Episode 2 of Obamacare Repeal and Replacement – Help!


In my ongoing analysis of the American Health Care Act, it did not take me long at all to get stuck figuring out the next section with the header “Community Health Center Program.” While I appreciate the fact that Congress did make the text of the Affordable Care Act repeal and replacement bill available to the public (unlike someone who shall remain nameless in terms of the Unaffordable Care Act, but her initials are Rep. Nancy Pelosi), I wish it were a little easier for a peon like me to understand.

Here’s the sentence I got stuck on:

“Effective as if included in the enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (Public Law …), paragraph (1) of section 221 (a) of such Act is amended by inserting ‘,and an additional $422,000,000 for fiscal year 2017′ after ‘2017’.”

I pondered it for a little bit, but still thought, “Really, what DOES this mean?”

Because I was at a total loss for an explanation of this section, I decided to ask someone I trust will be an “expert” on the subject – the media relations person for Rep. Chris Stewart (R-Utah) because he is my Congressman. Although I have some guesses as to what this section means, I don’t want to explain it unless I can explain it accurately. That’s just a little OCD thing of mine.

Unfortunately, I made a major miscalculation regarding my timing. I emailed the question to this lady at about 2:50 p.m. – my time in Utah, which means it is almost 5 p.m. in Washington, D.C. where she is apparently located. The chances are good that if she had not yet packed it in for the day (and the weekend), she was probably close to it. So I may not get an answer today. I need to remember to time my blog post writing to take in explanation needs, with this series anyway. I hope I don’t need too many questions answered or this lady is going to want to kill me!

So, while we wait for an answer – probably next Monday – I just learned some news about the repeal and replacement bill. According to a tweet from NBC News, apparently the House of Representatives has slated a full House vote on the bill next Thursday, March 23, 2017.

Next week should be pretty interesting, needless to say. From what I’m hearing from Speaker of the House Paul Ryan in Fox News reports, the whole Obamacare repeal and replacement process is divided into three stages. Stay tuned – I’m sure next week will be crazy.



Episode 1 – Obamacare Repeal and Replace


Unlocking the Puzzle of the Obamacare Repeal and Replace Plan

As I said when introducing the American Health Care Act (aka Obamacare repeal and replacement), my first introduction to that bill was a host of punctuation directives after the introductory sentence. Many people are calling this Obamacare Lite, and when I read the first paragraph, I am forced to agree. Why?

The first paragraph reads as follows:

“Subsection (b) of Section 4002 of the Patient Protection and Affordable Care Act (42 U.S.C. 300u-11), as amended (emphasis mine) by Section 5009 of the 21st Century Cures Act is amended (emphasis mine AGAIN)–”

What Do I Think?

Let’s just stop here for a moment and take in the beginning paragraph of what is supposed to be the repeal and replacement of the Affordable (better known as Unaffordable) Care Act. However, the very first sentence uses the word “amended” TWICE as the first legislative action in the repeal and replacement action by our Republican majority Congress.

This first sentence appears to be more of a patchwork between two laws – the ACA and the 21st Century Cures Act, and not any basic repeal – just an amendment (at least in my eyes).

I wanted to find out what the 21st Century Cures Act is all about. I have heard about it, but I until I just looked it up, I didn’t know much about it. So this was a learning experience for me as well as you, my readers. First of all, it is a bill originating out of the House of Representatives 2015-2016 session, according to the website CONGRESS.GOV, and it has only passed the House, not the Senate so it is not yet law. How handy to have an old bill that has not completely passed Congress yet, or signed into law, to patchwork into the Obamacare repeal and replace bill. Maybe this is their idea of government efficiency.

The  basic summary of the 21st Century Cures Act is, according to CONGRESS.GOV is this:

“The NIH [National Institute of Health] and Cures Innovation Fund is established and funds are appropriated: 1) for biomedical research including high risk, high reward research and research conducted by early stage investigators; 2) to develop and implement a strategic plan for biomedical research; and 3) to carry out specified provisions of this Act.”

In short, Congress proposes to appropriate some taxpayer money (everything the government has belongs to “we the people,” you know) to fund biomedical research.

It is also interesting to note in the 21st Century Cures Act I am looking at, the section numbers only go as far as 4061, so the Section 5009 referred to in the first sentence of the repeal and replace plan for Obamacare must be brand new.

Then the American Health Care bill goes on to add a series of conjunctions and punctuation directions as well as striking the phrase “each of fiscal years 2018 and 2019,” and inserting “fiscal year 2018.” Then about four paragraphs are stricken to be replaced with the following sentence and a few others after it, but for today, I am only going to focus on this one substituted sentence.

“(b) Rescission of Unobligated Funds. – Of the funds made available by such section 4002, the unobligated balance at the end of fiscal year 2018 is rescinded.”

I suppose that means that if Congress has not committed a certain amount in funds to any particular recipient by the end of that year, that amount cannot be paid out. Does that amount then go back into the federal government’s general fund?

The next question is – Where are funds being directed as a result of Section 4002 of the ACA? According to a fact sheet by the American Public Health Association, Section 4002 covers the Prevention and Public Health Fund. So the logical deduction for this first tidbit from the Obamacare repeal and reform bill is that if there are any public health funds that go unclaimed by the government’s Prevention and Public Health Fund at the end of fiscal year 2018, they will NOT be used by that fund at all.

It is interesting to note that, according to a chart on the APHA fact sheet, the amount that remains appropriated for the Prevention and Public Health Fund as of 2015 (after one cut in 2012 and a sequestration cut in fiscal year 2015, is $927 million. Who knows how much of that will remain unobligated by the end of fiscal year 2018? It’s possible this first section could be interpreted as a repeal provision of the ACA. We’ll see.

Stay Tuned for More

Whew! That was something else! I don’t suppose there is a translation somewhere for the “average Joe,” so I will continue to do my best to analyze this Obamacare repeal and replacement bill as it is worded in the text I have, and as my poor little brain can handle.

Sources for further reading:





It’s Here! The First Draft of the American Health Care Act


Well, the Republicans in Congress finally rolled out legal language (and I do mean legal language) outlining their plan for repealing and replacing the Patient Protection and Affordable Care Act of 2010. Now there were outlines of a plan for a long time, and people could get a glimpse of what a replacement plan might entail in everyday English, but this plan is now codified into barely decipherable legalese so only lawyers can tell us exactly what in means. Believe me on that count because I have started to read it.

On the plus side, any citizen can actually download a copy of the proposed bill, which is known as the American Health Care Act. Fortunately, we are not going to revisit the Rep. Nancy Pelosi line, “We have to pass it to find out what’s in it.” Therefore, any citizen who can read and gets a kick out of legalese headaches, can “find out what’s in it.” If someone does not like what is in it, he or she can contact their elected representatives at the federal level to register their comments.

Basic Principles

First, the basics in real English. I found what is being called a fact sheet from the office of Rep. Paul Ryan, Speaker of the House of Representatives. This fact sheet outlines the fundamental principles of the American Health Care Act. Here they are as presented in this fact sheet with a little bit of editorializing from me.

  • The new bill keeps the promise made by Republicans and President Donald Trump to repeal and replace Obamacare.
  • This bill provides for a stable transition from the Unaffordable Care Act as the country (hopefully) transitions to health care policies that encourage individual choice and less government interference in personal health care decisions.
  • Finally, this bill aims to lower health care costs, allow more choices, and provide individuals with more control over their health care. (I really hope this one happens!)

So What’s Next?

Needless to say, I have been hearing a lot of bellyaching about this plan by people from every political stripe – yes, Republican and Democrat. The most important issue though is whether this plan has a chance to succeed in lowering costs and providing more choices in health care while protecting the most vulnerable in our society.

I have just begun to read the repeal and replacement bill, which seems to have a strong predilection for punctuation directives. But I am getting through it. Wow, I should have tried to read it when I was having trouble falling asleep last night!

In future posts, I am going to try to describe my impression of the bill for you, and whether I think there is a chance that it may accomplish the goals that Rep. Ryan expects it to.

If you are interested in being notified of future posts and other offers, please subscribe to my email list (the form is located to the top right side of this post), and be sure to contact me and let me know your thoughts about all of this. I’d love to read about what you are thinking.

Photo courtesy of canstockphoto.com.

How Numbers Are Manipulated in the Obamacare Debate


Ah … numbers are enough to drive one crazy unless you’re a math fanatic. I’m definitely NOT!

So Why Did I Undertake Research on Obamacare Numbers?

I was inspired by a tweet from Gerard Gianoli, M.D., one of the doctors I follow on Twitter, to look into the number of people who had their health insurance plans canceled as the Obamacare exchanges opened in the fall of 2013, and people started to sign up (or in many cases, TRIED to sign up) for one of the Obamacare-compliant plans with all the bells and whistles. Then there have been cancellations for other reasons as well.

I had originally responded to an editorial in The Hill that Dr. Gianoli had posted, “Debunking the 20-million Obamacare Myth,” written by opinion contributors Justin Haskins and Michael Hamilton. The article showed how all the numbers that were used to make Obamacare look like a big success over the last three years were very fungible. And indeed they are.

My Foray Into Numbers – Ouch!

I’m not going to put you to sleep with a whole array of numbers here because frankly they make my head spin, but the basic premise of this editorial was that the oft-cited number of 20 million people in the United States who have gained health insurance coverage via the Affordable Care Act since it became effective in 2014 is closer to 16.5 million than 20 million. However, that estimate is not limited to those who gained commercial insurance through the ACA; it includes approximately 2,044,809 of those new “enrollees” being signed up for Medicaid and the Children’s Heath Insurance Program (CHIP) primarily because of the Medicaid expansion in many states, which offered “coverage” to able-bodied low-income people and was almost completely subsidized by government.

Dr. Gianoli brought up the point about the many people who lost insurance because of the ACA. I suppose that number could include those with individual insurance policies prior to 2014 who had them canceled because they did not meet the coverage mandates required by the ACA. It could also include those who lost insurance for a plethora of other reasons such as employers cutting employee hours so they didn’t have to provide benefits, etc. So I set out to do a little bit of internet research. Here is what I found, and the results of my research were dizzying.

According to the website FactCheck.org, the Associated Press had cited a number of people whose insurance policies had been cancelled because of non-compliance with ACA mandates to be 4.7 million. However, according to FactCheck.org, an article published on the journal Health Affairs’ website estimated that number to be more like 2.6 million. Apparently that estimate was based on the work of two researchers with the Urban Institute, which has been a known cheering section for Obamacare.

In an online editorial in Forbes entitled “How Many People Has Obamacare Really Insured” by Scott Gottlieb, he cites two different studies of the actual numbers that Obamacare can be credited with insuring – one by Goldman Sachs and one by the Rand Corporation.

According to Gottlieb, the Goldman Sachs study estimated that total insurance coverage as the result of the ACA increased by between 13 and 14 million in 2014 with a possible 4 million people being added to that number in the first five months of 2015, for a grand total of 17 to 18 million people “newly” covered in that period.

The Rand Corporation estimated that a total of 22.8 million people gained coverage under the ACA, and yet it also calculated that 5.9 million people lost coverage as the result of the law, which brings the estimate of actual covered lives as a result of the ACA to 16.9 million, which is really not far, in either direction, from the estimates of the Goldman Sachs study or the estimates in the The Hill editorial.

It is interesting to note that the Forbes article did not state the reasons an estimated 5.9 million people lost health insurance as the result of Obamacare. That may include those who lost it because their plans prior to 2014 did not meet the Obamacare compliance standards as well as those who lost coverage because of insurance carriers withdrawing from the Obamacare exchanges when they found they were experiencing too much in the way of losses. Who knows? That estimated number could even include those who decided the Obamacare plans were worthless and concluded that they would be better off not having insurance while Obamacare was still in effect, even though that clearly has some risk attached.

All in all, whether the number of people who lost their insurance as a result of Obamacare was 2.6 million or 5.9 million, or somewhere in between, the REAL number of people being covered by Obamacare has never actually reached the 20 million additional people the ACA proponents claim. No matter what, you can tell how easily manipulated as well as only partially reliable numbers can be.

Yet even today, I have come across “figures” being touted that 30 to 32 million people will “lose insurance” if the Unaffordable¬† Care Act is repealed without a replacement. All I’ve heard from Congress and Trump is replacement, replacement, replacement … so where are those people getting their information? From the fake news?

They Have No Clue!


Once again the people whose socialist candidate, Hillary Clinton, lost the election in November are, like Chicken Little, screaming that “the sky is falling” because President Donald Trump is preparing to do what he said he would do in the election – repeal and replace the Patient Protection and Affordable Care Act of 2010. I prefer to call it the Unaffordable Care Act, and I’m not the only one.

Faulty Information

These people (who are sadly misinformed) are attending town halls, or protesting outside them, screaming holy heck about the possibility of losing their insurance when Republicans have made it quite clear that there is NO intention of pulling the rug out from under anybody as our elected representatives work to enable the health care sector of our economy to function much better and help everyone to access much more affordable health care. These protestors are afraid because someone has apparently told them that the Republicans just want to take their “health care away.”

One woman who actually paid for admission to an event in Kentucky where Senator Mitch McConnell was present said she had come to protest, among other things, “losing our health care.” So this is what they think: if the collapsing Obamacare system is actually reformed to provide access to care for everyone in an affordable manner, that means they will lose their health care.

Too many people in this country have become accustomed to the concept of “insurance coverage” for health needs as being equated to receiving health care, when in fact, coverage does not always enable access to health care. Just look at our Veterans Administration system or Medicaid where beneficiaries often have a difficult time finding a doctor who accepts Medicaid because of its below-cost reimbursement rates.

While I am very much in favor of people being allowed to protest in this country (our constitutional right), it is time for all of them to become truly educated about what they are protesting. At the end of this post, I have re-posted the interview Tucker Carlson from Fox News did with Steven Weissman, a former hospital CEO regarding one of the major cost drivers of health care – phony pricing by hospitals and other providers. I posted it on my blog last Friday to give people something to think about over the weekend before I wrote this post.

The notion that all people need is to be “covered” by some health insurance policy, means they will “have health care” is very faulty. First of all the combination of Obamacare insurance premiums, deductibles, and co-insurance payments are so high for many people that they have decided it would be less expensive to go without insurance.

Yes, it is reassuring to have at least an insurance policy for those really large-ticket treatments such as surgeries or cancer treatments, etc. – those problems over which we may not have a lot of control. However, if we are working individuals with at least a lower middle class income, we would be better served by the government allowing some tax breaks for health savings accounts and possibly the catastrophic insurance policy that goes with it and then getting out of the way to give us room to be wise health care consumers. We would also be better served if the tax deductions for health care were the same for individuals employed by a company that offers health insurance and those who are self-employed or employed by a small business that cannot provide health insurance.

The people who are screaming are probably those who have received substantial subsidies through the Obamacare exchanges to help pay for their health insurance costs. However, these are plans that place a lot of control over people in the form of narrower provider networks, insurance denials for treatment, insurance companies’ control over the number of doctors practicing in an area, etc. These people do not understand the impact that the insurance companies’ phony negotiations with providers (many of them tax-exempt) have on the actual cost of health care that has been hyper-inflated because of those phony discounts touted by the insurance companies. I cannot say it enough – these “discounts” are the cause of higher health care costs, and NOT the solution.

Real Compassion is Important Too

One disclaimer – I am very well aware that we, as a society, need to provide for the care of the extremely sick, unemployed and disabled who are unable to take care of themselves either temporarily or long-term. I believe in mercy and compassion. But, as I have outlined in earlier posts, there are innovative ways to take care of them that do not require government control over everyone in the form of expensive mandates.

Stand For Real Freedom!

I suggest to these protestors that instead of screaming about the unlikely possibility of “losing their health care,” that they get educated regarding how they can make health care accessible and affordable to everyone without a nanny government keeping average able-bodied people pacified with government giveaways.

Where is the spirit of independence and freedom that drove the founding fathers of our country to reject the tyrannical rule of Britain and establish a government intended to stay out of the way of the individual as much as possible enabling “life, liberty, and the pursuit of happiness?”

Photo attribution:

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More Calling Out High Health Care Costs


Update on this video interview: Apparently it has been removed from YouTube. I tweeted Tucker Carlson to find out why. I hope he actually answers. I have this fear that there may have been some crony insurance company/health care system pressure on Fox News to remove it, or maybe the copyright really did just run out, which is the original claim when I looked into it. It’s weird though. In all this time I have been posting videos and articles on different platforms, I don’t remember seeing one disappear. This is definitely a first for me.

Upon discovering the removal of that video, I found an article/editorial by Steven Weissman about the way health care cost discrepancies and manipulations between insurers and “health care” systems are the real problem with insurance coverage (in terms of premium costs). It is the same information that Tucker Carlson covered with Weissman in the video interview that got removed. Better yet, there is a petition you can sign to get some action regarding pricing practice changes. Here’s the link.


When Congress (hopefully) debates the repeal of Obamacare, I hope they consider this situation, which is one of the drivers of the high cost of health care. It’s not the only one, of course. I felt it was very important to link this video on my blog because it is so timely and goes right to the heart of our problems.

I have posted this interview just about everywhere I have a platform – my blog, my Facebook page and my Twitter page. Now I will let everybody chew on this over the weekend and I will be back next week to write about what should happen in the repeal of Obamacare.

More Taxpayer Theft by Non-Profit Hospitals


I have discussed a couple of facets of the ride on which Americans are being taken as they have had the impression drilled into them that non-profit hospitals are these innocuous, charitable, caring organizations dedicated to the health of their patients and surrounding communities. I believe that many of the people who work in these facilities – doctors, nurses, radiology technicians, etc. – ARE truly dedicated to helping to restore health to the patients for whom they are caring. It’s the leadership of these facilities that, I would contend, have less than ideal motivations. And if their motivations are so altruistic why are they content to feed at the tax-exempt public trough while overcharging patients?

In my last post, I referred to a very notable article in Time Magazine by Steven Brill entitled, “Bitter Pill: Why Medical Bills Are Killing Us.” This article was HUGE when it was originally published in 2013. One of the the major points that Brill made was the extreme overpricing of medical services.

He used the example of a man who came to MD Anderson Cancer Center for cancer treatment. Although he had an insurance policy, it was not the kind that MD Anderson accepted, so this man was required to pay cash up front for his assessment and treatment.

Here are just a couple of examples of the money he was expected to fork out for his treatment because he was a cash patient.

  • According to Brill’s article, laboratory testing charges for this man totaled more than $15,000, and if he were old enough to be a Medicare beneficiary, Medicare would have paid MD Anderson only a few hundred dollars for those same tests.
  • Then the cost of the cancer drug to treat him – Rituximab- was billed to this patient at $13,702 for an injection of 660 mg. Brill explained that the average cost of the drug to hospitals in general was $4,000 for the same dose of the drug. Brill also mentioned that he believed the hospital probably got a volume discount for the drug which would have made the hospital’s cost closer to a maximum of $3,500, which means there was markup of approximately 400 percent for this lifesaving drug.

These are only a couple of examples Brill provided regarding the markups for services and medications that this cancer patient had to pay for in advance before receiving any treatment. However, Brill reported that while this unfortunate cancer patient was being milked for his lifesaving cancer treatment, MD Anderson Cancer Center, which is a “non-profit” institution, managed to take in a “profit/surplus” of $531 million in one year.

Although, I am not sure I agree with all of Brill’s conclusions in this article, I would strongly agree with this statement by him.

“Taken as a whole, these powerful institutions and the bills they churn out dominate the nation’s economy and put demands on taxpayers to a degree unequaled anywhere on earth.”

In another article entitled “The Five Things Hospitals Don’t Want You to Know About Obamacare,” by Nigel Jaquiss, that ran on April 12, 2016 in the Oregon publication “Willamette Week,” the majority of Oregon hospitals are non-profit. However, they are making huge “profits/surpluses,” whatever you want to call them. The article reports that Providence Health & Services has managed to accrue $5.8 billion in cash reserves.

This article quotes a representative of the Service Employees International Union Local 49 as saying the union would prefer that rather than stockpiling all that cash, the health system would lower its prices, improve access and the quality of its services. Wow! I agree with a union. Will wonders never cease?

I never tire of pointing out that the hospitals with these “profits/surpluses” are non-profit and tax-exempt. Is this right? Is this good for our country? I would say “no.”

My question is – what would happen if non-profit hospitals lost their tax-exempt status? Would they continue to overcharge and rack up huge surpluses or would they be forced to lower their prices for patient care? I think it might be worth a try. After all, look how much they have been getting away with, and at the expense of taxpaying citizens.

Sources (and further reading):



Image courtesy of canstockphoto.com.

Why Do Non-profit Hospitals Pay Their Administrators Huge Salaries?


As I seek to expose the less humanitarian side of non-profit hospitals, one subject that has come up quite a bit in my reading is the ridiculous salaries paid to chief executive officers and other administrators in these hospitals that are supposedly so dedicated to their communities.

Say What?

I’ll give a few of the more egregious examples of of highly paid administrators at non-profit hospitals in the U.S. The first one would be Jeffrey Romoff, the CEO of University of Pittsburgh Medical Center. According to an article in the Pittsburgh Post-Gazette (May 13, 2016), his total compensation that includes salary, along with bonuses and incentives, totaled $6.43 million in the fiscal year that ended June 30, 2015, which is the fourth consecutive year his compensation has topped $6 million.

The Post-Gazette article goes on to say that Romoff is not the only administrator at UPMC who is enjoying remarkably high compensation for his work. Others who received large compensation packages include James Luketich, chairman of the Department of Cardiothoracic Surgery who earned $2.48 million. Then Diane Holder, president and CEO of the UPMC Health Plan earned a total package of $2.46 million. Just so I don’t bore you to death with a laundry list of others making more than $2 million in a year at UPMC, I will just say that there are four more of them.

The Post-Gazette article states that a total of 31 administrators, including the aforementioned, made at least $1 million at UPMC in 2015.

These high salaries are not localized to UPMC, but are widespread in non-profit “health care” systems throughout the United States.

Another Example

An article in NJ.com dated September 22, 2016 reported that Joe Trunfio, the CEO of Atlantic Health System, which is the parent company of Morristown Medical Center in New Jersey, was making close to $5 million a year in total compensation before his retirement shortly after 2014.

The article further states that State Tax Court Judge Vito Bianco ruled that Morristown Medical Center should lose its tax-exempt status because of Trunfio’s excessively high pay.

The NJ.com article quotes Bianco as saying that today’s non-profit hospitals “generate significant revenue and pay their professionals salaries that are competitive even by for-profit standards.”

Morristown Medical Center has managed to wiggle out from under that judgment through a settlement in which the facility agreed to “pay out” a total of $15.5 million over the next decade to “help offset property taxes.” The interesting part of this story is that it does not specifically state to what agency Morristown MC will be making that payment. I would assume that it is to the state.

Wow! Morristown must be pretty desperate to hold onto its tax-exempt status if they were willing to pay the state (or whoever) a little more than $1.5 million a year for the next ten years. Since Trunfio has retired, I wonder what his successor is making.

This article made the statement, in its introduction, that non-profit hospital CEOs would say that they are not earning too much money because “their compensation packages are based on what other CEOs are making in a highly competitive market.”

Perspective Time

I believe heavily in capitalism and the free market, and that everyone should have the opportunity to make the money they want to make if they have the skills and drive to accomplish that. However, I have some major reservations about high administrator salaries in non-profit health systems.

These systems are paying no taxes, and yet they claim to be serving their local communities. Let me take you back a moment to my last post about whether non-profit hospitals really lower the cost of health care. I referred to a list of non-profit hospitals in which Gundersen Lutheran Medical Center in Lacrosse, Wisconsin reported an annual profit/surplus (whatever you want to call it) of $302 million.

An average hospital bill for a surgery or major illness can cost upwards of $100,000, and the average person rarely has that much money. Hospitals, whether they are non-profit or for-profit, charge excessive amounts of money for services (although I am learning that some physician-owned for-profit hospitals provide better pricing). One of the most notable investigative articles regarding outrageous charges, “Bitter Pill: Why Medical Bills Are Killing Us,” was published in Time Magazine about four years ago. In this article, Steven Brill discusses the ridiculously high charges for medical care at non-profit hospitals, the high salaries of non-profit hospital administrators and the large profits/surpluses these non-profit facilities drag in.

I will share some of the insights from this article, and others, in my next post about non-profit hospitals. I am on a roll here!

If you too are concerned about why health care costs are so high, please sign up to receive emails from me and continue to join me on this blog. We still have a lot of ground to cover. The sign-up is to the upper right of this post.




(Photo courtesy of www.canstockphoto.com.)