Individual Mandate

February 15, 2011 in Affordable Health Insurance, Employer Sponsored Plans, Grandfathered Health Plans, Group Health Plans, Health Care, Health Care Costs, Health Insurance Exchange, Health Insurance Reform, Individual Health Insurance

Individual Mandate

By Ashley Ahle
February 15, 2011

Most of the hubub about the individual mandate of the Patient Protection and Affordable Care Act has to do with it’s unconstitutionality. Before deciding whether or not it is, it is important to know exactly what the mandate is and how it is meant to help consumers.

In layman’s terms, the individual mandate requires all individuals for whom the minimum coverage allowed will not cost more than eight percent of their monthly wages, and who are not below the poverty line, to purchase minimally comprehensive coverage. People who can’t afford this and do not fall above the poverty line, will have government subsidies available which will virtually pay for all of their coverage.

For people who are already covered or have employee benefits, there will be no effect on them. They are already covered by a government accepted plan and no penalty will affect them. The mandate will go unnoticed. For people who are penalized this is how it will work; The fine will be either $695 per year, or 2.5% of their income, whichever is higher. And if it is not paid, you will not be arrested or sent to jail. As of now the enforcements of the penalty are so small that they may not even be enacted.

So why have the mandate? Because with out it the insurance companies and market itself will fail. No longer allowing companies to discriminate against pre-existing conditions allows people to forgo purchasing coverage until they are critically ill. Flooding the market will sick people will only drive up premium costs and the plans would become too expensive for most. By forcing healthy people to be covered, the idea is they will help to average out insurance costs.

Without a mandate, health care reform would not last and we are too far into the game at this point to take it out of the PPACA.

Health Insurance Exchanges, Part 2

February 9, 2011 in Affordable Health Insurance, College Students, Dependants, Doctors, Employer Sponsored Plans, Grandfathered Health Plans, Group Health Plans, Health Care, Health Care Costs, Health Care Reform, Health Insurance Exchange, Health Insurance Reform, Individual Health Insurance, Primary Care Physician, Specialists

Health Insurance Exchanges, Part 2

By Ashley Ahle
February 9, 2011

Last week we left off talking about some of the costs related to insurance exchanges. What will directly cause insurance premiums to rise and how will exchanges help manage and keep them down?

Government money will be provided to help get the exchanges running, but what about after that? Well, subsidies will also be in place to help lower income families and individuals acquire coverage and pay for premiums.

The main reason people believe premiums will drop in price after the exchanges are in place, is because companies will be forced to have really competitive prices. These exchanges will need to be in the interest of the buyers, forcing the insurance companies to be very transparent about any rise in costs.

Insurance companies will still be setting their own prices, but within each state they can be rejected. Though the states can not set the premiums, they can however, reject certain plans if they think there is not enough justification for their cost.

Small businesses are concerned that exchanges will only complicate the process of insuring their employees because they would have to diversify their actual premium payments, rather than just writing one check. Though there will be significant tax deductions available for small businesses who opt into the exchange, the fear is that those deductions will not offset the cost of insures needing to meet certain plan standards.

For the small business owners, it may be difficult to make the change, however these exchanges would help make available millions of dollars for low-income and uninsured or un-insurable people. Not only will this help the US citizens, but the money will also help health insurers, hospitals, pharmaceuticals and physicians by reducing the amount of money each state spends on uncompensated care.

A Brief Look at the Impact of Health Insurance Exchanges (Part 1)

February 3, 2011 in Affordable Health Insurance, Employer Sponsored Plans, Group Health Plans, Health Care Costs, Health Care Reform, Health Insurance Exchange, Health Insurance Quotes, Health Insurance Reform, Individual Health Insurance

A Brief Look at the Impact of Health Insurance Exchanges

By Ashley Ahle
February 3, 2011

Cutting costs and providing health insurance coverage to the many Americans who are currently uninsured are two huge focuses of health care reform. The plan to achieve both of these goals is to implement either a federal health insurance exchange, or a state regulated exchange.

Health exchanges are intended to create a more competitive marketplace for insurance companies. By competing against each other, the companies would be forced to lower prices for their more “cadillac” coverage plans.

Exchanges are also another way to universally regulate the insurance market by requiring companies to offer plans that meet minimum coverage requirements. These guidelines and regulations are created by the Health Choices Administration in an effort to federally oversee what happens inside the exchanges.

Although the exchanges are meant to provide an easily accessible and understandable way to shop for coverage, not everyone will be eligible to insure within the exchanges. Individuals must meet one or more of the following criteria in order to be eligible:

1. Must work for a company that employs 100 or less people.
2. Must work at a company that is not providing insurance.
3. Must be self employed.
4. Must be unemployed.
5. Must be retired but ineligible for Medicare.
6. Must be a small business.
7. After 2017 medium and large businesses will be eligible.

If one does not meet the above criteria , they will still be able to purchase coverage. Insurers involved in the exchanges will be required to offer the same plans with same premiums outside of the exchange so as to keep premium costs down.

Also, individuals who cannot afford to pay all of the premiums offered in the exchanges may qualify for Government funded subsidies to help pay for the premiums. This also directly ties into the individual mandate and the concern about low-income individuals not being able to pay for coverage.

Tune in tomorrow for Part two where we will discuss the costs and some Pro’s and Con’s.

Five Points of Focus For House Republicans in Efforts To Repeal “Job-Killing Health Care Act”

February 1, 2011 in Affordable Health Insurance, Dependants, Employer Sponsored Plans, Grandfathered Health Plans, Group Health Plans, Health Care, Health Care Costs, Health Care Reform, Health Insurance Exchange, Health Insurance Reform, Individual Health Insurance, Specialists

Five Points of Focus For House Republicans in Efforts To Repeal “Job-Killing Health Care Act”

February 1, 2011
By Ashley Ahle

As you may know, House Republicans are leading a huge effort to repeal Health Care Reform. The following points are claims that have been made in order to sway voters, however what you may find is that these claims are not all true.

There are aspects of the Affordable Care Act that need to be revised, however a full repeal of the law at this time would cost billions of taxpayer dollars and truthfully, is just unlikely. Here are the main issues being argued in favor of repeal.

1. House Republicans claim that the Affordable Care Act will lose 1.6 million jobs.

This claim is outdated and comes from a National Federal Independent Business study of a completely different Reform proposal made back in 2009. This proposal stated that ALL employers must provide coverage. Under the ACA, businesses with fewer than 50 employees are exempt from providing coverage. In reality, the ACA would ADD jobs due to the rise in demand for health services.

2. The ACA would destroy 650 thousand jobs.

A report from the Congressional Budget Office states that “650 thousand people will work less and retire early” if they don’t have to depend on their employers for coverage. Hopefully the ACA will cut premium costs, making individual insurance more affordable. If that happens and the 650 thousand people do stop working, that’s not because the ACA is making them. Those jobs are still available. Nowhere in the ACA does it state there will be a 650 thousand person job loss.

3. The Obama Administrations own speaker for Medicare and Medicaid says the ACA will actually INCREASE spending on health care.

While spending is expected to increase, it’s only because there will be more people with coverage able to receive care. The demand for services will rise, yes. But the spending isn’t rising because of ballooning prices caused by the ACA.

4. Republicans say the ACA will cost $2.6 trillion, and add $701 billion to the deficit.

This estimate comes directly from the House Republicans themselves, and is based off of future actions that may not ever come to fruition. It contradicts an earlier estimate made by the non-partisan group, CBO. According to them, REPEALING the reform act would increase the deficit by $230 billion. Selectively discrediting the CBO estimations only acts to ruin the credibility of the Republicans since the CBO acts objectively.

5. The Obama administration says 129 million Americans have pre-existing conditions and could be denied coverage.

While this fact may be true, one has to realize that the majority of those people are insured by their employers. Therefore, people who work for the large companies with those conditions don’t have an affect on access to insurance. This makes it impossible for over 100 million people to lack options for insurance coverage.
In fact, since November of 2010 over 8,000 uninsured people have gained access to coverage due to the high-risk-pools put into action by health reform.

While these arguments are being made and held up in some courts across the country, all in all health reform is not going away. It would cost too much to fully repeal it, and breaking it down piece by piece would only strengthen it more.

Rising Healthcare Costs, and the Introduction of Accountable Care Organizations

January 27, 2011 in Affordable Health Insurance, Doctors, Employer Sponsored Plans, Health Care, Health Care Costs, Health Insurance Reform, Individual Health Insurance, Primary Care Physician, Specialists

Rising Healthcare costs, and the Introduction of Accountable Care Organizations

By Ashley Ahle
January 27, 2011

While most of the buzz around Health Care Reform seems to be about keeping costs down by holding insurance companies accountable for rising premiums, there is one area that, more often than not, is overlooked by many. Who is holding Doctors and Hospitals accountable for their rising costs?

One part of the Health Care law that is not too often talked about, is the inclusion of Accountable Care Organizations. In the law, ACO’s take up only seven pages. What are ACO’s you may ask? It’s basically a new model of incentives for hospitals and doctors who provide quality care while also keeping costs down.

When basic procedures are done, instead of the doctor recommending many more unexplained tests and visits they merely do it right the first time therefore cutting costs. If they succeed in treating patients while cutting costs, there are incentives, such as savings bonuses available. Other benefits of ACO’s are the melding of all parts of care for patients. Currently one patient can have many specialists providing treatment, without working with each-other. ACO’s would bring all of these components together so that patients have easy access to quality care.

Now, this may sound similar to HMO’s, however with ACO’s the patient may not even know they are in an ACO. Also, the patient still has the freedom to choose who treats them. Conversely, with HMO’s patients are penalized for going out of network.

Accountable Care Organizations come with their own downfalls. Many people worry that the rush to be a part of and ACO will have a huge effect on market share, and give the hospitals too much leverage, therefore back lashing and actually driving health costs up. Also in more rural areas the fear is that independent providers will disappear completely, stifling all competition.

Like it’s all encompassing partner, Health Reform, Accountable Care Organizations still need to be tweaked. They have yet to decide who will run them, insurance companies, hospitals or doctors. There is growing enthusiasm for ACO’s and once the finer points are ironed out, we could potentially see great savings.

The New Republic: The Worst Case For Health Reform

January 21, 2011 in Affordable Health Insurance, Employer Sponsored Plans, Health Care, Health Care Costs, Health Care Reform, Health Insurance Reform, Individual Health Insurance

The New Republic: The Worst Case For Health Reform

by Jonathan Cohn
January 20, 2011
Jonathan Cohn is a senior editor at The New Republic and a senior fellow at Demos

Steven Hyder, 40, runs his own legal practice out of a shared office in downtown Monroe, Michigan, a blue-collar town south of Detroit. Mostly he handles relatively routine, low-profile work: bankruptcies, personal injury claims, that sort of thing. But recently, he became part of a much bigger case. He’s a named plaintiff in a lawsuit challenging the constitutionality of the Patient Protection and Affordable Care Act….

Why Health Reform Won’t be Repealed

January 20, 2011 in Affordable Health Insurance, Child(ren) Only Health Plans, College Students, Dependants, Doctors, Employer Sponsored Plans, Grandfathered Health Plans, Group Health Plans, Health Care, Health Care Costs, Health Care Reform, Health Insurance Exchange, Health Insurance Quotes, Health Insurance Reform, Individual Health Insurance, Primary Care Physician, Specialists

Why Health Reform Won’t be Repealed

By Aaron Carroll, Special to CNN
January 19, 2011 1:05 p.m. EST

Editor’s note: Dr. Aaron E. Carroll is an associate professor of pediatrics at the Indiana University School of Medicine and director of the university’s Center for Health Policy and Professionalism Research. He blogs about health policy at The Incidental Economist.

(CNN) — This week, the House of Representatives plans to vote to repeal the Patient Protection and Affordable Care Act. It will succeed….”

Another Lawsuit Against ObamaCare Survives a Preliminary Challenge

January 20, 2011 in Affordable Health Insurance, Child(ren) Only Health Plans, Doctors, eHealthInsurance.com, Group Health Plans, Health Care, Health Care Costs, Health Care Reform, Health Insurance Agent, Health Insurance Exchange, Health Insurance Quotes, Health Insurance Reform, Individual Health Insurance, Life Insurance, Permanent Life Insurance, Primary Care Physician, Specialists, Term Life Insurance, Uncategorized, Whole Life Insurance

Another Lawsuit Against ObamaCare Survives a Preliminary Challenge
October 14, 2010 6:32 pm

The rulings keep rolling in on the constitutionality of the federal reform law. On Thursday, a federal judge in Florida refused to dismiss the lawsuit brought by a group of state attorneys general( led by Florida’s Bill McCollum), although he threw out several of the suit’s lesser claims. (Here’s the ruling, courtesy of the Wall Street Journal.) That’s the second such decision; a federal judge in Virginia held in August that the Commonwealth’s attorney general could proceed with a similar lawsuit. On the flip side, a federal judge in Michigan ruled earlier this month against a lawsuit that had been brought by the Thomas More Law Center, declaring that the law’s requirement to buy was constitutional….

— Jon Healey

Myths — Ahem — Lies About Health-Care Reform

January 19, 2011 in Affordable Health Insurance, Dependants, Health Care, Health Care Costs, Health Care Reform, Health Insurance Reform, Individual Health Insurance

Myths — Ahem — Lies About Health-Care Reform

By Richard Cohen
Posted at 11:41 AM ET, 01/19/2011

The Post, enamored of euphemisms, calls lies myths. Thus the headline on a terrific article by Glenn Kessler entitled “Debunking common myths about health-care reform.”

The first myth is that “This is a ‘government takeover’ of the health-care system.” It is, of course, no such thing, unless the term “takeover” means the passing of some regulations. If that’s the case, then the government long ago took over the radio and television industry (the FCC and all of that), the drug industry (the FDA) and, of course, mining, what with all those pesky inspections and periodic indignation over the deaths of miners. In fact, as Kessler points out, the government did not take over the health insurance industry….

Administration: Health Repeal Could Cost Millions Coverage

January 18, 2011 in Affordable Health Insurance, Child(ren) Only Health Plans, Dependants, Employer Sponsored Plans, Grandfathered Health Plans, Group Health Plans, Health Care, Health Care Costs, Health Care Reform, Health Insurance Agent, Health Insurance Exchange, Health Insurance Quotes, Health Insurance Reform, Individual Health Insurance, Specialists

Administration: Health Repeal Could Cost Millions Coverage

By the CNN Wire Staff
January 18, 2011 1:19 p.m. EST

Washington (CNN) — Nearly half of all Americans under the age of 65 have health conditions that could prevent them from getting insurance if the Republican effort to repeal health care reform is successful, U.S. Health and Human Services Secretary Kathleen Sebelius said Tuesday.

Sebelius said 129 million people — nearly half of all Americans under the age of 65 — have some form of pre-existing condition that could make them ineligible for coverage should they lose or change jobs, get divorced or face other changes that force them to seek new insurance….

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