Amazing Statistic!

March 21st, 2019

The latest survey shows that

three out of four people make

up 75% of the population

 

 

The 20 Most Expensive Drugs in the U.S.A.

March 21st, 2019

All 20 of these drugs are priced well over $25,000 for a monthly supply, or + $300,000 per year

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Will Texas Consider Feasibility of Reference Based Pricing Strategies for Public Educators?

March 20th, 2019

               $64,000 Question

House Bill 3987, if passed, will direct a commission to study alternative mechanisms for offering health benefit plan coverage to the affected employees  of the TRS ActiveCare program and their dependents. Will “alternative mechanisms” include a study of Reference Based Pricing strategies? Will Texas follow the lead of Montana, North Carolina and the South Texas Health Cooperative? 

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Insurance Agent Who Stole 80+ Identities Gets Probation

March 18th, 2019

A Colorado insurance agent who created more than 80 phony life insurance policies has been sentenced to probation.

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What Health Care Consumers Never See

March 15th, 2019

I get emails like the one below almost every day on claims incurred under various Reference Based Pricing plans. The redacted email below shows how egregious health care billing practices are and what consumers are expected to pay in relationship to what Medicare pays.

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3 Drug Manufacturers Hold 7,000,000 Americans Hostage – Life or Death?

March 15th, 2019

The Canadian inventor of insulin sold his patent for $1 to the University of Toranto back in the 1920’s to benefit mankind with a life saving, inexpensive drug. Now three drug manufacturers hold the power of life and death over 7,000,000 diabetic Americans. Why?

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A Cost Effective Approach to Reference Based Pricing

March 14th, 2019

 

 

Going with a PEPM subscription model yields greater plan savings than charging a percentage of savings. Our RBP solution, powered by Payer Compass, uses that model and helping is helping clients save up to 72% over traditional PPO networks.

Texas School District Continues Deficit Spending On Health Plan

March 14th, 2019

The Donna Independent School District (DISD) in deep South Texas continues to under fund their self-funded health plan. In a competitive RFP process last year the district moved their self-funded health plan administration from Blue Cross to United HealthCare. However, the change in plan administrators have not shown any savings to date, although there is a “shared savings” fee paid to the administrator. Try explaining that to the boys in the domino parlor.

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New Health Plans Expose Insureds To Less Risk

March 14th, 2019

New health plans expose insureds to less risk:

The risk of systematic rising health insurance costs, erosion of  benefits and less choice. Provider payments are fully transparent unlike traditional health plans that cloak provider pricing in secrecy.

Members may select any provider of choice unlike PPO and HMO plans. There are no high deductibles and in some cases no deductibles at all. So what’s the catch?

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Some TPA’s Are Planning For Survival, Others Are Not

March 13th, 2019

With a single payer system only one election away, some TPA’s are looking towards the future. Others have their heads in the sand.

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Blue Cross Enters Food Business

March 13th, 2019

For a low co-pay of $10 every time you order a meal and a reasonable $6 delivery charge (tips encouraged) you can get free meals from Blue Cross if you live in designated areas. You don’t even have to be a Blue Cross member, although we suspect those are the ones paying for all of this……………

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Mother Knows Best

March 12th, 2019

A major carrier (Mother) will require all new self-funded employer customers (Children) to incorporate this feature into their plan designs……………….As children don’t you hate to be told what to do?

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Lockton Enters Reinsurance Business

March 11th, 2019

Reinsurance is a key pillar of Lockton’s aggressive growth plan……………………..

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Monkey Business?

March 11th, 2019

1980’s BCBS Representative At Work

I remember years ago when I was a naive young salesman for BCBS working in a rural area office. I was eventually promoted to a big city office. It was a new experience for me. I noticed real fast that all the other sales reps. were involved in some sort of  “monkey business.”

They were typing up group health insurance proposals in the confines of their company paid offices (door closed of course) on behalf of competitors, pocketing commissions earned in addition to their BCBS salary. One rep. showed me his check stubs from more than one competitor and said “Bill, why don’t you do the same? It’s easy money! And, if I get fired or quit, I have a nice steady income coming in!”

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Population Health on Steroids

March 11th, 2019
Does your self-funded health plan have the latest technology required for advanced risk management purposes?

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Solving Health Care At An Affordable Price

March 7th, 2019

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Opening The Black Box

March 6th, 2019

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Retail Rx Prices Vary a Lot!

March 6th, 2019

I take a prescription drug that costs $18 at a mom & pop pharmacy in Cuero, Texas that costs $95 at a chain pharmacy 34 miles down the road in Victoria, Texas. A pharmacist friend told me his cost is $6…………..But of course not too many people know this or care. All they see is a Rx co-pay which effectively hides the scheme from public outcry…………..Many of our clients exclude two of the largest drug store chains in the country because they know prices there are 500-600% higher at the retail level than most independent pharmacies. That alone will save on average 5-10% off a group’s total drug spend.

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Seize The Day & Reference Based Pricing

March 5th, 2019
One of many emails I get every week about Reference Based Pricing strategies. Seems there are more and more TPA’s entering that space in partnership with either ELAP, AMPS, Six Degrees or Payer Compass, the Big Four. Then there are all the others like HST and UCC making inroads too. Now we are seeing some of the BUCA’s entering into the Reference Based Pricing space via their wholly own TPA subsidiaries with the apparent mantra “If you can’t beat them, join them.”

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Specialty Drugs Are Killing Your Renewals!

March 5th, 2019

War On Drugs Continues……….

We specialize in helping self-funded employers dramatically reduce Rx spend while providing members a $0 Rx copay for many name brand and specialty meds.

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Insurer of Last Resort

March 5th, 2019

“No problem Joe, I’ll make a call for you”

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Glenn McLellan – Sales & Account Management at Centivo

March 4th, 2019

For 35 years I have worked closely with all constituents in the self-insurance industry to help our industry be the best that it can be. From my perspective, the development of Centivo is the culmination of every effort I have made for a TPA to be “world class” and represent the future.

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TPA Offers New Health Plan Model

March 3rd, 2019

Centivo offers an alternative to traditional insurance carriers or third-party administrators……..

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War On Drugs – The Indians Are Restless

March 3rd, 2019

Boston Tea Party

What’s the price of tea in China? How about insulin………….Insulin which was discovered in the 1920’s and whose patent sold for $1, has doubled in price between 2012 and 2016 while the price of insulin drug lantus increased 49% in 2014 alone. Why? In this war on drugs we should “Just Say No.”

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It’s Scary – House of Representatives or House of Horrors?

March 2nd, 2019

Rather than finding a way to provide for the small minority who still need health insurance, they want to overhaul the whole health system for everyone……………….

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Texas Addresses Balance Billing Issue

March 1st, 2019

A Texas Senate Bill was introduced a few days ago that addresses balance billing issues including credit reporting agencies……………….

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SOAP

February 28th, 2019

 

Our STRATEGIC OPEN ACCESS PLAN (SOAP) is designed to clean up your group medical program using common sense and traditional American business practices. Clients who adopt our strategies will realize plan savings of 20-40% while maintaining or even improving benefits at the same time.

 

 

“Cleaning up Your Employee Health Plan”

Field Rated Dental/Vision Plan

February 28th, 2019

Still quoting the same 100/80/50 Dental Plans that were popular 20 years ago? Let’s surprise your client with a new and innovative dental offering.

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Naysayers Bring Message of Impending Doom

February 28th, 2019

Maybe the problem with solving health care in this country centers around the apparent abundance of naysayers………………

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Jilted Lover Wants Back Billion Dollar Engagement Ring

February 28th, 2019

Judge, he’s a bully, manipulative, passive-aggressive and self-centered. I don’t love him anymore!

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SmartDecision Offered By HealthSmart

February 27th, 2019

A Reference Based Pricing solution called SmartDecision. It offers RBP, bundled pricing, cost and quality information, and a concierge service to help members navigate the entire healthcare episode. Please review our flyer to learn more about this truly unique program. Click here to download.

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Attention Health Insurance Brokers: You’re One Election Away From Extinction

February 27th, 2019

Medicare-for-all would move every American onto one government insurer in two years, while providing everyone with medical, vision, dental and long-term care at no cost………….

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February 27th, 2019

Anthem Antitrust Atty ‘Stunned’ At Cigna Balk On $54B Deal

A 25-year veteran antitrust lawyer for Anthem Inc. testified Tuesday he was stunned by Cigna Corp.’s sudden and allegedly fatal resistance to their now-abandoned, $54 billion tie-up, in the second day of a multibillion-dollar Delaware Chancery Court trial over the collapsed deal.

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February 26th, 2019

In Florida, Drug Re-Importation from Canada Finds New Champions, Old Snags

“Florida is joining the growing ranks of states that, squeezed by climbing drug prices, are eyeing the Canadian fix…. Legislation has been advanced this year in about a dozen states that would advance wholesale drug importation programs … While statehouses may be abuzz, in Washington, national politics impedes feasibility. And skeptics question how much relief these initiatives could actually provide.”
Kaiser Health News

Departments Ask for Advice from Health Plan Sponsors: Preserving ‘Grandfathered Status’ Under the ACA

“The specific questions include: [1] Do any of the requirements for maintaining grandfathered status create particular challenges, and how could these requirements be modified to reduce these challenges? [2] Why do plan sponsors choose to retain grandfathered status? [3] What are the costs and benefits that plan sponsors consider in deciding whether to retain grandfathered status? [4] Is preserving grandfathered status important to plan participants? [5] What changes in benefits typically trigger a loss of grandfathered status?” 
Segal Consulting

To RBP, or Not to RBP: That Is The Question

February 26th, 2019

Once upon a time, health benefits were just that – “benefits.”  Now, it’s assumed health insurance is included in an employment package, and what was once a benefit is now an entitlement…..

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Single Mom Jailed Over Unpaid Medical Bill

February 25th, 2019

Mugshot photo of Melissa Welch-Latronica, 30, of LaPorte. (Porter County Sheriff’s Dept.)

Single mother goes from traffic stop to bench warrant to jail over unpaid medical bill: ‘It just isn’t right’

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Insulin Makers Face Drug Pricing Suit

February 22nd, 2019

Price of Drugs Is Too Damn High!

“This ruling blows the insulin racket wide open,’’ said Steve Berman, a plaintiffs’ lawyer who is one of the leaders of the potential class-action case. The ruling “clears the way for us to begin obtaining discovery from the manufacturers and PBMs so we can shine the light on exactly what has driven insulin prices sky-high,’’ he said.

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Primary Care – The Future of Employee Care?

February 22nd, 2019

“Direct primary care (DCP) — a fee-based model that gives individuals unlimited access to a primary care doctor for anywhere between $60 to $150 a month, without insurance being billed — is the “future of healthcare….”

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New MEWA in Texas Announced

February 21st, 2019

Last month, we received our license to sell Association Health Plans (AHPs) to medical groups in Texas through the Oklahoma State Medical Association (OSMA). They have a proven track record of providing significant savings to their members and offer a broad range of health plans.

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How You Can Save On Health Care in Texas

February 21st, 2019

Just like 4.3 million other Texans, they have zero health coverage. They simply cannot afford health insurance. “We don’t have health insurance because it’s just outrageous. We have to choose food or clothing over health insurance, and food and clothing are just going to come first,” Kevin Doetticher said.

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Jeanne Pinder On TED Talk

February 20th, 2019

My TED talk is up! 

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Insurers Hand Out Cash and Gifts To Sway Brokers Who Sell Employer Health Plans

February 20th, 2019

 Industry wide, transparency is not the standard. ProPublica sent a list of questions to 10 of the largest broker agencies, some worth $1 billion or more, including Marsh & McLennan, Aon and Willis Towers Watson, asking if they took bonuses and commissions from insurance companies, and whether they disclosed them to their clients. Four firms declined to answer; the others never responded despite repeated requests.

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TO UNDERSTAND VALUE’S MARKET PROGRESS, WATCH PRIMARY CARE

February 19th, 2019

Brian Klepper

“Renegade PCPs long for independent practices where their patient care decisions are not so influenced by their employers’ interests……………….By recapturing control of care and cost, they also are re-establishing primary care’s primacy within health care……………..”

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Debunking The Stagnant Wage Myth

February 18th, 2019

“In 60 seconds, this CEO explains why healthcare has blocked many manufacturing jobs from coming back to the U.S.” – Dave Chase on Linkedin………………..

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How Dare You! 177% of Medicare Is Insulting!

February 17th, 2019

The state of North Carolina has adopted Reference Based Pricing for their state employee benefit program to become effective in 2020. The reference price will be pegged at 177% of Medicare. That has caused an uproar with the state’s hospitals and they are fighting back hard.

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McAllen ISD To Interview Top 3 Consultant Finalists

February 17th, 2019

By Molly Mulebriar

McAllen Independent School District in deep South Texas is set to interview the top three finalist for the district’s insurance consultant position this week. MISD employee benefit program is self-insured and administered by Blue Cross & Blue Shield.

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Texas Medical Association Highlights Reference Based Pricing

February 16th, 2019

“It’s an intriguing way to lower costs for both physicians and health plans, and it could reduce premiums for patients. It also could enable doctors to wrestle more contract-negotiating leverage out of the hands of the market’s dominant health plans ― and in some cases, contracting with them might not even be necessary.”

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American Health Care – The Economic Trojan Horse of Destruction

February 16th, 2019

“We are taking that wasted money and artificially inflating the cost of health care to the point that nobody can afford it without government continuing the death spiral of spending, monopolizing, and price inflation.”

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Reference Based Pricing

February 14th, 2019

In this video, Dr. Eric Bricker Explains Reference-Based Pricing.

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Reasons For Having A Primary Care Physician

February 14th, 2019

Dr. Eric Bricker Explains 3 Reasons for Having a PCP: 1) Screening, 2) Same-Day / Next-Day Appointments and 3) After-Hours Call-In Access.

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Why Aren’t More Employers Implementing Reference-Based Pricing Benefit Design?

February 12th, 2019

In contrast to deductibles, where the patient pays the “first dollar” of medical expenses, under RBP, the patient is responsible for the “last dollar.”

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The Great Free Standing ER Scam Continues…………………

February 12th, 2019

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Catholic Diocese Insured Against Child Sexual Abuse Claims

February 11th, 2019

Liberty Mutual has agreed to pay the Diocese of Duluth US$6.5 million under a recent settlement agreement over litigation of insurance coverage for child sexual abuse damages………..

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Greenlight Re invests in Texas-based TPA

February 10th, 2019

Greenlight Re Innovations, part of specialist property and casualty insurer Greenlight Capital Re, has announced an investment in Sana Benefits, a Texas-based third-party administrator (TPA) focused on the self-insured health market……………...

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$1,000,000,000.00 Insurance Scam

February 10th, 2019

Four men and seven companies have been charged in connection with a $1 billion healthcare scam, according to the Department of Justice………………….

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AccuRisk Solutions LLC

February 10th, 2019

AccuRisk Solutions LLC is a Chicago-based Managing General Underwriter focused on providing its producers with innovative insurance products and outstanding customer service.

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Mexican Drug Run

February 10th, 2019

“It’s cheaper for us to pay for the drug down there, send them down there and then give them $500….”

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Japan Post Eyes $2.6 Billion Investment in AFLAC

February 10th, 2019

Japan Post would like to expand Aflac’s cancer insurance products sold at post office counters…..

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Kratom Anyone?

February 8th, 2019

Kratom is a miracle cure for everything from opioid addiction to anxiety……..

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Nataline Could Have Been 28 Today If Not For A Health Insurance Decision

February 8th, 2019

I’ve been asked many times if there was one thing, one moment, that led me to leave my job at a big health insurance corporation. Yes, there was, and it occurred five days before Christmas in 2007. That was when a beautiful 17-year-old girl named Nataline Sarkisyan passed away, days after the company I worked for refused to pay for a liver transplant that her doctors believed would save her life. A few days after Nataline’s death, I turned in my notice.

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Climate Change & Employee Benefits – Are You Kidding Me!

February 8th, 2019

If your’re in HR and believe in climate change this article is for you. You may want to consider offering your employees energy-free light bulbs and mandate car pooling………….

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Insurance Denials Can Be Death Sentences

February 8th, 2019

                  Molly Fetzer

Self-funded school district overrides TPA’s (Anthem) decision to deny coverage and authorizes doctor ordered treatment plan for stage 4 cancer member………………….

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Patient Sentenced To Death?

February 7th, 2019

Putting dollars in front of saving lives……………………..?

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Sheryl Bonner 1963-2019

February 6th, 2019

Respected industry leader passes………………………

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Why Employers Should Work With Older Folks

February 6th, 2019

“I’m 67, so I could give a shit,” she says. “What are they going to do, fire me? I’m packin’ a Medicare card.” – Marilyn Bartlett

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USA Rx Revolt Looks To Canada For Help

February 5th, 2019

Colorado on Thursday joined a growing number of states that want to cut certain prescription drug prices by importing licensed drugs from Canada………………..

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Gotta Love Bernie!

February 5th, 2019

Bernie Discovers Self At Early Age

Senator Sanders asks why drug, once free, now costs $375,000,000.00…………..

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HRA’s To The Rescue!

February 5th, 2019

The HRA’s Are Coming!

Expands the use of HRAs to allow for the purchase of individual health insurance coverage…..

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Centenarians Rejoice

February 4th, 2019

Hawaii considers ban on cigarette sales except for centenarians…………………..

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Cigna’s $54 Billion Problem

February 3rd, 2019

Health insurer’s purchase of Express Scripts is looking like even more of a blunder……..

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The Prevalence of Self-Funded Health & Welfare Plans

February 3rd, 2019

With steady growth in the last four decades, self-funded plans are now the most common type of health plan that workers are enrolled in across the United States. Various sources put this number at nearly 70% and climbing. Nearly all self-funded employee benefit plans are managed through a third party administrator (TPA) firm, an independent organization that assists with overall plan operations, benefit coordination and claims processing.

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Nonprofit Dental Insurer Under Scrutiny For ‘Flagrant’ Spending

January 31st, 2019

Dental insurance giant Delta Dental of California is facing mounting criticism for paying its CEO exorbitantly, flying board members and their companions to Barbados for a meeting……

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January 30th, 2019

Man Robs Bank, Demands To Be Sent To Prison

January 30th, 2019

“I’ve never heard anyone rob a bank so they can get to prison so they could get health care,” James Griffin, the assistant district attorney prosecuting Gallagher……………..

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Solution To High Health Costs: Abolish Health Insurance!

January 30th, 2019

Health Insurance Agent Reacts to News

Raging Left Coast Democrat vows to eliminate all private health care insurance for approximately 150 million Americans………………………………….

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