What Really Worries Democrats About Obamacare

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Ignore the media, and the liberal spin.  There is one simple political reality:  Democrats across the board are extremely worried about the Affordable Care Act, and its effect on the 2014 elections.

I have quite a few connections to staffers and other behind-the-scenes people in the Democrat Party.  Talking to them, there is a consensus: they are in trouble.

Some of them fully believe that Barack Obama, Kathleen Sebelius and the rest of the President’s administration can right the ship, and some make the Obamacare system functional enough to please the public.

Most, however, don’t believe anything of the sort.

There is a reason for this:  for all the bluster and hot air about the Obamacare website debacle, that is the least of the worries for liberal supporters of the health insurance reform plan.  In fact, the failure of the website may actually be hiding some of the more pernicious aspects to the health care law.

So here is a timeline of the largest hurdles  the supporters of Obamacare face over the next twelve months:

 

November through December 2013

The enrollment numbers for the first month were terrible, and that is unlikely to dramatically change any time soon.  Initial numbers stated the total enrollment nationwide for October was a meager 50,000 or so.  That is less than 1/10th of 1% of the total necessary to keep the system sustainable.

Obamacare defenders will try to spin that the tens of thousands added on to the Medicaid system as a sign of success, but even people not familiar with the ACA understand it is easy to give away free stuff; It is another thing entirely to get Americans to pay their hard-earned money into the system, when that system may not provide them any great benefit in the near term.

The website functionality is going to be an ongoing challenge as well. President Obama and HHS Secretary Kathleen Sebelius both promised that the website would be working by the end of November.  That now appears to be another ‘incorrect promise’ and frankly, most IT experts I talk to would be surprised if the system is up and running before February.

Website Security will be an issue as this process continues as well. Consumer Reports and others already warned Americans that they should wait until major fixes in the security loopholes were corrected. On 11/19/13, there was testimony that the website places user data at “critical risk” despite recent government assurances it is safe to use.   Several security experts have predicted a large-scale breach in security. Imagine millions of Social Security numbers, credit card numbers, along with IRS tax data and health data being breached.

Amazingly, the entire ACA Payment system also has to be built, after three years.  There is no system at present to transfer funds from the Federal government to the states or to insurers.  And even more shocking? On November 18th, the head of the IT for the ACA admitted that at least 30% of the ENTIRE IT INFRASTRUCTURE still needed to be constructed.

To compound matters, the system also has a nonfunctional subsidy calculator.  What does this mean?  Right now, they are only estimating individuals expected subsidies.  However, if the estimate is incorrect and over estimates your subsidy, you could be liable for hundreds or thousands of dollars more in premiums next year.  This would be problematic in the best of situations.

To compound this problem, the administration is trying to shunt customers to private insurance websites, as a ‘work around’ for  the broken Federal exchange.  The problem is, it is technically against the law for purchases outside of the exchanges to receive federal subsidies.  What happens if a legal entanglement results in those subsidies to be ultimately rejected?  Customers could be in for a real disaster if they agree to purchase insurance, only to find they are not eligible for subsidies.

 

January through June 2014

The first problem is one I have already written about:  Obama will have to break his promise that If you like your doctor, you can keep your doctor.  This promise could never have held true in the market that Obamacare creates, because as predicted, many of the policies purposefully eliminate expensive and elite institutions.

I personally have been booted off of several health care plans because of a cancer center I work at.  I know many doctors stating similar experiences at elite institutions such as Memorial Sloan-Kettering Cancer Center, Mayo Clinic, Cleveland Clinic, and other prestigious institutions. The most famous case was a cancer patient in California who wrote an editorial in the Wall Street Journal, and who could no longer see her oncologists and other treating physicians, because the California exchange had no policies that would include all of her physicians.

The next major debacle will be the surprise of high deductible payments. The majority of the policies being sold are the cheaper ones on the exchanges; the so-called Bronze and Silver plans.  The average yearly deductible, after paying your premium for these policies, is around $5,000.  There is a high degree of variability, but on average these are high deductible plans.  What will happen the first time there is a sick child, and a $5,000 deductible stands between that poor family and a life saving procedure?

One interesting twist will be the use of Obamacare Navigators.  This was a program the administration started to ‘guide’ customers through the process.  Sounds great.  Except for one problem:  many of the Navigators were not appropriately screened, and there has already been a fair amount of fraud in this group of government workers. Undercover videos of Navigators telling customers to defraud the government have already surfaced, and I am sure you will see dozens of those as time goes on.

 

July through September 2014

This is actually when the rubber meets the road.  By this point, no matter how incompetent the administration’s IT experts are, virtually everyone that wants to have insurance should have insurance.  The website problems, even if they still persist, should no longer be relevant.

The first question that will arise is how many people chose to pay the penalty?  For many of the lowest income persons, a penalty of $95 was all that was required to opt out; with the high expense of many plans, a fair number of people will choose this option.

More important is the ratio of healthy individuals compared to sick ones in the exchanges.  For the exchanges to survive, they require a very high ratio of healthy people buying in, in order to subsidize the rest of the population.  Recent data from Kentucky (supposedly a liberal success story) shows that the ratio of healthy to sick is closer to 1:4 than the close to parity required for financial sustainability.

What happens if this does not occur?  Insurers will enter the oft talked about ‘death spiral’.  They will be required to raise their future premiums in 2015, because the cohort of patients in their insurance pools are less healthy, and thus, more expensive to treat.  The death spiral occurs as young, healthy persons realize that the increased costs of their insurance is not worth it, and opt out…further increasing the ratio of sick persons in the insurance pools, and further increasing costs.  This is the scenario that most scares Obamacare proponents.

The irony of all this is this presumes that the individual mandate  is not delayed.  Right now, the Upton and Landrieu bills sit in Congress, and Obama has announced his executive order to ‘fix’ the problem of policy cancellations.  The more delay of the individual mandate, either by legal methods or presidential signature, the more likely it is that insurers will have costlier insurance pools that will drive up premium costs moving forward.

The next problem is how this huge new population of insured patients will be treated by a system that is already overburdened.  A doctor shortage very well could arise.  Something similar, but to a lesser scale, occurred during Romneycare’s implementation in Massachusetts.  Massachusetts was more prepared than most states, as it has the highest ratio of doctors to patients in the country.  Even then, access to physicians, especially specialists, was restricted substantially.  Now imagine the states with low doctor to patient ratios, and you can imagine the complications that could arise.

That doesn’t even take into consideration that many physicians are likely to opt out to the largest expanding health care insurance program in the country:  Medicaid.  Already in states like New York, about a third of doctors have opted out.  Many physicians, especially those tied to hospitals, cannot opt out.  But this decrease in available primary physicians to handle this huge new number of Medicaid patients (who are among the sickest and poorest patients around) could be a disaster, and there is no short term solution to this problem.

 

October through December 2014

This is where all the real excitement occurs.  Let us assume some how, some way, Democrats have survived the year without any major catastrophes, and are holding their head above water as the midterm elections come.  There are several huge hurdles still remaining.

The first, and largest by far, will be the kicking in of the employer mandate. Remember that this mandate was supposed to occur this year; however, because of the completely broken and unworkable system, Obama delayed it (outside of legal bounds no less).  But the employer mandate is the crux of the entire system; the majority of Americans get their insurance through their employer, and insuring this mandate is vital to that majority.

The problem arises in the fact that in the same way that millions are losing their private insurance plans today, even a greater number of employees are likely to either lose their plans or see drastic changes next year.  This was predicted by the Department of Health and Human Services as far back as 2010.  Now is when that change kicks in.

Furthermore, millions of small business owners will have to decide whether to pay for insurance, or send their employees into the exchanges; the same exchanges that are so far struggling to handle the volume and load.

For employers that are going to continue their insurance plans, another problem: they will likely get notices from insurance companies that the plans they currently purchased no longer exist.  Sound familiar?  And insurers will, under Federal law, have to do that a minimum of 60 days before cancellation, meaning…the beginning of November, at the very latest.

And, remember the ‘death spiral’ we discussed above?  If insurers face that hurdle, they are likely to raise rates across the board.  Here is the biggest problem of all: for all the talk about these changes affecting only the people on the exchanges, if and when a ‘death spiral’ or anything like it occurs, costs will rise for everyone.  That means increased premiums for businesses, which will likely be passed on directly to employees.  Some employers will also likely choose the easy option, which is shifting their employees to the exchanges.

And all this will be announced just weeks before the election.

 

After all of this, you begin to understand why those that truly understand the steps necessary in the next year to implement the full-scale of the Affordable Care Act are worried.  Right now, we are seeing the tip of the iceberg: gross incompetence in establishing a website for entry into this behemoth government monstrosity.

But once you enter this behemoth, you start to understand that there are numerous interweaving and interconnected cogs that will need to work relatively smoothly, or the system as a whole will flounder.

That doesn’t even tell the political story.  Every week, if not daily, there will be a story about individuals who are being harmed by the ACA.  Those stories will drown out any of the positive stories, because we know that ultimately the media highlights the negative.  As stated above, when a child or young mother is denied life saving treatment because of restrictions placed upon them by Obamacare, who takes the blame?

Liberals are trying to circle the wagons, to keep sustainable political support for the plan, in the hopes that the Obama Administration can fix the problems in short order.  But as you can see above, there is no simple fix.  Many of the ‘problems’ with Obamacare are inherent to the system that Democrats devised.  These were intended results.  How do you fix the plan, when it is the intent of the plan that is the problem in the first place.

So batten down the hatches, America…it is going to be a bumpy ride.

 

A Happy Conservative’s Thoughts On The Shutdown

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A few random pontifications on the government shutdown.

  • I for one think politically speaking, this is going much better than I could have predicted. I was supportive of the defund strategy, but thought it would all fall  apart in the first few minutes of a actual shutdown.  Give credit where credit is due:  Ted Cruz et al may have started this, but John Boehner is the one keeping the caucus together, against moderate threats like Peter King.
  • Where do we go from here?  I think it is pretty clear it will take another cliff to get both sides together, for a simple reason:  the government shutdown has not been very painful.  There is no motivation for either side to compromise right now.  Sure, the polls show a slightly larger portion of the population blames the GOP, but nowhere near the numbers of the 1995 shutdown. That is bad news for Obama. However, Obama is still under the illusion that this is a repeat of 1995, as are his West Wing advisors.  Until that view changes, we are on lockdown.
  • The next bump in the road:  the debt ceiling.  I think for all sides, that is far more important than this shutdown.  Default clearly would cause more repercussions than anything occurring today.
  • Be prepared for an unsatisfying end to this.  There is no way the GOP wins on all its points.  However, even a partial win by the GOP should be considered an achievement, considering the make up of D.C. today.  If we can get the medical device tax repealed, or something along the lines of the Vitter amendment, along with some other cost savings, I would be content.
  • The one negative of the shutdown?  The diluted news coverage of the debacle that has been the Obamacare startup.  The Feds are searching frantically for good news, and the best they can come up with is web hits.  Sorry, but that is about as useless a barometer as I can imagine.  Now, show me number of people who actually signed up for insurance, and then we can talk.  The most successful exchanges have signed up a few thousand customers; some have not signed up a single person yet, two days into this process.
  • So far, the Obama people have failed in finding any victims to point to in order to villify Republicans, but they did a pretty good job in creating victims to villify Obama.  The silliness at the World War II Memorial was about as stupid a political move as one can imagine.  And don’t doubt for a second that some political appointee reading Alinsky Rules didn’t make this decision.  No such barricades were placed during the Clinton-Gingrich shutdown, for example.  No, this was calculated, and it blew up in their collective faces.
  • Harry Reid compounded the Democrat debacle yesterday, when asked why the Senate wouldn’t try to help “one child who has cancer” by approving a mini-spending bill, he shot back: “Why would we want to do that?”  Reid spent the rest of the day trying to explain why this didn’t imply he wanted kids to die.  The House has twice passed funding bills to keep NIH and other essential services open.  If the media was actually nonpartisan, this would have a political impact.  We will see how much this story plays out.
  • As for tactics:  First, understand thy enemy.  Liberals are basically in the ‘Kermit the Frog hand flailing’ mode now.  Why?  I have had many conservatives ask this, and I thought it was blatantly obvious:  for liberals, shutdown of the Federal government is like taking away their oxygen.  You must understand that for many of them, their core ideological belief is that the government is the end all, be all of human existence. Life without a large, bureaucratic government overseeing their daily lives is unthinkable.
  • I suggest conservatives try to show sympathy for the furloughed government workers and others suffering from the shutdown.  I understand the hatred for big government, but many of these people are simply caught up in this, and are paying a price for the stupidity of our political leadership.  Be neighborly; help out any friends that are struggling. I have had friends that are Veterans, and some of their benefits have been cut.  Conservatives care about these things, and we should be the first to help and aid these people, and not revel in any of their misery.  This sympathy for fellow Americans does not mean inherently mean we should change our strategy; short term pain is one thing, long term good of the country is another.
  • Conservatives on the other hand need to react to these angry liberals in one, simple fashion:  Don’t worry, be happy.  Look, this is our ideal!  We have a government that is funding defense, and little other extraneous spending.  Doesn’t mean we support the level of spending that is occurring right now, but we can’t complain much about it either.  Be the happy warriors that Reagan used to talk about. We have little to lose, and a lot to win.  And unfortunately, many of these spending programs will be starting up sooner than we would like anyway.

Thoughts On The Benghazi Hearing

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Capitol Hill hearings today featured three compelling witnesses, all State Department veterans: Gregory N. Hicks, deputy chief of mission at the U.S. embassy in Libya and the highest-ranking U.S. diplomat in the country at the time of the Benghazi jihad attacks; Mark I. Thompson, a former Marine who now serves as deputy coordinator for operations in the agency’s Counterterrorism Bureau; and Eric Nordstrom, a diplomatic-security officer who was the top security officer in Libya.

Clearly, those that testified today appeared overall to be much more non-partisan and professional than some of the people questioning them.  Anyone that watched the testimony is going to be hard pressed to label Hicks and the others as some kind of political firebrands.  Tears were in the eyes of many of these whistleblowers, as they told of how their friends died while they watched.

A few questions clearly remain after today’s testimony:

1.  Not once, but TWICE, there was a ‘stand down’ order made on the night of 9/11/2012.  We can argue whether or not this action could have saved any lives; there is some dispute of whether the force in Tripoli could have made a difference, and whether there were other assets in the area.  Only the Defense Department review of events of that night will answer that question.

However, Hicks argues that even an Air Force fly over may have pushed the rebel insurgents back.  That is only his theory, however.

That said, we know the military was ready to move.  According to Hicks, the deputy chief of mission in Libya, special forces in Tripoli were “furious” when they were told to stand down during the Benghazi attack. “I will quote Lieutenant Colonel Gibson,” Hicks told the House Oversight Committee in hearings today, “He said, ‘This is the first time in my career that a diplomat has more balls than somebody in the military.’”

Mark Thompson, the deputy coordinator for operations at the State Department’s bureau of counter-terrorism during the Benghazi attacks, testified in previous testimony, that the Foreign Emergency Support Team (FEST)—a special unit comprised of special-operations officers, FBI officers and diplomatic security personnel—was not deployed on the evening of the attacks.

“I alerted my leadership indicating that we needed to go forward and consider the deployment of the Foreign Emergency Support Team,” Thompson said. He added that he was told that meetings had already taken place. “I was told this was not the right time to deploy the team.”

So who made the decision to stop deployment? Maybe it was the right decision, maybe it wasn’t, but 8 months after the attack, we don’t know who in the leadership made the call.  I presume it was President Obama.

2.  Secretary of State Hillary Clinton was personally called by Hicks at 2 A.M. that night…did she issues the ‘stand down’ order herself?  Is that even legal?

What is more important about this call is that at that time, he told Ms. Clinton, in no uncertain terms, that this was clearly a terrorist attack, according to Ambassador Stevens himself, who told this to Hicks as the attack was starting.  Why Clinton then repeated the rhetoric that it was a ‘spontaneous protest’ days later, even at the funeral of one of the dead, remains a mystery.  Some intelligence sources in D.C. remained unsure of the facts, but if your own diplomatic personnel say it was a terrorist attack…why wouldn’t you believe your own people on the ground over intelligence sources in Washington?

3.  Following up on the previous, one thing is clear:  The “protest” about a YouTube video was a complete fabrication by the Obama administration. There was at no moment in time any evidence that this was spontaneous or that it was instigated by the video.  Not according to the people in Libya at the time.

4.  There was clear push back from allies of Ms. Clinton in allowing these whistleblowers to testify to Congress. Secretary of State Hillary Clinton’s chief of staff Cheryl Mills on multiple occasions put up road blocks and pressured the witnesses to limit their testimony.  Why?  If Ms. Clinton supported full openness and transparency, there was absolutely no reason for these actions.

Further worsening the appearance of this, Hicks testified that he basically has been demoted; and the demotion came only after his intent to testify and bring his version of the facts came to light.  So much for whistleblower protections in the Obama Administration.

The reality is, ultimately, this testimony will do nothing on the larger scale.  Liberals dismissed this testimony without every hearing a second of it, and the media will aid their wish to remain ignorant.  They feel they know everything they need to know, even though there were numerous facts today that were omitted in the internal review performed by the State Department, and out right contradictions to testimony by Sec. Clinton and others.  It has gone so far as the White House complaining to CBS that Sharyl Attkisson, who has done brilliant work on Benghazi, should basically be ‘shut down’.  That is what transparency means to this White House and to the media today.

Furthermore, because of the lack of transparency from the White House, we don’t know who gave the ‘stand down’ order. If it was the President, he should admit it.  It was clearly his right, but to pass the buck to low level staffers who should never have had that responsibility is simply unfair.

However, Republicans have failed to show an outright cover-up.  The clearest we get to such a ‘crime’ is the Susan Rice debacle, with the repetitive blaming of the YouTube video for the riot instead of it clearly being, by all evidence even on the day of the attack, a coordinated terrorist event.  Was this a true cover-up, or was the administration really so stupid to believe their own story?  This is the most politically slanted part of the story, and my guess is neither side will accept the other’s version completely. Let us accept this much: it is reasonable to say the administration was clearly and utterly incompetent, and honestly should never have even mentioned the video in relation to Benghazi.

Ultimately, the country learned a lot about how the Obama Administration works today.  The blame, when things go wrong, will never reside with the President or his key advisers, but will be displaced to low level players that have no political leverage.  When those low level advisers try to tell their story, they are treated as pariahs and they are attacked mercilessly.  Democrats in that hearing today had no respect whatsoever for the concept of ‘whistleblower protections’, and sadly, future whistleblowers in this administration surely will have learned that lesson; they will get no protection from this President.

As for the night of the attacks, there was poor execution for any response, and even with the ‘fog of war’, the Obama people performed poorly and in hindsight, were completely taken aback by the events.  What is more disturbing is that on 9/11, one of the few days on the calendar when we should be prepared for a terrorist attack…our President and his administration were woefully unprepared.

One final point.  What is also clear, and that we have long known, is that those that died that night were left alone, without enough security, and still did their duty to our country.  They died as heroes.