Delay of the fiduciary rule improves the outlook for a vital retirement planning tool.
via https://www.naifa.org/news-publications/naifa-blog/february-2018/naifa-advocacy-gets-results-the-dol-rule-delay-an?feed=blogs
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Nearly two dozen states participate in a VA program to encourage veterans to become licensed advisors.
via https://www.naifa.org/news-publications/naifa-blog/february-2018/naifa-advocates-with-states-to-help-veterans-becom?feed=blogs
Ten state associations have received grants to help them bolster their advocacy efforts.
via https://www.naifa.org/news-publications/naifa-blog/february-2018/naifa-capital-50-fund-takes-state-advocacy-to-new?feed=blogs Bernie Sanders’ Medicare for All proposal, first introduced in the 2016 presidential campaign, got a lot of progressive pulses racing. No private insurance. No out-of-network charges. No premiums, deductibles or copays (or at most, $200 for non-preferred drugs, added to the legislative version Sanders introduced in September 2017). Most healthcare experts, including progressive ones, were less enthusiastic. More than 150 million Americans get health insurance through employers, and most are satisfied. Ending that system would cause massive disruption. Eliminating cost-sharing would make cost control difficult – while the federal government would be footing the entire bill for everyone. Major new taxes would be required. An incremental alternative: ‘Medicare for All Who Need It’Enter the Center for American Progress, a think tank with close ties to the Democratic party, with a more incremental and phased-in plan that gradually draws together existing Medicare, Medicaid and employer-sponsored insurance systems. Importantly, employer-sponsored insurance would not go away, but its costs would be contained because the rates such plans pay to healthcare providers would be brought in line with the public program. Enrollees in the new public program, dubbed Medicare Extra, would have access to all doctors, hospitals and other healthcare providers who accept Medicare – i.e., virtually all providers. Care would not be free to enrollees, except for the poor and near-poor. Premiums would rise with income, maxing out at 10% of income for the affluent. Actuarial value – the percentage of the average user’s costs covered by the plan – would range from 100% for the poor and near-poor to 80% for the affluent. Coverage would be comprehensive, encompassing not only the ACA’s Essential Health Benefits but dental, vision and hearing services. Existing barriers to coverage for the disabled would be removed. The two-year waiting period before those who qualify for Social Security Disability Insurance can enroll in Medicare would be eliminated, as would asset tests required to qualify for disability Medicaid. “Given the leadership role the disability community played in protecting the ACA, it’s especially important that disability issues be included,” notes Harold Pollack a professor of public policy at the University of Chicago. Medicare Extra would not be “Medicare for All,” since employers could continue to offer their own plans if they chose. Within a few years, though, it would be “Medicare for Most.” Newborns would be automatically enrolled, as would people turning age 65, all who buy their own insurance in the individual market, and all of the uninsured, including legally present noncitizens. In Year 6, Medicaid and CHIP would be absorbed. Many employers would likely opt in, too. Private options maintainedLike current Medicare beneficiaries, a third of whom are enrolled in private Medicare Advantage plans, enrollees in Medicare Extra would have the option of choosing a private plan that would offer the same benefits and could add extra benefits for additional premium. Thus private insurers would not go away – the plan’s authors acknowledge that Medicare Advantage plans often provide high quality care – but as with MA, the rates those plans pay to providers would be closely tied to the rates paid by the public Medicare Extra plan. The same is true for plans maintained by employers, thanks to a rule that healthcare providers outside the employer’s network could charge no more than Medicare Extra rates – effectively tethering in-network rates to the program as well. Employers could opt to continue providing private insurance to their employees, or sponsor employees’ enrollment in Medicare Extra, or leave employees to enroll in Medicare Extra on their own and reimburse the federal government for a share of the cost. Small employers (under 100 employees) could simply leave their employees to enroll in Medicare Extra without contributing to the cost. If the employer opts to offer private insurance, employee costs could not exceed the levels those employees would pay in Medicare Extra. ‘All-payer’ cost controlThus, while the system would not be strictly single payer, all payers would pay basically the same rates to healthcare providers. The authors specifically identify this rate-setting power as the essential cost-control ingredient in diverse kinds of successful national healthcare systems in countries such as Germany, Denmark and Canada. A “blended” rate means that Medicaid will pay more than at present, while employers will pay less (as will the new public plan for working age people). The plan would achieve additional cost savings by negotiating rates on a national level for prescription drugs, medical devices, and medical equipment – and by demanding rebates for drugs priced above a level deemed appropriate by independent evaluators. Why maintain the employer-sponsored health insurance system? In a word, to control the federal government’s share of the total cost of healthcare in the U.S. – and so the required tax increases, which would still be substantial. (The plan would finance new spending mainly by new taxes on the wealthy.) The plan’s authors point out that employers currently contribute $485 billion annually to the payment of healthcare costs. The CAP plan aims both to preserve some of that private sector funding and to make it more cost-efficient, so that employees get more bang for their buck. Political realitiesThere’s not much for beneficiaries of such a system not to like. Medicare Extra promises all-but-universal access to virtually all healthcare providers, on an affordable sliding scale with respect both to premiums and out-of-pocket costs. But how viable is it politically? What are the chances that Democrats would pass such a plan? Not very high, according to Timothy Jost, emeritus professor of law at Washington and Lee University. “I can’t see that it’s feasible from a political standpoint,” Jost says. “Pharmaceutical companies will hate it, because it will limit their profits – they’ll say it limits innovation. Physicians will see diminished income, or diminished growth in income. Hospitals are going to paid at Medicare rates, or Medicare plus a bit rather than commercial rates – that’s going to trouble them. Wealthy people are going to have to pay higher taxes.” As to whom the plan benefits, Jost points out that as with all plans to expand and improve healthcare access, it’s primarily people in the lower end of the income distribution, who historically don’t vote in large numbers. At the same time, Jost allows that for Democratic elected officials, supporting a plan with this kind of sweeping reach “could be a litmus test to win the support of the hardest-working people in the Democratic party. That support is very important for electoral politics – but whether at the national level they would have enough clout to overcome incredibly powerful lobbying efforts is very questionable.” Pollack, who like Jost closely followed implementation of the Affordable Care Act, takes a different view of the political realities. His starting premise is the deep regard in which Americans hold Medicare and the broad support, expressed since the 2016 campaign, for expanded access to affordable healthcare. As for the partisan manner in which the Affordable Care Act was passed (without a single Republican vote) and the eight years of Republican sabotage it’s sustained since then, Pollack’s takeaway is somewhat counterintuitive. The fact that Republicans wholly rejected the private-plan structure of the ACA marketplace, Pollack says, “requires Democrats to think about expanded Medicare or Medicaid models, not because of ideology but because a complex, ideologically moderate approach to expanding coverage can’t be implemented within a politically polarized environment.” Oddly enough, we’ve learned, “Republicans are more likely to protect and embrace expanded Medicare benefits than to protect the private market established through the ACA marketplace.” What about the fierce opposition from the various sectors of the healthcare industry to payment rates imposed by government, directly or indirectly, across all market segments? “I don’t think they’ll like it. There will be some negotiation, but it’s coming,” Pollack said. “People lived with the cuts the ACA made in hospital reimbursement.” Here too Pollack’s takeaway is somewhat counterintuitive. Healthcare providers, he senses, may have a harder time resisting straightforward rate-setting than various forms of “micromanagement” based on “outcomes research” – e.g., various government-imposed pay-for-performance programs. That may hold for the general public too. “I think people are ready to have government use its monopsony [single-payer] power to hold prices down … but whether Americans are willing to use comparative effectiveness research [which could reduce access to some treatments] is a very open question.” Bipartisanship? Not this timeIn crafting the ACA, Democrats worked hard and failed to win Republican support, and they worked hard, with some success, to win support from doctors, hospitals, pharma and other “stakeholders.” But that support – from doctor and hospital groups in particular – was lukewarm at best eight years later as Republicans pressed their repeal efforts. And so, according to Pollack: “The lesson Democrats have learned politically is that they’re alone. They’re not going to get Republican support. They’re not going to get stakeholder support for some of the most critical things.” Pollack added that Democrats have also learned from the tactics Republicans used in their bids to ram through ACA repeal bills (very nearly successful) and tax cuts (successful) via budget reconciliation, a Senate maneuver that avoids filibuster and so can enable a bill to pass with just 51 Senate votes. (That would solve the problem, highlighted by Timothy Jost, of winning over the most moderate and vulnerable Democratic senators.) “Democrats will be much more ruthless the next time around,” Pollack asserts. As momentum for health reform built in 2008 and 2009, Pollack recalled, there was a strong demand in Democratic circles for bipartisanship – a belief that they could win Republican buy-in for a national plan modeled on the plan Republican Governor Mitt Romney had put through in Massachusetts. Now, Pollack concludes, “there’s much more demand for authoritative Democratic solutions. There’s a belief across the Democratic spectrum that Republicans are not viable partners.” via https://www.healthinsurance.org/blog/2018/02/23/medicare-for-almost-all-brought-to-earth/ It’s February 15 … and a day too late for a Valentine Edition of Health Wonk Review this week. The good news? I’m all swept up in the Olympic spirit and ready to award some hardware to this week’s Health Wonk Review contributors. No medal awarded.Is the JPMorgan/Amazon/Berkshire Hathaway healthcare alliance the “worst idea ever?” Joe Paduda – over at Managed Care Matters – doesn’t think so. In fact, it’s not the proposal that’s getting low marks from Paduda. In Media coverage of Amazon/Berkshire/JPMorgan misses the point. Paduda gives critics of – and coverage of – the healthcare alliance a thumbs down. He also speculates on some outcomes of the A/B/J alliance. Meanwhile, David Harlow has a medal-worthy rundown of the Amazon/Berkshire/JPMorgan alliance and also Apple’s foray into personal health records. David asks, “Are they both less than they seem? What would it take for these announcements to really capture our attention?” David shares his thoughts on what it will take for these behemoths to succeed in A tale of two tech titans hoping to help healthcare. And speaking of behemoths and healthcare, in Anthem Insurance & Emergency Room Visits That Go Uncovered Louise Norris offers a great explainer about unexpected ER bills and a controversy over how insurers pay for trips to the ER. Norris is, of course, writing about Anthem, which issued new rules in Georgia, Indiana, Missouri, and Kentucky in 2017 that shift the cost of ER visits to the patient if a review of the claim determines that the situation was not an emergency after all. An infraction worthy of a DQAt Health Care Renewal, Roy Poses brings us the tale of an Olympic-level assault on freedom of the press – one that rises to the level of not doping but perhaps dopiness. In Free Press? Don’t Need No Stinkin’ Free Press – Center for Medicare and Medicaid Services (CMS) Tries to Intimidate Modern Healthcare Journalist, Poses tells the story of a ham-handed CMS attempt to bully (unsuccessfully) Modern Healthcare journalist Virgil Dickson into changing a January 23 story. It’s a must-read. Head-to-head action that will make you hit Instant ReplayThis week’s submission from #CareTalk – Mr. Azar Goes to Washington – actually required me to tune in to a 10-minute discussion on YouTube. And I’ve gotta say I was both entertained and enlightened by the banter between David Williams (Health Business Group) and John Driscoll (CareCentrix) as they made predictions about the impact of newly appointed HHS Secretary Alex Azar. Come for the zingers. Stay for the Lightning Round. The American ‘judge’ scores PeruInternational flavor is, of course, what the Olympics is all about – and Jason Shafrin definitely fills the bill with his fascinating look at Health care in Peru. Let’s just say that if health systems competed for medals, Peru would have a tough time overcoming its apparent underdog status. Spoiler: life expectancy in Peru is ranked 126 out of 224 countries. (Before 2007, more than 60 percent of the population had no health insurance coverage.) A medal for members of Congress?Over at ACASignups.net, Charles Gaba has the dirt on efforts by Senate Democrats to help stabilize the Affordable Care Act by pushing for increased ACA subsidies. Should Patty Murray get a medal for her efforts? Not sure, but Charles should definitely get a Gold for his tireless work to deliver health reform updates and analysis to us all. But wait. Tom Lynch at Workers’ Comp Insider is also awarding high marks to * gasp * legislators in DC. In Who’d A Thunk It? Something Good Out Of DC!, Lynch explains how “in a rare Washington Kumbaya moment,” legislators dedicated a little pork to “poor people who are aging and sick: America’s Dual Eligibles.” “Finally, this Congress has done something that will benefit our most vulnerable citizens. Let’s hope it’s not a one-off,” Lynch writes. (And we concur.) Something else we can all cheer forAnd speaking of news that gives us hope and inspiration … Henry Stern at Insureblog had a post that elicited a cheer from Yours Truly this week. In Something different (and potentially quite helpful), Stern adds his voice to an apparently growing movement intended to give us all more coverage when we go to the hospital. I won’t spoil the post for you, but I will drink to Henry’s sentiment with a wink and a “Bottoms up!” A recap from the podium. No, not THAT podium.OK. So it wasn’t a medalist podium somewhere in South Korea, but Andrew Sprung did make it to that OTHER important convo in 2018 – Health Action 2018, Families USA’s annual confab of healthcare activists. Andrew reports that the event was “largely devoted to taking the measure of the political power somewhat miraculously tapped by a wave grassroots passion and action that staved off repeal – and groping toward a path by which Democrats can build on or move beyond the ACA in years ahead.” His recap of the conference – Democrats and activists prepare health care offensive – examines what kinds of next steps – or false starts – the conference conversations pointed toward. And finally – a story of indomitable spiritThe thrill of victory in defeating ACA repeal. The agony of Obamacare sabotage. It’s a great story. Also great? A story on this site: Shawn Dhanak’s account of four consumers who are ignoring news of health reform setbacks and continuing to put their faith in the ACA’s protections. They’re still enrolling – like their lives depend on it. So put on your giant foam finger and join me in waving a little American flag for this week’s contributors. You stuck that landing! via https://www.healthinsurance.org/blog/2018/02/15/health-wonk-review-for-february-15-2018/
Integration of Iowa-based The Grassley Group advances NAIFA 20/20 Strategic Plan to improve quality member experience.
via https://www.naifa.org/news-publications/naifa-blog/february-2018/naifa-launches-midwest-office-to-strengthen-member?feed=blogs In 2017, Donald Trump and Congressional Republicans did everything within their power to dismantle the Affordable Care Act. And while they haven’t achieved their ultimate goal of full repeal, the law’s saboteurs certainly managed to foster uncertainty about the law’s fate. What’s not at all uncertain? That more Americans are appreciating the law more than ever – and they’re showing it by continuing to enroll in ACA-compliant plans. Is there uncertainty about the law’s growing popularity? Recent research shows that by the end of 2017, a record-high percentage of Americans viewed the law’s impact as “mostly positive,” while the percentage who viewed its effects as “mostly negative” reached a five-year low. Did repeal attempts – including successful repeal of ACA’s individual mandate – make consumers uncertain about whether they still need the law? Not hardly. Even with the enrollment window shortened by the Trump Administration, at least 17 states have already exceeded last year’s enrollment numbers and by late January, enrollment had already reached more than 96 percent of last year’s total. “The demand – as well as the need – for health insurance is as strong today as it was when we first began offering coverage five years ago,” said Peter V. Lee, executive director of Covered California. In the past week, California drew within striking distance of an all-time exchange enrollment record. Consumers still want – and need – ACA’s helpSo what’s on the minds of these consumers? I talked to a handful of them who enrolled in 2017 for coverage this year and who also say they’ll enroll again in 2018 – shortened enrollment window and no mandate be damned. For these consumers – and millions of other Americans – Obamacare was not collapsing prior to actions taken by this Congress and Trump administration saboteurs. It was not a disaster, but rather the only thing standing between them and the inability to treat a chronic illness, or bankruptcy due to unforeseen medical bills. With all the wrenches thrown into the gears, the future of the ACA is still far from certain. ‘Get it while you still can’ is the dominant theme I hear in conversations with consumers these days. ‘It’s unaffordable for me without the subsidy’Awsam Alloos, 37, of Clinton Township, Michigan has stayed covered despite being relatively young and in good health. He told me he plans to re-enroll next year despite the loss of the individual mandate.Fittingly – given his work as a Financial Coach with the Dearborn, Michigan-based Arab Community Center for Economic and Social Services (ACCESS) – he says it doesn’t make any sense go without health coverage while the Affordable Care Act makes it possible to get covered. “You could be walking in the snow and slip. You never know what will happen.” Only needing to see the doctor once or twice per year, Awsam values the peace of mind that coverage provides him. “If I had an accident, thousands of dollars in medical bills could be devastating.” Awsam further explained to me that part of his motivation for staying covered is to take advantage of the monthly tax credits he qualifies for. “It’s unaffordable for me without the subsidy. It’s there now, so I’m going to use it.” Awsam enrolled in a Silver HMO plan through the federal exchange, or Marketplace, for just under $100 per month after a roughly $200 per month tax credit is applied. “The Marketplace is a great deal,” he exclaims. ‘Consumers are scared to lose their insurance’Eva Jirjis, a federally certified enrollment assister and colleague of Awsam’s at ACCESS, says many of the people she helped enroll during the last enrollment period were enthusiastic about enrolling after they found they still could. “They were excited that their insurance wasn’t canceled and that the subsidy was still there – and they want to get it again. Many are sick and really need the help.” The most recent enrollment window had a different feel from previous years, Jirjis says, as someone who has worked as an enrollment aide since 2014. “[Consumers] are scared to lose their insurance, so they want to [enroll] while they still have the chance … They don’t know what’s going to happen; it either will be here or won’t be here.” Eva admits she cries for some of the individuals she helps sign up when she thinks about what would happen to them without access to comprehensive medical insurance. “They need the insurance. They wake up every morning and turn on the news to see if there are any changes, to see if they still have their insurance. I have hundreds of families like that.” ‘Unshackled’ from her cubicalKatya Powder, 34, is a freelance singing instructor in New York City. Diagnosed with epilepsy at the age of 18 and Crohn’s Disease at age 21, her pre-existing conditions rendered her unable to purchase insurance on her own for years until the ACA came along. She stayed on her parents’ plan as long as she could through college, and reluctantly took job as a receptionist just she could gain medical coverage after college. Marketplace coverage proved to be the key Katya needed to unshackle her from that cubicle job. In calling the Marketplace for the first time and learning she could get covered – no questions asked – “I began sobbing uncontrollably. After being rejected my entire life for something that I literally needed to survive, I was so overwhelmed with relief and gratefulness,” she wrote in a blog posted on Progress Michigan’s web site. “When I look at the past four years of the healthcare I have received, I’m even more grateful because my health has improved tenfold.” Powder has, not surprisingly, re-enrolled in coverage for 2018, and receives about a $300 monthly subsidy through New York’s exchange. Today she’s doing what she loves because of her access to quality, affordable coverage. “Ever since Obamacare, I haven’t been hospitalized,” she told me recently. “I attribute that to the fact that I can provide for myself, and I can see the doctor more often and not worry about how much it will cost. I don’t know how many people believe in the mind-body connection, but for me it’s very apparent. ” Spared $150,000 in medical expensesMany consumers on the roller coaster ride of the past year have no other choice but to make use of the ACA for as long as they can. Namir Yedid, a 35-year-old, San Diego-based entrepreneur, is one such individual. In 2014 he wanted to pursue his own software company start-up. After having employer-sponsored insurance for much of his adult life, he felt comfortable enough to make that leap on his own – knowing he could purchase coverage through California’s exchange. It’s a good thing the Marketplace coverage was there for him. Cut to February 2015, when his dermatologist noticed a bump on his chest that looked like a cyst. A biopsy later revealed that it was in fact a rare form of malignant cancer. Fortunately, the cancer was removed with an operation and has not returned. But, in all, the cost of multiple rounds of surgeries to remove the tumor and reconstruct his chest – and about a week and a half in the hospital – totaled over $150,000. Thanks to the ACA, however, his out-of-pocket expense was a grand total of $7,500. Even before that experience, “it wasn’t like I was not going to get covered,” Namir says. “But it was very clear to me … that the ACA made a tremendous difference in my experience [fighting cancer]. It was due to the provision about capping my out-of-pocket expenses. The fact that I wasn’t bankrupt was because of the ACA.” While Namir is healthy now, his type of cancer does tend to recur. He says grateful for the accessibility he still has to coverage – in spite of his having cancer – as well as the financial assistance he receives to offset his monthly premium and the many deeper provisions of the law he’s learned of through his ordeal. Cautious optimismThe Trump administration is hoping its thinly veiled strategy to dismantle the law piece by piece will discourage or shove people out of the Marketplace one by one, leading to further erosion of the program. Sure, its tactics could very likely impact Obamacare’s structural soundness in years to come. But these stories seem to reflect a deeper trend in consumer sentiments about the ACA: Enthusiasm for the relatively new coverage options and all its protections has staying power. Shawn Dhanak is a former media strategist for Enroll America’s ACA outreach and education campaign in Michigan. As a victim of the pre-Obamacare health insurance marketplace himself, Shawn is committed to cutting through the noise and political spin to dispel myths about the historic healthcare law and highlighting examples of just how beneficial it has been to people who need access to care the most. via https://www.healthinsurance.org/blog/2018/02/07/enrolling-like-their-lives-depend-on-it/
The legislation allows insurance and financial advisors to report suspected cases of financial fraud involving senior clients to financial institutions.
via https://www.naifa.org/news-publications/naifa-blog/february-2018/the-senior-safe-act-passes-in-house?feed=blogs |
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