Feds: Repeal, States: Replace


Avik Roy wrote an excellent piece in Forbes taking on the issue of guaranteed issue head on:

Thanks To Democrats, Pre-Existing Conditions Outweigh The Uninsured In The GOP Obamacare Deal

Should we continue letting the “ludicrously dishonest” (well stated Avik Roy) presumptions of the ACA shape the future of our healthcare delivery system?

I think not.

Prior to the ACA, 6 states (Maine, Massachusetts, New Jersey, New York, Vermont and Washington) required guaranteed issue individual plans. In 2010 these states had some of the highest individual insurance rates in the country:

KFF 2010 Average Individual Premium Per Person

There were another 35 states that offered guaranteed issue high risk pools:  

High-Risk Pools For Uninsurable Individuals

That means 41 states already had access to guaranteed issue individual health insurance plans prior to the ACA. 

Here’s another point… around my part of the country (KS / MO) the guaranteed issue plans available prior to the ACA were less expensive than the non-subsidized 2017 individual plans! 

ACA proponents are quick to point out that there are more people insured now than prior to the ACA. What they fail to mention is that most of those gains are from new Medicaid enrollments (15 million) vs. state or federal Marketplaces (11 million):

Key Facts about the Uninsured Population

Since I don’t just want to be the one pointing out problems without offering a solution, here are my recommendations for an ACA replacement plan:

  • Repeal the ACA… All of it
  • Individual mandates and employer mandates would be gone (no more 1095-C forms… would anyone be disappointed?)
  • All individual health insurance premiums should be tax deductible just like employer group plans are tax deductible
  • Employers should be able to contribute to individual health insurance premiums or group health insurance premiums pre-tax so employees can choose to keep their individual plans if they prefer
  • States should decide if they want dependents covered through age 26
  • States should decide if they want to require all individual plans to be guaranteed issue
  • States that don’t require guaranteed issue should be required to have a high risk pool

Since government programs are the nearest thing to eternal life we’ll ever see on earth (Reagan / Byrnes), I am assuming subsidies are here to stay.

  • These high risk pools would be partially subsidized by states and the federal government to help make them affordable
  • Low income people would receive reduced tax credits / subsidies to purchase whichever health plans they want (no minimum essential coverage / minimum value requirements)

Keep in mind, the subsidies could be reduced (if not eliminated) for a lot of people when the cost of insurance goes back down to pre-ACA rates.

  • States should decide if they want Medicaid expansion (and be willing to pay for it themselves)
  • Include tort reform legislation limiting frivolous lawsuits and capping malpractice settlements
  • Include Price Transparency legislation letting patients know up front what tests and procedures will cost

And since health insurance does not equal health care, there needs to be fundamental changes to physician access:

  • Direct Primary Care’s (DPC) monthly membership fees should be allowed as an eligible HSA / FSA / HRA expense (are you surprised I made it this far before mentioning HSA?)
  • States should be given block grants to explore more effective health care delivery systems (i.e. HSA & DPC) for Medicaid, Medicare, and VA

Allowing healthy Americans to purchase underwritten health insurance plans at substantially lower rates has been called discrimination by some. That is true. Insurance companies discriminate.

What would happen to auto insurance rates if everyone paid the same regardless of driving records or previous accidents? Most would pay substantially higher, some would pay less.

What would happen to life insurance rates if everyone paid the same regardless of weight / tobacco use / health issues? Most would pay more, some would pay less.

Providing access to high risk individual insurance plans for the few that need it while allowing healthy individuals to purchase lower cost underwritten plans would make individual health insurance affordable again.


ObamaCare Calculators



Yes, the Affordable Care Act (ObamaCare) is upon us. As of now (August 2013) there are still way more questions than answers.

Should I keep my existing plan or get a new EXCHANGE plan?

Should employees & their dependents remain on employer group plan or get their own individual policy?

Will I qualify for a subsidy?

We have assembled several calculators available today that can help make preparing for 2014 much easier.

Although the employer mandate has been postponed until 2015, the individual mandate still applies.  Anyone not covered by Minimum Essential Coverage next year could be subject to a penalty tax of the greater of $95 per uninsured or 1% of household over the filing threshold:


All new health insurance plans will be guaranteed issue and required to include essential health benefits which will greatly increase premiums.  The Public Exchanges (both state and federal) are to be open in October.  People making less than 400% of poverty level could be eligible for subsidized health insurance plans if they are purchased on the State / Federal Exchanges. It is estimated that 26 million should be eligible for these subsidies, however only 6 million are estimated to enroll in 2014. Here is a calculator to see if you would be eligible for a subsidy:


Small businesses with less than 25 employees that earn less than $50,000 average annual salary and pay at least 50% of their health insurance premiums could also qualify for a small business tax credit.  For 2014 the tax credit is only available if the plan is purchased through the Small Business Health Options Program (SHOP) Marketplace:


Don’t wait until it’s too late.  If you are relatively healthy, you could save money by applying now BEFORE all plans are guaranteed issue and are weighed down with expensive government mandated benefits next year.


Or you can call an independent health insurance agent at 913-432-2732.

Although the employer mandate has been delayed 12 months, businesses are still concerned about how to minimize (or eliminate) their exposure in 2015. This calculator helps calculate how many full time equivalent (FTE) employees you have and what your potential penalty might be if/when the employer mandate is reinstated:


And finally, for those of you with seven minutes to spare, here are the YouToons simplifying ObamaCare:

  • HSA Contribution Calculator