The President and Congress own Obamacare

I have written often about the imperfect Affordable Care Act and ways to improve it. I have written often about the Republicans role in sabatoging the ACA making premiums even higher by not funding promised payments to insurers for adverse selection as well as naysaying the law and not expanding Medicaid in 19 states.

This sabatoge continues under this President who says the ACA is in a death spiral. It is hurting in many areas, but stabilizing in others. He said he wants to let it implode and then fix it.

Mr. President, that is not good enough. You are threatening to cease further promised payments to insurance companies which will harm people. You see, what you and Congress fail to realize is you own Obamacare. If it fails, it is on your watch. And, to be frank the significant majority of Americans and the press do not recognize the role you played in hamstringing the imperfect law.

My strong advice is to do what is necessary thinking of its patients and users. Those Americans out there deserve your best efforts to help them. Watching the ACA fail after you greased the skids is extremely poor form and uncaring. It is that simple. Fix the ACA. That is what is done to laws that need it to help people.

Sunday sermon-ettes, the sequel

Good Sunday morning all and enjoy the day. A few tidbits have been bouncing around in my head, so I will commit them to writing for your review and critique. The tidbits are light on religious tone.

Guns and butter: For some reason, in the US we spend more time discussing protecting the right to own a 34th assault weapon than feeding 34 people. We have far too many food deserts in our country where the closest food is a convenience store. Far too many in our country are undernourished. Yet, pick up any local paper on any day of the week, and you will find multiple gun killing stories. Better gun governance is essential, but it is a nonstarter with the NRA who is more interested in gun sales. I think our priorities are off.

Kicking poor people in the teeth: Along those same lines, our President is pushing the Republicans in the Senate to vote on whether to kick 22 million Americans in the teeth or 34 million, many of whom are in poverty or near poverty. It should be noted the President said he would not touch Medicaid. I guess that detail escapes him in his desire to have a photo op of him signing something.

Brexit is a hard pill to swallow: The word Brexit sounds like one of those new fangled drugs to cure something you did not know you should worry about. I think voters were not told the whole story and many are wishing they had a do over. As foretold, the financial companies who based their EU regional business in London, are making definitive plans to move. Bank of America just announced a move to Dublin, Citigroup is moving folks to Frankfurt and other places, and Japanese banks are doing likewise. While I  understand the desire to fully govern your future, the UK is harming its future growth. That is not just my opinion, but that of financial experts.

Shrinking to greatness is not a good strategy: Speaking of financial growth, limiting relationships with other countries is not conducive to growth. And, a venture capitalist noted that what creates jobs is customers. Plus, when we discuss global trade, we need to reflect the whole picture and that is the foreign owned companies who make things here with American workers. Why? Selling big durable products is more cost effective and less risky if they are not shipped from abroad. Just ask BMW, Toyota, Husqvarna, Michelin, Mercedes, Volvo, Mitsibishi, etc. about their plants here in the US.

The bible says many things: There is a minister who upsets a few applecarts by preaching that the bible should not be cherry-picked to support points of view. His obvious example is in Genesis where God tells Adam and Eve to go forth and multiply and then gets mad at them when they like being naked with each other. The question is how did they know how to go forth and multiply? The minister’s premise is we should take away the overarching messages that are taught therein and remember the context of when the bible was written.

So, on that note, go enjoy your day, whether you choose to practice your multiplication tables or not.

 

Gone to seed

We have a poverty problem in the United States. Too many of our declining middle class did not rise to the next strata, falling instead, to near poverty and into poverty. Yet, we do not talk about this problem enough. We have let their ladders out of poverty, go to seed along with their environment.

Poverty should be succinctly defined, as it is often misdefined along with simplistic diagnoses. Quite simply, poverty is the lack of money. The causes are many and complex, so the solutions must be holistic.

Some like to say it is due to lack of virtue. Some like to say it is due to lack of work ethic, while others may claim it is due to drug use or alcoholism. When I work with people in poverty, I witness hard working, often pious people. I see people with a lesser propensity to do drugs than general society.

If we recognize the simple definition of poverty as lack of money, we can focus our attention on providing ladders out of poverty. We can invest in the communities that have gone to seed, both with economic and social capital. We can start with redeveloping depleted assets. The term coined with a successful program in Atlanta is ABCD – Asset Based Comminuty Development.

ABCD could focus on repairing and not closing a community school, recognizing the during and after school value it offers. Or, it could be redeveloping a gone to seed golf course or empty textile or tobacco mill. Or, it could be repurposing a mall to be a school, church, charity or governmental building. Replacing or refurbishing blighted assets makes a huge difference.

Coupled with these investments must be education and career development, or social investments. Jobs and careers are scarce in too many areas. Opportunities must be introduced and nurtured to make them sustainable. STEM education, apprenticeships, trades skills are part of an all of the above tactical strategy,

But, we must be mindful of four negative trends in areas that have gone to seed Рcrime, opioids, food deserts  and single families. Community policing by people living in the community is key. Targeted help with the opiod epidemic is important. Better food choices must be available as they may not have a grocery market. And, we must have holistic sex education and access to planned parenthood tools and birth control.

What we cannot have is kicking tens of millions off health care insurance. We cannot reduce an already minuscule food stamps program. We need to think about improving the minimum wage.

These are just a few ideas. But, first we need to address what people in poverty lack – money.

 

 

 

Tuesday’s Gone with the Wind

With a shout out to one of my favorite Lynyrd Skynyrd’s songs “Tuesday’s Gone with the Wind,” here are a few tidbits for this Tuesday.

It should not be lost on anyone that two of the biggest players in wind energy are two of the largest manufacturing companies in the world – Siemens and GE. With Iowa at almost 1/3 of its electricity provided by wind and oil rich Texas at 13% and the largest US wind energy state, this is much more than a breeze and just shy of a gale.

What the ranchers and farmers in the Midwest and in other areas have learned, is leasing their land to wind mills earns annual income and let’s them continue to use the land. In North Carolina, for example, one farmer leased his farm for eleven wind mills for annual income of $55,000. With the variability of profit margin associated with working the land, this adds some stability.

Thinking of a different kind of wind, the Senate leader is a particularly blowhard. Now, that the third effort to revise the Senate ACA repeal and replace has fallen apart, he is still reluctant to take the more appropriate path. Rather than working with all members of the Senate following normal procedure for legislation, he now is talking about a full repeal vote, without replacement. Not only is that malfeasance in my view, it runs contrary to the wishes of most Americans. The fact the President suggested it does not improve the veracity of the idea.

Folks, please pay attention to the good and bad things happening. We can no longer assume our elected leaders will act with the necessary diligence and stewardship.

 

 

 

Ides of July – the heat is on

Summer is in full force here in the Northern Hemisphere. If I don’t get my yard work started before Noon, it is not happening. I worked through 12:30 pm today and am a worn out camper.

Speaking of heat, the Senior and Junior Donald are feeling the heat right now. More than a few conservative reporters, pundits and legislators are concerned over Junior’s zeal to collude with Russia and his evasive storytelling. As Charles Krauthammer noted in his column, the ability for Senior to claim this is a media and Democrat witchhunt is now over.

Continuing with the theme of heat, a large chunk of Antarctica sea ice fell into the ocean. The fact that it was the size of Rhode Island should be a wake up call. Melting sea ice won’t directly increase sea level, but the buffer it provided to land ice is gone. And, as land ice melts, it will become a problem for sea levels. The best description I heard is the sea ice melting is like losing the white edge of your finger nail exposing the more painful parts.

Finally, please provide more heat on Republican Senators before they pass one of the more unpopular and damaging pieces of legislation to repeal and replace the ACA. Not only will the CBO score this poorly, but it is opposed by the National Governors Association, the American Hospital Association, Blue Cross and Blue Shield, the American Cancer Society and AARP to name a few. I encourage these Senators to work with Democrats to improve the ACA, which is the preferred choice of the American public.

If the Republicans pass this into law, they have not seen the heat it will bring on their party. This law will harm Americans and the party who passes it.

A few suggestions on ACA Reform

Since the House and 13 Senate Republicans have decided not to listen to the American majority or review actual data, here are a few suggestions on reforming the ACA. The ACA is imperfect and seeing higher premiums than expected in some places, but critics overlook three key things. It has dramatically reduced the number of uninsured, it has introduced positive benefit requirements to all plans including employer sponsored ones and its premiums are even higher due to Republican Senators stiffing insurers.

What should we do about improving the ACA? First, do not pass any variation of the ill-conceived AHCA bill passed by the House. It is obvious the gang of thirteen GOP male Senators are not listening to the American majority. For what it is worth, here is what this retired benefit consultant, actuary and manager suggests for consideration.

– Pay insurers for the amounts promised them under the ACA to take on initial adverse risk (as was done when Medicare Part D was rolled out) and invite them to stay or return to the exchanges. Part and parcel with this change is to restore the risk corridor funding for adverse selection going forward. This will bring premiums down.

– Fully expand Medicaid in the remaining 19 states. The National Governors Association advocates the positives of Medicaid expansion with Ohio Governor and former Presidential candidate John Kasich calling it a “no brainer.” This will help rural hospitals, economies and residents as well as others in more urban settings.

– Reduce eligibility to Medicare to age 62. This will reduce the overall risk profile under the exchanges and Medicare since the added Medicare population is older than the average exchange population it would leave and younger than the Medicare population it would be joining.

– Where competition in the exchanges is nonexistent with only one provider, offer a public option through Medicare or a variation therefrom. The pricing needs to be fair when contrasted to the lone offering as you want provide viable choice, but not drive the lone insurer away

– Finally, I would suggest we evaluate the efficacy of all fee arrangements under the ACA. Which ones make sense to continue, which ones make sense to alter, and which ones should be shelved or replaced?

It would also be helpful for naysaying for the sake of a party position to cease. Some impressionable people have refused to consider the ACA because a politician told them not to saying it was horrible or in a death spiral. People need to be mindful that health care and insurance are complex and politicians are offering advice in areas for which they are not licensed or knowledgeable to do so.

To be frank, I would rather see us go down the path of a national health insurance model. Yet, that is s tough sell in this country. So, improving the ACA is the better course versus what is being discussed. Plus, the strategic expansion of Medicare noted above will permit us to study this option and expand or contract it based on its measured veracity.

 

 

 

Monday, Monday

With this famous Mamas and the Papas’ song in my head, have the best of weeks. Here are a few random musings to start off the week.

The new sleight of hand approach being used by the US President on Russiagate is “It is his fault I cheated.” In essence, his predecessor chose not to make public the verified Russian meddling in the Presidential election due to the polarized political climate. While I understand his logic, I disagree with his silence. Yet, his choice does not alter the fact the newly elected President is at the very minimum an unwitting participant in the meddling and, as yet to be proven, a known colluder. Either way, he cheated, but that is consistent with his history.

Speaking of cheating, having clandestine discussions about health care reform does not give off the impression what you are doing is on the up and up. David Brooks, the conservative pundit, said on Friday that a key reason for the secrecy is there is no overriding mission to what is being done. Also, it could be construed as cheating to sabatoging the Affordable Care Act by not giving money promised to insurance companies to reimburse them for the initial adverse risk they took on. These actions harmed people as premiums went up even more and some companies left the market because they were stiffed.

The reason the “Black lives matter” movement started has been in evidence even more of late. Apparently, in terms of police shootings, they don’t. I would not want a police officer’s job as it is very dangerous. And, there are many, many fine officers. Yet, there have been too many actions taken that seem to fly in the face of reasonable use of force. Why must shots be taken? Why must so many shots be taken? Why must the shooter shoot to kill? When I see seven, twelve, sixteen shots are fired, I find that excessive. We must have honest review by all parties and better training. Too many Black men are dying and yes, their lives do matter.

These reflections turned quite sobering. I hope everyone stays safe and travels safely this week. And, don’t forget to hug your loved ones and tell them how you feel.