Common Sense Health Reform

So many things happening in the Health Care debate, its hard to keep up with. I spent most of the morning this morning writing e-mails to Senators and Congressman. This afternoon I read that some are coming together and maybe going to propose health reform with OUT the government option, which is what we want. Anyway, just for fun since I am really getting into this, I have come up with a "bill" of my own. Not that anyone really cares, but who knows.
I do believe that we need health reform, but not a government option. President Obama keeps telling us that there are all these people without health insurance, I agree with that but who are they? It has been my experience, being in the insurance business that the following groups represent the uninsured in America.

6 foot Tall and Bullet Prof Group: These people are mostly males 21 to 31 years old. They are either newly married, or just coming off of their parents insurance plan, and do not see health insurance or Life insurance for that matter as a priority in their life. They think, "Nothing is ever going to happen to me, I will never get sick."

Self Insuring group: Most of this group is 32 to 50 year old and mostly farmers and Ranchers. They can afford the premium, but just elect not to pay the premium. This group does a good job of taking care of themselves as far as doctor visits and minor stuff that comes up. But then when the big one hits, they find that they need insurance and then can not get it. The big one being, heat trouble, cancer, diabetes, and other things that deny coverage. You would not believe the people that call me that are in this age group that tell me, I have not had coverage in 10 years or so, but now I need it because I have been diagnosed with something. This is kinda like shutting the gate after the cows get out.

Oh One of These Days I will Check Into That group: This group is actually eligible for some type of coverage, such as Medicare or Medicaid, but either do not know it or just do not check into getting enrolled. I do not know how many times we have had the conversation with someone: "Mr Smith did you know that you are eligible for Medicare?" Mr. Smith: "Oh yeah I have been told that, but I am so busy, I just have not had time to check into it." WHAT??? You are eligible for a plan that helps pay your doctor and hospital bills, and can get a supplement to pay 100% of what that plan does not pay, and you have not taken the time to check into it, UGGG.

I Can Not Afford Group: There is this group, that just can not afford health insurance,their job does not offer it, and they can not afford to get it. This is sad, and we need to do something to help this group.

So here it is a Part of my "bill" understand that this does not probably cover all that needs to be done, but maybe it would help some:

Common Sense Health Reform Bill 1:
1) Premiums: We must get premiums down and stop them from rising so fast. One thing is we must stop the fraud with claims. Especially in the Medicare program. Example: We have a client that before he went on Medicare he was getting a shot by the doctor each month for his condition. He had NO insurance, the doctor was charging like $150.00 for this shot. When he went on Medicare the doctor charged Medicare Part B, like, $1,500. This is crazy! To get premiums down the medical Field and the insurance companies must come together and come to some type of agreement on procedures and payments. No more over charging and no more cutting payments back. Also in this part of the bill there must be a provision where there is some type of limitation on doctors being sued. This way maybe we can cut back on doubling up of tests. Insurance companies should have to give at least a two year rate guarantee, then be limited on the percentage that they can go up after that. This part still needs some thought and work, but can be accomplished.

2) Enrollment Period: After the above is accomplished, lets give everyone the opportunity to get insured. Starting January 1 of given year, till June1, of same year there will be an OPEN ENROLLMENT PERIOD. During this Open Enrollment Period, anyone regardless of health condition may choose a plan and an insurance company and be insured. The insurance company must take each applicant with NO riders, NO waivers NO waiting periods, NO preexisting conditions. At this time any existing riders, waivers and waiting periods or preexisting conditions will come off of all existing policies. This is where I disagree with the reform bill. It is not fair to the insurance company for someone to never pay a premium, and then when they have a problem expect to get coverage at that time, and expect the insurance company to pay out many high claims, when there has been no premiums payed to the insurance company. We must realize that these insurance companies are in business to make money, not to lose money. So under my plan, you would have 6 months to get insurance regardless of health. If you do not take advantage of that 6 month period, then you can apply later but will be subject to be declined. Maybe we have this Open Enrollment every two years or so.

3) Right to Shop: If you have a plan that you have kept for 2 years, and decide that you want to change companies for what ever reason, as long as you have had that creditable coverage you may change and the new insurance company that you are going to has take you regardless of health. NO riders, NO waivers, NO preexisting.

4) Medicare: Fraud is killing Medicare. We must get rid of it. Part 1 of my bill will hopefully address part of this. Medicare should reward preventative care for our Seniors, some preventative tests are not payed by Medicare each year, this should change. We would do away with Medicare Advantage, there is NO advantage of being on one of these plans, and it would save our government LOTS of money. Prescription Drug plan would change to the following:
1) NO MORE donut hole or Gap in coverage.
2) Able to change plans in middle of year if needed, No more having special enrollment periods and being locked out if not enrolled, no more penalties for not enrolling.
3) Standardize co-pays: Generics $7.00 Brand $25.00 Specialty drugs 25% coinsurance: Insurance companies can still set premiums, but would be regulated and would have guarantees for 2 year periods.
4) Pharmaceutical companies must lower cost of prescriptions. We have a client who takes a pill that cost for a 30 day supply around $1,000. This is outrageous. We must find away to lower cost of these prescriptions.

This is the basics to my bill, it is not complete, but it is a start. I have sent some of these ideas to Senators and Congressmen in Washington, probably will have not effect, but who knows. Please continue to pray for our country and for this bill. Only God can change all of this. I truly believe that this bill would be the biggest effect on our country. Please continue to pray that God gives us all wisdom to make good choices.