Obamacare is Coming! Obamacare is Coming!

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[Ed. note: Although I try and avoid political entries on this blog, the topic of this blog has been so politicized, that I am not able to avoid it.]

In spite of the fact that representatives in Congress have tried to repeal the Health Care Reform Act a whopping 40 times, open enrollment is due to begin on October 1 and the Health Care Reform Act, aka Obama Care, officially will go into effect the first of January 2014.  That is the good news.

The news that really chagrins me is that each time the obstructionists in Congress tried to repeal the law (which would actually benefit most American citizens) they did so to the tune of 1.5 MILLION dollars.  EACH time!  SIXTY MILLION DOLLARS of OUR tax dollars ended up being spent for what I can only conclude is shenanigans on the part of the obstructionists.  These are the same people who keep telling us that the government does not have enough money to operate.  They are the same people who can get the very best healthcare available at a 72-75% discount.*  As we have been the only developed nation in the world that still does not provide universal healthcare to its citizens, the actions of these obstructionists has been destructive.  Okay.  Politics over.  Back to the good news.

Starting October 1, people will be able to choose their healthcare coverage and healthcare provider.  Health insurers are no longer allowed to deny individuals with pre-existing conditions.  They are no longer allowed to drop individuals if they cost them too much or put a lifetime limit on benefits.

The following is the coverage that every citizen will have a right to regardless of the healthcare plan they choose.

Free annual check ups; Emergency services; Hospitalizations; Laboratory services; Maternity care; Mental health and substance abuse treatment; Outpatient, or ambulatory care; Pediatric care; Prescription drugs; Preventive care; Rehabilitative services; Vision and dental care for children.

Open enrollment will allow one to compare coverage options before enrolling.  In this new requirement that all citizens own health insurance, the government is offering an exchange rate between what the premiums cost and what the insured will have to pay. This exchange rate will be determined by the individual states.

In Virginia for example:

The average premium, without tax credits, would be $237 a month for the lowest-cost bronze plan and $335 a month for the second-lowest silver plan.

For a family of four making $50,000, a mid-range plan, after tax credits, would be $282 a month under the second-lowest silver plan. Without a tax credit, $799.

For a 27-year-old person earning $25,000 a year, the premium would be $80 a month, with a tax credit, for the bronze plan and $145 for the silver plan, also with a tax credit.

Six out of 10 Virginians who are uninsured will be able to find coverage for less than $100 a month when tax credits and Medicaid coverage are included.

 

© Yvonne Behrens, M.Ed  2013

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*According to the Congressional Research Service, the FEHBP offers about 300 different private health care plans, including five government-wide, fee-for-service plans and many regional health maintenance organization (HMO) plans, plus high-deductible, tax-advantaged plans. All plans cover hospital, surgical and physician services, and mental health services, prescription drugs and “catastrophic” coverage against very large medical expenses. There are no waiting periods for coverage when new employees are hired, and there are no exclusions for preexisting conditions. The FEHBP negotiates contracts annually with all insurance companies who wish to participate. There is plenty of competition for the business; FEHBP is the largest employer-sponsored health plan in the U.S.

Like other large employers, the government pays a large share of the cost of coverage. On average, the government pays 72 percent of the premiums for its workers, up to a maximum of 75 percent depending on the policy chosen. For example, the popular Blue Cross and Blue Shield standard fee-for-service family plan carries a total premium of $1,327.80 per month, of which the beneficiary pays $430.04. Washington, D.C.-based employees who prefer an HMO option might choose the Kaiser standard family plan. It carries a total premium of $825.15 per month, of which the employee pays only $206.29.  (Factcheck.org)

 

“Obama Care” summarized – part 4

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…and so here is the final entry to the long story of trying to implement universal health care in the United States.

The opposition fought a dirty war, even incorporating racism to try and prevent the Health Care Reform Act from becoming law.  But politics is a dirty game and often has very little to do with us, the people.

The reality is that health care in this country has become so exorbitantly expensive, the system would become financially bankrupt were it allowed to continue in the direction it has been.   Thus, all the posturing by the opponents of the bill had more to do with buying time in order to figure out how to ensure their interests under the new system.  In the end, much of the original bill was watered down and implementing universal health care will be much more expensive than it would have been when originally considered.  However, some important laws did get passed and, hopefully, States will recognize the benefits to them.  Unfortunately, since so much of the focus on the part of big businesses is on how to take advantage of circumstances, (and by this I mean milk the system) we have become a society that is encouraged to look at how to take advantage of legislation.  I really do not know a remedy for this since the example in front of us is that one can get away with milking the system (Wall Street being the biggest example of getting away with….).

So, in the end, what is the Health Care Reform Act?  I think the following video will probably do a better job of explaining than I can.  So view and enjoy.

© Yvonne Behrens, M.Ed  2013

 

 

Obama Care Part 3 – 2009: The Battle

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In my previous entries, I shared the history of the whole universal health care debate, a debate that has been going on for almost a hundred years in our country.

President Obama rolled out the details of the Health Care Reform Initiative in the summer of 2009.  As you may recall, there was an unbelievable amount of acrimony around the topic.  This was where older folks, who really did not know what was within the 906 page document, were encouraged to come to Washington, D.C. (free bus ride and free lunch) and hold up placards that “yelled out” such lines as “Don’t kill Grandma.”  This phrase, it turns out, was referring to a clause, somewhere in the middle of the 906 page document in which every patient would have a right to talk with their doctors about end of life issues and it would be covered by insurance.

Ah, yes.  It was quite a period of time, back then.  Representatives, who backed the President’s health care initiative, would hold town meetings, facing really angry voters, who, quite frankly, did not fully understand how this health care initiative would benefit them.  I remember our representative in the Fifth District of Virginia, Tom Perriello, one of the finest politicians I have ever met.  He was a straight shooter and he had the most impeccable manners.  He held town meeting after town meeting after town meeting, where angry folk would challenge the initiative. In fact, it was known that the opposition sent in individuals with prepared questions on specific, if not, obscure points within the document.  Congressman Perriello had such a grasp on what those 906 pages contained, that he was able to answer most every single person’s question, no matter how obscure.    On the rare occasion that  he was unfamiliar with a clause that was brought up, he took the person’s name and address and promised to get back with him/her within the 24 hour period with an answer.

In spite of his efforts, not only did he loose re-election because he stood firmly behind the health care reform initiative, but the anger and fear that had been stirred up to such a frenzy, made his answers fall on deaf ears.  The people were not there to learn, but rather to try and trip up or embarrass the Congressman.

During a June 2009 speech, President Obama  outlined his strategy for reform. He suggested seven steps that would bring down the costs of our exhorbitant health care costs:  1)  electronic record-keeping; 2) preventing expensive conditions; 3)  reducing obesity; 4) refocusing doctor incentives from quantity of care to quality; 5) bundling payments for treatment of conditions rather than specific services; 6) better identifying and communicating the most cost-effective treatments; and, 7) reducing defensive medicine.[8]

In September of 2009, the President added a a few more points to the original plan: 1)  by having everyone be part of the insurance plan, the plan would be deficit neutral; 2) implementing laws that would prevent insurance companies to discriminate based on pre-existing conditions; 3) individuals would have a cap on how much they would have to spend out-of-pocket;  4) the creation of an insurance exchange for individuals and small businesses so that these entities would not be unfairly penalized for not having the numbers that larger companies have and thereby lack the means of equal coverage; 5) tax credits for individuals and small companies; 6) the creation of  independent commissions to identify fraud, waste and abuse; 7) in order to lower insurance costs for doctors to protect themselves against malpractice suits, the President added malpractice reform projects to the package.   [9][10]

Atul Gawande, a surgeon, writing in The New Yorker, further distinguished between the delivery system and the payment system.  He argued that reform of the delivery system is critical to getting costs under control, but that payment system reform (e.g., whether the government or private insurers process payments) is considerably less important yet gathers a disproportionate share of attention. Gawande argued that dramatic improvements and savings in the delivery system will take “at least a decade.” His recommendations were to address the over-utilization of healthcare in our country.  That the focus of healthcare needs to move back to keeping people healthy rather than making profits.  He also suggested that a comparative analysis system of the cost of treatments and outcomes across various healthcare providers be initiated.  Gawande argued:

this would be an iterative, empirical process and should be administered by a “national institute for healthcare delivery” to analyze and communicate improvement opportunities.[13]

When I read these points, they certainly make sense to me.  So why all the anger?  Why all the hostility?  Why all the emotion?

Because a group would stand to loose quite a bit if the Health Care Reform Act were to become law.  What group?  The Health Care Industry which is made up of the insurance companies, the pharmaceuticals, and the hospitals.  Oh, and then the investors in this industry.  (To be continued)

© Yvonne Behrens, M.Ed  2012

“Obama Care” Part 1, The History

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Since President Obama has been re-elected, I decided that I had better educate myself on the question of the Health Care Reform Act and find out what is really at stake.  I do believe that the only way the President will get the support he needs to make this initiative successful is if he and his Administration educate the public with the same energy and coordination that they used for his election and re-election.  For my part, I will begin with the history of the universal health care question in our country and move forward.

Many people think that the whole question of universal health care was “pushed” on us  by “this” president.   Untrue.  Universal health care has been a topic of discussion since the turn of the century — the 20th century.  Yes, since the early 1900s.  Why is it that the idea of universal health care has not been embraced by our country, the only advanced nation in the world not to have universal health care?  The answer to that question has many components.  Jill Lepore, in an article  she penned December 7, 2009 for the New Yorker, wrote that a group of economists which included Louis Brandeis, Jane Addams and Woodrow Wilson formed a committee they called the Committee on Social Insurance.  By 1915, the committee had drafted a bill to provide universal medical coverage.  At the time, the American Medical Association enthusiastically supported the idea and by the end of 1916, the idea was presented to Congress for their approval.

According to Lepore, part of their presentation lauded Germany as the great example to be emulated.

“Germany showed the way in 1883,” Fisher [one of the committee members] told his audience. “Her wonderful industrial progress since that time, her comparative freedom from poverty . . . and the physical preparedness of her soldiery, are presumably due, in considerable measure, to health insurance.”

However, in April 1917, the United States declared war with Germany,  killing, along with some German soldiers, any move towards Universal Health Care which was now being correlated as a product of Germany.

In Lepore’s article, we learn that:

In California, where the legislature had passed a constitutional amendment providing for universal health insurance, it was put on the ballot for ratification: a federation of insurance companies took out an ad in the San Francisco Chronicle warning that it “would spell social ruin to the United States.” Every voter in the state received in the mail a pamphlet with a picture of the Kaiser and the words “Born in Germany. Do you want it in California?” (“If you are opposed to a thing these days,” one frustrated health-care advocate wrote, “the cheapest way to attack it is to call it ‘German.’ ”) The people of California voted it down. By 1919, John J. A. O’Reilly, a Brooklyn physician, was calling universal health insurance “UnAmerican, Unsafe, Uneconomic, Unscientific, Unfair and Unscrupulous.”

Hm.  This certainly sounds familiar, although these days, the word German has been replaced with the word socialist.

Fast Forward to Franklin D. Roosevelt and the New Deal.  Once again, universal health care was bandied around as a right of all citizens.  But opposition came, in the form of Southern Senators (who were mostly Democrats at the time, because Abraham Lincoln had been a Republican), concerned about the implications that a National Health Insurance (NHI) might have in their segregated societies.  They aligned themselves with Republican senators and brought the American Medical Association (AMA) into the fold to put a block to this.  President Roosevelt, concerned that other New Deal reforms would not pass if he pushed too hard on NIH, dropped it.

However, after World War II ended, President Truman tried to implement the national health insurance once again. His plan proposed a single insurance program that would cover all Americans with public subsidies to pay for the poor.   Once again, according to an article published by the Kaiser Foundation:

Southern Democrats in key positions blocked Truman’s initiative, partly in fear that the federal involvement in health care might lead to federal action against segregation at a time when hospitals (in the South) were still separating patients by race. [The irony of the fact that it was President Obama who successfully brought universal health care into law is not lost on me.]

Also “an increasingly powerful AMA opposed National Health Insurance believing that physicians would lose their autonomy, be required to work in group practice models and be paid by salary or capitated methods.  In addition, business and labor groups were not supportive, nor was the emerging private health insurance industry. “

Now the opposition was becoming stronger.  The area of health care was being recognized as a potentially huge money making enterprise by the business class.  But the government continued to plug away at the idea of universal healthcare.  President John F. Kennedy presented the concept in the form of health care coverage for all those on Social Security.  This was in 1962.  President Lyndon B. Johnson was able to pass legislation creating Medicare/Medicaid programs to provide comprehensive health care coverage for people aged 65 and older, as well as for the poor, blind, and disabled in 1965.  At this point, healthcare related spending started to skyrocket.  Health care became a lucrative business.

In 1971, confronting the escalating costs of healthcare, President Richard M. Nixon backed a proposal that would require employers to provide a minimum level of health care for their employees, while maintaining competition among insurance companies, keeping medicare/medicaid for those over 65 and creating a pool insurance coverage for self-employed individuals.  Senator Teddy Kennedy at the time was promoting a universal health care coverage directed and financed entirely by the government.

In hindsight, President Nixon’s proposal might have helped to contain health care costs.  The issue that was being challenged by Senator Kennedy was that President Nixon’s program supported private insurance companies as the providers of health insurance.  Kennedy’s proposal would take health care out of the private sector.

The debate that occurred between President Nixon and Senator Kennedy probably best epitomizes the struggle our country has had throughout its existence [go back to the acrimonious exchanges between Thomas Jefferson and Alexander Hamilton].  The debate has always centered around the rights of the citizenry and the rights of businesses to thrive and keep this country moving forward economically.  What the debate never seems to quite latch onto is that there are some areas that are service areas by nature and other areas that fit under the intent of business.  Health care is a service area.  It should not be a money making enterprise.  When the focus is on making money, the focus is no longer on service.    [to be continued....]

© Yvonne Behrens, M.Ed  2012

 

 

BCBS – Emphasis on the BS

In my last and fourth entry about my woes and “fight” with the insurance company, Anthem Blue Cross Blue Shield, I cautiously opined that maybe, just maybe, I had won the fight because I was given a level 1 with a reasonable premium.  I should have known better.

Turns out that they have set me up as being on probation, sort of.  That is to say, for 12 months, I am not covered for any pre-existing conditions.  So I asked the Customer Service person if they had a specific pre-existing condition outlined in my policy.  ”No,” she replied.  So I asked, “Then how do I know or how do they know what might be a pre-existing condition?”  ”By looking through your medical records,” she informed me.  ”Since the time of my birth?” I asked, incredulously.  ”Pretty much,” she replied.  ”Does that mean that if I had a wart on my finger when I was 12 years old and I develop a wart tomorrow, they won’t cover removal on the basis of the pre-existing clause?”  ”That’s right.”  ”What if I was six weeks pregnant when I applied.  Does that mean they would not cover the costs of the birth?”  ”That’s right.  Here is a scenario that might help you understand.  If you go to the doctors and he finds that you have kidney stones, the insurance company would not pay for their removal because those kidney stones were forming before the doctor found them, thus a pre-existing condition. But if you should walk out your front door and fall down the steps and break your hip, they would cover that.”  ”By that logic, then,  what if I go to the doctor next month and he/she finds evidence of the C word in me. Would that be considered a pre-existing condition?” “Absolutely.  The insurance company’s argument would be that the cancer had developed before the doctor had found it.”

How did I get on this probationary period?  It all came about because although I have been using Anthem Blue Cross Blue Shield since 1997, more than 63 days had passed between the time I began my objections for the cost of the premium on my previous insurance coverage and the present coverage, thus, erasing all previous  records and causing my status to become one of a new client.

WOW!  So I am once again throwing my money out of the window and I have absolutely no positioning power to fight this injustice.

I believe this is a thumbing of the nose towards President Obama’s Affordable Health Care Act, (derogatorily termed “Obama Care” by his opponents — although some day that title will become an honorific, I have no doubt), specifically the clause in which a person seeking insurance will not be penalized for having a pre-existing condition, which, unfortunately, does not become law until 2014.  But the fact of the matter is that by utilizing “pre-existing condition” without definition, the insurance companies are basically avoiding their responsibility for covering any new client.  This clause might well also discourage people from signing on for insurance.  And the people in Congress who have put up such a fight against the Affordable Health Care Act bask in the comfort of their excellent insurance plans paid for by our tax dollars!

Well, I am grateful for this customer service person’s forthrightness and I am just kicking myself for not having thought to ask her if there were any questions I should be asking her that I had not.

I have become aware, over the past two weeks, that the danger of our society being torn apart does not just come from the major amounts of negative propaganda from the opponents, nor the major amounts of money fueling these ads and these opponents, but the choice on the part of the media to not cover what is going on.  It is truly frightening to be aware of just how poorly informed we are, and I include myself, because in spite of the fact that I plan to vote for President Obama, a part of me actually has been affected by the negative campaign that has dogged him throughout his presidency and I have not actively acknowledged/recognized just how much his Administration has been doing to try and make things better in this country.

© Yvonne Behrens 2012