The battle is between major insurance corporations and the government. Major insurance industries are spending a record pace. The OFA reports:
“Sure enough, the insurance industry is already stepping up the attack: Reports just leaked from a closed-door meeting where insurance industry lobbyists frantically warned Republican members of Congress that it was not in their interest to "ever vote for this thing" and said supporting reform is like "giving comfort to the enemy." USA Today is reporting that groups opposing reform are lobbying at "a record pace" -- and the Associated Press notes that they've already spent an astounding $32 million on TV ads this year.”
The question is who does the congressman and senator represents “The People” or they themselves are the lobbyists for the insurance industry? Let’s not forget this is an American issue, and both parties have taken substantial campaign contribution from the insurance industry. So it’s no surprise that in an upcoming election year the insurance industry would remind our representatives who has been buttering their bread.
We as American must remind our congressman and senators we are “The People” and will not accept this and vote against any representative that does not protect America, and place us first above party and special interest.
We also must remind the president if he wants all Americans help to making health reform a reality he must consider other options. The health care reform reads as an insurance policy favoring one type of insurance over the others. It’s time to consider a community option and catastrophic policies which cost a fraction of what is proposed and covers everyone.
So we need to send a loud message to those representatives who vow to do the right thing for America, show us. America is tired of empty promises. Every elected official going forward should agree to sign a contract with “The People”, perform or resign and accept no contribution from lobbyist going forward in these coming elections and let get our country back.
Saturday, October 24, 2009
Wednesday, October 21, 2009
47MR Amendment to America’s Healthy Future Act of 2009
Title: The 47 Million Reasons Direct Basic Health Service Plan Community Centers (47MR Centers)
Overview: This amendment provides for federally funded community healthcare centers, non-Medicaid, state plan which combines the innovation and quality of private sector providing direct care facilities for basic health services, wellness, prevention, and stand alone catastrophic insurance plans for major illness.
Under this amendment, the federal government would provides funds to the participating states in order to allow such states to provide affordable health care coverage through private community healthcare centers combined with extending the catastrophic coverage of self insured government facilities to include coverage for the members of the 47MR Direct Basic Health Service Plan Community Centers or allowing for a wrap around stand alone catastrophic plan.
People with incomes above the Medicaid eligibility, above 300 percent federal poverty level(FPL) would be eligible for participation in these centers and these wrap-around stand alone catastrophic plans.
This approach takes advantage of an innovative, non Medicaid coverage model that protects the middle-class that can work at a state level for the people of that state. State government would use their share of federal dollars to empower 47MR Centers in local communities to include and negotiate with the healthcare systems for higher-quality, cost effective services for direct basic health services and wrap-around a stand alone catastrophic insurance policy to provide better value to individual and families in their state. Eligible individual and families would have access to several 47MR Centers at pre-negotiated monthly membership rate options paid direct to the centers for basic health services rather than being limited to fee for service distribution healthcare system offered through the Exchange as the only choice.
By using pre-negotiated monthly membership method for basic health care services, wellness, and prevention, we are improving access, eliminating administration cost, and dramatically reducing cost.
Description of Amendment: The Secretary of Health and Human Services would work with participating states to establish state 47 MR Direct Basic Health Services Plan Community Centers.
State 47MR Direct Basic Health Service Plan Funding: For the purpose of this amendment, a state’s 47MR Direct Basis Health Service Plan funding level would be based on the sum of the value of the direct monthly membership fee to the facility and the cost of individual insurance rate for the catastrophic insurance, which would be assumed eligible for the mandated coverage for the middle-class population in the state. Federal funds distributed to the state would be provided to independent state based trusts for innovative state of art community centers that would be used to negotiate for better medical services, supplies, and medical providers services for 47MR Direct Basic Health Services Plan Community Centers and its members.
Eligibility: The 47MR Direct Basic Health Service Plan Community Centers would be available to people with income over 300 percent of FPL. State could enroll the following middle-class person in their 47MR Direct Basic Health Service Plan Community Centers, as of July 1, 2010 upon availability of the centers: persons who (1) are under age 65; (2) are unemployed; (3) are residence of the community and states; (4) have gross income above 300 percent FPL; (5) choose to be a member of 47MR Direct Health Service Plan Community Centers and obtain stand-alone catastrophic policy coverage: (6) have access by participating in employer sponsored benefits program which include 47MR Centers.
Benefit package and tax credits: Minimum benefit package in the 47MR Direct Basic Health Service Plan Community Centers is set based on the levels provided in Marking Coverage Affordable section of the Chairman’s marks concerning wellness, Prevention, eliminating pre-existing condition, etc. The exception is in having these 47MR Centers deal direct with patients for basic health services and prevention without the current distribution insurance system. Rather a membership fee directly to the facility that meets the guidelines set by the state and HHS for middle-class people. Coverage commence for major illness and hospitalization based on a stand-alone catastrophic policy provided by the state or private sector meeting all the levels. The catastrophic insurance wraps around the 47MR Centers without limitations of HSA rules or deductibles. The tax credits to individuals and businesses for eligible population would have access to tax credits as available in the marks.
State would be encouraged to include innovative services in the 47 MR Centers, included but not limited to; triage, care coordination, care management, care maintenance for those with medical conditions, preventive services which includes a comprehensive physical examinations, risk assessment, and establishment of patient/primary care doctor relationship that maximizes patient involvement in healthcare decision making through educational learning of western and eastern philosophy for maintaining good health.
Health care service plan contracting; State will negotiates contract directly with 47MR Centers providers to ensure the guidelines for the state of the art centers meet the innovative services in the direct health service plan for middle-class people over 300 percent FPL.
The state will under the NAIC will regulate the stand-alone catastrophic policies which provide coverage offered to the members of the 47MR Centers, such as negotiations of payment rates, premiums, and in compliance with benefits package that may exceed the minimum requirement outline above. The Secretary of HHS would be required to verify that state 47MR Direct Basic Health Service Plan are operating within the federal cost and eligibility guidelines as stated above.
The state HHS in coordination with the NAIC are to consider and make suitable allowance for qualifying 47MR Centers based on differences in local communities and availability of healthcare providers resources. The HHS would be encouraged to find ways to upgrade and integrate the direct basic service plan negotiations with community hospitals, specialist, other providers to maximize the quality of care and efficiency and improve the continuity of information between all services providers and the patient.
Incentives to the 47MR Centers would be offered based on specific performance measures and standards based on the improvement of the patients risk assessment report, blood lab results, and physical exams and health outcome. Each 47MR Direct Health Service Plan Community Center must report to the HHS on the performance and results of its members. The NAIC will oversee the catastrophic insurance policy offered by state or private sector.
Cost Savings: State will be able through an independent state trust determine and fund to the 47MR Direct Basic Health Service Plan Community Centers. The 47MR Centers would be able to raise funds through membership in each community servicing the middle-class over 300 percent FPL. Medical providers’ services will be contracted by the 47MR Centers. Each community in the state will have state of the art center. The cost of the centers funded by the individuals, small business, and part-time employees will be direct to the facility overseen by the HHS. The state would be able to negotiate lower prices for medical services, supplies, lab work, hospital stays, etc. by directly purchasing and contracting for all the 47MR Direct Basic Health Service Plan Community Centers.
In addition, the catastrophic insurance policy which provides coverage for self-insured state plans as well as private sector stand-alone plans are one sixth of the cost of the comprehensive plan set at the levels in the Making Coverage Affordable section of the Chairman marks. Therefore combined with the 47MR Direct Basic Health Service Community Center facilities, people will pay a membership fees and affordable premium for catastrophic coverage which is one fraction of the cost, and each local community services their own people.
The high deductible associated with the catastrophic plan can be offset by the independent trust as well or philanthropic measures which exist today. This insures the 25 million uninsured middle-class people whom are not included and have no subsidy. This provides choices for them and give access to healthcare.
Overview: This amendment provides for federally funded community healthcare centers, non-Medicaid, state plan which combines the innovation and quality of private sector providing direct care facilities for basic health services, wellness, prevention, and stand alone catastrophic insurance plans for major illness.
Under this amendment, the federal government would provides funds to the participating states in order to allow such states to provide affordable health care coverage through private community healthcare centers combined with extending the catastrophic coverage of self insured government facilities to include coverage for the members of the 47MR Direct Basic Health Service Plan Community Centers or allowing for a wrap around stand alone catastrophic plan.
People with incomes above the Medicaid eligibility, above 300 percent federal poverty level(FPL) would be eligible for participation in these centers and these wrap-around stand alone catastrophic plans.
This approach takes advantage of an innovative, non Medicaid coverage model that protects the middle-class that can work at a state level for the people of that state. State government would use their share of federal dollars to empower 47MR Centers in local communities to include and negotiate with the healthcare systems for higher-quality, cost effective services for direct basic health services and wrap-around a stand alone catastrophic insurance policy to provide better value to individual and families in their state. Eligible individual and families would have access to several 47MR Centers at pre-negotiated monthly membership rate options paid direct to the centers for basic health services rather than being limited to fee for service distribution healthcare system offered through the Exchange as the only choice.
By using pre-negotiated monthly membership method for basic health care services, wellness, and prevention, we are improving access, eliminating administration cost, and dramatically reducing cost.
Description of Amendment: The Secretary of Health and Human Services would work with participating states to establish state 47 MR Direct Basic Health Services Plan Community Centers.
State 47MR Direct Basic Health Service Plan Funding: For the purpose of this amendment, a state’s 47MR Direct Basis Health Service Plan funding level would be based on the sum of the value of the direct monthly membership fee to the facility and the cost of individual insurance rate for the catastrophic insurance, which would be assumed eligible for the mandated coverage for the middle-class population in the state. Federal funds distributed to the state would be provided to independent state based trusts for innovative state of art community centers that would be used to negotiate for better medical services, supplies, and medical providers services for 47MR Direct Basic Health Services Plan Community Centers and its members.
Eligibility: The 47MR Direct Basic Health Service Plan Community Centers would be available to people with income over 300 percent of FPL. State could enroll the following middle-class person in their 47MR Direct Basic Health Service Plan Community Centers, as of July 1, 2010 upon availability of the centers: persons who (1) are under age 65; (2) are unemployed; (3) are residence of the community and states; (4) have gross income above 300 percent FPL; (5) choose to be a member of 47MR Direct Health Service Plan Community Centers and obtain stand-alone catastrophic policy coverage: (6) have access by participating in employer sponsored benefits program which include 47MR Centers.
Benefit package and tax credits: Minimum benefit package in the 47MR Direct Basic Health Service Plan Community Centers is set based on the levels provided in Marking Coverage Affordable section of the Chairman’s marks concerning wellness, Prevention, eliminating pre-existing condition, etc. The exception is in having these 47MR Centers deal direct with patients for basic health services and prevention without the current distribution insurance system. Rather a membership fee directly to the facility that meets the guidelines set by the state and HHS for middle-class people. Coverage commence for major illness and hospitalization based on a stand-alone catastrophic policy provided by the state or private sector meeting all the levels. The catastrophic insurance wraps around the 47MR Centers without limitations of HSA rules or deductibles. The tax credits to individuals and businesses for eligible population would have access to tax credits as available in the marks.
State would be encouraged to include innovative services in the 47 MR Centers, included but not limited to; triage, care coordination, care management, care maintenance for those with medical conditions, preventive services which includes a comprehensive physical examinations, risk assessment, and establishment of patient/primary care doctor relationship that maximizes patient involvement in healthcare decision making through educational learning of western and eastern philosophy for maintaining good health.
Health care service plan contracting; State will negotiates contract directly with 47MR Centers providers to ensure the guidelines for the state of the art centers meet the innovative services in the direct health service plan for middle-class people over 300 percent FPL.
The state will under the NAIC will regulate the stand-alone catastrophic policies which provide coverage offered to the members of the 47MR Centers, such as negotiations of payment rates, premiums, and in compliance with benefits package that may exceed the minimum requirement outline above. The Secretary of HHS would be required to verify that state 47MR Direct Basic Health Service Plan are operating within the federal cost and eligibility guidelines as stated above.
The state HHS in coordination with the NAIC are to consider and make suitable allowance for qualifying 47MR Centers based on differences in local communities and availability of healthcare providers resources. The HHS would be encouraged to find ways to upgrade and integrate the direct basic service plan negotiations with community hospitals, specialist, other providers to maximize the quality of care and efficiency and improve the continuity of information between all services providers and the patient.
Incentives to the 47MR Centers would be offered based on specific performance measures and standards based on the improvement of the patients risk assessment report, blood lab results, and physical exams and health outcome. Each 47MR Direct Health Service Plan Community Center must report to the HHS on the performance and results of its members. The NAIC will oversee the catastrophic insurance policy offered by state or private sector.
Cost Savings: State will be able through an independent state trust determine and fund to the 47MR Direct Basic Health Service Plan Community Centers. The 47MR Centers would be able to raise funds through membership in each community servicing the middle-class over 300 percent FPL. Medical providers’ services will be contracted by the 47MR Centers. Each community in the state will have state of the art center. The cost of the centers funded by the individuals, small business, and part-time employees will be direct to the facility overseen by the HHS. The state would be able to negotiate lower prices for medical services, supplies, lab work, hospital stays, etc. by directly purchasing and contracting for all the 47MR Direct Basic Health Service Plan Community Centers.
In addition, the catastrophic insurance policy which provides coverage for self-insured state plans as well as private sector stand-alone plans are one sixth of the cost of the comprehensive plan set at the levels in the Making Coverage Affordable section of the Chairman marks. Therefore combined with the 47MR Direct Basic Health Service Community Center facilities, people will pay a membership fees and affordable premium for catastrophic coverage which is one fraction of the cost, and each local community services their own people.
The high deductible associated with the catastrophic plan can be offset by the independent trust as well or philanthropic measures which exist today. This insures the 25 million uninsured middle-class people whom are not included and have no subsidy. This provides choices for them and give access to healthcare.
Monday, October 5, 2009
The baseline premium rate is set at $ 3,500 per single coverage for healthcare reform.
In evaluating the bill chairman's markup these last few weeks, the summation is the middle-class Americans loses in the Senates overhaul healthcare reform bill. What Americans wanted was a new system, which can reduce the cost, include all Americans, and have multiple choices. What American is getting is an overhaul of the Medicaid system, expanding a broken system to include up to 300% poverty level, and eliminate help to the middle-class Americans.
In recent articles, it assumes this overhaul plan will resolve most of American issues, and bring down the number of the uninsured, even thought over 10 million Americans may continue to not afford coverage. So the consensus would be most of the problem is resolved. Well if Americans believe in the end justifies the means we perhaps can accept the collateral damage of leaving the middle class behind. However, this is America and we believe in leaving no man behind.
So to accept anything else is not what we do. Congress in both sides and the White House should carefully evaluate the options and choices. I have seen amendments voted down which offers choices. One of the Senators offered catastrophic insurance as an option to all and he was refused. Why? If affordable coverage is what is needed then this should be an option. Especially when the minimum cost of the proposed young person age 25 making 32,500 is fixed at 2200 per year with no subsidy. So the government will be subsidizing everyone else below that income. The price does not change but the government will pay the premiums to the insurance companies. The Kaiser foundation created a calculator to show the premiums you will pay under this overhaul reform.
The average 40 year old male, premium is based at 1.0 baseline rate of $3500 per year. The rate drops and levels off at 0.62 age 25 and below. The rate increase to 2.46 above baseline at age 64
What this means to middle class professional is:
Any young professional age 25 who earns over 32,500 per year pays $2194 to $2633
Any professional age 35 who earns over 32,500 per year pays $3082 to $3698
Any professional age 40 who earns over 35,000 per year pays $3500 to $4200
Any professional age 45 who earns over 36,400 per year pays $4362 to $5235
Any professional age 55 who earns over 44,000 per year pays $6607 to $7928
Any professional age 64 who earns over 44,000 per year pays $8614 to $8614
The whole Healthcare Reform Act is based on paying premiums to the insurance industry with no pressure on the insurance industry to make it affordable. The savings to the consumer is on government subsidies (taxpayer’s money) lowering our own premiums. However, the middle-class receives no subsidies as shown above.
With the baseline rate remaining at 3500 for single adult, there is no break or anything to look forward too. In family coverage the insurance rates are even more shocking.
Age 64 Actual plan premium ranges from $22,207 to 26,649, our government will pay premiums of $19,137 to $23,579
Age 55 actual plan premium ranges from $15,361 to $18,434, our government will pay premiums of $12,291 to $15,364
Age 40 actual plan premium ranges from $9,435 to $11,321, our government will pay premiums of $7,707 to $9,594
So the subsides sound great if you are under 50,000 in income. If both spouses work and earn over 90,000, there is no subsidies and you pay the actual premiums.
How does this help the baby boomers today,who makes up a large portion of the population?
Why must we reward an insurance industry whom failed to lower cost and make healthcare affordable. We ourselves the American people are funding the premiums to make it affordable. All we have accomplished is to make the industries that fail us a stronger monopoly that we will never again be able to defeat and get true reform pass.
Let the middle-class have their own plan, a community option with direct care and a catastrophic policy to cover the major illnesses as an option. Give American a choice to fix their own uninsured problems in their own communities.
Consider what this overhaul healthcare reform plan is doing. Pass the regulation on the industry to change their ways, but do not close the door on creative thinking in healthcare. The design of one plan fits all, with mandates is the wrong medicine and will frustrate all middle-class Americans.
In recent articles, it assumes this overhaul plan will resolve most of American issues, and bring down the number of the uninsured, even thought over 10 million Americans may continue to not afford coverage. So the consensus would be most of the problem is resolved. Well if Americans believe in the end justifies the means we perhaps can accept the collateral damage of leaving the middle class behind. However, this is America and we believe in leaving no man behind.
So to accept anything else is not what we do. Congress in both sides and the White House should carefully evaluate the options and choices. I have seen amendments voted down which offers choices. One of the Senators offered catastrophic insurance as an option to all and he was refused. Why? If affordable coverage is what is needed then this should be an option. Especially when the minimum cost of the proposed young person age 25 making 32,500 is fixed at 2200 per year with no subsidy. So the government will be subsidizing everyone else below that income. The price does not change but the government will pay the premiums to the insurance companies. The Kaiser foundation created a calculator to show the premiums you will pay under this overhaul reform.
The average 40 year old male, premium is based at 1.0 baseline rate of $3500 per year. The rate drops and levels off at 0.62 age 25 and below. The rate increase to 2.46 above baseline at age 64
What this means to middle class professional is:
Any young professional age 25 who earns over 32,500 per year pays $2194 to $2633
Any professional age 35 who earns over 32,500 per year pays $3082 to $3698
Any professional age 40 who earns over 35,000 per year pays $3500 to $4200
Any professional age 45 who earns over 36,400 per year pays $4362 to $5235
Any professional age 55 who earns over 44,000 per year pays $6607 to $7928
Any professional age 64 who earns over 44,000 per year pays $8614 to $8614
The whole Healthcare Reform Act is based on paying premiums to the insurance industry with no pressure on the insurance industry to make it affordable. The savings to the consumer is on government subsidies (taxpayer’s money) lowering our own premiums. However, the middle-class receives no subsidies as shown above.
With the baseline rate remaining at 3500 for single adult, there is no break or anything to look forward too. In family coverage the insurance rates are even more shocking.
Age 64 Actual plan premium ranges from $22,207 to 26,649, our government will pay premiums of $19,137 to $23,579
Age 55 actual plan premium ranges from $15,361 to $18,434, our government will pay premiums of $12,291 to $15,364
Age 40 actual plan premium ranges from $9,435 to $11,321, our government will pay premiums of $7,707 to $9,594
So the subsides sound great if you are under 50,000 in income. If both spouses work and earn over 90,000, there is no subsidies and you pay the actual premiums.
How does this help the baby boomers today,who makes up a large portion of the population?
Why must we reward an insurance industry whom failed to lower cost and make healthcare affordable. We ourselves the American people are funding the premiums to make it affordable. All we have accomplished is to make the industries that fail us a stronger monopoly that we will never again be able to defeat and get true reform pass.
Let the middle-class have their own plan, a community option with direct care and a catastrophic policy to cover the major illnesses as an option. Give American a choice to fix their own uninsured problems in their own communities.
Consider what this overhaul healthcare reform plan is doing. Pass the regulation on the industry to change their ways, but do not close the door on creative thinking in healthcare. The design of one plan fits all, with mandates is the wrong medicine and will frustrate all middle-class Americans.
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