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.

Letter from Mitt Romney to Barack Obama

This is not a real letter, but one that could be written.

Dear Mr. President,

I hope this finds you well. I know we have had our differences and I disagree with some of the positions and decisions you have made, but I want to commend you for your role in helping lower the unemployment rate to 5%. As you know, I promised during our campaign to get the unemployment rate down to 6% by the end of 2016, so you have done well on this issue. I also commend you for overseeing 68 consecutive months of job growth in our country, which has helped reduce this rate.

While I could not advocate this during the campaign, I would like to thank you for using many features of Romneycare as part of your formulation of Obamacare. I take pride that Romneycare is working well in Massachusetts helping to lower the overall mortality rate and am proud that you borrowed from my successful template. I recognize it still needs some seasoning, but Obamacare is on the right track for our country. As you know, I shared these thoughts in an interview a few weeks ago.

We still have our work cut out for us, so I hope our next President can build on these successes. By the way, our friend Newt Gingrich wanted me to pass along his thanks for getting the gas prices down so low, which was a campaign promise he made in 2012.

Best wishes for continued success,

Former Governor Mitt Romney

Only fools rush in – why do the pawns get punished over fights to derail Obamacare?

Elvis used to sing “wise men say, only fools rush in…” Unfortunately, we have too few Elvis fans or, maybe, they were watching more than listening to the words. There have been some foolish behaviors that will come back to haunt the ones who are executing the behaviors. If they don’t, others will pay the price for their foolish acts.

The Cato Institute is funding the legal teams that are fighting court battles against the subsidies under the Affordable Care Act, if they were provided through the federal exchange. There is one place in the law that can be taken out of context with the rest of the document, with its intent and with the practicality that some states could not or did not want to run the exchanges. One ruling said that only the state exchanges could offer the subsidy per this interpretation, while other court decisions looked at the broader picture and said the federal exchange subsidy is OK. Fortunately, the one case should be overturned in appeal, but there are other ones as well in the works.

From where I sit, what do you gain by winning your narrow-minded argument? You will screw over 5 million people which will likely grow to more, if these cases go to the Supreme Court in a year or two. I often say that it is the pawns who get screwed in these political zero-sum games. To me, it is prima facie evidence that there are some who only want to win an argument without caring about who is impacted. In this case, people of all political stripes and races will be impacted.

The irony here is the Affordable Care Act is largely a Republican idea, borrowing from Romneycare which was supported by Tea Party leadership until Romney ran for President. The reason there is no countervailing GOP idea is Obamacare is largely it. People think I make this up, but I encourage them to Google “Jim DeMint and Romneycare” and read the many articles. And, the larger truth is Obamacare is showing many signs of success, especially with lowering the rate of uninsureds.

Here is where I remind people that I am Independent voter who has over 33 years of experience in benefits consulting and benefits management before retiring. I am also a former actuary by trade. I have long grown weary of the many attacks on this imperfect and complex law. I have been saying for two years, make the law better, as we will be better for it with more people insured. We have to get people to the doctor before the inevitable train wrecks happen. We also need the remaining states to expand Medicaid. Those states are in the bottom half of the country on healthcare quality and child poverty. This will gain even more coverage for people in need of all political stripes and races. This would include Republicans and Libertarians.

As a volunteer who helps people in need, the absence of healthcare insurance creates poverty. It can create homelessness. We need for people to be covered and when politicians or pundits tell people not to consider coverage because they do not like the President, his party or the law, they are doing that person a disservice. The subsidies go up to a family of four making $94,000 in income. For larger families, it is even more. So, my question for that so-called advisor is, should the person go into the hospital following your advice, will you pay that person’s $50,000 expense? This may sound trivial to some, but a friend of our family was told this very thing and she is in poor health. I encouraged her to speak with a navigator and she now has coverage. One month later, she entered the hospital. She would have had to declare bankruptcy otherwise. By the way, most people who declare bankruptcy cite the lack of healthcare insurance (or poor insurance) as the key reason.

My strong suggestion is for the Cato Institute to drop their cases. The one case where their contention was upheld, will likely be overturned, but if it goes to all the way to our highest court, with this Supreme Court, who knows what will happen? And, if it gets that far and it is not overturned, then what? You will be happy you won. And, at least 5 million Americans will be screwed. They should know now, that this Independent voter says they should ask their politicians to drop this Obamacare witchhunt and help make the law better. In the long run, we will be better for it. They should also know whom to blame now when they vote in the fall. If a candidate continues to harp on Obamacare, vote for someone else. I am tired of these machinations and most Americans have said they are, as well. Unfortunately, the Cato’s foolish behavior could cause us to be the fools. And, that would be a shame. My belief is it will fall back on them, but stranger things have happened.

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.

 

 

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.

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.’

CNSNews.com on March 5, 2012 – “Sen. Jim DeMint (R.-S.C.) told CNSNews.com that both Obamacare and Romneycare are unjust laws because they wrongfully mandate that individuals must purchase a product prescribed by the government. CNSNews.com 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:  https://musingsofanoldfart.wordpress.com/2012/08/08/healthcare-is-more-than-a-pawn-it-is-a-problem/.  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.