Wednesday, April 23, 2014

PERSONALIZED DESIGNER HEALTH INSURANCE PLAN NOT YOUR ORDINARY OBAMACARE




Associated Press, Judy Lin writes a post enrollment critique of Obamacare. Criticizing is all too easy now that the law is in full effect following the initial enrollment. All that needs to be done is to fine those not in compliance.  Unfortunately there are many who cannot fulfill  the requirement because the subsidized premiums are still unaffordable.  Then there are those who can buy coverage but cannot afford the copayments, or deductibles.  Some who only qualify for medicaid may be fortunate relative to those needing a subsidy.

Reporters find it easy to discover people who fall out or are in a ‘gap’ for the ACA.  

There is little doubt that the law will fail and/or require much fine tuning.

Clinical medicine takes place as  personaly designed treatment for individuals. It is not an assembly line process. In an era where treatments for cancer are personally designed using DNA guided therapy, why not Personally Designed Health Insurance?

Few if any potential patients fall into a category that is meaningful. The federal poverty level is an  easy way to categorize people, but it does not allow for different needs for many.

MORE TO  DO.

  • The share of adults without insurance shrank from 17.1 percent at the end of 2013 to 15.6 percent for the first three months of 2014 according to a Galllup-Healthways Well-Being Index released this month. In California This decrease translates to about 3.5 million people gaining insurance coverage according to the study.
  • Anthony Wright, executive director of Health Access California, says the work is not finished. ”California has made huge progress with the benefits of the Affordable Care Act.”

WHAT ARE THE GAPS?

  • Cost remains a particularly high hurdle for low-income people who are most likely to be uninsured.
  • Some are eligible for discounted policies but say they still can’t afford their share of exchange plans.
  • Others earn too much for subsidies.
  • Undocumented immigrants living in the U.S. illegally can’t obtain care under the law.
  • Dozens of states have not expanded Medicaid. (24 states have opted out of the federal plan to expand medicaid. The federal program funds the expansion for up to three  years. The states refusing this option say they don’t trust the federal government to live up to the promise and will be stuck with huge overruns. The promise is based largely upon unknown costs and risks.
  • Some employers have reduced staff hours to avoid being mandated to provide insurance.
  • Some will buy minimal coverage which does not fulfill the ACA requirement for less, however they will face the fine for non-compliance.  These policies are bare bones and do not allow broad protection.

WHAT NEEDS TO BE DONE?

  • A careful analysis of those in the gap itemizing the reason for each person falling into a gap
  • A PERSONALLY DESIGNED PLAN can be designed for these individuals from the ground up based on their individual situation and medical needs rather than a top down plan that often is worthless.
  • The current system of standards, while well meaning sabotages any real attempt to make insurance affordable for many citizens.



WHO WILL DO THIS?

  • Any program requires a post introduction review by competent personell experienced in the area. This is a form of quality assurance, one that is in common in most industries, and actually is required by hospitals and HHS.
  • Non-qualiifying patients will require personal interviews regarding their income, expenses. Once a base line sample is obtained a plan can be designed that would benefit.
  • Local insurers,  providers, hospitals,  pharmacies, home health companies must be involved in planning for this group of patients.
  • The review and analysis should not be done by the federal government, but rather at the local level (state or county). The medical records should be reviewed (and this may also be beneficial for those who do qualify for a subsidy.
  • This will be labor intensive, however it may also be very cost effective and result in  a much lower expenditure for subsidies.  
A ‘shot-gun’ approach, which is what the Affordable Care Act provides is inadequate, and is a ‘roulette wheel’ solution to a complex problem. Poorly designed and poorly executed programs are designed to fail and increase cost.

Commentary is welcome.

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