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 18^th 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.

DAVE

http://www.cunixinsurance.com/

Screaming Meemies

I visited the Senate day care center on Friday. The room was filled with Screaming Meemies. One little girl had the word Protocol on her t-shirt. She was standing in the middle of the room, hitting herself in the head with a wooden spoon. It was a big room. On the south side there were several old men in rockers with sobbing babies sitting on their laps. The old men were crying about a past that might not have ever happened. The babies were crying about a future that never will. And in one corner a child kept wailing “nobody likes me” as tears flowed down his face. “Who’s that” I asked Mitch, the facility director. “Oh, him? That’s the health care bill. We found him in a basket on our doorstep a week or so ago. Nobody likes him!”

There are days were it feels like we are all stuck in the Senate day care center. The unexpected firings and resignations, alone, could fill the daily news cycle. Add the Russians, the specter of war, and all of the questions about the economy, taxation, and regulation and we are on overload. Wouldn’t a nap sound good right now? Perhaps a vacation? But we are adults and we don’t have the luxury of allowing ourselves to be distracted. And since this is Health Insurance Issues With Dave, we are going to spend some time with that lonely unloved health care bill.

That also means that we are stuck spending more time with Mitch.

The Senate Majority Leader opened the door and brought into his chamber the bill he never wanted. He could have turned to Senators Susan Collins (R-Maine) and Bill Cassidy (R-Louisiana) who have been working for months on legislation. Both have years of experience on this issue. Or, the Majority Leader could have attempted to create a bipartisan group to draft meaningful legislation like the gang of six in 2009 that worked on the original bill. Instead, McConnell assembled 13 other Republicans, all male, who represented the full diversity of Republican thinking from Conservative to VERY Conservative.

The current fight in the Senate, in those rare moments when they can focus on something other than the President’s antics, has not been about healthcare or preexisting conditions. This being Republican legislation, the first big issue is Medicaid.

Senator Rob Portman (R-Ohio) is being portrayed as a moderate since he has expressed real concern about slashing Medicaid. The Wall Street Journal is reporting that Senator Mike Lee (R-Utah) and others are “weighing faster and steeper cuts in Medicaid”. The question is never about who is served by Medicaid and how much is really needed to provide for their care. That doesn’t appear to be relevant. The issue is strictly how soon can Medicaid funding be cut and by how much.

We might want to remember that Medicaid serves a number of communities. The schools depend on Medicaid funding to help defray the cost of educating children with disabilities. The AP quoted Kriner Cash, superintendent of the Buffalo, New York public schools. 80% of his students are low income and 22% have disabilities. The district currently receives approximately $2.5 million annually from Medicaid.

…individual student care comes with highly variable costs, especially in the case of students with disabilities.

Those costs would not be considered in a system where money is allocated on a per person basis regardless of need. And need does not appear to be relevant to our senators.

At some point our senators may resolve the Medicaid issue to their satisfaction and then move on to preexisting conditions, maternity care, and the Essential Health Benefits. Or not. The Senate may just cobble together something as unsatisfactory as the American Health Care Act, but set it up where their bill wouldn’t go through reconciliation so that the Democrats can kill it with a filibuster. That is a scenario only someone as cynical as Mitch McConnell could orchestrate.

The reporters are trying to get details about the latest Trump debacle and Senator Collins just plaintively asked if we could have just one day without chaos. There is a lot of unhappiness in the Senate day care center, but it is time for our friends in Washington to finally work across the aisle to fix the way we deliver and pay for healthcare in this country. Soon, before we all become a bunch of Screaming Meemies.

DAVE

http://www.cunixinsurance.com/

 

 

 

 

They Don't Need To Do A Thing

They didn’t look 74. He was reading, sitting mostly in the shade, his skin dark and leathery. And, he still had a full head of hair, though it appeared very white against his well-tanned face. His wife was still working on her tan. She wasn’t that far behind. She was filling out a yellow bikini and, like Sally, frequently moving her beach chair to catch the best rays. We talked for a few minutes before he asked my occupation. Once I said health insurance he began to ask questions.

We just got back from a week in Mexico. (Feel free to insert your wall joke here!) We talked with Europeans, Canadians, Mexicans, and lots and lots of US Citizens. World affairs dominated our conversations with the Europeans. Canadians wanted to know “What the Hell is going on?” The Mexicans seemed to politely concentrate on their culture. Americans immediately asked healthcare questions as soon as they learned that I was an agent. Thank G-d for the NFL Draft. It was my major break from shop talk.

I talked with business owners overwhelmed by changes in the group health insurance market. There were hospital workers worried about facility consolidations and closings. Republicans sought reassurance. “It is going to get better, right?” Dems seemed worried about everything. Cost? Coverage? Preexisting Conditions? Americans, now accustomed to simple answers to complex questions, wanted to know what was going to change and when it was going to happen.

There are no simple answers.

I left for vacation as the Republicans struggled with their amended American Health Care Act (Trumpcare). In a rush to accomplish something/anything within the first 100 days of this term, a stab was made at both healthcare and at the budget. Neither got done. Nothing changed while I was gone. There was a lot of grandstanding in Washington and Harrisburg. Lots of angst everywhere else.

There are Congressmen on TV declaring that the new, new, new plan still doesn’t protect their constituents with preexisting conditions. Other Congressmen are pooh-poohing the issue. And the President is unclear, at best. Worse, all of these elected officials are Republicans. Somehow the Democrats have extricated themselves from this circular firing squad. Would that the American people were so lucky.

Today is Wednesday, May 3^rd. The President and Vice-President are busy twisting arms and begging for votes. They hope to have a vote tomorrow afternoon. Why? Surely it isn’t because they have a solution. Trump needs a victory. The Republican controlled Congress needs to prove that it can pass a bill.

The current sticking point appears to be preexisting conditions. The MacArthur Amendment appears to open the door to shuttling the sick to an insurance Siberia of underfunded high risk pools. According to FamiliesUSA, there was a fund of $13 billion per year for ten years to help protect high risk individuals from higher premiums. An additional $8 billion dollars was dumped in yesterday to help make the final push for approval. That isn’t $8 billion per year. No, that is $800,000 per year, essentially no change at all.

We have already seen what happens when you underfund high risk pools. Over 30 states tried one version or another prior to the Patient Protection and Affordable Care Act (Obamacare). Even the PPACA had a high risk pool to help during the transition. The $5 billion dollar fund quickly evaporated.

Conservatives James Capretta and Tom Miller tackled this issue in the Spring 2010 edition of National Affairs. They lay out a compelling argument for high risk pools and a well-regulated insurance market. They also call for reasonable funding - $15 - $20 billion per year. That was in 2010. The current bill calls for less money, not more. It also calls for less regulation. It is a recipe for disaster.

The elderly couple on the beach asked if they should finally purchase a Medicare Supplement. I took a few minutes to explain the basics of Medicare Part A and Part B, the drug benefits of Medicare Part D (Rx), and even Medicare Advantage Part C. That’s when their faces lit up and they remembered that they had advantage plans through UnitedHealth Care. I confirmed that their coverage was working for them and congratulated them on the choice. They are lucky. They don’t need to do a thing.

If you are under age 65, you aren’t that lucky.

DAVE

www.cunixinsurance.com

 

Picture by David L. Cunix

 

 

Milestone / Miles From Nowhere

Thirteen. At thirteen, a milestone, a Jewish boy is viewed to be a man. He has a Bar Mitzvah, becomes responsible for his actions, and three days later is reprimanded by his parents for failing to do his homework. So which is it? Is thirteen a milestone or is it really miles from nowhere?

We have a lot of artificial milestones, deadlines to get something accomplished, a deadline to be somebody. Twenty-one seems to be the threshold to adulthood. Fifty to being whatever we might actually accomplish professionally. Retirement at 65. But these are just numbers, an average, perhaps, maybe even a goal for some, but these numbers. These milestones are not law, not mandatory, and the first true sign of maturity is to understand that in our quest to achieve our best we must first discard artificial, imposed timelines. While some may peak at 23, others are still honing their skills in their 70’s. Limiting oneself to someone else’s milestones might even force someone into foolish actions.

And that brings us to Donald Trump and the rush to pass a healthcare bill next week.

Donald Trump has decided that he must repeal and replace Obamacare (The Patient Protection and Affordable Care) within his first 100 days. This is not because he has a prescription for better, cheaper, or even easier access to healthcare for most Americans. It is strictly because the first 100 days is a milestone. He has no concern about leaving us miles from nowhere.

President Trump is trying to get the House Republicans to pass a bill by next Friday. And though the legislation hasn’t been written, the Congressional Budget Office hasn’t revised its scoring, and no House committee has held a single hearing, Trump thinks he can get a bill passed. Of course, it could be passed if the details don’t matter. Just a reminder – we are talking about close to 20% of our economy and how the doctors and hospitals get paid if you happen to get sick or injured. The details are important.

Trump’s latest partners are two Republican House members representing two different wings of the party, House Freedom Caucus Chairman Mark Meadows and Tuesday Group co-chairman Tom MacArthur. Together they have crafted a compromise that is more likely to anger the members of their caucuses than to garner their support. The MacArthur Amendment (draft provided to Politico) to the American Health Care Act does not fulfill the Republican promise of repealing and replacing Obamacare, guarantee that Americans won’t lose their healthcare coverage, or even deliver more coverage for less. They have shuffled the deck, added a couple of jokers, and then mistakenly dealt the cards face up.

The MacArthur Amendment reaffirms the value of having real standards of insurance. The Essential Health Benefits, a list of ten benefits delineated under the PPACA, were scheduled to disappear under the original Republican plan. This amendment brings the EHB back, but only for a moment. Section 1 reinstates the EHB. Section 2 allows states to seek a waiver to eliminate the EHB if they claim that this would lead to lower premiums or the possibility of more insureds. And it isn’t just the Essential Health Benefits. Section 1 guarantees useful insurance and Section 2 guarantees that usefulness won’t be around for long.

We are rushing towards a milestone – Trump’s first 100 days. It is an artificial deadline. But healthcare, taxes, war and peace are not artificial. These issues are real. And when it comes to reality, he is miles from nowhere.

DAVE

www.cunixinsurance.com

Donald Trump Needs A Friend

It may be a little late in the game, at age 70, to finally make a friend, but Donald Trump needs a friend. A real friend. This is becoming a priority. I’m not volunteering, but I would at least try if no one else is available.

It is obvious that our current president has never had a friend. He has never learned the importance or value in real friendship. Instead his relationships, with people or the truth, have been of convenience. He is transactional and of the moment. In the last few weeks he has demoted Steve Bannon, Michael Flynn, and Paul Manafort. The president now claims that these three men, previously among his closest advisors, played small, insignificant rolls in his campaign. Let’s be clear. Removing Bannon, Flynn, and Manafort from the executive branch of our government is a good thing. The issue is how it happened and what that means for other areas affected by President Trump’s leadership “process”.

Let’s look at healthcare. Candidate Trump campaigned in superlatives. He was going to replace Obamacare with something BETTER. It was going to be GREAT. Only Mr. Trump’s biggest fans believe that he ever had any plan or knows anything about our healthcare system. The less charitable might also point out that he probably doesn’t give a damn about any of the details. His relationship with the healthcare issue is strictly one of convenience. All of the details are negotiable since the only, I do mean only, goal is the opportunity to declare victory. This was supposed to be a series of transactions.

1. He told the American people what they wanted to hear – He got votes
2. He tells Congress to give him a bill, any bill – He signs it
3. He then declares victory and claims to have killed Obamacare – He then moves on to the next victory

The issues are not relevant to him. And whether you are accusing the Chinese of currency manipulation or bargaining away coverage for preexisting conditions, details matter. Bluff and bluster might work in the real estate market where it may be assumed that little of what he said was true or relevant. Governing is different. At some point they either call his bluff (see Freedom Caucus) or just ignore him.

Monitoring the rumors swirling around Washington could become a fulltime job. One day President Trump is all in on the American Health Care Act, the hastily assembled Republican healthcare bill. It quickly devolved into Trumpcare, a collection of disparate bargaining chips unloved by even its creators. The AHCA didn’t have a champion, just Trump offering one more deal to find a vote or two. The AHCA died without a vote. And who was the first to kick dirt on the grave? Donald Trump!

I'm a little surprised, to be honest with you. We really had it. It was pretty much there within grasp. But I'll tell you what's going to come out of it is a better bill -- I really believe a better bill. Because there were things in this bill I didn’t particularly love. And I think it's a better bill.

The big rumor today is that Trump is threatening to undermine the tax credit subsidies in an effort to torpedo The Patient Protection and Affordable Care Act (Obamacare). The other alternative is that this is a bluff to force Democrats, legislators that have exhibited a certain level of seriousness on the healthcare issue, to come to the table. This would not be to discuss improving the way we pay for healthcare. No, this would be about the dismantling of Obamacare. It is important to remember that repealing Obamacare does not get one more patient admitted to a hospital nor does it guarantee the payment of a single doctor’s fee. Repealing Obamacare is the political exercise of the intellectually flabby.

Jeffrey Lord has represented Donald Trump on CNN for the last year. Today he declared Trump to be the Martin Luther King, Jr. of healthcare. Honest. I can’t make this stuff up. Two days ago Sean Spicer lauded Adolph Hitler’s restraint with poison gas as compared to Assad in Syria. Why appropriate other people’s heroes or minimize other people’s suffering unless they are simply means to an end. Why shift positions on ALL issues unless no position has any value save as a stepping stone to a deal, regardless of the terms. And why pledge loyalty to someone who places no value in relationships that fail to yield results.

Loyalty. Truth. The ability to look someone in the eye and tell him when he is wrong and demand a heartfelt apology. Friend, the person that brings out the very best in each of us. American needs Donald Trump to find a friend.

DAVE

www.cunixinsurance.com

 

Let Me Help You To Hurt Me

You never write about medical issues. Why don’t you ever talk about heart conditions or even cancer other than yours? How about the latest prescriptions? You never cover any of them in your blog.

This is Health INSURANCE Issues With Dave. This blog covers health insurance, an organized method of compensating medical providers. It is not about health. In fact, our system has never been about your health.

Blue Cross was created in 1929 as a way to prepay days in the hospital. Blue Shield soon followed to prepay for the services of doctors. Health insurance, pooled risk and shared responsibility, was also created in the 1930’s to cover medical expenses. Congress gave us Medicare in 1965 to help pay for the medical bills of the elderly. And even Medicare Part D (Rx) was designed, in part, to cover the high cost of prescriptions for senior citizens. The focus has never been on health, just the COST of health care.

The Patient Protection and Affordable Care Act (PPACA) was passed in 2010 to provide health insurance for every American. That was the goal. The combination of expanding Medicaid, tax credit subsidies, and the elimination of medical underwriting was supposed to remove every obstacle from our country achieving universal coverage. That didn’t happen. We have fewer people uninsured, but there have been significant problems with the PPACA.

Last week the Republicans attempted to pass the American Health Care Act (AHCA). This was a first. For ninety years we have tried to find better ways to pay for health care. This law wasn’t about that. Trumpcare’s only goal was the repeal of Obamacare. The vote was scheduled on the seventh anniversary of the passage of the PPACA to emphasize the point.

This blog reviewed the original AHCA when it was first released a couple of weeks ago. This half-baked compilation of grudges and campaign rhetoric found few friends outside of the party leadership. Governors and members of Congress of states that had expanded Medicaid worried about the citizens who would lose coverage. The absolutists on the far right, the Freedom Caucus, derided the bill as Obamacare-light. Last week President Trump, Speaker Ryan, and various Congressmen negotiated the dismantling of consumer protections and coverage guarantees. But it wasn’t enough. With nowhere near enough votes for passage, both Trump and Paul Ryan now each claim responsibility for pulling the bill. Neither could have afforded another embarrassing defeat.

And who did Trump blame for his failure to repeal Obamacare? The Democrats!

The Republicans have been beating the Democrats over the head with a baseball bat for the last seven years. The bat broke on November 8, 2016. President Trump is mad that the Dems didn’t buy him a new bat.

DAVE
www.cnixinsurance.com

It Should Be My Choice

I want more choices.

Damn Right!

The government limits what I am allowed to buy. It isn’t up to Washington to tell me what I need.

Agreed!

All those extras just add to the cost.

Yes, make it cheaper.

I’m tired of the nanny state. Too many politicians are butting in. They are taking money out of my wallet. Let me make my own decisions. I want more choices.

I’m with you.

Yep. I’m going to call my Congressman and demand change.

Me, too.

I’m tired of Washington adding thousands of dollars to the price of a car. I don’t want to pay extra for air bags. Seat belts are a waste of my money. I never wear them. Man, there’s a bunch of stuff like this. Anti-lock brakes? Really? I want to get rid of all this unnecessary crap and get a better price on my next car.

Cars? I thought you were talking about health insurance.

 

When Tom Price, Secretary of Health and Human Services (HHS) says that he wants Americans to have more choices what he is really saying is that the current policies are too expensive because they are too comprehensive. Americans no longer have the opportunity to purchase inadequate health insurance policies. All policies are now required to cover the ten Essential Health Benefits (EHB). Which of the following would you like to leave off your next policy? Are you sure?

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Pregnancy, maternity, and newborn care
5. Mental health and substance use disorder services
6. Prescription Drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services
10. Pediatric services

How could you know that you’ll never have cancer or a chronic back problem? Which benefits can you eliminate? The easy one is maternity. How much does a 60 year old pay for maternity? About the same amount as a 22 year old pays for prostate cancer. The truth is that you can’t make an informed decision. You can’t guarantee that you will never suffer from depression or get hooked on opioids after major dental work. And none of that really matters because it assumes that you would be making these choices with your eyes wide-open and know exactly what types of coverage you would be eliminating. You won’t.

This whole push to get policies sold across state lines is about removing care. Ohio, for example, recently passed legislation guaranteeing coverage for the treatment of autism. That is a Republican governor, a Republican controlled senate, and a Republican controlled house voted to grant this benefit for all of Ohio’s children. Tom Price wants you to have the opportunity to purchase a cut-rate policy from Tulsa based Shaky Ground Mutual. Minnesota may be leading the way towards the new, useless policies. More importantly, it won’t be until you go to the doctor that you will find out that your child’s autism or your cancer isn’t covered.

It may be difficult to read today’s heavily regulated health insurance policies, but these have much less fine print and legalese than what we used to provide. Remove the regulations and we immediately return to the gobbledygook of the past. If locked doors keep honest people honest, than regulations are the locked doors that protect the consumer from our insurance providers.

Please don’t confuse this post as a full-throated endorsement of the Patient Protection and Affordable Care Act. It is not. The PPACA is a badly written law that needs significant changes if it ever has a chance to succeed. Most of our representatives in Washington know this. That’s not repeal. That’s repair.

Will the Republicans overcome their obsession with our last president and choose to do what’s in the country’s best interest? I don’t know. It is the one choice they didn’t want.

DAVE

 
www.cunixinsurance.com