President Trump and his administration are actively engaged in negotiations about legislation meant to repeal and replace the Affordable Care Act (ACA). In late January, Trump signed an executive order that urges the current administration to fight the ACA.
In order to try and understand the executive order, here is a quick look at what the order contains:
- The new administration’s policy is to seek a prompt repeal of the ACA
- The order intends to efficiently maintain the ACA until repeal efforts are concluded
- The order minimizes regulatory and economic burdens to the states
- The order provides the states with greater flexibility to implement a free marketplace in the health care insurance industry
The full text of the order is far more revealing and it directs the Secretary of the Department of Health and Human Services (HHS) and other agencies with authority under the ACA to: “exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the [ACA] that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications.”
It is clear that Trump intends to follow up on his campaign promise, and repeal and replace the ACA. In the months and years to come, a number of significant changes to the health care industry are expected. How this will impact on consumers is another question. Therefore, it is advisable that you check your existing health care insurance, understand fully what it covers and when any changes will be made to your coverage. Staying current on any healthcare news will allow you to transition into the future health care plan with ease.
One of the first executive orders President Trump signed was to pave the way for Congress to repeal and replace the Affordable Care Act (ACA). That order came one week after the House of Representatives passed a Senate budget resolution bill opening the door for the first step in a three step process to repeal the ACA.
A “reconciliation directive” in the budget resolution bill instructs four committees that oversee the federal healthcare program to draft legislation to repeal the ACA. The four committees involved include: the Energy and Commerce Committee in the House; the Health, Education, Labor and Pensions Committee in the Senate; the Finance Committee and the Ways and Means Committee.
The resolution bill gave instructions to complete a draft of repeal legislation by January 27, 2017. This deadline was unrealistic, as discussion about which parts of the ACA to repeal took more than only a couple of weeks. It is not clear what parts of the ACA, if any, are to be preserved.
The next step in the complete repeal and replacement of the ACA, is for the four committees to send their plan, also known as budget reconciliation, to the budget committee. Following this, both houses of Congress will take a vote, and a simple majority is necessary for the reconciliation to pass. Only after the vote, will parts of the ACA be repealed.
The last step in the process of ACA repeal and replacement is a comprehensive healthcare plan to replace the ACA. Following the release of the American Health Care Act, the Republican plan to replace and repeal the ACA a debate erupted between the Democrats and Republicans regarding the protection of coverage for low-income people.
The growing opposition to the proposed Republican healthcare program will likely affect the timeline of the repeal and replacement of the ACA.
Medicare Part A and Part B does not cover every medical procedure. If you find that some of the services you need are not covered under Medicare, you will need to cover the remainder yourself. If you have supplemental insurance or additional Medicare plans, they may offer the necessary coverage.
Medicare Part A and Part B cover hospital stays, outpatient care, medical supplies and more. However, even if Medicare Part A and Part B covers medical procedures, the plans still require a co-payment, a deductible or co-insurance.
Some of the services that Medicare Part A and Part B do not cover are:
- Routine foot care
- Hearing aids
- Exams for fitting hearing aids
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Eye exams for prescribing glasses
- Dentures
- Long-term care/custodial care
- Cosmetic surgery
- Acupuncture
- Most dental care
- Treatment not medically necessary
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Vaccinations/Immunizations
- Prescription drugs taken at home
- Non-prescription drugs
Posted on Friday, March 17th, 2017. Filed under
Medicare.
Many Americans are hoping for a reform in the health insurance system. They are hoping that the Trump administration delivers on its promises regarding health care. People want choices and perhaps that is what the incoming administration is planning to accomplish. It is not clear what changes may be made yet.
What most do no know is that in many states people only had one choice for their health insurance. What is worse is that in other states people had no choice in health insurance. Moreover, many of those who did sign up for insurance through the ACA, were unable to pay their premiums. Many people who qualified for the ACA, did not qualify for government subsidies.
The idea of the ACA was to get the young and healthy people to sign up to provide a cushion for those older Americans who do need health insurance more often. This, however, was not very successful. Young people were priced out of the market, as current wages do not keep up with the rising cost of living.
Obviously the health care system is incredibly imbalanced and a ponderously expensive entity that needs work to make it function well. Much like immigration reform, a replacement for the ACA is going to take some foresight and careful consideration.
Before the Affordable Care Act (ACA) came into being there was a four tier co-pay plan in place. When the ACA was passed people had to know their insurance plan very well, in order to make the most informed decision about switching healthcare.
While there is a great deal of speculation as to what may or may not replace the ACA, it is clear that it was challenging for many people who were used to the previous health care system. Before it was implemented, the four tier co-pay plan was clear: a set price for Tier 1 (preferred generic) and another price for Tier 2 (non-preferred generic).
When the ACA arrived, Americans had to pay close attention to their insurance plans. Many plans stated generic drugs were at no cost; Tier 2 through Tier 4 did not have a co-pay (only after the deductible is reached). Bronze and Silver plans use a major medical deductible before you get the co-pay for brand name drugs. Many of these changes, however, are proving to be costly for individuals and families.
Tier 3 had a certain dollar amount for preferred brand name drugs and Tier 4 may have had a higher set price or an option of paying 25 percent of a drugs listed price. Some individuals may have had a separate deductible for brand name drugs. Health Savings Accounts were in effect prior to the ACA’s arrival, but there was not separate deductible for brand name drugs.
In or out of network was a hard choice due to the costs. An example would be a woman who chose to go out of network on a Preferred Provider Organization plan (PPO). Once out of the network, out-of-pocket expenses and deductibles double. Put another way, going out of the network not only significantly hiked costs but some services are not covered. This means you pay thousands of dollars for medical care and none of it would be applied toward your out-of-pocket maximum.
All ACA plans must have ten health benefits compared to the “other” system which included seven benefits.
ACA Must Have Benefits:
- Outpatient care
- Emergency room care
- Hospital care
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Prescription drugs
- Recovery services
- Lab work, blood work
- Preventative care
Private (Individual Market) Plan Benefits:
- Outpatient care
- Emergency room care
- Hospital care
-
Prescription drugs
- Recovery services
- Lab work, blood work
- Preventative care (a moving target in terms of what is/is not covered)
- Mental health (optional)
- Maternity (optional)
- Pediatric dental (optional)
Many Americans wondered why their costs soared instead of dropped. The answer lies in the way the ACA reform was funded. To fund such changes, there were multiple federally mandated fees (five to be exact) that began to show up on premiums in 2014. The fees were billed to insurance companies and in turn were passed along to the healthcare user.
Will the private, individual market plans return? Would a return to the old system benefit Americans? Would a blend of the old and new systems work best? Only time will tell.
With the United States facing significant changes in many areas, including health care, trying to understand what the Patient Protection Affordable Care Act (ACA) may evolve into is an unknown.
According to many industry watchers, since the ACA was enacted, over five millions people saw their health insurance policies discontinued because they did not meet ACA standards. Those plans were labeled as being unsatisfactory. However many scrapped plans offered more and were more valuable to customers than what was being sold under the auspices of the ACA.
What are the possible differences between the ACA and what may happen if it is repealed?
- The ACA plans are focused on preventive care
- According to the law, many of the services are covered without co-pay
- Many of the services are not subject to co-insurance
- Many of the services do not have a deductible
- These services are supposedly free, but as benefits, they add to premium costs
- Added premium costs are paid for by policy holders on the front end
- Health Savings Account-like plans are in the Bronze category under the ACA with a family deductible of over $12,000
The number of claims an insurance carrier gets determines premium costs. There is no underwriting under the ACA, which increases an insurance company’s claim expenses. Increased costs for the increased risks translate into higher premiums. To bring costs down many carriers have restricted their networks of hospitals and doctors — a turn of events that means Americans may have to change doctors or change insurance carriers.
If the ACA is repealed and a different kind of health care system comes into play, such as the system in existence before the ACA was passed into law, the following may be implemented:
- Insurance plans would focus on major medical
- Health Savings Accounts with a High Deductible Health Plan or plans similar in nature may return
- Prescription drug coverage and doctor visit co-pays were applied to the deductible
-
Monies in the savings account could pay for drugs and doctor visits
- Many people can pay $100 to $200 to visit a doctor
The possible repeal of the ACA and what would replace it is unknown. If the old system is revitalized, consumers may well see more choices and competitive rates and plans.
While the repeal of ACA is ongoing, the prospect for more fair insurance rates and a return to better plans may be hovering on the horizon.
The incoming administration is determined to repeal and replace the Affordable Care Act (ACA). It is difficult to know yet, what is to replace it and how the new system will work. Some provisions from the ACA may be kept in place like keeping kids on a parent’s health plan until they are 26 years-old and not denying people health insurance if they have pre-existing conditions. But the question remains how is the Trump administration going to accomplish this?
Because there is no established system that keeps track of who signed up for insurance and who did not. The question is how to determine who did get insurance, who did not, who was possibly forced into buying it and who still does not have insurance.
Some pundits claim that the ACA gave coverage to 20 million Americans who had never had insurance before. Others say, that it was 14 million counting those who were insured but lost their insurance and had to buy new plans under the ACA. Many people feel cheated and overcharged with their health insurance plans under the ACA.
What is next? Some Americans hope that the Trump administration will repeal the and replace the current healthcare system with something that will lower insurance costs, lower premiums and open the market up with more insurance choices.
According to president-elect Donald Trump, Americans have suffered under the weight of a massive economic burden brought about by the Affordable Care Act (ACA).
Apparently the Affordable Care Act was passed into law without much foresight, resulting in out-of-control costs, non-functional websites, higher premiums, less competition in the insurance industry and a greater rationing of care. As a result of the legislation, every American was allegedly faced with uncertainty of the ACA collapsing, causing even greater economic concern and hardship when it came to health care.
President Donald Trump’s administration suggests that on day one of a new administration free market reforms would be introduced into the health care industry by completely repealing the ACA. Replacing the repealed legislation would be the next task and the administration indicates it would have such reforms ready that closely follow free market principles geared to restore certainty and economic freedom to all Americans. Free market principles combined with sound public policy are intended to broaden health care access, improve the quality of care and make it more affordable.
The proposed seven-point plan touted by president-elect Donald Trump to make health care more affordable for all Americans will allegedly:
- Lower health care costs for every American
- Remove uncertainty about health care
- Offer financial security for Americans
- Tackle other policy revisions to lower the cost of health care
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Enforce immigration laws to relieve economic pressures on Americans in health care
- Stop fraud and waste and energize the American economy
- Reduce the number of people accessing programs such as Children’s Health Insurance, Medicaid
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Work on growing the economy by bringing jobs and capital back to the United States
- Reform mental health services
It appears that the plan to reform health care in the United States is ambitious and may result in some significant changes for Americans. While it is not precisely clear how many of the proposed reforms are to be implemented and what may be designed to replace existing health care legislation, there are many industry pundits who feel that change may be a good thing to stimulate the economy.
The country is on the brink of a new era and it appears that approaching health care with a different point-of-view may produce some interesting results, not only for the people, but also for the insurance industry as a whole.
The insurance industry is complex and adjusting how its products are marketed may have a negative impact on consumers. Economists swear by a free market environment as being beneficial to all who participate in it.
But would a free market environment work for the insurance industry? To answer that question, a group of economists studied Medicare Advantage, where beneficiaries chose from alternative cost-sharing arrangements and restricted provider networks. A healthy 32 percent of seniors have opted for Medicare Advantage where the government pays insurers a fixed fee to cover patients, not a separate service fee as in traditional Medicare.
Based on the growing numbers of seniors opting for Medicare Advantage, it appears they find the competition for their business and the choices they are offered to be very appealing and beneficial. According to House Speaker Paul Ryan, choice and competition are better options when it comes to selecting health insurance. It appears research supports his contention.
What does the future hold? It may be interesting to see what happens when the transition from one administration to another completes.
In 2013 the Congressional Budget Office (CBO) researched how premium support, as suggested by House Speaker Paul Ryan’s “A Better Way,” would impact the federal budget, beneficiaries’ payments and choices.
The results of their research revealed that under the two different proposed premium support plans, that both would “reduce federal spending for Medicare net of beneficiaries’ premiums and other offsetting receipts.” Put another way, introducing premium support would adjust the current health care system and permit the free market to offer seniors the ability to pick plans suited to their health needs.
Based on this research, House Speaker Paul Ryan hopefully forecasts that by 2024, Medicare beneficiaries may see private insurers compete for their business on a proposed new Medicare Exchange. The futuristic plan would allegedly have no disruptions in the Medicare Fee For Service program for retired individuals or those about to retire. These individuals would also have the option to enroll in the new premium support program.
With research backing up Ryan’s conclusions that a free market choice is more beneficial to those seeking health insurance it appears that competition and choice may be the future of health care in the United States.
