The American Dilemma and How We Can Fix It

Posts tagged ‘Patient Protection and Affordable Care Act’

GAMING THE SYSTEM

You really have to hand it to young, tech savvy people.  Sure, they may walk into lamp posts while texting, but their proficiency in understanding technology provides them with huge advantages in dealing with today’s complex issues – which, of course, includes Obamacare.

There is a young man who lives down the street and who just turned 27.  Under the rules which are currently in place that means that he can no longer be covered under his parents’ health insurance plan.  And, of course, that means that he needs to obtain health insurance on his own or face a tax penalty for non-compliance.  At least those are the rules today – and since Obamacare relies on fleecing people like this young man to subsidize the system, that rule is likely to remain – unlike others which change almost daily.

So my young friend who has more patience than many his age made a run at the Nevada Health Insurance Exchange.  My experience in looking at the sites for various states was that the Nevada marketplace seemed to work better than most.  That is a little surprising since in Nevada we have a Republican governor.

When he went through the application process and looked at his options he realized that given the fact that he was healthy and hadn’t seen a doctor in four years, the least expensive of the plans which were available to him were totally unaffordable.  This is the same “sticker shock” that many are experiencing throughout the country.  So he decided that he would simply pay the penalty – which in his case would amount to about $350.  That compared to a subsidized cost for a “Catastrophic” plan with a $660 annual premium which carried with it a $6,000 deductible he would have to satisfy before insurance would pay for his medical costs should he incur any.

As it happens, this young man works in the accounting department of a major corporation that runs a large number of casinos nationwide and in the Orient.  Because he just started with them he is not currently eligible for the company’s group insurance plan.

There is probably no industry which has more controls in place which check, double and triple check the amount of cash that runs through their business.  If you’ve ever had the opportunity to get a tour of one of these back offices, you’ll know what I mean.  There are cameras all over the place and people checking on the people checking on those who count and account for the casino’s receipts.  The casinos have developed one of the most “hacker-proof” systems ever, Hollywood movies notwithstanding.  They have to do that because it is their livelihood and they take it very seriously.

So as my friend was thinking about all the issues that have become obvious in the implementation of Obamacare a thought suddenly struck him.  Given all the problems in setting up a working website, he wondered, “How likely is it that the IRS which is responsible for imposing penalties for not having insurance will be able to verify anyone’s answer that they indeed have purchased it?”   Of course, falsifying a tax return is a criminal offense because the individual has committed perjury.  But the way Obamacare is currently worded, the question the IRS will be asking is “Did you have health insurance on January 1, 2014.”

What my young friend decided to do is to purchase a Catastrophic plan, pay the net $55 premium for one month – and then cancel it.  So for an out of pocket cost of $55 he can honestly answer that IRS question, “Yes,” and save himself the balance that would be due as a penalty as well as avoid paying substantially more for insurance that he really doesn’t want.

Now here’s the dirty little secret.  If this idea catches on with the young “Invincibles” whose premium payments are essential to subsidize this Ponzi scheme it will collapse like a house of cards caught up in a tornado.  Perhaps then we can find the will and insight to craft health insurance and health care reform that is both bipartisan and which actually works.

WEBSITE DESIGN 101(01010101)

Health and Human Services Secretary Kathleen Sebelius might have been more gracious recently when a local council member handed her a copy of “Websites for Dummies,” while she was pitching the virtues of Obamacare at a community meeting.   Perhaps his gesture was too little too late – as the “enrollment numbers” for www.healthcare.gov have been released for its first month of operation.  Even to the supporters of this legislation they were “bad.”

Let me be the first to say that I am not a computer programmer.  But I do have a solid educational background in logic and an affinity for math – which are the bases for any program.  As an end user, I have commissioned and paid to have two separate programs written.  And while I believe that I might have, with the aid of “Websites for Dummies” and other reference guides, been able to write those programs myself, I recognized that contracting this work out to people who made a living doing just that would be both time and cost effective.

In my case, unlike the government website administrator, I had accountability – to the bank that held my mortgage, to my dry cleaner, to my dogs to provide food for them and to myself.  In the second of these efforts I made a terrible mistake.

I hired a programmer who talked a great game and delivered virtually nothing.  After looking at what he had developed after three weeks (the whole project was only supposed to require six), I realized that I had spent five thousand dollars on a retainer on which I would see no return.  (The fact that he accepted the retainer and immediately took off for ten days in Tahiti – where he could “think about the project” was my first clue).  So I fired him and replaced him with someone who was able to accomplish the task.

You would think that if a person were in charge of a major project such as the Obamacare website rollout, that individual would be getting very little sleep and spend all her time checking to make sure that the project was on schedule and was working properly.  Apparently, that is not the tack that HHS Secretary Sebelius employed.  There is no other reason to believe that it has been such a dismal failure.  And that despite the fact that hundreds of millions of dollars have been spent.

What should be disturbing to anyone who is being pressed into the Obamacare system is that developing a website is by far the most simple of the tasks that government will be expected to perform regarding the nation’s healthcare system.  If this is such a disaster, what are we to expect down the road when we might actually need to use the much touted “superior health insurance” for which they want us to sign on the dotted line?

One of the issues that I think was missed in the website development but which is borne out by the initial low enrollment numbers, notwithstanding the federal website’s problems, is the fact that “selling insurance” is not the same as “selling a tangible product.”

If you go to Amazon you can look at that beautiful four piece toaster or the warm and snuggly down comforter.  These are items that you can touch, feel and envision in your home.  Insurance, whether it is for your house, auto, health or life are intangibles – and they are products, while they have a potential value, are ones that you hope never to use.

Most consumers view paying for any kind of insurance as a monetary outlay and paying the premiums does not provide the psychic reward that purchasing a tangible product offers.  They view this as an expense rather than a benefit.  Therefore, this is a hard sell – and one that is best effected with the interaction of another person.

A website, even the best designed one, does not provide that personal dialogue and discussion.  And when you have a website that simply does not function in a user-friendly manner, that provides a discouragement that the already unwilling potential buyer might find to be the final reason not to bother with it.

With only slightly more than 100,000 people “enrolled” in Obamacare during the first month of operation, the administration is only twenty per cent to the goal they have set for the law to work.  By “enrolled” we do not know how many of those people are purchasers – and how many are merely browsers who are considering making a purchase.  And it is significant that three quarters of the people who have so enrolled came through websites that the states, rather than the Federal government constructed.  So apparently, building a working website is not  all that tough as 36 states have accomplished it.

But imperative in Obamacare’s succeeding is the demographics of who is actually signing up for health insurance.  It is imperative if this law is to work that 2.4 Million people who are 18-34 years old participate because they will be overcharged for the insurance that they receive in order to make up for the deficits that older and sicker people will drain from the insurance companies.  We have no word as to the makeup of those enrollees although that is promised for next month.

As I write this I am listening to President Obama give a press conference in which he is offering a “fix” for those whose health insurance contracts have been cancelled by their carriers.  His solution is to “allow” those insurance companies who cancelled their contracts which did not comply with Obamacare’s mandated coverage to extend those through 2014.  There is only one problem with this solution – as well intended as it might be.

The states regulate insurance companies who offer product within their boundaries and the Federal government does not have the power nor the authority to issue this “fix.”  And therein lies the fundamental flawed premise which underpins Obamacare and every other over-reaching intrusion that those of “the Federal government can do it best and should do it” mindset subscribe.

Not surprisingly, even if we accept the statement that 100,000 have actually enrolled and will confirm that with premium payments to Obamacare in the first month, almost four times as many people have signed up for Medicaid – which is free to them and will result in increasing medical costs paid by all American taxpayers.  The explosion in Medicaid in and of itself will certainly sabotage the financial assumptions that President Obama made and touted that this law would actually provide savings to our skyrocketing healthcare costs.

But if the President wants to attract those 18-34 year olds who under the most rosy scenario have to enroll in order for this scheme to work, I would like to offer a suggestion that may attract them.  Simply offer them a new free iPhone every time one is released.  Giving away “free stuff” is something that this administration does very well.

QU’ILS MANGENT DE LA BRIOCHE

Perhaps one of the most famous quotes in history, “Let them eat cake,” has been attributed to Marie Antoinette.  Purportedly that was her response when told that the peasants had no bread to eat.  Although there is debate over who actually uttered this and the suspicion is that it was not the Queen of France, we now know the author with certainty, President Obama.

When he spoke in Boston the other day to his groveling throng of admirers and referred to the millions whose health insurance policies have been cancelled, he arrogantly offered advice to them.  “Let them go to the website and go shoppin’ – that’s what’s it’s there for.”  The arrogance of that statement and the way that it was delivered speaks volumes about Obama’s attitude towards the American people.

The premise on which “universal healthcare” via Obamacare was sold is that it was a matter of social justice that everyone have access to health insurance.  That is not an unreasonable goal – although I would again remind my readers that having comprehensive health insurance and having excellent healthcare are two separate and distinct issues.  And from the onset, non-partisan estimates suggested that there would still be thirty million who would remain uninsured even if Obamacare were fully implemented.

But if we accept the purported lofty ideals with which the bill was sold, it is incumbent that we ask ourselves, why then does the administration appear so unfeeling toward those who, because of the way HHS wrote the regulations, are being prevented from keeping the insurance that they freely chose and liked?

In many reported cases, these were not the “shoddy” policies which the omniscient in Washington deemed unworthy.  In many cases there are people who are losing decades long relationships with their physicians and their insurers.  And all of those are now faced with having to replace health insurance through a website that simply doesn’t work – and usually at greater cost than what they already had.

If we listen to Obama, he preaches a gospel of compassion, but he delivers the reality of indifference while working to the ultimate goal which is control – total and complete control of every aspect of every American’s life.  Obamacare is nothing more or less than a tool to bring about the total enslavement of a nation – no longer under God but under the heel of those who consider themselves the anointed ones.

What is worse, this President is so filled with hubris that today he re-wrote history – his own history.  He no longer claims that he committed to Americans’ being able to keep their old insurance policies if they were in place before Obamacare was passed.  The new line is that he promised that “if” no changes were made to those plans.  Thanks to the wonderful world of video tape we know that is an outright untruth (my polite way for saying that was a bald-faced lie).

Perhaps the President is as oblivious to his former remarks as he is to his promise to bring those who were responsible for the Benghazi massacre to justice.  Perhaps he was unaware that someone in his administration purposely barricaded the WW II Memorial to make the opposition party look bad during the partial government shutdown.

Perhaps, returning to the original thought that prompted this post, if the President wants to attempt to leave behind him a reputation as other than the worst president we have ever elected, he should call down to the White House kitchen and ask for a double helping of humble pie.  That would be a just dessert.

WHAT MY VET TAUGHT ME ABOUT OBAMACARE

While I have read the ACA in its entirety I wished that I were dyslexic while going through that task.  It might have made more sense.  Unless I missed it there is not  yet a provision that those of us who have companion animals are required to provide health insurance for our pets.  That might be coming.

So when Gracie developed a hematoma near her right ear, I realized that I was going to have to pay to have this treated out of pocket.  My regular vet was on vacation and would not return for two weeks.  While this was not a life-threatening condition, I could tell that it bothered her as she shook her head regularly throughout the day and I wanted to get her treated as soon as possible.  And the hematoma was enlarging on a daily basis.

I took her to another animal hospital which is close to my home and which I had used from time to time for routine things such as updating vaccinations.  This facility is only about five minutes from  the house and, unlike my regular vet, is open seven days a week.  But I always get the impression when I go there that I am going to a place that is a business more than a healing practice.  It’s hard to describe the reason for that impression other than to say that perhaps having had the company of dogs all my life, perhaps I’ve picked up on some of their intuitive perceptions.

Gracie and I met with a young female vet who was extremely sweet and very nice.  She got on the floor to examine Gracie and obviously loved animals.  So far so good.  As I lost a dog years ago while under anesthesia I asked if they could treat the hematoma using a local and simply drain it.  She went to confer with the owner of the hospital and returned to tell me that they would indeed need to use a general anesthetic and remove any mass that might have formed at the base.  She also returned with an estimate of the costs.  Reluctantly, I resigned myself to going through the general anesthesia and treating the condition as they had suggested.

As I read through the estimate I noticed that she had included a charge for a teeth cleaning.  I pointed out to her that there was no need for that as I had Gracie’s teeth cleaned five months earlier.  She said, “Well, if you don’t do the cleaning ($65) the cost of the anesthetic ($32) will be “slightly higher.  We give you a break on the anesthesia with a cleaning because we try to encourage people to follow a regular oral regimen for their pets.”  The actual charge for the mass removal was $140.  I thought to myself, that seems like a reasonable fee – $140 plus (I figured for the “slightly higher” anesthesia at $50-$60), not too bad.

So I left Gracie at the vet and asked them to call me when they had finished the procedure.  The doctor called me promptly when the operation was finished to let me know that Gracie was doing fine, the operation was a success and I could pick her up after four o’clock that afternoon.

I arrived to pick up Gracie precisely at four and asked the reception for my bill so that I could settle it while the staff brought Gracie out from the back.  When I looked at the bill I was a little startled.  The mass removal was listed at $140 per the estimate, but the anesthesia had gone from $32 to $150.  My invoice came to $53 more than it would have been had I not only had the mass removed but had her teeth cleaned unnecessarily.  Naturally, I thought this was an error so I asked to speak with the vet who owns the hospital, but he had just left for the day.

So I gave the hospital a check for the balance – less $53 and said, “I’m going to pretend that you actually did Gracie’s teeth cleaning and pay you on the basis of the estimate.  Since you didn’t actually do a cleaning, I think that’s more than fair.  But please ask Doctor K. to call me tomorrow so that we can discuss it.”  Gracie and I then left.

I didn’t hear from the owner the next day or the next so I called to speak with him.  I was connected to the office manager.  I explained my view and asked her to confirm that the bill I paid, as adjusted, was satisfactory to the hospital.  She promised to call me back within a few days.  When I didn’t hear from her I called her back.  At that point she said that she had discussed it with the owner and they were going to give me a $50 credit for the anesthesia and that my balance was $3.

I said that I would like to speak to the owner directly and would do so a few days later when I brought Gracie in to have her stitches removed.

By that time I was feeling exasperated over this three dollar invoice and had decided just to pay it.  In fact, I brought 300 pennies with me in a paper bag to settle the account.  But when I went to reception and Gracie went to the back to have the stitches removed, I was informed by reception that I owed them $53.  I explained that the office manager had indicated that the hospital was going to issue a $50 credit and that my balance was only three dollars.  So they asked the owner to come out and speak with me.

Dr. K. came out and began our conversation with the statement, “I understand you have a problem.”  Given the strident way in which he made that statement, I truly understood how John Boehner must feel in dealing with Harry Reid and President Obama.  I replied, “No, actually I have a question.  And here it is.”

“Why is it that anesthesia and a mass removal costs $290 but anesthesia, a mass removal and a dental cleaning costs $237?  This reminds me a little of Obamacare where you pay more and get less.”  (That did elicit a smile from the vet).

Well, we finally agreed that my balance was only three dollars.  So I left my bag of pennies on the desk and Gracie and I went home.  I’m most grateful that she is doing well and the scar has almost completely healed. 

I am not the sort of person who simply alters invoices because I believe that the product or service provided was worth a lesser amount.  At least, I wouldn’t do that without offering the provider the opportunity to discuss the matter.  So the reason for this post is to solicit some input from my readers.

What are your thoughts on this situation.  Should I have paid the invoice just as rendered?  Should the vet have offered to accept the amount that I tendered as payment in full?  Or should he have made a reduction in the amount he charged since one of the services wasn’t provided?

I look forward to hearing from you.

P. S.  Isn’t this a pleasant change from all the politics that I’ve posted of late?

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.

DEFUNDING OBAMACARE

When I started this blog nearly two years ago, my motivation was to try to examine the problems afflicting the Republic and to try to offer positive solutions which might begin the corrective process.  I’ve attempted to achieve that goal in over six hundred posts.

All this work is, of course, rather theoretical in nature.  Perhaps I’ve persuaded one or two readers or struck a chord with a few others.  But I realize that this impact is limited.  I have satisfied myself with trying to do what I could do and hope that others would do the same and that we might start a revolution one person at a time.

That, of course, speaks to my latent optimistic attitude far more deeply than it does to reality.

But today each of us who believes that the Affordable Care Act is a disaster both to the delivery of quality medical care as well as to individual liberty has an opportunity to speak up and speak out.

The link below will take you to a petition that urges our lawmakers to defund the portion of the budget that creates OBAMACARE.  If you believe, as I do, that this massive intrusion and overreach by the federal government into something which is not their prerogative should be repealed – or at the least – defunded, then I urge you to take a minute, sign the petition and circulate the web address to as many people in your sphere of influence as you can – urging them to do the same.

This is something that each of us can and should do if we are committed to the ideals of personal action and responsibility.

http://www.dontfundobamacare.com/

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