Health insurance premiums skyrocket as industry scrambles for answers.

Health insurance premiums skyrocket as industry scrambles for answers.

06/01/15
1434 pm

Blue Cross announced recently that it lost 141 million dollars last year under the Obamacare Health Care exchanges.

The deficit in this category of insurance, under the Silver plan, was grossly underestimated as to cost and total claims by this population. 

BCBS serves nearly 2/3 of the 231, 000 total people in TN seeking insurance through the exchanges.

BCBS because of this population’s over usage and a disproportionate share seeking care at inappropriate portals of entry have requested a 36 percent increase in premiums. Of course this will have to be decided upon by the state insurance regulatory body.

“We don’t have prior claim status information” is being used as an excuse for the premium increases.

“It’s a fairly new program.” Insurance officials keep spewing as a reason to further the conversation toward future increases and unanswered questions about overutilization, fraud and abuse.

I would venture to say that if you used the TennCare program as your template for prior claim data you may obtain a wealth of information on how this pool of patients will utilize their insurance options and their spending and use habits, to influence your bottom line.

The main problems lies in the main areas below with subsets stemming from these as generators of continued high costs and a resultant higher premium. 

For the most part, from my observations, we are putting our dollars in the wrong places and not promoting proper access to care.

Let’s attempt to bridle this non frugal population that relies largely on LIP, Low Income Pools to fund or  compensate inside a broken system. One can see that if you restrain and properly train this population in a complementary setting with adequate providers hospitals across the land will see a difference in their bottom line. 

For so long hospitals, mainly ERs have promoted seeking care at their place, relying heavily on those LIPs or DSH, Disproportionate Share Hospital money to pick up the slack. 

Now that federal money is being threatened to be taken away hospitals are now clamoring for a way to survive. 

I think if we took a minute to look at our system based on the suggestions in the section below, a great impact could be made in our fight for healthcare dollars inside a dwindling reimbursement scenario.

We are currently seeing about 45,000 ER visits at an average cost of about $1300.00 for an ER visit. With 1.2 million uninsured in TN you can easily see the impact on our hospitals.

In one study at a hospital in Texas they showed that 6,000 patients to their ER had 10 or more visits. The breakdown for this population cost the hospital on average about $134,000.00 per person per year. If we dared look, I am convinced you would see similar numbers in every state in the US.

There is an irresponsible and overwhelming pattern of use among this population that must be broken. 

Just as those who pay high premiums and even greater deductible and out of pocket expenses we must exercise frugality and promote accountability at all levels. On a large scale, this is not being done.

My assessment of where our healthcare dollars are being wasted that is resulting in these higher premiums.

There is a lack of education as to when and where resources are to be consumed appropriately.

There is a serious shortage of middle level providers in our state and across the US.

We also have a significant portion of providers that see reimbursement too low to continue seeing these patients, thus bouncing them to inappropriate care areas.

There are too many providers protecting their tales and over utilizing the resources available, a serious question arises here about tort reform.

There is very little oversight controlling and directing care and suggesting or providing the proper setting for that care defined.

Overusers and repeat offenders are posting record numbers visiting our ERs, our most costly entry point. Many are seeking drugs to fuel their habits. It is estimated that 4 to 8 percent of Medicaid/TennCare patients represent 21 to 28 percent of all ER visits.

Current federal law states our most expensive easiest access portal to healthcare, the ER, can be used regardless of your ability to pay and we must see you if you show up for any reason.

Over prescribing and fueling drug addiction is leading patients to enter the ER for their drug needs. Currently in conjunction with Joint Commission, a private entity, has joined with Big Pharma to prescribe via a completely subjective pain scale that  encourages over prescribing and threatens fines if not followed. 

We must issue Providers higher reimbursement and incentives to see Medicaid and exchange patients. In one study, 45 percent of Medicaid patients didn’t know who there Primary Care giver was.

In the same vein, primary providers need to reprimanded for referring everyone seen as underinsured or uninsured to go to the ER for care. Especially during office hours.

There needs to be after hour care clinics equipped with dental services to absorb a large portion of this population that uses the ER for primary or dental concerns after hours as well as for primary care issues.

Make the underinsured aware that if they seek care outside of a specified  more costly portal of entry they will be asked to put some skin in the game, or foot a proportionate share of the cost at the door. We used to be able to do this and it was very effective.

Encourage after hour care seekers to pay a co pay at the door of an unauthorized care area. 

And,

Repeat offender, overutilizers and abusers must be limited in their visits. Place limits on use aside from emergencies and reward those that use restraint.

It’s a start, certainly not a complete plan but one that will definitely set a precedent for future utilization of resources.  

I will contacting my reps soon. How about you.

I don’t know about you, I’m frankly tired of talking about these problems. It’s time we act.

Also, I will be releasing a book soon that elaborates more on these subjects and will even point you in a direction to make a difference.

It is in the We the People Books series called “Creating a Health Care Revolution.”

You can follow the book and the series to follow on Face Book called “We the People Books” like and follow if you desire.

Sources of info! Please visit these sights regularly. 
 
http://www.timesfreepress.com/news/local/story/2015/may/31/insurers-proposehefty-rate-increases/307112/

http://www.tennessean.com/story/money/industries/health-care/2015/05/15/health-insurance-rate-filing-requests-vary-insurer/27363437/

Fair Tax passed to House Ways and Means for up or down vote, eliminate IRS, waste and abuse

Fair Tax passed to House Ways and Means for up or down vote, eliminate IRS, waste and abuse

Dear over-burdened Taxpayer,

We’re close.

Close to an up or down vote.

Close to eliminating the IRS.

And closer to making April 15 just another spring day.

That’s right, by passing the FairTax Plan® we end the IRS and restore economic freedom, and freedom from intimidation, for every single American.

That’s because the House Committee on Ways and Means is going to vote the FairTax plan up or down.

This historic vote will represent the FIRST time a true tax reform plan will be voted on by a body of Congress since the 16th Amendment was passed, enacting the current income tax system in 1913.

This is our chance to fundamentally change Washington!

Americans For Fair Taxation is committed to building a national grassroots army of Citizen Patriots committed to passing the FairTax Plan.  Are you also committed?

Will you help us accomplish this goal?

Please forward this email to 25 or 50 or even 100 friends right now!  Encourage them to add their name to our Rapid Response Force email list. They can also learn about the FairTax Plan that will change their country and their pocketbooks, forever.

Urgently,

Cindy Canevaro
Executive Director
Americans For Fair Taxation

What is the Fair Tax?

The FairTax is fair. One flat 23% rate for all Americans.

The FairTax replaces federal income taxes, including personal, estate, gift, capital gains, Social Security, Medicare, self-employment and corporate taxes.

The FairTax Plan eliminates the IRS. If you haven’t noticed lately, the IRS is completely out of control; they have lied to the American people, they have abused their power, they have leaked confidential taxpayer information, they have targeted political enemies, veterans organizations, and one top official “plead the 5th Amendment” before a Congressional Oversight Hearing. 

It’s way past time to eliminate one of the most obtrusive and dangerous federal agencies ever created.

Learn More About the FairTax Plan here.
http://www.fairtax.org/site/PageServer?pagename=FAQs

Report OSCE and others if election day fraud, intimidation or abuse observed

See one report one! Sound familiar?

If you see anything questionable at the polls in the form of fraud, abuse or intimidation please report those results with pictures or video of it’s proof to me at bradleycountynews@gmail.com and I will report this to the proper national authorities and prompt the appropriate response if warranted.

Tea Party Patriots and True the Vote have made themselves available to report any variances at the polls and have the resources to act accordingly.

Of particular interest is the OSCE and their close involvement at our polls. If you see them within 100 feet of our polls, first call police and have them arrested then report to the email above and a national response will be activated.

Furthermore the ACLU, the NAACP, SEIU and Reverend Al Sharpton are deeply involved with OSCE and I have said before they plan to disrupt and intimidate voters.

I feel they collectively could mount a heavy response if the election doesn’t go their way and may activate many to civil unrest that could plunge our country into turmoil.

So please report any occurrences that may occur and use the lefts tactics against them also by seeing one, report one.

Please do not hesitate to contact me via email or call me and leave a message to 423-284-4250.

Thanks for your assistance as we must make sure this election does not get stolen by the left and their socialist tactics.

Iowa joins other states reigning in UN “poll watchers”, TN remains mute

Iowa has joined with Alabama and Texas as states listening to the will of the people and warning UN “poll watchers” that they will be arrested if they violate strict election and voting laws.

In a specific statement Iowas Secretary of State issued a warning to UN “poll watchers” that if they enter polling areas and are within 100 feet of a voting booth they will be arrested on the spot.

Many have reported seeing UN “poll watchers” inside election buildings meeting candidates and observing along side election officials as a few sources observing the observers have confirmed.

To date, in Tennessee we have not heard such a bold statement from our elected leaders even at the behest of many of their constituency.

Altough Tennessee State Senator Mike Bell did report via email, in a conversation recently with Tennessee Secretary of State Tre Hargett, Bell went on to explain Hargett said the observers will only be there to “learn and observe and the will adhere to election laws.”

Senator Bell added that concerns about the observers were “overblown” but did affirm his distaste for the UN in this email statement, “First, I will say we should be completely out of the U.N.  This organization is (and) has always been controlled by interest who would like nothing better than to take down America.”

Multiple attempts to converse with other Tennessee local state and federal officials has gone unanswered.

Several concerned citizens from Bradley County, Tennessee are exploring the option of seeking court injunctions to stop the observation and potential overreach of UN/OSCE delegates while on US soil if our representatives fail to act.

The lack of response of our elected officials to protect our sovereignty and integrity of our election process should be noticed, especially in light of a recent Tn State House resolution by State Representative Kevin Brooks, HJR 587, condemning UN involvement in our communities, as it relates to Agenda 21, a UN agenda to transform our communities. The measure passed easily in the house and Senate but failed to get Governor Bill Haslams signature.

The letter below from Iowa Secretary of State Shultz lays down specific ground rules for UN involvement from observers and draws a line in the sand citing specific state laws that confines their activities in and around the polling booths.

(DES MOINES)—Matt Schultz, Iowa Secretary of State, issued the following statement in response to reports that members of a UN-chartered delegation are being dispatched across the United States, including Iowa, to observe the General Election:

“As Secretary of State, I support the efforts of other nations to learn more about our election process and ways in which they might improve their own election systems. We welcome the four international visitors to our great state.

The Texas Secretary of State recently drew the ire of the OSCE when he announced that UN International poll watchers would be arrested if they showed up within 100 feet of polling areas. However, it was reported yesterday that members of this organization are attempting to gain access to Iowa polling places on Election Day. My office met with two delegation representatives last week to discuss Iowa’s election process and it was explained to them that they are not permitted at the polls. Iowa law is very specific about who is permitted at polling places, and there is no exception for members of this group.”

Iowa Code section 49.104 defines the limited number of individuals permitted at polling places on Election Day, and section 49.105 states that poll workers “shall order the arrest” of any persons violating these provisions.

Any election law violations can be reported to the Iowa Secretary of State’s office by calling the Election Hotline at 1-888-SOS-VOTE.

The OSCE recently responded to the Texas Secretary of State in a speech to NATO and in a letter to Secretary Hillary Clinton regarding Texas’ threats to arrest UN “poll watchers” that violate the law.

“The threat of criminal sanctions against [international] observers is unacceptable,” Janez Lenari, the director of the OSCE Office for Democratic Institutions and Human Rights (ODIHR), said in a statement. “The United States, like all countries in the OSCE, has an obligation to invite ODIHR observers to observe its elections.”

It shows that we have allowed way too much control by international bodies when they scathingly address the US and it’s people the way the OSCE Director Janez Lenari recently did.

This type of reprimand by the UN asserts that they have some type of ownership and supervision of a free people. This is unacceptable to a freedom loving country and should not be tolerated by those in office that represent us.

“The only thing between accepting tyranny from the UN is an undying desire from its patriots to remain sovereign and free!”

You can quote me on that one!
http://patdollard.com/2012/10/iowa-to-forbid-un-international-observers-at-elections/

http://m.wcfcourier.com/mobile-touch-2/?disableTNStatsTracker=1&asset=75e4c70f-76f3-599a-9722-8943b3e36379#75e4c70f-76f3-599a-9722-8943b3e36379

OSCE TO NATO: “The US is obligated” to allow monitoring of US elections

PRESS RELEASE
October 29, 2012

In what can be summed up as the most under reported story of our time is that our elections have been under surveillance of UN International bodies since 2002 with incremental increased authority over them.

In a recent press release by the OSCE Ambassador Janez Lenarcic, he addresses NATO over concerns the Texas Attorney General said he would arrest OSCE observers if they stepped foot in his state. The idea that an international body would address NATO and the UN over our states wanting to remain free and sovereign is beyond me.

The mere thought that the UN or the OSCE has scolded the US in front of NATO makes me sick at my stomach. We ask them to leave and they get upset and whine. Folks let me tell you this is another incremental and gradual takeover of our nation that I have harped on for years. We open one door to them and then another and then we are under UN control completely.

They are even whining to Secretary of State Clinton. You know they will get whatever they want from her.

Read the press release below and see if you don’t think they are on their way to owning the election process. This international body is way to close to my ballot box for comfort.

OSCE Press Release:
http://www.osce.org/odihr/elections/96639

Threat of criminal prosecution of observers at odds with established co-operation on United States elections, ODIHR Director says

ODIHR Director Ambassador Janez Lenarcic addresses a session of NATO’s Parliamentary Assembly at the Sejm, Poland’s parliament, in Warsaw on 16 November 2010. (OSCE/Curtis Budden)
WARSAW, 24 October 2012 – Ambassador Janez Lenarčič, the Director of the OSCE Office for Democratic Institutions and Human Rights (ODIHR), expressed his grave concern today over the threat of criminal prosecution of OSCE/ODIHR election observers.

This threat, contained in an open letter from the Attorney General of Texas, is at odds with the established good co-operation between OSCE/ODIHR observers and state authorities across the United States, including in Texas, Lenarčič said, adding that it is also contrary to the country’s obligations as an OSCE participating State.

The ODIHR Director shared his concerns in a letter to United States Secretary of State Hillary Clinton.

“The threat of criminal sanctions against OSCE/ODIHR observers is unacceptable,” Lenarčič said. “The United States, like all countries in the OSCE, has an obligation to invite ODIHR observers to observe its elections.”

The ODIHR Director also stressed that any concerns or reports that the election observers intended to influence or interfere with the election process were groundless. He underlined that OSCE/ODIHR election observers adhere to all national laws and regulations, as well as a strict code of conduct.

“Our observers are required to remain strictly impartial and not to intervene in the voting process in any way,” Lenarčič said. “They are in the United States to observe these elections, not to interfere in them.”

The ODIHR limited election observation mission for the 2012 general elections in the United States consists of a core team of 13 experts, from 10 OSCE participating States, based in Washington D.C., and 44 long-term observers deployed throughout the country. These are the sixth United States elections the Office has observed, without incident, since 2002.
 

Decade of Records Document (Cleveland Tennessee) Police Misconduct

I am going to only report this with very little commentary because of the sensitive nature of these happenings!

I find it interesting that local papers are noticing that the City Council and City Manager Janice Casteel have not acted pro or con on this issue!

A newspaper choosing to chew up on the council and City Manager for not acting! Hey, I think I like it…….alot!

Please read the banner article below calling on our council and city manager to act one way or another! The problem is and I think the council realizes it , is if they lean one way or another, it may backfire on them and cause some great distress downtown among close circles that may or may not be directly involved!

This may be fun to watch! Watching our elected leaders squirm a little while being held to a standard by the local news media!

http://www.clevelandbanner.com/view/full_story/16679108/article-City-Council-should-act?instance=most_recommended

Additional note! Seeing the Mayor Rowland and City Councilmen supporting the Chief on the front page of the Banner does not surprise me especially after the local media scolded them and called them out for not supporting the Chief publicly.

I do not have a personal beef with the Chief and I don’t know him personally and he may be a great guy and the way everyone has rallied to him to support him but with that said one thing seems very odd!

I don’t see anyone supporting the children or laying down blanket endorsements for the children! The children are the losers in this dilemma. I have not heard the local media, the Mayors or the Council say one thing in support of the children!

Lest I need to remind you, many children, not consenting adults, but little girls, someone’s babies, raped, drugged and molested! Sure the Chief didn’t participate in these children’s abuse but it happened under his watch for 10 to 12 years and someone must stand in the gap for the children!

These children still exist! They still must attempt to put their lives together as adults with their own way of coping!

There was a day when the child abuse in any form was not pushed aside so easily! Perhaps we are further down that road to collapse than first thought!

The article below is from officer.com by a reporter that I believe currently works or used to write for the Times Free Press!

December 12, 2011
Decade of Records Documents Tenn. Police Misconduct
Judy Walton, Staff Writer
Cleveland police have said there was “no proof” that officers in 2008 were abusing prescription pills and having sex with underage girls before an investigation began late in the year.

But police department records show that one of the Cleveland officers now serving a prison term for two statutory rapes in 2008 and 2009 was known to be dallying with a teenage girl 10 years ago.

Files also document substance abuse by the officer, Nathan Thomas, in 2005 and 2007.

Another officer involved in the 2008 investigation, Dennis Hughes, was investigated twice in late 2007 for domestic altercations and harassing phone calls to a former girlfriend. The file notes that Hughes was intoxicated both times and when investigators came to question him.

Thomas never was disciplined beyond counseling. Hughes was given three days off for harassment, records show. Hughes later told TBI investigators that he had been addicted to hydrocodone pills since 2006, and Thomas confessed to pill addiction.

A third officer, Lt. Jeremy Noble, who was not involved in the 2008 case, was named in 2003 and 2004 reports saying he tried to date students while working as a school resource officer at Cleveland High School; that he left campus with a girl at least three times; and that he propositioned a Lee University student.

In 2009, Noble was demoted and suspended without pay after he confessed to having three sexual affairs while on duty.

Cleveland city officials, including City Manager Janice Casteel and Mayor Tom Rowland, have not returned calls seeking comment over almost two weeks.

IN THE BEGINNING

Such activities by Cleveland officers returned to public attention in November, when Assistant Police Chief Gary Hicks testified that officers were warned in May 2008 against “dating minors, porn on city-owned phones, consumption of alcoholic beverages while off-duty, snorting crushed pills [and] oral sex in public” and other misbehavior, according to a memo on Cleveland Police Department stationery.

Hicks was testifying in a lawsuit filed by a Cleveland detective who had been fired.

Police Chief Wes Snyder said that allegations about such activities weren’t specific enough to investigate the officers’ conduct.

But in November 2008, Hughes accidentally shot another officer in the hand and the ensuing investigation uncovered prescription pill abuse. In January 2008, another investigation began when a 15-year-old runaway was found with Hughes and told police that two other teen girls were involved with the adult police officers.

Thomas pleaded guilty to having sex with 14- and 16-year-old girls as well as drug and forgery charges. Hughes pleaded guilty to statutory rape and aggravated assault.

When the mother of the 15-year-old tried to draw attention to Hughes’ conduct in May 2008, her complaint was not written down or investigated, which department policy requires.

“We teach people to trust teachers and trust law enforcement, and when they violate that trust, what do you do?” the mother said in an interview last week. Her name is not being revealed to protect her daughter’s identity.

Snyder said last week his office “acted appropriately and transparently” in the 2008 investigation.

Asked if his officers did everything they were required to do under department policy and their oaths as police officers, Snyder said in an email: “If the young ladies [sic] mother wants to file a complaint on them, I will review it and deal with it transparently and within the Cities [sic] policy and state law.”

THOMAS

Police records provided to the Times Free Press listed only two incidents for Hughes, both related to domestic incidents with a former girlfriend.

Four internal charges were brought against Thomas in August 2001, after a Cleveland woman said he had been dating her and giving her alcohol since 1999 when she was 18 and he was 28. According to police records, the girl broke off the relationship with the married Thomas when she caught him with yet another woman.

One count, conduct unbecoming an officer, was sustained, but nothing in the documents provided under the state’s Open Records Law show Thomas being given any punishment.

He was reprimanded in December 2004 after police found him at home when he was supposed to be working. In February 2005, an internal investigation noted he was coming to work late and leaving early. Confronted with suspicions of alcohol abuse, Thomas confessed and said he would handle the problem.

In June 2007, his file shows a counseling session with Snyder and noting that domestic incidents at his home required police response five times since 2001.

Snyder wrote that “I informed Thomas that I was becoming weary of dealing with his personal problems and that this behavior could not continue. I told him if he could not correct these issues in his personal life more severe disciplinary measures will be taken.”

NOBLE

Files show three incidents for Noble, who was Snyder’s brother-in-law and wasn’t connected to the 2008 investigation into the accidental shooting.

In 2003, Cleveland High School Principal Chuck Rockholt told police that female students allegedly had complained to a school board member that Noble was trying to date girls at the school.

No formal compliant was filed. Schools Superintendent Rick Denning told police he didn’t think the allegations were credible and he wouldn’t reveal the board member’s name.

The same report documents that Noble left the high school campus at least three times with a girl. The report said he took her to a DARE program, to pick up his wife’s car at the mechanic and to observe his wife teaching a class at another school. The girl’s statement wasn’t in the package of records given to the Times Free Press.

On Friday, Snyder said the girl was a baby sitter and no misconduct ever was alleged. Snyder then was the captain over the criminal investigation division and had responsibility for internal affairs investigations.

He said in an email Friday that he didn’t remember whether he or Lt. Ken Simpson investigated the Noble case and there’s no name listed on the internal affairs investigator’s notes.

In 2004, a mother reported to police that Noble propositioned her daughter, a Lee University student. This was one day after Noble reported that the young woman propositioned him while he was interviewing her over a harassment complaint she had filed against a fellow student. No formal complaint was filed.

And in 2009, Noble admitted that he had had three sexual affairs — including one with the wife of a fellow officer — while on duty.

Noble was cited for immoral conduct, dereliction of duty, misuse of city property and falsification of documents. He was reduced in rank from lieutenant to sergeant, given 10 days off without pay, lost use of his city car for 20 days and was required to serve a year on disciplinary probation.

Contact staff writer Judy Walton at jwalton@timesfreepress.com or 423-757-6298.