Archive for November, 2017

Will “political gimmick” of eliminating the ACA Individual Mandate in the GOP Tax bill cause higher premiums for Americans not subsidized. Yep!

November 30, 2017

Everyone wants lower personal taxes and lowering corporate taxes will create more jobs and higher wages. But political gimmicks to get votes, such as eliminating the Individual Mandate (I Mandate), is another example of weak leadership and the GOP being unable to pull its ranks together. The GOP won’t get another chance to lower or reform taxes yet they once again muddle up the effort with gimmicks.

The Congressional Budget Office has estimated that repeal of the insurance requirement would save the government $338 billion over 10 years. That estimate comes mainly because the CBO projects that fewer people would seek subsidized coverage.

There’s a gimmick for you because there is no evidence or reason to think that people who could get a subsidy won’t sign up for it simply because there is no mandate penalty. If you knew that you qualified for a subsidy for your health insurance why on earth would you not sign up?

CBO estimates the number of uninsured would rise by 13 million during the same 10 year period used for the budget gimmick. The CBO has been so wildly incorrect in its estimates concerning coverage that why would we believe its estimate of 13 million fewer covered. BTW, statistics show that there are approximately 30 million Americans without any coverage while only 10 million covered under the ACA individual exchanges. And that’s with the Mandate in place so the I Mandate makes little impact.

The I Mandate as well as all of the ACA should go away and be replaced but eliminating the I Mandate will definitely put pressure on insurers to increase premiums on their individual plans in or out of the exchanges. If people are not punished by a tax if they don’t get coverage, then allowing people to buy coverage only if they need it will certainly lead to higher premiums.

Business Example:
Let’s assume that my business replaces windows in office buildings.
I get a call to estimate the price to replace a window in an office building. I’m told that the window is on the first floor. I quote $100.
But when I show up to do the work I discover that the window is actually on the tenth floor, not first floor. Do you think my price to install the window will go up?
You bet it would because the risk to install the window has gone up!

So, the result will be higher premiums for people who need good comprehensive health insurance. But there is hope for those of us who are optimist as foolish as I may seem. The GOP’s tax bill does not eliminate the I Mandate until January 2019. That would give the DOL/HHS/IRS time to spell out the guidelines on President Trump’s Executive Order providing for Association Health Plans and for selling cross state lines.
The potential from the President’s EO could bring many new insurers and plans into the market providing more choice and lower premiums to those Americans whose premiums we believe will increase. But that starts the clock ticking to get those new guidelines to the public so that insurers and more likely TPAs can develop the plans we all need.
OK, so I’m trying to be optimistic even though I dislike mucking up the GOP tax bill with gimmicks. If we had our way I’d say just reduce the tax rates and brackets but leave the other “Cr***p” like SALT and medical expense deductions alone. But the GOP leadership can’t seem to keep it simple, defensible and passable. We saw that on R&R didn’t we?
As I write this the Congress is off for yet another holiday break (Thanksgiving) but when you read this the Congress will be back in session and we will see that once again, we’re right!
As is usual in politics, the benefit and cost for 330 million Americans is being adversely impacted by the political and media agenda on 6 million(or fewer) Americans. It could be positive for all with proper leadership on the topics of budget and healthcare.
Let’s keep the pressure up cause we’re all in this together.
Until next week.
Mark Reynolds, RHU


The Thanksgiving Holiday is not unique to the USA but we may enjoy it more than most. Given the way History is taught in schools, do younger Americans know its origin? Let’s review.

November 21, 2017

We’re Posting two days early as we take a break from discussing healthcare reform and the ridiculousness of Washington DC to pause for one of our most cherished of traditions.

Why is it that we have this Thanksgiving Holiday? It’s a national holiday and generally grants us a 4-day weekend, at least for many of us. If one searches the internet for Thanksgiving there is a plethora of good info. But why do we celebrate it?

Most of us don’t research the reason for any holiday and we are perfectly happy enjoying the time off from work. I say this as someone who is not good help and therefore banished from the kitchen so Thanksgiving Day has always been a full day of food, parades and football. (Except this year, it’s just food and parades since we can’t watch the NFL until the protests against our National Anthem stop.)
But that’s not the story for today.

Let’s take a brief look at the origin of Thanksgiving; courtesy of Wikipedia and the Internet.

Early thanksgiving observances

, or Thanksgiving Day, is a public holiday celebrated on the fourth Thursday of November[1] in the United States. It originated as a harvest festival. Thanksgiving has been celebrated nationally on and off since 1789, after Congress requested a proclamation by George Washington.[2] It has been celebrated as a federal holiday every year since 1864, when, during the American Civil War, President Abraham Lincoln proclaimed a national day of “Thanksgiving and Praise to our beneficent Father who dwelleth in the Heavens,” to be celebrated on the last Thursday in November.[3][4] Together with Christmas and the New Year, Thanksgiving is a part of the broader fall/winter holiday season in the U.S.

The event that Americans commonly call the “First Thanksgiving” was celebrated by the Pilgrims after their first harvest in the New World in October 1621.[5] This feast lasted three days, and—as accounted by attendee Edward Winslow[6]—it was attended by 90 Native Americans and 53 Pilgrims.[7] The New England colonists were accustomed to regularly celebrating “thanksgivings”—days of prayer thanking God for blessings such as military victory or the end of a drought.[8]

Setting aside time to give thanks for one’s blessings, along with holding feasts to celebrate a harvest, are both practices that long predate the European settlement of North America. The first documented thanksgiving services in territory currently belonging to the United States were conducted by Spaniards[9][10] and the French[11] in the 16th century. Wisdom practices such as expressing gratitude, sharing, and giving away, are an integral part of indigenous communities since time immemorial.

Thanksgiving services were routine in what became the Commonwealth of Virginia as early as 1607,[12] with the first permanent settlement of Jamestown, Virginia holding a thanksgiving in 1610.[9] In 1619, 38 English settlers arrived at Berkeley Hundred in Charles City County, Virginia. The group’s London Company charter specifically required “that the day of our ships arrival at the place assigned… in the land of Virginia shall be yearly and perpetually kept holy as a day of thanksgiving to Almighty God.”[13][14] Three years later, after the Indian massacre of 1622, the Berkeley Hundred site and other outlying locations were abandoned and colonists moved their celebration to Jamestown and other more secure spots.

Harvest festival observed by the Pilgrims at Plymouth

Americans also trace the Thanksgiving holiday to a 1621 celebration at the Plymouth Plantation, where the settlers held a harvest feast after a successful growing season. Autumn or early winter feasts continued sporadically in later years, first as an impromptu religious observance and later as a civil tradition.

Squanto, a Patuxet Native American who resided with the Wampanoag tribe, taught the Pilgrims how to catch eel and grow corn and served as an interpreter for them. Squanto had learned the English language during his enslavement in England. The Wampanoag leader Massasoit had given food to the colonists during the first winter when supplies brought from England were insufficient.

The Pilgrims celebrated at Plymouth for three days after their first harvest in 1621. The exact time is unknown, but James Baker, the Plimoth Plantation vice president of research, stated in 1996, “The event occurred between Sept. 21 and Nov. 11, 1621, with the most likely time being around Michaelmas (Sept. 29), the traditional time.”[16]  ] The feast was cooked by the four adult Pilgrim women who survived their first winter in the New World (Eleanor Billington, Elizabeth Hopkins, Mary Brewster, and Susanna White), along with young daughters and male and female servants.[16][17]

So, there you go, a brief history lesson for us all. Can you imagine our Congress declaring a day be set aside for honoring the Almighty who Dweleth in the Heavens in 2017?

Over 120 Pilgrims landed on Plymouth Rock but only 53 survived the first year, to celebrate and offer thanks, in the New World.   As we enjoy our Thanksgiving Holiday I hope we all  can benefit by knowing the first years of this celebration were precluded by great hardship and therefore were indeed a blessing for the settlers. They endured much and likely would have all perished if not assisted greatly by the Native Americans living in the region. We each need a little help in our lives from time to time!

There’s a lesson in history for each of us. Unfortunately it is quickly forgotten as the Monday following Thanksgiving arrives. Hey, maybe it will be different this year.
Next week we’re back to healthcare reform, tax reform and the unbelievable mess we call our US government.
Until next week, let’s remember what Thanksgiving is about and that like the Pilgrims in 1621, we’re all in this together.
Until then,
Mark Reynolds, RHU

Charges concerning Sexual Harassment, rampant in the news lately, seem to be every where. It provides me a selfish opportunity to promote TPAs as a career path for women.

November 16, 2017

This Post is not intended to minimize the many stories about the impact of sexual harassment in the workplace. There is no way for most of us to know how being sexually harassed in the work place feels emotionally, spiritually, or physically especially chubby middle-aged guys like me. The stories are disgusting and abhorrent to any sense of normalcy in the workplace. So, this Post supports women in the workplace.

Let me frame the discussion. Your humble author has been married (to a women) for 32 years and I have three terrific daughters. In addition, I have worked at three TPAs in my career and each one of those companies has/had 70-90% female employees. The point is that I have personally witnessed the effort, input and sacrifices that women must make to be in the workforce.

That’s why I decided to write this shamelessly self-serving Post to promote the advantages of TPAs as a career choice for women. I have never heard of a harassment issue in this industry that was not dealt with immediately and appropriately. That’s why I think women should consider applying to and working for TPAs in their local community.

I am friends with many people at a number of TPAs and I have visited or know how many others operate. Without exception every TPA is dependent upon and could not function without the women employed. In my opinion this clearly shows that women are indispensable to these businesses. My opinion also includes other niches within the insurance industry.

Women routinely hold 50% to 90% of the management positions at TPAs including as  President, CEO, Vice-president, General Manager, CFO and other key positions. Women hold management positions in Accounting, Administration, Marketing, Sales, Customer Service, HR, Underwriting, as well as Technology just to name a few. Women also fill the multitude of staff positions which no TPA can live without in every aspect of the business.

At every TPA I know women are key to current operations as well as strategic planning for the future. It pains me to sound a bit sexist but women actually have advantages over men in the insurance industry. They are willing to work hard or harder than many men, they don’t feel entitled, they are more detail oriented, more empathetic to member’s issues and don’t doubt the power of a women’s gut feelings or intuition.

If I could give women career advice I would suggest strongly they investigate the insurance industry and specifically TPAs as career path. There are opportunities  available in all of the areas mentioned above. But maybe most of all, a woman will be appreciated and will be able to make a difference in the lives of many others without fear of harassment or of any inappropriate situation going uncorrected.

Don’t misunderstand, though, it takes a desire to learn the business with all of its regulations, policies, procedures and bureaucratic hassles. TPAs are the backbone for the delivery of employer sponsored benefits to millions of Americans but it is not an easy business, by any means. Maybe that’s why women have an advantage over men.

Forgive me for not focusing on the ongoing dilemma caused by the ACA but I felt it important to reach out to women to let them know they don’t need to put up with any bullsh##t in the workplace. And they won’t at a well managed TPA.

So, that’s it. Let me know what you think.
Concerning harassment, either sexual or any other kind, we are all in this together.

Until next week.

Mark Reynolds, RHU


Rates for the subsidy-eligible ACA Silver Plans projected to increase by an average 34% in 2018. Who does this really affect? Not who you think!

November 9, 2017

The Media as well as private news sites and blogs are making a lot of noise about the projected increase in premiums on ACA health plans for 2018. Clearly, 90% of the US public will be mislead by these headlines and not understand who these premium increase will affect. And who is paying for them. Let’s look closer.

Most reports are trying to blame President Trump’s decision to discontinue the Cost Sharing Reductions (CSRs) as the reason these rates are increasing. I don’t think that’s true and I don’t think 90% of America understand the truth about the plans and citizens for whom these plans apply.

Remember, the CSRs apply only to:

  • Roughly 6 million out of the 10 million Americans covered by individual Silver plans on State Exchanges.
  • These citizens get their premiums and out-of-pocket (OOP) costs subsidized.
  • So their OOP is not effected by increased premiums or the decision to discontinue the CSRs.

A couple other points to remember:

  • Insurers are not obligated to offer individual plans on the Exchanges.
  • If carriers offer similar plans on and off the exchanges then the premiums must be equal.
    • This is a somewhat awkward requirement since On Exchange plans have fees added on to pay the Exchange.
    • That means that Insurer plans Off Exchange, if their plan mirrors an On Exchange plan, must match the price.
    • That means the insurer keeps the cost added in that was due the Exchange.
  • BUT, insurers can offer different plans off the Exchange than on the Exchange with those Off Exchange plans can be priced however the insurer deems is appropriate.

To summarize:

  • Americans can buy their individual plans On or Off Exchange depending on their own needs or desires.
  • Only On Exchange Silver plans qualify for Subsidy for either premium or OOP.
  • Subsidy is based on annual income relative to Federal Poverty lines
  • Insurers are allowed to offer plans Off Exchange that are different from On Exchange plans.

The ACA did change the way individual plans are priced, the benefits offered, how they are sold and how they are underwritten. They are guaranteed acceptance with no denial of any treatment due to previous health history or treatment. The ACA made it possible for anyone, including the least healthy, to buy a policy that covers what ever ails them.
And do so almost when ever they choose.

Remember, an Off Exchange plan is simply a health insurance plan that is available from the insurer direct without the need to go through an official Exchange. It can be different from On Exchange plans both in benefits and premium. Honestly, there are probably only two reasons to shop through the Exchange:

  • One, is if applicant will qualify for subsidy.
  • Two, the applicant does not know or want an agent to be involved. (Foolish)

 In most states there are more plans available Off Exchange than ON. Most advisors will advise that the only reason to use an Exchange is if you will qualify for a subsidy, one must admit that makes sense.

So, the premium increases the press is screaming about affect a small number of citizens who are not responsible for the premium or OOP on the Silver plan they select. That means they are NOT paying for the increases the media is protesting. So, who does?

If the pundits and ACA proponents had their way it would be you, the US tax payer, who pays these increases. Your cost would be paid by the CMS and HHS which are funded by your taxes.

As we projected in earlier Posts, the Media and libs are making a big deal by distorting the facts and misleading the rest of us Americans. Six million Americans  affected, out of 330 million people, and those six million won’t be paying the increases anyway.

So, premium increases on both individual and group plans have little to do with the Presidents decision to discontinue the CSRs. The reasons for the increases are complex but basically the result of the ACA and its punitive restrictive rules.

Those are the facts as I see them. But what do you think, after all, we are all in this together.

Until next week.

Mark Reynolds, RHU













Tax Reform, may not seem related to Healthcare Reform, but it is. Particularly, the deduction of State taxes on Federal returns. Let’s see why.

November 2, 2017

This Post may seem odd to those in states that have no or very low state income taxes. But the prospect that Congress might pass and President Trump sign a bill causing the elimination of the deductibility of state taxes on Federal returns is a possibility.

Let’s frame the discussion a bit.
For example, California and New York have state income taxes on their residents that are among the highest tax rates in America. Why do these states tax their residents so highly? It’s widely reported that it’s because these states are also the most liberal in entitlement payments to residents. You’ve all read how much is given away to residents in these states with little or no accountability and seemingly little fear for how to pay for the entitlements in the future.

Heck, in CA is seems the Dems seldom say “No” to any give away to residents (legal or not) not to mention the many restrictions on business. These attitudes result in a tax policy that is very burdensome to employers, employees and the folks who pay the majority of the taxes in Ca. and many other states.

To help offset these high state taxes the folks in Ca. and NY (and other states) are allowed to deduct the state taxes they pay from their Federal tax return which eases the pain (tax due) caused by Federal income tax, a bit. It also means that the tax payers in these states get higher deductions than tax payers in other states.

Your humble author lives, works and pays taxes in Ca so eliminating the deduction for state taxes would affect me directly. But is this one of those times when one must look further ahead than just the next tax year and make decisions based on what’s best for the Nation. I don’t mean to sound too honorable because it is my hope that if these deductions are eliminated that then more Ca citizens will stand up against the continual onslaught by Ca’s Legislature against financial fairness and accountability.

So, if more people of means or at least higher income taxes in Ca and NY  stand up and fight against foolish spending, frivolous projects and staggering regulations that kill opportunity for everyone then maybe everyone will have a chance to improve their lives with more jobs with higher wages, better access to healthcare and a chance to change the lives of their children and children’s children.

You know that I am an optimist trapped in a skeptic’s body, but are my ideas naïve? Well, what we have is failing so what do we have to lose if we give it a try.

When I moved to Ca in 1985 it was a different place with opportunity that fueled the ambitions of those willing to try. It also was a state in which one could take an idea, build on it and with luck and toil make it work. Sure, Hollywood and Silicon Valley have created a bunch of Ka-zillionaires but what about the folks that just wanted to start a small business to create jobs for others so they could prosper and live better?

The economy grows because of the small businesses that employ just a few employees, that provide sound benefits and good wages. It can be that way again if we make some well conceived gradual improvements.

So, how is Tax Reform related to Healthcare Reform? If people in Ca and NY (and other states) can’t deduct their “high state taxes” and therefore become frustrated by higher federal taxes, then maybe they’ll start looking for ways to reduce other costs. One area would to make more reasonable decisions about  reforming healthcare financing.  Healthcare premiums and OOP is costing many people more than their taxes.

Anyway, I think it’s possible. Let me know what you think because we’re all in this together.

Until next week.

Mark Reynolds