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House urges defunding much of Obamacare

July 24, 2012

Since the Supreme Court would not throw out Obamacare, the next best solution is to turn off the funds to it. The House approved a bill that defunds much of Obamacare. Without these funds, there will be no money to implement or enforce any of it.

People want to be in control of their own medical decisions. Patients make smarter choices when their own funds are involved by using HSAs to pay cash for small services like office visits or medication. MediBid helps these cash-paying patients save money and finds them doctors who wish to treat them without insurance restraints.

House proposes defunding much of Obamacare—including the HHS Mandate

http://netrightdaily.com/2012/07/house-proposes-defunding-much-of-obamacare-including-the-hhs-mandate/#ixzz21S3k9FCx

By John Vinci

On July 18, a House Appropriations subcommittee approved a funding bill for the Departments of Labor, Education, and Health and Human Services that would defund much of Obamacare. According to the Committee, the cuts will save $8.6 billion in 2013 and $123 billion in the next five years.

Wednesday, a House Appropriations subcommittee approved a funding bill for the Departments of Labor, Education, and Health and Human Services that would defund much of Obamacare. According to the Committee, the cuts will save $8.6 billion in 2013 and $123 billion in the next five years.[1]

With very limited exceptions, the bill would prevent any newly authorized funds from being “used to implement, administer, enforce, or further” the provisions of Obamacare.[2]

“This committee cannot repeal Obamacare directly,” explained subcommittee Chairman Rep. Denny Rehberg (R-MT) in a statement. “But we can prevent it from being further implemented with taxpayer dollars we have jurisdiction over. The legislation therefore prevents the Secretary of Health and Human Services from using any funding in this bill to continue to implement Obamacare. It also rescinds unspent funds that have already been made available in the health care law itself. These dollars are directed to other, higher priority programs.”[3]

The bill, then, also rescinds past funding authorizations—reducing funding for or completely eliminating the following programs:

The Consumer Operated and Oriented Plan (CO-OP) program ($3 billion)[4]
The CO-OP program gives grant loans to non-profit, consumer-controlled, startup insurance companies. But even the Obama Administration has had to admit that these loans are at high risk for default.
The Center for Medicare and Medicaid Innovation ($1.6 billion)[5]
The Independent Payment Advisory Board (IPAB) ($15 million)[6]
IPAB is sometimes referred to as the “Death Panel” because of its potential power to ration health care. More troubling is the level of independence this powerful agency will have from public oversight.
Community Health Centers Fund ($300 million)[7]
Prevention and Public Health Fund ($1 billion)[8]
Patient-Centered Outcomes Research Trust Fund ($150 million)[9]

Finally, the bill would eliminate HHS’s anti-religious liberty mandate. Under the mandate HHS will require employers to provide contraceptive drugs and services (including abortifacients) to their employees.

Many religious groups find this requirement forces them to act against their consciences. HHS has provided an exemption for “houses of worship” and an accommodation for religious non-profits. But the exemption is narrower than the liberties guaranteed by the First Amendment and the Religious Freedom Restoration Act and many religious organizations believe that the accommodation is not adequate. In addition HHS has done nothing to exempt for-profit religious employers.

The proposed bill would prohibit funds from being used to force coverage of “abortion or other items or services” that violate certain “religious beliefs or moral convictions.”[10]

In addition, the bill, would make it easier for conscientious objectors to sue the government for violating their rights under the Free Exercise Clause of the First Amendment. First, the bill authorizes individuals to sue even if they haven’t yet cleared the potential legal hurdle of first “exhaust[ing] available administrative remedies.”[11] Though this section probably will not affect the HHS mandate suits, it may shorten the length of time it takes for a court to hear a plaintiff’s case in other situations. And second, the proposed bill would require the government to pay the attorney’s fees of any successful plaintiffs. [12]

John Vinci is a staff attorney with Americans for Limited Government and is the editor in chief for the www.obamacarewatcher.org website.

[1] Press Release, U.S. House of Representatives Comm. on Appropriations, Appropriations Committee Releases the Fiscal Year 2013 Labor, Health and Human Services Funding Bill (July 17, 2012) available at http://appropriations.house.gov/news/documentsingle.aspx?DocumentID=303303.
[2] Id. at § 529.
[3] Statement, Rep. Denny Rehberg, Chairman Labor, Health and Human Services, Education, and Related Agencies Subcommittee of the House Appropriations Comm., Chairman Rehberg Opening Statement on FY 2013 Labor, Health and Human Services, and Education Appropriations Bill for Subcommittee Markup (July 18, 2012) available at http://appropriations.house.gov/news/documentsingle.aspx?DocumentID=303464.
[4] Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013, H.R. ___, 112th Cong. § 530 (July 15, 2012) available at http://appropriations.house.gov/uploadedfiles/bills-112hr-sc-ap-fy13-lab….
[5] Id. at § 531.
[6] Id. at § 532.
[7] Id. at § 533.
[8] Id. at § 534.
[9] Id. at § 535.
[10] Id. at § 537.
[11] Id. at § 537(b)(2)
[12] Id. at § 537(b)(4)(B)

Paying currency to physicians affects the treatment plan

July 23, 2012

This is a first-hand account of how easy and affordable it is to get medical treatment when paying cash. Over the counter medicines and talking one-on-one with his doctor resulted in avoiding pricey skin tests and CT scans. A phone follow-up was all that was needed, saving the cost of another office visit. Paying cash made medical treatment fast and was affordable.

Patient-centered care for cash is what you will get at MediBid. Doctors are willing to work with you directly to ensure you get the proper and complete treatment you require at an affordable price in a timely fashion.

Paying cash to doctors affects the treatment plan

http://www.kevinmd.com/blog/2010/07/paying-cash-doctors-affects-treatment-plan.html

by Jay Parkinson, MD

If we really want to find out how to damn near perfectly manage any medical problem as efficiently and cost-effectively as possible, we should be studying how doctors manage the medical problems of the cash-paying doctors they see in their own practice.

My visit with Dr. Grubman was fairly simple. We discussed allergy shots and how they could possibly help significantly with my dust allergy. Since I always take Claritin (an antihistamine for my allergies), he couldn’t do a skin test to test for all the various common allergies (tree pollen, grasses, dog, etc) to include in the shots.

Claritin would inhibit the skin reaction that appears when your skin is pricked with something you’re allergic to. I’d have to be off Claritin for a week and then return to get tested. The other option is a blood test to determine if I’m allergic to other things. However, they are much more expensive than a simple skin test. I decided to wait for the skin test when I can go off my Claritin for a week. Therefore, I did not get the expensive blood tests.

So here is where it gets interesting. Allergists get paid by the visit and by the various things they do, like skin tests— the more tests they do on you, the more they get paid. If a person is not taking any antihistamines and has insurance, many allergists often test for as many allergies as possible. They simply get paid more. I could have also gotten a CT scan of my sinuses to diagnose the sinus infection.

Instead, Dr. Grubman did it the “old school” way and simply examined me and listened to my story. I would have had to pay for the CT scan out of my own pocket, something that would have been anywhere from $350 to $1000 depending on which radiologist I randomly chose. Therefore, I did not get a CT scan.

Dr. Grubman also said to call him in three weeks to let him know how I am doing. He didn’t want to reschedule me for an office visit (where he would have gotten paid), he just wanted to communicate with me and make sure I am doing better. Therefore, I didn’t have the extra added expense of another office visit when a two minute conversation over the phone would suffice.

If I would have had traditional co-pay insurance, not been a doctor, and not seen a doctor who wanted to partner with me to do the right thing, I probably would have gotten a CT test and an array of expensive blood tests. The visit would have cost someone probably on order of $2000. And then the follow-up visit would have been scheduled, adding another $200 to the bill.

Because I paid cash, because Dr. Grubman and I are knowledgeable about my options, and because we both wanted to manage my problem efficiently and cost-effectively… we did the right things and the best things for managing my problem.

Also, on the way to Kings Pharmacy to drop off my prescription for Augmentin where I was quoted $144, I stopped in another mom & pop pharmacy and asked how much Augmentin would be. They quoted $79, almost half as much as three other pharmacies I called.

Jay Parkinson is a pediatrician and preventive medicine specialist and founder of The Future Well. He blogs at his self-titled site, Jay Parkinson + MD + MPH.

Quality care prevented by Obamacare

July 22, 2012

There is nothing “affordable” about the ACA. In fact, it is quite the opposite. With more regulations, mandates, and extra paperwork, physicians are having to take time away from their patients. Due to increased patient load and getting reimbursed even less from insurance companies, some physicians are throwing in the towel and retiring early. This is admitting defeat! Should a physician choose to convert to a cash-only practice, they can continue to do the work they enjoy and not have to worry about being hassled by third-party-payers.

MediBid connects these doctors who accept cash with patients who are looking for timely medical care outside of an insurance network. With no middle man, doctors and patients deal directly with each other, the way medical care should be.

URIBE: Obamacare prevents quality care

Government meddling driving doctors from medicine

http://www.washingtontimes.com/news/2012/jul/19/obamacare-prevents-quality-care/

By Dr. Constance Uribe Thursday, July 19, 2012

Americans are so focused on the availability of health care provided by the Affordable Care Act that they completely overlook the quality of care they might receive. Government interference, intrusive mandates and cumbersome regulations are making it impossible to continue providing high-quality care.

Physicians across the nation have been planning for the worst, and an exodus of more than 100,000 doctors is expected by 2020. I will be closing the doors of my office in December after 32 years in surgical practice.

Patients will be lucky to see a physician because fewer will be available. The government does not recognize the term “physician” anymore. A fully trained doctor of medicine or doctor of osteopathic medicine who completed a residency and became board-certified will be rare because the lesser-trained licensed health care provider will be the norm.

Since the 1980s, my career has been riddled with regulations created by a government bent on controlling every aspect of patients’ lives. The coup de grace was delivered by the Affordable Care Act, but the blindfold was placed by President George W. Bush.

By executive order, Mr. Bush in 2004 created the position of national coordinator for health information technology. This allowed for the establishment of a health information technology storehouse. Funding for this came from President Obama’s American Recovery and Reinvestment Act of 2009.

To insure buy-in from all health care providers, the government had to create meaningful incentives, the first of these being marginal payback for compliance. What started out as voluntary soon became mandatory. While physicians may have received partial reimbursements from the government to equip their offices with the computer systems, these did not come close to meeting the costs of implementation.

Mandates meant as meaningful incentives are quickly turning into penalties. Physicians see deductions on already-lowered Medicare payments because of failure to use e-prescribing. They are threatened with further deductions if they do not have electronic medical records in place by 2014.

The practicing physician is buried in more mandates, more regulations and more penalties. As entry of patient data into the computer becomes more burdensome, it does not take long to discover that the system has been designed for auditing purposes, not for charting purposes.

Not only are health records no longer protected within the walls of a medical office, but physicians are complaining about the time consumption, computer errors and false sense of security created as a scheme rather than a service. One physician wrote on a blog, “It adds an hour of work to my day and makes my office notes sound like they were written by an imbecile.”

From the patient’s viewpoint, the physician has turned his attention to clicking computer keys with eyes glued to the screen. Data entry now takes priority over quality time.

The Affordable Care Act will finish driving the wedge between the doctor and the patient and put an end to a once-sacred relationship. Not only will the current mandates remain in place, but physicians will be inundated with the new insurance exchange identification numbers, authorizations, codes and denials.

My office staff puts the patient’s interest first and tries to follow Medicare guidelines, yet we have problems getting insurance carriers to cover routine procedures without writing letters and making myriad phone calls. With my upcoming retirement comes the relief of no longer screaming four-letter words into the phone at uneducated bureaucrats and medical directors committed to pigeonholing people and withholding care.

The health information technology storehouse gives the government more ammunition to track physicians, enforce new evidence-based standards and grade physicians accordingly. The grading, called “pay for performance,” will be another way for the government to cut costs under the guise of improving health care.

If the health care provider fails in a certain category such as infection rate or mortality rate, his reimbursement will be affected. With this type of incentive for physicians, high-risk patients will have difficulty finding access to quality care. The art of medicine is becoming the trade of medicine.

The health information technology storehouse and the Affordable Care will rip total control of patient care from the hands of physicians. Anyone who believes differently is as delusional as the congressional leaders who passed the legislation in the first place. Then again, no one bothered to read it.

Dr. Constance Uribe is a general surgeon and author of “The Health Care Provider’s Guide to Facing the Malpractice Deposition” (CRC Press, 1999).

Medical care sharing groups offer insurance substitute

July 20, 2012

A smart alternative to buying insurance, or pre-paid medical care, is saving up cash for your future needs. One form of that is a health care sharing group. These cost-sharing groups must be faith-based to be exempted from Obamacare. Members of the group share medical costs which meet certain criteria, so when any member of the group needs funds for a procedure, the members share treatment costs. They all take care of each other, as following the Christian principle of the Good Samaritan. Since the members of these sharing groups do not belong to any “network”, they need a source of physicians to treat them. Samaritan Ministries members use MediBid to help find doctors, and MediBid saved them $200,000 last year.

Samaritan Ministries members save money on medical care by using MediBid to shop for medical care. One Samaritan Ministries member saves $30,000 on a single surgery. Many Samaritan Ministries members paid as low as $535 for a colonoscopy. MediBid’s average price for an MRI for Samaritan members was $410.

Health care sharing ministries offer insurance alternative

http://www.usatoday.com/news/religion/story/2012-07-08/health-insurance-sharing-ministries/56083586/1

By Shari Rudavsky, The Indianapolis Star

INDIANAPOLIS — Ellery Hunsley doesn’t have health insurance. But eight years ago, when his daughter went through treatment for a brain tumor, the assistant pastor at a local church didn’t worry about the medical bills.

Hunsley paid every bill out of pocket, largely thanks to the help of strangers — people who, like himself, participate in an alternative to insurance, a health care sharing ministry.

Unlike most uninsured Americans, Hunsley will not have to buy health insurance or risk paying a fine under the dictates of the Affordable Care Act. He and other members of health care sharing ministries are among the minority to be exempted from the individual mandate that begins in 2014.

No one views health care sharing ministries as a solution to the problem of how to provide care for as many people as possible. But their existence represents a creative approach that has worked for a small minority for more than two decades.

Health care sharing ministries stem from the New Testament concept that people must share one another’s burdens.

In these ministries, members pay a monthly fee that gets dispersed to a member who needs help paying medical bills. Depending on the ministry, the money may go directly to the family in need or through the ministry.

Most of those who opt to belong lack affordable insurance through an employer. Ministry members must attest they are good Christians and live life accordingly

“I don’t think it would work without the faith element,” said Tony Meggs, president and chief executive officer of Christian Care Ministry, one of the three large health care sharing ministries. “I don’t think that ultimately it would work outside of this collective moral agreement with each other, that commandment in Galatians that we’re required to carry each other burdens.”

Hunsley found out how well the system can work. His daughter Autumn, now 16, was diagnosed in 2004 with a brain tumor and required brain surgery.

Before they knew it, the family had racked up about $300,000 in medical bills. And, the family did not have catastrophic insurance, as they thought, but only $100,000.

Hunsley turned to Samaritan Ministries, of which he had been a member for about four years.

“I thought I was going to lose everything,” Hunsley said. “I started praying and called them and talked to them and told them what was going on.

The organization saw to it that all the bills were paid, asking others to help by sending additional funds that month.

“It was just Christian people helping Christians,” said Hunsley, a pastor at Indianapolis Baptist Temple.

In addition to money, the strangers sent hundreds letters to Autumn, and some still check in regularly.

Hunsley estimates he has paid close to $400,000 for Autumn’s initial treatment and follow-up care, including proton beam treatment two years ago for another tumor. Hunsley said much of the cost has been defrayed by his Samaritan membership.

Hospitals bill him as though he is non-insured, and he handles all the paperwork. He’s responsible for paying — as well as explaining to the clerical staff his situation.

At times, he’s negotiated down the costs of the care with the medical institutions that provided it, explaining that he’ll be paying cash. Often it takes him two to three months to pay the bills.

“I kind of say it’s self-funding. It’s not like insurance,” he said.

Describing health care sharing ministries can prove complicated because each one is a little different.

Christian Care Ministry’s Medi-Share program has about 50,000 members nationwide and was founded in 1993. Samaritan Ministries started the following year and now includes 20,000 households.

Christian Healthcare Ministries, another major player, did not respond to requests for an interview.

Both Medi-Share and Samaritan ask for a statement of Christian faith of any denomination. Members also agree not to abuse alcohol or drugs, smoke or have sex outside of marriage.

About 99 percent of people who apply to Medi-Share become members, Meggs said. However, the ministry rejects some people based on pre-existing conditions, such as advanced cancer.

Some people, such as those who are obese, receive conditional memberships. The ministry connects them to a life coach who works with them to improve their health, Meggs said. If they do not make progress, eventually the program will terminate their membership.

“This is a sharing ministry, and you have a responsibility to not be an undue burden to the other members,” he said.

Preventive care is not covered. Members are expected to budget and prepare for such visits, including minor things like trips to the doctor for a child’s cold.

About half of Samaritan’s members fall below 200 percent of the federal poverty levels and in some states would qualify for government aid, said James Lansberry, executive vice president.

Samaritan members receive information monthly telling them which family needs their shares, Lansberry said. Members send their monthly share directly to the designated family.

Medi-Share members, however, deposit their share each month into an account they hold with a credit union. Medi-Share has limited authority to move that money into the account of the members who need help paying a medical bill.

“The funds simply get moved from one account to one account,” Meggs said. “You never send money to us.”

Because the arrangement is outside the world of traditional insurance, they aren’t regulated by any state or federal agencies.

In 2007, when Massachusetts passed a law similar to the federal Affordable Care Act, the ministries’ existence was in danger. The ministries formed the Alliance of Health Care Sharing Ministries, said Lansberry, who also serves as its president. Eventually they managed to get a exemption for the 150 or so families in the state who belonged to a health care sharing ministry.

When national health care reform loomed, the ministries were positioned to ensure their existence. They made sure the federal legislation exempted their members from having to buy insurance.

Health care ministries argue that no one should mistake them for insurers, saying that they’re more akin to charities.

“Our ministries function very different from insurance,” Lansberry said. “We don’t shift risks. Our members are just sharing directly with one another.”

Fearing that some departments of insurance might view the ministries as insurers, legislators in more than 20 states introduced legislation defining the ministries and exempting them from insurance regulation.

Others agree health care ministries bear little resemblance to health insurance.

Basically, it’s individuals agreeing to bail each other out if they have a problem, said Timothy Jost, a professor of law at Washington and Lee University in Lexington, Va. He has researched the practice and found one instance of a person complaining that a health care ministry did not help him in his time of need.

However, Jost cautioned the practice needs to be watched closely to ensure people sign up because they believe in the concept, not as a way to shirk the individual health care mandate.

In the long run, Jost said, he doesn’t see the health care ministries undermining the Affordable Care Act.

“I think they’re very important to the people who belong to them,” he said. “I think they’re not very important in terms of the big picture, because they’re pretty small.”

Displaying alternatives to Obamacare

July 19, 2012

This article describes how HSAs and a catastrophic insurance plan are the recipe to making medical care affordable. Obamacare is a huge step in the wrong direction. Instead of throwing away your money on expensive insurance premiums, the smart thing to do is to save your money and then pay cash for your medical needs. A critical illness plan can cover large expenses like accidents or long-term illness.

MediBid helps you find a doctor willing to treat you, and you pay them directly. With no insurance middle-man, you will not have restrictions on treatment, and the savings is tremendous!

Presenting alternatives to Obamacare

http://washingtonexaminer.com/presenting-alternatives-to-obamacare/article/2501768

by Diana Furchtgott-Roth July 10, 2012

On Wednesday the House of Representatives will vote to repeal the Patient Protection and Affordable Care Act.

Let’s hope that the congressmen will also present an alternative. For inspiration, backed up with data, they should read “Priceless: Curing the Healthcare Crisis,” a new book by John Goodman, president of the Dallas-based National Center for Policy Analysis.

Not only is good health priceless, but one characteristic of American health care is that people who consume it don’t see prices, and they don’t know how much the service costs.

Goodman’s solution is built around tax-deductible health savings accounts, where people can save for routine health expenditures. Combined with high-deductible insurance for unpredictable major expenses, such as heart attacks and bike accidents, this offers coverage more like auto or home insurance, with lower premiums.

Low-income Americans would receive vouchers to set up savings accounts and buy such insurance.

This would lower health care costs, because when people are aware of prices, they spend less. To offer an example, this is why prices for cosmetic surgery, which is not usually covered by insurance, have steadily declined.

In today’s health care market, third-party payers are the ones who see the prices — that is, insurance companies and the government. They have put themselves in the position of telling people what care they should have. But, as Goodman shows, the incentives of patients and third-party payers are very different.

A test for cervical cancer might cost $12,000 per life saved if women received the test every four years, and $1.5 million per life saved if women were tested annually. So, from society’s perspective, testing women every four years is a more cost-efficient outcome, even though many more women might die.

What makes the most sense is for women to manage their own routine health care dollars out of health savings accounts, so they can decide if they want to spend $100 on the test every year, every two years or every four years.

The PPACA would take America in the opposite direction. There would be more government regulations and institutions deciding what treatments people should have. The PPACA’s Independent Payment Advisory Board would decide what treatments are cost-effective. It would take away the freedom of doctors and patients to decide for themselves on courses of treatment by forbidding certain drugs, devices and procedures from reaching the market.

This type of health care rationing is a feature of other countries. But the U.S. system, with its high use of Magnetic Resonance Imaging units and exams, achieves the highest five-year cancer survival rates in a group of 18 industrialized countries in a Lancet study by Dr. Michel P. Coleman.

In the United States, 84 percent of women diagnosed with breast cancer live for five years, compared with 70 percent in the United Kingdom. For other cancers, the data are similar — 59 percent of Americans survive colorectal cancer, compared with 42 percent in the U.K.; and 92 percent of Americans survive prostate cancer, compared with 51 percent of U.K. men.

American health care works in other ways, too, Goodman shows. It’s often stated that Americans’ average life expectancy is 19th among countries in the Organisation for Economic Co-operation and Development. But this is not because of sickness, but because of a higher rate of fatal injuries from violence and car accidents. Without fatal injuries, Americans have the highest average life expectancy in the OECD.

Goodman shows that Congress should look to consumer-driven care as an alternative to the PPACA, just as purchases of other insurance products, ranging from life insurance to renters’ insurance, are consumer-driven.

As America looks to replace the PPACA, Goodman’s book is worth a careful read. Call it priceless.

Examiner Columnist Diana Furchtgott-Roth (dfr@manhattan-institute.org), former chief economist at the U.S. Department of Labor, is a senior fellow at the Manhattan Institute for Policy Research.

With Corrupt Scam Intact? No “Repeal and Replace”, Thanks

July 18, 2012

Obamacare does not need to be replaced with any other law besides the free market. In the free market, competition and transparency lead to reasonable prices. Dr. Keith Smith runs a cash-only surgery center in Oklahoma, with prices listed on his website so patients know well in advance what they will be charged.

Dr. Smith is a member of MediBid, and has had numerous patients sent to him through MediBid have a positive experience with their results. Affordable knee replacements are hard to come by. Whatever procedure you might be looking for, your future doctor is waiting at MediBid. Sign up today!

Repeal and Replace- With Corrupt Scam Intact? No Thanks

http://townhall.com/columnists/keithsmith/2012/07/16/repeal_and_replace_with_corrupt_scam_intact_no_thanks

by Keith Smith, MD

We hear the “repeal and replace” slogan a lot. Pundits such as the socialist editorialist Clarence Page have called Republican leaders out, Sen. Mitch McConnell in particular, for not having a replacement plan for ObamaCare if they can manage to repeal it.

This very short-lived interlude, void of any more health care ideas from Washington, is refreshing, I think. Unfortunately, I’m sure the GOP will soon spoil the silence. And can anyone believe that any answer coming from Washington wouldn’t be designed to line the pockets of the special interests at the table writing the bill?

I’m all for repeal. But let’s not stop with ObamaCare. Let’s move on to many disastrous legislative interventions brought to us from the other side of the aisle. How about Medicare Part D, rammed through in the dead of night by a GOP-led executive? How about the costly administrative nightmare of HIPAA?

We don’t need another massive Rube Goldberg contraption that claims to fix our problems. We need to repeal the laws that created the problems.

Why didn’t the GOP change the tax code to end the discrimination against individual purchases of health insurance during the time they had all the power? This tax reform isn’t likely, even though it would do much to relieve the problem of pre-existings as people could keep a guaranteed-renewable policy all their lives, instead of having to be underwritten again if they lose their job. Why not? Hint: The shift away from employer-purchased plans would gut the scam of PPO repricing, a devastating blow to the big insurance companies.

Most people don’t even know how “repricing” works. Insurance companies are perversely rewarded by seeking out the most expensive “providers” they can find. They subsequently “reprice” a bill of $100,000 to perhaps $28,000 and charge the employer plan a fee that is a percentage of the amount they have “saved” them—$72,000 in this example. Hospitals gladly produce these bills for their pals, as they can write the fictitious loss off as “uncompensated care” and bill Uncle Sam for a percentage of this number. Insurance companies agree to lock out certain competitors to garner the hospitals’ participation in this little scam.

Insurance companies make more money doing this than they do from premium collection! This money isn’t included in the calculation of the new MLR (medical loss ratio) requirements of the UCA (Unaffordable Care Act). This MLR only applies to premiums collected. Beginning to see why the big insurance companies wrote the bill this way? Administrative fees and PPO access fees are also not included in the MLR calculations.

Changing the tax code ends this scam. Individual policies (as opposed to group or employer-sponsored policies) are not subjected to “repricing” fees. You will know that the GOP is furious with the insurance companies when this tax reform passes. If the GOP threatens to pass it, then doesn’t, you will know that they did this to raise money from the insurance companies as extortion.

What would the reaction of the average working person be to the following from the GOP? “We aren’t advocating a replacement plan because this government is so completely compromised, corrupt, and incompetent that something as important as health care can’t be trusted to it. We are going to fade back and punt this to the states and let them unwind the insanity we have thrust on everyone in the country. Our gift to you is to remove ourselves from this issue entirely, rather than continue to sell our influence at your expense.”

Will anyone say this? Jim Jordan (R-Ohio) has gone further. He has recommended block grants. He has openly encouraged governors to ignore ObamaCare (nullification, anyone?). And he is circulating a petition that will commit legislators to deny funding to implement it. Most of the GOP will abandon the big money of the insurance lobby when “acting under their influence” (AUI) costs them their jobs. Others like Jordan are advocating a principled path, one we can only hope will attract the others.

Young, healthy, and broke have health care options

July 17, 2012

Young people don’t tend to purchase health insurance, and in fact, many don’t feel they need to. They should be saving up money from their part-time jobs to pay for any minor medical treatment or doctor visits they might need as a healthy young adult. If they can afford a night out at the bar with friends, they can afford an office visit. When they get older with a full-time job, they can open an HSA to save up for future costs and purchase a catastrophic insurance plan.

For young people with little or no insurance coverage, MediBid is perfect! A student can find a doctor willing to give them a physical exam or sports injury treatment without the need for a “network” physician or any needless paperwork. A simple email or phone call is all it takes for them to make arrangements directly with the doctor of their choice.

Health care options for young, healthy and broke

http://www.usatoday.com/money/industries/insurance/story/2012-07-14/health-care-young-broke/56226296/1

WASHINGTON (AP) – They’re young, healthy and flat broke — and now the government says they have to buy thousands of dollars’ worth of medical insurance. What should tapped-out twenty-somethings do?

Well, some may just do nothing. The annual fine for shrugging off the new federal insurance requirement, which is to begin in 2014, starts out at a relatively low $95, depending on income. That would be far cheaper than paying premiums.

But that doesn’t necessarily make blowing off the mandate a good idea for the fit and frugal. Millions of young people will qualify for good deals on health care if they take time to sort through the complicated law (www.healthcare.gov).

Many will get Medicaid coverage at virtually no cost. Others will qualify for private insurance at a fraction of the full premiums. And health plans offered under the law will limit individuals’ out-of-pocket expenses to about $6,250 per year or less — a bulwark against gigantic, unexpected medical bills.

“It doesn’t have to be cancer or a heart attack or even a bad car accident,” said Karen Pollitz, a health policy expert at the Kaiser Family Foundation whose own son needed $15,000 worth of surgery after he broke his wrist while skateboarding at age 20. “Once you show up in the ER (emergency room), it starts to cost you some money.”

The plans also will cover at no charge preventive care such as HIV tests, screening for depression or alcoholism, flu shots, hepatitis vaccine, contraception and pregnancy care. And insurers will no longer be able to exclude or charge extra for people who already have health problems.

“It’s the 15% of young people who have chronic conditions like asthma or diabetes, and the young women looking to have a baby,” said Aaron Smith, 30, co-founder of Young Invincibles, which advocates for young adults’ health care (www.younginvincibles.org) “That discrimination won’t fly in 2014.”

Young Americans are the least likely to be insured: almost three of 10 adults who are under 35 aren’t covered. And they go to emergency rooms more than any other group except seniors.

It’s still possible President Obama’s health care law won’t be around in 2014, when the big changes are to kick in. Congressional Republicans and GOP presidential candidate Mitt Romney want to repeal the law if they win the November elections. Still, with open enrollment for the law’s new state-based insurance markets scheduled to begin in October of next year, it’s prudent to start considering the options for getting covered.

GOT A JOB? START THERE

More than half of Americans already are covered through their jobs. But young adults have the nation’s highest unemployment rate and also are more likely to toil in low-wage jobs without benefits.

Some employers, especially smaller businesses paying lower wages, may now drop their plans and expect their workers to get government help. Other businesses, but not quite as many, will probably begin coverage in response to the law’s penalties and incentives for employers, the Congressional Budget Office (CBO) predicts.

UNDER 26? LEAN ON MOM OR DAD

One of the law’s most popular provisions, already in effect, ensures that parents with family plans can keep their adult kids enrolled until they turn 26, if the children don’t have a suitable workplace option. Pollitz’s skateboarding son is one of them.

The government estimates that 3.1 million uninsured young people already have gained coverage this way.

CONSIDER MEDICAID

Right now, Medicaid mostly covers children and low-income adults who are disabled, pregnant or raising kids. But the health care law will push states to expand Medicaid to also cover other adults with incomes up to around $15,000, adjusted for inflation in 2014. That’s designed to account for about half of the 30 million people expected to gain insurance coverage under the overhaul.

It may fall short, however. The Supreme Court recently ruled that the federal government can’t coerce states into joining the Medicaid expansion. Some states may decline to add people to their rolls.

THERE’S OTHER HELP

Most people with incomes up to four times the poverty level — which currently comes out to $44,680 for an individual or $92,200 for a family of four — will qualify for some help paying for private insurance. Aid drops off sharply as income climbs, and younger people get smaller subsidies than older folks whose insurance rates are higher.

The lowest earners shouldn’t have to pay more than 2% of their incomes toward insurance premiums for mid-level plans; those at the high end would have to contribute 9.5%. These plans also have significant co-pays and deductibles, but some help is available there, too.

For example, a single 26-year-old earning $16,000 might pay $537 toward the annual premium for a mid-level “silver” plan, according to estimates from the Kaiser Family Foundation (www.healthreform.kff.org/subsidycalculator). The rest of the premium would be covered by a $2,853 tax credit. (Deductibles and co-pays could cost up to an additional $2,083, depending on how much care the person needs.)

A 26-year-old earning $35,000 would pay $3,325 in premiums — $277 a month — for the same plan, after only a $66 tax credit. (And that patient might be on the hook for another $4,167 in out-of-pocket costs.)

A CHEAPER BUT SKIMPY CHOICE

For those under 30, there’s a special option to buy “catastrophic” insurance with the lowest premiums but scant coverage until a deductible of about $6,250 is met. While it may be tempting, caution is advised.

“We really encourage folks to do their homework and look at the details of the plan,” said Smith, who’s organizing efforts to help young people learn about their choices. “It’s not just the premium. You have to look at what’s being covered, what the deductibles are.”

GO BARE?

People who would have to spend more than 8% of their income to buy basic insurance are exempt from paying a penalty if they go without.

For others who feel they can’t afford or just don’t want coverage, the penalties start off relatively low in 2014.

Private insurers have yet to set the prices for their 2014 plans, because coverage that will comply with the law is still being developed. The CBO has estimated that premiums for the bare-bones plan, called “bronze” level, might average between $4,500 and $5,000 per year. Family plans might cost $12,500 per year.

Rates for young adults would be lower. Kaiser’s cost calculator gives a ballpark estimate of about $3,400 for an average single 26-year-old who doesn’t get subsidies.

In contrast, the first year’s minimum penalty for an individual is $95; that’s what a worker making $16,000 would pay. A $35,000 earner would owe $255 — not even a tenth of the estimated $3,325 in premiums.

In 2016, the minimum penalty rises to $695 and it’s capped at a little less than 2.5% of taxable income. That’s about a $1,600 fine for someone making $75,000 per year.

Even for the wealthiest folks, the law says the penalties can never exceed the average cost of a “bronze” plan. But most of those people already have insurance, anyway.

The Internal Revenue Service could withhold the penalties from taxpayers’ refunds if they don’t show proof of insurance. About 4 million people are expected to end up paying the penalties.

“For many young people, this is the first time they’ve had to deal with health insurance and the health care system,” said Smith. “There will be a learning curve.”

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