The Next Procedure

 

I was reminded of the Billy Joel song: 

Live long enough you get a Cataract, act, act, act, act

            You ought to know by now 

I may have misheard the lyrics.

 

Dr. K. delivered the news last Tuesday.  I was not surprised.  Most people lucky enough to reach their 70’s will develop a cataract on one or both of their eyes.  Plus, Dr. K. told me that this was inevitable while he was treating my torn retina last year.  This is not an emergency.  Last year I overheard two doctors:

“We have to get him next Tuesday”

“We’re booked”

“Get him scheduled.  We’ll make it work”

This is more chill.  I will see the specialist next month.

 

There is no reason to be concerned.  We all know plenty of people who have had cataract surgery.  Most brag about their improved vision.  There are plenty of websites, mostly from providers, touting the success of the new procedures.  I do have one friend, a doctor known for his wit that he wields like a blunt instrument.  He told me not to worry.  If the surgeon screws up, I still have another eye.  We all know someone like him… 

As this blog has noted in the past, I am on Original Medicare and I have Medicare Supplement Plan G.  I have already satisfied my $283 deductible for 2026.  I am free to go to any doctor, any facility, any place in the United States that accepts Medicare.  University Hospital has taken pretty good care of me, so there is no reason to look elsewhere.  The basics are under control. 

My questions to you, my readers, are about your experiences with cataract surgery.  Some of you will feel comfortable posting your responses in the comment section.  Some of you will send me emails at dave@ohiohealthinsurancellc.com  That is your choice.  I am interested in your answers now and those readers a touch younger may also find your information useful. 

1.      Which type of Intraocular Lens did you choose?  Why?

2.      How long was it before you could drive safely?

3.      How long before you could read a book?  With or without glasses?

4.      What surprised you? 

5.      How long did you wait before you had this surgery on your other eye?

I’m sure that I should, and will, have lots of other questions, but these are a good start.  I look forward to your answers. 

Dave 

Health Insurance Issues With Dave 

Picture – Polish The Fender – David L Cunix

The Key To Success Is Sincerity

 

I was captured by the sincerity of his voice.  Gentle.  Reassuring.  But most of all, sincere.  The voice was coming through my radio, but it seemed like he was sitting next to me.  His message was clear.  If I was a good person, a person of faith, I could join his club.  And as long as I didn’t need a car now, he and the other members of his club would help pay for a car if/when I ever needed one.  Yes, other good people would care so much that they would actually pray for me and help me pay for my car.  This alternative way to pay the high cost of an auto purchase was the smart way for people like us.  Even their toll-free number, 1.800.xxx.xxxx, spoke of a higher purpose.  The friendly operator told me that the State of Ohio is promoting this program.  My monthly payments to the club are tax deductible!  I was impressed and immediately signed up.  I am telling you all of this because I am in shock.  It has been two years and now I really need a car.  I went into the dealership, picked out a car, and showed the car salesman my membership card.  He laughed and asked me how I was going to pay for the car.  He wanted money, NOW, or for me to apply for a car loan, NOW.  I have to buy the car.  People may send me nice notes.  They may pray for me.  Some might even send money.  It turns out that none of this is guaranteed.  None of this is regulated by the State of Ohio.  My bills are my own and I don’t know if I can afford a car now that I really need one. 

There really aren’t commercials on the radio for a join now – get a car when you need it club.  There are politicians pushing for alternative, cheaper ways to cover your future health care costs.  Some of these plans are very, very high-deductible plans that only focus on major hospital care.  Some are association plans that purposely neglect to cover conditions as common as pregnancy.  And then there are the health care sharing ministries that offer something that could help pay for your health care, but are NOT INSURANCE.  I put those words, NOT INSURANCE in all caps, because you might have a hard time figuring that out if you hear their commercials or visit their websites.  The alternative plans, whether they are actually insurance or not such as most of the association and Share Plans, have several things in common:

·         The plans are underwritten.  You may or may not be accepted.

·         These plans do not cover preexisting conditions.

·         Insurance plans are regulated by your state’s Department of Insurance

·         Most association plans (like the Farm Bureau) and Share Plans are exempt from all state insurance regulation since they are NOT INSURANCE.

·         In the case of the Share Plans, paying your claim is optional.  You are responsible for the bills you incur.  People may choose to ignore you in your time of need, send you their thoughts and prayers, or send you some money.

I visited the websites from a couple of the larger Share Plans:

1.      Liberty HealthShare

2.      Medi-Share

These look like insurance websites.  There are plenty of stock photos of happy, smiling individuals, couples, and families.  There are bold numbers and tons of promises.  You will be hard pressed to find the line that says that these aren’t insurance plans.  If you visit these websites, you might believe that you could access care anywhere.  But you can be denied non-emergency care if you take their plan into a doctor’s office or your local hospital.  The medical provider can, and probably will, require you to pay for all services in advance or to apply for financial assistance. 

Do these plans work?  The honest answer is sometimes.  There are people who value the notes and prayers almost as much as the money according to one member of the Ohio House of Representatives.  Others are not quite as happy.  As an agent, I have had to try to help cancer patients find real coverage once they’ve learned that having a Share Plan didn’t mean that their bills were going to be paid.  The reviews are less than positive.  Here is one link to reviews.  Here is another. In all fairness, the reviews for Liberty were more positive.  The real problem with non-insurance is that there is no real way to know if your claims will be paid or if you will be reimbursed. 

There are legislators on both the state and federal level that decry the high cost of health insurance.  Normally their complaint is centered on Obamacare, the Patient Protection and Affordable Care Act.  Some of their issues are legitimate, some purely political.  This blog has detailed the 15 year effort to sabotage Obamacare, noting that there has never been a viable alternative proposed nor an answer as to how we could properly cover the millions of Americans with preexisting conditions.  The Kaiser Family Foundation has noted the rise in alternative health schemes and risks associated with these plans.  Those pushing alternative plans for the purpose of the short term premium savings are simply removing healthy people from the insurance pool, which in turn raises the prices for everyone left.  You can not fund a health care system with only the sick and the responsible participating. 

Some of you may be old enough to remember, “We have to destroy the village to save it”.   Our legislators in Columbus are trying to apply that solution to our health care system with Ohio House Bill 21, Enact the Health Care Sharing Ministries Freedom to Share Act.  This legislation attempts to make Health Care Sharing Ministries a legitimate funding alternative to health insurance for Ohioans.

1.      It begins by making sure that there is no regulatory oversight.  They are exempt from all insurance regulation

2.      The monthly payments are deductible.  The lobbyist for the Samaritan Ministries stated in written testimony, “Lastly, HB 21 will allow HCSM members to deduct the shares they send to other members on their Ohio state tax returns. Nearly 50% of our members are below 200% of the poverty line and choose to forgo Medicaid; many also live in rural areas where health care options are limited. These tax savings will make a meaningful difference for thousands of Ohioans.”  Medicaid eligible people seldom need a tax deduction.  Is the purpose of the tax deduction to entice some wealthy individuals choose to contribute to a stranger’s bill?  Of equal value, the tax deduction grants legitimacy and will be a selling point to the gullible.  This does create a new class of tax deductions since it is not insurance and it isn’t a charity.

3.      Students at Ohio universities would be allowed (encouraged) to opt out of their mandatory health insurance requirement if they purchase a Health Share Plan.  Who will pay their unpaid bills?  We might as well have them buy two tin cans and some string and tell them to pretend they have a phone. 

You can not depend on a club to buy you a car.  And health insurance is still the way most Americans access and pay for health care. 

George Burns is credited with saying, “The key to success is sincerity, if you can fake that you’ve got it made”.   We need more than sincerity, real or fake, to cover our medical expenses.  We need insurance. 

Dave 

Health Insurance Issues With Dave 

Picture – A Mouse And A Free Car – David L Cunix

The Blind Men And The Elephant - 2026

 

 

 

No, I am not recycling titles.  This post is an update of sorts to the May 22, 2015 blog of the same name. 

Dan Crenshaw (R-TX) was on Bill Maher’s show last week.  Though he consistently supported the administration’s agenda and reliably parroted all of the talking points, he still failed to get President Trump’s endorsement.  He lost in the March primary.  Now, with eight months left, he COULD, COULD deviate from the script when discussing health care in general or Obamacare in particular.  Not Dan.  Never Dan. 

It has been eleven years since I wrote a blog detailing the ways an E/R doctor, a chiropractor, and a psychiatrist perceived the Patient Protection and Affordable Care Act.  Their impressions of the law, like mine, were informed by their personal experiences.  For providers, this often meant how much they were paid for the procedures and services they performed as well as how hard it was for them to get their money.  Agents see which clients can now have insurance (private or public) to help them access and pay for health care.  We also see people who once had health insurance but are now exiled from the market. 

I am reminded of the story of the blind men and the elephant. In the ancient Jain version, six blind men are asked to describe an elephant. They each feel a different part of the animal. Each is convinced that he, and he alone, understands the nature of the beast from his limited contact. 

I never pretend that I see the PPACA in its entirety.

One of my friends recently corrected me.  He noted that I often refer to Louisiana as G-d’s Waiting Room.  He insists that that is Florida, a legitimate retirement destination.  Louisiana, hardly a destination for anyone, actually had population declines for most of the last five years.  But I’m not focused on elderly pensioners in golf carts.  I am interested in access to health care, the quality of said care, and the roadblocks erected by the state, local, and congressional leaders from the state.  And that is why this blog has so often discussed Texas and Louisiana, two states that would be happy to impose their level of awfulness upon the entire country. 

My perspective comes from nearly fifty years in the insurance business.  I worked with small businesses and the self-employed through most of my career.  Policies effective prior to the start of the PPACA in January 2014 were subject to underwriting.  We asked lots of health questions, as well as your occupation, driving record, hobbies, travel plans, and even criminal history.  The wrong answer might result in a higher price (rating), an exclusion for the treatment of certain illnesses or hobbies (rider), or you could be declined.  I was forced to say “NO” more often than I liked.  And I spent a lot of time looking for backdoors into the system.  Agents fought the insurers for their clients.  I find it odd how few people remember that fight.

Agents also had another fight, one that often seemed even more difficult.  Though we had many employers who only wanted the best for their families and their employees, we also had our fair share of employer clients who needed to be convinced to adequately cover their employees.  I will never forget the doctor and his wife who told me, “I know that the contract says that I have to provide health insurance for my nanny, but it doesn’t say that it has to be good insurance.”  That was 30 years ago when deductibles were $100, $250, or $500 and they wanted a plan with a $10,000 deductible.  There were machine shop owners who wouldn’t bother to provide insurance that included the doctors seen by their foreign-born employees.  Those employees couldn’t or wouldn’t work elsewhere.  They were stuck.  Many of us viewed the employees, not just the employers, as our clients.  We expended a ridiculous amount of energy helping them access and pay for the health care they needed. 

When I see Texas, the state with the highest number of uninsureds, export the Ken Paxton lawsuit chaos designed to invalidate the PPACA or to eliminate preventive care, I think of those machine shop employees.  Texas is a large state.  Their congressional delegation has enough weight to impact the rest of us.  And Louisiana?  Becker’s Payer Issues has released a new report listing the best and worst states for Medicare.  Louisiana, the home to Mike Johnson, the Speaker of the House, and his Majority Leader Steve Scalise is ranked dead last.  Louisiana ranks near the bottom on most tables such as life expectancy (47^th).  And I keep thinking of that doctor, not the feckless Dr. Bill Cassidy (R-LA), no, the one who would cheat his underpaid nanny. 

I still see the Patient Protection and Affordable Care Act, even after all of the intentional harm inflicted on it over the last 15 years, as a step towards helping Americans access and pay for health care. 

We are all blind men standing around the elephant.  We will describe what we perceive.  And guys like Dan Crenshaw will always be positioned directly behind the beast. 

Dave 

Health Insurance Issues With Dave

Pictures – An Elephant? Really?

                 A Behind The Scenes Peek at Health Insurance Issues With Dave

            Both – David L Cunix

 

 

The Intelligence Is Artificial. The Pain Is Real.

 

 

"Dave, I know you are retired, but can I ask you a Medicare question?"

My answer, of course, was “Yes’.  The fact that we were in Costco and any time I spent talking with her was time I didn’t spend by the samples, was a bonus.  

Lori (name changed) has been on Medicare for several years.  She also suffers from significant neck and shoulder pain.  She has seen doctors affiliated with both of our major hospital systems.  Her Original Medicare and Medicare Supplement have provided excellent access to care.  She has been to doctors, pain management specialists, and the sports medicine departments.  Her current doctor prescribed a cortisone shot in her neck.  Please follow this link if you are not familiar with this procedure. 

“How much pain do you have to be in to accept a cortisone shot in your neck?”  

Her question painted a picture.  Her shot was scheduled for early January.  We were talking during the first week of March.  She was still waiting for the shot.  And she was not alone.  Lori’s current doctor, a pain management specialist, has over a dozen patients waiting for government approval. 

“Why do we suddenly have this pre-approval step in Ohio, but residents of other states don’t?  And why are they doing this?” 

The “Why” is an easy question to answer.  MONEY.  The details are a touch more complicated. 

This article appeared in the KFF News in September 2025:  AI Will Soon Have a Say in Approving or Denying Medicare Treatments - KFF Health News. 

Taking a page from the private insurance industry’s playbook, the Trump administration will launch a program next year to find out how much money an artificial intelligence algorithm could save the federal government by denying care to Medicare patients. 

The pilot program, designed to weed out wasteful, “low-value” services, amounts to a federal expansion of an unpopular process called prior authorization, which requires patients or someone on their medical team to seek insurance approval before proceeding with certain procedures, tests, and prescriptions. It will affect Medicare patients, and the doctors and hospitals who care for them, in Arizona, Ohio, Oklahoma, New Jersey, Texas, and Washington, starting Jan. 1 and running through 2031.

Yes, Ohio.  Your friends in Michigan or in G-d’s waiting room, Louisiana, don’t have to jump through AI hoops to access care.  Yet.  Lori’s shot is one of the procedures Dr. Oz wants to target. 

The program is WISeR which stands for “Wasteful and Inappropriate Service Reduction”.  That link is to the Centers for Medicare and Medicaid (CMS) website.  The best real-world explanation of the ins and outs of WISeR can be found on the website of Davis Wright Tremaine LLP.  And yes, if you need to review the attorney’s analysis first, you already know that none of this has anything to do with anyone’s health.   From their website: 

Services Targeted for Prior Authorization

The services eligible for prior authorization under WISeR include:

·         Electrical Nerve Stimulators

·         Sacral Nerve Stimulation for Urinary Incontinence

·         Phrenic Nerve Stimulator

·         Deep Brain Stimulation for Essential Tremor and Parkinson's Disease

·         Vagus Nerve Stimulation

·         Induced Lesions of Nerve Tracts

·         Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

·         Epidural Steroid Injections for Pain Management, Excluding Facet Joint Injections

·         Percutaneous Vertebral Augmentation for Vertebral Compression Fracture

·         Cervical Fusion

·         Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee

·         Incontinence Control Devices

·         Diagnosis and Treatment of Impotence

·         Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis

·         Skin and Tissue Substitutes

·         Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds

·         Wound Application of Cellular and/or Tissue-Based Products, Lower Extremities 

All of these could be wasteful and unnecessary, unless you are the person afflicted.  The AI companies are supposedly not being directly compensated for denying claims, but there is a shared savings arrangement for the vendors.  Your pain is their gain. 

Hospitals are preparing strategies to work with WISeR.  U.S. News recently interviewed Mike Levin, general counsel and chief information security officer at the digital healthcare technology company, Solera Health. 

So the first principle is non-negotiable: Human clinical authority must always be preserved. AI can serve us information, can flag patterns and can generate recommendations. But any coverage determination has to come back to a human: a licensed clinician must review it.

There's an old IBM presentation from 1971 that says a machine can never make a management decision because a machine cannot be held accountable. I feel like that's more applicable now than ever 50-plus years later.

Humans must have the final say.  If you have doubts, you might appreciate this recent article in the Atlantic - My Tesla Was Driving Itself Perfectly—Until It Crashed - The Atlantic. 

Lori and her fellow patients at our local pain clinic are not the only people impacted by this new AI intrusion into Original Medicare.  This was a segment from last weekend’s Velshi - Jacob Ward: AI is being used to ‘disenfranchise’ people on Medicare.  

What are the possible outcomes?  Some people will eventually get the care they need and feel better.  For some, care delayed is care denied.  Their situation will deteriorate and they will never recover.  Some will just give up.  And in the case of unrelieved pain, some will just resort to higher doses of pain medications.  It is hard to feel positive about this.  We chose Original Medicare to avoid the greed of the Medicare Advantage insurers (I don’t need to name them.  You know their names.)  I don’t think any of us ever expected Dr. Oz to implement this controversial cost saving method into Medicare. 

##########          ##########          ##########

This has been quite a year.  There was an unusual growth on my right ear.  Thankfully this was not one of the issues being reviewed by AI.  The dermatologist got me in, examined it, and removed the growth right in the office.  She was sure that it was skin cancer.  The biopsy confirmed her diagnosis.  I had a Mohs surgery on March 5^th.  Everything looks great and I’m fully recovered.  And on a positive note, I am only two procedures away from my own parking spot! 

Dave 

Health Insurance Issues With Dave 

Picture – I ordered the van Gogh – David L Cunix

 

Seventy-one And Counting

 

I turned seventy-one last week, a milestone birthday.  For many of us, anything over 65 is truly a milestone and we tend to celebrate among strangers in medical office waiting rooms.  Last week I had a CT scan on Monday, two Ultrasounds on Tuesday, and an MRI on Thursday.  This week features two doctors’ visits and lab work.  It costs a lot of time and money to prove I’m still here. 

My primary doctor asked me about the differences between Original Medicare paired with a Medicare Supplement vs. a Medicare Advantage plan.  He had a pretty good idea, but he wanted to confirm the reasons why I am on Original Medicare.  Actually, he really understood how this choice had worked so well for me and was trying to learn whether my decision had been well-planned or just a happy accident.  Really?  There are no accidents.  We talked for a few minutes.  Medicare is about 20 years away for him.  He hopes to have the choices I had when I turned 65.  I made no promises. 

My Original Medicare and Medicare Supplement Cards have gotten quite the workout this year.  Over and above the usual stuff, I had a little eye issue in late June.  It started on a Thursday evening.  I felt like I was in my late teens and my then shoulder length hair was flopping in front of my eyes.  I could see these dark waves in front of my face.  The problem was that there was nothing there!  It was not much better the next day.  Dots.  Lines.  My right eye was seeing lots of stuff that wasn’t there.  My secretary looked for these symptoms online.  Ruling out pregnancy, she was positive that it was definitely a serious eye condition. 

·         I called the optometrist that did my last eye exam.  He was too busy to talk.

·         I called a friend, an ophthalmologist at the Cleveland Clinic.  He was not available.

·         I called University Hospital.  I was told that the emergency room at main campus has an ophthalmologist on-call.  I drove to UH, but instead of going to the E/R, I went directly to the ophthalmology department.  They viewed me with a little healthy skepticism but listened to my description of my symptoms.  They took my insurance information and started to exam my eyes.

Let’s stop here for a moment.  You may have noticed that I attempted to see doctors from the two competing medical centers.  I didn’t waste any time verifying network participation.  I didn’t have a referral.  I haven’t asked nor received anyone’s or any insurance company’s permission to pursue care.  I have access to any doctor any facility anywhere in the country that accepts Medicare.  The payment issue has already been addressed and resolved.  Back to my eye care. 

·         The first tests got everyone’s attention.  There were more tests.  I was brought into an exam room and introduced to Dr. K, an experienced ophthalmologist and another doctor on his team.  After another exam he explained that I had four tears in my retina.  One was horseshoe shaped and of real concern.  He outlined a treatment plan that included an immediate laser retinopexy followed by surgery as soon as possible.  He was trying for the following Tuesday.

·         I had two questions:  What is the success rate of these procedures and is this all covered by Medicare?  He quickly answered that there was no problem with MY Medicare coverage.  He pegged the success rate at well over 90%, but if I was in the less than 10% failure rate, I could have a permanent problem.  I would not have believed him if he had said that there was a 100% chance of success.

·         The tests and procedures of that Friday, the surgery on the following Tuesday, and the subsequent follow-up visits and testing have all been covered.  Would a Medicare Advantage plan have covered all of this?  Probably, but I would have been limited to a network doctor, their availability, the possibility of pre-authorization, and I would have had co-payments every step of the way. 

Original Medicare coupled with a Medicare Supplement provide greater access to care.  Would a Medicare Advantage plan have approved all of last week’s tests?  It depends on the company.  As agents we all knew of companies that had the reputation of throwing up roadblocks.  The pre-certification process can take months.  Stall.  Deny.  Submit for “review”.  The insertion of Artificial Intelligence when common sense might be the better choice.  I am bringing this up today because it is front and center in my mind after the experiences some of my friends and I have had recently and because our government wants to insert A I into Original Medicare claims’ management. 

The Center for Medicare Advocacy sounded the alarm this past September.  The program will be tested in Ohio and five other states. 

“The model, designed in theory to cut down on “fraud” and “unnecessary” services, would introduce AI-powered Prior Authorization requirements for about a dozen procedures into Traditional Medicare. What the model would likely do – as has been the case with Prior Authorization in Medicare Advantage – is complicate, delay and even outright deny necessary care.”

This is the link to a recent article posted by the Centers for Medicare and Medicaid (CMS).  WISeR (Wasteful and Inappropriate Service Reduction) Model.  Will I still have the same access this time next year?  I hope so, but there are no guarantees.  What happens if the same people who discourage parents from vaccinating their children suddenly take a jaundiced view of CT scans?  Medical imaging costs a lot of money.  It doesn’t take a lot of effort to convince yourself to not spend the money, once you are predisposed to cutting care. 

Our nation’s leaders are wrestling with the cost of healthcare.  Some, OK a few, really are concerned about the health and wellbeing of their constituents.  Most see this as a line item and the challenge to balance the competing desires of the people pounding on their office doors.  And we are in the middle.  If you, like me, spend a lot of time with strangers in medical office waiting rooms, your concerns are personal and time-sensitive. 

I’m seventy-one and counting.  I hope to have the opportunity to show how good a counter I can be. 

Dave 

Health Insurance Issues With Dave  

Picture – I Couldn’t Find A Stunt Double – David L Cunix

 

Open Sesame

 

We open today’s post by remembering Ali Baba and the Forty Thieves.  It took a magical command to open the cave filled with treasure, “Open Sesame”.  That story, part of the One Thousand and One Nights Arabic folktales, is, of course, fiction.  The story of the American people trying to get Speaker of the House Mike Johnson to open the US House of Representatives is, unfortunately, very real. 

You may recall that Mr. Johnson sent our representatives home for 54 days during the government shutdown so that he could avoid the Discharge Petition that had been created to force the release of the Epstein Files as well as addressing the expiring Enhanced Premium Tax Credit Subsidies of the Patient Protection and Affordable Care Act (Obamacare).  Mr. Johnson recently adjourned the House before Christmas in an effort to stall talks, again, on the subsidies.  The House might be gaveled into session once more in 2025 or he might wait until the first week of January 2026.  And we wait.  You can scream “Open Sesame”, but doing nothing is his superpower. 

This blog has discussed the Enhanced Premium Tax Credits since their inclusion in the American Rescue Plan Act of 2021.  This is the link to the post from March 2021.  Many of us celebrated what was the first meaningful tweak of Obamacare.  What we found amazing was that the elected representatives from the states that would most benefit from this change, states like West Virginia, Tennessee, Louisiana, and Texas, would be the ones leading the fight against this enhancement of the subsidy program.  They fought it at inception and they have worked hard to eliminate these tax credits.  The October 2025 post listed the ten states that would experience the highest rates increases if the subsidies were allowed to expire. 

The rate increases that so many of you are about to pay were inevitable.  The number of rural hospitals that will close due to the rise in the number of uninsured and under-insured will not be a surprise to our leaders in Washington.  And as each rate increase puts comprehensive coverage out of reach, our health insurance system, the way most Americans access and pay for health care, will enter into a death spiral. This blog has been detailing the intentional sabotaging of our system since 2017, but a post from February 2025 brought a lot of this up to date.  This blog also presented a detailed explanation of Project 2025 in the July 2024 post.  If you don’t know how we got here, you aren’t prepared to stop the destruction we are witnessing.  It is not too late! 

IF, and this is a big if, if Congress addresses this issue and continues the Enhanced Premium Tax Credit Subsidies, we will need a Special Enrollment Period.  If the work gets done and signed into law in January, Americans will need an opportunity to reevaluate their health insurance options.  This can be done by opening a three month window, such as February, March, and April.  The first step is to get Mike Johnson to open the House. 

The doors, like Congress, seemed impossible to open.  The riddle was “Speak friend and enter”.  The wisest among them could not see the solution, but riddles are meant to be solved.  And Congress, comprised of men and women elected to represent us, is meant to be open. 

Dave 

Health Insurance Issues With Dave 

Picture – Open Just A Crack – David L Cunix

I hope you enjoyed the riddle...

 

The Fog Of Insurance

 

The Fog Of WAR Insurance

 

There currently seems to be a lot of fogs, fuzziness, and outright sleeping through meetings in Washington.  It may be hard to keep track who is bombing who and worse, who is throwing who under the proverbial bus.  But here at Health Insurance Issues With Dave, we aren’t worried about buses.  No, we our concerned about steamrollers, specifically the ones that are about to flatten the insurance buying public.  Wile E Coyote may walk away from his encounter with the steamroller.  We will not be so lucky. 

The fact that The Patient Protection and Affordable Care Act (Obamacare) survived 15+ years of government ineptitude and bureaucracy should not be a surprise.  Government programs often suffer a bumpy start.  But people of good will eventually take the helm and the program moves forward.  Social Security was created in 1935, ninety years ago.   Undoubtedly, many doubted that Social Security would survive the Roosevelt presidency much less last well into the next century.  The real danger to Obamacare has not been government inefficiency.  No, the danger has come from the Republicans.  There has been a concerted effort to villainize this program since its inception.  And now, through sheer neglect, they might finally have their way. 

Today is Sunday, December 7^th.  The fight is different.  Failing to successfully terminate Obamacare head-on, we are witnessing the success of a Republican-controlled House and Senate that has ceded its power to the president and has fully become passive/aggressive.  Their inaction is action.  They will succeed in destroying our health care system by doing nothing.  At least, they are going to try. 

The Enhanced Premium Tax Credit Subsidies were a part of the American Rescue Plan Act of 2021.  This was the first meaningful tweak of Obamacare.  The focus was to make health insurance more affordable by tying the tax credit subsidies to a percentage of the individual’s/family’s income.   These subsidies were a huge help to people age 55 to 64 ½, individuals who pay higher premiums due to their age.  And the enhanced tax credit subsidies of the ARPA also made health insurance affordable to the residents of states that chose to not expand Medicaid.  Many, perhaps millions, of Americans will lose their health insurance if the enhanced premium tax credits are eliminated.  This was the intentional choice of the Republican Congress and Donald Trump.  The One Big Beautiful Bill of earlier this year intentionally excluded the continuation of the enhanced premium tax credit subsidies. 

The Democrats, the insurance industry, and darn near anyone concerned about our health care system have been trying to get the enhanced subsidies extended.  The Republicans are still doing nothing.   Mike Johnson, the Speaker of the House, doesn’t have to pretend that he doesn’t care.  He represents hard-hit Louisiana.  Doesn’t care.  His inaction is action.  

Now, at the 11^th hour, we have a few Republican Senators hoping that the American public will be convinced that talking points and platitudes are the same as a fully vetted alternative to Obamacare.  Spare us the joys of choice, a hodge podge of garbage non-insurance plans from health sharing ministries, association plans like the farm bureau, and indemnity coverage.  You may need magnifying glasses to find the legally required disclaimer that these plans are not really health insurance and are not subject to our insurance laws or regulation.  Or you can find out when you have a claim. 

The Republicans are embracing Health Savings Accounts (HSA).  The idea is to give less help to the people who really need it, but to give them that help in cash.  People with ongoing issues will suffer immediately.  Others will be just one accident or illness away from disaster.  One of the proponents is Senator Bill Cassidy (R-LA).  Thinking of what RFK, Jr. is doing to the Department of Health and Human Services, it appears that Senator Bill Cassidy, a Gastroenterologist, is the Neville Chamberlain of medicine.  This is a link to information on Cassidy’s plan.  The link is real.  The plan is not. 

The cemeteries of Kansas would be full to overflowing if Senator “Doc” Roger Marshall (R-KS) practiced medicine the way he practices health care politics.  Here is the link of his embarrassing appearance on Morning Joe. 

Though Floridians would be devasted by the loss of the enhanced premium tax credit subsidies, Senator Rick Scott (R-FL) prefers to focus on the Health Savings Accounts.  Those familiar with Scott know that when he will be asked about the cost to Floridians, he’ll just take the fifth. 

It is hard for me to watch our health insurance system slowly go over the cliff.  Health insurance is the way most Americans access and pay for health care.  We experienced a terrible defeat on this day, December 7, 1941.  Our nation was forced to come together and we emerged from World War II a better country.  We will overcome this war, this war on the middle class, this war on making life affordable for the average American.  Until then, who can blame you if you have the Steamroller Blues? 

Dave 

Health Insurance Issues With Dave 

Picture – Pen in Camo - David L Cunix