Category Archives: Uncategorized

We got our guvment back. And blog too

From Mike King


The confederacy of extreme right wingers of the Republican House caucus — aided by their new bestest buds Ted Cruz and a Mike Lee in the Senate — got what they have been begging for the last couple of years — a government shutdown and a chance to make even wilder-than-usual, fact-challenged claims about Obamacare, which they failed to repeal, shutdown or even significantly alter as a price for their ransom of the U.S. economy. But enough about that now. Because these folks long ago detached themselves from rationality, we might have to go through the whole thing again after the first of the year. So no need to waste time about who won and who lost, as the media is likes to do. Mostly, that’s because the media doesn’t have the stomach to actually analyze whether one side was really right and the other side was really wrong to think that sucking $24 billion out of the economy with the shutdown, and putting the credit of the country on the block by threatening not to pay some of our bills, was worth it.

Let’s return instead to some of the discussion points that got lost — as John Boehner may say — while the hot air was still in the room during the shutdown. There are many that need more airing, like whether the individual mandate should be delayed; whether the faulty, horribly-rolled out sign-up process for the exchanges is indicative of other problems administering the new law as it is implemented; whether Congress really did “exempt” itself from the law by providing staffers a special subsidy when they sign up for insurance on the exchange, and whether some of the taxing mechanisms for paying for the insurance subsidies should be repealed.

We’ll deal with one of those — the medical device tax — today. It’s worth a closer look, not because it is all that controversial — although the K Street lobbyists in Washington would have you believe it is — but because it almost got included as part of the ransom demand for Obamacare changes during the shutdown. Thankfully, the White House help firm on it, despite some weak-kneed Senate Democrats who wanted to repeal or delay it and justified their position by claiming they and the White House had to give the House hostage-takers something to claim as a win.

The best analysis of the medical device tax issue is presented in this op-ed in today’s NYT. 

I can only add with 20 to 30 million more Americans now eligible for insurance coverage — and presumably a bigger market for their wares —  it’s a little disingenuous for these manufacturers to be crying wolf that a small tax on their profits will kill the industry.

And lastly, there’s this: Anyone who has ever dealt with filing claims or purchasing a needed piece of equipment directly from device manufacturers or suppliers — from sophisticated, implantable, life-sustaining devices like insulin pumps to simple technology like CPAP –has figured out the incredible markups they get on these devices. Moreover, they understand how manufacturers collude with doctors and insurance companies to limit choices of what kinds you can purchase or lease if you want to claim coverage.

So don’t expect a lot of sympathy for these health care providers. They don’t deserve it.


A red state that can’t adopt Obamacare fast enough

From Mike King

I used to live in Kentucky. It’s a great state. I’d be hard pressed to say that most of the state is any more or less conservative than Georgia. It is, after all, home to the Senate Majority Leader (Mitch McConnell) and an up-and-coming tea party favorite who may be a presidential candidate in 2016 (Rand Paul). On the political color spectrum, it’s very red.

But it isn’t a one-party state. Steve Beshear, the governor, is a Democrat. He’s a former Attorney General for the state and a long-time political figure in Kentucky. And he was smart enough to understand, quickly, how Obamacare can help his state economically while at the same time improving the health and welfare of Kentucky residents by moving thousands of them from no insurance to Medicaid. He also quickly signed Kentucky up to manage its own health insurance exchanges and, by doing so, seemed to generate enough competition in the bluegrass to help keep policies affordable.

Here’s Beshear’s explanation of his decision in today’s New York Times

Contrast that with Georgia, a similarly red state. Unfortunately one-party domination (and the accompanying fear of tea party tail wagging that now controls that party) will leave Georgians to fend for themselves on the federal insurance exchanges. Meanwhile, 650,000 of the state’s residents who could have qualified for Medicaid will be left out altogether.

Georgia’s claim is the state can’t afford it. The state has a $20 billion annual budget. It is much healthier than Kentucky. Georgia can afford it. Kentucky has a visionary governor. Georgia has an intimidated governor who probably, deep down, knows it would have been the right thing for the state to expand Medicaid and set up its own exchanges. But he lacked the political fortitude to do it.





About those companies dropping insurance…


UPS, Delta, now Home Depot. There’s a lot going on in the employer-based insurance market. And because the changes these companies are enacting come at the same time Obamacare is rolling out, it’s easy to connect them to the new law.

Today’s story is just the latest

But, as these stories unfold, it’s important to keep a few things in mind before jumping to conclusions:

* This is the time of year all large companies, including those that are self-insured, make changes in their employee benefit plans. Changes like dropping spouses from the employee plan if the spouse qualifies for a plan because he/she works for another company that offers group health benefits have been accelerating in recent years. There’s nothing new about this change, but with health insurance about to become much more widely available it may make sense for some companies to do this.

* Go back over the last 10-12 years and think about how often during open enrollment employees were shocked to read about higher premium costs, higher deductibles and higher co-pays, just to keep the plans they had. Then consider that for many workers those costs continued to rise year after year while wages stayed stagnant, and in many cases (because of furloughs and other cost-cutting measures), were cut. It was during those years that momentum began to build for major reforms in the system.

* Keep in mind that the employer-based insurance market has fluctuated widely in the plans available to part-timers. They go from bare-bones plans that don’t cover much and don’t cost much (for employees, as well as their employers) to more traditional plans that can come with a hefty price tag for both. Again, with the insurance exchanges about to open up, it only makes business sense for companies to think about whether they want to continue to offer a plan to their part-timers that may not be as good, or even as affordable, as one the employee will be able to buy on the exchange.

*Speaking of part-timers, it’s important to remember that if the job at Home Depot, or Wal-Mart, or anywhere else that hires a huge volume of part-timers is the only job the employee has — for whatever reason he or she can’t find full-time work — then these employees will more than likely qualify for a subsidy to help pay for their insurance. And because these plans must meet basic minimum benefit standards — paying for preventive care, prescription drugs, etc. — the employees could be much better off buying on the market than having to re-enroll in the plan they now get on the job. Unfortunately, because some states have decided they would rather try to obstruct the new law by any legal means necessary, Home Depot workers in California will more than likely find a more affordable plan on their state exchange than Home Depot workers in Georgia. That’s why it was important for states to create their own exchanges, so they could negotiate with insurers on behalf of consumers for a more competitive marketplace. Georgia didn’t do that. State officials couldn’t muster up even that little amount of political courage to help the state’s residents get a better deal. So Georgia consumers will have to take the prices Ralph Hudgens and his friends in the insurance industry stick them with. Still, it’s better than nothing…but, wait, I digress, that’s another post on another day.

* From the perspective of recent history anyway, it’s also important to remember that many of these large, part-time-employee-based companies were pretty damn late to the notion that while they were fat and happy they ought to be providing decent benefits to this huge volume of workers. They may have been good about providing those benefits to supervisors and full-timers, but it wasn’t that long ago that workers advocates and others shamed these companies into providing at least something to part-timers. In other words, if it took them years to start offering their employees a health plan, it shouldn’t surprise us when they choose the first opportunity they can to get out of it. Only this time, with the new law in place, their employees won’t be left out in the cold. In fact they could be better off.

So read these and future stories about employer changes in health care plans carefully. No doubt, with the market about to change so dramatically, some of the decisions being made by companies are being implemented because of the new law. But more than likely they are the result of accountants showing executives how the bottom line can be improved by diminishing — if not eliminating altogether — the continuing cost of insuring some of their employees. Come to think of it, when hasn’t it always been that way?




A lot of info to cram into a video

Sister Rose Patrice, a Dominican nun who was principal at my elementary school, once told me while she was preparing me for a speech, “Michael, even if you don’t have much to say, say it with vigor.” This guy has a lot to say, and he says it with vigor — maybe a little too much vigor. But, as we used to say in the newspaper business, he can back up more than half of what he reports. This video has been making the rounds on Facebook. It deals with why medical costs are so high and challenges some of the usual talking points on the issue. I recommend giving it eight minutes or so of your time. Here’s the link: