Thursday’s little bit of this and that

Having been away at the funeral for my friend’s mother, I have been a little out of sorts as well as out-of-pocket. The elections and next two days of affairs have my mind spinning, so please forgive me as I comment on a little bit of this and that.

The election results are encouraging from a number of fronts, but most of all from the number of diverse candidates that led to the Democrats retaking the House of Representatives. I am proud to see more newcomers and many women getting elected. These folks felt the need to get involved to focus on issues and decorum, which has been kicked to the curb. I wish for them to have the wisdom of Solomon, the patience of Job and the collaborative bipartisan bent of former Speaker Tip O’Neill and President Ronald Reagan.

I was also pleased to see a number of ballot initiatives pass in various states. Several so-called red states voted on the expansion of Medicaid, which is telling. Florida passed an initiative that would overturn the highly restrictive limitations on former felons regaining the right to vote after they get out. And, in North Carolina, every former governor advocated for the successful defeat of a power grabbing measures by the GOP led legislature to limit the powers of appointment of the governor.

While the Senate result was a little displeasing given the election of a couple of folks who should not hold public office (Former Florida Governor Rick Scott and Texas Senator Ted Cruz), the GOP maintaining the majority was not news. My greatest disappointment is two races benefitted racist efforts to likely win, although one is still not certain. The fact Brian Kemp may win the Georgia governor’s race after his blatant unethical and untruthful efforts to channel Jim Crow-like voter restriction is disheartening. Should he win, the state of Georgia deserves much better than him, as if he cheated to win, he will cheat while serving. The other is in Florida, where the new governor Ron DeSantis has a racist past and benefitted from racists robo calls and dog whistle statements, one he made. Florida deserves better, especially following Scott.

What has not changed is the US President continuing to channel his inner child heightening his lack of truthfulness, bullying and denigration of the media. At his tempestuous news conference yesterday, I kept thinking that a leader needed to step up and put him in time-out. I am still amazed at how he can sell his followers that he is the one telling the truth and that everyone who is against him is lying. But, per his five biographers, that has been his schtick over time. His firing of AG Jeff Sessions was expected, but at the heart of this, is the US President thinks the AG represents him, not the country. It is not a puzzle that Trump cannot fathom that the recusal was the ethical thing to do. He asked, “what kind of man would do that?” An ethical one.

Finally, we have one more mass shooting in America. How can we stop them? It is simply quite difficult to stop a motivated lone gunman (and it is almost always a man). Our police and FBI are terrific, but with our freedoms of less-inhibited gun ownership and the focus more on the lesser problem of foreign terrorists taking money from preventing the far worse domestic terrorists and hate groups, we are making it easier not harder to kill many at one time. Our leaders have lacked the courage to do more and too many are paid to avoid doing so. So, I just pray that my family, friends and others are just not in the wrong place at the wrong time. And, I pray that those leaders find that conscience they misplaced.

 

 

 

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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.

 

The President and Congress own Obamacare

I have written often about the imperfect Affordable Care Act and ways to improve it. I have written often about the Republicans role in sabatoging the ACA making premiums even higher by not funding promised payments to insurers for adverse selection as well as naysaying the law and not expanding Medicaid in 19 states.

This sabatoge continues under this President who says the ACA is in a death spiral. It is hurting in many areas, but stabilizing in others. He said he wants to let it implode and then fix it.

Mr. President, that is not good enough. You are threatening to cease further promised payments to insurance companies which will harm people. You see, what you and Congress fail to realize is you own Obamacare. If it fails, it is on your watch. And, to be frank the significant majority of Americans and the press do not recognize the role you played in hamstringing the imperfect law.

My strong advice is to do what is necessary thinking of its patients and users. Those Americans out there deserve your best efforts to help them. Watching the ACA fail after you greased the skids is extremely poor form and uncaring. It is that simple. Fix the ACA. That is what is done to laws that need it to help people.