obamacare

If You Like Your Health Insurance Plan, You Can Keep It

March 25, 2014 by Bitchy

I’ve called this a lie with an asterisk in the past, and I still refer to it as a lie with an asterisk. Strictly speaking, it wasn’t a lie. It was a rosy statement designed to reassure and sell a plan, while leaving out a bunch of information that would have sounded like the last 20 seconds of a 30 second pharmaceutical ad. You know, the part that warns that increased suicidal thoughts and anal leakage are some of the fabulous side-effects that you can look forward to if you ask your doctor about this drug. Here’s what the absolute truth would have sounded like;

If you like your plan, you can keep it*

*except for the 17% of you in the single subscriber market that get a cancellation letter every year, because your insurance company chooses not to offer your plan anymore since they’ve found a new way to screw you

*and the additional 1% of you in the single subscriber market that will receive a cancellation letter this year, because your crap plan doesn’t meet the new federal minimum requirements for health insurance

*and those of you in the employer provided market whose plans change every year because your employer needs to find a new way to tamp down the rising costs

That wouldn’t have sounded as good, and would have been much wordier than "If you like your health insurance plan, you can keep it", but it would have been more accurate.

Every time someone would crow about the huge number of cancellation letters that people were getting because of Obamacare, I would ask, "how many more cancellation letters went out this year, versus prior years?" I wasn’t asking the question to be cute, or clever. I asked the question because without that information, there’s no point there. So if 10 million cancellation letters went out last December, the logical question that any critical thinker would ask themselves, is how many cancellation letters went out in previous years? Without that information, 10 million is a meaningless piece of data. Since I never ask a question I don’t know the answer to, I had already done the legwork of hunting this information down. The answer was that we didn’t know. Those numbers lie with each individual insurance company, and they never release those numbers. They historically don’t release those numbers, and they certainly didn’t release those numbers for last December. So even though I didn’t know the answer to my question, I knew two things; the answer was unknowable and the numbers that were being thrown out for last December were completely fabricated. I didn’t know the answer to my question, but I did know that the "information" being thrown around was meaningless, and that the point that was supposed to be made with that information wasn’t made.

But now I have a pretty good idea of what the answer is. Health Affairs just released a very well sourced report wherein they took a very close look at the individual insurance marketplace and came up with historical data on insurance cancellations. Here’s what they found out; historically, only 17% of those in the individual health insurance marketplace stay on the individual marketplace for more than two years. Why? Because most people get single subscriber plans only when they don’t have access to a public or employer based plan. In other words, people turn to the single subscriber insurance marketplace temporarily while they’re in the gap between full time employment. What percentage of single subscribers actually got cancellation letters in December? 18.6%, or 2.6 million people. Nowhere near that 10 million number that the noncritical thinkers loved to throw around.

So what happens for those 2.6 million people? From the report:

While our sample size of those with non-group health insurance who report that their plan was cancelled due to ACA compliance is small (N=123), we estimate that over half of this population is likely to be eligible for coverage assistance, mostly through Marketplace subsidies. Consistent with these findings, other work by Urban Institute researchers estimated that slightly more than half of adults with pre-reform, nongroup coverage would be eligible for Marketplace subsidies or Medicaid.

So over half of those people will either qualify for free coverage through medicaid, or get subsidies under the medicaid expansion. In other words, over 1.3 million of those people will be better off this year, than they were last year. That leaves us with about a million people who are maybe getting screwed by Obamacare. Why do I say maybe? Because we don’t know what their premiums were, versus what their premiums look like on the exchange. But a bigger problem than we not knowing the premium differences, is that most of them don’t know. From the Urban Institute Study:

Yet making the best enrollment choice may be difficult for consumers. HRMS findings show that many people are not aware of the new state Marketplaces, few know whether their state is expanding Medicaid, and many lack the confidence to enroll, make choices, and pay their premiums.

In other words, the disinformation campaign is working. People don’t know their options, and are very likely paying more than they need to. I personally have found this to be true while helping some of my Facebook and G+ followers with their quest to find health insurance. Granted, I have two advantages in that I’ve been following the ACA and changes to the ACA very closely, and I’m an HR professional with nearly fifteen years of experience in designing corporate insurance plans.

Health insurance is complicated and annoying on a good day when you’re not being fed a bunch of crap about how you’re fucked, and there’s nothing you can do about it. It’s exponentially worse when you’re being used as a pawn in a political chess board to take down a president. The health insurance doomsday crowd is going well beyond not giving a flying fuck about you; they’re actively encouraging you to screw yourself so that they can be right about something they’re completely wrong about. It’s needless and sad, and you should spend as much time as you have to spend to root out the information you need to protect your own self interest.

We Won’t Be Calling It Obamacare By Next Summer

December 2, 2013 by Bitchy

According to a Bloomberg article this morning, 100,000 people purchased insurance on the federal exchanges in November alone. That’s nearly 4x more than the nearly 27,000 who bought insurance on the federal exchanges in October.

127,000 enrollments nationwide may sound low, but it’s actually very promising for a number of reasons. First off, if you look at when people actually bought health insurance in Massachusetts when they rolled out their own Obamacare, you’ll realize that the lion’s share of enrollments will happen just before the deadline to buy. There’s no empirical reason to believe that the same thing won’t happen nationally.

Secondly, those 127,000 people represent enrollment in just the states who have governors that refused to help their constituents get affordable insurance. That number does not include people in NY, CA, KY, or the other twenty-three states who took the medicaid expansion and set up their own exchanges. California alone has enrolled 80,000 people, and Kentucky has enrolled about 50,000 people so that 127,000 federal enrollment number is already smaller than those of just two states who embraced the ACA. The number of people who have been able to purchase insurance as a result of the ACA is much higher than we’re currently aware of.

Thirdly, you need to look at the trend. A four time multiplier on the number of enrollments from one month to the next is much more telling than the overall number. This is especially true since we’re still four months away from the deadline to buy insurance.

But there is one factor that is more relevant to the success of the ACA than overall enrollment numbers; how many people under the age of 30 are signing up? We don’t yet know what that number is on the federal exchange. I don’t believe we’re going to know that number until March or April. But we do know what is happening in Kentucky. 41% of the people that bought insurance in Kentucky are under 31 years old. That’s a huge percentage that I never saw coming. I suspect (I don’t have the data on any other state yet) that the percentages will be similar in all of the states that elected to take the medicaid expansion, since Kentucky doesn’t have a substantively younger population than any of the other states. I also suspect that the national percentage of under 31s will be lower, absent the medicaid expansion. For the under 30 population in the expansion states, coverage is well under $100 a month. It will be around, or a little bit higher than $100 for those same people who live in states where their governors are trying to undermine Obamacare. It’s reasonable to expect that higher costs will equal lower enrollments. I would be shocked if that 41% were cut in half in the more expensive states. But if we assume that nationally, the under 30 percentage is 20%, we will definitely get the 2.9 million enrollments that we need to keep the current premium levels.

In other words, this reform is most assuredly going to work. None of the early indicators suggest otherwise to me. I must say that I’m pleasantly surprised at how well this is going. I was very skeptical was passed, but I’m always happy to be proven wrong by evidence.

Blinded By Your Own Douchiness

November 11, 2012 by Bitchy

I’m talking about John Schnatter (even his name is douchy), CEO of Papa John’s (barely) Pizza, as well as Darden Restaurants Inc (who own Red Lobster, Olive Garden, and Longhorn Steak House) who have all said that they will be cutting their workers’ hours so that they don’t have to offer them health coverage, as mandated by ObamaCare.

Let me tell you the number of ways this is douchy. The most obvious, is that this is a PR nightmare. I believe that most Americans are good people, who want the people that prepare their food to be able to live a life that includes health insurance. I don’t believe that (with the exception of ideologues) most of us have a problem paying a few cents, or even a few dollars more for restaurant meals if that means providing health coverage to the employees that prepare and serve those meals. How do I know this? Because since 2008, restaurant patrons in San Francisco have been paying an extra 4% on each meal they consume, so that the restaurant workers in San Francisco have universal coverage. This 4% charge hasn’t made it any easier for me to get a table at The Slanted Door when I’m in town, so I’m guessing that San Franciscans aren’t eating at home because that 4% is overly burdensome.

It’s also douchy because these announcements are clearly politically motivated. The announcements didn’t have to be made. They could have quietly implemented the WalMart model of two part time employees, rather than one full time employee in order to avoid providing any benefits at all. No, they want to make a last ditch effort to scare people into believing that ObamaCare is a bad thing.

But the douchiest part of this, is that it demonstrates how bad these people are at business. Remember what I told you about San Francisco and the added charge for health insurance? Well, a lot of restaurants in San Francisco have turned these surcharges into a profit center. They’re pocketing some, if not all of the money. Wayfair Tavern in downtown San Francisco collected almost $64,000 from it’s customers in 2010. They spent a little over $6,000 of it on health insurance for their employees. I’m not going to go into how they did this, since it’s not relevant to this post. You can click on the link in this paragraph to get more information on it. My point is that John Schnatter, who claims that providing insurance for his employees will cost consumers fifteen cents more per shitty pizza. If he weren’t so blinded by his own douchiness, he would have realized that quietly raising the prices by fifty cents for each inedible pie, would have increased his profits. This would have enabled him to buy another obnoxious castle, while treating his employees to doctor visits. It would have been a win/win, but he douchebagged himself into a lose/lose.

When people don’t have insurance, and can’t get full time hours, they leave as soon as they can so you create a fast-spinning revolving door of employees. As an HR professional, I can tell you that it costs significantly less to keep an employee happy than it does to replace them. In the high tech arena, the cost of replacing an employee can range between 60 – 200% of that employees annual salary. I’m positive these percentages are much lower in fast food, but I’m also positive that it’s cheaper to garner some loyalty and slow the spinning of that revolving door. You have to pay to add an employee to your payroll system, and then you have to pay to remove them. You have to pay someone to perpetually interview new employees, and you have to pay someone else to process the new hire and termination paperwork.

This whole thing is douchy, and it’s bad business. So I say boycott, boycott, boycott! And to the idiots who say that this will cause layoffs, don’t you think I thought of that? You can take your business to Little Caesars, who have no plans to fuck their employees because they never wanted to treat them humanely in the first place. An increase in business at Little Caesars means more hiring of employees who will get the benefits they need. Laid off Papa John’s employees can get a better job down the street.

Obamacare Couldn’t BE More Constitutional

April 3, 2015February 3, 2011 by Bitchy

Partisan, right wing, hack judges all across the country are ruling health reform unconstitutional. Specifically, they’re targeting the part of the bill that mandates that every American obtain health insurance. These rulings are comical, but I’ll get to that soon enough. I first want to start with my prediction on what will happen with health reform. Republicans have passed repeal in the house. This is meaningless and purely a ceremonial gesture to appease their base. They know it won’t pass the senate and they don’t want it to. Let me explain. We all know that the health insurance industry has spent a lot of money on political contributions to ensure that politicians (both democratic and republican) protect their interests. The provisions of the bill that have already been enacted have increased the number of subscribers of health insurance. Small businesses are taking advantage of the federal subsidies that are now available to them, and offering their employees insurance for the first time. Parents of twenty-something kids are adding their children to their policies because they now can. Insurance companies are seeing double digit spikes in new enrollments. Do you think that the insurance company overlords are going to let their republican subjugates take away all that new business? Fuck no! The part of the bill that sounds most egregious (mandates) is the part that insurance companies won’t ever, ever allow to be repealed. They’ll never, ever repeal the small business subsidies or mandates because they’re bringing in the cash, and at the end of the day, that’s all the insurance companies care about. My guess is that they’re going to have to subversively chip away at the parts of the bill that cost insurance companies money. You know, the parts that all Americans agree we want like disallowing rescission, or denial of coverage based on pre-existing conditions. The republicans won’t be allowed to repeal the parts of the bill that they rail against. So if you’re worried about full repeal, don’t be. It will never happen. Now onto the idiot judges, dipshit state attorneys general, and any asshat that claims unconstitutionality in an effort to repeal the bill. Thanks to Tom Hartman for bringing this little gem to my attention. Turns out that the 5th congress of the United States passed a bill titled, "An Act For The Relief Of Sick And Disabled Seamen". This law required that privately employed sailors obtain health insurance. Here’s a little background. Even early on in our country’s history, it was obvious that trade with other countries was going to be instrumental in creating a strong economy. In those days, our ability to trade relied solely on private merchant ships. Since working on a merchant ship was dangerous work, seamen were getting hurt in such numbers, and with such frequency, that it was leaving shipping companies with a serious shortage of manpower. Enter; the federal government. In 1798, they passed "An Act For The Relief Of Sick And Disabled Seamen". This law did a couple of things;

It created The Maritime Hospital Service, which was a series of hospitals that were built and run by the federal government for the purpose of treating injured private seamen.
It mandated that maritime sailors pay 1% in taxes to pay for these hospitals. Those taxes were withheld by the ship’s owner and paid directly to the federal government.

Can you smell the socialism in the air? Oh, but it gets better. Members of the 5th congress that passed this law included:

John Langdon
Jonathan Dayton
William Blount
Richard Dobbs Spaight
John Rutledge
Abraham Baldwin

Why are these names relevant? Because they fucking signed the United States Constitution. The Vice President at the time, who served as President Of The Senate was Thomas Jefferson. Wanna know who the President that signed the bill into law was? That would be John Adams. What do John Adams and Thomas Jefferson have in common? They helped to write the freakin Declaration Of Independence. I think that they had a really fucking clear idea of what the founders intended. Let’s add another historically deficient asshat to this group, shall we? A couple of weeks ago, a North Dakota state representative (and asshat) Hal Wick proposed legislation that would mandate that every citizen of North Dakota purchase a gun, upon reaching twenty one years of age. He thought that he was getting cute by pointing out that mandating people to buy anything is unconstitutional. Wick maintains that he knows that his proposed legislation is unconstitutional, and that he’s just trying to make a statement about mandates. Wrong again, Bob. George Washington signed a bill entitled, "The Militia Act Of 1792". Wanna guess what provisions were in this bill? Read for yourself;

That each and every free able-bodied white male citizen of the respective States, resident therein, who is or shall be of age of eighteen years, and under the age of forty-five years (except as is herein after excepted) shall severally and respectively be enrolled in the militia, by the Captain or Commanding Officer of the company, within whose bounds such citizen shall reside, and that within twelve months after the passing of this Act.

That every citizen, so enrolled and notified, shall, within six months thereafter, provide himself with a good musket or firelock, a sufficient bayonet and belt, two spare flints, and a knapsack, a pouch, with a box therein, to contain not less than twenty four cartridges, suited to the bore of his musket or firelock, each cartridge to contain a proper quantity of powder and ball; or with a good rifle, knapsack, shot-pouch, and powder-horn, twenty balls suited to the bore of his rifle, and a quarter of a pound of powder;

Ignorant and unoriginal Hal. Way to go!

This health reform issue will ultimately end up with the supreme court. That’s where it will get fun. What do you think the odds are that Scalia will advocate for his strict constructionist views on this one? They’re actually pretty good. Not because Scalia is actually a strict constructionist, meaning that he doesn’t believe that the constitution is a living, breathing document that was intended to be amended over time. He clearly isn’t, despite what he says. If he were a strict constructionist, he would never have argued for corporate personhood in the Citizen’s United ruling, since corporate personhood doesn’t appear anywhere in the constitution. No, he will whip out the strict constructionist routine because it enables him to serve his corporate masters. Remember, the insurance companies don’t want the revenue generating mandate removed from the health reform bill.

So if you’re worried about health reform being repealed, don’t be. But beware of your legislators quietly trying to strip away the really good stuff that we all want.

In the meantime, feel free to rub the founders’ real intent in the noses of any asshat that tries to tell you that Obamacare is unconstitutional.