The number 1 issue global Wall Street Clinton/Obama neo-liberals pretending Affordable Care Act had any intentions of protecting public health access for 99% of people is the HEALTH INSURANCE CORPORATIONS. These several years of course have seen health care insurance rates SOAR---HITTING PARTICULAR INDUSTRIES FIRST. If we remember the deregulation of energy---California had soaring electricity costs because its newly privatized public utilities openly went wild on rates. What happened? Almost all small and regional businesses were pushed out of business----same tactic was used when global oil was deregulated and openly allowed to treat gas prices as ATM'S creating the 1970s gas lines. This pushed more small and regional transportation businesses out of business---
So, here we are these few decades later watching the EXACT SAME POLICIES doing the same thing this time health insurance killing small and regional health corporations---what is left of our public hospitals and clinics----and killing a once perfectly functioning health insurance structure in US.
Health insurance corporations were able to do this because AFFORDABLE CARE ACT deregulated health care and insurance industry was placed at the top of control of CONSOLIDATED, MONOPOLIZED global health systems.....ergo, they can now do anything they want and pick winners and losers. So, of course corporations are going to end their health packages and go to PREVENTATIVE CARE ONLY.
THIS WAS INSTALLED DURING OBAMA BY CLINTON NEO-LIBERALS---IT IS TAKING HOLD NOW UNDER TRUMP---
Don't feel sorry for corporations over these costs----global corporations paid CLINTON/BUSH/OBAMA pols to install this right wing global Wall Street health policy---AFFORDABLE CARE ACT.
FIX IT 2016 “Healthcare at the Tipping Point”
Richard Master is the founder and owner of MCS Industries, a world leader in the picture frame and decorative mirror business. Like most US companies, he fac...
youtube.com
Published on Jun 11, 2016
Richard Master is the founder and owner of MCS Industries, a world leader in the picture frame and decorative mirror business. Like most US companies, he faces relentless annual cost increases to provide health insurance for his employees.
He decided to tackle the problem of healthcare using best business practices... doing an in-depth analysis, finding the right diagnosis and then determining the fix. Fix It, the movie, is a result of his journey to find a solution to the dysfunctional US healthcare system.
...a powerful new documentary that reaches across the political and ideological divide to expand support for major healthcare reform.
The film was two years in the making, with more than forty voices advocating for reform, including: activists, health policy experts, economists, physicians, nurses, patients, business and labor leaders. This documentary takes an in-depth look into how our dysfunctional health care system is damaging our economy, suffocating our businesses, discouraging physicians and negatively impacting on the nation's health, while remaining un-affordable for a third of our citizens.
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Produced: 2016, Episode:FIXIT, Category: Education, 58:00
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Since we KNOW URBAN INSTITUTE is a global Wall Street 1% organization we can look at articles and goals written by them and know they will be bad for WE THE PEOPLE THE 99%. These are far-right wing think tanks so they are not helping us keep our strong, accessible, affordable, American health care. They will create TALKING POINTS that will send those pesky 5% global Wall Street player organizations out to sell especially poor communities ----THIS WILL HELP THE POOR ACCESS HEALTH CARE.
MEDICARE AND MEDICAID ended with AFFORDABLE CARE ACT----it was gutted of $1 trillion in budget those cuts hitting hardest in just a few years by OBAMA AND CLINTON NEO-LIBERALS----not TRUMP.
It is DISINGENUOUS to keep suggesting MEDICAID be expanded when we have $20 TRILLION IN NATIONAL DEBT AND A COLLAPSING ECONOMY----so this is all SMOKE AND MIRRORS confusing our working class and poor citizens which of course is now 80% of Americans and rising.
'A central problem is that 19 states have yet to take advantage of the ACA’s Medicaid eligibility expansion, and that leaves many low-income people in those states without an option for affordable coverage. We suggest allowing states to expand Medicaid eligibility for those with incomes up to 100 percent of the federal poverty, level instead of 138 percent, to encourage more states to expand'.
The first thing we notice in this article is the reference to MEDICARE ADVANTAGE as a model-----MEDICARE ADVANTAGE is the privatized MEDICARE---not our Federal public trust filled with decades of PAYROLL TAX MEDICAL SAVINGS ACCOUNTS. This is how we know it is a right wing group working against WE THE PEOPLE THE 99%.
Blumberg is frequently asked to testify before Congress and is quoted in major media outlets on health reform topics. She serves on the Cancer Policy Institute’s Advisory Board and has served on the Health Affairs editorial board. From 1993 through 1994 she was a health policy advisor to the Clinton administration during its health care reform effort, and she was a 1996 Ian Axford Fellow in Public Policy.
She received her PhD in economics from the University of Michigan.
'The Fulbright Program is administered by cooperating organizations like the Institute of International Education.
James William Fulbright (April 9, 1905 – February 9, 1995) was a United States Senator representing Arkansas from January 1945 until his resignation in December 1974. Fulbright is the longest serving chairman in the history of the Senate Foreign Relations Committee'.
All of Linda Blumberg's connections is with CLINTON ERA AND INTERNATIONAL DEVELOPMENT TRUSTS. This is how we know her solutions will be ONE WORLD ONE GOVERNANCE and not WE THE PEOPLE THE 99%. HERE IS ARKANSAS GALORE WITH CLINTON AND FULBRIGHT.
HILLARY WAS TRYING TO DO TO HEALTH CARE BACK THEN WHAT BILL WAS DOING TO DEREGULATED AND GLOBAL WALL STREET.......Blumberg wanted to join Hillary in doing this----fast forward these few decades and VOILA---OBAMA does to health care what Bill did to Wall Street banking.
Urban Wire Health and Health PolicyRSS
The voices of Urban Institute's researchers and staff
July 6, 2017
Robert Abare
Linda J. Blumberg
Fixing the ACA is the overlooked solution to the health care puzzle
Linda Blumberg, senior fellow in the Urban Institute’s Health Policy Center, is an expert on private health insurance and health system reform. She has conducted extensive studies on the impacts of the Affordable Care Act (ACA) on families and communities across the country following the law’s initial implementation in 2014.
In January 2017, Blumberg and Institute fellow John Holahan proposed strategies to fix the biggest problems with the ACA, rather than repealing and replacing the law as sought by the Affordable Health Care Act (AHCA) passed by the House in May and the Better Care Reconciliation Act (BCRA) under debate in the Senate.
What, by your estimation, is the ACA’s primary weakness?
A central problem is that 19 states have yet to take advantage of the ACA’s Medicaid eligibility expansion, and that leaves many low-income people in those states without an option for affordable coverage. We suggest allowing states to expand Medicaid eligibility for those with incomes up to 100 percent of the federal poverty, level instead of 138 percent, to encourage more states to expand.
Second, the nongroup insurance reforms of the ACA have faced real challenges in regions that are sparsely populated. These areas have little competition in their insurance markets, health care provider markets, or both. It’s difficult to engender new competition in these areas.
In areas that experience a lot of consolidation among insurers or providers, unsubsidized premiums are high. In markets with only one or two insurers, there is little to no incentive for insurers to be tough negotiators to bring down provider prices (and thus premiums), and in markets with a dominant health care system, even strong insurers do not have bargaining power to bring provider prices down. These situations are most common in rural and other areas with low population density.
Rising premiums have been a primary concern among critics of the ACA. How do you propose lowering them?
First, in many areas of the country, particularly large metropolitan areas where lots of people live, premiums have been low, as has premium growth. The areas of concern are largely outside these population centers. Concerns over whether insurers will be reimbursed for the cost-sharing subsidies they have paid out and are required to pay out in the future is now affecting how insurers set premiums, however, and this uncertainty can be immediately addressed by Congress and the administration committing to pay these bills.
In addition to that immediate need, we suggest that insurer and provider consolidation and the higher premiums that result from them can be addressed using a strategy employed by the Medicare Advantage program. We propose that provider payment rates charged by nongroup insurers be capped at Medicare rates, Medicare rates plus some percentage, or at some other standard.
These caps would allow insurers to negotiate lower rates with providers if they can, but these insurers would not have to pay more. The caps would take away the pricing power of provider monopolies, allowing insurers to set lower premiums. The caps would also make it easier for additional insurers to enter markets with only one or two insurers because the new entrants could set competitive premiums even in markets where they currently have no market share.
How does “fixing” the ACA differ from the other options on the table? Could the AHCA and BCRA be described as fixing the ACA?Fixing the ACA requires addressing existing problems such that the ACA’s objectives can better be achieved. An approach that does not share the ACA’s objectives is not a fix.
The ACA’s objectives were primarily to do the following:
The BCRA and AHCA have different objectives.
They would increase the number of uninsured people and would decrease access to care and affordability via decreasing Medicaid funding, eliminating the ACA’s subsidies to lower deductibles and other out-of-pocket costs, and decreasing premium tax credits for many low- and middle-income people purchasing private nongroup insurance today.
Various strategies in the bills would move private insurance markets back toward separating the costs of the healthy from those of the sick, making access to care less affordable when health issues arise. And we estimate that the BCRA would lead to 24.7 million more people uninsured than under the ACA in 2022. The AHCA would lead to an additional 23 million uninsured in 2022.
With such different objectives and outcomes, neither piece of legislation can be considered a fix to the ACA.
The individual mandate is one of the most unpopular provisions in the ACA. Do you have a fix for that?The individual mandate, though unpopular, is critical. It broadens health care risk by keeping healthy people in the insurance market and attracting more healthy people to enroll.
But it’s difficult to find an alternative to the individual mandate that is equally effective and fair.
In our “fix it” paper, we discussed using late-enrollment penalties, but this strategy has significant downsides relative to the individual mandate. The AHCA proposes a 30 percent premium surcharge for late enrollees. But only people who expect to need substantial amounts of medical care in the coming year are going to be willing to pay that extra 30 percent in addition to their regular premium.
People who experienced a gap in coverage but expect to be healthy would be less likely to enroll because of the higher price. So, that 30 percent penalty would make the insurance pool sicker, on average, and drive premiums up.
This shows that it’s not straightforward to find an alternative to the individual mandate that doesn’t dissuade healthy people from getting insured or make it prohibitively expensive for people who need care to enroll after a coverage gap.
And people’s lives are complicated—difficult situations lead many to experience these gaps. We want to encourage people to get and stay covered, but we should be careful about being overly punitive in a way that will compromise the health of people who have gone through tough times.
What are the most important steps for fixing problems with the ACA?
First, Congress and the administration should commit to fully reimbursing Marketplace insurers for the cost-sharing reductions these insurers have paid and will pay out in the future.
Next, a permanent reinsurance program for the private nongroup insurance market would address markets experiencing disproportionate enrollment of people with high medical needs. The ACA, AHCA, and BCRA include temporary reinsurance programs while Medicare has a permanent one, so there should be bipartisan support for this.
Third, capping provider payment rates for nongroup insurers, at least in low insurer or provider competition areas, should help a great deal.
Enrollment could be improved in several ways, some less costly than others. Increasing outreach and enrollment assistance is an inexpensive way to get more healthy people to join the insurance market. Uninsured people reached by such programs are more likely to be healthy because they haven’t entered the system on their own knowing that they need care.
Closing loopholes for insurers to sell plans that do not comply with the ACA’s consumer protections would also bring more healthy people into the broad insurance pool, which would help bring average premiums down.
Other important fixes come with a bigger price tag, but even those would represent a small percentage increase in overall health spending.
The ACA has made major advances in making health care affordable through Medicaid expansion, premium tax credits, and cost-sharing reductions for nongroup insurance coverage. But as people go up the income scale and federal assistance decreases, there are people who still look at the cost of insurance and feel that coverage is not affordable or the cost-sharing requirements are too high for their income.
We can do better by improving the premium tax credits and cost-sharing assistance and by encouraging states that have not expanded Medicaid eligibility to do so.
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'When President-elect Donald Trump enters office on Jan. 20, he will inherit almost $20 trillion of national debt. This debt is a threat to the American economy, and its key driver—unsustainable spending—must be controlled'.
Here it is-----all US Treasury debt -----Wall Street bailouts in trillions ----global corporate development subsidies in trillions----THIS IS WHAT KILLED MEDICARE AND MEDICAID TRUSTS. Of course these same 5% to the 1% Clinton/Obama pols and players are now PRETENDING it is all Trump's fault.
WE THE PEOPLE must know goals in health policy----global Wall Street goal of killing all of MLK'S WAR ON POVERTY would kill MEDICARE AND MEDICAID.
When a LINDA BLUMBERG continues to talk about expanded Medicaid blaming it on states that OPT OUT----she knows she is POSING LEFT SOCIAL PROGRESSIVE.......it ain't happening because it was never supposed to happen.
Entitlements are absorbing all taxes because of health industry PROFITEERING AND FRAUD---and because corporations and the rich stopped paying taxes these few decades ago.
3 Things Trump Can Do to Control the National Debt
Mollie McNeill / @molliemcneill / January 11, 2017 /
The U.S. national debt is racing toward $20 trillion. (Photo: iStock Photos)
Commentary ByMollie McNeill @molliemcneill
Mollie McNeill is a research assistant with economic and budget policy at The Heritage Foundation.
When President-elect Donald Trump enters office on Jan. 20, he will inherit almost $20 trillion of national debt. This debt is a threat to the American economy, and its key driver—unsustainable spending—must be controlled.
Come Jan. 20, the new administration should act immediately to tame the federal budget and reduce the national debt. Here are three solutions from The Heritage Foundation’s Blueprint Series that do just that.
1. Reform autopilot entitlement programs.
Entitlement programs like Medicare, Medicaid, and Social Security make up the largest portion of the federal budget. In 2015, major entitlement programs consumed 52 percent of all tax dollars. They will grow to consume even more of the budget unless lawmakers intervene.
Currently, entitlement programs run on autopilot, meaning they don’t require new spending bills to keep running. Because of laws put in place years ago, agencies spend whatever is necessary each year to fund these programs, and it is politically unpopular for politicians to reform or downsize them.
The next administration should reform these unsustainable mandatory programs. Some commonsense solutions include repealing and replacing Obamacare, modernizing Medicare, capping the federal allotment for Medicaid, and making reforms to Social Security.
Entitlements Devour All Taxes by 2038
2. Balance the budget.
Persistent budget deficits allow the national debt to spiral out of control. For the last 50 years, the federal budget had an average deficit of 2.8 percent of gross domestic product, and the current Congressional Budget Office baseline projects that deficits will surpass $1 trillion before the end of the decade.
Balancing the budget isn’t a cure all, since legislators can always use higher taxes to support higher spending and technically balance the budget in the short term. In the long run, higher taxes would end up chasing ever higher spending, which is unsustainable. Instead, a balanced budget is an important goal to prioritize spending and reduce deficits and debt.
The incoming administration should adopt a plan that balances the budget while reducing spending and taxes. The Heritage Foundation’s “Blueprint for Balance” balances the budget in six years and creates a surplus in seven years.
How to Balance the Budget
3. Reform the budget process.
The current budget process is broken. The budget process is supposed to enable lawmakers to set national priorities in a timely and predictable way. But the current process, established in 1974, has only worked four times.
The current process leads to higher government spending and debt. Since the most expensive programs, like Social Security, Medicare, and Medicaid grow on autopilot, and because they are also the most popular, politicians have little incentive to change them.
The next administration must enact budget process reforms that restore accountability and fiscal responsibility to the federal budget.
Commonsense budget process reforms such as fair value accounting, including interest in estimating the impact of congressional budget proposals, and statutory spending caps that limit spending growth enforced by sequestration, will help reform the budget process and get national debt under control.
How the Budget Has Changed
So far, the new administration’s plans for addressing the national debt haven’t been great. Trump has proposed renegotiating the national debt and printing more money. Both are possible, but will ultimately prove to be unhelpful and economically dangerous distractions from the out-of-control spending that is driving the national debt.
Despite the lack of concrete current plans to control the debt, the next administration will have ample opportunity to tame the federal budget. Trump’s pick for Office of Management and Budget director, Rep. Mick Mulvaney, R-S.C., is a budget hawk who values fiscal conservatism.
The Congress is controlled by Republicans who have put forth sensible and realistic proposals to reduce out-of-control health spending with Medicare premium support and caps on federal Medicaid allotments. With the House, Senate, and executive all controlled by the same party, serious budget reform is within reach.
The incoming administration needs a plan to get spending and high national debt under control now, to ensure economic freedom and secure prosperity for Americans in the future.
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When a global Wall Street Clinton/Obama health care group have us shouting MEDICARE FOR ALL-----they are again MISINFORMING PEOPLE. These groups are not working to reinstate our American Federal Medicare Trust into which citizens have paid for several decades---they are talking, as was BLUMBERG----about this MEDICARE ADVANTAGE that OBAMA strengthened while weakening and ending our Federal Medicare Trust.
Having MEDICARE ADVANTAGE speaking for what is good for 99% of citizens is like having AARP speaking for what is good for 99% of citizens---AARP is MEDICARE ADVANTAGE----this corporations' goal these few decades has been just that ---PRIVATIZING MEDICARE. We have what are global corporations allowed to pretend to advocate for what is good for 99% of American people.
Our Federal government was captured by global Wall Street so these FEDERAL MEDICARE AND MEDICAID TRUSTS have not been corrupted as is----now global Wall Street is simply handing us to corporations pretending they are advocates for our good.
'Rising premiums have been a primary concern among critics of the ACA. How do you propose lowering them?
'In addition to that immediate need, we suggest that insurer and provider consolidation and the higher premiums that result from them can be addressed using a strategy employed by the Medicare Advantage program. We propose that provider payment rates charged by nongroup insurers be capped at Medicare rates, Medicare rates plus some percentage, or at some other standard'.
For those not understanding HEALTH INSURANCE TALK----the buzz words from MS BLUMBERG and this article are now PRIVATE HEALTH INSURANCE IN NON-GROUP OR INDIVIDUAL MARKET under Affordable Care Act. All that was done was to create TIERED HEALTH INSURANCE plans pretending non-group individual health plans are abiding by AFFORDABLE CARE ACT with what people wanted to hear----when in fact they are not. This strips 80% of Americans from the national and global health corporation market and now they are installing these same TAX CREDITS----VOUCHERS----replacing what was a national MEDICARE AND MEDICAID program where everyone received the same and could go anywhere to get that health care.
What happens in every industry regarding the receipt of tax credits for services? That's right ----the entire tax credit funding system is corrupted and used to enrich those NON-GROUP health insurance corporations with citizens not accessing what is Federally mandated because no federal agency is providing oversight and accountability. The non-groups in Maryland are largely tied to global corporations like Johns Hopkins.
Blog
Challenges in Estimating the Number of People With Nongroup Health Insurance Coverage Under Proposals for Refundable Tax Credits
Posted by Susan Yeh Beyer and Jared Maeda on
December 20, 2016
Some policymakers have expressed interest in developing proposals to replace the current tax-based subsidies for the purchase of private health insurance in the nongroup (or individual) market under the Affordable Care Act (ACA) with refundable tax credits that would be structured differently from those under current law. Many such proposals would also eliminate or reduce the extent of current federal laws regulating the nongroup market, particularly the rules governing health insurance benefits. Two key questions for policymakers in developing such proposals are what type of insurance products would qualify for tax credits and what role states would have in making that determination.
CBO and the staff of the Joint Committee on Taxation (JCT) anticipate that insurers would respond to such legislation by offering new types of insurance products in the nongroup market, which are likely to differ from existing products in their depth and extent of health insurance benefits.
If there were no clear definition of what type of insurance product people could use their tax credit to purchase, some of those insurance products would probably not provide enough financial protection against high medical costs to meet the broad definition of coverage that CBO and JCT have typically used in the past—that is, a comprehensive major medical policy that, at a minimum, covers high-cost medical events and various services, including those provided by physicians and hospitals. (For a discussion about how CBO defines health insurance coverage, see CBO’s blog post on how CBO defines and estimates coverage.)
If there were no clear definition of what type of insurance product people could use their tax credit to purchase, everyone who received the tax credit would have access to some limited set of health care services, at a minimum, but not everyone would have insurance coverage that offered financial protection against a high-cost or catastrophic medical event; CBO and JCT would not count those people with limited health benefits as having coverage. One could thus assess the effects of such proposals on insurance coverage in two different ways—how many people would obtain any type of insurance policy using the tax credit and how many people would obtain an insurance policy that meets the broad definition of coverage described above. If policymakers expressed interest in knowing the number of people who, under those proposals, would purchase private insurance in the nongroup market that met a broad definition of coverage, CBO and JCT would estimate separately the number of people who would receive the tax credits and the number of people who would obtain such coverage. In this blog post, we describe the challenges CBO and JCT would face in estimating the number of people who would purchase coverage in the nongroup market, and the scope of that coverage, under such proposals. (Similar challenges could arise in the group market if tax credits were extended to people with employment-based coverage. However, that discussion is beyond the scope of this blog.) For context, we first provide some background about private insurance and summarize how the nongroup market is regulated under current law, including the changes that were made by the ACA. (For additional information about that market, see CBO’s report about private health insurance premiums.)
What Features of Private Insurance Determine the Share of Medical Costs It Covers?
The amount of financial protection against medical costs that private insurance covers can be described in terms of the depth and extent of coverage. (Another dimension by which private insurance coverage can vary is the size of the provider network. However, that discussion is beyond the scope of this blog post.)
The depth of coverage can be measured by examining the cost-sharing structure and any maximum benefits or limits that apply. The cost-sharing structure is the amount of out-of-pocket costs—typically in the form of deductibles, coinsurance, and copayments—that a person is required to pay when using medical services. Those out-of-pocket costs may be subject to a maximum limit (in a given year or over a lifetime) beyond which the insurer covers most or all remaining medical costs. Another limit may apply to the maximum dollar amount of medical costs that an insurer will pay for. When benefits reach their maximum allowed by the plan, the person is responsible for all remaining medical costs. In general, plans have only one of those two limits (or none at all).
The actuarial value of a health insurance plan is a summary measure of the depth of coverage for a given set of health care benefits. More specifically, the actuarial value measures the percentage of medical costs that an insurer would pay if it covered people with average health expenditures. For example, a plan with an actuarial value of 70 percent would, on average, pay 70 percent of the expected medical costs on covered benefits for a person with average health risks and patterns of use.
The extent of coverage can be measured by examining the scope of benefits—that is, the services and the types of providers whose services are covered by a health plan. Covered benefits for most plans include physicians’ and hospitals’ services and often laboratory services, radiology services, and prescription drugs. More extensive plans cover a broader range of services, such as behavioral health and substance abuse treatment and rehabilitative therapy. Less extensive plans limit the range of services covered and might exclude maternity benefits and prescription drugs.
How Is the Nongroup Market Regulated Under Current Law?
States have traditionally been responsible for regulating health insurance benefits in the nongroup market. Before enactment of the ACA, nongroup market regulations varied widely across states. In 2014, however, many federal regulations that governed the benefits that new policies sold in the nongroup market must provide went into effect as part of the ACA. The depth and extent of coverage in the nongroup market were standardized to a large degree under the ACA, which established a set of “essential health benefits” and a minimum actuarial value for insurance plans (along with a definition of that measure). In addition, plans sold in the nongroup market were no longer allowed to set maximum annual or lifetime limits on covered medical costs for the essential health benefits. The states’ role in defining the depth and extent of coverage in the nongroup market was, thus, substantially reduced after 2014.
The ACA also established several regulations that limit insurers’ ability to deny coverage to people with high expected medical costs. Three regulations, in particular, apply to such people: modified community rating rules, guaranteed issue, and requiring coverage of preexisting conditions. Modified community rating rules prohibit insurers from engaging in medical underwriting (pricing premiums on the basis of a person’s health) and limit the degree to which premiums are allowed to vary by age. Under guaranteed issue, insurers are required to sell coverage to a person regardless of his or her health. The prohibition on excluding coverage of preexisting conditions requires nongroup insurers to cover the treatment of those conditions.
What Are Some Alternative Proposals to the Current Tax-Based Subsidies to Purchase Private Insurance in the Nongroup Market?
Currently, tax credits for nongroup policies sold through the ACA marketplaces vary in relation to the premium of the second-lowest-cost “silver” plan in a market that offers the policies and in relation to certain characteristics of enrollees, including family size, income, age, and tobacco use. To qualify for tax credits under current law, a person must purchase a plan offered through a health insurance marketplace that covers 10 categories of benefits defined as essential and meets a minimum actuarial value, among other features. In addition, cost-sharing subsidies reduce the cost-sharing amounts for low-income people who select a silver plan.
Some policymakers want to replace the current tax-based subsidies to purchase private insurance in the nongroup market with alternative proposals. Under some proposals, refundable tax credits would generally be based on a fixed dollar amount and might vary by age or family size. The amount of such credits often does not depend on an enrollee’s income or a plan’s premium. A key question for federal policymakers is what types of insurance products would qualify for the tax credits. Often, such proposals would allow states to regulate the nongroup market. In that case, regulation of the nongroup market would probably vary widely from state to state. Without a federal standard, some states might not impose any regulations that would govern the depth and extent of coverage and that would define what insurance products qualify for tax credits.
What Are the Challenges of Estimating the Number of People With Nongroup Coverage Under an Alternative Refundable Tax Credit Proposal?
CBO and JCT face several challenges in estimating the number of people who would purchase private insurance coverage in the nongroup market under an alternative refundable tax credit proposal. It is difficult to predict what regulations states would impose on the nongroup market, what types of products insurers might offer given those regulations, and which types of insurance products people might purchase based on their preferences and their characteristics (such as age, income, and health).
One way to predict the types of plans that people might purchase is to look at the types of plans that existed in the nongroup market before enactment of the ACA. Before then, nongroup market regulations varied widely across states. Only a few states required guaranteed issue and implemented modified community rating rules. Although many states specified a set of services that insurers had to cover, no states regulated the depth of coverage or the amount of cost sharing. Most plans sold in the nongroup market included major medical benefits that provided comprehensive coverage for a range of services, including care by physicians and at hospitals. But certain services, such as maternity benefits and prescription drugs, were not always covered. Many of those plans also had very high deductibles and maximum annual or lifetime limits on benefits. Nevertheless, many of them would meet the broad definition of coverage that CBO and JCT have typically used in the past.
Other plans that were less commonly sold offered benefits that were even more limited. Such plans included fixed-dollar indemnity plans that paid a certain amount per day for illness or hospitalization, or plans that covered only preventive care and routine office-based physicians’ services but did not cover hospitalizations. Such limited plans would generally not meet the broad definition of coverage.
Looking back at the pre-ACA nongroup market is not enough to determine what might happen under a tax credit proposal, however, because no such financial incentive to purchase health insurance existed in that market. Plans that were previously offered in that market might be offered again in the future, and new products might also be offered. In the absence of a clear definition of what type of plan qualifies for a tax credit, some plans would probably have premiums that covered minimal services and would be priced close to the amount of the tax credit. Such plans have been offered in the past in response to a similar incentive: They were used in conjunction with a tax credit related to child health that was in effect in 1992 and 1993, and the depth and extent of coverage that people purchased were often very limited.
In addition to the response by states and insurers, people at different income levels might have different preferences for the depth and extent of their insurance coverage. For example, low-income people might prefer coverage for preventive services and routine physicians’ visits to keep their monthly expenses low, even if such a policy did not cover more costly services such as hospital care. High-income people might not care as much about predictable monthly expenses and might prefer catastrophic coverage to protect their assets against high medical costs.
People’s preferences for insurance products might also vary with other characteristics, such as their sex or health. In states without regulations that limit insurers’ ability to exclude people with high expected medical costs, however, those individuals would probably face high premiums or have access to insurance plans with only limited coverage.
In response to a future policy that had minimal federal or state regulations, CBO and JCT expect that some new insurance products would be offered that limited coverage to the amount of the tax credit. Some of those insurance products purchased by people using a tax credit would probably not offer much financial protection against high out-of-pocket costs. Depending on the size of the tax credit, however, the depth and extent of coverage and the premiums of plans could vary. As discussed in another blog post about how CBO defines and estimates coverage, CBO does not count plans that have very limited benefits in measuring the extent of private insurance coverage; in such an assessment, it counts only people with a comprehensive major medical policy as having private insurance.
Under such proposals, CBO and JCT would separately estimate the number of people who would receive the tax credits and, if policymakers expressed interest in such estimates, the number of people who would purchase private insurance in the nongroup market that met a broad definition of coverage. In that case, the latter estimate of the number of people with coverage would probably be smaller than the estimate of the number of people who would receive the tax credit.
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Below we see from where these Affordable Care Act policies stem----again, Bush era 2000 right wing global corporate think tank HEALTH INSURANCE ASSOCIATION OF AMERICA---which of course was the strongest corporate health insurance lobbyist for AFFORDABLE CARE ACT.
If we don't like this health reform it is because it was written by these corporate groups----they all have talking points that begin----STRATEGIES FOR WORKING AMERICANS----
'Richard E. Curtis
President
Institute for Health Policy
Employment History
Director of Policy and Research
Health Insurance Association of America'
This is only the start of a very long health policy article----if you want to know from where Affordable Care Act comes ---this is it----tied to MASSACHUSETTS' ROMNEYCARE-----For those not noticing yet MA is raging far-right wing global Wall Street 1%---not DEMOCRATS. So, now that no one can afford all these tiered health plans we all need tax credits to get what we simply received through corporate and government health plans.
'Starting up a pool would be considered a “charitable purpose,” so that pools could
more easily obtain foundation grants to pay for start-up and administrative costs'.
This is essentially ending our FEDERAL AND STATE health plans and EXPOSING WE THE PEOPLE to yet more FOUNDATION AND CORPORATE PATRONAGE in lieu of their paying taxes-----when they DONATE they write the conditions of what that health programs looks like and who dispenses that program----just as with our social services where most of these few decades of massive frauds took place. This is supposed to be our health care PLAN.
If we notice we are still paying those PAYROLL TAXES supposedly creating health savings accounts and clinical care when needed---yet all this is moving towards CHARITY PATRONAGE with those corporations receiving tax credits.
We keep allowing far-right wing pretend to be helping the poor-----stay in office CLINTON/BUSH/OBAMA----
PRIVATE PURCHASING POOLS TO HARNESS INDIVIDUAL TAX CREDITS FOR CONSUMERS
Richard E. Curtis, Edward
Neuschler, and Rafe Forland
Institute for Health Policy Solutions
December 2000
Strategies to Expand Health Insurance for Working Americans
A Report Series from The Commonwealth Fund Task Force on the Future of Health Insurance
v
EXECUTIVE SUMMARY
A health insurance tax credit could help many people who cannot afford to
purchase coverage. However, even with these subsidies, many of the uninsured would
probably still find non-group private insurance too expensive. Many would also find the
complexities of the individual market and its myriad insurance products bewildering.
Private purchasing pools for tax-credit recipients could address these problems by
providing individual purchasers with many of the advantages of a group market, such as
relatively low administrative costs, no health rating and professional purchasing expertise.
Insurance purchased through pools should cost 5 percent to 10 percent less than private,
non-group insurance. Unlike many employer plans, however, purchasing pools will allow
individuals to choose among several health plans.
All tax-credit recipients would be required to purchase coverage through private
purchasing pools. This requirement is necessary to ensure that the pools become large
enough to operate efficiently and offer their members the advantages of group purchasing.
Individual purchasers who were not eligible for tax credits, and firms with 50 or fewer
employees could also join the pools. Income-eligible workers in small firms with a majority
of low-wage workers would be eligible for the full amount of the tax credit for coverage
purchased through a pool, whether or not their employer paid any part of their premium.
In the recent past, many small state-run purchasing pools have failed, largely
because of hostility from insurers and agents. Agents fear loss of commissions, and health
plans prefer to deal with employer groups directly through exclusive contracts. However,
the pools proposed here should be more attractive to insurers. Because pools would be the
only vehicle for using the health insurance tax credit, they would be much larger and have
greater cohesion and stability than any other pools to date. In addition, since people will
join pools for reasons not related to their health status, risk selection should be much less
frequent than in the individual insurance market.
In turn, pools should be attractive to low-income purchasers of health insurance,
because they would provide a more consumer-friendly source of coverage than the
existing individual health insurance market. Like large employers, pools would act as
“sponsors,” using their size and professional purchasing expertise to obtain good value for
their members. Individual consumers would be assured that the plans offered through the
pool were those that best met the informed standards of their sponsor, the pool.
Premiums for full tax-credit recipients would not vary based on individual health
status. They would be permitted to vary only by age, and only to the extent permitted in
the state’s regular insurance market. Premiums for non-tax-credit recipients could be health
rated, and health rating could be phased in for recipients of partial credits. More generally,
these pools would provide a stable source of coverage for people whose circumstances
change, allowing them to keep their insurance provider and their physicians.
The federal government would provide the enabling legislation and start-up funds
for health insurance purchasing pools, so that at least one competing pool would be available
in every region of the United States. Federal funds would cover 80 percent of the cost of
establishing a pool, up to $2 million per pool. Thereafter, administrative costs would be
paid for with a small (3%–4%) surcharge on premiums. State responsibilities would include
regulating pools, preventing “redlining,” limiting the number of pools so they reach
sufficient size, and arranging an alternative purchasing mechanism for tax-credit recipients
if no private organization came forward to sponsor a pool in the state. Where necessary,
state benefit mandates would be waived, so that plans costing no more than the value of
the tax credit could be offered through pools. However, a federal minimum benefit package
would be established. Pools would be permitted to contract selectively with health plans.
In each region of the United States, several competing pools would be preferable
to just one, for several reasons. First of all, people prefer to have a choice of plans, and
presumably a choice of pools. More importantly, a single purchasing pool, especially one
seen to be an agent of government, might not have the same freedom to contract
selectively with the health plans it considers the best value.
Starting up a pool would be considered a “charitable purpose,” so that pools could
more easily obtain foundation grants to pay for start-up and administrative costs. Their
boards of directors would represent employers and consumers, not insurance vendors or
health care providers. Pools would negotiate with health plans, and would provide easy
ways to enroll. The pools would receive tax credits and pay premiums, and would serve as
an ombudsman for participants. Pools would be required to offer at least three different
health plans and at least one coverage option that cost no more than the maximum tax
credit, and pools could refuse to contract with plans that are deemed too expensive or that
offer poor benefits. Pools must be open to all tax-credit recipients.
The tax credits would be payable in advance, based on an individual’s tax return
from the previous year or expected income for the current year. Overpayments and
underpayments would be adjusted through a reconciliation process at the end of the year.
Employers would use payroll deductions to obtain the employee’s share of the premiums,
when required, and send them to the pools.
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Most citizens understand that BRONZE has so high a deductible and co-pay that the goal was making it too hard for WE THE PEOPLE the 99% to access health care----this is what is called MAKING HEALTH CARE MORE AFFORDABLE----affordable to global corporations and global Wall Street---not you and I.
National news back in 2014 made it sound as if lots of Americans were getting those SILVER, GOLD, AND PLATINUM PLANS----well, below we see a temporary subsidy for the poor allowing them in the short term to access a higher plan until that subsidy disappears which will occur not long after this coming economic crash. So, the stats were rigged to show more Americans able to access a higher SILVER PLAN. They will be back on gutted of funding UNITED NATIONS UNIVERSAL CARE MEDICAID FOR ALL----preventative care only.
I hear in Baltimore citizens thinking they have a SILVER PLAN because they received that subsidy-----all this is designed to keep WE THE PEOPLE THE 99% from mass protest ----
'In addition, cost-sharing subsidies reduce the cost-sharing amounts for low-income people who select a silver plan'.
Silver plans by far the most popular insurance option
Kelly Kennedy, USA TODAY Published 2:16 p.m. ET May 1, 2014 | Updated 5:45 p.m. ET May 1, 2014(Photo: Pablo Alcala, AP)
WASHINGTON — Almost two-thirds of the 8 million Americans who enrolled in health insurance through the Affordable Care Act picked mid-range "silver" plans, according to new data on sign-ups released Thursday by the Department of Health and Human Services Department.
The type of plans selected by those choosing private insurance, as well as the new customers' demographics, were key parts of the latest HHS report, which covers the entire open-enrollment period for the law.
Silver plans cover 70% of health costs, leaving the consumer responsible for the rest. Consumers could choose from bronze, silver, gold or platinum plans, with platinum plans having the highest premium and the lowest out-of-pocket costs for the consumer. About 20% chose bronze, 9% chose gold, 5% chose platinum. Two percent a bare-bones catastrophic care plan. All plans include no out-of-pocket costs for preventive exams, such as yearly physicals or women's annual cancer screenings.
The new data showed that 54% of those enrolling in insurance were women, while 63% of all enrollees were white. Of the remaining enrollees, the HHS report showed, 17% were African American, 11% Hispanic, 8% Asian, 1% multiracial, 0.3% American Indian/Alaska native and 0.1% native Hawaiian/Pacific islander.
Administration officials said they believe they will enroll more Latinos and younger people over the years, as they continue to emphasize their recruiting efforts.
Latino enrollment is "slightly lower" than the number of people qualified to enroll, with about 11% of the 14% of people eligible to enroll actually purchasing a plan, said Myra Alvarez, associate director of the HHS Office of Minority Health. But she said that was to be expected.
The statistics also do not include states with their own exchanges, such as California and New York, where millions of people enrolled in private plans. U.S. Census figures show that about 29% of Hispanic people are uninsured. Often, educating people about the Affordable Care Act and the exchanges also involved educating people about what health insurance is in general, Alvarez said.
One million of the 20 million calls to the HHS call center were in Spanish, said Julie Bataille, communications director for the Centers for Medicare and Medicaid Services.
About 20.8 million people are now enrolled in insurance because of the law, said HHS Secretary Kathleen Sebelius. That includes those 8 million who enrolled in private insurance, 4.8 million now covered by Medicaid and the Children's Health Insurance Program, 5 million who bought coverage outside the state and federal exchanges and 3 million adults younger than 26 now covered through their parents' insurance.
Eighty-five percent of those who enrolled in private health insurance through the state and federal exchanges between Oct. 1 and April 15 received federal subsidies to help pay for it, the HHS report showed. That is similar to figures released earlier by HHS.
The statistics also show that 28% of the 8,019,763 people who selected private health insurance are between the ages of 18 and 34, the age group that insurance analysts believe will help balance out the market's finances.
Thirty-one percent of the 3.8 million who enrolled in March were in the 18-to-34 age group, the latest records show. In the first three months of open enrollment, only 25% of those who enrolled were in that age group.
Officials believe enough younger people have bought insurance to keep premiums stable, said Michael Hash, director of the HHS Office of Health Reform.
There are some who believe the numbers could still go up significantly, particularly from the young and healthy.
Although open enrollment ended March 31, anyone who experiences a major life event may qualify to buy insurance, said Jen Mishory, executive director of the Young Invincibles, a non-profit group urging young people to get coverage. That includes marriage, moving, job changes and aging off parents' plans.
"All of those events are more likely to happen to people younger than 35," Mishory said. "The numbers are high in terms of who could qualify."
For example, Mishory said, about 2.6 million people will turn 26 and no longer be eligible for coverage under their parents' plans.
Enrollment in exchanges not run by the federal or state governments was estimated by the Congressional Budget Office to be 5 million. On Thursday, eHealth, the nation's largest private health exchange, released quarterly results that showed a 34% increase in individual and family insurance plans.
Brian Mast, an eHealth spokesman, said shopping for insurance on private exchanges has increased significantly.
While the number of people ages 18 to 34 fell from just over 50% last year to 42% this year at eHealth, Mast said it was still "a pretty healthy number." Last year, about 9% of enrollees were ages 55 to 64; this year, it's 16%.
In the first month of open enrollment, Mast said people who were not eligible for federal subsidies rushed to eHealth to buy insurance they probably could not buy before. They also tended to choose bronze plans, unlike the government exchanges where people chose silver plans.
An eHealth survey, Mast said, showed that 44% of its customers were previously uninsured.
WHO PAID PREMIUMS?
Despite the extent of the statistics, HHS still does not know how many people have actually paid their insurance premiums or how many have bought insurance that complies with the law but is outside the federal and state marketplaces.
"We are interested in having reliable and accurate data as much as you are," Bataille said, adding that she doesn't expect to have it until the end of the year.
HHS, however, did cite numerous reports from media organizations and insurance companies that show between 80% and 90% of those who selected plans have paid their premiums.
House Republicans pre-empted the data Tuesday with a report from the Energy and Commerce Committee that says that 67% of enrollees had paid their first month's premium by April 15. Committee members sent letters to every insurer included in the plan and asked for the data. However, the insurers told the committee that people still have time to pay the premium, so committee members will ask for an update by May 20. Committee members nevertheless cited the incomplete data to criticize the law.
"These numbers stand in stark contrast to the White House's previous assertions," said House Majority Leader Eric Cantor, R-Va. "If President Obama disputes the information provided by the insurance companies, he should direct HHS to immediately release complete enrollment data, including how many people were previously insured."
The House report did not include data from state-run exchanges. California announced that 1,395,929 people had signed up by April 15, well above its initial goal of 580,000, and that about 85% had already paid their premiums.
Though the market officially closed March 31, the federal site and several state sites remained open until April 15 for people who said they had a hard time completing their application by the deadline.
Sebelius announced her resignation last month after the federal exchange reached 7.5 million enrollees, which outpaced estimates. She will remain in the job until her designated successor, Office of Management and Budget Director Sylvia Mathews Burwell, is confirmed by the Senate.
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What we are seeing more and more is this centralization of low-income citizens into health systems separate from all others and this is sold as OFFERING A LOWER COST. This global health system has no problem handling a lower threshold for some years as all others serving lower income go bankrupt or close----this is marketeering and profiteering folks---it is not strong public health care.
The goal of AFFORDABLE CARE ACT is getting 95% of Americans tied to GLOBAL TELEMEDICINE with our global health systems recruiting health tourists of the global 1% and their 2%----that's the goal so what we are seeing is a change of behavior of US citizens going to any hospital----to going to selected hospitals----to not being able to go to any hospital. We see in this article it is all about deregulating our strong public health structure that protected all citizens equally----our low-income citizens in US cities that have never installed WAR ON POVERTY PROGRAMS like Baltimore will say----
THAT SHIP SAILED A LONG TIME AGO----but across the US standards were kept high for our low-income health access.
I tell you----all these global Wall Street corporations and pols working so hard to help the poor---it's a wonder they can still earn billions in profits each year and our pols pockets millions in thanks from Wall Street.
Horizon enrolls 234K into controversial new OMNIA plan
Updated on March 12, 2016 at 8:10 AM Posted on March 10, 2016 at 1:23 PM
Images of the Horizon Blue Cross Blue Shield headquarters in Newark. About 234,000 people have signed up for the OMNIA health insurance plans, the company announced Thursday. (Matt Smith | For NJ Advance Media)
78 sharesBy Susan K. Livio
slivio@njadvancemedia.com,
NJ Advance Media for NJ.com
TRENTON -- About 234,500 people signed up for the OMNIA line of tiered network health plans offering discounted premiums and low or no copays for patients who use a select group of hospitals and doctors, Horizon Blue Cross Blue Shield of New Jersey announced Thursday.
The eagerly-awaited enrollment figures for Horizon's newest and most talked about insurance products show there are about 234,500 OMNIA members, including 41,300 of them who were previously uninsured, according to the company's announcement.
Most of the enrollees -- 189,200 -- bought the policies themselves, including 154,250 through the health exchange created by the landmark health care law, the Affordable Care Act. About another 45,240 people enrolled through their job.
Talk of OMNIA has dominated the health care industry since Horizon announced the discount line of plans in September, and much of that has been criticism leveled by hospital excluded by the preferred "tier 1" network, which offers consumers the greatest amount of savings.
Eighteen hospitals are suing Horizon for breach of contract and defamation for implying their facilities are second-rate.
Why Horizon has sued these 2 hospitals
When some hospitals brought a lawsuit claiming Horizon's 'Tier 2' designation maligned their reputation, Horizon fired back with a lawsuit of its own.
Many of these Tier 2 facilities are independent, relatively small and serve a large number of Medicaid or uninsured patients, and say the loss of commercially insured people will force them to merge or close.
The enrollment figures come close to the 256,000 members Horizon executives predicted, and are a good indication the company is meeting a need for quality care that costs less, said Robert A. Marino, Horizon's chairman and CEO.
"Affordability has been a barrier for some uninsured individuals and too often lower-priced policies required consumers to trade cost for quality," Marino said. "OMNIA premiums, on average, cost 15 percent less than our non-tiered plans and unlike high-deductible policies, don't require members to incur large out-of-pocket expenses before the insurer pays claims."
"OMNIA is focused on keeping people healthy, not just treating them when they become sick," Marino's statement said.
Steven M. Goldman, attorney for 17 Tier 2 hospitals suing OMNIA and a former Banking and Insurance commissioner, said the people who signed up were not given the full story on OMNIA.
"Since Horizon hasn't disclosed any information about the criteria it used in selecting its OMNIA providers, the only information consumers had available in making their decision was price," Goldman said in a statement. "This is particularly true of the Affordable Care Act enrollees."
"Many of these people may not even have access to a Tier 1 provider in their community or be aware that their trusted hospital has been designated Tier 2, while their long-time doctor has been designated Tier 1, or vice versa," Goldman added. "Horizon has created this confusion in the marketplace by refusing to provide answers of any kind about the plan's selection criteria."
OMNIA members can be found in all of New Jersey's 21 counties, with the greatest concentration in the most populated counties: Bergen (24,248), Middlesex (19,377) and Essex (14,813), according to Horizon.
Health policy experts said the figures show a promising future for OMNIA.
The impact on tier 2 hospitals is unlikely to be felt right away, said Joel Cantor, director of the Rutgers Center for State Health Policy.
While Horizon appears to have met their enrollment target, at this level I doubt there will be very substantial impacts on tier two hospitals," Cantor said. "Their data also show that enrollment is spread over all NJ counties, which will mitigate the impact on any single hospital."
"That said, these results are just for the first enrollment period. In the future, enrollment - and impacts on hospitals - could grow," Cantor added.
Horizon highlighted the racial and ethnic makeup of the 41,258 previously uninsured OMNIA policy holders, noting 15 percent are Latino, and 13 percent are black and 13 percent are Asian. Public sign-up events were held with organizations such as the Hispanic Statewide Chamber of Commerce, Horizon added.
More than three-quarters of OMNIA enrollees selected a mid-price "silver" or higher metallic level plan, based on the Affordable Care Act's four tiers of coverage corresponding to size of deductible and premiums. OMNIA's silver plans feature no deductible, no coinsurance, and co-pays of $50 or less when using a Tier 1 provider, according to Horizon.
Linda Schwimmer, president and CEO for the New Jersey Health Care Quality Institute, said OMNIA's cost savings would be enhanced if enrollees met the income requirements that qualify them for federal subsidies to help pay their premiums.
"That means that even if they go to a Tier 2 provider, they are receiving significant federal support to pay for it. I think that is why both the OMNIA plan and the silver level were so popular," Schwimmer said.
A 35-year-old man who buys a silver OMNIA plan on the health exchange pays $360.27 a month, 15 percent less than the Horizon Advantage plan which would cost him $424.94, Horizon spokesman Tom Vincz said. A couple, both 35 years old with two children under 21 would pay $1,094.98 under OMNIA, 15 percent less than the Advantage premium of $1,291.51.
"Overall, despite the valid concerns about transparency, consumer confusion, and updating the network adequacy rules, I think it is fantastic that so many previously uninsured people were able to afford a comprehensive insurance plan," she added
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We think it is pretty clear that both corporate and government health plans WILL DISAPPEAR---so what we see being built for the 'working class and poor' will be what WE THE PEOPLE THE 99% will get and these corporate and government plans will drop like hotcakes after the coming economic crash.
Well, my child is intelligent and will get that really good job we say----will she/he be able to compete with global labor pool for that good job. We are leaving the age of MERITOCRACY and MOVING FORWARD to mediocracy and cronyism/nepotism not only from our own US 5% ---but globally that 1% and their 2% getting these jobs.
All of what is happening TODAY-----UNDER TRUMP was written in AFFORDABLE CARE ACT----is simply took several years of building structures for people to see NO ONE WILL HAVE HEALTH INSURANCE as one of my doctors in Baltimore said 10 years ago.
Who supported Clinton global Wall Street neo-liberals each election pushing REAL LEFT SOCIAL PROGRESSIVES that actually cared for the 99% out of office? Those global Wall Street Baltimore Development 'labor and justice' 5% to the 1% players----HOLD THESE 5% BLACK, WHITE, AND BROWN CITIZENS ACCOUNTABLE WHEN WE CANNOT ACCESS ORDINARY HEALTH CARE.
Striking Verizon workers soon to lose company health insurance coverage
Reprints Thomson Reuters
4/28/2016 12:00:00 AM
(Reuters) — A strike by nearly 40,000 Verizon Communications Inc. workers is in its third week with unions and the company still far apart on contract talks, even as employee healthcare benefits are set to expire on Saturday.
Workers, from network technicians to customer service representatives, in Verizon's Fios Internet, telephone and TV services walked off the job on April 13 in one of the largest U.S. strikes in recent years after contract talks hit an impasse.
A resolution on various issues, including temporary job relocations, pensions and moving call center jobs offshore, has yet to be reached, representatives of Verizon and the Communications Workers of America union said on Wednesday.
Verizon, which said last week that a long-drawn labor dispute would pressure its earnings, remains committed to reaching a fair deal, spokesman Rich Young said in a phone interview.
A meeting between Verizon and union representatives is scheduled for Thursday afternoon, he said.
Healthcare options
Verizon has notified striking workers that under federal law their health care coverage was set to expire on April 30, Young said.
Verizon has said it spent over $3.2 billion on healthcare for employees last year. The company offers insurance coverage to those employees who are actively working, Young said.
Striking employees have the option of seeking coverage under the U.S government's Consolidated Omnibus Budget Reconciliation Act (COBRA) health insurance plan to get temporary healthcare coverage.
"They think that this is going to be used as a wedge to break this strike. I assure you it will not," said Ed Mooney, vice president of CWA District 2-13, said in a phone interview.
The CWA also has funds, collected through contributions from affiliated union members and other donors, to help cover healthcare costs of members when needed, Mooney said.
"It's horrible. Most of us are parents, I have a daughter and the prospect of losing our children's healthcare is actually quite disturbing," Fitz Boyce, 45, a field technician at Verizon for over two decades, said in an interview at the picket line in front of the company's Times Square store in New York.
The strike affects Fios Internet, telephone and TV services across several U.S. East Coast states, including New York and Virginia.
Verizon has trained thousands of non-union employees over the past year to ensure no service disruption. The company has fielded over 60,000 requests since the strike began, Young said.
The unions have said that replacement workers do not have the necessary expertise, especially in highly technical jobs such as equipment installations.
_____________________________
This is the propaganda we are hearing in all in US CITIES DEEMED FOREIGN ECONOMIC ZONES----reversing and going back to the old system would be PAINFUL and she lists some social progressive bones thrown at our citizens with addictions.
The only way WE THE PEOPLE THE 99% can indeed return to quality health care in US IS TO END AFFORDABLE CARE ACT and break up health system MONOPOLIES AND GLOBAL MONOPOLIES and take back health policy decisions from global health corporation executives and get it back to our communities and citizens.
It will be a shock in America as 99% of citizens will lose access to ordinary health care. What does MOVING FORWARD DO? Kills employment for all American citizens---what drives addictive behaviors ----depressions from being unemployed and unstable.
'Potentially huge shock to health systems
Kathleen Nolan, formerly the director of state policy and programs for the National Association of Medicaid Directors, discussed the importance of viewing potential cuts amid the context of the broader health system, which has undergone major changes since the ACA’s passage. Reverting to the health system we had before Obamacare would be painful, she said.
For example, as the opioid crisis has worsened in recent years, states that expanded Medicaid have helped provide treatment for those beneficiaries battling addiction. And, as insured populations grew through Medicaid expansion, other funding streams that once helped with uninsured care are no longer in place'.
Below we see Kellie is tied to global media and the ECONOMIST no less---the hyper neo-liberal news journal and from that pesky SAN FRAN global Google US CITIES AS FOREIGN ECONOMIC ZONE. We happen to know CENTER FOR HEALTH JOURNALISM is a global Wall Street Clinton neo-liberal media outlet telling us what affordable health care looks like.
Kellie Schmitt - Health Journalism Fellow
Fellow
Kellie Schmitt
Affordable Care Act Blogger, Freelance Health Reporter
Reporting on Health
Email Kellie Schmitt
About Myself: I write for Reporting on Health's Affordable Care Act blog. Previously, I was a health reporter for the Bakersfield Californian, a staff writer for the San Jose Mercury News, and a business reporter for the San Francisco Recorder. I spent two years reporting from China for publications including The Economist's Business China, China Economic Review, and CNN Travel.
In 2012, I was a Health Journalism Fellow. My project examined the high number of foreign-trained doctors in California's Central Valley, a series which won awards from the Association of Healthcare Journalists and the California Newspaper Publishers Association.
I also worked with Reporting on Health's multi-part, collaborative series on the devastating toll Valley Fever has had on California's Central Valley.
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Remaking Health Care
Experts weigh in how to cover the big changes GOP plans for Medicaid
By Kellie Schmitt
July 28, 2017
Getty Images
As the country faces the possibility of massive Medicaid cuts, a panel of experts offered tips on how to navigate the fast-developing story in a Center for Health Journalism webinar this week.
Edwin Park, the vice president for health policy at the Center on Budget and Policy Priorities; Kathleen Nolan, a managing principal at Health Management Associates; and Lauren Sausser, a health care editor and reporter at The Post and Courier in Charleston, South Carolina, offered ideas and expertise on a story that could affect communities across the nation.
Park focused on Republican efforts to create a “per capita cap” on federal Medicaid dollars as well as plans to reduce the federal government’s share of funding for the Affordable Care Act’s Medicaid expansion – both of which would shift more responsibly to states.
For states that expanded Medicaid under the Affordable Care Act, the federal government fully funded those expenses for three years, then phasing down the contribution until it reaches 90 percent in 2020 and beyond. If the federal government’s contribution is further reduced, states that expanded Medicaid will have to shoulder more of the costs. So-called “trigger states” have a provision that would end the expansion if the federal contribution drops, Park said.
The other major proposed change is a “per capita cap,” which would affect all states. Under current law, the federal government pays a percentage of a state’s Medicaid costs, which averages about 57 percent though it varies by state. Per capita caps would allow the federal government to set a fixed amount for each beneficiary, “with that fixed amount set a level below what would be provided under the current financing system,” Park said. Those figures would likely be adjusted annually at a rate that doesn’t keep up with soaring health care costs, he added.
As states face massive cuts, they would have three choices, he said: Raise taxes; cut other parts of their budget such as education; or cut Medicaid, leaving more and more people uninsured or underinsured.
“Those cuts are only going to get more and more severe over the long run, particularly as the population continues to age,” Park said.
Potentially huge shock to health systems
Kathleen Nolan, formerly the director of state policy and programs for the National Association of Medicaid Directors, discussed the importance of viewing potential cuts amid the context of the broader health system, which has undergone major changes since the ACA’s passage. Reverting to the health system we had before Obamacare would be painful, she said.
For example, as the opioid crisis has worsened in recent years, states that expanded Medicaid have helped provide treatment for those beneficiaries battling addiction. And, as insured populations grew through Medicaid expansion, other funding streams that once helped with uninsured care are no longer in place.
“If you suddenly have an increase in uninsured, those health system and hospitals are not yet prepared to deal with that shift back,” Nolan said.
To deal with the loss of insurance for so many, some states might do something innovative, such as offer state-only insurance products. Other may create new programs to address specific health needs.
In every state — regardless of whether they expanded Medicaid under the ACA — Medicaid populations will face cuts under per capita caps.
Nolan said the people most impacted will be those who use the most services, such as the frail elderly in nursing homes and people with disabilities. She emphasized, though, that Medicaid beneficiaries should not be lumped together. The impact of changes will be different depending upon the population affected — distinct groups may be pitted against each other in a fight for diminishing dollars.
Even if the GOP’s efforts to “repeal and replace” collapse, changes are likely still in store for Medicaid through state-specific waivers under existing law, she said. For example, some states might look into work requirements, drug testing, or cost sharing for Medicaid beneficiaries, she said.
“A lot of conversations around these kind of waivers are happening more in expansion states, particularly conservative expansion states,” Nolan said, adding that some conversations might extend into other Medicaid populations.
Explaining the impact to audiences
Those Medicaid conversations can be complex for the average newspaper reader, said the Courier and Post’s Sausser. And it might not be something they think they care about.
That’s why she makes sure to include several key facts in articles involving Medicaid. Along with costs, she mentions how many people are enrolled in her home state and how many of them are children and disabled.
“There are a lot of negative stereotypes in South Carolina — and I imagine in other states, too — about who qualifies for Medicaid,” she said.
In covering Medicaid, Sausser suggested that reporters find a policy mentor who can help with complicated health policy questions. And, she recommended getting to know not only the state’s current Medicaid director, but also previous directors who might speak more candidly now that they’re no longer in office.
To cut through the policy jargon, Sausser shared how she uses personal stories to demonstrate Medicaid’s impact. She recently wrote about an 11-year-old girl with sickle cell disease, who “has received 45 blood transfusions and has been hospitalized 49 time.”
“If you can put a face and a story with policy, I think that’s a winning combination,” she said.
So, here we are these few decades later watching the EXACT SAME POLICIES doing the same thing this time health insurance killing small and regional health corporations---what is left of our public hospitals and clinics----and killing a once perfectly functioning health insurance structure in US.
Health insurance corporations were able to do this because AFFORDABLE CARE ACT deregulated health care and insurance industry was placed at the top of control of CONSOLIDATED, MONOPOLIZED global health systems.....ergo, they can now do anything they want and pick winners and losers. So, of course corporations are going to end their health packages and go to PREVENTATIVE CARE ONLY.
THIS WAS INSTALLED DURING OBAMA BY CLINTON NEO-LIBERALS---IT IS TAKING HOLD NOW UNDER TRUMP---
Don't feel sorry for corporations over these costs----global corporations paid CLINTON/BUSH/OBAMA pols to install this right wing global Wall Street health policy---AFFORDABLE CARE ACT.
FIX IT 2016 “Healthcare at the Tipping Point”
Richard Master is the founder and owner of MCS Industries, a world leader in the picture frame and decorative mirror business. Like most US companies, he fac...
youtube.com
Published on Jun 11, 2016
Richard Master is the founder and owner of MCS Industries, a world leader in the picture frame and decorative mirror business. Like most US companies, he faces relentless annual cost increases to provide health insurance for his employees.
He decided to tackle the problem of healthcare using best business practices... doing an in-depth analysis, finding the right diagnosis and then determining the fix. Fix It, the movie, is a result of his journey to find a solution to the dysfunctional US healthcare system.
...a powerful new documentary that reaches across the political and ideological divide to expand support for major healthcare reform.
The film was two years in the making, with more than forty voices advocating for reform, including: activists, health policy experts, economists, physicians, nurses, patients, business and labor leaders. This documentary takes an in-depth look into how our dysfunctional health care system is damaging our economy, suffocating our businesses, discouraging physicians and negatively impacting on the nation's health, while remaining un-affordable for a third of our citizens.
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Produced: 2016, Episode:FIXIT, Category: Education, 58:00
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Since we KNOW URBAN INSTITUTE is a global Wall Street 1% organization we can look at articles and goals written by them and know they will be bad for WE THE PEOPLE THE 99%. These are far-right wing think tanks so they are not helping us keep our strong, accessible, affordable, American health care. They will create TALKING POINTS that will send those pesky 5% global Wall Street player organizations out to sell especially poor communities ----THIS WILL HELP THE POOR ACCESS HEALTH CARE.
MEDICARE AND MEDICAID ended with AFFORDABLE CARE ACT----it was gutted of $1 trillion in budget those cuts hitting hardest in just a few years by OBAMA AND CLINTON NEO-LIBERALS----not TRUMP.
It is DISINGENUOUS to keep suggesting MEDICAID be expanded when we have $20 TRILLION IN NATIONAL DEBT AND A COLLAPSING ECONOMY----so this is all SMOKE AND MIRRORS confusing our working class and poor citizens which of course is now 80% of Americans and rising.
'A central problem is that 19 states have yet to take advantage of the ACA’s Medicaid eligibility expansion, and that leaves many low-income people in those states without an option for affordable coverage. We suggest allowing states to expand Medicaid eligibility for those with incomes up to 100 percent of the federal poverty, level instead of 138 percent, to encourage more states to expand'.
The first thing we notice in this article is the reference to MEDICARE ADVANTAGE as a model-----MEDICARE ADVANTAGE is the privatized MEDICARE---not our Federal public trust filled with decades of PAYROLL TAX MEDICAL SAVINGS ACCOUNTS. This is how we know it is a right wing group working against WE THE PEOPLE THE 99%.
Blumberg is frequently asked to testify before Congress and is quoted in major media outlets on health reform topics. She serves on the Cancer Policy Institute’s Advisory Board and has served on the Health Affairs editorial board. From 1993 through 1994 she was a health policy advisor to the Clinton administration during its health care reform effort, and she was a 1996 Ian Axford Fellow in Public Policy.
She received her PhD in economics from the University of Michigan.
'The Fulbright Program is administered by cooperating organizations like the Institute of International Education.
James William Fulbright (April 9, 1905 – February 9, 1995) was a United States Senator representing Arkansas from January 1945 until his resignation in December 1974. Fulbright is the longest serving chairman in the history of the Senate Foreign Relations Committee'.
All of Linda Blumberg's connections is with CLINTON ERA AND INTERNATIONAL DEVELOPMENT TRUSTS. This is how we know her solutions will be ONE WORLD ONE GOVERNANCE and not WE THE PEOPLE THE 99%. HERE IS ARKANSAS GALORE WITH CLINTON AND FULBRIGHT.
HILLARY WAS TRYING TO DO TO HEALTH CARE BACK THEN WHAT BILL WAS DOING TO DEREGULATED AND GLOBAL WALL STREET.......Blumberg wanted to join Hillary in doing this----fast forward these few decades and VOILA---OBAMA does to health care what Bill did to Wall Street banking.
Urban Wire Health and Health PolicyRSS
The voices of Urban Institute's researchers and staff
July 6, 2017
Robert Abare
Linda J. Blumberg
Fixing the ACA is the overlooked solution to the health care puzzle
Linda Blumberg, senior fellow in the Urban Institute’s Health Policy Center, is an expert on private health insurance and health system reform. She has conducted extensive studies on the impacts of the Affordable Care Act (ACA) on families and communities across the country following the law’s initial implementation in 2014.
In January 2017, Blumberg and Institute fellow John Holahan proposed strategies to fix the biggest problems with the ACA, rather than repealing and replacing the law as sought by the Affordable Health Care Act (AHCA) passed by the House in May and the Better Care Reconciliation Act (BCRA) under debate in the Senate.
What, by your estimation, is the ACA’s primary weakness?
A central problem is that 19 states have yet to take advantage of the ACA’s Medicaid eligibility expansion, and that leaves many low-income people in those states without an option for affordable coverage. We suggest allowing states to expand Medicaid eligibility for those with incomes up to 100 percent of the federal poverty, level instead of 138 percent, to encourage more states to expand.
Second, the nongroup insurance reforms of the ACA have faced real challenges in regions that are sparsely populated. These areas have little competition in their insurance markets, health care provider markets, or both. It’s difficult to engender new competition in these areas.
In areas that experience a lot of consolidation among insurers or providers, unsubsidized premiums are high. In markets with only one or two insurers, there is little to no incentive for insurers to be tough negotiators to bring down provider prices (and thus premiums), and in markets with a dominant health care system, even strong insurers do not have bargaining power to bring provider prices down. These situations are most common in rural and other areas with low population density.
Rising premiums have been a primary concern among critics of the ACA. How do you propose lowering them?
First, in many areas of the country, particularly large metropolitan areas where lots of people live, premiums have been low, as has premium growth. The areas of concern are largely outside these population centers. Concerns over whether insurers will be reimbursed for the cost-sharing subsidies they have paid out and are required to pay out in the future is now affecting how insurers set premiums, however, and this uncertainty can be immediately addressed by Congress and the administration committing to pay these bills.
In addition to that immediate need, we suggest that insurer and provider consolidation and the higher premiums that result from them can be addressed using a strategy employed by the Medicare Advantage program. We propose that provider payment rates charged by nongroup insurers be capped at Medicare rates, Medicare rates plus some percentage, or at some other standard.
These caps would allow insurers to negotiate lower rates with providers if they can, but these insurers would not have to pay more. The caps would take away the pricing power of provider monopolies, allowing insurers to set lower premiums. The caps would also make it easier for additional insurers to enter markets with only one or two insurers because the new entrants could set competitive premiums even in markets where they currently have no market share.
How does “fixing” the ACA differ from the other options on the table? Could the AHCA and BCRA be described as fixing the ACA?Fixing the ACA requires addressing existing problems such that the ACA’s objectives can better be achieved. An approach that does not share the ACA’s objectives is not a fix.
The ACA’s objectives were primarily to do the following:
- Expand insurance coverage.
- Increase access to and affordability of necessary medical care.
- Broaden the way risk is shared in insurance markets, eliminating price and coverage discrimination by health status. The goal was to have the large number of people who are healthy at a given time more broadly contribute to the costs of care for the smaller number of people who have health problems at a given time, thus providing affordable access to necessary care. In addition, competition based on quality and efficiency could be engendered in such an environment, replacing the competition for the healthiest enrollees that dominated insurance markets before reform.
The BCRA and AHCA have different objectives.
They would increase the number of uninsured people and would decrease access to care and affordability via decreasing Medicaid funding, eliminating the ACA’s subsidies to lower deductibles and other out-of-pocket costs, and decreasing premium tax credits for many low- and middle-income people purchasing private nongroup insurance today.
Various strategies in the bills would move private insurance markets back toward separating the costs of the healthy from those of the sick, making access to care less affordable when health issues arise. And we estimate that the BCRA would lead to 24.7 million more people uninsured than under the ACA in 2022. The AHCA would lead to an additional 23 million uninsured in 2022.
With such different objectives and outcomes, neither piece of legislation can be considered a fix to the ACA.
The individual mandate is one of the most unpopular provisions in the ACA. Do you have a fix for that?The individual mandate, though unpopular, is critical. It broadens health care risk by keeping healthy people in the insurance market and attracting more healthy people to enroll.
But it’s difficult to find an alternative to the individual mandate that is equally effective and fair.
In our “fix it” paper, we discussed using late-enrollment penalties, but this strategy has significant downsides relative to the individual mandate. The AHCA proposes a 30 percent premium surcharge for late enrollees. But only people who expect to need substantial amounts of medical care in the coming year are going to be willing to pay that extra 30 percent in addition to their regular premium.
People who experienced a gap in coverage but expect to be healthy would be less likely to enroll because of the higher price. So, that 30 percent penalty would make the insurance pool sicker, on average, and drive premiums up.
This shows that it’s not straightforward to find an alternative to the individual mandate that doesn’t dissuade healthy people from getting insured or make it prohibitively expensive for people who need care to enroll after a coverage gap.
And people’s lives are complicated—difficult situations lead many to experience these gaps. We want to encourage people to get and stay covered, but we should be careful about being overly punitive in a way that will compromise the health of people who have gone through tough times.
What are the most important steps for fixing problems with the ACA?
First, Congress and the administration should commit to fully reimbursing Marketplace insurers for the cost-sharing reductions these insurers have paid and will pay out in the future.
Next, a permanent reinsurance program for the private nongroup insurance market would address markets experiencing disproportionate enrollment of people with high medical needs. The ACA, AHCA, and BCRA include temporary reinsurance programs while Medicare has a permanent one, so there should be bipartisan support for this.
Third, capping provider payment rates for nongroup insurers, at least in low insurer or provider competition areas, should help a great deal.
Enrollment could be improved in several ways, some less costly than others. Increasing outreach and enrollment assistance is an inexpensive way to get more healthy people to join the insurance market. Uninsured people reached by such programs are more likely to be healthy because they haven’t entered the system on their own knowing that they need care.
Closing loopholes for insurers to sell plans that do not comply with the ACA’s consumer protections would also bring more healthy people into the broad insurance pool, which would help bring average premiums down.
Other important fixes come with a bigger price tag, but even those would represent a small percentage increase in overall health spending.
The ACA has made major advances in making health care affordable through Medicaid expansion, premium tax credits, and cost-sharing reductions for nongroup insurance coverage. But as people go up the income scale and federal assistance decreases, there are people who still look at the cost of insurance and feel that coverage is not affordable or the cost-sharing requirements are too high for their income.
We can do better by improving the premium tax credits and cost-sharing assistance and by encouraging states that have not expanded Medicaid eligibility to do so.
_____________________________________________
'When President-elect Donald Trump enters office on Jan. 20, he will inherit almost $20 trillion of national debt. This debt is a threat to the American economy, and its key driver—unsustainable spending—must be controlled'.
Here it is-----all US Treasury debt -----Wall Street bailouts in trillions ----global corporate development subsidies in trillions----THIS IS WHAT KILLED MEDICARE AND MEDICAID TRUSTS. Of course these same 5% to the 1% Clinton/Obama pols and players are now PRETENDING it is all Trump's fault.
WE THE PEOPLE must know goals in health policy----global Wall Street goal of killing all of MLK'S WAR ON POVERTY would kill MEDICARE AND MEDICAID.
When a LINDA BLUMBERG continues to talk about expanded Medicaid blaming it on states that OPT OUT----she knows she is POSING LEFT SOCIAL PROGRESSIVE.......it ain't happening because it was never supposed to happen.
Entitlements are absorbing all taxes because of health industry PROFITEERING AND FRAUD---and because corporations and the rich stopped paying taxes these few decades ago.
3 Things Trump Can Do to Control the National Debt
Mollie McNeill / @molliemcneill / January 11, 2017 /
The U.S. national debt is racing toward $20 trillion. (Photo: iStock Photos)
Commentary ByMollie McNeill @molliemcneill
Mollie McNeill is a research assistant with economic and budget policy at The Heritage Foundation.
When President-elect Donald Trump enters office on Jan. 20, he will inherit almost $20 trillion of national debt. This debt is a threat to the American economy, and its key driver—unsustainable spending—must be controlled.
Come Jan. 20, the new administration should act immediately to tame the federal budget and reduce the national debt. Here are three solutions from The Heritage Foundation’s Blueprint Series that do just that.
1. Reform autopilot entitlement programs.
Entitlement programs like Medicare, Medicaid, and Social Security make up the largest portion of the federal budget. In 2015, major entitlement programs consumed 52 percent of all tax dollars. They will grow to consume even more of the budget unless lawmakers intervene.
Currently, entitlement programs run on autopilot, meaning they don’t require new spending bills to keep running. Because of laws put in place years ago, agencies spend whatever is necessary each year to fund these programs, and it is politically unpopular for politicians to reform or downsize them.
The next administration should reform these unsustainable mandatory programs. Some commonsense solutions include repealing and replacing Obamacare, modernizing Medicare, capping the federal allotment for Medicaid, and making reforms to Social Security.
Entitlements Devour All Taxes by 2038
2. Balance the budget.
Persistent budget deficits allow the national debt to spiral out of control. For the last 50 years, the federal budget had an average deficit of 2.8 percent of gross domestic product, and the current Congressional Budget Office baseline projects that deficits will surpass $1 trillion before the end of the decade.
Balancing the budget isn’t a cure all, since legislators can always use higher taxes to support higher spending and technically balance the budget in the short term. In the long run, higher taxes would end up chasing ever higher spending, which is unsustainable. Instead, a balanced budget is an important goal to prioritize spending and reduce deficits and debt.
The incoming administration should adopt a plan that balances the budget while reducing spending and taxes. The Heritage Foundation’s “Blueprint for Balance” balances the budget in six years and creates a surplus in seven years.
How to Balance the Budget
3. Reform the budget process.
The current budget process is broken. The budget process is supposed to enable lawmakers to set national priorities in a timely and predictable way. But the current process, established in 1974, has only worked four times.
The current process leads to higher government spending and debt. Since the most expensive programs, like Social Security, Medicare, and Medicaid grow on autopilot, and because they are also the most popular, politicians have little incentive to change them.
The next administration must enact budget process reforms that restore accountability and fiscal responsibility to the federal budget.
Commonsense budget process reforms such as fair value accounting, including interest in estimating the impact of congressional budget proposals, and statutory spending caps that limit spending growth enforced by sequestration, will help reform the budget process and get national debt under control.
How the Budget Has Changed
So far, the new administration’s plans for addressing the national debt haven’t been great. Trump has proposed renegotiating the national debt and printing more money. Both are possible, but will ultimately prove to be unhelpful and economically dangerous distractions from the out-of-control spending that is driving the national debt.
Despite the lack of concrete current plans to control the debt, the next administration will have ample opportunity to tame the federal budget. Trump’s pick for Office of Management and Budget director, Rep. Mick Mulvaney, R-S.C., is a budget hawk who values fiscal conservatism.
The Congress is controlled by Republicans who have put forth sensible and realistic proposals to reduce out-of-control health spending with Medicare premium support and caps on federal Medicaid allotments. With the House, Senate, and executive all controlled by the same party, serious budget reform is within reach.
The incoming administration needs a plan to get spending and high national debt under control now, to ensure economic freedom and secure prosperity for Americans in the future.
__________________________________________________
When a global Wall Street Clinton/Obama health care group have us shouting MEDICARE FOR ALL-----they are again MISINFORMING PEOPLE. These groups are not working to reinstate our American Federal Medicare Trust into which citizens have paid for several decades---they are talking, as was BLUMBERG----about this MEDICARE ADVANTAGE that OBAMA strengthened while weakening and ending our Federal Medicare Trust.
Having MEDICARE ADVANTAGE speaking for what is good for 99% of citizens is like having AARP speaking for what is good for 99% of citizens---AARP is MEDICARE ADVANTAGE----this corporations' goal these few decades has been just that ---PRIVATIZING MEDICARE. We have what are global corporations allowed to pretend to advocate for what is good for 99% of American people.
Our Federal government was captured by global Wall Street so these FEDERAL MEDICARE AND MEDICAID TRUSTS have not been corrupted as is----now global Wall Street is simply handing us to corporations pretending they are advocates for our good.
'Rising premiums have been a primary concern among critics of the ACA. How do you propose lowering them?
'In addition to that immediate need, we suggest that insurer and provider consolidation and the higher premiums that result from them can be addressed using a strategy employed by the Medicare Advantage program. We propose that provider payment rates charged by nongroup insurers be capped at Medicare rates, Medicare rates plus some percentage, or at some other standard'.
For those not understanding HEALTH INSURANCE TALK----the buzz words from MS BLUMBERG and this article are now PRIVATE HEALTH INSURANCE IN NON-GROUP OR INDIVIDUAL MARKET under Affordable Care Act. All that was done was to create TIERED HEALTH INSURANCE plans pretending non-group individual health plans are abiding by AFFORDABLE CARE ACT with what people wanted to hear----when in fact they are not. This strips 80% of Americans from the national and global health corporation market and now they are installing these same TAX CREDITS----VOUCHERS----replacing what was a national MEDICARE AND MEDICAID program where everyone received the same and could go anywhere to get that health care.
What happens in every industry regarding the receipt of tax credits for services? That's right ----the entire tax credit funding system is corrupted and used to enrich those NON-GROUP health insurance corporations with citizens not accessing what is Federally mandated because no federal agency is providing oversight and accountability. The non-groups in Maryland are largely tied to global corporations like Johns Hopkins.
Blog
Challenges in Estimating the Number of People With Nongroup Health Insurance Coverage Under Proposals for Refundable Tax Credits
Posted by Susan Yeh Beyer and Jared Maeda on
December 20, 2016
Some policymakers have expressed interest in developing proposals to replace the current tax-based subsidies for the purchase of private health insurance in the nongroup (or individual) market under the Affordable Care Act (ACA) with refundable tax credits that would be structured differently from those under current law. Many such proposals would also eliminate or reduce the extent of current federal laws regulating the nongroup market, particularly the rules governing health insurance benefits. Two key questions for policymakers in developing such proposals are what type of insurance products would qualify for tax credits and what role states would have in making that determination.
CBO and the staff of the Joint Committee on Taxation (JCT) anticipate that insurers would respond to such legislation by offering new types of insurance products in the nongroup market, which are likely to differ from existing products in their depth and extent of health insurance benefits.
If there were no clear definition of what type of insurance product people could use their tax credit to purchase, some of those insurance products would probably not provide enough financial protection against high medical costs to meet the broad definition of coverage that CBO and JCT have typically used in the past—that is, a comprehensive major medical policy that, at a minimum, covers high-cost medical events and various services, including those provided by physicians and hospitals. (For a discussion about how CBO defines health insurance coverage, see CBO’s blog post on how CBO defines and estimates coverage.)
If there were no clear definition of what type of insurance product people could use their tax credit to purchase, everyone who received the tax credit would have access to some limited set of health care services, at a minimum, but not everyone would have insurance coverage that offered financial protection against a high-cost or catastrophic medical event; CBO and JCT would not count those people with limited health benefits as having coverage. One could thus assess the effects of such proposals on insurance coverage in two different ways—how many people would obtain any type of insurance policy using the tax credit and how many people would obtain an insurance policy that meets the broad definition of coverage described above. If policymakers expressed interest in knowing the number of people who, under those proposals, would purchase private insurance in the nongroup market that met a broad definition of coverage, CBO and JCT would estimate separately the number of people who would receive the tax credits and the number of people who would obtain such coverage. In this blog post, we describe the challenges CBO and JCT would face in estimating the number of people who would purchase coverage in the nongroup market, and the scope of that coverage, under such proposals. (Similar challenges could arise in the group market if tax credits were extended to people with employment-based coverage. However, that discussion is beyond the scope of this blog.) For context, we first provide some background about private insurance and summarize how the nongroup market is regulated under current law, including the changes that were made by the ACA. (For additional information about that market, see CBO’s report about private health insurance premiums.)
What Features of Private Insurance Determine the Share of Medical Costs It Covers?
The amount of financial protection against medical costs that private insurance covers can be described in terms of the depth and extent of coverage. (Another dimension by which private insurance coverage can vary is the size of the provider network. However, that discussion is beyond the scope of this blog post.)
The depth of coverage can be measured by examining the cost-sharing structure and any maximum benefits or limits that apply. The cost-sharing structure is the amount of out-of-pocket costs—typically in the form of deductibles, coinsurance, and copayments—that a person is required to pay when using medical services. Those out-of-pocket costs may be subject to a maximum limit (in a given year or over a lifetime) beyond which the insurer covers most or all remaining medical costs. Another limit may apply to the maximum dollar amount of medical costs that an insurer will pay for. When benefits reach their maximum allowed by the plan, the person is responsible for all remaining medical costs. In general, plans have only one of those two limits (or none at all).
The actuarial value of a health insurance plan is a summary measure of the depth of coverage for a given set of health care benefits. More specifically, the actuarial value measures the percentage of medical costs that an insurer would pay if it covered people with average health expenditures. For example, a plan with an actuarial value of 70 percent would, on average, pay 70 percent of the expected medical costs on covered benefits for a person with average health risks and patterns of use.
The extent of coverage can be measured by examining the scope of benefits—that is, the services and the types of providers whose services are covered by a health plan. Covered benefits for most plans include physicians’ and hospitals’ services and often laboratory services, radiology services, and prescription drugs. More extensive plans cover a broader range of services, such as behavioral health and substance abuse treatment and rehabilitative therapy. Less extensive plans limit the range of services covered and might exclude maternity benefits and prescription drugs.
How Is the Nongroup Market Regulated Under Current Law?
States have traditionally been responsible for regulating health insurance benefits in the nongroup market. Before enactment of the ACA, nongroup market regulations varied widely across states. In 2014, however, many federal regulations that governed the benefits that new policies sold in the nongroup market must provide went into effect as part of the ACA. The depth and extent of coverage in the nongroup market were standardized to a large degree under the ACA, which established a set of “essential health benefits” and a minimum actuarial value for insurance plans (along with a definition of that measure). In addition, plans sold in the nongroup market were no longer allowed to set maximum annual or lifetime limits on covered medical costs for the essential health benefits. The states’ role in defining the depth and extent of coverage in the nongroup market was, thus, substantially reduced after 2014.
The ACA also established several regulations that limit insurers’ ability to deny coverage to people with high expected medical costs. Three regulations, in particular, apply to such people: modified community rating rules, guaranteed issue, and requiring coverage of preexisting conditions. Modified community rating rules prohibit insurers from engaging in medical underwriting (pricing premiums on the basis of a person’s health) and limit the degree to which premiums are allowed to vary by age. Under guaranteed issue, insurers are required to sell coverage to a person regardless of his or her health. The prohibition on excluding coverage of preexisting conditions requires nongroup insurers to cover the treatment of those conditions.
What Are Some Alternative Proposals to the Current Tax-Based Subsidies to Purchase Private Insurance in the Nongroup Market?
Currently, tax credits for nongroup policies sold through the ACA marketplaces vary in relation to the premium of the second-lowest-cost “silver” plan in a market that offers the policies and in relation to certain characteristics of enrollees, including family size, income, age, and tobacco use. To qualify for tax credits under current law, a person must purchase a plan offered through a health insurance marketplace that covers 10 categories of benefits defined as essential and meets a minimum actuarial value, among other features. In addition, cost-sharing subsidies reduce the cost-sharing amounts for low-income people who select a silver plan.
Some policymakers want to replace the current tax-based subsidies to purchase private insurance in the nongroup market with alternative proposals. Under some proposals, refundable tax credits would generally be based on a fixed dollar amount and might vary by age or family size. The amount of such credits often does not depend on an enrollee’s income or a plan’s premium. A key question for federal policymakers is what types of insurance products would qualify for the tax credits. Often, such proposals would allow states to regulate the nongroup market. In that case, regulation of the nongroup market would probably vary widely from state to state. Without a federal standard, some states might not impose any regulations that would govern the depth and extent of coverage and that would define what insurance products qualify for tax credits.
What Are the Challenges of Estimating the Number of People With Nongroup Coverage Under an Alternative Refundable Tax Credit Proposal?
CBO and JCT face several challenges in estimating the number of people who would purchase private insurance coverage in the nongroup market under an alternative refundable tax credit proposal. It is difficult to predict what regulations states would impose on the nongroup market, what types of products insurers might offer given those regulations, and which types of insurance products people might purchase based on their preferences and their characteristics (such as age, income, and health).
One way to predict the types of plans that people might purchase is to look at the types of plans that existed in the nongroup market before enactment of the ACA. Before then, nongroup market regulations varied widely across states. Only a few states required guaranteed issue and implemented modified community rating rules. Although many states specified a set of services that insurers had to cover, no states regulated the depth of coverage or the amount of cost sharing. Most plans sold in the nongroup market included major medical benefits that provided comprehensive coverage for a range of services, including care by physicians and at hospitals. But certain services, such as maternity benefits and prescription drugs, were not always covered. Many of those plans also had very high deductibles and maximum annual or lifetime limits on benefits. Nevertheless, many of them would meet the broad definition of coverage that CBO and JCT have typically used in the past.
Other plans that were less commonly sold offered benefits that were even more limited. Such plans included fixed-dollar indemnity plans that paid a certain amount per day for illness or hospitalization, or plans that covered only preventive care and routine office-based physicians’ services but did not cover hospitalizations. Such limited plans would generally not meet the broad definition of coverage.
Looking back at the pre-ACA nongroup market is not enough to determine what might happen under a tax credit proposal, however, because no such financial incentive to purchase health insurance existed in that market. Plans that were previously offered in that market might be offered again in the future, and new products might also be offered. In the absence of a clear definition of what type of plan qualifies for a tax credit, some plans would probably have premiums that covered minimal services and would be priced close to the amount of the tax credit. Such plans have been offered in the past in response to a similar incentive: They were used in conjunction with a tax credit related to child health that was in effect in 1992 and 1993, and the depth and extent of coverage that people purchased were often very limited.
In addition to the response by states and insurers, people at different income levels might have different preferences for the depth and extent of their insurance coverage. For example, low-income people might prefer coverage for preventive services and routine physicians’ visits to keep their monthly expenses low, even if such a policy did not cover more costly services such as hospital care. High-income people might not care as much about predictable monthly expenses and might prefer catastrophic coverage to protect their assets against high medical costs.
People’s preferences for insurance products might also vary with other characteristics, such as their sex or health. In states without regulations that limit insurers’ ability to exclude people with high expected medical costs, however, those individuals would probably face high premiums or have access to insurance plans with only limited coverage.
In response to a future policy that had minimal federal or state regulations, CBO and JCT expect that some new insurance products would be offered that limited coverage to the amount of the tax credit. Some of those insurance products purchased by people using a tax credit would probably not offer much financial protection against high out-of-pocket costs. Depending on the size of the tax credit, however, the depth and extent of coverage and the premiums of plans could vary. As discussed in another blog post about how CBO defines and estimates coverage, CBO does not count plans that have very limited benefits in measuring the extent of private insurance coverage; in such an assessment, it counts only people with a comprehensive major medical policy as having private insurance.
Under such proposals, CBO and JCT would separately estimate the number of people who would receive the tax credits and, if policymakers expressed interest in such estimates, the number of people who would purchase private insurance in the nongroup market that met a broad definition of coverage. In that case, the latter estimate of the number of people with coverage would probably be smaller than the estimate of the number of people who would receive the tax credit.
_____________________________________________
Below we see from where these Affordable Care Act policies stem----again, Bush era 2000 right wing global corporate think tank HEALTH INSURANCE ASSOCIATION OF AMERICA---which of course was the strongest corporate health insurance lobbyist for AFFORDABLE CARE ACT.
If we don't like this health reform it is because it was written by these corporate groups----they all have talking points that begin----STRATEGIES FOR WORKING AMERICANS----
'Richard E. Curtis
President
Institute for Health Policy
Employment History
Director of Policy and Research
Health Insurance Association of America'
This is only the start of a very long health policy article----if you want to know from where Affordable Care Act comes ---this is it----tied to MASSACHUSETTS' ROMNEYCARE-----For those not noticing yet MA is raging far-right wing global Wall Street 1%---not DEMOCRATS. So, now that no one can afford all these tiered health plans we all need tax credits to get what we simply received through corporate and government health plans.
'Starting up a pool would be considered a “charitable purpose,” so that pools could
more easily obtain foundation grants to pay for start-up and administrative costs'.
This is essentially ending our FEDERAL AND STATE health plans and EXPOSING WE THE PEOPLE to yet more FOUNDATION AND CORPORATE PATRONAGE in lieu of their paying taxes-----when they DONATE they write the conditions of what that health programs looks like and who dispenses that program----just as with our social services where most of these few decades of massive frauds took place. This is supposed to be our health care PLAN.
If we notice we are still paying those PAYROLL TAXES supposedly creating health savings accounts and clinical care when needed---yet all this is moving towards CHARITY PATRONAGE with those corporations receiving tax credits.
We keep allowing far-right wing pretend to be helping the poor-----stay in office CLINTON/BUSH/OBAMA----
PRIVATE PURCHASING POOLS TO HARNESS INDIVIDUAL TAX CREDITS FOR CONSUMERS
Richard E. Curtis, Edward
Neuschler, and Rafe Forland
Institute for Health Policy Solutions
December 2000
Strategies to Expand Health Insurance for Working Americans
A Report Series from The Commonwealth Fund Task Force on the Future of Health Insurance
v
EXECUTIVE SUMMARY
A health insurance tax credit could help many people who cannot afford to
purchase coverage. However, even with these subsidies, many of the uninsured would
probably still find non-group private insurance too expensive. Many would also find the
complexities of the individual market and its myriad insurance products bewildering.
Private purchasing pools for tax-credit recipients could address these problems by
providing individual purchasers with many of the advantages of a group market, such as
relatively low administrative costs, no health rating and professional purchasing expertise.
Insurance purchased through pools should cost 5 percent to 10 percent less than private,
non-group insurance. Unlike many employer plans, however, purchasing pools will allow
individuals to choose among several health plans.
All tax-credit recipients would be required to purchase coverage through private
purchasing pools. This requirement is necessary to ensure that the pools become large
enough to operate efficiently and offer their members the advantages of group purchasing.
Individual purchasers who were not eligible for tax credits, and firms with 50 or fewer
employees could also join the pools. Income-eligible workers in small firms with a majority
of low-wage workers would be eligible for the full amount of the tax credit for coverage
purchased through a pool, whether or not their employer paid any part of their premium.
In the recent past, many small state-run purchasing pools have failed, largely
because of hostility from insurers and agents. Agents fear loss of commissions, and health
plans prefer to deal with employer groups directly through exclusive contracts. However,
the pools proposed here should be more attractive to insurers. Because pools would be the
only vehicle for using the health insurance tax credit, they would be much larger and have
greater cohesion and stability than any other pools to date. In addition, since people will
join pools for reasons not related to their health status, risk selection should be much less
frequent than in the individual insurance market.
In turn, pools should be attractive to low-income purchasers of health insurance,
because they would provide a more consumer-friendly source of coverage than the
existing individual health insurance market. Like large employers, pools would act as
“sponsors,” using their size and professional purchasing expertise to obtain good value for
their members. Individual consumers would be assured that the plans offered through the
pool were those that best met the informed standards of their sponsor, the pool.
Premiums for full tax-credit recipients would not vary based on individual health
status. They would be permitted to vary only by age, and only to the extent permitted in
the state’s regular insurance market. Premiums for non-tax-credit recipients could be health
rated, and health rating could be phased in for recipients of partial credits. More generally,
these pools would provide a stable source of coverage for people whose circumstances
change, allowing them to keep their insurance provider and their physicians.
The federal government would provide the enabling legislation and start-up funds
for health insurance purchasing pools, so that at least one competing pool would be available
in every region of the United States. Federal funds would cover 80 percent of the cost of
establishing a pool, up to $2 million per pool. Thereafter, administrative costs would be
paid for with a small (3%–4%) surcharge on premiums. State responsibilities would include
regulating pools, preventing “redlining,” limiting the number of pools so they reach
sufficient size, and arranging an alternative purchasing mechanism for tax-credit recipients
if no private organization came forward to sponsor a pool in the state. Where necessary,
state benefit mandates would be waived, so that plans costing no more than the value of
the tax credit could be offered through pools. However, a federal minimum benefit package
would be established. Pools would be permitted to contract selectively with health plans.
In each region of the United States, several competing pools would be preferable
to just one, for several reasons. First of all, people prefer to have a choice of plans, and
presumably a choice of pools. More importantly, a single purchasing pool, especially one
seen to be an agent of government, might not have the same freedom to contract
selectively with the health plans it considers the best value.
Starting up a pool would be considered a “charitable purpose,” so that pools could
more easily obtain foundation grants to pay for start-up and administrative costs. Their
boards of directors would represent employers and consumers, not insurance vendors or
health care providers. Pools would negotiate with health plans, and would provide easy
ways to enroll. The pools would receive tax credits and pay premiums, and would serve as
an ombudsman for participants. Pools would be required to offer at least three different
health plans and at least one coverage option that cost no more than the maximum tax
credit, and pools could refuse to contract with plans that are deemed too expensive or that
offer poor benefits. Pools must be open to all tax-credit recipients.
The tax credits would be payable in advance, based on an individual’s tax return
from the previous year or expected income for the current year. Overpayments and
underpayments would be adjusted through a reconciliation process at the end of the year.
Employers would use payroll deductions to obtain the employee’s share of the premiums,
when required, and send them to the pools.
_______________________________________________
Most citizens understand that BRONZE has so high a deductible and co-pay that the goal was making it too hard for WE THE PEOPLE the 99% to access health care----this is what is called MAKING HEALTH CARE MORE AFFORDABLE----affordable to global corporations and global Wall Street---not you and I.
National news back in 2014 made it sound as if lots of Americans were getting those SILVER, GOLD, AND PLATINUM PLANS----well, below we see a temporary subsidy for the poor allowing them in the short term to access a higher plan until that subsidy disappears which will occur not long after this coming economic crash. So, the stats were rigged to show more Americans able to access a higher SILVER PLAN. They will be back on gutted of funding UNITED NATIONS UNIVERSAL CARE MEDICAID FOR ALL----preventative care only.
I hear in Baltimore citizens thinking they have a SILVER PLAN because they received that subsidy-----all this is designed to keep WE THE PEOPLE THE 99% from mass protest ----
'In addition, cost-sharing subsidies reduce the cost-sharing amounts for low-income people who select a silver plan'.
Silver plans by far the most popular insurance option
Kelly Kennedy, USA TODAY Published 2:16 p.m. ET May 1, 2014 | Updated 5:45 p.m. ET May 1, 2014(Photo: Pablo Alcala, AP)
WASHINGTON — Almost two-thirds of the 8 million Americans who enrolled in health insurance through the Affordable Care Act picked mid-range "silver" plans, according to new data on sign-ups released Thursday by the Department of Health and Human Services Department.
The type of plans selected by those choosing private insurance, as well as the new customers' demographics, were key parts of the latest HHS report, which covers the entire open-enrollment period for the law.
Silver plans cover 70% of health costs, leaving the consumer responsible for the rest. Consumers could choose from bronze, silver, gold or platinum plans, with platinum plans having the highest premium and the lowest out-of-pocket costs for the consumer. About 20% chose bronze, 9% chose gold, 5% chose platinum. Two percent a bare-bones catastrophic care plan. All plans include no out-of-pocket costs for preventive exams, such as yearly physicals or women's annual cancer screenings.
The new data showed that 54% of those enrolling in insurance were women, while 63% of all enrollees were white. Of the remaining enrollees, the HHS report showed, 17% were African American, 11% Hispanic, 8% Asian, 1% multiracial, 0.3% American Indian/Alaska native and 0.1% native Hawaiian/Pacific islander.
Administration officials said they believe they will enroll more Latinos and younger people over the years, as they continue to emphasize their recruiting efforts.
Latino enrollment is "slightly lower" than the number of people qualified to enroll, with about 11% of the 14% of people eligible to enroll actually purchasing a plan, said Myra Alvarez, associate director of the HHS Office of Minority Health. But she said that was to be expected.
The statistics also do not include states with their own exchanges, such as California and New York, where millions of people enrolled in private plans. U.S. Census figures show that about 29% of Hispanic people are uninsured. Often, educating people about the Affordable Care Act and the exchanges also involved educating people about what health insurance is in general, Alvarez said.
One million of the 20 million calls to the HHS call center were in Spanish, said Julie Bataille, communications director for the Centers for Medicare and Medicaid Services.
About 20.8 million people are now enrolled in insurance because of the law, said HHS Secretary Kathleen Sebelius. That includes those 8 million who enrolled in private insurance, 4.8 million now covered by Medicaid and the Children's Health Insurance Program, 5 million who bought coverage outside the state and federal exchanges and 3 million adults younger than 26 now covered through their parents' insurance.
Eighty-five percent of those who enrolled in private health insurance through the state and federal exchanges between Oct. 1 and April 15 received federal subsidies to help pay for it, the HHS report showed. That is similar to figures released earlier by HHS.
The statistics also show that 28% of the 8,019,763 people who selected private health insurance are between the ages of 18 and 34, the age group that insurance analysts believe will help balance out the market's finances.
Thirty-one percent of the 3.8 million who enrolled in March were in the 18-to-34 age group, the latest records show. In the first three months of open enrollment, only 25% of those who enrolled were in that age group.
Officials believe enough younger people have bought insurance to keep premiums stable, said Michael Hash, director of the HHS Office of Health Reform.
There are some who believe the numbers could still go up significantly, particularly from the young and healthy.
Although open enrollment ended March 31, anyone who experiences a major life event may qualify to buy insurance, said Jen Mishory, executive director of the Young Invincibles, a non-profit group urging young people to get coverage. That includes marriage, moving, job changes and aging off parents' plans.
"All of those events are more likely to happen to people younger than 35," Mishory said. "The numbers are high in terms of who could qualify."
For example, Mishory said, about 2.6 million people will turn 26 and no longer be eligible for coverage under their parents' plans.
Enrollment in exchanges not run by the federal or state governments was estimated by the Congressional Budget Office to be 5 million. On Thursday, eHealth, the nation's largest private health exchange, released quarterly results that showed a 34% increase in individual and family insurance plans.
Brian Mast, an eHealth spokesman, said shopping for insurance on private exchanges has increased significantly.
While the number of people ages 18 to 34 fell from just over 50% last year to 42% this year at eHealth, Mast said it was still "a pretty healthy number." Last year, about 9% of enrollees were ages 55 to 64; this year, it's 16%.
In the first month of open enrollment, Mast said people who were not eligible for federal subsidies rushed to eHealth to buy insurance they probably could not buy before. They also tended to choose bronze plans, unlike the government exchanges where people chose silver plans.
An eHealth survey, Mast said, showed that 44% of its customers were previously uninsured.
WHO PAID PREMIUMS?
Despite the extent of the statistics, HHS still does not know how many people have actually paid their insurance premiums or how many have bought insurance that complies with the law but is outside the federal and state marketplaces.
"We are interested in having reliable and accurate data as much as you are," Bataille said, adding that she doesn't expect to have it until the end of the year.
HHS, however, did cite numerous reports from media organizations and insurance companies that show between 80% and 90% of those who selected plans have paid their premiums.
House Republicans pre-empted the data Tuesday with a report from the Energy and Commerce Committee that says that 67% of enrollees had paid their first month's premium by April 15. Committee members sent letters to every insurer included in the plan and asked for the data. However, the insurers told the committee that people still have time to pay the premium, so committee members will ask for an update by May 20. Committee members nevertheless cited the incomplete data to criticize the law.
"These numbers stand in stark contrast to the White House's previous assertions," said House Majority Leader Eric Cantor, R-Va. "If President Obama disputes the information provided by the insurance companies, he should direct HHS to immediately release complete enrollment data, including how many people were previously insured."
The House report did not include data from state-run exchanges. California announced that 1,395,929 people had signed up by April 15, well above its initial goal of 580,000, and that about 85% had already paid their premiums.
Though the market officially closed March 31, the federal site and several state sites remained open until April 15 for people who said they had a hard time completing their application by the deadline.
Sebelius announced her resignation last month after the federal exchange reached 7.5 million enrollees, which outpaced estimates. She will remain in the job until her designated successor, Office of Management and Budget Director Sylvia Mathews Burwell, is confirmed by the Senate.
_________________________________________
What we are seeing more and more is this centralization of low-income citizens into health systems separate from all others and this is sold as OFFERING A LOWER COST. This global health system has no problem handling a lower threshold for some years as all others serving lower income go bankrupt or close----this is marketeering and profiteering folks---it is not strong public health care.
The goal of AFFORDABLE CARE ACT is getting 95% of Americans tied to GLOBAL TELEMEDICINE with our global health systems recruiting health tourists of the global 1% and their 2%----that's the goal so what we are seeing is a change of behavior of US citizens going to any hospital----to going to selected hospitals----to not being able to go to any hospital. We see in this article it is all about deregulating our strong public health structure that protected all citizens equally----our low-income citizens in US cities that have never installed WAR ON POVERTY PROGRAMS like Baltimore will say----
THAT SHIP SAILED A LONG TIME AGO----but across the US standards were kept high for our low-income health access.
I tell you----all these global Wall Street corporations and pols working so hard to help the poor---it's a wonder they can still earn billions in profits each year and our pols pockets millions in thanks from Wall Street.
Horizon enrolls 234K into controversial new OMNIA plan
Updated on March 12, 2016 at 8:10 AM Posted on March 10, 2016 at 1:23 PM
Images of the Horizon Blue Cross Blue Shield headquarters in Newark. About 234,000 people have signed up for the OMNIA health insurance plans, the company announced Thursday. (Matt Smith | For NJ Advance Media)
78 sharesBy Susan K. Livio
slivio@njadvancemedia.com,
NJ Advance Media for NJ.com
TRENTON -- About 234,500 people signed up for the OMNIA line of tiered network health plans offering discounted premiums and low or no copays for patients who use a select group of hospitals and doctors, Horizon Blue Cross Blue Shield of New Jersey announced Thursday.
The eagerly-awaited enrollment figures for Horizon's newest and most talked about insurance products show there are about 234,500 OMNIA members, including 41,300 of them who were previously uninsured, according to the company's announcement.
Most of the enrollees -- 189,200 -- bought the policies themselves, including 154,250 through the health exchange created by the landmark health care law, the Affordable Care Act. About another 45,240 people enrolled through their job.
Talk of OMNIA has dominated the health care industry since Horizon announced the discount line of plans in September, and much of that has been criticism leveled by hospital excluded by the preferred "tier 1" network, which offers consumers the greatest amount of savings.
Eighteen hospitals are suing Horizon for breach of contract and defamation for implying their facilities are second-rate.
Why Horizon has sued these 2 hospitals
When some hospitals brought a lawsuit claiming Horizon's 'Tier 2' designation maligned their reputation, Horizon fired back with a lawsuit of its own.
Many of these Tier 2 facilities are independent, relatively small and serve a large number of Medicaid or uninsured patients, and say the loss of commercially insured people will force them to merge or close.
The enrollment figures come close to the 256,000 members Horizon executives predicted, and are a good indication the company is meeting a need for quality care that costs less, said Robert A. Marino, Horizon's chairman and CEO.
"Affordability has been a barrier for some uninsured individuals and too often lower-priced policies required consumers to trade cost for quality," Marino said. "OMNIA premiums, on average, cost 15 percent less than our non-tiered plans and unlike high-deductible policies, don't require members to incur large out-of-pocket expenses before the insurer pays claims."
"OMNIA is focused on keeping people healthy, not just treating them when they become sick," Marino's statement said.
Steven M. Goldman, attorney for 17 Tier 2 hospitals suing OMNIA and a former Banking and Insurance commissioner, said the people who signed up were not given the full story on OMNIA.
"Since Horizon hasn't disclosed any information about the criteria it used in selecting its OMNIA providers, the only information consumers had available in making their decision was price," Goldman said in a statement. "This is particularly true of the Affordable Care Act enrollees."
"Many of these people may not even have access to a Tier 1 provider in their community or be aware that their trusted hospital has been designated Tier 2, while their long-time doctor has been designated Tier 1, or vice versa," Goldman added. "Horizon has created this confusion in the marketplace by refusing to provide answers of any kind about the plan's selection criteria."
OMNIA members can be found in all of New Jersey's 21 counties, with the greatest concentration in the most populated counties: Bergen (24,248), Middlesex (19,377) and Essex (14,813), according to Horizon.
Health policy experts said the figures show a promising future for OMNIA.
The impact on tier 2 hospitals is unlikely to be felt right away, said Joel Cantor, director of the Rutgers Center for State Health Policy.
While Horizon appears to have met their enrollment target, at this level I doubt there will be very substantial impacts on tier two hospitals," Cantor said. "Their data also show that enrollment is spread over all NJ counties, which will mitigate the impact on any single hospital."
"That said, these results are just for the first enrollment period. In the future, enrollment - and impacts on hospitals - could grow," Cantor added.
Horizon highlighted the racial and ethnic makeup of the 41,258 previously uninsured OMNIA policy holders, noting 15 percent are Latino, and 13 percent are black and 13 percent are Asian. Public sign-up events were held with organizations such as the Hispanic Statewide Chamber of Commerce, Horizon added.
More than three-quarters of OMNIA enrollees selected a mid-price "silver" or higher metallic level plan, based on the Affordable Care Act's four tiers of coverage corresponding to size of deductible and premiums. OMNIA's silver plans feature no deductible, no coinsurance, and co-pays of $50 or less when using a Tier 1 provider, according to Horizon.
Linda Schwimmer, president and CEO for the New Jersey Health Care Quality Institute, said OMNIA's cost savings would be enhanced if enrollees met the income requirements that qualify them for federal subsidies to help pay their premiums.
"That means that even if they go to a Tier 2 provider, they are receiving significant federal support to pay for it. I think that is why both the OMNIA plan and the silver level were so popular," Schwimmer said.
A 35-year-old man who buys a silver OMNIA plan on the health exchange pays $360.27 a month, 15 percent less than the Horizon Advantage plan which would cost him $424.94, Horizon spokesman Tom Vincz said. A couple, both 35 years old with two children under 21 would pay $1,094.98 under OMNIA, 15 percent less than the Advantage premium of $1,291.51.
"Overall, despite the valid concerns about transparency, consumer confusion, and updating the network adequacy rules, I think it is fantastic that so many previously uninsured people were able to afford a comprehensive insurance plan," she added
___________________________________________
We think it is pretty clear that both corporate and government health plans WILL DISAPPEAR---so what we see being built for the 'working class and poor' will be what WE THE PEOPLE THE 99% will get and these corporate and government plans will drop like hotcakes after the coming economic crash.
Well, my child is intelligent and will get that really good job we say----will she/he be able to compete with global labor pool for that good job. We are leaving the age of MERITOCRACY and MOVING FORWARD to mediocracy and cronyism/nepotism not only from our own US 5% ---but globally that 1% and their 2% getting these jobs.
All of what is happening TODAY-----UNDER TRUMP was written in AFFORDABLE CARE ACT----is simply took several years of building structures for people to see NO ONE WILL HAVE HEALTH INSURANCE as one of my doctors in Baltimore said 10 years ago.
Who supported Clinton global Wall Street neo-liberals each election pushing REAL LEFT SOCIAL PROGRESSIVES that actually cared for the 99% out of office? Those global Wall Street Baltimore Development 'labor and justice' 5% to the 1% players----HOLD THESE 5% BLACK, WHITE, AND BROWN CITIZENS ACCOUNTABLE WHEN WE CANNOT ACCESS ORDINARY HEALTH CARE.
Striking Verizon workers soon to lose company health insurance coverage
Reprints Thomson Reuters
4/28/2016 12:00:00 AM
(Reuters) — A strike by nearly 40,000 Verizon Communications Inc. workers is in its third week with unions and the company still far apart on contract talks, even as employee healthcare benefits are set to expire on Saturday.
Workers, from network technicians to customer service representatives, in Verizon's Fios Internet, telephone and TV services walked off the job on April 13 in one of the largest U.S. strikes in recent years after contract talks hit an impasse.
A resolution on various issues, including temporary job relocations, pensions and moving call center jobs offshore, has yet to be reached, representatives of Verizon and the Communications Workers of America union said on Wednesday.
Verizon, which said last week that a long-drawn labor dispute would pressure its earnings, remains committed to reaching a fair deal, spokesman Rich Young said in a phone interview.
A meeting between Verizon and union representatives is scheduled for Thursday afternoon, he said.
Healthcare options
Verizon has notified striking workers that under federal law their health care coverage was set to expire on April 30, Young said.
Verizon has said it spent over $3.2 billion on healthcare for employees last year. The company offers insurance coverage to those employees who are actively working, Young said.
Striking employees have the option of seeking coverage under the U.S government's Consolidated Omnibus Budget Reconciliation Act (COBRA) health insurance plan to get temporary healthcare coverage.
"They think that this is going to be used as a wedge to break this strike. I assure you it will not," said Ed Mooney, vice president of CWA District 2-13, said in a phone interview.
The CWA also has funds, collected through contributions from affiliated union members and other donors, to help cover healthcare costs of members when needed, Mooney said.
"It's horrible. Most of us are parents, I have a daughter and the prospect of losing our children's healthcare is actually quite disturbing," Fitz Boyce, 45, a field technician at Verizon for over two decades, said in an interview at the picket line in front of the company's Times Square store in New York.
The strike affects Fios Internet, telephone and TV services across several U.S. East Coast states, including New York and Virginia.
Verizon has trained thousands of non-union employees over the past year to ensure no service disruption. The company has fielded over 60,000 requests since the strike began, Young said.
The unions have said that replacement workers do not have the necessary expertise, especially in highly technical jobs such as equipment installations.
_____________________________
This is the propaganda we are hearing in all in US CITIES DEEMED FOREIGN ECONOMIC ZONES----reversing and going back to the old system would be PAINFUL and she lists some social progressive bones thrown at our citizens with addictions.
The only way WE THE PEOPLE THE 99% can indeed return to quality health care in US IS TO END AFFORDABLE CARE ACT and break up health system MONOPOLIES AND GLOBAL MONOPOLIES and take back health policy decisions from global health corporation executives and get it back to our communities and citizens.
It will be a shock in America as 99% of citizens will lose access to ordinary health care. What does MOVING FORWARD DO? Kills employment for all American citizens---what drives addictive behaviors ----depressions from being unemployed and unstable.
'Potentially huge shock to health systems
Kathleen Nolan, formerly the director of state policy and programs for the National Association of Medicaid Directors, discussed the importance of viewing potential cuts amid the context of the broader health system, which has undergone major changes since the ACA’s passage. Reverting to the health system we had before Obamacare would be painful, she said.
For example, as the opioid crisis has worsened in recent years, states that expanded Medicaid have helped provide treatment for those beneficiaries battling addiction. And, as insured populations grew through Medicaid expansion, other funding streams that once helped with uninsured care are no longer in place'.
Below we see Kellie is tied to global media and the ECONOMIST no less---the hyper neo-liberal news journal and from that pesky SAN FRAN global Google US CITIES AS FOREIGN ECONOMIC ZONE. We happen to know CENTER FOR HEALTH JOURNALISM is a global Wall Street Clinton neo-liberal media outlet telling us what affordable health care looks like.
Kellie Schmitt - Health Journalism Fellow
Fellow
Kellie Schmitt
Affordable Care Act Blogger, Freelance Health Reporter
Reporting on Health
Email Kellie Schmitt
About Myself: I write for Reporting on Health's Affordable Care Act blog. Previously, I was a health reporter for the Bakersfield Californian, a staff writer for the San Jose Mercury News, and a business reporter for the San Francisco Recorder. I spent two years reporting from China for publications including The Economist's Business China, China Economic Review, and CNN Travel.
In 2012, I was a Health Journalism Fellow. My project examined the high number of foreign-trained doctors in California's Central Valley, a series which won awards from the Association of Healthcare Journalists and the California Newspaper Publishers Association.
I also worked with Reporting on Health's multi-part, collaborative series on the devastating toll Valley Fever has had on California's Central Valley.
******************************************************
Remaking Health Care
Experts weigh in how to cover the big changes GOP plans for Medicaid
By Kellie Schmitt
July 28, 2017
Getty Images
As the country faces the possibility of massive Medicaid cuts, a panel of experts offered tips on how to navigate the fast-developing story in a Center for Health Journalism webinar this week.
Edwin Park, the vice president for health policy at the Center on Budget and Policy Priorities; Kathleen Nolan, a managing principal at Health Management Associates; and Lauren Sausser, a health care editor and reporter at The Post and Courier in Charleston, South Carolina, offered ideas and expertise on a story that could affect communities across the nation.
Park focused on Republican efforts to create a “per capita cap” on federal Medicaid dollars as well as plans to reduce the federal government’s share of funding for the Affordable Care Act’s Medicaid expansion – both of which would shift more responsibly to states.
For states that expanded Medicaid under the Affordable Care Act, the federal government fully funded those expenses for three years, then phasing down the contribution until it reaches 90 percent in 2020 and beyond. If the federal government’s contribution is further reduced, states that expanded Medicaid will have to shoulder more of the costs. So-called “trigger states” have a provision that would end the expansion if the federal contribution drops, Park said.
The other major proposed change is a “per capita cap,” which would affect all states. Under current law, the federal government pays a percentage of a state’s Medicaid costs, which averages about 57 percent though it varies by state. Per capita caps would allow the federal government to set a fixed amount for each beneficiary, “with that fixed amount set a level below what would be provided under the current financing system,” Park said. Those figures would likely be adjusted annually at a rate that doesn’t keep up with soaring health care costs, he added.
As states face massive cuts, they would have three choices, he said: Raise taxes; cut other parts of their budget such as education; or cut Medicaid, leaving more and more people uninsured or underinsured.
“Those cuts are only going to get more and more severe over the long run, particularly as the population continues to age,” Park said.
Potentially huge shock to health systems
Kathleen Nolan, formerly the director of state policy and programs for the National Association of Medicaid Directors, discussed the importance of viewing potential cuts amid the context of the broader health system, which has undergone major changes since the ACA’s passage. Reverting to the health system we had before Obamacare would be painful, she said.
For example, as the opioid crisis has worsened in recent years, states that expanded Medicaid have helped provide treatment for those beneficiaries battling addiction. And, as insured populations grew through Medicaid expansion, other funding streams that once helped with uninsured care are no longer in place.
“If you suddenly have an increase in uninsured, those health system and hospitals are not yet prepared to deal with that shift back,” Nolan said.
To deal with the loss of insurance for so many, some states might do something innovative, such as offer state-only insurance products. Other may create new programs to address specific health needs.
In every state — regardless of whether they expanded Medicaid under the ACA — Medicaid populations will face cuts under per capita caps.
Nolan said the people most impacted will be those who use the most services, such as the frail elderly in nursing homes and people with disabilities. She emphasized, though, that Medicaid beneficiaries should not be lumped together. The impact of changes will be different depending upon the population affected — distinct groups may be pitted against each other in a fight for diminishing dollars.
Even if the GOP’s efforts to “repeal and replace” collapse, changes are likely still in store for Medicaid through state-specific waivers under existing law, she said. For example, some states might look into work requirements, drug testing, or cost sharing for Medicaid beneficiaries, she said.
“A lot of conversations around these kind of waivers are happening more in expansion states, particularly conservative expansion states,” Nolan said, adding that some conversations might extend into other Medicaid populations.
Explaining the impact to audiences
Those Medicaid conversations can be complex for the average newspaper reader, said the Courier and Post’s Sausser. And it might not be something they think they care about.
That’s why she makes sure to include several key facts in articles involving Medicaid. Along with costs, she mentions how many people are enrolled in her home state and how many of them are children and disabled.
“There are a lot of negative stereotypes in South Carolina — and I imagine in other states, too — about who qualifies for Medicaid,” she said.
In covering Medicaid, Sausser suggested that reporters find a policy mentor who can help with complicated health policy questions. And, she recommended getting to know not only the state’s current Medicaid director, but also previous directors who might speak more candidly now that they’re no longer in office.
To cut through the policy jargon, Sausser shared how she uses personal stories to demonstrate Medicaid’s impact. She recently wrote about an 11-year-old girl with sickle cell disease, who “has received 45 blood transfusions and has been hospitalized 49 time.”
“If you can put a face and a story with policy, I think that’s a winning combination,” she said.
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