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Still Stuck Inside

A health care blog with references to exchanges, Moses, and Tolkien. Must be the latest Health Insurance Issues With Dave...

Will you indulge me?  Will you return with me to a post I wrote on August 21, 2009?  That post, Stuck Inside, was about an insurance agent, me, trying to give a quick, off-the-cuff answer to the question, “So, what would you do?”  

What would you do?  That is the real question.  It is incredibly easy to shoot down everyone else’s ideas.  All ideas, born from the minds of imperfect humans, have flaws.  And the more complicated the ideas, the more potential there is for mistakes.  All of our plans have big, gaping holes.  So designing a solution to any problem opens you up to derision.  It is easy to do nothing.  It is even easier to do nothing but snipe at those flawed ideas and the people who created them. 

This blog has consistently held that the Patient Protection and Affordable Care Act (PPACA) is a poorly written law that lacks both transparency and logical goals.  Either the eventual plan is to have us in a national health plan or our guys in Congress are getting directions from Moses’s map maker.  Flaws?  We got ’em.  But most of  the people fighting the PPACA have spent their time picking the low hanging fruit and defending the status quo. 

This blog has contended that the PPACA is not only the law of the land, but that it was never going to be overturned.  Deal with it.  Kathleen Sebelius, Secretary of Health and Human Services, is busily churning out new rules and regulations. Some of these edicts from on high will help the American people.  Some are patently absurd and will, hopefully, be changed.  No matter, we need to start to prepare for a future that will soon be upon us whether or not we want it or are prepared. 

My August 2009 post, seven months prior to the passage of the PPACA, laid out a program where health insurance would be guaranteed issue, would cover all preexisting conditions, and would be mandatory.  My off-the-cuff solution also included the concept of creating a limited number of uniform plans that would be easier for the consumer to understand, easier to compare, and would include preventive care. 

The President’s plan includes many of these ideas.  I may quibble with what is included in the standardized plans and what all was thrown in to the preventive care catch-all, but THEY DIDN’T ASK ME.  And you might not be a huge fan of the specifics had I been the author of the plan. 

The Exchanges are currently designed to offer four levels of coverage – Platinum, Gold, Silver, and Bronze.  We are still getting information on plan design and specifics.  My last post covered the Essential Health Benefits that each plan must include.  The difference will simply be the percent of coverage paid by the insurer and you.

The Cunix option included the idea of Medicaid being opened up to people earning up to 300% of the poverty level, paid on a sliding scale.  The PPACA provides premium support and/or tax credits through the exchanges for people who earn up to 400% of the poverty level.  That would mean a family of four may receive a tax credit for purchasing a policy through the exchange even though they have a family income of $92,200 (2012).  By pushing individuals to the exchanges and making the premium support federal money, Washington has eliminated any potential problems or fights with recalcitrant Republican governors. 

My program included a number of starting places to create cost controls.  The PPACA is eerily silent when it comes to controlling costs.  But then again, there is a lot of wishful thinking built into the PPACA. 

The HHS has been dropping new rules on an almost daily basis.  Last week it was announced that the federal government will be charging user fees to the insurers who market policies through the exchanges.  These (premium taxes) fees, approximately 3.5%, will be on top of the new taxes imposed on a national basis to all health insurers as determined by their market share, and any state and local insurance tax.  Some of this makes sense.  This is how the Obama administration expects to pay for this transition and the ongoing process.  

Here is the fun part as it appeared in the New York Times

Erin Shields Britt, a spokeswoman for Ms. Sebelius, predicted that insurers would not raise prices.  “Exchanges will provide already profitable insurance companies with access to 30 million new customers while cutting down insurers’ marketing and advertising expenses,” Ms. Shields Britt said.  “Exchanges force insurance companies to compete and drive down costs for consumers.  The congressional Budget Office has estimated consumers will save up to 20 percent on their premiums.

And J. R. R. Tolkien wrote non-fiction. 

But sniping on the sidelines isn’t going to help.  Jumping up and down and threatening to repeal the PPACA (attn: Republican run House of Representatives) only made things worse.  Now is the time to talk to your Congressional Representative.  The course can’t be reversed, but it can be modified.  The Patient Protection and Affordable Care Act is an open-ended medical spending spree guaranteed to make private insurance untenable.  Will our elected officials, Democrats and Republicans, work together to create effective cost controls, common sense limitations, and robust fraud enforcement?  Those are just for starters. 

Now, before we’re stuck.

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

Holly Vogel-Engel December 09, 2012 at 05:27 PM
We ARE stuck, stuck with a policy that does NOT have price control, includes everyone and just has so many opportunities for more and more COST, more and more spending of money we don't have. Congress right now can't agree on how they are going to avoid fiscal catastrophe, the PPACA will be the next catastrophe!!!

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