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The Devil Is In The Details

Stanley Feld M.D., FACP,MACE

 

The devil
is in the details. Many of the Obama administrations sound bites are lies.

The Megyn
Kelly interview of Ezekial Emanual on the Kelly File October 25th
2013 is a must watch video. It is worth 9 minutes of every American’s time.

The Obama
administration rolled out one of the chief architects of Obamacare to provide
disinformation about the pending success of Obamacare.

 

  

 http://youtu.be/cwfk3vOvzvE

I have
written about Ezekial Emanuel’s disinformation campaigns.
His misinformation is
based on incorrect facts leading to misguided conclusions.

This Megyn
Kelly interview is a perfect example of President Obama’s disinformation
campaign.

The
interview starts with President Obama’s promise that Obamacare will let you
save up to $2500 on insurance premiums and be able to keep your doctor and your
insurance plan if you like them.  Obamacare
will bend the cost curve. It looks like Obamacare is going to bend the cost
curve up not down.

Dr. Emanuel
says it is not President Obama’s fault that people cannot keep the same doctor or
healthcare plan
. Corporations and the healthcare insurance industry changed their
insurance rules for business reasons. Obamacare did not change the rules.

Obamacare
forced the healthcare insurance industry to change its rules.

Is Dr.
Emanual in denial or is he lying?   

Dr. Emanuel
contradicts himself immediately by saying it is unethical and immoral to sell
healthcare insurance plans that do not cover bare minimum care coverage such as
maternity care, preventive care (not defined), pregnancy, pediatric dental care
and drug coverage.

It should
be obvious that everyone does not need maternity care or pediatric dental care.

Ezekial
Emanuel then continues with a rant about McDonald’s Minimed insurance coverage
plans
being immoral and unethical.

This is a
point at which reality and being disingenuous gets buried in the weeds.

President
Obama has allowed corporations to avoid penalties by using “minimal essential coverage” criteria. 

Dr. Emanuel certainly knows about and understands this nuance. The Obama
administration has certainly not explained it to the public.

Dr. Emanuel
also ignores the fact the President Obama’s gave waivers to 13,000 companies permitting
them to continue to provide Minimed coverage until January 2014. It has now
been extended until January 2015.

President
Obama has modified minimal essential coverage
criteria
through CMS administrative regulations bypassing congress.

In August
2013 The Kaiser Foundation News published an article called “Why Health
Law's 'Essential' Coverage Might Mean 'Bare Bones' “

 “It came as a surprise
to some that the Affordable Care Act seems to allow large employers to offer
health insurance that pays for preventive care and not much else.”
 

“How can Ezekial Emanual
brag about a law he praises for expanding coverage — one that includes an
"employer mandate" to offer "minimum essential coverage" —
allow companies to offer insurance that might not even cover hospitalization?

I will
spend the rest of this blog explaining this nuance.

Dr. Emanuel
misinforms the audience throughout the interview.  

There has
been no outright ban on these skinny plans — even after the employer mandate
kicks in in 2015.

Instead,
large employers — those with 50 or more full-time employees — run the risk of
fines (penalty) only if the coverage
doesn't conform to ACA (Obamacare) rules.

 The
regulations published so far, however, seem to allow skinny plans
with a
penalty that many employers may choose to pay because it is less costly than
offering fuller coverage.”

There are two fines in the health law for
large employers.   There is a $2,000 per
employee fine for any company that does not offer "minimum essential coverage."

Most people
do not know that the fine is only triggered when at least one employee enrolls
in the health insurance exchange and receives subsidized coverage.

If none of
the employees enroll and get subsidized coverage from the government, the
corporation is not liable for the $2,000 per employee fine.

What
is the definition of “minimum essential
coverage
”? It is not the same as  "essential health benefits," that
include maternity benefits and prescription drugs. Those essential health benefits vs. minimum essential coverage are
benefits that must be included in plans sold to individuals or small employers.

Who
suffers? The small businessman, and the individual buyer in the health
insurance exchange will suffer the most.

Most
large corporations are self- insured. A self-insured company provides dollar
coverage for their employees’ illness. The company pays the bills minus the
deductibles for each employee. The corporation is assuming the risk rather than
the healthcare insurance company.

The
insurance company does the administrative services just as they do for the
federal government for Medicare, Medicaid and government worker insurance
(Medicare Part C). 

The
self-insured corporation is the sponsor for the health insurance. A
self-insured corporation passes one test necessary for “minimum essential coverage.” This avoids the $2,000 per employee
penalty (fine).

If
the company goes over the amount the company paid the previous year to cover
employees’ illnesses, the corporations pays the difference in the following
years administrative services fee to the healthcare insurance carrier.  

 The regulations are
obscure
, defining minimum essential coverage largely in terms of what it is not.
Therein lies the loophole.

“As a result, many
experts believe large employers can shield themselves from the $2,000 penalty
by offering a plan that covers the health law's required preventive care, but
still leaves workers vulnerable to thousands in bills if they're hospitalized.”

The young people working for
minimum wage at McDonald don’t want to spend their money on full healthcare
insurance. They believe they will not get sick. They cannot to buy insurance
through the health insurance exchange.

They do not want to go on Medicaid.
Many physicians view Medicaid as unacceptable insurance.

Government reimbursement is for
Medicaid is extremely low. In some cases it is lower than the physician’s
overhead to provide the care.

Many physicians do not take
Medicaid patients. This results in long waits for appointments, a lack of
access to timely care and in many cases rationing of care.

Medicaid is free to the
needy. Nonetheless the government must pay the insurance industry for their
administrative services.

According
to Alden Bianchi, a Boston-based benefits and compensation lawyer. “

“Skinny coverage flunks the
test, based on regulations that
measure minimum value
against "benchmark plans" in each state.”

The trick
is the employer penalty is only $3,000 for each worker enrolling in subsidized
exchange coverage. The fine is not imposed on the employer for all workers.  

The fine
will be much less than the fine for not offering a minimum essential coverage
plan of $2,000 per employee if one employee buys subsidized coverage through
the health insurance exchange.

Bianchi,
who represents large employers said in an industry
brief
.

 “The people who wrote the law intended to give
companies a bare-bones option.”

"The ability to
offer such plans is a result of conscious policy decisions by Congress, as
implemented by the regulators."

I
think he is wrong.

I
think the Cato Institute’s Michael Cannon is right.

Cannon
suspects the administration "had no idea what they were doing," as he wrote
on the libertarian think tank's blog.

I
think President Obama’s goal is to drive everyone into the health insurance
exchanges and use the “public option.” 

The
health insurance exchanges’ non-subsidized options are in some cases double the
previous price for healthcare insurance despite the claims of the Obama
administration.

Obamacare
is now backfiring on the President and his administration.

I
apologize for not exposing the misinformation of each point Ezekial Emanual was
sent out by the Obama administration to make on the Kelly File.

It
is all disinformation and spin.

I felt
it was important to explain the confusion created about the $2,000 and $3,000
dollar penalties attached to the mandates.

The
corporate self-insured have figured out a way to get around the mandate and
penalty. They also get around the mandate by hiring only part-time new
employees who work less than 30 hours per week.

President
Obama has bragged that new job creation is slowly improving. However, 77% of
the new job creation is for part time employment.

If
one puts it all together it spells hard times for economic growth and
Obamacare.

I
implore you to watch the video and hear disinformation one of President Obama’s
architects is peddling.

 The issue is becoming clear. Can the American
people trust President Obama to tell them the real story?

My
impression is that it is doubtful.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Permalink:

The Method Of Operation

Stanley Feld M.D.,FACP,MACE

It’s clear. President Obama
has used the same techniques to neutralize the scandals and mishaps during his
administration.

In has been the same for Benghazi,
NSA, IRS, and Fast and Furious scandals.

President Obama makes his
characteristic statement, “This is unacceptable
and we will get to the bottom of this.”

After this statement there is
never any follow-up. What has been done? Has President Obama gotten to the
bottom of it?

The public never learns who
was responsible for the debacle. No one ever gets fired and the traditional
media carries on. The public soon forgets about a non-resolved scandal.   

President Obama always leads the
public to believe he had nothing to do with the scandals or the decision-making
leading to the scandals.

He is the President. He should
know. If congress investigates the scandal it gets stonewalled by the administration. The investigationg committee then is accused
of muckraking.

Somehow the traditional media
buys this story and sells it to the public. It is the journalist’s obligation to
dig into a scandal and find out the real story. It is not done.

Nothing this administration
does has been transparent. The traditional media ignores the scandals and so
does the public.

The devil is always in the
details.  

The real story is the attack on individual
freedoms and choices. They are being impinged upon by the bureaucratic regulations of
big government. The traditional media should make this clear.

America does have a freedom
of information act and constitutional rights that have to be protected and not
ignored.

All the participants in the
various scandals finger point to others being responsible for the actions that
would not be approved by the people.

No one ever questions whether President Obama is
responsible for the scandals.  

The same method of operation
is being put in place to explain the colossal disaster of www.healthcare.gov’s rollout.

The Obamacare web site has
many problems. It is not a simple fix as the President and his administration
has declared it to be.

President Obama claims he did
not know anything about the problems before the launch. He has promised to get
to the bottom of this.

He is finger pointing to
everyone except himself and his administration. 

If the Obama administration
did not know about the impending failure it is either stupid, or irresponsible
or both.

President Obama is not stupid. He is cunning.

These are President Obama’s remarks in the
Rose Garden of the White House last week.

 “Shortly
before the president’s appearance, White House officials 
let it be known that the “president will directly address the technical
problems with HealthCare.gov – troubles he and his team find unacceptable.” But
in that Rose Garden appearance, the president did not explain what the
technical problems with HealthCare.gov were, though he did acknowledge their existence and stated “there is no excuse” for them.

He then promised he would recruit the best
information technology talent in the country to come to the rescue and fix the
problems.

President Obama happened to hire one of Michelle
Obama classmates at Princeton in a no-bid contract to build the web site.
The
administration paid $634 million taxpayer dollars to Michelle Obama’s friend’s
company and got a disaster.

"Toni
Townes-Whitley, Princeton class of ’85, is senior vice president
at CGI Federal, which earned the no-bid contract to
build the $678 million Obamacare enrollment website at Healthcare.gov. CGI
Federal is the U.S. arm of a Canadian company.

"Townes-Whitley
and her Princeton classmate Michelle Obama are both members of the Association of Black Princeton Alumni."

The Obama administration also awarded CGI
another no-bid contract for 2 billion dollars to clean up from the Sandy
Hurricane.

 Mr.
Nelson
chair
of Housing Trust Fund Corporation
presented that the State
received a $1.7 billion allocation in CDBG Disaster Recovery aid from HUD to
aid impacted businesses and residences.



 The
corporation requires immediate access to consultant services to assist in policy and
procedure development, training, surge capacity, and call center assistance,
and stated that CGI Federal Inc. could provide such services.

The
resolution was passed and scheduled to “take effect immediately.”

Nearly a
year after the devastating storm, a majority of the 24,000 families that have
requested monetary assistance have yet to receive a penny from the federal aid
package.”

Does anyone think something funny going on at
taxpayers’ expense?

Shouldn’t President Obama have hired the best
minds in the country to build the web site to begin with?

Do you
remember this famous statement?


 
 

http://nyti.ms/18ThbbJ

Ezra Pound
is a big fan of President Obama and Obamacare. What happened? Did he change his
mind?

  

http://www.youtube.com/watch?v=AQxYY2dyChY&feature=player_detailpage

 Uwe Reinhardt is an economics professor
Princeton. He
gave
President Obama an F on his mid-term grade on Obamacare.

 “With proper management and more energetic work earlier
on, and untainted by the political desiderata
 reported to have affected the architecture of
HealthCare.gov, that Web site’s management team should have been able to
achieve the same success. It did not, hence the midterm grade F.”



 

A key discussion being avoided in the
mainstream media is whether President knew about the impending disaster. I suspect
he did.

It was one of the reasons he gave the group
healthcare insurance holders a one-year waiver. Parenthetically, he is not
seeking the advice or consent of the congress. This is probably
unconstitutional.

The group healthcare insurance market represents
the largest percentage of people insured. The individual insurance market represents
a relatively small percentage of the total insured population. The number of
people affected cannot make a big enough stink to be noticed by the traditional
media.

If the group insurance market were included in
the rollout, the community uproar would be too great for the Obama administration
to ignore or pivot from.

The public is already hearing the pivot from
President Obama and Kathleen Sibelius. They claim the past is the past. We must
ignore the past and go forward to fix the problem.

It sounds like the same story Hillary Clinton
told congress about Benghazi when she scolded a congressman during her Benghazi
testimony about Ambassador Stevens death. “He
is dead. Let us go on and deal with the problem.”

This method of operation is going to back fire
on President Obama for two reasons.

1. Americans are finally recognizing the Obama
administration’s methods of operation. It is to deflect with half-truths,
deceive and pivot. The public is getting angry.

2. There are an increasing number of people
who have lost their job, their healthcare insurance and the doctors. In the last
week 650,000 people lost healthcare insurance coverage they liked.

This is because of the exclusive regulatory
control the Democrats gave Kathleen Sibelius in passing Obamacare.

Not one single Republican voted for the
Affordable Care Act (Obamacare). 

The preparations for the implementation of
Obamacare for the group healthcare insurance market through health insurance
exchanges and www.healthcare.gov have unleashed gigantic outcries from both the
young and the middle-aged middle class.

The outrage is not over yet.

President Obama said he did not anticipate
that so many corporations would reduce insuring so many of their workers.

President Obama has discovered an obviously
scapegoat.

The “glitch” is not
Obamacare fault. It is the big bad corporations that are trying to make a
profit.

Wait a minute! Isn’t that the American way?
You build a business to try to make a profit within the rules.

The 40,000 new Kathleen Sibelius healthcare
regulations are preventing them from making a profit while providing healthcare
insurance. They want to provide affordable healthcare coverage.

The only way corporations can make a profit is
by dropping healthcare insurance of their employees.

Maybe driving people into the health insurance
exchange was President Obama’s goal in the first place. Remember Barney Frank
and John Kerry’s dismay about passing a bill without a public option. President
Obama response was don’t worry.

Well, we have an expensive public option that
doesn’t work. Who is going to pay for it?

 The
middle class is going to pay for it with increased healthcare insurance
payments and increased taxes. 

 The
cost of insurance on the health insurance exchange is high unless one qualifies
for a government subsidy. I have previously explained the dynamics involved in the
cost of healthcare insurance when a person receives a government subsidy.

Young healthy people will not buy insurance.
With the present computer programs the government will not know who qualifies
for a subsidy or be able to identify people will should be penalized.

A key to a business’ survival is to adjust to
adverse circumstance as long as the business has the freedom to adjust.

Watch out for the freedom to adjust to
anything.

Watch out seniors. Medicare is next.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Permalink:

Additional Defects In Obamacare

Stanley Feld M.D.,FACP,MACE

I have been saying Obamacare is going to fail long before
the bill was passed into law. Obamacare will fail because of multiple system
design defects.

I would hate to believe these defects were built into the
system purposefully.

It was done to prove that free market forces do not work.
The Obama administration created a “not so free market”. These not so free
markets have been proven to fail over and over again.

It seems logical that given the $1 trillion dollar a year
deficits of the Obama administration, someone, somewhere would be interested in
decreasing the deficit spending.

None of the increased government spending has improved the
economy, decreased unemployment or decreased uncertainty.

The computer system defects in the health insurance
exchanges are much deeper than the sound bite treatment they getting from the
Obama administration.

The task of integrating 40-50 year old legacy computer
systems is an extremely difficult task using 50-year-old software.

Information technology experts have told me that the
health insurance exchange computer sign up system (healthcare.org) is months to
years away from getting the health insurance exchange information system fixed.

It should be destroyed after spending $634 million dollars
and redone using modern technology.               

The verification of people who qualify for government
subsidies is being dropped. The patient’s word about need is being accepted in
lieu of verification.

This is a tremendous glitch in the system, opening the
system to tremendous fraud and abuse. It is not a way to run a business.

John McAfee former CEO and founder of McAfee antivirus
said the health insurance exchange web site is a hacker's wet dream. The You
Tube explains why he came to this conclusion.

 

 

http://youtu.be/5TCtLtzSe6I

Poor patients who might qualify for the Obamacare tax
credits do not pay income tax. Therefore they have no income to apply a tax
credit against.

The administration has dropped word tax credit. It is now called
a subsidy. The law’s tax credit will be given to the healthcare insurance
company selling the insurance.

This is a “glitch.” The law was written to pay the states
for those who qualify for a tax credit. A Washington D.C. ruled that the case
by states against Obamacare has merit.

The states contend that persons’ insured through the
federal government exchanges do not qualify for federal tax credits.
Only
states can receive and distribute the tax credits.

The law was reinterpreted by the Obama administration
without the consent of congress.

Another “glitch” is that the healthcare insurance industry
is given limitless power to collect money from the Treasury. The mechanics are not
transparent.

 “The
Affordable Care Act may give health insurance companies a virtually limitless
power to tap the U.S. Treasury, thereby lifting insurers' profits to
undreamt-of heights. This power derives from the mathematical formula for
calculating individual subsidies.”

The mathematical formula for calculating the subsidies
will cause America’s deficit to skyrocket further each year.

President Obama told America that Obamacare would bend the
cost curve downward and provide an efficient cost effective healthcare system
for all.

Let us look at the payment formula. A family of four
earning $30,000 year will not pay more than 2% a year for healthcare insurance
($600/year). This makes the Accountable Care Act (Obamacare) affordable for the
poor (maybe).  

If the premium of the healthcare insurance policy obtained
by this poor family costs $10,000 a year through the health insurance exchange the
federal government will pay the remaining $9,400 in the form of a tax credit to
the insurance company.

Originally, it sounded like the family would get a tax
credit after the family paid $10,000. A family making up to $40,000 a year does
not pay any taxes and therefore a tax credit is worthless.

The wording was changed from a tax credit to a
subsidy.  The tax credit now goes to the
healthcare insurance company providing the insurance policy.

The tricky thing about all this is the insurance
industry’s tax credits  reduce the
governments tax receipts and increases the insurance companies net profit.

The net effect is an increase in tax-free income from the
federal treasury.

The government collects less income tax from the insurance
company.

 The Obama
administration has given the healthcare insurance industry a huge tax break.
The tax break will increase the industry’s bottom line profits.

Obamacare has permitted the insurance company to have a
Medical/Loss ratio of 80/20. The Medical/Loss ratio means that the healthcare
industry must spend at least 80% of the insurance premiums collected on direct
medical care.

If it only spends 75% on direct medical care, the healthcare
company must give provide a 5% rebate.  

Here in lies the rub. The Obama administration has let the
healthcare insurance industry define direct medical care.

These are some of the services the Obama administration
has permitted the healthcare insurance industry to categorize as direct medical
care.

 

  1. The cost of verifying the credentials
    of doctors in its networks.
  2. The cost of ferreting out fraud such as
    catching physicians over testing patients or doing unnecessary operations.
  3.  The cost of programs such as help desks
    that keep people who have
    diabetes
    out of emergency rooms.
  4.  Some insurers have insisted that
    typical business expenses are included — such as sales commissions for
    insurance agents and taxes paid on healthcare insurance companies investments

Each one of these "direct medical care expenses"
has an added on profit included in the direct medical care expense category.

This is the way the healthcare insurance industry takes
40-60% of each premium off the top and leaves only 40-60% of healthcare dollars
for direct medical care.

Next year the healthcare insurance company will be
permitted to raise the healthcare insurance premium of a poor family to
$12,000. Its excuse will be that it is losing money.

If the premium is not raised the healthcare insurer will
quit providing the insurance. The government is totally dependent on the
insurer whether the insurer provides insurance as it does in the health
insurance exchanges or for administrative services as it does for Medicare (a single
party payer).  

The poor family still makes $30,000 dollars a year and
still pays $600 dollar a year for the now $12,000 dollar premium.

The insurance company now keeps $2,400 vs. $2,000 for
overhead and profit plus all the profit they can get from the direct care
dollars that should really be overhead.

The federal government gives the healthcare insurer a tax
credit of $11,400 vs. $9,400.

 The poor insurance
enrollee doesn't pay a penny more for his healthcare insurance.

The only loser is the American taxpayer who will pay the
subsidy in the form of increased taxes.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Permalink:

Obamacare Drives Premiums Up In 45 Of 50 States

Stanley Feld M.D.,FACP, MACE

President Obama promised
during his campaign for passage of the Affordable Care Act that the Act would
cause premiums "for the typical family" to fall by $2500.

He also said it would bend
the healthcare cost curve and if you like your doctor you can keep him or her.
We all remember these sound bites. The sound bites are all turning out to be
false.

Many intelligent people who
believe in Obamacare refuse to consider these facts. I can understand the
denial.

They will pay attention as
soon as it effects them.   

The added required benefits mandated
in insurance coverage in the law and the way the healthcare insurance industry
is permitted to calculate its Medical Loss Ratio makes President Obama’s
calculation impossible.

President Obama has been telling
the American public a lie all the while. People are starting to understand.  

The average one month premium
change from buying insurance in the non-group market in 2013 versus the
Obamacare exchanges in 2014 is not revealed in any government statistics. Two
studies were completed by private sources.

 Premium comparisons between
2013 and 2014 are not available from Health and Human Services (HHS).

The 2013 premiums increased
by double digits from the 2012 premiums because of Obamacare. The traditional
media has not pressed the government to provide these comparisons.

The media continues to quote
the administration press releases of lower premium prices.  The Obama administration uses CBO estimates
of premium prices calculated in 2010 for 2016 by data provided by the Obama
administration. The tradition media refuses to report reality.

A 50-state study has found
that insurance premiums will increase the first year of Obamacare in 45 of 50
states.

Insurance cost under obamacare

Premiums paid outside the
health insurance exchange will increase the same percentage or more.

No one can
say the American public has not been warned.  

There is
going to be tremendous public outcry in the individual market for insurance
when the cost to individuals and the American taxpayers is realized.

October
1,2013 is open enrollment season for the individual and group insurance market.

President
Obama has exempted the group market from Obamacare until 2015.

One of the
reasons for the exemption for the group market is to try to mute the outcry by
splitting the non group insurance from the group insurance holders.

Some of the
premium increases have already been report in the traditional media.

 "Individuals in most states will end up
spending more on the exchanges," policy analyst Drew Gonshorowski writes”

The Department of Health and Human Services published a similar
report. The government’s report is incomprehensible to me.

It does not compare pre Obamacare premiums of 2013 to
Obamacare Health Insurance Exchange premiums of 2014.

There
are literally no comparisons to current rates. That is, [the Department of Health
and Human Services] has chosen to dodge the question of whose rates are going
up, and how much. Instead they try to distract with a comparison to a
hypothetical number that has nothing to do with the actual experience of real
people.

—Douglas
Holtz-Eakin
President, American Action Forum[1]

 

The Department of Health and Human Services has
declared a 16% decrease in premium costs compared to the CBO’s 2010 estimate of
premiums for 2016.

It is important to remember the CBO’s
calculation was with faulty data provided by the administration.

Based on a Manhattan Institute analysis of the HHS numbers,
Obamacare will increase underlying insurance rates for younger men by an
average of 97 to 99 percent, and for younger women by an average of 55 to 62
percent.
Worst off is North Carolina, which will see individual-market rates
triple for women, and quadruple for
men.”

  

http://youtu.be/JwPr59nA1fM

The Obama
administration’s methods of deception are cunning, powerful and effective.

He always blames others and hides his ideology.

President
Obama continues to try to fool a majority of the people most of the time.

Americans will
get the point where the rubber meets the road. The public is going to
have to reach into their pockets and pay these enormous increases in premiums
or not buy healthcare insurance coverage.

Taxpaying
Americans are also going to experience massive increases in taxes above and beyond those already experienced.

I predict the
public outcry will drown out the spin of the Obama administration. The
traditional media will not be able to ignore this public outcry.

People will
finally realize the enormous government grab of power and control of Obamacare at
taxpayers’ expense.

People
can’t complete applications or secure premium prices on the health insurance
exchanges because of technical problems resulting from ancient information technology
used by the government to construct the exchanges.

All of the
consumers’ demographics must be filled out before the government provides a
premium price. There is at tricky reason for this.

This
computer “glitch” solidifies my view that President Obama wants Obamacare to
fail in order to replace it with a single party payer system that America
cannot afford.

This last
statement is counterintuitive but I believe true.

Is it wise
for consumers to hand over all their medical decision making to a government
that has this much difficulty with executing a computer program and providing
healthcare insurance premiums?

Americans
must wake up soon. They have to insist on a consumer driven healthcare system
in which they have control over their healthcare and their healthcare dollars.

Americans have
to insist on having an Ideal Medical Saving Account healthcare system

I have described the Ideal Medical Saving Account System in great detail.

 

 
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Permalink:

Pure Genius Or Pure Stupidity?

Stanley Feld M.D.,FACP,MACE

President
Obama’s actions as leader of this country have been either pure genius or purely
stupid.

I think it
is pure genius. He promised Americans he was going to fundamentally change
America. He has!

Americans
have been under stress during the last few weeks. First it was the government
shutdown. Now it is the nation going into default. It is common knowledge the
shutdown and default is political theater.

President
Obama has run circles around Republican in the game of political theater.

The
traditional media has ignored the underlying causes of America’s problems.

We are increasing
debt to the point of unaffordability. The only way out is to increase taxes
further or decrease government spending while lowering taxes.

Increased
deficits are not good. Deficit increases devalues our currency. America’s currency
has already been devalued by the Federal Reserve increase in printing money.

Increasing
taxes leads to decreased jobs creation. Decreased employment leads to decreased
discretionary spending. The result is decreased economic growth.

Rather
than trying to decrease spending rationally by increasing government
efficiency, President Obama has closed down silly things to make it most painful
and noticeable to the public. These noticeable services have little overhead.
These closures are not an example of reducing inefficient spending.

In the
meanwhile his administration has spent over $600 million dollars for a health
insurance exchange software program. The program is poorly designed and does
not have an integrated back end.

Even if
the software was great, the cost of healthcare insurance through the exchanges
is increased and out of reach of the individual buyers.

 The cost of insurance is cheap for the poor who
qualify for government subsidies. The poor will receive a tax credit which will
be credited to the insurance company whose policy the poor person buys.

The math
is grotesque. If a healthcare policy costs $10,000 and a patient makes $30,000
dollars a year, he pays only 2% of his net income for the policy or $600 per
year. The taxpayer pays $9,400 a year for that policy.

This is
an example of hidden “redistribution of
wealth
” and another entitlement.

The
Obama administration has waived the verification requirement for receiving a health
insurance exchange subsidy. Verification of need does not have to be fulfilled
by the health insurance exchanges. Anyone can lie and receive a subsidy to
purchase healthcare insurance threw an exchange.

Another
big mistake was the design of the roll out to promote electronic medical
records. After 4 years only 11% of these records are functional. Physicians have
spent money for EMRs they could not afford. Hospital systems spent money they
could not afford. The government wasted $30 -60 million dollars of taxpayers
money in the unsuccessful effort to implement EMRs.

America
is a long way away from being computerized with a functional EMR.

Accountable
care organizations (ACO) are another important cog in Obamacare’s success or
failure. The administration brags about the fact that 250 ACOs are in
development.

There
are over 5,000 ACOs that need to be developed. A premier organization such as
the Cleveland Clinic had to drop out of the program because of the cost to the
institution. The Mayo Clinic refused to participate.

At the
same time ACO’s are turning out not to be cheaper or have better outcomes than
traditional medical care.

ACOs
were supposed to improve quality. ACOs were supposed to be a free market
solution to the dysfunctional healthcare system.

The
administration has been bragging about the greatness of the VA system. The
bragging stopped when the system’s poor quality of care was exposed. Veterans
are receiving poor treatment.

Everyone
would certainly have to admit Obamacare has been disruptive to the delivery of healthcare
in America.

The
months of healthcare insurance open enrollment for people is starting. People
are starting to see massive increases in their healthcare premiums. In order to
avoid these premium increases and the Obamacare penalties, large organization
such as Home Depot are hiring only part time workers.

The
Obama administration has developed a low cost insurance plan for the McDonalds
of the world. These health insurance policies cost little a cover less.

President
Obama has also provided waivers for congress and its employees. He is at
present trying to sneak in waivers from Obamacare to unions.

First, there was the delay of
Obamacare’s
 Medicare cuts until
after the election. Then there was the delay of the law’s employer mandate. Then there was the announcement,
buried in the
Federal Register, that the administration would delay
enforcement of a number of key eligibility requirements for the law’s health
insurance subsidies, relying on the “honor system” instead. Now comes word that another
costly provision of the health law—its caps on out-of-pocket insurance
costs—will be delayed for one more year.”

 The
Obama administration has issued a blizzard of mandates and regulations. These
regulations have increased the cost of health insurance.

The caps
on out-of-pocket insurance costs, such as co-pays and deductibles have not been
publicized. On January 1, 2014, deductibles were supposed to be limited to $2,000 per year for
individual plans, and $4,000 per year for family plans.

In
February 2014, the Department of Labor published a little-noticed rule delaying
the cap until 2015. The costs of these deductible limits were already built into
the 2014 healthcare insurance premiums and were not removed.

The
government did nothing to reduce the increased healthcare premiums after the
limits did not apply.

 “Federal officials said that many insurers and
employers needed more time to comply because they used separate companies
to
help administer major medical coverage and drug benefits, with separate limits
on out-of-pocket costs. In many cases, the companies have separate computer
systems that cannot communicate with one another.”

“We
had to balance the interests of consumers with the concerns of health plan
sponsors and carriers.”

How is it in the consumers’ interests to pay far
more for health insurance than they do already?

I have a theory.

President Obama’s ultimate goal is to have a complete
government takeover of the healthcare system. A takeover the government cannot
afford.

He figures by creating as much chaos as possible
now in the “not so free market healthcare system”, he can declare the free
market healthcare system has failed.   

There will be a resulting public outcry for the
government to help and take over the system.

The takeover will be with a single party payer
system.

What are the chances a government takeover will
result in an efficient, cost effective system that will provide access to care
without rationing of care while being affordable?

With all the delays, exemptions and regulations,
it looks as if Obamacare is destined to fail. Obamacare is going to be
impossible to execute effectively.

Obamacare’s ultimate failure is playing right
into President Obama’s     ideological goal
of a single party payer system.

President Obama is not stupid. He is a genius.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Permalink:

A Disaster, Not A Glitch

 

Stanley
Feld M.D.,FACP,MACE

 

There is an important
lesson in the recent Healthcare Insurance Exchange computer program “glitches”.

Once more the Obama
administration only presents a fragment of the truth. Unfortunately, the
traditional media accepts President Obama’s explanation and that is the news.

 

http://youtu.be/OCZLy_-IJ_s

The online
health insurance exchange program should be very easy to execute. All of the
major healthcare insurance companies have an online presence. People can go
online, put in simple demographics, and in a matter of seconds they can have at
least 100 healthcare insurance products to choose from. 

The Obama administration told the media that the software
developed for the web site, by CGI a Canadian company with offices in
Washington D.C., had an estimated cost of $93 million.

USAspending.gov said it cost the government $634 million dollars. The site calculated the cost from grants paid to CGI. This is seven times the
estimate published by the administration.

“Not only was the site still experiencing
substantial problems a week after launching, but the White House had reportedly
been aware for months that the HealthCare.gov website had flaws and might not be
ready to launch. Yet officials insisted on the Oct. 1 roll out anyway.”

The problems experienced by people trying to use the user
interface was something that was tested least or not done right — or both.'

– James
Turner, a member of the technical staff at software firm Beeonics, Inc
.

The healthcare industry,
participating in the new exchange, complained “loudly” that the site had
experienced problems before the launch.  

Speaker of the
House John Boehner asked, "How can we tax people for not
buying a product from a website that doesn't work?"

The front end user experience is only a fraction
of the problem with the federal health insurance exchange site.
A front end user’s
experience typically means there is something wrong with the basic construction
of the software.

The
monumental issue of the site involves interfacing seamlessly the multiple
government agencies (IRS, HSS, CMS, Welfare, Food Stamps and others) and
private insurers legacy’ computer networks. Each agency and organization has a
myriad of computer networks that must interface with the health insurance
exchange web site.

It is
reality easy to have a pretty front end interface with the user. If the
software program is poor the interface is a disaster.

These
computer networks must be integrated into what appears to be a fancy front end.
It looks as if this software is incapable of this very complex integration.

It is
one of the reasons that verifying patient for subsides has been dropped and the
government is going to take the patient’s word.

These
problems were published in blogs for months. The software  failed initial testing.

The
Obama administration did not delay the launch despite these warnings.

Now President Obama has
told us that this is a small “glitch.” He compare it a glitch Apple had with
its launch and it did not put them out of business.

"Take
away the volume and it works," President Barack Obama's chief technology
adviser, Todd Park, 
told
USA Today. 

Either
President Obama does not know what is going on or he is not telling the truth to
the American people.

The
administration has blamed the glitch on the high volume of people trying to
access the site. This is partially true.  

The prediction by experts is it will likely take
months to get it running properly. The rollout was disastrous.  There were 8.6 million unique visitors in the
first 3 days hoping to apply and enroll in a healthcare
insurance plan.  Instead they experienced
an online nightmare, with websites crashing, refusing to load, and failing to
offer comprehensive choices.

 The demographics of the 8.6 million are
unknown. They may all have been high risk uninsured people.

The Daily Mail is reporting that
sources within HHS are saying only 51,000 people signed up for insurance via
the government run website Healthcare.gov in the first 12 days,
 

Two HHS career civil servants told
the Daily Mail that only 6200 people signed up on the first day. “

White House and administration officials continue to insist they
have no idea how many people have signed up but will release the numbers
monthly after November 1.

Is the administration trying
to hide something?

“If the state-run
exchanges were to have a similar response rate for six months, the national
enrollment total would be approximately 2 million in six months."

That number is less than
29 per cent of the 7 million the Obama administration would need, according to
the nonpartisan Congressional Budget Office, in order to balance the new health
insurance system's books and keep it from financial collapse.”

The White
House’s published goal is to enroll at least 2.7 million young, healthy people
between the ages of 18 and 35 in 6 months.

The monthly
premiums of healthy, low risk people are needed to offset the cost
of health care for older, sicker Americans who will certainly try
enroll.

The CGI website states;

“Exchanges
must provide many different functions, the soundest approaches bring together
expertise and best practices in federal and state health programs, commercial
insurance, data exchange, portals, e-commerce over the cloud, and financial
management.”

“ CGI
brings all of this expertise to the table, along with direct experience in
developing sustainable HIX programs. We also have a dedicated group of subject
matter experts tracking best practices for state HIX and
integrated
eligibility systems
across the United States.”

CGI knows
what to say. It has not shown that they know what to do.

The Obama
administration may have wasted $634 million taxpayer dollars on software that
does not work.

This is
more than a glitch. This is a disaster.

Just wait
and see the prices for a Bronze level healthcare insurance plan once people can
negotiate the site.

No one is
going to be able to afford the insurance in the Affordable Care Act
(Obamacare).

Another
disaster will be coming your way complements of Obamacare.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Permalink:

Don’t Confuse Me With Facts

Stanley
Feld M.D.,FACP,MACE

Sometimes,
in order to believe a certain ideology, some smart people take the position of
not wanting to be to be confused by facts.  

Countries
with socialized medicine have said their citizens are happy with their care.
Therefore, this is the evidence that the U.S. should have a socialized medicine
system.

Less
than 20% of a nation’s population experiences the healthcare system at a moment
in time
. The 80% who are not sick are happy because they feel secure. If they
got sick they believe they would receive free medical care. The result is the
majority of the population under a socialized medical system likes the system.

This
Is A FACT (TIAF)

Dr.
Donald Berwick former acting head of CMS and author of Obamacare wrote, in a
personal letter to “Senior Government Officials and Senior Executives of the National
Health Service in England after doing a review of the NHS.”

“You are stewards of a
globally important treasure:
the NHS. In its form and mission, guided by the
unwavering charter of universal care, accessible to all, and free at the point
of service, the NHS is a unique example for all to learn from and emulate.”

Dr.
Donald Berwick added, “redistribution of
wealth is the very essence of a compassionate healthcare system for all.”

I
disagreed with Dr. Berwick in an earlier blog. I said citizens responsible for
their own health, healthcare and healthcare dollars are essential ingredients
for a cost efficient healthcare system.

Patients
are the primary stakeholders. Patients must be actively responsible for their
health. They must have a moral and intellectual responsibility for their own
health as well as a financial incentive to be responsible for themselves.

They
must have own their healthcare dollars, have the freedom to make their own
healthcare choices and have access to care.

The
government must create educational vehicles to help patients make the correct
choices.

 The government must provide financial
incentives for people to make those choices.

Medical
care and medical decisions made for patients by a bureaucracy has historically
failed to control costs or provide efficient and compassionate medical care.

Socialized
medicine run by bureaucrats has failed in England. Medical care consumes more
than 50% of England’s GDP.

This
Is A Fact (TIAF)

Medicare
is wonderful for people over 65 years old. Seniors could not buy healthcare
insurance from a healthcare insurance company. The healthcare industry had not
figured out how to make money from these people so they disqualified them.

If
the government got rid of the $250 billion dollars in administrative waste and
inefficiencies each year, Medicare and Medicaid would become sustainable.

This
Is A Fact (TIAF)

Medicare
and Medicaid provide no incentives for patients to take care of their health.

Chronic
diseases are ineffectively managed. The complications of chronic diseases
consume 80% o
f Medicare’s healthcare dollars. If chronic diseases were managed
properly the complication rate from chronic diseases could be decreased by at
least 50%.

This
Is A Fact (TIAF)

Many
patients do not have the incentive to take care of themselves
. They leave it up
to the system to take care of them.

Unfortunately,
it has be demonstrated that a government controlled system creates ever
increasing bureaucracies and cost inflation.

This
Is Fact. (TIAF)

Most
all of the nation’s attempts to control healthcare costs in the past 50 years
have failed. (Price control of the 70’s, HMO’s, Managed Care, PPOs.)

These
systems had to be abandoned. Nevertheless, healthcare policy wonks continue to
give the same advice and make the same mistakes. The policy wonks’ advice is to
institute greater government controls over medical care.  

This
Is A Fact (TIAF)

 A recent report about England’s hospital
conditions in Mid Staffordshire has emphasized the defects in England’s 60 year
socialized medicine experiment.

The
report only covers hospital inpatient defects. It does not cover the many
defects in outpatient services. 

 The report is “Report of the Mid Staffordshire NHS Foundation Trust
Public Inquiry

5
February 2013 to the Secretary of State.”

The
report stated that;

1. For
many patients the most basic elements of care were neglected.

2. Calls
for help to use the bathroom were ignored and patients were left lying in
soiled sheeting and sitting on commodes for hours.

3.
Patients felt afraid and disenfranchised.

4. Patients
were left unwashed, at times for up to a month.

5.
Food and drinks were left out of the reach of patients and many were forced to
rely on family members for help with feeding.

6. Staff
failed to make basic observations and pain relief was provided late or in some
cases not at all.

7. Patients
were too often discharged before it was appropriate, only to have to be
re-admitted shortly afterwards.

8.
The standards of hygiene were at times awful, with families forced to remove
used bandages and dressings from public areas and clean toilets themselves for
fear of spreading infections.

9. These
healthcare conditions caused the deaths of an unknown number of patients.  

Robert Francis QC Inquiry Chairman who wrote
the report covered a wide range of system failures. I will only highlight the
key failures contained in the 500-page report. This report was mandated by the House of Commons.

These defect are occurring throughout the
entire NHS system. The NHS is not as glorious as the Obama administration or
Dr. Berwick’s has idealization the NHS to be.

"The
story the report tells is first and foremost of appalling suffering of many
patients. This was primarily caused by a serious failure on the part of a
provider Trust Board. (Bureaucracy)"

 "The trust board did not listen
sufficiently to its patients and staff or ensure the correction of deficiencies
brought to the Trust’s attention."

The NHS bureaucracy did not put patients
first. It put the various levels of bureaucracy in charge. Bureaucracies deaden
incentives and lose focus on who is the main stakeholder in the healthcare system.

"The
trust failed to tackle an insidious negative culture involving a tolerance of
poor standards and a disengagement from managerial and leadership
responsibilities".

"This
failure was in part the consequence of
allowing a focus on reaching national access targets; achieving financial
balance and seeking foundation trust status to be at the cost of delivering
acceptable standards of care."

Appropriate
statistical reports and collection of reports are more important that
appropriate patient care.

Robert
Francis goes on to outline how the bureaucracy puts measurements first, not
patients.

None
of the bureaucrats want to take responsibility for what is going wrong. Finger
pointing and blame shifting is an occupation in the British healthcare system.

"The
NHS system includes many checks and balances. These checks and balances should
have prevented serious systemic failure of this sort."

"There
were and are a plethora of agencies, scrutiny groups, commissioners, regulators
and professional bodies, all of whom might have been expected by patients and
the public to detect and do something effective to remedy non-compliance with
acceptable standards of care.

For
years that did not occur."

Watch out America!

We are falling into the same trap with Obamacare.
It might sound good to some. It will not work judging by the experience of
others.

Unfortunately,
the Obamacare’s model is the British healthcare system. I do not think the
traditional media should praise it. The traditional media should publish the
facts of history.

The
traditional media should call for the repeal of Obamacare.

 

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Permalink:

Speaking Of Chaos And Uncertainty

Stanley Feld M.D., FACP, MACE

I ended my last blog with,

“President Obama’s goal is to create more chaos
and dysfunction in the healthcare system. “


“Only then can the government really step in and
say let me help you.”


It is the only
reason President Obama told the then Senator Kerry and Congressman Frank not to
worry if the final bill does not have a public option.

Kerry and Frank said
Obamacare would not work without a public option. The only thing that would
work is a single party payer system.

  

 

 

With limited benefit
plan, employers would avoid the broader $2,000 per-worker penalty.

It is not
clear is whether employers could face a $3,000 penalty per individual for any
employee who opts out of the limited benefit plan.

Four
problems are being discovered with the health insurance exchanges.

1.
If the employee is a low wage employee that refused employer provided insurance
he is not eligible for a government subsidy.

2.
If the federal government runs the health insurance exchange, the federal
government by law is not permitted to provide a subsidy. Only state run
healthcare insurance plans can provide subsidies.

Over
50% of the states have refused to run health insurance plans. Therefore people
who need subsidies are not eligible in over 50% of the states.

3.
The law calls for tax credits and not subsidies. All of a sudden the words “tax
credits” have been dropped in discussion. Only taxpayers who earn over $38,000
per year pay taxes. The only way a person can utilize a tax credit is by
deducting the tax credit from taxable income.

The
government has gotten around this problem by giving the healthcare insurance companies a tax credit in advance and calling it a subsidy for qualified
persons.

Those
workers who opt out of the employer provider plan for a health insurance
exchange plan would not be eligible for a government subsidy. 

A full-time worker earning $9 an hour would
have to pay as much as $70 a month for a mid level exchange plan from a health
insurance exchange, even with the subsidies, according to the Kaiser Foundation.

At $12 an
hour, the workers' share of the premium would rise to as much as $140 a month.

 A $12 an hour worker cannot afford to pay $1680
a year for healthcare insurance.

Mid
level coverage is limited coverage. A patient might need a higher-level plan that costs $200
a month or $2400 per year. This plan is out of reach for most patients making $40,000/year.

 "There are going to be many people who will
be ill and need a more robust plan,” a
health benefit
advisor proclaimed.

Currently, only one-quarter of workers eligible
for the mini-med plan take it. Ms. Newman said,
"We
really feel like the people who are not taking it now will not take it
then."

There
is a huge glitch in the health insurance exchanges’ individual healthcare
market. This glitch will make the health insurance exchanges more costly and
less attractive to all stakeholders. It will decrease the number of people
insured and increase the federal deficit.

The
majority of the individual market is comprised of low wage earners with
irregular work histories.

These people may be
self-employed or seasonal workers with surges of income. They could be
part-time workers with several part time jobs. 

Obamacare does not permit cancellation of the health insurance exchange
policy because it will mean that people will be in violation of the federal mandate
if they do not have insurance. 

The Obamacare bureaucrats realize that people receiving subsidies might
have a hard time paying the premiums even if they receive a subsidy.

These people live from month to month. Some have surges in income. Some
collect commissions one month and nothing the next month. Most have old cars.
They might suddenly need new brakes or new tires. Some might get the flu and have
to stay home without pay for a week. There are many reasons low wage earners
suddenly have a hard time paying healthcare premiums even if they are subsidized.

Many do not have bank accounts or credit cards. There is no such thing
as auto pay in their world.

The Obamacare bureaucrats writing the health insurance exchange
regulations are people with nice bureaucratic jobs with steady paychecks. They
have no idea how difficult it is to make ends meet for these people each month.

The healthcare insurance industry
does not care about these problems. It may provide for a grace period of a week or two. If a healthcare
policyholder fails to pay their healthcare policy premium the policy is
cancelled in the real world.

In the bureaucratic world of Obamacare the healthcare insurer cannot
cancel the insurance in the usual way.

HHS has created through multiple regulations a whole new and very
restrictive method of discontinuing healthcare policies that must be followed
to a “T” by the healthcare insurance industry.

This method will lead to even more dysfunction in the healthcare system.

HSS has instituted a 90-day grace period for paying premiums only for those
receiving federal subsidies from the health insurance exchanges
.  

At the end of the 90-day grace period the policyholders must pay the
entire three months due. If they could not pay the premium monthly how are
they going to pay the three month fee?

Aetna was not so dumb in dropping out of the health insurance exchange
system after all.

During the three-month grace period if a policyholder get sick and
needs care they will be entitled to care.

Who will bear the financial responsibility for the care? Not the
patient.

HHS has decided to split the financial responsibility between the
insurance companies and the providers. The insurance company will cover the
first month and the hospitals and physicians will cover the next two months.

After three months the insurance company can cancel the insurance.  However people can re-enroll again during the
next signup period without penalty.

If one is clever enough a patient can receive 12 months of care and
coverage for nine months of premiums without penalty.  

“Along with paying for services during the first month of
the delinquency, the insurer must:

1) notify HHS of the non-payment;

2) notify
providers of the possibility of denied claims during the second and third
months;

3) notify the insured that he/she is delinquent;

4) continue to collect
the advanced tax credit on behalf of the policyholder;

5) return the tax credit
for the second and third month to the Treasury;

6) issue a termination notice
to the insured at the end of the grace period.”

This procedure is a
very large administrative burden and potential financial loss because of the
federal government's decreases in funding. Most providers and insurance companies will quit
participating in the health insurance exchange program.

Rather than increasing affordability and access to care it will decrease
access to care and affordability of care. It will create a more dysfunctional
healthcare system.

 The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Permalink:

Is There A Solution?

Stanley Feld M.D.,FACP
MACE

 

A study of the organization chart presented in my last blog shows
that Obamacare will be an unworkable mess. 


The health insurance exchanges look like they
are going to make healthcare more expensive because of 20,000 new
regulations.  Employers are looking for
ways to avoid Obamacare and get out of the healthcare coverage business.

Employers
are realizing they can avoid certain penalties under Obamacare by offering very
limited plans that lack key benefits which satisfy the true definition of
healthcare insurance. 

Benefits
advisers and insurance brokers are increasing their commissions by offering low
benefit plans that cover minimum benefits such as preventive services. The
healthcare plans provide just enough minimum benefit requirements to avoid Obamacare’s
penalty. If an employee wants real coverage he is on his own.

Obamacare’s
promise was that healthcare insurance coverage would broadly enrich at lower
affordable costs.   

Federal
officials say these limited benefits plans, in concept, would appear to qualify
as acceptable minimum coverage under the law, and let most employers avoid an
across-the-workforce $2,000-per-worker penalty for firms that offer nothing.

 It is unclear how many employers will adopt the strategy this year.
There are dozens of brokers and benefit administrators discussing this strategy
with their clients. I bet many will adopt this strategy.

"There
had to be a way out"
of the penalty for employers with low-wage workers,
said Todd Dorton, a consultant and broker for Gallagher Benefit Services Inc.,
a unit of 
Arthur J. Gallagher AJG -0.44% &
Co., who has enrolled several employers in the limited plans.”

Obamacare
requires employers with 50 or more workers to offer coverage to their workers
or pay a 2,000 per worker penalty.

The
employers and benefits experts initially thought the rules required robust
insurance with a long list of  "essential" benefits.

Federal
officials confirm the mandates affect only plans sponsored by insurers” that are sold to small businesses and
individuals.

Healthcare
insurance “sponsored by insurers”
that are sold to small businesses and individuals affect only about 30 million
of the more than 160 million people with private insurance.

Employers
provide these “insurer sponsored plans”
to 19 million out of the 30 million people. These plans are going to disappear.

 Some benefits advisers feel they face
regulatory uncertainty. New regulation can cancel older regulations. These
advisors say they would adjust to new regulations as regulators clarify the
law.

According
to Obamacare, regulations written by the multiple new agencies, larger
employers with more than 50 workers only have to provide preventive services,
without a lifetime or annual dollar-value limit, in order to avoid the
across-the-workforce penalty.

Such policies would generally cost far
less to provide to employees than paying the penalty or providing more
comprehensive benefits.  

Most low-benefit plans would cost
employers between $40 and $100 monthly per employee, according to benefit
firms' estimates.

These
plans essentially provide no insurance for healthcare problems if someone needs
insurance. The financial burden falls directly on the consumer.

Obama
administration officials confirmed in interviews that the low benefit plans
would be sufficient to avoid the across-the-workforce penalty.

Several
Obama administration officials expressed surprise that employers would consider
the low benefit approach.

"We
wouldn't have anticipated that there'd be demand for these types of band-aid
plans in 2014," said Robert Kocher, a former White House health adviser
who helped shepherd the law. "Our expectation was that employers would
offer high quality insurance."

 Another trick benefit managers are offering
small employers in order for them to avoid higher costs of premiums due to
compliance with some of the provisions in Obamacare is early yearly renewal of
preexisting healthcare coverage. UnitedHealth, Aetna and Humana are offering
small companies this option. The savings is significant.

Self-insured
companies face fewer changes under Obamacare. Many small companies are now switching
to self-insurance. Large corporations have been self-insured for years.

I
have previously discussed the large trend to hire only part time employees to
avoid the penalty as well as the requirement to provide insurance.

Many
employers are trying to get out of providing healthcare insurance to employees.
Employers fear they will be penalized by the Obama administration at a later
time. The administration is constantly changing regulations. This has lead to
tremendous uncertainty.

Some
Obama administration regulators worry that some of these strategies will be
widely adopted. If this happens it could decrease the effectiveness of
Obamacare’s online health-insurance exchanges.

Only
older and sicker workers, who need real healthcare insurance coverage will opt
out of low benefit employer coverage and join the health insurance exchanges.

The
premium cost for good coverage in Obamacare’s health insurance exchanges is
high already. The adverse selection will drive these costs even higher.

The
whole idea behind Obamacare’s health insurance exchanges is to force healthy
people to pay for the resources used by sick people. (“Redistribution of
wealth”)

The
Obama administration refuses to believe options to avoid Obamacare will be a
widespread trend.

How
come? Didn’t congress exempt itself from Obamacare?

"Any
activities that take place on the margins by a small number of employers would
not have a significant impact on the small group or the individual
market," said Mike Hash, director of the department's Office of Health
Reform.”

These
new plans are a substitute for the Obamacare exempt Minimed plans. Companies
that provided Minimed plans received over 13,000 waivers for Obamacare until
January 2014. Companies such as McDonald and Burger King provided Minimed Plans
to employees.  

All
of these twists and turns make Obamacare look like it is unworkable. It is!

President
Obama’s goal is to create more chaos and dysfunction in the healthcare system.

Only
then can the government really step in and say let me help you.

Then
the government can provide a single party payer system and complete the journey
to socialized medicine.

Based
on past experience in many other countries, the result will be skyrocketing costs
and increased deficits. 

Americans
have a lot to look forward to. The only was out is to repeal Obamacare and
replace it with a consumer driven healthcare system.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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