Obamacare open enrollment for 2017. Highest premiums, fewest options and good luck finding a broker or agent.

November 1, 2016 will be the first day of the third national PPACA (Obamacare) open enrollment period. This will be the most challenging open enrollment period yet. Not only because we now have so few health insurers to choose from but also because residents in states like Illinois, Minnesota, Arizona, Montana, Oklahoma, Pennsylvania, Tennessee and new Mexico are now facing annual premium increases of 50% to 93%! The state hit hardest is Arizona with a historic 145% increase. These are the highest annual renewal increases in recorded history. I guess we’ll now have to wait until 2018 to enjoy that “$2,500 premium reduction for a family of four” that our dear leader promised us way back in 2009.

In my home state of Illinois a.k.a. “The People’s Republik of Madiganistan” we now have 17 LESS health insurance carriers to choose from than we did before the wonders of Obamacare were implemented. In fact, this year we’re now down to 3 major carriers. Namely, Aetna (and their company Coventry) United Healthcare (and their company Harken Health) and Blue Cross Blue Shield of Illinois. Of those three major carriers only one is offering ‘subsidized’ plans ‘on the exchange’. United Healthcare/Harken Health has pulled out of nearly every state exchange in the country and Aetna/Coventy has pulled out of 11 state exchanges, including ours. So, you can still buy Aetna, Coventry, United Healthcare and Harken Health plans but you cannot get a subsidy to lower the premiums even if you qualify. This should work out famously! Forward!

Why pay an agent or broker when you can have an unlicensed “Navigator” for free?

Oh, I almost forgot to mention! Commissions. Since the implementation of Obamacare thousands of licensed, experienced health insurance broker agents have left the industry entirely since our commissions were cut from an average of 20% of first year annualized premium to 6% but “hey, you’ll make it up in volume” the masterminds said. Tell me masterminds, how exactly are the few remaining licensed health insurance brokers like myself supposed to “make it up in volume” when Aetna, Coventry, United Healthcare and Harken Health have all made the decision to no longer pay ANY commissions? That’s right, all of these carriers have decided that they will no longer pay ANYTHING to agents and brokers. But never fear! You can always call your friendly unlicensed and inexperienced “Navigator” over at Healthcare gov to help you navigate the system. To all of my clients, don’t worry, you can still call me. I’ll figure out another way to eat.

Narrow PPO & HMO networks provide NO ACCESS to the best hospitals and specialists.

In the fall of 2015 our premier carrier, BCBSIL – Blue Cross Blue Shield of Illinois – made the decision to remove access to their “Broad PPO” for all policy holders who purchase their own individual and family policies (non-group plans). The “Broad PPO” includes access to Northwestern Memorial Hospital, the University of Chicago Medical Center, Rush University Medical Center and the Ann and Robert H. Lurie Children’s hospital (among others). That decision drove tens of thousands of unwitting Illinois consumers into the arms of “LOL Health” a.k.a. “Land of Lincoln Health” our state’s only Obamacare ‘co-op’. Last year, I warned every consumer I could via article, radio and in person that “LOL Health” had, at that time already suffered more than $90 million in net underwriting losses. They SHOULD have been placed into receivership BEFORE innocent Illinois consumers ended up without insurance. Sadly, it took our department of insurance an entire year to place “LOL Health” into liquidation. This action left many thousands of Illinois consumers without coverage and scrambling for alternatives one month BEFORE the next annual open enrollment period begins on November 1st. This, my friends is central planning at it’s absolute finest.

Great! What now? What am I supposed to do? My doctors are all at Northwestern?

Good question! Good question! There is still a way for individuals to buy a plan that includes a “Broad PPO” with access to Northwestern Memorial, University of Chicago Hospital and Rush University Medical Center and the Ann & Robert H. Lurie Children’s hospital BUT their is ONLY a 45 day window to do so. From November 1st to December 15th of 2016. To find out how, contact me after November 1st. Or, you can call those helpful “Navigators” over at Healthcare gov. I’m sure they have all the answers you need. Good luck with that.

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Aetna is leaving EXCHANGES in 11 states NOT the states themselves.

For clarification Aetna is not “leaving 11 states”. They are simply no longer offering SUBSIDIZED plans in those 11 states. If you purchased your Aetna plan OFF the exchange WITHOUT a subsidy you will most likely NOT lose your Aetna plan in 2017. Below is a statement from Aetna.

We will narrow our individual on-exchange participation for 2017

Individuals and families

Aetna believes that everyone should have access to high-quality health care at an affordable cost.  Over the past three years, we made significant investments in the individual public exchanges, working closely with regulators and lawmakers to provide options for consumers.  Unfortunately, the public exchange environment remains more volatile than expected. 

Following a thorough business review, we will reduce our individual on-exchange participation for 2017 to 242 counties, maintaining an on-exchange presence in Delaware, Iowa, Nebraska and Virginia.  We will continue to offer an off-exchange individual product option for 2017 to consumers in the vast majority of counties where we offered individual public exchange products in 2016.

These changes do not affect coverage for the 2016 plan year.  We will communicate to impacted members before the 2017 open enrollment period begins, and provide resources to assist them in transitioning to other plans as appropriate.

Policy changes are needed for the public exchanges to remain viable. The public exchange model needs to evolve from its current state to address the inadequate risk adjustment mechanism, increase product diversity and attract the remaining uninsured population who could improve the risk pool. 

Moving forward, we are hopeful that we can work with policymakers to create a sustainable solution that meets the needs of the uninsured.  With that in mind, we may expand our footprint in the future should there be meaningful exchange-related policy improvements.

Thank you for your continued support.  As per our normal practice each year, we will publish 2017 commission schedules before the start of 2017 open enrollment.       

Aetna health insurance plans are underwritten by Aetna Life Insurance Company, Aetna Health Inc., and/or by Aetna Health of Utah Inc. (Aetna).

Coventry health insurance plans are underwritten by Aetna Health Inc., Aetna Health of Iowa, Inc., Aetna Health of Utah Inc. and/or the following affiliates of Aetna Life Insurance Company: Coventry Health and Life Insurance Company, Coventry Health Care of Florida, Inc., Coventry Health Plan of Florida, Coventry Health Care of Kansas, Inc., Coventry Health Care of Nebraska, Inc., Coventry Health Care of Illinois, Inc. and Coventry Health Care of Virginia, Inc. 

Coventry Health Care of Georgia, Inc., Coventry Health Care of the Carolinas, Coventry Health Care of Delaware, Inc, Coventry Health Care of Louisiana, Inc., and HealthAmerica Pennsylvania, Inc., plans are underwritten by Aetna Health Inc. (8/16)

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Broker: Doomed business model, politics fuel Land of Lincoln failure

Broker: Doomed business model, politics fuel Land of Lincoln failure

Contributed photo

 

There is unquestionably a hefty amount of blame that should be laid on the role Illinois politicians played in the demise of Land of Lincoln Mutual Health Insurance Co., the Illinois Obamacare co-op that was in the Healthcare.gov marketplace, C. Steven Tucker, founder and principal broker at Health Insurance Mentors, said.

“The state has a tremendous responsibility,” Tucker said. “It’s not like they weren’t warned. It’s not like they didn’t know. A lot of this is ideological and political. People turned the other way because this was a co-op; and everybody wanted it to work because in their false ideas, they thought this was creating competition.”

Land of Lincoln is a 3-year-old nonprofit cooperative created under the Patient Protection and Affordable Care Act (PPACA), known colloquially as Obamacare, during Democratic Gov. Pat Quinn’s last term in office.

U.S. Rep. Randy Hultgren (R-Dist. 14) said the failure of Land of Lincoln and other co-ops like it, and Obamacare as a whole, has left health care consumers in worse shape than before the bill’s passage.

“The end of Land of Lincoln means the end of affordable health coverage for tens of thousands of people in my home state,” Hultgren said. “The ACA-mandated insurance exchange will now be left with even fewer, more expensive options as the law cripples under its own weight. States can’t take this anymore.”

The co-ops were created to spark competition in state insurance marketplaces. Land of Lincoln has some 10,000 policyholders who received coverage through their employers and roughly 39,000 enrollees who bought insurance on HealthCare.gov or through a broker, like Tucker.

The only nonprofit health insurer formed in Illinois under Obamacare went operational in 2013, after being passed by a Democrat-controlled General Assembly and signed into law by Quinn, with a $160 million loan from the U.S. government. Since then, financial issues had been strangling Land of Lincoln for months. The failed insurer had seen a loss of more than $90 million last year, and it owes a payment of $31.8 million to other insurers as part of the risk-balancing stipulations of the PPACA.

Prior to the Illinois Department of Insurance takeover on July 14, Land of Lincoln sued the federal government for an estimated $80 million the company said it is owed because the federal government allegedly violated federal law and cut funding for a federally authorized program.

Now the Illinois Department of Insurance has taken control of Land of Lincoln’s operations to ensure its claims are paid, debts are collected and assets are liquidated, the department, which is working with the federal government to institute a “special enrollment” period in the marketplace, said.

This special enrollment period would give Land of Lincoln policyholders 60 days to obtain new coverage from another plan on the Illinois exchange. If this special enrollment opens Aug. 1, as hoped, Land of Lincoln coverage would end Sept. 30.

So in the end, Tucker said, competition hasn’t been created.

“When you wipe out 17 health insurance companies since the passage of the PPACA, that’s where your competition went,” Tucker said. “The creation of taxpayer-funded entities to create so-called competition is not creating competition, and the evidence of that is the death of 17 of the 23 co-ops thus far.”

Furthermore, Tucker said the remaining co-ops will go under by the end of the year because their formation has been based on a bad business model that has set them up for failure, i.e., extremely low-interest-rate loans from the federal government, governing boards and CEOs inexperienced in the health insurance industry and no reserves to pay claims.

“But the Illinois Department of Insurance looked the other way because it’s Obamacare; it’s the president’s signature law,” Tucker said. “But when you look the other way, and you don’t do your job as a regulator, these are the consequences, and innocent people suffer.”

In addition, four of the state’s major teaching hospitals – the University of Chicago Medical Center, Northwestern Memorial Hospital, the Ann and Robert H. Lurie Children’s Hospital, and Rush University Medical Center, all in Chicago — should carry some of the burden, Tucker said.

“Most shamefully, besides the Department of Insurance not taking action when they should have, are these hospitals that promoted replacing Blue Cross Blue Shield of Illinois policies with Land of Lincoln health policies,” Tucker said.

Tucker said all four hospitals were recommending such policy replacements with Land of Lincoln health policies when the co-op was $90.8 million under water.

“So they recommended enrolling these people into a co-op that was already upside down,” Tucker said. “That is just reprehensible, and that’s why thousands of these consumers are now in this situation.”

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Shutdown of Land of Lincoln leaves consumers with limited choices

Shutdown of Land of Lincoln leaves consumers with limited choices, expert says

Kim Sunderland Jul. 19, 2016

The recent failure of the Land of Lincoln co-ops leaves consumers with limited choices, according to expert. | Courtesy of Shutterstock

For the last two years, Steven Tucker, a health activist, has been warning consumers about the pending demise of Land of Lincoln Mutual Health Insurance Co., Illinois’ Obamacare co-op on the HealthCare.gov marketplace.

Now that the shutdown of the company by the Illinois Department of Insurance has officially been announced, Tucker — who is also the founder and principal broker at Health Insurance Mentors — is relieved.

“Finally … the Illinois Department of Insurance has taken action and shut them down,”he recently told Patient Daily News. “Unfortunately, that’s going to disenfranchise about 49,000 people, who — if the Department of Insurance had acted when they should have prior to the last open enrollment period that began Nov. 1, 2015 — they would have protected thousands of those consumers from being in this situation.”

Land of Lincoln is a three-year-old nonprofit cooperative created under the Patient Protection and Affordable Care Act (PPACA), known colloquially as Obamacare. The co-ops were created to spark competition in state insurance marketplaces.

Land of Lincoln was created when Democrat Gov. Pat Quinn was in office,something Tucker said would have been unlikely if current Gov. Bruce Rauner, a Republican who took office in 2015, had been heading the state at the time.

The only nonprofit health insurer formed in Illinois under Obamacare went operational in 2013 with a $160 million loan from the U.S. government. Since then, financial issues have been strangling the company for months. The failing insurer had seen a loss of more than $90 million last year, and it owes a payment of $31.8 million to other insurers as part of the risk-balancing stipulations of the PPACA.

Prior to the Illinois Department of Insurance takeover on July 14, Land of Lincoln sued Uncle Sam for an estimated $80 million the company claims it is owed because the federal government has allegedly violated federal law and cut funding for a federally authorized program.

Now the Illinois Department of Insurance has taken control of Land of Lincoln’s operations to ensure its claims are paid, debts collected and assets liquidated, according to the department.

Land of Lincoln has some 10,000 policyholders who received coverage through their employer and roughly 39,000 enrollees who bought insurance on HealthCare.gov or through a broker, like Tucker.

“This is the worst time for them to lose their coverage because we’re in the nap period, the period between open enrollment periods when you have to have a qualifying life event,” Tucker said. “Thankfully, the loss of coverage is a qualifying life event and they can get other coverage.”

But the tough part for Land of Lincoln policyholders is that the other insurance companies are no longer paying brokers like Tucker to sell health insurance or to advise them on obtaining new coverage.

“That means no commissions at all,” he said. “So it’s going to be very difficult for them to find brokers who are willing to work for free during this period to help advise them.”

While Tucker said that he will do it, there are a lot of brokers out there who will not.

“It’s a very, very caustic environment for these consumers — and for all consumers for that matter during the nap period — because their only advice then is a navigator on HealthCare.gov, and these are unlicensed people with very little experience in this industry,” he said. “It’s really a mess.”

The Illinois Department of Insurance, meanwhile, is working with the federal government to institute a “special enrollment” period on the marketplace that would allow Land of Lincoln policyholders 60 days to obtain new coverage from another plan on the Illinois exchange. If this special enrollment opens Aug. 1, as hoped, then Land of Lincoln coverage would end Sept. 30.

“At least now, because Land of Lincoln has officially gone under, now these people have a special enrollment period and they can seek other coverage,” Tucker said. “They’re just going to have difficulty getting that coverage because brokers aren’t being paid. That’s what you describe as a train wreck.”

By the end of the year, Tucker expects that the remaining six co-ops of the original 23 created under Obamacare will follow in the footsteps of Land of Lincoln and the other failed companies. He blames the Illinois Department of Insurance in this case.

“When you look the other way and you don’t do your job as a regulator, these are the consequences — and innocent people suffer,” he said.

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Donald Trump’s health care plan is NOT a Single Payer Socialized medicine plan.

Long before Mr. Trump published his health care plans on his campaign web site on March 1, 2016 he outlined his plans in both of his books “Time To Get Tough” from 2011 and his latest book “Crippled America” from 2015. I have linked the pertinent sections pertaining to Mr. Trump’s health care policy proposals as outlined in those two books below.

CLICK HERE TO READ CHAPTER 8 of Mr. Trump’s book “Time To Get Tough“.
CLICK HERE TO READ CHAPTER 7 of Mr. Trump’s book “Crippled America.”

Contrary to a popular but false narrative, Mr. Trump does not propose a “Single Payer Socialized Medicine” plan now nor did he propose such a plan when he first penned his actual plans in his book “Time To Get Tough”. As you read through chapter 8 of “Time To Get Tough” and you read through chapter 7 of “Crippled America” you will not find Mr. Trump calling for a “Single Payer Socialized Medicine” health care plan anywhere. In fact, in chapter 7 of “Crippled America” you will find that Mr. Trump specifically disavows his tepid and earlier consideration of a Single Payer system as one of the options he was considering as a person in the private sector more than 15 years ago. Mr. Trump starts his plan with repeal and replacement of the PPACA a.k.a. “Obamacare”. This begs the question, replace with what?

In both of Mr. Trump’s books he calls for the following private sector reform alternatives. Some of which are also called for under Dr. Ben Carson’s plan among others. In addition to federal and state reforms, they include:

1.) Repeal of the McCarran Ferguson Act so health insurance can be sold across state lines.
2.) Expansion of Health Savings Accounts to promote price transparency & accountability.
3.) Tort (or Medical Malpractice Reform)
4.) Reform of our health care safety nets including block granting Medicaid back to the states so states have more control.
5.) Mr. Trump has most recently added necessary reforms to be made to our broken Veteran’s Administration health care system specifically because it, like all other Single Payer systems is an unmitigated disaster!

“But Steve, Trump said he wants “Universal Healthcare! I heard him say it on CBS!!” Yes, he did. So what does Mr. Trump mean by “universal” healthcare? For that we simply have to look up the definition of the word ‘universal”. According to Miriam Webster’s dictionary the term “universal” means “existing or available for everyone”. That does not mean ‘Single Payer’ nor does it mean ‘Socialized Medicine’. It does mean a health care system where everyone has access to some form of health care delivery. That is what I want. That is what nearly every politician on both sides of the isle wants. Affordable access to health care services for everyone. How do we do that? When it comes to Medicaid, you can look to former Governor Mitch Daniel’s reforms that worked in Indiana or more recently to Governor Scott Walker’s reforms that were made in Wisconsin. There are other ideas also.

Most importantly when it comes to the vast majority of Americans this is what Mr. Trump actually said at the end of chapter 7 of “Crippled America” and I quote:

“The government doesn’t belong in health care except at the very last resort. The main way the government should be involved is to make sure the insurance companies (not a top down, authoritative single payer health care system) are financially strong so that if there is a catastrophic event or they make some kind of miscalculation, they have the resources they need to handle it.”

Mr. Trump also said in the beginning of chapter 7 of “Time To Get Tough” and I quote:

“..we still need a plan to bring down health care costs and to make health care insurance (not a top down, authoritative Single Payer health care system) more affordable for everyone. It starts withincreasing competition between insurance companies. Competition makes everything better and more affordable.”

Providing a safety net is NOT a “Single Payer Socialized Medicine plan for all Americans

But Steve! Trump said “the government is going to pay for it.” I saw it on CBS!” Yes, he did. Firstly, the government pays for nothing. It confiscates wealth from taxpayers and redistributes it. Secondly, we taxpayers already pay to provide health care services to millions of our nation’s indigent and those who are developmentally disabled. Some of the health care programs that ‘the government pays for’ include:

1.) Ronald Reagan’s E.M.T.A.L.A which requires every hospital that accepts Medicare and Medicaid (which is nearly all of them) to care for any patient who presents with an emergency “regardless of their ability to pay.” Oh my gosh! Reagan was a SOCIALIST!??

2.) Medicaid which provides either taxpayer funded access to health care services or subsidized private health insurance on a sliding income scale for the indigent and the developmentally disabled.

3.) S.C.H.I.P which was a bipartisan piece of legislation written to ensure that children of parents – who make too much to qualify for Medicaid but too little to afford private health insurance – have access to health insurance on a sliding income scale.

We also subsidize programs such as Medicare Part C & D and other health care programs. We will continue to do so because Americans are compassionate people who seek to help those who aretruly in need. I say truly in need because under the PPACA (Obamacare) we expanded Medicaid to single adults without children who happen to fall below 138% of the Federal Poverty Level. In doing so we robbed those finite resources from single mothers and the developmentally disabled. That is not helping those who are truly in need and this among other reasons is why Mr. Trump wants Obamacare repealed and replaced with a “universal” health care system that encourages more competition among private health insurers for most of us with an emphasis on reforming how taxpayers pay for our health care safety net.

In the video linked below, Johns Hopkins 2015 Physician Of The Year, Ramin Oskoui confirms that Donald Trump is NOT proposing a “Single Payer Socialized Medicine” plan:

Handling preexisting conditions in the individual health insurance marketplace. 

What I found lacking in Mr. Trump’s proposals is specifically how preexisting conditions will be covered in the individual health insurance market place. Some Republicans are proposing a preexisting solution to preexisting conditions. They rely upon protections that existed before the PPACA as outlined in sections 2741 and 2744 of 1996 HIPPA law for those who are HIPAA qualified. This means that they have maintained existing coverage for at least 18 months with no lapse in coverage of more than 63 days. These insured members would have guaranteed access to coverage for preexisting conditions in the individual marketplace via:

A). A state high risk health insurance pool – which existed in 35 states long before PPACA
B.) A guarantee issue individual mandate – which existed in 10 states – including Ohio – long before the PPACA
C.) A state mandated replacement policy – which is required to be offered in the states that did not have one of the two aforementioned options under section 2744 of HIPAA.

That is one option that Mr. Trump could consider. That option would require rebuilding and refunding that preexisting state infrastructure since that was largely abolished because it was no longer necessary upon full implementation of the PPACA in 2014.

This brings me to Mr. Trump’s other option. To keep our existing national 90 day open enrollment period which was originally an idea used by 10 different states long before the PPACA. However, if Mr. Trump chooses this option, he absolutely must correct the mistake made by the ‘masterminds’ who wrote the PPACA. That mistake was not allowing health insurers to underwrite normal paper throughout the year. This was allowed in states like Ohio (and 9 other states) long before the PPACA. In fact, that’s where the ‘authors’ of the PPACA got the idea of a short annual open enrollment period for those with preexisting conditions. The state of Ohio was doing that for all Ohio residents for years before the PPACA. However, Ohio regulators did not stop health insurers from underwriting individual health insurance coverage throughout the rest of the year. So, people with preexisting conditions that were severe enough to warrant a decline (cancer, diabetes, morbid obesity etc.) could purchase health insurance during the annual open enrollment window and everyone else could buy health insurance throughout the rest of the year whenever they wanted. Best part? That system worked remarkably well without the unconstitutional imposition of an ‘individual mandate’ to purchase health insurance.

By allowing health insurers to underwrite other consumers with less severe preexisting conditions like Hypertension or Hyperlipidimia throughout the rest of the year, health insurers were able to mitigate the risk they would have to assume during the annual open enrollment period. The ‘masterminds’ who wrote the PPACA decided that part wasn’t such a good idea to include. You know, because they didn’t want those ‘evil’ insurance companies ‘discriminating’ against anyone. How exactly is that ‘discriminating’ when the carriers were still offering those consumers coverage and covering their preexisting conditions? It’s not, but the masterminds of the PPACA decided to place their Leftist ideology ahead of time tested and proven business models. Surely we can do better.

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Donald Trump posts health care reform plans on his site. No Socialized Medicine. Will Senator Cruz do the same?

There is now no longer any excuse for senator Ted Cruz to continue with his false narrative that Donald Trump supports a Single Payer Socialized Medicine plan just like Hillary and Bernie’s plan. Mr. Trump’s healthcare reform plans are now on his website and like in his books there is no call for a “Single Payer Socialized Medicine plan exactly like Hillary and Bernie’s plan” as Senator Cruz keeps falsely asserting. In fact, Mr. Trump’s reforms rely on common sense Conservative reforms whilst also ensuring we have a working safety net for the indigent and for our developmentally disabled who WANT access to health care services. There is no ‘individual mandate’ because Mr. Trump calls for full repeal of Obamacare “not keeping Obamacare” as senator Cruz also continues to falsely assert.

As a delegate for senator Cruz I am now calling on senator Cruz to post his health care reform plans on his website so everyone can finally see just how close both candidate’s health care reform plans are, just as I stated they were. The time for transparency is long past due.

To the hundreds of Cruz supporters who called me a ‘liar, traitor and on Trump’s payroll” you are all forgiven. Can we please just work together now to defeat the democrat candidate who actually does want a “Single Payer Socialized Medicine” plan? #NEVERHILLARY 

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Donald Trump, Socialism and preexisting conditions.

Well it has now been more than two weeks since my last post which proved by linking to Donald Trump’s written health care policy proposals that Mr. Trump does not support a “Single Payer Socialized Medicine” system. Since I wrote that piece I have been basking in the hate of Ted Cruz supporters – many of whom neither read my piece or Mr. Trump’s written policy proposals linked within. So, I have decided to write a new piece for all who are still interested in my take on health care policy. I can only assume that does not include hundreds of my fellow Conservative former friends and allies who are Ted Cruz supporters who have since blocked me on Facebook and Twitter after leaving encouraging comments like “you’re a f*cking liar and a traitorous piece of sh*t“. “Believe me” I’m “feeling the burn” and it’s not coming from Bernie Sanders supporters or an untreated STD.

The hate is unfortunately coming from my fellow Conservatives who are so ideologically opposed to a Trump presidency that they are willing to ignore his current proposals and instead find every opinion piece they can find that links to interviews Trump gave 15 years ago (or earlier) in a failed attempt to prove that Mr. Trump supports a “Single Payer Socialized Medicine” system. Even though Mr. Trump has stated repeatedly in print and verbally that he abandoned consideration of such a plan for the United States long before writing his current proposals contained in chapter 8 of his 2011 book entitled “Time To Get Tough” and chapter 7 of his 2015 book entitled “Crippled America”.

Providing a safety net is NOT “supporting Socialized Medicine for all Americans

What you will find in those two chapters of Mr. Trump’s most recent books are free market health care reform proposals that are remarkably similar to Ted Cruz’s health care reform proposals. I wrote about Ted Cruz’s “Healthy Choice Act of 2015” shortly after it was released last year. Both candidates propose the following:

1.) Repeal of the PPACA (Obamacare)
2.) Repeal of the McCarran Ferguson Act so health insurance can be sold across state lines.
3.) Expansion of Health Savings Accounts to promote price transparency & accountability.
4.) Tort (or Medical Malpractice Reform)
5.) Mr. Trump has most recently added private sector reforms to be made to our broken Veteran’s Administration health care system specifically because it, like all other Single Payer systems is an unmitigated disaster!

It is unfortunately rather difficult for the average person to determine the similarities between both candidate’s plans because neither Mr. Trump or Mr. Cruz have their health care policy proposals linked on their websites and that needs to change yesterday.

Preserving and reforming existing health care safety nets

There’s something else you will discover when you compare Mr. Trump’s proposals to Mr. Cruz’s proposals. Neither candidate proposes abolishing our existing health care safety nets. They include the following:

1.) Ronald Reagan’s E.M.T.A.L.A which requires every hospital that accepts Medicare and Medicaid (which is nearly all of them) to care for any patient who presents with an emergency “regardless of their ability to pay.” Oh my gosh! Reagan was a SOCIALIST!??

2.) Medicaid which provides either taxpayer funded access to health care services or subsidized private health insurance on a sliding income scale for the indigent and the developmentally disabled.

3.) S.C.H.I.P which was a bipartisan piece of legislation written to ensure that children of parents – who make too much to qualify for Medicaid but too little to afford private health insurance – have access to health insurance on a sliding income scale.

So, either Donald Trump and Ted Cruz are both ‘Socialists’ seeking to ‘subvert our Constitution’ by implementing ‘Socialized Medicine’ or far too many Americans are either ignorant about actual health care policy or willfully ignorant and choose instead to promulgate a false narrative to advance an agenda…..but I digress.

Two options for covering preexisting conditions in the individual marketplace

What I found lacking in Donald Trump’s proposals but clearly outlined in Ted Cruz’s proposals is specifically how preexisting conditions will be covered in the individual health insurance market place. Senator Cruz proposes a preexisting solution to preexisting conditions. He relies upon protections that existed before the PPACA as outlined in sections 2741 and 2744 of 1996 HIPPA law for those who are HIPAA qualified. This means that they have maintained existing coverage for at least 18 months with no lapse in coverage of more than 63 days. These insured members would have guaranteed access to coverage for preexisting conditions in the individual marketplace via:

A). A state high risk health insurance pool – which existed in 35 states long before the PPACA
B.) A guarantee issue individual mandate – which existed in 10 states – including Ohio – long before the PPACA
C.) A state mandated replacement policy – which is required to be offered in the states that did not have one of the two aforementioned options under section 2744 of HIPAA.

That is one option that Mr. Trump could consider. That option would require rebuilding and funding that preexisting state infrastructure since that was largely abolished because it was no longer necessary upon full implementation of the PPACA in 2014.

This brings me to Mr. Trump’s other option. To keep our existing national 90 day open enrollment period which was originally an idea used by 10 different states long before the PPACA. However, if Mr. Trump chooses this option, he absolutely must correct the mistake made by the ‘masterminds’ who wrote the PPACA. That mistake was not allowing health insurers to underwrite normal paper throughout the year. This was allowed in states like Ohio (and 9 other states) long before the PPACA. In fact, that’s where the ‘authors’ of the PPACA got the idea of a short annual open enrollment period for those with preexisting conditions. The state of Ohio was doing that for all Ohio residents for years before the PPACA. However, Ohio regulators did not stop health insurers from underwriting other coverage throughout the year. So, people with preexisting conditions that were severe enough to warrant a decline (cancer, diabetes, morbid obesity etc.) could purchase health insurance during the annual open enrollment window and everyone else could buy health insurance throughout the rest of the year whenever they wanted. Best part? That system worked remarkably well without the unconstitutional imposition of an ‘individual mandate’ to purchase health insurance.

By allowing health insurers to underwrite other consumers with less severe preexisting conditions like hypertension or hyperlipidimia throughout the rest of the year, health insurers were able to mitigate the risk they would have to assume during the annual open enrollment period. The ‘masterminds’ who wrote the PPACA decided that part wasn’t such a good idea to include. You know, because they didn’t want those ‘evil’ insurance companies ‘discriminating’ against anyone. How exactly is that ‘discriminating’ when the carriers were still offering those consumers coverage and covering their preexisting conditions? It’s not, but the masterminds of the PPACA decided to place their Leftist ideology ahead of time tested and proven business models. Surely we can do better.

To learn more about preexisting conditions visit: TruthAboutPreexistingConditions.com

March 2, 2016 UPDATE: Mr. Trump posts healthcare reform plans on his website. No “Single Payer Socialized Medicine” included.

 

 

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