An important reminder, Federal and State exchanges are closing for their annual enrollment as of January 31, 2017 for a March 1 effective date. Visit Healthcare.Gov to find your state and be sure you are enrolled. If you miss this opportunity, you will not be able to enroll into a plan till December 2017, for a January 1, 2018 effective date. And, you will be paying the fine for not having insurance in place.
There are some exceptions to this.
1. Buying Direct: You may have an opportunity to enroll directly with an insurance carrier until February 15, 2017 for a March 1st effective date but you get NO tax credits and it is not through the State/Federal Exchange program. It is up to you to figure out the carriers that will write policies directly with you outside of the exchange but this too, will end very soon.
2. Special Enrollment Period (SEP): If you lose coverage, move, have a change in family status, outside of the annual Open Enrollment, you may be able to join the Exchange or buy a policy directly. Just be careful -- you have to be aware of the cut off dates. Click here to learn more about these options Special Enrollment Periods @ Healthcare.gov
3. Medicaid & Child Health Insurance Plan: This is the only product you have the ability to enroll in anytime during the year. If you become eligible, based on your income, you can apply and you will be able to enroll, without proof of a loss of coverage. Medicaid & CHIP @ Healthcare.gov
Don't let the window slam down on your hands - get enrolled while it is still open. We will continue to talk and explore the future, but this is important now.
Monday, January 30, 2017
Sunday, January 29, 2017
Say my name, say my name, if no one is around you (The Collins/Cassidy Bill). . . .
Say it with me, The Patient Freedom
Act.
We have it: the Collins/Cassidy bill
has a name, it has a written outline that provides the basics, and it has
growing support. (Note: this is just one a few ideas coming together, and
we will look at them all.)
If you remember, I mentioned that
Susan Collins (R-ME) and Bill Cassidy (R-LA) brought forward a plan for a
replacement for Obamacare. We now have more support for the plan: Johnny
Isakson (R-GA), Lindsey Graham (R-SC) and Shelley Moore Capito (R-WV)..
The plan, The Patient Freedom Act
(PFA), offers three options for states to choose from. It follows the doctrine
of States’ Rights and gives power back to the states. However, while it
does that, the Federal Government is
there if you want its financial support.
PFA would preserve the following
consumer protections:
1. Pre-existing Conditions will be
covered
2. Prohibition on annual and lifetime
maximums on policies
3. Keeps guaranteed issue (GI). I have not touched on this, but in a nutshell
GI means you are guaranteed to be issued a policy, regardless of
age/gender/medical background. (Funny how some of these terms mean what they
say, isn't it?)
4. Young adults can stay on their
parent's plan until age 26
What would the PFA repeal?
1. The individual mandate - the
'fine' for not having insurance
2. The employer mandate - the minimum
value coverage and 9.66% affordability test
3. The age band requirements -
checking into this one. . . .
4. The benefit mandates - the 10
Essential Health Benefits
How would the PFA work?
1. Keeping Obamacare: A state will be
allowed to opt in and keep the ACA plan as it is today. (Remember, ACA
and Obamacare are the same things? Just testing you, to see if you are listening).
The state can continue to get federal funding, allow for federal premium
tax credits, cost-sharing subsidies & expanded Medicaid. (Caveat - as
long as the funding doesn't cost more than the second option below).
3. States are on their own - I like to call this the "Bye Felicia" approach. Do it yourself with NO funding or help from the Federal Government.
OK, so let's just huddle and regroup. Hey, are you still listening? This is important.
I can guess what states would pick 1 & 2. Got it, and let's not even waste time arguing the point. But option 3, really? I'll leave it to say; I would not want to live in a state that chooses option 3. How is the state going to fund this and how are you going to afford health insurance? You might not realize, and I have said I would not talk about the single payer option (I think my words were more, I will not argue the single payer option) but let's go back in time, to 2014, when Governor Peter Shumlin D-VT, pulled the plug on their proposal, Green Mountain Care. This was the program that would cost $2.6B to run. Vermont received $1.7B in tax revenue. You can do the math. And, just a little nugget of information, Shumlin won his reelection bid against Scott Milne R-VT, by only 1.1%. And I can say, without political persecution, Vermont is not purple. It is quite blue. What state would want to carry this burden for their residents?
A note on the PFA repeals - remember that pool I keep talking about? The risk pool? If you take away the mandate and don't require employers to participate (or at least encourage), we start to drain the water out of that risk pool, and if you are sick and jump in, it will hurt, in your pocketbook. We need to find a way to keep the pool filled.
And regarding the PFA repealing the mandated benefits (#4 under repeal in the list above) which increase premium costs for people if they don't need them. Look, we entered the ACA covering 8 of the ten essential benefits already. The last two pediatric vision and dental, I can tell you that is not breaking the bank folks.
And, again, states regulate insurance premiums much more than the federal government. I challenge you to Google state mandated benefits and your state and see what is mandated to be covered by an insurance carrier (in a fully insured funding arrangement - you can refer to yesterday's post to refresh yourself in funding - funny how this all starts to make sense). That mandated stuff doesn't come free, additional mandated coverage options cost money and are added to your premium dollars. As are state premium taxes & fees - Google that too. Your state may be telling you they are not raising your taxes, but they are getting them from taxing your insurance premiums. Here is a place you could demand transparency.
And, again, states regulate insurance premiums much more than the federal government. I challenge you to Google state mandated benefits and your state and see what is mandated to be covered by an insurance carrier (in a fully insured funding arrangement - you can refer to yesterday's post to refresh yourself in funding - funny how this all starts to make sense). That mandated stuff doesn't come free, additional mandated coverage options cost money and are added to your premium dollars. As are state premium taxes & fees - Google that too. Your state may be telling you they are not raising your taxes, but they are getting them from taxing your insurance premiums. Here is a place you could demand transparency.
At the end of the day, we need everyone at the table, and we need to make a concerted effort to implement and change with a cool head. The healthcare system is extremely delicate and cannot take a hard strike against it without breaking. Even the ACA was a 7-year implementation - of which a lot of it was changed, massaged and delayed. Some parts have yet to be implemented, such as the Cadillac tax.
Calm, cool and collected - that is what we need right now when it comes to the system we have to provide healthcare to us.
Saturday, January 28, 2017
But I get my insurance from my employer, what do I care about Obamacare?
Well, let me say this - you should care a lot! We spoke about the Medicaid programs (remember state level oversight); Medicare (Federal Oversight) & the individual markets. Now let's talk about the employer market.
The employer market is quite a complex program offering depending on the state your contract is written out of; the size of your employer (yes, size does matter in this case) and how your contract is financially funded.
Pre-ACA -
Employers were defined as Small Group: 2-50 Employees; Large Group: 51+ Employees. In most states, an employee was considered someone who worked full-time hours, as defined by the state and were a W2 employee. Meaning, they were on payroll and were not a contract worker (i.e. 1099 recipient).
Small Group: States directed how cases would be rated. Some states took a community rating approach which means, it didn't matter if you were young, old, sick or healthy, you got a rate from a carrier, and that rate was the same rate, regardless of your group make up. If you were 25/M/Healthy, you pay the same rate as someone who is 52/M/Chronic Condition. (Let's just say - YIKES - EXPENSIVE)
Some states rated based on age; zip codes and gender - but you would still have the same rate based on that gender, zip & date of birth. So for example - if you were two 25/Male/ZipCode12534 - you got the same rate. (So - less expensive for some and more expensive for others - or ANA - Affordable/Not Affordable)
Then some states would use your age, zip code & gender and provide a preliminary rate. Then you would pick a plan, have employees fill out their applications with health underwriting questionnaires and the employer would get a final rate that could be either less expensive or far far away, in another galaxy, to the dismay of their purse strings. (I like to call this, what the hell did I get myself into effect - as you might have to pull the offering and revert to the original carrier or just fill out new paperwork and find a carrier that was more affordable.)
Large Group: Large group employers had the opportunity to be rated in various ways. The most common were (and this did vary by state, so I am using general definitions): 51-99 Employer was mainly manually rated - they would look at the industry; where the employees lived (zip codes); the average males versus females & the average age. They would then apply medical/pharmacy trend (no, not the fashion type of trend; the medical trend is inflation - or the cost of care based on contracts held with insurance companies and providers (doctors; labs; pharmacy; hospitals)). Then you would be provided rates.
100 + groups (again depending on the state) - would throw in claims data - or the MLR - Medical Loss Ratio. The MLR is a simple calculation of the claims paid out by the insurance company versus the premium received by the insurance company. So an MLR of 75% was much better than an MLR of 105%. 75% means, simplicity, for every dollar paid by the employer to the insurance company, $.075 was used to pay out claims. 105% means for every dollar paid by the employer in premium to the insurance company, $1.05 was used to pay out claims. And these claims costs were applied at a higher percentage based on a larger employer. So a 200 life group could use 80% manual rating and 20% claim data, and a group of 500 lives could use 40% manual rates and 60% claims data.
You then can get into funding vehicles, which I won't do today, in detail. But you have FULLY INSURED - where the employer pays a fixed cost monthly, and the insurance company takes on the full risk. If the group runs well (75% example), the carrier keeps the savings & if the group runs poorly (105% example), the carrier takes the hit but hopes to offset it with the well-running groups. This funding the employer has the least skin in the game - think wool head to toe bathing costumes. SELF-FUNDED - here the employer becomes the plan where they fund claims; they pick the provider network; they choose the carrier or third party administrator to process claims; provide medical management and customer service. Here the employer has the most skin in the game - like literally skinny dipping - They fund the claims as they come in. They have to protections built in, the individual deductible Individual Stop Loss - ISL) and the group deductible (Aggregate - ASL). The ISL would kick in at a predetermined level, say $75K per member enrolled and the ASL would kick in based on a total claim dollar amount for all members enrolled, perhaps $1M. In this funding, the employer could have a claim hit at any time for $75K and have to fund it immediately. But if they run well, they enjoy the claim savings, and under this contract, they are not required to pay state premium tax or implement state mandates, only federal mandated benefits. Level Premium - this is a hybrid of self-funded and fully insured. It is still a self-funded contract, but there are other built-in protections for the employer. They employer will pay their fixed cost premiums, of which, a portion of them are used to pay fixed costs (network access/customer service/claim processing), and the remaining amount is set aside for claims. At the end of the 12-month contract, the group would be reviewed, and if the group ran better than expected, the employer received a refund, and if they ran worse, they were not on the hook for claims over the Aggregate, but they also were probably not renewing with that carrier.
Now, how has this all changed in the Post-ACA world?
1. ACA initially mandated that states change their small group definition from 2-50 to 2-100 as of 1/1/2016. So the groups that were being rated by their specific group demographics were now thrown into one of rating models mentioned above in the pre-ACA world. The carriers had to adjust and reprogram their systems; new rating models had to be created, and the industry had to adjust and learn the new way to provide this programming. And this didn't happen by the flick of a wand from a Hugglepuff wizard. It cost money, time, and a huge amount of investment. It also caused sheer panic and chaos. State rates rose drastically - poor Uncle Sal - carriers that exited the small group market (i.e. CIGNA) were no longer able to sell to the 51-99 market, so the market shrank, and there was just a sense of the market not being sustainable. In comes the PACE Act, from the Obama administration - which gave each state the flexibility to example the group size if they wanted to. And boy howdy, did they! EXCEPT for California; Colorado; Maryland; New York; Vermont. Yeah - that purple issue again! And specifically to speak to NY for a moment, NYer's have a smaller number of options in the 2-100 market to choose from; rates skyrocketed (yeah they are not cheering this one on); self-funding and level premium were off the table as NY law states that small group employers (however that is defined) were not able to self-fund. The fact that NY Governor and legislature did not adopt the PACE Act is STILL an issue in NY and needs to be addressed in Albany. Oh - and all that programming and investment by the market; had to be undone, so more money was spent.
2. We were introduced to the new glitzy plan offerings called the Metallics (no they are not a singing group): Platinum (90%); Gold (80%); Silver (70%) and Bronze (60%) - a way to easily identify the product type and the average percentage that the insurance company would pay in versus what you would pay, in a typical population. You are protected with a total out of pocket so you cannot pay as an individual more than for 2017: $7,150 for an individual & $14,300 for families. All costs covered under the policy applied towards this: deductibles; copays for doctors and medication; co-insurance (%). If you had a catastrophic event or chronic disease, the out of pocket limits your payments and kicks in and the coverage moves to 100% paid by the carrier.
3. The 10 Essential Health Benefits: in the small group market (depending on the state) you were required to offer ten essential health benefits. 8 of which, were already normally included in an insurance contract, two of which were new: Pediatric Vision & Dental Coverage - for children up to age 19.
4. Employer Mandate: yes, it sounds scary - the MANDATE! So let's make this even more complicated - if you were an employer with 50 or more FTEs - hold up - "What the heck is an FTE? An FTE is a full-time equivalent employee, not to be confused with a full-time employee. I will spare you the details. But if you had more of these FTEs, you were mandated to provide health insurance coverage or risk a penalty - to balance out the risk pool, remember that risk pool? Not only did you have to offer coverage but you had to offer minimum value of 60%, enter Miss Bronze AND it had to be affordable - as of 2017: the lowest cost single rate, annually, could not cost more than 9.66% of the employee's annual income.
So - I'm going to stop there as by now, your coffee must be cold and your eggs like rubber for a Saturday morning read.
We will pick this up later with break news - the Collins/Cassidy bill has a name, and Rand Paul R-KY has an idea too!
The employer market is quite a complex program offering depending on the state your contract is written out of; the size of your employer (yes, size does matter in this case) and how your contract is financially funded.
Pre-ACA -
Employers were defined as Small Group: 2-50 Employees; Large Group: 51+ Employees. In most states, an employee was considered someone who worked full-time hours, as defined by the state and were a W2 employee. Meaning, they were on payroll and were not a contract worker (i.e. 1099 recipient).
Small Group: States directed how cases would be rated. Some states took a community rating approach which means, it didn't matter if you were young, old, sick or healthy, you got a rate from a carrier, and that rate was the same rate, regardless of your group make up. If you were 25/M/Healthy, you pay the same rate as someone who is 52/M/Chronic Condition. (Let's just say - YIKES - EXPENSIVE)
Some states rated based on age; zip codes and gender - but you would still have the same rate based on that gender, zip & date of birth. So for example - if you were two 25/Male/ZipCode12534 - you got the same rate. (So - less expensive for some and more expensive for others - or ANA - Affordable/Not Affordable)
Then some states would use your age, zip code & gender and provide a preliminary rate. Then you would pick a plan, have employees fill out their applications with health underwriting questionnaires and the employer would get a final rate that could be either less expensive or far far away, in another galaxy, to the dismay of their purse strings. (I like to call this, what the hell did I get myself into effect - as you might have to pull the offering and revert to the original carrier or just fill out new paperwork and find a carrier that was more affordable.)
Large Group: Large group employers had the opportunity to be rated in various ways. The most common were (and this did vary by state, so I am using general definitions): 51-99 Employer was mainly manually rated - they would look at the industry; where the employees lived (zip codes); the average males versus females & the average age. They would then apply medical/pharmacy trend (no, not the fashion type of trend; the medical trend is inflation - or the cost of care based on contracts held with insurance companies and providers (doctors; labs; pharmacy; hospitals)). Then you would be provided rates.
100 + groups (again depending on the state) - would throw in claims data - or the MLR - Medical Loss Ratio. The MLR is a simple calculation of the claims paid out by the insurance company versus the premium received by the insurance company. So an MLR of 75% was much better than an MLR of 105%. 75% means, simplicity, for every dollar paid by the employer to the insurance company, $.075 was used to pay out claims. 105% means for every dollar paid by the employer in premium to the insurance company, $1.05 was used to pay out claims. And these claims costs were applied at a higher percentage based on a larger employer. So a 200 life group could use 80% manual rating and 20% claim data, and a group of 500 lives could use 40% manual rates and 60% claims data.
You then can get into funding vehicles, which I won't do today, in detail. But you have FULLY INSURED - where the employer pays a fixed cost monthly, and the insurance company takes on the full risk. If the group runs well (75% example), the carrier keeps the savings & if the group runs poorly (105% example), the carrier takes the hit but hopes to offset it with the well-running groups. This funding the employer has the least skin in the game - think wool head to toe bathing costumes. SELF-FUNDED - here the employer becomes the plan where they fund claims; they pick the provider network; they choose the carrier or third party administrator to process claims; provide medical management and customer service. Here the employer has the most skin in the game - like literally skinny dipping - They fund the claims as they come in. They have to protections built in, the individual deductible Individual Stop Loss - ISL) and the group deductible (Aggregate - ASL). The ISL would kick in at a predetermined level, say $75K per member enrolled and the ASL would kick in based on a total claim dollar amount for all members enrolled, perhaps $1M. In this funding, the employer could have a claim hit at any time for $75K and have to fund it immediately. But if they run well, they enjoy the claim savings, and under this contract, they are not required to pay state premium tax or implement state mandates, only federal mandated benefits. Level Premium - this is a hybrid of self-funded and fully insured. It is still a self-funded contract, but there are other built-in protections for the employer. They employer will pay their fixed cost premiums, of which, a portion of them are used to pay fixed costs (network access/customer service/claim processing), and the remaining amount is set aside for claims. At the end of the 12-month contract, the group would be reviewed, and if the group ran better than expected, the employer received a refund, and if they ran worse, they were not on the hook for claims over the Aggregate, but they also were probably not renewing with that carrier.
Now, how has this all changed in the Post-ACA world?
1. ACA initially mandated that states change their small group definition from 2-50 to 2-100 as of 1/1/2016. So the groups that were being rated by their specific group demographics were now thrown into one of rating models mentioned above in the pre-ACA world. The carriers had to adjust and reprogram their systems; new rating models had to be created, and the industry had to adjust and learn the new way to provide this programming. And this didn't happen by the flick of a wand from a Hugglepuff wizard. It cost money, time, and a huge amount of investment. It also caused sheer panic and chaos. State rates rose drastically - poor Uncle Sal - carriers that exited the small group market (i.e. CIGNA) were no longer able to sell to the 51-99 market, so the market shrank, and there was just a sense of the market not being sustainable. In comes the PACE Act, from the Obama administration - which gave each state the flexibility to example the group size if they wanted to. And boy howdy, did they! EXCEPT for California; Colorado; Maryland; New York; Vermont. Yeah - that purple issue again! And specifically to speak to NY for a moment, NYer's have a smaller number of options in the 2-100 market to choose from; rates skyrocketed (yeah they are not cheering this one on); self-funding and level premium were off the table as NY law states that small group employers (however that is defined) were not able to self-fund. The fact that NY Governor and legislature did not adopt the PACE Act is STILL an issue in NY and needs to be addressed in Albany. Oh - and all that programming and investment by the market; had to be undone, so more money was spent.
2. We were introduced to the new glitzy plan offerings called the Metallics (no they are not a singing group): Platinum (90%); Gold (80%); Silver (70%) and Bronze (60%) - a way to easily identify the product type and the average percentage that the insurance company would pay in versus what you would pay, in a typical population. You are protected with a total out of pocket so you cannot pay as an individual more than for 2017: $7,150 for an individual & $14,300 for families. All costs covered under the policy applied towards this: deductibles; copays for doctors and medication; co-insurance (%). If you had a catastrophic event or chronic disease, the out of pocket limits your payments and kicks in and the coverage moves to 100% paid by the carrier.
3. The 10 Essential Health Benefits: in the small group market (depending on the state) you were required to offer ten essential health benefits. 8 of which, were already normally included in an insurance contract, two of which were new: Pediatric Vision & Dental Coverage - for children up to age 19.
4. Employer Mandate: yes, it sounds scary - the MANDATE! So let's make this even more complicated - if you were an employer with 50 or more FTEs - hold up - "What the heck is an FTE? An FTE is a full-time equivalent employee, not to be confused with a full-time employee. I will spare you the details. But if you had more of these FTEs, you were mandated to provide health insurance coverage or risk a penalty - to balance out the risk pool, remember that risk pool? Not only did you have to offer coverage but you had to offer minimum value of 60%, enter Miss Bronze AND it had to be affordable - as of 2017: the lowest cost single rate, annually, could not cost more than 9.66% of the employee's annual income.
So - I'm going to stop there as by now, your coffee must be cold and your eggs like rubber for a Saturday morning read.
We will pick this up later with break news - the Collins/Cassidy bill has a name, and Rand Paul R-KY has an idea too!
Keep your hands off my Medicaid! Why I oughta. . . .
Just a quick update on the fight for Medicaid. I noted in my post called Turning Alternative Fact to Actual Facts that there were bipartisan Governor support to keep Medicaid expansion offered under the ACA.
16 Republican Governors too federal money to expand Medicaid. To be specific, there are 5 Republican Governors that are leading this charge, and are making their voices heard to keep what the ACA provided and expand on it, not turn them into block grants. They include Govs. Charlie Baker - MA (Also the birth place of Romneycare) ; John Kasich - OH; Brian Sandoval - NV; Asa Hutchinson - AR & Rich Snyder - MI. Interestingly enough - More Governors may join this opposition.
Stay tuned to this page turner: who will win, who will lose, who will walk away with the statuette?
Wednesday, January 25, 2017
WHAT? That's my new monthly premium bill? I thought it was my new German luxury car payment, or wait, is it?
Probably one of the most hotly debated items of the ACA are the premiums. I talk to people daily who tell me how excited they are that their premiums are the lowest they have been in 11 years. I hang up my phone and then I have the same conversation with someone in a different part of the country and they tell me that their premium increased more than the ratings of the most recent chapter of a space movie. (insert heavy breathing and strangulation).
Yes, premiums are high and they are low; they are your parents in the 70's at a swingers party and your dad can't find the keys.
Why you ask? So let's break it down just tonight on the individual market -
The individual market. Pre-ACA, every state regulated their insurance costs in the individual market, and some states regulated the rates themselves. To keep this somewhat basic and not too complicated, and there are variations around the country, I am focusing on underwritten rates and community rating
Age/Sex Or Underwriting Rates: Some states (TX/NJ as an example- check google for the whole list of how states regulated individual premiums) set premium rates based on age bands (i.e. 25-30; 30-35, etc.); could have added a cost for gender (Male/Female); and where you lived in the state. All that data put into a box and shaken around would produce a rate. What it actually did was look at actuarial tables and give you a rate based on your age, gender and where you lived (called underwriting). At times, based on state, health questions were asked and also you could throw in smoker versus non smoker, but you get the picture. So - if you were a 24 year old male your rate would probably be somewhat lower than a 25 year old female. Women are giving birth and men are supermen who are invincible (i.e. - I don't need a check up, I feel GREAT!). As we trend up in age, the costs start to shift and males are becoming more expensive and women are starting to trend lower. No more babies and men are paying the price for being invincible in their 20's.
Community Rating: Other states (like NY - again google it) put into law community rating, or risk pool rating. The state would set a rate for the risk pool in the individual market and you would purchase a plan based on your county and carrier. (crickets. . . . ) Yes, that is it. So as you can imagine, the rates were sky high, as people bought insurance if they needed it. So in 2005, for example, in NYC - you could purchase an HMO plan that had a referral and was an HMO network for at the high end $900-$1000 a month. You were not rated on your demographics, you were rated on a community risk pool.
So here comes the ACA to save the day. NY is cheering as premiums dropped drastically. like 50% - and they are still about 45%-50% lower than they were in the risk pool, in some parts of the state.
But wait. . . .remember those states that did individual underwriting? Well, the ACA is now pushing them towards being more inline with the community rating and adding additional mandated coverage - and what happened? You couldn't keep the coverage you had, you were required to have additional coverage you many not want and your rates went up faster than Uncle Sal's blood pressure on Christmas Eve.
So - before we go further, you can see where you have parts of the country saying the ACA is their savior and parts of it saying it is bankrupting them. Remember that, as we are one country BUT we are still regulated on a state level, even with that ACA net sitting underneath us. And not only did premiums change, the cover requirements did too - enter our friends: I'd like to introduce you the metallic family:
- Platinum (90%)
- Gold (80%)
- Silver (70%)
- Bronze (60%)
I'll talk more about them in our employer conversation. And I'll tell you about those percentages - they have nothing to do with Dancing with the Stars.
That is just the individual market in a quick overview. I'll dive into employer premiums and plans and state regulations in the coming days. Good night, sleep well and let's keep educating on healthcare, as I said before, forget the metallic family - it is a PURPLE issue.
Yes, premiums are high and they are low; they are your parents in the 70's at a swingers party and your dad can't find the keys.
Why you ask? So let's break it down just tonight on the individual market -
The individual market. Pre-ACA, every state regulated their insurance costs in the individual market, and some states regulated the rates themselves. To keep this somewhat basic and not too complicated, and there are variations around the country, I am focusing on underwritten rates and community rating
Age/Sex Or Underwriting Rates: Some states (TX/NJ as an example- check google for the whole list of how states regulated individual premiums) set premium rates based on age bands (i.e. 25-30; 30-35, etc.); could have added a cost for gender (Male/Female); and where you lived in the state. All that data put into a box and shaken around would produce a rate. What it actually did was look at actuarial tables and give you a rate based on your age, gender and where you lived (called underwriting). At times, based on state, health questions were asked and also you could throw in smoker versus non smoker, but you get the picture. So - if you were a 24 year old male your rate would probably be somewhat lower than a 25 year old female. Women are giving birth and men are supermen who are invincible (i.e. - I don't need a check up, I feel GREAT!). As we trend up in age, the costs start to shift and males are becoming more expensive and women are starting to trend lower. No more babies and men are paying the price for being invincible in their 20's.
Community Rating: Other states (like NY - again google it) put into law community rating, or risk pool rating. The state would set a rate for the risk pool in the individual market and you would purchase a plan based on your county and carrier. (crickets. . . . ) Yes, that is it. So as you can imagine, the rates were sky high, as people bought insurance if they needed it. So in 2005, for example, in NYC - you could purchase an HMO plan that had a referral and was an HMO network for at the high end $900-$1000 a month. You were not rated on your demographics, you were rated on a community risk pool.
So here comes the ACA to save the day. NY is cheering as premiums dropped drastically. like 50% - and they are still about 45%-50% lower than they were in the risk pool, in some parts of the state.
But wait. . . .remember those states that did individual underwriting? Well, the ACA is now pushing them towards being more inline with the community rating and adding additional mandated coverage - and what happened? You couldn't keep the coverage you had, you were required to have additional coverage you many not want and your rates went up faster than Uncle Sal's blood pressure on Christmas Eve.
So - before we go further, you can see where you have parts of the country saying the ACA is their savior and parts of it saying it is bankrupting them. Remember that, as we are one country BUT we are still regulated on a state level, even with that ACA net sitting underneath us. And not only did premiums change, the cover requirements did too - enter our friends: I'd like to introduce you the metallic family:
- Platinum (90%)
- Gold (80%)
- Silver (70%)
- Bronze (60%)
I'll talk more about them in our employer conversation. And I'll tell you about those percentages - they have nothing to do with Dancing with the Stars.
That is just the individual market in a quick overview. I'll dive into employer premiums and plans and state regulations in the coming days. Good night, sleep well and let's keep educating on healthcare, as I said before, forget the metallic family - it is a PURPLE issue.
Tuesday, January 24, 2017
Wait, I'm confused, I MUST have healthcare or I am FINED?
Simple answer is yes. NEXT BLOG PAGE PLEASE. . . . . .
But seriously - yes. ACA provided a net to allow, yet require, all citizens to be insured in one of a host of ways: medicaid; medicare; individual market place; small group employer or large group employer plans. Remember that risk pool I talked about? That risk pool that needs EVERYONE in the US to be insured in order to spread risk around? This is the reason we are penalized if we don't have the coverage. But the only way to attempt to manage rates is by having everyone participate. And when I say everyone, I also mean employers.
So as an individual, who does not have access to employer based healthcare, you have to get it through the individual market; Medicaid or Medicare. Oh - and for those that are scratching their heads about the millions of undocumented workers, or those who have not 'paid into it for just immigrating here' who are getting free healthcare through the system - it is NOT happening. in NYS, I have to provide numerous documents to the state to prove someone is eligible to receive healthcare that is under the Medicaid program or are offered a tax credit. If they want to purchase insurance directly from a carrier and pay for it themselves at rack rate, go for it, if they have a social security number. But if they want to get subsidized coverage, I need socials, citizenship documents, tax returns and a myriad of other proof before NYS will 'give' free or credited insurance to someone. Really - test me - comment below and I will show you the requirements to get healthcare in the NY State of Health. I sometimes have to provide that paperwork to get folks approved who were from the Mayflower landing and have an accent that only a New Yorker 5 generations back can have.
As an employer with over 50 employees - you have to offer access to affordable health care (it cannot cost more than 9.69% of the lowest cost single rate offered by your employer based on your monthly income - unless you qualify for Medicaid, then you are exempt and can enroll into Medicaid with no penalty to the employee or employer) and it has to have a threshold of coverage to meet minimum value (it has to cover at least 60% of the total cost of health care - think Bronze plan in metallic terms) - we will get back to that.
An employer with under 50 employees - you don't have to do anything. But your employees do.
So what happens if I don't comply? The individual as a sole proprietor or an employee in an employer under 50 employees will be fined. An employer with over 50 employees that doesn't make it affordable and of minimum value will also be fined.
Why all the fines you whine? (or, let me stop reading this blog and get my bottle of wine) Remember that pesky risk pool? We have to have EVERYONE enrolled to balance the system and have the health pay for the sick. And since everyone is not enrolled in healthcare, there are fines to balance that out.
Oh - and by the way, those that don't have healthcare coverage, in an emergency, they can't be turned away. The Emergency Medical and Treatment Labor Act (EMTLA) passed by Congress in 1986 forbids the denial of care due to lack of health insurance coverage because of a lack of an ability to pay. It doesn't keep them from asking if they can pay and under the ACA, they will attempt to enroll them in Medicaid if an option, but they cannot deny emergency care.
And some states still collect taxes and fees from insurance companies to cover the uninsured (in a world where we are supposed to be 100% insured). Where do you think those fees come from? Your insurance premiums as the state will insert surcharges on the insurance company that then feed them down to your premium costs.
If I have not lost you yet, let's get to later this week when we talk about how premiums are calculated and why is my insurance more expensive in one state than another - wait, the states STILL regulate my healthcare? Obamacare isn't just the law of the land?
But seriously - yes. ACA provided a net to allow, yet require, all citizens to be insured in one of a host of ways: medicaid; medicare; individual market place; small group employer or large group employer plans. Remember that risk pool I talked about? That risk pool that needs EVERYONE in the US to be insured in order to spread risk around? This is the reason we are penalized if we don't have the coverage. But the only way to attempt to manage rates is by having everyone participate. And when I say everyone, I also mean employers.
So as an individual, who does not have access to employer based healthcare, you have to get it through the individual market; Medicaid or Medicare. Oh - and for those that are scratching their heads about the millions of undocumented workers, or those who have not 'paid into it for just immigrating here' who are getting free healthcare through the system - it is NOT happening. in NYS, I have to provide numerous documents to the state to prove someone is eligible to receive healthcare that is under the Medicaid program or are offered a tax credit. If they want to purchase insurance directly from a carrier and pay for it themselves at rack rate, go for it, if they have a social security number. But if they want to get subsidized coverage, I need socials, citizenship documents, tax returns and a myriad of other proof before NYS will 'give' free or credited insurance to someone. Really - test me - comment below and I will show you the requirements to get healthcare in the NY State of Health. I sometimes have to provide that paperwork to get folks approved who were from the Mayflower landing and have an accent that only a New Yorker 5 generations back can have.
As an employer with over 50 employees - you have to offer access to affordable health care (it cannot cost more than 9.69% of the lowest cost single rate offered by your employer based on your monthly income - unless you qualify for Medicaid, then you are exempt and can enroll into Medicaid with no penalty to the employee or employer) and it has to have a threshold of coverage to meet minimum value (it has to cover at least 60% of the total cost of health care - think Bronze plan in metallic terms) - we will get back to that.
An employer with under 50 employees - you don't have to do anything. But your employees do.
So what happens if I don't comply? The individual as a sole proprietor or an employee in an employer under 50 employees will be fined. An employer with over 50 employees that doesn't make it affordable and of minimum value will also be fined.
Why all the fines you whine? (or, let me stop reading this blog and get my bottle of wine) Remember that pesky risk pool? We have to have EVERYONE enrolled to balance the system and have the health pay for the sick. And since everyone is not enrolled in healthcare, there are fines to balance that out.
Oh - and by the way, those that don't have healthcare coverage, in an emergency, they can't be turned away. The Emergency Medical and Treatment Labor Act (EMTLA) passed by Congress in 1986 forbids the denial of care due to lack of health insurance coverage because of a lack of an ability to pay. It doesn't keep them from asking if they can pay and under the ACA, they will attempt to enroll them in Medicaid if an option, but they cannot deny emergency care.
And some states still collect taxes and fees from insurance companies to cover the uninsured (in a world where we are supposed to be 100% insured). Where do you think those fees come from? Your insurance premiums as the state will insert surcharges on the insurance company that then feed them down to your premium costs.
If I have not lost you yet, let's get to later this week when we talk about how premiums are calculated and why is my insurance more expensive in one state than another - wait, the states STILL regulate my healthcare? Obamacare isn't just the law of the land?
Turning Alternative Facts to Actual Facts
So - let's dig a bit further into the facts of the matter. The actual facts, not the alternative facts that seem to be the new norm. And I'll leave it at the top two that talked about the most Just a reminder - I am not looking for an argument about healthcare for all, the single payer system, insurance companies are the devil, etc - I am reporting the FACTS and laws and how this system works currently. If you want to change the delivery of the system, you will have the facts to go to your representatives, demand change and go out and vote that change in.
Before I get started on this. OBAMACARE IS THE ACA IS PPACA. Got it? ObamaCare is a nickname for the ACA. Watch this link if you don't get this statement. ObamaCare versus ACA oh - and yeah, I'll have whatever that last kid is having.
1. The ACA gets repealed and I lose my insurance because I have a pre-existing condition: Let's speak from the NY State point of view - as you can dig this out for each state on line. NYS has had pre-existing in place for a long time before the ACA came about. Refer to N.Y. Ins Law 4318 (McKinney 2000) - as long as you have had coverage for the last 12 months without a break in coverage of over 63 days, you cannot be denied services for said condition. And if you did not have coverage, after that 12 months, you would also be covered. Yes - I know you are thinking, but why 12 months of coverage? Looking at this as a risk pool, this law was to protect both the insured and the risk pool in the state. To put it in different terms - let's say you got in an accident with your car on Monday and then on Thursday you bought a new policy and asked that insurance company to cover the accident on Monday. What would they say? They would say no, as they don't want to buy a claim, just like a health insurance company doesn't want to buy a claim. This is the SAME reason there is a penalty in place under the ACA - we have to have EVERYONE insured in order to cover the most costly diseases and conditions. Without full participation, you will have a market that people join when they are sick and leave when they are well and that market will collapse.
2. If the ACA is repealed, Medicare, Medicaid and Child Health Insurance Plans will disappear too: So let's break this down a bit. Medicare/Medicaid were signed into law by President Lyndon B. Johnson as amendments to the Social Security Act on July 30, 1965. As a piece of interesting information, President Truman was the first US Citizen enrolled into Medicare as he was the President that started the search for an answer on healthcare for seniors (Medicare). Now let's clarify what these programs are.
Medicare: is a Federally Run Program that offers insurance based on paying into a program while you are working. It is offered to citizens who have worked for at least 30 quarters who turn 65 or to folks who are permanently disabled under Social Security normally for 2 years. Part A is your hospital coverage and is usually at no cost, if you paid those 30 quarters & Part B, your outpatient coverage, comes with a monthly premium. Medications are not covered under original medicare, they are covered under the new program Medicare Part D - Prescription Drug Coverage - as part of the Medicare Modernization Act and signed into law by President George W. Bush on December 8, 2003.
Medicaid: is a State run program that offers insurance to those based primarily on income level. States are responsible for administering their own Medicaid programs, with the assistance of the federal government funding. Under the ACA, states were encourged to expand their definition of household income to cover more folks under the Medicaid program as part of ACA reform. Let's focus back on NY for a moment - this meant that under the ACA, NYS was able to expand the definition of income to 133% of the federal poverty level (FPL) (which is a whole other blog within itself) - but you can find the levels of poverty, as defined by our government here Federal Poverty Levels
Child Health Insurance Plan: this program was a result of the failed attempt at healthcare reform program under the Clinton Administration. It was sponsored by Senator Kennedy D-Massachusetts & Senator Hatch R-Utah. It was promoted and supported by Former Secretary of State Hillary Clinton (as First Lady) and was created in 1997. Each state was given flexibility in its implementation of the program but they had guidelines they had to follow.
So - what does this all mean? These programs were in place PRIOR to the ACA - the ACA did give states more ability to expand their medicaid programs. But there were state and federal programs around for seniors, disadvantaged and disabled. A repeal of the ACA doesn't necessarily mean these program go away. Yes, we have law makers stating that Medicare should be privatized (in some instances one could argue there is a level of privatization now, if you look at some of the programs that are available through medicare advantage programs.) And, there are numerous reports that Republican Governors are having meetings with the current administration, their representatives to urge them to be cautious and not repeal the Medicaid expansion. The following states have adopted the Medicaid Expansion: Alaska; California; Colorado; Connecticut; Delaware; Washington DC; Hawaii; Illinois; Kentucky; Louisiana; Maryland; Massachusetts; Minnesota; Nevada; New Jersey; New Mexico; New York; North Dakota; Ohio; Oregon; Pennsylvania; Rhode Island; Vermont; Washington; West Virginia.
Arizona/Arkansas/Indiana/Iowa/Michigan/Montana & New Hampshire did not approve the full expansion but did approve Section 1115 Waivers that allow states to test alternative approaches to expansion. Only 19 states have no expansion or waivers at this time.
Look at the states that have these programs in place under the ACA and approved them, they are not falling down a party line and this is not a blue red issue. This is a really purple issue.
Before I get started on this. OBAMACARE IS THE ACA IS PPACA. Got it? ObamaCare is a nickname for the ACA. Watch this link if you don't get this statement. ObamaCare versus ACA oh - and yeah, I'll have whatever that last kid is having.
1. The ACA gets repealed and I lose my insurance because I have a pre-existing condition: Let's speak from the NY State point of view - as you can dig this out for each state on line. NYS has had pre-existing in place for a long time before the ACA came about. Refer to N.Y. Ins Law 4318 (McKinney 2000) - as long as you have had coverage for the last 12 months without a break in coverage of over 63 days, you cannot be denied services for said condition. And if you did not have coverage, after that 12 months, you would also be covered. Yes - I know you are thinking, but why 12 months of coverage? Looking at this as a risk pool, this law was to protect both the insured and the risk pool in the state. To put it in different terms - let's say you got in an accident with your car on Monday and then on Thursday you bought a new policy and asked that insurance company to cover the accident on Monday. What would they say? They would say no, as they don't want to buy a claim, just like a health insurance company doesn't want to buy a claim. This is the SAME reason there is a penalty in place under the ACA - we have to have EVERYONE insured in order to cover the most costly diseases and conditions. Without full participation, you will have a market that people join when they are sick and leave when they are well and that market will collapse.
2. If the ACA is repealed, Medicare, Medicaid and Child Health Insurance Plans will disappear too: So let's break this down a bit. Medicare/Medicaid were signed into law by President Lyndon B. Johnson as amendments to the Social Security Act on July 30, 1965. As a piece of interesting information, President Truman was the first US Citizen enrolled into Medicare as he was the President that started the search for an answer on healthcare for seniors (Medicare). Now let's clarify what these programs are.
Medicare: is a Federally Run Program that offers insurance based on paying into a program while you are working. It is offered to citizens who have worked for at least 30 quarters who turn 65 or to folks who are permanently disabled under Social Security normally for 2 years. Part A is your hospital coverage and is usually at no cost, if you paid those 30 quarters & Part B, your outpatient coverage, comes with a monthly premium. Medications are not covered under original medicare, they are covered under the new program Medicare Part D - Prescription Drug Coverage - as part of the Medicare Modernization Act and signed into law by President George W. Bush on December 8, 2003.
Medicaid: is a State run program that offers insurance to those based primarily on income level. States are responsible for administering their own Medicaid programs, with the assistance of the federal government funding. Under the ACA, states were encourged to expand their definition of household income to cover more folks under the Medicaid program as part of ACA reform. Let's focus back on NY for a moment - this meant that under the ACA, NYS was able to expand the definition of income to 133% of the federal poverty level (FPL) (which is a whole other blog within itself) - but you can find the levels of poverty, as defined by our government here Federal Poverty Levels
Child Health Insurance Plan: this program was a result of the failed attempt at healthcare reform program under the Clinton Administration. It was sponsored by Senator Kennedy D-Massachusetts & Senator Hatch R-Utah. It was promoted and supported by Former Secretary of State Hillary Clinton (as First Lady) and was created in 1997. Each state was given flexibility in its implementation of the program but they had guidelines they had to follow.
So - what does this all mean? These programs were in place PRIOR to the ACA - the ACA did give states more ability to expand their medicaid programs. But there were state and federal programs around for seniors, disadvantaged and disabled. A repeal of the ACA doesn't necessarily mean these program go away. Yes, we have law makers stating that Medicare should be privatized (in some instances one could argue there is a level of privatization now, if you look at some of the programs that are available through medicare advantage programs.) And, there are numerous reports that Republican Governors are having meetings with the current administration, their representatives to urge them to be cautious and not repeal the Medicaid expansion. The following states have adopted the Medicaid Expansion: Alaska; California; Colorado; Connecticut; Delaware; Washington DC; Hawaii; Illinois; Kentucky; Louisiana; Maryland; Massachusetts; Minnesota; Nevada; New Jersey; New Mexico; New York; North Dakota; Ohio; Oregon; Pennsylvania; Rhode Island; Vermont; Washington; West Virginia.
Arizona/Arkansas/Indiana/Iowa/Michigan/Montana & New Hampshire did not approve the full expansion but did approve Section 1115 Waivers that allow states to test alternative approaches to expansion. Only 19 states have no expansion or waivers at this time.
Look at the states that have these programs in place under the ACA and approved them, they are not falling down a party line and this is not a blue red issue. This is a really purple issue.
Monday, January 23, 2017
What does the Collins-Cassidy Bill actually say?
As mentioned in my previous post,
Senator Collins (R-Maine) and Senator Cassidy (R-Louisiana), have brought
forward a bill to replace the ACA. This bill is a draft, in its early
stages. The bill is something they both have worked on in the past as
they felt it was important to bring forth a measure and not just vote to
repeal.
The bill presents states with three primary options:
1. Keep the ACA - if a state likes the current way their ACA program is being administered, then keep it.
2. Give states most of the Federal funding under the ACA to create tax-free Health Savings Accounts (HSA) for low-income residents,using money from the Medicaid expansion and about 95% of the subsidies provided to folks now. Individuals can then use this HSA money to purchase insurance and offset out of pocket costs like copays and deductibles. (This is similar to the arrangement today under the HSA offering, but expanded.)
3. Do nothing - take no federal aid and manage the insurance industry on a state level.
All three of these options are going back to the states running the plans. We were there prior to the ACA, but there are risks - states who reject assistance or money will see a spike in the uninsured which will drive up costs everywhere. And we are still not solving the overarching problem that this is all health insurance reform, not healthcare reform.
Watch this bill, as Collins and Cassidy are the only two senators that have brought anything forward and both are considered moderate Republicans who could help stop the repeal and fend for yourself approach.
The bill presents states with three primary options:
1. Keep the ACA - if a state likes the current way their ACA program is being administered, then keep it.
2. Give states most of the Federal funding under the ACA to create tax-free Health Savings Accounts (HSA) for low-income residents,using money from the Medicaid expansion and about 95% of the subsidies provided to folks now. Individuals can then use this HSA money to purchase insurance and offset out of pocket costs like copays and deductibles. (This is similar to the arrangement today under the HSA offering, but expanded.)
3. Do nothing - take no federal aid and manage the insurance industry on a state level.
All three of these options are going back to the states running the plans. We were there prior to the ACA, but there are risks - states who reject assistance or money will see a spike in the uninsured which will drive up costs everywhere. And we are still not solving the overarching problem that this is all health insurance reform, not healthcare reform.
Watch this bill, as Collins and Cassidy are the only two senators that have brought anything forward and both are considered moderate Republicans who could help stop the repeal and fend for yourself approach.
What does the ACA EO repeal really mean?
The Executive Order (EO), signed on Friday Jan 20, 2017 - just signals that the Trump administration is looking to repeal the ACA quickly. The Executive Order is clear to state that the executive branch must ensure the law is being followed to minimize any unwarranted financial or regulatory consequences.
The EO directs the heads of each
department that has oversight to the law -- Health and Human Services, IRS,
Department of Labor, and other agencies -- to ease the fiscal or regulatory
burden on states and on individuals and families. It goes on to say that
waiving or not enforcing taxes, fees and penalties as some ways to
alleviate the burden.
It also speaks to finding ways for
states to implement more state-specific healthcare plans and to encourage the
free market purchase of healthcare across state lines.
The agencies can build from this and
specifically not implement certain aspects of the law in a future form, e.g., they can delay the collection of a tax.
But they cannot repeal a specific piece of the law, as it is set now.
That all said - no one knows exactly what
the GOP’s intent is at this point - I don't even think they do.. If/when
they do find a replacement (a bare bones outline has been presented today by Senators
Collins (R-Maine) and Cassidy (R – Louisiana)), experts say it could take at least
2 years to actually implement.
Next up - what does the GOP have in
mind? - the Collins-Cassidy Bill
Trump's Executive order to Repeal Omabacare Jan 20, 2017
THE EXECUTIVE ORDER FOR THE REPEAL OF THE AFFORDABLE CARE ACT
(ACA ALSO KNOWN AS OBAMACARE)
THE
WHITE HOUSE
Office
of the Press Secretary
For
Immediate
Release
January 20, 2017
EXECUTIVE
ORDER
-
- - - - - -
MINIMIZING
THE ECONOMIC BURDEN OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT PENDING
REPEAL
By the authority vested in me as President by the Constitution and the laws
of the United States of America, it is hereby ordered as follows:
Section 1. It is the policy of my Administration to seek the prompt
repeal of the Patient Protection and Affordable Care Act (Public Law
111-148), as amended (the "Act"). In the meantime, pending
such repeal, it is imperative for the executive branch to ensure that the law
is being efficiently implemented, take all actions consistent with law to
minimize the unwarranted economic and regulatory burdens of the Act, and
prepare to afford the States more flexibility and control to create a more
free and open healthcare market.
Sec. 2. To the maximum extent permitted by law, the Secretary of Health
and Human Services (Secretary) and the heads of all other executive
departments and agencies (agencies) with authorities and responsibilities
under the Act shall exercise all authority and discretion available to them
to waive, defer, grant exemptions from, or delay the implementation of any
provision or requirement of the Act that would impose a fiscal burden on any
State or a cost, fee, tax, penalty, or regulatory burden on individuals,
families, healthcare providers, health insurers, patients, recipients of
healthcare services, purchasers of health insurance, or makers of medical
devices, products, or medications.
Sec. 3. To the maximum extent permitted by law, the Secretary and the
heads of all other executive departments and agencies with authorities and
responsibilities under the Act, shall exercise all authority and discretion
available to them to provide greater flexibility to States and cooperate with
them in implementing healthcare programs.
Sec. 4. To the maximum extent permitted by law, the head of each
department or agency with responsibilities relating to healthcare or health
insurance shall encourage the development of a free and open market in
interstate commerce for the offering of healthcare services and health
insurance, with the goal of achieving and preserving maximum options for
patients and consumers.
Sec. 5. To the extent that carrying out the directives in this order
would require revision of regulations issued through notice-and-comment
rulemaking, the heads of agencies shall comply with the Administrative
Procedure Act and other applicable statutes in considering or promulgating
such regulatory revisions.
Sec. 6. (a) Nothing in this order shall be construed to impair or
otherwise affect:
(i)
the authority granted by law to an executive department or agency, or the
head thereof; or
(ii)
the functions of the Director of the Office of Management and Budget relating
to budgetary, administrative, or legislative proposals.
(b) This order shall be implemented consistent with applicable law and
subject to the availability of appropriations.
(c) This order is not intended to, and does not, create any right or
benefit, substantive or procedural, enforceable at law or in equity by any
party against the United States, its departments, agencies, or entities, its
officers, employees, or agents, or any other person.
DONALD J. TRUMP
THE
WHITE HOUSE,
January 20, 2017.
|
Monday, January 16, 2017
Welcome to Pulling the Plug on Healthcare in the United States
Welcome to my blog about the health
insurance industry in the United States. This blog is meant to educate you as a
consumer and shed light on the actual facts of what is happening in the US regarding
healthcare and how Americans are covered under insurance.
We will dive into the alphabet soup of healthcare and break down the ways one would access healthcare by the different delivery models.
There is a sense of panic as to what is going to happen in the future with the Affordable Care Act (ACA) and I will do my best to piece together what is actually going on and how it will affect you.
However, it is everyone's responsibility to be involved in this discussion. Yes, we are in a potential crisis right now, but it should not have taken a crisis for people to understand the current delivery system in the US. Far too many people just say it is too confusing and don't take time to understand the mechanics.
I hope to change that and start a conversation where you will learn, as a consumer, how to access your care, who provides your care on a state or federal level, and who to call to voice your concerns and what to say.
Please understand, I am not defending the industry, the politics or the consumer - I am going to lay this out so that you can make your own decisions. My goal is to make you an educated citizen.
We will dive into the alphabet soup of healthcare and break down the ways one would access healthcare by the different delivery models.
There is a sense of panic as to what is going to happen in the future with the Affordable Care Act (ACA) and I will do my best to piece together what is actually going on and how it will affect you.
However, it is everyone's responsibility to be involved in this discussion. Yes, we are in a potential crisis right now, but it should not have taken a crisis for people to understand the current delivery system in the US. Far too many people just say it is too confusing and don't take time to understand the mechanics.
I hope to change that and start a conversation where you will learn, as a consumer, how to access your care, who provides your care on a state or federal level, and who to call to voice your concerns and what to say.
Please understand, I am not defending the industry, the politics or the consumer - I am going to lay this out so that you can make your own decisions. My goal is to make you an educated citizen.
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