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Healthcare-Left & Right

 

The Law From The Left

Passed in March of 2010, the Patient Protection and Affordable Care Act, or PPACA (Public Law 111-148) as amended by the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) substantially reduces the number of people in the U.S. without health insurance, primarily by significantly increasing the number of individuals receiving government funded Medicaid, creating new federally funded health care subsidies, and establishing a federal mandate to purchase health insurance or pay a penalty. 


Compared with prior law, the ACA is now estimated to reduce the number of nonelderly people without health insurance coverage by 30 million to 33 million in 2016 and subsequent years, leaving 26 million to 27 million nonelderly residents uninsured in those years.  

between 20 million and 23 million people will receive coverage through the new insurance exchanges, and 16 million to 17 million people will be enrolled in Medicaid and CHIP. Also, 3 million to 5 million fewer people will have coverage through an employer compared with the number under prior law.

Click here to verify at Summary


(All statements for the left are from the non-partisan Congressional Budget Office (CBO) and Richard S. Foster, the Chief Actuary for Medicare and Medicaid Services (CMS). Occasionally minor word adjustments may have been made for clarity or to reflect the updated nature of the subject. Verify and view in full context as often as possible.)

Click here for a more detailed look at the new health care law in the Fast Facts Health Care section.

The ideas from the Right

The data below represents a culmination of ideas from the right aimed at lowering costs to governments and consumers in order to reduce the number of people without access.

These ideas focus on creating a system of universal access, or very near universal access, by expanding high quality primary care access to high risk, uninsured, and undocumented workers by making it very affordable.  These ideas also include expanding catastrophic health insurance access by removing primary care services from their role and thereby making policies much more affordable.

The Congressional Budget Office has scored a few Republican proposals, but none of those proposals mirror this presentation. However, CBO scores for those proposals may be presented here as evidence of successfully lowering the cost of premiums and costs to the government.  The list below does not represent every change that needs to be made.  However, should you prefer greater discussion about this sort of vision for health care reform in America, you would need to contact your elected officials.

 

Peter Schiff, who attempted to sound the alarm bell of the financial crisis before it occurred, recently said of housing:

“The government solution is high prices but low mortgage payments subsidized by the government. The free-market solution is low prices. Because if real-estate prices go down, you don’t need to borrow that much money to buy a house.”

Click here to read full Peter Schiff interview

 

 

A modified version of that statement, replacing the housing subject with health care might look a little like this.

The government solution is higher priced premiums at a reduced cost to you because your premium is subsidized by the government.  The free-market solution is low prices.  Because if health insurance premiums go way down, fewer people need the subsidy.  If comprehensive primary care costs go way down, more people can afford to buy it themselves.


Costs/Deficit

 

The legislation will have a number of effects on the federal budget—including added spending to subsidize the purchase of health insurance and increased outlays for Medicaid, as well as reductions in outlays for Medicare and added revenues from taxes, fees, and penaltiesClick here to verify at Page 2

Federal revenues will be increased through an excise tax on high-cost insurance plans; fees or excise taxes on drugs, devices, and health plans; higher Hospital Insurance payroll taxes for high-income taxpayers; a new tax on investment revenues and other unearned income; and other provisions.  Click here to verify at Page 21

 

 

The PPACA’s provisions related to insurance coverage are now projected to have a net cost of $1.252 trillion over the 2012–2022 period; that amount represents a gross cost to the federal government of $1.762 trillion, offset in part by $510 billion in receipts and other budgetary effects (primarily revenues from penalties and other sources). 

The addition of the year 2022 to the projection period has the effect of increasing the costs of the coverage provisions of the new health care law relative to those projected in March 2011 for the 2012–2021 period because that change adds a year in which the expansion of eligibility for Medicaid and subsidies for health insurance purchased through the exchanges will be in effect.

Click here to verify at Page 3

 

 

The new health care law includes a number of provisions that are intended, in part, to help control health care costs and to change the overall trend in health spending growth.  Many of these are specific to the Medicare program.

Click here to verify at Page 12

 

 

CBO reported budget deficits would be reduced ($210 billion over the 2012–2021 period), in their estimation, if the new health care law remains unchanged throughout the next two decades.  However, the law would maintain and put into effect a number of provisions that might be difficult to sustain over a long period of time.  Whether any of its provisions—and if so, which ones—might be changed in the future is not for CBO to judge.   Click here to verify at Paragraph 6

 

 

CBO estimates that the effect of the new health care law would be to reduce federal budget deficits during the 2020s relative to those projected under prior law—with a total effect during that decade in a broad range around one-half percent of gross domestic product (GDP). That calculation reflects an assumption that the provisions of the legislation are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation.    Click here to verify

 

 

The mandated reductions in Medicare payment updates for providers, the actions of the Independent Payment Advisory Board, and the excise tax on high-cost employer-sponsored health insurance would have a downward impact on future health care cost growth rates.  During 2010-2019, however, these effects would be outweighed by the increased costs associated with the expansions of health insurance coverage. 

Also, the longer-term viability of the Medicare update reductions is doubtful.  Other provisions, such as comparative effectiveness research, are estimated to have a relatively small effect on expenditure growth rates. 

Click here to verify at Page 21

 

 

Although, compared to prior law, the level of total national health expenditures (NHE) is estimated to be higher through 2019 under the PPACA, two particular provisions of the legislation would help reduce NHE growth rates after 2016Those are: productivity adjustments to most Medicare payment updates; and the excise tax on high-cost employer health plansSuch an outcome, however, would depend critically on the sustainability of both provisions. 

Click here to verify at Page 17-18


 

Reductions in payment updates to health care providers, based on economy-wide productivity gains, are unlikely to be sustainable on a permanent annual basis. 

If these reductions were to prove unworkable within the 10-year period 2010-2019 (as appears probable for significant numbers of hospitals, skilled nursing facilities, and home health agencies), then the actual Medicare savings from these provisions would be less than shown in this memorandum.  Similarly, the further reductions in Medicare growth rates mandated for 2015 through 2019 through the Independent Payment Advisory Board may be difficult to achieve in practice.    Click here to verify at Page 20

 

 

Under current law, payment rates for physicians’ services under Part B of Medicare are slated to decline by 29 percent and by additional amounts in later years.  The President’s budget proposes to avoid those reductions by freezing payment rates at their 2011 levels for the next 10 years.  That policy would increase net outlays by $298 billion over the 2012–2021 period, CBO estimates.

Click here to verify at Page 11

 

 

Medicare provider productivity adjustments could become unsustainable even within the next 10 years, and over time the reductions in the scope of employer-sponsored health insurance could also become an issue.  For these reasons, the estimated reductions in National Health Expenditure (NHE) growth rates after 2016 may not be fully achievable.

 Click here to verify at Page 18 

 

 

Under the legislation, CBO expects that Medicare spending would increase significantly more slowly during the next two decades than it has increased during the past two decades (per beneficiary, after adjusting for inflation).

It is unclear whether such a reduction in the growth rate of spending could be achieved, and if so, whether it would be accomplished through greater efficiencies in the delivery of health care or through reductions in access to care or the quality of care.  The long-term budgetary impact could be quite different if key provisions of the legislation were ultimately changed or not fully implemented.

Click here to verify at Page 14

 

 

On October 14, 2011, the Secretary of Health and Human Services announced that the Administration would not implement the Community Living Assistance Services and Supports (CLASS) long-term care program authorized by the Affordable Care Act.  CBO has therefore updated its baseline to remove collections and expenditures related to that program…

the agency anticipated that the CLASS program would begin collecting premiums in fiscal year 2012 and that net receipts from the program between 2012 and 2021 would total $76 billion.  In the absence of that program, the government will not receive that income.     Click here to verify at Page 103

 

 

After 2018, an additional (subsidy) indexing factor will probably apply; if so, the shares of income that (subsidy) enrollees have to pay will increase more rapidly, and the shares of the premiums that the subsidies cover will decline. 

Whether a widening gap between subsidies and premiums will increase pressure on the Congress to adjust the subsidy schedule and how the Congress might respond are uncertain. 

Click here to verify at Page 29

 

 

CBO projects that if current laws do not change, federal spending on major mandatory health care programs will grow from roughly 5 percent of gross domestic product (GDP) today to about 10 percent in 2035 and will continue to increase thereafter.  Those projections include all of the effects of the recently enacted health care legislation, which is expected to increase federal spending in the next 10 years and for most of the following decade.   Click here to verify

 

 

By 2030, however, that legislation will slightly reduce federal spending for health care if all of its provisions are fully implemented, CBO projects.    Click here to verify

 

 

The new health law would maintain and put into effect a number of policies that might be difficult to sustain over a long period of time.    Click here to verify

 

 

CBO estimated that growth in such spending under the new health care law would drop from about 4 percent per year for the past two decades to roughly 2 percent per year for the next two decades; whether such a reduction could be achieved through greater efficiencies in the delivery of health care or would reduce access to care or diminish the quality of care is unclear.     Click here to verify

 

 

Under current law, the balance of the Medicare Hospital Insurance trust fund will be exhausted in 2022, CBO Projects.

Click here to verify at Page 126

 

 

According to CMS, even with the new health care law; The projected date of Medicare’s Hospital Insurance (HI) Trust Fund exhaustion is 2024, five years earlier than estimated in last year’s report.

Click here to verify

 

 

CMS estimates that overall out-of-pocket spending would be reduced significantly by the PPACA (a net total decline of $237 billion in calendar years 2010-2019).   Public spending would increase under the PPACA as a result of the expansion of the Medicaid program and additional CHIP funding but would be reduced by the net Medicare savings from the legislation.   Private expenditures would decrease somewhat because of the net reduction in the number of persons with employer-sponsored health insurance and the reduced benefits for plans affected by the excise tax on high-cost employer coverage.

Click here to verify at Page 18

 

 

Additional Federal funding provided by the American Recovery and Reinvestment Act of 2009 and the Education, Jobs, and Medicaid Assistance Act of 2010 has alleviated some pressure on the States, but it is apparent that the Medicaid program is large enough to place serious strain on many States’ budgets.

Click here to verify at Page 35

 

 

Medicaid is expected to grow about 8.3 percent per year on
average—which would be much faster than the projection of average annual GDP growth of 5.1 percent. If these Medicaid trends continue as projected under current law—even after accounting for the increase associated with covering newly eligible beneficiaries in 2014—a steadily increasing share of both Federal and State budgets would be devoted to Medicaid absent other changes to the program, other budget expenditures, or budget revenues.     Click here to verify at Page 35

 

 

The March 2010 health care legislation also established the Independent Payment Advisory Board (IPAB), which will be required to submit proposals to reduce Medicare’s spending per enrollee if the growth of such spending is projected to exceed certain targets. Those proposals would go into effect automatically unless blocked or replaced by subsequent legislative action.    Click here to verify at Page 38

 

 

The Centers for Medicare and Medicaid Services (CMS) estimates Medicaid enrollment will increase by about 20 million in 2019. Click here to verify Page i

 

 

An estimated 25 million health care Exchange enrollees (79 percent) would receive Federal government premium subsidies.     Click here to verify at Page 5

 

 

Total net savings in 2010-2019 from Medicare provisions would offset about $575 billion of the Federal costs for the national coverage provisions.     Click here to verify at Page 21

 

 

Without fundamental changes in today’s health care delivery and payment systems, [provider] reductions would probably not be viable indefinitely into the future and would likely result in Medicare HI payment rates that would eventually become inadequate to compensate providers for their costs of treating beneficiaries, with adverse implications for beneficiary access to care.    Click here to verify at Page 6

 

 

The Patient Protection and Affordable Care Act is projected to increase Medicaid expenditures by a total of $455 billion for FY 2010 through FY 2019, an increase of about 8 percent over projections of Medicaid spending without the impact of the new health care law. Almost all of this increase is projected to be paid by the Federal government ($434 billion, or about 95 percent). Click here to verify at Page iiii

 

 

The health reform legislation, as enacted, imposes collective annual fees on manufacturers and importers of brand-name prescription drugs and on health insurance plans.  CMS anticipates that the fees and the excise tax would generally be passed through to health consumers in the form of higher drug and device prices and higher insurance premiums, with an associated increase in overall national health expenditures ranging from $2.1 billion in 2011 to $18.2 billion in 2018 and $17.8 billion in 2019. Click here to verify at Page 17

 

 

For drugs covered by Medicare’s drug benefit, CBO estimated that those provisions of the legislation would raise the prices paid by pharmacies less any rebates paid to insurers by manufacturers by about 1 percent, on average.

Click here to verify at Page 66

 

 

That increase in prices would make federal costs for Medicare’s drug benefit and the costs faced by some beneficiaries slightly higher than they would be in the absence of those provisions, while the new discounts would make the costs faced by other beneficiaries substantially lower.

Click here to verify at Page 66

 

 

CBO does not have a comprehensive estimate of all of the potential discretionary costs associated with PPACA, but we can provide information on the major components of such costs.

Click here to verify at Page 55

 

 

CBO’s estimates of the net savings that would result from the health care law have a roughly equal chance of turning out to be too high or too low.  Click here to verify

 

Click here for Fast Facts on
the new health care law and deficit/costs.

 

 

 

 

Costs/Deficit

 

 

The Congressional Budget Office

Federal spending on mandatory programs can be lowered by reducing the federal government’s share of the programs’ spending and increasing the shares borne by state governments, program participants, and others.  Requiring people to pay more for a service would decrease federal costs and might lower the overall cost of providing that service if people responded by using less of it.

Click here to verify at Page 17

 

 

Free Market Direct Primary Care:

 

Access Health Care – North Carolina

“We lower costs for primary care by around 85%. Getting rid of the overhead associated with billing and filing claims is a big part of that. Also, getting buy in from specialists and ancillary service providers to give patients “cash up front” discounts for paying directly can reduce many of these costs by a similar margin.


“For an anecdote- Several years ago a woman came to our practice for the first time- her husband had left her and dropped her health insurance the same day (and her 16 year old son’s too). She was diabetic and could not afford any insurance due to this preexisting condition. Her first year after he left, she told me she spend about $5000 on medical care. This consisted of an annual exam and 4 follow-up visits for her diabetes including blood work, office visits, an EKG, and ancillaries. She had worked about 60-80 hours per week at two retail jobs in that interim year and could still barely afford her care and medication. Then she found us. When she arrived her HGBA1C was 11.9- meaning very poorly controlled. One year later- her A1C was 6.8 (well controlled) and she had only spent about $450 for an entire year of care with us- including the annual physical, all of her follow-up visits, all of her lab work and ancillaries. As she told NPR in an interview a few years ago “We were a God send for her.”

 

“We create an access point to quality health care that did not exist for patients before. People who had no insurance can now afford primary care for less than the cost of a carton of cigarettes per month. For insured patients we provide longer visits with more streamlined service since none of their visit has anything to do with what insurance they have.”


“We spend more time with patients – on average 3-4 times longer than a traditional practice. We utilize that time to do teaching about goals, medications, and to coordinate referrals and resources for lower costs medication.”

 

“The data shows that for blood pressure control, diabetes control, and cholesterol goals we are in the top tier percentile in the US. It also shows that every quarter we continue to get better.”

 

“We offer full scope primary care with advanced chronic disease management for about 85% less than what those service would typically cost- that’s value- especially when the clinical outcomes are superior.”

 

“From a consumer standpoint, when you combine the direct primary care model with a high deductible wrap-around, that can still save 30-50% off of a traditional policy with all kinds of limitations. That excess money is what I use to fund a Health Savings Account while getting a much better patient experience. Health Insurance has the lowest average Net Promoter Score (industry metric for patient satisfaction). Qliance has published their score and it’s higher than Apple or Google.”

 

“On a related note, this sort of model has shown itself in vexing chronic disease populations. A reasonable sized pilot in Ohio of Medicaid diabetics has shown savings that if scaled statewide would be over $500MM per year. What state couldn’t use those kinds of savings. They did it with a combination of primary care MDs, health coaches and pharmacists.”

Click here for entire interview

 

 

 

Epiphany Health

Florida

Epiphany is a health care program created primarily for individuals and families who either don’t qualify for health insurance, can’t afford traditional insurance or aren’t offered health benefits though their place of employment. 

 

We provide preventive care, chronic disease management and acute care for a variety of conditions for patients of all ages.  The most common medical conditions can be successfully managed at the primary care level, meaning most people do not need to see specialists.

 

Each member is allowed 25 visits per year with no added fee or copayment. Additional visits will be charged a nominal $25 per visit fee.

 

For women, this examination includes a screening Pap smear and mammogram, and for men it will include a PSA prostate cancer screen.

 

High blood pressure, diabetes, high cholesterol, heart disease, asthma, arthritis, osteoporosis and many other chronic conditions can be managed effectively by your Primary Care Provider (PCP).  Since the majority of your follow-up visits are included in your membership…chronic disease management becomes very affordable.

 

We provide same or next-day care for urgent medical issues including sprains, strains, cuts requiring stitches, acute illnesses and more.

 

Any service that is provided in our office is done at no additional cost, including splinting, sutures, nebulizers, abscess drainage, skin biopsies, joint injections, EKGs, spirometry, and appropriate in-house testing, such as urinalysis, strep throat testing, influenza testing.

 

The following vaccinations will be provided at no additional cost (when indicated by standard guidelines and time intervals)

  • Annual Flu vaccine
  • Pneumonia vaccine
  • Tetanus booster
  • Other vaccinations are provided at or near cost, including childhood immunizations.

 

Click here for Epiphany Health website

 

 

QLiance

 

Direct primary care practices, such as Qliance, do not take health insurance but instead charge one low monthly fee for unrestricted access to primary, preventive and chronic care. These flat-fee practices are designed to handle and treat the majority of reasons people see a doctor, including but not limited to vaccinations, routine blood tests, women’s health services, pediatric care, common injuries, as well as ongoing management of chronic diseases like diabetes, high blood pressure and obesity.

By eliminating insurance, co-pays and deductibles from such routine and predictable care, the direct primary care model significantly reduces the cost of health care.

 

Direct primary care is ideal for patients with chronic diseases and other health conditions that require regular attention and monitoring. It keeps people healthier, reducing the need for expensive emergency room and specialty care that often result when small issues turn into big issues. This, in turn, helps reduce the overall cost of health care.

Click here for link to QLiance

 

 

 

Surgery Center of Oklahoma

Oklahoma

It is no secret to anyone that the pricing of surgical services is at the top of the list of problems in our dysfunctional healthcare system. Bureaucracy at the insurance and hospital levels, cost shifting and the absence of free market principles are among the culprits for what has caused surgical care in the United States to be cost prohibitive.

The pricing outlined on this website is not a teaser, nor is it a bait-and-switch ploy. It is the actual price you will pay. We can offer these prices because we are completely physician-owned and managed. We control every aspect of the facility from real estate costs, to the most efficient use of staff, to the elimination of wasteful operating room practices that non-profit hospitals have no incentive to curb. We are truly committed to providing the best quality care at the lowest possible price.

Click here for Surgery Center of Oklahoma website

 

Physician Care Direct

 North Carolina
with practices now in
Virginia, Georgia, New Jersey, Washington,
California and Texas

 

Annual Plan

1 annual payment of $399.00

The following services will be provided at no additional charge to you when deemed necessary by your provider for the term of your Access Card:

Comprehensive Physical Examination with Health Maintenance and Screening for Diabetes, High cholesterol, Pap Smear or Prostate Screen

Common Laboratory Tests provided as necessary at no additional charge:

Comprehensive Metabolic Panel

Lipid Panel

Thyroid Screen

Hemoglobin A1c

Complete Blood Count

ECG

Urinalysis

Hemoccult

Rapid Strep

As an Access Card Patient, you will pay a $20 Scheduling Fee each time you come to the office regardless of any other fees charged that day. This $20 fee for scheduling is not a covered service by insurers and cannot be submitted for reimbursement.

Additional services, lab tests, immunizations, and equipment (i.e., laceration repair, supplies, aircast) not directly stated above will be an additional charge paid by the patient at a transparent, affordable price.

Click here for Physician Care Direct website

Employer Education Video

Click here

Private Practice Doctors, LLC

California

The enduring intimate relationship between doctor and patient that has long defined private practice medicine is eroding.  Private Practice Doctors (PPD) is a limited liability corporation established in the state of California to help private practice doctors continue to deliver personalized care while remaining independent.  In order for the private practice physician to continue to exist, office expenses must be lowered.  Physicians were trained to heal, not to analyze merchant account rates and employee benefit costs, for example.  

Click here for Private Practice Doctors, LLC website

The Congressional Budget Office

Report on H.R. 3962

submitted by Republicans in the

House of Representatives.

According to CBO and JCT’s assessment, enacting the amendment would result in a net reduction in federal budget deficits of $68 billion over the 2010–2019 period. That estimate reflects a projected net cost of $8 billion over 10 years for the provisions directly related to insurance coverage; that net cost reflects a gross cost of $61 billion that is partly offset by about $52 billion in additional revenues associated with the coverage provisions. Over the same period, the other provisions of the amendment would reduce direct spending by $49 billion and increase tax revenues by $27 billion.

Click here to verify at Page 1

All told, the amendment would reduce the federal deficit by $18 billion in 2019, CBO and JCT estimate. As a rough approximation, CBO assumes that the effect of the proposal on budget deficits would grow at roughly the rate of health care spending during the following decade. Consequently, CBO expects that the legislation would slightly reduce federal budget deficits in that decade relative to those projected under current law—with a total effect during that decade that is in a broad range between zero and one-quarter percent of gross domestic product.

Click here to verify at Page 7

 

The figures presented here do not represent a comprehensive cost estimate for the amendment. Nevertheless, the estimates reflect the major net budgetary effects of the proposal.

Click here to verify at Page 2


Premiums

 

In the small group market, which is defined as consisting of employers with 50 or fewer workers, Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) estimate that the change in the average premium per person resulting from the new health care law could range from an increase of 1 percent to a reduction of 2 percent in 2016.   Click here to verify

 

The average, unsubsidized premium per person covered (including dependents) for new nongroup (individual market) policies would be about 10 percent to 13 percent higher in 2016 than the average premium for nongroup coverage in that same year absent the new health care law.    Click here to verify

 

More than half of the enrollees in nongroup policies would get federal subsidies, and taking those subsidies into account, the amount that subsidized enrollees would pay for nongroup coverage would be roughly 56 percent to 59 percent lower, on average, than the nongroup premiums.   Click here to verify

 

CMS estimates that the subsidy costs in 2018 would exceed the limit on the Federal cost of the premium and cost-sharing subsidy amount, with the result that the enrollee share of the total premium would generally increase in 2019 and later Click here to verify at Page 5

 

In the large group market, which is defined as consisting of employers with more than 50 workers, the PPACA would yield an average premium per person that is zero to 3 percent lower in 2016 (relative to prior law).  Click here to verify

 

For the estimated 23 million people who would remain uninsured in 2019, roughly 5 million are undocumented aliens who would be ineligible for Medicaid or the Exchange coverage subsidies under the health reform legislation. Click here to verify at Page 8

 

Click here for more details on the new health care law and premiums.

 

Premiums

 

The Congressional Budget Office

Report on H.R. 3962 submitted by

Republicans in the House

of Representatives.

 

In the small group market, which represents about 15 percent of total private premiums, the amendment would lower average insurance premiums in 2016 by an estimated 7 percent to 10 percent compared with amounts under current law.

Click here to verify at Page 4

In the market for individually purchased insurance, which represents a little more than 5 percent of total private premiums, the amendment would lower average insurance premiums in 2016 by an estimated 5 percent to 8 percent compared with amounts under current law.

Click here to verify at Page 4-5

The large group market, which represents nearly 80 percent of total private premiums, the amendment would lower average insurance premiums in 2016 by zero to 3 percent compared with amounts under current law, according to CBO’s estimates.

 John Mackey, Founder of Whole Foods

and John Stossel on Health Insurance

and Health Savings Accounts


 

High Risk-Caps-Young Adults

 

Section 1101 of the PPACA authorizes the expenditure of up to $5 billion in support of a temporary national insurance pool for high-risk individuals without other health insurance.   Click here to verify at Page 15

 

CMS estimates that the creation of a national high-risk insurance pool will result in roughly 375,000 people gaining coverage in 2010, increasing national health spending by $4 billion.  By 2011 and 2012 the initial $5 billion in Federal funding for this program would be exhausted, resulting in substantial premium increases to sustain the program; we anticipate that such increases would limit further participation. 

Click here to verify at Page 16

 

Beginning in 2010, qualified child dependents below age 26 who are uninsured will be allowed to enroll under dependent coverage.  An estimated 485,000 dependent children will gain insurance coverage through their parents’ private group health plans, increasing national health spending by $0.9 billion.  These impacts are expected to persist through 2013. 

Click here to verify at Page 16

 

 

Section 1101 of the PPACA authorizes the expenditure of up to $5 billion in support of a temporary national insurance pool for high-risk individuals without other health insurance.  Section 1102 requires the Secretary of Health and Human Services (HHS) to establish a Federal reinsurance program in 2010-2013 for early retirees and their families in employer-sponsored health plans.

Participation by employers is optional, and the law authorizes up to $5 billion in Federal financing for the reinsurance costs. No other financing is provided, and reinsurance claims would be paid only as long as the authorized amount lasts.  

We estimate that the full amount of the authorizations for sections 1101 and 1102 would be expended during the first 1 to 3 calendar years of operation.

Click here to verify at Page 15

 

High Risk-Caps-Young Adults

President Obama

“We (Democrats and Republicans) agree on:

- the notion that you can’t just drop somebody if they have already purchased coverage…

- We agree on the idea of extending dependent coverage to a certain age, some people say up to 25, some people say up to 26…

- We agree on no annual or lifetime limits. 

- We agree philosophically that we want to end the prohibition on pre-existing conditions and I think the thing we’re gonna have to talk about is how do you actually accomplish that.”


~these statements begin at 2 hours, 5 minutes, 22 seconds~

 

 

Access Health Care – North Carolina

For High Risk, uninsured, and undocumented wokers

“We create an access point to quality health care that did not exist for patients before. People who had no insurance can now afford primary care for less than the cost of a carton of cigarettes per month. For insured patients we provide longer visits with more streamlined service since none of their visit has anything to do with what insurance they have.”

 

Docs 4 Patient Care

States should be encouraged to set up mechanisms such as high-risk pools that allow individuals with pre-existing conditions to obtain health insurance with state assistance.  Protections for those with preexisting conditions who maintain continuous coverage should be extended in order to reward responsible behavior and minimize the number of patients requiring high-risk pools in the future.

Group purchasing arrangements based on membership in organizations such as professional and small business associations and religious groups should be promoted.  Participation in these groups should be allowed across state lines.

Click to visit Docs 4 Patient Care Website


 


 

 

 

 

 

 

 

 


 

 

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