ACA truths Republicans don’t want you to know

The Affordable Care Act is an imperfect and complex law, but it is actually working pretty good. It does need improvements, but a few of its imperfections have been heightened by our Republican friends in Congress and in state legislatures. Yet, they do not want you to know about these actions, some of which are quite devious and harmful to Americans. To be frank, this subterfuge frustrates me as people are harmed as the GOP tried to waylay the law.

What has not been reported very much in main stream news is Senator Marco Rubio’s successful efforts to stiff insurance companies. These companies were promised additional funding for taking on excessive bad risk, called adverse selection. This was done successfully when the Medicare Part D plans were rolled out. By stiffing the carriers, the insurance companies had to raise premiums even more than they otherwise would have. Some even left the exchanges as this action hurt their bottom line. Let me say this plainly. Senate Republicans screwed Americans with higher premiums to try and strangle the ACA. Rubio even bragged about this on the campaign, so please Google “Senator Marco Rubio and risk corridors” to read about what he did.

On the state level, 19 Republican led states chose not to expand Medicaid, a key component of the ACA. 31 states who did so are seeing fewer personal bankruptcies and better hospital accounts receivables. Republican John Kasich, who expanded Medicaid as Governor in Ohio and ran for President, said “Medicaid expansion is a no brainier.” I would have likely voted for Kasich had he won the GOP nomination.

Then there is the naysaying that has been facilitated by the 50 plus repeal votes. Far too many folks never gave the ACA the benefit of the doubt. It is imperfect and the exchanges were rolled out horribly, for which I blame former President Obama. Yet, this law has made a huge difference in the lives of many Americans.

Finally, what is ironic is the ACA is built off a Republican idea. This is a key reason Republicans don’t have a good replacement. In fact, former Senator Jim DeMint, the initial Tea Party leader, strongly advocated Romneycare, on which the ACA is loosely based, for the whole country. He even wrote a letter to President Bush advocating for it. Yet, when Romney ran for President in 2012, DeMint said both Romneycare and the ACA were unconstitutional. This hypocritical change of heart can be easily found by Googling “Senator DeMint and Romneycare.”

People need to know the truth. This is not false news as our President likes to claim. Please research these facts and read as much as you like. Then, ask your representatives to start governing with real information and look to help Americans. I strongly recommend we do not repeal the ACA and improve the law. To do otherwise, is poor form for those who hindered it at the expense of Americans.





Big Issue #4 – Harnessing Healthcare Insurance

A topic that has been highly politicized around a lightning rod of a name is what to do about Obamacare. To illustrate this point, if we call it the Affordable Care Act, approval rates increase and if we use the name KyNect in Kentucky it increases even more. In a Kaiser Health monthly poll (see Note to Reader comment below) from November, 74% of Americans and half of Republicans want the ACA to continue. But, if you dig deeper, the Republican voters heavily favor almost all features of the ACA except those dealing with the mandates for coverage for the employer and individual.

The Affordable Care Act is not perfect and is complex, but it is actually working even though it has been hamstrung and is not fully implemented in 19 states. Given the states who have expanded Medicaid, we can actually contrast their results with those who have not. What is revealed is personal bankruptcy rates have declined and hospital accounts receivable have improved in those expansion states.

Unwinding the ACA will prove difficult and a different tactic is needed. A data driven analysis would help leaving the political rhetoric aside. A key recognition is our health care costs have a tendency to increase as we have an aging and overweight population. We are also over-medicated and have more surgical procedures than needed. So, any insurance system needs to be mindful of those cost pressures. Plus, we need to recognize the restriction on funding to insurance carriers for adverse selection exposure has led to increased premiums and some leaving the market.

I have several suggestions around the idea of not throwing the baby out with the bath water, supported by many more Americans than not as well as the hospital industry. A few to consider are as follows:

– Fully fund the risk corridors for insurers to tie them over for the initial adverse selection from unhealthier risks. This will moderate premium increases.
– Expand Medicaid in the remaining states. This helps people, hospitals and economies as per several healthcare foundation studies like Kaiser, Commonwealth, RAND, et al.
– Introduce a public option in states where insufficient competition exists. This would offer choice and a lower expense option since it eliminates a profit margin expense.
– Evaluate the efficacy of various fees and improve, eliminate or validate what makes sense to continue.
– Seek more ways to offer choice, but make this less confusing. Healthcare insurance is already confusing enough.
– Legislators need to buy into this and stop political posturing. It is clear to me that any success that has been achieved has been in spite of partisan naysaying. What far too many don’t realize is the ACA borrows from a largely Republican idea that was supported by the Tea Party leadership (Google “Senator Jim DeMint and Romneycare”)

As a former actuary, the principle of insurance is the good risks pay for the bad risks. Plus, insurance is designed to keep you from bankruptcy should a catastrophic event occur. So, an effort should be made to get better risks in the plan.

What many don’t realize, by having insurance you tap the agreed upon network discounts with the hospitals. For example a double hernia operation might cost $32,000 with no insurance, but the network discounted price is $18,000. With a plan that has a $6,000 deductible, you end up saving $26,000.

So, as our leaders evaluate options, we need for them to set rhetoric aside and look at the data. Access to insurance is vital and ACA requirements imposed on all insurance, even employer-provided care, benefit far more than than the 20 million covered directly.

Tuesday’s gone with the wind – a few odds and ends for this Tuesday

As a tribute to the great southern rock band, Lynyrd Skynyrd, I will use a chorus line of one of my favorite songs of theirs, to highlight a few odds and ends this Tuesday – “Tuesday’s Gone.” If you don’t know the song, give it a listen. You may also like “Call Me the Breeze” and “Simple Man” as well by the band. But, before Tuesday’s gone with the wind, here you go.

Economic recovery continues, but the recovery is continually challenged by people not spending. Wal-Mart announced a 5th consecutive quarter of negative same store results, year over year. They cite dampened wages as the culprit. When you have a heavy sales economy, people need to make a decent wage rate or they do what every else does, spend less. In this ongoing debate about minimum wage increase, this is a key outcome by not getting more money into people’s hands. By the way, you can trace the desperate nature of the retailer, car dealer or college, etc  in direct proportion to their eagerness to sell you something. I have had “final offers” made to me over and over again – but you said it was final three times ago.

Moral Monday’s in North Carolina have started up again, but the issues remain the same. They did help get more notice on the poor teacher pay plight which came to a head last year by limits and changes made by our conservative General Assembly. They have promised to do something this session and they need to or opportunity will be lost. The other issues remain – expand Medicaid to those in need, repeal the voter restrictive Voter ID Law which has been ruled unconstitutional in four other states and is on trial right now here, eliminate the severity of the unemployment benefit cuts which are highly punitive, and avoid fracking in our state. I attended my second Moral Monday yesterday and witnessed a diverse group of a couple of thousands people including doctors, teachers, professors, ministers and students. Their voice needs to be heard and heeded.

Failing to remember history, even recent history, can blind your reasoning, especially when people are adamantly against something they were for a few years ago. Former Senator Jim DeMint is adamantly against Obamacare, which is strange because it was patterned after Romneycare which he strongly advocated in writing, TV appearances and campaign speeches for Romney, as something we should do for the whole country. He particularly liked the mandate, as it shows personal responsibility, which he hates today. Newt Gingrich went on TV with Nancy Pelosi to show a united front that global warming was real and man-influenced and we need to do something about it. Newt noted he was wrong before to say it was a hoax. This change was in 2006. Then he ran for President in 2012 and he said he was wrong to say he was wrong. In this cases, two wrongs do not make a right. The make a wrong a wrong.

Finally, our friend Karl Rove won’t stop making a scandal out of nothing. This time Hillary Clinton is the target. Instead, why don’t we talk about a real scandal and ask Rove why his subordinate Scooter Libby went to jail. The greater question is why did not Rove who admitted later that he knew the same information that Libby did. Libby outed a CIA operative (Valerie Plame) in the press to discredit her husband who was a former Middle East ambassador that took issue with the Bush White House misusing his information inappropriately as evidence of Weapons of Mass Destruction as a reason to invade Iraq. The ambassador’s report said for the trail he looked into, there was no evidence, yet the White House said he did find something. Please feel free to Google various combinations of Karl Rove, Scooter Libby and Valerie Plame. My problem with this, is over 4,000 US soldiers (and countless civilians) died because of making up the WMD reason on false or unverified intelligence. That is a scandal.

Speaking of trails, happy trails to you on this Tuesday. Have a great week. I would love to hear your feedback.


Obamacare continues to show success and irony

As reported by Kent Hoover of The Business Journal, an April 2014 Gallup Poll indicates the rate of those without healthcare insurance has now fallen to 13.4%. The Gallup Poll notes this is the lowest rate since 2008, when they first started tracking the issue. Many know that the public exchanges have signed up over 8 million consumers, but what many don’t know, including some reporters, is the expansion of Medicaid has added over 3 million covered individuals. Plus, what very few know, is that the pre-2014 Obamacare changes included a provision to allow parents to continue their adult children until age 26, irrespective of whether they are attending college. This pre-2014 change added 3 million people.

When you tally all of those numbers together, you get over 14 million additional covered individuals. There has been a lot of naysaying about the complex and imperfect law, fueled in a huge way by the poor rollout of the exchanges. But, that ship was righted and now people have signed up and are using the coverage. The naysayers have also noted the early sign-ups were older, higher costing medical consumers. Yet, the late push to get folks enrolled has improved the number of younger folks, to the extent that most insurers are feeling better about their risk profile. It still needs to be measured on a case by case basis, but this is encouraging. Also, the Congressional Budget Office is so enthralled with the better demographics, they reduced their cost estimates by $104 Billion over the next 10 years.

But, two final articles should be noted. First, about two weeks ago, Benefits Pro and Bloomberg News both reported that bond investors like Invesco, Credit Suisse, and Charles Schwab are looking favorably at the dampening effect on medical inflation that Obamacare is doing which is improving the outlook on US Treasury bonds. Second, today a study out of Massachusetts where Romneycare went into place several years ago, has indicated that mortality experience has improved for those who have been insured. In other words, the doctors, who analyzed the data, said it shows that if you have healthcare coverage, you will live longer, on average. Obamacare was patterned after Romneycare, so this is very telling.

On the flip side, there are still 24 states who need to complete the Obamacare package by expanding Medicaid. These states rank consistently in the bottom third of states on the quality of healthcare for its population by The Commonwealth Fund, who tracks healthcare data by state. They have shown, as has RAND Corporation and the Economic Policy Institute, that expanding Medicaid will help millions more people, help the rural hospitals in those states who are struggling and help the economies in the states.

As a retired benefits consultant, former actuary and former Director of Compensation and Benefits for a Fortune 500 company, I know Obamacare is not perfect, but I also know that there has been a mountainous effort to discredit it with true and untrue statements about its shortcomings. We need to keep Obamacare and embrace the changes it has made both before 2014 and in this year. We should also look to find ways to improve it. To replace it would be ill-advised and hurt many. Expanding Medicaid in those remaining 24 states would be the first change that would help.

And, the folks who are shouting the loudest should do some homework and read recent history that shows the Tea Party leadership strongly supported Romneycare for the whole country, including the mandate requiring insurance, before Obamacare was patterned after it and Mitt Romney ran for president. Once that occurred, Romneycare’s most strident supporter and de facto Tea Party leader, Senator Jim DeMint, said both Romneycare and Obamacare are unconstitutional. Isn’t it ironic that the idea the Tea Party favored then and now hate, actually is showing success? For people who do not believe this change in posture, they should Google “Jim DeMint and Romneycare” and read as much as they care to.



Stop equating things you disagree with to atrocities

Earlier this week, former Presidential candidate Rick Santorum equated Obamacare with Apartheid. Obamacare has also been referred to as Nazism because in the mind of its critics they associate anything that has a hint of socialistic concern as something that should be labeled with such an atrocious label. The obvious purpose is to inflame and influence an uninformed electorate using terms representing atrocities to label something that they do not like. While imperfect, complex and rolled out poorly, to equate something that is trying to help people gain access to insurance and healthcare as akin to Apartheid and Nazism to me portrays ignorance, deception or some of both.

Apartheid was the government sanctioned version of our Jim Crow laws and culture in the US. The sad difference is in South Africa, the main perpetrator was the federal government itself as it cracked down on people of color stripping them of human rights and their dignity. It took worldwide boycotts and sanctions to shine a spotlight on these atrocities. It should be added that President Reagan did not support these sanctions, but fortunately Congress overturned his veto and we joined the rest of the world in economically condemning South Africa’s apartheid. I have yet to see sanctions or boycotts on the US for passing Obamacare, so I think it is indeed a stretch by Mr. Santorum’s to equate the two.

Nazism means far more than the socialism in its underlying name. Nazism stands for fascism and purging of those who disagree with you. It also stands for exterminating Jewish people or people of different sexual orientation. When people say Nazism to describe something, its meaning portrays malevolence. To equate anything with Nazism needs to be a very serious set of atrocities. To call Obamacare or anything that has a concern for a greater good as Nazism is just plain wrong and akin to the Santorum’s ignorant remark about Apartheid.

Setting the atrocity labels aside, socialism is getting an unfair rap. First, per a recent survey, the happiest people on the planet are in Sweden, which has a socialistic economy. Second, the US Social Security, Medicare and Medicaid are all social insurance programs and they are appreciated by Americans. If you don’t believe me, just watch the fervor over any issue to decrease or cut back those benefits. Since I mentioned President Reagan above, he did several commercials calling Medicare socialism before it was passed in 1965. Does this tactic sound familiar? Fortunately for him, he did not say Nazism, as the greatest generation who fought them twenty years earlier and all Jews would have ended his political career then and there.

Third, Obamacare is actually a blend of socialism and capitalism. It is not national healthcare nor will it lead to it – the healthcare industrial complex won’t let that happen. While the Medicaid expansion is socialistic in nature, the exchanges are capitalistic in nature. The ironic part is the exchanges are a GOP idea created as an initial concept by the Heritage Foundation (yes that one) and used in Romneycare and supported by Mr. Tea Party, former Senator Jim DeMInt until Obamacare adopted the concept. DeMint even went so far to advocate the mandate on talk shows. So, for several years now, I have found GOP opposition to Obamacare fairly hypocritical.

I recognize that I will not change the minds of people on Obamacare. The public relation engines against it are quite powerful and its imperfections and poor roll out provide suitable ammunition. Yet, it does move the ball forward in spite of highly political attempts to cause it to fail – not expanding Medicaid in twenty states, not running state based exchanges in 36 states, telling young people not to sign up (what parent would do that?) and not allowing communication dollars to help promote how to use it. Even with the balky rollout, as of November 30, 803,000 people had signed up for Medicaid expansion in the states allowing it and 365,000 have signed up for the exchanges and those numbers are growing rapidly. That is on top of the 3 million young adults who have been able to remain on their parents plan before age 26 because of an early implemented feature of Obamacare.

Yet, irrespective of how you feel about the law, please stop calling it Apartheid or Nazism. You are showing your ignorance or being Machiavellian or both. Plus, it does a disservice to South Africans and Jews who died at the hands of their oppressors and that is an insult. I think Santorum owes an apology to many people, those he offended and those he tried to disinform.



Speaker Boehner – you are right, it is not a damn game

I watched Speaker John Boehner speak with righteous indignation at the government shutdown not being a game. You are right, it is not. I agree with you. You have the power as of this moment to call a vote on the Senate bill they sent back to the House. You have enough votes between moderate Republicans, who are tired of the Tea Party hostage taking, to side with the Democrats and get the budget passed. Right now, you have the votes. Make a move.

This budget is based on what you want from a GOP standpoint. It keeps the GOP desired numbers, but is without change to Obamacare funding. The Democrats have already conceded on this point. You have the votes right now, if you call for a vote. Someone wrote a comment into our newspaper this morning. The Senate has voted several times on bills sent over from the house. You should make a move on what the Senate sent back. You have the votes right now.

As an Independent voter and former Republican and Democrat and I don’t care who wins or loses. I do care about people using misinformation. I do care that a small group of people called the Tea Party can hold the GOP and America hostage over something that is largely a Republican idea. The exchanges in particular are a capitalistic, GOP idea that leverages the existing market. I also know the former Senator Jim DeMint, who was the Tea Party leader before resigning his senate seat to become President of the Heritage Foundation, supported Romneycare as last as 2009.

This is of importance, as Obamacare is patterned in many respects after Romneycare. DeMint liked Romneycare so much he wrote a letter to President George W. Bush saying we should do this for our entire country to solve the healthcare problem. He even advocated in interviews how much he liked the mandate as he thought it added personal responsibility. Yet, when Obamacare was passed, he declared in 2010 that both Romneycare and Obamacare were unconstitutional. Only one year before, Romneycare was the best thing since sliced bread.

This is the ultimate flip-flop, as now DeMint, as President of the Heritage Foundation, writes an anti-Obamacare post complete with a hammer and sickle implying Obamacare is communism. Again, I would add the exchanges are about as capitalistic as you can get. If not, why did the healthcare insurer stock prices go up on October 1? Another irony is origination of some of the ideas within Obamacare came from the Heritage Foundation and were adopted by Senator Bob Dole when he ran for President in 1996 as a the Republican nominee.

So, it is not a game Speaker Boehner. You cannot just change opinions like this because the guy in the White House passed your idea. This is important as if you ask Americans if they like the Affordable Care Act, you get more people liking it than when you ask them if they like Obamacare. They are the same thing, which Jimmy Kimmel has now made famous with his video from the other night. When people say Obamacare will be bad for the country, these are the same people who do not know what Obamacare does and are reacting to the name and the PR against it. You may recall when your PR firm told Republicans to always add the modifier of “job-killing” to Obamacare.

It is also not a game that about 50 million Americans do not have healthcare insurance, the worst offender being the state of Texas, home of Senator Ted Cruz and Governor Rick Perry. Texas has more uninsureds than other state. Cruz has been the principal culprit in holding America hostage and has done a disservice to this country. Perry has called Obamacare “criminal.” The Koch Brothers have funded commercials that use last year’s campaign tactics against Obamacare reference Uncle Sam standing between you and your doctor and using a poor woman to reference death panels. I know it is not perfect and is complex. I know Obama has done a poor job of explaining it to Americans. But, I do know the Tea Party, GOP, DeMint and Koch Brothers have pulled out the stops on the misinformation and disinformation calling it criminal, communism, Nazism, etc. Personally, I don’t like being lied to.

I also know politicians don’t know what Obamacare is. My representative still makes statements that I am sure he believes to be true, but are not correct. Either that or he is being Machiavellian. Governor Perry, Obamacare is not perfect, but it is certainly not criminal. However, what is extremely poor stewardship is to have a state where so many suffer and not do anything about it. Some would call that criminal. To me it is a damn shame, especially when entities like the Rand Corporation talk about the positive financial impact to a state to have Obamacare with the Medicaid expansion. So, you are not only not representing all Texans, you are harming the economy in Texas.

So, back to Speaker Boehner, you are right is not a damn game. It frustrates the hell out of me to have the country being held hostage over something that is largely your own idea. Call the vote right now and end this madness. There are so many Republicans that are ticked off at Cruz and the Tea Party, you will see what will happen. Call the vote now. It will pass and we can move onto the debt ceiling crisis.

Note to Tea Party – being cold hearted serves no one

I debated if I should try to be politically correct, but I thought I would share my candid thoughts as an Independent voter regarding the latest of several efforts by our Tea Party friends to defang Obamacare, which is largely a Republican idea. I find of interest that Obamacare is an idea that was supported by the leader of Tea Party in 2009, Senator Jim DeMint, when it was called Romneycare and was working pretty successfully in Massachusetts. This was before Obama passed a version of the law and Romney decided to run for President again in 2012.

You see, DeMint supported Romney and Romneycare in the 2008 presidential election even going on stage to advocate for both and writing a letter to then President Bush that Romneycare was the solution for America’s healthcare problem. Yet, once 2012 rolled around after Obamacare had been passed, DeMint could not continue his earlier advocacy, so he distanced himself from both Romney and Romneycare and did an ultimate flip-flop. DeMint is leading the current charge against Obamacare from his position as President of the conservative Heritage Foundation. I personally find this hypocritical.

But enough on that subject. Our Tea Party friends have advocated taking the subsidies away to help people in need buy the healthcare under the exchanges and expanded Medicaid in 25 states that did so. These subsidies would go up to people making four times the poverty limit declining to zero at the higher income level. Since poverty is an equal opportunity offender affecting all political parties, races, ethnicities and genders, this latest attempt to kill their own idea will be harmful to many people in need. We lose sight of the fact that Obamacare was set up to help reduce the number of uninsured which was near 50 million Americans. The earlier implemented phases of Obamacare have been well received and have reduced that count with adult children under age 26 being allowed to continue on their parent’s plan if not in college. The exchanges will work well, once the kinks get worked out, and we need other states to expand Medicaid to help those in poverty.

Yet, this latest effort follows on a litany of other stances advocated by Tea Partiers that add to this feeling of cold heartedness.

– A way several GOP led states are trying to limit the success of Obamacare is not to expand Medicaid. This is harmful to about 500,000 people in North Carolina as an example, yet it is also harmful to the economy of the state. The Rand Corporation said expanding Medicaid should be a no-brainer as it is a win-win for the people in poverty and state economy. Rural healthcare is hemorrhaging due to a high percentage of uninsured claimants, and one hospital has already announced it will have to close its doors if Medicaid is not expanded. This rural impact will especially hit many GOP voters hard, so it is not just Democrats that are impacted by this move, which should not matter in the decision-making.

– With no evidence of any material Voter ID fraud, the Tea Party has helped pass Jim Crow like voter restrictions (of which the ID is only one part) in several states. These states are being sued for the unconstitutionally of the laws including the most onerous one in North Carolina passed a few months ago. As reported by former Secretary of State Colin Powell, voter fraud is not an issue with the bigger problem by far being not enough people voting. So the laws do not attempt to solve the real issue. By the way, Tuesday in primary voting in my home town in North Carolina, only 6.67% of voters participated in the election. It is easier to count voters when no one is voting. Our country is dwarfed by other democratic countries in voting percentages, so we need to address that problem, not this phantom voter fraud issue which for some reason lacks data to support it, so says conservative columnist David Brooks. These voter ID laws are designed to suppress votes.

– In my state of North Carolina, the unemployment benefits were so severely cut, that we lost Federal funding. Not only is this harmful to the 70,000 people impacted, there is a huge impact on the economy of the state with hundreds of millions of dollars not flowing into the marketplace of transactions. This hurts people of all stripes, but will have an echo effect on the economy which will impact others.

– Also in my state of North Carolina, a law was passed to require drug testing for people who are suspected of use and are getting welfare benefits. A version of this law was passed in Florida and was found to be unconstitutional and declared invalid. However, enough data was analyzed while it was up and running and an interesting data point emerged. People on welfare used drugs at one-fourth the rate of the non-welfare recipients in Florida. Saying this in reverse, people not on welfare used drugs at a rate four times the rate of those folks on welfare.

– We are also holding the farm subsidies bill hostage which impacts those on food stamps. Again, the food stamp issue is waved as yet another example of fraud, yet per Brooks, he has seen no blatant examples of fraud around food stamp usage. Since we have a hunger problem in our country, we should be finding more ways to get people nourished and helping them climb a ladder. Yet, we have some folks who want to kick people while they are down. I could add a lot about not doing more to stimulate the economy building on the success of the initial stimulus bill which did work per five econometric firms, but that would require its own post.

I mention North Carolina as an example several times, but what the GOP and Tea Party have done is used their political clout at the state levels to pass cooker cutter laws in many states that harm people. The laws are worded largely the same as they come from the same source. Yet, they also have passed laws that harm the environment giving greater freedom to industries, especially those in the fossil fuel industry. These laws will provide a windfall to industry, but the state will be left holding the bag for clean-up and healthcare impact. I would be remiss if I did not mention the largest backers of the Tea Party made their billions in the fossil fuel industry. I will let you draw your own conclusions.

This 41st effort to repeal or defund Obamacare reeks of gamesmanship that will end up hurting the pawns. The states who did not expand Medicaid are harming people as well as their economies. The Republican Ohio governor is arguing for expansion as it will bring $13 Billion to his state over the next seven years. These are his words, not mine. Yet, I want people to think about this next statement. The main reason the Tea Party is against Obamacare is while it is not perfect, Obamacare has already made headway with its earlier implemented features and will largely work to get more people insured. Blue Cross Blue Shield has been running exchanges in several states for years and they work pretty well. I have been in one for the past two months. And, the GOP has long favored the idea of more competition, which is what the exchanges will be doing.

So, note to my Tea Party friends. Close your eyes and go back in time to 2009. Let’s hear Senator Jim DeMint supporting the use of exchanges, favoring the mandate and advocating doing Romneycare for the whole country. Because, in large part, that is what Obamacare is. Please do not let there be a 42nd attempt.

Some more odds and ends on Obamacare

Two of my more frequented posts have been around trying to set the record straight on Obamacare, an imperfect, but needed law. The earlier features of the law have already made the following changes: eliminated lifetime limits on medical benefits, eliminated the underwriting limit on pre-existing conditions for children, permitted adult children under age 26 to remain on a parent’s plan (before you had to be in college), limited the amount of profit an insurance company could make on your fully insured premiums (with two refunds the past two summers to many policyholders) and a few other items. Yet, the main body of the changes will be coming 2014 with enrollment in the exchanges and expanded Medicaid (where possible) available next month. A few odd and ends might be of interest:

Exchanges which will be available to many

If not covered by a suitable corporate plan, you will have the opportunity to go into the exchanges. The exchanges actually are a pretty cool idea and in many states, the Blue Cross Blue Shields have been running their own exchanges pretty successfully for several years. So the Obamacare exchanges are similar with more insurance carriers in the mix. And, if your pay is beneath 4 times the poverty level, there will be a declining subsidy. The exchanges are one area where the GOP is out of sorts, as the exchanges are, in essence, a Republican idea. So, there is some hypocrisy here when the GOP tries to discredit them. Also, three separate surveys have indicated the prices in the exchanges will be pretty reasonable. So, once the kinks are worked out, this is a pretty neat feature in Obamacare. By the way, I have been in a BCBS exchange for over two months and it has been very easy to enroll and use.

Medicaid Expansion

When the Supreme Court said Obamacare was constitutional, they unfortunately added a ruling that said states could opt out of the Medicaid expansion. What does this mean? For people making less than 133% of the poverty level, the Medicaid expansion was supposed to be the place where lowly paid citizens could gain access to free care. The US government will subsidize the expanded care 100% for three years and then phase down to 90%. Right now 25 states have opted to expand Medicaid, including several states with GOP leadership. There are several more thinking about it. The Ohio governor said we are talking about $13 Billion coming into our state over the next seven years and I would be foolish not to support this.

The key for doing this is each state has hundreds of thousands or more people who would benefit from the Medicaid expansion. My home state has 500,000 people who would benefit, yet North Carolina is one that has declined at this point. I should add a rural North Carolina hospital announced yesterday it will have to close if the state does not expand Medicaid. These hospitals have to chase too many unpaid bills or have too many uninsured patients and needed this funding of Medicaid coverage. The Rand Corporation said Medicaid expansion is truly a win-win for the citizens and the state economically. The key reason for not expanding Medicaid is highly political. It is very frustrating to me to see GOP leadership in these states make a political decision as they want to defeat the other person’s idea. The pawns in this chess game are the ones that get screwed and the state will be harmed economically.

Access to healthcare and poverty

We have a poverty problem in this country which is an equal opportunity offender. It impacts people of all political parties, genders, races, ethnic groups and ages. A key reason for people in poverty is the absence of medical coverage. It is the primary reason for personal bankruptcy at around 62%. To many people live paycheck to paycheck and cannot afford healthcare. I am deeply troubled when I see people “who have theirs” act so cold-hearted to those who do not have similar access to healthcare or have access, but cannot afford it. I had one former retail client where only 20% of their employees were signed up for the company medical plan. That means 80% could not afford it or were on their spouse’s plan.

Not having access to healthcare greatly hurts the individual and his or her family. It also hurts the economy. With more people without care, that puts a huge amount of pressure on the charitable and government-funded agencies to step in and do what they can. When someone loses their home or apartment because of an uninsured healthcare claim that costs $250,000, then that puts honest, hardworking people in harm’s way, where they cannot spend in our economy, but have to accept services to make ends meet.

Sum up

Folks, I know Obamacare is not perfect. It is complex and the President has made some changes to make it less so or give folks more time. To hold the country hostage over a debt crisis and budget season when Obamacare is largely a Republican idea is harmful to people, harmful to our economy and is hypocritical. On this last point, Jim DeMint, the former Senator and now President of the Heritage Foundation, who now thinks Obamacare is the devil incarnate and is quite vocal of late, was praising in writing and in person the key elements of Obamacare that were represented in Romneycare as late as 2009. His flip-flop is almost as bad as Newt Gingrich’s two televised flip-flops on global warming, where he changed his mind twice.

Let’s move forward with Obamacare. It is not perfect, but it is a strong step forward.

Stop being hypocritical – Obamacare is largely a GOP Idea

Several Republican politicians in the US Senate, US Congress and NC State General Assembly have said in the press or in correspondence written in response to my queries have described Obamacare as “National Health Insurance.” I have responded when I could that Obamacare is not national health insurance. It requires health insurance coverage through employer plans, exchanges of plans with more insurance and expanded Medicaid. For those who make below certain income thresholds (basically 4 x the poverty level) an increasing subsidy for the premiums is offered as the income level decreases.

What I also universally tell people is Obamacare is largely a Republican idea that was presented in early forms back in 1994 by Senator Bob Dole, as an alternative to the national health insurance proposed by President Clinton. The idea was liked so much, that Governor Mitt Romney of Massachusetts implemented a variation for his state which is working pretty well today. Senator Jim DeMint, Mr. Tea Party, even endorsed Romney and his plan in 2008, before he did the ultimate flip-flop once President Obama was able to get the very similar Obamacare passed. But, don’t take my word for it, here are selective news quotes from news stories the past few years and even a campaign website.

From the Bob Dole/ Jack Kemp Presidential Campaign website in 1996 – “In1994, Dole introduced a health care reform bill which had no price controls, no mandates and no taxes. The bill took on a common sense, free market approach to health-care reform, focusing primarily on insurance reform, while offering subsidies to help low-income Americans buy health insurance.”

Per Ezra Klein of The Washington Post on July 1, 2012 “In 2007, Republican Sen. Jim DeMint of South Carolina sent a letter to President George W. Bush. DeMint said he would like to work with Bush to pass legislation that would ‘ensure that all Americans would have affordable, quality, private health coverage, while protecting current government programs. We believe the health care system cannot be fixed without providing solutions for everyone. Otherwise, the costs of those without insurance will continue to be shifted to those who do have coverage.’

“In the 2000s, Romney used the individual mandate to make Massachusetts the first state to actually achieve near-universal coverage. On the national level, Republicans as diverse as Newt Gingrich, Lamar Alexander and (Trent) Lott joined him. Republicans sometimes like to present their support for the individual mandate as a youthful indiscretion, but as late as June 2009, Charles Grassley, R-Iowa, the ranking Republican on the Senate Finance Committee, was telling Fox News that ‘there is a bipartisan consensus to have an individual mandate.’ on March 5, 2012 – “Sen. Jim DeMint (R.-S.C.) told that both Obamacare and Romneycare are unjust laws because they wrongfully mandate that individuals must purchase a product prescribed by the government. asked DeMint in an Online With Terry Jeffrey interview, if he believed that the ‘type of health-care prescription and mandate’ enacted in Massachusetts under Gov. Mitt Romney was ‘a violation of the natural right of liberty.’ ‘Yeah, I think it is,’ said DeMint.”

From Right Speak News on March 19, 2011 – “If I sound like a broken record with my ‘individual mandate is a conservative creation’ posts, it is only because I am determined to not let spineless, conservative leaders rewrite the history of the conservative movement. DeMint can pretend all he wants that he believes that the individual mandate is horrible, but he can’t hide from the words he uttered less than three years ago. I personally saw DeMint live smothering Romney with praise at a Republican event in 2007. He had no qualms about Romneycare at the time. No qualms.”

Obamacare is not perfect, but it moves the ball forward in a huge way and has already helped millions with the earlier implemented provisions – no pre-existing conditions for children will deny coverage, adult children can stay on their parents’ plans until age 26, no more lifetime maximums, and refunds to participants if an insurance company makes too much profit on your premiums, e.g. The forthcoming exchanges are an excellent idea and one that the GOP should embrace. In fact, my GOP Congressman has advocated repealing Obamacare and offering exchanges with subsidies (er, that is what Obamacare does).

I have written several posts on Obamacare. One such example follows:  It is complex, but it is much-needed with so many lacking coverage and the US having the highest costing healthcare in the world with only the 38th best quality of care per the World Health Organization. I am frustrated with our GOP friends for making Obamacare a political chess game. For GOP led states choosing not to expand Medicaid to help millions of citizens around the country and economically benefitting the healthcare delivery system is poor stewardship and the pawns are the ones who suffer, not the politicians.

I have written my GOP Congressman several times to cease the Obamacare repeal votes and asking him not consider defunding it. I have also asked him to push our state legislature to reconsider the Medicaid expansion decision to not help those in need. These efforts make the GOP look poor and are not in the best interests of our country or state. And, if you read the above, it makes them look hypocritical.