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.

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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.

 

Wise men say…

If you are any semblance of an Elvis fan, you know the next phrase of this song is “…only fools rush in.” While this song is about not listening to your head and what others say, but rushing ahead with what your heart says, it does apply well to legislation. When legislators rush into anything, they will make mistakes. You can take that to the bank.

I cite four examples, two at the federal level and two at the state level. In North Carolina, our legislators called a special session last spring to pass the HB2 Law, henceforth known as the Bathroom Bill, in ten hours. They did not ask what others thought of this legislation. The transgender discrimination part of the bill was sold on fear, and when that is done, it is hard to back off. Yet, the part that ruffled the feathers of the NCAA, NBA and ACC as well as businesses and musicians, was the part that denied protection for LGBT members under the law. This is flat out unconstitutional, but since they passed it so quickly, they did not take the time to know this.

You would think our General Assembly would learn this lesson, but last month after it was official the new governor would be a Democrat, this impatient and power-hungry assembly met to address something more than hurricane assistance, which was the purpose for the gathering. They decided to strip powers away from the new governor. Mind you, the General Assembly already had a super-majority, but they had to flex their muscles and use a coup to grab more power. Even Republican voters thought this was poor form. Yet, our leaders in the General Assembly seem to not care what people think. As an Independent, I find this to be horrific legislation, an abuse of power and poor stewardship.

Not to be out done, the first measure our Republican friends in Congress wanted to change was the nonpartisan Ethics Committee. Over the chagrin of their leaders and after meeting in secret, they decided to restrict this ethics review process. After backlash from the public and with the President-elect piling on, they repealed the bill in less than 24 hours. When the President-elect, not known for his ethics, calls you on the carpet for ethics, you really screwed up. In my view, this may have been one of the more idiotic bills ever passed. The fact that this measure was the first thing that was done is outrageous and sets a tone of poor governance.

Which brings us to the rush to repeal Obamacare. This law is imperfect and complex, but is working pretty well. It does need to be improved and there are ways to do that leaving the framework in place. The administration is already built to accommodate some needed changes, so it is only for political reasons that it must be repealed first. I have written many posts, including the previous one, which shows how we got to this place, adds some needed truths, and asks for a data-driven change. Yet, if you govern off rhetoric, you suffer the consequences. The President-elect said he’s going to make benefits more generous and cheaper at the same time – that sounds like a TV ad for a new product, so good luck with that.

Wise men say, only fools rush in. These are four examples of foolish behavior that led to or are leading to poor legislation. The sad part is there are many more. Legislation is hard enough without rushing into it. When you do, mistakes will happen. I also believe, legislators don’t want citizens to take the time to see the real story. And, if you govern by tweet without input from advisors, you are being foolish.

 

Genghis Khan – Beyond his Brutality

My oldest son and I attended a traveling Genghis Khan museum exhibit on Sunday which is on our city for a few months. He is fascinated by Khan and his legacy that brought his Mongols to the doorsteps of Europe and conquered most of Asia, including China. He listens to a podcast with an avid and knowledgeable historian about Khan.

Khan first consolidated the nomadic tribes of Mongolia who tended to fight amongst themselves. He then turned his sights on other lands and was quite brutal in his quest. Yet, the story that cements his rule is he was a great leader that understood merit hiring over nepotism and allowed certain freedoms. More on this later.

The Mongols were a formidable fighting force for three principal reasons. They were superior horsemen where the entire battalion would attack on horseback overwhelming superior numbers. And, what amazed me is each rider would travel with two to three horses. Their army could move 75 miles in contrast to an opponent’s ten.

They were prolific archers with self-made and unusually shaped bows, which could shoot as far as 350 yards, much longer than other bows. And, they could shoot them accurately off horseback, even backwards. Often, the Mongols would pretend to retreat to lure their foes out and then reverse course and attack.

Finally, Khan organized them into a fighting force in numbers of ten. Each battalion had multiple groups of ten, who picked their own leader. And, the group of ten would be punished as a group for the failures of the one. These tens would be multiplied to a battalion of a thousand or ten thousand, which would be a potent and organized force.

Once a group was conquered, after certain leaders would be killed, the subordinate troops would swear allegiance and fight with the Mongols. They would not rule as harshly as they conquered, as they wanted the civilians to support the conquering enemy and new leadership. Plus, there were several governing principles that last to this day.

  • Religious freedom was provided where people would worship their religion of choice. Several religions were readily available even in the capitol city.
  • Civil service officials came from a wide swath of people based on merit. So, civil service officials were more proficient than if they were hired on relationships..
  • Diplomatic immunity was afforded any envoy traveling from another kingdom to visit. Kings do not kill envoys was a stated rule.
  • People could move around with some limits as a passport system offered organized travel. One passport we saw had three languages on it.
  • Environmental mandates were given for communities to protect their water sources.
  • Taxation was often lowered on the conquered lands and exemptions afforded teachers and religious figures.
  • Communication and organization were key. Some say Khan brought an organized purpose to previous rivals to fight together. The same held true in his governance.

These principles can be found in many societies today. The empire lasted for several hundred years, but what caused its retrenchment, in my view, are the vast distances to govern, but also the infighting of the Khan siblings and offspring. HIs grandson Kublai Khan was the last of the great Khan leaders, so after his demise, the empire started a slow wane.

If this exhibit comes to your city, I would encourage you to go see it. I am certain their are people more knowledgeable than me who can offer more specifics about the Mongolian empire, its rise, its governance and its decline. I would welcome any and all comments, especially if I am off base.