A few HealthCare Reform Ideas that would work

My Healthcare Reform Recommendations (not all inclusive) just a little rant:

A meeting of all 50 state insurance commissioners will take place to adopt the same rules. The buying across the state lines mantra is a red herring. Buying across state lines will be allowed but the people of states will find that certain companies will not offer networks in their state or doctors not included in their networks. Also states have different tax laws so policies may be more expensive in certain states. People will either be encouraged or discouraged to purchase outside of their state.

1. Tort Reform:  One of the leading causes of escalating Healthcare costs. Enact caps on monetary judgments much like Texas.

2. No lifetime limits

3. No pre existing conditions for illness or injury diagnosed before age 19

4. Children can stay on parents plan till 26 but if moved to own plan then pre existing conditions apply unless diagnosed prior to age 19. If parents want to pay for it then let them. If they want to create a dependent child on them for life, that’s their problem.

5. Pregnancy surcharge:

·         Pregnancy will be covered in insurance policies as any other illness for those in CHILDBEARING and legal AGE 18 – 49 or can PROVE that unable to have children.

·          If married then pregnancy surcharge charged to husband’s policy as well at 50% for husband and 50% for wife of total surcharge.

·         When 50 years old is reached surcharge is removed automatically.

6. A FEDERAL pre existing subsidy pool. Every insurance company MAY offer plans to members with pre existing conditions when they apply at rates approved by STATES.

• Insurance companies that do offer plans will receive both FEDERAL and STATE tax credits in order to offset the cost of offering those plans.
• Those members that choose a HIGH RISK plan and whose income does not qualify them for MEDICAID can apply for FEDERAL HIGH RISK subsidy. Either by tax credits at tax time or monthly payments to insurance company.
• Must be deficit neutral

7. Health & Wellness Algorithm:  Those that take care of themselves receive discounts on plans.  This will encourage people to take care of themselves.

• Insurance companies can write programming code the when rates are provided to states on annual basis as in the past, those that meet health & wellness parameters will not incur such rate increases at 100% or may receive rate reduction.

8.  Wellness physicals covered 100%.  We take our cars to be checked out, we should be able to do the same to our bodies. This actually will decrease costs due to prevention and proactive treatments.

9. ALL individual and group Health & Health Indemnity insurance are able to be pre taxed or credited on taxes to not exceed negative tax payments. NO TAXES paid on health insurance products.

10.  Those not willing to insurance themselves either traditionally or MEDICAID will not be FORCED to purchase plans but hospitals and doctors etc. that are not paid for services provided to an uninsured individual can:

·         Submit to IRS the written off reduced charges for services provided and any tax refunds due to individual will be submitted directly as payment to care providers.

·         Work with individual at reduced rates to pay off debt

·         This will encourage people to take responsibility either by getting insurance or paying what is owed.

·         This will decrease costs to hospitals and care providers due to non payment.

11. Child Only plans encouraged once again.

12. MEDICAID threshold reduced to pre PPACA limits. 

Please feel free to comment.

www.gulfbreezeinsurance.com

Short Blog Post regarding ACA

The Unaffordable Care Act is working just the way the Liberal Democrats want it to work. It is designed to fail in order to give rise to the reason for a Single Payer System...Period!

Let me know what you think about that.

ACA mandates delayed, but reporting requirements are crucial - Articles - Employee Benefit News

By Diane A. Thompson and Sharon M. Marshall

November 8, 2013

 The Internal Revenue Service has issued proposed regulations on reporting requirements under the Affordable Care Act. The regulations, released on Sept. 9, address two separate ACA reporting requirements: one relating to the individual mandate and the other relating to the employer mandate. Failure to comply could result in tax penalties unless the failure is due to reasonable cause and not willful neglect.
Each of these requirements has been delayed one year. The government is encouraging voluntary compliance for reports due in 2015 (for the 2014 calendar year), but the first mandatory reports are not due until 2016 (for the 2015 calendar year).

The regulations under section 6055 of the Internal Revenue Code impose new reporting requirements on health insurers, sponsors of self-funded group health plans, and others who provide individuals with minimum essential health coverage. These health benefit providers must furnish a report to the IRS and a statement to enrollees containing specific information to be used in the administration of the individual mandate. Although the report and statement are due annually (on the same schedule that applies to Form W-2), they must set forth information on a month-by-month basis.

The regulations under section 6056 require large employers (more than 50 full-time employees or full-time equivalents) to furnish a report to the IRS and a statement to all full-time employees containing information about the employer-provided coverage that is offered, regardless of whether the employee enrolls. This information will be used in the administration of the employer mandate. As under section 6055, the report and statement are due annually (on the same schedule as Form W-2), but present information on a monthly basis. The report also provides the IRS and individuals with information necessary to administer the premium tax credit under section 36B of the Internal Revenue Code.

The two new reporting requirements are in addition to the current requirement to report the cost of coverage on Form W-2. Many are hoping that some or all of these reporting requirements will be combined and simplified. The U.S. Department of the Treasury and IRS have not yet found an approach to reconcile the differences among the requirements, but they continue to consider a combined approach, pending the issuance of regulations.

Diane A. Thompson and Sharon M. Marshall practice in executive compensation and business law at Ballard Spahr. Thompson can be reached at thompsonda@ballardspahr.com or 424-204-4334 and Marshall at marshalls@ballardspahr.com or 215-864-8506.
The information in this alert is meant for educational purposes only and should not be taken as specific legal advice.

ACA mandates delayed, but reporting requirements are crucial - Articles - Employee Benefit News

Video: White House intimidating insurers into staying quiet on the ObamaCare debacle? « Hot Air

I have been wondering where all the CEO's of health insurance companies are??

posted at 12:01 pm on October 30, 2013 by Ed Morrissey

It could be worse, as Audrey Hudson can tell you.  All these insurers are getting are phone calls, not raids by the Maryland State Police seizing their notes on government malfeasance.  CNN’s Anderson Cooper reports that the insurers want to get the real story out about why millions of people will have their policies cancelled, and how they tried to warn HHS of this unnecessary outcome.  For now, they’re outsourcing the job to Robert Laszewski (via Daniel Halper):

Why are they so intimidated? Because the federal government is their biggest customer.  If that doesn’t point out the issues of crony capitalism and transparency on the uses and abuses of power, I’d hate to have to experience a clearer one.
By the way, I’ll have Audrey Hudson on my show this afternoon to give TEMS viewers a first-person perpective on real intimidation.  Maybe a few of these executives can watch and find their intestinal fortitude.

Video: White House intimidating insurers into staying quiet on the ObamaCare debacle? « Hot Air

Waxman on 10,535 Pages of Obamacare Regs: ‘Is It Important That I Read It?’ | CNS News

 Yes I really do think it is important that you read a law before you enslave the American people to it. This is the mentality of those that are constantly elected and reelected for terms over and over. This is only the beginning people. Look for the nationalization of oil and gas and the madness will not stop there. Anything that can be used as a controlling factor upon me and upon you can and will be used against you by the government of these United States.
Waxman on 10,535 Pages of Obamacare Regs: ‘Is It Important That I Read It?’ | CNS News

Bad exchange decisions could cost consumers billions | BenefitsPro

By Kathryn Mayer

October 1, 2013
 
One looming problem for public exchange enrollment under the Patient Protection and Affordable Care Act could be a (very) costly one to consumers.

A study from the Columbia School of Business found that more than 80 percent of consumers unknowingly will choose a higher cost health care plan than they need.
The total bill for these mistakes? $9 billion.

“Consumers’ failure to identify the most appropriate plan has considerable consequences on both their pocketbooks as well as the cost of the overall system,” said Eric Johnson, co-author of the report and co-director of Columbia Business School’s Center for Decision Sciences.

“If consumers can’t identify the most cost-efficient plan for their needs, the exchanges will fail to produce competitive pressures on health care providers and bring down costs across the board, one of the main advantages of relying upon choice and markets,” Johnson said.

Johnson has advised several state health exchange systems on their designs and structure.
To get the estimate, researchers from the school used simulated exchanges modeled on the design of the actual exchanges.

Researchers found the average consumer stands to lose on average $611 — roughly half a week’s salary for a family making $42,000 per year — by failing to choose the most cost-effective option for their needs.
And, because the federal government will subsidize many policies, American taxpayers could pay an additional $9 billion for consumers’ mistakes in choosing more costly plans.

But Johnson and his colleagues identified several mechanisms that significantly improved outcomes for the consumer, they said. And it's a two-way street as both consumers and exchange designers could improve the exchange experience.They suggested consumers “estimate first; peruse the plans second;” educate themselves about the basics of health insurance and have a calculator on hand.

As for the exchanges, researchers suggested exchanges limit the number of choices in health care plans to avoid consumer confusion; include tutorial links and pop-ups that explain basic health insurance terms; and include online tools for the consumer including smart defaults, and cost calculators.

Bad exchange decisions could cost consumers billions | BenefitsPro

HCAN: Anti-Obamacare states cannot sabotage Navigators | LifeHealthPro

By Arthur D. Postal

September 26, 2013

The efforts of governors and state legislators to block consumers who want to use PPACA Navigators to help them sign up for health care could have “profound effects,” a consumer advocacy group contends in a report released today.
“This is Navigator suppression, and it perpetuates the systematic denial of affordable health care to huge numbers of the most vulnerable individuals in our society, especially those in minority and lower-income populations,” said Ethan Rome, executive director for Health Care for America Now (HCAN).
The National Association of Insurance and Financial Advisors (NAIFA), however, said they could understand the decision of states to act.
"While the thousands of Navigators hired will help consumers enroll through a state or federally-facilitated marketplace, consumers will require assistance that goes far beyond registering for a plan," said NAIFA President-Elect John Nichols said.
According to Nichols, agents and brokers do much more than sell insurance. They explain critical differences in plan options and coverage, which may involve substantial research and fact-finding about the client’s needs. They advocate on behalf of their clients, helping people when they have trouble getting procedures approved or claims processed.
"They also review coverage on a periodic basis, suggesting changes when appropriate and counseling on ways to reduce costs," Nichols said. "When purchasing a plan from a marketplace, the companies that sell health insurance should immediately assign consumers an agent. The healthcare system is complex, and coverage does not begin and end with enrollment. Consumers benefit from the expertise that brokers and agents provide in servicing the plan throughout the year. They need to be involved, or customer service surely will be a casualty of healthcare reform.”
HCAN officials said Jay Angoff, a partner at Mehri & Skalet in Washington, is considering filing lawsuits that would stop the recalcitrant states from interfering with the Navigators and acting to stop the states from delaying the work of the Navigators.
Angoff is the former insurance commissioner of Missouri, and the first head of the Health and Human Services Department’s Office of Consumer Information and Insurance Oversight (OCIIO). OCIIO is the office responsible for implementing the insurance reform provisions. He did not return phone call seeking comment.
Those participating in today's conference call said it is unlikely HHS would file its own lawsuits to stop the interference because it is so busy implementing the many pieces of the law, the Patient Protection and Affordable Care Act (PPACA).
Rep. Jackie Speier, D-Calif., ranking minority member of the House Subcommittee on Energy Policy, Healthcare and Entitlements of the House Energy and Commerce Committee, discounted the utility of filing lawsuits. Speier said on the conference call that courts would likely not find the suits “ripe for litigation” because the provisions of the law involved have not yet taken effect.
Speier said the feedback she is getting from her district is that when the exchanges are launched Oct. 1, enrollment will probably be slow “as we start out and then gain as times on.”
Speier predicted that the exchanges “will probably see a takeup rate that is quite high.” She said that in her polling of young people, she "was surprised at how important this is to the 20-somehtings; I was surprised at how readily this will be embraced.”
Sabrina Corlette, a health policy expert at Georgetown University, called the state laws "unprecedented." She said they were unnecessary given Medicare's positive history with counselors similar to the Navigators. "It's not to say there aren't legitimate concerns about fraud, or con artists taking advantage of Obamacare," she said. "It's just that these state laws are really barking up the wrong tree … There is no credible evidence whatsoever that Navigators will be a source of fraud."
Corlette said the criminal background check some of the state laws are requiring, as well as additional training are imposing an additional hurdle to the Navigators’ starting their work.
“They are already required to undergo training, training that is quite extensive and includes the providing of a lot of educational material. This involves piling on information they already have.
“All it does is make it more difficult for people to have access to important information on health care options,” she said.
As to background checks, Corlette said the organizations to which the Navigators are associated “had to be vetted through an extensive process.” And, she said, “some of the checks are being required incredibly late in the game, and will not be complied with in time to allow these people to start doing their job on time.”
Read More...HCAN: Anti-Obamacare states cannot sabotage Navigators | LifeHealthPro

List of grants DHHS gave for navigators in Florida

Here is the list of where grants went for Navigators

The Department of Health and Human Services (HHS) announced on August 15 the entities that were awarded Navigator grants. The following entities were awarded grants in Florida:

• University of South Florida, College of Public Health
• Epilepsy Foundation of Florida
• Advanced Patient Advocacy, LLC
• Legal Aid Society of Palm Beach County, Inc.
• Pinellas County Board of County Commissioners
• National Hispanic Council on Aging
• Mental Health America
  

Individuals interested in becoming Navigators should contact these entities for potential employment opportunities. Navigators are not hired directly by the federal government or the Marketplace.

House Oversight blasts exchange helper incentives | LifeHealthPro

By Allison Bell

September 19, 2013
A House committee is accusing managers of the new public exchange program of encouraging enrollers to use biased information to hype the program. Holes in enroller compensation rules "raise the risk of massive fraudulent spending on Medicaid and exchange subsidies for individuals who do not meet the eligibility requirements," committee staffers say.

The staff of the House Oversight and Government Reform Committee make their case in a report on the risk of fraud at the public exchange outreach campaign.

Rep. Darrell Issa, R-chairman of the committee, had his staff look at U.S. Department of Health and Human Services (HHS) efforts to set up the Patient Protection and Affordable Care Act (PPACA) exchange navigator and "in-person assister" programs.

PPACA requires each state's exchange to offer consumers "navigators," or independent ombudsmen, to help the consumers understand how to use the exchanges. The Center for Consumer Information and Insurance Oversight (CCIIO), the arm of HHS running the exchange program, also has created a similar but separate "in-person assister" program.

House Oversight staffers say CCIIO set up the assister program to get around a PPACA provision that requires states to pay for their navigators with their own money. In the District of Columbia, for the example, the exchange expects to spend $100,000 in local money on navigators and $35 million in federal money on assisters.

The committee staffers say CCIIO is creating an opening for con artists to pretend to be exchange enrollers by failing to create an enroller database or giving the enrollers official badges.

Even the official enrollers may go to work with less than 20 hours of training, and no independent entity has had any oversight over the content of the training or the information the enrollers will be giving out, the staffers say.

CCIIO will be letting navigator and assister programs at state-based exchanges pay employees based on enrollment volume, without imposing any requirement that the enrollers tell consumers about the volume-based pay, the staffers say.

Gary Cohen, the CCIIO director, told the staffers in an interview that exchange enrollers will give consumers information about the small value of the PPACA individual coverage mandate violation mandate penalty, and exceptions to the individual coverage ownership requirements, only if consumers ask for that information.
The compensation rules, and the lack of emphasis on giving consumers clear information about mandate exceptions, mean that enrollers may fail to give consumers the information they need to know how to reconcile PPACA requirements with their own needs, the committee staffers say.

Also in the report, the staffers note that the press already has covered one major exchange-related data security incident.

In Minnesota, the staffers say, an exchange employee accidentally released a confidential document that included the Social Security numbers of 2,400 insurance brokers.
See also:
House Oversight blasts exchange helper incentives | LifeHealthPro

Louisiana official blasts HHS PPACA delays | LifeHealthPro

By Allison Bell

September 18, 2013

Problems with getting the U.S. Department of Health and Human Services to answer questions about federal health law details have jacked up implementation costs, a state official testified today.

The official, Kathy Kliebert, secretary of the Louisiana Department of Health and Hospitals, spoke at a hearing on state implementation of the Patient Protection and Affordable Care Act (PPACA) that was organized by the U.S. House Oversight and Government Reform health care subcommittee.

Getting a response from HHS on important questions can take three to four months, Kliebert said.
"We cannot afford to wait months for these answers," Kliebert said.

Kliebert cited efforts to get HHS officials to help state Medicaid programs adopt a new income eligibility testing standard -- a "Modified Adjusted Gross Income" standard -- as an example of a result of the delays.
Most states have to revamp their Medicaid eligibility systems to shift to the MAGI standard.

Federal officials promised in March that HHS would develop a "MAGI in a box" solution that would be free to the states.

Instead, Kliebert said, HHS officials said in June, during a conference call, that the states would have to develop their own MAGI implementation systems instead.

That shift is forcing Louisiana to spend about $750,000 on 5,437 in additional contractor work, Kliebert said.
Kliebert also questioned how well HHS has trained the call center workers supporting exchanges in states like Louisiana that are letting HHS run their public exchange programs.

A call center worker told one Louisiana man that many states are expanding Medicaid eligibility, and that the man should call the Louisiana Medicaid program to see if it was one of those states, even though Louisiana is one of the states that has definitely rejected Medicaid expansion, Kliebert said.
Louisiana official blasts HHS PPACA delays | LifeHealthPro

Former SSA chief doubts exchange hub readiness | LifeHealthPro

By Allison Bell

September 12, 2013


The former head of the Social Security Administration is scoffing at the idea that new exchange data hub will be ready on time.The former SSA commissioner, Michael Astrue, said the Centers for Medicare & Medicaid Services held up work on the hub while trying to get other agencies to chip in on the bill."CMS struggled to meet its deadline," Astrue testified Wednesday at a data hub hearing organized by the House Homeland Security cybersecurity subcommittee.

The agency’s “failures and delays” were common knowledge within the Obama administration, but the U.S. Department of Health and Human Services was never candid with states when they wrestled with building their own exchanges or letting the feds run things, Astrue said. The hub is supposed to help the public exchanges get information they can use to verify health benefits program eligibility applications from federal and state agencies, such as the Internal Revenue Service and SSA.

Astrue noted that, in an August report, Daniel Levinson, the HHS inspector general, said required security findings were set to take place the day before implementation.Levinson devoted just five pages to analyzing the hub performance and only relied on interviews and documents, Astrue said.

Read more....
Former SSA chief doubts exchange hub readiness | LifeHealthPro

$100-a-day penalties: ACA non-compliance can be expensive - Articles - Employee Benefit News

By Keith R. McMurdy

September 13, 2013

While a lot of employers are focused on the penalties associated with not offering appropriate coverage (the $2,000 penalty) or not offering affordable coverage (the $3,000 penalty), what can get overlooked is the myriad of daily penalties that come with non-compliance. Take the Oct. 1 exchange notice requirement as an example. While the regulations do not identify a specific penalty for failing to comply with the notice requirement, the Affordable Care Act has a $100-a-day general non-compliance penalty. Read More...
$100-a-day penalties: ACA non-compliance can be expensive - Articles - Employee Benefit News

Florida bans navigators from county health offices | LifeHealthPro

By Kelli Kennedy

September 12, 2013
MIAMI (AP) — The Florida Department of Health has issued a memo telling county health departments to keep Patient Protection and Affordable Care Act (PPACA) navigators out of their offices.
Local health departments can accept public exchange brochures and other exchange outreach material, but they can distribute the materials only if consumers ask for information.

Agency officials said they sent the memo earlier this week to provide clarity for local departments about the exchange navigators because the navigators aren't acting on behalf of the state.
PPACA calls for the new public exchange system to open Oct. 1.

Florida bans navigators from county health offices | LifeHealthPro

PPACA may pack bigger punch than RomneyCare | LifeHealthPro

By Allison Bell

September 4, 2013

     A University of Colorado economist says new Patient Protection and Affordable Care Act requirements could hit employers about 12 times as hard as its Massachusetts predecessor. Some PPACA defenders have pointed to the relatively modest effects of the RomneyCare employer and individual mandates as evidence that it would only be a bump in the national economy.

     But the economist, Casey Mulligan, concludes in a working paper circulated by the National Bureau of Economic Research that RomneyCare imposed the equivalent of an increase of just $20 per month, or 0.4 percent of median earnings potential, on the typical Massachusetts labor income tax rate.The RomneyCare increase amounts to a big implicit tax on a small fraction of the Massachusetts population plus a small employer penalty, Mulligan writes.

     PPACA could lead to the equivalent of a 4.9 percent increase in the typical labor income tax rate at the national level, Mulligan estimates. Read More...PPACA may pack bigger punch than RomneyCare | LifeHealthPro

Workers Nudged to Health Exchanges Seen Costing U.S. Taxpayers

 by: Alex Wayne September 12, 2013

(Bloomberg) — U.S. retirees being pushed out of company-sponsored health plans may prove a harbinger for existing employees as well.

About $6.7 billion in taxpayer money may be at risk if companies raise premiums by as little as $100 a month. That may spur as many as 2.25 million people to drop company coverage and enroll in plans under the Affordable Care Act, Stanford University researchers say.
International Business Machines Corp. and Time Warner Inc. say that they’ll give retirees a stipend to move to coverage in private health exchanges. Rising health care costs and the availability of new government coverage options may spur companies to similarly shift active workers out of employer-sponsored insurance.
The cost of the ACA “is much more sensitive than people previously appreciated” to employers’ decisions to drop coverage, says Jay Bhattacharya, an economist and Stanford associate professor of medicine. He published a study in the journal Health Affairs this week that shows about 37 million workers would get a better deal in the taxpayer-subsided exchanges next year than through their companies as employers raise or redistribute health costs.

Health Insurance Exchange

Court rules Hobby Lobby can challenge PPACA | BenefitsPro

DENVER (AP) — In a health care decision giving hope to opponents of the federal birth-control coverage mandate, a federal appeals court ruled Thursday that Hobby Lobby stores won't have to start paying millions of dollars in fines next week for not complying with the requirement.
The 10th Circuit Court of Appeals in Denver decided the Oklahoma City-based arts and crafts chain can proceed with its case and won't be subject to fines in the meantime.
The reprieve gives Hobby Lobby Stores Inc. more time to argue in a lower court that for-profit businesses — not just currently exempted religious groups — should be allowed to seek an exception if the law violates their religious beliefs. The company had sued to overturn the mandate on grounds that it violates the faith of founder and CEO David Green and his family.
The appeals court remanded the case for more argument, but the judges indicated Hobby Lobby had a reasonable chance of success. Read More...Court rules Hobby Lobby can challenge PPACA | BenefitsPro

White House begins big push for exchanges | LifeHealthPro

Americans struggling to understand the exchanges and other components of the Patient Protection and Affordable Care Act can now get some help from the government.
The Obama administration on Monday launched its a public-outreach campaign to help consumers understand PPACA benefits with a new, consumer-focused HealthCare.gov website and a 24-hours-a-day consumer call center. Read More...White House begins big push for exchanges | LifeHealthPro