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.
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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The Obamacare Spin Goes On | Stanley Feld M.D., FACP, MACE