Of the 16.7 million uninsured people who could be shopping on the Marketplace whether or not they are eligible for a subsidy; a Kaiser Family Foundation analysis estimates 4.7 million of the uninsured Americans are eligible for free ($0 premiums) Bronze plans in the ACA marketplace. The 4.7 million is also a bit less than half of the uninsured who are eligible for marketplace subsidies, according to a 2017 Kaiser estimate.

Bronze plans have an average deductible of $6,506, and many people eligible for a $0 bronze premium would also be eligible for significant cost-sharing assistance by instead purchasing a silver plan. Single individuals with incomes below 250% of the poverty level can purchase benchmark silver plans with cost-sharing reductions (CSR) for $20 to $215 per month after subsidies in 2020, on average, depending on an enrollees’ income. Silver CSR plans have average annual deductibles ranging from $209 to $3,268 in 2020, also depending on income, and have reduced copays and coinsurance. It is therefore important for potential enrollees, particularly those with significant health needs, to not only consider the premium, but also the significant cost-sharing assistance that is only available if they enroll in a silver plan.

Trump and Republicans  stifling ACA advertising has made it impossible for people to gain the knowledge. They support the healthcare industry which can be legitimately blamed for the rising cost of healthcare premiums and deductibles.

How Many of the Uninsured Can Purchase a Marketplace Plan for Free in 2020?, KFF; Rachel Fehr, Cynthia Cox, and Matthew Rae; December 10, 2019

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As I pointed out in a public meeting, Republicans have had control of the Michigan Senate since 1992, the House two-thirds of the time, and the governorship two of 3 times up till Gretchen Whitmer came to office. Yet under the control of Republicans, the state’s infrastructure is crumbling, its economy has decreased when compared to other nearby competitive states, and employment Participation Rate still has not returned to what it was pre-2008 when the Republicans left a nation’s economy in shambles and a large deficit.

The one thing Republicans are good at is attacking the rights of everyday citizens,  a woman’s right to birth control and information, the rights of minorities to societal equality, and the rights of those living homeless and in poverty. In Michigan, the majority Republican legislature mostly sponsored by creative districting will pass a veto – proof bill based upon petitions from those who wish to deny women the right to decide rather than put the decision on a ballot initiative in Michigan.

From Bloomberg Law:

“Anti-abortion group Right to Life Michigan said it handed in more than enough valid signatures Dec. 23 to put its proposed ban of dilation-and-evacuation abortion procedures before the Legislature in 2020. The procedure, which dismembers the fetus, is the most common second-trimester abortion operation.

The vote would be held under a divisive process that allows the Michigan House and Senate to adopt citizen referendums headed to the ballot on a majority vote not subject to veto. Right to Life of Michigan has used the referendum-to-adoption process four times in the past when a governor opposing abortion restrictions proved a barrier in Lansing, and the group says it already has assurances from GOP leaders in the House and Senate that the ban will be adopted.

‘The 379,418 people who signed their names on this life-saving dismemberment ban should be confident that our prolife majorities in the Michigan Legislature will pass the bill again, just like they did back in May,’ Right to Life of Michigan President Barbara Listing said in a Dec. 23 statement.’”

Michigan Edges Toward Ban on Common Abortion Procedure, Bloomberg Law, December 23, 2019

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Poverty is the worst form of violence.  Mahatma Gandhi

This particular Baltimore Sun commentary goes hand in hand with Paul Krugman’s commentary on making life more difficult for the <less than 138% FPL  using Medicaid. The motive of the Trumpians. Trump, and Republicans is to punish people for things impacting them through no fault of their own. Trumps plays to a crowd who believe others less fortunate are getting something for nothing. It is an old ploy to establish a class lower than the next level so they believe they have a her level of existence.

Imagine if sleeping were to get you thrown in jail. Or sitting and lying down in public. Or camping. Or snoozing in your car.

In cities across the country, that is exactly what is happening to homeless people who engage in these activities. In an effort to clean up their cities and make residents and visitors more comfortable, lawmakers have taken an inhumane approach to homelessness and made all these actions illegal.

Civil liberties advocates have challenged these laws arguing, arguing they violate the 8th Amendment against cruel and unusual punishment. This month, they were handed a victory from the Supreme Court, which declined to review a lower court ruling that allowed people to sleep in public when shelters are full. The justices made their decision with no comment or dissent in the case, which stemmed from a lawsuit filed by homeless people in Boise, Idaho, who were ticketed for sleeping outside.

We hope the high court’s decision will make other cities think twice about adopting such laws, which punishes people for their predicament. A study released last week by the National Law Center on Homelessness & Poverty found the number of cities with such regulations is growing rapidly. In 2019, 83% of 187 cities had at least one law that restricted begging in public. Fifty-five percent of these cities have one or more laws prohibiting sitting or lying down in public and 51% had at least one law restricting sleeping in public. Currently, 72% of the cities have at least one law restricting camping in public. There are even laws that prohibit people from sleeping in their cars.

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This sets the tone in Michigan as the richest Republican controlled County of Livingston continues its attack on women along with the State of Michigan House and Senate using a petition to pass a veto-proof law limiting abortion without putting it forward on a ballot initiative. A tyranny of a minority imposing its will upon others.

“By Trump-era standards, Ebenezer Scrooge was a nice guy.

It’s common, especially around this time of year, to describe conservative politicians who cut off aid to the poor as Scrooges; I’ve done it myself. But if you think about it, this is deeply unfair to Scrooge.

For while Dickens portrays Scrooge as a miser, he’s notably lacking in malice. True, he’s heartless until visited by various ghosts. But his heartlessness consists merely of unwillingness to help those in need. He’s never shown taking pleasure in others’ suffering, or spending money to make the lives of the poor worse.

These are things you can’t say about the modern American right. In fact, many conservative politicians only pretend to be Scrooges, when they’re actually much worse–not mere misers, but actively cruel. This was true long before Donald Trump moved into the White House. What’s new about the Trump era is that the cruelty is more open, not just on Trump’s part, but throughout his party.

The conventional wisdom about today’s Republicans is that they are Scrooge-like. The story is that they want to serve the interests of the rich (which is true), and that the reason they want to slash aid to the poor is to free up money for plutocrat-friendly tax cuts.

But is that really why the right is so determined to cut programs like food stamps and unemployment benefits?

(more by Krugman)

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Steve Hutkins, a literature professor who teaches “place studies” at the Gallatin School of New York University. A few days ago, the Trump administration announced that one of its goals is to privatize the Postal Service. A private postal system, says the White House proposal, would deliver mail fewer days per week, shift to cluster boxes instead of door and curb delivery, adjust prices and negotiate wages and benefits without government interference, and “shrink its physical and personnel footprints,” i.e., close post offices, consolidate processing facilities, sell buildings, and shed jobs. According to Trump’s proposal, before privatization can happen, the Postal Service must show that it can be profitable, so it needs to cut costs on delivery, wages, benefits, and footprint sooner rather than later. That process is actually well underway, and it has been for decades. The following post was originally published in July 2011, but it seems as relevant as ever, so it’s reprinted here with a few minor edits to update some numbers.

Marketization is “the process that enables state-owned enterprises to act like market-oriented firms.” It is achieved by reducing government subsidies, deregulation, organizational restructuring, The post office thus came to be viewed in terms of a business model. Like a private corporation, it was expected to adopt the methods and values of the marketplace — cut costs, streamline operations, fight unions, don’t run in the red — rather than operating as a public service “to bind the nation together”and decentralization. It often paves the way for complete privatization.

It was the Postal Reorganization Act of 1970 that began the marketization of the postal system. It transformed the U.S. Post Office Department – a government agency and part of the Cabinet — into the independent U.S. Postal Service – a government-owned corporation that is self-supporting and receives no tax dollars.

The post office thus came to be viewed in terms of a business model. Like a private corporation, it was expected to adopt the methods and values of the marketplace — cut costs, streamline operations, fight unions, don’t run in the red — rather than operating as a public service “to bind the nation together.”

That’s why you keep hearing politicians and USPS leaders say “the Postal Service is a business,” and it needs to “optimize its infrastructure facilities” and “shed under-utilized assets.” And that’s why a few weeks ago Dennis Ross’s committee on postal infrastructure brought in a couple of corporate execs to explain how they run their businesses.

The Reorganization Act, it’s worth noting, was the product of a presidential commission in 1967-68, chaired by retired AT&T Chairman Frederick R. Kappel, who, in testimony before Congress, said, “If I could, I’d make it a private enterprise and I would create a private corporation to run the postal service and the country would be better off financially. But I can’t get from here to there.” It would be left to others to “get from here to there.”

Steps two, three and four after the leap

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The Afghanistan War

(posted by run75441)

The Washington Post has over the last 7 days published a detailed account based on many secret documents they have spent years obtaining to provide an accurate account of what has happened during what is now the longest war the US has been engaged in. It is an impressive account, which I have tried to follow, although with finishing a semester I did not read every word of it. But it is a serious and important serious series, just reaching its conclusion today, along with lots of commentary in the WaPo Sunday Outlook section.

One extremely serious bottom line on both of them was lying by US officials, just rampant and all over the place for both wars. WaPo Outlook had an especially useful column by Lauren Kay Johnson who was US military PR person in late 2009-early 2010, soon after Obama came in. Lies, lies, lies.

The obvious comparison is with the Vietnam War, and much does carryover such as corruption and bad excuses for continuing with unlikely improvement outcomes. Vietnam was bigger and deadlier, well over 2000 dead per year in Vietnam compared to about 100 Americans dying in Afghanistan per year. Easy to pay no attention to them.

So aside from much lower US deaths, maybe the other big difference from the Vietnam War is the shift to drones, perhaps not unconnected to the first. While this almost certainly reduced the US deaths, it also led to less knowledge on the ground that was there in Vietnam (see “They Marched into Sunlight” by David Maraniss, old friend of mine).

Obviously, a big difference between the two wars is that Vietnam beyond some point engendered a massive anti-war protest movement, while the longer Afghan war has not even to now triggered anything like the protests the Vietnam predecessor brought. Certainly both the far lower death rate and lower costs lie behind this.

But the similarities are clear and must be recognized. This has been a corrupt, ultimately hopeless war that people at many levels of the US govt have just routinely lied about. One difference between the two wars is the big role of opium in Afghanistan, with the money in it being hugely important, while it played a more minor matter in the earlier war.

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It is not a dirty or hidden little secret. Insurance companies offering MA plans do not tell you that once you are in their plan, you are there potentially forever. Returning to traditional Medicare is ok but, getting a Medigap Plans to supplement the gap may lead to rejection or much higher premiums if you choose to come back and especially if their are pre-existing conditions.

The same as the Commercial MA companies, Medicare.gov websites are not always clear about the process of transferring out of MA to traditional Medicare and obtaining a Medigap plan. Being unconditionally accepted by a Medigap plan is guaranteed only within the first 12 months after enrolling in Medicare at age 65.

In 2019, one-third (34%) of all Medicare beneficiaries, 22 million seniors were enrolled in Medicare Advantage (MA) plans.

As most know, Medicare consists of Part A, B, C, and D plans. Part A has no premiums, Part B has a premium (paid to the Gov), and Part D (prescriptions) has a premium which is paid to commercial healthcare insurance. To cover the gaps in A & B and the gap, you buy supplemental insurance which is about the same as Part B in premium cost. Unless Medicare rules change, the most one can experience is changes in premiums.

In contrast, Part C or Medicare Advantage plans can cover a broad array of health services at a low cost. Unless one gets sick, the price for MA Plans can remain low. If one does gets sick, out-of-pocket costs can increase in later years. Once in an MA plan, getting out can result in less affordability. Medigap plans in all but four states can and do reject people or require higher premiums if you caome back to them after Medicare Advantage Plans. Diabetes, heart disease, or even a knee replacement can be criteria for exclusion.

“After Mills underwent a mitral valve repair and suffered a mild stroke with no lasting effects, the San Diego resident’s plan now charges him hundreds of dollars in monthly copays for drugs and other medical services. He had to pay $295 a night for his hospital stay.

But there was a much bigger shock. Mills, 71, learned that switching out of his MA plan he would incur exorbitantly higher costs the next time he needs a serious medical intervention. If he moves to traditional Medicare and a prescription plan, he will still need a supplemental Medigap plan to pick up his 20% copays and deductibles.”

Again, this is something most people do not know, an should know before they make any move to Medicare Advantage plans. Furthermore, there are many MA plans which have narrow networks to which you must go to. In comparison, traditional Medicare pays where ever you go in the United States.

Medicare Advantage Enrollees Discover Dirty Little Secret – Getting Out is a lot harder than Getting In, MedPageToday, Cheryl Clark, December 3, 2019.

A Dozen Facts About Medicare Advantage in 2019, Gretchen Jacobson, Meredith Freed, Anthony Damico, and Tricia Neuman, KFF, June 06, 2019

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“The New Hospital Price Disclosure Rule Is Important, But Only A First Step,” Health Affairs, James C. Capretta, August 26, 2019

The new proposed regulation on hospital price transparency is an important step toward consumer-friendly price information. The regulation introduces into federal price transparency, requirements such as the concepts: of service standardization, consumer-friendly organization and terminology, and bundling of which all of are crucial for a marketplace to become price competitive.

As the administration acknowledges, this regulation by itself will not fully address the opacity of today’s market. Additional disruptive changes will be necessary to give consumers usable pricing information. Among which, meaningful transparency requires stricter standardization of the services being priced and “all in” pricing matching how consumers think about the services they need.

Additionally, the reform of the nation’s insurance payment system must be integrated into the price transparency effort to ensure consumers are price sensitive across a wider range of services. Suppliers of services will only compete on price when significant numbers of consumers have strong incentives to seek out low-cost alternatives.

Me: To which I would add there is a big difference between price and cost and it is not being acknowledged.

The Trump administration on Friday put forth two long-anticipated rules that increase price transparency for both hospitals and insurers.

The CMS’ hospital price transparency requirements finalize changes that require health systems to make their standard fees available on-demand and online. The “transparency in coverage” proposed rule would require health plans, including employer-based plans, and group and individual plans, to inform participants, beneficiaries and enrollees about price and cost-sharing information ahead of time.

The agency hopes increased price transparency will boost competition among hospitals and insurers to drive down healthcare spending.

Under the new price transparency rule, hospitals must publish their standard charges online in a machine-readable format. They will need to create at least 300 “shoppable” services, including 70 selected by the CMS.

Under the rule, hospitals would have to disclose the rates they negotiate with third-party payers, which some experts say could be illegal.

“Hospitals get ready to fight CMS in Court over Transparency,” FierceHealthcare, Robert King, November 15, 2019

More after the leap!

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I hope everyone had a good Thanksgiving with family, friends, or strangers.

My young and pretty 20 – something year-old wife and I were traveling years ago. We were standing in a long line into the only restaurant at O’hare airport. It was a couple of days before a holiday and the airport was packed.

If you frequent O’Hare today, you must be thinking; “What is he thinking? O’Hare has many assorted places to dine.” Like I said this was years ago. O’Hare was not as big then as it is today.

The line was moving slow and we finally arrived at the front. There were two men dressed in suits behind us, a rarity today, unless you are traveling for business and doing a meeting that same day . . . which I have done at times. The restaurant greeter came to get us.

I asked my wife if she minded if others sat with us as we were going to have a table for 4. She did not mind which I already knew and even so, thought I had better ask first. I asked the greeter if it was ok and of course she did not care as it was two more people out of her way. I turned to the two men.

“We have a table for four and wondered if you might want to join us as the restaurant is terribly crowded.” Of course they did not mind. The one had limited time in which to eat. We were thanked for our courtesy and kindness to include them, strangers, at our table. I do not remember their names. It did not really matter to me. That we could help someone else was more important.

My daughter who looks like a young version of her mom returned from Guatemala a few days ago. Each year, she travels there. No, it was not a vacation. She is a registered nurse (ER) and travels there with a team of nurses, techs, doctors, and surgeons to render aid in this part of North America to those in need. This time they performed 400 hundred surgeries during the 8 days they were there. She sends us pictures of the area and what facilities she visits. Each volunteer pays for their own transportation to there.

My youngest son has taken on similar acts of kindness and assistance to people in need as well as my oldest son. I am sitting here in the quiet of my oldest son’s family room. Everyone is still asleep after having a nice Thanksgiving meal yesterday with my daughter-in-law’s family.

We are doing well in life. I point to two examples of showing a degree of kindness and empathy for others regardless of who they are or from where they emanated. An action of kindness can be whatever you wish it to be towards others and it does not have to be of great magnitude. What matters is whether you will extend yourself to a stranger in need.

I hope you had a good Thanksgiving Day wherever you were yesterday whether it be with family, friends, or strangers. It is a day meant to be with others no matter where you were.

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Putin Beating Up People At Russia’s Top University

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