Healthcare

Both of these programs are public health insurance plans, but they are administered very differently and would have drastically different impacts on the healthcare system,

A public health insurance plan, also known as a “public option,” is a government-sponsored plan designed to compete alongside private insurers. It is intended to address the market failure where consumers are faced with only one or two health insurers offering coverage in their area. As a public plan it could have the power to dictate prices, provider networks, and provider reimbursements. It could also potentially indemnify itself for unexpected costs, allowing it to offer insurance at below-market costs.

Single-payer is a health insurance system that is wholly sponsored and administered by a single entity with no direct private market competition. Private insurers would not be able to offer any primary coverage, although in some proposals they would be able to offer supplemental coverage to those who choose to purchase. Providers would be compensated directly by the government, which would also set reimbursement rates, networks, and costs of services. Rationing of services would be among its strongest tool to control costs.

Existing public healthcare plans like Medicare and Medicaid already demonstrate the challenges faced by government-run insurance plans and their ability to provide adequate coverage to their beneficiaries. They may provide less coverage and restrict provider access more than the average employer-sponsored plan, with the Congressional Budget Office estimating that the benefit package for Medicare is 15% below the average employer-sponsored plan. Under Medicaid, specialists are often inaccessible without long waits. Extending this government-run coverage to all Americans would exacerbate these inefficiencies, high costs, and bureaucracy, along with unilaterally restricting consumer choice. Further, the experience of the ACA’s healthcare CO-OP program, where 16 of the 23 non-profit cooperatives failed after their first three years, demonstrates that challenges that would plague a fully government-run insurance plan.

Employee Benefit Advisor’s would like to acknowledge the National Association of Health Underwriters for the content of this blog. EBA is a member of NAHU.

The New York Times reports the Affordable Care Act may have to change to survive. Bill Clinton calls Obamacare the “Craziest thing in the world.” Bloomberg Politics reports Obama says ACS has “real Problems.”

Wasn’t Obamacare supposed to solve out countries insurance woes? Now, before it can be fully implemented – it is being recommended the Public Option is the answer. Why would anyone trust the same people that said we could keep our doctor and it would drive down health care cost – amongst other promises?

The public option would be a government-sponsored and government-run insurance plan, modeled after Medicare which would be offered as an alternative to the private-insurance plans. Democrats are saying it is needed to save Obamacare. What’s wrong with this model? Medicare adds another 3% administrative cost to insurance as it must pass through the insurance carriers and the government. Take away the insurance carriers (as some suggest) and now we have a government monopoly, with no competition, no checks-and-balances. We’ll have far worse than the VA on our hands. And rationing of health care will be a fact.

America will deserve the government it votes for, good or bad.

Call me a cynic.

Revolutionize health insurance, save states billions and render Obamacare obsolete – that’s the message from the 2016 Direct Primary Care Summit.

Under a DPC model, patients pay a monthly membership fee directly to a physician in exchange for preventive care services, consultation by e-mail or phone and in-office procedures and diagnostics. Estimates range from $50 to $125 pending several factors, i.e. services, geography, etc. Contracts are between patients and insurers. Members will need to purchase “wraparound” insurance to cover non-primary medical needs. (EBA believes this will be most effective inside the employer market where buying power and health advocacy can be leveraged.)

It’ll be interesting to see how the government reacts to DPC. The DPC proponents are touting it as an avenue for physician’s being able to afford to opt out as a Medicare provider. Doctors reduce their overhead 20 to 40 percent with reduced paperwork, compliance and staff needs.

(Summit hosts are the American Academy of Family Physicians (AAFP), the Family Medicine Education Consortium, and the American College of Osteopathic Family Physicians.)

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

The Obama Administration is encouraging young adults to obtain coverage through health insurance marketplaces, which need healthy people to balance sicker ones in the risk pool. Why is this important? Keep reading.

Aetna projects over $300 million loss on ACA business and announced that it will stop selling in 11 of the 15 states where it currently offers individual insurance on the Affordable Care Act exchanges.  – Aetna released its second-quarter earnings report and also announced it will not go forward with previous plans to expand its offerings on state health insurance exchanges.  Aetna CEO Mark T. Bertolini said if the company cannot fix this aspect of its business then it will leave the exchanges.

Humana Plans to Scale Back ACA Business. – Humana is concerned about growing losses in its ACA business and “set aside about $208 million more in the second quarter to cover losses in” its ACA business. Humana said it plans to “scale back” its individual business for 2017, which means it will offer coverage in only 156 counties, compared to 1,351 in 2016, and it will sell healthcare plans through Affordable Care Act exchanges in 11 states, compared to 15 this year.

Obama Administration Sues to Prevent Mergers of Big Insurers – The Obama Administration is attempting to prevent the mergers of four large insurers. The Justice Department sued Anthem, Cigna, Aetna, and Humana to block their mergers, saying that they “would ‘drastically’ curb competition in the insurance industry,” and negatively impact options for consumers who purchase coverage through Affordable Care Act exchanges. (Finally, something on which Employee Benefit Advisors agrees with the Administration.) Aetna and Humana announced a plan to sell some of their assets with the aim of gaining regulatory approval for their proposed merger.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

ACA Enrollment Down To About 11.1M – CMS figures show that enrollment under the ACA dropped from 1.6 million people down to 11.1 million. Nearly 85 percent of remaining enrollees, 9.4 million, were receiving tax credits averaging $291 per month to help them pay their premiums.

Battle over ACA Continues In Court and In Congress – Surprise! The Obama Administration and Congress are again at odds over the ACA. The Administration filed an appeal to US Judge Rosemary Collyer’s ruling that it used Treasury funds to subsidize ACA plans without approval from Congress. House Republicans unveiled a report which concluded that the Administration proceeded to use the funds despite knowing that congressional approval was necessary. The “scathing report” concluded the Administration “ignored its own advice and forged ahead with Obamacare payments to insurers without permission from Congress.” In 2012, the Treasury Department concluded Congress would have to approve funding for the ACA’s cost-sharing program, yet “the administration quietly withdrew its budget request for the program drafting a memo that said it didn’t need Congress’ blessing and running it by then-Attorney General Eric H. Holder Jr.”

President Obama Renews Call for Public Option – Healthcare reform has already proven to be a major player in the election debate, President Obama is advocating once again for a “public option.” This, along with proposals to cap the employer exclusion as well as single-payer initiatives in both Colorado and New York.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.