words to live by

Live out of your imagination, not your history

~Stephen Covey

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What drives insurance premium costs? It’s not what you think.

Before the House GOP health care bill to repeal and replace the Affordable Care Act stalled, there was some discussion by lawmakers to repeal the “essential health benefits.”  These were mandatory requirements created by the Affordable Care Act that most insurance plans must offer 10 specific categories of coverage, including things like prescription drug coverage and maternity care.  When the news leaked, it caused quite a stir – particularly among the political left but also among moderate Republicans.  Remember the outrage when a lawmaker suggested that men shouldn’t have to pay for maternity care?

Many attribute the demands of the House Freedom Caucus to pull the essential health benefits as the reason the bill stalled.  The reason they want the cut the benefits? Rising insurance premiums.

The Freedom Caucus has been pushing for those benefits to be removed because they believe that the coverage guarantees were largely responsible for driving up the price of health insurance.

So the question is whether these benefits actually drive increases in premiums, and whether eliminating them would actually bring premiums down.  The answer is pretty simple.

The true drivers of health insurance costs are hospital care, doctors visits, and prescription drugs.  Things like maternity care, substance abuse, and mental health treatment have a marginal impact on premiums.

As John Bertko, an actuary who worked in the Obama administration and served on the board of Massachusetts’ health exchange, put it: if you want cheaper insurance premiums, “you would either have very crappy benefits without drugs or physicians or hospitalization, or you would have roughly the same costs.”  Maternity care, mental health and substance abuse, “are probably less than 5 percent” of premium costs.

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Medicaid while you work

It’s a tagline from politicians that we’ve heard before for the Welfare program – and now they have their eyes set on Medicaid.  If you are able bodied to work and you want Medicaid, you better find employment or be in a work training program.

Health and Human Service Secretary Tom Price recently notified governors that the federal government will approve state waivers to the Medicaid program for “meritorious” programs – basically prioritizing beneficiaries who have jobs.  The now stalled House GOP health care bill also would allow individual states to have a work requirement for adults applying for Medicaid.

The problem with this thinking is that the majority of Medicaid recipients are already employed.  Nearly 60% of Medicaid beneficiaries work either full or part time.  Why are they uninsured you ask?  For most of them – their employers do not offer health insurance. The other 40% who aren’t working report reasons such as illnesses, caring for a family member, going to school, or disability.


Work requirements are under discussion in a number of states, and the first test for the Trump administration could come on a pending waiver application by Kentucky. The proposal from Republican Gov. Matt Bevin would allow the state to suspend coverage for able-bodied adults who don’t comply. Job training and caring for a disabled relative would count toward fulfilling the obligation. “Medically frail” people dealing with certain conditions, from substance abuse to cancer, would be exempt.
But critics argue that Medicaid is a health program or “medical assistance” program – not a work program.  And they also point out that although the economy has improved, there aren’t exactly free floating jobs out there.  People in small towns who lost manufacturing jobs – the jobs that the current administration promises to bring back – don’t have many employment opportunities.
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Office faux pas

Could not agree with this more


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Happy Easter!

Seriously the Easter Bunny better back away from the wine…

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Happy Passover

I know it technically started last night, but just wanted to wish all those who celebrate a Happy Pesach!

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Spring cleaning?

Posted without comment…

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