The Fear Before Now

Health insurance used to be hard to get and expensive.  It is no longer hard to get health insurance, but it certainly is expensive.  In that health insurance is the way most Americans access and pay for their health care, it was very important to make it easier for us to become insured.

Too many of us forget what it once was like to purchase insurance.  In ancient times, pre-2014, your agent would ask you questions about your health, occupation, driving record, and hobbies.  If you needed coverage for a spouse or children, we needed all of that information on each of them, too.  As you can imagine, there were plenty of adults with Diabetes (Type 1 or 2), cancers, and sports injuries that either prevented them from acquiring coverage or resulted in higher premiums.  Some policies waived (excluded) preexisting conditions.  Some policies accepted an individual and his/her preexisting conditions after extensive conversations with the underwriters and the insurer had collected all of the pertinent medical records.

Insurance companies hate preexisting conditions, the difference between a risk and a certainty.  Children were an agent’s biggest challenge.  Ask any agent.  We remember the children we fought to cover.  There were children, sometimes babies, with cystic fibrosis, heart conditions, and even adolescents with ADHD.  We fought and we fought and most of the time we succeeded at finding the families health insurance.

No one wants to be responsible for the payment of the costs associated with preexisting conditions.  Not even the government.  Today’s proof comes courtesy of The Military Times.  The Pentagon has confirmed a recently released memo that stated that any recruit who has been diagnosed as having had COVID-19 will be permanently disqualified.  Permanently.  We have no idea what costs may be incurred 5, 10, or even 20 years from now by those who survive the Coronavirus.

We used to worry about getting insurance once we contracting an illness or suffered an injury even if we had a complete recovery.  That fear was real.  Now, thanks to the Patient Protection and Affordable Care Act (Obamacare), we no longer have that concern.  That could change if Donald Trump and 18 Republican governors have their way.

This blog has extensively covered the Texas lawsuit, the effort to declare Obamacare unconstitutional which would eliminate coverage for preexisting conditions and throw our entire system into disarray.  This past Wednesday was an important milepost, the last day for the Trump administration to disengage from the case as it heads to the Supreme Court.  Instead, President Trump said, “We want to terminate health care under Obamacare”.  What would happen if he is successful and Obamacare destroyed?  He has no idea.  What is his alternative, his replacement for our current system?  Trust him, it will be great.

Senator Lamar Alexander (R-TN) was interviewed by Chuck Todd on Meet The Press (5/20/2020).  The Senator expressed disappointment that Trump decided to stay a part of the lawsuit.  It was one thing for Senator Alexander and other Congressional Republicans to cast dozens of meaningless votes to dismantle Obamacare.  It is entirely different to actually be a part of an action that could succeed in harming millions of Americans.

It is amazing that Texas, with almost 25% uninsured, the highest in the country, wants to impose its success on the rest of us.

States suing to immediately end the Patient Protection and Affordable Care Act:

            Texas                                 Alabama

            Arkansas                            Arizona

            Florida                               Georgia

            Indiana                              Kansas

            Louisiana                           Mississippi

            Missouri                            Nebraska

            North Dakota                    South Carolina

            South Dakota                     Tennessee

            Utah                                  West Virginia

These states were part of the lawsuit, but dropped off:

            Maine                                Wisconsin

States defending the Patient Protection and Affordable Care Act (initial filing):

            California                          Connecticut

            District of Columbia          Delaware

            Hawaii                               Illinois

            Kentucky                            Massachusetts

            Minnesota                         New Jersey

            New York                           North Carolina

            Oregon                              Rhode Island

            Vermont                            Virginia

            Washington

These states joined in the defense:

            Colorado                           Iowa

            Michigan                           Nevada

Data courtesy Center on Budget and Policy Priorities

There was fear before now, the fear that we would not be able to get health insurance for ourselves and our families due to a preexisting condition.  It was real.  The question, now in the middle of a pandemic, is whether that fear is about to return.

DAVE

www.cunixinsurance.com

Picture – The Other Side Of The Fence – David L Cunix

How Do You Spell HSA?

Spelling was my Achilles Heel.  I couldn’t spell.  I even got a D in spelling on a report card!  And whether I was at home or school, when I asked an adult how to spell a word I would inevitably get the same answer, “Look it up”.  Looking up a word in a dictionary, decades before AI, meant that you took your best guess, failed, and kept on trying until you bumped into the correct spelling.  It was not efficient.  There was one benefit to this exercise.  Opening up a dictionary was like handing me a car with a full-tank of gasoline and access to the freeways.  There were no dead-ends or wrong turns.  And reading a dictionary was far more interesting than whatever project I had been assigned.

Our computers and phones now have spellcheck.  The big dictionary has been replaced by Google, Alexa, and Siri.  The information you need is at your fingertips or by simply asking your electronic assistant.  So I was very surprised when one of my life insurance clients recently asked me some questions about Health Savings Accounts (HSA).  I told him that the information was readily available and that I had covered this on my searchable blog.  He had little interest in reading the blog(!) and felt that I should put the information into a useable format for him and some of his friends and coworkers at a local large business.  I wrote him a letter.  Not only did I answer his questions he even insisted that I create a special page for this on my website.  Instead, I will just post the letter as part of today’s blog.

April 21, 2020

Dear Roger (Name changed so that my attorney can sleep at night):

It is important to remind you, up front, that I am an insurance agent not a CPA.  You should consult with your professional tax preparer about whether or not anything is deductible for you.  The information I am providing is based on my understanding of how these insurance policies impact my clients’ taxes.

The term H.S.A. is normally used to refer to two very separate things.  Part One is a High Deductible Health Insurance Policy.  Part Two is a Health Savings Account.  You can have Part One without Part Two.  You cannot have Part Two without Part One!  This is very important and has been an area of confusion.

A High Deductible Health Insurance Policy (HDHP):

·         For 2020, the IRS defines a high deductible health plan as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family. An HDHP’s total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can’t be more than $6,900 for an individual or $13,800 for a family. (This limit doesn't apply to out-of-network services.)

·        All covered services must apply to the deductible prior to any copays or coinsurance.

·        The exception has been Preventive Care performed by a network provider.

·        A recently added exception is the diagnosis and treatment for COVID 19 which will be covered without deductible, copayment, or coinsurance.

·        It has been generally ruled that even telemedicine, other than for COVID 19, cannot be provided free or with copayments until the deductible has been met.

Once you have an HDHP, whether it is an individual policy or an employer sponsored group contract, you may open a Health Savings Account.

·        An HSA may be opened through an insurer, a bank affiliated with an insurer, a bank, or an online HSA bank

·        The employer may contribute $0 to the annual maximum

·        An individual or employee may contribute between $0 to the maximum

·         The annual maximum is the same regardless of who is contributing

·        The maximum contribution for 2020 is $3,550 for an individual and $7,100 for a family.

·        The catch-up contribution limit for those over age 55 will remain at $1,000.

Medicare:

A friend of mine, an attorney, had a couple of quick questions about Medicare.  He will be turning 65 soon and needed to confirm that he didn’t have to sign up for Medicare Part B since he plans to stay on his wife’s group health policy.  I verified that his wife works for a company with over 20 employees.  So yes, he doesn’t need Medicare Part B.  But, I asked, is the group plan a High Deductible Health Savings Account (HSA) Qualified Policy and do you contribute to the HSA?  He confirmed that Yes and Yes.  In that case, he must renounce Medicare Part A, too.  You cannot contribute to a Health Savings Account if you have Medicare.  In fact, there is a six month look-back.  He didn’t know.  And if an attorney could have accidentally screwed this up, what are the chances that your average office worker or machinist couldn’t make the same mistake?

The Medicare issue is particularly troubling.  The HR departments do not discuss this with employees.  I have talked with Senator Brown’s office about this. They have looked into correcting this, but there are not enough people pushing on this to see action anytime soon.

I hope that this answers your questions about High Deductible Health Insurance Policies and Health Savings Accounts.

The good news is that now, if you search this blog or ask Google, you might come up with this information.  The bad news is that you won’t spend an hour or two getting lost on other tangents learning all kinds of interesting stuff you wouldn’t otherwise know.

DAVE

www.cunixinsurance.com      

Picture – Old School – David L Cunix

A Tool, Not A Weapon

The Patient Protection and Affordable Care Act (Obamacare) was designed to be a tool, a way to improve healthcare in our country and the health insurance that provides the access and payment for that care.  It certainly wasn’t a great tool.  This blog has detailed many of the PPACA’s flaws and shortcomings, but the goals were always about more care for more people.  Through the last ten years many Americans paid less per month for comprehensive coverage and, unfortunately, many Americans have paid more.  There certainly were ways to improve the law.  Few were ever tried.

As previous national health insurance programs that were designed to cover preexisting conditions such as Medicare Part A, Part B, and even Part D (Rx), the PPACA requires individuals to enroll in a timely manner.  Left to their own devices, many people would delay purchasing insurance until they had an immediate need.

Obamacare has an Open Enrollment Period that currently runs from November 1^st to December 15^th each year.  It used to be a lot longer until the current administration shrunk it to only six weeks in 2017.  There are also Special Enrollment Periods available to Americans who have involuntarily lost their coverage.  The combination of Open Enrollment and Special Enrollments usually meets most people’s needs.

These are not usual times.  States that run their own insurance exchanges have recognized the need to hold an emergency Open Enrollment Period to meet the insurance requirements of their citizens.  Other states, like Ohio, utilize the federal government’s healthcare.gov.  The federal government, read President Trump, is in a position to be a help or a hindrance.  Will Ohioans have an emergency Open Enrollment?  NO!  Donald Trump is happy to convert a tool into a weapon.

Here are some of the people who might benefit from an emergency Open Enrollment:

·         People who never bothered to purchase insurance

·         People who missed the shorter open enrollment period

·         Ohioans who purchased short term major medical and now want comprehensive coverage

·         Ohioans that purchased comprehensive coverage directly from the insurer.  Example – I have a client in her late 20’s.  She is a mechanical engineer making $55K per year.  Since she wouldn’t qualify for a tax credit subsidy, we didn’t have to go through the Exchange to get her policy.  That saves her time and money.  She lost her job.  Too bad.  This doesn’t qualify as a SEP.  If we got the Exchange opened, I could get her a subsidy to help her.

·         Individual policies are HMO contracts that can provide good LOCAL coverage.  If you live in Cleveland and send your child to school in Columbus or Denver or wherever, you will take the child off the Cleveland policy and buy a health plan for the school.  The schools are closed.  The kids are home.  We cannot put the child on the parent’s policy or offer the child a comprehensive policy to purchase.

There is only one reason to not have an emergency Open Enrollment.  By allowing citizens from across the country, many residents of battleground states, to purchase coverage, Trump would be admitting the value of the Patient Protection and Affordable Care Act, the law he is actively trying to invalidate.  His support of the Texas lawsuit which would rule the PPACA unconstitutional and eliminate coverage for, among other things, preexisting conditions has gone virtually unnoticed by the general public.  Much like the Coronavirus, many Americans will ignore the implications of the Texas lawsuit until in impacts them directly.  And again like the virus, when they lose their health insurance coverage it will not be dissimilar to being isolated on a ventilator at the end of a darkened hall.

Without a whole lot of thought or planning, Mr. Trump recently announced that the uninsured would have their COVID 19 related bills covered.  When pressed he declared that the hospitals would have to accept the Medicare funding level, as if that was sufficient.   Worse, the president decided to take the money from the desperately needed funds just allocated to our nation’s hospital systems.  We are back to spending the same dollar a couple of times and hoping nobody notices…

We have tools.  In the hands of the right people, the federal government, in concert with the states and major cities, can marshal the professionals needed to treat our sick, work to reduce our risks, and insure our general safety.  All we need are people who understand how to make our system work for us.  And, we need someone who doesn’t want to convert a tool into a weapon.

DAVE

www.cunixinsurance.com

Picture – Taking A Hammer To The Level - David L Cunix

PSA

Time for a quick Public Service Announcement from Health Insurance Issues With Dave:

By now almost all of us accept that the Coronavirus threat is real.  The two ways we can protect ourselves and others is to wash our hands properly for a full 20 seconds and to stay home as much as possible.  It turns out that lots of people are asymptomatic and capable of infecting others for days before they start coughing and/or running a fever.  It is important that even though you need to maximize social (physical) distancing, you shouldn’t let this force you to minimize social interaction.  My friend John in New Orleans, a veteran of Hurricane Katrina, has expressed to me his concerns about the mental health implications of both the virus and the necessary lockdown.  Stay connected.  Your friends, your family, and even your co-workers miss you.

The insurance companies have a variety of resources for all Americans, not just their clients.  Aetna has an excellent information post about coping with the obvious and reasonable fears that we are all experiencing with the Coronavirus pandemic.  This link is worth a couple of moments of your time.

Oscar has created a personal risk assessment survey that is available to both their clients and the general public.  This survey is no replacement for a test, but you will find it useful.  This is a reminder that the more information you have the better chance you have to protect yourself.

The federal government reports, per Dr. Fauci and Dr. Birx, that if we do everything correctly between 100,000 and 200,000 Americans will succumb to COVID 19.   Mr. Trump considers 100,000 dead Americans a victory.  Let’s be clear, there is nothing special about being 1 out of 100,000.  Stay Safe.  Stay Healthy.

DAVE

www.cunixinsurance.com

Picture – A Quiet Place in Tennessee – David L Cunix

The Connections

         The Lakota universe can be described as Mitakuye Oyasin.

         That means that everything is connected,

         Interrelated, and dependent in order to exist.

                     The universe includes all things that grow,

                     things that fly-everything you see in the world

                     or the place that you walk on.

         These are all included in what

         The Lakota see as the universe.

         All of this is related.

                     Robert Two Crow, Community Curator, 1999

For every action there is an equal and opposite reaction.

         Newton’s Third Law

                    

Your car has a group of idiot lights that alert you when the vehicle needs service.  If the tires need air, a light comes on.  When the car needs gas, a different light comes on.  Time for an oil change?  There is a light for that, too.  Until now there hasn’t been an idiot light to warn the American public that our health care system is under attack.  Until now.  On Monday the U.S. Supreme Court agreed to hear Texas v. U.S., the lawsuit that could dismantle the Patient Protection and Affordable Care Act (Obamacare).  The red light is on.

The 974 pages of the PPACA touch every aspect of how Americans access and pay for health care.  It is far from perfect.  It did not even do everything it set out to accomplish.  But millions of Americans have benefited from:

·   Coverage for preexisting conditions

·   Policies that are guaranteed issue

·   Maternity treated the same as any other condition

·   Children covered till age 26 on a parent’s policy

·   Medicaid expanded to cover the working poor

·   No maximum benefit

Successive Republican Congresses and the current administration have promised something better.  There have been over 60 votes to repeal the law.  The Supreme Court has upheld the law twice.  Donald Trump promised that he would cover everybody with a plan that would cost less and provide better coverage.  After he was elected he said, “Nobody knew health care could be so complicated”.  No sir.  Everybody knew but you.

Eliminate the law and you eliminate our protections.  Amend the law, improve the law and we retain the benefits Americans need and have come to expect.

This is all connected.  The Individual Mandate was designed to enlarge the pool of insureds.  We can’t build a health care system based on the sick and responsible.  The 23 year old woman might get pregnant.  The 63 year old man might develop prostate cancer.  And any of us could fall victim to the Coronavirus or countless other risks.  An efficient health care system must collect enough money to be prepared for the illnesses and accidents that inevitably strike all humans.

Few of us could ever pay all of the costs associated with our health care.  So whether or not we wish to admit it, we are connected.  The Texas lawsuit doesn’t end the connection, just our current method of addressing the costs.

There aren’t any viable alternatives on the table.  Russell Voight, Trump’s Acting Office of Management and Budget Director, was asked last month during his Congressional testimony about the president’s health care plan.  “The president is working on his own plan that we’re not yet ready to reveal.”  This plan is as non-existent as his pre-election plan.  Your preexisting conditions are real.  His plans are not.

The Supreme Court will hear oral arguments this summer, but it is unlikely that a ruling will be issued prior to Election Day.  The red is flashing.  The invalidation of Obamacare, ruling that the Patient Protection and Affordable Care Act is unconstitutional, would cause immediate irreparable chaos.

For every action, there is an equal and opposite reaction.

DAVE

www.cunixinsurance.com

Picture – The Lakota Universe – David L Cunix.  This is part of the exhibit at the National Museum of the American Indian, Washington DC.

Clean Hands

A friend of mine, an attorney, had a couple of quick questions about Medicare.  He will be turning 65 soon and needed to confirm that he didn’t have to sign up for Medicare Part B since he plans to stay on his wife’s group health policy.  I verified that his wife works for a company with over 20 employees.  So yes, he doesn’t need Medicare Part B.  But, I asked, is the group plan a High Deductible Health Savings Account (HSA) Qualified Policy and do you contribute to the HSA?  He confirmed that Yes and Yes.  In that’s case, he must renounce Medicare Part A, too.  You can not contribute to a Health Savings Account if you have Medicare.  In fact, there is a six month look-back.  He didn’t know.  And if an attorney could have accidentally screwed this up, what are the chances that your average office worker or machinist couldn’t make the same mistake?

Capitol Conference, the annual opportunity for members of the National Association of Health Underwriters to hear from members of the administration and meet with our elected officials, was the last week of February.  Fourteen of us from Northeast Ohio were part of the audience of over 700 that heard from Seema Verma the Administrator of the Center of Medicare and Medicaid Services (CMS).  House members Lauren Underwood (D-IL), Joe Courtney (D-CT), Greg Walden (R-OR), Kurt Schrader (D-OR), Adrian Smith (R-NE) as well as Senator Todd Young (R-IN) shared their views on pending legislation.  The speeches were interesting, the graphs (!) colorful, but the most important part of our annual trip to Washington are our scheduled appointments with our Congressman and Senators.

For many of us, our favorite appointment each year is with Abby Duggan, Senator Sherrod Brown’s legislative aide.  We appreciate that she is well prepared and that Senator Brown has shown a real interest in some of our issues.  Ms. Duggan has acknowledged that we come with “Clean Hands”.  Our issues – Surprise Billing, Employer Reporting, and the big Medicare concerns dealing with the Observation Trap, COBRA as Medicare compliant, and HSA's – have nothing to do with our incomes.  We are here to solve problems, to represent our clients.

Senator Brown is the sponsor of S. 753 which would allow observation stays to be counted toward the three day mandatory inpatient stay for Medicare coverage of a skilled nursing facility.  This happens to be one of our priorities.

We talked about the Medicare COBRA and HSA issues in Senator Brown’s office three days before my friend asked his questions.  H.R. 2564 and H.R. 3796 address these problems.  Our members discussed these bills with every Congressman and legislative aide we met.

Our #1 issue was Surprise Billing / Balance Billing.  As Congressman Walden noted, 1 in 5 emergency room visits and 1 in 6 hospital admissions produce a Surprise Bill.  We’ve discussed and defined Surprise Billing in previous posts.  Our goal is to take the unsuspecting client out of the equation and to focus on reimbursement being tied to the median in-network amount determined by reasonable, contracted amounts paid by private health plans to similar providers in a geographic area.  Obviously, we don’t want our clients forced into arbitration.

Our friends and clients count on us for good advice and to be alert to their needs.  Our periodic trips to Washington and our state capitols allow us to work with our elected officials to make health insurance, the way most Americans access and pay for health care, better.  We carry with us two messages wherever we go.  All health care is local.  And, we are all on the same team.

DAVE

www.cunixinsurance.com

Pictures – Looking For Something To Read At The Library Of Congress – David L Cunix

And – A Plane Washington – David L Cunix

February 4, 2020

Morning Joe broke for a commercial moments after I had turned on the television.  The first ad was from You Know Who, one of the largest marketers of insurance in this country.  They don’t like to admit that they sell insurance.  They prefer to advertise that they endorse certain products.  Yeah. Yeah.  In this day and age of 10 second and 20 second spots, this one full minute Medicare Supplement advertisement felt like a documentary.  As soon as that commercial ended, a new ad, from a different company began.  This one featured a former football star, 40+ years past his glory, pitching all of the free stuff that came with some unnamed Medicare Advantage policy.  The 30 second commercial for Tylenol was a welcomed relief.

I turned 65 today.  That stack of junk mail pictured above is a small fraction of the solicitations I’ve received in the last year.  One company, You Know Who, has been sending stuff to both my home and office.  As an official old person, I find that the television shows that I watch seem to be sponsored by medications, investment companies, and Medicare products.  The newspaper, yes I still get the Plain Dealer delivered, has envelopes inserted for Medicare products.  I sometimes watch football just to be a part of a different demographic.

I had a doctor’s appointment this morning.  My first on Medicare.  I presented my Medicare Card and my Medicare Supplement Card.  I won’t mention the company since I don’t want this to be seen as a recommendation of a particular insurer.  My previous coverage was a Grandmothered $5,500 deductible HSA qualified policy with Anthem Blue Cross.  My January premium was over $800.  My new Medicare premium for a Plan G contract is around $125 per month and my deductible for Part B services is $198!  The doctor’s staff gladly accepted my Medicare Card.  I now have the best, most comprehensive insurance I’ve had in almost 30 years.  And I am covered in all fifty states.

There are people who misuse the word Medicare and apply it to a very different type of coverage, to a policy that covers 100% of everything.  That isn’t Medicare.  That is a fantasy.   Medicare, with its deductibles and copayments, was designed to pay approximately 75% to 80% of a beneficiary’s medical bills.  But just as some long to make Medicare even more comprehensive, there are others trying to weaken it.  As noted in a recent post, the Association of American Physicians and Surgeons is still fighting the existence of Medicare fifty-five years after its creation.  And Mitch McConnell has targeted both Social Security and Medicare for cuts after the next election.  The impact this could have on those reliant on these programs is beyond comprehension.  Some might caution that we should first wait to see the results before we raise our concerns.  But those are the very same people who would have repealed the Patient Protection and Affordable Care Act without any replacement.

My health insurance, the way I will access and pay for care, changed last Saturday.  I am now on Medicare.  But my concern, and the concern of other insurance agents around this country, is unchanged.  We are here to make this system work.  And as our system changes, to make that new one work, too.  About 1,000 of us will be in Washington at the end of this month to meet with members of this administration, the House, and the Senate.  Now is the time to let us know your thoughts and your concerns so that we can share them with the people who write the rules.  That, too, is part of our job.

DAVE

www.cunixinsurance.com

Picture – Junk Mail – David L Cunix