Just so everyone understands correctly. Thanks to the failure of certain Republicans to pass the American Health Care Act which would have provided immediate relief to MILLIONS of Americans, the PPACA (Obamacare) Individual Mandate is still FULLY in force and codified by IRS law. In addition, the Employer Mandate is still FULLY IN FORCE and codified by IRS law. So, we will still be a “Part -Time” nation until at least 2019. There is a REASON both the Individual and Employer mandates were “zeroed out” and set to be repealed in the AHCA. It’s because President Trump’s executive order is just that, an order, it is NOT codified law. The AHCA would have ensured that his order became codified law and that the IRS code was permanently changed officially so that no one ever pays those penalties again. Also, for the 19 million Americans who have to purchase their own health insurance, be prepared for premium increases of at least 50% next year, if you can find a health plan since there is now only ONE carrier left to ‘choose’ from in 1/3rd of our nation’s counties. Buy hey, what do I know? I’ve only been doing this for 21 years. I’m sure the “Freedom Caucus” knows better than I do. Keep waiving those flags everyone, forget about ADVANCING them. “The enemy of better is perfect.” – Dennis Prager
Obamacare Individual and Employer mandates are still codified IRS law now that Republicans failed to pass AHCA.
It’s been a while since I’ve put fingers to keyboard to write about health care policy. That’s primarily due to the fact that I’ve been a bit busy for the last four months helping consumers navigate what is left of the individual health insurance marketplace during the annual PPACA (Obamacare) open enrollment period. I say “what is left” because we have lost 19 health insurance carriers since the passage of Obamacare and the taxpayer funded Obamacare co-op ‘health insurers’ that were supposed to replace them are also now bankrupt. This rapid demolition of the individual (non employer sponsored) health insurance market place has robbed my clients not only of access to their doctors but also to their preferred hospitals. Worse yet, they have lost their health plans every year now for 4 years in a row and their health insurance premiums have increased up to 150% since the passage of Obamacare. In other words, they have been forced to endure the exact opposite of what they were promised by Barack Obama and the Democrat party.
To say the individual health insurance marketplace in this country is in a dire situation is an understatement. In fact, if something is not done now to preserve what is left of that marketplace, we will have no health insurance carriers left to choose from in 2018. United Healthcare has already exited after losing more than a billion dollars. Aetna exited after losing more than half a billion dollars and Humana now has wisely exited the marketplace as well in most states. This leaves consumers with a monopoly dominated mostly by Blue Cross entities all of which have lost hundreds of millions of dollars since the inception of Obamacare. These few remaining carriers will not continue to contribute to their own demise forever. Something has to be done now, not later and that is the impetus behind the current GOP proposal to repeal and replace Obamacare. This is also why myself and other health care policy experts like Betsy McCaughey support the proposal. It is also important to note that because President Trump is an intelligent, informed and proven leader, he too supports this plan. Why? Because he understands how dire the situation currently is and how many people will be “hurt and hurt badly” if we do not act NOW. Watch his weekly address by clicking below:
To be frank, if you’re just reading this and you’ve never been on the other end of the phone with a woman with Ovarian cancer who’s calling you for help whilst she’s lying in her bed at Northwestern Memorial hospital weeping because she can no longer receive care there, you cannot possibly understand how dire the situation is. The worst part is that for the first time in my 20 year career as a licensed health insurance broker, there was nothing I could do to help this woman. There were literally no other options for her. There were only two other carriers I could offer her and those carriers offer only restrictive HMOs, none of which provide access to her preferred hospital or any of our other teaching hospitals. There are 19 million Americans just like her who are self employed sole proprietors and as such have to purchase their own health insurance in the individual marketplace. Their choices will soon be zero if something is not done now to incentivize health insurance carriers to once again reenter the individual health insurance marketplace. Already nearly 1/3rd of all counties in this nation have only ONE health insurance carrier to choose from. Soon it will be NONE.
The American Health Care Act
So, how do we accomplish that? The Republican party has chosen to do so in three phases. Paul Ryan did a power point presentation and I must say as a guy who has given hundreds of power point presentations, Ryan did a very good job explaining the process and I encourage you to watch it by clicking on the image below. I’m going to go a few steps further by breaking it down even more in bullet points listed below the video.
As aforementioned, three phases comprise the process of developing what will eventually be known as “The American Health Care Act“. They are as follows:
1.) The first phase of the GOP’s current proposal to repeal and replace Obamacare is the Budget Reconciliation Bill released on Monday March 6, 2017 which goes a long way towards doing so. Because it deals with only budgetary issues, it only requires 51 votes in the U.S. Senate to pass which means it should pass quickly. This budget reconciliation bill accomplishes the following:
a.) Repeals $600 billion in Obamacare taxes AND the individual & employer mandates. This means we will no longer be a ‘part time nation’ and individuals will no longer be unconstitutionally TAXED by a rogue I.R.S. for simply existing and refusing to purchase overpriced, government designed and mandated health insurance plans. It also repeals the 2.35% Obamacare payroll tax hike and the 3.8% tax on unearned income (capital gains).
b.) Puts caps on Medicaid enrollment to discourage over spending and allows states to structure their own Medicaid programs in order to better serve their Medicaid recipients.
c.) Creates innovation grants for states to redevelop health insurance risk abatement programs such as high risk pools which were abolished under Obamacare. These high risk pools help isolate and better control costs for those with the highest health care costs which makes health insurance for the healthy less expensive.
d.) DOUBLES the amount one can deposit into an HSA.
e.) STOPS all abortion funding under Obamacare.
f.) Creates a tax favored status for individual health plans by providing a refundable tax credit to purchase those plans. Currently there is no tax favored status for individual health insurance plans. Tax favored status has traditionally only been awarded to employer sponsored group health insurance plans. Ever try to deduct your health insurance premiums as a sole proprietor? Or for that matter deduct any of your medical costs above 10% of your A.G.I.? It isn’t possible now. If the American Health Care Act passes, sole proprietors will finally enjoy tax favored status for purchasing their own individual health insurance. It’s about damned time! In addition those who are not offered coverage via an employer will have a portable refundable tax credit to help pay for health insurance and a refundable tax credit is NOT a ‘subsidy’ that you did not EARN. It is simply a way of you keeping more of YOUR money by not paying as much in taxes so that you can use it to pay for health insurance. It is NOT a ‘new entitlement’ Rand Paul… but I digress.
g.) Covers preexisting conditions but rightfully penalizes those who attempt to game the system by waiting until they are sick to purchase health insurance. Such conduct increases health insurance costs for everyone and that is why that conduct was originally prohibited under 1996 HIPAA law. That law outlined specific waiting periods before one could qualify for coverage for preexisting conditions if they did not keep consistent health insurance coverage in place. There were also financial penalties for those who attempted to game the system that way. Obamacare allowed anyone who claimed a ‘loss of income’ to game the system throughout the year by jumping on and off health plans which resulted in massive losses to health insurers and their subsequent exit from the marketplace. That conduct MUST stop and the only way to do so is to penalize such bad behavior and no Rand Paul the 30% penalty (which is far too low) is not “another individual mandate”! It is instead proper management of risk. The Obamacare individual mandate was an unconstitutional IRS enforced penalty for simply existing and refusing to purchase overpriced, government designed and mandated health insurance! Without such proper management of risk which includes the aforementioned penalties for bad behavior we will have more of the same and by that I mean fewer choices, higher prices and a rapid collapse of the entire individual health insurance marketplace. “NeverTrumper” Rand Paul was WRONG about President Trump during the election and he is WRONG about the American Health Care Act. Period.
2.) The second phase will be performed by our new H.H.S. Secretary Dr. Tom Price who will roll back the massive pile of regulations that were put in place by the fourth branch of government known unaffectionately as the ‘administrative state’. There are 1,400 references in the Obamacare legislation that state “the secretary may” or “the secretary shall” so Dr. Price can fix or roll back a lot of things on his own as our new H.H.S. Secretary.
3.) The third phase is the final repeal legislation which will take an act of congress requiring 60 votes. It will take longer because of this to pass and be signed by President Trump but no longer in my estimation than summertime. This is so because health insurers have to begin providing their 2018 plans and prices for review by state and federal regulators in the early fall of this year. So, there isn’t a lot of time for this final bill to pass. Vice President Mike Pence stated that we could see this legislation by April and I concur. This legislation will include all other things that we Conservatives want in a repeal and replace legislation. Those things include:
a.) “Selling across state lines” a.k.a. repeal of the McCarron Ferguson Act which requires and act of congress and 6o votes and cannot be done via the budget reconciliation process.
b.) Repeal of the Obamacare mandates on health insurers so they can offer new plans that are less expensive and do not include all of the onerous Obamacare mandates, many of which required coverage for non medically necessary expenses like sexual reassignment surgery, maternity for 64 year old women and so much more. This of course also requires an act of congress and 60 votes and cannot be done via the budget reconciliation process.
c.) Association health plans so that groups of people who work in the same field can pool together and purchase lower priced, group health insurance plans.
d.) Medical Malpractice Reform a.k.a. “Tort” reform.
e.) The income threshold for the deductibility of medical expenses drops from 10% to 5.8% which will provide $85 billion in tax relief to individuals
f.) Other parts of Dr. Tom Price’s reform legislation originally released in 2009 entitled “Empowering Patient’s First” which is the best piece of health care reform legislation I have ever read and I have read many. This is the template for the final repeal bill along with Paul Ryan’s “A Better Way” which he also worked with Dr. Price in devising.
But Steve! Why can’t we just suspend the filibuster and repeal and replace the whole thing all at once?! Because there is not enough political will to do so in the U.S. Senate and Senate Majority Leader McConnell has stated that he is not willing to do so. Why? Because there are political ramifications for doing so which could easily come back to haunt us in the future if we lose our narrow Senate majority. Just ask Harry Reid. Why expose ourselves to that risk if there is another way forward?
In conclusion as Dennis Prager said so eloquently “the BEST is the ENEMY of the BETTER“. In other words when you spend all your time screaming for the best you inhibit the progress currently being made on the better and the American Health Care Act is far, FAR better than Obamacare. As Dan Proft also said so eloquently, “instead of WAIVING the flag, help ADVANCE the flag.” This is the BEST shot we have had in 7 LONG years to repeal and replace Obamacare. Please everyone, let us work TOGETHER to get this done!
March 21, 2017 UPDATE: 7 EXCELLENT manager’s amendments added to President Trump’s American Health Care Act thus far:
1.) End most of Obamacare taxes THIS year, not next year.
2.) BAR any new states from expanding Medicaid.
3.) Establish a WORK REQUIREMENT for Medicaid enrollee adults who aren’t disabled, elderly or pregnant; states that institute a work requirement would receive a 5% extra administrative payment.
4.) Give states the option to receive Medicaid funding in a BLOCK GRANT or receive it in the form of per-capita allocations.
5.) Increase the growth rate of capped federal payments to the states for elderly and disabled beneficiaries by the medical component of the consumer price index plus one percentage point.
6.) Delay implementation of the Obamacare excise tax on high-value employer health plans for an additional year, from 2025 to 2026.
7.) Establish a reserve fund of at least $75 billion for tax credits to help Americans between the ages of 50 and 64 better afford health insurance with larger tax credits. The original amount was $4,000 for those over the age of 60. Read all the amendments here.
For an excellent fact based comparison between the PPACA (Obamacare) and the AHCA -American Health Care Act – see this > Kaiser Family Foundation comparison grid.
P.S. To Daniel Horowitz. SHAME on you sir for writing this hyperbolic TRIPE at Conservative Review. The Budget Reconciliation bill which you shamefully refer to as “Obamacare 2.0” is NOT a ‘gift to illegals‘. You would know that if you had linked the ENTIRE Budget Reconciliation bill to your ridiculous piece. Instead, you linked only a small part of the actual bill leaving out 66 pages, including pages 19 & 20 which specifically requires PROOF of CITIZENSHIP or LEGAL residency status before receiving benefits. No one eats their own like Republicans aye Daniel? Pathetic.
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.
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)
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.”
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.
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.
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.