Category Archives: Healthcare/Insurance

King v Burwell, Marijuana, and a Path to Marginalize Obamacare in its Presence

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States Should Start It / If Weed is Worth it……..

Short of repealing Obamacare the next best thing would be finding a method to marginalize it in its presence.  Oddly King v Burwell, along with 23 states plus DC that approved medical use of marijuana and three plus DC that approved recreational posession and use of the plant, may provide a path to doing just that if King prevails.

King v Burwell is the case challenging whether government subsidies can apply to qualified health insurance sold on exchanges run by the federal government.  Proponents of King, led by Michael Cannon of Cato Institute, and Jonathan Adler of Case Western Reserve University School of Law, contend the law is clear that subsidies can only be applied in exchanges established by the states.  As the issue was raised, the IRS simply declared that federal exchanges too are eligible for subsidies.

Four separate but related court cases challenged this IRS decision, and in November the Supreme Court agreed to hear King.  The case is scheduled to be heard March 4th, with a decision sometime in June.  In the event King prevails, most agree there will ensue chaos of a sudden affordability vacuum if the approximately 5 million people who own qualified health insurance bought in states with federal exchanges lose their subsidies.  This will likely bring intense political pressure to find a fix, even as businesses, relieved of penalties triggered by employees obtaining subsidies will argue for other remedies.

In addition, many individuals will find the cost of unsubsidized ACA triggering plans now exceed 8% of their income, relieving them of the individual mandate and its tax for not buying insurance, except they will then either have to scrape to find the unsubsidized premium or be left uninsured with no other choices.

Several Republican governors of federal exchange states, including rising star Scott Walker are feeling nervous about a King win, and don’t seem to know what they may be able to do.  At a National Governors Association event, they took to saying that it’s Congress’s job to deal with any fallout.  None expressed any ideas of what states may be able to do short of somehow restoring the subsidies.

So what if federal exchange states, rather than looking to Congress, switching to a state exchange or piggybacking on another state’s successful state exchange, as has been suggested, would simply make alternate, non ACA qualified, more affordable choices available off the exchange?

Since I had never seen evidence to the contrary and had been told by both Andrew Schlafly, attorney with the Association of American Physicians and Surgeons, and Oklahoma Attorney General Scott Pruitt, whose name is on one of the other three cases, that they knew of nothing in the ACA to prohibit states from making available non ACA qualified choices off the exchange, I heretofore thought this was possible and within the law.

My take had been that the ACA only defined what must be in health insurance plans to be on the exchange, qualify for subidy, and avoid paying the mandate tax, making possible, with or without King, state provision of a parallel free system along side the government control system, allowing states, with their retained authority to regulate insurance through their insurance departments, the potential to allow or even require the availability of alternate choices off the exchange, understanding non qualified plans would not avoid the mandate tax.

I thought this may be especially attractive to those individuals discovering low cost direct primary care arrangements, where an increasing number of primary care physicians are offering unlimited care for a monthly fee.  Here is a rapidly growing need for pure catastrophic insurance as a compliment, that ACA qualified plans have shut down.

I believed all this.  Then, February 9, in a twitter exchange with Phil Kerpen, President of American Commitment, he sent me a link indicating otherwise.  There is indeed federal code that prohibits what I thought was possible.  The office of my Congressman, also previously unaware, identified it as a law from the 1940s that had been amended by Obamacare.  Talk of leaving no stone of iron fisted control unturned!

So what to do now?  State offer of non ACA compliant health insurance off the exchange, no matter how welcome, or as immunization against the affordability aspects of a King win in 37 federal exchange states, would run afoul of Federal law.  It would be an act of defiance, but isn’t this what 23 states plus the District of Columbia did when they approved the medical use of marijuana?  Taking it further, isn’t this what Colorado, Washington, and now Alaska and DC did by approving the recreational use of marijuana?  So far, for those state actions, the feds have chosen to stand down.  If legal weed is important enough to risk federal admonishment, how is offering citizens, still willing to pay the mandate tax, the choice of affordable non ACA qualified options off the exchange not?  It would seem.

More likely, on an Obamacare challenge, the feds would push back hard, but states would have arguments in defense, as well as significant public support that may even exceed weed, especially if King prevails, subsidies are lost, and a sudden affordability vacuum ensues.  While the stand down on marijuana would mean nothing in a legal sense, it may help state defiance on Obamacare play well in the court of public opinion, giving state officials more backbone to act.

States can point to their continued regulation of health insurance where the feds have found it convenient to not supplant them.  State coverage mandates in excess of ACA essential minimum coverage rules still apply, as do their definitions of regional pricing zone boundaries.  They can question also why their regulation of all other types of insurance remains intact, without federal meddling.

There’s the argument McCarran-Ferguson 1945 still gives states the authority to offer alternatives, so long as they don’t attempt to eliminate the federally designed plans.  They could claim restriction only to such limited choices represents overbearing federal imposition and violates the Constitutionally protected freedom of their citizens to contract.  They could point to a long standing tradition of state regulation of insurance in return for insurance being exempt from federal antitrust law.

Perhaps as important, since the ACA unquestionably allows doing absolutely nothing upon payment of the mandate tax, any opposition would be forced into the absurd argument that doing something substantially more than nothing in protecting others from one’s potential inability to pay their medical bills should be prevented, so long as the tax is paid.  In fact, Congress, seeing this argument play out, may be motivated to specifically allow non ACA qualified offerings and reduce or eliminate the mandate tax for buyers, in recognition of their obvious reduction in potential liability to others by their actions.

If only one state or a few, federal exchange or otherwise, would boldly take this course of action, we would present, at least the opportunity to embark on a path to marginalize Obamacare in its presence.  A parallel free system, alongside the government control system could be created, and repeal would no longer be necessary as people could freely choose which system they prefer.

The sudden chaos of a King win would be the perfect time to have alternate choices available, as the potential to quickly attract sufficient numbers to spread the risk enough to insure viability would be most opportune.  If weed is worth it………

Don’t Be Like Me…Resolve to Get That Colonoscopy!

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Now over two weeks into 2015, those well intended resolutions, often centered around taking better care of one’s self, are no doubt already beginning to be forgotten.  Gym attendance is likely already on the slide.  Diets are being forgotten.  Tobacco revenue is recovering.  All as accepting return to the status quo proves easier than determined vigilance for many.

Most of us can take better care of ourselves and should keep tabs on the state of our health.  As I’ve learned the hard way, having that screening colonoscopy, especially after age 50, in spite of a family history, is one diagnostic test not to be avoided.

Not being one to worry or “run to meet trouble”, as an old friend used to say, for the 13 years that it has been available at no cost to me, I’ve avoided and made excuses for getting this most important procedure.  In spite of reminders and urging from my wife, as well as the fact that my mother had polyps removed, I took the position that only a small percent of those who don’t bother to get checked, will actually develop colon cancer.  While this assumption is true, I’m now facing what should have been caught in its earliest stages, likely as a  precancerous polyp, years ago.

The trouble with colorectal cancer is that it can grow without pain or notice until it becomes very serious, causing a bowel blockage or spreading to other organs.  Nor do tumors always bleed.  Fortunately mine did.  A couple months ago, when I noticed blood in my stool, I knew something was amiss.  I went to a primary care physician for only the second time in my adult life for a head to toe checkup.

Of course when I described the symptom that motivated my visit, a diagnostic colonoscopy was arranged a week later, on Christmas eve.  An “ulcerated mass”, confirmed as cancerous by pathology inspection, was discovered along with a polyp showing cancerous attributes.  A surgical resection of part of my colon was suggested.

Three days later I had a lower abdominal CT scan and chest x-ray that fortunately showed no obvious spread of my cancer to other organs.  Although that’s great news, if the cancer is found in surrounding lymph nodes that will be harvested and inspected during my surgery, I’ll certainly be facing chemotherapy follow up to try to attain a cure, often considered 5 year cancer free survival.  My odds of achieving that outcome are about 65%.

So, yes, my negligence to have regular medical exams, and a screening colonoscopy in particular, may yet prove a fatal choice.  I can’t begin to explain the feeling of personal complicity and stupidity that comes with my situation, nor the impact this has on friends and loved ones.  My hope, in writing this, revealing the details of my medical condition, is to spare others.  Don’t be me! Resolve to get that screening colonoscopy!  Don’t make excuses!

Even for those without insurance coverage there are options.  Healthcare Bluebook is a great resource to find fair prices in your area, that can be used to negotiate with providers.  In the Harrisburg, PA area where I live, the fair price for a screening colonoscopy, that amount normally accepted as insurance payment by network physicians, is listed as $1609.  This is broken down as $676 facility fee, $413 physician fee, and $520 anesthesia fee.  Also, colonoscopies can be, and sometimes are, done without anesthesia.

Another option is MediBid, a medical brokerage service started by a Canadian immigrant, Ralph Weber, to connect patients and physicians for specific procedures nationwide.  As one notable example, KATU, Channel 2, Portland, reported in September, 2013, the story of a Chicago man without insurance, looking for a colonoscopy.  Through Medibid he found a physician in McMinnville, OR.  His cost for the procedure, including airfare, lodging, and a rental car was less than half the average $3500 best price he could find in the Chicago area.

Three days from now I’ll be in surgery, beginning the process of trying to stop what could still prove fatal, and likely could have been prevented.  Again, don’t be me!  Resolve to get that screening colonoscopy!  NO excuses!

Stolen Health Data Threatens Pennsylvanians/Others With Identity Theft

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Chinese Hackers implicated

Monday August 18 CNN Money reported Community Health Systems, headquartered in Franklin, Tennessee, announced it’s 206 hospital system, spanning 29 states, had been hacked, exposing critical personal information of 4.5 million patients of its affiliated physicians.  Anyone who used the services of a linked doctor in the past five years, even if never seen at a hospital, is potentially at risk.

Pennsylvania is one of seven states identified as having the most significant presence in the Community Health Systems network, operating 20 hospitals in the Commonwealth.  As a rough estimate, 20 of 206 hospitals is 9.7% of the hospitals in the network.  9.7% of the reported 4.5 million patients suggests about 436,500 Pennsylvanians could be at risk.

It’s reported that the hackers, identified as Chinese, did not get any information related to medical history or credit cards, but information critical to obtaining credit cards and stealing the identities of those at risk, including names, social security numbers, addresses, birthdays, and telephone numbers.  Community Health Systems has said it will be offering identity theft prevention services when it notifies individual patients.

Spokesperson Jason McSherry, representing affiliated and affected Memorial Hospital in York, PA, provided the following statement, shared here in its entirety:

Limited personal identification data belonging to some patients who were seen at physician practices and clinics affiliated with Memorial Hospital over the past five years was transferred out of our organization in a criminal cyber attack by a foreign-based intruder. The transferred information did not include any medical information or credit card information, but it did include names, addresses, birthdates, telephone numbers and social security numbers.

We take very seriously the security and confidentiality of private patient information and we sincerely regret any concern or inconvenience to patients. Though we have no reason to believe that this data would ever be used, all affected patients are being notified by letter and offered free identity theft protection.

Our organization believes the intruder was a foreign-based group out of China that was likely looking for intellectual property. The intruder used highly sophisticated methods to bypass security systems. The intruder has been eradicated and applications have been deployed to protect against future attacks. We are working with federal law enforcement authorities in their investigation and will support prosecution of those responsible for this attack.

Many American companies and organizations have been victimized by foreign-based cyber intrusions. It is up to the Federal Government to create a national cyber defense that can prevent this type of criminal invasion from happening in the future.

In discussion with McSherry, he emphasized that stolen information resided in connected doctors offices rather than the hospitals.  For this reason, he does not think anyone using a hospital directly for emergency or any other reason would be at risk.  The Memorial Hospital website currently lists 267 affiliated physicians.

McSherry also said that not all network hospitals are affected by the breach.  For instance, the affiliated nearby Carlisle Regional Medical Center, although part of the Community Health Centers network, uses a different information system.  He did not know how many different information systems are used by Community Health Centers.

Back to the provided statement, it’s interesting that Community Health Centers looks to the Federal Government to “create a national cyber defense that can prevent this type of criminal invasion from happening in the future”.  There may be some justification to their position, as it’s the Federal Government that’s been dictating so much of what has been happening in medicine.

HIPAA, the 1996 Health Insurance Portability and Accountability Act; ASCA, the 2001 Administrative Simplification Compliance Act; HITECH, the 2009 Health Information Technology for Economic and Clinical Health Act; PPACA, the 2010 Patient Protection and Affordability Act all, along with regulations promulgated under them, address, in various ways, requirements concerning electronic medical records, their use, protection and transmission.  While purported to be money saving measures or patient protections, this maze of imposed regulations, with cost of compliance and threat of substantial penalties, has been driving doctors out of independent practice to hospital employment or out of the profession entirely, while exposing patients to hacking risks, as we’ve seen here.

In addition, can the same Federal Government that runs the Post Office or Veterans Administration really ever do more than stay one step ahead of hackers in protecting us, as the cost of the attempt must be born by all?

Note: This article shared to WatchdogWire-Pennsylvania

GOP Stuck in ACA Replacement “Plan Trap” as Magic Bullet Solution Hides in Plain Sight

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Best Plan is NO Plan

Whether by reaction to charges from Obamacare supporters on the Left, or by their own lack of faith in freedom over planning, Republicans, not one of whom voted for the Affordable Care Act, along with conservative allied groups, think tanks, or prominent individuals, are, by last count, now promoting close to a dozen different concepts of how to replace one version of federal government planning with another less abrasive one.  Despite many replacement proposals, Republicans in congress seem unable to coalesce around any one approach, still leaving the impression they have none.

Some of the proposals are introduced bills. Others are wish lists of items to be in bills.  All have myriad suggestions that either move money around by extending tax deductions or refundable credits, allow formation of small business associations, require price transparency, reform medical malpractice, enhance health savings accounts, shuffle money to states for high risk pools, or various changes to Medicare and Medicaid, among others.

Far away the most popular inclusion is selling health insurance across state lines, itself a dangerous (and here) invitation to Federal micromanagement under the twisted  modern interpretation of the Commerce clause.

Such is the pressure and propensity for government to “do something” that bears on both sides of the political spectrum.  This is the plan trap.

Rarely is there a peep from anyone suggesting that no plan is the proper path, that simple policies to promote, restore, and support the proper functioning of the free market, usually by removing government intrusion rather than supplanting it, should be the goal.  One lone voice, Association of American Physicians and Surgeons past-president Dr Alieta Eck, GOP candidate for the 12th Congressional district from New Jersey, wrote an article defending freedom over planning in January 2014.  She opens:

We constantly are told that “while ObamaCare might not be perfect, the right has not come up with a better plan.” Is it possible that we do not need a “plan” at all?

Think about it. Has the federal government set up a food plan for all? A housing plan? Is the Secretary of Whatever empowered to decide what and when we eat? What kind of house each of us lives in? Of course not. We work, we plan and we buy what we need, saving up for the big-ticket items. Government does not control us, nor should it.

Yet one element contained in a few of the plans and wish lists can be the basis for a market revolution.  Unfortunately, no one seems to have grasped the power of its singular focus.  Had Dr Ben Carson simply stopped at Step 1 of his still in progress 5 step plan he would be almost completely there.

Relatively simple modification, enhancement, and expansion of tax policy surrounding HSAs, done right, has the power to be a true game changer by its potential to encourage employers to drop their long standing provision of health insurance in favor of a defined contribution approach.  It is the magic bullet.  It hides in plain sight, and here is how to get there:

Please follow these simple policy modifications:

1) Decouple HSAs from the requirement to be attached to any insurance policy.  While HSAs could still be attached to insurance (suitable for many), anyone should be allowed (and perhaps even required) to have an HSA.  Monies in HSAs receive rare triple tax advantage and protect others from the owner’s potential inability to pay for needed medical services.

2) Allow the purchase of health insurance or medical services through an HSA.  This establishes favored equal tax treatment without the need for separate legislation.

3) Greatly expand contribution limits to allow #2 to happen.  The HSA can be the tax advantaged conduit for all medically related purchases allowed under it.

4) Allow employers to contribute pre tax to an employee’s private HSA.  This is the crucial trigger for a spontaneous move of employers away from policy provision to defined contribution.  Resulting individual ownership solves portability and suitability issues for those who choose to buy health insurance in the open market through their HSA.  Employers could offer direct contributions or matches to employee HSAs.  Contributions from several employers could be combined, as well as HSA assets among family members’ accounts to purchase one insurance contract if desired.

5) Establish a permanent mechanism whereby Americans can look to each other rather than government for assistance by allowing gifting from one HSA to another both within and beyond family connections.  This is similar to the medical sharing ministry concept without the structure of membership or formal organization.  Any groups could pledge to come to the assistance of each other as needed. Such transfers could keep some people away from Medicaid, where access problems are well known or safely allow lower cost policies with higher deductible amounts.

6) For those in need fund a portion of all government assistance transfer payments into personal HSAs to be used ahead of Medicaid.  The power and influence of ownership is stronger than artificially concocted restrictions on use.  Funds from HSA extend dignity of choice and equal access until exhausted

Nothing more at the federal level may be necessary.  States would have to do their part by discovering their proper constrained regulatory role, requiring sufficient reserves to pay claims and enforcing rather than defining terms of health insurance contracts buyers and sellers find right for them.  All this, of course, requires and follows total Obamacare repeal.

While the benefits of defined contribution in a free market (not to escape or game Obamacare) have been recognized (tops list in American Doctors for Truth Plan) and discussed, no one has suggested a good way to transition. Less attention has been paid to the damage done by employer provision of health insurance, which itself was propelled by government tinkering with wage controls in World War II.

Frank Chodorov, in his 1959 book The Rise and Fall of Society, provides clues to understand why employer provision has been the enabling force of most of our problems.  He argues that a natural law of human behavior leads men to seek the highest degree of satisfactions with the least expense of labor to thereby pursue limitless desires, in order to obtain even greater gratifications.  This leads to efficiencies of effort and specialization of tasks via cooperation with others in forming societies.

Unfortunately this natural inclination also presents a weakness to seek something for nothing.  Such is the case when the employer provision of health insurance disconnects the employee from its cost.  As soon as the employee disassociates health insurance with being a part of his employer’s total cost of his employment, rather than realizing he is really giving his employer permission to spend his money in ways that may be against his best interest, he’s in trouble.  He will request or even demand more, without consideration of alternatives that would be likely choices if he was paying directly.

This then is the source of a gradual movement away from direct payment, even for that normally within the ability to easily afford otherwise, to prepayment schemes that defy the normal purpose and function of insurance to protect assets from expenses that are beyond the ability to pay.

This excess third party payment itself bolsters the illusion of getting “covered” services for free or almost free, even as the premium includes the incentivized overuse of others when not getting one’s own.  It is through these false satisfactions that we accept in healthcare what we don’t see anywhere else in our economy, a situation where almost every transaction involves, at least in part, someone else’s money, driving overuse from both the consumer and provider side along with the associated administrative costs to accomplish it.

It’s not hard to imagine how employer provision of car insurance over time would look just as ridiculous.  Oil changes would require a small copay and many other services would be “covered”.  The brake lobby would have used safety as an excuse to convince legislators to require brake “coverage” in every policy issued, all as employees, under the illusion of something for nothing, would keep asking and demanding more “generous coverage” from employers.

On the other hand, employees reconnected to cost through defined contribution, sparked by simple modification of tax policy related to HSAs, in states that likewise get government out of the way to allow multiple market choices, will make wise decisions that fit their specific financial needs.  The abuses of excess third party payment will naturally end and the free market magic bullet solution some say cannot exist will be a reality.  No one thing can accomplish so much by doing so little.

Note: This article shared to Watchdogwire-Pennsylvania

Illogical Response to Simple RTK Request – Pennsylvania DPW Digs in on Healthy PA

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Healthy PA is Pennsylvania Governor Tom Corbett’s idea for unconventional optional Medicaid expansion that would require a waiver from the Federal Government.  As part of the process the Department of Public Welfare held a series of hearings around the Commonwealth, soliciting public comment via strictly limited three minute turns at the microphone.  Written comments were accepted at the same time or separately through January 13, 2014.  This video is the Power Point presentation that preceded public comments at each meeting.

I was able to get a total of nine minutes to comment by attending three of the eight hearings.  At two of the hearings I spoke unscripted and at the Harrisburg hearing January 9, read a prepared script which I then left as a written submission.

My intention was and is to publish some observations on the hearings.  I took notes but made no recording, especially since the presenter’s comments were being transcribed either by manual input or voice recognition and appeared on a large screen facing the audience in real time.  DPW says they intend to publish a summary of the comments with responses prior to the waiver request submission, but I wanted the verbatim account in the transcripts, both to read comments of others and publish my own unscripted remarks as they were presented.

I called DPW to let them know what I wanted.  They said I would have to go through Right to Know to get records they never suggested do not exist.  So that is what I did in a simple straightforward request.  Today, within the required period, I got an answer.  My request is being delayed for up to 30 more days for the following reasons:

    • Your request is under legal review to determine whether a requested record is a “public record” for purposes of the RTKL
    • The extent or nature of the request precludes a response within the required time period.

I simply cannot buy either of these excuses.  How can they solicit public comment, which anyone had the right to record, obviously make a direct transcription of it, and then suggest it may not be part of the public record?  Then too, why would it take longer than a week to give the records to anyone who properly requests them?  Would the fact that they know me to be a detractor from Healthy PA have anything to do with their response?

Also I wonder why any of this should be necessary.  Yes, I did have a right to record the event but chose to not do it.  That said, how much trouble would it be to require all public meetings to be voice recorded (if not video also) and posted within hours online so anyone unable to attend in person could listen?  It seems that would be a very easy but very significant improvement to our Sunshine Act and Right to Know laws, greatly improving transparency, as well as saving costly clerical efforts in situations like this.

While I’m waiting for bureaucratic determination involving legal experts, what follows is my prepared text I read at the final Healthy PA hearing in Harrisburg on January 9.  Among what mostly amounted to various interest groups slithering up to the Federal money trough, or those objecting in favor of unaltered Medicaid expansion, or those complaining of any suggestions whatsoever of personal responsibility (as exist in Healthy PA), or even one arguably socialist Republican house member passionately pleading to not delay grabbing Federal money one more day, there was this:

Comment to PA DPW hearings on Healthy PA

Despite its good intentions Healthy PA is a misguided and dangerous additional step in the direction of fiscal insanity.  First let’s think about the insidious lure of “Federal” money.  Federal money IS our money.  It comes from the pockets of Pennsylvanians or is imposed as a crushing debt on our children. 

While Healthy PA is not exactly an expansion of the existing failed structure, we know there are better approaches to the entire Medicaid program.  We can see the results of situations where people are empowered with ownership of accounts they control.  We know how spending one’s own money can control overuse, encourage wise use, and reduce fraud.  Healthy Indiana showed how money can be saved by giving it away-such is the power of ownership! Knowing this we should insist that any expansion only be considered after first changing how we run the existing system, using savings wrung from it, except in this “partnership” arrangement the rules only go in one direction, from the Federal Government top down.

We also know of suggestions to boost the number of and participation in free charity clinics, where doctors can operate outside the crush of burdensome regulations.  We’ve passed Act 10, and HB1760 sits in our Health Committee and would not need a Medicaid waiver.

While any state would put itself at an extreme financial disadvantage by exiting the Medicaid program entirely, we also know that if every state did so we would all be better off.  The added layer of Federal bureaucracy and administrative expense could be used to treat needy sick people. 

Think then where we are today.  Here we stand asking a powerful central authority to give us permission to do what should be the absolute right of free sovereign states and people under a constitution unique in the history of the world.  This is America upside down.   This is a great nation in decline.  Healthy PA is further participation in that decline, and it’s time we stop allowing it to continue and expand. 

Rather than making a stand for commonsense solutions we do understand, by becoming leaders for freedom, educating our citizens to what really would work to the extent they understand and demand it, we succumb to expediency, dare I say, political expediency, in an election year.  It’s time we act like the sovereigns we are and end this bowing to a powerful central authority in Washington DC that is changing the fabric and face of America.  Thinking beyond ourselves to generations yet to come we would set Healthy PA aside and choose a different path.

Submitted January 9, 2014

Todd Keefer, York County

Note: This article shared to WatchdogWire-Pennsylvania 1/27/14

Open Letter to PA Insurance Commissioner Michael F Consedine

Michael F Consedine
Commissioner
Pennsylvania Insurance Dept
 

In an October 31 article I questioned whether states could cross the line and offer non qualified health insurance policies along side those conforming to the Affordable Care Act.  I argued a prohibition of this amounts to an assault on freedom to enter into contracts, protected by Article 1, Section 10 of the United States Constitution, and Americans should not be strictly bound to accept only contract terms dictated by a strong central authority in Washington DC.  I noted a long-standing tradition of state regulation of insurance under McCarran-Ferguson 1945.

Only rarely prior to Obamacare had the federal government stuck its nose into insurance regulation, and as far as I know, that only involved health insurance, never any other form.  Insurance regulation was something understood to be handled by the states.

Then Obamacare stood everything on its head.  The federal government would now decide what proper health insurance must look like, that is until this past week when they realized they were in over their heads with an avalanche of policy cancellations and a failed exchange website, upon which they said, in effect, the states are once again good enough to take the reins, if only to bail us out for a while, attempting to shift the focus of public frustration somewhere else.  We broke it.  Now you can fix it.

Prior to realizing the magnitude of the crisis they created, the feds assured us their new policies were somehow better than those “inferior” policies being cancelled, providing more “coverage” that would cost less (after applying money taken from others).  In my mind this is just more lies on top of the big “you can keep your coverage and your doctor” lie.  Yet the biggest insurance lie may be the one we tell ourselves.

As Commissioner of a state insurance department, Mr. Consedine, you should understand the commonly held public misconceptions surrounding the purpose and use of insurance, the notion that somehow low or no deductible, low or no copay, cover everything policies are, in reality,  anything more than costly third party prepayment schemes that benefit no one more than the company that sold it.  Yes, I do mean those dressed up Yugos we call Cadillac plans, as the most extreme example.

You should know that the purpose of insurance is not “coverage” but limitation of risk, to protect assets and provide protection beyond the ability to afford otherwise, and that any attempt to “insure” the ordinary, everyday, or expected is a fool’s game that only insures the incentivized overuse of others will be in your premium.  Yet the warm and fuzzy feeling provided by the illusion of free or almost free when one gets theirs, blinds many people to the fact they are paying for everyone else’s overuse when not getting theirs. It truly is a costly false comfort based in feelings rather than facts.

Indeed, if there is blame for the insurance companies, it is their failure to disclose that what most people say they want is not in the best interest of the vast majority of those saying they want it.  This is the price of a nation poorly educated in personal finance and basic economics.  It is also the challenge of ever hoping to attain real reform.  Insurance companies will continue to maintain their silence as the low end false insurance part of their business is to them as slot machines are to casinos, providing a license to predictably print money thanks to huge numbers narrowing the range of possible outcomes.  Is not insurance, after all, a business based in statistics and probabilities?

Crazy talk?  Then check out Paul Hsieh’s op-ed, “The Only Obamacare Fix Is For Obama To Legalize Real Health Insurance”, published by Forbes this past Sunday.  It is essentially everything I’ve been trying to tell you.  Obamacare thus, rather than fixing anything, only takes a problem and makes it worse!  You should realize these facts, because, after all, you are a Commissioner of insurance.

What you may not realize is the developing movement by physicians to direct pay cash only practice models, such as AtlasMD, a pioneer three physician concierge practice in Wichita, Kansas that offers a family of four unlimited primary care for $120 per month, plus access to wholesale prices on medications and laboratory services.  With the overhead and hassle of third party payers removed, they limit their patient load and offer same or next day appointments that average half an hour and even provide home visits!  This can likely be the future, especially with the availability of low cost catastrophic “real” insurance to compliment it, so long as it can be found.

That’s where you come in, Mr. Consedine.  I know you’ve been complicit with Obamacare from the start, even favoring Pennsylvania’s setting up its own exchange.  Your attitude has been that it’s now the law and we must follow it.  I don’t agree because of the magnitude of the intrusion of Obamacare on our freedom, but respect your view.

Under that same law, though, it is perfectly legal to pay a tax and do absolutely nothing in protecting others from ourselves.  Can it make any sense then, that those same people willing to pay the tax and even forgo the subsidy, should not be able to do something significantly more than nothing in protecting their neighbors from having to pick up for them?  How can anyone argue against that?

As Insurance Commissioner along with our legislators, Pennsylvania should make a stand and tell the federal government that in our state, we will offer qualified policies as required, but also non qualified policies for those who prefer them.  How can doing nothing to protect others be legal but doing something more be illegal?  That makes no sense whatsoever.

Finally, if you don’t think you can make a stand for choice, freedom, truth, limited central government, and local control, then please resign so we can find someone who will.

Thank You

Todd Keefer

Note: This post shared to WatchdogWire-Pennsylvania

Can Obamacare’s “Barrycades” to Insurance Freedom be Crossed?

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Gettysburg Battlefield Aug 13 2013

Not so unlike the fences, signs and traffic cones used to unnecessarily block Americans from their open space national treasures during the recent Federal Government shutdown, similar “Barrycades” to healthcare and insurance freedom are limiting Americans’ ability to freely enter into contracts on terms they decide are right for them.  As the millions having their health insurance policies cancelled are learning, there is currently not an option to simply pay the tax, if necessary, and even forgo the subsidy for those willing, in order to keep a health insurance policy they may have owned for years.

While the freedom to contract, as provided in Article 1, Section 10 of the United States Constitution may seem clear to many, who likely consider it one of our foundational rights, it has endured a surprisingly rocky history in our courts, and as such, provides no guarantee of support against the impositions of the Affordable Care Act.  In America today, Obamacare is erecting barriers to contract freedom by attempting to restrict terms of health insurance policies to those dictated by powerful government bureaucrats, in total disregard of individual choice or basic considerations of sound personal finance.

Especially hard to understand is that a tax can be paid to legally remain completely uninsured, yet plans not deemed “qualified” are not supported as better than nothing (and in many cases completely adequate) in relieving others of ever having to pick up for those without the resources to fend for themselves.  Wasn’t that the stated goal all along?  Like so much of Obamacare, this makes no sense and can only be about elitist control, a step into socialism Americans used to think only happened elsewhere.

Also, with a growing healthcare freedom movement by doctors to eliminate third party payers entirely, from at least primary care, by the establishment of direct pay cash-only pay-per-use or concierge practice models, other options will be needed for those who choose this interesting, and so far, legal alternative.  The use of still available critical illness insurance, as a proxy for unavailable pure high deductible insurance that would make much more sense in these situations, has been suggested.  Dr. Merrill Matthews, of the Institute for Policy Innovation, in a recent article in Forbes, shows how being wrapped in a cloak of life insurance has allowed the critical illness insurance option to survive, and may be a good choice, if not ideal, for many.

As I wrote in a post last December, the curious Miscellaneous Provisions, Subtitle G, Section 1555 single paragraph in the Affordable Care Act clearly says that issuers of health insurance are not required to participate under the act, nor can fines or penalties be imposed for choosing to not participate.  When this is combined with the option for states to regulate insurance, as has been tradition under authority of the McCarran-Ferguson Act of 1945, questions arise as to what states may still be able to do.

Even under Obamacare currently, states may add to the essential minimum benefit requirements of insurance needed to “qualify”.  So states are still involved in their health insurance regulation, if only to a much reduced degree.  A question is how far that authority goes the other way.  Could a state right now, in answer to the current mess of cancellations along with a failed exchange website, exploit the crisis to require the suspension and reversal of all policy cancellations within its borders until the exchanges are fixed?  Could they allow and even require companies that want to sell health insurance in their state to offer the choice of non qualifying plans along side or in place of (Section 1555) Obamacare compliant plans, sold off the exchange, now and in the future?  Could states take charge of the situation to the point that, if Obamacare cannot be eliminated, there could remain legal alternative insurance options apart from Obamacare, even if the federal tax would be due and subsidies not available?

Senator Ron Johnson of Wisconsin has made an attempt to settle this question at the Federal level, at least for currently existing plans, with the introduction of what he calls the “If You Like Your Health Plan, You Can Keep it Act“.  Current political reality makes actual passage unlikely, of course, returning to the possibility that states could act on their own.

One of those I respect most in the Obamacare debate, Michael F Cannon, at Cato Institute, told me the Supremacy Clause would make my suggested state actions illegal, however one of the attorneys on a panel event I attended at Cato was less dismissive of my suggestion of what states could possibly do.  Adding further speculation is the answer I got from ehealthinsurance.com when I questioned them about a month ago.  Their first contact representative, told me they expect to see some states “go rogue” and attempt to offer non Obamacare compliant choices in the future.

As with the shutdown “Barrycades”, when free citizens defiantly crossed the lines and prevailed, will there arise states that tell the Federal Government they have gone too far and we the people have had enough?

Note: This post shared to WatchdogWire-Pennsylvania