Thursday, April 25, 2013

All Animals Are Equal...

For once, Benjamin consented to break his rule, and he read out to her what was written on the wall. There was nothing there except a single commandment. It read:All animals are equal. But some animals are more equal than others.
George Orwell – Animal Farm

Congress never fails to disappoint. Whether you are discussing financial disclosure and insider trading or just the day to day struggles with the Sequester, our elected officials from both parties seem find the retention of their jobs as their number one priority. And unless you are a total whack job running for the Senate from Connecticut, a major determinant of election success is the campaign war chest. Money gets you to Washington and once you’re there, you sure want to stay.

Like the previously mentioned insider trading issue, Congress has crafted laws that appear to apply to everyone but them. And that brings us to the Patient Protection and Affordable Care Act (PPACA). There was a poison pill buried deep within the PPACA by Charles Grassley (R-IA). While negotiating with the Democrats in the summer of 2009, Grassley pushed for Congress and its staffers to be required to participate in the future health care process. If the PPACA was good enough for the average American citizen, it was good enough for Congress.

Theory meet reality.

Today’s POLITICO reveals the backroom negotiations that have been going on for months to resolve this problem. Congress and their staffers are currently covered by the federal government, their employer. Approximately 75% of the cost of their coverage is paid by the government. The insurance is good. The 75 / 25 split is fair. But an exchange doesn’t work that way.

The health care exchanges will be offering plans that conform to the new plan designs created by Health and Human Services. As this blog has detailed in the past, the new metal plans (platinum, gold, silver, and bronze) will have a lot of benefits that you may, or may not, want. These new benefits and the elimination of medical underwriting will have a significant impact on premiums. The new taxes on health insurance will also add to the escalating prices of individual and small group health insurance.

The first health care exchanges will be designed to sell individual policies and small group health insurance. An employee of the federal government, covered by group health insurance, wouldn’t be shopping at an exchange unless he/she was losing the group policy. BINGO! To comply with the law and reality, Congress and the staffers have to buy their own policies, at their own expense. They may qualify for a tax subsidy if any of them earn less than 400% of the federal poverty rate. But they lose the 75% now paid by their employer.

Senator Richard Burr (R-N.C) is quoted in the POLITICO article as noting the impact. “…put yourself in the position of a lot of entry-level staff people who make $25,000 a year, and all of a sudden, they have a $7,000 a year health care tab? That would be devastating.”

Congress fears a brain drain as young, under-paid employees, untainted by the cynicism years in Washington breeds, leave the Capital for a more affordable start to their careers. And who in Congress wants to pay for his/her own coverage? So Democrats and Republicans are working behind the scenes to exempt themselves and their staffs from the effects of the PPACA.

There is no one working to exempt you.

Businesses, especially those with fewer than 100 employees, are assessing their need to offer group health insurance to their employees. Many will follow the government’s lead and eliminate coverage. Dropping coverage eliminates compliance questions, paperwork and expense. The employees will be left to fend for themselves.

In other words, the PPACA will perform as designed. Less and less Americans will rely on their employers for health insurance benefits. And as we are herded into the exchanges with their ever escalating prices, a great hue and cry will rise from our fellow citizens for rate relief. The transition to a Single Payer System will then appear to be the only solution. Damn near welcome.

Except for those who have been exempted. There is really only one rule: All animals are equal. But some animals are more equal than others.  



Thursday, April 11, 2013

He Went That-a-Way

Today’s news gave me the opportunity to view two competing views of reality. The headline at the top of Page B1 of today’s Plain Dealer was “Hospitals keep leaning on lawmakers over balking at Medicaid expansion”. It took two reporters and over 30 paragraphs to clearly explain why hospitals around the state were pushing to have the Republicans in the Ohio House reconsider their decision to kill Ohio’s participation in the program to deliver health care to the poor. Dr. David Bronson of the Cleveland Clinic’s executive board and Robin Bachman, assistant vice president for government affairs and public policy at Sisters of Charity the nonprofit Catholic system that operates St. Vincent Charity Medical Center, seemed to completely understand how the Medicaid expansion would work and benefit their hospitals. The Speaker of the Ohio House, William G. Batchelder (R-Medina), wasn’t as clear. “I have never seen anything as confusing as this situation,” said Batchelder.

It was easy to understand Batchelder’s confusion. His governor, John Kasich, had crossed the big red line and agreed to expand Medicaid, a key part of the Patient Protection and Affordable Care Act (PPACA). Republicans are supposed to block Obamacare, not implement it. Worse, the Hospital Association and the Ohio Chamber of Commerce are also OK with the expansion.

There was one guy, two pages away on Page A7, who was not confused, who is never hampered by either indecision or second thoughts, and who was totally prepared to stay the course. Kevin O’Brien, the Plain Dealer’s representative from the Right and resident scold, KNOWS the answer. Unconcerned about budgets or deficits during the first six years of the Bush presidency, Mr. O’Brien now appears to spend a great deal of his waking hours tinkering with his own, personal, federal debt register. Accepting the expansion of Medicaid “would do nothing more than move some of Ohio’s hospitals a few places farther back in the line of institutions and practitioners destined to starve to death under the federal bureaucratic yoke if Obamacare remains the law of the land and produces the single-payer, government-run health care by utterly destroying the insurance market, as it is designed to do.”
Even when we agree, we disagree.

This blog has contended for three years that we are marching towards a single-payer type system. I am not a fan. Never have been. But, that doesn’t mean that we will have bodies on the streets, abandoned hospitals, and shuttered clinics. I’m not even positive that any BMW dealerships will be forced to close.

We can’t have a conversation if we don’t lower the volume.

The online Crain’s Cleveland Business released an article this afternoon about MetroHealth’s position in this fight. We are paying for the care Metro delivers. We pay in higher insurance rates and higher taxes. In an effort to take a stand against the President, Speaker Batchelder may have, accidently, destroyed a program that was funded entirely by Cuyahoga County and the federal government. The article explained why Metro is so concerned. “Expanding Medicaid to cover more of the county’s poorest residents –who typically are the most expensive to treat because they often use the emergency room for routine care or have neglected medical needs – is expected to help buoy MetroHealth’s finances.”

So will Medicaid be expanded in Ohio? I think so. It will be a bit of a slog and the horse-trading may be unpleasant, but I think it will get done. And once again we are all reminded that the national health care debate is not about health care. Never was.

The issue is money. Who is going to pay our medical providers? And once that is settled, we might tackle How Much?   DAVE   **