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Monday, September 30, 2013

Marketing the Affordable Care Act


Infographic for Affordable Care Act

Countdown for the Affordable Care Act and Covered California

In my travels and daily life this week I have been surveying most people I meet. These are ordinary citizens, single Moms, minimum wage workers. My cohort has been fast food employees,  real estate agents, truck drivers, taxi drivers,  and the type of people we run across every day (In California).  This is not a scientific study.

Few if any of them have reliable and/or affordable health insurance, and I doubt if the figure of 8 million uninsured in California is correct.   I really don’t think statistics are that important except to number crunchers who seem to manipulate numbers to prove their point or determine what it will cost to implement the Affordable Care Act.  You are either insured, or not insured.  Many who have ‘Medi-Cal have it only in name…high shares of cost sometimes as much as 2,000/month and unable to access health coverage due to pre-existing conditions.  The devil is in the details and it is all supposed to be revealed with a wave of a wand and flashing of a magicians’ handkerchief.

Out of the first ten people I met not one of them  new what Obamacare planned to accomplish. The had never heard the term “Affordable Care Act”.  They had no idea what a Health Benefit Exchange is and also did not know when each step occurred for it’s implementation.

The Amazon Shopping Cart Model

The survey was accomplished in Riverside California a city which is fairly metropolitan and is ‘internet enabled” as much as any other city.  If they received Medi-cal  they were entirely passive about receiving the benefit, did not know much about share of cost or how it would change as income rose or as their children left home.

Despite all the television and newspaper reporting about Obamacare most did not “get it”.  The message has not been visible and there are no advertisement in newspapers, magazines or gathering areas such as shopping malls, theaters, or sport’s venues.

On the eve of Obamacare’s launch, the White House is lowering expectations for it, downplaying their assumptions for signups and emphasizing this won’t be a launch so much as the start of a conversation with the American people, and so on and so forth. The truth, of course, is they’re downplaying things because the exchanges, implementation, and promotional efforts for Obamacare are so far behind and have had such little impact on the very people the approach is intended to reach.

How little impact?

A new poll finds a majority of the public -- especially those lacking health coverage -- is unaware that new insurance marketplaces created by the health law are slated to open ... The poll also found deep skepticism of media coverage of the law, with more than half the public saying they don’t trust any media source to provide credible information. Two-thirds of the public were not aware when the new online marketplaces open to allow people without employer coverage to shop and purchase their own health policies, according to the poll by the Kaiser Family Foundation. These exchanges open Tuesday. Despite outreach efforts by the Obama administration and supporters of the law, the poll found the number of uninsured unaware of the opening date is even greater than the public at large, with three out of every four not knowing the marketplaces are supposed to open in October.

The rollout has not gone as expected, or as supporters had hoped. Even hours before open enrollment is set to begin, confusion reigns in states where navigators haven’t even gotten a chance to use the systems they’re supposed to guide people through. These IT problems are significant, but they will come and go in the context of these political battles. Some will seize on them as signs Obamacare will crash and burn. This isn’t the case, though – it’s not the glitches that will undermine Obamacare, it’s the effect it has on the people who already have insurance.

I don’t know whether to laugh or cry. My health insurer, Kaiser Permanente, has finally calculated what our family’s new health insurance rates will be under the grotesquely misnamed Affordable Care Act (a.k.a. Obamacare.) The upshot: my premiums are about to rise by 114.6%. My wife’s rates? Up 109%. Our kids? Don’t ask.

Yes, it’s time to say goodbye to my current plan, with its $232-a-month premium. That plan is being discontinued, I’m told, because it “does not meet the requirements of the ACA.” It was a nice plan, with low premiums, free physical exams, a high deductible and eligibility for a Health Savings account. We got access to Kaiser’s lower in-plan rates for minor medical care, and we had the peace of mind of substantial coverage if anything catastrophic ever happened. But that plan is going the way of Lake Superior sturgeon or the Hetch Hetchy meadows. It’s vanishing in favor of what someone else has decided would be progress. So now I’m being offered what’s dubbed the KP CA Bronze HSA 4500/40%. My new premium will $519.25 a month -- more than double my old rates.

I wish there was some way of regarding this new “bronze” plan as an improvement over what we had before. But that’s really not possible. The new deductible will be higher ($4,500 instead of $4,000.) My primary care benefit is worse (I’m now being told to pay 40% of billed charges, instead of a cap of $40.) My inpatient hospital coverage is worse (I’m to pay 40% instead of 30%.) Terms on emergency-room visits and prescriptions drugs are inferior, too. There’s probably a “silver” or “gold” plan that would match or even top my old coverage. But then I wouldn’t be looking at a mere 114.6% increase in my premium. I’d have to pay even more.

There’s little wonder that Obamacare remains unpopular, even if you don’t call it that. On the eve of its launch, CNN found 38 percent of Americans favor it and 57 percent oppose it – even when described in neutral terms. That measure of success or failure will have more to do with Obamacare’s survival as a long-term policy reality than any of the early glitches – and that’s something the American people themselves will determine according to their own measures.

-- Benjamin Domenech

Other key concerns include






Wednesday, September 25, 2013

Secretary Jack Lew’s Message to Congress


Health Train Express' investigation reveals the enclosed letter from the Secretary of the Treasury, Jack Lew.

The news is not good. Our country has backed itself into a corner. The reasons are many, and finger-ponying and filibuster will not solve any problems. There is no rational reason to negotiate Obama Care Funding or link Government shut down with the challenges ahead.

Regardless of the outcome the news is disheartening. All of us have known this was coming and we have allowed our congressional representatives to kick the can down the road.

This is the consequence of citizen apathy and allowing politicians to grandstand for their own sake of power and narcissistic argument. This of course does not apply to all our representatives, however some leadership has gained control due to the specific nature of their local constituency.

Text of John Lew's letter to the Speaker of the Houses (and to all Americans)  this document loads very slowly.  If so try this link instead.

All of this takes place behind the center stage of Health Reform. In the desperation of taking credit for a long conceived goal for Americans the current democratic administration and democratic leaders have gained political capital by autocratic methods of decision making.

Republicans are in favor of health reform and are standing fast against the present financial methods of the Affordable Care Act and illegal powers delegated to the Department of HHS, without regard to expert authorities in health. Deadlines are near for a series o mandates, which will have consequential effects on our economy and business. Is Obama care even affordable?

Lew's Letter points out our plight. Some wish to prioritize debts. This is what most businesses do on the brink of insolvency. He argues that our credit worthiness is at stake. Can we guarantee all our creditors will be happy? No. Banks especially stand to lose more interest if we do not increase the debt ceiling.

In my home we have to prioritize some debt at times. The truth will set us free. To obfuscate our challenges with false hope and faulty reasoning as well as outright falsehoods is to damn ourselves and we will suffer the consequences. We are out of time.

We are still powerful even if our debt is excessive irresponsible and self-serving. Our credit-worthiness is a set of numbers that are arbitrarily set by bankers. Have you ever dealt with credit bureaus, and credit scores? Do we default on our loans? No, but we default on many obligations and legal mandates within the United States by offering false promises and misleading explanations.

Truth is always simple when explanations become complex, chaotic and dysfunctional you can be certain issues are manipulated. Statistics can prove anything. Attorneys can argue quite effectively against truth depending on their goals.

Note: These are my own opinions and may freely distributed, shared in social media, conventional newspaper and magazines..

GML September 25, 2013


Tuesday, September 24, 2013

Stop, Look and Listen


…to the ongoing Senate Filibuster sparked by Obama care defunding and Budgetary impasse. The filibuster is ongoing on C-Span Live .

Almost three  years from the date that the Affordable Care Act passed in 2010 and in the past 12 months as each layer of the law becomes exposed to the light of day, discussions, and analysis reveal serious issues with the law.  These are issues that should have been analyzed and discussed in committee and in the  Congress before it was passed into law by Democrats.

No one can predict accurately if the Affordable Care Act will suceed. Certainly not in the way mandates are put into effect.  While the goals are admirable to insure all our citizens the law is unpredictable whether it can be supported by business, insurers, hospitals and providers.

After ten to fifteen years of reimbursement decline these entities are in  no position to bear the brunt of further reimbursement decline. Yet HHS is demanding more administration, regulation, and expensive analytic studies with the hope that this will cut costs.

The issues are not political in nature and the substance of the argument is carried strongly by Republicans, and a few brave Democrats. The Democrats have a lot riding on this. It has been the theme of Democrats for the past four years. They want credit for a national health reform for which ObamaCare is not.  The Republicans are not just being obstinate nor grandstanding….they are out to protect the country from unconstitutional law.  Freedom is at stake here.

Tomorrow the House will vote whether to defund ObamaCare or shut down the government.  This should never have come to this point. 

The many features of this law were actually developed by ex-Senator Hillary Clinton (also recent Secretary of State) in 1992-1994 while Bill Clinton was President. At that time President Clinton assigned health reform to her as ‘the first lady’.   Many of the items can be traced directly to Clinton’s administration.

In previous posts I have outlined the deficits of Obamacare, and it’s consequences on cost, the economy, and whether the mandates can be funded.


Michael R. Connelly (ret) a constitutional lawyer read the entire Affordable Care Bill and basis his opinion on many issues that were not plead before the Supreme Court’s decision on Individual Mandates.  That was just one of the many talking points and did not address the other important conflicts with the constitution nor the misguided powers given to the Secretary of Health and Human Services. Never before has such arbitrary and absolute powers been delegated to an administrator. The law provides for little congressional oversight, nor built in checks and/or balances. Our congress was negligent and incompetent in drafting this law.

To begin with, much of what has been said about the law and its implications is in fact true, despite what the Democrats and the media are saying. The law does provide for rationing of health care, particularly where senior citizens and other classes of citizens are involved, free health care for illegal immigrants, free abortion services, and probably forced participation in abortions by members of the medical profession.

The Bill will also eventually force private insurance companies out of business and put everyone into a government run system. All decisions about personal health care will ultimately be made by federal bureaucrats and most of them will not be health care professionals. Hospital admissions, payments to physicians, and allocations of necessary medical devices will be strictly controlled.

However, as scary as all of that is, it just scratches the surface. In fact, I have concluded that this legislation really has no intention of providing affordable health care choices. Instead it is a convenient cover for the most massive transfer of power to the Executive Branch of government that has ever occurred, or even been contemplated. If this law or a similar one is adopted, major portions of the Constitution of the United States will effectively have been destroyed.

The first thing to go will be the masterfully crafted balance of power between the Executive, Legislative, and Judicial branches of the U.S. Government. The Congress will be transferring to the Obama Administration authority in a number of different areas over the lives of the American people and the businesses they own. The irony is that the Congress doesn’t have any authority to legislate in most of those areas to begin with. I defy anyone to read the text of the U.S. Constitution and find any authority granted to the members of Congress to regulate health care.

For those who might doubt the nature of this threat I suggest they consult the source. Here is a link to the Constitution:

And another to the Bill of Rights:

There you can see exactly what we are about to have taken from us.

There are better and more legal methods to provide needed care to the uninsured.

ORRIN G. HATCH, J. KENNETH BLACKWELL AND KENNETH A. KLUKOWSKI also support Mr Connelly’s position as published in the Wall Street Journal

This is far worse than ‘socialized medicine’ which presents a uniform and equitable health care system, even with it’s serious shortcomings. 

Monday, September 23, 2013

Covered California Health Benefit Exchange and Federally sponsored Health Benefit Exchanges




How to find a job as a NAVIGATOR ?

It is not easy. Even Google and other search engines are confused. After spending an hour with multiple search terms this is my best guess,and estimate to help.

In California roughly 6-8 million uninsured may line up to learn about Covered California from a “NAVIGATOR”

As a physician or other independent health care provider you need to know how this will work in California. 

California is amongst   the states that refused to set up a  Federally operated exchange by not accepting federal grants to assist in the organizations

Those states who chose to go it alone are all unique and administered differently

This monograph applies ONLY IN CALIFORNIA

California has set a high bar to become a “Navigator” for the Affordable Care Act.

Despite what has been written about ‘non-profits’ California’s web site for Covered California outlines a list of requirements.  It is somewhat contradictory because in one section it states that you must be a certified and licensed insurance agent, yet in another it refers to non-profits.

Covered California also offers these tools for orientation about the program;.

Webinar  Assistance Program and the process to become a Certified Enrollment Entity  

This Covered California webinar will provide Certified Enrollment Entity applicants with additional information on “next steps” to becoming a Certified Enrollment Entity (CEE).  

This webinar reviews the process for affiliated individuals to become Certified Enrollment Counselors (CECs).  It will also provide details on the following:

  • Next steps for the CEE is to identify staff that will become CEC
  • CEE Administrative Training
  • CEC next steps:
    • Criminal Disclosure Form
    • Background Screening and fingerprinting process and timeline
    • CEC training – process for registering and training timeline

    Note:  Webinars were held  February 2013 through September 2013  Content may be different. I recommend the latest webinar and slide deck

    Click here to view the "Next Steps" Webinar

  • Click here to download the accompanying slide deck

Slide Deck

These instructions were dated September 2013, however the webinars and slide decks were produced in early 2013.  All of this is subject to change and we advise calling the HBE for updates. 


Enrollment Assistance Program
Proposed 2013 Timeline- for FEDERAL HBE’s  does not apply to Covered California.


Certified Enrollment Entity Application Release
Summer 2013

Certified Enrollment Entity Training Begins
Summer 2013

In-Person Assistance Certified Enrollment Counselor Training and Certification Begins
Summer 2013

Open Enrollment Begins
Fall 2013

Navigator Program

Navigator Grant Application Release
February 2014

Navigator Grant Application Submission Due
March 2014     

Navigator Grant Award
June 2014   

Navigator Training and Certification Begins
June 2014

Navigator Entities begin Enrollment Assistance
July 2014

Confused?  You will note that many of these dates are after HBEs are scheduled to begin after open enrollment.

If you live in a state that is or has set up it’s own HBE check with the state’s Health Benefit Exchange web site.  It may be hard to find.  In addition, those states who are setting up their own HBE are not listed on the Federal Web Site for how to apply.

The Covered California HBE offers enrollment material for Navigators and Independent Assistance Advisors. (note the distinction as explained at Covered California’ Slide Deck.

A greatly expanded monograph for Covered California

The Affordable Care Act’s  “California’s Navigator Program” on Amazon in a downloadable e-Book for $ 0.99 USD It should be available by October 1, 2013 .

The Affordable Care Act’s U.S. Federal and State Navigator Programs will also be available for $4.99 USD. Individual states are also available for $0.99 USD

Saturday, September 21, 2013

Medicine's Search for Meaning -

A Health Train Express Extra:

Medicine’s Search for Meaning

Medicine's Search for Meaning -

Every day, we are reminded that the health care system is in crisis. We are going bankrupt. There are too many lawsuits. We practice defensive medicine. We restrict access. But surveys of doctors indicate a problem that penetrates much deeper than this. Today, almost 50 percent of doctors report symptoms of burnout — emotional exhaustion, low sense of accomplishment, detachment.

Countering doctor burnout with a refresher course on the capacity to heal.

House Bill Links Health Care Law and Budget Plan


Your Health and How has it become a “Crap Shoot”

Politics and health never have been a good mix. The outcome of the evolution of what political game playing and mixing the financing of health with political greed for power is now evident. While Medicare which was put into effect in 1964 has benefited millions of the elder population it too was passed without concern for cost and more important input from physicians (who were largely ignored when they warned it would eventually bankrupt the country. ) Congress was warned by many physician groups that the demand for healthcare can be infinite and by treating medicare as another insurer without restriction would inflate the national debt and fuel medical inflation.

Despite many wars much of our national debt can be attributed to Medicare liabilities current and future. Now the surge in Gen X, Y and Millennial adds to the disaster. Coupled with the national recession and evolution of the global economy it all crystallizes into what we now face.

Today's New York Times:


House Bill Links Health Care Law and Budget Plan

Sylvia Mathews Burwell, the White House budget director, told executive branch officials to begin preparing by updating their contingency plans. This has become so common that we now have what is a several thousand page manual on shutting off our government.

All or none? The Congress is using our health care as a political football. Neither side will not negotiate and it has gradually evolved into the present quagmire. Congress is having it's usual tantrum and is acting out it's negligence. 2010 was the time when this might have been avoided if the law was read and experts were allowed to apply the appropriate fixes to the bill(s).

House Republicans muscled through a stopgap bill Friday that would fund the government only if all spending for President Obama’s health care law is eliminated. Senate Democrats and President Obama quickly made it clear they had no intention of going along, putting the government on a course toward a shutdown unless one side relents.'

'The 230-to-189 party-line vote in a bitterly divided House set in motion a fiscal confrontation with significant implications — politically and economically — but with an uncertain ending. Without a resolution, large parts of the government could shut down Oct. 1, and a first-ever default on federal debt could follow weeks later.

Each side predicted that the other would be held responsible, but determined House Republicans knew they were taking a risk even as leaders of the party’s establishment warned about the threat of destructive political consequences.'

Mr. Obama called House Speaker John A. Boehner on Friday evening but only to reiterate that he would not negotiate with him on raising the federal debt limit and said it was Congress’s constitutional obligation to pay the nation’s bills. Both sides described the call as brief and fruitless.

Congressional gridlock. It occurs frequently, not just in healthcare. We pay our Presidents and Congressmen well enough to do the 'people's business'. Through a variety of decisions government has forcibly intruded into your physician's and hospitals duties to provide for your health. The football has been intercepted and a one hundred yard game ending run to the goal is now in progress.

The conundrum is that Congress is really not interested in is only interested in a 'victory dance' sponsored by either Elephants or Donkeys. The result will be a stable full of excrement on the floor....needing to be mucked out by the people's assets in the name of taxes and debt to foreign countries.

There must have been a better way to accomplish this goal.

A brilliant physician, Donald Berwick MD, was run out as head of HHS by his choice of words regarding the NHS of the U.K. Berwick is a highly respected former head of the Institute of Medicine, a credible authority on medicine, but a novice in the world of American politics. Our country has an anaphylactic reaction to words such as 'socialism','entitlement',

Berwick holds a position at Harvard Medical School. His N.H.S.remark was poorly worded and timed also a politically unwise statement in public about his wishes for our US health system. Other physicians, including Mike Leavitt and others have been ground up and spit out by politicians. Congress defies expert opinions in many areas of their decision making. Their bad choices overflow into all areas of society, from IT to immigration.

My health is not a Republican vs Democratic be kicked around for political expediency and headline news. Nor should it be for you either.

The real truth is Obama's statement when speaking to a labor group,

““They’re focused on politics,” Mr. Obama told autoworkers at a Ford plant in Liberty. “They’re focused on trying to mess with me; they’re not focused on you.”

Mr. President, no one is focused on your narcissistic goal of being the President who forced the wrong treatment on our health system. Inaccurate dosing, error in prescribing and malpractice.

(see non-disclaimer and waiver on the right hand banner.)

September 21, 2013