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Phia Group Media


Trump’s Healthcare Bill Failed… Here’s Why
By: Adam Russo, Esq.

The fact that Trump’s healthcare bill failed is big news and now everyone in Washington and in the media is trying to place blame on someone, whether it’s president Trump, Speaker Ryan, the Freedom Caucus or the Democrats. The reality is that this bill would not have worked and I believe that no bill passed in the next few years will work either and the reason is simple. Neither the Democrats nor the Republicans are willing to truly lower the overall cost of healthcare.  The only way that we can have a successful health plan for all Americans is by fighting the root of the problem – the ridiculously high priced hospital and other facility bills and the huge sticker prices on specialty drugs.

There is an easy solution – force the hospitals to justify their charges and negotiate with the pharmaceutical companies on what they can charge. However, the politicians in Washington will never do it because these two entities are the reason they are in DC in the first place. They fund the campaigns, they feed the lobbyists, they are the biggest employers in most representatives’ districts.  They will never push them or fight them or even question them because they need them. If you are a politician and the largest employer in your district that employs the most people is the hospital, then are you really going to criticize their practices? Hell, no! Until this changes, we will see the same games being played as they are now. That’s why we are here at The Phia Group, because we are not afraid to criticize, to fight, to question and to ensure that our clients can offer their employees the best health care coverage at the lowest prices possible.

Concerns about Health Care Coverage Mandates
By: Brady Bizarro, Esq.

One of the biggest unknowns of the Trump Administration’s health policy priorities is whether or not the new administration plans to repeal the individual and employer mandate. The White House has already directed federal agencies to “ease the burden” of ACA regulations on employers. Ditching the employer mandate would significantly change the landscape of employer-provided insurance, and it is something we will be watching closely.

Egregious Billing Hits the Common Man – Who Now Has a Place to Vent Their Frustration
By: Garrick Hunt

For those of us who are embedded in the health care industry, we know that the greatest issue with health care in America is the price tag. For the average American, health care is all about “what’s my out-of-pocket going to be?” Just recently a friend of mine, an average America to be sure, took to social media and went on a tangent about their bill. He was completely dumbfounded as he read through each line item…I laughed a little, unfortunately, this is the state of the industry.

The Big Elephant in the Room….
By: Michael Branco

From day one, over 16 years ago, we have offered overpayment recovery services, but over the last year, I have seen the largest growth in this service. It’s not enough to simply make a call or send a letter, and it’s okay to have that uncomfortable conversation with your client on why an overpayment occurred.  Ignoring the issue is no longer an option.

Want to improve health care? Focus on hospitals
By Rich Lesser & Barry Rosenberg

(CNN) As Congress and the Trump administration debate the future of America’s health care system, they should go beyond the issues of access and cost and recognize an equally important priority: that patients come first, so health reform should also focus on quality of care.

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The ACA, a New Congress, and President Trump – Oh My….
By Tim Callender, Esq.

On Friday January 20th, President Donald Trump signed his first executive order, directing agencies to give more leeway to the states in the way that states implement (“carry out”) the Affordable Care Act.  It appears that this executive order is primarily a precursor of things to come and is an attempt to set general expectations as to healthcare policy under the Trump Administration.  At its core, the order provides a sweeping mandate, directed at the heads of agencies that administer the ACA, to find ways to ease the financial burden of the ACA.  Specifically, the order does mention the Department of Health and Human Services, soon to be headed up by Representative Tom Price.  As all of us in the industry know, HHS might be the federal agency most impacted by the ACA.  HHS’s actions, or inactions, under this order will likely guide the IRS and the DOL, the other two federal agencies primarily guiding the day-to-day execution of the ACA.


Many pundits have already spoken up, concerned, or pleased, that this marks the end of the individual marketplace (aka The Exchanges).  Truth be told, whether a support of the ACA and its marketplaces, or not, it seems that all would agree the marketplaces have seen significant troubles and the sustainability of the model has been in question for some time.  Is this the piece that truly spells the end of the ACA marketplaces?  Perhaps it is.

But, as in all things coming from Washington D.C., we will have to wait to see the true, logistical impact of this broad, executive order.

In addition, GOP Senators Bill Cassidy (R-LA) and Susan Collins (R-ME) recently released one Republican-led proposal that may be introduced as a replacement to the ACA.  Among the highlights of the plan are measures allowing states to continue with the ACA, should they “like it” – whatever that means.  Additionally, the proposal appears to urge pricing transparency on medical procedures, while also allowing for the existing subsidies and tax credits provided in the 2010 law to remain intact.  This proposal seems to be a mid-ground departure from many other GOP plans, in that it seems to allow for many aspects of the ACA to remain in place.

The most interesting aspect of the Cassidy-Collins proposal is an item that would appear to push all uninsured residents into a federally subsidized catastrophic plan, through auto-enrollment.  Good idea or bad idea – I don’t know.  But, it feels like an interesting departure from the typical, market-driven, free-choice arguments that conservative lawmakers usually provide when discussing healthcare.  Then again, perhaps the focus on a catastrophic plan narrows the concern that this “forced” auto-enrollment would be replacing market-driven free-choice in that a catastrophic plan would not cover many of the day-to-day health needs that a plan member might want, thus pushing him or her to explore additional, private options for their routine coverage.  Perhaps the genius of this “forced” catastrophic move is that it takes a good deal of the risk off of the primary insurer thus causing those costs to decline?

It all remains to be seen.  Stay tuned as we watch, digest, and continue to comment on the upcoming changes affecting our industry.

Why Trump’s Obamacare Promise Will Be So Hard to Keep
By Margot Sanger-Katz

As a candidate back in July 2015, Donald J. Trump promised that he would repeal Obamacare and replace it with “something terrific.”

The Senate voted, 51 to 48, on Thursday morning for a measure setting Congress on the path toward repealing President Obama’s health care law, and Mr. Trump is now a few days from taking office. The public, however, knows little more about his proposal than it did in 2015.

Opinion: I’m a former health insurance CEO and this is what Obamacare repeal will do
By J.B. Silvers

There’s a joke among insurers that there are two things that health insurance companies hate to do — take risks and pay claims. But, of course, these are the essence of their business!

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