Hillary Clinton flip flops, attacks Sanders on healthcare
RT | January 13, 2016
Former first daughter Chelsea Clinton joined her mother, presidential candidate Hillary Clinton, on the campaign trail this week to attack the single-payer healthcare plan proposed by opponent Bernie Sanders.
Even though Hillary asked “since when do Democrats attack one another on universal health care?” during a 2008 speech in response to a mailer from her opponent at the time, Barack Obama, she called the Sanders plan to cover everyone regardless of their ability to pay as a “risky deal”.
The Sanders plan would destroy private insurance and drug companies, who have donated millions of dollars to Hillary’s campaigns for senate and president.
Clinton famously told candidate Obama “shame on you” in 2008, but now she’s defending his legacy healthcare program dubbed Obamacare, which delivered millions of new customers to for-profit insurance companies through its mandatory coverage clause.
Mother Jones described the new attacks as “an abrupt shift” with just a few weeks before the Iowa caucuses and New Hampshire primary.
Chelsea falsely claimed that millions of people would lose coverage under the Sanders plan during a campaign stop on Tuesday in New Hampshire, where Sanders is now leading in the polls.
“Senator Sanders wants to dismantle Obamacare, dismantle the CHIP program, dismantle Medicare, and dismantle private insurance,” she said. “I worry if we give Republicans Democratic permission to do that, we’ll go back to an era – before we had the Affordable Care Act – that would strip millions and millions and millions of people off their health insurance.”
In fact, not only would those Americans currently covered by Obamacare continue to be protected by the Sanders plan, but it would also cover the millions of Americans who still can’t afford insurance under the so-called “Affordable Care Act”.
Sanders believes healthcare should be a human right and available to all, regardless of wealth or income.
Chelsea, on the other hand, married a former Goldman Sachs investment banker, lives in an expensive New York City condo, serves on several boards including her father’s controversial Clinton Foundation and Clinton Global Initiative, and previously worked at a hedge fund.
Sanders voted for Obamacare, but believes it has not gone far enough to provide adequate care for all.
“Deductibles remain much too high for people,” Sanders explained on the MSNBC program Morning Joe. “The question we have to ask is, why are we paying almost three times more per capita than the folks in the UK, 50 percent more than the French, and they guarantee health care to all of their people?”
Sanders proposes Medicare for all, which he says will save taxpayers about $500 billion per year including the initial costs of transitioning from Obamacare.
He also wants to tackle pharmaceutical companies who have been accused by doctors of letting patients die for the sake of profit and donated more money to Clinton’s campaign than any other candidate from either party.
READ MORE:
Bernie gains double-digit lead on Hillary in New Hampshire – poll
Would You Buy An Obamamobile From This Man?
By Howard Wait | Black Agenda Report | December 17, 2014
Consider the prospect of buying a car at a certain price, but not knowing what the costs for gasoline, oil changes, tires or other repairs would cost until after you made a purchase. Parking this Obamabile might cost $5 per hour, maybe $500; who knows? Maybe that defective air bag or gas pedal is covered under the warranty: maybe it isn’t. That doesn’t seem right, or legal, does it?
That’s basically what people are doing when they purchase individual health insurance, especially Affordable Care Act Insurance. For those inclined to read all the fine print on dozens of health insurance plans, familiarize themselves with arcane terms like split deductibles, coinsurance and balance-billing and then review the provider lists and drug formularies for ailments they may not even have yet, there is a chance, but no guarantee, they could select the least-worst plan available.
What if you contract cancer, or HIV, and the drug formularies and specialists you need aren’t included? What if the provider lists and formularies are complete fabrications? Well, they probably are, at least in the managed care plans surveyed by HHS Inspector General:
“We found that slightly more than half of providers could not offer appointments to enrollees. Notably, 35 percent could not be found at the location listed by the plan, and another 8 percent were at the location but said that they were not participating in the plan. An additional 8 percent were not accepting new patients.”
With all the money flowing into the coffers of managed care companies, they can’t be bothered to update their provider lists? There should be a law, but there isn’t. If you bought a useless health plan, blame yo’self. Caveat emptor.
The idea that individual patients are capable of sifting through all the contingencies of hundreds of insurance plans, devised by teams of industry professionals intent on fleecing them, to arrive at an optimal choice that will promote better healthcare through market competition is a wonderful fantasy for those who stand to profit from this scheme, but it’s not reality. The truth is that only 11% of people surveyed are capable of understanding the terms and costs of a single health insurance plan, when the plan is sitting in front of them on a table.
Carnegie-Mellon’s George Lowenstein surveyed 202 employer-based policy holders and asked them to compute costs of a 4-day hospital stay. They can’t. Funny thing is, he can’t either:
“I have a PhD in economics and I’ve spent a bunch of time giving insurance companies feedback about policies, and I still find them difficult to understand,” Loewenstein said. Just 14% of white people and 30% of people with a bachelor’s or greater are “proficient” in health literacy, says health.gov.”
Clearly people cannot effectively understand and manage health costs, despite all the PR blather otherwise, in a system designed not to. We’re not managing health costs, we’re being managed. The hyper-vigilance required to navigate the minefield of financial hazards we are continually defending against is itself a health hazard and dealing with a con artist when you’re deathly sick is the last thing your doctor would advise.
What we do know is bad enough. Let’s remember the census reports in 2011 that the median wage earner in the US earns just $26,965. Half earn LESS. For anyone inclined to dismiss it as just a few poor people, please check your privilege at the door. A cursory review of silver plans available for Cook County on Healthcare.gov has seven silver level plans from Blue Cross. After the ACA subsidy, the premiums range from $245 to $416 for a single, 45 year-old person who smokes and earns $26,965 before taxes. That’s $2,940 to $4,992 annually before health care or BHC®. The “subsidy” is $76.28 per month. Ha ha.
“The truth is that only 11% of people surveyed are capable of understanding the terms and costs of a single health insurance plan, when the plan is sitting in front of them on a table.”
Here we should note the idiocy of “cost-sharing reduction” which in this example is negligible. In the 200%-250% FPL tier above “poverty” level, it would increase actuarial value of his silver plan from 70% to 73%, and isn’t worth discussing here. It may help people just over the Medicaid cutoff more, but they’re in such dire straits, they may not care either.
Let’s deduct about $5,000 for various taxes, $4,000 for premiums, and maybe $8,000 for rent (in lousy neighborhood in a middle tier city) and our patient has $9,965 left, for food and transportation and clothing and utilities and… medical costs. The deductibles on these plans average $3,821 before the insurance company kicks in a dime. Goodbye food, clothing and transportation. More likely, goodbye health care.
Realistically, the person with about $191 per week for all those expenses will “chose” food and bus fare and lights. After all, these things are essential to his health. The chances he will spend $100 on medication, $50 on a specialist visit, $500 on an MRI or $900 to visit an emergency room are vanishingly small. After the deductible is paid, which will be never, health care is free! Let’s hope that pain in his side isn’t appendicitis! The Commonwealth Fund Health Care Affordability Tracking Survey spells it out:
“Having health insurance doesn’t guarantee that Americans with lower incomes can afford needed care… Two of five adults with private insurance who had high deductibles relative to their income said they had delayed needed care because of the deductible.”
That means missed prescriptions, medical appointments skipped, or just not seeing a doctor in the first place. Most likely the other three-fifths didn’t need health care at the time, which tends to skew the results more favorably than the reality of needing health care actually is.
With catastrophic junk plans like this, healthy people are in a lot of trouble if they need health care. Their best scenario is getting hit by a truck and not caring that total costs for them, although bankrupting, will be capped – sort of – if they can stay awake long enough to insist that no out-of-network anesthesiologists at their in-network hospital work on them.
Chronic care patients are another story. They need medical care every month without which their lives are endangered. Like Medicare’s famously crappy “donut hole” that left elders on the hook for 100% of prescription costs each August, the ACA’s donut hole starts over every year at January 1st in the form of a huge deductible for which “some costs may not apply” and will be ruinous for chronic patients and beyond the reach of many, depending on actual costs for their illnesses.
Has anyone looked lately at the cost of cancer drugs? Or the huge spike in generics like humalog for diabetics? How many sick, low-income people can come up with $3,000 out-of-pocket on January 1st? Oh yeah, we already know: “A majority, or 64%, of Americans don’t have enough cash on hand to handle a $1,000 emergency expense.”
After they finish their health insurance literacy class, they can attend the financial literacy class offered by their credit card company. Deadbeats.
We’ve heard endlessly how many people have enrolled in “coverage.” The ad campaigns blare “are you covered?” At the modest rate of 2.4 physicians per 1,000 patients (Cuba has 6.7 per 1,000), we need 38,400 new doctors to treat 16 million new patients, or 120,000 for 50 million uninsured. Never mind that no one asked where the doctors were coming from. For a bunch of corporate and government types swooning over data and metrics, they’re doing a lousy job of collecting data on anything that counts for actual patients. You know, basic stuff, like: what percentage of policy holders receive any cash benefit after premiums and out-of-pocket costs that run about $12,400? What percentage of chronic care patients can afford their prescriptions? How much health care is provided to typical policy holders, not just the sickest tier, for all the money they spend? And what about the sickest? Or, maybe: are health outcomes any better for all this? At what cost?
Obamacare is the leading edge, the template for future health insurance for the rest of you. HDHP’s—High Deductible Health Plans—with skinny networks, overpriced medicines and more tricks and traps than a Halloween funhouse. The woefully misnamed Affordable Care Act is designed to deliver $8,000 per year to insurance companies and $5,000 per year to medical providers before it delivers a dime to patients. That’s $208,000,000,000, give or take a few bucks, per year to the medical complex. And it’s working exactly as planned.
Howard Wait writes to unveil the reality behind the cultural trance that permeates American life. He lives in Chicago.
ObamaCare in California
By JEFF SHER | CounterPunch | January 9, 2014
The morning of January 6th I received maybe my fourth warning email, all in the last week or so, from Covered California, the state agency that administers the exchange where individuals can now buy health plans under the Affordable Care Act, otherwise known as Obamacare.
First they congratulated me for signing up for a new health insurance plan through Covered California. Then the punch line: “In order for your health care coverage to take effect, you need to pay your premium.”
This is a bit disconcerting, because at the same time that Covered California is filling up my inbox with warnings to PAY MY BILL, the insurance company I am supposed to pay hasn’t sent me a bill yet, and they won’t answer my phone calls due to unusually heavy call volume associated “to” the Affordable Care Act.
Meanwhile, my old insurance company, which cancelled my previous insurance plan effective January 1 precisely because Obamacare was scheduled to take effect on that date, is sending me bills for a much more expensive plan to replace the one they cancelled, only I never applied to them for a replacement plan.
Maybe I’m taking these pay-up warnings the wrong way, but the message seems to be that I’m the fly in the ointment, the monkey wrench in the finely oiled machine, the reprobate who is refusing to hold up his end of the deal and pay the nice insurance company for the excellent service they are providing to me.
I get it. It’s on me. If I get hit by a bus next week and don’t have health insurance, it’s going to be my fault, and the new insurance company I selected through the exchange, Anthem (the conglomerate that swallowed what used to be Blue Cross of California), will have valid reason not to pay my claims.
I understand. I’ve heard about “consumer driven health care,” a core principle of Obamacare. You know, it’s the idea that the reason health care costs are so high is because for too long health care consumers have had too big a share of their costs paid by their employers. Low co-pays and deductibles have led consumers to over-consume. If they have to spend more of their own money, they will make better health care decisions. Like they do when they shop for shoes, or flat screen TV’s. It’s just good solid free market logic.
Consumers are responsible for high-health care costs, not insurance companies, doctors, hospitals and pharmaceutical companies. That’s why Obamacare in a few years will impose harsh penalties for any insurance plans (provided by corporations or unions, for instance) that are too good, so called “cadillac health care plans”. You know, that’s the kind of plan that has low deductibles and co-pays, under which you can actually afford to go see your doctor and consult with him about how you should manage your health. How old school is that, what with all the info available on the internet, Web MD and all that. You can make your own health care decisions now.
So I’m pretty clear by now that if something goes wrong it’s going to be my fault and not the fault of my insurance company. So I’m getting a little nervous, despite the fact that I’ve been a health insurance consultant for over 20 years, and I’m supposed to know how to work this system.
You see, I’d like to pay Anthem for my first month’s (January) coverage. It’s not a lot of money, seeing as how it’s subsidized by the federal government in order to enable more people to afford the prohibitively expensive products on offer from the four-headed insurance/doctor/hospital/pharmaceutical Cerebrus that guards the gates to the Hades that our health insurance system has become. By the way, Cerebrus’s job was not to keep people out of Hades. It was to prevent those who had entered from escaping.
Problem is, I can’t pay my bill because Anthem hasn’t sent me a bill. January 6th was the original deadline for paying January bills for the exchange plans. Well, that deadline has been extended now by Anthem to January 15. Will Anthem send me a bill before then? Do I have health insurance now?
Covered California instructed me that if I hadn’t received a bill yet, I should contact the insurance company I selected. They provided a link to a special page that explained what my options were for contacting and paying each company.
For Anthem I can either pay by telephone – and they gave me a phone number to call – or I can pay by mail. How do you pay by mail? You put a check in an envelope and send it to a P.O. Box in Oxnard, CA. O, and make sure you attach the application number assigned to you by the exchange to your check, along with the primary subscriber’s name. That way Anthem will be sure to know exactly who you are and everything will be just fine. No forms, no plan name, no other identifiers. Just a check in an envelope.
Not being real confident with that approach, I called the Anthem phone number. I worked my way through the phone tree, until the moment I identified myself as an applicant, following which I was immediately informed that Anthem would not be able to take my call at this time because they were experiencing unusually high call volume associated “to” the Affordable Care Act. They told me to call back later.
Perhaps you are thinking I got myself into this fix because I was late in filing my application for Obamacare coverage. On the contrary, I signed up for Obamacare and selected my insurance plan and company way back in October.
That was after my friends at Blue Shield of California (not the same organization as Blue Cross in the State of California) informed me in September that the insurance plan I had at the time was going to be cancelled effective January 1, 2014. Of course they offered me alternatives, I could go to the exchange or I could sign up for a Blue Shield plan outside the exchange comparable to the one I already had – with one slight change. The premium for the new, almost the same, plan, would increase from $436 to a cool $709.87 per month.
Same plan more or less. Same person. Same health status. Same age, 63. The only difference: a new player had entered the market. So Blue Shield decided the appropriate price for my plan had increased by 62.8%. Who am I to ask questions? I couldn’t possibly understand. Just the mysterious ways of the free market as divined by the oracles in the Blue Shield underwriting department.
So I went to the exchange and ordered up my comparable and much less expensive plan and just sat back to enjoy the warm glow of knowing that I would have coverage come January 1, 2014.
Along about December I started to hear rumors that maybe the insurance companies were not going to be able to get the bills out on time to enable people to comply with the January 6 deadline for payment.
So I called Covered California again on December 17, and after waiting on hold for about 96 minutes, I spoke with an agent who assured me that yes, the exchange had sent my information to Anthem and I could be expecting a bill. Not to worry, I would be covered Jan. 1 as far as the exchange was concerned. But of course I would still have to pay my bill.
Yes, the agent said, he had heard about the billing problems. He explained that the insurance companies were dealing with a huge number of applications from the exchange. He wasn’t exactly sure when my application had been sent over to Anthem, because the exchange had held up a lot of the early applications until late November because they weren’t sure the insurance companies were ready to accept them before that.
I insisted that the agent provide documentation that our call had taken place and that he had assured me that I would have coverage and that all my information had been sent to Anthem sometime before Dec. 17. He gave me an incident number which he said would be added to my record with all the details of our call.
I thanked him and told him that with his help, if I got hit by a bus sometime after January 1 but before Anthem billed me and I could pay, I was confident I would be able to win the lawsuit that would ensue when Anthem tried to claim I did not have valid coverage at the time of my accident. Not that they would mind you. Insurance companies in this country are notoriously liberal in their efforts to go that extra mile to take into account all extenuating circumstances when paying claims. They really are not known for trying to evade responsibility on the basis of technicalities. I mean, except for that recisions thing a few years back.
For now, I’m trying to stay off the streets and out of harm’s way. I’ll hold out for a couple more days, hoping a bill arrives from Anthem, and then I’ll follow instructions and put a check in an envelope and hope it gets to the right place. Maybe I should send it registered mail.
Maybe I’m not confident because Anthem has had years to prepare for the coming of Obamacare but couldn’t quite get a handle on this highly complicated billing thing. You know, where one agency collects information and confirms applications and eligibility then sends that information to you, and you enter it into your database and generate a bill and send it out. This insurance stuff is really complicated.
Remember, Anthem and the other insurance companies are from the private sector, which is constantly harping at us about how government can’t do anything right and the private sector always does it better.
I find it hard to believe Anthem (and the other companies) didn’t expect an unusually large number of applications, or unusually high call volume for that matter. Remember, Obamacare mandates that millions of people who didn’t have health insurance before have to buy it now.
Perhaps a more reasonable explanation for this administrative mess is that the insurance companies weren’t really all that invested in delivering a successful launch to Obamacare. Which is surprising, since Obamacare is going to deliver them more customers and greater profits than ever before.
Or maybe the explanation runs a little deeper than that: it’s probably been 20 years since health insurance have really focused any energy on delivering good service to their customers. Why should they? There’s very little competition in the industry. The few companies that remain are going to get their share of customers, no matter how poorly they perform. And after all, they are for-profit companies and their primary responsibility is to deliver profits for their shareholders. It’s not really their business to guarantee that people get high quality health care or a system that functions smoothly.
Please don’t think I just have it in for Anthem. That’s just the carrier I chose for my coverage, so it’s the carrier whose system I have had to try to navigate.
My old friends from Blue Shield aren’t much different. They cancelled my old plan effective January 1. But they kept offering me their new, more expensive substitute plan, and even though I never responded to any of their offers, not long before January 1 they sent me a letter thanking me for my application and telling me how much I owed them for my new, more expensive plan.
In other words, they put the burden on me (the reprobate) to call them (only a 30-something minute wait on hold) to cancel a plan I never asked for in the first place.
I don’t see how that’s much different from Anthem putting the onus on me to pay a bill that they haven’t yet bothered to send me.
JEFF SHER can be reached at:jeffsher@sbcglobal.net
The Left after the Failure of Obamacare
By Shamus Cooke | Worker’s Compass | January 4, 2014
It’s satisfying to watch rats flee a sinking ship. This is because onlookers knew the ship was doomed long ago, and swimming rats signify that the drawn-out tragedy is nearing an end. A collective sense of relief is a natural response.
The rats who propped up the broken boat of Obamacare are a collection of liberal and labor groups who frittered away their group’s resources—and integrity— to sell a crappy product to the American people.
Those in the deepest denial went “all in” for Obamacare— such as some unions and groups like Moveon.org— while the more conniving groups and individuals—like Michael Moore— playacted “critical” of Obamacare, while nevertheless declaring it “progressive”, in effect adding crucial political support to a project that deserved none.
But of course Obamacare was always more barrier than progress: we’ve wasted the last several years planning, debating, and reconstructing the national health care system, all the while going in the wrong direction— into the pockets of the insurance mega corporations. A couple progressive patches on the sails won’t keep her afloat. It’s shipbuilding time.
It was painful to watch otherwise intelligent people lend support to something that’s such an obviously bad idea. So it’s with immense relief that liberals like Michael Moore, labor groups, and others are finally distancing themselves from Obamacare’s Titanic failure. Now these individuals and groups can stop living in denial and the rest of us can proceed towards a rational discussion about a real health care solution.
The inevitable failure of Obamacare is not due to a bad website, but deeper issues. The hammering of the nails in the coffin has begun: millions of young people are suddenly realizing that Obamacare does not offer affordable health care. It’s a lie, and they aren’t buying it, literally.
The system depends on sufficient young people to opt in and purchase plans, in order to offset the costs of the older, higher-needs population. Poor young people with zero disposable income are being asked to pay monthly premiums of $150 and more, and they’re opting out, inevitably sinking Obamacare in the process.
Those young people who actually do buy Obamacare plans—to avoid the “mandate” fine— will be further enraged when they attempt to actually use their “insurance”. Many of the cheapest plans—the obvious choice for most young people— have $5,000 deductibles before the insurance will pay for anything. For poor young people this is no insurance at all, but a form of extortion.
At the same time millions of union members are being punished under Obamacare: those with decent insurance plans will suffer the “Cadillac” tax, which will push up the cost of their healthcare plans, and employers are already demanding concessions from union members in the form of higher health care premiums, co-pays, deductibles, etc.
Lower paid union workers will suffer as well. Those who are part of the Taft Hartley insurance plans will be pressured to leave the plans and buy their own insurance, since they cannot keep their plans and get the subsidy that the lowest income workers get. This has the potential to bust the whole Taft Hartley health care system that millions of union members benefit from, which is one of the reasons that labor leaders suddenly became outraged at Obamacare, after having wasted millions of union member’s dollars propping it up.
Ultimately, the American working class will collectively cheer Obamacare’s demise. They just need labor and other lefties to cheer lead its destruction a little more fiercely.
Surprisingly, most of the rats are still clinging to Obama’s hopeless vessel, frantically bailing water. Sure they’ve put on their life preservers and are anxiously eyeing the lifeboats, but they’re also preaching about how to re-align the deckchairs.
For example, in his “critical” New York Times op-ed piece, Michael Moore called Obamacare “awful”, but also called it a “godsend”, singing his same tired tune. Part of Moore’s solution for Obamacare—which was cheered on in the Daily Kos— is equally ludicrous, and follows his consistently flawed logic that Obamacare is worth saving, since its “progress” that we can build on. Moore writes:
“Those who live in red [Republican dominated] states need the benefit of Medicaid expansion [a provision of Obamacare]…. In blue [Democrat dominated] states, let’s lobby for a public option on the insurance exchange — a health plan run by the state government, rather than a private insurer.”
This is Moore at his absolute worst. He’s neck deep in the flooded hull of the U.S.S Obamacare and giving us advice on how to tread water.
Of course Moore doesn’t criticize the heart of Obamacare, the individual mandate, the most hated component.
Moore also relies on the trump card argument of the pro-Obamacare liberals: there are progressive aspects to the scheme—such as the expansion of Medicaid— and therefore the whole system is worth saving.
Of course it’s untrue that we need Obamacare to expand Medicaid. In fact, the expansion of Medicaid acted more as a Trojan horse to introduce the pro-corporate heart of the system; a horse that Moore and other liberals nauseatingly continue to ride on.
But Moore’s sneakiest argument is his advice to blue states to “…lobby for a public option on the insurance exchange…”
Again, Moore implies that it’s ok if we are “mandated” to buy health insurance, so long is there is a public option. But that aside, the deeper scheme here is that Moore wants us to further waste our energy “reforming” Obamacare, rather than driving it to the bottom of the sea.
Moore surely knows that very few people are going to march in the streets demanding a public option at this point; he therefore knows that even this tiny reform of the system is unachievable. He’s wasting our time. Real change only happens in politics when there is a surge of energy among large sections of the population, and it’s extremely unlikely that more than a handful of people are going to be active towards “fixing” Obamacare— they want to drown it.
Moore’s attempt to funnel people’s outrage at Obamacare towards a “public option” falls laughably short, and this is likely his intention, since his ongoing piecemeal “criticisms” of the system have only served to salvage a sunken ship.
Instead of wasting energy trying to pry Obamacare out of the grip of the corporations, Moore would be better served to focus exclusive energy towards expanding the movement for Medicare For All, which he claims that he also supports, while maintaining that somehow Obamacare will evolve into Single Payer system.
Most developed nations have achieved universal health care through a single payer system, which in the United States can be easily achieved by expanding Medicare to everybody. Once the realities of Obamacare directly affect the majority of the population and exacerbates the crisis of U.S. healthcare, people will inevitably choose to support the movement of Medicare for All, the only real option for a sane health care system.
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Obama’s Popularity Among the Young Falls in US
Prensa Latina | December 5, 2013
Young people in the US are disappointed with President Barack Obama’s administration and disapproved of his management of the main problems in the country, a poll revealed today.
Young people were the main support to the president in his election in 2008 and reelection in 2012. That sector of the population is currently showing a marked decrease in their support.
The poll by the Institute for Politics of the University of Harvard that included people from 18 to 29 years of age revealed that 44 percent of that sector disapproves of Obama’s work, compared to 41 percent in support.
The data shows an 11-point fall compared to a poll by the same entity this past spring, and to another poll in the fall of 2009, when 58 percent of the young supported him and 39 percent voted against.
According to Trey Grayson, director of Harvard’s Institute for Politics, this is the lowest level of support for the president since he assumed office in 2009.
Of those polled, 55 percent said they had voted for Obama, 33 percent said they voted in favor of Mitt Romney and four percent chose another politician.
Being asked today about their vote intention, 46 percent said they would vote for the current White House tenant, while 35 percent would do it for Romney and 13 percent would choose someone else.
Asking opinions about health reform, 61 percent of those polled disapproved of Obama’s administration and 57 percent rejected Obamacare, and also 44 percent consider that health care will worsen, while 34 percent said it will remain the same and just 17 percent think that it will improve.
The poll also revealed that frustration is not only against Obama, because 59 percent of those polled do not support democrats in Congress, while 35 percent approved them, but also two thirds of them do not support republicans and just 19 percent support them.
The poll included 2,089 people and defining their political inclination: 41 percent of the young defined themselves as independents, 33 percent as democrats and 24 percent as republicans, and predicted a large number of non-participants in the primary elections in 2014.
Obamacare is Doomed by Its Internal Logic
A Black Agenda Radio commentary by Glen Ford | November 20, 2013
Obamacare is unraveling, not because the administration is particularly incompetent or unlucky, and certainly not as a result of the Republicans’ unrelenting hostility to the Obama health insurance plan. Indeed, ever since the bill’s passage in early 2010, the GOP’s holy war against Obamacare has served to solidify reflexive Democratic support for what has always been a Republican-inspired bill.
The truth is, the Affordable Health Care Act is coming undone because of its own, tortured internal logic. At root, it is a fraud on the public: a scheme to subsidize and more deeply embed a private insurance system that can only make profits by denying sick and vulnerable people health care, and playing different demographics of Americans against each other. As every other industrialized country in the world has already learned, it is impossible to build a genuine, universal healthcare system on a cut-throat capitalist foundation. Private insurers make money by betting against the health interests of their customers. Obama served his corporate masters by conspiring to make tens of millions more Americans into customers of private insurers. He tried to dress up one of the greatest corporate subsidies in history as if it were a solemn national mission, a rebirth of the social compact between the American people. But of course, Obamacare is no such thing; it is a racket to prop up private insurers with public money, while allowing the profiteers to continue to run the show.
You can’t hide a truth that big. The Obamacare website has suffered from terminal complexity because white collar crime is usually quite complex. The web site attempts to reconcile the profit margins and various products of a universe of private insurance corporations, while at the same time pretending to serve the health needs of the people at an affordable cost. Obamacare claims to be in the business of serving both the public and corporate stockholders. But that’s mission impossible. If Obamacare is based on making profits for private corporations – if that is what keeps the system going – then the public’s health care needs will always be an afterthought. And, that will be obvious in the way that the website is organized as a sales platform that matches federal subsidies with corporate products, rather than matching people with the medical resources they need to survive and thrive.
Website complexity and failures aside, Obamacare can never become part of a national social compact, something of which all Americans can be proud. That’s because, by definition, corporate insurance schemes divide people into “winners” and “losers” – although, of course, the big winner is always the corporation. Young, healthy people know they are the fatted calves of the insurance business, and they are avoiding Obamacare like the plague. If this were really a national health care program, like Medicare for All, then most young people would join in the national health care mission. But this is just Obama working a scam for the insurance companies, and young folks know it. Anybody who manages to get access to the web site knows it.
The fatal flaw in Obamacare can’t be fixed. The best thing that could happen would be a quick and total collapse. Large majorities of Americans still support Medicare for All, but Obamacare stands in the way of a real national health plan – just as the Republican right-wingers that invented Obamacare back in 1989 intended.
Glen Ford can be contacted at Glen.Ford@BlackAgendaReport.com.
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- That Popping Noise? The Obamacare Bubble! (correntewire.com)
ObamaCare is Another Private Sector Rip-Off
By PAUL CRAIG ROBERTS | CounterPunch | October 3, 2013
The government of the “world’s only superpower,” the “exceptional,” the “indispensable” country, claims to know what is best for Syria, Iraq, Afghanistan, Libya, Yemen, Pakistan, Somalia, Mali, Russia, Venezuela, Bolivia, Ecuador, Brazil, China, indeed for the entire world. However, the “indispensable” country cannot even govern itself, much less the world over which the “superpower” desires hegemony. The government of the “world’s only superpower” has shut itself down.
The government has shut itself down, because it cannot deal with the budget deficit and mounting public debt caused by twelve years of wars, by financial deregulation that allows “banks too big to fail” to loot the taxpayers, and by the loss of jobs, GDP, and tax base that jobs offshoring forced by Wall Street caused.
The Republicans are using the fight over the limit on new public debt to block Obamacare. The Republicans are right to oppose Obamacare, but they are opposing Obamacare largely for ideological reasons when there are very good sound reasons to oppose Obamacare.
Last February 3, I posted on this website a column, “Obamacare: A Deception,” written by an expert on the subject.
When Republicans for ideological reasons blocked a single-payer health system like the rest of the developed world has and, indeed, even some developing countries have, the Obama regime, needing a victory, went to the insurance companies and told them to come up with a health care plan that the insurance lobby could get passed by Congress. Obamacare was written by the private insurance industry with the goal of raising its profits with 50 million mandated new customers.
Obamacare works for the insurance companies, but not for the uninsured. The cost of using Obamacare is prohibitive for those who most need the health coverage. The cost of the premiums net of the government subsidy is large. It amounts to a substantial pay cut for people struggling to pay their bills. In addition to the premium cost, it is prohibitive for hard pressed Americans to use the policies because of the deductibles and co-pays. For the very poor, who are thrown into Medicaid systems, any assets they might have, such as a home, are subject to confiscation to cover their Medicaid bills. The only people other than the insurance companies who benefit from Obamacare are the down and out who are devoid of all assets.
This might prove to be a growing percentage of Americans. On September 19 the New York Times on the front page of the business section reported what I have reported for years: that real median family incomes in the US are where they were a quarter of a century ago. In other words, in a quarter of a century there has been no income growth for the median American family.
In 2013 payroll employment is below where it was six years ago. During 2013 most of the new jobs, barely sufficient to stay even with population growth and insufficient to recover the job loss from the recession, have been part-time jobs that do not provide any discretionary income with which to drive a consumer economy.
Obamacare has resulted in the health insurance companies, who thought that they would be living in high profits from the mandated health coverage, being outsmarted by employers, who have reduced their full-time workers to part-time in order to avoid Omamacare’s requirement to provide health coverage to those employees who work 30 hours a week or more.
Employers can get away with this, because jobs are hard to find. The lack of employment opportunities results in Americans with engineering degrees working as retail sales clerks and as shelf stockers in Walmart and Home Depot. Despite the abundance of unemployed and under-employed American technical and engineering workers, the large corporations lobby Congress for more H-1B visas to bring in lowly paid foreigners with the argument that there is a shortage of qualified Americans for technical work.
As I have pointed out so many times, if there were a shortage of engineering and technical workers, salaries would be rising, not falling.
For millions of employees, Obamacare means cut hours and less take home pay plus out-of-pocket expenses to purchase an Obamacare health policy. For most people covered by Obamacare, this is a lose-lose situation.
It is also a lose-loss situation for the vast majority of the young. Most young people, unless they have jobs that provide health coverage, do without it, because the chances of the young having heart attacks, cancer, and other serious health problems is low.
Obamacare, however, requires the healthy young to pay premiums for coverage or to pay a penalty to the IRS.
In my day this might not have been a problem. However, today there are few jobs for the young that pay enough to have an independent existence. The monthly payroll jobs reports do not show well-paying jobs. The Labor Department’s projections of future jobs are not jobs that pay well. For the youth, it seems that the penalty is less than the premium, so youthful penalties paid out of waitress and bartender tips will subsidize the unusable Obamacare health policies for the poor adults who are not thrown into Medicaid, which confiscates their assets, if any.
Obamacare benefits only two classes of people. It benefits employers who drop their employees working hours below the hours specified for Obamacare coverage, and it benefits the insurance companies or the IRS who collect the premiums and penalties.
Many of the people who pay the premiums won’t be able to use the policies because of co-pays and deductions.
The very poor with no assets might receive health care if they reside in states that accept the Medicaid provisions of Obamacare.
In 21st century America, the few people who have experienced income gains are the executives and shareholders of firms who offshored their production for US markets, Wall Street which makes bets covered by the Federal Reserve, and the military-security complex which has been enriched by the neoconservatives’ wars.
Every other American has lost.
Paul Craig Roberts is a former Assistant Secretary of the US Treasury and Associate Editor of the Wall Street Journal. His latest book The Failure of Laissez-Faire Capitalism. Roberts’ How the Economy Was Lost is now available from CounterPunch in electronic format.
Obamacare: A Deception
The Devil is in the Details
By PAUL CRAIG ROBERTS | CounterPunch | February 5, 2013
The article below is the most comprehensive analysis available of “Obamacare” – the Patient Protection and Affordable Care Act. The author, a knowledgeable person who wishes to remain anonymous, explains how Obamacare works for the insurance companies but not for you.
Obamacare was formulated on the concept of health care as a commercial commodity and was cloaked in ideological slogans such as “shared responsibility,” “no free riders” and “ownership society.” These slogans dress the insurance industry’s raid on public resources in the cloak of a “free market” health care system.
You will learn how to purchase a subsidized plan at the Exchange, what will happen when income and family circumstances change during the year or from one year to the next, and other perils brought to you by Obamacare. It is one of the most important articles that will be posted on my website this year. Americans will be shocked to learn the extent to which they have been deceived. The legislation neither protects the patient nor are the plans affordable.
The author shows that for those Americans whose income places them between 138% and 400% of the Federal Poverty Level, the out-of-pocket cost for one of the least expensive (lower coverage) subsidized policies ranges from 2% to 9.5% of Modified Adjusted Gross Income (MAGI), a tax base larger than the Adjusted Gross Income used for calculating federal income tax.
What this means is that those Americans with the least or no disposable income are faced in effect with a substantial pay cut. The author provides an example of a 35 year-old with a MAGI of $27,925. The out-of- pocket cost to this person of a Silver level plan (second least expensive) is $187.33 per month. This cost is based on pre-tax income, that is, before income is reduced by payroll and income taxes. There goes the car payment or utility bill. The lives of millions of Americans will change drastically as they struggle with a new, large expense – particularly in an era of no jobs, low-paying jobs and rising cost of living.
The author also points out that the cost of using the mandated policies will be prohibitive because of the large deductibles and co-pays. Many Americans will find themselves not only with a policy they can’t afford, but also with one they cannot afford to use. Those who cannot afford the insurance, even with a subsidy, will be faced with a costly penalty, and in many cases, this, too, will be difficult, if not impossible, to pay. As each year’s subsidy is based on last year’s income, there will be a substantial year-end tax liability for those who must repay the subsidy in whole or part because their income increased during the year.
The stress alone from such a regressive scheme is, without a doubt, not conducive to good health and well-being.
Diets will worsen for millions of Americans as they struggle with a new large expense. Thus, the effect of Obamacare will be to worsen the health of millions. Indeed, a “glitch” in the legislation allows millions to be priced out of coverage.
Alternatively, Americans might be able to acquire health insurance coverage but have no doctors willing to treat them.
The demand that Obamacare places on household budgets in which there is no slack makes me wonder where the president’s economists were while the insurance lobby crafted the product that serves the profits of insurance companies. Two well-known economic facts are that real family income has been stagnant or declining for a number of years and Americans are over their heads in debt.
How does Obama preside over a recovery when consumer purchasing power is redirected to insurance company profits?
Obamacare not only rations health care by what a person or family can afford, but also has implications for Medicare patients. Hundreds of billions of dollars are siphoned from Medicare to help pay the cost of Obamacare. The health care provided to Medicare patients will decline with the reduced payments to care providers. Health care seems destined to be rationed according to the age and illnesses of Medicare patients. Those judged too old and too ill could be denied expensive treatments or procedures that would prolong their lives.
Obama will rue the day that his name was put on this special interest legislation, and most Americans, once they realize what has been done to them, will be angry that special interests again prevailed over the health of the nation.
OBAMACARE: THE DEVIL IS IN THE DETAILS
The Patient Protection and Affordable Care Act of 2010, commonly referred to as the ACA or Obamacare, will go into full effect in 2014. This decree mandates that all Americans must purchase and maintain government-approved health insurance or pay a penalty to the IRS. Touted as a plan to provide all Americans with access to medical care, in reality, this compulsory shakedown commands everyone to purchase insurance that for many will be too expensive, even with government subsidies – or unaffordable to use – or both.
The ACA was not selflessly designed with the intent of providing affordable and equitable medical services to those in need, but rather to acquire taxpayer money for the private insurance companies under the seemingly helpful guise of health care and the ideological excuse of personal responsibility. It takes money from ordinary people and gives it to a medical insurance industry that profits handsomely from this legally-enforced corporate welfare – all while keeping Americans locked in the same broken system that puts profit before patients. The law was essentially written by business executives from the industry so that special interests would not be upset and profits assured.
There’s a lot to digest about how the ACA works and much is buried in a complex, convoluted maze of regulations and procedures. A few websites contain explanations, but very important details have either been left out or glossed over. These details are well worth understanding so you will know what’s at stake for you and your family. This lesson is not meant to convey a political opinion. This is how the ACA works and under this law, there are no sacred cows.
In today’s lesson, you will learn why 2013 is an important year for many of you with regard to your income and the ACA. We will discuss 1) use of Modified Adjusted Gross Income, 2) tax credits (help paying for insurance), 3) your share of the premium, 4) paying back the tax credits to the IRS, 5) expansion of Medicaid and estate recovery which could affect you if you are put into that plan, 6) inadequate coverage in most subsidized plans, 7) penalties, 8) exemptions and 9) a few tidbits. We’ll also take a look at the agenda of Enroll America and the Health Insurance Exchanges, and what you can expect to hear in the very near future.
Here we go. Fasten your seat belts.
1. HEALTH INSURANCE EXCHANGE BASICS
In 2014, each state will have an Affordable Insurance Exchange where qualified individuals and families with incomes between 138 and 400 percent of the Federal Poverty Level (FPL) can shop for commercial insurance policies. Most individuals and families with incomes at or below 138 percent FPL will be put into Medicaid. You may be eligible for help paying for your insurance in the form of a tax credit. In most states, the Children’s Health Insurance Program (CHIP) will continue to cover children in families with incomes up to at least 200 percent FPL. Some states may offer a Basic Health Plan for those who earn up to 200 percent FPL and are not eligible for Medicaid. Under limited circumstances, you may also be eligible for a cost-sharing credit.
Eligibility to receive a tax credit, the amount of your tax credit and your out-of-pocket share for the insurance will be determined by your income and where you fall in the Federal Poverty Level Guidelines (FPL). This is easy to understand.
Your annual gross income determines which FPL you’re in. For example, based on 2012 FPL Guidelines, an individual with an annual income of $33,510 is at 300 percent FPL; a family of 4 with an annual income of $69,150 is at 300 percent FPL. To see where you’re at, try the handy calculator at this link. FPL Guidelines are revised every January, so the 2013 edition should be up soon.
The ACA requires use of MODIFIED ADJUSTED GROSS INCOME (MAGI) instead of Adjusted Gross Income for all determinations made by an Exchange including eligibility for Medicaid except in certain cases. So, in this lesson, we’ll refer to annual income as MAGI.
Modified Adjusted Gross Income (MAGI) is defined as Adjusted Gross Income PLUS
a) all tax exempt interest accrued or received in the taxable year;
b) the non-taxable portion of Social Security benefits provided under Title II of the Social Security Act which includes old-age benefits, disability benefits, spousal benefits, child benefits, survivor benefits and parental benefits;
c) tier 1 Railroad Retirement benefits that are not includible in gross income; and
d) the exclusion from gross income for citizens or residents living abroad.
The adoption of MAGI, created by the ACA, is defined in a new section of the IRS code.
2. DETERMINING ELIGIBILITY FOR A TAX CREDIT
The tax credit is to help you pay for insurance. The ACA says it must be based on annual income for the tax year it’s received, but since you will need help paying for your plan during that year, the ACA allows for advance payment of the tax credit.
Here’s an example of what that means: Let’s say you apply for insurance at an Exchange in 2014. Therefore, 2014 is the tax year you will receive your tax credit, and per the ACA, the amount you receive must be based on that year’s MAGI. But, that year’s MAGI won’t be available until 2015 when you file your 2014 tax return and you need help paying for your insurance plan when you buy it in 2014. So, the amount of your tax credit has to be determined on information that is available such as your prior-year (2013) tax return. Thus, the tax credit morphs into an ‘advance payment of the tax credit’ (also referred to as an advance premium assistance credit). Now you see why 2013 is an important year for many of you.
The ACA allows for limited disclosure of tax return info in order for an Exchange employee to verify your citizenship status and MAGI, and, not only to let you know how much your advance tax credit will be, but also to see if you are eligible to receive this in the first place. An Exchange can also consider using your real-time income by looking at your state’s most current quarterly wage database, or it may agree to accept paper verification (pay stubs, etc.) as a last resort or an attestation of your income with no verification. Creation of a federal ‘data services hub’ is in the works so your income information will be more readily accessible. But, no matter how this plays out, you’ll still receive an advance payment of the tax credit because your actual MAGI for 2014 will not be known by you nor can it be verified by an Exchange until you file your 2014 tax return in 2015.
Ultimately, no matter which method is used – prior year or partial current year – this advance payment of the tax credit carries with it some heavy-duty consequences which are discussed in topic 4 of this lesson.
3. TAX CREDITS AND YOUR SHARE OF THE PREMIUM
The amount of your tax credit will be based on the second lowest-cost Silver plan in the area where you live and your MAGI. Here’s how this works – it’s quite simple:
a) First, the amount you will pay out of your pocket for that Silver plan – copays and deductibles not included – will be a specific percentage of your MAGI, and you will pay this to the insurer on a monthly basis. The way this percentage will be calculated is described a few lines down.
b) Next, your share will be deducted from the cost of that Silver plan and the difference will be your tax credit which the government will pay directly to the insurer on a monthly basis when you purchase a plan.
The specific percentage you will have to pay for the second lowest-cost Silver plan will be based on your FPL using a well-greased sliding scale. As your FPL increases little by little, the percentage you will pay increases. The same percentage applies to an individual or a family. Here’s how much of your MAGI you will pay for that Silver plan:
— up to 138 % FPL: 2% for people legally present less than 5 full years and residents of states that do not expand Medicaid
— 138-150% FPL: 3 to 4%
— 150-200% FPL: 4 to 6.3%
— 200-250% FPL: 6.3 to 8.05%
— 250-300% FPL: 8.05 to 9.5%
— 300-400% FPL: 9.5% – there’s no range, but the dollar amount of your share will change because 9.5% of a lower MAGI is less than 9.5% of a higher MAGI.
Here are two examples in dollars using 2012 FPL Guidelines and an estimate for a second lowest-cost Silver plan which will vary depending where you live – actual costs are not yet available:
a) You are 35 years old and the price of the second lowest-cost Silver plan for an individual in the area where you live is $4,750 with no tax credit. If your MAGI is $33,510 ($2,792.50 per month) putting you at 300 percent FPL, your share for that Silver plan, per the chart above, would be 9.5 percent of your MAGI which comes to $3,183 ($265.25 per month). Your tax credit would be $1,567 which is the difference between the unsubsidized cost of that Silver plan and your share.
b) You are 35 years old and your MAGI is $27,925 ($2,327 per month) putting you at 250 percent FPL, so, your share of that Silver plan would be 8.05 percent of your MAGI which comes to $2,247.96 ($187.33 per month) and your tax credit would be $2,502.
If the second lowest-cost Silver plan is too expensive, you can apply your tax credit to a Bronze plan which will be cheaper but less comprehensive. If you want a better plan than the Silver, you will have to pay the full difference in the premium.
Don’t forget that your share of the monthly premium will be figured on your MAGI which is pre-tax income. So, after you deduct your income taxes and your share of an insurance plan, will you be able to cover your monthly basic living costs including paying off debt you may owe and still have some cash left to pay for medical care if you have to use your insurance? Check out topic 6 in this lesson for a rundown of plans and coverage you can expect to find at an Exchange. Hope you don’t faint.
Once you purchase a plan, your share and your tax credit won’t change until the next enrollment period unless, before that time, your income goes up or down enough to bump you into a different FPL or you get a job with insurance. You can let your Exchange know by phone or via your online account, or, your Exchange might notice while cruising the data services hub you learned about in topic 2 and notify you that you must ‘up’ your coverage or that you’ve been tossed into Medicaid if your MAGI has decreased enough to make you eligible for that plan. Exchanges will be encouraged to use as many different avenues as possible including private databases to keep tabs on your income.
Thus, you could end up bouncing from Medicaid to a subsidized plan or vice versa. By the same token, you could take some extra work to help pay the bills or to save for a vacation, and, oops, you went over 400 percent FPL and are no longer eligible for a tax credit. The Exchange may not find out about this unless you spill the beans, but, no matter how it all plays out, income changes will catch up with you when you file your tax return.
To be eligible for a tax credit you must file your tax return no later than April 15. Married taxpayers must file a joint return. Individuals who are listed as dependents on a return are ineligible for a tax credit.
If you are eligible for Medicaid, you will not be allowed to receive a tax credit or a cost-sharing credit although some states impose premium and cost-sharing charges on certain Medicaid enrollees per the Deficit Reduction Act of 2005 (DRA) and clarified in the Tax Relief and Health Care Act of 2006.
On January 22, 2013, the Centers for Medicare & Medicaid Services (CMS) proposed allowing states to further increase Medicaid premiums and out-of-pocket costs by 5 percent. The most egregious part of this proposed rule says that states may allow providers to deny services for failure to pay the required cost-sharing in certain circumstances. The Obama administration is behind this proposed rule hoping to persuade states to expand Medicaid since many have refused and others are still undecided – the expansion of Medicaid is an integral part of the ACA. Allowing states to further increase premiums and cost-sharing for the poorest segment of the population underscores the existing political bias toward low-income Americans despite rhetoric which claims otherwise.
https://www.federalregister.gov/articles/2013/01/22/2013-00659/medicaid-childrens-health-insurance-programs-and-exchanges-essen- tial-health-benefits-in-alternative#h-186 http://www.nytimes.com/2013/01/23/health/medicaid-patients-could-face-higher-fees-under-a-proposed-federal-policy.html
Affordability rates (the percentage of your MAGI the government has decided you can afford to pay for insurance) are based on boardroom formulas which don’t take particular individual needs into account such as housing costs, property taxes, debt, education, transportation, retirement savings, etc. Also, FPL Guidelines are standard across the country and do not take into consideration those who reside in a more expensive region or vice versa. They are one-size-fits-all with the exception of Alaska and Hawaii. See topic 8 in this lesson to learn about exemptions.
Check out what self-proclaimed health care expert Jonathan Gruber says about affordability and get a load of all the “formulas.” According to Mr. Gruber, you may be having too much fun in life and need to get serious, buy health insurance and live under a rock in order to pay for it. He was involved with Romneycare in Massachusetts and was also Mr. Obama’s go to man under a no-bid contract. Per a bar graph on page 6 of a report prepared by Stan Dom for the Urban Institute, subsidized plans under the ACA are estimated to cost 2 to 3 times more (give or take) than the subsidized plans under Romneycare. Per several surveys during the years that Romneycare has been in effect, many low and modest income MA residents have had difficulty paying for those plans and the out-of-pocket costs to use the insurance, particularly chronically-ill residents.
http://ebookbrowse.com/1493-gruber-will-affordable-care-act-make-hlt-ins-affordable-reform-brief-v2-pdf-d124754327
http://www.statecoverage.org/files/TheBasicHealthProgramOptionUnderHealthReform.pdf
4. PAYBACK OF TAX CREDITS TO THE IRS
Perhaps you recall hearing politicians including Mr. Obama say if you can’t afford to pay for health insurance, the government will help you. That was one of the key talking points repeated non stop. We just went over the help part – the tax credits. Now we’ll look at what Mr. Obama et al didn’t tell you which is important to understand because it could cause you some serious financial distress.
Remember the “advance payment of the tax credit” in topic 2 of this lesson? Well, essentially, that was a loan from the government which was paid in advance to the insurer on your behalf when you purchased your plan, and, as you know, loans have to be paid back. So, when you file your tax return for the year you received your “advance tax credit” (your loan), if your income has changed, you have to settle this with the IRS. Here’s the deal:
a) If your MAGI is higher and the increase puts you into a higher FPL, you may have to pay back a portion or all of the tax credit because it was based on a lower MAGI. In other words, you could have an additional tax liability on top of the income taxes you already paid (or still owe) because you received a higher tax credit than you were entitled to.
b) If your MAGI is lower and the decrease puts you into a lower FPL, a refund could be coming to you because you were eligible for a larger tax credit than the government paid to the insurer. In other words, you overpaid for your portion of the insurance premium.
c) If you earned a bit more or less, but your extra earnings or loss didn’t bump you into another FPL, you’re home free.
To figure out your payback, you will have to enter the relevant figures on the reconciliation page of the tax return. Changes in filing status such as the number of people in your household will also have an impact. For those of you who marry or divorce, the rules for the payback amount as well as the amount of the tax credit you are eligible to receive will make your head spin – the computation includes pre- and post-marriage FPL and uses the highest FPL of the two people involved. Ditto for divorce.
Here is one of the reconciliation explanations in IRS-speak: Your liability for an excess tax credit you received must be reflected on your current year income tax return subject to a limitation on the amount of such liability.
Oh! Limitation on the amount of such liability. That sounds good.
Let’s take a peek at the payback limitations on record at the time of this writing. “At the time of this writing” are the operative words because the cap has been increased twice since the ACA was signed into law. The original payback was capped at $400 for families under 400 percent FPL and $200 for individuals. We’ll skip over the first increase. The story behind the second one is that a particular revenue stream was removed from the original law, so something had to be done to compensate for this lost money. Thus, an amendment was passed that increased the cap using a sliding scale, thereby putting a huge financial burden on the backs of the very people the ACA claims to help. In other words, tag, you’re it. You are the cash cow.
Here are the current sliding-scale caps:
If the household income (expressed as a percent of poverty line) is:
less than 200 percent, the applicable dollar amount is $600
at least 200 percent but less than 300 percent, the applicable dollar amount is $1,500
at least 300 percent but less than 400 percent, the applicable dollar amount is $2,500
Effective date: the amendment made by this topic shall apply to taxable years ending after December 31, 2013. Very truly yours, House Ways and Means Committee
The name of this bloodsucker is The Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011.
http://www.gpo.gov/fdsys/pkg/PLAW-112publ9/html/PLAW-112publ9.htm
But wait, there’s more!
a) Update: Today (Feb. 17) (2011) the House Ways and Means Committee approved the 1099 repeal bill which requires consumers earning more than 400 percent of the poverty line to pay back the [entire] subsidy.
b) Also, per IRS final regulations: for taxable years beginning after December 31, 2014, the payback caps may be adjusted to reflect changes in the consumer price index.
Payback amounts are reduced to one-half for unmarried individuals who are not surviving spouses or filing as heads of households. There is no help if you get hit with a payback and many of you will have difficulty paying this liability.
Chances that you may have received an incorrect tax credit are not exactly slim because this poorly thought-out scheme does not take into account the unpredictable and complex financial situations that confront the low and modest income population.
Keep in mind that by ending up in a higher FPL, you may also have to pay more out of your pocket for an insurance premium. You learned how that works in topic 3. If you can’t afford a higher premium and drop your insurance, you may still owe a payback plus a penalty for being uninsured which is also MAGI-based. Penalties are discussed in topic 7. If your MAGI puts you over 400 percent FPL, you just knocked yourself into left field and are on your own paying for an insurance plan on the open market. And, you may also be required to payback the entire tax credit.
If you get a job during the current year that offers health insurance which is not more than 9.5 percent of your total salary and the coverage is not less than 60 percent, you must take that insurance or pay a penalty for being uninsured. But, you may owe a payback for the months you received a tax credit before you landed the job. How large that payback is will depend on your MAGI for the entire tax year, not just on your income during the months you received the tax credit. Or, you may lose a job during the year and have a significantly reduced income even though the amount reported on your tax return is high because you had a job for part of the year. In this case as well, your payback will be based on your MAGI for the entire tax year.
More interest income from taxable and tax-exempt savings or a year-end bonus could also contribute to an increased MAGI and the possibility of a payback as well as taking extra work to help pay the monthly bills, house and car repairs, educational aspirations or a vacation. So, whether or not you end up in payback land will depend on how close you are teetering on the edge of an FPL. Ditto for your share of the premium and the amount of your tax credit.
The payback may stop many of you from purchasing insurance at the Exchange because you know in advance you will not have the money to pay it. If this is the case, you may be allowed to negotiate a lesser tax credit by paying more out of your pocket for your monthly insurance premium in order to avoid or decrease the payback. It’s a crap shoot. Considering what you’ve learned so far in today’s lesson, many of you will find yourselves between a rock and a hard place under the ACA, and you will be forced to make untenable choices. Given the skyrocketing costs of food, heat and other basics, how will you even tread water under this set-up, never mind get ahead?
Being told you will receive help from the government if you can’t afford to purchase insurance and finding out at tax time this was really a loan and you owe the IRS a substantial debt on top of your income taxes is outright shameful. But most politicians have no shame – which brings us to the next topic.
5. MEDICAID EXPANSION AND ESTATE RECOVERY
In order to expand Medicaid, several Medicaid regulations were changed:
a) the income limit for eligibility was increased to 133 percent FPL, but since states must apply a 5 percent disregard, this effectively raises the eligibility to 138 percent FPL
b) Modified Adjusted Gross Income will be used in most cases to determine eligibility (also applies to certain CHIP applicants)
c) the age limit was increased to 64, childless adults will be eligible; and
d) the asset test was dropped except for certain groups such as the elderly and people on Social Security Disability – BINGO!
The fact that the asset test was dropped is very important, but before we look at why, you must first understand that if an Exchange determines you are eligible for Medicaid, you have no other choice. Code for Exchanges specifies, “an applicant is not eligible for advance payment of the premium tax credit (a subsidized plan) or cost-sharing reductions to the extent that he or she is eligible for other minimum essential coverage, including coverage under Medicaid and CHIP.” Therefore, you will be tossed into Medicaid unless there are specific rules as to why you would not be eligible. If you are enrolled in a private plan through an Exchange and have been receiving a tax credit, and your income decreases making you eligible for Medicaid, in you go. If you are allowed to opt out because you don’t want Medicaid, you will have to pay a penalty for being uninsured unless you can afford to purchase insurance in the open market.
Just so you’re clear on this: the ACA stipulates that the system will ensure that if any individual applying to an Exchange is found to be eligible for Medicaid or a state children’s health insurance program (CHIP), the individual will be enrolled in such a plan.
Furthermore, to increase enrollment in health coverage without requiring people to complete an application on their own, states are advised to automate enrollment whenever possible by using existing databases for social services programs such as SNAP (food stamps) to enroll people who appear eligible for Medicaid but are not currently enrolled. Therefore, you could find yourself auto-enrolled in Medicaid against your will if your state acts on this advice.
Many times over Mr. Obama et al told you that all Americans would have choice. Choice was another big talking point. Are poor and low-income Americans undeserving of choice? Is the ACA a class-based system? Maybe they meant that for this segment of the population, the choice would be between Medicaid or a penalty for remaining uninsured. This is blatant discrimination.
Here’s why dropping the asset test got the BINGO – Estate Recovery! You won’t find the following info in the ACA. It’s in the Omnibus Reconciliation Act of 1993 (OBRA 1993) – a federal statute which applies to Medicaid, and, if you are enrolled in Medicaid, it will apply to you depending on your age.
a) OBRA 1993 requires all states that receive Medicaid funding to seek recovery from the estates of deceased individuals who used Medicaid benefits at age 55 or older. It allows recovery for any items or services under the state Medicaid plan going beyond nursing homes and other long-term care institutions. In fact, The Centers for Medicare & Medicaid Services (CMS) site says that states have the option of recovering payments for all Medicaid services provided. The Department of Health and Human Services (HHS) site says at state option, recovery can be pursued for any items covered by the Medicaid state plan.
b) The HHS site has an overview of the Medicaid estate recovery mandate which also says that at a minimum, states must pursue recoveries from the “probate estate,” which includes property that passes to the heirs under state probate law, but states can expand the definition of estate to allow recovery from property that bypasses probate. This means states can use procedures for direct recovery from bank accounts and other funds.
c) Some states use recovery for RX and hospital only as required by OBRA 1993; some recover for a few additional benefits and some recover for all benefits under the state plan. Recovery provides revenue for cash-strapped states and it’s a big business.
Your estate is what you own when you die – your home and what’s in it, other real estate you may own, your bank account, annuities and so on. And even if you have a will, your heirs are chopped liver. Low-income people often have only one major asset – the home in which they live and, in some cases, this has been the family home through several generations.
So what this boils down to is: if you are put into Medicaid – congratulations – you just got a mandated collateral loan if you use Medicaid benefits at age 55 or older! States keep a running tally.
Estate recovery can be exempted or deferred in certain situations after your death, but the regulations for this are limited and complicated with multitudes of conditions. You may not have an attorney on speed dial, but with regard to this hundred pound gorilla, it sure would be handy.
Should you decide to ask your congresscritter about estate recovery, be prepared for responses such as:
— “Estate recovery doesn’t apply to you.” (Great news. Please overnight a copy of the amendment to OBRA 1993 that stipulates estate recovery is no longer required and no longer allowed. Here’s my address.)
— “Oh, estate recovery is state, I’m federal.” (Wrong – estate recovery is federally mandated although the estate recovery program itself is administered by each state.)
— “I don’t know anything about this.” (Highly unlikely because the expansion of Medicaid is an integral part of the ACA and estate recovery is not a secret.)
— “The ACA wasn’t about revamping Medicaid.” (As explained above, Medicaid regs were revised in order to expand Medicaid.)
— “I’ll look into that and get back to you.” (Don’t hold your breath – they don’t want to go there.)
If you ask about estate recovery when you contact an Exchange or speak with an outreach agency, you’ll probably run into a brick wall or be told it doesn’t apply to you – whatever. But, it doesn’t matter because what you are told is not legally binding. What is legally binding is your signature on the Medicaid application which indicates that you agree to the terms of the contract – which brings us to another item in OBRA 1993. Read on.
OBRA 1993 also contains procedural rules intended to ensure that individuals are informed about Medicaid program requirements including disclosure of estate recovery before they complete the application process and also during the annual re-determination process. Notification of estate recovery should be on the signature page of your state’s Medicaid application and is usually a one-liner: I understand that if I am aged 55 or older, (name of your state’s Medicaid plan) may be able to get back money from my estate after I die. (Use of the word ‘may’ doesn’t mean if the state feels like it – it means recovery will take place unless there are specific circumstances for exemption or deferment as mentioned above.) There are also strict recovery/repayment clauses for injury-related settlements disclosed on the signature page and a few other ditties that apply to you or a family member who is enrolled in Medicaid. All of these items must also be disclosed in your state’s Medicaid handbook.
Under the ACA and proposed federal rules for implementation, states will be required to provide a single, simple application to apply for and enroll in Exchange plans, Medicaid and CHIP, and consumers must be able to apply by phone, in person or online. The Secretary (HHS) is charged with this task and it’s in the works. This begs an answer to the following questions:
— Will Medicaid applicants be diligently informed about estate recovery and other rules that apply to Medicaid enrollees on this single application?
Failure to do so would be in non compliance with OBRA 1993 and would also be deceptive.
— Will applicants be provided with a signature page that contains appropriate disclosure of these rules so they can be reviewed before signing on the dotted line?
— How will appropriate disclosure and obtaining a signature work for those who are bumped into Medicaid due to a decrease in income or who might be auto-enrolled because they were presumed eligible through a database.
If an applicant or someone who has been bumped or auto-enrolled in Medicaid is not satisfied with the terms of the Medicaid contract, lack of another health insurance option that is in the best interest of low-income earners represents undue and unconscionable advantage being taken of this segment of the population under a law that mandates health insurance or a penalty.
Do the health insurance policies enjoyed by lawmakers on Capitol Hill and paid for by taxpayers include an estate recovery program?
Medicaid is poor, underfunded, overstretched and constantly bombarded by state budget cuts – even before an ACA expansion. It offers a low quality of care in many states, and, in general, represents inequities in care. Office-based doctors typically refuse to accept Medicaid patients, thus, millions thrust into this plan will have difficulty finding a primary-care doctor or a specialist.
A perfect example is the December 2012 federal appeals court decision that allowed California to cut reimbursements by 10 percent to doctors, pharmacies and others who serve low-income residents under the state’s Medi-Cal plan (a version of Medicaid) due to state budget issues. California was already at the bottom of the rate-reimbursement heap which made finding doctors difficult for residents in Medi-Cal. This decision will further reduce the number of health care providers willing to take new Medi-Cal patients, thus jeopardizing their access to primary and specialized care. Under the ACA’s expansion of Medicaid, state budget crises across the nation will exacerbate the ongoing problems regarding access to care for Medicaid patients, particularly in states that have a high low-income population.
http://www.sfgate.com/health/article/Medi-Cal-cuts-upheld-by-appellate-court-4116971.php
6. INSURANCE PLANS AT THE EXCHANGES
Below are the 4 plan levels that will be offered at Exchanges for people between 138 and 400 percent FPL. Each one has government- approved benefits including prescription coverage. You will be entitled to one free preventive visit each year. Per the most recent study commissioned by the Kaiser Family Foundation, several cost-sharing options were estimated for non-group (individual and family) Bronze and Silver plans. Cost-sharing is the amount you must pay to use your insurance. Your share of the premium is not part of cost-sharing.
The way this works is you will pay for all your medical care until you reach the annual deductible. Then you’ll pay the applicable percentage of coinsurance until you reach the annual out-of-pocket spending cap which will be set on a sliding scale. Annual means these amounts start again the following year, and if they change, you will find out when you re-apply for insurance. There will also be copays – an amount you will pay to the doctor for an office visit.
Here are the current estimates:
Bronze: cheapest and dry as dust with 60/40 coverage – a win-win for insurers
a) annual deductible of $4,375 for an individual (double for a family) with 20 percent coinsurance, b) annual deductible of $3,475 for an individual (double for a family) with 40 percent coinsurance
Silver: next cheapest – offers an illusion of coverage at 70/30
a) annual deductible of $2,050 for an individual (double for a family) with 20 percent coinsurance, b) annual deductible of $650 for an individual (double for a family) with 40 percent coinsurance
Gold: expensive – 80/20 – better coverage
Platinum: most expensive – 90/10 – most comprehensive coverage
A fifth plan will be available for the under-30 crowd and people who have been granted a hardship exemption. See topic 8 in this lesson. Coverage in this plan will be less comprehensive than the Bronze – it is primarily for major-medical expenses except that it has a free preventive visit. Cost-sharing for people at 138 to 200 percent FPL is estimated to be a bit less than the Bronze and Silver estimates mentioned above.
The high deductibles in all but the two most expensive plans could saddle you with mounting bills for routine care and may stop you from seeking necessary treatment for illness or injuries. Many of you will find that the promise of access to affordable health care really means access to inadequate coverage at a price the government has decided you can afford to pay.
The number of drugs in each plan at an Exchange will vary from state to state. In some states, plans will offer up to 99 percent of available drugs and others only 45 percent which means you may not have access to the specific drugs you need. Perhaps Big Pharma will change its stance on this before 2014.
The cost of plans at an Exchange will vary from state to state based on where you live and your age. The ACA allows insurers to charge older customers up to three times more for a plan, even if they are in good health, as long as the state in which an Exchange is located doesn’t have a law that caps age-rating. Some Exchanges will tuck an administrative fee of 2 to 4 percent into premiums to help cover operating expenses.
Cost-sharing tax credits will be available if you are below 250 percent FPL to protect you from high deductibles and copays – but only if you purchase a Silver plan. If you buy the cheaper Bronze plan, you won’t be eligible for these credits, which are, by the way, direct federal payouts to private health insurance companies.
Obamacare has no cost controls. There is nothing stopping the insurance companies from increasing their rates, and Washington has already estimated higher premium costs at the Exchange for 2016 which doesn’t mean that 2015 won’t have an increase. Sounds like 2014 prices will be an Introductory Offer. Get ‘em while their hot!
7. PENALTY FOR BEING UNINSURED
The ACA requires that people who have been deemed able to purchase health insurance but decide not to buy it starting in 2014 will owe a penalty (a tax) to the IRS. Here’s what this looks like:
a) In 2014, the annual penalty will be $95 per adult and $47.50 per child, up to a family maximum of $285 or 1 percent of family income, whichever is greater.
b) In 2015, the penalty will be $325 per adult and $162.50 per child, up to a family maximum of $975 or 2 percent of family income, whichever is greater.
c) In 2016, the penalty will be $695 per adult and $347.50 per child, up to a family maximum of $2,085 or 2.5 percent of family income, whichever is greater.
The IRS collects the penalty, but the ACA stipulates that taxpayers shall not be subject to any criminal prosecution or penalty, tax liens, seizure of bank accounts or garnishment of wages for failure to pay it and no accumulation of interest on the unpaid balance. So, it appears that all the IRS can do is deduct the penalty from a refund it owes you, and if you’re not due a refund, then you’ll have an outstanding tax obligation.
Keep in mind that the penalty is described in annual amounts but is really monthly. So, if you are uninsured for only part of the year, you will accrue only 1/12 of the total for each month you are uninsured unless you qualify for an exemption.
8. EXEMPTIONS FROM THE PENALTY
You may be eligible for official permission that excuses you from having to pay the penalty for being uninsured. The requirements are:
a) If the cheapest health care plan available costs more than 8 percent of your MAGI after subtracting the tax credit or employer contribution, whichever is applicable.
b) Your income is so low that you aren’t required to file federal income taxes.
c) You are between jobs and without insurance for up to three months.
d) You have a sincerely-held religious belief that prevents you from seeking and obtaining medical care.
e) You are in jail.
f) You are an undocumented immigrant.
g) You are a member of an Indian tribe or a religious group currently exempt from paying Social Security tax.
If item d) is the case, you must file a sworn statement as part of your tax return, and should you obtain care during the tax year, the exemption will no longer apply and you will have to pay a penalty for being uninsured. Per H.R. 6597, medical care is defined as acute care at a hospital emergency room, walk-in clinic or similar facilities. Medical care excludes treatment not administered or supervised by a medical doctor such as chiropractic, dental, midwifery, personal care assistance, optometry, physical exams or treatment where required by law or third parties such as an employer, and vaccinations.
If you think you can’t afford the amount the government has decided you can afford to pay for your insurance plan, and you don’t fit into any of the categories described above, you can apply for a Hardship Waiver. Details have not yet been provided regarding hardship eligibility requirements under the ACA, but, for an idea of what they might look like, let’s check out what the deal is in Massachusetts which already has a mandated health insurance law – Romneycare! In fact, Romneycare was the model for Obamacare. That’s why some people call Obamacare, Obamneycare.
To qualify for a Certificate of Exemption under Romneycare, a Massachusetts resident must demonstrate that health insurance is not affordable due to one of the following: 1) homelessness; 2) eviction or foreclosure notice; 3) domestic violence-related medical trauma; 4) major long-term illness of a child; 5) death of your spouse; 6) your house burned down; or 7) “you can establish that the expense of purchasing health insurance would cause you to experience serious deprivation of food, shelter, clothing or other necessities.”
Ya gotta luv number 7. And in Massachusetts, exemptions come with an expiration date, so you have to clean up your act in short order. Under the ACA, the Secretary of Health and Human Services will determine if, indeed, you have suffered a hardship that keeps you from being able to pay for coverage.
9. OTHER TIDBITS
There is much more in the ACA including all kinds of rules and penalties for employers, employees and the self employed as well as the Accountable Care Organization (ACO) model which will be mandated starting in 2014. The latter works as follows: under the simplest option available, a small group of doctors and hospitals – an ACO – will manage your care and be graded and paid based on the outcome of all patients who seek treatment with that ACO. The ACO will also be rewarded with a share of the savings in health costs it achieves by following best treatment practices and reaching specific benchmarks set by CMS. The second option, “shared savings plus risk,” is for larger ACOs. Providers will receive a lump-sum payment to treat their patients and assume a portion of the risk for above target spending but are eligible to keep a greater portion of the savings.
Either of these options reduce patient care to numbers and paperwork because doctors are essentially controlled and incentivized by an administrator in some far-flung office. The ACO model is the insurance industry’s version of “budgeting” the cost of health care which ultimately benefits insurers at the expense of doctors and their patients.
Doctors say that basing their pay on treatment outcomes creates an incentive for them to avoid tough cases whose outcomes could “kill my numbers.” “Paradoxically,” writes Dr. G. Keith Smith, “doctors who are doing sham surgery will be the ones with the best outcomes, as their patients, many of whom don’t need surgery in the first place, will exhibit great, basically perfect outcomes. Physicians who don’t do unnecessary surgery will be pushed to do so to improve their ‘scores.’ ‘Pay for performance’ trends in medicine are not a good idea in my opinion. Paying based on patient outcomes will have perverse effects, not the least of which will be the complete denial of care to the very sick.”
The ACA also requires Health Insurance Exchanges to establish a navigator program to inform the uninsured about the availability of government-approved subsidized plans at an Exchange and to facilitate enrollment in these plans, but it leaves the design of the program up to each Exchange.
Depending how an Exchange sets up its program, some Navigators will sell plans offered by an Exchange while others will be responsible for maintaining the existing market but may also be allowed to sell Exchange plans. All seller Navigators will be compensated either by Exchanges or insurance carriers for the plans they sell. Many options are being considered by Exchanges including using insurance agents. Hopefully, Navigators and insurance agents will not be knocking on your door or contacting you by phone. That would be over the top. Here’s a link to read what the California Exchange is pondering with regard to its Navigation program.
10. ENROLL AMERICA, HERNDON ALLIANCE & THE EXCHANGES – MASTERS OF SPIN
Since many Americans don’t know about the ACA, somehow the word has to get out and people must be encouraged to purchase health insurance either in the open market or at an Exchange. And who better to do this?
Enter “Enroll America” – a nonprofit 501(c)3, financially backed by Aetna, Blue Cross Blue Shield, UnitedHealth, America’s Health Insurance Plans, hospitals, associations that represent drug manufacturers and nonprofits with vested interests. For insurers and pharma, the ACA is manna from heaven – scratch that – manna from Capitol Hill – and the dollar signs in their eyes are on fire! These profit seekers and connected nonprofits will be using every avenue possible to maximize their bottom lines.
The mission of Enroll America per its website is to “ensure that all Americans are enrolled in and retain health coverage.” It’s Board of Directors and Advisory Council reads like a Who’s Who in the Medical Industry Cartel – CEOs, presidents, vice presidents and directors of such entities as the American Hospital Association, Express Scripts, Medicaid Health Plans of America, Kaiser Permanente and many others – the list is long. If you would like to donate to these mega-profit vultures, you can do so on the Enroll America home- page. The goal is $100 million by 2014.
In its publication, “Ten Ways to Make Health Coverage Enrollment and Renewal Easy,” Enroll America has recommended availability of web-based applications to increase the places where people can enroll in coverage: at home, at grocery stores, community health centers, state fairs, sporting events, places of worship, and more. Gee, you can apply for insurance while you pray. How thoughtful.
The strategy for insurers and state Exchanges to persuade you to purchase insurance and warn you about the penalties includes using ads, social media, blogs, YouTube, Flickr, Twitter, hospitals, health centers, McDonald’s, in-store radio announcements, ballparks, county fairs, libraries, laundromats, community events, libraries, county fairs and drugstores – you name it. Blue Cross Blue Shield has partnered with H & R Block. Health insurers are already setting up shop inside some supermarkets so they can answer your questions and sign you up for coverage while you do your grocery shopping. They will likely be showing up in shopping malls – maybe even in parking lots, on street corners and at church fairs. And, their aim is to recreate themselves from the bloodsucking leeches that they are to your new, cool-dude friends.
We’ll be living in Occupied Territory.
Let’s connect some dots. The executive director of Enroll America is Ron Pollack, also president of Families USA – a nonprofit and friend of the industry. On its website, Families USA bills itself as “a national non-partisan organization dedicated to the achievement of high quality, affordable health care for all Americans.” Philippe Villers and Robert Crittenden, M.D. are on Families USA Board of Directors. Mr. Villers is also on the BOD of Herndon Alliance, Bob Crittenden is a Herndon staff member and Ron Pollack is a Herndon founder.
Herndon Alliance is an influential health care spinmeister creating messaging to change public opinion and tweaking each message to reach particular groups.
Herndon has close ties to Capitol Hill and helped market the ACA providing words politicians and supporters should use to promote the bill. For example, during the national health care debacle a few years ago, you heard Mr. Obama et al continually talk about ‘choice,’ ‘we need a uniquely American solution,’ ‘fair rules,’ ‘investing in America’s future’ and ‘high-quality, affordable healthcare.’ That last one is used in Families USA mission statement. The Council for Affordable Health Insurance, a frontgroup for the industry, gets right to the point – its name. Ron Pollack worked with the Obama administration to help reshape public opinion of Mr. Obama’s unpopular health care bill. Leading up to 2014 when the Exchanges are scheduled to open, there will most likely be a blitz of TV ads in which you will hear many of these same nebulous, feel-good words. And, you’ll undoubtedly read or hear plenty of Herndon spin from your Exchange and throughout your state in the immediate future.
In the interest of coming up with messaging, Enroll America held a few focus groups and commissioned a nationwide survey in fall 2012. Research was provided by Celinda Lake from Lake Research Partners, a national public opinion and political strategy research firm. One takeaway was when a monthly premium cost was given, the majority of people polled thought that it was too expensive and the ACA would not provide affordable and comprehensive coverage even with the government tax credits (subsidies). So, Lake Research Partners advised Enroll America not to mention specific costs but to use the phrase ‘free or low-cost plans.’
Herndon has been working on messaging various parts of the ACA that will be used by outreach partners, insurers and state Exchanges. Its messaging is not based on truth or evidence – Herndon actually stays away from any mention of facts as you read above regarding the cost of plans. Instead, its messaging is designed to mislead an uninformed public.
A few of Herndon’s target populations include voters, people of color, red states, skeptical audiences, and you’ll love this one – Elevator Language with a list of succinct scripts to use based on the person you’re speaking to during the ride. You must check out Herndon’s website and read the many instructions of what to say and what not to say. You’ll either get very annoyed or laugh yourself silly.
http://herndonalliance.org/resources/research/communications-tips-exchange-talking-with-voters.html
http://herndonalliance.org/resources/implementation-basics/communications-tips-to-use-with-skeptical-audiences.html
Here are some examples of Herndon spin regarding the ACA:
— Use “family values” when talking to the public about the expansion of Medicaid. Is estate recovery a family value?
— When talking about the ACA’s required Accountable Care Organization (ACO) model that will pay doctors according to patient outcomes and reward them for savings they achieve, Herndon says to call this “Coordinated Patient Care” and “do not connect pricing with rewards or incentives for doctors” or “with lump-sum payments for medical care” and do not mention “payment based on positive patient outcomes.” Why not? The three do-nots are how ACOs work. (ACOs are described in topic 9.)
http://herndonalliance.org/resources/system-change/payment-reform-quality-care-pricing.html http://herndonalliance.org/resources/system-change/coordinated-patient-care.html
— Here’s an award winner: “Members of Congress will purchase their insurance at the Exchange. If members of Congress are part of the marketplace then it’s got to offer quality plans and protections.”
http://herndonalliance.org/resources/research/communications-tips-exchange-talking-with-voters.html
— Stressing that under the ACA insurers won’t be able to deny coverage for pre-existing diseases is a Herndon biggie. In fact, you heard this many times over from Mr. Obama and other politicians. But a loophole in the law allows insurers to rescind (cancel) your policy if you intentionally put false or incomplete information on your application. The ACA says you must be given at least 30 days’ notice before your coverage can be rescinded, giving you time to appeal the decision or find new coverage. So, if your care becomes costly for the insurer and you didn’t mention you had a rash on your arm when you were 15, that will work. How can you prove if leaving this out was intentional or not? It’s them against you.
Enroll America’s Best Practices Institute is publishing a series of briefs on the best way to write and design websites and marketing materials, no doubt, using Herndon messaging. PR and marketing firms are helping various state Exchanges come up with appealing branding such as using a name everyone will like and spiffy logos with cool type styles in colors that will appeal to all audiences. Branding lessons include advising Exchanges which words to ‘embrace’ such as emphasizing choice, control, transparency and competition. Other messaging includes, “the Exchange should be viewed as an educator, not an enforcer” and using the word ‘marketplace’ instead of Exchange is a must. Tennessee Health Care Campaign will be telling potential customers “. . . the exchange offers us more choices, greater control over our health care, and more competition to control costs.” It’s all Herndon’s handywork in one form or another.
http://dhmh.maryland.gov/exchange/pdf/Brand_Recommd_may182012_final.pdf http://www.thcc2.org/PDFs/rtm_exchange_talking_point.pdf
More choice means choice of insurance companies, not choice of doctors and hospitals. In rural areas, there may be only one insurer offering plans which means one network and doctors may not be taking new patients. This happened in MA under Romneycare, and on top of that, many doctors would not accept people in the subsidized plans because of time-consuming red tape and low reimbursement rates. Under the ACA, insurers are planning to limit networks in the cheaper plans at the Exchanges. Having too few doctors in a network is a means of suppressing the use of health care which increases an insurer’s profits. Further on in this lesson, you’ll learn that the Maryland Exchange has been advised to ignore negative problems such as not enough doctors to serve the newly insured.
Choice is definitely a non starter for people found eligible for Medicaid – the ACA allows no other choice for this segment of the population and many doctors do not accept Medicaid. As for giving you greater control, considering all the rules about income and FPL, not to mention the data-mining to monitor your income during the year and those nasty tax credit paybacks, it’s you who is being controlled. And competition? Read this stunning op-ed by Nomi Prins: “Real Danger of “Obamacare” Insurance Company Takeover of Health Care.”
In Enroll America’s January 15, 2013 press release, Executive Director Rachel Klein says the ACA offers the promise of “access to comprehensive, affordable health coverage.” That is a false promise. As you learned in this lesson, coverage in the plans that will be offered at the Exchanges, with the exception of the two most expensive, is anything but comprehensive – the cheaper plans are unaffordable to use. Furthermore, how can she claim that the cost of the plans are affordable? Ms. Klein should be well aware of the nationwide survey Enroll America commissioned in which the majority of people polled said that the plans are too expensive.
http://files.www.enrollamerica.org/news-room/press-releases/Enroll_America_Plans_Major_Affordable_Care_Act_Enrollment_Campaign_1-15-13.pdf
http://www.nytimes.com/2012/12/20/us/officials-confront-skepticism-over-health-law.html?ref=us&_r=0&pagewanted=all
Currently PR firms are working with some state Exchanges to develop effective communications plans and advertising campaigns. Names include Mintz & Hoke, Hill & Company Communications and Weber Shandwick just to name a few. Ask the Massachusetts Health Insurance Connector – the prototype of an Exchange in the land of Romneycare – how much it spent on PR contracts over the years. In 2007, board members signed off on a two-year contract with Weber Shandwick for $1.85 million the first year with nearly $3 million for advertising – commission on media buys not included. And, by the way, the MA Connector upper management boasts six-figure salaries. Former MA Connector Executive Director Jon Kingsdale’s salary in 2007 was $225,000 and increased in 2008 to $231,750. In 2007, Deputy Director Rosemary Day alternated between a four-day and five-day work week to the tune of $175,000. These are only two examples of the many high-flying salaries at the MA Connector, an operation run by politicians and unelected political appointees and influenced by executives from the private insurance industry,
http://www.wickedlocal.com/cambridge/news/x497793387/Connector-re-ups-contract-with-Cambridge-based-Weber-Shandwick http://www.boston.com/yourlife/health/other/articles/2007/01/27/6_figure_pay_for_care_plan_overseers/?page=full http://www.highbeam.com/doc/1G1-166773095.html
Add up pay scales like that for every Exchange in the country, throw in some bennies, a PR contract for each Exchange, campaign costs and compensation paid by Exchanges to Navigators for plans they sell – a grand and costly effort to push more people into America’s for-profit health care system. Your tax dollars at work and mega bucks that could be used for actual hands-on medical care.
The Maryland Exchange has three campaign funding levels – Basic, Plus and Full-Scale – with a total for year one, two and three. Basic funding for year one is $2,450,000, Plus is $4,000,000 and Full-Scale is $6,300,000. See p.137 at this link for years two and three.
http://www.dhmh.maryland.gov/exchange/pdf/FinalAdvertisingReportWeber.pdf
The following, from the maryland link above, gives you an idea of some of the strategies that will be in play, most likely in all states. The Maryland Exchange has been advised by Weber Shandwick to “establish a system to monitor newspaper, radio, TV and online conversations about the Exchange and the program and to establish procedures and priorities for responding to negative media stories, op-eds, blogs and reports.” You can find this in the Risk Management and Responses section of Maryland’s strategic marketing plan.
In the Earned Media/Public Relations section, advice includes “ . . . putting out stories on the first effective enrollees, enrollment number milestones, and enrollee testimonials. Each of these becomes the focus for positive, brand-reinforcing stories. There will also be the risk of negative stories, including potential topics such as enrollment snafus, delays in issuing insurance cards, the cost of Qualified Health Plans [government-approved plans], claims of ‘shoddy’ Bronze coverage, incidents of physicians refusing to accept enough new patients to serve the uninsured and other negative topics.” “While coverage is bound to include some level of criticism it can be success- fully countered by putting a human face on heatlh reform.”
The Social and Digital Media section advises an invasion of the Internet including social media to market health insurance by “delivering the right messages to the right audience at the right time,” (probably using Herndon spin) to “help drive enrollment in the Exchange,” and also flooding newspapers with op-eds to contradict reported adverse effects of the ACA.
More details can be found at the Maryland pdf link below. It’s worth looking at this presentation to grasp the big business approach of Exchanges which is clearly profit-driven. The Maryland Exchange strategy is just one example. The goal of Exchanges is sell, sell, sell.
http://www.dhmh.maryland.gov/exchange/pdf/FinalAdvertisingReportWeber.pdf
Exchanges certainly have a lofty goal – promote success stories only and be ready to contradict and cover up the bad stuff as quickly as possible. Massachusetts residents have been there. The Connector and state politicians including the governor made sure that anyone being harmed by Romneycare would not be heard in spite of statewide survey reports put together by outreach agencies advising state legislators and power-players that low-income people were not faring well under this law. Various issues were spelled out and testimonials were included, but residents’ concerns about the adverse effects of Romneycare were ignored. MA national legislators also went along with this agenda as did the mainstream media.
When $130 million was needed in 2009 to balance the Massachusetts state budget, the Connector – with the blessing of MA Gov. Deval Patrick and the MA legislature – removed about 28,000 legal immigrants – working people paying taxes – from their insurance plans. Another 8,000 or so were barred from enrolling in insurance plans because the MA legislature voted to cap enrollment in the subsidized plans. This took place at the same time Mr. Obama was trying to sell the ACA to the nation, so, under pressure from Washington, the MA legislature restored some of the money, and the Connector dumped these people, without their consent, into an out-of-state plan with higher copays, less comprehensive coverage and next to no doctors or safety net hospitals in its network.
http://www.huffingtonpost.com/iyah-romm/lessons-from-massachusett_b_380718.html
This has huge implications for the ACA. If legal immigrants can be removed from their plans and others denied enrollment when a state budget is squeezed, which vulnerable segment of the population is next in line? The good news is these legal immigrants in MA sued the Connector and its then-Executive Director, Jon Kingsdale, and the Massachusetts Supreme Judicial Court ruled unanimously that the state could not violate their right to equal protection under the state and federal constitutions and fiscal considerations alone can not justify a state’s invidious discrimination against them. As a result of this decision, the state had to come up with some bucks, and the Connector was forced to put the plaintiffs back into their original plans.
Getting back to Enroll America, Herndon Alliance and some of the less-than-honorable Exchange strategies – it’s one thing to inform Americans about the ACA and Exchanges that offer the possibility of either purchasing high-deductible or catastrophic coverage with a loan from the government to help pay for it or being tossed into expanded Medicaid – but, mounting a costly, massive campaign to purposely deceive and manipulate the public with the unstated goal of more profit for the already extremely lucrative health insurance industry is disgraceful.
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Is the ACA a fair law if it helps only one small segment of the population but hurts and exploits a larger number to do so? The way this law works is fundamentally unfair and will not bring medical care to the many, but, instead will progress to greater personal debt for individuals and families who can’t afford the “affordable” insurance as well as those who must keep an eye on their income to avoid the many traps and false ends this law creates. At their expense, the forced purchase of health insurance will bring increased revenue to the industry, not to mention more kickbacks to Congress, and in the very near future, the health insurance industry will be “too big to fail.”
The ACA is most definitely a “uniquely American solution” which has little to do with reforming this country’s barbaric health care system. It merely controls peoples’ finances and choices while leaving insurance companies in charge and does virtually nothing to end their abuses. It will leave many millions of Americans uninsured and millions more underinsured at a staggering cost to taxpayers.
Politicians, health care policy wonks and vested interests will brush aside the ACA’s adverse effects. You’ll hear that some have fallen through the cracks of health care reform but the problems can be easily tweaked. You will also witness the usual dog-and-pony show on Capitol Hill in which the two parties play the blame game. The bought-and-paid-for mainstream media will regurgitate whatever Washington feeds it, and TV talking heads will chime in, inviting their “experts” to analyze the situation while real people in the real world struggle to get by under this law or fall by the wayside.
Good luck everyone and watch out for the folding chairs.
addendum:
Obamacare architect leaves White House for pharmaceutical industry job
http://www.guardian.co.uk/commentisfree/2012/dec/05/obamacare-fowler-lobbyist-industry1
Paul Craig Roberts is a former Assistant Secretary of the US Treasury and Associate Editor of the Wall Street Journal. His latest book, Wirtschaft am Abgrund (Economies In Collapse) has just been published.
What is ObamaCare?
High-Cost Privatized Medicine that Guarantees Billions of Dollars in Profits to Private Insurance Companies
By PAUL CRAIG ROBERTS | CounterPunch | April 11, 2012
Growing up in the post-war era (after the Second World War), I never expected to live in the strange Kafkaesque world that exists today. The US government can assassinate any US citizen that the executive branch thinks could possibly be a “threat” to the US government, or throw the hapless citizen into a dungeon for the rest of his or her life without presenting any evidence to a court or obtaining a conviction of any crime, or send the “threat” to a puppet foreign state to be tortured until the “threat” confesses to a crime that never occurred or dies at the hands of “freedom and democracy” while professing innocence.
It has never been revealed how a single citizen, or any number thereof, could possibly comprise a threat to a government that has a trillion plus dollars to spend each year on security and weapons, the world’s largest navy and air force, 700 plus military bases across the world, large numbers of nuclear weapons, 16 intelligence agencies plus the intelligence agencies of its NATO puppet states and the intelligence service of Israel.
Nevertheless, air travelers are subjected to porno-scanning and sexual groping. Cars traveling on Interstate highways can expect to be stopped, with traffic backed up for miles, while Homeland Security and the federalized state or local police conduct searches.
I witnessed one such warrantless search on Easter Sunday. The south bound lanes of I-185 heading into Columbus, Georgia, were at a standstill while black SUV and police car lights flashed. US citizens were treated by “security” forces that they finance as if they were “terrorists” or “domestic extremists,” another undefined class of Americans devoid of constitutional protections.
These events are Kafkaesque in themselves, but they are ever more so when one considers that these extraordinary violations of the US Constitution fail to be overturned in the Supreme Court. Apparently, American citizens lack standing to defend their civil liberties.
Yet, ObamaCare is before the US Supreme Court. The conservative majority might now utilize the “judicial activism” for which conservatives have criticized liberals. Hypocrisy should no longer surprise us. However, the fight over ObamaCare is not worth five cents.
It is extraordinary that “liberals,” “progressives,” “Democrats,” whatever they are, are defending a “health program” that uses public monies to pay private insurance companies and that raises the cost of health care.
Americans have been brainwashed that “a single-payer system is unaffordable” because it is “socialized medicine.” Despite this propaganda, accepted by many Americans, European countries manage to afford single-payer systems. Health care is not a stress, a trauma, an unaffordable expense for European populations. Among the Western Civilized Nations, only the richest, the US, has no universal health care.
The American health care system is the most expensive of all on earth. The reason for the extraordinary expense is the multiple of entities that must make profits. The private doctors must make profits. The private testing centers must make profits.The private specialists who receive the referrals from general practitioners must make profits. The private hospitals must make profits. The private insurance companies must make profits. The profits are a huge cost of health care.
On top of these profits come the costs of preventing and combatting fraud. Because private insurance companies resist paying and Medicare pays a small fraction of the medical charges, private health care providers charge as much as they possibly can, knowing that the payments will be cut to the bone. But a billing mistake of even $300 can bankrupt a health care provider from legal expenses defending him/her self from fraud accusations.
The beauty of a single-payer system is that it takes the profits out of the system. No one has to make profits. Wall Street cannot threaten insurance companies and private health care companies with being taken over because their profits are too low. No health-provider in a single-payer system has to worry about being displaced in a takeover organized by Wall Street because the profits are too low.
Because a single-payer system eliminates the profits that drive up the costs, Wall Street, Insurance companies, and “free market economists” hate a “socialized” medical care system. They prefer a socialized “private” health care system in which public monies flow into private insurance companies.
To make the costs as high as possible, conservatives and the private insurance companies devised ObamaCare. The bill was written by conservative think tanks and the private insurance companies. What the “socialistic” ObamaCare bill does is to take income taxes paid by citizens and use the taxes to subsidize the private medical premiums charges by private health care providers in order to provide “private” health care to US citizens who cannot afford it.
The extremely high costs of ObamaCare is not “socialistic medicine.” ObamaCare is high-cost privatized medicine that guarantees billions of dollars in profits to private insurance companies.
It remains to be seen whether such a ridiculous health care scheme, nowhere extant on earth except in Romney’s Massachusetts, will provide health care or just private profits.
PAUL CRAIG ROBERTS was an editor of the Wall Street Journal and an Assistant Secretary of the U.S. Treasury. His latest book, HOW THE ECONOMY WAS LOST, has just been published by CounterPunch/AK Press.
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- Left Takes ObamaCare To Court – Supreme Court (alethonews.wordpress.com)
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From the Archives
The Leo Frank Case and the Origins of the ADL
BY RON UNZ • UNZ REVIEW • MARCH 27, 2023
About a week ago both the New York Times and the Wall Street Journal devoted considerable space to the coverage of “Parade,” the revival of a 1998 Broadway musical on the 1915 killing of Leo Frank, a Jewish factory manager in Atlanta, Georgia, arguably the most famous lynching in American history.
Frank had been convicted and sentenced to death for the rape and murder of a young girl in his employ and the Anti-Defamation League (ADL) was founded in an effort to save his life. After numerous legal appeals failed, the state’s governor eventually commuted Frank’s sentence and a group of outraged citizens responded by hanging Frank. The incident was portrayed in both the musical and the associated media coverage as a particularly horrifying example of American anti-Semitism.
Micaela Diamond and Ben Platt in “Parade” at the Bernard B. Jacobs Theater
However, the actual facts of that case were quite different than that and in 2018 I’d discussed them at considerable length as part of a longer article. Given the recently renewed spotlight on the issue and the fascinating implications of the true story, I’ve decided to extract and republish my analysis in hopes of bringing it to wider current attention. … continue
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