It’s open season!

Yup, until the 15th of December, we can change our healthcare plan- if we are under the age of 65.  PPACA (aka Obamacare, the Patient Protection and Affordable Care Act) actually demands we sign up for the plan by the ides of December.

(While I am not really discussing Medicare- those of us over 65 should know that its open season ends on the 7th of December.  Where one can change plans- from Medicare to Medicare Advantage or vice-versa, from one Medicare Advantage plan to another, or even switch to a different Part D plan, all with no penalties.)

The good thing- this year the most popular plans (these are the 2nd tier ‘silver’ plans, those chosen by 20% of the insured)  have dropped in price.  Not by a lot- but there’s also no increase, as we’ve seen for the past two years as the GOP tinkered (now there’s an understatement) with the regulations.

That’s true for the states that don’t run their own plans (39 states)- and rely on www.healthcare.org .   As an example, the state of Tennessee will manifest more than a 25% drop in costs, North Dakota a drop of about 1/5.   (These drops are not the result of better healthcare administration- it’s because many of the plans upped their 2018 premiums to accommodate the GOP abrogation of the subsidy they would receive for cost-sharing needs.)

Oh, yeah.  A lot of the companies that pulled out of PPACA are back in the fray.  So, being stuck with only 1 insurance company is a lot less likely this year.  (A little less than 40% of US counties will only have one insurer, a drop of about 1/5 from last year; four small states will have only 1 plan, 6 less than 2018.)

However, I am worried that next year (2020) won’t be so good.  After all, the GOP has removed the individual mandate.  So, fewer of our younger, healthier citizens will feel induced (or forced) to sign up for insurance.  And, those folks will leave the US Healthcare system with a lot of unpaid bills should (or is that when) they get sick.   After all, many of the states are going to let substandard medical (let us NEVER call them health) plans, ones that penalize pre-existing conditions, have cost limitations that won’t cover a 30 day hospital stay (or less), will limit the extent of care, etc.  Sure- they’ll be cheap- because they are simply window dressing.

By the way, PPACA was envisioned to treat all Americans.  Knowing full well that some folks would have to be pressured to get insurance (since they perceive they will never get sick- i.e., these [typically younger]   folks manifest the ‘Superman’ syndrome).

Moreover, under PPACA,  hospitals and clinics were to be paid for patient care by outcome- not by episode. Right now, we still pay our doctors per visit.  We pay our hospitals for an episodic stay- or for an operation.  That fee is not based upon keeping us healthy- or out of the hospitals for at least 30 days after discharge.  (PPACA  conceived that the delivered compensation would be based upon outcomes.)  And, by publicizing how clinics and hospitals achieved their outcomes, we’d be able to pick the better facility for our needs.

Exactly what Walmart (which self-insures) is doing for its own employees.  When and if one of their employees is diagnosed with cancer of the breast, lung, or colorectal regions, Walmart will send patients to the Mayo Clinic  (These cancers are the 3 most common varieties in the US; with some 640K new diagnoses each year [37% of all cancer diagnoses].)  Mayo gets to advise WalMart whether their intended doctors are up to the need- and move them to a different professional, when the course of treatment needs to be upgraded. (Of the 600 already subjected to this program, 15% were found to be misdiagnosed, and 20% of the treatment plans were altered.)

Oh, and WalMart (and Boeing, Disney, and Intel) employ direct contracting.  That means employee health care plans are using the PPACA concept of outcomes-based compensation, also known as pay-for-performance (or value-based care), abandoning the fee-based model.

(Just so you know,  doctors and hospital administrators are not thrilled with this concept.  And, that’s why their lobbying groups have been leaning on the GOP to alter the PPACA program tenets.  Outcomes- based compensation is far riskier for the healthcare professional  than being paid for a patient just showing up.  But, our fee-based system is a prime reason why US healthcare is so much more expensive than that of the rest of the world.  And, now Corporate America is joining the bandwagon- so the switch to outcomes-based compensation going to happen.)

Get yourself properly insured.  NOW!

While you’re at it- get your finances in order.  There’s a new tax law in the land.  And, my book helps you navigate it.  If you buy the paper edition, I will give you some personal insight into how your business can benefit.  (The rules of the offer can be found here.)