Pros and Cons
of Health Care Reform Blog

Jul 11

AMERICA’S HEALTH INSURANCE (Part 3) - THE AMERICAN HEALTH CARE ACT 2017 (AHCA)- The Winners and Losers: Medicaid/Medi-Cal

Posted by Dina Collins on Tuesday, July 11, 2017

Prior to the ACA, aka Obamacare, it was difficult in most states for those without children to get Medicaid, called Medi-Cal in California. A citizen needed at least one child and income between zero and 106% of the federal poverty level. For example, in 2013, a family of two would qualify if they earned $16,440 and under; a family of three by making $20,702 and under; a family of four earning $24,963 and under, and so on.

Post ACA, the House-approved American Health Care Act 2017 (AHCA) would increase the income level to 133% of the federal poverty level in most states regardless of how many children a taxpayer claims. So far, 32 states and the District of Columbia expanded Medicaid, including California, which extended Medi-Cal’s level to 138%. This income level would increase contingent on the number of dependents. A single person making $16,643 or less in California qualifies. A family of two, based on their tax return, would qualify if they make $22,411 and under; a family of three making $28,180 and under; a family of four at $33,948 and under, etc. Read More


Jun 10

AHCA-The Winners and Losers-Part 2-Tax Credits and Subsidies

Posted by Dina Collins on Saturday, June 10, 2017

With the proposed AHCA (aka Trumpcare)—passed by the House, but not yet the Senate—you would receive an age-and income-based fixed credit, rather than a deduction, upon filing your tax return. Someone under 30 would receive $2,000 per year; between 30 and 39, $2,500; between 40 and 49, $3,000; between 50 and 59, $3,500; and 60 and above, $4,000. The sum amount of the credit cannot exceed $14,000, a maximum that comes into play for families with children. If your Modified Adjusted Gross Income (MAGI) income is $75,000 filing singly or $150,000 if married filing jointly, then the tax credit is reduced by 10% of the excess. For example, a family of four makes $200,000. Husband and wife are in their 40’s. Looking at age alone, the total tax credit is $10,000 ($3K+$3K+$2K+$2K). However, because income is $50,000 over the $150,000 limit, the credit is reduced by $5,000 ($50,000 multiplied by 10%). With AHCA, this family’s credit would be $5,000. If that family’s income increases to $250,000, they would no longer receive a credit.  Read More


May 22

America's Health Insurance-Part 1-The American Health Care Act of 2017-The Winners and Losers

Posted by Dina Collins on Monday, May 22, 2017

The AHCA (aka Trumpcare) has passed the U.S. House of Representatives and is, understandably so, a hot topic. Being an insurance broker for nearly 30 years, I’d like to share my opinions on this matter that’s so vitally important to us all. This blog post is Part 1 in a series that will address the issues.

First, let me set the stage of my overall view on health care reform. I found our pre-ACA (aka Obamacare) system in severe need of repair. Although it produced winners and losers over our pre-ACA system, the ACA was drastically different than my idea for reform. Similarly, the AHCA is also a radical departure from my reform preferences, although it too will produce winners and losers over our current ACA system. But alas, no one in a position of power asked for my opinion.

Let’s start dissecting the AHCA. The winner of the ACA system over the pre-ACA system seems to be those with pre-existing conditions. Is this actually true? Possibly. First, it depends on the state where you live. Here in California, we had a major risk pool for the uninsured (MRMIP), as did many other states. It was subsidized by the state to help keep costs as low as possible. Let’s compare rates. In 2013, a Kaiser MRMIP plan for someone living in Sacramento County cost approximately $452 for a 40-year-old, $573 for a 50-year-old, and $727 for a 60-year-old. This was for a plan that offered low copays, no deductible and a $2,500 maximum out-of-pocket. However, it did have a $750,000 lifetime maximum. For similar coverage through Anthem Blue Cross in a PPO plan, the premium was about $670 for a 40-year-old, $822 for a 50-year-old and $1,246 for a 60-year-old. Now, let’s compare today’s premiums for the similar Platinum Plan ($0 deductible, but $4,000 max out of pocket). Kaiser/Anthem is $514/$708 for a 40-year-old, $718/$989 for a 50-year-old, and  $1,091/$1,504 for a 60-year-old. Looks eerily similar. But remember, we’re comparing rates for those who were declined medical coverage, so they had to go with the MRMIP plan.

Now, let’s compare premiums for those who passed their medical screenings. In 2013, Kaiser would have charged a healthy 40-year-old $451 for similar coverage; $508 for a 50-year-old and $646 for a 60-year-old. Anthem’s rates were a comparable percentage decrease. If we only consider those who couldn’t get coverage previously, who are the winners? You could argue no one wins on that issue alone. However, once we mix in the Advanced Premium Tax Credits and subsidies, we will see more winners. You may be surprised that the biggest losers are people who pass their health screenings. For those who were unable to get coverage in California and who are above 400% of the federal poverty level, it was practically a wash.   Read More


Aug 19

Was Health Insurance Reform Needed?

Posted by Dina Collins on Monday, August 19, 2013

Did our health care system need reform? Yes, but the real reforms needed to be done at the medical systems arena. When we remodel our bathroom, we get 3 bids. Do we do this same comparison shopping when facing an expensive medical procedure? For most of us, no. Even if we wanted to, we wouldn’t be able. Medical systems and insurance companies are tight lipped about what rates will be charged for various services with various insurance companies. This secrecracy in part is to help add future negotiations between hospital and medical groups and the insurance plans. In the glory days, no one much cared what the prices were.  The doctors and hospitals charged the rates and no one much complained except once a contract was up and the powers at be once again sat down at the negotiating table. Now that consumers have more teeth in the game with higher deductibles and copays, they are desiring to do more shopping. Also, the government has put the squeeze on insurance companies so they need to be the bad guy and put the squeeze on hospitals and medical groups.  This “squeeze” needed to happen but before it had real impact we threw guarantee issue coverage in the mix. If premiums are unaffordable, the healthy people, especially those without many assets, will go uninsured and only the unhealthy will sacrifice to have the insurance. This will in turn compound the issue.  Read More


Jul 18

Covered CA participating insurance companies announced

Posted by Dina Collins on Thursday, July 18, 2013

Covered CA announced in May the insurance companies participating in the individual exchange, called Covered CA. In the greater Sacramento area those four companies will be Blue Shield, Anthem Blue Cross, Kaiser and Western Health Advantage. Health Net is offered in other counties. Health Net is participating in certain counties but not Sacramento. Aetna has decided to no longer offer individual coverage in CA for new subscribers and January 2014 for current. Cigna and UnitedHealthcare have chosen not to participate at least initially. Will they prove wise or foolish? The media and government spokespersons are jubilant that the individual rates aren’t as high as some were predicting. Yes, that is good news and we can take a slight breath but the rates are still increasing by up to 25% (depending on age and county and health status). These are the numbers Covered CA released. How did they arrive at the numbers? Are they a fair representation? We won’t know until we can begin quoting October 1st. Read More


Jul 18

Pre-existing Conditions and Health Insurance Reform

Posted by Dina Collins on Thursday, July 18, 2013

Over the years, I had the great displeasure of having to inform clients that their health insurance application was denied. Their only option at that point was to apply for coverage through the Major Risk Medical Insurance Bureau which was super expensive for limited coverage. In 2014, coverage will be guarantee issue for everyone. Not only will it be guarantee issue, the premiums will be the same for those with pre-exisitng conditions as it is for those without. This means there will be no need for insurance companies to have medical questions on their applications. This is a huge sigh of relief for many people. Even if you don’t have pre-exisitng conditions, you will benefit by not having to answer pages of medical questions during the application completing process. Just the other day, a client came in and decided on a health plan for her and her family. She decided to apply online right there in my office. About two hours later, that application was complete. Now granted we ran into a few technology hiccups but still, that is a long time to complete an application. She and her family were very healthy, it would have taken even longer for those with a lot of pre-exisiting conditions. How will the rates vary? By your age but only with a 3 to 1 rating and based on the county you live in. Read More