Claims And Issues

NO, actually, THEY are TAKING YOUR HEALTHCARE COVERAGE AWAY.

Before the Affordable Care Act was passed in 2010, this country and the availability of healthcare in it looked very different from the way it looks now.  Then, health insurance coverage was almost totally unavailable without excluding pre-existing conditions, placing limits on benefits every year and over a lifetime, and setting premiums so high that most people simply could not afford to pay them and so they famously visited hospital emergency rooms instead.

    The Affordable Care Act expanded access to health insurance in a number of important ways, including:
• Inventing and shaping marketplaces for private health insurance ;
• Stretching both the extent and the financial accessibility of health insurance coverage with a new requirement that health insurance plans offered to individuals and small groups include a minimum level of “essential health benefits” including emergency care, hospitalization, maternity and newborn care, outpatient services, mental health treatment, rehabilitative services and devices, prescription drugs, preventive services, and pediatric care, and
• Barring discrimination against individuals based on their health status, eliminating exclusions for pre-existing conditions, and mandating through a "guaranteed-issue provision" that health-insurance providers "must accept every employer and individual in the State that applies for such coverage."

    Congress has considered many bills since 2010 when the ACA was first enacted, which would "repeal, defund, delay, or otherwise amend the ACA—including legislation that would have repealed the entire Act." Although many bills were introduced during that time to repeal the individual mandate and even to repeal the entire ACA, they never had the votes. The substance remains unchanged through the time of this writing in 2020.

    And now it's on to the U.S. Supreme Court once again, and let's see if they have the votes there to "repeal, defund, delay, or otherwise amend the ACA."

To be continued tomorrow on Claims and Bad Faith Law Blog.  Adapted by the author from his new Chapter 18E forthcoming in the Spring of 2020 in the book, CATASTROPHE CLAIMS:  INSURANCE COVERAGE FOR NATURAL AND MAN-MADE DISASTERS (Thomson Reuters).  Please Read The Disclaimer. ©2020 Dennis J. Wall.  All Rights Reserved.

THE CENSUS, THE STATES, AND THE AFFORDABLE CARE ACT.

The constitutionality of the Affordable Care Act is on appeal.  Again.

Twenty States are suing to declare all of the ACA unconstitutional because Congress in 2017 reduced a tax to zero dollars.  (Seriously.)  The 20 States contain a collective population of 135,928,851 according to U.S. Census 2019 Population Estimates.

Twenty States plus the District of Columbia are on the other side defending the ACA.  They have a collective population of 158,550,088.

To put the difference in perspective, it is greater than the population of the entire State of Florida.  So even if everyone in Florida was accounted for, and even if all the people in all the States were all for or all against the ACA depending on whether their own States were suing or defending the ACA's constitutionality, there would still be 2 Million more people left over who want the Affordable Care Act's provisions to continue.

And that's the way it is.

Please Read The Disclaimer. ©2020 Dennis J. Wall.  All Rights Reserved.

SPEAK, MR. BARR, SPEAK.

A guest article by John K. DiMugno, Esquire, a California attorney, legal educator, and the author or coauthor of multiple legal treatises and legal periodicals published by Thomson Reuters.

William P. Barr, Attorney General of the United States, recently spoke at the American Law Institute’s Annual Meeting in Washington, D.C. The ALI likely extended the invitation shortly after Mr. Barr’s confirmation when there was hope that he would play a role similar to that of the departed General Mattis and General McMaster and place guardrails on the President’s more authoritarian instincts. By the time of the Annual Meeting, those hopes had evaporated. Mr. Barr’s dissembling about the contents of the Mueller Report raised serious concerns about the Attorney General’s complicity in administration efforts to undermine the rule of law.

This Blog highlighted the incongruity between Mr. Barr’s conduct in office and the core mission of the ALI. Notably, Mr. Wall’s post made no attempt to silence Mr. Barr, a solution that would have satisfied the wishes of many in the ALI who were rightfully appalled by Mr. Barr’s transparent attempt to mislead the American public. But barring Mr. Barr from speaking would have entangled the ALI in partisan politics, something the organization scrupulously avoids for good reason. Staying above the political fray insulates the ALI’s Restatements of the Law against charges of political bias and broadens their influence on courts and legislatures around the country.

Mr. Wall’s proposed solution—letting Mr. Barr speak while contributing the ALI’s earnings from the speech to legal aid societies around the country—perfectly balanced those competing concerns. It had the salutary effect of simultaneously benefitting public interest groups that desperately need the money while drawing attention to questions about Mr. Barr’s integrity.

Mr. Barr’s penchant for making transparently misleading and often contradictory statements has left some wondering what he hopes to achieve other than aggrandize power and influence in the Trump administration. Sharon LaFraniere, Charlie Savage and Katie Benner, People Are Trying to Figure Out William Barr. He’s Busy Stockpiling Power, New York Times on line, June 9, 2019. 

He misled the American public about the contents of the Mueller Report knowing full well that when the report was released several weeks later his lies would be evident to everyone.

When Mr. Barr sought confirmation as Attorney General, he told the U.S. Senate that he had known Robert Mueller for years and did not believe that Mr. Mueller would engage in a “witch hunt.”  Yet, shortly before his confirmation hearings, he sent a memo to the Justice Department characterizing the obstruction of justice charges against the President as “asinine” and sent an e-mail stating he saw far less reason to scrutinize the Trump campaign’s ties to Russia than to investigate whether donations to Hillary Clinton’s family foundation had influenced her actions as secretary of state. Once he was confirmed, he enabled the President’s attempts to distract from the contents of the Mueller Report by opening an investigation of those who investigated him.

When Mr. Barr was seeking confirmation, he told the U.S. Senate Judiciary Committee that he was willing to reconsider the Justice Department’s decision not to defend the Affordable Care Act (ACA).  But, when he became Attorney General, he put the resources of the Justice Department behind litigation in Texas federal district court seeking to invalidate the entire Affordable Care Act.

As the song goes, “There’s something happening here. What it is ain’t exactly clear.” Buffalo Springfield, For What It’s Worth.  I say let Mr. Barr speak. Listen closely to what he says and watch what he does. Only then will whatever is happening start to become clear.

Download John DiMugno 06 13 19 Blog Article for IC Also (2)

Please Read The Disclaimer.

HEALTHCARE COVERAGE: STILL THERE, YOU CAN SIGN UP RIGHT NOW.

Is Healthcare Coverage still available under the Affordable Care Act?

Absolutely.

Can you and can your clients still sign up?

Definitely.

Will you and will your clients be able to sign up now if you want?

Totally.

Answers to these and other important questions are reported in an excellent article by Haeyoun Park, "Yes, You Can Still Enroll in Obamacare:  Five Answers to Questions About Getting Covered" (New York Times online, posted on Saturday, October 14, 2017).

Please Read The Disclaimer.  ©2017 by Dennis J. Wall.  All Rights Reserved.

NOTE TO HARVEY, IRMA & MARIA: "FLOOD" INCLUDES BROKEN WATER MAIN.

A first-party property insurance policy containing both specified perils or multiperils coverages, and specified perils or multiperils exclusions, if you will, was not rendered ambiguous as a result, in Comley v. Auto-Owners Ins. Co., NO. 2016-CA-001305-MR, 2017 WL 4448528 (Ky. Ct. App. October 6, 2017; Stated Not Final And Not to be Cited As Authority in Kentucky Courts).

The facts of that case center around a water main outside the plaintiff's property.  The water main broke and inundated plaintiff's-policyholder's house and personal property with damage.  Kentucky's intermediate appellate court held that the water damage exclusion for a "flood" did not require natural causes in order for the exclusion to apply.

Accordingly, the policy at bar was not ambiguous and the policyholder's claimed damage was excluded "water damage," the Kentucky Court of Appeals held in that case.

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2018 OPEN ENROLLMENT RUNS FROM NOVEMBER 1 THROUGH DECEMBER 15.  READY?

If you or your clients do not have health insurance coverage, check out and sign up at www.healthcare.gov.

You may not have heard the word that health care coverage is available -- right now, today, even as you read these words.  It's your right.  It's the law of the land!

Please Read The Disclaimer.  ©2017 by Dennis J. Wall.  All Rights Reserved.

HEALTH CARE COVERAGE.

If you or your clients do not have health insurance coverage, check out and sign up at www.healthcare.gov.

You may not have heard the word that health care coverage is available -- right now, today, even as you read these words.  It's your right.  It's the law of the land!

Please Read The Disclaimer.  ©2017 by Dennis J. Wall.  All Rights Reserved.

Is This Conduct in Office Malum in Se?

I was originally preparing an article to post here on the issues raised by "Trump Administration Sharply Cuts Spending on Health Law Enrollment," by Abby Goodnough and Robert Pear (New York Times online, posted on Thursday, August 31, 2017), also available at https://www.nytimes.com/2017/08/31/health/affordable-care-act-trump-spending.html (subscription may be required).

Then came another article raising issues of what to do when the federal government which is supposed to spend money to enforce a law, instead spends that same money to dismantle the same law, see this article posted online on Labor Day 2017, by Audrey Carlsen and Haeyoun Park, "The Same Agency That Runs Obamacare is Using Taxpayer Money to Undermine It"  (New York Times online, posted Monday, September 4, 2017), also available at https://www.nytimes.com/interactive/2017/09/04/us/hhs-anti-obamacare-campaign.html.

If these people were using their own money to dismantle the law they swore to enforce, that would not eliminate at least the issue of how can public officers they get away with acting against the public interest?  Concentrating on remaining insurance coverage issues is part and parcel with that issue.

Related questions, then:  Since the law in question that these people took an oath to uphold is the Affordable Care Act, what remedies are available to the people who have enrolled for health care insurance under that law?

And do those available remedies include a mandatory injunction to make public officials obey the law they have sworn to uphold and enforce?

Please Read The Disclaimer.  ©2017 by Dennis J. Wall.  All Rights Reserved.

"FAKE INSURANCE?"

Senator Mitch McConnell has announced that he does not have the votes to bring the latest attempt at Trumpcare to a vote in the Senate, not without the vote of Senator John McCain who must convalesce from sudden eye surgery.  Godspeed John McCain.  Take your time coming back.

When if ever there is a vote on Trumpcare, will this "insurance" provide much coverage?  The current iteration of Senator McConnell's Trumpcare bill, as reported in an Associated Press Copyrighted story published on Sunday, July 16, 2017, reporting the views of legislators, "will, among other things, gut protections for people with pre-existing conditions and kick millions of people off Medicaid."

And see Lenny Bernstein and Paige Winfield Cunningham, "Health & Science / ‘Bare bones’ insurance policies really only work for people who are healthy," (Washington Post Online, posted on Saturday, July 15, 2017) (subscription may be required).

Insurance without coverage is fake insurance.

Sad!

Please Read The Disclaimer.  ©2017 by Dennis J. Wall.  All Rights Reserved.

SENATOR RUBIO, UNBLOCK!

I wrote on Sunday about the healthcare insurance proposal called Trumpcare that one of my senators' offices blocked EMails about it.

I saved one of the returned "undelivered" EMails.  My EM was sent to the office of Senator Marco Rubio of Florida.  Here is the part with the "undeliverable" details.  I have emphasized the "Blocked" part to make it easier for you to see:

A message that you sent could not be delivered to one or more of its recipients. This is a permanent error. The following address(es) failed:

  [email protected]

    host p-ess-ppmx2.senate.gov [156.33.195.96]

    SMTP error from remote mail server after initial connection:

    554 Blocked -

  [email protected]

    host p-ess-ppmx2.senate.gov [156.33.195.96]

    SMTP error from remote mail server after initial connection:

    554 Blocked -

After I wrote about it, my ip address is apparently no longer being blocked.  Senator Marco Rubio, unblock ALL the people!

Please Read The Disclaimer.  ©2017 by Dennis J. Wall.  All Rights Reserved.

SENATOR RUBIO, YOU HAVE NO RIGHT TO CALL YOUR RULE AMERICA.

After many weeks of secrecy with no debate and no hearings, Senator Mitch McConnell last Thursday introduced a "draft" Trumpcare bill in the U.S. Senate that was written for the United States by thirteen hand-picked men.  For his part, Senator Marco Rubio's office has blocked EMails from his constituents, the people of Florida, about healthcare insurance coverage.

They may hurt people behind closed doors in Russia, but not in the United States.

They may gag their victims to silence their cries of pain in Castro's Cuba, but not in the U.S.

Their so-called "people's representatives" may refuse to listen to the people they are supposed to represent, but not in America.

They may rule, if we let them.  But they have no right to call their rule America.

Out of the many insurance coverage and bad faith cases that Dennis Wall has litigated, the hardest cases were the ones that centered around secrecy.  He is currently at work on his latest book, "Concealed Evidence and Secret Settlements:  How They Take Our Money, Foreclose on Our Homes, and Ruin Our Lives" ©Dennis J. Wall.

 

Please Read The Disclaimer.  ©2017 by Dennis J. Wall.  All Rights Reserved.

ENDING HEALTHCARE WITHOUT A VOTE.

Healthcare.gov may become a portal without a port.  Like any online venue, it needs to be updated.  It also needs to be improved.  Without enough people to work on the site, it will not be staffed adequately.

There are also some deeper questions including about the levels at which subsidies are set for the health insurance coverages offered through the portal.

A major question is about whether or not the income levels are set at the right "height" to allow people to qualify for financial help in paying their health insurance premiums, or whether they need to be adjusted.

The 180 million people in the U.S. who have employers who pay part of their health insurance premiums are not affected by these questions or by the answers to them.  They have subsidies from their employers, in reality, and so they are not really affected very much by questions about subsides from the federal government.  Not nearly as much as the people who do not have employers who will pay part of their health insurance premiums, people who would pay 100% of their health insurance premiums without subsidies from the government.

According to former Health and Human Services Secretary Kathleen Sebelius, whose past service includes being the Kansas Insurance Commissioner, "if some decisions aren't made pretty quickly that stabilize the market and actually encourage more competition for 2018, I think you may see, sooner rather than later, a market collapse.  In general, most economists believe that this is not a market currently that is in a so-called death spiral....  But if the administration actually, intentionally wants it to fall apart, then it could happen."  Kathleen Sebelius, quoted by Nick Tabor in "Kathleen Sebelius Knows Better Than Anyone How Trump Can Still Mess With Obamacare" (New York Magazine Online, posted on Friday, March 31, 2017), also at http://nymag.com/daily/intelligencer/2017/03/kathleen-sebelius-how-trump-can-still-mess-with-obamacare.html (last accessed on Tuesday, April 4, 2017).

When the government actually, intentionally wants things to happen and dozes in inaction whenever the law requires a thing to be done, or when the government actually, intentionally does not carry out specific duties of office, there is a remedy.

The remedy is an ancient one.  And it is equitable.  In fact, this remedy was made for exactly the kind of situation under discussion here.  It is the ancient remedy of mandamus.

Mandamus was invented to check the failure of kings to perform their duties.   Whether mandamus is available in your jurisdiction depends on what judges have done to it there, because mandamus has been treated differently by different courts.  In some places, for some reason mandamus may even have been abolished.  In other places, the writ is still available to force the king to perform the king's duties. 

Now may be a good time to think about using pre-existing remedies to address present issues.

Please Read The Disclaimer.  ©2017 by Dennis J. Wall.  All Rights Reserved.

 

HSA'S: "HIGHLY SUSPECT ALTERNATIVES" TO HEALTH INSURANCE?

Health savings accounts may not be such a good option for you or your clients.  We have been examining some of these patient solutions recently.

Health savings accounts demonstrably work best if you or your clients have a health insurance plan with a high deductible and you do not try to put off healthcare costs thinking that keeping a health savings account balance high is like keeping a savings account balance high.  "A high balance doesn't help if you die because you did not want to spend your H.S.A. money to have a doctor check a mysterious lump."  Ron Lieber, "HEALTH INSURANCE / Your Money" (Online on Friday, February 24, 2017).  This "Your Money" column is a good place to "begin with a quick review session on H.S.A.s."

So, the people who will get the most out of health savings accounts as their health insurance are wealthy people with steady incomes increasing their wealth and therefore with a greater need for income tax deductions than for having the money to pay for healthcare.

"Is that something we wish to cement and perpetuate? Because if we do, our health care system will start to resemble a wealth care system, too."  Ron Lieber, "HEALTH INSURANCE / Your Money" (Online on Friday, February 24, 2017).

Please Read The Disclaimer.  ©2017 by Dennis J. Wall.  All Rights Reserved.

CUTTING THE FEDERAL BUDGET BY CUTTING MEDICAID ... INCREASING STATES' BURDENS.

In the course of signing a new law that would attack heroin overdose, Governor John Kasich, Republican of Ohio, was reported by the Toledo Blade newspaper to say:

“We have spent a billion dollars on this issue. A billion dollars…,” Mr. Kasich said. “Thank God we expanded Medicaid, because that Medicaid money is helping to rehab people…There are going to be more tools to come, but we’re not going to defeat this just from the top down.”

Toledo Blade Online, January 4, 2017.

When Medicaid is not available to help to rehab people, for one thing, then there will be more people presenting drug overdoses to hospital emergency rooms.  And the bills will go to the States, not Washington.

And a billion dollars will look like pocket change.

But the money will not show up in the new Federal budget.

Please Read The Disclaimer.  Copyright 2017 by Dennis J. Wall.  All Rights Reserved.

 

 

MEDICAL CARE COSTS UNTOUCHED BY INCREASING PATIENTS' COSTS, CUTTING GOVERNMENT COSTS.

There are three "balls in the air" so to speak for health insurance costs and coverages, and each one comes back to costs:  The costs of medical care, patients' costs, and government costs.  For any new proposal to replace the Affordable Care Act a/k/a "Obamacare" (and there will be many), look for how it handles the costs of medical care.

The current proposals include all or some combination of the following measures:

1. Higher deductibles and co-pays paid by patients.  Higher deductibles and co-pays do not lower the costs of medical care.
2. Cost-sharing which reduces government costs with a corresponding increase in patients' costs. (The twin effects of cost-sharing, where it has been implemented, are that it causes patients to (1) skip necessary treatments or (2) cut back on prescribed medicines, and (3) both.)  Cost-sharing does not reduce the costs of medical care.
3. Narrower physicians networks, such that with fewer physicians to choose "in network" patients' costs go up whenever they cannot find treatment in the narrow limits of the carrier's "network" and so the patient pays more going "out of network."  Narrower physicians networks do not reduce the costs of medical care.
4. Return to the pre-existing condition exclusion. Again, the only group that pays more under this measure is the only group containing the people who need medical care:    Patients.  The pre-existing condition exclusion bars coverage for the costs of medical care for pre-existing conditions.  Period.  Moreover, government costs for healthcare are reduced substantially while patients' costs for healthcare are increased substantially.  The pre-existing condition exclusion never reduced the costs of medical care and it will not reduce the costs of medical care now.

All of these points and more are discussed by Professor C.F. Chang in his op-ed piece in the Memphis Commercial Appeal on Lincoln's Birthday, 2017.

Two points before closing, to be addressed by these measures and by any substitute proposal for that matter:

What is the point of having a government program if the government's only purpose is for government not to pay for the program, but just to shift existing government costs to patients to pay?

And, what is the point of shouting "reducing costs" if the proposal totally leaves the costs of medical care untouched?

Many people can think up better solutions than these.

Please Read The Disclaimer.  ©2017 by Dennis J. Wall.  All Rights Reserved.

ALTERNATIVE HEALTH CARE POLICIES AND PROPOSALS: EXPLORING THE NEXT FRONTIER.

This article is being posted a little later than usual this morning.  I hope you will find it worth the short wait.

Much is still being written lately about the repeal of the Affordable Care Act, or "Obamacare."  Once the ACA is repealed, the question of course becomes what will replace it. 

Insurance Claims and Issues Blog will continue to take a look at the main replacement proposals and the health care policies behind them, drawing on the far more granular observations in the easily understandable essay by Allison K. Hoffman, "The Unhealthy Return to Individual Responsibility in Health Policy" published on January 16, 2017 on RegBlog, the University of Pennsylvania Blog on Regulation.

We continue with a look at vouchers.  The announced theory behind replacing insurance under the Act with vouchers is freedom of movement.  Voucher proposals would allow patients to take their voucher in hand and buy the kind of medical treatment they want, similar to those TV commercials I suppose that encourage people to tell their doctors what drugs the manufacturers want doctors to prescribe.

The voucher proposals voiced so far have a major flaw for most patients, however.  The vouchers proposed so far would not keep pace with inflation.  They would be just like a dollar bill in the sense that they would not be enough to cover the doctor bills as time goes on, because even putting inflation to one side, the costs of doctors and drugs are rising even faster than inflation.  The medicalcare reality is that unless vouchers under any name -- voucher, tax credit, or tax deduction -- keep pace with and match doctors and drug costs, they would be a down payment at most.

On the other hand, vouchers would reduce the federal budget if they do not keep pace with medical costs.  It is the patients who would pay the costs, or go without medical care.

Vouchers that do not keep up with medicalcare costs leave no other choice.

Please Read The Disclaimer.  ©2017 by Dennis J. Wall.  All Rights Reserved.

ALTERNATIVE HEALTH CARE POLICIES AND PROPOSALS Part 2: "CATASTROPHIC" HEALTH INSURANCE.

Have you noticed just how much has been written lately about the repeal of the Affordable Care Act, or "Obamacare?"  Once the ACA is repealed, the question of course remains what will replace it. 

On Insurance Claims and Issues Blog, we began taking a look at possible replacements, starting with Health Savings Accounts or HSA's on Monday, January 23, 2017.

Today we will take a look at another potential 'replacement' for health care:   Catastrophic Health Insurance.

One of the points about the ACA or Obamacare that has drawn a lot of attention is that many people earning "about $30,000 to $50,000 a year" have policies currently with deductibles of $6,000 to $12,000.  Removing subsidies that prop up the payment of premiums even for that much coverage may not leave much of an alternative.

Catastrophe Health Insurance, whether or not supported by subsidies, "often have deductibles of around $14,000 for family coverage."  New York Times Editorial, Sunday, January 21, 2017, also accessible at https://nyti.ms/2kcTPr2.  It may be that numbers in a New York Times editorial have been 'skewed' toward the result preferred by the editorial.  Be that as it may, these numbers have not been offered by the persons who suggest that Catastrophic Health Insurance is an alternative to health care insurance.  It remained for the New York Times Editorial Board to state them when there was no other source for them.

Catastrophic Health Insurance would demonstrably be worse, at least on average and perhaps totally, than Obamacare with higher deductibles.  If the sick and injured are not seeking health care now, when their premiums are subsidized for policies even with $6,000 to $12,000 deductibles, even fewer people are likely to seek health care when their premiums are not subsidized as much or at all, for policies with $14,000 deductibles.

Indulge me with the following baseball analogy that I find apropos here.  You replace a home-run hitter with another home-run hitter.  You don't "replace" a home-run hitter with a utility infielder.

Or, to put it another way:   If you're the Chicago Cubs, and heaven forbid Anthony Rizzo goes to say the New York Yankees or some other place for more money or for whatever reason, you don't "replace" Anthony Rizzo with an overweight guy who never played baseball above Class A, let's say, and expect people to believe you when you call the Class A guy a "replacement."

Next:  More alternative health care policies and proposals.  Please Read The Disclaimer.  ©2017 by Dennis J. Wall.  All Rights Reserved. 

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ALTERNATIVE HEALTH CARE POLICIES AND PROPOSALS.

Much has been written lately about the repeal of the Affordable Care Act, or "Obamacare."  Once the ACA is repealed, the question of course becomes what will replace it. 

Insurance Claims and Issues Blog will take a look at four of the main replacement proposals and the health care policies behind them, drawing on the far more granular observations in the easily understandable essay by Allison K. Hoffman, "The Unhealthy Return to Individual Responsibility in Health Policy" published on January 16, 2017 on RegBlog, the University of Pennsylvania Blog on Regulation.

We begin with a look at Health Savings Accounts (HSA's).

Health Savings Accounts are not insurance policies.  Nor are they health plans.  Rather, they are financial instruments.  HSA's are available as a matter of choice right now.  If HSA's are made to replace the Affordable Care Act, presumably their tax benefits will be expanded beyond the present level of tax benefits they afford, so as to make them even more attractive to health insurance policyholders.

HSA's are maintained by individuals like savings accounts in a bank.  The individual deposits money in the HSA, just as in a savings account, except that in the case of an HSA the money is to be used for health care.

HSA's enjoy tax advantages right now.  Currently the Internal Revenue Service "stipulates that these accounts must be paired with a high deductible plan -- at least a $2,600 deductible -- and have a maximum annual contribution of $6,750 for family coverage in 2017."  Allison K. Hoffman, supra.

So, the reason that an HSA is attractive to anyone is that it affords tax savings.  The purpose of the tax savings is to encourage saving for medical expenses.  If a person saves her money "for a rainy day" in an HSA, or in this case, saves her money in an HSA to pay medical bills, then she will either be able to spend that money on out-of-pocket health expenses, tax free, or at least get a tax break for her HSA deposits.

The health care policy at work behind HSA's is clear:  HSA's are offered to attract individuals who may be responsible enough to manage their health care expenses, by providing a tax incentive to save for them.  This may be true for people who are fortunate to have enough money to deposit in the HSA's.

How large a set of persons the health care policy may reach, however, remains to be demonstrated.  In the meantime, it may legitimately be asked of HSA's, "what if any benefit is there for a person whose tax reduction if any would have no effect on their household budget?"  What difference would it make not paying taxes on out-of-pocket medical expenses, if there is no food on the table, no fuel for the heater, or gasoline in the car (if there is a car at all)?

This kind of jumps the gun, however.  The first question to ask is how many people can afford to make deposits in health savings accounts in the first place?

Where are the numbers to answer these questions?  Once the answers are proffered to support HSA's as an actual, viable alternative health care proposal, what are the numbers based on?

Answers to these and other questions should be found first, before HSA's become the law.  Unless we want to base the law on speculation without evidence.  That would not be stepping backward.  In the final analysis, that would be law supported only by force, without any reason for public obedience.

Please Read The Disclaimer.  ©2017 by Dennis J. Wall.  All Rights Reserved.

THE AFFORDABLE CARE ACT, NOT THE ECONOMY, MAKES US HEALTHY.

According to a copyrighted Associated Press report published on March 21 in the Washington Post, the accumulating evidence on the question shows "most of the dramatic gain in the number of Americans with health care coverage" is on account of the Affordable Care Act and "not the gradual recovery of the nation’s economy."

Even the American Enterprise Institute writes publicly and for attribution about the ACA's achievements.  The report notes that 10 "health policy experts" reported to the American Enterprise Institute that because of the good results it has produced, the ACA should not be replaced without an adequate substitute available. 

Please Read The Disclaimer.  ©2016 by Dennis J. Wall, author of "Insurance Claims and Issues" (forthcoming Thomson Reuters 2016).  All rights reserved.

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AFFORDABLE CARE ACT'S SILENT SUCCESS FOLLOWS BOBOS' BLUSTER. Shhh.

Obamacare: What's in a Name? Nothing. Look It Up.

AFFORDABLE CARE ACT'S SILENT SUCCESS FOLLOWS BOBOS' BLUSTER. Shhh.

   More people have signed up for the Affordable Care Act than were predicted to sign up.  The numbers of uninsured have been reduced and Medicaid has been expanded in States which have accepted the Federal Government's offer of a 0% expense for joining the expansion over the next couple of years.

    These achievements have come more or less in silence.  Particularly when these achievements are stood up alongside the very loud failed predictions of doom from opponents of the ACA a/k/a Obamacare.

    Do we have to listen to those people anymore?

    Please Read The Disclaimer.  Copyright 2014 by Dennis J. Wall.  All rights reserved.  No claim to original U.S. Government Works.

 

 

 

 

 

 

 

 

 

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Medicaid Expansion, Insurance Exchanges Under the ACA ... And More.

CONVINCING ANYONE YET? COVERAGE, CONTRACEPTION, AND THE COURT.

           On the same morning as this article is written, the U.S. Supreme Court is scheduled to release its opinion striking down coverage for contraception.

          The opinion will or may continue the Court's trend of writing words which convince very few people, probably not even the Justices themselves.   If we want to find an explanation of the issues involved and how past precedents might have been used by judges and lawyers to resolve those issues, we may want to look elsewhere.

          The issues are all addressed and the precedents all seem to be thoroughly examined in this comprehensive article published in 2013:  DiMugno, “The Affordable Care Act’s Contraceptive Coverage Mandate,” 35 Insurance Litigation Reporter 5 (Thomson Reuters 2013).

© 2014 by Dennis J. Wall.  All rights reserved.  No claim to original U.S. Government works.

Please Read The Disclaimer.

 

 

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THE "AFFORDABLE Catholic CARE ACT" PERCEPTION OF CONTRACEPTION.

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Sixth Circuit Rejects Challenge to Contraception Mandate Accommodation

THE "AFFORDABLE Catholic CARE ACT" PERCEPTION OF CONTRACEPTION.

   Six of the sitting Justices on the United States Supreme Court are Catholic.  Catholic Church doctrine holds that artificial means of contraception are forbidden.  The Supreme Court has on its docket of pending cases several that present the question of whether employers and corporations which oppose contraception on religious grounds (a corporation is a person, my friend, and sometimes a person has religious beliefs), must provide a group health insurance plan or policy which includes coverage for women who elect to use artificial means of contraception.

   So far as is known, none of the Catholic Justices has recused himself or herself in any of the cases presenting these issues.

   If or as many people have no doubt, when at least 5 of the Catholic Justices vote against artificial contraception in health insurance, and if none of the 5 has recused himself, what if any legitimacy is their decision expected to carry?

Please Read The Disclaimer.  Copyright 2014 by Dennis J. Wall.  No claim to original U.S. Government works.

   

Related articles

They Should Be Ashamed, and Notre Dame, Revisited.

More to Come: Present, Future Costs; Future Contraception and Catholics.

NUMBERS TURN TO MONEY FROM SIGN-UPS: OBAMACARE EVIDENCE OF SUCCESS.

          Numbers for Obamacare have been reported in terms of the number of people signing up for it.  Until now.

          Now it is reported that Health Insurance Companies are planning their profits from Obamacare.  Health Insurance Companies are counting up the premium money they will take in. See Chad Terhune, "Insurers Already Calculating 2015 Premiums as Obamacare Kicks In" (Los Angeles Times online, posted Sunday, March 30, 2014).

 © 2014 by Dennis J. Wall.  All rights reserved.  No claim to original U.S. Government works.

 Please Read The Disclaimer.

MARCH 31 HEALTHCARE.GOV SIGN-UP DEADLINE.

Monday, March 31, 2014 is the current deadline to sign up for health care online.  It will almost certainly be worth your time, if you like saving money and having adequate health insurance.  OBAMACARE:  WHAT'S IN A NAME?  NOTHING.  LOOK IT UP.

 

P.S.  BREAKING NEWS!  MARCH 31, 2014 IS NOT THE DEADLINE FOR EVERYONE!  MAJOR SURPRISE ANNOUNCED BY OBAMA ADMINISTRATION FOR NEWEST SIGN-UP DEADLINE!

   Open enrollment was scheduled to end on Monday for all Americans. The White House had previously insisted that the deadline was firm and would not be extended.

   Under the move planned by the administration, some people will be given a special enrollment period, beyond the deadline, if they can show they were not able to enroll because of an error by the federal exchange or by the Department of Health and Human Services. Federal officials allowed a special enrollment period, on a case-by-case basis, for some people who were unable to meet the Dec. 24, 2013, enrollment deadline for coverage starting Jan. 1 of this year.

Robert Pear, "U.S. to Extend Sign-Up Period for Insurance" (New York Times online, posted on Tuesday, March 25, 2014 for publication on Wednesday, March 26, 2014).

© 2014 by Dennis J. Wall.  All rights reserved.  No claim to original U.S. Government works.

 Please Read The Disclaimer.

Related articles

Obamacare: What's in a Name? Nothing. Look It Up.

 

HOSPITALS SELL PATIENTS HEALTH CARE PRODUCT. COST CONQUERS ALL.

And they sell their product to our Health Insurance Companies, too, of course.

 

“We want to be providing a more coordinated product that delivers health care at a lower overall cost to the community we serve,” *** ****, general counsel at St. Luke’s, told me.

Quoted by Eduardo Porter, "Economic Scene / Health Law Goals Face Antitrust Hurdles" p. B1, col. 1 (New York Times Nat'l ed., "Business Day" Section, Wednesday, February 5, 2014).

 

The moment caring for our health became a product and stopped being a profession, the terrorists won.

 

© 2014 by Dennis J. Wall.  All rights reserved.  No claim to original U.S. Government works.

Please Read The Disclaimer.

AFFORDABLE CARE ACT BENEFITS: "WHO'S RESPONSIBLE?"

          I just recently had my annual physical, which I passed with flying colors.  The doctor's office handed me some papers to fill out on my visit, as usual.  This time, one of the papers asked me to acknowledge that the physical was "free" or at least at no cost to me, courtesy of my insurance company and the doctor.

          They forgot something and left it out.

          The Affordable Care Act requires health insurance plans to provide coverage for at least one annual physical exam at no cost to the patient.

          So, it is true as far as it goes that my insurance company and my doctor provided me with a physical at no cost to me.  However, the rest of the story as they say is that the ACA made my health insurance carrier cover the cost of my physical exam at no cost to me.

          So, ask this about your ACA benefits:  "Who's RESPONSIBLE?"  The ACA, that's who.

 HAPPY NEW YEAR!

© 2014 by Dennis J. Wall.  All rights reserved.  No claim to original U.S. Government works.

Please Read The Disclaimer.

POSTSCRIPT TO More IGNORANCE OF INSURANCE IS DANGEROUS TO OUR HEALTH.

A postscript to an article posted here earlier today.

           A p.s. about "retroactive" insurance coverage.  Many health insurance companies may be providing applicants more time, until January 10, 2014, to pay their premiums for health insurance coverage beginning on January 1, 2014.  But three things:  First, they are not happy about it.

          Second, many health insurance companies may be extending the time for accepting premiums, but no health insurance companies have agreed to issue "retroactive" coverage after a loss or, in this case, after an illness or an injury.

          Third, and most important to applicants, the deadline for enrollment is today, December 23, 2013 "even as the Obama administration has urged insurers to allow retroactive sign-ups into next month."  Alex Wayne and Alex Nussbaum, "Insurers Balk at Obamacare Concessions as Health-Risk Pool Thins" (Bloomberg News at businessweek.com, posted online on Monday, December 23, 2013).

          There they go again, "retroactive sign-ups".  Not happening.

MERRY CHRISTMAS AND HAPPY HOLIDAYS IN 2013, AND HAPPY NEW YEAR IN 2014!

© 2013 by Dennis J. Wall.  All rights reserved.  No claim to original U.S. Government works.

Please Read The Disclaimer.

More on IGNORANCE OF INSURANCE IS DANGEROUS TO OUR HEALTH.

          Reportedly, one of the many ideas recently floated by the Administration was encouraging health insurance companies to offer what Administration officials called and newspaper reporters wrote would be, 'retroactive insurance coverage'.  The idea is to offer some resolution to the dilemma of millions of people who could not sign up for Obamacare on www.healthcare.gov, due to the massive failures of that website (which have been documented elsewhere).  Millions of people could still have health insurance coverage as of January 1, 2014 and afterward, under this resolution of the thing, if health insurance companies would only issue so-called 'retroactive coverage'.  These reports were explored from an insurance perspective here in an article posted on December 16, 2013, IGNORANCE OF INSURANCE IS DANGEROUS TO OUR HEALTH.

          The idea of so-called 'retroactive insurance coverage' did not implicate retroactive insurance coverage at all.  The Administration's idea, translated, was actually to postpone payment of insurance premiums by a few days to allow more people to sign up now, and pay their premiums later.  (If the applicants do not pay their insurance premiums, they will not have insurance coverage, of course.)  See Tara Siegel Bernard, "Your Money / Weighing Health Plans:  The Devilish Details" p. B1, col. 4 (New York Times Nat'l ed., "BusinessDay Section," Saturday, December 21, 2013), an article which also provides a lot of useful information on Deadlines, Deductibles, Networks, Coinsurance, and Drug Plans.

 

© 2013 by Dennis J. Wall.  All rights reserved.  No claim to original U.S. Government works.

 Please Read The Disclaimer.

IGNORANCE OF INSURANCE IS DANGEROUS TO OUR HEALTH.

In this case, I mean the Federal Government's ignorance of insurance.

           Once before, the Federal Government's ignorance of insurance was laid bare, and its ignorance hurt many people.  President Obama suggested before consulting the Health Insurance Companies that health insurers could just "reinstate" the health insurance policies they cancelled because those policies did not offer the coverages required by the Affordable Care Act a/k/a Obamacare.  The health insurance companies, who were not consulted beforehand, did not respond favorably to this idea nor did many State Insurance Commissioners.  See, e.g., the article posted on Insurance Claims and Bad Faith Issues weblog on November 17, 2013  and its postscript, posted on November 21, 2013.

          Remember that last little bit:  Many State Insurance Commissioners did not respond favorably to the Federal Government's suggestion, through the President, that cancelled health insurance policies could simply be "reinstated" in order to make good on President Obama's promise that we could all keep our previous health insurance if we liked it.  The chief of the Federal Insurance Office has since requested that the authority to regulate insurance be taken away from the State Insurance Commissioners and given to him instead.  See "Bad Faith Power Grab by Federal Insurance Office" posted on Insurance Claims and Bad Faith Weblog on Sunday, December 15, 2013.

          Now, reportedly, the Administration is suggesting that health insurance companies can simply issue "retroactive" coverage effective as of January 1, 2014, which conforms to the ACA.  The Administration is concerned with the mandate of Obamacare that people must have health coverage as of January 1, 2014.  They want that to happen even if people have not paid their health insurance premiums by then.

          The ACA is supposed to take effect on January 1, 2014 and the Administration once again wants to make that happen.  Health insurance companies, who again were not consulted in advance, did not respond favorably to the idea that insurance coverage could or should be issued "retroactively".

          Anyone who knows anything about insurance knows this much:  There is no such thing as "insurance" which retroactively covers loss.  That is simply not "insurance".  It may be a wager, like the deals that are made on Wall Street, but it is not insurance.

 

© 2013 by Dennis J. Wall.  All rights reserved.  No claim to original U.S. Government works.

Please Read The Disclaimer.

SO, "NO ONLINE PORTAL, NO HEALTH INSURANCE?"

Who told you that?

          The problems with www.healthcare.gov, the government's website portal into the Affordable Care Act a/k/a Obamacare, are well known and well-publicized.  It almost seems like if the beleaguered website portal does not work, then there is no health insurance.

          Not so.

          Although seemingly reluctant to earn their new-found premium dollars, America's Health Insurance Plans can accept applications by U.S. Mail, by Fax, by EMail, and by telephone.  Whether they let anyone know before the current signup period ends, may be another story, but it is true that America's Health Insurance Companies can offer you coverage consistent with the ACA and that you can apply for that coverage right now.

          You just may not be able to enter the narrow portal at www.healthcare.gov right now is all.

© 2013 by Dennis J. Wall.  All rights reserved.  No claim to original U.S. Government works.

Please Read The Disclaimer. 

SO LEAD ALREADY, AMERICA'S HEALTH INSURANCE COMPANIES.

Sign 'em up, baby, sign 'em up.

           America's health insurance companies still have problems with the White House's website for health insurance, www.healthcare.gov.  See Robert Pear and Reed Abelson, "Insurers Claim Health Website Is Still Flawed / White House Praises Software Upgrades" p. A1, col. 1 (New York Times Nat'l ed., Monday, December 2, 2013).  Ms. Karen Ignagni, the current president of AHIP, "America's Health Insurance Plans, a trade group," is quoted in the linked newspaper report as saying:  "Until the enrollment process is working from end to end, many consumers will not be able to enroll in coverage."

          Relying on the website will not get you all those new premium dollars from potential new insureds, America's health insurance companies.  Now is the time to earn them.

Take the lead.  Many State websites are functioning, if needed.  Telephones, faxes and paper insurance applications have not stopped working.  Enroll people in new health insurance coverages now.  Use websites if necessary.

© 2013 by Dennis J. Wall.  All rights reserved.  No claim to original U.S. Government works.

Please Read The Disclaimer.