The Big Fix

The Big Fix – Three Steps to Health Care Reform

-by Bobb Joseph


Executive Summary

Many today think that the USA needs comprehensive health care reform, but that Obamacare (The Patient Protection and Affordable Care Act) is the wrong solution. That there are more effective ways to reach the goals of lowering the cost of healthcare and health insurance, protecting consumers, and covering the uninsured. To that end, here is a blueprint for reform that seeks to build on some of the best ideas put forward (e.g., The Patients’ Choice Act, The Protecting Access to Healthcare [PATH] Act, et al.), using public‑private partnerships and state-based solutions with a federal framework.


First, we need to establish a federal framework, or foundation. Rather than a comprehensive national reshaping of health insurance and the health care industry, we need to set some fundamental, basic national guidelines as a framework for health care reform. The components of a new federal law – or federal framework around state-based reform (as was done for Small Group Reform in 1992 – e.g., California) would include the following:

-minimum benefits (exceptions: school plans, Basic Coverage [e.g., Idaho HRP], faith-based coverage, short-term plans)

-guaranteed-issue and portability provisions

-no cancellation without third‑party review

-rate bands

-federal tax credit

-facilitate establishment of Health Innovator (HI) reward program for up to $1 million to individuals or groups who provide creative solutions around lower cost, increased transparency, and consumer engagement; examples:

-“Groupon” concept by insurers

-bottom-up “eBay” solutions for provider/illness shopping

-consumer data-chip option for health history

-multiple ease-of-shopping portals – e.g., kiosks/terminals in hospitals, doctors’ offices, malls/shopping centers, financial institutions, airports, etc. (both Medicaid and traditional insurance)

-financial or tax credits for wellness, smoking cessation, weight-loss, etc.

-pursue out-of-state insurance shopping

-fully-funded shopping exchanges/coops

-promote insurer startups – with full bonding/funding


Second, using states as what some have referred to as the “laboratories of democracy,” facilitate and support state-based solutions around health care reform. Since each state is unique, with its own needs and issues, allow states to put forward best solutions to meet their health care coverage needs. The state insurance commissioner would submit a roadmap or blueprint for reform, along with a request for a block grant for up to $1 billion, funded by a public-private partnership, to fully cover its population. Some components of such a proposal might include:

-“All Covered” requirement – everyone must provide proof of insurance or bonding

-Medicaid to cover 100% of the Federal Poverty Level (FPL)

– Basic Coverage plans [e.g., Idaho HRP]) for the working poor above FPL

-state tax credit

-tort reform

-mandate reform (strip out state mandates and allow carriers to offer them under optional provisions)

-participate in federal Health Innovator (HI) reward program.

Finally, establish a Health Reform Commission to provide ongoing review and recommendations. This would be made up of the federal government agency Health and Human Services (HHS), the National Association of Insurance Commissioners (NAIC), industry trade groups such as the Association of Health Insurance Plans (AHIP) and the National Association of Health Underwriters (NAHU), and other professional and industry leaders. The Commission would meet annually to review state and federal status, and recommend changes and best practices for continued innovation. And as states develop successful models for health insurance reform, best practices would emerge, which could then be shared nationally for adoption.



The essential components of comprehensive, strategic health care reform are fundamentally simple, while the implementation relies on the political will to come together with bipartisan consensus sans inveigle on a national level to provide a federal foundational framework for reform. This would be followed by state‑level reform, guided by national modeling, funded by block grants, and executed locally. Finally, as best‑practice solutions emerge, states would share these and provide continuous improvement to lower the cost of care and insurance and cover the uninsured.



So the Obamacare Exchanges are now up and running – what do I need to know?

So what’s up with buying health insurance starting October 1 on the new Health Insurance Exchange (or “Marketplace”)? In Iowa, depending on what county (and Region) you live in, there will be up to four insurance companies to choose from (there are two in Cass County). Here are some questions that might help you figure out if the Exchange is right for you.


Question: What do I have to do starting October 1?

Answer: Nothing, if you already have health insurance through work or from an individual plan (including Senior plans). If you don’t have health insurance, then you must buy a plan or pay a tax penalty.


Question: Do I have to buy a plan on the Exchange?

Answer: No. You can buy a plan on the Exchange, or off the Exchange from any health insurance company doing business in Iowa (an independent health insurance agent can let you know what your choices are either way).


Question: So why should I buy a health plan from the Exchange?

Answer: You would only want to buy a plan on the Exchange if you are in a lower income bracket. If your estimated 2014 income is between about $12,000 and $46,000, so you may qualify for a subsidy or tax credit, to lower your monthly insurance payment.


Question: Even if I have health insurance now, can I shop for new coverage?

Answer: Yes, you can shop on or off the Exchange during an “Open Enrollment Period” starting October 1 and up to next March 31, and not be turned down or rated due to health problems.


Question: Where can I find out more information?

Answer: Contact your local independent health insurance agent, attend an upcoming State of Iowa Market Place Meeting, or call (877-955-1212 or 515-281-5705) or click the Iowa Insurance Division. There is also a fact sheet from the Governor with some helpful information for Iowans, as well as a robust website from Wellmark Blue Cross Blue Shield of Iowa.


Robert Joseph

Independent Health Insurance Agent

Midwest Insurance Mart

Ph: 243-2483



The content provided is for information purposes only and not intended as legal advice.  The information provided is not a substitute for a consultation with a professional advisor or health plan.

Obamacare Collapse: Section 89 Déjà Vu?

Amidst all the words by pen and screen about Obamacare, few have compared President Obama’s signature health care reform legislation to the late ‘80s debacle of “Section 89,” the now-forgotten attempted addition to the IRS code included in the sweeping Tax Reform Act of 1986, which collapsed under its own weight – just before it was to take effect. Section 89 was a federal government’s attempt to require employers to provide non-discriminatory life and health insurance benefits to all employees, without regard to income. But the nightmarish rules and regulatory burden it was poised to foist onto businesses was so onerous and complex that as it neared implementation, there were 13 bills before Congress to change or eliminate it entirely.

Could this same fate befall the so-called Affordable Care Act, or Obamacare?

With many “shoes” having already dropped, and so many straws of exemption placed on the camel’s back, the possibility of Obamacare simply collapsing under the weight of its 906 pages1 and over 15,000 pages of regulations2 is not just a wish of conservatives but a real possibility.

So here are some of the dropped shoes to date:

Waivers – More than 700 organizations and 2 million Americans have been given waivers3

Delays – Companies with more than 50 employees have been given a one-year delay4 in implementation

No income verification – Individual income verification for the insurance exchange changed to the  “honor system” for now5

Missed deadlines – Over 20% (41 out of 82) deadlines for implementation have been missed 6

Insufficient funding – Some of the 18 separate tax increases7 needed to fund Obamacare are being eliminated or postponed, and some groups are finding ways to avoid them8, which – combined with an overly optimistic initial estimate, may lead to a significant shortfall9 and debt

Messy rolloutGlitch-filled initial enrollment October 110

Despite the administration’s relentless and daedal efforts to keep pitching this landmark legislation of President Obama and restructuring of the healthcare and insurance for more than 310 million Americans, there are threatening dark clouds on the horizon that may portend its demise.

Perhaps, in the event of the collapse of this “snow globing” of one-sixth of the American economy which fails in its two fundamental stated goals of reducing health care cost and covering the uninsured, the prescient one‑sentence warning from Dr. Barbara Bellar should have been heeded:

“We’re going to be gifted with a health care plan we are forced to purchase and fined if we don’t, which purportedly covers at least 10 million more people without adding a single new doctor, but provides for 16,000 new IRS agents written by a committee whose chairman says he doesn’t understand it, passed by a Congress that didn’t read it, but exempted themselves from it, and signed by a president who smokes with funding administered by a treasury chief who didn’t pay his taxes, for which we will be taxed for four years before any benefits take effect by the government, which has already bankrupted Social Security and Medicare — all to be overseen by a Surgeon General who is obese, and financed by a country that’s broke.”