Well, it appears that it is-for now. With the public speaking out via the election in Mass I believe Obama and the Dems will need to pull back on their agenda.  However, without some type of “reform”, which was one of Obama’s campaign platforms I think Pelosi and Reid will not give up and they will try to re-work the bill in a much more centrist format.

Let’s wait and see what the version of “health care reform” brings us and how it will affect the California Health Insurance Market-both individual, family and group health insurance.

Your comments are appreciated and welcome.

Item    House   Senate 
Cost    $1.1 trillion over 10 years     $849 billion over 10 years     
Exchanges -     A federal exchange will be established; initially for individuals and small groups.  States will be given the option of opting out of the federal exchange to operate a state exchange, but they must comply with the federal exchange rules.   Requires that state-based exchanges begin in 2013.  The exchanges will be limited to individuals and small groups, until 2017.  At that time, large groups will be given the opportunity to participate in the exchanges.      
Market Reforms -       Starting with 2013, Insurance companies would no longer be able deny coverage for preexisting conditions or set lifetime limits on the amount of care they will cover.  Increased premiums will not be allowed for pre-existing conditions or gender; higher premiums will only be allowed based on age.        Beginning in 2014, the Senate requires guarantee issue and renewability of all policies, prohibits rating based on either health status or gender and only allows rating factors of age, tobacco use, family status and location.  At enactment (when the legislation is signed) children up to age 26 can stay on parents insurance and lifetime limits on coverage will be eliminated.       
Individual insurance mandates  –        House requires that all Americans carry health insurance or face fines, with exemptions for those with religious objections or financial hardship. This would certainly affect the California Health Insurance market-both individual and small group.  This will be enforced through a 2.5% income tax penalty.  Subsidies would be provided to help some people pay insurance costs. A new health insurance exchange would be established to offer individual and small business policies. Children would be carried on their parents’ policies until they are 26 years old.       All individuals must obtain insurance through either their employer, private insurance, on the exchange or through the government plan.  There are exemptions for hardship.  Those who refuse to obtain insurance would pay a fine of $95 in 2014 rising to $750.      
Benefits Package –      A committee would recommend a so-called essential benefits package.  This package would include preventative services.  This package would be the basic benefit package offered in the exchange.        This bill sets four levels of coverage.  The low-end level would pay an estimated 60% of health care costs per year.  The most general would cover an estimated 90% of costs.  
Paying for Reform –     A new 5.4 percent income tax on those with high incomes, more than $500,000 for individuals or $1 million for couples. The tax is on the amount earned above the threshold. Also includes a new 2.5 percent tax on medical device makers.

        Reform will be paid with fees on insurance companies, pharmaceutical companies and medical device manufacturers.  In addition, there will be a Medicare payroll tax increase to 1.95 percent on income over $200,000 a year for individuals, $250,000 for couples.  A new 5% tax on elective cosmetic surgery will be implemented as well as additional cuts to Medicare and Medicaid.  An excise tax on insurance companies for “Cadillac” plans, fees on employers whose workers receive government subsidies to help them pay premiums and fines on people who fail to purchase coverage.   
Employer Mandate –      Employers with a payroll of less than $500,00 are exempt; others are required to provide coverage or pay a penalty of 8% (phased in for employers with payrolls of between $500,000 and $850,000.)      This Bill requires groups of 50+ to provide “qualified” coverage or pay a $750 fine for non-covered employees. 
Subsidies       Affordability credits would be offered to individuals with incomes of less than $43,320 or $88,200 for a family of four. Tax credits of up to 50 percent of insurance costs would be offered to small businesses.       Same as House  
Medicare and Medicare Advantage – 
        Reduces funding for both Medicare and Medicare Advantage. Begins to close the “doughnut hole,” the gap in prescription drug coverage for seniors.       Payment reforms would reduce Medicare Advantage funding by an estimated $120 billion over ten years, beginning in 2011. Special Needs Plans would be extended through 2013 and Cost Plans would be extended through 2012.      
Government Run Plan -   A government-run plan would be one of the options offered on the Exchange to compete with private insurance.    States could opt out of a government-run plan, which would be one of the options on the Exchange.  The HHS would determine the payment rates for medical providers with a cap at the average rate of private plans.  If this option does not survive debate, it may be replaced with the “trigger” option.  States will be allowed to offer their own public programs for people between 133% and 200% of FPL. 
Abortion
        No federal subsidies would be used to buy policies with abortion coverage, but private funding could be used to buy abortion coverage through a rider. No public or private funds could be used to buy abortion coverage in the public plan.    Every state must offer one insurance plan with abortion coverage and one without. No federal subsidies would be used to buy policies with abortion coverage, but abortion coverage could be offered in the public plan if public and private funding are segregated.   
Illegal immigrants
        No federal subsidies could be provided to help illegal immigrants buy insurance, but those here illegally could use their own money to buy policies on the new health insurance exchange.       No federal subsidies could be provided to help illegal immigrants buy insurance, and those here illegally would not be allowed to use their own money to buy policies on the health insurance exchange.

As the suicidal Democratic congressmen proceed to rubber-stamp the Obama health care “reform”, the president trotted out the endorsements of the AMA and the AARP to stimulate support.  But these — and the other endorsements his package has received are all bought and paid for.  How and to what extent?

Here are the deals:

* The American Medical Association (AMA) was facing a 21 percent cut in physicians’ reimbursements under the current law. Obama promised to kill the cut if they backed his bill. The cuts are the fruit of a law requiring annual 5-6 percent reductions in doctor reimbursements for treating Medicare patients. Bravely, each year Congress has rolled the cuts over, suspending them but not repealing them. So each year, the accumulated cuts threaten doctors. By now, they have risen to 21 percent. With this blackmail leverage, Obama compelled the AMA to support his bill…or else!

* The AARP got a financial windfall in return for its support of the health care bill. Over the past decade, the AARP has morphed from an advocacy group to an insurance company (through its subsidiary company). It is one of the main suppliers of Medi-gap insurance, a high-cost, privately purchased coverage that picks up where Medicare leaves off. But President Bush-43 passed the Medicare Advantage program, which offered a subsidized, lower-cost alternative to Medi-gap. Under Medicare Advantage, the elderly get all the extra coverage they need plus coordinated, well-managed care, usually by the same physician. So more than 10 million seniors went with Medicare Advantage, cutting into AARP Medi-gap revenues.

Presto! Obama solved their problem. He eliminates subsidies for Medicare Advantage. The elderly will have to pay more for coverage under Medigap, but the AARP — which supposedly represents them — will make more money. (If this galls you, join the American Seniors Association, the alternative group)

* The drug industry backed ObamaCare and, in return, got a 10-year limit of $80 billion on cuts in prescription drug costs. (A drop in the bucket of their almost $3 trillion projected cost over the next decade.) They also got administration assurances that it will continue to bar lower-cost Canadian drugs from coming into the U.S. All it had to do was put its formidable advertising budget at the disposal of the administration.

* Insurance companies got access to 40 million potential new customers. But when the Senate Finance Committee lowered the fine that would be imposed on those who don’t buy insurance from $3,500 to $1,500, the insurance companies jumped ship and now oppose the bill, albeit for the worst of motives.

The only industry that refused to knuckle under was the medical device makers. They stood for principle and wouldn’t go along with Obama’s blackmail. So the Senate Finance Committee retaliated by imposing a tax on medical devices such as automated wheelchairs, pacemakers, arterial stints, prosthetic limbs, artificial knees and hips and other necessary devises.

So these endorsements are not freely given, but bought and paid for by an administration that is intent on passing its program at any cost.  How and to what extent this will affect the California Health Insurance Individual and Small Group Market is to be determined.  However,  deep cuts to Medicare are guarenteed and our health premiums are going to go up.  So, in the end are we any better off with ObamaCare?

Your commnents are apperciated.

As the US Senate weighs and debates it 2,074 health care “reform” bill let’s take a brief look at how the Medicare and Medicaid “scoreboard” look right now.  California Health Insurance and the Obama Care legislation will affect how these plans move forward.  According to FEDERAL statistic fraud devours some 60 billion (that’s right billion) or 13.3 percent or Medicare’s $452 billion dollar budget.  One thief told Steve Kroft “60 Minutes” that he personally robbed 60 million dollars and he could have easily took 100 million.  He was quoted as saying it was “really easy” to steal patient names, doctors name and just start billing the Federal government for fictitious services and devises.  If you think health insurance is expensive now-wait until it’s free and the thieves get their claws into the new program.

Medicare failed to investigate frauds and in many cases where the members (who received their explanation of coverage and never received the services or devises) called Medicare and reported the fraud.  Additionally, Medicare continues to be one of the slowest “payees”-according to the Athena Health Payers View report.  North Carolina is the fastest state at 40 days.  Among the top payees it ranks 8th and in some states takes 77-89 days to pay providers.

Additionally, Medicare also ranked among the highest payees in rejecting claims.  In California Health Insurance Medicare and Medicaid rejected 19.5% while NY rejected 34% and Florida 38%.

Last year even the Post Office lost 2.5 billion dollars.

Folks as the 2000 page healthcare bill makes it’s way through the Senate we need to be aware that if this bill passes it will be more costly than budgeted, will be filled with administrativered-tape, be stifled with delays and problems and surely have a tremendous amount of waste and fraud.

Why do I say this?  Because the government can’t run their existing programs efficiently and on budget.

Your comments are appreciated.

OK so Obama is stating the his program is revenue neutral.  For those of you who believe that-please allow me to present a few facts and opinions.

1-The Senate Finance Committee “carefully” drafted a bill that assumes that cuts in Medicare will save $200 billion with cuts to the “Sustainable Growth Rate” cuts to Medicare spending through 2012 and beyond.  (Sound the trumpets please)…  These same requirements drafted by the CBO have been in place since 2003-and every year Congress has vetoed these same cuts. The assumption that Congress will all of a sudden get financially prudent is silly and certainly not realistic to budget savings accordingly.

2-Another similar analysis applies to the other 200 billion that the government seeks to cut from fraud, waste and abuse from Medicare and other federal health care spending. Well, hasn’t the government been promising to do this since my parents were born? Every now and then a little “fingernail” get’s trimmed.  But, the last time I checked the spending keeps rising and proportionately fraud and waste follow right behind.  Please explain how this pattern is now all of a sudden going to change?

3-It also worth noting that the Baucus bill includes more spending than cuts.  The biggest is the 40% tax on health insurance plans in excess of $8,000 for individual and $21,000 for families-the “Cadillac” plans.

So, to sum this up provided that the sun rises in the west and sets in the east I think the Obama care health care bill will be (1) deficit neutral, (2) be on budget and (3) reduce the budget-as stated.

I have been in the California Health Insurance Market for about 10 years and thus I have been following this really close.   Some of the controversial issues are listed below and how it will affect you are:

1-Will I be able to keep my current doctor? Maybe not.  If you employer deems the government plan will cost save him money (the fine is less than his company premium) you can bet your last nickle some employers that offer group coverage will drop their company plan and force employees to go on the government plan.   Like Medicare and Medical many doctors don’t accept these plan, even Medicare Supplements (they don’t pay the market rate for services) and if you fall into this situation you may be forced to find a new health care provider.

2-How will the government pay for the program? Well, politicians say that it will be deficit neutral and won’t add a dime to the deficit.  If this is the case this will be the first (ever) government program to be delivered on budget and on time.  If we look at Medicare and Medical and even Social Security they are completely under funded and tinkering on being financially insolvent.    I think this statement is mis-leading and not even possible-to say the least.  Plus, they have identified $600 billion dollars to TAKE from Medicare to pay for this program. As if there was just $600 billion dollars of money sitting there that they are “waiting” to take from roll out their plan?  If it is there “why have the been waiting so long to save the tax payers the money”-come on?

These are just (2) areas of concern and conversation that I thought I would throw out to the web world. Your comments pro or con are much appreciated.

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CIF Insurance Agency Inc

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