Tag Archives: health insurance

Beware The Artful Codger

One congressional Representative for our northern neighbor, Idaho, has a problem in his Lewiston office: Too many artful codgers showing up there around lunch time with complaints about his political philosophy.

“A spokesman for U.S. Rep. Raul Labrador’s office in Lewiston has filed a complaint alleging a threat from a group of local citizens who routinely visit congressional offices.

Scott Carlton reported the issue to the U.S. Capitol Police early last month. Carlton, who works out of the congressman’s downtown Lewiston office, declined to comment when contacted by the Tribune and referred all questions to Doug Taylor, Labrador’s spokesman in Meridian, Idaho.

The citizen group, LC Valley Indivisible, is comprised of mostly older residents of the Lewiston-Clarkston Valley, according to its members. The organization is loosely affiliated with the national Indivisible groups that call for town hall meetings with members of Congress to raise issues regarding President Donald Trump’s administration.” [SR]

The group members recall a civil engagement with Scott Carlton, Labrador’s spokesperson. Carlton told people at a Chamber of Commerce gathering that the group was “aggressive,” and reported that he (Carlton) had contacted Capitol Police who have jurisdiction over congressional offices. [Spokesman pdf]

Not that those in Nevada’s 2nd congressional district can complain about this issue too strenuously, Mark Amodei (R-NV2) hasn’t scheduled a public performance since venturing out to Carson City recently. It is noteworthy that Amodei told the Reno Gazette Journal: “… he would not vote for any plan that resulted in reduced coverage for anyone. “No, I don’t think you can say forget it, we’re going to let them be uninsured because as a practical solution, that’s not an answer and somebody ends up paying in the end anyhow,” Amodei said.”

Now, Representative Amodei has a GOP plan before him that does precisely that — reduces health insurance coverage for people in his district, and the amendments to the bill recently announced make the situation even worse, dismantling Medicaid protection for seniors in record time.  However, Representative Amodei doesn’t appear to want to pencil in a town hall meeting in a major metropolitan area in his district — like Reno/Sparks?  Perhaps some of those artful codgers, similar to the Lewiston lunch bunch, might show up?

However, there are other ways to get the attention of elected representatives. I am particularly fond of the Empty Suit Town Hall. Let’s hear it for Lexington, Kentucky:

“…voters in Lexington, Ky., have been clamoring for the state’s congressional representatives — Senate Majority Leader Mitch McConnell, Sen. Rand Paul and Rep. Garland “Andy” Barr — to tackle constituents’ questions in person. They even booked a venue for Saturday and hand-delivered town hall invites to the politicians’ offices.  The legislators were a no-show, but that didn’t stop things. Instead of McConnell, Paul and Barr, organizers propped up three mannequins wearing suits.” [WaPo]

Perhaps not the best optics for a congressional delegation? At least it’s better to be an empty suit than to sic the Capitol Police on office visitors?

There are other ways to contact GOP representatives like Mark Amodei — and this should be done before the vote on the Repeal/Replace bill on Thursday.

For those living in District 2 there’s Amodei’s contact form for quick e-mail messages. Simply scroll down the page to the “e-mail link.”  The page also has the phone numbers for Amodei’s offices in Reno Phone: (775) 686-5760, Elko Phone: (775) 777-7705 , and Washington, D.C Phone: (202) 225-6155.

This is as good a time as any to remind Representative Amodei what he said to the Gazette Journal: “… he would not vote for any plan that resulted in reduced coverage for anyone. “No, I don’t think you can say forget it, we’re going to let them be uninsured because as a practical solution, that’s not an answer and somebody ends up paying in the end anyhow,” Amodei said.”

Now, if only those artful souls in Idaho can get the attention of their Representative…

 

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Filed under Amodei, Health Care, health insurance, Medicaid, Nevada politics, Politics, Republicans

Myths and Legends: The Medicaid Issue in Nevada

There was a Republican politician on my television screen this morning telling me, or trying to tell me, that Medicaid was “meant for mothers, children, and those who couldn’t work…” This is outdated. Then, he tried to convince me that Medicaid was being “abused” by those who work and ‘game the system,’ while spouting platitudes about the Free Market and the Joys of Competition.  Let’s start at the very beginning.

This is the explanation of Medicaid as reported by Nevada’s Division of Health Care Financing and Policy (pdf)

“Medicaid is the nation’s main public health insurance program for people with low incomes and the single largest source of health coverage in the U.S.”

The program is meant to help people with low incomes.

“The PPACA extended coverage to many of the non-elderly uninsured people nationwide. The June 2012 Supreme Court Ruling made Medicaid expansion optional for states, and Nevada elected to join the expansion and maximize federal dollars. Effective January 1, 2014, this move broadened Medicaid eligibility to nearly all adults under age 65 with income at or below 138% of the Federal Poverty Level (FPL). At the end of SFY 2014 that meant that there were an additional 125,989 new enrollees in Nevada Medicaid, and increased expenditures of $154,816,777.00. These new expenditures are 100% federally funded.” [NV med pdf]

Medicaid expansion added those working Americans who were earning 138% of the poverty line and below, (pdf) and more specifically: (1) Those between the ages of 19 and 64 who are earning less than 138% of the FPL. (2) Pregnant women in homes earning less than 165% of the FPL. (3) Children from birth to 19 years of age in homes wherein the earnings are at or below 205% of the FPL, with a small premium required in some cases. Translated into real people with real levels of low income earned, this means a family of four would be eligible for Medicaid in Nevada if the family earnings are less than $2795 per month; for pregnant women if the earnings are at or less than $3341 per month; and families are eligible for the kids’ Check Up program if family earnings are less than $4151 per month.

If we calculate annual earnings, then monthly earnings of $2795 mean an annual income  of $33,540. At $3341 annual earnings of $40,092, and at $4151 annual income of $41,630. Nevada’s median income is $52,431 (2015). To put these numbers in perspective, the average weekly wages of a person working in a private restaurant in this state are $382, or $1528 per month ($18,336 yearly). [DETR] The average rent for a 2 bedroom apartment in Las Vegas, the obvious site for most private restaurants, is $932 per month. [RJ] In short, not only are wages not all that generous in Nevada, the benefits available for Nevada families aren’t all that generous either.

Republicans, however, strenuously oppose benefits for adults capable of working. This would make infinitely more sense IF and ONLY IF they were willing to support a living wage for all employees. One really doesn’t get to have it both ways.  Either you want a reduction in benefits that most working people can afford to purchase on their own because they have the financial resources to do so, or you want lower wages which mean that individuals and families cannot afford those things, like health insurance, and the public benefits are required to make up the difference.  However, at this point we slam into another GOP myth.

Free market competition will make health insurance affordable for everyone, even those who are working in low wage jobs.  Good luck with that. Personally, I have yet to hear anyone explain with any specificity why health insurance corporations will be flocking to Clark, Washoe, or even Esmeralda counties because there is more “free market” applied to the situation. If the insurance companies weren’t wildly excited about selling individual and family health insurance before the enaction of the ACA, why would they do so now? Unless, of course…

They could sell policies that didn’t cover all that much? That cost more for those between the ages of 50 and 64?  That didn’t cover maternity expenses? That didn’t cover preventative care? That didn’t cover drug rehabilitation and mental health services in parity with physical treatments? That only covered the items required in those states with the least consumer protections? And, even then all we have to look to is the situation in Nevada when insurance corporations were free to offer what they were pleased to call comprehensive policies.  Again, if they weren’t interested in selling a plethora of individual and family policies then why believe they would be now?

And that Free Marketeering? It doesn’t work in the health care industry:

“In a free market, goods and services are allocated through transactions based on mutual consent. No one is forced to buy from a particular supplier. No one is forced to engage in any transaction at all. In a free market, no transactions occur if a price cannot be agreed.

The medical industry exists almost entirely to serve people who have been rendered incapable of representing their own interests in an adversarial transaction. When I need health services I often need them in a way that is quite different from my desire for a good quality television or a fine automobile. As I lie unconscious under a bus, I am in no position to shop for the best provider of ambulance services at the most reasonable price. All personal volition is lost. Whatever happens next, it will not be a market transaction.” [Forbes]

The only thing I can say with any certainty is that the Republicans have little idea exactly what constitutes a Free Market, and instead are waving it like a banner crovering their underlying desire to be free from the moral requirements compelling us to be our brother’s keepers.  The range of misanthropic explications are appalling, from “we need not do anything because the poor will always be with us anyway,” to “when Jesus told us to provide for one another he only meant fellow Christians.”

The Repeal and Replace campaign is as void of humanity as it is of understanding of the reality of most family economics, and of the comprehension of what the term ‘free market’ actually means.

 

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Filed under Economy, Health Care, health insurance, Politics

To Our GOP Friends Who Don’t Seem To Have A Clue How Insurance Works

We might go for the Ryan budget bill in regard health insurance directly, but others have already noted that either (a) he doesn’t have a clue how insurance works, or (b) he’s trying to pull a fast one on the American public.  At any  rate, the phase I of the ACA repeal is essentially a gigantic giveaway to health insurance and pharmaceutical corporations, a tax boon to those in the upper 0.1% income bracket, and a dismantling of the Medicaid program. The contents of Phase II have been tipped.  It’s on the Speaker’s website, but requires a bit of unpacking:

“Administration actions, notably by HHS Secretary Price, to stabilize the health insurance market, increase choices, and lower costs…”

Translation: The content of health insurance policies, currently listed as “essential provisions” for all policies, is under a head on assault.

If a corporation is going to offer a comprehensive health insurance policy for sale to customers, it must include “ambulatory care for patients in a hospital or not,” “emergency services,” “hospitalization,” “pregnancy, maternity, and newborn care,” “mental health and substance abuse treatment,” “prescription drugs,” “rehabilitation,” “laboratory services,” “preventive and wellness care,” “pediatric care including vision and oral care,” and “birth control and breastfeeding coverage.”

Now, just guess what parts of this coverage the GOP finds objectionable?  If you guessed anything having to do with WOMEN give yourself the prize of the day.

Why, the guys grouse, do I have to have a policy covering maternity and neo-natal care, birth control prescriptions, and pediatric care?  It’s because of how insurance works.

Aside from the obvious part wherein it requires both men and women to create a ‘maternity situation,’ the whole idea of insurance is encapsulated in the word POOL.

“When you buy insurance, you join many others who pay money to an insurance company.  The insurance company uses the money collected to pay claims that are submitted by those who have purchased insurance.  The money is “pooled” and losses and expenses are shared.  An important aspect is the members of a pool share similar risk characteristics.” [HIW]

In the case of health insurance, the “shared characteristic” of note is that everyone who buys a policy is a human being, who at some point will need health care.  The more people (policies) in the pool the wider the risk can be shared. And, that’s the point of insurance — spreading the risk among as many policy holders as possible.

Creating ‘cafeteria’ policies might be profitable for the insurance corporations, but it doesn’t make health care affordable for most people.  If we carve out special coverage for maternity care and remove this from the larger pool (which includes men) all this serves to do is to increase costs for those remaining in a smaller pool.  Similarly, if prostate cancer screening and treatment is carved out from comprehensive coverage, this serves to increase costs as the overall pool is diminished.

Got it? If not, think of your auto insurance.  10 people buy GenZ Insurance, 9 of them never file a claim, 1 does. The costs related to the one claim are shared among those who bought into the pool and paid premiums to maintain their insurance.  We require all automobile owners in this state to have at least minimal insurance. In Nevada, this means you have to have a policy covering $15,000 for bodily injury or death in an accident for one person, $30,000 for bodily injury or death of two persons in an accident, and $10,000 to cover property damage. Thus, all Nevada drivers must have at least minimal participation in the auto insurance pool. Again, the larger the pool the greater sharing of risk, the entire point of having insurance.

Back to health insurance, if we thought Phase I is a disaster, Phase II should be even worse. Phase III is the ‘portability canard.”  Has it occurred to anyone in the GOP hierarchy that nothing that really prevents insurance corporations from selling their policies across state lines — IF they agree to accept the standards set by state insurance commissions for the protection of their consumers.  More on this later — if necessary.

 

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Filed under Economy, Health Care, health insurance, Insurance, Politics

My List

Monday morning the need for accountability becomes paramount.  There are some issues which require continuous investigation and reporting, my list:

  • The efforts of the Russian government to interfere in the 2016 election. Investigations have been launched, some ongoing since last summer.  Efforts to curtail or stall these investigations could easily be characterized as evidence substantiating the charges.
  • The efforts of Tom Price as a cabinet member to implement the elements of his Empowering Patients First Act, which would send the health insurance system back to the days of junk insurance and perhaps worse should the corporations be allowed to bypass state consumer protection systems.
  • The unholy alliance of Pruitt, Perry, et.al. to deconstruct environmental protection in favor of protecting the interests of exploiters and polluters.
  • The efforts to suppress voting and civil rights.
  • The privatization of public education, and coordinated efforts to use public funds to support religious efforts.
  • The tendency to demonize members of minority/ethnic communities.

That should keep journalists busy for a while?

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Filed under Politics

Unanswered Questions

It’s lovely to listen to melodic phrases like “patient centered care” and “freedom of choice,” as well as all manner of other Republican catch all incantations…but none of these address practical questions Representative Mark Amodei  (RNV2) needs to answer about the replacement of the Affordable Care Act.  A few examples:

The extension of health care insurance and Medicaid helped reduce the level of uncompensated care for which hospitals could ultimately be liable. How will a GOP plan reduce the level of uncompensated care? How will rural hospitals be affected? How will hospitals in Lander, Pershing, and Humboldt counties be affected?

Prior to the Affordable Care Act there was only one health insurance company selling individual policies in large swaths of District 2. How will the GOP replacement legislation insure competition for those seeking to purchase individual health insurance policies for their families?

Prior to the Affordable Care Act insurance companies could market policies with lifetime limits.  These were certainly cheaper than comprehensive policies, however they never seemed to be adequate for serious and chronic illnesses or very serious accidents with long term recovery and rehabilitation.  In fact, many respected consumer advocates called these “junk insurance.” What will the GOP replacement do to prevent the reintroduction of junk insurance?

Before the Affordable Care Act Republicans touted health savings accounts as an alternative. How would a GOP replacement for the Affordable Care Act address the health care needs of those whose wages and salaries are insufficient to sustain the contributions needed to establish an adequate health savings account level?

Prior to the Affordable Care Act insurance corporations could refuse policies for those with preexisting conditions and to those engaged in what the companies categorized as high risk occupations.  How will a GOP replacement prevent a reintroduction of these practices?

Before the Affordable Care Act insurance corporations were allowed to charge higher premiums for policies sold to women, or which covered female members of families. How will the GOP replacement address this issue?

The Affordable Care Act extended the viability of Medicare.  How will a GOP replacement extend the capacity of Medicare?

These are but a few of the questionsame raised by the GOP calls for repeal. They cannot be answered by pious recitals of Republican rhetorical flourishes. They cannot be addressed by reiterating Republican buzz words and phrases. They have to be addressed in the real world, of real people, with real health care needs.

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Filed under Health Care, health insurance, Politics

Don’t Grab Your Pearls: ACA Exchange Premium Increase in Nevada 6%

Premium Increase Map

Far from it. First, these are REAL numbers, not Trumpian hyperbole about ACA exchange purchased premium increases.  Secondly, increases in insurance premiums whether exchange purchased or privately purchased are going up.  The insurance companies set the premium prices; and if a person used the exchange to buy personal health insurance, and qualifies for a subsidy, then the increase will be felt less than if the insurance isn’t subsidized.

However, this is an excellent argument FOR a PUBLIC OPTION, which would provide competition for the private insurance corporations (and thereby could cause some cost-containment not now built into the system).  We could, for example, allow private citizens who don’t have health insurance provided by their employers to buy into the Medicare system.

Why the increases? Business Insider explained last May:

“However, the most important factors associated with lowest-cost silver plan premiums and premium increases are those defining the contours of competition in the market,” the report concluded. “Rating areas with more competitors had significantly lower premiums and lower rates of increase than those that did not.”

“The paper also found that there was one player that had more of an effect on prices than any other provider.

“Those rating areas with a Medicaid insurer competing in the marketplace also have lower premiums and lower rates of increase than those regions without a Medicaid insurer competing,” Blumberg, Holahan, and Wengle said.

This is an issue as insurance companies evaluate the profitability of the state exchanges. With considerable political pushback against expanding Medicaid, private insurers will have to carry most of the load and provide competition.”

Or, to put it more succinctly – Republican opposition to the expansion of the Medicaid programs helps drive UP health insurance premium costs.  Full. Stop.

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Filed under Health Care, health insurance

Mountains and Mole Hills

Mountain MolehillOne of the more unpleasant aspects of today’s media offerings is the tendency to confuse mountains and molehills.  No disrespect to all those diligent moles out there assiduously plying their turf disrupting trade, but when Everything Is A Crisis! perspective is the first casualty.

Mountain:  We have an immigration policy in place which doesn’t work for us.  There are two bills addressing this issue, S. 744 which passed the Senate and H.R. 15 which languishes in the House while the TeaParty/GOP leadership decides which they’d prefer to tick off — their corporate backers or the xenophobic right wing.    Representative Amodei (R-NV2) thinks he could support Rep. Eric Cantor’s “Kids Act” and he provides a summary of the issue on his webpage, but his statements on comprehensive immigration policy reform remain fuzzy.  Where Representative Heck (R-NV3)  stands is a bit more clear, given his statement on October 25th:

“I have spent countless hours meeting with community members and addressing town hall meetings on the topic of immigration reform. There is no doubt in my mind that reforming our immigration system is right and necessary and I remain committed to enacting real solutions that will fix our current broken system. I will continue to urge the House leadership to move forward on immigration reform with all possible haste.”

While he’s “urging leadership to move forward,” the question remains — toward what?  A piecemeal enactment of immigration policies which serve only to protract the issues, and may never arrive at a complete picture — or — legislation like S. 744 or H.R. 15?

Congresswoman Dina Titus (D-NV1) drilled down to one of the major issues in the piecemeal approach to immigration policy reform:  What of women who work in the service sector?

“Comprehensive immigration reform must take into account the fact that many immigrant women work at home or in the informal economy.  If, for example, eligibility for the path to citizenship requires proof of employment, providing paystubs cannot be the only acceptable proof or we risk leaving millions of women behind.  Approximately 74 percent of undocumented domestic workers do not receive documentation of their pay from an employer.  Thankfully, H.R. 15, the bipartisan, comprehensive immigration reform bill recently introduced in the House, addresses this issue by allowing flexible forms of proof of employment. It is critical that we incorporate this thoughtful approach into any immigration reform bill considered by the House.”

Meanwhile, the mountain remains, impervious to rational debate and reasonable action.

Mole Hill:   Those who have purchased individual health insurance plans constitute about 5% of the population. [UI]  This translates to a maximum of 16,500,000 individuals out of a total 330,000,000; if we count every single person large or small, young or old.  The actual percentage is probably closer to 14.3 million individuals. [UI pdf]  Some of these people bought JUNK.  In a search for low premiums they purchased policies that didn’t cover much, if anything, or bought policies the coverage terms of which were so confusing that the insurance corporation was able to deny compensation for even basic treatment options.   The infamous Barrette Case is a classic example of a JUNK policy.   Forbes magazine estimates that about  4 million Americans were sold some 1,200 of these junk policies.

Thus, it should be fairly easy for the press to find some individual examples for popular consumption of these Outraged Individuals who want to keep the cheap junk they purchased, out of a category of 4 million.   Therefore, the media cry “there are millions of Americans affected by this ‘mistake'” is technically accurate but ultimately misleading.   Some broadcasters have jumped on the “Crisis” bandwagon, only to have their stellar examples debunked within hours.  You can tell when the mole hill is being magnified into a mountain IF (1) the report doesn’t compare the junk policy to the coverage available in the health insurance exchanges, (2) if the report doesn’t take into consideration the subsidies available to assist the policy holder pay for the premiums, and (3) if the report relies on individual examples to generate conclusions for which there is no other substantiation.

Mountain:  Speaking of health issues — 32,163 Americans died as a result of gun fire in 2011.  6,220 died as a result of a homicide. 19,766 individuals used a gun to commit suicide.  [GP]  73,883 Americans were injured by gun fire.  432 Americans died in gun related accidents. [GP]  By contrast, in 2011 there were 9,878 fatal automobile accidents in which there was a driver with a BAC level above 0.08 or even higher.  [NRD pdf]  We are coming perilously close to the point at which the number of gun deaths equals or surpasses the number of automobile deaths.  According to figures released by the CDC 33,687 Americans died in auto accidents, 31,672 died as a result of gun violence.  We do something about drunk drivers.  We restrict the licenses of some drivers. We have yet to address the issues related to the easy access to firearms in this country.

When Gallup polled Americans about controlling gun sales in the U.S. during the week of October 3-6, 2013 some 49% favored more stringent controls, 13% thought restrictions should be eased, and 37% called for controls to be kept the same.  A September poll by Quinnipiac University found 89% of Americans supportive of legislation to require universal background checks.  These numbers aside, on September 17th Senate Majority Leader Harry Reid (D-NV) announced he didn’t have enough support to reintroduce the background check bill in the Senate. [TheHill]

Mole Hill: I’m really pleased that there are at least seven retailers who will give their employees a break for celebrating Thanksgiving with their families.  [TP]   That said — when wages for American workers have stagnated for the past decade [EPI], when there are about 10% of our young veterans  still looking for work while the programs to help them are shrinking [CNN], and when the unemployment rate for Whites 6.3% while the unemployment rate for Blacks stands at 13.1% we have a problem far larger than whether or not people go home for Thanksgiving.

Mountain:  Did anyone read the IPCC climate report?   Did anyone delve into Chapter 12, wherein the commission discussed climate change implications for pattern scaling, temperatures and energy budgets, atmospheric circulation, the water cycle, the cryosphere, our oceans, and carbon cycle feedback?  [IPCC pdf] One newspaper noted that the report made the climate change deniers overheat.  Too many media outlets were engaged in sowing seeds of doubt about the report’s content and all but ignoring the conclusions and commentary contained therein.

Mole Hill:  There were 48 bills in the 113th Congress related to the abortion issue. [GovTrack]  There’s Sen. Rand Paul’s S.583 Personhood Bill, H.R. 2300 from Rep. Tom Price to “empower patients” (not), Rep. Trent Frank’s H.R. 1797 “pain” bill, and his H.R. 447 PRENDA, Rep. Jim Jordan introduced H.R. 1091, life begins at conception act, and the list goes on.

Meanwhile back in the world of reality — the rate of abortions per 1,000 women of child bearing age has declined from a high of 29.3 in 1981 to 19.6 in 2008. [Guttmacher]

A Suggestion

Could we start talking about the mountains, and minimize our time spent in elaborate and protracted debates about mole hills?

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Filed under abortion, Amodei, anti-immigration, ecology, Gun Issues, Health Care, health insurance, Heck, media