Fix Health Care Policy

The Sensible Solution for Pre-Existing Condition Exclusions

The problem of individuals being denied health insurance because of a pre-existing medical condition is frequently cited by defenders of Obamacare as justification for the law, particularly its new insurance regulations and individual mandate.

In truth, however, the problem is actually much smaller than portrayed, and a sensible solution does not require anything like the massive new spending, taxing, and insurance market takeover included in Obamacare.

In the group market, where over 90 percent of Americans with private health insurance are enrolled, there are reasonable rules limiting the application and duration of pre-existing condition exclusions. For employment-based coverage, a pre-existing condition exclusion can only be imposed if an individual has less than 12 months of prior coverage. Furthermore any coverage exclusion can be for no more than 12 months—or 18 months if the individual didn’t enroll in the employer plan when first eligible.

As Heritage’s Ed Haislmaier explains, “Those existing rules represent a fair approach: Individuals who do the right thing (getting and keeping coverage) are rewarded; individuals who do the wrong thing (waiting until they are sick to buy coverage) are penalized.”

The one problem remaining is in the individual market—which represents less than 10 percent of the total private insurance market—is that the same rules that protect consumers from unreasonable pre-existing condition exclusions in the group market do not currently apply to the individual market. An individual can keep continuous insurance coverage in the individual market for years and still face unjust exclusions when switching plans.

Read the rest on The Foundry…

Tags: continuous coverage, exclusions, health insurance, individual market, ObamaCare, pre-existing conditions, switching plans

Turner Lays Out the Case Against Obamacare

Grace-Marie Turner, president of the Galen Institute, was among a number of experts who recently convened at The Heritage Foundation on a panel entitled “Beyond the Individual Mandate: Why Obamacare Must Be Repealed.” Turner is one of the authors of Why Obamacare Is Wrong for America, along with James Capretta, Thomas Miller, and Heritage expert Robert Moffit.

At the panel, Turner highlighted a number of the law’s problems, including its constitutionality. Never before has the federal government required individuals to purchase a product, which as she says in her book, “makes one wonder what else Congress can make Americans do if it makes us buy health insurance.”

The law’s mandate, she believes, also presents an economic problem. The legislation requires employers to provide insurance for employees or pay a penalty, forcing businesses to hire fewer employers, keep wages down, and reduce investments. As a result, business will suffer, which could translate into higher prices for consumers.   (Read the rest on The Foundry…)

Tags: Grace-Marie Turner, health insurance, Individual Mandate, repeal Obamacare

Don’t Blame Heritage for ObamaCare Mandate

Is the individual mandate at the heart of “ObamaCare” a conservative idea? Is it constitutional? And was it invented at The Heritage Foundation? In a word, no.

The U.S. Supreme Court will put the middle issue to rest. The answers to the first and last can come from me. After all, I headed Heritage’s health work for 30 years. And make no mistake: Heritage and I actively oppose the individual mandate, including in an amicus brief filed in the 11th Circuit Court of Appeals to the Supreme Court.

Nevertheless, the myth persists. ObamaCare “adopts the ‘individual mandate’ concept from the conservative Heritage Foundation,” Jonathan Alter wrote recently in The Washington Post. MSNBC’s Chris Matthews makes the same claim, asserting that Republican support of a mandate “has its roots in a proposal by the conservative Heritage Foundation.” Former House speaker Nancy Pelosi and others have made similar claims.  (Read the rest on The Foundry…)

Tags: amicus brief, health insurance, Individual Mandate, ObamaCare, Supreme Court

Love Conquers All…Except Obamacare

Thanks to Obamacare, Americans looking to tie the knot may find that it’s a lot cheaper to stay single.

Last week, the House Oversight Committee released a report and held a hearing to unpack its subject matter: a hidden penalty on marriage created by the structure of the Patient Protection and Affordable Care Act’s (PPACA) tax subsidies for low- and middle-income Americans to purchase health insurance.

Obamacare’s new tax subsidies are linked to the federal poverty level, discriminating against married couples by failing to increase proportionally with household size. Heritage research has shown how two individuals could qualify for more financial assistance to purchase health insurance individually than as a couple, leading many to forego marriage altogether. The difference could amount to several thousand dollars.  (Read the rest on The Foundry…)

Tags: federal poverty level, health insurance, hidden marriage penalty, ObamaCare, tax subsidies

Employers Consider Dropping Health Coverage Under Obamacare

Reports from employers continue to belie President Obama’s repeated insistence that, under his new health care law, Americans would not lose their employer-provided health insurance coverage. A new survey shows that more than one in ten midsized and large employers are at least “somewhat likely” to drop their health coverage once Obamacare’s “exchanges” go into effect in 2014.

“Let me be exactly clear about what health care reform means to you,” President Obama said during his Obamacare push. “First of all, if you’ve got health insurance, you like your doctors, you like your plan, you can keep your doctor, you can keep your plan. Nobody is talking about taking that away from you.”  (Read the rest on The Foundry…)

Tags: doctors, employer coverage, health insurance, ObamaCare, plans

VIDEO: The Obama Economy Is Killing Jobs, Restaurant CEO Explains

Want to know the true impact of Obamacare on job creation in America? Listen to what the job creators have to say. Last month, Andy Puzder, CEO of CKE Restaurants, testified before Congress about the law’s impact on his business. And in this new video he explains how government regulations are costing America jobs.

CKE, which owns and franchises 3,182 restaurants in 42 states and 23 foreign countries under the Carl’s Jr. and Hardee’s brand names, employs about 70,000 people in the United States. As Puzder explains, his company is “a job creation machine,” but he fears that Obamacare, or the Patient Protection and Affordable Care Act (PPACA), will be the wrench that grinds it to a halt.  (Read the rest on The Foundry…)

Tags: CKE Restaurants, health insurance, job creation, ObamaCare

House Subcommittee: Obamacare Will Burden Small Businesses

The House Energy and Commerce Subcommittee on Health recently held a hearing to review how Obamacare regulations will affect employers’ ability to maintain health coverage.

To illustrate the magnitude of the new regulatory burdens on businesses, subcommittee chairman Joe Pitts (R–PA) displayed a stack of over 3,500 pages of Obamacare rules, notices, and regulatory guidance issued so far by the Administration. This additional burden, the hearing highlighted, will harm employers’ ability to offer health coverage and disrupt coverage for Americans across the country.

Among the new regulations are “minimum loss ratio” (MLR) requirements, which force health insurers to spend at least 80 percent of premium revenues on medical claims costs or “activities that improve health care quality.” The MLR requirements are likely to force some insurers out of the market, leaving businesses with fewer coverage options.   (Read the rest on The Foundry…)

Tags: health insurance, House Energy and Commerce Subcommittee, medical claim costs, minimum loss ratio, Rep. Joe Pitts, repeal Obamacare

Obamacare’s Premium Subsidies Will Stifle Small Business

As small business goes, so goes the economy. They have been responsible for creating almost two-thirds of all net new jobs over the last 15 years. Indeed, one reason Obamacare is such a concern is that it will significantly reduce the incentive for small businesses to hire. Especially once the premium subsidies become available in 2014.

The premium subsidies are Obamacare’s way of making health insurance more affordable for low-income earners who buy coverage in the new exchanges. Eligibility for a subsidy is limited to people who lack public or employment-based insurance and have incomes less than four times the poverty level. The values of the subsidies are set so as to limit the amount one contributes towards insurance as a percent of income.

The actual implementation, however, is complex.

Say you’re under 65 and not on Medicaid (or CHIP), and the year you would be eligible to purchase insurance through an exchange is 2014. Your premium subsidy is determined by your income and family structure from two years earlier (in this case, 2012), applied against the poverty level for the calendar year in which you purchase the insurance (2014).

The consequences of this complicated formula are far worse.  (Read the rest on The Foundry…)

Tags: family income, federal poverty level, health insurance, Medicaid, Medicare, Obamacare subsidies, small businesses

Making Health Insurance More Accessible

On Tuesday, May 10, 2011, the U.S. Department of Health and Human Services released a report on the uninsured population and their ability to pay their hospital bills. One of the more interesting takeaways from the report is that if you add up all the savings of the uninsured with incomes over 400 percent of the federal poverty level (or about $88,000 for a family of four), it will cover about 37 percent of their total hospital bills.

How do the uninsured get away with not having the assets to pay their bills? Well, the average uninsured person only pays for about a quarter of their total health care costs. Taxpayers end up covering about 75 percent of the unpaid tab through direct payment and extra disproportionate share hospital (DSH) payments made by Medicaid and Medicare, while those with private insurance, hospitals, and charities pick up the rest. (Read the rest on The Foundry…)

Tags: bills, charities, health insurance, hospitals, ObamaCare, repeal the law

Accepting Federal Exchange Funding for Obamacare: A Dangerous Proposition for the States

Right now, states across the country are trying to figure out what to do in response to Obamacare and its health insurance exchange architecture. In Oklahoma, the question has gone even further as the state government debates whether or not to accept federal funding, appropriated in the Obamacare statute, to create a state information technology system for a health care exchange.

In Ed Haislmaier’s recent paper, he describes this dilemma:

Trying to shoehorn patient-centered, market-based reforms into the bureaucratic architecture of Obamacare’s health insurance exchanges is not a viable strategy, either practically or politically. But refusing to create an Obamacare state exchange, while politically appealing, would leave state health insurance markets vulnerable to even more federal interference and disruption over the next two years. (Read the rest at The Foundry…)

Tags: funds, health insurance, health insurance exchanges, information technology systems, ObamaCare, States