The insurance company lobby AHIP is making demands and it is at our peril that consumers remain silent as President Elect Trump shows his stuff when it comes to meaningful negotiation.
By now we know that insurers were really behind Obamacare, laid out in their 2008 "deal" for Obama trying to satisfy Obama's political agenda of playing the hero and avoiding denial of those with pre-existing conditions while offering up the rest of America in sacrifice with the individual mandate--BUY THIS CONSUMER FINANCIAL PRODUCT OR PAY A TAX PENALTY, ("Health Plans Propose Guaranteed Coverage for Pre-Existing Conditions and Individual Coverage Mandate,” produced by AHIP).
Naturally, it didn't work. They never got the enrollment they wanted, raised their prices anyway, got their government partners to make it harder for people to choose by raising prices on cheaper health plans more each year than more expensive plans hoping to close the gap between cheap and less cheap plans thereby making selection of more expensive plans a "better deal," got CMS to bar the availability of short-term health plans that were keeping the young-healthies out of exchange plans, and finally, after dramatic price increases, pulled out of exchanges anyway when the government's temporary bribes in the form of risk corridors and risk reinsurance, designed to protect them from losses expired for plan year 2017.
But back to Trump--We KNOW Paul Ryan is not the answer. He's already shown he's the Republican Obama, willing to deal by giving in just to get "something" done. And the letter from AHIP confirms it with a heavy emphasis on continuous coverage which is just another way of forcing Americans to buy insurance or pay a penalty, in this case, higher premium prices, a continued scam of non-insurance (which is coverage designed to cover UNANTICIPATED medical costs) with the Obamacare style "service agreement," covering preventive checkups and education--finite cheap costs INSTEAD of medical needs for which we pay more under Obamacare in the form of higher deductibles, coinsurance, copays and face narrow network choices, balance billing risks, and STILL pay increased amounts to insurers.
So now consumers can play mute, believe the words of government partners with insurers as we did with Obama or speak up.
AHIP's "new" way of pacifying presidential goals while lining their own pockets: AHIP's at it again with their new document, "Making Health Care Work for Every American, Solutions to Deliver More Competition, Market Stability and Affordable Coverage," their new title reflecting how insurers are trying to hoodwink us again, meet this new President's demands so he can brag politically and still screw consumers.
Hopefully Donald Trump's ego isn't as fragile as Obama's and he'll actually look at the deal and use the strongest power, be willing to walk away from it.
I'll refer here to and thank TPM and its December 7, 2016 article by Tierney Sneed, "Insurer Trade Group Lists Its Demands Of Republicans In Obamacare Repeal Fight," because it's got a full copy of the AHIP letter. Here I address the provisions in the newest INSURANCE COMPANY DEMANDS LIST.
AHIP DARES TRUMP: This one should be easy for Trump. The letter opens with a threat: Repeal can "either begin a stable transition to a better approach, or they can bring about even more uncertainty and instability." Hopefully President elect Trump recognizes the threat and recognizes that a STABLE BAD INDUSTRY is not a goal. Obamacare was so bad that even as we were told it's all good, we knew it was unstable, with a rash of regulations trying to fix patchwork gaps, with insurers still pulling out of exchanges--Obamacare taught us that BAD LAW IS NOT STABLE.
AHIP Wants Continuous Coverage (An individual mandate by another name is still a mandate): Told you this one was coming and for consumers it amounts to the same thing as the individual mandate: Buy our product or you'll pay more. Under the individual mandate you pay more via tax penalty under continuous coverage you get charged more in premiums. This is NOT acceptable. Continuous coverage is the individual mandate--forcing people to purchase a consumer financial product or be penalized. For consumers, this is non-negotiable NO CONTINUOUS COVERAGE MAKE 'EM PAY MORE IF THEY DON'T BUY OUR PRODUCT.
AHIP wants high-risk pools: It sucks that we're charged more based on habits or age or prior illness, but Obamacare did NOT create a single risk pool (just another presidential lie). Under Obamacare people were charged more based on age and tobacco use--already obviously not a single risk pool. Then the government also started eroding employee and individual rights to be screened by insurance companies which information was used to "better price" insurance plans, same thing except charging more to a group based on the health of the individuals in the group.
But here's what Trump CAN do: Insist on a cap--an out of pocket maximum (which we already have but which keeps going up since CMS is partnered with insurers) that INCLUDES Premiums. If this UNIVERSAL OUT OF POCKET INCLUDING PREMIUMS exceeds a certain dollar amount, insurers are on the hook for the rest. Then the ball's in their court---Extort your money up-front in premiums or extort it with lousy coverage of needed medical services, but the out of pocket is firm.
Then AHIP pushes HSAs: Of course they do, and under Obamacare our government supports it, because these old time plans, nicknamed "healthy-wealthy" plans with enormous deductibles are a way of getting healthy people to pay more of their medical costs by luring them with the "savings" opportunities if they don't spend all the money in a year. Here's the problem: The savings disappear the minute you're sick and the plans favor those with multiple insurances eg married couples who have one traditional insurance policy and an HSA.
Then AHIP wants states to develop solutions: Sounds great except that many state insurance departments have been phoning it in, which in part brought us Obamacare. Still, it might be a good way of cleaning house in your own state as well as all the state-level public employees who also like Obama, ceded their ability to negotiate with companies doing business in their states and instead took a, "Yes sir," approach to insurance company demands.
Then AHIP wants continuous coverage: Yeah, this isn't listed in error, they demand it again, the individual mandate of continuous coverage: "What is clear is that the foundation of an effective individual insurance market is continuous coverage…" Individual mandate, continuous coverage kills consumer CHOICE and deincentivizes insurers from producing a product that consumers want.
Then AHIP advocates government paying them: AHIP advocates for continued government payments through January 2019. No sir. These payments should stop immediately because whenever they stop insurers will make up the money elsewhere (raise their prices, reduce coverage, not offer plans). We don't have to guess this, we just have to acknowledge it by looking at this year's insurance company behavior when the temporary government bribes stopped under Obamacare, the risk reinsurance and risk corridor provisions.
Then AHIP wants insurance company taxes decreased "promising" that this will help them keep their INCREASES lower--Nonsense, insurers will keep charging more especially if we're forced to buy their product. They want a tax decrease? Hinge it on consumer reviews of their plans, popularity of their plans, acceptance of their plans instead of relying on the foreseeable broken promise that they'll increase their premiums less if they get the tax break.
Then AHIP wants the government to cover the poor to make sure they get paid--Let 'em use Medicaid: AHIP threatens to make sure that "…people who are eligible for public programs…[are not]…inappropriately steered into the commercial insurance market."
Then AHIP wants continuous coverage: Nope, no error, this is the third time AHIP demands the individual mandate aka continuous coverage.
Then AHIP advocates retaining Medicaid expansion where the federal government pays the lion's share of payments for newly eligible for Medicaid. This one should go unless the structure of Medicaid changes to a unified Federal government-majority responsibility. Right now the costs are shared, state and federal. Insurance companies are making a killing on Medicaid. If states are responsible for Medicaid and to their citizens, this is better handled by states instead of the one-size-fits-all federal. States would not get the federal dollars if they didn't satisfy federal requirements.
Then AHIP wants to be unaccountable: This one is almost crazy, the insurance companies want to "reduce red tape," by removing just about ANY requirements for THEM such as: network adequacy (already an insurer weapon, making the choice of participating providers pathetic at best), no quality reporting, no rate reviews, and no requirements that they provide Summary of Benefits Coverage, renewal notices (which after all, if they don't give you those your insurance lapses you get charged more).
Then AHIP wants Medicaid to keep paying and wants to make sure that the governments pay enough and don't have the option of using "…private sector health plans for Medicaid programs."
Then AHIP wants to be able to do what they want and call it Medicare Advantage. Already these plans are not bound by Medicare requirements under federal law, AHIP wants them to provide even less.
That's AHIP's wish list and if Donald Trump succumbs to the ego-based Obama-like conduct of "I did something," we will be worse off after repeal. Paul Ryan, the political hack who protects public employees like himself while slashing benefits for taxpayers will succumb, after all, he's a Republican version of Obama. But Trump we can only hope will not.
Instead Trump must not deal with the domestic terrorism of insurance companies.
First and foremost, whatever Americans are expected to live with, federal public employees live with--no more superior benefits by people justifying slashing ours.
Second, out of pocket limits, absolute for everyone. If insurers want to charge someone more in premiums, do that, if they steal it by covering less, do that but let them know there is an absolute non-negotiable cap on what consumers pay.
Tax penalties if an insurer denies health insurance to applicants for reasons other than fraud combined with a government program to cover those denied insurance policies for pre-existing conditions.
Consumer choice of plan without a surcharge penalty for gaps in coverage. Reasonable choice of providers or liability of plan to cover out-of-network care. Penalize defensive medicine instead of rewarding it through "preventive" checkups that amount to a cottage industry and increase the risk of a consumer experiencing MEDICAL ERROR, the third leading cause of death in this country.
Don't mandate that insurers offer coverage to up to 26 year old grown children, instead let them decide to bring in the young healthies (or not) by offering such coverage to older employees. Implement a tax break for consumers who pay for the health insurance policy of any other adult in the US to encourage charitable giving of such policies to Americans.
Remember, we're 26 out of 36 in our life expectancy ranking by the OECD, if we're not brave now, things will only get worse.
Instead, let's face it if we're being threatened with instability BY INSURANCE COMPANIES that have gotten rich off our HEALTH NEEDS, get rid of health insurance all together--if it's useless and we have the choice we will opt out. Eventually doctors will charge less as insurance bucks dry up, eventually hospitals will charge less as insurance bucks dry up, eventually, after sick Americans declare bankruptcy and America's already substandard life expectancy which is currently 26/36, "Life expectancy in the United States ranks 26th out of the 36 member countries of the Organization for Economic Cooperation and Development (OECD) worsens still, we'll come up with something new.
But more OBAMACARE, government partnership with insurers to focus on education and prevention, finite costs INSTEAD of cost of care and charge MORE for those policies each year AND require every American to buy them or be financially penalized (continuous coverage) even as our life expectancy drops? Trump's answer should be simple: NO.
