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This concept has many features that medical care does not promote today
Financially responsible for healthcare needs of an individual, doctors get paid at time of service, promotes competition, insurance policies as if being sold across state lines, eliminates Medicare fraud, eliminates ever growing Federal Government bureaucracies and ends Federal Government requirement to provide medical services to individuals (could be a state requirement).
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To assess this concept you should first assume that you are designing a system that would institute some basic goals:
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1 Encourage quality medical care
2 Individual financial responsibility
3 Hinder medical care fraud
4 Promote competition
5 Alleviate the ever growing Government bureaucracies
6 Tort Reform
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Medicaid/SCHIP
Medicare
VA HealthCare
Health Caring Account “HCA"
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Under this system the Federal Government would not have any financial responsibility of healthcare for anyone except for the VA healthcare system.
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Medicaid/SCHIP would be moved under state control without Federal jurisdiction or control and any tax money collected to support the Medicaid/SCHIP would be transferred back to the state of origin.
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The control of Medicare would be separate from the Federal Government and shall not be expanded. Medicare system would become "The Elder HealthCare System" and contracted out similar to the US Postal Service or Amtrak, until it is not required but no longer than twenty years, then it would be terminated. An individual that is 65 years of age at time of implementation of "HealthCare for the Future" and lives longer than age 85 would fall under the state controlled Medicaid system or under their own “HCA”.
“Todays Medicare”
Part A (hospital insurance)
From payroll contribution "tax"
Part B (mostly outpatient services)
Seniors fund through premiums (money withheld from their SSA check or paid out of pocket)
Part C (Medicare Advantage)
Is a combination of part "A" & "B" with a private insurer, seniors fund through premiums as in part B with additional funds by the taxpayers (Gov)
Part D (prescription drug coverage)
Seniors fund through premiums (money withheld from their SSA check or paid out of pocket)
Medigap policies help pay some of the healthcare costs that the Original Medicare Plan doesn't cover in Part B, and/or Part D or Part "C"
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It would include the healthcare of active duty military, their families along with our veterans. Also it would be financed within the Military budget.
Note: No money from the Federal Government shall be used to pay (non VA) medical cost.
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Health Caring Account “HCA"
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This is how the HealthCare for the Future "HC for the F" concept is envisioned to be implemented. “HCA” would have similar elements as Health Saving Accounts does today.
HealthCare is personal between yourself and health care providers. Anyone with a "HCA" will be able to receive the care they decide to be appropriate for their own situation. HealthCare is our personal financial responsibility and the quality of care is our decision.
Any person requiring medical care would be eligible for and could get their health care needs with an individual "HCA” or within a "Family-HCA". When two individuals get married they could combine their individual "HCA"s into a "Family-HCA" or they could remain separate. The only difference between the two is their debit card accounts. The family has only one debit card account shared by the whole family where an individual would have their own personal debit card account. When referring to an “HCA” it applies to both.
"HCA" would be sanctioned by the Federal Government, under standards set up by a non-governmental
HealthCare Committee
"HCC"
made up of healthcare providers , healthcare insurance companies, economists, accountants, attorneys, etc. The HCC would be appointed by but not under the Governments control. Your "HCA" monies would be eligible for tax exempt status.
This concept would require you to have a combination of an "HCA", a
HealthCare Provider Servicing Company
"HCPSC"
, a high deductible healthcare insurance policy and a healthcare provider.
Note: Your primary healthcare provider would maintain your digital medical records. Your "HCA" is where the money comes from to pay for all your health care needs.
To be fair to as many people as can be, there are three stages within the HealthCare for the Future "HC for the F" concept: 1)
the Standard System
"SS"
, persons up to 55 years of age. 2)
the Hybrid System
"HS"
, persons within 55 to 65 years of age. 3)
the Elder HealthCare System
"EHCS"
, for persons on Medicare at the time of implementation to "HC for the F".
All individuals would choose a "HCPSC”. The "HCPSC" would issue you a medical identification card, handle the funding for your health care needs and maintain your deductible healthcare policies supplied by the healthcare insurance company you have chosen.
Healthcare insurance companies would be required to be in at least 3/4 of all states and each state would have at least 2/3 of all healthcare insurance companies. If there are 12 participating healthcare insurance companies, there would be a least 9 insurance companies in each state and each healthcare insurance company would be in a least 38 states.
Every healthcare insurance company would provide 30 "standard coverage" plans as follows: 7 individual plans (3 female plans, 3 male plans and 1 coed) covering 4 age groups, 15 family plans and 8 group plans.
Note: All plans have no restriction on pre-existing conditions. "HC for the F" considers all health needs were at one time or another pre-existing.
"FUNDS"
to your "HCA" would come from your income and be tax exempt from Federal income tax and/or come from contributions from your employer cost for your healthcare benefits. Funds from your "HCA" could pay for all doctors, hospitals and health costs (“Over the Counter “OTC” meds + needs, prescriptions, etc).
Because your “HCA” funds (money) is yours from year to year (unlike health saving accounts today), an individuals’ “HCA” could be passed tax exempt to a designated family members' "HCA" at the individuals’ death.
Medicare withheld from your income, what happens to it? It stops, but you could put 10% of your income with
Tax Exempt Money
"TEM"
that meets the
Income and Wealth
"I&W"
requirement into your "HCA".
How individuals would benefit financially with an “HCA" because of the
Cost Saving
"CS"
to Insurance companies, Health care providers, Business owners and Federal Government.
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The Standard System
"SS"
The Standard System is the primary HealthCare system concept from pre-natal up to persons 55 years of age at the time of implementation to "HC for the F" and you will continue under the “SS” for the rest of your life.
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"HCC"
HealthCare Committee would be made up of health care providers, healthcare insurance companies, economists, accountants, attorneys, etc. The"HCC" would be appointed by but not under the Governments control. Your "HCA" monies would be eligible for tax exempt status.
"HCC" would establish the standards for the "HCA" system.
These standards would address:
Medical procedures eligibility
Define medical procedures
Procedure coding matching health insurance provider coding
Establish the “standard coverage” for each of the healthcare insurance plans
Note; “standard coverage” could not exempt pre-existing conditions,
Medical record security
Standardizing the software
Standardizing the receipt design from the Health Care Provider that shows the codes of the services or treatments for that visit, also would show two prior codes and the date they were paid by your “HCA”. This would alert you of possible fraud.
Standardizing the web page design for the health care providers. So once an individual becomes familiar with one providers web site all of the other providers’ web site would be fundamentally the same.
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Your “HCA” would be maintained with your ”HCPSC” and could be in conjunction with a healthcare insurance company or as a standalone company.
”HCPSC” would maintain your “HCA” debit card account, deductible insurance plans and how to access your medical records.
“HCC” would establish "standard coverage" for healthcare insurance companies’ policies they provide to ““HCA” individuals / families that could cover age and sex appropriate plans for individuals.
Your “HCA” is where the money comes from to pay for your healthcare needs. Your “HCA” could be used to pay your health care providers, over the counter “OTC” items such as band aids, cough drops, cough syrup, eye drops and etc, unlike your insurance plan that would not cover your OTC items.
Establishes guide lines and determines how & who would fund the state medical finding boards to deal with medical malpractice
Tort Reform
"TR"
, etc.
This “HCA” system could be implemented once the standards are set up and would replace future Medicare recipients with the
Hybrid System
"HS"
ages 55 - 65 and for today’s Medicare system with the
Elder HealthCare System
"EHCS"
.
The “HCC” would set up guide lines pertaining to transferring funds between your “HCA” and IRAs, 401ks, etc as a
Family Safety Net
"FSN"
for individuals under 59 ½ years old.
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"HCPSC"
Health Care Provider Servicing Company would maintain where and how your “HCA” records are being kept. Your health record would be kept with your primary health provider and/or a copy would be in the smart chip on your
Medical Identification Card
"MIC"
.
All records would become digital so individuals would have a copy in the smart chip. “HCPSC” would issue you a
"MIC", handle the funding for your healthcare needs, maintain your deductible healthcare policy, and it would also maintain your “HCA”
Debit Card Account
"DCA"
.
Your “HCA” funds above the deductible amount of the insurance policy at the “HCPSC” could be invested as you choose for your risk tolerance as a saving or money market account at a bank, stock market mutual funds, etc., that is sanctioned by the “HCA” Committee”. Those accounts would be subjected to ongoing audits by an outside agency with guide lines set up by the “HCC”.
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"MIC"
Medical Identification Card will have your name, picture, phone number of next of kin, your medical information an EMT should know in case of an emergency, etc. Your “MIC" would contain a smart chip with information where your medical records could be accessed via the internet or the smart chip would contain your health records, either way the smart chip would be password protected. As an emergency backup there would also be a code that could be used by calling your “HCPSC” to receive the password to unlock the smart chip to access your health records.
Your “MIC" would be used for “check in” at the health care provider along with your pin number. It would provide access to your medical records maintained by your health provider.
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"DCA"
Debit card account is accessed with your "MIC" and used to pay your "HCP" at time of service. Your "MIC" debit card can also pay for over the counter "OTC" healthcare needed items such as band aids, cough drops, cough syrup, eye drops and etc.
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"HCP"
Health Care Providers: Doctors, clinics, urgent care centers, hospitals, emergency rooms, trauma centers, nursing, long term nursing/assistance care, mental health professionals, medical laboratories, physical therapy, etc., just to name a few.
For health providers to participate in the "HCP" system they would be required to have a web site that list the services provided by name and by medical code along with the cost of that procedure or service. Individuals could go to one provider to see the cost of a procedure (by code), then check with a second provider in the same area to see who you want to do the procedure. Also, you would be able to compare costs of procedures and services with the rest of the country.
Note: The "HCC" would provide a list of standard procedures and the coding with a general description and explanation of that service.
Note: Under "HC for the F", "HCP" would not be expected to give charity healthcare or pro-bono work. If the individual is under a state Medicaid system the fee would be covered by Medicaid. All "HCP" service fees are collectable and would be turned over to a state sanctioned debt collector.
Note: Health Care Providers would have to have a state license, be certified or what the state requires of them to have so they could receive compensation for their healthcare services.
Note: Health Care Providers would not be in a network, HMO, etc, or have to apply to be accepted by a HealthCare Insurance Company to be able to have their services paid for.
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"TEM"
Tax Exempt Money would fund your "HCA" and would have elements similar to Health Saving Accounts today. "TEM" would be subject to the
Income and Wealth
"I&W"
,
requirement.
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"FUNDS"
Funding for and funds from your “HCA”
Would be funded with “TEM” for those who meet the "I&W" requirement” similar to IRA's, 401k's, etc.
An employer that supplies medical coverage could contribute that amount to the employees’ paycheck and / or purchase a high deductible insurance plan (group plan?) equal to their cost of supplying the employee medical coverage or could contribute that amount to the employees' “HCA”.
The employee / individual would be required to put 5%, but could take 10% of their income to fund their “HCA” until it becomes fully funded.
An individuals' “HCA” that equals $100,000 would be considered
Fully Funded
"FF"
. Once fully funded the % of “TEM” could be as much as 5%.
A 1% tax or less on your “HCA” at the end of the individuals' plan year (their birth date) would be used to support the current Medicare “Part A” system until its termination.
A .05% fee or less on your “HCA” at the end of the individuals' plan year (their birth date) would be used to support the cost of “HCC”.
Would pay the premium for the individuals' health Insurance plan
and the deductible portion of your health Insurance plan.
Would be used for all medical, doctors, hospitals and health costs (OTC meds, Prescriptions, etc),
Could also be used for cosmetic procedures (face lifts, breast implants, etc) with money above the deductible portion of the insurance plan.
Could be used for assisted living costs,
Individual would use their “HCA” debit card to pay for any healthcare needs at time of service.
Stays with the individual until death and then it would be transferred to their beneficiaries' “HCA”.
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"I&W"
Income and Wealth requirement
Individuals / families with taxable income over of $250,000 / $500,000(adjusted for inflation) would not be eligible for any tax exempt money added to their “HCA”, or individuals’ wealth over $500,000.00 or $1,000,000.00 for a family.
Note: Wealth would include IRA's, 401k's, investment real estate, liquid investment holdings, except for the first $350,000 of the individuals/family residents would be exempt from your wealth requirement also your “HCA” would be exempt. Individuals must meet these requirements to be eligible for tax exempt money status.
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"FF"
Fully Funded
Individuals whose “HCA” equals $100,000 would be considered to be fully funded. So before fully funded a family would be able to continue to contribute at the maximum amount until each member of the family had a fully funded “HCA”. If there are five members in a family and there is only one member working then the working member could contribute at the maximum until there was $500,000.00 ($100,000.00 for each of the five members) before the worker would be required to cut back to the 5%.
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The schedule to address the maximum amount an individual would contribute to a “HCA” before it is fully funded:
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ages 0-54 up to 10%
age 59 up to 20%
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age 55 up to 12%
age 60 up to 22%
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age 56 up to 14%
age 61 up to 24%
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age 57 up to 16%
age 62 up to 26%
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age 58 up to 18%
age 63 up to 28%
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age 64+ up to 30% of their income
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For each individual “income earner” having dependents, that “income earner” could add an additional 1% for each dependent to the amount they can contribute to an “HCA”.
Example, an income earner with four dependents could contribute a total of 14% of their earners income. A family of five with two income earners could split up the additional 1%, The higher earner could contribute 13% of their income and the second earner contribute 10% of their income. Likewise the first earner could contribute 12% of their income and the second earner 11% of their income.
In a family of five, when an individual becomes age 18 they would have their own “HCA” so 20% of the total amount of the family “HCA” would go to fund a new “HCA” for the individual that became 18 years old.
Any changes made to the individual “HCA” would be made before the last day of the month of their birthday.
When two individuals become a family, each could have their own “HCA”, or the two “HCAs” could be combined as a family “HCA”.
As a family “HCA”, if only one is an income earner that income earner could increase the % contributed into the total need to fully fund both “HCAs”.
Once your “HCA” is fully funded, an individual “income earner” would be required to contribute no more than the minimum of 5% of their total income. After their “HCA” is 200% of fully funded they could decrease / suspend their contribution until their “HCA” falls below 200%.
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"HCIC"
HealthCare Insurance Company
For an “HCIC” to be included in the “HCA” system they would have to be in at least 3/4 of all 50 states. Of all the “HCIC” in the system, there would be at least 2/3 of those companies in each state. If there are 12 participating healthcare insurance companies, there would be a least 9 insurance companies in each state and each healthcare insurance company would be in a least 38 states. This would promote competition.
Funds from your “HCA” would pay only for
High Deductible
"HD"
healthcare insurance plan premiums for Individuals in "HealthCare for the Future" system. By having “HD” plans you would know that your own “HCA” is paying for your own healthcare needs.
Health insurance premiums would be based on age and sex, along with the zip code of where the covered individual lives for each of the
HealthCare Insurance Plans
"HCIP"
.
All premiums would be good for one year only and would expire at 11:59PM the last day of the month of your birthday.
All participating “HCIC” would be required to carry the standard coverage set up by the “HCC” for three types of their thirty healthcare insurance plans. Those healthcare plans would be age and sex appropriate. Also “HCIC” could offer additional benefits at the standard price. This would promote competition.
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"HCIP"
HealthCare Insurance Plans
The standards for the coverage set up by "HCC" would not cover cosmetic procedures (face lifts, breast implants, etc) or OTC meds (band aids, cough drops, etc), some cosmetic procedures for restoration after an accident would be covered as prescriptions drugs, prescribed medical devices and etc could also be covered.
"HCC" set up standard for the three types (individual, family and group) of the thirty "HCIP" . There would be 7 individual "HCIP", 15 families "HCIP" and 8 groups "HCIP" in High Deductible “HD” categories.
Coverage: The coverage for each of the thirty "HCIP" for each individual in that particular "HCIP" would be the same.
Premiums: Premiums could vary within each "HCIP" only for the age of an individual in the same zip code of the same sex.
Example: a male age 66 could pay less than a male age 85 in the same zip code. "HCIC" actuarial may show that healthcare for a male age 85 could be expected to be more than a male age 66 to justify that premium variation.
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"HD"
The larger you’re "HCA" becomes the higher your deductible could be.
If your "HCA" is greater than $3,000 then your insurance deductible could be $2,500 or
If your "HCA" is greater than $6,000 then your insurance deductible could be $5,000, or
If your "HCA" is greater than $8,000 then your insurance deductible could be $7,500, etc.
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If and when your "HCA" declines in value, the high deductible "HCIP" could also be changed to a lesser deductible plan at your renewal date.
Just remember there would not be any restriction of the size of the gap between your "HCA" and the high deductible "HCIP" is out of pocket cost to you.
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The * indicates the deductible amount, each plan has ten levels of "HD"
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*5= $15,000
*10= $100,000
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Note: The higher the deductible, the lower the insurance premium should be
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“IP”
Individuals plans, (Single person) (7) plans:
Would cover persons that are not a part of a Family, group/organization or covered under their parents plan.
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The * indicates the deductible amount, each plan has ten levels of "HD".
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IA*
= female 0 to 18 years of age
IC*
= female 18 to 45 years of age
IE*
= female 45 to 65 years of age
IG*
= 65 + years of age
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IB*
= male 0 to 18 years of age
ID*
= male 18 to 45 years of age
IF*
= male 45 to 65 years of age
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Example:
An IE3 plan would be for an Individual female between 45 and 65 years of age with a high deductible amount of $7,500.
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"P/FP"
Parents/Family Plan (15) plans
Would cover persons that are part of a family or a single person with children less than 18 years of age, a disabled dependent/child/parent over 17 years of age.
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The *
indicates the deductible amount, each plan has ten levels of "HD".
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FA*= 2 adults < 45 years old average,
FC*= 1 adults + 1 child < 18 years old,
FE*= 1 adults + 2 children < 18 years old,
FG*= 1 adults + 3 children < 18 years old,
FJ*= 1 adults + 4 children < 18 years old
FM*= 1 adults + 5 children < 18 years old,
FP*= 1 adults + > 5 children < 18 years old,
FS*= 2 adults > 65 years old average
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FB*= 2 adults + 1 child < 18 years old
FD*= 2 adults + 2 children < 18 years old
FF*= 2 adults + 3 children < 18 years old
FH*= 2 adults + 4 children < 18 years old
FK*= 2 adults + 5 children < 18 years old
FN*= 2 adults + > 5 children < 18 years old
FR*= 2 adults > 45 < 65 years old average
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Note: a single parent would be considered an adult regardless of age
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Example:
A “FC2” could be a family plan for a single parent with a "HD" of $5,000 or could be a pregnant female with a "HD" of $5,000.
A “FD4” could be a family plan for (a man, pregnant female, and with one child) with a "HD" of $10,000 or could be a family of (two adults + two children) with a "HD" of $10,000.
A "FK6" would be a family plan for two adults + five children with a "HD" of $20,000.
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"GP"
Group (8) plans
Would cover groups / organizations that are self employed or are a member of an organization that would receive discount rates for their high deductible health insurance.
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The * indicates the deductible amount, each plan has ten levels of "HD".
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GA*= <5 individual
GB* = >5 <10 individual
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GC* = >10 <20 individual
GD* = >20 <50 individual
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GE* = >50 <100 individual
GF* = >100 <500 individual
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GG* = >500 <1000 individual
GH* = >1000 individual
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Example:
A "GD4" plan would be for a Group with 20 to 50 individual in that group with a high deduction of $10,000.
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The Hybrid System
"HS"
The Hybrid System is for individuals between ages 55 and older that are not on Medicare at time of implementation. The Hybrid system is the same as the Standard System “SS” except for how some of the individuals’ "HCA" is funded.
Where the funds comes from to fund your "HCA".
1. An employer that supplies medical coverage could contribute that amount to the employees’ paycheck and / or purchase a high deductible insurance plan (group plan?) equal to their cost of supplying the employee medical coverage or contribute that amount to the employee "HCA", same as in the "FUNDS" section.
2. All individuals are encouraged to build up their "HCA" with "TEM" during their pre-retirement years (55 + years old) as shown in Chart-A, same as in the "FF" section.
Depends on the number of years before age 65, chart “A” show the % of "TEM" an individual could contribute at that age to their "HCA" until the "HCA" has reach 150% of being "FF".
Chart-A
Within the income and wealth requirement guidelines the % an individual could contribute:
at age 55 up to 12%
at age 59 up to 20%
at age 63 up to 28% at age 64 + up to 30%
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at age 56 up to 14%
at age 60 up to 22%
at age 64 + up to 30%
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at age 57 up to 16%
at age 61 up to 24%
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at age 58 up to 18%
at age 62 up to 26%
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For each individual “income earner” in The Hybrid System having dependents, that “income earner” could add an additional 5% for each dependent to the amount they can contribute to an "HCA", the % is not the same as in the fully funded section. This would help make up for the shorter time the individual has to fully fund their "HCA" or a familys’ "HCA" .
The % in this section pertains to the individuals’ income only, the employers’ contribution to the employee "HCA" is not included in that %.
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3.
Being in the hybrid system you would be responsible for funding your high deductible insurance plan in the years prior to age 65 ("EHCS" eligible) same as with the “SS”.
When taken in account, all the money the individual has paid into Medicare before age 55 or older at the time of implementation would be compensated by having their high deductible insurance plan provided by "EHCS” until "EHCS” would be terminated.
Then, after age 65 "EHCS" would pay for a 10K(?) high deductible insurance plan until the individuals’ "HCA" has reached 150% of being fully funded, then "EHCS" would pay for a 20K high deductible insurance plan (the individual would have the option to pay the difference to have a lower deductible plan), or until "EHCS" is terminated.
4. Individuals having money taken out of their paycheck for Medicare "Part A" at time of implementation would continue to have that same amount withheld but the money would go to the individuals "HCA". Their "HCA" would keep a % for the individuals "HCA" and send the remainder to fund "EHCS" until reaching the age when they would have been able to receive Medicare. These funds would be in addition to the funds in chart-A.
The Elder HealthCare System "EHCS" (was Medicare) withheld from your income, Chart-B shows how the "EHCS" withholding is divided up by % to help fund your "HCA" and "EHCS" for your high deductible insurance after age 65.
At age 65 or when you retire (which ever comes later) your high deductible insurance plan of 10k would be paid for out of the "EHCS" until "EHCS" would be terminated.
When taken into account all the money the individual has paid into Medicare before age 55 and what is also paid by the individual within the Hybrid System is why "EHCS" pays for the high deductible insurance.
That money (from "EHCS") would pay for your deductible insurance in your 65+ retirement years unless their "HCA" is fully funded.
Chart-B
*Years until reaching the age when you would be able to be on "EHCS" (age 65)
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By front loading the funds, the larger % to your "HCA", the individual would have additional funds to pay health provider for their health care.
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The assumption is the individual would work until reaching full Social Security age or older, then retire at which time there would be no more payments to Medicare.
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The Elder HealthCare System
"EHCS"
The Elder HealthCare System would replace todays Medicare Part-A, Part-B, Part-D or Part-C. Funding for “EHCS” derives from payments from individuals in The Hybrid System for up to ten years and the Medicare trust fund.
Note: The Social Security and Medicare trust fund had $4.5T (?) as of 2011(?).
A SUMMARY OF THE 2012 ANNUAL REPORTS
&
A SUMMARY OF THE 2013 ANNUAL REPORTS
The payout from the Medicare trust fund declines each year because; 1. Death, 2. Chart-C, and 3. individuals using their own "HCA" / Family Safety Net “FSN”
Chart-C
Shows % of reimbursement from “EHCS” (Medicare trust fund) and your "HCA" from the first year through the twentieth year.
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(#) the number of years into the "HC for the F" the elder healthcare system
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"HCA"
05%
20%
35%
50%
65%
80%
95%
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"EHCS"
95%
80%
65%
50%
45%
20%
05%
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"HCA"
10%
25%
40%
55%
70%
85%
100%
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"EHCS"
90%
75%
60%
45%
30%
15%
00%
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"HCA"
15%
30%
45%
60%
75%
90%
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"EHCS"
85%
70%
55%
40%
25%
10%
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"SI"
Self Insured
Individuals not eligible for Medicare, self employed, not employed and chooses not to be covered with their own "HCA", the money spent on their healthcare cost would not be from tax exempt money. Some states Medicaid / SCHIP programs may elect to become self insured.
As self insured individuals, doctor’s visits, hospital stays, prescriptions drugs, OTC meds and etc, would be expected to pay the bill in full at the time of visit, stay and/or treatment. The receipt from the health care provider would have all the information needed for any reimbursement that you would submit to an insurance company that was not in the “HealthCare of the “Future” system.
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"FSN"
Family Safety Net
Family Safety Net would allow funds from your “HCA” that could be transferred to another family members’ “HCA” to help pay their health needs.
Example; your adult child’ “HCA” was only valued at $10K with a $20K deductible with their “HCIP” and was in an accident that was going to cost $15K then you would be able to transfer funds from your “HCA” to your adult childs’ “HCA”. Likewise, if your brother, sister, aunt, uncle, parent or grandparent needed help funding their “HCA” you would be able to transfer funds from your “HCA” to their “HCA” .
Because your “HCA” contains “TEM” just like your IRA, 401K and other tax deferred money you would also be able to transfer some those funds into your “HCA” under the guide- lines established with the "HCC" for individuals under age 59 1/2. This could be a loan to you and would have to be paid back with interest. After age 59 1/2 you would be able to transfer money to and from those accounts without any restrictions.
If you had an IRA that had $250K in it and your “HCA” drops in value to $20K below your deductible for your “HCIP” and needed a $15K medical procedure, then you would be able to transfer $15K from your IRA, 401K or other tax deferred accounts without being subject to taxes.
Example: An individual that is terminally ill could transfer their total IRA, 401K and other tax deferred monies into their “HCA”.
Example: A married couple (two individuals) with a “family HCA" that is fully funded ($100,000.00 each) and one dies, the other could take $100,000.00 and transfer it to their IRA and be used for living expenses.
Likewise, if you have $95K in your “HCA” and a deductible of $50K to the "“HCIP”, you could transfer as much as $45K (the amount greater than the deductible amount) to your IRA, 401K or other tax deferred accounts.
Note: any funds removed from your IRA, 401K or other tax deferred accounts would be subject to taxes due at that time if not put in an “HCA” .
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"TR"
Tort Reform
All federal Law and regulations pertaining to Medicare would be rescinded / repealed and medical litigation would become a state issue. State would have the ability to set up medical finding boards with doctors and healthcare personnel to review each case to see if there was malpractice before heading to court. If an individual wanted to bring a malpractice suit, without the use of the medical finding board or if the board found against the individual they would still have that ability to the suit but the loser would pay all court and lawyer fees. This would cut down on frivolous law suits.
Note: No “HCA” monies can be used for legal fees.
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Medicaid/SCHIP
Medicaid/SCHIP would be moved under state control without Federal jurisdiction or control and any tax money collected to support the Medicaid/SCHIP would be transferred back to the state of origin.
States could have three options for their Medicaid / SCHIP programs:
1. To continue the State’s Medicaid / SCHIP programs system as it is today (because under the “HealthCare of the Future” “HCA” health care providers would not have insurance or billing office staff), the state would have to have their own medical providers (Doctors, clinics, urgent care centers, hospitals, emergency rooms, trauma centers, nursing, long term nursing/assistance care, mental health professionals, medical laboratories, physical therapy, etc., just to name a few) that would accept payment that meet the pay scale of the State’s Medicaid / SCHIP programs. The bureaucracy that the health care providers have to deal with today would continue to drive up the cost of healthcare.
2. Self insured would mean the State’s Medicaid / SCHIP program would have to issue each of the individuals a debit card to pay for the services at the time of service, because most of the health care providers would not have a billing or insurance office staff.
3. Join in with the private sector with an “HCA” and take advantage of the benefits
"CS"
of the “HealthCare for the Future" concept. The state would take the place of and perform the same functions that a “HCA”s
"HCPSC"
provides: 1. Issue a
“MIC”
, 2. Debit card account, 3.
“HD”
Insurance policies and 4. Where and how the individuals health records are being kept.
The individuals’ “MIC” would be the debit card to pay for health care at the time of service, also your “MIC” would store your medical records. A “MIC” would be used the same as the “MIC” issued by an “HCPSC” .
For those states joining the “HealthCare for the Future" concept:
How could the state fund the individuals’ “HCA” ?
--funding, 10 % of the value of funds derived from any (local, state, federal) government agency (welfare, housing, food stamps, etc) would be deposited into the individuals “HCA” also 10% of the individuals income and the value of their employers medical costs for that employee.
---by funding their “HCA” that way, they would be spending their own money, their “HCA” would stay with them when they were no longer eligible for Medicaid / SCHIP. Their “HCA” could also benefit from
“FSN”
. There would be no restrictions other than what is in
“FF”
and
“I&W”
.
How could the state fund the individuals’ “HD” insurance plans?
- “HD” insurance policies would be paid for by The State’s Medicaid / SCHIP program funds.
--the number of Medicaid / SCHIP participants, the amount of money the state has to fund the Medicaid / SCHIP program and the cost of the “HD”insurance plans would determine the deductable amount of the plan.
---Example: if the state has $1B in their Medicaid / SCHIP program, and there were 300,000 individuals in the program. The state might be able to provide a $15K “HD” insurance policy for $1,500 per-year. That would leave the state nearly $2000.00 per Medicaid / SCHIP participant.
Individuals requesting coverage from State’s Medicaid / SCHIP programs would be required to attend an orientation class about their “HCA”. The class would include how it is funded, what it covers, how to take advantage of going to a doctor’s office, a “walk-in clinic” for non life threatening conditions VS “urgent care” for more serious / urgent medical conditions and only use the “ER” for emergencies / life threatening conditions for cost consideration of their “HCA” .
The individuals’ “HCA” remains with them when they transition out of the Medicaid / SCHIP program.
An individual that transitions into the State’s Medicaid / SCHIP that already has a “HCA” would continue to use it.
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"CS"
Cost saving actions;
Government and the AMA should encourage/allocate more doctors training, by calculating the number of doctors retiring each year they should allocate 120% of that number each year. Likewise the government should encourage the establishment of more “walk-in clinics” and “urgent care” centers for non-life threatening cases.
First: Patients seeking routine “health care” should first consider using their personal doctor's office or a “walk-in clinic”; the cost of these services should cost less than urgent care or at a Hospital ER.
Second: When their condition is more serious but non-life threatening they should consider going to a “walk-in clinic” / “urgent care” center.
Third: Emergency rooms are for emergencies / life threatening conditions and cost more per visit.
Cost saving with your "HCA"
Insurance companies:
-Would be required to be in at least 3/4 of all states and each state would have at least 2/3 of all insurance companies
-Individual plans would be gender specific, male or female with four age groups (0 to 18, 18 to 45, 45 to 65 and 65 +), family plans could not only include 0 to 18 year old, but older individuals that are their dependents. Group plans would include individuals with a common interest (unions, clubs and etc) for a discount on their premiums.
--Each plan would cover all procedures listed as a requirement by the "HCC"
---The list of requirements would not include female procedures in a male plan or male procedures in a female plan, likewise a 65+ age plan would not have pre-natal care or a female plan to cover prostate care
-All plans would be the same from company to company, individuals would choose the company, and insurance companies would not be able to refuse individuals with or without pre-existing conditions
Labor cost saving for the insurance companies
-Because insurance companies would not have to give pre-approval for any coded procedures the insurance company’s work force could be reduced likewise because the companies would not have to process applications from individuals. The work force could be reduced even more. Because of the lower labor cost and more competition insurance plan premiums would be lower.
Health care providers:
Health care providers would save on office staff, labor costs, office space, office equipment (desks, computers, etc).
-Health care providers would be paid at time of service
--The requirement for a billing and/or an insurance department in their office staff would be eliminated
---No requirement of getting pre-approvals so record-keeping of insurance forms, submission data and/or receipt of insurance payments
--There would be no need to send out bills because payment was made via debit card at time of service
Labor cost saving for the Health care providers
-Because health care providers would not have to submit forms, record payment or get pre-approval for any coded procedures from insurance companies, office staff may be cut by as much as two thirds. Health care providers would be able to provide services at a lower cost to the patients. Because of the savings, their cost for their services would be lower to stay competitive. The same would be by any other medical providers.
-Because of the tort reform in the "HealthCare for the Future", health care providers’ malpractice insurance premiums should be much lower; these savings could be passed on in lower procedure costs.
-Health care providers would not be expected to provide their services to charity so their fees would represent the true cost of their services and not inflated to be paid for by others.
Business owner:
Businesses that provide health insurance benefits for their employee
-Employer with HR department, the personnel that manage the insurance benefit could be eliminated.
-Employer would either pay the employee for the cost of their health benefit into their pay check as a pay raise or directly into the employee "HCA"
-The cost saving in the HR department would increase profits` and share values.
Federal Government:
Would be able to eliminate the 16K IRS workers hired for ACA, unknown number of workers eliminated from H&HS that was hired for the ACA, tens of thousands of ACA navigators. Federal employee that manages the Medicaid program would also be eliminated because the monies would return to the states for them to manage. Cost savings to the tax payers by removing those workers could be substantial.
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Goals
1 Encourage quality medical care
Doctors could practice medicine for the care of the individual, instead of defensive medicine, complying with ever growing / changing government regulations.
2 Individual financial responsible
Individuals would have to make a decision on what care they are willing to pay for themselves (not what they think someone else will pay for)
3 Thwart Medical care fraud by providers
The receipt when using the “HCA” debit card would show the individuals name & ID number, the name, medical code, cost of all procedures for that visit. The individual could go on the providers’ web site to verify what they had paid for was in fact the services received.
Also on the receipt would be the balance of their “HCA” along with two prior medical codes, name of and the date of those procedures. The individuals could then check their account online to see if the charges were indeed theirs.
This type of receipt should prevent billing for services that were not provided, misrepresenting the service provided “Upcoding” charging for a more complex or expensive service than was actually provided.
Note: Insurance fraud would greatly be reduced because the individual would be paying the high deductible portion prior to any cost to the insurance plan.
Any fraud by the individual patient would be fraud against themselves because it is their money that was paid into their "HCA".
PS: Medicare fraud
"MF"
is estimated to cost Taxpayers as much as $60 billion annually or even more about Medicare, Medicaid and Medical Insurance Fraud
4 Promotes competition
Due to the requirement of health care providers to have a web site that lists by name, medical codes and costs of all procedures, services, the individual can choose what provider they go to.
Insurance Companies would be in at least 3/4 of all 50 stateds and 2/3 of those companies would be in each state.
5 Alleviate the ever growing Government bureaucracy
By moving to the “HCA” system it would do away with all federal government personnel that were involved with Medicare. Some of those personnel would move to the contracted out Medicare system for some time but no longer then twenty years.
6 Tort Reform
All federal Law and regulations pertaining to Medicare would be rescinded / repealed and medical litigation would become a state issue. States would have the ability to set up medical finding boards with doctors and health care personnel to review each case to see if there was malpractice before heading to court. If an individual wanted to bring a malpractice case, without the uses of the medical finding board or if the board found against the individual they would still have that ability to sue but the loser would pay all court and lawyer fees. This would cut down on frivolous law suits. Note: no “HCA” monies can be used for legal fees.
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PROs
By paying with a “HCA” debit card the transfer of funds into the providers account is immediate. Once the deductible portion is met the insurance will cover the costs of any procedures, services that are within the limits of the individuals’ insurance plan, costs above that will come out of the individuals “HCA” or pocket.
By consolidating medical coverage under one insurance policy, it would eliminate Medicare Parts “A”, “B”, “D”, Medigap or personal policies.
Note: Doctors’ office staff will not have to file insurance claims under the “HCA” system.
Government and the AMA should encourage/allocate more doctor's training and encourage the establishment of more “walk-in clinics” and “urgent care” centers for non-life threatening cases.
First, patients seeking routine “health care” should first consider using their personal doctors office or a “walk-in clinic”; the cost of these services cost less than urgent care or at the ER.
Second, when their condition is more serious but non-life threatening should consider going to a “walk-in clinic” / “urgent care” center.
Third, emergency rooms are for emergencies / life threatening conditions and cost more per visit.
Fourth, eliminate the tax payer costs of thousand of IRS agencies to enforce the taxes in the ACA, also the tax payer costs of hundreds of thousands of ACA navigators.
CONs
This would be a "CON" for congress, they would lose control over our healthcare.
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Visitors
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HEALTHCARE for the FUTURE