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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.

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.

What Exactly are Reform Lawsuits Arguing?

February 24, 2011 in Affordable Health Insurance, College Students, Dependants, Employer Sponsored Plans, Health Care, Health Care Costs, Health Care Reform, Health Insurance Exchange, Health Insurance Reform, Individual Health Insurance, Specialists

What Exactly are Reform Lawsuits Arguing?

By Ashley Ahle
February 24th, 2011

Lawsuits being filed against the Obama administration’s Patient Protection and Affordable Care Act (PPACA), have amounted to the unconstitutionality of the individual mandate, and whether the federal government has the legal power to enforce such a provision. Currently out of five lawsuits that have made it to the courts, two of them have passed while still three have been ruled constitutional.

Tuesday night, United States District Judge Gladys Kessler ruled in favor of health reform, stating that it does not violate the individual’s religious freedoms. She also stated that Congress is well within their means to penalize people who forgo insurance. under the Commerce Clause in the constitution.

A ruling in favor of a 26 state lawsuit against reform in Florida was upheld by Judge Roger Vinson. He dismissed the law in it’s entirety stating that picking apart the law and taking out the mandate would render it “toothless” anyway. The administration is asking Vinson to further clarify his ruling and will more than likely seek a stay of judgment, further delaying the case’s move to the Supreme Court.

When fighting the reform, the state’s main fear is that it would give the government too much power by allowing it to penalize individuals without, and force people to purchase health insurance. In defense, the government claims that everyone will buy health care at some point whether it’s with insurance or in an emergency. Without the mandate, premiums would skyrocket and no one would benefit.

Parts of the constitution that are being used in these cases are Commerce Clause, Supremacy Clause (states that federal power is supreme over state power), and the 10th amendment which leaves to the state “all powers not explicitly granted to the federal government go to the state.”

While it remains to be heard in the Supreme Court, it is also unclear if the PPACA can stand without the individual mandate. There may be too many other parts of the bill connected with the mandate that would have to be repealed or changed as well.

Don’t let any of this confuse you as these cases have yet to make it to the supreme court. As of now there has been no final decision about repeal and the cases are still being heard around the country.

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.

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.

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