UHC and Obamacare; More of Your Money

My Answer to a customer who asked,

“This caught my eye over the weekend. Does this change our decision matrix at all?”

This customer is in the middle of making decisions today for their employees. I wrote the  email that follows to help them understand what this article is really about. The customer can move ahead as planned but should know more changes are coming for Obamacare. More importantly I explain how this article is an example of how the government and insurers do not care about your health.

If that’s important to you read on.


 

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The article includes this CEO quote,

“We cannot sustain these losses,” Chief Executive Officer Stephen Hemsley told analysts on a conference call. “We can’t really subsidize a marketplace that doesn’t appear at the moment to be sustaining itself.”

Source: http://www.bloomberg.com/news/articles/2015-11-19/unitedhealth-may-pull-out-of-obamacare-marketplace-stock-slides


 

My email to my business customer asking about how this UHC article may affect their present decisions for their employees.

Short answer to your question about UHC:

No, what they’re deciding makes no difference for your decision today. Your decision today will only be good until they make more changes and they do that everyday. What you decide today could change tomorrow, that’s not a joke, that’s real.

Long answer to your question about UHC:

Still, the answer is no, this won’t affect you in the short term and you can’t plan long term.

I’ve been using the words, “shifting sands” for 5 years now. The Obamacare law is 5 years old, March 23rd, 2010. Shifting sands means continuous course corrections by all system stake holders that affects more than $2-3 Trillion of the American economy. This means, today UHC is saying they’re out. But, what it actually means is they’re lobbying for more money. What we have going on here is “lobbying for position.” In the halls of congress, the industry exerts leverage in order to get more money from the government. Welcome to modern politics.

Our elected officials didn’t read the law; they had no idea what they approved and now it’s obvious. People like me have been calling attention to the cost problem for 5 years or more (my blog: https://www.donwatza.com/category/benstaff-inc/white-paper-research/) but the American public won’t listen to someone like me over articles like this. The evidence and problem is documented in my white paper posts.

Sad, but true, I can confidently say, I’ve never seen a bigger mess. Before Obamacare, Healthcare needed a fix because the insurance industry wouldn’t police itself. But, this isn’t a fix and national healthcare won’t fix it any better either (watch my video on, “US healthcare system in crisis”).

My guess about UHC? UHC and the feds will make up; the feds will give UHC more money (this will drag on over the next few months) and in order to give them money they have to make the fix look like they didn’t. In the end, just more rules, overhead, confusion and frustration; and cost.

Summary: The government is making massive changes everyday while the plane is flying. Thoughtless unread regulations created this mess and their fix is a daily stream of thousands of new patches, regulations, paperwork and confusion. I’ve been living in the trenches for 5 years trying to help employers understand and navigate. The reality and size of this law is starting to impact small employers like you.

 There has been NO improvement in health or cost because your health doesn’t matter to them (any of them). What are we going to get if we keep doing what we’ve been doing? Do you expect a different result?

My frustration is clear, we’re in an awful mess and no one cares. There’s a different voice that’s needed; here’s my hope (https://www.donwatza.com/about-2/owners-health-initiative/).

Peace,

Don

Read Don’s Huffington Post Article for Owners

PS

P.S. I will add below related articles;

“Insurers say Obamacare changes needed soon to protect companies from losses” USA Today, 11-24-2015.

“New research out this week from Commonwealth Fund shows far fewer people think their insurance premiums and deductibles — from employer-provided or exchange plans — are affordable than the government does when it defines affordability. About 40% of 2,700 people surveyed said they delay care and prescription refills when they were sick because of high deductibles, Commonwealth found.”

http://www6.lexisnexis.com/publisher/EndUser?Action=UserDisplayFullDocument&orgId=2778&topicId=100025082&docId=l:2487319212

It’s morbid to compare: GM 124; Hospitals 400,000

Outraged over auto deaths?

Mary Barra in front of congress.
Mary Barra in front of congress.

All human life matters and to my way of thinking it’s good the autos and government have a way to track responsibility. I live in Detroit so that makes me a car guy. I feel attached to the auto industry. It’s good the cars we drive are safe.

Outrage over car deaths, of course, makes sense. And, the autos have taken responsibility because the government has a good method to enforce the autos to be accountable to the public.

General Motors will pay $900 million to settle criminal charges related to its flawed ignition switch that has been tied to at least 124 deaths.

CNNMoney (New York) September 17, 2015: 2:46 PM ET;  “GM CEO: ‘People died in our cars’ ” Poppy Harlow

http://money.cnn.com/2015/09/17/news/companies/gm-recall-ignition-switch/

Let’s compare; outrage over 124 auto related deaths compared to more than 400,000 preventable deaths at hospitals? Where’s the outrage? Where’s accountability?

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Healthcare IT news aritcle,

 

In this article, congress talks about possible solutions but isn’t demanding accountability from our medical system.

“The tragedy that we’re talking about here (is) deaths taking place that should not be taking place,” said subcommittee Chair Sen. Bernie Sanders, I-Vt., in his opening remarks.

Healthcare IT News, Erin McCann “Deaths by medical mistakes hit records, the way IT is designed remains part of the problem.” WASHINGTON | July 18, 2014

http://www.healthcareitnews.com/news/deaths-by-medical-mistakes-hit-records

When I talk about our medical system is broken, it’s clear that if the auto tracking method were applied to hospitals we’d have accountability.

Here’s a quote from the same article;

In the hearing’s closing questions, when Sanders inquired as to why this crisis was not constantly splashed across front page news, he was met with this: “When people go to the hospital, they are sick. It is very easy to confuse the fact that somebody might have died because of a fatal consequence of their disease, versus they died from a complication from a medical error,” Jha said. “It has taken a lot to prove to all of us that many of these deaths are not a natural consequence of the underlying disease. They are purely failures of the system.”

In our premiums and in our government run healthcare we pay for these services.

But, our system requires more fixes than just this. The white paper is breaking apart many pieces of the medical system apparatus in order to demonstrate the areas where the system is broken. Follow the white paper for what’s wrong, then we’ll be publishing the fixes in 1qtr 2016.

A Real Life Story of Accepting ACA Changes for a Small Business; Part II

Part II – a Small Business Looking to Do Better

The story starts with a business who engaged us for our Decoder because they asked the simple question, “we know it’s different than it use to be, and we perceive we could do better but we don’t know how to make the right decision.” In the first post, a couple days ago, you learned about the background a little bit. Feel free to review that post below.

Today, we’ll begin to cover details about who is being covered and who is not. It’s very common to have employers who cover individuals that should not be covered. Would you be surprised to know that employers have been known to cover deceased employees, or family members? When we visit with employers we never expect problems but we’re never surprised to find them either.

Job One, Research

Our first job is to research the details about all those covered and all those who are, or were, working for a company. We ask for lists that would show us this information. For instance, tax statements that provide lists of employees and payroll reports that show hours worked plus HR rosters of employees and former employees and other data. The research starts almost immediately and it usually entails asking questions about documentation that’s available that an insurance company would ask to prove the status of an employee or dependent. Identifying problems can be as easy as doing this research.

Our research immediately draws our attention to questions about a former board president who is still covered. In asking questions, it’s obvious there is no current relationship with the former executive. They had been involved and were made promises by the company. As we discuss this with current ownership, no one wants to address the issue with the board or the former executive. We helped solve the problem by including a proper commentary about the liability to both parties for covering someone who should not be covered.

But the former executive had an agreement?

Insurance companies can audit large claims any time, that’s in the small print. If they audit a claim on a former executive, like in our story, and they discover this person is covered it would be bad for both the employer and former employee. Coverage for groups means employees of the group must be covered and individuals who are not employees can not be covered. This is why it’s called group coverage.

So what actually would happen?

If an audit were to occur by the insurance company they would deny the claim of the former employee stating they’re not an employee of the company and not eligible for “group” coverage.  This is bad because the former employee and covered individual could use promises by the government to impose upon the employer the need to pay the claim. To keep the story simple, I’ve eliminated all the details and possibilities for how this could happen. The point is, there’s a chance the employer would be stuck paying the claims of the employee without insurance coverage. This is bad for everyone.

When we arrived the former employee had been on the plan more than 10 years. Why this had been left to linger is anyone’s guess.

What was the outcome?

The employer and former employee understood the risk to both employer and former employee. We introduced an agent who could help with individual coverage. We directed them to seek individual coverage immediately. This was completed within a week. As a note about how this worked, ACA makes transition from group to individual possible because it eliminated pre-existing conditions and medical underwriting. In the old days, these two rules made doing what we did much more difficult.

This small adjustment to the rules gave us the understanding to help the employer. Because the Decoder puts all of these facts in writing, it made it much easier for the employer to make the change with confidence. They just had to see it in writing and be able to show the former employee as well. This is the purpose of the Decoder.

If you enjoyed the story, or learned something from it, please let me know in the comment below. Do you have your own insurance story?

See All Your ACA Options With Your Eyes Open.

A Real Life Story of Accepting ACA Changes for a Small Business

The ACA landscape is “shifting sands,” a phrase we coined a couple years ago as we started designing the “BenStaff ACA Decoder“. I’d expect by now everyone understands ACA like we do. Sadly, this is a long way from true. We’re troubled that so few owners are taking advantage of options but then, there is so much “shifting sands” no one who does this part time should be expected to “get it” fast. There is a thread of continuous change, consider this example; the government just announced that open enrollment that ended 2/15 is open still through 4/15. You can still enroll so don’t miss out. See my post, or talk to one of the agents we like to make sure you don’t miss this NEW open enrollment.

Today begins a Story

ACA has changed the world of benefits. We're using our Decoder everyday to help employers meet the challenge.
ACA has changed the world of benefits. We’re using our Decoder everyday to help employers meet the challenge.

Today, I wanted to begin telling a real life story about a family and small business. Of course, names have been changed to protect the innocent (a bit of a Dragnet reference). The reason for it to be a multi-part story, is to allow me to keep tackling the days work. If you follow the story you will learn what’s really happening in the employee benefit world and how it affects you, or could affect you.

It would take too long to write the entire story in one sitting and likely, you wouldn’t have time to read it. If I understand my audience, your interests are different than your neighbor (in viewing anyway). My interest in telling this story is the circumstances cover most every variation for you. Undoubtedly, in this story, there’s something in it for everyone. Owners will appreciate it and also will their HR and Finance staff plus any employee of any employer plus individuals looking for coverage. This story is about any typical business trying under the new law to provide coverage. It should help us collectively understand what ACA means in many different ways.

Part I – a Small Business Looking to Do Better

The story starts with a business who engaged us for our Decoder because they asked the simple question, “we know it’s different than it use to be, and we perceive we could do better but we don’t know how to make the right decision.” This is the question that we answer most of the time. So, here’s a brief background for the story. This is an employer with 18 employees many of whom are part time. We agreed to complete an ACA Decoder for them. We delivered the Decoder to the owners (2 of them) and started the conversation about which of the 3 options was best for them to pursue.

No two employers are the same and no two employers can solve the problems the same. No matter the employer size there are issues employers are facing. There are more than 20 options available to employers. And most employers are facing today’s rate increases with the same tools and intellect as they did last year, or the year before that and this is not serving them well. It’s why no matter your best efforts, you will find employers who use the Decoder do so with added confidence. As you will see with the story as it unfolds over the next few days.

This employer had an agent who was capable by any measure but not attentive to the employers needs. Of course, we established a connection with the current agent by encouraging them to participate with the completion of the Decoder. They objected to the idea and explained they would not be participating. This is so unfortunate, why would an agent not want to work with BenStaff or me to help a customer make a better decision and implement change? This kind of reception by the agent community really doesn’t make sense but we offered introductions to local agents who we knew who would work with us to develop the Decoder. The new agent worked with us to develop options, added a new customer and delivered the services I told the customer they should expect.

Too bad for the old agent but as you will see, the story ends happily every after in the end, you will see how we helped the employer navigate the ACA shifting sands by digging in and getting it done.

I’ll post Part II in the next day or so. Stay tuned.

Physicians form group to advocate for Obamcare change

Physicians need a way out, we call them locked doc’s. These are doctors, especially primary care physicians who are being crowded out of doing their work. This sounds particularly harsh but have you asked your physician about staying in business?

This is a good article describing a physician PAC built to bring change.

“All these things are churning and it’s imperative that the subject of the ACA come up (in Congress),” Singer said. “The ACA is not sustainable. We want to play a role in influencing the agenda to make sure patients are first.”

Read more at http://www.sunshinestatenews.com/story/democratic-obamacare-supporters-doctors-are-watching

Contact us to talk more about a small course correction that would have a big impact.