The federal Patient Protection and Affordable Care Act (aka PPACA/Obamacare) will go into effect in January of 2014.
It's a hopelessly confusing mess of non-reform foisted off on America by the health insurance combines, and corporate Democrats like Obama sign off on mass rip-offs like this one, which is not only a rip-off but a mandatory one. You can’t opt out. And neither can Mendo.
According to the agenda packet for the Tuesday April 9 Board of Supervisors meeting, “Key issues include: Nearly all US citizens and legal residents will be required to have qualifying health insurance coverage or pay a tax penalty; Health Insurance Exchanges will be run by states, the federal government, or through a federal-state partnership; US Supreme Court decision effectively allows states to decide whether or not to expand Medicaid.
“In California, Governor Brown convened an Extraordinary Session of the Legislature to prepare for implementation of the ACA including the optional Medicaid (Medi-Cal) expansion. Health Care Reform, when implemented, will impact health benefits provided to our employees and dependents. It will also impact services to clients of the Health and Human Services Agency and Child Support Services, as well as State and Federal funding streams. When PPACA takes full effect, it is estimated that approximately one million more people will be eligible for Medi-Cal by expanding coverage to adults of up to 138% of the federal poverty level. The Governor’s proposals for Medi-Cal expansion will have significant implications for the manner in which County health programs are administered and for Mendocino County as a whole.”
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“The internal County Health Care Reform Working Group has identified potential areas for heightened risk exposure, including Impacts to the County-run health plan; Managing utilization of extra-help employees with regard to employee benefits; Administration of health programs for new eligibles; New training and legal requirements for Medi-Cal eligibility workers in HHSA; Expanded county behavioral health responsibilities; and Impacts to Child Support Services clients.
Obamacare: “Requires most US citizens and legal residents to have health insurance; creates state-based Health Benefit Exchanges for the sale of individual and small business health coverage; provides premium and cost-sharing credits to individuals/families with income between 133-400% FPL (Federal Poverty Level); requires employers to pay a penalty when their employees receive tax credits for health insurance through an Exchange (exceptions for small employers); imposes new regulations on health plans in the Exchanges and in the individual and small group markets; expands Medicaid eligibility to cover single adults under age 65 up to 138% of FPL.”
There’s also a flood of attached background materials. Here are some typical excerpts:
• “There are numerous potential challenges and ‘known unknowns’ that could arise for Mendocino County during the implementation process over the next nine months.”
• “In late February of 2013, the California Legislative Analyst’s Office (LAO) produced an extensive report, Examining the State and County roles in the Medi-Cal Expansion, analyzing Governor Brown’s proposals to expand Medi-Cal. The LAO also reviewed the two proposals put forth by the Governor to achieve the legally required, and successful, implementation of the Affordable Care Act. The following is an excerpt from the 1-page Executive Summary in the LAO Report: ‘We also find that the state is in a better position than the counties to effectively organize and coordinate the delivery of health services to the newly eligible population – potentially resulting in improved health outcomes and administrative efficiencies. As a practical matter, we also believe the state is better positioned than the counties to successfully implement an expansion by January 1, 2014. We recommend the Legislature adopt a state-based expansion, shifting the fiscal and programmatic responsibility of providing health care to the expansion population from counties to the state. Given this shift of responsibility, we further find that implementation of a state-based approach results in the need for a reexamination of state-county funding arrangements for indigent health care. Accordingly, we recommend the Legislature redirect a portion of funding currently allocated to counties under 1991 realignment for indigent health’.”
This last recommendation from the state Legislative Analyst’s office is not being implemented.
California counties, many of them understaffed and undertrained, and inexperienced in the intricacies of the ever-more complicated health insurance industry, are having reams of new rules and requirements dumped on them, which, in turn, will be implemented in 58 different ways (in California alone), making certain aspects of insurance coverage and eligibility vary from county to county.
This in turn means that on top of all the burdensome new requirements there will be differences in coverage if you move from one county (or state) to another or if your income goes up or down.
Mendo currently has 21,000 Medi-Cal “clients,” plus 1,700 enrolled in the soon to be defunct Healthy Families program, and 3,000 in equally nearly-defunct CMSP program, totaling about 25,700. All of them will have to be re-evaluated to see which crack they fall through, er, which program they will be shifted to.
Among the dozens of new requirements is one which requires the County to “provide health benefits to all employees working an average of 30 hours per week.” According to the County review, the “status” of this requirement is: “Health benefits are currently offered to all part-time employees working 16 hours/week. Human Resources has established 12 month “look back” period for defining part-time/extra help average work hours for purpose of qualifying for health benefits. County policy to restrict extra help and seasonal employees hours to 1,508 hours per Calendar Year beginning Jan 1, 2013. HR analysis on extra-help workforce for FY2011/FY2012 completed and distributed to Dept Heads Sept 2012. Dept Heads responsible for monitoring its extra help hours with HR oversight. Penalty not triggered if coverage offered to at least 95% FTEs (aver 30+ hrs/wk). Annual penalty [for employer non-compliance] significant — estimate $2,218,000 ($2,000 x 1,109 workforce as of 1/19/13).”
And don’t forget “County responsibility for delivery of behavioral health services to the expansion population” which “will occur as a result of 1991 and 2011 Realignment statutes, which transfer these responsibilities to counties. Behavioral health service demands are expected to increase and put pressure on county systems resulting from the following:
-Needs of the low income adult expansion population
-Needs of jail inmates and those paroled/released
-Federal parity requirements for mental health and substance use disorder services
-Essential benefits package requirements
-Lack of provider capacity.”
Translation: The County must now go to a huge amount of extra work to bring inmates, parolees and probationers, adult and juvenile, into the bureaucratic mess that is Obamacare. This “client population” presents unfathomable difficulties, which will necessitate hours of burdensome and difficult administrative time to unravel for a relatively small group of, well, frequent flyers.
Summary: Obamacare is an unmitigated bureaucratic nightmare of categories, incentives, requirements, penalties, tax loopholes and new insurance jargon which takes the existing healthcare mess and makes it messier while turning over billions of tax and private dollars to the insurance industry for pretty lousy health insurance (high deductible and co-pays are expected to make actual healthcare out of reach of many of the people it mandatorily “covers.”
As mentioned above, much of the implementation work is being pushed down to counties where the difficulties will be compounded. To rub this mess in everyone’s face, especially for small counties like Mendo, which is expected to become insurance experts in a matter of months, Obamacare sarcastically mandates that states and counties “Adopt standards for financial and administrative transactions to promote administrative simplification.”
Single-payer health care, i.e., Medicare without the 65-year minimum, would have not only eliminated all the insurance monopoly’s folderol, coverage limits, and expense, but would not require any of these preposterous new layers of government bureaucracy, nor burden counties with whole new levels of unreimbursed requirements. But Obama and the Democratic Party took Single-Payer “off the table” before the discussion even began and here we are.
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The Brooktrails Subdivision outside of Willits continues to create financial and bureaucratic tensions and problems for the County because the thousands of small, unbuildable, unmarketable Brooktrails lots have become nearly worthless and a substantial (but still unknown) amount of property taxes are going unpaid (and the lots don’t even sell in low-cost tax lien sales which in the past allowed the County to collect back taxes and penalties, years after the fact). But the County still has to pay the taxes and fees to the Brooktrails District (under the so-called “Teeter Plan) because when the lots don’t sell, the County has to front the tax money and the service fees to Brooktrails.
At their last Board meeting on March 26, after considerable and somewhat tense discussion, the Board of Supervisors directed staff to “develop and bring back to the Board a method to cost-effectively discontinue the Teeter Plan’s relationship with the Ad Valorem property tax for the BTCSD.”
But staff — especially Auditor-Controller Meredith Ford — doesn’t think there’s a cost-effective method to do it. And Supervisor Pinches remains unconvinced that it’s even necessary.
According to County Treasurer-Tax Collector Shari Schapmire in a staff report for this week’s Board meeting, “Public auctions are routinely conducted on an annual basis and the offered parcels primarily consist of properties located in the Brooktrails Subdivision. The Brooktrails Subdivision contains approximately 6,000 parcels, of which 4,216 parcels remain unimproved vacant lots. From time to time, the tax collector has experienced difficulties in selling the vacant lots at public auction; prior to 2007, most of the vacant lots eventually culminated in a successful sale of the property. Even with full disclosure of the water moratorium imposed by the California State Department of Health Services in February 2003, vacant lots would intermittently sell at public auction. However, since the recession of 2007, there has been a notable increase of Brooktrails parcels that appear to be unsellable. … The 2011-12 outstanding delinquent taxes and direct assessments as of March 19, 2013 are $243,065, which equates to slightly under 10% of the total outstanding delinquent taxes and direct assessments amount for the year ($2,697,425). This amount represents outstanding taxes on both improved and unimproved parcels; to date, Brooktrails parcels with improvements seldom make it to the public auction process. … Important to note: prior to January 1, 2012, staff in the Assessor’s Office examined the assessed valuations on every vacant lot located in the Brooktrails subdivision; through this process, as well as change in ownership evaluations, assessed valuations on numerous parcels have been drastically reduced. The assessed value and subsequent property tax decline are reflected in the 2012-13 fiscal year. Through this process, in a comparison between 2011-12 and 2012-13, it is not uncommon to see an unimproved Brooktrails parcel have a decrease in annual property taxes by $200 to $300. Data on 2012-13 delinquent property taxes will be available after June 30, 2013.”
In turn, Auditor-Controller Ford advises against even trying to solve the problem: “The short update is: I don’t believe there is a cost effective method to remove these three taxing entities [Brooktrails Community Services District; Brooktrails Maintenance District and Brooktrails Maintenance District 1976-1] from the Teeter Plan.” Ms. Ford goes on to say that the amount of staff time necessary to figure it all out isn’t worth the potential savings that would result.
Supervisor Pinches said at the March 26 board meeting that he thinks the whole issue should be dropped. “The house is not on fire with Teeter,” said Pinches, basically saying that the County isn’t losing that much money by having to front taxes to the Brooktrails District on the delinquent properties without being reimbursed when the lots don’t sell. “A little money might be saved,” added Pinches, “but it could put Brooktrails out of existence — it would pretty much devastate the Brooktrails Fire Department. … Sales went up this year, and more will happen next year. If it gets worse, we can re-evaluate, but I don’t support [removing Brooktrails from the tax rolls so that the County no longer has to pay the taxes and fees].”
But Pinches may well be in the minority at the moment. Supervisor John McCowen thinks there’s more to it than just the basic numbers and that a lot of County tax money is going to Brooktrails that isn’t reimbursed.
Back on March 26 McCowen said he didn’t think all the components of the problem were on the table. In addition, McCowen said, “We have an outmoded computer system here that speaks an antiquated language that no one here speaks anymore. The one employee that we had who did speak that language retired a year ago. … A new system would allow the County to get the information. The current system impedes employee work.”
So McCowen wanted to form an ad hoc committee to deal with the Brooktrails question because to him, “Teeter is still a problem. Tax delinquent parcels are increasing,” and, McCowen said, he didn’t agree with Ms. Ford that it wasn’t worth putting in $17k of staff time to figure out what should be done: “The County put out $171k in taxes, plus $75k in water and sewer last year [although the water and sewer fees have apparently already been taken out of the County’s obligation]. But there’s still that $171k. We can identify the lots; and, doing the math, we could save $79k or more, rough cut. I think there’s more than $17k in savings.”
So far it appears that Supervisor Gjerde tends to agree with McCowen that something has to be done about the Brooktrails problem, including consolidating some of the smaller lots. Supervisors Dan Hamburg and Carre Brown have not yet taken a clear position on the Brooktrails question but they may have to soon.
This Tuesday, the argument will become sharper as the Board again debates whether to form an ad hoc Brooktrails committee, especially since it would require ordering Auditor Ford to do something she, an independent elected official, opposes.
In addition, historically, ad hoc committees include the Supervisor of the affected Supervisorial district, in this case, Pinches, who is against the ad-hoc committee entirely.
If they form an ad hoc committee, they’ll probably have to figure out some way to include both the very reluctant Ms. Ford and members of the Brooktrails Board of Directors in the process, all of whom will tend to be in the Pinches camp, opposed to even addressing the question.
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