12 March 2017

Replace the Affordable Care Act?

I'm sharing perspectives on some of key provisions of the House of Representatives' proposed legislation to replace The Affordable Care Act ("Obamacare").  Thanks to my dad for the terrific insights and perspective based on his many years dealing with insurers and those they insure.

As you may be able to see by the comments, I'm not a fan of the proposed legislation.  I come to this issue with a bit of experience - seeing people who were totally uninsurable 5 years ago now being treated for major health conditions that would have shortened their lives or left them with significant impairment now being able to be cared for as a result of The Affordable Care Act.  I also have seen insurance premiums increasing over the last several years at the lowest average percentage than I had in the 5 years before The Affordable Care Act came into being.

There is much to dislike about The Affordable Care Act… it needs modifications.  The act left many people in a bind - unable to afford health insurance but not poor enough to qualify for premium subsidies - because their particular state didn't expand Medicaid coverage as those drafting the bill thought every state would.  Texas, a state that didn't expand Medicaid for example, leaves many people without coverage because there's no way they can afford health insurance, but they make too much money to qualify for financial assistance.  They have to make a choice each month between paying the rent or paying for food or trying to buy health insurance.  So many with dire health conditions go without coverage, without medications, and without treatment of their health problems.  But amendments to The Affordable Care Act could correct its faults.  A whole new plan isn't necessary.

The House bill being proposed is being sold as a plan that puts health care back in the hands of doctors and patients and takes health care decisions away from the Federal government.  Health care decisions are NOT being made by the Federal government.  The Federal government legislation in effect right now DOES mandate that everyone buy insurance or pay a penalty.  That puts more people in the purchasing pool, and it helps to keep premiums lower than they would be otherwise.  The GOP has blasted the insurance purchasing co-ops - low cost programs funded by The Affordable Care Act to provide alternative methods of health care delivery and reduce overall costs.  The GOP shouts that most of the co-ops have closed.  But they don't announce that the co-ops have closed mostly as a result of funding cuts made in the last several years because Republican sponsored legislation.   The GOP has been sabotaging the co-op's operational budgets.

My views on just a few key provisions of the House bill are below.  I hope you'll take some time to read over the summary and give some thought to how you feel about the legislation.  I'm sure not everyone receiving this note will agree with me that the bill is a step backwards and will end up costing us all more.  But I'm hoping that - whichever side you're on in the discussion - you'll get involved.  Let your legislators know your position so that whatever comes out of Congress at the end of this process actually does serve the needs of the broadest segment of society.

The House bill requires that no person with a pre-existing condition will be turned away from getting insurance coverage.

HOWEVER: There is no mandate that everyone must purchase insurance or pay a penalty so the pool of healthy people purchasing insurance will be smaller. A person with a pre-existing condition won't be required to purchase insurance so can go without coverage until the health condition requires treatment. Then, if the person purchases at that time - outside of open
enrollment - a 30% penalty is added to his or her premium.

If the person with the pre-existing condition can't afford the premium or chooses not to buy insurance, he can still resort to the old way of doing things...show up at the hospital emergency room, get whatever necessary treatment to keep him alive, and walk off without paying a penny. Who do you think pays for the costs of uninsured people getting expensive treatment at hospitals? We all know that the costs are passed along to those WITH insurance...our premiums are higher to cover the costs of care of the uninsured.

The House bill will reduce funding for Medicaid - a program that provides health care for those at or below the poverty level of income - which will save the federal government millions of dollars.

HOWEVER: By phasing out the additional federal funding that provided for the expansion of Medicaid (MediCal in California), millions of people who now get health insurance through that program will lose it.

Funding for Medicaid will change from a system that reimburses states for the cost of care provided to Medicaid recipients to a program that gives states a flat amount of funding each year - a "per capita" system. So when those on Medicaid run up significant medical expenses and the funding exceeds the amount allotted by the federal government, the cost of care will be passed along to the states. SOMEONE will pay - either the federal government or the state government. No savings are likely to occur UNLESS - as expected - the states significantly cut back on eligibility for coverage. In states that have not expanded Medicaid as allowed under The Affordable Care Act we already have a large group of people not eligible for Medicaid (because they are at the top end of the poverty scale) and not eligible for premium payment assistance because they make too much money to qualify. So most of these people who can't afford insurance are not covered, and their unpaid medical expenses are passed along to the rest of us in the form of higher insurance premiums and higher medical care costs.

The House bill provides income tax credits to help people afford to buy health insurance in place of the premium subsidies available through The Affordable Care Act.

HOWEVER: The income tax credits will be available at the end of the year when someone files their income taxes. During the year - as premiums are due - they get no help at all. So if premiums are unaffordable on a month-to-month basis, many people will not buy insurance at all, and they won't qualify for the income tax credits.

The tax credits available to a single person age 27 and making only $20,000 per year will be $2,000. That sounds generous except that under The Affordable Care Act, that person would qualify for a premium subsidy of $3,940 per year - paid to the insurance company in monthly installments of about $328 to help the person purchase insurance.

Making $20,000, it's unlikely that the person will even purchase health insurance if he has to wait until the end of the year to get his income tax subsidy.

A 40 year old person making $20,000 per year would have a 40% reduction in assistance with the tax credit being $3,000 versus a $5,000 amount of premium assistance.

The winners under the House plan are those making higher incomes who currently get no premium assistance under The Affordable Care Act. At incomes of $40,000, $50,000, or $75,000 per year, a 40 year old qualifies for a $3,000 per year income tax credit if he has maintained health insurance coverage for the entire year. There's no argument that this credit is welcome news with insurance premiums being at their current level; but the legislation provides this credit to those in the middle and upper income levels by essentially taking insurance funding away from those at poverty level.

This bill is being touted as only the first step in a three step process of repealing and replacing The Affordable Care Act. This first step is likely to lead to millions of people who currently have insurance losing that essential coverage. This is a life-threatening bill.

One of the next steps planned is to introduce legislation that will allow people to buy insurance across state lines. The purpose? To allow someone to purchase coverage at a lower premium in a different state that doesn't mandate as comprehensive coverage as the home state. So -for example - if one lives in California that mandates free pregnancy visits for low income people, and that person buys a plan from another state at a lower premium because that provision isn't included, the person will be saving premium dollars. However, when faced with the condition that ISN'T covered by the cheap policy, the person may not get the health care needed. Or, perhaps, the health care will be provided - once again - at the local emergency room, be unreimbursed by the insurance plan, and the costs - once again - passed along to the rest of us in higher health care costs and higher insurance premiums on the QUALITY health insurance plans.

10 June 2011

01 June 2011

The Friend Thing: Google Fail!

The Wall Street Journal reports that former Google CEO Eric Schmidt has admitted that Google missed "the friend thing".  Well, that's a shocker.  Really, Eric?


Not only did Google miss the rise of Facebook, it has a track record of mangling - or at best "sub-optimizing" - initiatives.  One of my favorite examples?  Dodgeball.com.  This service, co-founded by Dennis Crowley of foursquare fame, was an innovative location-based social software service for mobile devices.

Google saw the promise of it, acquired it, and managed it so well that Crowley left two years later after what he called an "incredibly frustrating" experience.  Google shut the service down in early 2009.  Crowley has since grown his self-proclaimed "sequel to the 'dodgeball' project" - foursquare.com - into a social location-based powerhouse with millions of unique users and enviable growth.

Think the Dodgeball example is an isolated one?  Ever hear of Google Latitude?  How about Google Buzz?  Even if you've heard of them, are either of them any more relevant today for you than MySpace, the one-time king of social media services?

Like many mature businesses, Google is grappling with change and the challenge of perpetuating its success.  What should it do as the sizzle of its core area of activity cools?  And, like many mature businesses, Google is struggling as it grasps for the great "what next?"

Fortunately, the firm has a very solid, very large, very profitable base business.  It's still riding high, but it's looking sluggish.  Having missed "the friend thing", will it be able to spot or take advantage of or even come up with "the next thing"?  Or, will Google end up like another tech behemoth, Microsoft, admired for its business success while mocked for its apparent lack of innovation?

29 May 2011

Back with a Bad Case of Techno-Lust

Hi everybody.  I know, I know... Been way too long since last post.  In fact, it's been so long that my intended "hey the Super Bowl was a while ago; remember the ads?" post seems moot.  Good thing, in a way, since the game (and the ads "in their natural environment") was deleted from my DVR.  I'm not saying the Twinkies did it to make room for more iCarly, but...

At least I'm back now.  I'll claim work and other priorities kept me distracted, but all excuses ring hollow.  I've just not kept up with blogging, and I miss it.  I'll be better. Really!  Promise!

Anyhow, the latest object of my techno-lust (cue a clever shiny object theme here) is the Asus Eee Pad Transformer.  It's desirable.  It's out of stock.  I'm having to wait.  X-mas to a five-year-old is easier than this act of patience!  I want I want I want!

In this, the day of the tablet, iPad still rules.  Many others are chasing Apple's "Jesus Tablet" (as it was dubbed pre-launch).  I'm not an Apple geek, though I massively respect the firm.  Asus may have a solution that at least matches the iPad for value, and likely is a more productive device in a couple ways:  a "real" keyboard and even longer battery life (if you count the battery in the keyboard dock, too).  Both attributes appeal to me massively.  

If and when I do get my hands on the object of my technology desires, I'll be sure to share the joys, delights, and even any disappointments with all of you.

19 March 2011

Just Back from SXSW: G's Thoughts on What's Next

I am back in my Upper Midwest home stomping grounds after several days at the SXSW Conference.  I loved the energy in Austin while I was there.

Yes, there were some great bands, most of which you've still not heard of.  The Types - from Russia, no less - generated jump-up-and-down energy in the audience, The Statesboro Review got folks jamming with their own tunes and a great cover of "Whole Lotta Love" by Led Zeppelin, TV Torso impressed even the music industry types at the back of the crowd, and Doomtree artists brought down the house on Thursday night.

What I've taken away from the conference, though, is a tremendous sense of optimism and positivity.  SXSW is a time and a place for people to come together and discuss how we are making the future better and brighter.  Whether it's the joy of music, the artistry of film, or the engagement enabled by interactive technologies, the folks who show up in Austin each year are literally creating the stuff we'll all be talking about for the next few years.

Twitter first hit the radar screen at SXSW in 2007, and I'm curious which aspects of this year's show will reach the tipping point in 2011.  My bet is on location based marketing, based on the buzz among attendees and the comments of Dennis Crowley, founder of both dodgeball.com and more recently, foursquare.  Even if I'm wrong on the specifics, it's a sure thing that something good is coming.

13 March 2011

Japan, Sorrow, and Compassion

Folks, there has been no shortage of tragedy of late.  The recent events in Japan seem to be the culmination of a string of unfortunate, sad events.

Having lived through a number of earthquakes - most of them during my years in California - I can tell you there is little as unsettling to the human soul as a furious Mother Nature.  The combined blows of earthquake and tsunami wrought destruction on a scale which stretches the imagination.  The NY Times provided me the most dramatic representation of the before and after of these events.

While we all go on with our lives, it is worthwhile to be thankful for what we have, to cherish those we love and our time with them, and to lend a hand to those in need.  Please consider making a donation to the American Red Cross or another worthy organization whose mission is to help others.

I am relieved my brother, who lives in Japan, is safe and sound.  I am sorry for all the many souls who were lost in this tragedy.  And, I am hopeful we all take this chance to display the compassion and support humanity can deliver in the most trying of times.

05 February 2011

Super Advertising Bowl Eve!

It's time.  It's the moment.  It's the culmination of a year's anticipation.  That's right.  It's Super Advertising Bowl Eve!

Football?  Oh, yeah, there's gonna be football.  There's been football for the last five months (regular & post-season only, folks... pre-season doesn't count).  And, here in the Land of Cheddarheads there is a lot of excitement building for the actual game to be played tomorrow.  The... The... What do they call it?  That's right! Super Bowl XLV.

For me, though, the game is mere filler between the real content of concern:  the ads.  Recall any of them from last year?  If not, try refreshing your memories with this past g-thought - "30 Days Later:  Remember the Super Bowl Ads?"

You can also build up your personal pre-game ad buzz by reviewing spots from 13 prior Super Bowls at superbowl-ads.com.  Who could forget the Budweiser frogs (1998) or e*trade's chimpanzees (2001)?

Regardless whether you're tuning in tomorrow for the game or the ads, enjoy it all...  I will.  I actually keep notes on every ad, though I only watch the game.  How else can I assess whether the spots deliver on the five critical tasks of advertising (engage the viewer, communicate the proposition, link it to the brand, in a memorable way, that is persuasive)?  I better sharpen a few extra pencils!

02 February 2011

Blizzaster 2011! The Branding of a Storm

Sitting in Chicago, watching the snow continue to fall, it's struck me that there's a hot competition underway to brand this storm.  Why?  It's a whopper, that's why!


Through midnight last night, records were being set for snowfall, including a one-day total of 13.6 inches at O'Hare (airport for anyone not familiar with Chicago... and yes, a few flights were cancelled).  The accumulation for the storm overall was approaching 2 feet as of 9:30 this morning, and it's still coming down.  That's right... It's still coming down!

Here are some of the branding options I've found:
With another 5 inches projected to fall today, truly polar temperatures, and more snow in the long-range forecast, the fun may just be getting underway... So, if you're stuck inside nearby or sitting someplace warmer and mocking us, the unfortunate souls of the Upper Midwest, share your thoughts on the branding options above or contribute a few of your own.  I'll be wondering how long my food provisions will hold out before I need to venture into the mounds of freezing white doom!