Posted in Access to healthcare, Consumer-Driven Health Care, Defined Contribution Benefit Plans, Direct-Pay Medicine, Direct-Pay Practice Models, Economic Issues, Employer-Sponsored Health Plans, Health Insurance, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, Policy Issues, Tax Policy, third-party payments, Uncategorized

Who Pays for Your Healthcare Matters

By Robert Nelson

Zero co-pays. No co-insurance. No surprise medical bills! Considering the inflated prices we pay for healthcare, who could pass up that deal, right?

Are the new generation of value-based employer-sponsored Direct Contracting Health Plans, which often include Direct Primary Care, a great deal and more efficient use of our healthcare dollars? Absolutely yes!

real-health-care-expenditures-and-third-party-largerBut we can’t lose sight of the economic reality that individuals always pay the cost of benefits, either directly or indirectly.  And linking benefits to employment has been a colossal policy mistake and the genesis of job-lock and our 3rd-party payer system, which has been the source of runaway costs for 50 years. As the graph illustrates, insurance (3rd party payer) is now a near surrogate for total healthcare costs!

Don’t be fooled. Within the modern paradigm of healthcare financing, employers don’t pay for our healthcare. Our healthcare expense, no matter how it is structured, IS part of our compensation and a huge portion of of it.

images-223535545945618981307.jpgFACT: Every dollar of tax-favored benefits paid by our employer reduces our take-home pay.

The beauty of Direct Primary Care is the portability (no job lock) and affordability which can exist independent of the size or benefit package of the employer. But the foundation which aligns the incentives is based on the identity of the customer. This is why we have to be careful to match the buyer with the recipient of care whenever possible. To insert another 3rd party, even the employer, undermines the sovereignty of the patient and the independence of the physician.

The supply side of healthcare has served the wrong customers for far too long. DPC should not make that same fatal error by exchanging its essence for a pipeline of patients.

This linkage highlights the importance of policy decisions regarding use of HSA funds; the importance of allowing HSA dollars to pay premiums AND DPC fees can’t be overstated.

For DPC, and Direct Contracting at-large, to dig us out from under the boot of the 3rd party apparatus it must remain accessible to the sole proprietor, independent contractor and very small businesses that don’t have “health plans.” And moving to defined contribution plans and away from defined benefit plans will help get us there.

third-party-2Getting first dollar decisions in hands of consumers will also be deflationary and spur competition; and essential to the goal of eventual portability & ownership of benefits. To do otherwise, with too much focus on a new & improved generation of employer-sponsored healthcare plans, will lead us right back to where we started.

Posted in Access to healthcare, advance-pricing, Affordable Care Act (ObamaCare), CPT billing, Deductibles, Economic Issues, Employer-Sponsored Health Plans, Government Regulations, Health Insurance, Healthcare financing, Medical Costs, medical inflation, out-of-pocket costs, Patient Choice, Policy Issues, Uncategorized

On the Importance of Price Transparency

Dollar-under-magnifying-glass-1024x910On the importance of transparency… may I present exhibit A: https://www.medpagetoday.com/publichealthpolicy/ethics/83459

Pay particular attention to the content of the last paragraph!!! 

“The Affordable Care Act mandates that health insurers cover all federally recommended vaccines…at no charge to patients,…

Kaiser Health News looked at what its own insurance carrier, Cigna, paid for those free flu shots. At the high end, it shelled out $85 for a flu shot given at a Sacramento, California, doctor’s office that was affiliated with Sutter Health, one of the largest hospital chains in the state. Further south, in Long Beach, Cigna paid $48 for a shot.

Prices in the Washington, D.C., area went even lower, to $40 per shot at a CVS in Rockville, Maryland, and to $32 per shot at a CVS in downtown Washington that’s less than 10 miles away from the Rockville location.

Picture1.pngOne expert told KHN that the variation has nothing to do with the cost of the drug, but stems from secret negotiations between health plans and providers. While patients are expected not to care since the shot is free to them, these costs come back to bite in the form of higher premiums — which is one of the major complaints about the ACA.”

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, Accountable Care Organizations, Affordable Care Act (ObamaCare), American Presidents, Canadian Health System, Direct-Pay Medicine, Economic Issues, Employer-Sponsored Health Plans, Government Regulations, Government Spending, Health Insurance, Healthcare financing, Independent Physicians, Medicaid, Medical Costs, Medical Practice Models, Medicare, News From Washington, out-of-pocket costs, Patient Choice, Policy Issues, Quality, Reforming Medicare, Uncategorized

What You Need To Know About Medicare For All, Part I

A study by Charles Blahousat the Mercatus Center estimates that Medicare for all would cost $32.6 trillion over the next ten years. Other studies have been in the same ballpark and they imply that we would need a 25% payroll tax. And that assumes that doctors and hospitals provide the same amount of care they provide today, even though they would be paid Medicare rates, which are about 40% below what private insurance has been paying. Without those cuts in provider payments, the needed payroll tax would be closer to 30%.

Of course, there would be savings on the other side of the ledger. People would no longer have to pay private insurance premiums and out-of-pocket fees. In fact, for the country as a whole this would largely be a financial wash – a huge substitution of public payment for private payment.

But remember, in today’s world how much you and your employer spend on health care is up to you and your employer. If the cost is too high, you can choose to jettison benefits of marginal value and be more choosey about the doctors and hospitals in your plan’s network. You could also take advantage of medical tourism (traveling to other cities where the costs are lower and the quality is higher) and phone, email and other telemedical innovations described above. The premiums you pay today are voluntary and (absent Obamacare mandates) what you buy with those premiums is a choice you and your employer are free to make.

With Medicare for all, you would have virtually no say in how costs are controlled other than the fact that you would be one of several hundred million potential voters.

Remember also that there is a reason why Obamacare is such a mess. The Democrats in Congress convened special interests around a figurative table – the drug companies, the insurance companies, the doctors, the hospitals, the device manufacturers, big business, big labor, etc. – and gave each a piece of the Obamacare pie in order to buy their political support.

As we show below, every single issue Obamacare had to contend with would be front and center in any plan to replace Obamacare with Medicare for all. So, the Democrats who gave us the last health care reform would be dealing with the same issues and the same special interests the second time around.

It takes a great deal of faith to believe there would be much improvement.

https://www.forbes.com/sites/johngoodman/2018/09/07/what-you-need-to-know-about-medicare-for-all-part-i/

Posted in Access to healthcare, Affordable Care Act (ObamaCare), American Presidents, Defined Contribution Benefit Plans, Economic Issues, Employee Benefits, Employer Mandate, Employer-Sponsored Health Plans, Government Regulations, Health Insurance, Health Reimbursement Arrangement (HRA), Healthcare financing, Individual Market, Individual ObamaCare Market, Individual Underwriting Standards, Medical Costs, News From Washington, Patient Choice, Policy Issues, Portable Insurance, Pre-existing Conditions, The Triple Aim, Uncategorized

Donald Trump Takes A Big Step Toward Personal And Portable Health Insurance

READ THIS ARTICLE below if you want to understand the degree to which this ruling is an important step for healthcare reform.

But as John C. Goodman points out, administrative ruling can only go so far without being codified by legislative action.

Some believe the Individual Market is too weak to revive, given the hit it took as as result of the ACA.

I am optimistic that this ruling to utilize HRA is this manner will be a “shot in the arm” and revitalize the market again.

This hopefully highlights the benefits, and spurs popularity, of a defined contribution approach as a means to purchase health insurance.

Anything that makes us less dependent on ESI and gives more portability & options, freeing the labor market from job-lock is a good thing. -Forum for Healthcare Freedom

John C. Goodman

https://www.forbes.com/sites/johngoodman/2019/06/18/donald-trump-takes-a-big-step-toward-personal-and-portable-health-insurance/

Posted in Access to healthcare, Affordable Care Act (ObamaCare), American Presidents, Defined Contribution Benefit Plans, Economic Issues, Employee Benefits, Employer-Sponsored Health Plans, Government Regulations, Health Insurance, Health Reimbursement Arrangement (HRA), Healthcare financing, Individual Market, Large group insurance market, Medical Costs, medical inflation, News From Washington, DC & Related Shenanigans, out-of-pocket costs, Policy Issues, Portable Insurance, Price Tansparency, Uncategorized

Trump could revolutionize the private health insurance market

Some believe the Individual Market is too weak to revive, given the hit it took as as result of the ACA.

I am optimistic that this ruling to utilize HRA is this manner will be a “shot in the arm” and revitalize the market again.

This article below highlights the benefits of a defined contribution approach as a means to purchase health insurance. Anything that makes us less dependent on ESI and gives more portability & options, freeing the labor market from job-lock is a good thing. – Forum for Healthcare Freedom

Avek Roy

“Last week, the White House finalized a rule that allows employers to fund health reimbursement arrangements (HRAs) that can be used by workers to buy their own coverage on the individual market. This subtle, technical tweak has the potential to revolutionize the private health insurance market…

The council found an elegant way to give employers the opportunity to voluntarily convert their health benefits from a defined benefit into a defined contribution. For example, an employer could fund an HRA for each worker and their family, which they could then use to shop for a plan that best suits their needs.”

https://www.washingtonpost.com/opinions/trump-could-revolutionize-the-private-health-insurance-market/2019/06/17/bc8ccce4-9124-11e9-aadb-74e6b2b46f6a_story.html

Posted in Access to healthcare, Affordable Care Act (ObamaCare), American Presidents, Consumer-Driven Health Care, Defined Contribution Benefit Plans, Economic Issues, Employee Benefits, Employer-Sponsored Health Plans, Government Regulations, Health Insurance, Health Reimbursement Arrangement (HRA), Healthcare financing, Individual Market, Individual ObamaCare Market, Medical Costs, Patient Choice, Policy Issues, Portable Insurance, Tax Policy, Uncategorized, Uninsured

Trump’s new rule will give businesses and workers better health care options – CNN

A HUGE WIN FOR THE LABOR MARKET AND A STEP TOWARDS ENDING JOB-LOCK!

This is one of the most positive and substantive changes in healthcare policy to come out of Washington, D.C. in the past 40 years.  It finally pierces the veil of separation between the Group Market & the Individual Market, helping to dissolve the perverse tax incentive which ties health insurance to employment. ~ Forum for Healthcare Freedom

“Starting on January 1, 2020, employers will be able to offer their workers HRAs to buy individual market coverage for themselves and their families. The administration’s new rule addresses a major inequity by, in effect, providing the same tax advantage that traditional employer-sponsored group plans receive — exclusion of premiums from federal income or payroll taxes — to coverage that workers in the individual market purchase from an HRA.

The rule will significantly expand worker options since 80% of firms that provide insurance currently offer only one type of plan. Now, workers will be able to use tax-advantaged money from their employers to buy coverage of their choosing. This new flexibility will allow people to maintain their coverage when they switch jobs.

In particular, this new rule should help small business workers by making it possible for employers to fund coverage with less hassle and cost than maintaining a traditional group health plan. Between 2010 and 2018, the proportion of workers at firms with three to 49 workers covered by an employer plan fell by more than 25%. This rule should help reverse that decline. The rule also makes it easier for small businesses to compete with larger businesses for talent.

It will take roughly five years for the full impact of the rule to hit — at which point, we expect 11 million workers and family members to use HRA funds to obtain individual coverage. The HRA rule may increase the size of the individual market by upwards of 50%, and should spur a more competitive market that drives insurers to deliver better options to consumers.”

Source: Trump’s new rule will give businesses and workers better health care options – CNN

Posted in advance-pricing, CPT billing, Economic Issues, Employee Benefits, Employer-Sponsored Health Plans, Healthcare financing, Medical Costs, medical inflation, Medicare, Network Discounts, Price Tansparency, Re-Pricing Scams, Uncategorized

The Urban Myth of PPOs | LinkedIn

“Preferred Provider Organization (PPO) A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network.”

Oh really. The BUCA (Blue Cross, United, Cigna, Aetna) payers reimburse out of network hospitals at about 125% of Medicare while clearly reimbursing In-Network hospitals closer to 300% of Medicare on average. Most hospitals now have cash-pay initiatives at a rate of about 135% of Medicare, and Reference Based Reimbursement pays at average levels just above 150% of Medicare.

So, if you desire to pay more for healthcare services, the PPO model is your best option. The PPOs will charge you an access fee of $12 to $20 to have that option too. One last thing, since employers sign the inane PPO agreements they are legally bound to pay the excessive provider fees by contract.  No wonder your healthcare expenses are so high.

Source: The Urban Myth of PPOs | LinkedIn