Let Americans Have Lower-Cost Choices for Health Care Payment Coverage

1. Allowing insurance companies to sell mandatory issue during PPACA open season, lower-cost coverage for a insurer-set number of days (24-hour periods), of at least 5, of hospital care coverage (EMTALA scope, essential newborn congenital surgery, operative tumors, pallitative cancer surgery, fractures of major bones), with a $1,000 hospitalization deductible,
with available riders, only mandatory issue and federal law exempt from previous condition restrictions with the purchase of at least five, for coverage:
a. up to $1,000 for outpatient/ER insurer-selected, Medicare Part B covered tests with patient Medicare Part B level co-insurance in-network and insurer reimbursable at Part B federal 80% amounts out-of-network
b. of primary drugs with insurer-set patient co-pays selected from $4, $10, $20, and $50 per 30-day prescription/course/treatment episode for insurer-selected, policy-listed drugs
c. of secondary drugs/appropriate infusion services with insurer-set patient co-pays selected from $100, $200 and $500 per 30-day prescription/course/treatment episode for insurer-selected, policy-listed drugs
d. up to $600 for Medicare Part B scope office care reimbursable at Part B federal 80% amounts out-of-network, in full (and subtracted at just 80% of Part B rates from the $600) with Medicare Part B 20% patient co-insurance in-network
e. up to $1,200 for Medicare Part B scope office care reimbursable at Part B federal 80% amounts out-of-network, in full (and deducted at just 80% Part B rates from the $1,200) with Medicare Part B 20% patient co-insurance in-network
f. up to a second $1,000 for outpatient/ER insurer-selected, Medicare Part B covered tests with patient Medicare Part B level co-insurance in-network and insurer reimburseable at Part B federal 80% amounts out-of-network
g. of one emergency terrestrial ambulance ride with a maximum insurer payout of $500 and minimum 20% patient co-insurance
h. of a second emergency terrestrial ambulance ride with a maximum insurer payout of $450 and minimum 30% patient co-insurance
i. of one ER visit (and ER treatment) with patient co-pays of $200 in-network, insurer payout(s) of at least Medicare Part B amount(s) out-of-network
j. of a second ER visit (and ER treatment) with patient co-pays of $200 in-network, insurer payout(s) of at least Medicare Part B amount(s) out-of-network
k. of up to an insurer-limited number, of at least five, of Part A equivalent days in a nursing home, with $50/day patient co-pays
[The riders are designed to have cost-control characteristics.]

2. Allowing purchase of any such coverage to be considered qualifying coverage for PPACA penalty avoidance

3. Providing a federal subsidy of:
a. 50%, plus
b. 3% for each rider a-e and 1% for each rider f-k listed above bought, plus
c. 1% for each hospital day above 5, up to 4, plus
d. .5% for each hospital day above 9, up to 7, of the person's PPACA “silver plan” maximum allowable amount.
[The coverage for an insured would cost Uncle Sam 50% to 78.5% of what PPACA coverage normally would.]

A customer must buy a primary rider of a kind before a secondary rider of the kind.

Insurance company created packages of required offer riders may be discounted.
[This would allow policy buyers to get cheaper risk-based pricing rather than just insurer wholesale purchase pricing.]

An insurance company may only label a hospital or doctor as in-network only if contracted as such for the calendar year(s) of the policy.

An insurance company may only describe a drug as covered only if contracted as such for the calendar year(s) of the policy.

Many of you want the choice to buy just traditional hospitalization coverage. Some of you will want to max out on rider coverage.

Make the RINOs (and Democrats) vote (by roll call) to refuse to allow Americans to buy good quality, lower-cost coverage.

To call a health coverage 'Cadillac' "affordable" just shows how unrepresentative our politicians are.

“why weren’t most hospitals bankrupt before 1965”

They were a lot smaller and cheaper to run.

Hospital employees were generally poorly paid back then, closer to the minimum wage.

I read about a nurse making $180,000/year in San Francisco in article about California housing prices yesterday.

A comparable nurse might have made $3,200/year in 1965.

Your replies at 15 and 16 reflect government’s involvement in the financial aspect of modern medicine, whereas I think a good many FReepers are concerned first and foremost with the innumerable regulations imposed by the government.

This country’s entire governmental system was created with fewer words than 0bamacare’s regulations on what hemorrhoidal creams are covered under plans designed for senior citizens. Okay, I made that up, but it gets the point across that government being daddy to everyone makes us more “subjects” and less “citizens”. We could use a bit more liberty and freedom.

If government at all levels federal and state would stop dictating coverage all this and more would be available. There would be ala carte policies available and people would buy as much coverage as they felt they needed or could afford.

But every special interest disease group has lobbied legislatures to include their pet condition as mandated coverage and pretty soon you can’t buy ala carte coverage.

The only thing government needs to regulate is basic fiduciary statutes as would be done for any insurance company.

And make premiums 100% tax deductible for those who buy insurance on the private market instead of from their employer.

“la carte policies”

I’d love to have lung cancer coverage for $12/month, but no insurer would sell me just lung cancer coverage because that’s my #2 risk now.

My #1 risk is getting hit by a motor vehicle.

My proposal has limited “a la carte” features.

However, expect to have to buy a bundle of riders, for pretty much the same reason I can’t buy two channels of cable TV at $1 per channel per month.

If you just buy say up to $600/year of office care, you might have to pay a flat $35/month for it, the average cost of the insurer to cover it and a small profit.

If you buy it in a bundle, the average cost to you might drop to $300/year, because you might be overpaying $100/year for something else in the bundle that isn’t of average value to you.

“The only thing government needs to regulate is basic fiduciary statutes as would be done for any insurance company.”

That would be fine for higher income people.

But if lower income people are going to get federal money for federal subsidies, the federal government is not going to want to pay a $100/month subsidy for the “cable TV anti-depression plan” offered by Comcast with free vaccinations and one doctor visit annually.

As long as there is no federal penalty and coverage minimum, you could buy any coverage your state allows to be sold. You might also be able to buy coverage over the Internet from a foreign insurance company.

There are two major issues we are concerned with:
1. getting rid of the PPACA penalty
2. affordable coverage for those of modest incomes

If you can pay for your own coverage, issue 1 is your only problem.

We have to make progress on issue 2 too. Some of us have modest incomes.

It has to be understood that Republican leaning voters are a minority. We need to win votes from leftist-leaning voters by solving their problems.

To say successfully vote for a reduction in growth in Medicaid and then be tossed out of office in 2018 would actually get us no place but in the doghouse.

We have to steer the medical industrial complex to a less costly structure. It has to be done in modest steps that have little negative impact and strong positive impact.

“cover my own expenses less than 20K/year”

Most people hate to pay a medical bill.

People will pay $500/year for cell phone service but will scream bloody murder if they had to pay $10 under Medicaid to see a doctor to get a $4 life-saving prescription.

“NOT INSURANCE OPTIONS - but ‘healthcare options’ for medicaid citizens.”

As has been noted in the past, we really aren’t talking about insurance.

Most states want private companies to handle Medicaid.

The reason is that bureaucrats really aren’t good at getting value for money, especially when it comes to drugs, fraud prevention and patient management.

Private companies are often much better at getting value than governments are.

We want millions of individuals to choose and have cost-efficient coverage. Only then can states, bound by the equal protection of the law idea, can also choose cost-efficient coverage.

Medicaid is required by federal law to at least equal typical private coverage.

They were a lot smaller and cheaper to run.

Why do you think that was?

Hospital employees were generally poorly paid back then

I doubt it. Inflation was much lower then.

The point is, we didn't have a healthcare crisis before 1965. Government CREATED the crisis, and now their spokesmen, - I hope you're not one of them - decry the effects of dismantling government interference with healthcare which problems government caused. Government's answer for their failure is ALWAYS more government.

And that is just the economic argument. The legal argument is much more straightforward and understandable: federal government interference in healthcare is unconstitutional. Nowhere does the Constitution give the feds authority to interfere with healthcare. So federal interference with healthcare is tyranny, defined as unconstitutional federal acts.

For economic and constitutional reasons, the feds need to get OUT of healthcare and let the marketplace run the show as it did before 1965 and America had the best healthcare in the world. As in other things so in healthcare, America is not about poverty-stricken, failed governmental socialist tyranny, it is about freedom which leads to wealth and prosperity.

“Small monthly charge for most needs.”

Dr. Primary Care: Mr. Griffin, you have cancer. Here’s my bill, $120.

Hospital Doctor: Mr. Griffin, we’re going to put you on the new $125,000/year cancer drug. Aetna won’t be glad to have met you.

Medicine is more than primary care folks.

Again, nothing is going to make the cost come down except by ending all government interference in insurance plan coverage. That is what drove the cost up into the stratosphere.

It doesn’t matter what kind of tinkering you do, as long as politicians are buying votes with other people’s money by legislating mandatory coverage of this, that and the kitchen sink, the cost will continue to go up.

It’s time for the government to get out of the insurance game and work on bringing down the cost of actual medical care by increasing the number of doctors.

The economic illiteracy of all this sturm and drang is staggering. We are doomed.

I would change the subsidy bit to:
3. Providing a federal subsidy of:
a. 42%, plus
b.
I. 3% for rider a if bought, plus
II. 5% for each of the riders b-e bought, but not more than half of the cost of each of the drug riders bought outside of a bundle, plus
III. 1% for each rider f-k listed above bought, plus
c. 1% for each hospital day above 5, up to 4, plus
d. .5% for each hospital day above 9, up to 7, of the person’s PPACA “silver plan” maximum allowable amount.

The hospital subsidy was reduced to encourage lower pricing, to free up funds to make the purchase of key riders more desirable and drug coverage broader.

The not more than half language is to encourage insurance companies to offer drug coverage of real value.

“If government at all levels federal and state would stop dictating coverage all this and more would be available. There would be ala carte policies available and people would buy as much coverage as they felt they needed or could afford.”

You have described a big problem well.

The hospitalization could easily be broken apart:
EMTALA birthing
EMTALA physical, non-birthing
EMTALA mental
essential newborn congenital surgery
operative tumors
palliative cancer surgery
open fractures of major bones
closed fractures of major bones.

Except for the EMTALA mental&birthing and essential newborn congenital surgery, I’m pretty sure that I would want to buy coverage for all.

A person my age of 58 wouldn’t be paying much for EMTALA birthing or congenital surgery anyway.

And if I had severe mental problems, I certainly would not want a hospital hounding me for an unpaid $1,000 deductible.

“To this day, Senator Murkowski believes health care reform must be addressed due to the continued, dramatic increases in insurance premiums each year and an individual exchanges that has be reduced to only 1 provider, Premera, due to the unsustainable course of the ACA as is. Yet, there are many provisions of the ACA that have worked for Alaska that Senator Murkowski believes should be retained. Those provisions are:
•Prohibitions on the discrimination for pre-existing conditions
•No annual or lifetime limits
•Coverage up to age 26
•Continuation of coverage afforded under Medicaid Expansion
•Maintaining access to Planned Parenthood facilities
....”

https://www.murkowski.senate.gov/issues/issues-and-priorities/health

“Quality healthcare is critical to maintaining the health and well-being of our citizens. This issue is especially critical in Alaska, where health care costs can be up to 70 percent higher than in the lower 48.”

https://www.murkowski.senate.gov/issues/issues-and-priorities

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