Affordable Care for More Americans

This blog has explored how Obamacare affects Americans with serious illnesses such as multiple sclerosis, end-stage kidney disease, and AIDS, and earlier discussed its effect on Medicaid recipients. I'm tired of complaining about what doesn't work. How about a post on what would?

We've tried meeting America's health care needs through big business (any company that can insure millions against a risk as expensive as cancer is "big" by any definition). Now we're trying to meet America's needs through a loveless marriage between big business and big government--but the honeymoon is over and the bride is talking to her lawyer. Progressives who held their noses to support Obamacare are now pushing for big government to do the job alone, through a single-payer system. While that makes sense (to them) in theory, the latest polls suggest that putting it into practice could be impossible for the time being.

Those polls suggest that neither the Republicans nor Democrats will have a commanding majority before 2016, leaving Obamacare the law of the land no matter how many "glitches" affect how many Americans. Big goals (repeal and replace! Switch to single payer!) will fire up the base on the left and right, but that won't help middle-of-the-road, middle-class folks for the next three years. We aren't going to get anything that can guarantee affordable care for all Americans--so how about finding something that would provide affordable care for more Americans? Especially if all we have to do is find something that works and make it work better?

There is already something that works. Obamacare provides an explicit exemption for healthcare sharing ministries ("healthshares"). Senator Max Baucus of Montana included a provision that recognizes not-for-profit healthshares as a valid way to comply with the Patient Protection and Affordable Care Act. That provision, which can be found at 26 USC 5000A(d)(2)(b), allows certain tax-deductible charities to share the costs of medical care among people with shared religious or ethical beliefs. More than 170,000 families currently participate in the three groups that were intentionally grandfathered in (Medi-Share, Samaritan Ministries, and Christian Healthcare Ministries) and membership seems to be rising since the new law took effect.

Healthshares aren't big business or big government, but they have been successful at meeting needs for more than thirty years. Between what members share and donors give, they have paid the bills for hundreds of thousands of patients--despite the fact that they are prohibited by law from paying salesmen, setting specific underwriting amounts, or using many of the other tools that the insurance industry has developed to serve their customers. Healthshares have succeeded with no direct government assistance and without the tools that insurance companies use--because members helping members is a better way to pay.

The Secular Coalition for America opposed Senator Baucus' plan to include healthshares in the law--but not because they disagree with healthshares. They wrote:

For centuries, numerous mutual aid societies in the United States have sponsored insurance and social services organized around a shared ethnic background, occupation, geographical region or religion. For example, in 1787 African Americans released from slavery organized a nondenominational benefit society called the "Free African Society of Philadelphia." By stating that only people belonging to religious mutual aid societies can be exempt from mandated health insurance this provision privileges Christian Americans over non-Christian Americans.

I couldn't agree more. That's why we need a Federal Health Union Act, which would amend the language of 26 USC 5000A(d)(2)(b) to include any not-for-profit organization united by any shared interests with an objective effect on health. Under such a law, Vegans as well as Hindus could share the health savings of a meat-free diet, while smokers could band together to cover their care without paying the 50% penalty Obamacare imposes.

Expanding healthshares to Vegans and smokers would make the law more just, but to make it more effective we need two additional changes. First, healthshares need to be able to use the same tools that health insurance companies need without apologizing for it or dancing around state regulations. Healthshares need to be expressly exempt from state insurance regulations in the same way that federal credit unions are exempt from state banking regulations.

That is why the Federal Health Union Act would be directly modeled on the Federal Credit Union Act of 1934, which created federally-chartered not-for-profit credit unions during the banking crisis of the Great Depression. The National Credit Union Association has been able to keep credit unions serving customers for many years--and a National HealthShare Association could ensure financial stability and consumer protection for not-for-profit health cooperatives.

The problem with allowing healthshares to compete directly with for-profit plans is that insurance companies are now required to accept all comers, even those with pre-existing conditions. This drives up the cost of healthcare, but low-income Americans are offered subsidies to help them cover the cost of these "free-market plans." If healthshares don't have to pay for pre-existing conditions, they won't be competing with for-profit plans--they'll be taking advantage of them. On the other hand, if plans sold on the exchange get subsidies and healthshares don't, it's the insurance companies that are taking the advantage.

The Federal Health Union Act funds pre-existing conditions and low-income insurance without forcing anybody to buy anything they don't want or pay for anything they detest. It does so through a "matching-funds" approach to fund-raising. Taxpayers who donate money to a federally-chartered healthshare will be eligible for a 50% tax credit for their gift. This saves taxpayers money (it costs taxpayers 50 cents to subsidize the poor and sick) and takes the politics out of healthcare. The Susan G. Komen Foundation could raise a lot more money for breast cancer in a very short time--and so could patients with less politically-prominent diseases, like Lyme Disease and multiple sclerosis.

Changing the tax law is not a simple matter--but in this case, it would be worth it. Medicare is a financial time bomb, and Medicaid has even more problems. Among other things, changes to Medicaid are raising the demand for healthcare while cutting the supply. Tax credits for healthshares could move millions of people off Medicaid onto non-profit plans, especially if not-for-profit hospitals can operate their own healthshare. A hospital healthshare could dramatically reduce the number of uninsured patients in a service area, reducing the amount that other patients pay. With a 50-cent-on-the-dollar tax credit, local businesses would have every reason to build good will by helping out their neighbors.

That's all it takes to provide affordable care for more Americans, including the poor, sick, and elderly. All we have to do is (a) expand healthshares, (b) allow them to compete directly with for-profit insurers, and (c) save 50 cents on donated dollars. It's a plan that Americans can understand, politicians can support, and the President can sign.

I hope to share this with my Senator (Joe Manchin of West Virginia) and Congresswoman (Shelley Moore Capito) at the earliest opportunity. If you think your representative might be interested in co-sponsoring such legislation, leave a comment explaining why. If we all work hard and work together, we can help millions of our neighbors in distress.

Obamacare and AIDS

One would assume that if anybody should benefit from Obama's changes to the healthcare laws, it would be people with AIDS. HIV positive people have been lobbying for government assistance since the nature of the disease first became evident in the 1980s, and Democratic politicians have led the charge to find a cure--or at least a treatment--for a disease that now affects millions of people, heterosexual and homosexual alike, around the world.

So it comes as something of a shock to learn that AIDS advocates are unhappy with Obamacare, as the Washington Post notes today:

But people who expected the new plans to provide pharmaceutical coverage comparable with that of employer-sponsored plans have been disappointed. In recent years, employers have compelled workers to pick up a growing share of the costs, especially for brand-name drugs. But insurers selling policies on the exchanges have pared their drug benefits significantly more, according to health advocates, patients and industry analysts. The plans are curbing their lists of covered drugs and limiting quantities, requiring prior authorizations and insisting on “fail first” or “step therapy” protocols that compel doctors to prescribe a certain drug first before moving on to another — even if it’s not the physician’s and patient’s drug of choice.

The disruption to the existing market leaves many AIDS patients who were covered worse off than they were before:

Paul Prince, 52, a former information technology manager from Houston, said he was surprised that some of the health plans in the new federal marketplace wouldn’t pay for one or more of his HIV medications. The policy that seemed to provide the best coverage, he said, would cover only about two-thirds of his monthly $2,400 drug tab, leaving him responsible for $840.

“There was no way I could pay that,” said Prince, who is studying to become a teacher after being laid off from his previous job and losing his insurance.

Insurers have responded Obamacare's prohibition against discrimination on the basis of pre-existing conditions by cutting costly benefits--like expensive drugs.  The Post cites a study by Avalere Health:

A new analysis of health plans sold in the federal exchange — which covers 36 states — and 14 state exchanges found that the benefits tend to be skimpier than in most other private insurance in the United States, with drug benefits a particular weak spot.

Right now, this only affects the 5% of Americans who get their insurance on the individual market, but the Post reports that many employers are already thinking about cutting costs the same way.

Dan Mendelson, Avalere’s chief executive, predicted that employers may soon adapt some of the benefit designs in the exchanges’ health plans. “We are already seeing interest,” he said, because they are less expensive for companies, shifting more of the expense to patients.

The Washington Post article makes it clear that (a) this problem affects a larger group of illnesses, including cancer, multiple sclerosis, rheumatoid arthritis and autoimmune disease and (b) AIDS activists are working hard to change the rules to solve the problem--for people with HIV.

If you care about someone with AIDS, read the Washington Post article and pass it on.

If you care about someone with cancer, multiple sclerosis, rheumatoid arthritis, autoimmune disease, or another disease that involves expensive medications, you may want to subscribe to this blog.

Obamacare and Multiple Sclerosis

Obamacare was always expected to result in some "winners" and some "losers." The argument for the new law was that some people (especially the young and healthy) should pay a little more so that other people (the old and sick) could get the help they need. It's troubling to discover that some of the people who may get hurt the worst are those who are the sickest.

Approximately five percent of multiple sclerosis sufferers (those who were covered by individual insurance policies) have begun to discover how Obamacare affects them personally. Whitney Johnson had a policy that covered her medical bills even though they added up to $350,000 per year. Her existing insurance was cancelled and she was invited to pick a new policy from HealthCare.gov. She had not been able to get what she needed through the Exchange, so she went directly to her insurer--only to discover that all her new options were unaffordable.  She writes:

I know I have five more IVIG treatments coming up over the next six months that cost $40,000 each. My insurance coverage ends in December, and I have to have these treatments. As a mother with a brand new baby, it’s a little unnerving to know that I may not be able to receive the care I need. It’s a little unnerving to know my health insurance that was working just fine for me was taken from me. The doctors I have used for years that have kept me this healthy will be taken from me.

Whitney is one of "small percentage" who have had their policies cancelled, but many more Americans with MS will be affected next November, when employer-provided policies must comply with the new law.  The Multiple Scerosis Association of America highlights the particular questions MS patients need to consider. These include:

• Are my needed medications covered, and what are my costs?
• Can I keep my doctor and are there restrictions on which doctors I can choose?
• What plans can I afford and am eligible for?
• Can I afford my deductible?
• What are my expected out-of-pocket costs for equipment I may need?
• Do I have to try lower-cost medications before I will be approved for the drugs I use now?

Forbes Magazine worked through the cost of MS medications in today's article, "No, You Can't Keep Your Drugs Either Under Obamacare."

Take, for example, the drug Copaxone for multiple sclerosis.

Someone on a bronze plan would be responsible for paying about 40% of the drug’s costs out of pocket, on average. That comes out to about $1,980 a month.

If you buy the highest cost platinum plan, the out of pocket costs drop to $792 a month.

But you’re probably better off with the cheaper bronze plan anyway. Since you’re going to hit your out of pocket cap regardless of your plan, you might as well save money on the premium (which doesn’t count against your deductible or out of pocket limits) and race to the $12,700 spending cap as quickly as your family can.

After all, the provider networks used by low cost bronze and high cost platinum plans are often the same. The only thing that varies between different “metal” plans is often the co-pay structure. The benefits are similar. So why pay higher premiums just to lower your co-pays when you know you’ll hit the out of pocket limits anyway.

By purchasing a costlier, gold or platinum plan, you typically can’t buy up the benefit much, if at all. What you’re doing is just prepaying the cost sharing.

That's assuming the drug you use is on the government's "formulary list, the list of drugs that are included in Obamacare. Even if it is on the government list, it may not be on your plan's list. Betaseron, for example, will not be available through ExpressScripts starting January 1. Forbes notes the out-of-pocket effects:

If the drug isn’t on this formulary list, then the patient could be responsible for its full cost (with little or no co-insurance to help offset that cost). Moreover, the money they spend won’t count against their deductibles or out of pocket limits ($12,700 for a family, $6,350 for an individual).

If you are an MS patient who has adequate employer-provided insurance today, don't wait until next November to find out how this works for you. Talk to your human resources department soon! If your employer is even thinking about changing your plan, call Washington! (All you need is your zipcode to find your Congressman, and you can find your Senators here.)

Not one single elected official wants you to lose coverage--but it's up to people with MS and the people who love them to help busy politicians understand the implications of this law. Whether you're Republican, Democrat, or terminally-turned-off by all things political, please speak out and spread the word!