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/

Insure TN is Obamacare, period!

Insure Tn is  Obamacare, period!

2/3/15
0802 am

Dress it up anyway you want!

Call it whatever you want!

Lie and deceive your constituency all you want.

Insure TN is Obamacare.

Congressman Scott Dejarlais, TN 4th District had this to say about Insure TN recently. He is a Doctor in the state of Tennessee and I would call him an expert on the subject.

“Governor Haslam’s Insure Tennessee proposal accepts federal funds in exchange for adopting Obamacare’s Medicaid expansion.”

” And while both the governor’s office and the Tennessean editorial board would like to claim Insure Tennessee is not Obamacare, that is simply not true.”

“Think about it: without Obamacare there would be no funding source for Insure Tennessee.” “The two programs are inextricably intertwined.”

“The governor’s proposal relies on the federal government to provide funding through the Affordable Care Act for 100 percent of the program until 2020, when Tennessee will be required to pay for 10 percent.”

“To complicate matters further, our debt is not the only threat to the future of this funding. ”

“My conservative colleagues in Congress are desperately working to abolish the Affordable Care Act – the very program the governor is relying on to subsidize INSURE TENNESSEE.”

“This sets up a situation where if Obamacare is repealed it will essentially be putting our state’s finances in jeopardy.”

“The governor is quick to say INSURE TENNESSEE is merely a pilot program and after two years HHS has assured his administration Tennessee will be able to end the program if we find it is not right for our state.”

“First, HHS is not an agency we should put much faith in as was seen in their complete mishandling of Obamacare’s rollout.”

“Second, it is extremely difficult to name a single government program that once established was eventually repealed.”

“The general rule is that once government establishes a program, it is usually here to stay.” he concluded in a recent interview. (Source below)

Haslam, Kevin Brooks and others have repeatedly said Insure TN is not Obamacare!  

This is a lie!

In an interview Q and A with the Cleveland Daily Banner recently State Representative 24 District Kevin Brooks talked about Insure Tn, defending claims by the Koch Brothers and AFP that he has betrayed Tennesseans by now supporting Obamacare in our state, a claim he denies.

His statements below sure sound like he is sold on Insure Tn, ie, Obamacare. But a vote occurs today and we will see.

Brooks says “I would not be surprised if this is one of at least two special sessions — one to turn the switch on and another to see if we want to continue or flip the switch off,” Brooks said. “That’s why I can say this is not Obamacare. Yes, there’s care, but it’s an attempt to ensure that Tennesseans have a healthy future and it won’t be costly.”

He went on to deceptively say ““This plan is Tennessee-unique and Tennessee-specific. It is not Obamacare,” Brooks said. “You cannot call it Obamacare; it is a health care plan to help these 200,000 Tennesseans that currently do not have health insurance. It is not going to cost Tennesseans any of their state tax dollars.” 

Brooks went on to say support has been overwhelming for him and is taking the AFP/Koch Brothers  attacks on him as personal, like a David and Goliath epic biblical struggle. 

I can assure you this is strictly political. A personal attack makes no sense. What benefit would it be to the Koch Brothers for this to be personal? He voted he did not want Obamacare in the state a few months ago and now it appears he does want Obamacare in the state. This isn’t personal, it’s political. This is strictly a discussion of your voting record.

I predict Brooks will probably go with Haslam and vote for the measure and the deceptive delays and avoidances will be just that.

What does the 24th District Tn State Representative expect will happen to his constituency when and if it passes and then “we” decide we do not “like” it? 

Those 200,000 plus you insured through Obamacare gets dropped and are returned to their previous uninsured status. This will leave veterans, disabled, elderly and poor people without insurance again. Wanna talk about “injury?” Giving, then taking away is pretty harmful to a group of constituents if you ask me. Then let’s not even discuss what it will cost those constituents in the form of higher taxes or what it could do to our budget.

Why not take our state back and find a workable situation to provide healthcare without a 1.4 billion price tag per year? Why not give them some longevity with their care? How about putting a think tank together and come up with solutions outside of Obamacare and the federal government?

To continue to say this is not Obamacare is irresponsible and puts  hundreds of thousands of Tennesseans at a disadvantage.

Attorney General Herbert Slattery was recently asked to give his opinion of the Haslam/Obama Insure plan. I understand Mr Slattery to be a friend and ex co-worker of Bill Haslam. He had this to say about Insure Tn, although, I doubt he knew he was not helping Haslams argument for Insure Tn. With that said, I doubt you will hear Haslam or Brooks reciting this opinion recently provided by Slattery.

In his opinion, Tennessee Attorney General Herbert Slatery says “the state can expand health care coverage through the Affordable Care Act and eventually revoke that coverage if it follows correct procedures.”

“Tennessee may expand its Medicaid program through the Affordable Care Act — also known as OBAMACARE — and discontinue that program in the future.”

He continues on page 5, paragraph 3, Slattery confirmed, although Haslam/Brooks has been denying:  Medicaid expansion as that proposed in Insure TN is, in fact — Obamacare.  

“The authority to create Insure TN is authorized and paid for by the Affordable Care Act (Obamacare) and is administered under the rules as laid down by the ACA”(Obamacare).

“All states looking to expand their Medicaid coverage in any way using funds made available by the Affordable Care Act must submit a proposal to federal health officials”

“The opinion clearly notes the plan expands coverage through the Affordable Care Act….”the state can expand health care coverage through the Affordable Care Act and eventually revoke that coverage if it follows correct procedures.”

This AG opinion sheds no doubt that this plan expands coverage through the Affordable Care Act, ie, Obamacare.

INSURE TN IS OBAMACARE!!!

Let’s pretend a Doctor who happens to be a Congressman in the 4th District and  true conservative is lying when he says Insure Tn is Obamacare.

Let’s also pretend that AG Slattery who also happens to be a friend and ex coworker of Haslams is also wrong.  We e are left with few options but to look at the plan and see it’s reliance upon Obamacare for it’s existence.

Remember, even Haslam or Brooks doesnt fully know what is in the plan but lets look at what we do know.

 Is this beginning to sound familiar? Let’s vote on it then we read it? Can we channel a little Pelosi anyone?

1) It encourages enrollment of able bodied, childless healthy young people that can sustain health and to focus on preventative health. Basically to consume little healthcare and to pay for those that are sick, just like Obamacare.

2) The Governor cannot unilaterally say Insure Tn can happen, he must have the legislatures approval.

3) “Haslam touts his “verbal agreement” with the Obama administration as a “market-based Tennessee solution”

4) The plan details are not easily accessible.

5) The majority would consume healthcare as a regular Tn Care patient but many could receive federal subsidies to offset employee sponsored healthcare coverage, just like Obamacare.

6) individuals below the poverty line would pay no premium and would pay a nominal co pay for prescription drugs. Sounding familiar?

7) Those above the poverty line would pay nominal co pays. A 20-25 dollar suggestion premium with no teeth or penalty if you don’t pay. Sound like socialism?

8)  Haslam offers a benefit package for those in good health just like managed care organizations have done for years and yes like Obamacare. The real challenge do those at the poverty level have the motivation or means to practice “healthy practices” or do they as witnessed continue to consume non frugally because it’s basically “free healthcare”, like Obamacare?

9) It is subject to the same cost sharing limits as traditional Medicaid, utilizes the same existing Medicaid system to deliver the same services and benefits as Medicaid.

10) The plan would operate under a Medicaid waiver, require an amended state Medicaid plan to implement and would be funded through the Medicaid plan, just like Obama intended from the beginning.

11) Is 100 percent funded through the federal government via the ACA, Obamacare till 2020. What if Obamacare is rescinded, I don’t wanna discuss those ramifications and cost to the state. This is a 100 percent cost to you the TN taxpayer. 

Remember Medicaid expansion in the early 1990s resulted in 300 percent debt above expected costs and enrollment shoving the state into near bankruptcy, a failing credit rating, a near state income tax and consumption of nearly 40 percent of the states total budget? 

The trouble with “free healthcare” under a state plan via Obamacare is exactly that, it’s free!

If you throw out a free state program via the federal government to those who unfortunately have very little, it will be ravenously and uncontrollably consumed. Consumed much like a wild animal being thrown a steak.

Costs will sore, few will restrain. At this point we may very well pull coverage from those who truly need it because we have a plan that does not reward low consumption, but encourages consumption. 

The corporations involved only make money when resources are consumed and believe me this will be encouraged. There is no incentive not to consume or penalty for doing so. The free fall begins!

The recipients of free healthcare see this as an entitlement and under these conditions cost control will not happen nor will over consumption be squelched. Costs will inevitably be beyond state budget restraints.

This formula being devised by Haslam and with the action oriented support of State Representative Kevin Brooks is a recipe for disaster and begs one to ask why would you want Obamacare in TN when just a few months ago you didn’t want it? My guess is follow the money, it may make all this very clear.

Regardless if you believe this blog and it’s culmination of facts, whether you believe Obama, Haslam or Brooks, INSURE TN, ie, OBAMACARE is bad for Tennessee.

INSURE TN IS OBAMACARE!!!

The opposite is being echoed by Haslam and Brooks!

Sources of info: 

I want to thank Forbes, the Cleveland Daily Banner, The Tennessean, all web solutions, Congressman Dejarlais, Rocky Top Politics and all others for their excellent coverage of this subject and the most excellent resource for my talking points. Please support these media outlets and visit their sites frequently. 

http://www.tennessean.com/story/opinion/contributors/2015/01/31/insure-tennessee-funds-linked-obamacare/22596057/

http://www.forbes.com/sites/theapothecary/2014/12/18/insure-tn-will-assure-more-obamacare-in-tennessee/

AG Slattery opinion “it is Obamacare”
http://www.allwebsolutions.net/politics/ag-state-can-expand-medicaid-through-insure-tennessee/

http://rockytoppolitics.com/