Shame on Darrell Issa

By Gregg A. Masters, MPH

It’s day one post disastrous 217 to 213 House vote to approve the sham American Healthcare Act (H.R. 1628).

IMG_0724
Andy Slavitt (left) Gregg Masters (right) at HiMSS Annual Convention 2017

Despite virtually every major AUTHORITATIVE healthcare industry association listed below:

To National voluntary health organizations including the American Cancer Society to the March of Dimes, and major physician and nursing professional societies:

And the OVERWHELMING weight of health policy experts such as former Acting Administrator of the Centers for Medicare and Medicaid Administration (CMS) Andy Slavitt who oversaw administration of the ACA (including yours truly) active counsel to vote NO on this tax cut for the rich masquerading as a sham health reform proposal to repeal and replace the Affordable Care Act, our tone deaf Congressman Darrell Issa cast his lot with this massive transfer of wealth from the poor and disabled to the top 2% of Americans.

For Andy’s take on ACA and attempts to repeal and replace listen here, then read ‘Health care score is Republicans 1, Americans 0‘ and ‘GOP health plan is awful and Americans know it’.

For summary opposing view on the AHCA watch:

Screen Shot 2017-05-06 at 12.07.33 PM

Now for perspective on Issa’s misguided policy thought processes the quote below frames his disingenuous and fundamental ignorance of evidence based health policy and functionality of health insurance markets.

Rep. Darrell Issa: “Let’s stop pretending Obamacare is going to fix itself or that somehow, someday, it’s going to get better. Today’s vote gives a voice to the victims of Obamacare, the millions of Americans who are paying higher premiums, receiving less coverage and for whom the status quo offered no end in sight.”

What Issa fails to mention is the relentless 7 year opposition to ANY attempt to fix this admittedly less than perfect law. The other part of his culpability is active support of GOP efforts designed to sabotage the ACA – which is nowhere in sight of his proffered narrative.

Let’s mention just a few.  The good faith abandonment of a Public Option by the Obama administration in favor of community owned ‘Co-Ops’ (a public/private alternative to the Government run ‘Public option’).  CO-OPs are de facto Federally supported ‘start-ups’ competing and pricing in a volatile (individual and small group) market with NO actuarial history.

NOTE: For an primer on premiums check out the issue brief ‘Drivers Of 2017 Health Insurance Premium Changesvia the American Society of Actuaries.

One thing to note about underwriting cycles, they have predictable years of profits followed by years of losses. Whether a qualified health plan or CO-OP survives the tender start-up years (often competing against well capitalized and seasoned players) has more to do with market (cycle) timing than management brilliance or business model per se.

Now add the need for ‘actuarial credibility‘ where the health plan enrolls a sufficient number of members with the proper mix of healthy and sick, young and old programmatically intended to be enabled by the ACA’s individual mandate (vigorously opposed by GOP) to purchase health insurance aka the ‘heavy hand of government‘, and you may begin to get the picture of the self inflicted wound.

In the anti-Obamacare narrative it is often noted, that CO-OPs mostly failed, yet what’s left out is the planned aggressive, proactive and coordinated GOP sabotage gaming stop loss and reinsurance provisions and the likely death knell of risk corridor de-funding (a mission critical component of the premium stabilization effort); see Marco Rubio Quietly Undermines Affordable Care Act.

For an explanation of how the GOP undermined the CO-OP program, here’s one analysis specific to United HealthGroup’s reasoning to exit the exchanges:

The Affordable Care Act (or ACA) created a new category of health insurance companies called Consumer Operated and Oriented Plans (or CO-OP). Also termed as health cooperatives, these non-profit health insurers offer plans on public exchanges and compete with commercial insurers such as UnitedHealth Group, Aetna, Cigna and Anthem.

Currently, 12 out of the total 23 healthcare co-operatives have failed, resulting in losses of $1.2 billion in loans granted to them by the federal government.

Insufficient support of risk corridor program

To avoid health insurance companies’ discriminating against people with pre-existing conditions, the ACA introduced a premium stabilization program as a risk management mechanism for health insurance companies. The 3R Program involves three sub-programs: risk adjustment, reinsurance, and risk corridors.

The risk corridor program attempts to protect health insurers selling plans on public exchanges from extreme gains and losses. Plans sold on public exchanges, also called QHPs (qualified health plans), project a target amount for costs.

If the actual claim costs of the QHPs vary greater than 3% above or below the target amount, the plan will either receive funds from or pay funds to the risk corridor program. The program operates by transferring funds from insurance players making profits on these exchanges to those who have suffered losses due to high costs.

On October 1, 2015, Centers for Medicare and Medicaid Services (or CMS) announced that it would not be able to cover the demand of $2.9 billion in risk corridor claims for 2014, as it had only $362 million in risk corridor collections. Hence, CMS will cover only 12.6% of the total claims made by each health insurer. Insufficient support of the risk corridor program has further increased the risk level of the individual exchange program.

NOTE: having either a viable Co-Op in a state operated or Federally facilitated exchange or the initially intended government sponsored public option in the communities many carriers are now declining to underwrite, none of the ‘failure claims’ of Obamacare’s death spiral would have standing in their disaster narrative.

A combination of funded risk corridors, reinsurance or other stop loss provisions would have buffered premium sticker shock from year to year and likely removed the death spiral or failure narrative – but then again, with that support exchange listed qualified health plans including Co-Ops may have succeeded which was not part of the GOP hell no’ and ‘one term President’ agenda.

The same undisclosed ‘inside story’ of self fulfilling sabotage applies to the terms of Qualified Health Plan  (QHP) listings on the exchanges (fortunately in California we have a different model Covered California bucking the trend of less proactive state exchanges). Yet, when Issa and his co-conspirators spin the anti ACA narrative, i.e., Obamacare is in a [fictional‘death spiral’ they point to Red states that more often than not did not expand Medicaid and in several markets (Tennessee and more recently Iowa) have one or no participating carriers in certain counties willing to assume the underwriting risk. But wait, what a surprise! Nonstop bully pulpit ‘dissing’ of Obamacare as a ‘disaster’ in a fictional ‘death spiral’ inevitably takes its toll. So, bottom-line Issa is a bold face liar and a selective spinster of half truths – and worse yet – the conscious failure to disclose his and his co-conspirators’ ACA sabotage agenda.

It should come as a NO surprise that Issa lives in a privileged bubble and is out of touch with everyday Americans. Watch as he arrogantly opines on those less fortunate than himself on the subject of correcting income inequality. This 2015 clip is via CNN Money:

darrellissa income inequality
Click image to watch

As a home owner and resident in the 49th District, I have had enough of Issa’s lies, dismissive arrogance and consistent efforts to undermine affordable healthcare for EVERY American and will now stand against him and his GOP colleagues [Rep. Ken Calvert (Corona), Rep. Paul Cook (Yucca Valley), Rep. Jeff Denham* (Turlock), Rep. Duncan Hunter (Alpine), Rep. Darrell Issa* (Vista), Rep. Steve Knight* (Palmdale), Rep. Doug LaMalfa (Richvale), Rep. Kevin McCarthy (Bakersfield), Rep. Tom McClintock (Elk Grove), Rep. Devin Nunes (Tulare), Rep. Dana Rohrabacher* (Costa Mesa), Rep. Ed Royce* (Fullerton), Rep. David Valadao* (Hanford), Rep. Mimi Walters* (Irvine) ] now radioactive with those ‘tattoo’s Minority Leader Pelosi noted after this tragic vote was tallied.

For a rather compelling sidebar on whether Issa cast the vote that pierced the majority threshold of 216, check out this awkward and somewhat arrogant exchange (apparently like attracts like) between Calvin Moore, Issa’s spokesman and Matthew Hall, the Union-Tribune’s editorial and opinion director: ‘Darrell Issa’s yes vote on Obamacare repeal makes him center of attention‘.

Screen Shot 2017-05-05 at 3.45.10 PM

Screen Shot 2017-05-05 at 3.45.26 PMScreen Shot 2017-05-05 at 3.46.03 PM.png

This effort is voluntary and grassroots. If so inclined I invite you to share your story on this blog and I encourage active tweeting using the hashtag #Flipthe49th.

Let’s stand against this man and elect someone who will protect access to affordable healthcare and not undermine Tri-City Medical Center right here in O’side! While the ACA was a step in the right direction, there is much work ahead of us!

Will you join me to flip the 49th? Please follow on twitter via @2healthguru.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s