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Effective as of the date of enactment of this bill, the following provisions of Obamacare are repealed: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

One of the best pieces I’ve read that exposes the real cost drivers in healthcare. Many of us have been shouting from the rooftops that the “villains” we implicate are just symptoms of a more fundamental poison in that is embedded in our third-party billing system and the cartel-like system it has created. Thanks to Dave Chase for putting the pieces together so clearly. Given the realities exposed here, we can no longer implicate something that has been virtually wholly absent from the healthcare economy which could have prevented this generational theft: A free market. 

The Sovereign Patient

Dave Chase
Dave Chase – Forbes contributor

Mike Dendy: I hear the talking heads on business TV (like CNBC) talk about stagnation of incomes for the middle class. Wrong. The additional money is there every year, it’s just going into a pool to pay for healthcare instead of into the pockets of the employees in the form of salary increases.

Americans overpay for healthcare by at least 30% and likely 50% in aggregate. For all intents and purposes, every employer in America gives every covered member on their healthcare plan a blank check every year and says….consume all the healthcare you want, anywhere you want, anytime you want, and never be concerned with or ask the price because it’s all paid for. Deductibles and co-pays are irrelevant, especially to hospitals, because pricing is so high it becomes somewhat immaterial.

Trillions Have Been Redistributed from the American Workforce to the Healthcare Industry Creating An Economic Depression for the Middle Class The Washington Post and Vox have done excellent reporting that shows U.S. spends so much more than other countries for one simple reason — price. The good news is that some […]

Source: Have PPO Networks Perpetrated The Greatest Heist In American History?

Have PPO Networks Perpetrated The Greatest Heist In American History?

Posted in Access to healthcare, advance-pricing, Affordable Care Act (ObamaCare), Consumer-Driven Health Care, Deductibles, Defined Contribution Benefit Plans, Direct-Pay Medicine, Economic Issues, Employee Benefits, Employer-Sponsored Health Plans, Essential Benefits under the ACA, Federal Exchanges, Free-Market, Government Spending, Health Insurance, Health Reimbursement Arrangement (HRA), Health Savings Accounts (HSA's), Healthcare financing, Independent Physicians, Individual Mandate, Individual Market, Individual ObamaCare Market, Individual Underwriting Standards, Insurance subsidies, Liberty, Medicaid, medical inflation, Patient Choice, Patient-centered Care, Policy Issues, Pre-existing Conditions, Price Tansparency, Private Exchanges, Quality, Reforming Medicaid, Self-Insured Companies, Self-Insured Plans, State-Run Insurance Exchanges, Subsidies, Tax Policy, Uncategorized, Uninsured

All the Problems plaguing ObamaCare are Solved by These 12 Bold Ideas

The Sessions – Cassidy bill:

Source: Summary | Goodman Institute for Public Policy Research

Posted in Access to healthcare, Affordable Care Act (ObamaCare), Consumer-Driven Health Care, Direct-Pay Medicine, Direct-Pay Practice Models, Doctor-Patient Relations, Doctor-Patient Relationship, Economic Issues, Employee Benefits, Employer-Sponsored Health Plans, Free-Market, Health Insurance, Independent Physicians, Medical Costs, medical inflation, Medical Practice Models, out-of-pocket costs, outcomes, Patient Choice, Patient-centered Care, Policy Issues, Price Tansparency, primary care, Self-Insured Companies, Self-Insured Plans, Telemedicine Trends, The Quadruple Aim, The Triple Aim, third-party payments, Uncategorized

Three Reasons Why Employers Should Care about Direct Primary Care | Samir Qamar | LinkedIn

Featured Image -- 24171.“Insurance is not necessary for all healthcare.”

2.“Not all healthcare is expensive.”

3.”Employers can use Direct Primary Care to lower healthcare costs.”

Healthcare is the only field where insurance is not only used for rare events, but also common and frequent events. However, “insurance is not necessary for all healthcare”.

To reduce frequency of claims, a large segment of medical care has to be affordable to render insurance unnecessary. Thankfully, “not all healthcare is expensive.”This is where Direct Primary Care makes its grand entrance.

Direct Primary Care takes this majority of healthcare, and caps the cost into an affordable, manageable, flat monthly fee, typically less than $90 per month. As a result, insurance use (and cost) is minimized to rare occurrences.“Employers can use Direct Primary Care to lower healthcare costs.”

Source: Three Reasons Why Employers Should Care about Direct Primary Care | Samir Qamar | LinkedIn

Posted in Access to healthcare, Direct-Pay Medicine, Doctor-Patient Relationship, Economic Issues, Employer-Sponsored Health Plans, Independent Physicians, Medical Costs, Medical Practice Models, Patient-centered Care, Price Tansparency, Self-Insured Companies, Self-Insured Plans

There is Hope America | Jed Constantz | LinkedIn

flagI just returned from the Mississippi Academy of Family Practice’s one day Direct Primary Care (DPC) event in Jackson, MS.  Pretty impressive I must say.  Truly a new breed of physician is emerging that if welcomed, properly supported, and given the opportunity can drive meaningful and valuable healthcare reform and transformation in communities throughout the United States. 

via There is Hope America | Jed Constantz | LinkedIn.

Posted in Access to healthcare, Affordable Care Act (ObamaCare), Deductibles, Direct-Pay Medicine, Direct-Pay Practice Models, Economic Issues, Health Insurance, Medical Costs, Medical Practice Models, Patient Choice, Policy Issues, Price Tansparency, Self-Insured Companies, Self-Insured Plans, Uncategorized

The Jig is up: Understanding Price drivers in Healthcare. It isn’t as expensive as you’ve been led to believe

Posted in Access to healthcare, Affordable Care Act (ObamaCare), Consumer-Driven Health Care, Deductibles, Direct-Pay Medicine, Direct-Pay Practice Models, Doctor-Patient Relations, Economic Issues, Employer-Sponsored Health Plans, Health Insurance, Independent Physicians, Medical Costs, Medical Practice Models, Patient Choice, Policy Issues, Price Tansparency, Quality, Self-Insured Companies, Self-Insured Plans, Third-Party Free Practices, Uncategorized

Direct primary care emerges in post-reform world. | The Direct Primary Care Journal

The DPC Consumer Guide -- Now Available for office/clinic use and and an educational/marketing resource for your patients.As DPC becomes more widespread, options for self-funded health plans are increasing. One example is a collaboration between NextCare Holdings, which owns urgent care centers in eleven states, and DPC network design firm Physician Care Direct. These two organizations are offering an “employer health ownership plan” to business owners in Dallas, Texas. The offer comes with a promise of healthcare savings of up to 30 percent.

via Direct primary care emerges in post-reform world. | The Direct Primary Care Journal.

Posted in Affordable Care Act (ObamaCare), Deductibles, Direct-Pay Medicine, Economic Issues, Electronic Health Records, Employer-Sponsored Health Plans, Entrepreneurs, Free-Market, Government Regulations, Health Insurance, Hospital Uncompensated Care / Disproportionate Share Revenue, Independent Physicians, Influence peddling, Medical Costs, Medical Practice Models, Medicare, Organizational structure, Patient Choice, Patient Safety, Policy Issues, Price Tansparency, Quality, Re-Pricing Scams, Self-Insured Plans, Uncategorized

How the Market Can Cure the Health Care Crisis w/Dr. Keith Smith! – YouTube

via How the Market Can Cure the Health Care Crisis w/Dr. Keith Smith! – YouTube.

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