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Report: 3.2 Million Americans Will Drop Obamacare for Association Health Plans
By Sean Moran
1 Mar 2018
A study from Avalere Health released on Wednesday found that 3.2 million Americans will leave Obamacare for more affordable options such as Association Health Plans (AHPs), thanks to President Donald Trump’s executive orders on health care.
Dan Mendelson, president of Avalere Health, said, “Consumers are always looking for a new low-cost health insurance option but migration of healthy people to a new product will ultimately take a toll on what is presently being sold in the market.”
AHPs are health insurance pools sponsored by an industry, trade, or professional association that provides health coverage to their members.
President Trump signed an executive order in October that expanded AHPs, as well as short-term limited-duration insurance plans to offer Americans more affordable options compared to Obamacare.
“This will cost the United States government virtually nothing and will provide people great, great health care,” Trump said in October.
Avalere found that by 2022, one million Americans would move out of the Obamacare individual market to join AHPs, and 2.2 million people would drop out of the small-group market to join an AHP as well.
The study also revealed that Americans would experience drastically lower health premiums through AHPs compared to Obamacare.
AHPs would be roughly $2,900 lower per year compared to the small-group market and $9,700 lower per year compared to the individual market.
Avalere cites that the lower average premiums in AHPs mostly result from a healthier insurance pool due to “risk selection,” and less generous offerings.
Chris Sloan, senior manager at Avalere, explained, “The proposed rule would lead to millions of individuals and small businesses shifting into a new form of coverage, likely reducing their premiums, but leading to higher premiums in the markets they leave behind.”
President Trump argued last week that, “Piece by piece by piece, Obamacare is being wiped out!”
Sen. Rand Paul (R-KY) praised the action last October as “the biggest free-market reform of health care in a generation.”
http://www.breitbart.com/big-government/2018/03/01/report-3-2-million-americans-will-drop-obamacare-for-association-health-plans/
Two countries, one insurance plan: San Diego workers find medical care in Tijuana
A patient receives dental care at the SIMNSA outpatient medical center in Tijuana near the San Ysidro Port of Entry. Many of the patients are San Diego workers on a cross-border health plan licensed by the state of California.
An electrician from San Diego, a hotel food services employee from Serra Mesa and a golf course groundskeeper from Oceanside all found themselves among the dozens of patients at the same Tijuana medical facility on a recent weekday morning.
One came for a therapeutic massage and to fill a prescription, another to see a nutritionist, the third to have his adolescent son’s persistent cough checked out.
Although their jobs are in the United States, their health care is in Mexico.
On this rainy January morning, the workers and their dependent family members have converged at an eight-story building just yards from the U.S. border.
Patients come to SIMNSA for everything from dental care to medical tests to physical therapy to consultations with specialists—all covered under SIMNSA’S cross-border health plan.
Nobody here is complaining about crossing the border; in fact, many of them prefer it this way.
The co-pay for a doctor’s visit is typically $7, a fraction of what they would pay in the United States, and there are no out-of-pocket deductibles on the plan. Many are Baja California residents or have family members on the plan who live in Mexico.
Amid uncertainty over the future of U.S. healthcare, large numbers of U.S. patients continue to cross to Mexico for medical appointments. Mexico’s lower costs have long offered alternatives for U.S. uninsured patients or those in search of elective procedures not covered by their plans.
A smaller but growing number of insured workers from San Diego and Imperial counties are also seeking health services in Baja California through two Mexican plans overseen by the state of California.
Geared to Mexican nationals and their dependents who work in San Diego and Imperial counties, the plans spell savings not only for patients, but employers: SIMNSA says its premiums are 60 to 70 percent lower than those of comparable U.S. health plans. Its network includes 400 physicians, 200 of them employed full time.
The aim is to “provide affordable, quality health care for the region,” said Frank Carrillo, the 73-year-old founder of SIMNSA, the oldest and largest of two Mexican insurance providers that are licensed by the state of California. “You can make a doctor’s appointment at 11 p.m., that’s why people come over here. Not only for affordability, but for accessibility.”
Among SIMNSA’s subscribers is María Teresa Contreras, a 68-year-old Barrio Logan resident insured through her husband, who works setting up banquets at at a La Jolla hotel.
“Over there, the doctor just checks you, gives you medicine and it’s time to go home,” said Contreras, seated in a recliner as she received ozone therapy. The treatment was not offered by her former U.S. health plan, but is available at SIMNSA for patients diagnosed with ailments such as diabetes, rheumatism and arthritis.
Shara Shapiro, 40, who lives in Serra Mesa and works in food service at a hotel in La Jolla, said she paid $90 every two weeks for a U.S. health plan before switching to SIMNSA three years ago at the recommendation of a colleague.
Now, she’s paying $20. “It’s much cheaper, I get better service, and I don’t have a huge co-pay to see a specialist,” she said.
A plan limited to the California-Mexico border
California is the only state on the U.S.-Mexico border that allows such cross-border plans. Of the two HMO plans licensed by the Department of Managed Care, the smaller and newer plan is MediExcel, which started in 2012.
Based in Tijuana’s Río Zone at the private Excel Hospital, MediExcel’s plan last year saw its enrollment grow by 35 percent last year, and currently counts some 10,000 enrollees, said executive vice-president Jim Arriola.
He concedes these plans are not for everyone: “If somebody doesn’t want to go to Mexico, it doesn’t matter how much they’re going to save, they’re not going to pick a cross-border plan,” Arriola said.
Since SIMNSA became licensed in 2000, the company says more than 500 U.S. employers have chosen to offer SIMNSA as one of the options for their workers. Among the plan's direct subscribers are employees of the Hotel del Coronado, General Dynamics in National City and Barona Casino.
Enrollees can receive care at five different SIMNSA outpatient centers in Mexicali, Tecate and Tijuana, with the largest facility within easy walking distance of the San Ysidro Port of Entry. The hours are 8 a.m. until midnight on weekdays, with shorter hours on weekends.
The plan provides for U.S. emergency and urgent care. For major surgeries and other procedures not offered directly by SIMNSA, the plan contracts with other Tijuana providers.
SIMNSA counts close to 50,000 direct enrollees, but has expanded its pool of potential patients by 80,000 through agreements with two U.S. plans — HealthNet and Anthem Blue Cross — that allow members access to medical care in Mexico through SIMNSA, said Christina Suggett, the chief operating officer. In addition, more than 10,000 people receive discounted care at SIMNSA through the purchase of a membership card, Mexsalud.
One of SIMNSA’s oldest clients is Local 30, the hotel and hospitality workers’ union in San Diego. Of 3,500 members on health plans, about a third are enrolled in SIMNSA, said president Brigette Cummings. Members who enroll in SIMNSA health plans pay no fee—the entire cost is covered by the employer.
“For people willing to cross the border, it’s an excellent option,” Cummings said. “The co-pay is cheaper, the medicine is cheaper.” But there are other advantages as well, she said: the extended hours allow participants to make appointments without having to take off from their jobs and the location in Mexico allows care for dependents in Mexico who are unable to cross to San Diego for treatment.
From field workers to hotel workers
The founder and driving force behind SIMNSA is Frank Carrillo, a Mexican-born immigrant who as a boy helped support his family selling popsicles by the border in Tijuana--at the very spot where SIMNSA’s medical building now rises.
He was 16 years when his family moved to the United States. While the others went to work in the fields, Carrillo stayed behind in Los Angeles, “painting cars, construction, whatever came along.”
He earned a GED, joined the U.S. Army, and after receiving an honorable discharge returned to civilian life and found work in sales for a health plan. After rising through the ranks, Carrillo struck out on his own as a consultant, helping companies get HMO licenses in California.
From there, he went to work for the Teamsters, overseeing the union’s agricultural worker health program in the state of California, setting up health care contracts with providers on both sides of the border, as some of the farm workers lived in Mexico.
He saw an opportunity in setting up cross-border healthcare networks for Mexicans who cross to work in San Diego. “I saw service workers living in Mexico and working in San Diego, and I said to myself, the same thing I did for farm workers, I can do for these workers.”
His newest project is a 120-bed, $120-million bi-national hospital being planned around the medical tower. Carrillo expects the first phase consisting of an emergency room and 30 beds will be completed this year, with the finished project set for opening in 2020.
SIMNSA and Scripps Health in 2016 announced they would be joining forces on the project, with Scripps acting as consultant, but a final agreement was not reached. Carrillo said he is moving forward, undeterred in his vision.
“I’m one of those immigrants who realized the American Dream,” said Carrillo, a dual U.S. and Mexican citizen who lives in Chula Vista’s East Lake. “When people say, ‘You can’t do it,’ I do it. My hunger comes from being an immigrant.”
Limited enrollment
Though Americans for decades have come south for a broad range of medical medical care, the concept of a cross-border health plan sanctioned by authorities both in the United States and Mexico is relatively recent. The 1998 passage of an amendment to the Knox-Keene Health Care Service Plan Act, which regulates managed care in California, opened the door to “Mexican prepaid health plans.” These are plans that are licensed in California to offer employer-sponsored group plan contracts to Mexican nationals legally employed in San Diego and Imperial counties and their dependents, no matter what the nationality.
The legislation's sponsor, Steve Peace, was then a Democratic state senator representing San Diego’s South Bay, and says Hispanic staff members first put the issue on his radar. “They came to me and said, ‘this is crazy, you have people living in Mexico and in some cases living in the South Bay, they are being forced to get medical care that is more expensive,” north of the border.
The option for insured workers to receive care in Mexico came on the heels of the signing of North American Free Trade Agreement, a period when “there was a lot of expectation that economic relationships were going to strengthen on both sides,” said Arturo Vargas Bustamante, a professor at University of California Los Angeles’ Fielding School of Public Health and a former official in Mexico’s health ministry.
But for all the flurry of initial interest, the expectations of high enrollment have fallen short, Vargas said. A 2008 article co-authored by Vargas cited “legal, cost and geographic limitations” as the main obstacles to expanding enrollment. The plans are limited to employers in San Diego and Imperial counties and exclude “self-employed people who might be interested in buying less costly coverage in Mexico,” the article stated.
Today, the California Department of Managed Care licenses only two Mexican prepaid health plans: the SIMNSA Health Plan and the MediExcel Health Plan. Both say they are compliant with the standards of the Affordable Care Act, and both are reporting growth.
“Many of the new members we’re getting were previously uninsured,” said Arriola of MediExcel. A big issue for low-wage earners in California is obtaining coverage for dependents, he said, and by selecting lower-cost cross-border plans, workers are able to enroll family members who previously did not have coverage.
While many San Diego service workers have found low-cost insurance under these plans, they are not the only U.S. option available to those employees willing to cross to Mexico for medical care.
The Western Growers Association offers one of the largest health plans to agricultural workers in California through its assurance trust plan; as part of their choices, enrollees can receive some or all of their care in Mexico through a proprietary network of contracted medical providers in Tijuana, Mexicali and Algodones in Baja California and San Luis Río Colorado in Sonora. According to the association, some 15,000 enrollees are receiving at least some of their treatment in Mexico.
http://www.sandiegouniontribune.com/news/border-baja-california/sd-me-simnsa-tijuana-20180108-story.html#nws=true
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New Mexico Obamacare Co-op Boasted Six-Figure Salaries and now is Insolvent!
New Mexico Health Connections, one of the four remaining nonprofit Obamacare Co-ops, did not inform its customers in June that it was insolvent and its entire board had resigned, The Daily Caller News Foundation has learned.
It also never told its customers the nonprofit paid its executives up to $450,000 in annual salaries.
The nonprofit, one of 24 Co-op’s originally set up under Obamacare, was supposed to provide affordable health insurance to individuals, predominantly low-income citizens. The demise of the New Mexico Co-op means that only three are fully functioning.
The New Mexico Co-op boasted extraordinarily high six figure salaries per year like many other failed Obamacare nonprofits, according to a DCNF review of its 2015 tax filing Form 990 with the Internal Revenue Service.
Dr. Martin Hickey, the nonprofit’s CEO, received a $450,000 salary, according to its 990. It is unclear what his compensation was in 2017 when the Co-op notified the state insurance superintendent it was insolvent.
All 12 of the nonprofit’s top staff received six-figure salaries, according to its tax filing. Joining Hickey was Chief Medical Officer Dr. Mark Epstein who received an annual salary of $413,000, Chief Operating Officer Anne Sapon who received $342,000, and Primary Care staffer Frances Torres who received $318,000.
The New Mexico Co-op burned through $77.3 million in federal loans awarded by the Obama administration’s Centers for Medicare and Medicaid in 2012. The nonprofit was “bleeding about $20 million in red ink a year,” an Albuquerque Journal editorial noted.
Customers first learned in September the Co-op was facing financial difficulties. It announced an agreement to sell its small and large business policies to a for-profit company called Evolent Health for $10 million in cash.
The deal meant the insolvent nonprofit would continue serving individual customers – its most vulnerable and poorest customers. About 22,000 customers were affected.
The nonprofit’s dire financial straits were so severe its total capital and surplus were $3.5 million even after the infusion of $10 million, according to its Sept. 30 financial filings as reported by the Journal last December.
Co-op customers also weren’t informed that their insurer was insolvent and its board had resigned until after the Obamacare “open enrollment” period for 2018 had expired.
Under New Mexico law, that state can take over insurers that face financial distress. Yet, the state did not assume control of Health Connections after the resignation of its board last June, according to the Albuquerque Journal. Instead, it allowed True Health to take over the two smaller divisions and permitted the individual market customers to remain in the cash-strapped nonprofit.
Hickey, the highest paid Co-op executive, left the nonprofit and joined True Health, Evolent’s subsidiary. True Health did not respond to a DCNF inquiry about his current compensation.
Sapon, in a Linked-In posting in the first week of 2018 attempted to claim the co-op wasn’t facing any financial distress.
“The nonprofit’s leadership have continued NMHC is happy to announce that, contrary to rumors that have been circulating, the company is in a great financial position for the coming year,” she wrote. “We look forward to continuing to serve our members with the same high levels of care, expertise, and compassion that we have been providing for the past four years. We wish you a healthy and happy 2018!”
“We all wanted the company to succeed, but we were effectively insolvent in June,” said Diane Denish, a Co-op board member and New Mexico’s lieutenant governor under Democratic Gov. Bill Richardson in an interview with the Journal on Jan. 9.
Other insurance companies are facing significant losses because of the nonprofit’s insolvency. The largest creditor is Presbyterian Healthcare Services, which is owed $7.6 million. Blue Cross Blue Shield of New Mexico said Health Connections will likely owe it several million dollars.
http://dailycaller.com/2018/01/10/exclusive-insolvent-new-mexico-obamacare-co-op-boasted-six-figure-salaries/?utm_medium=email
Canada’s health-care wait times hit new record—21.2 weeks
VANCOUVER—Wait times for medically necessary treatment hit a new record in 2017 and eclipsed 20 weeks for a second year in a row, finds a new study released today by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank.
The study, an annual survey of physicians from across Canada, reports a median wait time in 2017 of 21.2 weeks—the longest ever recorded.
By comparison, Canadians waited 9.3 weeks in 1993 when the Fraser Institute first reported wait times for medically necessary elective treatments.
“Excessively long wait times remain a defining characteristic of Canada’s health-care system,” said Bacchus Barua, associate director of health policy studies at the Fraser Institute and author of Waiting Your Turn: Wait Times for Health Care in Canada, 2017.
The study examines the total wait time faced by patients across 12 medical specialties from referral by a general practitioner (i.e. family doctor) to consultation with a specialist, to when the patient ultimately receives treatment.
Among the provinces, Ontario again recorded the shortest wait time at 15.4 weeks—nearly four months—and New Brunswick recorded the longest wait time (41.7 weeks).
For the fifth year in a row, British Columbia saw an increase in wait times with the median hitting 26.6 weeks—the longest ever measured in that province. Alberta also experienced its longest wait time ever at 26.5 weeks this year, and wait times in Quebec also crossed the 20 week mark for the first time since 2003.
Among the various specialties, national wait times were longest for orthopedic surgery (41.7 weeks) and neurosurgery (32.9 weeks) and shortest for medical oncology (3.2 weeks).
“Long wait times are not a trivial matter—they can increase suffering for patients, decrease quality of life, and in the worst cases, lead to disability or death,” Barua said.
“It’s time for policymakers to consider reforming the outdated policies that continue to contribute to long wait times in Canada.”
