What a New Administration May Mean for Healthcare Reform

Biden Healthcare Reform 2021
The incoming Biden administration will face a shrinking workforce and growing number of Medicare enrollees through 2028. 

In the New Year What a New Administration May Mean for Healthcare Reform

 December 2, 2020 – The incoming Biden administration could force mandates for private firms and their employees to provide for and buy health insurance. This according to Dr. Steven Goldstein on his regular podcast. The respected neurosurgeon and founder of the Houston Healthcare Initiative discussed the possibilities for healthcare reform in the coming year on his regular podcast. The Houston Healthcare Initiative podcast can be heard on: on SoundCloudGoogle PlayLibsyn FeedStitcheriHeartRadioSpotify, and the Houston Healthcare Initiative web site.

Mandates Could Eliminate Opting Out

The Affordable Care Act, also known as Obama Care, made more choices for insurance available and penalized people who did not purchase health insurance. While not ideal, it was a way to get more people covered by private insurance than before. And it offered subsidies for people who could not afford insurance. But there was a downside.

The financial penalties were unpopular and made Obama Care an easy target for those who were against it. Without the specter of financial penalties, many employees chose to go without health insurance and keep the part of their pay that would normally go to help fund it. “One economic rationale for employer mandates is that the cost of care for these uninsured workers is often passed along to the insured through higher insurance premiums, taxes and other mechanisms,” Dr. Goldstein said. “Employer mandates are, in part, an attempt to eliminate those who opt out of available coverage. By adding more payers, health insurance is more affordable at the individual level. At least in theory.”

Do Less for More Or just Pay More

According to the Centers for Medicare and Medicaid, national health spending will grow at an average annual rate of 5.4 percent for the years 2019-28 and reach $6.2 trillion by 2028. Among major payers, Medicare is expected to experience the fastest spending growth of 7.6 percent per year from 2019-to 2028, largely as a result of the highest projected enrollment growth. “National health expenditures will grow 1.1 percentage points faster than the gross domestic product every year on average from now through 2028, said Dr. Goldstein. “The health share of the economy is projected to rise over a full percentage point by 2028. In other words, the costs are growing faster than the income. So, we have to do less of something or boost the gross national product.”

Make A Bad System Less Bad

If the current healthcare system remains unchanged, there will be less in the way of medical resources for the public. But according to Dr. Goldstein, that is unlikely. The overall insurance industry and its approach to paying for healthcare are very flawed in fundamental ways but unlikely to realize any dramatic reform.  Working around the edges to make a bad system work somewhat better is what he believes will happen. As Dr. Goldstein told his audience, “we can spend time and money to make a bad system work better and that is probably what will happen in the near term.”

Another Possibility, Pay Cash

According to Dr. Goldstein, cash payments are accepted for most if not all medical charges and prescription drugs. But that comes with a caveat for those who do have insurance, especially catastrophic health insurance. “Do not try to get the ‘insured’ rate to put against your deductible,” he counselled. “Paying cash is much less desirable when put against the insured rate, it will cost you more but not buy any more benefit.”

Most people with catastrophic coverage will never reach their deductible amount. Better to put that money directly into care, at a much-discounted price. This arrangement is the best value for people under the current system. So, while at the doctors’ office show them your insurance card but tell them you are paying cash.

About Houston Healthcare Initiative

The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To learn more about the Houston Healthcare Initiative please visit www.houstonhealthcareinitiative.org.

Job Losses Equal Employer Funded Health Insurance Loss

Closed for Coronavirus

Here Are Some Resources

Even with fewer jobs lost in May than anticipated Americans now experience an unemployment rate of 13.3% or 21 million people out of work due to the coronavirus/covid-19 pandemic. On top of lost income, loss of employer provided health insurance makes the cost even higher for those who through no fault of their own find themselves in a very challenging situation. On his podcast this week, Dr. Steven Goldstein describes how job losses equal employer funded health insurance loss and some available and often free resources for those who need health insurance. To listen to the podcast go to: Soundcloud, iHeart, Spotify, or iTunes. Or click here to listen:

 

Double Loss; Job and Health Insurance

Most Americans rely on their employers to provide health insurance for them and their families and when those jobs disappear so does the coverage. “It is extremely important that people get some type of coverage when they have lost their health insurance,” Dr. Goldstein told his listeners. “The available things to look into are COBRA, spouse insurance, faith-based cooperatives, enrollment on the insurance exchange (Obama Care), Medicaid and CHIP.”

COBRA Coverage

COBRA allows employees (and their families) who would otherwise lose their group health coverage due to certain life events to continue their same group health coverage. The former employee generally pays the full monthly rate and not the discounted one for their health insurance. Under COBRA, group health plans must also provide covered employees and their families with certain notices explaining their COBRA rights. The revised model notices provide additional information to address COBRA’s interaction with Medicare. The model notices explain that there may be advantages to enrolling in Medicare before, or instead of, electing COBRA.

State Insurance Exchange

While typically only available during certain months of the year, the state insurance exchange can open for those who experience a ‘life changing’ event. One such event is the loss of a job and employer sponsored health insurance. “You can shop for health plans through your state’s insurance marketplace,” Dr. Goldstein said. “But don’t wait around, there are 30 to 60 days to sign up after a qualifying life event before the end of that special enrollment period.”

Spouse Insurance

In households where a spouse’ employer offers health insurance; those benefits may be available. “It is easy enough to find out if a spouse’s job offers health insurance and sign on for that,” Dr. Goldstein said.

Faith Based Health Cooperatives

Faith based plans most often share expenses among members. Each member pays a monthly premium. When one of the members becomes ill or needs treatment for an injury, his or her contributions cover the expenses, in conjunction with the collective input of fellow members. “As such, the premiums are lower in comparison to those of traditional health care,” Dr. Goldstein said. “These operate with exemptions to the mandates of the Affordable Care Act, also known as Obama Care.”

Medicare

Eligibility for Medicare is based on income and the size of family. Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities in all fifty states.  In some states the program covers all low-income adults below a certain income level. “But do not assume that you do or do not qualify,” said Dr. Goldstein. “There are online resources available from the U.S. Department of Health and Human Services along with state references to help guide you.”

CHIP

CHIP stands for ‘Children’s Health Insurance Program.’ CHIP offers low-cost health coverage for children from birth through age 18. CHIP is designed for families who earn too much money to qualify for Medicaid but cannot afford to buy private health coverage. This coverage comes through the Medicaid program, which is why they are frequently seen together.

Income Qualification for Medicare

A family of four with an income of $25,750.00 at the poverty level and eligible for Medicaid or CHIP coverage. For an individual the amount was $12,490.00. The amount goes up by $4,420.00 for each additional family member. “The guidelines change every year,” Goldstein said.

The Good News

There are plenty of alternatives available to individuals and families that can be used short or for the longer term that are not all based on a job with insurance. People under age 26, may even be able to join their parents’ employer-based plan. “There are places to go and affordable resources available,” Dr. Goldstein concluded. “Any type of healthcare insurance or coverage will help protect your finances later.”

About Houston Healthcare Initiative And Dr. Steven Goldstein

Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.

 

Retired But Too Young for Medicare? What Now?

Retired But Too Young for Medicare? What Now?

There are plenty of people who retire before the age of 65, whether this was their choice or had retirement thrust upon them. Regardless of the circumstance, these people need health coverage. And since they are ‘retired’ they likely need low or lower cost coverage without sacrificing their quality of care. There are several options for those people according to Houston based neurologist and founder of the Houston Healthcare Initiative CO-OP, Dr. Steven Goldstein. 

Retired But Too Young for Medicare? What Now?

Fear of Loss

Employees fear losing their company subsidized health insurance and when accepting or choosing retirement, that benefit ceases along with the paycheck. According to Dr. Goldstein, it is a situation worth examining and planning for. “There are several alternatives for people who are not old enough for Medicare,” Dr. Goldstein said. “For one, they can choose an extension of their former employers’ insurance through what is known as COBRA.”

COBRA

COBRA stands for “Consolidated Omnibus Budget Reconciliation Act. “It’s a law that since 1985, provides for continuing group health insurance coverage for employees and family members after what they call ‘job loss’,” Dr. Goldstein said. “But, it only applies at companies with more than 20 employees and to state and local government workers. It does not apply to federal workers, churches, or some church related organizations. What’s more this is a short-term fix because there is an 18-month limit on this option. So for someone who is 60 this will get them to 61.5. But there are those other 3.5 years remaining.” COBRA is also a costly choice. Those choosing it can expect to pay up to 102% of the premiums including the part your employer used to pay. 

Affordable Care Act

Options for the Affordable Care Act or Obama-Care are available on line. While the politics of healthcare mean that future choices may be different or even non-existent, but at the moment the law remains in place. “Here in Texas, everyone is required to have health insurance, but they are not required to purchase it through the government,” Dr. Goldstein said. “There is no longer the threat of a fine from the federal government for not having health insurance but going without is never a good idea.”

Healthcare Co-Ops

People can and probably should consider one of the health sharing cooperatives. There are several from which to choose, not the least of them the Houston Healthcare Initiative CO-OP. But according to Dr. Goldstein, there is more to the Houston Healthcare Initiative CO-OPthan inexpensive health coverage. “Our first priority is to improve our members health first and help pay for ‘sick care’ second,” Dr Goldstein stated. “As people work with us to manage their own health, the cost goes down. When they do get sick, we can provide lists of places to get the best prices on prescription medicine, tests, imaging and hospitalization. But, and I want to really stress this, our approach to managing the cost of healthcare is to find ways to be sick less often. We help people manage their weight, level of fitness and other choices they can consciously make to be healthier. So, if you want to save money on healthcare, find ways to be sick less often.”

To find ways to be sick less often and save on health coverage, then look to the  Houston Healthcare Initiative CO-OP and visit the web site at www.houstonhealthcareinitiative.org.