Medicare For All: What It Really Means & Thoughts on Alternatives

It is December.  Hard to believe that we will be voting in less than a year.  So here are some thoughts. I am not in favor of Medicare for All, at least not in the way several political candidates have proposed it. Medicare, as I know it, has copays, deductibles, maximums, and premiums based on income.  In many cases, it also requires a Supplement to cover the deductibles, copays, and amounts above the maximums. I have it and I love it.

Medicare for All has no copays, no deductibles, no premiums, no maximums and covers medical inpatient and outpatient, drugs with no copay, dental, and vision.  See the problem? Have any trouble getting in to see a doctor recently; or even getting a doctor to accept you as a patient? Imagine what it will be like when everyone knows they can go to see a physician or dentist and it won’t cost them anything. There is already a problem with people using the emergency room because it is more convenient than waiting two weeks for an appointment or going during the day when the evening is more to their liking.  If the cost of such a program doesn’t scare you (and I have heard the rich will pay for it) then the lack of resources should and the millions of people involved in the health insurance industry that will be looking for jobs should.

But just knocking a problem and not offering any solutions is counterproductive.  So here is what I am in favor of:

• Outlawing advertising of drugs except for medical professionals.  The drug companies say they spend more on R&D than advertising but it is not true.  Those billions of advertising dollars could be used to look for cures.   Congress outlawed alcohol advertisements they can do it with drugs.

• Universal Coverage:  Medicare, expanded Affordable Care Act (ACA) or some other vehicle.   These plans should have no annual maximums; deductibles and premiums should be based on income.  Insurance companies could sell supplements to those that wanted them as they do now for Medicare.

• Dental:  Free cleanings and fillings done at clinics staffed by senior dental students or by your favorite dentist for a fee.  We actually had this system in Hawaii for a while.  If you want veneers or some of the other things that make you look beautiful, like whitening, then I’m with you.  I want them too but we should pay for them from our own pocket.

Next issue:   what I think of  Koa furniture in the waiting room.

Laudra's Lessons - Medicare for All

It’s fall already and by this time next year we will all (I hope) be thinking about who we will vote for in November.  I’m not going to go into President Trump’s policies and promises as we will have 5 years worth of those, counting the time he was campaigning.  I do urge you to consider what the opposition is proposing because there is a good deal to choose from. Unfortunately, Hawaii being a relatively small State, our impact is limited.

At least two candidates are proposing “Medicare for All.”  Medicare by itself is not enough. Seniors that have Medicare already either have employer coverage that supplements their Medicare or they buy a 

Supplement or Medicare Advantage Plan.  Medicare for All would be extremely expensive but our health system is already extremely expensive and it doesn’t serve everyone.  Medicare for All would cut down on the costs for claims administration and other bureaucratic paperwork and could cut the cost of drugs.  There is a bill in Congress right now that would do that but chances of passage are slim.

On the negative side, many medical professionals are leaving Hawaii and they cite low reimbursement rates.  Reimbursement rates even for insurance companies are set by Medicare. The insurance companies look at what Medicare is paying and set their reimbursement rates as a percentage or ratio of what Medicare pays; generally, a few percentage points higher.  That means that medical professionals would be making less money than they are now. And every year Congress would be able to cut the reimbursement level. 

We don’t get to vote on whether to have Medicare for All or the Patient Protection Act but the candidate that is elected will decide.  President Trump has said he has a plan but we have not seen any specifics. If John McCain had not had the courage to vote against the bill to cancel the PPA  three quarters of the country would have been without any medical coverage at all because there was no plan to replace it and it would have taken time for the insurance companies to get any new plans through State Insurance Departments.  

Think about it, and vote.

Travel Smart

One of the great things about summer is the coveted family vacation.  This season, be prepared in the case of an unexpected trip to the emergency room or urgent care while traveling away from home.  Here are some smart tips when planning your next vacation:

• Before you leave, look up a participating doctor, clinic or hospital in the area you will be traveling. All carriers have a link to their mainland network on their website where you can search for participating entities by name, city and zip code (see links below).

• Take a picture (front and back) of your insurance card. Even if you lose your wallet, you will know who to call in the case of an emergency.

• Fill up on any prescriptions before leaving on vacation.  Having an ample supply of your medication while away from home will come in handy in the event of a delayed return.

• Sign up for an online account or download an app. All carriers have online accounts (and some a phone app) for their members to use.  This helps with keeping track of your medical history, doctor’s visits, lab results and some even allow to fill prescriptions right from your phone. Having this information at the tip of your fingertips can be useful when traveling.

• Consider using your telemedicine benefit (if applicable) to connect with a doctor over the phone for minor conditions.

Please refer to your insurance carrier and details of you plan coverage to see what kind of resources and benefits are available to you. Happy traveling!

UHA

HMAA

KAISER

HMSA

HDS

Weekdays with Bernie 2019 Review

Joni, Lachelle and Jessica had the opportunity to participate in the Bernie Portal Weekdays with Bernie which was conducted over 3 days from March 25 to March 27 in Nashville, Tennessee.  As the days progressed, it was clear that Bernie Portal is not just a typical HR tool and it was evident they share our desire want to help HR departments eliminate redundancies in their everyday processes.  During one of the sessions, we were shown the staggering increase in healthcare administrative costs over the years which has resulted in more paperwork and time spent for everyone.  Our ability to provide Bernie Portal to our clients means these administrative tasks can be completed with accuracy and efficiency therein giving HR departments more time to focus on the real issues and initiatives their companies and employees need to be addressed.  The conference expanded our knowledge of the system’s capabilities and we learned how to best leverage these features to assist our clients to reduce their workloads and free up valuable time.  We look forward to utilizing our newfound knowledge to support our client’s HR teams and their employees.

To learn more about how we have teamed up with Bernie Portal to assist HR teams, please contact us at HRsupport@ebchawaii.com.

FMLA Basics

The following is written by Laudra Eber

FEDERAL & MEDICAL LEAVE ACT

Passed by Congress to cover all employers in the US and Territories, FMLA applies to all eligible employees of covered employers and provides twelve weeks of unpaid leave with job protection and continuation of health insurance under the same terms as though they had not taken leave. The twelve weeks is extended to 26 weeks if the leave is taken to care for a related service member.

Eligible employee:   a salaried or hourly individual employed for 12 month with 1250 hours of service.

Covered employer:  a company with 50 or more employees within a 75 mile radius.

Twelve weeks: may be intermittent

Employees are entitled to 12 weeks in a 12 month period for the following:

1. The birth of a child or care of a newborn within one year of birth.

2. Placement of child for adoption or foster care within one year of placement.

3. Care of spouse, child, or parent with serious health condition.

4. Serious health condition of the employee.

5. A qualifying emergency of an active duty military service member who is the

spouse, son, daughter or parent of employee.

The employer or the employee may require that FMLA be run concurrently with accrued paid leave

(vacation, sick leave) or in the case of the employee, with TDI.

Words of caution and how to avoid a lawsuit.

• Dads as well as moms can take 12 weeks to care for a newborn or bond with a newly adopted or fostered baby.

• Do not tell employee that you “cannot afford” for them to take time off.

• When bonuses or pay increases are automatically given, ie COLA, an employee on FMLA is entitled to the same increase.

• It is a good idea, though not required, that you insist that individuals taking FMLA make two phone calls, one to their immediate supervisor and one to (pick one) Human Resources, a third party administrator, a preselected manager.  Failure to do so negates FMLA.  This has already been upheld in several court cases.

• Another option being used, and legal, is to have the employee submit requests in writing for all absences.   Not practical for someone who wakes up in the morning with the flu but for vacation, scheduled medical appointments and FMLA, easily done.

Stuck and Stressed: The Health Costs of Traffic : Review Series Part 2

Frakt’s article on health effects of commuting resonated with my past life of an eight to nine Monday through Friday worker.  My commute to work became increasingly difficult and stressful when we had our first child.  Leaving in the mornings were filled with anxiety of getting our baby to daycare on time and missing traffic to get to work on time.  Then the commute home meant leaving work at a certain time to get the baby before the center closed.  That anxiety led to stress at work.  I was afraid meetings would run late as they often did or there would be traffic on the way home which would all delay me from picking up our son.  My husband’s commute was even worse so there was never a chance to switch responsibilities.  By the time we got home, we were both exhausted from the day’s stress, leaving us with little energy to really enjoy time with our son. 

We were on the verge of breaking down when we were both offered opportunities that allowed for flexibility and a significant cut in our commute time.  Working with EBC, I don’t have to commute and can work from home or my nearby coffee shop.  Eliminating our commutes thanks to our new flexible schedules gives us more time to take care of ourselves and our new baby boy.  In positions where a flexible work schedule was not offered, I felt an extra stress from my job plus a feeling that my employer did not care about my personal life outside of the office.  Those factors often lead employees like me to resent their job and care less about the quality of work they produce.  With this new opportunity for flexible work and less overall stress from a daily commute, I want to produce quality work for an employer I know cares about my well-being.  It goes a very long way to show your employee you trust them by offering options to help balance their work/life.  We can all benefit from less time in the traffic zone and more time at home.