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/).



Read Don’s Huffington Post Article for Owners


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.”


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


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


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.

Hard Working Americans Trust Their Leaders

Do You Think Leaders are Making the Same Decisions You’d Make?

Link: http://www.pacificresearch.org/home/article-detail/?tx_ttnews%5Btt_news%5D=6814&cHash=b34e1ec79d3e473aab5f27222d25d467
Ordinary Consumers Are Paying For ObamaCare’s ‘Savings’

Obamacare is not “affordable” because it wasn’t intended to lower costs, only increase them (see video why). Obamacare created a way to give an insurance card to 16 million Americans. The lie was that it would save money.

As a medical economist, a veteran of rating and pricing, of more than 28 years, it’s time to consider real reforms before we leave more decisions to poor leadership. The direction we’re headed will guarantee us a healthcare system that looks like our struggling cities and schools.

Ordinary Consumers Are Paying For ObamaCare’s ‘Savings’

“ObamaCare may cost the feds less than anticipated, but it’s extracting far more from consumers’ wallets than they bargained for.  …

Meanwhile, overall health-care spending has increased drastically under ObamaCare.”

Source: Pacific Research Institute, quoting Investors’ Business Daily, April 7th, 2015, Author Sally C. Pipes. It can be found at this link: Pacific Research Institu…r ObamaCare’s ‘Savings’ 4-7-15  and from the original web source at:

When Obamacare was conceived it threatened the existence of many players in the “healthcare system.” These players gathered together to stop Obamacare from becoming law. To get the law passed and accepted by the healthcare system stakeholders, Obamacare authors provided access to all these parties to participate in Obamacare in a way that helped their position. Maybe you’d call this “bellying up to the bar.” They were afforded the opportunity to lobby their position and were offered incentives to accept Obamcare, or at a minimum not fight it. All the Stake holders got something except the American public. They were not represented and as a result they are now paying the tab in these higher rates.

Are you suspect of that this is true? If you want proof, read the law and you will find revenue that is earmarked for every stakeholder in the system who “bellied up to the bar.” If you unravel what was signed into law five years ago you will find only a token measure or two that helps Americans. And, at that, they’re only there because they made good sound bites for the public.

It’s amazing that with the intellect of so many, that so little was done.

Making the systematic changes that will make healthcare more affordable are not pie-in-the-sky ideas but ideas that will work. They will require hard work, if you want to help out, call me.

5 Reasons to Avoid Self Funding Your Health Plan

Bring balance to your decision making with an independent evaluation.
Bring balance to your decision making with an independent evaluation. www.DonWatza.com

Small Businesses are putting their businesses at serious risk

In talking with prospective employers one of the most popular topics that arise is self-funding. It being sold like it is the magic solution for employers. The fact is, it’s being sold because it’s an expedient way for carriers and group agents to “stay in the group market.” This means, by offering self funding as the preferred option to “save money” the agent can keep an employer in a “group” policy.

A group policy is much better for a group agent because they can maintain the employer relationship and write greater premium with one policy, the commission is greater too. It is much easier to sell the “popular” fad solution than to dig into the specific details of your plan. There is a large investment of time needed to do the best job comparing all the possible options.

Unfortunately, in the process to “win the sale” important facts about self-funding are left out. There are pitfalls to self funding no matter what your agent, consultant, carrier, TPA or administrator may say. Employers must consider the small print about self-funding before jumping in.

For larger employers, there are benefits to self-funding, but for a group of 25, 40 or 75 employees it is a bad idea. The proposed gain can easily be outweighed by an unexpected $1,000,000 unpaid claim.

Here’s a short list of reasons that should give a small business owner pause before self funding.

1 – Being an Insurance Company Isn’t On Your Bucket List

Being self funded means you move out from under the safety of having an insurance company paying claims. There’s the potential that you may have to pay claims when the TPA/administrator/insurer decides not to pay.

Not to mention, all the new rules and obligations.

2 – You Want to Buy Coverage, Not Be the Coverage

Here is a quote that most people would call the “small print.” You won’t find it in the typical sales material or presentation. You will find it when you’re asked to defend the non-payment in court.

“The participating employer agrees to be solely responsible for compliance with all laws, including the payment of any required benefits that are not covered as illustrated in the Summary Plan Description or the stop loss policy.”

Administrator Actual Policy Language

3 – You Become The Expert In Making This Decision

This carrier is being honest when they say, you should have experts telling you what to expect before you choose self-funding. This quote is a warning found in the sales material.

“While many employers can benefit from a self-funded plan, it may not be the right choice for every business. The biggest question a small group employer has to consider is if the additional risk will jeopardize their business.”

Administrator Advertising Materials

If you self-fund you will need a qualified person to evaluate your risk before making the decision. Your sales agent, consultant, insurer, CFO, HR person are not qualified to make this assessment. Will they pay the claim or will that come from you, the owners pocket?

This is a skill that is working for others every day why not ask for help after all, you hope people hire you for your expertise.

4 – You Didn’t Have Time to Read the Small Print

"If a material or fraudulent omission or misstatement is made in the application form, We have the right to deny any claim."
“If a material or fraudulent omission or misstatement is made in the application form, We have the right to deny any claim.”

The Big Print makes promises but the small print takes those promises away. When your self-funded administrator, TPA,insurer decides not to pay a claim, you’re on the hook. You as a business owner become the checkbook.

It’s true, in today’s sophisticated and complicated healthcare world it’s becoming more necessary to independently evaluate your options.


This is just one example of the big print:

“Your maximum self-funding cost for the plan year is determined up front – and it’s guaranteed not to change, …

And here’s one example of the corresponding small print written into the policy of the carrier who published the “big print” quote above. There are many statements like this and you should know them all, or have someone who does.

  1. “We issued this coverage in reliance upon the accuracy and completeness of the information provided in the application form and during the enrollment process. If a material or fraudulent omission or misstatement is made in the application form, We have the right to deny any claim, rescind the coverage and/or modify the terms of the coverage or the premium amount.”

Actual policy language, page 1.

5 – You Didn’t Make a Benefit Plan to Tell Employees They Aren’t Covered

It happens, google the topic of “self-funded plans that couldn’t pay claims” and you will find 42 million website hits (graphic below).  The point is, there’s not shortage of problems for those who get in over their head.

Google search on self funded plans that couldn't pay claims.
Google search on self funded plans that couldn’t pay claims.


Do you Still Need Convincing?

Show me the options in front of you and I’ll show you the trouble.

Send any quote you have received and the comparisons I’ll give you my two cents for free.

This offer is available to owners only. Send them to my email without PHI, djwatza@gmail.com.

Source: Actual administrator and carrier language from marketing promotions and specimen policy.