Today is my first day on Medicare. It’s no time for rejoicing.
This category of mandatory spending by the federal government garners renewed attention with each new congress. With Republicans having majorities in the House of Representative and Senate, it will continue to be under attack from conservatives and wing nuts. There is little comfort having made it to the next milestone on the road to full retirement.
As with any health insurance, one hopes never to have to use it.
The good news about finishing three full weeks at the home, farm and auto supply store is the company offers health insurance that meets the Internal Revenue Service “minimum value standard” for less money than coverage available through the government’s health insurance marketplace or elsewhere.
The bad news is all of the pay from this full-time job will fund health care insurance, co-pays and deductibles for our family if we seek any care. If we don’t need health care once the coverage goes into effect Feb. 1 that will leave us roughly $150 take home pay per week. We’ll need more than that to pay the rest of our expenses.
Ada Blenkhorn and J. Howard Entwistle wrote the song “Keep on the Sunny Side” in 1899:
There’s a dark and a troubled side of life;
There’s a bright and a sunny side, too;
Tho’ we meet with the darkness and strife,
The sunny side we also may view.
Most people know the version Mother Maybelle Carter sang on the 1972 record album Will the Circle Be Unbroken produced by William E. McEuan. I favor the original A.P. Carter version which hearkens back to our family roots in Southwestern Virginia. Dig deep enough and you’ll find we’re shirt tail relatives on the Addington side, which is Mother Maybelle’s maiden name.
Not only may we view the sunny side, keeping there will be the only thing that gives us hope. This first job sets a foundation upon which to build the rest of my worklife.
What else?
In the works are spring at the Community Supported Agriculture project, summer editing at Blog for Iowa, and fall weekends at the apple orchard. These were all discussed during my interview with the home, farm and auto supply company, so getting time off shouldn’t be a problem.
The most excitement I felt in a while was finding the Seed Savers Exchange 2016 seed catalog in the mailbox yesterday.
Someone gave me a packet of their scarlet kale seeds last year and it was a great addition to the garden. Too bad all of my customers are used to getting kale for free, or it could be a source of some income.
It is conceivable I could generate a thousand or so dollars from the garden this year by expanding the planting area and selling excess. Circumstances may have me doing that.
It is a reasonably warm fall day near the lake — a time for hope and getting lost in seed catalogs.
I looked at a live image of the inside of my large intestine on the monitor. It originated from a camera in the tip of a a colonoscope being operated by the physician who performed my first colonoscopy 11 or 12 years ago. It is a humbling and fascinating experience. No polyps, so I’m good for another ten years.
Medical practitioners recommend a colonoscopy for people aged 50 and older as a screening for colorectal cancer, the third most common cancer diagnosed in both men and women in the U.S. With the changes initiated by the Patient Protection and Affordable Care Act, insurance companies are required to provide the procedure without any charge, co-pays or incidental expenses.
The worst part of the procedure is clearing the bowels the day prior to the office visit. As the anesthesia wore off, we were ready for a meal and stopped at Salt Fork Kitchen for breakfast on our way home.
Check that off this year’s to-do list. Now the work begins anew.
I called into the warehouse and got a shift for Saturday. Three days off in a row would have been too much, and we can use the income. I’m also writing three stories for the newspaper and contemplating what else can be done to generate income to pay bills and reduce our debt.
Caesura came between the weary past and tomorrow’s promise with the colonoscopy.
When I get to the warehouse, I’d better fill the tank because we’re not off fossil fuels yet and my Subaru has a few miles left in it before heading to a scrap heap.
Once again, a new day dawns.
When I had my first colonoscopy there was no President Obama, no Patient Protection and Affordable Care Act, I hadn’t begun blogging, and I was on my employer’s health insurance plan.
The company I worked for would have liked nothing better than to present a cash payment to employees in lieu of paying their 65 percent share of health insurance. However, people they asked wouldn’t go for it.
My second procedure is scheduled Friday and I’m curious to see how it will be paid for by the health insurance plan purchased through the ACA marketplace for some $14,400 annually.
The ACA requires health insurance providers to cover recommended preventive services without any patient cost-sharing such as co-pays and deductibles. A colonoscopy is one of these services.
Information is seeping out through administrative cracks in the health care system. It began with a voicemail from the doctor’s office. My insurance company wouldn’t pay for the sodium sulfate, potassium sulfate and magnesium sulfate solution called a “bowel prep kit.” The kit came with two 6-ounce bottles of the solution and a handy plastic measuring cup. I asked our local pharmacist if I could buy it directly as I remembered it was inexpensive. With a $10 off manufacturer’s coupon it would have been $110, making it worth the trip to the clinic in the county seat to pick up a physician’s sample of the brew.
What I am finding in my limited personal health care is the ACA is peeling off add-on procedures that used to be covered by health insurance. No add-ons to physicals, colonoscopies, and other preventive procedures, at least in my experience.
I don’t know, but the change has to have affected gross margin for these businesses and reduced the cost of health care. Whether savings will be passed on in terms of premium reductions remains to be seen, but I doubt it.
While I didn’t receive a bill for my last physical examination, the hospital sent me a bill for lab tests, which I paid. We’ll see if there are any more cracks in the system after my procedure. If there are, I’ll be posting again.
We had a brief, light snowfall this month, and that’s it. With four days left in January, it seems unlikely winter as we know it will come.
We have had the scenic vistas, frozen lakes and automobile crashes associated with Iowa winter, but the temperatures have been nowhere near cold enough to kill off pests we want dead come spring.
I’m not an entomologist, however, it’s a problem if bugs over-winter.
On the other hand, even with warmer temperatures, most of life at home is indoors. Drawing down the pantry, preparing to file taxes, reading, writing, budgeting and planning take up much of the desk time. It’s okay, but not as much fun as it may seem.
It is time for the Patient Protection and Affordable Care Act to enter the tax filing scene. Businesses utilizing part time workers in their operations are expected to have a reckoning with the Internal Revenue Service. Depending on what time period is audited, businesses with part time employees with more than 780 hours in six months, or 1,560 hours in 12 months, will be required to pay full benefits. My 2014 totals for the job where this is relevant were 694/1,249, so my employer is in the clear.
This has been a complaint about the ACA It is said to limit how much money part time no benefits people can earn and make it more expensive for employers to add employees. IMHO, those are bad arguments against the law. If the government had provided Medicare for all instead of the ACA, the financial burden would have been much less for everyone.
As it is, the cost of health insurance premiums went up post ACA. I’m not sure this was caused by the law, or by insurance companies using it as an excuse to improve margins.
From a cost standpoint, the ACA made health insurance less expensive only in the framework of what certain lower income people pay for health insurance. There were more dollars, just shifted around with government subsidizing many newly insured people.
What matters more about the ACA is how employers manage their business.Employee costs are always a concern and a key part of any business model. Let’s face it. Small and mid-sized businesses would like to get away with all employees being independent contractors without benefits from the company. The problem is the wages paid are comparable to what used to be offered in the form of wages plus benefits, only without the benefits or the amount of money it takes to provide them.
I’ve heard I will have a reckoning with the IRS in the form of a question on my tax return about health insurance. For 2014, the answer is we had it.
As the sun rises it’s time to turn to other work. Working on newspaper articles, planting seeds and cooking will figure prominently as we work through January hoping winter actually comes.
LAKE MACBRIDE— When the U.S. Senate passed the continuing resolution to fund the government (CRomnibus) on Dec. 13, who knew what was in it?
The folks at CoOportunity Health, an Iowa nonprofit insurance cooperative established by the Patient Protection and Affordable Care Act (ACA), should have. If they didn’t, they would find out three days later when the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) notified them and the Iowa Insurance Commissioner that it would not provide solvency funding in the amount of $60 million.
CoOportunity had booked 2015 accounts receivable from the federal government in the amount of $125.6 million to meet projected claims. The shortfall in CRomnibus funding triggered a process wherein the Iowa insurance commissioner, Nick Gerhart, petitioned and was granted a court order appointing him as rehabilitator of the nonprofit.
The bottom line is that CoOportunity created health insurance policies under the ACA offering a very low premium—based upon the government subsidizing the risk. They attracted more customers than expected. A subsequent adverse claims experience resulted in deterioration of the companies financial reserves, and the funding cut in CRomnibus crippled the company. (Read analysis by the Lincoln Journal Star here).
Like it or not, Iowa is involved with fallout from the health insurance marketplace.
What does all of this mean to individuals and businesses who participate in the marketplace? The insurance commissioner was clear in a Christmas Eve press release:
The Iowa Insurance Division determined that CoOportunity Health is in a hazardous financial condition. On Dec. 23, 2014, Insurance Commissioner, Nick Gerhart, applied for and the Polk County District Court issued an order appointing the Commissioner as rehabilitator of CoOportunity Health. The company will continue in existence, but the Commissioner, as rehabilitator, is granted authority to manage the company. The Commissioner will assume management of the company; attempt to correct existing problems; continue operations; maintain policyholder accounting; and develop a plan of rehabilitation or petition the court for liquidation.
Most policyholders may find it in their best interests to find other coverage before the end of open enrollment, which ends Feb. 15, 2015.
Will people who signed up for CoOportunity health insurance on the marketplace be insured in 2015? According to the commissioner,
Yes, if you enrolled on or before Dec. 15, 2014, and you continue to make your premium payments.
No, if you signed up on Dec. 16, 2014 or later you will not have coverage with CoOportunity Health. You have until the end of open enrollment, which ends Feb. 15, 2015, to enroll in another plan.
In simpler language, Republicans can and will do anything they can to de-fund the ACA.
The other ACA-related issue that affects Iowans is the U.S. Supreme Court case King v. Burwell wherein the plaintiff seeks to strike down the health insurance subsidies provided by the federal government where states chose not to manage the health insurance marketplace. If the court strikes the subsidies, it is an open question what Iowans will do to secure coverage in the ACA marketplace, as federal subsidies are a basic idea of what the law does. Without them, participants could ill afford to pay the entire premium amounts.
Here’s what we know and knew before recent events:
It is better not to get sick, even if one has health insurance.
After taxes, health insurance is the biggest single cost in our household, representing significantly more than the mortgage payment was when we had one. We must face the music and pony up the health insurance money as a first priority.
It would have been cheaper for the federal government to put people my age into Medicare early, than to pay the subsidies to insurance companies.
For those of us fortunate enough to have had a health insurance plan throughout our adult years, the CoOportunity plan offered in the marketplace was inexpensive, but was new, and a bad deal. It did not have the network of providers we wanted. For example, instead of seeing a doctor three miles from my house, we would have had to travel to Cedar Rapids for treatment with CoOportunity. In the end, CoOportunity had inadequate capitalization and the idea of a member-owned cooperative was not sustainable, at least in Iowa.
The political will to take care of people’s health care needs, whether by the government or by other means, does not exist in Iowa and elsewhere. We are on our own when it comes to sustaining a life in a turbulent world.
There is a lot more that can be said about the ACA and the Republican opposition to it. Here’s hoping Democrats built enough resilience into the law.
LAKE MACBRIDE— We rush toward the new year with hope. Imperfect, we still try and that is something. Some would say it is everything.
On a piece of scratch paper I estimated 2015 income from known sources. The information was to apply for a tax credit during the open enrollment period in the Health Care Marketplace. Our budgeted income is about the same as 2014 actual, although with fewer part time jobs. We qualified for a tax credit of $13,224, which will actually be a payment by the federal government to a health insurance company.
The Patient Protection and Affordable Care Act has been under relentless criticism and legal challenge, and it’s far from over. The Muscatine Journal published an article that explained the current case to be heard by the U.S. Supreme Court this spring or summer.
“The court has decided to hear a case that questions the legality of federal subsidies for private health insurance purchased via the federal government under the new health care law,” Erin Murphy wrote. Depending upon what the court decides, the tax credits like mine may be on the chopping block for some 24,000 Iowans.
If the subsidy is eliminated, and lawmakers take no corrective action, it means I would have to find more part time work to produce weekly take-home pay of $254.31 to pay for health insurance. It would be the equivalent of working another 30-hour per week job at about $8.50 per hour.
In 2011, Medicare cost $549.1 billion to provide services for 48.7 million beneficiaries, according to the Medicare Newsgroup. That works out to $11,275.15 per year, or $1,949 less than the tax credit we were provided in the Marketplace. It seems doubtful a politician could connect the dots, but wouldn’t it be cheaper to lower the eligibility age for Medicare and pay less to insurance companies? That makes sense, so what was I thinking?
I’ll complete the process of choosing a plan before the Dec. 15 deadline, and it looks like we’ll keep our current policy. Then we’ll wait and see what the high court does.
And we’ll still be trying to sustain a life in a turbulent world.
LAKE MACBRIDE— It has been a day of staying busy indoors. The driveway is loaded with snow, and without any need to leave the property, we didn’t. Tomorrow is the big dig to get ready for work and a trip to the grocery store, but not today.
There was some kitchen work. I brought the last of the fall apples upstairs, setting aside some for baking, and made apple sauce of the rest. The Winecrisp and Gold Rush apples were past their prime, but stored well. I also made a pot of winter soup which is simmering as I type. The malady about which I wrote Saturday is on the mend. What I know is health care is about staying healthy, and I’m working on that.
The good news is I feel well enough to start reading again and picked out a book. By tomorrow I hope to be ready to wield a shovel and dig the way out to the road that leads to town.
LAKE MACBRIDE— All the people waiting for the Patient Protection and Affordable Care Act to collapse under its own weight had better find something else to do. Almost four years in, there’s no way to hop in the DeLorean, go back in time and undo the good the law has already done.
Don’t get me wrong. I expect to hear more laments and entreaties about how wrong it was for President Obama to do it, and that government is taking over health care, yada, yada, yada. Please people. Get a grip. We went through all of these arguments during the Clinton administration. When the Republican idea of filibustering health care reform to death the way Bob Dole did died, so did the idea of repealing Obamacare. If Republicans gained control of the presidency and both chambers of the legislature, how would the repeal even work three years from now? Could they go back in time and undo the mammograms already provided, the colon screenings performed, or take away the happiness people who didn’t have health insurance experienced when they got it? I suppose one Back to the Future reference is sufficient: they won’t be able to go back in time, and some form of the law is here to stay.
The ship has sailed for Obamacare, and by that I mean we are in a period of waiting to know how it will work out. The website is working. The reforms set in place are working. The number of enrollments is increasing. What seems most important about new enrollments is answering the question, what kind of medical treatment will people require? Even though part of the new fee structure includes a premium for excess insurance to cover a bad claims experience, if everyone who comes into a plan needs expensive treatment, it will skew the costs. How will that work out? We won’t know until insurance companies review the data and actuarial experience and set 2015 rates. So we wait. For the close of open enrollment on March 31, and to see the claims experience during 2014.
Josh Mitchell of Talking Points Memo has written that as enrollments increase above ten million people (not a typo, read the article), so does conservative rage. Chill dudes. Greg Sargent of the Washington Post has suggested there are three stages of Obamacare acceptance. Get with the program.
What seems clear to me is that once people get health insurance two things will happen. First, life will return to a semblance of normal, and people will discover that having health insurance is far from a perfect situation. Conservatives will be quick to point this out, although we all know this experience is logical and predictable. Secondly, Obamacare will become the paradigm, generating new struggles to reduce government costs for Medicare, Medicaid, nutrition and other programs, while at the same time attempting to do right by the American people. We’re moving forward in the incredible storm and stress that is living in this country.
If you don’t like it, either move into a yurt, or contribute something positive to the discussion, one our country has been having since Harry Truman was president. A discussion that is likely to continue for the foreseeable future.
Late last Thursday the electronic payment to Coventry Health Care cleared our bank account, indicating we have new health insurance coverage effective Jan. 1, 2014, purchased on the exchange created by the Patient Protection and Affordable Care Act. With that action, our household budget changed from health insurance costs that were 38.0 percent of annual expenses to 9.8 percent. The budget decrease was due solely to the federal tax credit for which we qualified, as the new policy cost more than the current plan. As vice president Joe Biden said to president Obama when the bill was signed into law, “this is a big fucking deal.” It is bigger than just one household budget.
Iowa is a place where a large majority of people already had health insurance before the ACA became law. As of Dec. 11, only 757 individual Iowans had signed up for a plan on the new exchange. Iowa’s target for enrollments was only 6,970. Here’s what seems most noteworthy moving forward.
The fact that Iowa’s largest insurer, Wellmark Blue Cross and Blue Shield, decided to opt out of the exchange in 2014 was significant. Since the law was enacted, Wellmark has been bringing their individual policies into compliance, removing the lifetime limits, and increasing the amount of covered preventive care, and taking substantial rate increases as they did. In a brilliant public relations move, they attributed their 2014 rate increase solely to the requirements of the new health care law. (That rate increase was very low at 6.8 percent). For 2015, Wellmark is likely to enter the exchange, and take another significant rate increase, again blaming the ACA requirements.Why is that important?
As a large business with substantial financial reserves, Wellmark will have used the time between 2010 when the law was enacted until October 2014 when the next open enrollment period begins to study the law and its effects on their business and competition to make a smooth transition. But also to maximize market share and profits. Here’s how.
In a marketplace people can shop for things, but they also can compare prices and the value proposition. It’s consumer behavior 101. Prices include the cost of delivery for the service and a gross margin (the difference between the selling price and cost of delivery). Today, almost all of the 30 health plans for which I was eligible were significantly more expensive than my current Wellmark policy, with a lot of variation in coverage. Whatever changes Wellmark has to make to finish the compliance process and enter the market, they will be positioned to sell a similar or better insurance policy for a lower price without substantial changes in their gross margin. This will enable them to pick up increased market share.
What almost no one is talking or writing about is the November report from the White House that describes how the underlying expense of providing health care is coming down already, as a part of the reforms of the ACA. These three bullet points from the report tell the story.
What does that mean for companies like Wellmark? Because of the new law and its impact upon underlying costs, they have a generational opportunity to make a bigger profit from their policy holders. This opportunity is made better by the ability to review their competitors’ pricing in the public health insurance marketplace. Wellmark will also benefit by watching what marketplace adjustments are made as the first year unfolds and how their competitors handle them. Thank goodness for the 80-20 rule that requires individual insurance policies to spend at least 80 percent of the premium dollars on health care. If I am missing something, please let me know by commenting on this post, but 2015 should be a very good year for Wellmark.
What about for the rest of us? Like always, I intend to stay away from the doctor as much as I can, taking an annual exam, and a colonoscopy that is covered by my new plan without any copay or expense on my part. (Fingers crossed on the outcome). Other than that, I’ll go on living with one less worry than I had before Obamacare came into reality.
~ Written for Blog for Iowa
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