Tag Archives: health insurance

Health insurance lawsuit has White House “grasping at straws”

The Wieland FamilyLast week, attorneys for the United States Department of Health and Human Services filed a document in a civil lawsuit by a Missouri legislator to support the Department’s motion for summary judgment that reiterated the same arguments previously rejected by the United States Court of Appeals for the Eighth Circuit. The Thomas More Society is representing Missouri State Senator Paul Wieland and his wife, Teresa Wieland, in Wieland v. U.S. Department of Health and Human Services, defending the Wieland family against the Affordable Care Act’s controversial contraceptive mandate and the substantial religious burden it places on them.  The lawsuit, in its simplest form, is the individual state employee’s version of the well-publicized Hobby Lobby case in which the United States Supreme Court rejected Obamacare’s infringement on religious rights. The Eighth Circuit soundly rejected the United States government’s position and sent the case back down to the United States District Court for the Eastern District of Missouri.

In response to the Obama administration is rehashing the same argument already rejected by the United States Supreme Court. Thomas More Society Special Counsel Timothy Belz stated, “The government is grasping at straws in their argument. The Eighth Circuit agreed with the Wielands that the contraceptive mandate is indeed a substantial religious burden on them, and if an injunction is granted in their favor, then the state-run insurance company would be required under state law to provide a contraceptive-free policy. The court has also disposed of the government’s other argument — that the Affordable Care Act’s contraceptive mandate survives strict scrutiny. The Burwell v. Hobby Lobby Stores, Inc. and Sharpe Holdings, Inc. v. U.S. Department of Health and Human Services decisions hold that the government flunks the strict scrutiny test.”

Wieland and his wife Teresa, like the owners of Hobby Lobby and Sharpe Holdings, object on religious grounds to mandated insurance coverage for contraceptives – which includes abortifacients such as Plan B and Ella as well as sterilization. The federal Religious Freedom Restoration Act assures them of religious liberty that cannot be federally usurped. The Wielands previously had exemption clauses in their policy, which were available to any employee, and easily accommodated by the insurance company, but that is something the Obama administration refuses to acknowledge.  [NORM ‘n’ AL Note:  Our emphasis.]

Read more about the Thomas More Society’s defense of the Wieland family’s religious liberty here .


[from the Thomas More Society]




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The Affordable Care Act (Obamacare): Is spending 25 to 30 percent of yearly income on medical care affordable?

The twin goals of health insurance are to enable affordable access to healthcare and to ease financial burdens when sick or injured.

Accordingly, a major objective of the Affordable Care Act’s (ACA) coverage is explicit: its affordability. But what counts as “affordable?” For the 7 million people who have received, on average, a 76 percent reduction in premium costs in the new Health Insurance Exchanges (or “marketplaces”) created by the ACA, health coverage has certainly become more affordable.

And, for the individuals and families whose incomes are below 250 percent of the federal poverty level (FPL), the additional “cost-sharing reductions” in exchange plans that limit the out-of-pocket expenses enrollees pay toward deductibles, copayments and coinsurance also ensure that health coverage is less expensive.

But what actually happens when people start using and paying for medical services? At that point the definition of affordability becomes less clear, particularly for folks who inch into moderate income brackets, are high medical-care utilizers, or unwittingly wade into the less well-known fiscal “landmines” embedded in some of the insurance policies offered under the law.

Consider this: A 51-year-old nonsmoker at 200 percent of the FPL making just shy of $23,000 a year (less than $12 per hour for a full-time worker) can purchase a subsidized “silver” ACA exchange plan in central Virginia with a $750 deductible and out-of-pocket maximum of $1,500 for about $1,400 a year. Theoretically, the maximum financial exposure for this individual would be $2,900 annually, or about 13 percent of income.

If this same 51-year-old had an income of just over $23,000, or 201 percent of the FPL, a similar health plan’s premium, with subsidy, would cost only $25 more but would carry a $2,350 deductible and $4,500 out-of-pocket maximum, with a potential financial exposure of $6,000 a year, or 26 percent of income.

Moving up the income scale, at 251 percent of the FPL ($28,840) and now no longer eligible for the cost-sharing reductions, the subsidized health plan for this 51-year-old would cost about $2,300 a year, the deductible would rise to $3,350, and the out-of-pocket maximum to $5,500. At this level of income, the total possible annual expenditure could reach $7,800, or 27 percent of income.

Contrast this with employer-sponsored health plans, where in 2013 the average worker’s portion of the premium was about $1,000, the average annual deductible was $1,135 and the out-of-pocket maximum was often less than $3,000.

Once the out-of-pocket maximum is satisfied, insurance coverage kicks in, assuming the person did not violate the rules regarding their health plan’s provider network. Most of the exchange plans tie coverage to the exclusive use of in-network providers. The use of out-of-network hospitals or physicians incurs additional charges above and beyond the designated out-of-pocket maximum.

Similarly, although the health law requires that preventive care such as vaccines, cancer screenings and annual checkups be covered at no cost to consumers in most health plans, patients can be charged for those services if they unknowingly use an out-of-network provider. While the ACA does require that an adequate number of providers be included in a health plan’s network, choice may be restricted in more narrow provider networks. A recent McKinsey & Company analysis of 120 silver-level exchange plans found that 70 percent of the “narrow” plans did not include 30 percent of the area’s largest hospitals, potentially leading to access problems for some individuals.

Is spending 25 to 30 percent of yearly income on medical care affordable? According to the Commonwealth Fund, probably not for most Americans. They assess health care affordability in terms of high medical cost burden relative to annual income. People with insurance are considered “underinsured” if they spend 10 percent or more of total income on medical care (not including premiums), or 5 percent or more if annual incomes are less than 200 percent of the poverty line.

When those spending thresholds are met, the “underinsured” are nearly as likely as the uninsured population to forego needed medical care because of costs and the fear of incurring additional medical debt. Using this affordability measure, even when the premiums are excluded, the hypothetical 51-year-old described above would be underinsured. At 200 percent FPL, total financial exposure would be 7 percent of income and would rise to almost 20 percent of income at 251 percent FPL. A more benign public policy for those with subsidized coverage under the ACA might be to link maximum out-of-pocket expenditures to a fixed percent of income rather than to an absolute dollar ceiling.

Of course, not everyone purchasing an ACA exchange plan will meet the out-of-pocket maximum during the course of a year of medical spending, but some will, particularly those with one or more chronic illnesses. Having a chronic health condition generates an average annual medical cost of $6,032 — five times higher than for those without such a condition. Currently, more than four out of 10 American adults have at least one chronic condition and for them it will be particularly important to dig into the details of their health insurance plans with regard to cost and coverage.

No law is perfect, but the intensely partisan political acrimony in Congress has made it impossible to tweak the ACA to make it better. (NORM ‘n’ AL Note:  Mr. O has done a lot of tweaking of the ACA all by himself since it was introduced, to try to improve it. As this article makes plain, the old coverage that his plan replaces was far more affordable than new Affordable Care Act coverage, especially for those who are higher-volume healthcare users.)  The premium assistance, cost-reduction subsidies and overall limits on healthcare spending within the ACA have benefited many low- and middle-income individuals and families and protected them from catastrophic medical bills. But for those with chronic conditions who require a greater volume of services, acquiring accessible, affordable health care in the individual market, even with the ACA subsidies, may still remain out of reach.

[by Carolyn Long Engelhard, director of the Health Policy Program at the University of Virginia School of Medicine’s Department of Public Health Sciences, writing for THE HILL. The author gratefully acknowledges the staff at the Charlottesville Free Clinic for bringing this issue to her attention.]


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NORM ‘n’ AL, Minneapolis

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Supreme Court rules employers cannot be forced to cover contraception…

The Supreme Court says corporations can hold religious objections that allow them to opt out of the new health law requirement that they cover contraceptives for women.

The justices’ 5-4 decision Monday is the first time that the high court has ruled that profit-seeking businesses can hold religious views under federal law. And it means the Obama administration must search for a different way of providing free contraception to women who are covered under objecting companies’ health insurance plans.

Contraception is among a range of preventive services that must be provided at no extra charge under the health care law that President Barack Obama signed in 2010 and the Supreme Court upheld two years later.

Two years ago, Chief Justice John Roberts cast the pivotal vote that saved the health care law in the midst of Obama’s campaign for re-election.

On Monday, dealing with a small sliver of the law, Roberts sided with the four justices who would have struck down the law in its entirety.

Justice Samuel Alito wrote the majority opinion. The court’s four liberal justices dissented.

The court stressed that its ruling applies only to corporations that are under the control of just a few people in which there is no essential difference between the business and its owners.

[by the Associated Press, published in The Washington Post]


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A doctor’s informed view of why Obamacare is not sustainable…

Dr. Ben Carson

We recently witnessed a victory lap by the Obama administration as they announced that over 8 million people had signed up for Obamacare.

 “The repeal debate is and should be over,” declared President Obama in the opening statement of his April 17 press conference. “The Affordable Care Act is working.”

 But with the release of a new study by Express Scripts, the largest pharmacy benefits manager in the country, we now have our first real look behind the curtain at how the law is working thus far — and it clearly validates one of the major concerns of Obamacare critics.

 With all due respect, Mr. President, it’s hard to see how the debate about Obamacare is now over, when the implosion of Obamacare has only just begun.

 The new study, which looked at 650,000 actual pharmacy claims made across 25 Obamacare insurers in January and February, shows that early enrollees in Obamacare exchange plans are indeed sicker and more costly than individuals with insurance coverage in non-exchange plans. This is important because it means the Obamacare health insurance pools are well on their way to collapse.

 The specific discoveries are as follows:

  • The rate of prescriptions for HIV medicines was four times higher in exchange plans than in non-exchange plans;
  • Pain medications were 35% higher in exchange plans;
  • Anti-seizure drugs were 27% higher;
  • Anti-depressants were 14% higher;

It is common sense that sicker people with higher costs are more likely to obtain health insurance when coverage is “guaranteed issue,” as it is in the Obamacare exchanges. Guaranteed issue means that anyone can buy health insurance at any time regardless of health status at the time of purchase. That may sound appealing, and it is certainly great for a few, but it results in obvious perverse incentives that can only lead to collapse.

 If car insurance were guaranteed issue, it would mean you could buy a policy after your car was stolen and get reimbursed for your car. If homeowners insurance were guaranteed issue, you could buy a policy after your house burned down and be sent a check for the value of your home.

 So who would buy an insurance policy in advance if they could always get a guaranteed issue policy later? The obvious answer is no one.

 The problem is that if everyone is making expensive claims that exceed the incoming premiums then soon there is no money left and the insurance pool implodes. This is called a “death spiral” in industry speak. An early symptom is rapidly escalating premiums in a frantic attempt to cover higher than expected costs. We will see this when 2015 premiums are announced later this year. We will also see more desperation when the employer mandate kicks in after the election and tens of millions of people lose what they thought were safe insurance policies.

Several states have tried guaranteed issue health insurance, and the results were a disaster. Kentucky passed guaranteed issue in 1994. Premiums in the individual market shot up 100 percent in some cases, the number of insurers selling policies declined over 90 percent, and there were more, not fewer, uninsured Kentuckians.

Iowa, New Hampshire, South Dakota and Washington also passed guaranteed issue in the mid-1990s. All of those states immediately experienced skyrocketing premiums and fewer choices for their citizens. Consequently, all four states either repealed guaranteed issue outright or modified it significantly. New York and New Jersey maintained their guaranteed issue and ended up with the highest premiums in the country, in some cases costing many thousands of dollars per month.

Obamacare supporters have three responses. The first is that the individual mandate will force people to buy coverage thereby ensuring sufficient money in the pools. The problem with this claim is that the tax for non-compliance ($95 or 1 percent of income in 2014, going up to 2.5 percent of income in 2016) is far less expensive than a year’s worth of premiums. A 27-year-old male in good health making $26,000 a year is unlikely to pay even $100 a month for health insurance, especially a policy with a deductible exceeding $2,000.

The second response is a concession that the truly sick and expensive were more motivated to buy guaranteed issue coverage early. But never fear, the young and healthy are now rushing to buy coverage, and it will balance out. That is only true if you believe that younger Americans, many struggling financially, will pay hundreds of dollars a month for health insurance they are unlikely to need. Michelle Obama may call them “knuckleheads,” but most of them are capable of simple arithmetic.

The third response is to describe how the law as written provides taxpayer bailouts to insurance companies when they are saddled with increasingly bad and expensive risks. The health insurance companies lobbied strongly for this provision in the law because they knew that guaranteed issue would be a financial mess. So yes, the authors of Obamacare were so aware of its eventual failure that they built in taxpayer bailouts in advance.

This position assumes that American taxpayers will tolerate their hard-earned money going to bail out health insurers who were complicit in authoring a failed law. We won’t.

The Express Scripts study is hard evidence of what common sense told us all along. Future studies of claims data will confirm the same trend. Obamacare cannot be fixed. It can only be replaced.

It can only be replaced with a logical system that puts the responsibility for health care back in the hands of patients and their healthcare providers. The details of such a plan have been previously discussed elsewhere and will be discussed here in greater detail soon.

[This article originally appeared in AMERICAN CURRENTSEE]


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“Obamacar” … the Affordable Car Insurance Act…

                                   Illustration by Alexander Hunter/The Washington Times

Since World War II, most Americans received health insurance from employers, had limited choices and, therefore, were often not very knowledgeable about marketplace forces. Insurance companies were viewed solely as the managing company that determined what resources were covered. When health insurance companies began canceling policies this year due to the Affordable Care Act (ACA), many people sought to blame the companies rather than the law which required the policies to be canceled.

Imagine if you obtained your car insurance in the same way health insurance is mandated under the Affordable Care Act:

1. All car owners will be required to purchase car insurance. (That sounds reasonable enough.)

2. But … all car insurance companies must provide exactly the same coverage for every car — and that coverage will be the “Cadillac” coverage.

a. Everything needed to maintain your car will be covered — oil changes and oil filters, automatic transmission fluid, brake repairs.

b. There will be no deductible, or up front costs, for these routine maintenance costs.

c. The car will be provided with a trailer towing mechanism, even if you never intend to use it.

d. No “vacation rates” will be available for those who have cars that are rarely driven.

e. No higher deductibles for collision coverage for those who have a good driving record and think they can afford a higher deductible.

f. No option to choose the amount of coverage you want for bodily injury, medical payments, comprehensive coverage or collision.

g. No ability to lower the cost of the insurance premium by choosing less expensive coverage.

And because the federal government has determined that each driver must receive exactly the same coverage, whether or not it is needed or desired:

i. Rates must therefore escalate to cover all these additional benefits.

j. And … policies that do not meet these requirements will be canceled.

3. Those who cannot afford car insurance must have the exact same coverage as those who have the resources to purchase insurance.

a. If you are employed and have a regular income, you will be required to subsidize those who cannot afford to purchase this expensive car insurance.

a.i. You drive a Ford Focus because it is more economical, has lower repair bills and better gas mileage, but notice your unemployed neighbor is driving an SUV. When you talk with your neighbor and question how he can afford to drive a gas-guzzling SUV while unemployed, you find out that you are subsidizing your neighbor’s car insurance.

a.ii. Then you learn your neighbor has been involved in several accidents.

a.iii. If your neighbor failed to purchase car insurance prior to his accident, he can still enroll in the government car insurance program even after he has been involved in the accident.

b. Your car insurance rates must escalate to cover these costs, too.

4. Since the federal government now controls the car insurance companies, under the guise of attempting to keep car insurance costs lower, the government can:

a. dictate the production of safer vehicle models and eliminate some models from production, so consumer choice is limited;

b. monitor driving records of citizens;

c. force car insurance companies to turn over accident records — and personal information of drivers;

d. monitor the automotive repair businesses, dictate their policies, state which repairs are covered and which repairs are deemed “unnecessary”;

e. determine that your older vehicle is not worth repairing and deny your repair bills, despite the fact that you are still paying your car insurance premiums;

f. require that your mechanic document how he spends every minute of his working day. (This will require that he install an expensive new computer and expensive new software, and he will spend hours inputting data for which he will not be compensated.);

g. require that your mechanic provide the government with information about your vehicle;

h. determine how much your mechanic will be reimbursed for the repairs performed, without regard for cost of living in your area of the country, your mechanic’s expertise, business expenses or the amount of work required to repair your vehicle.

Soon you notice that mechanics are closing their shops due to the long hours and high business costs and are leaving the profession. Then you realize that when you do need your car repaired, there is a long wait at one of the few remaining automotive repair stores still in business. Surely this was not the desired effect of the Affordable Car Insurance Act!

Now you may begin to understand the unintended consequences of the Affordable Care Act, which dictates what type of insurance must be held by everyone in America, regardless of their medical needs or desires. Physicians are already leaving their practices due to the enormous cost and long hours required to implement electronic medical records that can provide all your health care information to government bureaucrats. Yes, the ACA requires rationing of services – and we have not even mentioned the 525 new committees and organizations the ACA requires to monitor every aspect of your health care.

[by Jane E. Anderson, M.D. , a retired pediatrician and clinical professor of pediatrics at University of California, San Francisco.  See AMERICAN CURRENTSEE for original article.]


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Next wave of “Obamacare outrage” is about to hit… “horrific details” of the program will “wreck the federal budget”

“Obamacare’s narrow networks are going to make people furious,” says Sarah Kliff of The Washington Post.

Narrowing a network means limiting patient choice of doctors and hospitals in an effort to cut costs. A McKinsey and Co. study says that 38% of Obamacare plans allow patients to choose from only 30% of the 20 largest hospitals in their geographic regions, with another 32% leaving patients 31%-70% of these.

Even Obamacare supporter Timothy Jost, who writes for Health Affairs, concedes Obamacare enrollees will be “unhappy to learn that their doctors are not available and shocked to discover charges from out-of-network specialists when they go to in-network hospitals.”

The controversial Obamacare program remains overwhelmingly unpopular; the latest RealClearPolitics average of polls finds just 40% of Americans support President Barack Obama’s signature legislative achievement.

Obamacare will cost U.S. taxpayers $2.6 trillion over the next ten years.


It’s fair to say Peter Schiff despises Obamacare.

“If current trends continue, the rollout [of Obamacare] may go down as the worst major product launch in history,” Schiff writes in his latest Euro Pacific Capital newsletter.

Schiff believes that even if the Obamacare website starts working, it won’t fix Obamacare.

“Given the government’s enormous resources, it’s safe to say that the site itself will ultimately be fixed,” says Schiff. “But when it is finally up and running, the plan’s many deeper, and more intractable, flaws will come into focus. That’s when the fun will really begin.”

He adds that “republicans should destroy this monster that threatens us all.”

“The real shock of Obamacare is not the unbelievable ineptitude in which it was launched, but the naiveté in which it was designed,” says Schiff.

Schiff warns, “The fact that Obamacare does nothing to rein in costs while providing an open-ended insurance subsidy may be good news for hospitals and insurance companies, but it’s bad news for taxpayers, on whom this increased burden will ultimately fall.”

Obamacare was supposed to make affordable healthcare available for all.

Yet, not only will healthcare costs rise, but Obamacare could actually increase the amount of uninsured Americans.

That’s because millions who have insurance have been told that they will lose their plan, even though President Obama promised “if you like your plan, you can keep it.”

And that’s just one of the many lies Americans are finding out about Obamacare.

“Put simply the program is built on a mountain of false assumptions and is covered by a terrain of unanticipated incentives. Any cleared-eyed observer should conclude that it is perfectly designed to raise the costs of care and wreck the federal budget.” says Schiff. “However, like just about every other complicated problem that bedevils the nation, the public has become far too caught up in the politics and has ignored the horrific details.”

The silver lining, according to Schiff, is that Obamacare could unravel before it does any long-term damage.

“Unlike other major entitlements, like Social Security and Medicare which took years to produce red ink that was far in excess of original assumptions, the financial shortfalls in Obamacare should show up very quickly.”

With the implementation of Obamacare quickly approaching, Americans are asking what they can do to prepare for all the new costs and rules.

One expert, Betsy McCaughey, former Lieutenant Governor of New York and constitutional scholar with a Ph.D. from Columbia University, recently wrote a best-selling book showing Americans how they can survive Obamacare.

McCaughey is one of the only people in the country — including members of Congress – who has actually read the entire 2,572 page law.

Her book, titled Beating Obamacare: Your Handbook for Surviving the New Health Care Law breaks down the complicated bill into 168 pages of actionable advice.

The book, written in an easy going, easy to read style, shows some startling facts about Obamacare not seen in the mainstream press.

For example, she points to a little known passage in the bill that shows how you could get slapped with a $2,000 fine for not having health insurance — even if you do actually have it.

She also goes into detail explaining how one third of all U.S. employers could stop offering health insurance to their workers.

In one chapter, she shows how ordinary Americans will get stuck paying for substance abuse coverage even if they never touched a drink or drug in their life.

According to McCaughey’s research, senior citizens will get hit the hardest. “If you’re a senior or a baby boomer, expect less care than in the past,” she says. “Hip and knee replacements and cataract surgery will be especially hard to get from Medicare in the months ahead.” Details on how to pick up her book here…

She warns seniors to get some of those types of procedures done now before Obamacare goes into full effect.

In addition, many will find it difficult to keep their medical records private, according to McCaughey.

“The law will compel Americans to share with millions of strangers who are not physicians confidential private and personal medical history information they do not wish to share.”



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