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Did Obamacare Cause The Increase In Private Healthcare Insurance Premiums?

Stanley Feld M.D.,FACP, MACE

A reader of my blog received this question from one of his friends.

The reader asked me his friend’s question  “I have a question and I don’t want it to be political (as I stay away from that for many reasons).                                                                                                                                 
Health insurance is so expensive and it does not cover hardly anything. We had to get the worst plan with the worst coverage. But it was not this way 6 years ago. We could afford good coverage.   

 The question is: Did Obamacare cause this change in healthcare insurance and these problems in access to care?

A reader asked:

Which of your blogs would be the best one to show him to answer his question?

The answer to the question is YES!! I will try to explain.

If I sent all the links to your friend would be overwhelmed. There are too many to count.  I will summarize some of the major reasons Obamacare is to blame for some of the increases in private healthcare insurance premiums and the decrease in the access to care. Obamacare has led us into a financial disaster. “Medicare for All” is not the answer.

I believe the goal of Obamacare was to create greater dysfunction in the healthcare system which would lead to huge premium increases for private healthcare coverage. The public would then beg the government to adopt a single party payer system with “Medicare for all.” This has been the progressives”  goal since 1935. Do you remember Barney Frank and John Kerry saying we cannot have a single party payer system yet because we do not have the votes?

https://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2018/10/the-main-reason-behind-rising-medical-costs.html

The government has not had a very successful single party payer systems record.  The VA Health Administration, the Indian Health Service, Medicare and Medicaid are all inefficient and financially unsustainable.

“Our federal government already runs three single-payer systems—Medicare, the Veterans Health Administration, and the Indian Health Service—each of which is in a shambles, noted for fraud, waste, and corruption.”

“Why would we want to turn over all of the American medicine to those who have proved themselves incompetent to run large parts of it?”

https://imprimis.hillsdale.edu/short-history-american-medical-insurance/

The federal government depends on healthcare insurance companies to do the administrative services for Medicare, Medicaid and Obamacare. Administrative services include negotiating payments to hospitals, nursing homes, physicians and providers on all levels.

The various healthcare insurance companies are supposed to bid for these service contracts. The insurance companies receive one global fee.  The healthcare insurance company with the contract must pay providers on a fee for service basis. The healthcare insurance companies do not have good enough data to make an accurate bid estimate.  Actuary science is not rocket science. The healthcare insurance company builds in a twenty percent cushion to the bid. If the bid was low and the healthcare insurance company that lost money Obamacare guaranteed through a complicated reinsurance formula reimbursement to the company for its loss.

Recently the government audit discovered an overpayment of $10 billion dollars to the healthcare insurance industry for Medicare Part D.

I believe there is much more overpayment in Medicare Part A, B and D because of the government bureaucracy. The government only had the money to pay 12% of the reinsurance claims of the healthcare insurance company one year. The insurance industry simply raised the premium in the private sector.

http://stanfeld.com/president-obama-somehow-finds-the-money/

http://stanfeld.com/accelerating-the-destruction-of-the-healthcare-system/

http://stanfeld.com/the-deception-and-disinformation-continues/

Nationwide, the Obama administration made $7.3 billion in reinsurance payments to health insurers. The reinsurance program, funded by taxes on health insurers and self-funded employer health plans, has been criticized by Republicans as a “bailout” for insurers.

https://www.ibj.com/blogs/12-the-dose-jk-wall/post/53906-obamacare-shovels-another-122m-to-indiana-insurers

The healthcare insurance industry then once again raised premiums on the private healthcare sector to make up for its losses. to

The government reinsurance payments weren’t enough in all cases. New York-based Assurant Inc. asked for a 26 percent hike in private premiums for 2016, due to high claims in Indiana, before that company decided to exit the Obamacare markets in all states.

This was typical price shifting.

http://stanfeld.com/?s=price+shifting

Healthcare insurance companies projected that Obamacare would result in them losing money because of adverse selection. Obamacare’s increase required benefits for both public and private insurance. Obamacare’s rules included coverage for oral contraceptives for all and coverage of pre-existing illnesses among others. A sixty-year-old male does not need an insurance policy the receives oral contraceptives.

The healthcare insurance industry asked for double-digit increases in private healthcare insurance in every state. The logic was that these enrollees would pay for the loses that would occur from the Obamacare enrollees.

http://stanfeld.com/managing-points-of-view-and-healthcare/

The government’s argument is all should pay for everyone ’s healthcare needs. These healthcare needs have increased as the population has gotten more obese and has had a rise in drug addiction. These increased healthcare risks resulted in increased actuary estimates of healthcare cost. It does not put a burden on consumers who do not act responsibly.

The increased healthcare premiums caused many employers to drop healthcare coverage for their employees. The decrease in healthcare insurance coverage added to the pressure of healthcare premium increases.

The healthcare insurance industry also plays games with the Medical Loss ratio. The result is an increase in healthcare premiums and deductibles while decreasing services. The Obamacare issued regulations that the insurance industry must dedicate 80% of the healthcare premium to direct medical care and 20 % can be used for administrative expenses for both the public government insurance and private insurance. It is the state insurance regulators responsibility to enforce the regulation.

The expenses the industry wanted to be included are;

Expenses to be included in direct medical care are:

  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 that keep people who have diabetes out of emergency rooms.
  4. The sales commissions paid to insurance agents.
  5. Taxes paid on investments.
  6. Taxes paid on premium income.

All these expenses are administrative expenses in my view and not medical expenses. If these expenses are permitted as benefit expenses, premium money available for direct medical care would decrease. The eighty percent required for direct medical care would be markedly reduced. The result would be an increase in healthcare insurance premiums.

http://stanfeld.com/medical-loss-ratio-how-did-the-healthcare-insurance-industry-do/

http://stanfeld.com/what-is-the-medical-loss-ratio/

The calculation for direct medical care helps the healthcare insurance company prove it lost money. The insurance company then applies to state regulators for a premium increase. The state regulators permit the premium increases.  If the premium increase is refused by the regulators the insurance company threatens to leave the state. The other option the healthcare insurance company uses is to decrease the insurance services and/or increase the insurance deductibles.

Another problem has developed in the healthcare insurance industry that is causing it to raise premiums and reduce services and access to care as a result of Obamacare.

Hospital systems are buying out physicians’ practices. Obamacare has put many restrictions on physician practices. It has increased practices overhead. Obamacare has decreased the ability for physicians to use their medical or surgical judgment that they have become happy to sell their practices to hospital systems. The hospital systems now have to deal with the problems of medical practice. The cost of electronic medical records, which have not added to the quality of medical care, increased many physicians’ willingness to sell their practices to hospital systems. At the moment the percentages of hospital-owned practices are up to 65% from only 17% ten years ago.

http://stanfeld.com/physicians-barriers-to-practice-their-profession/

https://www.wsj.com/articles/SB10001424052748704122904575315213525018390

As premiums have gone up physicians have not experienced an increase in reimbursement. They have been forced to see more patients quickly to earn almost as much as before Obamacare. Obamacare has destroyed the patient-physician relationship which in my view is essential in medical care. Physicians simply do not have time to talk to patients.

Hospital systems have taken over physician populations in many communities. This gives the hospital leverage over the healthcare insurance industry. The hospital system can demand higher reimbursement because it provides all the physicians.

The large hospital systems can demand that the insurance company only use the physicians in its hospital system even if there are lower cost of care options in a community.

The result is an increase in healthcare premiums and decreased the quality of care.

All of this is the result of Obamacare. There are about ten more reasons why Obamacare has increased premiums and decreased access to care. I have left link exposed. You are encouraged to look at them to see the full explanation for some of the point I have made.

I hope this blog answers your friend’s question. :  Did Obamacare cause this change in healthcare insurance and these problems in access to care? 

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



Copywrite 2006-2019

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The Mainstream Media Refuses to Understand the Meaning of President Trump’s Healthcare Insurance Associations  

 Stanley Feld M.D.,FACP,MACE

The Mainstream media refuses to acknowledge the advantage of the Presidential order to allow Associations to participate in available health insurance plans.

Democrats do not want the public to understand the advantages President Trump’s healthcare insurance associations will provide to consumers. It is an important step in Repairing the Healthcare System. Obamacare was advertised only to fix the individual insurance market.

Pre- Obamacare there were 14 million people who had individual healthcare insurance plans. Most were unaffordable. Now, there are only 12 million in the individual market on Obamacare. Most are unaffordable.

Medicaid has expanded from 2 million to 10 million under Obamacare. The total on healthcare insurance provide by Obamacare  is 22 million. Medicaid is a failed healthcare insurance plan. It is a socialized medical insurance plan the has failed.

The mainstream media has forgotten that Obamacare was originally sold by President Obama to cover the individual insurance market. The individual healthcare insurance market was unaffordable. Obamacare was supposed to make it affordable. It turns out that 85% of Obamacare recipients are subsidized by the federal government. President Obama has expanded socialized medicine and a single party payer (the government) with Obamacare. Even with government subsidies the insurance is unaffordable because of the high deductibles.

It is difficult for me to understand how President Obama says he always tells the truth. He said he was going to make the healthcare individual market more affordable. He has not.

I remember he also said; “If you like your doctor you can keep your doctor” and “if you like your healthcare plan you can keep your healthcare plan.” Nothing could be further from the truth.

When Obamacare was passed there were requirements in the bill that outlined coverage the healthcare insurance industry must provide for everyone who has any kind of healthcare insurance. These requirements included levels of coverage that many people did not need. This excess coverage raised the cost of healthcare insurance in both the individual healthcare insurance market and the group healthcare insurance market. Both types of insurance became unaffordable.

This, combined with the inefficiency of a bureaucratic government raised prices of healthcare insurance even further. Remember the government outsources all of the administrative services to the healthcare insurance industry.

Now, the Democrats want the government to run the entire healthcare delivery system with “Medicare for All.” The unsustainability of “Medicare for All” is estimated at 32 TRILLION dollars over the next ten years!

Associations will not solve all the problems in the healthcare system.  However, they will start solving a good many of them. The Democrats are scared to death that the public will start to understand the advantages of associations. Consumers will have a choice of healthcare insurance plans. Consumers will be in a position to start controlling their healthcare dollars.

The pundits in the mainstream media seem to have no interest in understanding this dynamic. Their only interest is to despise President Trump and regurgitate the Democrats’ easy to understand talking points.

Trump’s associations will:

  1. allow the healthcare industry to sell healthcare plans without the rigid requirements imposed on them by Obamacare.
  1. make individual healthcare plans tax deductible. The large corporations’ group healthcare insurance plans are tax deductible. The individual healthcare insurance plans presently are not tax deductible.
  1. allow members to buy healthcare insurance across state lines. This will create price competition that will lower premiums.
  1. let small companies and the self-employed band together and buy health insurance outside of Obamacare’s strict rules.
  1. offer a way for people to take advantage of the group insurance market, even if they are self-employed or work for a business too small to provide insurance.
  1. will “level the playing field” by giving small businesses bargaining power.” This statement was made by Labor Secretary Alexander Acosta.

Mr. Acosta said “As the cost of insurance for small businesses has been increasing, the percentage of small business offering health coverage has been dropping substantially,”. “This expansion will offer millions of Americans more affordable health care options.”

The U.S. Chamber of Commerce said the change, “will give employers the relief and flexibility they need to cover more employees at a lower cost with more choices for quality care.”

The Congressional Budget Office estimates that 4 million people, including 400,000 who otherwise would go without insurance, are expected to join association health care plans by 2023.

The introduction of associations is going to disrupt the Democrats plans to take total control of the delivery of healthcare. It is going to start to put healthcare delivery back in the hands of the consumer!

Mr. Trump said at the National Federation of Independent Business’ 75th anniversary celebration in his usual hyperbolic style;

“You’re going to save a fortune,”

I believe he is closer to being right than he is being wrong.

 

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



Copywrite 2006-2018

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Obamacare Owes Insurance Companies $2.5 Billion Dollars For 2014 Health Exchange Losses

Stanley Feld M.D.,FACP,MACE

These days there is very little news in the traditional mainstream media about Obamacare.

The average person thinks everything is fine. President Obama has told us over and over again that Obamacare is a great success.

Unfortunately, this is far from the truth as the Obama administration prepares for the 2016 enrollment period.

Open enrollment is supposed to start November I, 2015 and end January 15, 2016 for 2016.

In 2013 and 2014 open enrollment was extended many months because of poor enrollment. I suspect the same will happen during the 2016 enrollment period.

The disastrous web site is still not fixed.

The healthcare insurance industry has increased Obamacare insurance premiums by double digits. The Obamacare deductibles remain in the thousands.

Even with large Obamacare subsidies people making under $50,000 cannot afford the subsidized premiums or deductibles.

Some people are registered through both the health insurance exchanges and Medicaid. This has been recently discovered by the Obama administration.

These people have received the Obamacare cash subsidy and Medicaid coverage. Now the Obama administration expects to be paid by these recipients for the government’s overpayment.

The Obama administration has refused to publish the number of people affected.

None of these issues have appeared in the traditional mainstream media.

The Obama administration continues to publish conflicting figures about how many people are actually enrolled through its federal health insurance exchanges.

The administration needs the healthcare insurance industry to do the administrative services for the health insurance exchanges.

At the onset of enrollment in 2013 healthcare insurance companies did not want sign up to do the administrative services. The companies figured that high-risk people without insurance would sign up for insurance and they would lose money. Obamacare required that the premium would be equal for everyone regardless of the health risk.

Obamacare originally wrote into the law three risk corridor programs that would be activated if necessary to subsidize the healthcare insurance industry against undo risk.

As a result of the healthcare industry’s lack of participation in the federal and state insurance exchanges, the risk corridors were activated.

“The healthcare reform law established three “market stabilization” programs to help insurers weather the first few years of covering a new population with unpredictable healthcare needs. At issue is the risk corridors program.”

I was astonished when I learned of these risk corridors. The corridors encouraged the healthcare insurance industry to participate in providing administrative services for each state and federal exchange at no risk of loss.

It was amazing that the leading Republicans for repeal of Obamacare did not make this clear to the public.

The insurance industry was actually guaranteed a profit because they provided its own profit and lost data. The Obama administration simply accepted its data. The healthcare insurance industry was supposed to receive the subsidy for its loss.

The government’s hope was to provide enough insurance choices to enrollees in the health insurance exchanges so there would be competitive pricing.

Unfortunately for Obamacare it did not work out as planned.

The government had planned on releasing risk corridors data in August but waited until October 1, 2015 due to discrepancies in the data.”

I suspect the delay was for political reasons and to provide enough time for the government to present the data in a less negative fashion.

The data provided by the Health insurers that sold health insurance plans showed that those insurers lost a great deal of money on the Affordable Care Act‘s exchanges in 2014.

The data shows the Obama administration has short changed the healthcare insurers that participated in Obamacare $2.5 billion dollars promised to them in the safety value risk corridor subsidies.

The Obama administration now is promising those insurance companies that the $2.5 billion dollars to cover the deficiency will be covered with budgeted monies from 2015 and 2016 if possible.

President Obama is now sowing the seeds to blame the nonpayment on Republicans since Republicans control congress.

Republicans thought the health insurance risk corridors were a stupid idea to begin with and predicted failure. Now the Obama administration is trapping the Republicans for not wanting to pay bills that are owed.

Some smaller insurance companies who were seduced into participating in this no risk insurance policy folly are now worried about experiencing “solvency and liquidity problems”.

CMS would not give the number of companies affected. It said the cases are isolated.

The insurers requested $2.87 billion in payments to cover their losses. The CMS will only reimburse 12.6% of the payment requests, meaning insurers will still be owed more than $2.5 billion.”

“ Names of companies that are owed money were not released.”

Does anyone think the insurance companies are going to sign up for the 2016 enrollment cycle?

Insurance companies do not know how much Obamacare will short- change them for the 2015 subsidies yet.

One can also begin to understand why insurance rates for both government and private insurance are increasing when physician and hospital reimbursement are falling.

The insurance industry feels it has to make up its loss.

Why are the Republicans not saying anything about this to the public?

Why aren’t Republican candidates for President not pointing out this folly?

Why are they letting themselves be set up to be blamed for not wanting to pay the government’s bill?

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

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Healthcare Insurance Industry Moves Against Obamacare

Stanley Feld M.D.,FACP,MACE

The 3 R’s are not working out well for the government, the patients or the healthcare insurance companies.

The temporary reinsurance portion of the 3R’s is about to expire. It was meant to support the healthcare insurance industry as enrollment in Health Insurance Exchanges grew.

Patient enrollment figures in State and Federal Exchanges have not grown significantly in the last two years. Enrollment ii exchanges has been from high risk and elderly patients.

High risk and comprehensive coverage has meant decreasing profit for the healthcare industry.

The numbers the Obama administration publishes are confusing and mostly false. State exchanges are failing. The State Health Insurance Exchanges are causing (in states that have State Health Insurance Exchanges) greater budget deficits.

The reinsurance program is not covering the healthcare industry’s expected profit because of the redistribution of wealth component in the 3R’s.

The significance of the redistribution of profit and wealth component of the 3R’s was not fully appreciated by the healthcare insurance industry as was the reinsurance subsidy was.

The industry’s first step to combat this barrier to profit was to increase next year’s insurance premiums by 20-30 percent in both the private sector and the State and Federal Health Insurance Exchanges.

This has created inflationary pressure on the private sector and unaffordable healthcare in both the private and public sectors for consumers and companies that provide healthcare coverage to their employees.

Its effect is the opposite of what President Obama promised. He promised to make healthcare insurance coverage affordable to all.

It is also forcing corporations to switch their healthcare coverage plans from defined benefit plans to defined contribution plans. The net effect is to increase employee out of pocket expenses.

We do not know how many more people have lost healthcare insurance because of Obamacare’s rules and regulations.

The public is also unaware of the exact number of people who have gained healthcare insurance through the Health Insurance Exchanges.

The real figures are not easily available.

The next step by the healthcare insurers is to merge.  A series of merger negotiations are occurring. In the last three weeks two merger negotiations have been completed.

Anthem Inc. agreed to buy Cigna Corp. for $48 billion, capping months of merger frenzy among top U.S. health insurers that is set to reshape the industry.

“The merged company is projected to have around $115 billion in annual revenue and cover about 53.2 million people.

The deal, which needs regulatory approval, would help reshape health insurance industry.”

Three weeks ago Aetna agreed to buy Humana for $34 billion. The two deals accelerated the rapid-fire reconfiguration of the U.S. health-insurance industries. The two deals would decrease the industry from five major companies to only three.

The traditional media has not discussed the reasons the healthcare insurance industry is merging or the details of the mergers.

I will try to connect the dots.

The healthcare insurance industry realizes that the Obama administration is trying to play one insurance company against another. The redistribution of profit from insurance companies that profit to those that make less profit must be irritating to the healthcare insurance industry.

Perhaps they did not appreciate the intricacies of the 3 Rs. Maybe there was a small window where the temporary reinsurance was profitable.

I would guess that the healthcare insurance industry would try to stop the redistribution of profit. These mergers will increase their individual profits.

The companies will be in a position to force the government to discontinue the redistribution of profit or lose a company that is an administrative service provider.

The losers will be taxpayers and non-subsidized insurance consumers. The increases in premiums to consumers that are subsidized will be passed on to taxpayers. Non-subsidized taxpayers will also be paying increased healthcare premiums.

This will create non-affordable insurance premiums for all as a result of the Affordable Healthcare Act (Obamacare).

The healthcare system will collapse. The government will move in with a single party payer system and a bloated and wasteful government bureaucracy.

Remember Senator Kerry and Representative Barney Frank saying the ACA would not work without a Public Option? Remember President Obama saying we don’t need a Public Option?

President Obama is backing healthcare insurers into a Public Option corner and a single party payer system.

The government will be forced to limit access to care and ration care. Americans will not have freedom of choice.

The problem is the government will still have to hire one of the three healthcare insurance carriers for its administrative services instead of one of five major carriers. The price to the taxpayer will probably be high along with all of the government’s bureaucratic inefficiencies.

Remember the VA? The VA scandal is continuing without any apparent improvement in VA services or in reforming the dysfunctional VA system.

Congress is simply giving the VA more money to continue its dysfunctional ways.

The latest step in the healthcare insurance industry’s attempt to protect itself is the hiring of Marilyn Tavenner as CEO of America’s Health Insurance Plans (AHIP) the lobbying group for the healthcare insurance industry.

Marilyn Tavenner is the former head and CEO of CMS overseeing Medicare, Medicaid and ACA (Obamacare) implementation.

Marilyn Tavenner oversaw the botched rollout of the federal insurance exchange and the ACA-mandated cuts in payment rates to Medicare Advantage in additional to a myriad of new Obamacare generated Medicare and Medicaid regulations.

Some of these regulations are unconstitutional according to lawmakers. However, the legislators have done nothing about these unconstitutional regulations.

They have not even attempted to make Americans aware of them.

Health Insurance Exchange plans and Medicare Advantage plans are two areas of tremendous profit and significant growth for private insurers. The Obama administration knows this and has tried to limit or eliminate this growth.  AHIP hopes Marilyn Travenner can help the industry continue this growth by pointing out the bureaucracy’s weaknesses to healthcare insurance company’s executives.

The healthcare industry (AHIP) hired her for her political connections inside the administration, inside the CMS bureaucracy and inside the congressional committees that regulate them,” said Tim LaPira, political science professor at James Madison University.”

 The mainstream media parroting the AHIP’s press release said, that the insurance industry has accepted Obamacare (the Affordable Care Act) as the new business environment. AHIP wants a CMS insider to help during the next phase of its market development.

According to the AHIP press release, “her government experience will be invaluable to AHIP given how rapidly the public sector is dominating the financial, market and regulatory facets of health plans”

It is obvious to me that AHIP did not hired Ms. Travenner in order to understand the new business environment better for an instant.

I believe AHIP hired her as CEO for her connections in,

1.   CMS,

2. The Obama administration,

3. The administration’s bureaucracy.

4. Congress

Along with her impressions of CMS’s weaknesses.

Weaknesses the AHIP can exploit.

Neither the Obama administration nor AHIP are working for the benefit of the American consumer of healthcare.

This behavior must be stopped somehow.

Permalink:

Double Digits Increases In Obamacare Insurance Rates Proposed

Stanley Feld M.D.,FACP,MACE

Thirty-seven states refused to setup Obamacare State Health Insurance Exchanges. Thirty-seven states refused because of the expected cost burden to those states and citizens. States are required to balance their state budgets. Most states have deficits and do not have balanced budgets. Obamacare’s requirements would simply add to their budget deficits. States would be forced increase state taxes.

The 37 states felt that the Obamacare State Health Insurance Exchanges were an attempt, by President Obama, to decrease the federal cost burden and shift it to the states.  

It was also a states’ rights issue.

None of those states felt that Obamacare State Health Insurance Exchanges could work and not become an increased cost burden.

The Supreme Court ruled in 2012 that states have the right under the constitution to refuse to create a State Health Insurance Exchange.

In June 2015 the Supreme Court will rule on King vs. Burwell.

Can the Federal Health Insurance Exchanges subsidize applicants the same way State Health Insurance Exchanges can subsidize applicants.

The law’s language is specific. The Obamacare law specifically states that only the State Insurance Exchanges can subsidies applicants.

The Obama administration media manipulation machine is already spinning the truth in case the Supreme Court rules against the federal government.

Eight million people will lose their subsidy. There are 330 million people in America. There are as many people uninsured in 2015 as there were before the law was enacted. In five years we are no closer to the promise that Obamacare would provide universal care.

Obamacare is failing because it is a bad law in many respects.

The essence of the Obama administration’s spin is that if the Supreme Court rules against the government the cost of insurance will escalate to unaffordable levels for Federal Health Insurance Exchange purchasers.

Subsidies that made insurance plans affordable face a crucial test with decision expected in June.

The truth is the cost of healthcare premiums are going to skyrocket for Obamacare applicants because the only people who signed up have pre-existing illnesses and had to buy insurance or the very poor because their insurance was fully subsidized.

 The adverse selection and the financial accounting rules for the healthcare insurance industry allow them to raise the premiums.

President Obama’s subsidies for Obamacare premiums expire in 2016.

 

Megan McCardle writing in Bloomberg says;

Insurance companies have been bullied by the Obama administration into keeping rates as low as they are, even though they can't make any money.

For sheer survival, most companies will begin to charge enough so they at least don't lose any money, or leave the exchanges altogether.

For those of you who have followed my blog carefully, you know President Obama has provided the healthcare insurance industry a subsidy in order to get them to participate. It guarantees that it cannot lose more than 2% of its expected profit.

The insurance industry determines its expected profit.

The insurance company subsidy is about to expire. The guarantee in Obamacare, of not losing any money, is going to evaporate. In addition, only the sickest and poorest people have obtained insurance from the federal and state health insurance exchanges. The federal and state exchanges have lost a great deal of money.

These losses are slowly being revealed.

The State Health Insurance Exchanges are starting to publish their losses at the same time the healthcare insurance industry is reporting their potential losses for next year. Those potential losses are reflected in the proposed premium increases.

Moda of Oregon says that its claims were 139 percent of revenue.

CareFirst of Maryland says claims were 120 percent of revenue.

Tennessee told the Wall Street Journal it lost $141 million on exchange plans last year.

 State of New Mexico says it lost $23 million on revenue of $121 million.

 The states that signed up for the State Health Insurance Exchanges are losing money. Maybe the states that did not sign up were right. It would be a financial burden on those states.

The clause in the law permits only those states having a health insurance exchange to provide subsidies to their applicants. It excludes all others, including the federal government.

The only question the Supreme Court has to consider is, can the federal health insurance exchanges provide subsidies to applicants according to the law as written?

The law was written to encourage states to create health insurance exchanges. It did not include the provision of subsidy to applicants for  federal health insurance exchanges.

If the federal exchange would be permitted to provide subsidies, the law should be amended by congress.

A Republican congress would have to amend the law.

Obamacare is an apparent disaster to consumers, insurance providers, hospitals and physicians.

The majority of Republican are calling for Obamacare’s repeal.

It is unlikely that a Republican congress will change that provision in the law.

The “States only provision” in the law has backfired on President Obama and those states creating health insurance exchanges.

The cost of setting up and administering this new bureaucracy was enormous. The healthcare insurance offered by Federal and State Health Insurance Exchanges were either too expensive for healthy or young consumers or had too many unnecessary benefits for those consumers.

The only consumers who signed up were people who were too sick to be able to buy private insurance or too poor to be able to buy insurance without being subsidized.

Those consumers comprise 85% of the applicants. The result has been an adverse selection pool.

If the Supreme Court rules against President Obama he is going to say that private insurance does not work. The federal government must create an entitlement to everyone.

The result will be socialized medicine with the federal government being the single party payer controlling rationing of care, access to care and the cost of care to consumers.

I believe it will make healthcare coverage even worse than it is now.

Why no one is considering my concept of consumer driven healthcare with my ideal medical saving account is beyond me.

Rather than making consumers actively responsible for their health, healthcare dollars and healthcare, we are on the road to making them passive recipients of their healthcare.

America is going to be further down the Road to Serfdom.

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

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Permalink:

Are Medicare Premiums Increasing In 2014

Stanley Feld M.D., FACP, MACE

The other day a reader received the new notification of Social Security benefits for himself and his wife in 2014.

He wrote,

 Dr. Feld

I am 72 years old.

I am a person who earns a substantial amount of earned and unearned income.

I am also forced by law to take a portion of money out of my retirement plan. I have been confused by the disinformation, misinformation, false promises we have been given by President Obama and his administration.

In the past I had not been curious about my Social Security benefits. It had no impact on my way of life. I paid into Social Security all my life and figured I should get some benefit.

However, with all the talk about the redistribution of wealth and Dr. Donald Berwick saying the essential fabric of universal healthcare coverage is the redistribution of wealth, I have been paying a little more attention to the Social Security benefit in recent years.

The change in the amount taken out of my benefit next year seemed way out of proportion to the amount taken out this year. I believe I made the same amount of money in earned and unearned in 2012 as I did in 2011.

I tried to figure out why the difference and ran into a lot of disjointed and uninterpretable explanations for these increases. Attached are mycommunications from the Social Security Administration. I have redacted our names from the letters.

Can you please explain these increases?

 Thank you in advance. 

 

Dear Sir;

I will give it a try.  The Obama administration has not raised the premium rates on Medicare Part B for 2014. I guess the plan is not to agitate seniors as Obamacare has agitated people in the individual market.

Most people do not pay attention to laws and regulations until those laws affect them adversely.

 Most of our senators and representatives did not read the Obamacare law before they passed it. On realizing Obamacare’s impact on them Congress lobbied the President for a waiver. Congress received the waiver.

Nancy Pelosi said in all her brilliance,

 “We need to pass the law in order to find out what is in it.”

 

 

http://youtu.be/R3GwEJrnC08

 

  Snopes.com printed this statement before the November elections in 2012.

"What you permit, you promote."

" The per person Medicare insurance premium will increase from the present monthly fee of $96.40, rising to: $104.20 in 2012; $120.20 in 2013; and $247.00 in 2014.

These are provisions incorporated in the Obamacare legislation, purposely delayed so as not to 'confuse' the 2012 re-election campaigns."

 The delay of the increase was one of President Obama’s trick plays.

 The author asked us;

"Send this to all seniors that you know, so they will know who's throwing them under the bus. Obama knows this will kill his chances for a second term if enacted now, and he thinks that voters are stupid and won't know or care about anything that doesn't affect them now!

REMEMBER THIS IN NOVEMBER 2012 & VOTE ACCORDINGLY”

This is a list of the increases from 2009 through 2012.

You will notice the base price went up each year until the election year. In 2012 the prices were published before the presidential election. President Obama used Medicare’s base price reduction as an election asset.

The projected increases published in April 2012 are,

2013:   $109.10

2014:   $112.10

2015:   $117.00

2016:   $122.00

2017:   $128.20

2018:   $135.50

The new projected increase to be published in November 2014 after the election cycle is a jump to a base price of $247 dollars a month per person.

 The 2014 increase is from $99.90 to $104.90.

 The big increase seniors will experience is in the deductibles, allowed services, and a restricted drug formulary.

The means testing adjusted gross income fees have not changed for 2014 price increases for the means adjusted gross income.

Sir, your means adjusted gross income must have jumped from $214,000 range to over $428,000 on your 2012 tax return.

You might have had a large carried forward tax lose on your 2011 tax return if your income in 2011 and 2012 were the same.

The result was a MAGI adjustment to a $230.80 increase to the base premium from the adjustment of $42.00 for 2013.

The Obama administration did not increase the prices in means testing for 2014.

The total premium for complete Medicare A,B,D,F is not cheap.

The premium is $405 dollars a month for each of you or a total of $810 dollars.

This amount will be deducted from your monthly Social Security check or $9,720 dollars a year.

 This amount does not include the $170 per month for each of your Medicare Part F supplemental insurance. Medicare Part F pays all your physician and hospital deductibles. The total premium is $4,080 per year in after tax dollars. Medicare Part D premium cost about $57 dollar per month each or a total of $1368 in after tax dollars. 

 The total in addition to $9,720 in pre tax dollars is $4,080 in post tax dollars or $13,800.

 The $4,080 post tax dollar premium is equal to $6,800 pre-tax dollars. This premium is not deductible.

Therefore the total is $6,800 plus $9,720 or a grand total of $16,520 a year for Medicare Part B, Part D, and Part F premiums for both you and your wife in 2014.

This is excluding deductible cost for brand name drugs and full the cost for drugs not on the formulary. It also does not pay for physicians that do not participate in Medicare.

 The Part A deductible has increased in 2014 to $1,216.00 from $1,084.00 in 2013. Medicare also pays 80% of the hospitals allowable fee after the $1,216.00.

 The Medicare Part B deductible is unchanged at $147.00. However you will get one free physical examination each year.

 These premiums are an example of the redistribution of wealth in our healthcare system.

 The means testing formula serves to supplement seniors who live on Social Security.

 Many have lost retirement benefits in the last few years.  Medicare’s base premium is too expensive for those less fortunate. Many are struggling to survive even if they do not need medical care.

Raising taxes or lowering premiums by the government is not going to solve the problems.

A single party payer system is not going to solve the problems.

Medicare is already single party payer system!! Its structure is wrong and destined to failure.

A consumer driven system for seniors with financial incentives to stay healthy will go a long way to decreasing costs and save consumers money.  

It will also save the government a great deal of money.

 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:

What Are Private Insurance Exchanges?

Stanley Feld M.D.,FACP,MACE

Corporations have been providing healthcare insurance
since after WWII. The cost of healthcare insurance has been rising since.

The increase in premiums became intolerable in the
1980’s when cost shifting occurred. Medicare decreased reimbursement and the
fees were shifted to private insurance.  Several experiments in healthcare coverage
were tried to reduce the cost to employers. All the schemes failed to control
costs.

The schemes include managed care and HMO’s. All the
insurance schemes were defined benefit plans. Employees were immune from
responsibility for themselves or their healthcare dollars.

As the costs have risen to unsustainable levels
corporations have been trying to figure out how to get out of providing
healthcare coverage for their employees as a benefit.

Most employers, large and small, want to limit their
exposure to healthcare premiums and Obamacare penalties.

A movement to limit employment to less than 30 hours
a week to avoid providing healthcare insurance to employees and avoid Obamacare
penalties has become viral.

No one has tackled the real reasons for the rising
healthcare costs. No one has tackled the perverse incentives and advantages
given to the healthcare insurance industry all these years.

I have argued that this perverse incentive can lead
to all the other perverse incentives initiated by the rest of the stakeholders
in the healthcare system in order to survive.

Once more the healthcare insurance industry figured
out how to increase their profits while making it appear they are helping both employers
and employees.

It must be remembered that the healthcare insurance
industry profits through both private insurance and government provided
healthcare coverage.

The industry makes its profits by providing
administrative services. The government outsources the administrative services
to the healthcare insurance industry.

The profit generated in both the private sector and
the government sector is far from transparent.

The healthcare industry’s new scheme converts defined
benefit coverage to defined contribution coverage for healthcare benefits.

In recent months we have seen large corporations
switch their employee healthcare benefits to defined contribution programs.

A partial list of companies includes Walgreens, Home
Depot, Sears, Trader Joes, Xerox and IBM retirees.

Rather than provide a healthcare insurance coverage
benefit through the corporation, the corporation is providing employees with a
defined contribution each year. The employees can then buy their insurance
through their employer’s contracted Private Health Insurance Exchange.

The Private Health Insurance Exchanges are provided
to the corporations by the healthcare insurance industry. There will be a menu
of insurance plans and premium levels employees eligible for coverage can
choose from.

The principals of healthcare coverage include all of
the basic requirements of Obamacare’s Health Insurance Exchanges. Employees
having a preexisting illness must be accepted. However, premiums might be
higher for patients with pre-existing conditions.

The defined contribution amount has not been defined.
It could be a couple of hundred dollars a year to a couple of thousand dollars
a year. In any event it does not sound as if it will be enough to cover the
cost of the healthcare insurance premium.

There will be high deductible plans with patients not
covered for the deductibles and co-pays.

If an employee doesn’t like what he buy in the
companies Private Insurance Exchange, he can always sign up for Obamacare’s
Health Insurance Exchange.

It sounds great for the employer because the employer
can predict costs. It is wonderful for the healthcare insurance industry.

It sounds terrible for the consumer.

It sounds both good and bad for the government. It
depends on how one looks at it.

The Obama administration will have more people sign
up for Obamacare’s Health Insurance Exchanges. The result will be greater
control over the healthcare system. I believe this is the reason the Obama administration has not opposed the Private Health Insurance Exchanges.

However, the consumers signing up for Obamacare Health Insurance Exchanges will be the sickest
consumers. These consumers will use the system more than average.

This will result in an increase in the deficit and
unsustainability of Obamacare. The only way out is to increase premiums and
taxes.

This is called a “redistribution of wealth” because
people making up to $40,000 per year do not pay taxes. If the tax increases are
means tested it will increase the amount of wealth that is redistributed will
increase.

The increase in taxes will decrease economic growth.

At the present time Obamacare’s Healthcare insurance
Exchanges do not have verification software. The system is vulnerable to fraud
and abuse even if it could work.

America is just becoming aware of the fraud and abuse
in the food stamp entitlement program. The food stamp entitlement has double. The
government has not fixed the food stamp program.

It is likely the same thing will happen with the government
run Health Insurance Exchanges. It will drive the federal deficit even higher.

Even though the Private Health Exchanges shift financial
responsibility to the consumer to pay for their own insurance it does not provide
financial incentive for patients to become responsible for their health.

It does not contain educational programs to help
patients deal with their chronic diseases. It does not teach consumers to be
responsible for their health and healthcare dollars.

Obamacare does not provide these incentives either.

The only plan that does is my Ideal Medical Saving
Accounts with employers providing support while shifting responsibility to
consumers by providing incentives for patients to lower the cost of their care.

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

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Permalink:

The Healthcare Insurance Industry Abandons Selling The Individual Insurance Policies In Health Insurance Exchanges

   
Stanley Feld M.D.,FACP,MACE

 

 
 

http://youtu.be/Kyv8ZRkXnfU?t=58s

President Obama is on the campaign trail. He is selling the
virtues of Obamacare to the young uninsured.

He wants the healthy young to buy the health insurance exchange
insurance policies in order to pay for the sick. He wants to prevent
Obamacare’s failure.

His speeches are political. They have little substance and are
loaded with disinformation and hyperbole.

The campaign is a political ploy to blame the Republican Party
for Obamacare’s impending failure.

Last week Harry Reid said he has to increase taxes by another
trillion dollars. This increase will make the economy worse, not better.

When is the public going to learn that socialism doesn’t work?
Taxing and spending does not improve economic growth. Socialism and increased
taxes stifle innovation and productivity.

I think it is time for a
couple of Ayn Rand’s truisms as they apply to Obamacare. Men pursue their
vested interests. They resist being forced to follow orders that contradict
their vested interests. The key in any system success is to align all the
stakeholders’ vested interests. Obamacare does not achieve this goal.

“It only
stands to reason that where there's sacrifice, there's someone collecting the
sacrificial offerings.”

Where
there's service, there is someone being served. The man who speaks to you of
sacrifice is speaking of slaves and masters, and intends to be the master.

Ayn
Rand

America is going through a period of
time where it is evident that something is wrong.  Americans and the traditional media are keeping
our eyes wide closed.

The hardest thing to
explain is the glaringly evident which everybody had decided not to see.

Ayn Rand

Peggy Noonan said it in a paragraph
in this weekend's blog.

"One irony here
is that the Obama White House, always keen to increase the reach and power of
government, also seems profoundly disinterested in good governing
. It is
strange. The long-term project of liberalism involves encouraging the idea of
faith in government as a bringer or guarantor of greater justice. But who needs
more government if government works so very badly, and is in its operations
unjust?"

"This White
House is careless with the reputation of government. They are a campaigning
organization, not a governing one."

Ayn
Rand goes on to say,

 “You
can avoid reality, but you cannot avoid the consequences of avoiding reality.”


Ayn
Rand

 A problem occurs when
constituents finally realize government is not defending its vested interests.
Change is demanded.

Americans are finally
waking up.  

We have seen this phenomenon
in my last two articles when I wrote that unions and hospitals finally realized
that Obamacare does not serve their vested interests.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2013/07/obamacares-games-for-stakeholders-and-the-unintended-consequences.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2013/07/hospital-systems-are-finally-realizing-there-are-problems-with-obamacare.html

This is also the reason
Aetna decided to not sell healthcare insurance policies in the California’s
health insurance exchange.

 

 “Aetna Inc.  will stop selling
health insurance to individual consumers in California at the end of the year,
withdrawing as the federal health law is expected to reshape the market in
2014.”

Aetna did not comment on
the reasons it is dropping out of the individual market in California.

“A company spokeswoman declined
to comment about the reasons for Aetna's individual-business withdrawal.”

The dominos are starting
to fall as more healthcare insurers realize what is going on.

“Aetna isn't one of the 13
insurers participating in the California state's new consumer insurance
marketplace set to launch this fall under the federal law.”

“Like several other major
national carriers, it has said it would join only a limited number of these
exchanges. A carrier can still offer consumer plans without being in the
exchange.”

President Obama and other supporters argue that the health
insurance exchange is a success because it is encouraging competition and
pushing down prices. It is not true.

 “Insurance-industry experts say
similar moves by other carriers in other states may emerge
in coming months, as
companies with limited market share decide to avoid the uncertainty tied to the
law's changes.”

The Obama administration’s concept of competition and price
reduction is tenuous. President Obama and other CMS official keep saying that
healthcare insurance prices will decrease.

The healthcare insurance industry originally calculated it would
make a killing by selling insurance through the healthcare insurance exchanges.

As the rules and regulations for health insurance exchanges are
slowly rolled out by the administration is it clear to the health insurance
industry they could get killed by selling insurance in the health insurance
exchanges.

The addition of a 3.5% tax on each policy sold is enough for the
insurance industry to realize the health insurance exchanges will cause them to
lose money.

These surprises do not serve the vested interests of the
healthcare insurance industry.

The Obama administration keeps announcing that health insurance
exchanges are decreasing healthcare premiums.

The public and businesses are experiencing double-digit
increases in healthcare insurance premiums since Obamacare was passed.

 The reason is clear. The increases are the result of all the additional
benefits President Obama brags about in his public relations campaign.

Obamacare contains community ratings for pre existing illness
and parental insurance for young adults under twenty-six.

These are important policies. The problem is it leads to an
increase in premiums for everyone.

Healthcare premiums have already increased 20- 30% since the
passage of Obamacare. BlueCross Blue Shield of Tennessee just announced,

 BlueCross BlueShield of Tennessee expects a 20 to 30 percent
increase in rates in the individual market starting next year and a 10 percent
increase in the small group market.”


“BlueCross BlueShield exec warns of
health care cost ‘explosion.’
 

A healthcare Insurance CE0 told a business group at the Nashville Area Chamber
of Commerce
that health care reform will cause “a lot of disruption in the
marketplace.”

The premium hikes will
be needed to offset new taxes
 on insurance payers such as his, he said.

We are getting
ready to have a health care cost explosion
,”  

“Details on the plans being offered on the exchanges, including
affordability, aren't yet known, but 
John
Maki
, vice president of regional sales at BlueCross
BlueShield of Tennessee
, said the company is looking at
offering traditional PPO plans, HSA-compatible plans and several other
"unique plan designs."

Only two commercial carriers have
applied to sell health insurance on Tennessee's new federally run insurance
exchange. They do not know if their submissions will be accepted. The deadline
for submission by other companies has passed.

Meanwhile, a New York Times editorial is conditioning Obamacare
fans as to who is to blame for the failure of the health insurance exchanges
. The
Times is putting the blame squarely on the shoulders of the Republican Party.

“To their shame and discredit, Republicans are trying to block
efforts to inform people
about the law and are using scare tactics to keep them
from enrolling.”

This is a typical Obama
administration tactic to blame the other guy for the impending failure of its
policy.

Obamacare is failing under
its own weight and the administration’s inability to implement the law.

The New York Times goes on,

The Republican mantra is that the nation will face economic and
medical catastrophe
— a “train wreck,” they say — unless health care reform is
stopped in its tracks.”

Obamacare is a train wreck. Max
Baucus Senator Democrat from Montana and author of Obamacare and head of the
finance committee said it.

Top officials in Ohio
and Indiana who oppose the law have issued dire, misleading forecasts
— roundly
debunked by analysts — that the law will raise premiums to astronomical levels.”

“roundly debunked by analysts”  This is not true. The Obama
administration’s analysis is biased and selective. By stating the analysis as a
fact the New York Times’ editorial board is expressing their bias without facts.

The New
York Times is once again acting as a shill for the Obama administration.  The New York Times is misleading the public.

Obamacare
is a bad law. It does not align any of the stakeholders’ vested interests. All the stakeholders are starting to realize it.

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

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