KEY AREAS OF FOCUS:
THE AMERICAN PEOPLE ARE SITTING ON A BOMB
When we come together as Americans, our collective ingenuity resolves even the most daunting and overwhelming problems. When we decided we were going to put a man on the moon and bring him home safely, we did it! It was the will of the American people that did it. At Medicare-Advantage-For-All.Com, we urge you to join us in confronting today’s most pressing issue: how to make health care affordable and accessible to all of our citizens. To us, the solution is clear and achievable. By modifying and expanding our Medicare Part C, which has long had strong bipartisan support in Congress, we can make this happen and protect all the people of our nation and improve our collective health and wellbeing. The time for us to Act is now.
A BRIEF AMERICAN POLITICAL HEALTH HISTORY
National Health in the United States has been a haphazard and bipartisan business. Although we have made great progress in improving the health and well-being of the people, we have failed to make access to health care universal. In 1945, after the Second World War, Democrat President Truman was the first President to propose a national health plan. He was unsuccessful. In 1965, Democrat President John F. Kennedy was also unsuccessful in getting a national health care program for seniors. Apparently, doing that for Americans was more difficult than going to the Moon. After Kennedy’s assassination, Democrat President Lyndon B. Johnson was able to expand a small program we had for military dependents into the beginnings of the Medicare program for seniors that we have today. Medicare has been the most successful national health plan for the American people, but it is limited to helping Americans, generally over age 65, who qualify for social security or disability and it is too exppnesive.
Medicare was enormously expensive from the start. Efforts were made to curb it's escalating cost as early as 1973 with the passage of the HMO Act that allowed the federal governement to contract directly with health maintenance organizations. Subsequently, the Tax Equity and Fiscal Responsibility Act (TEFRA) in 1982, sponsored by Democrat Pete Stark of CA and signed into law by Republican President Ronald Reagan (closed some tax loopholes) tried to stem a rapidly increasing cost of Medicare. But, the most importantly, TEFRA created Medicare + Choice demonstration programs, which were the first Medicare Advantage plans.
In 1994, twenty-five years ago, Hillary Clinton made an attempt to pass legislation to create national health plan that would cover all Americans. During that time she used the name Medicare Plan C to describe her reform. Her efforts fractured into over a dozen competing legislative alternatives and was finally defeated by heavy lobbying by conservative, libertarian and insurance industry interests. Subsequently the United States experienced an unexpected period of relativerly low medical inflation spurred by the HMO Act and the growth and development of HMO's and managed care, which relieved the urgency of a universal nationalized approach to health care for all Americans. Mean while the Medicare + Choice programs were saving the federal governement money on Medicare and three years after Hillary Clinton plan was declared dead, Medicare Part C re-emerged as the Medicare Advantage plans we know today under the 1997 Balanced Budget Act, which was introduced by Republican John Kasich and signed into law by Democrat President Bill Clinton. These plans continued to grow in number, strength and poulaqrity because they were saving the federal governement money and their regulation was such that insurance companies were given adequate latitude to creat attractive anf cost effective alternatives to tradional Medicare.
At the time President Barack Obama was elected, this success had not gone unnoticed by the Congressional Budget Office. On this web site you can find testomoney by Perter Osterick, the then Head of CBO indicating that Medicare Advantage Plans could play an important role in advancing the effort to make Mecicare more affordable and a cost effective alternative for the American people. At that time the Democrats were pressuring President Obama to move health care to the front of his agenda. In collaboration with the Associated Health Plans (AHIP) representing the health insurance industry, the Obama administration crafted the structure of the PPACA, otherwise known as Obamacare.
Their goals were noble. They wanted to find a away to extend health care to all Americans and do it in such a way as to lower the cost, guarantee coverage for all Americans and do so with the cooperation of the health insurance industry. Thus fracturing the unholy alliance that had previously prevented Hillary health plan from being successful. Peter Osterik was later elevated to the position of Budget Director and can be considered one of the principal architects of Obamacare. The health insurance industry at the time were only cautiously optimistic about accommodating the Obama Administration given the promise of federal money pouring into their quafers for Americans in a market to which they had little or no access or exposure. The Americans that the Administration was targeting were employed in low wage positions working for companies that normally did not sponsor health insurance programs. They were unable to gain access to this market through traditional marketing channels. Ivy League theorists and social idealists had teamed up to provide a hopeful scenario where all Americans would be compelled to sign up for the program which had ample subsidies and tax incentives and through the elimination of all private non-group health insurance. Eventually, employers would be required to offer similar programs and with the expansion of Medicaid, All Americans would be gain affordable universal coverage.
The ACA passed the Congress by one vote in Congress and signed into law on March 23, 2010. Essentally, the program sought to replace the commercial individual health insurance products that were working after a fasion, but were often too expensive and subject to a predicable death spiral that would leave Americans with health problems trapped in unaffordabe programs with no alterntive but bancruptcy. The first thing the ACA did was end the direct contact between the health insurance companies in the American consumer by spending Billions of taxpayer dollars on marketplaces and maketplace software to support federal and state "market places" that here-to-for had not existed. this concept was designed to level a playing field but smacked of distrust and distain for the health insurance industry and it's role in the proberems and the solutions.
The federal government intiailly paid out substantial amounts of money in an effort to protect health insurance companies from experiencing any loosses from the program and for a time it appeared like the progranm would be a win-win proposition for the American people. Unfortunately, that didn't happen for a lot of reasons. Most importantly the ACA program stimulated of the cost of health care, which eliminated the savings promised by the program, preventing the continued growth of enrollment and resulting in the ultimate stagnation of the program as a true source of universal coverage for the American people.
In the meantime, the insurance companys and the medical and institutional health care providers have been more than satisfied with the results of the Obamacare program. The program is a great success because almost everybody in the health care industry is making money. Community hospital balance sheets are positive, the bad debt situation is at an all time low and some of the larger health insurance companies have locked in monopolistic market control of a majority the nations jurisdictional U.S. counties. The number of uninsured Americans, even lately with the increases, the total number has never been lower. More Americans are covered today than ever before. The unfortunate problem is we still have approximately 30 Million American (about 10% of our population) who can't afford health insurance and don't qualify for Medicaid. Also, while health care providers are experiencing some financial security, almost nothing meaningful is being done about our deplorable health status of the American people, which is ulimately the reason health care in the United States in the first place. Health care cost are increasing to the point that even middle class Americans with good jobs are finding it increasing difficult to afford even their employer sponsored health insurance plans.
THIS IS AN EMERGENCY
In the United States, we have a health insurance EMERGENCY CRISIS. But because major constituencies are doing well, you don’t see our politicians getting into too much of a frenzy over it. We are all alarmed to have over 30 Million fellow Americans living and working in our country and by and large, they do not have and cannot afford health insurance. And, many of them want it. They worry about their ability to get health care. Some of them do postpone necessary treatement. Unfortunately, they still can't get it, because even with Obamacarfe, it is still too expensive. The reason that health insurance is so expensive is not the greed of the insurance industry or malfeasance of our provider community. The primary reason for the high cost of healthcare is that most of us are in such bad health and our health care system is failing to improve our health status. As Americans, given how much we collectively spend on health care in this country, the average American citizen should be absolutely outraged at this situation! Consider the following facts:
The Congressional Budget Office (CBO) says Thirty Million Americans will have NO health insurance in 2019 and that number will increase to 35 Million by 2030. The Old Age Survivors and Disability Insurance (Social Security) Trustees project by 2026 the Medicare Trust Fund whci supports the health insurance for 59.8 Million retired Americans will be 100% GONE, completely bankrupt! The Center for Disease Control says that 90% of the National Health Care Expenditure (NHC) GDP ($3.285 Trillion Dollars in 2018) is spent on the treatment of chronic illness, the risk of which is 80% preventable. Sixty-six percent (66%) of Americans are overweight according to the National Institutes of Health. We see that 2 out of every 3 Americans is overweight and the Centers for Disease Control reports that nearly 40% of U.S. residents ( approx. 124.4 Million Americans) are obese, which is one of the highest causes of our chronic illness epidemic!
The American people are literally sitting on a BOMB. This really is an Emergency! In 2018 National Healthcare GDP was $3.65 Trillion Dollars. That is by far more money than any other country in the world spends on healthcare. The CBO expects this level of expenditure to increase by 5.5% annually through 2030. By the year 2030 our over age 65 population will have almost doubled. The CBO estimates that we will have added another 5 Million more Americans to the ranks of the uninsured by then. Our estemed business oracle, Omaha's Warren Buffet, the founder of Berkshire Hathaway, one of the most successful U.S. comglomerates in the histroy of the world, says that we are a rich country and we can do the wrong thing for some period of time but we can NOT continue to do the WRONG thing indefinitely. In 2020 the Affordable Care Act, known as Obamacare, without the Individual Mandate, willl in our opinion, be declared unconstitutional by the United States Supreme Court. The democrat proposal to extend Medicare for All are going no where. Unless we start doing the RIGHT thing, our seniors will lose Medicare as we know it and and they will NOT be able to keep their plan, as most of our politicians are so fond of promising!
In 2007, before Obamacare became a reality, Peter Orszag believed that Medicare Advantage programs could be the answer to our need to find a national health care public option that would effectively delivery universal health care to all Americans. Hillary Clinton talked about a Medicare Public Option, that was actually in the original ACA Legislation. This suggestions was also echoed in the Simpson Bowles Deficit Reduction Plan delivered to Congress back in 2010. If it were not for the alliance between the health insurance industry and the Obama Administration, it is likely that the program we know as the Affordable Care Act would have been a Medicare Advantage type option plan. The administration planned to fund Obamacare with massive cuts to Medicare and Medicare Advantage. Hence the study highlighted by video on our Home and Cost Containment pages done by Professor Mark Duggan and the researchers at the Wharton School of Business at the University of Pennsylvania to uncover flaws in Medicare Advantage. Despite political attempts to cut the funding for these programs, the Medicare Advantage plans have continued to grow and to demonstrate solid savings, cost containment and strong popularity among the American people.
Obamacare enrollment has declined for the last three years. The number of unisured American has increased to over 30 Million. The annual inflation in Obamacare premiums has been double digit over the last four years and 52% of our jusrisdictional county health insurance markets have no competition. The Democrats blame the Republicans for this failure, they claim their restriction of open enrollment periods and advertising, stopping their unauthorized payments of CRM deductibles and coinsure and a continued vociferousness in their failed attempts to repeal and replace the legislation. One HHS official hinted at the fact that advertising a sinking ship would not keep it a float. All of that is a little far fetched when one considers the considerable structural problems with the health insurance contract, the excessive regulation of health insurance marketing, benefits and the restrictive monopolistic markets and the fact that their are virtually no effective cost controls or efforts at control anything but minimum loss ratios. If anything, both parties are only too happy to throw money at these problems in the hope that it will not have any deleterious effect on election results for either political party. None of this detracts from the fact that the ACA program is broken. We should now realize that the reason for it's failure is shared with traditional Medicare and similar reforms are needed in both programs. Both programs suffer from too much governement control and regulation of health insurance program which creates problems, that result in excessive costs to the tax payers.
Merrill Goozner, the Father of “Modern Healthcare” magazine and Editor Emeritus says that Medicare Advantage is the health insurance industry’s counter to “Medicare 4 All". Therefore, he is at least suggesting that the Medicare Advantage program may also be the insurance companies answer to the failing Affodable Care Act, as the Democrat Presidential hopefuls and the liberal progressive wing of the democratic party have generally suggested Medicare 4 All as their preferred health plan in the United States. Extending Traditional Medicare to everyone is not realistic. However, extending the Medicare advantage program, which was created to reduce the cost of Traditional Medicare, with an integral health and wellness program that can constructivetively lower our National Healthcare GDP by $1.3 Trillion Dollars to a 12% level by reducing or eliminating more than half of the incidence of chronic illness we suffer in the United States is good judgement.
Now as we have stated, many democrats, including most to the presidential hopefuls in the upcoming 2020 elections are championing Medicare 4 All. There are significant problems with this approach to universal healthcare not the least of which is the fact that we can not afford to do it that way. The second most important factor is the insistence of the Democrats to a single payer type system. Republicans have labeled this approach as socialist medicine. They are not completely wrong about that. The actual Democrat Bills on Medicare 4 All leave most of the important decisions as to how to handle the program up to the Secretary of Health and Human Services. Right now, to a significant degree, the Secretary of Health and Human Services uses private health insurance companies to handle the Traditional Medicare program, Medicare Advantage and almost all of the other government sponsored health insurance programs. Increasingly even the states are taking the same approach with Medicaid Program administration. Most of the states now contraxct with health insuranc e companies to manage their Medicaid programs. So, is the Democrats proposal really Socialist?
To the extent that the Democrats believe that the federal government should or will create some huge burocracy to handle the Medicare 4 All program, this would be true. However, we beleive the Democrats may just be willing to allow the Secretary of Health and Human Services to make that decision. In which case, the program that is controlled by the Department of Health and Human Services extending universal health insurance to every American may not look as much like the British Health Service as it does the an efficient professional extension of the Department's mission to enhance the health and well-being of all Americans by providing for effective health and human services and fostering sound, sustained advances in the sciences underlying medicine, public health and social services.
REPUBLICANS ARE FIRMLY IN CONTROL OF THE SENATE AND WILL NOT PASS MEDICARE 4 ALL IN ITS PRESENT FORM
The two most incontrovertible facts about the proposal for universal health insurance are that the Republicans are firmly in control of the Senate and they will not pass the Medicare 4 All legislation in its present form. In the meantime, We the People caught in this partisan battle that deprives us of the ability to extend health insurance to every American and benefit from a concerted effort to improve our health, reduce the cost of health care and increase our productivity and and our competitivemeness in world markets, so that our livelihood as a nation is secured. Warren Buffet appreciates how important this issue is to the future success of the American economy and the future success of our country as a leader in the world.
Senator Bernie Sanders is absolutely right. He has often stated that for him, this contrvoersy is NOT about health care. But, with all due respect, this perspective is a part of the problem. This is about health care. In fact it is profoundly about health care and the fact that We the American people are getting too little of it, whether or not we are covered by health insurance. Senator Samnders is wrong to believe this debate is about greed. This controversaery is about politics and We the American people are cought between the two political parties and held hostage by our inability to move forward in a positive way that will effectively deliver a health care system of which we may all be proud.
The only progress we have ever made in the United States toward the goal of better health has been bipartisan. We the American people have to brake this log jam and get the river of health flowing in this country. We can't do it as our President has suggested by sitting back and waiting for new elections, for the political parties (like the stars) to align, because it isn't going to happen no matter how much we may want of need it too, unless We the People get ivloved and start to put political pressure to get a program that will solve the problems. Medicare Advantage is that program.
MEDICARE-ADVANATGE-FOR-ALL IS THE ANSWER
Medicare-Advantage-For-All is the Answer: WE THE PEOPLE must take hold of our TRUE AMERICAN destiny and reduce the cost of healthcare by demanding that the federal government improve our health, well-being and productivity. Our competitiveness as a nation depends upon it!
NOTHING is more important than your health! We must get our elected officials to accept and support our uniquely American health care system and give us the better health and the better health insurance that we deserve!
Join Us! Help the United States to continue it's prosperity and work for truth and justice in the free world. We can not do this without "YOU", especially if you are not in the BEST of health! Medicare Advantage is the most popular health plan in the United States and extending it to everybody will NOT happen without YOUR support! We can reduce an estimated 80% of this risk of chronic illness with better medical care and an integral Medicare-Advantage-For-All health and wellness program. Extending Medicare-Advantage-For-All to the 30 Million uninsured and low-wage Americans can lower our NHC-GDP by $1.3 Trillion Dollars to 12% by eventually eliminating more than half the chronic illness risk that we suffer from in the United States.
We have practically the lowest uninsured rate in our nations history and our hospitals, most other medical providers and most of the health insurance companies are enjoying some of the best years they have ever had. Hospital bad debt write-offs are at an all-time low. Community hospital margins through-out the nation are up. Merger and Acquisition (M&A) activity in the provider community is approaching all-time highs. Thirteen healthcare M&A deals that made headlines in 2017. Eighty-seven (87) Hospital mergers were recorded through the third quarter of 2017 alone, as compared to 102 for the full deals the year before. Eight (8) of these hospital deals were collectively worth over 8 Billion Dollars in annual revenues. These mergers are driven by smart health care providers strategically positioning themselves for greater future control over their markets, improving their operations and increasing their profitability. This is NOT all bad for us consumers!
The Council of Economic Advisors in their March 2018 Report found that health insurer profitability in the individual market had risen, due to substantial premium increases, government premium tax credit increases, and the large government-funded Medicaid expansion. As of 2018, the ACA's implementation fueled health insurance stock prices to outperform the S&P 500 by 106%. Some of the largest health insurance carriers expect earnings to have increased by 8.7 to 19.6 percent in 2018. The A.M. Best Company projected that health insurance payers will have had a positive year in 2018 as they continue to engage in profitable health plan markets. Further, A. M. Best believe the health insurer profitability will continue for many years to come; especially if the carriers can successfully work around the political challenges that we put in their path.
As an example, even though Senator Bernie Sanders has had a Medicare 4 All (M4A) Bill in the Senate for many years, just by re-introducing his Bill in 2019 (pretty much the same Bill he has proposed in the past) sent the health care stock market sector down the immediate down dramatically. UnitedHealth, Anthem and Cigna alone lost over $40 Billion Dollars in market value. Even the Massachusetts Hospital Association came out strongly against the new Sanders M4A Bill, despite strong local political support from local Democrats Elizabeth Warren and Joseph Kennedy. In fact, this concern over Bernie's M4A Plan is probably why many health insurance carriers, including the Blue Cross Blue Shield Association support, continuing to fund Obamacare. Why would they want to wreck a good thing for them?
The political challenges that we place upon them now are potential threats to their profitability. That is why America's Health Insurance Plans (AHIP) and most of the health insurance industry are reluctant to support any changes. And, Congress can not come up with any innovations to the ACA, apart from approving more market stabilization funding. The failure of the ACA is the principal reason Rand Paul and other Senators and the Heritage Foundation oppose more spending on these health plans.
HERITAGE FOUNDATION OPPOSES ADDITIONAL FUNDING FOR OBAMACARE
Providers and health insurance carriers are reluctant to support anything that reduces revenue, just as normal Americans are reluctant to support anything that would arbitrarily reduce our take-home pay or increase our family budget. That is part of the reason why almost every single health-related entity in our nation opposed the Graham-Cassidy Bill, the last Republican effort to replace Obamacare. After some considerable lobbying on the part of it's sponsors, they were forced to withdrawn the Bill from the Senate floor without a vote. We understand now. Health insurance carriers are still in love with Obamacare and is the leadership of the House of Representatives. Admittedly Obamacare has been great for California. Their Covered California Exchange carriers include lots of Obamacare programs. Same thing in New York State which has a huge number of ACA participants. Both states have a significant percentage of Obamacare participants that are eligible for federal subsidies.
Further, the Blue Cross and Blue Shield Association, which represents all of the Blue Cross Blue Shield plans in the country wants to resurrect congressional efforts to stabilize the Affordable Care Act's exchanges by boosting tax subsidies and cost-sharing payments. In March 2019 they released a legislative proposal to increase subsidies for ACA exchanges and help customers, who earn too much to qualify for a federal subsidy. The proposal would also install a re-insurance program (which we support) resume reimbursements for CSR payments and further delay the tax on health insurance, which Obama intended as their fair share of the taxpayer's burden, to help pay for the program. These taxes have been delayed but not yet repealed. We are NOT in favor of ANY specific taxation to pay for any program that should be designed to benefit every American! Medicare was fairly funded by payroll taxes and everyone with the requisite quarters of contribution is eligible. If you are going to tax everybody then everybody should be eligible. If everybody isn't eligible, selective taxation is without representation.
In an effort to apply the brakes to this runaway train, we are seeing some private sector market innovation deals. Amazon, Berkshire Hathaway, and J.P. Morgan recently formed an independent company called Haven to improve the health care system for their employees and reduce the spiraling cost of their medical treatments. In February, the U.S. Justice Department formally asked a federal judge to approve the $69 Billion Dollar merger between CVS and Aetna to better serve their 44.7 Million customers and manage their health care more efficiently. Humana and Walmart are looking to combine services to create a “One Stop Shop” where Humana can offer their Medicare Advantage Plans and their popular Prescription Drug Plans. Walmart can use its massive investment in primary health care clinics to serve both its employees and customers from their many strategic geographic locations.
THIS HEALTH INSURANCE "Emergency" THAT CONGRESS FACES IS THE HIGH COST OF INACTION
This health insurance "Emergency" that Congress faces is the high cost of inaction! There is no end in sight to the rising cost of health insurance. And, the concomitant increasing cost of health care makes it less and less likely that our most deserving citizens are ever going to be able to take advantage of one of the greatest American innovations, the creativity and the health and well-being that most of us now enjoy. Congress is bankrupting the nation, and the cost of our healthcare and our government-sponsored health insurance programs and their future liability are a burden. In testimony before the Senate Budget Committee in 2007 (before Obamacare) Peter Orszag, Director of the Congressional Budget Office (CBO) famously stated that “the nation's long-term fiscal balance will be determined primarily by the future rate of health care cost growth. And, a Medicare Advantage program that is able to thread the policy needle and offer high-quality health plans while saving money has the potential to improve the performance and sustainability of the Medicare program overall.”
Congress has not been able to agree on a way to Repeal or Replace Obamacare, and the Trump Administration has never put forward a credible alternative. Out of the frustration, on both sides of the aisle, Congress almost passed an ACA bailout as a part of the last major Omnibus (break the bank) Budget deal to avolid a governement shut down. The ACA insurance companies were threatening to raise rates in advance of the midterm elections if they didn’t get the “market stabilization" (money) they wanted. Nervous about the mid-terms and keeping their jobs, on both sides of the aisle, our congressional representatives were more willing to throw money at the ACA, rather than face the serious problems head-on. The opposition to funding for abortions was the only thing that stopped these funds from being included in that last budget deal.
Modern Healthcare Magazine reports in their April 2018 issue that the lack of comprehensive national health reform is causing on “A patchwork of ACA changes that will result in a hodgepodge of insurance laws and outcomes across states.” This hodge podge is similar to what we may expect with whole-sale state and local options, as Graham-Cassidy proposed. Modern Healthcare notes that as the Trump administration and Congress whittle away at the Affordable Care Act, Blue States are filling in gaps to bolster their markets. And, some Red States are taking up more sweeping solutions to try and get their health insurance markets back to the place they used to be before ACA wrecked them.
The Commonwealth Fund has correctly sounded the alarm of growing concern about, “How (the) State and Federal Actions Will Affect Individual Health Insurance Coverage for Middle-Income Americans.” Although they believe the Affordable Care Act (ACA) has accomplished much of what it’s drafters intended, that middle-income working-age consumers will Not be able to afford health insurance coverage in the future and the percentage of the national debt consumed by health care will cripple our nation’s ability to compete effectively in the world.
The ACA has increasingly become a program almost exclusively for Americans living close to the poverty line in urban areas and has failed miserably in making a sustainable reduction in the number of uninsured Americans. We created the ACA to cover the uninsured, but instead of making health insurance more affordable, the ACA Law has legalized runaway health care inflation and health insurance cost escalation by establishing a financing system with minimum loss ratios (MLR), premium loading and risk-adjusted payment transfers designed to increase premium rates and government subsidies and stifle insurance carrier competition, innovation, creativity and cost containment.
Between 2013 and 2017 “marketplace” exchange premiums have increased by over 105%. The ACA has created regulations and practices that restrict the free and fair trade of health insurance, causing competition among health insurers to collapse and promoting monopolistic markets where 52% of the jurisdictional counties in the U.S. have only 1 (one) approved health insurance carrier! This may not have been the intent of the ACA, but it has been the result.
We believe that HHS and the Congress have unwittingly created a government-sponsored Cartel of health insurance carriers. These health insurance carriers are financed by the taxpayers, with little or no risk of long term losses. A few major health insurance carriers are controlling the cost of Obamacare insurance programs for what has turned out to be a deserving but painfully few American citizens (only 8.4 Million). At the same time, the federal regulations have potentially permanently priced the 30 Million uninsured Americans out of the market. Meanwhile, for those of us, who are doing the right thing, paying for our health insurance, paying our taxes and paying the lion’s share of the ACA program (with our hard-earned tax dollars), we are taken to the cleaners with the double whammy of higher health insurance premiums and higher health care costs. How can this be fair?
Isn't it about time that We the People come up with a Health Insurance Program that works? President Trump promises to come up with a plan that takes care of everybody. To accomplish this goal, Congress does not need to prop up failing insurance exchanges, subsidize the profits of large and successful health insurance carriers, re-invent new benefit plans or generate new taxes on the public. We are sponsoring this web site to make it clear to you and everybody that we can reach with it, that our Medicare Advantage (Medicare Part C) is the right platform for a meaningful alternative to Obamacare. "We the People" and our Congress created Medicaid, Medicare A, B, C and D, Tricare, the Federal Employee Health Benefits Program and most recently the Affordable Care Act (Obamacare). All these insurance programs have enjoyed some measure of success, but the ACA has been the DOG among them. It was ill-conceived by the health insurance industry, exaggerated by an over-jealous Obama Administration, passed by a naive Congress and paid for by us hood-winked taxpayers.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Extending the Medicare Fee-for-Service program and forcing "The Secretary of Health and Human Services" to re-organize an industry, which effectively is the largest national employer, under a big government run health care system bureaucracy is NOT the better way of fixing our health insurance system! Common sense leads us to conclude that extending the successful Medicare-Advantage-for-All is the better solution that the Democrats and the Republicans should be looking for. Medicare Advantage is a "Program That Works". It has been around for twenty (20) Years. Our seniors are so satisfied with it, that it grows practically all by itself. It has a few of the key ingredients the Democrats are looking for. It is popular. It is cost effective. It is currently an important component of the existing Medicare system covering over 38% of the Medicare eligible population. What democratic sense does it make, to potentially wreck any of their Plans? That certainly isn't what Senator Bernie Sanders wants to do. But, it is what most likely will happen if the M4A program he is proposing is legislated.
Senator Bernie Sander's recognizes that Medicare works well by giving seniors direct access to some of the best health care in the world. Even as he has sensibly grandfathered all the current beneficiaries into their current programs; what no Democrats is telling our seniors, is that the resources required for Medicare 4 All are likely to force the federal government to make more drastic changes in everybody's coverage! Obama was told the American people that the ACA would save everybody money. Obama was told us that everyone would be able to keep their doctor. He told us all that these things were the truth. And, they were NOT the truth. In fact, they turned out to be lies. The ACA raised the cost of health care. Health insurance programs premiums skyrocketed and many Americans were forced to give up their health insurance programs and their doctors.
Obama certainly did not intend for this to happen. We don't believe he was intentionally lying when he made these statements and Senator Bernie Sander's doesn't think M4A will make wreck the Medicare program. But, based on what we know about traditional Medicare and what we know about the cost of M4A, it is reasonable for Republicans to claim that this program will wreck Medicare as we know it. Look what happened with Obamacare. We know for a fact that the Medicare fee-for-service program is the second most expensive health care plan on the planet. No one can seriously believes that Senator Sander's may not have all of the information he needs to be certain that the American people are going to be better off with a Medicare 4 All single payer system? It is questionable. And, given what we do know; the 32.6 Trillion Dollar price tag, the ineffectual efforts of Obamacare to lower the cost of health insurance, the failure to attract 30 Million uninsured Americans and the government's abject failure to maintain the health and wellbeing of the American people are just a few of the good sound reasons for the American people NOT to believe that Senator Bernie Sander's idea that the government can expand the existing Medicare program will fix the problems.
Senator Bernie Sander's and Barrack Obama will never admit that they were wrong. In the later case, the historical record speaks for itself. No matter what anybody claims, SENIORS WILL NOT GET TO KEEP THEIR PLANS. And, if anyone tells you that they will, just remember what happened the last time! Our Medicare program is far from what we would like to see in a national health plan. Even so, the Medicare beneficiaries have worked long and hard for the right to have that coverage and we should NOT do anything to screw that up! That is exactly what some of the Democrat proposals for "Medicare 4 All" will do.
Medicare Advantage is A SUCCESSFUL PROGRAM. It has most of the characteristics we need on a national health plan. First of all, it is popular. It has been working successfully for 20 years, grown in enrollment by leaps and bounds, demonstrated solid health care management and cost control and satisfied the health insurance needs of the most demanding segment of the American people, our seniors. Merrill Goozner, who is the Father and Editor Emeritus of "Modern Healthcare" magazine, said in their May 13th issue that, "the insurance industries counter to Medicare for All is Medicare Advantage, the privately run plans that already serve 22 million seniors or more than a third of beneficiaries." We hope he is right, but thus far many of the health insurance companies are making so much money under Obamacare that extending Medicare-Advantage-For-All may NOT be their highest priority right now.
Merrill Goozner thinks that Medicare Advantage plans are the lowest cost health plans because the carriers cherry pick the healthiest seniors. To support his supposition he sites that the Kaiser Family Foundation (KFF) reported that Medicare Advantage subscribers are less prone to require health care services. This may be true but it is also logical, because Medicare Advantage plans require seniors to pay more money out of their own pockets for the services. If they had stayed with traditional Medicare, they would have been paying MORE in health insurance premiums, but paying less out of pocket for any medical services they required. So naturally if you are healthy and not in the habit of requiring medical services so much, choosing a Medicare Advantage plan saves you money. So perhaps MA beneficiaries would rather save money than pay for health insurance coverage they do not use. If so, that is not cherry picking. That is common sense. Statistically however, both view points produce the same utilization. As more people are eligible to join MA plans, this risk pool will balance out to some degree and more people will have to enrolled to support the participants that maintain a higher levels of health care utilization. This is where the integral health and wellness program comes into play in our Plan.
THE COST OF ANTI-SELECTION
Health plan anti-selection is real. For those unaware, anti-selection happens when people already suffering from an illness or injury are able to sign up for health insurance plan with no waiting period and obtain immediate coverage. Obamacare plans all have the risk of anti-selection. There are no waiting periods for pre-existing illnesses and injuries and all health insurance plans are required to accept all pre-existing conditions. Accepting all pre-existing conditions is a very equitable thing to do. Prior to health insurance being required to do so, some Americans with pre-existing health conditions either could not get any health insurance or had to pay more for it. However, there is a big difference between accepting a pre-existing condition and accepting it "right away." Accepting a pre-existing conditions allows everyone to get health insurance regardless of their health history. Accepting everyone with a pre-existing condition "right away" just prevents people from routinely signing up (at all) for health insurance. Why would any self-respecting person sign up for something they don't need, if they know they can sign up for it later, if and when they do need it? If a person can jump into a health plan any time they get ill their symptoms get to the point that they require treatment, why would anyone pay premiums before they actually need the services? There really is no reason to sign up unless you need treatment because as soon as you sign up, you are going to have to start paying for it.
Of course most Americans families that fear the loss of credit or the devastating cost of a catastrophic illness usually seek regular medical care and routinely sign up for health insurance to pay for it. However, more and more American are willing to take the risk of going without health insurance either because they don't have enough money to afford health insurance or they just don't have anything to loose. Anti-selection happens when these people get sick and then sign up for health insurance. Every health plan has this risk. The extent of anti-selection directly effects the cost of the health insurance. Obamacare tried to solve this problem by outlawing all other non-group commercial private insurance. This tried to force everybody in the individual health insurance market to buy an ACA plan or required everybody to pay a tax penalty. The goal was to force everyone into those plans, so there would be a "balanced risk pool". The greater the number of healthy people enrolled, the more healthy people paying premiums and not using services, the more money there would be to pay for the fewer number of people who suffered an illness or injury. Every health insurance plan trys to achieve this balance. But, trying to force everybody into ACA plans didn't solve the Obamacare anti-selection problem. This is because most people could easily avoid signing up for a plan by paying a small tax penalty (much less that the health insurance premium). And, there were a lot of waivers to the tax penalty which were also pretty east to get. So, Obamacare opened itself to anti-selection because generally a lot of the people that signed up for the plans needed the health insurance because they were suffering from an illness or injury. The program designers simply couldn't deliver a balanced risk pool.
If they had been successful, the rates for the ACA programs would have stabilized at lower levels. Unfortunately, rate increases were rampant for a lot of reasons and anti-selection was just a contributory factor. The Average monthly rates over the last four years increased by over 100%. As a result, millions of ACA participants were forced to drop out of the plans, further souring the remaining risk pools. This syndrome is referred to as the "death cycle". The fact of the matter is, all health plans, including ACA plans, have to face anti-selection head on. The plans have to be designed to limit anti-selection, manage health risks and improve the risks that they cover in their plans. Obamacare does not do that and that is one of the many reasons such a governement plan, operating as anything but a huge burocracy, is likely to fail financially!
ACA plans ineffectually addressed anti-selection and simultaneously built cost escalation into the programs. Because the cost escalation under the ACA was so great, the American people who were NOT eligible for premium subsidies (and could avoid being insured) neglected to sign up for the program or dropped out of it over time. This situation was exacerbated by the fact that they knew they could still sign up if they became ill. None of this has anything to do with health and well being of those Obamacare participants with the insurance or helping people to maintain and improve their health, which all of the programs should be doing.
Presidential hopeful Elizabeth Warren, a "Medicare 4 All" sponsor, said in her first debate, "Look at the business model of an insurance company. It is to bring in as many dollars as they can in premium and pay out as few dollars as possible for your health care." With all due respect to Senator Elisabeth Warren, she is wrong about that. The basic assumption that all health insurance companies put profits before the health and wellbeing of their subscribers is a gross generalization of the truth. Health insurance companies are not like the credit card companies and the bank lending institutions that she has been trying to regulate with in the Consumer Financial Protection Bureau. Health insurance companies are not banks! They spend Million of Dollars on programs and human resources necessary to improve the health of the people they insure. They do not arbitrarily try to drain their subscribers of ever premium dollar they can in premiums. If they did that, they would be out of business quicker that we can say Jiminy Cricket. Unfortunately, government regulation of the health insurance companies did not help with this perception.
Obamacare had no requirements to improve the health of the American people. And, there were no special efforts at cost containment and no incentive what-so-ever for the health insurance companies to do anything other than just spend money. In general, the ACA carriers have nothing to show us in the way of genuine efforts to improve the health of the American people covered by the Affordable Care Act, except to make it unaffordable. Senator Elizabeth Warren's solution to the rising cost of health care is to add more governement regulation. Rather than rely on healthy competition, which would be a logical American solution to the problem, she has introduced legislation to further restrict the loss ratios of the insurers. This type or regulation is more like what a Senator may propose when dealing with a utility company. I guess we could characterize most of the Democratic ideas for improving the health care system as treating it like a common electric or water utility. Health care is much more than a utility and treating it like one, especially given that it is our largest employer, will not improve the situation. Bless Elizabeth's heart, but we believe her efforts are misguided.
MEDICARE ADVANTAGE IS DIFFERENT
Blue Cross Blue Shield, Humana and other major health insurance plans (many of them non-profit) have been helping their subscribers improve their health for decades. Their sponsorship of HMO's, IPA's and other group practices, employer health and wellness programs and improved provider contracting are designed to keep the cost down and the help keep the people that sign up for their programs healthy. This is exactly why Medicare Advantage plans have been so successful. Peter Orszag, Obama's Budget Director acknowledged that MA carriers did a better job than the government with provider contracting. We believe Medicare Advantage Plans can do a better job than the federal governement for everybody enrolling in a Medicare Advantage Plan For All and there is some hard evidence to indicate that they will be successful at it.
There is solid evidence that Medicare Advantage lowers the cost of health care for the most seriously ill people suffering from chronic disease. Humana has produced numerous study's showing shorter lengths of stay in the hospital and Avalere Health recently released a landmark study (featured on our Cost Containment page) which found that Medicare Advantage achieves cost-effective care and better outcomes for beneficiaries with chronic conditions relative to Medicare. Key findings include that fact that, despite KFF studies showing lower utilization, Medicare Advantage plans have a higher proportion of patients with clinical and social risk factors shown to affect health costs and outcomes than the more popular Traditional Fee-For-Service Medicare. Forty-eight percent (48%) of Medicare Advantage beneficiaries suffer from at least one chronic illness. Despite a higher proportion of clinical and social risk factors:
- Medicare Advantage beneficiaries with chronic conditions experienced lower utilization of high-cost services, comparable average costs, and better outcomes.
- Medicare Advantage beneficiaries that suffer from chronic illness have six percent (6%) lower medical expenses.
- They have twenty-three percent (23%) fewer hospital admissions. And, they have thirty-three percent (33%) fewer hospital visits
- Compared with traditional fee-for-service Medicare, health outcomes and cost savings are significantly better for Medicare Advantage beneficiaries with diabetes—the most clinically complex cohort, even though seventy-five percent (75%) of the MA beneficiaries had at least 3 chronic conditions.
- Medicare Advantage beneficiaries with chronic conditions in general, experience significantly better patient outcomes and lower costs savings compared to similar beneficiaries in Fee-For-Service traditional Medicare.
As we have said before, "Obamacare can make NO such claims." The skill of ACA Plans is raising the cost of health care and health insurance premiums for everybody. Even as Medicare Advantage plans have a financial incentive to accurately report claims to CMS, we recognize that Med PAC has not been satisfied with the data they have been getting from the Medicare Advantage Plans. Sometimes their encounter data doesn't match up. They are paid on capitation, so reporting claims data accurately is not their highest priority. Most risk-adjusted payments are based on diagnoses and not the actual treatments delivered, so both CMS and the Medicare Advantage carriers will potentially benefit from more accurate data reporting. The overall success of Medicare Advantage plans however speaks loudly for itself. Americans are voting with their feet. Obamacare enrollment is dropping and Medicare Advantage enrollment is climbing. The Medicare Advantage plans enroll more than twice as many Americans, are generally less costly than ACA plans and Traditional Medicare and if the federal government doesn't get it's act together, nobody without a federal health insurance subsidy or tax credit, even middle-income wage earners, are going to be able to afford any of these health insurance programs in the United States of America and the full cost of our health care is going to be thrown on the backs of tax payers, who are already straining under the burden.
THIS IS A BIG DEAL
There are a couple of BIG problems with Bernie Sanders Bill to establish a “Medicare 4 All” national health insurance program for all Americans. The first big problem is the dollar cost of the program. If the health care plans in the United States were in a horse race, the Affordable Care Act (ACA) would be on the inside track and the all-time winner on cost. We believe the ACA has been by far the most expensive federal health insurance program in American history. Unfortunately, the Traditional Medicare (Medicare Parts A and B) fee-for-service is in solid second place and our current Medicare Advantage (Medicare Part C) is a very close third. These are all very expensive horses that the federal government, with the support of the taxpayers, are running this race and the track is sloppy.
We need to put these programs out to stud and bring forth the NEXT GENERATION health plan, the new Triple Crown winner that will work for everybody and have the best qualities of all three programs. Medicare Advantage is the best, the cheapest and the most popular of the three plans and consequently, it is the most reasonable cost-effective place for us to start. The Mercatus Center at Georgetown University recently released a Study, paid for by the Koch brothers, that finds that the Sanders “Medicare 4 All” Bill (after some adjustment requested by Bernie Sander’s campaign) will cost $32.6 Trillion Dollars over ten years. The United States now has a total national debt level that is just $21.7 Trillion Dollars. The interest we pay on this debt is the largest single line item expense in our national budget and with interest rates increasing, the interest on our debt is going to cripple our national spending for almost everything else, including health care. How can the American people afford a program that would EXPLODE our national debt at a time we are annually generating 650+ Billion Dollar budget deficits? The answer is; we Can’t!
Our national health care expense is eighteen percent (18%) of our Gross Domestic Product (GDP) and that level is almost twice that of our nearest industrialized competitor nations! Recently elected NY Congresswoman Alexandria Ocasio-Cortez says that we should, “Just pay for it”. And, that is what we tend to do in the United States with almost everything else. We pass tax cuts we cannot afford. We spend way over our annual earnings. Senator Rand Paul, a populist Senator from Bowling Green, Kentucky explained it well when he addressed the Senate on February 8, 2018. He exclaimed that,
“George W. Bush doubled the debt from 5 Trillion to $10 Trillion. President Obama doubled the debt from $10 Trillion to $20 Trillion. Now (with the new Trump tax cuts) we’re on course to exceed $30 Trillion in the next seven years.”
He further exclaimed that increasing our national debt was NOT what the people of Kentucky elected him to Congress to do. And, in fact he often votes NO on this very principle alone, because he is thinking about the future of our country and the success of our children and NOT the political appeal of programs.
In talking about our nation’s health care GDP, Warren Buffet recently proclaimed that
“We are a rich country and we can get along doing the wrong thing for some time, but we can’t get along doing the wrong thing indefinitely.”
So, what can we do about it? For starters, we must deregulate the non-group health insurance market and request our health insurance plans to come up with Medicare Advantage a variety of specially designed Gold, Silver and Bronze Medicare Adavantage public option plan choices that will be attractive and more affordable for young and middle-aged Americans.
The second BIG problem with "Medicare 4 All" is the government's ability to react. John F. Kennedy warned Americans in a Sports Illustrated article in the 1960s that we were getting soft. At that time only 15% of Americans were overweight. Now 66% of Americans are overweight. In fact, we lead the world with the highest population percentage of citizens being overweight, followed by England at 60%. In the ensuing 60 years our federal governement has had several diet pyramids (now we have the "diet plate"), at least two sets of exercise guidelines and a runaway incidence of chronic disease. the United States has a level of health care costs that the other countries of the world CAN NOT EVEN TOUCH! We can not afford to turn our health care system over to a Big Government operation. We will drown in the debt a national health service would create and the service itself would have little incentive to improve our health and lower the cost. Look no further the Veterans Administration and all the problems we have had taking care of out war hero's with a national health service.
One Marketing Director for BlueCross BlueShield claims that “What the Congress and the health insurance companies have done to the health insurance marketplace under the Affordable Care Act is criminal.” Back in 2017, the Kaiser Family Foundation (KFF) found that the Affordable Care Act had restricted non-group health insurance markets in the U.S. to the point that 32% of the jurisdictional counties had only one approved health insurance carrier. The New York Times reported that at least 1,433 jurisdictional counties (45%) have either One or No approved Obamacare non-group health insurance carriers. In 2018 fifty-two percent (52%) of counties have only one carrier. If our commercial health insurance companies, managed care plans and BlueCross BlueShield plans had purposely conspired to restrain the health insurance markets and restrict the competition to this degree, without the complicity of the federal government, such action would probably be deemed illegal under the Sherman Anti-Trust Act and the Federal Trade Commission Act of 1914.
Is this the best that your federal government can do? The short answer is: Absolutely Not! This ACA is a disaster. And, there is absolutely no one credible excuse for these conditions to exist. Congress effectively delivers health insurance programs for themselves and over 160 Million Americans, including the and the some 8 Million employees in Civil Service. Obviously, we can not continue to throw money down this rat hole. We need to try something new. And, in so doing we must rely upon the programs that are working! Medicare Advantage is just such a program that can work for All Americans and extending to All Americans should be our highest national priority.
IMPROVEMENTS IN THE HEALTH INSURANCE IS A NATURAL EVOLUTION
We assume the by 2020 the ACA will be declared unconstitutional by the United States Supreme Court. Although we are not lawyers and therefore not qualified to give legal advice, it is naïve for Medicare-Advantage-For-All.Com to assume that if the ACA Law survived the first Supreme Court challenge because the government had the Right to Tax using the Individual Mandate, that then when the Congress removed the "Tax" from the Law? Well, you get our point. Secondly, we have yet to hear of any legal opinion that argues that it WILL be overturned. To our way of thinking, that in and of itself, dooms the constitutionality of the ACA Law. All we hear is that the constitutionality of the Law will be upheld, and that in our humble opinion, will be it's undoing. If we are Right, we are eventually going to need an alternative to the ACA. Medicare Advantage For All (MAA) is a plan that can peacefully coexist with the ACA. If the ACA is upheld, MAA will be another choice for Americans. Americans like choices. Medicare Advantage for All is the most popular health insurance plan on the planet and Americans under the age of 65 should not arbitrarily be deprived of the right to have it.
LOOK AT THE HISTORY OF THE PENSION PLANS
Traditional Medicare for All is not the answer. Tradional Medicare can be compared to the old Defined Benefit Pension Plans that dominated (60%) of the pension market in the early 1980s. Now, these Plans represent only 4% of the pension plan market. They have been replaced by Defined Contribution Pension (401k) plans, in the same way, that Medicare Advantage Plans are replacing Traditional Medicare. Medicare-Advantage-For-All (MAA) is the next generation of Defined Contribution health insurance reform that we must embrace in the United States. This is not because the traditional Defined Benefit Pension Plans are bad. It was because the 401k Plans are better. They are more affordable. They appeal to more people. They offer Americans more investment choices and flexibility. They can be financially sustained by businesses that offer them. And, the money is segregated so employees can rely on 401k plans in the long run.
Medicare Advantage Plans are just like these new 401k Defined Contribution Pension Plans which are the standard way in which almost all retirements are managed today. The Apollo Medciare Advantage plans are the Defined Contribution health plans of the future. These plans will have the latest innovative design that allows the health benefits to respond to the person choosing to buy the plan. Just like Defined Contribution pension plans, depending upon which plan one chooses and how much one is willing to put into it; will determine how much one pays for it and how much they get out of it. The more you are willing to put into it, in terms of effort, time and life-style changes, the more you will get in terms of health benefits and how much the plans will cost. The Apollo Medicare Advantage Plan will be the first health plans to respond positively to those people who are willing to take an active role in improving and maintaining their health. They will get more benefits and the plans and they will cost less. Alternatively, the Tradional Defined Benefit Health Plans will not adjust to your health status, your excersize routine or your diet. Those people that buy the traditional Defined Benefit plans that will continue to pay insurance benefits regardless of their health. And, the healthy people that have these palns will be making contributions to the plan that are going to be directed to apy for those people who are sick. No matter how much more you put into that plan, you will never get any more out of it.
And, you are free to choose the plan that is best for you. Both Medicare plans and our Pension plans are conscientiously and scrupulously regulated by the federal government. They are both safe, sound and reliable. Apollo Medicare Advantage is the New Paradigm in health insurance that can be made into a program to cover All Americans today.
LOOK AT THE RECENT HISTORY OF RETIREE HEALTH INSURANCE
Most larger American corporations used to offer retirees continued health insurance when they retired. All the big banks, the telecommunications firms, large manufacturers, defense contractors, railroads, you name it. If the employer was big and successful, it offered (and still does) retirees the option to continue some kind of health plan. Retirees would be eligible for Medicare Part A at age 65 and they could purchase Medicare Part B. The companies would offer supplemental plans on top of Medicare that coordinated the programs with Medicare. Since as we get older, we tend to use more health care and the cost of extending coverage to retirees has tended to grow astronomically.
These plans have also gotten to be very expensive and in response to the interest of employers, the federal government has now granted approval to offer Employer Group Waivers Plans (EGWP’s) to give retirees the opportunity to have access to Medicare Advantage plans. These waivers allow employers to replace (or add) Medicare Advantage plans to their portfolio for retiring and retired employees. Well established companies like AT&T and Verizon have recently adopted these plans. While not being required to do so, some of these employers are saving so much money in this conversion that they are also offering retirees the opportunity to increase their health benefits, reduced cost-sharing or lower their premiums. Under the EGWP waivers, employers may even choose to pay their retirees Medicare Part B premiums, which every Medicare enrollee must pay, regardless of whether they enroll in MA or receive Part B benefits through Traditional Fee-for-Service Medicare. Read more about EGWP.
WHAT CAN CONGRESS DO ABOUT IT?
Democrats in the 2018 midterm election cycle took the House of Representatives with the advocacy of health care reform. It a very successful campaign issue and the Republicans had a lot of smaller health care issues related to the Opiod crisis, allowing Association health Plans to operate across state lines and the resurrection of short-term health coverage. But, no programs addressing the broader issues of health care affordability and a reasonable alternative to Obamacare. The last Gallup Poll shows that 78% of Americans are MORE concerned about health care than fifteen (15) other important issues, including their usual top priorities, Crime and Violence and Federal Spending. A recent study on health equity in the United States, published in JAMA Network Open, finds that our overall health in the United States has declined over the last twenty-five years and health equity has not improved. The lead author, he hopes the study will, "galvanize the policy community to be serious about bench-marking their progress and understanding what works an d what isn't working, and getting themselves to the stuff that does work." Read more from U.S. News on Health Equity in America. What works is Medicare Advantage.
Health Care is the Democrats most important political issue, besides of course defeating Donald Trump in the next Presidential election. The Democrats have introduced multiple health care bills in both houses of Congress and more are on the way. Senator Bernie Sanders just re-introduced his newest Medicare 4 All (M4A) Bill in the Senate (S. 1129). It is pretty much the same as the Bills he has introduced in the past, except it adds more detailed benefits for disability. The immediate reaction in the financial markets to his presentation was dramatic! The big boys, UnitedHealth, Anthem and Cigna alone lost over $40 billion in market value. And, the Massachusetts Hospital Association came out strongly against the new Sanders M4A Bill, despite the strong local political support from Senator Elizabeth Warren and Representative Joseph Kennedy, who both support the Sanders Bill. Despite some strong support from liberal professionals and institutional health care providers, Wall Street investors do not seem to like Big Government health care. Markets recovered almost immediately when it was obvious nothing had really changed.
Believe it or not, the Republicans have also accomplished a lot of funding for health care, advancing the work of CMS and the CDC and funding the devastating national Opioid addiction crisis. President Trump has restricted the reimbursement of the unauthorized CSR's, allowed Association Health Plans to operate across state lines and taken some steps to continue allowing the renewal of the remnant, once vibrant non-group health insurance products. Commercial individual health insurance played such a vital role in providing Americans with affordable health insurance, before the ACA essentially outlawed those plans. However, since Republicans failed to repeal the ACA, they have generally left their "powder dry" on the broader issues of how to reform the system. Trump has mentioned Medicare Advantage at two of his political Rallies and vowed to present a plan that will likely wait until they re-take the House of Representatives.
Right now, most of the Democrat Presidential hopefuls, have signed on to Bernie Sander's effort to establish a "Medicare 4 All" plan under a Single Payer Health Care System. But, in their first debate, only three of the candidates besides Bernie vowed to give up their private health insurance in favor of a governement-run health plan. This may be because they realize it is both unrealistic as it is unpopular with main stream voters. John Delaney the Multi-millionaire candidate from Iowa says that the other candidates are pandering to the progressive wing of the party. On Firing Line he said," They are just telling people whatever they think they want to hear." The Senate and House leadership including most of the Whips have not signed on a supporters of the Medicare 4 All bills and when Senator Chuck Schumer talks about what he would like to see, he sounds like a Republican.
Although the Democrats proposals may lead to Government control (socialization) of our health care system; it is consistent with their sincere desire to improve access to the current health care system for their constituents. At Medicare-Advantage-For-All, we applaud the Democrats for their efforts and their interest. Kamala Harris has expressed her concern for improving access to health care for all Americans. We fervently hope All the Democrats who support Bernie Sander's Bill, will also support this Medicare-Advantage-For-All Bill, as a way to more immediately responding to the needs of their constituencies. And, we hope their Republican colleagues will cross the aisle and demonstrate their traditional bipartisan support for Medicare Advantage plans and the extension of these popular programs to every American.
Modern Healthcare Magazine (April 2018) rightly states that the lack of health reform is resulting in, “A patchwork of ACA changes that will result in a hodgepodge of insurance laws and outcomes across states.” They believe that as the Trump administration and Congress whittle away at the Affordable Care Act, the Blue States are filling in gaps to bolster their local markets. This was demonstrated by four (4) successful state ballot initiatives expanding Medicaid in the 2018 midterm elections. This may result in an estimated 130,000 low-income people qualifying for fully paid health insurance, compliments of the state government (10%) and federal government (90%). Now thirty-seven (37) states have passed Medicaid expansion. And, some Red States are taking up even more sweeping solutions to try and get their health insurance markets back to the way they were before ACA outlawed them (Reference). This includes Texas which is successfully suing the federal government to declare the ACA unconstitutional. They are challenging the whole law, but despite Democrat candidates assertions to the contrary, no one truly believes that this is an assault on pre-existing condition coverage, to which almost every Republican, including the President and Senate Majority Leader Mitch McConnell have pledged continued support. If the ACA is struck down in the Supreme Court in 2020, that does not stop any insurance carrier or managed care provider from covering pre-existing conditions. Please select: “The Best Bi-Partisan Answer To Repeal and Replace Obamacare”, under Key Documents for our unique solution to this underwriting problem.
Most legal experts do not believe the ACA will be struck down. And, this is exactly why the Medicare-Advantage-For-All Family believe it WILL be struck down. The Supreme Court does not work on public concensus and when there is one, we are often in for a surprise. We expect the Law will be declared unconstitutional and we want to have a viable realistic comprehensive alternative firmly in place before that happens. The Affordable Care Act and Medicare-Advantage-For-All can peacefully coexist side by side of each other. And, BOTH programs should be a choice that the American people can make for themselves. We are the ones that pay for all these programs and it is about time that the federal government step up and give us the choices that we need to maintain and improve our health and well-being. We are suffering and we need the politicians to get the politics out of our doctor's office and our hospitals!
The Commonwealth Fund (CF) is correctly sounding the alarm of growing concern about, “How (the) State and Federal Actions Will Affect Individual Health Insurance Coverage for Middle-Income Americans.” CF believes the Affordable Care Act (ACA) has accomplished much of what it’s drafters intended. There is some evidence of increased access to health care and some reduced consumer medical debt. However, there is the growing concern that middle-income working-age consumers will Not be able to afford health insurance coverage in the future and the percentage of the national debt consumed by health care will cripple our nation’s ability to compete effectively in the world.
The Affordable Care Act has increasingly become a program for Americans living close to the poverty line in urban areas and has miserably failed to make an appreciable reduction in the number of uninsured Americans. This was why President Obama proposed the ACA. He once referred to it as a wealth transfer. Instead of making health insurance more affordable, the Affordable Care Act has legalized the institution of runaway health care inflation. Health insurance cost escalation is now built into the system and by trying to regulate the insurers with minimum loss ratios (MLR), premium loading and risk-adjusted payment transfers, these mechanisms end up increasing premiums and federal government subsidies and stifling insurance carrier competition, innovation, creativity and cost containment. Is this any way to run a health plan? The answer is: No! This is a federal disaster and the American people need to accept it and move on.
WHAT IS THE SOLUTION?
Between 2013 and 2017 “marketplace” exchange premiums have increased by over 105%. HHS has created regulations and practices that restrict the free and fair trade of non-group health insurance, causing competition among health insurers to collapse and promoting monopolistic market practices (where 52% of the jurisdictional counties have only one health insurance carrier)! Admittedly, some of these markets are so small, they may have only had the local Blue Cross Blue Shield options, to begin with, but with the government regulation, what formerly may have been a BCBS non-profit community commitment, has turned into a government-sponsored monopoly. This may not have been the intent of the Affordable Care Act, but it has been the result! The Affordable Care Act has created a government-sponsored de facto Cartel of health insurance carriers. These health insurance carriers are financed by the taxpayers, formerly with little or no risk of loss. They are controlling the cost of health insurance for a deserving but painfully small number of our citizens (only 8.4 Million federally enrolled people). At the same time, the ACA regulations have permanently priced over 30 Million uninsured Americans out of the market. Meanwhile, for those of us who are doing the right thing, paying for our health insurance, paying our taxes and paying for the lion’s share of the ACA program (with our hard-earned tax dollars), we are being taken to the cleaners with the double whammy of higher health insurance premiums and higher health care costs. How can this be fair?
Medicare-Advantage-For-All is NOT advocating for the Repeal and Replacement of Obamacare. We just want our Congressional Representatives to focus their attention on creating a health insurance Program that works for All of the American people. President Trump promised to come up with a plan that takes care of everybody. To accomplish this goal, Congress does not need to prop up failing Marketplace Exchanges, subsidize the profits of large and successful health insurance carriers, re-invent new benefit plans or generate new taxes on the American businesses and the public. We are arguing for letting the Secretary of Health and Human Services come up with a plan to extend Medicare-Advantage-For-All (Medicare Part C) Plans (that can peacefully coexist with Obamacare) to All Americans. The market should decide what health care program are best for "We the People". Congress created Medicaid, Medicare Parts A, B, C and D, Tri-Care, the Federal Employee Health Benefits Program and most recently the Affordable Care Act (Obamacare). All these insurance programs have enjoyed some measure of success, but the ACA has been the DOG among them. It was ill-conceived by the health insurance industry, exaggerated by an over-jealous federal regulation, passed by a hopeful Congress and paid for by the hood-winked taxpayers.
DRAFT SENATE BILL
This is the first page of a draft bill that "WE THE PEOPLE" propose to the leadership of the U.S. Senate in order to form a more perfect Union. The Medicare-Advantage-For-All.Com Family firmly believes that such a bill is necessary to improve our personal health and preserve our uniquely American healthcare system that has become a burden on the American people, U.S. manufacturing and the American businesses upon which we rely for our prosperity. WE THE PEOPLE know that Congress has successfully provided health insurance for themselves and approximately 160 Million Americans for many years. WE deserve whatever is necessary for this Congress to come together and PASS “A BILL” as follows, to create a Medicare Advantage Plan For All Americans that will improve our personal health and lower our cost of healthcare:
- BEGINNING OF FIRST PAGE OF THE DRAFT BILL -
To establish a Medicare Advantage For All national health insurance program. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled.
SECTION 1. Short title; table of contents
(a) SHORT TITLE - This Act may be cited as the “Medicare Advantage Plan For All of 2019”.
(b) TABLE OF CONTENTS - The partial table of contents for this (proposed) Act is as follows:
TITLE I — ESTABLISHMENT OF THE MEDICARE ADVANTAGE PLAN AND ENTITLEMENT
SEC. 101. ESTABLISHMENT OF THE MEDICARE ADVANTAGE FOR ALL PROGRAM.
Congress hereby affirms that the health of the American people is in crisis and requires national health insurance with an integral health and wellness program to provide comprehensive protection against the cost of health care and to lower the cost of health care in accordance with the standards specified under this Act. Due to the fact that Medicare Advantage is the most successful and popular Medicare program in the United States and already addresses most of the needs of Americans that have reached age 65, and is ably administered by the Department of Health and Human Services, we must immediately develop a plan to extend the Medicare Advantage Plans with an integral health and wellness program for all residents of the United States.
By this (proposed) “ACT”, we authorize The Secretary of Health and Human Services, to within six (6) months, consult with all the relative Departments, Agencies and all parts of the federal government and all the immediately applicable interests of our private health care economic sector, to devise a plan to extend Medicare Advantage to All Americans. The Secretary is required to report back to Congress on the rules and the necessary criteria for extending the Medicare Advantage program to ALL Americans in an affordable, accessible, universal and feasible fashion. Such Report must contain a firm and reasonable proposal and time frame for implementation. The Report to Congress must be debate-ready to allow Congress to debate and act in a timely fashion, in accordance with and in recognition of all the provisions and purposes under this ACT and the Constitution of the United States of America.
SEC. 102. UNIVERSAL ENTITLEMENT
All residents in the United States who are NOT otherwise eligible for, or covered by, other health insurance will have the right to voluntarily subscribe to this program. Nothing in this Act shall be construed to require residents to buy this program.
Sec. 103. - FREEDOM OF CHOICE
Any individual entitled to benefits under this Act may obtain health services from any institution, agency, or individual qualified to participate under this Act.
TITLE II — HEALTH BENENFITS AND THE INTEGRAL HEALTH AND WELLNESS PROGRAM
The Secretary shall establish an integrated health and wellness Program that will effectively reduce the incidence of chronic illness in the United States to below the international average for all the other industrialized countries in the world. Implicit in this instruction is the development of a Wellness Program for the American people that goes beyond exercise and diet guidelines. Our private sector employers and health plans have all of the experience necessary to create an integrated health and wellness program that will reduce the incidence of chronic illness and improve the health and productivity of the American people. The Academic Medical Centers need to formalize what they have learned about value-based care and introduce it effectively to the medical community in guidelines, practice protocols, and medical school instruction. The Secretary must also use the premier Preventative Care Task Force to inform the protocols for a health and wellness program and the CMS Centers for Innovation to develop a bold New Paradigm of risk-based capitation reimbursement that rewards successful performance in predictive, preventative and personal medical care that assists the American people in attaining and maintaining optimal health.
All residents in the United States who are NOT otherwise eligible for, or covered by, other health insurance will have the right to voluntarily subscribe to this program. Nothing in this Act shall be construed to require residents to buy this program.
TITLE III — PROVIDER PARTICIPATION
TITLE IV — ADMINISTRATION
SEC. 401. ADMINISTRATION
(a) General duties of the Secretary.—
(1) IN GENERAL.—The Secretary shall develop policies, procedures, guidelines, and requirements to carry out this Act, including related to—
(A) eligibility for benefits;
(C) benefits provided;
(D) provider participation standards and qualifications, as described in title III;
(E) levels of funding;
(F) methods for determining amounts of payments to providers of covered services, consistent with subtitle B;
(G) the determination of medical necessity and appropriateness with respect to coverage of certain services;
(H) planning for capital expenditures and service delivery;
(I) planning for health professional education funding;
(J) encouraging States to develop regional planning mechanisms; and
(K) any other regulations necessary to carry out the purpose of this Act.
- END OF FIRST PAGE OF THE DRAFT BILL -
Our Program that works Page and Read More and Topics Pages on this very web site include dozens of downloads and online references related to the justification for this Bill. Our True American page includes copies of all the Editions of the True American which are routinely distributed to our members. Our Key Documents Section and every Web Page include a wealth of information, including our “Legislative Appeal” that we mailed to every member of Congress and the Trump Administration back in April 2017. That Appeal was meant to expose them to the Medicare Advantage for All idea and hopefully to spark Congress to use Medicare Advantage to replace Obamacare. A second Key Document, “The Best Bipartisan Answer to Repeal and Replace Obamacare” was hand-delivered to the Heritage Foundation, HHS, and the most of key members of Congress on both sides of the aisle during the recess week of August 2017. This Plan Document was handed to the staff of most of the Senators in the Senate Finance Committee and the Health (HELP) Committee and in the House of Representatives, members in the Energy & Commerce, Ways & Means, Budget, Tuesday Group Committees and the Freedom Caucus, including the leadership of both bodies on both sides of the aisle. Based on the lack of acknowledgement we received after both distributions; it is likely that both documents were never read, certainly by the Congressional Representatives themselves. However, we now stay in regular communication with the majority and minority Chairs of these committees and some of the Senators and Representatives that are in our corner.
Undaunted in our quest (and although we would make some amendments) we still believe “THE BEST BIPARTISAN SOLUTION” document which was hand delivered, is a well-referenced expose of how we, as a nation, got into the Affordable Care Act mess that we are in and why Medicare-Advantage-for-All is the best way out of that mess, Today. We have 30 Million Americans with NO health insurance. This should be of greater concern to All Americans.
Congress is still struggling to find a solution to the problem of affordable health insurance that is fair and equitable for everybody. Hillary Clinton was the First Lady to come up with the name - Medicare Part C - twenty-five (25) years ago when her husband Bill was President. She subsequently tried to promote a Medicare Buy-In Program. Hillary has kept this idea alive for her entire career. Democrats essentially put the Hillary Public Option idea on the table and still promote it. But now it certainly is on the back-burner since the ACA and now Senator Bernie Sanders' Medicare for All plan. The Democrats House and Senate versions of the "Medicare 4 All" programs, is in and of itself, a tacit admission that the ACA is "NOT" working and they need to support another program that We The People can afford. The Medicare Advantage For All program that we recommend should be their answer, and also the Republicans answer to our problems. Representatives from Both parties need to come together and sign on as sponsors to the above DRAFT Senate Bill, which we recommend to get the ball rolling! Is doing nothing for the American people a better alternative for Congress? We do not think so.
WHAT CAN YOU DO NOW?
The first thing you should do is join Medicare-Advantage-For-All and become a member. Support our efforts to change the health insurance system in the United States. Now that the ACA Program has failed, Democrats and Republicans should return to what Hillary Clinton and many others, including the bipartisan Congressional team that served together on the National Commission on Fiscal Responsibility and Reform (Simpson-Bowles) recommended to the American people back in 2010. Many people, then and now, call for the establishment of a robust Public Option and to extend this Medicare Advantage program to everybody under the age of 65! Alexandria Ocasio-Cortez has suggested as much. During Hillary Clinton’s Presidential bid, Hillary herself suggested that Senator Bernie Sanders' idea for "Medicare 4 All" went too far. After the DNC and Senator Elizabeth Warren backed up Bernie's "Medicare 4 All" plank, the idea went front and center.
In our publication, The Best Bipartisan Answer, found among our Key Documents, we resurrect this basic Medicare Part C proposal, and the content of this website attempts explains why it is still the RIGHT THING TO DO, how we can use the Medicare Advantage as a platform and why we can make Medicare Advantage “A Program that Really Works” using the existing Medicare C Programs.
This should be the Democrats NEW "Medicare For All" proposal. They should support and sign onto the above DRAFT BILL. And, it should be supported by both Democrats and Republicans, in keeping with the bipartisan support that the Medicare Advantage program has always enjoyed in Congress.
Given that Democrats are not likely to agree with the Republicans on the repeal of the ACA (or anything else) and that the Republicans are NEVER going to support a Medicare 4 All plan, perhaps this Medicare-Advantage-For-All is the PERRRRRFECT compromise? We believe a re-engineered current Medicare Advantage program is a responsible approach and worthy of support on both sides of the aisle. Documents in our library also include, "The Medicare Advantage for All Win/Win for Elections" doc. That summarizes the ten key benefits to adopting our program and the Third, Fourth and Fifth Editions of "The True American", a name we borrowed from Cassius Marcellus Clay's famous pre-Civil War era Newspaper. The Third Edition of the True American is an Op-Ed succinctly making the case for Medicare Advantage. The Fourth Edition is our Cost Comparison which blows the cost savings of the ACA out of the water. And, the newest Fifth Edition, which is a four-page explanation of the HEALTH CARE BOMB that we Americans are sitting on. We have recently mailed this Fifth Edition of the True American to every single member of Congress again, trying to raise their awareness of this important idea. Now it is your turn. Please join us as a member so that we may continue this work! And, call your congressional representatives and refer them to the Fifth Edition of the True American and this web site. The Edition will be on each of their desks when they return from the 2019 Fall recess. Every single Congressperson in the U.S. Congress will have received this plan. if you don't call them and tell them you believe in ti and that they should support it, if they "round file" it, who's fault is that? Call them at 202-224-3121. All you do is tell the operator which Congress person you are calling and you will go straight tto their voice mail.
We have to take responsibility for our "Better" Health and getting our "Better" health insurance. We can not leave it to Congress, because they obviously can't do it all by themselves.
Over the last twenty-five years, Medicare Advantage – under Medicare Part C - has been emancipated. This program is now the sole source of revenue, earnings and organic growth of the largest health insurance carriers in the nation. Analysts at Price Waterhouse Coopers (PwC), the Gorman Health Group and the A.M. Best team believe that the MA market is poised to explode. Last year PwC projected that MA enrollment would grow by 8 percent in 2018 to a total of 19 million beneficiaries (almost three times larger than the ACA enrollment). As you know, this prediction was a little LOW. In 2018 Medicare Advantage enrollment reached 19.9 Million but in 2019, enrollment currently exceeds 22.6 Million members. It is by far the most popular health plan in America.
The previous research from A.M. Best and the Kaiser Family Foundation found that MA premium revenues grew from $69.9 billion in 2007 to $187.5 billion in 2016, indicating an upward trend in popularity among the American people. MA now covers over 38% of all Medicare beneficiaries, and of the 12,000 citizens that age into eligibility for the Medicare program each day, approximately 50% of them choose Medicare Advantage within their first year of enrollment. They choose MA because there are no pre-existing condition exclusions, they don't have to buy separate prescription drug coverage or an extra supplemental insurance policy. They get the prescription drugs, wellness and other supplemental essential coverage for deductibles and coinsurance that they need. In most cases, the program is fully paid for by the federal government. It is now very common to meet people with the MA plan.
The federal government can afford to pay the full premium for Americans over the age of 65 because the insurance companies and managed care providers are delivering the MA programs so well, that they are saving the federal government money on every participant. That is what the program was originally intended to do. The health plans administer these programs for less money than it would cost the taxpayers to cover these people under the Medicare "fee for service" traditional program. And, they will do it for less than it would cost the federal government under ANY Big Government single-payer socialized health system.
This is a win/win proposition for all involved, unlike the Affordable Care Act where the taxpayers, the federal government, the insurance carriers and the participants ALL LOSE! Please become an MAA Supporter. We need your help to change the narrative and the mindset in Washington D.C.! Sign up to be a supporter, Today. And, then contact your congressional representative and tell them you support the Medicare Advantage For All program. They all know about it. They have read our materials and they are waiting for your telephone contact. Please call or email us if you have any questions or need any more information.