Over the past couple of years, I have found myself trying to focus more on helping my clients rather than posting online reviews or Op-ed pieces regarding healthcare reform.   The combination of Donna Brazile’s Twitter posts regarding health insurance premiums and the posting of the ‘Essential’ benefits by CMS  is too much to for me to handle, quietly.

PART 1 – Donna Brazile –  Tag day

Donna Brazile is well educated, popular, Democratic strategist.  She headed Al Gore’s 2000 Presidential election campaign and is frequently seen on all the major TV networks as a political expert and she is the current Vice-Chair of the Democratic National Committee.  She gets a perfect 100 score on the political-meter.     Let’s not forget that Obamacare is every bit political as it is law.  Perception means so much and it’s shocking to see how unprepared and informed Brazile is on healthcare reform.

I don’t want this article to belittle or insult a very bright and successful woman.   I feel bad for her and tens of millions of other Americans who are going to suffer as a result of not understanding the laws that created.

On Feb 27th – Brazile tweeted the following about her Health Insurance:

  • Q1 What’s on your menu? Just got off the phone with my health care provider asking them to explain why my premium jumped up. No good answer!
  • Q2 Why are your health insurance premiums higher? Price gauging, not . My provider told me it was because of my age. More to come
  • Q3 Starting in 2014, insurers will no longer be able to raise rates as they can right now. #Obamacare
  • Q4 Being a woman will no longer be a pre-existing condition justifying higher rates & being over 40 will no longer be an excuse to price-gouge.
  • Q5 Under Obamacare, the no insurer can charge mature folks more than 3 times as much as they charge twentysomethings. Again, January 1, 2014.
  • Q6 We are living at the end of that era until Jan. 1. And folks like me under 65 will have to endure this until fully kicks in.
  • Q7 So, I am looking forward to the full implementation of so I do not have to fight with my health provider on an ongoing basis.
  • Q8 Starting in 2014, being a woman will no longer be a pre-existing condition that causes higher rates.

So let’s review her misgivings and misunderstandings one-by-one.  

First, there are lots of reasons that prices to go up.  Many of them are because of already implemented or coming healthcare reform.   I assume that Ms. Brazile called her insurance company, not her doctor although she tweeted that she called her doctor.

1 A.  Prescription costs and utilization of prescriptions result in higher costs.    Increased costs from doctors and hospitals are passed on in higher costs.    And no cost to the customer routine care and birth control adds to the costs.    With the new laws on no copay for birth control or other women’s healthcare issues, if 100 million women save even $10 per month in copay’s, that $12 billion a year in extra payment by insurance company’s.   Add 15% gross margin and you have an additional $13.8 billion in premium charged to the public.

2A. Price Gouging?  Really?   Isn’t that libelous to call your insurer a price gouger?  How much did your premium go up?    50% ?  100%.    Wait, it was based on your age?    if your birthday is in December, are you just paying your bills late?    If you have group insurance, your group plan was not based on your age.   As a prominent public figure, you have a greater responsibility to use your powers with care.   You have demonstrated a bias with this tweet that is irresponsible at best.

3A.   A misleading statement.  37 states already possess the ability to roll back excessive increases.   I believe that Ms. Brazile’s State possess that right already.    I guess you deserved that increase.

4A.   Being a woman has always, and will always, be a preexisting condition.    That said, so is being a man, or a dog, or a fish.   Being a woman has never meant anything except that you have other medical needs than men do.   A person diminishes their argument when they play the “card:”.

5A.   This is truth.  With Ms. Brazile only 53 years old, her premiums, even if she does have individual insurance would not be more than 3x the premium a 20-something would pay anyway.  More than that, healthcare reform is likely to make the premiums of 20-somethings go up substantially. In December 2012, at a United Healthcare conference in California, estimated rate increases of 80-110% are expected for people under 35 due to healthcare reform changes.    While Ms. Brazile would be correct about the 3x limit, she, as well as others, will most likely be paying more in significantly more in 2014.

Are the higher prices for insurance a shock to HHS or CMS, or the Obama administration?    I doubt it.  On Feb 22, 2013  Health and Human Services released a new145 page clarification of some of the rules.    In it is reference to plans referred to as “catastrophic” plans that will live outside the normal health plan offerings.  http://www.ofr.gov/OFRUpload/OFRData/2013-04335_PI.pdf  These plans will be specifically for young adults who are priced out of the individual market.      Everyone on the inside already knows that higher prices are coming.   Why this financial shift is acceptable is to so many, is meant for a book, not a blog.

6A.   There will be changes on January 1, 2014.  100% true.  For those living at poverty, you will receive a significant benefit.   More on that later.    For Ms. Brazile,  she should read her insurance renewal.   Most carriers are notifying their clients that although their rates may be frozen for 12 months, effective January 1, 2014, the carrier reserves the right add surcharges to insurance premiums outside of renewal.   These surcharges will be better defined once HHS and CMS give additional clarification on the rules.      I may be taking liberty with Ms. Brazile’s lack of mentioning a specific year that Obamacare takes full effect.    Some of the effects stretch into the 2020’s.

7A .  Why is Ms. Brazile arguing with her insurer?    We know from her tweets that she believes that Men should subsidize a womans premium.  We also know that she believes that young people should subsidize her higher premiums.   What about low BMI people subsidizing higher BMI people?   Darn’d low BMI, normal cholesterol and blood pressure folks.  You should not benefit from your luck.

8A.  One tweet wasn’t enough.   Play the “card” again.

Sadly, Ms. Brazile is probably well intended.   I see it as a problem when the well-intended use their power and publicity to perpetuate falsehoods.   The undeniable fact is the more that is paid out, the higher the premium.

PART 2 – Essential Benefits

The last week of February had the government staffs working overtime before sequestration kicked in.  This included the release and definition of “benchmark” health  plans and “essential’ benefits.

Link:  http://cciio.cms.gov/resources/data/ehb.html#review

When reading through the rules and definitions, I approach it not as a consumer, but rather what does it cost, and who pays for it.

Those living in poverty will be eligible for great insurance.   Great insurance does not mean that they will get excellent care.    Many others will find their disposal income significantly reduced to meet the demands and mandates of insurance coverage.   Aside from the common and known rules about no deductible in excess of $2000 with out of pocket limits not to exceed to HSA rules for families, there are new parameters designed to make prices skyrocket.

Here are a few “Essential” benefits for the poor.

  • Essential –   Infertility-  you may not be able to feed your family, but the government will mandate that you get free treatment to get pregnant.   And then free delivery too.
  • Essential – Orthodontics for children-   You may not be able to afford a good balanced meal or school books, but damn if you wont look good compared to those poor kids in England.
  • Essential –  Lenses AND FRAMES- EACH YEAR for kids –   You working people, with a job and good employer benefits may not be able to get frames but every two years, and you may not be able to go to a decent school but darn tootin if you aren’t going to be able to clearly and stylishly see what’s going on.

A basic benefit package for all is essential.   Obamacare is just a huge give away.  Help for a 90 year old who has to choose between food or a copayment on their medication is essential.    This is health plan is not.  Look for strip malls in the poorest neighborhoods to fill with dentists, Eye wear providers, and other ESSENTIAL providers who don’t help you stay healthy.

Ms Brazile and so many others bought into the belief that the bill would help.   Sadly, you have all been misled.  The educated proponents of this legislation, Ms. Brazile, thought that they would get someone else to pay their share.  Ooops!