Romney: Obama's Gift-Giving Beat Me

Mitt Romney isn’t running for president any longer, but he’s still our there saying odd things. My local paper this morning contains several snarky letters-to-the-editor about that conference call last week, where he said President Obama won a second term by giving “gifts” to special interest groups. Even Newt Gingrich and Bobby Jindal are on his case!

It feels weird to be on the same side with those guys (especially Newt), but I must also take exception to what Romney said. Of course, I wasn’t in on the call, so I didn’t actually hear him say it. But I’m told it went something like this:

"With regards to the young people, for instance, a forgiveness of college loan interest was a big gift. Free contraceptives were very big with young, college-aged women. And then, finally, Obamacare also made a difference for them, because as you know, anybody now 26 years of age and younger was now going to be part of their parents' plan, and that was a big gift to young people.”

The college loan interest isn’t one of my issues, but health care is. So I’ll start with those free contraceptives.

You may be right, Mitt. Getting pills and diaphragms without a copay might make life easier for many young women, and may have won some points for Obama. On the other hand, it’s just as likely that you lost points with your vow to “get rid” of Planned Parenthood, along with other things you’ve said about abortion and birth control. I was a college-aged woman in the 1970s. My primary concern wasn’t getting those services for free; it was being able to get them at all.

And those young adults who can stay on their parents’ health insurance until they’re 26? You’re not the first to take a pot-shot at that. Somewhere back in the campaign cycle, another guy -- it might have been Ron Paul -- said, well, if that’s going to be the rule, we ought to raise the voting age to 27.

I’m tired of hearing politicians speak of this provision like it was some kind of wild, new, un-American idea, because it isn’t.

First of all, it isn’t a “gift.” Young folks up to 26 can be covered on a parent’s health insurance policy if (a) the parent has health insurance, and (b) the parent agrees to keep the kid on as a dependent.

Parents may not have insurance. A lot of Americans don’t. Those parts of Obamacare that say we all have to get some and the insurance companies can’t refuse to sell it to us won’t kick in until 2014. If parents do have insurance, and choose to keep under-26 offspring on the policy, chances are it won’t be free. I’ve worked at places that had group health plans. Most paid at least part of the premium for the employees, but if I wanted coverage for my family, I’ve always had to pay extra for that.

Point two: Young adults need that insurance, and many don’t yet have the means to get their own. We’ve seen some job growth in recent months, but it’s still tough out there, especially for young folks just entering the market. When they find a job, it often comes without benefits. In the two weeks since the election, I’ve heard businesses wailing about Obamacare and how it’s going to break their budgets, how they can’t afford to provide health care for their employees, The complaints all seem to be coming from restaurant chains, and that’s where a lot of young adults work.

Point three: This is not a new idea. Before Obama signed the health care act, before he was elected to his first term, many existing health insurance plans (including the one at my company) offered coverage for unmarried dependents up to age 25. And I personally know quite a few parents who have used that option for kids who were still in school or still trying to find their place in the economy.

Under the new law, young adults can stay on until 26 and it doesn’t matter if they’re married. On this provision at least, Obamacare didn’t make a big, sweeping change. It simply took an existing industry practice, made a couple of incremental changes, and made it a required feature of any policy issued after September 23, 2010.

Gifts, indeed.

Five Good Things About the 2012 Election

Barack Obama won a second term. I’m glad about that, but I didn’t feel like popping balloons and shooting fireworks on election night.

This campaign season was crazy, disheartening, hideously expensive and unconscionably long. And what do we have at the end of it? Same President, same Speaker of the House, same Senate Majority Leader, and more or less the same divided Congress. Is there any hope that our elected leaders will solve any of our pressing problems in the next four years, or will it be the same old gridlock?

Now that a week has passed, and some of the dust has settled, I find a few signs of hope in last Tuesday’s results.

1. Big Money didn’t buy our votes. This was our first presidential contest since the Citizens United ruling. Corporations and SuperPacs spent $billions to elect Mitt Romney and other candidates who would do things their way. For the most part, they lost.
2. Health care reform (the Patient Protection and Affordable Care Act, Obamacare, or whatever you want to call it) has survived a Supreme Court challenge and a slew of candidates who vowed to repeal it. Looks like it'll stick around long enough for all its provisions to go into effect. I don’t doubt it will be a rocky road. But I’d rather see the country go down that road, making course corrections as needed, than go back to the way things were.
3. Outrageous comments about rape did not win over the electorate. Missouri’s Todd Akin (legitimate rape rarely causes pregnancy) and Indiana’s Richard Mourdock (if it does, it’s a gift from God) lost their Senate bids.
4. We will, in fact, see some new faces in the Senate, and they aren't all tea-party favorites like Ted Cruz (newly elected in my home state). The League of Conservation voters reports that seven of eight environmentally-minded candidates won. And come January, we’ll have more women in the Senate than ever before. Maybe these leaders will find something better to do than deny climate change and block access to birth control.
5. Texas is still very much a red state, but our House of Representatives will be less lopsidedly Republican than it was during the last session. I suppose that's something.

That Contraceptive Mandate

I got e-mail this week from Senator John Cornyn. He sends out a newsletter called “The Lonestar Weekly.” The lead story this time was about the contraceptive mandate that’s been causing the big firestorm in the media. Pundits everywhere seem to be arguing one side or the other: should faith-based employers be required to provide health insurance plans that cover birth control?

Cornyn, predictably, says no. Not that he, personally, has anything against birth control. Well, he doesn’t exactly say that, but he makes a point of saying contraception isn’t the point:
 “The dispute over the mandate is not a dispute over the use of contraception. It is a dispute over First Amendment rights.”

He devotes several paragraphs to this argument, using phrases like “a blow to one of our most cherished liberties” and “the bedrock principles upon which our great country was established.” His headline vows, “If President Obama doesn't end contraception rule, Congress will.”

Health Reform for Small Business: Burden or Blessing?

Can’t find it right now, but I recently got a piece of campaign mail that claims the health care reform act puts “onerous requirements on small business.” And the U.S. Chamber of Commerce is running an ad that slams a Colorado Congresswoman who voted for the act, “crushing small businesses with billions in penalties.”

Politifact pretty well debunks that claim by pointing out:

-       Businesses with fewer than 25 employees will not be required to offer health insurance or penalized for not doing so.

-       But if they do, many will be eligible for tax credits to offset the costs. Those credits are available now. Here’s more information from the IRS. 

Okay, there’s some paperwork involved. (Isn’t there always?) But on the whole, it seems to me that this bill should be a boon to small business.

If they aren’t providing health insurance to their employees now – and many of them aren’t – I don’t think it’s because they don’t want to. It’s because escalating prices have made it impossible.

Pre-Existing Conditions, Part 2

see Part 1

There was a time, 30+ years ago, when a “pre-existing condition” clause in a health insurance policy did not seem unreasonable to me.

I’m working from memory here, looking back to my twenties, when I was just out of school and starting to make my own way in the world. I had a few jobs that offered group insurance, and I recall shopping for an individual policy when they didn’t. At that time, premiums weren’t altogether out of reach for a healthy person with a paycheck.

I’m sure I read at least one plan that excluded coverage for pre-existing conditions. Fair enough, I thought. For the likes of me, that might mean I broke my leg or caught strep throat the week before the policy was in effect. Of course the insurance company wouldn’t pay to treat an illness that didn’t happen on their watch!

Back then, I viewed illness and injury as temporary things. If they didn’t kill you, they could be cured, and then you could get on with your life. I had no concept of injuries that result in long-term disability; of chronic diseases like diabetes that require lifetime management and care.

Pre-Existing Conditions, Part 1

As of two days ago, most health plans will not be allowed to deny coverage or limit benefits to children on account of pre-existing conditions. More information

This is one provision of the Affordable Care Act that I’m really glad to see. I just wish it would kick in sooner for grownups. We have to wait until 2014 to get the same protection.

And of course there are politicians who think that mandated coverage of pre-existing conditions is a crazy idea, that it will put insurance companies out of business. In a recent speech, Mike Huckabee made a crack about trying to buy auto insurance for a car that was already wrecked. Months ago, when the health care bills were being debated in Congress, I heard Senator Ron Paul argue that nobody would sell homeowner’s insurance for a house that was on fire. I can’t give you a direct quote, but he finished up with something like: That’s not how insurance works. If we’re going to make them do that, maybe we should call it something else.

He may have a point, which I’ll explore in a moment. Before I go any farther, however, I should note that members of Congress and other federal employees have access to a range of health insurance plans, none of which have waiting periods or exclusions for pre-existing conditions.

When There's No Insurance...

I know a married couple who are getting along without health insurance and say they prefer it that way. They don’t get sick often. When they need a doctor or medical treatment, they pay cash. They don’t carry any kind of insurance, except on their vehicles (being working musicians, they do spend a lot of time on the road.) These folks have made no secret of their views in recent months. They believe insurance is a dirty game, and choose not to play it.

I can respect that. My own feelings about the insurance industry aren’t exactly warm and fuzzy. If I had to sum it up, I’d sigh and say, “Can’t live with ’em; can’t live without ’em.”

But I know plenty of musicians, artists, and small-business owners who don’t have health insurance. In most cases, I don’t get the idea that they are happily paying cash for their medical expenses. They simply avoid going to doctors. They don’t get checkups. If they get sick, they try folk remedies or just wait for it to go away. And if, God forbid, they suffer a serious injury or an illness that can’t be cured with a few cups of herb tea, they go to the emergency room. Where they often get decent treatment. And then their friends get together and organize a benefit show or a silent auction to help them pay the bills.

In the past twenty years, I’ve attended more of these benefit events than I can count. I’ve served on organizing committees, donated items to auction, and been a performing act at one or two. Musicians in my community spend so much time playing benefit shows for free, I wonder how they make any money at all. But most are glad to do it, when asked. They know that, fate being what it is, it could be their own bills that need paying next time around.

I used to think of all this as an informal support network for people who were “outside” the health care system. But two years ago, as my spouse and I were discussing how much we could afford to donate to a friend who fell off a horse and broke herself in several places, it hit me that I’d been looking at it wrong.

It takes a great deal of time and energy to stage a successful benefit. With few exceptions, all that work is done by unpaid volunteers. And folks, this is PART of the system.

I’m lucky enough to have health insurance, but it doesn’t come cheap. My employer pays most of the premium. I kick in a share for my dependents. And over the years, in order to keep us insured, I’ve made some choices I wish I hadn’t had to make.

There are people who are much worse off than I am, and some of my tax dollars are used to provide health care for them.

And then our crazy, dysfunctional system counts on me and the rest of my crowd to dip into what time and money we have left, to take care of people who fall through the cracks: the hundreds of thousands of Americans who can’t afford health insurance (or can’t buy it at any price) but are too well off to qualify for public assistance.

Ah, well. For your friends, you do what you have to.

But wouldn’t it be better if all the people you care about could afford their own health care, and you could show your friendship by dropping off a casserole or offering to mow the yard while they’re laid up?

Health Insurance at Work

I’m one of the 158 million Americans who get health insurance through our jobs. My plan is a decent one. I like my primary care physician, and she’s good about referring me to a specialist if I need one. Seven years ago, I faced a life-threatening condition that required major surgery. I got excellent care, and my insurance paid what it was supposed to without giving me any grief.

You may say, “Gee, texaslupine, you’re one of the lucky ones. Why would you want to mess with a system that’s working for you?”

Because even from where I sit, I can tell the system is broken.

Two weeks ago, I compared our current health care mess to a slow-motion train wreck. Let’s say I’m riding that train, in a Pullman car close to the back end. Somewhere up ahead, my train has collided head-on with another in the middle of a high trestle. Both locomotives are doing a swan dive into the gorge, with cars careening off behind them. The car I’m riding in is still on the tracks –- for the moment, anyway -- but there’s no reason to think it’ll stay there.

I’m a State of Texas employee. I’ve been with the state nine years. Before that, I spent a few years on staff at The University of Texas. Which means that since 1996, I’ve had health insurance through the Employees Retirement System. I know it’s a valuable benefit, way better than a lot of my friends have. But still, I’ve seen that benefit erode over time.

• When I worked at UT, and when I first signed on with the state, employees had a choice of health plans. Everyone had access to the self-insured plan administered by Blue Cross/Blue Shield, and depending on where a person lived, there might be three or four HMOs available. Nowadays, there may be one HMO in a given area; in many parts of the state, the self-insured plan is the only choice.
  
• In my job at UT, I was amazed to find that health insurance was in effect on my first day. Other places I’d worked had a waiting period of one to six months before new employees could enroll. Well, state employees used to be covered from day one, but not any more. New people coming in have a three-month waiting period. This doesn’t affect me personally, since I’m already in the system. But it’s another example of benefits being gradually chipped away.
  
• Earlier this year, state employees were notified that our health care plan was out of money and might be forced to make some changes. I was invited to fill out a survey, which basically presented a range of unhappy options and asked me to pick the ones I hated least. The result? Our monthly premiums will increase next month, and so will our co-pays for doctor visits, hospital stays and prescription drugs. And the ERS website ominously states, “More changes will be necessary in the near future.”

Yes, and with all the recent news about state budget cuts, there’s no guarantee that I’ll even have a job two years from now.

Somewhere out there, I hear the faint sound of a violin playing “My Heart Bleeds…” Okay, I’ll stop whining, and I really wasn’t asking for sympathy. I just wanted to share a story that is, I believe, representative of what’s happening everywhere. I suspect all Americans are paying more for less coverage than they were ten years ago.

… that is, if they can get any coverage at all. We’ll talk about that next time.

Health Care Reform: The Individual Mandate

When health care reform takes full effect in 2014, nearly everyone in the United States will be required to carry some kind of health insurance.

I have mixed feelings about this.

From a philosophical standpoint, I don’t like it. My gut says nobody should be forced to buy something, especially if he has to buy it from a private company. And since the “public option” got dropped along the way, that’s what many of us will have to do.

On the other hand, I can see that reform won’t work unless we all participate. Under the new law, insurance companies will no longer be allowed to deny coverage on account of pre-existing conditions or kick customers off the plan for getting sick. This is a huge improvement. Over the past decade, when I’ve thought about all that needs fixing in our current health care system, that thing about pre-existing conditions tops the list.

There are economic realities in this equation. A recent post on HealthBeatBlog explains it well:

"If the law didn’t insist that everyone have 'minimal coverage' (or pay a financial penalty), many young, healthy Americans might well wait until they were injured, or seriously ill, before signing up for a policy—safe in the knowledge that no insurer could refuse them, or charge an exorbitant premium. If that happened, insurers would find themselves covering a pool made up largely of the elderly, the disabled, and the chronically ill. Premiums would sky-rocket. If we are going to try to provide health insurance for all citizens, the healthy must join the pool…."

So, despite my distaste for the mandate, I support the health care act. And I confess that somewhere in the back of my mind, I’m hoping this will eventually work itself out. If the law works the way I hope it does, if it forces insurance companies to be better corporate citizens, if health insurance becomes more affordable and works better for the people who have it, maybe it will come to be seen as something everybody wants and needs, and a mandate will be unnecessary. Perhaps the changed playing field will give rise to non-profits, co-ops, or new types of health care/health insurance providers we haven’t even thought of yet.

There are some big “ifs” in those scenarios, but I can dream, can’t I?

In Defense of Health Care Reform

My home state, along with a dozen others, is suing the U.S. government over the Patient Protection and Affordable Care Act.

Yes, I’m talking about Texas, Our Texas, the place where I was born and raised. A state where one in four people has no health insurance; a state that’s home to more uninsured people than any other.

I don’t mean to say I just found out about this. The suit was filed last March, the same day President Obama signed health care reform into law. But I just got around to reading the 23-page document last night. Clearly, the chief attorneys for all these states are hoping to get the act thrown out before it fully takes effect.

Come on, people. The system we have isn’t working. Why not give this new law a try?

As I see it, the current state of health care in this country is a slow-motion train wreck. I’ve watched for twenty years at fairly close range: as a consumer of health services…a breadwinner with responsibility for other household members…a friend of working musicians who have played countless benefit concerts for sick and injured colleagues who can’t pay their doctor bills. It’s a tangled mess that ruins lives and warps our whole economy. And it’s steadily getting worse.

I have a lot to say about various aspects of this imbroglio. I’ll share some in future posts, and hope to get some additional comments from readers. For now, I’ll just say this:

If I knew how to fix health care, I’d have typed up my plan and sent it to our last four presidents. So I’m not going to point fingers at the members of Congress who spent a year debating this legislation, tweaking its provisions, making deals, and finally getting it passed.

I don’t agree with every single provision in the act, but I think there’s enough good stuff there to make a start on fixing some very thorny problems. I’m more than willing to give it a chance.