Paul Ryan’s Health Bill: Good, Bad and Ugly

John C. Goodman

Remember how the Democrats did it. They created Obamacare behind closed doors. There was no real pubic vetting. No real attempt to make sure the pieces fit together in a sensible way. And no possibility of a single vote from the other party.

The House Republican Leadership seems enamored of that approach. The latest GOP replacement plan was announced last Monday after weeks of secrecy. The two relevant committees began their markup two days later – with no hearings, no vetting, no CBO score and no amendments.

It does not lower costs. It insures many fewer people. It does not stop the race to the bottom in the exchanges that is so harmful to the chronically ill.

Instead, the GOP plan seems designed to make the individual market work better. That means helping Obamacare work better. For all the apparent differences, the Republicans are just as committed to the managed competition model as the Democrats were.

Source: Paul Ryan’s Health Bill: Good, Bad and Ugly

A Path Towards a Viable Interstate Health Insurance Market | Robert Nelson, MD | Pulse | LinkedIn

Alternatives to our current over-priced and dysfunctional health insurance market are often biased, and thus limited, by our current operational and regulatory structure. These structures are so entrenched in our healthcare psyche that it makes it difficult sometimes to set these aside in our minds while entertaining how another approach might work.

If we view all alternative plans to replace the Affordable Care Act from the vantage point of “what is”, then there is little room for anything other than attempts at further regulating the problems away. If one presupposes that the current regulatory framework remains unchanged, indeed the same framework has served to suppress the very market we wish create, then of course that market will not be created.

The dilemma facing alternative healthcare plans being considered to replace the ACA is particularly evident when it comes to the issue of selling health insurance across state lines. A brief on this subject published by the American Academy of Actuaries in February of 2017 speaks to the the main challenges facing the advent of a viable interstate market for the sale of health insurance.

Source: A Path Towards a Viable Interstate Health Insurance Market | Robert Nelson, MD | Pulse | LinkedIn

Obamacare Replacement Act – Senate Bill 222 by Senator Rand Paul – KY

Sen. Rand Paul, R-Ky., speaks during an event at the University of Chicago's Ida Noyes Hall in Chicago on Tuesday, April 22, 2014. (AP Photo/Andrew A. Nelles) ORG XMIT: ILAN114Lots to like and consider here.  We need more details about how tax equalization in the group market vs the individual market will be handled.  The expansion of uses and benefits of HSAs is robust and will go along way to establishing more ways to self-insure and less reliance on networks and government programs; both are a good thing.  The flexible, market-friendly Interstate Market for Health Insurance Cooperative Governing of Individual Health Insurance Coverage will be a welcome change.  Again, devil is always in the details.  Stay tuned for more details and insightful analysis here on the Sovereign Patient; we will post them as available. 

Some highlights:

Effective as of the date of enactment of this bill, the following provisions of Obamacare are repealed:

  • Individual and employer mandates, community rating restrictions, rate review, essential health benefits requirement, medical loss ratio, and other insurance mandates.

Protecting Individuals with Pre-Existing Conditions:

  • Provides a two-year open-enrollment period under which individuals with pre-existing conditions can obtain coverage.
  • Restores HIPAA pre-existing conditions protections. Prior to Obamacare, HIPAA guaranteed those within the group market could obtain continuous health coverage regardless of preexisting conditions.

Equalize the Tax Treatment of Health Insurance:

  • Individuals who receive health insurance through an employer are able to exclude the premium amount from their taxable income. However, this subsidy is unavailable for those that do not receive their insurance through an employer but instead shop for insurance on the individual market.
  • Equalizes the tax treatment of the purchase of health insurance for individuals and employers. By providing a universal deduction on both income and payroll taxes regardless of how an individual obtains their health insurance, Americans will be empowered to purchase insurance independent of employment. Furthermore, this provision does not interfere with employer-provided coverage for Americans who prefer those plans.

Expansion of Health Savings Accounts:

  • Tax Credit for HSA Contributions
    • Provides individuals the option of a tax credit of up to $5,000 per taxpayer for contributions to an HSA. If an individual chooses not to accept the tax credit or contributes in excess of $5,000, those contributions are still tax-preferred.
  • Maximum Contribution Limit to HSA. Removes the maximum allowable annual contribution, so that individuals may make unlimited contributions to an HSA.
  • Eliminates the requirement that a participant in an HSA be enrolled in a high deductible health care plan. This section removes the HSA plan type requirement to allow individuals with all types of insurance to establish and use an HSA.
  • This would also enable individuals who are eligible for Medicare, VA benefits, TRICARE, IHS, and members of health care sharing ministries to be eligible to establish an HSA.
  • Allowance of Distributions for Prescription and OTC Drugs o Allows prescription and OTC drug costs to be treated as allowable expenses of HSAs.
  • Purchase of Health Insurance from HSA Account o Currently, HSA funds may not be used to purchase insurance or cover the cost of premiums. Allowing the use of HSA funds for insurance premiums will help make health coverage more affordable for American families.
  • Medical Expenses Incurred Prior to Account Establishment o Allows qualified expenses incurred prior to HSA establishment to be reimbursed from an HSA as long as the account is established prior to tax filing.
  • Administrative Error Correction Before Due Date of Return o Amends current law by allowing for administrative or clerical error corrections on filings.
  • Allowing HSA Rollover to Child or Parent of Account Holder o Allows an account holder’s HSA to rollover to a child, parent, or grandparent, in addition to a spouse.
  • Equivalent Bankruptcy Protections for HSAs as Retirement Funds o Most tax-exempt retirement accounts are also fully exempt from bankruptcy by federal law. While some states have passed laws that exempt HSA funds from being seized in bankruptcy, there is no federal protection for HSA funds in bankruptcy.
  • Certain Exercise Equipment and Physical Fitness Programs to be Treated as Medical Care. Expands allowable HSA expenses to include equipment for physical exercise or health coaching, including weight loss programs.
  • Nutritional and Dietary Supplements to be Treated as Medical Care o Amends the definition of “medical care” to include dietary and nutritional supplements for the purposes of HSA expenditures.
  • Certain Providers Fees to be Treated as Medical Care o Allows HSA funds to be used for periodic fees paid to medical practitioners for access to medical care.
  • Capitated Primary Care Payments o HSAs can be used for pre-paid physician fees, which includes payments associated with “concierge” or “direct practice” medicine.
  • Provisions Relating to Medicare o Allows Medicare enrollees to contribute their own money to the Medicare Medical Savings Accounts (MSAs).

Interstate Market for Health Insurance Cooperative Governing of Individual Health Insurance Coverage:

  • Increases access to individual health coverage by allowing insurers licensed to sell policies in one state to offer them to residents of any other state.
  • Exempts issuers from secondary state laws that would prohibit or regulate their operation in the secondary state. However, states may impose requirements such as consumer protections and applicable taxes, among others.
  • Prohibits an issuer from offering, selling, or issuing individual health insurance coverage in a secondary state: If the state insurance commissioner does not use a risk-based capital formula for the determination of capital and surplus requirements for all issuers. Unless both the secondary and primary states have legislation or regulations in place establishing an independent review process for individuals who have individual health insurance coverage; or The issuer provides an acceptable mechanism under which the review is conducted by an independent medical reviewer or panel.
  • Gives sole jurisdiction to the primary state to enforce the primary state’s covered laws in the primary state and any secondary state.
  • Allows the secondary state to notify the primary state if the coverage offered in the secondary state fails to comply with the covered laws in the primary state.

Source: Microsoft Word – Obamacare Replacement Act SBS.docx

Can Tom Price Fulfill Donald Trump’s Campaign Promises?

“A couple details need fixed, but Tom Price’s plan and the Cassidy-Sessions Plan are on the right track.  This is an important article that anyone should read who really wants to understand the economic issues AND the political issues surrounding healthcare reform as it related to repealing and replacing ObamaCare.” – R. Nelson, MD

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John C. Goodman

There is no practical way to achieve universal coverage by giving everyone a tax deduction for health insurance. The tax relief must be in the form of a credit and it must be refundable – allowing people access to it even if they owe no taxes. Yet refundable tax credits and the idea of universal coverage in general strike many in the Republican Party as socialism.

Price is of the view that we are going to end up subsidizing the health care of the poor and the indigent one way or the other. We can do it through cost shifting and subsidies conferred on impersonal hospital bureaucracies or we can give the money to the people and let the bureaucracies compete for their patronage. The Price tax credit would be refundable and it would vary by age. But unlike the Obamacare credits, Price’s credit would be the same, regardless of income.” –  a quote by John C. Goodman, author of the article in Forbes below.

Elevators close on Rep. Tom Price, R-Ga., as he arrives at Trump Tower, Wednesday, Nov. 16, 2016, in New York. (AP Photo/Carolyn Kaster) There are two things you need to know about Congressman Tom Price’s views on health policy : he believes in universal coverage and he believes in tax credits. Why […]

Source: Can Tom Price Fulfill Donald Trump’s Campaign Promises?

Components of Optimal Health Insurance: # 3 – Uninterrupted Ownership | Robert Nelson, MD | LinkedIn

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Robert Nelson, MD

Installment #3 of Components of Optimal Health Insurance will discuss how regulatory and tax policy has contributed to the health care insurance crisis by promoting “job-lock”.  Tax laws and insurance regulatory policy need to change in order to affect real health insurance reform. 

via Components of Optimal Health Insurance: # 3 – Uninterrupted Ownership | Robert Nelson, MD | LinkedIn.

What Will Happen If Supreme Court Cuts ObamaCare Subsidies?

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Dr. Jane Orient

The Administration, however, had a ready fix: the IRS just wrote a rule that allows the subsidies to flow anyway, arguing that that must be what the law really meant.

It reminds me of Gilbert and Sullivan’s operetta Iolanthe. There was a most inconvenient law on the books: “The fairy that marries a mortal dies!” It was terrible enough that the beloved Iolanthe had broken the law. But ultimately when all the fairies marry members of the House of Peers, what is the Fairy Queen to do? “I can’t slaughter the whole company!”

The Lord Chancellor comes to the rescue. “The subtleties of the legal mind are equal to the emergency. The thing is really quite simple—the insertion of a single word will do it. Let it stand that every fairy shall die who doesn’t marry a mortal.”

The Obama Administration is assuming that the Court will act as Lord Chancellor, or else the Republican Congress will do so, and therefore has not bothered to warn anyone of the possible loss of subsidy.

via What Will Happen If Supreme Court Cuts ObamaCare Subsidies?.

Fair-Healthcare Zones: No Third-Party Contracts Permitted! | Robert Nelson, MD | LinkedIn

third-party-insurance-quote-m5uykrfyBut these government-given advantages enjoyed by the health plan networks are just the icing on the cake compared to the fact that these network health plans utilize strictly defined benefits that rely on a totally separate provider contract that must be in force in order to use those “benefits” (really mostly pre-paid health maintenance plan that is heavily restricted)!

And, to make matters even more economically perverse, a non-negotiable cumbersome and expensive “claims” process is required by the payer and must be filed by the provider for each encounter used by a subscriber, no matter how minor or inexpensive. It is only after the properly documented and coded “claim” has been filed with the payer that the doctor gets paid.

Read the entire article at Fair-Healthcare Zones: No Third-Party Contracts Permitted! | Robert Nelson, MD | LinkedIn.