Archive for the ‘Affordale Care Act’ Category

People “think” the ACA Individual Mandate and its “penalty” is gone thanks to the Tax Cut & Jobs Act of 2017. But is it and why are so many confused about it?

March 15, 2018

As happens so often, people hear about an action taken by some level of their local, state or Federal Government authority and misunderstand its effect it has on them as well as the timeline for that effect in their life. The ACA Individual Mandate (IM) is addressed in the Tax Cut & Jobs Act of 2017 (TCJA). But two things seem to be confused.

One, its being reported that the IM is “repealed” by the TCJA but what is really more accurate is that the penalty for not having medical insurance coverage is simply being set to zero. As we’ve discussed in previous Posts, every effort to R&R the ACA by the GOP has included setting the penalty for non-compliance to zero. As discussed before, at any time in the future a new Congress, probably Dem but possibly GOP, can reset the penalty for not having coverage to what ever it decides and even higher that the levels within the original IM of the ACA. That should not be defined as “repealed”!

The second issue is that many people think they do not have to worry about a tax penalty for not having medical insurance coverage in 2018? That’s understanding is wrong. The IM and its penalties remain in place for the tax year 2018. In a statement that some called a “finger in the air to Americans” retiring IRS Commissioner Koskinen stated that the IRS will vigorously enforce the ACA IM penalty for tax year 2018. So folks, don’t let your coverage lapse.

We have started to see the next phase of the IM “repeal” as prognosticators predict and promise that the elimination of the IM will lead to a spike in premiums and huge drop in the number of Americans will health insurance. Seriously, do you think folks could tell the difference in their premiums after what they have felt so far over the past 8 years? Well, let’s wait to see shall we?.

My bet is that eliminating the IM will have minimal affect on citizens who do not get their health insurance through their employer. I’m certain that many individual States will take actions on their own to mandate coverage, especially Liberal states with a highly subsidized Exchange. But, even that action will not produce any noticeable change in coverage.

Those states suing about the TCJA or President Trump or taking other steps within their state will be busy for the next 2 years. They will see and probably resist the growth in Association Health Plans, the introduction of selling medical insurance cross state lines, as well as Short Term Medical plans.

So, if you are in the consulting business, are a CPA, or other tax preparer it would be helpful to clarify this issue with your clients and prospects. They may think you are really smart. They may just think ho-hum. But, you will be clarifying for them something that may save them some money.

That’s it for this week. Short Post, I know, but that’s because the subject matter called for no more and also because we’re focused on a few other topics in the weeks to come.

Let me know what you think.
Thanks for your feedback. It confirms for me that we are all in this together.

Until next week.

Mark Reynolds, RHU
It stands for “walk the faith”.

Remember the ACA’s Independent Payment Advisory Board or “IPAB”. The so-called “Death Panel” is dead! Why is no one talking about this?

March 1, 2018

It’s often difficult to remember things that occurred yesterday, let alone 7 years ago, but do you remember when the ACA was signed in 2010 and its provisions started taking “root”? I know, I know, you think I’m wrong  because everyone thinks the ACA took effect in 2014. But, it actually began its insidious spread across American healthcare in 2010 by imposing taxes, fees, reporting requirements, pricing regulations, speculation and the formation of new agencies and processes including the Independent Payment Advisory Board (IPAB). 

Well, IPAB is dead and credit goes to the Tax Cuts and Jobs Act of 2017 that Congress passed and President Trump signed in December 2017. It’s demise received no fanfare, in fact, I’ve only seen one article about it and no TV commentator has mentioned it to my knowledge. Why is that?

Everyone remembers Governor, turned VP candidate, Sarah Palin calling out the IPAB as a “Death Panel”. Heck, even today when commentators speak of Governor Palin they bring up her comments about IPAB. Calling IPAB the “Death Panel” was not a totally inappropriate synonym for the IPAB given the political nature in Washington. But, that does not mean that the concept of IPAB was necessarily evil.

The concept of IPAB is/was not necessarily a bad one, that is until it gets combined with politics and the politicians in Washington.  Its intended goal was to control, lower, and eliminate cost for Medicare and specifically Medicaid. So, if something could lower costs then it would be good. But if its goal was to eliminate services for Seniors…”What would people like you and me call it? “Death Panel”! 

However, IPAB did not have regulatory or enforcement authority. It could only make suggestions to HHS, other governmental agencies and the commercial markets. IPAB could only recommend lower reimbursement levels for specific services, suggest lower frequency of treatments, or treatment protocol of a specific service can be used for treating “this” condition but not “that” condition. IPAB could only make recommendations.

Did you ever wonder why no politicians, from either party, ever talked about IPAB over the past several years. Democrats, especially, did not want their names connected with IPAB. Why was/is that?

The reason is that IPAB was created to be a scapegoat. It was designed to provide political cover for jelly-spined politicians from either party if allowable treatment protocol for medical services were altered, reimbursements to providers lower, or benefits cut back on Medicaid and Medicare recipients.

Stated more directly, if IPAB did its job, the result of which cut benefits or services to Seniors, then politicians could blame the IPAB people or ACA or Government in general and escape blame for themselves. You must admit that’s clever.

Some will remember that in 2013 the IPAB published new recommendations for “lady check-ups” for women over 40 years of age. Specifically, it stated that the frequency for the exams women, over 40, needed could be less frequent than what was in practice and recommended at the time by every healthcare organization in the free world. 

Of course, that news met with loud protests so Secretary Kathleen Sibelius, of Health and Human Services, quickly released statements clarifying that IPAB was an “independent board” and did not speak for the Government and the IPAB suggestions would not be implemented by Medicare or Medicaid. Whew, dodged a political crisis, right?

Again, stated more clearly, IPAB could only suggest ways to reduce costs. But if the IPAB suggestion was not politically expedient or cast dispersion on the ACA then it might reveal potentially harmful  political result, caused by the ACA. Plus, President Obama’s reign in office had not ended so the Dems could not have an independent board established by the ACA actually start reducing benefits to older Americans and especially not to woman.   

The GOP does not get off scott-free here either. The GOP always states that Medicare and Medicaid costs must be lowered so the GOP was/is perfectly willing to allow an independent board make decisions that would be political suicide for any party in the majority. The GOP was also perfectly willing leave the IPAB in place with no acknowledgement what so ever. Hold it in reserve, so to speak.

But, if the GOP is serious about controlling healthcare costs then why eliminate the IPAB in the 2017 Tax Cuts and Jobs Act? Spending trends in healthcare must be controlled, some how, right? Granted healthier life styles and lower utilization is preferable but that ain’t happening. 

Remember the Military Base closures in the 1990s? There were dozens and dozens of Military bases around the country that could have been moved or closed all together as a byproduct of the Cold-war ending. But, to close a base in a politicians district did not help in the politician’s re-election process. So, Congress formed an independent board to identify and suggest to Congress bases and facilities that could be closed. Hundreds of facilities were closed or relocated to reduce cost but the politicians did not have to take direct responsibility for the closure decision. Another scapegoat to the rescue.

The IPAB and its objective is worthy and one might say absolutely necessary given America’s out of control healthcare system. But, when someone is 65+ years old the trend for their healthcare cost-line may already be determined by their life’s previous choices or DNA. So, to reduce or eliminate the service these American most certainly need seems heartless and wrong. However, we need to reduce cost so there in lies our dilemma.

If we’ve seen anything consistently out of Washington it is that it can not solve these kinds of dilemmas. They can’t have reasonable discussions or debate. They can’t introduce creative ideas because politicians refuse to take risks that could end a political career. UGH!

IPAB was a good scapegoat, a good talking point during elections and maybe a good way to make suggestions about healthcare delivery and its costs. But, it’s gone.

We have loads of examples of the hypocrisy of politicians as they dodge responsibility and accountability. Eliminating the IPAB with no fanfare or the slightest public discussion is one we all recognize. Let’s hope the ideas our Posts discussed previously can make a difference some how.

Let me know what you think.
And remember, we are all in this together.

Until next week.

Mark Reynolds, RHU
It means “Walk the Faith”

Healthcare utilization drops but healthcare costs increase. What’s up with that? That’s right, Americans used less healthcare but costs increased?

February 15, 2018

As you can imagine (or at least hope) there are groups that closely study the results of American’s consumption of healthcare and the cost of delivering that care. The Health Care Cost Institute (HCCI) is one of those groups. The following is a short summary of HCCI’s recent study as well as facts about healthcare. It’s very interesting and supports the ideas and actions supported by your humble author in earlier Posts.

HCCI’s annual Health Care Cost and Utilization Report analyzes health care spending and utilization from 2012 to 2016 for people up to age 65 with employer-sponsored health insurance. That means HCCI analyzed actual utilization data from employer group plans.

One of the many interesting facts identified by HCCI’s analysis is, Americans consumed (used) the same amount or less health care in 2016 than they did in 2015. However, rising prices caused overall spending in 2016 to grow faster than any time in the last five years. 

Niall Brennan, president of HCCI, states;
“It is time to have a national conversation on the role of price increases in the growth of health care spending,” said Niall Brennan, MPP, president of HCCI. “Despite the progress made in recent years on value-based care, the reality is that working Americans are using less care but paying more for it every year. Rising prices, especially for prescription drugs, surgery, and emergency department visits, have been primary drivers of faster growth in recent years.” (HCCI Press release)

Here are some of HCCI’s facts & conclusions:

  • While the number of emergency room visits rose just slightly, the average price for an emergency room visit grew steadily over the five-year study for a 31.5 percent cumulative increase, driving the increase in outpatient spending.
  • The average price of surgery went up as well, pushing up spending for both inpatient and outpatient care.
  • The average price for surgical admissions increased by nearly $10,000 or 30 percent over the five-year study period, despite a -16 percent cumulative decline in utilization.
  • The price for outpatient surgery rose more than 19 percent.
  • Over the five-year study period, prescription drug spending had cumulative growth of 27 percent, despite a flat or decreasing trend in generic drug prices and despite a decline in utilization of brand prescription drugs.
    *The increased spending was driven by double-digit price increases from 2012 to 2016 for brand prescription drugs.
  • Total spending on primary care office visits fell by almost 6 percent over five years due to a decline in the number of visits.
    *This was offset by a 31 percent spending increase on office visits to specialists and a 23 percent increase in visits for preventive care, changes that could be partly attributable to changes in billing practices or in the way people seek care.

“While consumers, especially those with employer-sponsored insurance, may not feel the direct impact of these charges via out of pocket payments, they ultimately pay through increased premiums and decreased benefits,” added Mr. Brennan.

Are these conclusions realistic – Yes!

  • Since 2011, HCCI has tracked, independently analyzed, and reported health care spending, utilization, and prices each year in its Health Care Cost and Utilization Report using de-identified claims data of people up to age 65 with employer-sponsored health insurance.
  • For this report, HCCI analyzed data from roughly 4 billion claims of nearly 40 million individuals. Claims data came from four of the largest health insurance providers in the U.S. representing about 26 percent of the employer-sponsored insured population. 

Isn’t it interesting that as utilization of healthcare services goes down the overall cost of health care goes up for both employees and employers?

Makes one ask: Why is it that when the Government gets involved costs go up and its the average tax-paying premium-paying citizen who bares the brunt of that cost increase.

  • It happened with Medicare and Medicaid.
  • It happens with military costs.
  • It happens with roads, bridges and all other infra-structure costs.

Why would we be surprised that the Government mandated Affordable Care Act would increase the costs on that which it sought and still alleges it controls?

It almost makes me want to re-print a couple dozen of our previous posts that describe how to lower cost while increasing coverage and access to healthcare. But, I won’t.

We want to thank the Health Care Cost Institute for its reporting and for the effort it makes to gather the information it reports. Americans would be doomed were it not for organizations that watch over our nation to report back to us.
Lord knows we can’t depend on the Press  any more, to do that! Sorry, that’s the cynic in me!

In the weeks to come, as we look at various efforts to create alternatives to the ACA, we will include additional statistics concerning healthcare utilization and spending. The statistics and utilization figures we have captured for years could help build solutions that lower costs to employers, employees and members while increasing benefits and access.

It isn’t that hard!

Let me know if the stats above shock you or infuriate you. I look forward to seeing what comes out of the many States that are trying to overcome the ACA. We’re in this together so let’s shout out when we see something that makes sense.

Until next week.

Mark Reynolds, RHU

Some States are taking steps to “develop” lower cost health plans that will help lower costs and improve access. But, they face opposition!

February 8, 2018

In previous Post, we discussed President Trump’s Exec Order allowing health plans to be created that would lower cost with benefits people really want but not be compliant with the ACA. A few states are moving in that direction. The plan development from these states is just getting started, for sure, but already there are promises from pro-ACA advocates to sue any State or Insurer that implements such plans.

We’ve seen litigious threats and real lawsuits, in other efforts to bring common sense ideas back to life. Limiting “immigration” or “visa” permits from certain countries, increasing border security, and even lowering taxes have all come under siege and litigation by the left. The Left continually tries to thwart  President Trump’s  efforts to improve the economy, increase jobs available, improve security, and well, Make America Great Again.

So, why should we be surprised that the pro-ACA advocates would threaten lawsuits against states when the State’s leadership is trying to increase health plan alternatives, lower cost and improve access to providers.

The good news should be reported that the various state leaders out in front in these attempts to improve healthcare delivery and finance are doing so with the right ideas and ideals in mind.

These state leaders are seeking plans and ideas that:

  • Include complete transparency. Transparency where the consumer could see the actual cost of treatment. Patients and their Doctors should be able consider the effectiveness as well as the cost to benefit of any treatment.
  • Change the treatment practice of ordering multiple tests to avoid potential liability. Treatment should focus on healing the patient not avoiding lawsuits.
  • Create a free market environment that allows providers and pharma to make a profit but avoid the outrageous pricing scenarios we see today.
  • Allow small employers to “partner” with insurers. This means allow employers to purchase coverage for catastrophic events and self insure the healthcare under a certain value, for example $10,000. This can be done using currently available HRAs.
  • Allow for employers to “incentivize” their employees to make better choices. Today employers fear being sued if they encourage their folks to stop smoking or lose 20 lbs. with a health plan that gets richer as the employee gets healthier.
  • We must stop federal government interference in the local marketplace. The rules and restrictions of the ACA are driving up the costs and the one-size-fits-all policies just don’t work.
    * For employers in some states, such as California, we might need some Federal assistance in the form of ERISA.
  •  Most agree that it is important to develop ways to help insurers provide coverage to the individuals who are driving the majority of the costs.
    * Let’s face it, the statistics prove that less than 5% of any group will incur more than $5000 (or even $10,000) in medical charges each year.
    * But, in that 5% of the population, the medical charges can be huge, catastrophic as they say, and there is little the citizen-patient can do about the cost of his/her treatment. So, insurers honestly need assistance to finance these charges.

The point is that we are watching state regulators look at realistic ways to improve access and lower cost without penalizing our citizens for their healthcare usage.

Remember this fact, the enrollment in ACA individual plans at the close of this year’s open enrollment is only about 8 million enrollees. The plans we’re discussing above could be considered as alternatives by 50 to 100 million employees currently in small group plans around the country.

But, these new ideas will be criticized and litigated simply because they conflict with and/or weaken the ACA. If 50 million of our fellow citizens could get access to enroll in these lower cost plans, would that not be a good deal. We might make America’s healthcare great again. Sorry for that.

Anyway, we should be glad that there are creative people developing ideas and even real plans that will increase access to more providers, provide the benefits people really want, and lower cost in both premium and out of pocket. As we said in previous Posts, you won’t see or hear much about it in the Media so we’ll have to watch for it ourselves.

But then, we’re all in this together, so let’s keep watching together.
Let me know what you think.

Until next week.

Mark Reynolds, RHU

The News is focused on Congress’s CR efforts. Good news is that the CR includes a few ACA taxes. Let’s take a look.

January 25, 2018

As your humble author drafts this Post the CR passed by the House was just passed by Democrats (and Republicans) in the Senate. The so-called Schumer Shutdown, as the White House named it, is created confusion, a lot of finger-pointing and pain for millions of Americans.
But, American premium payers do get relief from 3 ACA taxes.

The CR, which is actually being attached as an amendment to H.R. 195 (Federal Register cost-reduction bill), will allow the federal government to continue with normal operations until Feb. 16. The reference to “normal operations” seems a bit ironic doesn’t it given the manner in which the US Congress works?

If you recall, a couple weeks ago we discussed some of the taxes still imbedded in the ACA and a few taxes that had been deferred over the past couple years.

The CR being voted upon currently addresses the taxes we discussed. It does not “repeal” them or permanently eliminate them, of course. The GOP can’t seem to actually deal with “permanent elimination” of anything in the ACA.

Let’s look at those taxes in the bill:

  • Postpone reinstatement of the ACA Medical Device tax for two years.
  • Postpone reinstatement of the ACA health insurer fees for two years.
  • Postpone the start date of the Cadillac tax or a tax on high-cost employer-sponsored health benefits packages, for two years.

It is good news to see these taxes deferred but it’s impossible to understand why the GOP can’t or won’t eliminate them permanently.

I think the honest reason for these actions, or lack of, lies with the basic problem inherit in our legislative representatives. I won’t expand on those thoughts because it becomes too negative and down right depressing.

Democracy is the best form of government in the world but it is the most difficult to maintain, as history as shown. For a democracy to survive, let alone thrive, it requires an informed voting public. That requires an open, free, and non-partisan Press. I won’t expand on that point either for the same reasons as mentioned prior.

As we discussed in earlier Posts, there will be much to discuss in the coming months concerning Healthcare Reform but for now let’s watch as the Democrats play their hand in the Continuing Resolution.

Whether one is a Republican, Democrat or Libertarian the activities in Washington DC are frustrating. But, one thing is clear and that is we’re all in this together.

Until next week.

Mark Reynolds, RHU

Association Health Plans – A chance to make a difference! The Department of Labor is asking for input. A positive step.

January 18, 2018

Association Health Plans (AHP), which we’ve discussed here before, may soon be in the news again. The DOL has released some initial guidelines on which it is requesting comments. As you may recall, your humble author has opined that AHPs present an opportunity to lower the cost of premiums as well as healthcare costs while increasing the number of options available for small employers and their employees.

You may not hear much about AHPs in the liberal Press outlets and maybe not on regular TV at all because it is a complex subject but also because liberals fear it furthers the dismantling of the ACA.

In fact the only outlets which may cover the ongoing discussion will be consumer oriented free market websites and blogs. Cable business shows will provide short segments but for detail we’ll need to stay tuned to trust-worthy entities such as SPBA (Society of Professional Benefit Advisors) or directly from the DOL or other government sites.

But, we’ll watch and discuss the progress of these regulations here and look for the best ideas being pushed forward. Today will be a view from 10,000 feet but we will fly lower in the weeks to come.

The guidelines will expand the existing DOL ERISA regs to incorporate the objective of allowing small employers to band together to create a larger unit which can be treated as a single employer.
In other words, by banding together, small employers with 2-50 EEs, can shop for and consider health insurance plans just like large employers. It increases their buying power. Wouldn’t you, as an individual, like to have the purchasing power of an employer the size Walmart, Microsoft, Boeing, or Amazon. I would.

Let’s start with some a couple of the DOL guidelines released:

  • Broadening the criteria under ERISA section 3(5) for determining when employers may join together in an employer group or association that is treated as the “employer” sponsor of a single multiple-employer “employee welfare benefit plan” and “group health plan” as those terms are defined in Title I of ERISA.
    (I know, a bit technical)
  • Redefines the term “group or association of employers” under ERISA more broadly, in a way that would allow more freedom for businesses to join together in organizations that could offer group health coverage regulated under the ACA as large group coverage.
  • Treating the AHP as the “employer sponsor” of a single plan. The regulation would facilitate the adoption and administration of such arrangements.

I’ll stop right there with the technical mumble jumble because the last point a key point.

By allowing small employers to be treated a like a large employer, because the small employer is member of an AHP, will increase the purchasing power along with the number of options available to the small employer.

There is much more to review such as:

  • Will individual employers within an AHP be able to purchase stop-loss coverage?
  • How will EHBs be addressed?
  • How does an AHP sign up its initial member employers?
  • Can a small employer’s initial premiums be set for each single employer or must premiums be the same for all member employers?
  • Will AHPs overcome the stop-loss killing regulations set in force in California?

So, there is much to review. I look forward to your input as the AHP guidelines are constructed.

It is important to remember that while the AHP approach provides a huge potential to reduce cost and improve access, we can not go away from guarantee access and providing responsible provisions for participant’s pre-existing conditions.

We’re all in this together so let me know what you think.
Until next week.

Mark Reynolds, RHU

They hope we’ll forget about the taxes still in the ACA. But we can’t, can we?

January 11, 2018

It’s easy to let things slide past us after awhile. Who among us can remember everything for ever and be willing and able to discuss a specific topic regarding of its importance? In the news reports on January 2nd, 2018 there were a scant few reports scattered among the daily news about how the ACA tax on Medical Devices was going live again. After a 2 year pause this tax will once again take affect and be a part of the cost and premiums we pay because it is a tax that the insurers will pay.

But, no one took notice. Nor did anyone start talking about the other taxes still remaining in the ACA. Why do you think no one is talking about these burdensome-premium raising taxes?
Here’s a couple thoughts:

  • In general the Press, both Liberal and Conservative, are focused on what they view as bigger topics such as the DACA issue, budget to keep the government open, Russia-Russia-Russia, is Jerusalem really Israel’s capital, Iran and North Korea, as well as the President’s Tweets, to name a couple.
  • The liberal Press does not want to bring up ACA taxes because it might distract from the get-Trump movement or worse, gain traction in the press and start the GOP in the direction of repealing the taxes.
  • The conservative Press does not want to bring it up because it points to the GOP’s failure to properly address the R&R of the ACA.
  • Democrats don’t want to discuss it for fear of losing the ACA completely even if it’s deleted a little at a time.
  • The GOP does not want to discuss it because it could pressure them to actually do something to solve the healthcare crisis of delivery and finance.
  • What a friggin mess, right?

In addition if the discussion on ACA taxes gets started the GOP may need to defend why it has done nothing about the following taxes:

  • Excise taxes on health insurance providers, pharmaceutical manufacturers and importers in addition to medical device manufacturers and importers.
    • These excise taxes are projected to raise $19 billion in 2020. 
  • An additional 0.9 percent payroll tax on earnings and a 3.8 percent tax on net investment income (NII) for individuals with incomes exceeding $200,000 and couples with incomes exceeding $250,000.
    • The high-income surtaxes are projected to raise $35 billion in 2020.
  • Excise tax on employer-sponsored health benefits whose value exceeds specified thresholds starting in 2020. The so called “Cadillac” tax reduces after-tax incomes the most in percentage terms for middle-income families. 
    • The excise tax on high-cost health plans is projected to raise $3 billion in 2020 with the revenue gain growing rapidly over time, reaching $20 billion by 2026.
  • Excise tax on employers offering inadequate health insurance coverage. The tax applies to employers with 50 or more full-time equivalent employees.
    • The excise tax is projected to raise $20 billion in 2020. 

Maybe these 5 additional taxes, in addition to the tax on the medical devices, answer the question as to why no one is screaming about the premium-increasing taxes remaining in the ACA.Oops, the cynic in me just popped out.

If the GOP had eliminated these taxes in the tax billed just signed then the GOP would have been forced(by CBO calculations) to adjust its calculated outcome. That could have made their job harder. But remember, Congress and Senate members(and staffers) don’t actually pay these taxes because they have their own health plan separate from the ACA. Therefore, how could we expect them to reduce these taxes.

I mean, if it would make their job harder, and all. Gees, we can’t expect them to work 5 full days each week, keep the promises they make, and still reduce our costs. Oh well!

OK, I know the new year is young and there is still time. But the Congress will soon set its full concentrated focus on the mid-term elections of November 2018, Then we can expect to see nothing being done except more speeches and more promises.
Dang, that cynic again.

Anyway, what do you think. Let’s keep an eye on it because we’re all in this together.

Until next week.

Mark Reynolds, RHU

We didn’t have to stress about saying Merry Christmas, this year. Thank you Mr. President!

December 21, 2017

It’s four days before Christmas and while the Stockings are not yet hung, I bet most of us are thankful that the “war on Christmas” has been placed on-hold, at least for this year.

So this week instead of promoting or dissecting some aspect of healthcare reform let’s look for aspects of 2017 and our own lives in America that bring peace and good will to man.

So, thank you to:

  • First Responders who run toward the crisis or danger while we run away. These brave men and women are better civil servants to our Nation than anyone else, especially politicians, can ever brag to be.
  • Military that in spite of a decline in funding and respect over the past 10 years continue to keep us save by stopping the dangers over there from reaching over here. I did not join the military when I was of age, a decision I regret to this day.
  • Law Enforcement officers on a daily bases as they walk or drive into unknown danger without hesitation and without the support of too many in our nation.
    We should all stand each time the National Anthem plays!
  • Teachers who signed up to help educate our future generations and continue do so even when facing the toughest environments. Wouldn’t it be easier to teach if English was the required language, parents would help from home, and Unions cared about kids more than self-preservation?
  • Moms for doing what they do to love their children even when we are unlovable. Giving birth might be the easy part for Moms these days as they too often take on the role of both parents and both bread winners in American homes. Moms are the first responders for our families and they need our help and thanks.
  • Churches that stand for the true Word of God and don’t give in to the secular-worldly efforts by too many to cast shadows upon what we all know is right.
  • Co-workers that come to work each day to work as a team toward similar goals of creating good products, good service, and respect for team.

Thank God, above all else, for His gift of the Lord Jesus Christ, for us all. God so love the world that He gave His only Son for us that we might have eternal life. To those of you who are believers you know that a relationship with Jesus Christ does give us an eternal home but also gives us a relationship throughout the year like none other possibly could.

That’s just a few. To whom or what are you thankful that makes your life safer and better?

Love to hear from you and especially at Christmas we should know that we’re all in this together. 

Merry Christmas to all!! And to all, until next week.

Mark Reynolds, RHU


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

November 21, 2017

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

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

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

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

Early thanksgiving observances

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

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

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

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

Harvest festival observed by the Pilgrims at Plymouth

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

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

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

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

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

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

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

November 9, 2017

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

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

Remember, the CSRs apply only to:

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

A couple other points to remember:

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

To summarize:

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

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

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

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

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

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

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

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

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

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

Until next week.

Mark Reynolds, RHU