Posted on 10/05/2012 1:18:09 PM PDT by pgyanke
“Unlike an HRA (which is a whole other ball of wax), when an employee with an HSA terminates, there is no right to COBRA on the HSA. The money in the HSA fund at the time of termination however belongs to the employee. An employee with a HSA can pay COBRA premiums with their HSA funds but this has no bearing on the cost of premiums or on the employer.”
What do you mean by “there is no right to COBRA on the HSA”? That folks are no longer entitled to HSA contributions (either employer or employee} to their account?
How would that interact with the actual policy benefits, in that the policy that goes with an HSA is often designed around elements of the HSA?
Thanks,
sitetest
You don’t know what you’re talking about.
Here’s what Romney’s website says about these particular issues:
- Ensure flexibility to help the uninsured, including public-private partnerships, exchanges, and subsidies (Exactly how is he planning on doing this? More specifics, please.)
- Ensure flexibility to help the chronically ill, including high-risk pools, reinsurance, and risk adjustment (again, how? specifics please?)
- Prevent discrimination against individuals with pre-existing conditions who maintain continuous coverage (and what if you get too sick to maintain ‘continuous coverage’? what then? Is he going to repeal the part of ObamaCare that protects people for pre-existing conditions that they acquired before they turned 19?)
NO. Romney is NOT sufficiently addressing these issues.
If vague platitudes satisfy you, great. But I’m not waiting to ‘pass the bill before we know what’s in it’ again.
Au contraire!
The nation has NEVER accepted Obamacare.
From the outset until today, there has been a 2-to-1 majority firmly against its implementation.
If you're taking the data from here:
You're misreading it.
It says there are CURRENTLY a TOTAL of about 23,000 folks in the Texas pool, not that 23,000 folks enrolled last month, and that the pool has served 90,000 or so folks since its inception (most of whom are obviously no longer enrolled).
This is consistent with other links with bits and piece of this sort of data. For instance, this link shows over 26,000 folks enrolled in Texas at the end of 2010:
http://www.statehealthfacts.org/comparetable.jsp?ind=602&cat=7
It isn't likely that between Dec 31, 2010 and Aug 31, 2011, enrollment jumped from 26,000 to 90,000, and then another 23,000 in September, 2012. Rather, enrollment has been bumping around the low- to mid-20 thousands for some time, now.
sitetest
“You don’t know what you’re talking about.”
I think you're projecting. ;-)
“- Ensure flexibility to help the uninsured, including public-private partnerships, exchanges, and subsidies (Exactly how is he planning on doing this? More specifics, please.)”
There are entire bodies of research on these topics. Folks who pay attention, who do a little reading, who do a little research, have some idea of what these are about, and what the overall policy initiatives will mean for health care. How will they be specifically implemented? Who knows? Last time I checked, presidents don't get to unilaterally write laws. President Romney will need to negotiate all the details with Congress.
It is more than specific-enough to understand the specific outline of his policies, without knowing what details will ultimately be negotiated.
“- Ensure flexibility to help the chronically ill, including high-risk pools, reinsurance, and risk adjustment (again, how? specifics please?)”
Again, anyone with a modest awareness of these policy concepts AND ACTUAL IMPLEMENTATIONS IN ACTUAL STATES understands the issues at hand, and understands, approximately, what roles high risk pools, reinsurance and risk adjustment will play in an overall plan. Again, presidents don't get to unilaterally write laws. Details will need to be negotiated.
“- Prevent discrimination against individuals with pre-existing conditions who maintain continuous coverage (and what if you get too sick to maintain ‘continuous coverage’? what then? Is he going to repeal the part of ObamaCare that protects people for pre-existing conditions that they acquired before they turned 19?)”
This point doesn't cover issues related to those who haven't been able to maintain continuous coverage. This is a reiteration of what was done in HIPAA (in 1996, not from Obamacare). This is a promise to continue and expand what HIPAA started.
“If vague platitudes satisfy you, great. But I’m not waiting to ‘pass the bill before we know what’s in it’ again.”
These are specific policy proposals. They are about as detailed as they get in a presidential campaign. They are certainly more detailed than anything we got from the Kenyan anti-Christ in 2008.
No one is asking anyone to “pass the bill before we know what's in it.” That was the DEMOCRAT idea. We're only being asked to elect someone who can then go on and negotiate specific legislation, and THEN we'll see it before it's passed.
Frankly, Marie, I'm starting to come to the conclusion that you're a pro-Obama troll. Your arguments are generally uninformed by either fact or logic, they're generally without merit, they confuse important issues regarding to health insurance and health care (such as your apparent confusion between COBRA and high risk pool insurance). Perhaps you're not a troll. Perhaps you just don't have the means to understand the issues at hand. If that's the case, my apologies.
sitetest
“You don’t know what you’re talking about.
Here’s what Romney’s website says about these particular issues:
- Ensure flexibility to help the uninsured, including public-private partnerships, exchanges, and subsidies (Exactly how is he planning on doing this? More specifics, please.)
- Ensure flexibility to help the chronically ill, including high-risk pools, reinsurance, and risk adjustment (again, how? specifics please?)
- Prevent discrimination against individuals with pre-existing conditions who maintain continuous coverage (and what if you get too sick to maintain ‘continuous coverage’? what then? Is he going to repeal the part of ObamaCare that protects people for pre-existing conditions that they acquired before they turned 19?)
NO. Romney is NOT sufficiently addressing these issues.
If vague platitudes satisfy you, great. But I’m not waiting to ‘pass the bill before we know what’s in it’ again.”
I think the greatest solution is to get the government out of the business of healthcare entirely, as laws have tended to favor the big healthcare businesses allowing them to, for example, sell a vaccine for 1 to 2 thousand dollars which, in Mexico, one can get for less than a hundred dollars. In fact, I often get medicines from Mexico without a prescription that I have to pay hundreds of dollars here (and a doctor’s visit) to get. It is because of laws like EMTALA and the government’s institutional meddling in the healthcare business that it becomes necessary to spend money on Insurance so the insurance can spend thousands more for things that are 5 to 6 times more costly than the cost would be in a real market. When it comes to the healthcare industry, the government has taken the same policy the Europeeons do with their entire economy: Corporatism, where they favor businesses and actively resist or block other providers for moving in.
People keep saying Romney is a businessman who knows how to fix things. But, it’s a lie, as Romney invented the current ObamaCare abomination with all the same fixes he now allegedly condemns. But even his fixes are vague, and often he confuses goals with specifics. The end result is that the government will still be subsidizing healthcare, but only temporarily, because the costs have been increasing at roughly 7 percent every year and only escalate the more we meddle with it. It is an unsustainable system that will be brought to collapse. And when it collapses, perhaps then we can start new with a free market system. We have no leadership with no real ideas.
How, then, would you address them?
Serious question.
There is nothing complicated about insurance, basically an insurer is a bookmaker. Ask any actuary.
Krugman, on the other hand, is mentally not all there. Like so many of his ilk.
Serious question that deserves a serious answer.
I don’t know. I’m an army wife and a mom. I don’t have all the answers.
But I do have some suggestions.
I do believe that the clause exempting anyone from being discriminated against for something that they acquired before the age of 19 is a good thing.
I also think that FREE healthcare should never happen. That’s what leads to the abuse of the state-run health systems. I don’t remember where I saw it, but years ago I saw a study that showed that even a $20 ‘at the point of service’ fee for healthcare dramatically cut down on abuse. (people going to the dr for every sniffle)
We also need to stop illegal immigrants from using our resources. Close the borders and deport. (This is *killing* Arizona and Texas.)
Allow family members to pay to keep their partially-disabled sons and daughters on their insurance for a reasonable premium. (Again, we’re not asking for a freebie, just a chance. We’re willing to pay - but we couldn’t afford $700 a month plus co-pays. The average family can’t do that.)
I do agree with Romney that we need to use the fact that we have 50 states to our advantage. Let each state come up with their own system and see which ideas play out in the real world. (One thing that I hate about Liberalism is that they live with Theory as if it were Fact. The Fact is that gov’t-run healthcare has never worked well. We know what doesn’t work, but not what does... not yet. Most of these issues are less than 60 years old.)
We need to deregulate the medical system and allow doctors to see cash patients on their own terms. Let there be the opportunity for patients to directly buy from doctors who chose to opt-out of all third-payer health plans. (Their overhead drops dramatically and a much greater portion of each dollar actually goes to medical care instead of paperwork and compliance with regulations and insurance companies’ demands.)
Stop funding cheap drugs overseas. If they want the medications, they can pay the same price we pay. It infuriates me that OUR drug companies sell to Socialist countries at a lower rate than they do to our own.
If we can drive down the cost of medical care, then we all win.
I do not think that gov’t subsidies are the answer. Subsidies ALWAYS drive the costs up. Regulation drives the costs up.
I don’t have all the answers, but the ‘walking sick’ need help. It’s not just my kids. It’s the 40 year old waitress with hypothyroidism or the 55 year old man with his first heart attack. Or the miner who’s just beat his body so deep into the ground after 25 years of hard labor that every joint is inflamed.
Really think about it. We have more disabled because we have better medical care. People who would’ve died are living crippled. (Then we’ll add the fall-out of better armor and front-line medical care in the last two wars... soldiers who would’ve been killed are now brain damaged or missing limbs. We have a MUCH higher rate of disabled troops. Again, most of these guys aren’t so messed up that they can’t function at all, but too messed up to be completely productive.)
This is one reason I am so ‘pro-education’. Retraining people to work their minds instead of their bodies. Maybe that’s part of the solution. People who worked in manual labor can be seriously retrained to do something else when their bodies fail. I’d support that “teach ‘em to fish” program. (And I really, REALLY hate to think of such a gov’t program. I can see that being ineffective and falling apart very quickly... but maybe private companies who are given an ‘x-prize’ for the number of people retrained, self-reliant and employed instead of paying for the program itself. Only pay for success. Hell, that’s the way every gov’t program should be run.)
There’s a few ideas to get started. If a housewife can come up with that much, I’d expect our best and brightest to come up with a good, solid, conservative program.
For decades the Republicans buried their heads in the sand on this issue. Not accepting that our nation has changed. Job stability just isn’t part of our culture anymore. More and more lives are being saved, but at a price. The costs of medical care have been driven insanely high. This is effecting the job market. Employers are having to pay more to insure their employees - thus, hiring fewer people. (This was before ObamaCare)
Over the years, I’ve run across many FReepers who’ve been doing fine, then had a health crisis and NEVER recovered - physically, financially, spiritually. Their lives are forever changed.
The system is broken - like so much in this country. That’s why I loved Herman Cain’s tax plan. It threw out decades of crap, duct tape and band-aids and started over from a fresh point.
Our medical system needs a similar overhaul. ObamaCare tries to fix a broken system when we really need to burn it down and start over from scratch. All it’s doing is compounding the massive problems that we already had.
Where I’m disappointed with Romney is that he’s doing the same thing. He’s not facing the health care crisis as a crisis.
Hopefully, the deregulation will make a significant difference. But millions of our ‘walking sick’ will be out in the cold. My son’s best hope right now is a thriving economy. In a boom, even the poor aren’t as poor. We seriously need an energy boom and we need a big one.
My son has a desperate plan in place if things get too bad. (Not suicide, thank G-d) I’ll not get into the details, but it makes me sick that I can understand it.
As with so many of our societal problems, the excessive cost of healthcare is a direct result of the government having gotten involved in the industry during the LBJ administration. Any reform, therefore, must start with the government withdrawing from the industry. Not overnight...but over time.
Government intervention inevitably causes distortions in the free market; indeed, that is why the government feels compelled in to intervene -- to create distortions, usually because of somebody's perceived "unfairness".
In general, that would be the best solution to the problem -- gradually withdraw the government from the equation, returning the industry to the sole control of healthcare providers, insurance companies...and the market. Plus, restricting regulatory functions to the several states.
That doesn't address your particular problem, however. And, while I don't share your experience, I'm sensitive to it.
The problem is we can't expect insurance companies to cover pre-existing conditions unless they charge an appropriate premium. That's what they have actuaries for, after all. More often than not, though, the "appropriate premium" is simply unaffordable. Nor can we expect the company's other insured to pick up the freight for somebody else's pre-existing condition. Doing so would make the company uncompetitive.
Some states, I'm aware, have established so-called "high risk" pools for health insurance (as well as auto insurance). I understand these pools are a.) subsidized (thus involving taxpayer money) and b.) require the insurance companies doing business in the state to share the costs more-or-less equally.
This solves the problem of availability and competitive balance, while spreading the incremental cost as broadly as it can perhaps be spread. Even at that, though, I understand this pooled coverage remains relatively expensive (as it no doubt must be) and is only rarely purchased (another commment up-thread remarked that only 90,000 such "pool" policies were in force in the entire state of Texas).
Making policies portable from state-to-state is an easy fix in many circumstances.
But children with a pre-existing condition growing into their majority and unable to get coverage is a problem that must be addressed in some fashion. I'm certainly up to letting the states address this rather than the feds.
I'll cut no slack for one group of people with pre-existing conditions: The people who had access to coverage and the resources to purchase it, who chose not to. That's called being irresponsible. And I wouldn't be surprised if the vast bulk of people complaining about this problem aren't in this particular group (e.g., Bob Beckel). Any program I might author would leave these people on their own.
At any rate, any move toward lower healthcare costs for all must begin with shoving the federal government out of the way.
Don't know whether I've helped you clarify your thoughts. But your post certainly helped me clarify mine...
And this is what we need. Not just in medicine, but in many areas.
We need to field the public for very good ideas and implement them.
My husband is a soldier and he sees MANY areas where we could cut military spending without cutting pay, military resources or readiness.
But the way that the system works, it rewards failure.
Let me give you one very small thing that’s been bugging me for years about TriCare.
My daughter’s doctor said that she needed to see a cardiologist. The cardiologist ran a bunch of tests, said that this was wrong and that she needed a neurologist.
The cardiologist can’t send her to a neurologist. He sends his report to my dr’s PM (suggesting the referral to the neuro), then my daughter has to make another appointment to see her PM who then gives her a new and separate referral to a neurologist.
The inability of one specialist to refer to another is stupid as hell.
So TriCare now has to pay for a NEW appt with her PM to get a new referral to the new specialist.
Now we not only add the cost of the appointment to the PM that wasn’t necessary, we add the paperwork with TriCare.
I know it seems small - $75 for an appt, half an hour of a TriCare employee to process this appt - but do this a thousand times... ten thousand times... twenty thousand times a year...
How much is this extra step costing taxpayers?
When you factor in that this stupid rule applies to every soldier, sailor, airman, marine, retiree and military dependent, it adds up.
Where can I go to suggest this small change that would probably save the military healthcare system a billion dollars each year? I’ve written a letter to TriCare. I’ve written op-eds. I’ve blogged about it.
Nobody listens. Nobody cares.
THAT is the problem with gov’t programs. Once the system is in place, nobody is motivated to change it.
Trust me, if a private insurance company found a way to cut a ton of money from their budget AND make their customers happier, they’d do it.
In 2005 the Texas High Risk Insurance Pool commissioned a study to figure out why nobody was using the program. The study found many issues with the program and multiple suggestions to fix it. The Texas legislature ignored the study.
I love the idea of an ‘x-prize’. There are many, MANY people out there smarter than me. But it’s worthless if there’s nobody to implement these ideas.
This is why we keep putting our hopes in politicians. In our minds, that’s what they’re hired to do. But *their* motivation is to get elected.
Trust me, if a private insurance company found a way to cut a ton of money from their budget AND make their customers happier, they’d do it.
Therein the wisdom of Paul Ryan's initiative to turn Medicare into a voucher program. Private insurance companies would never stand for the waste and corruption that exists within any government program.
Costs can only go down. Service can only improve.
In the interest of full disclosure: I am a dialysis patient, on Medicare. It's my understanding that dialysis patients are responsible for around 2/3 of all Medicare outlays.
The treatments are expensive...and they keep us alive almost indefinitely.
My wife is an accountant...and she views every statement and invoice we get -- from providers, Medicare and the supplemental insurance. Medicare normally pays around 1/3 the cost of the invoice..and the supplemental provider automatically pays 25% of that. And, shazam, everybody is happy.
But it's obvious what is happening. Every time Medicare ratchets down the percentage of the bill they will pay, the suppliers ratchet up their invoice -- so that their eventual compensation is equivalent to their real cost of service (plus profit).
Thus, a totally artificial price structure is in place that has no relationship to reality...and is ripe for corruption.
How would that interact with the actual policy benefits, in that the policy that goes with an HSA is often designed around elements of the HSA?
With an HSA all the money in the HSA account belongs to the employee as soon as those funds are contributed (both employee and employer contributions) including after termination. And after terminating with your employer, you can move the funds out of the employer’s HSA banking institution into one of your choosing, for example find an account with a better rate of return if you have enough money in the account. You can even use funds in an HSA to pay for COBRA premiums. That’s what is so good about an HSA, it is 100% employee owned and 100% portable and unlike an FSA or HRA, the unused funds at the end of the plan year or at termination do not revert back to the employer.
The difference is that, unlike with an HRA, with an HSA if the employer funds part of the employee’s HSA contribution which some do, at termination and or with election of COBRA benefits, the employer is no longer obligated to fund the employer portion – that’s why it is said that there is “no right to COBRA with an HSA”.
If an employee has an HRA and elects COBRA the employer has to continue to fund their share of the HRA contribution.
http://info.cobraguard.net/COBRA-blog/bid/121807/HRA-vs-HSA-COBRA-Administration-Considerations
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