Social Security, Medicare & Cheese

I remember visiting my grandmother in Texas as a child in the summer and she would have these frozen blocks of government "cheese" in her freezer.  Massive blocks - with important looking seals and eagles.  She got them to give to neighbors when they were in need.  

Apparently - this cheese was part of a larger program with the US Government when stockpiles got so large, they gave it away.  It was an entitlement, you didn't have to pay for the cheese, it was just given to you if you were entitled to it.  

This week, as I was listening to the never-ending pundits and politicians talk about the tax bill, one high ranking house leader mentioned that because of the bill, we are going to have to make cuts to entitlement programs, such as Medicare & Social Security.  $25B in Medicare cuts.  (AARP is not a fan, as you can imagine)

That gave me pause - so I googled entitlement and it brings up three definitions: 1. the fact of having a right to something, 2. the amount to which a person has a right, 3. the belief that tone is inherently deserving of privileges or special treatment.

Let's start with Social Security - signed into law by President Roosevelt on August 14, 1935, it created a social program to pay retired workers an income after retirement.  Taxes were collected starting in 1937 and regular benefits paid out starting in January 1940.  Who is eligible for this benefit - anyone who has worked for at least 10 years.

Now on to Medicare - The Medicare Act (Title XVII of the SS Act) was signed into law by President Johnson on July 30, 1965.  IT established Medicare, health coverage for the elderly and Medicaid a program for the poor.  Workers pay a tax for Medicare.  Who is eligible for this benefit - anyone who has worked for at least 10 years.  Then you are able to get Part A at no cost (hospital) and you pay a premium for Part B (outpatient or doctor services) - based on your income.

A couple who both make $44,000 in 2012 dollars who turned 65 in 2010 would have paid $722,000 into Social Security and Medicare.  

So if we apply the facts of these two programs to the definition of entitlement, I guess I can make a case that under definition 1 & 2 - someone would have the right to something - that they paid for their whole life - so if this was why it was an entitlement, I guess home ownership or automobiles are entitlements too.  

Now, let's look at 3 - the belief that you are deserving of special treatment - that doesn't hold water - one pays into this program and you have to meet certain criteria in order to be eligible for the benefits, i.e. working 10 years.  I don't think that I would define work as a special treatment.   

So - in a nutshell:

• Cheese = OK, an entitlement
• Healthcare for seniors or children and retirement benefits = money out of hard-working Americans' pockets, not an entitlement.

$25B in cuts is a lot of cheese, isn't it?

P.S. - And I use the term "cheese" loosely.

It's October 27, 2017, do you know if your children are covered?

Growing up, we would hear that PSA, "It is 10PM, do you know where your children are?"  I was always in front of the TV and wondered what children are out at 10PM????

Well - it is October 27th, 27 days past the expiration of the Child Health Insurance Program (CHIP) which funding should have been renewed by September 30.

Well, not only has Congress managed to instill a level of fear and panic in the actuarial world of insurance in 2017, they also let our children down.  What used to be an assumed renewal of funding has turned into finger pointing & partisan excuses on both sides of the aisle.  

And who loses, not Congress - they get their coverage through their state exchange.

Who loses? - 9 MILLION AMERICAN CHILDREN & EXPECTING MOTHERS.  

What happens if we don't renew?

I don't need to have children to know that this is absolutely unacceptable to put any child in danger of losing access to their healthcare.  Not just the ability to see a doctor if they have a sore throat, but what about that 9-month-old in the Neo-Natal ICU?  What happens to her?  What about the newborn, born with a life-threatening illness?  

Is it worth the DC power trip to put any child at risk?  I don't think so.  This should be a guaranteed yes vote, with no string attached, no pork, no hesitation.

If they would take healthcare away from a child, what would they take away from an adult?  

Will your 2017 tax return be returned by the IRS because of your health insurance?

When you took a test in school and you didn't know an answer, or you just didn't feel like answering the question, you might have skipped it.  In school, that question would have been marked wrong, but more than likely, your teacher still accepted the test.

Well, the IRS is not a teacher and we live in a whole new world today.  

The IRS has recently announced that when filing your income taxes you can no longer be silent on the question of whether or not you have had health insurance during the tax year.  Read more about this here.   If you skip this question, you will not be able to file your taxes.  So - prepare now to answer the question - whether it be yes or no, they want to know and they are going to make a point of having you tell them.

Make sure to note this when having a conversation with your accountant.

And while I normally don't need to say this, I am not an accountant or a tax attorney, nor do I play one on television - this is my personal blog that I provide information gathered in my worldly & exotic travels as a benefits consultant.

Excuse me, my copay is how much? - Direct Primary Care

As we ready ourselves to enter the 'dog days of summer' - you can't go online, read a paper or turn on a TV without someone utter the words, "HEALTHCARE" (cue horror movie music) 

We are inundated with updates about the repeal & replace debate going on in Washington DC.  The details and changes coming out of the halls of Congress move faster than a chicken on a june bug. 

Currently, under insurance - you get your outpatient, inpatient & pharmacy coverage through a policy that is managed by the insurance carrier.  You may get the new"ish" program embedded in that called Telemedicine where you have access to a physician 24 hours a day to deal with non-emergent issues, such as pink eye or a sore throat. The doctor can prescribe (routine medications)in most states, and you only have to go to the pharmacist to pick up the prescription.  No trying to get fit into an appointment or waiting in the waiting room for hours.  

But, did you know - there is a trend in the medical field - a trend that could possibly change how we receive our primary care?  It is called Direct Primary Care, and it is a new approach to medicine.  

We have seen this program in NYC, and some of our clients have actually purchased this for their employees, to sit on top of a high deductible insurance policy.  

You pay a subscription fee to a primary care group, and that fee gives you access to your primary care doctor.  Most visits are covered under the fee - you may pay a wholesale cost for blood work, and pharmacy is wholesale +10% (which, by the way, is the same charge that self-insured employers can get on their group plans).

Read more about this trend here.

By the way, the "dog days of summer" has nothing to do with dogs panting on a hot day, but comes from the Greeks and the rise of Sirius, the dog star and its position in the sky in July.  

Looking at the exchange numbers in NYS - while getting sun on a beach somewhere

Most of us enjoyed a 3, if not a 4 day holiday weekend celebrating our country's independence!  Hopefully, your vacation brought you to a state where you actually had access to your beaches and were able to take in some safe sun and fun.

If you still have some time for summer reading, I would suggest digging into the New York State of Health (NYSOH)'s report on enrollment for 2017.  For those that might not know, the NYSOH is the NY state exchange.  While many states opted out of their own exchange and use healthcare.gov, NY decided to manage their own.  The state was better off being able to manage and offer products that the federal exchange wasn't but the functionality of the NYSOH site is nowhere near the ease of the exchange site - I guess you can't have it all, after all.  

3.6M New Yorkers get their coverage through the exchange - that is about 18% of the total population of NY.  That does not include Medicare; those who get benefits through their employer or directly from a carrier with no subsidy.

Find out the details here NYSOH 2017 Enrollment Report

Enjoy the read, and it is quite timely, as it will give you numbers to put behind the debate that is occurring now in Congress.

Is the Senate's BCRA bill destined for the same future as the T-Rex?

My recent months have been filled with live town halls around New York State (someone has to do live town halls, right??) - to bring the updates of Repeal and Replace to employers, employees, and individuals concerned about their healthcare.

Now that the Senate has released their secret bill, and in less than a week - the bill doesn't seem to have enough votes to pass on the floor.  Conservatives think it too expensive and moderates think it's too heavy handed in gutting Medicaid. There is talk about trying to sway some bi-partisan support to garner the votes.

The majority of the Senate, democrats & republicans, were not included in the negotiations.  And the Congressional Budget Office (CBO) came out with The CBO scoring and their message is just as gloomy as it was for the House bill. While reducing the federal budget by $321 billion, it will increase the uninsured by 22 million.  

To learn more about what BCRA (Better Care Reconciliation Act of 2017) is, we have a good chart that compares the current ACA, the AHCA (House Bill) & BCRA below. 

GOP pulls the AHCA - what is next

The Repeal and Replace of the ACA has been pulled from the floor of the House. While the bill looks like it is dead, the conversation is not.  NOW is the time we need to come together now and find ways to adjust and fix this.  More to come. . . .