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Jeanne Ives to protect coverage for preexisting conditions.

This is a rebuttal to a piece entitled “Health care coverage threats” published in the Northwest Herald on May 14, 2020. This “letter to the editor” improperly maligns Illinois 6th district candidate for U.S. congress, Jeanne Ives by inaccurately describing her position on health care reform. It also incorrectly describes how medical risk was mitigated prior to A.C.A. (Obamacare) implementation and how Republicans plan to control that risk going forward. These inaccurate statements need to be corrected, publicly. I submitted this rebuttal to the Northwest Herald on May 15, 2020 and as of today, the Northwest Herald has not published my rebuttal.

The aforementioned letter to the editor incorrectly refers to state based high risk health insurance pools as providing “uniformly dismal results, plagued by under-funding, high premiums and deductibles, long waiting periods and enrollment caps”.

If those statements were true our state based high risk health insurance pool known as “I.C.H.I.P” – Illinois Comprehensive Health Insurance Plan – would not still be in operation today, but it is. It is still in operation because our House Speaker, Michael Madigan has requested that it stay in operation. This is because I.C.H.I.P. policies (insured by Blue Cross Blue Shield) offer premiums that are commensurate or less than those offered to unsubsidized applicants who purchase A.C.A.-qualified (Obamacare) policies via I.C.H.I.P. policies also expose the policyholder to lower out of pocket expenses and better access. I.C.H.I.P policies include in network P.P.O. access to our Teaching hospitals in Chicago like the University of Chicago hospital, Rush university medical center and Lurie Children’s hospital.

There are no individual ACA-qualified policies available in Chicagoland that include access to those Teaching hospitals. In fact, the only individual A.C.A.-qualified P.P.O. plans that are still available in Chicagoland are the Blue Choice Preferred PPO plans from Blue Cross Blue Shield of Illinois. However, even those plans are not accepted at any of the Northshore hospitals or any of the Advocate hospitals. For access to those hospitals, you must purchase an H.M.O. That is not the case with I.C.H.I.P. policies. They are accepted at all of our Teaching hospitals and many other hospitals around Illinois and around our nation.

Secondly, the concept of separating and subsidizing those with the largest medical claims from those who are healthy has been proven to work time and time again. Doing so is how 45 states (including Illinois) kept individual health insurance premiums at an affordable rate long before the A.C.A. Back when individual health insurance premiums were 200% lower than they are today. Back when we had 168 more health insurers offering individual health insurance products than we have today

It is also how states are once again substantially reducing individual marketplace premiums today. In 2017 Alaska was granted a 1332 waiver from the stringent requirements of the A.C.A. which allowed them to reestablish their own reinsurance risk pool. Before Alaska’s 1332 waiver was granted, individual marketplace premiums were projected to increase by another 42%. Afterwards, Alaska regulators were able to reduce those increases to only 7.3%.

This is why Families U.S.A. has stated that these concepts “can work”.

It is also why 34 other states have filed for a 1332 waiver since 2018.

Lastly, I want to address the “long waiting periods”. There are no waiting periods under our current I.C.H.I.P. program and there were no waiting periods under our I.C.H.I.P. program before the A.C.A. so long as the applicant was H.I.P.A.A eligible. H.I.P.A.A. eligible applicants are those who can demonstrate that they have maintained existing health insurance coverage for at least 18 months, with no lapse in coverage of more than 63 days. The only “waiting period” that ever existed under I.C.H.I.P. applied to those who did not maintain consistent health insurance coverage and chose instead to wait to purchase health insurance until they needed it. Those kinds of applicants must wait until January 1st to obtain individual health insurance under current A.C.A. rules. Just as they were required to wait under I.C.H.I.P. long before the A.C.A. became the law of the land.

They must wait today and they were made to wait then because those who wait to purchase health insurance until they are sick have been proven to drive up the cost of health insurance for everyone else. 

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The new RSC health care plan is the best health care plan I have ever read.


On October 22, 2019, the Republican Study Committee released the best health care proposal I have ever read. You can read it here. Below are the reasons why these common sense reforms will dramatically reduce health insurance premiums, increase consumer choice and protect our most vulnerable and those with preexisting conditions.

1.) Health insurance carriers would not be able to rescind, increase rates, or refuse to renew one’s health insurance simply because a person developed a new medical condition after enrollment.

2.) Individuals with high risk medical conditions would have affordable access to state-run Guaranteed Coverage Pools under which their health care costs would be subsidized with federal grants and further contained by any state-enacted premium-setting restrictions. This is is the way these risks were mitigated in 45 states before Obamacare.
3.) You can elect COBRA and then move to an individual plan with guarantee issue rights without having to exhaust COBRA first. The ACA currently prohibits those who have elected COBRA from moving to a lower priced Individual plan until the annual ACA open enrollment period begins in which case their coverage cannot begin until January 1st.
4.) Everyone seeking coverage in the individual marketplace would have guaranteed issue protections and could not be refused a plan based on the enrollee’s health status, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, or disability.
However, proof of prior coverage consistent coverage would once again be required which will prohibit gaming the system by remaining uninsured for long periods of time and then simply purchasing health insurance when you are then sick. This simple restoration of a common sense provision enacted under 1996 HIPPA law will reduce premiums for everyone. If a person does not have twelve months of continuous coverage, the person could be subject to an exclusion period of up to twelve months for an existing condition. Prior periods of continuous coverage would reduce any exclusion period month-for-month. Additionally, as was the case under HIPAA, states would be able to satisfy the RSC plan’s portability protections through the implementation of a Guaranteed Coverage Pool providing these same portability protections. Again, 45 states had either a High Risk health insurance pool or a Guaranteed Issue Individual mandate provision enacted for many years before Obamacare.

5.) States can satisfy the RSC plan’s individual marketplace portability protections through the implementation of a Guaranteed Coverage Pool that provides such protections. Accordingly, the coverage pool would have to:

1) Provide immediate access to a plan and prohibit condition exclusions for individuals who have maintained twelve months of continuous coverage.
2) Cap any condition exclusion period at twelve months.
3) Reduce any exclusions month-for-month for individuals with less than twelve months continuous coverage. Consequently, everyone with an existing condition who is seeking coverage in the individual market would be provided a pathway to obtaining complete coverage of all their conditions within just twelve months.

States would also be free under the RSC plan to enact shorter exclusion periods. Prior to the ACA, the vast majority of states with high-risk pools capped their exclusion period at six months or shorter.

6.) To ensure that ample options exist for Americans to possess continuous coverage, short-term health plans would also count toward periods of continuous coverage under the RSC plan. Additionally, the RSC plan would codify the Department of Health and Human Services’ new rule allowing short-term, limited-duration plans to last for a term of one year (and renewable for up to 36 months).

7.) 1332 waivers – seven states, including Alaska, Maine, Maryland, Minnesota, New Jersey, Oregon and Wisconsin, were awarded waivers under Section 1332 of the ACA to deviate from certain ACA mandates and redirect ACA subsidies toward uniquely designed reinsurance programs. Alaska applied for and was (finally) granted a 1332 waiver from CMS on July 11, 2017 thanks to President Trump. That waiver allowed Alaska to separate the most expensive consumers from the rest of that state’s risk pool and as a result health insurance premiums dropped from an expected increase of 40% to an actual increase of only 7%. The same risk mitigation strategies are now being adopted by other states like Hawaii, Maine, Maryland, Minnesota, and Oregon.

Wisconsin applied for and received an ACA waiver allowing them to create a state based reinsurance program sponsored in part by the Federal government. The “Wisconsin Health Care Stability Plan” will pay 50% of insurers’ claims between $50,000 and $250,000. The state projects it will spend $34 million of its own funds for these claims next year, with the rest coming from the federal government. The feds, however, aren’t expected to shell out any new money because reinsurance also helps the federal government. The lower rates mean it will spend less on premium subsidies for those who qualify. Those savings will be redirected to the stability plan.

An additional five states (Colorado, Delaware, Montana, North Dakota, Rhode Island) project premium reductions of up to 16 percent in 2020 due to 1332 waivers.”
8.) The cost to implement these state based risk mitigation systems is $17 billion annually. That may not seem ideal but it sets up a sustainable path for the individual marketplace and deters our nation from heading toward a government-run, one-size-fits-all health care system that would cost taxpayers more than $30 trillion over the next decade.

9.) Use can FINALLY use your H.S.A. dollars to pay for health insurance premiums which will equalize the tax favored status between individual and employer sponsored plans. By allowing individuals to use health savings accounts funds to pay for their health care premiums, the RSC plan allows individuals to take advantage of the triple-tax advantaged status of health savings accounts. First, funds that are deposited in a health savings account are not subject to income tax or payroll taxes (including individual and employer payroll taxes) when they are earned. Once in the account, funds are not subject to taxation for any interest accrued. Nor are funds taxed when they are removed from the health savings account and spent on qualifying medical costs. An individual who utilized their health savings account in this way would no longer be penalized for choosing to shop for a plan on the individual market. Under current law, for 2019, $3,500 may be contributed to health savings accounts for an individual, and $7,000 for families. In 2018, the House of Representatives passed legislation to increase the contribution caps to $6,650 for an individual and $13,300 for a family.

This limits are currently way too low. According to the Kaiser Family Foundation, the average annual family premium per enrolled employee for employer-based health insurance in 2017 was $18,687.148 Because of this, under the RSC plan, contribution limits would be increased even more to $9,000 per individual and $18,000 for families. The RSC plan would also allow working seniors, or anyone on Medicare, to have a health savings accounts and continue to contribute to it. Individuals enrolled in other public health insurance programs, such as those with Tricare, Indian Health Service, or Veterans benefits, would also be able to contribute to a health savings accounts. Furthermore, FSA and HRA balances could be converted into a health savings account,

10.) The FMAP rate for the expansion population would eventually match normal FMAP rates. There is no reason why an able-bodied adult without any dependents should be more heavily subsidized than a poor pregnant woman, elderly person, child, disabled individual, or parent.
11.) Association Health Plans. The RSC plan urges codification of the reforms promulgated by the Department of Labor that ensure Americans have greater access to Association Health Plans (AHP). Association Health Plans currently work by allowing small businesses to band together by geography or industry to obtain health care coverage as if they were a single large employer. Importantly, AHPs offer benefits comparable to employer-sponsored plans and cannot discriminate against patients with pre-existing conditions. They also “strengthen negotiating power with providers from larger risk pools and [provide] greater economies of scale,” according to the Department of Labor.

12.) Unfortunately, many states have passed laws impeding the provision of telemedicine by banning or heavily restricting its progress. Notably, the position of the American Medical Association still calls for doctors to be physically present when rendering medical services. This will end and you’ll be able to log on and consult with your doctor without driving all the way to the doctor’s office and waiting for God knows how long in a waiting room.

Major Kudos to the Republican Study Committee. I could not have written a better plan!

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Group health insurance for one person ensures access to Chicago Teaching hospitals for small businesses owners.

In November of 2015, Chicagoland residents were shocked to learn that Northwestern Memorial hospital, University of Chicago medical center, Rush University medical center and the Lurie Children’s hospital would no longer accept patients who have ACA-qualified (Obamacare) individual health insurance plans.

This action led to a significant increase in the purchase of small group health insurance policies which still provide national PPO networks and still ensure access to the aforementioned teaching hospitals in Chicago.

For small corporations who could afford to insure themselves and 70% of their eligible full time employees (the usual minimum participation requirement), purchasing small group health insurance was a costly fix to the new narrow networks in the individual health insurance marketplace.

The ability to purchase group health insurance for you and your full-time employees is well known. What is not well known is the fact that you can purchase a small group health insurance policy without insuring any of your employees during a small window each year. That window begins on November 1st and ends on December 15th. The same time period the annual ACA Open Enrollment for individual plans begins and ends.

During this little known ‘relaxed underwriting’ period, an owner of a small corporation (less than 50 full-time employees) can purchase small group health insurance while employees ‘waive’ coverage without producing an eligible waiver. Normally, 70% of all full-time employees must participate in a group health insurance plan unless they have an eligible waiver such as an offer of group health insurance from a spouse’s employer or Medicare and Medicaid coverage. If you do decide to offer coverage to your full-time W2 employees during this Special Enrollment period, you do not have to insure any of your employees and instead can only insure yourself and or your family without insuring employees. Normal 70% minimum participation requirements are waived.

If you are a small business owner who is seeking to purchase small group health insurance and cannot afford to insure your employees or, your employees simply do not want to participate in a group health insurance plan. Now is the time to learn more about “relaxed underwriting period”. The cost for group health insurance is now commensurate with individual health insurance but the PPO network is much larger and far more inclusive than any of the narrow networks now available in the individual marketplace. Want to learn more? Click on “contact” at



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My evening with President Trump.

Here’s how my evening went at the Trump 2020 Victory fundraiser on Tuesday, June 25th at the Trump International hotel in Washington D.C. We arrived at the hotel which is GORGEOUS inside and out. See pic below:

Jeannie and I at Trump Hotel in DC
As we were walking in, Mark Meadows and Jim Jordan were walking out. So, we of course told them how much we loved and appreciated them as they were getting into their car. Then we waited about 45 minutes until our wonderful POTUS walked in. Even though he was surrounded by Secret Service, he still took time to sign autographs. See that moment here.
Then, we entered the secure area where we were wanded by Secret Service and then given lanyards pictured below.
Trump Dinner Lanyard

We were then told (much to our chagrin) that our phones had to be placed into these secure magnetized bags which were impossible to open until the evening was over. So, we couldn’t use our phones for the entire evening which meant NO pictures, unless of course I wanted to cough up another $13,800 ON TOP of the $12,200 I already donated. I just couldn’t justify that additional amount as much as I LOVE my POTUS. Not being able to take pictures REALLY sucked BUT later on, my new friend Sam Ukss realized that his “phone killer bag” was not working properly so he was able to snap the picture and capture the video below featuring President Trump, our new friend Deelip Mhaske, Jeannie and myself at our dinner table listening to our great POTUS speak. It’s not a long video but it is a video that I will treasure forever.

Dinner with POTUS pic

Dinner with Potus

We were then directed down a flight of stairs where we dined on the most fabulous Hors d’Oevres like bacon wrapped scallops and other scrumptious things whilst also enjoying an open bar. Then, DJT Jr. and Kimberly Guilfoyle came into our room and gave two speeches about POTUS’s many accomplishments. As I listened, I realized that the diminutive man next to me was Lindsey Graham. Man is he TINY.
Anyway, it was at that moment while DJT Jr. was speaking that we heard someone yell from the floor above us over the railing “Don! Is that YOU?!” So, we all walked over to where the balcony overlooked us and leaning over was our great POTUS! See that moment here.
Shortly thereafter, these huge doors opened and we entered the grand dining room which had a bunch of tables draped with white clothes and on each plate was filet mignon, roasted potatoes, corn and peas and delicious raspberry cheesecake for dessert. It was the most elegant dinner I have ever consumed at a political fundraiser by far. There is NO rubber chicken at a Trump fundraiser. It was then that “half pint” (which is my new name for the shockingly diminutive Lindsey Graham) came on stage and gave a 15 minute speech about POTUS and his accomplishments and then out came our wonderful POTUS! Hoping the guy we sat with follows through and sends me the video so I’ll have a few minutes of that speech to share soon.
The ONLY good part of not being able to record anything is that POTUS was able to be himself. So he was HILARIOUS. At one point during his speech he said “with the tariff threat I was able to get Mexico to send 15,000 of their National Guard soldiers to their southern border to help stop illegals coming here. The FAKE NEWS said 15,000 is ‘nothing’. NOTHING?! That’s a f***ing army!” And of course the crowd began laughing loudly. He was cracking us up the whole time.
POTUS left shortly thereafter and after a LONG day which began at 5 a.m. we headed back to our hotel. Along the way, I snapped the picture below of the Washington Monument at sunset. Sometimes “the swamp” is actually beautiful.
Washington Monument

It was definitely a once in a lifetime, historical moment. The first fundraiser for President Trump’s reelection campaign. That is WAY cool. He raised $6 MILLION that night. Of course I say ONCE in a lifetime because $12,200 is by FAR the most I have ever given to ANY politician and it sure as hell ain’t happening again. lol

I discussed my evening with the President on Chicago’s Morning Answer on 06/28/19. Click below to hear the replay.

ChicagosMorningAnswer 06 28 19


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My testimony delivered at our state capitol today regarding Short Term health insurance plans.

My purpose here today is to ask for your help to protect an unrepresented minority. Specifically, those who have been priced out of the ACA marketplace and do not qualify for federal health insurance subsidies to lower their health insurance premiums. According to CMS – Centers for Medicare & Medicaid Services – numbers released yesterday, during last year’s ACA open enrollment period, 360,168 individual applications were processed in Illinois via our State/Federal partnership health insurance exchange. 282,491 of those applications were eligible for a Federal health insurance subsidy to help lower their premiums.

That means 77,677 applications did not receive financial assistance and were forced to pay the full price for health insurance. In addition to those who applied via our exchange and were denied a federal subsidy, there were an additional 127,459 applicants who applied OFF our exchange directly with insurance companies because they already knew they were not eligible for financial assistance. That equates to 205,136 applicants who were forced to pay the full premium for individual health insurance. A premium that has more than doubled since 2014.

The most important aspect of the ACA we can all agree on, is that the law was intended to provide some form of health insurance coverage to everyone, whether they could afford it or not. That’s why subsidies were written into the law. Unfortunately, for the 205,000 consumers who do not qualify for federal health insurance subsidies in Illinois that is no longer the case. For them, ACA-qualified coverage has become anything but ‘affordable’.

The full price for a family of four for the cheapest Bronze PPO plan with Blue Cross Blue Shield of Illinois with a $15,800 out of pocket expense in Chicago is now $1,835 per month which equates to $22,000 annually. This is why so many who do not qualify for health insurance subsidies have been priced out of the ACA marketplace and are now seeking other options that are not safe now but can be made much safer by this legislative body. Those non safe products are known as Non ACA-qualified Short Term policies. They are not safe now because this legislative body restricted the amount of time one can own these policies from 12 months to 6 months of maximum policy ownership and I am asking you to restore the amount of time one can own a non ACA-qualified policy back to 12 months so that they are once again safe to purchase.

It’s not that applicant’s who don’t qualify for federal health insurance subsidies don’t want ACA coverage. They’d be crazy not to want it. It is the most comprehensive health insurance coverage ever sold in the United States and there is no underwriting. Everyone gets coverage regardless of preexisting conditions. That is a VERY good thing. However, the recent actions taken by this legislative body are not only placing those priced out of the ACA marketplace at great peril but you are threatening the structural integrity of our health insurance exchange and the ACA overall.

It may sound strange that I’m asking you to fortify non-ACA policies in order to protect the ACA but there is sound reasoning and supporting data behind this request.

First and foremost, is the fact that consumers who purchase Short Term policies in Illinois are now placed at great risk if at the end of the 6 month policy period they are then laying in a hospital bed with a life threatening condition when their coverage ends. Even if that individual could qualify for another 6 month Short Term policy, that life threatening condition would be considered preexisting which means it would not be covered under their next 6 month Short Term policy. This would leave them uninsured entirely until the next annual ACA open enrollment period begins again in November in which case their coverage cannot begin until the 1st of the following year. This is why it is essential to have 12 month Short Term policies available in Illinois so that consumers stay consistently insured between ACA open enrollment periods. This way when the Short Term policy ends at the end of 12 months, it ends safely the following year during the ACA open enrollment period. If a family member develops a new medical condition they can obtain coverage for that new condition via the ACA exchanges.

Secondly, let’s identify the fiscal implications. Companies who provide health insurance, both ACA-qualified AND non ACA-qualified Short Term health insurance are required to contribute hundreds of billions of dollars in order to help stabilize the ACA health insurance marketplace and ensure those who are eligible for subsidies continue to receive them.

Section 1910 of the Affordable Care Act outlines the Health Insurance Tax which has resulted in $58 billion dollars being collected from health insurance companies since 2014. $14.3 billion of that was collected last year alone. That money is then used to stabilize the health insurance marketplace by ensuring that those who do qualify for federal health insurance subsidies continue to receive them. The health insurance tax is an essential risk mitigation system build into the ACA and without it premiums would be much higher and subsidies would be much smaller and available to fewer people.

The pertinent section of Section 1910 of the ACA was outlined in the final rules posted in the Federal Register on November 29, 2013. In those final rules the following paragraph outlines which type of health insurers are subject to this tax and I quote: “Section 9010(a) imposes an annual fee, beginning in 2014, on each covered entity engaged in the business of providing health insurance. Section 9010(c) provides that a covered entity is any entity that provides health insurance for any United States health risk during each year.” The important point to note here is that the tax is levied only on health insurance plans.

By restricting Short Term policies to 6 months this legislative body has unknowingly left these consumers with no other option but to enroll in similarly low priced “Christian Sharing Plans” which do not end abruptly but are also not insurance and as such are not required to contribute anything under the aforementioned health insurance tax. By shifting those dollars that would normally be spent on Short Term health insurance to Sharing Plans which are not insurance, you are undermining the structural integrity of the ACA and so is every other state legislative body that has restricted this type of health insurance to 6 months or less. As ACA-qualified policies continue to increase in price this trend is going to continue unless you take action to stop it.

Lastly, let me address the often repeated fallacy that Short Term health insurance policies are “junk” policies or that they are “skinny plans”. Whilst it is true that Short Term health insurance plans do not cover preexisting conditions, those that are offered by companies like United Healthcare do provide coverage for the vast majority of illnesses and injuries such as Cancer, Stroke, Heart Attack, Organ Transplants, Mental Nervous Disorders, Newborn care, Diabetes, Autism, Durable Medical Equipment, Home Health Care, inpatient and outpatient diagnostic testing as well as Nuclear Medicine, MRI and CT including a routine colonoscopy. They also provide coverage for inpatient and outpatient surgery, anesthesia as well as outpatient prescription drugs. They even provide first dollar coverage with no deductible required for outpatient doctor visits, urgent care visits and state mandated routine preventive care such as Mammograms, Cancer screenings and Contraceptives. That does not sound like a “junk plan” to me. Neither does it sound like a “skinny plan”. These policies also provide $2,000,000 in coverage annually for each insured member. So no, they do not provide all the protections that ACA-qualified policies do but they do provide very good coverage and for half the price. THIS makes them very attractive to those who do not qualify for health insurance subsidies.

Equally important to know is that both United Healthcare and National General which are the two largest Short Term health insurance policy providers in Illinois provide a national PPO network with their policies which includes in network access to Northwestern Memorial hospital, University of Chicago medical center, Rush university medical center and the Lurie Children’s hospital. None of those hospitals accept ANY individual ACA-qualified health insurance policy, not even those offered by Blue Cross Blue Shield of Illinois. No matter how much you pay for an ACA-qualified Individual policy in Illinois you cannot take your sick child to the premier Children’s hospital in the Midwest which is Lurie Children’s hospital. With non ACA-qualified Short Term policies you can walk right in the door at all four of those hospitals and hospitals around the nation.

In closing, because so many are now abandoning the ACA exchanges and can no longer safely purchase Short Term health insurance due to the aforementioned 6 month restriction and instead are now shifting those dollars to “Christian Sharing Plans” which are not insurance and as such do not contribute anything under the aforementioned health insurance tax. And because those who participate in “Christian Sharing Plans” have no policy, no contract and no regulatory recourse when Sharing Plans stop paying claims as they have done repeatedly. I am asking for this regulatory body to restore non ACA-qualified Short Term health insurance plans to 12 months in order to ensure that those who have been priced out of the ACA marketplace remain safely insured with actual health insurance without risk of running out of coverage in the middle of the year which can lead to disastrous consequences.

I thank you for your valuable time today. I will take questions if time allows.

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Contrary to popular belief, both Democrats AND Republicans have had a long history of ensuring that Americans have access to coverage for preexisting conditions. In fact, a bipartisan piece of federal legislation requiring coverage for preexisting conditions existed long before the implementation of the ACA – Affordable Care Act, known colloquially as “Obamacare”. Public law 104-191 also known as HIPAA – Health Insurance Portability & Accountability Act – of 1996 outlined in sections 2741, 2742 and 2744 the role that both health insurers and state regulators must play in ensuring coverage for those with preexisting conditions. That law was supported by both Democrats AND Republicans for more than a decade before Obamacare.

Not long after HIPAA was signed into law, states began developing one or more state run risk mitigation mechanisms to ensure that those in the individual health insurance marketplace were ensured access to coverage for preexisting conditions. 35 states decided to develop High Risk health insurance pools. In Illinois, our High Risk health insurance pool was called ICHIP – Illinois Comprehensive Health Insurance Plan. The existence of ICHIP ensured that Illinois residents who purchase their own individual health insurance were guaranteed coverage for preexisting conditions long before Obamacare. In order to qualify for ICHIP coverage one would have to have been denied coverage from a health insurer in the individual marketplace due to a preexisting condition or have exhausted COBRA continuation coverage from a former employer. If that individual applicant had kept consistent health insurance coverage without a lapse of more than 63 days, they were guaranteed immediate coverage from Blue Cross Blue Shield of Illinois via ICHIP. If they had a lapse in coverage of more than 63 days, they would have to wait up to 6 months before preexisting conditions would be covered. These regulations provided a strong impetus for consumers to keep consistent health insurance coverage in place. This prevented applicants from ‘gaming the system’ by waiting until they were sick to purchase health insurance coverage.

10 other states chose to implement an “Individual market guaranteed issue mandate.” Under this state run risk mitigation system, residents of those states were guaranteed coverage for preexisting conditions from a variety of health insurers operating in that state. For example, in the state of Ohio, there were multiple health insurance carriers that had to “guarantee issue” 4% of their block of business to people with preexisting conditions during an annual ‘open enrollment’ period. During this annual open enrollment period, each health insurance carrier had to report to the Ohio Department of Insurance as to whether or not they “met their 4% guarantee issue quota”. Once one health insurer met their 4% quota, all future applicants with preexisting conditions were then referred to one of the other health insurers operating in Ohio who had not met their 4% quota and those remaining applicants would then be guaranteed coverage from that carrier. Under this innovative and intelligent state run risk mitigation system, all health insurers in the state shared the risk and everyone had access to coverage for preexisting conditions. Again, long before Obamacare. See page 10 of the Ohio “Guide to Health Insurance”

To learn more more about consumer protections under HIPAA law, download
“Protecting Your Health Insurance Coverage” from CMS –
Centers For Medicare and Medicaid Services.

There is nothing new under the sun.

You probably noticed something familiar about how Ohio’s annual “open enrollment” period. You should, because that is how risk in the individual health insurance marketplace is managed today under the ACA. We now have a national ACA open enrollment period which begins on November 1st and ends on December 15th of each calendar year. During this 45 day window, all Americans can purchase individual health insurance regardless of their health history and preexisting conditions are not excluded from coverage.

Why though is this annual open enrollment window only 45 days long? Why can’t we just buy health insurance whenever we want? Why do we have to wait until November each year? The reason you cannot do so is because if you were allowed to buy health insurance whenever you want, no matter how sick you may be, you would simply wait until you were sick to buy it and you would have no impetus to keep that coverage after you received whatever medical treatment you were seeking at the time. This is akin to buying home owner’s insurance after your home burns down or car insurance after you wreck your vehicle. Allowing such behavior would rapidly bankrupt all health insurers in a very short time.

The purpose of “insurance” is to manage future risk if and when it may occur. It is not to absorb all risk as it occurs. It is the consistent payment of monthly premiums by multiple policy holders which allows insurers to build the necessary financial reserves from which to pay your claims if and when they may occur. This is why the annual ACA open enrollment period is restricted to a 45 day window once a year. It forces Americans to keep their health insurance coverage in place throughout the year to ensure they keep consistent coverage for preexisting conditions between open enrollment periods. Consistent payment of those premiums allows the health insurers to build the necessary financial reserves to pay your claims if and when they may occur.

Republicans allocated $100 billion plus to ensure coverage for preexisting conditions

The aforementioned preexisting solutions to preexisting conditions were only two of the types of protections that could have been implemented had the House Republican’s “American Health Care Act” survived Senate scrutiny or, if the Senate “Better Care Reconciliation Act” had survived John McCain’s 2 a.m. thumbs down vote. Both bills provided solid protection for consumers with preexisting conditions. Page 45 of the American Health Care Act created the “Patient and State stability fund” which outlined on page 51 more than $100 billion over the first 8 years for states to re-establish state run High Risk health insurance pools or other state and federally run risk mitigation systems. This is nothing new. In fact, our Illinois health insurance exchange is a state/federal partnership exchange. Both entities working together to ensure coverage for preexisting conditions.

So, the evidence proves that Republicans not only want to ensure preexisting conditions are covered but they are also willing to allocate many hundreds of billions of dollars to ensure that they are. The evidence also proves that we did not need Obamacare to ensure coverage for preexisting conditions. The states already had risk mitigation systems in place long before Obamacare and those systems or similar systems could be implemented once again.

The question is not if Republicans want to cover preexisting conditions. The question is how they are to be covered going forward. Mandating that health insurers cover preexisting conditions is fruitless if there are no health insurers left to provide said coverage for preexisting conditions. So many health insurers have exited the individual health insurance marketplace since Obamacare, including the nation’s largest health insurers, United Healthcare, Aetna, Humana, Anthem Blue Cross etc. This has left states like Indiana with only one health insurer left for those who purchase individual health insurance and that carrier only offers a small HMO option.

State based risk mitigation systems currently employed via ACA waivers granted by the Trump administration.

Alaska applied for and was (finally) granted a 1332 waiver from CMS on July 11, 2017. That waiver allowed Alaska to separate the most expensive consumers from the rest of that state’s risk pool and as a result health insurance premiums dropped from an expected increase of 40% to an actual increase of only 7%. The same risk mitigation strategies are now being adopted by other states like  
HawaiiMaineMarylandMinnesota, and Oregon

Wisconsin applied for and received an ACA waiver allowing them to create a state based reinsurance program sponsored in part by the Federal government. The “Wisconsin Health Care Stability Plan” will pay 50% of insurers’ claims between $50,000 and $250,000. The state projects it will spend $34 million of its own funds for these claims next year, with the rest coming from the federal government. The feds, however, aren’t expected to shell out any new money because reinsurance also helps the federal government. The lower rates mean it will spend less on premium subsidies for those who qualify. Those savings will be redirected to the stability plan.

These are just two examples of how state’s can better manage risk at the local level by being granted waivers from the “one size does NOT fit all” government take over of the American health care system known as “Obamacare”. There will be more to come thanks ONLY to the leeway allotted to state’s by the election of President Donald J. Trump.

The truth about Trump not defending the latest legal challenge to Obamacare

President Trump’s D.O.J. has chosen not to defend Obamacare against the latest legal challenge to it led by Texas and 19 other states. That case argues (legitimately) that since the SCOTUS found the “Individual Mandate” constitutional in 2012 by defining it as a “tax” and later Republicans passed tax reform which included repeal of the Individual Mandate. The Individual Mandate can no longer be constitutional because there will be no more penalties assessed for not buying health insurance as of January 1, 2019. The D.O.J. is also arguing that two other Obamacare provisions should be struck down — one requiring insurers to cover those with preexisting conditions AT THE SAME PRICE AS THOSE WITHOUT PREEXISTING CONDITIONS. The Leftist media cabal reporting on this case conveniently leaves that last part out. That does mean that if the state led case against Obamacare succeeds, that preexisting conditions would not be covered. It simply means that those with certain preexisting conditions could pay more than those without preexisting conditions which is how the system worked prior to Obamacare.

I discussed this issue in greater detail with Dan Proft and Amy Jacobson on Chicago’s Morning Answer on WIND. Click below for to watch the replay:



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Actual “affordable care” is coming soon thanks to President Trump

The next likely chance to achieve any kind of legislative change to the ACA (Obamacare) will be on November 6, 2018, which is the midterm election. If Republicans then have enough Senators who are actually willing to cast a yes vote they will then deliberate throughout 2019 until the last date to use the Budget Reconciliation process (requiring only 51 votes). Since it is unlikely that Republicans will achieve a 60 vote majority in the U.S. Senate, they will have to rely once again upon Reconcliation. The final date to pass legislation using Reconcilation is September 30, 2019.  A month later, the next annual ACA open enrollment period begins again. There will be no changes to health care policy until that ACA open enrollment period ends on December 15, 2019. This means the earliest we might see legislative changes to the ACA will be early 2020.

Now for the GOOD news 

The good news is that like his predecessor, President Trump also has a “pen and a phone” and he’s been using them. On October 12, 2017 he signed this executive order which was designed to restore consumer choice in the non-ACA marketplace and to spur competition “across the United States”.  After considerable hand wringing from regulators and opposition groups, H.H.S. finally issued a final rule pertaining to the President’s executive action on August 3, 2018. This final rule makes two important regulatory changes. Both will become law on October 2, 2018. On that date, non-ACA Short Term health insurance plans will once again provide consistent uninterrupted health insurance coverage for up to 364 days. This is a very welcome change since our prior president reduced the amount of time consumers could own non-ACA Short Term health insurance plans to a maximum period of 90 days.

This action by former president Obama exposed consumers to the additional risk of not only facing up to four separate deductibles in one year but also facing the risk of not qualifying for a new 90 day policy due to a preexisting condition. This is true because non-ACA Short Term health insurance policies do not cover preexisting conditions nor do they cover other ACA mandated benefits such as drug rehab therapy and mental health parity. As such, they are much less expensive than ACA qualified health insurance plans and are very popular among the millions of Americans who do not qualify for health insurance subsidies. President Trump’s executive order also requires that these plans be renewable for a period of up to 3 years.


Unfortunately, Illinois legislators are trying to stop President Trump’s reforms to the non-ACA Short Term health insurance marketplace. If successful, Illinois consumers will continue to risk paying up to four deductibles in one year. The bill that stops President Trump’s reforms is HB2624, which passed both of our chambers at the end of May, 2018 and was sent to Governor Rauner in late June. The amended version of HB2624 limits non-ACA qualified short term health insurance plans to a maximum duration of less than 181 days and it prohibits renewals. HB2624 also restricts insured members from purchasing a new short-term plan from the same health insurer within 60 days of the termination of a previous short-term plan. This will further restrict consumer choice and increase out of pocket costs exponentially for Illinois consumers seeking to escape from Obamacare. Please CALL Governor Rauner’s office now and ask him not to sign HB2624.

Governor Rauner’s Chicago office: (312) 814-2121

Governor Rauner’s Springfield Office: (217) 782-0244

Governor Rauner’s Email Address:



THANK YOU Governor Rauner for using your VETO power to stop HB2624. This is GREAT news for Illinois consumers who do not need coverage for preexisting conditions and who do not qualify for ACA (Obamacare) subsidies. Thanks to Governor Rauner (and President Trump) as of October 2, 2018, non-ACA qualified Short Term health insurance policies will once AGAIN provide consistent, uninterrupted coverage for up to 364 days (not just 90 days) and they will be renewable (for the first time ever) for up to 3 years!

Click below to listen to my commentary on Chicago’s Morning Answer – 8/22/2018


Expanding Association health plans

The  second regulatory change outlined in the final ruling is the expansion of AHPs – “Association Health Plans”. By “expansion”, this order refers to expanding upon the law that has regulated AHPs since 1974. That law is called ERISA – Employee Retirement Income Security Act. Traditionally, ERISA required AHP members to share a professional or other common interest in order to form an association and then offer health insurance benefits to members. Under the new final rule, those who enroll in AHPs after October 2, 2018 can purchase AHPs based on geographic location alone or by the traditional definitions of sharing a common profession or trade. And, new Associations can be formed solely for the purpose of offering health insurance to new Association members. This was heretofore prohibited.

Most importantly, unlike many of the traditional AHPs which offered substandard coverage resulting in multiple lawsuits. The new AHPs must provide many of the same consumer protections that ACA-qualified plans are federally mandated to cover such as keeping your child on your plan until the age of 26, covering preexisting conditions and including the same calendar year maximum out of pocket spending limits which are in place now for ACA-qualified plans. Those limits this year are $7,350 for an individual policy and $14,700 for a family policy.  The new AHPs also cannot impose annual or lifetime maximum coverage amounts which is a welcome improvement to traditional AHPs. AHPs that cover employers with at least 15 employees must also cover Maternity.

Even though all of the aforementioned consumer protections must be included with the new AHPs, they are not required to cover all 10 “Essential Health Benefits” that ACA plans are required to cover. So, if you need coverage for substance abuse disorders, mental health parity or pediatric dental and vision, you may still want to consider an ACA-qualified plan which may be much more expensive for those who do not qualify for federal health insurance subsidies. Either way more options are always better than less.

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