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Canceled Health Plans Get Reprieve

The Obama administration will allow some health plans that fall short of Obamacare coverage requirements to be offered for two more years, extending the coverage past the November elections and through President Barack Obama’s second term.

The decision, announced Wednesday by federal health officials, extends an earlier decision by the White House to let people keep their existing health plans through 2014, even if those plans fell short of the Affordable Care Act requirements. Under the new policy, some people could renew plans in 2016, meaning they would be covered into 2017.

Read the full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

White House Expected to OK Another ACA Extension

The Obama administration is expected to announce yet another delay in the rollout of the Affordable Care Act.  According to reports from Bloomberg and the Wall Street Journal, insurers will likely be allowed to continue selling non-compliant health policies for another 12 months.

The policies were originally meant to be discontinued in November, thanks to a last-minute reprieve from President Obama. Now, it appears that policyholders will be able to renew non-compliant plans again, meaning some policies could stay in place through 2016 depending on anniversary date.

Read the full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

A Child’s Mind in an Adult Body

A child’s mind in an adult body. This is the most accurate way I can describe Ezehiel J. Emanuel’s opinions expressed in a recent article on the future extinction of health insurance companies. Mr. Emanuel knows not the history and the polarizing affects limited health plans have on a population. Read his prediction on the future of health insurance companies.

http://www.newrepublic.com/article/116752/ezekiel-emanuel-book-excerpt-end-health-insurance-companies

The new term Accountable Care Organization, ACO, varies little in concept from the Health Maintenance Organizations, HMO. Exceptions are some technological advancements in reporting that have evolved in the last decade. On March 3, 1978, in a Senate hearing the late Senator Ted Kennedy celebrates HMOs:

  • “Today the Subcommittee on Health and Scientific Research holds hearings on proposed amendments to federal statutes supporting the development of health maintenance organizations…These amendments would extend and strengthen current authorities supporting HMOs in this country….
  • “As the author of the first HMO bill ever to pass the Senate, I find this spreading support for HMOs truly gratifying. Just a few years ago, proponents of health maintenance organizations faced bitter opposition from organized medicine. And just a few years ago, congressional advocates of HMOs faced an administration which was long on HMO rhetoric, but very short on action.
  • “The current revival of the HMO movement should come as no surprise. HMOs have proven themselves again and again to be effective and efficient mechanisms for delivering health care of the highest quality. HMOs cut hospital utilization by an average of 20 to 25 percent compared to the fee-for-service sector. They cut the total cost of health care by anywhere from 10 to 30 percent. And they accomplish these savings without compromising the quality of care they provide their members.
  • “In fact, many medical experts argue that the peer review built into group practice in the HMO setting promotes a quality of care superior to that found in the traditional health care system….
  • “In our enthusiasm to see HMOs proliferate throughout this country we should not lose sight of the need to guarantee the quality and integrity of the prepaid plans we create.”

Compare this to is remarks on May 15, 2001:

On May 15, 2001, Senator Ted Kennedy released a statement regarding the need for an effective patients’ bill of rights to end HMO abuse.  Following are excerpts from that press release:

  • “Today, if your child has a rare congenital heart defect and no specialist in the plan is equipped to treat it, your [HMO] plan can condemn your child to second rate care from the doctor who happens to be on the plan’s list…”
  • “Today, if you have incurable cancer and your best hope of a cure is participation in a clinical trial, your [HMO] plan can deny you access to that trial…”
  • “Today, your doctor can be financially coerced by your HMO into giving you less than optimal care…”
  • “Today, if you need an expensive drug that is not on your plan’s list, the [HMO] plan can make you pay for it yourself or go without…”

Senator Kennedy continues:  “It is time to end the abuses of managed care that victimize thousands of patients each day. It is time for doctors and nurses and patients to make medical decisions again, not insurance company accountants. The American people deserve prompt action, and we intend to see that they get it.”

Mr. Emanuel would be better writer if you studied history more than what he apparently has. The market will likely bifurcate into two fractions:

  • One, those in need of being directed and taken care of my our medical system through ACO (HMO) and
  • two, those who desire more autonomy and ability to self-direct their own care using higher deductible plans that resemble insurance combined with the tax incentives present within our tax code.

A Child’s Mind in an Adult Body

A child’s mind in an adult body. This is the most accurate way I can describe Ezehiel J. Emanuel’s opinions expressed in a recent article on the future extinction of health insurance companies. Mr. Emanuel knows not the history and the polarizing affects limited health plans have on a population. Read his prediction on the future of health insurance companies.

http://www.newrepublic.com/article/116752/ezekiel-emanuel-book-excerpt-end-health-insurance-companies

The new term Accountable Care Organization, ACO, varies little in concept from the Health Maintenance Organizations, HMO. Exceptions are some technological advancements in reporting that have evolved in the last decade. On March 3, 1978, in a Senate hearing the late Senator Ted Kennedy celebrates HMOs:

  • “Today the Subcommittee on Health and Scientific Research holds hearings on proposed amendments to federal statutes supporting the development of health maintenance organizations…These amendments would extend and strengthen current authorities supporting HMOs in this country….
  • “As the author of the first HMO bill ever to pass the Senate, I find this spreading support for HMOs truly gratifying. Just a few years ago, proponents of health maintenance organizations faced bitter opposition from organized medicine. And just a few years ago, congressional advocates of HMOs faced an administration which was long on HMO rhetoric, but very short on action.
  • “The current revival of the HMO movement should come as no surprise. HMOs have proven themselves again and again to be effective and efficient mechanisms for delivering health care of the highest quality. HMOs cut hospital utilization by an average of 20 to 25 percent compared to the fee-for-service sector. They cut the total cost of health care by anywhere from 10 to 30 percent. And they accomplish these savings without compromising the quality of care they provide their members.
  • “In fact, many medical experts argue that the peer review built into group practice in the HMO setting promotes a quality of care superior to that found in the traditional health care system….
  • “In our enthusiasm to see HMOs proliferate throughout this country we should not lose sight of the need to guarantee the quality and integrity of the prepaid plans we create.”

Compare this to is remarks on May 15, 2001:

On May 15, 2001, Senator Ted Kennedy released a statement regarding the need for an effective patients’ bill of rights to end HMO abuse.  Following are excerpts from that press release:

  • “Today, if your child has a rare congenital heart defect and no specialist in the plan is equipped to treat it, your [HMO] plan can condemn your child to second rate care from the doctor who happens to be on the plan’s list…”
  • “Today, if you have incurable cancer and your best hope of a cure is participation in a clinical trial, your [HMO] plan can deny you access to that trial…”
  • “Today, your doctor can be financially coerced by your HMO into giving you less than optimal care…”
  • “Today, if you need an expensive drug that is not on your plan’s list, the [HMO] plan can make you pay for it yourself or go without…”

Senator Kennedy continues:  “It is time to end the abuses of managed care that victimize thousands of patients each day. It is time for doctors and nurses and patients to make medical decisions again, not insurance company accountants. The American people deserve prompt action, and we intend to see that they get it.”

Mr. Emanuel would be better writer if you studied history more than what he apparently has. The market will likely bifurcate into two fractions:

  • One, those in need of being directed and taken care of my our medical system through ACO (HMO) and
  • two, those who desire more autonomy and ability to self-direct their own care using higher deductible plans that resemble insurance combined with the tax incentives present within our tax code.

Report to Congress on the Impact on Premiums for Individuals & Families with Employer-Sponsored Health Insurance

The “Department of Defense and Full-Year Continuing Appropriations Act, 2011” required this report to Congress on the impact of sections 2701 through 2703 of the Public Health Service (PHS) Act, as amended by the Affordable Care Act (ACA) on the premiums paid by individuals and families with employer-sponsored health insurance. Specifically, the Chief Actuary of the Centers for Medicare & Medicaid Services (CMS) is to provide an estimate of the number of individuals and families who will experience a premium increase and the number who will see a decrease as a result of these three provisions.

Section 2701 of PHS Act is titled “Fair Health Insurance Premiums” and requires adjusted community rating for plan years beginning on or after January 1, 2014. Specifically, premium rates in the individual and small group market charged for non-grandfathered health insurance coverage may only be varied on the basis of the following four characteristics:

• Individual or family enrollment.
• Geographic area – premium rates can vary by the area of the country.
• Age – premium rates can be higher for an older applicant than that for a younger applicant, but the ratio of premiums cannot exceed 3:1 for adults.
• Tobacco use – premium rates can be higher for smokers, but the ratio cannot exceed 1.5:1.

Section 2702 of the PHS Act requires the guaranteed issuance of health insurance coverage in the individual and group market subject to specified exceptions. This means that insurers that offer coverage in the individual or group market generally must accept all applicants for that coverage in that market. Under section 2703 of the PHS Act, group and individual health insurance coverage
must be guaranteed renewable at the option of the plan sponsor or individual, subject to specified exceptions. These three sections do not apply to grandfathered health insurance coverage.

Read the full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.