Dems open ACA repeal bill hearing with slashing attack

By Harris Meyer  | March 8, 2017

Democrats opened a House committee hearing Wednesday to mark up the Republicans’ bill to repeal and replace the Affordable Care Act with a slashing attack on the GOP for not offering an open and transparent process for considering the legislation.

Democratic Rep. Lloyd Doggett of Texas asked that House Ways & Means Committee chairman Kevin Brady to postpone the markup until March 16 to allow time for at least one public hearing to discuss the bill. He insisted that the Trump administration send a representative to testify before the committee to discuss how the bill meets President Donald Trump’s promise to cover everyone at less cost with better coverage.

Doggett noted that before passing the ACA, House Democrats in 2009 heard 181 witnesses in 79 hearings, while Senate Democrats held 53 hearings. He compared the process of evaluating the GOP bill to the way consumers buy a new pair of pants. “They have two questions – how much does it cost and what is its size,” he said. “We are being asked to vote without knowing how much this bill costs, what it covers, and how many millions of people are once again being left without coverage. If you have nothing to hide, one week will not impair your effort.”

Republicans then defeated the motion on a party-line vote of 22 to 16.

Prevention benefits at risk with an Obamacare repeal

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By Harris Meyer  | January 28, 2017

The Affordable Care Act extended 100% coverage for a range of preventive healthcare services, including some types of cancer screening, to seniors on Medicare. That first-dollar coverage likely saved lives by increasing diagnoses of early-stage colorectal cancer by 8% among Medicare beneficiaries during the first three years it was in effect, a new study in Health Affairs reported.

Now experts fear Republicans will eliminate the law’s mandate for full coverage of recommended preventive services in taxpayer-financed and employer-based health plans. The GOP proposals also would erase the requirement that individual plans offer minimum essential benefits in 10 categories, including mental health and substance abuse, maternity care and prescription drugs.

Even without a replacement plan, some predict the Trump administration may move quickly to ease coverage rules. The president’s recent executive order instructed federal agencies to roll back the ACA.

That could have lethal consequences for some seniors. “We found that about 8,400 people had their colorectal cancer detected at an early stage due to the first-dollar coverage, and their chance for five-year survival is much higher,” said Nengliang Yao, an assistant professor of public health at the University of Virginia, who co-authored the Health Affairs study. “That’s a lot of lives. I hope (the Republicans) will keep and strengthen prevention-related services.”

GOP proposals, including those released by House Speaker Paul Ryan and HHS secretary-nominee Dr. Tom Price, would encourage insurers to offer cheaper, high-deductible plans by eliminating various ACA mandates, including coverage of preventive services. The theory is that consumers could funnel savings from lower premiums into tax-sheltered health savings accounts to pay for voluntarily purchased cancer screening and other preventive services.

The GOP replacement plan “won’t say you can’t or shouldn’t have preventive coverage, but it won’t micromanage it,” said Tom Miller, a conservative health policy expert at the American Enterprise Institute. “Out-of-pocket medical costs compete against people’s other living costs. We should allow people to make those tradeoffs.”

MH TAKEAWAYSACA repeal puts free cancer screenings and prevention benefits for seniors and many privately insured patients at risk, although it might take a prolonged rulemaking process to make it happen.
Without a benefit mandate, private insurers would be free to limit prevention coverage to plans with higher premiums, said J.B. Silvers, a professor of healthcare finance at Case Western Reserve University and former health plan CEO.

Better health care in Canada than in America

I’m a Canadian, in Canada. Jack, my cousin in NC, asked me about health care in Canada and if a universal plan was do-able in the States. I said, “No”. I told him, 8 years ago, that the insurance companies would do EVERYTHING to stop it and they have. I told Jack that our system was far from ideal. Drugs, eye care and other services, like physio, were generally not included. However, the BIG health challenges, like cancer and heart disease, were covered well. It is a bit of patchwork quilt. However, there is no doubt that average folks were better cared for in Canada.

I have struggled to understand the American system. In 1983, my mother had a heart attack and required a triple bypass. At the reunion of her high school class in 1988, in Cleveland, she was sitting with an old friend. When mom told her about her health issues her friend said, “I have needed bypass surgery for the last 8 months, but my HMO won’t cover it.” These were both surgical nurses. My mom instantly realized that her old friend was telling her that she would likely be dead in six months. My mom’s reconstructed heart sank and I’m sure she was thankful that she was now living in Canada. My mom lived 14 more years.
Let’s be clear, there is little doubt that the wealthiest Americans have healthcare plans that put what I have to shame. However, what I have – the main provincial plan and a modest extended family plan through my wife’s work (for about $230/month) – would surpass what 80% of Americans have. I am now 61, retired and still well covered. My cousin, Jack is 75 and the last I heard he was still working.
The United States is the only first world country that does not have a comprehensive, universal health care plan. Yet, more is spent per capita on health care there than anywhere in the world. Clearly, something is amiss.


It is a sad indictment of America. My nephew, now 2, required 3 major heart surgeries in his first 5 months. His care, thank God, was covered by the Ontario health plan. If they were in the States his family would be scrambling and asking all of his aunts and uncles to mortgage their houses to help pay for his care – estimated at about $2 million. Maybe, YOU are in great health, but what would say to your sister IF she said, “Can you give me $30000 for your nephew’s care?” I am forever grateful for the public plan that saved my nephew’s life. If, as you contend, a shared cost system leads to more obesity and chronic ailments, then why do Canadians enjoy better health and live longer than Americans? Could it be that we have better preventative plans?


Every first world country with comprehensive health care plans have healthier and more fit communities. Childhood obesity rates in Canada are half of that in the States. That is because our public health programs know that the cost of addressing these issues with our youth are a fraction of the cost of dealing with them down the line. I agree, people need to be more responsible. However, it starts with education and ensuring that our children are raised to value good nutrition. Turn on the TV today and you will see nothing but a stream of ads promoting food products that are a one-way ticket to health issues. Children are bombarded with catchy ads for junk cereals and convenient, highly processed, snacks. And, the industries that produce this slow acting poisons, do so with the blessings of the government agencies. In some European countries the producers of junk cereal are not permitted to advertise on television. Some would call it a “nanny state”. However, if we are to educate children to make good food choices we need to ensure they have the best information required to make an informed choices. Overwhelming them with ads for junk cereals only serves to undermine the goals of a government healthcare system committed to lowering the shared costs.


Boy, you’re either naive or heartless. I had an emergency appendectomy when I was a healthy 35, as humanly possible, could run 10 miles, not over weight, etc. Cost: $10K with 80 percent picked up by my employer sponsored insurance. Twenty years later, a small spot of cancer appeared on my yearly mammogram. Again, I had employer sponsored insurance.

Today, I do not have employer sponsored health insurance, so I went to the ACA exchange. I’ve got a $3500 deductible with maximum out of pocket of $10,000, and I have those pesky pre-existing conditions.

Good choices and healthy living do a lot, but none of us, not even you, can control some aspects of ill health. To me, your attitude is part of the problem.


I bought private health care insurance for years pre-ACA. This will be a return to high premiums, high deductibles and very limited coverage. This will be access to health care only if you can afford it. It is all good and well for the Republican members of congress, because we, the tax payers, pay for their insurance. I bet they never lost sleep at night wondering how to pay out of pocket for simple things like getting your child treated for asthma, in addition to paying for your high monthly premium, because you hadn’t met the $10,000 family deductible yet, and forgoing the colonoscopy that you knew you should have, but couldn’t cover because you were paying out of pocket for your children’s health care.


I feel sorry for Americans. The basic care I receive here in Ontario is better than most people get with insurance companies and once I get sick I still don’t have to worry about losing my plan. What Obama had the courage to do was to put forward a public health care plan that doesn’t even touch what I have. I knew, when he endeavored to do so 8 years ago the GOP and insurance companies would do EVERYTHING they could to vilify it and kill it. When you can afford $1000/month premiums for a comprehensive family plan you have nothing to worry. That is until you get sick. Then, the insurance company will shut you down. While the Canadian system is far from perfect over 95% of Canadians would not have a fear if they got cancer or needed bypass surgery. People rail about “entitlements” and how to pay for what the government has already committed to. We have the same concerns here in Canada. However, even the most conservative voices in Canada do not talk about scrapping our public health care system. We seem to have learned how to do more with less. Our health care costs are less per capita and we live longer and healthier lives. As or your challenges, I hope that the government understands that if people are worrying continuously about paying for health care they will be a more stressed out and unproductive workforce. There is a saying, “They know the cost of everything, but the value of nothing'” . That, sadly, is the GOP. My heart goes out to you, buddy.


It’s not just the poor. I’ve retired early with substantial savings. My wife, still working, has amassed a very healthy retirement nest egg, too. But that does us no good if insurers can go back to denying us coverage, or excluding wide swaths of care, because of our pre-existing conditions. Without medical insurance, all that we’ve worked for, throughout our decades of contributing to this economy and paying our taxes, could be wiped out, leaving us destitute and unable to afford the medical care we need to stay alive.

Prior to the ACA, when I tried to purchase health insurance privately, I was told by United Healthcare that the only way they would provide me a policy, with my pre-existing back problems, would be to exclude all care related to the spine. I asked (paraphrasing here, since it’s been quite a while) ‘so if I’m in an automobile accident in which I have a spinal injury that leaves me paralyzed, your company will pay nothing towards my medical expenses?’ The representative said, yes, that was true.


This is really frightening. Charge older people – many on fixed incomes, in the years of greatest medical costs – 3 times the insurance rate for younger ones? What sense does that make except to ensure older people suffer? Re continuous care younger people also are prone to risk having no insurance if financially strapped, so they may try to manage diabetes or heart issues on their own for a while. So then they can’t get anything? And no one knows when a catastrophic injury or illness may befall or a child born with some expensive medical problem. So (1) coverage has to be affordable and (2) there’s just no way around eliminating the pre-existing condition claus. That is, unless you’re either deeply cruel of heart or have the imagination of a gnat. So where does that lead? The ACA! It’s really disheartening reading these stories about people who opposed evil communist “Obamacare” until they got cancer or had a heart attack and suddenly faced huge bills they couldn’t possibly pay without it. Does it really take a personal crisis to open people’s eyes? Surely, as a nation and as humanity, we can do better than that!


Many people think that Trump will increase coverage and lower costs. He and Republicans will never support universal coverage and single payer which is the only way to achieve this. Wait until they discover that their coverage will cost more and won’t cover them when they are sick or will drop them quickly once they have a serious diagnosis. I had one of those policies years ago and they dropped us as soon as my daughter was diagnosed with asthma.


Healthy folks don’t need insurance, only ill folks do. Unfortunately, healthy folks turn into ill folks when they get older. Fact is, everyone sees the doctor, so we don’t need for-profit insurance which only works for relatively rare events like fire or theft. We just need a single payer system paid for by federal income taxes. No one need purchase health insurance ever again. No more profits paying for dividends, high executive salaries and stock options, or lobbyists. Our current system is definitely corrupt.


Cobra for us was 1800 a month for great coverage. Got charged $250 copay for a 450k liver transplant. Now who can save 450k in a hsa account, guess who trump and his cabinet. We need single payer with a tax everyone pays from cradle to grave. Anything else is stupid.


One of the reasons Medicare pays out a lot in benefits is that many people don’t see doctors for years before they reach age 65. When they become eligible for Medicare there are previously unaddressed conditions and other problems for which medical care is finally provided.

Call and write to your state elected govt officials to participate in democracy

Support the following causes/organization and write/call your elected local officials to participate in democracy:

  • Planned parenthood
  • New York Times
  • Washington Posts
  • Others listed in the video above by John Oliver of Last Week Tonight show.

 

 

Expect increase govt subsidy to offset increase in premium for OBAMACARE

Enrollment opens Nov. 1. For coverage effective Jan. 1, people need to pick a plan by Dec. 15. With a few exceptions, the last day to sign up for Obamacare is Jan. 31, 2017. Plans are available on HealthCare.gov and state-run exchanges.

While the average premiums on the benchmark health plans are increasing, the government says more than 70 percent of people buying insurance on the marketplaces created by the law could get a health plan for less than $75 a month for 2017. To get the best deal, people would have to pick a low-cost plan with limited benefits and take advantage of all the subsidies available.

People who already have coverage through the exchanges can often save money by switching plans, the administration said. More than three-quarters of people could save money by switching to the lowest-cost plan within the level of coverage, such as bronze or silver, that they’ve previously selected.

open-enrollment

Health Insurers Performance 2012-2014 OBAMACARE

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Over a third of the total sample (53 insurers, groups 1 and 2) were profitable in 2014; these insurers accounted for 41 percent of the total members in this sample (data not shown). The remainder were either unprofitable both years or moved from profit to loss. Medical claims, rather than administrative costs, were the main driver of the negative financial experiences.

Reinsurance

Most of insurers’ underestimated claims in 2014 were offset by $7.9 billion in reinsurance payments for high-cost patients from the federal government. The reinsurance program helps insurers transition to the new market rules, using federal funds collected through an earmarked fee on all health insurance, included self-funded plans, to pay a large portion of high-cost claims incurred in the individual market.

Insurers that turned profitable in 2014 (group 1) saw their medical costs decrease by almost 12 percentage points as a percentage of premium—that is, their MLR decreased. Coupled with a 1.4 point decline in the mean administrative cost ratio, these changes resulted in a substantial (13.2-point) rise in their overall profit margin to 7.6 percent, from a loss of 5.6 percent. In contrast, insurers that reported losses (groups 3 and 4) had substantially higher mean MLRs. Although they managed to reduce their administrative costs significantly, their MLR increased even more, producing a mean loss greater than 10 percent.

 CONCLUSION

 By subsidizing coverage, establishing insurance exchanges, and making insurance available to people with preexisting conditions, the ACA’s reforms changed market conditions in ways that insurers had difficulty predicting, at least initially. In 2014, the ACA’s reinsurance program offset much of insurers’ underestimated medical claims in the individual market. Also, despite overall losses in the individual market, the insurance industry as a whole earned modest operating profits (in addition to profits from investments).

 Only some insurers fared especially poorly. One-quarter of insurers underestimated medical claims in the individual market to a much greater extent than the rest. A fifth of insurers in the individual market substantially improved their financial performance between 2013 and 2014.

 All well-functioning markets have winners and losers, so it should be no surprise that some health insurers failed to succeed in the ACA’s reformed market, especially during the first year. As insurers gain greater experience with these new conditions, it can be expected that their actuarial precision will improve and that large differences in financial performance will diminish. Moreover, additional market stabilization can be expected as more previously insured people move out of grandfathered and transitional plans and into ACA-compliant coverage.

 However, improved financial performance will require increased premiums, especially as the ACA’s reinsurance component phases out, starting in 2017. This reinsurance has played a crucial role in helping insurers transition. Because this has taken longer than initially expected, policymakers should consider extending the ACA’s reinsurance program until the reformed market has matured.

 

What a connected patient wants?

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Motherhealth LLC – Health Mobile Outpatient application (in design stage) will address the needs of connected patients in today’s health care with video chats, electronic communication/appointment and data storage and an integrated system to reduce chronic care costs and increase preventive measures towards saving lives.

  • Match care provider and patients , electronic appointment, video chats
  • Monitor patient generated health data integrated with doctors health data
  • Report analytics , personalized and for global cancer care coordination

Email motherhealth@gmail.com http://www.careme.live if you are a doctor or investing partner or a mobile health developer.  All doctors are welcome to be part owner of this health application.