Archive for the ‘Chamber of Commerce’ Category

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

December 7, 2017

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

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

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

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

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

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

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

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

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

This was just something on my mind.

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

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

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

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

November 30, 2017

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

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

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

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

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

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

So, the result will be higher premiums for people who need good comprehensive health insurance. But there is hope for those of us who are optimist as foolish as I may seem. The GOP’s tax bill does not eliminate the I Mandate until January 2019. That would give the DOL/HHS/IRS time to spell out the guidelines on President Trump’s Executive Order providing for Association Health Plans and for selling cross state lines.
The potential from the President’s EO could bring many new insurers and plans into the market providing more choice and lower premiums to those Americans whose premiums we believe will increase. But that starts the clock ticking to get those new guidelines to the public so that insurers and more likely TPAs can develop the plans we all need.
OK, so I’m trying to be optimistic even though I dislike mucking up the GOP tax bill with gimmicks. If we had our way I’d say just reduce the tax rates and brackets but leave the other “Cr***p” like SALT and medical expense deductions alone. But the GOP leadership can’t seem to keep it simple, defensible and passable. We saw that on R&R didn’t we?
As I write this the Congress is off for yet another holiday break (Thanksgiving) but when you read this the Congress will be back in session and we will see that once again, we’re right!
As is usual in politics, the benefit and cost for 330 million Americans is being adversely impacted by the political and media agenda on 6 million(or fewer) Americans. It could be positive for all with proper leadership on the topics of budget and healthcare.
Let’s keep the pressure up cause we’re all in this together.
Until next week.
Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

 

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

Thanksgiving
, 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
559-250-2000
mark@reynolds.wtf

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

November 16, 2017

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

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

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

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

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

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

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

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

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

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

Until next week.

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

 

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
559-250-2000
mark@reynolds.wtf

 

 

 

 

 

 

  

 

 

 

 

 

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

November 2, 2017

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

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

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

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

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

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

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

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

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

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

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

Until next week.

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

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

October 26, 2017

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

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

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

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

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

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

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

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

Now the good, because AHPs:

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

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

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

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

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

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

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

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

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

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

Eliminating President Obama’s Cost Sharing Reduction (CSRs) payments. Is it legal, constitutional, and a good idea? Let’s discuss.

October 19, 2017

Our intent was to continue discussing President Trump’s EO providing for the formation of Association Health Plans. But, in the interest of fair discussion, maintaining topical subjects and allowing more details from HHS, Treasury and IRS to develop, let’s discuss the President’s Executive Order discontinuing the Obama era subsidy payments to insurers. Is President Trump’s action legal or even a good idea?

First of all, how else does anything get done in Washington to correct any issues let alone the problems caused by the ACA if steps aren’t taken to initiate action by Congress. It seems that our Congress can only take action when there is a crisis or deadline. It is certain that Congress, particularly the GOP, does not have the stones to take on the opposition to changing the ACA without some catalyst to make them do so.

Which brings us to the Cost Sharing Reduction payments, the subsidies paid to insurers for low-income citizens out-of-pocket cost, which President Obama initiated. The Courts have already ruled that these payments are unconstitutional. 

The money for the subsidies was never appropriated by Congress, but President Obama paid insurers anyway.  The payments were ruled illegal by a Federal Appeals Court last year, but the order was stayed pending congressional action.

It’s estimated that about 6 million enrollees in the exchanges qualify for the cost-sharing payments this year, costing the federal government about $7 billion in 2017.  Insurance companies are required to fund the payments to reduce deductibles and co-insurance even if they are not reimbursed by the federal government.

If this were not the case then any President could initiate payments out of the US Treasury for any project a President desired. For example, President G.W. Bush could have pulled funds to start and continue the war in Iraq.

President Trump would be free to start writing checks to pay for the new border wall between the US and Mexico without the approval or appropriations from Congress. I’m sure most Libs would love that. In a country where the citizen’s freedoms are set for in the Constitution do we want our leaders to be free to pick the laws he/she wants to ignore or follow? 

So, if President Trump can’t decide unilaterally to pay for the border wall then how could President Obama decide to make payments to insurers unilaterally?

Consider some perspective. These CSRs are intended to cover the out-of-pocket costs such as deductibles, copays, and co-insurance  for low-income citizens covered on individual plans through an ACA authorized state exchange.

Also for perspective it’s important to remember that only about 10 million Americans are actually covered by the individual exchanges. As stated above, experts calculate that the CSRs affect about 6 million citizens.

So, once again a big hub-bub is created in the media for 6 million folks in a country of 330 million about payments estimated to $7 Billion. It might also be interesting for Americans in 48 states to know that about 3 million of the 6 million people receiving the CSRs reside in California and New York.

The point isn’t that these people don’t need and deserve assistance. Nor is the point that citizens from two of the most liberal states in America require around half of all these payments. The point is that the actions taken by the Obama administration to make these payments was/is unconstitutional. Even though those 6 million good Americans may deserve this help, don’t we need to follow the law. Why didn’t the Obama administration do the right thing and shouldn’t we expect Congress to do the legal thing.

Maybe the states should make these payments to insurers out of their own state treasuries. The payments might then be accounted for and more closely monitored. But, certainly the citizens of these states would be acutely aware of the impact.

Sure, I realize the GOP did not vote for the ACA and now the issue flares up during the GOP’s leadership which seems unfair and certainly untimely. The Obama team was masterful in its timing of many aspects of the ACA which is worth an entire Post on its own. 
But, the GOP had 7+ years to develop a workable replacement and failed to do so.

Next step? We’ll discuss further but first, stick to the facts and the constitution. Second, write and present a realistic replacement plan that provides solutions for all Americans including low income citizens, employees, employers, patients, providers,  that provide more alternatives, better choices and lower costs as its focus.
Simple, right? We’ve already outlined it in previous Posts.

Let me know what you think.
I enjoy the feedback especially since we’re all in this together.

Until next week.

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

 

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

October 12, 2017

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

October 5, 2017

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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