CARE NOT COVERAGE – PROPOSAL TO STRENGTHEN HEALTHCARE REFORM
I have been encouraged by the health care reform initiatives I have heard over recent weeks by several legislators committed to the repeal and replacement of “Obamacare”. The proposals which call for health savings accounts, high deductible plans and transparent pricing draw from consumer driven healthcare practices which have been demonstrated to be effective, but there are provisions missing that must be included in both the narrative and the solution in order for the benefits we seek to achieve from PROPER healthcare reform can be realized.
First, we must eliminate the expectation and commitment that a person cannot be denied health insurance regardless of any pre-existing condition. It’s irresponsible, and is a red carpet to buy insurance only when you need it, which IS NOT insurance. Imagine trying to buy auto insurance after you total yours or someone else’s vehicle in an accident? No one would suggest that should be allowed and allowing for waiting to purchase health insurance until you have been diagnosed with an illness is no different.
This proposal required a DEFINITION of what a pre-existing medical condition is. It is a condition that has been DIAGNOSED by a qualified and recognized medical professional. You do not have a pre-existing condition of Hypertension because you have taken your blood pressure at Walgreens and the readings have been high, even if it’s been so repeatedly. In fact, while it could be a sign a lung cancer, you do NOT have a pre-existing condition if you are coughing up blood. It’s important for the public to realize this when discussing pre-existing condition exclusion and inclusions.
This proposal also requires a discussion of the significant protections offered to insured who suffered from pre-existing medical conditions by the passage of HIPAA, many years before the Affordable Care Act. Many people think of the Health Insurance Portability and Accountability Act (HIPAA) in terms of medical privacy, but it also put in place SIGNIFICANT protections against insurers excluding coverage for pre-existing condition, and those provisions, in my professional and qualified opinion, are generous and sufficient and represent a proper RESPONSIBLE limit on the pre-existing condition coverage insurers are required to cover. The provisions of HIPAA REQUIRE that if you have been covered by a qualified health plan in the previous sixty days, a new group plan cannot exclude coverage for pre-existing conditions. Throughout the entire presidential campaign, I have heard no mention of this important protection which has been in place more than 10 years. I will not go into details about the provisions of HIPAA, but healthcare reform should not be discussed outside of the context of the HIPAA protections already in place, and anyone unfamiliar with those provisions should study them. It is popular and feel good, but irresponsible to continue to tell the American people that they can wait to buy insurance until after a tragic accident or unfortunate illness, or after years of less than responsible health care choices and/or behaviors have “wrecked” their body. Government should not encourage this sort of irresponsible behavior, and once reforms are passed, any provisions in healthcare reform legislation which requires insurance companies to cover “pre-existing” conditions beyond what is provided for in HIPAA (and I don’t believe such a provision should be required) should be phased out in 20 years, OR LESS.
The biggest failure of the so called Affordable Care Act was the damage it did to employer sponsored healthcare system. It caused under employment as employers reduced hours to employees to avoid mandates and discontinued sponsoring plans sending employees to the flawed Obamacare exchange to purchase coverage that was worse and more costly than almost any employer sponsored plan.
Conventional wisdom is that the insured (through individual and group plans) pay the cost of the uninsured because the ultimate healthcare they receive is the most expensive and inefficient method of treatment. Any reforms should include provisions to provide INCENTIVES for PREVENTIVE CARE, instead of mandating health insurance coverage. This can and should be done in a manner similar to that which was successfully used to eradicate many deadly and/or debilitating diseases through vaccinations.
1. STATES should select any number of access points where in individuals are given incentive to demonstrate they have undergone basic preventive care. The number of conditions which can be diagnosed early and treated inexpensively from a basic physical examination by a physician and basic blood panel & urine testing are numerous. The reality is that lack of insurance is NOT the primary barrier to a healthy 30y/o getting routine preventive care.
True Case Study
A 36 year old professional male goes to the ER after several weeks of illness which resembled severe nausea, vomiting and malaise. He is immediately admitted and ultimately diagnosed with end stage renal failure. Doctors determined that the renal failure was caused by chronic high blood pressure which had never been diagnosed or treated. By the time he was discharged, after a three week hospitalization, including two weeks in intensive care, his medical bills totaled almost $500,000. This man had worked for companies which offered competitive health insurance and had been insured most of his adult life through his employer plans, however, at the time he was diagnosed with Kidney failure he was uninsured because he failed to complete and return the proper paperwork to ensure his coverage. While the outcome of this story is separately unique, the discharge included instructions to continue dialysis several times a week, and instructions to begin the process of registration for a kidney transplant.
It is common medical knowledge that the silent killer know as high blood pressure is easily managed with diet, exercise and a vast array of relatively inexpensive medications. Further, in this specific case, while the young man had a history of struggling with obesity, he had managed to reduce his weight to healthy level through diet and exercise, but unknown to him, his blood pressure was not controlled due to, among other things, hereditary factors. Doctors hypothesized that a commitment by the patient to monitor his blood pressure at widely available public machines could have alerted him to the elevation in his blood pressure years earlier, and could have been controlled by very inexpensive medications, and simple blood and/or urine test as much as two years prior to the diagnosis of kidney failure could have alerted doctors to the patients reduced kidney function at a time when early intervention and treatment would have led to significant decrease in the associated long term medical cost.
Incentive for Preventive
At the outset of mandated vaccinations, children were required to be vaccinated prior to their ability to enroll in school and low or no cost vaccinations became widely available over time. As adults, opportunities to offer incentive to promote routine preventive care should be built into normal life events.
States should establish a Certificate of Health Responsibility that can be issued and renewed to and for adults who have obtained minimum preventative care, and must ensure that preventative care is never cost prohibitive, the same as vaccines.
a. Employers can ask for documentation of routine preventative care when starting a new job and can provide preventative care time off to employees for the express purpose of getting a basic physical. It’s important to protect the medical privacy by ensuring that employers are never informed of or privy to the medical information of their employees, but only that they demonstrate they have undergone preventative care. Again, I believe in incentives, not mandates, so all health tax benefits and credits and should be tied to an employer offering meaningful incentive to employees to obtain preventative care, and tax treatment on for employer sponsored health plans should be rewarded for high and increasing percentages of a health responsible workforce.
b. States that require driver licenses renewal or auto registration can require certification of health responsibility or an acknowledgment that you are aware of the availability of preventative care and consciously declining to be health responsible by getting such care, and they can also offer reduced cost of driver licenses renewal/auto registration to those who choose to become health certified.
c. Kids and teens have little if any control over either the health insurance coverage or the medical care which their parents provide for them, but most people are legal adults or almost legal adults when they graduate from high school, and this is another opportunity to encourage them to consider preventative healthcare as a responsible life choice as is arranging for coverage of unforeseen health care needs through health savings accounts, learning about the plan that may be provided to them by their parents or coverage available to them privately or through their own employer.
d. The cost of auto insurance is already adjusted in some states based on responsible life choices and the purchase of auto insurance is another excellent opportunity to provide reminders about the importance of health insurance coverage and to offer incentives and discounts to those who have certified their health responsibility.
Ultimately, states should determine which method and/or combination of methods would best encourage the people of the state to certify their heath responsibility by seeking appropriate preventative care, and the legislation passed to replace the failing Obamacare should structure tax treatment, tax credits and subsidies to reward states who certify the health responsibility of large and growing numbers of their population.
The INCENTIVE FOR PREVENTIVE provisions will begin to address the problem of healthcare cost. We already know that diabetes is the highest cost medical condition, so our ability to change the habits of increasing numbers in our population because a blood or urine test alerted them of pre-diabetic markers, has the potential to have a substantial impact on slowing cost. If a physical results in someone starting the proper medication to manage their blood pressure, imagine the impact this would have on cost associated with catastrophic heart disease in the population. We also know that chronic hypertension and diabetes are the leading causes of kidney failure, so we open up the possibility of reducing the instances of this costly, debilitating condition and imagine if we could finally eliminate the need for a kidney transplant list.
I look forward to sharing with you additional ideas I have documented over the years to improve health care education and I am excited over health savings account ideas that will ensure the solvency of Medicare and I hope so soon volunteer or work with congress and or health and human services to deliver true health care reform to the American people.
My name is Marina Boyd, and I have worked in Human Resources, employee benefits plans, and the systems that track and manage these cost from 1990 to 2010. I am a demonstrated expert on Section 125, COBRA, HIPPA, ERISA and have worked in the trenches on the cost side for employers, and the care delivery side for employees. I have been enrolled in at least 10 different employer group health plans during my career till I was sidelined due to disability from a chronic illness in 2010. From that time, I experienced enrollment in Medi-Cal (the California rendition of Medicaid, and the worst medical care of any plan I every have ever had, or administered) and Medicare (currently), and I have experienced the woes of consumers and medical providers struggling with claims administration, pre-approvals, complex plan rules and regulatory requirements. I know that market driven solutions such as health care price transparency and accountability, health savings account and an engaged, responsible health care consumer population is the ONLY healthcare reform that is sustainable in the long term.