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Waiving Healthcare Reform Goodbye- Part Deux

March 9, 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

Waiving Healthcare Reform Goodbye- Part Deux

By Ashley Ahle
March 7, 2011

As reported on March 2nd, President Obama has chosen to allow certain states and companies to opt out of the Patient Protection and Affordable Care Act. So far the number of waiver’s granted by the Department of Health and Human Services has reached above 1,000. Though these waivers aren’t exactly the same as the Waiver for State Innovation, they do act in the same way, as a stop gap for companies and firms unable to meet the minimum annual coverage limit for 2011.

Companies eligible for these waivers receive a one year grace period for meeting the $750,000 coverage limit. Providing these waivers minimizes disruption in the health insurance market by allowing people to keep their coverage until realistic options become available. A spokesperson for HHS said that these waivers will ensure that American’s can continue to access needed services with little impact on premiums while the transition to a new marketplace in 2014 is under way.

So far, these waivers are covering about 2.6 million American’s- less than 2% of privately insured individuals. Waivers have been denied to companies, however, that cannot demonstrate that their compliance with the annual limit requirement would significantly increase their premiums or decrease coverage.

An important question being raised right now, is how will granting these waivers affect the credibility of health care reform all together? According to Kaiser Health News columnist John McDonough– a professor at Harvard School of Public Health, these waivers “offer a useful window into the health law’s evolving politics and future bargaining likely to take place.”

Lawmakers opposing health care overhaul are using these waivers as examples of flaws in the reform by saying they make for too many loopholes. While at the same time, they are demanding more “transparency” from HHS regarding why companies are being denied.

In response, HHS has said they have already provided the information requested, to the House Committee on Oversight and Government Reform. However in a letter sent in February the committee had clearly stated that they wanted a defined method of how the HHS was processing waivers, and where in the PPACA did it give HHS the legal right to grant these waivers.

Most companies being granted the one year waiver, are companies offering the lower cost “mini-med” plans. House members in opposition claim that this prevents the 2.6 million Americans covered by these plans from receiving the health insurance coverage that “President Obama believes every American deserves.”

There needs to be an adjustment period for everyone while this policy changing, far reaching health care overhaul takes place. If passed, one cannot expect changes to come immediately. Much like holding the Presidential elections in November but having a change of office in January, this law will need time to meld with the current market. And in time, if granted, these wrinkles may be ironed out in a way that suits us all.

Waiving Reform Goodbye? For Some States It May Be Possible

March 7, 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

Waiving Reform Goodbye? For Some States It May Be Possible

By Ashley Ahle
March 7th, 2011

On the eve of February 28th, President Obama announced his support of the Waiver For State Innovation bill, authored by Sen. Ron Wyden and Sen. Scott Brown. This bill is one of the first bi-partisan acts supported by the President in regards to health care reform.

First proposed back in November of 2010, this bill was only 200 words long, allowing States the Opt out option in 2014 instead 2017. This will eliminate any costs accrued for states already planning to opt out in 2017, by allowing them to avoid costs associated with implementing the Affordable Care Act mandates, IE: individual mandate, employer mandate, health insurance exchanges and the federal design of health insurance coverage.

These costs would potentially be avoided because the federal subsidies allowed to the States could be used to implement health reform how they see fit. Now, the states planning to opt out will have to come up with an alternative reform that meets the following requirements:

1. The State waiver ensures that individuals receive coverage that is at least as comprehensive as under the Federal law.

2. State waiver ensures individuals get coverage as affordable as under federal law.

3. State waiver ensures that as many people are covered as under Federal law.

4. State waiver cannot increase Federal deficit.

These waivers, when granted, will be valid for 5 years with the option to renew after. If states are seen not fulfilling any of the aforementioned requirements, then Federal Overhaul and reform will take effect.

The main problem seen from moving this opt-out up is that without 3 years of complete overhaul experience under their belts, the states may set their figures for grants too high, since there wouldn’t have been enough time to actually see what their costs will be related to insuring their own citizens.

This bi-partisan bill may be just what Washington D.C. needs in order to break the gridlock surrounding the Affordable Care Act. This plan would lessen the government’s rule over health reform (wanted by Conservatives) and would ensure reform happens for everyone (wanted by Liberals).

As stated in previous posts, repeal of reform is extremely unlikely. Many Republicans are still unwilling to ‘reform health reform’ strictly because they are holding out for a full repeal, while their counterparts are making efforts to ensure a bi-partisan agreement can be made. The only thing to do now is wait and see what changes will come. And hope for the best.

Oregon May Have the Answer for Child Only Health Policies

March 3, 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 Reform, Individual Health Insurance

Oregon May Have the Answer for Child Only Health Policies

By John Rueschenberg & Ashley Ahle of Coverage Point Insurance in Happy Valley, OR

The state of Oregon, a few months ago, restructured child only individual enrollments by switching to open enrollment periods, similar to that of a group open enrollment period. Child only applications are only accepted during the months of February and August of every year with effective dates of either March 1st or September 1st.

Congress Passed a law earlier this week allowing states to create similar laws that will close the loopholes in child only policies applications, which prevent insurance abuse of benefits. In order to keep insurance companies on board, regulation is needed to keep premiums from skyrocketing due people only obtaining coverage after they become sick and with no no consequences.

To simplify the process and reduce risk, annual enrollment periods across the industry, including enrollment for Medicare Advantage plans, should be changed to the month the eldest applicant was born. If this were to happen consumers, insurance companies, agents and the Federal Government would experience more ease when dealing with coverage.

Remembering the month you were born is far easier than researching the dates for the next enrollment period. Making this change would eliminate confusion that comes with purchasing an insurance policy. Enrollment periods that are lumped into a small time frame, like what currently happens for Medicare, group coverage and now child only policies in Oregon, increases the chances for error and reduces the quality of service, by creating an increased workload for the government, insurance companies and agents involved with enrollment.

Not only would changing the open enrollment period to the month of birth lessen the workload, it would also reduce the amount of SPAM email consumers receive year round. Instead of soliciting year round, agents and companies would only focus on the weeks leading up to the insureds birthday, making it easier for all parties involved.

Under health care reform, insurance companies are prohibited from denying any child with pre-existing conditions. Due to this change, many companies have either adopted the open enrollment periods or have stopped offering child only policies all together. Although companies are allowed to offer them outside enrollment periods, they are still prohibited from denying any child thus allowing people the opportunity to only gain coverage when an illness occurs, therefore driving up costs for everyone.

Not only would the birth month enrollment periods ease workloads across the industry, many more consumers would find it easier to obtain coverage and in turn, more people would be covered. Which is the goal of health care overhaul all together.

Changes and Rescission of “Conscience Clause”

February 21, 2011 in Doctors, Health Care, Health Care Costs, Health Care Reform, Health Insurance Reform, Individual Health Insurance, Primary Care Physician, Specialists

Changes and Rescission of “Conscience Clause”

By Ashley Ahle
February 21, 2011

In 2008, former President Bush put into act during his final days the 2008 Final Rule. This law aimed to further protect health-care employees, including Doctors, who chose not to perform certain medical procedures or assist with them due to religious or moral convictions. In January of 2009, President Obama sought to rescind this rule and further clarify the need to protect workers in these situations. What some opponents don’t realize is that for the past 30 or so years, the “Conscience Clause” has already been in effect.

Bush’s final rule, however, was never permanently enacted because it used “too broad of language” for the workers in the health care industry. Here is a little background into why this is a current issue with health care reform.

The “Conscience Clause,” originally known as the “Church Amendments,” were enacted in the 1970’s to clarify that federally funded health care facilities wouldn’t require their employees to perform medical procedures, like abortion or sterilization, if it went against their moral or religious beliefs. It also protected those people from being fired or wrongfully terminated because of those actions. On the very basic level this was essential in retaining the credibility of the Medical Field.

This original law went to include, beyond abortions and sterilizations, biomedical research, behavioral study programs and health study programs. Essentially, any person or entity receiving federal funding (grants, loans etc.) had the ability to opt out of providing certain medical services without recourse, if it went against their beleifs.

Under the new Affordable Care Act, no health plan offered in the health exchanges is allowed to discriminate against any provider or facility because of their unwillingness to provide, pay for, cover or refer for abortions. Obama moved to rescind part or all of the 2008 Final Rule because it’s power was thought to be too broad and unclearly written.

In order for protection of these individual’s beliefs, and for the 2008 Final Rule to work, there had to be some form of enforcement in place. These regulations included clear education of the “Conscience Clauses” to the public, working with state and local governments receiving federal funding to make sure they comply, and if compliance is deemed unsuccessful, non-discriminatory laws would be enforced by Department mechanisms to ensure Federal money is not going to supporting discrimination.

Obama’s original proposal to rescind or replace the ’08 Rule received over 300,000 public comments both for and against the changes. Many comments supporting Obama stated that the main fear with Bush’s rule is that patients would lose their right to receive services and that this blanket law would allow Doctors to easily refuse any kind of care.

Rescinding this rule allows patients the right to make unbiased informed decisions about their choices of treatment. If the ’08 rule stays the way it is, one runs the risk of letting informed decision making fall by the way side.

Everyone deserves the right to their beliefs and it goes both ways. Homosexual couples should be allowed to receive fertility treatments, and women who need life saving abortions should be able to receive them. Doctors and health care providers deserve their right to deny treatment, but they shouldn’t walk away form these patients either. Their duty as a Doctor, and one of their first oaths upon entering into their chosen field, is to ‘Do No Harm.’ Do No Harm. That’s what we all strive for.

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.

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….”

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….

Health Insurance Exchanges Should Not Be Like eHealthInsurance

September 20, 2010 in Affordable Health Insurance, eHealthInsurance.com, Health Care, Health Care Costs, Health Care Reform, Health Insurance Agent, Health Insurance Exchange, Health Insurance Quotes, Health Insurance Reform, Individual Health Insurance

Health Insurance Exchanges Should Not Be Like eHealthInsurance
By John Rueschenberg
CoveragePoint.com

Two months ago, I had a meeting with Mary, a director at a reputable health insurance company. Mary’s name has been changed and her company’s name will not be disclosed to protect her identity. Mary and I were talking about the different insurance agencies and the amount of production that they bring to her company each year. Not at all to my surprise, her number one producer of individual health plans was and has been eHealthInsurance. eHealthInsurance is the largest online insurance agency, owned by publicly traded company eHealth Inc. We have all seen their TV commercials for affordable health insurance. The truth is that the rates are no different if you apply using eHealthInsurance, another agency or if you apply directly to the company by yourself. It will be the same rate no matter what, but keep in mind that an agent can help you and keep you from making a costly mistake, so that is why you should always use an agent.

Most will agree, the ongoing history of publicly traded companies is to make a huge profit and achieve excellent numbers so that they can keep their stock holders happy. While some publicly traded companies do care about customer service, many others don’t. I have never been to the eHealthInsurance’s headquarters before nor have I spoken to someone who works for, or previously worked for the company, therefore I don’t know exactly how they operate. What I do know and can share with you are the experiences of others who have dealt with the company at one time or another.

In my meeting with Mary, she described eHealthInsurance as her double edged sword. They continually have brought Mary’s company the most new individual health business, but eHealthInsurance has had an ongoing history of not providing adequate service to their clientele after the policy is issued. Mary also said of the people who applied for one of her companies health plans using eHealthInsurance.com, that ongoing for years now, eHealthInsurance has had the highest percentage of policies not taken after an application was submitted. “Not taken” is an insurance term meaning someone applied, but for one reason or another the policy was never issued. Similar stories are out there on websites such as Epinions.com and other product or service review websites. Interestingly enough, one of the automatically generated search terms that Google gives is “eHealthInsurance scam.” The Better Business Business Bureau of North Eastern California alone has received 22 complaints in the past 36 months for eHealthInsurance.

Ordinarily, I’m not about attacking someone or a company and pointing out their flaws, but this has changed because EhealthInsurance has made the recommendation that the new health insurance exchanges starting up over the next few years should operate similar to how eHealthInsurance.com does now. While lack of service does sound like how most government agencies have long been operating; such as the Department of Motor Vehicle, the Internal Revenue Service and Social Security Administration, the US population as a whole is not looking for health care to operate as another poorly serviced government agency.

There are other sites out there that do provide the same great online experience as eHealthInsurance, but also offer ongoing service for years to come. Websites like CoveragePoint.com give you the same great online service as eHealthInsurance.com does, but they instead have an ongoing reputation of being there for you when sticky situations come along. It is important that the example of the health insurance exchanges follow the examples of agents and agencies who have built a solid reputation of being there after the policy is issued. The agent is the person who is supposed to be there for you at the hardest time, such as when dealing with a difficult claim, especially if you have to deal with multiple insurance companies. An agent helps you during the application process, prevents you from making a simple mistake that would otherwise hold up your application in underwriting for days or weeks longer than necessary, or cause for you to receive a higher premium. An agent can help prevent a decline or a rider. An agents advice and experience are both invaluable and free to the consumer.

Circumstance and claims often do happen where you are dealing with your health insurance company, your auto insurance insurance company and Workman’s Comp; all three at once, or two at the same time for the same injury or claim. More than likely, each company wants the other to pay the claim, so often times none of them pay. Your agent is there to get you through these unfortunate circumstances as your personal representative. Your agent is supposed to be on your side. They should help you figure out the mess and point you in the right direction. The example of health insurance exchanges should not be eHealthInsurance, but instead the example should be that of agents and agencies who have built a solid reputation of being there for their clients when they are needed.

The Centers for Medicare and Medicaid Services(CMS) projects that the expense of health care would be 0.3% less by the year 2019 had the health care reform bill never passed. CMS also predicts health insurance exchanges are expected to cost roughly a total of $220 billion just to start up by 2014. Between 2014 through 2019, the health insurance exchanges are predicted to cost an additional $37.7 billion to operate. Roughly 85% of US health insurance policies are issued with the assistance of an agent. When you consider that about 85% of policies are issued using an agent, the duplicated efforts of exchanges will be a waste of taxpayer dollars. Eliminating the creation of the exchanges all together will save over $250 billion between now and 2019; health care savings would be seen and achieved much sooner. The creation of the health insurance exchanges will simply be a waste of time and taxpayer money, especially if they will be run like any other poorly serviced government agency. There is no reason to reinvent what has already been proven to work.

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