Health Reform Passes - So Now What?

Well, let's get to what appears to be stuff to happen in 2010....uninsured now, and with medical problems, folks will be able to buy insurance in 2010 through high-risk pools later in the year. How it is funded, what the cost structure is like and plan design remains to be seen (probably medicaid model).

Starting this year health insurance companies will not be able to exclude coverage for pre-existing conditions, and can't drop you suddenly from a policy for that reason too. Cost structure, how they rate, presumably more information to follow.

Young, college student aged kids on parent's polilcies, to be covered to age 26.

Employers with 25 or less employees will get up to a 35% tax credit towards the cost of providing health insurance to employees, again presumably on top of the deduction as business expense too.

Other milestones will be 2011, 2012 and ultimately 2014 when it will be required to carry health insurance in the U.S. Exceptions will be for severe financial hardship, elsewise folks will pay what has been published recently (in 2010 anyway) as up to a $695 dollar fine.

The Flaw in What Obamacare DOES NOT Discuss Enough

Well, as an expert in this field for close to 20 years now, and having spent a considerable amount of my career in NYC, helping middle market companies combat health insurance premium increases, and "smart" benefit designs to prompt utilization that hopefully "slows" these carriers from ratcheting up premiums, I focus my attention on NYC specifically. There are some good intentions in Obamacare, honestly, but as an expert and listening to the often useless and almost nonsensical political jousting I get back to a place where the theme behind Obamacare has been in place, has not worked, and has pushed pricing to the SKY!!! NYC folks.... in NYC we have guaranteed-issue individual/family health insurance offered normally by just a few carriers (as they get forced to because they do tons of commercial business too) but in 2010 for example Empire Blue Cross Blue Shield, and Oxford Health Plans to name 2. We get calls daily of people looking for alternatives to their SINGLE rate of 985/mos to get an HMO plan, yes folks, almost $1,000/mos or a mortgage payment to have coverage that limits him/her to network only coverage. Well, that is exactly what Obamacare will deliver unless the young, healthy folks in this country are also forced to carry health insurance. The problem in NYC, is they can't deny coverage, and they charge the same rate whether you are deathly ill or healthy as a horse. The only catch for them to be able to apply pre-exisiting condition language is if you go beyond the 63 day "uncovered" HIPAA window (if you do not have coverage for greater than 63 days, you open yourself up to having pre-X language). So, when you get sick, you can jump in and buy, and not get denied, sounds great right? Wrong, that is how you end up with $1,000/month rate for a single 25 year old.

As such, we must have mandatory coverage like auto coverage, with a la carte plan designs, so if we want to buy hospital coverage and pharmacy coverage, but pay our own physician office visits, speech therapy, physical therapy and mental health visits, carriers should be forced to offer them....state and federal benefit mandates also kill the system(again another problem in NYC, where they mandate EVERYTHING to be covered in every offered policy - another way to DRIVE UP COSTS!).

So, let me lay this out again, a la carte plan designs, cheaper plan designs for higher deductible (my up front risk) and lesser benefits (no mental health, office visits, physical therapy, chiropractic care) and conversely, higher costs for folks who wish to have that coverage, AS IT SHOULD BE. We need to be paying a portion of the underlying benefits we consume, and others in our "risk pool" within insurance carriers need to be rated accordingly. Same thing for the "risk pools" of consumers with different product/plan designs.

I am not an actuary but have spent lots of my career around them and in HUGE institutions in which I used to work early on....smart people, who can figure out how to still get us what we need and make a profit, or perhaps not....maybe health insurance carriers should all be forced to be non-profit? Not sure on that, but strong arguement for it.

I hope this has given some insight in to the bigger problem with Health Care Reform...we do not need another NYC, nor Massachusetts (their mandatory system has absolutely imploded, for similar reasons to NYC)....

Let's go the route of how be must carry car insurance, and pay for what we actually have in benefits.

Thanks for so much Feedback

First, I want to thank all of our fans, and followers for so much great feedback on our blog, and what we say about health care reform, as well as the health care system including health insurance plans/coverage etc...so THANKS, it has been great to read, learn, and also be able to reflect on what assumptions some folks make based on their readings.

A few points of clarity, I as a specialist in this business for quite a long time have worked on and with some of the largest most complex businesses with their insurance woes (Like JPMorganChase, Scudder Kemper,even some of these mega-banks before they all merged)....I have also helped thousands of small businesses with their problems. So with that as a back-drop let me please clarify, my opinions and comments are based on lots of experiences, many years, things that have frustrated my clients and me, and also watching hours of debates from folks that I would deem to be way off "center" whether on one side of the political isle or the other. So with that said, I do not support what is on the table right now regarding Reform in its entirety as they are not talking incessantly and focusing on the real problem....THE WHOLE SYSTEM. Again as i blogged last time, I do believe we need to be accountable for researching our health care options, but we also need all of the stats to make informed choices...that is where technology is severely lacking from insurance carriers and providers (who need to get hooked up) - if I have ready data regarding the physicians that have performed thousands of ACL reconstructions (knee injury) have great rehab and success rates, low infection rates, and low recurrance of injury, and charge a fee that is reasonable (as it would be great to compare his/hers with a few other docs stats, and fees) than why in the world would I go to the "goon" down the road who charges double, screws me back together terribly with rapidly approaching arthritic symptoms and chronic pain, and ba-bing, I blow it back out running up steps to catch a train....SOMETHING IS WRONG HERE FOLKS. That is the "corner of the mouth" statement Obama says about "evidence-based medicine." That is the problem with health care, and rising health insurance premiums. Billions of waste in the system.

Somewhere we have "learned" that a person with a Harvard medical degree or Harvard Business School degree (or Stanford, Duke, Michigan, Columbia - so we do not just pick on Harvard here) is practically a law-abiding "God" who can't have criminal intent....I have read now for 2 years in the WSJ and other papers about what I would basically call criminal as far as the crap banks swapped with each other under the covers, so all parties could make repeated fees on the same crap and almost cripple the entire world economy.

I could talk for hours, and hours on this, and as someone educated in this field, who supports a capitalistic society, happens to own and operate a business, has four children of his own with his wife, has friends, parents, in-laws, nephews and nieces, likes the outdoors, is active, tells a funny story here and there, is not a staunch "anything political", and just basically thinks we need to get the healthcare system updated with good technology that supports paying for things that "work", I rest my case.