Medicare Advantage is the most popular health plan in the United States. Extending it to everyone will lower our National Healthcare GDP
by over $1.3 Trillion Dollars by eliminating just half of our chronic illness.
A Medicare Advantage For All Plan
A Medicare Advantage For All Plan is an idea that's time has come! Now that SCOTUS has upheld the ACA statute, nothing is going to be done to lower the cost of health care or cover the over thirty million plus uninsured American or improve the health and welfare of the low-wage and under served minority communities, that are covered by the ACA.
Biden has successfully opened the federal ACA marketplaces and increased the ACA enrollment for the first time in 8 years. Covid drove a lot of people into the ranks of the unemployed and this fueled ACA enrollment in 2022. Federal ACA enrollment went from 8.3 Million to over 10 Million, demonstrating the real need many Americans have for health insurance and their willingness to pay for it when it is unavailable through their employers.
The democrats have tried to expand the age qualifications Medicare. The ACA is Nancy Pelosi's darling. Senator Bernie Sanders wants his Medicare for All Plan. And, Kamala Harris, fortunately for us, at the beginning of her campaign listened to Kathleen Sebelius, former head of HHS. AQs a candidate for President, Kamala was originally in favor of a Medicare-Advantage-For-All proposal, before being pulled into Bernie and now Joe's directions. Both Joe and Kamala were generally in favor of the HR 1425 Public Option, which would potentially undermine all employer sponsored private health insurance programs. Needless to say, the powerful health insurance companies are heavily in favor of the ACA and democratic approaches to fixing things. Any threat to their near monopolistic control over the current health insurance marketplace will initially be challenged.
The saving grace of Medicare-Advantage-For-All is the fact that the health insurance companies like the Medicare Advantage program business and they have gotten really good at it. In the early days of Medicare Advantage, the health insurance companies were almost saving more money than they were charging the federal government in expenses. From the beginning of the program they have been paid a capitation reimbursement that has allowed them to save money by lowering the cost of health care for their memebers, while holding the capitation rates at less than what it would have cost the Medicare program to cover the people for whom they would otherwise have been responsible. As a result, the members were healthier, the insurance companies were making more money and the federal government was saving money; all at the same time. This is how Medicare-Advantage-For-All will work. The insurance companies and the democrats will eventually come around to supporting our Medicare Advantage For All plan, if We the People force their Representatives to make them do it. It is ultimately in their best interest.
Our Medicare Advantage Plan will enable affordable, comprehensive, cost-effective health insurance for All Americans. It will take advantage of Trump's Executive Orders on Improving Price and Quality Transparency in American Healthcare, which have so far survived the Biden administration. We desperately need this kind of health reform to put Patients First in the United States! The CDC says that Ninety-four percent (94%) of Americans dying with the Covid virus have comorbidities. Our former Surgeon General claimed that Native Americans are 3 times more likely to die and Black Americans are 4 - 5 times more likely to die than whites from COVID-19. Our low-wage workers and minority communities suffer Covid deaths in much higher proportion to white middle and upper class Americans because they are over-weight, have diabetes, heart disease and many other chronic illnesses, resulting partly from stress, poor diets and a lack of exercise. The Urban Institue has been documenting these problems for decades. Most experts think that the working-poor's lack of access to medical care through health insurance is a major contributor to these excess deaths and can be a major solution to improving their overall health status. The hands down positive thing that the ACA does for Americans is increase the number of people covered by health insurance. There is no question that having more people covered by health insurance is a good thing. But, it is the kind of health insurance that will really make the difference in the cost of health care. The ACA does almost nothing to improve the health of their subscribers. However, Medicare Advantage does tons of things to improve the health of their insured population, because the insurance companies make more money when they do that. under the ACA, they make more money when they cover more people and they pay fee for service for all of the things they need. And, if they haven't had health insurance and they haven't been taking care of their health, they need a lot! This is a NO BRAINER and every expert in this industry understands these facts. The health care providers and the health insurance companies do not want a healthy American population. They want the government to pay for more sick people and our politicians are in the business of obliging them. And, so it goes.
In order to pass any major health care legislation, we need at least 218 votes in the House of Representatives and 60 votes in the Senate. Before the Wuhan virus came to our shores, we had 293 of the members of the 116th House of Representatives and 60 Senators ON-RECORD supporting Medicare Advantage! Their support for Medicare Advantage For All is obviously the Best bipartisan solution to our problems! On June 11, 2020 Steve Forbes writing under the banner of - MEDICARE ADVANTAGE FOR ALL CAN SAVE OUR HEALTH-CARE SYSTEM - endorsed our solution to the need to provide affordable health care for the American people. We have been promoting this idea for three years. The article written by George Halvorson, former CEO of Kaiser Permanente, and Dr. Mehmet OZ, that can be found at: https://www.forbes.com/sites/steveforbes/2020/06/11/medicare-advantage-for-all-can-save-our-health-care-system/#1b1e2c694d12 proposes our Medicare-Advantage-For-All solution as a quick and comprehensive way to provide Americans with Universal health-care coverage and better health care, especially for poor and underserved communities! The article was written as though the authors writing it from reading this web site.
But, we can't get this program implemented because the political parties are too polarized, and they can't agree on anything! The only way we are going to stop the bleeding and start saving lives is with a change the political parties orientation in both the House of Representatives and the Senate! Nancy Pelosi will allow mild debate on Medicare for All, but nothing but nothing that doesn't have ACA written on it will ever go to the floor of the House for a seriuos vote. Mitch McConnell eats his lunch at Humana when he is in Louisville, KY. The last administration thought that the HR 1425 Public Option was simply doubling down on the same expensive, inefficient and burocratic approach to health coverage that has failed well over 30 Million Americans with unaffordable plans, high deductibles and coinsurance and did nothing to improve their health and well being of the American people. The House Republicans have adopted a Framework (see details below) for Personalized, Affordable Care, which allows for Short Term Plans, Faith Based Programs, Association Health Plans and health inusrance options like Medicare Advantage for All. This Framework could include a Public Option. A "Framework" of this nature could become the key to the compromise that "We the American People" need to change the whole system and save lives?
Birth rates and life expectancy are critical markers for the overall health of a nation. Our health care needs are being violated. Our babies are dying at a rate that is 71% higher than comparable nations. A new U.C. Berkeley study shows that if we survive the neonatal period and live to age 25, those of us who are working in every income bracket and of every race and ethnic background are more likely to have a shorter life span. This includes all of the opioid addiction and every other illness. This decline has been going on for the last eight years. Like Influenza, this is the silent epidemic.
Our OASDI Medicare Fund Trustees have notified the Trump Administration that the Medicare Trust Fund will have to rely on the general fund, rather than payroll-tax revenues starting in 2026. The Medicare Trust Fund now covers almost 58.7 million seniors. And, in 2030, the T.H. Chan School of Public Health at Harvard projects that Fifty percent of all Americans will be obese, and one-quarter of those Americans will be grossly obese. Also, in 2030, the number qualifying for Medicare will have almost doubled. This is the BOMB the American people are sitting on! This situation is as serious as the Coronavirus, and we must act as boldly to defuse it.
Now we vote for politicians who tell us they care about our health. We spend $3.65 Trillion Dollars a year, yet our elected officials and presidential candidates pursue proposals that will NOT pass the House of Representatives or the Senate. In the meantime, our babies are dying, our productive lives are being cut short, and we are getting so fat that we have a crisis with chronic illness. Medicare is running out of money. And, now, on top of it all, we have the Coronavirus. This is absolute insanity. We Americans must wake up to the fact that we are collectively being screwed, and we need to clean house.
THE PROBLEMS: AMERICANS ARE SITTING ON A BOMB
30.9 Million Uninsured: The Kaiser Family Foundation estimated that 27.9 Million were uninsured in 2018 before COVID-19. This number had reached one of it's lowest points ever, under President Trump's pre-pandemic economy. Even Medicad enrollment declined for ther first time ever. CMS recently estimated that Obamacare enrollment for 2020 has declined (by 100,000) again for the fourth straight year, despite some premium rate decreases. The CBO previously projected that the number of pre-covid uninsured Americans will increase to Thirty-five (35) Million by 2030. We are still on this track.
Medicare Bankruptcy: Old-Age Survivors and Disability Insurance (Social Security) Trustees project that the Medicare Trust Fund for 58.7 Million retired Americans will be 100% BROKE BY 2026! Unfunded - Seniors will lose their Medicare.
We are the #1 Spender: The United States is the Number One national spender on healthcare, but We The People are being ripped off. Our babies are dying unnecessarily, our productive life spans are shorter, and we are not healthy. The World Health Organization says the United States is only 37th in health quality. We have just appropriated $8.3 Billion Dollars to fight COVID-19 Coronavirus and Billions more to support our health care workers in their fight, but we need to give our health care workers a healthier population to heal. We can not keep paying for poorer health.
Coronavirus Pandemic: We see a fair amount of fear and panic over the Coronavirus Pandemic. The public concern is made worse by the fact that many Americans have NO secure relationship with a primary care physician. A recent national study showed that in 2016, forty-six percent (46%) of Americans aged 18 to 64 did not have a primary care visit in any given year. This is up from 38% in 2008. Among those aged 18 - 34, the percentage of Americans NOT seeing a primary care physician increased to fifty-seven percent (57%). Consequently, the level of concern Americans have over the COVID-19 Coronavirus is heightened. Americans are turning to Emergency Rooms for primary care. Ninety percent of the COVID tests are NEGATIVE! Health professionals fear that our vital health care system will be overwhelmed. Even though most of these people do have health insurance, they either have a very weak or NO relationship with a primary care physician. A personal relationship with a primary care physician is the very foundation of good health in America and necessary to our success in combating viruses like Corona. The Trump Medicare Advantage plan will reverse this situation by encouraging Americans to establish such relationships and incentivizing primary care physicians to engage their patients with predictive preventive medicine that will reduce the cost of health care across the board.
Coronavirus Death Rates: We have just appropriated Billions of Dollars to fight COVID-19, but we are not giving our health care workers a healthy population to heal. 94% of COVID death are Americans with underlying medical conditions. Blacks are 4 - 5 times and Native Americans are 3 times more liely to die than healthy Americans. The Coronavirus death rates suffered by all our citizens with Cardiovascular disease are higher by 10.5%, Diabetes 7.3%, COPD 6.3%, and Hypertension 6.0%. However, of those Americans with Covid and No underlying medical conditions, only 6% die. The failure of our health care system and our ill health was killing us before this virus hit, and the Covid-19 has made this situation even worse.
Baby Deaths Increased: The Kaiser Family Foundation - Peterson Partnership recently posted the fact that the United States has 63% more neonatal deaths and 90% more postnatal deaths than other comparable countries with similar GDPs. In the last two decades ending in 2017, our infant death rate declined 40% more slowly than all these other nations. In total, our babies currently die at a rate of approximately 71% higher than our competitor nations, and our infant death rates have increased (not decreased) in 2018 and probably 2019. That is why President Trump asked Congress to approve an additional $50 Million Dollars in 2020 to fund more neonatal research. Trump has committed to fighting aides, neonatal death rates, and now COVID-19. We need a Trump Medicare Advantage Plan.
Average American Death Rates Increased: The National Institute of Aging and U.C. Berkely recently uncovered the fact that all Americans aged 25 - 64 have increased rates of death from ALL causes. These increases shockingly affected all racial and ethnic groups in the seven years ending 2017. This Study's lead author was quoted as saying, "The whole country (U.S.) is at a health disadvantage compared to other wealthy nations. (U.S.) Employers have a sicker workforce." We are not only sicker; we are dying earlier than in comparable nations that spend much less money than we do on health care. With the neglect of Congress, our politicians have failed "We the People." We need legislation to implement a Trump Medicare Advantage plan modeled after the current Medicare Advantage plan, which is a program that really works and allows us to stop this decline.
Americans are Overweight: The National Institutes of Health says 2 out of 3 (66%) Americans are currently overweight, and the CDC reports 40% of the U.S. population, approximately 124.4 Million Americans are obese! On December 18, 2019, the Harvard T.H. Chan School of Public Health released a study predicting American obesity will increase to 50%, a quarter of which will be severe obesity by 2030. This epidemic will affect over 40% - 60% of the population in every state in the union. Obesity is partially responsible for our early infant death rate. The senior author of the Harvard Study, Steven Gortmaker, said, "Obesity and especially severe obesity are associated with increased rates of chronic disease and medical spending, and have negative consequences for life expectancy." Amen!
Chronic Disease Epidemic: The CDC says that Ninety percent (90%)of the U.S. National Health Care GDP (90% = $3.285 Trillion Dollars in 2018) is spent on the treatment of chronic illness, most of which is preventable. Most medical professionals estimate that 80% of this risk can be reduced or eliminated with better medical care. We believe that a Trump Medicare Advantage plan can be structured to reduce 50% of chronic illness in the United States. The Trump plan will include an integral health and wellness program that will lower our National Health Care-GDP by $1.3 Trillion Dollars to 12%, by reversing or eliminating half of the chronic illness conditions from which we suffer.
High Cost of Health: In 2018, in the United States, we spent $3.65 Trillion Dollars. That amounted to 18% of our total GDP. The Congressional Budget Office (CBO) expects that to increase by 5.5% annually through 2030, at which time our over age 65 population will double more Americans will be uninsured, and with Corona and other viruses, our chronic illness cost will "EXPLODE." The sage of Omaha, Warren Buffet, says, "We can NOT continue to do the WRONG thing indefinitely."
Seniors Will Lose Medicare: It has been clearly demonstrated by the cost estimates of Senators Bernie Sanders and Elizabeth Warren that their Medicare for All proposals would have created a financial burden on the American people that will ultimately deprive Medicare beneficiaries of the health insurance plans they have today. There is no politician on the face of this earth, not even President Donald J. Trump, who can credibly promise that our seniors will be able to keep their plans, especially if we nationalize healthcare! And, unless we start to do the RIGHT thing and support a plan that puts the health of the American people first, NO American will be able to afford to keep their health plans.
ACA will be Declared Unconstitutional?: In 2020 the Affordable Care Act (Obamacare) without the Individual Tax Mandate will be declared unconstitutional by the United States Supreme Court. Most lawyers think this will not happen, which is why we think it is a virtual certainty! On December 18, 2019, a federal Appeals Court recently ruled Obamacare's 'individual mandate' is unconstitutional, but other parts of the law still require further legal review. We need to get behind a viable bipartisan alternative. We believe a Trump Medicare Advantage Plan For All is the answer.
Trump Medicare Advantage For All is the right answer: "WE THE PEOPLE" must hold to our True American Values and not let the government take over our health care. We must demand that the federal government reduce the cost of our health care by IMPROVING OUR HEALTH, well-being, and productivity. There is no question that our future competitiveness as a nation depends upon this! Just as we are the only ones that can prevent us from getting Coronavirus, we are the only ones that can be responsible for our health. That is the lesson of the recent Teflon movie "Dark Waters," and it is true in everything we do.
NOTHING is more important than OUR health! We must get our elected officials to accept and support our uniquely American health care system and help us get the "Better" Health and the "Better" Health insurance that we deserve!
Join Us! Go to the "About Us" page and sign up. Help the United States to continue its prosperity and work for truth and justice in the free world. We can not do this without "YOU" and with you being in the BEST health of your life! Medicare Advantage is the most popular health plan in the United States, and President Trump extending it to everybody will NOT happen without YOUR HELP!
MEDICARE ADVANTAGE IS THE MOST POPULAR HEALTH PLAN IN AMERICA
Medicare Advantage (MA) enrollment exceeds 22 Million Americans, which is well over twice the number of ACA (Obamacare) participants. Medicare Advantage is THE FASTEST GROWING HEALTH INSURANCE PLAN IN AMERICA, adding thousands of new members aging into the program daily. Extending Medicare Advantage to everybody will NOT happen without YOUR HELP!. If an American qualifies for Social Security (SSI) and is over age 65, they are eligible for Medicare and Medicare Advantage. If you are NOT eligible for SSI, you are eligible for Obamacare. While Medicare Advantage enrollment exceeds 22 Million Americans, roughly 38% of all Medicare's eligible, Obamacare covers have just 8.4 Million, which is less than 22% of its eligible population. The big difference between NOT choosing Medicare Advantage vs. Not choosing Obamacare is the non-Medicare Advantage people are usually covered by Medicare. Those that do not choose Obamacare are usually uninsured. They go without health insurance altogether, and they are NOT covered.
ACA (OBAMACARE) IS THE MOST EXPENSIVE HEALTH PLAN ON EARTH
COMPARISON OF TOTAL OBAMACARE (ACA) COST WITH MEDICARE ADVANTAGE (MA) AND MEDICARE (MFFS) EXPENSES
| YEARS | ACA 2015 | MA 2015 | MFFS 2015 |
|---|---|---|---|
| A M EARNED TOTAL COST (Billions) ACA & MA 1.+2. & MFFS 4. |
95.9 | 173 | 549.3 |
| CSR PAYMENTS (Billions) 1.Milliman |
5.7 | 0 | 0 |
| REINSURANCE (Billions) 7.Harvard |
7.8 | 0 | 0 |
| RISK ADJUSTMENT (Billions) 1.Milliman |
4.8 | 0 | 0 |
| RISK CORRIDOR (Billions) 1.Milliman |
5.9 | 0 | 0 |
| TOTAL COST/BENEFIT (Billions - Sum) |
120.1 | 173 | 549.3 |
| TOTAL ENROLLMENT (Millions) ACA & MA 3. & MFFS 5. |
9.1 | 17.8 | 55.3 |
| ANNUAL COST/BENEFIT PER MEM. 6. | $13,198 | $9,719 | $10,419 |
In 2015 the ACA cost eclipsed the annual Per Member cost of the Medicare Advantage plans (and Traditional Medicare) by over 35%. Although the 3 R’s: Reinsurance, Risk Adjustment, and Risk Corridor which were primarily responsible for the 2015 overage are no longer paid by the federal government, the Per Member Cost of Obamacare far exceeds the benefits being provided to the American taxpayers and the unsubsidized Americans, who are paying for these programs. Obamacare is NOT ONLY the most costly health plan on the planet, but it has also failed to attract the majority of uninsured Americans.
AMERICANS ARE CONCERNED ABOUT HEALTH CARE ISSUES
Eighty-three percent (83%) of Americans are struggling to pay the out-of-pocket costs associated with most qualified plans. The high deductibles and coinsurance of ACA programs require Americans to pay most of their normal healthcare expenses out-of-their own pockets. THIS IS NOT FAIR!
A MEDICARE ADVANTAGE PROGRAM
Many concerned Democrats are advocating a wholesale change to a "Medicare for All" program, as the answer to our dysfunctional health insurance system. On October 22, 2019, the House Republican Study Committee (RSC) released a plan document outlining a framework for a Personalized Affordable Health Care plan designed to encompass a variety of innovative health insurance plans. Several House members of this committee have expressed approval and interest in having a Medicare Advantage Plan for All incorporated into the plan as an option. The RSC plan also focuses on equalizing the federal tax playing field between businesses and individuals.
This framework RSC Study followed on the heels of a report entitled "Reforming Americas Healthcare System through Choice and Competiton" issued to President Trump by the Departments of Health & Human Services, Treasury and Labor and designed to get these massive bureaucracies on the same page. The RSC Framework for Personalized, Affordable Care envisions incorporating plans like a Trump Medicare Advantage For All, Direct Primary Care plans Rand Paul's Association Health Plans, and the Short-Term Health plans that have enjoyed a popular resurgence and Health Care Sharing Ministries plans. All of these health plans are practical ways to make health care more affordable for the American people.
Both political parties are united on the need to improve the health insurance system, especially considering that the Medicare Trust Fund is running out money. The main hang-up seems to be deciding on who is going to pay the claims. Obviously, Republicans think this should be up to the experts that design these health plans, not the government. So, what will a Trump Medicare Advantage Plan look like?
The Biden administration needs to draw on the experience of the current Medicare Advantage program, which is the most popular health plan in the United States. It has demonstrated impressive cost savings and improved quality of care for seniors. Humana's most recent 2019 Value-based Care Report is a good example. Humana has documented improved quality of care with its value-based approach while saving Millions of dollars over the cost of traditional Medicare. The Trump Medicare Advantage for All plan should incorporate all of the objectives in the RSC framework for Affordable Personalized Care and require that certain federal guard rails are observed by the health insurance companies and health care providers that develop these plans.
Each jurisdictional state government will be asked to approve their own programs in the same way that each of the states now has its own Medicaid programs. The state-based programs have been referred to as the incubator approach because each state will be able to develop systems that suit their particular population, and innovative, successful characteristics can be shared among the states. This was also the approach proposed by the last Republican health reform effort in the Graham-Cassidy bill.
PROGRAM GUIDELINES
These are the RSC program guidelines that the Trump Medicare Advantage Plan will use to PROTECT, EMPOWER AND PERSONALIZE our health insurance to improve our health status, lower the cost of our health care and make comprehensive health insurance more affordable for all Americans.
PROTECT - The Trump plan will focus on covering our most vulnerable citizens with viable Medicaid programs, Guaranteed Coverage Pools for Pre-existing Conditions, a vibrant Community Health Center network, and adequate Subsidies to make the Coverage Choices more affordable for everybody.
- Medicaid Plans- Medicaid is a vital state safety-net health insurance program for economically challenged and needy Americans. There are approximately 72 million Americans enrolled in Medicaid and CHIP, the cost of which is paid 50% / 50% by the state and federal taxpayers. The federal share is open-ended. The ACA allows for states to expand Medicaid programs. Those states that expanded their programs enrolled millions of new members. These new members included able-bodied single men, many of who were working. The expansion was 100% paid for by federal taxpayers. Medicaid was originally intended to cover poor, unemployed, pregnant women, parents, elderly persons, disabled individuals, and children. It was not intended to cover able-bodied adults who are capable of community service and gainful employment. This is why Republicans in many states have fought over work requirements for eligibility. Otherwise, the fear is it is just another give away program. Expanding Medicaid enrollment to cover this group has caused problems in the health care delivery system. The Trump Medicare Advantage plan will capitate the current open-ended federal entitlement structure of the program with per capita grants to help the states address the needs of the traditional Medicaid populations. Each state can enroll whoever they want to enroll in their program.
- Guaranteed Coverage Pools - The Trump Medicare Advantage program will guarantee coverage for pre-existing health conditions. It will require the states to set up these federally funded state-administered Guaranteed Coverage pools to cover those people with pre-existing conditions. This will lower the cost of health insurance for everybody. These Pools can also be used to help people between jobs and those that need health insurance portability to maintain continuous coverage.
- Premium Subsidies - We have 27.9 million Americans without health insurance. The Congressional Budget Office projects that this number will increase to 35 Million by 2030. Many of these people are working in low-wage jobs and cannot afford health insurance. The Kaiser Family Foundation has documented the fact that the high cost of health insurance is the principle reason they don't have health insurance. The Urban Institute has confirmed that low-wage Americans have more health problems. We believe the high cost and incidence of chronic illness is directly related to the health of our uninsured population. And, the cost of their health care inflates the cost of health insurance for everybody. The Trump Medicare Advantage plan will focus on providing needed health care services to this underserved population. The Trump plan should fund the necessary premium subsidies to make coverage affordable for every American that needs it. These subsidies should be delivered to the states in the form of flexible grants designed to match the current ACA individual marketplace subsidies and Medicaid expansion funds. This should also be the method by which all states receive federal funding for their reinsurance pools under 1332 waivers. All federal funding levels should at least match the current ACA subsidy spending.
- Community Health Center Funding - Our Community Health Center Network has over 10,000 locations throughout the country, mostly in underserved urban areas and rural communities where health care services are most needed by our most vulnerable residents. The health centers employ over 51,000 health care workers serving over 1,400 communities and are substantially supported by the federal government. The community health centers accept all forms of health insurance, including Medicare and Medicaid, but if a person has no health insurance and cannot afford to pay for health services, the health services are free. The Trump Medicare Advantage plan should fund these centers directly and arrange to sponsor a Community Health Center "Association" Health Plan Option. This proposed Community Health Center Health Plan (CHCHP) would rely on the community health centers for all primary care, like the Direct Primary Care plans and provide tertiary care to the insured population through a third-party insurance mechanism. The federal government, here to for, has been unable to offer a program that attracts low-wage workers who make up a significant portion of the uninsured population. These special programs will require participants to receive all their primary care from the community health centers (CHC) in their area. The CHC will become the sole primary care home, in place of the ER's. This program will definitely make available the primary health care they need in a more affordable manner.
- Plan Coverage Choices - Congress and the American people have got to get real about the deplorable condition of American health. We have to have a special commitment to "Make American Healthy Again." Our proposal for "Trump Medicare Advantage For All plan is all about health care, and it is all about the health of the American people. The traditional Medicare program is NOT affordable, partly because of the deplorable health condition of the American people and partly because our medical care delivery is not structured to improve our health. See our Wellness and Well Being page for more information on how we can incorporate integral health, wellness, and well-being program into the Trump Medicare Advantage plan to address this grave situation. We recommend coverage for gym memberships, personal trainers, and diet programs. Our proposal is to create comprehensive platinum, gold, silver, and bronze health plan options that cover necessary health services and reward people for improving their health status. We propose covering at least four (4) non-deductible primary care physician visits a year. Coverage for things like mental health, maternity, and various therapies that many Americans do not need will be offered as riders. We would scrap Obamacare essential health benefits because they are not essential, and people who don't need them should not be forced to pay for them. The Trump Medicare Advantage plan will also use capitation reimbursement to pay the carriers and health providers in the same way we pay for the Medicare Advantage programs now.
EMPOWER - The Trump Medicare Advantage plan should enable Enhanced Portability, unleash the power of Health Savings Accounts, provide Tax Benefit Equity, Price Transparency, Lower Prescription Drugs Costs, and Empower Providers.
- Enhanced Portability - Implementing the RSC's tax equity provisions will give everybody the freedom to have insurance plan mobility. Americans will have the freedom to buy individual health insurance after being covered by a group insurance program or a COBRA extension without the fear of losing continuity. They can take their insurance with them, regardless of whether they move jobs or become self-employed without the risk of losing coverage and having a problem with coverage for pre-existing conditions. Americans would gain greater control over their own money and their health care choices and further neutralize the issue of pre-existing conditions.
- Tax Benefit Equity - The RSC plan proposes to provide equal tax treatment in the employer and individual health insurance markets, which has contributed to high-priced health plans, overly comprehensive benefit structures, and overutilization of health care. This has fueled inflation in insurance costs and health care prices in general. We need to tax the benefits for employer-sponsored plans and for employees so that both parties have an incentive to reduce costs and become better consumers. Expanding the use of Health Savings Accounts should more than offset the additional taxation.
- Health Savings Accounts - Equalizing tax benefits will also make it possible to allow employees to use Health Savings Accounts (HSA) to pay their health insurance premiums and an expanded set of health care services that would otherwise be purchased with after-tax dollars. The use of HSAs will be allowed with all the Trump Medicare Advantage plan options as well as all of the other types of health plans. One of the keys to reducing the cost of health care is to make consumers more responsible. The RSC plan and the Trump Medicare Advantage plan would legislate increases in Health Savings Account contributions so they could be more flexible and effective for consumers' use of pre-tax dollars.
- Price Transparency - On June 24, 2019, President Trump issued an Executive Order for Improving Price and Quality Transparency to make health care provider prices more transparent to the American consumer. Obviously, as consumers bare more responsibility for the cost of their care, they need to know what they are paying for and how much their planned health services are going to cost. This is necessary so that they can make the best decisions of where to get services and from whom. Competition is the American way, and next to improved health, competition is the best way to keep provider charges under control. Transparency and increased patient responsibility are the keys to success. Dr. Marty MaKary of John Hopkins Hospital has recently written a book entitled "The Price We Pay." He believes that 20% of medical care is inappropriate, and greater price transparency is the way to reduce it. This also makes it easier for consumers to negotiate with providers and will result in lowering the cost of health care for everybody.
- Lower Prescription Drug Costs - There is a lot of controversy over the cost of prescription drugs in the United States. Our costs are much higher than drug companies are charging for the same products in other countries. More government intervention in foreign markets is a factor. Governor Ron Desantis of Florida has been urging President Trump to allow Floridians to import prescription drugs from other countries. This would significantly reduce the cost of drugs for his constituents. Trump is trying to finalize his Health 202 Executive Order to allow foreign imports but is running into some formidable opposition from Big Pharma. There are potent arguments on both sides of the issue. There are extremely high costs to do the research and satisfy the regulatory requirements to bring new drugs to our markets. We benefit, and subsequently, these drugs become available to the rest of the world. In a very real way, we are contributing to the improved health of everyone on the planet. Big Pharma's argument is that the high cost of our drugs is supporting significant improvements in medical care and our patient lifestyles. And, the industry offers even greater promise for future improvements with the promising research into the human genome. These advancements allow better diagnosis and treatment of illness and ultimately save a lot of money. The question is, how much is too much. We don't want to kill the goose that lays the golden egg. Hopefully, the powers that be will be able to answer that question in the not too distant future.
- Empower Health Insurance Companies & Providers -
- The Trump Medicare Advantage plan will require insurance companies and healthcare providers to transition to Value-Based Care by mandating the use of contracts and payment models that encourage provider risk-taking and place the responsibility for positive health outcomes firmly into the hands of the hospital and medical community where it belongs. Predictive, Preventive, and Personalized Medical Care (PPPM) will be a model for transforming medical care and incentivizing physicians to help their patients avoid obesity and chronic illness. For too long, we have been paying insurance companies and healthcare providers for piece work; the end product has been overlooked and completely broken-down. Unfortunately, the sicker their patients, the more money they made. At this point, the Emperor has no clothes. The Centers for Innovation have successfully developed models for reimbursement reform. CMS and health insurance carriers have experimented with HMO's, ACO's, Primary Care First, and Direct Contracting. The Health Care Payment-LAN network has set out all the necessary reimbursement parameters. It is time to require that APM's be incorporated into the administration of every insurance plan and provider reimbursement arrangement that is approved for participation in the Trump Medicare Advantage Plan.
PERSONALIZE -
The problem with all of these great ideas for improving the health care system and efforts to lower the cost of health care is that the "patient is still the pawn in the system." No one is really focused on the patient. In December, Seema Verma said," For too long, the health care system has catered to the demands of special interests and left the patients as an after-thought. We are trying to flip that on its head and restore patients to their rightful place at the center of American healthcare." Everyone is concerned with the providers and insurance plans, market share, reimbursement routines, medical records, system scaling, patient privacy, price transparency, surprise medical bills, and political grandstanding. Not enough time is spent figuring out how to successfully go about improving the health of the patient and putting the patient first! Ultimately, the American people are responsible for their own health and well being. This truth was driven home in the movie "The Devil We Know" (Atlas films -2018, directed by Stephaine Soechtig) about the DuPont Company and the chemical dangers of Teflon, etc. Patients are the only ones that can actually reduce the cost of our health care. The questions we should be asking are, "What does the American public need to do, to improve their health?" and "How do we get them to do it?" The Trump Medicare Advantage Plan can tackle these challenges head-on and answer them successfully.
If the Personalization of health care, under the Trump Medicare Advantage Plan, is going to improve the health of the American people, we first need to unite them behind a bold national goal. There is nothing more important than our health, on both a personal and national level. Our very livelihood depends upon our good health. The healthcare "BOMB" described above is real and proof positive that our health and our country are headed for a huge explosion!
We believe a Trump Medicare Advantage program needs to re-structure medical care reimbursement to reflect what we have already learned from the CMS Innovation Centers and the ACM's work studies on paying physicians and hospitals for delivering successful value-based health care using PPPM models. We must also take what we have already learned on workplace health, wellness, and well-being programs and incorporate it into integral wellness and well-being program benefit structures, supervised by the HHS. These programs must be structured to rewards program participants with better benefits and/or lower premiums in return for improved health status. And finally, we need to free our hospitals and physicians from burdensome regulations and restrictions that prevent them from doing their best work.
- Make American Healthy Again -We believe the Trump Administration must get us united behind a national program to "Make America Healthy Again." This could be something like the Kennedy Apollo Space Program. In the 1960s, only 15% of Americans were overweight, and President Kennedy was warning that we were getting soft. Now 66% of Americans are overweight, and we desperately need to make American healthy again. A national goal of achieving the lowest National Health Care GDP (NHC-GDP) of any industrialized nation in the world by 2030 is just such a goal. The Kennedy program drew in expertise from every relevant resource. Going to the moon and back was no less challenging than the job of achieving the lowest NHC-GDP, but how much more personally important? In Kennedy's day, only 15% of our population was overweight. In 2030 it will likely be 75% unless we do something about it.
- Health, Wellness & Well Being Progam - We must draw on the extensive program knowledge of our employer community and develop a comprehensive Wellness & Well Being Program that incentivizes Americans to do the right thing. And, the program needs to be integral to the health plans, administered by HHS and required by all the TMA health plans. The program must include educating Americans on the right thing to do, giving them the opportunity to do it, and then rewarding them for positive results. In addition, health plans and health providers must also be rewarded like they are under the STAR program, with more money based on their ability to improve patient outcomes, improve patient health status and reduce the cost of their health care. The American people will be personally rewarded with more insurance coverage or lower premiums, not to mention their improved health status. The effect of this reduction will lower the cost of health care and health insurance for individuals and businesses and will increase our health condition, our productivity, and our competitiveness as a nation in world markets. This is how we will pay for the Trump Medicare Advantage For All plan and how we will win, win-win while Making America Healthy Again.
- Predictive, Preventive and Personalized Medical Care (PPPM)- The practice of integrative medicine called Predictive, Preventive and Personalized Medicine (PPPM) uses advanced diagnostics (including genomic & DNA testing and family history), targeted prevention, and treatments tailored to the patients in such a way as to deliver the most cost-effective health care. For instance, at Geisinger, in Gainesville, PA, experts on patient-centric care, they use multi-disciplinary teams and treat patients in their homes, with a 40% reduction in ER and inpatient admissions. They have a "fresh food clinic" that delivers over 8,000 doctor-prescribed meals to their patients, who have had an average reduction in A1C of 2.0. If we are successful in upgrading our reimbursement incentives for physicians and hospitals to support healthy living in a more meaningful way, we will be able to lower the cost of health care. It has been proven that the combination of the main healthy lifestyle factors -- maintaining a healthy weight, exercising regularly, following a healthy diet and not smoking are associated with as much as an eighty percent (80%) reduction in the risk of developing the most common and deadly chronic diseases.
- Academic Medical Centers, MA Provider and CMS Innovation - Our renowned Academic Medical Centers (AMCs) are studying new models for paying for and delivering medical care. Johns Hopkins and Dana Farber and many others are creating high-performing health care systems, establishing operational evidence for how to transform health care delivery to train the next generation of medical practitioners to better address the needs of the patient. Humana (MA provider) is the leader in Value-Based Care (VBC) for its insureds and Medicare Advantage subscribers. Their most recent report showed VBC had a 27% reduction in inpatient admissions and a 14.6% reduction in ER visits, creating a 20.1% reduction in medical cost and a savings of over $3.5 Billion Dollars. The Innovation Center also plays a critical role in implementing the Quality Payment Program, which Congress created as part of the Medicare Access and CHIP Reauthorization Act of 2015. In this new program, clinicians may earn incentive payments by participating to a sufficient extent in Advanced Alternative Payment Models (APMs). In Advanced APMs, clinicians accept some risk for their patients' quality and cost outcomes and meet other standards. In this arena, our AMC's, the MA Providers, and the CMS Innovation Center will be most useful to HHS in establishing the contractual arrangements necessary to implement the Trump Medicare Advantage For All program (TMA).
- Physician Freedom - State and Federal Laws and regulations are responsible for unnecessarily increasing the cost of health care. For instance, it is illegal for physicians to participate in Medicare to direct contracts for any services covered by the Medicare program. So, technically if a physician wants to provide a comprehensive set of medical services for a global fee, even though this course of treatment may be the most effective way of addressing the illness, they are prevented from contracting directly with the patient for those services, while continuing to participate in the Medicare program. Medicare reimbursement for such services is also not allowed. Senator Rand Paul has recently introduced a bill to correct this misguided regulation. Even Senator Bernie Sanders allows this type of contracting in his proposal of Medicare for All. Generally, these laws and regulations were written to support solo private practice physicians (who's numbers are declining) and the most expensive treatments and venues. The support and insurance coverage for holistic and integrative approaches to the treatment of cancer and other illnesses has been held back in the United States. This has limited the ability for patients to have the full range of treatments that may be as successful and more cost expensive than traditional medical practices.
- Hospital Freedom - In some cases, the practice of Immunotherapy, while being recognized as one of the most hopeful and cost-effective treatments for cancer, has been illegal in some states in favor of more expensive traditional chemotherapy. CMS has tried to increase provider competition, with the implementation of transparency regulations, ACO's, changes in 340 B discount program, Physician Fee Schedules, Relative Vale Units, and Site-Neutral payment practices, which are being blocked by the hospitals in the courts. The challenges in the courts, to the rights of patients, should be mitigated when private contracting required of TMA carriers, which should be required for participation in the Trump Medicare Advantage plans.
- Old Defined Benefit Health Plan - Medicare is enjoying it's 50 year anniversary. It is an antiquated collection of insurance plan policies that have gotten as complicated as the tax code. Robert Moffit, a Senior Fellow at the Heritage Foundation, has written volumes on the characteristics of the program and how it needs to change. In his "Reform - Medicare at 50," he writes, ".... fiscal and demographic problems that are inherent in its outdated structure threaten seniors future access to quality care and impose massive burdens on taxpayers." Extending Medicare for All, as the Democrats propose, to any American resident, under the age of 65, is ludicrous. There are so many positive things we can do to make health insurance more affordable and contribute to improving our health.
We have to focus on the United States Capitol
S. 1129 and H.R. 1384 - BILLS to establish a Medicare-for-all-national insurance program.
Bernie's Senate Bill has had two readings and sits waiting like a crouching lion in a Senate Sub-Commitee. Pramila's Bill has been referred to numerous House commitees with jurisdiction in remains buried, as the leadership wishes it to be. Neither Bill would be considered the sponsorship of socialized medicine if the Secretary of Health and Human Services (HHS) were an administrator and not an insurer. But both Senator Sander's (R-Vt.) and Representative Pramila Jayapal's (D-Wash.) rely heavily on HHS to administer and ensure their Medicare for All proposal, and they both Bills outlaw private health insurance. Both Bills give a lot of responsibility to the Secretary of Health and Human Services. I always love it when Bernie exclaims, "I wrote the damn bill!" Bernie, we can see that! After all as a senior Senator from Vermont, who could be more qualified to, "write the damn Bill"?
In the House and in the Senate, the Democrat leadership does not really want anything to do with "Medicare for All." Nancy Pelosi has been polite to Pramila about it, especially with the Squad on her back, but she loves Obamacare. So much so, that when this Bill was heard, Nancy hand picked the speakers. She does not want to have anything to do with any bill that isn't Obamacare revisited.
Senator Chuck Schumer feels the same way. He is quoted as saying, "We want more people covered, everyone covered; we want better healthcare at a lower cost. People have different views as to how to get there. Many are for Medicare for All; some are for Medicare buy-in, some are Medicare over 55, some are Medicaid buy-in, some is a public option," Schumer added. "I'm going to support a plan that can pass, and that can provide the best, cheapest healthcare for all Americans." We agree with Senator Chuck Schumer! And, by the way, revising Obamacare will NOT pass a Senate that has enough Republican votes to kill it, as this one does.
The bottom line, the Congressional Democratic leadership actually believes there is a role for private health insurance carriers in the American health care system. And, that role must be reflected in any bill that passes Congress. Certainly the preponderance of the health care industry, including the AMA and the AHA. Even the AHIA representing most of the Health Insurance Carriers that administer the ACA (and Medicare Advantage Plans) support Obamacare, because everyone is making so much money.
The Republicans also believe in private enterprise. Republicans believe in both the health provider community and in the health insurer community. We are talking about 1/6th of our economy, our largest employer. If the Democrat leadership and the Republican leadership could agree to support a bill that would be flexible on the role of private insurance carriers in order to champion the need for substantive improvement in the health and well being of the American people, we might have a chance.
