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.

 

 

 

Mama told me not to come

Three Dog Night had so many great songs, but when they sang Randy Newman’s song “Mama told me not to come,” they struck a nerve with many. As teens, we wanted to listen less to our parents and more to our friends.

Even when our friends may be leading us down a perilous path, we will continue onward. Even when Mama told us that the path may be fraught with perils, we knew better and we ventured onward. The Three Dog Night song speaks to the realization by our teen selves that walking down that path or, in this case, going to an ill-advised party may have been a mistake. Not wanting to listen to Mama did not make her opinion less valid.

Why am I thinking of this song? I am trying  to put myself in the heads of people who voted for our President as they begin to realize who they voted for. I read a statistic last week from The Los Angeles Times that 11% of Trump voters have regrets. Going beyond the inane tweets, the consistent lying and puzzling incoherence and incompetence, he has submitted a budget and supports the repeal and replacement plan for the ACA which kick his voters in the teeth. This is already after he signed a bill in his first two hours to take away a mortgage premium reduction that would have helped a million Americans and his intention to cease or hamstring the Consumer Financial Protection Bureau that helps multiple millions of Americans from aggressive and fraudulent financial practices.

“Mama told me not to come,” will be that song which echoes over the cognitive dissonance that will be dished out in spades to Trump voters.

 

Jason Chaffetz says let them eat cake

As reported in “The Hill” yesterday, “Rep. Jason Chaffetz (R-Utah) on Tuesday said Americans may have to choose between purchasing a new iPhone or paying for health insurance.

‘You know what, Americans have choices. And they’ve got to make a choice, the House Oversight Committee chairman told CNN Newsday one day after the House GOP unveiled its plan to replace Obamacare.

‘And so maybe, rather than getting that new iPhone that they just love and they want to spend hundreds of dollars on, maybe they should invest in their own healthcare.'”

Let me remind the Representative of what he is advocating and who is getting harmed by this change. In essence, this replacement plan takes away expanded Medicaid which harms people making less than 138% of the poverty level. It also will put further cost pressure on other lower paid individuals and older people.

These folks may have to choose between eating and healthcare. They may have to choose between rent and healthcare. So, as you think of Chaffetz’ comments, please be reminded of Marie Antoinette who is said to have uttered the line “let them eat cake,” when told the poor did not have flour to make bread.

To me, this is prima facie evidence of a group of legislators who have little understanding of the havoc they are about to wreak with their proposed replacement plan, many of whom just do not care. Let me climb to a hill top and shout these words, “do not repeal the ACA, make it better.”

 

 

 

We need to know the truth

The new leadership of our country has a modus operandi that the truth is only a commodity to be used when it works in their favor. I have witnessed in my consulting and managerial career that organizations take on the personality of its leader. Our leader is combative, thin-skinned and not too comfortable with the truth. Other leaders have lied, but we are talking about a whole different level of lying here as measured by fact checking organizations and just paying attention.

So, his PR people feel obligated to do the same, as once a lie is told and discovered, it either needs to be apologized for or padded with more lies. For this regime, the latter is the more common course of action. Cover a lie with more lies. The dilemma is it is a relentless effort to confuse people paying attention and sway those who do not.

But, this is not new, as our leader has been this way for most of his career. Who says so? His five biographers and ghost writer of his most popular book, “The Art of the Deal” say so. He has exploited many people during his career through bullying, misrepresentation, stiffing people, and many lawsuits, both threatened and real.

I have said before that I start out with the position of not believing a word the man and now his PR people say. The odds are in my favor that I am correct. Instead, I encourage folks to watch his actions, decisions and appointments.

For example, the so-called man of the people, has done the following, to name only a few of his actions, all of which are true.

  • He eliminated a planned mortgage premium reduction that would have helped millions of homeowners who did not put a large amount down on their house.
  • He is requesting the removal of a new requirement that would make all investment advisors act as fiduciaries, meaning they would operate in your best interests, which means that they would instead push transactions that may not be in your, but in their best interests.
  • He said Obamacare was in a death spiral, yet in a letter by the American Academy of Actuaries to Congress, they said that was not true. It should be noted Obamacare is helping twenty million plus Americans and, needs improvement, but is not a disaster, as he conveys.
  • He said Climate Change is a hoax invented by the Chinese to steal our jobs and has appointed several cabinet members and advisors who are perpetuating climate change denial in the face of overwhelming and convincing numbers of climate or environmental scientists. He is censoring climate change science by his departments which is a sure sign of not having faith in his own argument. It was reported by Bill McKibben in The Guardian, rural areas will be heavily impacted by not addressing climate change and not moving to renewable energy.
  • He introduced a travel ban that will do little to help with terrorism and actually will do the opposite. The terrorists are already here, but what is little known, he reduced funding on terrorism to address the 1,000 plus domestic terrorists groups that are tracked here. This coupled with ostracizing Muslims here and abroad, makes us less safe, as we should welcome all of our citizens and afford them the same rights and respect as others.

All of the above have an impact on the people who voted for him, as well as the rest of us, and not in a good way. It would be nice if these actions are highlighted, as  we need the truth. Otherwise, our complex problems will not get solved and we will have to address them in the future.

 

 

 

Wise men say…

If you are any semblance of an Elvis fan, you know the next phrase of this song is “…only fools rush in.” While this song is about not listening to your head and what others say, but rushing ahead with what your heart says, it does apply well to legislation. When legislators rush into anything, they will make mistakes. You can take that to the bank.

I cite four examples, two at the federal level and two at the state level. In North Carolina, our legislators called a special session last spring to pass the HB2 Law, henceforth known as the Bathroom Bill, in ten hours. They did not ask what others thought of this legislation. The transgender discrimination part of the bill was sold on fear, and when that is done, it is hard to back off. Yet, the part that ruffled the feathers of the NCAA, NBA and ACC as well as businesses and musicians, was the part that denied protection for LGBT members under the law. This is flat out unconstitutional, but since they passed it so quickly, they did not take the time to know this.

You would think our General Assembly would learn this lesson, but last month after it was official the new governor would be a Democrat, this impatient and power-hungry assembly met to address something more than hurricane assistance, which was the purpose for the gathering. They decided to strip powers away from the new governor. Mind you, the General Assembly already had a super-majority, but they had to flex their muscles and use a coup to grab more power. Even Republican voters thought this was poor form. Yet, our leaders in the General Assembly seem to not care what people think. As an Independent, I find this to be horrific legislation, an abuse of power and poor stewardship.

Not to be out done, the first measure our Republican friends in Congress wanted to change was the nonpartisan Ethics Committee. Over the chagrin of their leaders and after meeting in secret, they decided to restrict this ethics review process. After backlash from the public and with the President-elect piling on, they repealed the bill in less than 24 hours. When the President-elect, not known for his ethics, calls you on the carpet for ethics, you really screwed up. In my view, this may have been one of the more idiotic bills ever passed. The fact that this measure was the first thing that was done is outrageous and sets a tone of poor governance.

Which brings us to the rush to repeal Obamacare. This law is imperfect and complex, but is working pretty well. It does need to be improved and there are ways to do that leaving the framework in place. The administration is already built to accommodate some needed changes, so it is only for political reasons that it must be repealed first. I have written many posts, including the previous one, which shows how we got to this place, adds some needed truths, and asks for a data-driven change. Yet, if you govern off rhetoric, you suffer the consequences. The President-elect said he’s going to make benefits more generous and cheaper at the same time – that sounds like a TV ad for a new product, so good luck with that.

Wise men say, only fools rush in. These are four examples of foolish behavior that led to or are leading to poor legislation. The sad part is there are many more. Legislation is hard enough without rushing into it. When you do, mistakes will happen. I also believe, legislators don’t want citizens to take the time to see the real story. And, if you govern by tweet without input from advisors, you are being foolish.

 

A few true statements about the ACA

In an effort to continue a push toward repeal of the Affordable Care Act, many statements have been made that are not truthful. But, this is not a surprise, as opposition to this imperfect law has used untruthful statements to show its lack of veracity. I should emphasize the following are opinions of a former benefits actuary, former benefits manager and a retired benefits consultant.

  • The ACA is not in a death spiral as stated by Speaker Paul Ryan, Senate Leader Mitch McConnell and President-elect Donald Trump. Who says so? The American Academy of Actuaries in a letter to Congress.
  • The ACA is imperfect and complex, but so is our healthcare system. In spite of this, the ACA is working pretty good, but could stand some improvements.
  • One key improvement would be to fully fund the risk corridors to help insurers with adverse selection. These were cut back by Congress to help strangle it. My former Republican friends are being very silent on this tactic, but it was done with intent to cause premiums to go up.
  • Another key improvement would be for the remaining 19 states to expand Medicaid, which would improve the states’ economies, rural hospitals and people in need. Who says so? The Commonwealth Fund, Kaiser Health Family Foundation, RAND Corporation, Economic Policy Institute and a George Washington University study. Data shows these states have reduced personal bankruptcies and hospitals have better accounts receivables.
  • A few other improvements would be to add a public option where needed to increase competition and reduce cost. We should also look at the various fees and determine which ones should stay or go. These fees help fund the subsidies.
  • A November poll from Kaiser Health noted 74% of Americans want the ACA to continue with improvements, with 48% of Republicans. It should be noted this survey shows with the exception of the employer and individual mandates, even Republicans like the specific features of the ACA by 63% (guaranteed issue and renewability) to 82% (continuing adult children to age 26) depending on the feature.
  • If the risk corridors are funded, this will help with higher premium increases and bring some insurers back to markets, yet we still have cost pressures – we are an overweight, overmedicated, and aging nation. As for prescriptions, other countries do not allow R&D to be factored into their pricing, so the US bears the brunt with their prescription cost.
  • Repealing the law will have a negative impact on the debt over the next ten years, so say nonpartisan budget reconciliation groups such as the CBO. This should be a factor in the analyses.
  • Then, there are the 20 million plus Americans who have benefitted from the system. If we are unwise with how we make any changes, people’s lives are affected.
  • A key item which is not discussed is the administration of the system. After the terrible exchange roll-out, which I fault the President as this was his baby, the system is working pretty well. Changes have to be administered. We should not lose sight of this, as many politicians do not have a good understanding of the complexities including the three folks mentioned above.

Healthcare is complex. Insurance is complex. So is the ACA. If the ACA is repealed, Republicans now own the problem. Since the ACA is largely based on a Republican idea borrowing features from Romneycare, it will be difficult for them to come up with a new idea, “something terrific,” which meets their objectives. We need a systematic, data centric analyses of what is working and what could be changed

One thing I know for certain – ramming a change through is not prudent, nor good stewardship.