A specific deficit problem – Social Security and Medicare

While we have an annual US deficit approaching $1 trillion on budgeted revenue around $3.4 trillion, nothing much is being done about it or our current debt of $22 trillion. A tangible subset of this problem includes Social Security and Medicare, which were reported yesterday by trustees to run out of money in the near future – Medicare by 2026 and Social Security by 2035.

A nonpartisan group called The Concord Coalition, who tracks and reports on our debt and deficit issues, offered the following statement.

“Today the trustees once again warn that Medicare and Social Security are not on sound financial ground,” said Robert L. Bixby, Concord’s executive director. “Sudden and substantial benefit cuts await beneficiaries in less than 20 years — well within the lifetimes of many current beneficiaries — if lawmakers fail to act. Any ‘political leader’ worthy of that title, including those out on the 2020 campaign trial, should make it a priority to find solutions that are both fiscally and generationally responsible.”

Bixby added: “The trustees’ warnings seem all the more alarming because the country is not in a position of current or projected fiscal strength. Delaying reforms, however, would simply exaggerate the generational inequities of reform. For example, the trustees say it would now take an immediate and permanent benefit cut of 17 percent to keep the Social Security trust fund solvent for 75 years. Waiting until 2035 to take action would increase that benefit cut to 23 percent.”

As a retired actuary, I have written before about a few ideas, not limited to the following:

– increase the Social Security taxable wage base to above $180,000 drawing more FICA taxes from employees and employers;

– reduce Medicare retirement age to 62 and use ACA funding for that group to shore up (it will help the risk pools of both groups);

– limit cost of living increases on Social Security benefits along with measured changes to select Medicare benefits;

– increase judiciously FICA taxes to shore up shortfalls (Medicare Part A is currently 1.45% and Social Security is 6.2% up to the taxable wage base of roughly $128,000). Medicare Part B premiums change annually.

Please encourage your legislators to act now on these issues. Bixby’s caution is a good one. As we age as a country, it will only add pressure. Also ask candidates what they propose. Do not let them off the hook with a non-answer. Deferring action has been the norm.

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On the downhill side of hump day

Tomorrow, the infamous Mueller report will be released in redacted form. Of course, the AG has called a press conference, so there are no guarantees. I would not be surprised by anything at this point. I do see a scared President.

What I find interesting is Giuliani and crowd are preparing a rebuttal, yet we have been told they had not see the report. I did not believe this for one bit, but I find it odd that you can write a rebuttal to a report you have not seen.

What I also find interesting is how someone can tout the summary conclusions that the AG offered and then denigrate the underlying report. This was akin to Trump saying Michael Cohen lied to Congress, except when he was bragging on Trump.

Herman Cain said he will keep his hat in the race for the Federal Reserve Board. This is giving the GOP Senate leaders heartburn as they see him as unqualified and unfit based on past issues. They have a right to be concerned, in my opinion.

Mayor Pete has some sound advice for his fellow Democrat Presidential candidates – do not make this about Trump bashing. I agree. Mayor Pete has impressed every where he has gone for interviews.

Speaking of impressing, Bernie impressed the Town Hall attendees on Fox. Dems need to do more of this, as their message is overall better than the current President and GOP. It is not perfect and needs to move to the center more, but talking about healthcare, job training, climate change, e.g. is much better than a border wall. By the way, the President, who feels Fox is his network, has fumed twice for Fox hosting Bernie. I find this amusing.

Finally, I was quite tickled when the President started criticizing Bernie’s taxes that he released. The response should be simple – “Mr. President, you are welcome to do this as I realized my tax returns. Where are yours? What are you hiding?”

Rural hospitals closing at an alarming rate

Rural hospitals in trouble is not a new topic, but the significant increase in closings and risk of such is finally getting some attention. The issue for years has been the large percentage of a rural hospital’s budget that went unpaid due to patient debt and indigent care. In some hospitals, the percentage of these two items is more than 1/2 of the budget.

Per a February, 2019 article in Modern Healthcare called “Nearly a quarter of rural hospitals are on the brink of closing” by Alex Kacik: “Twenty-one percent of rural hospitals are at high risk of closing, according to Navigant’s analysis of CMS data on 2,045 rural hospitals. That equates to 430 hospitals across 43 states that employ about 150,000 people and generate about $21.2 billion in total patient revenue a year.

Hospitals are often the economic drivers of rural communities. Per capita income falls 4% and the unemployment rate rises 1.6 percentage points when a hospital closes, a related study found. Ninety-seven rural hospitals have closed since 2010, according to the University of North Carolina Cecil G. Sheps Center for Health Services Research.

They also broke the impact down by state, revealing that half of Alabama’s rural hospitals are in financial distress, the highest percentage in the country. At least 36% of the hospitals in Alaska, Arkansas, Georgia, Maine and Mississippi are in financial jeopardy.”

Most of the states in trouble chose not to expand Medicaid, but there are some who did or are now doing so. Per several studies by The Commonwealth Fund, RAND Corporation, Economic Policy Institute and George Washington University, expanding Medicaid would help patients, state economies and rural hospitals. Why? It would allow these hospitals to get paid and paid closer to the time of service reducing accounts receivables. Getting paid has an echo effect on employees and consumers.

This issue was brought home by two Republicans pleading with their party to acquiesce in states like North and South Carolina that did not expand Medicaid. GOP Governor John Kasich of Ohio, who ran for President, said Medicaid expansion is a “no brainer” and would add over $13 billion to Ohio over several years. Yet, the most dramatic plea was from Adam O’Neal, a GOP Mayor of a North Carolina town called Belhaven.

After failing to get the GOP majority in Raleigh to help save his town’s Vidant Pungo Hospital that served 20,000 people, he walked 273 miles to Washington, DC over 14 days. “You can’t let rural hospitals close across the country. People die,” O’Neal, told Modern Healthcare in 2014. Unfortunately, Vidant Pungo closed later that year (note a non-ER clinic opened in 2016).

You can add my pleas for help back then (and now). Folks, this stuff is real. I do not care if your tribe is blue, red, purple are chartreuse, hospital closings impact people’s lives and people’s livelihoods. Closings also hurt their community’s economy. My strong advice is for legislators to stop political posturing and do something. I do not care who wins or loses a political game. Stop focusing on keeping your job and do your job. You could start by expanding Medicaid, joining the other 36 states.

Note to Democrat Senators running for President – stabilize the ACA

The following note was posted on the website for the seven Democrat Senators running for President, with a copy to select others.

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I am an Independent voter and retired, but my career included being an actuary, benefits consultant and benefits manager for a Fortune 500 company. I have shared with Senators and Congress people a few thoughts on stabilizing the ACA, something Democrats campaigned on last fall and won.

Medicare for All deserves debate, but will require a more elongated and data-driven discussion. We need to have Congress take steps to stabilize the ACA now. To do otherwise, is a disservice to Americans.

Here are my thoughts.

– the GOP sabotaged the ACA in two specific steps which increased premiums even more. They defunded 89% of the risk corridors (for initial adverse selection) driving some insurers out of the market. The other is Trump reneged on reimbursing insurers for copays/ deductibles for people making less than 2 1/2 times the poverty level. My suggestion is to pay insurers what we promised in writing and invite those who left back into the exchanges.*

– I suggest the lowering of the eligibility age for Medicare to age 62 (the age when retirees can first draw Social Security). This could be viewed as a pilot for Medicare for All. This action would lower the Medicare premium rate for all and lower the ACA exchange premiums due to the age of those leaving the ACA and joining Medicare. In other words, both the average age of Medicare and the exchanges would be lower, so the actuarial cost per person is less in both.

– Actively encourage the expansion of Medicaid in the remaining states – this will help the economies, healthcare providers and people in those markets. There are now 36 states who have done so. GOP Ohio Governor John Kasich calls Medicaid expansion a “no brainer.”

– Finally, where only one option exists in a rural county, offer a Medicare option, again as a pilot. People should have choices.

There are other changes that would help, but this needs a data-driven analysis and not whatever the GOP did in 2017, which was a horrible approach to legislation that resulted in horrible legislation. Had any of the GOP legislation passed to kill the ACA, the GOP would have lost even more seats and we would be talking about a recession coming our way.

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* Please feel free to Google these topics: “Marco Rubio and risk corridors” and Donald “Trump and ACA subsidy decision”. The former caused insurance premiums to increase more than they otherwise would have and some insurance companies left the exchanges with the US government owing them money.  The risk corridors were designed to tie insurers over until the initial adverse selection flushed out of the system.

The latter was frustrating because the subsidy helped people in need. Trump untruthfully claimed it will only affect insurer profits, but the carriers committed to the customers to do this under contract. The CBO said this action raised the deficit by $10 billion, since premium subsidies went up to pay for the increased premiums. In my home state of NC, BCBS said before the Trump decision premiums were NOT going to increase. After the decision, the premiums increased 8%.

Saying this in a more succinct way, the GOP screwed American people to win a political argument. Sadly, that is the truth, but very few people know of this. This also is an exemplar of the President’s lying affecting hard-working people. Lying is one thing, but setting policy off lying is another matter altogether.

Note, the ACA is imperfect and complex. But, it still has not been fully implemented in all the states with those who did not expand Medicaid. But, people need to be fully aware of the sabotaging of the ACA undertaken by the GOP, which I find interesting, as the ACA is largely based on a GOP idea. That is politics for you – you did it, so I must be against it.

Hey Dems, focus on these four issues

One of this Independent voter’s frustrations with politics, which is exacerbated by this President, is pressing issues are not getting discussed. And, some are made worse or are sabotaged by the current White House incumbent as we are told to focus our attention on issues he has overstated in importance or sold on fear.

While there are many issues, it is hard to boil the ocean. So, my advice to all politicians, but especially the Democrats who are pushing these ideas, is to narrow the focus to the following four issues.

– Stabilize the healthcare system and have a good debate on Medicare for All, which is a hard sell. The GOP has failed to realize that a reason they lost the House is not listening to most Americans, instead sabotaging the ACA reneging on commitments to insurers and trying to repeal it. As a retired benefits actuary, consultant and manager. I would suggest an idea to stabilize the ACA is to expand Medicare to retirees at age 60 or 62 and measure the impact for its veracity. But, we need to start by paying insurers what we committed to them.

– Climate change is real, is happening and is man-influenced. AOC is dramatizing a little about the end of the world, but the data point she is citing is if we do not make huge strides by 2030 (12 years), our ability to stop the warming trend impact is minimal. She has been ridiculed for he Green New Deal by the GOP, but I would rather discuss her plan than Senator Marco Rubio ignoring the fact the largest city in Florida is the most at risk city on the planet and is seeing a larger number of sunny days flooding from the rising tides. Who is the crazier person, the one speaking to a problem or the one ignoring it altogether?

– Job retraining is key, but we need to understand the major reasons the jobs are going away are technology/ robotics and CEOs chasing cheap labor. It is not immigration or trade, which are down the list. This especially true in those impoverished areas where industry has left them behind moving or closing a plant.

– Finally, the debt and deficit are critical to discuss. The debt just passed $22 trillion and is headed to $34 trillion by the end of 2027. The annual deficit will pass $1 trillion this year, which is nearly 1/3 of our annual revenue. My former party and, in particular, the Freedom Caucus, are as hypocritical as they come. When the Dems had the White House, the Freedom Caucus screamed bloody murder when the debt was $8 trillion, then $13 trillion. But, I give the same caution to Dems I give to the GOP, we must reduce spending and increase revenue. The math will not work otherwise, so says the CBO, Committee for a Responsible Federal Budget, The Concord Coalition and Simpson-Bowles Deficit Reduction Committee.

Of course, there are other critical issues. But, if you focus on the important few, it will resonate. This is especially true for younger folks – climate change, debt, future jobs and healthcare are important. In my view, the GOP has lost its way on issues of import. When I left the party twelve years ago, a key reason was its global warming denying stance. My thesis is if you are denying the greatest threat facing our planet, how can I trust you on resolving other issues?

We are behind the eight ball on too many issues. We are leaving our problems to our children and grandchildren. They will ask us, why did you do that? Why, indeed?

This, that and another thing

Now that the state of the union and Democrat rebuttal are behind us, it would be nice if an independent voter had a turn. On the talk (and some shouting) shows, the independent views do not get heard enough and that is disappointing. For once, it would be illuminating for a member of neither party to share their thoughts.

For example, we might learn:

  • Global warming really is a concern and we should be doing something about it. On Bill Maher’s Friday show,  he noted that Senator Marco Rubio used the argument against the President for declaring a national emergency to build the wall, as what would stop President Kamala Harris from doing so to address climate change? Maher correctly pointed out the latter is becoming a national emergency, while the wall is not even a top ten issue and is overblown as a solution. He also noted, with the very real concerns over Miami, Rubio may become the Senator of Atlantis.
  •  A growing debt which is around $22 trillion with an annual deficit about to hit $1 trillion is a problem, especially with the deficit in a good economy. The Committee for a Responsible Federal Budget models the debt to be around $34 trillion at the end of the 2027 fiscal year. We must have spending cuts and revenue increases both. The math will not otherwise work. If a politician tells you differently, he or she is lying to you. Don’t let them.
  • The Affordable Care Act and Obamacare are the same thing. So is KyNect in Kentucky. Too many people still don’t realize this in the GOP. But, don’t look to politicians to solve this, as they really do not understand how our complex healthcare system works. We need to stabilize the ACA and stop sabotaging it, as the GOP has done.  My recommendation as a retired benefits consultant, actuary and manager is to fund money promised to insurance companies to pay for adverse selection and committed to deductibles, copays for people beneath 2 1/2 times the poverty limit. I would also expand Medicare as a pilot, measured effort to retirees below age 65, such as 60 or 62. This will reduce the cost rate in the exchanges and Medicare. The remaining states need to get off the dime and expand Medicaid – it is a no brainer per GOP Governor John Kasich.
  •  Addressing America’s crumbling infrastructure would help rebuild assets and provide good jobs. We also need to build on the community college system with some added funding to retrain people to do the jobs of the future, as technology claims even more (this is the major threat, not immigration or trade). Also, building on the bipartisan idea pitched to the President last year by Senators Sherrod Brown and Rob Portman from Ohio, we should co-invest with car manufacturers to retool plants to make the cars in demand and keep the factories open. This idea was ignored and the President was offended when GM announced some plant closings.
  •  There are so many more ideas around rethinking ill-conceived tariffs and trade fights, poverty issues, and gun governance, but let me make a general statement that is important. Start treating our allies and citizens with fairness and dignity. Stop the adversarial BS. A country and business makes more money long term by having a productive long term relationship. We need to stop measuring success on short-term transactions. Listen to your advisors as they actually study our problems. And, stop beating up on a free press. From where I sit, they are not perfect, but the true journalists try to get it right. The main source of fake news in the country sits in the oval office and he only cares about looking good.

Well, that is enough for now. I would love to hear your thoughts.

Real problems are not getting addressed

In lieu of focusing on problems that have been overstated by fear and misinformation, several real problems remain. Just to name a few – $22 trillion in debt with an expected $1 trillion annual deficit; ill-crafted tariffs which are slowing the global economy; increasing poverty and hunger; climate change interventions; infrastructure needs that are ticking time bombs; retraining workers impacted by technology; domestic terrorism and gun deaths; and stabilizing the ACA. These are the concerns of this independent voter, who has belonged to both parties.

Note: I wish to applaud Germany for announcing last Friday they plan to phase out coal energy by 2038. It should be noted that in 2018, renewable energy surpassed coal energy in Germany. This is what can be done when real problems are addressed with planning. The US is doing many good things with renewable energy, but it could do so much more with supportive federal leadership.