The American Dilemma and How We Can Fix It

Posts tagged ‘Patient Protection and Affordable Care Act’

OUR LIVES ARE AN OPEN BOOK

The reality is that apparently Obamacare is going to move forward with the state exchanges open for business in October, 2013.  It will probably take a little bit of time for us to really see the full impact of how poorly designed this law was from inception.

Of course, by illegally deferring the employer reporting mandate, the administration put off (until after the mid-term elections) some of the effect this portion of the law would have in reducing the number of workers who will have their work weeks cut in order to avoid the act’s onerous requirements.  So we will have to wait until 2015 to see how harmfully this affects the economy and “recovery”.

Of course, now that Congress has gained an exemption for themselves and their staffers and then gone on vacation (although they have a long way to go to catch up with the vacation time the Prez has taken), these esteemed lawmakers can just sit back and let the dice roll as the Obamacare craps game plays itself out.

That, of course, is really only the concern for those of us who remain who actually will be compelled to obey the law.  The unions who were ardent advocates for the passage of universal coverage have now looked at the law (probably ahead of former Speaker Nancy (Pip Squeak) Pelosi and decided that it reeks and have asked for exemptions.  This includes the union representing those who are given the responsibility of administering a significant portion of the law – the IRS.

While we do not know how much of this law will play out – whether we include the limitation of services (death panels), the actual cost of obtaining insurance, whether the predication of Obamacare’s success that younger, healthier people will actually enroll or just pay the rather minimal penalty that will apply in its first year of existence which could sink it, there is one thing that we do know now.

The administration (translation Health and Human Services) which has had nearly four years to develop a secure system to maintain the personal information to which it will be entrusted, has yet to test their system and prove that it is hacker-proof and secure.  It missed its first deadline to do so earlier this year and is going to try again later this month.  We will need to see if they are able to accomplish this.

The IT systems developers with whom I have spoken have unanimously doubted the likelihood that this test will prove the system to be secure.  Their experience suggests that a system of this scope and magnitude needs one to two years of constant testing before it is safe to unleash.

You’ve probably heard of a service called “Life Lock” which is supposed to protect your financial information from hacker intrusion.  There are a number of such services which attempt to alert us and provide early detection against hacker intrusion into our private financial records.  But what this service protects against, the amount of data that they monitor on our behalf, is so small compared with that which will be collected under Obamacare that it pales in comparison.

Imagine listing not only your social security number, your DOB, your home address, your marital status but add to that your entire health history – all reposited in one unsecure data base.  What a field day for our hacker friends to gain complete access to our most intimate, private matters.  Are you comfortable with exposing your life to anyone who is clever enough to hack into these servers?

But let’s assume, and this is a big assumption, that HHS is successful in implementing a secure system.  We will have eliminated one threat – or so we hope.  But there is another that might be even more dangerous.

Think about the bureaucrats who will have access to all that personal information.  Under normal circumstances and with a functional administration that conducted its affairs based on some at least minimal moral standard, that might not be much of a concern.  But that is not this administration.

We have all heard President Obama descry those who are “distracting the American people by raising the specter of all the ‘phony scandals.’”   Those, of course include the truth about Benghazi; the revelation that the IRS not only targeted conservative organizations – delaying their approving tax exempt status for purely political reasons – but the latest part of that “phony scandal” that they apparently communicated information to the Federal Elections Commission and redacted (translation deleted) certain information which they might have had to supply to Congressional committees based on what their friends at the DEA taught them; and, of course, the last “phony scandal” that the NSA has actively been collecting information on law abiding Americans and archiving what we once thought was personal, privileged communications.

My grammar school English teachers would have raked me across the coals for producing something akin to that last lengthy paragraph.  But when the administration continues to provide so much fodder, it’s hard not to run on a bit too long.

With an ever-growing list of such malevolence, it’s simply too great a leap of faith to believe that those in this administration will not use whatever information is available to benefit their own political agenda and not the citizens of this country.

reallyyoustilltrustthegovernment

WHAT ARE YOU THINKING, JOHN BOEHNER?

Today the House is set to vote to delay certain portions of the ACA (a/k/a/ Obamacare) from being implemented.  The reasoning of Speaker Boehner is that if the President can delay employers’ having to comply with the reporting requirements until 2015, then it is only fair that the individual mandate, requiring every American to purchase health insurance also be deferred until then as well.

This is exactly the wrong approach to take on two bases – one of which is a matter of legality and one of which is a matter of politics.

It is the responsibility of the Congress – not the President to enact laws.  As we all know, a Democrat controlled Congress passed this law unanimously over the unanimous objection of Republicans in the House and the Senate ratified this legislation.  In theory, the only role the President played was in signing the legislation to make it the law of the land.

It is still the law of the land and has not in any way been modified since its original passage.  The only branch of government which has the right to alter an existing law is the Legislative branch.  And if the Legislative branch enacts a law which the Judicial branch deems to violate a provision of the Constitution, it may strike down or amend that law so that it conforms to the Constitution as the Justices interpret it.  But nowhere does the Constitution grant the Executive branch the authority to modify any law which is duly passed by the Legislative branch of the government.

In deferring the employer reporting requirement, President Obama has overreached his Constitutional authority and is in violation of his oath that he will (to the best of his ability), preserve, protect and defend the Constitution of the United States.  Arguably, this might be sufficient grounds for a Bill of Impeachment.  But as we all know, that will provide us with more distractions and more melodrama and has a zero possibility of success.

But it does give Speaker Boehner an opportunity to achieve his laudable goal of killing ACA in the womb (if you’ll pardon the somewhat distasteful mixed metaphor).

Rather than attempt to defer the individual mandate, the Speaker should point out the facts of my first argument and insist that both mandates be implemented beginning in 2014 as the law is written.  Unless he has ceded the responsibility of lawmaking which rightly belongs to him and his colleagues in Congress to the President and has, thus, violated his own oath of office.

It was clear to those of us who read this law that it was, to be kind, bad legislation from the beginning.  That is becoming ever more apparent as the details of it unfold.  The American people in the majority opposed it when it was passed, and as it comes closer to implementation that majority is swelling.  There are too many requirements which may have sounded good, but the act of actually effectuating those (the employer reporting requirements is a good example), are so onerous that they simply are unachievable – at least according to the schedule which the original bill contained.

If the Speaker, the Republican party, and the majority of the American people want this bill repealed, the most efficient way to do that is to insist that it be implemented as the Democrat Congress wrote it and the Democrat President signed it.

It would be hard for those in the Administration to argue that requiring that ACA, the “jewel” in the crown of team Obama’s first term in office be put into full effect could in any way be called Republican “obstructionism.”

GOOD NEWS FOR SENIORS

If you don’t like pizza – well, you’re just un-American.  I’m a good and loyal American so it goes without saying that I not only like, I LOVE pizza.  Hot, cold, thin or thick crust – other than throwing pineapple and ham on it (or peanut butter), it’s almost impossible to ruin this all-American favorite.  (We did invent it didn’t we?)

Well if you’re thinking that under our ever-beneficent radical socialist leaders in Washington, seniors are going to be able to get all the pizza they can eat, I’m sorry to report that you’re wrong.  (At least for the moment – but who knows?)  No, I’m referring to new job opportunities which those who rely on walkers to perambulate may soon have available to them.

You see, there’s this law that passed called the Patient Protection and Affordable Care Act (a/k/a/ Obamacare).  And a mighty law it is indeed – as we’re only beginning to discover.  Fortunately, it doesn’t fully kick in for another year so that allows us time to think and pine and fret over its implications as they begin to further unfold.  But there are a few things about it which we do know.

(This includes those Democrats including my own former Congresswoman Shelley Berkley who recently failed to advance her career to the United States Senate and is now out of politics.  The good Congresswoman followed leader Pelosi’s advice and voted to pass the bill without bothering to read it.  Details, details.)  And, by the way there are a lot of details.

One of the details that we do know is that employers will be required to provide health insurance for all employees who earn less than $15 per hour.  If they fail to do so they will be subject to a fine of $2000 per employee.  But the cost of the insurance is likely to be at least five times as expensive as the fine.  So, in essence, the reasonable employer will make the choice between spending $2000 per year or $10,000 per year – and which number do you think she will select?

But, wait – there’s a way around this.  You see this only applies to those employees who are considered “full time” employees – that is to say that they work (or at least show up) for 30 hours or more a week.  (Whatever happened to the 40 hour work week?  I guess I owe myself a lot of back pay at an overtime rate!)

So, as an alternative, an employer can cut back on her full-time staff, reducing them to part-time status and thus skirt this provision of Obamacare.  Apparently when our esteemed Congress passed this bill and the President signed it into law, they overlooked this eventuality and the consequent reduction in income and standard of living that those whom the law is intended to benefit will undergo.  I guess it’s just another example of unintended consequences.

But in my musings, I have arrived at a solution which I would like to share with all those small business owners (and little pizzerias that I love to frequent).

HIRE THE ELEDERLY

You see, if we merely raid the retirement homes to find the able-bodied among our senior citizens, we can recruit them to work in our stores and businesses and avoid this provision of Obamacare since they already have insurance, Medicare.

And this works out well for our seniors.  Not only will it provide them with additional income that they need to compensate for the rising prices of food and gas (the kind you put in your vehicle) which are far outstripping the increase in their Social Security benefits but, since their doctors are now becoming veterinarians, there’s no need for them to worry about missing their appointments – since there won’t be any.

And this works out for the pizza-eating public as well.  I mean really, would you rather see some acne-pimpled teenager tossing the dough for your pizza, or some lovely silver-haired lady who reminds you of your grandmother?

“I’m here to pick up my extra large pepperoni, mushroom, green pepper and onion pizza, Grams.  Oh, wait.  Don’t strain yourself.  Let me help you lift that.”

THE AARP AGENDA

I was approaching one of those milestone birthdays – you know, one of those ending in a zero.  It happened to be my 50th and several months before the actual day I had a new friend who didn’t want the day to go by unnoticed.

The American Association of Retired Persons as it was formerly called, began sending me solicitations to become a member of their organization.  A number of my friends were members and the cost to join was inexpensive, so I returned my invitation together with a check.

AARP efficiently returned an informative membership packet and I began receiving a copy of their bi-monthly magazine.  As it turned out, I was already getting the travel and hotel discounts that they offered from other sources, their offerings for Medicare health insurance supplements were not available to me because of my age and I found I could do better shopping on my own for auto and homeowner’s insurance.

The magazine which AARP publishes is very informative and I highly recommend it to people who do not have the time or are unwilling to make the effort to do their own research.  I have always preferred learning things on my own, comparing several sources so that I get a variety of views and then drawing my own conclusions.  So after perusing several issues, the remainder of my subscription went into the recycling bin unread.

At the end of my year’s membership, AARP sent me a renewal form which also went into recycling as have many solicitations that I received from them over the following years.  I have chosen not to renew my membership in AARP.

If you’ve watched any television recently, you will certainly have seen some ads for “AARP endorsed” Medicare supplement plans.  That is because the period between October 15th and December 7th is “open enrollment season” when seniors on Medicare can choose to switch or change their supplemental coverage for the following calendar year.

I admit that with my sometimes twisted sense of humor, when I hear “open enrollment season” I think of hunters going after our senior population, armed with bazookas to bring down their targets.  There is big, very big money in selling Medicare insurance supplements – a fact that is not lost on AARP.

As part of our regulatory system, both “for profit” and “not for profit” organizations must file financial statements with the Federal government.  What is required of “not for profits” is less than for their counterparts.  But reviewing these statements can still be informative.  So that’s what I did.

In the year ending December 31, 2011, AARP received more than two and one half times the amount of revenue from “endorsing” insurance products than it did from its membership fees – a rather staggering, $704 Million.  By anyone’s standard, this could hardly be considered chump change.  The vast majority of this income was derived from royalties paid by United Health Group based in Minnetonka, MN, but some of it was derived by its “affiliate programs” with other insurers who provide auto, homeowners and life insurance to AARP members.

If you can recall any of United Health’s ads for Medicare supplements, to promote sales of their products they include the phrase, “the ONLY Medicare supplement endorsed by AARP”.  The implication, of course, is that AARP wouldn’t “lend” its name to a product that it hadn’t thoroughly checked out in much the way that consumers used to look for the “UL” label on an appliance to make sure that Underwriters Labs, an independent organization, had thoroughly tested the product before passing on its safety.

There is a big difference between the UL seal on a product and the AARP endorsement of a Medicare insurance supplement.  Underwriters Labs provides an independent assessment of each product it reviews.  It is not compensated by any company for passing or rejecting their products.  AARP has a significant vested financial interest in promoting products by United Health because they receive a royalty for each one of these supplements which are sold.

United Health Group is a fine and reputable company.  It owns the largest portion of the Medicare supplement business with a 30% market share.  I am not suggesting that their products are in any way inferior to those offered by their competitors.  In fact, if I may cite one example in which government regulations have actually proven effective, it is the Medicare supplement business.

Our seniors can choose a “lettered” supplement which will pay part or all of the costs which Medicare does not cover.  The government has standardized these different options and each insurance company which underwrites them must offer the same government-specified coverage for that particular contract as does its competitors.  The only difference between them is the cost that a particular insurer charges and the service that the insured receives from the underwriter.

Considering that fact, an AARP endorsement, or lack of one, makes absolutely no difference to the consumer when they select a Medicare supplement.  It all comes down to the cost of the product and the service that they will receive should they need to file a claim.

According to the financial statement which AARP filed for calendar year ending December 31, 2011, of its $1.35 Billion in income which the organization recorded, more than 50% of it was derived from royalties from insurance contract sales.  In other words, AARP has a vested interest in making sure that there is no threat to its primary source of income – the royalties it receives from the sales of insurance contracts.

And that brings me, together with another item in its financial statement, to question its motivation in criticizing the Romney campaign for statements that they have made regarding Medicare and Obamacare.  Are these criticisms that have been leveled by an independent organization whose mission is to defend and protect our senior population?  Or are they self-serving statements made by a business, intent on protecting its own interests?

The other item in the financial statement which stood out to me was the income the AARP received from “grants”.  The amount that it recorded was $101 Million, and of this amount $92 Million came from the Federal government.

My friends in academia used to sweat bullets when it came time for their “grants” from Uncle Sam to be reviewed for renewal.  Although they may have lived in ivory towers, they realized that the individual who made the determination of continuing or stopping their grants had the power of financial life or death over them.

I would suggest that AARP is in much the same position as my academic friends.  If you combine the royalties it receives from the sale of Medicare supplements and the money it receives in grants, AARP is dependent on the Federal government and its programs for over 60% of its income.

Is it, therefore, any surprise, that AARP took Mitt Romney to task for challenging the administration on its healthcare programs calling his statements “false and misleading?”

As I head out with Gracie for our morning visit to the dog park, the old adage comes to mind.

“You don’t bite the hand that feeds you.”

HOW OBAMACARE IS AFFECTING REAL PEOPLE ON MEDICARE

If you are on Medicare you have probably received (or will shortly) your Official Guide to Medicare, sent to you by your friends in Washington.  It’s a large and informative book which does a good job of explaining what you need to know.

For those people who are considering the merits or deficiencies of a Federal health care system but are not currently on Medicare, allow me to give you a brief overview of how the system is structured.

If you are Medicare eligible (generally you either have attained the age of 65 or are younger but have won a disability case with the Social Security Administration) then you are automatically enrolled in Medicare Part A.  This portion of the program provides for payment to hospitals for their services.  There is no premium associated with this coverage.

Part B of Medicare is optional coverage which pays about 80% of the negotiated fee for services such as doctors’ visits, doctor ordered tests including MRI’s, blood work, etc.  The premium for this coverage ranges between $100 – $320 per month dependent on income.  Medicare pays 80% of the charges which a patient incurs for these services – the balance being the patient’s responsibility.

Typically, people who have significant medical conditions or want to avoid incurring such charges should they contract a new infirmity will purchase a supplement from a private insurer.  Depending on the plan, they may get private insurance coverage which may pay the balance that Medicare does not pay.  Premiums for these plans typically range between $200 – $1,000 per month depending on the insurer and their underwriting determinations based on an individual’s specific health profile.

Excuse the skip in lettering but we will now go to Medicare Part D.  This is the prescription drug portion of Medicare and is also optional.  The cost of participating in Medicare Part D is also determined by income.  Most plans require a monthly payment ranging from about $20 – $60 a month.  Plans have an annual deductible which range between $0 – $325 before making any benefit payments.  All require an additional co-pay for any prescription drugs a patient takes.  Most plans do not cover all drugs which a patient might be prescribed or will only pay for certain drugs in non-generic form.  They all contain a cap on the maximum amount of benefit they will pay annually and are underwritten by private insurance companies.

Medicare Part C is known as “Medicare Advantage”.  This is also underwritten by individual insurers at no monthly premium cost to the patient and include a prescription drug plan.  These plans include an annual physical exam at no charge.  For all other services including doctors and hospitalizations and drugs the patient must make a co-payment which varies depending on the service that is involved.  Of course, for an individual who is generally healthy, doesn’t make frequent trips to the doctor or takes a limited amount of medication, this is the most attractive supplement since there is no monthly premium – merely the co-payment which must be made for each service or prescription.

The reason I went into such detail on how Medicare works in its various components is because of a conversation I had with a friend the other day.  She is a young 66 year old, active and healthy and living on Social Security for the majority of her income.  She was covered under a Medicare Advantage plan but was informed by her insurer, Sierra Health Systems that they are discontinuing their plans in Clark County, NV in 2013.  Anthem (which is Blue Cross) also underwrote this coverage and they too are discontinuing their plans.

So my friend was advised by her insurance agent that she can expect to obtain similar coverage for next year, but instead of paying no monthly premium, she can expect a premium of at least $30 a month with a new insurer for the same coverage.  The reason which the agent cited – Obamacare.

This is a real person with an income from Social Security of about $1,100 per month who is currently paying $100 per month to Medicare for insurance coverage.  That is 9% of her income.  That cost (assuming that her Medicare Part B premium doesn’t increase at all) will now escalate to $130 per month – a 30% increase in the amount she must spend for insurance – thanks to the Affordable Care Act which the Congress passed and President Obama signed into law.

So for whom is the “Affordable Care Act” affordable?  Apparently not for the members of Congress who, without reading the law, were wise enough to exempt themselves from being subject to it.

THE THREE BRANCHES OF GOVERNMENT

Gracie wanted to go out for a walk this afternoon.  It wasn’t at a time that was on my schedule for the dog park so I thought that I would just take her in the neighborhood.  The temperature was approaching 100 degrees and I really didn’t think she would stay out very long in the heat.

So we went to the little park a few minutes away and there we found a number of children from the neighborhood, celebrating their last day of school and the beginning of their summer vacation.  They hadn’t seen either Gracie or me for some time and greeted us warmly.

One of the youngsters, a young boy named Scott came over and said hello to us and began to pet Gracie.  He’s a very bright and gentle child whose parents raised him with a wonderful sense of generosity and kindness.  Scott will be a junior in high school next year.

So we talked for a few minutes about school and his break from it.  I asked which subject he had most enjoyed in his sophomore year.  Much to my delight, he said, “history.”  As half my college background was in history nothing could have pleased me more.

So I pursued our conversation and asked, “What history did you study this year?”  He responded, “American.”

I should have known better but I pursued this and asked him if he could tell me the three branches of government.  I like giving pop tests.

Scott thought for a brief second and said, “Well, there’s the DMV …”  And at that point, despite my shock I said, “Hey, you got the toughest one.  I’m sure you know the other two.”

For a moment I thought I should correct him – but I knew that our encounter was going to be brief and I thought to myself, “Self – how could you possibly hope to overcome ten years of “education” in a minute or two?”  So I kept my mouth shut, let the kids play with Gracie a bit longer and went home.

I went online when we got back and read that the latest polls said the Supreme Court has fallen to its lowest approval rating in many years with only 44% of the American public viewing the Court positively .  Based on my encounter with Scott I was shocked at this number.

I was amazed that 44% of our populace knew there was a Supreme Court.

More significantly, despite it’s low level of positive public acceptance, it may well be the determinant in who becomes the next President of the United States.  Allow me a moment to express my thinking.

The Supreme Court is supposed to be one of three branches in our system of checks and balances.  It has the authority to overturn law which Congress enacts and has the right to overturn orders issued under Executive authority.  It might be most descriptive to categorize it as the “Court of Last Resort.”

The court is, in theory, impartial.  The Justices are supposed to view each case which they choose to accept on the basis of their interpretation of the Constitution as it applies to that case.  It is supposed to be apolitical.

The current court has made its decisions based on an obvious political bias – the four conservative Justices voting as a block; the four liberal Justices voting as a block; and the lone independent having the responsibility to cast the deciding vote.

Perhaps that is one of the reasons that our view of the Justices and confidence in their decisions has fallen to record lows in the polls.  But the truth is that, given what must be construed as a politically divided Court, the Supreme Court may well be the arbitrator of who is the next President.

Currently the Supreme Court is considering the constitutionality of what we generally call “Obamacare.”  This legislation is opposed by a vast majority of the American populace.  In particular, certain provisions within the bill has helped to catalyze a solidarity movement among a particular group – our Roman Catholic citizens.

They strenuously object to the imposition of providing contraceptive and abortive “treatments” in direct conflict with their view of morality.  They view this as a First Amendment issue – Freedom of Religion.  Prayer vigils in advance of the Court’s ruling on the law’s constitutionality were held today country-wide.  They hope and pray that the Court will overturn at least portions of the bill.

President Obama has done nothing more effective in three and one half years than to coalesce the Roman Catholic minority in the country over this issue.  Many of these voters contributed to his victory in 2008.  Wouldn’t it be ironic if  the President and our Catholic friends both want the same decision from the Court – that the law be found unconstitutional?

If that were to happen, Catholic organizations would not be required to provide abortive services as the law, as it is being implemented currently, demands.   Thus they would be relieved of the current requirement that either they break the law or violate their consciences.

From Obama’s perspective, striking down the law would enable him to say, “I gave America this wonderful law which covers uninsured Americans with medical care.  I am a person of the people.  Don’t blame me if the Supreme Court overturned my great and valiant efforts.”

Should the Court overturn Obamacare it might diffuse much of the opposition which has coalesced among Roman Catholic Americans and provide him the needed extra  votes to continue his agenda for another four years.

It’s a little frightening that the part of our government which enjoys the lowest rating of any of the three branches may have it in its power to make the difference this November.

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