Posts Tagged ‘Affordable Care Act’

We Report, You Decide

March 29, 2017

 

Obamacare will implode. So say the GOP president, congressional representatives and local enthusiasts. The popular media focuses on the incongruity of 8 years active oppositions, and over 60 legislative bills to end the Affordable Care Act. And yet it remains “the law of the land.” Stephen Koff of cleveland.com thinks otherwise. In a 3-29-17 article entitled “Did Republicans sabotage Obamacare? Ohio insurers owed $100M they’ll likely never see” he looks at how any success was undermined in advance. Analysis finds this to be worthwhile, especially considering that the current chief executive interprets government to be by decree, without regard of legislative involvement or intent. Most of his priorities are being promulgated and enforced by executive order. As the chief executive, he would differ little from his predecessors in eliding enforcement of existing laws. Could the implosion of the ACA be one of them? Mr. Koff points out that the ACA, like the expansion of Medicare prescription drug benefits during the Bush presidency, relied on government underwriting of risk for its initial years of operation. “One way of protecting them involved a concept known as a risk corridor, a way to guard insurers against inaccurate projections. At the ACA’s full start in 2014 no one truly knew what the enrollment mix would be — young, old, healthy, sick — and how much insurers would have to spend on medical care.” Koff explains “With risk corridors, insurers made their best estimates when they priced their policies and offered them for sale. The projections were based on actuarial principles and double-checked by state insurance officials and HHS. If insurer projections turned out to be wrong even after all that checking and a company made a big gain, the company would have to share part of it with the losers through the risk corridor program, maintained by the federal Centers for Medicare and Medicaid Services, or CMS, a division of HHS.” But a funny thing happened on the way to affordable healthcare, “Under risk-corridor rules, no company would give up all its gains, and no company would be able to recoup all its losses. But it could recoup enough to stay in business.” “Obamacare passed narrowly when Democrats had majorities in Congress. Republicans never liked it. So in 2014, as both parties hurried to pass a year-end spending measure that was already overdue, Republicans managed to work in a small but meaningful change to the Obamacare rules — specifically, the risk corridor rules. They required that the risk corridors be self-funding, or what is known as budget neutral. That meant any money paid out to insurers would have to come from money coming in from other insurers. Key to this: CMS would not be permitted to draw from other accounts if the risk corridors lacked enough money. Democrats arguably left themselves open to this change by not being more specific when drafting the ACA. Yet it’s clear Republicans knew this would create problems. Some even bragged about it.” The article quotes one of Ohio’s Senators: “”There’s no question,” said U.S. Sen. Sherrod Brown, an Ohio Democrat, “that efforts to undermine the ACA’s risk corridors program drove insurers out of Ohio’s marketplace and starved our state’s CO-OP of the resources it needed to get off the ground, leading to less competition and higher prices for consumers.”” Newark’s 12th congressional district’s representative chose to address his constituents through a spokesperson: “”Obamacare is fundamentally flawed,” Olivia Hnat, spokeswoman for Rep. Pat Tiberi, said when asked about Republicans using the risk corridors to undermine Obamacare. Tiberi is on the House Ways and Means Committee and chairs its subcommittee on health. “The individual mandate is failing to patients in the marketplace,” Hnat said. “No matter how much the government subsidizes care or props up the insurance market, the individual mandate hasn’t worked and it is just one reason why Obamacare is on an unsustainable path.”” Analysis concludes with the article’s beginning. “The provision slipped into a spending bill in late 2014, after the Affordable Care Act was under way, restricted the government in making payments. As a result, some insurers have been forced to pare down their medical networks, cut their markets or leave Obamacare altogether — contributing to the higher premiums for customers and insurer withdrawals that Republicans point to as proof of the program’s failure. Republicans say they were just preventing an ill-advised insurer bailout because, they say, Obamacare was bound to fail. But Democrats and some health policy analysts say Republicans purposely sabotaged the Affordable Care Act by denying promised payments to insurers at a crucial time.” Analysis ends with those inimitable words of Fox News: “We report, you decide”

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Take A Peek At The Right To Look Today

March 21, 2015

This week, Analysis would like to revisit the right to look, something not guaranteed by the US Constitution or Bill of Rights. Looking is the most natural and spontaneous activity of the human body (a vestigial defense response still genetically imprinted for human survival?). It is not considered a right within the US representative democracy. Please, check your spontaneity at the door! The online Newark Advocate shows an “Editorial; Better late than never for Buckeye Lake (3-21-15). After the Governor’s press conference re; that damn issue, the Advocate cites the projected cost of repair – $125-$150 million (given the Corps’ track record, probably significantly more). The editorial board then does something quite extraordinary and out of character, it actually looks. “But his own Ohio Department of Natural Resources director was quoted three years ago saying the problem had grown critical and something must be done.” But (for the sake of modesty?) the board doesn’t linger in its looking. Speaking on the 3-20-15 Columbus On The Record, WOSU’s Ann Fisher unabashedly stated that three years ago the ODNR’s figures for that tier 1 critical damn repair were half of what is given today (same ODNR that issues permits for fracking). Ann exercises her unconstitutional right to look. John the governator is quick to lobby nationwide for a balanced budget amendment. Given a contingency, he is just as prone to forsake the balancing act and borrow money to keep that damn issue from bursting his presidential aspirations (the state issuing bonds is a “politically correct” way of saying “borrowing money”, as someone waaaay in the future will be paying it off). But the right to look slips into the “legislated” right to look ever so perniciously. Practically innocuous is what Michael McAuliff reports via the Huffington Post (3-19-15, “Republicans Vote To Hide Costs Of Repealing Obamacare In Budget”). In a trying bit of reporting, McAuliff reports on the convoluted effort by the Senate Budget Committee to hide the added deficit to eliminate the Affordable Care Act while including its projected revenues within the GOP’s proposed deficit busting budget (“repealing Obamcare would add $210 billion to the deficit.”). “”We have a point of order in the budget for anything that adds to the deficit, but we have a section that specifically excludes the Affordable Care Act from that,” [Senator Debbie] Stabenow said. “So think about it. This budget is conceding the fact that the Affordable Care Act has reduced the deficit, and repealing the law would increase the deficit.” Stabenow also alluded a related problem the GOP budget ignores: At the same time that it instructs Congress to come up with a repeal, it continues to count all the revenue that the Affordable Care Act is expected to raise — and which the government wouldn’t collect if the law is dismantled.” But wait, there’s so much more. After having prostituted the US congress, and pulling a George Bush “So what?” in regards to his pre election negation of a two state solution re; Palestine and Israel, Benjamin “Bibi” Netanyahu virtually won reelection in the recent Parliamentary campaign. As an aside re: the right to look, Harry Shearer (on le Show) ran a recording of the Bibi sitter’s address to congress back in January of 2002 when Netanyahu spelled out how much better off the mid east would be if Saddam Hussein were toppled by US military invasion. The day after his recent electoral triumph, some online pundit headlined that the US is following the lead of Israel, reflects what is happening there. How can this be, you say? The AP’s Ryan J. Foley headlines “Bills would limit access to officer body camera videos” (3-20-15). “IOWA CITY, Iowa – State legislators are pushing to make it much harder to release police officer body camera videos, undermining their promise as a tool people can use to hold law enforcement accountable. Lawmakers in at least 15 states have introduced bills to exempt video recordings of police encounters with citizens from state public records laws, or to limit what can be made public.” “Absent public-records protections, these police decisions can be unilateral and final in many cases.” “The Kansas Senate voted 40-0 last month to exempt the recordings from the state’s open-records act. Police would only have to release them to people who are the subject of the recordings and their representatives, and could charge them a viewing fee. Kansas police also would be able to release videos at their own discretion.” The elderly may (or may not) remember what it was like in the days prior to cameras on phones and the disruptive technology of hand held video recorders. For even a minor traffic violation, the state’s only witness needed to be the arresting officer. On the stand, whatever came out of his mouth was considered irreproachable fact. Currently several US states also have legislation pending that outlaws bystanders recording officers engaged in police activity.

“Move along now. Nothing more to see here.”

IT Politics

January 11, 2014

            Of course, the fiasco of the Affordable Care Act website last year is on everyone’s mind. It now has refocused the opposition’s attention from eliminating the law entirely to “over” regulating it on account of that failure (ironic in that it comes from folks who otherwise push for de regulation). Ronald Reagan’s Star Wars initiative, 30 years in the making and totally IT dependent, has yet to successfully conduct a spontaneous, unanticipated test. Edward Snowden’s exposure of the NSA also springs to mind, though this is not a failure of information technology but rather a “success” of information technology, especially considering the ongoing construction of the huge new facility in Utah to expand this (in)security success. Target has also reappeared in the news with revelations that even more customer information was obtained from its credit card transactions than initially reported. One TV news program cited that now 1 in 4 Americans are affected. UPS/FedEx also failed Santa at Christmas time with IT projected “guaranteed” delivery dates. Closer to home we have the recent failure of the Ohio BMV’s operating system for issuing/renewing ID cards (what some say ought to be needed for voting), driver’s licenses, etc. Whether that “glitch” has been worked out by this time is not known. Likewise, though officially Ohio’s online Medicaid application site is working “just fine”, there are some reports that for home computer users without the latest and fastest upgrades, it is not. Often we read of legal, law enforcement, or local government failures attributed to things that fell through the cracks of an IT system employed.

 

            Analysis looks at these and many other such “systemic” instances of failure that appear in the news and asks “Why does the inadequacy of the federal health care website receive such incredible scrutiny?” All of these are mega information/user interaction systems. Many operate at less than 100%. Some are outright failures. Taken as a whole, the reliance on such systems to deliver product and services, they all have the IT component in common. Yet the public relations “spin” is that they have nothing in common – this is a commercial criminal invasion, this is a political disaster, that one is a minor “insignificant” glitch, etc. depending on who is running the program for whom. Analysis would like to consider that all of them, perhaps, stumble because they outstrip the expectations “built in” to their deployment. The systems are being asked to fulfill tomorrow’s dreams with yesterday’s technology (technology is the solution to all our problems, whatever they may be). This, at least, appears to be especially the case with what the NSA is doing in that they are racing to fulfill even greater abilities to utilize systems that are not even here today but are projected to be. The focus on the political usefulness of some of these failures displaces the reality that, like other aspects of infrastructure (highways and bridges, water and sewer, utility delivery, etc.), IT likewise is bound and limited by what is available only today, and not by what it can promise for tomorrow. After all, we still are not commuting in yesterday’s anticipated flying cars though today we are promised they will drive themselves tomorrow.

Economics And Democracy

September 24, 2013

            Jamie Dimon’s Chase bank will be letting go over 400 workers in the Columbus area. Less than ten years ago the business was championed (and received public subsidies) for bringing jobs to the Columbus area. The folks out of work might say what so many others have said before them, “All my life I’ve played by the rules, gone to school, served my country, got a job and now I find myself out of work, on the verge of losing my house (if not already), without health insurance and scrapping to just get by.” We’ve heard the same over, and over, and over for how many years now? Jamie, of course, has not only survived the London Whale debacle (over $2 Bil loss plus $920 Mil fine), the Wall Street meltdown 5 years ago, and the illegal robo-signing and marketing of toxic mortgages (and the resultant foreclosures which earned Chase even greater profits through derivative credit default swaps) but Jamie also received a bonus. American Microsoft is buying Finnish Nokia. According to many economists, inevitable! Microsoft is sitting on a pile of cash. As long as it is spent overseas (and not brought home), no tax is due. All of this is in perfect accord with “the rules” that the workers without a job played by so assiduously. How is this possible?

 

            Bill Moyers had Robert Reich on over the weekend. No judgmental good guy/ bad guy for his tenure as treasury secretary under the Clinton presidency will be pursued here (a digression that would NOT contribute to what is at stake today). Mr. Reich was on to promote his new movie (of all things!), Inequality For All, a didactic documentary. The film is a primer on the interface of “economics” (the great inscrutable mystery that determines all our lives) and “democracy” (our government, or at least what we’d like to believe is how we govern ourselves). Put simplistically, according to the current University of California public policy professor the economy IS the rules put into play by society through its own governance. In our case, unlike a monarchy or totalitarian regime, it is the rules formulated through the determinations of the democratic process. What we have today is the outcome of laws, rules and regulations implemented before, during and after Reich’s service to the president and country in the 1990’s. Chase, Dimon, Microsoft, etc. all are doing what is allowed, even promoted, by the “rules” put into play over the last 40 years. It would be “irrational” for them to do otherwise. Through all the gloom and doom Mr. Reich is upbeat, positive, downright hopeful. This is because he believes that, in a democracy, we can likewise change the rules and thereby change the economy.  How does this work?

 

            Two recent news articles cut to the chase. They are current, relevant, and interface precisely with contemporary efforts to deal with the economy through the democratic process. Prior to passage of the Patient Protection and Affordable Care Act, there were numerous television and film documentaries regarding health care in the US, other countries in the world, and the economics involved. There were images of long lines of infirm people in North Carolina, Tennessee, etc. for donated health care who hadn’t been to a doctor. We had accounts of hospitals, and physician organizations saying something must be done as health care cost are rising at (some years) double the inflation rate. The cost of health care is making it unavailable, where in other countries it is less costly and accessible, etc. Suffice to say, all this was a motivating factor for passage of the ACA. The ACA has been in place now for going on three years, and has passed constitutional muster. In an article entitled “CBO: We Have a Tax Problem, Not a Spending Problem” Nicole Woo of the Wall Street Cheat Sheet (9-23-13) reports: “The non-partisan Congressional Budget Office has released its 2013 Long-Term Budget Outlook, and it has some great news. Specifically, CBO is predicting substantially lower healthcare spending this year and 25 years into the future. While last year CBO estimated that, “Federal spending for those [health care] programs would grow to 9.6 percent of GDP in 2037; in that year, 6.0 percent of GDP would be devoted to Medicare, and 3.6 percent would be spent on Medicaid, CHIP, and the exchange subsidies.”” In online Forbes (9-24-13) “Health spending slows as Obamacare sign-up looms” by contributor Bruce Japsen “Health care spending continues to slow as more medical care moves to less costly outpatient settings, consumers choose cheaper generic drugs and insurance companies alter plan designs to increase out-of-pocket costs on workers, a new Health Care Cost Institute study shows.

The Health Care Cost Institute, which analyzes claims from major U.S. health plans, said the growth rate of health care spending in 2012 “remained low” for the third straight year for nearly 156 million Americans 65 years old and under with employer-sponsored coverage, growing just four percent. The health spending rate grew 4.1 percent in 2011, the institute said.

The institute’s report is the latest to show spending on medical care slowing. A report last week from the Centers for Medicare & Medicaid Services that was published in the journal Health Affairs said low rates of health care spending would continue through 2013. Both studies come as states and the federal government prepare to rollout broader coverage for uninsured individuals under the Affordable Care Act.” The article ends with, “ The independent nonprofit institute [the Health Care Cost Institute], which bills itself as nonpartisan, is supported by investor-owned health insurers Aetna, Humana, and UnitedHealth Group and the California-based nonprofit health insurer, Kaiser Permanente.” Nicole Woo adds this contextual insight: “CBO specifies that The American Taxpayer Relief Act of 2012 (which made permanent most of the Bush tax cuts and indexed the Alternative Minimum Tax to inflation) as the cause for the bulk of the decrease in taxes. As a result, it lowers its estimates of federal revenues a portion of our economy. ”Federal revenues are now expected to be substantially lower in coming decades. By 2023, revenues are projected to be 2.8 percent of GDP lower than projected in the 2012 analysis: 18.5 percent of GDP rather than 21.3 percent. Revenues are now projected to equal 19.7 percent of GDP in 2038, 4.2 percentage points lower than the 23.9 percent figure projected last year.”

By lowering its projections of future spending levels as well, CBO shows that we have a tax problem, not a spending problem. “Non-interest spending in 2038 is projected to be 1.4 percent of GDP lower than in the 2012 analysis. Total federal spending on everything other than major health care programs, Social Security, and net interest is now projected to equal a smaller share of GDP throughout the next 25 years than CBO projected last year.”

In addition, CBO quantifies how high unemployment rates do damage to the economy (and, by extension, future debt levels). “CBO raised its projection of the unemployment rate over the long term from 5.0 percent to 5.3 percent. That change in the long-term unemployment rate reduced CBO’s projection of the level of GDP by about 0.6 percent after 2027.”” This is the same Budget Office that our “democratically” elected representatives pay to inform them regarding economic policy decisions.

           

Robert Reich is right to be hopeful about the economy. Of course, Bill Moyers never asked the public policy professor how he felt about democracy in America.

 

Violence Of Direction

September 19, 2013

“The learned and the studious of thought have no monopoly of wisdom. Their violence of direction in some degree disqualifies them to think truly. We owe many valuable observations to people who are not very acute or profound, and who say the thing without effort which we want and have long been hunting in vain.”

Ralph Waldo Emerson, essay The Over- Soul, from The Portable Emerson, pg. 216

 

The following is a commentary posted online 9-18-13 by Jared Spurbeck who  lives in Cary, N.C. and appeared on the Yahoo Contributing Network:

 

“Let’s get a few things straight.

 

First, House Republicans are not going to stop Obamacare, also known as the Affordable Care Act. They’re not going to prevent freeloaders from having to buy health insurance (to help pay for care for people with actual medical conditions, which the ACA also requires insurance companies to stop coming up with excuses not to cover them), and they’re not going to prevent the Medicaid expansion, which will let poor families and workers get chronic and life-threatening medical conditions taken care of. Their leadership has very publicly refused to commit to a course of action, and it’s kind of ridiculous to talk about “defunding Obamacare” in the first place.

 

Second, it’s even more ridiculous to talk about generally defunding the government (via refusing to raise the debt ceiling or continuing “sequestration”) versus letting Americans have some semblance of the health care coverage people in practically every other first-world country have already. That’s because those aren’t the only two options on the table. We can choose what we want our society to look like, and it doesn’t have to be a “winner-take-all, the rest of you fight for the scraps” universe.

 

I currently depend on government-funded health care for life-saving medical interventions, through hard-to-find and hard-to-sign-up-for programs that I didn’t even know existed and that put a hard limit on how often I can see a health care professional. I wanted to go on Medicaid in 2014, but the Republicans in my state of North Carolina rejected federal funding of the ACA Medicaid expansion, over the protest of the state’s doctors and even though it’d cost them nothing.

 

I’m scared that my life will be thrown away.

 

Right now, we have widespread unemployment and poverty because no one’s spending enough to justify hiring more workers. Poor and middle-class Americans can’t spend the money, and people with unearned wealth simply aren’t.

 

We, as a society, go to a lot of trouble to make life easier for rich people. We build the roads, bridges, and public schools that make the United States a better and safer place to do business than Somalia, and even though they get most of the benefits, we don’t even make them pay their fair share of the cost. Instead, we let them deduct practically everything from their taxes, avoid paying corporate income tax, and rewrite the tax laws every year with the help of their full-time accountants.

 

“Sequestration” is basically rich people saying — via the House Republicans — “screw you all, my $300,000 wristwatch is more important than your child’s health care.” Or her preschool program, or her breakfast, or her teacher’s salary. Why do we think this is OK? Do we really have to let people curl up and die — 502 of them every week in 2010 — to make sure rich people get to keep all the unearned wealth that we worked so hard to give them?

 

Why are we even talking about this in the 21st century?”

Some Assembly Required

September 8, 2013

            We’ve all been to some sport match from another culture or time, or maybe a theater performance, even a new board game with friends. “What are they doing and why” immediately springs to mind as well as what is a “yellow card”, or “icing”, or a “contralto.” The one who owns the language owns the game. With the Patient Protection (yes, that’s part of it) and Affordable Care Act, we need to hop in as participants, some of us without ever having played the game.

 

            In central Ohio it is difficult, if not impossible, to hold a job without owning a vehicle (public transportation is not of the caliber that would permit anyone who relied on it the accuracy of appearing at work, on time, everyday). The state of Ohio requires insurance for the use of such a vehicle on the roads we all share in common. To pay for this “coverage”, the “policy” requires a “premium” to be paid (monthly, quarterly, half year, etc.). The premium is what the policy will cost the person insured (the rent). The policy is the contract that spells out what the buyer (policy holder, the insured) is obligated to, what the seller (the insurer, the provider) is obligated to, etc. Lots of fine print and more terms! All of which spell out the “coverage”, what is included and what is specifically not included. Health insurance differs from property insurance (car, boat, home). Although AFLAC may make it look simple with a cute duck, it can be quite convoluted because of the uniqueness of individuals and what it takes to make/keep them healthy (side effects may include, but are not limited to, death and dying). With health insurance, as with property insurance, there can be a deductible. This is the initial amount of the cost of any claim which the buyer (the insured) agrees to pay. A claim is when something that is covered by the policy occurs and the policy holder (the insured) “claims” that under the terms of the policy, the insurance provider now needs to do their part and pay the amount owed to cover the costs. If an operation costs a total of 10K, and everything involved with that 10K billing falls under the coverage that my policy provides for, then my claim will be for the entire 10K. If the policy I contracted has a 1K deductible. Then 9K would be paid. If the operation cost 1K or less, I could not file a claim because my policy stipulates that I have agreed to pay the first 1K of whatever occurs. The amount of the premium for a policy reflects the amount of deductible; the greater the deductible, the lower the cost (premium) of purchasing that policy (having that coverage). Confusion swirls around the term “co-payment”. Health insurance coverage is a business to earn a profit for the company. No different than Walmart or Home Depot, if the company can provide its own transportation, products or services through its subsidiaries, then it will. The subsidiaries contribute to the money making endeavor of the parent company. A co-pay is money the insured must pay per each doctor’s visit, therapy session, or pharmacy purchase, etc. Like a deductible, it is the upfront amount agreed to with whatever coverage is purchased. It differs from a deductible in that it is not part of an overall “claim” but rather it is ongoing care (akin to repair of a vehicle after an accident and the regular routine service required continuously). A health insurance company may have subsidiary health care providers, thereby allowing them to offer a lower premium but requiring that the insured utilize the services of those subsidiaries with a specified co-payment for each use. The Patient Protection and Affordable Care Act is centered on health insurance exchanges or markets. Like a farmer’s market, the various businesses which wish to offer coverage within the parameters of the ACA (Affordable Care Act)  list the policies they offer, what each policy covers, what the terms of the coverage are (what’s included, not included, deductibles, co pays, etc.) as well commitments (on the part of the insurer as well as the insured). The ACA has grouped coverage into 4 categories so that it is easier to compare like with like. The categories have been described as bronze, silver, gold and platinum (or catastrophic). Essentially, the bronze has the highest deductible with the catastrophic having none. The bronze should be at the lowest “cost”, with the catastrophic the most expensive. The premium amount of any policy with any of the categories depends on the coverage spelled out in the individual policies offered by the different insurers. A single insurer could offer several different policies within the silver category. One policy may involve using the insurer’s subsidiary health care provider, another may allow the insured to choose whatever source, etc. The premiums on these different products (the policies with their coverage differences) will likewise differ although they will qualify as havng the characteristics of all silver policies (in terms of deductibles, etc.). The enrollment period is the window of time in which a policy is purchased, modified or changed. As coverage is for only a year, during the enrollment period the insured as well as insurer can decide to renew or make a change. The final term which has been part of business but rarely indicated is “subsidy.” Several years ago it was brought to this writer’s attention that the Swiss government pays a subsidy to the inhabitants of the quaint little villages and farms in the high altitudes of the alps. Yodeling aside, having the cheese, mountain climbing, skiing, etc. associated with “Switzerland” is incredibly important to the Swiss identity, to tourism, maintaining the “quality” of Swiss products, etc. But no one really wants to live up there isolated and cut off with bad satellite reception and no Seven Elevens. And if they have kids, they likewise want them to go to college, be soccer stars, etc. It is hard to play soccer on the side of a mountain. So the government assists these folks with a “subsidy”, a payment that helps insure that the mountain lifestyle continues to benefit all Swiss. In the US this is part and parcel of our agriculture policy (since being able to eat is essential to national security). The bank bailout instituted at the end of the Bush presidency was described as a subsidy, as well as payments to schools, manufacturers of nationally vital products, energy producers, etc. (in fact most CIC’s can be described as subsidies since payment is made for the ultimate benefit of the community served).  It’s there, unseen, but essential in making sure that America has the benefits of these endeavors, at a cost the individual consumer can afford. The ACA likewise has a built in subsidy. This is the portion of the health insurance premium that the government will reimburse the provider. The amount of the subsidy varies with the income level of the insured. It is likewise paid either directly to the insurer providing the coverage or credited to the income tax of the insured. So the same policy offered to two different income level purchasers will involve a different cost for each.

 

            The ACA only, and exclusively, operates through an online exchange — meaning one has to have access to the internet to obtain health insurance. The Licking County library offers access to the internet on computers available to its card holders. According to the Newark computer desk librarian, no formal policy has yet been established with regard the ACA. The 9-8-13 Newark Advocate article (Exchange 101: The basics of the new health insurance marketplaces) discusses health insurance navigators, and likewise (as this blog has done) points out that the Ohio legislature has chosen to officially license and recognize a limited number. The librarians at the computer desk will assist with the operation of the computers, accessing the internet and interacting with any programs but they cannot assist with anything pertaining to the ACA. They are NOT health insurance navigators. The application to obtain a library card (in order to use the computers) requires personal identification such as a photo ID or two pieces of mail addressed to the applicant, etc. The card is issued immediately, along with a pin that grants access to the terminals. There is a 2 hour limit on each use. Notify the computer desk librarian if you are unfamiliar with the use of a computer and are applying for health insurance; this will allow for more time. This is all happening at healthcare.gov where we will meet next time.     

It Is Getting Real Gnarly Out There, Dude

September 4, 2013

            Insurance. Can’t live with it; can’t live without it. Pay me a sum of money regularly and if something goes awry, I will cover the costs incurred by any loss you suffer. Insurance is akin to derivatives which helped cause the near meltdown of the financial industry 6 years ago. Unlike derivatives which are often described as a bet on something to fail, insurance is based on a contract that specifies obligations and responsibilities. Due to the contractual nature of what is for the most part intangible, and to a certain degree subjective (“if your house burns down I promise to reimburse the loss.” Intangible promise made. “But that melted folding aluminum lawn chair with the torn webbing was my granny’s and is a priceless antique worth thousands.” Subjective appraisal), the state long ago stepped in to regulate this business; both to protect and promote the business itself as well as the interests of the consumer. The state IS very much involved in the Affordable Care Act though it begs to differ, saying it is a federal program. An AP article (9-3-13) by Scott Bauer, Insurance rates released by Wis. gov questioned, mirrors the controversy spawned in Ohio when Lieutenant Governor Mary Taylor released cost increase projections on premiums for health insurance coverage in Ohio after January 2014. In both cases independent study groups, as well as advocacy groups for consumer citizens, said the projections were flawed and didn’t reflect the entire package of subsidies, incentives, as well as benefits of increased enrollment.  In an online article entitled “Obamacare Rate Shock Isn’t What You Think” Adrianna McIntyre of the University of Michigan and Austin Frakt, health economist with the Department of Veterans Affairs present figures showing this to be not so; that it will make health care more affordable and enable young people to enter their most productive years without the anxiety of no health care protection. Many articles have pointed out that because health insurance currently offered will need to meet the “essential health benefits” specified by the Affordable Care Act and health insurers cannot deny coverage to anyone because of pre-existing conditions (and will thus have no excuse for providing insurance coverage) the cost of health insurance will increase. This is countered by economic analysis that says the increased pool of those insured (more buyers) will offset the initial shock of coverage to those previously uninsured. The most popular aspect of the ACA, embraced by both proponents and opponents has been the extension of parental health insurance coverage to their offspring who are no longer children but young adults. McIntyre and Frakt conclude “Rate shock isn’t a myth, but the notion that Obamacare transfers significant wealth from the young to the old is. Of course, the more that young and healthy consumers believe it’s real, the more likely they’ll be to opt out, pushing premiums higher for everyone else. It’s a cynical way to perpetuate the market dysfunction that Obamacare is intended to address.” Rate shock or not, health insurance aside, health care costs continue to increase faster and more extensively than the overall economy itself. Althea Chang reports: “Insurers stand to benefit from the impending health care mandates, however. “Insurance companies are happy that they’re getting more volume into their system,” Clifford said [“Tim Clifford, co-president of national account services at ADP”], but those companies face added risk since they’ll no longer be able to exclude consumers with pre-existing medical conditions.” (The financial impact of affordable health care 8-29-13, Yahoo Financial)

           

And now for the derivatives part, the bet on something to fail. Online Bruce Japsen (To Help Navigate Obamacare, United Way, Catholic Church, Others Get $67 Million 8-15-13): “The Obama administration said navigators are “trained to provide unbiased information in a culturally competent manner to consumers about health insurance, the new Health Insurance Marketplaces, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program.”” But the Ohio legislature recently regulated this aspect requiring that insurance navigators be licensed and limiting their number. In Florida, which like Ohio opposes Medicaid expansion as well as state run health insurance market exchanges, “Republican opponents of the reform law were the driving force behind Florida Senate Bill 1842. Signed into law by Governor Scott in May, the legislation prohibits Florida’s Office of Insurance Regulation from providing any real protection for consumers from unreasonably high health insurance rates.” (Tom Brown for Reuters Top Florida health insurer touts Obamacare pain relief 8-31-13). In Browns article it is reported that ads are running touting: “”When the new healthcare law takes effect, you may be surprised how much more you could pay for health insurance,” says an advisory to consumers from Blue Cross and Blue Shield of Florida, also known as Florida Blue. “Find out how much you’ll save if you buy now,” adds the advisory, which has been mailed over the past month to homes of existing policyholders and potential new clients. “Let us help you get the best deal on health insurance right now,” the notice says. “We can even tell you if you can get help paying for coverage from the government.”” Caroline Humer for Reuters (6-29-13) headlines: Aetna pulls out of another Obamacare health exchange. She writes, ““Michener [Aetna spokesperson Cynthia Michener] said the full list of state exchanges where Aetna will participate is still being finalized. The new online insurance exchanges are the lynchpin of Obama’s healthcare reform, representing a massive technology build-out that has run up against multiple delays and political opposition in many states. In their first year, the exchanges aim to provide coverage to 7 million uninsured Americans, many of whom will be eligible for government subsidies. Aetna’s large competitors, such as UnitedHealth Group Inc and WellPoint Inc, have also planned limited entries into the new exchanges while they wait and see whether they operate smoothly and whether enough healthy people sign on to offset the costs of sicker new members.” Later she writes, ““Since then, it has withdrawn applications in Maryland, Ohio, Georgia, and Connecticut, where it is based. In Maryland, Aetna’s decision came after state regulators ordered the company to lower rates dramatically from what it had proposed.”  Finally, in a 9-1-13 online article, How Rick Perry’s And Bobby Jindal’s Medicaid Snubs Boost Private Insurance Costs, Bruce Japsen writes: “Health insurance rates for individuals purchasing private coverage could jump 8 to 10 percent in Louisiana, Florida and Texas where state political leaders have decided against expanding the Medicaid health insurance program for the poor under the Affordable Care Act, new research indicates. In a new study from the nonprofit research organization RAND Corp., researchers said the lack of an expanded Medicaid program will force more lower income people into the individual insurance market via exchanges created by the health law to provide more private coverage. The cost increase from this shift of more people to the individual market “reflects an influx of slightly lower-income and less healthy enrollees onto the exchanges,” RAND researchers wrote. “For these three states, these newly eligible individuals could cause premiums standardized for age, actuarial value and tobacco use on the nongroup market to rise by 8 to 10 percent, relative to scenarios that include Medicaid expansion.”” Tom Brown in the previously cited 8-31-13 article writes: “Florida Blue said the advisory is part of a direct mail advertising campaign aimed at drumming up new business for the Jacksonville, Florida-based giant, which reported $8.9 billion in revenues last year and covers more than 4.3 million people in its primary health business in the state. The company, a leading contributor to the political action committee of Florida’s Republican Governor Rick Scott, is one of nine insurers that have applied to sell non-group policies on the state’s new marketplace and the only one that promises to cover every county in Florida.” The vulgar, “on the street” definition of what a derivative is, and how it works, is that it is a money maker (for the seller) no matter how it turns out. In this case the “it” happens to be the Affordable Care Act and health care/health care costs for all Americans.

 

To sum up, AP’s Jonathan J. Cooper (States experimenting to lower health care costs 8-28-13) writes: “Most of the experiments are too new to produce reliable data about their success, but health policy experts warn that the rapid rise in costs is unsustainable. “It has to end eventually,” said Larry Levitt, senior vice president of the Kaiser Family Foundation, “because we can’t have an economy driven entirely by health care.””

 

As Jerry Lee Lewis would say: “Think about it.”

           

Si Se Puede

August 25, 2013

            In an article entitled “Sebelius: Misinformation is Obamacare Enemy No. 1” (8-15-13) Wall Street Cheat Sheet’s Meghan Foley writes: “A speech given by Department of Health and Human Services (NYSE:HHS) Secretary Kathleen Sebelius before the National Conference of State Legislatures Health Summit in Atlanta, Georgia on Monday was meant to highlight the efforts the Obama administration was making to help states “meet the challenges” of implementing the Affordable Care Act. But the comments Sebelius made in an interview after the speech carried a much stronger indictment of what she believes to be the main problem facing implementation: misinformation.” Midway through the same article Foley interjects: “Education of some form is needed; a Kaiser Family Foundation showed in April that more than 40 percent of Americans are confused as to the legal standing of the Affordable Care Act, and the administration is hoping as many as 7 million Americans who are not covered by employer-sponsored insurance plans sign up by early next year.” The article ends with “As for the success of Obamacare, states like Georgia that have declined to expand Medicaid present “a big challenge” for enrollment efforts, she [Sebelius] added.”

 

            The Affordable Care Act, referred to as Obamacare by its detractors, certainly is surrounded by misinformation and deliberate attempts to destroy it by whatever means (“In Congress, Senator Mike Lee of Utah and a small group of other Republicans have threatened to force a federal government shutdown unless President Barack Obama agrees to cut Obamacare funding from the fiscal 2014 budget.” Same article). There is obviously a plethora of misinformation available from innumerable sources (contributing to the nascent scam industry that feeds on such nationally recognized and embraced disinformation). Some things we do know, or can put together from what is out there. First of all that Ohio, like Georgia, has declined to expand Medicaid and therefore presents a “big challenge”. We also know that Newark is located in central Ohio and that probably, at least 40 percent of the population are confused in terms of where they stand within the Affordable Care Act and the lack of an expansion of Medicaid. As pointed out in the previous post, no official state funded resources will be utilized to help these tax payers learn about this, a travesty of what government purports to be about. And yes, they are taxpayers. If you don’t believe it, look at the recently enacted Ohio budget which raises the sales tax in addition to shifting the burden on other taxes.

 

            To become informed of the various mechanisms and contents of “misinformation” is not the purpose of this posting. Articles like that are as plentiful (and available) as tabloid articles regarding Hollywood stars. Sources like The Wall Street Cheat Sheet satisfy content requirement by writing articles about the misinformation mills. Some things multiple sources seem to confirm. Writing for the Motley Fool Keith Speights writes (7 things you need to know about Obamacare before 2014 8-24-13): “You could have to pay a penalty if you don’t have health insurance. You will be required to pay a tax penalty if you’re not covered by an acceptable insurance policy. The penalty for 2014 will be the greater of $95 per adult and $47.50 per child up to a $285 family maximum or 1% of income above a specified filing threshold ($10,000 for an individual and $20,000 for a family) — whichever is greater.” Unfortunately no one informs how this penalty will be actually assessed – ticket in the mail, court summons, lien, etc. “Under the ACA, insurance plans offered in the individual and small group markets will be required to cover a particular set of benefits and services called the “essential health benefits” package. These cover services in at least 10 categories, including prescription drugs; emergency services; hospitalization; mental health disorder services, and others. Some of those benefits haven’t been previously covered by plans. Additionally, consumers can’t be denied coverage because of their health status as they can be now in some states.” (5 Things to Know About the Cost of Obamacare Coverage By Lisa Scherzer | The Exchange  8-19-13) Writing for Money Talks News (8 Steps to prepare for Obamacare 8-22-13) Angela Brandt states: “So, if you currently have an individual policy — some 15 million Americans do – you may or may not want to keep it. Or you may find that your insurance company is eliminating your plan and replacing it with plans that meet the new standards for care.”

 

            OK, so from others we learn that everyone needs to get involved with obtaining health insurance and that under the provisions of the Affordable Care Act, no one can be denied coverage because of any pre-existing condition, or financial status. If you already have health insurance through your employer and it doesn’t cover the “essential health benefits”, you can opt out and obtain coverage through that provided by an exchange through the ACA. In an article entitled “Analysis: Many insurance options under exchange Analysis finds most of Wisconsin will have multiple insurance options under new exchanges” the AP’s Scott Bauer (8-23-13) writes: “In Wisconsin, about 92,000 people currently on Medicaid will be losing their coverage starting in January. Gov. Scott Walker, an opponent of the federal law, toughened Medicaid eligibility, forcing those people off of the state’s BadgerCare plan and into the marketplace.” As Ohio has no Medicaid expansion involvement, those in Newark who have no health insurance coverage (through their employer or otherwise) and who would have qualified for inclusion in the Medicaid coverage (because of their financial status or otherwise) MUST involve themselves in participating by obtaining health insurance coverage through the federally established health insurance exchange. The State of Ohio will not be providing a health insurance exchange so don’t call Ohio’s tax payer funded public servants like Jay Hottinger, Tim Schaffer or John Kasich if you need help, education, or assistance.

 

“Si se puede.” Together we will investigate and discover how this can be done in future posts.  

 

If The War Was Over We’d All Be Cheering

August 22, 2013

            The other day the AP reported the results of a recent poll in California regarding the Affordable Care Act. “The Field Poll, surveying uninsured, lower-income voters who it said would qualify for coverage, found slightly more than half either did not know it or believed the opposite — that they were not eligible. Forty-eight percent were aware they could qualify, the poll found. The margin was even wider for voters currently not covered by an employer or government program but who would qualify for tax credits when purchasing coverage under the Affordable Care Act, which takes full effect next year. Two of three of those voters either did not know about their eligibility for the tax breaks or thought they would not qualify.” (Poll: Many who could get ‘Obamacare’ don’t know it AP 8-21-13). Motivation for passage of the Patient Protection and Affordable Care Act was twofold – including as many Americans as possible within health insurance coverage and through this mechanism, gaining some control over the rising cost of health care in this country. The objectives “seem” to make sense. As the cost of health care rises unchecked, the number of those being unable to afford it (or the insurance to cover it) will grow. The situation parallels that of higher education in this country. As cost go up, those able to afford it decreases. Yet economic forecasts indicate the demand for uneducated workers decreases with the ever developing technology of today’s world.  So health care, like education, is a national concern with a direct correlation to the security and overall well-being of our country. Unfortunately, both of these are not deemed to be such (critical to our security and well-being) by all the leaders of our country. No alternative to the Affordable Care Act has been formulated, let alone presented, to address what motivated the law that was passed and found constitutional. Instead, every means possible to defund and negate the law have been put into play, with a proposed shut down of the government of the United States of America suggested for late September. Here in Ohio, one aspect of the law that the Supreme Court ruled was not correct (mandatory Medicaid expansion by the individual states) has been embraced as a means of dismantling the law. Another is the non-institution of the state health insurance marketplace, which the state legislators chose to defer to the federal authorities. The roadblock was expanded through the ingenious logic that since all this falls under the purview of Ohio’s insurance laws, those offering guidance and assistance must be officially licensed as “navigators” by the state of Ohio. The legislated total number possible is less than the total number of counties in the state. You do the math.

 

            This blog’s 3-6-13 post (Updated Statistics) gave 2011 US census data for Newark. That data indicated that per capita income for 2011 was listed as $21,951, median household income between 2007 and 2011 came out as $37,927, and the number of persons below the poverty level for 2007 – 2011 at 20.1% of the population. This data also breaks down the number of households in Newark and their income. Approximately 85% of the households in Newark are below the $92,000 annual income category that is one of the thresholds in The Affordable Care Act. That threshold applies to a family of four. Of course, many of these households will not be a family of four. The important point is that so many, probably more than half of the households in Newark, are eligible and enabled to obtain health insurance coverage through the Affordable Care Act. Yet there is a virtual news blackout with regard to how to go about doing this, who is able to inform the potential purchaser about obtaining coverage, and what to expect from this coverage. In its place we have obfuscation and brinksmanship without any alternative presented as to how to get as many Americans covered by health insurance and bring health care costs within reason. If you are an individual who has never had health care because you can’t afford it (with a per capita income well under the affordable care individual cut off of $45,000, a great number of the citizens of Newark) or you are employed where insurance is offered but not for you because of some employer restrictions or policy, or you are unemployed, a student, etc., well, in Ohio today, you are in the company of mushrooms with regard to how to obtain health insurance coverage.

 

            Currently Ohio has opted out of the Medicaid expansion which complicates matters for the over 20% of Newark residents that could be, would be, or are included. Determination of such expansion is once again in the hands of those who favor brinksmanship instead of acting in serving and assisting all their constituents. This blog will attempt to present what is known and doable regarding the Affordable Care Act with its future posts. If the war was over we’d all be cheering. Here an achievement has been made, an end reached, and yet everyone is silent. Is this because we are a people, a culture that only understands a perpetual state of war – the war on terrorism, the war on drugs, the war on poverty, the war on crime, the war on …?