Friday, December 29, 2017

We're Tired

Can you really talk something to death? Can you stress over an issue, every day, to the point that you are just numb? Health Insurance? It appears that the new Republican goal is to do just that. In just the last week we have been told by President Trump that he has repealed Obamacare (The Patient Protection and Affordable Care Act), that he has severely damaged it, and that Congress’s next task is to fix Obamacare in a bi-partisan fashion. I’m tired and I’m not alone.

The PPACA has proven to be far more resilient than anyone imagined. Abandoned at birth by some of the very people who had created it (The Gang of Six), the law was relegated to a life with a parent (the Democrats) who didn’t always understand it and consistently failed to explain both its benefits and drawbacks to the American public. For seven years the Republican controlled Congress has proven that “sticks and stones may break my bones, but words will never hurt me”. The 60 plus faux attempts to repeal Obamacare may have riled up the base and kept the campaign funds coming, but they had little impact on the law. And in 2017, in the year of Trump, we have seen the end of the funding for the Cost Sharing Reduction, a 50% reduction in the Open Enrollment Period, and, last week, the elimination of the Individual Mandate.

So this time he succeeded? Obamacare is dead, right? Not so fast.

Cleveland area insurance agents became reacquainted with our clients in 2017’s Open Enrollment Period. There was a major change in our market. Anthem Blue Cross, a major player since 1985 when the then Community Mutual Blue Cross Blue Shield of Cincinnati invaded Cleveland, chose to stop selling individual policies until the Cost Sharing Reduction got resolved. Mr. Reliable, Medical Mutual of Ohio, found it necessary to move policies on individuals, under age 65, purchased after 2014 away from the Cleveland Clinic Foundation. And the Cleveland Clinic formed a partnership with New York based Oscar to market their own policy.

Due to the PPACA, agents no longer ask health questions or engage in medical underwriting. We used to get involved with claims issues, but HIPAA ended that. So imagine our surprise when we got calls like this:

“Dave, I really like Medical Mutual, but my cardiologist is at the Clinic”.
“Yes. I had quadruple by-pass in February”.
“Wow. I didn’t know. Didn’t I see you over the summer at an art show? You didn’t say anything about this.”

The last two months have been filled with talks about cancers, heart conditions, and expensive dermatology treatments. Who knew? More importantly, which insurance company would cover these people if there was medical underwriting and the possibility to decline a bad risk? The clients come in, concerned, sometimes crying, hoping to hear that they can still purchase health insurance for another year. AND THEY CAN.

But the stress is showing. How many times can you walk to the edge of the abyss before you fall in? If you are working your way through a major illness, facing months of treatment, and hundreds of thousands of dollars of medical expenses, you hope that this is all a bluff. You hope that the president will forget about health care and his fixation on all things Obama and move on to something less consequential. Like Korea.

But more than anything else, you’re tired.


Photo – “It’s True It’s True” – David L Cunix


Tuesday, December 19, 2017

Pacing The Hallway

We are pacing the hallways waiting for news. Our seven year old, no, nearly eight year old, is in surgery donating a major organ. Giving a part of yourself for the benefit of others is always an important life lesson to teach our youth. Sometimes it is a kidney. In this case it is the Individual Mandate. If Obamacare (Patient Protection and Affordable Care Act) can just give up the Individual Mandate, the corporations, the very rich, and certain elected officials will be able to have their taxes cut. It seems like a wonderful trade-off. Never have so many been willing to sacrifice so much for so few.

The American public has been forced to pace the hallways for most of 2017. There were the two major attempts to repeal the PPACA without a concern given to the consequences. The funding for the Cost Sharing Reduction was eliminated. Other actions, great and small, were taken to sabotage the law. And each time we found ourselves pacing the hallways left to wonder how all of this will play out once the Republicans were forced to accept that 20% of our economy and peoples’ lives hung in the balance.

Paul Ryan and the Republican House are about to pass the final version of the new tax bill. They may not know nor understand the Corker Kickback or the myriad of other favors granted by the law. Here is the link to the final version. Trust me, your Congressman and Senators haven’t bothered reading it. What they do know is that the spigots to their campaign donations have been opened and that the Individual Mandate has been repealed. What they don’t know is how much this will cost you and me.

We have covered this ground before. Millions of Americans depend on health insurance to provide access and payment for care. You cannot base our system on the sick and the responsible. To work efficiently, we all have to participate. Much as the Republicans determined when they created Medicare Part D in 2003, there must either be an incentive to get everyone to participate or a penalty if they don’t. There are some Americans who don’t qualify for enough subsidy to make insurance affordable. But the young, the healthy, and the cheap will abandon ship. Spreading the risk, the inevitable claims, across a smaller group of people leads to higher pricing. Higher pricing forces those who pay the full cost of their insurance to either bail out or choose significantly less comprehensive contracts. And for those who qualify for those subsidies? As the premiums increase the subsidies increase.

The loser is the American taxpayer, you know, those of us who don’t own a Congressman. By the time you read this the House will have passed the legislation. The Senate will vote later tonight. Still we pace…


Photo – Emergency by David L Cunix


Sunday, November 19, 2017

The Law Of Unintended Consequences

Fall 2017

There are certain things I can count on every November – Sunday afternoons in my office working on renewals and Open Enrollment, trees shedding their leaves, and the Republicans trying to screw up healthcare. Yes, just another November.

We are a little over halfway through this year’s Open Enrollment Period. Now is a good time to see how we’re doing.

Ball of Confusion – What has been the most confusing part of this year’s open Enrollment? Medical Mutual of Ohio’s network change. I’m still getting calls weekly. First and most importantly, the MMO network change ONLY APPLIES TO POLICIES SOLD TO PEOPLE UNDER AGE 65 SINCE 2014. The new network does not apply to Medicare supplements. It does not apply to group policies. When in doubt, call your agent.

Against all odds – The Patient Protection and Affordable Care Act (Obamacare) has withstood seven years of attacks and sabotage. This year, with an administration actively trying to undermine the law daily, the PPACA has proven to be remarkably resilient. The Open Enrollment has been reduced to 45 days, less than half of what it should be. The advertisement budget disappeared. The federal healthcare Exchange is closed on Sundays. Funding for the Cost Sharing Reduction was eliminated. And with all of that Enrollment is up, way up.

Skinny Networks – One of the ways the insurers have used to rein in costs has been to limit your choice of doctors. Like the original HMO’s and PPO’s of 30 years ago, the insurer can negotiate better pricing if it can drive more business to specific hospitals and providers. This gives us the new partnership between the Cleveland Clinic and NY based Oscar and the Medical Mutual network changes mentioned above. Rate increase would have been much higher in Cuyahoga County without this change. Some counties even saw a rate reduction. But limiting access has hit Northeast Ohioans hard. Many in Greater Cleveland utilize doctors and services at both University Hospital and the Clinic. Individual policyholders in Lorain County will find it difficult to access University Hospital doctors at nearby St. John West Shore. And people living in Chesterland will find it hard to purchase a policy that will cover them at Hillcrest. This trend won’t end anytime soon.

25% and Higher – Did we really see rate increases over 25%? Yes, but not across the board. As noted above, President Trump eliminated the funding for the Cost Sharing Reduction last month. Ohio insurers were prepared. The Silver Level policies purchased through the Exchange, the only contracts impacted by this decision, experienced significant price increases. All policies may have taken a bit of a hit, but the real impact was on the Silver policies. Individuals and families committed to comprehensive coverage will experience the full impact of the rate increases if they don’t qualify for a premium tax credit subsidy. If you are getting a subsidy, you might not notice a change.

A Price Decrease – Yes, lots of people are seeing no change in their premium for 2018 or even a decrease. It doesn’t appear that the President or his advisors actually understand how the PPACA works. Increasing the price of Silver Level policies increases the premium tax credit for all subsidy eligible participants. The price goes up, the subsidy goes up, and the net premium stays about the same. The insured doesn’t pay more, but we, the US Taxpayer, are covering the difference. This is the law of unintended consequences. And it gets worse. The subsidy is based on income. So if the insured purchases a Bronze Level policy, the new higher premium tax credit can result in a lower premium for 2018. I have seen reductions between 15% to as high as 20%! Lots of insureds, especially the healthier ones, are moving to the Bronze Level policies and pocketing the savings.

Up is Down - The Republicans have turned their attention to tax reform. This being Health Insurance Issues With Dave, we wouldn’t have wasted any time on the merits of the current proposals had the Senate not floated the idea of eliminating the Individual Mandate as a way to fake a balance. We have covered how you can’t build a healthcare payment system based solely on the sick and the responsible. We have noted that the Individual Mandate, strikingly similar to the plan the Republicans used when creating Medicare Part D, traces its origins to the Heritage Foundation. So why insert this in a tax bill? The concept is that more Americans, the healthy ones, would take a pass on health insurance and save the taxpayer the subsidy money. Terribly cynical, but would that work? Of course not! As with the Cost Sharing Reduction debacle, what we would see is a severe hike in the price of health insurance as we remove the best risks from the insurance pool. The premiums would spike, the subsidies would jump, and the taxpayer would, again, be on the hook for the additional cost. And if you don’t qualify for a subsidy? You get hit twice – higher premiums and higher taxes if and when Congress ever chooses to bring in enough money to pay the bills.

Just another November.


Photos – David L. Cunix

Sunday, October 15, 2017

Playing Chicken

Bruce Springsteen was right. You really could have 57 stations with nothing on. There were tons of reruns, and worse, the same shows were on multiple stations. One saga looked familiar. It was a New York production, a remake of a Hollywood classic. Only this time we didn’t get James Dean. Instead, the two ne’er-do-wells racing the stolen cars to the cliff were Donald Trump and Mitch McConnell. In this version they both jumped out in time but the American public was bound and gagged in the trunk. Dozens of stations were showing A President Without A Clue.

The Patient Protection and Affordable Care Act (Obamacare) took its first breath on March 23, 2010. It survived over sixty Congressional assaults, but died of stab wounds and blunt force trauma on October 13, 2017. We now have Trumpcare.

Obamacare was a failed attempt to make health insurance universal and affordable. It failed. Millions of Americans did acquire better, cheaper coverage, but others did not. You can trace the problems to the design, the actual language of the bill, the process (numerous Republican amendments and poison pills), or the concerted effort of the Republicans to discredit and destroy it once it became law. It doesn’t matter. We knew the goals and the PPACA came up short.

What is the goal of Trumpcare?

The last post of this blog covered Donald Trump’s Executive Order a few days before he issued it. The changes, the expansion of cherry-picking association policies and the revival of short term contracts, are not immediate. The first step is a sixty day period for the public and the stakeholders to comment. The immediate impact is Market Instability, the hallmark of Trumpcare. I talked with insurers on Friday. They will be ready to roll out alternative products by January 1st.

Trumpcare was born with the elimination of the Cost Sharing Reduction Subsidy. Trump had been threatening to do this for months even though many, including his then HHS Secretary, Tom Price, had urged him to continue the program until Congress passed an Obamacare alternative. You may remember that these threats were the reason Anthem withdrew from the individual market.

There were four steps to individual health insurance under Obamacare, all based on the personal or family income of Americans who didn’t have access to coverage at work.
  • Income below 138% of the federal poverty level – Medicaid
  • Income between 138% to 250% of the federal poverty level - A tax credit subsidy to help pay for the premium and a cost sharing reduction to reduce the deductibles and out-of-pocket costs
  • Income between 250% to 400% of the federal poverty level – A tax credit subsidy to help pay the premium
  • Income in excess of 400% of the federal poverty level – Full premium
The insurers are contractually obligated to reduce the deductibles and out-of-pocket costs for those who qualify, but due to a failure in the wording of the law, the federal responsibility to fund it became a political football. Republicans sued and the courts let the funding continue as long as the President defended it. I don’t know that anyone really believed that Trump would do more than threaten to upend the market. But which insures could take a chance?

Insurers across the country are now being forced to decide whether or not to withdraw from the individual market. At the very least premiums must be increased to cover their additional exposure. Excellent reporting by Stephen Koff in Saturday’s Plain Dealer detailed how insurers were forced through the difficult processes of preparing rates for each state and how this will impact the consumers, the insurers, and yes, the American taxpayers.

It is assumed that Trump will institute this immediately, cutting off payments due for the rest of 2017.
Medical Mutual of Ohio, based in Cleveland, says it will lose $3 million to $5 million in just those three months because of this. The company is large enough to withstand it. Smaller companies might not have the same financial fortitude.
Consumers who qualify for a tax credit subsidy will receive a higher subsidy. The Congressional Budget Office, according to the Plain Dealer, projects that this one decision will increase the “deficit by $194 billion in the next 10 years”. And those that don’t qualify for subsidies will see higher premiums as soon as January 1st.

Mitch McConnell and Paul Ryan have been playing chicken with 20% of our economy and the way Americans access and pay for healthcare for over seven years. It was cynical and unprincipled. It took Donald Trump to drive over the cliff.


Picture – Cliff Straight Ahead - David L Cunix



Tuesday, October 10, 2017


The wire services are abuzz with news that President Trump, the guy who campaigned in part on his disdain for President Obama’s use of the Executive Order, is poised to sign another Executive Order dealing with health insurance. Frustrated and confused by the Republican controlled Congress’s inability to simply pass any unvetted, purely political legislation regardless of the potential harm it might do to both the economy and the public’s access to care, Donald Trump is more than willing to take matters into his own hands.

The word for today is ASSOCIATION. Associations are not inherently good or bad. In fact, we have had the term Association within the health insurance lexicon for years. Small businesses in the Greater Cleveland area have joined COSE (Council of Smaller Enterprises) or NOACC (Northeast Ohio Area Chamber of Commerce) to get a discount on their group health insurance policies. The discount was often no more than the premium tax that wasn’t assessed on an association group contract. The businesses were still subject to health underwriting and the policies conformed to Ohio regulations.

I used to write health insurance on certain hardware stores. The stores were part of a franchise and the owners were given guaranteed access to an association health policy, the association of XXXX Hardware Stores. It didn’t take long for some of the owners to realize that if they and their employees had better than average health, they could purchase a group policy in the open market. The guaranteed issue, no health questions asked association policy became the insurer of last resort. The healthy bailed out until the only ones left were the most expensive to insure.

The difference between these two types of associations is that in the first example association members and non-members were on equal footing. The only thing different was the absence of a premium tax, which may or may not have been as much as the membership fee into the organization. In the second example, one path led to a health insurance policy that was selective and rewarded the healthy and/or punished the sick while the other path led to a policy that charged everyone the same price regardless of risk.

The more open, less selective plan was doomed to failure.

Senator Rand Paul (R-KY) has long championed a version of the association health insurance model. His option would allow businesses or individuals to form associations specifically created to avoid the regulations and consumer protections of The Patient Protection and Affordable Care Act (Obamacare). And President Trump appears to be ready to sign off on this.

The Paul / Trump associations will offer flexibility and lower premiums and will be hailed as a consumer benefit. There are two ways that these association policies can save money and both center on flexibility.
  1. The policies will have the flexibility to eliminate a broad range of coverages for particular illnesses. The rush to the bottom will feature policies that fail to cover specific conditions or will place limits on the amounts paid.
  2. The policies will have the flexibility to ask health questions and choose to insure only the healthiest individuals and groups.
And who does that leave on the outside looking in? The unhealthy, the older worker, and eventually everyone who might be a worse than average risk. In other words, the unlucky. And the unlucky will be trapped in a health insurance death spiral consisting of individuals and families dependent upon the good graces of a system that was initially designed to spread risk across the broad spectrum of American citizens. There is a reason why the National Association of Insurance Commissioners (every state has one) has adamantly opposed this type of association health policy. Someone has to look out for the American consumer.

My friend and fellow agent, Barb, heard about this possible change and exclaimed, “It will be just like it was where people with preexisting conditions can’t get covered!”

So a couple of quick questions:

Can he really wreck this much havoc on 20% of the economy without Congressional approval? YES.

Are you young enough, healthy enough, and lucky enough to not be hurt by this? HOPE SO.


Banner – Lianesha Mays

Monday, October 9, 2017

A Small Victory

Birth Control was always a point of contention. Facing numerous failures to execute one large sweeping rebuke of President Obama and his most important legacy, the Patient Protection and Affordable Care Act (Obamacare), the Trump administration continues its smaller scale attacks of sabotage, subterfuge, and repeal by executive fiat. President Trump’s latest victim is the coverage for Birth Control Pills, IUD’s, and the Morning After Pill.

This blog has detailed Obamacare’s numerous battles to provide no-cost reproductive coverage for women. Making this a part of the Preventive Care Benefit, FREE and available to just about everyone, intensified the fight. And let us be clear, this was a fight Secretary of Health and Human Services Kathleen Sebelius wanted. Though a majority of American women may favor and utilize some form of contraception such as Birth Control Pills, the addition of IUD’s and the Morning After Pill guaranteed that powerful forces would never settle for anything less than the total elimination of this benefit.

Trump gave them what they wanted this past Friday.

Before we go any further, let us first address the accessibility of Birth Control. Under the PPACA the pills, or at least many versions, are FREE. With Birth Control Pills being lumped in with the Preventive Care Benefit, both the cost and the stigma associated with contraception was eliminated. And though many organizations will now eliminate the benefit under either religious or moral grounds, Birth Control Pill will still be prescribed to their employees and may still be covered. We will just revert to the way it used to be. Young women will parade into their doctors’ offices complaining of menstrual issues and the doctors will prescribe the Pill to regulate their cycles. The medication will be covered, just not free, so that we will also be back where access to contraception was as much a class issue as it was religious. Can the employers remove this medication completely from their lists of covered meds? In some instances, perhaps. I sure wouldn’t want to be the HR manager that had to explain this to the mother of a distraught 15 year old.

And while we are here, let us take a moment to award this year’s King of Hypocrisy Award to Tim Murphy who was just forced to resign from Congress.

All health policies force us to pay for certain medications and/or procedures that we, personally, couldn’t or wouldn’t use. A single, never married, male never encountered any of the claims associated with pregnancy or menopause. My prostate cancer claims were paid with the premiums of men AND women. We are all in this together. You might find the concept of organ transplants for adults over 50 as an unnecessary luxury, a cost that should be borne by the organ recipient. Perhaps, but that isn’t how our system works. We don’t take a poll to see which health issues you choose to cover. Here we spread the risks amongst as many people as possible.

There are organizations that are applauding this latest executive action. And since it was broken into two parts (religious organizations and those with a moral objection), at least part of Friday’s order may survive a court challenge. I view it as another step towards separating health insurance, the way we access and pay for healthcare, from employment. I certainly understand why the Catholic Church didn’t want to pay for Birth Control Pills for nuns (They were exempted), but do you want to be forced to ask about the Pill when you are applying for a job at a machine shop? Where, exactly, does the line get drawn?

I have insured churches and synagogues. I have insured the deeply religious and the ritualistically observant of many faiths. My clients, in almost every case, simply chose to forego those benefits that they deemed inappropriate. They didn’t try to impose their deeply help values on the rest of society.

On Friday the Trump administration scored a small victory. One hundred thousand women and/or their daughters may be forced to pay for Birth Control Pills. Some will. Some won’t. We won’t know for about five years if this leads to more unplanned pregnancies, unwanted children, and abortions. But right now the thing to remember is that Donald Trump scored a small victory.

Break out the Champagne!


Picture - "Time to Dedicate Another Trophy" by David L Cunix

Sunday, September 24, 2017

The Speech

Where were you when he delivered The Speech? Yes, it was just days after his inauguration when President Donald Trump addressed a joint session of Congress. The topic, of course, was healthcare. His victory could be traced, in part, to his rally cry to Repeal and Replace Obamacare. This has been a Republican mantra since 2010, but it sounded new from Donald Trump. His opponents, both Democrats and Republicans, had been taken aback by the aggressiveness of his assertions. He had promised a great new health plan. This blog was underwhelmed by the plan information he released during the campaign. But there he was, delivering a prime-time address, unveiling his proposal. Trumpcare was a comprehensive proposal that worked hard to provide protection for every American family. Leadership.

There was no speech. There was no plan. And, there is no leadership.

2017 has been a terrible year for serious people and a difficult time for those of us who once revered “The world’s Greatest Deliberative Body”. Washington’s most cynical politician, Majority Leader Mitch McConnell, decided that he would push a bill through the Senate with as little scrutiny as possible. Utilizing the Reconciliation rules, McConnell worked hard to keep the legislation under wraps. No hearings! No input from any of the stakeholders. And absolutely, positively, no Democrats. McConnell’s strategy was to get 50 of the 52 Senate Republicans to vote Yes and then have Vice-president Mike Pence break the tie. The details were irrelevant.

It may seem crazy to you or me to upend nearly 20% of the economy, not to mention the method that we access and pay for healthcare, with a legislative sleight-of-hand. But it almost happened this past July. And they are about to try again this week.

The current proposal is called Graham-Cassidy. The authors are Senators Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), Ron Johnson (R-WI). Their television interviews have revealed the plan to be a last ditch effort to erase Barack Obama’s legacy, repeal parts of the Patient Protection and Affordable Care Act (Obamacare), and to transfer billions of dollars to states that have shown little interest in health insurance protection for their citizens, Healthcare? That hardly enters into their thinking.

Here are the basics of Graham-Cassidy

  • The federal exchange –
  • The tax credit subsidies
  • The Cost Sharing Reduction
  • The Individual Mandate
  • The Essential Health Benefits
  • The Medicaid Expansion
  • All funding for one year for Planned Parenthood (Surprise!)
  • With greater flexibility, the current protections for people with preexisting conditions would be at risk.
  • The majority of taxes used to pay for the PPACA would still be collected. The money would be dispensed to the states in the form of block grants. (Think the tobacco settlement)
  • Money that went to states that had expanded Medicaid will be redistributed to states that didn’t. Ohio would lose between $4 billion to $9 billion!
Who is strongly supporting this legislation?
  • Donald Trump
Who is opposed?
And where is our guy, Senator Rob Portman? He has been a solid Yes for every other lame-brained proposal. He has maintained his usual silence on this one. Perhaps he is waiting for Senators Lisa Murkowski (R-AK) and Susan Collins (R-ME) to save us again.

What we know for sure is that there will never be a comprehensive health care proposal from this White House. There will never be “The Speech”.


Sunday, September 10, 2017

You're Invited

John Doak, Oklahoma’s Insurance Commissioner, is an outspoken critic of the Patient Protection and Affordable Care Act (Obamacare). Mr. Doak and four other insurance commissioners were in Washington this past week to testify before a Senate panel. Their goal was simple – What do we need to do NOW to strengthen the law for the benefit of the American consumer?

The five insurance commissioners, even ones like Doak who are opposed to the PPACA, all agreed on the importance of stabilizing the health insurance markets. The first step would be to lock in both the premium tax credit subsidy and the Cost Sharing Reduction, an important consumer benefit that has become a political football. There appears to be bipartisan support to do this. The big question is whether a bill can emerge from both the House and the Senate.

Another key area of agreement centers on the Section 1332 Waiver. Can Congress streamline the process of securing a waiver?

Ohio is preparing its Section 1332 Waiver application. And we, agents and consumers, have an opportunity to participate. Now is the time to provide your input into what rules should be changed or relaxed to improve health insurance pricing and availability. We have until October 15th to provide our ideas.

There are four areas of concern:
  • The delivery system
  • Benefit Package
  • Cost Containment and/or medical management options
  • Funding or the delivery of a reinsurance pool

Here are some questions to get you thinking:
  1. Should there be annual or lifetime maximums?
  2. Should pediatric dental and vision be optional?
  3. Would mandating a second opinion save money?
  4. Would a state exchange be more effective than
  5. If we develop a high risk pool, can we incentivize carriers from ceding business to the pool?
  6. Can certain benefits such as Mental Health or Maternity become optional?
  7. Should there be a baseline standard plan with the option to buy up?
I think you get the idea. The process is just beginning. Our job is to stop complaining and to start working. You may post your suggestions in the Comment section or send me a private email at

We are all in this together. Let’s make health insurance, our way to access and pay for healthcare, more affordable and effective.


Sunday, August 27, 2017

Back To Work

Congress is off on recess. Some of our elected representatives are in their home districts, meeting with constituents, and discussing the issues of the day. Judging from the news, most are locked in their homes, hiding from the public, and avoiding the press. Even the usual stand-bys, Chamber of Commerce luncheons and district picnics are likely to lead to embarrassing questions about the recent craziness in Washington. Neither you, my readers, nor I have the luxury of a month away from reality.

We are in the last week of August. Senior Open Enrollment begins October 15th. The Open enrollment for individuals and families under age 65 begins November 1st, a little over two months from now. Rates have not been finalized, due in part to President Trump’s indifference to market stability. And for those who believe that change is inevitable, you ain’t seen nothing yet.

The Deck Is About To Be Reshuffled

Change is no longer on the horizon. Change is here and now. New companies are entering into our market. Old companies are either leaving or making significant changes. And through it all only one question truly matters – “Will more Americans have access to high quality, affordable health care?” The answer, at this point, can only be, “I hope so.”

This is a moment for adults. This is a moment for leadership. Seven years’ of meaningless votes to repeal the Patient Protection and Affordable Care Act (Obamacare) have given way to bipartisan initiatives to stabilize the insurance markets. Will these Congressmen and Senators overcome the objections of Paul Ryan and Mitch McConnell and craft a law that can garner enough votes? Would Trump veto the bill?

Our elected representatives will be forced to deal with a number of significant issues when they return from recess. Health Insurance is but one area of concern. There is a debt ceiling vote, the budget, Korea, Afghanistan, and a host of other major issues that were put on the back burner while Congress debated a variety of politically driven, incredibly illogical, Repeal and Replace bills.

Take a look at who is representing you in Congress. Take a look at the White House. Are they up to the job?


Photo – The Halls of Congress by David L Cunix 2017

Wednesday, August 9, 2017

We're Off To Get A Waiver!

We’re off to get a waiver! A wonderful waiver from Washington.

In an exciting new development, the State of Ohio is putting together a team of stakeholders to create a Section 1332 State Innovation Waiver. What will we ask for? Will this stabilize and improve our health insurance market?

Per The Centers for Medicare & Medicaid Services (CMS), the Section 1332 Waiver is where each state has the opportunity to tweak the Patient Protection and Affordable Care Act (Obamacare).

Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA.

State Innovation Waivers allow states to implement innovative ways to provide access to quality health care that is at least as comprehensive and affordable as would be provided absent the waiver, provides coverage to a comparable number of residents of the state as would be provided coverage absent a waiver, and does not increase the federal deficit.

State Innovation Waivers are available beginning January 1, 2017. State Innovation Waivers are approved for five-year periods, and can be renewed. Waivers must not increase the Federal deficit.

Simply said, an Innovation Waiver would allow the state to modify the existing law or create something entirely new to meet the healthcare needs unique to Ohio.

As the Legislative Chairman of our local chapter of the National Association of Health Underwriters (NEOHUA), I will be closely monitoring our state’s progress. I will share information as it becomes available.

The first two states to file were California and Alaska. Their needs and plans are totally different. Hawaii, Vermont, and Minnesota have also filed applications. What they all have in common are the goal to provide health insurance coverage to at least as many people, retain insurance that is both comprehensive and affordable, and to not increase the federal deficit.

We know the rules. We understand the goals. Now, let the creativity begin.





Monday, July 31, 2017

Dave Cunix - Career Counselor

Oliver really wanted to talk with me. I hadn’t heard from him since he took a job at a major law firm about ten years ago. But NOW he wanted to talk. I checked my email late Wednesday evening. There were two emails, a Linked In message, a friend request on Facebook, and a message left on the office phone. I scheduled a phone appointment for 9 o’clock Thursday morning.

Oliver (name changed) wants to open his own office. We discussed where he would set up shop and the areas of law he would practice. I guessed that he was targeting the first of the year and wondered about the urgency to connect. And that is when he asked to purchase coverage for August 1st.

Now? Oliver had decided to quit his job right now while he could still purchase a health insurance policy under the Patient Protection and Affordable Care Act (Obamacare). The Senate was debating repeal and seemed unconcerned about people like him, people with preexisting conditions. We had a heck of a time getting him insurance last time. Oliver didn’t want to take a chance.

The Better Care Reconciliation Act of 2017 (BCRA) was released on June 22nd. I printed it, read it, and had an analysis posted by the next day. I’ve also printed and read Senator McConnell’s subsequent attempts. There is a good chance that I have dedicated more time and paper to these half-baked plans than most of his fellow senators. The question was never whether any of this could become law, but which senators would be forced to stop this charade. In the end it was Senators Lisa Murkowski (R-AK), John McCain (R-AZ), and Susan Collins (R-ME). One has to wonder if our Republican senator would have voted NO if the bill was actually going to pass.

But Oliver and millions of Americans just like him didn’t know what the Senate was going to do. Will this game of chicken continue until someone forgets to blink? Will President Trump goad the Senate into another vote, and another, until someone screws up? Will Trump further destabilize the health insurance market? Will there be health insurance coverage available?

It is way too early for Oliver to quit his job. He’s not ready. We reviewed the steps necessary to successfully create a business. I assured him that we will find him health insurance coverage the day he actually needs it.

We focus so much on the big picture. We know that this debate is about nearly 20% of our economy. We know that we are talking about the way Americans access health care. But we too often forget that there are real people impacted by these political decisions. Oliver. Your friends. Your parents. Maybe even you. It is time for Washington to see us.


Friday, July 21, 2017

Wrong Way

Today’s Health Insurance Issues With Dave is a short quiz. Grading is Pass/Fail.

You find that you are going the wrong way on Gates Mills Boulevard. Do you

A. Turn around in the first available driveway

B. Turn at the first intersection or median cut-through

C. Push the Detonate button and blow-up your car

D. A or B whichever comes first

If you chose A, B, or D, please forward your copy of this quiz to your Congressional representative. The subject line should be Healthcare. If you chose C, you may already work in Washington.



Monday, July 10, 2017

Begging The Arsonists To Put Out The Fire

Need a surgeon? Would you consult Dr, Jack the Ripper? Would you hire Godzilla for your next construction project? And yet, we have entrusted our healthcare system to Paul Ryan, Mitch McConnell, and Donald Trump. What could go wrong?

The U.S. Senate is about to return from their latest vacation. The push is on. Senate Majority Leader Mitch McConnell is determined to get his legislation, the Better Care Reconciliation Act of 2017 (BCRA), passed before their next vacation, the August recess. Faster legislation, but not necessarily good legislation.

Health insurance is regulated on both the federal and state level. Our elected officials in Washington and Columbus have been very busy. Some of their focus has been on tax cuts, election nullification, and sabotage. And every once in a while, when they have nothing better to do, they put some effort towards solving problems.

A key element of the Patient Protection and Affordable Care Act (Obamacare) is the Individual Mandate, the requirement to purchase insurance. This blog and numerous other published articles have noted that the Individual Mandate traces its roots to the conservative Heritage Foundation over twenty-five years ago. The logic is simple – If we are going to offer health insurance to all Americans and cover preexisting conditions, we must have everyone participate.

You can’t fund a healthcare system if only the sick and the responsible are participating.

President Trump and Congress are actively sabotaging the system. As previously discussed, Mr. Trump’s first Executive Order directed federal agencies to “waive, defer, grant exemptions from or delay the implementation of the Act…” And with that the IRS stopped holding tax returns that didn’t include proof of insurance coverage. Enforcement became optional. But that isn’t enough for Congress.

The New York Times recently reported that a bill is moving through Congress that would prevent the IRS from enforcing the Individual Mandate. Why leave anything to chance? With the replacement bill floundering and Obamacare, by default, looking better every day, it is important to the Republicans to harm PPACA any way they can. Every healthy person that chooses to not purchase coverage is a future rate increase for everyone else.

* * * * *

I’ve left the message on our system. Every comment on this blog is appreciated. He had given his response a lot of time and thought, so much that he wasn’t able to call my office until 10:30 on a Saturday night. He was careful to mask his number to evade the caller ID but, oddly enough, forgot to leave his name. My reader wanted me to know how much he respected President Trump and that my opinion wasn’t appreciated, though he didn’t use those exact words.



Monday, July 3, 2017

What Road Is Paved With Bad Intentions?

At some point we have to ask, “Where the Hell are we going?” Seriously, we have a couple hundred Congressmen and 50-60 Senators gambling with 20% of our economy and people’s lives in an effort to negate the 2008 and 2012 elections. And leading the charge is a guy so obsessed with his predecessor that he would sign a bill mandating daily doses of arsenic if he was told that it would reverse an Obama achievement.

The Patient Protection and Affordable Care Act (Obamacare) was passed in 2010 after months of Congressional hearings, public meetings, and debate. The final law borrowed heavily from Republican plans pushed by The Heritage Foundation, Newt Gingrich, and Mitt Romney. It was not the traditional Democratic plan focused on either a Single Payer or Public Option. Like all compromises, there was plenty to love and lots to hate in the PPACA. But the legislation’s intention was to give every American access to affordable healthcare.

Obamacare fell short of its goal.

What is the goal of the American Health Care Act (AHCA)? What is the goal of the Better Care Reconciliation Act (BCRA)?

Both the House and the Senate bills are focused on tax cuts, Medicaid reduction, and defunding Planned Parenthood. Neither has a single provision to lower the cost of healthcare. Neither provides access for a single American. Both bill would eliminate health insurance coverage for over 20 million Americans over the next ten years.

The AHCA and the BCRA are both championed and denigrated by President Trump. It just depends on the hour. The reason is simply. He doesn’t care. He just wants a win.

On Friday Senator Ben Sasse (R-NE) revisited a different Republican option, Repeal Now – Replace Later. His website features his newly found relevance since President Trump has reversed himself and is now embracing this idea. This simplistic concept features a triumphant Republican controlled Congress repealing OBAMAcare and then, now with a clean slate, the Republicans invite the Democrats to join them to create a similar system. Yes, this is exactly like an arsonist burning down his own home and then demanding that you help him rebuild it.

There are, of course, other options. Steven Brill, author of America’s Bitter Pill, published an article last week in the Washington Post. Nine ways to really fix Obamacare is a short list of common sense solutions that advance the goals of access and affordability. There are Republican and Democratic ideas incorporated into these nine changes. It is a short article. Click here to read it.

I don’t know that there is a road to an insurance nirvana. But if there is, it certainly isn’t paved with bad intentions.



Monday, June 26, 2017


Passover is my favorite holiday. And my favorite part of the Passover Seder is the singing of Dayenu. As we list each miracle and wonder that was done for us, such as freeing us from slavery or saving us at the Red Sea, we say Dayenu. Dayenu is loosely translated to “That would have been enough for us”.

The Patient Protection and Affordable Care Act (Obamacare) was a poorly written bill. It was compromise legislation that didn’t fully satisfy anyone on the left or the right. But when asked over the last seven years what Obamacare did well, I have always cited the expansion of Medicaid. If the Patient Protection and Affordable Care Act had done nothing but expand Medicaid – Dayenu!

Destigmatizing Medicaid was the first positive step we could take as a society to help the poor and working poor. And Medicaid helps more than just the poor. It also helps the disabled and the elderly. Medicaid is our insurer of last resort, which means that an awful lot of our friends and neighbors rely on this government provided insurance.

In Greater Cleveland Medicaid coverage allows those in need access to our world-class medical facilities, highly trained doctors, and needed prescriptions. Medicaid even covers office visits which are much cheaper and more convenient than the inefficient emergency room.

The Kaiser Family Foundation has done extensive research on Medicaid. Their Medicaid utilization graph has appeared on numerous TV shows as well as in newspapers such as the New York Times and the Plain Dealer. On a national level Medicaid covers:
  • 49% of all births
  • 76% of all poor children
  • 60% of all children with disabilities
  • 64% of all nursing home residents
  • 30% of all adults with disabilities
Medicaid is helping our most vulnerable. Do we have some people who could/should be paying for their own insurance? Of course. Can we do a better job policing utilization and reimbursement (fraud and waste)? Of course. Can we significantly reduce funding without impacting access to care? NO WAY.

There has been excellent reporting on Mitch McConnell’s Senate “working draft”, the Better Care Reconciliation Act of 2017 (Trumpcare). Steven Koff of the Plain Dealer has delivered some of his best work. The New York Times has again proven why it is the paper of record. The “working draft” is only 142 pages. It is a quick read. Follow this link. We’re talking about the way we, all Americans, access and pay for healthcare. We are talking about nearly 20% of our economy. It is your responsibility to at least read McConnell’s plan. You have the time.

We can discuss the merits of a huge tax cut for the wealthy. We can wonder how eliminating the individual and employer mandates while retaining guaranteed issue won’t destroy the insurance market. We can go page by page through the BCRA and ask “Why?” But for today, I just want you to read the bill. And if you do that, it will be enough for me.



Friday, June 23, 2017

Trojan Horse

President Lyndon Johnson declared the War on Poverty in 1964. It was a sincere effort, but poverty persists to this very day. Senate Majority Leader Mitch McConnell, President Trump, and Speaker of the House Paul Ryan have decided that a War on the Poor is a better idea. They are weaponizing healthcare. The opening salvo was the American Health Care Act (AHCA). And yesterday, June 22, 2017, we got the working draft of the Better Care Reconciliation Act of 2017 (BCRA). The names might imply that these efforts are designed to enhance our access and payment of healthcare. A more honest name might have been Bang Bang You’re Dead.

The Senate released a “working draft”. This could be the actual bill. It could be a Trojan Horse. Since McConnell is trying to ram this through under the Senate’s rules for reconciliation, we may not know until the last possible moment.

I apologize for focusing so much on process, but that is where we must start. Leader McConnell is an incredibly cynical politician. He is a master of the game. We need to at least know some of the rules.

Under reconciliation, McConnell only needs 50 votes for a tie. Vice-president Pence would then cast the deciding vote. This “working draft” could be introduced as legislation. Debate will be limited to TEN HOURS. The Democrats would be able to introduce amendments, but debate is limited to TWO MINUTES per amendment. The Republican majority could quickly defeat all of Dem’s motions. Then, at the nine hour fifty minute mark, McConnell could introduce the actual legislation as a replacement amendment. The real bill is then passed before anyone can read or debate it.

Farfetched? Really? Have you been paying attention?

This blog will analyze the “working draft” over the next few days, but we must first focus on the process. Certain key Republican Senators and lobbyists have had advance copies of the BCRA. The first to complain weren’t Senators Portman or Collins. The first to the TV cameras to voice their disapproval were Senators Cruz, Lee, Paul, and Johnson who represent the extreme right wing of their party. They voiced opposition to the concessions made to the moderates. It feels like the fix is in.

I may see a Trojan Horse. The poor and working poor are staring at a tank.


Monday, June 19, 2017

The Path

I felt the first large drops of rain before I had managed to get in four miles. I had planned to golf, but there had been an 80% chance of thunderstorms. So I was walking. I was now in the Mayfield Village Wetlands, a mile long circle of bridges and gravel. I tried to stay on dirt and gravel paths to keep my focus on where I stepped as opposed to how far I was walking or the hot, sticky air. This particular trail was designed to be walked clockwise. I, of course, was going counterclockwise. I laughed at the thought. NO ONE WAS IMPACTED BY MY CHOICE. One path was as good as another.

Senate Majority Leader Mitch McConnell (R-KY) is engaged in a different type of exercise. He and his new best friends aren’t trying to lose a couple of pounds. President Trump, Speaker of the House Paul Ryan, and McConnell are trying to eliminate a legacy. They are not alone. There appears to be plenty of Republicans who would like to return to 2005, a time when they controlled the House, the Senate, and Bush was the president. A time before their failures. A time before Obama.

Many of their actions are petty and/or irrelevant. Then there is healthcare. For seven years McConnell and Ryan cynically fanned the flames of hatred and resentment of Obamacare, the Patient Protection and Affordable Care Act. Now it is Trumpcare and they own it.

Some paths lead nowhere. Some are dead ends.

Somewhere in Washington, behind locked doors, thirteen Republican Senators are creating the Senate version of Trumpcare. No hearings. No amendments. No debate. We are discussing how Americans access and pay for healthcare. We are talking about nearly 20% of the economy. We are talking, but they aren’t talking to us.

One of the senators is Rob Portman (R-OH). I have contacted his office about the secrecy. I have asked about specifics. What I’ve received, to date, was a form letter about his commitment to the treatment of opioid addiction. He is clear that he doesn’t support the House bill (The American Health Care Act) that doesn’t do enough to protect Ohioans dependent on the Medicaid expansion. Our governor and my local congressman, David Joyce (R-OH) have also voiced concerns.

OK, now what?

This secret bill is being cobbled together to garner 50 Republican votes in the Senate. That is all McConnell needs. Fifty, and then Vice-president Pence casts the tiebreaker. And the fate of millions of Ohioans depends on Rob Portman having more influence in the Senate than Senators Ted Cruz, Rand Paul, and Mike Lee. This dangerous path leads us to a cliff. Who are we willing to lose?



Wednesday, June 7, 2017

Thin Skin

The coroner was ready to address the press. She stood behind the podium with its bank of microphones, looked directly into the cameras, and delivered her judgement. “The cause of death was thin skin.” Several reporters nodded in agreement. They had been predicting this would be the answer. But one journalist refused to close his notebook and felt compelled to get a clarification. “Pardon me, Madame Coroner, but you are saying that the deceased perished from thin skin?” “Yes”, she replied without even a hint of emotion. “So the 27 stab wounds had nothing to do with his death?” “Well”, the coroner replied, “if he had had stronger skin he’d still be with us today, wouldn’t he?”

There was a rumor in 1897 that Mark Twain had died. A newspaper printed an obituary. Twain’s response was “The reports of my death are greatly exaggerated”. I was thinking of this earlier today as President Trump was again telling the American public that Obamacare is imploding. It is true that our current health insurance system seems to be having difficulty breathing, but the first step might be to convince Trump to stop choking it.

Yesterday’s big news was Anthem Blue Cross and Blue Shield’s announcement to abandon the exchange market in Ohio for 2018. This was not a shock to those of us following the shenanigans in Washington. This business decision by Anthem will be spun more than a dreidel during Hanukkah, but their simple words tell the real story:

Anthem has a long history of serving individuals in our communities. Customers have grown to expect great value and access to health care coverage from us. And our desire to meet those needs has not changed. But the current regulatory climate and the uncertainty it has produced in our industry do not give us the clarity and confidence we need to commit to offering broad-based, affordable health plans for 2018. So, while we wait for new regulations to be released, we’ve made the difficult decision to reduce the number of Individual health plans we’ll offer next year.
Please note that Anthem isn’t crying poverty. There are no claims of insurmountable losses. Washington seems determined to play politics with Anthem’s clients and gamble with Anthem’s money. Anthem walked. My clients have been calling all day, mostly elderly, Medicare beneficiaries who aren’t impacted, to ask what they need to do. The answer today is – NOTHING. We may need to take action in November, but there is absolutely nothing to do today.

There have been members of Congress and various Republican state officeholders who have been attempting to kill the Patient Protection and Affordable Care Act (Obamacare) since its inception. There were the 60+ votes in the House that we’ve discussed ad nauseum. There have been various law suits from red states. Some of the suits have been more effective than others. We don’t have Medicaid expansion in all 50 states, thus blocking millions of Americans from access to healthcare. Other cases involve subsidies, who gets them and how much.

CWRU Professor J. B. Silvers, the former CEO of QualChoice, published an article on January 4th of this year on MarketWatch year about the dangers of repealing Obamacare without a comprehensive plan. He returns again and again to market uncertainty. The insurers have to trust the government to not change the rules in the middle of the game. AND THEY CAN’T.

One example he (and others) cited was an initial risk reduction program built into Obamacare to defray the high cost of claims anticipated during the first three years of the program. The claims were significantly higher than anticipated, “But when the time came to pay for the risk reduction in the Obamacare exchanges, Congress reneged and paid only 12% of what was owed to the insurers.” This shortfall chased some insurers out of the market and forced those remaining to raise rates significantly last year.

And now we are in the middle of another bait and switch.

One of the lawsuits the Obama administration had been fighting was designed to eliminate a special subsidy for those Americans earning between 138% and 250% of the federal poverty level. This additional benefit not only helped to make the premium affordable, it also reduced the deductibles and out of pocket limits for these insureds. The Obama administration had won a stay while the fight went on in the courts. Trump could simply drop the fight. He has been threatening to do this for months. The insurers would be left holding the bag. This is a link to an April Forbes article on the issue. Katherine Hempstead of the Robert Wood Johnson Foundation is quoted in the article. “It probably was inevitable that the threat of cost-sharing reduction non-payment would be dangled for leverage.”

What we learn, time and again, isn’t that Obamacare is imploding. It is being sabotaged. It is under attack. And if the way we deliver and pay for healthcare, nearly 20% of our economy, suffers an untimely demise it won’t be from thin skin. I think we have to see who is holding the knife.




Tuesday, June 6, 2017

Healthcare And The Politics Of Resentment

It happened again last week, this time on a golf course. A fourth was added to our group. Our new friend, Ken (name changed), is a businessman from the Akron area. It only took a couple of holes for him to learn what the rest of us did for a living and only another before he started to complain about Obamacare.

I can’t offer my employees health insurance because of Obamacare.


My Insurance went up 400%!

That seems odd.

My premium jumped to $3,000!

For just you?

And my deductible was $10,000. It was worthless insurance.

You had an individual deductible of $10,000? That’s not possible.

What really ticks me off is how all those people are getting free insurance, great insurance, for doing nothing!

It always devolves to a complaint about the poor. There are winners and losers in the Patient Protection and Affordable Care Act (Obamacare). There had to be. We can look back to September 1993 when then President Bill Clinton went before Congress to explain that it was inevitable that some people would be forced to pay more if we were to overhaul our healthcare system for the betterment of most.

The Obamacare winners are easy to list:
  • The unhealthy
  • The poor
  • The working poor
  • Anyone stuck in a job or marriage to retain health insurance
  • Young women
  • Hospitals
The losers, mostly due to additional premium or taxes:
  • Young healthy males
  • Businesses employing unskilled, low income workers
  • Individuals earning over $200,000
  • Healthy middle income wage earners purchasing their own coverage
There has to be winners and losers. Republicans constantly cite President Obama’s claim that insurance rates were going to decrease and that if you liked your doctor you can keep your doctor. Yes, Obama oversold Obamacare as he confused goals with deliverables. But these same Congressmen give Trump a pass on his sugarplum and rainbow description of his non-existent health plan. Would there be winners and losers if Trump, Ryan, and McConnell ever pass an alternative to Obamacare? Of course. There has to be.

But what galls me are the politics of resentment. Being poor is a full-time job. I recently helped a young woman apply for coverage. She had aged off her parents’ policy and we went through to get her a new policy. She qualified for Medicaid. This was a huge relief. Her expensive prescription would be covered. Her premium - $0. That was in March. Today is June 6th. She is still waiting. No word from the State of Ohio. No Rx card. No help.

Not only are my tax dollars helping to provide Medicaid to the poor and the working poor, I am also losing commissions. Some of those people were or would be clients. I am no longer paid to be their agent. That’s a trade I’m happy to make. Do we really believe that people want to be poor? Are we better off as a society by punishing the sick and the hungry?

The problem with Obamacare isn’t that the Medicaid expansion extended access to healthcare to millions of Americans. The problem is that millions of Americans are still uninsured. The problem with Ken? Who cares?



Sunday, May 21, 2017

Hey Nancy, Queen Me!

Paul Ryan triumphantly moved his pawn to the last square. “Hey Nancy, queen me!” His gallery went wild. He jumped out of his chair and high-fived his backers. “You da man”, his new friend, Donald Trump, shouted from the front row. It wasn’t until he returned to his seat that he noticed that his opponent had remained silent, oddly silent, throughout the celebration. But that didn’t matter to Paul. He leaned back in his chair and didn’t even bother to hide his smirk. Nancy Pelosi reached for her rook, pushed it three blocks to the right, and said “Checkmate”.

While the TV has been Trump 24/7, there are other news sources helping to bring important info to the American public. Excellent reporting from Bloomberg Politics on May 18th revealed that “the American Health Care Act, H.R. 1628, hasn’t been transmitted from the House to the Senate, according to Senate Bill Clerk Sara Schwartzman”. Confirmed by CNN, House Bill 1628, the American Health Care Act is sitting in Paul Ryan’s desk while he sweats out a Congressional Budget Office report.

The danger of creating a piece of legislation that is designed more to punch your opponents in the nose than to solve a particular policy problem is that the House can pass just about anything by a simple majority but that the Senate’s rules are a lot more complicated. The Senate’s filibuster and reconciliation rules shaped the final structure of the Patient Protection and Affordable Care Act (Obamacare). And Trumpcare will only become law if the legislation meets these same arcane regulations. And we won’t know until Wednesday, when the Congressional Budget Office releases their scoring, if the AHCA complies.

The minimal requirements are that the American Health Care Act must reduce the deficit by at least Two Billion Dollars. That removes the possibility of a Democratic lead filibuster and allows the Senate to pass legislation by simple majority. The bill must also provide the proper optics. If the CBO report comes back with too many people losing their coverage, that too could bury the legislation. The original House version had only 24 million Americans losing their coverage, not nearly enough to slow Speaker Ryan. The uninsured issue could cause real concern in the Senate, but doesn’t force the House to act. But if the deficit reduction goals weren’t met, the House will be forced to retool the AHCA and then VOTE AGAIN. President Trump and Speaker Ryan twisted an awful lot of arms to get those 217 votes a few weeks ago. Could he get them again?

The biggest problem with the AHCA isn’t that it fails to answer how all Americans can access and pay for healthcare. The biggest issue is that its starting point is the repeal and replacement of Obamacare. The goal is to eliminate President Obama’s legacy, not affordable healthcare and certainly not patient protection. There can’t be any real progress or any true bipartisan effort until our elected representatives choose to fix the existing law. There are responsible Democrats and Republicans who will privately acknowledge that there are ways to improve the PPACA that both sides could accept once the focus changes from the name to the content.

Mark Bertolini, the chairman and CEO of Aetna, was recently quoted as saying “Single-payer, I think we should have that debate as a nation”. In the attached article Bertolini describes the public/private partnership that already exists in both Medicare and Medicaid. He also notes that the insurers already run many of these programs and process the paperwork. Some are viewing this as expanding Medicare Part C, the Advantage Plans, to all Americans both under and over 65. I look at this as a direct extension of my blog post of April 2010 where I claimed that the insurers would eventually push for a single-payer type of system.

Democrats like Pelosi wanted a single-payer program in 2010. Republicans have long promoted market-based solutions such as the Advantage Plans. It is difficult to predict how soon the adults in Congress gain control of the news cycle, much less the legislative agenda. But no one wants to campaign on the value of taking access to healthcare away from Americans. Paul Ryan had a minor victory two weeks ago. Nancy Pelosi appears to still be winning the chess match.