Chutzpah

The old definition of Chutzpah – A man kills his parents. He is tried and convicted. As the court is about to announce his sentence, he stops the judge and begs for mercy because he is an orphan. That’s Chutzpah.

The new definition of Chutzpah – After the Trump Administration has spent the last eighteen months intentionally destabilizing the health insurance marketplace, Alex Azar, the Secretary of Health and Human Services, publishes an article in the Washington Post with the headline “Obamacare forgot about you. But Trump didn’t.” That’s Chutzpah.

Mr. Azar uses about a thousand words to trash the Patient Protection and Affordable Care Act (Obamacare), decry the rising premium costs that only some people have to pay, and tout the expansion of short term health insurance options. He unfortunately ran out of space before he had an opportunity to mention any of the consumer benefits of the PPACA (guaranteed issue, coverage for preexisting conditions, etc…) or how President Trump and his administration have played a significant part in the premium increases for 2018 and 2019.

One of the points that Secretary Azar hammers is that people who get subsidies through the marketplace aren’t as negatively impacted by premium increases as those of us who pay the full premium. Yes, and the sun rises in the east daily. This blog detailed how Mr. Trump’s Executive Orders and Trumpcare would balloon the deficit and raise premiums. This was all explained last October. Eliminating the funding for the Cost Sharing Reduction and the penalty for healthy people choosing to forego coverage (Individual Mandate) have had the predictable results. The creation of an alternate health insurance marketplace for the young and healthy (Short terms on steroids) will only escalate the pricing crises. It is hard to believe that someone with Mr. Azar’s resume wouldn’t know all of this, wouldn’t be able to explain this better than me, were he not a member of this Cabinet.

Mr. Azar wants us to know that President Trump didn’t forget us. This may a good time to pray for amnesia. That and that Chutzpah is only fun to watch when you aren’t involved.

DAVE

www.cunixinsurance.com

Picture – David L Cunix – He Had 4 Of A Kind

 

Meet The New Boss

I felt like a time traveler. I was in a Mayfield Heights home, standing in a packed living room, listening to a political candidate dismantle the current administration’s (mis)handling of our country’s health care system. Point by point the candidate highlighted the president’s statements and actions. It was like shooting fish in a barrel. The audience agreed with every point. Many of those in attendance volunteered to take yard signs and campaign.

I would have had a difficult time disagreeing with the generalities. I even found some of the details and potential solutions realistic. But I still felt that I had been here before.

The advantage/disadvantage of a blog is the existence of a paper trail. OK. Now What? was published on November 3, 2010, the day after the Republicans regained control of the U.S. House of Representatives.

The Patient Protection and Affordable Care Act succeeded in energizing the opposition. Even centrist Democrats and Republicans were outraged by this combination of government overreach and intellectual dishonesty. Democrats representing swing districts, like John Boccieri, were pressured into supporting a bill that almost single-handedly caused their defeat.

Republicans have campaigned against the PPACA. Some have implied, some have even promised, to repeal this legislation. Can this legislation, passed only seven and a half months ago, be reversed? And, more importantly, do the Republicans want to?

NO and NO.

The Patient Protection and Affordable Care Act is not going to be repealed or reversed anytime soon. Oh, I’m sure Speaker-designate John Boehner will run a bill through the House. It will be great political theater. And, it will be risk free. The legislation won’t get through the Senate, and even if it did, it would be vetoed by the President.

I sincerely doubt that the Republicans would want to repeal this legislation. This is a fundraising bonanza. Campaigning against PPACA is far more profitable than solving the problems that necessitated the law.

So, we have a bad bill and the real possibility that cynicism may rule the day. Plus, we have yet to mention the insurers who have already spent millions to comply with the new rules and regulations. I firmly believe that the insurers have devised a path to real success under a government run health plan where they provide supplementary coverages. The major insurance companies would then have no desire to repeal the law.

We are quickly approaching the next calendar triggers of the health care legislation. It is possible that the Republican lead House of Representatives, far more interested in extending the Bush era tax cuts than anything else, might tackle meaningful reform in early spring. In a yet to be exhibited act of political maturity, the House could even draft a bill to limit and refine the PPACA. Such legislation could be passed by the Senate and signed by the President. It is possible. I leave the question of probability to you.

That was eight years ago. We are on the verge of a Blue Wave. Some of the people swept into office will be as prepared as the candidate I heard Sunday afternoon. Some will just be talented at pointing out President Trump’s obvious shortcomings. Now, before the election, is the time to talk to the candidates. Help them understand that health care is more than just a fundraising vehicle and that talking points don’t pay for medical bills.

Pray that we don’t get fooled again.

DAVE

www.cunixinsurance.com

Pictures – David L Cunix - New Boss and Old Boss

Make Insurance Cheap Again

The Wall Street Journal has never been a big fan of the Patient Protection and Affordable Care Act (Obamacare). The paper has added gravitas to even the flimsiest of the alternate plans offered by the Republicans over the last few years. But, the WSJ has also featured some of the deepest thinkers of the Conservative Movement. One of these brighter stars is John C. Goodman, president of the Goodman Institute for Public Policy Research.

The Goodman Institute has been the intellectual force behind such policies as the recent Paul Ryan “Better Way” tax reform and other tax and health initiatives promoted by Republicans over the last twenty plus years. I confess that I have not been a big fan of their work. A recent Opinion/Commentary piece from Mr. Goodman appearing in the WSJ did nothing to change my opinion. Here is the link to the article.

My initial impression was that Mr. Goodman had strung together an interesting collection of non-sequiturs. Texas, the state that had the nation’s highest rate of uninsured, 27%, prior to the inception of Obamacare, appears to be a hot mess where the insurers and providers are still trying to get onto the same page. We in Ohio are happy to not be Texans! In Greater Cleveland we have watched the Cleveland Clinic partner with New York based Oscar to form a new partnership and Medical Mutual of Ohio cement a new relationship with University Hospitals. It is a process and it is not without flaws. 2019 could be better.

I would have dismissed Mr. Goodman’s musing had it not been for this:

What’s driving this race to the bottom? The problem starts with the community rating system, which requires insurers to charge the same premiums to all comers regardless of health status.

Do you want cheap insurance? Do you want great coverage with access to the world’s best doctors? According to Mr. Goodman and the politicians promoting his agenda, all we need to do is to return to medical underwriting. We can save you a lot of money, if we are allowed to price our policies based on your health. Of course, that only works, you only save money, IF YOU ARE HEALTHY AND STAY HEALTHY. If you aren’t? Oh well.

This blog started discussed the pitfalls of Community Rating in October 2009. We, the insurance industry, can base our rates on you and the risk you present. We have the statistics. Age, gender, location, health status, hobbies, occupation, and even driving habits can impact your likelihood of having a claim. One hundred years ago the insurance companies even charged premiums based on race. The numbers, the math, determines the premium. If we, as a society, choose to ignore or minimize these factors, the premiums are deemed to be fairer, especially if you are getting a lower rate. The PPACA has insurers ignoring gender, health conditions, occupations, and hobbies. The premium ratio between a 62 year old and a 22 year old was about 5 to 1 in 2013. The PPACA limits that ration to 3 to 1. All of these changes impact premiums. Some people pay more. Some people pay less. And some now qualify for coverage when they would have been turned down a few short years ago.

Do we want to return to medical underwriting?

The Kaiser Family Foundation estimated that 52 million Americans would be declined for insurance if forced to submit to medical underwriting. G-d knows I would be declined if my insurer was given a chance to ask me health questions. And I remember what it was like to tell my clients that they were not eligible for regular health insurance coverage. Is that the solution?

Maybe it is just different in Ohio. Maybe the concept of 27% uninsured seems like a bigger deal here, a place where a Republican governor fought to expand Medicaid to provide coverage for the working poor. Taking insurance away from other people doesn’t make your insurance cheaper, not in the long run, not if we are going to treat the sick and injured. Insurance is simply the way most Americans access and pay for care. There can’t be cheap insurance paying expensive health care. The two go hand in hand. Managing health care costs, whether that is through provider networks or other limitations, will have to be part of the discussion.

Make Insurance Cheap Again? It was never cheap for some of us.

DAVE

www.cunixinsurance.com

Picture – David L Cunix - Turning Back The Clock