Kaiser Family Foundation Annual ACA Survey

Posted on May 20th, 2016 By Michael Suhany

The Kaiser Family Foundation Annual ACA Survey of those who have purchased individual health insurance coverage under the Affordable Care Act has just been released.  The results reflect the experiences and perceptions of those who obtained or renewed individual coverage under the ACA during the open enrollment for plans for 2016.  These experiences and perceptions are compared with those of enrollees in the individual market for the previous two years as well as with those who have coverage through an employer-sponsored Group Health Plan.  There are two items in the survey worth pointing out. (more…)

Marco Rubio Likes Barack Obama’s Ideas on Healthcare

Posted on March 4th, 2016 By Michael Suhany

Marco Rubio states on his campaign web site that he is opposed to and wants to repeal and replace the Affordable Care Act.  His web site offers an overview of his vision for healthcare reform.  But how different are his proposals from what is currently happening under the Affordable Care Act?

Marco Rubio’s Healthcare Reform Proposals

Marco Rubio states that his healthcare reform proposal will “Expand access to affordable, quality health coverage by providing every American with an advanceable, refundable tax credit that can be used to purchase insurance.”  Such a proposal recognizes that everyone having health insurance is a social good, but that people can sometimes lack motivation to obtain or be unable to afford coverage.  This proposal attempts to use the tax code to address this problem.  Presumably, someone who refuses to obtain coverage would forfeit their tax credit and would thus be motivated to purchase insurance.  The tax credit would also make coverage affordable for those who could not otherwise be able to pay for coverage.

Further, Marco Rubio states that his plan will “Reduce health care costs, promote innovation, and ensure access for the most vulnerable by expanding access to consumer-centered health plans, reforming insurance regulations, and putting protections in place to ensure those with pre-existing health conditions can get access to affordable coverage.”  This proposal covers quite a bit of territory.  The most significant element concerns those with pre-existing health conditions and the desire to ensure that those who have these conditions can get affordable health insurance.  This requires that insurance companies accept these people who are at higher risk of incurring claims and that they spread this risk out to healthy people in the form of increased premiums.

Third, Marco Rubio says that his plan will “Promote innovation in the Medicaid program by giving states a per-capita block grant, which preserves funding for Medicaid’s unique populations while freeing states from Washington mandates.”  This proposal recognizes that being on Medicaid can be a miserable experience of bureaucrats making eligibility determinations, administrators making coverage decisions, and difficulty in finding providers who will take Medicaid’s diminished reimbursements. (more…)

Donald Trump – Will His Healthcare Reform Plan Work?

Posted on March 3rd, 2016 By Michael Suhany

Donald Trump – Will His Healthcare Reform Plan Work?

Donald Trump has released his healthcare reform plan on his campaign web site.  He calls on Congress to make seven specific changes in the laws that he will presumably sign if he is elected the next President.  What are the proposals?  What do they really mean for the marketplace and the consumer?  Will his healthcare reform plan work?

1. Completely Repeal Obamacare Including the Individual Mandate

Donald Trump calls for the repeal of Obamacare in general and specifically the Individual Mandate.  The Individual Mandate is the requirement under the Affordable Care Act that almost everyone must either demonstrate that they have health insurance or face a penalty when they file their taxes.  The Individual Mandate is certainly one of the least popular features of the Affordable Care Act, but what else would happen if the Individual Mandate went away?

If the Affordable Care Act were to be repealed and the Individual Mandate as well, the insurance market would have to return to much the same state it was before the implementation of the law.  Insurance companies would once again ask medical questions of their applicants.  People could be denied coverage or charged higher premiums because of their medical conditions.  Pre-existing conditions could be excluded.  Affordability would once again be a major concern as insurance premiums would be no lower than 2013 levels and the tax credits under the Affordable Care Act would go away.

If most of the Affordable Care Act were to remain intact but the Individual Mandate were to be removed, then insurance companies would be faced with leaving the market altogether for inability to stay solvent or further increase premiums to make up for the fact that healthy people formerly purchasing insurance and paying premiums would no longer keep their policies. (more…)

My Response to Anthem Suspending Payment of Commissions

Posted on February 3rd, 2016 By Michael Suhany

Anthem Blue Cross and Blue Shield has announced that they are suspending payment of commissions on individual and family policies issued under the Affordable Care Act with effective dates between April 1st and December 31st.  In order to obtain a policy with an effective date within this range, a person must have a qualifying event that generates a Special Enrollment Period.

In my opinion, the reason that Anthem is taking this step is because they want to discourage the purchasing of their policies by individuals and families that have a Special Enrollment Period.  Such an action would be premised on the belief that the cohort of policyholders who come onto Anthem’s book via a Special Enrollment Period represents unfair or unacceptable risk.

Conceding that the current system provides no effective policing as to whether individuals and families truly qualify for a Special Enrollment Period and that many consumers are using this as their opportunity to wait until they need coverage to apply, Anthem’s action in suspending payment of commissions is still misdirected.  This action hurts their most valuable distribution channels while not addressing the root of the problem.

(more…)

Is it Impossible to Retire Early Because of Health Insurance?

Posted on January 22nd, 2016 By Michael Suhany

A recent article in the Indianapolis Star by Pete the Planner painted a dark picture of the possibility of early retirement because of the cost of health insurance.  While it is true that early retirement is a significant decision requiring careful planning, the situation is not as desperate as the article makes it sound.

Before the implementation of the Affordable Care Act, only healthy people could even consider early retirement unless they worked for a major corporation that offered retiree coverage.  With the guaranteed issue of coverage under the Affordable Care Act, even those with significant medical conditions can retire and obtain their own health insurance.

With regard to cost, the situation is also not so dire as the article suggests.  Since qualification for the Advanced Premium Tax Credit is based largely on taxable income and not assets, it is possible for many individuals and couples who have accumulated a nest egg for retirement to qualify for the APTC and get their monthly premium down well within their budgets.

If someone is considering early retirement, they need to consult with a qualified financial planner to map out an overall strategy.  They also need to consult with a local health insurance professional to map out a specific strategy with regard to the cost of their healthcare.  If health insurance is all that is standing between you and retirement, give me a call.

What Happens if You Don’t Have Health Insurance in 2016?

Posted on January 20th, 2016 By Michael Suhany

What happens if you don’t have health insurance in 2016?  An article from The Motley Fool provides a pretty good answer to this question.  The article does bury the lead, however.  The very worst thing that can happen to you if you don’t have health insurance is that you may experience a significant illness or injury and receive less medical care than you otherwise would because you lack the ability to pay.  After that follows the massive bills that you will have to pay for the care you did receive.

Open enrollment for 2016 ends on January 31st.  It would be a shame to be without coverage when it could have been so affordable.  Want to estimate your tax credits or tax penalty for 2016?  Want to find out the cost of plans that are available to you?  Follow the link and you can even start the process of shopping for insurance  by providing me with all of the information I will need to find the best plan for you.