Happy New Year .... NOT for Health Reform

Should we be content that we made it through 2013, it seems we always do, no matter what happpens.  Now is the time to become accountable and assertive to determine our future health care.

Many aspects come together to produce 'the perfect storm'.  This storm is not necessarily a destructive one. It has set off an early warning signal for our country that we must be cautious of how we reform our health system.

Nevertheless our health system is in shambles, further delays in revising it, or continuing on with the ACA will lead to a train wreck.

Obamacare is focused on health insurance, with caveats, rewards, and penalties.. Neither patients or providers were the center of the reform.  The  item that did serve patients was solving the pre-existing conditions as a reason  for denying coverage,and eliminating the cap on coverage.

Health Reform will not take place in isolation or in one swoop,  and despite the ACA we will not yet have a functioning plan, nor will we if we continue with the present legislation.

Health Train Express receives a daily stream of analysis and recommendations for future modification to our system.  Neither hype, grandiosity, political motives nor slick marketing by 'celebrities' is going to 'fix' our system.

The good news is that we do have the finest scientific and technical resources already at our beck and call. All of this is available, it's a question of distribution, and we can compare it to supply line  management. We do not need a "Manhattan Project" to invent a new technology.  We already possess it. Perhaps this is an oversimplification, however many have compared our system to other industries, such as the airline business, the banking business and shipping businesses. No one model correctly addresses health financing.

There are aspects, accessibility, funding, prevention, and correcting the huge cost disparites and how to correct the burden for deficits & reimbursements.

Although  the ACA passed in 2010, we are more than three years down the road,  and most of the ACA has not occurred.  Further delays will occur now due to the inability to implement the first stages and mandates.  What has happened is the insurance companies have been sent into disarray, and have been asked already to double back.

The extent of increases in implementation cost will accelerate further and even cancel whatever cost reductions are predicted by the ACA.   Some studies have already demonstrated this fact.

Fortunately, the disagreements and controversy have focused attention on our health system for many who have been  passive and willing to accept the system for what it is. Each  year we witness a steady increase in premiums, increasing deductibles, increasing co-payments and decreasing reimbursements. We have mistakenly used tax law to minimize or maximize gains from insurance coverage with MSPs, HSAs, and now face a myriad of new, unproven schemes such as Accountable Care Organizations (ACO) predicted to decrease cost and improve quality.

It is a highly complex equation, involving some market economics, and a system of reimbursement that defies logic.  For some time the financing has been approached as a point of service transaction(POS) with creative financing such as capitation, some tax credits, and deductions. A portion of the state's public social service system is deemed 'free care' although it is not.

There are many 'misnomers' , such as 'usual and customary charges', pre-paid rates, adjustments, and cash deductions, Insurance companies have based their rates and policies upon algorithms and actuarial analysis, and a 'fudge factor' for unpredictability.

Many have sad, health care is a right, based upon aspects of the constitution in regard to the pursuit of happiness and freedom.  Although the word health does not appear in the  constitution, health can be construed to be a part of pursuing........life and happiness.

Others state that health care is not a right and not everyone should have health coverage, with a bit of 'they don't deserve it.  Neither truly can be legitimized by such a callous attitude.

What we need is a steady hand on the system that will deal equitably and with imperturbability the illnesses of human life and the equal ability to cope with it.

Freedom Works is an organization now intent upon  health reform and maintaining the underlying freedoms we as all Americans cherish.

How will Freedom Works support our goals for health reform? Freedom Works not only is interested in health care, it also  works across a wide variety of niches with a consistent underlying standard based on our most fundamental beliefs of freedom and constitutional law.

An email arrived in my inbox from Freedom Works that i would share with all my readers, providers, patients, employees of our health system and leaders in Congress.

This is your chance to weigh in on improving the Accountable Care Act.  Take the Survey constructed by Freedom Works.

ObamaCare: We Did Not Know What was In It Until It Passed

It did pass, and we still don't know what  is in it.  Each day we learn of waivers, modifications, amendments to 'fix' fatal flaws in the law.  This is the simple part.....getting people to sign on for health coverage....the doorway to health and wellness.

Dates have been set, mandates have been put on hold, insurance policies were cancelled, no wait..Obama says "Kings X", I take that back. Sebelius smiles and goes before congress, non-plussed.  She must be close to retirement so no problem and undoubtedly she will be through with her public service.  I wonder if she has health coverage?

Many of us have tried to take the high road and plan health reform logically analyzing each step as we proceed.  This is almost a futile endeavour, because the landscape is constantly changing.




Secretary of Health and Human Services Kathleen Sebelius testifies at a Congressional panel last week. The White House has outlined a new exemption under the Affordable Care Act

n a last-minute policy change, the Obama administration waived the so-called individual mandate under the Affordable Care Act for people whose individual health insurance policy is being canceled.

The act requires most Americans to have qualified health insurance starting in 2014 or pay a tax penalty, unless they meet one of myriad exemptions. One is if qualifying coverage would cost more than 8 percent of household income (the affordability exemption). Another is they can prove a hardship such as homelessness, bankruptcy, domestic violence, large medical debts, utility shutoff notice or death in the family.

Under new guidance issued late Thursday, the Centers for Medicare and Medicaid Services (CMS) said that having an individual insurance policy canceled now qualifies for the hardship exemption.

The process is not really that simple:

People who qualify for the cancellation hardship exemption have two options:

-- Don't buy coverage and don't pay a fine.

-- Buy a bare-bones catastrophic policy on an exchange. These catastrophic policies do not meet the requirements of the Affordable Care Act, but people who buy them won't owe a fine. Before Thursday's rule change, to buy this policy a person had to be younger than 30 or meet the affordability exemption.

To qualify for the new policy-cancellation exemption, consumers must complete a hardship application, which will let them purchase a catastrophic plan or receive a penalty waiver, according to Centers for Medicare and Medicaid Services. (For the application, see http://1.usa.gov/19YrBnK.)

To purchase the catastrophic policy, they must submit the form, and evidence of a canceled policy, to a company selling such policies in their area.

The announcement came just days before the Monday deadline for enrolling in coverage to start Jan. 1, and insurance companies are not happy.

When Obama announced another policy reversal in November - saying insurance companies could temporarily renew certain policies that were to be canceled because they did not comply with the act - he gave states the option of allowing that or not.

Covered California did not. As a result, most individual health policies in California that are not grandfathered will be canceled Dec. 31.

Some customers of Anthem Blue Cross and Blue Shield of California will be able to keep their non compliant policies until the end of February or March, respectively, under a settlement with the state insurance commissioner.

People with individual plans that are grandfathered, meaning they had them before the act was signed in March 2010, may keep them until the insurance company decides to cancel them.

It appears that nothing is guaranteed as to the roll out. Insurers, providers, hospitals are all nervously watching and waiting. 

Poll: Americans better understand, still don’t love, health-care reform

Lake forming behind an Ice Dam

The recent melt-down of the Affordable Care Act's opening of the Health.gov website served to cast a spotlight on the entire law.  More than 60% of the public pretend to know what it is about. That is about the same as Congress knew when they voted to enact the bill into law.

Despite and perhaps because of it's sudden visibility and the topic of all news media most know of it's shortcomings and how it was passed with major deceptions on the part of the Democrats, HHS, and President Obama's administration.

According to the Seattle Times, "A poll released today by Harris Interactive dug more deeply into the opinions of the uninsured, who face penalties if they don’t get insurance by March of next year. The survey found that more than one-third of uninsured Americans say they are prepared to make health-insurance choices — but 31 percent said they didn’t know about the health insurance exchanges set up to sell the coverage.

On top of that, 61 percent of the uninsured say they have done “nothing” in the past year to get ready for the Affordable Care Act. More than half say they don’t know what they’re going to do about the requirement that they get insurance."

As you may recall, it’s been rough going since the Oct. 1 launch of online insurance markets created to enroll people in individual insurance plans. The federal site, which serves 36 states, essentially wasn’t working for weeks and only really kicked into gear over the last week or so. Washington state’s site had some hiccups, then got itself sorted out, but in the past few days has been down again for software fixes.

Added to those technical glitches like a bee sting on a raging sunburn was the outcry by folks who learned their individual and family insurance plans were being canceled at the end of the year. People felt betrayed by President Obama’s promise that if you liked your health care plan, you could keep it.

A survey conducted and released last week by Gallup found that only 37 percent of Americans approve of the Affordable Care Act or would like to see it expanded while 52 percent want it revised or repealed (the rest are undecided).

The crazy thing — given all of the recent attention to the problems with the roll out of the health-insurance exchanges — is that public opinion hasn’t changed a whole bunch from the same Gallup survey nearly three years ago. In January 2011, 37 percent of those surveyed approved of the ACA while 57 percent did not.

So it begs the question: How and Why was the ACA passed into law?

Many think this was a major move toward consolidating control of healthcare costs, and giving government a major role in 1/6th of the American Economy. It effectively destroys a major freedom of choice of what Americans buy in a market place.

How could public opinion remain so constant despite the tumult in recent news? It could come down to politics.

The Seattle Times teamed up with the Elway Poll in September to take the ACA pulse of Washington residents. It turned out that public opinion on health-care reform largely hewed with political leanings.

In that survey, 80 percent of Democrats approved of the Affordable Care Act, while 80 percent of Republicans did not.

This may reflect more upon the discordance between Democrats and Republicans overall, including budget difficulties which are also severe given the expanding national debt.  Republicans are vehement about corraling the national debit, which will again take canter stage in March 2014.