Sen. Brown discusses proposal to address health care costs

Read the following; sounds pretty good doesn’t it? Significantly lower the cost to the patient for the most used services while at the same time save money overall.

img_0311The fact is the report referred to includes an actuarial study based only on select plans in certain markets and shows very small changes. If you take certain services previously subject to a deductible and now make them subject to a co-pay, you not only increase the overall cost of the plan, you increase the potential utilization.

As the quote below notes, (“patients ask to defer or refuse routine tests because the costs come directly out of their pocket”) when a patient must actually pay for something with their own money, they may avoid the care or defer it … but you can bet most will spend that same amount of money on something else. The generally accepted notion that somebody else should pay for our health care is the essence of the problem we face regarding health care costs and why we can’t solve it  

Unless you increase or decrease the use of health care services, you can play with deductibles, co-pays and coinsurance all you want. In the end the cost of health care will be paid for by the patient or more likely reflected in the premiums everyone in the plan pays. Or, in the case of Obamacare also paid for by taxpayers.

There is no shortcut or quick fix as this article implies.

LOGAN — U.S. Sen. Sherrod Brown has revealed a new proposal designed to help reduce the cost of health care and give Ohio residents a wider range of choices when choosing quality affordable health insurance plans. On Wednesday, he discussed at length a report that was released by Families USA that outlined how a standardized health plan could lower the cost of care for those who are currently paying significant out-of-pocket costs and meeting their deductibles for care before their coverage actually takes effect. 

Pediatric Urologist Dr. Donald Nguyen, of Dayton, was also on hand to discuss how healthcare law has evolved to make care more readily available to citizens, and increasing the number of Affordable Care Act plans can improve access even further. “High deductible plans have become more than just skin in the game,” Dr. Nguyen said. “They are skin, flesh, and bone for most hard-working Americans. When my patients ask to defer or refuse routine tests because the costs come directly out of their pocket, I realize that these high-deductible plans have gone too far. They are now interfering with care to my patients.” 

The proposal involved standardized options, which would provide an alternative to high-deductible plans. There would be set standard deductibles, maximum out-of-pocket spending limits, established co-payments or coinsurance for the different services. Additionally, primary care and specialist visits would not be subject to the deductible in the standard gold- and silver- level plans, nor would prescription medication. Instead, patients would usually have a flat co-payment for the services; for example, a $30 cost for a primary care visit, instead of owing the entire amount until they managed to meet their deductible for the year. 

“Thanks to the Affordable Care Act, hundreds of thousands more Ohioans now have health care coverage, many preventive health screenings are now free and no one can be turned away from coverage because of a preexisting medical condition,” Brown said. “But too many people — especially people on high deductible plans — are still struggling to afford the care they need. “But as today’s report shows,” he continued, “standardized health plans can help bring down costs and give Americans more choice in selecting high-quality, affordable health insurance. 

Cost should never be a barrier to life-saving care, and patients should not have to postpone treatments or services because they haven’t met their deductible.” The Centers for Medicare and Medicaid Services (CMS) finalized a rule that would create these standardized plans earlier this year. The plans would be offered on the health care exchange beginning in 2017 in order to help patients make more-informed choices regarding their plans. A new report issued by Families USA, called “Federal Standardized Plans Could Improve Access to Care without Raising Premiums,” found that insurers can offer federal standardized plans with premiums that would be comparable to the current silver marketplace plans which cover little- to no services before the deductible.

Source: Sen. Brown discusses proposal to address health care costs | News |


1 reply »

  1. No problem. What Sherrod Brown and Families USA wants is to decide what should and should not be subject to the deductible in a health insurance policy.

    OK with me.

    They can go out and purchase a health insurance company and they can decide what to offer.

    HHS has already issued regulations to require such offerings in 2017. Unfortunately, it looks like the HHS regulations may chill insurance companies from offering options other than “standardized options”.

    Who knows, maybe they will amend IRC 223 (the section of the tax code that governs high deductible health plans) so as to broaden the number and type of services that need not be subject to the deductible – without losing the ability to contribute to a Health Savings Account. The rules were arbitrarily set by Congress in the Medicare Modernization Act of 2003 – so nothing wrong with Congress arbitrarily deciding to expand the number of services not subject to the deductible (beyond today’s limit of preventive services). But, not likely. That would be a rational response.

    However, if they do squeeze the balloon with regard to “routine tests”, what the report calls “routine or ambulatory or outpatient” care, “… office-based care, laboratory tests, imaging, and outpatient rehabilitative and habilitative care…”, primary care and generic drugs, setting a standard deductible, maximum out-of-pocket spending limits, fixed co-payments or coinsurance; and primary care and specialist office visits and prescription medication subject to copays instead of the deductible, that balloon will either burst or it will “pop out” elsewhere – and elsewhere would be in terms of premiums, and employer, employee or taxpayer contributions.

    Of course, the government conveniently forgets that Congress ALREADY ADDRESSED this issue in the Patient Protection and Affordable Care Act of 2010. There is a provision in health reform that provides those with incomes under 250 percent of
    the federal poverty level ($50,400 for a family of three in 2016) to receive federal cost sharing reduction subsidies.

    Why are you so surprised that Senator Brown and Dr. Donald Nguyen would be supportive of having others spend more – so Senator Brown can buy your vote, and so Dr. Nguyen gets a better revenue stream if YOU, YOUR EMPLOYER or TAXPAYERS (YOU AGAIN) INCREASE YOUR COSTS.

    The Families USA study actually dates back to 2014. It defines standardized plans as “… designs that are developed by the marketplace, have defined or identical cost-sharing (the share of health care costs a consumer is responsible for paying) for covered services, all insurers in the marketplace are required to sell.”

    However, note the above statements:
    – Developed by the marketplace, not by government regulation or law (I guess, however, when you read the report, it states that the states and federal governments will make this a mandate), and it includes
    – IDENTICAL cost sharing defined as the share of costs paid by the patient/consumer.

    So, again, they suggest a lower cost outcome for patients/consumers can be achieved by lowering the cost of some services and increasing the cost of other services. And, of course, their economics model is probably a static one – that consumer behavior won’t change. But, of course, as Dr. Nguyen confirms, people DO CHANGE THEIR HEALTH USAGE BASED ON WHO PAYS, AND HOW MUCH.

    So, expect the costs to increase, not decline, as behaviors change. Because Families USA is talking about coverage through the public exchanges, where soon 95+% will receive taxpayer subsidies, we are talking about taxpayers picking up the added costs because the participant’s contribution is based on and limited by their relative income. Again, those who enroll in the public exchange who have a household income less than 400% of the federal poverty level do not contribute based on the cost of coverage, but based on their income.


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