Your Money Is Only Whispering

My friend was trying to prove that it is never too late to get interested and involved in politics.  Ralph (name changed) finally got excited about a political candidate and donated money to the campaign.  How much?  Let’s just say it was a lot of money to him.  And when the candidate won, Ralph expected to be recognized, thanked, and mentioned on the Congressional website.  Ralph was now a Player, at least in his own mind.

An individual was allowed to contribute up to $2,800 to a particular Congressional candidate per election in 2020.  Ralph was nowhere near that amount, but even if he was, Congressional campaigns raise and spend millions of dollars.  He contributed less than 1/10 of 1% of what his candidate spent.  I’m sure that Ralph and his donation were momentarily appreciated by whoever processed the check before he/she opened the next envelope.

To put this into perspective, let’s look at what the pharmaceutical industry (Big Pharma) donated to Ohio politicians in 2020.  The Columbus Dispatch and the website Lobbyists for Citizens are the source of this information.  It was noted that Ohio politicians, Republicans and Democrats, received over $250,000 in the 2020 election cycle from Big Pharma.  To no one’s surprise, the top recipient, even though he wasn’t up for reelection, was Rob Portman.  Here are the numbers:

US Senators

  • Rob Portman – $65,000
  • Sherrod Brown – $0

US House

  • Brad Wenstrup – $64,000
  • Bob Latte – $41,000
  • Steve Stivers – $26,000
  • Jim Jordan – $15,000
  • Bill Johnson – $14,500
  • Marcia Fudge – $11,500
  • Joyce Beatty – $7,500
  • Tim Ryan – $4,000
  • Steve Chabot – $2,500
  • Anthony Gonzalez – $2,000
  • Troy Balderson – $1,000
  • Bob Gibbs – $1,000

I showed this to Ralph and had him look at Senator Portman’s website.  Big Pharma isn’t mentioned or thanked.  Portman has found other ways to thank them and earn their favor.  Our political donations are whispering while the real money, the PAC money is shouting.

Prescription Drug prices have spiraled out of control for years.  The creation of Medicare Part D in 2003 was a license to print money.  Every couple of years Washington flirts with the concept of regaining control.  Success is hardly guaranteed.

A quick bit of history:  Medicare Part D specifically prohibits the government (the Secretary of Health and Human Services) from negotiating with the drug manufacturers over price.  This is called the “noninterference clause”.  My clients are still surprised by this.  What is not surprising is that the Congressman who co-authored the legislation, Billy Tauzin (R-La) was also negotiating with Big Pharma to become their top lobbyist at a salary of $2 million per year.  He had that job from 2004 through 2010.  We continue to be impacted by his efforts to this very day.

Congress, or at least some members of Congress, would like to eliminate the noninterference clause.  As you can imagine, Big Pharma is not happy.  They have two tools (weapons) at their disposal, money and emotion.  We know that the money is flowing to elected officials.  Emotion and fear are on full view on our TV screens.  By now you have been introduced to Sue from Ohio, an ad that the Washington Post rated 3 Pinocchios.  There will be more Sue’s and more misleading BS.

Will we, the consumers, win this time or will Big Pharma win again?  It is way too early to tell.  There is legislation pending that may pass as currently written, be watered down to irrelevance, or just defeated by filibuster in the Senate.  You can contact your Congressman and/or Senator. But it is important to remember that you may donate what seems to you a lot of money, but it is, in truth, but a whisper.


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Donald And Susan Deserve Better

Donald needed to talk.  He was very upset.  He and his wife, Susan (names changed), moved to Greater Cleveland in 2020.  He came to see me for health insurance when his COBRA ended.  They had a choice between Medical Mutual of Ohio with access to University Hospital and its affiliate doctors and facilities or the Cleveland Clinic + Oscar policy that would get them into the Cleveland Clinic.  They had yet to see a doctor and had no preference.  Medical Mutual was a little less, so University Hospital won this round.  Donald was calling to change policies and provider networks.

Donald’s problems started when he tried to schedule their initial appointments.  Friends had recommended a couple of doctors.  None of those doctors had an opening for a routine exam for three to six months at the soonest.  Annual Preventive Care is a covered benefit under the Patient Protection and Affordable Care Act (Obamacare), but the money is in treating conditions.  Very little time is set aside in today’s medical practices for routine care.  Donald gave up and scheduled an appointment.  Susan had more immediate needs and accepted an appointment with a physician who was very available.

Susan’s appointment did not go well.  The doctor failed to focus on her patient, or ask good questions, and seemed intent on getting the exam done as quickly as possible.  Follow-up testing was ordered without adequate explanation.  This precipitated Donald’s first email to me.  No action was taken at that time.  Today’s call came after they saw Susan’s medical records.  They were shocked to learn that the doctor had completed a series of questions as if she had actually discussed any of these topics with Susan.  She hadn’t.   Their solution was to schedule a meeting for next week when they would drop Medical Mutual and move to Oscar so that they could access the Cleveland Clinic and get better care.  They will be here on the 11th.

To be clear, I receive most of my health care at University Hospital facilities.  The facilities are world-class and a lot of the doctors are excellent.  A lot, but not all.  There are great doctors and there are people who might do a better job at something else.  Donald and Susan may live in a Cleveland suburb, but this isn’t about University Hospital or the Cleveland Clinic.  They could just as easily have encountered the same level of care in Philadelphia, Seattle, or any other place in this country.  One of the complicating factors in our health care system is the number of medical practices owned by the institutions, corporate entities, and private equity firms as reported in the recent Radiology Business:

The COVID-19 pandemic has accelerated this decade-long trend as business interests “dramatically” reshape the practice of medicine. Corporate entities own half of the nation’s medical practices, with private equity and similar stakeholders producing the sharpest increase (32%) in acquisitions between 2019-2020.

I would like Donald and Susan to think this through before we change plans and networks.  Politely, but firmly, they need to assert their rights as consumers.  I needed to remind them that the doctor is a PAID service provider.  If the service provided is less than satisfactory, you should fire the doctor.

All large institutions have a patient care office / ombudsman / patient experience office.  I urged Donald to find the one for University Hospital and call it.  Susan should tell UH about her experience and the substandard level of care she received.  Sure all of the medical systems send out surveys, but who knows if a human being every reads them.  It is time to let someone, other than me, know about this visit.

Some of us still remember House Calls, when the doctor came to your home to treat you.  That time has come and gone, but you can still demand the undivided attention of the person you hire to attempt to treat your illnesses and keep you healthy.  I don’t know if Donald and Susan will follow through and call UH, and if they do, whether anything will come of it.  My job is to help people access and pay for health care.  I also think that my job is to help people understand that they should expect to be respected, valued as customers (patients), and given the best care possible.

Donald and Susan deserve better.  And so do you.


Picture – What Could Be Better Than A Lake Erie Sunset? – David L Cunix

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What Changed?

It is entirely fair and reasonable to ask, “What changed?”  What is the difference between purchasing a health policy now in July 2021 vs. twelve years ago in 2009?  And yes, there are significant differences.  Here are a few:

  • Insurance Companies in our market
  • Insurance Products
  • Who can purchase insurance
  • When you can buy a policy
  • Insurance premiums

We once had lots of insurers.  Now there are only a few in each area.  My market is the State of Ohio, but my friends from around the country report the same thing.  Some states only have one or two insurers offering comprehensive major medical coverage.  Major insurers with well-known names abandoned entire states.  Some, like Anthem Blue Cross, have started to reenter the individual health insurance business in selected counties.  They carefully pick their spots and severely limit the doctors and hospitals in their networks as they search for a way to make this segment of the industry profitable.

This leads us to the next big change.  Most of our policies in 2009 were PPO’s, Preferred Provider Organizations that provided access to doctors and hospitals around the country.  All of our current policies are HMO’s.  Our clients are limited, except in the case of an emergency, from accessing care outside of a very narrow network.  This is done to control costs.

Our 2021 products are more comprehensive.  The Patient Protection and Affordable Care Act (Obamacare) requires all policies to include the ten Essential Health Benefits (EHB):

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Pregnancy, maternity, and newborn care
  5. Mental health and substance use disorder services
  6. Prescription Drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services
  10. Pediatric services

It may seem sound odd now, but in 2009 women had a difficult time finding a policy that covered maternity.  Mental health treatments, doctors’ visits or medications, were excluded or severely limited in many of our policies in 2009.

The Who and When are the reasons for today’s post.

Arnold (name changed) has finally decided to devote himself full-time to his business.  He had been operating it for several years as a “side-hustle” while working in a totally unrelated field.  His job gave him security and health insurance.  His business allowed him to explore both his creativity and his full potential.  COVID made the job less and less secure.  And now is the time to jump.  He was in my office today to get health insurance.  If this had been 2009, I would have welcomed him into my office and started the process.  There wasn’t an Open Enrollment Period in 2009.  He could apply at any time.  I would have asked him a lot of questions about his health, occupation, hobbies, and driving record.  And then I would have apologized after explaining that we were not going to be able to secure coverage for him through normal channels.  The problem is that Arnold has a few interesting medical conditions and he weighs 300 pounds.  Health insurance was one of the main reasons that the Arnolds chose to work jobs with benefits and weren’t able to create new businesses in 2009.

Today is July 29, 2021.  Arnold’s previous employer has yet to provide him with the needed documentation proving that his group policy has ended.  That isn’t a problem because this administration created a special enrollment period from March 15, 2021 to August 15, 2021.  For Arnold the big question was whether he wanted the Medical Mutual of Ohio policy that gives him access to the University Hospital System or the Cleveland Clinic + Oscar policy.  The policies are guaranteed issue and preexisting conditions are covered.  The entire process took only a few minutes.

The last change is the cost.  Obamacare created Tax Credit Subsidies to help individuals and families earning less than 400% of the Federal Poverty Level pay for their premiums.  President Biden has expanded that benefit.  Are premiums higher in 2021?  Of course.  Wouldn’t it be odd if you could improve the benefits, insure anyone, and cover preexisting conditions without increasing the price?

Are we better now than we were in 2009?  As always, it depends on who you ask.  If you were a very healthy, young, single male in 2009 your coverage would have been a whole lot cheaper than your 2021 counterpart.  If you are Arnold or one of the 50 million Americans with preexisting conditions, health insurance, the way most Americans access and pay for health care, is a lot better today.

My opinion?  I want Arnold, every Arnold, to fully explore his/her creativity.  Access to insurance should never stand in their way.


Picture – I Was So Much Older Then – David L Cunix

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More Good News!


The current Special Open Enrollment Period will come to an end on August 15th.   Many of you have taken advantage of the changes in the Tax Credit Subsidy.  Several of my clients have saved over $1,000 per month!  We have one more change coming next week.

First, let’s review the Tax Credit SubsidyThis may be one of the most important changes of the new law.  The Patient Protection and Affordable Care Act (Obamacare) included provisions to help Americans pay for their health insurance, the way most of us access and pay for health care.  The 2010 law created Tax Credit Subsidies which were tied to the Federal Poverty Level.  If you, or you and your family, earned less than 400% of the FPL, you could get help.  This was never updated till now.  The new subsidies are going to increase for most of you who have policies on the Exchange.  And the 400% cut-off is going to be eliminated for at least 2021 and 2022.  Instead, the law will extend benefits to all Americans purchasing their own coverage on the Exchange with a goal to limit the cost of insurance to no more than 8.5% of their income.   These changes will impact over 3 million Americans this year.

One of the provisions of the American Rescue Plan Act of 2021 is a special subsidy for anyone who has received unemployment compensation during 2021.  Even if you only received one week of unemployment, you may be eligible for a significant reduction in your monthly premium.  The system will be ready as of July 1st and your new, LOWER premium will start as of August 1st for the rest of the year.


  • If you are currently on the Exchange, you should review your current subsidy. You may qualify for a higher subsidy which would lower your premium or allow you to switch to a more comprehensive policy.
  • If you are not currently on the Exchange but you or a family member received unemployment in 2021, you need to see if you, or you and your family, now qualify for a subsidy. There’s no guarantee that you will, but it doesn’t hurt to try.

Delivering good news isn’t normally part of my job description.  This has been a lot of fun.  A large number of you are fully vaccinated and agents are enjoying the return of in-person appointments.  Whether you meet in your agent’s office or by phone, it is time to save some money.

We are all in this together.


Picture – More Good News – David L Cunix

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They Don’t Have A Leg To Stand On

“What right does Texas have to take away my insurance?”  I can’t tell you how many times my clients have asked me that question.  The Texas Lawsuit has weighed heavily on many of my clients, especially those with preexisting conditions.  The idea of eliminating the Patient Protection and Affordable Care Act (Obamacare) and all of its protections with nothing, scared the daylights out of many of us.  Who would sell health insurance to someone with cancer?  Where would a pregnant woman, or even a family that wanted to have children, get covered?  The answer, of course, was to have faith that the system would not fail them.  Whether help would come from the State of Ohio, our elected representatives in Washington, or the Supreme Court, someone would step up and protect them.  Someone will do the right thing for them.  Have faith.  Be patient.  Don’t worry.

To be clear, I may have had faith, but I was more than a little worried.

Today, in a 7 – 2 ruling, the Supreme Court saved my clients and Obamacare for the third time.  As always, the best analysis of the decision was written by Amy Howe at ScotusBlog.  I strongly urge you to read her three page post.

On June 17th the Supreme Court ruled what many of us had suspected, neither the groups of states led by Texas nor the individuals challenging the mandate have a legal right to sue.  They didn’t have standing.  My attorney readers will enjoy both the way the decision was reached as well as that the majority included Chief Justice Roberts, Justices Amy Coney Barrett, Brett Kavanaugh, Clarence Thomas as well as the two remaining liberals.  The majority opinion was written by Justice Stephen Breyer.  An opinion that bridges the court’s extremes is guaranteed to surprise or confound the pundits.

There will be more challenges.  Since there are no problems in Texas, the Governor and Attorney General feel compelled to spend their time fighting to destroy our health care system.  And we can only hope that like this time, the Supreme Court will again tell them that they don’t have a leg to stand on.


Picture – You Say Hello. I Say GOODBYE – Original batik by Batik by Amit

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The Impact Of External Pressure

Richard Stengel, the former Editor of Time Magazine and Under Secretary of State during the Obama administration, said something on TV the other day that stopped the other guests in their tracks.  “The same fire that melts the butter, hardens the egg”.  Mr. Stengel didn’t create this idiom, nor did he claim authorship.  A quick Google search will reveal that lots of Americans found the comment insightful, and more importantly, got them to think.

I, of course, thought about the health care legislation of the last dozen years.  From 2011 through 2016 our Republican members of the US House of Representatives and Senate voted over 50 times to repeal the Patient Protection and Affordable Care Act even though there wasn’t a viable replacement.  Why?  Perhaps a few didn’t really have any idea the damage repeal would have done.  Most didn’t really care.  Their votes were inconsequential.  The law wasn’t going to be repealed, but their base remained riled up and the fundraising dollars flowed in.  My local Congressman, Dave Joyce, was just one of the guys.  We live in Ohio, a state where all districts are safe.  Mr. Joyce rode the wave, the fire melted the butter.

Everything changed in November 2016.  With the election of Donald Trump as President and the Republicans controlling both the US House and Senate, the PPACA could finally be repealed.  The alternative was the abominable American Health Care Act (House of Representatives) and the Senate bill, the Better Care Reconciliation Act of 2017 which was analyzed in this blog at the time.  We all remember that the House passed its bill and the beer celebration held by the White House.  And we remember that Senators Lisa Murkowski (R-AK), John McCain (R-AZ), and Susan Collins (R-ME) saved the day and voted with the Democrats to defend our system.  Few recall that twenty Republicans in the House also voted against the bill.  One of them was Dave Joyce.  The same fire that had melted the butter hardened the egg.

We are now back to the Democrats holding the keys to power.  And though President Biden may want to make Obamacare better and improve access to health care, he can’t do it by himself.  It will take Congressmen and Senators from both sides of the aisle to work together.  The previous paragraph isn’t an endorsement of Mr. Joyce, simply an acknowledgement of the Congressman rising to the moment.  And we will need a lot of those moments as our elected representatives feel the heat from their respective bases.  The denizens of the extremes are never quiet.  Our elected officials will have to overcome the pressure to move our country forward.  The fire must harden the egg.


Picture – Ready for Action – David L Cunix

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Getting To Work

Here is a problem.  You live in Mayfield Heights and your job is in Strongsville, about 30 miles away.  Worse, you hate your old car, it is unreliable, gets terrible gas mileage, and needs expensive repairs.  Do you

  1. Get a job closer to home?
  2. Move?
  3. Get a better car?
  4. Put your car up on blocks, give away the tires, and hope that a new way to get to work will magically appear?

I have a lot of faith in my readers.  I’m absolutely positive that almost all of you will choose some combination of options 1, 2, or 3.

Our health insurance system, an organized way for most of us to access and pay for health care, had a lot of problems twelve years ago.  Some people thought that it was OK.  Some thought that it wasn’t great, but major action wasn’t needed.  But, a lot of Americans demanded significant improvements.  A year’s worth of haggling, negotiations, and foot-dragging resulted in the Patient Protection and Affordable Care Act.  President Barack Obama’s new book, A Promised Land, details the negotiations with Republicans such as Senators Chuck Grassley and Olympia Snowe.  There were concessions made and amendments accepted, but in the end the legislation passed along party lines.  The law was hardly perfect.

It has been eleven years since the law’s passage.  The law was fully implemented January 1, 2014.  Some of my clients were adversely impacted by the law, principally with higher pricing.  Many more benefited from the elimination of medical underwriting, comprehensive benefits, and the Tax Credit Subsidies.  Again, the law is hardly perfect and I certainly would have structured it differently, but the transition to life under Obamacare was infinitely smoother than the naysayers had predicted.  There was, and still is, plenty of room for improvement.

How do you improve the PPACA?  What would you do to make it better? For eleven years some people have had only one answer.  Like the guy who disables his car to improve the way he gets to work, their answer was to repeal Obamacare without any viable replacement.   Chest pounding, meaningless votes, and even a beer celebration with President Trump didn’t pay for a single doctor’s visit or hospital stay.  The last four years featured the defunding of the Cost Share Reduction and untold stress for the millions of Americans with preexisting conditions.

The new administration has taken a much different approach.  President Biden is trying to make the system work.  We are in the middle of a Special Enrollment that has opened the process to purchase individual (non-group) coverage until August 15th.  Over one million Americans have signed up since March 15th. The Tax Credit Subsidy has been updated to cover more people.  And all of this is once again being publicized so that Americans will have a chance to improve their coverage.  Perfect?  Not yet.  But this is a step in the right direction.

Your representatives in Washington may be Republicans or Democrats.  Here is a quick experiment.  If you ever see them in person again, ask them what, specifically they would do to improve Obamacare (Both sides call it that.  It is not a pejorative.)  Ask to see their plan.  It has been eleven years.  If they can’t answer the question by now, then your Congressman or Senator is no better than the guy at the beginning of this post who put his car up on blocks.


Picture – The Hard Way – David L Cunix

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We May Not Be Able To Prevent This

What image comes to your mind when you hear the word “Texas”?  Do you see cowboys and old Westerns?  Do you see Ted Cruz boarding a plane to Mexico while over half of his constituents were sitting in the dark without heat or water?  Perhaps you see a stadium full of COVID deniers watching their baseball team lose their home opener.  When I think of Texas I think of millions of uninsured Americans and a State government that not only doesn’t care about its citizens, but for some unexplained reason, feels compelled to drag the rest of the country down to their citizen’s level of health care insecurity.

This blog has extensively covered the Texas Lawsuit, the effort by the Attorney General of Texas, a number of other Republican Attorneys of State, and the previous administration to declare the Patient Protection and Affordable Care Act (Obamacare) unconstitutional.  That case was argued before the US Supreme Court last November.  We should have a decision soon.  But one attempt to disrupt the country’s health insurance is not enough.

Preventive Care

Chances are that your health insurance coverage includes Preventive Care.  Preventive Care is defined by as “Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.”  The goal is to keep Americans healthy, to prevent certain illnesses or to catch those medical conditions at an early stage which might improve the odds of a positive outcome.  The benefit was designed to be provided at no charge to the patient.  And the list of covered services is extensive.  As this article from Kaiser Health News notes, “These changes have made it more affordable for Americans to get a wide range of services, such as cancer screenings, contraception, HIV prevention drugs, vaccines, tobacco cessation treatment, alcohol abuse counseling and domestic violence counseling.”

The same article quotes Tim Jost, a retired Washington & Lee University Law Professor.

“It’s billions and billions of dollars of services that Americans get every year, not just from ACA health plans but also from employer plans. If this benefit ends, it would mean a lot of people would forgo preventive services and end up with much worse medical problems.”

It works!  Free access to preventive care is allowing some Americans to get annual physicals, vaccines, and have a chance to get/stay healthy.  That would appear to run counter to the Texas model.  The lead plaintiff, Dr. John Kelley, is a Fort Worth, Texas orthodontist.  He and a small group of others have sued to eliminate the Preventive Care benefit from the PPACA.  Their suit appears to have been motivated, in large part, by the inclusion of contraception and HIV prevention drugs within the definition of Preventive Care.  Birth Control has had a significant impact on the PPACA.  It is not a coincidence that this case landed in the court of Judge Reed O’Connor, the judge who has previously ruled that the entire Patient Protection and Affordable Care Act should be dismantled.  Though Judge O’Connor’s decisions have been mocked by legal scholars on the Right and the Left, he is a federal judge, appointed for life, and capable of doing untold harm.

The PPACA was signed into law 11 years ago.  Since then it has withstood over 50 votes in Congress, most designed not to overturn the law but to empty the pockets of potential campaign supporters. (Yes, the initial bill in January 2011 really was “H.R.2 – 112th Congress (2011-2012): Repealing the Job-Killing Health Care Law Act”.  This was not serious legislation.)  The law has also been upheld by the Supreme Court. Twice!  The new strategy is to pick away at the law by filing lawsuits in “friendly” courts.  And no court is as friendly as Reed O’Connor’s when it comes to limiting your access to coverage.

It would appear that Texas seeks to infect our insurance, the way most Americans access and pay for health care.  We might not be able to prevent that.


Picture – The Texas Option – David L Cunix

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The News Is Good

We are getting a better understanding of the American Rescue Plan Act of 2021 and how it will impact your health insurance if you are under age 65 and buying your own policy.  Much of the focus on the recently passed law has been on the stimulus checks and child tax credit.  Today’s post is from an update I sent my clients.  This blog has a national following according to Google Analytics.  Most of you reading this are outside of my service area.  It is not an advertisement.  The information is relevant whether you live Portland, Maine or Portland, Oregon.  I encourage you to talk with your local agent to review your specific options.

Tax Credit Subsidy – This may be one of the most important changes.  The Patient Protection and Affordable Care Act (Obamacare) included provisions to help Americans pay for their health insurance, the way most of us access and pay for health care.  The 2010 law created Tax Credit Subsidies which were tied to the Federal Poverty Level.  If you, or you and your family, earned less than 400% of the FPL, you could get help.  This was never updated till now.  The new subsidies are going to increase for most of you who have policies on the Exchange.  And the 400% cut-off is going to be eliminated for at least 2021 and 2022.  Instead, the law will extend benefits to all Americans purchasing their own coverage on the Exchange with a goal to limit the cost of insurance to no more than 8.5% of their income.   These changes will impact over 3 million Americans this year.


  • If you are currently on the Exchange, you should review you current subsidy. You may qualify for a higher subsidy which would lower your premium or allow you to switch to a more comprehensive policy.
  • If you are currently on the Exchange and don’t do anything, you will probably get a larger refund when you file your taxes next year.
  • If you are not currently on the Exchange, you and your agent should take a look to see if you would save money. I can’t guarantee that you will, but it doesn’t hurt to try.
  • THE SYSTEM WILL NOT HAVE THE NEW CALCULATIONS INSTALLED UNTIL EARLY APRIL. You will be much happier if you wait till at least the middle of April to meet with your agent. I am going to schedule my clients for the end of April and the first two weeks of May.

COBRA – Some people will qualify for a 100% premium subsidy for COBRA coverage for as much as March 1, 2020 to September 1, 2021.  There are some details to be resolved, but the key is that the employee must have been involuntarily terminated or had his/her hours reduced to zero.  Please contact your former employer’s COBRA administrator if you think that you might qualify.

Grandmothered Policies – We hold our breath each year waiting for the federal and state governments to approve an extension of Transitional Relief, the right to retain the policies sold and put in place between April 2010 and December 2013.  The Biden administration pushed this through in February and Ohio quickly followed.  This is good news for some of my individual and small group clients.

Rx Discount Cards – Many of you have asked how to deal with the ridiculous cost of prescription drugs.  This is especially relevant for those of you with high deductible policies that don’t have an Rx copay.  Clever Rx is new option.  The link will let you to sign up for a free discount card.  There is a great app that will allow you to price your medications based on both the dosage and the drug store.  Yes, the drug store matters.  This may help.  There are other Rx plans, too.  Find the one that works with drugstores in your area.

The American Rescue Plan Act of 2021 is major legislation.  Today’s post is just to make sure that you are aware of a few of the ways it will impact your health insurance options.  Please contact me if you have any questions.

It is great to be able to deliver good news.  My second shot is scheduled for March 31st!  New vaccine locations are being announced every day.  Be smart.  Be careful.


Picture – We Celebrate Good News – David L Cunix

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Leadership 2021

Congress has its fair share of villains.  You know their names because once elected they view being on television as important as breathing.  They may not actually do anything you or I might associate with legislating.  Their names are seldom connected to legislation that ever becomes law.  At best, they often seem to delight in their ability to prevent action.  You will see them on the Sunday morning shows bragging about the presidential appointees they have tried to block or the meaningless amendments they have offered in an attempt to clutter the process.  Other Congressmen are merely placeholders.  They carefully embrace anonymity.  Their weekly constituent emails extol the virtues of mom and apple pie and hope like heck that they are never called upon to exhibit leadership or to take a stand on a controversial issue.  For them, reelection is the only goal.

I would rather focus on the heroes.  And yes, Congress does have heroes, individuals who view their election as an opportunity to devise legislation that could help their constituents.  I introduced my readers to Representative Lauren Underwood (D-IL) this past July.  She drafted H.R. 4996, Helping Medicaid Offer Maternity Services (MOMS) Act of 2019 as a freshman Congresswoman.   Her legislation was designed to expand Medicaid services a full year postpartum.  The logic was clear.  “The majority of pregnancy-related deaths happen after the day of delivery, and nearly one quarter of deaths happen more than six weeks postpartum.”  It took a nurse to bring this to Congress’s attention.  And now, the American Rescue Plan Act of 2021 includes her legislation!

The current COVID relief package includes several other provisions to help Americans acquire health insurance, the way most of us access and pay for health care.

Tax Credit Subsidy

The Patient Protection and Affordable Care Act (Obamacare) was designed to help people purchase their health insurance.  The initial plan was to provide a tax subsidy starting with individuals earning 150% of the federal poverty rate that decreased in value until it ended with an income equivalent to 400%.  This has never been updated until now.  For the next two years the subsidy at the lower income levels has been increased and, and this is really important, it doesn’t cut off at 400%.  Many of my clients have had difficulty paying for insurance because they make just a little too much to qualify for a subsidy.  This is going to allow them to purchase a regular policy instead of short term major medical.


The COBRA regulation allows a former employee to retain the health insurance coverage he/she had from the previous employer.  The former employee must pay the full premium plus a fee of up to 2%.  The American Rescue Plan Act of 2021 will help laid off employees by paying the premiums through September.  This will allow some people to retain their coverage who might not have otherwise.

There are other provisions in the new law related to Medicaid and subsidy relief.  Much of the focus of the new COVID relief package will be on the stimulus checks coming to American families by the end of this month and the enhanced unemployment checks.  Others will focus on the fact that no Republicans voted for the bill, even after some of their amendments were included.  My focus is on health insurance and our elected representatives who are trying to make things better.  That’s leadership.


Picture – Visiting The People’s House – David L Cunix


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