Trump 
The Great Healthcare Plan

 

  • President Trump Announces The Great Healthcare Plan:
  • “I am thrilled to announce my plan to lower healthcare prices for all Americans and truly make healthcare affordable again—we’re doing things that nobody’s ever been able to do, we’re calling it The Great Healthcare Plan.
  • “Instead of putting the needs of big corporations and special interests first our plan finally puts you first and puts more money in your pocket.”
  • “The government is going to pay the money directly to you. It goes to you, and then you take the money and buy your own healthcare… the big insurance companies lose and the people of our country win.”
    • Where do they buy the coverage?
    • Will there be Pre Existing Conditions?
    • Mandated essential benefits?  see our webpage
  • “This proposal locks in the massive discount on prescription drugs that my administration is achieving through our most-favored-nations drug pricing agreement… It’ll bring down drug prices 80, 90% in some cases, just numbers that nobody’s ever heard of before.”
    • “Your prescription drugs will come way, way down and, under this policy, the prices of many drugs will be slashed by 300, 400 even 500% starting this month at the Trumprx.gov.
    • “So instead of Americans paying the highest drug prices in the world, which we have for decades, we will now be paying the lowest cost paid by any other nation… that’s what we’re going to pay, and the American people will get the savings.”
    • “I have to reiterate, the lowest price in the world is what you’re going to pay, before you were paying the highest price in the world by far and the politicians did nothing about it, so I’m asking Congress to complete the work that we’ve started.”
  • “My plan would reduce your insurance premiums by stopping government payoffs to big insurance companies and sending that money directly to the people.”
    • “Obamacare was designed to make insurance companies rich. I call it the UNAFFORDABLE Care Act, with billions of dollars and taxpayer subsidies that help their stock prices skyrocket over 1,700% as you paid more money for healthcare every single year—more and more the premiums went higher and higher.”
    • “I want to end this flagrant scam and put extra money straight into the healthcare savings account
      • in your name, and you go out and buy your own healthcare, and you’ll make a great deal, you’ll get better healthcare for less money—that way you can choose the care that is right for your family.”
    • “To further reduce insurance premiums, my plan ends the giant kickbacks to insurance brokers
        • I’d like to see that.  I haven’t been getting any kickbacks.    The premium is the same if you call the Customer Service Rep at Covered CA or the Insurance Company 
      • and corporate middleman that only drive up the costs…”
  • “It fully funds a long-neglected part of the law known as the Cost Sharing Reduction [Enhanced Silver 73, 87. 94] program.
    • This measure alone should cut premiums on the most popular Obamacare plans—it’s hard to believe there are any because it’s a hated program, it’s unaffordable—but it’s going to cut them by an average of 10 to 15%.”
      • All plans or just Silver?
  • The Great Healthcare Plan… It’s great healthcare at a lower price, mandates unprecedented accountability and transparency from insurance companies and all healthcare providers so that special interests can no longer profiteer at your expense.”
      • Our webpage on MLR Medical Loss Ratio and mandated rebates
      • Trump has already mandated Hospitals post their prices…  see our webpage
    • “As the saying goes, sunlight is the best disinfectant, that is why my plan orders all the insurance companies to publish rate and coverage comparisons in very plain English.”
      • Our quote engine  quotit.com does that today!
      • Our webpage on the authority of CA Department of Insurance on Rate Regulation
    • “It requires insurers to publish detailed information about how much of your money they’re going to be paying out in claims versus how much they are taking in in profits… It forces them to release detailed data on how many claims are being denied and whether those denials are eventually overturned on appeal.”
    • “Most importantly, it will require any hospital or insurer who accepts Medicare or Medicaid to prominently post all prices of their place of business so that you are never surprised, and you can easily shop for a better deal or better care—and you’re going to end up doing both, you’re going to get a better deal and better care.”
    • Trump already did this!  see our webpage
    • “We will have maximum price transparency and costs will come down incredibly. I’m calling on Congress to pass this framework into law without delay—we have to do it right now so that we can get immediate relief to the American people, the people I love.”
    • Trump already did this!  see our webpage
  • By implementing these measures, The Great Healthcare Plan will deliver immediate relief to millions of Americans struggling with high healthcare costs due to Democrats’ Unaffordable Care Act.
  • For more information on The Great Healthcare Plan visit: great health care.gov.

Health Insurance unfortunately is very complicated

President Trump February 27, 2017

Medical Loss Ratio 80% Claims - 20% Operating Costs & Profit
So, why trade $$$ back and forth if you can afford not to?

premium dollar

Image from BCBS.com

 

Steve's Explanation of MLR Medical Loss Ratio

 

More Video's 

 

Plain English Mandate 

AI Summary 

 

  • California law requires insurance policies to be written in "plain English" or clear, understandable language, meaning exclusions and conditions must be conspicuous, clear, and understandable to the average person, not hidden in jargon; if ambiguous, they're interpreted for coverage, favoring the insured's reasonable expectations.
    • Our webpage on how to read an EOC Evidence of Coverage - Actual Policy
  • While laws mandate clarity, courts often find actual policies difficult to read, applying strict rules to insurers who must make terms obvious, or else they're interpreted in favor of coverage. [1, 2, 3, 4, 5, 6]

 

Key Requirements & Rules
  • Conspicuous, Plain, & Clear: Insurers have the duty to make policy limitations, exclusions, and conditions conspicuous, plain, and clear to the ordinary person.
  • Contra Proferentem Rule: If ambiguity remains after applying other rules, ambiguous terms are interpreted strictly against the insurer (the drafter).
  • Reasonable Expectations: Courts consider the policyholder's objectively reasonable expectations when interpreting ambiguous terms, often leading to coverage.
  • Statutory Mandates: California statutes require clarity, and the California Department of Insurance won't approve policies with unintelligible or misleading language. [1, 2, 3, 5, 6, 7, 8, 9]
Why It Matters
  • Difficulty in Practice: Despite laws, many policies are still complex, leading to disputes.
  • Insurer's Burden: The burden is on the insurer to ensure clarity, especially for exclusions, rather than on the insured to decipher dense text, notes this article on insurance law.
  • Judicial Interpretation: Courts actively enforce these principles, protecting policyholders from being misled by hidden or confusing contract language. [1, 2, 3, 4, 5, 6]
In essence, California law pushes for policies understandable by a fourth-grade education, but if insurers fail, courts step in to ensure fairness for the insured. [2, 5]
AI responses may include mistakes.

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