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.

 

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.