Trump's Executive Order Could Dismantle Parts Of ACA Before Replacement Is Ready Minda Wilson responds

Trump's Executive Order Could Dismantle Parts Of ACA 

Before Replacement Is Ready

President Donald Trump, fulfilling a campaign promise to start to repeal Obamacare on Day 1, signed an order directing federal agencies to waive enforcement of large swaths of the law.

The one-page order allows the head of the Department of Health and Human Services or any other agency with authority under the law, not to enforce regulations that impose a financial burden on a state, company or individual.

It's so broad it could allow many of the law's provisions, including many of taxes it imposes on insurers and the requirement that individuals buy insurance, to die from lack of enforcement.

The order is an important political act for Trump, who pledged throughout his campaign that he would act quickly to roll back the health care law. Its reach, however, depends upon exactly which provisions he decides to target.

The order comes as Trump's pick to lead the Department of Health and Human Services, Rep. Tom Price, R-Ga., is awaiting his confirmation hearing and vote, which could come within days or weeks.

It's unclear how much of this order could be carried out before Price, if he's confirmed, is installed at HHS.

Trump's order also pushes one of his favorite health care ideas — to allow insurance companies to sell policies across state lines — by encouraging "the development of a free and open market in interstate commerce for the offering of healthcare services and health insurance, with the goal of achieving and preserving maximum options for patients and consumers."

It lands just as members of Congress are working to repeal and replace the Affordable Care Act.

Trump and Republican lawmakers have promised that any repeal would be followed immediately by a replacement for the law and they've said that anyone who has insurance through the ACA will not lose it in the transition.

"While President Trump may have promised a smooth transition, the Executive Order does the opposite, threatening disruption for health providers and patients," said Leslie Dach, director of the Protect our Care Coalition, a group of organizations trying to save the Affordable Care Act.

Health policy analysts have warned that repealing the unpopular parts of the law such as the taxes or individual mandate could lead to the collapse of the individual health insurance market. This executive order could allow those provisions to be rolled back before a replacement bill is ready.

Republicans in Congress have laid out a number of broad road maps for a new health care law but have yet to reveal a specific bill that would show how many people will get insurance coverage or how much it might cost.

Here are my thoughts on this:-

"This is good news.  Local hospitals have been closing in droves.  If things continued on their current course 20% of hospitals are expected to close by 2020.  The reason is that administrative costs made the operating at a profit prohibited.  For most hospitals one in every three dollars they receive in revenue is spent on administrative costs.  It used to be one in every four.  The elimination of these administrative costs could mean the difference between your local hospital closing or keeping its doors open."

Minda Wilson

Author of Urgent Care

Urgent Care is available on amazon  click here, purchase a copy of Urgent Care today

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Why is Repeal of the ACA So Scary?

Why is Repeal of the ACA So Scary?

By Minda Wilson,

 Author of Urgent Care

 

Repeal simply means that the requirements of the ACA that were enacted would cease to exist.  It would be as if the law was never passed. 

 

Here is what won’t happen if the ACA is repealed!

 

You won’t lose your coverage if you pay your bill.   Insurance is a contractual obligation of the insurance company to provide coverage if you pay the agreed upon rate.  If you or your company have entered into a contract for coverage for the year 2017 and the premiums are paid, the insurance company must honor those contracts. Not until it is time to renew, 2018, will your coverage may be terminated or changed.

 

Penalties.  No penalty will be assessed for businesses who did not offer coverage to their employees but were required to under the ACA.  It also means that individuals who did not obtain insurance would not be subject to penalties.

 

What does ACA repeal mean; what are the consequences, for 2017? 

 

It means that restaurants who posted the calories of their double cheese burgers or burritos or of their iced mocha-chinos would no longer be required to provide that information.  It means that, in future, the Cadillac tax on high cost, high benefit insurance plans would be eliminated.   It means that the affordability requirement in the ACA will also be eliminated.  This means that the requirement that plans be standardized will be eliminated.  In future rich plans, including low deductible plans, may again be offered; catastrophic coverage may be made available; and businesses will have the right to pick and choose coverage made available to their employees .   We will have to say goodbye to the Medical Device Tax and taxes on vaccinations, which should lower the cost of both. 

 

Most importantly, what repeal really means is that a lot of the mess surrounding the implementation ACA would go away. 

 

There would be no more money spent on exchanges and no more exchanges.  Billions of dollars wasted each year will end. The administrative nightmare for businesses will go away. 

 

The requirement that every policy provide “Essential Health Benefits” would be eliminated.  Men would no longer be required to purchase coverage for pregnancy and women would no longer have to pay to have their non-existent prostates covered for cancer.  There would be a return of the opportunity to purchase less expensive, catastrophic coverage as well as the ability to purchase limited coverage for only things you might need. 

 

For 2017, insurance companies have agreed to offer for the entire year all policies they currently make available within the 50 states.  In each state an insurance company offers any policy the state’s insurance commission has approved that offering. Once approved and made available, insurance companies cannot change their offerings in a given state.  If the state approved the policy you bought providing coverage for your 25 year old son, the insurance company can’t cancel that policy if the ACA is repealed. If the insurance company agreed to provide coverage to any and all individuals despite their pre-existing conditions, they must honor their agreement.  If the insurance company agreed to eliminate lifetime caps and/or annual caps, for policies issued in 2017, they cannot take that back.  If the ACA is repealed, these benefits could be eliminated in 2018; but for now you are safe.

 

Federal subsidies that used to be paid to emergency rooms when they saw uninsured patients will be reinstated.

 

The Downside

 

Unless the states step up to the plate, the working poor who due to the eligibility expansion received Medicaid would no longer be eligible to receive it.  

 

If your insurance is subsidized and the federal government refuses to pay the subsidy this year, you could lose your insurance.  Technically, you are not responsible to step in if the Federal government doesn’t pay or doesn’t pay on time; the insurance companies are supposed to go after the government. It’s a contract and, if all was right with the world, the insurance companies would not punish you for the government’s failure to pay. If the insurance companies cut you off, I envision new highs in awards to those damaged by being denied insurance, when they continued to pay their agreed upon payment.  I don’t think juries would be very sympathetic to insurance companies who acted to deny care to people who paid their contracted obligation under their insurance contracts.

 

For those suffering from drug or alcohol addiction, coverage will no longer be mandated.  You could purchase coverage separately; but it is expensive.   It is unlikely those who are covered for these problems will continue to receive employer paid coverage.

 

The really bad news for the government is that all the taxes that were enacted as part of the ACA will be repealed.  This is the biggest issue.  Assuming the government is contractually obligated for paying the subsidies, there will be no revenues generated to offset these expenses.  This could mean a deficit from healthcare subsidies that could exceed a trillion dollars.

 

The Unknown

 

Repeal means the “Donut Hole” of Medicare Reimbursement is no longer required to be closed.  Therefore, drug reimbursement between $2800 and $6400 is no longer required to be paid by Medicare.  It is unclear whether or not the gap will remain closed. 

 

 

Long Term Implications

 

The real impact will be felt in 2018.    Premium discrimination will return.  Rejection for preexisting conditions could also return.  Cost will no longer be required to be based only on age, tobacco use and location.  Your health history may influence the cost of your plan. There will be no more subsidies.   The ability to cover your children up to 26 as well as the restriction on annual lifetime caps on benefits will go away.  The elimination of the “Essential Health Benefits” means that physicals, vaccinations, mammograms, etc. are no longer required to be offered for free.  The Donut Hole will definitely be re-opened.  Insurance companies will be able to rescind policies and we will have limited right to appeal.

 

The Solution

 

"The truth is that any state can step up to the plate. They can require any insurance company that does business in their state to offer individual plans at a rate comparable to what business pay.  They can enact requirements eliminating lifetime caps on benefits, premium discrimination, or any other of the provisions that their citizens would want continued."

 

We will just have to wait and see.

Minda Wilson 

My book, Urgent Care is available on amazon  click here, purchase a copy of Urgent Care today

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The Real Impact of our Healthcare in America and how it effects you

Could This Really Be True?

Sarah (her name has been changed) got an EOB, explanation of benefits, saying that Blue Shield of California denied coverage for appointments related to her back injury because the doctor's notes mentioned that the back injury was a result of a car accident.

Picture this:  You are a passenger in a car driven by your friend.  A drunk driver plows into you and you are seriously injured.  You are taken from the accident site to the ER; treated for a concussion and injuries to your back and neck.  It is clear you will need additional and ongoing treatment.  You are referred to a neurologist for the head injury, an orthopedist for the back and neck injury, and a physical therapist.

In the old days, if you were the passenger, your insurance would pay for your medical bills, even though the insurance of the person that hit you would ultimately be responsible for paying those bills.  Your insurance company would become a party to the lawsuit against the driver responsible and would attempt to recover monies advanced.  If the person who hit you was found to be at fault, the insurance company would recover what they advanced.  If the court ruled against them, they would recover nothing.  Either way, Sarah would not be responsible for coming up with the money for paying bills that would otherwise be covered by her insurance.

The Blue Shield representative explained to Sarah that, in the case of an automobile accident, Blue Shield is no longer willing to put up the money in advance of a settlement.  What this means is Sarah is the financially responsible party to the hospital, the doctors, the physical therapist, and any other party that provided medical treatment related to the accident.  It also turns out, that since the insurance company is not responsible for these bills until the court says they are, the out of pocket payments you make are not counted towards your deductible.

The question is "Why?"

Blue Shield believes that they are in second position to the drunk driver's insurance.  Blue Shield is only responsible for paying what the primary insured does not pay.  Both these statements are true.  Based on these beliefs, Blue Shield has decided that they should no longer advance money to those who are injured in automobile accidents unless and until it is clear that Blue Shield is the party responsible for those payments.  When they pay and it turns out they are not responsible Blue Shield risks that they won't be able to recoup their payments.

Seems like a wise business decision.

This seems like just another step in the process to transfer financial risk for one's healthcare away from insurance companies.

According to the Kaiser foundation, annual premiums for employer-sponsored family health coverage reached $17,545 in 2015, with workers on average paying $4,955 towards the cost of their coverage;  individual policies cost more.  Since 2015 these costs, have increased, on average, greater than 25%.  This means that a company with 50 or more employees is likely to spend over a million dollars annually on health insurance.  As a result of risk transfer, more of the costs for healthcare are being born by the employee.  In addition to the $5,000 they pay for the premium, individual deductibles are averaging $2500 and family deductibles are $10,000.  In California, the all in cost for a policy including deductibles and co-pays exceeds $30,000, if you don't receive a subsidy.  These increases are not economically sustainable.

In any other business, when one abuses one's customers, they go elsewhere.  New reform proposals focus on giving more power to insurance companies.  Inter-state operations allows insurance companies to build operations in multiple states, but more overhead is required to manage a larger operation.  In addition, except for federal benefits, regulations on policies in each state must still be met.  There is no guarantee that cost savings will result.  Tax breaks and subsidies may help ease the pain, but they to nothing to curb price increased that are expected to be passed onto the consumer.

There could be some price relief from disruptive product offerings coming from outside the insurance industry.  Otherwise, the will continue to experience the abusive cycle of risk transfer, price increases, and declining benefits.

Minda Wilson



My book, Urgent Care is available on amazon  click here, purchase a copy of Urgent Care today

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