Forbes Rick Ungar vs. C. Steven Tucker on Obamacare. For the record.

On May 24, 2013 Forbes columnist Rick Ungar wrote an article entitled “Unexpected Health Insurance Rate Shock – California Obamacare Insurance Exchange Announces Premium Rates“. In the article Mr. Ungar refers to a press release made the day earlier by Peter Lee – the Executive Director of Covered California – the new Obamacare exchange in that state. In the announcement Mr. Lee stated that the premium required for health insurance purchased in the new Covered California exchange would be lower than expected, significantly lower. This of course let to a veritable jubilee amongst the political Left. The article went ‘viral’ and was shared widely by those who falsely still believe that Obamacare is the solution for the American health care system’s woes.

The truth however is that on it’s face the article is based on a falsehood. A falsehood perpetrated by Mr. Lee himself. You see, Mr. Lee knew that the prices he released to the public in his press release on May 23, 2013 were based on a falsehood. Here’s how we know. On December 26, 2012 Mr. Lee wrote a letter to HHS secretary Kathleen Sebellius in which he stated the following: “California would like to consider designating a larger number of geographic rating areas in order to minimize rate shock.… We have concerns about the potential rate impact that this may have on younger individuals who are purchasing coverage in the individual market.” So you see, Mr. Lee was concerned about the impact that Community Rating would have on young people in the state of California. Chief amongst his concerns was the fact that because younger people would now be subsidizing the premiums for older people, the cost for young people to obtain health insurance would be dramatically higher.

So, instead of comparing the cost of the individual California Obamacare exchange plans which will be available to individuals in 2014 to the existing individual health insurance plans available to Californians today. He simply compared the rates for individual plans soon to be sold in the California Obamacare exchange to the rates for employer sponsored group health insurance plans available to Californians today. This makes a huge difference because individual health plans sold today do not include the “Essential Health Benefits” that they must include in 2014. Whereas the vast majority of employer sponsored group health insurance plans already include all of the ‘Essential Health Benefits’. Once the ‘Essential Health Benefits’ are added to individual health plans in 2014, the cost will increase substantially.

Less than a week after Mr. Ungar’s article was published, senior fellow at the Manhattan Institute – Avik Roy decided to run the real numbers and respond to Mr. Ungar’s hyperbolic piece in his column also at Forbes. It is a must read. Feeling a bit ‘wonky’ myself. I also felt compelled to post the following comment under Mr. Ungar’s article at Forbes which was picked up by my friends over at IownTheWorld.com. This lead to a one hour debate between Mr. Ungar and myself on the David Webb show on XM Satellite Patriot radio. You can download on MP3 of our debate here.

“This is lunacy. No actuary in the private sector (in their right mind) would publish fixed health insurance premiums 6 months before the release of a health plan. Only a government entity would do something so foolish. Furthermore, these rates assume that Community Rating will work. Community Rating has failed in all 8 states it has been implemented in before. Resulting in doubling, tripling and even quadrupling health insurance premiums in those unfortunate states. California’s HIX – Health Insurance Exchange – rates also assume that people will actually purchase these health plans. Since the ‘fine’ for not purchasing health insurance is only 1% of one’s MAGI – Modified Adjust Gross Income – in 2014. Many will simply pay that miniscule fine instead of purchasing health insurance. Most especially when they can get health insurance on a guaranteed issue basis, regardless of how sick they are during “Open Enrollment”. Once people begin opting out and paying the miniscule fine and waiting until they ‘need’ health insurance (this will happen, it’s human nature). These rates will have to be adjusted UP, significantly UP. It’s just a matter of time. The day of reckoning will come in 2014.

Historical precedent has already been sent. No government health care program has ever remained at or under it’s projected cost. Like the Medicaid special hospital subsidy which was projected to cost $100 million in 1987 and by 1992 costs had soared to $11 billion. That’s more than 100 times more expensive. Or Medicare Part A projected to cost $9 billion in 1965 and soared to $67 billion by 1990. Oh, and then there’s the PPACA – “Obamacare” which had initial cost projections of $960 billion (you know, so Barack Obama could say it cost less than $1 Trillion). Now the PPACA has been reassessed at a cost of $2.5 trillion. But I digress.

Health insurance premiums will continue to rise in 2014. In March of this year, the non partisan, highly respected Society of Actuaries came out with a comprehensive nationwide study on where health insurance premiums will be going post 2014. It does not look good. According to the study, health insurance premiums for individual policies will be increasing dramatically all over the country. Even though president Obama promised that our premiums would decrease under his law. In some states like Wisconsin premiums will increase as high as 80%. It’s important to understand the reason for this.

Beginning in October of this year, the first national “Open Enrollment” period will begin. During this “Open Enrollment” period Americans can purchase health insurance on a guaranteed issue basis without regard to their medical history. This means that many who have ongoing medical conditions will be heavily incentivized to purchase health insurance. Most especially with a federal mandate to do so in place. Whereas the young invincibles, who statistically have very few claims will most likely not purchase health insurance even with the mandate in place because the fine for not doing so is only 1% of their MAGI – Modified Adjusted Gross Income. This amount is so small compared to the high cost of health insurance in the exchanges that many of the young invincibles will simply pay the miniscule fine instead. Even when the fine graduates to a maximum of 2.5% in 2016 many will still pay that small fine instead of purchasing far more expensive insurance. This will lead to an unhealthy risk pool and will force the carriers to raise premiums to compensate for these losses. It’s just a matter of numbers and human nature. It is the nature of man to look out for his own best interests. Paying a miniscule fine instead of expensive health insurance just makes more sense.

The cost to taxpayers will be staggering. Many Americans have heard about the 2.5% tax on medical devices. The capital gains taxes and other taxes imposed under Obamacare but the most costly tax by far is the “Advance Premium Tax Credit”. If you visit the Kaiser Family Institute’s website you will find a Health Insurance Exchange calculator. Using this tool, you can determine right now what you will pay for health insurance in 2014. All you have to do is enter your income, age and the age of your dependents. The calculator accurately displays the premium required for health insurance in the exchange. For a family of four it will cost roughly $15,000 annually. However, if that family’s income falls below 400% of the Federal Poverty level (less than $94,200 annually) they will receive a gift from the taxpayers of more than $10,600 each and every year to artificially lower the high cost of Obamacare approved health insurance. That’s almost $11,000 a year for one family. Now, consider this. According to the Congressional Budget Office 20 million Americans will receive an Advance Premium Tax Credit. Where that money is coming from, I have no idea. Most especially when we are printing $85 billion a month and borrowing .46 cents of every dollar. This is precisely why the projected cost of Obamacare has soared from the initial projections of $960 billion to more than $2.5 trillion.

But that cost is going to be even higher. Once employers with 50 or more full time employees realize that they can reduce their fixed cost for health insurance down to $2,000 per employee (since that is the fine for not purchasing Obamacare approved health insurance). They will simply dump their employees onto the exchanges as a cost saving measure. Watch the CBO’s projections of 20 million receiving Advance Premium Tax Credits to more than double as we enter 2015. Millions and millions more Americans will lose their employer sponsored health insurance coverage. Again, it’s just a matter of numbers and human nature. It is the nature of man, to look out for his own self interest. Paying the $2,000 fine and saving hundreds of thousands of dollars in health insurance premiums is just human nature for the average employer. And frankly, it makes good business sense. Keeping your costs low is crucial for survival in this competitive marketplace. Obamacare is designed to fail. Period.” – C. Steven Tucker

During our debate Mr. Ungar stated that I wrote in this article that I penned for Jeremy Segal at Rebel Pundit.com that “seniors over 70 will be denied care next year”. The truth is I did not write that. I simply quoted the Neurosurgeon who called into the Mark Levin show. Nice try though Rick.

Also for the record, Rick stated that he tried to enroll in the California High Risk health insurance pool (MRMIB) for 5 years and was unable to do so because of ‘waiting periods’. I attempted to educate him to the fact that there are no waiting periods for HIPAA qualified applicants. Meaning one of 2 things:

1.) You are HIPAA qualified (meaning you have maintained employer sponsored health insurance for at least 18 months) and then you lose that coverage to no fault of your own and your employer does not offer you COBRA continuation coverage.

OR

2.) You are HIPAA qualified and lose your employer sponsored coverage, elect COBRA continuation coverage and exhaust that coverage. At the end of that 18 month period the California MRMIB risk pool MUST insure you and cover your preexisting conditions from day one. Providing of course that they are a covered expense on the policy.

The only applicants who wait (and waiting periods are now gone as of 1/1/14) are uninsured applicants who are not HIPAA qualified and attempt to purchase a policy in the individual market and are denied due to one or more preexisting conditions. For proof of this FACT read page 6 of the MRMIB application.

Lastly, Rick attempted to criticize me for not having any friends on the Left of the political spectrum. To clarify, I will use Webster’s definition of the word “friend”. Friend – Noun: a person you know well and regard with affection and trust. 

I do not trust the Left. So I do not have any ‘friends’ on the Left. For it is the Left who support Barack Obama. It is the Left who supported and voted for Obamacare. Not one Republican did.  It is the institutional Left, of which Rick is a proud member and defender who still support a president who has no regard for the rule of law, our Constitution or individual Liberty.

I do have a few acquaintances on the Left. They are not my friends, but they are learning the meaning of Liberty. When they fully understand individual Liberty and agree to embrace our Constitution and the rule of law and agree to fight for and protect the civil society. I will indeed consider them my friends. But friendship is earned and no matter what battle ground you are fighting on, a Patriot does not befriend the enemy.

P.S. Rick, per your request, I did indeed call the MRMIP program today and they verified precisely what I stated above.

Defund Obamacare by stopping IRS illegal act and starving Federally Faciliated exchanges.

Since our current GOP leadership does not have the political will to defund Obamacare and have funded it willingly in every CR – Continuing Resolution – since early 2011. Where we should be concentrating our efforts is on making sure that there is no money appropriated for federally-facilitated HIX – Health Insurance Exchanges. As it stands now, 27 states have rejected state-based health insurance exchanges. When a state rejects a state-based exchange, the PPACA legislation allows HHS to usurp our 10th amendment rights and establish a federally-facilitated exchange in that state whether the state legislature wants it or not. Section 1311 of the PPACA outlines the powers granted to the IRS to provide APTC – Advance Premium Tax Credits – that will be used to artificially lower the massive cost of health insurance in the exchanges. Tied to those APTC’s is also the power allotted to the IRS to penalize employers in that state (with 50 or more full-time employees) $2,000 or $3,000 per employee (first 30 employees waived). This is a LOT of new power granted to the IRS and this is the reason the IRS is hiring thousands of new agents.

However, section 1321 describes federally-facilitated exchanges that will be established in all 27 states that have rejected a state-based exchange. In these exchanges, the IRS is granted no such authority. In these federally-facilitated exchanges, the IRS has no power to provide APTC’s OR to penalize ANY employer in that state. Now, since the crafters of the PPACA assumed that every state would willingly establish a state-based exchange, there was NO money appropriated for federally-facilitated exchanges. And, here’s the kicker, in late 2011 the IRS simply wrote new law to empower themselves to be able to offer APTC’s and penalize employers in all 27 states that have wisely rejected a state-based exchange. Not only is this illegal since the IRS is not a Legislative branch but President Obama is planning on following that new law that was written by the IRS. Watch Michael Cannon of CATO discuss this issue below:

This illegal action and President Obama’s support of it has prompted the Oklahoma Attorney General E. Scott Pruitt to amend his lawsuit to include a section that sues the IRS for illegally writing new law and granting itself power that it was not granted in the PPACA as originally written. There have been zero funds appropriated for these federally-facilitated exchanges. And, it is up to us to sound the clarion horn to make sure every American knows this illegal action was taken by the IRS and to make sure that no debt ceiling deal, no CR and no bill is allowed to pass that provides funding for these federally- facilitated exchanges. Read more about Mr. Pruitt’s lawsuit here.

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.

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