Medicaid expansion is needed for NC says this retired benefits professional

As North Carolina continues its stalemate on Medicaid expansion, it might be interesting to heed the words of former Ohio Republican governor John Kasich. When Ohio moved forward with the Medicaid expansion, he called it a “no brainer.”

Now why would he say that? Kasich noted Medicaid expansion would not only help people, it would bring $13 billion to his state over several years. George Washington University did a study that said Medicaid expansion would help a state’s economy, help a state’s rural hospitals and help people. We should also remember NC Republican Mayor Adam O’Neal of Belhaven walking to Washington seeking the expansion of Medicaid after his colleagues in Raleigh turned him down as he tried to save his town’s hospital.

Rather than offer stale arguments, it would be nice if the Senate and House leaders figure out a way to get this done. Let me add the voices of The Commonwealth Fund, RAND Corporation and Economic Policy Institute that echo the results of the GWU study. NC is already in the minority on this. Please let’s find a way to help people.

Let me close with a truism about health coverage to think about. Those with coverage will see doctors earlier and will have access to prescription drugs to avoid future train wrecks. Preventive care and health maintenance are better paths forward for people and healthcare financing.

Note: The author of this post is a retired benefits professional who is a former actuary, former benefits consultant and benefits manager for a Fortune 500 company

Credit risk appraiser Moody’s buys a firm that assesses climate change risk

Even for those not very familiar with Moody’s, this headline speaks volumes about the impact of the risk of climate change on our country and planet. In a July 24, 2019 article in The New York Times by Christopher Flavelle called “Moody’s Buys Climate Data Firm, Signaling New Scrutiny of Climate Risks,” the company that measures credit risks for bond investors in companies, cities, counties, states and countries, has added to its expertise. Per Flavelle’s article

“Moody’s Corporation has purchased a controlling stake in a firm that measures the physical risks of climate change, the latest indication that global warming can threaten the creditworthiness of governments and companies around the world.

The rating agency bought a majority share in Four Twenty Seven, a California-based company that measures a range of hazards, including extreme rainfall, hurricanes, heat stress and sea level rise, and tracks their impact on 2,000 companies and 196 countries. In the US, the data covers 761 cities and more than 3,000 counties.

‘We are taking these risks very seriously,’ said Myriam Durand, global head of assessments at Moody’s Investor Service, who said the purchase would allow its credit analysts to be more precise in their review of climate-related risks. ‘You can’t mitigate what you don’t understand.’

Sudden shocks such as floods, wildfires, or storms can hurt businesses and send residents fleeing, taking away the tax revenue that government s use to pay debts. And, longer term threats – such as rising seas or higher temperatures – can make those places less desirable to live in, hurting property values and, in turn, the amount raised by taxes.”

To illustrate this risk, the same day I read a reprint of this article in The Charlotte Observer, the local paper ran a story on the town of Fair Bluff, NC which has been flooded twice in that past four years due to Hurricanes Matthew and Florence which lingered over their area. Sitting near the Lumber River, the citizens of Fair Bluff saw the river rise well beyond flood range. The previous flood of this magnitude occurred 90 years before. Sadly, the population and business is declining due to rebuilding costs. As a result, so is the tax revenue to provide services.

There is a huge financial impact of climate change on the lives and business of people and communities. Rebuilding a town that may continue to be in harms way adds to the risk and some people are choosing to relocate. And, It is not just small towns. Houston has had two major floods over the past five years, as well. Houston has felt on a larger scale what Fair Bluff has felt. Not only do the rains of the Hurricane sit over them, the rivers upstate overfill and flow toward the sea. This causes extra flooding.

So, Moody’s is improving their ability to assess repayment risk to bondholders. A city that has rebuilt or prepared poorly is at greater risk of flight of people, businesses and tax dollars. What should also be alarming to American citizens is while Moody’s is taking forward thinking action, the US government is stripping climate change reports from their websites and demoting, transferring or running off Ph.Ds who are expert in measuring and addressing climate change. In short, we are throwing away a technical advantage that could help the US and the world.

Repeating what Ms. Durand said above, “You can’t mitigate what you don’t understand.”  So, please ask all politicians what they plan to do about climate change including the US president. And, a question for those who still buy the hoax stuff, why is Moody’s spending all of that money on a hoax?

 

Please stabilize the Affordable Care Act NOW to help Americans

A February, 2017 Morning Consult Poll noted that 35% did not know the Affordable Care Act (ACA) and Obamacare are the same thing. I want you to think of this poll when you see how Americans feel about the ACA. Today, just under half of American approve of the ACA, but that is in part due to the above and the fact more progressive Democrats want a Medicare-for-All replacement.

I wrote the following post a few months back as I am of the opinion Democrats and Republicans need to stabilize the ACA now and explore a few changes on a measured basis. As I wrote this, I call politics on the carpet for causing some of this mess, but everyone needs to check their egos and zero-sum games and fix the problems which are fixable. They also need to drop the BS lawsuits that are asking to rule the ACA unconstitutional again, when the group making the request changed a feature to further this mission. That is like ripping an engine off the plane and blaming the engineer while it is flying.

So for what it is worth, here are my suggestions. 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 Congressional representatives a few thoughts on stabilizing the ACA, something Democrats campaigned on last fall and won in the midterms after the disastrous attempts of the Republicans to clean the slate that fortunately failed.

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.” North Carolina is debating this issue, but it needs to move forward with the number of rural hospitals that have closed thus far in the state.

– 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. Obama was not truthful when he said you could keep your doctor – no new network should make that universal claim. 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.

The real voter fraud

Living in a state that has had its voter ID law overturned for unconstitutional discrimination along with several attempts at gerrymandered districts, I have witnessed first hand Jim Crow-like voter suppression. In fact, the latest ruling against gerrymandering happened just two months ago, too late to change the districts for the 2018 election.

To avoid the obvious point, this is cheating. Both sides have cheated in the past, but using the wording of an appellate judge on the North Carolina GOP voter ID law, it was a “precision-like” effort to discriminate.

Sadly, the states of Georgia and North Dakota are witnessing orchestrated attempts to suppress votes. What makes the Georgia suppression efforts targeting African-American voters so inappropriate is the man running for Governor, Brian Kemp, oversees the voting process as Secretary of State. He is running against a Black female Democratic candidate, so this is blatant cheating and highly unethical.

In North Dakota, Native Americans are being discriminated against. Many use a PO Box for mail purposes, as their rural homes often do not have a physical address. So, a voting law was passed requiring the use of a street address or you have to go through more hoops to vote. The Native Americans tend to favor Democrats. Again, to state the obvious, this is cheating.

These laws are designed to address a fairly non-existent problem. Yet, the orchestrated public relation efforts of their advocates paints a much overstated problem. The laws tend to go beyond an innocuous sounding voter ID issue, which is discriminatory by itself. The laws tend to include other 21st century versions of Jim Crow efforts to make voting harder for people of color. Ironically, the one area that sees a more than a trace voting fraud is absentee voting by mail. Since this method has tended to favor Republican voters, it tends not to get included in the voter ID laws.

I am Independent voter who was a Democrat as a young adult and Republican as an older one. A key reason I left the GOP was a tendency by the party and its biased news support to make things up, far more than the Democrats. This obfuscation of the truth has actually gotten much worse with the current US President. So, from my vantage point, the only voter fraud I see is being perpetuated by the Republican Party.

Messers. Trump and Pruitt – it is the Environmental Protection Agency

Almost one year ago, the President of the United States announced a plan to withdraw from the Paris Climate Change Accord making the US a very isolated country on the world stage. That announcement both betrays and galvanizes further the significant efforts and science behind America’s push toward renewable energy and conservation.

Yet, that is only part of the attack by this administration on our home planet. Under the tutelage of Scott Pruitt, the Environmental Protection Agency, has decided to have an all out war on science and the environment. The orchestrated removal of climate change science data accessible by the EPA website and the repositioning, demotion or firing of some scientists, is indicative of a parent wanting to mask the fact they do drugs from their kids.

Pruitt has also tried successfully and unsuccessfully to let companies pollute waterways and the environment with fewer repercussions. The fact we have a global water shortage is irrelevant. He has also championed the ability for industry to question the EPA’s data. That may sound good, but industry has challenged data for years and, as a country, we do not adhere to the Precautionary Principle.

This principle states that if it is believed an industry is polluting the environment, then they must prove they are not before going further. In the US, industry has to be proven they wronged people many years after the fact. The reason Erin Brockovich is so famous is it is rare to win against industry. The sad part is people have died or been made ill by then. The Pruitt change is to let industry cherry pick data more easily. I should note the flame retardant industry used a study that had nothing to do with that issue to show the retardants were safe – it was proven they cause cancer in firefighters, toddlers and mothers.

Last week, a new report came out that noted the Outer Banks of North Carolina will be the hardest hit region by rising tides by the end of the century. Yet, the report eliminated any reference to man’s influence of climate change. It should be noted a few years earlier, the NC General Assembly refused to accept a similar finding, but paid for a report that used the past 100 years sea level increase as a guide for the future showing an increase of 8 inches versus 39 inches per the scientists. Apparently, that report has been proven faulty.

Finally, a report by the United Nations has estimated the failure to address climate change will cost the world $100 trillion in US dollars. Some have cried foul over this number, but I would add a study sanctioned by the world’s largest pension scheme (plan) investors in 2010 estimated the cost of repairing climate change problems in the $10 trillion to $20 trillion range. The key word in both is trillion.

We should recognize these numbers are guesses backed by science and some rationale. I would quibble less if the numbers are toward either end and focus on the observation that doing nothing will cost money and a lot of it. Hurricanes are more severe now when they hit shore from elevated sea levels. The costs to fix the damage run in the tens to hundreds of billions range. When you multiple just the hurricanes by these cost fixes, then one can see how the numbers can rise.

If that does not scare, there is a new term that should called “sunny day flooding.” These are days when high tides flood the streets of coastal cities when no storm is present. These days are increasing significantly in places like Miami, Hampton Roads, Charleston, New Orleans, etc. In the next fifteen to twenty years, some of these cities may have fewer non-flooding days than flooding ones.

So, Messers. Trump and Pruitt, you can choose to play ostrich all you want, but the people that care about our home need to move forward. It would be nice if you were an enabler rather than a blocker.

Good news for NC voters

Amid the pervasive news out of Washington, the US Supreme Court refused to hear an appellate case that ruled the North Carolina Voter ID unconstitutional. This is excellent news for all voters, but in particular African-American, older and college student voters.

Within the law were highly discriminatory provisions designed with “surgical precision” per the US Court of Appeals in the 4th District to infringe upon African-Americans. It was designed to “kick Democrats butts,” so said a Buncombe County GOP leader on The Daily Show, a tape of which was shown during the court case. It should be noted the leader resigned the next day.

When I made reference to this law as “unconstitutional and Jim Crow-like,” to members of the NC General Assembly before it was passed, one of its authors strongly disagreed. My response was simple, “as a 56 year-old white man and former Republican, we both know what this law is about.”

It also attempted to solve a problem that is not significant. Voting fraud is not pervasive as some would let you believe. Numerous studies do not support the claim of more than very small numbers of voting problems. It should be noted that the attempt to discredit our Presidential election through claims of voter fraud was a key part of Russian meddling in October to create doubt.

And, a final key comment is important. The problem we face in our country is not enough people voting. To be such a significant democracy, we don’t have enough citizens participating in the process. We should be doing everything in our power to encourage not discourage voting. And, if voter fraud is such a concern, why did the NC General Assembly not include absentee voting in the law, where there is more fraud (still not a lot) than at the polling sites? The answer is who tends to vote in larger numbers as absentees.

Right now, my strong advice to the NC General Assembly is to not do what they are thinking about, trying to rework the law. The General Assembly has now had four laws passed in the last few years ruled unconstitutional. The solution is stop passing laws that are unconstitutional, not trying to see what you can sneak through.

Bigotry is a lousy money-maker

I have written before how coexisting and capitalism are not at odds with each other, in spite of the attempts of some through bumper stickers to show you should pick one or the other. History has shown, it is far more economical to coexist. Why? More customers. And, more customers means more jobs.

In my home state of North Carolina, we have forgotten this equation. In early 2016, our General Assembly rammed through a discriminatory law called HB2 in a special session taking just ten hours. I recognize fully the transgender bathroom portion of the law gets most of the press, but the piece which has caused the most consternation in the eyes of businesses looking at our state and ruling bodies of the NBA, NCAA and ACC, is the elimination of LGBTQ people as a protected class who should not be discriminated against.

The transgender portion was sold on fear without much data to support its issues. So, it is hard to back away from something its supporters made people scared of. But, let’s set that part aside and focus on the LGBTQ part. While there are proponents of HB2 who will argue the bathroom law should remain, the denial of protection to LGBTQ folks is flat out unconstitutional.

The proponents of the law said it is only the cities that are impacted by this law due to larger populations of LGBTQ people. Legislators in rural NC say what does it matter if Charlotte, Raleigh and Greensboro don’t get sporting events or new businesses? The economic dilemma for the rural parts of the state is this concept of revenue sharing. A portion of sales taxes from larger cities are distributed throughout the state to help finance smaller investments and pay for services.

The less money in the big cities means less money for the state. And, our entire state has damaged its reputation not just around the country, but around the world. I have read that some members of the General Assembly say they had no idea there would be such a backlash. The answer to these legislators is you did not take the time to know passing the law in ten hours.

I firmly believe HB2 should be fully repealed. Its treatment of transgender people using a sledgehammer approach to legislation is unjust. There could have been a more surgical answer. So, short of a full repeal, let me offer a compromise.

  • eliminate the LGBTQ discrimination feature in its entirety before you are made to by the courts. This feature is unconstitutional. Period.
  • eliminate the feature on restricting a city from having a higher minimum wage; cities who have larger economic competition and cost of living should have the right to allow a higher minimum wage than the national one. This feature needs to be vetted more than it was by itself.
  • change the transgender portion of the law to do the following; if a person has a formal document indicating a gender different from his or her birth certificate, he or she should legally have the right to use the bathroom he or she identifies with.

Again, I believe the whole law should be repealed. Yet, this compromise should help the state move forward before these business decisions not to move, expand or hold events here are more recognizable in our economic growth. The scary part, as shared by Chamber of Commerce recruiters, is we have no idea how many organizations did not consider North Carolina.

Jesus told us to treat others like he we want to be treated. It is the right thing to do as well as the economical thing to do. Bigotry is not much of a money-maker.