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Jim Demint is correct, Medicaid expansion does hurt everyone and John Kasich is a liar.

On March 18, 2015 former U.S. Senator and president of the Heritage Foundation​, Jim DeMint wrote a great piece on Medicaid expansion entitled Why state Medicaid expansion hurts everyone. ​I can only find one fault with it. The term “bump out Medicaid payment” should have been explained in the piece or at least an asterisk provided with an explanation at the end. Often times further explanation is not given due to the number of words the author can use being constrained. Since there are no such constraints on me, I will provide that explanation and add further context below.

Bump out Medicaid payment” refers to the end of the PPACA (Obamacare) mandated increase in reimbursements (pay) to primary care physicians who accept Medicaid. Under the PPACA, physicians who accept MediCAID were to receive an increase in reimbursements commensurate to what physicians who accept MediCARE get, which is a significantly higher. That sounds great right? That means Medicaid recipients will have access to more physicians! This would normally be a good thing, at least for the most vulnerable in our society. Only one problem, and it’s a BIG one.

The Federal government only pays for the first TWO YEARS of this increased reimbursement. After two years, STATE governments will struggle to maintain this increased rate of pay. Why is this an issue now? Because the first two years of this temporary provision were 2013 and 2014. That means state taxpayers are facing the reality of maintaining that increased rate of pay right now. In 24 states, like Illinois there is NO MONEY to maintain this pay hike for primary care physicians who accept Medicaid. Those states have already decided NOT to continue funding this increase in Medicaid primary care physician payments with state taxpayer dollars.  Many of the physicians who received this temporary pay hike have already expanded their patient lists to include many of these new Medicaid recipients. If the state cannot maintain the new increased rate of pay these new patients will most likely end up right where they were before, struggling to find a doctor who accepts Medicaid.

Worse YET, because far too many states expanded Medicaid eligibility to 138% above the FPL – Federal Poverty Level – and because the PPACA expands Medicaid to SINGLE, childless adults in the prime of their lives. The truly indigent and disabled end up disenfranchised due to the fact that single, childless adults in the prime of their lives (who should be WORKING) are now COMPETING for those Medicaid dollars. This in turn makes it more difficult for those who Medicaid was originally designed for (disabled, blind, single mothers, etc.) to receive the care they often times desperately need. Oh and let’s not forget that Medicaid recipients are also now competing with JAILED PRISONERS and ex convicts in Illinois, Ohio and other states thanks to PPACA Medicaid expansion.


There’s another ticking fiscal Medicaid time bomb, not referred to in Demint’s article that begins next year in 2016. For states that implement Medicaid expansion, the federal government will finance 100% of ALL costs (not just primary care visits) of those made newly eligible for Medicaid from 2014 to 2016. Then in 2016 the fed begins ‘phasing down’ that reimbursement to only 90% by 2020 and beyond. States will once again have to struggle to continue to pay the traditional Medicaid match rate for increased participation among those currently eligible. In addition to those costs are the administrative costs to the state. These are estimated to cost an ADDITIONAL $12 BILLION by 2020. This is why states like Texas which faced a $25 BILLION budget deficit in 2010 opted out of PPACA Medicaid expansion, prompting then governor Rick Perry to write this letter to then Secretary of HHS Kathleen Sebellius. Governor Perry was right then and he’s right now. Obamacare Medicaid expansion is a bad deal for states and a very bad deal for the most vulnerable in our society.

Illinois took the opposite role under former Governor Pat Quinn. He expanded Medicaid under the PPACA in the summer of 2013. A document sent by Quinn’s office over the summer of 2014 to the federal government significantly raised the per-person estimated Medicaid cost, INCREASING the state’s total outlay to $2 BILLION, using 2014 enrollment numbers. That is more than more than THREE TIMES the original cost estimate. Illinois has budgeted about $20 billion in 2015 for its Medicaid program. About half will be reimbursed with federal funds.

This shortsighted decision by former Governor Quinn has played a significant role in the current $9 BILLION budget DEFICIT that new governor Bruce Rauner now has to deal with. He is doing so by making deep and necessary cuts across the board. Much to the chagrin of the hospital lobby which seeks to maintain status quo by tapping into more federal dollars, regardless of the impact on our state’s budget.


Since I already addressed Indiana’s faux ‘Conservative’ Governor Mike Pence and his ridiculous decision to expand Medicaid under Obamacare on this episode of Indiana’s “Chicks On The Right” radio show. Let me address another faux ‘Conservative’ governor. Ohio’s John Kasich who Senator Demint accurately states is ALREADY facing a Medicaid expansion program 53% OVER budget and that’s just for the first HALF of 2015!

Mr. Kasich you have LIED to your constituents over and over again making public statements like the following:
“[Rejecting Medicaid expansion] takes $13 billion of Ohioans’ federal tax dollars out of our state and gives it to other states, —where it will go to work helping to rev up some other state’s economy instead of Ohio’’s.”  The worst part sir is that you KNOW it’s a lie. You are NOT an economic illiterate. You served as a member of the United States Congress for 18 years as the CHAIRMAN of the House BUDGET Committee!

The truth was revealed by Nic Horton, Jonathan Ingram and Josh Archambault. In a recent article at Forbes, these gentlemen pointed to a recent report from the Congressional Research Service which CONFIRMS what many of us policy experts have known for a long time. States that reject Obamacare’s Medicaid expansion are NOT “sending that Medicaid expansion money to other states“. Instead, that money is simply NEVER spent.

Nice try Governor. Next time just admit you’re a big government Statist who seeks to use taxpayer dollars to make you and your state’s budget look better, regardless of the additional burden that places on other taxpayers, their children and their grandchildren. But hey, you know what they say Governor. When you rob Peter to pay Paul you can ALWAYS count on Paul’s vote. Shame on you sir. You and those like you give Republicans a bad name.

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Blue Cross Blue Shield of Illinois to accept OFF exchange applications starting March 9, 2015.

On March 6, 2015 Blue Cross Blue Shield of Illinois announced that they will begin accepting guaranteed issue (no preexisting conditions) applications completed off the exchange beginning Monday, March 9, 2015. Off exchange applications are applications completed by those who have incomes to high to qualify for a subsidy via the “Marketplace” a.k.a. This new ‘Special Enrollment Period’ will last until April 30, 2015. 

For those who do qualify for a subsidy, Blue Cross Blue Shield of Illinois will be accepting on exchange applications completed via the “Marketplace” a.k.a. beginning March 15, 2015 and ending April 30, 2015. Below is the new announcement from Blue Cross Blue Shield of Illinois:

Tax Filing Special Enrollment Period Available for On- and Off- Marketplace Enrollment SEP for Off-Marketplace Plans Opens March 9!

As was announced last week, the Centers for Medicare and Medicaid Services (CMS) has approved a new Special Enrollment Period (SEP), meant to help consumers avoid tax penalties for not obtaining health insurance coverage this year.

The SEP for Marketplace enrollment begins Sunday, March 15.

We will offer this SEP for off-Marketplace enrollment also. To assist more of our customers with getting coverage beginning April 1, we are opening the tax SEP for coverage purchased from us on Monday, March 9. This gives them an extra week to enroll for an April 1 effective date when choosing an off-Marketplace plan.

Below are instructions on how to enroll OFF the exchange during this new Special Enrollment Period:

  • You will need to use this paper application.
  • On the paper application, you will need to select #8 (“Other”) as the SEP reason and must write “TAX SEP” in the Home Use Only box in the upper right corner. Paper applications for an off-Marketplace plan sent to us will only be accepted under the SEP if the application has the SEP designation selected.
  • You can then fax the application to (630) 582-1043. Or you can mail the application to:
    Small Business Insurance Services Inc.
    430 Northampton Lane
    Roselle, IL. 60172
    Or, you can email the application to This manual process is only necessary for the special tax SEP.

Below are instructions on how to enroll ON the exchange during this new Special Enrollment Period

If applicants are subsidy eligible and want to apply for financial assistance, they will need to apply directly online on the Marketplace starting March 15 via Using a broker to guide you through this process costs you nothing extra. It is highly recommended to call a licensed broker toll free at 866-724-7123 to help guide you through the application process at

Enrollment effective dates will follow the 15th of the month rule, as follows:

  • Applications submitted from March 9 through March 15 will have an April 1 effective date.
  • Applications submitted March 16 through April 15 will have a May 1 effective date.
  • Applications submitted April 16 through April 30 will have a June 1 effective date.
  • Members cannot ask for a different effective date.

By indicating “TAX SEP” on the application for insurance, the applicant is self-attesting that they qualify for the special enrollment period because they:

  • had to pay a penalty for not having coverage in 2014,
  • are not currently enrolled in a plan on, and
  • only found out about the tax penalty or understood the implications when they had to pay a tax penalty with their income tax return for 2014.

To see prices and plan options click the Blue Cross Blue Shield of Illinois logo below. Then click the orange “Just Browsing” button at the bottom of the “Are you eligible for special enrollment” page:


For expert guidance in Illinois please call (630) 674-1551. Outside of Illinois please call toll free (866) 724-7123.

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Analysis of Senator Ted Cruz’s “Health Choice Act of 2015″

I have now read through Senator Ted Cruz​’s entire new “Health Choice Act of 2015“. Here’s what it accomplishes in a nutshell:

1.) It repeals Title 1 of the Patient Protection & Affordable Care Act a.k.a “Obamacare” and all it’s amendments, including those amendments put forth via the law’s companion. Namely  the Health Care and Education Reconciliation Act of 2010.

Title 1 of the PPACA contains:

A. ) The onerous “pay or play” mandates on individuals and employers a.k.a the unconstitutional ‘fine’ (TAX) for not buying health insurance.

B.) The health insurance “exchanges”.

C.) The federally mandated policy design changes forced upon every health insurer i.e. the ‘Ten Essential Benefits‘ including maternity, 63 ‘free’ preventive care tests and exams, abortifacient drugs etc.

As I have proven before, the vast majority of health insurance plans that existed before the PPACA – that were subsequently canceled because of the PPACA – contained most of the PPACA required “Ten Essential Benefits” already. As such, they did not need to be canceled in order to provide adequate coverage.

D.) The onerous MLR – Medical Loss Ratio – requirements that have forced 13 health insurance carriers out of the market.

E.) The ‘Failure To Launch’ clause a.k.a. ‘keeping your child on you plan until age 26‘ whether they are married, unmarried, attending college or dependent on their parents financially.

Most states required carriers to keep your child on your plan until age 25 or longer,long before Obamacare. Contrary to popular belief, many states did not require these young adults to be attending college. However,  unlike the PPACA requirement, you had to be single (unmarried).

F.) Eliminates annual and lifetime maximums of coverage.

Annual coverage maximums should continue to be barred as well as lifetime caps. Lifetime caps are so rarely exceeded that this is nearly a moot point. Annual maximums should never have been allowed in the first place.

G.) The prohibition on preexisting conditions in the individual health insurance marketplace.

Cruz relies upon existing protections outlined in section 2741 and 2744 of 1996 HIPPA law for those with preexisting conditions in the individual market who are HIPAA qualified. This means that they have maintained existing coverage for at least 18 months with no lapse in coverage of more than 63 days. These insured members would have guaranteed access to coverage for preexisting conditions in the individual market via:

A). A state high risk health insurance pool – which existed in 35 states long before the PPACA
B.) A guarantee issue individual mandate – which existed in 10 states long before the PPACA
C.) A state mandated replacement policy – which is required to be offered in the states that did not have one of the two aforementioned options under section 2744 of HIPAA.

All of these existing protections against preexisting condition clauses were in existence for years before the PPACA. As I have proven before the Democrat’s argument pertaining to preexisting conditions has been inaccurate, disingenuous and in the case of President Obama a proven and repetitive lie.

H.) The Advance Premium Tax Credits and Cost Sharing Reduction federal subsidies allotted to those who fall below certain income levels and purchase their coverage “on the exchange” via

Other Republican proposals such as Avik Roy’s “Transcending Obamacare” plan suggest keeping the exchanges and lowering the eligibility to receive the aforementioned federal subsidies from 400% above FPL to 317% above FPL. Still other plans such as the “Patient Care Act” proposed by Senator Burr, Hatch and Upton would replace the PPACA with a means-tested tax credit that individuals could use to buy a far broader range of insurance products, or deposit the funds in a health savings account. Other Republicans have proposed keeping PPACA subsidies in place for a ‘transitional period’ should the rule of law prevail in the pending King v. Burwell case, currently being heard by the U.S. Supreme Court.

2.) Cruz’s plan also provides a viable and well regulated solution to selling health insurance across states lines.

Whilst Cruz’s plan is a very good start to providing real alternative reforms of the individual health insurance market. It does not attack the primary drivers of cost. Namely, cost shifting from preexisting federal health care programs like Medicare and Medicaid and the prohibition of competing hospitals and surgical centers promulgated for far too many years by the Federal Trade Commission. It also does not address the massive and fiscally unsustainable expansion of Medicaid under the PPACA nor does it provide a plan for the preservation of Medicare. All of those issues and more are addressed in Avik Roy’s “Transcending Obamacare“. To be fair, Senator Cruz plans on revealing a far more comprehensive plan in the coming months. I am waiting to read it with great anticipation.

One thing remains true, unlike the lies from our ‘friends on the Left’. Republicans have no shortage of Obamacare replacement plans. More than 25 have been proposed. What we do need to do is coalesce around one of them and promote it nationally and consistently starting yesterday.


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There are 46 days left in 2015 to get health insurance that covers preexisting conditions without a Qualifying Life Event.

If you need health insurance that covers preexisting conditions, you have until Sunday February 22, 2015 at 11:59 p.m. to apply for health insurance with Blue Cross Blue Shield on or off the exchange (Healthcare gov). After that, you will be unable to purchase health insurance again unless you have filed your 2014 taxes and can prove that you are subject to the tax for not buying health insurance. In this case, you will have a 45 day window from March 15, 2015 to April 30, 2015 to get health insurance again. After that, you can not get health insurance that covers preexisting conditions again until 2016 without experiencing a ‘Qualifying Life Event‘. If you miss these Special Enrollment dates and do not experience a Qualifying Life Event you can purchase non renewable Short-Term or Temporary health insurance that does not cover preexisting conditions any time throughout the year. Visit for expert guidance.

Portrait of beautiful middle aged woman


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Obamacare subsidy repayment amounts are capped based on your income level.

If you have received a notice from the IRS stating that you estimated your income level incorrectly last year and as such received an Advance Premium Tax Credit (subsidy) that was incorrect. The chances are very good that you won’t have to pay back the full amount. In fact, only those with income levels above 400% of FPL – Federal Poverty Level – will have to pay back the full amount. For the rest of us, the repayment amount is capped based on our income level.

Below is a chart that states the maximum amount you will have to pay back to the IRS regardless of how large of a subsidy that you took incorrectly. How much will this ‘subsidy forgiveness’ cost taxpayers? That number has yet to be determined.

subsidy repayment caps

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Filed under Uncategorized 2014 Year In Review

The stats helper monkeys prepared a 2014 annual report for this blog.

Here’s an excerpt:

The Louvre Museum has 8.5 million visitors per year. This blog was viewed about 95,000 times in 2014. If it were an exhibit at the Louvre Museum, it would take about 4 days for that many people to see it.

Click here to see the complete report.

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Humana Aetna and BCBSTX are canceling plans but this year it’s MUCH different.

On October 2nd President Obama touted an “improved, strong U.S. economy” and the “benefits of Obamacare” at Northwestern University. It all sounded great but this is what I’ve been dealing with today. I’m fielding angry calls from my HumanaOne, Aetna and Blue Cross Blue Shield of Texas clients. All of their policies will be canceled  as of December 31, 2014. See the letters here and here. Cigna is also terminating their pre-2014 plans. This is the second year I’ve had to deal with this but this year it’s much different.

Last year when more than 4 million cancellation notices went out, Americans were able to shop for prices as early as October 1st, granted the initial roll out left much to be desired. In fact, in my opinion it was an unmitigated disaster. Many of my clients spent hours on the phone with ‘navigators’ only to find out that their application had then mysteriously disappeared.

Worse yet, because our state’s “C.H.I.P” program was expanded long before Obamacare. The few members of my clientele who actually qualified for an APTC – “Advance Premium Tax Credit”  a.k.a. “subsidy” to artificially lower their premiums were unable to add their children to their subsidized policies. They were instead instructed to enroll their children in Medicaid. Or, they could pay full price for each of their children. The rates for a single child in my state are at least $100 a month for the cheapest “Bronze” plan which includes a $6,000 deductible per person. That’s not exactly ‘affordable care’ when you have three children.

This year, for the first time in 20 years I can not even quote a replacement product because Barack Obama has issued a GAG ORDER to the health insurance industry instructing them not to disclose their January 2015 health insurance rates until after the mid-term elections. This is unprecedented. Normally health insurance premiums are released for public viewing 60 days before the January 1st effective date. Where are the reports on these cancellations and the gag order from NBC, ABC, CBS and CNN? The only news organization that I am aware of that has reported on any of this is the Fox News channel. I can guarantee you one thing, not one of my clients who received a cancellation notice is voting Democrat on Tuesday.

Republicans have outstanding alternatives to this disastrous health care law. The two most recent are the American Health Care Reform Act and the Universal Exchange Plan. Please read them, for it will be up to us to forge a new path forward for the American people and time is of the essence. The insurance company bail outs are temporary and they will expire in 2016. Without a bailout the health insurance industry will pull out of the individual and family health insurance market. Before that happens we need to be able to articulate intelligent, market based alternatives. It’s up to us.

11/4/2014 UPDATE Yesterday, “Snopes” the ‘fact check’ site stated that the actual term ‘Gag Order’ was not used in the original Wall Street Journal article which I link to above. Whilst that is true, Snopes does not disagree with the fact that 2015 health insurance premiums and plans are not available for viewing until after the election. Since the term ‘Gag Order’ was not used in that WSJ post “Snopes” lists my post as ‘false’. Anyone who has access to the internet can visit my health insurance brokerage site  and then click on the orange ‘Start Shopping Now” button. Then attempt to get a quote for January 1, 2015. You will not be able to. That is the point of this entire piece. Not the fact that the actual term “Gag Order” was not used but the fact that you can not quote premiums for January 1, 2015 and this is what is unprecedented.  That is the point. Certainly the good folks at ‘Snopes’ are intelligent enough to figure that out. Maybe they should take a lesson from USA Today who figured out the point and used the term “Gag Rule” last month. Does the fact that USA Today used the term “Gag Rule” render their entire piece ‘false’? No one with a working cerebral cortex would believe such nonsense.


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