United Benefit Advisors Insight and Analysis Blog

Biting the Hand that Pays Them

Posted by: Ron E. Peck, Esq.    Aug 10, 2017 9:30:00 AM

I was recently asked to speak to a gathering of hospital-sponsored health plans and providers of health care services about our health care system, and trends I see developing which threaten it. I’d planned to talk about how the Patient Protection and Affordable Care Act (ACA or Obamacare) only targets one-third of the health care system – that being payers (insurance), while mostly ignoring the other two-thirds: providers and patients. Call it a scapegoat, or something else, but of the three players in health care, insurance is the villain. It’s easy, then, to say that what’s wrong with health care is what’s wrong with insurance, and vice versa. As such, fixing health care then becomes fixing health insurance. Rather than assign blame to all three – providers, patients, and payers – it’s politically expedient to point a finger solely at the least popular of the three: the payer. And so, health care reform became health insurance reform; but as I’ve said many times before, insurance isn’t health care – it’s a way to pay for health care. This idea that insurance is to blame for the overall cost of health care, that it can strong-arm providers into taking whatever they want to pay, and thus, the rising cost of insurance is based solely on greed and not at all on the actual cost of the care, is a lie. There is another attitude that it’s easier for insurance to raise premiums than push back on the cost of care, because pushing back on providers is tough, and – for the insured – not having insurance means certain death (and thus they will pay any premium). This holds a little more water; however, it wrongfully assumes that without insurance there is no health care. Yet, the truth is that health care would exist with or without insurance; we’d just need to find a different way to pay for it. People “need” insurance – not for its own sake – but to pay for health care, because health care itself is too expensive.

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Topics: single-payer system, benefits cost control, group health care cost, health care plan design

SCOTUS and the Future of U.S. Health Care

Posted by: Peter Freska    Apr 14, 2015 12:00:00 PM

The Patient Protection and Affordable Care Act (PPACA), commonly referred to as “Obamacare,” was signed into law with the intention of decreasing the number of uninsured Americans and reducing the overall costs of health care in the United States. In order to increase the number of U.S. citizens covered, a number of mechanisms including mandates, subsidies, and tax credits became effective beginning January 1, 2014. The federal health care law also contains many reforms aimed at improving health care outcomes and streamlining the delivery of care. While this reform may be appealing, there are many concerns as to its viability, beginning with the increased number of people covered to effective reduction of health care costs. In the latest arguments for or against PPACA, the Supreme Court of the United States (SCOTUS) heard arguments on the legality of who is able to provide subsidies to those who qualify for subsidies. This lawsuit contends that subsidies are illegal unless a state has set up its own health insurance exchange. The charge is based on wording in the law, which states that subsidies are for health coverage obtained on an “Exchange established by the State under section 1311.”

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Topics: health care reform, premium subsidies, Medicaid, PPACA Affordable Care Act, U.S. Supreme Court, Medicare, single-payer system, Obamacare