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What Changes are coming to the ACA?

November 14, 2016

With the election of Donald Trump and a Republican Majority it is time for the Republicans to put their constructive ideas where their destructive mouths have been.

There is no question that millions more Americans have health coverage than before the Affordable Care Act came into being. Now the Republicans have the unenviable task of turning “Obamacare” into “something terrific”.  No surprise that the proposed changes will benefit the upper class and also attempt to limit or deny a woman’s right to choose.

From greatagain.gov:

          The [Republican] Administration recognizes that the problems with the U.S. health care system did not begin with – and will not end with the repeal of – the ACA.  With the assistance of Congress and working with the States, as appropriate, the Administration will act to:

     *Protect individual conscience in healthcare

     *Protect innocent human life from conception to natural death, including the most defenseless and those Americans with disabilities

     *Advance research and development in healthcare

     *Reform the Food and Drug Administration, to put greater focus on the need of patients for new and innovative medical products

     *Modernize Medicare, so that it will be ready for the challenges with the coming retirement of the Baby Boom generation – and beyond

     *Maximize flexibility for States in administering Medicaid, to enable States to experiment with innovative methods to deliver healthcare to our low-income                citizens


There is an excellent article on the future of the ACA at http://www.latimes.com/business/hiltzik/la-fi-hiltzik-repealing-obamacare-20161110-story.html


To address your immediate concern, it is highly unlikely that any changes will affect your coverage options for 2017. It may be your last chance to get a Tax Credit toward the cost of your premium. I say take advantage of it now, you know Trump would!

On the state of Obamacare

November 4, 2016

I have been observing, from my intimate perch of acting as a Broker for over 150 Individual Clients seeking Health Insurance, the implementation, accessibility and expense of Health Insurance in NY. I assist people in trying to find insurance that will work for them. I try to be of help but I did not create the system and (as I often say) they didn’t ask my input!

First let me say that I believe that seeking and finding quality medical care should be a fundamental human right. I think it sits right alongside basic (and even higher) education, clean drinking water, feeding the poor and children, and income for our elders (Social Security). I believe that an educated privileged society has a responsibility to all its members to do better. I do not have the answers about how this can be done but I do have some basic tenants;

* Individual rights must be ranked above the rights of  Corporations

* All citizens must contribute a fair share of their earnings to the sustainability of the government and infrastructure of the society.

* Government must be minimal, logical, fair, efficient and serve the best interest of ALL its citizens. (I know, I know, I’m a dreamer)

Witnessing the adjustments to the rates and policies offered to New Yorkers is shocking. An ordinary, middle class individual can easily pay $6000 to $10000 per year for Health Insurance and still have to pay out of pocket for a visit to a Doctor! The basic formula of the Affordable Care Act is that an individual earning less than $47,500 (400%) of the Federal Poverty Level should not have to pay more than about 10% of their gross income for health insurance with a deductible of about $2,000. If you make $50,000 you are expected to pay about 15% for the same coverage.

The Insurance companies continue to post profits and pay obscene salaries to their CEO’s and cry that they need to access risk pool funds to pay their way out of the high costs of Insuring sick people. I see several problems: One is that even though NY State oversees the Insurance Industry in NY, compensation to executives does not seem to fall into the profit line item of an Insurer. Another is that many Insurance policies do not cover mail order prescriptions AT ALL. This demonstrates that the Pharmaceutical companies have used their influence to plug up the hole that allowed people to save money by ordering their drugs from across borders that did not have exorbitant prices.  Lobby much?

The problem goes back to my 1st tenant, the rights of Corporations. Continually our representatives in Congress choose to accept money and promote the interests of Corporations over their constituents. The laughably named Affordable Care Act does not have a chance if it does not find a way to control the costs associated with medical care. Insurance companies are just 3rd party payers, they try to limit their costs but at the expense of their customers and their providers. Doctors have bills to pay too, not the least of which are school loans, malpractice insurance and a staff whose primary job is to bill the insurance companies!

Basic Arithmetic – A large Corporation employs 1000 who earn $50k each. What if a CEO was paid a % of the earnings of their employees? 10% would be $5 MILLION. Want a bonus? Pay your employees more money and you got it!  Too logical. And I’m not even asking for the CEO to pay 10% of their GROSS income on Health Insurance.

Single Payer?

July 20, 2016

With the increased cost of Health Insurance since the advent of the PPACA it is only logical that people turn to an idea that would seem to make costs more reasonable. The notion of a Single Payer system is that the government is the payer (that means all of us taxpayers) rather than the insurance companies. The Hospitals would receive “global” funds instead of per treatment payments.

Touted as “Medicare for All” it would seem that everyone would have access to whatever health care they needed at a modest cost. After all good Medicare coverage is not free either.

The things that I wonder about are;

The ever escalating costs of pharmaceuticals, diagnostic equipment, facility, malpractice insurance and administration fees, what keeps those in check?

Are all medical professionals given a stipend? Even the not so good ones? How do Dr’s repay their student loans?

Most importantly I wonder how the government will administer this program? I can tell you from my nearly 3 years of working on the New York State of Health that a government funded and operated program is not efficient or in the least bit effective. Working with multiple random contacts that are not familiar with the system and not accountable for their “advice” or behavior is not effective. At least with multiple Private Insurers there is the notion of competition, that to earn your business they must to it better than the other guy. Service is the key to satisfaction and service is not something that government run programs do well.

“Obamacare” – a brief introduction

May 23, 2016

One of the best indications for me to know that someone doesn’t really understand the Patient and Protection Affordable Care Act (PPACA), shortened to the Affordable Care Act (ACA) and nicknamed “Obamacare” is when they refer to it as Obamacare.

Let’s start off with Obamacare is not a Health Insurance plan. If you have Empire or MVP or the like Obamacare is not an alternative. I prefer to call it by it’s abbreviated acronym ACA or more specifically in we have “The New York State of Health”, the NYSoH, which is our state’s access to the Affordable Care Act.

In the simplest terms the ACA is the governments way of helping people afford the monthly premium for their Health Insurance by giving them an upfront tax credit, on a monthly basis, and applying it directly toward their Health Insurance premium. Really, that’s it.

Of course they have little control over the Insurance, Pharmaceutical, Provider or Facility fees. Therein lies the problem. I am not going to tell you that there haven’t been massive changes to what Health coverage is available to you, just that some of the changes are good. Hopefully, with time, the other changes can get the kinks worked out.

Are you a good candidate for the Affordable Care Act? Let’s find out!