Archive for the ‘affordable care act’ Category

Enrollment period for ACA Individual plans is over. All the effort and stress for 8 million citizens.

January 4, 2018

We talked a bit about the craziness surrounding the open enrollment period for individual plans on previous occasions. Now the open enrollment period is over and the media will quiet down.

But, the other 300+ million Americans adversely impacted by these individual plans should continue to raise hell! As we’ve discussed in previous posts the entire private sector healthcare system of finance and delivery is suffering because of ACA imposed rules, metallic plans, burdensome regulations, and liberal press bias.

We should not begrudge these 8 million Americans, in fact it’s just the opposite, I wish the number included every American not covered by an employer sponsored plan or Medicare/Medicaid. If the reports are correct there could be another 20 to 25 million Americans on individual plans but choose not to for one reason or another.

The fact remains that Democrats inflicted us all with the ACA in an effort to take over private healthcare so that the government would then control 100% of the health finance and delivery system in America. But, they failed.

Their failure is not due to efforts by the GOP which we’ve all seen to be dysfunctional, pitiful and weak. No, the ACA’s failure is due to the character and spirit of free markets and the American people.

But, once again, the efforts by Liberals cause the many to pay extra for the few. In this case, the many have seen their premiums increase 300%, their doctors disappear off PPOs, and the number as well as quality of the health plans offered reduced.

We see similar punitive results in the liberal assault on so-called climate change. Their efforts here are another example in which the people who can least afford it bear the brunt of the cost. We all want clean water, clean air and blue shies. But, the regulations demanded by liberals raise the cost for Americans struggling to get by while the governments in India, China, and other polluting countries just skip on by.

I start out 2018 with this rather negative post not because I think the future is bad or that we are doomed to the same crappy health plans forever. I begin 2018 with this message because I know we all need reminded and that while you and I are busy living our lives there are others who won’t give up the fight.

I think 2018 will bring continual reminders about the need to change or repeal the ACA. But since the Congress and Senate seem incapable of pulling it together the changes we need will likely come in piece meal bills and directives.

So, don’t begrudge the 8 million mentioned above because many of them could not qualify for or afford coverage before the ACA. The ACA would never have gotten a foothold and could have been avoided had the GOP implemented GI back in 2002-2003 when they implemented HSA and HRA plans. It could have been simple!

I think change is coming and is in the works as you read this. Let’s not forget the potential for Association Health Plans and the ability to sell across state lines were put into motion in 2017.

We have reason to be angry but we also have reason to have hope. Let’s watch for the incremental glacial movements in 2018 that will bring relief to the millions of premium paying citizens of America.And I’ll keep you updated along the way.
Happy New Year.

Let me know what you think because you know we’re all in this together!

Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf.

Skinny Plans, what are they and why do they draw so much criticism? Let’s look at the truth.

December 14, 2017

We have all witnessed this term “skinny” become common for promotion of many facets of our everyday life. Skinny margaritas(I’ve heard of these but never ordered), skinny chicken, skinny shrimp or other skinny menu items, and skinny jeans (which I totally don’t understand), and many-many more common everyday items turned skinny in our everyday life. I apologize, in advance, for discussing anything “skinny” midway between Thanksgiving and Christmas but it is important to address the term as it is being used in the effort to obstruct the needed overhaul of healthcare in America.

But, calling a health plan “skinny” , while descriptive, may be misunderstood my most which opens up the opportunity for opponents to mislead the public about the potential positive impact of these plans. So, let’s look a little deeper.

As we’ve stated many times before, clever names or phrases are often used to criticize an idea then the name quickly becomes the label that misleads the public from the truth. Such is the case with the rhetoric we’re hearing and reading concerning medical plans that are not compliant with the mandated benefits of the ACA.

People started calling these “not 100% compliant” medical plans “skinny” in an effort, I believe, to mislead the public. At the very least the term is being used to draw attention or improve the critic’s own ratings.

Why do critics think that we Americans should not have more plans from which to choose for employer’s or our family’s health plan. Sure, many Americans are uninformed about quality maybe reality, as is evident by the popularity of such shows as the Bachelor or sports like soccer(too much trotting around). But when it comes to healthcare I think people know what they can or can’t afford and what they need or don’t need.

Plus, our citizens can always turn to the thousands of qualified insurance professionals available in every state in America. Insurance agents are well trained and can easily assist Americans in making the best choice for their needs and budget. But, agents need, just like the public needs, these alternatives so that the citizen can make the choice that best fits their own personal need.

So, what are these plans that so many fear will undermine the integrity and financial stability of our nation?
What will a Skinny plan likely not include? They may not include:

  • Pediatric dental and vision for adults.
  • Unlimited brand name Rx.
  • Maternity
  • Pregnancy termination (abortion)
  • Unlimited Office visits
  • Unlimited lifetime benefits
  • GI without reasonable pre-ex policies.
  • All of the 63 MEC benefits
  • Other benefits that increase premium but nobody uses.

What will skinny plans likely offer:

  • Choice of Copays.
  • Telemedicine.
  • Maternity if desired.
  • Wellness (true wellness with incentives).
  • Choice of PPO networks.
  • Higher OOP to lower premium
  • Lower OOP plans for more choice.
  • Alternative Rx plans
  • HSA option with higher HSA allowance.
  • Higher OOP for wasteful healthcare decisions.
  • Lower OOP with incentives for smart healthcare decisions.

There will be dozens, possible hundreds, of plan choices instead of the current 4 choices available! Health plans will be developed ranging from Minimum Essential Coverage to Cadillac rich plans. Employers will be allowed and encouraged to buy minimal plans that can be enriched with HRAs.

The bottom line – at the end of the day – when all’s said-n-done, the objective is that the insurance industry, led by local TPAs, will provide America more choice with better benefits at lower costs. Now what’s wrong with that?

I’m serious, what’s is possibly wrong with that? If you have objective arguments against these options please let us know. And, please don’t argue that these plans will hurt insurers by taking all of the good risks and leaving the bad risks to the insurers. It’s all GI so the risks can go where they think their needs are best served.

But, let me know your thoughts because we’re all in this together.

Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

 

Watch for the coming News “onslaught” concerning enrollments on ACA individual plans. Watch for actual enrollment numbers and blame!

December 7, 2017

Most Americans are most likely unaware of the enrollment process going on around the Country as six to eighteen million (number varies depending on source) American go on-line to enroll in the ACA individual plans available through State Exchanges or ACA.gov.

Most are not aware because out of a population of 330 million Americans only 10 million were signed up last year which was less than 3 percent. If one does not qualify for the subsidies offered through the ACA Exchanges then most people wanting an individual plan will sign up directly with an insurer.

During the initial  21 days of enrollments the Media anxiously reported that enrollment figures were ahead of a year ago substantially. But that will not last as today’s reports state that enrollment has slacked off greatly.

The media will ultimately tell us that enrollments are down because President Trump did not authorize the CSR subsidy payments, which caused premiums to increase. That is not true, of course, but the average citizen won’t know the truth. Unless they have followed our Posts.

It will be interesting to see the actual enrollment figures especially if Congress does insert the elimination of the Individual Mandate in the proposed Tax Bill. I bet the Mandate waiver remains which means there will be people not enrolling or canceling coverage because there will no longer be a tax upon them for not enrolling. It would be fascinating if Las Vegas bookmakers were to allow wagering on enrollment figures. My wager would be for fewer than 8 million. So, what should we expect?

On a separate and unrelated topic; today is December 7th. These days most folks go about the day without acknowledging the importance of this date in American or World history. I mentioned this because last month on November 10th we celebrated the Veteran’s Day holiday with a day off, without much fanfare.

I played golf that day (Nov 10th) and commented to a friend “do you remember when we were kids in school acknowledging Veteran’s Day by standing up with a moment of silence at 11am?”. Of course he did and today is December 7th, a day proclaimed by President Roosevelt in a message to Congress in 1941, that would live in infamy after the attack on Pearl Harbor

I mention this subject because I am increasingly concerned that our current population and our legislators will be less able to learn from our nation’s experience and its history if we stop acknowledging that history and those experiences. How will we successfully deal with radical Islamic terrorism, threats from N. Korea and Iran, or the ongoing war that Russia and China wage against the US if we are not willing or unable to remember how we mishandled threats and issues in our Nation’s past.

It also applies to important issues we face as a nation such as the financing and delivery of healthcare. If we are unwilling or unable to look back at insurance “policies” and solutions that worked in the 1980s, and 90s then we will continue to get results such as those delivered by the ACA.  The ACA was suppose to deliver better access and lower costs but does neither. We can still recover but not if we neglect those principles we know to be sound.

This was just something on my mind.

Much to discuss in the coming weeks about the ACA as well as potential changes in healthcare delivery and financing. I fear the trek to improve what our citizens see on both group and individual plans will be slow but we must continue the struggle.
Let me know what you think.

We can’t let up because we’re all in this together.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

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
559-250-2000
mark@reynolds.wtf

 

Association Health Plans, AHPs, as predicted may soon be reality. But, opposition will be intense and insane. Let’s look closer.

October 26, 2017

As he promised, the President signed an EO directing the Departments of HHS, of Labor, and Treasury to review and implement guidelines allowing for AHPs and for the selling of these AHPs cross state lines.

Be for-warned that the opponents of AHPs, selling cross state lines or any change to the ACA will scream bloody-murder & disaster. They will “cry” that babies will die in their mother’s womb(don’t say it, too easy), that children will go without vaccinations, that women won’t get their lady healthcare, that severe disease won’t be treated and that our streets will be filled with the bodies of citizens denied care. Think that’s too strong? Just watch!

Why would any employer or citizen purchase a health plan that did not fit their needs unless they were forced to, as they are by the ACA. So, let’s take an honest look at AHPs and project what could happen, if the GOP gives us a chance.

AHPs are not a new concept and there are countless examples of where and how they have been successful. In California, for example, there are dozens of examples of successful AHPs, from the pre-ACA era, that provided alternatives for CPAs, Attorneys, Auto Dealers, Chambers of Commerce, Builders Associations, Growers Associations, Engineers, Architects, Plumbers, Contractors, Farmers, even Insurance Agents and you can go on for ever.

Why the confusion or fear? Setting aside the obvious political and ideological opposition let’s look at this logically. There are examples of successful AHPs that are both Fully Insured and Self-funded. But, there are also examples of AHPs that failed which were both Fully Insured and Self-funded.

Why were some successful and some not? The answer, as success always is, is complicated but reasons include burdensome regulations and over-reach by regulators, hundreds of miscellaneous state mandates, poor management or sometimes mismanagement, managed care, PPOs, competition and changing times. But, the fact remains that history shows us how AHPs can work and don’t we all agree that small employers need alternatives to what’s been forced upon them the past 7 years.

Let’s look at some specifics both bad and good. The bad first because it’s possible that:

  • Some AHPs will be created and sold that fail.
  • Some AHPs created may offer less benefit than ACA EHB’s require.
  • Some purchasers may not understand the AHP presented to them.
  • Some Brokers may not understand the AHP they’re presenting.
  • Well designed and managed AHPs could take healthy customers from existing plans.

Now the good, because AHPs:

  • May be created with EHBs but still lower premium cost.
  • May include richer benefits than the ACA plans with EHBs.
  • May result in lower out of pocket for members.
  • Will provide alternatives and more choice.
  • Will be well-managed and properly presented.
  • Not every one requires Pediatric dental or other mandated benefits.
  • Small employers will get choices similar to large employers.
  • Restrictive “state specific” limitations can be over-come.
  • Employers will get better transparency in their plans.
  • May increase enrollments.
  • Brokers will be enabled to do their job!

The last bullet is important because I believe that insurance brokers are better suited to counsel employers than state bureaucrats or ACA enrollers. Brokers, given the chance and products, will help employers select the plan(s) that best suit an employer’s goals of providing a health plan to its employees.

If the Depts. of Labor, HHS, and Treasury do their job well, AHPs will allow employers:

  • Access to Fully Insured and Stop-Loss plans that currently can not be offered due to the ACA’s or local state restrictions.
  • Buy with discounts like other large purchasers can. (Do you think Wal-Mart pays the same price for the goods it sells as your local independent small store?)
  • More competitive pricing from the current plans available.
  • Make plans available to employers where none are available now.

There are many details for us to see worked out by the various departments noted above. Those details and the process to create them will be viciously assaulted by opponents of AHPs and any change to the ACA.

Already, we’ve read statements by one leading Dem Congresswomen Americans will have their pre-existing conditions denied even though there is no evidence to support that claim. Plus, why would a broker present or an employer purchase a plan that hurts the very employees the employer needs for success.

AHPs could lead to some exciting opportunities to improve healthcare in our country. Plans created by innovative TPAs will offer solid benefit packages with lower premiums that include cost controls, transparency, and stability for the next 3-5 years.
Jeez, wouldn’t a little stability be nice.

That’s it for now but we’ll watch this development as it evolves. Let us know what you think. We want to hear concerns as well as platitudes for these AHPs.

Never a better time cause we’re in this together.
Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

Is Healthcare Reform dead? Maybe, but the President promises to sign Exec Orders allowing for health plans to be offered through Associations. It could be that now is a good time to discuss selling cross state lines.

October 12, 2017

It sounds as though President Trump may sign executive order(s) this week or next that would permit the forming of association health plans (AHPs) that would provide plans for employers and/or individuals. Years ago we called them Multiple Employer Trust (MET) or Multiple Employer Welfare Arrangement (MEWA) and so forth. They provided affordable competitive alternatives that could be easily sold across state lines.

If AHPs, METs and MEWAs are well managed then why not give employers more alternatives to lower cost and improve benefits? We’ll discuss AHPs in more detail next week after President Trump signs and releases the details of his Executive Orders allowing for AHPs.

The President states that his Order will allow for selling cross state lines which is the topic of today’s post.

When discussing the prospect of selling health insurance cross state lines, during the heat of HCR earlier this year, there were objections to this idea, some reasonable. Now, given the status of HCR in Washington DC and the probability of no significant reform, maybe we should kick this around a bit, and debate the reasonable objections.

One objection, to selling cross state lines, was a fear that sub-standard benefit plans might be offered which if sold to unsuspecting employers could lack benefits, ;eave people hanging with large medical bills and cause problems. Clearly, some folks have gotten comfortable with the pre-set benefit designs of ACA even with their increase cost and inflexible nature of only having 4 “flavors” from which to choose.

The opponents of selling cross-state lines were/are afraid that carriers would build plans in one state with stripped-out benefits and lower cost then sell those plans in another state. The purchaser might think they are buying a “gold or silver” plan but under closer scrutiny would be getting something less.

The goal of lowering cost and providing alternatives to the rigid expensive metallic plans is appealing but one must admit than when more alternatives are available the potential for confusion is there.

The opponents other reasonable objection is that if lower cost plans are offered cross-state lines that it might imperil the financial stability of in-state plans. Examples of in-state plans could be plans associated with the Blue Shield and Blue Cross organizations but one could add many HMOs which tend to be landlocked so to speak. These in-state plans often have large market share and wield political clout within their state’s legislature.

If plans with large market share, such as the Blues or HMO, experience group migration to lower cost plans, offered by AHPs or plans from other states, then their revenues could be reduced. But, would their profitability be impaired? The fact is that well designed, properly presented and purchased lower cost plans could pull groups away from large in-state plans. In business that’s called competition, isn’t it?

Another obstacle, maybe the biggest, cited by opponents is that you have 50 independent state insurance commissioners most of which don’t want to relinquish any control over the plans in their state. It’s a turf thing. Some of these Insurance Commissioners, especially ones from large liberal states, do not want to see any plans compete with their state’s ACA Exchange. They will resist AHPs and selling cross state lines.

Shouldn’t we consider the idea of selling across stateliness as a chance to increase competition and lower cost? Clearly, it would allow smaller insurers, that are excellent companies but not household names, compete with the huge carrier names we all recognize.

One step that would be easy and helpful is to expand the ERISA Preemption which would allow small employers to get access to great self-funding plans.

Self-funded plans are regulated by ERISA and managed by the Department of Labor. Insurance commissioners only get to rule over the “fully insured” insurers in their states so ERISA plans will be largely free from the heavy burdens many states put on fully insured plans.

However, many states have recently enacted bills to “kill” self-funded plans and prevent smaller employers, with 100 or fewer employees, from getting access to these plans. These state by state “option killing” rules would need to be addressed.

For example, California established arbitrary rules, under Senate bill 161, that mandate how self-funded plans can be priced. Proponents of SB161 admitted that the purpose of this stifling legislation was to prevent smaller employers access to stop-loss plans by making the prices too high thus forcing smaller employers to buy the Exchange.
It was a double blow to employers however because employers did not go to the Exchange because it is not competitive yet were/are blocked from competitively priced self-funded plans.

ERISA and its State Preemption capabilities could be expanded to make it easier for fully insured plans to market across state lines. It could reduce the burdensome processes and long approval times by insurance commissioners and allow more flexibility.

We have all heard the statistics that 1/3 of the counties in the United States have only one insurer offering plans. Expanding ERISA could give the folks living and working in those counties some well deserved relief.

How could insurers offer lower cost fully insured plans yet still offer benefits comparable or richer than the benefit mandates of Platinum, Gold, Silver, etc.?
It’s easy and affordable. It should have been done already and could be accomplished tomorrow with the right vision.

Next week we’ll discuss the details of the President’s Executive Order concerning AHPs and just how to make these affordable (lower cost) alternatives compliant!

Let me know your ideas for selling cross state lines OR your reservations about doing so. I’d love to get your input.

We might as well air this option out a bit because we’re all in this together.
Until next week.

Mark Reynolds
559-250-2000
mark@reynolds.wtf

 

The calendar once again makes its call. For me – Platrix Chapter 2, “Queen of the Cow Counties” No one can resist the call.

October 5, 2017

Two times each year your humble author retreats from his solemn duties to Trek to
E Clampus Vitus, Platrix Chapter #2, that most ancient and honorable group. This is one of those times, kid. Would you like to read just a bit about The History of ECV.

E CLAMPUS VITUS is said by its adherents to be the most ancient of all fraternal orders. It’s founding, as the tale is told, was coeval with the origin of the human race.

It is related that in 1852 Steamboat Jake. a merchant from Yreka, thinking to improve his business by fraternal affiliations, made arrangements through certain Clampers for initiation into the Masons, the Odd Fellows and E CLAMPUS VITUS at one bargain priceof $98.50. When the various brethern were assembled at the Hall of Comparative Ovation and Jake, bound and blindfolded was brought to be initiated, the question arose as to which Order should first apply the branding iron. It was agreed that the oldest should have priority.

 The Odd Fellows presented their claim for that honor, stating that their order was created by a charter issued in the form of a golden tablet by the Emperor Titus to his Jewish Legion in the first century A.D.

 The Masons disputed the claim, relating the scholarly history of Reverend Dr. Anderson to prove that the Grand Master Moses often marshalled the Isrealites onto a regular and general lodge whilst in the wilderness, and that King Solomon was “Grand Master of the Lodge at Jerusalem”.

 The Noble Grand Humbug of E Clampus Vitus then rose and confounded the rival oraganizations with proof abducted from the unimpeachable unwritten works of St. Vitus, the final authority in all such matters, that E CLAMPUS VITUS was founded by our Clampatriarch Adam himself in the Garden of Eden, and that the original Staff of Relief, which figures so greatly in the Clamper ritual, was a branch that Adam broke from the Tree of Knowledge and smuggled out with him, hidden beneath his apron, when he was driven from Eden. All present in the Hall agreed that such antiquity was beyond compare.

The senority of the Clampers was recognized, and Steamboat Jake accordingly was given into the hands for initiation. It is then told that by the time they were through with him he had lost all desire for further fraternal connections.

 The unsurpassable antiquity of E CLAMPUS VITUS has been recognized and proven on many occasions. There are those who claim they can trace it through the times of the Old Testament and the beginnings of the Christian Era when its rites were conducted in the catacombs of Rome and referred to as the “Enigmatical Book of Vitus” and the “Curious Book of the Clampers”. These tales tell how it was spread through Europe by the Frolicking Friars, and carried to the Orient by the indomitable Vituscan Fathers.

According to the Clampers, the introduction of the order into the United States has long been shrouded in mystery and legend. Only recently has the true history been traced by the Royal Platrix Chapter and the Archivist of the West Virginia Lodge. The result of this research supposedly proves by documentary evidence that the secrets and symbols of E CLAMPUS VITUS were imparted by the Emperor of China, Tao-Kwang, Great Hotchot of the Chinese Grand Lodge to Caleb Cushing when the latter visited China in 1844 to negotiate the first treaty between the United States and the Celestial Kingdom. Cushing was specially charged by the Emperor to deliver the secrets and signs of authority to Ephrairn Bee, innkeeper of Bush Creek, Boone County, Virginia, to be disseminated by him at his descretion among the fellow citizens so that the Chinese and American People might henceforth be united by the Bonds of Fraternal Brotherhood as well as by the more formal ties of diplomatic relations. By virtue of his authority, Ephraim Bee traveled about his native state organizing lodges of E CLAMPUS VITUS in villages and county seats. 

It is also said that among others, a number of drummers were taken into the order, with or without authority from Bee. These travelers took the gullible villagers and townsmen along their routes into the Brotherhood, until by 1849, the East and Middle West were dotted with Clamper Lodges. From these Lodges many lusty Clampers went West in the Gold Rush and founded the historic lodges in the mining camps that constitiuted themselves as guardians of the morals of these communities.Their duty as they saw it was to prevent the preachers and pious wives who followed the 49′ers, from imposing any excess of morality that might hamper the full enjoyment of life. How well the Clampers performed this function is commonly known, despite the lack of written records. This lack of written records is attributed to the circumstance that during the meetings there was never anyone capable of keeping the minutes and that afterwards no one remembered what had taken place.

As E CLAMPUS VITUS mushroomed along with the rapid growth of the gold towns, it declined as rapidly as they did, and, therefore, lived only in the memory of a few ancient dwellers in the mountains and in the annals of the county histories until, in 1930, when a new prophet, a second Ephraim Bee , appeared in the person of Carl Wheat to reorganize the historic organization. 

Members of the Ancient and Honorable Order of E CLAMPUS VITUS have always been adventurers and many have been leaders in conquest of their respective countries. The most noteworthy of that band of stalwarts was Juan Rodriquez Cabrillo, a doughty explorer in the service of the Spanish Empire, who on October 19, 1542, raised the Spanish Flag at a point near the beach city of Hueneme in Ventura County and took possession of the land in the name of the King. Cabrillo is buried on San Miguel island and some Clampers make an annual pilgrimage to his grave. 

Sir Francis Drake was a Clamper but not in good standing because of his piratical exploits until June 15, 1579, when this bold bucaneer reached California in the famous ship, the “Golden Hind”, and anchored in Drakes Bay where he raised the English Flag and took possession for Queen Elizabeth and called the land New Albion.

Then Spain decided to occupy California to protect her colonial possessions, so two courageous Clampers were selected for the expedition: one was Don Gaspar de Portola, and the other was Father Junipero Serra. These men raised the Emperors flag at San Diego on May 17, 1769.

After Mexico revolted from Spain, an admirable Clamper, General Antonio de Santa Ana, ordered the flag of the Mexican Republic raised at Monterey on January 7,1769. 

John Charles Fremont was a peritatetic Clamper and he raised his ensign as Captain of the United States Topographical Engineers above every camp that he made in California during his expeditions between 1844 and 1846. That flag is now in the custody of the Southwest Museum in Los Angeles. 

On June 14, 1846, a Sonoma group of justly indignant Clampers rebelled against the aggression of Mexican officials. They captured the garrison at Sonoma, issued a clampotent proclamation declaring California to be an independent republic and raiseda crudely designed but historic Bear Flag.

 Clampers played an important part in the history of California in the nineteenth century because the American membersof this Order worked in unison. Commodore John D. Sloat in command of the Pacific Squadron of the U.S. Navy captured Monterey and on July 7, 1846 he instructed a fellow Clamper William Mervine to raise the flag of the United States above the customhouse. When Fremont learned of Brother Sloat’s coup he ordered the Bear Flag struck at Sonoma and replaced by a 28-star flag of the United States.

It is manifest that Clampers have been leaders throughout the history of California and the flag-raising members of the Order of E CLAMPUS VITUS have contributed glamor and deeds of courage and gallantry to our heritage. It must be noted however that this history has never been proven.

 CREDO QUIA ABSURDUM – BECAUSE ITS ABSURD I BELIEVE
QUOTED FROM E CLAMPUS VITUS, THEN AND NOW, 1852-1979

As for me, I’ve been a “clamper” since 1992 at the Tehachapi Loop.
How many of you are Brothers of the Order?

Next week, we’re back to common sense ideas for healthcare reform. Promise!
Until then remember, we’re all in this together.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

 

Graham-Cassidy Healthcare reform bill: sure, it’s dead but was it just AHCA 3.0? Let’s look closer.

September 28, 2017

Not living nor making my living with in the political pressure constant in Wash DC it’s hard to look at this new GOP effort, the Graham-Cassidy bill, without a healthy bit of skepticism.

Why is that? Have you ever witnessed some one make a decision based upon desperation or a willingness to “settle”? We all have. It’s common in personal relationships, it’s frequent in business decisions, and it’s compulsory in politics.

The Graham-Cassidy bill GCB) looks and feels a lot like a political effort to avoid “doing nothing” and facing constitutes after having made the promise to “repeal & replace” the ACA. If you were a GOP legislator up for re-election in 2018, especially in the House, do you want to go home  at the end of the year to face those who trusted you when you said “Obama-care must be repealed”? Of course you wouldn’t, no sane person would. But, we’re talking about politicians not sanity.

Here are a couple of points from GCB for reference:

  • Says it repeals the Individual mandate but truthfully only reduces penalty to zero. If you don’t want to buy, don’t worry, no penalty.
  • Says it repeals the Employer mandate but truthfully only reduces penalty to zero. If you don’t want to provide coverage, don’t worry, no penalty.
  • Maintains guarantee issue with no pre-ex while reducing penalty to zero for no coverage. Like the other GOP attempts this adds the burden to premium calculations and to premium payers.
  • Eliminates only the medical device tax while leaving all the others such as the Cadillac tax. Why not eliminate all the taxes.
  • Maintains Medicaid expansion and its subsidies but does so in a block grant manner.
  • Converts Federal subsidies given to states into Block grants so states can use as they please. Giving states flexibility sounds great but this may create chaos between states.
  • Gives states freedom to determine Essential Health Benefits and how block grant funds are to be spent. This sounds good except for the poor souls in liberal states like NY and Ca. who will see those funds spent on more freebies and no accountability.

There are countless other provisions that are a mirror of the two previous failed GOP attempts but I won’t burden you with this.

So, the language you will hear from supporters will be:

  • This is our last chance to get rid of the evil Obama-care.
  • If we don’t do something now then we won’t have another chance.
  • Doing something is better than doing nothing
  • Choice is clear, you’re either for Socialism or federalism.

If this effort fails the GOP folks can return to their districts and tell their supporters that “I tried but we just did not have enough votes” “Re-elect me again and we will continue our fight to repeal the evil liberal OB-care”.

Then, what are we suppose to do, vote for a Democrat or not vote. This is political baloney at its worst or best depending on your perspective.

If the GCB passes its initial vote in the Senate it will still face an incredible battle in the House. Plus remember that the House GOP is in a worse pickle that the Senate so they will try to flavor the baloney to their best interest.
I actually give it a 60/40 probability of passing the initial Senate vote.

OK, enough huh? Let’s watch this debate (debacle) unfold. It does not need to be this way but the swamp has not yet been drained, as they say.

Until next week, we’re all in this together.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

PCORI – is this a worthwhile expense on your health plan or another example of Government bureaucracy and waste?

September 21, 2017

Evaluating the benefit of PCORI, the Patient Centered Outcomes Research Institute, relative to the impact on healthcare costs and efficacy of current treatment protocols may be impossible. One’s opinion may well be determined by your baseline feelings about redundant government programs, government bureaucracy, or even political positions.

One could also add data security to the list of concerns. More about that below.

Honestly, it is hard to justify the added expense to health plan costs or the benefit to healthcare practitioners and their patients. If the goal is to study comparative outcomes for current practice protocols then how will the analysis be delivered. One problem is that the PCORI has no authority to implement any findings nor to direct healthcare practitioners to modify their practices. Another problem may be human nature, that being, Doctors wanting to practice in their own experienced manner.

We all want affordable high-quality healthcare with the latest and most effective technology. There’s no argument there. But, given the history of what happens in the private sector when government intercedes don’t we have the obligation to investigate and challenge the established bureaucracy?

There are already at least two notable government agencies that experts say could incorporate the PCORI objectives with in their current structure. One is the National Institutes of Health and another is the Agency for Healthcare Research and Quality,

The Agency for Healthcare Research and Quality has the stated mission of “making health care safer, higher quality, more accessible, equitable, and affordable”. It is considered small by federal government standards with a budget of about $440 million. Believe that, small at $440m? Anyway, the mission for the AHRQ sounds like something we want so why couldn’t it dish out the $3.5 Billion expected to be awarded by PCORI?

Plus, the GAO (Government Accountability Office) states that the PCORI won’t go through a review by any independent outside entity until 2020, after the program has run it’s course, awarded an expected $3.5 billion and PCORI is no longer operative.

So, one must ask, is PCORI a worthwhile venture or just another government program scheduled to end but destined for in perpetuity?

After reviewing many of the awards given to date it is easy to lean toward the obvious: that PCORI has both great waste and great potential, depending on one’s fiscol perspective.
Let’s look at a couple PCORI awards:

  • One project looks at how doctors can create a “Zone of Openness” with patients which was part of $61 million in awards. Were you wondering about your doctor’s “Zone of Openness” the  last time you were waiting to see the doctor, dressed in your paper robe, sitting on that awkward metal bench covered in butcher block paper?
  • $14 million for a study on the appropriate dose for aspirin being taken to prevent heart attacks. Too much and you could bleed to death. How long have doctors been practicing this treatment protocol and they don’t know the correct dose?
  • $500,000 went to AHIP (America’s Health Insurance Plans) to “build and maintain support from health plan leaders” and to “identify important gaps in availability of health insurance administrative data”.
    A spokesman for AHIP stated that sharing health plan data is “complex” and “requires a significant amount of review and expertise from the industry”.
  • $249,000 went to Society of General Internal Medicine for a 2 year program, as stated “to help us develop a better understanding of the attitudes and knowledge of our membership”.
  • I’m not kidding!

Will we see any demonstrative results from the $3.5 billion in research awards expected to be doled out? Good question! Supporters say that we will see the results in articles published in medical journals and through presentations , seminars and other public dissemination. Since the PCORI has no authority the information obtained will not be sent out as directives to be followed. That part may be good.

In fact, some legislators and professional groups are concerned that the government, particularly CMS, may try to use the PCORI results to limit or restrict healthcare services to citizens covered by Medicare and Medicaid. That means our senior folks covered by Medicare and Medi-cal. We were told about this potential issue in 2009, remember. 

Will doctors change due to PCORI?

  • Some who belong to large practice groups might if directed to by their group.
  • If payments for services rendered are reduced as a result of  procedures deemed ineffective by PCORI then doctors may change. 
  • Unless there are consequences, either financial or legal, doctors may not modify their current practices simply because of a result of a PCORI award.

My initial opinion was that PCORI was another example of over-reach by the government adding cost to premiums as well as costing taxpayer billions of wasted dollars and unneeded oversight. After doing my research and preparing for this Post, I have found no reason to modify my initial opinion.
Hey, maybe my opinion is just like the results of the billions spent on PCORI; nothing changes!

One other thought has lingered with me since 2010. The ACA also mandated that all health plans submit their data to the CMS and PCORI for the purpose of analysis. By data I mean every individual’s personal & private information including SS#s, employment & health status, and specific information on every healthcare service incurred.

So, how has that data been protected and by whom? The list of entities that have had data breaches is endless and includes cities, states, nations, government agencies, many insurance carriers, and thousands of other private businesses.
Here is a short list with the estimate of records stolen :

  • US Office of Personnel & Management -22 Million
  • Yahoo 1st time -500 Million
  • Yahoo 2nd time -1 Billion
  • Equifax – 143 Million (this is recent and huge!)
  • E-bay -145 Million
  • Anthem -80 Million
  • Target -40 Million
  • Home Depot -56 Million
  •  Sony – 77 Million
  • What are the odds that your personal info was not part of at least one of these?
  • Do you think the health records of our citizens stored at CMS are an attractive target to hackers?

As I said, it was a lingering thought!

Well, you can give it some thought and ask yourself some questions. Have you read or heard anything about PCORI in the past 2 years. Probably not because one of the operative guidelines of PCORI is to be invisible and not draw attention.

Geez, does that makes sense; a government bureaucracy created to analyze comparative treatment outcomes but do so without making any news?

That’s it for now. Let me know what you think or if you’ve seen any data that shines a positive light on PCORI. I want to be fair in our review.

Next week we’ll look at the Graham-Cassidy Healthcare reform bill now being urgently pushed by the GOP. The Senate has until Sept 30th to get it started with only 51 votes.

Until next week, let’s work together and stay positive.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

 

 
 

Two things that unite us as Americans: One is the start of the Football Season. The Other is Catastrophic events like 911 and hurricanes.

September 14, 2017

This week’s Post about PCORI, established in 2010 by the ACA, was printed, polished and ready to go until about 6am this Monday morning. That’s when I started watching the news that was showing the various memorial services to 911 on the East coast. It reminded me again of how united and how resilient the people of the United States are when times are tough.

Recently, we have all been saddened and heartened with the stories from Hurricanes Harvey and Irma. The pictures and interviews display how Americans of every race and origin willingly help out other Americans of every race and origin when the time comes.

The 911 memorials today may become a bit smaller in years to come but if and when the next event occurs we know that Americans will not hesitate to jump into the fight to help others when needed.
To quote the famous philosopher and great fiddle player Mr. Charles Daniels: “you just go ahead and lay your hands on a Pittsburgh Steelers’ fan and I think you’ll finally understand”.  Which means, that Packers fans and Cowboy fans or Dolphin fans alike will step up to help a fellow American when outsiders bring trouble to the United States.

As I watched a few of the speeches this morning it made me start to think about how, as Americans, we are resilient and we are resolved to the actions needed to protect ourselves and others from future harm. Americans will do what needs to be done if given good leadership and good planning.

However, over the past 16 years, plus the 10 years prior to 911, it seems that politicians often forget this aspect of our citizens and instead start thinking about their next election. Political correctness, identity politics, and a complacent culpable media add to the danger we face.

But this week instead of PCORI, the ACA, the media or politicians I want to focus on the core strengths we have as Americans. Those strengths that led our ancestors to leave their original homes to traverse across great oceans and  mountain ranges to build the greatest country the world has ever known.

The past 4 weeks have shown us how we come together when times are tough. The memorial ceremonies for 911 show us how we come together as a nation when attacked. Now, we just need to maintain that steadfast resolution on a day-to-day basis. Help your neighbor when they need it, forgive that careless driver that cut you off this morning, and continue to pray, praise and donate to our fellow Americans who need our help.

Let me finish with a thought about the idea that the football season being a factor of unity. Some may disagree (probably soccer fans) but for six months each year three hundred of million American come together to root for their favorite team or teams. Whether its high school, college, the NFL or even Pee-wee or arena one must admit that we are avid fans. Heck, look how many people watch the Super Bowl each year (without any rioting in the stands).
So, back your favorite team which I know for all of us is Team USA.

Next week, we’re back to common sense solutions for healthcare, OK?
And remember, we’re all in this together.
Until next week,

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf