The world is coming to an end! According to CBO (cough, cough) by 2026, 23 million people will lose insurance as Obamacare is "dismantled". This is the headline reverberating through the MSM echo chamber.
The reality is something very different than what is being portrayed. Here are four reasons why the CBO score is flawed.
Baseline Data
Under CBO rules the only way to determine the impact of a new law is to compare it to the data presented under current law. The baseline that was used in calculating the impact of AHCA was from 2016. At that time CBO projected that this year there would be 15 million people enrolled in exchanges. Actual plan election - not paid enrollment - for 2017 was 12.2 million. History shows that 10% never pay a premium giving a conservative true paid enrollment at 11 million.
What this means for the AHCA score is that CBO is assuming 4 million more people starting out with insurance than the actual number.
Medicaid Expansion Assumption
Another significant figure is the number of people who will lose Medicaid. There are 31 states plus DC who have expanded Medicaid. Without a doubt killing the expansion over the course of a few years will decrease the number of people eligible in these states. But, with no changes to Medicaid funding prior to 2020 why would any state that has expanded coverage elect to kill the program early? I highly doubt any of them will.
Using the logic that no state will turn away the Federal matching funds for their expansion, the question becomes why does the AHCA have 6 million people dropped from the Medicaid rolls before 2020? The answer is, AHCA's CBO score includes the potential enrollment from the 19 states that "could" expand their Medicaid rules.
Defining Insurance
Under Obamacare the definition of good insurance is set by the government. CBO, in it's infinite wisdom, thinks that they know what good insurance is too. So much so that they have set their own parameters in the scoring. In their estimation "a few million people" would buy policies that don't meet their definition of having "sufficient financial protection". Never mind that it might be what the consumer wants.
While CBO doesn't actually define what constitutes insurance in the score, they insinuate that some states will cut or reduce the number of essential health benefits and cause out-of-pocket limits to rise. Suffice it to say it's amazing that they can't give us this definition yet count a few million people as uninsured because of this definition.
Who Doesn't Want It
Finally, the CBO score doesn't tell us who doesn't want to buy insurance. Without a mandate any number of people might simply say no thanks. These people aren't losing insurance, they simply don't want it.
Does it Matter?
Take the 4 million baseline error plus 6 million Medicaid error plus a few million with "bad insurance" and add in an unknown amount who don't want insurance and the CBO scoring model just doesn't add up. The echo chamber will say it does and many will fall in line with the narrative. But, reality is this CBO score doesn't matter.
At the end of all the political gamesmanship and shouting matches AHCA will not pass. Not because of a fictitious number people losing insurance. Not because of pre-existing conditions. Not because of funding cuts. Definitely not because Obamacare is working.
It will fail because just like Obamacare it focuses on the effect and not the cause.
Showing posts sorted by date for query election year. Sort by relevance Show all posts
Showing posts sorted by date for query election year. Sort by relevance Show all posts
Friday, May 26, 2017
Friday, March 10, 2017
The Stupidity of The GOP Congressman
AHCA. Another acronym that falls short on facing the real problem with our health care system.
Republicans' latest attempt to change Obamacare is nothing more than misdirection. It replaces "subsidies" with "tax credits", continues Medicaid expansion until an election year (when nothing gets done), and keeps the most costly items such as guaranteed issue, community rating, and no pre-existing conditions exclusion in place.
It eliminates the individual mandate and creates a new continuous coverage rule allowing insurers to charge 30% higher premiums for up to 12 months to those who have a break in insurance coverage greater than 63 days. The new rule, like the mandate tax, has no teeth.
Speaking of taxes, it eliminates almost $600 million over ten years - which is a good thing. Except for the fact that over half of that amount does nothing to reduce or influence costs of health care or health insurance. More than half ($275 million) is going back to high income earners who are currently paying more in taxes for Medicare and investment income. We should also note these two taxes aren't indexed so as incomes rise more of us would pay these over time.
For Medicaid, it would roll back the enhanced matching rate for the expansion population. This has serious implications for states who fell hook, line, and sinker for the bait of government funding that they knew wasn't financially sustainable.
Think about it: traditional Medicaid funding for those the program was intended to help is paid at roughly a 63%/37% federal to state ratio. By law the range is set at 83% all the way down to 50%. Under expansion the funding started at 100% federal and will reduce to no lower than 90%. Not only is the expansion paid at a higher level, it is also paid to fund able bodied, working adults.
With Medicaid expansion running significantly over budget already it's amazing that the GOP hasn't pushed this financial disaster to the forefront. They should be putting pressure on the other side of the aisle to address how Obamacare gives more to fund those who can work while penalizing states for trying to care for those who need help most. Instead these clowns roll out cuts to the program without explaining why they might be necessary or focusing on who the cuts are geared towards.
We should have known this was going to be a poo-poo platter. Anything short of full repeal - which takes 60 senators to accomplish - is nothing more than lip service.
Going forward my advice to Congressman Ryan, Secretary Price, and President Trump is simple: Stop pretending you can do something that we know you can't. Be truthful. Democrats own Obamacare. They used a supermajority to pass a bill on a party line vote. They then used the Nuclear Option to push it through. Retaliation isn't the answer. Instead it ensures an endless cycle of political warfare that leaves constituents in the crossfire.
You owe it to the people who elected you to stand up and say that because Democrats are being obstructionists there is nothing you can do to make our health care and health insurance systems better. While you would like to see things change for the positive it falls on Democrats to come up with solutions that can come as a compromise. The compromise can't include their go-to move of throwing more money or expanding an entitlement program that is already financially unsustainable.
It must be the opposite, which is coming up with a solution to the real problem: how do we control costs of care and what ways are best to utilize insurance to help protect us from health issues that we can't control or predict.
It eliminates the individual mandate and creates a new continuous coverage rule allowing insurers to charge 30% higher premiums for up to 12 months to those who have a break in insurance coverage greater than 63 days. The new rule, like the mandate tax, has no teeth.
Speaking of taxes, it eliminates almost $600 million over ten years - which is a good thing. Except for the fact that over half of that amount does nothing to reduce or influence costs of health care or health insurance. More than half ($275 million) is going back to high income earners who are currently paying more in taxes for Medicare and investment income. We should also note these two taxes aren't indexed so as incomes rise more of us would pay these over time.
For Medicaid, it would roll back the enhanced matching rate for the expansion population. This has serious implications for states who fell hook, line, and sinker for the bait of government funding that they knew wasn't financially sustainable.
Think about it: traditional Medicaid funding for those the program was intended to help is paid at roughly a 63%/37% federal to state ratio. By law the range is set at 83% all the way down to 50%. Under expansion the funding started at 100% federal and will reduce to no lower than 90%. Not only is the expansion paid at a higher level, it is also paid to fund able bodied, working adults.
With Medicaid expansion running significantly over budget already it's amazing that the GOP hasn't pushed this financial disaster to the forefront. They should be putting pressure on the other side of the aisle to address how Obamacare gives more to fund those who can work while penalizing states for trying to care for those who need help most. Instead these clowns roll out cuts to the program without explaining why they might be necessary or focusing on who the cuts are geared towards.
We should have known this was going to be a poo-poo platter. Anything short of full repeal - which takes 60 senators to accomplish - is nothing more than lip service.
Going forward my advice to Congressman Ryan, Secretary Price, and President Trump is simple: Stop pretending you can do something that we know you can't. Be truthful. Democrats own Obamacare. They used a supermajority to pass a bill on a party line vote. They then used the Nuclear Option to push it through. Retaliation isn't the answer. Instead it ensures an endless cycle of political warfare that leaves constituents in the crossfire.
You owe it to the people who elected you to stand up and say that because Democrats are being obstructionists there is nothing you can do to make our health care and health insurance systems better. While you would like to see things change for the positive it falls on Democrats to come up with solutions that can come as a compromise. The compromise can't include their go-to move of throwing more money or expanding an entitlement program that is already financially unsustainable.
It must be the opposite, which is coming up with a solution to the real problem: how do we control costs of care and what ways are best to utilize insurance to help protect us from health issues that we can't control or predict.
Thursday, December 01, 2016
Health Wonk Review: Puppies and Kittens edition
After a contentious election season, where my preferred candidate didn't even show up, I thought it'd be nice to focus on something a bit more pleasant. And nothing quite brings the smiles like pics of our little furry friends [ed: bonus points to anyone able to guess the significance of the first one].
And so, without further ado, this week's hectic, eclectic, fur-bally HWR:
■ HWR co-founder Joe Paduda offers the first two entries in his new series The Flash vs Spiderman "Getting Serious About Health Reform" (Part 1 here, Part 2 here), wherein he offers his own suggestions about where we go from here. As usual, interesting stuff.
■ One of our favorite wonks, David Harlow is actually traveling quite a bit lately, most recently to an innovation in healthcare convo in The Big Apple. He graciously took time out to send in his take on how the election will likely affect not only the ACA, but what the various pols are likely to propose.
■ It's been a while since Adam Fein's participated in the HWR, but he's back and in fine form with this post on "The 2025 Payer Market for Prescription Drugs" (wait, Adam's the new Dr Who?).
■ The Health Affairs blog's Karen DeSalvo and Georges Benjamin offer their thoughts on what the future of public health will (should?) look like, including how to compete in a global economy.
■ Our good friend David Williams sends in this post on legalizing marijuana, both for recreational and medicinal purposes. Considering how well pot-related ballot issues did this year, it's likely to be a hot topic for a while. In his post, David interviews a "marijuana entrepreneur" about implementation.
■ Another HWR favorite, Louise Norris, looks past the election results to dispel some misinformation currently making the rounds: she thinks it's likely that the mandate/tax will still be in force for 2017, and explores what that means to thee and me.
■ Uber-wonk Roy Poses submits his take on the "Bio Telemetry Settlement" (see, I told you he's an uber-wonk 😊), wherein he continues his long-standing exploration of ethics (and/or the lack thereof) in healthcare, this time specifically about physician kickbacks and medical devices.
[ed: And pay special attention to the sidebar pic for that post]
■ Dr Jaan Siderov, still another long-time 'Review regular, takes a respectful (and insightful) look at the potential winners and losers in the upcoming ACA battles, focusing specifically on "organized medicine" and mHealth.
■ Our very favorite Healthcare Economist, Jason Shafrin, talks about "Precision Medicine" and how it potentially offers both vast benefits for patients and challenges for providers (and government regulators).
■ Peggy Salvatore waxes philosophical about the "Healthcare Industry in an Age of Uncertainty;" her concern about special interests is quite thoughtful, especially when we really don't know how things will ultimately shake out.
■ Our dear friend Julie Ferguson asks "what's in store for OSHA and the Department of Labor under the new administration?" Reading the tea leaves in her crystal ball [ed: heh], she takes the President-elect at his word about the ACA being on the chopping block, and what that may portend for OSHA and worker's comp.
■ Our own post explores the changing landscape of specialty prescription meds, specifically the effect of manufacturers' coupons on claims and balances.
And please tune in again on the 15th, when Julie Ferguson works her own Health Wonk Review magic.
And please tune in again on the 15th, when Julie Ferguson works her own Health Wonk Review magic.
Thursday, November 03, 2016
Game 7 Health Wonk Review is up
Brad Wright hosts this week's World Series (and election) themed collection of the best health care wonkery on the 'net.
And, like the Cubs this year, a winner indeed.
And, like the Cubs this year, a winner indeed.
Wednesday, April 06, 2016
Hey DOI, Where'$ The Money?
Insurance agents make their living from the commissions that they earn on policies they sell. Those commissions are "baked into the cake;" that is, they're already included in the premium (except for certain group plans that are essentially fee-based). Some commissions are calculated as a percentage of the premium, others are a flat amount. Until recently (past 3 or 4 years), individual health insurance almost always used the percentage of premium model; that changed and most (all?) now pay a flat fee.The key point to keep in mind is that the commissions are already included in the premiums, which are filed with and approved (or not) by the 58 state Departments of Insurance.
Come now carriers that have decreed that they will no longer pay those commissions (at least on plans written between Open Enrollment seasons), and the question arises: what happens to those commission dollars?
If you answered "well, since the agent's not getting them, then the consumer must be" you'd be wrong. Sure, it makes sense, but that's not what's happened. Instead, the carriers are keeping these dollars allegedly to offset other costs. But they'd already (ostensibly) calculated those costs, and priced their products accordingly. So in reality, this is just pure profit for the carrier.
But Henry, you may note, if that's true, then why isn't the Department of Insurance stepping in and making them reimburse that excess back to the policyholders?
Good question, and one I decided some months ago to pursue. I reached out to my own state's Department of Insurance seeking an answer.
Multiple times, with no response.
Finally, frustrated, I contacted every state representative and senator associated with my zip code, as well as the chairman of the Insurance Committee, asking them for assistance.
To his credit, and all the others' shame, only State Representative Niraj Antani replied. He (like his colleagues) was unaware of the conflict, and agreed to look into it.
Which he did, relentlessly. Over the course of several months he reached out to the Department of Insurance (DOI). I don't know that they're connected, but it was after Rep Antani began his quest that I finally received an answer from the DOI; unfortunately, they answered only a few of my questions, completely ignoring the most important one: where's the money going?
[ed: For those interested, I've posted the letter here]
Eventually, Rep Antani got an answer from the DOI's Deputy Director, who told him that she was aware of the issue, but that the rates were already filed and couldn't be changed at this time. Which is nice and all, but irrelevant: no one's asking Anthem (for example) to change their rates, only to refund to consumers the amount that should have been paid out as commissions. She also said that the Department has no power to "compel" carriers to do so.
Hunh.
Seems like government agencies have a lot of power to force other industries to toe the line, just not insurance? Interesting.
So here's where we are: carriers priced commissions into their rates and aren't paying them to agents or reimbursing them to their insureds. And from the media? /crickets. I know that Rep Antani also broached this to the Ohio Consumers Council folks, but that seems to have gained no traction.
Why isn't this a bigger issue, especially in an election year? One would think that it's custom-tailored for state and national candidates: most folks have to buy insurance, and here's a very obvious, and easily fixed, rip-off.
Well?
[Special IB thanks to Rep Antani and Lindsay S]
Thursday, January 14, 2016
Health Wonk Review: Happy New Year! edition
Welcome, friends, to 2016-style health care wonkery. Later this month, we'll be celebrating our 11th anniversary here at IB; it's fascinating to look back over almost a dozen years of posts (and quite a few 'Reviews hosted) to see how much has changed, and how much hasn't.
But no time for waxing nostalgic, let's get on with the show:
■ First up is our good friend (and colleague) Jay Norris. Jay was recently appointed to the Board of Directors of Connect for Health Colorado, the Centennial State's exchange. He's concerned about a policy decision made by the Exchange to begin blocking enrollments from out of state brokers at the beginning of open enrollment. Here he explains why.
■ Over at Health Affairs Blog, Susan DeVore writes about six big trends to watch for in health care for 2016, including MACRA, telemedicine, value-based contracting, specialty pharmaceuticals, and others. She notes that with the upcoming Presidential election, health care is once again keeping us up at night. How much of the current debate is hyperbolic rhetoric? What policy changes are realistic in an election year? What market trends in the private sector will drive the most change?” Good questions, Susan.
■ At Workers Comp Insider, 'Review coordinator (and all-around gracious lady) Julie Ferguson lets us in on the depressing fact of the week: In 2014, there were approximately one and a half times more drug overdose deaths in the U.S. than deaths from motor vehicle crashes. She looks at developments in the nation’s opioid and prescription drug epidemic via a pair of recent studies on the topic, as well as a roundup of some other noteworthy writing on opioids.
■ For the next few months, Health System Ed's Peggy Salvatore will be blogging on digital strategy for healthcare organizations in preparation for a pharmaceutical conference on digital health (the ePharma Summit 2016). This is the first post in the series, which is about how pharma spends a lot on marketing and provides a necessary product, and that as an industry it the means and the clout to make a positive difference. But will it? Stay tuned...
■ Longtime foil Wendell Potter notes that all of the Republican presidential candidates have condemned the Affordable Care Act and pledged to replace it as soon as they’re elected. But with what? Wendell runs down their likely replacement proposals, which he’s dubbed “The Faulty Five."
■ Dr Jaan Sidorov is one of my very favorite wonk-bloggers and. as usual, he doesn't disappoint. This week, he likens mHealth to dashboard tachometers, arguing that when mHealth is "smart, synergistic and scalable," the tachometer can improve insurer/vehicle performance. Without those features, however, there's enough about mHealth to make it very attractive to consumers on a retail basis. Vroom, vroom!
■ I've only recently been following Charles Gaba, and I regret having missed his insights over the years. Here, he acknowledges that the ACA mandate penalty costs less than the premiums for some people, but... Well, he offers some important clarifications regarding the case studies quoted in a recent NY Times story about people deliberately choosing to pay the Individual Mandate penalty rather than sign up.
■ Like Peggy S, Joe Paduda has put together a series; his is on how he thinks the ACA's getting along, from enrollment to costs. As usual, he's concise and on-point. Part One is here, and Part Two here.
■ Longtime HWR contributor David Williams has been following Republican presidential candidate Ted Cruz, specifically his proposal to speed up FDA approvals, which has been garnering a lot of criticism, much of it deserved. But why do opponents have to go all the way back to 1956 for evidence against the plan? Instead, asks David, shouldn't we use the proposal as an opportunity to debate the role of safety and efficacy in approvals, and to examine why some parts of the FDA work better than others? Another good question.
[ed: Do I sense a theme?]
■ Uber-wonk Roy Poses alerts us to the new CDC draft guidelines that urged more conservative use of narcotics for non-malignant chronic pain, and which immediately attracted a barrage of criticism. His take? Those arguments against them were underwhelming. Click through to learn why.
■ Dr Brad Flansbaum addresses a recent New Yorks Time article about whether doctors should unionize, and comes away unconvinced either way. What's so great about this post is the series of insightful questions he poses to both sides of the debate.
[ed: Yup]
■ And now for something completely different. Our own post examines CanuckCare©'s rather lackadaisical view of death: as in the Canadian Medical Association considering allowing doctors to LIE about patients death to cover up euthanasia. Spoiler Alert: at least one Canadian med school's already doing so.
Thanks for tuning in, and please join us at Joe P's place on the 28th.
But no time for waxing nostalgic, let's get on with the show:
■ First up is our good friend (and colleague) Jay Norris. Jay was recently appointed to the Board of Directors of Connect for Health Colorado, the Centennial State's exchange. He's concerned about a policy decision made by the Exchange to begin blocking enrollments from out of state brokers at the beginning of open enrollment. Here he explains why.
■ Over at Health Affairs Blog, Susan DeVore writes about six big trends to watch for in health care for 2016, including MACRA, telemedicine, value-based contracting, specialty pharmaceuticals, and others. She notes that with the upcoming Presidential election, health care is once again keeping us up at night. How much of the current debate is hyperbolic rhetoric? What policy changes are realistic in an election year? What market trends in the private sector will drive the most change?” Good questions, Susan.
■ At Workers Comp Insider, 'Review coordinator (and all-around gracious lady) Julie Ferguson lets us in on the depressing fact of the week: In 2014, there were approximately one and a half times more drug overdose deaths in the U.S. than deaths from motor vehicle crashes. She looks at developments in the nation’s opioid and prescription drug epidemic via a pair of recent studies on the topic, as well as a roundup of some other noteworthy writing on opioids.
■ For the next few months, Health System Ed's Peggy Salvatore will be blogging on digital strategy for healthcare organizations in preparation for a pharmaceutical conference on digital health (the ePharma Summit 2016). This is the first post in the series, which is about how pharma spends a lot on marketing and provides a necessary product, and that as an industry it the means and the clout to make a positive difference. But will it? Stay tuned...
■ Longtime foil Wendell Potter notes that all of the Republican presidential candidates have condemned the Affordable Care Act and pledged to replace it as soon as they’re elected. But with what? Wendell runs down their likely replacement proposals, which he’s dubbed “The Faulty Five."
■ Dr Jaan Sidorov is one of my very favorite wonk-bloggers and. as usual, he doesn't disappoint. This week, he likens mHealth to dashboard tachometers, arguing that when mHealth is "smart, synergistic and scalable," the tachometer can improve insurer/vehicle performance. Without those features, however, there's enough about mHealth to make it very attractive to consumers on a retail basis. Vroom, vroom!
■ I've only recently been following Charles Gaba, and I regret having missed his insights over the years. Here, he acknowledges that the ACA mandate penalty costs less than the premiums for some people, but... Well, he offers some important clarifications regarding the case studies quoted in a recent NY Times story about people deliberately choosing to pay the Individual Mandate penalty rather than sign up.
■ Like Peggy S, Joe Paduda has put together a series; his is on how he thinks the ACA's getting along, from enrollment to costs. As usual, he's concise and on-point. Part One is here, and Part Two here.
■ Longtime HWR contributor David Williams has been following Republican presidential candidate Ted Cruz, specifically his proposal to speed up FDA approvals, which has been garnering a lot of criticism, much of it deserved. But why do opponents have to go all the way back to 1956 for evidence against the plan? Instead, asks David, shouldn't we use the proposal as an opportunity to debate the role of safety and efficacy in approvals, and to examine why some parts of the FDA work better than others? Another good question.
[ed: Do I sense a theme?]
■ Uber-wonk Roy Poses alerts us to the new CDC draft guidelines that urged more conservative use of narcotics for non-malignant chronic pain, and which immediately attracted a barrage of criticism. His take? Those arguments against them were underwhelming. Click through to learn why.
■ Dr Brad Flansbaum addresses a recent New Yorks Time article about whether doctors should unionize, and comes away unconvinced either way. What's so great about this post is the series of insightful questions he poses to both sides of the debate.
[ed: Yup]
■ And now for something completely different. Our own post examines CanuckCare©'s rather lackadaisical view of death: as in the Canadian Medical Association considering allowing doctors to LIE about patients death to cover up euthanasia. Spoiler Alert: at least one Canadian med school's already doing so.
Thanks for tuning in, and please join us at Joe P's place on the 28th.
Thursday, October 16, 2014
From the Mailbag: Now you see it, now you don't
FoIB Jeff M, commenting on the curious case of the missing renewal numbers, wonders:
"Our most transparent administration ever has announced that ACA plan renewal rates won't be released until after election day. But don't renewal rates have to be released 60 days prior to renewal?"
Great question.
Our own Pat Paule has your answer:
"The 60 day written notification applies to grandfathered plans in the individual market, as well as grandfathered and non-grandfathered plans in the small group market. Non-grandfathered coverage in the individual market doesn't have to receive their written notice until "BEFORE THE FIRST DAY OF THE NEXT ANNUAL OPEN ENROLLMENT PERIOD." Insurers in this market are not allowed to send written notices of renewal until the QHP (Qualified Health Plan) Issuer Agreements for the plan year have been signed, "to ensure that the correct information is included."
It is my understanding that a few states have approved rates available to view - without benefit summaries - and others are still waiting on their Compliant Issuer Agreements to be approved. Any guess where these agreements are at? Also, none of the plans take into account the beloved subsidies. Without that information we really have no idea how much more these plans will cost people until they have the ability to enroll beginning on 11/15"
Thank, Pat!
"Our most transparent administration ever has announced that ACA plan renewal rates won't be released until after election day. But don't renewal rates have to be released 60 days prior to renewal?"
Great question.
Our own Pat Paule has your answer:
"The 60 day written notification applies to grandfathered plans in the individual market, as well as grandfathered and non-grandfathered plans in the small group market. Non-grandfathered coverage in the individual market doesn't have to receive their written notice until "BEFORE THE FIRST DAY OF THE NEXT ANNUAL OPEN ENROLLMENT PERIOD." Insurers in this market are not allowed to send written notices of renewal until the QHP (Qualified Health Plan) Issuer Agreements for the plan year have been signed, "to ensure that the correct information is included."
It is my understanding that a few states have approved rates available to view - without benefit summaries - and others are still waiting on their Compliant Issuer Agreements to be approved. Any guess where these agreements are at? Also, none of the plans take into account the beloved subsidies. Without that information we really have no idea how much more these plans will cost people until they have the ability to enroll beginning on 11/15"
Thank, Pat!
Wednesday, July 23, 2014
Five Takeaways from Halbig and King
1. The decision on Halbig (D.C. Circuit) isn't taking subsidies away from people nor is the decision on King (4th Circuit) to allow everyone who qualifies to receive a subsidy. It is simply about the law and how it is interpreted. One might also ask how one court ruling said 36 states were federal exchanges while the other ruling said 34 states were federal exchange. This is what happens when a law is poorly written, rushed to a vote, and passes. We end up with a discombobulated mess. This isn't unique to Obamacare. Many other laws that were rushed through end up with unintended consequences too. Obamacare is still full steam ahead on rickety tracks and those who are on board still have ways to purchase heavily discounted tickets. Until further court rulings, these discounted tickets can still be purchased in every state.
2. Media loves a crisis even more than Rahm Emanuel. Coverage of both cases were headline news across the country. But as Bob pointed out yesterday, maybe this isn't such a BFD. The number of people this impacts is less than 2.5% of our population. While that number is projected to rise, CBO figures it will max out at 8% of our population.
3. We are more divided as a nation than ever. Six judges voted exactly along partisan lines for yesterday's rulings. Immediately following the release of Halbig the Twitter world lit up with liberals claiming Republican judges were guilty of Judicial Activism then followed it up - in the same article - with how the White House would request the entire D.C. Circuit Court hear the case and that the court leans 7-4 in favor of democrats. Evidently they don't see this side of it as Judicial Activism.
4. Lobbyists. The American Hospital Association, Association of Health Insurance Plans, and AARP were three of the organizations that filed amicus briefs on behalf of the government in the Halbig case. Obamacare is a gravy train for the people and the businesses they represent. There is no doubt that these groups have some legitimate business concerns surrounding these rulings. But they also see Obamacare as an opportunity. I would expect a very strong grassroots effort by these groups to begin extensive lobbying at the state level. Someone once said elections have consequences. 2014 will no doubt be about Obamacare once again. There are 33 senate seats, all house seats, and 36 governorships up for election this year.
5. Expect a huge push for states to establish their own exchanges over the next several months. Lobbyists and backers of Obamacare will inundate states who didn't set up exchanges. It will also push states that were looking to go from their state based exchange to the federal exchange. The only point agreed upon by all courts is that an exchange established by a state is eligible for federal subsidies. To make this mess go away the only avenue to take is for all 57 states to step up and create their own. For supporters of subsidies, waiting on John Roberts to decide the outcome would be like playing a game of Russian roulette.
Wednesday, April 23, 2014
Alphabet Soup News
From our friends at FlexBank:
■ "The IRS announced [last October] the ability to permit employees to carryover up to $500 of an unused health FSA balance. IRS Notice 2013-71 now offers an employer the option to amend their Section 125 plan to allow up to $500 of unused funds remaining at the end of a plan year to be carried forward into the following plan year."
This is significant because these plans have traditionally been "use it or lost it," and now participants may have the opportunity to roll-over unused dollars.
■ "The IRS released a memorandum on March 28, 2014 that confirms that employees participating in a general purpose health FSA, and who have carryover from a prior year, cannot contribute to an HSA for the entire following year."
General Purpose Flex Spending Accounts are those which cover any so-called 213(d) expenses (a laundry list of eligible expenses) as opposed to a Limited Purpose FSA which covers only those specifically stated in the plan document. This is significant because it may severely limit one's participation in a Health Savings Account.
■ "Section 125 Plans (also known as a Cafeteria Plan or Premium Only Plan (POP), must follow the general principle that employees' pre-tax elections are irrevocable for the plan year, except under certain conditions"
Generally speaking, you only get to change your "cafeteria plan" choices once a year - at Open Enrollment. But there are exceptions to these rules, although they're quite limited. These would include a "Change in Status" (eg marriage, adoption, etc), as well as a few others. The fine folks at FlexBank offer you this link for an overview of the permitted election changes.
■ "The IRS announced [last October] the ability to permit employees to carryover up to $500 of an unused health FSA balance. IRS Notice 2013-71 now offers an employer the option to amend their Section 125 plan to allow up to $500 of unused funds remaining at the end of a plan year to be carried forward into the following plan year."
This is significant because these plans have traditionally been "use it or lost it," and now participants may have the opportunity to roll-over unused dollars.
■ "The IRS released a memorandum on March 28, 2014 that confirms that employees participating in a general purpose health FSA, and who have carryover from a prior year, cannot contribute to an HSA for the entire following year."
General Purpose Flex Spending Accounts are those which cover any so-called 213(d) expenses (a laundry list of eligible expenses) as opposed to a Limited Purpose FSA which covers only those specifically stated in the plan document. This is significant because it may severely limit one's participation in a Health Savings Account.
■ "Section 125 Plans (also known as a Cafeteria Plan or Premium Only Plan (POP), must follow the general principle that employees' pre-tax elections are irrevocable for the plan year, except under certain conditions"
Generally speaking, you only get to change your "cafeteria plan" choices once a year - at Open Enrollment. But there are exceptions to these rules, although they're quite limited. These would include a "Change in Status" (eg marriage, adoption, etc), as well as a few others. The fine folks at FlexBank offer you this link for an overview of the permitted election changes.
Wednesday, October 23, 2013
MVNHS© News
It's been a while since we've heard from the Much Vaunted National Health System© (aka that which the ObamaTax seeks to become), which is a shame, since it provides a glimpse into our own future, health-wise.
First up, the Independent reports that "free" health care isn't really, um, free:
"Stagnant health spending combined with ever rising costs and demand mean the NHS is facing "the most challenging period in its 65-year existence," ... In a frank assessment of the dangers faced by the health service, senior officials ... say that the two years following the next general election will be pivotal in deciding whether the NHS can continue to provide free health care for all patients."
I think that we can all surmise what the answer will be. Math is relentless.
Next, the Daily Mail reports that the MVNHS© may well have found its cost-cutting groove:
"GPs have been paid bonuses to put elderly patients on controversial ‘death lists’ in an attempt to save the NHS money by cutting the number of people who die in hospital"
At $81 (£50) a pop, a doc could make a nice living on these one-way tickets to Liverpool (Pathway, that is).
Easy come, easy go.
[Hat Tip: Ace of Spades]
First up, the Independent reports that "free" health care isn't really, um, free:
"Stagnant health spending combined with ever rising costs and demand mean the NHS is facing "the most challenging period in its 65-year existence," ... In a frank assessment of the dangers faced by the health service, senior officials ... say that the two years following the next general election will be pivotal in deciding whether the NHS can continue to provide free health care for all patients."
I think that we can all surmise what the answer will be. Math is relentless.
Next, the Daily Mail reports that the MVNHS© may well have found its cost-cutting groove:
"GPs have been paid bonuses to put elderly patients on controversial ‘death lists’ in an attempt to save the NHS money by cutting the number of people who die in hospital"
At $81 (£50) a pop, a doc could make a nice living on these one-way tickets to Liverpool (Pathway, that is).
Easy come, easy go.
[Hat Tip: Ace of Spades]
Monday, September 30, 2013
On ObamaCare Messaging and Strategy
It's no secret that, like most Americans, we're no fans of Obamacare. So it's frustrating to see the political party that did not ram it down our throats being so weak-kneed in its opposition as it's being rolled out.
The latest tactic would delay the Exchanges for a year. How stupid is this? The administration is already accusing the Republicans of everything short of murdering people by not wanting them to have insurance. The one aspect of Obamacare that gets positive polling is people getting covered. Delaying that a year would be terrible press going into an election year, press the Media will heap on them gleefully. In the end they aren’t going to win that fight.
So what should they do? I have some suggestions:
1 - Waive the individual mandate for 1 year after the employer mandate is enforced
2 - Allow exchange subsidies but fund it with;
a. Elimination of government contribution to Congress and staff premiums
b. Force executive & Judicial branch and all staff to buy their coverage through the exchange with no subsidy from the tax payors
c. Require passage of Keystone pipeline immediately with small small tax on oil passing through it earmarked for exchange subsidies
d. Eliminate PCORI and allocate all collected money to exchange subsidies
Now instead of Republicans not wanting people to have insurance it will be on the administration to give up graft or shut down the government. None of the items are meaningful to the public; the majority of people would argue they should be sacrificed to fund the subsidies.
Thursday, September 20, 2012
MLR news
Regular readers know of our disdain for the Medical Loss Ratio (MLR) requirements in the ObamaTax plan. One of the reasons - although by no means the most egregious - is that the rules include agent compensation as part of the calculations. As we pointed out last year, "[b]y mandating a specific disbursement threshold, agents' commissions go away, making it impossible for us to continue servicing existing clients" who would then be subject to the "tender" mercies of the federal leviathon bureaucracy.
There may be good news on the horizon, however:
"Legislation that would exempt agent commissions from the medical loss ratio (MLR) calculation ... passed a House committee today."
That's the good news. And then, of course, there's the bad:
"[G]iven that both the House and Senate will recess Friday until after the November election, final action is unlikely before late fall."
One step forward, two steps back.
There may be good news on the horizon, however:
"Legislation that would exempt agent commissions from the medical loss ratio (MLR) calculation ... passed a House committee today."
That's the good news. And then, of course, there's the bad:
"[G]iven that both the House and Senate will recess Friday until after the November election, final action is unlikely before late fall."
One step forward, two steps back.
Friday, December 16, 2011
ERRP - We have to pass this bill so that you can find out what is in it.
This is a follow up to Bob’s Tapped Out post of December 13.
HHS has now reported that, thru December 2, the Early Retiree Reimbursement Program (ERRP) has paid out just over $4.5 billion or almost 91% of the authorized funds. This total amount was distributed among approximately 2,700 group sponsors of pre-Medicare retiree plans.
The HHS report shows that the UAW retiree trust has received over $387 million - which is, all by itself, 8.5% of the total distributed.
Other facts revealed in the report:
• There are 17 plans that each received more than $50 million, and together these 17 plans account for a bit over $1.9 billion, or about 42% of the total ERRP payments.
• Only 3 of these top 17 are corporate plans (Boeing, Verizon, and AT & T) - - the remaining 14 are either union funds or public employer retiree plans.
• There are 66 plans (including the top 17) that each received $10 million or more, and together these 66 plans account for almost $2.9 billion, or about 63% of the total ERRP payments.
If you scroll thru the entire HHS report, you'll see a large number of plan sponsors that are clearly union funds. Some of the corporate retiree plans in the report likely contain a lot of union retirees - for example, Verizon and AT & T probably contains a significant number of retired members of the Communication Workers of America; Boeing probably contains a large number of IAM and other union retirees too. You'll also see a large number of state and municipal plans that I'm sure also contain a lot of public employee union retirees. In other words, while it's not possible using this HHS report to pin down the exact share of the $4.5 billion that was paid to plans covering union retirees - it seems very unlikely that share is less than 50%.
About 12% of the US workforce is represented by unions.
Recall that ERRP's $5 billion funding was part of the health care reform act. The administration says that these funds were intended to provide financial assistance for pre-Medicare retiree group plan sponsors thru 2013 - keeping in mind that the exchanges and other main provisions of the reform act become effective in 2014. The attached document states that HHS stopped accepting new applications for these funds after May 6, 2011 - not even a year after the first applications were accepted. HHS has now announced that even the plans already approved will not be reimbursed for any claims incurred after December 31, 2011.
So how did it happen that the funding was exhausted so quickly? Was it just sloppy actuarial work?
I don't think so. Here's my guess – ERRP was never intended to do what the administration told us. Instead, it was intended all along as a big "thank you" to the unions (including public unions) that had helped with the 2008 election. I recall that the UAW submitted its complete application almost immediately - almost as though they knew in advance what to do. Other types of plans found out about ERRP in due course but in my opinion, payments to other plans were not part of the main intent. However those payments did serve a useful purpose as a smoke screen; I mean, an extra couple billion might cover the tracks nicely and what's another couple billion anyway?
Here’s an additional observation regarding the HHS notice. Its cover text includes 4 whole examples - count 'em, 4 - to illustrate how the ERRP payments "significantly benefitted employers across the country."
And here, verbatim, is what HHS says about these 4:
1. The City of Minot in North Dakota has over 2000 plan participants and has received $112,933 in ERRP reimbursements. As a direct result of these reimbursements the City was able to reduce 2012 premiums by 17 percent.
2. Silgan Containers Manufacturing, located in California, has received $246,152 in ERRP reimbursements. Silgan will use funding to offset claims costs by about 5 percent.
3. To date, Elkhart County in Indiana, has received $84,175 in ERRP reimbursements. They have been able to use this funding to help maintain coverage, and keep costs down, for over 1400 plan participants. Specifically, with the help of ERRP funds, Elkhart County was able to reduce employee and retiree premiums for 2011 and maintain that lower rate for 2012.
4. In Minnesota, East Central Energy has over 250 plan participants and has received $13,272.37 in ERRP reimbursements. East Central Energy has used ERRP funds to offset increases to claims costs by 7 percent.
These 4 plan sponsors appear to include fewer than 5,000 people and the total ERRP payout for these plan sponsors was less than $500,000. Yet the HHS report claims "ERRP has benefited over 5 million people to date" and has issued payments in excess of $4.5 billion..
Why does HHS offer examples including only one-tenth of one percent of the people it claims to have "benefitted ??? Why does HHS offer examples that comprise only one one-hundredth of one percent of the total payments? Is it because HHS tried but could not find better examples among the dozens of large plans that cover many thousands of people? Is it because HHS wants the public to believe that most of the money is going to small plans--rather than to the giant plans such as UAW and The Ohio Public Employee Retirement System? Is it because (as I suspect) there was some hidden agenda behind ERRP that has now been carried out? I doubt we’ll ever know why HHS chose such lame examples or learn whether there was, in fact, some hidden agenda.
Regardless, and whatever the explanation may be, the examples HHS offers are at BEST laughable.
"We have to pass this bill so that you can find out what is in it"
Yes ma’am, we remember. True then, true now.
HHS has now reported that, thru December 2, the Early Retiree Reimbursement Program (ERRP) has paid out just over $4.5 billion or almost 91% of the authorized funds. This total amount was distributed among approximately 2,700 group sponsors of pre-Medicare retiree plans.
The HHS report shows that the UAW retiree trust has received over $387 million - which is, all by itself, 8.5% of the total distributed.
Other facts revealed in the report:
• There are 17 plans that each received more than $50 million, and together these 17 plans account for a bit over $1.9 billion, or about 42% of the total ERRP payments.
• Only 3 of these top 17 are corporate plans (Boeing, Verizon, and AT & T) - - the remaining 14 are either union funds or public employer retiree plans.
• There are 66 plans (including the top 17) that each received $10 million or more, and together these 66 plans account for almost $2.9 billion, or about 63% of the total ERRP payments.
If you scroll thru the entire HHS report, you'll see a large number of plan sponsors that are clearly union funds. Some of the corporate retiree plans in the report likely contain a lot of union retirees - for example, Verizon and AT & T probably contains a significant number of retired members of the Communication Workers of America; Boeing probably contains a large number of IAM and other union retirees too. You'll also see a large number of state and municipal plans that I'm sure also contain a lot of public employee union retirees. In other words, while it's not possible using this HHS report to pin down the exact share of the $4.5 billion that was paid to plans covering union retirees - it seems very unlikely that share is less than 50%.
About 12% of the US workforce is represented by unions.
Recall that ERRP's $5 billion funding was part of the health care reform act. The administration says that these funds were intended to provide financial assistance for pre-Medicare retiree group plan sponsors thru 2013 - keeping in mind that the exchanges and other main provisions of the reform act become effective in 2014. The attached document states that HHS stopped accepting new applications for these funds after May 6, 2011 - not even a year after the first applications were accepted. HHS has now announced that even the plans already approved will not be reimbursed for any claims incurred after December 31, 2011.
So how did it happen that the funding was exhausted so quickly? Was it just sloppy actuarial work?
I don't think so. Here's my guess – ERRP was never intended to do what the administration told us. Instead, it was intended all along as a big "thank you" to the unions (including public unions) that had helped with the 2008 election. I recall that the UAW submitted its complete application almost immediately - almost as though they knew in advance what to do. Other types of plans found out about ERRP in due course but in my opinion, payments to other plans were not part of the main intent. However those payments did serve a useful purpose as a smoke screen; I mean, an extra couple billion might cover the tracks nicely and what's another couple billion anyway?
Here’s an additional observation regarding the HHS notice. Its cover text includes 4 whole examples - count 'em, 4 - to illustrate how the ERRP payments "significantly benefitted employers across the country."
And here, verbatim, is what HHS says about these 4:
1. The City of Minot in North Dakota has over 2000 plan participants and has received $112,933 in ERRP reimbursements. As a direct result of these reimbursements the City was able to reduce 2012 premiums by 17 percent.
2. Silgan Containers Manufacturing, located in California, has received $246,152 in ERRP reimbursements. Silgan will use funding to offset claims costs by about 5 percent.
3. To date, Elkhart County in Indiana, has received $84,175 in ERRP reimbursements. They have been able to use this funding to help maintain coverage, and keep costs down, for over 1400 plan participants. Specifically, with the help of ERRP funds, Elkhart County was able to reduce employee and retiree premiums for 2011 and maintain that lower rate for 2012.
4. In Minnesota, East Central Energy has over 250 plan participants and has received $13,272.37 in ERRP reimbursements. East Central Energy has used ERRP funds to offset increases to claims costs by 7 percent.
These 4 plan sponsors appear to include fewer than 5,000 people and the total ERRP payout for these plan sponsors was less than $500,000. Yet the HHS report claims "ERRP has benefited over 5 million people to date" and has issued payments in excess of $4.5 billion..
Why does HHS offer examples including only one-tenth of one percent of the people it claims to have "benefitted ??? Why does HHS offer examples that comprise only one one-hundredth of one percent of the total payments? Is it because HHS tried but could not find better examples among the dozens of large plans that cover many thousands of people? Is it because HHS wants the public to believe that most of the money is going to small plans--rather than to the giant plans such as UAW and The Ohio Public Employee Retirement System? Is it because (as I suspect) there was some hidden agenda behind ERRP that has now been carried out? I doubt we’ll ever know why HHS chose such lame examples or learn whether there was, in fact, some hidden agenda.
Regardless, and whatever the explanation may be, the examples HHS offers are at BEST laughable.
"We have to pass this bill so that you can find out what is in it"
Yes ma’am, we remember. True then, true now.
Wednesday, May 18, 2011
Alphabet Soup Update
■ First up, courtesy of our friend Joe Kristan, next year's Health Savings Account (HSA) contribution limits:
For singles, the max you can drop in will be $3,100 (up $50 from this year); for families, it's $6,250 (up $100). Remember, you need to be covered by a qualifying High Deductible Health Plan (HDHP) to make contributions. The 2012 minimum deductible for these plans remain at the 2011 level ($1,200 for singles, and $2,400 for families).
Some HDHP's include additional out-of-pocket requirements above the deductible (I hate these). These will increase $100 for singles and $200 for family coverage next year.
■ FlexBank's Lou Gellenbeck sent along this helpful info on how ObamaCare©'s new W-2 reporting requirements affect Health Reimbursement Arrangements (HRAs). The key take-away is that they're "exempt from the new W-2 reporting requirements for group health plans."
But what's that really mean?
Lou explains:
"Starting in tax year 2012 ...employers that file 250 or more Forms W-2 for the preceding calendar year [must] report the aggregate reportable cost of applicable employer-sponsored health insurance coverage provided on each employee's annual Form W-2...
Aggregate reportable cost does not include amounts contributed to a Health Savings Account (HSA), the amount of any employee salary reduction election to a health Flexible Spending Account (FSA), or the cost of coverage under a Health Reimbursement Arrangement (HRA). This reporting will be for informational purposes only and will not affect tax liability.
Specifically noted in the legislation is the requirement that employer contributions to a health FSA (i.e. matching contributions or where the employer seeds the health FSA with funds) must also be reported in certain situations. FlexBank's FSA clients will receive additional information on this part of the ruling in the near future under separate cover."
See why one's choice of administrator for these kinds of plans are local and accountable? Did your admin alert you to these changes?
She also reminds us that "comprehensive guidance on the W-2 reporting requirement may be found here."
Thanks, Lou!
For singles, the max you can drop in will be $3,100 (up $50 from this year); for families, it's $6,250 (up $100). Remember, you need to be covered by a qualifying High Deductible Health Plan (HDHP) to make contributions. The 2012 minimum deductible for these plans remain at the 2011 level ($1,200 for singles, and $2,400 for families).
Some HDHP's include additional out-of-pocket requirements above the deductible (I hate these). These will increase $100 for singles and $200 for family coverage next year.
■ FlexBank's Lou Gellenbeck sent along this helpful info on how ObamaCare©'s new W-2 reporting requirements affect Health Reimbursement Arrangements (HRAs). The key take-away is that they're "exempt from the new W-2 reporting requirements for group health plans."
But what's that really mean?
Lou explains:
"Starting in tax year 2012 ...employers that file 250 or more Forms W-2 for the preceding calendar year [must] report the aggregate reportable cost of applicable employer-sponsored health insurance coverage provided on each employee's annual Form W-2...
Aggregate reportable cost does not include amounts contributed to a Health Savings Account (HSA), the amount of any employee salary reduction election to a health Flexible Spending Account (FSA), or the cost of coverage under a Health Reimbursement Arrangement (HRA). This reporting will be for informational purposes only and will not affect tax liability.
Specifically noted in the legislation is the requirement that employer contributions to a health FSA (i.e. matching contributions or where the employer seeds the health FSA with funds) must also be reported in certain situations. FlexBank's FSA clients will receive additional information on this part of the ruling in the near future under separate cover."
See why one's choice of administrator for these kinds of plans are local and accountable? Did your admin alert you to these changes?
She also reminds us that "comprehensive guidance on the W-2 reporting requirement may be found here."
Thanks, Lou!
Tuesday, October 19, 2010
If you like your (Medicare Advantage) plan, you can keep it. Not:
From email:
"Did you know that the 236,000 displaced Private Fee for Service members nationwide are eligible for an SEP (Special Election Period) and can enroll now?"
This is an announcement (from Anthem) about the upcoming Special Election Period (no, not that election - although it's relevant); HHS Secretary Shecantbeserious has ordained this unique opportunity for folks being booted from their preferred plans.
This "special" opportunity actually began a few weeks ago (on October 1st), and extends through the end of the year.
Which is convenient for those unfortunate seniors who actually believed DC.
"Did you know that the 236,000 displaced Private Fee for Service members nationwide are eligible for an SEP (Special Election Period) and can enroll now?"
This is an announcement (from Anthem) about the upcoming Special Election Period (no, not that election - although it's relevant); HHS Secretary Shecantbeserious has ordained this unique opportunity for folks being booted from their preferred plans.
This "special" opportunity actually began a few weeks ago (on October 1st), and extends through the end of the year.
Which is convenient for those unfortunate seniors who actually believed DC.
Thursday, January 14, 2010
Another Winger Disses MassCare and Obamacare
President Present has cut a new commercial, ostensibly to help Martha Coakley retain the vacant "Massachusettes" (sorry, but that's how she spells it) senate seat for her party. One of the issues he addresses is, of course, ObamaCare, and how Ms Coakley represents a key vote for its enactment.
Oh, that "winger?" I meant "lifelong Democrat." Posted in the comments section of that Politico story is this little gem:
"I am a lifelong Democrat that will vote for Brown on Tuesday. My main reason is the universal health care plan that is said to be similar to the Massachusetts plan. Under Massachusetts universal health care, I have seen my care and that of my adult children decline during the past year. My daugher has a serious chronic condition and must wait 6 months to see a specialist - she never had to wait more than 4 weeks before the universal health care plan. I have seen my own insurance premiums go up nearly 50%. My son has been assigned a primary care physician who is located three towns away from where he lives and who has a backlog of several weeks. I don't like the plan working through the Congress because there are too many mandates and I believe the cost will be prohibitive. I also believe it analogous to the Mass plan that has given my family poor and deteriorating service. I believe that the federal plan should go back to the drawing board. There should be no denial of coverage because of pre-existing conditions, but there should be fewer other mandates and no one should be mandated to have health insurance. I also think that there is much too much new spending by the federal government. New initiatives used to cost millions, then billions, and now trillions. I don't believe these initiatives are well planned nor efficient. I voted for President Obama -- I thought he was more centrist than he seems to be now. I will be voting for Brown precisely for the reasons that the President outlines as the reasons to vote for Coakley. I am not alone among Democrats in Massachusetts who will vote for Brown -- that is why the polls are so close in this election. - Ben from Boston"
Now, can we guarantee with 100% credibility that "Ben" really is a "lifelong Democrat," or that he even really exists? Nope.
But he's certainly more credible than, say, Jonathan Gruber.
Oh, that "winger?" I meant "lifelong Democrat." Posted in the comments section of that Politico story is this little gem:
"I am a lifelong Democrat that will vote for Brown on Tuesday. My main reason is the universal health care plan that is said to be similar to the Massachusetts plan. Under Massachusetts universal health care, I have seen my care and that of my adult children decline during the past year. My daugher has a serious chronic condition and must wait 6 months to see a specialist - she never had to wait more than 4 weeks before the universal health care plan. I have seen my own insurance premiums go up nearly 50%. My son has been assigned a primary care physician who is located three towns away from where he lives and who has a backlog of several weeks. I don't like the plan working through the Congress because there are too many mandates and I believe the cost will be prohibitive. I also believe it analogous to the Mass plan that has given my family poor and deteriorating service. I believe that the federal plan should go back to the drawing board. There should be no denial of coverage because of pre-existing conditions, but there should be fewer other mandates and no one should be mandated to have health insurance. I also think that there is much too much new spending by the federal government. New initiatives used to cost millions, then billions, and now trillions. I don't believe these initiatives are well planned nor efficient. I voted for President Obama -- I thought he was more centrist than he seems to be now. I will be voting for Brown precisely for the reasons that the President outlines as the reasons to vote for Coakley. I am not alone among Democrats in Massachusetts who will vote for Brown -- that is why the polls are so close in this election. - Ben from Boston"
Now, can we guarantee with 100% credibility that "Ben" really is a "lifelong Democrat," or that he even really exists? Nope.
But he's certainly more credible than, say, Jonathan Gruber.
Friday, November 06, 2009
On the Record with Joe Wilson
This morning, I was privileged to participate in a blogger teleconference with Rep Joe "You Lie!" Wilson (R-SC) about health care and the War on Terror. We'll focus primarily on the former, but I learned something very interesting about the latter which I'll share at the end of this post.
Rep Wilson began by acknowledging the terrible events at Ft Hood yesterday, and expressing his concern about the victims and their families. He then spoke about yesterday's demonstration in Obamington, and segued into his support of HR 3400 (a Republican version of health care "reform"). He spoke about "limited government and expanded freedom," which he believes is in direct contravention to PelosiCare.
Tuesday's elections, he observed, marked a watershed moment for those opposed to government take-over of our health care system. Given the results in Virginia and (especially) New Jersey, he thinks that Blue Dog Democrats have to be concerned about backing that kind of effort at their own re-election expense.
He spoke a bit about Afghanistan and Iraq, and then took questions from the half dozen or so of us on the call.
I had the privilege of asking the first one. Truth be told, I had at hand a number of questions, some my own, some from Mike, and chose to ask about his amendment that would require CongressCritters to go on the Public Option if it's passed. I pointed out that, two years ago, then-Senator John Edwards had proposed an essentially similar idea, which was deemed to be unenforceable. I asked Rep Wilson what he thought the chances were of its passing (slim-to-none) and whether it would be practical if it did.
He answered that the way his was worded was enforceable; that a specific class of "employee" could be carved out and put on that plan.
I followed up by asking why Speaker Pelosi was in such a rush, since Sen Reid was on record that no Senate bill exists and that they wouldn't even be considering the matter until after the first of the year. He replied that he believed that Nancy and her allies are obsessed with the government takeover of health care, in a continuing bid to "grow government." She knows that this may well be their last real chance at passing something, based on what they saw Tuesday.
Jim Hoft of Gateway Pundit then asked about Rep Wilson's take on Sen Alan Grayson's recent outbursts regarding Republican efforts. He replied that "Sen Grayson speaks for himself...truly outrageous and insulting." For those who liken Sen Grayson's comments to Rep Wilson's outburst at SOTU, he pointed out that his own was a "townhall moment;" that is, spontaneous and unscripted. By contrast, Sen Grayson spoke with the aid of storyboards, and were obviously not spur-of-the-moment.
Publius Forum's Warner Todd Huston asked if the Republican caucus had pushed any further on the constitutionality of many of the ObamaCare provisions (e.g. mandates, jail time, etc). Rep Wilson said that, should it pass, it would take litigation to determine that. He also took to task those who would equate auto insurance to health insurance; these folks point out that auto insurance is mandatory, but neglect to finish the sentence: "if you want to drive." But no one is required to own a car, whereas we are all "required to breathe." Thus, it becomes a tax simply for living.
I then asked about his thoughts on tomorrow's (potential) vote. Rep Wilson believes that the Democrats are counting on winning with a "one vote margin," but that there's not much assurance they'll have even that [ed: see link re: "(potential")]. He said that so-called "Blue Dogs risk becoming Lap Dogs" if they toe the party line.
He also pointed out that it wasn't until July that folks began to understand the "squeeze on Medicare and the elderly" that ObamaCare represents. The other major problem, he said, was how it would adversely affect small business, "the backbone of our economy." He then praised groups like the National Federation of Independent Businesses (NFIB) for their efforts to educate the public, pointing out that the additional taxes which would accrue would likely result in at least "another 1.6 million jobs lost."
Next up was Jeff Poor from NewsBusters, who stayed on the unemployment theme, quoting (Sheriff) Joe Biden's claim about the mess this administration had inherited. Rep Wilson took that as an opportunity to point out that, in hard economic times, history has shown that tax cuts are the way to go, citing both Presidents Kennedy and Reagan. He also had little use for the "Porkulus" which, he said has cost more jobs than it's saved [ed: a claim borne out by this chart].
Richard Zuendt, from Conservatives with Attitude, spent some time reviewing the profound impact of the election results in New Jersey. He was quite concerned about how the draconian cuts in Medicare will fall to the states to make up. He and Rep Wilson agreed that governors from both parties are justifiably concerned about this increase in states' costs, especially in a troubled economy.
Rep Wilson then pointed to Tenncare as a failed example of government-run health care, one which nearly bankrupted the Volunteer State.
Finally, The Hill's Tony Romm asked about the "one vote margin" which Rep Wilson had mentioned early on. He wanted to know if the vote was really going to happen tomorrow [ed: doubtful], and Rep Wilson was skeptical. He believes that Tuesday's vote put a real damper on that effort. He also pointed out that the political class was surprised at the intensity of the Republican base, as well as the cooling off of the corresponding Democrat's.
In a followup from Mr Romm, Rep Wilson was asked about AARP's endorsement of Pelosicare. The Congressman replied that folks should cut up their AARP cards, and send them back with a letter as to why [ed: sound familiar?]. He then named some other seniors' organizations that more accurately reflect their members' needs.
I mentioned at the top of this post that I learned something interesting about Afghanistan, and that country's economic woes. Rep Wilson told us that there is obviously concern about continued poppy (and thus heroin) production, but that Afghani's actually have an attractive alternative: apparently, Afghani pomegranates and grapes are highly prized in the Arab world, and are actually more profitable than poppies. There's now an effort to move Afghanistan's poppy farmers to these more profitable (and safer) crops.
And that's that. Our very Special Thanks to Lyndsi Thomas for making this happen. And again, I'll be updating this post with names and links as they become available.
UPDATE 1: Conservatives With Attitude reports on the call here.
UPDATE 2: Names and links are now in place.
Rep Wilson began by acknowledging the terrible events at Ft Hood yesterday, and expressing his concern about the victims and their families. He then spoke about yesterday's demonstration in Obamington, and segued into his support of HR 3400 (a Republican version of health care "reform"). He spoke about "limited government and expanded freedom," which he believes is in direct contravention to PelosiCare.
Tuesday's elections, he observed, marked a watershed moment for those opposed to government take-over of our health care system. Given the results in Virginia and (especially) New Jersey, he thinks that Blue Dog Democrats have to be concerned about backing that kind of effort at their own re-election expense.
He spoke a bit about Afghanistan and Iraq, and then took questions from the half dozen or so of us on the call.
I had the privilege of asking the first one. Truth be told, I had at hand a number of questions, some my own, some from Mike, and chose to ask about his amendment that would require CongressCritters to go on the Public Option if it's passed. I pointed out that, two years ago, then-Senator John Edwards had proposed an essentially similar idea, which was deemed to be unenforceable. I asked Rep Wilson what he thought the chances were of its passing (slim-to-none) and whether it would be practical if it did.
He answered that the way his was worded was enforceable; that a specific class of "employee" could be carved out and put on that plan.
I followed up by asking why Speaker Pelosi was in such a rush, since Sen Reid was on record that no Senate bill exists and that they wouldn't even be considering the matter until after the first of the year. He replied that he believed that Nancy and her allies are obsessed with the government takeover of health care, in a continuing bid to "grow government." She knows that this may well be their last real chance at passing something, based on what they saw Tuesday.
Jim Hoft of Gateway Pundit then asked about Rep Wilson's take on Sen Alan Grayson's recent outbursts regarding Republican efforts. He replied that "Sen Grayson speaks for himself...truly outrageous and insulting." For those who liken Sen Grayson's comments to Rep Wilson's outburst at SOTU, he pointed out that his own was a "townhall moment;" that is, spontaneous and unscripted. By contrast, Sen Grayson spoke with the aid of storyboards, and were obviously not spur-of-the-moment.
Publius Forum's Warner Todd Huston asked if the Republican caucus had pushed any further on the constitutionality of many of the ObamaCare provisions (e.g. mandates, jail time, etc). Rep Wilson said that, should it pass, it would take litigation to determine that. He also took to task those who would equate auto insurance to health insurance; these folks point out that auto insurance is mandatory, but neglect to finish the sentence: "if you want to drive." But no one is required to own a car, whereas we are all "required to breathe." Thus, it becomes a tax simply for living.
I then asked about his thoughts on tomorrow's (potential) vote. Rep Wilson believes that the Democrats are counting on winning with a "one vote margin," but that there's not much assurance they'll have even that [ed: see link re: "(potential")]. He said that so-called "Blue Dogs risk becoming Lap Dogs" if they toe the party line.
He also pointed out that it wasn't until July that folks began to understand the "squeeze on Medicare and the elderly" that ObamaCare represents. The other major problem, he said, was how it would adversely affect small business, "the backbone of our economy." He then praised groups like the National Federation of Independent Businesses (NFIB) for their efforts to educate the public, pointing out that the additional taxes which would accrue would likely result in at least "another 1.6 million jobs lost."
Next up was Jeff Poor from NewsBusters, who stayed on the unemployment theme, quoting (Sheriff) Joe Biden's claim about the mess this administration had inherited. Rep Wilson took that as an opportunity to point out that, in hard economic times, history has shown that tax cuts are the way to go, citing both Presidents Kennedy and Reagan. He also had little use for the "Porkulus" which, he said has cost more jobs than it's saved [ed: a claim borne out by this chart].
Richard Zuendt, from Conservatives with Attitude, spent some time reviewing the profound impact of the election results in New Jersey. He was quite concerned about how the draconian cuts in Medicare will fall to the states to make up. He and Rep Wilson agreed that governors from both parties are justifiably concerned about this increase in states' costs, especially in a troubled economy.
Rep Wilson then pointed to Tenncare as a failed example of government-run health care, one which nearly bankrupted the Volunteer State.
Finally, The Hill's Tony Romm asked about the "one vote margin" which Rep Wilson had mentioned early on. He wanted to know if the vote was really going to happen tomorrow [ed: doubtful], and Rep Wilson was skeptical. He believes that Tuesday's vote put a real damper on that effort. He also pointed out that the political class was surprised at the intensity of the Republican base, as well as the cooling off of the corresponding Democrat's.
In a followup from Mr Romm, Rep Wilson was asked about AARP's endorsement of Pelosicare. The Congressman replied that folks should cut up their AARP cards, and send them back with a letter as to why [ed: sound familiar?]. He then named some other seniors' organizations that more accurately reflect their members' needs.
I mentioned at the top of this post that I learned something interesting about Afghanistan, and that country's economic woes. Rep Wilson told us that there is obviously concern about continued poppy (and thus heroin) production, but that Afghani's actually have an attractive alternative: apparently, Afghani pomegranates and grapes are highly prized in the Arab world, and are actually more profitable than poppies. There's now an effort to move Afghanistan's poppy farmers to these more profitable (and safer) crops.
And that's that. Our very Special Thanks to Lyndsi Thomas for making this happen. And again, I'll be updating this post with names and links as they become available.
UPDATE 1: Conservatives With Attitude reports on the call here.
UPDATE 2: Names and links are now in place.
Friday, September 04, 2009
Health Care Town Hall - West Hartford CT, Sept 2. Part I
Here’s a summary of my notes from the Town Hall meeting on health care, hosted by Congressman John B. Larson, First District, Connecticut. The meeting took place in West Hartford Wednesday evening September 2. For background on this Town Hall, look in the comments section here. Also, there are presently 5 bills in Congress (3 in the House and 2 in the Senate). The discussion September 2 focused on one of the House Bills, HR3200.
This is Part 1 of 2 Parts. It summarizes some of the Q and A interaction in the Town Hall meeting. Part 2 contains my overall impressions and observations.
Each numbered item below includes a question posed to the Congressman, the Congressman’s answer, and where I have a comment it's [in brackets]. I haven't included all the questions that were asked.
1. Obama says we can keep our existing insurance if we like it. Is that just for 5 years?
--Larson simply answered "you can keep your insurance". He did not refer to the 5-year grace period at all. A voice from the back of the room shouted "Sir you are lying! I'm a physician and I've read the bill!" Larson's face got red, he raised his own voice to say "I have never lied to you" and moved on to the next question.
2. Will you pledge that you & your family will join the public option?
--Larson said that there is presently no public option, and that he is not in the federal employees' plan either.
[This was a confusing answer. He apparently has insurance thru his wife's employment. His answer stimulated a lot of crosstalk from the floor, the loudest ones asking if Larson read the bill. Larson responded by stating that he "had the bill read" one day to the Democratic Caucus for "5 1/2 hours" followed by a couple more hours of discussion. I think this is a whopper. This bill is complicated legalese and it's a real tough slog to read. Reading the whole Bill - 1,017 pages - in 5 1/2 hours, works out to less than 20 seconds per page. Is THAT all the attention HR3200 gets from our Congressman? I doubt the complete bill was actually "read" in the time frame Larson claimed. But clearly Larson wanted the audience to believe it was.]
7. Will this raise my taxes? Will it raise my insurance premiums?
--Larson said the Bill will cut Medicare waste and claimed that Medicare savings will help pay for the cost of the Bill. He also cited a RAND Corporation study that there would be $77 billion annual savings from health information technology.
[He didn't explain how Medicare might reduce "waste", he just said it would happen. He also failed to explain how HIT would save anything and I think left the impression that significant savings would come from reductions to HIT spending. Well, how much HIT spending is there, now?]
11. Why can't we just buy our insurance directly from an insurance company? Why does it have to go true an employer?
--Larson said "that would be single-payer"
[Many people shouted No it's not! - including me. Larson just moved on to the next question.]
15. Will drug prices go down?
--"What will make drug prices go down is when the government negotiates them down like VA"
18. In the current system private companies sell Medicare supplement insurance. Will that disappear in the new public option?
--Larson said no, they won't disappear
[btw he gave a very different answer regarding Medicare Advantage - see #19 below]
Larson also stated that the CBO projects "only about 10 million participants in the public option".
[A question no one asked: if there are 47 million uninsured, how does a public option that covers only 10 million in total solve the uninsured problem? My guess is that he would answer that HR3200 will subsidize the uninsured so they can buy insurance either thru the public option or private insurance. My response would then be "doesn't that mean government subsidy of the insurance companies? Isn't that exactly what he objects to in Medicare Advantage?]
19. Do you support dissolving Medicare Advantage to save money?
--Larson said yes, and the reasons he gave were that Medicare Advantage plans are "subsidized by the government" yet provide the "same benefits and no better health outcomes".
[Larson - and the President - ignore (a) MA plans provide extra benefits (vision, hearing, dental, home care, wellness, and others not included in original Medicare; (b) MA also provides other modern health services not available in original Medicare (case management, disease management programs, nurse hotlines) (c) MA participants have fewer out-of-pocket expenses than original Medicare participants - documented by CMS and the Kaiser Family Foundation, (d) CMS data show that fewer MA participants, compared with original Medicare participants, have reported delayed care, and fewer reported having trouble getting care - perhaps because more MA participants report a regular relationship with a physician. An old report in JAMA (Jan 15, 2003) found that MA participants outperformed original Medicare in five of the seven HEDIS quality measures for health care.
Larson also ignored the cost-shift from Medicare and Medicaid into the private sector which has been going on for more than FORTY YEARS.
It appeared to me that Larson substantially skirted important facts on this question.]
22. The President says a public option will keep insurance companies honest. Aren't state regulators doing this? Who will keep the public option honest?
--Larson's answer - "the people - you can vote us out of office"
[This answer strikes me as inane. Federal agencies are the nearest things to immortality on earth. And besides, when has a Congressional election ever resulted in the closure of a federal agency? Ever? Anyway, Larson's seat is very safe as are most Congressional seats. The answer might be acceptable in a 9th grade civics class but in the real world I think it falls flat. It comes across as condescending to the extent that Larson expects anyone is so naive to believe it, and cynical to the extent he does not care if anyone believes it but says it anyway because it's politically correct.]
25. National debt is $12 trillion going up another $9 trillion in the next 10 years. And CBO estimates that health care will increase the deficit.
--Larson said "this bill is paid for by savings and it's revenue neutral."
[Another whopper. CBO said exactly the reverse. According to CBO, House bill HR3200 would increase the federal budget by $239 billion in the first 10 years. What's more, when the Director of the CBO was asked point-blank if HR3200 would “bend the cost curve,” he responded “no.”]
26. Will there be interstate portability?
--"Yes".
[No explanation. I wonder whether most people understood the question or the answer.]
Part 2 is here.
This is Part 1 of 2 Parts. It summarizes some of the Q and A interaction in the Town Hall meeting. Part 2 contains my overall impressions and observations.
Each numbered item below includes a question posed to the Congressman, the Congressman’s answer, and where I have a comment it's [in brackets]. I haven't included all the questions that were asked.
1. Obama says we can keep our existing insurance if we like it. Is that just for 5 years?
--Larson simply answered "you can keep your insurance". He did not refer to the 5-year grace period at all. A voice from the back of the room shouted "Sir you are lying! I'm a physician and I've read the bill!" Larson's face got red, he raised his own voice to say "I have never lied to you" and moved on to the next question.
2. Will you pledge that you & your family will join the public option?
--Larson said that there is presently no public option, and that he is not in the federal employees' plan either.
[This was a confusing answer. He apparently has insurance thru his wife's employment. His answer stimulated a lot of crosstalk from the floor, the loudest ones asking if Larson read the bill. Larson responded by stating that he "had the bill read" one day to the Democratic Caucus for "5 1/2 hours" followed by a couple more hours of discussion. I think this is a whopper. This bill is complicated legalese and it's a real tough slog to read. Reading the whole Bill - 1,017 pages - in 5 1/2 hours, works out to less than 20 seconds per page. Is THAT all the attention HR3200 gets from our Congressman? I doubt the complete bill was actually "read" in the time frame Larson claimed. But clearly Larson wanted the audience to believe it was.]
7. Will this raise my taxes? Will it raise my insurance premiums?
--Larson said the Bill will cut Medicare waste and claimed that Medicare savings will help pay for the cost of the Bill. He also cited a RAND Corporation study that there would be $77 billion annual savings from health information technology.
[He didn't explain how Medicare might reduce "waste", he just said it would happen. He also failed to explain how HIT would save anything and I think left the impression that significant savings would come from reductions to HIT spending. Well, how much HIT spending is there, now?]
11. Why can't we just buy our insurance directly from an insurance company? Why does it have to go true an employer?
--Larson said "that would be single-payer"
[Many people shouted No it's not! - including me. Larson just moved on to the next question.]
15. Will drug prices go down?
--"What will make drug prices go down is when the government negotiates them down like VA"
18. In the current system private companies sell Medicare supplement insurance. Will that disappear in the new public option?
--Larson said no, they won't disappear
[btw he gave a very different answer regarding Medicare Advantage - see #19 below]
Larson also stated that the CBO projects "only about 10 million participants in the public option".
[A question no one asked: if there are 47 million uninsured, how does a public option that covers only 10 million in total solve the uninsured problem? My guess is that he would answer that HR3200 will subsidize the uninsured so they can buy insurance either thru the public option or private insurance. My response would then be "doesn't that mean government subsidy of the insurance companies? Isn't that exactly what he objects to in Medicare Advantage?]
19. Do you support dissolving Medicare Advantage to save money?
--Larson said yes, and the reasons he gave were that Medicare Advantage plans are "subsidized by the government" yet provide the "same benefits and no better health outcomes".
[Larson - and the President - ignore (a) MA plans provide extra benefits (vision, hearing, dental, home care, wellness, and others not included in original Medicare; (b) MA also provides other modern health services not available in original Medicare (case management, disease management programs, nurse hotlines) (c) MA participants have fewer out-of-pocket expenses than original Medicare participants - documented by CMS and the Kaiser Family Foundation, (d) CMS data show that fewer MA participants, compared with original Medicare participants, have reported delayed care, and fewer reported having trouble getting care - perhaps because more MA participants report a regular relationship with a physician. An old report in JAMA (Jan 15, 2003) found that MA participants outperformed original Medicare in five of the seven HEDIS quality measures for health care.
Larson also ignored the cost-shift from Medicare and Medicaid into the private sector which has been going on for more than FORTY YEARS.
It appeared to me that Larson substantially skirted important facts on this question.]
22. The President says a public option will keep insurance companies honest. Aren't state regulators doing this? Who will keep the public option honest?
--Larson's answer - "the people - you can vote us out of office"
[This answer strikes me as inane. Federal agencies are the nearest things to immortality on earth. And besides, when has a Congressional election ever resulted in the closure of a federal agency? Ever? Anyway, Larson's seat is very safe as are most Congressional seats. The answer might be acceptable in a 9th grade civics class but in the real world I think it falls flat. It comes across as condescending to the extent that Larson expects anyone is so naive to believe it, and cynical to the extent he does not care if anyone believes it but says it anyway because it's politically correct.]
25. National debt is $12 trillion going up another $9 trillion in the next 10 years. And CBO estimates that health care will increase the deficit.
--Larson said "this bill is paid for by savings and it's revenue neutral."
[Another whopper. CBO said exactly the reverse. According to CBO, House bill HR3200 would increase the federal budget by $239 billion in the first 10 years. What's more, when the Director of the CBO was asked point-blank if HR3200 would “bend the cost curve,” he responded “no.”]
26. Will there be interstate portability?
--"Yes".
[No explanation. I wonder whether most people understood the question or the answer.]
Part 2 is here.
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