Wednesday, August 19, 2009

A Closer look at the "46 Million Uninsured"

OK boys and girls, today I want to look at one of the main talking point reasons people use to support the President's HC Bill, HR3200. It is widely said by those in power that there are 46million uninsured people, and we must get them covered. It sounds like a crying shame that there are so many uninsured people in our prosperous country. Let's break this group down and see who is in it, shall we?
According to the U.S. Census Bureau, of the 46 million who are uninsured:
  • 10.1 million are individuals who have income of $66,000 for a family of four, but who elect to remain uninsured.
  • 9.3 million are non-citizens who generally do not pay tax.
  • 6.4 million who are enrolled in Medicaid or S-CHIP but reported to the Census taker that they were not. (This phenomenon is known among statisticians as the Medicaid undercount.)
  • 4.3 million are eligible for Medicaid or S-CHIP but have not enrolled.
  • 5 million are childless adults, mainly healthy, young adults who simply do not wish to pay for insurance.
  • 10.9million remain who are truly uninsured, some for short periods of time averaging less than four months.
Of those who are uninsured on a continuing basis, this is in most cases due to the working poor earning too much to get Medicaid/SCHIP/Medicare, but too little to afford (less than $50,000) HC insurance (HCI). There are varying estimates of these numbers, but all are roughly the same. It is the chronically uninsured working poor who should be the target of any HC reform.

Why, you may ask, are some not getting into the available coverage? Well, for the young, it is mostly the sense of invincibility and they often don't see any cost benefit. For many, it may just be a lack of initiative, planning, or interest. There may also be some shame at getting into the government handout business, so they just don't sign up. Still others may not realize they are eligible. These factors could be addressed, and in fact, many of the programs allow people to sign up when they enter the ER, so essentially, they are already covered.

Can we all agree that the 46 million number is a myth, and that the real starting point for covering "the uninsured" needs to be those who cannot afford or qualify for HCI? Also, I would be remiss to not direct you to my previous post of 8/7/09 with my analysis of HR3200. This post bumped it off the top of the list, though it is still being updated.

Friday, August 7, 2009

Healthcare Bill H.R. 3200 Analysis

Ok boys and girls, today we will look at the President's Healthcare bill that Congress has written. This is the first installment, as I am certain that I can't possibly fit all of the facts into this one blog, and even more certain that you won't read them even if I did. it has been updated as of 15 Aug 2009, even though the blog spot says the date of its creation, August 7th.

First, let's set the ground rules:
  1. I will cite sections by page and line number, so you can go read it for yourself. I have also decided to put in headlines, or titles, so you can search by subject.
  2. Don't just take my word for it, go check me! I get it wrong, and some things may be subject to interpretation.
  3. This is not a witch hunt, it is an analysis, so there will be good as well as bad noted, not just the things that fit my bias. I get so sick of hearing only one side reported, as though the whole bill were either a totally unacceptable piece of trash or the salvational piece of legislation that will do everything for everybody. I don't believe that from either side, and I intend to not treat this bill so trivially. Too much is at stake to play politics, though I do admit my biases.
  4. Since I brought up my biases, my bias is against too much government, and toward freedom. It's the American way, and self-determination, with the ability to make "stupid choices" is what I believe we all should have. If you can't choose the stupid, you have no true choice. Once Government decides what you can and cannot choose, in this context of Healthcare especially, We the People will suffer. There is a place for regulation, but excessive regulation is inimical to my way of thinking, so let's just get that out there right from the jump. Knowing that I have this bias, I will try extra hard to cover the other side as well. The reason I use the term "stupid choices" is that Elizabeth Edwards used that term when discussing Healthcare before her husband's affair came out into the news. My choices may seem "stupid" to her, or to others, but my choices make sense for my situation, as your do for yours. If they are uninformed, they may not be the best, but we all deserve the right to make choices that we deem the best for ourselves, no matter how "stupid" they may seem to others. I think many choices made by others are "stupid", like that of ever having an abortion. So you have the right to make your "stupid choices", and I have mine. Let's keep it that way!
  5. If you find that I have grossly mischaracterized some passage of the bill, please bring it to my attention, with an explanation of why you think so, and what the bill really means. Lord knows I am no legal scholar, but I am a scholar in general, and a scientific mind who is trained and experienced in debug, analysis, and getting to the root cause of problems.
  6. I have read, myself, every line I am pointing out.
Now for the actual Analysis:
  • Funnel into Public Plan - Page 16, line 10-20: Existing plans may not enroll new individuals, except as family members of the grandfathered-in enrollees. They let you cover your new spouse and children, but nobody else can get in. This means that insurance plans may not grow, and their customers will die off, effectively cutting the insurance companies source of income and customers off. This will cause people to funnel into the only plans that can accept ne enrollees, the government plans.
  • Minimum benefits set by government panel - Page 17, lines 10-20: All private insurance plans must conform to the same requirements as those for the essential benefit package described by the government plans, within five years. this removes choice of plan benefits, and makes all plans a one-size fits all type, which never fits everyone. It causes some to waste money, and others to not get level of coverage they want and are willing to pay for.
  • No new plans on open market - page 19, lines 1 thru 5: All new individual plans must be offered thru the Exchange the government sets up for Health Insurance plans. This means you cannot go buy a plan that is not conforming to the Government standards or benefit packages.
  • No rejection for preexisting conditions - Page 19, line 18 thru page 20, line 23, there are no limits based on pre-existing conditions to getting into a plan, nor can a person be dropped for another reason than not paying the premiums. this is actually a good reform, and should be so noted, unless it is negated by some other provisions. This is the best thing so far in this bill.
  • Discouraging company self-insurance - Page 21 line 22 thru Page 23 line 7: The Bill MANDATES a government audit of the books of ALL EMPLOYERS that self-insure in order to “ensure that the law does not provide incentives for small and mid-size employers to self-insure”! This is totally wrong, as it should be up to the employers to find the most cost-effective way to provide for their employees, not the Government's job to disincentive companies from certain choices that are acceptable to their employees. The studies are to be done in 18 months, with reports providing recommendations (on how to change the law to disincentiveize companies from self-insuring).
  • Limits on profits of insurance plans - Page 25 line 1 thru 11: The Government shall set the amount of profit an insurance plan can have, and the insured (you), will get money back if the plan gets too profitable. How profitable is "too profitable"? The Commissioner will decide.
  • Minimum Coverage includes substance abuse Disorder Services - Page 28 lines 10 and 11: This will expand the cost for those who don't have such problems. Not all do!
  • Minimum coverage includes maternity - Page 28, line 17. This may not seem bad on its face, but for the single guy, it is a waste of money. For the older couple, it is a waste as well. Same for well-baby/child coverage in lines 18 thru 20. Should be optional, to allow cost savings for the buyer.
  • Rationing of HC Benefits - Pages 29 line 4 thru Page 30 line 10: The text is somewhat technical, but it says basically that the cost sharing will be "actuarially equivalent to approximately" 70% of the total cost of the individual benefits, and has a maximum of $10,000 per year for a family, and $5,000 for an individual. This seems to indicate taht the benefits woudl cost more a-la-cart, but together there is some cost savings. If someone who has a better understanding of legalese and/or insurance cost structures, I'd love to get a more complete explanation. I'll insert it, if it comes via email, Facebook, or comments.
  • A Government Health Benefits Advisory Board will determine covered benefits - page 30 lines 13 thru 18: This board of public and private persons will recommend covered benefits, for the plans. This section introduced the idea of Enhanced and Premium plans, and they decide what goes into them. They are to take into account advances in HC and how they can reduce health disparities. Not HCI disparities, but actual "health disparities". This seems to restrict new medical advances, since the use by doctors often provides incentive to develop new technologies and products. If it can't be used until it is covered, it will slowly strangle our development process (see page 32 lines 18 thru 21).
  • Standard Definitions of Insurance and Medical Terms - Page 45 lines 11 thru 15: the Government will develop standard terminology for HCI and medical related terms. This is another good thing. This should keep the Commissioner busy for a good while!
  • HC will be provided to all, even non-US citizens - Page 51 line 21 thru page 52 line 3. This is part of Section 152, "Prohibiting Discrimination in Health Care ", and say "...all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services." No mention of citizenship required, and no limit is placed on non-US citizens either. This is a loophole big enough to fit all undocumented persons through!
  • This Tax is not a "Tax" - Page 203, lines 13 thru 18: ‘‘(4) NOT TREATED AS TAX IMPOSED BY THIS CHAPTER FOR CERTAIN PURPOSES.—The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55.’’ This speaks for itself. Not a tax? Note, there is nto even a section 55, so to what are they referring? What did Section 55 say?
  • Home visits to Parents for child development - Page 837 line 10 thru page 839 line 5: The Government will send trained people to homes of families who are expecting or have young children, to help parents to raise their children properly. Hat tip to Chuck Norris, who pointed this out, though I have verified it myself. The exact wording of their goal is in line 13 on page 837: "to improve the well-being, health, and development of children". Also, on page 839, lines 1-5 indicates that they will "identify and prioritize serving communities that are in high need of such services, especially communities with a high proportion of low-income families or a high incidence of child maltreatment". Who determines what is "maltreatment"? Is it spanking? Deprivation of cell-phones? Allowing kids to eat "bad" food? This is a nice goal, but it is not the responsibility of the Government to intrude on the raising of our kids. I am certain that we will not be able to influence the content and standards they apply to this program. Amish and Muslims will certainly raise their kids differently from each other, and from those who are Atheists. One size will never fit all.

More later!