Posts
10:05. Not Bad. I was right on time for my 10 AM appointment. It had taken me years to do this, to break my habit of arriving early, or at worse, exactly at the scheduled moment for certain clients who are always late. There is a certain comfort in predictability. If we have a chance to prepare, we can deal with almost anything.
Security – Consistency – Predictability
One place Americans beg for a measure of predictability is in the delivery of health care, especially for senior citizens. Sadly, the only consistency of late has been the unrelenting fear mongering delivered by both political parties. And my prediction is that there is no end in sight.
This blog has tackled Medicare numerous times over the last two years. The February 5, 2010 post includes a complete break-down of Medicare Part A and Part B. The Doc-Fix, Medicare Fraud, the need for private coverage, Medicare Advantage policies, and even hospital reimbursements have been addressed. There is no need to rehash any of that today.
Both the Democrats and the Republicans agree that Medicare needs help. Their only other area of agreement is the political value of Medicare. Seniors vote. Each side is willing to manipulate Medicare’s funding, physician reimbursements, and even plan design to garner those votes.
The Democrats have spent much of the last two years demonizing insurance companies. One of their favorite targets is the Medicare Advantage program. Instead of having traditional Medicare, plus a Medicare Supplement that may cost $150 a month or more, and a Medicare Part D (Rx) plan for another $50 + per month, a senior may choose a Medicare Advantage policy that might not cost him a penny. The federal government pays the insurer a set amount to handle all of the senior’s health bills. Medicare Advantage policies may include office and hospital co-payments.
The low monthly premium, or in many cases the total absence of premium, is very attractive to some seniors. In exchange, there may be a network of preferred providers and the possibility of lots of copayments should the senior require multiple hospital stays and doctor visits.
Medicare Advantage policies are not for everyone. Approximately eleven million seniors have chosen this option.
This administration has bemoaned the very existence of Medicare Advantage policies since they took office. Part of the President’s plan has been to cut funding for this program. This week the administration reversed itself and plowed an additional $6.7 Billion into Medicare Advantage.
You may have heard that there is an election next year.
The Republicans have dabbled in Medicare politics, too. Medicare Part D (Rx) was created, in large part, to insure the reelection of George W. Bush in 2004. Their new found interest on deficit reduction arrived long after they created this program.
Representative Paul Ryan is now talking about eventually moving all seniors into a voucher program. I have yet to see the details, but is sounds a whole lot like Medicare Advantage. The Democrats have already begun the campaign against this. They paint a picture of frail, elderly Americans forced to return to work to pay for their insurance. The Republicans are claiming that this is a necessary major step to controlling costs and reducing the deficit.
It is all great theater, but there is precious little truth in any of it. And, there is no security, consistency, or predictability. The cost of care, unaddressed in any of this, continues to rise. Our seniors, our medical providers, and even the insurers suffer from the uncertainty of this process.
If I could monetize frustration, I would be rich.
Instead, I just learned that my client forgot about our appointment. I only predicted that she would be late, not a total no show at her own business. Her employee and I just negotiated an appointment in my office at 2 PM.
I’m positive that she will arrive before 3.
DAVE
www.bcandb.com
Thursday, April 21, 2011
Thursday, April 7, 2011
The World's Worst Lobbyist
She was making a joke. It was her second joke/witticism in the last twenty minutes. And like the first time, I didn’t laugh. I’m not a good fake laugher. At least I smiled. Busted! She again noticed that I wasn’t laughing. Her protests may also have been attempts at humor. Oh well. I had no trouble convincing her that I was not an experienced lobbyist.
About seventy-five members of the Ohio Association of Health Underwriters were at the State House to voice our concerns about pending legislation. The Lieutenant Governor, Mary Taylor, who is also in charge of Ohio’s Department of Insurance, came to talk with us. Even Democrats like me appreciated what we heard as long as she didn’t stray from our particular area of concern.
Like any health insurance agent program, the day began with coffee, juice, and platters upon platters of cakes and pastries. The morning program consisted of several speakers who detailed Ohio’s attempt to deal with the Patient Protection and Affordable Care Act (PPACA), the new exchanges, and where we, professional insurance agents, fit into this evolving system. Next was lunch and another couple of speakers. By three o’clock we were more than eager to meet with legislators for our pre-set appointments.
There were heavy hors d’oeuvres and cocktails waiting for us at the five o’clock finish line. Being a health insurance agent isn’t necessarily healthy, but it can be fun.
I met with two Democratic State Senators and a Republican member of the Ohio House. While waiting for my appointments I bumped into representatives of the credit unions, service unions, YMCA’s, and other interest groups. I found our elected officials to be incredibly generous with their time. They were sincerely interested in talking with me, not at me. They appeared to be committed to doing the people’s business.
I’m not sure that I was up to the task.
I was supposed to talk insurance. The states can not wait to see if the PPACA will be defunded or struck down by the Supreme Court. All 50 states are attempting to create a mechanism to comply with the law that will best serve their particular population. 50 plans. All different. All based on a law and a set of assumptions that could change at any moment. Ohio’s options and my clients’ needs were my topics. All three legislators veered into other areas.
The Republican and the Democrats wanted to talk about S.B. 5, the bill that was pushed through last week. The Republican appeared to be shaken by the vitriolic push-back. The Democrats were shocked by the over-reach of the newly elected, and incredibly partisan, Republican Governor. The similarities between S.B. 5 and the PPACA are striking. In each case the party in power passed a highly partisan, one sided piece of legislation that is opposed by close to 50% of the population. The victory is short-lived. The Democrats paid dearly at the polls last November. The Republicans in states like Wisconsin and Ohio will probably pay for their impudence this November and next.
My message was that whether you love or hate the PPACA, it is our job to make this legislation work for our clients and all Ohioans. The best use of our time and efforts will be programs that will provide greater access and information. That was the message. I don’t know if I was successful in delivering it.
I might have been more effective had I been able to laugh at those jokes.
DAVE
www.bcandb.com
About seventy-five members of the Ohio Association of Health Underwriters were at the State House to voice our concerns about pending legislation. The Lieutenant Governor, Mary Taylor, who is also in charge of Ohio’s Department of Insurance, came to talk with us. Even Democrats like me appreciated what we heard as long as she didn’t stray from our particular area of concern.
Like any health insurance agent program, the day began with coffee, juice, and platters upon platters of cakes and pastries. The morning program consisted of several speakers who detailed Ohio’s attempt to deal with the Patient Protection and Affordable Care Act (PPACA), the new exchanges, and where we, professional insurance agents, fit into this evolving system. Next was lunch and another couple of speakers. By three o’clock we were more than eager to meet with legislators for our pre-set appointments.
There were heavy hors d’oeuvres and cocktails waiting for us at the five o’clock finish line. Being a health insurance agent isn’t necessarily healthy, but it can be fun.
I met with two Democratic State Senators and a Republican member of the Ohio House. While waiting for my appointments I bumped into representatives of the credit unions, service unions, YMCA’s, and other interest groups. I found our elected officials to be incredibly generous with their time. They were sincerely interested in talking with me, not at me. They appeared to be committed to doing the people’s business.
I’m not sure that I was up to the task.
I was supposed to talk insurance. The states can not wait to see if the PPACA will be defunded or struck down by the Supreme Court. All 50 states are attempting to create a mechanism to comply with the law that will best serve their particular population. 50 plans. All different. All based on a law and a set of assumptions that could change at any moment. Ohio’s options and my clients’ needs were my topics. All three legislators veered into other areas.
The Republican and the Democrats wanted to talk about S.B. 5, the bill that was pushed through last week. The Republican appeared to be shaken by the vitriolic push-back. The Democrats were shocked by the over-reach of the newly elected, and incredibly partisan, Republican Governor. The similarities between S.B. 5 and the PPACA are striking. In each case the party in power passed a highly partisan, one sided piece of legislation that is opposed by close to 50% of the population. The victory is short-lived. The Democrats paid dearly at the polls last November. The Republicans in states like Wisconsin and Ohio will probably pay for their impudence this November and next.
My message was that whether you love or hate the PPACA, it is our job to make this legislation work for our clients and all Ohioans. The best use of our time and efforts will be programs that will provide greater access and information. That was the message. I don’t know if I was successful in delivering it.
I might have been more effective had I been able to laugh at those jokes.
DAVE
www.bcandb.com
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.
DAVE
www.bcandb.com
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.
DAVE
www.bcandb.com
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.
DAVE
www.bcandb.com
This blog post is now appearing on my website in a word press format. Those of you who use a reader might prefer that format. http://bcandb.com/cunix/?p=80 Please let me know what you think.
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.
DAVE
www.bcandb.com
This blog post is now appearing on my website in a word press format. Those of you who use a reader might prefer that format. http://bcandb.com/cunix/?p=80 Please let me know what you think.
Friday, February 25, 2011
Promises Promises
When is a contract a contract? When is a promise a promise? The answer in 2011 is “It Depends”.
Public employees have contracts. Some of their contracts promised adequate wages with really good fringe benefits and generous retirements. Almost all of their contracts guaranteed stability. Governments; cities, states and the feds, and public institutions such as schools, often took the easy route. Our leaders and elected officials pushed these payroll costs back twenty or thirty years when funding would be someone else’s problem. This strategy was so popular at the steel mills and the auto plants that it had to be a good idea.
The future is now.
Vice-President Dick Cheney once said the deficits don’t matter. And they didn’t. To him. In 2011, after ten years of unfunded wars, unregulated banking, and reckless spending, we are in a real mess. We could reassess our priorities and then align our income (taxes) to pay our bills, but that would be difficult. That would take courage. Instead, we tear up contracts, de-certify unions, and cut heating oil subsidies for the poor.
What does all of this have to do with the delivery of health care? After all, this is Health Insurance Issues With Dave. In a word, everything.
The recent election gave us Republican governors in Wisconsin, Ohio, etc… Elected to create jobs and right their ships of state, these new governors have chosen a different path. They have decided to target their public employees and to eliminate the unions that represent them. We are being told that these contracts are too expensive to honor. We don’t have the money. Their jobs, and the incomes that paid their bills, will disappear. The pensions they were promised may be gone.
Why is this different than government’s promise of health care? We haven’t properly funded the health care we have promised to the poor and the elderly. We have deferred the expenses and punted every time a difficult decision has been on the table. A quick example is the Medicare Doc Fix.
In an effort to make a dent in the fiscal mess that is Medicare, a decision was made in 1997 to control the escalating costs of medical care. The Sustainable Growth Rate was a payment formula designed to keep doctors’ rates in check. Unfortunately, the formula didn’t work in the real world. The adjusted payment rates would have forced a large number of doctors to not accept Medicare and to leave the system. One option would have been to correct the formula. Another option would have been to scrap the Sustainable Growth Rate and start over. Congress, Republicans and Democrats, chose a third option. They passed periodic fixes to the bill and pushed the tough decisions back for someone else to handle. The Sustainable Growth Rate was passed in 1997. How much have we saved to date? Nothing. The implementation is still getting postponed every month.
Is the Doc Fix a good idea? Would the Doc Fix solve Medicare’s problems? Probably not. But if Congress doesn’t get Medicare’s costs and funding under control, we will eventually be facing the same problems, and the same decisions, that the states are grappling with today.
Can the federal government be entrusted with more responsibility for our health care? What promises are too important to break?
DAVE
www.bcandb.com
Public employees have contracts. Some of their contracts promised adequate wages with really good fringe benefits and generous retirements. Almost all of their contracts guaranteed stability. Governments; cities, states and the feds, and public institutions such as schools, often took the easy route. Our leaders and elected officials pushed these payroll costs back twenty or thirty years when funding would be someone else’s problem. This strategy was so popular at the steel mills and the auto plants that it had to be a good idea.
The future is now.
Vice-President Dick Cheney once said the deficits don’t matter. And they didn’t. To him. In 2011, after ten years of unfunded wars, unregulated banking, and reckless spending, we are in a real mess. We could reassess our priorities and then align our income (taxes) to pay our bills, but that would be difficult. That would take courage. Instead, we tear up contracts, de-certify unions, and cut heating oil subsidies for the poor.
What does all of this have to do with the delivery of health care? After all, this is Health Insurance Issues With Dave. In a word, everything.
The recent election gave us Republican governors in Wisconsin, Ohio, etc… Elected to create jobs and right their ships of state, these new governors have chosen a different path. They have decided to target their public employees and to eliminate the unions that represent them. We are being told that these contracts are too expensive to honor. We don’t have the money. Their jobs, and the incomes that paid their bills, will disappear. The pensions they were promised may be gone.
Why is this different than government’s promise of health care? We haven’t properly funded the health care we have promised to the poor and the elderly. We have deferred the expenses and punted every time a difficult decision has been on the table. A quick example is the Medicare Doc Fix.
In an effort to make a dent in the fiscal mess that is Medicare, a decision was made in 1997 to control the escalating costs of medical care. The Sustainable Growth Rate was a payment formula designed to keep doctors’ rates in check. Unfortunately, the formula didn’t work in the real world. The adjusted payment rates would have forced a large number of doctors to not accept Medicare and to leave the system. One option would have been to correct the formula. Another option would have been to scrap the Sustainable Growth Rate and start over. Congress, Republicans and Democrats, chose a third option. They passed periodic fixes to the bill and pushed the tough decisions back for someone else to handle. The Sustainable Growth Rate was passed in 1997. How much have we saved to date? Nothing. The implementation is still getting postponed every month.
Is the Doc Fix a good idea? Would the Doc Fix solve Medicare’s problems? Probably not. But if Congress doesn’t get Medicare’s costs and funding under control, we will eventually be facing the same problems, and the same decisions, that the states are grappling with today.
Can the federal government be entrusted with more responsibility for our health care? What promises are too important to break?
DAVE
www.bcandb.com
Wednesday, February 9, 2011
Are We Serious About Change?
I wasn’t expecting a letter from State Farm. Of course, the news wasn’t good. My insurer regretted to inform me that I was never going to be reimbursed. Hit by an uninsured motorist (Mr. Popularity – March 6, 2009), I was forced to pick up my deductible and part of the car rental expenses. That money was gone. In a final act of irresponsibility, Ms. P. had her debts discharged through bankruptcy.
Ms. P. was driving illegally. She did not have insurance. Had she followed the law, she either wouldn’t have been on the road, thus not hitting me, or her insurance would have paid for the repair of my car. Her insurance. Instead, State Farm spent thousands and I lost about $800. Since bankruptcy is a matter of public record, I could, if I was a glutton for punishment, learn who else got screwed by Ms. P. Banks? Retail stores? Did she go on a shopping trip before she ran to the courts for relief?
Why should you care? Her refusal to follow the law and to pay her debts costs you money. We are covering her debts. And there will be more.
1 o’clock. No Oliver. No surprise.
Oliver may be the poster child for the uninsured. He is in his late fifties, disabled from an accident, and officially under-employed. He gets by through the kindness of his family members. One has him working part-time in a small business. Another helps with the rent. Insurance was to be paid by his little sister. All he has to do is show up for our appointment and give her the bill when it arrives with the policy.
Oliver was covered, briefly, last year, but he was too busy to get the bill to his sister. He has been too busy to get here to my office. He is just busy. Odd how much time it takes to do nothing.
Oliver’s family can’t force him to have free insurance. Who will pay when Oliver seeks medical care? Who will cover his next surgery? YOU, of course.
There is much to dislike about President Obama’s Patient Protection and Affordable Care Act. It was poorly designed and even more poorly explained. But, it is the individual mandate that is being attacked by Republican judges. And without a legal requirement to be in the system, to be responsible, we can not move forward. We can not improve the delivery of health care, guarantee universal access, and control costs if we don’t require everyone to participate.
Federal District Judge Roger Vinson recently ruled that the PPACA is unconstitutional. He wrote that Congress couldn’t require Americans to buy insurance. He also determined that this provision, the individual mandate, could not be severed from the rest of the law. The second part of his ruling strikes down the entire bill.
As a non-attorney, I will not discuss the merits of Judge Vinson’s ruling. Is he right? Will he be upheld or reversed on appeal? What will the Supreme Court decide? It is important to remember that all rulings are subjective and reflect the Court and their time. Previous Supreme Court decisions have, in retrospect, been all over the map.
So let’s skip the law for a second and talk about people. There are lots and lots of Ms. P.’s and Olivers, far more than any of us might want to admit. I encounter the intentionally uninsured daily. They are healthy young people who are convinced that they are incapable of getting sick or injured, even though they ski, ride motorcycles, or engage in other hazardous activities. Some are just selfish people who have never pulled their own weight and never will until forced. And some are simply weak-willed who can’t walk past shiny new things.
We also have the unintentionally uninsured. We have 50 and 60 year olds who have lost their jobs and group health insurance and can’t afford food, much less insurance. There are any number of sick and disabled who need our help. Helping the unintentionally uninsured was supposed to be the goal of the PPACA.
Ms. P. chose to drive a car without insurance. Almost all of us will one day need health care. It won’t be a choice. U.S. hospitals are not going to deny care. We aren’t going to barricade the Emergency Room doors to keep out the uninsured. So what we are discussing is money. How are we going to pay for care? How do we pay for doctors, hospitals and prescriptions?
We understand, or least most of us do, why drivers must be forced to carry insurance. Requiring people to be responsible for a portion of their health care expenses is just as reasonable. We will never have 100% participation. Just as there are a small but dangerous group of uninsured motorists, there will always be people who evade the system. They will fly under the radar right up to the moment that they need care.
Don’t like the individual mandate? OK. Tell us how you will improve our system without it.
DAVE
www.bcandb.com
Ms. P. was driving illegally. She did not have insurance. Had she followed the law, she either wouldn’t have been on the road, thus not hitting me, or her insurance would have paid for the repair of my car. Her insurance. Instead, State Farm spent thousands and I lost about $800. Since bankruptcy is a matter of public record, I could, if I was a glutton for punishment, learn who else got screwed by Ms. P. Banks? Retail stores? Did she go on a shopping trip before she ran to the courts for relief?
Why should you care? Her refusal to follow the law and to pay her debts costs you money. We are covering her debts. And there will be more.
1 o’clock. No Oliver. No surprise.
Oliver may be the poster child for the uninsured. He is in his late fifties, disabled from an accident, and officially under-employed. He gets by through the kindness of his family members. One has him working part-time in a small business. Another helps with the rent. Insurance was to be paid by his little sister. All he has to do is show up for our appointment and give her the bill when it arrives with the policy.
Oliver was covered, briefly, last year, but he was too busy to get the bill to his sister. He has been too busy to get here to my office. He is just busy. Odd how much time it takes to do nothing.
Oliver’s family can’t force him to have free insurance. Who will pay when Oliver seeks medical care? Who will cover his next surgery? YOU, of course.
There is much to dislike about President Obama’s Patient Protection and Affordable Care Act. It was poorly designed and even more poorly explained. But, it is the individual mandate that is being attacked by Republican judges. And without a legal requirement to be in the system, to be responsible, we can not move forward. We can not improve the delivery of health care, guarantee universal access, and control costs if we don’t require everyone to participate.
Federal District Judge Roger Vinson recently ruled that the PPACA is unconstitutional. He wrote that Congress couldn’t require Americans to buy insurance. He also determined that this provision, the individual mandate, could not be severed from the rest of the law. The second part of his ruling strikes down the entire bill.
As a non-attorney, I will not discuss the merits of Judge Vinson’s ruling. Is he right? Will he be upheld or reversed on appeal? What will the Supreme Court decide? It is important to remember that all rulings are subjective and reflect the Court and their time. Previous Supreme Court decisions have, in retrospect, been all over the map.
So let’s skip the law for a second and talk about people. There are lots and lots of Ms. P.’s and Olivers, far more than any of us might want to admit. I encounter the intentionally uninsured daily. They are healthy young people who are convinced that they are incapable of getting sick or injured, even though they ski, ride motorcycles, or engage in other hazardous activities. Some are just selfish people who have never pulled their own weight and never will until forced. And some are simply weak-willed who can’t walk past shiny new things.
We also have the unintentionally uninsured. We have 50 and 60 year olds who have lost their jobs and group health insurance and can’t afford food, much less insurance. There are any number of sick and disabled who need our help. Helping the unintentionally uninsured was supposed to be the goal of the PPACA.
Ms. P. chose to drive a car without insurance. Almost all of us will one day need health care. It won’t be a choice. U.S. hospitals are not going to deny care. We aren’t going to barricade the Emergency Room doors to keep out the uninsured. So what we are discussing is money. How are we going to pay for care? How do we pay for doctors, hospitals and prescriptions?
We understand, or least most of us do, why drivers must be forced to carry insurance. Requiring people to be responsible for a portion of their health care expenses is just as reasonable. We will never have 100% participation. Just as there are a small but dangerous group of uninsured motorists, there will always be people who evade the system. They will fly under the radar right up to the moment that they need care.
Don’t like the individual mandate? OK. Tell us how you will improve our system without it.
DAVE
www.bcandb.com
Monday, January 24, 2011
Give Us Something We Can Use
“Mr. Cunix?”
I recognized that voice.
“This is Belinda Prinz from Congresswoman Marcia Fudge’s office.”
Regular readers know that I have mentioned my Congresswoman a couple of times in my two blogs. We also know that Congresswoman Fudge, or her staff, are regular readers. Ms. Prinz even commented on the August 30, 2010 post, Choosing Sides.
Belinda Prinz must have drawn the short straw. There is no doubt that she considered herself fortunate that she reached my voicemail instead of me. Her assignment was doomed to failure. She was on a fool’s errand and the longer she talked, the more apparent it became to her.
One of Congresswoman Fudge’s other staffers had called the Beachwood Chamber of Commerce and had talked with our Executive Director, Wayne Lawrence. He suggested that she call me. What did the Congresswoman want?
“We would like to know the name of a small business that can now provide insurance benefits to its employees because of the tax credits in the Patient Protection and Affordable Care Act. We want to tell their story.”
Yes, Congresswoman Fudge is desperate to find someone, anyone, who has benefited from last year’s legislative train wreck.
Let’s think about this for just a second. We would need to find a small business that
* Didn’t provide health insurance
* Wasn’t motivated by the tax deductibility of health insurance premiums
* Doesn’t pay its employees very well
* Is making enough profit that the tax credit is irresistible
Does that sound like any business you know? Of course not. Will Congresswoman Fudge or one of her cohorts find a couple of examples somewhere in this country? I like their odds. Still, it might be worthwhile to research the details when they trot out their success stories.
It is far easier to find the victims of last year’s legislation. There are businesses that fear my phone calls, worried that this year’s renewal rates will be more than they can spend. My restaurants and other clients that employ lots of unskilled and semi-skilled workers are very worried about the planned tax/fee/penalty to be assessed to businesses that don’t provide group health insurance. The saddest and most immediate blow was dealt to parents.
Proponents of the Patient Protection and Affordable Care Act love to note that children are now guaranteed issue. Insurance companies can no longer refuse to cover a minor due to preexisting conditions. Fearing the inevitable dumping of unhealthy children from group (employer sponsored) policies to individual contracts, the insurance companies simply stopped selling Child,Only policies.
The few unhealthy uninsured children of families that neither qualified for group health insurance or Medicaid are still uninsured. This will not change for another couple of years, if ever. But the negative impact was immediate.
Janet (name changed) works for a large property management company. Her employer’s new policy, as of February 1st, will cost her only $60 per month. That is the price for just her, the employee. The premium for her and her two daughters would be just a touch over $500 per month. Employers across the country are cutting back. One way to save money is to pay only a portion of the employee’s health insurance. If the employee wants to cover a spouse and children, he/she will be charged the difference.
A year ago I could have written great coverage on Janet’s two healthy daughters for less than $200 per month. Janet would have stayed on the employer’s plan, placed the girls with Anthem or MMO, and saved over $2,000. Janet even had the option of choosing a higher deductible and saving even more. Today? Nothing!
Janet has two options. She can stay on her employer’s plan and work for the insurance or she and her two daughters can purchase a fully underwritten individual (non-group) policy. She chose a high deductible health plan that will cost her $194 per month for the three of them. Is this the best solution? Of course not. But Congresswoman Fudge and her friends killed the best solution last March.
I didn’t return Ms. Prinz’s phone call. I don’t know of any businesses or employees who have benefitted from her boss’s efforts. And I have no reason to believe that our Congresswoman has any interest in learning about the collateral damage.
Besides, we know they are reading this. We just don’t know if they care enough to make any changes.
DAVE
www.bcandb.com
I recognized that voice.
“This is Belinda Prinz from Congresswoman Marcia Fudge’s office.”
Regular readers know that I have mentioned my Congresswoman a couple of times in my two blogs. We also know that Congresswoman Fudge, or her staff, are regular readers. Ms. Prinz even commented on the August 30, 2010 post, Choosing Sides.
Belinda Prinz must have drawn the short straw. There is no doubt that she considered herself fortunate that she reached my voicemail instead of me. Her assignment was doomed to failure. She was on a fool’s errand and the longer she talked, the more apparent it became to her.
One of Congresswoman Fudge’s other staffers had called the Beachwood Chamber of Commerce and had talked with our Executive Director, Wayne Lawrence. He suggested that she call me. What did the Congresswoman want?
“We would like to know the name of a small business that can now provide insurance benefits to its employees because of the tax credits in the Patient Protection and Affordable Care Act. We want to tell their story.”
Yes, Congresswoman Fudge is desperate to find someone, anyone, who has benefited from last year’s legislative train wreck.
Let’s think about this for just a second. We would need to find a small business that
* Didn’t provide health insurance
* Wasn’t motivated by the tax deductibility of health insurance premiums
* Doesn’t pay its employees very well
* Is making enough profit that the tax credit is irresistible
Does that sound like any business you know? Of course not. Will Congresswoman Fudge or one of her cohorts find a couple of examples somewhere in this country? I like their odds. Still, it might be worthwhile to research the details when they trot out their success stories.
It is far easier to find the victims of last year’s legislation. There are businesses that fear my phone calls, worried that this year’s renewal rates will be more than they can spend. My restaurants and other clients that employ lots of unskilled and semi-skilled workers are very worried about the planned tax/fee/penalty to be assessed to businesses that don’t provide group health insurance. The saddest and most immediate blow was dealt to parents.
Proponents of the Patient Protection and Affordable Care Act love to note that children are now guaranteed issue. Insurance companies can no longer refuse to cover a minor due to preexisting conditions. Fearing the inevitable dumping of unhealthy children from group (employer sponsored) policies to individual contracts, the insurance companies simply stopped selling Child,Only policies.
The few unhealthy uninsured children of families that neither qualified for group health insurance or Medicaid are still uninsured. This will not change for another couple of years, if ever. But the negative impact was immediate.
Janet (name changed) works for a large property management company. Her employer’s new policy, as of February 1st, will cost her only $60 per month. That is the price for just her, the employee. The premium for her and her two daughters would be just a touch over $500 per month. Employers across the country are cutting back. One way to save money is to pay only a portion of the employee’s health insurance. If the employee wants to cover a spouse and children, he/she will be charged the difference.
A year ago I could have written great coverage on Janet’s two healthy daughters for less than $200 per month. Janet would have stayed on the employer’s plan, placed the girls with Anthem or MMO, and saved over $2,000. Janet even had the option of choosing a higher deductible and saving even more. Today? Nothing!
Janet has two options. She can stay on her employer’s plan and work for the insurance or she and her two daughters can purchase a fully underwritten individual (non-group) policy. She chose a high deductible health plan that will cost her $194 per month for the three of them. Is this the best solution? Of course not. But Congresswoman Fudge and her friends killed the best solution last March.
I didn’t return Ms. Prinz’s phone call. I don’t know of any businesses or employees who have benefitted from her boss’s efforts. And I have no reason to believe that our Congresswoman has any interest in learning about the collateral damage.
Besides, we know they are reading this. We just don’t know if they care enough to make any changes.
DAVE
www.bcandb.com
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