President Obama: Acme Health Plans

In the recent health care summit that the President presided over, he made mention several times to "Acme Health Plans' when referring to High Deductible Health Plans (HDHP). This is just further evidence of Washington's elitist attitude toward health care options that don't conform to their view of the way the world should operate. Furthermore, his plan would all but do away with the incentives for Health Savings Accounts, therefore, rendering them a thing of the past. And for good reason. In order to pay for this massive cash cow, he has to take away the tax advantages associated with Health Savings Accounts. Instead, he should be revising the tax code to allow for individuals to deduct the amount of out-of-pocket medical expenses they incur throughout the year for co-pays and the like. Right now, the tax favor-ability only applies to individuals with Health Savings Accounts and employer-sponsored health plans.

I personally have many clients who have made the choice of going to a higher deductible plan because it made sense for them and their families.  Therefore, I find it offensive to make this characterization! To somehow suggest that individuals that choose to take a higher deductible to lower there monthly premium are actually buying "Acme Health Insurance" is just plain wrong and disingenuous on the part of the President and those who support their plan. There are many Americans that want the comfort of knowing that catastrophic medical claims would be taken care of under a high deductible health plan but don't mind paying for the smaller expenses such as office visits and prescription drugs out-of-pocket.  Especially, if the expenses are paid for out of a tax-free savings account.  To some individuals, prescription drugs may be a very big expense so a plan with a richer Rx component would be better for them.

There's a basic principal at work here that those in Congress are incapable understanding because they don't know health care and that is, the higher the deductible the lower the monthly premiums. Conversely, the lower the deductible the higher the premium. Those that choose higher deductible health plans would rather see the savings in monthly premium because that don't use the health care system that heavily. However, if they do have a catastrophic claims it's covered - many times at 100% with lifetime limits in upwards of 5 to 8 million dollars. All of these plans are provided by reputable, well-known companies like Aetna, United Health Care, Assurant Health, Health America, Capital Blue Cross and many more. It's just pain ignorance to imply that these plans are "Acme Health Plans". They are, in fact, a legitimate health care cost-reduction driver. The President and Democrats seem to be talking out of both sides of their mouths when they highlight how many Americans claim medical bankruptcy because of so-called catastrophic claims, while at the same time, look down upon a plan that allows for this very coverage for individuals to actually avoid bankruptcy.

If you'd like to understand more about how High Deductible Health Plans with Health Savings Accounts might benefit you or your company then email me at bknauss@employeemployersolutions.com or visit my website at www.employeemployersolutions.com 

Confidence In Our Goverment To Manage Health Care?

I listened very intently as the President made his passionate plea for Congress to act on and pass the current health care legislation.  He spoke of the plight of millions of people who are currently without health insurance.  He also spoke about those that have serious medical conditions that either prohibit them from getting coverage or are in jeopardy of loosing coverage.  There's no doubt that these stories tug at the heartstrings of every American.  The President also made a statement that really hit me in a very profound way.  He said that the American people are waiting for them [the federal government] to act.  Moreover, that our future, yours and mine, depends on whether or not they act.

With all do respect, Mr. President, I think it's terribly arrogant to think that you, and those in Washington, can somehow take better care of my family then I can.  After all, you don't even know me or anyone in my family.  Aside from the few Americans you've spoken to about their plight with the current health care system, you really don't know anything about the rest of us.  And what in the federal governments history of implementing programs and services can you point to that is an overwhelming success, and therefore, warrants pursuing your proposal?  Isn't that what you're really saying, that the federal government is the only mechanism to bring about effective reform?  It seems to me that the federal government has a long-standing history of exactly the opposite - complete failure regardless of the party in charge! 

Don't take my word for it, let's look at some simple facts.  Over the last 70 years, the federal government has tried it's hand at many different business endeavors such as, transportation (AMTRAK), package delivery (USPS), health care (Medicare), welfare, food distribution (Food Stamps), the auto industry, retirement planning, financial institutions and many more.  Let's examine just a few that many Americans would be very familiar with.

First, we have the nation-wide package delivery system called the United States Postal Service.  The USPS hasn't actually generated any sort of profit for years and the recent announcement of canceling Saturday deliveries came as no surprise.  The fact is, that long before the popularity of email, the USPS was in financial peril.  If it weren't for a constant stream of funding from Congress - they would have to close their doors completely.

Secondly, we have the federal governments attempt at providing transportation in - Amtrak.  Again, if it weren't for the constant stream of operating capital supplied by Congress, this form of transportation would be gone.  I happen to believe that a high-speed rail system is vital to the growth of our nation and our economy but I don't have faith in the governments ability to make it happen.  If you look at how we rank around the world with respect to well operated high-speed rail systems we are at the bottom of the list.

Lastly, let's look at the federal governments fifty year plus experiment with a health care delivery system called Medicare.  Ladies and gentlemen, I don't care whether you're a Democrat, Republican or Independent.  We can all look to the current system of health care for seniors and consider it a failure on so many levels.  The President himself points out the need to provide massive funding to keep Medicare solvent for only another 10 years.  Most seniors are grateful to have the kind of coverage they have with Medicare but most cite the unending barrage of red tape, changes in regulations, cost and coverage as some of the biggest problems with the system.  The rules governing Medicare are so enormous that brokers like myself are required to go through a separate certification process just to be able to offer Medicare Advantage Plans.  After going through it, I understand why.

I haven't yet mentioned one other huge factor with all these Federal Government attempts at private sector ventures, they become huge political footballs for those who find themselves in power.  You need to ask yourself, is that what I really want for my health care?  Polls overwhelming show that the American people want some sort of health insurance reform.  But I think an even better question to ask the America people is, do they have complete faith in our federal government to run and manage the health insurance industry?  Or would they rather it be left to the health insurance carriers like Aetna, Health America, United Health Care and Capital Blue Cross?  The over-whelming response has to be - no to the federal government!  Base your decision on history - not on sound bites or talking points.  I do believe that there is a healthy combination of government and private sector reforms that would bring about meaningful change.  If you're interested to find out what those ideas are - email me.

Whether you agree or disagree with me I'd like to hear you make your case as to why or why not the Federal Government is better suited to run our health care system by emailing me at bknauss@employeemployersolutions.com or visit my website at www.employeemployersolutions.com Thanks

Drive-Thru Health Care

With all the negative talk about the health care industry these days it's easy to overlook some very important, highly positive aspects - namely, advances in medical technology.

Americans are living longer today than anytime in our history. Advances in modern medicine have made the seemingly impossible - possible. Technology has improved laboratory testing; allowing for the development of CT scans, MRI's, and PET scan imaging to improve diagnosis accuracy. New advancements in treating heart disease have made it possible to treat a potential heart attack within minutes rather than hours. Hospitals have highly trained and technologically savvy medical professionals available a round-the-clock to treat patients. Cure rates for critical illnesses are up. The pharmaceutical industry has produced a myriad of new drugs to effectively treat anything from high cholesterol to reducing the effects of clogged arteries. There are drugs for treating impotence, depression, high blood pressure, osteoporosis and anxiety. Successful organ transplants and joint replacements have increased the quality of life for countless Americans. These are all some amazing advancements that each one of us should be grateful for.

However, these modern miracles have created an unhealthy level of expectation with so many Americans that wrongly think we can have our cake and eat it to. It's gotten to the point where Americans act as though they're going up to the drive-thru window to order their health care. It might sound something like this, "may we help you sir/madam?" "Yes, I'll have one upper GI and a lower GI, I'd like 5 different inhalers to improve my lung function so I can continue to smoke. I'd also like to order an MRI and why don't you throw in a CAT scan while you're at it! Let me get the gastric by-pass surgery to. One knee replacement and my usual 30 day supply of high blood pressure meds, anti-depressants, anxiety medicine and my purple pill for acid reflux - to go please". "Will that be all sir/madam?" "That will be all for now".

I don't mean to sound flippant about such important matters. Really, I know how vital these advancements are to changing the lives of some many. However, we're under some kind of illusion that we can have such a high demand for all these amazing wonders in medical science and not have costs spiral out of control. Our Government is making a promise that they just can't keep. We can't possibly stay on our current course and be able to effectively reduce health care costs. Furthermore, if we stifle advancement in the medical community by a massive government takeover then the only result will be to reduce the level of advancement.

The other myth that we fall prey to is that we can reduce the cost of health care without making any personal sacrifices to our current lifestyle choices. If we don't become a national that values health and wellness again we can forget about making any real and sustainable impact on our nations health care costs. Obesity, for example, is related to so many controllable and preventable medical conditions. We need to take more personally accountability for our own health and well-being and stop looking to the government or the medical profession to take care of us from cradle to grave and start with making right lifestyle choices today. No one will look out for you better than you!

My mission is to make the complex world of employee benefits understandable. Please reach out to me at bknauss@employeemployersolutions.com, visit my website at http://www.employeemployersolutions.com/ or twitter me at http://twitter.com/mployebenefits

The Year of the Broker

With all the changes to health care being talked about in Washington today, the consensus seems to be that employer groups are going to be more likely to seek out the expertise of a professional employee benefits broker. In the past, employer groups have been largely split on the value and benefits they derived from dealing with a professional. Some, have been under the false assumption that if you go through a broker your premium will go up to compensate for commissions being paid out - that's just not the case. Rates are the same regardless of whether or not a broker is involved. The same is true for the individual market, yet still, many people try to got it alone on-line to secure the right health care coverage for their family. Here are some interesting facts:

Plan Sponsor's Current and Future Use of Benefit Brokers

1. Currently use a broker/consultant - 83%
2. Use of broker/consultant will increase in the next five years - 17%
3. Use of broker/consultant will stay the same in the next 5 years - 64%
4. Use of broker/consultant will decrease in the next five years - 8%
5. Don't know how use of broker/consultant will change - 11%

* source Benefits Selling Magazine January 2010 edition

Regardless of where you stand on the whole idea of overhauling our entire health care system, it doesn't negate the fact that managing employee benefits going forward will not be reduced in the level of complexity but only increased. Underscoring the need to deal with a professional benefit broker. If you don't currently work with a broker/consultant or you're not happy with the level of service you've been getting from the one your with than we should chat. It's very easy to switch. I can be reached at:

email: bknauss@employeemployersolutions.com
website: http://www.employeemployersolutions.com/
twitter: http://twitter.com/mployebenefits

Medicare Changes For 2010

Section 102: Currently, Medicare outpatient mental health services require beneficiaries to pay a 50% co-payment under Part B. Other physician services under Part B require only a 20% co-payment. A phased reduction in this co-payment for outpatient mental health services begins in 2010. In the actual statute, the current co-payment amount is not described as “50%”. Rather, it defines what counts as incurred costs in such a way that the result is a 50% co-payment. So, the current statute counts incurred costs at 62.5% and this results in a 50% copayment for beneficiaries. In 2010, instead of incurred costs counting at 62.5% as they do now, they are counted at 68.75%. Once the definition of incurred costs reaches 100%, there is parity.

Section 112: Currently, the Medicare Savings Programs (QMB, SLIB, QI-1) have countable resource limits of $4000 for an individual and $6000 for a couple. This provision increases the amount of allowable resources for applicants to these programs so that it is the same as the resource limit for the full low-income subsidy individuals in 2010. The full low-income subsidy program has higher resource limits that increase based on a formula every year. Therefore, this change should result in an enrollment increase into these Programs, which can provide much needed assistance in Medicare cost sharing.

Section 113: Beginning January 1, 2010, SSA shall have in place a system for electronically transmitting information from an LIS application to the appropriate state agency that accepts Medicare Savings Program applications. Transmittal will only 4 occur with consent of the beneficiary. The information will be used to complete an application for the Medicare Savings Programs.

Section 115: Under the current Social Security statute, states are allowed to collect from the estates of deceased individuals any items or services under a state Medicaid plan that were provided to the individual when he or she was 55 or older. This Section amends the statute to eliminate that authority to collect from Medicare cost-sharing (the Medicare Savings Programs) beginning in 2010.

Section 116: With respect to applications filed on or after January 1, 2010, the value of a life insurance policy and in-kind support and maintenance will not be considered as income or resources for LIS determinations.

Section 118: This provision requires the Secretary provide the application for the Medicare Savings Program in the 10 languages (other than English) most commonly used by applicants for Medicare hospital insurance to states and the Social Security Administration. Such applications must be provided by January 1, 2010.

Section 176: Beginning with the 2010 plan year, the Secretary is required to identify categories of drugs and require that all drugs in those categories that are Part D covered drugs be included on all plan formularies. Such classes must meet specific criteria. It is generally expected that the current 6 protected classes would meet this criteria. The Secretary is also allowed to establish exceptions to this requirement for particular drugs within the class, including allowance for benefits management tools. However, any of these exceptions must meet particular criteria and can only be allowed after notice and comment.

Section 187: A report is due no later than two years of the date of enactment (July 15, 2010) that will describe the extent to which providers and plans are complying with Title VI prohibition against national origin discrimination affecting limited English proficient persons and the Office of Minority Health’s Culturally and Linguistically Appropriate Services (CLAS) Standards. This report shall also make recommendation on improving compliance and enforcement of CLAS Standards.

For more information on Medicare and Medicare Advantage Plans email me at bknauss@employeemployersolutions.com visit us on the web at www.employeemployersolutions.com or Twitter me at http://twitter.com/mployebenefits