Tag Archives: Disability insurance Atlanta

Early Retiree Reinsurance Program

(Reprinted from BCBSGA)
The Patient Protection and Affordable Care Act includes an early retiree reinsurance program that is available to group health plan sponsors who provide medical coverage to early retirees and their spouses, surviving spouses and dependents. It is intended to encourage employers to provide health coverage to early retirees until state health exchanges and federal subsidies for health coverage are implemented. This temporary program will provide $5 billion to help employers to continue to provide coverage to certain retirees. The program provides for reimbursement of an early retiree’s (and covered dependents’) health care claims in an amount equal to 80% of the costs between $15,000 and $90,000.
The employer is then expected to use the reimbursement to help lower health care costs (such as premium contributions, copays and deductibles) for participating enrollees. The program provides for reimbursement of an early retiree’s (and covered dependents’) claims in an amount equal to 80% of health benefits costs between $15,000 and $90,000.
This program is expected to be effective from June 1, 2010, to January 1, 2014. After January 1, 2014, retirees will have additional coverage options through the health insurance exchanges. Both self-insured and fully insured employer groups can participate. To participate in the program, employers must first submit applications (likely available beginning in June) to the Department of Health and Human Services.

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House Passes Health Reform Legislation

After intense negotiations that included a budget reconciliation process, the House of Representatives passed health care reform legislation. The House passed both H.R. 3590, the Patient Protection and Affordable Care Act (the Affordable Care Act), and H.R. 4872, the Health Care and Education Reconciliation Act of 2010 (the Reconciliation Act).
The Affordable Care Act was approved by the Senate on December 24, 2009, and it can now go to President Barack Obama for his signature. The Health Care Reconciliation Act strikes out or modifies a number of tax and revenue provisions in the Senate’s Affordable Care Act to which the House objected. Under budget reconciliation rules, the House Health Care Reconciliation Act now goes to the Senate, which can pass the bill with a 51 majority that is not subject to the 60-vote filibuster rules for other legislation considered in the Senate.
The Senate is expected to take up the Health Care Reconciliation Act this week, and Senate Democrats have the goal of sending a final package to the White House before its scheduled April recess begins on March 29. However, if the Senate makes any changes, the House and the Senate versions will go to a conference of House and Senate negotiators. An agreement by negotiators then will go back to the House and the Senate for a simple majority final vote by the two chambers under strict rules that set a timetable for action and that prohibit any amendments. Assuming passage of this conference committee agreement, it will be sent to the President Obama for his signature.
The president’s signature to both H.R. 3590 and 4872 will put into effect the provisions of the Affordable Care Act as amended by the Health Care Reconciliation Act. These provisions include the following:
Employer Responsibilities. Effective in 2014, assess certain employers a fee of $2,000 per full-time employee, excluding the first 30 employees from the assessment: employers with more than 50 employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit. Employers with more than 50 employees that offer coverage but have at least one full-time employee receiving a premium tax credit, will pay the lesser of $3,000 for each employee receiving a premium credit or $750 for each fulltime employee. (Effective January 1, 2014).
Employers with 50 or fewer employees are exempt from penalties.
Effective in 2014, employers that offer coverage would be required to provide a free choice voucher to employees with incomes less than 400% FPL whose share of the premium exceeds 8% but is less than 9.8% of their income and who choose to enroll in a plan in the Exchange. The voucher amount is equal to what the employer would have paid to provide coverage to the employee under the employer’s plan and will be used to offset the premium costs for the plan in which the employee is enrolled. Employers providing free choice vouchers will not be subject to penalties for employees that receive premium credits in the Exchange.
Employers with more than 200 employees must automatically enroll employees coverage offered by the employer. Employees may opt out of coverage.
Individual Reponsibilities. Citizens and legal residents are required to have “qualifying health coverage.” Those without coverage pay a tax penalty of the greater of $695 per year up to a maximum of three times that amount ($2,085) per family or 2.5% of household income. The penalty will be phased-in according to the following schedule: $95 in 2014, $325 in 2015, and $695 in 2016 for the flat fee or 1.0% of taxable income in 2014, 2.0% of taxable income in 2015, and 2.5% of taxable income in 2016. After 2016, the penalty will be increased annually by the cost-of-living adjustment. Exemptions will be granted for those for whom the lowest cost plan option exceeds 8% of an individual’s income, and those with incomes below the tax filing threshold (in 2009 the threshold for taxpayers under age 65 was $9,350 for singles and $18,700 for couples).
Health Benefit Exchanges. Effective in 2014, state-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges are established, administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage. States are permitted to allow businesses with more than 100 employees to purchase coverage in the SHOP Exchange beginning in 2017. States may form regional Exchanges or allow more than one Exchange to operate in a state as long as each Exchange serves a distinct geographic area. (Funding available to states to establish Exchanges within one year of enactment and until January 1, 2015)
Individual subsidies. Refundable and advanceable premium credits are made available to eligible individuals and families with incomes between 133 and 400% of the federal poverty level to purchase insurance through the Health Insurance Exchanges. The premium credits will be tied to the second lowest cost silver plan in the area and will be set on a sliding scale.
Employer subsidies. Small employers with no more than 25 employees and average annual wages of less than $40,000 that purchase health insurance for employees are provided with a tax credit.
For 2010 through 2013, a tax credit of up to 35% of the employer’s contribution toward the employee’s health insurance premium is provided if the employer contributes at least 50% of the total premium cost or 50% of a benchmark premium.
For 2014 and later, for eligible small businesses that purchase coverage through the state Exchange, a tax credit is provided of up to 50% of the employer’s contribution toward the employee’s health insurance premium if the employer contributes at least 50% of the total premium cost. The credit will be available for two years. The full credit will be available to employers with 10 or fewer employees and average annual wages of less than $25,000.
Effective 90 days after enactment and extending until Jan. 1, 2014, a temporary reinsurance program is established for employers providing health insurance coverage to retirees over age 55 who are not eligible for Medicare. The program will reimburse employers or insurers for 80% of retiree claims between $15,000 and $90,000
Financing of health reform. Beginning in 2014, a tax on individuals without qualifying coverage is imposed that is the greater of $695 per year up to a maximum of three times that amount or 2.5% of household income.
Effective in 2018, an excise tax is imposed on insurers of employer-sponsored health plans with aggregate values that exceed $10,200 for individual coverage and $27,500 for family coverage. The tax is equal to 40% of the value of the plan that exceeds the threshold amounts and is imposed on the issuer of the health insurance policy, which in the case of a self-insured plan is the plan administrator or, in some cases, the employer. The aggregate value of the health insurance plan includes reimbursements under a flexible spending account for medical expenses (health FSA) or health reimbursement arrangement (HRA), employer contributions to a health savings account (HSA), and coverage for supplementary health insurance coverage, excluding dental and vision coverage.
Benefit design. Effective in 2014, an essential health benefits package is established that provides a comprehensive set of services, covers at least 60% of the actuarial value of the covered benefits, limits annual cost-sharing to the current law HSA limits ($5,950/individual and $11,900/family in 2010), and is not more extensive than the typical employer plan. Require the Secretary to define and annually update the benefit package through a transparent and public process.
Abortion coverage is prohibited from being required as part of the essential health benefits package.
Effective in 2014, all qualified health benefits plans, including those offered through the Exchanges and those offered in the individual and small group markets (except grandfathered plans) are required to offer at least an essential health benefits package.
Private Insurance. Effective within 90 days of enactment and extending through Jan. 1, 2014, a temporary national high-risk pool is established to provide health coverage to individuals with pre-existing medical conditions. Individuals who have a pre-existing medical condition and who have been uninsured for at least six months will be eligible to enroll in the high-risk pool and receive subsidized premiums. Premiums for the pool will be established for a standard population and may vary by no more than 4 to 1 due to age; maximum cost-sharing will be limited to the current law HSA limit ($5,950/individual and $11,900/family in 2010).
Effective in 2010, health insurance plans are required to report the proportion of premium dollars spent on clinical services, quality, and other costs. Effective in 2011, insurers must provide rebates to consumers for the amount of the premium spent on clinical services and quality that is less than 85% for plans in the large group market and 80% for plans in the individual and small group markets. A process is established for reviewing increases in health plan premiums and requiring plans to justify increases. States are required to report on trends in premium increases and recommend whether certain plan should be excluded from the Exchange based on unjustified premium increases.
Effective six months after enactment, all individual and group policies must provide dependent coverage for children through age 26; individual and group health plans are prohibited from placing lifetime limits on the dollar value of coverage and insurers are prohibited from rescinding coverage except in cases of fraud; plans are prohibited from imposing pre-existing condition exclusions for children
Beginning in January 2014, individual and group health plans are prohibited from placing annual limits on the dollar value of coverage. Prior to January 2014, plans may only impose annual limits on coverage as determined by the Secretary.
Six months following enactment, grandfathered plans are required to extend dependent coverage to age 26, prohibit rescissions of coverage, eliminate waiting periods for coverage of greater than 90 days, and eliminate pre-existing condition exclusions for children. Beginning in 2014, grandfathered group plans must eliminate lifetime limits on coverage and eliminate annual limits on coverage.
Effective in 2014, waiting periods for coverage are limited to 90 days and states have the option of merging the individual and small group markets.
Financing. The Congressional Budget Office estimates the cost of the coverage components of the reconciliation bill in combination with the Patient Protection and Affordable Care Act to be $940 billion over ten years. These costs are financed through a combination of savings from Medicare and Medicaid and new taxes and fees, including an excise tax on high-cost insurance, which CBO estimates will raise $32 billion over ten years. CBO estimates the proposal will reduce the deficit by $143 billion over ten years.
Additional Medicare tax. A 40 percent excise tax will be imposed on high-dollar insurance plans and an increase in Medicare payroll taxes on taxpayers in the $200,000 plus income category ($250,000 for joint filers), beginning in 2013.
Medicare: Several provisions link quality outcomes and payments under Medicare. Quality measure reporting programs, already in place for inpatient acute hospitals, will be developed for long-term care hospitals, rehabilitation hospitals, hospice programs, and PPS-exempt cancer hospitals.
Starting in fiscal year 2015, hospitals in the top 25th percentile of rates of hospital-acquired conditions for certain high-cost procedures will be subject to a payment penalty.
A value-based purchasing (VBP) program for hospitals will be implemented in 2013. A portion of a hospital’s Medicare payment will be linked to the hospital’s performance on quality measures related to common and high-cost conditions, such as cardiac, surgical, and pneumonia care. Similar programs will be introduced for other health care providers as well.
Reimbursement for most types of Medicare providers will be adjusted to improve payment accuracy. Medicare Advantage payments will be adjusted to be more in line with Medicare fee-for-service payments.
Physician fee schedule. Payments would increase by 0.5 percent increase over 2009 rates.
Rural health care. Medicare payments will increase to providers in any state where at least 50 percent of the counties are “frontier counties,” those having a population density less than six people per square mile. Several existing statutes related to improving Medicare payments to providers in rural areas are extended.
Prescription drugs. Changes to Medicare Part D, prescription drug reimbursement, includes an attempt to close the “donut hole” for prescription drug coverage.
Medicaid: Access to Medicaid, as well as the types of services that are covered under Medicaid is expanded, including preventive services and long-term care. Additional revenue is allocated for specific maternal and child health services.
Expanded eligibility. States will have the option starting in 2014 to expand Medicaid eligibility to nonelderly, non-pregnant individuals who are not otherwise eligible for Medicare, with incomes up to 133 percent of the federal poverty level (FPL). From 2014 through 2016, the federal government will pay 100 percent of the cost of covering newly eligible individuals.
Children’s Health Insurance Program. States are required to maintain income eligibility levels for CHIP through the end of fiscal year 2019. Enrollment changes. Individuals may apply for or enroll in Medicaid, CHIP, or an insurance plan offered by one of the new state-based Exchanges through one state-run website. Hospitals are allowed to provide Medicaid services during a period of presumptive eligibility of all Medicaid eligibility categories.
Expansion of services. Medicaid will cover services provided by free-standing birth centers. States will have the option of offering community-based attendant services to disabled Medicaid beneficiaries who would otherwise need institutional care. State also may provide more home- and community-based services through a state plan amendment rather than a waiver.
Fraud prevention. Provisions to prevent fraud in federal healthcare programs and to increase the program integrity of both Medicare and Medicaid will be implemented.
CCH Law, Explanation and Analysis of Health Reform Act Available Soon
CCH’s LAW, EXPLANATION AND ANALYSIS of the Patient Protection and Affordable Care Act of 2010 provides the most comprehensive and practical guidance available to professionals needing to make sense of this historic legislation. CCH editorial staff, together with leading experts, provides clear and practical guidance on the many new areas of compliance in the law, so professionals can quickly understand, comply with new requirements, and plan for the future. The book is now available for purchase. The cost is $149.00.
Note that Internet customers will receive an electronic version of the book. Chapters are being posted as they are completed.
• To access on IntelliConnect, visit “News” under the Browse tree menu “Health Care Compliance and Reimbursement.”
• To access on the Internet Research Network, click on “Patient Protection and Affordable Care Act: Law, Explanation, and Analysis” on the “Health Care Reimbursement” tab, under the “Medicare and Medicaid Guide” blue bar.
• To access on the Tax Research NetWork, click on “Patient Protection and Affordable Care Act: Law, Explanation, and Analysis” on the “Pension & Payroll” tab under the “Primary Sources” blue bar.
For more information or to order, please call 1-800-248-3248 or visit [http://health.cch.com/Products/ProductID-7127.asp

House Passes Health Care Overhaul in Historic

(from AOL 3/22/2010)
Patricia Murphy
Columnist
The House of Representatives voted 219 to 212 late Sunday night to approve a sweeping overhaul of the health insurance industry after more than a year of planning, debate, delay and frequent internal party disarray among Democrats in Washington. The vote represents a historic victory for Democrats, who have promised for decades to extend health insurance to the millions of Americans who do not have it. All Republicans and 34 Democrats voted against the bill. “We proved that we are still a people
capable of doing big things and of tackling big challenges,” President Obama said in remarks shortly after the vote. The legislation will prevent insurance companies from dropping or denying coverage based on a customer’s medical history. It will also require every American to purchase health insurance and will penalize large businesses that do not provide insurance for their employees. By 2014, individuals will be able to shop for
insurance on new health care exchanges, and will be subsidized by the government if they cannot afford it. To pay for the reforms and expansion, the bill will increase fees on pharmaceuticals and medical devices; tax expensive insurance policies beginning in 2018; and expand Medicare payroll taxes to investment income. Despite the bill’s $940 billion, 10-year price tag, the Congressional Budget Office estimated that it would reduce the federal deficit by $130 billion in the next ten years, and by $1.2 trillion during the following ten years.

After the House voted to approve the Senate bill, it took up a package of “fixes”
to the underlying Senate legislation, which some House Democrats had vocally opposed. The package included overhauling the student loan program, eliminating the “Cornhusker Kickback” to Nebraska, narrowing the effects of the excise tax and adding more funding for subsidies to make insurance more affordable. The House passed the
amendment 220 to 211.

Earlier Sunday, Rep. Bart Stupak (DMich.) announced that he had come to an
agreement with the White House on restrictions for abortion funding in the
bills. The White House confirmed that the president would sign an executive order
Sunday night explicitly stating that no funds from the health reform package
would be used for abortion services or abortion coverage. “We wanted to see health care reform,” Stupak said Sunday afternoon. “But there was a principle that mattered more to us than anything and that was the sanctity of life.” Before the House voted, House Speaker Nancy Pelosi spoke from the House floor at the end of several hours of sometimes heated debate between Democrats and Republicans. She quoted the late Sen. Ted Kennedy in calling health care reform “the great unfinished business of our society,” but added, “unfinished until today.” The speaker framed Sunday night’s vote as a historic moment that would be remembered as the day that America defined health care to be a right and not a privilege. “We tonight will make history for our country and progress for the American people,” Pelosi said. House Majority Leader Steny Hoyer
called the bill a compassionate example of what it means to be American. “Illness
and infirmity are universal,” Hoyer said. “Our bodies may fail us, but our neighbors
don’t have to.” As much as House Democrats praised their bill, Republicans spoke out in fierce opposition to it. Republican whip Rep. Eric Cantor accused President Obama and the Democrats of passing a bill that will bankrupt the country and of ignoring
Americans’ opposition to the bill in their fervor to pass it. “I have a message for
those Americans — we hear you,” Cantor said. “We hear you loud and clear.
Because we believe this government must stop spending money it doesn’t have.”
Rep. John Boehner, the top Republican in the House, excoriated Democrats for
using tactics they had decried when they were in the minority. “Can you say this bill was done openly, with transparency and accountability?

Without backroom deals and struck behind closed doors, hidden from the people?” Boehner said as his voice grew louder. “Hell no you can’t!” In addition to the health care legislation and debate, the House also passed a major overhaul of the student loan
industry. The legislation eliminates the role of private lenders, which have received billions of dollars in federal subsidies and guarantees over the last 35 years to encourage them to lend to students. Instead, students would now get their loans directly from the Department of Education starting July 1. Now that the Senate health reform bill has passed the House, it will go to President Obama to be signed into law immediately. The package of fixes to the bill will go to the Senate, where debate will begin Tuesday. Because the Senate will use budget reconciliation rules to pass the bill, no filibusters will be allowed, but Republicans can offer as many amendments as they want. If even one amendment passes, the package will have to go back to the House to be passed again and again, until the two chambers pass identical bills.
As the House voted Sunday, President Obama watched the proceedings from the
White House’s Roosevelt room with the vice president and several members of
his staff. When the House reached the 216 votes needed to pass the bill, the AP
reports, Obama cheered and reached over to White House Chief of Staff Rahm
Emanuel to exchange a high-five. Moments later, the president spoke to the press in the East Room of the White House, calling the bill “a reform package finally worthy of the people we serve.” “We rose above the weight of our politics,” Obama said. “We pushed back on the undue influence of special interests. We didn’t give in to mistrust or
cynicism or to fear.” The president thanked Pelosi for passing the bill through the House, and spoke directly to the members of Congress who voted for it. “I know this wasn’t an easy vote for people, but it was the right vote,” he said. “This is what change looks like.” The day on Capitol Hill began with partisan passions vividly on display, as
conservative protesters outside the Capitol shouted “Kill the bill!” and “We won’t pay for murder!” at Democratic members of Congress as they arrived to begin the climactic debate and vote.
The protesters’ numbers and volume grew as the day wore on, as did the suspense over whether Pelosi would be able to marshal the votes she would need to pass the final bill. Although several of the 20 undecided Democrats announced throughout the day how they would cast their votes, too few came out in favor of the legislation to guarantee its passage. With the number of hold-outs dwindling and a 1 p.m. ET debate approaching, it became clear that Democrats could not pass health care reform without Stupak and his coalition of anti-abortion Democrats, who have said for months
that they would not vote for reform without specific language guaranteeing that no
federal funds from the bill would be used for abortion services. After meeting well into the night Saturday on the abortion issue, Democratic leaders again huddled behind closed doors with Stupak’s group Sunday morning. They also held separate meetings with the prochoice caucus to make sure that any agreement with one side would not cost the votes of the other. As rumors of an agreement popped up and were batted down throughout the afternoon, Pelosi gathered all of her Democratic members for one final meeting to urge them to stay committed to their votes. She noted that the House
debate would come on the anniversary of Rep. John Lewis’ march over the Pettus
Bridge in Selma, Ala., at the height of the Civil Rights era. She also said she would
use the same gavel on the House floor Sunday that Rep. John Dingell (D-Mich.)
used when Medicare passed the House in 1965. Pelosi emerged from her meeting and
walked members of her caucus from the Cannon house office building across the
street to the Capitol, hand-in-hand with Rep. Lewis, to begin the final debate on
the bill. Protesters, now numbering in the thousands, loudly shouted at the members as they filed past and waved signs saying, “Doctors not dictators!” and “Liberty or death!”
The formal debate on the bill began with Stupak’s coalition still undecided, but all of the remaining Democrats and Republicans firmly entrenched in their “for” and “against” positions. As the partisan show played out on the House chamber, the ultimate outcome of health care reform became clear when Stupak announced that he had indeed come to an agreement with the White House, and that the president would sign
an executive order Sunday with the language the congressman had sought for months.
For Republicans looking to stop health care reform from passing the House at that point, there was little they could do but speak out against the bill and wait for the 2010 elections, which they believe will be a referendum on a bill they say Americans don’t want. Just before the votes, Rep. James Clyburn, the Democratic whip, reflected
on what the bill would mean in the scope of his 18-year career in Congress and said he hadn’t been particularly emotional about it until his teenage grandson sent him a text Saturday to wish him luck on the vote. “It’s personal with him,” Clyburn said of
his grandson, who has struggled with his health since his premature birth. “You
don’t expect a 15-year-old to be paying attention, but he is.”

Under Obama Plan, Health Premiums Would Rise

(from FoxNews.com 3/17/2010)
Insurance premiums are likely to keep going up even if the health care bill passes, experts say. If cost controls work as advertised, annual increases would level off with time.
WASHINGTON — Buyers, beware: President Barack Obama says his health care overhaul will lower premiums by double digits, but check the fine print.
Premiums are likely to keep going up even if the health care bill passes, experts say. If cost controls work as advertised, annual increases would level off with time. But don’t look for a rollback. Instead, the main reason premiums would be more affordable is that new government tax credits would help cover the cost for millions of people.
Listening to Obama pitch his plan, you might not realize that’s how it works.
Visiting a Cleveland suburb this week, the president described how individuals and small businesses will be able to buy coverage in a new kind of health insurance marketplace, gaining the same strength in numbers that federal employees have.
“You’ll be able to buy in, or a small business will be able to buy into this pool,” Obama said. “And that will lower rates, it’s estimated, by up to 14 to 20 percent over what you’re currently getting. That’s money out of pocket.”
And that’s not all.
Obama asked his audience for a show of hands from people with employer-provided coverage, what most Americans have.
“Your employer, it’s estimated, would see premiums fall by as much as 3,000 percent,” said the president, “which means they could give you a raise.”
A White House press spokesman later said the president misspoke; he had meant to say annual premiums would drop by $3,000.
It could be a long wait.
“There’s no question premiums are still going to keep going up,” said Larry Levitt of the Kaiser Family Foundation, a research clearinghouse on the health care system. “There are pieces of reform that will hopefully keep them from going up as fast. But it would be miraculous if premiums actually went down relative to where they are today.”
The statistics Obama based his claims on come from two sources. In both cases, the caveats got left out.
A report for the Business Roundtable, an association of big company CEOs, was the source for the claim that employers could save $3,000 per worker on health care costs, the White House said.
Issued in November, the report looked generally at proposals that Democrats were considering to curb health care costs, concluding they had the potential to significantly reduce future increases.
But the analysis didn’t consider specific legislation, much less the final language being tweaked this week. It’s unclear to what degree the bill that the House is expected to vote on within days would reduce costs for employers.
An analysis by the Congressional Budget Office of earlier Senate legislation suggested savings could be fairly modest.
It found that large employers would see premium savings of at most 3 percent compared with what their costs would have been without the legislation. That would be more like a few hundred dollars instead of several thousand.
The claim that people buying coverage individually would save 14 percent to 20 percent comes from the same budget office report, prepared in November for Sen. Evan Bayh, D-Ind. But the presidential sound bite fails to convey the full picture.
The budget office concluded that premiums for people buying their own coverage would go up by an average of 10 percent to 13 percent, compared with the levels they’d reach without the legislation. That’s mainly because policies in the individual insurance market would provide more comprehensive benefits than they do today.
For most households, those added costs would be more than offset by the tax credits provided under the bill, and they would pay significantly less than they have to now.
The premium reduction of 14 percent to 20 percent that Obama cites would apply only to a portion of the people buying coverage on their own — those who decide they want to keep the skimpier kinds of policies available today.
Their costs would go down because more young people would be joining the risk pool and because insurance company overhead costs would be lower in the more efficient system Obama wants to create.
The president usually alludes to that distinction in his health care stump speech, saying the savings would accrue to those people who continue to buy “comparable” coverage to what they have today.
But many of his listeners may not pick up on it.
“People are likely to not buy the same low-value policies they are buying now,” said health economist Len Nichols of George Mason University. “If they did buy the same value plans … the premium would be lower than it is now. This makes the White House statement true. But is it possibly misleading for some people? Sure.”

Why Health Insurance Is So Expensive

It seems like Congress will take a more measured approach to passing Health Care Reform, one that better includes views from both sides of the asile as well as those from people like me that aren’t on either side of the asiles. That’s a good thing.

I’d like to take a moment to talk about why Health Insurance is so expensive and why the currently approved legislation is sooo expensive and will increase cost. True, as currently written, some people with low economic abilities will have their premiums subsidized by the Federal Government. But for most of us the cost will go up?

Why is that? Becuase Health Insurance is expensive because Health Care is expensive. We can debate as to whether Health Care should be so expensive (I do not think it should be) but whether it should or shouldn’t be, there is nothing in this legislation that will make it cost less.

Health Care Reform, where people don’t get turned down or have their claims denied for pre-exisiting conditions and where they shouldn’t be charged a small fortune if they have any of these, is the RIGHT THING TO DO. However, that costs money. Why, because the insurnace companies will have to pay more claims and pay more money on the claims they do pay. If you owned a restaurnat and the Federal Government required you to give everyone that placed and order more food, would you charge more. Of course you would. And if the Government says you can’t charge more but you have to give more, you’d close your business, either by choice or by economics.

Health Care Reform isn’t new. Back in 1998 the Federal Government passed a law called HIPAA. Most people are familiar with HIPAA because of the privacy statements you now have to sign at your doctors office, but HIPAA also contained a mini-Health Care Reform provision, one that said if you change employers and have a pre-exisiting condition and you had health insurance under your old employer you would not have to satisfy a new pre-exisitng condition exclusion. A very good idea. But guess what, it meant the insurance companies would have to pay more claims and pay more money on the claims they were paying anyway. When I ran the SE Underwriting shop for Aetna I priced out the impact of HIPAA for Aetna. The estimate was a one time bump up of 8% (to be felt over 2 years) and an annual additional increase of 2%. That doesn’t sound like much, but 12 years later, the 8%+2% means health insurance for small businesses and many individuals is 33.6% more expensive than it would have been.

I don’t know a single business owner or person who is happy with the cost of Health Insurance but I’ve almost not met a single person that understands the mini-Health Care Reform of 1998 is in large part responsible for the high Health Insurance Cost today. It should not be a surprize to any American except for the fact that it’s s not carried on CNN or FOX.

Last world on Health Insurance Cost. Most all insurance companies are regulated about how much money they must pay out and how much they can keep. If you have individual health insurance the number is close to 75% must be paid out and if you are with a very large employer (say 500+ employees), about 85% is paid out. You might not like those numbers but they are not new. So when Health Insurance Premiums increase, the % the insurance company pays out or keeps is the same. If you have any facility with math whatsoever, this should tell you that without changing the cost of Health Care, Health Care Reform, in its current format, will only make costs and therefore premiums, even higher.

State of The Union Speech and Health Care Reform

Tonight will be a significant evening in the path to Health Care Reform. What will President Obama do? Will he focus on jobs? Will he talk new stimulus? Will he prep us for his Budget Speech on February 1st? What will he say about Health Care Reform. I’ve got to be frank with everyone and tell them that I’ve met nearly no one that is against Health Care Reform. I’ve also met no one that is for Health Care Reform as recently passed. They do not think now or even later are good times to raise taxes and to raise them so significantly. And not only are they upset that taxes will be raised, they are upset that both Health Care and Health Insurance costs will go up across the board. You know that Congress is talking about adding a 1.6% tax to insurance companies which means insurance companies will raise premiums by 2.13% to compensate for this (they need to maintain their normal profit margins which is why the final number higher). Plus, part of the bills want to tax many health care services by another 1.6%. Believe me you, that addtional 1.6% will be passed onto the insurance companies who will pass it on to you and me in the form of higher premiums. Folks, Health Care Reform is absolutely critical for our great country, but increasing the cost of Health Insurance is not the answer. Remember, Health Insurance in the USA is expensive because Health Care in the USA is expensive, not the other way around. Thanks for listening!~