Poverty is highly correlated with large families

We have a global poverty problem, but what may surprise some, the US has not escaped the problem. Our middle class has been squeezed, but unfortunately, gravity has caused too many of them to fall beneath or just above the poverty line.

There are many reasons for the decline, but it has been occurring over the last 45 years, so all politicians own this issue. Technology advances, globalization, stagnant wages, downsizing of union populations, costly healthcare, etc. are all contributing factors.

Yet, it should be noted that large family size and one parent families are highly correlated with increased poverty. These two factors should not be a revelation, but too many folks look past these causes to others. This a key reason for the importance of family planning to help families manage their family size and health.

Today, I saw a report that noted the US has more teen pregnancies than other western nations. A data point was cited (without a source) that 30% of teens in the 9th grade have sexual relationships increasing to 60% in the 12th grade. The report supported the practice of more holistic sex education in schools, an experiment being promoted in West Virginia, where 1 out of eight births are to teen mother.

The training speaks to more than abstinence and contraception. It speaks to   how to say no and not give in to pressure. It discusses sexual assault and STDs. It speaks to relationships and the role sex plays when folks are ready.

Family planning and sex education are key tools in fighting poverty. There is a causal relationship between family planning and fewer abortions, which should give  those against family planning some consolation, Rather than condemn or not fund these efforts, we should look at the data and support them.

Celebration for passing a bill may have been premature

With a White House eager to claim legislative victory, there was a celebratory bash after the Republican led House passed the AHCA by a squeaker of margins 217 to 213. The bill has been vilified by several advocacy groups like the AMA, American Cancer Society and AARP and it has still not been scored by the Congressional Budget Office. The bill is also dead in the water in the Senate “once it gets sent there.”

Wait a minute, the last sentence said “once it gets sent there.” To the surprise of some Republican House members, the AHCA bill has not yet been sent to the Senate. Why, you might ask? Since the House did not wait for the CBO to score the cost and impact of the bill on the numbers of uninsured, it cannot be included in the budgeting process, and would thus require 60 votes, not 51 to pass in the Senate. The whole idea was to sneak the bill through this process, so it did not need the super-majority of 60 votes, which it cannot achieve.

Unless the CBO scores this where it saves a threshold amount of the budget, it may not qualify. So, the House leadership has not yet sent the AHCA to the Senate. If they did and the CBO results were not favorable, the House would have to start over. Again, I should reiterate that this bill cannot get even the 51 votes needed due to the impact on Medicaid. As we speak, about two dozen state governors are beseeching the Senate about not harming Medicaid. Unlike the House, the Senate is actually listening.

So, the victory lap on mile 250 of the Indy 500, may have been premature. Voting on something without knowing its impact is not the wisest course of action and is unbecoming of a legislator we trust to do our homework.

 

I want to buy this

Little Donnie has always had money. Daddy made sure of that, but Daddy is no longer around. As he was walking down Main Street with his friend Paul, he pointed to the shiny bike in the window and said, “I want to buy that bike.”

“But, you don’t know how much it costs,” said Paul.

“It does not matter, I want it,” said Little Donnie.

“But, you have a bike and it just needs a little oil for the chain and air in the tires. Plus, others can ride if when you don’t.”

“That does not matter. I want it. Go buy it for me,” said Little Donnie.

“OK, but we still don’t know how much it costs and whether others can ride it,” said Paul.

“Just buy the thing or I will tell all my friends you were mean to me. Some of them are your friends, too. They will stop being your friend and some may beat you up, believe me,” said Little Donnie.

“OK, but my big brother Mitch is not going to like this and he may make you give it back. We at least should know what it costs.”

“I will deal with Mitch later as I really want this bicycle,” said Little Donnie, “and I always get what I want.”

ACA truths Republicans don’t want you to know

The Affordable Care Act is an imperfect and complex law, but it is actually working pretty good. It does need improvements, but a few of its imperfections have been heightened by our Republican friends in Congress and in state legislatures. Yet, they do not want you to know about these actions, some of which are quite devious and harmful to Americans. To be frank, this subterfuge frustrates me as people are harmed as the GOP tried to waylay the law.

What has not been reported very much in main stream news is Senator Marco Rubio’s successful efforts to stiff insurance companies. These companies were promised additional funding for taking on excessive bad risk, called adverse selection. This was done successfully when the Medicare Part D plans were rolled out. By stiffing the carriers, the insurance companies had to raise premiums even more than they otherwise would have. Some even left the exchanges as this action hurt their bottom line. Let me say this plainly. Senate Republicans screwed Americans with higher premiums to try and strangle the ACA. Rubio even bragged about this on the campaign, so please Google “Senator Marco Rubio and risk corridors” to read about what he did.

On the state level, 19 Republican led states chose not to expand Medicaid, a key component of the ACA. 31 states who did so are seeing fewer personal bankruptcies and better hospital accounts receivables. Republican John Kasich, who expanded Medicaid as Governor in Ohio and ran for President, said “Medicaid expansion is a no brainier.” I would have likely voted for Kasich had he won the GOP nomination.

Then there is the naysaying that has been facilitated by the 50 plus repeal votes. Far too many folks never gave the ACA the benefit of the doubt. It is imperfect and the exchanges were rolled out horribly, for which I blame former President Obama. Yet, this law has made a huge difference in the lives of many Americans.

Finally, what is ironic is the ACA is built off a Republican idea. This is a key reason Republicans don’t have a good replacement. In fact, former Senator Jim DeMint, the initial Tea Party leader, strongly advocated Romneycare, on which the ACA is loosely based, for the whole country. He even wrote a letter to President Bush advocating for it. Yet, when Romney ran for President in 2012, DeMint said both Romneycare and the ACA were unconstitutional. This hypocritical change of heart can be easily found by Googling “Senator DeMint and Romneycare.”

People need to know the truth. This is not false news as our President likes to claim. Please research these facts and read as much as you like. Then, ask your representatives to start governing with real information and look to help Americans. I strongly recommend we do not repeal the ACA and improve the law. To do otherwise, is poor form for those who hindered it at the expense of Americans.

 

 

 

Puzzled about the ACA – take this quick quiz

Now that the AHCA effort by the President and Republican majority has fizzled, it would be appropriate to step away from the rhetoric and ask a few questions about the Affordable Care Act (ACA). I would also suggest you may not want to listen only to politicians on this as I have learned the health care awareness of politicians is not as high as we need it to be and some are more interested in optics than impact.

The questions and answers have been provided by a retired benefits actuary, consultant and manager for a Fortune 500 company.

Question 1: The ACA is: (a) undergoing a death spiral, (b) a disaster and will implode, (c) doing well in a number of places, but needs help in a few others.

Question 2: The reasons for rising costs under the ACA are: (a) adverse selection where more bad risks are signing up than good risks, (b) Congress refusing to fully fund insurers as promised for this adverse selection, (c) increased demand of services due to our aging and more obese country and pent-up demand, (d) over-prescribed medicine and tests due to profit-induced incentives, (e) all of the above.

Question 3: In its report of the initial and refined draft of the ill-fated AHCA bill, the Congressional Budget Office noted the number of un-insureds under this bill if passed would: (a) increase by 14 million in 2018, (b) increase by 24 million by 2026, (c) both (a) and (b).

Question 4: Medicaid expansion to cover individuals who earn less than 138% of the poverty level is a key part of the ACA. What do we know about the Medicaid expansion effort: (a) 31 states elected to do so, (b) states that did so received federal funding that started at 100% and will phase down to 90%, (c) per a study by George Washington University, the states that expanded Medicaid have more insureds, better performing economies and more secure hospitals, especially rural ones who had a high percentage of indigent (unpaid for) care, (d) the states who expanded Medicaid are witnessing a decline in personal bankruptcy rates and an increase in hospital accounts receivable rates (e) all of the above.

Question 5: The ACA added which of the following improvements to insurance coverage under the employer and the ACA marketplaces (a) guaranteed issue and renewability of insurance, (b) eliminated life time limits on coverage, (c) extended eligibility to adult children not going to college up to age 26 on their parent plans, (d) provided subsidies to purchase coverage up to 4 times the poverty level based on family size and income, (e) all of the above.

Question 6: What are reasonable considerations to improve the ACA? (a) better fund the promised adverse selection protection to stabilize premiums for insurers, (b) offer to reimburse insurers who left the marketplace for unpaid adverse selection protection as promised under the law to woo them back, (c) offer a public option (such as Medicare) in some places with no competition, (d) encourage the expansion of Medicaid in the remaining 19 states, (e) stop the unproductive naysaying and think of the impact on people not the politics, (f) all of the above.

In my view as a benefits professional who follows these issues, the answers to each of these questions is the last choice provided. I have grown weary of politicians playing with people’s lives. We are owed the truth. Overall, this law is working reasonably well, but needs improvements, especially where insurers have left markets leaving one choice. The framework is there, but the improvements noted in Question 6 are reasonable changes.

One final thought I learned this weekend. To some there is a stigma of being on Medicaid. One man said he was embarrassed to show his card. Under the Medicaid expansion with the ACA, the card does not reference Medicaid, so it removes some of the stigma. The man began seeing a doctor and that has made a huge difference.

 

 

Encourage a No vote on the AHCA

The following is an email posted to my US Representative’s website today.

As a retired benefits actuary, consultant and manager, I encourage you to vote no on the AHCA vote today. The CBO says the modifications made do not alter the expectation that over ten million people will lose coverage. Plus, two hospital groups, two Doctor groups and the AARP have all recommended a no vote.

As a benefits professional, my strong recommendation is to improve the imperfect ACA. It is disappointing that my former party has highlighted the negatives of the ACA, while downplaying the many positives.

I would recommend the ACA be improved with a few changes:
– fully fund the risk corridors to reimburse insurers for adverse selection, the absence of which drove premiums up and forced some insurers out of the market,
– introduce a public option in areas that have no competition,
– encourage the 19 states who did not to fully expand Medicaid.

There are other changes that would help, but getting rid of this law would cause more problems that it would solve. Also, a poor reason to vote for the AHCA is to do so because a President who has little understanding of healthcare and wants to check a box is threatening you.

Please vote no to the AHCA and improve the ACA instead.

Voting on something important not knowing the cost is malfeasance

Allow me to come right to the point. Voting on a repeal and replacement healthcare law without it being measured by the CBO for its financial impact is malfeasance. My old party has waited seven years for this, they can at least know what it costs, who is helped and harmed by it and its impact on the debt. Trying to ram something this complicated through is about as poor stewardship as can be found.

This especially true with at least two hospital groups and two doctor groups coming out against it, not to mention the largest lobbying group for retired persons, the AARP. This is especially true with the numbers of people impacted, in particular, the lower paid and older people. As a retired benefit actuary, consultant and manager, I am also troubled by the naysaying of the imperfect ACA in the first place.

The ACA is not in death spiral so says the American Academy of Actuaries. It could be improved, but it is not a disaster as spouted by Messrs. Trump, Ryan and McConnell. It frustrates me that a law that is working pretty good expanding coverage, is being beaten on to support a change that appears to be ill-conceived. It also frustrates me we are not using data driven analysis to decide what to do.

Medicaid expansion is a “no brainer” said Ohio Governor John Kasich, the most reasonable Presidential candidate in my view. This is also the view of The Commonwealth Fund, Economic Policy Institute, RAND Corporation, Kaiser Family Foundation and a study by George Washington University. We have data to contrast the results in the 19 states that did not expand to those of 31 states that did. What I have read is the states that did are seeing fewer personal bankruptcies than before and improved hospital accounts receivable rates.

But, a huge factor should be the following. The ACA administration is already built. As a former benefits manager and consultant, I have witnessed far too many mistakes in administration by reputable insurers and state and federal governments. While the ACA exchange roll out fits this bill, it has now stabilized and is working. My strong advice is to improve the ACA and not throw the baby out with the bath water. To be frank, there is so much in fighting in the Republican Party, that may be the only course of action achievable.