Category: Legislation

S. 544 : Changing the Veteran’s Choice Program

The Veteran’s Choice Program is not without its flaws. News agencies far and wide have reported on inefficiency, ridiculous eligibility criteria, and general messiness. Perhaps some would be glad to see it expire in August 2017 as scheduled, but considering that wait times and care services are still not where they should be across the board, we may be better off hoping that President Trump signs this bill into law. Instead of expiring three years after enactment of the original bill, the Veteran’s Choice Program will continue as long as there is money in the fund. Initially, 10 billion was allocated, but President Trump’s proposed budget would add 3.5 billion for the program. Given this fact and the president’s promises to take care of Veteran’s, it would be unlikely that he would veto this bill.

In addition to changing the termination date of the Choice Program, this bill, which amends the Veterans Access, Choice, and Accountability Act of 2014, will also allow for the Choice Program to recoup money from third parties (insurance companies) for provided medical care that is not service-connected. This will clearly help extend the budget of the program and ensure that the appropriate parties pay for care.

VA medical records will also be able to be send to outside agencies for the purpose of providing medical care. Any other use of the records will be prohibited. If you have ever tried to get records sent from one government agency to another, especially the VA, you know what a pain it can be!

These changes may not seem like much but they are certainly a step in the right direction. For some, the Choice Program works, for others, it does not. Each improvement provides more Veterans with the care that they need.

What Is Your Computer Saying About You?

Clearly our computers and phones don’t speak (well, unless you count Siri, Cortana, and the like) but they do say an awful lot about us when we don’t even realize it. Have you ever gone through your browser history and deleted it because you didn’t want anyone to know what you were looking for? I have and I would be willing to bet you are in the same boat. I’m not saying anything immoral or criminal is going on but we don’t want others to accidentally see that we search for baby-making tips or a questionable rash when and if they borrow any of our devices.

The truth is, no matter how many times we delete our history, we have left digital footprints that we can’t erase. Cable and internet providers track what we do, even if the websites are encrypted. Granted, they see less when it’s encrypted, but it leaves a faint print anyway. This isn’t necessarily a bad thing. It’s helpful for law enforcement and service companies learn more about us which can, over time, help them tailor programming and services to our needs and likes. This can even help discover when someone has hacked into your service! A couple of months ago, my mother-in-law received a warning phone call from her internet provider that someone had illegally downloaded Dolly Parton’s song, 9 to 5. The irony of someone stealing a song about working your butt off is not lost on me. The important part was that she was able to explain that not only does she not have a desktop computer (and especially not the one with the IP address they had recorded) but this let her, and the company, know that she needed to change her passwords because someone was stealing the service she was paying for. Being a law-abiding citizen, this concerned my mother-in-law as to whether or not she would get in further trouble but I am happy to report that she, and Dolly Parton, have not been violated on her internet connection since!

But wait though… if the internet company can see all of that, is it a violation of my mother-in-law’s rights? We are in the information/digital/media/internet age, after all. Most of us are pretty aware that our internet use can be tracked, if for no other reason than you can’t even look for a warehouse-sized container of toilet paper on Amazon without suddenly seeing rolls of white, bears wiping their butts, and women knitting TP all over your screen. We can’t really call our internet use “intellectual property” although I tried REALLY hard to rationalize it so we could say it was protected by law. It could be argued that internet service providers (ISPs) have a right to see how their service is being used. If you loaned something to a neighbor, you would want to know where they were going with it and when they will give it back. The same is true for these companies.

That being said, is it okay for companies to sell the information of our hard internet-surfing work? It is a by-product of our own time and can say a lot about us; everything from political opinions to financial information can be gathered. The House and Senate have passed a bill that will revoke a rule passed in the last few months of the Obama administrations which prohibits service providers from selling the information they collect from you. This does NOT apply to Google, Facebook, Yahoo, Bing, etc. Let’s acknowledge that if they can sell our information, it is unfair to keep the service providers from doing it. The rule which will no longer be in effect wasn’t even in effect yet, so I suppose you could say we haven’t gained or lost anything.

I get that we don’t want our information to be used for monetary gain or criminal purposes. ID theft seems just as inevitable as death and taxes these days and we don’t want to make that easier either. Nevertheless, we need to seriously consider how much we are willing to fight for this one small area of information, when much more personal information is being bought and sold. I am much more concerned about my medical information being sold than I am about my internet traffic between Facebook and Congress.gov. (Seriously, my browsing history is uber boring.) When sold, all of this personal data is separated from your personal identifying information. I have had my medical and pay information compromised via government-controlled systems several times since becoming an adult but never have I been notified that any information that had been sold could be tracked back to me and used to steal my identity.

If the concern is that money is being made from our online searching, it might be more profitable to turn that frustration into a movement to reduce the insane prices we pay for these services. I don’t think there is a such thing as a manure farm… but it sure happens a lot and it gets sold too. The manure is just a by-product, but it commands a price and I’m pretty sure farmers who like to sell it are going to be fairly angry if you come and take it. If you are an internet farmer… demand that when they sell info on the crap we search, a reverse fee be paid back to us! It will certainly help offset the fees on the bill that make no sense.

Veterans 2nd Amendment Protection Act (H.R. 1181)

It’s no secret that the mental health of our Veterans is a hot topic; not only how to manage it, but also the consequences of it. As a Veteran and a caregiver to my Veteran husband who was injured in Iraq, I understand first-hand why it is so important that we study and improve on services for our men and women in the military. That being said, the rights of some Veterans are being taken away because the VA has determined they are “mentally incompetent” to manage their own finances. This determination could be for many different reasons but it results in the appointment of someone to oversee their VA compensation (often a loved one or friend) and the denial to own a firearm. You read that properly. A man or woman who has served our country honorably and fought to keep them safe could potentially lose the right to bear arms, a right afforded to them in the 2nd Amendment.

Enter H.R. 1181, the Veterans 2nd Amendment Protection Act. With a vote of 240-175, the bill was passed in the House today. The bill seeks to correct language about gun ownership that is too broad. The U.S. Code which outlines criminal acts, makes owning a gun a crime for anyone who has been “adjudicated as a mental defective.” Under this new bill, if passed, a judge, magistrate, or someone “of judical authority” must determine that a Veteran is a danger to themself or others.

I am not going to slam the VA here. After five years in Army administration, I know how hard it can be to ensure that you are following regulation to the letter of the law (there is rarely room for “spirit of the law”). However, in an attempt to do so, the VA has reported thousands of names of Veterans to the FBI’s National Instant Background Check System which would prevent them from buying a gun. This may not seem like a bad idea, except a Veteran who can’t manage their bills properly are now kept from claiming a right that they, ironically, had to make use of during their service.  Some reports say that 167,000 Veterans are listed because of their inability to manage finances; still others list it at 257,000. Whatever the number, it is unfair to take away such a right under these circumstances. Forgetting that your cable bill is due every month does not equal being a danger to anyone.

I thoroughly support background checks and preventing those who are dangerous from owning a gun. I will add that where there is a will, there is, unfortunately sometimes, a way. We cannot prevent all gun violence, or violence using any weapon, however, laws are an important defense against it. Nevertheless, we have to give our Veterans a fair chance. Just because you are bruised, doesn’t mean you are broken.

 

 

 

 

 

 

 

American Health Care Act: Premium Tax Credits (Proposed Bill)

We start today’s installment of the health care bill translation with discussion about advanced tax credits. I know, that sent chills of excitement down your spine, didn’t it!?! Either way, under the Affordable Care Act, any tax credits for health care that were advanced and overpaid had to be paid back to the government. There is no real surprise there and it seems only fair, right? Well, there was a plan in place on how much the government would get back, a limit on repayment. For the years 2018 and 2019, there will now be no limit. If you are given an advanced tax credit for health care, you will be required to pay back any and all over-payments, regardless of the amount and personal income. This still seems fair but perhaps it would also be a good idea to work on calculating payments and credits more accurately.

For the purposes of this tax credit, the term “Qualified Health Plan” would now include plans that are not offered on State exchanges. It would not include a grandfathered or grandmothered health plan or one that includes coverage for abortions unless it was necessary to save the life of the mother. Women can still opt to buy separate insurance that would cover abortion but they cannot use or claim any tax credits for that plan. Should any side effects, illness, or injury occur because of an abortion, the treatment of those things would be able to be treated by a health plan that is paid for by credits.

Advanced payments of tax credits will not be made for any health insurance plan that is not part of the State exchange. If you wish to claim the credits for non-exchange plans, you will need to include a statement with your tax return showing that it is a qualified health plan, the months you were covered, the adjusted monthly premium for a silver plan at the second lowest cost (wow that is getting specific), and any other information requested in the  future. These requirements for information will not apply to any coverage starting in January 2020.

Seniors are seeing another raise in their health care premiums through this bill starting in the 2019 tax year. Should they be eligible to receive any premium tax credits, the percentage of personal income that they are required to pay towards premiums increases with age once you get income above 150% of the poverty line.

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And really, this doesn’t just affect seniors. The older you are, the more  you will pay. Have a younger spouse? Well that won’t help either! My husband is 12 years older than me. Filing a joint return means that his age is the one they base the required percentage off of. That could mean 2% or more difference and it would be another 30 years before we are both in the same bracket and that won’t matter because the premium tax credits will be gone after the 2019 tax year. Why does age matter for tax credits anyway? Isn’t a dollar still a dollar no matter whose pocket it is in?

Next up… Small Business Tax Credit…

American Health Care Act: Buh-Bye Random Taxes (Proposed Health Care Bills)

Several pages of the American Health Care Act repeal a few taxes and even a deduction. Unfortunately, only a couple of them will directly affect the American consumer. If the bill passes, we can say buh-bye to the so-called “Tanning Tax.” The 10% tax is paid by the person who actually hops inside the tanning bed. The 3.8% Investment Income Tax will go away as well. According to businessinsider.com, just over 40% of Americans are invested in the stock market, but it really depends on how much each person holds in stock as to whether or not they really feel a boost. As with all of the other repeals discussed in this post, these taxes will end December 31, 2017.

The IRS code does not allow health insurance companies to deduct pay paid to an  employee that goes over $500k. There are a few exceptions but now this won’t be a problem. They can pay a CEO a buttload of money and deduct it as a payroll expense. In case you are wondering, buttload is a technical term…

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Now that we can all legitimately use “buttload,” let’s get back to all of the fun money that companies will be saving after 2017!

Prescription drug makers and importers will no longer be paying the special tax imposed upon them. Could this lead to lower prescription drug costs? We can only hope.

And finally, health insurance companies pay another tax that has to do with how much they collect in monthly premiums. The tax was suspended for this year and if this bill makes it through without changing this, the tax will formally end at the end of the year.

These tax cuts could be a positive thing, as long as they translate to lower costs to the consumer. I’ll be honest, I’m not entirely sure why the Investment Income Tax is addressed in health care legislation, but random stuff happens like this all the time.Perhaps you could argue that the tax that would have been paid could be used to pay monthly insurance premiums but I just don’t see Americans who need help the most carrying a stock portfolio that makes that kind of money. But, I’ve been wrong before.

‘Til tomorrow, when I will bring you another buttload of information!

American Health Care Act, Subtitle D: Patient & Health Insurance Market Stability

This subtitle of the American Health Care Act (AHCA) may possibly be the most important part that I have reviewed thus far. I can finally see where the drafters of this legislation can support their call for “Repeal and Replace.” That is exactly what this section does.

Section 1402 of the Affordable Care Act (Obamacare) will be repealed. This section covers the decrease of “cost-sharing” for insured Americans. Things like copays and deductibles are reduced but premiums and out of network services are not.

This is to be replaced with a new title section added to the Social Security Act which governs medical assistance programs and payments. This new section will be:

Title XXII – Patient and State Stability Fund

For the period of January 1, 2018 to December 31, 2026, funds will be given to each state for the following purposes:

  1. Financial assistance for “high-risk” people who don’t have health care coverage through their employer. The term “high-risk” was not defined anywhere in the subtitle and poses a concern because it can mean many things to different people.Do they mean high-risk financially or medically? And what would the criteria be to fall into that category. Implementation gets sketchy when details are left out.
  2. States can provide “incentives” to “appropriate entities” that enter into arrangements with the State to help level off the cost of premiums (the bill you get to pay to the insurance companies… ).
  3. The funds can be used to reduce the cost to insurance companies for people who are  expected to need a lot of medical care. Although it isn’t stated, I can see where this could be a good idea. Premiums go up when insurance companies think they will have to pay more for your care. There should probably be some oversight here to make sure the insurance companies follow through completely on this.
  4. States can use the money to promote participation in the health insurance market and to increase the number of options available in the individual/small group market.
  5. They can promote access to preventive services, dental and vision care, and services mental health or substance use disorders.
  6. Payments can be made directly or indirectly to health care providers
  7. Finally, and perhaps what families will notice the most, these funds from the federal government to the States can be used to reduce out of pocket costs to those who are insured to include copays, premiums, and deductibles.

State Eligibility and Approval; Default Safeguard

States will need to formally tell the federal government how these funds will be used before they can receive them. They will also need to certify that they will use their own State money to supplement the federal money in the percentage required by law (discussed a little later). If a State doesn’t have and approved application for funding for the year, the Administrator of the Centers for Medicare and Medicaid Services will work with the State Insurance Commissioner and spend the money for the State for the purposes stated above.

For insurance claims that exceed $50k, but less than $350k, part of the State funds will be used to pay 75% of those claims to the insurer. This will be done in hopes of stabilizing the price of insurance. $15 billion in total will be given to the States in 2018 and 2019 and 10 billion for every year after  that through 2026.Any funds that are not used each year can be applied to payment of insurance claims that exceed $1 million or they can be rolled over to the next year.

Beginning in 2020, States must also agree to use a portion of their own money for the same seven reasons listed above that the federal money is used for. It starts at 7% in 2020 and increases by 7% each year until it jumps by 8% in 2026 to make an even 50%. So for every $1 million that the federal government gives the States for this section in 2026, the States will have to use $500k of their own money for the same activities. If they do not agree to this, they will only receive a portion of the money they would otherwise get.

The penalty for not having health care doesn’t seem to be going away. Instead of a flat penalty for being uninsured that many Americans enjoy so much… the punishment will be 30% of the monthly premiums you would have paid if you remain uninsured for more than 63 days continuous days. My thoughts on this are best described in this quote from B.F. Skinner:

“A person who has been punished is not thereby simply less inclined to behave in a given way; at best, he learns how to avoid punishment.”

I would confidently say that the majority of people who are uninsured do not remain that way because they want to. It’s a matter of “Do I eat today” or “Do I pay my insurance bill” more than anything. No one likes to be surprised by hospital and doctor bills, just like we don’t like to be surprised by natural disasters and car wrecks. The difference is the cost. Car and home insurance can be had fairly cheaply as long as you are take precaution and follow the applicable laws. If this – or any – health care bill works to control the spiraling costs of health care, then – and only then – will you see people happy to have a law requiring them to buy health insurance.

Section 134 Increasing Coverage Options

This section takes away the mandate for basic “Health Benefit Packages” in order for health insurance to be part of an approved plan by the government. If you have read my previous posts, this may sound familiar to you… and it should. This section takes away the mandate within the Affordable Care Act. There was a similar removal from the Social Security Act under Subtitle B of this bill.

Finally, and probably a really terrible note to end on, age related premiums have gone from a ration of 3:1 to 5:1. Basically, if you are 22 year old woman and are charged $200 for a health insurance plan, it would be legal for an insurance company to charge a 64 year old woman $1000 for the exact same plan.

What a crappy note to end on. There better be some serious help for that 64 year old woman…

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