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.

This zero-sum discourse needs to stop

What does zero-sum discourse mean? It means framing topics in terms of who wins and who loses. I fault politicians, pundits and reporters for this mindset. This mindset preceded the current White House incumbent, but he views most everything through a very short-term transactional lens. Did I win?

The dilemma in discussing who wins and loses on actions, speeches or tweets is it takes the focus away from the issues. Does this decision help or hurt the people, environment or region?

I heard a news discussion on whether the US pulling out of the Iran nuclear deal helps or hurts Trump’s image? That is the wrong question among many better questions. Does it make the US safer? Does it make the world safer? Are we harming our relationships with our allies? Are we making a fact based decision as other leaders are questioning the veracity of this decision? And, so on.

Whether it is healthcare, debt, taxes, environment, financial protection, etc., I do not care who wins or loses politically. When people care too much about winning or losing, I can tell you who gets screwed – it is the people they represent.

Americans want Congress to address healthcare, with the majority saying to fix Obamacare. Instead, the President and leaders in Congress have sabotaged it over the past three years making premiums even higher. They want to see it politically fail while screwing American people.

I am tired of the lack of collaboration. I am tired of the abuse of factual information. And, I am tired of this zero-sum discourse. To be frank, our leaders need to stop trying to keep their job and start doing their job.

Lyin’ Eyes

The Eagles sang about infidelity in their popular song “You can’t hide your lyin’ eyes. And, your smile is a thin disguise.” I mention these lyrics because of the lack of fidelity to the truth exhibited by various politicians.

The comedian Jimmy Kimmel is being vilified by conservative news sources regarding his calling on the carpet Senator Tom Cassidy about his misrepresentation of what is included in the Graham-Cassidy Obamacare replacement bill. Based on fact checkers, Kimmel knows what is in Cassidy’s bill more than Cassidy does.

This would not be the first time politicians have lied about Obamacare. Obama oversold it saying you could keep your plan, which was at odds with most insurance changes. Yet, the lion share of the lying has been by Republicans. This law is imperfect and needs improvements, but it is not in a death spiral or is broken as portrayed by the GOP. The GOP has also not been forthcoming about their multiple attempts to hamstring the law at the expense of Americans increasing their premiums even more.

But, no US politician can lay a hand on the  greatest liar on record. This man has been measured by Politifacts as telling the complete truth only 5% of the time. When partial truthtelling or more is included, the rate increases to 31%. Saying it differently, this man lies 69% of the time, which is consistent with his rate of lying on the campaign trail. This man, of course, is the White House incumbent.

What I have noticed over the years, when politicians lie, the people who are most harmed are US citizens. The reasons and broadcast success rates for the Vietnam War were packed with lies. The sad truth is the percentages of those who died or were injured were much higher for African-Americans and poorer Americans. They bore the brunt of the lies.

Scrolling forward, when Trump and other politicians lie, people tend to die at higher rates. If the ACA is replaced as planned in GOP bills, more folks will be uninsured and  be at risk. By pretending climate change is not a threat or that governing environmental issues are less important than business leaders’ companies, people will die.

I recognize politicians have always lied, but never before at this rate or with such impunity. Our leaders dishonor the flag when they lie so much. And, they hurt our standing in the world. Right now, other world leaders do not trust Trump. They have good reason.

 

 

 

 

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.

 

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.