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By gulfsouthb32553561, Jun 17 2019 02:10PM

The Trump administration unveiled this week a final rule that will dramatically improve workers’ ability to access health insurance of their choice.


The new rule will significantly expand the permitted uses of tax-advantaged health reimbursement accounts, or HRAs.


Today, these special employer-based accounts, in which funds can be rolled over year to year, are used by employees to cover medical expenses, including out-of-pocket costs and services uncovered by traditional insurance.


But with this rule, for the first time in the history of these tax-free accounts, the administration would allow employees to use them to pay premiums for individual health insurance.


The liberal Left continue to push their radical agenda against American values. The good news is there is a solution.


This change will not only expand health insurance coverage, but will also lower health care costs.


The rule is the product of the combined efforts of the U.S. departments of the Treasury, Health and Human Services, and Labor. It will take effect on Jan. 1, 2020.


A Big Change for Workers Whose Companies Don’t Offer Insurance


With this regulatory initiative, the Trump administration is making a major change in health care financing.


Employers who do not, or cannot, offer health insurance at the place of work, would henceforth be able to deposit tax-free funds into health reimbursement accounts on behalf of employees who wish to use those funds to buy health insurance plans in the individual insurance markets.


While announcing the final rule, administration officials said they expected that the new rule, within a five-year period, could encourage as many as 800,000 businesses to sponsor health reimbursement accounts to fund individual coverage for more than 11 million workers.


This change is a major component of the Trump administration’s efforts to repair Obamacare’s damage to the badly battered individual and small group health insurance markets.


Trump administration officials expect regulatory relief would be most beneficial to small business employers and their workers, a class of Americans hit particularly hard by the dramatic Obamacare premium and deductible increases in the small group market.


In recent years, there has been a serious decline in the number of small and mid-size firms offering their workers group health care coverage.


Not surprisingly, administration officials expect that most of the firms that will take advantage of the new rule will have fewer than 20 employers. The new rule thus holds potential to reverse the decline in health coverage among small business employees.


For current and future employers who already offer health reimbursement accounts alongside traditional group health insurance, the new rule would create an “excepted benefit HRA.”


It would allow employers to provide their workers an additional $1,800 yearly (indexed to inflation) in their health reimbursement accounts to reimburse them for certain medical expenses, including dental and vision benefits.


In the case where an employee would turn down the offer of a job-based health insurance plan, for one reason or another, this health reimbursement account funding could be used to offset employees’ premiums if they chose to instead buy a new short-term, limited duration health plan, which can be renewed for three years.


These plans have broad networks, and are much less expensive than the pricey Obamacare health plans.


Beyond the shrinkage of employer-sponsored coverage among small firms, there has also been little choice in terms of health care plans for small business employees.


Trump administration officials highlight data that shows that among small businesses (with fewer than 200 employees), 81% offered only one health plan. Among larger firms, with 200 or more workers, 42% of employers offered only one health plan. One choice is, of course, no choice.


The new health reimbursement accounts rule has the potential to rectify this problem, and expand employees’ choices well beyond the limited options they have today.


With this change, the Trump administration expects the individual health insurance market to grow significantly, and become more robust as an arena for health plan participation and competition.


This, of course, would partially reverse the disastrous decline in health plan choice and competition that has marked the last six years.


Creating a Fairer Tax Code


The greatest impact of the Trump administration’s change to the existing health reimbursement account regulations is the liberalization of the federal tax treatment of health insurance.


Under current law, employers and employees enjoy unlimited tax relief for the provision and purchase of health insurance—but if, and only if, that insurance is provided under the conventional umbrella of employer-sponsored group coverage.


For the many small businesses that cannot afford to offer such coverage, many workers and their families, deprived of any individual tax relief to offset their health insurance costs, face the dilemma of either buying inordinately expensive individual coverage on or off the Obamacare exchanges or going without any coverage at all.


By extending the federal tax advantages of traditional group health insurance coverage to health reimbursement accounts for the purchase of individual insurance, the Trump administration rule would give employers who do not, or cannot, offer job-based coverage the chance to help their workers and their families with their premium costs.


There is no cap on the employers’ tax-free contributions; they can give as much as they wish to help their workers.


The rule, in effect, allows for an employer-based defined contribution for health insurance, precisely the kind of financing mechanism that could spur a resurgence in consumer choice, personal ownership of portable health plans, increased plan participation, and robust competition in the nation’s health insurance markets.


However, administrative changes, no matter how beneficial, are no substitute for legislative solutions.


The Trump administration can make a rule change, and the next administration can just as easily unmake a rule change. Good, sound, and stable public policy can only be assured through congressional action. Transient regulation is no substitution for permanent law.


President Donald Trump is practicing addition, not subtraction by offering more options, not fewer.


The president has done what he can within the law to improve the market environment for personal health plan choice and competition. His actions will doubtless contribute to an increase in health insurance coverage.


Now, Congress needs to step up. First, Congress should codify the president’s rules in statute. Second, Congress should fix the nation’s badly broken health insurance markets.


The roadmap for that reform is the Health Care Choices Proposal, widely supported by a broad coalition of health policy analysts.


It would return most regulatory power over health insurance markets back to the states, guarantee financial help to the poor and the sick, and allow any person in a government health program to redirect their public funding to payment for a private or employer plan of their choice.


Americans need relief. They want lower costs and more choice. Trump’s team has taken a good step in that direction and Congress should follow suit.

By gulfsouthb32553561, May 28 2019 07:17PM

With the debate over health care heating up again, Medicare for All once more is a hot topic. Sen. Bernie Sanders, I-Vt., has sponsored a new version of his Senate bill that promises to free Americans from health care concerns.

But at the core of the Sanders bill is still the vast and fundamentally illiberal restriction on choice for both patients and providers.

One key provision of the bill would outlaw health care plans that duplicate coverage. Section 107 states bluntly that “it shall be unlawful for—(1) a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act.”

In other words, it will be expressly illegal for any private company or employer to provide health benefits that compete with the government.

The liberal Left continue to push their radical agenda against American values. The good news is there is a solution. Find out more >>

The Sanders bill, however, is gracious enough to allow insurers or employers to provide any benefit not covered in the legislation.

This provision to outlaw private plans that duplicate government coverage, allowing only the sale of supplemental plans, is similar to Canadian Medicare, which covers all Canadian citizens.

In Canada, approximately 30% of health care spending is private spending, with 12.4% coming from private insurers. The Canadian system, however, does not include dental, vision, and prescription drug coverage that is part of the Medicare for All package. The Sanders bill would leave almost no room for the private sector at all.

Where Canadian health care leaves significant room for private health care plans, Medicare for All would preclude a substantial amount of private coverage in America, leaving essentially cosmetic surgery and experimental drugs excluded by the secretary of the Department of Health and Human Services, per Section 203(b) of the bill.

Under this regime, the government would take near complete control over the 18% of gross domestic product that is health spending. Private spending, which amounts to about 45% of national health expenditures, would collapse.

If Medicare for All passes, you will not keep your health care plan. And you will not be able to find one if you so choose.

Proponents of Medicare for All would argue the loss in choice is a worthy trade-off, but they will have to countenance the government’s having the final say in health care choices between patient and provider.

Title II of Medicare for All gives the HHS secretary explicit authority to determine what items or services are “medically necessary or appropriate for maintenance of health.”

We already have seen the result of this in the United Kingdom’s National Health Service, which decided to cut or limit coverage for certain procedures in an effort to control costs. Although the NHS has deemed those procedures “unnecessary,” the decision to perform, for instance, a tonsillectomy should be decided in the clinic rather than by HHS.

It is theoretically possible to avoid that kind of government intrusion into an individual’s health choices. Enrollment as a patient in Medicare for All would not be necessary, although it would be automatic. Likewise, participation as a provider technically would be voluntary.

The problem is that the bill makes it virtually impossible to practice medicine without participating in the program.

Under Title III, nonparticipating providers could not bill the government for services offered under Medicare for All. And if the provider does furnish such a service, he or she would have to submit an affidavit affirming the service and could not participate in Medicare for All or treat anyone covered by it for a period of one year.

Thus, if a patient wants to avoid waiting for an appointment with a physician and contract with one privately, that physician either would have to renounce his participation in Medicare for All, which would cover practically everyone in the United States, or he already must have been practicing outside the program.

There likely would be a market for direct primary care physicians, otherwise known as concierge medicine doctors, but it is unrealistic to expect these services to be widely available to the average American.

In essence, we would see a two-tiered medical system: one for most Americans, and one for wealthy Americans. This is a common complaint in Canada, and one of the ways the Canadian Medical Association has suggested to address it is by contracting more with, interestingly, private providers.

Medicare for All would make it nearly impossible to practice medicine outside of participation in the program. Patients would have little other option than to accept the medical decisions of the HHS secretary.

Today, about half of the $3.5 trillion a year in American health care spending is direct government spending; the rest is private health spending, mostly directed by employers.

Medicare for All would cede that spending entirely to the government.

By gulfsouthb32553561, Apr 12 2019 07:10PM

Independent Vermont Sen. Bernie Sanders, a self-described “socialist,” is doubling down on his efforts to give federal officials total control over Americans’ health care.


The senator has just unveiled the Medicare for All Act of 2019 with 13 leading Senate Democrats, including fellow contenders for the 2020 Democratic presidential nomination: Sens. Cory Booker of New Jersey, Kirsten Gillibrand of New York, Kamala Harris of California, and Elizabeth Warren of Massachusetts.


Americans should find this bill chilling. If passed, it would essentially abolish all private health coverage in America, regardless of whether Americans like their current plans.


Here are the specifics.


Outlawing Current Coverage


This bill, title by title and section by section, is almost identical in substance to the Medicare for All Act of 2017 (S.1804) introduced last Congress.


Under Title I, the bill would create a new national health insurance plan to provide universal coverage to all U.S. residents, regardless of their legal status. This new program would be phased in over a four-year period.


Under Section 107, the bill would outlaw private health coverage, including employer-sponsored coverage, that “duplicates” the coverage provided under the government health plan. Approximately 181 million Americans would lose their existing private coverage.


Like the earlier version, the new Senate bill would also abolish other federal health programs, including Medicare, Medicaid, the Children’s Health Insurance Program, Tricare, and the popular and successful Federal Employees Health Benefits Program. The tens of millions of Americans currently covered by these programs would also be involuntarily absorbed into the new government health program.


Under Title II, the bill would provide 13 categories of health benefits, including a new long-term care benefit. This is a richer benefit package than that contained in the earlier Sanders bill, which listed 10 categories of benefits. Also like the earlier bill, taxpayers would be compelled to fund abortion, and the bill would override current law that ensures conscience protections for medical professionals.


The new bill would also eliminate virtually all cost sharing, except for a limited out-of-pocket obligation for prescription drugs. This provision, of course, would induce increased demand for medical services and thus increase the overall costs of the program.


Under Title II, the bill would set forth detailed terms and conditions for the participation of doctors and other medical professionals in the government system, including the limiting conditions governing private contracts.


Under Section 303 of the new Senate bill, private contracts between doctors and patients would be discouraged. Doctors who choose to take private payment from patients outside the system would face a stiff penalty.


Under Section 303, the physician would have to sign an affidavit that he engaged in such a contract, submit it to the secretary of health and human services, and then forego all reimbursement from all other patients enrolled in the new federal entitlement for a period of one year. Few doctors, of course, would be able to do such a thing.


This is essentially the same policy embodied in the previous version of the Sanders legislation, and an even more restrictive version is embodied in the House bill (H.R. 1384).


This, along with the abolition of all insurance alternatives, would come as a striking restriction on patients’ personal liberty. Interactions with physicians are sometimes focused on highly sensitive matters, and patients might desire confidentiality and prefer not to submit a claim either to a government agency or even a private insurance company.


Then, of course, there is also the problem of getting access to specialized services. If the government plan, operating as a monopoly, does not or cannot offer you what you want or need, you would have no viable alternative under this legislation.


The Likely Consequences


If the Senate bill—or some version of it, such as the House Democratic bill—were to become law, ordinary Americans could surely expect three major consequences.


1. Slower care.


With a single government health program designed as an entitlement for 327 million Americans—providing services “free” at the point of service—utilization would explode. Americans would face long waiting lists, delays, and even denials of medical care. It would be unavoidable.


The experience of “single payer” countries, like Britain and Canada, shows that waiting lists for medical treatment are common, especially for hospitalization and specialized medical services.


2. Even fewer doctors available.


Today’s doctor shortage, fueled by accelerated retirements and physician burnout, would surely worsen. Beyond imposing Medicare’s huge regulatory regime and its paperwork burden on the entire nation, the Senate bill would impose Medicare payment rates (rates lower than private insurance) as the means to reduce reimbursement for all doctors, hospitals, and medical professionals. Former Medicare Trustee Charles Blahous estimates that this would translate into a stunning 40% decline in medical reimbursement.


While leftist ideologues might vigorously applaud such a radical reduction in physician payment as a major source of health care “savings,” the negative impact on patient access and quality of care would be incalculable.


3. Massive new taxation.


Curiously, the new Senate bill, like its predecessor, has no financing provisions. Instead, as with the last version, Sanders has offered a list of financing options that could be used to pay for this massive enterprise, including a 4% income-based premium, a 7.5% payroll tax, the elimination of all tax breaks for existing health insurance, and a series of taxes on wealthy citizens.


Independent analysts have concluded that such “options” would fall far short of covering the true costs of such a program, meaning that individuals and families would pay much higher taxes than the senator’s revenue proposals anticipate. Both the liberal Urban Institute and the conservative Mercatus Center projected that the earlier version of the Sanders’ plan would cost approximately $32 trillion over 10 years.


Those earlier projections are obsolete, because the senator has now added a costly long-term care program to the bill’s mandatory benefits package.


This is not a realistic way forward. Socialism is the wrong prescription for Americans who want quality, affordable health care.

By gulfsouthb32553561, Feb 19 2019 01:05PM

COMMENTARY BY

Portrait of Robert Moffit

Robert Moffit

Robert E. Moffit, Ph.D., a seasoned veteran of more than three decades in Washington policymaking, is a senior fellow in domestic policy studies at The Heritage Foundation.

Liberals in Congress are promising Americans that their “Medicare for All” proposals for government-controlled health care will expand access to care.

As Sen. Cory Booker, D-N.J., explains,“Obamacare was a first step in advancing this country, but I won’t rest until every American has a basic security that comes with having access to affordable health care.”

Likewise, Sen. Kamala Harris, the California Democrat, predicts, “Well, the idea is that everyone gets access to medical care. And you don’t have to go through the process of going through an insurance company, having them give you approval, going through the paperwork, all of the delay that may require.”

Universal access to health care—and no bureaucratic delays.

Though it sounds too good to be true, a plurality of Americans, according to the National Opinion Research Center, actually think it is. It reports that 42 percent of respondents in a national survey believe that “Medicare for All” would increase access to doctors and hospitals, while only 24 percent expect such a program would reduce access.

This faith is misplaced. Britain and Canada provide their citizens with single-payer national health insurance, and the evidence is overwhelming: Access to government health insurance does not automatically translate into access to medical care, let alone the avoidance of frustrating and sometimes dangerous delays in medical treatment.

Consider the problem of delays. In the British National Health Service—the grand-daddy of “single payer” health care—there are more than 4 million people awaiting hospitalization. To their credit, the British media has not been shy about reporting the shabby conditions in overcrowded and understaffed British hospitals, the denials or cancellations of surgeries, and the sufferingof British patients.

For those British citizens who want to avoid care delays or denials by the National Health Service, there is the option of enrolling in British private health insurance. Such an option is especially desirable for British patients in need of highly specialized medical procedures, such as a coronary bypass or orthopedic surgeries.

In the United States, congressional liberals—in the text of their leading “Medicare for All” bills (H.R. 676 and S. 1804)—would outlaw virtually all private health insurance, including job-based health coverage. In short, they would deny every American the right to enroll in any alternative to the government plan.

American health care deficiencies are indeed serious—quality is uneven and noncompetitive markets drive up costs and undercut the affordability of care and coverage. On measures of access to care, however, researchers writing for the Journal of the American Medical Association—examining the comparative performance of 11 “high-income” nations—found that “the United States generally performed better than other countries.”

Concerning access to specialized care, for example, they found that only 6 percent of American patients reported waiting more than two months to see a medical specialist, compared to 39 percent of Canadian patients and 19 percent of British patients. The Fraser Institute, a prominent Canadian think tank, estimated that in 2018 the median waiting time for a Canadian patient to see a medical specialist on referral from a general practitioner was 19.8 weeks.

Access to high-quality care is also dependent on the availability of medical goods, as well as specialized services, including advanced medical technology. The Journal of the American Medical Association researchers found that the U.S. ranks first in the utilization of computed tomography units, and second in the number of magnetic resonance imaging (MRI) machines per million of the population (38.1), while Canada has only 8.9 MRIs per million and Britain has just 7.2

Likewise, in fighting breast cancer, the United States deploys 43.3 mammography units per million of the population, while Britain has just 21 and Canada has only 17.3.

Not surprisingly, the researchers found that screening for the prevention of breast cancer is higher in the United States than for all other high-income countries.

Americans can also celebrate stellar progress in reducing death from heart disease. In a major study for the National Bureau of Economic Research, another team of researchers report that between 1950 and 2015, mortality from cardiovascular disease declined by a stunning 73 percent.

Thank the quality American medical interventions. At a rate of 79 procedures per 100,000 in the population, according to the report, Americans lead other high-income countries in the availability of coronary bypass surgery. In comparison, Canadians have a rate of 58 procedures per 100,000 and the British just 26.

On the provision of coronary angioplasty, the United States operates at a rate of 248 per 100,000 of the population, compared to Canada with just 157 and Britain at only 128. The United States also has a much better record of reduced mortality after incidents of stroke and heart attacks than most other advanced countries.

Access and quality problems in government-controlled health care are not far from home. Just ponder the scandalous delays and denials of care at the “single payer” Veterans Administration, Obamacare’s notoriously narrow provider networks, and the historically poor record of patient access to doctors, quality care, and medical outcomes in the Medicaid program.

A National Opinion Research Center survey reports that most Americans are “somewhat” or “very” concerned about their access to doctors and hospitals. Not surprisingly, therefore, the Kaiser Family Foundation reports that 70 percent of Americans would oppose “Medicare for All” if it would “lead to delays in people getting some medical tests and treatments.”

Experience is the best teacher. The lesson: Liberal promises do not match “single payer” performance. Looking at the record, ordinary Americans can know the truth.

By gulfsouthb32553561, Feb 12 2019 04:43PM

The Trump administration’s proposed new rule taking aim at healthcare costs by eliminating hidden drug rebates is a positive step that would increase transparency and eliminate conflicts of interest — and better serve both employers and employees in the process.

That’s the view of one of the largest employer groups, after the Trump administration proposed a major change last week to how the U.S. drug pricing system works, in an effort to bring down the cost of prescription medications for patients. The proposed regulation from Health and Human Services Secretary Alex Azar would eliminate behind-the-scenes discounts among drugmakers, insurers and go-betweens and instead require that the rebates be paid directly to consumers when they buy their medications.

“This is one of the most transformative health reforms we’ve seen in the past few years,” says Mike Thompson, CEO of the National Alliance of Healthcare Purchaser Coalitions. “Rebates sound good in [theory], but the reality is they’ve disrupted [the marketplace] and have created a market that is non-transparent and more focused on rebates than value.”

This proposal would increase pricing transparency for pharmaceutical consumers and will help eliminate conflicts of interest, ultimately leading of greater competition based on value from the eye of the employer, employer groups argue.

“The push for more straightforward, simple and streamlined supply-chain pricing and contracting models is reaching a tipping point,” says Brian Marcotte, president and CEO of the National Business Group on Health.

Employers have been calling for change in the drug industry and long argued that drug rebates are an ineffective strategy: 84% say the pharmaceutical supply chain needs to change and 35% believe it needs to be more transparent and that drug manufacturers rebates should be reduced, according to a National Business Group on Health survey.

Three-quarters of large employers do not believe drug manufacturer rebates are an effective tool to drive down pharmaceutical costs, and more than 90% of employers would welcome an alternative to the rebate-driven approach to managing drug costs.

If the rule goes into effect, the transition will be critical for employers, as many of them have three- to five-year contracts with their pharmacy benefit manager, Thompson says.

“Obviously those contracts would quickly become null and void if the rebates were eliminated,” he says. “I suspect there will be some sort of transitional rules that will allow employers and PBMs to transition to the new rules.”

The move also will give employers more power when it comes to drug pricing, he adds. “Ultimately we’re going to have greater transparency at the individual drug level and employers will be able to be much more effective and influencing the practices and drug pricing of PBMs and ultimately the pharmaceutical industry.”

Thompson says that under the proposed rule, employees would get the benefit of the discounts that were previously behind the scenes. “That will be at the expense of the employer, but they’ll have other ways they can balance their financial needs,” he says.

For employers that have fixed copays, there’s no real effect financially, he says, assuming those rebates get translated into the net prices for the pharmacies. While employers in the end will come out even, they just won’t see these big rebate checks; instead they’ll see the actual costs on the front end.

“But for employers who offer percentage coinsurance, today, very few of them would have passed back the value of the rebate in how the employees were getting charged the coinsurance,” he adds. “For those employers, the employees will start getting the benefit of their share of those discounts.”

As PBMs play an important aggregation role for employers, Thompson says, the proposed rule does not spell their demise.

However, the rule will lead to more transparency and greater competition among PBMs, including non-traditional PBMs, he says. “It will help to eliminate what many have perceived as conflicts of interest in how formularies and drug management have been performed in recent years,” Thompson says. “From that perspective, this is critical to the long-term sustainability of this industry.”

Some critics warn the proposed rule could lead to higher premiums for consumers.

Employee benefits

“We are concerned that eliminating the long-standing safe harbor protection for drug manufacturer rebates to PBMs would increase drug costs and force Medicare beneficiaries to pay higher premiums and out-of-pocket expenses, unless there is a viable alternative for PBMs to negotiate on behalf of beneficiaries,” says Pharmaceutical Care Management Association President and CEO JC Scott.

“While we are reviewing the proposed rule, we stand ready to work with the administration to achieve our shared goal to reduce high drug costs,” Scott adds. “PBMs are part of the solution to high cost prescription drugs. Drugmakers alone set and raise prices.”

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