Governing Majorities and Health Reform: Part One

Republicans are struggling with the repeal and replacement of Obamacare.

They should be.

Health is a matter of life and death. People pay very personal attention to it. In the end, regular people skip past the macro policies that shape the nation and ask, “what about me?”

In our immediate network of family and friends, Callista and I know an older woman with a history of breast cancer who has had both hips replaced, a middle-aged woman taking anti-rejection medicine for a recent liver transplant, a young woman (30) diagnosed with breast cancer, a dear friend suffering from a rare disease in which his red blood cells no longer carry oxygen, and the list goes on.

In every case, the individuals and their family and friends will ask: How does this health care bill affect me? Will I be better or worse off? Their natural bias is against change, because they have adjusted to the current system and know how they are getting care today.

Everyone who gets money from health care, and everyone who pays money for health care, has a direct, immediate personal interest in how their lives will be affected.

I am not arguing against repealing and replacing Obamacare. It is a failing system that will ultimately cripple the country and leave millions without insurance coverage. I am suggesting that its replacement must be carefully thought out. Every House and Senate Republican who deals with this issue, along with the leaders in the Executive Branch, will be asked a lot more questions about this bill than they would about other legislation. They must be able to answer those questions.

Health care is almost one-fifth of the national economy. That means nearly one dollar out of every five in the entire system is affected by health reform. Everyone who gets money from health care, and everyone who pays money for health care, has a direct, immediate personal interest in how their lives will be affected.

Speaker Paul Ryan was exactly right shortly after the House Republicans had to pull the health bill from the floor when he said, “What you’re seeing is we’re going through the inevitable growing pains from being an opposition party to becoming a governing party.” He noted then that 64 percent of House Republicans have never worked with a Republican in the White House and majorities in both houses of Congress.

As Speaker Ryan concluded “It’s a new system for people.”

The same is true for President Trump and his White House team. No one on the team has ever shepherded a major reform through the Congress.

In every case, the individuals and their family and friends will ask: How does this health care bill affect me? Will I be better or worse off?

But House Republicans and the president can – and will – learn quickly. We can achieve a dramatically better health system.

We can pass very effective and ultimately very popular bills on health and health care.

Over the next several newsletters, I am going to outline the principles of “becoming a governing party,” recognizing that it is a new system for the GOP team, and the principles of successful health reform.

Principle No. 1: A governing majority system always pays attention to the wishes of the American people, because that is what makes it a majority.

Minority parties develop the attitude that they are never going to be a majority anyway, so they might as well do what they want even if it infuriates the public. I fought with this mentality for 16 years in a House GOP that had been in the minority since 1954.

Ironically, the very nature of President Reagan (who had been a Democrat for most of his life and automatically thought about governing rather than opposing) made the House Republicans work as part of a governing majority from 1981-1988. As a second term member when Reagan came into office, I imbibed the spirit of governing from him. It was reinforced by studying Prime Minister Thatcher, who thought of herself as the leader of the next government – not the leader of the opposition.

My next newsletter will be about the health reform that the vast majority of Americans want. That is the starting point for a governing majority that wants to continue to govern.

FollowNewt Gingrich

Former Speaker of the U.S. House of Representatives


Innovator’s wellness app aims to improve employee nutrition

Jason Langheier, a physician, knew that poor diet was a major problem in the U.S. But he also knew employers could be — and should be — be part of the solution.

“I’ve seen firsthand the immense impact that diet has on overall health — both when I launched the pediatric weight management clinic at Boston Medical Center and in my own family, as multiple family members have struggled with obesity,” Langheier says. “Employers have both the opportunity, as health plan providers and locations where many food choices are made, and the motive — lowering health costs — to take on poor nutrition in the U.S.”


That’s why he created Zipongo in 2011. Through technology, the app aims to reshape the food landscape for employees and health-plan members by presenting the healthiest options via mobile device, whether users are grocery shopping, eating in their workplace cafeteria or out at a restaurant. At home, Zipongo offers healthy recipes customized to the user’s biometric data, food allergies and preferences.

“Health costs and rates of obesity and diabetes will rise if we do not make significant progress in changing Americans’ eating habits,” says Langheier, who for his efforts has earned an EBN Benefits Technology Innovator Award, which recognizes individuals leading the digital transformation of the industry. “And since employers shoulder more than half of all U.S. health costs, the time is now to intervene for better health among [employees].”

Jason Langheier

(Jason Langheier)

Zipongo’s solutions are currently in use at more than 150 companies, including Google and IBM. The company offers food benefits management services as a new employee benefit, similar to pharmacy benefit management. The program includes digital nutrition coaching, diabetes management and a “step therapy” approach to prescribe healthy food as a first-line therapy before prescribing pharmaceutical drugs where medically appropriate.

Technology, Langheier says, is the smart way to help employees make behavioral changes.

“Traditional approaches to healthy eating — such as nutrition and behavioral counseling visits, traditional food tracking, dieting, walking programs and incentives — are either too costly or ineffective,” he says. “Technology allows workers to take a dietitian with them wherever they go. It also gives employers options to personalize solutions to individual workers.”

Additionally, he says, for many employees whose problems aren’t acute enough to justify expensive personal counseling, or who prefer technology-driven solutions, they “may actually see better outcomes with the support of a highly personalized app.”

  • April 18 2017, 8:47pm EDT

Trump Warms ACA Marketplaces Will Collapse Without Federal Funding

The Wall Street Journal  (4/23, Hackman, Subscription Publication) reports that on Sunday, President Trump warned in several tweets that the Affordable Care Act’s marketplaces will collapse if the federal government refuses to continue making subsidy payments to insurers, and urged Democrats to support funding to build the wall along the border with Mexico in exchange for preserving the subsidies.

The Los Angeles Times  (4/23, King) reports that despite the “collapse” of the American Health Care Act, Trump “has said he wants a House vote in the coming week.” On Sunday, he “sought…to put pressure on the Democrats by renewing a threat to withhold funding for insurance subsidies.”

Reuters  (4/23, Chiacu) reports that Trump tweeted that the ACA “is in serious trouble. The Dems need big money to keep it going – otherwise it dies far sooner than anyone would have thought.”

The Hill  (4/23, Beavers) reports that Trump’s comments were made “just days before the Democrats and Republicans must agree on a federal budget or face a government shutdown.” The article says each party is pushing its own priorities: the White House wants funding “to build a wall along the Mexican border and enhance border security, while Democrats hope to make more inroads in healthcare coverage.”

State Policies Have Influenced The Health Of ACA Marketplaces. The New York Times  (4/21, Goodnough, Abelson, Subscription Publication) reported that only one insurer still sells Affordable Care Act plans in Oklahoma, which provides support for President Trump’s claim that ACA marketplaces are “imploding.” But, in New Mexico, which also has GOP leadership, the ACA “marketplace is in far better shape,” consumers “can still choose among four insurers, and the state has one of the lowest average premium costs.” The article added that almost “four years after they opened, the Affordable Care Act’s health insurance marketplaces, also known as exchanges, are not uniformly failing, as Mr. Trump likes to claim.” However, “they have risen or fallen in no small part because of political and policy decisions by each state.”

Here’s the six-figure mistake millennial parents are making

  • Seven out of 10 millennial parents have less than $250,000 in life insurance.
  • Child care costs can run upward of $10,000 a year.
  • One rule of thumb: Your coverage should be 10 times your salary.

Thursday, 20 Apr 2017 | 8:30 AM ET

For millennials having children, here’s another worry they can add to the list: They are underinsured.

A recent survey from Haven Life Insurance Agency showed that seven out of 10 of these parents have less than $250,000 in life insurance.

Personal finance

Image Source | Getty Images

In March, the firm took an online poll of 500 adults with children ages 5 years and under.

By contrast, these millennial parents report spending approximately $10,000 a year on child care expenses — which accounts for about 12 percent of income, according to the study.

They’re also devoting more than 30 percent of their income to housing costs.

“There’s a lack of education about life insurance,” said Yaron Ben-Zvi, co-founder and CEO of Haven Life.

“People often assume they have adequate coverage through their employer, but it’s inadequate in terms of the amount and you can’t take it with you if you leave the job,” he said.

Here’s how to figure out whether you have enough to insure your young family.

Income protection

“The most common mistake I see is when people assume that the policy at work is sufficient,” said Matt Cosgriff, a certified financial planner at BerganKDV in Minneapolis. “They’re often two times your income.”

That’s far less than what’s needed: Generally it should be an amount that’s equal to 10 times your income, he said.

Exactly how much coverage you require will depend on whether you and your spouse work, whether your income is fixed or variable, and how much you and your spouse earn.

“Factor in your income, paying off your debts, monthly living expenses and big-picture goals,” Cosgriff said.

You should also account for debts, including your mortgage and student loans.

Last year 42.4 million Americans owed $1.3 trillion in federal student loans. The good thing about these debts is that they can be discharged at death.

This isn’t necessarily the case for private student loans or loans on which you have a cosigner. In this case, creditors can chase your survivors for the balance due.

“Your estate will still owe on private student loans, so when you look at how much life insurance you need, consider your private student loans,” said Rianka R. Dorsainvil, a certified financial planner and founder of Your Greatest Contribution in Capitol Heights, Maryland.

Children in the picture

Insurable needs go up once children are in the picture. Consider how much it costs to place an infant and a 4-year-old in day care.

010k20k30k40k50kChildren of the coinAverage annual cost of child care in a center (infant anda 4-year-old)+-Source: Child Care Aware of America | Graphic by Nick Wells © Natural Earth


Cost: $14,448
Rank: 43

As you figure out how much coverage you need, you may also want to project the cost of a four-year college education.

“Often people want to make sure that if they were to die that they have enough money for the kids to go to school and that at least some of it is paid for,” said Ben-Zvi of Haven Life.

Comparing policies

When it comes to replacing income, financial planners favor term life coverage — that is, insurance that’s in place for 20 or 30 years. That time period is just long enough to raise a child into adulthood or to pay off your mortgage.

A healthy 35-year-old woman can secure $500,000 of coverage for 20 years for less than $20 a month.

So-called permanent life insurance, which tends to be more costly, may be better suited for advanced planning strategies, such as estate or business succession planning.

As you compare term policies, you’ll want to consider the insurance company’s financial ratings — a measure of its financial strength — and the monthly premiums.

“Term insurance is somewhat a commodity and very much undifferentiated, so the price is the primary focal point,” Cosgriff said.

White House Pushing for Revised Version of ACA Repeal Legislation by Next Week

The New York Times  (4/20, A1, Flegenheimer, Abelson, Subscription Publication) reports on its front page that White House officials who are “desperate to demonstrate progress on President Trump’s promise to repeal the Affordable Care Act are pushing to resurrect a revamped version of a Republican health care bill before his 100th day in office next week.” The article says some of the President’s aides “have grown consumed by the marker, worrying that public appraisals at this traditional evaluation period will be brutal and hoping that a last push might bring a measure of salvation.” The piece adds that the White House and GOP leaders “have been searching for a health care compromise that could placate enough moderates and hard-line conservatives to win passage in the House.”

Similarly, the Washington Post  (4/20, Cunningham) reports that congressional GOP lawmakers are “under heavy pressure from the White House,” and while they “are inching closer to passing a bill to repeal and replace parts of the Affordable Care Act…possible revisions released Thursday may not clinch a deal.” The White House is hoping to determine the level of support for the revised plan by Saturday, and expects a possible vote on the matter by Wednesday. Yet, House Republicans remain uncertain if “changes to the GOP health-care measure proposed by moderate Rep. Tom MacArthur (R-N.J.) would win over enough conservative and moderate holdouts, who have butted heads over removing some of the Affordable Care Act’s key insurance regulations.”

The Wall Street Journal  (4/20, Ballhaus, Subscription Publication) reports Trump said he would like to see an ACA repeal bill passed, and also prevent the government from shutting down, although he would not say which goal was more important.

Health Care Reform Updates

New Individual Marketplace Open Enrollment Period Dates Announced

The U.S. Department of Health and Human Services (HHS) has issued a final rule which, among other things, amends the timing of the annual Health Insurance Marketplace (“Marketplace”) open enrollment period for the 2018 plan year and modifies the rules for Marketplace special enrollment periods.

New Individual Marketplace Open Enrollment Period
The final rule changes the dates for open enrollment in the individual Marketplace for the 2018 plan year to November 1, 2017 through December 15, 2017 (consistent with the open enrollment period dates previously established for plan years starting in 2019 and beyond). The previously established open enrollment period for the 2018 plan year was scheduled to run from November 1, 2017 through January 31, 2018. Accordingly, this change will require individuals to enroll in coverage prior to the beginning of the year, unless they are eligible for a special enrollment period.

Modifications to Individual Marketplace Special Enrollment Periods
The final rule also makes the following modifications to Marketplace special enrollment period rules:

  • Starting in June 2017, HHS will conduct pre-enrollment verification of eligibility for Marketplace coverage for all categories of special enrollment periods for all new consumers in all states served by the platform.
  • The ability of existing Marketplace enrollees to change plan metal levels during the coverage year will be limited.
  • Issuers will be permitted to deny Marketplace special enrollment due to loss of minimum essential coverage where the issuer has a record of termination due to non-payment of premiums by the individual, unless obligations for premiums due for previous coverage are fulfilled.