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Articles by Donald E. L. Johnson

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Today is Friday, April 18, 2014

States' Health Legislation

10 fixes for ObamaCare; Speaker Boehner has to get real

House Speaker John Boehner (R-OH) should include the 10 fixes for ObamaCare in the bill that he announced he will have the House vote on next week.

If the House bill doesn't include fixes for ObamaCare that are being demanded by both Republicans and Democrats, it's a political fraud.

1. Remove provisions that give DHHS the power to give special treatments to unions and other Obama Democrats, the power to dictate insurance premiums and premium increases and the power to manipulate health insurance benefit designs.

2. Remove provisions that are causing employers to shorten work weeks to less than 30 hours and keep their payrolls under 50 people.

3. Remove mandated benefits that make ObamaCare plans unaffordable for all but those who will be subsidized by the federal government.

4. Remove the "death panels" that will decide without political review what will be covered and what won't be under ObamaCare.

5. Ban state laws that will make it unlawful for small and large companies and unions' Taft Hartley plans to self insure and buy stop loss reinsurance.

6. Remove the corrupt IRS from the role of enforcing ObamaCare rules.

7. Remove all pork that makes ObamaCare a multi-trillion dollar loser. The real positive provisions in ObamaCare can be implemented for less than $20 billions, not trillions.

8. Remove all provisions that fund immoral, unethical and dishonest government promotions of ObamaCare to clueless consumers.

9. Remove funding for worthless wellness and preventive care programs.

10. Remove the 37 new government agencies that are created under ObamaCare.

Keep health care providers out of the health insurance business

The Wall Street Journal reports that some health care systems are getting into the health insurance business.

Gosh, how history repeats itself. Back in the 80s and 90s, several so-called "integrated" health systems got burned in the health insurance business. They didn't have insurance expertise, financial resources, market clout or credibility with individuals, employers or regulators. So most failed.

Hospitals and docs created Blue Cross and Blue Shield back in the 30s to make sure that they got paid the way they wanted to be paid, patients and payers be damned. That scam worked for decades until Medicare/Medicaid and smarter employers came along and forced the Blues to work for the payers instead of the providers.

If hospital systems try to compete with national health insurers, they'll lose the price wars even if they are the providers. This is because the national insurers have the financial and political resources and the market share that will allow them to crush the providers' plans whenever they decide to do that.

Over the last 35 to 40 years, too many hospital administrators have gotten their institutions into businesses that they knew little about, and they cost those institutions millions. Or, I should say, they ran up huge losses that they recovered by over-charging insurers and self-insured patients.

Most health care administrators are too smart to get into the insurance business. But their medical staffs get frustrated with insurers and demand that the hospital systems go into the health insurance, medical supply, group purchasing or whatever business the docs think will help them become richer.

Any board of directors that lets its CEO take it into what will be a money-losing, over-regulated business such as health insurance strikes me as being either incompetent, manipulated, self serving and/or all of the above.

State and federal legislators and regulators should not only outlaw health care providers from getting into the health insurance business, they also should enact anti-trust laws that break up the big regional and national health care chains and insurers.

State Rep. Cindy Acree has agenda for improving Medicaid

Since Medicaid was created in 1965, politicians have been trying to "fix" Medicaid, the Federal and States program that pays for health care for mostly women and children in poverty. 

Richard Epstein: States may prevail against ObamaCare Medicaid expansion

The 13 state attorney generals who are suing to overturn ObamaCare’s coercive Medicaid expansion that would cost states billions may be affirmed by the U.S. Supreme Court, according to University of Chicago law professor, Richard A. Epstein. Impact graph:

In Massachusetts v. EPA—the notorious 2007 decision allowing the EPA to treat carbon dioxide as a pollutant—the Supreme Court recognized that the state had standing to sue to protect its own coastline from the supposed ravages of excess CO2. The Supreme Court should likewise also recognize a state’s standing to sue when the federal government seeks to command its resources to serve federal objectives. In New York v. United States (1992), the Court prevented the U.S. from forcing states to take title to nuclear waste. It can surely prevent the federal government from mandating massive expenditures of scarce state resources.

Under the Constitution the states are not wards of the federal government. Clever federal tax and spending statutes must not be allowed to reduce states to a servile status that allows the federal government to force massive wealth shifts among them.

Providers are trying to keep health insurance premiums high by protecting expensive mandates

In Colorado, state laws that mandate that health insurers cover services offered by numerous alternative care providers increase the cost of health insurance by some 50%. These mandates generally are backed by the providers who profit from them and by disease-specific advocacy groups that don’t care that they’re making health insurance unaffordable for millions.

The health insurance reforms in the bill before the Senate (HR 3590) would allow 

Public option dead: Will Michael Bennet, Ed Perlmutter defend Colorado against Medicaid expansion?

House Democrats have found they don’t have the votes to pass a health insurance deform bill with a “robust” public option HMO/PPO, and now they’re talking about expanding the number of people who would be eligible for Medicaid benefits.

Unless Sen. Michael Bennet (D-CO) and Rep. Ed Perlmutter (D-CO CD 7) defend Colorado’s budget the way Senate Majority Leader Harry Reid (D-NV) and Sen. Chuck Schumer (D-NY) are defending their states with special favors, Colorado’s taxpayers will pay big time for an expansion of Medicaid benefits by Congress. Colorado and the federal government share the cost of Medicaid, which has been bloating states’ budgets for years.

Martin Vaughan at’s impact graphs:

Rep. Mike Coffman’s town hall: won’t support HR 3200; wants Congress to deal with jobs, economy

Rep. Mike Coffman (R-CO, CD-6) met in Conifer with more than 30 constituents. His summary of the most pressing issues before Congress and questions and answers that followed are below. Click on the headline.


Speculators are giving ObamaCare’s public option a 13.7% chance of passing

Speculators on the futures market are giving the public option health plan (government HMO, Fannie Med) only a 13.7% chance of enactment by January, down from over 30% only a few days ago.

Intrade shows 13.7% bid, 15% ask and 15% last trade. This means the sellers of the contract have caved to the buyers who don’t think there is much of a chance of enactment but are willing to take a flyer at the current price. Technically, the chart on the market is signaling “sell,” which means that buying the contract is very risky at this point.

In other words, folks who are following the ObamaCare debates and feel that they know enough about the politics of ObamaCare are willing to put up their money on the short side of the market more than on the buy side. Once optimistic buyers are demoralized, and, basically, at the moment, aren’t willing to bet that the public option will be part of ObamaCare.


Health Care Reform - Will a federal government run health

Democrats angry about new insurance industry report; states will lose power

Congressional Democrats are planning to retaliate against health insurers because they released a damaging report on the cost of the Senate Finance Committee bill on Monday, one day before the committee approved its version, according to Politico.

Instead of focusing on reforming health insurance markets, Congressional leaders are working on a repeal of an exemption of health insurers from anti-trust legislation. That anti-trust legislation gives states control over their health insurance markets and somewhat limits the Federal government’s powers to regulate these markets.

So, it appears that removal of the anti-trust exemption would be more than a slap back at health insurers.

It would be another component of the power grab, which is what ObamaCare has been about since day one.

The Feds would take power from the states, most of which have mismanaged their health insurance regulations for decades.

That certainly is true in Colorado, where too many mandates increase the cost of health insurance by up to 50%.

The insurance industry’s report is being called controversial only because it makes everything the Democrats are promising look undoable and wrong, which it is.

Impact graphs from the report:

There are four provisions included in the Senate Finance Committee proposal that could increase private health insurance premiums above the levels projected under current law:
o Insurance market reforms coupled with a weak coverage requirement, o A new tax on high-cost health care plans, o Cost-shifting as a result of cuts to Medicare, and o New taxes on several health care sectors.
␣ The overall impact of these provisions will be to increase the cost of private insurance coverage for individuals, families, and businesses above what these costs would be in the absence of reform.
␣ On average, the cost of private health insurance coverage will increase: o 26 percent between 2009 and 2013 under the current system and by 40 percent
during this same period if these four provisions are implemented.
o 50 percent between 2009 and 2016 under the current system and by 73 percent during this same period if these four provisions are implemented.
o 79 percent between 2009 and 2019 under the current system and by 111 percent during this same period if these four provisions are implemented.

In other words, as I’ve warned many times, when Congress reforms health care and health insurance markets, it makes them more expensive and dysfunctional.

And the Senate Finance Committee’s bill, which is expected to be made even more dysfunctional when it hits the Senate floor and a House-Senate conference committee will replace Medicare and Medicaid as the worst social program enacted in the last 60 years.

Democrats, of course, can demonize the report by PricewaterhouseCoopers because it was commissioned and released by the trade association for health insurers, America’s Health Insurance Plans (AHIP).


Democrats launch attack on insurer exemption

Potential Impact of Health Reform on the Cost of Private Health Insurance Coverage

Mandated health benefits in Colorado increase the cost of health insurance up to 50%. The Business Word.

America’s Health Insurance Plans.


Congress must set rules for selling health insurance across state lines, McInnis says

Republican gubernatorial candidate Scott McInnis said in an interview Friday that he supports making it possible for health insurance across state lines, but the former Congressman and state legislator warned that Congress must pass health reforms that create uniform regulations in all of the states.

I asked:


Mandated health benefits in Colorado increase the cost of health insurance up to 50%

Colorado laws mandate that health insurers cover 51 preventive and alternative health care services and providers.  Nationally, the 50 states and Washington, DC, have 2,133 health benefit mandates on their books.  Each mandated benefit increases Colorado’s health insurance premiums by less than 1% to between 5% and 10%, according to a compilation and actuarial calculations by the Council for Affordable Health Insurance (CAHI). These mandates apply to health insurance purchased by small employers and individuals who buy non group policies. Large, multi-state employers are not affected because they are governed by federal laws and regulations, specifically the Employe Retirement Income Security Act of 1974 (ERISA).  Among expensive services that Colorado mandates insurers cover and the amount they add to insurance premiums:

Letting health insurers sell across state lines is not the easy answer

Conservatives and Republicans (there is a difference) repeatedly hammer home the message that the way to reform health insurance regulations is to let insurers sell across state lines.

The argument is that this would let insurers avoid the benefit mandates that high cost states impose on insurers and insurance buyers. And they rightly blame the states’ politicians for the mandates. But it’s not just the states’ politicians who have made health insurance so unaffordable for millions of Americans.

Blame the providers who profit from states’ mandates for the expensive premiums in those states. If the mandates were reduced or eliminated, premiums would be 30% lower.

What the WSJ doesn’t say in its editorial today (see link below) is that

Questions on health insurance reform for Congressional Budget Office

I"ve sent this e-mail to my Senators and Rep. Mike Coffman (R-CO).

Just to get another view of the health options, please ask the CBO for a report that answers these questions:

Estimate the 5, 10 and 15 year costs increases or cost savings for the government if each health insurer were required to community rate all of its insureds by Metropolitan area or state with a minimum enrollment after a set period in business of 50k to 100k per risk pool, assuming that individuals would be required to buy catastrophic policies with no lifetime coverage caps and no or means tested tax incentives?

On Medicare, what would be the savings/costs if benefits covered only financially catastrophic (including chronic) illnesses using community rating, means tested premiums and tax deductions for out-of-pocket expenditures for prescription drugs, medical devices, office visits and wellness care?

On Medicaid, what would happen to state and federal budgets if it were federalized, benefits covered only financially catastrophic illnesses (chronic and long-term) and substantial tax benefits were granted to philanthropists who funded low-cost or free community health clinics for Medicaid enrollees only, not including illegal immigrants?

Assume no government-run health plans for the privately insured. And assume insurers would be required to update their rates and contracts on the Internet daily. Assume insurers could sell policies with no state mandated coverage of preventive, wellness or alternative health care services.


Colorado’s HB 1355 returns state to modified community rating on health insurance

Last month Gov. Bill Ritter signed HB1355, which returns modified community rating of small health insurance groups to Colorado. The bill reverses the Republican’s 2003 bill, HB 1164, which killed modified community rating at the behest of health insurers and in the face of opposition by small employers.

The GOP became the anti-small business party in Colorado after it passed the 2003 bill. And that among other things helped turn the state over to the Democrats. Now the Democrats are the pro-small business party when it comes to health insurance market regulation, at least as far as this issue is concerned.

The reason HB 1355 is pro small business is simple. I’m guessing more than a small majority of small businesses are owned by people over 40 and 50. They will benefit from the bill.

Having had people with all kinds of serious illnesses work for me as well as near seniors and seniors, I can tell you that your group can go from being healthy to unhealthy in a doctor’s appointment.

Sooner or later, all groups become unhealthy. And all groups will benefit from modified community rating. This bill makes the health insurers more honest and spreads risk among everyone.

Now we have a true health insurance market instead of one distorted by insurers’ cherry picking.

We all get sick, and we all need insurance when we face catastrophic illnesses and accidents.

Good for the Democrats and Governor Bill Ritter on this one.

Jeff Goldsmith offers good overview of health care reform debate, economics and politics

This is for people who have the time to read a long, thoughtful article and about 44 comments on the article.

Jeff Goldsmith has been a health care industry guru since he published his first article in the Harvard Business Review in the late 1970s.


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