By Elise Viebeck
The Hill, November 25, 2012

The Obama administration faces major logistical and financial challenges in creating health insurance exchanges for states that have declined to set up their own systems.

Since different states have different insurance markets and different eligibility requirements for Medicaid, Obama’s Health and Human Services Department can’t simply take a system off the shelf as a one-size-fits-all fail-safe.

“You can’t simply deploy one federal exchange across the board,” said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.

“Each state is different — their eligibility systems are different, their insurance markets are different. [HHS is] going to have to build these exchanges to fit into the context of each state.”

Experts have predicted that the department will soon have to tap budgets from its other programs to cover exchange costs. Other have said it might charge fees on the insurance purchased in its exchanges once they are launched.

The idea behind the exchanges is to match the uninsured with plans that meet their needs and reflect their eligibility (or lack thereof) for government help.

In practice, the process will require websites that can process massive amounts of personal information from users and yield search results for everyone.

Each portal will require a front end — the interface consumers will use to submit their information and shop for plans — and a specialized back end that is customized based on the state.

HHS will also construct a range of other systems: a federal data hub for verifying user identity; programs for user assistance; a way to certify that health plans meet federal standards; a way to navigate the exchanges via phone or apply for coverage by mail; and so on.

Experts expressed one main concern across the board — that people eligible for Medicaid but not for the exchanges might fall through the cracks in federally run systems, since enrollment in the program is run by states.

http://thehill.com/blogs/healthwatch/health-reform-implementation/269137-obama-faces-huge-challenge-in-setting-up-health-exchanges

Comment:

By Don McCanne, MD

One unique feature of health care financing in the United States is our shameful administrative excesses. The new state insurance exchanges required by the Affordable Care Act (ACA) add to that waste, whether run by the states or by the federal government by default.

To begin with, since the plans offered by the exchanges will be in the individual and small group markets, under ACA they will be allowed to keep 20 percent of the insurance premiums for their own administration and profits.

Next, the exchanges will be much more complex than a mere website from which to compare and choose plans. These portals (exchanges) will require a complex front end to determine eligibility or lack thereof for Medicaid or for the premium subsidies which vary based on the actuarial values of the plans and the incomes of the applicants. Also the managers of the exchanges will have considerable work on the back end in establishing plan eligibility to participate in the exchanges, evaluating the essential health benefits of each plan, confirming that each metal level (bronze, silver, gold, platinum) meets actuarial standards, meeting regulatory requirements that vary from state to state, and providing a mechanism for the purchaser to intelligently navigate the maze established by the exchanges.

Obviously there will be considerable administrative costs associated with these exchanges – costs that are beyond the 20 percent retained by the insurers. ACA requires that the exchanges be self-sustaining, meaning that these administrative costs must be paid by the insurers (beyond the 20 percent) or by the purchases of the plans. Either way, those enrolling in plans through the exchanges will ultimately bear the costs of these administrative excesses.

Finally, physicians, hospitals and other providers of care will continue to bear the costs of the excessive administrative burden placed on them by this fragmented, complex financing system. Instead of providing administrative relief, the exchanges further increase the administrative burden and excess costs of allocating our health care dollars.

Readers already know how over 99 percent of this portion of our administrative waste could be eliminated. Enroll each individual once, at birth, in a single national health program – an improved Medicare that includes everyone. So why aren’t we doing it?

Obama faces huge challenge in setting up health insurance exchanges

By Elise Viebeck
The Hill, November 25, 2012
The Obama administration faces major logistical and financial challenges in creating health insurance exchanges for states that have declined to set up their own systems.
Since different states have different insurance markets and different eligibility requirements for Medicaid, Obama’s Health and Human Services Department can’t simply take a system off the shelf as a one-size-fits-all fail-safe.
“You can’t simply deploy one federal exchange across the board,” said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.
“Each state is different — their eligibility systems are different, their insurance markets are different. [HHS is] going to have to build these exchanges to fit into the context of each state.”
Experts have predicted that the department will soon have to tap budgets from its other programs to cover exchange costs. Other have said it might charge fees on the insurance purchased in its exchanges once they are launched.
The idea behind the exchanges is to match the uninsured with plans that meet their needs and reflect their eligibility (or lack thereof) for government help.
In practice, the process will require websites that can process massive amounts of personal information from users and yield search results for everyone.
Each portal will require a front end — the interface consumers will use to submit their information and shop for plans — and a specialized back end that is customized based on the state.
HHS will also construct a range of other systems: a federal data hub for verifying user identity; programs for user assistance; a way to certify that health plans meet federal standards; a way to navigate the exchanges via phone or apply for coverage by mail; and so on.
Experts expressed one main concern across the board — that people eligible for Medicaid but not for the exchanges might fall through the cracks in federally run systems, since enrollment in the program is run by states.
http://thehill.com/blogs/healthwatch/health-reform-implementation/269137…

One unique feature of health care financing in the United States is our shameful administrative excesses. The new state insurance exchanges required by the Affordable Care Act (ACA) add to that waste, whether run by the states or by the federal government by default.
To begin with, since the plans offered by the exchanges will be in the individual and small group markets, under ACA they will be allowed to keep 20 percent of the insurance premiums for their own administration and profits.
Next, the exchanges will be much more complex than a mere website from which to compare and choose plans. These portals (exchanges) will require a complex front end to determine eligibility or lack thereof for Medicaid or for the premium subsidies which vary based on the actuarial values of the plans and the incomes of the applicants. Also the managers of the exchanges will have considerable work on the back end in establishing plan eligibility to participate in the exchanges, evaluating the essential health benefits of each plan, confirming that each metal level (bronze, silver, gold, platinum) meets actuarial standards, meeting regulatory requirements that vary from state to state, and providing a mechanism for the purchaser to intelligently navigate the maze established by the exchanges.
Obviously there will be considerable administrative costs associated with these exchanges – costs that are beyond the 20 percent retained by the insurers. ACA requires that the exchanges be self-sustaining, meaning that these administrative costs must be paid by the insurers (beyond the 20 percent) or by the purchases of the plans. Either way, those enrolling in plans through the exchanges will ultimately bear the costs of these administrative excesses.
Finally, physicians, hospitals and other providers of care will continue to bear the costs of the excessive administrative burden placed on them by this fragmented, complex financing system. Instead of providing administrative relief, the exchanges further increase the administrative burden and excess costs of allocating our health care dollars.
Readers already know how over 99 percent of this portion of our administrative waste could be eliminated. Enroll each individual once, at birth, in a single national health program – an improved Medicare that includes everyone. So why aren’t we doing it?

Rep. Judy Biggert and 57 cosponsors
November 16, 2012

SECTION 1. SHORT TITLE.

This Act may be cited as the “Equitable Access to Care and Health Act” or the “EACH Act”.

SEC. 2. ADDITIONAL RELIGIOUS EXEMPTION TO HEALTH COVERAGE MANDATE.
 
(a) IN GENERAL.—Paragraph (2) of section 5000A(d) of the Internal Revenue Code of 1986 is amended by adding at the end the following new subparagraph:

“(C) ADDITIONAL RELIGIOUS EXEMPTION.—
 “(i) IN GENERAL.—Such term shall not include an individual for any month during a taxable year if such individual files a sworn statement, as part of the return of tax for the taxable year, that the individual was not covered under minimum essential coverage at any time during such taxable year and that the individual’s sincerely held religious beliefs would cause the individual to object to medical health care that would be covered under such coverage.
 “(ii) NULLIFIED IF RECEIPT OF MEDICAL HEALTH CARE DURING TAXABLE YEAR.-Clause (i) shall not apply to an individual for any month during a taxable year if the individual received medical health care during the taxable year.
 “(iii) MEDICAL HEALTH CARE DEFINED.—For purposes of this subparagraph, the term ‘medical health care’ means voluntary health treatment by or supervised by a medical doctor that would be covered under minimum essential coverage and—
  “(I) includes voluntary acute care treatment at hospital emergency rooms, walk-in clinics, or similar facilities, and
  “(II) excludes—
   “(aa) treatment not administered or supervised by a medical doctor, such as chiropractic treatment, dental care, midwifery, personal care assistance, or optometry,
   “(bb) physical examinations or treatment where required by law or third parties, such as a prospective employer, and
   “(cc) vaccinations.”.
 
(b) EFFECTIVE DATE.—The amendment made by subsection (a) shall take effect as if included in the amendments made by section 1501 of the Patient Protection and Affordable Care Act.

http://thomas.loc.gov/cgi-bin/thomas

Comment:

By Don McCanne, MD

H.R. 6597, the “Equitable Access to Care and Health Act,” is a proposed amendment to the Affordable Care Act that would provide a religious exemption to an individual from a penalty for being uninsured, providing that the individual files a sworn statement, as part of the tax return, that “the individual’s sincerely held religious beliefs would cause the individual to object to medical health care that would be covered” under health plans mandated by the Affordable Care Act.

If any medical care were obtained, that would nullify the exemption, and penalties for being uninsured would apply. Theoretically, that would separate those whose religious beliefs regarding abstaining from health care were sincere, from those who would submit a sworn statement merely to avoid the penalty while remaining uninsured. In actuality, even with such religious beliefs, individuals might find it difficult to refuse care in some instances such as major trauma.

If you check the list of cosponsors, you will see that this act does have very broad bipartisan support. It seems like a reasonable amendment, though it still doesn’t protect the rest of us from the costs of care that the person might receive when the medical imperative is greater than the religious conviction.

Is there a better way of doing this? Of course. Include everyone in a single national health program. Do not fund it based on medical need, but fund it through equitable, progressive tax policies. Under such a system, anyone can decline medical care for whatever reason, religious or otherwise (except if the person’s disorder constitutes a genuine threat to public health).

Should a person be required to pay taxes into a universal health care system? I can answer that by stating, as a pacifist, I vehemently object to paying taxes to fight wars. Yet I cannot be allowed the option of withholding my allocated tax assessment assigned to our nation’s military ventures. Nor can anyone be allowed to opt out of paying taxes for any public service that, through our democratic process, we decide to provide for the public good. That includes health care.

H.R. 6597

Rep. Judy Biggert and 57 cosponsors
November 16, 2012
SECTION 1. SHORT TITLE.
This Act may be cited as the “Equitable Access to Care and Health Act” or the “EACH Act”.
SEC. 2. ADDITIONAL RELIGIOUS EXEMPTION TO HEALTH COVERAGE MANDATE.
(a) IN GENERAL.—Paragraph (2) of section 5000A(d) of the Internal Revenue Code of 1986 is amended by adding at the end the following new subparagraph:
“(C) ADDITIONAL RELIGIOUS EXEMPTION.—
“(i) IN GENERAL.—Such term shall not include an individual for any month during a taxable year if such individual files a sworn statement, as part of the return of tax for the taxable year, that the individual was not covered under minimum essential coverage at any time during such taxable year and that the individual’s sincerely held religious beliefs would cause the individual to object to medical health care that would be covered under such coverage.
“(ii) NULLIFIED IF RECEIPT OF MEDICAL HEALTH CARE DURING TAXABLE YEAR.-Clause (i) shall not apply to an individual for any month during a taxable year if the individual received medical health care during the taxable year.
“(iii) MEDICAL HEALTH CARE DEFINED.—For purposes of this subparagraph, the term ‘medical health care’ means voluntary health treatment by or supervised by a medical doctor that would be covered under minimum essential coverage and—
“(I) includes voluntary acute care treatment at hospital emergency rooms, walk-in clinics, or similar facilities, and
“(II) excludes—
“(aa) treatment not administered or supervised by a medical doctor, such as chiropractic treatment, dental care, midwifery, personal care assistance, or optometry,
“(bb) physical examinations or treatment where required by law or third parties, such as a prospective employer, and
“(cc) vaccinations.”.
(b) EFFECTIVE DATE.—The amendment made by subsection (a) shall take effect as if included in the amendments made by section 1501 of the Patient Protection and Affordable Care Act.
http://thomas.loc.gov/cgi-bin/thomas

H.R. 6597, the “Equitable Access to Care and Health Act,” is a proposed amendment to the Affordable Care Act that would provide a religious exemption to an individual from a penalty for being uninsured, providing that the individual files a sworn statement, as part of the tax return, that “the individual’s sincerely held religious beliefs would cause the individual to object to medical health care that would be covered” under health plans mandated by the Affordable Care Act.
If any medical care were obtained, that would nullify the exemption, and penalties for being uninsured would apply. Theoretically, that would separate those whose religious beliefs regarding abstaining from health care were sincere, from those who would submit a sworn statement merely to avoid the penalty while remaining uninsured. In actuality, even with such religious beliefs, individuals might find it difficult to refuse care in some instances such as major trauma.
If you check the list of cosponsors, you will see that this act does have very broad bipartisan support. It seems like a reasonable amendment, though it still doesn’t protect the rest of us from the costs of care that the person might receive when the medical imperative is greater than the religious conviction.
Is there a better way of doing this? Of course. Include everyone in a single national health program. Do not fund it based on medical need, but fund it through equitable, progressive tax policies. Under such a system, anyone can decline medical care for whatever reason, religious or otherwise (except if the person’s disorder constitutes a genuine threat to public health).
Should a person be required to pay taxes into a universal health care system? I can answer that by stating, as a pacifist, I vehemently object to paying taxes to fight wars. Yet I cannot be allowed the option of withholding my allocated tax assessment assigned to our nation’s military ventures. Nor can anyone be allowed to opt out of paying taxes for any public service that, through our democratic process, we decide to provide for the public good. That includes health care.