Archive for the ‘Amazon’ Category

We warned you about the Employer Mandate. The Congress is working quickly toward an outcome that makes little sense! let’s see why.

September 20, 2018

You read here on August 16th 2018 how the US House passed out of Ways and Means a bill  which would suspend the employer penalty payments for the period after December 31, 2014 up to January 1st, 2019. Again Yes, you read that correctly. For years, 2015 through 2018 the employers affected by “play or pay” would not be required to make the penalty payments. I’m sure it’s some clever GOP move to throw off logic.

The Bill was voted out of the House last week which means the Senate gets a whack at it. Will it make it into law before the mid-terms? I doubt it but let’s take a look at the brilliance of our House GOP as it stumbles over itself yet again in its efforts to repeal and replace the ACA.

Here are a few high points of what H.R. 3798 would provide:

  • Change the ACA employer coverage mandate threshold for “full-time employee” to 40 hours per week, from 30 hours per week. (May increase uninsured ranks)
  • Keep the ACA employer coverage mandate from applying to any month beginning after Dec. 31, 2014, and before Jan. 1, 2019. (Will employers that complied receive any restitution?)
  • Postpone the start date of the ACA excise tax on high-cost health benefits packages to Dec. 31, 2022, from the Dec. 31, 2021, start date now in effect. (No one likes this tax or even understands who will pay it. Why not just eliminate it?)
  • Repeal an ACA excise tax on indoor tanning services. (Duh, who cares!)
  • Require employers to provide Form 1095 coverage statements to individuals only when individuals ask for the statements, instead of having to send the statements to all employees, recently departed employees and certain dependents every year.
    (This is not a bad idea, but if there is no Individual Mandate and no Employer Mandate why is reporting necessary at all?)

Here are the challenges as stated by experts:

One challenge supporters of H.R. 3798 face is finding new federal revenue, or new federal spending cuts, to offset the effects of ACA employer mandate changes on the federal budget.

Analysts at the Congressional Budget Office estimated in a report posted Tuesday that H.R. 3798 could cut federal revenue by about $12 billion in 2019, and by about $52 billion over the period from 2019 through 2028.

The delay in the effective date of the employer mandate and the change in the definition of full-time worker could cost the government about $46 billion in revenue over the 10-year period starting in 2019, according to the CBO analysts.

Here’s what I said before and I’ll say it again:
Is it even close to being a good idea in the first place or just a political gimmick by politicians so that they have bragging points as they campaign for reelection? We know from the Individual Mandate that they won’t repeal it outright but rather they will  simply reduce the penalty to zero. Jeez, that’s a cowardly way to legislate.

As we asked previously, is the employer “play or pay” mandate a good idea or should it be eliminated? Plus, what effect will it have on the thousands of employers and hundreds of thousands of employees who complied already?

I am a free market, let the private sector resolve it and keep the Government the hell out of it, kind of guy. But, this issue is a complex one because as I mentioned tens of thousands of employers have already taken steps to comply.

Those employers stepped up to do what was required, those employers purchased the plans that complied with the law and spent money that the non-compliant employers did not. It would be unfair for non-compliant employers to avoid the penalty while other employers have already spent untold fortunes with no hope of getting that money back.
Can these employers, who feel they were forced to comply, receive any restitution equal to what they paid to comply?

Remember this example:
If Company A and Company B both bid on the same project they would both include all of their operating and legacy costs in those bids. Therefore, if Company B provides no health plan, because it was and is noncompliant, then its costs might be lower thus allowing it to submit a lower bid and possibly win a project over Company A which does provide benefits.

Personally, I think an employer who provides benefits is probably a better run company and certainly tries to take care of its staff. So, that employer should have an advantage but money is money which means the buyer may take the lower bid. That sucks but happens.

But, the other side of this is the employee’s. Hundreds of thousands of employees have been offered and enrolled on a health plan, possibly for their first time. What happens to them if their employer discontinues a plan because it’s no longer required legally? Many would go without coverage simply due to affordability.

Let’s face it, the ACA has caused premiums to increase astronomically over the past 7 years on individual plans (all plans really). These employees, pushed off an employer sponsored plans, would be required to go into that ACA Individual Plan jungle, and I do mean jungle as it is a “freaking” mess in that market. Would those employees want to pay those high premiums – could they afford those premiums? Probably not.

In addition, the health plan landscape, that is alternatives and access, varies greatly state by state. Many states, like California, are not allowing any of the Trump administration’s new ideas to come to California. California says No AHPs, No to skinny plans on top of what California had already implemented to harm small employers with its stop loss killing legislation known as SB 161.

Again, I would wager that many employers, who bit the bullet and complied, will maintain their plans thus continuing the expense they incur. The elimination of the penalty will make it so that non-compliant employers will be allowed to continue not providing benefits, not spending those funds and may think they have a financial advantage in the market against competitors.

So, against my human nature and all that helps one develop values I don’t think the “Play or pay” mandate should be eliminated for large employers. In fact it should be enforced. The IRS has had difficulty identifying which employers should or should not be Playing and less success in getting noncompliant employers to pay. Big deal – get it done so that the law is applied equally.

So, even though the House will be in recess as you read this, you will be informed. Together we need to stay focused on healthcare issues like this. Can you think of a single big government bureaucracy that has ever not fouled it’s intended objective? No, so when we identify issues that need attention or fixed or eliminated we should shout for it.

That way they’ll know that we’re all in this together.

Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf
It means “Walk the Faith”.

Labor Day: our National tribute to America’s workers. It’s history tells much about America! Let’s take a look.

August 30, 2018

History of Labor Day

Admit it though, you like Labor Day for the extra day off, me too. But it’s interesting and fun to explore just why it is that we get that day off. At least some of us do.
I want to thank the US Dept of Labor and its historical tribute to Labor Day.

Labor Day: What it Means

Labor Day, the first Monday in September, is a creation of the labor movement and is dedicated to the social and economic achievements of American workers. It constitutes a yearly national tribute to the contributions workers have made to the strength, prosperity, and well-being of our country.

Labor Day Legislation

The first governmental recognition came through municipal ordinances passed in 1885 and 1886. From these, a movement developed to secure state legislation. The first state bill was introduced into the New York legislature, but the first to become law was passed by Oregon on February 21, 1887. During 1887 four more states — Colorado, Massachusetts, New Jersey, and New York — created the Labor Day holiday by legislative enactment. By the end of the decade Connecticut, Nebraska, and Pennsylvania had followed suit. By 1894, 23 more states had adopted the holiday, and on June 28, 1884, Congress passed an act making the first Monday in September of each year a legal holiday in the District of Columbia and the territories.

Founder of Labor Day

More than a century after the first Labor Day observance, there is still some doubt as to who first proposed the holiday for workers.

Some records show that Peter J. McGuire, general secretary of the Brotherhood of Carpenters and Joiners and a co-founder of the American Federation of Labor, was first in suggesting a day to honor those “who from rude nature have delved and carved all the grandeur we behold.”

But Peter McGuire’s place in Labor Day history has not gone unchallenged. Many believe that Matthew Maguire, a machinist, not Peter McGuire, founded the holiday. Recent research seems to support the contention that Matthew Maguire, later the secretary of Local 344 of the International Association of Machinists in Paterson, N.J., proposed the holiday in 1882 while serving as secretary of the Central Labor Union in New York. What is clear is that the Central Labor Union adopted a Labor Day proposal and appointed a committee to plan a demonstration and picnic.

The First Labor Day

The first Labor Day holiday was celebrated on Tuesday, September 5, 1882, in New York City, in accordance with the plans of the Central Labor Union. The Central Labor Union held its second Labor Day holiday just a year later, on September 5, 1883.

In 1884 the first Monday in September was selected as the holiday, as originally proposed, and the Central Labor Union urged similar organizations in other cities to follow the example of New York and celebrate a “workingmen’s holiday” on that date. The idea spread with the growth of labor organizations, and in 1885 Labor Day was celebrated in many industrial centers of the country.

A Nationwide Holiday

Women's Auxiliary Typographical UnionThe form that the observance and celebration of Labor Day should take was outlined in the first proposal of the holiday — a street parade to exhibit to the public “the strength and esprit de corps of the trade and labor organizations” of the community, followed by a festival for the recreation and amusement of the workers and their families. This became the pattern for the celebrations of Labor Day. Speeches by prominent men and women were introduced later, as more emphasis was placed upon the economic and civic significance of the holiday. Still later, by a resolution of the American Federation of Labor convention of 1909, the Sunday preceding Labor Day was adopted as Labor Sunday and dedicated to the spiritual and educational aspects of the labor movement.

The character of the Labor Day celebration has undergone a change in recent years, especially in large industrial centers where mass displays and huge parades have proved a problem. This change, however, is more a shift in emphasis and medium of expression. Labor Day addresses by leading union officials, industrialists, educators, clerics and government officials are given wide coverage in newspapers, radio, and television.

The vital force of labor added materially to the highest standard of living and the greatest production the world has ever known and has brought us closer to the realization of our traditional ideals of economic and political democracy. It is appropriate, therefore, that the nation pays tribute on Labor Day to the creator of so much of the nation’s strength, freedom, and leadership — the American worker.

If you’ve read this far then I congratulate you because you now know more about America’s labor Day holiday than most of your friends do.

Many of our holidays demonstrate for all to witness how we have evolved over the past 250 years, how we change even though it is sometimes slow and painful and how historically Americans both fight and defend one another.

So, it’s clear to see that we truly are all in this together.

Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf
It means “Walk the Faith”.

 

 

Covered California premiums for ACA Individual plans projected to average 8.7% increase for 2019. Many are cheering but I wonder, have they forgotten the effect of compound interest?

August 9, 2018

That’s right, articles are every where announcing the good news of the projected 8.7% increase in premiums, which is  smaller increase than we’ve seen since the ACA was created. ACA supporters hail this as a sign that the ACA is working, that Insurers are getting used to the ACA requirements and that it’s smooth sailing from here on.

One must remember that the writers of these countless articles expressing glee at the 8.7% probably don’t pay for their own insurance and others are subsidized by the ACA. Otherwise they would scream, “Are you kidding me, another freaking increase”.

It’s almost like they forget the effect of compound interest. What other product or service would one consider an 8.7% increase as good news? It’s been 105 degrees in the San Joaquin Valley for the past 10 days. Would an 8.7% increase in the unit rate on your electric bill be agreeable. Probably, NOT!

Plus, what other goods or services, that you use, have had unit rates increased 300% plus over the past 7 years? So, we see again that the supporters of the ACA are searching and clawing for any tidbit of a subject on which they weave a positive story about the ACA.

For instance, seven years ago, pre-ACA, the insurance rate for a single person 30 years old might have been as low as $100. If you multiply $100 times 8.7% you get $8.70 bring the premium to $108.70.

But in the real world that 30 year old rate is now $300 so when 8.7% is calculated it equals $26.10 bringing the premium a member will be asked to pay up to $326.10. So, the “compounding effect” on premiums in this example yield a huge difference between $8.70 and $26.10. Since the authors of all of the “happy” stories don’t pay premium or are subsidized they exclaim that this is good news.

If you use the premium change of  a 50 year old the impact increases in magnitude. A 50 year old 7 years ago, pre-ACA, might have paid $400 for a decent plan. But now a 50 year old would pay closer to $1,000. Again, 8.7% of $400 equals $34.8 verses $1,000 times 8.7% equaling $87.00 for a $52.20 increase in the difference.

You know what I mean. The problem, as usual, is that the majority of premium paying voting Americans are not paying attention or have assumed the attitude that there is nothing they can do. I can’t blame them for feeling that way because they are busy working, raising their family, paying the electric bills, their cable bills, their car payments etc. and just don’t have the time to even think about this issue.

As I’ve written over the past several months, we are in a period in which people just are not paying attention to much other than their jobs, their families and every day life. That’s why it’s up to us who do pay attention to this and can see what’s happening to raise our voices.

There are things that can be done. In California voters could make a difference by voting for the correct candidate for Governor and Insurance Commissioner. Those two position would yield huge results that could lower premiums, increase options and improve access to providers. You can bet on it so vote on it!

Sorry to post on such a simple subject matter this week but frankly, it just pissed me off. Over the next few Posts we will discuss Rx costs, Insurer subsidies, impact of HRAs, and the power of Employer Driven Plans.

As always, we’re all in this together, so if you get a chance, tell a friend about the best healthcare blog you’ve ever read.

Until Next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf
It means “Walk the Faith”.

Lot’s of talk about the suspension of the ACA’s Risk Adjustment Payments to Insurers. Is this critical or just another scapegoat?

August 2, 2018

I’d bet you lunch, anywhere in town, that 99% of Americans have no idea what this risk adjustment program (RAP) is or what it does or why it was implemented by the ACA. I’d also wager that 99% of Americans are unaware of the inequities and issues the RAP created.

So, for the 99% of us – what the heck is this Risk Adjustment Program?
The idea was hatched, during the creation of the ACA, as Insurers voiced their fears that Insurers would be inundated with new applicants who had no prior coverage and whose potential healthcare cost (in other words amount of new claims) was impossible to determine. Couldn’t blame the Insurers for their concern, especially when it could be $$billions of dollars in claims on members who had no previous coverage. Plus, the ACA needed a way to entice Insurers to the table.

So, to offer some comfort for planning, the ACA created a complex formula primarily applying to individual plans, that was supposed to level the playing field, so to speak. If one insurer got hit with an inordinate amount of claims while other Insurers did not then the RAP was designed to equal out the pain.

For example: suppose there are just two Insurers offering and accepting applicants in an area, Insurer #1 and Insurer #2. Also, to make the example easier to understand let’s assume that both Insurers  end up covering 1,000 individuals. But, for what ever reason, Insurer #1’s members are all healthy people under 40 years old while Insurer #2’s members are all above 40 years old with a bunch of 60+ and the entire lot is unhealthy.

Obviously, the claim costs for Insurer #2 would be expected to be much higher than Insurer #1. If the claims experience for #2 exceeds 100%, thus loses money, then the loss would have been shared by #1 making payments into the RAP program. Theoretically, every plan should have had this potential cost factored into its plans so that it was a pass through.

Now, the Courts has ruled that the ACA’s RAP payment methodology is flawed which has caused any movement by the Feds to issue RAPs to be suspended. Actually, I don’t think this is a bad think for a couple reasons. One is that Government methodology in almost every initial program is often flawed but seldom corrected. This provides a chance for correction.

Another reason why this halt may be good is that some Insurer’s planning and pricing for initial their plans may have been skewed in an attempt to “game” the RAP.  Your humble author can report on this matter directly. I had conversations with more than one Insurer representative concerning this matter. It was widely agreed that pricing individual plans for the ACA was extremely difficult but more than once I heard “it really does not make a difference because if we’re priced too low and lose money the Gov will make us whole”

The first couple times I heard that sentiment it confused me. I thought, “How could an Insurer not be worried about underpricing their plan?”. The it hit me.

The ACA was designed to be an entitlement plan. Most folks agree that it is an entitlement for the people subsidized under the state run Exchanges. But, did you ever consider that it was an entitlement for the Insurers, too?

How else could the ACA convince Insurers to offer Individual plans with GI and no pre-ex to people who had no prior coverage or worse had been decline for previous coverage.

Now, 7 years in to the ACA and we can see a clearer picture. The big Insurers, you know them, are making money, even though they plead poverty, because they have increased their premiums 300% to as much as 900% in some areas. But, small Insurers and regional Insurers have not done so well because the RAP may have taken money from them to give to the bigger national Insurers.

Of course the battle cry, incited by the ACA supportive Press, is printing headlines about premiums increasing because of the Trump administration’s decision to suspend RAP payments. We should remember:

  1. The Trump Team did not make the decision, the Court did. The Trump folks may not be supportive of the ACA or these RAPs but the Court decided that the RAP methodology was flawed.
  2. The carriers are raising rates anyway, often just because the ACA provides cover, and ACA supporters depend on un-informed readers forgetting that premiums have already been increased a zillion percent.
  3. Finally, as stated above, it’s good to suspend a government program once in a while, at least, to verify its accuracy if not its effectiveness.

We’ll hear more about this as we head toward the Fall and the mid-term elections.

But, you and I won’t be fooled because we’re all in this together.

Until next week,

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

 

Are Politicians and the Press trying to make Folks nervous about losing the ACA guidelines on “pre-existing conditions”? Should they be? Let’s discuss it.

July 19, 2018

According to a Poll by the Kaiser Family Foundation, about 65% of likely voters say a candidate’s support for continued protections for people with pre-existing health conditions is either the “single most important factor” or “very important” to their vote in the upcoming midterms elections.
That’s significant and important!

The KFF Poll also reports that 57% of the voters in the poll say that they or someone in their household has a pre-existing condition of some sort. Critically important!

Additionally, 76% of the public say it is “very important” that the law continue to prohibit insurers from denying coverage because of a person’s medical history. Finally, 72% say it is “very important” that the law continue to keep insurers from charging sick people more for coverage. 

Once again, I say thank you to the KFF team for compiling these numbers which demonstrate how important the issue of “pre-ex” is to our citizens. I would add that this issue has always been the foundation on which every healthcare reform project has either thrived or failed. It’s really a no-brainer so why are the Press and certain Politicians stoking the fire of fear in our citizens.

In 1992, California’s healthcare reform bill, referred to locally as Ab 1672, provided for guarantee issue (GI) and full take-over for small group plans. It included a “pre-ex” clause for new enrollees who had no coverage during the previous 60 days. If a new enrollee had not had coverage in the previous 60 days then anything for which the new member had received treatment  in the previous six months would not be covered by the new plan until the member is covered under the new plan for six months. At that point coverage was full for any benefits covered under the plan. Pretty reasonable, right?

I remember the hysteria in the Press as well as brokers and industry pundits about how much premiums would increase due the GI and no pre-ex. Here’s what happened. Premiums increased initially about 6% to as much as 12% during the first year or so. Then in the second, third and fourth year the insurers actually started reducing premiums. No one organized any parades nor did the Press praise the results about the premiums coming down, but we in the industry knew it and employers appreciated it.

The failure of Ab 1672 was that it did not address individual and family plans (IFP), those plans not sponsored by employers. That error or purposeful neglect of leadership is where the crisis began yet no one in California had the vision or courage to address it.

So, let’s fast forward to the bantering we here today by the Press and Politicians as they try to scare up support for themselves and chip away at the efforts being made to improve healthcare pricing, benefits, and access.

As we continue, remember that the problem they’re projecting is for the State Exchange members covered by Individual and Family Plans (IFPs). We know that only about 8 million Americans have coverage on these plans but that 80-90% of those receive subsidies making their coverage be free or nearly so. But the fear is legitimate and fare; but the hysteria is not helpful.

There is a rather simple solution but it won’t happen because no Politician is going to take the risk and endure the public criticism of providing a workable solution.

So, I will.
A few simple steps:

  1. IFPs continue to be GI with its timely enrollment guidelines unchanged.
  2. New enrollees, not covered by any IFP or group plan for the preceding 60 or 90 days, would not have coverage for any pre-existing condition for which treatment had been received with in the previous 6 months. 
  3. Once the new enrollee is covered continually for 6 months then coverage is provided for all benefits provided by the plan. 
  4. During the period in which pre-existing conditions are not covered the enrollee would have coverage for all other benefits under the plan.
    Example: If pre-ex is treatment for diabetes but the enrollee breaks a leg or develops cancer during fist 6 months on plan, the broken leg and cancer is covered.

The time frames above could be adjusted but the result would be significant:

  1. It would encourage continuous enrollment, without a IRS implemented fine as demanded by the ACA, especially if one has an on-going condition which according to the KFF poll 57% of families do.
  2. It would stabilize premiums. The current mandates and guidelines of the ACA actually push premiums higher. Plus, Insurers have no incentive to control premium and as long as Insurers get reimbursed for 85% of covered enrollees the Insurers won’t have any incentive to control premiums in the future.
  3. Citizens would no longer need to fear being without coverage or not being able to acquire coverage and best of all, premiums would be lower.

That’s pretty easy.
Next, we add in the new Association Health Plans approved by President Trump and  we would see a revival of stability, faith and confidence in our healthcare delivery and finance system.

Of course we still need to deal with the core cost issues such as smoking, obesity and drug usage to really get the job done. But that’s for another day.

If we could encourage a healthy life style that is rewarded by a health plan while addressing the Unit Cost of Care” we will have made our healthcare system great again.
Sorry, that’s a dopey closing statement, but we could get it done.

That is if, we’re all in this together.
Until Next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf
It means “Walk the Faith”

July 4th is a “uniquely American date” as the Celebration of our Independence. Let’s look at it’s history.

June 28, 2018

Let’s take a day off from our normal healthcare reform discussions.

Next week we celebrate the 4th of July which at its core is why we have the freedoms we enjoy and for which so many have fought. No where in the course of history on this planet has any nation achieved what the USA has or is trying to retain. So, let’s take a moment to remember why we have the freedoms to debate and disagree.
Please enjoy the brief history and interesting facts to follow:

Have you ever wondered why we celebrate the Fourth of July or the risk our original Founders took to make July 4th significant to us? Many people think we celebrate the Fourth of July because it is the day we received our Independence from England on July 4th 1776.  Not true because it would be another 7 years before we would gain our independence because the war with England to gain independence did not end until 1783.

When the original 13 colonies were first settled, and before we were called the United States, England pretty much allowed the colonies to develop freely without much interference. But starting around 1763 Britain decided that they needed to take more control over the colonies(which means money) and that the colonies needed to return revenue(taxes) to the mother country. England’s reasoning was that it provided protection to the colonies so the colonies needed to pay for their defense.

But the colonies did not agree and felt that since they were not represented in Parliament (Congress) that they shouldn’t have to pay taxes to England, which gave origin to the phrase “no taxation without representation”. But England continued to tax which led the colonies to form the First Continental Congress with the intent to persuade the British government to recognize the rights of the colonies. Of course England did not so a war was declared, which we call the American Revolution.

Most folks forget that the American Revolution (the war) lasted for nearly 10 years. Failing to get satisfaction at first, the leaders of the 13 colonies organized a second Continental Congress. It is this group that adopted the final draft of the Declaration of Independence. The first draft of the Declaration of Independence was written by Thomas Jefferson, it was revised by Ben Franklin, John Adams, and Thomas Jefferson before it was sent the Continental Congress for approval.

The Declaration was finished and ready for signature on July 2nd but was not voted upon and approved until 2 days later. All thirteen colonies stood behind the Declaration of Independence and adopted it in full on July 4, 1776.

The Fourth of July is known as Independence Day because that is the day that the Second Continental Congress adopted the full and formal Declaration of Independence. Even though we had declared that we were independent, the American Revolution was still being fought, which meant that we were still not independent.

After the war ended in 1783 the Fourth of July was celebrated for its importance and shortly thereafter became a holiday. We celebrate the Fourth of July as the most patriotic holiday celebrated in the United States.

Maybe our political leaders from both parties and at every level of government from local school boards to the US House and Senate would be wise to remember how it is that we celebrate the 4th of July to this day.
Below are some interesting facts you might enjoy.

Let’s all remember why we love the USA as well as how brave and wise our Founders must have been.

Did you know:
The Fourth of July commemorates the adoption of the Declaration of Independence. It was initially adopted by Congress on July 2, 1776, but then it was revised and the final version was adopted two days later.

  • As Thomas Jefferson penned the Declaration, Britain’s army was on its way toward to New York Harbor. It began:
    “When in the course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature’s God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.
  • The Declaration of Independence was signed by 56 men representing the 13 colonies. The moment marked the beginning of all-out war against the British. The American Revolutionary War is said to have started in 1775, however. The Declaration was signed more than two years after Boston officials refused to return three shiploads of taxed tea to Britain, fueling colonists to dump the tea into the harbor in what became the infamous Boston Tea Party.
  • Several countries used the Declaration of Independence as a beacon in their own struggles for freedom. Among them, France. Then later, Greece, Poland, Russia and many countries in South America.
  • “Yankee Doodle,” one of many patriotic songs in the United States, was originally sung prior to the Revolution by British military officers who mocked the unorganized and buckskin-wearing “Yankees” with whom they fought during the French and Indian War.
  • The “Star Spangled Banner” wasn’t written until Francis Scott Key wrote a poem stemming from observations in 1814, when the British relentlessly attacked Baltimore’s Fort McHenry during the War of 1812. It was later put to music, though not decreed the official national anthem of the United States until 1931.
  • We’ve grown up: In 1776, there were about 2.5 million people living in the newly independent United States, according to the U.S. Censure Bureau. Today there over 330 million  citizens in the US so let’s hope all of us as Americans will celebrate Independence Day.

We hope you enjoyed the brief respite from the frustrating conversations concerning the reform of the US healthcare system. I wish to thank the folks at LiveScience for their research and insight.

Next week will be off in honor of Independence Day.
Maybe then we can get back to thinking America first because we are all in this together!!

Until  we talk again.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf
It means “Walk the Faith”.

 

 

Yes it’s true: California Voters have a chance to lower healthcare costs plus improve access. But it will take the proper “Vote” in the June 5th Primary and again Nov 6th in the general election.

May 31, 2018

As much as I hate to repeat a Post, I just can’t help it today because the subject is too important. California’s health plans are the most expensive in the land with killer high out of pockets and “way too skinny” PPO networks.
That’s not News, so why is that important?
Because, with your vote June 5th, you have a chance to set forth the real possibility of changing the healthcare delivery and plans available in Ca. Be sure to VOTE!

It’s true and for certain, California voters have a chance to start taking back control of the crazy out-of-control,  high-premium, low-benefit healthcare system in California. Premium increases exceeding 300%, since 2010, have literally destroyed our citizen’s access to the healthcare we need.

To lower premiums, improve benefits, increase access to more providers and get more health plan options – Voters just need to vote:

 Insurance Commissioner  –  Steve Poizner

For Governor  –    Travis Allen or John Cox
(Current polls show Cox in 2nd place trailing Gavin Newsome)

It’s that simple, REALLY!

Then, we can begin introducing the solutions that you have read about in previous Posts. Can you imagine a California in which you have:

  • Dozens of high quality health plans available.
  • Plans with benefits that fit your need – not the Government’s.
  • Rich plan benefits or narrow plan benefits.
  • Plans with huge provider lists.
  • Plans with narrow provider lists.
  • Premiums that are affordable and 50% lower!
  • Reasonable reimbursement for providers.
  • Transparency and better control.
  • Most of all: available when you need it!

I know what you’re thinking. How can two elected positions create such possibility for change? The truth is that it will take effort and a little time but my bet is that Ca. citizens would start seeing a difference within nine to fifteen months after these men take office.

Reports are starting to emerge projecting insurer premiums for 2019. Estimates are that premium may increase from 15% to as much as 100% depending on the state or region of the country. In Ca. we will see increases on employer sponsored group plans in the range of 10% to above 50% with further push toward Silver and Bronze plans.

Of course, we all know that the premiums we pay for Silver and Bronze don’t buy us first dollar benefits and leave huge out of pocket risks. If they do provide copays then those copays range from $50 to $250 which of course means people defer their medical care.

Regardless if you are Republican, Democrat, Independent, Libertarian or Green; we all have been hurt by the changes brought about by the ACA. This Fall’s election, the so-called mid-terms, provide Ca. citizens a chance to make a difference.

And isn’t that something we all crave, “a chance to make a difference”?

I could spend another 10,000 words outlining the potential improvements that might become reality if we vote wisely June 5th and Nov 6th.
But I’ll save that for future Posts.

Certainly we can all agree that elections provide a time when truly “we’re all in this together”.
Let me know what you think.

Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf
It means “Walk the Faith”.

Memorial Day: we all look forward to it but what do we really know about it. Please take just a moment now to know that we honor a true American Holiday.

May 25, 2018

Memorial Day is an American holiday, observed on the last Monday of May, honoring the men and women who died while serving in the U.S. military. Let’s take a moment to look at its origin and history.

Memorial Day History

Three years after the Civil War ended, on May 5, 1868, the head of an organization of Union veterans — the Grand Army of the Republic (GAR) — established Decoration Day as a time for the nation to decorate the graves of the war dead with flowers. Maj. Gen. John A. Logan declared that Decoration Day should be observed on May 30. It is believed that date was chosen because flowers would be in bloom all over the country.

The first large observance was held that year at Arlington National Cemetery, across the Potomac River from Washington, D.C.

The ceremonies centered around the mourning-draped veranda of the Arlington mansion, once the home of Gen. Robert E. Lee. Various Washington officials, including Gen. and Mrs. Ulysses S. Grant, presided over the ceremonies. After speeches, children from the Soldiers’ and Sailors’ Orphan Home and members of the GAR made their way through the cemetery, strewing flowers on both Union and Confederate graves, reciting prayers and singing hymns.

Local Observances Claim To Be First Local springtime tributes to the Civil War dead already had been held in various places. One of the first occurred in Columbus, Miss., April 25, 1866, when a group of women visited a cemetery to decorate the graves of Confederate soldiers who had fallen in battle at Shiloh. Nearby were the graves of Union soldiers, neglected because they were the enemy. Disturbed at the sight of the bare graves, the women placed some of their flowers on those graves, as well.

Today, cities in the North and the South claim to be the birthplace of Memorial Day in 1866. Both Macon and Columbus, Ga., claim the title, as well as Richmond, Va. The village of Boalsburg, Pa., claims it began there two years earlier. A stone in a Carbondale, Ill., cemetery carries the statement that the first Decoration Day ceremony took place there on April 29, 1866. Carbondale was the wartime home of Gen. Logan. Approximately 25 places have been named in connection with the origin of Memorial Day, many of them in the South where most of the war dead were buried.

Official Birthplace Declared In 1966, Congress and President Lyndon Johnson declared Waterloo, N.Y., the “birthplace” of Memorial Day. There, a ceremony on May 5, 1866, honored local veterans who had fought in the Civil War. Businesses closed and residents flew flags at half-staff. Supporters of Waterloo’s claim say earlier observances in other places were either informal, not community-wide or one-time events.

By the end of the 19th century, Memorial Day ceremonies were being held on May 30 throughout the nation. State legislatures passed proclamations designating the day, and the Army and Navy adopted regulations for proper observance at their facilities.

It was not until after World War I, however, that the day was expanded to honor those who have died in all American wars. In 1971, Memorial Day was declared a national holiday by an act of Congress, though it is still often called Decoration Day. It was then also placed on the last Monday in May, as were some other federal holidays.

Some States Have Confederate Observances Many Southern states also have their own days for honoring the Confederate dead. Mississippi celebrates Confederate Memorial Day on the last Monday of April, Alabama on the fourth Monday of April, and Georgia on April 26. North and South Carolina observe it on May 10, Louisiana on June 3 and Tennessee calls that date Confederate Decoration Day. Texas celebrates Confederate Heroes Day January 19 and Virginia calls the last Monday in May Confederate Memorial Day.

Gen. Logan’s order for his posts to decorate graves in 1868 “with the choicest flowers of springtime” urged: “We should guard their graves with sacred vigilance. … Let pleasant paths invite the coming and going of reverent visitors and fond mourners. Let no neglect, no ravages of time, testify to the present or to the coming generations that we have forgotten as a people the cost of a free and undivided republic.”

The crowd attending the first Memorial Day ceremony at Arlington National Cemetery was approximately the same size as those that attend today’s observance, about 5,000 people. Then, as now, small American flags were placed on each grave — a tradition followed at many national cemeteries today. In recent years, the custom has grown in many families to decorate the graves of all departed loved ones.

The origins of special services to honor those who die in war can be found in antiquity. The Athenian leader Pericles offered a tribute to the fallen heroes of the Peloponnesian War over 24 centuries ago that could be applied today to the 1.1 million Americans who have died in the nation’s wars: “Not only are they commemorated by columns and inscriptions, but there dwells also an unwritten memorial of them, graven not on stone but in the hearts of men.”

To ensure the sacrifices of America ’s fallen heroes are never forgotten, in December 2000, the U.S. Congress passed and the president signed into law “The National Moment of Remembrance Act,” P.L. 106-579, creating the White House Commission on the National Moment of Remembrance. The commission’s charter is to “encourage the people of the United States to give something back to their country, which provides them so much freedom and opportunity” by encouraging and coordinating commemorations in the United States of Memorial Day and the National Moment of Remembrance.

The National Moment of Remembrance encourages all Americans to pause wherever they are at 3 p.m. local time on Memorial Day for a minute of silence to remember and honor those who have died in service to the nation. As Moment of Remembrance founder Carmella La Spada states: “It’s a way we can all help put the memorial back in Memorial Day.”

I want to give a special thank you to the U.S. Department of Veteran Affairs for the facts about our history. It’s through the efforts of these fine folks that we all can stop what we’re doing, just for a moment, to appreciate the sacrifice that so many fellow Americans made for your and my benefit. It’s these American heroes that allowed the United States to become the beacon of hope and the land to which so many want to immigrate. In its brief 240 year existence let’s hope we’re just getting started.

Surely, those brave men and women who we celebrate would want us to know that “we’re all in this together”.

Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf
It means “Walk the Faith”.

 

A special post Mother’s Day Post. Everyone has or had a Mother and we generally honor them on Mother’s Day. But do you ever wonder what your delivery cost your Mother? Let’s look.

May 17, 2018

I know that you are reading this after Mom’s special day but give me two minutes to enlighten you on the cost to your Mom, at least medical cost, of bringing you in to this world. Now, I can’t address all that you cost your Mom since then but that is another day.

The tipping point for maternity costs, all medical costs really, was 1967 and the Medicare Act. Yep, that grand old bill that 80+ million Americans count on today was the catalyst for an explosion in healthcare costs.

My first daughter was born in 1986. When we visited the hospital where she would be delivered we were ushered into a room with dozens of other hopeful couples. The hospital staff’s goal was to convince us to utilize their hospital when our lucky day arrived. So, they presented all of the terrific features the hospital offered as well promoted their staff as being experienced, caring and loveing what they do.

The hospital administrator presented several option for delivery each having a different price attached as well as easy payment plans, if desired.

  • If you just planned to stop in, pop out the new little one, then go home in less than 22 hours the cost would be $1,800. I remember the 22 hours comment specifically because I remembered thinking, how does someone get in, deliver a child, and get out in 22 hours.
  • Then, for you more traditional types who plan to take your time, labor for 20 hours, then get some rest before you go home and the cost would be $5,600. I remember the $5,600 because it struck me as an arbitrary number and I wondered how many times they actually kept to that estimate.
    Heck, we all know aspirin cost $12-$18, depending on time of day.
  • Now, for you couples who might have a little complication in delivery or just want to choose the day and time of day your baby is born, they offered cesarean or C-section delivery. That was $12,800. For that price they’ll let you stay 3-4 days, teach the Dad how to change a diaper and feed you a steak & lobster dinner on your last night. Got to admit, the steak and lobster was pretty good.

That experience was at a respected hospital in the west San Fernando Valley of California. These prices, as well as last meal, vary greatly as one crosses the country.

I remember people telling me what a delivery would cost in “the old days”. Great friends of ours, who were 30 years older, regaled me with stories of how their first son, born in 1953 cost $250. Plus they paid the nurse $50, just because she was so nice to them.
I’ve had dinner for 4 in the San Fernando Valley that cost more than $250.

We’ve all heard the stories of the doctor getting paid a couple of chickens or a prize pig for his OB work. I can’t imagine the anguish of giving up my prize pig. That’ll make sense for those of you who know my origins.

On the other end of the spectrum there are the unfortunate many who have premature or early delivery or other complications. In 1993, I heard Leonard Schaffer, former CEO of Blue Cross of Ca., state to a group that  Blue Cross of Ca. had a $1 million baby born every week. He did not mean it in any glib sense but only as a fact related to healthcare cost that would be meaningful to the group.

In 2018, babies are as adorable as ever but a lot more expensive. Again, I’m speaking only of delivery, not the other stuff they cost their parents. But as we celebrate or rather celebrated Mother’s Day we should all reflect on this lesson to share with our kids.

Abstinence is the only means to 100% prevent pregnancy. Seriously.
Jeez, that sounded like Smokey the Bear and his forest fire warning. That doesn’t work either.

The point in this post Mother’s Day Post is that we love our Mom’s, or the memories of our Mom’s and this day gives us a chance to pause to be thankful. But also that it’s a great example of how healthcare has changed in both services available and costs. It also amplifies the urgency to solve the crisis in healthcare cost and access.
Plus, because of our Mom, we’re all in this together!

Until next week.

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

Last July, our Post heading was “What would the consequences be if the GOP passes NO legislation to Repeal & Replace? Let’s look at the impact on insurance coverage.” Were we RIGHT?

April 19, 2018

Below is a re-Post of July 27th 2017 with a few comments highlighted in Red. With midterms only 6+ months away, will the decisions made by the GOP last year come back to bite? Read on to see if we were close.

 As I write this post, the Senate has voted to open hearings and take amendments for the Senate’s R&R bill. Basically this is the Senate’s last effort do accomplish anything  for now on Repeal & Replace. Without being pessimistic, I would wager that the smart money will be bet on nothing coming of this.

Regardless of one’s political leaning everyone must agree that action is needed to either replace the ACA (with something better) or make repairs to the ACA (that will keep it alive). I realize that is a big summation but if we are honest then we must conclude that the ACA is failing so one way or another action is needed. Either for the benefit of the millions of Medicare Expansion subsidized enrollees or for the tens-of-millions of premium paying citizens and employers, the ACA needs either fixed or replaced.

So, what would the consequences be if our House & Senate don’t do anything. That is, if they don’t provide or modify the subsidies for the insurers and all of the other ACA issues that need changed to survive or don’t replace the whole darn thing, then we will see a number of absolutely predictable results.

Of course, the Politician’s thoughts will immediately turn to their own future and the 2018 elections (probably have been already) but I want to focus on the impact to all of us, the hard-working premium paying, mortgage paying, car payment making, tax paying citizens. It won’t be good but let’s look at it:

  1. Regardless of whether or not the subsidies of the ACA are paid to insurers we will see: (Correctly so, they’re not paid, yet.)
    a. Premiums for individual plans increase double-digit (20% or more) and be projected to continue for the next few years. It’s happening!
    b. The Counties without an insurer for the individual ACA plans will continue to increase. It’s projected that as many as 1/3 of all counties will have no individual ACA plan available. In the more rural states we could see the number of counties with no individual plans exceed 80% of the counties within those states.
    YEP, that’s what’s happening!
    c. The number of insurers willing to even offer plans anywhere in the country will decline, including those insurers offering plans outside the ACA Exchanges for both group and individual plans. Sadly, for rural areas this is true.
  2. Medicaid enrollment will continue to rise. Even though Medicaid plans provide lower benefits and there are fewer providers, most people don’t realize those facts until it’s too late. Besides, the idea of “free insurance” will become more and more appealing as premiums continue to rise for the tens-of-millions of premium paying citizens that use very little or no healthcare each year. “Why should I pay premium when I never use my plan and those folks are getting it for free?”. Right?
    This is happening plus a few states are trying to expand further.
  3. To summarize: fewer insurers offering fewer choices with few participating providers all at premiums increased each year. That is correct, Madam.
  4. Of course, the result of # 1, 2, and 3 above will lead to another crisis because there won’t be enough money to pay for all of the Medicaid claims and insurer’s subsidies. Which will lead to:
    a. Increased taxes or create new taxes on benefits to generate more funds.
    b. Decrease the benefits at either the plan benefit level or utilization level. That means the IPAB “Independent Patient Advisory Board” or Death Panel will decide what gets authorized and covered and what does not.
    Your 90-year-old mom may need a new hip but will the IPAB authorize it?”
    Luckily, as you read in previous Posts the IPAB is dead, not your 90-year-old mom.

We could go on and on because it is clear that the entire healthcare finance and delivery system will feel the impact of our Congress doing nothing. There is some hope though due to the President’s EOs for AHPs.

One additional concern is the “overly optimistic political corrected” desire to pass a “skinny bill” that would simply repeal the Play or Pay mandates. That could be catastrophic to insurers and to premiums that would need to be increased.

I don’t understand politics and have the scars to prove it but I do try to understand human nature. Human nature will drive most politicians to look out for themselves in their own individual voting district throughout the healthcare debate. This is already occurring in many districts.
Sad thing is that the GOP seems to be immobilized from taking action on R&R  due to the criticisms from people who wouldn’t vote for them regardless of any action taken.

Makes you want to ask, “So, a small percentage of people in your district, who wouldn’t vote for you under any circumstances, are preventing you from doing what’s right for tens of millions of American?” See this example before, haven’t we?
As I said, I don’t understand politics.

Sorry for the negative outlook concerning our Congress and especially its leadership. But, since neither the House nor Senate bills actually repeal the ACA there seems to be little to ignite optimism. And of course, times and circumstances change the immediate need of the population so all help is on hold.

I think we can point to the children’s book “The Emperor’s New Suit” as the beginning of the GOP’s downfall.  You can’t tell people it’s an ACA repeal bill, while leaving the core foundation of the ACA including taxes, and expect the people to embrace it. Reducing the Play or Pay penalties to zero and calling it repeal  does not repeal the Play or Pay core fear of the ACA. It only increases premiums.
I didn’t like that book when I was a kid, and I still don’t!

Well, we’ll see what happens this week and together we will address it.
Because, we’re all in this together, right?
It’s because we suffer with these political blunders together that makes it more frustrating. Together, we are fed up and should do something.
I know – vote.

Until next time.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf
It means “Walk the Faith”.