Is Louisiana G-d's Waiting Room?

 

So many of my clients are retiring and looking to move out of Ohio.  There are too many reasons to list as to why they want to leave, but the eternal question is “WHERE?”.   I have clients looking at Portugal, Spain, Italy, and Central America.  There is a certain romanticism to the thought of being an Ex-Pat.  Cost of living, politics, and access to health care all factor into these decisions.  Most of my clients will stay in the U.S.  In fact, many will look elsewhere but will stay here in Ohio either because they have weighed the options and made the positive decision to stay or due to inertia.  With Ohio’s population growing at less than 50% of the U.S. average, our governor and legislators don’t really care why you stay.  They are just glad you are here. 

But let’s say that you are thinking about moving.  Becker’s Payer Issues has released a new report listing the best and worst states for Medicare.  This is the link.  The table also includes the District of Columbia. 

“The healthcare research foundation evaluated states on criteria spanning four domains: access to care, quality of care, costs and affordability, and population health. These performance indicators draw from CMS, federal surveys and other public data sources. The Commonwealth Fund ranked states according to how well Medicare was working based on those indicators. The organization mostly reviewed data from 2023 through 2025.” 

There are a few surprises in the list.  The first five states are Vermont, Utah, Minnesota, Rhode Island, and Colorado.  You were hoping for a beach and warm temperatures.  In a Chamber of Commerce moment, Ohio ranks 25^th.  Florida came in #40, just a touch better than Alaska (Polar bears may or may not have factored into this report).  If you have been reading these blogs over the last 15+ years, you know which states were the worst.      

     41. Alaska

     42. Georgia

     43. New Mexico

     44. Alabama

     45. West Virginia

     46. Texas

     47. Arkansas

     48. Oklahoma

     49. Kentucky

     50. Mississippi

     51. Louisiana

Residence of these states have the lowest life expectancy, and the highest rates of uninsured.  It may be reasonable to ask if Speaker of the House, Mike Johnson, is representing G-d’s Waiting Room. 

My advice is to learn to ski and move to Vermont or to stay in Ohio and hope that climate change improves our weather. 

Dave 

Health Insurance Issues With Dave

Picture – Some Of Us Will Stay – David L Cunix

 

 

Is Your Senator Killing You?

 

We are still in a government shutdown and we are still covering the number one cause of this impasse – the extension of the Expanded Tax Credits for the Patient Protection and Affordable Care Act (Obamacare).  The Republicans intentionally left these important middle class benefits out of their Big Beautiful Bill.  This is the only chance the Democrats have to salvage our health insurance, the way most Americans access and pay for health care. 

Senator Patty Murray (D-WA) published a list of the ten states that would see the highest family premium increases if the Republicans refuse to extend these tax credits.  The names of the states, and their Senators, always appear on lists like this. 

     State                                                 Percent of Increase

1.   West Virginia                                 387%

                Senators – Shelly Moore Capito (R) and Jim Justice (R)

2.   Wyoming                                       382%

               Senators – John Barrasso (R) and Cynthia Lummis (R)

3.   Alaska                                            346%

               Senators – Lisa Murkowski (R) and Dan Sullivan (R)

4.   Tennessee                                      320%

               Senators – Marsha Blackburn (R) and Tom Cotton (R)

5.   Mississippi                                     314%

               Senators – Roger Wicker (R) and Cindy Hyde-Smith (R)

6.   Texas                                              289%

               Senators – John Cornyn (R) and Ted Cruz (R)

7.   South Carolina                              285%

               Senators – Lyndsay Graham (R) and Tim Scott(R)

8.   Alabama                                        284%

               Senators – Tommy Tuberville (R) and Katie Britt (R)

9.   South Dakota                                235%

               Senators – John Thune (R) and Mike Rounds (R)

10.  North Dakota                               234%

               Senators – John Hoeven (R) and Kevin Cramer (R)

As this blog has noted, many of the above named states will have the highest percentage of uninsured and their residents have the lowest life expectancy. 

Per the United States Census Bureau, the state with the highest number of uninsured is Texas.  But you knew that.  Per the last available data, 2022, 18% of Texans, nearly one in 5, don’t have health insurance coverage.  That is almost 5 million people.   In case you’ve forgotten, Texas is represented in the US Senate by Republicans John Cornyn and Ted Cruz. 

The World Population Review lists the life expectancy for all 50 states and the District of Columbia.  According to their website, these are the factors that will affect life expectancy: 

“In general, life expectancy is based on two major factors: genetics and lifestyle choices. These include—but are not limited to—gender, access to quality health care, hygiene, obesity, diet and nutrition, exercise, and crime rates. Overall, the highest life expectancies appear in the healthiest states. Additionally, women tend to live longer than men. In 2021, American men could expect to live 73.5 years on average, while American women could expect to live 79.3 years—a 5.8-year gap.”

The gap between men and women is, on average, 5.8 years.  But the gap between Hawaii (79.9), represented by Democrats Brian Schatz and Mazie Hirono, and Mississippi (70.9) is NINE FULL YEARS.  And yes, there is a pattern. 

   State                                                 Average Life Expectancy

50.  Mississippi                                    70.9

               Senators – Roger Wicker (R) and Cindy Hyde-Smith (R)

49.  West Virginia                                71.0

               Senators – Shelly Moore Capito (R) and Jim Justice (R)

48.  Alabama                                       72.0

               Senators – Tommy Tuberville (R) and Katie Britt (R)

47.  Louisiana                                    72.2

               Senators – Bill Cassidy (R) and John Kennedy (R)

               Also – Speaker of the House – Mike Johnson (R)

46.  Kentucky                                       72.3

               Senators – Mitch McConnell (R) and Rand Paul (R)

 

On the other end of the spectrum:

1.   Hawaii                                           79.9

               Senators – Brian Schatz (D) and Mazie Hirono

2.   Massachusetts                               79.6

               Senators – Elizabeth Warren (D) and Ed Markey (D)

3.   Connecticut                                   79.2

               Senators – Richard Blumenthal (D) and Chris Murphy (D)

4.   New Jersey                                    79.0

               Senators – Cory Booker (D) and Andy Kim (D)

5.   New York                                       79.0

               Senators – Chuck Schumer (D) and Kirsten Gillibrand (D)  

There is an obvious correlation between access to health care and life expectancy.  It may be just coincidental that states led by Democrats and represented in the Senate by Dems seem to enjoy the highest percentage of insured citizens and the highest life expectancy.  Could be.  Take a look at the charts and tell me if you see a pattern.  Ohio is now at 12^th from the bottom in life expectancy.  We could crack the bottom 10 soon. 

So here is a question to ponder while we wait to see if the Republicans will relent and extend the expanded tax credits, is your Senator killing you?  It is nothing personal.  Trust me.  Senator Jon Husted doesn’t know your name and, more importantly, he really doesn’t care. It’s not his job to care.  Your access to health care may depend on how the votes go in the next week. 

Or you could move to Hawaii.

Dave

Health Insurance Issues With Dave

Picture – They’re Killing The Grass, Too – David L Cunix

                                                           

Reality Used To Be A Friend Of Mine

 

Quick Note – I sincerely apologize to the five or six of you, my regular readers, who wondered what happened to this blog.  Between the closing of my office and a little health care issue, I have not had the opportunity to address all of the craziness of the last few months.  

 

Vice President Gary Nance, played by Ben Kingsley, talked about how he got started in politics in the movie, “Dave”.  He was motivated to help his community.  He was motivated to do GOOD.  And I wonder, each time I think about that movie and everyday when I watch our politicians, like Speaker of the House Mike Johnson, on TV, when doing GOOD no longer became their defining purpose.  I refuse to believe that the majority of our elected officials have abandoned such basics as honesty, human decency, and the desire to help our fellow citizens, especially those most in need.  But I could be wrong. 

Today’s post is going to get into the details, the details for how Congress passes legislation and the consequences of said legislation.  There will be a lot of links to take you to the source materials.  Of course this is an opinion piece, but I am providing you with the facts to back up my conclusions.  Read the materials.  Please share with me your conclusions.  You may, or may not, agree with me. 

Reconciliation – This must be our starting point.  Per the Brookings Institute:

“Reconciliation is, essentially, a way for Congress to enact legislation on taxes, spending, and the debt limit with only a majority (51 votes, or 50 if the vice president breaks a tie) in the Senate, avoiding the threat of a filibuster, which requires 60 votes to overcome. Because Republicans have 53 seats in the Senate—plus a Republican vice president—reconciliation is a way to get a tax-and-spending bill to the president’s desk even if no Democrats support it.” 

We start with Reconciliation because that is how the Republican controlled Senate was able to pass H.R. 1, The Big Beautiful Bill.  This legislation could not have passed otherwise.  The bill specifically includes certain provisions, such as tax cuts for certain groups, and intentionally reduces the access to benefits, such as Medicaid.  The bill also intentionally chooses to ignore the need to extend the Patient Protection and Affordable Care Act (Obamacare) enhanced tax credits.  These were choices made by the Republicans.  There were no negotiations.  They had enough votes to pass H.R. 1 through Reconciliation. 

The expanded tax credits are addressed at Congress.gov:

“Summary

Although the premium tax credit (PTC) has been available since 2014, there is increased congressional interest in the federal subsidy due to the impending expiration of a provision that enhanced the PTC.

The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) established the PTC to help eligible households lower their payments toward premiums for qualified health plans offered through health insurance exchanges. The American Rescue Plan Act of 2021 (ARPA; P.L. 117-2) expanded eligibility for and the amount of the PTC for tax years 2021 and 2022. The Fiscal Year (FY) 2022 Budget Reconciliation Law (P.L. 117-169) extended the ARPA provision for three additional tax years, 2023 through 2025.

In general, the enhanced PTC provision allowed more households to become eligible for the credit and provided larger subsidies to all eligible households, compared with ACA-only rules. As a result, federal expenditures for the PTC were larger under ARPA/FY2022 Budget Reconciliation Law rules than under ACA-only rules.

If the enhanced subsidies expire, the Congressional Budget Office (CBO) estimates a decrease in enrollees with subsidized exchange coverage resulting in a reduction in federal expenditures. CBO also estimates that expiration of the enhanced PTC would contribute to a rise in the uninsured rate.

If the enhanced subsidies are permanently extended, CBO and the staff of the Joint Committee on Taxation estimate an overall increase in exchange enrollment leading to an increase in the federal budget deficit.” 

Please note that this current online document from the CURRENT Congress details the importance of the premium tax credits in reducing our rate of uninsureds.  Health insurance is the way most Americans access and pay for health care.  

Let’s go back to the first meaningful and positive tweak to Obamacare, the March 2021 expansion of the premium tax credits to more accurately reflect the realities of the market.  This is the CNN report from March 31, 2021: 

“More help to buy health coverage

The boost in aid is part of Biden’s effort to get more Americans covered by health insurance. The relief package makes two changes to the subsidies to address long-standing complaints that Obamacare plans are not affordable for many people, particularly the middle class.

Enrollees will pay no more than 8.5% of their income toward coverage, down from nearly 10%. And lower-income policyholders will receive subsidies that eliminate their premiums completely.

Also, those earning more than 400% of the federal poverty level – about $51,000 for an individual and $104,800 for a family of four in 2021 – will become eligible for help for the first time.” 

The purpose of the change was to help Americans, to do good.  And it did.  The expanded tax credits really helped our clients over age 55.  Individuals in the early sixties, many suddenly force to purchase their own coverage for the first time, were only able to afford the purchase of health coverage because of the extended premium tax credits. 

The Big Beautiful Bill intentionally allows the extended premium tax credits to end.  Many older Americans, age 55 to 64, will no longer be able to afford comprehensive coverage.  The healthiest of them will opt for short term coverage or to be uninsured.  Both options only work if you never get sick or injured.  The unhealthiest will find some way to stay insured.  This only serves to make insurance even more expensive.  The term is Death Spiral.  In this case, the damage is intentional. 

Sequestration – Per the Congressional Budget Office:

“Sequestration refers to automatic spending cuts that occur through the withdrawal of funding for certain (but not all) government programs. CBO provides estimates of the statutory caps on discretionary funding and an assessment of whether sequestration might be necessary under current budgetary rules, but the Administration's Office of Management and Budget makes the ultimate determination of whether a sequestration is necessary and, if so, how big it should be.”

The Big Beautiful Bill adversely affects your access to health care by intentionally driving up the deficit.  This will, in turn, cause automatic cuts in the budgets of the entire social safety net, INCLUDING MEDICARE.  This is the link to the CBO response to the question, “Would Sequestration impact Medicare?”

We, meaning anyone interested in fighting to preserve our current system of accessing health care, have one last chance – the current fight in the U S Senate.  The Senate Majority Leader, John Thune, is asking the Democrats to just let everything go through for now.  There is plenty of time to address these issues in November.  No, if this isn’t addressed now, it will not be done at all. 

None of this should come as a surprise.  Many of us spent all of the summer of 2024 discussing the Heritage Foundation’s Project 2025.  My blog posts included a link to a searchable online version that helped many of us to fully understand the potential danger.  The Heritage Foundation has removed that online document.  Instead, I can provide you with the link to the Project 2025 Tracker.  Yes, someone is meticulously monitoring the dismantling of the federal government by Russ Vought, the Director of the Office of Management and Budget. 

Few would argue that Obamacare is perfect.  It was perceived to be the best legislation that could be passed through Congress at the time.  It has survived over a decade of political grandstanding and sabotage.  But the core was the attempt to help more people access and pay for coverage.  Steven Brill wrote a thoughtful piece in June 2017 that detailed nine ways to fix Obamacare.  I can’t imagine Mike Johnson having any desire to read the article, much less implement any of the ideas. 

This has been a long article, but I hope that I have put the current government shutdown into perspective.  I would like to believe that our elected representatives have our best interests at heart.  That all of these shenanigans are just a difference in perspective.  But reality used to be a friend of mine.  I’m afraid that we can no longer pretend that we are having an honest difference of opinion of how best to help the American people. 

Dave 

Health Insurance Issues With Dave

Picture – Some Things Must Be Stopped! – David L Cunix