SHBP Protest Groups Misguided

Georgia SHBP protest groups are misinformed and misguided. Teachers Rally Against Group Insurance Changes shbp protest(T.R.A.G.I.C.) formed a Facebook group in early January to express their frustration in changes to the GA State Health Benefit Plan. Obamacare is at the root of their complaints, but they refuse to concede this point and would rather direct their efforts toward the governor’s office.

Members and supporters of SHBP protest groups are certainly vocal but completely misguided in their efforts. They have not connected the dots between changes in the SHBP and Obamacare. TRAGIC and their supporters also fail to accept responsibility for the choices they made during last falls open enrollment.

  • The 2013 SHBP package was not ACA compliant
  • SHBP 2014 was required to be updated to meet Obamacare mandates
  • SHBP fall open enrollment clearly outlined benefit changes for 2014
  • Covered participants of SHBP had a choice of accepting the change or purchasing coverage in the open market

My wife and I are covered under the SHBP. We were given handouts at employee meetings and links to the state website where SHBP plan options were delineated. Yet no one complained at that time. SHBP protest groups did not spring up until AFTER the benefits were active on January 1, 2014.

Did they fail to read the handouts or visit the choices site?

One must assume the whiners never bothered to study the plans and weigh options outside the SHBP. The plan cannot be changed at this point. There is no going back. The Obamacare plans are not popular among individuals who have tried to use the exchange which is part of the reason why enrollment goals have not been met. For the 2 million or so that have selected a plan, estimates that 60 – 80% have yet to pay their first premium.

Over 65 million visitors to but only 2 million have “signed up” for a plan they are required by law to have. Perhaps fewer than 500,000 have paid for their purchase.

Had the SHBP protest groups followed a similar process and studied the plans many of them may have refused to accept the plan designs and sought other coverage.

But they didn’t.

SHBP covered participants don’t get a Mulligan. Barring a Special Election Period because of a qualifying event, they will need to learn to live with their choice.

We reviewed the plans during open enrollment. We understood there were changes. Premiums were higher. Benefits were lower. Higher deductibles and more out of pocket.

We also considered our health care needs, our budget and looked at options OFF the exchange. (Most SHBP plan participants are not eligible for a subsidy so exchange plans should not even be a consideration).

So what can you do if you are in the SHBP to minimize your cost for health care?

  • Maximize your HRA dollars and go through the wellness steps at BeWell
  • If you have not read your plan, do it now.
  • Go to the BCBSGA/shbp site and look up everyone of your providers.
  • Print it out, especially participating urgent care facilities
  • Register with Express Scripts. Look up all your meds
  • Consider changing to generics
  • Evaluate 90 day mail order options
  • Consider ordering from a Canadian pharmacy such as Blue Sky

Rather than treating your health insurance plan like an “all you can eat” buffet, learn to manage your dollars. The sooner you master this skill the better off you will be. The current plan design is the future of health insurance. Protest groups like TRAGIC will not be able to roll back the calendar to the old days so get over yourself. If you spent as much time educating your members on ways to save money on health care everyone would be better off.

Many chronic health conditions can be effectively managed with a healthier lifestyle. Diet and exercise can do wonders for hypertension, high cholesterol, back pain and type II diabetes.

You can change the way you manage and pay for your health care, or you can join a Georgia SHBP protest group and be miserable. Your choice.

Simple Explanation of Obamacare

Obamacare sticker shockCan Obamacare be explained simply? Is there a way to take a 2400 page law and offer an easy, simple explanation of  Obamacare, a complex law that affects ALL citizens, not just those who are currently insured? Will health insurance rates rise? Can I lock in today’s low health insurance rates?

  • Who is included in Obama-care?
  • Will I be allowed to keep my current plan?
  • Can I keep my current doctor?
  • How much will health insurance cost under Obamacare?
  • How much will Obamacare cut from Medicare? Will I have to pay more?

All great questions and typical of inquiries I get on a daily basis. Let’s start with a simple explanation of Obamacare, if that is even possible.


Obamacare Explained Simply

In the most basic terms, Obama-care requires everyone to have health insurance. Not only must you have a health insurance plan, but it must meet certain standards of coverage and affordability (as defined by the government). If you are not covered under a government plan such as Medicare or Medicaid, and do not have health insurance provided by your employer, you must purchase health insurance from an insurance company.


Who is Included In Obamacare?

Virtually everyone who is a citizen or is in this country legally must have an approved health insurance policy.


Will I be Allowed to Keep my Current Health Insurance Plan?

Probably not.

A simple explanation of Obamacare rules for plan design and “affordability” means everyone will eventually lose their current health insurance policy and replace it with an Obama-care approved plan.

You can forget “If you like the plan you have you can keep it.”


Can I Keep my Current Doctor?

Maybe, but not likely.

Patients with Medicare and Medicaid currently have difficulty in finding doctors willing to take on new patients. It is not unusual to wait 3 months or longer to get an appointment if you are a new patient. The same is true if you have a health insurance plan and go on Medicare, Medicare or have an “exchange” purchased health insurance plan.

If your health insurance was purchased through the exchange (now called the “marketplace”), good luck finding a doctor. A simple explanation of Obamacare includes a provision that requires doctors to provide health care at no charge if you fail to pay your health insurance premium. How many doctors do you think are willing to provide free health care?


How Much Will Health Insurance Cost Under Obamacare?

A lot.

Expect premiums to double for most. If you are under age 35 your rates may easily triple.

A simple explanation of Obamacare means insurance carriers are now required to issue coverage to anyone regardless of health. That means two people age 35, one is athletic trim while the other is 200 pounds overweight and takes 6 different medications, pay the same premium.

Rates will go up next year. But you can lock in today’s low rates and never have an increase in premiums until 2015. Click now to compare plans and rates for over 100 plans. 


How Much Will Obamacare Cut From Medicare?

A simple explanation of Obamacare is this. President Obama has directed Congress to reduce funding for Medicare by more than $700 billion dollars between now and 2020. If you are on a Medicare Advantage plan your premiums, copay’s, deductibles and out of pocket costs will go up.

If you have original Medicare and a Medicare supplement plan your premiums, deductibles and copay’s will increase. Georgia Medicare Plans offers free, no obligation quotes for over 40 different Medigap plans at this site. We showed one Georgia couple  how to save over $1700 in Medigap premiums by making a simple change in coverage.

How much can you save?

Is there a simple explanation of Obamacare? In a word, no. This far-reaching law affects everyone and very few people will be pleased.



Wanting More for Less

 From the land of "Duh!" comes this report from the folks at Kaiser Health News.

A survey of ages 18 – 64 with employer paid health insurance found that
  • 60% were unwilling to pay more for brand name drugs
  • 61% were not willing to opt for a higher deductible, even if it meant saving premium dollars
  • 65% would not accept a more restrictive list of docs and hospitals


Well duh!
But a surprising (to me at least) 68% said they would be willing to participate in a wellness program.
I wonder if it is like those New Year resolutions that are well intended but somehow fall by the wayside in a few weeks. Gym rats hate January and February because of overcrowding, but by March things are back to normal.
Kind of like the Easter-Christmas church goers.

The poll found two-thirds of Americans are positive about one new government action on health care: the new rule that requires insurers to cover the full cost of birth control and other preventive health services for women. Not surprisingly, support is strongest among those of child-bearing age, while seniors are split about the plan.

Well of course.
Anything that is free is good, right?

Another Obamacare Lie

HHS official: Employers may gradually move to exchanges



By Jason Millman – 03/29/11 11:42 AM ET

Big companies may eventually look to dump their employees onto new state-run health insurance markets in the future if a key aspect of healthcare reform turns out to be successful, an Obama administration health official predicted Tuesday morning. 

Starting in 2014, millions of individuals are expected to purchase insurance through new state health insurance exchanges, which are supposed to offer more affordable and quality coverage. But comments from some large employers have sparked fears that major corporations will eliminate health insurance when the exchanges open, adding an unanticipated burden of millions more onto the new markets. 

Firms with 50 or more employees face penalties in 2014 if they don’t offer minimum essential health coverage to their employees, but many think that the penalties will be cheaper than actually offering health coverage. 

“Congress estimated that as many as four million people would move from employer-provided care to the exchanges,” the HR Policy Association wrote to state governors on Monday. “We believe, however, Congress may have significantly underestimated the shift to exchange-based care that will result from the new law.”

Joel Ario, who oversees the exchanges for the Department of Health and Human Services, said fears about the blow to the employer-sponsored health system have been overstated. In the interest of remaining competitive, major employers won’t drop their health insurance right away, Ario said.

“They’ll continue to provide it, and we may wind up with an employer-based system for a long time because exchanges may not develop,” Ario said.

However, if the exchanges prove to be a source for better and cheaper coverage, then employers will be incentivized to scrap their health plans.

“If it plays out the exchanges work pretty well, then the employer can say ‘This is a great thing. I can now dump my people into the exchange and it would be good for them, good for me,' ” Ario continued.



So much for, if you like the plan you have you can keep it . . .

Employer Health Survey

Must I answer my employer's questions about my health?


Q. I have to fill out a questionnaire for my company’s new wellness program. Do I have to disclose my depression and slightly high cholesterol levels? I don't want to jeopardize my coverage or be forced to take drugs.

A. Yes, you do need to tell the truth when filling out this questionnaire, which is part of a wellness program designed to save you, and your employer, money on health care. But participation is optional. Your decision depends on whether you want to take advantage of the potential savings, which are currently up to 20 percent off your insurance premiums and will rise to up to 50 percent starting in 2014, or whether you’re too worried by the possible restrictions that joining might entail.


To help make that decision, ask your employer what kind of program it has in mind. A “pay-to-participate” approach simply offers an incentive to, for example, attend a quit-smoking or weight-loss class. What seems to have you rightly worried, though, is the “results-based” approach, which rewards you for actually meetingspecific health goals—for example, attaining a certain body mass index or, you guessed it, cholesterol level.


Even if it’s a results-based program, by law the company must offer alternative benchmarks to employees for whom it’s “unreasonably difficult or medically inadvisable” to meet the standard. Most doctors look at aperson’s overall risk of heart attack when prescribing cholesterol medications, which are taken for extended periods of time, may be less effective in women, and do have side effects.

Two final points. Your worry that your mental-health condition will somehow result in loss of coverage is understandable, given the myriad ways Americans can stumble into the ranks of the uninsured these days. But it’s against federal law for your group-health plan to drop you or raise your premiums because of your current health status. And the personally identifiable information you provide can be seen only by the staff who administer the wellness program. That might include an outside contractor as well as designated company employees; you have every right to ask.

—Nancy Metcalf, senior program editor


Obamacare is Good News for High Wage Earners

If you earn a better than average wage, Obamacrap might be your key to job security. But if you earn less than the average bear you might want to retrain for a better job.

One of the hidden traps in Obamacrap and the mandate to buy health insurance is a built in incentive for employers to not only keep total employment below 50 lives, but to jettison low wage earners.

Others will pay the $2,000 fine rather than continue to provide health insurance benefits. Doing so will save them a bunch of bucks.

Experts expect the cost of family insurance provided under a group health insurance plan to be in the $20,000 range by 2014. If that happens, and some plans are already in range already, the employee contribution cap built in to Obamacrap is bad news for low wage earners.

The folks at Employee Benefit News found this nugget.

assume that an employee, Bob, is married with a family and is the sole wage earner. If Bob makes $125,000 per year, his employer, Acme Enterprises, may charge him 8% of $125,000, or $10,000, for his share of the premium. This means that Acme and Bob will each pay half. And Acme will pay a manageable (and historically reasonable) 8% of Bob's salary toward his insurance.

Conversely, Bob's co-worker Clara is also married with a family and is the sole wage earner, but only makes $25,000 a year. Acme may only ask for a $2,000 contribution toward her $20,000 premium and would be compelled to pay the $18,000 balance.

So Acme will pay nearly twice as much for Clara's coverage as it will for Bob's. And instead of health insurance costing Acme 8% of Bob's pay, it would be 72% of Clara's pay.

Good news for Bob.

Bad news for Clara.

In attempting to mandate how much an employee can pay for health coverage and tying the test of affordability to a person's household income, PPACA creates a new, insidious discriminatory intent against lower paid individuals.

Furthermore, raising the question of annual household income unnecessarily invades an individual's privacy by compelling employers to make someone's annual tax return part of their benefits administration.


Change you can believe in.


Obamacare Impact on Business Group Health Insurance in Georgia

Rob Johnson of WGST asked me during an interview how Obamacare had impacted Georgia business and their group health plans. My response was the impact is minimal  . . . so far. The big change will come in 2014 but Obamacrap has had some effect on group health insurance premiums.

Two provisions of Obamacrap that have already affected Georgia employer health plan rates are the "free" annual wellness exams and requiring most employers to cover dependent children up to age 26.

The second provision is quite odd to me since I did not consider myself a child at age 26 and still don't. If you had not moved out of the house when you finished school we had a break-the-plate celebration.

The idea is, if your dinner plate was broken you would find somewhere else to live and eat.

None the less, while the expansion of the definition of a child had an impact on rates, so far it has been minimal. I expect that might change over the next year as parents add on children that have expensive medical problems while the healthy children are left to fend for themselves.

If this happens, watch for dependent rates to rise as a reflection of the increased risk of high claims.

Most employer group health insurance plans in Georgia already had low cost, and in some cases, free annual exams any way. So the removal of a nominal copay of perhaps $30 and substituting "free" has not had an effect on premiums and probably won't.

From a risk standpoint, it is doubtful if more people will seek to have their annual exam simply because it is free. This is especially true for males who would rather take a beating than go to the doctor, especially if they are not sick.

The bigger impact on business health insurance premiums will come in 2014 when all employers with 50 or more employees will be subject to "play or pay" rules.

While yesterday's court ruling did not specifically address the employer mandate it stands to reason that this was an oversight, perhaps by those who brought the suit, to address the requirement that businesses must provide health insurance or pay a fine (tax).

I am not a Constitutional lawyer, and apparently neither is Obama or members of Congress,  but it would appear to me that if the INDIVIDUAL mandate (requiring individuals to buy health insurance or pay a tax) is unconstitutional, then the same should apply to the EMPLOYER mandate.

Starting in 2014 if individuals do not buy health insurance they are fined.

Starting in 2014 if employers (with 50+ employees) do not buy health insurance for their employees they are fined.

What is the difference?

To my untrained eye, nothing.

I want to thank Rob Johnson and the folks at AM 650 WGST in Atlanta for inviting me on their show. You can hear a portion of the show including the interview with Bob Vineyard of Georgia Insurance Shop as well as some real legal scholars by clicking on the link in my name and wait for the audio to begin.

Obamacare – Another One Bites The Dust

Obamacare has led to one more health insurance company withdrawing from the market. This means less competition, fewer choices, higher rates. Aetna is pulling out of the Colorado market as of 2/1/2011. They will no longer offer health insurance for individuals, families or self employed in Colorado.

Aetna decided to withdraw from the small group health insurance market in Colorado last October (2010), so this is a natural progression.

Existing major medical policyholders will be offered one 12 month renewal before their coverage with Aetna terminates.

Aetna is still under a cloud imposed by CMS (Center for Medicare Services) and is enjoined from offering Medicare Advantage plans anywhere in the United States. This sanction has lasted for a year with no indication it will be lifted any time soon.

As for now, Aetna has not indicated they will withdraw from the individual major medical market or small group market in any other states, including Georgia. Given their relatively small market share we would not be surprised in seeing them systematically withdraw from other states over the next few months.

If you live in GA, and have Aetna coverage for individual major medical or small group coverage, now might be a good time to consider making a change.

Employer group health plans can move at any time without loss of coverage.

Individuals in GA are not as lucky. Only those who can pass underwriting will be able to move to a new health insurance company. Do not drop your Aetna coverage until you have secured new coverage from a new health insurance company. Do not make application with a new health insurance company until you have had your medical conditions pre-screened by a competent Georgia health insurance agent.

Georgia Insurance Shop represents all the major health insurance companies in GA and will be glad to review your current coverage, offer side by side comparisons, and assist in finding the most affordable health insurance plan available to you.


Obamacare Puts the Squeeze on Health Insurance

The Spectator informs us that HHS has finally spoken with regard to the MLR (medical loss ratio) guidelines for health insurance companies. The MLR dictates how much of every premium dollar health insurance companies must spend on claims.

On the surface this may sound nice but in practicality it is smoke and mirrors.

When you consider that health insurance is marketed in (at least for now) a free market where carriers are free to set prices for their product, it would seem foolish for a carrier to arbitrarily attempt to mark their product up more than their competitors. But the folks in DC and the media would have you believe just that.

The decreed loss ratio's are 80% for individual major medical and 85% for group health plans. But this comes with a hidden price.

These requirements were at the root of the controversy that arose in September over McDonald's having to drop 30,000 workers from its health plans. Eventually, they were granted a waiver from the requirements. But a lot of businesses won't receive a waiver, meaning that insurers will have to stop offering some policies, and many of them will decide to exit the individual market entirely, due to the nature of the way the financing works. This will translate into less choice and competition, and is another way that the law will lead to people losing coverage they may like.

As the article points out, not everyone got a waiver. So many who currently have health insurance will lose that benefit.

If you like the plan you have you can keep it . . . . but only if  HHS grants it a special waiver.

If the carriers fall short of those payout's they have to cut refund checks.  HHS estimates the refunds will total about $1.4 billion or about $164 per insured.

Think about this for a moment.

Each carrier will have to incur ADDITIONAL costs to comply with this stupid rule in order to calculate IF they owe a refund. Once they complete that task they will have to track down anyone who has been covered by their company, calculate their pro-rata share of the refund, and cut them a check.

If you are a business that get's a refund after you have filed your tax return that means adjusting your return to reflect the lower outlay you had for health insurance. More costs and hidden taxes associated with Obamacrap.

And then there is this little goody.

Also, it's no accident that the requirements were set at 85 percent and 80 percent. Last December, the Congressional Budget Office issued a memo saying that if the requirements were set any higher than that, health insurers would have to be considered part of the federal budget — driving up the cost estimate of ObamaCare. As the CBO put it, referencing proposals for even more stringent requirements, "this further expansion of the federal government's role in the health insurance market would make such insurance an essentially governmental program, so that all payments related to health insurance policies should be recorded as cash flows in the federal budget." At the time, the Cato Institute's Michael Cannon pointed to the memo as a "smoking gun," revealing that Democrats had deliberately hidden the true cost of ObamaCare by making sure the CBO wouldn't factor in the cost of the private sector mandates imposed by the legislation.

Well isn't that interesting?

The MLR thing is a heated battle that will result in fewer health insurance companies offering fewer choices and higher rates overall. Somehow that doesn't match up with what was promised.

AFFORDABLE Health Insurance in Georgia

Georgia Insurance Shop still has affordable health insurance plans for individuals and families in Georgia. We also have HSA's and HRA's for small businesses and self employed looking to save money on group health insurance. All the major health insurance companies are represented, including Blue Cross, Humana, Cigna, Aetna and more.

The Rest of the Story . . .

Bloomberg is reporting that a non-profit cooperative to "help small businesses in South Carolina find affordable health insurance for their workers."


If they expect to operate as a MEWA (Multi Employer Welfare Association) good luck. Most of those have either been declared illegal or have gone out of business, often due to shady business practices.

Perhaps all they will do is operate as a "super" broker. Getting something like this off the ground is challenging and more often than not, unproductive. Trying to negotiate favorable rates with a carrier on a rag tag group of businesses covering a wide range of industries is virtually impossible.

PEO's (Professional Employer Organization) have mostly failed when it comes to establishing favorable offerings of group health insurance.

And there is this . . .

Unless Obamacrap is unwound, gutted or outright repealed, all these efforts become moot in 2014.

I fail to see how this is news or what they will accomplish.

Group Health Insurance in Georgia

Georgia Insurance Shop helps small businesses and self employed business owners find affordable group health insurance plans for themselves and their families.