Posted in Affordable Care Act (ObamaCare), Economic Issues, Employee Benefits, Employer Mandate, Employer-Sponsored Health Plans, Health Insurance, Individual Mandate, Large group insurance market, Medical Costs, Small group market, Subsidies, Uncategorized

The Current Status of the ACA Employer Mandate: 2019 – Integrity Data

Caution Employers!

With all the focus on Transparency mandates and HRA executive orders, much of the ACA remains in force (unfortunately). Even though the individual mandate penalty (uh…tax) will not be enforced beyond 2018, the employer mandate is still in effect, with all the coverage provisions!

https://www.integrity-data.com/current-status-of-aca-employer-mandate-2019/

Posted in Access to healthcare, Affordable Care Act (ObamaCare), Direct-Pay Practice Models, Employee Benefits, Employer Mandate, Employer-Sponsored Health Plans, Essential Benefits under the ACA, Health Insurance, Health Reimbursement Arrangement (HRA), Health Savings Accounts (HSA's), Healthcare financing, Individual Mandate, Policy Issues, Tax Policy, Uncategorized

Healthcare: What to Watch For

“…it is important for employers to be fully aware of what the regulations may impact them to safeguard against inadvertently putting themselves, or their employees, in an untenable situation.

It is important for an employer looking to offer an unconventional or untraditional benefit package to speak with an independent health plan attorney or CPA (not employed by the agency selling the program) regarding potential liability and compliance with federal and state laws regarding employer sponsored health plans.

Can your employee afford to reimburse the IRS for taxes not collected on an inappropriately structured HSA? Can your business afford a fine of $100 per day per employee for every day that the unqualified arrangement was offered? These are just some of the potential liabilities.”

http://ushealthmedia.com/healthcare-what-to-watch-for/

Posted in Access to healthcare, Affordable Care Act (ObamaCare), Economic Issues, Employee Benefits, Employer-Sponsored Health Plans, Essential Benefits under the ACA, Health Insurance, Healthcare financing, Individual Mandate, Individual Market, Insurance subsidies, Large group insurance market, Medicaid, Medicaid Expansion, Medical Costs, Policy Issues, Small group market, Subsidies, Tax Policy, Uncategorized

Who Wouldn’t Have Coverage If the Obamacare Mandate Is Repealed | The Heritage Foundation

…a recent review of the academic literature on the subject finds a mixed bag, but with the strongest link between coverage and health outcomes in cases where health insurance coverage improves access to care, “particularly among people with lower incomes and chronic conditions.”

That makes sense. Having health insurance makes less of a difference to people with higher incomes who can afford to pay for more of their medical care directly. 

That leads us to the crucial, practical question that this academic debate largely misses: Who are the people that would no longer have health insurance if the mandate penalty were repealed?

Notice what CBO is not saying. CBO is not saying that those Americans will “lose” coverage. Rather, CBO is saying is that—absent the mandate penalties—those Americans, will voluntarily forego enrolling in health coverage. CBO is explicit on this point…

That explains CBO’s somewhat counterintuitive projection that, without a mandate penalty, millions of poor people will turn down the offer of free Medicaid coverage. The reason is that they don’t think they need it (because they are healthy) and if they become ill and seek care at a hospital, they know the hospital will enroll them in Medicaid to get paid. Indeed, it is also why, long before Obamacare came along, that there was a persistent and notable gap between the number of people eligible for Medicaid and the number of people enrolled in the program.

It also explains CBO’s other counterintuitive projection: that eliminating the mandate penalty will generate higher tax revenues.  While not collecting mandate penalties brings in less revenue, CBO projects that there will be new revenues coming from the healthy people who decide to turn down tax-free employer health insurance in exchange for higher (taxable) cash wages. Presumably, CBO thinks that being healthy and very much alive are basic prerequisites for expecting those folks to generate additional tax revenues.

Repeal of the Obamacare mandate will not result in social catastrophe. Supporters of the mandate would have a more compelling argument if millions of poor and sick persons would be thrown out of their existing coverage, struggling with potentially fatal chronic illnesses and unable to get insurance to maintain continuous access to regular care. But that is not what CBO is projecting. Their argument is hardly compelling, to say the least, when the cohort of the future uninsured are healthy people who simply choose not to buy Obamacare coverage because they believe they don’t need it or want it.

http://www.heritage.org/health-care-reform/commentary/who-wouldnt-have-coverage-if-the-obamacare-mandate-repealed

Posted in Access to healthcare, Affordable Care Act (ObamaCare), Community Underwriting, Economic Issues, Free-Market, government incompetence, Government Regulations, Health Insurance, Healthcare financing, Individual Mandate, Individual Market, Insurance subsidies, Medicaid, Medicaid Expansion, Medical Costs, medical inflation, Medicare, Organizational structure, outcomes, Policy Issues, Uncategorized

Hard Truths about Health Care ‌ by Michael Tanner

Micheal Tanner
Michael Tanner

“Every health-care system in the world rations care in some way, either through bureaucratic fiat (Scandinavia, the U.K.), waiting lists (Canada), or price (that’s us). One can argue about which of these rationing mechanisms is fairest or most efficient, but let’s not pretend that it won’t occur.”

http://www.nationalreview.com/article/446439/health-care-basic-facts-and-hard-truths

Posted in Access to healthcare, Affordable Care Act (ObamaCare), Direct-Pay Medicine, Economic Issues, Employee Benefits, Employer-Sponsored Health Plans, Essential Benefits under the ACA, Government Regulations, Health Insurance, Health Savings Accounts (HSA's), Healthcare financing, Individual Mandate, Medicaid, Medical Costs, medical inflation, Medicare, Patient Choice, Policy Issues, Portable Insurance, Price Tansparency, Quality, Subsidies, third-party payments, Uncategorized

Free Market Care – John Stossel

John Stossel

Imagine if you had “grocery insurance.” You’d buy expensive foods; supermarkets would never have sales. Everyone would spend more.

Insurance coverage — third-party payment — is revered by the media and socialists (redundant?) but is a terrible way to pay for things.

Today, 7 in 8 health care dollars are paid by Medicare, Medicaid or private insurance companies. Because there’s no real health care market, costs rose 467 percent over the last three decades.

By contrast, prices fell in the few medical areas not covered by insurance, like plastic surgery and LASIK eye care. Patients shop around, forcing health providers to compete.

The National Center for Policy Analysis found that from 1999 to 2011 the price of traditional LASIK eye surgery dropped from over $2,100 to about $1,700.

Source: Free Market Care – John Stossel

Posted in Access to healthcare, advance-pricing, Affordable Care Act (ObamaCare), Consumer-Driven Health Care, CPT billing, Direct-Pay Medicine, Economic Issues, Employee Benefits, Employer-Sponsored Health Plans, Government Regulations, Health Insurance, Health Savings Accounts (HSA's), Healthcare financing, Individual Mandate, Individual Market, Individual ObamaCare Market, Individual Underwriting Standards, Insurance subsidies, Large group insurance market, Medicaid, medical inflation, Medical Practice Models, Patient Choice, Policy Issues, Portable Insurance, Pre-existing Conditions, Private Exchanges, Quality, Subsidies, Tax Policy, Uncategorized

A Path Towards a Viable Interstate Health Insurance Market | Robert Nelson, MD | Pulse | LinkedIn

Alternatives to our current over-priced and dysfunctional health insurance market are often biased, and thus limited, by our current operational and regulatory structure. These structures are so entrenched in our healthcare psyche that it makes it difficult sometimes to set these aside in our minds while entertaining how another approach might work.

If we view all alternative plans to replace the Affordable Care Act from the vantage point of “what is”, then there is little room for anything other than attempts at further regulating the problems away. If one presupposes that the current regulatory framework remains unchanged, indeed the same framework has served to suppress the very market we wish create, then of course that market will not be created.

The dilemma facing alternative healthcare plans being considered to replace the ACA is particularly evident when it comes to the issue of selling health insurance across state lines. A brief on this subject published by the American Academy of Actuaries in February of 2017 speaks to the the main challenges facing the advent of a viable interstate market for the sale of health insurance.

Source: A Path Towards a Viable Interstate Health Insurance Market | Robert Nelson, MD | Pulse | LinkedIn

Posted in Access to healthcare, Affordable Care Act (ObamaCare), Deductibles, Employee Benefits, Employer Mandate, Employer-Sponsored Health Plans, Essential Benefits under the ACA, Health Insurance, Health Savings Accounts (HSA's), Healthcare financing, Individual Mandate, Individual Market, Individual ObamaCare Market, Individual Underwriting Standards, Large group insurance market, Medicaid, Medical Costs, Medical Practice Models, Medicare, Organizational structure, Policy Issues, Portable Insurance, Pre-existing Conditions, primary care, Reforming Medicaid, Self-Insured Plans, Small group market, Tax Policy, Uncategorized

Obamacare Replacement Act – Senate Bill 222 by Senator Rand Paul – KY

Sen. Rand Paul, R-Ky., speaks during an event at the University of Chicago's Ida Noyes Hall in Chicago on Tuesday, April 22, 2014. (AP Photo/Andrew A. Nelles) ORG XMIT: ILAN114Lots to like and consider here.  We need more details about how tax equalization in the group market vs the individual market will be handled.  The expansion of uses and benefits of HSAs is robust and will go along way to establishing more ways to self-insure and less reliance on networks and government programs; both are a good thing.  The flexible, market-friendly Interstate Market for Health Insurance Cooperative Governing of Individual Health Insurance Coverage will be a welcome change.  Again, devil is always in the details.  Stay tuned for more details and insightful analysis here on the Sovereign Patient; we will post them as available. 

Some highlights:

Effective as of the date of enactment of this bill, the following provisions of Obamacare are repealed:

  • Individual and employer mandates, community rating restrictions, rate review, essential health benefits requirement, medical loss ratio, and other insurance mandates.

Protecting Individuals with Pre-Existing Conditions:

  • Provides a two-year open-enrollment period under which individuals with pre-existing conditions can obtain coverage.
  • Restores HIPAA pre-existing conditions protections. Prior to Obamacare, HIPAA guaranteed those within the group market could obtain continuous health coverage regardless of preexisting conditions.

Equalize the Tax Treatment of Health Insurance:

  • Individuals who receive health insurance through an employer are able to exclude the premium amount from their taxable income. However, this subsidy is unavailable for those that do not receive their insurance through an employer but instead shop for insurance on the individual market.
  • Equalizes the tax treatment of the purchase of health insurance for individuals and employers. By providing a universal deduction on both income and payroll taxes regardless of how an individual obtains their health insurance, Americans will be empowered to purchase insurance independent of employment. Furthermore, this provision does not interfere with employer-provided coverage for Americans who prefer those plans.

Expansion of Health Savings Accounts:

  • Tax Credit for HSA Contributions
    • Provides individuals the option of a tax credit of up to $5,000 per taxpayer for contributions to an HSA. If an individual chooses not to accept the tax credit or contributes in excess of $5,000, those contributions are still tax-preferred.
  • Maximum Contribution Limit to HSA. Removes the maximum allowable annual contribution, so that individuals may make unlimited contributions to an HSA.
  • Eliminates the requirement that a participant in an HSA be enrolled in a high deductible health care plan. This section removes the HSA plan type requirement to allow individuals with all types of insurance to establish and use an HSA.
  • This would also enable individuals who are eligible for Medicare, VA benefits, TRICARE, IHS, and members of health care sharing ministries to be eligible to establish an HSA.
  • Allowance of Distributions for Prescription and OTC Drugs o Allows prescription and OTC drug costs to be treated as allowable expenses of HSAs.
  • Purchase of Health Insurance from HSA Account o Currently, HSA funds may not be used to purchase insurance or cover the cost of premiums. Allowing the use of HSA funds for insurance premiums will help make health coverage more affordable for American families.
  • Medical Expenses Incurred Prior to Account Establishment o Allows qualified expenses incurred prior to HSA establishment to be reimbursed from an HSA as long as the account is established prior to tax filing.
  • Administrative Error Correction Before Due Date of Return o Amends current law by allowing for administrative or clerical error corrections on filings.
  • Allowing HSA Rollover to Child or Parent of Account Holder o Allows an account holder’s HSA to rollover to a child, parent, or grandparent, in addition to a spouse.
  • Equivalent Bankruptcy Protections for HSAs as Retirement Funds o Most tax-exempt retirement accounts are also fully exempt from bankruptcy by federal law. While some states have passed laws that exempt HSA funds from being seized in bankruptcy, there is no federal protection for HSA funds in bankruptcy.
  • Certain Exercise Equipment and Physical Fitness Programs to be Treated as Medical Care. Expands allowable HSA expenses to include equipment for physical exercise or health coaching, including weight loss programs.
  • Nutritional and Dietary Supplements to be Treated as Medical Care o Amends the definition of “medical care” to include dietary and nutritional supplements for the purposes of HSA expenditures.
  • Certain Providers Fees to be Treated as Medical Care o Allows HSA funds to be used for periodic fees paid to medical practitioners for access to medical care.
  • Capitated Primary Care Payments o HSAs can be used for pre-paid physician fees, which includes payments associated with “concierge” or “direct practice” medicine.
  • Provisions Relating to Medicare o Allows Medicare enrollees to contribute their own money to the Medicare Medical Savings Accounts (MSAs).

Interstate Market for Health Insurance Cooperative Governing of Individual Health Insurance Coverage:

  • Increases access to individual health coverage by allowing insurers licensed to sell policies in one state to offer them to residents of any other state.
  • Exempts issuers from secondary state laws that would prohibit or regulate their operation in the secondary state. However, states may impose requirements such as consumer protections and applicable taxes, among others.
  • Prohibits an issuer from offering, selling, or issuing individual health insurance coverage in a secondary state: If the state insurance commissioner does not use a risk-based capital formula for the determination of capital and surplus requirements for all issuers. Unless both the secondary and primary states have legislation or regulations in place establishing an independent review process for individuals who have individual health insurance coverage; or The issuer provides an acceptable mechanism under which the review is conducted by an independent medical reviewer or panel.
  • Gives sole jurisdiction to the primary state to enforce the primary state’s covered laws in the primary state and any secondary state.
  • Allows the secondary state to notify the primary state if the coverage offered in the secondary state fails to comply with the covered laws in the primary state.

Source: Microsoft Word – Obamacare Replacement Act SBS.docx

Posted in Affordable Care Act (ObamaCare), American Presidents, big government, Crony Capitalism, Economic Issues, Free Society, Free-Market, Government Regulations, Government Spending, Health Insurance, Individual Mandate, Liberty, Nation-Building, Neo-conservatism, Policy Issues, Progressivism, U.S. Security, Uncategorized

Fascism: A Bipartisan Affliction – Ron Paul

ron-paulFascism’s distinguishing characteristic is a “mixed economy.” Unlike socialists and communists who seek to abolish private business, fascists are content to let business remain in private hands. Instead, fascists use regulations, mandates, and taxes to control business and run (and ruin) the economy. A fascist system, then, is one where private businesses serve politicians and bureaucrats instead of consumers. Does the modern American economy not fit the definition of fascism?

Obamacare is an example of fascism that is often mislabeled as socialism. Obamacare did not create a government-run “single payer” system as would exist under socialism. Instead, Obamacare extended government control over health care via mandates, regulations, and subsidies. The most infamous part of Obamacare – the individual mandate – forces individuals to purchase a product from a private industry.

The true path to real free markets, peace, and individual liberty starts with rejecting the bipartisan authoritarianism in favor of the non-aggression principle. 

Source: Fascism: A Bipartisan Affliction – Ron Paul