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larger, the company told the Observer in 201, if the GOP tax reform legislation signed by President Donald Trump hadn’t repealed the ACA’s individual health insurance mandate.”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.

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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.

Out of the pool

I think it is time to fire any politician in Washington who is forgetting why they are there. We could start with the White House incumbent and then take out hundreds of members of Congress in both houses. I understand fully Congress must investigate and provide oversight over the Executive Branch. That is part of their job and the current incumbent has given them cause to dig further.

Yet, I have this simple idea that leaders of both houses sit down with legislative liaisons from the White House and figure out some things they can pass and sign into law. I think a civilian board could list about a dozen major issues to focus on and say work these out. It should not take a civilian board, but these folks are too beholden to funders to come up with a workable list.

A key reason for not listing the problems is too much discussion occurs around whether not solving an issue helps them politically. A curse word comes to mind, so please insert your favorite. A good example is a bipartisan Senate immigration bill was passed in 2013, but the House refused to take it up as leaving immigration unaddressed would help the Republicans in the 2014 midterms. The Democrats should not be smug as they do the same thing.

Because of the Republicans unhealthy focus on dismantling the Affordable Care Act, the party justifiably lost seats in the 2018 midterms. To be frank, they should have lost seats with a rushed process that did not follow form and came up with several awful ideas. They should also thank Senators John McCain, Susan Collins and Lisa Murkowski for saving them from themselves by voting against an ill-conceived vote.

But, what have Dems done with improving the ACA with their winning back the majority in the House – nothing other than “beating on their chest” bills that went nowhere? Not that they were bad bills, but don’t wait until an election in 2020 to address healthcare. The ACA is imperfect, but is working OK and needs some more stability and improvements due to initial design flaws and several efforts by the GOP to sabotage it.

So, Ms. Pelosi, Mr. McConnell, and Mr. Pence, get your fannies in a room with a white board and figure out how to get something done. I do not care which party benefits from what comes out of this. The key is we benefit. Do something that will be signed into law by the mercurial man in the White House. So, Mr. Pence you better have the Queen of Hearts’ blessing to make deals or you may lose your head.

Here are few items for the list:

  • Stabilize the ACA: pay insurers what we owe them (yes we reneged on two deals with them) and invite them back to the market to have more competition. Consider expanding Medicare to age 62 as a trial to improve the risk pools in both the ACA and Medicare. Push for the remaining states to expand Medicaid.
  • Address better gun governance: another mass shooting occurred yesterday and nobody in office cares. More suicides occurred yesterday and nobody in office cares. A few accidental shootings and homicides occurred and nobody in office cares. It is a holistic problem that needs holistic solutions. Do something, anything that will help even if it is just a little. Universal background checks and elongated waiting periods would be well received by the majority of Americans.
  • Address climate change at the federal level: Cities, states and some industries are moving forward without an active federal government role, which is rightfully being sued by 21 children for failure to address what they have known about for three decades. They actually have a good case. This is also a jobs and economy issue as we can look backwards and get passed by or look to growing renewables industries. As a good example of looking backward, we let China seize a significant majority of the rare earth metals market share from us which is now a threat to national security.
  • Address the debt and deficit: Trade deficits are not a big thing as we are a consumer driven economy. The far bigger crisis is our national debt and growing deficit. We have to pay for things and the less we do, the more risk we have with a growing interest cost as a percent of our annual budget. We must increase taxes and reduce spending, both. The GOP has forsaken its role in being a budget hawk passing a tax bill that made a growing problem worse. Revisit the Simpson-Bowles Deficit Reduction plan and do some of those things.

I will stop there, but there are more problems to address. Immigration is a problem, but it has been made worse under this president by cutting funding to help some Central American countries improve the lives of their citizens and the lack of judges to address the increased migration. A wall is not an answer. It is merely a structure. Dusting off that bipartisan Senate bill from 2013 would be a good start as well as addressing DACA. We need to keep educated young people in our country, as growth is an issue.

So, legislators, please get in a room and do some things that will pass. The focus should be on helping Americans, not helping legislators. Stop worrying about keeping your job and do your job. And, yes continue your oversight role as we are a republic not a kingdom.

 

 

 

Call me crazy

I hope everyone had a great weekend. We are living in interesting times, some would even use the word “crazy.” Here are a few random thoughts to match the times.

– A real hero is someone like Lori Gilbert Kaye, a 60 year-old woman who lost her life in this weekend’s synagogue shooting. She lost her life because she threw her body in front of the Rabbi. Please share her story rather than the name of the cold-blooded killer, who not only killed her, but shot two others, including an eight year old girl.

– I agreed with the President when he said people need to get vaccinated for measles.. Then, as I read on, he said during the campaign the measles vaccine is linked to autism. When will this man understand that words matter and people do not realize that the significant majority of the words this man says are untruthful ones?

– Speaking of lies, The Washington Post has recorded 10,000 lies by Trump as President. Former Speaker Newt Gingrich defended the President saying he is a businessman and is allowed to exaggerate. Mr. Gingrich, I am a businessman and if someone in business lied like the President, people would not do business with him very long. Further, why did an independent contractor who dealt with Trump companies say “Word on the street is if you do work for Trump, get paid in advance.”

– A recent poll conducted by Opinium said 55% of Brits now feel the 2016 Brexit vote was a bad idea. They have time for another vote, but not if they wait. A fact based process would help, but it would also help here in the states.

– With the advent of market segmentation in all things, including the pseudo-news and now data, we seem to be moving closer to another Robber Baron period. Now, it is so easy to obfuscate voters, they do not know that elected officials are making changes that help the wealthy. What is also unsurprising is how easily more strident groups can be fooled to go along, provided you play to their fears.  Immigration is being sold as the problem, but the main problems are technology and CEOs chasing cheaper labor costs. In Western countries the haves and have-nots are even more divided. Unless something is tangibly done, this bifurcation is unsustainable.

– Finally, it is amazing how little the US leaders talk about our ticking time bomb problems – job retraining as technology kills more jobs, increasing debt, environmental degradation, global water crisis, stabilizing healthcare costs, crumbling infrastructure and climate change. The GOP is running on building a wall, proliferating gun ownerships, restraining abortions and how bad socialization is. Make all candidates answer questions about these ticking time bomb problems. If they cannot, do not vote for them.

Call me crazy, but maybe, just maybe, the ones who are crazy are the ones not addressing real issues and telling real truths. You be the judge.