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.

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.

 

Truth does matter

“We pay more taxes than anybody else in the world,” said President Trump on August 10, 2017 having said similar statements on more than a few occasions.

“You know this Russia thing with Trump and Russia is a made-up story,” said the President to Lester Holt on May 11, 2017 which he has said on multiple occasions.

The cut in the subsidies will only affect the “gift” to the insurance companies, said the President to his cabinet in October, 2017 when he defunded some ACA subsidies to the companies to repay them for subsidizing co-pays and deductibles for people making less than 2 1/2 times the poverty limit. He used variations of this theme on several occasions to defend his cuts to financial help to those in need.

The two common threads of these statements are they are all lies and were uttered consistently by Donald Trump. Yet, this should not be a shock to anyone as the man has a hard time telling the truth.

Per Politifacts, on 483 measured statements by the President, 69% of the time they were either mostly false, false or pants-on-fire false. In other words, more than 2 out of 3 statements he makes or tweets should not be considered as true.

In a fairly recent interview with The New York Times, the reporters measured the President averaged lying every 75 seconds. The Washington Post counted 1,950 false or misstated claims in his first 347 days. This is consistent with statements made by his five biographers who note Trump has a hard time with the truth.

But this is not news to most Americans per a Quinnipiac Survey. The survey said 62% of Americans do not think Trump is honest. And, in a University of Missouri Journalism survey, the President was listed in the bottom ten of trustworthy news sources, meaning the ten least trusted sources.

The truth matters. The Russia thing is real, whether it links directly to Trump or not, as intelligence officials say he is at minimum an unwitting participant in the meddling. In fact, General Barry McCaffrey, the most decorated retired four star general said this weekend that the President is a “serious threat to national security,” based on his adoring view of Putin.

On the taxes comment, we just reduced taxes with this lie laying groundwork. We are increasing our debt by $1.5 trillion to try to make a pretty good economy even better. On the health care subsidies, this lie covered for a change that will increase our debt by $10 billion meaning it impacts taxpayers as well as non-subsidized premium payers, not insurers.

Our problems are complex and they are hard enough to solve when we deal with the truth. When our leader lies and others support his lies, solving problems become even harder. The truth matters. And, with respect to his many alleged affairs and sexual misconduct, I would bet on the women’s stories as being more true than his defense.

Are you going to believe me or your own eyes?

The man residing in the White House has basically told his followers that everyone else is lying, only believe me. By itself, that is a pretty audacious claim, yet when the man’s history is reviewed, truthful is not the word his biographers or business relationships would use to define the man. Yet, his fans still follow his lead.

It is very difficult to manage the response to three major hurricanes. Yet, don’t lie to people and tell them everything is going well in Puerto Rico, when it is obviously not. As the Mayor of San Juan said bluntly, “we need to get our shit together.” The better answer would have been for the man in the White House to say we have been slow to get help to people, but here is what we are going to do about it. This same Mayor was ticked off today when a DHS person said Puerto Rico is a “good news story.”

The same man is trying to ram a tax cut through that may offer some relief for middle class families, but who is he kidding? The percentage reductions for the top of the house are substantively more than for the middle class. Abolishing things like the estate tax (which already does not exist on the first $5 million of inherited assets) and the Alternative Minimum Tax (which is what most of these high earners pay) is a windfall. And, let us not look past the comment that a tax cut that will impact the debt by $2 Trillion will create sufficient economic growth to pay for that increase. If we can grow our way out of the problem, let’s cut the taxes to 0%.

The same man has echoed the party line that the ACA has failed, but there are a couple of things he is not letting on. It is not failing, but needs improvement. And, it could be doing even better if it were not for the sabotaging done by the man and his party. Premiums are even higher and carriers are fewer in part due to the efforts of the Republican Party leadership, including the man in the White House. The sad part is most Americans have no clue about this sabotoging role, but it is entirely true.

Finally, just a thought to consider. Why did the man in the White House refer to African-American protestors who civilly made a statement taking a knee during the national anthem as “sons of bitches,” yet made no such references to torch bearing White Supremacists chanting “blood and soil” and carrying Nazi slogans? Then, he said his words had nothing to do with race, yet that is why these men risked their careers by protesting.

On this latter point, my wife shared with me the comments of a third generation soldier. He said he, his father and his grandfather fought people who were not permitted to civilly protest their leadership in WWII, Korea and Vietnam. To him, to see the man in the White House criticize Americans for exercising their rights of civil protest, citing the reason to condemn them so as not to offend the flag or the military, is what this soldier fought against.