid by insurance and $24 was paid by the patient as a copayment. Making this change, mandating that the exam is totally free, will only result in a $24 shortfall.

My exam, which doesn’t cover all of the stuff that falls under the new law, was a lot more than $264. Yours will be, too. That’s a gap of at least $153. If your current plan covered less than $264 of preventive care, or even no preventive care at all, your gap is much higher. Who will be charged for your free physical? You, of course, will be funding your free exam through higher health insurance premiums.

I believe in the value of routine physical exams. I have been poked and prodded annually for over twenty years. I also believe in routine auto maintenance and oil changes for my cars, but I don’t expect State Farm to cover them. I made a conscious decision to purchase a health insurance policy that includes preventive care. I chose to pay extra.

I believe that you are smart enough to make your own decisions, too. But, the government believes that the benefits of an annual exam, especially the opportunity to have a doctor educate you on the dangers of smoking and obesity, are too important to leave to chance. OK. Sell that.

It is time for the government to explain to the American people how much this program is going to cost us. The answer is not $24. If this really is beneficial, if it is truly warranted, the facts will win out. I believe in the American people. I trust our judgment. We will spend money if we understand why it is in our best interest. But the PPACA has been sold to us as a way to lower our costs and premiums.

That is clearly not true.

My numbers were great. Blood Pressure – 107/74! Resting heart rate of 65. No medications. Anticipated bill - $35. I hope your numbers are just as good, if not better. Diet and exercise can help to control your blood pressure. There may be no way to control that last number, the cost, under the new legislation.


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