Medicaid expansion – letter to the editor

When the Affordable Care Act was passed in 2010, a key element was for people who made less than 133% of the poverty limit based on their family size. This group would pay no premiums through a state-by-state expansion of Medicaid. The federal government said it would reimburse each state for 90% of that cost.

At this point in 2022, there are twelve holdout states that have not expanded Medicaid. That leaves 2 million Americans with access to no healthcare coverage. The holdout states include my home state of North Carolina and big states like Texas, Florida and Georgia (see link below to a NPR article).

North Carolina was close to passing Medicaid expansion, but the effort stalled once again. Here is a letter I sent to my newspaper that they graciously printed this morning.

NC and Medicaid

As a retired benefits consultant and former benefits manager for a Fortune 500 company, I was hopeful that the N.C. General Assembly would at long last pass an expansion of Medicaid to fully comply with the Affordable Care Act. Failing to do this has harmed N.C. residents. Our economy has been impacted and some rural hospitals have either closed or are in financial trouble, according to the Commonwealth Fund, a nonpartisan healthcare advisor.

As former GOP presidential candidate and Ohio governor John Kasich noted when Ohio expanded Medicaid years ago, it was a no-brainer with the federal funding the state has realized for years now. Please move forward on Medicaid expansion.

We have heard of food deserts in largely rural states which impact people in need more than others. But, we also have healthcare deserts as well. Taking only one data point, it is not a surprise to learn that maternal mortality rates in these states are worse than in other states and first-world countries. Note, this is mother’s dying in childbirth. That is a sad state of affairs, especially for a country who claims exceptionalism.

https://www.npr.org/sections/health-shots/2021/07/01/1011502538/12-holdout-states-havent-expanded-medicaid-leaving-2-million-people-in-limbo

Texas Republicans want to deny STD and HIV screenings under ACA

In an article in Politico by Alice Miranda Ollstein called Obamacare back in court as Texans challenge coverage for STDs and HIV care,” yet one more try to gut certain preceived, unsavory provisions will be headed toward the Supreme Court. A few paragraphs are below, with a link to the article at the end:

“This challenge, filed in March of 2020 by a group of Texas residents and employers and backed by former Trump officials, argues that the ACA’s preventive care mandates violate the Religious Freedom Restoration Act and that forcing people to pay for plans that cover STD screenings and HIV prevention drugs will ‘facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use….’

‘Ending the requirement that preventive services be free to patients will have negative health and financial consequences for millions,’ warned Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation.

The Biden administration is arguing that the case should be thrown out because the Texans do not have legal standing because they aren’t being harmed by their insurance covering preventive services — a line of argument that has been successful in past defenses of the Affordable Care Act.

They also argue that there’s a clear government interest in preventing the spread of HIV and STDs for the health of the population at large which justifies the policy.”

The Religious Freedom Restoration Act has been used like a hammer since it came about to legislate some version of morality that suits a strident set of religious folks. Since many teens are going to have sex whether their minister or parents tell them not to and often it will be unprotected sex, having preventive coverage against STDs and HIV is important. And, with prostitution being the oldest profession and drug use more rampant now that drug companies have hooked people on pain-killers which are more expensive than heroin, exposure exists even to the teen and adult children of the most pious of us.

I have used this example before, but a pretty devout friend noted church parents would be astounded at the level of unleashed promiscuity that goes on even at the most ardent of religious colleges. College students are going to have sex. And, my guess is they will like it and want more. Further, I do not think whether their plan covers STD or HIV prevention will be too much of a factor in that decision. If Rx is a factor, it will likely be around a Plan B pill or daily birth control.

If certain ministers and priests are so concerned with sexual promiscuity, then they may want to govern some of their fellow ministers and priests about their sexual misconduct. While I fully recognize that the significant majority of religious leaders do not do these things, predatory sexual behavior is not good form for a religious leader.

Let’s protect people with health care preventive options. Health care is a private matter and is no business of a minister or even the parents, once the child is legally an adult.

https://www.yahoo.com/entertainment/obamacare-back-court-texans-challenge-110000749.html

US is the only developed nation where rate of pregnant mother deaths is rising (a reprise from 2015)

The rise in maternal mortality in the United States has been hitting the headlines, especially as it relates to Louisiana leading the way. Senator Bill Cassidy is getting flak, rightfully so, for trying to minimize the problem focusing on taking the African-American mothers out of the equation. Their deaths are an important part of this, but they are only a part, but deserve due diligence as to why just like every other race, income group, ethnic group, etc. We should look to things like – lack of healthcare access, fewer rural hospitals, food deserts and poverty as several of the causes. Yet, this is not a new problem, as I wrote this post seven years ago.

Recently, a very powerful article was written by Danielle Paquette in The Washington Post entitled “Why pregnant women in Mississippi keep dying.” A link to the article follows: http://www.washingtonpost.com/blogs/wonkblog/wp/2015/04/24/why-pregnant-women-in-mississippi-keep-dying/. While the article focuses its title on Mississippi, that is a metaphor for a national problem. The US is now the only developed nation where the rate of pregnant mother deaths is increasing. In 1987 only 7.2 pregnant women were dying per 100,000 births. That rate has more than doubled in 2013 to 18.5 deaths per 100,000 births. Our maternal death rate in childbirth is 3x the rate in Saudi Arabia and 2x the rate in the UK.

In Mississippi, it is far worse with 54.7 black mothers dying in childbirth out of 100,000 births and 29.3 white mothers dying per 100,000. There a number of reasons cited, but one of the key reasons is that Mississippi has not expanded Medicaid and have over 107,000 people who do not have access to healthcare coverage. Note, other reasons are cited, but not having health care coverage limits access to preventive visits that expectant mothers with care get.

As many know, I have been a broken record for the need to continue and improve the Affordable Care Act, which is working pretty well by a number of studies and has dampened cost increases with the Congressional Budget Office lowering health care projections three times due in part to the ACA. In fact, just yesterday at Congress’ request, the CBO and Joint Committee on Taxation noted that repealing the ACA would increase the deficit by $353 Billion (or $137 Billion when a new dynamic scoring approach is used). This seems to run counter to rhetoric of how harmful the law is. Here is a link to the article: http://www.msn.com/en-us/news/politics/obamacare-repeal-would-boost-10-year-deficit-by-dollar353b-cbo/ar-AAbQa2S?ocid=DELLDHP

But, we need to finish the job and completely implement the ACA in about twenty states, such as North Carolina, that have not expanded Medicaid to cover a key tranche of people under the ACA. It is not surprising, these predominantly southern states are seeing the worst child and mother health results. Several reputable health-related foundations (The Commonwealth Fund, Kaiser Family Foundation) and economic think tanks (RAND and Economic Policy Institute) have noted that not expanding Medicaid is actually harmful to people and this is more evidence of that assertion.

Please read these articles and, if you concur these are problems worth doing something about, reach out to your state legislators and US representatives and senators. Ask them to support the continuation of the ACA as the majority of Americans wish to happen. Ask the states who have not expanded Medicaid to do so as they are hurting people, rural hospitals and their own economies in not so doing. These issues are that important as people are the pawns in these political chess games and they bear the brunt of these decisions with their health and lives.

Are US hospitals in trouble?

Many hospitals, especially more rural ones, have been in trouble for some time. More on the rural hospitals later.

“More than 33% of all hospitals are operating on negative margins, according to the American Hospital Association,” per Michael Popke of Benefits Pro in a piece called “America’s hospitals facing ‘massive growth in expenses’.” Here are two select paragraphs from the piece that tell the gist of the story.

“Hospital employment is down approximately 100,000 from pre-pandemic levels, while hospital labor expenses per patient through 2021 were more than 19% higher than pre-pandemic levels. A new report from the American Hospital Association highlights the financial and operational toll the pandemic and inflation has taken on hospitals — concluding that more than one-third are operating on negative margins.

‘Hospitals and health systems have been nimble in responding to surges in COVID-19 cases throughout the pandemic by expanding treatment capacity, hiring staff to meet demand, acquiring and maintaining adequate supplies and personal protective equipment to protect patients and staff, and ensuring that critical services and programs remain available to the patients and communities they serve,’ notes the nine-page report released this month. ‘However, these and other factors have led to billions of dollars in losses over the last two years for hospitals.’”

Per an article called “The South’s health care system is crumbling under Covid-19. Enter Tennessee” by Daniel Payne of Politico, the demise of heath care in more rural areas has been exacerbated by COVID-19.

“Rural hospital closures have been accelerating, with 181 since 2005 — and over half of those happening since 2015, according to data from the University of North Carolina. But that may be just the beginning. Over 450 rural hospitals are at risk of closure, according to an analysis by the Chartis Group, one of the nation’s largest independent health care advisory firms.”

The rural hospital concerns predate the advent of the Affordable Care Act. Too many hospitals had high percentages of indigent health care costs, meaning people without insurance. If they were not funded by a county, the hospital was at severe risk of closing. Since fourteen states have still not expanded Medicaid under the ACA, the opportunity for getting paid did not increase and many have closed. And, the patients, employees and communities suffer.

Yet, a major part of this cost dilemma existed before COVID-19. The US has the most expensive health care system in the world, but we rank around 38th in health care quality. That is a pretty poor rate of return on one’s spend. Hospitals spent too much on technologies that need to be used. There exists a correlation between the ownership of a technology and its higher frequency of use. Yet, with COVID-19 and its aftermath, fewer elective procedures and tests were done in hospitals.

These issues need to be evaluated outside of the political lens and with data. Yet, that is not bound to happen. It would at least be helpful to see more people covered with full Medicaid expansion, but that has been politicized for zero-sum game reasons, not to actually help people. It would be helpful to see Medicare expanded, at least down to age 62 from 65. As Medicare works reasonably well, I would like to see it go lower, but whatever we do, it should be evaluated on its results, not a politician’s beliefs.

If people think I am unfairly picking on politicians, it would not be a stretch to say most politicians do not know a whole lot about health care. We saw this with the atrocious “throw stuff against the wall” repeal and replace discussion in 2017 by the thirteen Republicans, which came within one vote from passing the Senate. That would have screwed about 20 million Americans. Senator John McCain gave it a thumbs down vote for its lack of veracity and its poor protocols on evaluation.

And, we saw it with the discussions and passing of the ACA, which Republicans refused to vote for which is strange since it has several Republican ideas in it from Romneycare in Massachusetts, when Mitt Romney was governor there. The ACA is not perfect, but at least we should fully implement it and shore up its deficiencies. It is only people’s lives.

Shore up the ACA – letter to the editor

My local newspaper ran my following letter to the editor Sunday. I have been preaching the message of improving the Affordable Care Act for seven years offering suggestions. I will link to one of those posts below. What I have never cared for is the naysaying, sabotaging and attempts to repeal it that have been a substitute for debate in the Republican party.

The legislation Republicans almost rammed through in 2017 was ill-conceived, poorly developed and punitive to multiple millions of Americans. These were the key reasons Senator John McCain saved the GOP from itself and voted it down before he died.

“Three times now the U.S. Supreme Court has upheld the Affordable Care Act in the face of Republican attempts to rule it unconstitutional.

Per this retired actuary, benefits consultant and benefits manager, the ACA is not perfect and could use some improvements. But it is helping Americans, including provisions required in employer sponsored plans, which people tend to forget.

What has puzzled me for 10 years is that the law is somewhat based on Republican ideas, the latest being Romneycare in Massachusetts, which at least one Tea Party leader, S.C.. Sen. Jim DeMint, once supported.   

My strong advice to my former party, stop trying to screw Americans by killing the ACA and let’s find ways to shore up its deficiencies.”

Please stabilize the Affordable Care Act NOW to help Americans | musingsofanoldfart (wordpress.com)

Conservative pundit David Brooks – How Democrats Won the War of Ideas

As an independent and former Republican (and Democrat), David Brooks is one of my favorite conservative pundits and authors. He is a regular participant on PBS Newhour’s Friday recap show with the more liberal Mark Shields. Like other key conservative pundits, MIchael Gerson, George Will, Ross Douthat, Eric Erickson and Max Boot, he is hoping that America votes out the incumbent president.

In his usual articulate and even-handed fashion, Brooks penned the following editorial last week called “How Democrats Won the War of Ideas.” The link is below, but I will highlight a few paragraphs for your review and comment.

“Over the last 100 years, Americans have engaged in a long debate about the role of markets and the welfare state. Republicans favored a limited government, fearing that a large nanny state would sap American dynamism and erode personal freedom. Democrats favored a larger state, arguing that giving people a basic economic security would enable them to take more risks and lead dignified lives.

That debate ebbed and flowed over the years, but 2020 has turned out to be a pivotal year in the struggle, and it looks now as if we can declare a winner. The Democrats won the big argument of the 20th century. It’s not that everybody has become a Democrat, but even Republicans are now embracing basic Democratic assumptions. Americans across the board fear economic and physical insecurity more than an overweening state. The era of big government is here.”

Brooks cites a few survey facts from last week’s New York Times/ Siena poll.

2/3 of Americans support allowing people to buy health insurance through the federal government

2/3 support Joe Biden’s $2 trillion plan to increase renewable energy and build efficient infrastructure

72% of likely voters and 56% of Republican voters favor another COVID-19 relief package

59% of Americans think government should do more to solve problems

2/3 think government should do more to fight climate change

60% support increasing the minimum wage and providing tax credits to low income workers

82% of voters and 70% of Republicans would like to expand requirements for paid family medical leave

Brooks also cites a study by the Mercatus Center which notes that Republicans are also moving left, just not at the pace of Democrats. This is contrary to what is believed by the media.

I have long said that more than 1/2 of the Republican voters are voting against their economic interests and do not know it. This survey indicates many do favor policies that would help them, but are sold a bill of goods packaged to woo their votes, but mask the purposeful deterioration of rights and opportunities.

A great example is the Affordable Care Act. When people are surveyed about the features of the act, the features receive high marks from all, including Republicans. The only feature that did not was eliminated – the mandate to buy coverage. Ironically, this elimination is the basis for 25 Republican Attorney Generals who have case to declare the ACA unconstitutional in front of the Supreme Court after the election, which should not occur as the case is not solid, but one never knows with these things. Sadly, the White House chose not to defend the law, which affects expanded Medicaid, exchange and employer-provided benefits.

Please read Brooks article below. It is very well done, as per usual.

Just a quick refresher on the ACA animosity in the Republican Party

Our friend Scottie asked me why the Republican Party detests the Affordable Care Act (ACA) so much and wants to kill it. I have written many posts about this, but here is quick refresher.

The Republican party has spent about ten years nay-saying the ACA. This is in addition to actual efforts to sabotage it by Senator Marco Rubio and President Donald Trump and the fourteen states who still have not expanded Medicaid. Rubio and Trump’s actions caused premiums to increase. Blue Cross and Blue Shield of North Carolina (BCBS of NC) said it was geared to have a 0% increase in 2018, but after Trump de-funded reimbursing insurers for co-pays/ deductibles for people making less than 2 1/2 times the poverty rate, BCBS of NC said it would have a 6.6% increase. Not only did Rubio’s action cause premiums to go up, it drove some insurers out of the exchanges lessening competition which also hurt consumers. *

So, to me the Republicans are so far down the path of killing something that is working pretty good (it still needs improvements), they cannot stop. And, it is apparent that Trump has an Obama obsession that he must kill everything that Obama did regardless of its level of efficacy. As a retired benefits consultant and former actuary, what the GOP came up with in 2017 to replace the ACA was god-awful. It was throw-against-the-wall planning. The fact the Republicans did not follow due process was a key reason Senator John McCain voted it down. Mind you, I fault Obama for the terrible roll out of the exchanges in 2013, but he at least involved Republicans in the planning process in very public sessions (although they were told not to vote for it).

And, here is the rub. The reason the GOP does not have a plan is the ACA is largely based on a Republican idea set in motion by Mitt Romney for Massachusetts, when he was governor. It worked so well, that Senator Jim DeMint, the leader of the Tea Party, advocated its national use in writing to President George W. Bush. And, DeMint politicked with Romney on stage in 2008, Romney’s first run for president. I recognize the ACA is not exactly the same as Romneycare, but there are a number of similar constructs.

Everything I mention above, including the DeMint piece can be found by Googling. But, here is the major concern I have. Employers have been going to more part-time and contract work forces even before the pandemic. Why? – to avoid providing subsidized health care benefits. So, to survive in this gig and part-time employment world, the ACA is essential.

Plus, the ACA imposes requirements on employer based plans as well that may go away if SCOTUS rules unwisely with the court case. Those include pre-existing condition protection, guaranteed renewability, no deductibles on wellness visits, and limitations on insurer margins in pricing, e.g. So, a bad SCOTUS ruling could impact over 200 million Americans not just those in the exchanges and Medicaid.

* Note: The reason for the premium increases are complex, so I will mention them here. Rubio led a Republican move to defund 89% of the payments to insurers for adverse selection (pent up demand for new policy holders) for the first few years, a process used when Medicare Part D was rolled out. Insurers were forced to increase premiums and some left the market with the US owing them money that was promised. The Trump change is more complex. By stopping the reimbursement to insurers for this extra benefit for low paid policyholders, the insurers still honored their commitment to the policyholders. This drove up premiums. Trump said this would only impact insurer profits, but that was not true. The CBO said it increased the annual deficit by $10 billion because the premium subsidies went up as well. The people who ultimately got screwed were those who did not get a full subsidy.

Letter to editor – health care actions speak loudly

I have written longer posts on the actions of Donald Trump, Marco Rubio and Republicans to sabotage the Affordable Care Act. What many do not know, after the election, a court case will decide its fate, brazenly brought forward by several Republican state AGs after Congress stripped away the coverage mandate during a budget vote. The following is a brief letter I sent to my newspaper.

The truth matters. Actions matter. Four years ago, Trump said we had to wait and see his healthcare plan. None existed and still does not. Three years ago Trump cut payments to insurers to fund their payment of co-pays and deductibles for ACA members making less than 2 1/2 x the poverty rate and then lied about its impact – it actually increased premiums and the deficit per the CBO.

After the election, SCOTUS will be hearing a case to rule on the constitutionality of the ACA premium subsidy after Republicans stripped away the coverage mandate, which would severely hamper the law and may lead to its end. The White House chose not to defend the law. The ACA impacts both exchange and employer benefits, three key provisions of which are allowing pre-existing conditions, requiring guaranteed renewability and requiring wellness doctor visits not be subject to deductibles.

Sadly, beyond the nay-saying, there has been more sabotage of the ACA which increased premiums (Google Marco Rubio and risk corridors), repeal and replace efforts which were fortunately defeated, and fourteen states (including NC and SC) who still have not expanded Medicaid, a key part to help people in poverty. Health care coverage access is a major issue this coming election so says this retired benefits consultant, benefits manager and former actuary.

Eliminating the ACA which which may impact over 200 million Americans  (including the ACA requirements on employer plans) is unwise in my view, in general. But, doing so in the middle of a poorly handled pandemic by the White House with over 200,000 and growing American deaths, is plain asinine and mean-spirited.

Please feel free to adapt and use. Actions speak louder than words and my former party, the GOP, has purposefully sabotaged the right for Americans to have access to health care coverage. This is why your vote matters.

Help me define the best (or worst in this case) metaphor of the Trump presidency

After the most recent incredulous statement by the US president about ingesting disinfectant as a possible cure for COVID-19, I felt this Marie Antoinette moment might be a metaphor for his presidency. Yet, there are truly many contenders for such a distinction.

Below are twelve top of mind statements or actions that could be considered. Sadly, there are more to choose from. So, readers please let me know your top three, including others I may have overlooked.

1. Ingesting disinfectant – he has to tried to explain this away as sarcasm, but to see Dr. Birx trying to avoid eye contact when he asked her what she thought is telling.

2. Sharpie gate – this is when the president played meterologist and scared the state of Alabama by drawing on the map the hurricane may hit them. This was an unforced error thst aides spent a week trying to diffuse.

3. Firing Comey without telling him – for a person who liked to say “You’re fired” on TV, the president cannot bring himself to fire soneone in person. James Comey found out he was fired via TV news. But, Trump failed to tell his Communication team, so Sean Spicer was hiding in the White House bushes with staff to plan what to say.

4. First travel ban – Trump likes to use the word disaster to define anything he did not do. The first travel ban was so disastrous, it waa pulled after two days. The president failed to vet the change with various stakeholders including the people who would need to conduct the ban. So, people did not know what to do and the lines were long.

5. India/ Pakistan brokering peace deal – this faux pas did not get much air time, but the president announced in front of the Pakistani leader the India prime minister asked him to broker a peace deal between the two countries over the Kashmir conflict. Within the hour, India put out a press release saying no such request was made.

6. Tariffs paid by China – the president has said this at least a dozen times, so it may be a good candidate because of its staying power. Trump likes to say China is paying the tariffs. Economists correct him each time saying US importers pay the tariffs which are passed onto the consumers. So, we pay the tariffs.

7. Extorting Ukraine – after watching a parade of reputable public servants testify under oath at a great risk with such a vindictive president, Trump was impeached over extorting Ukraine for personal gain. He likes to focus on one phone call, but if that call was so “perfect,” why did his staff try to bury it?

8. Siding with Putin over CIA – in Helsinki, standing side by side with a man who is KGB trained on disinformation, Trump sided with Putin over the advice of his intelligence people. Senator John McCain wrote an op-ed piece to blast the president’s words as “traiterous.”

9. Pulling out of Paris Climate Change Accord – the president’s stance on climate change was my worst fear going in. So, he announced pulling out of the Paris accord on June 1, 2017, the day following Exxon shareholders voting for management to tell them what Exxon is doing to address climate change. When we exit, the US will stand alone in the world.

10. Transgender in military – the announcement to ban new transgender people in the military got the press, but the decision process is the metaphor. Per the book “Fear” by two-time Pulitzer Prize winner Bob Woodward, the president announced his decision by two tweets around 10:05 one morning saying the Joint Chiefs of Staff and he had decided to do this. Problem is they had not. The time is important as the Joint Chiefs waited downstairs to meet with the president to go over four options and the pros/ cons of each. The president was told of this and asked when would be a good time to meet. This is a key reason DOD James Mattis abruptly said that a tweet is not an order.

11. Wandering alone at G20 – this was a sad to watch as the president wandered the tables looking for someone to talk with after dinner at a G20 meeting. He finally wandered over to meet with Vladimir Putin alone, a very scary situation with a very informed leader and Trump, who does not study history or issues. Plus, it is a metaphor that he would gravitate to Putin’s table rather than an ally of our country.

12. Bragging on fixing the economy – this is the most relentless of topics and, until the virus hit, was his claim to fame. The problem is he did not fix the economy. Yes, economic growth continued under his watch, but when he was sworn in on January 20, 2017, the US GDP was in its 91st consecutive month of economic growth (that is seven plus years), the stock market had more than doubled under Obama, and unemployment was under 5%. Presidents get too much credit and blame for the economy, but for Trump to say he fixed the economy is untrue – it was not broken He has added both short term tailwinds and long term headwinds.

So, that is a dirty dozen, so to speak. I wanted to limit them twelve, so leaving off Charlottesville, his rallies, his ignoring the early warnings on COVID-19, or just his litany of routine, daily untruthfulness or beating up on the press, etc. proved difficult. Let me know your top three choices. Please feel free to add any others. It is funny, depending on how I want to focus my attention, I could pick a different three – is impact, continuity, or inanity the best measure?

Supreme Court rules against a GOP effort to renege on owed payments to health insurers

On Monday, the US Supreme Court ruled against an effort of several years ago led by Senator Marco Rubio to shortchange health insurers money owed to them for accepting higher risk claimants early on under the Affordable Care Act. In essence, Rubio led GOP Senators to eliminate 89% of the funding under a risk corridor agreement to tie insurers through initial adverse risk (due to pent up demand from folks who were not previously covered).

The following excerpt from an article called “Supreme Court rules government must pay billions to Obamacare insurers,” by Susannah Luthi of Politico, may be of interest.

“The Supreme Court on Monday ruled the federal government owes health insurers massive payments from an Obamacare program shielding them from financial risks after the companies accused Washington of reneging on its funding promises.

The 8-1 decision could open the floodgates for federal cash to the insurance industry. Insurers who accused the government of a ‘bait and switch’ claimed they’re owed $12 billion from the Affordable Care Act program.”

The lone dissenting vote was from Justice Samuel Alito who said the insurers were getting a “windfall.” No, Justice Alito and Senator Rubio, they are getting what was promised in writing.

People could easily dismiss this as a fight that does not concern them. That would be a misjudgment. The Republican Senators led by Rubio screwed Americans to win a political argument in attempt to sabotage the ACA. Why do I say that? As a consequence, these insurers had to raise premiums that impacted unsubsidized folks and caused an increase to the offsetting premium credit under the ACA for the subsidized folks. That subsidy increase in turn increased our budget deficit. It also forced some insurers to exit the ACA with the US government owing them money, which hurt competition.

Sadly, all of the efforts noted above, which the Supreme Court just overturned, are true. That is a reason for the near unanimous vote. I encourage you to Google “Marco Rubio and ACA Risk Corridors” and read as much as you like. What frustrates this retired benefits consultant, manager and actuary is very few people know they got screwed. The following links to this article and one of my many pieces on shoring up the ACA are below.

https://www.politico.com/news/2020/04/27/supreme-court-rules-government-must-pay-billions-to-obamacare-insurers-211184

https://musingsofanoldfart.wordpress.com/2019/07/19/please-stabilize-the-affordable-care-act-now-to-help-americans/