The consumers that receive the refunds under Patient Protection and Affordable Care Act regulations include both businesses and individual consumers. However, employers which receive refunds are under no obligation to pass these funds onto their employees. Below you will find a breakdown of which groups stand to gain the greatest refunds from their health insurance companies.

• Large Employers: 7.2 million people ($541 million averaging $72.13 each)
• Small Employers: 5 million people ($377 million averaging $75.40 each)
• Individual Policyholders: 3.4 million people ($426 million averaging $125 each)

Please note that the above figures are rounded as final statistics were unavailable at the time of this post. Large employers, which are self insured, are exempt from the health insurance spending requirements contained in the PPACA. Health insurance companies which serve the largest employers are required by law to spend 85% of their collected premiums on payments for medical claims.

Tentative figures for major health insurer refund liabilities under the Patient Protection and Affordable Care Act are below.

• UnitedHealth: $307 million
• Aetna: $177 million
• WellPoint: $94 million
• Coventry: $50 million

Although the major health insurance companies listed above are responsible for nearly half of the total $1.3 billion industry-wide refunds, smaller health insurance companies are responsible for the remaining refunds.

While provisions of the PPACA are intended to protect consumers, it is important to note that seventeen states applied for waivers from the 80% minimum medical care reimbursement spending requirements. Of the applicants, only seven states received Federal approval.

In early summer the final statistics regarding the health insurance refunds will be produced by the Federal Government. However, initial statistics indicate consumers will benefit from such health insurance spending requirements. These consumers include many businesses and especially the individual or private policyholders which pay for their health insurance premiums without the support of an employer.

Keep in mind that these anticipated refunds could potentially be invalidated by the United States Supreme Court in its decision regarding the constitutionality of the Patient Protection and Affordable Care Act. If this were to happen, these refunds would not got to businesses and individuals, but instead add more cushion to an already significant profit margin enjoyed by many health insurance companies.

Opponents of the Affordable Care Act are focusing much of their attention on the individual mandate. They are of the opinion that the government can’t compel you to purchase any product or service. Additionally, these opponents to health care reform also claim that allowing this law to go into effect would set a dangerous precedent for future laws to infringe on the rights of Americans. There are many comparisons being tossed about in the media that compare forced participation in a national health insurance program to the government forcing people to eat broccoli, peanuts and even macadamia nuts. Surely, some people involved in this debate are not forced to eat nuts but rather listen to the nuts babble.

Is the individual mandate in the Patient Protection and Affordable Care Act constitutional? Can our government force us to buy health insurance? These are the questions the Supreme Court will be called upon to answer. But there’s one problem. We already are forced to buy health insurance. Even though government does not call it “health insurance,” Medicare is not a voluntary health care program. If you work, you must pay into it whether you are an employee, small business owner or corporate executive.

In all of the chatter about the individual mandate, not one single professor or attorney has yet to compare this individual mandate to the funding requirement of Medicare. Granted, you do not have to pay into Medicare. The way to avoid Medicare payments is to not work. Since there is no real “free ride” in the United States, just about everyone has to work at one point or another in their life. Therefore, it is quite reasonable to assume that there is no way that people can avoid making mandatory Medicare payments.

Should the opponents of health care reform be successful in their efforts to deem the Patient Protection and Affordable Care Act unconstitutional, on the grounds of the individual mandate requirement, I personally would like to see the opt-out form for Medicare made available to all. Since the United States already uses an individual mandate for Medicare, arguing that the government has no authority to require people to buy something is moot. Medicare is funded solely by an individual mandate that requires working men, women and children to fund this national health care program for senior citizens.

First, it is important to note that polling often includes certain “qualifiers” which are used to determine an individual’s answer to a specific question before it is even asked.  Besides simply polling “friendly” groups of individuals, which are likely to respond according to ones pre-determined wishes, such qualifiers can easily be used to distort polls.  Unfortunately, biased polling happens all the time and can’t really be trusted.

According to Fox News, 74% of all polled businesses believe that the Patient Protection and Affordable Care Act is preventing the creation of jobs.  While any new expense is likely to have some impact on job creation, a lack of consumers for the products and services these businesses offer is the primary reason why job creation has stalled.  With nearly 25% of the United States citizenry lacking health insurance, many households will unfortunately feel the financial impact of coping with paying full price for medical care services.  Need your tonsils removed and lack health insurance?  No problem, just place the $8,000.00 charge on your credit care and pay on it each month.

Considering that many of the uninsured also lack employment, an $8,000.00 tonsillectomy surgery would leave a person just $6,000.00 to live off of if they received the national weekly unemployment check average of $270.00 per week.  These are the financial realities that many families are coping with each and every day.

Instead of producing lopsided polls, Fox News and the U.S. Chamber of Commerce need to realize that the nation’s health must come before profits.  The health of the working class directly impacts productivity.  In addition to worker productivity, many individuals and families are paying for short term health insurance coverage which depletes their finances and their ability to spend on other consumables.

Although a small percentage of businesses will be required to pay more for not helping their employees maintain an acceptable level of health insurance coverage, the fact remains that 25% of the population lacks health insurance coverage.  Since 2001 there has been a steady decline in the number of insured people, and this is a real trend that should not be distorted by either politics or biased polling.  By continuing to ignore the citizenry’s access to even the most basic health care, we risk a rapid increase in the number of those which are disabled and permanently harmed from having no affordable access to medical treatment.

Reference:

Fox News: Poll Shows Most Small Businesses Fear Health Care Law

U.S. Chamber of Commerce: Health Care & Jobs Agenda

The purpose of the medical research fee is designed to provide funding for the collection of data in regards to the effectiveness of prescription drugs, diagnostic testing, medical treatments and procedures. This information will be collected by the Patient-Centered Outcomes Research Institute, which is an independent organization with the stated purpose of helping people make informed decisions regarding their health. Improved health care delivery and effective treatment options are a component of the Patient-Centered Outcomes Research Institute’s overall mission.

Although some view this medical research fee as a tax, it does have the potential to collect and analyze important medical data. However, serious questions do remain for those that are skeptical of any organization that has not ensured the public of its objectivity and by providing transparency to bring credibility to their findings. Just like the FDA, there will be a significant amount of outside influence from the health care industry to shift findings to a more profitable outcome for the medical companies which they represent.

How much does the Federal medical research fee cost?

Starting in 2012, those with health insurance policies will see a $1 fee added to their premiums. Although these funds are to be collected in 2012, the Federal Government will not likely receive payment from the health insurance companies until 2013. In 2013, this fee increases to $2 per person and will be inflation adjusted in years 2014 and beyond.

Even though the Patient-Centered Outcomes Research Institute is not a decision making body, its findings may be used in the future to determine which prescription drugs, diagnostic tests and treatments will be covered under health insurance plans. Because of this, it is critical that the purpose of this medical research and the findings derived from it are not corrupted by outside influences.

Reference:

Patient-Centered Outcomes Research Institute

The Federal Patient Protection and Affordable Care Act requires that all states adopt and operate health insurance exchanges. These exchanges are intended to be utilized by individuals that are not able to obtain health insurance through their employer, Medicare and other sources. Small businesses are also eligible to participate in the exchange so that they too can obtain affordable medical coverage for their employees.

Those in charge of running the health insurance exchange, and implementing its policies, are appointed health exchange board members. These board members are typically appointed by Governors and are supposed to be comprised of a majority of members that represent the best interests of consumers. But in Connecticut, a large portion of their health insurance exchange board has strong ties to the insurance industry.

Three appointed members of the health insurance exchange board in Connecticut have held high level positions with Aetna, ConnectiCare, Anthem and one member is the active chairman of Patient Care, an organization that helps businesses with their health insurance policies. One must ask why Governor Dannel Malloy felt compelled to appoint insurance representatives to a board designed to offer small business and individuals an opportunity to purchase health insurance in a competitive marketplace.

Certain small businesses in Connecticut fear that the loaded health insurance exchange board in their state will not represent the best interests of its people, but rather steer profits towards those that they have or are presently working for. These small business owners have very legitimate concerns, which have yet to be addressed by Governor Malloy.

What has happened in Connecticut should be a wakeup call for all Americans and small business owners that are hopeful the Patient Protection and Affordable Care Act will enable them to seek affordable medical care. The loaded health insurance exchange board in Connecticut also illustrates how a law intended to help people is potentially being corrupted by those with extremely close ties to the health insurance industry.

Reference:

Connecticut Office of Health Reform & Innovation
Connecticut Governor Dannel Malloy

A number of people are reporting that their medical providers are hitting them with “facility fees” that are not covered by health insurance policies. The facility fee bonanza has exploded in some regions of the country and is especially prevalent in the City of Cleveland, Ohio. A number of individuals in the Cleveland area have complained that these facility fees are costing patients $65 an office visit and even more.

One patient, which received a cortisone injection in his thumb, paid $453.00 for this medical service at a MetroHealth satellite medical office. Approximately eight months later, this same patient had another injection in the opposite thumb at MetroHealth Medical Center and was billed $1007.00. The difference in cost totals $554.00. Please note that this patient had the identical procedures performed by the same physician. The only difference was that the higher billing occurred at MetroHealth’s headquarters, but both procedures were billed by MetroHealth directly. Being a proactive consumer, this individual contacted MetroHealth to find out what was going on. MetroHealth’s customer service representative noted that MetroHealth Medical Center’s billing was higher because it is a registered hospital facility and is regulated by the government, which the satellite office is not a hospital and can bill at a lower rate.

MetroHealth is not the only large medical provider in the Cleveland area taking advantage of these add-on fees. Cleveland Clinic recently opened their Twinsburg satellite office and other regional offices are also in the making. A patient which had recently visited her doctor at the Cleveland Clinic Twinsburg facility was shocked to see that she was billed an extra $65 “facility fee” in addition to the ordinary office visit fee. Since this woman is on a fixed income, the additional facility fee she was billed is even more difficult to absorb.

Since facility fees are not covered under health insurance, patients are left to fend for themselves and are financially obligated to pay these fees. These facility fees subvert the negotiating arm of health insurance companies and are ripe for abuse. Unknowing patients, who still to this day have extremely limited access to a service and fee schedule from medical care providers to compare prices, are unaware of these facility fees until they receive their medical bill statements in the mail.

Health care reform is desperately needed as the patients described above would surely attest to. Empowering consumers with an up-front pricing schedule would allow them to have far greater control over the expenses associated with their own personal health care. But with a national health care system that is intent on avoiding any public scrutiny, it is clear that large health care providers will continue to bill for anything they can in the absence of any laws which empower patients with something as simple as the ability to price shop for the medical services they need.

Fox Business, which still falls under the Fox News umbrella, noted that regions which have a higher percentage of uninsured residents typically have a harder time gaining access to care. Does Fox Business lack even the most basic fundamentals of operating in the black? If people can’t pay for their medical care in a community, how can any medical practice survive? It can’t. The basic principles of operating in profit still apply in the health care industry, even though Fox does not appear to quite understand that principal yet.

Because over 17% of the adult population in the United States lacks health insurance, somebody has to pick up the bill for their medical care. This has been happening for many years, but the problem these days is that the large number of uninsured citizens is growing at an alarming rate. Should doctors charge health insurance companies more to compensate for those they provide care to that have no health insurance? Or, should doctors simply relocate to regions that have a population that can afford their services? In a free market, everything is on the table and few doctors are going to work for free.

What many people fail to acknowledge, including major media outlets, is that the entire population of the United States has been subsidizing medical care for the uninsured and those subsidies are rising every year. Since hospitals typically do not refuse emergency room care to patients, the ER becomes an urgent care facility that treats minor conditions including colds, sprains and other conditions that would be more cost effectively treated in a doctor’s office. When these patients bill up thousands of dollars in unnecessary medical bills, they can simply file bankruptcy and all the bills are washed away. Who pays for this? Everyone. Doctor’s charge health insurance companies more for services and our monthly premiums rise because of it.

Because the entire population is already subsidizing medical care for the uninsured, indirectly, isn’t it about time we just do it directly? By subsidizing medical care directly, we can not only alleviate the inefficient use of emergency rooms but we can also end the practice of trying to sweep the uninsured under the rug. Our monthly health insurance premiums are going up for a reason, and that reason is because the insured pool is shrinking rapidly and uncompensated medical care has grown sharply.

The reality is that the employer sponsored health insurance model this country has relied on for many years is quickly fading away. The “haves,” which typically blame the “have nots,” may find out soon that they too will be forced into the “have not” class if their monthly health insurance premiums continue to double every few years. While the Patient Protection and Affordable Care Act does restrict increases in premiums charged to policyholders, the Supreme Court may toss this basic protection out the window in 2012. Instead of pointing fingers at each other, just like members of Congress, it is time that everyone works together to solve the medical care problems which we are all paying for.

While the problem of childhood obesity is clearly an important national health concern, just as it is for adults, I am personally against limiting the choices which are available to individuals. When it comes to our health care, government does have a significant role to play but that role should not extend into the micro-management of our daily lives. However, not everyone agrees with this opinion and has taken the issue of school cafeteria food options to an entirely new level. Now, according to some groups, what your child can eat at school is a matter of national security.

A group named Mission: Readiness, a non-profit organization comprised of retired senior level military officials, has declared that childhood obesity is a matter of national security and that America’s children should not be permitted the option of eating pizza or french fries at school. While I applaud their efforts to bring greater awareness to treating childhood obesity, the fact that they tied this medical condition to national security is irresponsible in my opinion. Such loose use of the term national security, and imposing the will of the few on our entire nation, is an attempted overreach by the military. The United States was founded on the freedom to choose and speak, and any military involvement in our personal lives is likened to dictatorships that impose the military rule of law on its citizens.

Obesity is a major medical problem for Americans, but limiting what they may choose to eat is not the solution to the problem. Solving America’s obesity problem begins in the kitchen of every home, and is a more complex problem to correct then most realize. For one, healthier foods cost more than fast food. Those households that are struggling to make ends meet, because of being unemployed or underemployed, lack the financial means to eat healthy. Then there is the matter of time.  Parents work hard to care and provide for their families and must work even harder to keep up with health insurance premium and college education increases that grow two or three times the rate of their own salaries.

The way to deal with childhood obesity is to allow parents the opportunity to put healthy food on the table, whether by an improved economy conducive to better household finances or by reducing the financial need for both parents to work. After a long day at work, it is difficult for any parent to spend an hour in the kitchen cooking a healthy meal. For these parents, that already have their time and finances stretched, they often choose a happy meal over something healthy.

The health care needs of America’s youth are very important, but micro-managing their every meal is wrong. A better solution to address obesity, on an individual level, is to increase their health insurance premiums to better reflect the actual risk factors of each person. This would place the responsibility for one’s health clearly on each individual’s own shoulders. Instead of worrying if our children should be permitted to eat pizza at school, politicians need to focus on the economy so that parents can care and provide for the needs of their families as they see fit.

In total, twenty six states are challenging the constitutionality of the Affordable Care Act and its provision that requires all Americans obtain health insurance. Their argument is that the government cannot force people to purchase any product or service. Regardless of the legality of that particular mandate, chances are the Affordable Care Act would still remain law even if the Supreme Court rules the government cannot force people to buy insurance.

At the present time, over fourteen million Americans lack health insurance coverage. 17.5% of the nation’s uninsured are adults and most are hopeful that the Affordable Care Act will allow them to seek the medical care they have been avoiding because of a lack of health insurance. These adults, many of which have children, need to maintain their health so that they can be productive citizens and parents.

As one would suspect, the different media outlets are using the Supreme Court’s announcement to further their own political agendas. While places like MSNBC are highlighting this as an opportunity for the Supreme Court to validate the health care reform law, other networks like Fox News are saying that the end of “Obamacare” is soon at hand. Meanwhile, the millions of people without health insurance simply want reform that allows them to get medical care without having to file bankruptcy afterwards.

2012 will be the year that the United States Supreme Court wields its judicial authority in such a way that will impact every American’s life and health. The importance of the Supreme Court hearing this case cannot be overstated. Especially with fewer employers offering health insurance to their employees, and the millions of people that can’t find a job or afford private health insurance, the Supreme Court’s ultimate decision on the constitutionality of the Patient Protection and Affordable Care Act will impact our nation’s financial obligations and the wellness of its citizens for many generations well into the future.

Currently, 44.5% of employees have the financial protection of an employer sponsored health insurance policy. Since 2008, the rate of coverage has dropped by 5.3%. As one would suspect, this rapid reduction in employer sponsored health insurance coverage has been attributed to the poor economy. Many employers have shifted large premium increases onto employees, reduced coverage options and have discontinued offering health insurance altogether.

As is indicated by the polling, the United States of America is coping with a rapidly changing health care industry that is leaving many people uninsured. For decades, individuals and families have relied on the employer based health insurance model for coverage. Unfortunately, this pathway to health insurance coverage is quickly falling apart as many businesses struggle to keep their doors open while also coping with insurance premium increases which are nearly three times the rate of inflation.

What these health insurance trends tell us should be no surprise. Each year, millions of Americans join the ranks of the uninsured. The impact this has on our health care industry is profound. While the uninsured seek emergency care, with no financial protection, these debts typically get written down or off through negotiations and bankruptcy. Health care providers recover these losses by charging more for services, which also drives health insurance premiums higher for those with coverage. Such trends are the reason why health insurance premiums continue to increase at triple the rate of inflation and are driving more employers to drop employee health insurance coverage completely.

To address the crisis in health care, an aggressive approach to covering the uninsured must be undertaken. Doing so would stabilize the fees health care providers receive from providing services and place far less of a burden on those that presently have health insurance. However, nothing is being spoken of in Washington D.C. to accomplish this. The number of uninsured individuals is expected to climb until the Federal Patient Protection and Affordable Care Act law is fully phased in.

Reference: Employer-Based Health Insurance Continues to Trend Down