I've spent a lot of time trying to understand the consequences of the healthcare reform.

I feel very strongly that it is terrible legislation.

The first thing I will ask when I vote this November is if my representative would vote to repeal it.

Just horrible legislation.

John,

What is so horrible about the legislation?  Please be specific. 

On the positive side, the legislation: (1) enables 20-30 million people to have health insurance for the first time; (2) contributes to balancing the budget in the long term; and (3) does this things without a "big government takeover."

With regard to point number three, the new legislation does not create a new, government run medical care program like Medicare.  Rather, it provides tax credits to help people purchase health insurance from private companies and it expands medicaid somewhat.  It represents an incremental shift away from the current system.  Private insurance plans will still be there.  Plans provided by employers will still be there.  Medicare will still be there.  V.A. Hospitals will still be there. 

Why is that so horrible?

just this health bill does not mess with medicare since there is so many baby boomers

Certainly the law will need to be improved upon, but overall it is an improvement over the status quo:

• No more yearly or lifetime limits

•  insurers cannot deny coverage based on  "pre-existing" conditions

• the exchange system will give insurance companies incentive to stop bad business practices

• insurance carriers will be rated by consumers (on line)

• children cannot be denied

• the law is designed to more-or-less force the companies to compete

Price containment is critical. So whether the exchange system -- which won't be in operation until 2014 --  will be effective enough remains to be seen.  If not, similar to Social Security when first introduced, the kinks will be worked out.  Bottom line, it's a start. 

FYI: 

The approval/disapproval percentage rates for the new healthcare plan do vary from pollster to pollster. The reason for the recent discrepancy between polls that show a wider gap and those that show a much narrower -- almost  50/50 -- split appears to be largely due to how much or how little people actually know about it. Notably those who have very little, if any, knowledge  initially disapproved, however, after given some information they more receptive they were. And the majority want to give the new law a chance. 

Not all pollsters ask the same questions or use the same phraseology, nevertheless this particular poll does not necessarily negate the others or vice versa. 

What is so horrible about Obamacare?  It's called redistribution, which ultimately ends up giving everyone mediocre care, except the very rich.  So once again, there is still no parity.

Why is it that people don't understand that liberalism only equals the playing field for those who are in low to average incomes?  The rich will always be rich, with the only difference being that they will work harder to protect and hide their money, and they will certainly not use it for investments in the U.S. because they know it will be taxed higher than nearly any other country.  Ultimately, more money will exit the U.S. and be invested in foreign companies which will build other countries wealth.  But, if you are aware of Obama's ideology that may be exactly what his plan is.  He believes in building up 3rd world countries by transferring wealth from richer nations.

That is what is wrong with Obamacare, and Obamacare is one of the reasons small businesses are not expanding.  They hate Obamacare, they hate Cap and Trade, they hate financial reform that does NOTHING to fix Fannie and Freddie.  In other words, socialism (or kakistocracy in this administration's case; (look it up)) kills innovation and expansion.

Here is my Summary of this terrible law.  Higher taxes, higher premiums and more government.

Now that the so called health care reform legislation has become law what does it mean for the future of our nation’s health care system? It means higher premiums, higher taxes and more complicated regulations and requirements.

 Here are my predictions. Health insurance premiums will rise between 20% and 40% starting next year. That is because many of the mandates and taxes contained in the legislation take affect this year. Insurance companies can not raise rates to cover these additional benefits until renewal time so they will have to make up for the extra costs this year by raising rates next year.

 Various members of Congress will spend a great deal of time holding hearings about restricting the insurance companies from raising rates. If they are successful expect less, not more insurance companies to choose from as many will make a financial decision to exit the health insurance market.

 Even though they opposed this legislation insurance companies will be blamed for a) rates going up, b) more uninsured, c) poor service, d) making profits, e) going bankrupt or f) all of the above. F is the correct answer.

 In three years, there will be no more Medicare Advantage Part C plans left in the market except for a few special needs and dual eligible plans. (Dual eligible plans are for people who are on both Medicare and Medicaid.) The reason for the devastation to this program is the premium reimbursement cuts by the Federal government that was touted as cost savings in Medicare during the debate on the legislation. Millions of seniors will be forced to flood back onto original Medicare.

 There will be significant growth in the sale of Medicare Supplement insurance as more seniors are forced off Medicare Advantage plans and as the baby boomers turn 65 and “age in” to Medicare. However, these private “Medigap” plans will have higher premiums as the government will continue to raise deductibles and co pays in Medicare forcing the supplement plans to pick up more of the cost of care.

 Prescription drug costs under the Medicare Part D plan will rise even faster than the experience of the last four years. More seniors will reach the so called donut hole (coverage gap) quicker and then be unhappy about having to pay 50% of the cost of the drug. For this year, seniors will be angry when they receive only a $250 rebate for their drugs in the coverage gap when they find out that the donut hole is not immediately being closed.

 Two years from now the most powerful and the most lobbied person in America will be the Secretary of Health and Human Services. Currently that person is Kathleen Sebelius. However she may eventually resign out of frustration and overwhelming responsibilities and the government may have difficulty recruiting a replacement. The reason is that all decisions over health care plan designs, benefits to be included in the exchanges and regulations fall to this person and his or her staff. Every conceivable health care service provider will want their particular activity covered by the plans being designed. To be left out will result in no funding for the services you provide. Delay in establishing the benefit designs will take place as more and more services will be required to be covered and the price for health plans to be marketed within the exchanges will skyrocket.

 In four years, the dirty word in health care in the USA will be Exchange as in, “I called the Exchange and got put on hold for 30 minutes.” Or “I called the Exchange and got four different answers from four different clerks.” The exchanges which only currently exist as “Connectors” in Massachusetts will be the primary way people will purchase health insurance under the “reforms.” The employees of these yet to be created entities will replace your personal health insurance agent. Their job will be to assist people in making purchasing decisions for their health insurance. Agents will be able to sell through the exchange but they probably will not want to as their compensation will decrease and they will have to comply with dozens of new requirements. Many insurance agents will choose to sell other types of insurance rather than health insurance in order to make a living and keep their sanity.

 The cost of the exchanges will actually increase the administrative cost of health insurance simply by creating another bureaucracy with workers who need to be paid.

The bright side is that there will be job growth in the public sector with all the new bureaucracies, mandates and regulations. However, these additional taxpayer provided jobs will create larger government spending. The reduction of the number of workers in the private sector in the insurance administration and marketing fields will result in significant revenue losses to the Federal government. The result of increased government employees and decreased private employees in the health care industry will drive up the national debt even farther.

 The eventual loss of a personal health insurance agent in the group and individual market as people leave the field due to drastically reduced income will force Americans to utilize clerks at the Exchanges and the insurance companies to answer all their questions and advocate on their behalf. The public perception of the entire program will become worse over time despite the hopes of the Democratic leadership that people will come to like the “reforms” they passed.

 For doctors, hospitals and other healthcare providers, lower reimbursements and additional administrative/compliance requirements on providers will result in more retirements and less young people choosing the Medical profession. This will create a quality of care issue as waiting times to see a doctor will increase.

 Providers will see the new Comparative Effectiveness Research requirements as interference in their practice of Medicine. Through this provision in the law the government will take a more active roll in determining what treatments will be paid for and which treatments will not be paid for.

 Americans will not get healthier under these “reforms” as the law is focused on what the government must provide and what the insurance companies and doctors must do and not on what patients should be doing. Lack of exercise, poor nutrition, violent crime, domestic abuse, and drug and alcohol abuse are all cost drivers. These issues are largely ignored in the legislation. Instead the legislation focuses on changing how insurance is purchased which has very little to do with the cost of care.

 Another bright spot is in the accounting and legal fields as individuals and employers will have mass confusion on new tax rules including how they transfer unearned income for higher income people to pay the Part A payroll taxes that is to be collected from paychecks and rules on tax credits, deductibility of premiums and new taxes on health care providers. The downside will be that businesses have to pay more in fees to comply with all the new rules.

 Many employers will give up in frustration and decide not to provide health benefits. More Americans will be on their own through the “help” of the exchanges to buy their insurance.

 The individual health insurance mandate will be a national disaster and embarrassment. If the Federal government can’t deal today with millions of undocumented aliens in the country, how will they be able to police the requirement that everyone have health insurance? Many Americans who choose not to buy insurance will simply ignore the mandate or pay the penalty. They will still be able to purchase insurance when they get sick on a guaranteed issue basis with no pre existing condition clauses applying.   The law will eventually require the insurance companies to cover these people who can easily game the system.  Health insurance rates will double and triple as people come in and out of coverage only when they get sick and need to access benefits.

 How do I know all of this will occur? Most of what the Federal government passed in this legislation has been tried on the state level with disastrous results. Ask the people in Maine, New Hampshire, Massachusetts, New York, New Jersey, Kentucky, Tennessee and Washington State. None of their reforms addressed cost. They simply tried to micromanage the health insurance markets. Many of these states rescinded their “reforms” and went back to more sensible regulations of the market.

 With all the problems occurring with the new massive Federal program eventually, the so called Single Payer advocates who look forward to the collapse of the private health insurance industry will be back demanded the government take over the system. They will be shocked when they find out the government is broke and can’t take over the payments of our entire healthcare system. (It is important to note that already government programs pay for about half of our health care system. The biggest two programs are Medicare and Medicaid. Each of these programs are running deficits and are facing looming future liabilities.)

 For people who were smart enough to purchase high deductible policies and carefully save their money in Health Savings Accounts the government, in order to increase revenue, will eventually try and impose outrageously high taxes on these accounts. How dare people accumulate money to pay for their future health care?

 Eventually our entire health care system could collapse as both the private and public funding mechanisms run out of money. I believe there is still time to take a more positive approach to our health care reform needs. Repeal of this legislative nightmare is necessary. A common sense workable approach to reform must then be passed. The new legislation must involve all Americans in educating and promoting good health choices and good decisions on buying coverage.

 Disclaimer: The opinions expressed above are my own and do not represent any other individual or organization viewpoints.

 Ross Schriftman has been an insurance representative since 1975. He is an employee benefit specialist with Kistler Tiffany Benefits of Berwyn, Pennsylvania and is a long term care and Medicare supplement insurance products specialist.  He has been with Kistler Tiffany Benefits since 1999 and directed the firm’s Senior Advisory Team from 2006 to 2010. He is an active member of the National Association of Health Underwriters and served as the organization’s Associate Chair for Long Term Care from 2001 to 2003. He also served as the Legislative Chair for the Pennsylvania Association of Health Underwriters from 1994 to 2003 and the Legislative Chair for the Montgomery County Association of Insurance and Financial Advisors from 2001 to 2003. He also has served twice as a panelist at the Montgomery County Estate Planning Council’s Annual Seminar.

 Mr. Schriftman holds the professional designations of Registered Health Underwriter, Fellow of the Life Underwriters Training Council, Advanced Chartered Benefit Consultant and Medicare Supplement Accredited Advisor. He teaches courses to other insurance agents including a course in preparation for the Chartered Benefit Consultant designation.

 Mr. Schriftman is a frequent speaker on health care reform and has published numerous articles related to long term care and health care reform. He also testifies regularly before the Pennsylvania General Assembly and has conducted briefings for legislators and their staff. Mr. Schriftman recently was appointed as a Senior Scholar (non-faculty affiliate) of the Department of Health Policy at Jefferson Medical College in Philadelphia, PA.

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