My Revised Health Care Coverage Proposal

Be gentle, this is a draft put out for the purposes of:
a. letting you find errors and suggest corrections and
b. providing Republican lawmakers with a coverage-expanding plan that keeps costs down

[The Founding Fathers would be astonished at the mere thought of federal health care/product coverage subsidies, but federal patent exclusivity and state law crimping of provider supply and (drug coverage) mandates have made the cost of drugs and medical care very expensive.]

[Having drug-only coverage plans allows hospital systems to be care-only coverage providers, increasing competition and eliminating the need for 'insurer' prior approval and quarrels over testing that has small marginal costs.]

[Subsidies would be provided via the existing federal exchange with subsidy calculation software that actually works quite right (because often hard-to-track household income would no longer be the basis for subsidy calculation).]

The age factor of a covered person would be:
age age >=six months & <3 years: 3
ages 3-11 years: 2
ages 12-17 years: 2.5
ages 18-38 years: 3
ages 39-44 years: 5
ages 45-49 years: 6
ages 50-54 years: 9
ages 55-59 years: 12
ages 60-64 years: 15

The age for any policy month shall be that of the beginning of the policy month.

[The subsidy amounts for kids are based on things that don't change much, to avoid loss of coverage due to payment error.]

The federal monthly care subsidy base amount for a US citizen baby under six months of age shall be:
$100+
$40 if the mother is dead+
$30 if the baby was in a household in an Obamaphone qualifying program when the first policy premium was paid
[Newborns often need surgery for congenital problems. Babies less than one month old are often hospitalized if they get sick.]
[Moms (and dads) that don't qualify for CHIP when the pregnancy is noticed will often buy this]

[Lower income kids will usually get CHIP coverage, not PPACA replacement subsidies.]
The federal monthly care subsidy base amount for a US citizen at least six months of age and less than 6 years of age shall be:
$15*age factor+
$8*age factor if the mother is dead+
$6*age factor if the child was in a Head Start/free school lunch program as of October 1 prior to the current policy year

The federal monthly care subsidy base amount for a US citizen at least 6 years of age and less than 13 years of age shall be:
$10*age factor+
[When Junior goes to school, mom can go to work.]
$12*age factor if the mother is dead+
$5*age factor if the child was in a free school lunch program as of October 1 prior to the current policy year

The federal monthly care subsidy base amount for a US citizen at least 13 years of age and less than 18 years of age shall be:
$6*age factor+
[When Junior nears 13 years of age, mom can work full-time.]
$3*age factor for each natural parent who is dead who was listed on a birth certificate of the citizen within one year of birth
$4*age factor if the child was in a free school lunch program as of October 1 prior to the current policy year

The federal monthly care subsidy base amount for a US citizen at least 18 years of age and less than 23 years of age shall be:
$12*age factor+
$4*age factor for each natural parent who is dead who was listed on a birth certificate of the citizen within one year of birth
[The higher multiplier is to account for college costs and getting tossed out of the parental nest.]

The federal monthly care subsidy base amount for a US citizen age 23 and over would be:
age factor*($30,000-'normally attainable annual income estimate')/1,200

The 'normally attainable annual income estimate' for a person age 23 and over shall be calculated by the exchange:
1. when a policy is selected and
2. shortly after the person's 1040 information for the calendar year prior to the policy year has been provided to the exchange, if it would raise the person's subsidy
3. shortly after (almost) all 1040s for the calendar year prior to the policy year filed by the due date(s) have been entered into IRS records
4. shortly after a person's 1040X information for the calendar year prior to the policy year has been provided to the exchange
5. when officially thought necessary.

A person may also request via the exchange website, subject to technical availability, that their 'normally attainable annual income estimate' be recalculated, for personal informational purposes or for official use, by the exchange.

The 'normally attainable annual income estimate' for a person at least 23 years of age for any monthly premium subsidy would be the maximum amount of:
a. the total amount, from forms submitted in the current calendar year, or for the prior calendar year when due not more than 13 months ago:
I. Form 1099-G "Taxable grants" and "Unemployment compensation" and
II. Form SSA-1099 "Net Benefits" and
III. Form 1099-R "State distributions" and "Local distributions"
IV. Form 1099-R "Taxable amount", if the person is at least 55 years of age
[to better compute a subsidy amount for grad students, the disabled and retired folks]
b. $12,000, unless the total amount of (a) exceeds $4,000
[to factor in working "under the table" and the ready availability of ~$9/hour, ~30-hour/week jobs paying about $12,000/year]
c. if a federal income tax [1040] return of the person for the last calendar year was entered into IRS records
the AGI of the return (as amended), divided by two for joint returns
d. if a federal income tax [1040] return of the person for the last calendar year was not yet entered into IRS records &
and the IRS has not processed (almost) of the personal returns for the last calendar year &
a federal income tax [1040] return of the person for the penultimate calendar year was entered into IRS records
the AGI of the return (as amended), divided by two for joint returns
e. if an amount was not set under (c) or (d) because of the lack of a timely return
the highest AGI of any return (as amended), divided by two for joint returns, from income tax returns (and amendments) for calendar years beginning not over 48 months ago in exchange records

A care subsidy base amount may be calculated after the 2nd of the month preceding the month of coverage to the 20th day preceding the month of coverage, or later in extraordinary circumstances.
[So timely notice can normally be given to the premium payer and 'insurer' to help them deal with an altered subsidy base amount.]

System use of records held electronically anytime within such time shall be considered correct and no subsidy shall be made or increased because of such use.

No subsidy payment will be made for a person without:
a. the person's date of birth information and
b.(I) the person's place of birth information and
(II) naturalization/report of the birth of a US citizen abroad information, if the person wasn't born in the USA
c.(I). an appropriate Zip+4 address for that person
(II). address type: family residence, shared dwelling, rooming house, workplace, hotel/motel, homeless shelter, social service agency, PO Box, mail drop
d. the person's US federal taxpayer ID, if the person is at least 18 years of age
e.(I). a request by a parent/aunt/uncle/grandmother/grandfather/legal guardian with a US federal taxpayer ID, if the person is under 18 years of age
(II). adequate documentation of such a relationship to a minor
f. the prior payment of the person's share of the first month's premium payment

No subsidy payout need be made or increased:
a. for failure to file or of a third party, including the IRS or a contractor, to process or provide correct information to the federal tax and subsidy systems in an automated or timely manner.

A subsidy underpayment correction not barred by the above shall be at the option of exchange management.

?Relevant subsidy payments need not be made by the system in a timely fashion, if its records indicate:
?1. there is an excessive number of people at an address of a person
?2. a person has tried to get a subsidy unlawfully
?3. a person has used/is using the identity of another
?4. a person may not be a US citizen
?5. a person may not be an actual relative or guardian of a minor for whom a subsidy is sought
?6. a person's W-4/I-9 information came from an employer who apparently provides coverage to most employees
?7. an employer has claimed to be paying for coverage for the applicant
?8. a benefit to a person was paid based on an address other than that currently listed on the exchange
?9. the subsidy probably shouldn't be granted

?Relevant subsidy payments need not be made by the system in a timely fashion, if:
?1. the applicant didn't answer at least three of four of the identity check questions posed to the applicant correctly or
?2. the applicant didn't provide a quick electronic response to a text message or e-mail from a phone/e-mail account of substantial and frequent use for at least 180 days or
?3. the exchange didn't get a response within ten days to a letter sent to the applicant at the address provided by the applicant.

Any excessive subsidy payout may be reclaimed if it was due to an:
a. unlawful failure to file or other illegal action
b. exchange or contractor or banking system processing error

Drug coverage subsidies shall be calculated using these age bracket multipliers:
ages 0 to 5: 2
ages 6 to 10: 1
ages 11 to 17: 2
ages 18 to 24: 3
ages 25 to 29: 4
ages 30 to 34: 6
ages 35 to 39: 8
ages 40 to 51: 10
ages 52 to 59: 13
ages 60 to 64: 15

The federal monthly drug subsidy base amount for a US citizen under age 23 would be:
age bracket multiplier*$5.
[It may seem silly to hand out $5/$10/$15/month subsidies, but it would help lower income people get 'insurer' volume price discounts.]

The federal monthly drug subsidy base amount for a US citizen at least 23 years of age would be:
age bracket multiplier*$4*($25,000-'normally attainable annual income estimate')/$20,000

Drug coverage subsidies would only be available to:
a. children and young adults under age 23 and
b. people 23 years of age or older with a 'normally attainable annual income estimate' of less than $20,000/year [to keep federal costs down].

Federally recommended subsidized drug coverage co-pays shall be as follows:
a. generic chemical $4/30-day supply, $10 90-day/course supply
b. patented chemical, other in USP class $20/30-day supply, $50 90-day/course supply
c. patented chemical, no other in USP class $50/30-day supply, $100 90-day/course supply
d. large volume (>=$200 million in penultimate year US sales) recombinant, other in USP class $10/vial
e. small volume recombinant, other in USP class $20/vial
f. large volume (>=$200 million in penultimate year annual US sales) recombinant, no other in USP class $20/vial
g. small volume recombinant, no other in USP class $50/vial

A drug supplier may ask for a higher co-pay and the plan sponsor may accept that.
[Recombinant drugs will often have higher co-pays since they are expensive to manufacture.]

After the second month of drug plan operation, the federal drug subsidy amount for a month shall be decreased by 30% if the total co-pay/co-insurance paid for the penultimate month exceeded by over 25% a total based on the recommended maximum amounts.

The federal government will match states 50/50 on recommended co-pay drugs so Medicaid (plan) customers would have a co-pay of the next smallest dollar amount, i.e. $10->$4.

The FDA-approved drug maker/US sales rights holder and pharmacy could set a lower co-pay.

To be federal subsidy eligible, all the drug purchase contracts of the plan must be on an all-the-doctors prescribe basis, subject to drug supplier prior authorization when their drug is in short supply.
[A $150/hour doctor shouldn't waste an hour of time begging for one authorization from a $10/hour 'insurer' phone rep.]

To be federal subsidy eligible, a drug plan must be built by one of the following methods:

MEDICARE PART D PLAN COPY
A plan formulary must have the same drugs as a plan sponsor's Medicare Part D plan, locked into the plan formulary for the entire policy term.

MEDICARE PART D PLAN SOURCED
Each USP class in the plan formulary must have the drugs of one or more then current Medicare Part D formularies, locked into the plan formulary for the entire policy term.

[This allows upstarts to easily create plans picking coverage from among existing Medicare Part D 'insurers'.]

PLAN OFFER/DRUG SELLER ACCEPTANCE PLANS
1. The plan sponsor must decide on a drug-only plan age bracket dollar multiplier between $6 and $10
[If a multiple of $10 is chosen, a 64-year old might wind up paying a drug-only premium of $150/month.]
2. The plan sponsor must then draw up a proposed list of drugs and their apparent drug makers and list the percentage of premiums that will go to the maker of each drug for an all-the-doctors prescribe supply with the recommended drug co-pay above, or a drug plan set lower co-pay amount.
3. The initial acceptance period must be open for at least 14 days.
4. If accepted, the drugs will be locked into the plan formulary for the entire term of the plan (and its policies).
5. The plan sponsor must then draw up another list of drugs and their apparent drug makers and list the percentage of premiums that will go to the maker each drug for an all-the-doctors prescribe supply with the recommended drug co-pay above, or a drug plan set lower co-pay amount.
6. The subsequent round acceptance period must be open for at least 14 days.
7. If accepted, the subsequent round drugs will be locked into the plan formulary for the entire term of the plan (and its policies).
8. steps 5 through 7 may be repeated as often as desired by the plan sponsor, as may be possible
9. The premium amounts would be reduced by the total percentage unallocated and the participating drug maker percentages raised to equal 100%.
[If a multiple of $10 was chosen and 4% of possible premiums remained unallocated, a 64-year old would be paying a drug-only premium of $144/month.]

Plan sponsors may set percentages to be split between two or more drugs based on their prescription volume (and other plan sponsor rules) and subject to acceptance by more than one drug maker.

No federal subsidy for a drug seller acceptance plan shall be issued for a person unless the person's doctor or physician assistant or one employed by the person's state approved enrollment in the manner in which the Secretary of HHS has required.
[Coverage under a drug seller acceptance plan might be far less than of a Medicare Part D type plan.]

Plan sponsors to pay for their drugs within 60 days of premium receipt or as otherwise agreed to.

Drug-only plan sponsors must spend all their drug plan premium money on drugs for covered persons (or pay a federal loss ratio tax).

Drug-only plan sponsors may annually charge each covered person a fully-earned overhead & profit fee of not more than $25.

[Subsidy reductions are to encourage people to cough up to buy better quality plans, not plans too expensive to use.]
[The 1% reductions are meant to be smaller than the average benefit cost so financially stressed people can usually find a lower benefit plan they can afford.]

The monthly care subsidy base amount of a person would be subject to the following cumulative reductions:
1. .7% for each $100 of any plan deductible not deposited with the 'insurer' at least ten business days before the policy issue date
2. 1% for lack of two-ride policy year minimum terrestrial ambulance coverage with:
a. co-pay < $201 for the first ride (<$501 in first month of coverage) or co-insurance, 40% or less
b. co-pay < $301 for the second ride (<$501 in first three months of coverage) or co-insurance, 50% or less
3. .5% for each $100 in-network hospital inpatient admission co-pay in excess of $1,200
4. 2% for each $100 in-network hospital inpatient daily co-pay in excess of $500
5. 20% if in-network hospital co-insurance could be above 10% of the Medicare DRG reimbursement amount or could be used with hospital co-pays
6. 1% if the plan will not reimburse out-of-network hospitals for policy benefits at least at the Medicare (DRG) rate, less 10%, less in-network hospital co-insurance/co-pays
7. 1% if the plan will not reimburse out-of-network practitioners for policy benefits at least at the Medicare rate, less 20%, less in-network co-insurance/co-pays
8. 1% for each $25,000 the maximum benefit is less than $200,000
9. 1% for each $10,000 the annual maximum benefit is less than $60,000
10. 1% for each $1,000 the annual maximum benefit is less than $40,000

Plans with an annual maximum benefit of less than $18,000/year [~one hospitalization] are not eligible for federal subsidies under this act.

In no case shall federal subsidy payment under this act cover more than:
a. 80% of the cost of any premium for a person 23 years of age or older.
xb. 50% of the cost of any premium for a person at least 30 years of age and less than 50 years of age, except when the federal percentage above 50% is evenly matched with state subsidy money.
b. 50% of the cost of any premium for a person 26/31/36/41/46-years old, except when the federal percentage above 50% is evenly matched with state subsidy money.
xc. 60% of the cost of any premium for a person at least 50 years of age and less than 60 years of age, except when the federal percentage above 50% is evenly matched with state subsidy money.
c. 60% of the cost of any premium for a person 51 and 59-years old, except when the federal percentage above 60% is evenly matched with state subsidy money.
[The last two, (b) and (c), are to induce people to seek out jobs with employer-provided coverage so employers will provide it and subsidy costs will be less.]

In no case shall a federal care coverage subsidy under this act be provided to a person allowed to get care coverage elsewhere or otherwise.

In no case shall a federal drug coverage subsidy under this act be provided to a person allowed to get drug coverage elsewhere or otherwise.

Combined plans offering both care and drug coverage:
1. must meet the requirements for each type of subsidy payout for each monthly subsidy payout to be allowed
2. shall be subject to all the subsidy reductions, bars and caps of each.

The (extraordinary) mandatory issue fees that may be required by the plan may be the sum for both types of coverage.

Premium amounts for an individual may vary by age, state of residence, county/city outside any SMSA and SMSA, but not by gender, race, ethnicity, national origin or any location factor [such as a zip code or census tract] within a SMSA.

Care (and drug) coverage premiums for a person may be increased by up to:
1. 1% for any month in which care coverage was lacking in the four years prior to policy application
2. 1% for each inpatient day in a hospital in the four-year period prior to policy application
3. 2% a month if the loss ratio on the policy type in the penultimate month was over 95%

Hospitals and hospital systems selling care-only coverage may increase premiums by up to 10% for lack of qualified drug coverage purchased together with their care coverage.

Other sellers of care-only coverage may increase premiums by up to 5% for lack of qualified drug coverage purchased together with their care coverage.

Drug coverage shall be considered qualified for this section if it covers at least:
a. two protease inhibitor(s)
b. one auto-immune recombinant drug
c. one recombinant clot-busting drug
d. one long-acting recombinant insulin

The financial relationship between a care-only coverage provider and a drug-only coverage provider shall only consist of premium forwarding.

Mandatory issue policies must be issued for all full first month premium-paid US citizen comers:
1. who were continuously covered for the coverage desired during the previous 12 months
2. whose coverage provider(s) ceased covering people who paid for the type of coverage desired during all the previous 12 months prior to failure
3. who were covered for at least nine of the previous twelve months and have paid a $500 issue fee
4. who were covered for at least eighteen of the previous twenty-four months and have paid a $800 issue fee

Extraordinary mandatory issue policies must be issued for all US citizen prospective insureds after one full payment to the 'insurer' of $1,000 in the name of the prospective insured between:
1. October 5th and October 20th, 2017 and then the first month's premium in one full payment by December 7th, 2017 for coverage starting January 1st
2. October 5th and October 20th of a Presidential election year and then the first month's premium in one full payment by December 7th of that year for coverage starting January 1st

Extraordinary mandatory issue policies would have an annual maximum (guaranteed) benefit of $18,000 [~one hospitalization] (or the ordinary policy limit, if smaller) for a covered person for the initial calendar year.

?(Extraordinary) mandatory issue policy issue may be delayed until all past due amounts owed the 'insurer' by/for the policy buyer/person to be covered have been paid in full.

The federal government would, not more than 60 days after 'insurer' payout and proper request to the Secretary of HHS, reimburse the 'insurer' at up to 60% of the federal Medicare DRG/Part B amounts for its extraordinary mandatory issue fee US citizen insureds, insomuch as necessary to cover, together with the issue fees and the premiums, 'insurer' payments for care (and drugs) to third parties under them in total during the calendar year.

An issue fee may be categorically waived/reduced by age and/or policy type for a period of at least one month by an 'insurer'.

Babies, born and unborn, would be covered under their mother's (or father's) policy until the end of a policy term.

Mandatory issue coverage for newborns would be available:
a. effective at the end of that policy term or
b. effective starting the six month after the sign-up month, provided each and every monthly premium was paid not less than 5 months and 15 days in advance.

Mandatory issue baby coverage would only cover the care of the baby after it is delivered.

No refunds need be given by an 'insurer' for babies that are aborted, stillborn or die.
[The need for surgery to correct congenital defects and first month hospitalization for illness are the major risks insured against.]

Any health care (and drug) coverage provider with a loss ratio (and pending claims) of less than 90% on individual coverage shall pay a tax equal to the amount(s) less than 90% within:
a. one year of the end of the policy term or
b. 90 days after each pending claim was terminated

The amount of the tax may be reduced by up to 5% of the individual market premiums paid to parties independent of the coverage provider for advertising 60 days prior to the end of federal open enrollment.

The loss ratio for the purpose of the tax shall be:
(payouts to third parties for medical care/products for 'insureds' + employee compensation costs of 'insurer' employed, non-managerial, state-licensed medical practitioners providing personal medical advice or care to 'insureds')/premiums

Any drug-only coverage provider with a loss ratio (and pending claims) of less than 100% of premiums on federal drug coverage subsidy eligible plans shall pay a tax equal to the amount(s) less than 100% within:
a. one year of the end of the policy term or
b. 90 days after each pending claim was terminated
[This is possible if a drug maker goes out of business or can't supply a drug.]

[Federal loss ratio taxation allows:
[a. subsidy reductions to be simplified
[b. 'insurers' to be given freedom to craft a variety of plans that overall offer good value for money
[c. state premium setting on individual plans sold through the federal exchange to be optional

Unconditional state premium payments, partial or full, [to subsidize or prevent loss of coverage] shall be accepted by 'insurers'.

A coverage provider may otherwise discontinue coverage if any amount in excess of $60 for a policy is then more than fifteen business days late.

A coverage provider may loan premium payment money to their policy holders whose coverage they may otherwise terminate at an interest rate not to exceed the IRS rate and with all other financial impositions not to exceed $20 per premium payment amount due not timely made.

[States are a big problem, folks. If a hospital operation is unduly expensive, the states are 99% to blame.]

[States such as Massachusetts, Connecticut and California are taking away gun rights.]

[State law new hospital lock-outs have allowed existing hospital systems to jack up prices.]

[Imagine if state law prevented the construction of a Burger King or Checker's within 20 miles of a McDonald's.]

[New York State pretty much wiped out its individual health insurance market by 2008.]

[The PPACA was created to deal with exploding drug prices and premiums and preexisting condition exclusions after states mandated that 'insurers' pay for drugs regardless of price.]

Persons and entities that have paid for products of interstate commerce and are in the market for such products shall be exempt from state health coverage mandates and coercive purchase measures.

States may require financial stability provision from/for out-of-state health care coverage 'insurers' that is not unduly discriminative.

States may provide premium payment and/or issue fee assistance to their residents, for such policies that are acceptable to the state according to its law(s), but 'insurers' shall not be under any state law obligation as a result of such assistance.

‘Insurers' may offer for sale and provide policies for exchange plans to employers at discounts based on the number of employees (and their children) covered.

[The US Treasury simply can't afford to have ~320 million people each getting an average of about $1,500/year in subsidies.]

Each employer who does not:
1. provide qualified care coverage to an active employee shall pay a tax of 60 cents per hour of work if the employee is tracked by time or $25/week if not.
2. provide qualified drug coverage to an active employee shall pay a tax of 15 cents per hour of work if the employee is tracked by time or $7/week if not.
3. offer qualified care and drug coverage to an employee for the employee's under age 23 children within 30 days of employment shall pay a tax of 30 cents per hour of work if the employee is tracked by time or $15/week if not.

Unincorporated employers with no more than three employees in any time of the year shall be exempt from each tax.

Drug coverage shall be considered qualified if:
1. it is PPACA conformant, or
2. it costs the employer as least as much as the drug coverage tax would, or
3. it is a Medicare Part D copy plan, or
4. it is a Medicare Part D sourced plan, or
5. it is an plan offer/seller acceptance plan, or
6. it covers, as medically necessary/appropriate:
a. protease inhibitor(s), if available throughout the coverage period at a total payor cost per drug of under $200/30-day supply for insured patients
b. at least one auto-immune recombinant drug, if available at a payor cost of under $30 per day of treatment level activity
c. at least one recombinant clot-busting drug, if available at a payor cost of under $1,500 per course of treatment
d. at least one long-acting recombinant insulin, if available at a payor cost of under $10 per day per insured patient
e. at least two (other) recombinant drugs for any insured, under initial federal patent protection, if medically essential to maintain insured's employment or proven by clinical trial(s) to extend life at least six month on average for patients and available at a payor cost of under $30 per day of treatment level activity
f. at least two non-recombinant drugs for any insured, under initial federal patent protection, if medically essential to maintain the insured's employment or proven by clinical trial(s) to extend life at least six month on average for patients and available at a payor cost of under $200/30-day supply

Care coverage shall be considered qualified if it is:
1. PPACA conformant or
2. it (and the employer's HSA/FSA contributions) (and dental coverage) cost(s) the employer as least as much as the care coverage tax, for non-exempt [low level] employees overall, or
3. it has coverage for:
a. at least two terrestrial ambulance rides, of less than $800 cost each, with a patient co-pay of no more than $300/ride or co-insurance of 50% of the cost for the first two
b. in-network inpatient hospital care for (most of) at least 80% of Medicare DRG groups [?], with:
I. an annual deductible not exceeding the Medicare Part A amount [~$1,200]
II. co-pays not exceeding $500/day
c. in-network hospital outpatient care, with co-insurance/co-pays of the Medicare Part B amount(s) or no more than 25% of the total employer & 'insurer' paid amount(s)
d. in-network ER care, with a per incident co-pay of less than $300
e. in-network office visit care, for at least 80% of Medicare Part B coverage items [?], with:
$10 physician assistant/$20 GP/$20 Ob-Gyn/$40 specialist/$40 physical therapy co-pays or 20% co-insurance, or less
f. out-of-network hospital care, for what would be covered both in-network and by Medicare, paying at least 90% of the Medicare (DRG/Part B) amounts, less the in-network deductible(s) and co-pay(s)
g. out-of-network non-hospital care, for what would be covered both in-network and by Medicare Part B, paying at least the federal Medicare Part B amounts, less in-network co-pay(s)/co-insurance
[This third option may appear unnecessary, but it might be if the employer mainly hires healthy younger people and self-insures.]

Full credit against the employer tax amount with respect to employees shall be given for FSA and HSA contributions and medical and dental coverage provided to non-exempt [low level] employees.

Full credit against the employer tax amount with respect to employees shall be given for payments made (in advance) to hospitals in the tax year for the (future) care of said/future employees and their children.
[An employer might pre-pay the nearest hospital say $1 million and the hospital might debit say 110% of the Medicare amounts for care given to needy employees.]

Ninety percent credit against the employer tax amount with respect to any employee shall be given for a financial contribution to a financial savings account (other than an HSA or FSA) [such as a 401-K] of the employee.

The employee's monthly subsidies will be cut to recoup the non-HSA/FSA financial savings account credit.
[None of us here regularly wants a federal subsidy system that wipes out market-based employer coverage.]

The PPACA Medicaid expansion program shall be continued, but with a state having to pay a share after 2021 equal to 18%.

[Right now, Medicaid expansion is virtually free for California and NY. These states pay 10% and their care providers pay that back in state sales and income taxation.]

[I would have states paying about 10% of the cost of Medicaid expansion once Medicaid providers have paid their state income and sales taxes.]

States would get annual block grants of say $100 per state resident of the last complete census used for Congressional apportionment plus each baby born in the state since the beginning of the census decade.

Low-income people would go to a state office, the state would use block grant money (and their base subsidy amount US citizen monthly subsidy) (and their own funds to):
1. put children meeting state statutory law specified income measures on a CHIP (equivalent) plan
2. put adults [18+], below meeting statutory law specified income measures, on a 'Medicare coverage equivalent' plan

The state however may provide for lower co-pays and/or co-insurance and/or deductibles, as per state statutory law.

The 'Medicare coverage equivalent' plan need not have the same providers as standard Medicare.

Permissible limitations to Medicare equivalency [to allow more low income adults to be covered] shall include:
1. One DRG payout per calendar year/multi-month window
2. maximum number(s) of office visits covered (Ob/Gyn, doctor, specialist [to count as 2], PA, PT) per week/month/quarter/periods twice as long
3. prior ambulance ride co-pay must be paid in full by the insured before the next ride is covered
4. maximum number(s), which may be one, of ER visits covered per week/month/quarter/periods twice as long

State law may allow an adult's doctor to pick an exchange plan (from among those that meet state Medicaid statutory law requirements) and the state to top up the adult's federal subsidy amount.

People would have to reapply at state-specified times, such as in their birthday month for an adult and their mom's (or dad's or guardian's) birthday month for a child.

[The expansion people would get care/drug coverage subsidies described herein instead of Medicaid.]

The state's Medicaid [share shall be decreased to 17%]/[block grant amount increased by 10%] if the state has enacted a law effective at least four years prior that effectively states:
1. Each hospital (provider) shall post within 30 days of the passage of this law and keep posted, on each external door used by the public to gain access to emergency care, information in at least 10-point type sufficient to calculate all bills of any out-of-network patient who might know the care to be provided and the Medicare DRG and Part B amounts.
2. Excessive payments received for out-of-network care and products entirely rendered to a patient after those 30 days shall be refunded to the payors. Penalties of 100% shall be payable to both the payors and the state government for failure (with or without demand) to refund within 30 days of receipt.
3. Any hospital provider that bills any hospital patient more than 150%/200%/250%/300% of Medicare would allow for care rendered to a patient after those 30 days shall wear a red shark emblem at least 2/3/4/5 inches wide on their upper left chest clothing in the hospital.
4. Any hospital that has billed any uninsured patient more than 150% of Medicare would allow for care rendered to a patient after those 30 days shall post and keep posted red pig emblem at least 6*(total initial billed amounts/amount Medicare would have paid) inches wide on each exterior door of their facility.
5. A hospital (provider) may initially bill/discount bills below posted amounts.
6. A hospital (provider) may provide charity/free care and discounted care below posted amounts.

[Drugs on offer via the federal drug marketplace would be generally affordable to consumers and makers of premium drugs would get paid pretty much what the "market" buyers could afford to pay.]

[The Federal Drug Marketplace would be]
[a. an exchange website drop-down financial payment calculator using postal service and federal tax system data ]
[b. provide a 6-digit alphanumeric code to registered exchange users.
[c. provide federal tax system data for the registered exchange user to an exchange registered ]
[ drug maker patient assistant program website that provided patient data and the code to the exchange website. ]

[The actual discounts would be provided voluntarily by drug maker participants.]

[Depending on individual drug maker policy, drugs would:]
[1. be sent to your doctor]
[2. picked up at a pharmacy after showing your prescription and payment page (and that page has been confirmed by the pharmacist)]
[3. paid for and picked up at a pharmacy using your prescription and special discount code]

FDA Commissioner designated breakthrough/orphan drugs and recombinant drugs/drugs adding at least 60 days of life expectancy against cancer listed by their FDA registered US sales agent
would be sold on with a patient daily treatment cost of $2 plus one of the following:
1. You, the patient, are in an Obamaphone qualifier program or are an Obamaphone subscriber (or officially their child or ward), $0 [Betty Babymaker: total $2/day -> $720/year], or
2. the higher of:
a. (a supplier-set multiple less than 1)*(your last federal income tax amount paid)/(100*(number of filers))
b. (a supplier-set multiple less than 1)*(2*FICA + self-employment tax going back three years)/1,000
c. if you live in a house, $8
d. if you live in another type of housing, $6

[Mr. & Mrs. Big Bucks: $10,000 annual federal income tax, .8, two filers~ = $52/day of treatment activity -> ~$18,980/year]
[Mr. Joe Six-Pack: $30,000/year income, .8, ~$14,000 3-year total 2*FICA&SE tax ~= $14/day of treatment activity -> ~$4,000/year]
[Mr. Robert Retired Houseowner: total $10/day -> $3,650/year]
[Bob Burgerflipper: total $8/day -> $2,920/year]

[Remember, that might be $2,920/year for a drug an employer might now pay $10,000/year for.]
[If an apartment dweller flips burgers for $17,000/year pre-tax, that $2,920/year may seem steep.]

[A patient quoted $18,980/year might pay $10,000/year locally or fly off to Canada or Europe.]

[Market-like pricing can be unpleasant, but market pricing actually is the natural order of things without government meddling.]

[Limiting the number of drugs that may be sold at high pricing via a federal government portal is meant to prevent ignorant consumers from over-paying for drugs.]
[As you well know, there are lots of really stupid people in the USA.]
[People can still go to a corner drug store and overpay for drugs.]

Any other drug (product) may be sold via the Federal Drug Marketplace for no more than
(a drug supplier-set multiple less than 4)*
($1 plus,
30 cents per molecular ring in any key drug, up to 4 total per USP class, plus,
10 cents for each known atom in a drug molecule other than of carbon or hydrogen, up to 10 total per USP class)*
('normally attainable annual income estimate'/$30,000)
per day of treatment level activity

[CVS and Walgreens will happily ignore my formula if you have enough green stuff or a plastic card from a bank.]

Drug makers may insist on:
a. a $20 per order minimum
b. delivery to a US doctor

Implantable medical devices may also be vended via in the Federal Drug Marketplace at or below 200-day pricing, with a supplier-set multiple less than .4 for any electronic-driven device and less than .2 for any mechanical-only device.

I’ll be damned if I’ll read this today but just got a letter from my insurance company that my premiums will be $4,000 a month! And, no, I’m not making that up although I am laughing...hysterically.

Thank you, Obama!

You’ve clearly spent a S_tload of time working that all out. I will save it and read it...might be a few weeks.

I have a larval plan I’ve been sketching out, not yet complete. I am not in nor connected to the medical profession, though I have relatives who are docs.

One thing I will point out that I noticed right away is you have “categories” or strata based upon age. My sketch has categories but in mine they are self-selected. No, an 83 year man cannot self-select “newborn”. My point would be; I question that approach because there are super-healthy 65 year olds and and horribly sick 9 year olds.

Just offering my 15 second drive-by reaction to not having read your plan in any depth at all and I’m not even soliciting a response.

The other thing I would say is creating a single plan for every person, and one run by the government, differs from the ACA only in small detail. Medical care is minimally 5 times as expensive as it should be, and it is so very much because of gov’t involvement as things are and were before ACA. Until that is addressed it is my belief that no single concoction will ever fix much of anything.

Well, the first thing is to eliminate healthcare for illegal aliens who enter the country to get free healthcare.

And the second thing is to eliminate healthcare for gender change.

And the third thing is to eliminate healthcare for abortion.

And the fourth thing is to eliminate free condoms or sterilization or the like. If people want sex without limit, then let them pay for it.

Too complex. Also I have no reason to think that you have any background worth considering

Allow insurance sales across state lines. Get rid of costly government refs. Limit tort values

I dunno. Why do people do sudoku and crossword puzzles? One day I hope to be able to explian it within some lib’s 11 second attention span but I suspect that may be impossible unless I lean how to to talk as fast as one of those guys narrating a mortgage refi commercial.

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