Saturday, April 28, 2012

SCOTUS Decision will be Critical to Economy


Either way the decision goes enormous changes will occur in the U.S. economy. As the Patient Care and Affordability Act plays out reality is effecting hospitals, doctors, insurers, Medicare and Medicaid.  This does not even factor the secondary consequences upon employers, large and small.

Several major goals of “Obama Care” have been initiated:

1. The implementation of “no prior illness can be reason for denying coverage

2. Minors will be eligible for insurance in their family’s insurance policy until the age of 25.

Looming on the horizon in August 2012 (three months from now) is the ruling that insurance companies must limit their administrative costs to a specified amount. Many companies thus far have failed to accomplish this, and face a  $ 1.5 billion dollar rebate in August

According to the Kaiser Family Foundation:

:Marylanders will receive $37.7 million from four insurance providers, according to the report. Kaiser did not name the insurers, but said the average rebate for Marylanders will be $293.50..”

The rebates will be paid by August of this year by insurers who are not following the provision that says insurers offering coverage to individuals and small businesses must devote at least 80 percent of their premium income on health care claims and "quality improvement" activities. Large group plans must spend at least 85 percent.

The rule went into effect in 2011 and this will be the first year rebates are paid. Full implementation of health care reform is slated for 2014. But their is uncertainty as the U.S. Supreme Court debates key parts of the law.

American Health Insurance Plans criticized the provision in the following statement:

“The new medical loss ratio requirement (MLR) does nothing to address the real driver of premium increases: the underlying cost of medical care.  Given the inherently unpredictable nature of health care costs, it is not surprising that some health plans expect to pay rebates to consumers in certain markets. However, the coverage disruptions and other unintended consequences of imposing a new arbitrary federal cap on health plan administrative costs are likely to outweigh any benefit these rebates will provide to consumers.  Moreover, the taxes, benefit mandates, and other regulations included in the health care reform law will cause premium increases that far exceed the value of prospective rebates.  For example, a technical analysis by Oliver Wyman estimates that the new health insurance tax included in the ACA “will increase premiums in the insured market on average by 1.9 percent to 2.3 percent in 2014,” and by 2023 “will increase premiums 2.8 percent to 3.7 percent.”

One thing is certain, we need to turn down the rhetoric.  The issues go far beyond partisan politics. Either issue…the Economy  and/or Health Reform are symbiotic and dependent upon each other. Politicians are failing to address this connection to their constituents, and so are health care experts.

A recent survey by Krames Staywell shows the economy is of concern to 42% of those polled, and to health 27% see it as a primary concern.

Health care reform advocacy group Health Care for America Now said the rebates are a victory for consumers.

"For far too long, health insurance companies have been ripping off consumers, and Obama care finally put a stop to that," the group said in a statement. "The rebate money will come to consumers from insurance companies that spent too little on medical care and too much on profit, red tape and bloated CEO pay."

What’s your opinion?  Repeal Obama care completely?  Have SCOTUS remand the law to Congress with Constitutional Guidelines? Just throw out the Individual Mandates?

What should be done with the changes already enacted?

In the next several weeks take a look at Health Train Express’ new presence at Google Plus and here at G + MD


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