White House and Rightwing Creating a Red State Healthcare Kill Zone

Pittsburgh   When someone is elected president, they used to actually believe the words their speechwriters would scribble on the line that they were the president of all of the people in America. It is becoming clearer under the Trump Administration that even though he and the White House might parrot those words, they clearly no longer believe them at all. The problem probably starts with the fact that when you are elected by the states through the weirdness of the archaic pro-slavery roots of the Electoral College, rather than the majority of the actual voters, as was the case for Trump, then you may easily slide to the incorrect understanding that you mandate is in the states.

Looking at the wrongheaded, feeble, and gutless concessions that the White House is offering to the Freedom Caucus, the 30-odd member secret cabal in the House of Representatives, it is hard to escape this theme that the President no long believes we are one united government with a national vision and program, but a patchwork quilt of states doing their own thing. What is really confusing to me though is why he would be willing to make his red state base a killing zone of his supporters.

The lead balloon floated to the Freedom Caucus by Vice-President Pence and Trump’s chief of staff would give states the ability to waive the crucial life and death protections that were part of the fabric of a national healthcare plan. According to the New York Times,

According to the so-called Freedom Caucus the White House is pitching a healthcare evisceration that would involve the following: States would have the option to jettison two major parts of the Affordable Care Act’s insurance regulations. They could decide to opt out of provisions that require insurers to cover a standard, minimum package of benefits, known as the essential health benefits. And they could decide to do away with a rule that requires insurance companies to charge the same price to everyone who is the same age, a provision called community rating.

Yes, you get it. The President’s offer to the cabal was that the full force and strength of the United States government would allow the far right and their allies and supporters in the states to eviscerate any semblance of health care coverage to allow insurance companies, soon to be their largest campaign contributors, to do whatever they want to whomever can’t pay the price. So, gone would be the bar against not insuring people with preexisting conditions, if they state said so be it. Gone would go the basic protections. Gone would be bars against pricing discrimination, and who knows what might be left. Once the White House says that they are going to greenlight any crazy waiver that comes their way, and leave that state’s people on bleeding and dying on the emergency room floor, then who knows what might go next.

Were this gutting of healthcare to proceed, it’s not really just about red states and blue states, but mainly about rich and poor. Besides this healthcare proposal being a huge giveaway to the rich on tax breaks, it would also further divide rich and poor based on their ability to pay the insurance piper whatever price they set as they establish the divide between their profit and loss as the same as the divide between life and death based on your wallet size.

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Sorting out Obamacare Problems Now

obamacare-premium-mapAmersfoort   To the degree that the final version of the Affordable Care Act was neither fish nor fowl and represented a compromise between those that hated the entire concept and those that were trying to make the best of whatever slices of the original loaf were left, we all knew that problems were inevitable. Over the last five years we have been treated to regular and confusing reports from the battlefront, but nothing that ever fixes any problems, some of which are normal and predictable in a huge, new program. Without progress many fall out of love with Obamacare, even as more than ten million have enrolled with huge positive health impacts. Now consensus is building that any new president will have to fix the plan in the coming year, though no one seems sure about the fix or how to come to agreement on a cure.

What to do?

Some notions are almost simple-minded. One I saw said the quick fix was essentially a minor tune-up. Raise the amount of the subsidies for lower income families so that they can absorb the higher premium costs, and raise the level of the penalties to force more of the young and able into the program.

I’m all for raising the level of subsidies, if there can be agreement on that from whoever emerges as the new Congress, but raising the level of penalties is not a real solution to anything. The quick fix folks think that the fact that 260 million Americans or covered by healthcare on their jobs means no problems there, but that’s wrong too. Or, at least it isn’t the whole story.

Many penalty payers are not necessarily just the young and healthy, but also lower waged workers caught in so-called company coverage that ostensibly is offered, but because of the combination of premium cost and exorbitant, almost no-limit deductible charges, means that almost whatever the penalty level might be, it will still be cheaper than paying a premium of 9% of your pay and then having to pay many thousands of dollars in deductibles before you get any real benefit from the so-called insurance. This is really not medical insurance but catastrophe insurance, meaning if you know you need a major operation, maybe you pay. If not, you take your chances and pay the piper. Luckily, it’s taken out of your IRS tax refund, so you can pretend it hurts you less.

A lower waged worker caught in the service industry by these kinds of premium plus high deductible policies would need to be making more than $20 per hour for full-time 40-hour per week work to make it worth taking the insurance rather than paying the penalty. In some healthcare companies where we have contracts, like the service contractor giant ResCare for example, there are literally no takers out of more than 400 workers. I know people who are literally saving up for a CT scan because they don’t have insurance and are paying the penalty, making their health care “cash-on-the-barrel.” The quick, simple fix does nothing for any of these people and pretends that the United States is not dominated now by the service economy and its workforce.

The argument for a public option, a government-funded insurance of last resort, for these workers and others that can offer real competition and leverage to the private insurers makes sense, as Jacob Hacker, the political scientist and health care experts has argued. That’s still not single-payer or any kind of a system that takes private insurers out of the market, but the last years have already established that there’s no free enterprise in this marketplace. There are private insurances still waiting for subsides — $2 billion from the government – and there are regular folks getting subsidies and more that need them who are caught in the bind. Either the government needs to let workers and families caught by corporate insurance gimmicks that technically qualify under the Act, but are worthless in reality, come into the marketplace and get subsidies if qualified, or set up a public option that offers real coverage for this huge segment of the population.

The justice of raising penalties to catch the scofflaws doesn’t work when we still need a lot more mercy or stiff requirements on corporations to provide real insurance coverage.

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Loopholes on Employer Mandates of Obamacare Killing Low Wage Workers

ACA-Employer-Mandate1Shreveport    The devil is in the details, and lower waged employers, like large nursing home chains, have figured out a way to be the devil with the details when it comes to making a mockery out of the employer mandate to provide healthcare coverage. Bargaining a renewal contract for Local 100 United Labor Unions at a nursing home in Shreveport that we had represented for almost thirty years was a case study in the travesty of the law and the tragedy for the workers.

In fulfilling the information request and providing details on the health insurance offering for the workers, this company, the second largest nursing home chain in Louisiana, gave us a mishmash of materials forcing the bargaining committee to ask a number of questions hoping for a glimmer of hope that didn’t seem obvious from the materials, but no such luck.

We saw two plans. One that covered some our bargaining unit, including the activities director and maintenance staff. The other for all of the certified nursing assistants.

The first plan was no Cadillac plan, believe me. The deductible was $2500 for an individual in or out of the network. The examples of coverage were cautionary. If you had a baby costing $7540 from the hospital, the plan would pay for $3530 and you would be out $4010. The second plan was from land of Simon Legree. The deductible was a whopping $6350 per person, the highest we have seen or heard of anywhere, no matter the low wage employer! Worse, it covered almost nothing. Having a baby with the same cost would have the plan paying less than a grand and in fact only $940 while the patient paid $6600 with the deductible now stated to be $6400 and something called “exceptions” adding another $200. Managing diabetes was another example where if the cost were $5400 on the first plan, the worker would pay $3280 and the plan $2120. On the second plan we devolve into farce, where on the cost of $5400, the plan would pay a measly $20 bucks and the worker would pay $5380. Yes, $20.

This is more than enough to describe the horrors here, but adding insult to injury, remember that the worker would also be paying for this sorry story. The rate of payment was not fixed which was a first for in our experience, but was calculated to the wage of each individual worker so that the company could squeeze the last penny of the 9.5% allowable for an Affordable Care Act plan from the worker. The cap was $175 per month at the highest worker’s wage and the minimum was around $111 per month figured at the individual worker’s hourly wage times 130 hours for a regular employee times 9.5%. No math shaming here but if you are a certified nursing assistant to elect this plan the employer begrudgingly was providing under the employer mandate of Obamacare, you would be paying anywhere from about $1300 to $2100 for the ability to claim health insurance on your job where you would then have to pay more than $6000 before you got the first dollar worth of health insurance benefit. The math is daunting. These are workers making less than $20,000 per year and closer to $18000 annually who would be paying up to $8000 out of their income to access any benefit from the policy! Incredible!

The employer insisted that the plan qualified, despite our objections, and, frankly, it may. The employer had no answer to the question of why all workers were not put in the first plan which was hardly a gift. The employer pretended not to have available the number of workers who had elected to pay for this travesty of insurance, even as the union asked if it was more than one and less than ten workers.

Meanwhile the workers are blocked from the subsidies and cost sharing payments provided under the Affordable Care Act, because their employer supposedly provides health insurance if that is what you call what is described here. And, to pile on since none or next to none are foolish enough to join this so-called plan that means beginning in 2016 the workers will pay a 2.5% penalty on their gross income or $450 to $500 for not having insurance, so their boss can take more money to the bank.

Needless to say there’s no Medicaid expansion yet in Louisiana – and many other states. This is not a health care solution for lower waged workers who desperately need health care protection!

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Affordable Care Act Renewal Time and the Puzzles for Workers

healthcareNew Orleans      The window has now opened for new signups under the Affordable Care Act.  This time around there won’t be any do-overs or make-ups, I’ll bet.  The Administration is already soft selling the numbers and predicting less than 10 million enrollees by the end of 2015, dampening expectations, either tactically or determinedly.

            This is also the renewal time for last year’s enrollees.  The earlier guidance from DC had been to just let your plan automatically renew, and you would be OK.  Now the new message is that everyone needs to start shopping on the marketplace website to try and find the best deal.  Generally the average of national insurance increases is relatively modest, but some renewals are as high as 20%.  Furthermore there are some new companies entering in different states and reducing prices to catch up with some market share, so there may be bargains if you take the time and go on.

            Cross your fingers and hope it all works this year!  There will be fewer navigators, so in many places you will be on your own.  Less money for the program this year, and what programs that were funded are beating the bush in the nooks and crannies of the country for new enrollees.

            Interviewing Kim Bobo, the executive director of the Chicago-based Interfaith Worker Center on Wade’s World on KABF/FM 88.3, she was recalling the old tradition in some large cities in the USA where churches and synagogue basements once housed worker centers that were designed to give people advice on these kinds of programs.  There’s not much of that now.  Kim’s network of 200 worker centers are focusing, appropriately on wage theft and basic rights, but this Obamacare is complicated and not easy to add to the menu.  Local 100 United Labor Unions is using our experience as navigators during the first year to establish Citizen Wealth Centers in Houston, Dallas, Baton Rouge, New Orleans, and Little Rock to support our members and their communities, but there’s no question the demand is going to outstrip capacity everywhere.

            And, confusion reigns.  There are some questions where no amount of research or direct calls to CMS and other experts have yet given us confident answers, so this is a call for a bit of crowdsourcing help.  The employers over 50 workers are coming under the mandate this year, and these high deductible plans are spreading, as are so-called “skinny” plans and other offerings that may not even meet the basic requirements, yet are likely to dominate lower waged work and the service sector.  There’s a penalty for employers of $2000 per worker if they offer nothing or an unqualified plan.  That much is clear.  There’s a higher penalty of $3000 per worker though if that worker goes to the marketplace, buys insurance there and gets a subsidy.  At the same time corporate consultants are telling bosses to audit their workforce to establish that they covered 70% of the workers and offered plans to everyone.  Makes it seem like they have to hit 70% or over, doesn’t it?  We need to know for certain.

Here is where we’ve suddenly gotten bogged down as we look at some crummy plans and whether or not there is an organizing campaign that might be possible by having workers desert the company’s bad plan for the marketplace where they might get both a better plan and a better deal.  We really need to know, yay or nay, whether or not workers might have some leverage in pushing for a better plan if they deserted the company’s pretend plan and triggered penalties individually?  And, if workers were able to organize more than 30% out of the plans, does the whole crummy corporate plan fall like the house of cards it is?

Like I said, it’s muy complicado, but vitally important and important now.  If anyone out there is confident they know the answer, let us know ASAP!

 

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New Study: Health Insurance Saves Lives of Poor

Nhealthinsuranceew Orleans This should be the least surprising news since you learned that sugar tastes good, but now there is actually statistical proof from a drug-trial-like study that when the poor have health insurance by damn their health improves!  I’m not sure having hard proof will change any minds or votes among lawmakers but at least in the grand debate about health insurance there will now be no pretense that voting to limit or end health insurance for low income families will put blood on your hands, because it will be killing them.  Ok, maybe I’m overreaching, because that will only be clearer once the second phase of the study is completed, but it is pretty obvious where it’s going at this point, so be ready for that, too.

A study “The Oregon Health Insurance Experiment: Evidence from the First Year,” by a baseball team full of academics (Amy Finkelstein, Sarah Taubman, Bill Wright, Mira Bernstein, Jonathan Gruber, Joseph P. Newhouse, Heidi Allen, Katherine Baicker, The Oregon Health Study Group) was published by the National Bureau of Economic Research this week and reported by Gina Kolata in the New York Times. In 2008 the professors jumped on the once-in-a-lifetime policy disaster and statistical goldmine.  Oregon had approved a statewide healthcare Medicaid plan for low income families but did not have the dollars to put the whole show on the road.  In a novel, random solution, the state held a lottery and chose the 10,000 winners, who received the insurance, from the 80000 odd folks who were eligible and therefore equally poor.  The profs then surveyed the winners and measured the outcomes compared to the losers.  It is important to note that Oregon was able to provide insurance to everyone in 2009.

According to the Times:

“Those with Medicaid were 34 percent more likely to go to a clinic or see a doctor, 15 percent more likely to use prescription drugs and 30 percent more likely to be admitted to a hospital.   Women …were 60 percent more likely to have mammograms…20 percent more likely to have their cholesterol checked…70 percent more likely to have a particular clinic or office for medical care and 55 percent more likely to have a doctor whom they usually saw.”

There was also a 25% increase in the numbers who said their health had improved to good or excellent, and “they were 40 percent less likely to say their health had worsened….”

Bam!  Debate over about the benefits of the poor having full health coverage is over!  Yes, people will use it, get better, feel better, and have less medical debt.

Couple this study with the finding I discussed yesterday on the number of people killed annually by inequitable access to services, including health, and this ought to be open and shut on what is indisputably a life-and-death decision.

Who’s ready to have their vote counted now?

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