{"id":25477,"date":"2013-02-04T03:00:55","date_gmt":"2013-02-04T02:00:55","guid":{"rendered":"http:\/\/rinf.com\/alt-news\/?p=25477"},"modified":"2013-02-07T05:17:58","modified_gmt":"2013-02-07T04:17:58","slug":"obamacare-a-deception","status":"publish","type":"post","link":"http:\/\/rinf.com\/alt-news\/latest-news\/obamacare-a-deception\/","title":{"rendered":"Obamacare: A Deception"},"content":{"rendered":"

Introduction by Paul Craig Roberts
\nrinf.com<\/strong><\/p>\n

The article below is the most comprehensive analysis available of \u201cObamacare\u201d \u2014 the Patient Protection and Affordable Care Act. The author, a knowledgeable person who wishes to remain anonymous, explains how Obamacare works for the insurance companies but not for you.<\/p>\n

Obamacare was formulated on the concept of health care as a commercial commodity and was cloaked in ideological slogans such as \u201cshared responsibility,\u201d \u201cno free riders\u201d and \u201cownership society.\u201d These slogans dress the insurance industry\u2019s raid on public resources in the cloak of a \u201cfree market\u201d health care system.<\/p>\n

You will learn how to purchase a subsidized plan at the Exchange, what will happen when income and family circumstances change during the year or from one year to the next, and other perils brought to you by Obamacare. It is one of the most important articles that will be posted on my website this year. Americans will be shocked to learn the extent to which they have been deceived. The legislation neither protects the patient nor are the plans affordable.<\/p>\n

The author shows that for those Americans whose income places them between 138% and 400% of the Federal Poverty Level, the out-of-pocket cost for one of the least expensive (lower coverage) subsidized policies ranges from 2% to 9.5% of Modified Adjusted Gross Income (MAGI), a tax base larger than the adjusted Gross Income used for calculating federal income tax.<\/p>\n

What this means is that those Americans with the least or no disposable income are faced in effect with a substantial pay cut. The author provides an example of a 35 year-old with a MAGI of $27,925. The out-of- pocket cost to this person of a Silver level plan (second least expensive) is $187.33 per month. This cost is based on pre-tax income, that is, before income is reduced by payroll and income taxes. There goes the car payment or utility bill. The lives of millions of Americans will change drastically as they struggle with a new, large expense \u2014 particularly in an era of no jobs, low-paying jobs and rising cost of living.<\/p>\n

The author also points out that the cost of using the mandated policies will be prohibitive because of the large deductibles and co-pays. Many Americans will find themselves not only with a policy they can\u2019t afford, but also with one they cannot afford to use. Those who cannot afford the insurance, even with a subsidy, will be faced with a costly penalty, and in many cases, this, too, will be difficult, if not impossible, to pay. As each year\u2019s subsidy is based on last year\u2019s income, there will be a substantial year-end tax liability for those who must repay the subsidy in whole or part because their income increased during the year. The stress alone from such a regressive scheme is, without a doubt, not conducive to good health and well-being.<\/p>\n

Diets will worsen for millions of Americans as they struggle with a new large expense. Thus, the effect of Obamacare will be to worsen the health of millions. Indeed, a \u201cglitch\u201d in the legislation allows millions to be priced out of coverage.\u00a0http:\/\/www.huffingtonpost.com\/2013\/01\/30\/obamacare-glitch-priced-out-of-health-care_n_2585695.html?view=print&comm_ref=false
\n<\/a>
\nAlternatively, Americans might be able to acquire health insurance coverage but have no doctors willing to treat them.\u00a0http:\/\/www.californiahealthline.org\/road-to-reform\/2013\/access-denied-implications-of-medi-cal-pay-cut.aspx#<\/a><\/p>\n

The demand that Obamacare places on household budgets in which there is no slack makes me wonder where the president\u2019s economists were while the insurance lobby crafted the product that serves the profits of insurance companies. Two well-known economic facts are that real family income has been stagnant or declining for a number of years and Americans are over their heads in debt.<\/p>\n

How does Obama preside over a recovery when consumer purchasing power is redirected to insurance company profits?<\/p>\n

Obamacare not only rations health care by what a person or family can afford, but also has implications for Medicare patients. Hundreds of billions of dollars are siphoned from Medicare to help pay the cost of Obamacare. The health care provided to Medicare patients will decline with the reduced payments to care providers. Health care seems destined to be rationed according to the age and illnesses of Medicare patients. Those judged too old and too ill could be denied expensive treatments or procedures that would prolong their lives.<\/p>\n

Obama will rue the day that his name was put on this special interest legislation, and most Americans, once they realize what has been done to them, will be angry that special interests again prevailed over the health of the nation.<\/p>\n

OBAMACARE: DEVILS IN THE DETAILS<\/p>\n

The Patient Protection and Affordable Care Act of 2010, commonly referred to as the ACA or Obamacare, will go into full effect in 2014. This decree mandates that all Americans must purchase and maintain government-approved health insurance or pay a penalty to the IRS. Touted as a plan to provide all Americans with access to medical care, in reality, this compulsory shakedown commands everyone to purchase insurance that for many will be too expensive, even with government subsidies \u2014 or unaffordable to use \u2014 or both.<\/p>\n

The ACA was not selflessly designed with the intent of providing affordable and equitable medical services to those in need, but rather to acquire taxpayer money for the private insurance companies under the seemingly helpful guise of health care and the ideological excuse of personal responsibility. It takes money from ordinary people and gives it to a medical insurance industry that profits handsomely from this legally-enforced corporate welfare \u2014 all while keeping Americans locked in the same broken system that puts profit before patients. The law was essentially written by business executives from the industry so that special interests would not be upset and profits assured.<\/p>\n

There\u2019s a lot to digest about how the ACA works and much is buried in a complex, convoluted maze of regulations and procedures. A few websites contain explanations, but very important details have either been left out or glossed over. These details are well worth understanding so you will know what\u2019s at stake for you and your family. This lesson is not meant to convey a political opinion. This is how the ACA works and under this law, there are no sacred cows.<\/p>\n

In today\u2019s lesson, you will learn why 2013 is an important year for many of you with regard to your income and the ACA. We will discuss 1) use of Modified Adjusted Gross Income, 2) tax credits (help paying for insurance), 3) your share of the premium, 4) paying back the tax credits to the IRS, 5) expansion of Medicaid and estate recovery which could affect you if you are put into that plan, 6) inadequate coverage in most subsidized plans, 7) penalties, 8) exemptions and 9) a few tidbits. We\u2019ll also take a look at the agenda of Enroll America and the Health Insurance Exchanges, and what you can expect to hear in the very near future.<\/p>\n

Here we go. Fasten your seat belts.<\/p>\n

1. HEALTH INSURANCE EXCHANGE BASICS<\/p>\n

In 2014, each state will have an Affordable Insurance Exchange where qualified individuals and families with incomes between 138 and 400 percent of the Federal Poverty Level (FPL) can shop for commercial insurance policies. Most individuals and families with incomes at or below 138 percent FPL will be put into Medicaid. You may be eligible for help paying for your insurance in the form of a tax credit. In most states, the Children\u2019s Health Insurance Program (CHIP) will continue to cover children in families with incomes up to at least 200 percent FPL. Some states may offer a Basic Health Plan for those who earn up to 200 percent FPL and are not eligible for Medicaid. Under limited circumstances, you may also be eligible for a cost-sharing credit.<\/p>\n

Eligibility to receive a tax credit, the amount of your tax credit and your out-of-pocket share for the insurance will be determined by your income and where you fall in the Federal Poverty Level Guidelines (FPL). This is easy to understand.<\/p>\n

Your annual gross income determines which FPL you\u2019re in. For example, based on 2012 FPL Guidelines, an individual with an annual income of $33,510 is at 300 percent FPL; a family of 4 with an annual income of $69,150 is at 300 percent FPL. To see where you\u2019re at, try the handy calculator at this link. FPL Guidelines are revised every January, so the 2013 edition should be up soon.http:\/\/www.safetyweb.org\/fpl.php<\/a><\/p>\n

The ACA requires use of MODIFIED ADJUSTED GROSS INCOME (MAGI) instead of Adjusted Gross Income for all determinations made by an Exchange including eligibility for Medicaid except in certain cases. So, in this lesson, we\u2019ll refer to annual income as MAGI.<\/p>\n

Modified Adjusted Gross Income (MAGI) is defined as Adjusted Gross Income PLUS
\na)\u00a0all tax exempt interest accrued or received in the taxable year;
\nb)\u00a0the non-taxable portion of Social Security benefits provided under Title II of the Social Security Act which includes old-age benefits, disability benefits, spousal benefits, child benefits, survivor benefits and parental benefits;
\nc)\u00a0tier 1 Railroad Retirement benefits that are not includible in gross income; and
\nd)\u00a0the exclusion from gross income for citizens or residents living abroad.<\/p>\n

The adoption of MAGI, created by the ACA, is defined in a new section of the IRS code.<\/p>\n

2. DETERMINING ELIGIBILITY FOR A TAX CREDIT<\/p>\n

The tax credit is to help you pay for insurance. The ACA says it must be based on annual income for the tax year it\u2019s received, but since you will need help paying for your plan during that year, the ACA allows for advance payment of the tax credit.<\/p>\n

Here\u2019s an example of what that means: Let\u2019s say you apply for insurance at an Exchange in 2014. Therefore, 2014 is the tax year you will receive your tax credit, and per the ACA, the amount you receive must be based on that year\u2019s MAGI. But, that year\u2019s MAGI won\u2019t be available until 2015 when you file your 2014 tax return and you need help paying for your insurance plan when you buy it in 2014. So, the amount of your tax credit has to be determined on information that is available such as your prior-year (2013) tax return. Thus, the tax credit morphs into an \u2018advance payment of the tax credit\u2019 (also referred to as an advance premium assistance credit). Now you see why 2013 is an important year for many of you.<\/p>\n

The ACA allows for limited disclosure of tax return info in order for an Exchange employee to verify your citizenship status and MAGI, and, not only to let you know how much your advance tax credit will be, but also to see if you are eligible to receive this in the first place. An Exchange can also consider using your real-time income by looking at your state\u2019s most current quarterly wage database, or it may agree to accept paper verification (pay stubs, etc.) as a last resort or an attestation of your income with no verification. Creation of a federal \u2018data services hub\u2019 is in the works so your income information will be more readily accessible. But, no matter how this plays out, you\u2019ll still receive an advance payment of the tax credit because your actual MAGI for 2014 will not be known by you nor can it be verified by an Exchange until you file your 2014 tax return in 2015.<\/p>\n

Ultimately, no matter which method is used \u2014 prior year or partial current year \u2014 this advance payment of the tax credit carries with it some heavy-duty consequences which are discussed in topic 4 of this lesson.<\/p>\n

3. TAX CREDITS AND YOUR SHARE OF THE PREMIUM<\/p>\n

The amount of your tax credit will be based on the second lowest-cost Silver plan in the area where you live and your MAGI. Here\u2019s how this works \u2014 it\u2019s quite simple:<\/p>\n

a)\u00a0First, the amount you will pay out of your pocket for that Silver plan \u2014 copays and deductibles not included \u2014 will be a specific percentage of your MAGI, and you will pay this to the insurer on a monthly basis. The way this percentage will be calculated is described a few lines down.<\/p>\n

b)\u00a0Next, your share will be deducted from the cost of that Silver plan and the difference will be your tax credit which the government will pay directly to the insurer on a monthly basis when you purchase a plan.<\/p>\n

The specific percentage you will have to pay for the second lowest-cost Silver plan will be based on your FPL using a well-greased sliding scale. As your FPL increases little by little, the percentage you will pay increases. The same percentage applies to an individual or a family. Here\u2019s how much of your MAGI you will pay for that Silver plan:<\/p>\n

\u2013 up to 138 % FPL: 2% for people legally present less than 5 full years and residents of states that do not expand Medicaid
\n\u2013 138-150% FPL: 3 to 4%
\n\u2013 150-200% FPL: 4 to 6.3%
\n\u2013 200-250% FPL: 6.3 to 8.05%
\n\u2013 250-300% FPL: 8.05 to 9.5%
\n\u2013 300-400% FPL: 9.5% \u2014 there\u2019s no range, but the dollar amount of your share will change because 9.5% of a lower MAGI is less than 9.5% of a higher MAGI.<\/p>\n

Here are two examples in dollars using 2012 FPL Guidelines and an estimate for a second lowest-cost Silver plan which will vary depending where you live \u2014 actual costs are not yet available:<\/p>\n

a)\u00a0You are 35 years old and the price of the second lowest-cost Silver plan for an individual in the area where you live is $4,750 with no tax credit. If your MAGI is $33,510 ($2,792.50 per month) putting you at 300 percent FPL, your share for that Silver plan, per the chart above, would be 9.5 percent of your MAGI which comes to $3,183 ($265.25 per month). Your tax credit would be $1,567 which is the difference between the unsubsidized cost of that Silver plan and your share.<\/p>\n

b)\u00a0You are 35 years old and your MAGI is $27,925 ($2,327 per month) putting you at 250 percent FPL, so, your share of that Silver plan would be 8.05 percent of your MAGI which comes to $2,247.96 ($187.33 per month) and your tax credit would be $2,502.<\/p>\n

If the second lowest-cost Silver plan is too expensive, you can apply your tax credit to a Bronze plan which will be cheaper but less comprehensive. If you want a better plan than the Silver, you will have to pay the full difference in the premium.<\/p>\n

Don\u2019t forget that your share of the monthly premium will be figured on your MAGI which is pre-tax income. So, after you deduct your income taxes and your share of an insurance plan, will you be able to cover your monthly basic living costs including paying off debt you may owe and still have some cash left to pay for medical care if you have to use your insurance? Check out topic 6 in this lesson\u00a0for a rundown of plans and coverage you can expect to find at an Exchange. Hope you don\u2019t faint.<\/p>\n

\u00ef\u00bf\u00bcOnce you purchase a plan, your share and your tax credit won\u2019t change until the next enrollment period unless, before that time, your income goes up or down enough to bump you into a different FPL or you get a job with insurance. You can let your Exchange know by phone or via your online account, or, your Exchange might notice while cruising the data services hub you learned about in topic 2 and notify you that you must \u2018up\u2019 your coverage or that you\u2019ve been tossed into Medicaid if your MAGI has decreased enough to make you eligible for that plan. Exchanges will be encouraged to use as many different avenues as possible including private databases to keep tabs on your income.<\/p>\n

Thus, you could end up bouncing from Medicaid to a subsidized plan or vice versa. By the same token, you could take some extra work to help pay the bills or to save for a vacation, and, oops, you went over 400 percent FPL and are no longer eligible for a tax credit. The Exchange may not find out about this unless you spill the beans, but, no matter how it all plays out, income changes will catch up with you when you file your tax return.<\/p>\n

To be eligible for a tax credit you must file your tax return no later than April 15. Married taxpayers must file a joint return. Individuals who are listed as dependents on a return are ineligible for a tax credit.<\/p>\n

If you are eligible for Medicaid, you will not be allowed to receive a tax credit or a cost-sharing credit although some states impose premium and cost-sharing charges on certain Medicaid enrollees per the Deficit Reduction Act of 2005 (DRA) and clarified in the Tax Relief and Health Care Act of 2006.<\/p>\n

On January 22, 2013, the Centers for Medicare & Medicaid Services (CMS) proposed allowing states to further increase Medicaid premiums and out-of-pocket costs by 5 percent. The most egregious part of this proposed rule says that states may allow providers to deny services for failure to pay the required cost-sharing in certain circumstances. The Obama administration is behind this proposed rule hoping to persuade states to expand Medicaid since many have refused and others are still undecided \u2014 the expansion of Medicaid is an integral part of the ACA. Allowing states to further increase premiums and cost-sharing for the poorest segment of the population under- scores the existing political bias toward low-income Americans despite rhetoric which claims otherwise.https:\/\/www.federalregister.gov\/articles\/2013\/01\/22\/2013-00659\/medicaid-childrens-health-insurance-programs-and-exchanges-essen- tial-health-benefits-in-alternative#h-186\u00a0<\/a>
\nhttp:\/\/www.nytimes.com\/2013\/01\/23\/health\/medicaid-patients-could-face-higher-fees-under-a-proposed-federal-policy.html
\n<\/a>
\nAffordability rates (the percentage of your MAGI the government has decided you can afford to pay for insurance) are based on boardroom formulas which don\u2019t take particular individual needs into account such as housing costs, property taxes, debt, education, transportation, retirement savings, etc. Also, FPL Guidelines are standard across the country and do not take into consideration those who reside in a more expensive region or vice versa. They are one-size-fits-all with the exception of Alaska and Hawaii. See topic 8 in this lesson to learn about exemptions.<\/p>\n

Check out what self-proclaimed health care expert Jonathan Gruber says about affordability and get a load of all the \u201cformulas.\u201d According to Mr. Gruber, you may be having too much fun in life and need to get serious, buy health insurance and live under a rock in order to pay for it. He was involved with Romneycare in Massachusetts and was also Mr. Obama\u2019s go to man under a no-bid contract. Per a bar graph on page 6 of a report prepared by Stan Dom for the Urban Institute, subsidized plans under the ACA are estimated to cost 2 to 3 times more (give or take) than the subsidized plans under Romneycare. Per several surveys during the years that Romneycare has been in effect, many low and modest income MA residents have had difficulty paying for those plans and the out-of-pocket costs to use the insurance, particularly chronically-ill residents.
\nhttp:\/\/ebookbrowse.com\/1493-gruber-will-affordable-care-act-make-hlt-ins-affordable-reform-brief-v2-pdf-d124754327<\/a>
\nhttp:\/\/www.statecoverage.org\/files\/TheBasicHealthProgramOptionUnderHealthReform.pdf<\/a><\/p>\n

4. PAYBACK OF TAX CREDITS TO THE IRS<\/p>\n

Perhaps you recall hearing politicians including Mr. Obama say if you can\u2019t afford to pay for health insurance, the government will help you. That was one of the key talking points repeated non stop. We just went over the help part \u2014 the tax credits. Now we\u2019ll look at what Mr. Obama et al didn\u2019t tell you which is important to understand because it could cause you some serious financial distress.<\/p>\n

Remember the \u201cadvance payment of the tax credit\u201d in topic 2 of this lesson? Well, essentially, that was a loan from the government which was paid in advance to the insurer on your behalf when you purchased your plan, and, as you know, loans have to be paid back. So, when you file your tax return for the year you received your \u201cadvance tax credit\u201d (your loan), if your income has changed, you have to settle this with the IRS. Here\u2019s the deal:<\/p>\n

a)\u00a0If your MAGI is higher and the increase puts you into a higher FPL, you may have to pay back a portion or all of the tax credit because it was based on a lower MAGI. In other words, you could have an additional tax liability on top of the income taxes you already paid (or still owe) because you received a higher tax credit than you were entitled to.<\/p>\n

\u00ef\u00bf\u00bcb)\u00a0If your MAGI is lower and the decrease puts you into a lower FPL, a refund could be coming to you because you were eligible for a larger tax credit than the government paid to the insurer. In other words, you overpaid for your portion of the insurance premium.<\/p>\n

c)\u00a0If you earned a bit more or less, but your extra earnings or loss didn\u2019t bump you into another FPL, you\u2019re home free.<\/p>\n

To figure out your payback, you will have to enter the relevant figures on the reconciliation page of the tax return. Changes in filing status such as the number of people in your household will also have an impact. For those of you who marry or divorce, the rules for the payback amount as well as the amount of the tax credit you are eligible to receive will make your head spin \u2014 the computation includes pre- and post-marriage FPL and uses the highest FPL of the two people involved. Ditto for divorce.<\/p>\n

Here is one of the reconciliation explanations in IRS-speak: Your liability for an excess tax credit you received must be reflected on your current year income tax return subject to a limitation on the amount of such liability.<\/p>\n

Oh! Limitation on the amount of such liability. That sounds good.<\/p>\n

Let\u2019s take a peek at the payback limitations on record at the time of this writing. \u201cAt the time of this writing\u201d are the operative words because the cap has been increased twice since the ACA was signed into law. The original payback was capped at $400 for families under 400 percent FPL and $200 for individuals. We\u2019ll skip over the first increase. The story behind the second one is that a particular revenue stream was removed from the original law, so something had to be done to compensate for this lost money. Thus, an amendment was passed that increased the cap using a sliding scale, thereby putting a huge financial burden on the backs of the very people the ACA claims to help. In other words, tag, you\u2019re it. You are the cash cow.<\/p>\n

Here are the current sliding-scale caps:<\/p>\n

If the household income (expressed as a percent of poverty line) is:
\nless than 200 percent, the applicable dollar amount is $600
\nat least 200 percent but less than 300 percent, the applicable dollar amount is $1,500
\nat least 300 percent but less than 400 percent, the applicable dollar amount is $2,500<\/p>\n

Effective date: the amendment made by this topic shall apply to taxable years ending after December 31, 2013. Very truly yours, House Ways and Means Committee<\/p>\n

The name of this bloodsucker is The Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011.
\nhttp:\/\/www.gpo.gov\/fdsys\/pkg\/PLAW-112publ9\/html\/PLAW-112publ9.htm<\/a><\/p>\n

But wait, there\u2019s more!<\/p>\n

a)\u00a0Update: Today (Feb. 17) (2011) the House Ways and Means Committee approved the 1099 repeal bill which requires consumers earning more than 400 percent of the poverty line to pay back the [entire] subsidy.\u00a0http:\/\/thehill.com\/blogs\/healthwatch\/health-reform-implementation\/144847-1099-repeal-gets-trickier-with-house-bill
\n<\/a>
\nb)\u00a0Also, per IRS final regulations: for taxable years beginning after December 31, 2014, the payback caps may be adjusted to reflect changes in the consumer price index.<\/p>\n

Payback amounts are reduced to one-half for unmarried individuals who are not surviving spouses or filing as heads of households. There is no help if you get hit with a payback and many of you will have difficulty paying this liability.<\/p>\n

Chances that you may have received an incorrect tax credit are not exactly slim because this poorly thought-out scheme does not take into account the unpredictable and complex financial situations that confront the low and modest income population.<\/p>\n

Keep in mind that by ending up in a higher FPL, you may also have to pay more out of your pocket for an insurance premium. You learned how that works in topic 3. If you can\u2019t afford a higher premium and drop your insurance, you may still owe a payback plus a penalty for being uninsured which is also MAGI-based. Penalties are discussed in topic 7. If your MAGI puts you over 400 percent FPL, you just knocked yourself into left field and are on your own paying for an insurance plan on the open market. And, you may also be required to payback the entire tax credit.<\/p>\n

If you get a job during the current year that offers health insurance which is not more than 9.5 percent of your total salary and the coverage is not less than 60 percent, you must take that insurance or pay a penalty for being uninsured. But, you may owe a payback for the months you received a tax credit before you landed the job. How large that payback is will depend on your MAGI for the entire tax year, not just on your income during the months you received the tax credit. Or, you may lose a job during the year and have a significantly reduced income even though the amount reported on your tax return is high because you had a job for part of the year. In this case as well, your payback will be based on your MAGI for the entire tax year.<\/p>\n

More interest income from taxable and tax-exempt savings or a year-end bonus could also contribute to an increased MAGI and the possibility of a payback as well as taking extra work to help pay the monthly bills, house and car repairs, educational aspirations or a vacation. So, whether or not you end up in payback land will depend on how close you are teetering on the edge of an FPL. Ditto for your share of the premium and the amount of your tax credit.<\/p>\n

The payback may stop many of you from purchasing insurance at the Exchange because you know in advance you will not have the money to pay it. If this is the case, you may be allowed to negotiate a lesser tax credit by paying more out of your pocket for your monthly insurance premium in order to avoid or decrease the payback. It\u2019s a crap shoot. Considering what you\u2019ve learned so far in today\u2019s lesson, many of you will find yourselves between a rock and a hard place under the ACA, and you will be forced to make unten- able choices. Given the skyrocketing costs of food, heat and other basics, how will you even tread water under this set-up, nevermind get ahead?<\/p>\n

Being told you will receive help from the government if you can\u2019t afford to purchase insurance and finding out at tax time this was really a loan and you owe the IRS a substantial debt on top of your income taxes is outright shameful. But most politicians have no shame \u2014 which brings us to the next topic.<\/p>\n

5. MEDICAID EXPANSION AND ESTATE RECOVERY<\/p>\n

In order to expand Medicaid, several Medicaid regulations were changed:<\/p>\n

a)\u00a0the income limit for eligibility was increased to 133 percent FPL, but since states must apply a 5 percent disregard, this effectively raises the eligibility to 138 percent FPL
\nb)\u00a0Modified Adjusted Gross Income will be used in most cases to determine eligibility (also applies to certain CHIP applicants)
\nc)\u00a0the age limit was increased to 64, childless adults will be eligible; and
\nd)\u00a0the asset test was dropped except for certain groups such as the elderly and people on Social Security Disability \u2014 BINGO!<\/p>\n

The fact that the asset test was dropped is very important, but before we look at why, you must first understand that if an Exchange determines you are eligible for Medicaid, you have no other choice. Code for Exchanges specifies, \u201can applicant is not eligible for advance payment of the premium tax credit (a subsidized plan) or cost-sharing reductions to the extent that he or she is eligible for other minimum essential coverage, including coverage under Medicaid and CHIP.\u201d Therefore, you will be tossed into Medicaid unless there are specific rules as to why you would not be eligible. If you are enrolled in a private plan through an Exchange and have been receiving a tax credit, and your income decreases making you eligible for Medicaid, in you go. If you are allowed to opt out because you don\u2019t want Medicaid, you will have to pay a penalty for being uninsured unless you can afford to purchase insurance in the open market.<\/p>\n

Just so you\u2019re clear on this: the ACA stipulates that the system will ensure that if any individual applying to an Exchange is found to be eligible for Medicaid or a state children\u2019s health insurance program (CHIP), the individual will be enrolled in such a plan.<\/p>\n

Furthermore, to increase enrollment in health coverage without requiring people to complete an application on their own, states are advised to automate enrollment whenever possible by using existing databases for social services programs such as SNAP (food stamps) to enroll people who appear eligible for Medicaid but are not currently enrolled. Therefore, you could find yourself auto-enrolled in Medicaid against your will if your state acts on this advice.<\/p>\n

Many times over Mr. Obama et al told you that all Americans would have choice. Choice was another big talking point. Are poor and low-income Americans undeserving of choice? Is the ACA a class-based system? Maybe they meant that for this segment of the population, the choice would be between Medicaid or a penalty for remaining uninsured. This is blatant discrimination.<\/p>\n

Here\u2019s why dropping the asset test got the BINGO \u2014 Estate Recovery! You won\u2019t find the following info in the ACA. It\u2019s in the Omnibus Reconciliation Act of 1993 (OBRA 1993) \u2014 a federal statute which applies to Medicaid, and, if you are enrolled in Medicaid, it will apply to you depending on your age.<\/p>\n

a)\u00a0OBRA 1993 requires all states that receive Medicaid funding to seek recovery from the estates of deceased individuals who used Medicaid benefits at age 55 or older. It allows recovery for any items or services under the state Medicaid plan going\u00a0beyond nursing homes and other long-term care institutions. In fact, The Centers for Medicare & Medicaid Services (CMS) site says that states have the option of recovering payments for all Medicaid services provided. The Department of Health and Human Services (HHS) site says at state option, recovery can be pursued for any items covered by the Medicaid state plan.<\/p>\n

b)\u00a0The HHS site has an overview of the Medicaid estate recovery mandate which also says that at a minimum, states must pursue recoveries from the \u201cprobate estate,\u201d which includes property that passes to the heirs under state probate law, but states can expand the definition of estate to allow recovery from property that bypasses probate. This means states can use procedures for direct recovery from bank accounts and other funds.<\/p>\n

c)\u00a0Some states use recovery for RX and hospital only as required by OBRA 1993; some recover for a few additional benefits and some recover for all benefits under the state plan. Recovery provides revenue for cash-strapped states and it\u2019s a big business.<\/p>\n

Your estate is what you own when you die \u2014 your home and what\u2019s in it, other real estate you may own, your bank account, annuities and so on. And even if you have a will, your heirs are chopped liver. Low-income people often have only one major asset \u2014 the home in which they live and, in some cases, this has been the family home through several generations.<\/p>\n

So what this boils down to is: if you are put into Medicaid \u2014 congratulations \u2014 you just got a collateral loan if you use Medicaid benefits at age 55 or older! States keep a running tally.<\/p>\n

Estate recovery can be exempted or deferred in certain situations after your death, but the regulations for this are limited and complicated with multitudes of conditions. You may not have an attorney on speed dial, but with regard to this hundred pound gorilla, it sure would be handy.<\/p>\n

Should you decide to ask your congresscritter about estate recovery, be prepared for responses such as:<\/p>\n

\u2013\u00a0\u201cEstate recovery doesn\u2019t apply to you.\u201d (Great news. Please overnight a copy of the amendment to OBRA 1993 that stipulates estate recovery is no longer required and no longer allowed. Here\u2019s my address.)
\n\u2013\u00a0\u201cOh, estate recovery is state, I\u2019m federal.\u201d (Wrong \u2014 estate recovery is federally mandated although the estate recovery program itself is administered by each state.)
\n\u2013\u00a0\u201cI don\u2019t know anything about this.\u201d (Highly unlikely because the expansion of Medicaid is an integral part of the ACA and estate recovery is not a secret.)
\n\u2013\u00a0\u201cThe ACA wasn\u2019t about revamping Medicaid.\u201d (As explained above, Medicaid regs were revised in order to expand Medicaid.)
\n\u2013\u00a0\u201cI\u2019ll look into that and get back to you.\u201d (Don\u2019t hold your breath \u2014 they don\u2019t want to go there.)<\/p>\n

If you ask about estate recovery when you contact an Exchange or speak with an outreach agency, you\u2019ll probably run into a brick wall or be told it doesn\u2019t apply to you \u2014 whatever. But, it doesn\u2019t matter because what you are told is not legally binding. What is legally binding is your signature on the Medicaid application which indicates that you agree to the terms of the contract \u2014 which brings us to another item in OBRA 1993. Read on.<\/p>\n

OBRA 1993 also contains procedural rules intended to ensure that individuals are informed about Medicaid program requirements including disclosure of estate recovery before they complete the application process and also during the annual re-determination process. Notification of estate recovery should be on the signature page of your state\u2019s Medicaid application and is usually a one-liner: I understand that if I am aged 55 or older, (name of your state\u2019s Medicaid plan) may be able to get back money from my estate after I die. (Use of the word \u2018may\u2019 doesn\u2019t mean if the state feels like it \u2014 it means recovery will take place unless there are specific circumstances for exemption or deferment as mentioned above.) There are also strict recovery\/repayment clauses for injury-related settlements disclosed on the signature page and a few other ditties that apply to you or a family member who is enrolled in Medicaid. All of these items must also be disclosed in your state\u2019s Medicaid handbook.<\/p>\n

Under the ACA and proposed federal rules for implementation, states will be required to provide a single, simple application to apply for and enroll in Exchange plans, Medicaid and CHIP, and consumers must be able to apply by phone, in person or online. The Secretary (HHS) is charged with this task and it\u2019s in the works. This begs an answer to the following questions:<\/p>\n

\u2013\u00a0Will Medicaid applicants be diligently informed about estate recovery and other rules that apply to Medicaid enrollees on this single application? Failure to do so would be in non compliance with OBRA 1993 and would also be deceptive.
\n\u2013\u00a0Will applicants be provided with a signature page that contains appropriate disclosure of these rules so they can be reviewed before signing on the dotted line?
\n\u2013\u00a0How will appropriate disclosure and obtaining a signature work for those who are bumped into Medicaid due to a decrease in income or who might be auto-enrolled because they were presumed eligible through a database.<\/p>\n

If an applicant or someone who has been bumped or auto-enrolled in Medicaid is not satisfied with the terms of the Medicaid contract, lack of another health insurance option that is in the best interest of low-income earners represents undue and unconscionable advantage being taken of this segment of the population under a law that mandates health insurance or a penalty.<\/p>\n

Do the health insurance policies enjoyed by lawmakers on Capitol Hill and paid for by taxpayers include an estate recovery program?<\/p>\n

Medicaid is poor, underfunded, overstretched and constantly bombarded by state budget cuts \u2014 even before an ACA expansion. It offers a low quality of care in many states, and, in general, represents inequities in care. Office-based doctors typically refuse to accept Medicaid patients, thus, millions thrust into this plan will have difficulty finding a primary-care doctor or a specialist.<\/p>\n

A perfect example is the December 2012 federal appeals court decision that allowed California to cut reimbursements by 10 percent to doctors, pharmacies and others who serve low-income residents under the state\u2019s Medi-Cal plan (a version of Medicaid) due to state budget issues. California was already at the bottom of the rate-reimbursement heap which made finding doctors difficult for residents in Medi-Cal. This decision will further reduce the number of health care providers willing to take new Medi-Cal patients, thus jeopardizing their access to primary and specialized care. Under the ACA\u2019s expansion of Medicaid, state budget crises across the nation will exacerbate the ongoing problems regarding access to care for Medicaid patients, particularly in states that have a high low-income population.\u00a0http:\/\/www.sfgate.com\/health\/article\/Medi-Cal-cuts-upheld-by-appellate-court-4116971.php<\/a><\/p>\n

6. INSURANCE PLANS AT THE EXCHANGES<\/p>\n

Below are the 4 plan levels that will be offered at Exchanges for people between 138 and 400 percent FPL. Each one has government- approved benefits including prescription coverage. You will be entitled to one free preventive visit each year. Per the most recent study commissioned by the Kaiser Family Foundation, several cost-sharing options were estimated for non-group (individual and family) Bronze and Silver plans. Cost-sharing is the amount you must pay to use your insurance. Your share of the premium is not part of cost-sharing.\u00a0http:\/\/www.kff.org\/healthreform\/upload\/8303.pdf<\/a><\/p>\n

The way this works is you will pay for all your medical care until you reach the annual deductible. Then you\u2019ll pay the applicable percent- age of coinsurance until you reach the annual out-of-pocket spending cap which will be set on a sliding scale. Annual means these amounts start again the following year, and if they change, you will find out when you re-apply for insurance. There will also be copays \u2014 an amount you will pay to the doctor for an office visit.
\nHere are the current estimates:<\/p>\n

Bronze: cheapest and dry as dust with 60\/40 coverage \u2014 a win-win for insurers
\na)\u00a0annual deductible of $4,375 for an individual (double for a family) with 20 percent coinsurance,\u00a0b)annual deductible of $3.475 for an individual (double for a family) with 40 percent coinsurance<\/p>\n

Silver: next cheapest \u2014 offers an illusion of coverage at 70\/30
\na)\u00a0annual deductible of $2,050 for an individual (double for a family) with 20 percent coinsurance,\u00a0b)annual deductible of $650 for an individual (double for a family) with 40 percent coinsurance<\/p>\n

Gold: expensive \u2014 80\/20 \u2014 better coverage
\nPlatinum: most expensive \u2014 90\/10 \u2014 most comprehensive coverage<\/p>\n

A fifth plan will be available for the under-30 crowd and people who have been granted a hardship exemption. See topic 8 in this lesson. Coverage in this plan will be less comprehensive than the Bronze \u2014 it is primarily for major-medical expenses except that it has a free preventive visit. Cost-sharing for people at 138 to 200 percent FPL is estimated to be a bit less than the Bronze and Silver estimates mentioned above.
\n\u00ef\u00bf\u00bc
\nThe high deductibles in all but the two most expensive plans could saddle you with mounting bills for routine care and may stop you from seeking necessary treatment for illness or injuries. Many of you will find that the promise of access to affordable health care really means access to inadequate coverage at a price the government has decided you can afford to pay.<\/p>\n

The number of drugs in each plan at an Exchange will vary from state to state. In some states, plans will offer up to 99 percent of available drugs and others only 45 percent which means you may not have access to the specific drugs you need. Perhaps Big Pharma will change its stance on this before 2014.<\/p>\n

The cost of plans at an Exchange will vary from state to state based on where you live and your age. The ACA allows insurers to charge older customers up to three times more for a plan, even if they are in good health, as long as the state in which an Exchange is located doesn\u2019t have a law that caps age-rating. Some Exchanges will tuck an administrative fee of 2 to 4 percent into premiums to help cover operating expenses.<\/p>\n

Cost-sharing tax credits will be available if you are below 250 percent FPL to protect you from high deductibles and copays \u2014 but only if you purchase a Silver plan. If you buy the cheaper Bronze plan, you won\u2019t be eligible for these credits, which are, by the way, direct federal payouts to private health insurance companies.<\/p>\n

Obamacare has no cost controls. There is nothing stopping the insurance companies from increasing their rates, and Washington has already estimated higher premium costs at the Exchange for 2016 which doesn\u2019t mean that 2015 won\u2019t have an increase. Sounds like 2014 prices will be an Introductory Offer. Get \u2018em while their hot!<\/p>\n

7. PENALTY FOR BEING UNINSURED<\/p>\n

The ACA requires that people who have been deemed able to purchase health insurance but decide not to buy it starting in 2014 will owe a penalty (a tax) to the IRS. Here\u2019s what this looks like:<\/p>\n

a)\u00a0In 2014, the annual penalty will be $95 per adult and $47.50 per child, up to a family maximum of $285 or 1 percent of family income, whichever is greater.
\nb)\u00a0In 2015, the penalty will be $325 per adult and $162.50 per child, up to a family maximum of $975 or 2 percent of family income, whichever is greater.
\nc)\u00a0In 2016, the penalty will be $695 per adult and $347.50 per child, up to a family maximum of $2,085 or 2.5 percent of family income, whichever is greater.<\/p>\n

The IRS collects the penalty, but the ACA stipulates that taxpayers shall not be subject to any criminal prosecution or penalty, tax liens, seizure of bank accounts or garnishment of wages for failure to pay it and no accumulation of interest on the unpaid balance. So, it appears that all the IRS can do is deduct the penalty from a refund it owes you, and if you\u2019re not due a refund, then you\u2019ll have an out- standing tax obligation.<\/p>\n

Keep in mind that the penalty is described in annual amounts but is really monthly. So, if you are uninsured for only part of the year, you will accrue only 1\/12 of the total for each month you are uninsured unless you qualify for an exemption.<\/p>\n

8. EXEMPTIONS FROM THE PENALTY<\/p>\n

You may be eligible for official permission that excuses you from having to pay the penalty for being uninsured. The requirements are:<\/p>\n

a)\u00a0If the cheapest health care plan available costs more than 8 percent of your MAGI after subtracting the tax credit or employer contribution, whichever is applicable.
\nb)\u00a0Your income is so low that you aren\u2019t required to file federal income taxes.
\nc)\u00a0You are between jobs and without insurance for up to three months.
\nd)\u00a0You have a sincerely-held religious belief that prevents you from seeking and obtaining medical care.
\ne)\u00a0You are in jail.
\nf)\u00a0You are an undocumented immigrant.
\ng)\u00a0You are a member of an Indian tribe or a religious group currently exempt from paying Social Security tax.<\/p>\n

If item d) is the case, you must file a sworn statement as part of your tax return, and should you obtain care during the tax year, the exemption will no longer apply and you will have to pay a penalty for being uninsured. Per H.R. 6597, medical care is defined as acute care at a hospital emergency room, walk-in clinic or similar facilities. Medical care excludes treatment not administered or supervised by a medical doctor such as chiropractic, dental, midwifery, personal care assistance, optometry, physical exams or treatment where required by law or third parties such as an employer, and vaccinations.
\n\u00ef\u00bf\u00bc
\nIf you think you can\u2019t afford the amount the government has decided you can afford to pay for your insurance plan, and you don\u2019t fit into any of the categories described above, you can apply for a Hardship Waiver. Details have not yet been provided regarding hardship eligibility requirements under the ACA, but, for an idea of what they might look like, let\u2019s check out what the deal is in Massachusetts which already has a mandated health insurance law \u2014 Romneycare! In fact, Romneycare was the model for Obamacare. That\u2019s why some people call Obamacare, Obamneycare.<\/p>\n

To qualify for a Certificate of Exemption under Romneycare, a Massachusetts resident must demonstrate that health insurance is not affordable due to one of the following:\u00a01)\u00a0homelessness;\u00a02)eviction or foreclosure notice;\u00a03)\u00a0domestic violence-related medical trauma;\u00a04)\u00a0major long-term illness of a child;\u00a05)\u00a0death of your spouse;\u00a06)\u00a0your house burned down; or\u00a07)\u00a0\u201cyou can establish that the expense of purchasing health insurance would cause you to experience serious deprivation of food, shelter, clothing or other necessities.\u201d<\/p>\n

Ya gotta luv number 7. And in Massachusetts, exemptions come with an expiration date, so you have to clean up your act in short order. Under the ACA, the Secretary of Health and Human Services will determine if, indeed, you have suffered a hardship that keeps you from being able to pay for coverage.<\/p>\n

9. OTHER TIDBITS<\/p>\n

There is much more in the ACA including all kinds of rules and penalties for employers, employees and the self employed as well as the Accountable Care Organization (ACO) model which will be mandated starting in 2014. The latter works as follows: under the simplest option available, a small group of doctors and hospitals \u2014 an ACO \u2014 will manage your care and be graded and paid based on the outcome of all patients who seek treatment with that ACO. The ACO will also be rewarded with a share of the savings in health costs it achieves by following best treatment practices and reaching specific benchmarks set by CMS. The second option, \u201cshared savings plus risk,\u201d is for larger ACOs. Providers will receive a lump-sum payment to treat their patients and assume a portion of the risk for above target spending but are eligible to keep a greater portion of the savings.<\/p>\n

Either of these options reduce patient care to numbers and paperwork because doctors are essentially controlled and incentivized by an administrator in some far-flung office. The ACO model is the insurance industry\u2019s version of \u201cbudgeting\u201d the cost of health care which ultimately benefits insurers at the expense of doctors and their patients.<\/p>\n

Doctors say that basing their pay on treatment outcomes creates an incentive for them to avoid tough cases whose outcomes could \u201ckill my numbers.\u201d \u201cParadoxically,\u201d writes Dr. G. Keith Smith, \u201cdoctors who are doing sham surgery will be the ones with the best outcomes, as their patients, many of whom don\u2019t need surgery in the first place, will exhibit great, basically perfect outcomes. Physicians who don\u2019t do unnecessary surgery will be pushed to do so to improve their \u2018scores.\u2019 \u2018Pay for performance\u2019 trends in medicine are not a good idea in my opinion. Paying based on patient outcomes will have perverse effects, not the least of which will be the complete denial of care to the very sick.\u201d\u00a0http:\/\/www.medibid.com\/blog\/2012\/10\/your-disease-can-kill-you-in-more-than-one-way\/?utm_source=Registered+Physicians&utm_campaign=8f9028ddaf-October_Physician_Newsletter11_17_2012&utm_medium=email<\/a><\/p>\n

The ACA also requires Health Insurance Exchanges to establish a navigator program to inform the uninsured about the availability of government-approved subsidized plans at an Exchange and to facilitate enrollment in these plans, but it leaves the design of the program up to each Exchange.<\/p>\n

Depending how an Exchange sets up its program, some Navigators will sell plans offered by an Exchange while others will be responsible for maintaining the existing market but may also be allowed to sell Exchange plans. All seller Navigators will be compensated either by Exchanges or insurance carriers for the plans they sell. Many options are being considered by Exchanges including using insurance agents. Hopefully, Navigators and insurance agents will not be knocking on your door or contacting you by phone. That would be over the top. Here\u2019s a link to read what the California Exchange is pondering with regard to its Navigation program.http:\/\/www.healthexchange.ca.gov\/StakeHolders\/Documents\/CHBE,DHCS,MRMIB_StatewideAssistersProgramDesignOptionsRecommendationsandWorkPlan_6-26-12.pdf<\/a><\/p>\n

10. ENROLL AMERICA, HERNDON ALLIANCE & THE EXCHANGES \u2014 MASTERS OF SPIN<\/p>\n

Since many Americans don\u2019t know about the ACA, somehow the word has to get out and people must be encouraged to purchase health insurance either in the open market or at an Exchange. And who better to do this?<\/p>\n

Enter \u201cEnroll America\u201d \u2014 a nonprofit 501(c)3, financially backed by Aetna, Blue Cross Blue Shield, UnitedHealth, America\u2019s Health Insurance Plans, hospitals, associations that represent drug manufacturers and nonprofits with vested interests. For insurers and pharma, the ACA is manna from heaven \u2014 scratch that \u2014 manna from Capitol Hill \u2014 and the dollar signs in their eyes are on fire! These profit seekers and connected nonprofits will be using every avenue possible to maximize their bottom lines.<\/p>\n

The mission of Enroll America per its website is to \u201censure that all Americans are enrolled in and retain health coverage.\u201d It\u2019s Board of Directors and Avisory Council reads like a Who\u2019s Who in the Medical Industry Cartel \u2014 CEOs, presidents, vice presidents and directors of such entities as the American Hospital Association, Express Scripts, Medicaid Health Plans of America, Kaiser Permanente and many others \u2014 the list is long. If you would like to donate to these mega-profit vultures, you can do so on the Enroll America home- page. The goal is $100 million by 2014.
\nhttp:\/\/www.enrollamerica.org<\/a><\/p>\n

In its publication, \u201cTen Ways to Make Health Coverage Enrollment and Renewal Easy,\u201d Enroll America has recommended availability of web-based applications to increase the places where people can enroll in coverage: at home, at grocery stores, community health centers, state fairs, sporting events, places of worship, and more. Gee, you can apply for insurance while you pray. How thoughtful.http:\/\/www.enrollamerica.org\/best-practices-institute<\/a>
\n\u00ef\u00bf\u00bc
\nThe strategy for insurers and state Exchanges to persuade you to purchase insurance and warn you about the penalties includes using ads, social media, blogs, YouTube, Flickr, Twitter, hospitals, health centers, McDonald\u2019s, in-store radio announcements, ballparks, county fairs, libraries, laundromats, community events, libraries, county fairs and drugstores \u2014 you name it. Blue Cross Blue Shield has partnered with H & R Block. Health insurers are already setting up shop inside some supermarkets so they can answer your questions and sign you up for coverage while you do your grocery shopping. They will likely be showing up in shopping malls \u2014 maybe even in parking lots, on street corners and at church fairs. And, their aim is to recreate themselves from the bloodsucking leeches that they are to your new, cool-dude friends.<\/p>\n

We\u2019ll be living in Occupied Territory.<\/p>\n

Let\u2019s connect some dots. The executive director of Enroll America is Ron Pollack, also president of Families USA \u2014 a nonprofit and friend of the industry. On its website, Families USA bills itself as \u201ca national non-partisan organization dedicated to the achievement of high quality, affordable health care for all Americans.\u201d Philippe Villers and Robert Crittenden, M.D. are on Families USA Board of Directors. Mr. Villers is also on the BOD of Herndon Alliance, Bob Crittenden is a Herndon staff member and Ron Pollack is a Herndon founder.\u00a0http:\/\/www.familiesusa.org<\/a><\/p>\n

Herndon Alliance is an influential health care spinmeister creating messaging to change public opinion and tweaking each message to reach particular groups.<\/p>\n

Herndon has close ties to Capitol Hill and helped market the ACA providing words politicians and supporters should use to promote the bill. For example, during the national health care debacle a few years ago, you heard Mr. Obama et al continually talk about \u2018choice,\u2019 \u2018we need a uniquely American solution,\u2019 \u2018fair rules,\u2019 \u2018investing in America\u2019s future\u2019 and \u2018high-quality, affordable healthcare.\u2019 That last one is used in Families USA mission statement. The Council for Affordable Health Insurance, a frontgroup for the industry, gets right to the point \u2014 its name. Ron Pollack worked with the Obama administration to help reshape public opinion of Mr. Obama\u2019s unpopular health care bill. Leading up to 2014 when the Exchanges are scheduled to open, there will most likely be a blitz of TV ads in which you will hear many of these same nebulous, feel-good words. And, you\u2019ll undoubtedly read or hear plenty of Herndon spin from your Exchange and throughout your state in the immediate future.<\/p>\n

In the interest of coming up with messaging, Enroll America held a few focus groups and commissioned a nationwide survey in fall 2012. Research was provided by Celinda Lake from Lake Research Partners, a national public opinion and political strategy research firm. One takeaway was when a monthly premium cost was given, the majority of people polled thought that it was too expensive and the ACA would not provide affordable and comprehensive coverage even with the government tax credits (subsidies). So, Lake Research Partners advised Enroll America not to mention specific costs but to use the phrase \u2018free or low-cost plans.\u2019http:\/\/www.nytimes.com\/2012\/12\/20\/us\/officials-confront-skepticism-over-health-law.html?ref=us&_r=0&pagewanted=all<\/a><\/p>\n

Herndon has been working on messaging various parts of the ACA that will be used by outreach partners, insurers and state Exchanges. Its messaging is not based on truth or evidence \u2014 Herndon actually stays away from any mention of facts as you read above regarding the cost of plans. Instead, its messaging is designed to mislead an uninformed public.<\/p>\n

A few of Herndon\u2019s target populations include voters, people of color, red states, skeptical audiences, and you\u2019ll love this one \u2014 Elevator Language with a list of succinct scripts to use based on the person you\u2019re speaking to during the ride. You must check out Herndon\u2019s website and read the many instructions of what to say and what not to say. You\u2019ll either get very annoyed or laugh yourself silly.http:\/\/herndonalliance.org\/resources\/research\/communications-tips-exchange-talking-with-voters.html\u00a0<\/a>
\nhttp:\/\/herndonalliance.org\/resources\/implementation-basics\/communications-tips-to-use-with-skeptical-audiences.html<\/a><\/p>\n

Here are some examples of Herndon spin regarding the ACA:<\/p>\n

\u2013\u00a0Use \u201cfamily values\u201d when talking to the public about the expansion of Medicaid. Is estate recovery a family value?\u00a0http:\/\/herndonalliance.org\/resources\/what-s-new\/talking-about-medicaid-connecting-with-the-public.html<\/a><\/p>\n

\u2013\u00a0When talking about the ACA\u2019s required Accountable Care Organization (ACO) model that will pay doctors according to patient outcomes and reward them for savings they achieve, Herndon says to call this \u201cCoordinated Patient Care\u201d and \u201cdo not connect pricing with rewards or incentives for doctors\u201d or \u201cwith lump-sum payments for medical care\u201d and do not mention \u201cpayment based on positive patient outcomes.\u201d Why not? The three do-nots are how ACOs work. (ACOs are described in topic 9.)\u00a0http:\/\/herndonalliance.org\/resources\/system-change\/payment-reform-quality-care-pricing.html\u00a0<\/a>http:\/\/herndonalliance.org\/resources\/system-change\/coordinated-patient-care.html<\/a><\/p>\n

\u2013\u00a0Here\u2019s an award winner: \u201cMembers of Congress will purchase their insurance at the Exchange. If members of Congress are part of the marketplace then it\u2019s got to offer quality plans and protections.\u201dhttp:\/\/herndonalliance.org\/resources\/research\/communications-tips-exchange-talking-with-voters.html<\/a>
\n\u00ef\u00bf\u00bc
\n\u2013\u00a0Stressing that under the ACA insurers won\u2019t be able to deny coverage for pre-existing diseases is a Herndon biggie. In fact,\u00a0you heard this many times over from Mr. Obama and other politicians. But a loophole in the law allows insurers to rescind (cancel) your policy if you intentionally put false or incomplete information on your application. The ACA says you must be given at least 30 days\u2019 notice before your coverage can be rescinded, giving you time to appeal the decision or find new coverage. So, if your care becomes costly for the insurer and you didn\u2019t mention you had a rash on your arm when you were 15, that\u2019ll work. How can you prove if leaving this out was intentional or not? It\u2019s them against you.<\/p>\n

Enroll America\u2019s Best Practices Institute is publishing a series of briefs on the best way to write and design websites and marketing materials, no doubt, using Herndon messaging. PR and marketing firms are helping various state Exchanges come up with appealing branding such as using a name everyone will like and spiffy logos with cool type styles in colors that will appeal to all audiences. Branding lessons include advising Exchanges which words to \u2018embrace\u2019 such as emphasizing choice, control, transparency and competition. Other messaging includes, \u201cthe Exchange should be viewed as an educator, not an enforcer\u201d and using the word \u2018marketplace\u2019 instead of Exchange is a must. Tennessee Health Care Campaign will be telling potential customers \u201c. . . the exchange offers us more choices, greater control over our health care, and more competition to control costs.\u201d It\u2019s all Herndon\u2019s handywork in one form or another.http:\/\/dhmh.maryland.gov\/exchange\/pdf\/Brand_Recommd_may182012_final.pdf<\/a>http:\/\/www.thcc2.org\/PDFs\/rtm_exchange_talking_point.pdf<\/a><\/p>\n

More choice means choice of insurance companies, not choice of doctors and hospitals. In rural areas, there may be only one insurer offer- ing plans which means one network and doctors may not be taking new patients. This happened in MA under Romneycare, and on top of that, many doctors would not accept people in the subsidized plans because of time-consuming red tape and low reimbursement rates. Under the ACA, insurers are planning to limit networks in the cheaper plans at the Exchanges. Having too few doctors in a network is a means of suppressing the use of health care which increases an insurer\u2019s profits. Further on in this lesson, you\u2019ll learn that the Maryland Exchange has been advised to ignore negative problems such as not enough doctors to serve the newly insured.\u00a0http:\/\/www.kaiserhealthnews.org\/Stories\/2013\/January\/23\/HMO-limited-networks-comeback-in-exchanges.aspx<\/a><\/p>\n

Choice is definitely a non starter for people found eligible for Medicaid \u2014 the ACA allows no other choice for this segment of the popula- tion and many doctors do not accept Medicaid. As for giving you greater control, considering all the rules about income and FPL, not to mention the data-mining to monitor your income during the year and those nasty tax credit paybacks, it\u2019s you who is being controlled. And competition? Read this stunning op-ed by Nomi Prins: \u201cReal Danger of \u201cObamacare\u201d Insurance Company Takeover of Health Care.\u201d\u00a0http:\/\/www.nationofchange.org\/real-danger-obamacare-insurance-company-takeover-health-care-1352648027<\/a><\/p>\n

In Enroll America\u2019s January 15, 2013 press release, Executive Director Rachel Klein says the ACA offers the promise of \u201caccess to comprehensive, affordable health coverage.\u201d That is a false promise. As you learned in this lesson, coverage in the plans that will be offered at the Exchanges, with the exception of the two most expensive, is anything but comprehensive \u2014 the cheaper plans are unafford- able to use. Furthermore, how can she claim that the cost of the plans are affordable? Ms. Klein should be well aware of the nationwide survey Enroll America commissioned in which the majority of people polled said that the plans are too expensive.http:\/\/files.www.enrollamerica.org\/news-room\/press-releases\/Enroll_America_Plans_Major_Affordable_Care_Act_Enrollment_Campaign_1-15-13.pdf<\/a>
\nhttp:\/\/www.nytimes.com\/2012\/12\/20\/us\/officials-confront-skepticism-over-health-law.html?ref=us&_r=0&pagewanted=all<\/a><\/p>\n

Currently PR firms are working with some state Exchanges to develop effective communications plans and advertising campaigns. Names include Mintz & Hoke, Hill & Company Communications and Weber Shandwick just to name a few. Ask the Massachusetts Health Insurance Connector \u2014 the prototype of an Exchange in the land of Romneycare \u2014 how much it spent on PR contracts over the years. In 2007, board members signed off on a two-year contract with Weber Shandwick for $1.85 million the first year with nearly $3 million for advertising \u2014 commission on media buys not included. And, by the way, the MA Connector upper management boasts six-figure salaries. Former MA Connector Executive Director Jon Kingsdale\u2019s salary in 2007 was $225,000 and increased in 2008 to $231,750. In 2007, Deputy Director Rosemary Day alternated between a four-day and five-day work week to the tune of $175,000. These are only two examples of the many high-flying salaries at the MA Connector, an operation run by politicians and unelected political appointees and influenced by executives from the private insurance industry,http:\/\/www.wickedlocal.com\/cambridge\/news\/x497793387\/Connector-re-ups-contract-with-Cambridge-based-Weber-Shandwick<\/a>http:\/\/www.boston.com\/yourlife\/health\/other\/articles\/2007\/01\/27\/6_figure_pay_for_care_plan_overseers\/?page=full<\/a>\u00a0http:\/\/www.highbeam.com\/doc\/1G1-166773095.html<\/a><\/p>\n

Add up pay scales like that for every Exchange in the country, throw in some bennies, a PR contract for each Exchange, campaign costs and compensation paid by Exchanges to Navigators for plans they sell \u2014 a grand and costly effort to push more people into America\u2019s for-profit health care system. Your tax dollars at work and mega bucks that could be used for actual hands-on medical care.<\/p>\n

The Maryland Exchange has three campaign funding levels \u2014 Basic, Plus and Full-Scale \u2014 with a total for year one, two and three. Basic funding for year one is $2,450,000, Plus is $4,000,000 and Full-Scale is $6,300,000. See p.137 at this link for years two and three.http:\/\/www.dhmh.maryland.gov\/exchange\/pdf\/FinalAdvertisingReportWeber.pdf<\/a>
\n\u00ef\u00bf\u00bc
\nThe following, from the maryland link above, gives you an idea of some of the strategies that will be in play, most likely in all states. The Maryland Exchange has been advised by Weber Shandwick to \u201cestablish a system to monitor newspaper, radio, TV and online conversations about the Exchange and the program and to establish procedures and priorities for responding to negative media stories, op-eds, blogs and reports.\u201d You can find this in the Risk Management and Responses section of Maryland\u2019s strategic marketing plan.<\/p>\n

In the Earned Media\/Public Relations section, advice includes \u201c . . . putting out stories on the first effective enrollees, enrollment number milestones, and enrollee testimonials. Each of these becomes the focus for positive, brand-reinforcing stories. There will also be the risk of negative stories, including potential topics such as enrollment snafus, delays in issuing insurance cards, the cost of Qualified Health Plans [government-approved plans], claims of \u2018shoddy\u2019 Bronze coverage, incidents of physicians refusing to accept enough new patients to serve the uninsured and other negative topics.\u201d \u201cWhile coverage is bound to include some level of criticism it can be success- fully countered by putting a human face on heatlh reform.\u201d<\/p>\n

The Social and Digital Media section advises an invasion of the Internet including social media to market health insurance by \u201cdelivering the right messages to the right audience at the right time,\u201d (probably using Herndon spin) to \u201chelp drive enrollment in the Exchange,\u201d and also flooding newspapers with op-eds to contradict reported adverse effects of the ACA.<\/p>\n

More details can be found at the Maryland pdf link below. It\u2019s worth looking at this presentation to grasp the big business approach of Exchanges which is clearly profit-driven. The Maryland Exchange strategy is just one example. The goal of Exchanges is sell, sell, sell.http:\/\/www.dhmh.maryland.gov\/exchange\/pdf\/FinalAdvertisingReportWeber.pdf<\/a><\/p>\n

Exchanges certainly have a lofty goal \u2014 promote success stories only and be ready to contradict and cover up the bad stuff as quickly as possible. Massachusetts residents have been there. The Connector and state politicians including the governor made sure that anyone being harmed by Romneycare would not be heard in spite of statewide survey reports put together by outreach agencies advising state legislators and powerplayers that low-income people were not faring well under this law. Various issues were spelled out and testimonials were included, but residents\u2019 concerns about the adverse effects of Romneycare were ignored. MA national legislators also went along with this agenda as did the mainstream media.<\/p>\n

When $130 million was needed in 2009 to balance the Massachusetts state budget, the Connector \u2014 with the blessing of MA Gov. Deval Patrick and the MA legislature \u2014 removed about 28,000 legal immigrants \u2014 working people paying taxes \u2014 from their insurance plans. Another 8,000 or so were barred from enrolling in insurance plans because the MA legislature voted to cap enrollment in the subsidized plans. This took place at the same time Mr. Obama was trying to sell the ACA to the nation, so, under pressure from Washington, the MA legislature restored some of the money, and the Connector dumped these people, without their consent, into an out-of-state plan with higher copays, less comprehensive coverage and next to no doctors or safety net hospitals in its network.http:\/\/www.huffingtonpost.com\/iyah-romm\/lessons-from-massachusett_b_380718.html<\/a><\/p>\n

This has huge implications for the ACA. If legal immigrants can be removed from their plans and others denied enrollment when a state budget is squeezed, which vulnerable segment of the population is next in line? The good news is these legal immigrants in MA sued the Connector and its then-Executive Director, Jon Kingsdale, and the Massachusetts Supreme Judicial Court ruled unanimously that the state could not violate their right to equal protection under the state and federal constitutions and fiscal considerations alone can not justify a state\u2019s invidious discrimination against them. As a result of this decision, the state had to come up with some bucks, and the Connector was forced to put the plaintiffs back into their original plans.
\nhttp:\/\/www.healthlawadvocates.org\/priority-areas?id=0015<\/a><\/p>\n

Getting back to Enroll America, Herndon Alliance and some of the less-than-honorable Exchange strategies \u2014 it\u2019s one thing to inform Americans about the ACA and Exchanges that offer the possibility of either purchasing high-deductible or catastrophic coverage with a loan from the government to help pay for it or being tossed into expanded Medicaid \u2014 but, mounting a costly, massive campaign to purposely deceive and manipulate the public with the unstated goal of more profit for the already extremely lucrative health insurance industry is disgraceful.<\/p>\n

\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013-<\/p>\n

Is the ACA a fair law if it helps only one small segment of the population but hurts and exploits a larger number to do so? The way this law works is fundamentally unfair and will not bring medical care to the many, but, instead will progress to greater personal debt for individuals and families who can\u2019t afford the \u201caffordable\u201d insurance as well as those who must keep an eye on their income to avoid the many traps and false ends this law creates. At their expense, the forced purchase of health insurance will bring increased revenue to the industry, not to mention more kickbacks to Congress, and in the very near future, the health insurance industry will be \u201ctoo big to fail.\u201d<\/p>\n

The ACA is most definitely a \u201cuniquely American solution\u201d which has little to do with reforming this country\u2019s barbaric health care system. It merely controls peoples\u2019 finances and choices while leaving insurance companies in charge and does virtually nothing to end their abuses. It will leave many millions of Americans uninsured and millions more underinsured at a staggering cost to taxpayers.
\n\u00ef\u00bf\u00bc
\nPoliticians, health care policy wonks and vested interests will brush aside the ACA\u2019s adverse effects. You\u2019ll hear that some have fallen through the cracks of health care reform but the problems can be easily tweaked. You will also witness the usual dog-and-pony show on Capitol Hill in which the two parties play the blame game. The bought-and-paid-for mainstream media will regurgitate whatever Washington feeds it, and TV talking heads will chime in, inviting their \u201cexperts\u201d to analyze the situation while real people in the real world struggle to get by under this law or fall by the wayside.<\/p>\n

Good luck everyone and watch out for the folding chairs.<\/p>\n

addendum:<\/p>\n

Obamacare architect leaves White House for pharmaceutical industry job
\nhttp:\/\/www.guardian.co.uk\/commentisfree\/2012\/dec\/05\/obamacare-fowler-lobbyist-industry1<\/a><\/p>\n

Physician payments based on outcomes
\nhttp:\/\/www.medibid.com\/blog\/2012\/10\/your-disease-can-kill-you-in-more-than-one-way\/?utm_source=Registered+Physicians&utm_campaign=8f9028ddaf-October_Physician_Newsletter11_17_2012&utm_medium=email<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Obamacare was formulated on the concept of health care as a commercial commodity and was cloaked in ideological slogans such as \u00e2\u20ac\u0153shared responsibility,\u00e2\u20ac\u009d \u00e2\u20ac\u0153no free riders\u00e2\u20ac\u009d and \u00e2\u20ac\u0153ownership society.\u00e2\u20ac\u009d <\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[18],"tags":[],"class_list":{"0":"post-25477","1":"post","2":"type-post","3":"status-publish","4":"format-standard","6":"category-latest-news"},"_links":{"self":[{"href":"http:\/\/rinf.com\/alt-news\/wp-json\/wp\/v2\/posts\/25477","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/rinf.com\/alt-news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/rinf.com\/alt-news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/rinf.com\/alt-news\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/rinf.com\/alt-news\/wp-json\/wp\/v2\/comments?post=25477"}],"version-history":[{"count":0,"href":"http:\/\/rinf.com\/alt-news\/wp-json\/wp\/v2\/posts\/25477\/revisions"}],"wp:attachment":[{"href":"http:\/\/rinf.com\/alt-news\/wp-json\/wp\/v2\/media?parent=25477"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/rinf.com\/alt-news\/wp-json\/wp\/v2\/categories?post=25477"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/rinf.com\/alt-news\/wp-json\/wp\/v2\/tags?post=25477"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}