Friday, November 22, 2013


When is the last time that an American president asked to have the law set aside so that presidential credibility might be restored? How about right now?

Even though California Insurance Commissioner Dave Jones has indicated that California should go along with the president's request to allow older insurance policies that don't meet the required criteria of the Affordable Care Act (ACA) to be extended, Covered California Executive Director Peter Lee says no dice because the state of California cannot force the insurance companies to grant extensions. Covered California voted 5 to 0 that allowing these older policies to continue would undermine the ACA even though President Obama himself, in a spectacularly furious backpedalling gesture, asked for just that. In so doing the president hoped to restore his diminished credibility when he promised so loudly and so often that if you liked your current doctor or your current policy you could retain either or both.

All the same, as of this writing, the ACA is doing well in California. About 80,000 persons have signed up for policies. Nevertheless,  about 220,000 non-compliant policies in California may be extended despite Peter Lee's exhortations otherwise. The reason, however, isn't as much the presidential plea for mercy as it is the insurance companies' assertions that they didn't have enough time to notify clients and don't have enough time anymore to make necessary adjustments.

By now it has become evident that ACA-compliant policies are likely to cost more than the non-compliant policies they replace -- we've already seen the example of the woman who congratulated the president on Obamacare and then found out that she couldn't afford it and would now be worse off than before when she had a non-compliant policy. Now she has none. Evidently, Peter Lee thinks that "none" is a suitable alternative for her. Lee may turn out to be even more of an ideologue than the president himself. It took a while for the president to acknowledge his mistake, but, in due course, he did just that. Meanwhile the ideologues stomp ahead, trampling opposition, no matter how small and desperate they are.

In general, the idea of insurance for all should take hold, but not in an atmosphere of partisan bickering, party affiliation, and ultimate hypocrisy where Congressional representatives, as one of their perks, may seek medical care at any American military hospital on a "prn" basis.

Yessirree,"prn" is the abbreviation for "pro re nata," which means according to need, their needs, not ours. Once again Congress looks out for itself first. Citizens like us get promises, then dregs, then raised premiums that push the ACA into offering policies that often turn out to cost more than the policies they replace. The risk now is that the ACA will protect us out of more health care than it'll provide in return. We hope not lest the ACA become known as the Unaffordable Care Act (UCA).  

Friday, November 15, 2013

"Keep Your Health Plan Act of 2013" clears the House of Representatives

HEALTH COVERAGE BILL PASSES WITH 39 DEMOCRATS CROSSING OVER. HR 3350 sponsored by Representative Fred Upton from Michigan passed 261 to 157 with 39 Democrats voting with the Republican majority and 4 Republicans crossing over to vote with the Democrat minority. The Senate is not in session today -- the pot is boiling but doth not yet runneth over. The simmering pot revolves about the three dozen plus three Democrats who have signaled by their crossover that they don't support President Obama who has promised a veto if the bill makes it through Congress.

The four Republicans who also crossed over to the Democrat side could eventually play a larger role. The Republican vote for this bill envisions not only allowing the rescinded health care plans to be returned to their buyers but also extends to the insurance companies the right to sell the  policies to new customers. This latter provision could wreak havoc with the Affordable Care Act (ACA) whereas the lesser proposal by the President to allow the already purchased policies to stay in effect for another year is seen as a healing measure to buy time even though this proposal also has its own troubles since it flies in the face of legislation already signed into law.

In California Insurance Commissioner Dave Jones has stated that he'll go along with the President's attempt at ACA repair. Proponents of the ACA feel that HR 3350 (Upton) is a not-so-subtle attempt to undermine Obamacare altogether. Stay tuned, stay informed!

Thursday, November 14, 2013


No doubt about it, President Obama heard the criticism and has responded in kind.  His announcement today that the individual mandate would be postponed by one year is designed to assuage the millions of subscribers who were satisfied with their health plans because they'll now be enabled to keep them for another year even if they're not compliant with the Affordable Care Act (ACA).

When queried by press about his constant reaffirmations of the original plan to promote the ACA in the face of a failed internet sign-up program, the president spoke to the people's hearts when he said "I'm not stupid enough" to have promoted an internet program had he known in advance that it was about to be an abject failure. He admitted the "fumble." Now that's language we can understand although we'd still like to know who in our capitol was stupid enough to have left the president holding the bag. In private business, such persons get reassigned to life-at-home although we've become inured to their walking away with golden parachutes.

Issues that weren't faced up to entirely include why increased cost may be an inevitable outcome. One argument we've used in this blog is that the ACA requires 60 year old grandmothers to purchase policies that include maternity care. Ridiculous? Maybe not. The same ACA requires 27 year olds to pay a rate that'll include prostate disease coverage for older men. That's just how all inclusive insurance works.

There's no denying that  private insurers used to dump patients once sickness and injury claims were filed and that previous administrations tolerated this rueful practice. There's no denying that some insurers used to resurrect claimants' healthcare histories and retroactively cancel a claimant's policy because the applicant had acne that came under medical treatment at age 17 and wasn't reported at the time the applicant bought insurance coverage -- but that, too, was tolerated. 

There's no denying that annual limits and lifetime limits would often ensnare the very sick into bankruptcy -- but this egregious insult and harm was also allowed by previous administrations. Obama's credit is that he sought to resolve these inequities but in his eagerness failed to keep  his eye on the ball and misled the public. He is now gradually trying to dig himself out of the hole he dug -- today's step is a shovelful in the right direction.

But will a one-year postponement do enough or will it just give everybody breathing room until the inevitable cancelation catastrophe one year from now?

One problem is that pro-private-insurance interests opposed to the ACA are rooting for failure and will inevitably point out that President Obama is unilaterally suspending the law to recoup his own popularity with midterm elections pending. Proponents will support the president or seek further enabling legislation.  

California will be a statewide workshop since we're being told on the one hand that  in California one million cancelations have been sent out and will now need to be rescinded -- what will be the cost of that and who will pay for it? On the other hand, we're also told that California leads the nation in ACA sign ups.

Political pundits will notice that today's discussions have so far not mentioned the Independent Payment Advisory Board (IPAB) -- that is Sections 3403 and 10320 of the ACA that'll allow cancelation of benefits once the ACA  gets too expensive. The IPAB is to be staffed by appointed bureaucrats at $165,000 per year. They will not need to report to Congress. Now there's something to worry about! Ask your Congressional representatives about it -- if they're making a beeline for legislation, tell them to take this item under advisement to strip the IPAB of its power to take away our increasingly hard-won benefits.

Friday, November 8, 2013


"I am sorry that they are finding themselves in this situation based on assurances they got from me" is as much of an apology from President Obama as we're likely to get. This apology isn't abject but it's a remarkable turn around from the president's previous wholehearted support of the Affordable Care Act (ACA). It's a far cry not only from his June 2009 promises but also from his September 25th statement in Maryland where he ringingly declared, once again, that "if you already have health care, you don't have to do anything."

By now we know that millions of  policy holders have been skunked because private plans purchased directly from insurance companies have been arbitrarily and unilaterally cancelled by the insurance companies that so eagerly sold them in the first place. These plans have conveniently been declared non-compliant with the ACA. The convenience is that the same companies can now turn around, create ACA-compliant health care plans, and sell them to their own customers at a hefty mark-up. It may not quite be double-billing, but it sure as Hades qualifies as "double-selling."

Here's what another one of our knowledgeable sources says:
"It's not the ACA doing this, it's the insurance industry using the ACA as an excuse to institute more advantageous plans for themselves." Right on! Too bad the president and his devoted inner clique didn't tumble to that in time  or didn't speak out. In fact, that millions of people would lose their health-care plans was actually reported in the Federal Register in June of 2010. Therefore, the obligation of public disclosure was technically met. Too bad, isn't it, that President Obama and Secretary Sibelius didn't read it or decided to ignore it while they steamrolled the public instead.

Our source whom we'll call Josefina points out that "the insurance companies were allowed to set up and offer whatever they wanted as long as they include no cap, no discrimination for pre-existing conditions, and some basic care inclusions such as maternity care and mammograms."

In fact, given these required inclusions, it can be argued with reasonable medical assurance that the ACA-compliant policies are probably superior to the plans that are now being pulled off the market. On the other hand, the buyer lost his choice of product.

Here's what happened to Josefina: first, Blue Cross cancelled her  health care plan. Blue Cross blamed the ACA. Then Blue Cross told Josefina they would send her a replacement policy that needed to be accepted by December, 2013 "in order to delay implementation of the ACA provisions at the same rate of $1427/month. They made it sound like that would be a good thing for me when the advantage is all theirs, including being able to max me out of my plan." A reasonable argument can be made that Blue Cross is complying with the ACA by offering a superior replacement policy even though such plans in the future are expected to cost more.

Josefina, who understands insurance, pointed out how the new plan could be ACA-compliant while also decreasing other coverage included in her previous plan but which isn't mandated by the ACA. By now our reading public knows that the ACA compliant plans include mandatory coverage of mental illness and maternity care even for 60 year old grandmothers. So the public finds it has to buy superior plans that cost more in order to cover the previously uninsured population estimated to be around 22 million persons.

Here's Josefina's summary: "They (the insurance companies) blame it on the ACA (Obamacare) but it actually (is) the insurance company industry manipulation while pretending that it's the ACA." 

Our conclusion: we agree with this assessment but feel obliged to point out that the Federal Government knew about the scam as early as June of 2010 -- that's when the president and Secretary Sebelius should have told the rest of us what was cooking in a pot that was shortly to boil over and burn millions of people who believed the presidential assurances from as early as 2009 and as recently as September of 2011.

One can only be dismayed at such deception unless we buy the argument  that the president and his staff were simply incompetent. Remember, this president is the same one who also promised in a speech on health reform in 2009 that he would make sure that "no government bureaucrat gets between you and the care you need." 

Although President Obama admitted that "we weren't as clear as we needed to be in terms of the changes that were taking place," he did not acknowledge that he knew at the time, or should have known at the time, that millions of persons would lose their private healthcare plans. Now we see a welcome reversal of field: "we've got to work hard to make sure that we're going to do everything we can to deal with folks who find themselves in a tough position as a consequence of this." Our information is that the president has instructed his staff to "close some of the holes and gaps in the law" and to find out to what extent he can help as many persons as possible who lost their insurance.

Is that a promise to interfere with policies that foist insurance plans on us that we don't need? Sometimes there's no winning strategy. Instead, there's  a chance for restorative damage control. That could be the ultimate winning strategy in this otherwise fiasco of healthcare reform.


"User's Guide to the Affordable Care Act (Obamacare) and the Independent Payment Advisory Board (IPAB)," 6/28/2012,

"What Obama should've said about health reform," The Hill, Washington, D.C., 9/16/09

Tuesday, November 5, 2013


By now we all know the story: "water, water everywhere, but not a drop to drink," or, in its latest revision, "words, words everywhere, but not a syllable of truth anywhere."

"If you like your doctor, you will be able to keep your doctor. Period. If you like your healthcare plan, you will be able to keep your health care plan. Period."

Ooops, not 'zackly "period," more like a comma from a president who must have been in a coma when he misspoke so badly and so carelessly on 15 June 2009 when he recklessly promised so much only to deliver so little four years later.

The new version of "period" is "if it (your health care plan) hasn't changed since the law was passed." The president's awkward attempts to shred and parse his previous language are downright embarrassing particularly to those among us who trusted him at the time.

Here's the latest horror story we have, relayed by a subscriber who has asked us not to publish his name but whose revulsion at the deception he's been offered is palpable.

Joe B, we'll call him, had an individual policy with Blue Shield in which he enrolled in 2012 and which he intended to keep especially since his president told him that if he liked his health-care plan he could keep it, "period!"

Joe B's plan was HSA compliant with high deductibles, $4,000 individual, $8,000 family-embedded. There was no so-called "lifetime maximum." Joe B recently was advised by Blue Shield that the health-care plan he liked and expected to keep would not be available after 12 December 2013. He was told that the plan he liked and had intended to keep was not compliant with the Affordable Care Act, that his new premium for a plan he didn't want would be increased by 40%,  that his deductibles would go up by 12.5%, and that his co-pays after the deductible was met would, in Joe's own words, "skyrocket."

Next Joe B  checked out CoveredCA. Too bad for Joe B, because CoveredCA did not offer him any HSA compliant plans. Joe B's conclusion, sadly on target, is that "the lies which were told that both got the law passed and got many elected or re-elected (Obama) are insidious and cause for great concern for our country."

Next, Joe B learned about the IPAB (Independent Payment Advisory Board) from our blog and finds that  provision of the ACA "cause for great additional concern."

Joe B's conclusion: "Stealthily setting up a plan to redistribute income through the healthcare system is what is resulting, and it's just not right."

Our conclusion: if the president wants to ease into a more socialized system, or a single-payer model, he should have the intestinal fortitude to tell that to the voting public.  What he is doing now is an attempt to deceive the public and re-write history. It is likely that the computer glitches in the sign-up process will eventually be fixed, but Joe B has just found out that the HSA compliant health care plan that he liked and was told he could keep is out the window -- that, my friends, is not a computer glitch. It was false when the promise that Joe B could keep his health care plan was initially floated and remains so today -- a sad commentary and severe blow to our ability to trust our president's promises on healthcare or anything else.