Why the Government’s Health Program (PCIP) is Running Out of Money

An article in today’s LifeHealthPro prompted my blog post today.  It’s about the Pre-existing Condition Insurance Plan (PCIP) that was established by the Affordable Care Act to guarantee health insurance for the unfortunate individuals who had health conditions so serious insurers wouldn’t write insurance on them.

Well, folks, the federally-run PCIP is running out of money to pay for the claims of all the sick people who purchased coverage through the plan.  Why is that? you may wonder.  Well, the government paid more in claims that it expected to pay.  Here’s my question:  Why did the government think insurance companies didn’t want to write coverage for those people?  And here’s my answer:  Because people with health issues have more claims than people without health issues do.

I’m not saying unhealthy people shouldn’t be able to have coverage.  However, since the very nature of insurance–and state insurance regulations–REQUIRES premiums to be adequate enough to pull in enough funds to pay claims, there’s only one things premiums can do when the costs of claims rise.  Yep, you guessed it.  So when the PCIP provided “affordable” insurance, it wasn’t charging enough premiums to pay the claims.  Which is really BAD news for the folks enrolled in the plan.  Which those of us who understand the nature of insurance expected to happen.  [P.S.   The PCIP stopped accepting new enrollees some time ago because the government saw the handwriting on the wall.]

I’m a nonsmoker in my late 50s who has no health issues:  my blood pressure is 120/80, my cholesterol is below 200, and I don’t take regular medication.  I don’t have diabetes or any other condition.  And I pay, personally, out of my own pocket (because I’m self-employed), $563 a month for health insurance.  I understand precisely what consumers are faced with concerning the costs of healthcare.

I’m also one of the few people who has a copy of the text of the Affordable Care Act on her computer, and who has read a good portion of that text.  (I admit it:  I haven’t read the whole thing.)  There are all kinds of provisions most consumers don’t know about.  And I’ll bet a lot of politicians don’t know about them, either.

If you’re interested in reading a brief, consumer-friendly timeline of what will be happening under the Affordable Care Act, you can visit Healtcare.gov at What’s Changing and When. Although many people know more about the Affordable Care Act than I do, I’ve  researched it extensively, written a couple of insurance courses on it, and presented a number of webinars on the topic.  I welcome your questions.

It’s Us … It’s Not the Guns

It isn’t guns that kill people; it’s the people who wield guns who kill.

A gun sitting on a table, on your front lawn, or in the back seat of my car is never going to cause a single injury.  Yes, firearms are made by humans–as are smog, poisonous chemicals, and acid rain.  Why aren’t we trying to ban smog, poisonous chemicals, and acid rain?  Unlike those man-made substances, guns have no inherent ability to cause injury or death. It’s only when guns interact with humans that fatal outcomes occur.

Cars and trucks sitting in driveways and parking lots don’t cause deaths either.  But when people get behind the wheel, cars and trucks can become killers.  If people get behind the wheel and drive while impaired (in a variety of ways), their potential for causing fatalities increases exponentially.

The same can be said when people with impairments own and use guns.  Some people are impaired by anger, or sadness, or mental illness.  Others are impaired by bad judgment or momentary insanity.  In insurance language, a human was the proximate cause of the event in Connecticut.  Human impairment was the first event in an unbroken chain of events that led to the tragic deaths.

Our society must find the proximate causes of problems before prevent them. We must identify people who are likely to use guns for inappropriate purposes and prevent them from owning, or having access to, guns.  We must not turn away when we see an impaired individual owns, possesses, or has access to a gun–regardless of the type of impairment or the reason for it.  Far too often, every one of us chooses to look the other way rather than make an “issue” of something we know in our heart is wrong or may lead to injury. We must dig beneath the surface until we reach the root, and then rip it out from where it’s buried.

Blaming guns for the heartbreaking deaths of shooting victims is understandable … but its a form of denial. It reminds me of something I heard recently about rape:  Why do we teach people about  how to avoid being raped instead of teaching them how NOT to rape?

What the Average American DOESN’T Know about the Affordable Care Act – Part II

Continuing from the blog post on Monday, here are few of the major provisions of the PPACA that will go into effect beginning in January 2014.

Most Americans will be required to be covered by health insurance or pay a penalty.  This is what is referred to as the individual mandate.   The following Americans will NOT be subject to a penalty if they aren’t covered by health insurance:

  • Members of a religion opposed to acceptance of health care benefits
  • Undocumented immigrants
  • Individuals serving time in jail
  • Members of an Indian tribe
  • Individuals with household income that doesn’t require the filing of a tax return
  • Individuals who must pay more than 8% of their income for health insurance—after application of any employer contributions and tax credits

A few facts about penalties:

  • They aren’t imposed until an individual has been uninsured for 90 days
  • Penalties are charged per person, with a family maximum, OR as a percentage of family income—whichever is more
  • Penalties, per person, per adult (children’s penalties are one-half the adult penalty) will be:  In 2014:  $95; in 2015:  $325; in 2016:  $695; and after 2016:  adjusted by annual cost of living increases
  • Penalties as a percentage of family income:  In 2014:  1%; in 2015:  2%; and in 2016:  2.5%

The following eligibility and rating restrictions will apply:

  • Coverage cannot be denied or non-renewed because of health status
  • Pre-existing conditions can’t be excluded
  • Premium rates may only be based on:  age, state of residence, individual or family enrollment, and tobacco use
  • Coverage cannot be cancelled or denied because of the enrollee’s participation in clinical trials for cancer or other life-threatening conditions

I’ll continue with more scintillating info on Friday!  So, what do you think so far?  Did you know these facts?  How do you feel about them?  How do you think they’ll affect you and your family?

What You Probably Don’t Know About the Affordable Care Act – Part I

During the past couple of years, I’ve written numerous insurance texts that are either devoted entirely to the Affordable Care Act or that contain chapters about it.  Formally known as the Patient Protection and Affordable Care Act of 2010, the media refers to this recent federal legislation as Obamacare.

I won’t bore you with details about provisions you already know, like the individual mandate and employer requirements going into effect on January 1, 2014.  I will provide you with lesser-known details that will either affect you directly or affect someone you know.  This first blog post discusses some changes that will go into effect in 2013.

(By the way, I have the text of the PPACA on my computer in PDF format; although I haven’t read all 974 pages of it, I have read significant portions of it and have conducted extensive research about it.)

As a warm-up, here are some of the provisions of the PPACA that have already been put into place:

  • Dependent coverage for adult children must now be provided on their parents’ health policies until age 26 (subject to requirements for being a “dependent”)
  • Certain types of preventive care is no longer subject to deductibles and copayments, such as mammograms and colonoscopies
  • Lifetime benefits have been eliminated
  • Annual benefits limits have been restricted
  • Pre-existing conditions limits may not be imposed upon children under age 19

Beginning in 2013, tax-deductibility of medical expenses will change.  At present, taxpayers are permitted to itemize and deduct medical expenses if those expenses exceed 7.5% of the taxpayer’s adjusted gross income.  This means if you earn $50,000 per year, you may itemize and deduct your medical expenses that exceed $3,750.  In 2013, the threshold increases to 10%.  So, if you earn $50,000 in 2013, you may only itemize and deduct your medical expenses that exceed $5,000.

If a person has a flexible spending account, the maximum contribution will be $2,500 beginning in 2013.  Up until that time, there has been no limit to contributions to this tax-advantaged plan that allows employees to designate a portion of their annual earnings to pay for qualified medical expenses.  (These funds are not taxed if used for qualified medical expenses.)

Also beginning in 2013, the Medicare tax rate for individuals who earn more than $200,000 per year will increase.  The same holds true for married taxpayers filing jointly if their combined wages are in excess of $250,000.  The increased tax rate applies to wages in excess of the thresholds.  These same individuals will also pay a higher Medicare tax rate on their investment income.

So, did you know these facts?  What are your thoughts?

Link to the text of the PPACA

Link to the Henry J. Kaiser Family Foundation site about the PPACA

Link to the U.S. Department of HHS about the PPACA

LifeHealthPro’s list of articles about the PPACA

Link to Healthcare Reform Article by the New York Times


Life’s Rule Book

Life’s Rule Book by Linda McHenry

Rule #1 – No lying.  Not to yourself or from anyone else.  P.S.  Silence equals lying by omission.

Rule #2 – Never try to change someone else—it’s disrespectful to both of you.  People are entitled to their own opinions, beliefs, and Rule Books.  Accept this fact, work out a compromise, or move on.  P.S.  Manipulation and bullying = lying.

Rule #3 – Listen to, and heed, your instincts.  Always.  You know how to shut down your mind and heart and listen to God.  He speaks through your instincts.  Listen to Him (or Her).

Rule #4 – Being open to people and experiences doesn’t mean you have to choose them.  Ultimately, people are responsible for themselves and their choices.  If you follow Rule #3, you’ll make your choices for the right reasons.

Rule #5 – You are not a fixer.  Just because you can fix things doesn’t mean you have to fix them.  P.S.  There is no rule that says you even have to try to fix something.

Rule #6 – Today’s feelings won’t necessarily be tomorrow’s feelings.  Forever is an illusion … its path can always be changed.  Live for today.  Embrace today’s feelings for what they are instead of trying to mold them into what you want them to become.  P.S.  This rule applies to other people’s feelings, too.

Rule #7 – The most important human emotions are caring, kindness, and compassion.  True love is a combination of these three.  A person who doesn’t care, isn’t kind, or lacks compassion doesn’t truly love … nor is that person able to love truly.

Rule #8 – A sense of humor is required.  If you don’t have one, get one.  Fact:  Laughing always feels better than crying feels.  It makes your face look better, too.

Rule #9 – Faith is required.  The only people who experience true happiness and love are those with faith in their Gods and in themselves.

Rule #10 – Trust is required.  You must give the gift of your trust, knowing it will sometimes be spurned or mistreated.  Trust is a demonstration of your faith and the knowledge that life is more enjoyable when shared with others.  If you misplace your trust, it doesn’t mean you failed, you’re flawed, or that life sucks.  No one knows what it means. There is no reason … other than “because.”  How do you deal with that?  See Rules #1 through #9.

This is What Happens When You Don’t Have Car Insurance

I worked in the insurance business for over 30 years and, during that time, heard some really wild stuff.  This week’s story takes the cake.

My son-in-law was sitting on the couch in his living room yesterday morning at 7 a.m. when he heard squealing tires and felt the earth shake in unison with a loud bang.  A few minutes later he took the photo that appears at the top of this blog post.

Yep.  That’s his truck snuggled up next to my daughter’s car.  Both were towed away to the salvage yard today.  Total losses.  Both of them.

Their house is the second one in on their very short street.  Seems a young woman turned the corner (with no brakes, mind you), snagged the tow hitch on the truck, dragged the truck into the car, and then dragged them both into the cement retaining wall surrounding the kids’ driveway.  She claims to have passed out.  Funny how a comatose person can back up her car and drive to the end of the street before her car gives out on her…

Funnier still how the insurance I.D. card she gave the police officer at the scene isn’t valid. Wonder if that has anything to do with her leaving the scene–which, technically, she didn’t do because in that state, if you’re still around when the cops come, and you give them your info, you didn’t leave the scene.  Or if it has anything to do with the “rare blood disorder” she has that caused her to pass out in the first place.

So, because this woman doesn’t have insurance, my kids missed two days of work, have no cars, need to buy two replacement vehicles, and need to rent a car until they can buy two new ones.  Oh, and did I mention they can’t go on vacation next week because … THEY HAVE TO BUY TWO CARS?

All I can say is I’m really proud of my kids for being smart enough to take care of themselves by purchasing their own insurance and for buying adequate enough protection.  It’s a shame that so may other people simply don’t care about the consequences of their actions and how their irresponsibility can hurt other people.

Reasons to Love April

Although I’m sure plenty of girls and women named April are lovable, I’m not referring to them.  I refer to the month of April.

April’s my favorite month of the year for a number of reasons:  pink and red tulips, blossoming trees, baby bunnies, warm sunshine…  Oh, and my birthday.  Yes, I like having birthdays.  As my dad says, it beats the alternative…

Seriously, I do a lot reflection this time of year.  I don’t know if it’s because of all the birthing that goes on, literally and figuratively, or the new beginnings I’m forced to make … and that I choose to make.  Maybe it’s because I’m so happy during this month, or because I’m open to the wonderful experiences spring has in store for me.  In any event, I always seem to stumble across life-altering events and circumstances during these 30 days.

I learned that a boy I had a serious crush on in middle school grew up to be a convicted felon/sex offender.  No, I haven’t heard anything about him since I was 15 years old–which is a time span of 40 years–until now, that is.  Still, his situation got me thinking.  And asking myself questions like:  When he was 12, did he exhibit signs that he’d grow up to molest young boys?  Was he already on that path at age 13 … or did an awful, significant experience direct him that way?  How does his mother feel, knowing he’s done these awful things … and that his face is plastered on the Internet via Mugshots.com?  And finally, angry thoughts that won’t serve anyone by being published here.

Then, there was the little medical “issue” I experienced on Easter Sunday that forced me to step back from my life and re-evaluate.  There’s nothing like spending 26 hours in the hospital, with people who are are really, truly suffering from illness, to convince you that you don’t ever want to be sick.  Or in the hospital.  Ever!

And finally, there’s love.  The unconditional love of my furry, adopted offspring, who always make me smile–and who always give just as much as they take.  Unlike some people I know…  Due to changes in my life during the past year, I’ve learned some significant lessons in the L department.  Letting go of people you wish would love you is hard.  But hanging onto to those who really do love you is amazing:  their strength soothes hurts and they re-teach you that genuine love, the two-way kind, really does exist.

This April, I’ve decided to focus my energy on people (and critters and pastimes) that make me happy, make me feel valued, and who practice reciprocity.  I guess I do spring resolutions instead of New Year’s resolutions.

P.S.  If you want to know some other famous people with birthdays in April, here goes:

  • Eddie Murphy and Alec Baldwin
  • Maya Angelou and Queen Elizabeth
  • Scott Turow, Tom Clancy, and Beverly Cleary
  •  Matt Medeiros and Joe Azzopardi
  • Kia, the Siberian Husky we had when my kids were little (that’s him on the right)

P.S.S.  My mother snipped a poem out of an edition of Reader’s Digest a long time ago.  I can’t remember all of it, but it began “Linda swings in the April elm.”  It ends with, “Linda keeps her eyes on heaven, after all she’s only seven.”  I’m suer it wasn’t about me, but it should have been!

What are YOUR thoughts about the month of April?

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Who, you might ask, is my son?  Michael Murphy.  Who, you might also ask, is his partner?  Michael King.  Yes, it gets confusing when someone calls and asks to speak to Mike.  But people are calling–which is the most important thing, right?

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What’s Your Birth Order?

I’m preparing to begin writing the first book in a series that revolves around a family:  two parents and four children.  I’ve researched birth order in the past and agreed a great deal with the opinions of Dr. Kevin Leman, who wrote The Birth Order Book: Why You Are the Way You Are.  I’m using the information gleaned from his book, and other sources, as I create my characters and–more importantly–their motivations.

Although I’m a firstborn, I admire the traits of the middleborn the most but get along better with lastborns.  Why do you think that is? 

Well, according to Dr. Leman (who’s a psychologist) people get along best with others who are opposites–personality-wise.  He claims  the majority of married couples he’s counseled during the past 30 years have been firstborns, onlies, or a combination of the two.  (I surely fit that demographic!)

Anyway, here are a few of the things Dr. Leman has to say, followed by brief descriptions of traits that are universally accepted to belong to certain birth orders (by people who agree with the concept, of course!).

  • In a family, each child is most directly affected by the next oldest child.
  • Each child typically behaves opposite the next oldest child. However, if he believes he can compete successfully with the next oldest child (and “overthrow” that child), role reversal takes place.
  • All children want attention from their parents and begin seeking it in infancy; if they don’t get it, they seek either power or revenge–in that order.

Firstborn traits:  Goal-oriented, seek control and approval; aggressive; type-A personality; responsible; conservative; organized; serious; self-sacrificing; puts self and others under stress and pressure; perfectionist

Middleborn traits:  Peacemaker; easy-going; peer-oriented rather than family-oriented; excellent people skills; adaptable; agreeable; may feel overlooked, unheard, ignored; compromising; loyal to friends; secretive; risk-taker; may be cynical or suspicious

Lastborn traits:  Creative; charming; manipulative; identifies with underdog; can be too dependent upon others; risk-taker; spoiled; lazy; temperamental; clown or comedian; entertainer; fun-loving; affectionate; reads people well

Only child traits:  (Very similar to firstborn):  Struggles with parental expectations; perfectionist; doesn’t handle criticism well; critical of self and others; confident; doesn’t relate well to peers when a child; self-motivated; fearful and/or cautions; self-centered

So, what say you?