June 19, 2019
Tags: Single Payer
Centene, which owns a number of carriers already, is buying WellCare Health Plans for $17 billion. A smart bet unless it isn’t, as Single Payer threatens carrier health.
June 17, 2019
The Trump administration promoted Association Health Plans as an option to help bring down costs with employers banding together with another form of “collective bargaining” The House Ways and Means Committee has pulled this from a health care bill, which simply amplifies the negative feelings about it. A Federal judge also struck down the plan in late March, saying that association health plans were clearly an end run around the consumer protections promised under the Affordable Care Act. This was done right in Trump’s backyard, with a DC judge making the ruling, in response to a suit filed by 11 Attorneys General. At the same time, President Trump said at a rally, “We are going to get rid of Obamacare…the Republican Party will become the party of great health care.”
June 12, 2019
Tags: Heath Care Costs
According to a survey by Gallup/West Health, Americans borrowed an estimated $88 billion over the last year to pay for health care. The survey also showed 1 in 4 Americans have skipped treatment because of the cost and that nearly half fear bankruptcy in the event of a health emergency. Both Republican and Democrat identified respondents said they lacked confidence in the ability of political leaders to solve the problem (70%).
June 10, 2019
At a time when some would rather be out of the business under the onslaught of Medicare for All proponent, venture funding for insurance and insurtech companies hit all-time highs in 2018. In 2014, funding was roughly $800 million. In 2018, funding was up to $2.5 billion. The leaders on the health insurance front are Oscar and Bright Health.
The “insurtech” play, while not related to health insurance, is also interesting and worth noting. Wefox Group is in the digital insurance market, Root Insurance will have auto insurance rates based on driver testing and Metromile will charge premiums based on miles driven.
June 5, 2019
Well remembered for urging the House to “pass the bill so we can see what’s in it,” House Speaker Nancy Pelosi has urged caution on Medicare for All, believing that the Affordable Care Act is still the best path to ‘quality, affordable care’ She clarified in an interview that Medicare for All, for most people, simply means “coverage for all” which then does not necessitate using a single payer system as advocated by Bernie Sanders.
President Trump, meanwhile, got support to drop the ACA when a District Court judge in Northern Texas said that ACA was unconstitutional. There is an appeal filed from a group of Attorneys General protesting this move. The administration continues to side with the court, with the Justice Department writing it had “determined that the district court’s judgment should be affirmed” and will file a brief. This in spite of the opposition of HHS Secretary Alex Azar and Attorney General William Barr.
June 3, 2019
Republicans have a counter, though no one yet knows what it is. President Trump has promised…to show what it is after the 2020 elections. He has endorsed some proposals already, which may be included in his more comprehensive plan. One (Graham-Cassidy) shows the elimination of the ACA Medicaid expansion and insurance subsidies, with the money being reallocated to the states, who would also be able to override some ACA benefit standards. The 2020 White House budget points to this by creating block grants to the states for a similar purpose. Conservatives also have a plan, which follows a similar path. In short, everyone is against having the Federal government run it – they are all passing to the states.
Of course, Trump really does need a plan, given that his 2020 budget calls for a cut of more than $845 billion in Medicare, purportedly to “cut waste, fraud and abuse.” The OMB director said “he’s not cutting Medicare in this budget” so…so how can we have Medicare for all when Medicare itself is always under attack?
The general grouping of proposals are:
- Passing block grants and funding to the states
- Adding public plan features to private insurance
- Giving people a choice of public plans alongside private plans (e.g. Medicare for those age 50 to 64 while still being able to buy private insurance instead)
May 30, 2019
It’s not just Bernie Sanders’ vision any more. Even more centrist Democrats have taken the pledge, with Senators Harris, Gillibrand and Booker having cosigned Sanders’ bill. The basics? Health insurance would now no longer be paid directly by employers, but indirectly through a 7.5% payroll tax and a contribution by employees of 4%. Medicare and Medicaid would be eliminated and everyone would be covered. Insurance companies would still exist, but only to sell supplemental or ancillary plans; they may not compete directly with the government plan. Insurers are, of course, worried and publicly pledging to come up with a way to build upon the existing system.
As if the bill for expanded coverage is not large enough, the Medicare for All proposal has been expanded further to include Long Term Care. This provision, which had been part of the initial Affordable Care Act, was abandoned almost as soon as it began once lawmakers saw the potential size of that coverage bill.
Things recently got more interesting when Seema Verma, the director of CMS (which runs Medicare) went on Fox News and said “Medicare for all is the biggest threat to the American health care system.” She noted that socialized health care systems in other countries have problems of their own, including long wait times and poor care, which leads citizens to travel to the U.S. for drugs and care they can’t secure at home. More to the point, she said “the reality is we’re having problems today paying for the Medicare program and the trustees have warned about solvency, so adding more people to the program is only going to exacerbate it.”
Arguments pro and con – why and why not:
Pro Advocates say the change is simple – money spent on private health insurance and health care would be shifted to the federal government in the form of taxation
The federal government would set prices and force health care providers to accept current Medicare payment rates, which is roughly 40% below what private insurers pay
The government run system would mean everyone would be insured and people would access health care services more frequently because they would be free (maybe copayments would be required, though this has not yet been decided)
Con “Trust US” – 70% say they are satisfied with their coverage, but all 181 million Americans now covered by employers would have to make a move to a program that is unexplained, unproven and about which the results are unsure
There are those who are not crazy about centralized big government in any aspect of our lives – and then, of course, there are the additional taxes
No matter how they slice it, hospitals, physicians and affiliated providers are going to take a big pay cut, and there won’t be much room for negotiation when the government is the only game in town (think Walmart)
Patients will have to make a shift in expectations – seen the waiting list and lines in Canada lately?
The Sanders plan would increase federal spending by about $32 trillion over its first ten years, or $3 trillion per year. The Congressional Budget Office projects federal spending for the entire 2019 fiscal year at $4.4 trillion
May 28, 2019
Medicare for All: Bernie Sanders has introduced the plan in the Senate, and it is supported by Cory Booker, Kirsten Gillibrand, Kamala Harris and Elizabeth Warren, who have all sponsored these bills, along with Rep. Tulsi Gabbard in the House. Mayor Pete Buttigieg is also on record as being in favor of such a system. The proposed plan would eliminate private insurance and transform Medicare into a single-payer system run entirely by the federal government. Opponents, even within the Democratic Party, are wary, however, of banning health insurers from selling anything, as well as the total price tag. The general estimate is a whopping $32 trillion.
Medicare for America: Supported by Beto O’Rourke and possibly Kirsten Gillibrand. This aims for universal coverage while giving workers the option of keeping their employer-sponsored plan or switching to a new and expanded version of Medicare. The proposal rolls in anyone now on Medicare, Medicaid, ObamaCare-subsidized plans and the Childrens’ Health Insurance Program. Plans offered by employers would have to match standards set under the proposed new program.
Medicare X Choice Act: Sponsored by Senators Michael Bennet and Tim Kaine and in the House by Antoniuo Delgado, John Larson and Brian Higgins. Among candidates, the plan is also supported by Beto O’Rourke, Amy Klobuchar, Pete Buttigieg, Kamala Harris and Cory Booker. The proposed plan leaves in the existing system and creates a public option (this was proposed during the debate over the Affordable Care Act and ultimately rejected). The proposal, if approved, would also expand tax credits for purchase.
Medicare at 50 Act: Supported by Cory Booker, Kamala Harris, Amy Klobuchar and Kirsten Gillibrand. The proposal essentially allows U.S. citizens between the ages of 50 and 64 to buy a Medicare plan, and can use Obamacare subsidies to do so.
May 28, 2019
The winter doldrums have left most of the country and we are witnessing the arrival of spring. Just like the budding trees and baby animals signify a new start, so does a fresh cleaning of your home. But don’t let the spring cleaning stop with the physical place where you live—extend it to all corners of your life. Give your life a good spring cleaning by organizing, decluttering, and setting goals.
By now everyone knows who Marie Kondo is—the master of “The Life-Changing Magic of Tidying Up.” What began a worldwide phenomenon of “sparking joy” in your home can be applied to your work life as well. Start by organizing your thoughts. Write down the tasks you want to accomplish whether it be daily, monthly, or yearly. Calendar the tasks so you know when you want them completed and prioritize them so you know what importance you assign to each item. Prioritizing tasks helps you accept a request or confidently say “no” when someone asks you to do something knowing it doesn’t fit in with your priorities. Organizing tasks works for both your personal and work life.
A good decluttering session is good for the soul! Step back and look at your workspace—are there piles of paper stacked on your desk? What about that mound of things you keep saying you’ll take upstairs in your house? Do you have relationships that are cluttering up your life? Take an hour each week to sort through your workspace piles. Choose to save only the papers/magazines/notes that you need to complete your job or that you want to save for sentimental reasons. Toss the rest of those papers in the recycle bin! After you are able to pare down the piles, begin asking yourself if the next paper that comes across your desk needs to be saved, trashed, or recycled so that those mounds don’t grow into mountains again. The same goes for stuff around your house. Start that garage sale box, begin a keepsake box, and trash the rest. Finally, kick those toxic relationships to the curb. You know the ones—the relationships that suck the life out of you. If you have someone whose values and priorities don’t align with yours, choose to keep them at arm’s length so you can spend more time with the people who hold priority in your life.
Goals are unlike resolutions. Resolutions are a firm decision to do or not to do something. “I resolve not to eat dessert after every meal.” Goals give direction to follow to achieve a desired outcome. For instance, a career goal may be to finish your college degree or obtain a special certification. A relationship goal could be to have weekly date night or to start a family. Financial goals may include paying down debt, setting aside money from each check for a summer vacation, or to begin regularly giving to a non-profit dear to your heart. Set goals as you spring clean your life to give yourself direction in how you spend your time and effort this year.
As you begin spring cleaning your life, you will be surprised what good things are able to flow into those corners that were previously inhabited by disorganization, clutter, or lack of focus. By giving yourself a chance to have a fresh start in your life, you are encouraging new growth. And new growth is always exciting!
May 23, 2019
Governor Gavin Newsom has released details on his overhauled “Healthy California for All Commission,” which will start meeting in September. It will also increase in size from 5 to 13 members, all appointed by legislative leaders including the governor, and headed by the Secretary of Health and Human Services. The Commission would be required to deliver its final report to the governor and Legislature by February 1, 2021.