The American Dilemma and How We Can Fix It

Posts tagged ‘Obamacare’

I SCREAM, YOU SCREAM, WE ALL SCREAM FOR ICE CREAM

When I was a child, ice cream came in three flavors –  Vanilla, Chocolate and Strawberry.  I was good with that since I liked all three.  Then one day my father shattered my view of the universe.  He came home with a quart of Peach ice cream.  That started me to wondering, “What will they think up next.”  Little did I know that they would think up a lot.

Years later, Dad took me to a Howard Johnson restaurant.  They had an astounding 28 flavors of ice cream from which I could select.  And then I heard about a place called Baskin Robbins that topped that with 31 flavors.  By the time I stepped inside my first BR I was in college and I realized that the universe was a much more wondrous place than the three flavor variety I accepted as a child.

Currently there are thousands of different health insurance policies available to the consumer.  That’s about to change.  Unlike the ice cream industry which realized that consumers liked choices and that limiting those choices resulted in fewer satisfied customers, Obamacare has reduced those thousands of policies to a mere four.  And in the view of the administration that’s a good thing because they, more than the consumer, know what is best.

Well, perhaps they do.  I’m willing to admit that.  But the explanations for why so many people are receiving cancellation notices from their present insurers is a bit confusing.  How many times did President Obama promise, “If you like your policy you can keep your policy?”  The spin put on “explaining” this statement has taken several paths.

The first explanation that is being offered by those who are Obamacare enthusiasts is that this is only going to affect five percent of the population.  That’s about 14 million people.  For a government that runs deficits in the billions, I guess that number would be considered statistically insignificant – unless you happen to be one of those affected.

The second explanation is that it isn’t the government but the insurance companies that are responsible for the cancellations.  That’s true.  But what they fail to disclose is that the insurers are being required to issue these cancellation notices because their specific plans don’t meet the four flavor variety standards which are mandated by the law and the regulations written by Secretary Kathleen Sebelius’ Department of Health and Human Services.

The third explanation, born out of the largesse and wisdom of the cognoscenti in the bureaucracy is that “We’re really doing these people with ‘sub-standard’ policies a favor by pushing them into policies that offer far better coverage.”  There might be some truth that replacing “skinny” policies with “obese” ones is a benefit – but only if a person wants all the bells and whistles they offer.  Why a single thirty year old with no children would select a policy that includes pediatric eye care and be happy to pay for it is unclear to me – and probably to that thirty year old as well.

I sincerely believe that there are a lot of Obamacare boosters who truly think that they are doing something good for the populace, getting them into more comprehensive insurance – whether they want it or not.  The predication for their assumption is that they, rather than the individual consumer, knows better what is in their best interest and ultimately in the best interest of the country.  Which brings me to a confusing and contradictory provision in the ACA.

If we are to assume that having more extensive insurance will not only be better for the insured and (this is a highly arguable belief) that this will result in better healthcare at a more affordable cost, it would seem logical that if having a better plan is a good thing, having the best plan would be an even better thing.  Therefore, we should encourage everyone to have the best plan that there is.

If we accept that assumption then why, beginning in 2018 does the law impose a punitive tax of 40% on what are known as “Cadillac insurance plans”  – the most comprehensive plans available in the market place?  It’s all so confusing.

Well, I often do my best thinking over a little treat.  So I think I’ll head downstairs to the kitchen and serve up two scoops of Rocky Road ice cream – in honor of Obamacare.

DENIAL, DELAY, DA DEMOCRATS

You have to say one thing about the late Richard J. Daley, Mayor of Chicago.  He was a colorful man.  (By that I refer to his speech rather than his skin tone).  Whether you were one of his supporters or one of his detractors, I think it was clear to all of us who lived under his reign that despite his heavy-handedness he truly loved Chicago and wanted to transform it into the greatest city in America.

Perhaps President Obama, as a legatee of the realm of King Richard I, has taken some lessons from the wisdom that the Mayor imparted to us during the years.  This comes to mind as the House holds hearings on the glitch-filled disaster that is the President’s Obamacare website which was rolled out three weeks ago.

“Look at our Lord’s disciples.  One denied Him; one doubted Him; one betrayed Him.  If our Lord couldn’t have perfection, how are you going to have it in [city] government?” – Mayor Richard J. Daley

How, indeed?  And at the core of that question is that if we should not expect functionality, let alone perfection, why would any rational person believe that turning over one-sixth of the national economy and our right to life to a cadre of bureaucrats who have proven, time and again, that they are inept, unaccountable and unconcerned about those things which concern its subjects?  I use the term subjects rather than citizens because that is the way that this imperious administration views the American people.

Right now the focus that the Congress is bringing to bear is on the only marginally functioning government healthcare web site.  The second portion of the investigation is centered on who should be held accountable for what now appears may amount to a one Billion dollar “glitch” when and if it is able to be repaired.

It would be unfair to say that conservatives are not taking a certain amount of glee at this massive screw up.  I know I am – other than for the fact that it is costing you, me and everyone else about $300 per person – money I would choose, if given the opportunity, to deploy on things other than a poorly designed website – like a donation to the St. Jude Children’s Research Hospital which charges none of its patients for treatment and actually delivers outstanding healthcare, specializing in pediatric medicine.

The first step in fixing any problem is admitting that the problem exists.  Every twelve step program is based on this fundamental truth.  And that might be the biggest impediment to repairing the website – if it is indeed reparable.  During the first days after the website’s not-so-grand opening, perhaps out of ignorance and perhaps out of denial, those who support Obamacare had a number of explanations for the site’s issues.

During the first few days, it is understandable that the source of the problem had not yet been identified.  But after several weeks, it is clear that the excuses which were offered were simply not the cause of the issues which surfaced.  To suggest that the site was experiencing difficulties because there was “too much traffic” is laughable since the goal of enrolling seven million people in the first wave would require that the number of visitors exceeded the amount of traffic the site actually received.

So, still in denial, a variety of other excuses were set out.  One of those was that there was insufficient time to get the product out.  The explanation for this argument was that the administration didn’t really have the full three and one half years to accomplish the setup for the website since the law was passed..  That is because the GOP had refused to allocate funds to set up the website and HHS had to raid various of its accounts in order to pay the vendors.  I would suggest that any government agency which can come up with over $600 million by looking in its couch cushions is overly-generously funded.  But that’s Washington.

Finally, only because the flaws in the software are apparent to your average five year old, the admission has come out that there are significant problems with this rollout and they need to be fixed.  How long that might take depends on whether the entire system has to be scrapped or whether it can be repaired.  At this point, the jury is out on that question.  But what is clear is that whichever path is followed, there is going to be a significant time lapse until people can actually get on the site and sign up as they are mandated to do by Obamacare.

This has caused five Democrat senators and five Democrat congressmen whose seats are vulnerable in next year’s election, to come forward and suggest that the mandate requiring individual coverage be delayed for some period of time.  The proposals vary in length – partly predicated on the length of time it will take to fix the website which at this point is an unknown.

Wait a minute.  Do you remember the partial government shutdown which recently ended?  Do you remember how the Tea Party and Republicans in general were excoriated as “terrorists” and “hostage takers”?  Do you remember the bill that they sent to the Senate to fund the entire government if the individual mandate were delayed – a bill which Senate Majority “Leader” Harry Reid refused to allow the membership of the Senate even to consider?

Perhaps the key to why we are where we are, not just with Obamacare but with a lackluster economy, over-regulation, the spiraling decrease in the middle class, the over-bloated and over budget federal bureaucracy, the NSA’s snooping and spying on our closest allies, can be found in another pithy quote from the late Mayor Daley – a quote that the president no doubt embraces.

“We as Democrats have no apologies to make to anyone.”

SELLING OBAMACARE

There’s no argument that President Obama is a good salesman.  He convinced enough people to vote for him to give him two terms in the White House.  P. T. Barnum would be proud of him.

So today, the Salesman in Chief turned his attention to Obamacare with a press conference.  Not surprisingly, he was surrounded by a group of people who will benefit from the ACA – and it is undeniable that there will be people who will benefit from it.  Those people are individuals with pre-existing conditions.  But the problem for this grand scheme is that there will be few else who will be able to make that statement.

It seems to me that enthusiasm for Obamacare is not much different than the reaction one might expect from a diffident bachelor whose friends are fixing him up with a blind date.  The young man asks, “What’s she like?”  To which he receives the answer, “She’s got a great personality.”

One of the statements that the President made today was that a person could purchase a plan at a mere one hundred dollars per month.  That’s an interesting statement.  Particularly as over the last five days I went to the exchanges for thirty-two states (which actually were semi-functional) to get quotes.

The quotes that I requested were for a 21 year old individual female.  This is the least expensive category of applicant that I was able to find.  Let me give you an example of premium and coverage costs for an applicant in just one of those states, Nevada.  The premiums varied by a few dollars depending on the state.

So, Ingrid Johnson, a single 21 year old wants the most affordable plan that is available under Obamacare in Nevada.  She is a non-smoker.  The least expensive plan available to her is what is known as a “Catastrophic” policy.  This is intended to cover her should she develop a serious medical condition.

Her premium cost for this policy is $143 per month.  (Not the $100 cited today by the President in his press conference).  But there is an annual deductible before she receives one dollar of benefit in the amount of $6,250 per year.  In other words, she will have to pay out $7,966 before her insurance starts paying any of her medical expenses.  That works out to an out-of-pocket cost of $663 per month.

But let’s assume that Ingrid has a small income and the full amount of her premium cost is subsidized by the Federal government.  That means she is still responsible for the full deductible before she receives benefits.  That translates to a monthly premium of $520 per month.

Perhaps the President is relying on the fact that the math skills of Americans is exceptionally poor.  Perhaps he is hoping that one of the glitches with the iPhones to which he has recently referred is that the built in calculators are malfunctioning.  Perhaps he just thinks that Americans are just plain stupid.  But the math and the President’s statements just don’t relate well to each other.

It’s seldom that I offer the President advice.  But here goes.

If the President wants to sell this to America, I can think of nothing that would be more effective than that he issue one of his executive orders and require that he and his family, the Congress, the members of the Supreme Court and all the toadies in the administration be enrolled in it.

That might get America a little more enthusiastic about the greatest Ponzi scheme ever concocted by Washington.

“THE FOLKS”

In the last post I spoke about the latest new catch phrase, “the law of the land” which those who support the ACA use in reference to justifying Obamacare.  But there is a second term which I find equally annoying and which is frequently employed both by the President and by some on the right, notably Bill O’Reilly of FOX News and literary fame.  That phrase is “The Folks.”

Personally, I find this term rather disparaging – no matter who the speaker.  To me it is condescending, as though the President and Mr. O’Reilly are both sitting on their lofty perches, looking down on those who are, in their perception, beneath them, the “little people.”

Well, “the folks” are getting a little taste of “the law of the land.”  The Heritage Foundation has released their analysis of how health insurance rates, on average, will be affected as a result of Obamacare.  The following link will take you to their study – which shows an increase in 45 of the 50 states and the District of Columbia.

http://www.heritage.org/research/reports/2013/10/enrollment-in-obamacare-exchanges-how-will-your-health-insurance-fare

The Heritage Foundation in this study, which makes certain assumptions which may or not prove to be completely valid, simply examines the cost of currently available insurance versus what will be available on the insurance exchanges.  It is unclear whether this study incorporates the generally higher deductibles which most insurers are building into the new policies.

This, however, is merely the first issue, albeit probably the most surprising one, which “the folks” will deal with come next year.

It is hard to argue that Obamacare is anything but an “ambitious program.”  And it shouldn’t surprise any of us that despite having more than three years to build a website, the one that HHS commissioned is flawed, perhaps fatally so.  We are now into week three of the “rollout” and even supporters of Obamacare are being forced to admit that there are “glitches” which some are even willing to admit are “serious problems.”

Beyond the problems of simply enrolling people in Obamacare, and if you review the increases which the majority of healthy, younger people will face in order to support those who are older and more sickly, it seems unreasonable that the underlying financial assumption that getting the young to enroll and pay more than they actuarially should in order to subsidize those with serious health and pre-existing conditions, will be realized.  That is simply a statement related to the economics of this program.

But that may be the least important reason for a person choosing not to enroll in Obamacare.

One of the much touted benefits which purportedly makes Obamacare “affordable” is the fact that some taxpayers will be eligible for subsidies.  However, the system is currently unable to compute what those subsidies will be.  Therefore, no one who enrolls can be certain what his or her net premium cost actually will be.  That, of course, provides a further dis-incentive for signing on the dotted internet line.

But let us “folks” step back from the problems in getting an effective website up and running, despite the government’s spending hundreds of millions of our taxpayer dollars to implement it, and look at the broader picture.

When I flew frequently, I remember reading an article in one of the In Flight magazines that there were certain things about an airplane which caused consternation among passengers.  One of those was getting on a flight and noticing that the ashtray in your seat’s armrest was filled with cigarette butts.  Passengers tended to ask themselves, “If they can’t clean the ashtrays, how well does the airline maintain the plane itself?”

That same line of thinking can reasonably be applied to Obamacare.  If it is essential for the success of the program that young people sign up but have commissioned a website, the primary vehicle to achieve that end, that is apparently incapable of achieving that goal, then what would a reasonable person expect from the far more important issue of taking care of “the folks’” health – and at what price?

If a person bought into the value of Obamacare as it was sold by the President and his supporters based on how it was originally presented, they must, if they are honest, be greatly disappointed in the product which we are now being required to purchase.  Of the original promises made by Obama, the only one which appears to be accurate is that those with pre-existing conditions will be able to obtain coverage.  And that is a good provision.

But the promise that “the folks” would on average see a decrease of $2,500 per year in the cost of insurance, apparently not the case for most; that people would be able to keep their present insurance if they liked it, apparently not the case for many; that people would be able to keep their health care provider, apparently not the case for many more.

A reasonable person would ask himself or herself, with this sort of a track record at its launch, what can we expect if Obamacare gets fully implemented?  But before you come to a conclusion there is yet more bad news.  Embedded into the source code is a disclaimer that “the government is not responsible for the security of any information which is posted by the user on the site.”  According to interviews I heard with five different IT professionals, the way this site was designed provides an open invitation to hackers to access our most important health and financial information.

Recently, I read that an astounding one out of four of us currently suffers from some form of mental illness, including depression.  I suspect that if Obamacare truly gets fully rolled out, “the folks” are going to be asking for a lot more prescriptions for valium. .

YO, BAMA–DO YOU CARE?

Well, there I was, trolling through the “news” shows yesterday when I heard something that truly startled me.  That news item was that those who have been hired (through government grants to various organizations) to become “navigators” for helping people enroll in Obamacare are getting paid up to $48 per hour.  By my quick math, assuming full time employment (now defined as 30 hours per week), that comes to just about $75,000 per year.

That’s not bad when you consider that apparently all you need to qualify is 16 hours of training.  When I compared that to what we pay a starting teacher who needs to spend a minimum of four years in college, I thought this sounds like a pretty cushy job.  So I thought to myself, “Well, self.  You’re retired, have time on your hands and have a background in insurance.  Why not check it out and see if you can pick up some extra income – and potentially become a one person fifth column?”

So I went to the internet to see where there were offices in Las Vegas where people could sign up for Obamacare.   As it turned out, that was somewhat akin to the journey that Jason and the Argonauts undertook in Greek mythology.

After spending nearly two hours on the internet trying to find a “center” where they had “navigators” helping with the process, I finally gave up because each link that I checked brought me back to the same place where I had begun my search.  So, I decided to call the toll free number, stupidly thinking that I might actually be able to speak to someone.  “Oh, what fools these mortals be.”

Naturally, I followed the computer’s instructions, trying to locate a center which served my zip code.  After punching in all the requisite numbers, including my zip, the system returned the answer that, “No centers were found.”  Not to be deterred, I tried again, seeking to locate a navigator for my area.  Once again, “No navigators were found.”  So I hung up.

After sitting back for a moment, I thought of another way to attempt reaching a person.  I called back and requested information on making a payment, the first of the computerized options.  I was finally connected to a live person.  (It’s funny how government always makes it as easy as possible to send money to them).

I spoke with a nice young woman who, when I asked where I could sign up for Obamacare, effervescently responded that, while she didn’t have any “centers” listed, she did have the telephone numbers for three “navigators” who would be available to service me based on my zip code.  She then provided me with the phone numbers of these three gentlemen (yes they were all men, how sexist).

I called all three of these “navigators” to find out how they could “facilitate” my enrollment in this divinely inspired program but was unable to reach any of them so I left messages for each.  That was about eight hours ago – but I have yet to hear from any of the three.

So here’s my analysis in review of this program thus far.

We know that there are fatal flaws, a/k/a “glitches” in the computer program.  After a fair amount of effort I tried an alternative method, the old-fashioned one on one contact.  Those who are being paid a substantial rate to get people enrolled have not responded to my inquiry.  Oh, did I mention that yesterday I created an account but when I went to access information based on the computer accepted account, it didn’t recognize me?

While I can’t verify this, purportedly during the first two weeks of the rollout of Obamacare, approximately 38,000 people have signed up.  If, in fact we are going to enroll 30 million people in this program, at that rate it will take a little over fifteen years to accomplish this goal.  And that’s a good thing.

You see, if this abominable law stays on the books that long, I guess that if I’m ever able to figure out how to be a “navigator,” in that period of time I could earn over $1,125,000 – all at the expense of other taxpayers.  America – what a country.

THE JOURNEY TO NATIONALIZED HEALTH CARE – DAY ONE

Well, we’ve survived the first day of partial government shutdown.  As I had no intent to go to the Statue of Liberty today or any of our national parks, the impact has been limited for me.  And as I don’t have a civilian job with the Federal Government, my paycheck is unaffected.  My sympathy to those Federal employees whose checks will be delayed.  But if previous shutdowns are any indication, they will get paid retroactively for their time off and have a little extra unscheduled vacation.

I was up until the wee hours this morning, listening to all the rhetoric over the shutdown.  This was good for the Obama administration, clouding as it did, the “rollout of Obamacare” as the state insurance exchanges opened for business this morning at 5:00 local time.  I couldn’t wait until they were up and running so that I could make a first hand analysis of the goodies that they had on display.

In all fairness, any new computer program is likely to have “glitches.”  That is neither a surprise nor is it a reason for condemning Obamacare.  There are plenty of other reasons to do that.  But the intelligent IT department is going to make sure that they have subjected any new system to extensive beta testing before making it public.  Perhaps that is what happened with the state exchange programs, but if so, the State of Nevada, whose site I checked, needs to hire people with better skills than those who put this program together

My first encounter with the system was that it simply didn’t respond to my clicking on their links.  I thought to myself, “Perhaps they are overwhelmed with inquiries, more than the system was designed to handle.”  Maybe that is what happened.  So after repeated attempts, I was about to give up when the system finally responded.

What I had in front of me was a list of all insurers whose insurance plans were approved for sale in the State of Nevada for calendar year 2014.  These plans, many from insurers of whom I had never heard, all indicated the level of coverage – Bronze, Silver, Gold and Platinum, as well as Catastrophic.  Not all insurers offered every plan – but in toto there were well over 100 for sale in the state.

Rather than work through that extensive a list, I decided to go to the insurance exchange only plans to get an idea of what was being sold.  There were four providers, three of whom I had never heard.  The only insurer who was recognizable was Anthem – Nevada’s version of Blue Cross Blue Shield.

By the time I had progressed this far, I did learn something.  There is a new, PC term that has entered the vocabulary.  That term is “Cost Sharing.”  Once upon a time, this was called co-insurance and was the amount that an insured person would have to pay out of pocket for covered medical services.  For someone purchasing a Bronze policy, the amount of Cost Sharing is 40%; for Silver policies, 30%; for Gold policies, 20% (this used to be the standard for co-insurance for every policy I purchased for myself and my employees); and for Platinum plans, 10%.

So, I randomly clicked on one of the Silver policies to get the details.  As we all know, the devil is in the details – but, unfortunately, the only detail was the monthly premium cost and no specifics as to what was covered, what was not, how much of a deductible applied to this policy and what, if any, was the maximum out-of-pocket cost to the insured in the event of a serious medical condition.  In other words, it was impossible to make any sort of intelligent decision as to whether this (or any of the other policies listed) was appropriate.

In my business, I handled all the benefits for my employees – so I believe it is fair to say that if I am having difficulties navigating this system, the less conversant consumer is going to have a more difficult and frustrating time.  And while we might realistically expect some improvement over time, there is one underlying factor that will determine the success or failure of this Obamanation of a law.  That is whether younger people will actually sign up for this at overly-inflated rates in order to subsidize the undersized premiums being charged to those who are older or who have significant health problems.  I predict that if it means giving up their Starbucks lattés, we shouldn’t expect to see a massive influx of young eager people looking for health insurance.

Perhaps you’ve had some experience reading the rules and regulations issued by the IRS to “assist” us in preparing our individual tax returns.  Oh, wait – they’re the ones who are involved in writing the regulations that pertain to Obamanationcare.  So the following regulation which determines whether someone is entitled to receive a “subsidy” should feel very familiar to you:

42 CFR–PART 435

View Printed Federal Register page 77 FR 17206 in PDF format.

Amendment(s) published March 23, 2012, in 77 FR 17206

Effective Dates: January 1, 2014

22. Section 435.603 is added to read as follows:

§ 435.603 Application of modified adjusted gross income (MAGI).

(a) Basis, scope, and implementation. (1) This section implements section 1902(e)(14) of the Act.

(2) Effective January 1, 2014, the agency must apply the financial methodologies set forth in this section in determining the financial eligibility of all individuals for Medicaid, except for individuals identified in paragraph (j) of this section and as provided in paragraph (a)(3) of this section.

(3) In the case of determining ongoing eligibility for beneficiaries determined eligible for Medicaid coverage to begin on or before December 31, 2013, application of the financial methodologies set forth in this section will not be applied until March 31, 2014 or the next regularly-scheduled renewal of eligibility for such individual under § 435.916 of this part, whichever is later.

(b) Definitions. For purposes of this section—

Code means the Internal Revenue Code.

Family size means the number of persons counted as members of an individual’s household. In the case of determining the family size of a pregnant woman, the pregnant woman is counted as herself plus the number of children she is expected to deliver. In the case of determining the family size of other individuals who have a pregnant woman in their household, the pregnant woman is counted, at State option, as either 1 or 2 person(s) or as herself plus the number of children she is expected to deliver.

Tax dependent has the meaning provided in § 435.4 of this part.

(c) Basic rule. Except as specified in paragraph (i) and (j) of this section, the agency must determine financial eligibility for Medicaid based on “household income” as defined in paragraph (d) of this section.

(d) Household income —(1) General rule. Except as provided in paragraphs (d)(2) and (d)(3) of this section, household income is the sum of the MAGI-based income, as defined in paragraph (e) of this section, of every individual included in the individual’s household, minus an amount equivalent to 5 percentage points of the Federal poverty level for the applicable family size.

(2) Income of children and tax dependents. (i) The MAGI-based income of an individual who is included in the household of his or her natural, adopted or step parent and is not expected to be required to file a tax return under section 6012(a)(1) of the Code for the taxable year in which eligibility for Medicaid is being determined, is not included in household income whether or not the individual files a tax return.

(ii) The MAGI-based income of a tax dependent described in paragraph (f)(2)(i) of this section who is not expected to be required to file a tax return under section 6012(a)(1) of the Code for the taxable year in which eligibility for Medicaid is being determined is not included in the household income of the taxpayer whether or not such tax dependent files a tax return.

(3) In the case of individuals described in paragraph (f)(2)(i) of this section, household income may, at State option, also include actually available cash support, exceeding nominal amounts, provided by the person claiming such individual as a tax dependent.

(e) MAGI-based income. For the purposes of this section, MAGI-based income means income calculated using the same financial methodologies used to determine modified adjusted gross income as defined in section 36B(d)(2)(B) of the Code, with the following exceptions—

(1) An amount received as a lump sum is counted as income only in the month received.

(2) Scholarships, awards, or fellowship grants used for education purposes and not for living expenses are excluded from income.

(3) American Indian/Alaska Native exceptions. The following are excluded from income:

(i) Distributions from Alaska Native Corporations and Settlement Trusts;

(ii) Distributions from any property held in trust, subject to Federal restrictions, located within the most recent boundaries of a prior Federal reservation, or otherwise under the supervision of the Secretary of the Interior;

(iii) Distributions and payments from rents, leases, rights of way, royalties, usage rights, or natural resource extraction and harvest from—

(A) Rights of ownership or possession in any lands described in paragraph (e)(3)(ii) of this section; or

(B) Federally protected rights regarding off-reservation hunting, fishing, gathering, or usage of natural resources;

(iv) Distributions resulting from real property ownership interests related to natural resources and improvements—

(A) Located on or near a reservation or within the most recent boundaries of a prior Federal reservation; or

(B) Resulting from the exercise of federally-protected rights relating to such real property ownership interests;

(v) Payments resulting from ownership interests in or usage rights to items that have unique religious, spiritual, traditional, or cultural significance or rights that support subsistence or a traditional lifestyle according to applicable Tribal Law or custom;

(vi) Student financial assistance provided under the Bureau of Indian Affairs education programs.

(f) Household —(1) Basic rule for taxpayers not claimed as a tax dependent. In the case of an individual who expects to file a tax return for the taxable year in which an initial determination or renewal of eligibility is being made, and who does not expect to be claimed as a tax dependent by another taxpayer, the household consists of the taxpayer and, subject to paragraph (f)(5) of this section, all persons whom such individual expects to claim as a tax dependent.

(2) Basic rule for individuals claimed as a tax dependent. In the case of an individual who expects to be claimed as a tax dependent by another taxpayer for the taxable year in which an initial determination or renewal of eligibility is being made, the household is the household of the taxpayer claiming such individual as a tax dependent, except that the household must be determined in accordance with paragraph (f)(3) of this section in the case of—

(i) Individuals other than a spouse or a biological, adopted, or step child who expect to be claimed as a tax dependent by another taxpayer;

(ii) Individuals under the age specified by the State under paragraph (f)(3)(iv) of this section who expect to be claimed by one parent as a tax dependent and are living with both parents but whose parents do not expect to file a joint tax return; and

(iii) Individuals under the age specified by the State under paragraph (f)(3)(iv) of this section who expect to be claimed as a tax dependent by a non-custodial parent. For purposes of this section—

(A) A court order or binding separation, divorce, or custody agreement establishing physical custody controls; or

(B) If there is no such order or agreement or in the event of a shared custody agreement, the custodial parent is the parent with whom the child spends most nights.

(3) Rules for individuals who neither file a tax return nor are claimed as a tax dependent. In the case of individuals who do not expect to file a Federal tax return and do not expect to be claimed as a tax dependent for the taxable year in which an initial determination or renewal of eligibility is being made, or who are described in paragraph (f)(2)(i), (f)(2)(ii), or (f)(2)(iii) of this section, the household consists of the individual and, if living with the individual—

(i) The individual’s spouse;

(ii) The individual’s natural, adopted and step children under the age specified in paragraph (f)(3)(iv) of this section; and

(iii) In the case of individuals under the age specified in paragraph (f)(3)(iv) of this section, the individual’s natural, adopted and step parents and natural, adoptive and step siblings under the age specified in paragraph (f)(3)(iv) of this section.

(iv) The age specified in this paragraph is either of the following, as elected by the agency in the State plan—

(A) Age 19; or

(B) Age 19 or, in the case of full-time students, age 21.

(4) Married couples. In the case of a married couple living together, each spouse will be included in the household of the other spouse, regardless of whether they expect to file a joint tax return under section 6013 of the Code or whether one spouse expects to be claimed as a tax dependent by the other spouse.

(5) For purposes of paragraph (f)(1) of this section, if, consistent with the procedures adopted by the State in accordance with § 435.956(f) of this part, a taxpayer cannot reasonably establish that another individual is a tax dependent of the taxpayer for the tax year in which Medicaid is sought, the inclusion of such individual in the household of the taxpayer is determined in accordance with paragraph (f)(3) of this section.

(g) No resource test or income disregards. In the case of individuals whose financial eligibility for Medicaid is determined in accordance with this section, the agency must not—

(1) Apply any assets or resources test; or

(2) Apply any income or expense disregards under sections 1902(r)(2) or 1931(b)(2)(C), or otherwise under title XIX of the Act, except as provided in paragraph (d)(1) of this section.

(h) Budget period —(1) Applicants and new enrollees. Financial eligibility for Medicaid for applicants, and other individuals not receiving Medicaid benefits at the point at which eligibility for Medicaid is being determined, must be based on current monthly household income and family size.

(2) Current beneficiaries. For individuals who have been determined financially-eligible for Medicaid using the MAGI-based methods set forth in this section, a State may elect in its State plan to base financial eligibility either on current monthly household income and family size or income based on projected annual household income and family size for the remainder of the current calendar year.

(3) In determining current monthly or projected annual household income and family size under paragraphs (h)(1) or (h)(2) of this section, the agency may adopt a reasonable method to include a prorated portion of reasonably predictable future income, to account for a reasonably predictable increase or decrease in future income, or both, as evidenced by a signed contract for employment, a clear history of predictable fluctuations in income, or other clear indicia of such future changes in income. Such future increase or decrease in income or family size must be verified in the same manner as other income and eligibility factors, in accordance with the income and eligibility verification requirements at § 435.940 through § 435.965, including by self-attestation if reasonably compatible with other electronic data obtained by the agency in accordance with such sections.

(i) If the household income of an individual determined in accordance with this section results in financial ineligibility for Medicaid and the household income of such individual determined in accordance with 26 CFR 1.36B-1(e) is below 100 percent FPL, Medicaid financial eligibility will be determined in accordance with 26 CFR 1.36B-1(e).

(j) Eligibility Groups for which MAGI-based methods do not apply. The financial methodologies described in this section are not applied in determining the Medicaid eligibility of individuals described in this paragraph. The agency must use the financial methods described in § 435.601 and § 435.602 of this subpart.

(1) Individuals whose eligibility for Medicaid does not require a determination of income by the agency, including, but not limited to, individuals receiving Supplemental Security Income (SSI) eligible for Medicaid under § 435.120 of this part, individuals deemed to be receiving SSI and eligible for Medicaid under § 435.135, § 435.137 or § 435.138 of this part and individuals for whom the State relies on a finding of income made by an Express Lane agency, in accordance with section 1902(e)(13) of the Act.

(2) Individuals who are age 65 or older when age is a condition of eligibility.

(3) Individuals whose eligibility is being determined on the basis of being blind or disabled, or on the basis of being treated as being blind or disabled, including, but not limited to, individuals eligible under § 435.121, § 435.232 or § 435.234 of this part or under section 1902(e)(3) of the Act, but only for the purpose of determining eligibility on such basis.

(4) Individuals who request coverage for long-term services and supports for the purpose of being evaluated for an eligibility group under which long-term services and supports are covered. “Long-term services and supports” include nursing facility services, a level of care in any institution equivalent to nursing facility services; home and community-based services furnished under a waiver or State plan under sections 1915 or 1115 of the Act; home health services as described in sections 1905(a)(7) of the Act and personal care services described in sections 1905(a)(24) of the Act.

(5) Individuals who are being evaluated for eligibility for Medicare cost sharing assistance under section 1902(a)(10)(E) of the Act, but only for purposes of determining eligibility for such assistance.

(6) Individuals who are being evaluated for coverage as medically needy under subparts D and I of this part, but only for the purpose of determining eligibility on such basis.


You’ve got to say one thing about the IRS – they’re never at a loss for words.  But if anyone reading this post can explain in simple English what that regulation actually means, I look forward to your elucidating me.  Sadly, I don’t have an advanced degree in Governmentalese.  Perhaps that’s something I should add to my “to do” list.

Oh, one last thought.  One of the “waivers” that Obama has “granted” is that the IRS will not need to verify the income that an Obamanationcare insured puts on his/her application in order to obtain a “subsidy.”  So this entire regulation, probably written by multiple IRS employees over multiple hours is moot.

Perhaps a government shutdown isn’t such a bad thing after all.

A PROFILE IN COURAGE

If you ever want to have a keen glimpse of what it is like feeling disheartened, I suggest you spend several decades as a Republican precinct worker in the City of Chicago.  On this subject I speak from personal experience.

There are 2,069 election precincts in the City of Chicago.  In the last twenty years, there is only one that consistently went to Republican candidates.  That is less than five hundredths of one percent.  Sadly, my work on behalf of Republican candidates did not occur in that particular precinct.

So why did my colleagues and I persist in this nearly masochistic endeavor?  The answer is simple.  We continued to beat our heads against the wall and get beaten up by our opponents because we believed that what we were doing was the right thing.

Back in the days when I was involved in local Chicago politics it was much more difficult to get out the vote, such as there was of it, than today.  There was no such thing as early voting.  If you wanted to exercise your civic responsibility you either had to apply for an absentee ballot or you had to show up personally at the poll on Election Day.

Many of those who voted Republican were senior citizens.  And with elections taking place in November, one of the major responsibilities for precinct workers was driving them to the polling place and then returning them to their residences and picking up the next group so that they could avoid the generally inclement weather.

The work was anything but glamorous but it was necessary to try to get out every single voter in order to try to reduce the plurality of votes that we knew would be cast by our opponents.  While we knew there was no chance that a Republican would win a local office, there still was the possibility that the party could elect someone for statewide or national office.

Sometimes accomplishing this, I am a little embarrassed to say, involved offering the voter a small bribe.  I recall one conversation I had with a lady who is now deceased, Estelle Schwartz.  She was feeling a bit under the weather and it was particularly cold that Election Day.  She was concerned about catching pneumonia while waiting in the line to get into the polls.

Despite my great powers of persuasion, I could tell that her fear of illness was overcoming my oratory.  So I asked her, “Estelle, do you like jam?”  She responded that she liked certain jams a lot.  So I said, “I just made up two batches of jams.  Would you prefer strawberry or blackberry?”  The word “blackberry” struck a chord and her face lit up.  “Does your blackberry jam have a lot of seeds?”  I explained that I had removed the seeds before putting it in the half pint mason jars.  This was a good thing because apparently the seeds worked their way under her dentures.  So I drove Mrs. Schwartz to and back from the polls and early that evening when the polls had closed dropped off some blackberry jam for her.  (She told me later that she had enjoyed the jam a great deal).

Despite all the efforts that my co-workers and I exerted, we knew going in to each election that we were going to lose.  And yet we kept putting forth our best efforts.  That is truly a lonely feeling – and most of my non-political friends thought I was either crazy, stupid or both.  Perhaps they were right.

And that brings me to the subject of the junior senator from the State of Texas, Ted Cruz.  As I write this he has just concluded his marathon speech on the floor of the U. S. Senate – protesting, as he promised he would when he was elected, to do everything within his power to disable, defund or destroy the law best known as Obamacare.  He is fighting a losing battle.  I am confident that Senator Cruz realizes that.

So why did this freshman senator engage in this futile effort?  Several more senior Republican senators and conservative commentators have suggested that this is merely an exercise in self-promotion.  They further suggest that this strategy, with its possibility of shutting down the federal government, with have adverse implications for the Republican party in the mid-term elections next year.  Perhaps one or both of those statements are true.

But while those who are part of the Washington establishment focus themselves on the possible results of the next election, they have lost sight of the fact that in following their middle of the road mediocrity, they have lost the country and our Constitutional government with its promise of rights and protections.

So my hat is off to Sen. Ted Cruz and to those few other Republican senators of principal who stood up with him, Rand Paul, Mike Lee and Marco Rubio.  If this country has any hope of returning to a Constitutional Republic and to get us back on the path of rationality, it is men and women like these who will lead that effort.

And to those who are primarily motivated by their concern for getting re-elected rather than by doing the right thing for America, I would tell them that they did not deserve to serve the people in the first place and most certainly do not deserve to be retained by them.

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