We just found out that United Healthcare’s division Golden Rule Insurance – due to health care reform legislation will no longer be selling “child only” insurance policies.  This is because they will be forced to cover the children with pre-existing conditions.

In the past, as an insurance broker – we used to be able to sell these “child only” policies to the employees of companies where we helped support their group health plan.  A lot of times these “child only” policies were an affordable option to the group benefits they were being offered at their work.

Mark my words – United my be the first to do this – there will be more that follow.

It is becoming more and more evident how the Obama Administration has zero regard for our borders.  Their de-funding of additional fencing and border safety is going to end up hurting America.

U.S. Border Security Part 1

U.S. Border Security Part 2

This is important stuff, please watch the videos and let us know your thoughts!

I got this today from HHS:

Yes, You Can Keep Your Health Plan

Posted May 19, 2010
By Stephanie Cutter, Assistant to the President for Special Projects
The Wall Street Journal published an op-ed today charging that the Affordable Care Act will prevent people from keeping their current health plan and limit their choices. However, this ignores the realities of health reform.

You can read the full Blog Post here, and you can read the WSJ Op-ed here – I Posed on the WSJ.com forum and below is my response:

Good Points – however, the biggest issue with the “Grandfathered” plans and why you will not be able to keep them (at least for very long) is:

HR 3590 requires that Individual and Small Employer Qualified Health Plans (those offered through the exchanges) and Grandfathered plans to be in two separate risk pools (this was NOT changed by the reconciliation bill). (See page 153 of HR3590 and start reading at line 24)

Ok, so what does this mean?

In order for insurance (no matter what kind) to stay affordable, the risk(s) of the insured are pooled into a group. The way for premiums to stay somewhat “level” is to continuously add new insured(s) into the risk pool.

By legislating that the risk of the Grandfathered plans and the New Qualified plans must be pooled separately, this administration has effectively destroyed the Risk Pool of the Grandfathered plans.

Side Note: A Grandfathered plans are those plans purchased prior to March 23rd, 2010 and in order to stay a grandfathered plan, the only thing that can change is the rate. If there are any benefit changes – it is no longer considered Grandfathered – hence, no longer a “Qualified Plan”

Bottom Line: Because the Grandfathered plans will no longer be able to be sold, their risk(s) will rise disproportionately (people will change plans between now and 2014) to the plans sold through the exchanges – so quite honestly, the 1/2 truth of “if you like your health plan, you can keep it” will only work as long as you can afford to pay the premiums. The Grandfathered plans will be dead; can’t sell new ones, can’t afford to pay the premiums – so really, you will not be able to keep your health plan – at least not for very long.

Sorry folks – you will not be able to keep your health plan – at least not for very long!!!!

Gratitude Campaign

Recently, a gentleman from Seattle created a gesture which could be used and has started a movement to get the word out

This is pretty neat…..(30 second video) …

Please everybody take just a moment to watch…. The Gratitude Campaign; …….and then forward it to your friends! THEN START USING THE SIGN

A CBO report sent Tuesday to Rep. Jerry Lewis of California, the ranking Republican on the House Appropriations Committee, said the estimated rise in discretionary spending – which is spending requiring annual congressional authorization – over the first 10 years under the new legislation could exceed
$115 billion.

Read More...

Read the letter from WellPoint CEO Angela F. Braly to President Obama

Bubye Harry Reid

I’ll attempt to analyze  his argument and show where he is following the talking points of the Liberal Socialist currently in control of our country.

Dude, this thing that I admittedly started was starting to get a little ugly so I thought I should email you to calm it down a bit.

I’m really wasn’t trying to pick a fight. I was being a little bit of a smart-ass but I really was trying to provoke a conversation. It’s just that I don’t fully understand where all this anger on the right is coming from and I am trying to figure it out.

First of all – this is not coming from the “Right”.  This is coming from a broad spectrum of Americans who believe this current administration is overstepping their Constitutional power.  This movement is for smaller government, lower taxes and economic freedom.  When I went to Searchlight – Sure, there were a few people who were a little off the wall in their views, but the super majority of the folks were just like me, my parents and my friends – normal everyday Americans.

I mean, I am not terribly happy about the state of union right now either but I don’t hurl racial epithets, threaten members of Congress or plot to murder policemen (not that you do either but you have to admit that much of this type of behavior is currently coming out of some of the more right-leaning elements)

Of course, this is the way the Liberals are “demonizing” the Tea Party Movement.  Everything turns to the race card, the rich/poor card, the male/female card etc.  This is just their way of dividing the country.  It is obvious this administration is using an “us vs. them” philosophy in order to create a divide in our country.  If we do not think their way, then we are not included in the so called “debate” over the issues.  Its their way or the highway.

1. The charges of Racial Epithets and Spitting are not proven and no one has been arrested for these allegations.  And let me be clear – I personally find anyone who uses this method to show their discontent for anyone – appalling.
2. Murder policemen?  Where in the word does this come from?

While there have been threats to Democratic Leaders.  What you are not seeing or hearing about are threats to Republican and Tea Party Activist.  With any “movement” or “party” or even “religion” there are extreme members – unfortunately, the media and the liberals are reporting that this is everyone in the Tea Party Movement.

Here are a few examples:

Man arrested for Eric Cantor death threat – Federal authorities have arrested a Philadelphia man and charged him with threatening to kill House Minority Whip Eric Cantor (R-Va.) and his family.  Read more

Racist, hate filled voicemail over healthcare controversy

Here’s a message that was left on the voicemail of Ohio Rep. Jean Schmidt – WARNING – Not Very Nice Language

Below is something that you probably didn’t hear about.  Students were arrested and people were blocked from getting to and from work.  Why isn’t this being demonized?  This is totally uncalled for and if I remember correctly – there were zero arrests with the Tea Party folks in DC.

March 4th “Day of Action” Students Rally Nationwide

Provost David Kliger warned students to keep the protests peaceful after protesters reportedly prevented a resident of faculty/student housing from leaving the campus and blocked a health care worker from getting to work.The protesters’ behavior is “disruptive, intimidating and destructive,” Kliger said. “Behavior that degrades into violence, personal intimidation and disrespect for the rights of others is reprehensible, and does nothing to aid efforts to restore funding to the university,” he said. “These actions should cease.”  Read More

150 Arrested In March 4th Actions

Today’s March 4^th Day of Action in Oakland was called and attended to defend public education. As working students and/or people of color, we believe that peaceful protest and civil disobedience are powerful forces for change in a democratic society, and we defend the rights of individuals and organizations to practice them.  Read More

While these people are marching for “no more cuts” to eduction – a good cause.  What they fail to realize, is that everyone has become too dependent on US and State Governments unnecessary programs.  This nation is about equal rights and opportunity.  With the freedoms that America has given it’s “true” citizens, everyone has the opportunity to be successful; as success is earned, not given.

Like you, I certainly do not agree with everything the current administration is doing, although I would guess that we disagree with them for different reasons. But, if you want to talk about transparency, back room deals and overspending then I think you need to be a little more critical of the last administration. Were you raising these same concerns when the Bush administration would not release lists of who it was having meetings with in the energy industry, when they were giving no-bid contracts to Haliburton, when they cut taxes on the wealthiest Americans while simultaneously fighting two wars? If you were then good for you and please accept my apologies.

This goes both ways – this is the basis for the Tea Party Movement.  We are tired of back room deals within both the Republican and Democrat Parties.  Today’s method of Politics has gotten out of control and when they use the the American tax payers dollars to bribe and influence agendas, it is time to change the way things are accomplished in DC.

However, the Obama administration has a hell of a mess to clean up  – in fairness this mess was not completely caused by Bush, 30 plus years of questionable governance from both sides of the aisle are to blame – and I think by and large they are doing an okay job. Health care is mess in this country and something had to be done to address it. It is not a government takeover. It leaves the private insurance market completely intact and even provides them with a some new competitive incentives as well as a ka-jillion new customers. I would think this would please most capitalists.

Here, he is absolutely correct – this is caused by our corrupt system of Government favoritism on both sides of the isle.  However, while this Health Care Bill does leave the Insurance Companies “in tact”, he fails to mention how the mandates on coverage are going to significantly increase the cost of health insurance across America.  This is just common sense.

This is evident by looking at New York and then Massachusetts:

1. New York has one of the highest quantity of state mandates and they are the most expensive  in the country.  Read More
2. Massachusetts health care program is the main cause for their budget woes.  Read More

Lets look at some of the health insurance premium increase estimates that Obamacare is going to cause:

1. Costs will rise for the younger people with Obamacare – as much as 17%.  Read More
2. Get your wallet out if you are ready to retire under Obamacare.  Read More

Bottom line folks – this is a take over of the health insurance companies.  What else do we call federal mandates? The below mandates are required to be put in place by October of this year:

• No lifetime caps on policies
• No pre-existing exclusions for children
• $250 tax rebate for Medicare Part D Doughnut hole cost
• Dependent coverage up to age 26 is mandated

While these are good things for the American insured, they were put in place to do two things:

1. Give Americans a benefit they do not want to give up – will be hard to repeal.  It also created a political talking point for the 2010 election season.
2. Increase the costs of health insurance across the country so more discontent will be created for the Health Insurance companies.  Ultimately leading to the feds stepping in with a costly government option.

Wellpoint shows these measure will increase the cost significantly.  The impact of guaranteed issue will increase premiums by 50% alone (this is just for Nevada).  While the link is just for Nevada – it is relative to the rest of the United States.  Polices are not currently actuarially budgeted for these types of mandates.

The stimulus did not fail. Its effects were modest (again but were sufficient in pulling the economy back from the brink. Would you rather the federal government sit idly by and let the economy tank, when it had both the means to save millions of Americans from immeasurable hardship?

Oh my – lets look at some of the stimulus programs and evaluated them for yourself.

1. Cash 4 Clunkers – all  this program did was accelerate demand and falsely impact sales numbers.  These types of government programs interfere on the laws of Supply and Demand.  In addition, because this is a government run program it wasted a ton of money – estimates of cost are at $24,000 per vehicle?  Just look at Senator Grassley’s inquiry and his attempt to get real answers.
2. Stimulus Money Going Overseas – This is a result of when the “Buy American” clause was pulled out of the Stimulus Bill – recommended by good ole’ Republican Senator Mitch McConnell.  I find this appalling, this was an American Stimulus Package – the “Buy American”  clause would have significantly helped the American worker.  Look at how it has affected “Green Stimulus Money“.  This is a Republican and Democratic issue and I feel it is a result of pushing the bill through as quickly as possible – and not fully understanding everything that is in the bill.
3. $75 Billion More Expensive – As with any government program the stimulus bill has proven to be more expensive than originally anticipated – I am sure we’ll have the same thing with the Healthcare Bill as well.
4. Unemployment – Was not supposed to go above 8%?

Lastly – let me look at “CNN’s Big Bang” – the total cost of Stimulus.

True Cost of The Stimulus Bill

The Stimulus Tracker FAQ

The government’s efforts to rescue the economy were bold and complex. Here is an explanation of our methodology to break down stimulus into its component parts.

(Q) What is the difference between “Stimulus 1″ and “Stimulus 2?”

Stimulus 1 is the $787 billion American Recovery and Reinvestment Act, signed into law in February 2009. It contains a combination of grants, loans, direct spending and tax cuts aimed at creating jobs and alleviating the economic stresses caused by the recession.

Stimulus 2 is a group of extensions of programs enacted by stimulus 1 that were about to expire. It also includes other economic stimulus that was not in the ARRA bill.

Q) What was included in “Stealth Stimulus?”

A) Since the credit crisis erupted in 2008, the government launched several dozen programs aimed at rescuing the financial sector, the housing market and the overall economy. We included only programs that were launched by the Federal Reserve, Treasury Department or Federal Deposit Insurance Corp. since 2008.

Q) I have seen other values assigned to stimulus categories. How did you arrive at these numbers?

A) The Recovery Act is by far the largest stimulus bill ever enacted, and there are many ways to divide the thousands of different programs into groupings. We chose to follow the Congressional Budget Office’s analysis of the bill, since CBO is an independent evaluator.

CBO grouped the bill’s contents into 47 categories, and we further condensed CBO’s groupings to seven main categories and 31 smaller parts.

Q) I thought some of these programs have yet to be funded, are winding down or have been paid back. What do the dollar amounts represent?

A) For the Recovery Act and its extensions, we listed the total appropriations for each category. For the Stealth Stimulus section, many of the programs were assigned credit caps that are unlikely to be reached, so we listed the highest value of government support during the life of each program.

Many of those programs are currently at their funding peaks, while others have been fully repaid.

Reference

With the above being said – personally, I did not and would never support this type of bail out – we would have been better off to let things run their course and get through the mess quicker.  The government blew a bunch of dough and we do not have much to show for it.

And let us not confuse the TARP with the stimulus bill. TARP was Bush’s doing. A necessary evil I would argue but it is one that seems to get blamed on Obama and provoke a lot of populist rage.

Completely false: Not Bush’s 100% doing – this was discussed and agreed upon by the powers to be – the above picture shows all who were involved in the decision.   When McCain supported TARP – my support for McCain diminished, on that day, he proved to me that he did not have the best interest of the country in mind – and this is when it became evident that Obama was going to be our next president.

One of my main beefs with modern American conservatism is that it constantly complains about how ineffective government is while simultaneously doing everything it can to make government ineffective. It’s easy enough to bitch and moan, but the hard work is in actual governing.

No facts here – pointless gibberish.

I too am down with minimal government intrusion in people’s lives. This does not mean that government does not have a role (one role it does not have is turning a profit, to address your final point). One of the popular misconceptions about liberalism is that it is somehow it is in favor of government control over everything. This demonstrably untrue. I don’t want government in my books, in my music, in my bedroom etc. but there are things that they need to do and things I expect them to do: police the streets, fight fires, build roads, educate our children, protect our environment just to name a few. But these things don’t come free. Somebody gotta pay for them. Like Oliver Wendell Homes said, “I like to pay taxes. With them I buy civilization.” Maybe I wouldn’t go so far as to say I like it, but damn dude, modern society is expensive and we have to pull together in order to afford it.

The problem here is that we as a country can not afford everything for everyone.  The inefficiencies of government are evident and politicians on both the right and left are to blame for program after program that is either failed, failing or prevents job growth.  Do you realize that if the Hoover Damn would have been built today, it would spend over 10 years in environmental litigation.  The special interest groups are stifling our economy and unless we do “something” soon, we will have exported every middle class paying job overseas.

It’s not big government I want. Like you, I simply want government that is truly responsive to the needs of its citizens – all its citizens – including the weak, the needy, and the sick (for what kind of a nation are we if we cannot collectively decide to protect the most vulnerable among us?). I want a government that recognizes there is more to governing than tax breaks and Social Security checks. I want a government that upholds the right of everyone to believe in whatever religion they see fit, or to not believe at all. I want a government that realizes workers should have just as strong a voice as the corporations they work for. I want a government that helps ensure freedom of opportunity for all, not just the wealthy and well-connected. I want a government that works to protect all Americans from privation, starvation, violence and exploitation. We can do this. We have the means. What we often lack is the will. It is not enough to say, “Here’s a $600 tax refund – good luck with that!” That isn’t governing. That isn’t building a society. That’s a cop-out. And Americans (usually) deserve better.

I agree with what you want – however, to use a talking point of a $600 check is of no value.  At least that program was overwhelmingly bipartisan.

It passed the Senate by a vote of 81 to 16 and, just hours later, by a House vote of 380 to 34.

And THAT my friend, is what the Tea Party Movement is upset about.

What’s the most important aspect of health insurance reform?

TEXT A to 42779 for:
Making sure people with preexisting conditions can get affordable insurance

TEXT B to 42779 for:
Prohibiting insurance companies from dropping people when they get sick

TEXT C to 42779 for:
Creating a public insurance option to lower costs by creating competition

TEXT D to 42779 for:
We should not reform health insurance, status quo is ok by me

TEXT your answer (A,B,C or D) to 42779 (HARRY) to vote

Repost this information NOW! – Test your answer NOW!

The Bacus plan uses the Quality Adjusted Remaining Years (QARY) method of assigning value to one’s life.  In addition, the plan will financially penalize the top 10% health care spending Physicians, Hospitals and other Medical Facilities (like long term care facilities).  The result will force America in to a brand new way of managing health care. 

Health Insurance Carriers are not ”evil” and I do understand how difficult of a task they have.  Bottom line - they are an easy target -  I have been in the health insurance industry for the past 7 years and while sometimes claims are denied for the wrong reason i.e. emergent vs. urgent care, failure to obtain prior authorization, going to an out of network physician / facility.  I have never seen them deny a claim when the treatment fell with-in American Medical Association (AMA) Guidelines.  This goes for both HMO and PPO plans.  The health insurance carriers really do attempt to do the right thing, just keep in mind – policies are contracts – and contracts should be explained and understood before purchasing or participating in any health insurance program.

So…. with the Health Insurance Carriers – for the most part they are predictable because they adhere to AMA standards.  This means tests and treatments are approved or disapproved based on AMA findings.  Solid medical evidence dictates what treatments are taken into consideration during the review process.  While not my favorite methode of medical care, at least the “treatment” has more weight in the decision making process when comparing to cost.

The lovely Bacus plan shifts medical treatment decisions to a financial based model.

Lets look at what QALY means and a couple examples of how it works.  Im going to use a number for “one” Quality Adjusted Remaining Year (QALY), and that number is going to be $20,000 – seems reasonable – it will make more sense in a minute.

Example -  Lets say Jim is 54 years old and is in relatively good health.  Based on today’s average life expectancy he should live to be about 75 (give or take).  The difference between 75 and 54 is his QALY, which is 21.  So at $20k per QALY, he could potentially access upto $440,000 in medical care. 

Not bad at all as long as he remains healthy.  What I mean by this is;  your QALY is assigned by your physician, if you become ill, he may reduce your QALY. 

This does two things:

1. Reduces the amount of money that you have access to for health related issues.
2. Possibly gets your physician thinking twice about treating you with an expensive but proven treatment.

Remember – the top 10% spending physicians will be penalized – either by fines or reductions to their insurance carrier reimbursements.

The QALY method is just plain age discrimination - consider the retired, disabled and elderly; And what about our special needs children?  How will the physicians assign the QALY in these instances?  They become caught between a rock and a hard spot – these are the most expensive patients to treat, and if the physician climbs above the 90th percential in healthcare spending, he/she will be financially penalized for prescribing the necessary, and sometimes expensive treatments.

To top things off, this will be regulated by the government, through the insurance companies (remember no public options).  The government will say ” these are the standards ” and if you breach the 90th percentile, you will be penalized.  This way, when the denials come because of the QALY standards, guess who the liberal government will get to “demonize” – yup, you guessed it – the insurance companies…….  AGAIN.

Every American will be touched by this legislation – both positively and negatively.  The poor, elderly and disabled will be negatively PUNCHED by this legislation.

We need to get involved.  Call your representatives NOW!  Make the White House Phone ring off the hook.  Tell your neighbors, your co-workers and your friends and families.  Do it NOW before its too late!

40% excise tax on health coverage in excess of $8,000/$21,000 indexed for inflation by CPI-U plus 1% and increased thresholds for over age 55 retirees or certain high-risk professions; levied at insurer level; employer aggregates and issues information return for insurers indicating amount subject to the excise tax; nondeductible; high 17 state transition relief

In my opinion – these taxes will create a more even playing field – IF the Unions are upheld to the same standard as the private sector.  If the Union’s are given a pass on this provision – then this is just another “soak the rich” tactic by the left.  The reason this may work is two-fold.  1) By placing an “artificial” cap on how much benefits should cost it will keep the unions from consistently “asking for more” in the benefit programs they offer their members.  It will also force the insurers to keep annual premiums below said thresholds.  No employer wants to pay the penalties and the insurers don’t either.  They list 201.4 billion (2010-2019) as the revenues this will create – I personally do not think the revenues will be close to this.  Employers, Unions and Insurers will do everything possible to “attempt” to keep the “Cadillac” plans under or close to the above listed thresholds.

Confirm the definition of medical expenses for health Flexible Spending Arrangements (FSA’s) to the definition of itemized deduction for medical expenses (excluding over-the-counter medications prescribed by a physician).

This is interesting – because most over the counter drugs such as Allegra, Prevacid and Motrin were at one point only available through a pharmacy and tax deductible or a qualified expense of an FSA.  Just remember when Obama said – “no new taxes to the middle class” – well, here is one staring you right in the face.

Increase the penalty for nonqualified Health Savings Account (HSA) distributions to 20%.

Here is another middle class tax hike.  I honest do not know many people who spend their HSA dollars on a new Rolex or that new Gucci Purse so the only time I would assume people to use their HSA dollars on non-qualified expenses is when they are out of work and have no other means to pay for whatever items they are purchasing.  And they say their are going to create 1.3 billion in offsets with this?  Just doesn’t make sense to me.

Limit Health Flexible Spending Arrangement (FSA) in cafeteria plans to $2,500.

Yet another middle class tax increase.  I just get more and more frustrated the more I read.  So tell me, when did your child’s braces cost $2,500?  In 1984 when I graduated High School??  Lets look at a family of four who has “standard” annual medical expenses:

• $1,500 in Prescription Drugs (4 adult maintenance medications + a few scripts for anti-biotic)
• $400 in Dental Work (cleanings, fillings etc)
• $180 in Vision Needs (one pair of glasses a year)
• $100 in urgent care visits (2 visits per year)
• $120 in standard office visits ($20ea 3 wellness, 3 sickness)

The above adds up to $2,300, so the $2,500 would work for this family, this year.  But when this family’s children need braces – Tax Increase – If someone in this family comes down with a catastrophic illness – Tax Increase – If someone in this family has an accident -  Tax Increase.  Seems they are now dictating as long as you are healthy – you won’t have a tax increase.  Give me a break.

Require information reporting on payments to corporations.

Hidden Tax Increase – all the costs will be passed to the consumer.

Additional requirements for section 501(c)(3) (non profit) hospitals.

Hidden Tax Increase – all the costs will be passed to the consumer.

Impose annual fee on manufacturers and importers of branded drugs.

Hidden Tax Increase – all the costs will be passed to the consumer.

Impose annual fee on manufacturers and importers of certain medical devices.

Hidden Tax Increase – all the costs will be passed to the consumer.

Impose annual fee on health insurance providers.

Hidden Tax Increase – all the costs will be passed to the consumer.

Eliminate deduction for expenses allocable to Medicare Part D subsidy.

Hidden Tax Increase – all the costs will be passed to the consumer.

Raise 7.5% AGI Floor on medical expenses deduction to 10%; AGI floor for individuals age and older (and their spouses) remains at 7.5%.

Blatant Middle Class Tax Increase

There are a few others – click here to see – but I think you get my point.  They say one thing and then do another.  Not one good idea has been taken from the Republican plans – just drives me nuts.