Note to Democrat Senators running for President – stabilize the ACA

The following note was posted on the website for the seven Democrat Senators running for President, with a copy to select others.

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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 Congress people a few thoughts on stabilizing the ACA, something Democrats campaigned on last fall and won.

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.”

– 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. 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.

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This, that and another thing

Now that the state of the union and Democrat rebuttal are behind us, it would be nice if an independent voter had a turn. On the talk (and some shouting) shows, the independent views do not get heard enough and that is disappointing. For once, it would be illuminating for a member of neither party to share their thoughts.

For example, we might learn:

  • Global warming really is a concern and we should be doing something about it. On Bill Maher’s Friday show,  he noted that Senator Marco Rubio used the argument against the President for declaring a national emergency to build the wall, as what would stop President Kamala Harris from doing so to address climate change? Maher correctly pointed out the latter is becoming a national emergency, while the wall is not even a top ten issue and is overblown as a solution. He also noted, with the very real concerns over Miami, Rubio may become the Senator of Atlantis.
  •  A growing debt which is around $22 trillion with an annual deficit about to hit $1 trillion is a problem, especially with the deficit in a good economy. The Committee for a Responsible Federal Budget models the debt to be around $34 trillion at the end of the 2027 fiscal year. We must have spending cuts and revenue increases both. The math will not otherwise work. If a politician tells you differently, he or she is lying to you. Don’t let them.
  • The Affordable Care Act and Obamacare are the same thing. So is KyNect in Kentucky. Too many people still don’t realize this in the GOP. But, don’t look to politicians to solve this, as they really do not understand how our complex healthcare system works. We need to stabilize the ACA and stop sabotaging it, as the GOP has done.  My recommendation as a retired benefits consultant, actuary and manager is to fund money promised to insurance companies to pay for adverse selection and committed to deductibles, copays for people beneath 2 1/2 times the poverty limit. I would also expand Medicare as a pilot, measured effort to retirees below age 65, such as 60 or 62. This will reduce the cost rate in the exchanges and Medicare. The remaining states need to get off the dime and expand Medicaid – it is a no brainer per GOP Governor John Kasich.
  •  Addressing America’s crumbling infrastructure would help rebuild assets and provide good jobs. We also need to build on the community college system with some added funding to retrain people to do the jobs of the future, as technology claims even more (this is the major threat, not immigration or trade). Also, building on the bipartisan idea pitched to the President last year by Senators Sherrod Brown and Rob Portman from Ohio, we should co-invest with car manufacturers to retool plants to make the cars in demand and keep the factories open. This idea was ignored and the President was offended when GM announced some plant closings.
  •  There are so many more ideas around rethinking ill-conceived tariffs and trade fights, poverty issues, and gun governance, but let me make a general statement that is important. Start treating our allies and citizens with fairness and dignity. Stop the adversarial BS. A country and business makes more money long term by having a productive long term relationship. We need to stop measuring success on short-term transactions. Listen to your advisors as they actually study our problems. And, stop beating up on a free press. From where I sit, they are not perfect, but the true journalists try to get it right. The main source of fake news in the country sits in the oval office and he only cares about looking good.

Well, that is enough for now. I would love to hear your thoughts.

Real problems are not getting addressed

In lieu of focusing on problems that have been overstated by fear and misinformation, several real problems remain. Just to name a few – $22 trillion in debt with an expected $1 trillion annual deficit; ill-crafted tariffs which are slowing the global economy; increasing poverty and hunger; climate change interventions; infrastructure needs that are ticking time bombs; retraining workers impacted by technology; domestic terrorism and gun deaths; and stabilizing the ACA. These are the concerns of this independent voter, who has belonged to both parties.

Note: I wish to applaud Germany for announcing last Friday they plan to phase out coal energy by 2038. It should be noted that in 2018, renewable energy surpassed coal energy in Germany. This is what can be done when real problems are addressed with planning. The US is doing many good things with renewable energy, but it could do so much more with supportive federal leadership.

Thursday thumbnails redux

Since I am kicking around several topics, let me throw a few together for your reading and reaction. Your thoughts are welcomed and appreciated.

  • It would be terribly unfair to say Republicans are racist, but it seems there are more than a few racists running for important offices in various states under the GOP banner. In Virginia, Illinois  and Florida, for example, a few candidates have a history of racist comments and associations. To their credit, the GOP leadership is not backing all of these candidates, but they should not back any and should condemn their words and actions in no uncertain terms. It is disappointing that the US President has done neither and has greased the skids for white supremacist hate groups who now feel empowered. Trump had a truly a low bar to step over to condemn white supremacists last summer and he tripped.
  • Sexual assault is a heinous crime, yet the accuser does not often come forward given the backlash they get. So, for it to take years to come forward is not uncommon. The fact they do so when the accused is being considered for high office, should reveal a greater sense of character. Professor Blasey Ford deserves due consideration and time for her accusations of Supreme Court nominee Brett Kavanaugh. Call me crazy, but we should take the time to get this right as this is one of the nine most important people in our courts. Because we did not take time back in 1991, we may have a man guilty of sexual misconduct on the bench already.
  • I have written before that Democrats are lousy marketers. Even when they have a better story to tell, they often let Republicans define the talking points. The Democrats have many fine candidates running for office. Some are running uphill battles in gerrymandered districts, but they are running well. What should be shouted from the rooftops is they will help improve and stabilize the ACA as it continues to be sabotaged by the GOP making premiums even higher, they will protect our environment against the further roll back of regulations enabling polluting and stay committed to the Paris Climate Change accord, they will make sure we do not devalue our allied relationships and retrench further from our global leadership role, and they will advocate for rights of all citizens, especially those in poverty. And, to be frank, since the GOP has ceded its leadership toward addressing the debt and deficit, the Democrats can be seen as better financial stewards.

Truth be told, the President touts what he has done with the economy, but what he fails to tell people is we are in the 113 consecutive month of economic growth, the bull stock market traces back to March, 2009 and unemployment was low when he took the reins. What has been done, is he is borrowing from our future to make a good economy a little better, but the cost is doing nothing but add fire to our burning debt.

Presidents get too much credit and too much blame for the economy. They do provide headwinds and tailwinds, though, and this President has done both. The headwinds will show up later as noted by most economists, while the tailwinds add today.

When you choose not to decide, you still have made a choice

If you have followed this blog for any length of time, you will know that I love cleverly worded song lyrics. The above title comes from an unexpected source (if you don’t follow the band) – a song called “Free will” by the rock band “Rush.” I find this lyric, penned by drummer Neil Peart, compelling as it speaks to people who choose to do nothing in the face of obvious problems. Martin Luther King saved some of his criticism for the silent people who did not condemn Jim Crow actions.

People choose not to vote because they do not like the choices. But, “none of the above” is not an option and one candidate tends to be worse or represents worse. If you did not vote because you did not think Brexit or Trump would win, you water down your right to protest. And, I would add there are seven white supremacists running for office, empowered by a US President who won’t condemn racist actions and has made racist statements. So, your vote does matter.

If you witness a daily assault on civil rights, women’s rights, truth, media, science, allies and environment and don’t speak up, then you condone the actions as acceptable.

– It is not OK for leaders to lie multiple times a day.

– It is not OK to have governmental websites delete data that run afoul of unsubstantiated opinions by leaders.

– It is not OK to demean people because they dare criticize a leader’s point of view.

– It is not OK to demonize groups of people or exaggerate causes of problems, as it is hard enough to solve real problems with real data.

– It is not OK to ignore real problems or have faux efforts to address them. Gun deaths, poverty, health care access and costs, infrastructure deterioration, increasing debt, environmental degradation, climate change, etc. are real problems.

Please do not remain silent. Speak up. Call or email your representatives. Attend marches and protests. Share diplomatically your opinion, but listen to theirs. Find a way to get your opinion heard and heeded. Calling someone a name is not the way to be heard.

The other day as I was looking for a new battery for my cordless mower, a store clerk and I chatted about the need to move toward renewable energy. While he supported the eventual move, he said renewable energy is “seven times” the cost of fossil fuel energy. I responded and said that is a ten-year old argument. The costs are now more on par. In fact, there is a city in Texas who chose to be 100% renewable energy powered as its CPA mayor said financially it is a better deal. Did he hear me? I don’t know, but he would not have  if I had not listened to his argument and responded.

Do not follow the words of the song lyric. Choose to decide.

Media – focus more on the problems needing solving and less on who wins

The main stream media is doing a better job on focusing on the issues, but they still have a bias toward conflict. Who wins and loses based on the airing of an issue or problem is covered way too much for my taste. The end result is problems and their many causes do not get addressed or are oversimplified, so they go unsolved.

The dilemma is we citizens lose. The focus must be on the issues rather than who benefits from whatever hits a news cycle. Substance matters more than image. Here are a few examples to digest.

We have a poverty problem in the US. It is not just a declining middle class. Too many are living beneath paycheck to paycheck or are one paycheck away from being in trouble. The United Nations just released a report that confirms the US has a poverty problem citing numerous examples and numbers. Instead of asking lawmakers what are we doing about it, the media focused on the Trump administration admonishing the UN for the report. The problem exists whether or not it makes Trump look bad, as it took decades to decline to this point. Addressing poverty is more important.

We have a significant and growing debt problem that has been made worse by the Tax law passed in December. The economy was already doing pretty good with a long growth period. Yet, rather than address our debt, we borrowed more from our future. This malfeasance must be highlighted. Yet, most of the focus is on the economy doing well and its impact on the midterm election. Note the economy would have done well without the tax change, but we have a day of reckoning coming that will require more revenue and less spending. What are we going to do about it now, especially with a good economy?

The Affordable Care Act has needed improvements and stabilization for some time. The American public favors this as do lawmakers from both parties. Yet, the media focuses too much on the political  impact of an ACA that could be doing better. Not only has the party in power not helped the ACA, they have sabotaged it making premiums go up even more. As I see it, the President and GOP own the ACA. Letting premiums go up hurts Americans. If the ACA fails, our poverty problem will get even worse and the economy will suffer.

Issues like immigration, climate change, water shortages, tariffs, exiting international agreements, eg, all need to be focused on. We need to drill down on what makes sense in a data driven and reasonable manner. Attempting to resolve issues based on optics of winning or losing won’t solve anything. And, that is what our President and legislators seem to be more interested in.

So, media please start asking our leaders what they plan on doing about these problems and asking them to explain why certain measures don’t seem to be helpful.  And, leaders stop worrying about keeping your job and start doing your job.

That healthcare thing

In more than a few surveys, the majority of Americans have noted that healthcare is a key dinner table issue. In several surveys, shoring up and stabilizing the Affordable Care Act (ACA) is preferred by a smaller, but still majority of Americans, than its repeal.

With a background of being a former benefits actuary, consultant and manager of benefits, here are a few facts and observations that I encourage you to research and verify.

– The ACA borrows from a Republican idea implemented by Governor Mitt Romney in Massachusetts which was advocated by de facto Tea Party leader Senator Jim DeMint for the whole country. Some elements can be found in a healthcare idea of Senator Bob Dole when he ran for President in 1996. These are reasons Republicans had a hard time with other ideas to repeal and replace it.

– The ACA is designed to require employer and public plans to offer certain minimum level benefits. The non-employer benefits are delivered through healthcare exchanges of policies and the expansion of Medicaid for people near or in poverty (32 states and the District of Columbia elected to do this).

– The biggest benefits of the ACA are guaranteed issue and renewability of coverage and the premium subsidy for people with incomes up to 4 x poverty limit. If you or a child has a preexisting condition, guaranteed issue and renewability are huge benefits.

– The botched roll out of the online exchanges sits at the feet of President Obama. For this to be such an important issue, it deserved better planning. The online exchanges are doing much better now, but you don’t get a second chance for a first impression. And, this poor roll out was used as fodder to nay-say the program, even though the problems were fixed.

– The ACA has experienced higher premiums due to adverse selection (pent-up demand and more high risk than better risk customers), but it is frustrating that the Republican Senators and President have masked their role in making premiums even higher. Senator Marco Rubio led an effort to strip 89% of the funding to insurers for initial adverse selection a couple of years ago and President Trump stripped out funding for co-pays and deductibles for lower paid people last year. Both of these changes cause premiums to increase even more than they otherwise would have.

– The lack of expansion of Medicaid in 18 states means the ACA is still not fully implemented. Per The Commonwealth Fund, this implementation would help people, rural hospitals and state economies. GOP Presidential candidate John Kasich called Medicaid expansion a no-brainer when he did it in Ohio as Governor.

The ACA is not perfect, but it is working OK. It could work even better if it were stabilized and improved. Taking away the mandate will be harmful and cause premiums to go up even more. What troubles me in our zero-sum game of politics is we are foregoing improving an imperfect law, which we have done countless times before on major changes. The way I see it, Congress and the President own this law now. If it fails, people should look to them asking why did they let it happen. This impacts people.

I have mentioned before several changes to consider. National healthcare is not going to happen in our country as it is too political and the healthcare industrial complex is strong. Yet, I advocate expanding Medicare in a targeted way down to age 62 (or maybe 55). Unlike the more complex Medicaid, Medicare actually works pretty well and strips out the profit load embedded in insurance premiums. This will reduce exchange premiums and Medicare premiums, as it makes both audiences younger on average.

I think we need to reconstitute the adverse selection and co-pay subsidies to insurers. The federal government needs to repay insurers they stiffed and invite insurers who left back into the exchanges. I would also recommend the remaining states expand Medicaid and I would add back the mandate for coverage, even though this feature is unpopular. If there are areas where competition is not significant, select use of Medicare (or Medicaid) could be deployed in those counties.

There are other changes that should be considered, but we need to shore this thing up. Congress and Mr. President, the ball is in your court as well as the legislatures for those eighteen states.