Volkswagen: The Union, the Worker and Intimidation

For the next three days, workers at the Volkswagen (VW) Plant in Tennessee will decide whether they want to organize as a Union. Volkswagen is a German company at which every plant across the world, except Chattanooga, TN and China, which manufacture these vehicles is unionized.  However, conservative law makers in Tennessee, as well as other vocal conservatives across the United States are outraged about the possibility that this plant may unionize.

The Volkswagen Corporation has taken a neutral stand in this issue for the Tennessee plant, but that has not stopped lawmakers from what appears to be both intimidation of the actual workers as well as the Company.  For example, “I’ve had conversations today and based on those am assured that should the workers vote against the UAW, Volkswagen will announce in the coming weeks that it will manufacture its new mid-size SUV here in Chattanooga”, said (Sen. Bob) Corker, without saying with whom he had the conversations. (http://www.dailykos.com/story/2014/02/13/1277294/-Corker-threatens-jobs-if-Volkswagen-workers-unionize?detail=facebook)  The article also points out however that VW is neutral when it comes to the unionization of the plant. Sen. Corker suggesting that there is a direct link between the workers voting down unionization in order to be named as the place chosen to build VW SUV’s seems disingenuous at best.

Senator Corker is not the only one making statements which appear to intimidate the election taking place at the plant.  Tennessee State Senator, Bo Watson said that if the workers choose to unionize they “would jeopardize any future financial incentives the state might offer Volkswagen.” (http://www.latimes.com/opinion/opinion-la/la-ol-vw-unions-uaw-republicans-crony-capitalism-20140212,0,7108450.story#axzz2tEu4mAyr)  This comment is more of a threat than it first appears to look.  Volkswagen has indicated they will be looking to expand to build an SUV in the United States as well.  Currently, VW has narrowed down the choices to expanding the plant in Chattanooga or building a plant in New Mexico.  Withholding financial incentives could possibly impact the decision of Volkswagen and seems like an outright threat.

Grover Norquist, a leading Conservative well known for his hard hitting and bullying political tactics, has purchased billboards all over Chattanooga encouraging people to vote down the bid for unionization at the plant.  The billboards have a very simple message “United Auto Workers” but the word United is crossed out and in its place is the word “Obama.”  (http://www.newsmax.com/US/grover-norquist-union-volkswaqen-tennessee/2014/02/07/id/551465)

He also makes the statement that in the past 30 years almost every job lost in a manufacturing plant has been at a unionized plant.  Why are these conservatives so concerned about the possible unionization of one plant in Chattanooga TN?  The simple answer is politics.  Historically, Unions have financially backed Democratic candidates.  In general, Republicans view Unions as a threat to their political power.

Radio and television ads abound about the “terrible” unions.  It is important to remember a few facts about unions and how they made significant and lasting changes to the American workforce which are now being threatened by Conservatives across the United States.  Changes that can be both directly and indirectly attributed to Unions include:

• 40 hour work weeks
• Overtime pay
• Child Labor laws
• Workers being paid a living wage vs. a minimum wage or less
• Workers get employer paid benefits such as vacation pay, sick leave, and even health care insurance

There is a reason there are unions in America.  It wasn’t an impulsive decision or created as a means to steal from employers.  Unions were created because workers were being taken advantage of in companies all across the nation.  Workers were poorly paid and lived in tenements.  Children often started work as young as 8.  If someone missed work due to illness or an emergency, someone else was hired to take their place.  There was no such thing as maternity leave.  Jobs were not protected.

We have Unions because most employers didn’t treat employees in a humane manner.  Now, we have Conservatives saying that Unions are the cause of the very things they worked so hard to protect.  Do you really believe that employers would simply do “the right thing” if we did not have Unions and/or the laws in place to protect workers?

Remember the Conservatives, who say employers will treat employees “better” without unions and minimum wage laws, also believe that the group of people in America called “servers” which is made up of waitresses, waiters etc. are paid approximately at $2.13 an hour because they make so much more in tips.   Perhaps that is true in metropolitan areas or up-scale eating establishments, but what about the folks who work at diners or in more rural areas.  Ryan’s is a restaurant that offers a buffet and also pays their servers this wage.  Customers dish up their own meals, carry them to the tables, and get their own condiments.  Servers ask customers what they want to drink and refill their glasses as needed.  Do you think that customer’s tip these people the same as they do in an establishment where the customer orders the food and the server does the rest?

Reviewing the history of unions and the changes they have brought as well as understanding the perceived impact they may have on political races results in an understanding of why Conservatives fight so hard to try “union busting”.  In addition, German plants that are unionized have an additional benefit of participation in “works committees.”   These committees are made up of both workers and management at plants.  These committees review things such as production, safety, and technical issues and how to improve the plant.  They give worker’s a voice and a stake in the actual product. How many employees who have worked for companies have not at one time or another thought of ways that would improve the product or the working environment in their company?  Volkswagen has created a process where these thoughts and opinions are valued and considered.

As we look to what is happening in Chattanooga it is important to remember the adage “if we don’t learn from history we are doomed to repeat it.”  Unions have an important place in American history and played and continue to play an important role in the lives of working people.  Intimidation of workers is against the law when voting on unionizing.  It is my opinion that some of the tactics being used by Conservatives, including but not limited to, suggesting that the plant will not receive any incentives from the state or federal government if they vote to unionize crosses the line into bullying and intimidation.  As workers, each of us owes a debt of gratitude for our working conditions to Unions.  We must never allow anyone to intimidate workers in the work place.

Project Gratitude…Americans Get Insured!

Thanksgiving is quickly approaching.  It is the one time of the year, when most people take time to inventory those things for which they are most grateful and identify their hopes and dreams for the coming year. The lists are varied and often include family, friends, good health and a good job just to name a few.  This year we hope you will take the time to participate in Project Gratitude.  Project Gratitude encourages people who are looking forward to the New Year with an especially thankful heart, because they will be on the receiving end of Affordable Health Care, to share their stories around the Thanksgiving table.

My guess is you or someone you know has faced a difficult time due to a medical issue.  You may even know someone, or perhaps you have been pushed to the financial brink due to gigantic medical bills.  If someone you love or care about is faced with a catastrophic illness or accident you know you can’t put a price on life.  It is our hope that the many and varied people throughout the United States whose hope has been renewed due to the ability to purchase affordable health care insurance will take a moment and share their story  and encourage others to check out the health care exchange and protect their families from the difficulties that come from having no insurance, a junk plan, or needs that outweigh their ability to pay.

Since the roll-out of the federal health exchange, the focus seems to have been on “all” the problems with getting coverage. Misinformation and mistruths have been spread by pundits and the media for the sole purpose of having ACA/Obamacare fail for political purposes.  Any way you look at it, it is sad.  By keeping people worried, afraid and suspicious of ACA/Obamacare it appears that many have missed the benefits it has provided to many others, many of whom who could not get insurance because it was too expensive or because they had a pre-existing illness.

It is common knowledge that the recession had a serious impact on many, many families throughout the United States.  People lost their jobs, their homes and in many cases their health insurance.  While some of these people may have qualified for unemployment, following a job loss, anyone who has ever tried to get a COBRA policy in between jobs, knows they are often very expensive.  The loss of a job, the inability to quickly find another job and the high cost of COBRA plans has resulted in numerous individuals and families going without health insurance.

It seems that in the last 30 years employees and/or individuals and families have had to pay a larger share of the cost of their health insurance.  Due to financial pressures, many people have come to view health insurance as a luxury instead of a necessity.  More and more people have dropped their insurance plans due to cost, as they feel they are unable to pay the increasing premiums and deductibles.  The following table compares the cost of health insurance premiums over the past ten years in comparison to worker’s wages.  Wages have increased less than 20% compared to health insurance premiums which have risen over 80%.  No wonder people believe health insurance has become just too expensive.  (http://t0.gstatic.com/images?q=tbn:ANd9GcSQrvziv3UOxK84MsCr5MRJC57xOonqWzUhJ3Fg2o2hFwEYA46u)

Since the ACA rolled out in early October thousands of people have applied for and obtained health insurance beginning in January 2014.  Consider the case of David Heitler-Klevens. He and his family were paying a $625 premium for health care per month and had a family deductible of $6,000 per year. They were able to cut their costs for health insurance considerably by shopping on the health care exchange.  Beginning in 2014, they will pay a premium of $67 per month and have a $1,000 deductible. Who wouldn’t be excited and thankful about that?

Not every person who accesses the exchange is eligible for tax incentives or subsidies.  That doesn’t mean they don’t benefit from being able to shop on the exchange.  Judy Tomlinson Hampson did not qualify for tax incentives or subsidies.  However, she was able to purchase a plan with about the same premium, but her deductible and co-pays will be half of what she had been paying.  In addition, all her doctors, clinics and hospitals  are on the  provider list so she will simply continue her care.

There is also an additional group of people who are thankful for Obamacare/ACA this year. Someone in their family has been diagnosed with a pre-existing condition and has been unable to buy affordable health insurance or has a plan in which the premiums and deductibles are so high that, while covered, it isn’t very helpful.  Sometimes families have had to make a choice to insure some members of their family and not others.

Cheryll Athorp from Alaska was unable to obtain affordable health insurance due to a pre-existing illness.  She is self-employed, but was diagnosed with breast cancer in 2003.  While she successfully completed treatment, she  only option prior to the federal exchange opening was to buy insurance that was sub-par due to a pre-existing condition. During 2013 this plan would have cost $1,700 a month in premiums and had a $20,000 deductible.  She accessed the federal health exchange and purchased a silver plan for a premium of $134 per month.  That means her savings are more than $1,500.00 per month on premiums alone.

Then there is Terri Mitchell from Iowa.  She needs to have surgery on her eyes but was worried about the financial strain it would place on her. She shopped on the health care exchange and found an affordable plan.  She is looking forward to having her surgery and is thrilled she will be able to maintain her eyesight.  Her two sons, ages 24 and 26, hadn’t had insurance since they were 18.  From January 1, 2014 they will have health insurance that they were able to purchase for the first time since becoming adults.

The final group of people who are purchasing health insurance plans on the state and federal exchanges are people with pre-existing conditions who in the past two years were able to purchase insurance through ACA.  Most people believe that ACA will be effective January, 2014.  While this is true, for the vast majority of people,  when the law was enacted it directed the federal government to set up a Pre-existing Condition Insurance Plan.  In many ways it was the “first” roll-out of ACA.  Premium prices were determined based on age only.

This insurance plan saved my life.  Three years ago I was in the hospital, swollen from Lymphedema, experiencing considerable difficulty breathing, malnourished, unable to walk and under insured.  After admission, late that night, the staff put in a call to my son, telling him he should probably come to the hospital because they weren’t sure I would make it through the night.  That hospitalization and subsequent Nursing Home stay almost drove me into bankruptcy and that didn’t even include all the help I needed that I just didn’t get because it was so unaffordable.

I live today because, due to ACA, I have received the medical care I needed.  While I will never walk again, my quality of life has vastly improved and I have hope that I will live many more years. If I had had good insurance, would I have been able to walk again?  Probably, I don’t know, but I am simply grateful for the opportunity to watch my son grow up and be around for many years to come.

Spike Dolomite Ward of California has a story similar to mine.  She too benefited from the PCIP program.  She was diagnosed with late stage breast cancer during a period she was uninsured.  She was able to purchase Affordable Health Insurance through the PCIP program.  She credits PCIP with saving her life as it allowed her to get the treatment she needed.  Like me, she has also become an advocate of ACA, telling her story in an attempt to pay it forward.  You can learn more about her on her website http://www.spikespeaks.net.

This year when you gather around the Thanksgiving table with friends, family, or acquaintances, consider the stories you read here or one of the hundreds you will find at https://www.facebook.com/acasignupsuccessstories.  For every story here, there are thousands of other people who share a common hope and gratitude for Affordable Health Insurance.  Our stories may be different, our needs varied, but each of us represents one of the reasons health care reform is needed. We  hope you will join us and institute Project Gratitude at your Thanksgiving table this year. Tell your story about how your life will change due to affordable health insurance.  After Thanksgiving, take a few minutes drop by our Facebook page and share your experiences.  We look forward to hearing from you and wish you and your family a wonderful Thanksgiving.

By Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO, Lynne Smith, MSSW and Peter J Wills, Accountant and Business Software Support Consultant.

Barbara is an independent consultant in healthcare providing consulting for physicians.  She is an industrial engineer from RPI with an MBA from NYU. She worked in the pharmaceutical industry for many years before moving into the healthcare industry where she had a company where she provided top quality coding, compliance and revenue cycle management services for physicians. She has since moved into full time consulting for physicians. Barbara is a nationally known expert known for her education, consulting and expert witness services.

Lynne has dedicated her career to helping others. She has experience as a social worker in a rural county, an administrator in a large hospital network and as a College Professor. She uses the skills she developed over the years as an advocate in a variety of areas including her most recent venture serving as a Healthcare Advocate. She is currently a recipient of the Pre-Existing Condition Insurance Plan, which she was able to purchase following ACA being enacted.

Together, Lynne and Barbara own the ACA Healthcare Advocates consulting firm and are available to individuals, families and businesses to help them meet the requirements of the Affordable Care Act in order to meet the specific needs of the client while optimizing the fiscal considerations.

Peter is an Accountant and Business Software Support Consultant. Prior to moving to America to marry he was an Accountant in public practice in Australia for most of his working life. For the last three years before moving here he worked as a Business Software Support Consultant for a business software developer in the housing, mining and engineering field. Peter is using his computer and business talents to assist Barbara and Lynne.

Please direct your questions and/or inquiries to askcobuzzi@gmail.com

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Cancellation of Health Insurance Policies – Undeniable Lies and Deliberate Misinformation Revealed and Obama Vindicated.

Implementation of the Affordable Care Act (ACA) has not been without its bumps in the road. Every day there appears to be a new crisis or a new aspect exposed that suggests the Affordable Care Act was not ready for implementation. Initially, these concerns seemed to center around problems and glitches associated with the roll-out of the online healthcare.gov website. Recently however, opponents, including various news organizations, politicians, and pundits expanded their drumbeat of attacks on the ACA, claiming that President Obama knowingly lied to the American people about being able to keep their current health insurance plan, “grandfathering them in,” rather than being forced against their “will” to choose a different plan, even if their plan does not meet the minimum standards of coverage required by the ACA law.

Sound bite after sound bite has been played with President Obama telling Americans they will not have to change their plans unless they choose to do so, resulting in the added benefit of being able to continue to see the same doctor (http://www.youtube.com/watch?v=wfl55GgHr5E.)  However, these statements have now been called into question.  Conservatives, as well as many media organizations, have jumped on the “bash President Obama and the Affordable Care Act” bandwagon expressing their outrage at the President’s alleged audacity at intentionally misleading or lying to the American public about protections afforded consumers through the ACA as it related to keeping their current health care plan.  Leading Republicans and Conservatives want the law scrapped or at the very least demand  implementation of the Affordable Care Act be delayed.   Recently, even some Democrats have expressed “their concern” about the promises President Obama made and indicate they are willing to consider extending the implementation of the ACA to ensure the problems are resolved.   Did President Obama consistently and continually lie to the American people?  Did he know that, in fact, the promises he made about people being able to keep their insurance plans, even if they were “crappy policies” or “junk policies” as the media has coined them, were allegedly false or at the very least, misleading? The evidence provided in this article will prove, beyond a shadow of a doubt, that President Obama spoke the absolute truth when he made those statements.

The Obama Administration and the authors of the Affordable Care Act recognized that people in general have a hard time with change, even if the result of the change will be positive for them (http://www4.uwm.edu/cuts/bench/change.htm). Even though health care reform will ultimately have positive consequences, a small percentage of the American people, encouraged by Conservative politicians and pundits appear to have resisted health care reform.  Resistance, in general, is often based on one or more of the following factors, including but not limited to when:

• People do not fully understand why the change is needed.   Many Americans believe that we have the best health care in the world.  This statement is not necessarily supported by the facts.  Studies suggest that the United States is now ranked 37^th in the World, according to the World Health Organization (http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/).
• People feel as if they had no participation in making the change.  In other words, people don’t like being told what to do just because someone said to do it.  If an action is required that is preceded by “must, have to, or need to”, a person is less likely to complete the action than if they decide they “want” to change.  This has proven to be true in the roll-out of the ACA state and federal health care exchanges.  There are people who have been unable or unwilling to purchase adequate health insurance due to pre-existing conditions, financially out of reach premiums, lack of a belief that healthcare is a necessity, and/or lack of health insurance as an employee benefit.  So much disagreement about aspects of the law have played out in the media, around kitchen tables and in the midst of social gatherings as well as political functions that nothing has been done to “fix” or resolve problem areas since the law was enacted in March, 2010.  When a new law is enacted it is not unusual to have to resolve “glitches” or make process adjustments, as was the case when the Medicare Part D law took effect during the Bush Administration. It took both parties working together for the good of the American public to resolve the glitches and make other adjustments (http://crooksandliars.com/jon-perr/how-democrats-saved-bushs-medicare-drug-program).
• Jobs, power, or financial pay-outs may be in jeopardy. Stake holders may attempt to undermine the change, or in this case health care reform, as appears to have been the case with healthcare insurance executives and/or stockholders, whose salaries and financial bonuses may be reduced due to ACA rules directing that on a schedule outlined by the federal government, at least 80% of premiums collected from enrollees, must be collectively used to provide healthcare services to the enrollees by 2014.  Prior to passage of the ACA, researchers determined that in many cases less than 60% of premiums were used on healthcare services for enrollees, with the rest being used for administrative costs, including but not limited to, what appears to have been excessive salaries and bonuses for upper management. (http://www.cms.gov/CCIIO/Resources/Files/Downloads/mlr-report-02-15-2013.pdf)

Based on the research associated with resistance to change, the authors of the ACA stated the following, in regard to the goal of the ACA:  “The Affordable Care Act balances the objective of preserving the ability of individuals to maintain their existing coverage with the goals of ensuring access to affordable essential coverage and improving the quality of coverage.”  (Federal Register/ Vol. 75, No. 116 / Thursday, June 17, 2010 / Rules and Regulations 34542)  “Section 1251 of the Affordable Care Act provides that “nothing in the ACA requires an individual to terminate the coverage in which the individual was enrolled on March 23, 2010.”  This contradicts the information provided to enrollees by letter from various insurance companies stating that due to the ACA, policies that did not offer the mandated services must be cancelled effective December 31, 2013.

This clearly proves that President Obama told the American people the truth, that the ACA gave people currently enrolled in a particular plan on or before March 23, 2010 the choice to change plans or continue with the same pre-ACA plan and, if it was grandfathered, then there would be no penalties imposed if a person kept their old plan.    The law also provides that, “with respect to group health plans or health insurance coverage in which an individual was enrolled on March 23, 2010, various requirements of the Act shall not apply to such plan or coverage, regardless of whether the individual renews such coverage after March 23, 2010.”  (Source:  Overview of the Regulations: Section 1251 of the Affordable Care Act, Preservation of Right To Maintain Existing Coverage (26 CFR 54.9815– 1251T, 29 CFR 2590.715–1251, and 45 CFR 147.140)  The Affordable Care Act specifically outlined how health care plans that were in effect prior to the ACA being signed into law on March 23, 2010 could be “grandfathered” and people who purchased these plans through their employment, as a part of the group or as an individual could choose to continue to be covered under their plan EVEN IF IT DID NOT MEET CERTAIN STANDARDS REGARDING ESSENTIAL BENEFITS SET FORTH BY THE ACA.

“Grandfathered” plans are defined by Bernadette Fernandez in the CRS Report R41166 as “those individual and group plans that an individual or family was enrolled in on the date of enactment (March 23, 2010).”  A “grandfathered” plan may “provide for the enrolling of new employees (and their families) in such plan after March 23, 2010 as long as the plan did not cease, and someone, although not necessarily the same person was continually enrolled in the plan.”  (CRS Report R41166, Grandfathered Health Plans under the Patient Protection and Affordable Care Act (ACA), Bernadette Fernandez)  Simply put a person that continues with a “grandfathered” policy, from before March 23, 2010, is not subject to fines and penalties even if they do not purchase a new conforming ACA health insurance policy as long as they remain enrolled in the “grandfathered” plan.  This points out again that President Obama told the American people the truth, that the ACA gave people currently enrolled in a particular plan on or before March 23, 2010 the choice to change plans or continue with the same pre-ACA plan and, if it was “grandfathered,”  then there would be no penalties imposed. 

The responsibility for gaining approval for a plan to be “grandfathered”  lies strictly with the health insurance company that sold the plan. The authors of the law, as well as proponents of the law just could not have conceived that insurance companies might intentionally cease providing these policies as a means to attempt to bypass the exchanges, dramatically increasing premiums while trying to sell different plans to their customers at a much higher rate.  In fact, insurance companies were given specific guidelines dictating what the insurance company had to tell consumers about the implementation of the ACA.

• If a health insurance plan was “grandfathered”, was not “grandfathered” or ceased to be “grandfathered” at some point, the insurance company was to inform the enrollee of the status of the plan, whether it met minimum ACA guidelines, offer them a choice to continue on the plan or choose to shop for a plan through the appropriate federal or state health care exchange.
• Insurance companies were also required to inform the consumer they might qualify for pre-tax incentives and/or cost-sharing subsidies if they purchase a plan through the exchange.
• Finally, enrollees had to be told that if they chose to buy a plan outside of the exchanges they would not be eligible for incentives or cost-sharing subsidies.

In the three months after the ACA was signed into law, as is typical when a new law is enacted, rules and guidelines were developed, implemented and publicized through the Federal Register that outlined what health insurance plans were eligible to be “grandfathered”, even though they did not meet the 10 new essential benefits.  It also outlined what could cause a plan to cease being a grandfathered plan.  “Grandfathered”  plans according to “Section 1251 of the Affordable Care Act, as modified by section 10103 of the Affordable Care Act and section 2301 of the Reconciliation Act, specifies that certain plans or coverage existing as of the date of enactment (that is, grandfathered health plans) are only subject to certain provisions” of the ACA. (https://webapps.dol.gov/federalregister/PdfDisplay.aspx?DocId=23967, Federal Register/ Vol. 75, No. 116 / Thursday, June 17, 2010 / Rules and Regulations 34539)  The language, although somewhat confusing, clearly outlines what health care plans are eligible to be “grandfathered” based on the law as well as the conditions that insurance plans must adhere to, in order for the plan to continue to be a “grandfathered” plan including but not limited to:

• The policy had to be in force before the Affordable Care Act became law on 3/23/2010 (For the record these rules were posted June 17, 2010 so it should have been something insurance companies informed enrollees of soon after that date.) In part two of this investigative blog, which will be available by November 6, 2013 we will explore this very issue.  Why weren’t enrollees informed of the status of their plan more than 30 to 60 days before the state and federal health exchanges were opened?
• No substantial financial change to the “grandfathered” plan can take place after the enactment of the ACA on 3/23/2010.
  • Financial substantial change is defined as “no significant increase in a percentage cost-sharing requirement such as co-insurance”.  The rules also outlined the definition of significant increase as “the maximum percentage increase is medical inflation (from March 23, 2010) plus 15 percentage points”.  Medical inflation is defined in these interim  final regulations “by reference to the overall medical care component of the Consumer Price Index for All Urban Consumers, unadjusted (CPI), published by the Department of Labor”. (Federal Register/ Vol. 75, No. 116 / Thursday, June 17, 2010 / Rules and Regulations  34543)\
  • “The employer contribution cannot decrease by five percent or more” in order to still be considered a “grandfathered” plan. (Federal Register/ Vol. 75, No. 116 / Thursday, June 17, 2010 / Rules and Regulations 34543)
  • “Employers and/or insurance companies cannot significantly change the dollar value of all benefits”.  This could include co-insurance, deductibles, and maximum out of pocket yearly or lifetime maximums.  (Federal Register/ Vol. 75, No. 116 / Thursday, June 17, 2010 / Rules and Regulations 34543)
• “Substantial change to coverage cannot be made after the enactment of the ACA on 3/23/2010 including but not limited to what services, illnesses, or treatments are covered by the plan dated on or before March 2010.”  (Federal Register/ Vol. 75, No. 116 / Thursday, June 17, 2010 / Rules and Regulations 34543)
  • If the enrollee’s plan covered a certain condition such as asthma prior to March 23, 2010 when the ACA was enacted and the plan was “grandfathered”, changes that deleted asthma from coverage would result in a substantial change and the plan would cease to be a “grandfathered” plan.
  • Substantial change could reflect an addition of a covered condition or service as well as a deletion of a covered condition or service.

The Federal Register also outlined the conditions that would result in a previously “grandfathered” plan losing its designation as a “grandfathered” plan resulting in enrollees having to purchase a different health insurance plan that would meet the guidelines of the ACA. Some of the things which could result in a health insurance plan losing this designation includes but is not limited to:

• “An increase in a percentage cost-sharing requirement” (such as coinsurance) causes a plan or health insurance coverage to cease to be a “grandfathered” health plan. (Federal Register/ Vol. 75, No. 116 / Thursday, June 17, 2010 / Rules and Regulations 34543)
• “With respect to fixed- amount cost-sharing requirements other than copayments, a plan or health insurance coverage ceases to be a “grandfathered” health plan if there is an increase, since March 23, 2010, in a fixed-amount cost-sharing requirement that is greater than the maximum percentage increase. The maximum percentage increase is defined as medical inflation (from March 23, 2010) plus 15 percentage points. Medical inflation is defined in these interim final regulations by reference to the overall medical care component of the Consumer Price Index for All Urban Consumers, unadjusted (CPI), published by the Department of Labor.” (Federal Register/ Vol. 75, No. 116 / Thursday, June 17, 2010 / Rules and Regulations 34543)
• If a company tries to decrease its employer contribution to the plan its eligibility to be “grandfathered” stops.  Specifically, the rules state that the employer contribution cannot decrease by five percent or more in order to still be considered a “grandfathered” plan. (Federal Register/ Vol. 75, No. 116 / Thursday, June 17, 2010 / Rules and Regulations 34543)
• Insurance companies can’t change what services, illnesses, or treatments offered on a plan dated on or before March 23, 2010 or it is no longer a “grandfathered” policy. (Federal Register/ Vol. 75, No. 116 / Thursday, June 17, 2010 / Rules and Regulations).  For example, if the plan had a stated life time out of pocket maximum, employers and/or insurance companies can’t change the dollar value of all benefits or it ceases to be a “grandfathered” health plan.  (Federal Register/ Vol. 75, No. 116 / Thursday, June 17, 2010 / Rules and Regulations)

As you are probably aware, some politicians, pundits and business owners have indicated they have “had to” cut back on the hours employees work due to the expense of the ACA and/or had to offer a much more expensive health care insurance plan to enrollees based on changes made to the law by the ACA.  This is simply not true. In fact, what the rules and regulations specifically state in the Federal Register/ Vol. 75, No. 116 / Thursday, June 17, 2010 / Rules and Regulations 34545, is that companies CAN continue to offer a plan that existed prior to March 23, 2010 and let employees choose between what some members of the media and some politicians refer to as a “junk plan” or “plan I have always had” even if it doesn’t meet ACA guidelines.  This rule clearly proves that many pundits, politicians and insurance companies are flat out lying or at the very least are flat out uninformed about the ACA when calling President Obama a liar.

This evidence points out again that President Obama told the American people the truth, that the ACA gave people currently enrolled in a particular plan on or before March 23, 2010 the choice to change plans or continue with the same pre-ACA plan.  Perhaps these Conservative politicians and pundits, who have been so quick to call President Obama dishonest should have spent their time actually READING and STUDYING the law, as well as the guidelines and rules published in the Federal Register, before labeling President Obama as a liar.

While many people call healthcare reform “Obamacare” and/or ACA (Affordable Care Act) it is important to remember neither of these two are the correct name of the law.  It is actually the Patient Protection and Affordable Care Act or PPACA. (http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf)  The law was enacted to PROTECT the health care plan consumer/enrollee as well as ensure that every American has the opportunity to obtain adequate, affordable health care insurance.  Why was this necessary?  Over the past several decades it appears that the percentage of the US budget being used to provide health care has sharply increased. (http://www.usgovernmentspending.com/past_spending) Premiums have risen dramatically in the past decade.  The trend over the past several decades has seen employers asking employees to bear a bigger share of the health care provided. (http://www.ahrq.gov/legacy/research/empspria/empspria.htm)  Due to the high cost of health insurance, many people have begun to view it as a luxury, as opposed to a necessity.  PPACA/ACA establishes regulations to reign in the Health Insurance Providers from consistent and continual efforts to undermine current plans, stop the reduction of employer responsibilities in providing this benefit, and ensure the benefits provided are adequate and affordable to meet the needs of the average American worker.

It seems abundantly clear that each of the three factors described above which impact the average person’s reaction to change, along with the consistent and continual negative barrage by Conservative politicians and pundits appear to have impacted the American people’s embrace of the healthcare reform as well their understanding of the provisions and the consumer protections it offers.   The ACA was intentionally structured to provide many choices for the consumers of healthcare insurance.  As a result, Americans were assured they could continue with their current plan via the “grandfathered” rules, purchase a plan through the appropriate state or federal health care exchange that meets the standards outlined by the ACA, or purchase a plan by a private insurer that does not offer the potential for pre-tax subsidies and/or cost sharing.  This points out again that President Obama told the American people the truth, that the ACA gave people currently enrolled in a particular plan on or before March 23, 2010 the choice to change plans or continue with the same pre-ACA plan.

People are more tolerant of change when they are given opportunities to make their own choices about a new concept.  The authors of the PPACA law, anticipating some people’s reluctance to change health insurance plans even if it would provide them better care at a lower cost, made the decision to allow insurance companies and employers the opportunity to “grandfather” plans in place prior to the ACA being enacted on March 23, 2010. Unfortunately, it appears that intentionally or unintentionally HEALTH INSURANCE COMPANIES, negated this choice for many Americans by canceling plans that could have met the guidelines for “grandfathered” plans. Consumers across the United States indicate they have received letters, from their insurance company, indicating their health insurance plans have been cancelled effective December 31, 2013.    The letters from the insurance companies seem to have some common elements:

• The enrollee is notified their plan is being cancelled effective December 31, 2013.
• The reason the plan is being cancelled is that it does not meet the requirements of the ACA.
• Enrollees are offered the opportunity to purchase a new plan, typically for a significantly higher premium which is identified and compared with their previous rate.
• Enrollees are encouraged to purchase the new plan and “lock-in” the rates before they increase again.
• Enrollees are NOT informed that they can choose to shop in the state or federal health care exchange for a plan which may include tax incentives and/or cost-sharing subsidies that may significantly decrease the cost of a health insurance plan, as well as copayments and deductibles via cost sharing.

People who have received the letters or heard about the letters appear outraged, shocked, and worried about how this will affect them. Was their worst nightmare coming true, as Republicans foreshadowed, that health insurance plan rates were going to sky-rocket and make health insurance even more unaffordable to a greater percentage of the population?  While it seems to be the consensus of most people who are very familiar with the canceled plans, that these plans could be labeled as “junk plans,” canceling  these health plans was entirely the decision of the insurance company since they had the option to continue offering them via the “grandfather” option under the ACA law. The insurance companies, not the requirements of the ACA law, decided that it was more profitable or less trouble to discontinue offering these policies and try to sell other, higher priced policies. The letters sent by insurance companies to enrollees informing them their plan was being cancelled, do not appear to meet these guidelines in most cases.

In fact, two insurance companies in Kentucky were investigated and fined for sending misleading instructions regarding the ACA and/or misinforming consumers about their ability to shop in the state exchange. (http://www.insurancejournal.com/topics/kentucky-humana-obamacare-letters/)(http://talkingpointsmemo.com/dc/insurance-companies-misleading-letters-obamacare)  In another case in California, a Stage 4 Cancer Survivor expresses her fear, concern and abject disappointment at the negative impact the Affordable Care Act will supposedly have on her quality of care.  She had been covered by a United Health Care (UHC) plan, but recently received a letter from them indicating her plan would no longer be available effective December 31, 2013.(http://thinkprogress.org/health/2013/11/04/2881581/wall-street-journal-horror-story-cancer-patient-losing-doctors-wrong/)  UHC went on to explain they were pulling out of the individual health care market and she would have to find a plan through the state exchange.  The exchange offered her one of two plans, but neither one allowed her keep the same provider’s she has used for her Cancer treatment. She stated, “Stanford has kept me alive—but UCSD has provided emergency and local treatment support during wretched periods of this disease, and it is where my primary-care doctors are.” (http://thinkprogress.org/health/2013/11/04/2881581/wall-street-journal-horror-story-cancer-patient-losing-doctors-wrong/)  Having to choose between the doctor who saved her life and directed her treatment and the facility where she received her care seems like a cruel choice at the very least. Igor Volsky, in his article published on the website Think Progress concludes the following about UHC. “The company packed its bags and dumped its beneficiaries because it wants its competitors to swallow the first wave of sicker enrollees only to re-enter the market later and profit from the healthy people who still haven’t signed up for coverage.” He supports his premise based on a statement made by UHC Chief Executive Officer Stephen Helmsley who according to Volsky, told investors last October. “UnitedHealth will watch and see how the exchanges evolve and expects the first enrollees will have ‘a pent-up appetite’ for medical care. The company’s plans reflect its concern that the first wave of newly insured customers under the law may be the costliest.” This is just a few of the horror stories told by people who thought they would be able to retain the insurance they have had for years, but instead in ALL the cases reviewed by the authors, regardless of whether they are described here, involved the health insurance company cancelling the plan as opposed to any dishonesty by President Obama and/or members of his Administration. This points out again that President Obama told the American people the truth, that the ACA gave people currently enrolled in a particular plan on or before March 23, 2010 the choice to change plans or continue with the same pre-ACA plan.

Some of the letters, sent by health insurance companies to enrollees in various health care plans, contained misleading or false information about the proposed cost of plans through the federal and/or state health care exchanges prior to any announcement of what the actual cost of the plans would ultimately be. (http://talkingpointsmemo.com/dc/insurance-companies-misleading-letters-obamacare ) One pointed example in Kentucky involved enrollees in a plan offered by a large health insurance company sent letters to their enrollees telling them their plan had been cancelled due to the ACA and that they would need to purchase another plan. In addition, many health insurance companies did not adequately notify an enrollee that if they chose to purchase another plan directly from the insurance company as opposed to through the federal or state health care exchange, that tax incentives and/or cost-sharing subsidies would not be available. Finally, it does not appear that enrollees were offered the opportunity by health insurance companies or their employers to remain covered under a plan that was initially purchased prior to March 23, 2010 as afforded by the law.   This points out again that President Obama told the American people the truth, that the ACA gave people currently enrolled in a particular plan on or before March 23, 2010 the choice to change plans or continue with the same pre-ACA plan.  What President Obama or his Administration could not control was whether the insurance company chose to offer the same plan.  It appears, based on preliminary evidence, that in most cases insurance companies did not choose to “grandfather” plans.

Certainly, Health Insurance Companies would not intentionally mislead the American people or would they? While it would be a terrible thing to do, it is a question that should be asked and investigated.  The American people are facing a different situation now, than what has occurred in the history of the United States previously when a bill was signed into law, like the Affordable Care Act was on March 23, 2010.  Examples abound throughout our history of strenuous, loud, and almost violent debates on proposed laws.  But, once the bill is voted on and becomes law, our nation’s history shows that people from both political parties have come together and abided by the law, worked together to enact the law and correct problems or confusion associated with the law and did not undermine the law when it goes into effect.

For example, although there were was great push back from the public with President George W. Bush’s Medicare Part D Prescription Drug Plan along with a difficult system roll out, the Democrats worked with the Republicans in educating their constituents, answering any questions holding town meetings and supporting the law once it had passed and was implemented. (http://crooksandliars.com/jon-perr/how-democrats-saved-bushs-medicare-drug-program)

Unfortunately, this has simply not been the case with the Affordable Care Act.  Even though the law was debated, changed, amended, and debated again and again prior to its passage, some members of Congress were determined, by their own admission, to do whatever it took to make this law fail, even after the law was enacted.  https://progressiveandproud.wordpress.com/2013/10/05/another-acaobamacare-myth-no-negotiation-between-democrats-and-republicans-on-acaobamacare/ )  Everyday, Conservative politicians and pundits seem to take to the airwaves and gleefully tell about supposedly “new” crises about aspects of the ACA.  Their refrain is the same each day, “We told you this was a bad idea.”  “We told you the law was not ready to be put in force”.  It reminds us of small children who when having a temper tantrum repeat over and over “told you so.”  However, based on the evidence presented here it is clear that President Obama told the American people the truth, that the ACA gave people currently enrolled in a particular plan on or before March 23, 2010 the choice to change plans or continue with the same pre-ACA plan. 

Clearly, the record shows that Conservatives have been somewhat successful in the pursuit of blaming President Obama for the problems with the roll-out of the ACA and up until today in calling him a liar about whether or not people could keep their same insurance plan, if they chose, even though it did not meet the minimum standards established by the law.  History will show, we think, that the determination of Conservatives such as Mitch McConnell, Rand Paul, Paul Ryan, John Boehner, Eric Cantor, Mike Lee and Ted Cruz just to name a few, to attempt to MAKE the Affordable Care Act fail was due almost entirely to the overwhelming desire on the part of these Conservatives to keep President Obama from having any legislative success or fulfilling any of the goals he set for his Administration.  This apparent rabid desire by Conservatives in opposing the Affordable Care Act is not good for the American people who will have paid an incredible price for this misplaced and misguided tenacity of opposition to the ACA.  They seem willing to let the American people go untreated, even die, and when receiving treatment, potentially go bankrupt all for the ability to be able to say that the current President did not succeed. They brought our country to the brink of financial disaster in an effort to try and stop the law from being enacted.  They appeared unconcerned about the $24 billion wasted in shutting down the government.  It does not seem that the American people are foremost in their minds, when the American people should be the only thing in their minds. They work for the American people.

President Obama has achieved what no other President before him was able to do even though many have tried, both Republicans and Democrats.  He led the pursuit for healthcare reform so that everyone in the United States would have the opportunity to have health insurance when and if needed. He stood in the gap for people like one of the authors of this blog, who developed an illness, and was unable to purchase adequate health insurance due to the presence of  pre-existing illness clauses which successfully precluded people from obtaining quality health insurance.  In 2011, based on the passage of the ACA, people like this author, were able to purchase affordable health insurance, prior to full implementation of the PPACA in 2014.  The author credits the ACA with saving her life.  Today, we, the authors, stand in the gap for President Obama, just as he did for one of the authors and many others, to report we have proven, beyond a shadow of a doubt, that President Obama told the American people the truth, that the ACA gave people currently enrolled in a particular plan on or before March 23, 2010 the choice to change plans or continue with the same pre-ACA plan. The choice WAS provided by the ACA, but the insurance companies decided that people should not have that choice. That is the bottom line.

Please Note:  This blog is based on the Federal Register that is issued regularly by the Federal Government and is used in the rule making process for every aspect of the government.  Preliminary, interim and final rules are published in the Federal Rules.  Since the Government provides stake holders the opportunity to provide comments during the rule making process, the comments are published as well along with rationales why those comments effected changes in the rules or did not.  The conclusions in this blog were solely based on information coming from the PPACA law and the implementation via the Federal Government rule making found in the Federal Register.  The interim rules that are applicable to the grandfathering of policies in effect prior to the signing for the PPACA can be found in the following Federal Register.  We relied on this Federal Register which defines the rules followed by the Federal Government for this content:

Federal Register section 1251 of the ACA (Source:  Overview of the Regulations: Section 1251 of the Affordable Care Act, Preservation of Right To Maintain Existing Coverage [26 CFR 54.9815– 1251T, 29 CFR 2590.715–1251, and 45 CFR 147.140] https://webapps.dol.gov/federalregister/PdfDisplay.aspx?DocId=23967 , Federal Register/ Vol. 75, No. 116 / Thursday, June 17, 2010 / Rules and Regulations 34539)

By: Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO, Lynne Smith, MSSW and Peter J Wills, Accountant and Business Software Support Consultant.

About the Authors:

Barbara is an independent consultant in healthcare providing consulting for physicians.  She is an industrial engineer from RPI with an MBA from NYU. She worked in the pharmaceutical industry for many years before moving into the healthcare industry where she had a company where she provided top quality coding, compliance and revenue cycle management services for physicians. She has since moved into full time consulting for physicians. Barbara is a nationally known expert known for her education, consulting and expert witness services.

Lynne has dedicated her career to helping others. She has experience as a social worker in a rural county, an administrator in a large hospital network and as a College Professor. She uses the skills she developed over the years as an advocate in a variety of areas including her most recent venture serving as a Healthcare Advocate. She is currently a recipient of the Pre-Existing Condition Insurance Plan, which she was able to purchase following ACA being enacted.

Together, Lynne and Barbara own the ACA Healthcare Advocates consulting firm and are available to individuals, families and businesses to help them meet the requirements of the Affordable Care Act in order to meet the specific needs of the client while optimizing the fiscal considerations.

Peter is an Accountant and Business Software Support Consultant. Prior to moving to America to marry he was an Accountant in public practice in Australia for most of his working life. For the last three years before moving here he worked as a Business Software Support Consultant for a business software developer in the housing, mining and engineering field. Peter is using his computer and business talents to assist Barbara and Lynne.

Please direct your questions and/or inquiries to askcobuzzi@gmail.com

Copyright:

© Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO, Lynne Smith, MSSW and Peter J. Wills, 2013. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO, Lynne Smith, MSSW and Peter J. Wills,  and The Place for Facts: Not Rhetoric with appropriate and specific direction to the original content. Permission for more comprehensive use may be obtained by contacting the authors at askcobuzzi@gmail.com

Why The Number Of People Who Enrolled in ACA/Obamacare on Day One is a Misleading Statistic!

The talking heads at FOX news, Conservatives in Congress, and fear mongers are at it again.  They are reporting, that unnamed studies suggest only “six” people enrolled in a health insurance plan through the federal exchange on October 1, 2013.  These Conservatives and even the Democrats who have bought into this latest meaningless piece of information are “appalled” at what a disaster the roll-out of ACA turned out to be.  It just doesn’t matter how many people enrolled the first day.  Why? Choosing a health care plan is NOT, contrary to what Conservatives want you to think, like buying a product off of Amazon. You don’t have to prove your citizenship, verify your identity, and verify your income to shop on Amazon.  You pick your product, provide payment, wait for the item to arrive and you are done.

There had been so much controversy about ACA/Obamacare that people were very curious about what they would find on the exchange.  Statistics suggest that hundreds of thousands of people checked out the web-site in the first few hours according to studies easily found through the search engines.  Unfortunately, the federal system crashed and other problems were identified.  The system has been taken down several times while analysts work to identify the problems and fix them.

However, I think there is a more important variable at play in terms of why enrollments are slower than some of the fatalists suggest. Purchasing a health insurance plan takes thought.  It is a major decision and one you have to live with for at least a year.  Assuming people would simply sign-up for a plan the first day is like looking at pictures of three homes on the internet and buying one sight unseen.  Most people I have spoken to wanted time to look at the various plans, verify that the doctors and clinics they use were in network providers and just think about the decision for a few days.  That is what most conscientious people do when considering any kind of a purchase.

So why then is everyone falling victim to “the sky is falling, hardly anyone signed up for ACA, it must be a failure.”  A better measure would be to determine the number of people who began the enrollment process.  As many of you know that read our blog, I have had PCIP (Pre-Existing Condition Insurance Plan), the first health plan rolled out under ACA, since 2011.  I will be transferring into the Kentucky Exchange by December 31, 2013 when this plan expires.  Newsflash, I haven’t completed the sign-up process.  I completed the online enrollment process, but I have to provide additional information to verify my income. This information must be mailed or faxed in. If you submit an anticipated income that is significantly different from income claimed in previous tax years, you are asked to submit additional information.  Once that information is received, I will be notified via email and then I will be cleared to actually choose the plan I want.

I was able to complete the enrollment process, right up to the point of making payment arrangements.  I have seen the plans and know which one I will choose when I am given the green light by the state.  I have to admit, I would not have finalized my enrollment process by choosing a plan day one, even if I hadn’t had to submit additional information on my income.  It isn’t that I had difficulties, it is just that I had many plans to choose from and frankly some were almost identical, even offered by the same company, so I felt the need to really study my choices.

During the past couple of weeks I have also had the opportunity to help a couple of my family members shop for a prescription drug plan on medicare.gov.  We perused the possible plans.  They picked their top three and then decided to talk about it for a few days and decide what they wanted to do.  Gee, that sounds very similar to what I chose to do in regard to plans on the exchange and what many others are doing everyday as they review their options and decide what plan they want to commit to.

This daily “crisis event” is exactly what the Conservatives and Insurance Companies want.  Remember they are working towards an “I told you so” mentality.  However, the real reason we are having all these issues with ACA is simple.  In the two years leading up to the roll-out of ACA, Conservatives and Republicans refused, absolutely refused to take up any issue that might have made the roll-out more effective and instead spent billions and billions of hard-earned tax payer money to undermine this program.  Am I the only one who wakes up each morning and wonders, “What will be the ACA fictional catastrophe of the day?” Once again, drama has ensued, over a “supposed” statistic, that only six people enrolled in ACA on the first day, that Conservatives are either unwilling or unable to expose the source of to the public.  It is time for this to STOP.  Pandemonium that is provoked by the media, Congress, and pundits must come to a close.  People’s lives are at stake here as they choose much needed health insurance.

As a country, that prides themselves on being well informed, we should be above this and refuse to give into these “manufactured crises” meant to deflect and denigrate the Affordable Care Act as Conservatives and Health Insurance Companies want so the American people are “free” to return to “junk” health insurance policies.  It is time to take a stand and call out these pundits and conservatives for the “crazy making” people they are and not buy into their hysteria.

 About the Authors: By: Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO and Lynne Smith, MSSW. Barbara is an industrial engineer with an MBA. She worked in the pharmaceutical industry for many years before moving into the healthcare industry where she had a company where she provided top quality coding, compliance and revenue cycle management services for physicians. She has since moved into full time consulting for physicians. Barbara is a nationally known expert known for her education, consulting and expert witness services. Lynne has dedicated her career to helping others. She has experience as a social worker in a rural county, an administrator in a large hospital network and as a College Professor. She uses the skills she developed over the years as an advocate in a variety of areas including her most recent venture serving as a Healthcare Advocate. Together, Lynne and Barbara own the ACA Healthcare Advocates consulting firm and are available to individuals, families and businesses to help them meet the requirements of the Affordable Care Act in order to meet the specific needs of the client while optimizing the fiscal considerations.  Please direct your questions and/or inquiries to askcobuzzi@gmail.com.

Grow Up Folks…Quit Whining…ACA/Obamacare Isn’t Perfect But It Is A Big Improvement On What We Had!

Everyday I wake up and I am excited and thankful that I have health insurance and I am alive to tell my story.  It means I can live each day and look forward to the next, instead of wondering will I survive or how am I going to take care of myself?  You see, I was one of the first people to get health insurance through the Affordable Care Act (ACA), because a little known caveat in the law created a plan for people like me who had a pre-existing illness.

See https://progressiveandproud.wordpress.com/2013/09/30/obamacare-the-health-insurance-that-saved-my-life/.

When I was without traditional insurance, it wasn’t that I couldn’t afford to pay for the premium, it was that no one wanted to insure me.  As soon as I told the truth about my medical problems, it was a flat-out “no”.  I was too big a risk, they might lose money on me.  It was devastating, disgusting, and depressing.  I was overcome with questions like:

• “Would I wake up in the morning?”
• “Would I live to see my son grow up?”
• “Would I see my son marry and have a family?”
•  “Would I ever be a functioning member of society again or would I be disabled and house bound    forever?”

I suffered in silence. If you asked my family or my close friends, they would tell you, they had no idea I had no insurance and was why I didn’t seek treatment that they perhaps thought I should have.   I was raised to be independent and strong and to have the mind set “when things get tough, the tough get going.” When I realized that I could get insurance, even though I had a pre-existing condition, prior to 2014, I was sure my prayers had been answered and maybe just maybe I could get the medical treatment I needed to get better before my illness got the best of me.   I wish I could say I just applied online and “abracadabra,” got insurance the next day, but it was a process.  Well actually the process wasn’t so bad.  It was set up similar to the healthcare.gov web page,  but everything that could go wrong, did go wrong. In fact, compared to the frustration people are having today, getting signed up, my experience was a nightmare. You can read all about the problems I faced getting signed up in this blog. (https://progressiveandproud.wordpress.com/2013/10/23/sometimes-the-best-things-in-life-arent-easy-dont-give-up-on-the-health-exchanges/)  You know what, it didn’t stop me.   Most people close to me, didn’t know until a few days ago I had any problems in the sign-up process.  It was frustrating at the time, but I was determined to get insurance and I did.  Like I said, I was raised to be tough, independent, and focused on a goal.  I was raised by a single mom as my father died when I was 10 and things were not always easy, but my mom and, in fact, my entire family, lived by the premise “where there is a will, there is a way.”

Tired of cliches? Well so am I, but I am MORE tired of people complaining that:

• “Signing up for ACA isn’t simple”.  Oh well, so you have to work a little to get it.  The pay-off is worth it.  If you are not comfortable with how to sign up, a detailed blog on how to sign up can be found at https://progressiveandproud.wordpress.com/2013/10/25/help-i-am-not-sure-how-to-sign-up-for-the-health-exchanges-the-process-from-start-to-finish-is-explored-here/.

• “President Obama ‘lied’ when he said people could change plans and keep their same doctors.”  Who could have ever dreamed there would be the “push back” about this law that there has been?  ACA was supposed to be a plan for people who did not get insurance through their employer, could not afford insurance, and/or had pre-existing conditions that kept them from getting insurance.  This law was not written to circumvent or eradicate the employer’s responsibility to provide benefits.  Somehow though, people are suddenly blaming ACA for not meeting their insurance needs even though they are employed, for their health insurance benefits changing even if the change is ultimately positive for them, and for business decisions by companies where they cancel policies either because they want to save money, reduce their adverse selection, are attempting to up sell policies to their customers or because they wish to replace previous plans with new plans that offer the “ten essential services” required of all plans based on the Affordable Care Act. I guess the employees of these companies should have just been left with the sub-standard policies (also called “junk Insurance” or “mini-insurance”) since the insureds feel so “angry” about losing them. (http://www.latimes.com/business/hiltzik/la-fi-mh-healthplans-20131030,0,5590179.story) It is clear that these folks have never faced a catastrophic illness, accident, or had insurance that cost a lot and covered nothing leave them in the lurch right when the insured needed the policy the most.  Any insurance policy in effect on 3/23/2010 is grandfathered in under the ACA if there are no substantial changes.  But if the customer’s insurance company makes any substantial changes in coverage, terms or pricing, the policy is no longer grandfathered in under the ACA Law and may no longer be offered.  It should also be noted that a grandfathered in policy does not have to contain all ten essential coverage elements required of new policies (https://www.healthcare.gov/what-if-i-have-a-grandfathered-health-plan/.) So when a customer’s insurance company sends them a termination letter, it is only because the insurance company alone made material changes to the policy, not because the ACA law invalidated the customer’s insurance law.  The Press and Pundits are directing their anger and the cause at the incorrect party. The cause lies entirely with the insurance companies, since they had the option to not make any material changes and grandfather in these policies.  Had they done this, these policies would not have had to be cancelled and as the President promised, the customers could have kept their insurance, whether the policies were adequate or not.

• “People could “choose” to keep their same insurance plan.”  Clearly that was the intent, but nobody could conceive that certain Congressional leaders and insurance companies would do everything possible for political gain and financial gain, while ignoring the needs of everyday Americans in favor of lining their own pockets and campaign coffers, choosing keeping their PUBLIC SERVICE JOB over the “greater good.”  However this is the story of politics today, take care of yourself and your best interests and forget about any sense of community that has always brought out the best in Americans.

• “The proverbial wool was pulled over the eyes of the American people when they were told that plans through ACA/Obamacare would be cheaper. If you have a plan as a benefit of your job, the cost of that plan is not within the realm of ACA.” That is between the company you work for, the benefit plan offered and the rate they negotiated with the insurance company. “Spending on health care in the United States has grown substantially over the past four decades. In 1965, that spending amounted to $187 billion (in 2005 dollars). It more than tripled in real (inflation-adjusted) terms over 20 years, reaching $666 billion in 1985. Over the next 20 years, spending nearly tripled again, reaching roughly $1.9 trillion in 2005.” See the following link. http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/89xx/doc8948/01-31-healthtestimony.pdf. Remember, as far back as 1992, Democrats wanted a single payer plan, however that was too “Socialist” in the eyes of Republicans when Hilary Clinton chaired the Health Reform Committee after President Clinton was elected. In fact, Universal Health Care was talked about even by the Nixon Administration in a plan that has many similarities to ACA. See the following link. http://www.presidency.ucsb.edu/ws/?pid=3757#axzz2jFxVItXT. In a letter to Congress President Nixon said, “An all-directions reform of our health care system– so that every citizen will be able to get quality health care at a reasonable cost regardless of income and regardless of area of residence–remains an item of highest priority on my unfinished agenda for America in the 1970s.” Read more at the American Presidency Project: Richard Nixon: Special Message to the Congress on Health Care. See the following link. http://www.presidency.ucsb.edu/ws/?pid=3757#ixzz2jFxnZzlv. I include this small summary of the history of Universal Health Care in America just for those people who deny ACA has any roots in Republicanism. In general, the plans offered by ACA are cheaper, however in order to see how much the tax incentive and cost-sharing subsidy will impact your chosen policy under ACA, you have to complete the “enrollment” process.You don’t have to pay for the plan when you complete the enrollment, but you have to get to that point before you will see the tax incentive for the premiums along with the cost- sharing available if you choose the Silver Plan.

Frankly, I am frustrated, fed up and even angry with the senseless complaining that goes on by the media, our elected Congressional leaders, the pundits, and yes even the American people.   For two years, I have woken up every morning thankful for having health insurance.  As the days came closer to the final phase of implementation of ACA/Obamacare my business partner and I worked hard to learn about ACA and it’s regulations to put us in a position of being able to help individuals, families and businesses sign up for ACA, get the best plan to meet their needs at the lowest cost, and educate businesses about how ACA could help their business grow.

Yes it’s true, ACA can help a business grow, based on the tax incentives offered to businesses doing the right thing and either providing health insurance to their employees or providing some part of the premium so their employees can buy insurance in the exchanges.  In fact, we have even seen businesses save enough money on insurance through the ACA and actually add new staff because of the tax credits. See http://thinkprogress.org/health/2013/09/11/2607221/employers-obamacare-wont-stop-hiring/.

Now I wake up every morning and cringe, and wonder:

• What will be the newest myth about ACA/Obamacare adding to the confusion today?
• What will be the new online sign-up drama, that the media and the GOP will hype that deceives and leaves people frustrated?
• Which Congressman will be on television trying to suggest the American people were lied to and manipulated into believing that ACA was going to cure all our medical needs in the United States?

I thought we were the country of “pull yourself up by the bootstraps,” that adversity makes us stronger, and that in America if you believe, and  keep trying you will succeed.   Instead, I suddenly see people complaining that the roll-out of ACA should have been perfect, that businesses are trying to cancel people’s policies because supposedly the regulations are “so tough” under ACA that it is cost prohibitive, and “oh no” birth control prevention services are required to be provided at “no cost”.

Interestingly, any businesses that claim their actions in 2013 were in anticipation of the ACA for 2014 are lying.  They are just doing what they have done as a money saving strategy in previous years.  The President has delayed the requirements for businesses with over 50 employees until 2015.  As such, there is no reason to take any actions in mid to late 2013 or the first half of 2014 which might be related to the ACA implementation as it affects businesses. Also, keep in mind,  abortion is not paid for folks, it is strictly prohibited from being paid for by ACA even though it is paid for within Romneycare.

See http://www.amycontrada.com/Romney_s_FREE_Abortions.html.

You can’t have it both ways.  You can’t say abortion is bad, birth control is bad, but pay for men to have Viagra to make them more virile and in the next breath, punish women for having children out of wedlock or while in poverty.  We need to get a grip and just say, women getting birth control at no cost is better than the other options.  A research study completed a year ago shows  that free birth control would cut abortions between 41-71% in the United States.

http://www.nytimes.com/2012/10/05/us/study-finds-free-contraceptives-cut-abortion-rate.html?_r=0.

One would think that those who felt that abortion was so wrong would be for free birth control since history has shown that taking away access to safe abortions does not eliminate abortions from taking place. See http://www.livescience.com/23726-birth-control-abortion-rate.html.

Whatever happened to common sense? People are having dramatic tantrums because things didn’t turn out perfect, that we have to spend some time on the web site, make a few phone calls, and horror upon horrors be patient. Yet, these same people seem to have no difficulty “camping out” before Black Friday to get the best deal, standing in line to get the new iPhone or video game to hit the market. Let’s act like adults and not just be the “want it, need it, gotta have it now” society.

How to act like an adult in terms of ACA!

1. Complete your enrollment. In order to see your Silver Plan subsidies you have to do everything EXCEPT pay for your plan.  Know that completion means verifying your income and your identity. (Remember all those undocumented workers the GOP keeps saying are stealing our benefits. You have to be an adult and verify your identity. Then there are the “liars and cheats”, so they verify your income through the IRS, just like in a credit check.  There is one big difference they are only verifying your income, so  your credit will not help you or hurt you purchasing a plan.  You do not find out your subsidies (reducing the premium and cost-sharing to reduce the deductible and co- pay) until you complete the full enrollment. YOU HAVE NOT YET PURCHASED A POLICY, SO DO NOT WORRY ABOUT PAYING FOR THE ENROLLMENT, YOU HAVE NOT COMMITTED TO A PURCHASE YET until you actually make arrangement to pay your monthly premium beginning in January 2014.
2. Review the plans.  Decide which one is best for you.  Do you choose a television satellite provider for your TV without getting the best deal? Don’t you look to see if your favorite channels are included? Come on  folks, check the offered plans to see if your doctors are on the plan…it’s not rocket science. Every plan has a website that you can go to and explore the specific benefits and identify the doctor, clinics and hospitals approved on that plan.  Guess what, if you find a plan you like and your doctor isn’t listed, call them and ask them to apply to be a provider.  They might just do it. It is beneficial for them to participate in a variety for plans as it increases their business.
3. When you get a good deal, regardless of the type of purchase, you have to weigh the pro’s and con’s. That is what you have to do with these plans too.  We are talking about an age when people consider the thread count of the sheets they are going to buy, but they can’t take the time to read about the individual plans and find out about the differences between them. Even people on Medicare do this every year during open enrollment in an effort to find the most cost effective plan for them.  Two members of my family changed their Part D enrollment four times in ten years.
4. Quit the panic mode…“OMG someone hacked into the healthcare.gov and they are going to get all my health information.” OK, really, what health information did you give?  Whether you are a smoker…yep…they are really going to be able to demand a ransom for that information.  The call should be for the person who hacked into the system to be arrested and held accountable for the crime.  Hacking is illegal.  Healthcare.gov is not subject to HIPAA (Health Insurance Portability and Accountability Act) since they are not a “Covered Entity”, a “Third Party Payer” or a “Clearinghouse”.  HIPAA admonishes clinics, doctors, and hospitals to name a few to keep your health information confidential.  Any “Covered Entity”, a “Third Party Payer” or a “Clearinghouse”  must give the patient notice of their rights under HIPAA.  These are the only three categories that fall under HIPAA.  You may have heard congress voicing concerns over HIPAA during their current hearings.  These congress people are showing just how little they  understand about security and HIPAA or they are simply fear mongering, because they didn’t want ACA to be the law of the land.
5. Wake up and smell the roses. You have the big lobbyists, the Tea Party, the Insurance Companies, the Medical Device Industry (https://progressiveandproud.wordpress.com/2013/10/19/the-medical-device-tax-a-burden-or-a-blessing-you-decide/), the Republicans and Big Pharma fighting against this plan. Why? It will hit them in the pocket book. They are not looking out for your interests, they are looking out for their financial interests only.  So, you have to learn how to differentiate between what is rhetoric and what is fact. It is the same as Chicken Little….just because he said the sky was falling didn’t make it true. These folks have a stake in making ACA fail, because guess what, this is the true free market, where you shop for the best plan FOR YOU, within the confines of an exchange and the insurance companies compete for YOUR business instead of making decisions about what YOU need.

The GOP is readying another campaign to bring down ACA.  They are trying to capitalize on any issue they can, because as long as they have insurance, a roof over their head, and food on their table, they don’t give one thought to the average American, who in the past have often had to make health insurance, a luxury in their budget.  Health insurance should not be a luxury. In today’s society it is simply a necessity. Just try going without it when you get ill.  You will figure out very quickly the havoc it can wreak in a person’s life who isn’t “lucky” enough to have coverage.

By: Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO and Lynne Smith, MSSW.

About the Authors: Barbara is an industrial engineer with an MBA. She worked in the pharmaceutical industry for many years before moving into the healthcare industry where she had a company where she provided top quality coding, compliance and revenue cycle management services for physicians. She has since moved into full time consulting for physicians. Barbara is a nationally known expert known for her education, consulting and expert witness services. Lynne has dedicated her career to helping others. She has experience as a social worker in a rural county, an administrator in a large hospital network and as a College Professor. She uses the skills she developed over the years as an advocate in a variety of areas including her most recent venture serving as a Healthcare Advocate. Together, Lynne and Barbara own the ACA Healthcare Advocates consulting firm and are available to individuals, families and businesses to help them meet the requirements of the Affordable Care Act in order to meet the specific needs of the client while optimizing the fiscal considerations.  Please direct your questions and/or inquiries to askcobuzzi@gmail.com.

Creepy Uncle Sam is baaaaaack? Is He a Koch Brother?

Really? I thought sure Creepy Uncle Sam had been laid to rest, but apparently no such luck. The Republican Anti-Affordable Care Act (ACA) mascot has returned for a Halloween run. Remember him, he is the “Uncle Sam”, that looms over young people who sign up for insurance through the Health Exchanges. (http://thecaucus.blogs.nytimes.com/2013/09/19/creepy-uncle-sam-is-anti-health-care-law-mascot/) In one commercial, a Nurse is heard saying, “Oh, YOU signed up for Obamacare.”  The next scene shows the patient, a young woman, in the doctor’s office with her legs in stirrups, awaiting a gynecological exam, when Creepy Uncle Sam,  who looks remarkably like the stereotypical description of “a dirty old man” suddenly pops up in the examination room and leers at the female patient, speculum in hand.  In the male version of the “Creepy Uncle Sam” commercials, Uncle Sam has medical gloves on and is snapping the gloves.  He seems too interested in a patient’s sex life, and supposedly represents the government being too involved in American’s health care.  The tag reads “Don’t let the Government Control your Health Care.”  Creepy Uncle Sam commercials have drawn much criticism, with some experts even suggesting it minimizes the issue of sexual assault of women.

Just when we thought “Creepy Uncle Sam” was down for the count, he popped back up on our televisions for another round of Anti-ACA ads in the “spirit” of Halloween. (http://www.csmonitor.com/USA/DC-Decoder/Decoder-Wire/2013/1025/Creepy-Uncle-Sam-returns!-Will-Halloween-ad-scare-Millennials-off-Obamacare-video) This ad seeks to suggest that ACA is being shoved down young people’s throats and encourages them to reject the Health Care Exchanges and get their health needs met through other options or at the very least through insurance plans not offered by the exchange. It suggests that young people can find more “cost effective” plans elsewhere.  However, statistics suggest that almost 90% of young people will receive some form of subsidies.( http://finance.fortune.cnn.com/2013/10/21/why-millennials-need-obamacare/) In fact, some young people will be able to purchase health insurance through the Exchanges for about $49.00 a month, which is much less than the average “private” insurance plan available outside the Exchanges. Republicans and Tea Party members seem to leave out the fact that if young people “opt out” of ACA, they will lose the government tax-incentive subsidies.

The “Creepy Uncle Sam” marketing campaign has been relatively popular, but in a “can’t take my eyes off the train wreck” kind of way.  The campaign had about 3.5 millions views on You Tube in September but the “dislikes” far out-weighed the “likes”. ((http://thecaucus.blogs.nytimes.com/2013/09/19/creepy-uncle-sam-is-anti-health-care-law-mascot/) The ad campaign is aimed at young people between the ages of 18 and 30.  It was developed by a marketing company called “Generation Inquiry,” who received a five million dollar contract from “Freedom Partners,” to develop a campaign aimed specifically at young people encouraging them not to participate in ACA.  Freedom Partners is funded by none other than the Koch Brothers. Are you surprised?  Here we go again, with conservative groups, funded by the Koch Brothers and others, this time, trying to take advantage of the website issues associated with signing up for  ACA/Obamacare.  I love the irony of this commercial, keep government out of health care, but “come on down Koch Brothers” and tell us what will be best for our medical needs.  I am pretty sure that “Creepy Uncle Sam” is really the missing lecherous Koch Brother.  I jest, but the sole purpose of this ad campaign is to stop young people from signing up for insurance through the Health Care Exchanges. The success of the Health Exchanges is dependent on people of all ages signing up for the various insurance plans.  Young people, who tend to go to the doctor less often and be in good health are the counter-balance to older enrollees, who may use medical services more often and tend to have more chronic illnesses.  Theoretically, by keeping younger, healthier people from signing up for insurance through the Health Exchanges, Republicans and Tea Party members hope the Affordable Care Act will fail and the costs will be much more than anticipated, so the Republicans can say “told you so” leading up to the 2014 elections and the 2016 presidential elections.

There is some statistical evidence to suggest that since the Health Exchanges opened, some people have become frustrated with what they perceive as their inability to sign up for health insurance through the exchanges and have sought coverage through private companies or exchanges. (http://www.reuters.com/article/2013/10/25/us-usa-healthcare-insurers-idUSBRE99O04B20131025) Many times, when these young people contact my partner and I or Navigators they realize they were “duped” and could have qualified for subsidies.  It is important that every young person, in fact anyone who may qualify for ACA give the website “gurus” time to correct the problems.  Perhaps Bill Gates, one of the richest men in the world, said it best in his “picture message.”  (https://scontent-b.xx.fbcdn.net/hphotos-frc3/q71/s720x720/1395325_10200210418781672_442422196_n.jpg)  “Healthcare.gov has Fewer Glitches than GOP, Works More Than John Boehner.” ( This photo, if true, makes a significant statement.  I searched the world wide web for several hours and could not find anything to say this statement and photograph has been photo shopped.  Because we pride ourselves on our fact checking, I used the photo and added this disclaimer.) Let’s give the Obama administration some time to work out the glitches, glitches that could have been resolved if the Republicans and Tea Party members had not thrown enormous temper tantrums about the Affordable Care Act and tried to repeal it over 40 times, and shut down the government when they did not get their way for much of October. Had the Administration been able to focus their attention on tweaking the plan we may not be experiencing the difficulties we are now. It’s important to remember that Medicare didn’t work out the application kinks until about two years after it’s inception;( http://en.wikipedia.org/wiki/Medicare_(United_States)  )There are still several weeks left before January 1, 2014 and with a little patience people will get signed up for the Exchanges and purchase health insurance in an affordable manner.  Tell “Creepy Uncle Sam” and the Koch Brothers  they are not welcome in our homes, our minds, our health insurance, or our wallets.

About the Authors: By: Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO and Lynne Smith, MSSW. Barbara is an industrial engineer with an MBA. She worked in the pharmaceutical industry for many years before moving into the healthcare industry where she had a company where she provided top quality coding, compliance and revenue cycle management services for physicians. She has since moved into full time consulting for physicians. Barbara is a nationally known expert known for her education, consulting and expert witness services. Lynne has dedicated her career to helping others. She has experience as a social worker in a rural county, an administrator in a large hospital network and as a College Professor. She uses the skills she developed over the years as an advocate in a variety of areas including her most recent venture serving as a Healthcare Advocate. Together, Lynne and Barbara own the ACA Healthcare Advocates consulting firm and are available to individuals, families and businesses to help them meet the requirements of the Affordable Care Act in order to meet the specific needs of the client while optimizing the fiscal considerations.  Please direct your questions and/or inquiries to askcobuzzi@gmail.com.

Help, I Am Not Sure How to Sign-Up for the Health Exchanges!! The Process from Start to Finish is Explored Here!

Healthcare.gov is booming since the Federal Health Care Exchange and State Health Care Exchanges opened on October 1st.  There have been so many hits, about eight million unique visitors, that the system has had trouble and crashed repeatedly. People are getting frustrated with the  inability to check out their options and learn how much plans are going to help them. There has been some talk that some of the volume, may be from suspected “hackers.”  However, after investigation, the NY Exchange has concluded that at least for their exchange they do not think hackers have infiltrated their marketplace. (http://www.wgrz.com/news/article/228302/37/Experts-NY-Health-Exchange-Website-Unprepared-For-30M-Visitors) The NY State Exchange has had over 30 million visitors as of October 24th. 

People who are able to access the site and look at the plans are at times incredibly excited, or frighteningly depressed about what they learn or as you are about to find out think they learn.  The Affordable Care Act is not perfect, but it is better than what we had;  a system controlled by the big Health Insurance Companies with premiums for plans spiraling out of control, while denying coverage to anyone and everyone who had a pre-existing illness, unless they or their spouse had insurance through an employer. The Affordable Care Act is changing the “lay of the land” when it comes to health insurance coverage. Anyone who is considering getting health insurance through the health care exchange, or wants to help family or friends will benefit from this step by step discussion of the exchanges.  The reader will learn about the Affordable Health Care system,  the different types of plans available through State and/or Federal Exchanges; helpful hints to insure you get the best price for plans when using the exchange; as well as an overview of the falsehoods being spread to keep people from signing up for The Affordable Care Act.

After President Obama was elected in 2008, he indicated that health care for all Americans was one of the priorities of his presidency. (http://www.nydailynews.com/news/national/high-hopes-political-realities-obama-term-retrospect-article-1.1243468)  By 2009, both the Republicans and the Democrats were involved in discussions about the design of a national health care system.  The Democrats favored a single payer system, while the Republicans were unwilling to consider this “road to socialism.”  After months of discussion, both parties agreed to a plan that was initially suggested by Republicans in the 90’s developed by the Heritage Foundation as an alternative to a single payer system.  Following much compromise and negotiation, the House and Senate, voted for The Affordable Care Act and it was signed into law in March, 2010. Refer to https://progressiveandproud.wordpress.com/2013/10/05/another-acaobamacare-myth-no-negotiation-between-democrats-and-republicans-on-acaobamacare/ for information on the negotiating process in regard to ACA. Let’s review how to sign up for health insurance using the Federal or State Exchanges. While there may be minute differences between the two, the process is similar. It should be noted that even if you think your state may have a program, the sign-up page at http://www.healthcare.gov will connect you with either the federal sign-up for those living in the 26 states that refused to run their own exchange or to the individual State Exchange page in the state in which you reside.  Please make sure you ONLY use http://www.healthcare.gov to initiate the sign-up process for insurance because some companies have set up private exchanges that look similar to the Federal or State Exchanges but do not offer the enrollee any subsides or cost-sharing which may be the difference between a plan being affordable or out of reach.

1. The first thing a person who wants health care insurance should do is go to http://www.healthcare.gov. (http://b-i.forbesimg.com/robertpearl/files/2013/10/Healthcare.gov_2-e1380635876183.png) The home page will have different choices.  Choose the one that best serves your needs such as individual/family or business.  This is a red alert.  Always start from the http://www.healthcare.gov website even if you think you have a State Exchange. Healthcare.gov will link you to your State Exchange, if available, but people have been fooled by looking up Federal Health Exchange or State Health Exchange in search engines. In order to get around the rules, companies including insurance companies have formed “private exchanges”.  It looks like a real exchange until you get to the costs. It may even have plans that are similarly named to the official ACA plans, but the enrollee will not be offered any subsidies to assist in paying for the plans.  In order to protect yourself and get the best rate ALWAYS begin your process to apply for health insurance at http://www.healthcare.gov.
2. When you get to the healthcare.gov website click on your state and it will take you to a new screen.  There you will be told whether your state has it’s own exchange or if you will be getting insurance through the Federal Exchange.
3. The computer will redirect you to your State Exchange home page or continue in the process of signing you up for the Federal Exchange.
4. The next screen will ask you for your name, email address and zip code.  In some cases, it may ask you what you expect your 2014 income will be.  It may also ask if you are eligible for and have insurance through your employer. If insurance is a benefit offered by your employer, you may not be eligible for the exchange.  Why?  ACA was enacted to insure those who did not have insurance through their job, those who are unable to purchase health insurance due to pre-existing conditions, and those who are unable to afford health insurance.  (http://www.bcwac.org/pdf/Health-Care-Comm-Report-on-ACA-to%20Coalition-11.30.12.pdf)
5. You may also be asked to identify 3 security questions and their answer.  Please make note of your user name, password, and the 3 questions you chose in addition to their answers. After you have completed this and clicked on “continue” you will see a screen that tells you to go to your email and verify your internet identity by clicking on the link.
6. Click on the link, contained in the e-mail, and you will go back to the exchange and most likely land on a page with one of the following messages:  You have successfully signed up” and you will be able to proceed with the sign up for insurance, or “The system is very busy”, and then you will be taken to a page that tells you to wait, the exchange is busy, but you will be sent to the next step as soon as possible. http://www.fbnstatic.com/static/managed/img/fb2/news/healthcare_exchange_error.jpg People have reported quite long waits, up to 45 minutes and sometimes the site crashes and you have to put your user name (email) and password in to log in again.  Please do not leave this page, as you will lose your place in line. If you are unable to wait, save your information and simply return at a better time.  The web site is so new, and people are eager to check out the costs for health insurance plans, so the site is very busy and the best time to access the health exchanges seems to be after midnight and before 6:00 AM. Remember you have until Dec. 15, 2013 to sign up and have the insurance start coverage on 1/1/2014 and even longer if you decide after January 1st but before March 15th that you want coverage. If the site is busy, you will also be given a number you can call and a navigator will help you sign up or you can have an application form sent to your address to complete and mail to the place they request. Most of the people I have talked to, indicate they get through to a navigator by phone faster and the navigator is very helpful in completing the application.
7. At any point between steps 4 and 6 you will be asked if you want to enroll in the plan or see an overview of the plans.  If you choose to review the plans, be aware you will be given an overview of the plans and none of the subsidies or cost -sharing information will be available.  This is causing a problem for many folks because, they do not see any cost sharing or subsidies on these plans, so they panic and immediately assume they do not qualify for subsidies from the federal government and will have to pay the full cost of the premium, deductibles and co-pays.  This is not necessarily true.  People who choose to review their possible plans prior to completing their application will have “artificially” high deductibles, premiums, and out of pocket expenses. You will not be able to see the plans with any subsidies or cost sharing applied until you complete the enrollment process.  (**As a note, this is the point where I am often contacted by email, phone, twitter or facebook because someone is frantic that the premiums are too high and not affordable and the deductibles and out of pocket maximums are often several thousand dollars.) They seem “sure” that they have been lied to and the rates are not what President Obama promised.
8. Remain calm and check to insure you have completed your enrollment in the program.  You will know if you have completed it because you will get a screen explaining what your subsidy is for the premium and it will tell you, if you are eligible for cost sharing and what types of programs are available for you.  If you choose to view the plans at the start of the application, you will be shown possible subsidies and absolutely no cost-sharing, so the moral of the story is be sure and complete the enrollment process.
9. The next step will be to fill out an application.  There will be several sections. This is pretty straightforward and simple.  You will be asked to identify the members of your family, and put in their dates of birth and social security numbers.  Be sure to include everyone in your family, you, your spouse and the children for whom you are responsible for obtaining insurance. (Don’t forget children can remain on your policy until they reach the age of 26, regardless of whether they live at home, are in college, or are working.)
10. Another page will ask you about your income.  There are three different types of income: employment income, small business income, and other income which could include retirement, unearned income from investments etc.  These questions are very specific and if you are married you will have to complete it for both spouses. and if you have children for each of them as well.
11. Once you enter your income, the program will attempt to verify your income and your identity. This is very similar to the process that occurs when you apply for a credit card, renting a home, or buying car insurance just to name a few. The big three credit companies are used to verify your identity and your last income tax form will be used to verify your income.  Although, in this situation, your credit does not impact your premium or cost sharing alternatives. The computer program is programmed to access your last tax return to compare the income you reported on your last return in comparison to the amount you are projecting you will earn in 2014.    ( find it very interesting that so many Republicans indicate an enrollee does not have to verify income.  For people apply for health insurance through the State or Federal Exchange must verify their income before they will be able to fully complete the application process.  These conservative and/or Republicans seem to assume people will cheat and/or under report their income and I am sure some will, just like some people cheat on their taxes.  However as noted in a previous blog the number of people who cheat on their taxes is much higher than those who cheat on entitlement programs.  If your income is significantly less or more than your most recent tax return, you may be asked to verify your income by submitting documents that support your reported income. You will be given several choices on how to document your income and how to get it to the health care exchange. As a personal note I had to do this.  I know my income will be more in 2014, than in the previous 2 years, so the amount I estimated is more than what is on my previous tax return.  I had to send in documentation to support this.  I sent in a copy of my taxes and a written explanation as to why  I think my income would be significantly more.  You can verify your identity by submitting a copy of your driver’s license or government ID for example. You can send your documents confirming your income by fax, mail, email.  You will have many choices.  You will also have a deadline by which time you must provide these documents.
12. Whether you choose to send in your income documents immediately via the web or fax or decide to send them to the address provided, you will be given the opportunity to continue with the enrollment process.  You will get a screen that reminds you that if you do not report your income correctly, you may have to return some or all of the subsidy or cost sharing money you received and that your enrollment will not be complete until the supporting documentation is received. (No, this is not just me repeating myself, you will see this statement 2 or 3 times during the process of enrolling in the exchange: at the very beginning, prior to giving any income amounts, after you enter your income if it doesn’t coincide with previous tax years, and finally  again after you have reviewed the plans with the subsidies added in, just before you finish the application process.
13. The exchange explains the consequences of under reporting your income and reminds you that you have to tell the truth and cites the law in regard to truth in reporting income. You will be asked if you want to continue or wait until after you “recheck your income,”  At this point you can save your data, or you can choose to move forward after acknowledging that the income you have documented does or does not agree with the information on your last tax return, and click on the button validating that the rates they are showing you are based on self-reported income and could change when you send in the verifying documents.
14. Finally, you will be asked to sign your application electronically. Your signature means that you understand the need to submit supporting documentation, which is simply a statement that says you understand the process, validate you have submitted your correct earnings, and know you need to change your reported income if there are any changes to it in 2014. Failure to notify the exchange about any change in income could result in the IRS subtracting any over payment from your next federal income tax refund. It also reviews the situations in which you can make other changes to your plan during 2014, including but not limited to, the birth of a child, retirement, quitting a job etc, in other words any situation might change your eligibility for the exchange and/or impact your premium subsidy or cost-sharing.
15. After completion of the application process, even if you have to send supporting documents to verify your income or identity, you will be given the option of reviewing the insurance plans available in your state.  At this point, you will be transferred to a page where you will see the plans available to you, the premium subsidy, and if you are reviewing the Silver Plan, any cost sharing for which you may be eligible.

Once you get to this point, the application is finished and you are ready to “shop in the exchange”. Don’t forget, that if you have been asked to submit supporting documents you must do so prior to setting up payment arrangements for your plan.  You will not be “officially” enrolled in the Health Exchange until that time.

So what can you expect to see when you review the plans. The first thing you need to know is that beginning in 2014 every health insurance plan will offer ten essential benefits that all enrollees will have in common regardless of what plan they are enrolled in:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization; maternity and newborn care
4. Mental health and substance use disorder services, including behavioral health treatment
5. Prescription drugs
6. Rehabilitative and habilitative services and devices
7. Laboratory services
8. Preventive and wellness services
9. Chronic disease management
10. Pediatric services, including oral and vision care.

Regardless of which plan you choose, these benefits will be a part of the plan. In addition, even if you have used none of your individual or family deductible you will not have to pay for every medical cost until you reach that deductible.  Some of the preventative services and physicals are provided at no cost to you each and every year, regardless of the plan. In addition, many services will be covered and enrollees will only pay a co-pay for services such as seeing a doctor when sick.

Based on the data currently available, there are four levels of health care plans offered through the State or Federal Exchanges.  They are named Bronze, Silver, Gold, and Platinum, so that regardless of where you live in the United States, you will be able to understand and recognize available plans. http://www.medicoverage.com/images/compare-exchange-plans.jpg. In addition, while the prices may be different, plans in various states, counties, and/or communities that are labeled as Bronze, Silver, Gold or Platinum will be essentially the same regardless of where you live.  The Kentucky State Exchange, for example, offered me sixteen different plans from which to choose.  Please note however, that 12 of the plans were from the same company, but had slight differences between them.  Be sure to review all the plans  carefully and insure they meet your needs.  Plans on the Exchange range from bare bones “Bronze” plans that have high deductibles and co-pays but have the cheapest premiums, to “Platinum” plans which have the most expensive premiums but the lowest deductible and co-pays.  It is also important to note that any Health Insurance Companies can participate in the Health Exchanges as long as they offer at least one Silver Plan and one Gold Plan. Companies may have different provider lists, so be sure to take this into consideration as well.(http://publications.milliman.com/publications/healthreform/pdfs/Employer-healthcare-reform-strategic-impact-study.pdf)  

Before you can understand your options in choosing one of the health insurance policies, on the State or Federal Exchange, you need to understand the two cost saving measures or tax benefits in the ACA. The first tax incentive is perhaps the most widely known and popular subsidy available to enrollees.  Based on the enrollee’s income they may be eligible for pre-tax incentives each year that are payable to the insurance companies to offset the costs of premiums for tax payers. Enrollees have the opportunity to anticipate their 2014 income, and based on that income receive a subsidy, that is sent to the insurance company each month as a partial payment of your premium.  You can also choose to pay the full-cost of the premium each month and reconcile it on your 2015 taxes and receive a refund if you qualified for a subsidy.

The second and more confusing subsidy is a cost sharing subsidy that may help those people who make less than 400% of the poverty rate, which is about $45,000 a year for a single to about $96,000 a year for a family of four. This cost sharing subsidy is only available on the Silver Plans.  While the tax incentive subsidy is available for any level of the plan, the cost sharing subsidy will only be allowed for use on the Silver Plan. The moral of this story is don’t assume the Gold or Platinum Plan is the best plan to choose, because choosing the Silver Plan may allow you to have lower deductibles and co-pays than the Platinum Plan or what is commonly referred to as the “Cadillac” plan.   Let’s review each of the plans:

• Bronze Plan: The Bronze Plan has the lowest premiums in the exchange, but has the highest out-of-pocket costs and deductibles. There is no cost-sharing subsidy available for this plan. The bronze plan may be a good choice for a young adult who is just going out on their own. People who choose the bronze plan will have 60% of medical costs paid for by insurance, after meeting the deductible.  They will also have certain preventative services provided free each year.
• Silver Plan: his is considered the “average” plan for most enrollees, because it is the most cost effective choice for reasonably healthy families who use medical services. Before any subsidies are figured into the equation the Silver Plan pays for 70% of the costs of medical services after the deductible is met.  “After the deductible is met” can be rather frightening for any consumer viewing their health insurance benefits.  Deductibles in the current market place can be high and still be “more” than most middle or working class families can afford.  The Silver Plans offered to consumers through the health exchanges, have a $2000.00 deductible and a $6,750.00 out of pocket maximum per year, prior to cost sharing for a single individual.  Once the out of pocket maximum is reached in a calendar year, the insurance company will pay 100% of the enrollees costs including prescription drugs for the remainder of the year.  For families, the deductible  and out of pocket maximum is higher.  This is NOT the whole story when deciding which insurance plan is best for you and your family.  Enrollees are offered another subsidy which is referred to as cost-sharing, if and only if, they earn 400% or less of the poverty level and choose the Silver Plan.  For a single person 400% of the poverty level is approximately $45,000.00 per year or less and for a family is $95,000.00 per year or less.  The purpose of the cost sharing subsidy is to lower the deductible, co-pays, and out of pocket maximums to more affordable rates based on income.  Cost sharing is ONLY available on the silver plan.  Two things are important for consumers to know:
• First, projecting your 2014 will be important, because if you earn significantly more                than you projected, you will be responsible to pay back that part of the subsidy you                used due to incorrect projections of your income.
• Second, when you view the plans available to you through the exchange, you will not be          able to see the cost-sharing component until you complete the application, verify your            identity and income, and electronically sign your application.

• Gold Plan: The Gold Plan is the second most expensive plan and has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.  It has lower deductibles than the Silver or Bronze Plan as well as lower co-pays, and out of pocket maximums per year.  People who do not meet the criteria for subsidies and/or cost-sharing may well find a Gold Plan that will offer them similar benefits to those who qualify for cost-sharing under the Silver Plan.
• Platinum Plan: The Platinum Plan or “Cadillac Plan” is the plan with the highest premiums offered on the insurance exchange. In this plan 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid for by the enrollee. This plan may be appropriate for those with high incomes and those in poor health. Although coverage is more expensive up front, the 90% coverage of costs will help those who use medical services frequently but do not qualify for cost-sharing on the Silver Plan due to their income.

Not every health insurance provider in the exchange has to offer each tier of the plans outlined by the federal government, however, all participating health insurance companies must offer at least one Silver Plan and one Gold Plan to potential enrollees.  There is one more type of  Health Insurance offered by the State and Federal Exchanges called the  Catastrophic Plan.  This plan is primarily for those people under 30 years of age who are in good health and do not plan or need to use medical services very often.  It protects this group of consumers from very high medical costs should the “unexpected” occur, such as an accident or catastrophic illness.  The Catastrophic Plan includes 3 primary care doctor visits per year as well as free preventive benefits at no additional out of pocket cost. Cost sharing and premium subsidies are not available for the Catastrophic Plans. People 30 and over or those with low incomes, that even with premium subsidies and cost sharing does not make health insurance affordable or who have received a hardship exemption from the fee may also be eligible for Catastrophic Plans. (http://www.advisory.com/Daily-Briefing/2013/06/27/Who-will-be-exempt-from-the-ACA-mandate-The-final-list)   Hardship exemptions include but are not limited to:

• Prisoners
• Undocumented immigrants
• Indian tribal members, living on an Indian reservation will be exempt from the penalties. This exemption is probably due in large part to the fact that Indian Reservations in the United States have an extensive public health system provided by the federal government.
• Members of some religious organizations or health care sharing ministries also can apply for a religious exemption.
• Other people or organizations may be granted a hardship exemption including but not limited to:
  • Those who cannot afford coverage, or live in states that have opted out of the Medicaid expansion;
  • People who have no plan options in their state’s health insurance exchange;
  • Individuals who have suffered a hardship or a coverage gap of three or fewer months;
  • Finally, exemptions may also be offered to individuals on a case by case basis.

As you can see, there is much information to take into consideration when you sign up for health insurance through the State or Federal Exchanges.  It is true that the process may be frustrating at times, overwhelming, and even maddening, however the outcome for the vast majority will be well worth the “pain” in getting covered.  How do I know?  In 2010, when the Affordable Care Act became law it included an amendment directing the federal government to set up a plan, the Pre-Existing Condition Insurance Plan (PCIP), through which people with pre-existing conditions could apply for and receive health insurance prior to the Affordable Care Act being available nation-wide in 2014.  I signed up and was approved for PCIP health insurance in 2011. (https://progressiveandproud.wordpress.com/2013/09/30/obamacare-the-health-insurance-that-saved-my-life/)  Premiums were not based on health, gender, or the ability to pay.  It was simply based on age. PCIP served as the “guinea pig” for the roll-out of the Affordable Care Act. If you have read my previous blogs, you would know my application process was not without it’s problems, however once I was approved, the health insurance turned out to be better than 95% of the plans I had ever had, even when I was employed. (https://progressiveandproud.wordpress.com/2013/10/23/sometimes-the-best-things-in-life-arent-easy-dont-give-up-on-the-health-exchanges/) I understand that people are impatient to get insurance. I certainly felt that way, however the end clearly made up for the means.  This was a huge undertaking for the government, to solve a huge problem in the United States. It may take several weeks or several months to work out the “glitches”, but that doesn’t mean we should “throw the baby out with the bath water.”  The administration is taking steps to correct the problems.  Bill Gates, one of the smartest and richest men in the world sent Americans a message on Facebook: https://www.facebook.com/photo.phpfbid=10200210418781672&set=gm.10151722315393861&type=1&theater which is self-explanatory.

Unfortunately, there are those who would rather “throw the baby out with the bathwater” and have consistently and continually since the law was enacted tried to proceed down that path.  Americans have been drowned in “facts” that cast an evil slant on the program. In truth, these aren’t facts at all but rather either a manipulation of information or flat out lies designed to anger or frighten Americans into not supporting this program and not signing up for an insurance plan they may desperately need.  Some of the most common lies and distortions include the following:

1. A micro-chip will be implanted into people who purchase a plan through the state or federal health exchange that essentially is “the mark of the beast” described in the Book of Revelation in the Bible. This is a flat-out lie.  No one participating in the State of Federal Exchanges will be injected with a chip.  The only injections a person will receive will be no different than those they receive now such as vaccinations, flu shots etc.
2. There was never any negotiation or compromise between the Republican and Democratic Party in regard to the Affordable Care Act.  President Obama simply “shoved it down the throat” of the American people.  Wrong! (https://progressiveandproud.wordpress.com/wp-admin/post.php?post=313&action=edit)  Affordable health care was a priority of the Obama administration, and in fact, of his campaign to be President in 2008.  Actually, President Obama favored a single payer system which the Republicans would not even consider.  The final plan that passed the Congress and was ultimately signed into law by President Obama was first suggested by the Heritage Foundation, a conservative think tank as an alternative to the single payer system suggested by the committee headed up by Hilary Clinton during the Clinton Administration. (http://online.wsj.com/news/articles/SB10001424052970204618704576641190920152366)
3. The government and the IRS will have free access to enrollees bank accounts and may use private information to spy on them.  This couldn’t be further from the truth. (https://progressiveandproud.wordpress.com/wp-admin/post.php?post=98&action=edit) Enrollees will be given the opportunity to pay their monthly premium by an automatic withdrawal from their checking account.   This insures that there will be no lapse in health care coverage and is no different than how millions of Americans pay their utility, phone, or cable bills.  The IRS will NOT have any access to a person’s bank account with regard to ACA.

These are just a few of the distortions and absolute lies being told by conservatives in order to make Americans suspicious and afraid of the Affordable Care Act. So much time has been spent debunking these myths and countering the more than 40 repeal efforts by the Republicans that could have been better spent working together in a bi-partisan basis to anticipate any problems that might occur on a program roll-out of this magnitude.  Instead Republicans appear to be gleefully having Congressional Hearings to continue to undercut the Affordable Care Act.  Congressman Issa in a recent Congressional Hearing yielded the floor to a Democrat, who began to counter the implications being presented at the meeting.  Congressman and other Republicans were asking questions of the witnesses that implied that questions about pre-existing illnesses and other health records would be used during the application process.  The Democrat was very vocal in confronting these Republicans about their line of questioning being unnecessary, because age and whether or not the individual applying is a smoker are the only criteria on which costs for the plans are based.  As a consumer, it is extremely important, that you consider the source when given “facts” about the Affordable Care Act.

There are people signing up each and every day under the Federal and State Exchanges. My best advice is to “stay calm and keep going” to quote a popular phrase.  If you can’t seem to get signed up, don’t despair, complete the contact form at the end of this blog and we will be happy to help you or direct you to someone who can.  Good Luck!

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About the Authors: By: Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO and Lynne Smith, MSSW. Barbara is an industrial engineer with an MBA. She worked in the pharmaceutical industry for many years before moving into the healthcare industry where she had a company where she provided top quality coding, compliance and revenue cycle management services for physicians. She has since moved into full time consulting for physicians. Barbara is a nationally known expert known for her education, consulting and expert witness services. Lynne has dedicated her career to helping others. She has experience as a social worker in a rural county, an administrator in a large hospital network and as a College Professor. She uses the skills she developed over the years as an advocate in a variety of areas including her most recent venture serving as a Healthcare Advocate. Together, Lynne and Barbara own the ACA Healthcare Advocates consulting firm and are available to individuals, families and businesses to help them meet the requirements of the Affordable Care Act in order to meet the specific needs of the client while optimizing the fiscal considerations.  Please direct your questions and/or inquiries to askcobuzzi@gmail.com.

Sometimes the Best Things in Life aren’t Easy! Don’t Give up on the Health Exchanges!

When the Affordable Care Act was passed into law in 2010, there was a little known caveat called the Pre-Existing Condition Insurance Plan(PCIP) connected to the law.  It recognized that there were millions of people in the United States who through no fault of their own did not have access to health insurance due to a chronic illness.  ACA directed the federal government to set up an insurance plan, PCIP, with premiums, based only on age, so that this group of people could purchase insurance enabling them to get the healthcare they needed.

In 2011, the PCIP program was rolled out with very little fanfare or advertisement, but allowed people across the United States who had been denied insurance based on pre-existing illnesses to sign up and pay a monthly premium for insurance. I often tell people that this was the first roll-out of ACA and is very similar to the silver plan offered on the current federal and state exchanges. The primary difference was that there were no tax subsidies or any cost sharing of deductibles and co-pays involved.  Unfortunately, many people did not learn of the available insurance, so while almost a million people signed up for the plan, many others knew nothing about it and have been awaiting 2014 with great anticipation.  In fact, as I have talked about PCIP in the months leading up to the roll-out of the exchanges and since the opening of the federal and state exchanges, many people have accused me of lying about PCIP being the first insurance plan of ACA.

I first applied for PCIP in July, 2011.  I learned about the program, just by luck, when doing some research on the internet on the Affordable Care Act.  I could hardly contain my excitement about being able to purchase health insurance at a reasonable cost.  Based on my age, the premiums would either be $220.00 or $300.00 per month.  The lesser monthly premium meant the enrollee would pay a higher deductible and co-pay.  I chose the more expensive premium that also offered lower deductibles and co-pays. I immediately signed up via the internet and mailed in my “supporting documents.” These documents consisted of a copy of my social security card, my driver’s license and a letter from my doctor indicating I had chronic health issues.  I wish I could say that two weeks later I had health insurance, however like is often true of anything new, there were problems.

It took me four months to get signed up and the problems worked out.  While I got frustrated at times, I never gave up.  The PCIP administration was located in two different places Missouri and Louisiana.  The eligibility workers were in Missouri, but the financial administration was in Louisiana.  The two components did not communicate very well.  I would get letters from one indicating I had failed to provide something, and be told via telephone call that the information had been received. Sometimes I wanted to bang my head against a wall or pull every hair out of my head, but I persevered.  Perhaps the biggest problem came when making arrangements to pay my premium each month.  I elected to have it automatically withdrawn from my checking account each month.  For this, I had to send in a voided check and a check for my first month’s payment.  I did this, not once, but three times.  Each time no one could figure out where it was.  In fact, one time I sent it federal express and they still couldn’t figure out what happened to it.

Was I frustrated?  Absolutely.  Was I ready to give up?  No.  I needed this insurance and I was going to use every option I had to get this insurance.  Now, perhaps for most people that would have involved a few phone calls, however I have been a social worker for 25 years and those who know me “might” say I am very strong willed. I called both the Missouri and Louisiana offices and spoke to workers, supervisors and supervisor’s supervisors.  I documented every call I made and wasn’t afraid to let them know they were going to hear from me every day until I was approved for PCIP.  I remember clearly about three and a half months after applying, I was finally connected to the person who headed up the financial division of PCIP.  I told him the problems I had been having and how badly I needed this insurance.  That day I hit pay dirt.  He made it his mission to find out what happened and promised me I would have insurance within 30 days at the most.

He was true to his word.  He fixed  the problems in three days.  Suddenly I got a call. with an apology. that I was approved for health insurance.  They let me give them a “check” by phone and said my cards would arrive shortly in the mail.  I can not tell you the relief I felt.  You see, I was very ill.  I had spend several weeks during 2010 in the hospital and Nursing Home and it has depleted to a great extent my financial capabilities.  I also knew, that I had ongoing and consistent health problems that needed to be treated and if they were not taken care of would lead to my death.  For me, this insurance was simply a life or death matter.

So, in late 2011, I became a person who had health insurance for the first time in 7 years.  I would have gladly paid for it prior to then, but I couldn’t, due to my health not financial reasons, not one company wanted to offer me insurance.  The process of initially getting that insurance was horrific, however, once I was approved and had the cards in hand, I never had another problem with the insurance.  It paid well, it paid on time, and all my doctors were approved providers.  Even my medications were reasonable and at that time I took a lot of them.  Oh and by the way, just for the purpose of humor, that check I wrote and supposedly they never received was sent back to me about a year later…lol.

I am happy to report that since being approved for PCIP, my health has improved greatly.  If you want to read my story about my slide into chronic illness you can do so here:  https://progressiveandproud.wordpress.com/2013/09/30/obamacare-the-health-insurance-that-saved-my-life/.  Suffice it to say, sometimes the best things in life aren’t easy, but that doesn’t mean they are not worth it.  If you are one of those people having trouble getting signed up through your state or federal exchange for health insurance, don’t give up and don’t give in.  These problems will be solved.  There are many officials like the one who finally helped me out there, who believe in this program and will do whatever it takes to help people get signed up for the exchange.  Remember it took me a few months, but the pay-off has been incredible.  Because of PCIP today, I have more quality of life than I had in the previous ten years.  Stay strong and keep on trying.

About the Authors: By: Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO and Lynne Smith, MSSW. Barbara is an industrial engineer with an MBA. She worked in the pharmaceutical industry for many years before moving into the healthcare industry where she had a company where she provided top quality coding, compliance and revenue cycle management services for physicians. She has since moved into full time consulting for physicians. Barbara is a nationally known expert known for her education, consulting and expert witness services. Lynne has dedicated her career to helping others. She has experience as a social worker in a rural county, an administrator in a large hospital network and as a College Professor. She uses the skills she developed over the years as an advocate in a variety of areas including her most recent venture serving as a Healthcare Advocate. Together, Lynne and Barbara own the ACA Healthcare Advocates consulting firm and are available to individuals, families and businesses to help them meet the requirements of the Affordable Care Act in order to meet the specific needs of the client while optimizing the fiscal considerations.  Please direct your questions and/or inquiries to askcobuzzi@gmail.com.

The Medical Device Tax: A Burden or a Blessing? You decide!

What is the Medical Device Tax?  Why there is such a battle to remove it as a revenue source of The Affordable Care Act (ACA) and/or Obamacare?  The Medical Device Tax has become one of the primary centerpieces of “what is wrong about ACA” for the Republicans.  Republicans advocated for removing this tax because it would be a burden on the American people and on the Medical Device manufacturers.  Looking at the history of revenues for new programs, the financial picture of Medical Device Manufacturers, and the process of determining how to pay for ACA/Obamacare will be reviewed to help the reader determine whether the tax is reasonable or a burden for the taxpayer and medical device manufacturers.

As lawmakers in Congress and the White House were developing the ACA/Obamacare, major healthcare industry players, including but not limited to the pharmaceutical industry, hospital industry, and healthcare insurance industry, were invited to participate in the process and offer suggestions about how the law could best be paid for.  Most of the industries contributed some revenue ideas to help fund the law, negotiated others and finally compromise on a plan and agreements were made on how the ACA/Obamacare would be funded.  However, one health care industry, The Medical Device Industry, appears to have refused to make suggestions, offer possible revenues, or suggested how they could contribute to the process of funding this law. (http://www.politico.com/story/2013/10/medical-device-tax-obamacare-affordable-care-act-government-shutdown-debt-ceiling-talks-98367.html)  Instead they suggested other industry players be the sources of revenue.  The medical device industry never offered any contribution in order to provide health insurance coverage to the 40-50 million uninsured Americans.

What is important to understand is that the Medical device industry is an exceptionally profitable industry.  It includes not only the manufacture of artificial knees and hips, but also CT and MRI equipment made by companies like GE and Seimans.   Recently on the news, it was reported that an artificial hip, just the hardware for it is manufactured for about $350.00 and sold for over $10,000.00. (http://www.motherjones.com/kevin-drum/2013/08/artificial-hip-cost-markup-healthcare) The patient may pay in excess of $20,000.00 for the surgery.  This represents an approximate 900% mark-up on the device alone.

After discussions and negotiations with industry leaders a “forced tax”, of 4.6% was levied, since the Medical Device industry was the only industry player to not offer a contribution to funding the Affordable Care Act. (Resource)  The planned contribution was an estimated $40 billion over 10 years.  This tax was cut in half from 4.6% to 2.3%, and the expected contribution was dropped to $20 billion.  But the industry’s profits have spiked recently, so the revised estimated ACA contribution from this tax is now $30 billion over 10 years due to the industry’s increased profitability. (http://www.politico.com/story/2013/10/medical-device-tax-obamacare-affordable-care-act-government-shutdown-debt-ceiling-talks-98367.html )

On the one hand the medical device industry was complaining about the $30 billion price tag, the industry invested $30 million a year to lobby congress in order to get this tax removed.   They spent in one year of lobbying, the cost to them for the ACA over 10 years.  Think about it, if 2.3% of profits over the next 10 years is $30 billion, that means that the medical device industry’s profits over the next 10 years is $1.3 trillion dollars, or on average, $130 billion a year. (http://www.nytimes.com/2013/10/17/opinion/the-myth-of-the-medical-device-tax.html?src=me&ref=general&_r=0)

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If Congress and the President agree to remove the Medical Device Tax, the $30 billion lost to complete the funding of the ACA Law will have to be made up in another area.    What is your opinion?  We would like to know.  Should new programs have a plan to pay for them attached to the law?  Should the Medical Device Industry be given a pass and not have to contribute to the funding of ACA/Obamacare? What are your ideas on funding ACA?  How do you think they will find that $30 billion?  Do you think we should raise taxes on the wealthy?  Do you think we should reduce services and benefits for the poor?  Fill out our poll!  Leave your comments as to what you think should be done with the Medical Device Tax, should it be repealed and if you think it should be repealed, where do you see Congress getting the lost $30 billion?  We will publish the results of our poll on October 25, 2013.

Concessions Requested by Republicans for ACA: Do They Pass The Truth Test?

While Republicans are playing a game of chicken with the Democrats,  that may mean America will not be able to pay their bills, they have once again tried to pull the “wool over the eyes” of the American people with two new myths about the Affordable Care Act. These myths are at the center of the debate of keeping the government shut down as well as whether to default on our debt.  The House Republicans refuse to sign a clean Continuing Resolution which would insure our government is reopened and more important we do not default on our debts. As many of you know, most of the time when we write a blog, we go through a long process of verifying the information we put in this blog stating the source so anyone can re-check the facts.  However, in order to get you information in real time, today we are simply going to  tell you the issues the Republicans have indicated are “bad for the public”, worthy of keeping the government closed and possibly defaulting on the country’s debt to “save the American people” from  ACA law and then counter these issues with the truth.  There will be no rhetoric.  The information contained in this blog is just the facts. As author’s of this blog, we recognize changes need to be made to ACA, however these are minor changes and easily fixed by the Congress or administrative modifications, if they just do their job, instead of playing politics with the well-being of the American public.  The Republicans, especially those in the Tea Party, are reporting to the American people that  they are trying to “save them” from the Affordable Care Act.  That is simply untrue, rather they are trying to “save face” and be able to say they won out against big government and out of control spending.  Being correct on the ACA is very important to them, even though, polls indicate the Congressional Republicans approval rating is less than 5%.  The Republican stubborness reminds me of the last election when these same Republicans, supported by FOX news denied that President Obama was elected.  They were sure, that their polls were correct, stating Nate Silver’s 535 predictions were wrong and numbers coming from the voting precincts along with the pundits who declared President Obama the “winner” were just plain wrong.  Of course, in the end the polls cited by the Republicans were wrong and President Obama was re-elected. However, this proved just how out of touch these Republicans are with the reality of how Americans feel in this country.  Now, they are exhibiting the same denial of truth, as moderate Republicans and Speaker Boehner are over-ruled by about 40 members, primarily of the Tea Party  who seem to care very little about the impact shutting our government down and/or defaulting on our debt could have on the American people and the world economy. The two newly reported major myths being spread by the Republicans, in a desperate attempt to have some concessions, surround verifying a person’s income  to “make sure” they are eligible for subsidies and/or cost sharing, as well as forcing ONLY members of Congress to buy insurance from the exchange, effectively exempting their staff from participating. While they are manipulating the data with regard to many issues, what they are saying about the ACA, in this case, is simply categorically untrue.  Let’s begin with the issue of verifying income.  As one of the writer’s of this blog, I can assure you from personal experience that income is verified when applying for coverage through the healthcare.gov website. I have recently finished signing up for a policy through the health care exchange and my income was verified immediately within the process.  In fact, during the sign-up process, I was asked to project what income I thought I would have in 2014,  Now, based on recent information, I have determined my income in 2014 will be greater than it was in 2012.  So, I declared what my best guess is of what my income will be and clicked on enter.  After a small waiting period, I received a message indicating that my stated anticipated income did not match income previously declared on my tax returns.  I was asked to review my information and then asked again if this was my anticipated income for 2014.  I clicked yes, and received a message, that I needed to submit documents to verify my income.  Now, in my case, I could submit a written document by me describing why my income would be increasing.  I was offered many choices on how to verify income, including pay stubs, prior tax returns, etc.  While I was able to continue in the enrollment process and see what subsidies and cost-sharing if any, I was entitled to, based on the income I submitted, I had to electronically agree that the information I was giving was true and correct to the best of my belief and indicate I understood I had to submit documented evidence prior to a certain date to actually get the insurance.  The exchanges do verify income.  This has been a part of the Affordable Care Act from the beginning.  Any information to suggest otherwise is simply false.   Why are the Republicans making this demand about insuring people are truthful about their anticipated income suddenly?  It is part of the same tired strategy and stereotype they have used to demean and embarrass anyone who participate in what they perceive is an entitlement program.  They are trying to make people believe that by nature, Americans will lie about their income and be “given” a handout by the federal government in the form of undeserved subsidies and/or cost sharing. Americans, who would accept a tax incentive or subsidy must be a “shady” kind of person.  Remember. these are also the folks who say millions of people apply for food stamps when they aren’t “truly” needy.  The studies show however that less than three percent of food stamp recipients lie in order to get food stamps. They also ignore the fact, that not only do people have to verify their income at the time of application, but also have to electronically sign a document indicating they know that if their income is proven to be greater in 2014 than stated on their application, they will be liable to return the money on their tax return when they file in April of 2015. Income is verified then at two points, both prior to obtaining insurance and on their 2014 (filed 4/2015) tax return to validate they told the truth on their application. This is simply another untruth promoted by the Republicans to make ACA is a “hot button” issue. The second issue that the Republicans are “taking a stand” on involves whether they and their staff should enroll in the federal exchange.  Initially, they tried saying Congress was exempt from the Affordable Care Act and that wasn’t fair to the average American.  They tried to make it seem as if they had been exempted from a “terrible program”. First of all, Congress and their Staff receive their insurance via the federal employee health insurance group.  Anyone reviving their health insurance from a large employer are not allowed to shop for insurance in the exchanges.  So, by design, Congress and their Staff should not be eligible to get their insurance in the ACA exchanges. While the ACA was in bill form, Senator Grassley (R) submitted an amendment that would require Congress and their staff to be receive their health insurance from the ACA federal exchange like all individuals, families, and smaller businesses in this country.  According to some Republicans he added this amendment as a “poison pill”, thinking that it would cause the bill to not be passed even by its supporters in Congress.  To Senator Grassley’s surprise, the ACA bill passed and became a law, with the Grassley amendment, meaning that all of Congress and their staff would receive their insurance via the ACA exchanges.  So, because of the Grassley Amendment, Congressional Republicans found themselves in the position of having to use the federal health exchange.  However, the executive branch and their staff will continue getting their employer sponsored insurance and rightly so because ACA was passed to insure people with out insurance, those who could not afford insurance, those who had pre-existing illnesses and young adults under the age of 26 would have a cost effective means of  obtaining insurance. Since the inception of the Affordable Care Act, Congress and their staff have known they would  be required to be a part of the exchange beginning in 2014.  In fact, over the past two years, the Government Insurance Health Administration (GIHA) has coordinated the Pre-Existing Condition Insurance Plan (PCIP), that provided insurance to thousands of people, like me, with pre-existing conditions beginning in 2011.  However, the Affordable Care Act is not perfect and there are things that should have been “tweaked” in terms of the law.  One of the tweaks needed involved how members of Congress and their staff, would be able to use their “employer contribution” when purchasing plans.  In the last two years, Republicans in the Congress have flat out refused to fix any issues associated with ACA, instead they appealed the law to the Supreme Court and made over 44 attempts to repeal or defund the law in Congress.  In response to Republicans continuous refusal to “tweak” the bill, President Obama signed an executive order indicating that all federal employees who were staff members or Congressman could use their “employer” contribution to pay for all or part of their insurance through the federal health exchange and still be eligible for subsidies and cost-sharing. In a move that is so hypocritical, it is hard to believe, the Tea Party specifically, and Congressional Republicans have added the Vitter amendment to the Continuing Resolution which will take away the employer contribution to the healthcare plan for all of congress and their staffs.   This represents a income reduction for everyone in Congress as well as their staff.  This does not effect the actual members of Congress to a great degree because due to their salary, they will not be eligible for tax incentives or cost-sharing.  But their staff, is a different story.  Staff members may earn  $40,000 to as high as $175,000 per year.  Taking away the employee benefit which pays for part of their healthcare insurance premium from these employees is simply unfair.  They should not be used as a political pawn just to prove a point by Congressional Republicans.  They are punishing the very people who help them do their job.  Why would they take away the possibility of their own staff members or others who work in the Capital from getting subsidies or cost sharing?  It makes absolutely no sense.  They are not doing the right thing and protecting their employees.  In essence, they are denying them tax cuts or tax incentives that everyone else in the country in the exchanges receive.  The Republicans proclaims that they want more money going to the average American and yet, they want to deny their staffs  the ability to get health insurance for less money so they can say they got a “concession” and declare victory to their constituents.  This is just plain cruel and clearly supports that these Republicans care very little about the people around them or their constituents. A third issue that is being considered in closing a deal to re-open the government and increase the debt limit is to remove the medical device tax.  Again this is being considered as a concession to the Republicans and the Tea Party.  The Medical Device Tax is one source of funding the ACA and removing this tax will require congress to find alternative funding.  The reason there is so much pressure to remove this tax is because the medical device manufactures (ie: GE, Seimons, J&J, etc) have been spending millions of dollars lobbying congress to remove this tax.  So you understand, this is a tax on the artificial hip that costs $350 to manufacture and ultimately costs over $30,000.  The margins in these products are huge and they can well afford this tax. Many of these companies do not pay any income taxes currently (ie: GE) because of tax loopholes.  Removal of this medical device tax will cause us to have to pay for it somewhere else. Watch our blog and we will let you know they want to replace these funds. Once again we have proven that the “concessions”  or major issues associated with ACA are manipulations and/or just plain lies being spread by the Republicans in Congress.  If Republicans and/or Tea Party Republicans were educated about ACA, and they should be because that is their responsibility and their job, they would know one of their “demands” may actually financially harm members of their own staff and the other demand to verify income is already a part of the law.   That is why we have decided to award Republican members of Congress and specifically the Tea Party our first “stupid and you know it” award. Call your Representative and Senators today and tell them to stop these ridiculous demands.  Let them know you are educated about the issues and you want truth as opposed to dishonest rhetoric.They need to re-open the government and not allow the United States to default on it’s debt  for their own political gain. About the Authors: By: Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO and Lynne Smith, MSSW. Barbara is an industrial engineer with an MBA. She worked in the pharmaceutical industry for many years before moving into the healthcare industry where she had a company where she provided top quality coding, compliance and revenue cycle management services for physicians. She has since moved into full time consulting for physicians. Barbara is a nationally known expert known for her education, consulting and expert witness services. Lynne has dedicated her career to helping others. She has experience as a social worker in a rural county, an administrator in a large hospital network and as a College Professor. She uses the skills she developed over the years as an advocate in a variety of areas including her most recent venture serving as a Healthcare Advocate. Together, Lynne and Barbara own the ACA Healthcare Advocates consulting firm and are available to individuals, families and businesses to help them meet the requirements of the Affordable Care Act in order to meet the specific needs of the client while optimizing the fiscal considerations.  Please direct your questions and/or inquiries to askcobuzzi@gmail.com.