Tag Archive: Health Insurance Exchange


The doctor was quick and to the point. “After all our tests, we believe an experimental drug, consisting of cells manufactured and implanted in the eye to stimulate optic nerve growth and activity, might be the best method of fighting your symptoms. We would require approval from the Food and Drug Administration (FDA) via a compassionate use request that allows experimental drugs to patients outside clinical trials. But getting access to not-yet-approved pharmaceuticals via a compassionate use request is both arduous and challenging.”

What the doctor implied but did not say was, “You will go blind in your left eye because you are not a VIP and associated costs are bigger than the ‘Big Mac Combo Meal 1’ range. Also, you are likely to expire before receiving therapy approval. and, since most experimental treatments rarely work on dying patients, ‘compassionate use’ requests from patients like you become ‘compassionate not.’ In the end, you can still get to heaven with one eye. Ensure you look left and right before merging and change lanes accordingly.”

While paying the $40 copay, I saw Trump’s photo op in front of Walter Reed Medical Center. America’s chief dude made what media sources claim was a ‘photo-up’ by leaving his hospital suite to make a “surprise” drive-by to supporters while undergoing COVID-19 treatment. Trump’s drive-by triggered both safety concerns, outrage, and giving the middle finger to the more than 208,000 Americans who perished. The joyride only occurred because our chief asshole received medical treatments the poor working slob on Mainstreet, U.S.A., will never obtain.

Before the president left the White House for Walter Reed Medical Center, he received a single dose of Regeneron’s polyclonal antibody cocktail. This experimental drug has shown promise in initial trials in improving symptoms and reducing virus levels in the body but has not received Food and Drug Administration approval. Trump was also treated with Remdesivir, an intravenous antiviral medication shown to help treat COVID-19. Remdesivir’s benefits are modest: reducing hospital stays from 11 to 15 days.

For those with insurance, Remdesivir will top $3,000. How much-uninsured patients would pay remains unclear. Regeneron’s cost has not been publicly shared, but suffice to say it will not be in the ‘Big Mac Combo Meal 1’ range.

Trump’s a ‘Very Important Person (VIP),’ I am not. VIP treatment is a feature of American medicine. Major hospitals throughout the country provide private spaces for celebrities, the super-rich, and the influential. These are the patients who get shielded from the public. VIP’s include foreign nationals from places including Saudi Arabia, China, Canada, and Mexico.

The real coronavirus war cannot be flouted in a presidential joyride victory lap. Memorable scenes of community hospitals fighting on the front lines from California to Maine depicted medical centers nearly overwhelmed by desperately sick people. They are pictures of doctors and nurses working around-the-clock with insufficient equipment. And as of now, there are at least 208,000 COVID victims who cannot take a celebratory joyride. These 208,000 are alumni of the Big Mac Combo Meal 1.

I hope Tuesday, November 3rd, the remaining Big Mac Combo Meal 1 alumni will remember this joyride. I also hope the alumni remember this probably started during Trump’s introduction of  Supreme Court nominee Judge Amy Coney Barrett — the same judge who will likely assist in overturning the Affordable Care Act. That means for Big Mac Combo Meal 1 alumni members. Get it now?

November 3rd.

Screen-Shot-2012-08-20-at-6.17.36-PMWhen America’s thirty-fourth president, Dwight D. Eisenhower, began his administration, he instructed his aides and his executive assistant that there should be only two stacks of papers placed on his desk in the Oval Office. The first would be a stack of those things that were urgent, and only the extremely urgent. The other was to be a stack of the important, and only the extremely important. Years later, Eisenhower commented his bewilderment at how many things were extremely urgent, but never very important.

I think of Eisenhower as I close my time helping to implement parts of the Affordable Care Act. Due by October 1st, Healthcare Insurance Exchanges across the country are estimated to enroll 7 million new healthcare applicants by March 0f 2014, with 24 million new recipients total by 2015 or 2016. In short, that’s a whole lot of new members in such a short period of time.

Of course complications have occurred throughout my tenure on this project. Failures have occurred on all leadership levels. Texas, Arizona, Alabama, Missouri, Oklahoma and Wyoming have all notified the federal government that they will not be policing the health law.

Missouri has prohibited active involvement by most state agencies. If you’re in Missouri and want information on the health insurance exchange, good luck in finding it.  Missouri also requires insurance counselors to get state licenses before they can help people search for health plans on an online marketplace. The counselors must be trained by Oct. 1, but the state has no regulatory framework to license the insurance navigators. Even if it can quickly create a licensing structure, the law bars insurance navigators from recommending specific plans. Additionally, if Missouri insurance regulators decline to approve any exchange health insurance plans because of concerns about the anti-exchange law, it’s not clear what plans an HHS exchange will be able to sell in Missouri.

In Texas, John Greeley, a spokesman for the Texas Department of Insurance, said his agency cannot enforce regulations tied to the federal insurance exchange or market reforms because it is not authorized to do so. Texas, along with Arizona, Alabama, Missouri, Oklahoma and Wyoming have notified the federal government that they will not be policing the health law.  Texas’ decision will create an “administrative burden” for insurance plans and could result in confusion for Texans who purchase health insurance under the federal exchange.

So when I think of all this, the conflict between the urgent and the important is inescapable. It is common for us to think that by staying busy and working hard to implement something important, leadership fails. Our ego and rarely represents the things most important. And therein lies the reason so many people today feel such a lack of satisfaction after working so hard for so many people. When we substitute the urgent for the important work, exhaustion replaces satisfaction.

Urgency is a dance. In horizontal perspectives of Texas, Arizona, Alabama, Missouri, Oklahoma and Wyoming, urgency of the ego has taken center stage. Yes urgency of the ego is popular. But rather than solve problems, it’s intended to drain time, energy and attention. It’s an all-too familiar voice in everyone’s life.

For Texas, Missouri and others like them, it is important to remember virtue, good conduct, morality needs to be based upon the key fundamental principles:

  1. The principle of equality. That means all living entities are equal; and
  2. The principle of reciprocity: This is the “Golden Rule” in Christianity — to do onto others as you would wish them to do onto you. It is found in all major religions.

For those caught in the urgency, “Are you really following the “Golden Rule.“” What is the voice to whom you listen?

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