Category Archives: Uncategorized

The real reasons that United Healthcare has exited the ACA exchange.

Crain’s Chicago Business wrote a piece today about United Healthcare wisely choosing to exit the ACA (Obamacare) exchange (Healthcare gov). Unfortunately, Crain’s neglected to mention the real reasons that United Healthcare has chosen to do so, so I will clarify. This decision was made for two reasons. They are as follows:

Firstly, the temporary “Three Rs” provision under the ACA (Obamacare) ends in 2017. The “Three Rs” provision (among other things) forces more profitable health insurers to redistribute their wealth to less profitable health insurers. Why would United Healthcare (the largest health insurer in America) voluntarily agree to continue to participate in such a foolish and misguided Socialist wealth redistribution scheme? A cursory review of human history proves that all other similar schemes have failed, and failed miserably. For example, Assurant Health did not survive after only one year of exchange risk exposure resulting in $63.7 million in losses in 2014 and projected operating losses of $80 million to $90 million for the first quarter of 2015.

Secondly, Republicans get very few victories in Washington D.C. They did however get one victory during the last budget battle in the fall of 2014. That victory was the END of taxpayer bail outs to health insurers. This victory was the impetus behind the rapid demise of companies like Land of Lincoln Health, one of the 23 troubled health care ‘co-ops’ which ended 2014 with a $17.7 million loss and in the first 6 months of 2015 had claims that outpaced premiums by $26 million.

Since selling health insurance off the exchange ( is still a viable option for now, it would be incredibly foolish for any carrier to continue to provide health insurance on the exchange. United Healthcare has wisely chosen not to continue contributing to their own demise. Other insurers should follow suit.

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Blue Cross Blue Shield of Illinois canceled plan members have new low priced option in Cook county including access to top teaching hospitals.

2016 ACA Open Enrollment is going on right now and the biggest health insurance story since the last time Blue Cross Blue Shield of Illinois canceled 185,000 individual health insurance policies in 2013 is their current decision to cancel 173,000 individual health insurance policies this year. What’s even worse is that this year, there has been no intervention from the White House (as there was in 2013) that allows at least some of these policy holders to keep their existing plans. Even worse is the fact that even though these former policy holders are willing to pay significantly more to keep access to the top teaching hospitals in Chicago like Northwestern Memorial, University of Chicago hospital and the Ann & Robert Lurie Children’s Memorial hospital, they are unable to do so. Instead, they are being auto enrolled into new plans that do not include access to any of the aforementioned teaching hospitals.

In an earlier article, I presented guidance for those living outside of Cook county to retain access to these hospitals. There is now a new and much lower priced option for those living inside Cook county. That option is a new health insurance start up called Harken Health, an independently operated subsidiary of United Health Group, America’s largest health insurer. Harken Health entered the Illinois health insurance marketplace on November 1st and we are just now getting a look at their prices. They are much more affordable than the options available to those living outside of Cook county who wish to retain access to the top teaching hospitals in Chicago.

What is unique about Harken Health is their networks, their prices and the unique ability to visit one of their “Harken Health Centers” and pay nothing. Harken Health’s networks include their ‘Preferred’ network which includes the aforementioned top teaching hospitals and their ‘General’ network which together include approximately 850,000 physicians and care professionals and 6,100 hospitals and other care facilities nationwide.

The best part about the presence of Harken Health is that Cook county residents no longer need to rely upon Land of Lincoln Health, one of the 23 troubled health care ‘co-ops’ which ended 2014 with a $17.7 million loss and in the first 6 months of 2015 had claims that outpaced premiums by $26 million and ended 2015 with $90.8 million in total operating losses.  ‘LOL’ Health is also now being sued by current policy holders.

There is now a far better option from a carrier that has the backing of the largest health insurer in the U.S. with tremendous financial reserves and a broad, inclusive nationwide PPO network. Now for some navigation tips. You can find Harken Health’s 2016 plans, see their prices and search their networks by clicking the Harken Health/United Healthcare logo below. Then follow these 5 easy steps:

1.) When you begin your quote it will look as though you can only get quotes from United Healthcare. However, once the four recommended plans load just click on “ACA Medical” just above those plans and all of the ACA qualified plan options will load.

2.) When all plans load, look to the left of those plans and you’ll see a section that says “Doctor Network / Network Type”. Click the circle next to “Harken Health Network” and then only Harken Health plans will load.

3.) Simply find a plan you like and click on ‘Doctor Network: Harken Health Network‘ just to the left of the price of that plan.

4.) That will then load the easy to use Harken Health network search page. From their you can search for your preferred doctors, hospitals and other network providers.

5.) To find the outline of coverage for each plan simply click on “SBC” under each plan name and an Adobe PDF document will open and you can view and download the plan brochure. Or you can click here to see all of the Harken Health plans.

As always, you can contact us directly for free guidance at (630) 582-1043 or email us at


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2016 ACA Open Enrollment begins today with higher prices, smaller networks and more canceled plans.

As we enter the third year of ‘full’ PPACA (Obamacare) implementation, policy holders in Illinois and around the country are once again facing higher prices, smaller PPO networks and even more canceled plans. On October 20, 2015, 173,000 Blue Cross Blue Shield of Illinois policy holders received cancellation letters like this one. The letter, among other things notifies these policy holders that not only has their health insurance policy been canceled (AGAIN) but that they have also been auto enrolled in a new plan with a newly revamped HMO network.

Instead of the “Broad” PPO that these members chose in 2014 which guaranteed them access to the top teaching hospitals in Chicago like Northwestern Memorial hospital, University of Chicago hospital and the Ann & Robert Lurie Children’s Memorial hospital, they are now auto enrolled into a plan that no longer includes that PPO network but now includes the newly revamped “Precision HMO” network which does not include access to the aforementioned teaching hospitals. Worse yet, none of the new PPO networks offered to individuals and families who seek to purchase health insurance with Blue Cross and Blue Shield of Illinois in 2016 include access to these hospitals. I’ll present guidance on how to retain access to these hospitals in the following paragraphs.

In the quaint old days the before the PPACA one would actually have to sign a legal contract before they would be enrolled in a new health insurance plan but I digress into nostalgia. Keep in mind that this for many, is the third time their perfectly good policies have been cancelled since Barack Obama promised “if you like your plan, you can keep your plan “. I miss the old days when we could actually call our clients and tell them that they have a plethora of lower priced options to choose from a variety of carriers in a vibrant and competitive market. Unfortunately, that is no longer the case since 16 health insurance carriers have either closed their doors or been ‘consumed’ by larger carriers since the implementation of the PPACA. Economics 101 teaches us that fewer carriers means less competition which always leads to higher prices. Monopoly isn’t just a board game.

Worse yet, the new 2016 plans are much more expensive. When I say “much more” I really mean it. You see, the majority of my clientele do not qualify for taxpayer-funded health insurance subsidies. Since they do not, they are suffering 2016 premium increases of 45% and higher. Since 2010 they have suffered increases of more than 105%. I guess they’ll have to wait until 2017 for Mr. Obama’s promised “$2,500 premium reduction for a family of four.”

So, what are your alternatives if you wish to retain access to the aforementioned teaching hospitals in Chicago? In my opinion, you have only two choices. They are as follows:

1.) If your company is incorporated you can purchase a small group health insurance plan with as little as two people. The Broad PPO has not changed for group health insurance plans. Northwestern Memorial hospital, University of Chicago hospital and Lurie Children’s Memorial are still participating in the “Broad” PPO that is still included with Blue Cross Blue Shield of Illinois small and large group health plans. If this is an option for you contact me directly or send me your census information online at this link.

2. ) If you cannot form a group then the health insurance carrier to switch to for 2016 is Coventry One which is now owned by Aetna insurance company. Northwestern Memorial hospital lists only three health insurance carriers that they have chosen to do business with in 2016. They are:

A.) Land of Lincoln Health, one of the 23 troubled health care ‘co-ops’ 22 of which lost money last year (LOL Health ended 2014 with a $17.7 million loss and in the first 6 months of 2015 LOL’s claims outpaced premiums by $26 million).

B.) Coventry One, now owned by Aetna insurance company.

C.) The Blue Cross Blue Shield of Illinois Precision HMO plans which use the 2016 Precision HMO network. However, it must be noted the Precision HMO network can only be used at the new Northwestern, formerly Cadence, formerly Delnor & Central Dupage hospital group in Winfield, Illinois. An added bonus according to Northwestern Memorial is that Blue Precision HMO policy holders may be referred to any Northwestern Medicine specialist or facility by their primary care physician.

Using the Coventry One PPO provider search tool you will also find that the University of Chicago hospital and the Ann & Robert Lurie Children’s Memorial hospital are also included in the Coventry One PPO network. Click the graphic below to see 2016 plans and prices from Coventry One and Aetna insurance company.


If you want to keep the plan that BCBSIL automatically enrolled you in for 2016, or you want to choose another plan please follow the instructions in this document and visit to accept the new plan or choose a different plan with Blue Cross Blue Shield of Illinois for the year 2016. Visit for more expert guidance throughout the 2016 ACA Open Enrollment period.


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Victims of Obamacare

Last year I appeared on the Emmy award winning television show “Facing Life Head-On” with my friend Bill Elliot. Bill voted for Barack Obama in 2012 so he was quite upset when he had his health insurance policy canceled in the middle of his fourth battle with cancer. We told our story and were joined in the two episodes by Dr. Bob Berger and J.T.M Food Group C.E.O.  Tony Maas. These episodes are currently airing on DIRECTV channels 372 and 378 .

On Thursday, November 7, 2013,  Bill appeared on “The Kelly File” with Megyn Kelly on the Fox News channel. Watch the clip:

This is the worst time to cancel someone’s coverage. And, that is precisely why Public Law 104-191 (HIPPA) was written and passed by Congress in 1996. It was written to protect Americans from such a situation. Since Bill committed no fraud and his insurer charged him more based on a preexisting condition, his insurer was in violation of Public Law 104-191 section 2742. As such, they had no legal right to terminate his coverage, regardless of a posting in the Federal register. The protections provided to individual policy holders under HIPAA law are reiterated by HHS, CMS and HCFA regulations. They are ironclad and were outlined long before Obamacare on page 22 of the “Protecting Your Health Insurance Coverage” booklet available for download at the site here.

After I watched this interview I ‘friended’ Bill on Facebook. I wanted him to know that even though his insurer was being forced to terminate his health insurance policy due to regulations posted by HHS and referred to in the Federal Register in June 2010 three months after the PPACA – Patient Protection & Affordable Care Act (Obamacare) – was signed into law. Such a posting in the Federal Register that has not been passed by Congress does not trump existing Federal protections. It was NBC News that broke the story about these federal register postings and revealed that the Obama administration knew that millions of individual policies would be canceled due to these regulations long before Barack Obama began repeating the lie ‘if you like your plan, you can keep your plan.” This lie was aptly named by Politifact as ‘the lie of the year.’ You can watch that NBC News clip below. Just to be clear, in the report below Brian Williams was actually telling the truth.

Bill took the information I gave him and contacted his governor in South Carolina Nikki Haley, and together they faxed section 2742 of HIPAA law to Bill’s health insurance company. The very next day Bill received notice from his insurer that his policy would not be canceled and that he could keep his existing plan with the same deductible and with the same premium. As you can imagine, this became a national news story. It was covered my many news sites and Bill and I began doing multiple radio interviews and I began writing and speaking publicly about our story. Shortly after Bill and I began speaking publicly, we were both sent letters of demand from the IRS asking for thousands of dollars. In fact, I received my first letter on  the same day that Bill received his. In my case, the IRS was asking for money all the way back to 2003. See both of my letters of demand below. Story continues below these lettersirs 3592 IRS letter 2106 Shortly after I received these letters I was contacted on my cell phone by the IRS Treasury Inspector General in Chicago who wanted me to come to his office so we could ‘discuss the case they heard about in the media’. I instead asked him to come to my home. I then reached out to my attorney who referred me to William J. Sneckenberg of the Sneckenberg, Thompson and Brody law firm in Chicago. Mr. Sneckenberg said that ‘this is highly irregular’ and then said he wanted to be in my home before the IRS arrived. Mr. Sneckenberg did indeed arrive about a half hour before the two IRS representatives knocked on my door. I foolishly thought they were there to resolve the issue and instead they began asking me questions pertaining to Bill’s contact information. They asked “Do you know Bill Elliot’s home address? Do you know his phone number?” I stated that we were Facebook friends and that they are the IRS and they should already have his address. They then began their inquisition of sorts. They asked for my wife’s name, date of birth and who she works for and other personal information so they could ‘complete their report’. They then stated ‘we did not send the letters, we are here simply to complete a full report’. You will need to contact the IRS directly to resolve these debts.

It was then that I contacted my friend Denise Cattoni, the state coordinator for the Illinois Tea Party. Denise was kind enough to contact Senator Mark Kirk’s office. It was only through the diligent efforts of Senator Kirk’s staff that the supposed debt I owed was finally abolished. As it turns out, the IRS told Senator Kirk’s office that I ‘bounced a check to them back in 2003’. I then asked Senator Kirk to ask the IRS to provide a copy of said ‘bounced check’. Shortly thereafter the entire $5,698.24 of ‘debt’ that I supposedly owed the IRS was expunged.  I am eternally grateful to Senator Kirk and his staff and all who took an interest in our story and who gave us emotional and legal support during this difficult time. See Senator Kirk’s letter below. Conclusion below letter …. IRS debts resolved 3 26 14 The best part of this story is that Bill is now in remission, largely due to the fact that he could keep his health insurance policy and continue to received the life saving treatment he needed from his existing doctors and hospitals on his existing health insurance plan. Also through the diligent efforts of Bill’s governor Nikki Haley and former Senator Kay Hagan. Bill’s IRS debt has also been abolished. I told the entire story from start to finish at the 2014 Chicago Illinois Tax Day Tea Party rally on April 15, 2014: I also wish to thank Jenny Beth Martin with TeaPartyPatriots for inviting me to speak the truth at the 5th anniversary of the Tea Party on February 27, 2014 in Washington D.C where I had the honor of meeting the ‘Great One’ Mark Levin:

Bill Elliot and Yours TrulyBill and Yours Truly at the taping of Facing Life Head-On episode “Victims of Obamacare”

The Great One and me at the 5th annivesary of the Tea Party
The Great One Mark Levin and Yours Truly at the 5th Anniversary of the Tea Party movement in D.C.

Credit where credit is due

I am eternally grateful to the following bloggers and reporters who comprise the ‘New Media’ for linking to this story and performing the job that Barack Obama’s old Praetorian Guard media still refuses to do:

“BigFurHat” at The trendsetter who started it all.
Daniel Greenfield of
Arlen Williams of who pushed the story out and detailed it’s movement via Storify.
Drudge Report
Eric Sheiner at CNSNews
“Zip” of
Fran Eaton at Illinois Review
Jim Hoft of
“Dr John” of
Madeleine Morgenstern at The Blaze
John Hayward at
Tom Tillison at
Thomas Lifson at
Mark Steyn at
Investors Business Daily
Dianny at AllTheRightSnark
Herman Cain on the Herman Cain radio show
Clark Barrow at CainTV
John Hawkins at
Sard at
Tammy Bruce radio show clip at
The Right Pundit at
Judson Phillips at TeaPartyNation
Instapundit at PJMedia
Michael Becker at
Ulysses S. Arn at USofArn
Emily Hulsey at IJReview
IDeb at
Jeff Dunetz at
Lily Dane at at TheDCClothesline
Scared Monkeys
Wintery Knight
Prison Planet
Janet at NewsDeskInternational

Steve Straub at TheFederalistPapers

Austin Petersen at TheLibertarianRepublic
Debra Heine at TheSteadyDrip

Khier Casino at OpposingViews
Lily Dane at TheDailySheeple
Deanna Fisher at VictoryGirlsBlog
Sara Noble at IndependentSentinel
Phineas at SisterToldjah
Joe Newby at

If I missed you contact me and I will list you. Thank you all!


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Jim Demint is correct, Medicaid expansion does hurt everyone and John Kasich is a liar.

On March 18, 2015 former U.S. Senator and president of the Heritage Foundation​, Jim DeMint wrote a great piece on Medicaid expansion entitled Why state Medicaid expansion hurts everyone. ​I can only find one fault with it. The term “bump out Medicaid payment” should have been explained in the piece or at least an asterisk provided with an explanation at the end. Often times further explanation is not given due to the number of words the author can use being constrained. Since there are no such constraints on me, I will provide that explanation and add further context below.

Bump out Medicaid payment” refers to the end of the PPACA (Obamacare) mandated increase in reimbursements (pay) to primary care physicians who accept Medicaid. Under the PPACA, physicians who accept MediCAID were to receive an increase in reimbursements commensurate to what physicians who accept MediCARE get, which is a significantly higher. That sounds great right? That means Medicaid recipients will have access to more physicians! This would normally be a good thing, at least for the most vulnerable in our society. Only one problem, and it’s a BIG one.

The Federal government only pays for the first TWO YEARS of this increased reimbursement. After two years, STATE governments will struggle to maintain this increased rate of pay. Why is this an issue now? Because the first two years of this temporary provision were 2013 and 2014. That means state taxpayers are facing the reality of maintaining that increased rate of pay right now. In 24 states, like Illinois there is NO MONEY to maintain this pay hike for primary care physicians who accept Medicaid. Those states have already decided NOT to continue funding this increase in Medicaid primary care physician payments with state taxpayer dollars.  Many of the physicians who received this temporary pay hike have already expanded their patient lists to include many of these new Medicaid recipients. If the state cannot maintain the new increased rate of pay these new patients will most likely end up right where they were before, struggling to find a doctor who accepts Medicaid.

Worse YET, because far too many states expanded Medicaid eligibility to 138% above the FPL – Federal Poverty Level – and because the PPACA expands Medicaid to SINGLE, childless adults in the prime of their lives. The truly indigent and disabled end up disenfranchised due to the fact that single, childless adults in the prime of their lives (who should be WORKING) are now COMPETING for those Medicaid dollars. This in turn makes it more difficult for those who Medicaid was originally designed for (disabled, blind, single mothers, etc.) to receive the care they often times desperately need. Oh and let’s not forget that Medicaid recipients are also now competing with JAILED PRISONERS and ex convicts in Illinois, Ohio and other states thanks to PPACA Medicaid expansion.


There’s another ticking fiscal Medicaid time bomb, not referred to in Demint’s article that begins next year in 2016. For states that implement Medicaid expansion, the federal government will finance 100% of ALL costs (not just primary care visits) of those made newly eligible for Medicaid from 2014 to 2016. Then in 2016 the fed begins ‘phasing down’ that reimbursement to only 90% by 2020 and beyond. States will once again have to struggle to continue to pay the traditional Medicaid match rate for increased participation among those currently eligible. In addition to those costs are the administrative costs to the state. These are estimated to cost an ADDITIONAL $12 BILLION by 2020. This is why states like Texas which faced a $25 BILLION budget deficit in 2010 opted out of PPACA Medicaid expansion, prompting then governor Rick Perry to write this letter to then Secretary of HHS Kathleen Sebellius. Governor Perry was right then and he’s right now. Obamacare Medicaid expansion is a bad deal for states and a very bad deal for the most vulnerable in our society.

Illinois took the opposite role under former Governor Pat Quinn. He expanded Medicaid under the PPACA in the summer of 2013. A document sent by Quinn’s office over the summer of 2014 to the federal government significantly raised the per-person estimated Medicaid cost, INCREASING the state’s total outlay to $2 BILLION, using 2014 enrollment numbers. That is more than more than THREE TIMES the original cost estimate. Illinois has budgeted about $20 billion in 2015 for its Medicaid program. About half will be reimbursed with federal funds.

This shortsighted decision by former Governor Quinn has played a significant role in the current $9 BILLION budget DEFICIT that new governor Bruce Rauner now has to deal with. He is doing so by making deep and necessary cuts across the board. Much to the chagrin of the hospital lobby which seeks to maintain status quo by tapping into more federal dollars, regardless of the impact on our state’s budget.


Since I already addressed Indiana’s faux ‘Conservative’ Governor Mike Pence and his ridiculous decision to expand Medicaid under Obamacare on this episode of Indiana’s “Chicks On The Right” radio show. Let me address another faux ‘Conservative’ governor. Ohio’s John Kasich who Senator Demint accurately states is ALREADY facing a Medicaid expansion program 53% OVER budget and that’s just for the first HALF of 2015!

Mr. Kasich you have LIED to your constituents over and over again making public statements like the following:
“[Rejecting Medicaid expansion] takes $13 billion of Ohioans’ federal tax dollars out of our state and gives it to other states, —where it will go to work helping to rev up some other state’s economy instead of Ohio’’s.”  The worst part sir is that you KNOW it’s a lie. You are NOT an economic illiterate. You served as a member of the United States Congress for 18 years as the CHAIRMAN of the House BUDGET Committee!

The truth was revealed by Nic Horton, Jonathan Ingram and Josh Archambault. In a recent article at Forbes, these gentlemen pointed to a recent report from the Congressional Research Service which CONFIRMS what many of us policy experts have known for a long time. States that reject Obamacare’s Medicaid expansion are NOT “sending that Medicaid expansion money to other states“. Instead, that money is simply NEVER spent.

Nice try Governor. Next time just admit you’re a big government Statist who seeks to use taxpayer dollars to make you and your state’s budget look better, regardless of the additional burden that places on other taxpayers, their children and their grandchildren. But hey, you know what they say Governor. When you rob Peter to pay Paul you can ALWAYS count on Paul’s vote. Shame on you sir. You and those like you give Republicans a bad name.

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Blue Cross Blue Shield of Illinois to accept OFF exchange applications starting March 9, 2015.

On March 6, 2015 Blue Cross Blue Shield of Illinois announced that they will begin accepting guaranteed issue (no preexisting conditions) applications completed off the exchange beginning Monday, March 9, 2015. Off exchange applications are applications completed by those who have incomes to high to qualify for a subsidy via the “Marketplace” a.k.a. This new ‘Special Enrollment Period’ will last until April 30, 2015. 

For those who do qualify for a subsidy, Blue Cross Blue Shield of Illinois will be accepting on exchange applications completed via the “Marketplace” a.k.a. beginning March 15, 2015 and ending April 30, 2015. Below is the new announcement from Blue Cross Blue Shield of Illinois:

Tax Filing Special Enrollment Period Available for On- and Off- Marketplace Enrollment SEP for Off-Marketplace Plans Opens March 9!

As was announced last week, the Centers for Medicare and Medicaid Services (CMS) has approved a new Special Enrollment Period (SEP), meant to help consumers avoid tax penalties for not obtaining health insurance coverage this year.

The SEP for Marketplace enrollment begins Sunday, March 15.

We will offer this SEP for off-Marketplace enrollment also. To assist more of our customers with getting coverage beginning April 1, we are opening the tax SEP for coverage purchased from us on Monday, March 9. This gives them an extra week to enroll for an April 1 effective date when choosing an off-Marketplace plan.

Below are instructions on how to enroll OFF the exchange during this new Special Enrollment Period:

  • You will need to use this paper application.
  • On the paper application, you will need to select #8 (“Other”) as the SEP reason and must write “TAX SEP” in the Home Use Only box in the upper right corner. Paper applications for an off-Marketplace plan sent to us will only be accepted under the SEP if the application has the SEP designation selected.
  • You can then fax the application to (630) 582-1043. Or you can mail the application to:
    Small Business Insurance Services Inc.
    430 Northampton Lane
    Roselle, IL. 60172
    Or, you can email the application to This manual process is only necessary for the special tax SEP.

Below are instructions on how to enroll ON the exchange during this new Special Enrollment Period

If applicants are subsidy eligible and want to apply for financial assistance, they will need to apply directly online on the Marketplace starting March 15 via Using a broker to guide you through this process costs you nothing extra. It is highly recommended to call a licensed broker toll free at 866-724-7123 to help guide you through the application process at

Enrollment effective dates will follow the 15th of the month rule, as follows:

  • Applications submitted from March 9 through March 15 will have an April 1 effective date.
  • Applications submitted March 16 through April 15 will have a May 1 effective date.
  • Applications submitted April 16 through April 30 will have a June 1 effective date.
  • Members cannot ask for a different effective date.

By indicating “TAX SEP” on the application for insurance, the applicant is self-attesting that they qualify for the special enrollment period because they:

  • had to pay a penalty for not having coverage in 2014,
  • are not currently enrolled in a plan on, and
  • only found out about the tax penalty or understood the implications when they had to pay a tax penalty with their income tax return for 2014.

To see prices and plan options click the Blue Cross Blue Shield of Illinois logo below. Then click the orange “Just Browsing” button at the bottom of the “Are you eligible for special enrollment” page:


For expert guidance in Illinois please call (630) 674-1551. Outside of Illinois please call toll free (866) 724-7123.

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Analysis of Senator Ted Cruz’s “Health Choice Act of 2015″

I have now read through Senator Ted Cruz​’s entire new “Health Choice Act of 2015“. Here’s what it accomplishes in a nutshell:

1.) It repeals Title 1 of the Patient Protection & Affordable Care Act a.k.a “Obamacare” and all it’s amendments, including those amendments put forth via the law’s companion. Namely  the Health Care and Education Reconciliation Act of 2010.

Title 1 of the PPACA contains:

A. ) The onerous “pay or play” mandates on individuals and employers a.k.a the unconstitutional ‘fine’ (TAX) for not buying health insurance.

B.) The health insurance “exchanges”.

C.) The federally mandated policy design changes forced upon every health insurer i.e. the ‘Ten Essential Benefits‘ including maternity, 63 ‘free’ preventive care tests and exams, abortifacient drugs etc.

As I have proven before, the vast majority of health insurance plans that existed before the PPACA – that were subsequently canceled because of the PPACA – contained most of the PPACA required “Ten Essential Benefits” already. As such, they did not need to be canceled in order to provide adequate coverage.

D.) The onerous MLR – Medical Loss Ratio – requirements that have forced 13 health insurance carriers out of the market.

E.) The ‘Failure To Launch’ clause a.k.a. ‘keeping your child on you plan until age 26‘ whether they are married, unmarried, attending college or dependent on their parents financially.

Most states required carriers to keep your child on your plan until age 25 or longer,long before Obamacare. Contrary to popular belief, many states did not require these young adults to be attending college. However,  unlike the PPACA requirement, you had to be single (unmarried).

F.) Eliminates annual and lifetime maximums of coverage.

Annual coverage maximums should continue to be barred as well as lifetime caps. Lifetime caps are so rarely exceeded that this is nearly a moot point. Annual maximums should never have been allowed in the first place.

G.) The prohibition on preexisting conditions in the individual health insurance marketplace.

Cruz relies upon existing protections outlined in section 2741 and 2744 of 1996 HIPPA law for those with preexisting conditions in the individual market 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 market 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 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.

All of these existing protections against preexisting condition clauses were in existence for years before the PPACA. As I have proven before the Democrat’s argument pertaining to preexisting conditions has been inaccurate, disingenuous and in the case of President Obama a proven and repetitive lie.

H.) The Advance Premium Tax Credits and Cost Sharing Reduction federal subsidies allotted to those who fall below certain income levels and purchase their coverage “on the exchange” via

Other Republican proposals such as Avik Roy’s “Transcending Obamacare” plan suggest keeping the exchanges and lowering the eligibility to receive the aforementioned federal subsidies from 400% above FPL to 317% above FPL. Still other plans such as the “Patient Care Act” proposed by Senator Burr, Hatch and Upton would replace the PPACA with a means-tested tax credit that individuals could use to buy a far broader range of insurance products, or deposit the funds in a health savings account. Other Republicans have proposed keeping PPACA subsidies in place for a ‘transitional period’ should the rule of law prevail in the pending King v. Burwell case, currently being heard by the U.S. Supreme Court.

2.) Cruz’s plan also provides a viable and well regulated solution to selling health insurance across states lines.

Whilst Cruz’s plan is a very good start to providing real alternative reforms of the individual health insurance market. It does not attack the primary drivers of cost. Namely, cost shifting from preexisting federal health care programs like Medicare and Medicaid and the prohibition of competing hospitals and surgical centers promulgated for far too many years by the Federal Trade Commission. It also does not address the massive and fiscally unsustainable expansion of Medicaid under the PPACA nor does it provide a plan for the preservation of Medicare. All of those issues and more are addressed in Avik Roy’s “Transcending Obamacare“. To be fair, Senator Cruz plans on revealing a far more comprehensive plan in the coming months. I am waiting to read it with great anticipation.

One thing remains true, unlike the lies from our ‘friends on the Left’. Republicans have no shortage of Obamacare replacement plans. More than 25 have been proposed. What we do need to do is coalesce around one of them and promote it nationally and consistently starting yesterday.


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