I am totally disgusted with Paul Ryan and the “Peloski-esk” way they attempted to ram this Obamacare replacement through Congress. So instead of just ranting, which is a useless endeavor, I decided to come up with my own version.
It involves all federal agencies like Social Security and HHS as well as the state insurance commissions. It includes HUD, Medicare, Medicaid, and any other necessary programs.
It does not make any different provisions for military families or veterans because they deserve and should receive the same level of care as any non-veteran or non-military;
Nor does it distinguish between federal, state, and regular citizens because EVERY citizen should be provided the same exact coverage;
Nor does it allow for any interference from Unions because they have over the years not been trustworthy on their efforts in health care for their members; and
Finally, I refuse to provide abortion for anybody except for extreme emergency reasons. If someone wants to murder an unborn child, then they have to pay for it themselves.
Nor does it address Illegal Immigrants. Immigrants and Refugees are supposed to get jobs as available so they are covered as others. (Revised note)
Phase 1 – Repeal 100% of Obamacare with a sunset of March 1, 2017.
Phase 2 – Basic Insurance Coverage –
to be implemented as soon as signed into law and with an experienced high-quality programming service providing a template for states to use.
1) Every individual can set up an individual or qualified family members insurance account at the state level with each state’s insurance board and coordinated with income tax departments. Restrictions on age of dependents who may draw from the account up to age 26 if attending qualified educational institutions. The restriction age generally to be 21 yrs old for dependents, if they work full-time then they have to establish their own insurance account.
The amount equal to $100 per month to be deducted from any and all payroll accounts per month including disability or non-Social Security based retirement accounts to cover tier 1 insurance. Each start-up can receive $600.00 toward its funding by the federal government as a one-time payment if they apply and any tax refunds or voluntary payments can be applied in part or whole as requested by the holder.
The accounts appear as a payroll deductible and submitted to the state insurance board just like taxes monthly. Payments from ALL qualified doctors – health, dental, alternative health or optometrist who are certified and registered in each state are deducted from this account. No insurance accounts may in any way be reduced by state ever except for intended purpose. Individuals may not access their accounts for any purpose other than health insurance except in the case of death when they become benefits for burial or non-taxable part of the estate. Accounts are cumulative for the life of the individual.
2) Open enrollment for all insurance carriers who wish to enter the health market in the US. and qualify with a 80% rating or better based on specific guidelines as a federal pool available to all citizens who choose to be covered. The citizen chosen insurance is responsible for all oversight, acceptable charges for services rendered, and notification to states of acceptance or determination of termination with qualifying reasons. States are then to determine further penalties and notification to individual and companies concerning resolution. No penalties or tax credits for refusing to participate, but those who do not get a basic insurance package may NOT be covered at any time of need except as needed to save their lives. They are responsible for all bills in full.
3) As a company incentive, a percent of wages paid into the account by the company may be applied and sent to the state insurance account registered to the citizen under his social security number and those deemed qualified dependents. An option for higher payment into the account by the holder of record can be added to the basic policy.
4) Basic policies include health and wellness including annual visits as well as procedures up to a maximum of $10,000 per year per citizen account. Doctors visits, x-rays, qualified procedures, and consultations recommended for mental health of up to $50 a visit to be covered at 100% through the state account. Fees for basic x-rays, yearly office exams from qualified health or dental or eye professionals not included or greater than $50 per visit, one set of glasses, four extractions, dentures partial or full, or basic teeth cleaning at 80% with 20% deductible up front from the account holder.
Phase 3 Insurance Coverage –
Basic Coverage Maximum and Riders – Unexpected, planned,or catastrophic events under $500,000. (any optional non-essential events such as cosmetic surgery require 50-60% payment by individual)
5) Second Tier policy – insurance rider covering further insurance expenses paid by the insurance holder up to a maximum of $500,000 for events not covered under Worker’s Compensation that are not more than 6 months recovery time, not to ve covered under intermediate or long-term disability, or are catastrophic in nature though a catastrophic rider of $1 million would be available. Reasonable fees including for cancer, essential plastic or other surgery, time off for pregnancy and delivery, accidents, eyes, and any others should be negotiated between individual and insurance company with the additional fee coming out of their state account as submitted at the time of opening or renewal. All hospital stays, basic procedures are covered by additional rider and basic fee contracts from the consumer’s state account and administered by the chosen health insurance company.
Phase 4 Insurance coverage
Events of Less Than Five Year Duration
6) Third Tier Policy – reasonable and expected “return to employment” recovery catastrophic events but not long-term of over five years. In addition Workers Compensation type insurance for which coverage is no longer available is considered in this group. Normal basic and second tier fees continue if any payroll exists. At this point Social Security Insurance up to the most recent payroll check recorded or catastrophic second tier riders needs to kick in for monthly medical expenses to augment or replace missing fees above the basic fees (or if opted in the catastrophic rider) for a maximum of five years recovery time for all physician-recommended and insurance approved conditions.
In the case of terminable illnesses with less than five-year treatment outlook or lacking any hope of recovery other than death within the timeframe, monthly SSI or SSD payments of $2,000 per month (or as determined) administered through the chosen insurance carrier plan for normal and medical expenses or transportation including a $300 fee to the insurance company. These should be overseen by Social Security and determined on a sliding scale of all available sources of income. The amount should be applied then placed in the person’s health account for payments to providers to draw from. Insurance coordination with Medicare and Medicaid is needed for household, , transportation, treatments, and medications. Citizen insurance accounts if zeroed then come under the most current rules of SSI or SSD for payment and resolution but still administered through the citizen’s chosen health insurance provider.
Medicare block grants from the federal annually or bi-annually to state governments and Medicaid should be utilized in meeting the person’s reasonable comfort and care needs either home health, hospice, emergency, or care by medical treatment facilities. In addition Medicaid dollars and restrictions by both Social Security agency and states should apply. Fraud flag watches by the insurance company should quickly be notified to the state insurance board and Social Security fraud division for further investigation and quick resolution especially where patients are in danger.
Phase 5 – Long-term care and Retirement
7) Tier Four Policy – Coverage for long-term care and retirement needs.
Block grant monies and payments to the insurance companies to be administered per Social Security requirements and overseen by state insurance department. It includes Medicare and Medicaid dollars as noted yearly by state and federal Social Security agencies.
Long-term care – after submitted of two recommendations from qualified doctors concerning long-term prognosis and medical needs and under 62 years of age. Patients with mental or physical monthly needs through their health insurance provider are paid $2,000 per month total (or based on current cost of living) for medical needs, and living expenses not included under SSI or SSD including a continued deduction of $300 to the person’s health insurance for monthly insurance fees payment so long as they are deemed no longer able to work for life. If needed a state advocate from the healthcare insurer should be provided generally for home visitation quarterly and specifically in order to oversee cases of those who are no longer able to be responsible for their own decisions as has been determined by two medical recommendations.
Review of this care is done at a minimum on a three-year basis or as needed if the healthcare professional, individual treated, or insurance provider has noted and/or flagged violations or questionable charges then submits reasonable investigation notification to the Social Security office. This is to include any apparatus or necessary equipment needed to provide for reasonable safe living and includes cost of daily overhead expenses, medical, food, transportation, and assistant or nurse care on a sliding scale (if under age 62) with any other income.
SSD and SSI retirement for health reasons begins at age 62. Normal retirement is at a congressionally mandated age. The health insurance provider as decided by the customer provides first-line health care and alerts to state of abuses by any providers or client. A total of $2,000 per month for normal, healthy adults (reduced by any retirement or other income) is provided through Medicare and Medicaid services. Payments of $100 from the consumer’s health account to the health insurance provider of record continues. The insurance sees to all annual and catastrophic charges. SSI or SSD coordinate their payments with those of retirement plans reducing their payments on a sliding scale by the income reported by the person’s other sources. Costs for retirement communities or living is deducted from the amount but must also include a minimum of $100 to the person for personal use. HUD or other government agency senior living facilities rules and regulations apply.
So there is my two-cents worth. What do you think or what ideas do you have?