The President and Congress own Obamacare

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

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

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

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

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Sunday sermon-ettes, the sequel

Good Sunday morning all and enjoy the day. A few tidbits have been bouncing around in my head, so I will commit them to writing for your review and critique. The tidbits are light on religious tone.

Guns and butter: For some reason, in the US we spend more time discussing protecting the right to own a 34th assault weapon than feeding 34 people. We have far too many food deserts in our country where the closest food is a convenience store. Far too many in our country are undernourished. Yet, pick up any local paper on any day of the week, and you will find multiple gun killing stories. Better gun governance is essential, but it is a nonstarter with the NRA who is more interested in gun sales. I think our priorities are off.

Kicking poor people in the teeth: Along those same lines, our President is pushing the Republicans in the Senate to vote on whether to kick 22 million Americans in the teeth or 34 million, many of whom are in poverty or near poverty. It should be noted the President said he would not touch Medicaid. I guess that detail escapes him in his desire to have a photo op of him signing something.

Brexit is a hard pill to swallow: The word Brexit sounds like one of those new fangled drugs to cure something you did not know you should worry about. I think voters were not told the whole story and many are wishing they had a do over. As foretold, the financial companies who based their EU regional business in London, are making definitive plans to move. Bank of America just announced a move to Dublin, Citigroup is moving folks to Frankfurt and other places, and Japanese banks are doing likewise. While I  understand the desire to fully govern your future, the UK is harming its future growth. That is not just my opinion, but that of financial experts.

Shrinking to greatness is not a good strategy: Speaking of financial growth, limiting relationships with other countries is not conducive to growth. And, a venture capitalist noted that what creates jobs is customers. Plus, when we discuss global trade, we need to reflect the whole picture and that is the foreign owned companies who make things here with American workers. Why? Selling big durable products is more cost effective and less risky if they are not shipped from abroad. Just ask BMW, Toyota, Husqvarna, Michelin, Mercedes, Volvo, Mitsibishi, etc. about their plants here in the US.

The bible says many things: There is a minister who upsets a few applecarts by preaching that the bible should not be cherry-picked to support points of view. His obvious example is in Genesis where God tells Adam and Eve to go forth and multiply and then gets mad at them when they like being naked with each other. The question is how did they know how to go forth and multiply? The minister’s premise is we should take away the overarching messages that are taught therein and remember the context of when the bible was written.

So, on that note, go enjoy your day, whether you choose to practice your multiplication tables or not.

 

Ides of July – the heat is on

Summer is in full force here in the Northern Hemisphere. If I don’t get my yard work started before Noon, it is not happening. I worked through 12:30 pm today and am a worn out camper.

Speaking of heat, the Senior and Junior Donald are feeling the heat right now. More than a few conservative reporters, pundits and legislators are concerned over Junior’s zeal to collude with Russia and his evasive storytelling. As Charles Krauthammer noted in his column, the ability for Senior to claim this is a media and Democrat witchhunt is now over.

Continuing with the theme of heat, a large chunk of Antarctica sea ice fell into the ocean. The fact that it was the size of Rhode Island should be a wake up call. Melting sea ice won’t directly increase sea level, but the buffer it provided to land ice is gone. And, as land ice melts, it will become a problem for sea levels. The best description I heard is the sea ice melting is like losing the white edge of your finger nail exposing the more painful parts.

Finally, please provide more heat on Republican Senators before they pass one of the more unpopular and damaging pieces of legislation to repeal and replace the ACA. Not only will the CBO score this poorly, but it is opposed by the National Governors Association, the American Hospital Association, Blue Cross and Blue Shield, the American Cancer Society and AARP to name a few. I encourage these Senators to work with Democrats to improve the ACA, which is the preferred choice of the American public.

If the Republicans pass this into law, they have not seen the heat it will bring on their party. This law will harm Americans and the party who passes it.

A few suggestions on ACA Reform

Since the House and 13 Senate Republicans have decided not to listen to the American majority or review actual data, here are a few suggestions on reforming the ACA. The ACA is imperfect and seeing higher premiums than expected in some places, but critics overlook three key things. It has dramatically reduced the number of uninsured, it has introduced positive benefit requirements to all plans including employer sponsored ones and its premiums are even higher due to Republican Senators stiffing insurers.

What should we do about improving the ACA? First, do not pass any variation of the ill-conceived AHCA bill passed by the House. It is obvious the gang of thirteen GOP male Senators are not listening to the American majority. For what it is worth, here is what this retired benefit consultant, actuary and manager suggests for consideration.

– Pay insurers for the amounts promised them under the ACA to take on initial adverse risk (as was done when Medicare Part D was rolled out) and invite them to stay or return to the exchanges. Part and parcel with this change is to restore the risk corridor funding for adverse selection going forward. This will bring premiums down.

– Fully expand Medicaid in the remaining 19 states. The National Governors Association advocates the positives of Medicaid expansion with Ohio Governor and former Presidential candidate John Kasich calling it a “no brainer.” This will help rural hospitals, economies and residents as well as others in more urban settings.

– Reduce eligibility to Medicare to age 62. This will reduce the overall risk profile under the exchanges and Medicare since the added Medicare population is older than the average exchange population it would leave and younger than the Medicare population it would be joining.

– Where competition in the exchanges is nonexistent with only one provider, offer a public option through Medicare or a variation therefrom. The pricing needs to be fair when contrasted to the lone offering as you want provide viable choice, but not drive the lone insurer away

– Finally, I would suggest we evaluate the efficacy of all fee arrangements under the ACA. Which ones make sense to continue, which ones make sense to alter, and which ones should be shelved or replaced?

It would also be helpful for naysaying for the sake of a party position to cease. Some impressionable people have refused to consider the ACA because a politician told them not to saying it was horrible or in a death spiral. People need to be mindful that health care and insurance are complex and politicians are offering advice in areas for which they are not licensed or knowledgeable to do so.

To be frank, I would rather see us go down the path of a national health insurance model. Yet, that is s tough sell in this country. So, improving the ACA is the better course versus what is being discussed. Plus, the strategic expansion of Medicare noted above will permit us to study this option and expand or contract it based on its measured veracity.

 

 

 

Celebration for passing a bill may have been premature

With a White House eager to claim legislative victory, there was a celebratory bash after the Republican led House passed the AHCA by a squeaker of margins 217 to 213. The bill has been vilified by several advocacy groups like the AMA, American Cancer Society and AARP and it has still not been scored by the Congressional Budget Office. The bill is also dead in the water in the Senate “once it gets sent there.”

Wait a minute, the last sentence said “once it gets sent there.” To the surprise of some Republican House members, the AHCA bill has not yet been sent to the Senate. Why, you might ask? Since the House did not wait for the CBO to score the cost and impact of the bill on the numbers of uninsured, it cannot be included in the budgeting process, and would thus require 60 votes, not 51 to pass in the Senate. The whole idea was to sneak the bill through this process, so it did not need the super-majority of 60 votes, which it cannot achieve.

Unless the CBO scores this where it saves a threshold amount of the budget, it may not qualify. So, the House leadership has not yet sent the AHCA to the Senate. If they did and the CBO results were not favorable, the House would have to start over. Again, I should reiterate that this bill cannot get even the 51 votes needed due to the impact on Medicaid. As we speak, about two dozen state governors are beseeching the Senate about not harming Medicaid. Unlike the House, the Senate is actually listening.

So, the victory lap on mile 250 of the Indy 500, may have been premature. Voting on something without knowing its impact is not the wisest course of action and is unbecoming of a legislator we trust to do our homework.

 

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.

 

 

 

Puzzled about the ACA – take this quick quiz

Now that the AHCA effort by the President and Republican majority has fizzled, it would be appropriate to step away from the rhetoric and ask a few questions about the Affordable Care Act (ACA). I would also suggest you may not want to listen only to politicians on this as I have learned the health care awareness of politicians is not as high as we need it to be and some are more interested in optics than impact.

The questions and answers have been provided by a retired benefits actuary, consultant and manager for a Fortune 500 company.

Question 1: The ACA is: (a) undergoing a death spiral, (b) a disaster and will implode, (c) doing well in a number of places, but needs help in a few others.

Question 2: The reasons for rising costs under the ACA are: (a) adverse selection where more bad risks are signing up than good risks, (b) Congress refusing to fully fund insurers as promised for this adverse selection, (c) increased demand of services due to our aging and more obese country and pent-up demand, (d) over-prescribed medicine and tests due to profit-induced incentives, (e) all of the above.

Question 3: In its report of the initial and refined draft of the ill-fated AHCA bill, the Congressional Budget Office noted the number of un-insureds under this bill if passed would: (a) increase by 14 million in 2018, (b) increase by 24 million by 2026, (c) both (a) and (b).

Question 4: Medicaid expansion to cover individuals who earn less than 138% of the poverty level is a key part of the ACA. What do we know about the Medicaid expansion effort: (a) 31 states elected to do so, (b) states that did so received federal funding that started at 100% and will phase down to 90%, (c) per a study by George Washington University, the states that expanded Medicaid have more insureds, better performing economies and more secure hospitals, especially rural ones who had a high percentage of indigent (unpaid for) care, (d) the states who expanded Medicaid are witnessing a decline in personal bankruptcy rates and an increase in hospital accounts receivable rates (e) all of the above.

Question 5: The ACA added which of the following improvements to insurance coverage under the employer and the ACA marketplaces (a) guaranteed issue and renewability of insurance, (b) eliminated life time limits on coverage, (c) extended eligibility to adult children not going to college up to age 26 on their parent plans, (d) provided subsidies to purchase coverage up to 4 times the poverty level based on family size and income, (e) all of the above.

Question 6: What are reasonable considerations to improve the ACA? (a) better fund the promised adverse selection protection to stabilize premiums for insurers, (b) offer to reimburse insurers who left the marketplace for unpaid adverse selection protection as promised under the law to woo them back, (c) offer a public option (such as Medicare) in some places with no competition, (d) encourage the expansion of Medicaid in the remaining 19 states, (e) stop the unproductive naysaying and think of the impact on people not the politics, (f) all of the above.

In my view as a benefits professional who follows these issues, the answers to each of these questions is the last choice provided. I have grown weary of politicians playing with people’s lives. We are owed the truth. Overall, this law is working reasonably well, but needs improvements, especially where insurers have left markets leaving one choice. The framework is there, but the improvements noted in Question 6 are reasonable changes.

One final thought I learned this weekend. To some there is a stigma of being on Medicaid. One man said he was embarrassed to show his card. Under the Medicaid expansion with the ACA, the card does not reference Medicaid, so it removes some of the stigma. The man began seeing a doctor and that has made a huge difference.