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Judge OKs Obamacare form

from The News Service of Florida:

An administrative law judge Monday dismissed a challenge by the advocacy group Florida CHAIN to a form that would be sent to insurance customers about the estimated impacts of the federal Affordable Care Act on health-care premiums.

Florida CHAIN, which supports the federal act better known as Obamacare, filed the challenge against the state Office of Insurance Regulation, which has carried out a new state law requiring the form. Florida CHAIN contended that the form, which was developed through an administrative rule-making process, is invalid for a number of reasons.

As an example, the group said the premium amounts included in the form would not take into consideration tax credits that many people would be able to receive under the federal law.

But Administrative Law Judge John Van Laningham, in a 25-page order, found that Florida CHAIN and its policy director, Greg Mellowe, did not have legal standing to challenge the form. Van Laningham wrote that Florida CHAIN, which offers insurance to its employees, and Mellowe had not shown they would be injured.

Also, Van Laningham wrote that receiving the form would not require Florida CHAIN to rely on it.

"Nothing in the statute indicates that the purpose behind it was to assist recipients of the notice in making decisions about the purchase of insurance,'' the judge wrote. "The statute was instead clearly designed to educate Florida citizens about Obamacare, presumably to shape public opinion concerning that controversial federal law, whose very existence remains, as of this writing, a matter of intense political debate. While information about the estimated impact of Obamacare on monthly premiums might possibly influence some notice recipient's decision regarding the purchase of health insurance, such a result would be plainly incidental to the statute's purpose."

Comments

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Thomas Cox PhD RN

While the challenge mounted by Florida CHAIN was worthwhile Florida Chain might better spend their time educating the public about how our health care finance systems work, or rather fail to work (See for example: "Standard Errors: Our Failing Health Care (Finance) Systems And How To Fix Them" available at http://www.standarderrors.org/.)

The real problem with our health care finance system, and which the PPACA does not correct, is that our hospitals, physicians, nursing homes and home health agencies are the real insurers. Health care finance schemes, such as capitation and the Medicare/Medicaid Prospective Payment Systems, pay health care providers in blocks of money. If, as is unlikely to happen, the health care provider incurs higher costs to treat than the block payment, the provider loses money on the transaction. If, as is far more likely to happen, the health care provider incurs lower costs to treat than the block payment, the provider gets a profit on the transaction.

But the key is that the provider, not the distant insurer or Medicare/Medicaid is managing the insurance risks involved. This is very bad because small insurers manage insurance risks very poorly. As a result, small insurers tend to have either very good, or very bad outcomes, often earning wildly excessive profits and at other times, incurring severe operating losses.

Risk assuming health care providers are not protected from these potential losses so they do what one would expect - cut the level of service they provide to protect against such losses.

Take health care providers out of the insurance business and we not only restore ethical balance, but we can actually provide more care at lower cost.

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