Medical Providers Are Giving Us The Run Around On Healthcare Price Transparency And It Needs To Stop

Now that the Supreme Court decision upholding subsidies for state exchange enrollees has come and gone, we need to focus on the biggest issue still plaguing health care reform--health care and prescription drug prices. Doctors, hospitals and pharmaceutical companies charge whatever prices they want for their services and products. And we have no idea how much we have to pay until we receive care. However, things are changing. As consumer healthcare cost sharing increases, so does the demand for upfront healthcare prices.

Excuses, Excuses

But our demand is meeting their excuses. Even though about
70% of states and the federal government have regulations in place requiring hospitals, medical providers and/or insurers to produce price lists they keep coming up with reasons why they can’t comply. Or, they send their lobbyists to make sure the legislation is so watered down that the data is useless. Really, how useful are average prices when some areas in a state can charge 1,000 times as much for the same medical procedure.

Of course we should listen to the healthcare industry’s concerns about providing healthcare price data. But we can’t allow them to continue to stall providing this data. Especially as they continue to rake in money and send patients who cannot pay to collection agencies. Besides, it’s been over a decade since we started seriously requesting healthcare price data and they are still using the same excuses for not providing it. Yeah, you know what they are:

  • Price data are trade secrets
  • Price data is meaningless without quality data
  • Prices are difficult to estimate due to the many variables in treatment
  • Price data is difficult to compile and format because of outdated computer systems
All of these excuses have been exposed for what they are—delaying tactics. And what these decade-long delaying tactics tell us is that healthcare providers are not willing to share price data with the public. Therefore, we need comprehensive legislation at the federal and state levels to force them to. No more compromises and no more delays.

Mandating Price Transparency Through Legislation
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It’s On. Financial Services Firms Won’t Give Up Their Control Over Retirement Plans Without A Fight.

It is fair to say that before federal and state lawmakers started focusing on individual access to health insurance and retirement plans, the private sector was okay with maintaining the status quo. A system where if you worked for a large employer and were continuously employed, you could receive subsidized health insurance and have access to a convenient workplace retirement plan. And, the higher your income the more you benefitted from the tax-favored design of these plans.

Then along came the Affordable Care Act (aka Obamacare), bringing the lack of access to affordable health insurance for tens of millions to the top of the public policy agenda. Sensing an inevitable shift in the status quo, private sector health insurance companies and big pharmaceutical companies mobilized to protect their interest. Change to the status quo was fine with them as long as the status quo did not change. Additions to the status quo that left the existing system intact are okay. They lobbied hard to get everything they wanted and little or none of what they did not, and they succeeded.

Soon after, the federal and many state and local governments turned their focus to individual access to retirement savings plans. They found similar problems as with access to health insurance. The lower an individual’s income, the less hours they worked, and the smaller the company they worked for, the less likely they were to have access to a workplace retirement plan. To address the issue, lawmakers proposed their own plans. Some wanted to allow workers without workplace retirement plan access to federal or state retirement plans. But most elected to design new plans that had some but not all of the features of 401(k) style defined contribution plans. Now who would have a problem with this approach? The current system showed little or no interest in these workers. Surely, the financial services sector would not object to everyone having access to a workplace retirement plan. Well, some of them kinda do object.

We Don’t Need No New Plans

Large financial institutions were not completely supportive of the idea of adding “new” retirement plans. They felt like they already had products to meet everyone’s needs even if they did not market these products to the individuals policymakers were trying to help. When President Obama announced the creation of the MyRA (My Retirement Account), many financial service providers scoffed. They called and small potatoes and redundant.

Some suggested that the
states might be able to do a better job at addressing the retirement plan access problem. Continue Reading...

We Can't Wait For Americans To Understand Health Insurance To Fix It

A quick look at the headlines of the latest polls on the Affordable Care Act (aka Obamacare) and you may conclude that Americans don't know what kind of health care system they want.

Most Americans like the fact that people with preexisting medical conditions have a legal right to purchase health insurance. Unlike the bad old days when insurers could deny them coverage... They also like that parents can keep their adult children on their health plans up to age 26. And they are not opposed to the poor receiving government subsidies to pay for health insurance.

Yet a simple majority of Americans still oppose Obamacare. And, they don't like the mandate to obtain health insurance or pay a penalty, despite the fact that this feature provides for the things they like about the law.

As policymakers, pollsters and the media try to understand and explain these clearly disengaged poll responses, employee benefit professionals in the trenches are happy someone finally feels their pain. For decades employers and their human resource departments have tried to provide workers with a comprehensive understanding of health insurance and the health care system. For decades they have failed to accomplish this. And it’s partially their fault, but mostly the average American citizen’s fault. Here’s why.

Employers Failed To Educate Workers About Health Insurance

Employers have to admit that they never shared the behind the scenes process of obtaining health insurance with workers. Plans just magically appeared and all workers had to do was choose one. But not before sifting through a multitude of jargon-filled, legalese mumble jumble about tax advantages and life status events. It wasn’t until the cost of health insurance started getting scary for employers did they start sharing more information about their health insurance plan design and purchasing decisions. However, by then it was too late. After years of receiving confusing insurance information, employees tuned out, keeping the same plan year after year.
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Employment-Based Health Insurance Supporters Should Get Out Of The Way Of Health Care Reform

By all accounts, and there are many, employers are committed to providing workplace health insurance for the foreseeable future. For them, offering coverage is purely an issue of competitiveness. The primary purpose of providing coverage is to attract and retain workers. Period. End of Story... Having a happy and healthy workforce was never a stated goal. However, it appears their selfishness is catching up with them and they know it. Even their traditional allies are questioning the benefits of continuing the health insurance access status quo.

Republicans Challenge Tax Status of Employment-based Health Insurance

Republicans in Congress and the Senate are rethinking the favorable tax treatment workplace health insurance plans currently enjoy. With the urging and free counsel of several conservative intellectuals, Republicans are adding language to their many Obamacare alternatives that would reduce, cap or eliminate these tax advantages. A
proposal, Empowering Patients First Act, from U.S. Representative Tom Price would provide tax credits to everyone purchasing individual coverage and cap the tax benefit of employer-provided coverage. An earlier republican proposal, the Patient C.A.R.E. Act, also calls for “reform” of the tax treatment of employer sponsored health insurance coverage to pay for tax credits provided to individuals who purchase coverage. And the latest proposal from the Republican Study Committee, American Health Care Reform Act, would eliminate the tax-favored status of employer-based health plans. The plan would instead provide a tax deduction to individuals and families to pay for health insurance.

If it looks like Republicans are looking to shake up the world of employer-sponsored health insurance, it is because they are. But let’s not give them too much credit because Obamacare already has a provision to limit or cap the tax benefits of workplace health insurance—the Cadillac tax. Ironically, many republicans want to repeal this tax. Even Representative Tom Price has called for repeal of the Cadillac tax before he put forth his proposal to offer something similar. Go figure.

Groups Defend Health Insurance Access Status Quo

Still, don’t expect businesses and the lobbying groups to take this sitting down. Trade groups, professional associations, insurers, brokers, human resources and benefit professionals will more than likely resist any changes to the workplace health insurance status quo. They will boldly claim the current system works and it is what workers prefer. Oh, yeah, they already claimed that. They will also claim that they support efforts to increase access to affordable health insurance to the unlucky millions who do not have workplace health insurance, and they’ll leave it at that.
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Birth Of A Health Care Reform Movement

There are powerful social and economic movements going on in America today. Some of the more known movements include Black Lives Matter, Occupy Wall Street and The Tea Party.

  • Black Lives Matter is a protest and advocacy movement founded in 2012 to address the dehumanization of black people.
  • Occupy Wall Street is a protest and advocacy movement started in 2011 to address social and economic inequality.
  • The Tea Party is a political movement established in 2004 promoting a fiscally responsible and limited government.
These are three very different movements with different objectives, but what they all have in common is their mission to bring national and even international awareness and change to issues impacting the nation. One has had more success than the others because of its continuous mainstream media coverage and impact on political elections. But the other two are finding that the issues they champion are resulting in proposed legislative and corporate changes. For example, cities, states, federal contractors and private companies are creating laws and policies to increase the minimum wage for workers. Also, the criminal justice system is receiving greater scrutiny in light of its many failures in black communities.

The individuals these movements represent want to change the status quo. And what they are finding out is that it is not easy. The Occupy Wall Street protestors know well how harsh the opposition can be. Politicians and many in the mainstream media often treat them with disdain. The Black Lives Matter protestors have to constantly defend their existence to critics and supporters. Even the Tea Party, the most organized and well funded of the three modern social movements has its haters among the elite.

As these movements struggle to develop their platform, their powerful critics, including many in the media and elected politicians, label them subversives and their leaders, hustlers. They say they are unorganized, naive and unable to articulate their purpose. As was the case for all new social, economic and political movements in the U.S., the odds are against them. Much as it has been for those looking to reform the American health care system.
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