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What's up with Obamacare/Trumpcare?


March 20, 2017 - Scott Demko

This is the root question of a conversation that I have any number of times a day.  Though the details of each conversation varies, it eventually boils down to a handful of absolutes with all the rest being nothing more than window dressing.  The bottom line for today:  The Affordable Care Act (ACA or ObamaCare) is a law.  It became a law on March 23rd, 2010.  Until it is not a law, it is the only thing that we can utilize.  When and if it is overturned or replaced, there will be plenty of lead time for everyone involved to prepare for the upcoming changes and develop a solid game plan for the transition.  Remember,  the ACA wasn’t fully implemented until January 1st, 2014–nearly four years after it was put on the books.

Next comes the big question for this portion of the program:  What are they going to replace it with?  This boils down to one very simple aspect—-Will the replacement coverage ask medical questions?

The current system is faulty because it ignores the very premise upon which insurance is built.  Insurance dictates that you take an assess a value to it by asking questions, then placing a premium on it based upon the assessed value.  If you can’t ask any medical questions, how can you properly assess the risk?  Is that 37-year-old applicant 5’10″/150 lbs and a picture of perfect health?  Or is he 5’0″/500 lbs and a medical nightmare?  If you can’t ask, then you have to assume the worst—and price for it.

This set-up leads to your base rate for health coverage being a really really sick 64-year-old male, because that’s the worst case scenario available.  From there you would prorate that number down to your 37-year-old for you premium……not real equitable.  Again, this is the only route you can take if you’re not able to ask medical questions so you can assess the risk.

This leaves the medical carriers in a lurch because they are not allowed to screen the incoming population.  The carriers’ response has been to limit access in other ways.  In 2017, both Aetna and United Health Care simply left the state of Ohio (that makes it easy, huh?).  Medical Mutual of Ohio, traditionally one of the state’s strongest carriers, is choosing to write in only 31 out of the 88 counties.  Nearly all of the carriers have also reduced the network access for the insured populations, giving the insured far less choice for doctors and hospitals.  Fewer plans are available, resulting in still less choice for the insured.  The plans that are available are generally very limiting with regard to doctor visits and prescriptions……simply not the value-oriented plans that an ordinary consumer would want out of a basic health plan set-up.

To sum it all up:  If the new regime replaces the current set-up with another version of coverage that does not ask medical questions, then they haven’t done a darn thing.  They’ve given you the same dog with a different set of fleas.

So that’s a quick report of the here and now as well as what to look for when changes are made.

We’ll keep abreast of changes and report them when they come to the fore.

***As a final aside—Listen to all the rhetoric coming out of Washington daily on this issue.  This, that, and the other–blah, blah, blah–EVERYDAY!

Have you once heard anyone address the medical question issue?  I have not.  A further illustration of the fact that the people that are talking about insurance have so very little knowledge in this area.

Sigh……………………………

Health Law Update! Grandfathered Plans Deadline Extended!

March 2, 2017 - Scott Demko

On February 23rd, The Department of Health and Human Services announced the extension of the deadline for ACA compliance for all grandfathered plans that are currently in force.  The extension states that all plans currently in force may renew their plan until October 1st, 2018, provided that plan ends no later than December 31st, 2018.

This means that everyone that is currently on a grandfathered plan will be allowed to extend their plan for another year!

Rest assured, come renewal time, we will still scan the health insurance landscape to make sure that you are both properly positioned as well as set up with the best plan for your needs.

For the full official release, you can find it at the following:

https://www.cms.gov/CCIIO/Resources/…/Extension-Transitional-Policy-CY2018.pdf