Monthly Archives: November 2013

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

So many people, including news organizations, political groups and in fact anyone with a vested interest in maintaining the status quo as it existed before the ACA, have been blaming President Obama for “lying” about being able to keep their insurance plans , especially since the rash of cancellation letters forthcoming from the insurance companies. Well, guess what? We have evidence that completely proves Obama’s statements about being able to keep your health insurance if you wanted to were true!

The evidence comes directly from the ACA Law and the Federal Register, indisputable and irrefutable evidence that President Obama told the truth about the law. Under the provisions of the ACA people could keep any insurance policy in effect when the law was signed on March 23, 2010, including their “Junk” healthcare policies, by virtue of the “grandfathering in” provisions contained in the ACA. But the insurance companies decided on their own to bypass this option, cancel existing policies and try to sell more expensive plans instead, plans that would not provide subsidies and cost shares.

Read more and link to the proof directly from the ACA Law and the Government’s implementation. This fully sourced Blog will show you that no one had all the facts straight, no one! Continue reading in the “Let’s Talk Facts not Rhetoric” Blog at www.bit.ly/1b24GJH

Note: The material at the link is copyrighted, but can be shared with attribution. Please read and adhere to the Copyright notice at the end of the Blog.

ByBarbara 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

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 37th 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)

ByBarbara 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

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:

  • “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 AuthorsBarbara 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.