United States – Health Care Bill

July 26, 2017

United States – Health Care Bill

By Padmini Arhant

The latest unsuccessful attempt to pass health care bill is perhaps due to lack of coordination and substance not in adherence with requirements.

The main aspects of the bill for robust health care law starting from eliminating mandates with penalty, Medicaid expansions not contractions, reviewing tax features for balanced appropriations, addressing opioid funding and state autonomy for health care benefits to suit respective needs with or without federal assistance.

The existing law enforcing penalty for failure to subscribe insurance and coverage lapse is pro-industry and neglect reality related to unfortunate and unpredictable circumstances that happens in life forcing people into unaffordability. There is a need for law to be flexible and democratic rather than the present conditions binding on the middle and lower income group who do not qualify for Medicaid.

With the current partisanship on this crucial bill, the focus is shifted from strengthening health care benefits to preserving  industry profitability against affordability burdening healthy citizens and segments unable to meet legislative and industry criteria.  Any reservations are seemingly political than practical.

United States fiscal budget FY 2018 –  Medicare and Medicaid costs under Mandatory spending are $582 billion and $404 billion respectively per The Office of Management and Budget. Mandatory Spending Control Mechanisms, Congressional Budget Office.

Medicare Hospital Insurance program entirely funded by payroll taxes right now alongside Supplementary Medical Insurance program and drug benefit provided by combination of payroll taxes and premiums making up 57 percent and the balance 43 percent from general tax revenues contributing to budget deficit. The long term appears costlier with escalating healthcare costs demanding 62 percent from general tax revenues to fund Medicare. The irony is the Affordable Care Act largely dependent on higher payroll taxes shifting the burden from the wealthy to younger population in the work force and small businesses – usually in the front line dealing with challenges during economic downturn.

Neither the present law nor the proposed health care bill demonstrate courage to rein in on ever rising health care costs with monopoly in health care, insurance and pharmaceutical industry confirming the political status on legislations passed to favor oligarchy over ordinary citizens.

No matter how the existing health care law and embattled legislation are viewed and interpreted, the average and healthy citizens are penalized for political reasons with little or no concern on the economic impact and real experience not propagated information with serious ramifications to follow. 

Thank you.

Padmini Arhant

Author & Presenter PadminiArhant.com

Spouse in Divine Mission

————————————————————————–

Health Care – Prevention is better than Cure. This article is dedicated to all Americans regardless of age, gender, socioeconomic background and importantly health status. The podcast on this article will be available shortly. The topic will continue further on funding medicaid expansion, opioids epidemic and health industry regulation. 

By Padmini Arhant

All citizens need health care access without having to differ medical consultation and treatment programs or going overseas witnessed in the trend created by unaffordable hospitalization and medical care costs in the United States.

United States with GDP per capita approximately $51,000 for 2016 and California @ $59,000 remaining the largest economy in the nation with $2.3trillion GDP – 12.43% of National GDP $18.5 trillion struggling to afford health care for all understandably frustrates citizens in the state that also clarifies escalating health care costs and insurance premiums in parallel with no point of intersection.

Taxpayers having the option to allocate pretax earnings towards health savings account is critical for health maintenance choosing the best suitable plan that fits their budget and health needs.

Medicaid Expansions for the poor, lower and middle income groups eliminating current caps to permit significant percentage of population not meeting present criteria would produce healthy results in cutting expenditure that is otherwise keeping them from dependable health plan.

Medicaid for basic to complete recovery based on individual medical conditions would save healthcare spending arising from neglected and preventable health issues costing patients, insurance and the states alike.

The topic will resume on Medicaid funding with dissection of federal and state disposable income, wasteful spending that could be divested in citizens health care and more.

———————————————————————————————————————————————–

Health care law – The Affordable Care Act in the United States is not quite affordable for many due to health care costs constantly on the rise along with insurance premium. With health insurance covering only certain percentage on health bill the remaining is expected to be paid by patient. This is apart from copayment and deductibles on the related item.

The law is claimed to protect 20 million people who are brought under the ambit via mandatory subscription tied with penalty on failure to do so. This enactment proved a bonanza to health insurance companies in their deal to offer coverage for a price not nearly meeting average consumer purchase power.

Then there are issues with insurance companies declining coverage on some ailments not necessarily pre-existing and when they do cover, they are not without terms and conditions to an extent of transferring the burden on to consumer.

Under the existing health care law, the provisions to allow subscriptions for patients with pre-existing illness and extension on dependent children until 25 years of age pegged to parents or primary subscribers is a partial relief and again the price is not any cheaper as insurance premium is twice or more than regular cost for subscribers with any pre-existing symptoms or treatment.

The insurance companies with different tier plans covering 60% – 80% maximum and the rest left for consumer to contend with, the bottom line is health care and insurance industry exorbitant price makes it difficult for modest income consumers to absorb significant portion of the bill.

The Affordable Care Act focus limited to health insurance subscription while allowing health care and insurance industry to maintain extraordinary gains with soaring costs beyond consumer affordability reflects monopoly in a market economy.

Ordinarily the price determined in a market economy based on demand and supply together with competitiveness from multiple providers contributes to price adjustment and consumer price index.

Health care being vital for survival and wellbeing, the rapid escalation in costs against controlled inflation deprives citizens with basic and contingency subscriptions from affordable care.

Again, any subsidy and discounts are usually offset with treatment vs. drug costs rather than comprehensive package covering entire medical expense inclusive of medicines and any other requirements enabling full recovery.

The argument that tax credits for out of pocket medical expenditure paying towards any surplus typically works in favor of higher income bracket while middle and lower income group with relatively less taxable income falling short to take advantage of deductions in annual return.

Another development in health care practice now is the insurance industry run health care centers and medical foundations hiring medical professionals and practitioners safeguarding insurance company policy on quantity over quality in patient consultation keeping accessibility to necessary medical exam and procedure to bare minimum or unavailable.

Similarly, the tradition on insurance company approval every step of the way is continued with any refills on prescription drugs not linked to opioids also left at the insurance company discretion overriding medical advice and illness status.

Unfortunately, the Affordable Care Act inability to address these persisting problems pose a greater challenge for average consumers forced into compulsory insurance subscription benefitting the insurance industry more than the subscriber.

Furthermore, the enrolment of consumers with pre-existing situation is hardly a loss for health insurance company since payments towards ongoing treatment to patients in this category are compensated by young and healthy individuals’ subscription under current law.

On health management, the middle aged healthy subscribers routine physical exam every two years also restricted with insurance company protocol requiring payment for lipid profile viz. cholesterol and other critical blood tests to rule out any potential disease. These rules are enforced on insurance plan across the board and not confined to lower or higher payment plan.

The prevalent health care woes outlined above are factual leading to worse scenarios for many struggling to stay alive in the heavily profit oriented environment.

The debate on nothing wrong with aiming for jumbo profits is possible in full employment and fair income distribution economy in contradiction to reality.

The argument has no meaning in economic situation where profitability exceeds affordability widening the gap between haves and have nots especially in economically disadvantaged segments and amongst income group both young and old with the former starting life and latter nearing retirement on meager savings or none at all.

———————————————————————————————————————————————

What needs to be done? 

SOLUTION

Any legislation – present or future only concerned about health insurance, health care and pharmaceutical industry profits unaffected rain or shine need to pay attention to the system being not quite effective in delivering service to the most vulnerable as well as others not receiving the value for money in protecting health and life.

The antitrust law compliance facilitating more competition is the fundamental course to curb ever increasing costs on minimal to prolonged medical care including prescription drugs and any medical device.

Tax breaks matching employer contribution to employee and those with dependents would create a flexible plan.

Tax credits with full deductions for self-employed and small business owners enable more choices for consumers in the market place.

Medical Savings Account (Medi-Fund) – Financial institutions like banks, credit unions and cooperatives set up accounts exclusively for medical expense with better interests on deposits and lower borrowing rate would ease expense for families having members suffering from minor to major illness. The funds are to be FDIC insured to prevent risks and guarantee anytime withdrawal for medical purpose. The ATM debit card for medical use would serve well during emergency.

Students unable to stay on parents or guardians’ insurance plan should be eligible for federal and state medical grants together with college or educational institution initiated private endowments for student medical aid.

Senior Citizens – Expanding Medicare as well as covering drug costs with choices to buy through government agency sponsored pharmacy. Additionally, any retailers discount on prescription drugs qualifying for tax rebate would also be helpful.

Medicaid Expansion under Obamacare – Supreme Court decision allowing States to exercise discretion based on voluntary Medicaid expansion emphasized status quo. As such Medicaid expansions are made possible by lower and middle-income tax payers and not the wealthiest of the wealthy in the economy.

As explained in the article below  – any subsidies and premium tax credits capped at 138% and 400% of federal poverty level (FPL) to qualify for Medicaid and tax deductions under Obamacare enables marginal members provided their taxable income is sufficient to offset credits again excluding higher medical expenses for patients with pre-existing conditions and those pre-disposed to any genetic disorders.

Thank you.

Padmini Arhant

Author & Presenter PadminiArhant.com

Spouse in Divine Mission

 

Health Care Bill – Myths and Facts

By Padmini Arhant

The heated debate on Health Care Bill pending votes in the United States Senate arguably attracts attention and tension.

Health Care Bill – Understanding the details would perhaps ease friction allowing focus on appropriate action.

OBAMA CARE:  Taxes, subsidies to insurance customers, Medicaid expansion program.

Obamacare requiring all Americans to subscribe to health insurance or pay tax penalty – A bonanza for health insurance industry bringing 35 million subscribers with mandatory insurance law tied to penalty.

The media reporting that repeal is expected to sharply increase the number of people who don’t have insurance which could in turn lead insurers to raise premiums.

This means the insurance for those unable to subscribe Obamacare compulsory insurance is essentially paid by healthy insured customers enabling health care industry mega profitability.

Obamacare mandate on large employers to offer health insurance or be fined.  Most corporations were offering some form of health insurance to employees negotiated in salary benefits prior to Obamacare rule. The penalty factor guarantees health insurance industry revenue.

In a real democracy and market economy choices combined with competition would facilitate affordability rather than mandatory law favoring monopoly in health care and health insurance industry. 

Health coverage to the poor – Medicaid criteria.

Prior to Affordable Care Act – In all states, Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states the program covers all low-income adults below a certain income level.

Obamacare Medicaid eligibility is based on income at or below 138% of federal poverty level (FPL).

Department of Health and Human Services determined FPL is used to evaluate Medicaid eligibility. The FPL is defined as set minimum gross income a family needs for survival that includes food, clothing, transportation, shelter and other essentials…allowing for inflation every year. The poverty level data is presented according to family size beginning with single person in a household upto family of 10 i.e. a couple with eight children. Then onwards the amount is incremental for additional person in a family.

FPL figures are released in January of the year.  FPL for 2017 for single person household is reported as $13,860. The single person would qualify for Medicaid under Obamacare with income level at $19,127 (i.e. 138% of FPL $13,860 for 2017).

Obamacare premium tax credit and cost sharing reductions supposedly leads to Medicaid eligibility.

Premium tax credits are generally available to people with household incomes between 100 and 400 percent of the federal poverty level (FPL) and are based on factors such as plan rates where you live.

In this instance, the single person household seeking premium tax credit would qualify upon annual income anywhere between $13,860 to $55,440 – this would be affordable when tax payable is more than insurance costs including deductibles and out of pocket payments.

Where does that leave others who neither belong in 138% FPL nor 400% FPL for premium tax credit and instead reminded of heavy penalty for not subscribing to health insurance?

The cost sharing reductions usually shifted on to subscriber by insurance industry given the insurance costs and health industry extraordinary profit margins not addressed in Obamacare or GOP health care bill.

GOP bill offering reimbursements for at least two years  to health insurance companies on the assumption of major loss to insurance providers for subsidies that reduce out-of-pocket costs for low income customers of Obamacare plans proves industry winning favor from both left and right of the political aisle.

Subsidies to reduce out-of-pocket costs for low income customers. The subsidies never affect insurance industry as no reduction in health insurance costs experienced with distribution across consumer base that penalize the healthy to bear expense. Even otherwise the subsidies are eventually paid for by middle income tax payers in the state and national economy. 

Thank you.

Padmini Arhant

Author & Presenter PadminiArhant.com

Spouse in Divine Mission

 

 

 

 

 

 

Written by Padmini Arhant · Filed Under Featured, Health 

Comments

Got something to say?

You must be logged in to post a comment.