Tuesday, December 1, 2015

Obamacare Co-op fails: This is what you could do with the money lost!

Today there is more fallout from the collapse of a New York state insurance Co-op set up to offer health insurance as part of the Affordable Care Act.  Health Republic Insurance ceased to exist today and has left a whole bunch of people (okay, a few more than a bunch - 200,000 patients!) without insurance.  

If you have been following my posts on the ACA and music therapy (just type in Obamacare into the search box for a list of articles), you may remember that the insurance co-ops are joint ventures with a given state and the federal government that acts like an insurance company to offer insurance plans on the state exchanges.  

Of the 23 co-ops set up around the country, 12 of them have gone bankrupt this year.  Part of the problem is that these co-ops set artificially low prices for monthly premiums on their insurance plans.  There was a fund set up by the federal government to reimburse these co-ops for the first few years until their subscriber pool became stabilized with the right mix of young and old, and sick and healthy customers.  Unfortunately for the co-ops, this pool of money has been cut back and it will not be able to bail out the co-ops as originally intended.

So this brings us back to the most recent failure: Health Republic Insurance.  The news reports that $265 million dollars in federal loans has virtually disappeared through this company!  Hospitals and doctors that offered services to patients on this health insurance do not expect to get reimbursed for any of the services they have rendered.

So I did some quick calculations based on the 2014 workforce analysis by the American Music Therapy Association and came up with the following as a better use for the wasted $265 million dollars:

  • $265 million would have paid for 4,152,954 hours (yes, that is over 4 million hours!) of direct music therapy services at the average hourly rate of $63.81/hour for 2014!
  • $265 million also would have paid the average yearly salary of $50,808 for 5,215 music therapists! 
 I don't know about you, but I think the money would have been much better spent on music therapy!  And that is only one of the 12 failed co-ops this year.  Only one co-op out of 24 did not lose money in 2015.  I guess I should keep my calculator handy for next November!           

Friday, November 13, 2015

The ACA and Music Therapy: Revisited!


Prezi presentation at the 2015 National Conference of the American Music Therapy Association in Kansas City. 

Thursday, June 25, 2015

Hey Justice Roberts! Can We Get Some Music Therapy With That??

Obamacare = SCOTUScare

If you are a regular reader, you know that I have been following the Affordable Care Act for the last several years.  My goal has always been to try to help music therapists and other related professionals figure out what the law actually might mean for access to music therapy and whether or not it will help or hurt our profession on the whole.  

This is obviously a huge task!  And not without peril!  Over the last few years I have found that many people are reluctant to engage in the conversation simply because there are so many strong opinions on both sides of the issue.  I have tried to to be very even-handed in my treatment of the topics discussed here on Music Makes Sense, and generally have kept things focused on the impacts the law may have for music therapy.  I believe I have been pretty successful so far and I appreciate the dialogues that have been opened up about the topic within my professional field.  

So let me break down the latest ruling for you:

Many people have been waiting on the Supreme Court decision King vs. Burwell that was handed down this morning.  This case basically asked the question, "Do words matter?"  

... and the justices have answered the question, "No!"  The Affordable Care Act specifically stated that federal subsidies for low income participants to help them pay for premiums purchased through the Health Care Exchanges could only be provided through exchanges "established by the States."  This was intentionally written into the original law as a way to encourage individual states to set up their own marketplace exchanges.  As it turned out, 27 states decided not to develop their own exchanges.  The federal government decided to step in and created Healthcare.gov for participants in those states to use.  In King vs. Burwell, states sued the federal government because the law did not say that people in these states should be able to receive subsidies.  

Now, whether you oppose or support the law, you can see the conundrum here.  If the Court ruled that the law meant what it said (and what Congress had intended), there would be a lot of people who have been receiving subsidies for almost two years, who would lose their subsidies and be unable to pay for their premiums.  These same people would then suffer a tax penalty for not having insurance.  What a mess!

(...I could digress here and point out that perhaps it is a good idea to write laws clearly, in a bi-partisan manner, and allow public review before voting on it...but, we'll leave that for a different blogger!)

But alas, we have been "saved" by SCOTUS!  The 6-3 ruling today explained that although the law was badly written, it was meant to help people.  Therefore, the court ruled that it will be okay for subsidies to extend to people signed up under the federal exchanges.  Basically, six unelected and unaccountable (except maybe to history) individuals have written a new law that applies to every citizen. 

Subscribe by email or obtain RSS feed by clicking here:

Amazon orders originating with clicks on any Amazon product link on the site help to benefit Music Makes Sense and its ongoing contribution to the world of music and music therapy. Thank You so much!
Related Posts with Thumbnails