Tag Archives: Obamacare

Quick Phone Call Fodder for Nevada District 2

Should the Trumpcare bill pass this evening, residents in the following Nevada Counties can expect changes in their premiums after tax credits: From $2400 to $3700 — Humboldt, Elko, Pershing, Esmeralda, Lander, Churchill, Esmeralda, and Mineral counties. (Source: Kaiser Family Foundation)

Comments Off on Quick Phone Call Fodder for Nevada District 2

Filed under Amodei, Health Care, health insurance, Politics

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…

 

Comments Off on Beware The Artful Codger

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

Questions for District 2’s Representative should we ever see a town hall session

Representative Mark Amodei (R-NV2) was pleased to spend his 2016 campaign season supporting the candidacy of one Donald J. Trump.  Now that the campaign is over — there are some pertinent questions the District 2 Representative might address should he ever have one of those ‘town hall’ things.Carter Page

#1. Do the constituents in your district deserve a full and complete explication of the ties between the present administration and the Russian government, its agents, and its affiliated operatives? How likely is it that there will be a full explanation without an independent commission investigation?

We have some hints at the extent of Russian meddling with our elections and administration in chart form here,  Mr. Trump’s connections in Russia here, and the implications here. And, Politifact’s explication here.   There’s the Carter Page  connection. The Roger Stone connection.  More about Wilbur Ross, the administration’s Secretary of Commerce here. A bit of the Russian reactions recently in this article. What of the activities of Paul Manafort?  The names, in the post Flynn flood, keep coming up and out. It seems necessary to have a full, independent, and comprehensive investigation to determine the extent and implications of the Trump ties to the Russians.

#2. How do you explain support for a health care  act which replaces the Affordable Care Act with legislation that doesn’t offer a route to affordable health insurance plans for working Americans? And, which looks for all the world like a whopper tax cut for millionaires, billionaires, and insurance corporations? 

This topic has been explored in the Washington Post, in the Fortune Magazine, and in Slate.

Will the replacement bill require insurance plans to cover mental health services on par with physical health coverage?

Will the replacement bill require insurance plans to cover pre-natal, maternity, and post-natal expenses for American families?

Will the replacement bill require that consumer protections provided by state insurance commissions be retained?

How will be the replacement make health care policies more ‘affordable’ without going back to the days when insurance companies could sell low coverage/high deductible policies which left families with massive medical debt?

How will the replacement bill maintain the fiscal health of rural hospitals and clinics?

Now, all we have to do is wait for Representative Mark Amodei to hold a meeting with constituents to address these, and other issues.  I’d not like to hang by my hair for as long as this might take.

Comments Off on Questions for District 2’s Representative should we ever see a town hall session

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

2092 days

The Trumpster promised that if President Obama would release his birth certificate he would release his tax returns.  So, as of April 27, 2011 Trumpster was on record … Not that keeping his word is of much importance.  It’s been 2092 days since the promise was made and subsequently ignored.

It’s not just the returns. Build a wall?  Well, maybe a bit of fencing. Mexico will pay for it? No, that would be the American taxpayers. Now, the Trumpster announces health insurance for everyone,  Everyone!  Well not unless the old ideas like health savings accounts, portability, high risk pool can do the job. That these haven’t worked in the past is conveniently omitted.

It appears the only words which tend to hold are the Kremlin talking points. NATO is obsolete. (Unless you happen to be in Estonia, Latvia, Lithuania, Poland…) The European market is failing. (Unless you happen to be in Germany, France, Spain…)

At least some questions might be addressed by releasing the tax returns, but until such time as they appear in public the obvious conclusion is that there are “foreign entanglements” enveloping the president-elect.

2092 and counting.

Comments Off on 2092 days

Filed under Foreign Policy, Health Care, health insurance, Politics

11% of Nevada Households could lose affordable health insurance plans

The Republicans are all but giddy over repealing the Deathly Obamacare! The “Failure,” which isn’t failing by any stretch of the imagination; the “Socialized Medicine,” which in fact subsidizes the private marketplace for health insurance coverage…  And what of those subsidies which help pay for health insurance plans in Nevada?

Nevada has 79,876 enrolled in the ACA marketplace. 71,472 of them are receiving Advance Premium Tax Credits, that would be 85%.  48,736 policy holders in Nevada are receiving Cost Sharing Reductions; 61%. [KFF]

Shouldn’t it be interesting when 85% of the Nevadans who are enrolled in marketplace health insurance plans find out that with “repeal” comes the prospect of getting no help to pay the premiums for the family health insurance policy?

What are the options?  Buy cheap policies, some of which meet the Consumer Reports standard for Junk? Drop coverage and let medical problems wait until it’s time to take a trip to the ER? 

Let us remind ourselves that there are some 751,165 households in the state of Nevada, and 79,876 of them are enrolled in an ACA marketplace private health insurance plan.  That’s about 11% of the households in the state standing to lose assistance securing affordable health insurance policies.

We also need to remember that these households are those which do not have employer provided health insurance for their family members – like small business owners, independent contractors, low wage contract laborers…

Next time the GOP rants on about “helping the Working People of America,” or “protecting small family businesses”  remind them they didn’t mind shoving the props out from under these people when it came time to help them get affordable health insurance.   Is this OK for Senator Heller and Representative Amodei?

Comments Off on 11% of Nevada Households could lose affordable health insurance plans

Filed under health insurance

Happy New Year Nevada: Here’s what we lose if the ACA is repealed

Perhaps we should now speak of two varieties of what was formerly known as the “Fog Of War.”  The older form is often attributed to Carl von Clausewitz (but never verified), the Nebel des Krieges, or the “uncertainty in situational awareness experienced by those engaged in military combat.”  Then there seems to be a more modern form, in which the Republicans fight against “Obamacare” and promise to Repeal and Replace it without inconvenience to anyone.  Or, the uncertainty of what to do when the fight stops being strategic and starts being ever so inconveniently tactical.

One of the elements that is truly popular is the ACA provision forbidding insurance companies from denying coverage because of a person’s medical history (the pre-existing condition provisions in policies).  69% of the country favors this provision including 75% of Democrats, 65% of Republicans, and 63% of independent voters. [KKF]

Perhaps this is a popular feature of the Affordable Care Act because 25% of Nevada’s non-elderly population, or 439,000 people  could be denied health insurance coverage if the pre-2010 rules were re-established for health insurance companies. [KFF]  If a person is without health insurance the problems are well documented.

“Lack of health coverage, even for short periods of time, results in decreased access to care.  Adults with gaps in their health insurance coverage in the previous year were less likely to have a regular source of care or to be up to date with blood pressure or cholesterol checks than those with continuous coverage.16 Children who are uninsured for part of the year have more access problems than those with full-year public or private coverage.17” [KFF] (emphasis in the original)

The pattern from this point on is predictable.  No health insurance, less likelihood of consistent care, less care begets more serious health problems, and more serious health problems are more expensive, especially if treatment is deferred until the emergency room is required.    MEPS has some 2013 data which is on point:

“Average expenses for people who had one or more visits to the Emergency Room were $1423 in 2013, according to the Medical Expenditure Panel Survey (MEPS). Median, or typical, cost was $703. For people ages 45 to 64, the cost was substantially higher on average ($1840). Uninsured people under age 65 averaged $1627 in expenses ($572 median), of which they paid almost 1/3 out of pocket. While average cost for those age 65 and up was about $1500, Medicare recipients paid only about 5% out of pocket. Median charges for children under age 18 were $471 to $477.”  (Full chart here)

The standard Republican response is that people ought to have Health Savings Accounts, and/or pay more out of pocket. [PUSA]  Therefore, our 439,000 Nevadans would be on the hook for emergency room treatment of approximately in the range of $703 to $1423.  Uninsured children? The parents would be liable for costs of at least $471 for that rash, laceration, abrasion…whatever the little critter managed to do to itself.  It’s all well and good to babble on about some theoretical notion of Personal Responsibility, but …

Health Savings Accounts and High Deductible Health Plans aren’t for everyone.  For example, the median household income in Nevada is $51,847 and the average household has 2.72 people.  The average mortgage payment is $1,442, and average gross rent is $973. [Census] Those in Clark County can expect to pay out $177.22 per month on utilities, and another $352.74 on groceries (at least) per month. 

We played with some of the numbers back in 2015, and the pressure on average families in the Silver State was obvious then:

“For the sake of the argument let’s propose that the family has one car, which means  ownership costs of $517.00, and operating costs in the western region of $236.00 per month. [IRS] Subtract another $753 from the monthly budget. Now we have $1,848 left for the remaining expenses.

Basic utilities in Las Vegas run about $175.56, and in Reno about $130.00; let’s call it in the middle and estimate monthly utility bills of $150.00; now we have $1,698 in the check book.

Now for the groceries.  A family of four can just get by on about $146 per week and eat healthier on about $289 on the higher end. [USDA pdf] Let’s settle for the “moderate” plan which will cost our average family of four about $1,062 per month if the kids are over 6 years of age.  Now there’s $636.00 left.”  [DB]

Without too much more arithmetic it should be clear that High Deductible Health Plans and Health Savings Accounts are a nice idea if (1) a person is generally healthy with no family history of serious illnesses; and (2) a person is wealthy enough to afford to put aside “extra” money each month for the Health Savings Account.  Return with us now to elementary school arithmetic.

We’ve been speaking of households in terms of their Median household income. So, we know that half the households in Nevada are earning less than $51,847 per year.  We also know that 14.7% of Nevadans have incomes below the poverty line ($24,250 for a family of four in 2015).  We also know that 22.8% of Nevadans under the age of 65 and below 138% of the poverty line did not have health insurance at any time during 2015. [TP.org]  Speaking about an HSA to those whose households are trying to function with incomes below the median and barely above the poverty line seems almost cruel.  It doesn’t do to bellow “personal responsibility” when the individuals and households in question don’t have the “personal resources” to meet this exalted standard.

It’s perhaps even more cruel to imagine the days when an insurance company in this or any other state could decline coverage for previous treatment of: alcohol or drug abuse Alzheimer’s or dementia, arthritis, cancer, cerebral palsy, congestive heart failure, coronary artery disease, Crohn’s disease, pulmonary disease, diabetes, epilepsy, hemophilia, hepatitis, kidney disease or renal failure, lupus, mental illness, multiple sclerosis, muscular dystrophy, obesity, organ transplant, paraplegia, paralysis, Parkinson’s disease, pending surgery or hospitalization, pneumocystic pneumonia, pregancy, sleep apnea, or strokes. [KFF]

Yet, this is precisely what the Republican Congress has in mind … repealing the Affordable Care Act, with it’s protections for those with pre-existing conditions and replacing it with … something…. somehow … some way… in some form… when the only two definitive responses have been “using the emergency room,” and “HDHP + health savings accounts.”  In short, back to the bad old days.

No more light on the subject, just more Nebel des Krieges from the Republicans, including Representative Mark Amodei (R-NV2) and Senator Dean Heller.  It would be well for them to blow off some of the fog and illuminate precisely what they want to do.

2 Comments

Filed under Health Care, health insurance, nevada health

Heller Takes The Easy Road: Cadillac Health Plan Target

Nevada Senator Dean Heller (R-NV) took aim at one of the more vulnerable (and questionable) parts of the Affordable Care Act as his contribution to the Republican Repeal – and eventually replace with something we don’t know what – plan.   [LVSun]

First, a “cadillac plan” is an exceptionally generous health care plan offered by some employers.  There’s good and bad news herein.  On the bright side, the plans offer very full coverage.  On the darker side, maybe there’s a bit too much coverage, and that has implications for restraining health care costs.

At this point it’s necessary to focus on what’s is important for the employees. Is it the continuation of the generous health care coverage OR is it health care cost containment. 

The Herring & Lentz report (2011) describes the cost and tax issues involved in summary form:

“One controversial aspect of the Patient Protection and Affordable Care Act is the provision to impose a 40% excise tax on insurance benefits above a certain threshold, commonly referred to as the “Cadillac tax.” We use the Employer Health Benefits Survey, sponsored by the Kaiser Family Foundation and Health Research and Educational Trust, to examine the number and characteristics of plans that likely will be affected. We estimate that about 16% of plans will incur the tax upon implementation in 2018, while about 75% of plans will incur the tax a decade later due to the indexing of the tax thresholds with the Consumer Price Index. If the Cadillac tax is ultimately implemented as written, we find that it will likely reduce private health care benefits by .7% in 2018 and 3.1% in 2029, and will likely raise about $931 billion in revenue over the ensuing 10-year budget window from 2020 to 2029.”

Senator Heller calls this “onerous,” however the Senator has often called any form of regulation on the insurance and banking sectors “onerous.”  Thus, it’s helpful to remember why this element was inserted in the bill in the first place.

Consider the following examples:

1) A patient with an extravagant health plan, often dubbed a Cadillac plan, goes to the doctor’s office. She’s told by her doctor that she should take a bunch of tests, even though the tests seem unnecessary. The patient knows most the tests are unnecessary, but she figures that since her health insurance covers everything, it’s better to be safe than sorry — it’s not like it’s costing her anything except a little time, anyway.

2) Another patient with a less generous health plan goes to the doctor’s office. She’s also told by her doctor that she should take a bunch of tests, even though the tests seem unnecessary. But this time the patient also knows her health insurance will charge her a bunch of extra fees for each test. Wanting to avoid a lot of costs, she decides to talk to her doctor about what tests are actually necessary, and she declines to take any of the tests that she and her doctor decide are unnecessary.

The Cadillac tax attempts to move more health plans from example No. 1 to example No. 2. [Vox]

The Cadillac Plans are popular – why not? Most medical costs are covered.  And, therein, as the examples suggest, lies the problem.  The employer can boast to prospective employees that “everything’s covered” in our health care plan; the employee can spend as much on medical care as is practical and then some; and, unions representing employees can boast about their prowess in gaining exemplary health care insurance coverage.  However, none of these positions suggests any form of health care cost containment.

There is no incentive built into the Cadillac  health insurance plans to contain rising health care costs. 

There are a couple of ways to address health care cost containment – none of which are evident in the Cadillac plans — (1) there could be limits on coverage, the bug-bear of the junk insurance policies sold before the ACA which put a lifetime limit on health care insurance coverage; met quickly if the person had a serious illness or accident; (2) there could be limits on the type of coverage sold to policy holders – unpopular with those who want (and can afford) the addition of vision, dental, etc. etc. (3) put an excise tax on the Cadillac plans to encourage employers and other policy holders to move from over-generous plans to more cost sharing models.  The third option was the intent of the ACA.

Repealing the excise tax on the Cadillac plans would completely remove any incentive for cost controls in this part of the ACA.

One of the trickier issues the Republicans will have to address in their Repeal and Replace operations is how to contain rising health care costs.  Repealing the “onerous” excise tax will eliminate one element of health care cost containment in the ACA. So, what do Senator Heller and other Republicans want as a way of replacement?  Junk insurance? Surely not. Limits on policy provisions for individual policy holders? Doesn’t sound very “freedom” or “customer oriented” to me at least.

Thus, the question Senator Heller, and others in his party, must face is how to “repeal” the ACA without opening the floodgates to rising health care costs?  Has anyone ask him about the implications of his suggestion?

Comments Off on Heller Takes The Easy Road: Cadillac Health Plan Target

Filed under Health Care, health insurance, Heller, Nevada politics