Fewer Uninsured People

Editorial
The New York Times
September 13, 2012

The number of Americans who lack health insurance declined last year, the first drop since 2007. This is, in large part, the result of the health care reform law and better coverage under public programs like Medicaid. This also shows why repealing the health care law or revamping and shrinking Medicaid, as many Republicans want to do, would be disastrous moves.
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Opponents of Obamacare beware--the refund checks are coming

Here is a warning.  If you run into Pat Hancock in the Hilton Head Island area of South Carolina, don't say anything bad about Obamacare--she'll take your head off.

As far as she's concerned the Prez just sent her a check for $405.  That was the amount of the refund her health insurance company sent her along with the following message:

“This letter is to inform you that you will receive a refund of a portion of your health insurance premiums.  This refund is required by the Affordable Care Act -- the health reform law.”

The Medical Loss Ratio of the Affordable Care Act requires health insurance companies to issue a refund to their policy holders if the company, as the letter states:

“…does not spend at least 80 percent of the premiums it receives on health care services, such as doctors and hospital bills, and activities to improve patient safety.  No more than 20 percent of premiums may be spent on administrative costs such as salaries, sales, and advertising....the 80/20 rule in the Affordable Care Act is intended to ensure that consumers get value for their health care dollars.”

Ms. Hancock’s health insurance company did not meet the Medical Loss Ratio requirement so she received a refund.  She is part of the approximately one-third of all individuals who buy their own health insurance coverage who will receive a refund check by the end of this month.  The total amount of these refunds will be approximately $426 million.  Small business owners who provide health insurance to employees are expected to receive $377 million in refunds and large employers will get back $541 million.

One of the principle reasons the nation is split in opinion on Obamacare is that none of the benefits Americans have received so far came with credit being given to the health care reform.  The public hasn’t been connecting the dots between the health care law and benefits such as the small business health insurance tax credits, affordable premiums in high-risk pools, children being allowed to stay on parents policies until they are 26, and rebate checks to Medicare patients who have reached the donut hole.

But that will change if all theses Medical Loss Ratio refund checks come with the same explanation Ms. Hancock received giving credit where credit is due—Obamacare.

  

This small business wants Obama’s health insurance law

Tomorrow might be the day the Supreme Court rules on the constitutionality of the Affordable Care Act--Obamacare. Then again it might be on Monday or next Wednesday. We're not sure but when the decision is revealed, the media will go crazy.

So until that happens, listen to Louisa McQueeney, the CFO of Palm Beach Groves, an orange shipping business in Lantana, Florida.

The Miami Herald
Jun. 18, 2012

This small business wants Obama’s health insurance law

BY LOUISA MCQUEENEY
louisamcq@gmail.com

Running a small business with four employees, I’ve got a lot hanging in the balance as the Supreme Court deliberates on the healthcare law. The legal challenge to the law was launched here in Florida with a small business lobby group as a plaintiff in the case. But if you’re thinking that means small business people like me want to see the law rolled back, think again.

The simple fact is, the healthcare law is saving our business serious money and saving our healthcare benefits. Rolling it back would be a real blow — it could spell the end of our healthcare benefits, and push more small business employees into bankruptcy.

I’ve spent the past 12 years at Palm Beach Groves, a small orange shipping business in South Florida. As general manager, I’ve seen our health insurance premiums increase by double-digits every year for a decade. Renewal season has always been a nerve-wracking time, as the decision to continue providing health coverage — and how much of the cost to shift onto employees — gets harder every year. Our staff hasn’t seen a raise in more than seven years because any extra income goes to pay for our rising insurance premiums.

Then along came “Obamacare.”

Last November, our health insurance agent called with our renewal: after annual increases of 12 percent, 22 percent, and even 32 percent, our premiums in 2012 would increase by a grand total of . . . 0.2 percent. Zero point two — ie, flat.

I was floored. And this flat renewal came with exactly the same plan — no dumbing down the coverage, no increase in our deductibles, everything was the same.

Then, at tax time, we qualified for the health law’s small business tax credit. This credit cut our total healthcare costs by about 10 percent, or $7,400, in 2011.

And we’re not through yet. I’m curious to see how the Affordable Care Act’s 80/20 value for premiums rule will affect our group. We might even get a rebate check from our insurance company this summer if it failed to spend the required 80 percent of premiums on actual healthcare costs. For the first time in my 12 years in this business, the healthcare picture is finally looking up for Palm Beach Groves.

Despite the benefits small businesses out in the real world are seeing from the law, the calls for the repeal of “ObamaCare” continue on. Opponents of the law say they want to replace it with something else. But the “alternatives” they offer are all talking points, no substance.

“Let health insurance companies sell across state lines.” Sounds nice in theory, until you learn that this is code for giving insurers license to sell any kind of junk insurance that likely won’t cover what you need. Besides, our neighbors in Georgia tried this last year. Not a single out-of-state insurance company showed up to the party.

Or “Health Savings Accounts,” which are supposed to make us “better,” “more informed,” and “more responsible” consumers of healthcare. Try calling a doctor’s office and ask for the price of a biopsy, or a fix for a broken leg or by-pass surgery. Good luck with that one.

We have experience with HSAs:

A few years ago, our company was forced into a high deductible HSA plan by our insurer. This meant paying the first $5,000 of healthcare costs out of pocket and then paying a high monthly premium on top of that before the health insurance company paid a dime.

That’s not a solution. It’s more of the same old squeeze.

The Affordable Care Act is working for our business. We now have free preventive well-care visits — a smart investment in our health. My daughter can stay on our plan until she turns 26. Kids can no longer be excluded because they have a pre-existing condition, and in 2014 none of us can be denied insurance or discriminated against because of pre-existing conditions.

Why would anyone want to take all this away?

The justices of the Supreme Court — who enjoy an array of healthcare choices as federal employees — hold our fate in their hands. If the court cares about small businesses — not business lobbyists, but real small businesses like ours — it should uphold the healthcare law.

We literally can’t afford to go back.

 http://www.miamiherald.com/2012/06/18/v-print/2856095/this-small-business-wants-obamas.html#storylink=cpy#storylink=cpy

An email on healthcare reform for the Supreme Court and public

If the GOP conservatives were distraught over the last few days because Mitt Romney selected Michael Leavitt (a supporter of parts of Obamacare) to head his transition team should he win in November, then they will be in full buyer’s remorse after reading today’s story in the Wall Street Journal.

Calling for the full repeal of national healthcare reform has been developed into a reflexive mantra of the Republican Party base.  Mr. Romney is still having difficulty securing the love of conservatives because of his past support in Massachusetts of much of what is in Obamacare including the individual mandate. 

So even while the GOP Presidential nominee calls for total repeal of Obamacare from the stage, Mr. Leavitt’s appointment caused quite a push-back from conservatives and raised their suspicion of Mr. Romney even higher.

But today’s Wall Street Journal story is more than just more fuel for the ABR primary voters (Anybody but Romney); it is an educational opportunity for the public and even the Supreme Court.

In spite of the Romney gubernatorial staff efforts to erase every trace of emails during his term of office in Massachusetts (they had every email on the governor’s office server computer removed and bought 17 hard drives from personal computers owned by the state—so much for transparency), the Wall Street Journal found a Romney cabinet member who obviously couldn’t find the delete button.

The emails obtained by the paper show Governor Romney and his aides as big supporters of the individual mandate within their healthcare reform plan.  Mr. Romney was intimately involved in creating every detail of the plan and pushed the mandate onto reluctant state Democrats.

In one uncovered email a top healthcare aide to Governor Romney wrote, “We must have an individual mandate for any plan to work.”  Mr. Romney himself drafted an opinion editorial to run the day before he signed his healthcare reform legislation.  In that piece Mr. Romney says, “Either the individual pays or the taxpayers pay.  A free ride on government is not libertarian.”

After Governor Romney signed his healthcare reform—individual mandate and all—into law, he sent the same top healthcare aide an email saying (according to the Wall Street Journal story), “Quite a day! … You have made a huge difference, for me and for hundreds of thousands of people who will have healthier and happier lives… Best, Mitt”

That is the message the country and the Supreme Court needs to hear. 

Bachmann gives me a headache

According to a story in today’s New York Times, “Representative Michele Bachmann suffers from migraine headaches so intense that she has sometimes sought emergency medical treatment, but the congresswoman said Tuesday that the condition would not preclude her from serving as president if elected.”

Well, GOP presidential hopeful Bachmann’s migraines might not “preclude her from serving as president” but they sure would preclude her from getting health insurance in the individual market.

Like 36 million other Americans with this pre-existing condition, today health insurance companies won’t write her individual coverage. So it’s a good thing that she has insurance through the Federal Employees Health Plan (subsidized by you and me). Of course, thanks to the Affordable Care Act, which Bachmann pledges to dismantle if she’s elected, come 2014 migraine patients will be eligible for insurance without being given higher rates due to the condition.

Bachmann also said yesterday that her migraines were “easily controlled with medication.”

Easily controlled but not inexpensively controlled. But again that’s no worry to Bachmann because she has very good health insurance through her employer. The rest of her fellow migrainers who can’t get insurance…well they just have to take a couple of Advil’s and stay in bed until the headaches go away.

If they can sleep, they can dream of 2014 when they will finally have access to insurance that will help them control their migraine pain and expenses. But if the dream includes a President Bachmann, the dream will be a nightmare that won’t go away.

Healthcare reform picks up speed in 2011

“Major insurers around the country are reporting that a growing number of small businesses are signing up to give their workers health benefits, a sign of potential progress for the nation's battered healthcare system.” (Los Angeles Times, 12-27-10)

The results are coming in and, as expected by those of us who supported health care reform this year, small businesses are responding to the new health insurance tax credits in the Affordable Care Act (ACA).

As the New Year kicks in, so do more parts of the ACA that the “hell no you can’t” Congressional folks and the small business pretender organization, the National Federation of Independent Business, want to repeal or defund.

Look at the long list below to see if you want to get rid of any of these new initiatives that go into effect in 2011, most in just a few days.

New Healthcare Reform Initiatives Becoming Effective in 2011

• Minimum Medical Loss Ratio for Insurers

Requires health plans to report the proportion of premium dollars spent on clinical services, quality, and other costs and provide rebates to consumers if the share of the premium spent on clinical services and quality is less than 85% for plans in the large group market and 80% for plans in the individual and small group markets.

• Closing the Medicare Drug Coverage Gap

Requires pharmaceutical manufacturers to provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap (donut hole) beginning in 2011 and begins phasing-in federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap.

• Medicare Payments for Primary Care

Provides a 10% Medicare bonus payment for primary care services; also, provides a 10% Medicare bonus payment to general surgeons practicing in health professional shortage areas.

• Medicare Prevention Benefits

Eliminates cost-sharing for Medicare-covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force and waives the Medicare deductible for colorectal cancer screening tests; authorizes Medicare coverage for a personalized prevention plan, including a comprehensive health risk assessment.

• Center for Medicare and Medicaid Innovation

Creates the Center for Medicare and Medicaid Innovation to test new payment and delivery system models that reduce costs while maintaining or improving quality.

• Medicare Premiums for Higher-Income Beneficiaries

Freezes the income threshold for income-related Medicare Part B premiums for 2011 through 2019 at 2010 levels resulting in more people paying income-related premiums, and reduces the Medicare Part D premium subsidy for those with incomes above $85,000/individual and $170,000/couple.

• Medicare Advantage Payment Changes

Restructures payments to private Medicare Advantage plans by phasing-in payments set at increasingly smaller percentages of Medicare fee-for-service rates; freezes 2011 payments at 2010 levels; and prohibits Medicare Advantage plans from imposing higher cost-sharing requirements for some Medicare covered benefits than is required under the traditional fee-for-service program.

• Medicaid Health Homes

Creates a new Medicaid state option to permit certain Medicaid enrollees to designate a provider as a health home and provides states taking up the option with 90% federal matching payments for two years for health home-related services.

• Chronic Disease Prevention in Medicaid

Provides 3-year grants to states to develop programs to provide Medicaid enrollees with incentives to participate in comprehensive health lifestyle programs and meet certain health behavior targets.

• CLASS Program

Establishes a national, voluntary insurance program for purchasing community living assistance services and supports (CLASS program).

• National Quality Strategy

Requires the Secretary of the federal Department of Health and Human Services to develop and update annually a national quality improvement strategy that includes priorities to improve the delivery of health care services, patient health outcomes, and population health.

• Changes to Tax-Free Savings Accounts

Excludes the costs for over-the-counter drugs not prescribed by a doctor from being reimbursed through a Health Reimbursement Account or health Flexible Spending Account and from being reimbursed on a tax-free basis through a Health Savings Account or Archer Medical Savings Account. Increases the tax on distributions from a health savings account or an Archer MSA that are not used for qualified medical expenses to 20% of the amount used.

• Grants to Establish Wellness Programs

Provides grants for up to five years to small employers that establish wellness programs.

• Teaching Health Centers

Establishes Teaching Health Centers and provides payments for primary care residency programs in community-based ambulatory patient care centers.

• Medical Malpractice Grants

Authorizes $50 million for five-year demonstration grants to states to develop, implement, and evaluate alternatives to current tort litigations.

• Funding for Health Insurance Exchanges

Provides grants to states to begin planning for the establishment of American Health Benefit Exchanges and Small Business Health Options Program Exchanges, which facilitate the purchase of insurance by individuals and small employers.

• Nutritional Labeling

Requires disclosure of the nutritional content of standard menu items at chain restaurants and food sold from vending machines.

• Medicaid Payments for Hospital-Acquired Infections

Prohibits federal payments to states for Medicaid services related to certain hospital-acquired infections.

• Graduate Medical Education

Increases the number of Graduate Medical Education (GME) training positions by redistributing currently unused slots and promotes training in outpatient settings.

• Medicare Independent Payment Advisory Board

Establishes an Independent Advisory Board, comprised of 15 members, to submit legislative proposals containing recommendations to reduce the per capita rate of growth in Medicare spending if spending exceeds targeted growth rates.

• Medicaid Long-Term Care Services

Creates the State Balancing Incentive Program in Medicaid to provide enhanced federal matching payments to increase non-institutionally based long-term care services and establishes the Community First Choice Option in Medicaid to provide community-based attendant support services to certain people with disabilities.

Source: The Henry J. Kaiser Family Foundation, 2010