Heartland Daily Podcast

This is the Heartland Daily Podcast.

Hello, everyone, and welcome to the podcast. This is AnneMarie Schieber from Healthcare News. You know, every once in a while, we'll get a blockbuster illustration of how the public appreciates or doesn't appreciate Obamacare. In late January, we got one. Mary Lou Retton, America's sweetheart Olympian recovering from a life threatening pneumonia, told NBC the reason she didn't have health insurance was she couldn't afford it.

Now there is so much to dissect in this, and that's why if I'm invited senator Beverly, Kansas state senator Beverly Gossage to be on the podcast. Like I mentioned, insurance agency, and she is also part of the American Care Choices Health Care Coalition. Thank you for coming on, senator Gossett. You know health care inside and out.

Anne Marie, thank you. It's a pleasure to be with you, and I'm glad we were able to find the time. It's this time when I'm in session, it's very hard to carve out a few minutes. So I'm happy to be with you.

Great. Well, you know, I have a hard time believing Mary Lou Renton couldn't afford healthcare. Now, she's had a successful career with many endorsements. And I know she went through a divorce. But, you know, she was married for many years to a professional football player.

My guess is that Rhett and, like so many people who do not buy Obamacare, just didn't think there was any value in it. Am I wrong?

No, I think you're right. Because we, as consumers, look at value compared to cost. So and I think I sent you an example of when I went in to look at her ZIP code and for her age. And by the way, when you go to healthcare.gov, that's really all they ask, because they don't even ask your sex, male or female, does it make any difference? So they wanna know what is your ZIP code, what is your age, and what is your income?

So quite likely, when she put in her income, if she's at least middle age, it's going to say you get no subsidy, so here you go. And it's the lowest price plan that I found for her was $1200 with a 94 or $98100 out of pocket. Who would think, wow. Is is it worth it? Maybe I could just pay for some of that myself instead of paying and that was the low on the low end.

I mean, she could have gotten a gold plan

for her.

Yeah.

Yeah.

So it's the bronze plan. And she could have gotten a gold plan, you know, for 4 or $5,000 a month. It gets extremely expensive. And when I tell people this, it's not uncommon for folks to go bet. Okay.

Well, what other options do I have? I'm afraid when they pass the ACA, they took away all your other options. I'll give you an example. In most states, especially in the Midwest, they had state laws, state regs. We still do.

And they said that insurance companies may, for example, underwrite. So that means, just like with life insurance or with homeowners insurance, it's based upon the risk. So if you're lower risk, well, when she would have signed up for this, maybe she did it have pneumonia, maybe she did. The idea is right. We want people to have insurance before they really need it.

That's the whole purpose of insurance. And that when we were a before the ACA, people were able to buy it very, very low premiums. I licensed in nearly half the states for 21 years. I wrote policies every day for children for $25 Young people could get a policy for around 50. Females were a little bit more about 62.

Even if you were a 69 year old female, the most expensive person to try to insure with private insurance, it'd be about 169 a month. What happened? Well, what happened was the ACA stepped in and said, oh, we want to be fair to people. We want to be nice to people. These mean insurance companies can't ask them health questions anymore.

They took away all healthy discount. So on average, in my state of Kansas and neighbor Missouri and others, they saw rates go up by 400%. So we knew that was going to happen. And so it was like, you have to take everybody. So when you say you have to take everybody, you can't ask them health questions, people are gonna wait until they get sick to buy.

Right? Why did I buy now? You can't ask me health questions. I'm gonna wait. So then they said, wait a minute.

People are gonna wait. So let's force them to buy. Remember that?

So you're gonna pay a

fine if you don't buy policies. And then it was like, well, how can people how can we force people to pay a fine for a policy they can't afford? Well, now we need to subsidize this. So let's figure out a way to pay for it. They had all these pay fors, of course, which were taxes on all of us.

And so only for the lowest income folks did they get these subsidies to reduce their premiums somewhat. But you know what happened? They reduced the premiums down to kind of what they were before. And they act this is the way I look at it. It's like the federal government says, you know what?

We're gonna make things better by crippling everybody. Not not to worry, though. We're going to give some people a crutch. So by crippling everybody, they made these rates astronomically high. And then the lower income people, the crutch was, we're going to pay we're going to give the insurance company some money on your behalf.

And, oh, if you're lower, lower income below that 250% of poverty level. If you choose a silver plan, we're gonna also lower your out of pocket. In other words, we're gonna lower your co pays, we're gonna lower your total out of pocket. We'll do double, so you get that double tax credit. But what did that do to the middle income people, even higher income?

Mhmm. Like, let's say, Mary Lou Retton. Those rates are still astronomically high. And they also did this. Insurance companies were like, well, if we're forced to take everybody, we have no clue who's going to apply.

We have to the rates are going to be really, really high. And they said the only way we can do this is squeeze our provider networks by saying, hey, such and such insurance or hospital association, you're gonna be the only hospital we're gonna send our people to. You're gonna be the only one in network, so give us a good deal. So Yeah. Reduce the rates a little bit.

So they have lower sorry. They have lower network or fewer hospitals to go to at very, very high rates.

Yeah. Well, you know, this interview on NBC didn't go into too much depth, But, you know, Rhetton did say she had preexisting conditions.

Right.

And, you know, which is surprising because Obamacare will not deny coverage for that. You just said that. Now what do you take from this? I guess, you know, the alternative to Obamacare are short term plans. I have one of these and, you know, I gotta get a new one every 6 months.

And we're you know, the Biden administration is about to change the rules on these again. Is that possibly an option for her? Because they don't cover preexisting conditions. You have to be they're very easy to apply for. But, you know, if you deceive them, they will go and find out that you lied and they won't cover you.

So you got to be really careful with the plans. What do you think that that do you think she possibly meant might have considered a short term plan? Would that have been a fix for her in her situation?

Sadly, because of the ACA, no. They the short term medical plans are at close to what we had prior to the ACA, which is they're going to look at your health risk. But here's the point. I'm sure that very healthy Mary Lou Retton could have had a health insurance plan prior to this. Right?

And it would have been extremely affordable for her because she was very low risk. She could have kept that year after year. It just would roll over. It might go up a little bit, but it was a very competitive free marketplace. So you could go like you buy auto insurance, they're gonna ask your risk, but, hey, they can't drop you.

Right? And rates don't go up very much. However, with short term medical plans, also called short term limited kind of a healthy discount at all. They are middle income, and they're like, okay. No.

I have very, I don't really have any preexisting conditions or I do have a very minor preexisting condition. And so and and I take a medication, but that's okay. I will cover that. I will cover that medication. I just want you to cover everything else that I may, encounter or I might have a new procedure or may develop a new condition, I want that to be covered.

And that's how short term plans work. Now in some states like yours, perhaps, you have to apply every 6 months. In mine, it's every 2 years. So you apply you apply, it's short term meaning less than one full year. So it's, like, 364 days, and you apply for that plan.

It can start as early as tomorrow, the next day. You have it for a year, then you reapply. But the you at that time, let's say that you reapply, it's up to the carrier to decide you were going to re underwrite you meaning we're going to ask again do you have any conditions? Well, anything that you developed in that 1st 12 months is now considered and so they could decline you that next year. Under the Trump administration, they made it 3 years.

So insurance companies may not underwrite you. So you sign up in advance, hey, I want to go ahead and sign up for 3 years so that you don't re underwrite me and I've got a guaranteed 3 years no matter what I develop. It's going to be covered for the next 3 years. And they will tell you upfront, your 1st year is going to cost you this, 2nd year is going to be a little bit more, 3rd year is going to be a little bit more. When you apply, you don't have to actually reapply.

But if you do reapply and you use the same policy, you're not going to have to be re underwritten. In other words, we're not going to ask you new health questions. Anything that was preexisting is now going to be covered. That was under the Trump administration. Why did they do that?

Because if somebody develops cancer in that 1st year and this is the only policy they can afford, it is going to be covered and it will continue to be covered probably long enough for you to get your chemo, all of the things that you need covered. And they are a full major medical plan. A perfect example is I had one of my clients, this was 2 years ago, bought a short term medical plan in January. In February, he had to go in for an emergency gallbladder surgery. Yes.

They dug into his past to see if he was lying. Did he have or have any trouble with his gallbladder before? He had not. So they did the research found, no. He had not.

A $95,000 hospital bill was fully covered with his $25100 deductible. This is actually how insurance used to work in most days

Right. Yeah.

Through the ACA. Yes. But here's another thing people don't know. We as insurance agents were called health underwriters back in those days because we were all given underwriting guides. So I had, in my state, 17 carriers to pick from.

Other states were 23 carriers to pick from. And if somebody starts, this is how they would say, I'd like to buy an insurance policy. I don't drink alcohol. I'm not I don't use tobacco. I've not really had anything.

About 4 years ago, why did they tell me all this stuff? Because it mattered. And so I would say, you have asthma. Let me go to the underwriting guides on asthma. Asthma.

These 5 these 5 companies will still take you depending on how severe is your asthma. I'm gonna ask you some questions. Were you hospitalized in the last 2 years with asthma? And if so, how often? What do you use for your asthma?

And how often do you need to use it? Is it something These three companies probably are gonna be your best bet. This is These three companies probably are gonna be your best bet. This one will ride her at meeting. We're not gonna cover the asthma for a couple of years.

Then we're gonna see how that goes. And then we could see if we would consider adding asthma back in for coverage. This one says, we're gonna cover your asthma, but we're gonna raise your rate by 10%. Which do you want? Yeah.

You had all those options, and they when Right. Right. We were lied to about Obamacare, Anne Marie, that they don't cover anything. They don't even cover do you remember this statement? They don't even cover if you have acne.

I thought, what?

What are you talking about? That.

And I well, I did because, you know, I wrote those plans, and I went back and thought, oh, wait a minute. There was a medication called Accutane that was very dangerous. Oh, yes. Right. Side effects.

So if you said you had acne, the question they were gonna ask you was, are you taking Accutane? And if you said yes, they would deny coverage, but not because you had acne.

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Oh, yeah. We're also on Rumble. See you there.

Yeah. Now, you know, I'll tell you, Obamacare is in effect really entering its 10th year. When did it affect What? 2014? Right.

Many people are now covered by it because Obamacare has also expanded Medicaid. Right? We have a ton of people now in Medicaid.

Right.

Not in Kansas. Right. Anyway, president Biden Biden touted a few weeks ago on how Obamacare enrollment went up 30% this year. What do you think about that? Are people starting to like it?

No. I'm happy to address that. What they did was, when we had the COVID outbreak, they said, if you keep people on, even though they no longer are eligible for Medicaid, if you keep them on during this pandemic, we will give you an additional FMAP. And, of course, an FMAP is the percentage that the federal government pays towards Medicaid. Right now in those states, my state, it's right around 60% that they pay.

The state pays 40%. Well, I've never seen a health department that didn't wanna get more money. So they said, sure. We'll keep them on. Give us that extra 6 point 9%, whatever it was for the FMAT.

Some states, 5.7. So they kept that. So for 3 years, people who were no longer eligible for Medicaid were kept on Medicaid and not kicked off. So when they did the, quote, unwinding, they were saying sending out an evaluate your updated income. So all these people were taken off.

Well, these people automatically then applied on health care dot gov for a very, very low premium, low subsidy lots of subsidies because they were just right at that poverty level or more. And so, yeah, so, of course, they had been on Medicaid. Now they're on health care dot gov. Big surprise.

Yeah. Yeah. Now, you know, one of the things I use with my short term plan is direct primary care, which is amazing. I pay $90 a month. I get in to see my doctor, and I never see my doctor for less than an hour.

I I

don't how he does it. Mhmm. But it's just incredible care. They give me discounted drugs sometimes, imaging labs.

Yep.

They now have a flat fee surgical center. You know, they've been around, I think, probably for about 10 years now, but they're not really no I mean, DPC has been around for about 15 years. Yeah. But around the country, a lot of people do not know about them. And they don't even know, you know, direct primary care.

Do a Google search in your city. I I know people that live in big cities. They have no idea what this is. Why do you suppose that's the case?

Well, I remember when they were calling cash doctors way back in the day, and there was a link where you can go and look up a cash doctor. And then they went from there to DPCs. They're terrific. I really support them. I've spoken at their conferences.

I think it's great, and we have more of them going to that all of the time. But, again, if I go back to, pre Obamacare, when you could pick a policy that said, we don't cover primary care physicians. Let's think about it. What is health insurance supposed to cover? The big catastrophic stuff, right, that you can't pay for or negotiate yourself.

So why in the world did we include a primary care physician visit or generic drugs for that matter? So you could have chosen the policy with a much smaller premium that says, we don't cover primary care. Go wherever you want and negotiate that rate with your doctor. We don't cover generic drugs. Those are $3.5.

So those are not catastrophic things. You negotiate that yourself. Under the ACA, they said, all insurance plans must cover, and that's one of the things, was primary care. So when people are going to a direct primary care doctor and they're paying that monthly fee, whatever it may be, they're kind of paying twice because they have to pay to be able to get a discount to see a primary care physician, plus go to the direct primary care. That stinks.

You know? But you couldn't take it off of your, you know, your traditional policy. Now with short term medical, they also they allow, for your primary care visit to apply to their deductible, but not to a direct primary care doctor. But in the long run, you win, especially if you have if you have several doctor's visits, you take several medications because most short term medical plans don't pay toward don't allow your medications to apply to the deductible. They don't cover them.

But their your direct primary care doctor can give you a lower price. Usually, it's a pass through price to you from the care from directly through the pharmacy. And, yeah, I think it's fabulous. But why do most people not know about them? For the very reason you mentioned, they say, oh, does that oh, they're not in my network.

Oh, it doesn't apply to my deductible. That's why.

Yeah.

They're just you. And we've

really, yeah, we've really warped people's thinking about what insurances. We've turned health insurance into payment plans. Yes. Prepayment. Plans and discount programs.

And, really, we've lost the true meaning of insurance, which, like you said earlier, is to cover stuff you don't anticipate that would really be devastating to you financially.

You're exactly right.

Crazy crazy.

You know, Anne

Marie You know, the other

Oh, I was just gonna say, if the I've actually had people call me. I need to get an insurance policy because I need to go to the doctor. Well, you do know that you could just call and make an appointment and go to a doctor. You can? Oh, I thought I had to have insurance.

It reminds me of years ago, there was a commercial of people standing on an escalator that had stopped, and nobody moved. Yeah. And, like, you know, you Oh, yeah. Walk up the stairs or walk down the stairs. You don't have to wait for the escalator to move.

It's the same we have so indoctrinated people in that. You don't even go to a doctor or you don't go get a prescription unless you get insurance. That's silly.

Yeah. I I I think of my DPC doctor as keeping me away from specialists. And in the rare event, they need to see a specialist. I call and I negotiate the price before you stay away from a hospital operated, physicians because the prices they charge are astronomical. Wonderful.

You know, the other op the other option Rhett and could have had was a health share ministry.

Now You might.

The costs are a bit higher and they're not really they're not insurance. And, you know, the cost can be pretty high because, again, they they're gonna ask you all about your lifestyle and your your premium's gonna be dependent on that. They may not even accept you if you have a, you know, a high risk lifestyle. What can you say about those arrangements?

Okay. 2 things. 1, we know they're not actually insurance. So you could not go file a complaint with your insurance department if they don't pay or you don't feel like the contract is made. It would have to be a lawsuit situation that they didn't fulfill a contract.

It is large group of folks that are faith based primarily, and they have all said, let's share each other's medical expenses. Initially, when this kind of first started and they approached me about this years ago, my concern was there were not enough people in the pool to be able to share the risk. In other words, let's have somebody who has a $300,000, premature twins. How is that going to be covered when everybody's paying this small amount into this pool? Now, of course, thanks to Obamacare, that was the exception of, paying the fine.

If you didn't go into Obamacare, you could go to a health sharing ministry, and you were not subject to the fine. Of course, under the Trump administration, they dropped that down that fine down to 0. So, you know, people can do that without paying a fine or get a short term medical plan, without paying a fine. But to answer the question, 22 things. And by the way, I help people sign up for those types of plans.

You have to understand why they they're not more expensive than the ACA, but they're they're about not quite half, but they could be about 80%. Or I'm sorry. You would pay about 80% of what it would be for the ACA depending on which of the plans that you went to. Was it Samaritan or was it CMS, which, can be the the, Christian Sharing Minister, CSM's Christian Sharing Ministry. There are several of them, that they all have varying rates.

No. They're not as low as the short term medical plans that can save you 75%. You're only paying 30%, you know, of what you would have paid. Then here's why. They they you don't have to reapply.

They continue. They don't drop you unless you drop them. Unlike the short term medical plans, it's only 1 year at a time. It's only 6 months at a time, and then you reevaluate it. So because it continues, they're going to be a little bit more.

They don't cover preexisting conditions either. They do and, like, short term medical plans don't cover normal maternity. So So let's say you're a young couple, you're not gonna have a baby right away, but you would like to sometime in the next 5 years, let's say. Then they do have some maternity built in, but you have to be with them for, say, 12 months or 24 months depending on the plan. So that's why they're a little bit more, but it depends on the type of coverage that you want and what you want it to cover.

But the one the one concern is, of course, it is not insurance. You have to rely upon the fact that it will be covered. Some of them have an actual network. They usually, work with the PCM network or one of the other national networks. Some don't have a network at all.

You negotiate your own prices. So, yeah, there are folks in that plan and it ballooned after the ACA. Some of those plans have 250,000 people in them.

Well, we have run out of time. Thank you for coming on the podcast.

My pleasure, Anne Marie. And sometime maybe we could talk about when I testified before the Republican study committee and what I recommended.

That would be great. Alright. Thank you. Beverly Gossage is a state senator from Kansas who is knowledgeable about Obamacare because she happens to be in the health insurance business. And thank you listeners for tuning in.

We appreciate, your giving us your time. And, we would also appreciate if you could share our link, rate us, and become a regular subscriber to the Heartland Daily podcast. This is AnneMarie Scheiber