by Chris Huckins Google+ Email 


Articles tagged with: Affordable Care Act

02 October 2013

10 Obamacare Tips for all Ages and Incomes

Posted in Covered California

10 Obamacare Tips for all Ages and Incomes

   Breaking Bad started with a man diagnosed with cancer whose health insurance was too expensive. Isn't it serendipitous how the series finale ended the same week Obamacare began*? You've waited long enough: let's get to the Top 10 Obamacare Tips!

   1) Obamacare is also known as the Patient Protection and Affordable Care Act.

    This is sometimes shorted to PPACA or Affordable Care Act or just ACA.

   2) *Obamacare has been the law since 2010.

    Some benefits (ex: kids staying on their parents' plan up to age 26) started sooner than others.

Other benefits start later: like on January 1st, 2014, all preexisting conditions must be covered by all insurance carriers at no added cost.

Most people say Obamacare began October 1st, but they really mean the biggest changes started.

   3) When someone mentions "Obamacare insurance" they probably mean new insurance plans in the exchange*

    Truthfully, Obamacare affects all insurance plans.

  4) *An exchange offers new health insurance plans, varied by state.

    Imagine an exchange like a call center for the DMV. The exchange will ask questions over the phone, enroll you in any insurance plan they offer, and mail you an insurance card.

Each state has its own exchange with its own name. For example, the exchange in California is called Covered California.

   5) Exchanges sell new plans. But they aren't the only place to buy them.

    Not everyone buys Coke from a vending machine. Likewise, not everyone will go to the exchange to buy insurance.

Insurance brokers and agents are more experienced than newly-hired Exchange workers, so most people will likely call an agent for faster, more convenient service.

    6) You may recognize new plans in the exchange.

    Major carriers: like Anthem, Kaiser, and HealthNet, competed to showcase their plans in the exchange. To be in the exchange, plans must have 10 Essential Benefits and premium assistance if you're low to middle income.

  7) Premium assistance lowers the cost for insurance and acts like a voucher.

    This is sometimes called subsidized insurance, a tax credit, or a subsidy. If you're under 65, don't qualify for Medicaid, and don't get insurance an employer, you may qualify for assistance if you buy an exchange plan.

Ask an insurance agent to help you enroll in an exchange plan. If you qualify for assistance, your premium will drop the day you enroll. Click here to calculate how much your premium assistance amount may be.

 8) Obamacare makes you buy insurance or pay a fine.

    The fine is $95 the first year, then sharply increases each year you're not covered.

  9) Not interested in exchange plans? There are still private plans.

    Insurance brokers and agents still offer private insurance plans. Likewise, plans in the exchange are also available as private plans (which means they don't come with premium assistance). Call an insurance agent for more details.

  10) You may keep your old plan. Your plan may also change.

    The only changes some plans will see are more benefits. As the healthcare system gets an overdue makeover, some plans will be reviewed to become more efficient and affordable. Ask an agent to review your plan for more details.

05 September 2013

Loophole in Obamacare of Godly Proportions

Posted in Latest News

Loophole in Obamacare of Godly Proportions

    In 3rd grade my best friend spent a week listening to the radio for our favorite songs. When they played, he recorded each on a blank cassette tape until our “Summer Mix” played awesome track after track back to back. It was a grueling experience, I’m sure, but it beat the alternative: buying music. In the digital era, my friend who I lost touch with most likely became a digital pirate. Who can blame him? As Americans, it’s in our nature to rebel against costs for something we can find for free.  So when the president orders us to pay for health insurance or tax us for disobeying, how do we react? We picket outside! No, that was our parent’s generation. Nowadays, we search online for loopholes.

    Big corporations usually benefit most from loopholes, which explains why they’re the first to discover them. Last year, Darden Restaurants, operator of casual dining restaurants such as Olive Garden and Red Lobster, slashed employee hours to avoid offering them healthcare. In 2014, the ACA (Affordable Care Act, “Obamacare”) requires all businesses with 50 or more full-time employees to provide government-approved health coverage for their workers or pay a $2,000 penalty for each employee after the first 30 workers.

    More recently, companies have allegedly found another solution to avoid imposing healthcare costs: go protean. This business strategy is named after Proteus, the son of Poseidon, who shape-shifted into anything from a lion or serpent to a tree or water itself to avoid gods who bothered him. To weather economic challenges, like Obamacare, a “protean corporation” shape shifts. It preserves core employees to manage the big-picture duties: business model, vision, and strategy, then outsources the business tasks to other employees, but labels them “corporations”. In other words, this is mutually beneficial as the company keeps its A-Team to itself, and names its B-Team owners of their own corporations. This shape shift is all perfectly legal, as long as the “corporations” don’t breach contract or commit fraud.

    If this strategy becomes popular, which it has not since the Wall Street Journal's original publication of the strategy, companies won’t have to worry about employing less than 50 to avoid paying for healthcare when the alternative is to “promote” the employee to a single “corporate entity”.  The only paperwork difference is substituting W-2 employees with 1099 contract relationships. Obamacare doesn’t stand a chance in Hades against the business model of a Greek god.

Update: Mandate for businesses with over 50 employees to provide coverage has been delayed until 2015.

06 August 2013

Pets Will Help Fund Obamacare, Pet Insurance Not Mandated

Posted in Health Insurance 101

Pets Will Help Fund Obamacare, Pet Insurance Not Mandated

    Contrary to the self-proclaimed "World's Only Reliable News" site, Weekly World News, your pets are not mandated to have pet insurance under the Affordable Care Act (Obamacare). Another false alarm is located in the top right-hand corner of their homepage: the news that aliens are coming so you should subscribe to their newsletter. 

No it's not an alien. Behold: Gizmo, the polydactyly Siamese. With claw polish.

    For clarification, Obamacare mandates every human buy health insurance or pay a tax called a shared responsibility payment. Well that sounds nice! Wonder how your pets feel about healthcare reform and being left out of the law's consideration? According to poll after poll, pets probably understand Obamacare as well as most humans.

    Dogs who sense natural disasters often run for the hills (unless it's an avalanche) and with the biggest changes to healthcare just 8 weeks away, one would think there'd be a lot less dogs around. Insurance marketplaces start open enrollment on October 1st, 2013 and while political animals (mainly Republican opponents) believe the sky will fall, state auditors show they're on track to open in time.

    These marketplaces will sell health insurance plans for anyone who doesn't already get affordable coverage at work. Small business owners with 50 employees or less, although not mandated to cover workers, may also shop around for  group plans through the SHOP (Small Business Health Options Program), a part of the marketplaces. Covered California recently revealed the rates for individual, family, and small business insurance plans, muzzling critics  who believed they would cost Americans way more money. The average prices of middle tier "Silver plans" are between 29% less and a mere 2% more than average comparable plans today.

    While pet insurance isn't mandated by Obamacare, there are connections between the two. Medical devices used by animals exclusively aren't taxed. Those considered by the FDA as "duel devices", which are used by humans and animals, e.g.: examination gloves, anesthesia machines, syringes, will be taxed at 2.3% to help fund Obamacare.

    The truth is out there....

01 August 2013

How the Government Pays Some Doctors for 40 Hours a Day or More

Posted in Latest News

How the Government Pays Some Doctors for 40 Hours a Day or More

    Ever wonder how doctors in Florida can perform 40 hours of colonoscopies in one day? It's crossed your mind once: admit it. According to the American Medical Association and new data, it's physically possible, if enough data is distorted.

    But in reality is it more likely they discovered a wormhole in the large intestine that leads to time travel? Or rather than science, is magic behind it (no pun intended)? After all, Florida, where 1 in 5 physicians worked at least 24 hours a day (at least?!), is also home to the Wizarding World of Harry Potter where time travel necklaces are sold. To understand how doctors clock hours and  get paid, we have to time travel to the 1980s. So jump in the nearest  intestinal worm hole and let's go!   

    In 1983, the Health Care Financial Administration (HCFA) - now renamed the Centers for Medicare and Medicaid Services (CMS) - adopted a universal coding system to classify services carried out by doctors and the value of each service. The coding system was called the Current Procedural Terminology (CPT).

    How does CPT work? Some services cost more than others but everything is given a Relative Value Unit (RVU). RVUs are based on 3 factors: time the doctor spent on the service (54%), resources used on the service (41%) and malpractice expense, i.e. liability insurance costs (5%). A colonoscopy is valued at twice as many RVUs as an ordinary doctor's visit. An overall example: Professor Dumbledore gets a colonoscopy. The doctor tells his insurer, Medicare, what service was performed. Medicare, which covers the services, pays the doctor based on the RVU.

    Since it seemed more convenient and less like a monopoly at the time, in 1986 Congress mandated every doctor, insurance company, and the government itself use the CPT system and pay an annual fee to the owners of the copyright, the American Medical Association, which also happens to be today's largest physician lobbying group. Since 2001, the AMA raised $70 to $100 million a year on the copyright fees from every organization (including the government) that used CPT. But they don't disclose the exact amount they make off of the system. They like to work in secret after all.

    In contrast, doctors in Florida, reported some procedures take less time than valued by CPT: 30 minutes instead of 75 for colonoscopies for example. Because of this, doctors doing 10 colonoscopies are paid for 12.5 hours when they should really be paid 5 hours. And who's to blame for the oversight?

    Every year, a secret meeting by 31 individuals who call themselves the Relative Value Update Committee (RUC), determines how to value each CPT based on new technology and medical advances. Even though the Federal Advisory Committee Act of 1972 says advisory committees must meet in public, the AMA doesn't consider RUC a formal committee, so the members are immune. Just who are they anyway?

    Experts in various medical practices, like the American Gastroenterological Association, complete surveys every year for RUC to gauge how valuable services are, like colonoscopies for example. A survey outwardly asks professionals to provide data, including how much time it may take for each service, to determine how to compensate doctors. It's the equivalent of your boss asking you how much you should be paid for each task you perform. Obviously you'll overestimate and the RUC sees that too. The problem is, there's only so much money they can squeeze from Medicare and Medicaid. And so meetings get intense because some cardiologists believe their services are more valuable than a gastroenterologist's. Everyone wants a bigger piece of the pie of the federal budget.

    A government oversight group, the Medicare Payment Advisory Commission (MedPAC), meets with RUC and Congress to decide how much of taxpayer money to allocate for Medicare and Medicaid, based on the outcomes of these meetings. Uncle Sam's hands are mostly tied, due to the conflict of interest in using AMA's coding system and MedPAC only having 6 to 8 people to review RUC's conclusions.

    Likewise, (and this one will get heavy on the abbreviations) AMA may have helped pass ACA (Affordable Care Act) by agreeing to cap doctor's income (based on RVUs) in return for secret RUC meetings to agree who gets how much of the USA's pie. More on that next time. Unless you want to time travel.

15 July 2013

California's Health Exchange Begins Training Educators

Posted in Covered California

California's Health Exchange Begins Training Educators

    Summer school is here! That's what's written on the many calendars of organizations who will begin outreach and education for the Affordable Care Act (ACA, "Obamacare") this season. In May, dozens of organizations: unions, educational and government entities, and more received federal grant money to begin training in July by Covered California. Behold, Obamacare cynics: the school bus has arrived right on schedule.

    UC Davis Center for Reducing Health Disparities, who received over $1 million for outreach toward spanish-speaking residents, began training last Monday and continues Certified Educator schooling on their campus this week. What's a Certified Educator and where can one ride such a whimsical learning shuttle as seen above?

    Grantees committed to spreading the benefits of ACA will undergo 3 days of training to become Certified Educators. By this fall, over 2000 Certified Educators will know the ins and outs of healthcare reform to approach uninsured Californians and persuade them to get coverage: the goal of the Affordable Care Act. What other organizations applied for Certified Educator status? Anaheim Health Medical Center (AHMC) in San Gabriel received $500,000 to attract college students and families via health fairs to show off the new health law and its benefits. They will also be training Certified Educators this week.

    Covered California, the state's Exchange aka marketplace, will offer new plans starting October 1st with 10 essential health benefits and tax credits for those who qualify to lower the costs for health insurance. Catch up on class today by following our Covered California coverage here!