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.

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.

 

 

 

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.

 

 

 

Musings at the start of summer

The longest day in the Northern Hemisphere is upon us. Maybe with this extra daylight we can have more illumination on issues. It seems we have a bad habit in our country of governing off rhetoric rather real information.

Saying it more basically, we believe our own BS. It is puzzling why we would make decisions off stuff we made up. Yet, that gets to the heart of the matter. The authors of change don’t necessarily want to solve the problems. They just want to win the election game of optics.

A good example is the secretive Senate effort to develop a repeal and replacement bill for the ACA. The effort has several of the remaining Republican and all of the Democrat Senators up in arms. What is missing is open and honest debate. What is missing is open acknowledgement of Republican efforts to strangle the imperfect law by withholding money from insurance companies promised them to take on adverse selection (higher risk).

Another good example is withdrawing from the Paris Climate Change Accord where America abdicated a global leadership role. While the President and EPA Director tell us there is not consensus on man’s influence on climate change, they fail to tell us that there is an overwhelming consensus from the scientific community. They also fail to heed the recommendations of countless companies, cities and states to remain, including ExxonMobil and Royal Dutch Shell. The sad part is the job growth and investment in renewable energy is growing rapidly and large companies like Amazon. Google, IKEA, Walmart et al are leading the way.

Let’s hope our myopic leaders will use today’s extra sunshine to see the light.

Dad did good

My Dad had a hard life growing up. His parents split up early and neither played a big role in his formative years. Fortunately, he was provided a safety net that would not let him fail. He was raised by his Great Aunt and Uncle.

His Uncle ran a general store in a small Georgia town. My Dad was asked to help out there. This eventually led my Dad to start his career with a regional supermarket after college and a stint in the Navy. More on that later.

He went to college in north Georgia, but it was under a required work study program.  You had to work to attend and that was the only way the students could afford the tuition costs. He met my mother there and they married in 1951 and moved to Jacksonvulle, FL.

He had a stint in the Navy when the Korean Conflict started joining with several friends. Serving on an aircraft carrier, he learned of 25 second showers, discipline and visited some exotic places,  Once home, he decided soon a supermarket career was not for him. Even with his low salary, he would have to cover bounced checks as a manager.

He and his good friend George decided to move into this career called data processing, the precursor to IT. He worked for a regional insurance company and eventually worked his way up. He was there until he retired in the early 1990s.

He and my Mom raised us three kids. She was a schoolteacher. I mentioned in my last post in a comment that he would pitch batting practice to me after work and coached me on occasion. He was a very good athlete in college playing basketball, baseball and track.

He also was a great outdoor cook. He would love to smoke hams and turkeys, and cooked a mean roast and chicken. He would tease us saying the chicken did not have any wings, as he would sample them outside. His team would have indoor office picnics and he would usually bring a ham or turkey. They tended to request this of him.

He and my Mom were a great couple, married for 54 years. He died too early after a life of smoking and drinking, even though he quit both a dozen years before he passed. Like me, my Dad was an alcoholic. I stopped drinking myself the year after he died.

When he passed in 2006, there were a half dozen couples that met in college like my parents and were still together that came to his funeral. He was remembered well, but it was a tribute to Mom, too. My Dad was not perfect, but he was a good man, husband and father. I love you Dad. Your lessons are remembered and appreciated.

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.