Medicaid expansion is needed for NC says this retired benefits professional

As North Carolina continues its stalemate on Medicaid expansion, it might be interesting to heed the words of former Ohio Republican governor John Kasich. When Ohio moved forward with the Medicaid expansion, he called it a “no brainer.”

Now why would he say that? Kasich noted Medicaid expansion would not only help people, it would bring $13 billion to his state over several years. George Washington University did a study that said Medicaid expansion would help a state’s economy, help a state’s rural hospitals and help people. We should also remember NC Republican Mayor Adam O’Neal of Belhaven walking to Washington seeking the expansion of Medicaid after his colleagues in Raleigh turned him down as he tried to save his town’s hospital.

Rather than offer stale arguments, it would be nice if the Senate and House leaders figure out a way to get this done. Let me add the voices of The Commonwealth Fund, RAND Corporation and Economic Policy Institute that echo the results of the GWU study. NC is already in the minority on this. Please let’s find a way to help people.

Let me close with a truism about health coverage to think about. Those with coverage will see doctors earlier and will have access to prescription drugs to avoid future train wrecks. Preventive care and health maintenance are better paths forward for people and healthcare financing.

Note: The author of this post is a retired benefits professional who is a former actuary, former benefits consultant and benefits manager for a Fortune 500 company

The most realistic path to ‘Medicare for All’ says a former Insurance CEO

I said back in 2010 to a healthcare consulting colleague, we will eventually need to consider national health insurance, but it won’t happen. When he asked why, I responded the “Healthcare industrial complex is too powerful.” People forget the reason we have the Affordable Care Act is CFOs were tired of rising healthcare costs to their bottom line.

Healthcare is a complex topic and the ACA added to that complexity. It has since gotten better, but we need to shore it up to stabilize it more, rather continue to allow it to be diminished as its opponents have down for several years.

But, national health care under the banner of “Medicare for All” is worthy of consideration with data and analysis. This retired actuary, benefits consultant and benefits manager supports data driven analysis to improve what we have and consider more substantive changes. JB Silvers, a former health insurance CEO and professor of health care finance at Case Western University, penned an article called “The most realistic path to ‘Medicare for All'” in The New York Times earlier this month. Here are excerpts from the article:

“Much to the dismay of single-payer advocates, our current health insurance system is likely to end with a whimper, not a bang. The average person simply prefers what we know versus the bureaucracy we fear.

But for entirely practical reasons, we might yet end up with a form of Medicare for All. Private health insurance is failing in slow motion, and all signs are that it will continue. It was for similar reasons that we got Medicare in 1965. Private insurance, under the crushing weight of chronic conditions and technologic breakthroughs (especially genetics), will increasingly be a losing proposition.

As a former health insurance company C.E.O., I know how insurance is supposed to work: It has to be reasonably priced, spread risks across a pool of policyholders and pay claims when needed. When companies can’t do those fundamental tasks and make a decent profit is when we will get single payer.

It’s already a tough business to be in. Right now the payment system for health care is just a mess. For every dollar of premium, administrative costs absorb up to 20 percent. That’s just too high, and it’s not the only reason for dissatisfaction.

Patients hate paying for cost-sharing in the form of deductibles and copays. Furthermore, narrow networks with a limited number of doctors and hospitals are good for insurers, because it gives them bargaining power, but patients are often left frustrated and hit with surprise bills.

As bad as these problems are, most people are afraid of losing coverage through their employers in favor of a government-run plan. Thus inertia wins — for now.

But there’s a reason Medicare for All is even a possibility: Most people like Medicare. It works reasonably well. And what could drive changes to our current arrangement is a disruption — like the collapse of private insurance.

There are two things insurers hate to do — take risks and pay claims. Before Affordable Care Act regulations, insurance companies cherry-picked for lower-risk customers and charged excessive rates for some enrollees…”

There is only one solution: pooling and financing many of the risks related to chronic and acute health care issues. A study by my former company noted generally 15% of participants drive 80% of the claims costs in any given year. It may not be the same 15%, but with major chronic issues, some could continue to be in the mix. The principle of insurance is to pool those risks, so that good risks can moderate the higher risks.

The ACA uses the private insurance system, exchanges and expanded Medicaid. Unfortunately, there are about 15 states who still have not expanded Medicaid. Medicare for All would consolidate the risk into one place, eliminating the profit load and reducing the relative administration cost of insurance companies. I have suggested for several years to do a pilot and expanded Medicare eligibility from age 65 to age 62, or even lower. This would let us measure the impact of such a change.

Yet, what we don’t need is this to become political. What people do not realize is the ACA has been sabotaged on several occasions by my former party which drove some insurers out of the market and increased premiums for everyone else more so than they otherwise would have been.

So, let’s cut to the chase and study options. And, politicians should let people who know what they are doing do the analysis. The ACA was made too complex and the exchange roll out was botched. On the flip side, what the GOP did in 2017 was sloppy and poorly staffed, so what was voted on woulf have been harmful to many.

Blue Cross Blue Shield of North Carolina ACA premium rate cut request

Earlier this week, Blue Cross Blue Shield of North Carolina (BCBSNC) has announced a request of a premium rate cut for the second year in a row under the Affordable Care Act. They announced a request of a 5.2% rate reduction for their 435,000 members and one of 3.3% for small businesses in the state. It would have been three years in a row, but as I mentioned in earlier blogs, the Trump decision to renege on paying insurers for absorbing co-pays and deductibles for people making less than 2 1/2 x poverty limit caused premiums to increase for all.

This shows the ACA is stabilizing for insurance carriers who have been at it a few years. It would be nice to get more carriers back in for members to have choices. Many left when the Senate, led by the GOP defunded the risk corrider payments to the tune of 89% of the adverse selection cost. These carriers left the markets with the US government owing them money.

These two efforts to dampen the ACA have gone largely unreported. But, there is one more which is critical that impacts premiums and threatens the entire ACA. The tax bill passed by the GOP led Congress eliminating an unpopular feature of the ACA, which required individual coverage. It was called the individual mandate. By obligating people to have coverage, it lessened the risk on the insurers which will keep premiums lower than they would be otherwise.

Here is what BCBSNC said in their announcement as reported by The Charlotte Observer.

“The rate of decrease requested for 2019 would have been larger, the company told the Observer in 201, if the GOP tax reform legislation signed by President Donald Trump hadn’t repealed the ACA’s individual health insurance mandate.”

Further, several GOP led-states are suing the federal government to rule the ACA unconstitutional due to the elimination of the mandate. The tax laws are complex, but it is going to end up at the Supreme Court. It is thought by experts this case is weak, but the Trump Justice Department has decided to not defend the law which helps so many. Ironically, this is happening as it stabilizes even more, the GOP lost seats because of their ham-handed efforts to repeal it and when some Democrats want Medicare-for-all.

The art of exaggeration

The following are paraphrases of actual quotes from a person known to exaggerate and even prevaricate. A famous comedian from the same area as this person noted three years ago that this was “schtick” used to improve your image.

  • I am the least racist person in the world,
  • I am a stable genius.
  • I know more about taxes than anyone in the history of taxes.
  • They love me in England.
  • My gut is smarter than an expert’s brain.
  • No one has treated Black people better than me.
  • African-American people love the job I’m doing.

These are just top of mind from a longer list of exaggerations. Often, these are said following scrutiny that he has brought om himself.

This last point is important as I have said repeatedly this person is his own worst enemy. Through exaggeration and prevarication, he is the biggest purveyor of fake news by far. Even when the news is good, he must make it better or the “best.” Things he must change are “disasters.”

Yet, exaggerating and lying is bad enough, in and of themselves, but become  far more serious when policy is set off one of the two. Here are some real examples that should concern us all.

  • He said eliminating the subsidy to insurers under the Affordable Care Act to repay them for co-pays/ deductibles they absorbed for people making less than 2 1/2 times the poverty limit would only effect their profits – this is not true, as the CBO said it would increase the US deficit by $10 billion per annum and increased premiums for all members.
  • He said the illegal immigrants were taking all the jobs and are the reason for the malaise in certain areas – this is a gross exaggeration, as the primary reason for job loss is technology gains and CEOs chasing cheaper profits by offshoring manufacturing plants.
  • He said to reporters in front of the Pakistan PM, the India PM asked him to mediate the conflict in Kashmir – this is not true and statement was made by the India PM within an hour to state “no such request was made” as well as the White House staff going silent on the issue. India is an ally and experts noted this was a slap in their face as Kashmir is hyper-sensitive.
  • He said it is OK to have trade issues with China as we are raking in tariffs from them in our treasury, a statement he has repeated multiple times, including yesterday – while tariffs are being collected, this is a lie that China is paying them; US importers are paying the tariffs and passing much of the cost to US consumers.

I could go on as there are many examples to choose – he promised a better and cheaper healthcare program than the ACA in the election, but it has yet to materialize, and he is advertising it again for 2020. What is it Mr. President?

Politicians, business people and marketers tend to exaggerate and even lie to sell their message. Yet, the people who track lying say the incumbent has lapped the field. By the way, a key message from the Mueller report is the president is not very truthful and his staff knows it. And, Mueller testified that Trump was “generally” untruthful in his responses to his questions.

Please stabilize the Affordable Care Act NOW to help Americans

A February, 2017 Morning Consult Poll noted that 35% did not know the Affordable Care Act (ACA) and Obamacare are the same thing. I want you to think of this poll when you see how Americans feel about the ACA. Today, just under half of American approve of the ACA, but that is in part due to the above and the fact more progressive Democrats want a Medicare-for-All replacement.

I wrote the following post a few months back as I am of the opinion Democrats and Republicans need to stabilize the ACA now and explore a few changes on a measured basis. As I wrote this, I call politics on the carpet for causing some of this mess, but everyone needs to check their egos and zero-sum games and fix the problems which are fixable. They also need to drop the BS lawsuits that are asking to rule the ACA unconstitutional again, when the group making the request changed a feature to further this mission. That is like ripping an engine off the plane and blaming the engineer while it is flying.

So for what it is worth, here are my suggestions. 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 Congressional representatives a few thoughts on stabilizing the ACA, something Democrats campaigned on last fall and won in the midterms after the disastrous attempts of the Republicans to clean the slate that fortunately failed.

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.” North Carolina is debating this issue, but it needs to move forward with the number of rural hospitals that have closed thus far in the state.

– 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. Obama was not truthful when he said you could keep your doctor – no new network should make that universal claim. 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.

An ostrich pulls his head out of the sand

This story should not be newsworthy as it is long overdue, but unfortunately it is. A headline from a USA Today last week proclaimed “Trump ally Lindsey Graham says president should ‘admit climate change is real’.” Senator Graham went on to say per the article:

“‘I’m tired of playing defense on the environment,’Graham told reporters on Capitol Hill Wednesday as he and other GOP lawmakers announced the formation of the Roosevelt Conservation Caucus, which will ’embrace and promote constructive efforts to resolve conservation and environmental problems.'”

I have written often about addressing climate change. Progress in fighting climate change is happening, but it desperately needs the leverage of the US federal government. Plus, we must alter harmful deregulation to our environment.

Rather than belabor these points, let me say I left the Republican Party about a dozen years ago, in part due to its stance on climate change. My thesis is if the GOP is going to play ostrich-with-its-head-in-the-sand on an existensial threat to our existence, how can I trust its judgment on other issues.

So, thank you Senator Graham for pulling your head out of the sand and asking the US president to join you. As an independent voter and parent, I take seriously the threats to our environment and agree the GOP needs to alter its path on these topics.

Weariness and Frankness

This independent voter is weary of people not addressing the obvious and rationalizing actions and behaviors that are less productive. Having been a member of both parties, a Democrat for about ten years of my early adult life and about twenty years as a Republican, I define myself as fiscally conservative and socially progressive. Both parties have some good ideas, while both have some bad ones.

So, let me be frank with my opinions, built off this foundation.

Democrats can defeat Trump, but they can also lose to him. Please study why George McGovern and Walter Mondale got shellacked in 1972 and 1984 and why Michael Dukakis and John Kerry lost in 1988 and 2004. It is not ironic that winning candidates Bill Clinton and Barack Obama were more moderate Democrats. Democrats cannot beat Trump without Independents and some Republicans. They could start by working now to address shoring up the ACA as they committed to do in the mid-terms and not waiting until 2021. Medicare for All is worth the discussion, but we need to address issues today, especially after the healthcare fiasco the GOP went through in 2017.

With that said, people need to look under the hood as to why more progressive Democrats have a few socialistic ideas. We should not ignore that the US economy is fettered capitalism with some socialist underpinnings. On the top end down, we have rules that govern collusion, monopolies, interlocking boards, insider trading, bankruptcy, etc. and on the bottom end up, we have socialistic programs that offer Social Security, Medicare, Medicaid, Workers Comp, and unemployment protections. Yet, the reason for their focus is America has a widened disparity between the haves and have nots. The key is to have a good debate as to how we address this disparity, not name-call ideas to win elections. Plus, this discussion must be done in the context of our huge debt and deficit problem (see below).

Seeing a dozen Oregon Republican state lawmakers leave the state to avoid voting for a Carbon Cap and Trade bill should be a clarion call. Cap and Trade used to be a GOP idea, but fossil fuel funders told them not to like it. We are facing a climate change crisis and voters must ask what candidates are going to do about climate change. Let me emphasize I left the GOP twelve years ago in large part due to its stance on climate change. Fortunately, climate change action is not waiting on head-in-the-sand politicians, but could be leveraged by more federal help.

My concerns are exacerbated as not only did the US president announce our withdrawal from the Paris Climate Change Accord, he asked the G20 this week to soften language on climate change. It should be noted this is in contrast to his businessman stance, where a few years ago Trump staff requested in writing the Scottish government give them permission to build a sea wall at one of his golf courses to hold back the rising seas due to climate change. The word you are looking for his hypocrisy. The other words are fossil-fuel funding.

An issue not being discussed is rising US debt and deficit. Both parties are to blame. Nonpartisan groups and the Simpson-Bowles Deficit Reduction Committee clearly state this problem cannot be solved with just spending cuts and tax increases – it must have both, as the math will not otherwise work. These groups also note the GOP tax cut in December, 2017 was imprudent. But, Democrat candidates speaking of tax increases to pay for new social programs are being imprudent, as well. We need tax increases and spending cuts to pay for the poor stewardship of their predecessors.

When America forgets its ideals, we become just another country. I hear we must be a nation of laws, but we are treating migrants like chattel and not following due legal process. There is a reason so many attorneys are volunteering their services to migrants. If we are concerned about illegal immigrants, punishing companies that hire them would limit the economic slavery that goes on every day. Yet, we should also recognize that these folks are doing many jobs Americans don’t want. So, a thoughtful, humane and fact-based solution is warranted rather than a political one. Both parties are to blame, but I hold this president to account for making a recurring problem much worse with his words and actions. He reneged on a bipartisan agreement sixteen months ago and the House never took up a bipartisan Senate bill passed in 2013.

Finally, if we are to be a nation of laws, we should be gravely concerned the country is being run like a mafia family. The White House incumbent is clearly making money off the presidency and favoring countries where he sees business growth for his empire. It greatly troubles me that is daughter and son-in-law are serving unvetted and unapproved roles in the White House, because the president values loyalty over competence and experience. Then, comes the lying, bullying and denigration of critics, allies, media, public servants, etc. I have long been concerned over his setting policy off his lies be it climate change, voter fraud, Russian influence, Saudi prince innocence, Iran nuclear deal, the ACA, environmental pollution, and so on.

There is so much more I could write about. We need Americans to pay attention to better news sources, question things, and push back on politicians asking what they intend to do about issues. We need Congress to remember their job of governance. I feel this president is a clear and present danger to our democracy, our planet and even the Republican party. We are a Republic, not a kingdom and certainly not a mafia-ruled domain.