Embattled Health and Human Services Secretary Kathleen Sebelius is resigning, ending a five-year tenure marred by the plagued rollout of Obamacare,the New York Times reports.
President Obama accepted her resignation this week and will nominate Sylvia Mathews Burwell, the director of the Office of Management and Budget, to take her place:
The departure comes as the Obama administration tries to move beyond its early stumbles in carrying out the law, persuade a still-skeptical public of its lasting benefits, and help Democratic incumbents, who face blistering attack ads after supporting the legislation, survive the midterm elections this fall.
Officials said Ms. Sebelius, 65, made the decision to resign and was not forced out. But the frustration at the White House over her performance had become increasingly clear, as administration aides worried that the crippling problems at HealthCare.gov, the website set up to enroll Americans in insurance exchanges, would result in lasting damage to the president’s legacy.
Even last week, as Mr. Obama triumphantly announced that enrollments in the exchanges had exceeded seven million, she did not appear next to him for the news conference in the Rose Garden.
The president is hoping that Ms. Burwell, 48, a Harvard- and Oxford-educated West Virginia native with a background in economic policy, will bring an intense focus and management acumen to the department. The budget office, which she has overseen since April of last year, is deeply involved in developing and carrying out health care policy.
“The president wants to make sure we have a proven manager and relentless implementer in the job over there, which is why he is going to nominate Sylvia,” said Denis R. McDonough, the White House chief of staff.
DC: “Outgoing Health and Human Services Sec. Kathleen Sebelius is now refusing to testify before the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, a Senate aide told The Daily Caller Tuesday. Sebelius had originally been set to testify before the subcommittee about the department’s 2015 $70 billion budget request on April 2. … Now, after announcing her resignation on April 11, she is refusing to testify according to the two aides, even though she is still the sitting secretary — remaining at the post until her successor, OMB Director Sylvia Mathews Burwell is confirmed.”
Sit down, shut up, and take what we give you. That seems to be the attitude of Marcus Merz, CEO of Minnesota insurer PreferredOne. The Obamacare insurer told the New York Times. Daily Caller:
“We have to break people away from the choice habit that everyone has,” Marcus Merz, CEO of Minnesota insurer PreferredOne, told The New York Times Tuesday. “We’re all trying to break away from this fixation on open access and broad networks.”
Imagine having a "fixation" on freedom. Perish the thought!
It's very simple; when you limit choices, you limit freedom.
With boatloads of mandatory services provided each and every customer whether they’re wanted or not, health insurers’ costs are going up. If insurance companies are going to keep prices at a manageable level, narrow networks are one of their only options. So far under the health care law, networks are narrowing while premiums are going up.
While insurance companies are trying to acclimate their customers to narrow networks, the limited choices were clearly not part of the promise President Barack Obama made when selling his health care law.
“It you like your doctor, you will be able to keep your doctor. Period,” Obama promised in 2009 in front of the American Medical Association. “If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away.”
Both of those promises have turned out to be false. Keeping your health care plan went out the window long ago — and now health insurance companies are defending their narrowed networks, which exclude many doctors and providers that customers prefer.
Narrow networks have essentially made one selling point of the law obsolete. Obamacare supporters constantly warned that health insurance is necessary for everyone because people may get cancer unexpectedly and not be able to get coverage afterward.
But cancer centers, with their top-of-the-line physicians and expensive procedures, have been a primary casualty of narrow networks. According to an Associated Press analysis, just four of the 19 top comprehensive cancer centers are covered by all Obamacare exchange plans in their states.
The networks are bound to narrow further as Obamacare reimbursement of doctors and hospitals continues to be cut in order to save money. Fewer physciains will be willing to treat Obamacare patients, putting pressure on premium prices.
Eventually, states like California may actually pass laws forcing physicians to enter the network. Coercion seems to be the only way to break consumers and doctors from this terrible habit of wanting "choice" in their healthcare - a long way from the empty promises and lies told to pass the law in the first place.
Review Journal: “The Las Vegas woman died Monday, less than two weeks after her family went public with details of how enrollment trouble through the Nevada Health Link insurance exchange kept her from getting treatment in January for an aggressive brain tumor. Rolain was one of about 150 Nevadans suing Nevada Health Link contractor Xerox for enrollment mixups that left them without the health insurance they paid for?”
“Rolain is the first to die of complications from an illness that her family said went untreated for lack of coverage. But observers close to her case say she may not be the last, because others are in similarly urgent situations.”
Why couldn’t this have been resolved prior to the death? More will die. Remember that government has already taken executive action to ensure women working for religious non-profits receive their contraceptives but not the private companies.
No one will get fired, arrested, jailed or even talked to twice. GRRRRRRRR
Forgotten vials of smallpox found in storage room
MIKE STOBBE, The Associated Press
FILE - This 1975 file electronmicrograph from the Centers for Disease Control shows the smallpox virus. Government officials say workers cleaning a storage room at the National Institute of Health's campus in Maryland made a startling discovery last week _ decades-old vials of smallpox forgotten in a cardboard box. (AP Photo/CDC, File)
ATLANTA (AP) — A government scientist cleaning out an old storage room at a research center near Washington made a startling discovery last week — decades-old vials of smallpox packed away and forgotten in a cardboard box.
The six glass vials were intact and sealed, and scientists have yet to establish whether the virus is dead or alive, the Centers for Disease Control and Prevention said Tuesday.
Still, the find was disturbing because for decades after smallpox was declared eradicated in 1980, world health authorities said the only known samples left were safely stored in super-secure laboratories in Atlanta and in Russia.
Officials said this is the first time in the U.S. that unaccounted-for smallpox has been discovered. At least one leading scientist raised the possibility that there are more such vials out there around the world.
The CDC and the FBI are investigating.
It was the second recent incident in which a U.S. government health agency appeared to have mishandled a highly dangerous germ. Last month, scores of CDC employees in Atlanta were feared exposed to anthrax because of a laboratory safety lapse. The CDC began giving them antibiotics as a precaution.
The freeze-dried smallpox samples were found in a building at the National Institutes of Health in Bethesda, Maryland, that has been used by the Food and Drug Administration since 1972, according to the CDC.
The scientist was cleaning out a cold room between two laboratories on July 1 when he made the discovery, FDA officials said.
Officials said labeling indicated the smallpox had been put in the vials in the 1950s. But they said it's not clear how long the vials had been in the building, which did not open until the 1960s.
No one has been infected, and no smallpox contamination was found in the building.
Smallpox can be deadly even after it is freeze-dried, but the virus usually has to be kept cold to remain alive and dangerous.
In an interview Tuesday, a CDC official said he believed the vials were stored for many years at room temperature, which would suggest the samples are dead. But FDA officials said later in the day that the smallpox was in cold storage for decades.
"We don't yet know if it's live and infectious," said Stephan Monroe, deputy director of the CDC center that handles highly dangerous infectious agents.
The samples were rushed under FBI protection to the CDC in Atlanta for testing, which could take a few weeks. After that, they will be destroyed.
Peter Marks, deputy director of the FDA's Center for Biologics Research and Evaluation, said the discovery was unexpected but not a total shock. He added, however, that "no one's denying we should have done a better job cleaning out what was there."
In at least one other such episode, vials of smallpox were found at the bottom of a freezer in an Eastern European country in the 1990s, according to Dr. David Heymann, a former World Health Organization official who is now a professor at the London School of Hygiene and Tropical Medicine.
Heymann said that when smallpox samples were gathered up for destruction decades ago, requests went out to ministers of health to collect all vials.
"As far as I know, there was never a confirmation they had checked in with all groups who could have had the virus," he said.
Dr. Donald "D.A." Henderson, who led the WHO smallpox-eradication effort and is now a professor at the Center for Health Security at the University of Pittsburgh, said it is highly unlikely more such stashes will be discovered. But he conceded "things were pretty casual" in the 1950s.
Decades ago, he recalled, "I came back from many a trip carrying specimens, and I just put them in the refrigerator until I could get them to a laboratory. My wife didn't appreciate that."
Smallpox was one of the most lethal diseases in history. For centuries, it killed about one-third of the people it infected, and left most survivors with deep scars on their faces from the pus-filled lesions.
The last known case was in Britain in 1978, when a university photographer who worked above a lab handling smallpox died after being accidentally exposed to it through the ventilation system.
Global vaccination campaigns finally brought smallpox under control. After it was declared eradicated, all known remaining samples of live virus were stored at a CDC lab in Atlanta and at a Russian lab in Novosibirsk, Siberia.
The labs take extreme precautions. Scientists must undergo fingerprint or retinal scans to get inside, they wear full-body suits including gloves and goggles, and they shower with strong disinfectant before leaving the labs.
There has long been debate over whether to destroy the stockpile.
Many scientists argue that any remaining samples pose a threat and that the deadly virus should be wiped off the planet altogether. Others contend the samples are needed for research on better treatments and vaccines.
At its recent annual meeting in May, WHO put off a decision again.
___
AP Medical Writers Maria Cheng in London and Marilynn Marchione in Milwaukee contributed to this report.
July 22nd, 2014, 14:44
American Patriot
Re: Mandating health Insurance - Obamacare
It appears, from what I am hearing, Obamacare is being gutted today. Has to do with the "heart of Obamacare" - but not sure I'm grasping the whole thing yet.
July 22nd, 2014, 16:43
American Patriot
Re: Mandating health Insurance - Obamacare
details
Appeals Courts Issue Conflicting Rulings on Health-Law Subsidies
Subsidies Seen as Crucial to Implementation of Affordable Care Act
By Brent Kendall And
Stephanie Armour
Updated July 22, 2014 12:33 p.m. ET http://si.wsj.net/public/resources/i...0722105448.jpg
President Barack Obama is applauded on March 23, 2010 after signing the Affordable Care Act into law. A federal appeals court on Tuesday rejected some subsidies to consumers who buy health coverage on federally-run health insurance exchanges. Charles Dharapak/AP
*Second Appeals Court Rules On Health Law Insurance Subsidies, Sides With Obama Administration
*Fourth Circuit Ruling Conflicts With Other Court Decision Issued Tuesday
*Appeals Courts Based in D.C. and Richmond, Va. Release Decisions on Subsidies Tuesday
(More to Come.)
WASHINGTON—A federal appeals court on Tuesday struck down the subsidies available to consumers in states where health coverage is purchased on insurance exchanges established by the federal government, in a substantial blow to the Obama administration's implementation of its signature health-care law.
The U.S. Court of Appeals for the District of Columbia Circuit, on a 2-1 vote, invalidated an Internal Revenue Service regulation that implemented a key piece of the 2010 Affordable Care Act. The regulation said subsidies for health insurance were available to qualifying middle- and low-income consumers whether they bought coverage on a state exchange or one run by the federal government.
The ruling potentially could cripple the law by making subsidies unavailable in as many as 36 states where the federal government has run some or all of the insurance exchanges. http://si.wsj.net/public/resources/i...0722112818.jpg
The Obama administration quickly announced it would appeal the decision, calling it "incorrect." The administration also said people would continue to receive the subsidies during the appeal.
"We are confident in the legal basis that supports our case," White House press secretary Josh Earnest said, noting the Justice Department is expected to ask the full appeals court to reconsider the case. "It is pretty obvious what the congressional intent was."
The appeals court sided with challengers, four individuals and three employers, who argued the health law allowed subsidies only for insurance purchases made through state exchanges. The issue became an important one after the law was enacted because more than two-thirds of the states chose not to set up their own exchanges, relying on federally-run exchanges instead.
The appeals court's opinion, by Judge Thomas Griffith, a George W. Bush appointee, acknowledged that the decision has "major consequences," but the court said the IRS rule wasn't a permissible interpretation of the health law. Both judges in the majority were appointed by Republican presidents.
"Federal bureaucrats can't override the clear language of the statute," said Michael Carvin, the lead attorney for the challengers. "We're confident any court will agree with the careful and thoughtful opinion of Judge Griffith."
Judge Harry Edwards, a Jimmy Carter appointee, said in dissent that the ruling "portends disastrous consequences."
The law requires most Americans to carry health insurance or pay a tax penalty. The subsidies were designed to work in tandem with the insurance mandate to make coverage more affordable for lower-income individuals.
More than 5 million Americans have selected a private plan through federal health exchanges and the majority received financial assistance, according to a June report by the Department of Health and Human Services. They pay an average of $82 a month in premiums, 76% less than the full premium.
Tuesday's ruling also could hobble the functioning of a health-law provision that can require larger employers to pay penalties if they don't offer affordable health coverage to full-time workers. They penalties are triggered when a worker receives federal subsidies for purchasing insurance on an exchange.
Insurers had warned a win for the challengers could destabilize insurance markets and lead to far higher premiums, even for those that didn't receive subsidies.
The administration has further legal options, including a possible appeal to the Supreme Court. But first it plans to ask the appeals court to rehear the case, with all active judges participating in the review, administration officials said. The full appeals court isn't seen as conservative as it once was, thanks to the arrival of several new judges appointed by President Barack Obama.
"We believe that this decision is incorrect, inconsistent with congressional intent, different from previous rulings, and at odds with the goal of the law,'' Justice Department spokeswoman Emily Pierce said. "In the meantime, to be clear, people getting premium tax credits should know that nothing has changed, tax credits remain available.''
The decision overturned a trial judge's ruling from January that upheld the subsidies.
July 22nd, 2014, 17:35
American Patriot
Re: Mandating health Insurance - Obamacare
ObamaCare in death spiral after federal appeals court strikes down some subsidies
Facebook0 Twitter0 livefyre14
Tuesday, a federal appeals court slapped down the Obama administration in a 2-1 ruling that could kill the president’s signature health care law. If upheld by the Supreme Court, the ruling would force Congress back to the drawing boards to design a health law that is actually affordable, rather than bearing the false title “Affordable Care Act.”
The ruling in Halbig v. Burwell bars the federal government from handing out taxpayer-funded subsidies to people who buy ObamaCare plans in nearly two-thirds of the states. Those subsidies took the sting out of being forced to buy pricey ObamaCare plans. If the ruling sticks, buyers in those states will have to pay full price, on average a whopping four times the subsidized price they paid this year.
Quadrupling the price would likely trigger a mass exodus out of the plans,causing what the insurance industry calls a “death spiral.”
The ruling by the influential appeals court for the District of Columbia also chastised the Obama administration for rewriting the law to suit its own ends.
Halbig is the latest in a series of warnings from federal judges that in America, the rule of law is king, not Mr. Obama.
Judge Thomas B. Griffith, writing for the majority, declared: "The Constitution assigns the legislative power to Congress, and to Congress alone."
No more governing by fiat, Mr. President.
The businesses and individuals who sued in Halbig argued that the actual wording of the Affordable Care Act allows the IRS to provide subsidies (via a tax credit) only to buyers in states that established state exchanges. Section 1401 of that law unambiguously states that subsidies will be made available “through an exchange established by the state.”
The subsidies were intended as a carrot to persuade states to establish exchanges. But surprise, only 14 states went along. The others, mostly led by Republican governors, refused.
Late in the game, the Obama administration had to establish the federal healthcare.gov exchange to get ObamaCare launched in those uncooperative states.
In 2012, the Congressional Research Service cautioned that the text of the law indicated “the IRS’s authority to issue the premium tax credits is limited only to situations in which the taxpayer is enrolled in a state established Exchange.”
Yet when the Obama administration launched the federal healthcare.gov exchange last fall, IRS officials dispensed tax credit subsidies in all fifty states, despite being warned they were violating the law.
Lawyers for the administration told the appeals court judges that regardless of what section 1401 says, Congress envisioned offering subsidies to buyers nationwide. The Court didn’t buy it.
"The fact is that the legislative record provides little indication one way or other of congressional intent," wrote Judge Griffith.
No wonder. ObamaCare was crammed through the Senate on Christmas Eve, 2009, before lawmakers had read it, much less debated it.
What is clear is that without subsidies, the Affordable Care Act is just the opposite -- hugely unaffordable. According to the Department of Health and Human Services, 87% of people who signed up for ObamaCarefor 2014 qualified for subsidies, and on average they paid 76% less than the true cost of their plan. $82 a month instead of $376 a month. That $82 price tag didn’t mean ObamaCare had succeeded in lowering health insurance costs. It just shifted the cost from premium payers to taxpayers.
The Court ruled "with reluctance," Judge Griffith said "At least until states that wish to can set up Exchanges, our ruling will likely have significant consequences both for the millions of individuals receiving tax credits through federal Exchanges and for health insurance markets more broadly. But, high as those stakes are, the principle of legislative supremacy that guides us is higher still."
The judges made it clear that either Congress must act to change the law (highly unlikely) or states must establish their own exchanges (also unlikely), or ObamaCare will collapse due to its unaffordable premiums.
Yesterday’s ruling put ObamaCare in legal limbo. Expect the administration to request an en banc hearing before the entire 11-judge appeals court, which is weighted in their favor with seven Democratic appointees. En banc hearings are not always granted even on issues as monumental as this. Either way, this controversy is headed to the U.S. Supreme Court. Three other federal appeals courts are deciding challenges almost identical to Halbig. A disagreement among any of them will force the high court to rule.
Judges don’t like to be overruled. Twice in recent months the Supreme Court has emphatically declared that the executive branch of government must execute the laws, not rewrite them. Down the street at the DC Court of Appeals, the judges were listening.
July 22nd, 2014, 17:39
American Patriot
Re: Mandating health Insurance - Obamacare
Two different courts came up with two different decisions on the same thing.
NOW, this is absolute PROOF that America is FUBAR
July 22nd, 2014, 17:41
American Patriot
Re: Mandating health Insurance - Obamacare
Federal court invalidates some ObamaCare subsidies, separate ruling preserves them
WASHINGTON – A federal appeals court dealt a major blow to ObamaCare on Tuesday, ruling against the legality of some subsidies issued to people through the Affordable Care Act exchanges.
The ruling is likely to be appealed. And a separate federal appeals court -- the Fourth Circuit Court of Appeals -- hours later issued its own ruling on a similar case that upheld the subsidies in their entirety.
But the decision Tuesday morning by a three-judge panel of the U.S. Court of Appeals for the District of Columbia nevertheless strikes at the foundation of the law by challenging subsidies that millions of people obtained through the federally run exchange known as HealthCare.gov.
The panel of the U.S. Court of Appeals for the District of Columbia ruled 2-1 that the IRS went too far in extending subsidies to those who buy insurance through that website.
The suit maintained that the language in ObamaCare actually restricts subsidies to state-run exchanges -- of which there are only 14 -- and does not authorize them to be given in the 36 states that use the federally run system.
The court agreed.
“We reach this conclusion, frankly, with reluctance. At least until states that wish to can set up Exchanges, our ruling will likely have significant consequences both for the millions of individuals receiving tax credits through federal Exchanges and for health insurance markets more broadly,” the ruling stated.
The case, Halbig v. Burwell, is one of the first major legal challenges that cuts to the heart of the Affordable Care Act by going after the legality of massive federal subsidies and those who benefit from them.
The decision said the law "unambiguously restricts" the subsidies to insurance bought on state-run exchanges.
The dissenting opinion, though, claimed political motivations were at play. “This case is about Appellants’ not-so-veiled attempt to gut the Patient Protection and Affordable Care Act ('ACA'),” the dissent stated.
The ruling, though likely to be appealed, could threaten the entire foundation of the newly devised health care system. Nearly 90 percent of the federal exchange’s insurance enrollees were eligible for subsidies because of low or moderate incomes, and the outcome of the case could potentially leave millions without affordable health insurance.
“Today’s decision rightly holds the Obama administration accountable to the law,” Sen. Orrin Hatch, R-Utah, said in a written statement adding, “… As it has on so many occasions, the Obama administration simply ignored the law and implemented its own policy instead.”
The next step for the Obama administration would be that they request a so-called en banc ruling, which means there would be a vote taken by all of the judges on the court. An appeals court can only overrule a decision made by a panel if the court is sitting en banc.
White House Press Secretary Josh Earnest stressed Tuesday that different courts have reached different conclusions on the subsidy issue, and said that the latest ruling “does not have any practical impact” at this point on the ability of people to get tax credits.
He said the Department of Justice will likely appeal to the full D.C. Circuit Court and defended the administration’s position that Congress intended “all eligible Americans” to have access to the subsidies regardless of which entity set up the exchange.
“We are confident in the legal position that we have,” Earnest said.
Ron Pollack, founding executive director of Families USA, said in a written statement that the ruling “represents the high-water mark for Affordable Care Act opponents, but the water will recede very quickly.”
He added, “It will inevitably be placed on hold pending further proceedings; will probably be reheard by all of the 11-member active D.C. Circuit Court of Appeals members, who predictably will reverse it; and runs contrary to" the ruling from the Fourth Circuit Court of Appeals.
The appeals process could eventually lead to the U.S. Supreme Court deciding on the legality of the subsidies, but Pollack, whose group supports the law, believes that won’t happen.
Of the 11 judges that could rehear the case, seven are Democrats and four are Republicans.
Halbig v. Burwell, which previously had been called Halbig v. Sebelius, is one of four federal lawsuits that have been filed aimed at targeting the idea of tax credits and other subsidies afforded under ObamaCare.
A total of $1 trillion in subsidies is projected to be doled out over the next decade.
A U.S. District Court previously sided with the Obama administration on Jan. 15.
July 22nd, 2014, 18:31
Malsua
Re: Mandating health Insurance - Obamacare
Single Payer is coming.
The only other way would be to get government out of it and that's not going to happen unless the government collapses.
Devin Payne had gone years without health insurance—having little need and not much money to pay for it.
Then Payne, who had a wife and four children, realized she could no longer live as a man.
In her early 40s, she changed her name, began wearing long skirts and grew out her sandy blond hair. And she started taking female hormones, which caused her breasts to develop and the muscle mass on her 6-foot one-inch frame to shrink.
The next step was gender reassignment surgery. For that, Payne, who is now 44, said she needed health coverage. “It is not a simple, easy, magical surgery,” said Payne, a photographer who lives in Palm Springs. “Trying to do this without insurance is a big risk. Things can go wrong … not having the money to pay for it would be awful.”
Payne learned in the fall that she might qualify for subsidies through the state’s new insurance marketplace, Covered California, because her income fell under the limit of $46,000 a year. She eagerly signed up in March for a Blue Shield plan for about $230 a month, and began making preparations for the surgery that would change her life.
A ‘Pre-existing Condition’
Among the less-talked-about implications of the Affordable Care Act is the relief it is providing to many transgender people, many of whom are low-income and who have struggled to obtain health coverage.
Getting jobs that offer insurance often has been difficult for transgender people and the cost of purchasing plans on the private market can be prohibitive. Some have been denied policies altogether after being diagnosed with “gender identity disorder,” often considered a pre-existing condition.
Without insurance, many people were unable to afford the hormones, surgeries and counseling needed to complete their transition. Nor would they have been covered in the event of surgical complications, which can include infections.
“We are still dependent on insurance and the medical community for us to be able to live authentically,” said Aydin Kennedy, coordinator of the transgender health program at St. John’s Well Child and Family Center in Los Angeles.
Now, federal law prohibits health insurance companies from discriminating against transgender people, and it bars insurers from denying coverage based on pre-existing conditions. That makes it possible for more transgender people to purchase private plans. And in states that expanded their Medicaid programs, those with low incomes may get free coverage.
The federal anti-discrimination regulations have yet to be written, but California insurance regulators have said that companies must treat transgender patients the same as other patients. For example, if plans cover hormones for post-menopausal women, they must also cover them for transgender women. Medicare, the program for the elderly and disabled, lifted its ban on covering sex reassignment surgery earlier this year.
“The law and policy are on a transgender person’s side for the first time,” said Anand Kalra, program administrator at the Oakland-based Transgender Law Center.
Conservative and religious groups oppose using government funds for transgender surgeries, questioning whether they are medically necessary, ethical or effective.
“We would oppose sex change operations all together,” said Peter Sprigg, senior fellow at the Family Research Council in Washington, D.C. “But as a public policy issue, we would feel particularly strongly that taxpayers shouldn’t be asked to pay for it.”
A few obstacles remain for transgender patients. Not many doctors specialize in transgender care. And while the law opens the door to insurance coverage, insurers can set conditions and don’t automatically approve payment.
“Insurance companies are making up their own rules as they go along,” said Kalra of the Transgender Law Center.
‘Feeling Complete’
Growing up in Kansas, Payne remembers trying on her mother’s clothes and dressing as a girl every year for Halloween. She dreamt of having another life after this one, as a girl. But Payne said she mostly suppressed her feelings and tried to live up to the expectations for a male.
“I put it out of my head,” she said.
She married a woman she met at work and they had four children, now ages 7 to 22. But she never felt comfortable in the traditional role of father and provider.
“Trying to do this without insurance is a big risk. Things can go wrong … not having the money to pay for it would be awful.”
“I was just horrible at it because it wasn’t who I was,” she said. So Payne became the primary caretaker, playing the “mommy role” as she worked from home doing software development for pharmaceutical companies.
She felt increasingly anxious, and in late 2012, a therapist helped her to realize that she was meant to live as a woman. Payne said her entire outlook on life changed when she started taking female hormones.
“All my anxiety and all of the bad things that I felt inside were just completely washed away,” she said.
Payne told her wife, who was upset. She told Payne: I married a man, not a woman—but she also admitted that she wasn’t entirely surprised. With mixed feelings, Payne’s wife stayed in the marriage, and the family moved from Kansas to California, in part so Payne could be more comfortable living as a transgender woman. They rented a small house in a middle-class neighborhood on the outskirts of Palm Springs and sent their children to the public school.
Late last year, Payne’s wife, who had battled alcoholism for years, died of liver disease.
Payne said the children worried how people would react to her transition, but she said they soon realized it wasn’t as big of a deal as they had feared. When Payne brought birthday cupcakes to her 7-year-old daughter’s classroom last year, the children asked if she was a girl or a boy. After Payne told them she was a girl, “They just wanted their cupcakes.”
In California, Payne found transgender friends and became an advocate within the community. “You find out that there is a whole world of people out there,” said Payne, who wears little makeup or jewelry and calls herself a “T-shirt and skirt kind of a girl.”
Payne was ready for the surgery. She started calling the approved providers in Blue Shield’s preferred provider network. But they were booked up for months, or years. She felt she couldn’t wait—she wanted to do the surgery while her children were on summer vacation so they could go to her parents’ house in Kansas as she recovered. She found an out-of-network doctor in Palo Alto who would do the surgery about a month later.
“The time was right and I wanted to get it done,” she said.
Her Blue Shield policy said that gender reassignment surgery—which uses existing tissue to construct female genitalia—could be covered if patients met certain guidelines. For example, she had to be diagnosed with gender identity disorder and have an “expressed desire” to live as a member of the opposite sex.
By the scheduled date, Blue Shield had authorized the operation but hadn’t determined exactly how much it would pay for an out-of-network provider. Payne got a cashier’s check for nearly all her savings, $27,000, to pay the doctor, hoping her insurance plan would reimburse most of it. She worried about all the other expenses too, including the hospital stay, lab work and anesthesiology services.
The day of the surgery at Sequoia Hospital in Redwood City, Payne said, she remembers being wheeled into the operating room and feeling very calm. When she woke up, with oxygen still attached and wearing her hospital gown, a friend told her that the surgery had gone well, without any immediate complications.
Later that day, she had just enough energy to type a few words on her Facebook profile: “Feeling complete.”
Grateful for Coverage
On a boiling afternoon in early July, about six weeks after the operation, Payne and her friends sat outside on the patio next to a pool. Misters sprayed above them, and Payne’s cat and two dogs wandered beneath their feet.
Payne said she did suffer a few complications later—some swelling and an infection—but she recovered with medication and support from friends.
She is still trying to figure out how much she has to pay out-of-pocket for the surgery and hospital stay—and how much of that her insurance plan will reimburse. Payne said she believes the lab work, pathology, anesthesiology services and follow-up doctor’s visits were all covered. But recently she got a statement saying she was on the hook for $17,000 of the total cost of the surgery.
Payne believes that the government and insurance companies should help cover such operations. The population of transgender patients who want surgery is small, and she said they are less likely to suffer mental health problems once they have it.
Payne said she will be grateful for whatever coverage she can receive. Her friend Jenny Taylor, who is staying with her during the recovery, has had an even harder time with her insurance.
An outgoing transgender woman who laughs easily and wears colorful outfits and painted nails, Taylor purchased a policy through the insurance exchange in Tennessee. But she soon learned her doctor wasn’t in the plan’s network and that she had to pay cash for everything, with no hope of reimbursement.
“My insurance, even though I finally got it, was useless,” she said.
The policy also wouldn’t pay for her hormones. A pharmacist told her the medication was for women—and her identification still listed her as a male. Taylor recently moved to Palm Springs and said she now plans to apply for insurance through Covered California.
“I was really frustrated,” she said. “We’re just trying to be ourselves, at the end of the day.”
Payne agreed, saying she finally feels like her body matches what she knows to be true—that she is a woman. “It seems more natural,” she said.
Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.
August 26th, 2014, 14:20
American Patriot
Re: Mandating health Insurance - Obamacare
Hate to tell you this...
Gender reassignment has been being paid for by the US government for military personnel for a LONG time now.
I know this for an ABSOLUTE FACT. If you want details, feel free to PM me. (And no, it wasn't ME you bad thinkers!)
November 13th, 2014, 18:55
American Patriot
Re: Mandating health Insurance - Obamacare
Media blackout shields ObamaCare architect who bet on public stupidity
I’ve been trying to figure out why the mainstream media has all but decided to ignore one of ObamaCare’s chief architects saying the administration played on the public’s stupidity in passing the law.
After all, the press usually loves when hidden video surfaces, as it did this week with MIT professor Jonathan Gruber, and we get unvarnished comments showing what someone really and truly believes.
And yet there hasn’t been a mention on the network evening newscasts. CNN's Jake Tapper, to his credit, played the clip twice, asked two senators about it and wrote an online column on the subject, but that was about it for the network. Nothing in the Washington Post but for a couple of online items. (Update: The Washington Post finally got around to covering the controversy today, three days after it broke.) Not a word in the New York Times, which in 2012 ran a puffy profile of Gruber (“It is his research that convinced the Obama administration that health care reform could not work without requiring everyone to buy insurance”).
This is utterly inexplicable, except as a matter of bias. No matter what you think of ObamaCare, on what planet is this not news? Maybe on that comet where the spaceship just landed.
I tried to think of the possible excuses. Too busy covering other stories? Hey, nobody in America has Ebola anymore! The only real competition is a big winter storm and Eminem disgustingly dropping F-bombs at HBO’s Veterans Day concert.
Was Gruber’s point about health care taxes and mandates too complicated? Then explain it. Besides, it isn't that this argument never came up before; it's that Gruber fesses up to the attempt at deception.
Even MSNBC’s Mika Brzezinski, who makes no secret of being a liberal, admitted yesterday that “had it been a Republican, the media would have been exploding.”
And yet MSNBC’s coverage in the previous two days basically consisted of Ronan Farrow doing a softball sitdown with Gruber. Now I’ve tried to avoid taking cheap shots at Farrow, a guy with zero journalistic experience, who worked for the administration, and who’s basically on the air because he’s Mia Farrow’s son (and maybe Frank Sinatra’s son). But this was a farce.
“I was speaking off the cuff and I basically spoke inappropriately, and I regret having made those comments,” Gruber said.
Did Farrow ask what was inappropriate? Did he ask whether the comments were true? Nope, he carried the professor’s water:
“But the point you were making underneath the choice of words was actually quite nuanced. You were saying, correct me if I’m wrong, that due to political pressure the language of ObamaCare had to be somewhat opaque.”
Somewhat opaque, I love that. Also known as being highly misleading and pulling the wool over people’s eyes.
Let’s review: Gruber, a highly paid administration consultant, said this at an academic conference a year ago:
“This bill was written in a tortured way to make sure CBO did not score the mandate as taxes…Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter, or whatever, but basically that was really, really critical for the thing to pass.”
Stupidity. Really critical. And where is the rest of the press?
Now Fox has certainly given the story heavy rotation, and conservatives on the network and elsewhere have jumped on the tape, and a second one that soon surfaced, to discredit the Affordable Care Act. Gruber’s comments don’t prove that the program is a mess or isn’t working. They show that the administration was counting on public ignorance to pass it.
In another interview, on Boston’s WGBH, Gruber didn’t argue with host Emily Rooney’s characterization that he had admitted to “intentional obfuscation.” In fact, he’s not really taking back what he said at all. He said he didn’t want it widely known that “we gave poor people money.” Gruber then pivoted to charge that “the master strategy of the Republican Party” is “to confuse people enough about the law so that they don’t understand that the subsidies they’re getting is because of the law.”
That’s a separate debate, but it’s kind of ironic that a guy who pleaded guilty to intentional deception is now accusing the other side of spreading confusion.
All this would seem to be a ripe subject for public debate. But in much of the mainstream media, it’s been blacked out. And that's downright embarrassing.
Fred Lucas
The White House posted seven cartoons on its website to help promote Obamacare, asking supporters to share them on social media.
The cartoons featured a cross section of various times of people: a hippie “not to hip” to get insurance; an acrobat/skydiver who won’t risk doing without health insurance, among others.
The artwork was produced by artist Carolyn Belefski, who lives in the Washington, D.C. area and collaborates with writer Joe Carabeo on the comic books Kid Roxy, Black Magic Tales and The Legettes, according to her website. She has also worked for the conservative Heritage Foundation, as well as National Geographic.
The cartoons are among the Obama administration’s attempts to promote HealthCare.gov to people who don’t normally follow politics. Last week, Obama did an interview with three YouTube personalities. Previously, Obama did an interview with the comical “Between Two Ferns” show.
Neither the White House nor Belefksi immediately responded to inquiries from TheBlaze.
Yeah. Let's see. I'm at almost 5k deductable a year now (was 1000). My co-pays are 40 or 50 dollars (I haven't been in to find out for sure yet). My EYE insurance was cancelled. I was diagosed with cataracts yesterday.
Tell me how fucking Obama has helped me again?
Fuck him.
February 12th, 2015, 15:42
vector7
Re: Mandating health Insurance - Obamacare
Obama Tells Companies Never To Complain About ObamaCare, Shame On Him
In an interview with a web-based news site called Buzzfeed, President Obama was asked to comment on news that Staples has been warning part-time workers not to clock in more than 25 hours a week because of ObamaCare. ( Reported Here )
Obama launched into a tirade.
"I haven't looked at Staples stock lately or what the compensation of the CEO is, but I suspect that they could well afford to treat their workers favorably and give them some basic financial security," he said.
Let's leave aside the fact that Staples is providing workers some basic financial security -- in the form of a paycheck.
The issue is how Staples will cope with the high costs of the ObamaCare employer mandate, which went into effect this year. Any worker who puts in more than 30 hours a week is now considered full time, and companies like Staples face a $3,000 fine for each of these former part-timers if they don't offer them "affordable" insurance.
According to Obama, these companies should just suck it up and never, ever complain in public.
"When I hear large corporations that make billions of dollars in profits trying to blame our interest in providing health insurance as an excuse for cutting back workers' wages, shame on them," he said.
But even state and local governments -- which can raise taxes to cover increased costs -- are making the exact same decision as Staples in the face of the hugely expensive employer mandate.
In fact, IBD for some time now has been tracking businesses and government agencies that have publicly blamed ObamaCare for cutbacks in worker hours or jobs.
In Obama's world, government can force companies to raise worker wages, provide paid time off, offer generous health insurance, and other mandated benefits, and they can just pull the extra money out of a hat to pay for it all.
Obama displayed the same level of ignorance about how businesses operate in an earlier interview with Vox.com.
Defending his proposal to increase sharply the capital gains tax, Obama claimed "there's no evidence that would hurt the incentives of folks at Google or Microsoft or Uber not to invent what they invent or not to provide services they provide. It just means that instead of $20 billion, maybe they've got $18, right?"
The problem with high capital gains tax rates, however, is that they distort investment decisions by locking money in established firms to avoid the tax hit while discouraging investment in start-ups, thereby starving capital needed to finance the next Google, Microsoft or Uber.
That's why capital gains tax hikes consistently produce far less revenue than expected, and why cutting the tax rate generates more.
President Obama hasn't spent a single day in the private sector, and has never balanced a budget. Yet he feels qualified to lecture businesses on how they should spend their money.
Crony Socialism: Among ObamaCare's many bad ideas was the attempt to create an entirely new industry of nonprofit insurance co-ops. It is fast turning into a huge, multibillion-dollar taxpayer boondoggle.
Created as an alternative to an outright "public option," the co-ops have received $2.5 billion in low-interest loans to help them get started.
Only about 500,000 enrolled in one of the 23 co-ops that ObamaCare spawned, which works out to $17,000 per enrollee, according to an analysis by the Daily Signal, a news site started by the Heritage Foundation.
The loans were supposed to provide the co-ops a years-long cushion to get their premiums right. But even with all this help, one of them — CoOportunity Health — is already insolvent, forcing its roughly 68,000 enrollees in Iowa and Nebraska to switch to other plans.
Just months before it went belly-up, CoOportunity was being hailed "as one of the most successful of the 23 such health-insurance co-ops organized nationally," according to the Des Moines Register.
The Community Health Alliance in Tennessee froze enrollment this January after posting an $8.5 million loss in the first nine months of last year.
These are likely to be the first of many such financial problems. A Standard & Poor's report out this week found that all but five of the co-ops had negative cash flow through Sept. 30, and 11 had bigger loss ratios than CoOportunity.
S&P also found that "medical loss ratios" — the percentage of premiums that go to pay medical claims — were "hopelessly high" for several co-ops, a sign they enrolled too many high-cost patients.
An earlier report from insurance rating firm A.M. Best also found trouble brewing. All but one co-op had operating losses through last September that totaled nearly $244 million. That led A.M. Best to say it "is concerned about the financial viability of these plans."
Now the co-ops are in Washington, "pushing federal officials to make it easier for the nascent plans to get significant private funding to stay solvent," according to Politico Pro.
Among the sticking points is whether the government will go to the back of the line when it comes to collecting on those debts.
Washington needs to pull the plug on this dubious experiment, not waste still more money to keep it on life support.