2020 New Year Concerns: Why the Hell Are Consumers Trusting Congress on Health Insurance? Part IV

Part IV addresses the October, 2019 findings that more children are uninsured in the years 2016 through 2018, which are already being used in partisan politics in 2020 campaigning.

Here it's pretty obvious that the number of uninsured, the argument relied upon to justify many of Obamacare's features, including the individual mandate, even when the uninsured are children, should NOT be a reason to vote one way or the other necessarily.

We're already living with the consequences of President Obama's approach of over-simplifying the health industrial complex problems facing consumers into "the number of uninsured." That has already proven to be a focus that might sound great politically, but in reality made the barrier of cost to access to needed health CARE services, in many instances, worse, even for those with insurance.

Number of Uninsured is NOT the key cause or solution to COST as a Barrier to Needed Health Care Services:

Flashback: Obamacare focused on the number of uninsured, as if lack of health INSURANCE was the primary factor responsible for COST of CARE becoming a barrier to access to needed health care. Some might still nod their heads at this assertion, ignoring the dangerous consequences of concluding that merely getting more people insured is a solution to the cost barrier to needed medical care instead of a focus on the type of health INSURANCE that would protect people from the financial risk of ruin from illness or injury.

Obviously, to the extent insurance FAILS to cover the costs associated with illness and injury and thereby prevent financial ruin, it is a less useful tool and therefore, merely having insurance does NOT prevent COST from being a barrier in obtaining needed medical services.

It cannot be argued that this was an Obama "mistake," because Congress and Obama made very certain, from the outset, that their health insurance would be not only remain superior in its coverage compared to what they deemed good enough for the rest of us, but that taxpayers would continue to pay for their public employee superior coverage. Ignored but known, Obama distracted the public from the fact that the quality of health insurance coverage and its cost matter as much or MORE than merely "having" health insurance.

Flash Forward: Medicare For All continues the dangerous trend of focusing on getting people insured rather than making sure that the health insurance product does what it's supposed to, protect consumers from the financial ruin IF they need medical services. Like Obamacare, there are no promises to make the consumer financial product of health insurance adequate to protect us against the financial risk of illness or injury, AND Medicare For All gives government even more authority and decision-making power on what our health CARE options will look like, specifically with enormous powers granted to the Secretary of HHS:

Go to Section 401(a)(1), Administration: "The Secretary shall develop policies, procedures, guidelines, and requirements to carry out this Act, including related to— (A) eligibility for benefits; (B) enrollment; (C) benefits provided; (D) provider participation standards and qualifications, as described in title III; (E) levels of funding; (F) methods for determining amounts of payments to providers of covered services, consistent with subtitle B; (G) the determination of medical necessity and appropriateness with respect to coverage of certain services; (H) planning for capital expenditures and service delivery; (I) planning for health professional education funding; (J) encouraging States to develop regional planning mechanisms; and (K) any other regulations necessary to carry out the purpose of this Act.
(2) REGULATIONS.—Regulations authorized by this Act shall be issued by the Secretary in accordance with section 553 of title 5, United States Code."

Further, under section 201, the Secretary is authorized "on a regular basis, evaluate whether the benefits package should be improved or adjusted to promote the health of beneficiaries, account for changes in medical practice or new information from medical research, or respond to other relevant developments in health science, and shall make recommendations to Congress regarding any such improvements or adjustments." (Sec 201 Comprehensive Benefits, (b) Revision and adjustment)."

Note, in addition to Medicare For All's enormous power and authority granted to the HHS Secretary, there appear to be no time limitations on how long Congress can take to assess and act on those HHS Secretary 201 recommendations EVEN IF THEY ARE essential for consumers. Medicare For All therefore creates a worsening two-fold problem, governmental overreach and dependence on a functioning Congress to make needed adjustments to protect consumers.

Cost Sharing:

Flashback: Obamacare resulted in increased cost sharing by consumers. Not only did consumers see steep increases in their deductibles, copays and coinsurance, but insurers increased the prices of premiums for their plans upwards of over 100 percent, in many cases.

Of course, these increases for exchange participants were disguised through the Obamacare government payments in the form of premium assistance, and for some, government cost-sharing provisions, yet STILL COST, even the reduced cost to participants on exchanges didn't prevent the COST of obtaining and using health insurance from remaining a persistent hurdle for consumers purchasing Obamacare exchange plans.

We know this from outcomes, first and foremost that in 2020 no candidates support Obamacare as is and instead are talking about either improving, replacing or repealing it.

We also know from reporting on enrollment in Obamacare exchange plans the such enrollment overall has never met promises or expectations and that even enrollment among all metal level plans has indicated that consumers sought cheaper bronze plans if they could, if they were healthy, specifically, which provide premium assistance, federal money for buying insurance, but unlike silver plans do not provide the option of the added benefit of cost sharing funds for USING health insurance for enrollees within lower income guidelines.

We also know that in 2015, Obama's Administration raised the prices for silver plans, but a lot less than prices were raised for bronze plans in that benefits year to further lure people into silver plans by offering better "value."

We also know that Obama's Administration changed the law regarding short-term health insurance plans, restricting those plans in 2015, in another effort to get people onto exchange plans.


Flash Forward: Without even attempting to calculate the tax increases that likely will be never-ending to support Medicare For All, what we are informed of is that OUT OF POCKET PAYMENTS could very well skyrocket causing more financial ruin for citizens under Medicare For All than we have now (where already 66 percent of bankruptcies include medical expenses as a cause).

This is for two reasons, first, because we have an unlimited tax increase potential as government determines what funding is needed and secondly because Medicare For All is presented as a bare minimum preventive care plan, primarily, with specific provision of all the uncovered services, drugs, and needed medical care being covered by the PURCHASE of private supplemental insurance plans with no limitations on what's charged for such supplemental coverage and-or the cost of services these private supplemental "contract" plans cover.

Even under Medicare For All, in Section 202, No Cost-sharing, we find that (a) The Secretary shall ensure that no cost-sharing, including deductibles, coinsurance, copayments, or similar charges, be imposed on an individual for any benefits provided under this Act, except as described in subsection (b).
(b) Exceptions.—The Secretary may set a cost-sharing schedule for prescription drugs and biological products." 202 (b)(1)(a) notes that such cost sharing be limited to $200 per person each year, adjusted annually for inflation.

We've already got experience with the Federal government determining our out of pocket limits. Under current law, this number has jumped significantly. In 2011 the out of pocket maximum for self-only was $5,950, and for a family was 11,900. As of 2020, it is 8,200 for individual plans and 16,400 for family plans.

We might be tempted to say, "Well, 200 bucks is a lot better than the thousands of today," but remember, Medicare For All doesn't EVEN CONSIDER all the out of pocket expenses to consumers purchasing private health insurance contracts for uncovered services, which we know will be an enormous part of insurance purchasing because of the bare minimum coverages of Medicare For All, AND we know that there is no LIMIT to what can be charged not only for those supplemental insurance coverages, but for the health care services provided for under those contracts.

Further, we have no idea how much our taxes will go up to cover the costs of the bare-minimum Medicare For All coverage, but we do know that cost sharing of at least 200 bucks per person per year for prescription drugs and biological products is built in, with provision for increases in that amount for inflation.

Flashback: Obamacare did not address balance billing or surprise billing except for emergency stabilizing treatments in emergency rooms. Today, we see that Congress is still "working" on a federal fix to balance billing (and surprise billing) though many states have begun to address this devastating financial risk to consumers.

Flash Forward: Under that same NO COST SHARING section 202 of Medicare For All, (which actually provides for cost sharing) we are also promised no balance billing: 202 (c)Notwithstanding contracts in accordance with section 303, no provider may impose a charge to an enrolled individual for covered services for which benefits are provided under this Act.

Basically, Medicare For All as outlined is like an HMO, authorized providers giving authorized services (as yet unknown and always subject to change by the HHS Secretary), and likely pretty "basic," meaning lots of preventive stuff with inadequate opportunities for real care for NEEDED medical services are not subject to balance billing, everything else, you're on your own.

An enormous part of medical services are likely NOT to be covered by Medicare For All, and only covered by private insurance contracts, which is why the law spends much time in describing such contracts under section 303.

Starkly drawing a difference between balance billing (those charges uncovered by insurance for which a consumer is financially responsible) and surprise billing (those charges uncovered by insurance for which a consumer was unaware," Medicare For All only prohibits SURPRISE billing.

Let's get to that Sec 303: Use of private contracts. Subject to the provisions of this subsection, nothing in this Act shall prohibit an institutional or individual provider from entering into a private contract with an enrolled individual for any item or service" as long as neither the provider, his institution or we, the consumer are making any claim that such service is covered under the Act, which we already know or should know will be the bare minimum as outlined in the Act's "list."

This one goes to the heart of our financial ruin.
Section 303 reminds consumers under (2)(C) that the beneficiary (consumer) "acknowledges that no limits under this Act apply to amounts that may be charged for such items or services," and that consumers are ultimately responsible for the costs charged by providers.

Medicare For All legislation advises us that what providers charge for such services covered by contracts is UNLIMITED as long as the consumer signs a contract saying they're aware of the cost and that they the consumer know they the consumer are responsible for it.

This is even more financially risky because outside of the Medicare For All basic insurance, consumers who purchase policies to cover these UNLIMITED expenses from insurance companies will not be protected by how much can be charged in premiums or copays or coinsurance or deductibles.

This alone should be enough to warn people off the Medicare For All as outlined by Bernie Sanders in his bill.

So what about that specious argument to vote one way or another because of a growing number of uninsured children?

Flashback: Even with Obama fans' determination to boost Obama's long list of failed promises about Obamacare by narrowing and focusing on the singular goal that Obamacare would "solve" the problem of the uninsured, we know even this didn't happen. There remain millions upon millions of people without health insurance, including the increase of children uninsured.

Flash Forward: Although conceivably, all would eventually have insurance under Medicare For All, we cannot be certain because we know all the changes to Obamacare that occurred after the law's enactment changing the original law. See https://galen.org/2016/changes-to-obamacare-so-far-3/, which includes "43 that the Obama administration has made unilaterally, 24 that Congress has passed and the President has signed, and 3 by the Supreme Court," 70 Changes to Obamacare… — So Far," POSTED BY Grace-Marie Turner, January 28, 2016.

What we do know is that under section 106, Medicare For All promises an effective date of FOUR YEARS after the law's passage (though for children under 106(b) coverage (through age 19) would begin January 1 of the first year after enactment, leaving plenty of time for similar changes to the proposed law.

There is no reason to suppose that President Trump has been worse for children than President Obama when it comes to health insurance. Actually, arguably the opposite is true.

Here we'll go to one of those October, 2019 anti-President Trump articles that desperately tries to lay the "blame" for the increased number of uninsured children at the Trump Administration's feet, an October, 2019 report out of Georgetown by Joan Alker and Lauren Roygardner, "The Number of Uninsured Children is on the Rise," https://ccf.georgetown.edu/wp-content/uploads/2019/10/Uninsured-Kids-Report.pdf. All cites will be from this report unless otherwise indicated.

The article begins: "From 2016 to 2018 there were more than 400,000 more children uninsured in the United States." OK, so from one year before Trump's presidency, which began on January 20, 2017, the number of uninsured children has been on the rise. That's right, from BEFORE Trump was President.

Spoiler alert, to get to the meat of the report's partisanship reasoning let's go straight to the report's conclusion:
"This serious erosion of child health coverage is likely due in large part to the Trump Administration’s actions that have made health coverage harder to access and have deterred families from enrolling their eligible children in Medicaid and CHIP.

These actions include attempting to repeal the ACA and deeply cut Medicaid, cutting outreach and advertising
funds, encouraging states to put up more red tape barriers that make it harder for families to enroll or renew their eligible children in Medicaid or CHIP (or ignoring it when they do), eliminating the ACA’s individual mandate penalty,
and creating a pervasive climate of fear and confusion for immigrant families. That has left many of these families
reluctant to enroll their (largely) citizen children in public coverage for fear of having this held against them."

OK, let's get rid of the easiest fallacy first, that somehow eliminating the ACA's individual mandate penalty increases the number of uninsured children. Financially this makes little sense since the individual mandate penalty funds collected by government are not destined to be spent on healthcare. As a matter of fact, it's unclear where these penalty dollars are spent by government. So, unless this is a sneaky way of arguing for a higher individual mandate penalty, which many Democrats have advocated because people chose to pay the penalty rather than purchase health insurance, this is not persuasive.

Nor is it persuasive that the argument that the repeal of the individual mandate accounts for the increased cost of Obamacare exchange plans, thereby somehow increasing the number of uninsured children. Most obviously, because the elimination of the individual mandate penalty was not effective until 2019, meaning that only for 2020 tax filings might the elimination of such penalty come into play.

Further, if partisans try to stretch it further and claim that anticipation of actions attempting to repeal Obamacare somehow influenced individuals' annual choice of health insurance for a year prior to President Trump's presidency or that elimination of the individual mandate encouraged people to opt out of purchasing health insurance, somehow retroactively inspiring insurers to raise prices for consumers on Obamacare exchange plans, this would be a lie.

Obama's own government told us that Obamacare plans would continue to rise in price way back in 2015, long before Donald Trump and before the 2016-2018 statistics of more uninsured children.
That's right, in 2015, Obama's Administration, Congressional Budget Office stated, "For the years 2016-2018 the cost of silver plans on the exchanges is expected to rise “…at an average rate of 8.5 percent per year… for two reasons: REINSURANCE PAYMENTS THAT THE GOVERNMENT MAKES TO INSURANCE PLANS whose enrollees incur particularly high costs for medical care WILL BE PHASED OUT over the next two years, placing upward pressure on exchange premiums [AND] PLANS INITIALLY OFFERED THROUGH THE EXCHANGE APPEARED TO HAVE, in general, lower payment rates for providers, NARROWER NETWORKS of providers, and TIGHTER MANAGE OF THEIR SUBSCRIBERS' USE OF HEALTH CARE than do employment-based plans. CBO and JCT anticipate that many plans will not be able to sustain such low provider payment rates or such narrow networks over the next few years, placing upward pressure on exchange premiums.” (CBO, Pub. 49973, page 22). [caps added].

It wasn't the only warning issued by the CBO under Obama: "Private Health Insurance Premiums and Federal Policy," https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/51130-Health_Insurance_Premiums.pdf:
"Over the period from 2005 to 2014, premiums for employment-based insurance grew by 48 percent for single coverage and by 55 percent for family coverage. CBO and JCT expect them to grow at similar rates over the next decade." -CBO

That's right, premiums went up by 55 percent for families from 2005 to 2014, that's according to the CBO under Obama, and there was NO SLOWDOWN of those increases anticipated by Obama's Administration over the next 10 years, so doing our math, that brings us to 2024. Not at all an indication that President Trump had much to do with premiums rising.

Back to the Georgetown report's next claim blaming Trump for more uninsured children: "These actions include attempting to repeal the ACA and deeply cut Medicaid," both cited by the report as apparently creating the increased number of uninsured children from 2016 to 2018. This must also be immediately dismissed because note the magic word "attempting." In fact, the ACA is not repealed and Medicaid has not been deeply cut.

Back to the Georgetown report's next claim: "…creating a pervasive climate of fear and confusion for immigrant families. That has left many of these families reluctant to enroll their (largely) citizen children in public coverage for fear of having this held against them." This is just straight-up partisanship drivel since even the irrationality of Trump haters can't blame the President for immigrant families not enrolling their children in public health insurance for which they're eligible.

Remember under Obamacare, (see healthcare.gov), "Immigrants who are 'qualified non-citizens' are generally eligible for coverage through Medicaid and the Children’s Health Insurance Program (CHIP), if they meet their state’s income and residency rules." There were already restrictions under Obamacare for non-citizens only, also not singling out their citizen children at all beyond state residency requirements that apply to all.

Contrary to its own reasoning, the Georgetown report under the heading "Sources of Coverage," states that In 2018, the largest source of coverage for children continued to be employer-sponsored insurance, though there was no statistically significant change between 2017and 2018 despite the continued strong economy and low unemployment rates."

The report acknowledges a strong economy and low unemployment, in addition to the fact that most children are insured through their parents' employer sponsored health insurance.

Obviously then, changes to employer-sponsored health insurance that would discourage dependent coverage of children would contribute to more uninsured children.

Well, that's Obama's gimmick of the family glitch, unaddressed and uncorrected for a decade because it would cost the federal government too much to fix. The family glitch also NOT President Trump. The family glitch gets a dismissive mention by the Georgetown folk: "The 'family glitch' may be contributing to the difficulties that families are facing in accessing marketplace subsidies."

Difficulties accessing marketplace subsidies to insure their children? That IS the family glitch under Obamacare, because employees who have access to affordable employer-sponsored self-only health insurance are INELIGIBLE for premium assistance if they purchase an Obamacare exchange plan.

This left full-price individual insurance plans, short term health insurance or CHIP to cover these employees' children. (Which is addressed further on.)

The Georgetown writers assert: "Children from higher-income families are also seeing increases in their uninsured rates, though those rates are still considerably lower than the national average. This likely reflects the rapidly increasing cost of employer-sponsored family coverage, reduced participation in subsidized Marketplace coverage, and the repeal of the individual mandate penalty."

As noted, the rapidly increasing cost of employer-sponsored family coverage was part and parcel of Obamacare, predicted by Obama's own government for many years. The family glitch, we know is laid at Obamacare's feet and remains ignored and uncorrected for a decade. We've already addressed the "repeal of the individual mandate," which only took effect for year 2019, tax filing in April, 2020.

What about families that tried to deal with gaps in insurance from unemployment or inability to afford employer-sponsored dependent coverage or individual marketplace plans for whatever reason by choosing to purchase short-term health insurance as a stopgap for making that decision?

Well, we know that it was Obama's administration in 2015 considered that a "loophole,' a means of avoiding participating in the marketplace and instead of expanding premium assistance coverage to such "ineligible families," the Obama Administration in 2015 severely restricted the availability of short-term plans. That Obama decision, President Trump has reversed.

But what about CHIP, that plan that covers children whose parents earn too much for Medicaid but still fall within some income requirement guidelines? This is where the "report" gets even more twisted in its reasoning. Switching to public insurance, Medicaid/CHIP, the report states that Medicaid/CHIP "administrative data clearly show that Medicaid/CHIP enrollment has declined substantially for children."

The report states that "children from low- and moderate-income families earning between 138 percent and 250 percent of the federal poverty level ($29,435 - $53,325 annually for a family of three) had the sharpest increase in their
uninsured rate and the highest uninsured rate compared to other children. Most of these children are likely eligible for Medicaid or CHIP but not currently enrolled."

Well, if they're eligible but not enrolled, that isn't on Donald Trump unless you argue that by reducing the budget for advertising for Obamacare, President Trump is somehow responsible for uninsured children. This seems pretty unlikely primarily because MEDICAID AND CHIP do not have an OPEN ENROLLMENT PERIOD. You CAN APPLY FOR MEDICAID OR CHIP AT ANY TIME.

Instead of partisan politics, a little reality check indicates that Obamacare actually wanted to get rid of CHIP and anticipated moving those children either into expanded Medicaid or onto Obamacare exchange plans.

FLASHBACK: Though often categorized together, Medicaid and CHIP, the children's health insurance program, are not the same in some very important ways. CHIP typically covers children whose families do NOT MEET the poverty level required for Medicaid. That's right, CHIP usually requires different income guidelines so the threshold for obtaining CHIP is usually less restrictive in terms of limits on income, eg those with higher incomes can utilize CHIP. CHIP also often includes state residency requirements.

As KHN.org explained in 2014, "ACA And The Children’s Health Insurance Program," https://khn.org/news/aca-and-the-childrens-health-insurance-program/, "The Children’s Health Insurance Program (CHIP) was enacted in 1997 to extend health coverage to children in poor families with modest incomes too high to qualify for Medicaid. The Affordable Care Act now offers many of those same families federal subsidies through the health insurance exchanges, calling into question whether the program should be continued over the long term."

However, as we know, or should know, Obamacare plans were always considered still too expensive by many, including the vast majority who received premium assistance, and especially for families unlucky enough to be victims of the family glitch who were ineligible for premium assistance, making it obvious that some preservation of the old CHIP program was necessary. Although Obamacare deemed the CHIP program dispensable and thereby merely included funding only through 2015, with a provision that after that Congress would have to authorize additional funding, under President Trump, in 2018, Congress funded CHIP for a full decade, that's right, 10 years.

The article concludes that "There are no signs that this disturbing trend in children's health coverage will abate unless national and state leaders fully rededicate themselves on a bipartisan basis to the goal of ensuring that all children have access to affordable, comprehensive health insurance."

Ah, and therein lies the next problem. Medicare For All will not be comprehensive health insurance, which should be pretty obvious if you read Section 201, Comprehensive Benefits which continue the trend of listing coverages, many of which are preventive rather than NEEDED medical services. Further, Medicare For All anticipates the inadequacy of its basic coverage with its Section 303, Use of Private Contracts provisions.

In other words, Obamacare created the conditions that could foreseeably cause an increase in uninsured children with his "vision" of doing away with CHIP and moving everyone onto exchange plans or into Medicaid, with the uncorrected family glitch, meaning that even those who couldn't afford dependent coverage might shop on exchanges but were ineligible for premium assistance, by limiting the availability of using short-term health insurance which might provide some protection to children whose parents earned too much for Medicaid but could not be insured under another program.

Medicare For All as proposed, will, like Obamacare focus on making sure everyone has some kind of health insurance, and therefore in its simplest terms could address the "problem of the uninsured," including the "problem of uninsured children." However, as written, Medicare For All will not likely protect children who are ill from the cost of treating their illness because it continues the Obamacare preventive care focus at the expense of truly protective illness/injury coverage and because private contracts will likely be necessary for purchase in order to obtain meaningful risk coverage, much like today's Medicare supplemental insurance, and because such uncovered services by Medicare For All will remove any limits to how much can be charged both for the supplemental policies and by providers to people who purchase such plans.

Under Medicare For All, there is also the "idea" that everyone, even public employees will have the same coverage within Medicare For All, but like Obamacare, it is unlikely Congress will legislate away their superior benefits paid for by taxpayers. Read carefully, Medicare For All anticipates getting rid of the Title 5 chapter 89 of United States Code for federal benefits, it doesn't say there won't be new ways enacted by Congress for public employees to be funded by taxpayers.

In fact, it's obvious from our Obamacare experience that public employees and Congress will protect themselves through the excuse that the federal government is an employer, and therefore, as an employer can choose to provide superior benefits to employees, including Congress who not only just happen to pass the laws for themselves, but are funded by taxpayers for those choices. Even without the "employer" door, old-time tricks of increases in their salaries to cover those "uncovered" costs, or other money allotments to cover the cost of purchasing supplemental plan style contracts funded by taxpayers could easily be used by Congress.

The federal government has proven itself inadequate in addressing the cost as barrier to needed medical services problem in the US. These risks to children's health and all of our health continue with each party's proposals and rather than being a justification to vote one way or the other, should be an inspiration for consumers to focus on what we need from the product of health insurance in order to make it a useful tool in protecting us from the risks of financial ruin that today accompany illness or injury and then communicate that to our government representatives.

2020 New Year Concerns: Why the Hell Are Consumers Trusting Congress on Health Insurance? Part III

We were lectured by the Affordable Care Act's boosters, key among them President Obama, that reducing the number of uninsured was a chief goal that depended on decreasing COST barriers to obtaining health insurance. Like so many Obama statements, the use of a study cited to support this idiotic claim that merely having health insurance would solve our problems of cost barriers to obtaining health care, as if health insurance is some magical amulet rather than a consumer financial product that varies in what it provides and how much it costs, was manipulated into justifying Obama's agenda of amorphously "reforming" health care with the Affordable Care Act which in most measurable ways has made the COST barriers for the majority of Americans worse.

In Obama's repetitive self-promotion of the false equivalency that "health insurance=health care" it's increasingly clear that Obama deliberately misled consumers. Obama didn't accurately state what the findings of the study were. [See What if I Said that "Obamacare Was Killing Americans"? http://conoutofconsumer.blogspot.com/2015/02/what-if-i-said-that-obamacare-was.html].

The study used to justify the Obama government con that health insurance=health care was 2012 research, “Mortality and Access to Care Among Adults After State Medicaid Expansions,” by Benjamin D. Sommers, Katherine Baicker, Arnold M. Epstein, New England Journal of Medicine, online July 25, print September 13, 2012, that found that “…expanding Medicaid to low-income adults leads to widespread gains in coverage, access to care, and—most importantly—improved health and reduced mortality.”

Now with Obama in our rearview mirror, it should be less difficult for his protectors to notice that the "study" actually found that basically free health insurance (Medicaid) with basically free health care (Medicaid services) led to gains in coverage (some health insurance versus none) and access to basically free care, improved health and reduced mortality. It was not the FACT of simply having or not having insurance, but the FACT of what that insurance provided, meaning that the affordability of care was as integral as the affordability of purchasing health insurance in order for the study to prove anything.

Having no health insurance did not impact health EXCEPT to the extent it meant you could not afford health CARE. Similarly, having all the health care available to you in the world is only useful if you can AFFORD it, and health insurance was one way people afforded health care. The two are integrally tied together, health insurance doesn't equal health care except to the extent it covers the COSTS of needed health care. Obamacare worsened both and therefore INCREASED barriers to health care with increased costs.

So, the study found, unremarkably, that getting needed medical care improved health and reduced mortality and that when both obtaining Medicaid and getting that care is free, COST barriers are reduced and health and longevity improve. This is NOT AT ALL what Obama and Obamacare was selling with the false equivalency justifying the real meat of Obamacare, the creation of health exchanges.

Flash Back: With the false equivalent that health insurance = health care, Obama was off and running with the myth that having any health insurance would naturally improve health care, a fallacy because if you can't afford care, you are facing a cost barrier whether or not you have health insurance, therefore the QUALITY of that health insurance in terms of coverage matters. This part of the con is also borne out today as up to 66 percent of US bankruptcies cite medical expenses as part of the reason for families' financial ruin and most of those individuals HAVE health insurance.

Obamacare ignores that Obamacare WORSENED the COST BARRIER TO HEALTH CARE FOR THE MAJORITY OF AMERICANS WITH EMPLOYER SPONSORED HEALTH INSURANCE. Obamacare and its deals with insurance companies ended up in increased premiums (the cost of obtaining health insurance) and increased cost of using health insurance for getting needed medical care (increased copayments, coinsurance payments, higher deductibles) for the majority of Americans.

The cost of OBTAINING health insurance went up over a hundred percent in most cases, which as recently as 12/16/2019, Drew Altman noted the increased costs of private insurance https://www.axios.com/health-insurance-costs-private-medicare-medicaid-c40bb6f1-c638-4bc3-9a71-c1787829e62e.html. And the cost of using health insurance also has left Americans in need of medical care and services in increased financial jeopardy.

Even the LA Times, which bent over backwards to justify all things Obama including Obamacare, noted in May of 2019, in an article by Noam N. Levey, "Health Insurance Deductibles Soar, Leaving Americans with Unaffordable Bills," https://www.latimes.com/politics/la-na-pol-health-insurance-medical-bills-20190502-story.html, stating that of those polled with employer-based health insurance "Half said that costs had forced them or a close family member to delay a doctor's appointment, not fill a prescription or postpone some other medical care in the previous year."

Still eager to never criticize Obama, the article implied it was simply an oversight and that "as Democrats and Republicans fought over the law, Altman said, neither focused on the rapid run-up in costs for people covered through work." [LA TIMES, 5/2/2019, Noam N. Levey] in other words, lawmakers were stupid.

Hold it right there. This claim is not supported by the facts which more closely support an assertion that OF COURSE Obama's Administration knew they were screwing the majority of Americans by creating the entitlement program of Obamacare exchanges with the false equivalency that any health insurance improved health care, even if the insurance is so bad that it leaves individuals unable to afford to get needed medical care.

Instead, Obama prioritized his political agenda and focused on the falsehood that ANY HEALTH INSURANCE improved HEALTH CARE and therefore the fewer number of uninsured there were, the healthier the population would be. Nonsensical. If you can't afford to use your health insurance because like Obamacare it costs you more than you can afford to get NEEDED HEALTH CARE, then health insurance is meaningless EXCEPT for satisfying the political agenda of a President like Obama. This is borne out by the LA Times poll of December, 2019, "Half said that costs had forced them or a close family member to delay a doctor's appointment, not fill a prescription or postpone some other medical care in the previous year."

Obama KNEW his false equivalency was a lie, otherwise he wouldn't have made sure that public employees like Congress not only got taxpayer funded health insurance, but that those plans provided superior coverage to the garbage that was deemed good enough for the rest of us.

So early on we got duped into believing that ANY insurance would improve access to health care because of the false equivalency laid out by Obama et al that health insurance=health care, therefore having health insurance meant you had health care. Clearly not true and only used by Obama as a means of claiming that reducing the number of uninsured was the solution Americans needed.

Obama ignored the quality of the insurance necessary to make that claim true…Health insurance is a tool to help us afford needed medical care, if we can't afford needed medical care with health insurance then it is a failed tool. Therefore, having mislabeled the problem as one of merely having health insurance, and thereby misidentifying the solution as just making sure people were insured without caring that his ideas encouraged insurers to cover less and charge more, Obama worsened the problems facing the American public in need of medical services.

And if they knew then, as outlined below, then they know NOW as the same garbage is included in Medicare for All that will again injure consumers and further worsen COST as a barrier to needed health care for the majority of Americans.

Obama claimed that his exchange plans sought to "equalize" the playing field for consumers (NOT public employees like himself, just other consumers). Obama supported a law that established bare minimum, low-hanging fruit coverage for individual insurance shoppers (the exchanges) as an entitlement that the rest of us would pay for to address those "uninsured." So the exchanges began.

First, using taxpayer money, Obama had to figure out how to get insurance companies to offer plans on his pet project entitlement, the exchanges, and since this was not group insurance, the government wasn't negotiating but arranged for a legislative quid pro quo for insurance companies: The law promised that if insurance companies participated on exchanges then the Federal government would make sure they didn't lose money. That was the three Rs, reinsurance, risk corridors and risk adjustment. The first two of which were temporary, only through the end of the 2016 benefits year.

Not only did Obamacare establish a new low bar for insurance coverage opening the way for employers to glom onto savings (but not the FEDERAL GOVERNMENT 'EMPLOYER') by providing cheaper options to their employees with the same low-bar coverage, but Obamacare intended to PENALIZE employers who provided better coverage (remember the Cadillac tax that never was put into practice that would put a 40 percent tax on generous employer-provided health insurance plans?) clearly indicating that Obama, having misidentified the problem as not having insurance, didn't care about the quality of insurance that people had (outside of public employees like Congress) because his political goals merely meant he'd declare victory as long as he reduced the number of uninsured.

Then Obama had to figure out more ways to force people to purchase besides having enacted legal penalties by federal law if we didn't (the individual mandate). Obama's Administration realized they weren't getting enough forced purchases by the law as it stood and went to court to expand who was forced to purchase off exchanges in King v. Burwell, which the government won in expanding the credits of "state-established exchanges" to the federal government in states that didn't establish exchanges. Still enrollment was low and lopsided, with money-conscious consumers forfeiting the discount in cost sharing available on more expensive silver plans and opting instead for bronze plans with premium assistance only. In 2015, Obama's Administration did two more things to try to force people onto his exchange vision, raising the cost of bronze plans significantly more than those of the silver plans to try to get people to enroll in more silver plans and further restricting the availability of short-term health insurance which was capturing a portion of the population unable to overcome the COST barrier of purchasing exchange health insurance.

Obama's Administration even unapologetically counted fraudulent enrollees to keep those enrollee numbers up. When Obama's own government called the Administration out for fraudulent applicants and enrollees in Obamacare, CMS revealed it didn't worry about fraud. In 2015, CMS explained to the GAO regarding its findings: "According to CMS, its document processing contractor is not required to authenticate documentation; the contractor told us it does not seek to detect fraud..." GAO-14-705T: Published: Jul 23, 2014, repeated in July 2015,"HealthCare.gov's document-processing contractor 'is not required to seek to detect fraud,' said Bagdoyan." That's right, authenticating documentation is unnecessary as is detecting fraud…That'll help boost numbers, and it's only taxpayer money anyway.

Obama continued his claims of victory based on the false premise that health insurance=health care, that individuals seemingly bought into, yet we also know that the number of enrollees on exchanges didn't separate out those who had insurance before Obamacare that was no longer offered because of Obamacare and therefore were forced onto exchanges, rendering them not "newly" insured in terms of reducing the uninsured number, but merely newly insured on Obama exchanges.

We also know that Obama's Administration, after repeated anemic enrollment numbers decided to change the number of uninsured downward, as if to explain why more people hadn't grabbed onto exchange participation (as stated by the CBO in 2015, “…slightly lower estimate of the number of people who will gain insurance coverage because of the ACA,” (CBO, Pub. 49973, page 19).

Deliberately miscommunicating what the study on the relationship of health insurance was to better health care, Obama fraudulently identified the basis of "success" for his pet project as whether he could reduce the number of uninsured. This commitment was a deal with insurance companies that they wouldn't deny anyone coverage (pre-existing conditions) in exchange for the federal government forcing people to purchase the consumer financial product of health insurance.

The quality of health insurance dropped the bar to low-hanging fruit so that again, Obama could argue about the free stuff he was guaranteeing, without explaining that it was at the cost of coverage for NEEDED medical care which would cost more (and has proven to cost more) in terms of copays, coinsurance and deductibles.

Again, Congress made sure that public employees like themselves would not be exposed to the HIGHER premium costs or the HIGHER costs of using their health insurance since they effectively exempted themselves from Obamacare, indicating that Congress KNEW that the Obamacare plans were sub-par.

Obamacare included PREMIUM ASSISTANCE and COST SHARING for exchange plans to help DISGUISE the costs of the coverage to the consumers in the marketplace because the government picked up the tab for Obamacare enrollees, but for the majority of Americans, we were simply price-gouged more by the costs of premiums and of using our health insurance.

Flash Forward: So Medicare for All fans SHOULD read the next installment of the Obamacare con. In this scenario, according to the published Senator Sanders Medicare for All plan, the continuation of bare minimum sub-par coverage will be provided for all, for free.

Of course, Medicare for All preserves the untrustworthy government as the decider of what is covered and what is not. Of course, it will be bare minimum coverage which is why the Medicare for All Plan specifically creates the opportunity for private provider contracts, basically all sorts of new supplemental policies consumers can PURCHASE for all the things not covered (Section 303).

Of course, the public employees in GOVERNMENT are again exempted and promised a continuation of their superior pre-Obamacare benefits paid for by taxpayers. (See Section 701, "Bernie Sanders and President Trump Agree About Health Care and Consumers Lose," http://conoutofconsumer.blogspot.com/2019/10/bernie-sanders-and-president-trump.html.

Of course how much our taxes will increase is also up to government.

Of course, even if the tax increase is kept remarkably low until post-election they will go up.

Of course, the problem of drug coverage is preserved and will likely be as bad or worse what is currently going on with formularies where Medicare for All uses preserves big pharma's chokehold on us: Under Section 614: Payments for Prescription Drugs and approved devices and equipment: (a) Negotiated prices.—The prices to be paid for covered pharmaceuticals, medical supplies, and medically necessary assistive equipment shall be negotiated annually by the Secretary."

NOTE "Prices paid for COVERED pharmaceuticals…" That's right, the ever -shrinking formulary game whereby drugs covered are often omitted from insurance company lists leaving patients in the catastrophic position of being unable to afford whatever-the-market-will-bear drug prices is preserved by Medicare for All.

The first step to believing any candidate-described, Congress endorsed solution to the Obamacare WORSE problems of access to needed HEALTH CARE based on cost as a barrier is that consumers demand that if we're being sold something then public employees like Congress better be bound by it too, without a blatant exemption like under Obamacare or a more insidious exemption where they're given pay increases to cover increased costs. If it's good enough for us, it should be good enough for them.

2020 New Year Concerns: Why the Hell Are Consumers Trusting Congress on Health Insurance? Part II

When the Supreme Court upheld the individual mandate as a legitimate tax in 2012, consumers lost because we became required to purchase the consumer financial product of health insurance or pay money to the government to finance other things, because the tax penalty money does not have a designated place where it must go, eg funding other government run health insurance programs for non-public employee consumers.

The individual mandate is another government piggy-bank paid for by consumers to benefit providers who are assured payment, and insurers who stand to benefit from the forced purchase because they are guaranteed, by the imposition of government responding to their lobbyists, a client base for their products, regardless of how poorly those products (insurance plans) give consumers what they need the consumer financial product of health insurance for: Protection from the contingent risk of economic devastation and inability to obtain needed medical services and care IF they become ill or disabled.

Instead of outrage when the individual mandate was first hinted at, consumers bought into Obama's claims that he'd been a strong leader with insurance companies on behalf of consumers and had agreed to the mandate in exchange for the promise by insurers that they wouldn't deny coverage for pre-existing conditions. This was bunk, because the proposal came in 2008 FROM the insurance lobby, AHIP in their publication that mirrored the plan Obama pretended he negotiated instead of the deal he made.

Led like ninnies, with little examination, consumers bought-in, in theory, though this clearly is not the same as a tax to pay for libraries or schools or other public services available for everyone, because in fact the dollars paid as tax penalites are not by law required to be used to pay for programs that might benefit everyone such as Medicaid or Medicare. Nope, these dollars go into the undefined coffers of government to be used for undefined purposes, untraced like a petty cash account used by lawmakers.

Flashback: Obamacare using the Affordable Care Act's repetitive "timing" con where provisions were carefully timed to avoid Obama facing defeat in his bid for re-election if consumers were tuned into what he'd really done with Obamacare, created a legal partnership between government and private insurance companies to bilk the American consumer, and "surprised" consumers with the individual mandate provision's effective date at the end of the 2013 benefits year, (after his re-election).

In 2012, the individual mandate was upheld by the Supreme Court as a legitimate exercise of Congress' taxing power rather than a penalty because it was indefensible to argue that the failure to purchase a consumer financial product, health insurance, should result in a penalty. After all, that would be like penalizing consumers for not having a credit card to establish credit and requiring them to pay a fee to the government for a failure to have a credit card.

Still, the effect was the same, the government muscle stood behind insurers and said, "Buy their product or pay what amounts to a fine." Now, since Obama's Administration protected government public workers, of course, their employer (the federal government ignoring that we pay for their benefits) preserved their pre-Obamacare health insurance providing superior coverage at our expense.

Obamacare also provided unclear pathways for spending the money collected in individual mandate "taxes," failing to require those funds be spent on behalf of taxpayers in public insurance plans like Medicare/Medicaid or Veterans benefits, Social Security and instead merely created an additional petty cash source for government.

Under Trump, first the penalty was defunded, to an amount of zero and now there is no individual mandate. However, state governments strapped by their irresponsible spending and bloated government benefits to public employee pensions, etc. have glommed onto the Supreme Court's "tax" concept and are instituting their own individual mandate. California is the latest. Similarly, the funds collected by states have unclear pathways of whether they're required to be spent on the consumers they're taxing creating simply another government piggy-bank tool.

Flash Forward: The shenanigans involved in creating the individual mandate unfortunately have benefited the most powerful voices in the health industrial complex, insurance companies that get forced customers for their products, providers who like dealing with insurance companies rather than individuals for payments because a) they negotiate higher prices and b) they have less hassle in getting paid, and government which gets a new piggy-bank stream of petty cash to spend how it likes.

Consumers remain the losers. Medicare for All is the same, with unknown tax increases to cover a program of health insurance that promises nothing except that government will decide what services and medicines and treatments are covered for consumers unlucky enough not to be them, public employees, as they preserve and expand their own benefits, and with a no-limit government determination of how high those taxes will go for consumers. With a track record of mismanagement of consumer funds, Medicare for All promises to simply be a bigger petty cash account for government.

Even without the individual mandate, which actually was proposed by insurance companies to Obama's Administration by the insurance lobby (AHIP) in exchange for a political quid pro quo to Obama who gained political clout claiming he'd protected consumers from being denied coverage for pre-existing conditions, insurers are not backing off the forced purchase of their products and include continuous coverage provisions that penalize those without insurance for a certain length of time with higher premiums. Continuous coverage requirements are simply another individual mandate.

Under Medicare for All, these forced payments to insurance companies for their products and to government for failing to purchase these products are expanded under the same tax reasoning to some unknown amount regardless of how bad coverage is under Medicare for All.

Consumers should first and foremost require detailed information from government and require legal obligations of government to spend any and all taxpayer funded mandates and taxes on the programs that are used to justify the tax penalties and-or taxes to benefit consumers directly, not amorphous government infrastructure or public employee expenses associated with administering programs or allowing a general fund-type provision where government can use the money for its own expenses and the raise taxes on consumers as currently is proposed.

Further, unlike the fallacy of the zero balance social security funds, which allows government to raid any amounts left in social security each year for other government purposes and then claim that social security is bankrupt, the balance should be clearly limited by law to payments on behalf of consumers only associated with these programs with balances, if there are any, carrying over from year to year.

This also means not an 80/20 rule like Obamacare's rule for insurance companies, which is basically a joke, but a 100/0 formula where direct payments on behalf of consumers to government associated with health insurance must be 100 percent and 0 is permissible to be used for government public employees and infrastructure which already have ballooned and are subject only to audits by government for government, which like public employee benefits ALWAYS end up benefiting the public employee class only.

New Year Concerns: Why the Hell Are Consumers Trusting Congress on Health Insurance? Part I

Tempted to jump on the bandwagon of Medicare for All? Well, you know what they say, "Fool me once, shame on you, fool me twice, shame on me." Just like the Affordable Care Act, Medicare for All preserves by law the inequities of our health CARE system by preserving inequities in our health INSURANCE system.

Currently, Congress gets a pretty sweet deal, superior benefits coverage reducing the amount they spend to use their health insurance AND premiums paid for by taxpayers upwards of 72 percent, reducing the amount they spend to obtain health insurance compared to the people they're supposed to represent. Now for those who want to immediately jump in and defend this public employee perk for Congress, we've heard it all before thanks to the Obamacare con.

Flashback: There was a tiny outcry by people subjected by our lawmakers to Obamacare who weren't among the minority of Americans who benefited from the insurance exchange plans made available to individuals based on income or didn't become eligible for expanded Medicaid, two distinct and separate parts of Obamacare. At that time, Congress neatly carved out an exemption for itself, though they'd double-talk and lecture the rest of us on how it wasn't truly an exemption, they just happened to pass laws that their employer (the federal government) would provide them with cushy benefits and premiums artificially lowered by contributions by us, the taxpayer.

Flash Forward: Like the sounds of Medicare for All? Guess what, Congress again will preserve its superior benefits for a taxpayer funded price under that law too. Go take a peek at section 701 under the proposed Medicare for All, "There are hereby appropriated to the Trust Fund for each fiscal year, beginning with the first fiscal year beginning on or after the effective date of benefits under section 106, the amounts that would otherwise have been appropriated to carry out the following programs: …
(C) The Federal employees health benefit program, under chapter 89 of title 5, United States Code."

Now, perhaps you think that sounds great, the Federal employees health benefit program funds will be put into the Medicare for All trust, but the Obamacare loophole for calling the Federal government an employer and thereby effectively exempting Congress from Obamacare persists because under Medicare for all employers can still provide their employees with superior benefits as long as they're not duplicative of Medicare for All coverage. The best way to consider this provision in the contracting for medical services provision is as supplemental insurance that will not only be outside the scope of Medicare for All legislation but will not be regulated, seemingly in terms of cost. So, what do you think Congress will provide for itself with our money?

Further, there is no assertion that the back-door funding of superior medical benefits through public employee pay raises or other dollar amounts won't be enacted. Yep, it's just another loophole that makes it seem like we're all in it together.

Flashback: Obamacare established national legislation for minimal coverage, padding its inadequacies with "preventive" checkups and essential benefits used by insurers to justify increases in out-of-pocket costs for consumers to use their health insurance from copays to coinsurance to deductibles, and by increasing the needed health care services uncovered as insurers complied with Obamacare's bare minimum coverage requirements.

Flash Forward: Medicare for All preserves this two-tiered bizarre system of covered health care services for the HEALTHY but increased cost barriers to needed medical care. In section 107 of the proposed Medicare for All bill you'll find that private insurance isn't going anywhere, as a matter of fact it will expand its profitability because it can't "duplicate" the bare minimum services provided under Medicare for All but allows for PRIVATE CONTRACTS for services NOT covered by Medicare for All.

This would be an option for needed medical services that would only be available to the rich able to purchase the sky's the limit insurance coverage for the myriad of services not covered by the basic Medicare for All, which is much needed medical services. So, you want a checkup, you're good, that's not needed medical care. You need cancer treatment, drugs, etc. probably not so much. (And don't forget, Congress' benefits are preserved by themselves for themselves, so they needn't worry).

Buying Additional Coverage: Congress Protecting Itself

Flashback: Obamacare disincentivized employers from providing quality benefits to employees by allowing insurance companies to raise their plan costs for anything beyond the bare minimum coverage supplied by Obamacare. Insurance companies went along with these requirements not out of the kindness of their hearts but because they knew they could make more money under Obamacare with a few simple strategies…The first one is the downside of lists, which insurance companies are masters of: Yes they would comply with uniform premiums for whole populations (rather than high-risk groups such as those with pre-existing conditions) BUT the cost of USING health insurance in the form of copays, coinsurance, and deductibles as well as non-coverage of things not on the Obamacare "list" would increase astronomically. Of course, Congress made sure its employer, the federal government would continue to protect them.

Flash Forward: Medicare for All expands this inequity with its contracting for supplemental plans to cover all the stuff insurers won't cover. So now, after disincentivizing employers from providing superior benefits to their employees, because after all, why would they provide more than the law requires and pay astronomic prices for the same, Medicare For All provides that employers CAN provide such superior benefits to their employees. This one should be crystal clear, because having made the federal government the "employer" and making the rules for their employer, Congress will make damned sure that their employer provides such superior benefits at no increased cost to them (just us, the taxpayers) while other employers continue the price shopping of bare minimum plans that meet federal guidelines.

So let's start with the obvious: Why would consumers support Medicare for All and trust that Congress which is preserving its pre-Obamacare and pre Medicare for All public financing of superior benefits is really doing anything but making sure it preserves the current system? The answer is: We shouldn't.