Affordable Care? 2017 Rates are Out Now!

middle-class-worker-help-obamacare

Here is a personal look at the impact of the impact the Affordable Care Act has had on me and my family.  For reference, in the beginning of 2016, I was 45, my wife 42 and my kids 13, 10 and 5.  Unfortunately, we are all a year older going into 2017.

I am using Blue Cross of Louisiana’s most popular Gold-level plan for my unsubsidized premium comparison.  The plan has a $1,000 deductible ($3,000 for the family) and and out of pocket maximum of $5,000 going down to $4,800 in 2017 ($10,000 going down to $9,600 in 2017 for the family).

  • 2016 Premiums – $1,583.70 per month or $19,004.40 for the year
  • 2017 Premiums – $2,023.05 per month or $24,276.60 for the year

That is an increase of $439.35 per month or $5,272.20 for the year.  It also represents a 27% rate increase.  OUCH!!!

My wife and I both work (pretty hard, I might add).  To be fair, if our combined income was lower, we would qualify for some help with this premium.  You can check your own subsidy availability here.  At $113,000 in combined family income, we would qualify for $303/month in help.  At $114,000 or more, we do not qualify for any help.  I think this is what President Clinton referred to as “the craziest thing in the world.”

Some more broad trends of note:

  • the % increase on some “more affordable” plans (silver and bronze level) is as much as 44%
  • there are more “narrow network” plans this year – both in total number and more drastically in % of total plans available.
  • comparable small group plans are significantly better priced and offer significantly more coverage options.  See – The Small Business Health Insurance Roller Coaster – What is Next? – If you have a business or influence with your small employer, it may be time to run some numbers.

I hope our next President and Congress work together for a better solution for all of our sake. This is not sustainable.

 

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The Small Business Health Insurance Roller Coaster – What is Next?

I have spent my entire 24 year career helping employers shop for, buy and manage their employee benefits.  In that time, the vast majority of large employers (50+ employees – for this discussion) have offered (and plan to continue to offer) their employees health insurance.  In 2010, the Affordable Care Act introduced new incentives (see employer shared responsibility penalties) to make sure that continues.  So far, it looks like that is happening as expected.

However, the small employer market (under 50 employees – not subject to employer mandate) has been much more volatile over the last 15 years.  That volatility has intensified in recent years. – peaking at 66% in 2010 and then bottoming out at 52% just 4 years later.

2015-employer-health-benefits-chart-pack-12-1024

 

Why has this happened and what does the future hold for small employers?

For small businesses, the initial decision to offer benefits is almost always driven by a key employee/employees who push the issue with the business owner.  Leading up to the 2010 passage of the Affordable Care Act, every news organization, talk show, politician, etc. talked about healthcare and health reform in some form just about every day. So, naturally, employees who had not thought about it before, were now asking about it.  Employers who hadn’t offered coverage before decided to make an offer for the first time.

This led to an almost 10% jump in firms offering health benefits from 2009 to 2010.  But, that increase completely vanished in 2011.  And, over the following years, the trend to away from group insurance increased as the % of firms offering health benefits reached a 15+ year low in 2014.

For employers with a higher percentage of low income employees, the move away from group insurance may continue.  This is because these employers cannot (and do not want to) compete financially with the subsidy available to low income employees.  Here is an example of how income impacts an individual’s coverage choices:

An unmarried 40 year old with 2 children under 18 years old can expect to pay about $391/month for herself or about $779/month for her and her children with no subsidy or medicaid available. She will also have the following subsidy options at different income levels:
Household Income Medicaid? Subsidy – Net cost
$25,000 Yes – entire family None – $0/month
$35,000 Yes – children only $180/month – $211/month
$45,000 Yes – children only $59/month – $332/month
$55,000 No $254/month – $525/month
$65,000 No $138/month – $641/month
$75,000 No $57/month – $722/month
$85,000 No None – $779/month

However, I expect that employers with higher-paid and geographically diverse employees will see that trend of moving away from group coverage reverse considerably.  This has already started and will accelerate very quickly.  Here are the 3 main drivers of that move:

  • Taxation of Employer Contribution to Individual Plans – In an updated Q&A about the practice of reimbursing individual health premiums, the IRS Q&A warns: “such an arrangement fails to satisfy the market reforms and may be subject to a $100/day excise tax per applicable employee (which is $36,500 per year, per employee) under section 4980D of the Internal Revenue Code.”  Though there are pockets that disagree with this interpretation and are fighting for a change, most have come to grips that it is best to avoid the practice rather than risk penalties.
  • Implosion of the Individual Health Insurance Market – Just about every carrier that has offered products on the individual exchange has lost money.  Some have lost so much money, they have decided to get out of the exchanges altogether.  The carriers that have remained have increased their prices significantly while drastically limiting their product offering – eliminating platinum-level plans, restricting the number of zip codes that they offer policies AND introducing more and more “narrow” network options.
  • Small Group Relative Stability – Trend price increases for small group (and group in general) have been modest in comparison to what we were seeing a few years back (pre-ACA) AND are modest compared to increases we have seen and expect to see in the individual market. In addition, there are now considerably more plan options to choose from in group vs. individual.  And finally, the price of comparable group plans are less than individual plans with similar benefit levels.

Individuals who are not eligible for subsidies because of their income will discover this discrepancy and push for change from their employer.  It will start with the business owner who is just a phone call or email away from discovering what this means to them and their families.

If you own a small business and want to see how all of this impacts you, your family and your employees we are always here to help.

 

Plain Language in Health Care Policy?

President Barack Obama listens to comments while meeting with healthcare stakeholders in the White House. At right is Health and Human Services Secretary Kathleen Sebelius. (Official White House Photo by Pete Souza)

This is one of my new, favorite excerpts from HR 3200, Section 133 REQUIRING INFORMATION TRANSPARENCY AND PLAN DISCLOSURE. (a) ACCURATE AND TIMELY DISCLOSURE, page 39 (of 1018).

(2) PLAIN LANGUAGE.—In this subsection, the term ‘‘plain language’’ means language that the intended audience, including individuals with limited English proficiency, can readily understand and use because that language is clean, concise, well-organized, and follows other best practices of plain language writing.

I don’t know why I think it is so funny to have a statement like this nestled snugly into a document like this.  It seems to support a widely growing sentiment that the rules set by our government don’t apply to our government.  If following “best practices of plain language writing” is important enough to be part of the resolution, surely they could have done better than this with the entire resolution.

I encourage everyone to read and attempt to understand the resolution.  You will have more questions than answers when you are finished.  But, you will at least get a glimpse into what the proposals are.  You can draw your own conclusions about what it would or could mean to you.

HR 3200 – A Line by Line Analysis

Here is a line-by-line analysis of HR 3200 currently under consideration in the House of Representatives.  This analysis was prepared by the Liberty Council and, like all parties to this discussion, they have their point of view.

I give anyone who reads this resolution credit.  I just hope our representatives are in that number BEFORE making their vote!

Pg 22 of the HC Bill MANDATES the Government will audit the books of ALL EMPLOYERS that self insure!!

Pg 29 lines 4-16 in the HC Bill – YOUR HEALTH CARE IS RATIONED!!!

Pg 30 Sec 123 of HC Bill – THERE WILL BE A GOVERNMENT COMMITTEE that decides what treatments/benefits you get

Pg 42 of HC Bill – The Health Choices Commissioner will choose your benefits for you. You have no choice!

Pg 50 Section 152 in HC Bill – HC will be provided to ALL non-U.S. citizens, illegal or otherwise

Pg 58 HC Bill – Government will have real-time access to individual’s finances and a National ID Health Care Card will be issued!

Pg 59 HC Bill lines 21-24 Government will have direct access to your banks accounts for electronic funds transfer.

(NOTE FROM RJ-This really does mean they can take your money at any time. Who will have this authority?—a government bureaucrat.)

Pg 65 Sec 164 is a payoff subsidized plan for retirees and their families in unions and community organizations (ACORN).

Pg 72 Lines 8-14 Government is creating a Health Care Exchange to bring private health care plans under government control.

Pg 84 Sec 203 HC Bill – Government mandates ALL benefit packages for private health care plans in the Exchange

Pg 85 Line 7 HC Bill – Specs for of Benefit Levels for Plans = The government will ration your health care!

Pg 91 Lines 4-7 HC Bill – Government mandates linguistic appropriate services.

Pg 95 HC Bill Lines 8-18 The government will use groups i.e., ACORN & AmeriCorps to sign up individuals for government Health Care Plan

Pg 85 Line 7 HC Bill – Specs of Ben Levels 4 Plans. #AARP members – Your health care WILL be rationed

Pg 102 Lines 12-18 HC Bill – Medicaid Eligible Individual will be automatically enrolled in Medicaid. No choice.

Pg 124 lines 24-25 HC No company can sue the government on price fixing. No “judicial review” against government monopoly.

Pg 127 Lines 1-16 HC Bill – Doctors/ #AMA – The government will tell YOU what you can make.

Pg 145 Line 15-17 An employer MUST auto enroll employees into public opt plan. NO CHOICE

Pg 126 Lines 22-25 Employers MUST pay for health care for part-time employees AND their families.

Pg 149 Lines 16-24 ANY Employer w/ payroll 400k and above who does not prov. pub opt. pays 8% tax on all payroll

Pg 150 Lines 9-13 Businesses with payroll between 251k and 400k who do not provide public opt pays 2-6% tax on all payroll

Pg 167 Lines 18-23 ANY individual who doesn’t have acceptable health care according to government will be taxed 2.5% of income.

Pg 170 Lines 1-3 Any NONRESIDENT Alien is exempt from individual taxes (Americans will pay).

Pg 195 Officers & employees of HC Admin (GOVT) will have access to ALL Americans’ financial and personal records.

Pg 203 Line 14-15 HC – “The tax imposed under this section shall not be treated as tax.” Yes, it says that.

Pg 239 Line 14-24 HC Bill Government will reduce physician services for Medicaid.  Seniors, low income, poor affected.

Pg 241 Line 6-8 HC Bill – Doctors, it does not matter what specialty you have, you’ll all be paid the same.

Pg 253 Line 10-18 Government sets value of doctors’ time, prof judg, etc. Literally value of humans.

Pg 265 Sec 1131Government mandates and controls productivity for private health care industries.

Pg 268 Sec 1141 Federal Government regulates rental and purchase of power-driven wheelchairs.

Pg 272 SEC. 1145. Treatment of certain cancer hospitals – Cancer patients – welcome to rationing!

(RJ-NOTE: Much cancer treatment will not work unless implemented early, but the waiting time just to see a specialist will likely be months when this plan is implemented. As you can see in this bill, the option of the health care bureaucrat is to deny treatment to those they deem not likely to be helped by it. Watch the cancer death rate skyrocket.)

Page 280 Sec 1151 The government will penalize hospitals for what government deems preventable readmissions. (Incentives for hospital to not treat and release.)

Pg 298 Lines 9-11 Doctors that treat a patient during initial admission that results in a readmission-Government will penalize you.

Pg 317 L 13-20 PROHIBITION on ownership/investment. Government tells Doctors what/how much they can own.

Pg 317-318 lines 21-25, 1-3 PROHIBITION on expansion- Government is mandating hospitals cannot expand.

pg 321 2-13 Hospitals have opportunity to apply for exception, BUT community input required. Can you say ACORN?!!

Pg335 L 16-25 Pg 336-339 – Government mandates establishment of outcome based measures. Health Care the way they want. Rationing.

Pg 341 Lines 3-9 Government has authority to disqualify Medicare Advantage Plans (Part B), HMOs, etc. Forcing people into Government plan.

Pg 354 Sec 1177 – Government will RESTRICT enrollment of special needs people!

Pg 379 Sec 1191 Government creates more bureaucracy – Tele-health Advisory Committee. Health care by phone/Internet?

Pg 425 Lines 4-12 Government mandates Advance [Death] Care Planning Consult. Think Senior Citizens end of life.

Pg 425 Lines 17-19 Government will instruct and consult regarding living wills, durable powers of attorney. Mandatory!

Pg 425 Lines 22-25, 426 Lines 1-3 Government provides approved list of end of life resources, guiding you in death.

Pg 427 Lines 15-24 Government mandates program for orders for end of life. The government has a say in how your life ends.

Pg 429 Lines 1-9 An “adv. care planning consult” will be used frequently as patient’s health deteriorates.

Pg 429 Lines 10-12 “adv. care consultation” may include an ORDER for end of life plans. AN ORDER from Government.

Pg 429 Lines 13-25 – The government will specify which doctors can write an end of life order.

PG 430 Lines 11-15 The government will decide what level of treatment you will have at end of life.

(NOTE FROM RJ: The above really does give the government the authority to determine who lives and dies, and when. A government bureaucrat really will be making this decision for you and your loved ones.)

Pg 469 – Community Based Home Medical Services=Non-profit orgs. Hello, ACORN Medical Services here!!?

Pg 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED ORG. 1 monthly payment to a community-based org. Like ACORN?

Pg 489 Sec 1308 The government will cover Marriage and Family therapy. They will insert government into your marriage.

Pg 494-498 Government will cover Mental Health Services including defining, creating, rationing those services.

PG 502 Sec 1181 Center for Comparative Effectiveness Research Established. – Hello Big Brother – Literally.

Pg 503 Lines 13-19 Government will build registries and data networks from YOUR electronic medical records.

Pg 503 lines 21-25 Government may secure data directly from any department or agency of the U.S., including your data.

Pg 504 Lines 6-10 The “Center” will collect data both published and unpublished (that means public and your private info).

PG 506 Lines 19-21 The Center will recommend policies that would allow for public access of data.

PG 518 Lines 21-25 The Commission will have input from Health Care consumer reps – Can you say unions and ACORN?

PG 524 18-22 Comparative Effectiveness Research Trust Fund set up. More taxes for ALL.

PG 621 Lines 20-25 Government will define what quality means in health care. Since when does government know about quality?

Pg 622 Lines 2-9 To pay for the Quality Standards, government will transfer money from other government Trust Funds. More Taxes.

PG 624 “Quality” measures shall be designed to assess outcomes and functional status of patients.

PG 624 “Quality” measures shall be designed to profile you including race, age, gender, place of residence, etc.

Pg 628 Sec 1443 Government will give “Multi-Stake Holders” Pre-Rule Making input into Selection of “Quality” Measures.

Pg 630 9-24/631 1-9 Those multi-stake holder groups include unions and groups like ACORN deciding health care quality.

Pg 632 Lines 14-25 The Government may implement any “Quality measure” of health care services as they see fit.

PG 633 14-25/ 634 1-9 The Secretary may issue non-endorsed “Quality Measures” for Physician Services and Dialysis Services.

Pg 635 to 653 Physicians Payments Sunshine Provision – Government wants to shine sunlight on doctor but not government.

Pg 654-659 Public Reporting on Health Care-Associated Infections – Looks okay.

PG 660-671 Doctors in Residency – Government will tell you where your residency will be, thus where you’ll live.

Pg 676-686 Government will regulate hospitals in EVERY aspect of residency programs, including teaching hospitals.

Pg 686-700 Increased Funding to Fight Waste, Fraud, and Abuse. You mean like the government with an $18 million website?

(NOTE FROM RJ—Can you actually imagine empowering the government to fight waste, fraud, and abuse????)

PGs 701-704 Sec 1619 If your part of health care plan isn’t in Government Health Care Exchange but you qualify for Federal aid, no payment.

PG 705-709 SEC. 1128 If Secretary gets complaints (ACORN) on health care provider or supplier, government can do background check.

PG 711 Lines 8-14 The Secretary has broad powers to deny health care providers/ suppliers admittance into Health Care Exchange. Your doctor could be thrown out of business.

Pg 719-720 Sec 1637 ANY Doctor who orders durable medical equipment or home medical services MUST be enrolled in Medicare.

PG 722 Sec 1639 Government MANDATES doctors must have face-to-face with patient to certify patient for Home Health Services.

PG 724 23-25 PG 725 1-5 The same government certifications will apply to Medicaid and CHIP (your kids).

PG 724 Lines 16-22 Government reserves right to apply face-to-face certification for patient to ANY other health care service.

Pg 735 lines 16-25 For law enforcement, proposes the Secretary-HHS will give Attorney General access to ALL data.

PG 740-757 Government sets guidelines for subsidizing the uninsured (That’s your tax dollars people).

Pg 757-762 Federal Government will shift burden of payments to Disproportionate Share Hospitals (DSH) to States. (Taxes)

Pg 763 1-8 No DS/EA hospitals will be paid unless they provide services without regard to national origin.

Pg 765 Sec 1711 Government will require Preventative Services including vaccines. (Choice?)

Pg 768 Sec 1713 Government – Nurse Home Visitation Services (Hello union paybacks).

Pg 769 11-14 Nurse Home Visit Services include economic self-sufficiency, employ adv, school-readiness.

Pg 769 3-5 Nurse Home Visit Services – “increasing birth intervals between pregnancies.” Government ABORTIONS anyone?

Pg 770 SEC 1714 Federal Government mandates eligibility for State Family Planning Services. Abortion and State Sovereign.

(NOTE FROM RJ—Can you believe that in America you will be told how many children you can have, and when? Does this mean we can expect the government to impose mandatory abortions? How else can this be interpreted?)

Pg 789-797 Government will set, mandate drug prices, controlling which drugs brought to market. Bye innovation.

Pgs 797-800 SEC. 1744 PAYMENTS for graduate medical education. The government will now control doctors’ educations.

PG 801 Sec 1751 The government will decide which health care conditions will be paid. Say RATION!

Pg 810 SEC. 1759. Billing Agents, clearinghouses, etc. req. to register. Government takes over private payment system.

Pg 820-824 Sec 1801 Government will identify individuals ineligible for subsidies. Will access all personal financial information.

Pg 824-829 SEC. 1802. Government sets up Comparative Effectiveness Research Trust Fund. Another tax black hole.

PG 829-833 Government will impose a fee on ALL private health insurance plans including self-insured to pay for Trust Fund!

PG 835 11-13 fees imposed by government for Trust Fund shall be treated as if they were taxes.

Pg 838-840 Government will design and implement Home Visitation Program for families with young kids and families expecting kids.

PG 844-845 This Home Visitation Program includes government coming into your house and telling you how to parent!!!

(NOTE FROM RJ—If you think this sounds like “Big Brother” actually coming into our homes, we really need to think about what comes after Big Brother. The scenario being set up by the government to control people through this, with the technology now available, is beyond what the science fiction horror works about this could conceive of.)

Pg 859 Government will establish a Public Health Fund at a cost of $88,800,000,000. Yes that’s billion.

Pg 865 The government will MANDATE the establishment of a National Health Service Corps.

PG 865 to 876 The NHS Corps is a program where doctors perform mandatory health care for two years for part loan repayment.

PG 876-892 The government takes over the education of our medical students and doctors.

PG 898 The government will establish a Public Health Workforce Corps to ensure supply of public health prof.

PG 898 The Public Health Workforce Corps shall consist of civilian employees of the U.S. as Secretary deems.

PG 898 The Public Health Workforce Corps shall consist of officers of Regular and Reserve Corps of Service.

PG 900 The Public Health Workforce Corps includes veterinarians.

PG 901 The Public Health Workforce Corps WILL include commissioned Regular and Reserve Officers. HC Draft?

PG 910 The government will develop, build, and run Public Health Training Centers.

PG 913-914 Government starts a health care affirmative action program thru guise of diversity scholarships.

PG 915 SEC. 2251. Government MANDDATES Cultural and linguistic competency training for health care professionals.

Pg 932 The Government will establish Preventative and Wellness Trust fund- initial cost of $30,800,000,000 billion.

PG 935 21-22 Government will identify specific goals & objectives for prevention & wellness activities. Control YOU!!

PG 936 Government will develop “Healthy People and National Public Health Performance Standards” Tell me what to eat?

(NOTE FROM RJ—This is no joke—the government will be able to actually mandate what you can eat or not eat. This could be helpful for some, but do we want the government doing it? What is the most fat and out of shape entity on the planet? The Federal Government. What kind of shape do you think the bureaucrats will be in who mandate such for everyone else?)

PG 942 Lines 22-25 More government? Offices of Surgeon General -Public Health Svc, Minority Health, Women’s Health

PG 950- 980 BIG GOVERNMENT core pub health infrastructure including workforce capacity, lab systems, health info sys, etc.

PG 993 Government will establish school based health clinics. Your kids won’t have a chance.

PG 994 School Based Health Clinic will be integrated into the school environment. Say government brainwash!

PG 1001 The government will establish a National Medical Device Registry. Will you be tracked?

Are You Kidding?

I am shocked and astounded to think that the Federal Government is even thinking of eliminating some very popular, long standing tax-advantaged saving and spending vehicles – FSAs and HRAs – as a way to pay for a government health plan.  See ARTICLE.

In my opinion, this is insane for a couple of reasons that come to mind.

1.  Theses tax advantaged vehicles are the ONLY health care related programs, created by the government, which are actually effective tools for both encouraging and rewarding active engagement by consumers in the purchase of their own health care.  Individuals who use these types of vehicles have an incentive to manage their costs.  Since overall health is most impacted by many individual lifestyle decisions, this is where the incentive NEEDS to be.

2.  No new tax or elimination of an existing tax break will EVER be enough to “pay” for a public health plan that lacks incentive for consumer engagement.  Nothing that is free, including medical services, is ever truly appreciated or valued appropriately.  With the goverment in a role of managing the cost of care, rationing is an inevitability.  Just look to any of the Universal Healthcare systems we emulate around the world.

Take a look at the Medicare website to get a glimpse into what may be an all too near future – indecipherable choices without clear and competent assistance through the maze.  I hope someone wakes up soon!

See my previous post – My Fix for Health Care – in less than 250 words.

ABC News: Universal Healthcare and the Waistline Police

This story really caught my eye.

Any organization (government, insurance company, large employer) that is paying for health care, must look at any and all measures at their disposal to manage this escalating cost.  With limited resources available for health related expenses, it is inevitable that more and more aggressive measures will be taken with prevention as the goal.

Hopefully, there are enough efficiencies to gain in system-wide changes to prevent the kind of limitation of freedoms we currently take for granted.

ABC News: Universal Healthcare and the Waistline Police

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