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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.

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.

Effect of Repealing the Individual Mandate

February 17, 2011 in Affordable Health Insurance, 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

Effect of Repealing the Individual Mandate

By Ashley Ahle
February 17th, 2011

Deeming the individual mandate of the Patient Protection and Affordable Care Act unconstitutional has caused many people to question the need for it. As I have said in past posts, an individual mandate is necessary for the PPACA to be successful. Without it or something similar, the Health Care Reform would fail. That said, how can the individual mandate be altered to fit the needs of those fighting for repeal? And by piecing apart the PPACA, what will the costs be to the government and will a repeal actually solve anything?

According to the Congressional Budget Office, they estimate that a repeal of the mandate would bring in roughly $202 billion dollars between 2014 and 2019, while at the same time increasing the number of uninsured by 16 million people. It would also reduce the number of people on Medicaid and the Children’s Health Insurance Program by 6-7 million people; individual coverage by 5 million and employee sponsored coverage by 4-5 million people. The question is, then, is saving that $202 billion dollars more beneficial to the people of the country?

Alternatives to the mandate are out there, however people voting to repeal all of the Reform are unwilling to present these options due to the fear that they may actually strengthen the PPACA. Since the reform will fail without a mandate, there needs to be something in place that is strong enough to discourage people from buying coverage only when they are sick. Reform will prohibit risk adjustments from being made individually. Instead there will be a community rating; this is a way to calculate premiums by evaluating the risk factors of all persons in the market, instead of evaluating it individually like it is done now.

Under this community rating, it makes it so healthy and sick people pay virtually the same amount in premiums. If there were a repeal of the mandate, health costs would rise to such a crushing rate that we may face another government bailout like that of the auto industry. The aim in repealing the mandate is to lessen the government’s involvement and this would run the risk of increasing it.

Other options to the mandate that have been kicked around include the possibility of a small tax, limiting enrollment to once every two years, penalizing people who wait, and implementing a five year lock-out. The small tax would be set close to the amount proposed for the penalty. For people who go uninsured this would be a tax they would pay at the end of the year and for people who can prove credible coverage this would be a tax credit at the end of the year. The reason that Democratic politico’s didn’t propose this originally is because of the political fight over taxes that would ensue.

Limiting enrollment to once every two years would disable people who decide to go uninsured from buying coverage only when they are sick. It would act as a buffer, similar to the enrollment periods for Medicare. Penalizing people who wait for coverage is similar to the penalty on Medicare Prescription Drug Benefit. It would implement higher premiums for those who decided to wait. The five year lock out would prevent people who go without coverage, access to government subsidies and insurance protections for five years. Even if they wanted to buy coverage in the first place.

Here the problem lies with Congress. There has to be a middle ground at this point, that both Republicans and Democrats can meet. The way things are progressing, that ground may continue to elude all parties. Republican’s and Democrats fighting for a repeal will not vote for alternatives to the individual mandate because they don’t want reform at all, and those alternatives may actually strengthen the PPACA. If we all, in fact want the same thing, a system with lower costs and near universal care, there has to be compromise. Otherwise the amount of money wasted on arguing all facets of Reform will outweigh the benefits.

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 Care Reform New health-care rules could add costs, and benefits, to some insurance plans

June 15, 2010 in Affordable Health Insurance, College Students, Dependants, Group Health Plans, Health Care, Health Care Costs, Health Care Reform, Health Insurance Exchange, Health Insurance Quotes, Health Insurance Reform, Individual Health Insurance

Health Care Reform New health-care rules could add costs, and benefits, to some insurance plans http://ow.ly/17KFTo

Health Care Reform Health Reform Continues To Dominate Campaigns

June 15, 2010 in Affordable Health Insurance, Group Health Plans, Health Care, Health Care Costs, Health Care Reform, Health Insurance Exchange, Health Insurance Reform, Individual Health Insurance

Health Care Reform Health Reform Continues To Dominate Campaigns http://ow.ly/17KDp3

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