47 million uninsured? Try 14.5 million

Posted on Sep 2, 2009 in Health Care Reform

They say you can use statistics to tell any story you want. Just make the numbers do what you need them to. We’ve all heard the lawmakers in favor of a public plan throw out a figure of 47 million uninsured in the United States. Well, if you really look at the calculations, that number shrinks to an actual number of 14.7-17.5 million uninsured.

Want to know how they come up with that 47 million number?
The real number of uninsuredSo if you look at the chart on the left, you’ll see that it starts with 47 million.

Now, subtract out the 8.4 million that are eligible for Medicare/SCHIP but have not bothered to enroll in the program.

Now, subtract out the 10.2 million people who are not U.S. citizens.

Now, subtract out the 4.7 million college students who would rather spend their money on textbooks than health insurance.

Now, subtract out the 9.2 million people who are in-between jobs and have not taken COBRA or are in their benefit waiting period. This also includes those people who have incomes higher than $75,000 who could buy insurance but chose not to  those individuals who are in-between jobs and have not taken COBRA or are in their benefit waiting period.  This includes the ultra-wealthy (think guys like Bill Gates) who can afford to pay out of pocket for anything they need.

So, once you clear up the numbers, you are left with 14.5 to 17.5 million uninsured. This is only 5.7% of the current U.S. population of 304 million!

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Details of the House Healthcare Reform plan

Posted on Jul 16, 2009 in Health Care Reform

Here is a summary of the U.S. House of Representatives’ Healthcare Reform:

(Reuters) – Here are major provisions of the U.S. House of Representatives’ healthcare plan introduced by Democratic leaders on Tuesday.

NEW INSURANCE EXCHANGE, MARKET REFORMS

* Creates an insurance exchange through which individuals and small businesses could shop among private companies and a new government-run plan for insurance policies. States may offer their own exchange or join with other states to create an exchange.

* Creates a government health plan that would be offered through the exchange and compete with insurance companies.

* Both the exchanges and the new government health insurance would start in 2013.

* Creates an independent agency, the Health Choices Administration, within the White House to work with states to oversee the proposed new health insurance exchange and set benefit standards.

* Insurers would be barred from excluding coverage for those with pre-existing medical conditions.

* Higher penalties for insurers that give false information to Medicare.

* Congressional aides said about 9 million people would be insured by the public plan, with 21 million insured by private companies in the exchange by 2019.

* Another 164 million would be insured through their employers.

MANDATES

* Employers would be required to offer health benefits to workers or pay a tax based on payroll. Exemptions and tax credits would be available for small businesses.

* Legal U.S. residents be would be required to enroll in health insurance or face an income tax penalty of 2.5 percent. The bill would allow some exemptions.

* Government subsidies provided for premiums and cost-sharing on a sliding scale up to 400 percent of poverty.

TAXES

* Taxes on wealthy would raise $544 billion over ten years.

* Additional tax of 1 percent on income for couples above $350,000, 1.5 percent above $500,000, 5.4 percent over $1 million.

* Triggers a higher rates in 2013 of 2.0 percent for those above $350,000 income and 3 percent for those above $500,000.

MEDICARE AND MEDICAID

* Medicare Advantage plans, private insurers who operate Medicare plans in some areas, would have a “quality performance score” starting in 2010.

* Medicare Advantage plans would face reporting requirements for quality of care by 2013.

* Quality assessments may include hospital readmission rates, patient mortality after surgery, survival for patients with chronic diseases.

* Government would publish “medical loss ratios” of Medicare Advantage plans.

* Expands Medicaid health care for the poor and long-term disabled to all non-elderly with incomes up to 133 percent of the federal poverty level.

* Newborns without insurance would automatically be enrolled in Medicaid for 60 days while their eligibility is decided.

* Medicaid payment rates would increase.

* Drug companies would be required to give rebates for medicines to Medicare and Medicaid patients.

* New measures to close the gap in drug coverage in Medicare.

MEDICAL CARE

* With an eye toward saving money, a new center would be set up to study the comparative effectiveness of various treatments to help consumers and payers make healthcare decisions “that improve quality and value.”

* Center would research the effectiveness of drugs, medical tests, surgical procedures and other medical treatments.

* Center would have the power to collect data, both published and unpublished, to study medical treatments.

* New commission of healthcare companies, drug companies, patients, and others would oversee the center’s work.

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Senate Health Care Reform HELP Committee Approves the Affordable Health Choices Act

Posted on Jul 15, 2009 in Health Care Reform

The Senate’s Health, Education, Labor and Pensions (HELP) Committee today announced their health reform suggestions called “The Affordable Health Choices Act”.

I’ve been scouring the news, Twitter, everywhere for details on what was agreed upon and found nothing! And then a friend of mine in D.C. sent me an official press release that has all the details.

I don’t know how some of these things are going to happen. The recommendations call for guaranteed issue, no pre-existing conditions, and a public plan. There are also provisions for revamping various facets of the health care system, electronic medical records, wellness programs, and tuition payments for nursing students.

I do agree that our health care insurance system needs some changing. We need to address the early retirement gap for people who retire before Medicare kicks in. We need to address pre-existing condition credit for people leaving group plans and going to individual plans. We need to offer plans that are affordable for low wage families (like CHIP here in Texas). But we need to let market forces work into the equation.

There is also a provision that allows the Government to seize assets of health plans if they are deemed to be in financial distress. I think there will be a lot of those after they have to compete with the public plan.

Experienced benefits professionals will not be selling the public plan; instead each State will appoint “Navigators” to explain the plan, advertise it, and help people enroll. Qualified “Navigators” will be Unions, Chambers of Commerce, and other similar entities. Health insurers or parties that receive financial support from insurers to assist with enrollment are ineligible to serve as navigators. I think I’ll head down to my local Chamber of Commerce and have them explain to me what “total out of pocket” in relation to “coinsurance” means.

To get to the meat of the details, you will have to get past the section where everyone is patting each other on the back and saying how wonderful life will be for us all, after taxes of course.

Here is the Press Release from the HELP committee that has all the details released directly from the Committee. $1.5 Trillion and counting.

HELP Press Release

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