It was a warm spring evening.  Warm enough for the guys to sit on the whiskey bar’s patio.  The group, a restaurateur, an insurance agent, a physical therapist, a scrap metals guy, and an attorney (isn’t there always an attorney?) were solving the world’s problems over adult beverages, mostly Scotch, and good cigars.  But their real focus that evening was Korea.  The insurance agent took notes on a couple of napkins as the group formulated a simple, common sense solution to Kim Jong-un and his nuclear paranoia.  The only thing these five guys knew about Korea was a good place to get kimchi, but that didn’t deter them.

Last week’s post noted the ignorance of Donald Trump, specifically when it came to the Patient Protection and Affordable Care Act (Obamacare).  I was not the only person to notice.  Mr. Trump’s opponents, especially Senator Rubio, focused on the emptiness of his rhetoric at last Thursday’s Republican Debate.  Even Mr. Trump’s most ardent supporters had to admit that he looked clueless and unprepared.  And thus the Healthcare Reform To Make America Great Again plan was created. (That is a real link to the Trump plan)

This blog has reviewed each of the Republican alternatives as they have been released.  The Bart Simpson Award for Spectacular Underachievement was presented to Scott Walker last summer for his fifteen page term paper.  We have our first entry for 2016.

I want you to imagine Mr. Trump, his shadow Chris Christie, and a few advisors sitting on the patio in Palm Beach.  The glasses are full of orange juice and unsellable bottles of Trump Vodka.  The ideas are coming fast and furious.

Scotland! We love their health care.

No Americans dying in the streets.

We have to get rid of the artificial lines around the states.

Mandates!  OK, maybe not.

No one had time to get a laptop or even a notepad.  A junior staffer stopped refilling the glasses and started to take notes on some napkins.  And that is how we got the Healthcare Reform To Make America Great Again, two and a half pages of napkin fodder.

The opening paragraphs were borrowed from all of the previous Republican offerings.  Obamacare is blamed for all of humanities ills.  Words like economic burden, higher premiums, and partisan litter the preamble with the promise that a complete repeal would bring the exact opposite.  Obamacare would be blamed for global warming if the Republicans accepted climate change.  The opening paragraphs also beg for help from Congress, the first time Mr. Trump has acknowledged that he isn’t officially running to be our dictator.

Here are the seven reforms that the Trump Administration wants Congress prepared to pass on the first day he is in office:

1. Completely repeal Obamacare and eliminate the individual mandate.  “No person should be required to buy insurance unless he or she wants to.”
2. Allow the sale of health insurance across state lines as long as the plan purchased complies with state requirements.
3. Allow everyone to deduct their health insurance premiums. Suggest to the various states what they should do about Medicaid and coverage for the poor.
4. Legalize Health Savings Accounts (HSA)
5. Require price transparency.
6. Send the states money for Medicaid (Block Grants)
7. Allow foreign companies easier access to sell prescriptions in the U.S.

“The reforms outlined above will lower healthcare for all Americans.”

That’s it.  I know that you are more surprised by what is missing than what little is there.  There is no mention of preexisting conditions.  None.  What do we do with the people who are now covered who wouldn’t be if the insurers had a choice?  Your guess is as good as mine.  How could any of this change happen?  Don’t ask Donald.  He ran out of napkins.

Unfortunately, I don’t have the luxury of running a fact-free presidential campaign.  Neither do our friends at Forbes or at the home offices of the major insurers.  My clients are already calling and asking how they would be affected by the Trump plan.  The quick answer is that they wouldn’t be impacted at all.  The seven bullet points simply prove that the candidate doesn’t care about their issue.

We’ve discussed points one and two.  Deducting health insurance premium (point 3) is really important to people who want to pay less taxes.  It is meaningless to people who want help in paying for their premiums. Donald and his team appear to be confused about the difference between the FSA, Flexible Spending Account, and the HSA, Health Savings Account.  You should know that BEFORE you release your paper to make America Great Again.  And if we send the states Medicaid Block Grants, we will condemn millions of Americans to substandard care as the money is misdirected elsewhere.

There are times in politics when being attacked from the Left and from the Right means that you really are in a good place.  The Healthcare Reform To Make America Great Again appears to be nothing more than random thoughts on a cocktail napkin.  And Donald came up empty.

www.cunixinsurance.com

The real name for this post would have been How Can You Be in Two Places at Once When You’re Not Anywhere at All.  The link to the 1969 Firesign Theater album will let you listen to the album while you continue to read this post.  Of course, if you are of a certain age, I’ve already lost you…

How can you be two places at once? How can you appear to advocate for something while you spend all of your time and energies undermining that very same thing?  This being Health Insurance Issues With Dave, smart money says that this is probably about health insurance and the companies that sell it.

The major insurers want you to know that they are here for you. Ask them.  They’ll tell you.  The major insurers litter their public pronouncements and email communications to their agents with words like commitment and partnership.  Companies such as Aetna, Cigna, Anthem and UnitedHealth Care want you, the American public, to know that they are committed to their partnership with the American people and are ready to deliver their product through the federal exchange, the state exchanges and whatever platform available to them.  You can hear the Battle Hymn of the Republic playing in the background as you read the emails, the fruit of the labors of their overworked PR departments.

And this would be wonderful if it were true. But, of course, it isn’t.  There would be a huge uproar if the largest insurers abandoned the exchanges.  Terrible publicity.  Government officials and the heads of the exchanges would all blast the insurers as bad corporate citizens and incompetents.  Plus, drop out of the market and they can’t get back in for five years.  So the insurers needed to find a backdoor.

The solution is to stop paying the agents. Anthem, Aetna, Cigna, UnitedHealth Care all hope that by not paying the agents during the Special Enrollment Period we will place our business with those companies who will. Sure that may push all of the clients to one or two companies from February till December, but it won’t be them.  And what would happen if all of the companies stop paying the agents, so that none of us can afford to spend the hours of time necessary to match Americans to the appropriate policy and insurer?  NOTHING!  No one with any authority would ever notice that thousands of Americans were even more unhappy than usual with their health insurance.

The insurers are losing millions of dollars on policies written on the exchanges. The Special Enrollment Periods are being abused.  The federal exchange is not enforcing the rules.  Fixing the problem is an option.  It would take a lot of work and require the building of trust between the exchanges and the insurers.  Removing the incentive to do our jobs is easier but terribly cynical.  But Congress attempted to repeal the Patient Protection and Affordable Care Act (PPACA or Obamacare) for the 60+ time last week.  What is more cynical than that?  So who is going to notice one more act of self-serving cynicism?

The insurers will continue to say one thing publicly and do the exact opposite privately. But like Nick Danger, we are lost on the wrong side of the album and you really can’t be two places at once.

We interrupt this blog for Breaking News.

We have the results from the latest poll. We asked the students of Mr. Miller’s 4^th grade class, here in East Podunk, Ohio, who they would vote for if the election was held today.  And this is shocking!  These student voters are equally divided – 33% for Donald Trump, 33% for Hillary Clinton, 33% for Beyoncé, and 1% for John Kasich.  This is the first poll we’ve taken that has shown Kasich ahead of Jeb Bush.

4^th graders.  Could the report be accurate?  Yes.  Could it be 100% true?  Sure.  Does it mean anything?  Absolutely Not.

Saturday’s Plain Dealer had a front page article – In 3^rd year, NE Ohio insurance costs drop 6.3%. For most of you, that number is as real as Beyoncé’s electability.

All of the new individual policies, purchased on or off the government’s Exchange, renew on January 1^st each year.  Like my fellow agents, I have been reviewing the records of several hundred clients since the information was released a little over a week ago.  One client at a time.

I have yet to see even one rate decrease.

How can that be? Where are these rate decreases?  My Anthem PPO clients, people who wanted a clear path into University Hospital, did not see their premiums shrink.  And Medical Mutual of Ohio, the E Ticket into the Cleveland Clinic, had rate increases of up to 27%.  How could the Plain Dealer be both 100% accurate and 100% irrelevant?

The answer lies at the heart of the Patient Protection and Affordable Care Act (PPACA or Obamacare).  The focus has never been on health or health care reform.  The point of the law is to reorganize how medical providers get paid.  And, herding lower income people into lower cost providers is more efficient than allowing them to ring up big bills at expensive facilities that are eventually written off.

I went on to healthcare.gov today and looked at the least expensive policies for me, a 60 year old living in Cuyahoga County. Please remember that rates are gender neutral and that there are no health questions.

The lease expensive policy, $434 per month, is from Ambetter Insurance.  The deductible is $6,800.  This policy sends you to Metro Health and St. Vincent’s.  More importantly, the Cleveland Clinic and University Hospital are not in their network.  Never heard of Ambetter?  Don’t want them?  Too bad.  They have lots of options on the Exchange close to this price point.  None get you into U.H. or the Clinic.

The next insurer is CareSource at $444 per month with a $6,650 deductible.  CareSource’s Medicaid policy has a great network, but if you are paying all or part of your premium you are again looking at a policy that fails to include University Hospital or the Cleveland Clinic.

Molina’s least expensive policy comes in at $468.  Still no University Hospital of Cleveland Clinic.

Aetna has introduced a full portfolio of innovative group policies that provide great access to all of our major hospitals.  Their least expensive individual policy at $520 per month does not.  The deductible is $6,450.  The doors to U.H. and C.C.F. are closed.

HealthSpan, an HMO, has a $4,500 deductible policy at $566 per month.  This is the least expensive policy on the Exchange that grants access to University Hospital.

The new Anthem HMO policy is also $566.  This policy has Anthem’s smallest network.  Neither University Hospital nor the Cleveland Clinic are included.

HUMANA has a $6,450 deductible policy at $567 per month.  University Hospital is in their network.

Medical Mutual of Ohio’s workhorse policy, the $6,000 deductible 100% plan, is $569 per month.  This plan utilizes the old SuperMed Plus Network.  It includes the Cleveland Clinic and the suburban facilities of University Hospital.  This is not an HMO and it does not require a referral to see a specialist.

$569! It takes eight different insurers and over a dozen policy options to get to a policy that provides easy access to the majority of doctors and hospitals in Greater Cleveland. The price for access isn’t decreasing.  It is increasing.

Are the rates decreasing on the Exchange? Sure.  We are getting more and more offerings from the Ambetters, Molinas, and CareSources.  But if we flood the market with Yugos, does it mean that the price of cars is going down?

The Plain Dealer reported that the price of insurance has decreased. Perhaps a more complete article would have noted the influx of limited access carriers.  Would you really pay $434 – $566 per month to go to Charity Hospital?  Do you really care how many 4^th graders support Donald Trump?

The news can be so depressing. Bad news 24/7. It is hard to believe, based on what is reported on FOX, MSNBC, or even CNN, that anything is getting done in Washington. And that is why I am particularly happy to devote today’s blog post to some good news.

President Obama signed into law H.R. 1624 last week. Yes, there are laws, bipartisan laws, getting through Congress. The Protecting Affordable Coverage for Employees (PACE) Act is legislation that will allow states to define the size of small groups for health insurance purposes.

The Patient Protection and Affordable Care Act (PPACA) changed the size of small groups from 2-50 to 2-100 as of January 1, 2016. The new regulations, especially community ratings, have the potential of eliminating group health coverage for hundreds of thousands of employees and their families. The PACE Act fixes the problem.

Many of my readers and clients wondered why I went to Washington in February. “Why waste your time and money?” they asked. PACE was one of the major issues on our agenda. Our elected representatives paid attention to me and my peers because they understood that we were there in Washington for our clients, not ourselves. We were able to impress upon them that fixing this and other issues didn’t mean that they agreed or disagreed with Obamacare. This was just constituent service.

This bill was sponsored by Representatives Brett Guthrie (R-KY-2) and Tony Cardenas (D-CA-29) in the House and Senators Tim Scott (R-SC) and Jeanne Shaheen (D-NH) once it got to the Senate. The President quietly signed the PACE Act into law Wednesday evening. The House, the Senate, and the President stripped the politics out of this and simply worked together to get something done. This is proof that our leaders are still capable of working in our best interest.

Our other big issue is “Grandmothered” policies. These are the policies that were issued with an effective date between April 2010 and December 31, 2013. I have mentioned that my personal health policy would be twice as much under the new law. Twice as much, over $600 per month.

The good news is the “Grandmothered” policies are still around for another year. The renewals are coming in and the rates are still terrific. Agents and our trade groups are committed to fighting for our clients and the option to retain these older, more affordable policies. And just like PACE, we know that the key to success is getting Congress to understand the scope of the problem.

The PACE Act may be the feel good story of 2015.

The check came in the mail earlier this week. My check. Made out to me personally. And I couldn’t be happier. One of the most touted provisions of the Patient Protection and Affordable Care Act (PPACA) is the MLR, Medical Loss Ratio. This check was my rebate.

The PPACA requires an insurer to issue a rebate to each client if it does not spend at least 80 percent of the premiums it receives on health care services. Allowable services include actual medical claims, activities to improve patient safety, and efforts to improve health care quality. The other 20% may be used for administrative costs, salaries, advertising and agents.

Last year my insurer, Anthem Blue Cross Blue Shield spent only 79.70% of a total of $340,647,389 of premium dollars on health care. They had to issue rebates since they fell .30% short. My check, my share of this windfall was $7.90.

I think I’ll go to Vegas.

Photo credit – Jeff Bogart