Diary

MAKING CHANGES TO THE PPACA

My preference in dealing with the Democratic made PPACA mess is:
1. grandfathering past federal subsidies not in excess of the proper amount and
legally authorizing federal exchange based subsidies with the immediate demise of the mandates and
complete remittance/refund of all related mandate “taxes”/fines/penalties

2. cutting all existing federal health care related fines except those related to fraud by 90%

3. the repeal of the EMTALA hospital emergency care act effective February 1, 2016

4. the introduction of enhanced EMTALA level plans, broadly subsidized, ASAP
exempt from all state mandates
with no deductible and
with a minimum $50 ER co-pay (with a one-time per insured per policy year waiver available if truly urgent) and
with an insurer set hospital admit co-pay from $500 to $1,500 and
with an insurer set hospital inpatient co-pay from $100 to $150 per day
with advance co-insurance payment generally required for testing and imaging and
with no added charge CDC recommended immunizations (current ones and new ones under $60 each) at policy authorized in-network providers and
with new-born coverage until the end of the current policy
with generally added by insurer riders such as:
A. non-emergency/office doctor visits with either:
a. insurer collected co-pays in the range of $10 to $20, and at the insurer’s option doubled for specialists,
or, in general, the insurer collected Medicare Part B co-insurance amounts, at the insurer’s option
b. pre-natal care shall not have co-pays or co-insurance exceeding $2 per visit
c. babies shall not have co-pays or co-insurance exceeding $2 per visit until six months after delivery
B. low-cost drug coverage
including the lowest cost recombinant rapid-acting and slow-acting insulin with $4 co-pays per vial
[and at least one other insulin of each type with a co-pay of three times as much per unit]
and other drugs whose monthly cost to the insurer is no more than
an insurer set maximum from $20 to $50
with $12 co-pays or less
C. insurer listed medically indicated cancer resection surgery
D. medically needed palliative surgery
E. insurer listed or approved other medically indicated surgery,
with optional insurer listed higher co-pays to be paid in advance for operations it considers often unnecessary
F. medically indicated testing with 20% to 50% insurer set co-insurance
to be paid in advance by cash (deposit), by check, by providing financial account information, prepaid deposit with insurer, HSA or
furnishing a debit/credit card or its information
a. babies shall not having co-insurance on up to $800 of testing done during the current policy term
[because many tests are by law and medical circumstances often needed shortly after birth]
G. medically indicated imaging with 20% to 50% insurer set co-insurance
to be paid in advance as with testing
a. mammograms as recommended by the United States Preventive Services Task Force shall not have co-insurance or co-pays
b. babies under one year old shall have an imaging co-insurance rate of no more than 10%, which need not be prepaid
H. one essential ambulance ride for each insured at an insurer set reimbursement rate of 70% to 90%
with the price of the rider and a ride reimbursement cap both based in insured’s place of residence
[a replacement rider may be issued for an individual at the insurer’s discretion and at a higher price]
I. insurer selected, policy listed drugs not covered under rider B selling for less than $X/30-day supply or $Y/course, where X and Y are insurer and then subscriber selected  with insurer set co-pays by drug
and unlisted drugs to be reimbursed at least 10% less than the closest policy listed drug
J. Pediatric dental coverage
K. an insurer/exchange-managed HSA contribution of $20/month
when the exchange and one’s insurer are ready to handle contributions and payouts
[generally if purchased using a subsidy, always at least one per insured if the policy is purchased by an employer]
[to help pay for birth control pills, colonoscopies, co-pays, co-insurance, etc.]
[This is gender, sexual orientation and age-neutral.]
[Can be used by any insured on the policy.]
L. Adult dental price capping coverage,
with an exchange listed, insurer specified number of contracted practitioners,
up to a total of $2,000/year in price capped service
a. up to two cleaning and exams per year at $50 each or less
b. amalgam fillings at $50/one surface, $70/two surface, $90/three surface
appropriate anterior white filling material at $10 more
c. extractions at $200 each or less for a wisdom tooth and $50 for any other tooth
d. anterior root canals at $300/each or less
e. premolar root canals at $400/each or less
f. molar root canals at $600/each or less
M. insurer selected, policy listed cancer drugs with their policy listed usages selling for less than $Z/month, where $Z is insurer selected
N. needed outpatient substance abuse treatment coverage
O. up to $R in nursing visit, home infusion, rehabilitative and child therapy services,
where $R is set by the insurer with
a. insurer set co-pays in the range of $10 to $30,
b. or, in general, the Medicare Part B co-insurance amounts, at the insurer’s option

such additional insured created riders that solely include what would be considered to be within the minimum essential coverage of the PPACA as of the date this bill becomes law are eligible to be subsidized.

Insurers may require listed riders to be bought in bundles to prevent consumer cherry picking.

Insurers may also require unlisted riders to be bought in separate bundles.

EMTALA enhanced plans to be available to all Americans not eligible for Medicaid or employer-based health insurance.

What I suggest to help Americans pay for a hospital co-pay is to hold up to $1,000 of a refundable tax credit until January 15th of the following year,
unless a refund request payable to a hospital for co-pay request is filed by a hospital in the US and the taxpayer.

SUBSIDIES

Prorated by policy cost subsidies for American citizens living in households under 300% FPL with coverage available beginning January 1, 2016.

Subsidy percentage to be .6% of each percentage of household income below 300% of FPL for households between 150% and 300% of FPL.

For under 150% of FPL households, the subsidy percentage is that of 150% of FPL(90%), which means silver plans costing about $20/month (young adult) to $60/month (over 55 adult).

The subsidy to be the subsidy percentage multiplied by 90% of the average price of an exchange silver plan premium based on all silver plan sales for the purchaser’s state as of January past but with premiums calculated for the same age purchaser(s) to get the maximum subsidy amount for the household.

People receiving subsidies who believe they can’t afford to pay their full share of the premium on time may reduce their coverage online prior to the first of the month to the basic EMTALA coverage plus any such additional riders in the order listed that their subsidy and other dollars on account will cover in full. Any subsidy dollars that are not used by the end of the year shall be forfeited to the exchange.

If any premium (share) becomes a month late, the insurer shall assume reduced coverage is desired for each month until all outstanding premium payments are paid in full.

In case the monthly subsidy amount are insufficient to pay the full cost of basic EMTALA level coverage with riders A(doctors) and B(low cost drugs), the insurer will allocate any remaining yearly subsidy dollars to purchase those three coverage items for as long as subsidy money lasts and then just rider A coverage (and rider B coverage if possible) for as long as subsidy money lasts. Once no more rider A coverage can be bought, the insurer shall take any remaining subsidy dollars for past due premium amounts and then return any remaining subsidy dollars to the exchange.

States may require an insurer to inform them per state law when any premium payment becomes 15 days late. No penalty or fine or other charge shall ever apply in an insurer’s attempt to comply with such a state law.

States may require no-fault unemployment system compensation system payment of COBRA coverage/health insurance premiums/premium shares for a number of months not in excess of either six or one-sixth the number of months the worker has worked for the employer, rounded down.

States may add money to an HSA with up to a $20/month federal match up to 300% of FPL tailing off linearly to 0% at 400% of FPL.

Once an insured household is over 8% of their income out-of-pocket on EMTALA plan co-insurance and co-pays with an insurer, the policy holder may request the insurer issue a pay down to 8% of household income. The insurer may take up to $20 from an EMTALA pay down as a service charge.

The insurer may recoup 60% of EMTALA insurance plan pay downs, less service charges, from the federal government. State governments may also pay down out-of-pockets.