C. Steven Tucker speaks to Tea Party groups, the media and individuals about Obamacare.

Street debate on Obamacare with a member of the ‘Progressive’ Left.

PPACA creates part-time work force.

Recently employees of Long Beach, California, Circle K convenient stores, the nation’s largest theater chain - Regal Entertainment Group, AAA Parking, the state of Virginia, the city of Dearborn, Michigan, selected Wendy’s restaurants, Taco Bell have been notified that their full-time work hours will be reduced to part-time hours. Specifically 29 hours or less. Why is this happening?

Under a clause of President Obama’s health care law called the “Shared Responsibility Penalty“. Employers with 50 or more full-time employees – are now incentivized to reduce full-time worker hours to part-time hours. For many years, a full-time employee was considered an employee who works 40 hours or more per week. Now, because of a ‘new regulation’ written by HHS, a ‘full-time employee’ has been redefined as one who works 30 hours or more per week.

Under the PPACA, any employer with 50 or more full-time employees who does not offer PPACA approved MEC – “Minimal Essential Coverage” must pay an annual, non tax deductible penalty of $2,000 to the IRS for each full-time employee. Starting with the 30th full-time employee on up.

How the PPACA “Shared Responsibility Penalty” is triggered by employers

Beginning in 2014, full-time employees who are not offered MEC – ‘Minimal Essential Coverage’ through their employer and who are not eligible for Medicaid may be eligible for “Advanced Premium Tax Credits”. These ‘Advanced Premium Tax Credits’ will be provided by the taxpayer to artificially lower the extremely expensive coverage that will be provided in the new “Health Insurance Exchanges”.

The PPACA empowers the Internal Revenue Service to provide these ‘Advance Premium Tax Credits’ to childless adult individuals with incomes surpassing 138% and families making up to 400% of the FPL – Federal Poverty Level. Using 2012 FPL, this would mean that individuals making $42,680 annually and families making $92,200 would now qualify for an ‘Advance Premium Tax Credit’ in the new “Health Insurance Exchanges”.

On Wednesday, January 2, 2013 the IRS released proposed new regulations related to the PPACA “Employer Shared Responsibility” rules. There is important new information for employers to consider.

Background

Beginning in 2014, an applicable ‘Large Employer” may be subject to a “Shared Responsibility Payment” under one of two different circumstances:

1. 4980H(a) liability – Applies if an employer does not offer its full-time equivalent employees (and their dependents) MEC – minimum essential coverage, and any full-time employee is certified as having received an ‘Advance Premium Tax Credit’ when purchasing individual health insurance through a public Health Insurance Exchange. In this case, the employer may be liable for a penalty of $2000 per year times the total number of full-time employees (not counting the first 30).

   or

2. 4980H(b) liability – Applies if the employer does offer its full-time employees (and their dependents) MEC – Minimum Essential Coverage – but the plan is ‘unaffordable’. ‘Unaffordable’ means that the employer requires their full-time employees to contribute more than 9.5% of their annual adjusted house hold income towards the cost of self-only MEC coverage, and at least one full-time employee is certified as having received an ‘Advance Premium Tax Credit’ subsidy when purchasing individual health insurance through a public Health Insurance Exchange. In this case, the employer may be liable for a penalty of $3000 per year times the number of full-time employees who are certified to receive, and purchase, subsidized individual health insurance using an ‘Advance Premium Tax Credit’ through a public Health Insurance Exchange.

In summary, employers with 50 or more full-time employees must either pay 90.5% of the cost to provide extremely expensive PPACA approved MEC – which includes the “Essential Health Benefits Package“, 65 Preventative Care tests and must conform to ‘Community Rating’ and ‘Guaranteed Issue” clauses. It is important to note that these clauses have already destroyed the individual health insurance market in all 8 states they were implemented in. Or, the employer must pay a $2,000 fine for each full-time employee (excluding the first 30 full-time employees).

Or, the employer can simply move full-time employees to part-time employees (less than 30 hours). In doing so they would then avoid both the massive cost to insure everyone and the $2,000 fine for not doing so. Tell me, which action do you think employers will take?

 

Why Are Health Insurance Premiums Still Increasing After The PPACA?

There are 5 primary reasons why health insurance premiums have already increased and will continue to increase since the passage of the PPACA. And, why insurers like Aetna are expecting some premiums to double after 2014.

1) My Blue Cross Group clients have received policy renewal rate increases since the passage of the PPACA of up to 46% for the first time in 17 years. See just a few of them here. Their prior premium increases were nothing near this amount. This is not isolated to Blue Cross either. These premium increases are happening in many markets across the United States in both the Individual and Group health insurance markets. Even though Barack Obama promised “my health care plan will save the average family $2,500 on their premium.”

And then their was this quote from Barack Obama: “It’s estimated that your employer’s premiums will fall by as much as 3,000% which means they could give you a raise.”

These premium increases are due in large part to the fact that multiple new “Preventative Care” mandates were imposed upon all “non-grandfathered” health insurance plans as of 9/23/2010 under the PPACA (Patient Protection & Affordable Care Act). A “Non-grandfathered” health insurance plan is a plan that was purchased after the PPACA (a.k.a “Obamacare”) was signed in to law on March 23, 2010. Keep in mind, these were ALL mandated to be covered no later than 1/1/2011 WITHOUT a co pay or a DEDUCTIBLE (a.k.a. “free”). The entire list is as follows:

• 15 Covered Preventive Services for Adults:

  1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
  2. Alcohol Misuse screening and counseling
  3. Aspirin use for men and women of certain ages
  4. Blood Pressure screening for all adults
  5. Cholesterol screening for adults of certain ages or at higher risk
  6. Colorectal Cancer screening for adults over 50
  7. Depression screening for adults
  8. Type 2 Diabetes screening for adults with high blood pressure
  9. Diet counseling for adults at higher risk for chronic disease
  10. HIV screening for all adults at higher risk
  11. Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:
      • Hepatitis A
      • Hepatitis B
      • Herpes Zoster
      • Human Papillomavirus
      • Influenza (Flu Shot)
      • Measles, Mumps, Rubella
      • Meningococcal
      • Pneumococcal
      • Tetanus, Diphtheria, Pertussis
      • Varicella
        Learn more about immunizations and see the latest vaccine schedules.
  12. Obesity screening and counseling for all adults
  13. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
  14. Tobacco Use screening for all adults and cessation interventions for tobacco users
  15. Syphilis screening for all adults at higher risk

  22 Covered Preventive Services for Women, Including Pregnant Women

  1. Anemia screening on a routine basis for pregnant women
  2. Bacteriuria urinary tract or other infection screening for pregnant women
  3. BRCA counseling about genetic testing for women at higher risk
  4. Breast Cancer Mammography screenings every 1 to 2 years for women over 40
  5. Breast Cancer Chemoprevention counseling for women at higher risk
  6. Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women*
  7. Cervical Cancer screening for sexually active women
  8. Chlamydia Infection screening for younger women and other women at higher risk
  9. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, including abortifacient drugs – some religious organizations are now exempt from this mandate
  10. Domestic and interpersonal violence screening and counseling for all women*
  11. Folic Acid supplements for women who may become pregnant
  12. Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
  13. Gonorrhea screening for all women at higher risk
  14. Hepatitis B screening for pregnant women at their first prenatal visit
  15. Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women*
  16. Human Papillomavirus (HPV) DNA Test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older
  17. Osteoporosis screening for women over age 60 depending on risk factors
  18. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
  19. Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
  20. Sexually Transmitted Infections (STI) counseling for sexually active women
  21. Syphilis screening for all pregnant women or other women at increased risk
  22. Well-woman visits to obtain recommended preventive services

  26 Covered Preventive Services for Children

  1. Alcohol and Drug Use assessments for adolescents
  2. Autism screening for children at 18 and 24 months
  3. Behavioral assessments for children of all ages
     Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  4. Blood Pressure screening for children
     Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  5. Cervical Dysplasia screening for sexually active females
  6. Congenital Hypothyroidism screening for newborns
  7. Depression screening for adolescents
  8. Developmental screening for children under age 3, and surveillance throughout childhood
  9. Dyslipidemia screening for children at higher risk of lipid disorders
     Ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  10. Fluoride Chemoprevention supplements for children without fluoride in their water source
  11. Gonorrhea preventive medication for the eyes of all newborns
  12. Hearing screening for all newborns
  13. Height, Weight and Body Mass Index measurements for children
      Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  14. Hematocrit or Hemoglobin screening for children
  15. Hemoglobinopathies or sickle cell screening for newborns
  16. HIV screening for adolescents at higher risk
  17. Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
      • Diphtheria, Tetanus, Pertussis
      • Haemophilus influenzae type b
      • Hepatitis A
      • Hepatitis B
      • Human Papillomavirus
      • Inactivated Poliovirus
      • Influenza (Flu Shot)
      • Measles, Mumps, Rubella
      • Meningococcal
      • Pneumococcal
      • Rotavirus
      • Varicella
        Learn more about immunizations and see the latest vaccine schedules.
  18. Iron supplements for children ages 6 to 12 months at risk for anemia
  19. Lead screening for children at risk of exposure
  20. Medical History for all children throughout development
      Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  21. Obesity screening and counseling
  22. Oral Health risk assessment for young children
      Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.
  23. Phenylketonuria (PKU) screening for this genetic disorder in newborns
  24. Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk
  25. Tuberculin testing for children at higher risk of tuberculosis
      Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  26. Vision screening for all children
      Source: http://www.healthcare.gov/law/about/provisions/services/lists.html

2.) Now for the policy “design” Mandates. Blue Cross outlines those here:
http://www.resourcebrokerage.com/BCBSupdates22510B/PPACAILInsuredNotification.pdf

3.) The recent inclusion of PPACA mandated “Essential Health Benefits”. Among these are the following:

• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care
  Source: http://www.uhc.com/united_for_reform_resource_center/health_reform_provisions/essential_health_benefits.htm

4.) Now we come to reason number four. The onerous PPACA mandated Medical Loss Ratios or “MLRs”. This is why health insurance premiums are increasing on “Non-Grand-Fathered” health insurance plans – plans purchased prior to the passage of the PPACA – as well. For full details on these I refer you to the following link from the Heritage Institute. http://www.heritage.org/Research/Reports/2010/01/Squeezing-out-Private-Health-Plans

This has left thousands of American’s either uninsured or without the plan they had prior to the passage of the PPACA. Here is a sample letter that many of my clients received when Guarantee Trust Life insurance company ceased providing health insurance to my clients around the country in 2010.

This is exactly the opposite of what President Obama promised when he said in his speech to the AMA on June 15, 2009 “If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.” Watch him repeat this lie over, and over again below:

Find out the names of the carriers that have left the industry since the passage of the PPACA as well as all the other damage done to the health insurance industry since the passage of the PPACA by reading the new study completed by the Galen Institute on December 1, 2011 entitled “A Radical Restructuring of Health Insurance.”

World Insurance company in Omaha, Nebraska and it’s subsidiary American Republic insurance company is the latest carrier to succumb to the PPACA’s onerous MLR – Medical Loss Ratio requirement. They have now exited the individual market due to the PPACA Medical Loss Ratios. This move left 35,000 former policy holders without their plans. Sadly, the exit of American Republic from the Individual health insurance market also left 110 former employees without a job. Read that story here. Both companies will be purchased by Celtic Insurance company of Chicago Illinois.

This is not an isolated incident in Iowa. Iowa’s Principle Financial Group also exited the health insurance market, leaving 840,000 policy holders without their health insurance plans. Principle was purchased by United Health Group. Thankfully, due to this purchase, United Health Group will be offering new coverage to those formerly insured with Principle Financial Group. Again, you can not keep your plan, even if you like it. President Obama lied. And, as these larger companies gobble up smaller companies, competition is stifled resulting in higher premiums, less choices for consumers and a rapidly growing monopoly.

Other companies that have either closed their doors entirely or stopped selling health insurance since Obamacare was signed into law are as follows:

1.) American National
2.) American Republic
3.) American Medical Security
4.) American Community Mutual
5.) Standard Life & Accident
6.) Principle Financial
7.) nHealth
8.) World Insurance
9.) Unicare
10.) Guarantee Trust Life
11.) Coventry

Other carriers are slowly withdrawing State by State. Page 7 of this white paper dated September 6, 2011 from the North Carolina Department of Insurance details exactly why the majority of all health insurance carriers that offered health insurance in their State have already exited and why even more are considering doing so shortly.

Millions more Americans will lose their Employer Sponsored health insurance after 2014. This is due to the fact that the ‘fine’ (Roberts Tax) on employers – with 50 more more full time employees – who do not offer HHS approved health insurance to their employees is only $2,000 annually. This is far less than the cost to provide health insurance. So, many employers will simply choose to pay the ‘fine’ and push their employees onto the ‘health insurance exchanges’. For the full impact of the PPACA “Roberts Tax” on Individuals, Taxpayers & Employers visit this link.

Historical precedent proves that forcing mandate after mandate and new regulation after regulation on to the health insurance industry does nothing but increase costs. In 1979 there were 252 mandates forced upon the health insurance industry, by 2007 there were nearly 1900. With the implementation of the PPACA  we have tipped the scales at nearly 2,262 mandates. Keep piling them on and costs will continue to rise.

5.) Premiums will continue to increase when the following additional PPACA imposed requirements begin on January 1, 2014

A.) The “minimum actuarial value” requirement that forces insurers to provide more financially generous coverage with fewer co-pays and deductibles.
B.) The “community rating” provision that forces young Americans to pay far more for health insurance in order to subsidize older Americans. This was included in the PPACA even though historical data points to the catastrophic failure of ‘community rating’.
C.) The “guaranteed issue” provision that forces insurers to take all comers, even if they are already sick.
D.) The “essential health benefits” mandate that forces insurers to cover health-care services that many customers wouldn’t otherwise want to pay for.

The sad truth is, even though the President promised ‘affordable health insurance for all Americans‘, many Americans will not receive health insurance at all. In fact, according to the Congressional Budget Office’s latest assessment,
30 million Americans will remain uninsured even after full implementation of the PPACA. Worse yet, 17 million more will simply be enrolled in a Government Welfare program called Medicaid. Many who do receive health insurance will receive a very large tax payer funded subsidy, which will continue to detach the consumer with the true cost of health insurance. To find out what health insurance will cost you in the PPACA ‘Health Insurance Exchanges’ click here.

Shocking Medicare and Medicaid fraud exposed at Illinois’ Sacred Heart Hospital

Sacred Heart hospital on Chicago’s west side is now a focal point for federal investigators following alleged Medicare and Medicaid fraud charges. Thus far 6 people have been arrested, including Sacred Heart’s owner and CEO – Edward J. Novak, of Park Ridge, and Sacred Heart’s executive V.P. and CFO – Roy M. Payawal, 64, of Burr Ridge. According to a press release from the U.S. Attorney’s office some of the alleged fraud details are shocking:

“Between January 2010 and February 2013, May allegedly received $74,000 in the form of 37 checks, for $2,000 each, disguised as ‘rental payments’; Moshiri, a podiatrist, allegedly received $86,000 in 38 checks pursuant to a purported contract to teach podiatry students; and Maitra allegedly received $68,000 in 34 checks pursuant to a purported teaching contract – and the $228,000 total in alleged kickbacks were all in exchange for their referral of patients to Sacred Heart, the charges allege.
 
“In a recorded conversation last month, Maitra allegedly explained to Administrator A that he used to make Novak ‘so much money’ performing almost daily penile implant procedures on patients, but that he no longer performed as many of those procedures because Medicare had decreased its rates of reimbursement for the procedure. Maitra did not comment on whether the patient need for the procedure had somehow changed, according to the affidavit.”
 
“On March 1, 2013, Administrator A recorded Novak stating that tracheotomies are Sacred Heart’s ‘biggest money maker’ and the hospital can make $160,000 for a tracheotomy if the patient stays 27 days. On March 7, 2013, the Intensive Care Unit case manager told Administrator A that she must often ‘stretch’ a tracheotomy patient’s stay to 28 days to maximize Medicare reimbursements ‘to make Novak happy.’”

Sadly, cases like these are not uncommon in Illinois. In fiscal year 2011, the Department of Health and Human Services reported that in Illinois alone there were:

326 Medicaid fraud investigations
48 were indicted on Medicaid fraud charges
30 were convicted
18 cases of civil settlements/judgments
$47.8 million dollars was recovered in Medicare fraud cases

Until recent legislation was passed in July of 2012, the state of Illinois Medicaid program did not even have a TPA – Third Party Administrator – or other fraud prevention system in place under Rod Blagojevich’s destructive tenure as governor. There was apparently no need for one in Blago’s mind because he was lawless himself. Blago illegally expanded our Illinois Medicaid program to 77,000 illegal aliens – who are still enrolled on our Medicaid program today – and increased the eligibility for one to receive Medicaid to 138% above the Federal poverty level. He did so without our Illinois House or Senate approval.

There is a better way to run Illinois’ Medicaid program. There are proven solutions. They are not new ideas. In fact, if Illinois had emulated Florida’s Medicaid reform program last year, we would have saved $1.1 billion. Or, we could have implemented what former governor Mitch Daniels did to reform Indiana’s Medicaid program. We don’t even need to look to other states for solutions. Our own Jonathan Ingram of the Illinois Policy Institute has penned a recent report that paves the way perfectly for Illinois lawmakers to follow. Will they follow these recommendations? Will Illinois legislators act to protect Illinois’ indigent residents? Or, will they simply auto enroll up to 900,000 more indigent residents – per the President’s health care law – onto a broken, bankrupt, dangerous Medicaid program that is already rationing care? Only time will tell.

Affordable health insurance solution until 2014.

If you are a healthy person without preexisting conditions, and cost is a concern, consider short term health insurance coverage until 2014 when there will be no more preexisting condition exclusions on individual and family health insurance plans.

To get quotes and apply online with only 7 health questions asked, click the banner below.

C. Steven Tucker PPACA interviews on the Joe Walsh radio show.

On Tuesday April 2, 2013 I was an in studio guest on the Joe Walsh radio show on Am560 The Answer radio in Chicago. The full interview can be downloaded here in MP3 format.

On Thursday April 25, 2013 I returned to the Joe Walsh radio show on Am560 The Answer radio in Chicago. The full interview can be downloaded here in MP3 format.

The TRUTH About Preexisting Conditions.

Have you been denied coverage for preexisting conditions on president Obama’s PCIP – ‘Preexisting Condition Insurance Plan‘? Yeah, me too. Imagine my surprise when I logged onto their web site and received this message from the Health & Human Services department stating that president Obama’s “Preexisting Condition Insurance Plan” was denying me coverage? In fact, as of March 5, 2013 president Obama’s ‘Preexisting Insurance Plan” began denying everyone coverage for preexisting conditions.I remember reading an article written by HHS secretary Kathleen Sebellius and U.S. Attorney General Eric Holder in the Washington Post that told the story about a preschool teacher with Leukemia who was able to get coverage on the president’s new PCIP – “Preexisting Condition Insurance Plan” thanks to the passage of the president’s “Affordable Care Act”. Leukemia is a far more serious preexisting condition than I have. So why did president Obama cover her and not me?

I also remember reading from the president’s Centers for Medicare and Medicaid Services website that his Preexisting Condition Insurance Plan would last until 2014 when the new health insurance exchanges open under the “Affordable Care Act”. So why is the President denying me coverage for preexisting conditions? The Health Care.gov website says it’s because “the program has a limited amount of funding from Congress.” This can’t possibly be about money! Everyone deserves quality health care right? Surely, the president would make sure there was enough money to cover Americans with preexisting conditions. How can the president’s HealthCare.gov site blame Congress when he said in his last State of the Union address: “If Congress won’t act soon to protect future generations, I will.”

So president Obama will act without Congress for funding on ‘Climate Change’ but blame Congress for not appropriating enough money to cover my preexisting condition? Why would the President lie to me and deny me coverage for preexisting conditions? Well, I did some research and it turns out he has lied to me before regarding preexisting conditions. In fact, he has lied many times.

Remember when President Obama said “Health Insurance companies can raise your premiums when you get sick” and “Health insurance companies can cancel your coverage when you get sick”? The truth is that Federal laws established more than 17 years ago already prohibit any Health Insurance company from raising your health insurance premium when you get sick or from ‘canceling coverage when you get sick.’ To add insult to injury, the President told the following LIES during a joint session of congress. Watch what he said below:

Really Mr. President? Here’s the truth from Politifact the Chicago Sun Times and Fox News. Watch their coverage below:

Then there was the LIE the President told about his own mother. In 2008 and again in the film created for Barack Obama entitled “The Road We’ve Traveled” – narrated by Tom Hanks. Watch him tell this lie in the video below:

In the book “A Singular Woman: The Untold Story of Barack Obama’s mother.” by journalist Janny Scott. Scott reviewed letters from the President’s mother – Anne Dunham – to CIGNA (the insurance company), and revealed the dispute was over disability coverage, not health insurance coverage. Disability coverage helps replace lost wages due to an illness. This story had absolutely nothing to do with her health insurer refusing to pay her medical bills. In fact, she had excellent health insurance, the hospital billed her health insurer directly and her health insurer paid her medical bills, less her deductible and applicable co pays.

Worse yet, the President described his mother as an indigent woman who was ‘pretty much drained of her resources.’ The truth is Anne Dunham received a base pay in 1995 of $82,500, plus a housing allowance and a car, to work in Indonesia for Development Alternatives Inc. of Bethesda. Today, adjusting for inflation, that salary would be equivalent to $123,500. This is far from indigent. Today, the Washington Post rightfully gives this story ‘Three Pinocchios”

What about the women who the President said had her cancer treatment denied because of acne? Well, as you may have guessed by now. That too is a lie. According to ABC News, “President Obama’s description that Beaton’s ‘insurance company canceled her policy because she forgot to declare a case of acne’ is not accurate.

As Robin Lynn Beaton’s congressman, Rep. Joe Barton, R-Texas, testified, the Blue Cross/Blue Shield letter ‘informed Ms. Beaton that an investigation into her claims for benefits resulted in the company reviewing her medical records in which they discovered that she has misinformed them on several pieces of information. One of them was that she did not list her weight accurately, and the other, that she had failed to disclose some medication she had taken for a preexisting heart condition.”

Blue Cross discovered the previous condition after her visit to the dermatologist for acne but her insurance was not canceled because she didn’t declare a case of acne.”

By now, you may be asking. ‘Who are you to call the President of the United States a liar?’ Let me answer that. I have been a multi-state licensed health and life insurance Broker for more nearly 20 years now. I have also served as a Subject Matter Expert for multiple business journals around our great country. One of the biggest challenges I’ve had to deal with  throughout the years has been trying to secure coverage for people with preexisting conditions who obtain their health insurance on the individual market. They represent 10% of the American insured.

I’ve never had to worry about preexisting conditions with the other 90% of American insured’s who get their health insurance through an Employer Sponsored Group plan. Why? Because A Federal law called HIPAA has protected them against being denied health insurance because of preexisting conditions for more than 17 years now.

Because government legislators did not apply this law to individual health insurance policies, you can be labeled as “uninsurable” when you apply for an individual health insurance policy if you have one or more preexisting conditions. That being said, who should we truly blame for the fact that you can be denied coverage for a preexisting condition? Is it the insurance company’s fault? Or are they simply following a law that was written by government law makers who did not include HIPAA portability protection for the millions of American’s who purchase health insurance on their own in the individual market?

Because there are no HIPAA portability protections for individual policy holders , this uninsurable status can last for many years and sometimes for life depending on the specific preexisting condition you have been diagnosed with. Some of the preexisting medical conditions that  render an applicant uninsurable on an individual policy are: Heart Attack, Stroke, Diabetes, Cancer,  Lupus, Multiple Sclerosis, Muscular Dystrophy, Degenerative Arthritis and a host of other preexisting conditions. In addition, there are applicants who have a combination of controlled preexisting conditions but since they have more than three “ratable conditions” they are also labeled uninsurable.

Does this mean then that there was some truth in the stories the President told about preexisting conditions? No, he’s still a liar. In fact, during the last 2 decades of my career as a health insurance broker I have never been unable to offer someone health insurance coverage, regardless of the severity of their preexisting conditions. In fact, I once secured legitimate major medical health insurance for a woman who was dying of cancer in the hospital. How did I do it? Simple, I am an informed American. I know the laws that were already in place to protect consumers. Laws that were passed long before the President’s health care ‘reform’ law was passed in 2010.

The truth is even if you have lost your employer sponsored group health insurance coverage and/or have exhausted a COBRA continuation plan you too can obtain guaranteed issue health insurance on an individual basis that will provide coverage for your preexisting conditions seamlessly from day one. Your options are as follows:

1.) If you have a Corporate tax i.d. number you can purchase a small group health insurance policy from most insurance carriers. With this scenario, a minimum of 2 people (often husband & wife) who work for the same corporation can apply for a small group health insurance policy. Those who are HIPAA qualified will receive coverage for their preexisting conditions immediately. Even those who are not HIPAA qualified will receive coverage for their Preexisting conditions after a maximum period of 12 months. Be sure to read the outline of coverage for the Small Group plan you are applying for to make sure it provides coverage for your preexisting condition before you apply.

2.) Some States, like Colorado, provide what is known as a “Self Employed Group of One”. In these States, you do not even need to have another person to comprise a “Group Health Insurance Plan”. To find out how your State defines Small Group health insurance visit this site:  http://www.statehealthfacts.org/comparetable.jsp?cat=7&ind=350

3.) Enroll in your States High Risk Health Insurance Pool. 35 States provide them. CLICK HERE to see if your State does. In our home state of Illinois the risk pool is called the Illinois Comprehensive Health Insurance Plan (ICHIP). ICHIP is a state health benefits program and not an insurance company. Persons must qualify for coverage, but in most cases if the applicant is coming off an exhausted qualified COBRA continuation plan from a prior employer sponsored group, their preexisting conditions will be covered from day one (provided again that those conditions are a covered expense on the ICHIP policy). ICHIP (and all insurance risk pools) are by no means entitlement programs. They do indeed require you to pay a monthly premium. Nothing in this life is free. To find out if your State has a State Sponsored High Risk Pool visit http://www.naschip.org/states_pools.htm

4.) If you live in one of the 10 States that have an “Individual Market Guaranteed Issue Mandate” you are guaranteed Health Insurance coverage for preexisting conditions from a variety of Health Insurance carriers that operate within that State. For example, in the State of Ohio, there are 20 Health Insurance carriers that must by law “Guarantee Issue” 4% of their block of business to people with preexisting conditions during an annual ‘Open Enrollment’ period. During this annual period, each health insurance carrier must report to the Ohio Department of Insurance as to whether or not they have “met their 4% Guarantee Issue quota”. Once they have met their 4% quota, any future applicants with preexisting conditions are then referred to one of the other health insurers operating in Ohio who have not met their 4% quota and are then guaranteed coverage from that carrier. Did you know that Ohio has never maxed out the 4% quota for all carriers? Never. And, everyone has access to coverage for preexisting conditions in the state of Ohio. In fact, HHS – the Health & Human Services department – has adopted this concept for 2014.

5.) Even if you are totally disabled and no longer able to work because of a debilitating medical condition, you can apply for one of our country’s MANY safety nets called SSDI (Social Security Disability Income) and with it early Medicare benefits. Learn more @ www.disabilitysecrets.com

In case you missed that information, let me reiterate. 45 States in our Union provide Guaranteed Insurability to individual health insurance applicants, regardless of preexisting conditions for decades before the ‘Patient Protection and Affordable Care Act’, a.k.a. “Obamacare”. This is not what we were told by the President. 

In addition to the aforementioned existing legal options to pursue Guaranteed Issue Health Insurance for those with preexisting conditions. There are also over 1,200 “free” (subsidized by Tax Payers and Philanthropists) health clinics around the United States. Click “free” clinics in your State to find more information. If your situation is dire, Federal EMTALA law mandates that you must be treated without discrimination at your local emergency room.

If your child has a preexisting condition and you are at or below the Federal Poverty Level you are further entitled to the Federal SCHIP program, which is an extension of our Medicaid system. To find out if you qualify click here. If you do qualify be sure to see if your State has any money left. Some States like Arizona recently terminated their SCHIP program because the entitlement rendered them BANKRUPT

Many States like Illinois have already dramatically expanded their Medicaid programs to include Tax Payer funded health insurance for low income adults , women who are currently pregnant and women who have been diagnosed with Breast or Cervical Cancer. All of these benefits are provided to those without health insurance. In fact, in the State of Illinois, our All Kids Covered plan quite literally provides “free” health insurance to ALL indigent kids including the 75% of current recipients who are illegal aliens. On January 30, 2012, the Civic Federation released its “Budget Roadmap” for the coming fiscal year. In it, they highlight the fact that Illinois state officials now believe that the Illinois Medicaid program will have between $21 and $23 billion in UNPAID bills by 2017.

The President’s “Patient Protection and Affordable Care Act’ will make that Medicaid debt exponentially worse. Not just in Illinois but around the country in states that choose to further expand Medicaid. Medicaid is the worst and most dangerous health care program ever devised by man. Without reform, I truly fear for the lives of the 17 million Americans that the CBO predicts will be auto enrolled onto this program beginning in 2014.

Back in 2010 I spoke the TRUTH about preexisting conditions at the 2010 Chicago Tax Day Tea Party rally:

2013 UPDATE Did you know that the PPACA – ‘Patient Protection and Affordable Care Act” has now been adjusted to include the same guidelines that were originally written in 1996 HIPAA law? The one I referred to in my speech above? That’s right, beginning October 1, 2013 HIX – Health Insurance Exchanges will open all over the nation. And, instead of offering Guaranteed Issue coverage to all applicants whenever they want it – which would lead to ‘Adverse Selection’ like it did in Massachusetts – HHS has authorized ‘Open Enrollment’ periods. These “Open Enrollment” periods – the first one begins on October 1, 2013 and ends on March 31, 2014 – will work just like Group health insurance has worked for more than 17 years under HIPAA law. Applicants will be able to purchase a “Qualified Health Plan” from any health insurance carrier operating within these exchanges on a Guaranteed Issue basis – meaning you can not be denied coverage because you have a preexisting condition.

However, once the ‘Open Enrollment’ period is over, applicants will not be able to obtain health insurance on a Guaranteed Issue basis again until the next “Open Enrollment” period begins the following October of 2014 and ends December 31st, 2014. Then, if all goes as planned. Future ‘Open Enrollment’ periods will begin and end during the same annual time periods. Very similar also to Medicare “Open Enrollment” periods for seniors purchasing Medicare Part C or D.

This will help to inhibit ‘Adverse Selection’ and provide an impetus for consumers to maintain health insurance between “Open Enrollment” periods. Most especially since the aforementioned existing state based High Risk health insurance pools – and their existing insured – will eventually be absorbed into the HIX – Health Insurance Exchanges. This means that individual (non-Group) policy holders will no longer able to purchase coverage for preexisting conditions between the “Open Enrollment” periods. Make no mistake though. ‘Adverse Selection’ will still exist because the fine for not purchasing health insurance is far less expensive than actually purchasing health insurance. If this fine amount is not increased, ‘Adverse Selection’ will still continue. This coupled with ‘Community Rating’ is a recipe for disaster.

Please Note: The vast majority of health insurance carriers that underwrite Individual Health Insurance plans DO INDEED provide coverage for many preexisting medical conditions (such as Hypertension, Hyperlipidimia, Gastric Reflux, Asthma, etc.) providing that these conditions are well controlled by diet or medication AND you duly disclose these preexisting conditions on your health insurance application. This is important to know now because the President’s temporary PCIP – ‘Preexisting Condition Insurance Plan’ already ran out of money and has ceased further enrollment as of March 5, 2013.