Posts Tagged With: United States

Appeal Denial Of Disability Benefits Until You Get Approved

English: A collection of pictograms. Three of ...

English: A collection of pictograms. Three of them used by the United States National Park Service. A package containing those three and all NPS symbols is available at the Open Icon Library (Photo credit: Wikipedia)

Social Security Disability Insurance (SSDI) is a federal entitlement created in 1956 as an insurance plan for long-tenured workers with the misfortune of becoming disabled before retirement. Today, the program has ballooned into a $135 billion behemoth threatening to collapse under its own weight. Left unchecked, decades of loose standards and poor enforcement may cause a collapse of the system that would culminate in thousands — if not millions — of deserving recipients being deprived their rightful benefit.

Federal disability insurance began from humble beginnings, but unfortunately, over time, has grown dramatically, and today the fastest-rising cost for Social Security is not retiring baby boomers, but skyrocketing disability insurance benefits. In 1970, the disability insurance program was financed with a payroll-tax rate of only 0.8 percent of wages. Today, the cost of SSDI has tripled relative to the 1970 level with disability benefits now making up 18 percent of all Social Security costs. This is a marked difference from 10 percent in 1990. The number of people on SSDI in 2012 exceeded the entire population of New York City at more than 8.7 million participants.

The biggest contributing factor has been the ease with which benefits can be obtained. While it is tempting to blame the aching knees and backs of an aging population, the truth is that American workers are healthier and fitter today than they were when SSDI was in better fiscal shape. Instead, the answer is the program has grown soft around the middle for three reasons: low standards, enticing benefits and far too little control over its own screening process.

It is unfortunate that the disability insurance program has morphed from a program for permanently disabled workers with a substantial work history who were over the age of 50 to a rapidly growing program covering an increasing number of marginally disabled workers.

The screening process of approving SSDI applicants, once run by the Social Security Administration, has been foisted upon a system of appeals run by an overworked and underregulated network of administrative law judges (ALJ). In this system, a growing amount of applicants and their well-practiced lawyers have come to treat initial approval-or-denial of benefits as merely the first stop on the way to an appeal, where the odds of success are higher. Worse, these lawyers face badly orchestrated incentives that can cost taxpayers dearly.

Part of the solution for rising disability costs is to refocus benefits on the most disabled individuals, coupled with incentives for employers to keep disabled people working. In 2010, one out of every 50 working Americans applied for federal disability benefits. Furthermore, with a challenging employment market, this program has also functioned as a fallback for workers without employable skills. Only half of those who enter the disability rolls will ever return to the workforce.

The expansion of this program is troubling even in a booming economy. In a country with a nearly $17 trillion national debt the fiscal unsoundness of this program is even more alarming. The program is growing faster than the payroll-tax revenues that fund it, and the Congressional Budget Office predicts that the SSDI trust fund will be entirely depleted by 2016. At that point, barring legislation to further fund SSDI, the program will be forced to begin paying smaller benefits, or will raid another program such as Social Security’s Old Age and Survivors Insurance trust to cover the balance.

Grappling with the problems posed by a rapidly expanding SSDI system would be simpler if it were the case that the working-age population had simply gotten older and less able to earn a living. Instead, the principal drivers of SSDI growth are a loosening of eligibility requirements, increasingly attractive benefits and an application process that has become incapable of distinguishing between truly disabled workers and those who should be rejected. Together, these three factors have combined to create a modern SSDI program very different than the one envisioned by its architects. Going forward, it is essential that Congress take significant steps to rein in SSDI’s growth. Those changes will inevitably be decried as insensitive and unjust, but they are essential. To do nothing — to continue to prioritize the able-bodied over the truly infirm — is far worse.

By MacMillin Slobodien , an executive director of Our Generation, a nonprofit advocacy group, which is launching the Reform SSDI Now project.

Categories: Social Security Benefits | Tags: , , , , , , , , | 1 Comment

Serena Williams Is Queen Of The Clay Court

 Sobbing Serena booed by French in 2003

Serena Williams broke down in tears last night after being booed at the end of her semi-final at the French Open.

The world number one was given a hostile reception as she
was knocked out of the championships in Paris by Justine Henin-Hardenne,
of Belgium, in three sets, 6-2, 4-6, 7-5.

 

Justine Henin-Hardenne at the 2006 Medibank In...
Justine Henin-Hardenne at the 2006 Medibank International, 12 January 2006 (Photo credit: Wikipedia)

Williams was booed every time she questioned a call, even
when justified, and, towards the end, every first serve she missed was
greeted by loud cheers.

Defeat not only cost her the title she won last year but
ended her run of four consecutive Grand Slam titles. “I’m not used to
crying but it’s a little difficult,” said the 21-year-old, whose elder
sister Venus went out earlier in the tournament.

She said she did not believe the crowd’s reaction was the
result of anti-American feeling in France. “Sometimes they just want the
underdog to win,” she added.

After initially denying that the crowd had made it harder
for her,
she stopped and added: “That’s a lie, it does make it harder. I
just have to be a little stronger next time.” Williams, who
side-stepped a suggestion that race might also have been a factor, said:
All my life I’ve had to fight and this is just another fight I have to
win”.

 

She said she would return to her home in Florida to work on
her serve. “I enjoy the challenge and I look forward to my next
tournament at Wimbledon.”

THAT WAS THEN 2003. THIS IS NOW 2013.

 


PARIS – The look in her eyes said “don’t mess with me” and no one
dared to cross Serena Williams during an unforgettable French Open
fortnight when the American proved she “really, really wanted” the title
“more than anyone else”.

 

Just how much she wanted it was clear for all to see when at
5.02pm local time on Saturday the world number one fired a lethal
198-kph ace, tossed her racket, sunk to her knees and arched back to let
out a primal roar that went on and on and on.

 

The guttural howl that marked her 6-4 6-4 win over 2012 champion
Maria Sharapova
was so loud that perhaps even her 71-year-old father
Richard
could hear it back in the United States.

As his youngest daughter added more silverware to the family’s
overflowing mantelpiece, a 16th singles grand slam trophy no less,
Serena was left to reflect on a journey 11 years in the making.

When she hoisted the Suzanne Lenglen Cup for the first time in
2002, little did she know she would have to wait until 2013 to
experience the joy of winning the claycourt major again.

 

 

 

“After 11 years it’s incredible. I want to come back here and win
again. I think I’m Parisienne,” a delirious Serena told the crowd in
French after becoming the oldest woman to win the title since tennis
went professional in 1968.

The last time she triumphed at the spiritual home of claycourt
tennis, the 31-year-old American turned out to be an unstoppable force
as she went on to complete what she dubbed the “Serena Slam”.

After conquering the surface that is considered to be her
weakest, it could well be game on for yet another “Serena Slam” as she
is now on an astonishing 31-match winning streak following her humbling
of Sharapova.

The top seed, who flashed up 10 manicured fingers and then six
more on Saturday to signal her total grand slam haul, completed a
remarkable turnaround from 12 months ago when she surprisingly perished
in the first round.

“I’ve always said a champion isn’t about how much they win but
it’s about how they recover from their downs, whether it’s an injury or
whether it’s a loss,” said Serena who is already guaranteed a place
among the all-time greats.

“I think that really creates a real champion. My winning appetite
is really high. I definitely want to continue my journey to get a few
more.”

Since that shock 2012 defeat Serena has scooped up titles at
Wimbledon, the Olympics, the U.S. Open and now Paris. She has also
climbed to the top of the rankings and has an incredible 75-4 win-loss
record
in the past 12 months.

Sharapova succumbed to her for the sixth time in a year on
Saturday as Roland Garros hosted a final between the world’s top two
women for the first time in 18 years.

DREADFUL RECORD

The 26-year-old Russian, who was playing in the juniors the last
time Serena was flashing the victory sign in Paris, has come a long way
since she likened herself to a “cow on ice” on red dirt.

But if she wanted to block out her dreadful record against
Serena, she was in for a horrid shock because as she walked up for the
opening service game, the giant screen on Philippe Chatrier Court
flashed up “Face-to-Face: Williams 13, Sharapova 2”.

It was little wonder the Russian was 0-40 down within a blink of
an eye. But she somehow managed to blast her way out of trouble before
breaking for a 2-0 lead.

Greeting each one of her winners with cries of “Come On”,
Sharapova capitalised on early Serena errors to move within a point of a
3-0 lead.

The American simply glared, picked out her target and made the
statuesque 6-foot-2 (1.88-metre) Sharapova skid around like a giraffe on
ice as she smashed the ball away to break back.

Serena left Sharapova grunting, lunging and scrambling in despair
as she moved into a 4-2 lead but the second seed refused to roll over
and dragged herself level at 4-4 when her opponent sent a backhand wide.

But there was no reprieve for the Russian as Serena kept bombarding her half of the court with relentless baseline winners.

The American broke serve for a third time with a screaming forehand winner that flew past her outstretched opponent.

After sealing the opening set in 51 minutes it was only a matter of time before Serena moved full throttle ahead.

The world number one was less than amused when she failed to
convert five break points in the opening game of the second set but at
1-1 the pressure began to mount on Sharapova who surrendered serve with a
mis-hit backhand into the tramlines.

The 15,000 fans packed into Chatrier Court got firmly behind the
2012 champion as they lustily cheered her winners but all the support in
the world could not save her from flatlining to a 13th straight defeat
against Serena.

Serving for the championship at 5-4, Serena thundered a 190-kph
ace, boomed down a 195-kph ace and finally banged the 198- kph effort
that snuffed out Sharapova’s hopes.

“Getting to the Roland Garros final is not too shabby…I put up a fight today but it was not enough,” said Sharapova.

Categories: American History | Tags: , , , , , , , | 1 Comment

Former Social Security Medical Expert Sentenced To Two Years In Federal Prison For Fraudulently Bilking SSA Of $1.5 Million In Benefits

 

( Wed, 29 May 2013 10:46:43 PST)

SAN DIEGO (CNS) – Doctor  Roberto J. Velasquez, a clinical psychologist, from National City,CA was sentenced Wednesday, May 29th, to nearly two years in federal prison for fraudulently obtaining government disability benefits via a scheme in which the Social Security Administration was swindled out of at least $1.5 million.

While handing down the 21-month custody term in federal court in downtown San Diego, Chief District Judge Barry Ted Moskowitz also ordered Doctor Velasquez, 55, to repay the funds he illicitly obtained.

Over a six-year period beginning in 2006, Velasquez falsely certified that dozens of able-bodied patients were disabled, according to court documents.

To further the fraud, Velasquez made up patient histories, fabricated test results, suggested symptoms and complaints that did not exist, and intentionally underestimated patient scores on standardized tests, prosecutors said.

In exchange for each false report, Velasquez charged his patients a $200 kickback, according to the government.

In his plea agreement, the defendant, who was arrested in the case 13 months ago, admitted that he faked disability-exception forms used by the Department of Homeland Security during naturalization processes.

Doctor Velasquez’s false certifications allowed immigrants to avoid taking civics and English-language portions of the U.S. citizenship exam, prompting the Department of Homeland Security to grant exemptions to about 50 applicants who were not actually disabled.

According to court documents, Doctor Velasquez coached his patients to skirt the citizenship requirements by instructing them to use poor English during interviews and avoid mentioning that they had college educations.

He also lied, prosecutors said, about the length of time he had been treating his patients, in order to falsify a record that would satisfy reviewers at the Social Security Administration, where he previously had worked as a consultant. (He was probably an expert medical witness.)

In addition, Doctor Velasquez conceded that he submitted phony medical reports to the Social Security Administration, falsely certifying that certain patients were eligible for disability benefits when he knew they were not, and admitted that roughly one-third of his patient files contained false statements and bogus certifications of disability.

The fraud was uncovered through an undercover operation conducted by the Department of Homeland Security, Immigration and Customs Enforcement/Homeland Security Investigations and the Office of Inspector General in the Social Security Administration.

The prosecution was part of the U.S. Attorney‘s Health Care Fraud Initiative.

Categories: Social Security Benefits | Tags: , , , , , , , | Leave a comment

The Judge Who Could Not Say No

HUNTINGTON, W.Va.—Americans seeking Social Security disability benefits will often appeal to one of 1,500 judges who help administer the program, where the odds of winning are slightly better than even. Unless, that is, they come in front of David B. Daugherty.

[Judge_A1] The Herald-DispatchJudge David B. Daugherty

In the fiscal year that ended in September, the administrative law judge, who sits in the impoverished intersection of West Virginia, Kentucky and Ohio, decided 1,284 cases and awarded benefits in all but four. For the first six months of fiscal 2011, Mr. Daugherty approved payments in every one of his 729 decisions, according to the Social Security Administration.

The judge has maintained his near-perfect record despite years of complaints from other judges and staff members. They say he awards benefits too generously and takes cases from other judges without their permission.

Staffers in the Huntington office say he hears a disproportionate number of cases filed by one area attorney. Mr. Daugherty has been known to hold hearings for as many as 20 of this lawyer’s clients spaced 15 minutes apart.

Mr. Daugherty is a standout in a judicial system that has lost its way, say numerous current and former judges. Judges say their jobs can be arduous, protecting the sometimes divergent interests of the applicant and the taxpayer. Critics blame the Social Security Administration, which oversees the disability program, charging that it is more interested in clearing a giant backlog than ensuring deserving candidates get benefits. Under pressure to meet monthly goals, some judges decide cases without a hearing. Some rely on medical testimony provided by the claimant’s attorney.

This breakdown is one reason why Social Security Disability Insurance—one of the federal government’s two disability programs—is under severe financial strain. It paid a record $124 billion in benefits in 2010 and is on track to become the first major entitlement program to go bust. Government officials said last week it is expected to run out of money in 2018.

Social Security Disability Awards

The U.S. program’s tribulations come as other countries are trying to limit the costs of their disability programs. In the U.K., officials have proposed requiring routine re-evaluations of people with disabilities to see if their conditions have changed. Australia has proposed that some beneficiaries participate in job-training programs, with the goal of eventually moving them off government support.

American applicants for disability benefits must first seek approval from state officials, who play a lead role in an initial review. Applicants twice denied can then appeal to one of the Social Security Administration’s administrative law judges. The judges are appointed by the federal agency after a competitive exam and screening process.

Hearings, which aren’t open to the public because of medical-privacy rules, typically last an hour and include either the judge or the applicant’s attorney questioning the petitioner. Medical or employment experts can testify, too. Judges consider an applicant’s health, age, education and job prospects before making a legally binding decision.

The average disability-benefit approval rate among all administrative judges is about 60% of cases. But there are Daugherty equivalents dotted across the country. In the first half of fiscal 2011, 27 judges awarded benefits 95% of the time, not counting those who heard just a handful of cases. More than 100 awarded benefits to 90% or more of applicants, according to agency statistics.

Mr. Daugherty, 75 years old, processes more cases than all but three judges in the U.S. He has a wry view of his less-generous peers. “Some of these judges act like it’s their own damn money we’re giving away,” Mr. Daugherty told a fellow Huntington judge, Algernon Tinsley, who worked in the same office until last year, Mr. Tinsley recalled.

[judgeconn] Damian PalettaJudges and local attorneys have complained about the volume of disability cases brought before Judge Daugherty by one lawyer, Eric C. Conn.

Mr. Daugherty, in a written response to questions about the comment, said such a phrase is “more or less a standing joke” among disability-benefit review offices around the country. “No more, no less.”

He said every decision he makes “is fully supported by relevant medical reports and physical and/or mental residual functionary capacity assessments from treating or examining doctors or other medical professionals.”

When asked about Mr. Daugherty, Social Security Administration Commissioner Michael Astrue said in an interview there were several “outliers” among administrative law judges, but that he has no power to intervene because their independence is protected by federal law. Their appointments are lifetime.

“We mostly have a very productive judiciary that makes high-quality decisions, and we’ve got some outliers and we’ve done what we can,” said Mr. Astrue. “Our hands are tied on some of the more extreme cases.”

Social Security Administration officials acknowledge they are trying to clear a backlog of 730,000 cases. But they say they remain focused on ensuring taxpayer money isn’t wasted. “We have an obligation to the people in need to provide them their benefits if they qualify, but we also have an obligation to the taxpayer not to give benefits to people who don’t qualify,” Mr. Astrue said.

Following inquiries from The Wall Street Journal, the Social Security Administration’s inspector general’s office launched an investigation into Mr. Daugherty’s approval rate, according to several people briefed on the matter. Mr. Daugherty said he isn’t aware of any investigation.

Sholten SingerJudge Daugherty, left, an active member of the Huntington, W. Va., community, performed in a recent play.

Social Security, with an $800 billion annual budget, is one of the government’s largest expenses, and is best known for sending monthly payments to retired Americans. But it also pays disability claims for 18 million people each year, with numbers pushed higher because of the recent recession. The federal government runs two separate programs to assist people unable to work because of a debilitating mental or physical disability.

For some, applying for benefits can be an agonizing process that takes more than two years. Benefits are modest—they can run around $1,000 a month—but come with access to government-run health plans Medicare and Medicaid. Analysts estimate the total package costs $300,000 over a beneficiary’s lifetime.

To clear the backlog of cases, the Social Security Administration in 2008 pushed judges to move between 500 and 700 cases a year, something less than half of judges were managing at the time, according to Mr. Astrue, the commissioner. To compensate, judges began making many decisions “on the record,” which means they grant benefits to applicants without meeting them, hearing testimony or asking questions, according to several judges. This has been a favorite approach for Mr. Daugherty, people who have worked with him say.

Mr. Daugherty doesn’t dispute the characterization, and said in these circumstances he weighs “the evidence in the same manner as in cases requiring a hearing.” He said the process “saves the agency a great deal of money and work hours.”

The Social Security Administration “cares only about number of resolutions; quality is no longer a serious concern,” James S. Bukes, a Pittsburgh administrative law judge, wrote in a recent letter to the House subcommittee that oversees Social Security. Mr. Bukes, who approved 46% of disability applicants through the first half of this fiscal year, said the system “wastes millions of dollars by granting claims that are not meritorious.”

Mr. Daugherty became a Social Security judge in 1990 after serving as an elected Cabell County circuit court judge during he 1970s and 1980s. Born and raised in Huntington, he introduces himself as “D.B.,” according to program notes for a recent local production of “Titanic: The Musical,” in which Mr. Daugherty played John Jacob Astor. He’s also a devotee of karaoke.

“He is a very, very well respected man in the community,” said Nancy Cartmill, president of the Cabell County Commission. “He’s been there for years.”

In 2005, he reached 955 decisions, approving benefits in 90% of the cases. From 2006 through 2008, he decided 3,645 cases, approving benefits roughly 95% of the time. Last year, at 99.7%, he had one of the highest award rates in the country, and is on pace to award even more benefits in 2011, according to agency statistics.

As Mr. Daugherty’s numbers rose, judges, staff and local attorneys began complaining about the volume of cases brought before the judge by one Kentucky lawyer.

The lawyer, Eric C. Conn, runs his Social Security practice out of a collection of connected mobile homes in Stanville, Ky., where he erected a giant statue of Abraham Lincoln in the parking lot. His smiling face adorns billboards up and down U.S. Highway 23, and his slogan is “he gets the job done.” Mr. Conn hired Mr. Tinsley, the former Huntington judge, and promotes him on local billboards, too. Mr. Conn often brings an inflatable replica of himself to events. His website address is mrsocialsecurity.com.

Judges and staff in the Huntington office have complained to supervisors that Mr. Daugherty assigns himself Mr. Conn’s cases, including some that were assigned to other judges, two former judges and several staff said. Cases are supposed to be assigned randomly.

According to a court schedule of Mr. Daugherty’s day reviewed by The Wall Street Journal dated Feb. 22, 2006, Mr. Daugherty held 20 hearings spaced 15 minutes apart for Mr. Conn and his clients in a Prestonsburg, Ky., field office. Such days can be a bonanza for lawyers: The average fee for one approval is between $3,000 and $3,500 and can go as high as $6,000.

“The Conn situation was something we really harped on,” said Jennifer Griffith, a master docket clerk in the office until she left in late 2007. “We made sure management knew about it. We gave them every chance to come up with some sort of logical explanation or to get it to stop, and that never happened.”

Mr. Daugherty said he prefers a crammed timetable because he is dyslexic and must fit all of his hearings within four or five days each month because he “simply cannot spend that much time in the courtroom.”

Holding hearings within just a few days “allows me sufficient time to review and prepare for hearings, resulting in full and complete knowledge of the documents in the case prior to hearing,” he added.

Huntington’s chief administrative judge, Charlie Andrus, said he was notified on four occasions of Mr. Daugherty either taking cases assigned to other judges or taking unassigned cases. Mr. Andrus said he issued a written directive on April 29 that “no case was to be reassigned between judges by anyone unless I gave specific permission.”

Mr. Daugherty said he believed judges could take cases “so long as no other [administrative law judge] had seen or reviewed the file.” He said he was “recently reminded that that is no longer true and I promptly returned the cases to the original assignees.”

Stephen Sammons, 37, of Mavisdale, Va., said he injured his neck and back in a truck accident in 2001. He continued working until 2008 when the pain became unbearable, he said. He quit his job and filed for disability benefits.

Several doctors authorized by the Social Security Administration to look at his injuries disputed his claim that his condition was caused by the accident. He retained Mr. Conn, and the case ended up before Huntington judge Toby J. Buel Sr., who rejected the claim in February 2010.

Mr. Conn resubmitted Mr. Sammons’ claim, and Mr. Sammons said he was surprised when Mr. Conn’s office called and said he wouldn’t have to appear before the judge and would only have to see a doctor, selected by Mr. Conn. The new medical records were filed to Mr. Daugherty, who approved the case without Mr. Sammons having to appear.

Mr. Daugherty declined to comment on the case.

A possible connection between Messrs. Daugherty and Conn is a subject of the inspector general’s investigation, according to two people familiar with the probe. Neither Messrs. Conn or Daugherty have been accused of wrongdoing. Mr. Daugherty said he has “absolutely not” received anything of value from Mr. Conn or his associates for processing the lawyer’s cases. He said he has denied a “goodly number” of Mr. Conn’s cases over the years, though he couldn’t provide a specific figure.

Mr. Conn declined multiple interview requests, and didn’t respond specifically to written questions. In a statement, he said he had “not been contacted by any one indicating any investigation being conducted.”

He added: “I have tried very hard in my 18 years of being a lawyer to represent my clients and the profession honestly and ethically seeking results based on the merits of my client’s cases and the results that come from hard work and not from any improper conduct.”

Some former judges and staff said one reason Mr. Daugherty was allowed to continue processing so many cases was because he single-handedly helped the office hit its monthly goals. Staff members can win bonuses and promotions if these goals are surpassed as part of performance reviews.

Dan Kemper, who began working as a judge in the Huntington office with Mr. Daugherty in 1990, said the Social Security agency’s management refused to intervene because of the numbers Mr. Daugherty delivered for the office. He said he complained for years about the number of cases Mr. Daugherty approved without interviewing applicants. Mr. Kemper, who was known in the area as “Denying Dan” for his relatively strict approach, retired in 2007 because he felt the system was unfair.

“The only way you could really get that many cases out was to grant them all, because it was so much easier,” Mr. Kemper said.

In late April, the Huntington office held 50 of Mr. Daugherty’s cases—all approvals for Mr. Conn’s clients—so they could be processed in May, because the office had already hit their monthly goal, people familiar with the matter said. Those applicants will have to wait an additional month to receive benefits. Mr. Conn, who receives a percentage of the back pay owed to his clients, will collect more fees because of the delay. The Huntington office will get a head start on the next month’s target.

Mr. Daugherty said cases are held to space out his approvals, which he attributed to “the ‘numbers game’ that most, if not all, federal agencies are subject to.”

Mr. Andrus said cases weren’t held to meet monthly numbers. He said Mr. Daugherty’s cases can be held because other applicants might have been waiting longer for benefits and those cases might take priority.

In a brief telephone interview in April, Mr. Daugherty blamed high poverty rates especially in Eastern Kentucky for his large case load and high approval rate.

“People would really be surprised at how little education those people have,” he said. “If they have a fourth-grade education, they couldn’t get a job if their lives depended on it.”

Written by Damian Paletta, WSJ, at damian.paletta@wsj.com

Categories: Social Security Judges | Tags: , , , , , , , , | Leave a comment

The Judge And His Husband

Border Guards Picked on the Wrong Judge And His Husband

By MATT REYNOLDS

May 20, 2013

LOS ANGELES (CN) – An administrative law judge (ALJ) for the NLRB and his husband sued U.S. Customs and Border Protection for $3 million, claiming an officer asked to see their marriage certificate at the border, and assaulted them when they complained.

 William Kocol and Timothy Gajewski sued Several Unnamed U.S. Customs and Border Protection Officers in Federal Court, alleging assault and battery, unlawful detention, slander, intentional infliction of emotional distress, and constitutional violations.

Koco

English: CBP Officer badge

English: CBP Officer badge (Photo credit: Wikipedia)

l, an administrative law judge (ALJ) for the National Labor Relations Board (NLRB), and Gajewski, an architect, were legally married in Beverly Hills in 2008.

English: Color logo of the National Labor Rela...

English: Color logo of the National Labor Relations Board, an independent agency of the United States federal government. (Photo credit: Wikipedia)

They claim that CBP officers singled them out in December 2012 at Los Angeles International airport after a trip to Puerto Vallarta, Mexico.

After Kocol handed a Customs officer a Customs card “indicating that he was the ‘head of household,’ and was traveling with one family member,” the plaintiffs say they were asked to explain their relationship.

“Plaintiff Gajewski said ‘husband’ and then plaintiff Kocol also said ‘husband,'” the complaint states.

The officer “shook his head in disapproval and after a few seconds plaintiff Kocol said, ‘Yes, this was California and we are legally married,'” according to the complaint.

The officer asked to see their marriage certificate, and refused to allow them to enter the United States, the couple says.

“At that point plaintiff Kocol asked to see his supervisor and plaintiff Gajewski said that he was sure that CBPO ‘A’ does not ask a straight married couple to produce a copy of their marriage certificate,” the complaint states.

The plaintiffs say the officer motioned for the next man and woman in line to step forward. Kocol and Gajewski protested, and were soon surrounded by five armed CBP officers and separated.

Kocol claims that one of the officers “put his right hand against plaintiff Kocol’s upper back, grabbed his left hand and began to forcefully push him into the room.”

Inside the room, the officer “twisted him around and pushed him down into a row of chairs, to his great personal discomfort,” the complaint states.

Gajewski told CBPO Officer D: “‘This is bullshit; do you treat every married couple this way?’ ‘This is my government being homophobic.'”

When Gajewski walked toward the room where Kocol was detained, the CBP officer “grabbed his wrist and twisted it backwards behind his back,” the complaint states.

The defendants returned Gajewski’s and Kocol’s passports after Kocol told them he was a federal judge, and that he intended to contact the Human Rights Campaign, and the Gay and Lesbian Center.

The plaintiffs say the officer who eventually processed their passports apologized, and told them: “‘Some people can’t seem to change with the times.'”

They seek more than $1 million in general damages, and more than $2 million in punitive damages.

They are represented by Scott McKee of West Hollywood.  

Categories: American History | Tags: , , , , , , , , , , | Leave a comment

Why Was Webster Smith Court-martialed?

U.S. Supreme Court building.

U.S. Supreme Court building. (Photo credit: Wikipedia)

Why was Cadet 1st Class Webster Smith investigated, charged, tried, and convicted? Why did he not find any justice in the military justice system? How could his case go through the entire appeal’s process and end up at the United States Supreme Court without being granted any relief?

At this point in history when America had come far enough to elect a Black President why was this shining example of the best and the brightest of the African Americans of his generation denied the equal protection of the law? Why was he relegated to the second rail of military justice? On the second rail one receives “almost equal protection“.  Like much else in the law, equal protection is a myth for America’s citizens of color. The myth gives one the illusion of fairness.

Could the answer have anything to do with the nature of the criminal justice system or the definition of crime?  Crime is a legal concept, and the law creates the crimes it punishes. But, what creates the criminal law?  Behind the law, above it, and surrounding it is our society. Before the law made certain behavior a crime, some aspect of social reality transformed certain behavior into a crime.

Justice is blind in the abstract. It cannot see or act on its own. It cannot create its own morals, principles and rules. That depends on society. Behind every legal determination of “guilty” lies a more powerful and more basic social and societal judgement, a judgement that this type of behavior is not acceptable. This type of behavior deserves to be prohibited and punished. Our society has long chosen to prohibit and punish interracial sex.

After society makes a social judgement that certain behavior, acts, or conduct is wrong, the criminal justice system goes to work. It refines and transforms the list of prohibited acts and behavior. It interprets the list of acts, and does whatever is necessary to catch, convict and punish the lawbreakers.

Bias is inevitable. Crime and punishment are highly charged, emotional, and political subjects. There is no way to wring prejudice, attitude, or race out of the system.

Is Justice truly blind? Is our Constitution color-blind? Supreme Court Justice John Marshall Harlan thought so. In 1896 he wrote “Our Constitution is color-blind”. He was the lone dissenter in the Case of Plessy v. Ferguson arguing that separate but equal facilities are inherently discriminatory. Justice Harlan was a voice crying in the wilderness that our Constitution neither knows nor tolerates classes among citizens.

The Webster Smith Case was a litmus test for military justice. Now, we know that Justice is not blind; The Constitution of the United States is not color-blind; and the Supreme Court is not color-blind. Justice peeks past the blindfold to see who stands before the Bar of Justice. And Justices of the Supreme Court peek to see who stands before the Bench. History has shown us that it does make a difference in the outcome of a case, whether the party who seeks relief is white or Black, male or female, rich or poor, educated or uneducated. Like most constitutional and justice “myths”, the claim of impartiality is truly a myth.

v.

WEBSTER M. SMITH, CADET, U.S. COAST GUARD

FILED UNDER SEAL[*]

MEMORANDUM ORDER AND OPINION FINDINGS OF FACT

During the summer training program at the start of their first class year, Cadet Smith and Cadet [SR] were both assigned to patrol boats that moored at Station Little Creek. Both lived in barracks rooms at the Station…she went on to state that on October 19th….she agreed to pose for a picture with him in which both of them were nude, and later that night allowed him to perform cunnilingus on her then she performed fellatio on him.

___________________________________

…. the Government’s objection that this evidence is inadmissible in accordance with M.R.E. 413 [sic] is SUSTAINED.

EFFECTIVE DATE

This order was effective on 26 May 2006.

Done at Washington, DC,

/s/

Brian Judge

Captain, U.S. Coast Guard

Military Judge

The Webster Smith case was a litmus test for justice in America. Every once in a while a case comes along that puts our humanity as a people, and as Americans, on trial. Everything that we profess to stand for as Americans was on trial. Our sense of justice in America and particularly in the U.S. Military was on trial. This was no ordinary trial. Our humanity was on trial. Our system of justice was on trial. This case dissolved the deceptive façade and exposed certain moral deficiencies in our system of justice. This case alone puts the legitimacy of the entire military justice system at risk.

This was not a sexual assault case. Webster Smith did not sexually assault anyone. What he did was engage in an act of consensual love making with a friend. He was charged and tried; his partner was not. Why not? They both violated the Coast Guard Academy Cadet Regulations by engaging in sexual activities in Chase Hall, the cadet barracks.

An article published in the New London DAY newspaper on 20 February 2008 entitled “Service Academies faulted in GAO report,”  stated: “In the summer of 2006, former cadet Webster Smith became the first student court-martialed at the Coast Guard Academy. He was acquitted of rape but convicted of extortion, sodomy and indecent assault.”

One might conclude that he was convicted of three of four charges. That is not correct. The truth is that of the 10 charges referred to the general court martial, Webster Smith was acquitted of one charge of rape, one count of extortion, one count of sodomy, one count of indecent assault and one charge of assault (five of 10 charges). All findings of guilty cited in the article related to one female.

That is only part of the story. The incidents related to Webster Smith were publicly announced as 16 pending charges in mid-February 2006. These charges concerned five women. In early 2006 the Coast Guard Investigative Service  (CGIS) began an investigation related to yet another woman (SR) and Webster Smith. This resulted in six additional charges, filed in March 2006. An Article 32 Investigation resulted in dismissal of 12 of the 22 charges.

This means, 17 of 22 charged allegations were dismissed prior to trial (12 dismissals; five acquittals).(Merle J. Smith Jr.,Esquire, Individual Military Attorney for Webster Smith.

Waterford, CT.)

One Judge on the Coast Guard Court of Criminal Appeals found that former cadet Webster Smith was denied a fair trial and that the case should have been sent back to the trial court for a new trial. He found that the Case of United States vs Webster Smith should have been returned to the Convening Authority for a new trial.

The Judge found so many discretionary errors in the court-martial proceedings that he had no choice but to rule that Webster Smith had been denied a fair trial.

It was a classic case of “he-said, she-said”. The trial came down to simply a credibility issue. The big question was who was telling the truth and who was not.

This was a question for the jury to decide. It was a fact question. The jury is the trier of facts. The court-martial judge (CAPT Brian Judge) went to extraordinary lengths to keep the question out of the hands of the jury. He took it upon himself to decide the issue of credibility. That is why Webster Smith was convicted.

The jury had no idea what the real issue was. They were kept in the dark. They were not given proper instructions. The judge decided who was the more credible witness. The judge abused his discretion.

The judge went beyond the authority and power delegated to him under the Uniform Code of Military Justice (UCMJ), and the Federal Rules of Evidence. Webster Smith was denied his Sixth Amendment Rights.

One does not have to read the Appeals Court decision to know that an accused at a court-martial has a right to cross-examine the witnesses against him. Anyone who has watched Perry Mason or Tom Cruise in the movie “A Few Good Men”, would come away with an appreciation for the fact that the jury has the responsibility to decide what the facts are and who is not telling the truth.

When a judge does not allow the jury to do its job, he commits reversible error. When a judge confuses his duties with the duties assigned to the jury, then he has abused his discretion and that constitutes reversible error.

The prosecution was allowed to ask Webster Smith questions that were like bombshells that would cave in the sides of a Sherman Tank, but on cross-examination of the principal witness, the Defense lawyers were reduced to tip-toeing through the tulips. The uncorroborated testimony of the principal witness (SR) was a roadside bomb to Webster Smith’s defense.

If the jury had only been allowed to follow the Yellow Brick Road and to resolve the credibility issue itself, then, at least, the trial of Webster Smith would have had some semblance of a fair trial. The trial judge, CAPT Brian Judge, was not taking any chances. He took matters into his own hands. He jumped onto the Scales of Justice and pulled them way down on the side of the Prosecution.

In a case where the principal witness was allowed to hide behind the military judge for protection from thorough cross-examination; and where facts and perceptions may have been dispositive of the ultimate issue, Truth can be elusive. In a case where a convincing and charming fabricator of facts can sway a jury that has not been fully informed, and where the jury has only been given some of the relevant facts, the judge left a lot of room for mischief on the part of a sneaky prosecutor. The judge left a lot of room for the imagination of the jury to run wild when he allowed the Prosecutor to introduce just enough evidence to put Webster Smith in a compromising position; but he denied the Defense lawyers an opportunity to explain the contradictions by cross-examining the principal witness. Then the judge left it to the jury to “connect the dots”. This was terribly unfair to the accused, Webster Smith.

Webster Smith was reduced to “a bug under a glass jar” for inspection, and the principal witness was kept as snug as a bug in a rug. Eventually all of this discretionary “hokus-pokus” became so egregious as to eliminate any possibility of a fair trial for Webster Smith. Finding the Truth became next to impossible. This case should have been remanded for a new trial. To send the case back to the Superintendent of the Coast Guard Academy, the Convening Authority, for a new trial was the only fair way to remedy the errors that were committed in the court-martial of Webster Smith.

The Founding Fathers and the framers of the U S Constitution provided procedural safeguards for criminal defendents facing the awesome powers on the Federal Government. They gave him; among other rights, the right to remain silent, the right to trial by jury, and the right to confront and to cross-examine the witnesses against him. These rights are inalienable. These rights cannot be taken away; not by the Government, and certainly not by a part-time trial judge.

One judge on the Coast Guard Court of Criminal Appeals saw clearly how the legal system, the Sixth Amendment to the Constitution, and the Military Rules of Evidence were misused to deny Webster Smith a fair trial.

I believe a great travesty of justice was committed. A gross miscarriage of justice was done at the Coast Guard Academy.The entire process was flawed.
The only evidence was the word of a couple of incredible females. There was no physical evidence whatsoever.
Webster Smith has apologized for his behavior. Confession is good for the soul. It is the first step toward true rehabilitation. No one else involved in the entire episode showed such strength of character. The Academy is a character building institution.

 Cadet Webster Smith was a victim of jealousy, racial discrimination, a violation of the 14th Amendment Equal Protection clause, and last but not the least, a victim of a double standard.
He was one of the most loved and respected cadets on campus. But he had two things going against him. One, he had dated the first female Regimental Commander, and the Dean of Admissions’ daughter. Both were white. Since they were white and Cadet Smith was Black, it did not sit well with the Commandant of Cadets.
Racial Prejudice is still very much alive at the Academy.

 America’s fighting men have come in many guises, shapes and sizes. They have had to fight all of America’s enemies, both foreign and domestic. Cadet Webster Smith had to fight his own senior officers, friends, and mentors. In the end he was proud. He had fought the good fight. Even TIME magazine carried the quote of the first cadet in Coast Guard history to be tried by a General Court-martial.

http://www.time.com/time/quotes/0,26174,1209244,00.html

Less than 60 days after the verdict was rendered in the Webster Smith case, I predicted that the case would make it all the way to the Supreme Court.

Supreme Court justices are not elected. They are appointed with the advice and consent of the Congress. The Nine Justices of the Supreme Court are the least democratic branch of the federal government. They have no constituency. They do not have to conform to the biases of the majority. They are the Court of Last Resort; so, they are infallible. With few exceptions, they have dealt with evenhandedly with all of America’s citizens.

They do not have to sit for re-election. They are appointed for life. They are totally isolated from busy bodies on the Right or Left Side of the political spectrum. With one stroke of the pen, they may act to curb injustices, correct unsavory attitudes, and breathe new life into a living Constitution.

Historically we have looked to them to solve our most vexing social problems. They are America’s ultimate arbiters of justice; and, that includes military justice.

Aside from the Webster Smith Case, I cannot think of any case or incident in Coast Guard history that affected more directly the hearts, minds, and daily lives of all members of the United States Coast Guard.

The U.S. Coast Guard Court of Criminal Appeals had to review the Webster Smith case. It had no choice. Article 66 of the Uniform Code of Military Justice, requires the Coast Guard Criminal appeals Court to review all cases of trial by court-martial in which the sentence as approved by the Convening Authority extends to dismissal of a cadet from the Coast Guard, and/or a dishonorable or bad conduct discharge, unless the accused waives appellate review. Webster Smith did not waive appellate review. He appealed his conviction. Oral arguments in the Case of The Appeal of the Court-martial Conviction of Cadet Webster Smith was scheduled for January 16, 2008 in Arlington, Virginia.

A legal brief filed by his lawyers claimed the convictions should have been thrown out because the defense team was not allowed to fully cross-examine one of his accusers during Smith’s court martial. They said that meant the jury didn’t hear testimony that the accuser, a female cadet, Shelly Roddenbush, had once had consensual sex with a Coast Guard enlisted man and then called it sexual assault. If she lied once, she very well could have lied again.

The Coast Guard Court of of Criminal Appeals is made up of Coast Guard Officers. It has the power to decide matter of both fact and law. Decisions of the Coast Guard Court of Criminal Appeals may be appealed to the Court of Appeals of the Armed Forces (CAAF). It is made up of five civilian judges, appointed to 15 year terms. It decides only issues of law. Its decisions may be appealed to the U. S. Supreme Court. The Webster Smith Case followed this long and winding path all the way to the Supreme Court.

The U.S. Supreme Court has refused to hear the appeal of Webster Smith. The justices declined to hear the case without comment.

Webster Smith was proud of his decision to fight the good fight all the way to the end of the road. See TIME magazine June 29, 2006.

http://www.time.com/time/quotes/0,26174,1209244,00.html

https://www.amazon.com/author/cgachall.blogspot.com

 

Friends of Webster

Raised in the house, but field certified.    (http://www.friendsofwebster.com/?p=464)

Well this is interesting. Below is an excerpt from Judge London Steverson’s Book.

I agree with his purpose but I can’t say that I agree with his tone and portrayal. To this day, I don’t blame my peers. In a sense, we were all pawns. And if the tables were turned, I probably one have done the same thing to protect my career. Sad but true.

The Webster Smith Story is an American tragedy. It is not just the story of a Black Coast Guard Academy cadet; it is the story of an American family. It is the story of his mother, Belinda; and his father, Cleon; his wife, Lindsey and their daughter; and of his sister and brothers. It is the story of the friends of Webster Smith. They have all been harmed by the violence directed at their son, brother, husband, father and friend.

At the Coast Guard Academy, Webster Smith was a member of the Eclipse, Track Team, Football team, Regimental Staff, and a Swab summer Staff. He represented the Coast Guard in Washington DC concerning fitness and nutrition programs. He received numerous silver stars and never received a demerit prior the incident and investigation in 2005 that led to his court-martial.

To his classmates, teachers, and coaches Webster Smith appeared to be a magnetic, charming and gifted man, who had risen above his circumstances. Yet, in a moment, as if in the twinkling of an eye, a swift series of events diminished his popularity, vilified his name, and assailed his honor. His image was converted by senior Coast Guard officers from a popular athlete and nice guy to that of a sexual predator and public enemy number one at the Coast Guard Academy.

Webster Smith had dared to dream some big dreams. Like Alex Haley he had dared to believe that he could rise in the USCG to the highest level to which his talents and initiative could take him.

His parents were middle class African Americans. His father, Cleon Smith, was a graduate of the Coast Guard Academy in the Class of 1978 along with Vice Admiral Manson K. Brown.

His mother, Belinda Ingram Smith, believed in God and a good education. After attending college at WSSU for four years she went on to become the first Black female Crime Scene Investigator in the history of the Winston-Salem police Department.

This unbelievable turn about in what had been a Black success story is a singularly American tragedy.

That a cadet so deeply respected and loved by his coaches and classmates could evoke such an outpouring of hate and anger from the senior officers at the Coast Guard Academy is a Coast Guard tragedy and an American tragedy.

All of the female cadets involved with and associated with Webster Smith escaped clean without any consequences for their actions or their behavior. Mother Nature was the only one who exacted a penalty. Natural Law resulted in a pregnancy for his girlfriend. An abortion followed.

If women are equal, they should be treated as equal. Not a single woman was disciplined under the UCMJ or the cadet regulations. All of the female cadets involved in the Webster Smith case graduated and were commissioned as Coast Guard officers. Their testimony at the court-martial painted a picture of female cadets who were untrustworthy, arrogant, and certainly not ladies. Their conduct was unbecoming an officer and a lady. (Read more at http://judgelondonsteverson.com)

These women were witnesses at a public trial yet they were accorded the equivalent of rape shield protection. This was not a rape case. Not one of the women had been raped. There was testimony of consensual sex acts. Some of the consensual sex acts were unlawful because, among other things, they occurred in Chase Hall, or at Academy functions. How could unlawful consensual sex acts result in charges against only one of the participants? It takes two to tango.

Is it wrong for Black people to ask if there is a double standard? Would that amount to paranoia on the part of Black people? Or would that be considered playing the race card simply to inquire? Is it absurd to believe that anything more than pure chance resulted in the court-martial of Webster Smith? The fact that he was court-martialed speaks to a social reality that African-Americans are acutely aware of in America. Race is not a card to be dealt, but it determines whom the dealer is and who gets dealt a losing hand.

According to a 2008 General Accounting Office Report, from 2003 to 2006 there were NO sexual-harassment complaints at the Coast Guard Academy, but there were 12 incidents of sexual assault reported to the Coast Guard Investigative Service (CGIS), with one incident in 2003, one in 2004, “NONE” in 2005 and 10 in 2006. It is hard to conceive of the facts relied upon by, Captain Douglas Wisniewski, the Commandant Of Cadets when he asserted in 2005 that there was a climate of fear of sexual assault in Chase Hall.

The 10 incidents reported in 2006 would appear to have occurred after the Webster Smith court-martial. Webster Smith was removed from Chase Hall in 2005. Who was doing all of the sexual assaulting in 2006? Why were none of these people brought to justice? They could have been tried along with Webster Smith.

The U.S. Supreme Court refused to hear the appeal of Webster Smith. The justices declined to hear the case without comment. The decision of the Court of Appeals for the Armed Forces (CAAF) became the final decision in the case.

Thirteen female cadets and 11 males at the U.S. Coast Guard Academy (CGA) reported anonymously in an April 2008 survey that they experienced “unwanted sexual contact,” ranging from touching to forced sexual acts, during the 2007-08 school year.

More than three-quarters said that alcohol or drugs were involved and that the offender was a fellow cadet.
None of the women sought professional help and only 7 percent discussed the incident with authorities.

When Alexander Hamilton organized the Revenue Cutter Service in 1790 it was established in the Department of the Treasury. Later it became known as the Coast Guard. In 1966 it was placed in the Department of Transportation. Today it is the nucleus of the Department of Homeland Security. Webster Smith’s case is currently being reviewed for clemency by the Secretary of the Department of Home Land Security, Janet Napolitano.

Webster Smith would have made an excellent military officer. It is Webster Smith and people like him that I want on the wall as our last line of defense for our American way of life protecting us from the great unwashed horde that is coming. Secretary Napolitano who do you want on that wall?
(Read more at http://judgelondonsteverson.com)

CONDUCT UNBECOMING an Officer and a Lady: A Case That Will Live In Infamy. The Conviction of Webster Smith. by Judge London Steverson

My rating: 4 of 5 stars

The Webster Smith Story is an American tragedy. It is not just the story of a Black Coast Guard Academy cadet; it is the story of an American family. To his classmates, teachers, and coaches at the Coast Guard Academy Webster Smith appeared to be a magnetic, charming and gifted man, who had risen above his circumstances. Yet, in a moment, as if in the twinkling of an eye, a swift series of events diminished his popularity, vilified his name, and assailed his honor. His image was converted by senior Coast Guard officers from a popular athlete and nice guy to that of a sexual predator and public enemy number one at the Coast Guard Academy.The Webster Smith case was a litmus test for justice in America. Every once in a while a case comes along that puts our humanity as a people on trial. Everything that we profess to stand for as Americans was on trial. I am ashamed of our justice system. This was a tragedy and a travesty.

I wanted to know why Webster Smith was court-martialed? Now I know. This book is the full story.

AND THEN AN AMAZON LINK: Amazon.com
Tell me how it is. I am too focused to remember yesterday.

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Why We Need Illegal Immigrants

Billions Earned Under Fake Social Security Numbers Calculate Benefits

 

One of the ironies of the challenging financial future faced by the Social Security Administration is this seldom-discussed fact: Undocumented workers contribute about $13 billion per year to the Social Security Trust Fund, and only get back a small fraction, adding a bit of black ink to a balance sheet in sore need of a boost. As President Obama mulls whether and when to enact executive orders that would affect the status of up to 11 million undocumented immigrants in the country, these Social Security payments are a proxy of sorts for the potential power of these workers who now stand in the shadows of the economy.

These immigrants are often accused of creating outsize social services costs, but in this important instance the opposite is true. Undocumented workers using fake, invalid, or borrowed Social Security numbers are subject to payroll taxes but usually receive nothing back. The extent of their contributions hints at the vast scale of the underground economy — and at the economic benefits that could be harnessed by giving undocumented workers a legal way to move out of it.

The chief actuary of the Social Security Administration recently told Vice News that, out of the estimated 7 million unauthorized workers currently in the US labor force, about 3 million use either false or expired Social Security numbers. The payroll taxes paid by these unauthorized workers go into the Social Security’s “Earnings Suspense File” — in effect, money without a lawful home.

“You could say legitimately that had we not received the contributions that we have had in the past from undocumented immigrants . . . that would of course diminish our ability to be paying benefits for as long as we now can,”. Undocumented immigrants have contributed $100 billion into Social Security over the last decade.

Major immigration reform legislation would provide work authorization and Social Security numbers for an estimated 11 million immigrants working here illegally. But without changes to protect Social Security, illegal workers whose status later changes could become entitled to benefits based on jobs worked under fake and invalid Social Security numbers. Social Security could be on the hook for hundreds of billions in new liabilities according to a new  research report based on data from the Social Security Administration.

Unauthorized immigrants getting jobs show employers false or invalid Social Security numbers. When the Social Security Administration receives copies of W2s in which the name and Social Security do not match those on Social Security’s records, they go into the Earnings Suspense File (ESF). The W2s remain on file until the earnings can be reconciled with the real worker, even if that occurs years later. Since 2000, the Social Security Administration has received about 9.3 million such W2s per year on average, representing more than $69.4 billion per year in earnings.

The earnings reported to the ESF over the past 11 years now total more than $763.5 billion, unadjusted for inflation. “Those earnings are important, because that’s what the Social Security Administration uses to determine entitlement and initial benefit amounts — not the amount of taxes paid in,” .

Although Social Security is aware of the problem, no government estimates of the potential future cost of benefits based on work under fake Social Security numbers exist.

Immigration advocates say that the taxes on earnings worked under invalid Social Security numbers help boost Social Security’s financing and that workers would have little chance of collecting benefits. “But that would change under immigration reform that provides work authorization”. “Work authorization and a valid Social Security number are the two requirements that would allow former unauthorized workers to file a claim for benefits.”

That could have significant implications for future Social Security costs because, under current law, the fraudulent use of Social Security numbers to gain employment is not penalized. “One would think that the earnings under fake Social Security numbers would not be used to calculate Social Security benefits. But to the contrary, under current policies, those earnings can be reinstated — no questions asked”.

Social Security uses all earnings to determine entitlement even for jobs worked under fake Social Security numbers. If workers have kept evidence of earnings, like copies of their W2s, tax return earnings under invalid Social Security numbers would be reinstated to the new valid number.

“Congress is considering Social Security changes that would cut the benefits of U.S. citizens and authorized workers who paid into the system under valid Social Security numbers”. “Yet our current polices reward people for the use of fraudulent Social Security numbers, undermining the financial solvency of the program”.

“You could say legitimately that had we not received the contributions that we have had in the past from undocumented immigrants . . . that would of course diminish our ability to be paying benefits for as long as we now can,”. Undocumented immigrants have contributed $100 billion into Social Security over the last decade.

Major immigration reform legislation would provide work authorization and Social Security numbers for an estimated 11 million immigrants working here illegally. But without changes to protect Social Security, illegal workers whose status later changes could become entitled to benefits based on jobs worked under fake and invalid Social Security numbers. Social Security could be on the hook for hundreds of billions in new liabilities according to a new  research report based on data from the Social Security Administration.

Unauthorized immigrants getting jobs show employers false or invalid Social Security numbers. When the Social Security Administration receives copies of W2s in which the name and Social Security do not match those on Social Security’s records, they go into the Earnings Suspense File (ESF). The W2s remain on file until the earnings can be reconciled with the real worker, even if that occurs years later. Since 2000, the Social Security Administration has received about 9.3 million such W2s per year on average, representing more than $69.4 billion per year in earnings.

The earnings reported to the ESF over the past 11 years now total more than $763.5 billion, unadjusted for inflation. “Those earnings are important, because that’s what the Social Security Administration uses to determine entitlement and initial benefit amounts — not the amount of taxes paid in,” .

Although Social Security is aware of the problem, no government estimates of the potential future cost of benefits based on work under fake Social Security numbers exist.

Immigration advocates say that the taxes on earnings worked under invalid Social Security numbers help boost Social Security’s financing and that workers would have little chance of collecting benefits. “But that would change under immigration reform that provides work authorization”. “Work authorization and a valid Social Security number are the two requirements that would allow former unauthorized workers to file a claim for benefits.”

That could have significant implications for future Social Security costs because, under current law, the fraudulent use of Social Security numbers to gain employment is not penalized. “One would think that the earnings under fake Social Security numbers would not be used to calculate Social Security benefits. But to the contrary, under current policies, those earnings can be reinstated — no questions asked”.

Social Security uses all earnings to determine entitlement even for jobs worked under fake Social Security numbers. If workers have kept evidence of earnings, like copies of their W2s, tax return earnings under invalid Social Security numbers would be reinstated to the new valid number.

Congress is considering Social Security changes that would cut the benefits of U.S. citizens and authorized workers who paid into the system under valid Social Security numbers”. “Yet our current polices reward people for the use of fraudulent Social Security numbers, undermining the financial solvency of the program”.

Categories: Social Security Benefits | Tags: , , , , , , , , | 1 Comment

Meet The New Acting Commissioner Of THe Social Security Administration, Carolyn Colvin.

On February 14, 2013, Carolyn W. Colvin became the Acting Commissioner of Social Security.  Prior to this designation, she served as the Deputy Commissioner, having been confirmed by the United States Senate on December 22, 2010 as President Obama’s nominee.  In addition to her role as the Acting Commissioner of Social Security, Ms. Colvin serves as a Trustee to the Social Security Board of Trustees.

 

Throughout her career, Ms. Colvin has managed programs that help people with their healthcare and financial needs.  She previously held key executive positions at Social Security Headquarters: Deputy Commissioner for Policy and External Affairs (1994–1996), Deputy Commissioner for Programs and Policy (1996–1998), and Deputy Commissioner for Operations (1998–2001).

 

Prior to returning to SSA, Ms. Colvin was the Director of Human Services for the District of Columbia (2001-2003); the Director of the Montgomery County Department of Health and Human Services (2003-2007); the Chief Executive Officer of AMERIGROUP Community Care of the District of Columbia (2007–2008); and, the Special Assistant to the Secretary of Maryland’s Department of Transportation (2009-2011).  In addition, Ms. Colvin served as the Secretary of Maryland’s Department of Human Resources (1989-1994).

 

Ms. Colvin has received numerous awards and recognition for her managerial expertise and creativity, including Maryland’s Top 100 Women Award from the Daily Record (2005) and the Women of Achievement Award from Suburban Maryland Business and Professional Women (2005).  She has served on a variety of boards and commissions, including the National Committee to Preserve Social Security and Medicare.

 

Ms. Colvin earned her graduate and undergraduate degrees in business administration from Morgan State University.  Additionally, she completed the Senior Executives in State and Local Government Program at Harvard University, the Maryland Leadership Program, and the Greater Baltimore Leadership Program. Ms. Colvin is from Maryland and currently resides in Anne Arundel County.  She has one son and six grandchildren.

 

Categories: Social Security Benefits | Tags: , , , , , , , | 6 Comments

The Moral Titan Of The Western World Resigns

The prince of this world has claimed another victim. The moral titan of the Western World throws in the towel. Homosexual “marriage,” contraception, sexual promiscuity, euthanasia, pornography, abortion and moral relativism proved too daunting a challenge for the aging pontiff.

The resignation of Pope Benedict XVI has sent shock waves throughout the USA and Catholic world. He has fought a ceaseless war against sin and moral relativism. He has kept the faith, but he did not finish the course. There is much work to be done. The Holy Father’s eight-year reign was very successful. With his announcement that he will be stepping down at the end of February, the church must find a suitable successor. It will be difficult.

PopeMobile Passes White House

Pope Benedict’s greatest accomplishment is that he put in place an impregnable defense of the culture of life — continuing the mission of his charismatic predecessor, Pope John Paul II. Pope Benedict is more than a gifted manager. He is a brilliant scholar and theologian. He has bravely spoken out against abortion, homosexual “marriage,” contraception, sexual promiscuity, euthanasia, pornography and moral relativism. His worldview can be distilled to one seminal idea: Secular liberalism is a false god and pseudo-religion; the only source of transcendental meaning is the church and Jesus Christ.

Obama Meets Benedict XVI

Many people and politicians see the role of the pope as simply a spiritual father who puts out documents now and then, and can be counted on for a blessing and a photo op with the occasional baby.

Hence, liberals despise him. They are now dancing on his papal grave. Since he ascended to the papacy, the anti-Catholic left has accused him of numerous crimes — being a Nazi sympathizer, fostering the hatred of women and perpetuating “homophobia” and “Islamophobia.” The now-deceased Christopher Hitchens referred to Pope Benedict’s career as having “the stench of evil.” (This from a man who, for years, rationalized communist tyrannies responsible for the slaughter of millions.)

Pope With NASA Astronauts Altman and Massimono

In the eyes of the secular left, the Holy Father’s real crime is he is a genuine Catholic. The pope’s teachings simply reinforced traditional orthodoxy, expressing the tenets of natural law. His views went against trendy progressive opinion. They amounted to restating basic, historic Catholic doctrine, such as homosexual behavior — sodomy — is immoral and unnatural; the family is the central unit of society; marriage consists of one man and one woman; contraception violates the fundamental purpose of sex, which is procreation; human life is sacrosanct from conception until natural death; and that male and female natures are distinct and different. He has consistently excoriated totalitarianism — both communism and fascism. In short, he opposes the culture of death in all of its malignant forms. No wonder liberals hate him.

Pope At WTC Ground Zero New York

Early in his papacy, he criticized radical Islam. Pope Benedict cited a 14th-century Byzantine emperor, pointing out that since its inception, Islam has had periods of violent expansion. For this, enraged protesters took to the streets in cities across the Muslim world, many of them calling for the pope to be killed. The Holy See has repeatedly championed the rights of Christians, especially in Muslim lands. Throughout the Middle East and Asia, Christians are the victims of persecution and pogroms. Yet, as Western leaders remain largely silent about this mass religious expulsion, the pope continues to raise his voice.

Pope AT UN

The topic he returns to repeatedly is the long-term threat posed by moral relativism to the West. It is fostering moral paralysis, hedonism and cultural decline. Ethical standards have been smashed. The doctrine of personal liberation is rampant. In America, the results have been disastrous: the breakdown of the family, skyrocketing divorce rates, a huge rise in illegitimate births, drugs, pornography, the mass murder of nearly 50 million unborn children and an AIDS epidemic that has led to millions of deaths. Recently, the Centers for Disease Control and Prevention released a report stating there are 20 million new cases of sexually transmitted infections each year. The most common diseases are gonorrhea, syphilis, herpes, hepatitis B and HIV. The CDC says the United States faces an “epidemic” of sexually transmitted diseases. We have become Sodom and Gomorrah.

Pope IN Israel

Like John Paul II, Pope Benedict continued to reach out to the Jewish community. Moreover, he began to finally confront and crack down on the sex-abuse scandal that has plagued the church. He apologized to the victims. He stripped pedophile priests of their positions, and started the long, difficult process of healing.

Pope In Africa

For decades, moral relativism — the belief there are no moral absolutes, no enduring principles of right and wrong — has been used as a battering ram to destroy the West’s Christian foundations. In particular, it forms the essence of our postmodern society’s fashionable bigotry: Christophobia. The hatred of Christianity lies at the core of the socialist project. In Europe, Christianity is dying. It is widely viewed as a superstitious institution that existed prior to the Enlightenment. Yet, the extinction of a religion inevitably leads to the destruction of the culture and the civilization it spawned.

The most recent popes have been preparing the Church for leadership in a world the likes of which has not existed in human history. John Paul II was young and had the energy to visit more than 100 countries, taking the leadership of the Church outside the Vatican walls to the world. He was known to almost everyone.

Benedict was 78 when he was elected pope, at a time when he was planning to retire and live quietly in Bavaria with his brother. He made clear from the beginning that he would not keep the same schedule that had helped define his predecessor.

The world has changed significantly, and the Church needs leaders who are more agile, supported by the natural endowments of relative youth. In the past, it might have made sense to nominate an older person who had a wealth of experience. Now, we need leaders who have experience and the ability to engage in a world that changes minute by minute.

Pope Benedict understood this. This is why he has been the West’s spiritual titan. His resignation opens up a moral vacuum. God willing, his successor will be able to fill his giant shoes.

(Selected Excerpts by Jeffrey Kuhner)

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ObamaCare: A Deception

The Patient Protection and Affordable Care Act of 2010, commonly referred to as the ACA or Obamacare, will go into full effect in 2014. This decree mandates that all Americans must purchase and maintain government-approved health insurance or pay a penalty to the IRS. Touted as a plan to provide all Americans with access to medical care, in reality, this compulsory shakedown commands everyone to purchase insurance that for many will be too expensive, even with government subsidies – or unaffordable to use – or both.

The ACA was not selflessly designed with the intent of providing affordable and equitable medical services to those in need, but rather to acquire taxpayer money for the private insurance companies under the seemingly helpful guise of health care and the ideological excuse of personal responsibility. It takes money from ordinary people and gives it to a medical insurance industry that profits handsomely from this legally-enforced corporate welfare – all while keeping Americans locked in the same broken system that puts profit before patients. The law was essentially written by business executives from the industry so that special interests would not be upset and profits assured.

There’s a lot to digest about how the ACA works and much is buried in a complex, convoluted maze of regulations and procedures. A few websites contain explanations, but very important details have either been left out or glossed over. These details are well worth understanding so you will know what’s at stake for you and your family. This lesson is not meant to convey a political opinion. This is how the ACA works and under this law, there are no sacred cows.

Read more at www.judgelondonsteverson.com

(Introduction by Paul Craig Roberts)
The article below is the most comprehensive analysis available of “Obamacare” – the Patient Protection and Affordable Care Act. The author, a knowledgeable person who wishes to remain anonymous, explains how Obamacare works for the insurance companies but not for you.
Obamacare was formulated on the concept of health care as a commercial commodity and was cloaked in ideological slogans such as “shared responsibility,” “no free riders” and “ownership society.” These slogans dress the insurance industry’s raid on public resources in the cloak of a “free market” health care system.
You will learn how to purchase a subsidized plan at the Exchange, what will happen when income and family circumstances change during the year or from one year to the next, and other perils brought to you by Obamacare. It is one of the most important articles that will be posted on my website this year. Americans will be shocked to learn the extent to which they have been deceived. The legislation neither protects the patient nor are the plans affordable.
The author shows that for those Americans whose income places them between 138% and 400% of the Federal Poverty Level, the out-of-pocket cost for one of the least expensive (lower coverage) subsidized policies ranges from 2% to 9.5% of Modified Adjusted Gross Income (MAGI), a tax base larger than the adjusted Gross Income used for calculating federal income tax.
What this means is that those Americans with the least or no disposable income are faced in effect with a substantial pay cut. The author provides an example of a 35 year-old with a MAGI of $27,925. The out-of- pocket cost to this person of a Silver level plan (second least expensive) is $187.33 per month. This cost is based on pre-tax income, that is, before income is reduced by payroll and income taxes. There goes the car payment or utility bill. The lives of millions of Americans will change drastically as they struggle with a new, large expense – particularly in an era of no jobs, low-paying jobs and rising cost of living.
The author also points out that the cost of using the mandated policies will be prohibitive because of the large deductibles and co-pays. Many Americans will find themselves not only with a policy they can’t afford, but also with one they cannot afford to use. Those who cannot afford the insurance, even with a subsidy, will be faced with a costly penalty, and in many cases, this, too, will be difficult, if not impossible, to pay. As each year’s subsidy is based on last year’s income, there will be a substantial year-end tax liability for those who must repay the subsidy in whole or part because their income increased during the year. The stress alone from such a regressive scheme is, without a doubt, not conducive to good health and well-being.
Diets will worsen for millions of Americans as they struggle with a new large expense. Thus, the effect of Obamacare will be to worsen the health of millions. Indeed, a “glitch” in the legislation allows millions to be priced out of coverage. http://www.huffingtonpost.com/2013/01/30/obamacare-glitch-priced-out-of-health-care_n_2585695.html?view=print&comm_ref=false

Alternatively, Americans might be able to acquire health insurance coverage but have no doctors willing to treat them. http://www.californiahealthline.org/road-to-reform/2013/access-denied-implications-of-medi-cal-pay-cut.aspx#
The demand that Obamacare places on household budgets in which there is no slack makes me wonder where the president’s economists were while the insurance lobby crafted the product that serves the profits of insurance companies. Two well-known economic facts are that real family income has been stagnant or declining for a number of years and Americans are over their heads in debt.
How does Obama preside over a recovery when consumer purchasing power is redirected to insurance company profits?
Obamacare not only rations health care by what a person or family can afford, but also has implications for Medicare patients. Hundreds of billions of dollars are siphoned from Medicare to help pay the cost of Obamacare. The health care provided to Medicare patients will decline with the reduced payments to care providers. Health care seems destined to be rationed according to the age and illnesses of Medicare patients. Those judged too old and too ill could be denied expensive treatments or procedures that would prolong their lives.
Obama will rue the day that his name was put on this special interest legislation, and most Americans, once they realize what has been done to them, will be angry that special interests again prevailed over the health of the nation.

OBAMACARE: DEVILS IN THE DETAILS
The Patient Protection and Affordable Care Act of 2010, commonly referred to as the ACA or Obamacare, will go into full effect in 2014. This decree mandates that all Americans must purchase and maintain government-approved health insurance or pay a penalty to the IRS. Touted as a plan to provide all Americans with access to medical care, in reality, this compulsory shakedown commands everyone to purchase insurance that for many will be too expensive, even with government subsidies – or unaffordable to use – or both.
The ACA was not selflessly designed with the intent of providing affordable and equitable medical services to those in need, but rather to acquire taxpayer money for the private insurance companies under the seemingly helpful guise of health care and the ideological excuse of personal responsibility. It takes money from ordinary people and gives it to a medical insurance industry that profits handsomely from this legally-enforced corporate welfare – all while keeping Americans locked in the same broken system that puts profit before patients. The law was essentially written by business executives from the industry so that special interests would not be upset and profits assured.
There’s a lot to digest about how the ACA works and much is buried in a complex, convoluted maze of regulations and procedures. A few websites contain explanations, but very important details have either been left out or glossed over. These details are well worth understanding so you will know what’s at stake for you and your family. This lesson is not meant to convey a political opinion. This is how the ACA works and under this law, there are no sacred cows.
In today’s lesson, you will learn why 2013 is an important year for many of you with regard to your income and the ACA. We will discuss 1) use of Modified Adjusted Gross Income, 2) tax credits (help paying for insurance), 3) your share of the premium, 4) paying back the tax credits to the IRS, 5) expansion of Medicaid and estate recovery which could affect you if you are put into that plan, 6) inadequate coverage in most subsidized plans, 7) penalties, 8) exemptions and 9) a few tidbits. We’ll also take a look at the agenda of Enroll America and the Health Insurance Exchanges, and what you can expect to hear in the very near future.
Here we go. Fasten your seat belts.
1. HEALTH INSURANCE EXCHANGE BASICS
In 2014, each state will have an Affordable Insurance Exchange where qualified individuals and families with incomes between 138 and 400 percent of the Federal Poverty Level (FPL) can shop for commercial insurance policies. Most individuals and families with incomes at or below 138 percent FPL will be put into Medicaid. You may be eligible for help paying for your insurance in the form of a tax credit. In most states, the Children’s Health Insurance Program (CHIP) will continue to cover children in families with incomes up to at least 200 percent FPL. Some states may offer a Basic Health Plan for those who earn up to 200 percent FPL and are not eligible for Medicaid. Under limited circumstances, you may also be eligible for a cost-sharing credit.
Eligibility to receive a tax credit, the amount of your tax credit and your out-of-pocket share for the insurance will be determined by your income and where you fall in the Federal Poverty Level Guidelines (FPL). This is easy to understand.
Your annual gross income determines which FPL you’re in. For example, based on 2012 FPL Guidelines, an individual with an annual income of $33,510 is at 300 percent FPL; a family of 4 with an annual income of $69,150 is at 300 percent FPL. To see where you’re at, try the handy calculator at this link. FPL Guidelines are revised every January, so the 2013 edition should be up soon. http://www.safetyweb.org/fpl.php
The ACA requires use of MODIFIED ADJUSTED GROSS INCOME (MAGI) instead of Adjusted Gross Income for all determinations made by an Exchange including eligibility for Medicaid except in certain cases. So, in this lesson, we’ll refer to annual income as MAGI.
Modified Adjusted Gross Income (MAGI) is defined as Adjusted Gross Income PLUS
a) all tax exempt interest accrued or received in the taxable year;
b) the non-taxable portion of Social Security benefits provided under Title II of the Social Security Act which includes old-age benefits, disability benefits, spousal benefits, child benefits, survivor benefits and parental benefits;
c) tier 1 Railroad Retirement benefits that are not includible in gross income; and
d) the exclusion from gross income for citizens or residents living abroad.
The adoption of MAGI, created by the ACA, is defined in a new section of the IRS code.
2. DETERMINING ELIGIBILITY FOR A TAX CREDIT
The tax credit is to help you pay for insurance. The ACA says it must be based on annual income for the tax year it’s received, but since you will need help paying for your plan during that year, the ACA allows for advance payment of the tax credit.
Here’s an example of what that means: Let’s say you apply for insurance at an Exchange in 2014. Therefore, 2014 is the tax year you will receive your tax credit, and per the ACA, the amount you receive must be based on that year’s MAGI. But, that year’s MAGI won’t be available until 2015 when you file your 2014 tax return and you need help paying for your insurance plan when you buy it in 2014. So, the amount of your tax credit has to be determined on information that is available such as your prior-year (2013) tax return. Thus, the tax credit morphs into an ‘advance payment of the tax credit’ (also referred to as an advance premium assistance credit). Now you see why 2013 is an important year for many of you.
The ACA allows for limited disclosure of tax return info in order for an Exchange employee to verify your citizenship status and MAGI, and, not only to let you know how much your advance tax credit will be, but also to see if you are eligible to receive this in the first place. An Exchange can also consider using your real-time income by looking at your state’s most current quarterly wage database, or it may agree to accept paper verification (pay stubs, etc.) as a last resort or an attestation of your income with no verification. Creation of a federal ‘data services hub’ is in the works so your income information will be more readily accessible. But, no matter how this plays out, you’ll still receive an advance payment of the tax credit because your actual MAGI for 2014 will not be known by you nor can it be verified by an Exchange until you file your 2014 tax return in 2015.
Ultimately, no matter which method is used – prior year or partial current year – this advance payment of the tax credit carries with it some heavy-duty consequences which are discussed in topic 4 of this lesson.
3. TAX CREDITS AND YOUR SHARE OF THE PREMIUM
The amount of your tax credit will be based on the second lowest-cost Silver plan in the area where you live and your MAGI. Here’s how this works – it’s quite simple:
a) First, the amount you will pay out of your pocket for that Silver plan – copays and deductibles not included – will be a specific percentage of your MAGI, and you will pay this to the insurer on a monthly basis. The way this percentage will be calculated is described a few lines down.
b) Next, your share will be deducted from the cost of that Silver plan and the difference will be your tax credit which the government will pay directly to the insurer on a monthly basis when you purchase a plan.
The specific percentage you will have to pay for the second lowest-cost Silver plan will be based on your FPL using a well-greased sliding scale. As your FPL increases little by little, the percentage you will pay increases. The same percentage applies to an individual or a family. Here’s how much of your MAGI you will pay for that Silver plan:
— up to 138 % FPL: 2% for people legally present less than 5 full years and residents of states that do not expand Medicaid
— 138-150% FPL: 3 to 4%
— 150-200% FPL: 4 to 6.3%
— 200-250% FPL: 6.3 to 8.05%
— 250-300% FPL: 8.05 to 9.5%
— 300-400% FPL: 9.5% – there’s no range, but the dollar amount of your share will change because 9.5% of a lower MAGI is less than 9.5% of a higher MAGI.
Here are two examples in dollars using 2012 FPL Guidelines and an estimate for a second lowest-cost Silver plan which will vary depending where you live – actual costs are not yet available:
a) You are 35 years old and the price of the second lowest-cost Silver plan for an individual in the area where you live is $4,750 with no tax credit. If your MAGI is $33,510 ($2,792.50 per month) putting you at 300 percent FPL, your share for that Silver plan, per the chart above, would be 9.5 percent of your MAGI which comes to $3,183 ($265.25 per month). Your tax credit would be $1,567 which is the difference between the unsubsidized cost of that Silver plan and your share.
b) You are 35 years old and your MAGI is $27,925 ($2,327 per month) putting you at 250 percent FPL, so, your share of that Silver plan would be 8.05 percent of your MAGI which comes to $2,247.96 ($187.33 per month) and your tax credit would be $2,502.
If the second lowest-cost Silver plan is too expensive, you can apply your tax credit to a Bronze plan which will be cheaper but less comprehensive. If you want a better plan than the Silver, you will have to pay the full difference in the premium.
Don’t forget that your share of the monthly premium will be figured on your MAGI which is pre-tax income. So, after you deduct your income taxes and your share of an insurance plan, will you be able to cover your monthly basic living costs including paying off debt you may owe and still have some cash left to pay for medical care if you have to use your insurance? Check out topic 6 in this lesson for a rundown of plans and coverage you can expect to find at an Exchange. Hope you don’t faint.
Once you purchase a plan, your share and your tax credit won’t change until the next enrollment period unless, before that time, your income goes up or down enough to bump you into a different FPL or you get a job with insurance. You can let your Exchange know by phone or via your online account, or, your Exchange might notice while cruising the data services hub you learned about in topic 2 and notify you that you must ‘up’ your coverage or that you’ve been tossed into Medicaid if your MAGI has decreased enough to make you eligible for that plan. Exchanges will be encouraged to use as many different avenues as possible including private databases to keep tabs on your income.
Thus, you could end up bouncing from Medicaid to a subsidized plan or vice versa. By the same token, you could take some extra work to help pay the bills or to save for a vacation, and, oops, you went over 400 percent FPL and are no longer eligible for a tax credit. The Exchange may not find out about this unless you spill the beans, but, no matter how it all plays out, income changes will catch up with you when you file your tax return.
To be eligible for a tax credit you must file your tax return no later than April 15. Married taxpayers must file a joint return. Individuals who are listed as dependents on a return are ineligible for a tax credit.
If you are eligible for Medicaid, you will not be allowed to receive a tax credit or a cost-sharing credit although some states impose premium and cost-sharing charges on certain Medicaid enrollees per the Deficit Reduction Act of 2005 (DRA) and clarified in the Tax Relief and Health Care Act of 2006.

On January 22, 2013, the Centers for Medicare & Medicaid Services (CMS) proposed allowing states to further increase Medicaid premiums and out-of-pocket costs by 5 percent. The most egregious part of this proposed rule says that states may allow providers to deny services for failure to pay the required cost-sharing in certain circumstances. The Obama administration is behind this proposed rule hoping to persuade states to expand Medicaid since many have refused and others are still undecided – the expansion of Medicaid is an integral part of the ACA. Allowing states to further increase premiums and cost-sharing for the poorest segment of the population under- scores the existing political bias toward low-income Americans despite rhetoric which claims otherwise. https://www.federalregister.gov/articles/2013/01/22/2013-00659/medicaid-childrens-health-insurance-programs-and-exchanges-essen- tial-health-benefits-in-alternative#h-186
http://www.nytimes.com/2013/01/23/health/medicaid-patients-could-face-higher-fees-under-a-proposed-federal-policy.html

Affordability rates (the percentage of your MAGI the government has decided you can afford to pay for insurance) are based on boardroom formulas which don’t take particular individual needs into account such as housing costs, property taxes, debt, education, transportation, retirement savings, etc. Also, FPL Guidelines are standard across the country and do not take into consideration those who reside in a more expensive region or vice versa. They are one-size-fits-all with the exception of Alaska and Hawaii. See topic 8 in this lesson to learn about exemptions.

Check out what self-proclaimed health care expert Jonathan Gruber says about affordability and get a load of all the “formulas.” According to Mr. Gruber, you may be having too much fun in life and need to get serious, buy health insurance and live under a rock in order to pay for it. He was involved with Romneycare in Massachusetts and was also Mr. Obama’s go to man under a no-bid contract. Per a bar graph on page 6 of a report prepared by Stan Dom for the Urban Institute, subsidized plans under the ACA are estimated to cost 2 to 3 times more (give or take) than the subsidized plans under Romneycare. Per several surveys during the years that Romneycare has been in effect, many low and modest income MA residents have had difficulty paying for those plans and the out-of-pocket costs to use the insurance, particularly chronically-ill residents.
http://ebookbrowse.com/1493-gruber-will-affordable-care-act-make-hlt-ins-affordable-reform-brief-v2-pdf-d124754327
http://www.statecoverage.org/files/TheBasicHealthProgramOptionUnderHealthReform.pdf
4. PAYBACK OF TAX CREDITS TO THE IRS
Perhaps you recall hearing politicians including Mr. Obama say if you can’t afford to pay for health insurance, the government will help you. That was one of the key talking points repeated non stop. We just went over the help part – the tax credits. Now we’ll look at what Mr. Obama et al didn’t tell you which is important to understand because it could cause you some serious financial distress.
Remember the “advance payment of the tax credit” in topic 2 of this lesson? Well, essentially, that was a loan from the government which was paid in advance to the insurer on your behalf when you purchased your plan, and, as you know, loans have to be paid back. So, when you file your tax return for the year you received your “advance tax credit” (your loan), if your income has changed, you have to settle this with the IRS. Here’s the deal:
a) If your MAGI is higher and the increase puts you into a higher FPL, you may have to pay back a portion or all of the tax credit because it was based on a lower MAGI. In other words, you could have an additional tax liability on top of the income taxes you already paid (or still owe) because you received a higher tax credit than you were entitled to.
b) If your MAGI is lower and the decrease puts you into a lower FPL, a refund could be coming to you because you were eligible for a larger tax credit than the government paid to the insurer. In other words, you overpaid for your portion of the insurance premium.
c) If you earned a bit more or less, but your extra earnings or loss didn’t bump you into another FPL, you’re home free.
To figure out your payback, you will have to enter the relevant figures on the reconciliation page of the tax return. Changes in filing status such as the number of people in your household will also have an impact. For those of you who marry or divorce, the rules for the payback amount as well as the amount of the tax credit you are eligible to receive will make your head spin – the computation includes pre- and post-marriage FPL and uses the highest FPL of the two people involved. Ditto for divorce.
Here is one of the reconciliation explanations in IRS-speak: Your liability for an excess tax credit you received must be reflected on your current year income tax return subject to a limitation on the amount of such liability.
Oh! Limitation on the amount of such liability. That sounds good.
Let’s take a peek at the payback limitations on record at the time of this writing. “At the time of this writing” are the operative words because the cap has been increased twice since the ACA was signed into law. The original payback was capped at $400 for families under 400 percent FPL and $200 for individuals. We’ll skip over the first increase. The story behind the second one is that a particular revenue stream was removed from the original law, so something had to be done to compensate for this lost money. Thus, an amendment was passed that increased the cap using a sliding scale, thereby putting a huge financial burden on the backs of the very people the ACA claims to help. In other words, tag, you’re it. You are the cash cow.
Here are the current sliding-scale caps:
If the household income (expressed as a percent of poverty line) is:
less than 200 percent, the applicable dollar amount is $600
at least 200 percent but less than 300 percent, the applicable dollar amount is $1,500
at least 300 percent but less than 400 percent, the applicable dollar amount is $2,500
Effective date: the amendment made by this topic shall apply to taxable years ending after December 31, 2013. Very truly yours, House Ways and Means Committee

The name of this bloodsucker is The Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011.

http://www.gpo.gov/fdsys/pkg/PLAW-112publ9/html/PLAW-112publ9.htm

But wait, there’s more!
a) Update: Today (Feb. 17) (2011) the House Ways and Means Committee approved the 1099 repeal bill which requires consumers earning more than 400 percent of the poverty line to pay back the [entire] subsidy. http://thehill.com/blogs/healthwatch/health-reform-implementation/144847-1099-repeal-gets-trickier-with-house-bill

b) Also, per IRS final regulations: for taxable years beginning after December 31, 2014, the payback caps may be adjusted to reflect changes in the consumer price index.
Payback amounts are reduced to one-half for unmarried individuals who are not surviving spouses or filing as heads of households. There is no help if you get hit with a payback and many of you will have difficulty paying this liability.
Chances that you may have received an incorrect tax credit are not exactly slim because this poorly thought-out scheme does not take into account the unpredictable and complex financial situations that confront the low and modest income population.
Keep in mind that by ending up in a higher FPL, you may also have to pay more out of your pocket for an insurance premium. You learned how that works in topic 3. If you can’t afford a higher premium and drop your insurance, you may still owe a payback plus a penalty for being uninsured which is also MAGI-based. Penalties are discussed in topic 7. If your MAGI puts you over 400 percent FPL, you just knocked yourself into left field and are on your own paying for an insurance plan on the open market. And, you may also be required to payback the entire tax credit.
If you get a job during the current year that offers health insurance which is not more than 9.5 percent of your total salary and the coverage is not less than 60 percent, you must take that insurance or pay a penalty for being uninsured. But, you may owe a payback for the months you received a tax credit before you landed the job. How large that payback is will depend on your MAGI for the entire tax year, not just on your income during the months you received the tax credit. Or, you may lose a job during the year and have a significantly reduced income even though the amount reported on your tax return is high because you had a job for part of the year. In this case as well, your payback will be based on your MAGI for the entire tax year.
More interest income from taxable and tax-exempt savings or a year-end bonus could also contribute to an increased MAGI and the possibility of a payback as well as taking extra work to help pay the monthly bills, house and car repairs, educational aspirations or a vacation. So, whether or not you end up in payback land will depend on how close you are teetering on the edge of an FPL. Ditto for your share of the premium and the amount of your tax credit.
The payback may stop many of you from purchasing insurance at the Exchange because you know in advance you will not have the money to pay it. If this is the case, you may be allowed to negotiate a lesser tax credit by paying more out of your pocket for your monthly insurance premium in order to avoid or decrease the payback. It’s a crap shoot. Considering what you’ve learned so far in today’s lesson, many of you will find yourselves between a rock and a hard place under the ACA, and you will be forced to make unten- able choices. Given the skyrocketing costs of food, heat and other basics, how will you even tread water under this set-up, nevermind get ahead?
Being told you will receive help from the government if you can’t afford to purchase insurance and finding out at tax time this was really a loan and you owe the IRS a substantial debt on top of your income taxes is outright shameful. But most politicians have no shame – which brings us to the next topic.
5. MEDICAID EXPANSION AND ESTATE RECOVERY
In order to expand Medicaid, several Medicaid regulations were changed:
a) the income limit for eligibility was increased to 133 percent FPL, but since states must apply a 5 percent disregard, this effectively raises the eligibility to 138 percent FPL
b) Modified Adjusted Gross Income will be used in most cases to determine eligibility (also applies to certain CHIP applicants)
c) the age limit was increased to 64, childless adults will be eligible; and
d) the asset test was dropped except for certain groups such as the elderly and people on Social Security Disability – BINGO!
The fact that the asset test was dropped is very important, but before we look at why, you must first understand that if an Exchange determines you are eligible for Medicaid, you have no other choice. Code for Exchanges specifies, “an applicant is not eligible for advance payment of the premium tax credit (a subsidized plan) or cost-sharing reductions to the extent that he or she is eligible for other minimum essential coverage, including coverage under Medicaid and CHIP.” Therefore, you will be tossed into Medicaid unless there are specific rules as to why you would not be eligible. If you are enrolled in a private plan through an Exchange and have been receiving a tax credit, and your income decreases making you eligible for Medicaid, in you go. If you are allowed to opt out because you don’t want Medicaid, you will have to pay a penalty for being uninsured unless you can afford to purchase insurance in the open market.
Just so you’re clear on this: the ACA stipulates that the system will ensure that if any individual applying to an Exchange is found to be eligible for Medicaid or a state children’s health insurance program (CHIP), the individual will be enrolled in such a plan.
Furthermore, to increase enrollment in health coverage without requiring people to complete an application on their own, states are advised to automate enrollment whenever possible by using existing databases for social services programs such as SNAP (food stamps) to enroll people who appear eligible for Medicaid but are not currently enrolled. Therefore, you could find yourself auto-enrolled in Medicaid against your will if your state acts on this advice.
Many times over Mr. Obama et al told you that all Americans would have choice. Choice was another big talking point. Are poor and low-income Americans undeserving of choice? Is the ACA a class-based system? Maybe they meant that for this segment of the population, the choice would be between Medicaid or a penalty for remaining uninsured. This is blatant discrimination.
Here’s why dropping the asset test got the BINGO – Estate Recovery! You won’t find the following info in the ACA. It’s in the Omnibus Reconciliation Act of 1993 (OBRA 1993) – a federal statute which applies to Medicaid, and, if you are enrolled in Medicaid, it will apply to you depending on your age.
a) OBRA 1993 requires all states that receive Medicaid funding to seek recovery from the estates of deceased individuals who used Medicaid benefits at age 55 or older. It allows recovery for any items or services under the state Medicaid plan going beyond nursing homes and other long-term care institutions. In fact, The Centers for Medicare & Medicaid Services (CMS) site says that states have the option of recovering payments for all Medicaid services provided. The Department of Health and Human Services (HHS) site says at state option, recovery can be pursued for any items covered by the Medicaid state plan.
b) The HHS site has an overview of the Medicaid estate recovery mandate which also says that at a minimum, states must pursue recoveries from the “probate estate,” which includes property that passes to the heirs under state probate law, but states can expand the definition of estate to allow recovery from property that bypasses probate. This means states can use procedures for direct recovery from bank accounts and other funds.
c) Some states use recovery for RX and hospital only as required by OBRA 1993; some recover for a few additional benefits and some recover for all benefits under the state plan. Recovery provides revenue for cash-strapped states and it’s a big business.
Your estate is what you own when you die – your home and what’s in it, other real estate you may own, your bank account, annuities and so on. And even if you have a will, your heirs are chopped liver. Low-income people often have only one major asset – the home in which they live and, in some cases, this has been the family home through several generations.
So what this boils down to is: if you are put into Medicaid – congratulations – you just got a collateral loan if you use Medicaid benefits at age 55 or older! States keep a running tally.
Estate recovery can be exempted or deferred in certain situations after your death, but the regulations for this are limited and complicated with multitudes of conditions. You may not have an attorney on speed dial, but with regard to this hundred pound gorilla, it sure would be handy.
Should you decide to ask your congresscritter about estate recovery, be prepared for responses such as:
— “Estate recovery doesn’t apply to you.” (Great news. Please overnight a copy of the amendment to OBRA 1993 that stipulates estate recovery is no longer required and no longer allowed. Here’s my address.)
— “Oh, estate recovery is state, I’m federal.” (Wrong – estate recovery is federally mandated although the estate recovery program itself is administered by each state.)
— “I don’t know anything about this.” (Highly unlikely because the expansion of Medicaid is an integral part of the ACA and estate recovery is not a secret.)
— “The ACA wasn’t about revamping Medicaid.” (As explained above, Medicaid regs were revised in order to expand Medicaid.)
— “I’ll look into that and get back to you.” (Don’t hold your breath – they don’t want to go there.)
If you ask about estate recovery when you contact an Exchange or speak with an outreach agency, you’ll probably run into a brick wall or be told it doesn’t apply to you – whatever. But, it doesn’t matter because what you are told is not legally binding. What is legally binding is your signature on the Medicaid application which indicates that you agree to the terms of the contract – which brings us to another item in OBRA 1993. Read on.
OBRA 1993 also contains procedural rules intended to ensure that individuals are informed about Medicaid program requirements including disclosure of estate recovery before they complete the application process and also during the annual re-determination process. Notification of estate recovery should be on the signature page of your state’s Medicaid application and is usually a one-liner: I understand that if I am aged 55 or older, (name of your state’s Medicaid plan) may be able to get back money from my estate after I die. (Use of the word ‘may’ doesn’t mean if the state feels like it – it means recovery will take place unless there are specific circumstances for exemption or deferment as mentioned above.) There are also strict recovery/repayment clauses for injury-related settlements disclosed on the signature page and a few other ditties that apply to you or a family member who is enrolled in Medicaid. All of these items must also be disclosed in your state’s Medicaid handbook.
Under the ACA and proposed federal rules for implementation, states will be required to provide a single, simple application to apply for and enroll in Exchange plans, Medicaid and CHIP, and consumers must be able to apply by phone, in person or online. The Secretary (HHS) is charged with this task and it’s in the works. This begs an answer to the following questions:
— Will Medicaid applicants be diligently informed about estate recovery and other rules that apply to Medicaid enrollees on this single application? Failure to do so would be in non compliance with OBRA 1993 and would also be deceptive.
— Will applicants be provided with a signature page that contains appropriate disclosure of these rules so they can be reviewed before signing on the dotted line?
— How will appropriate disclosure and obtaining a signature work for those who are bumped into Medicaid due to a decrease in income or who might be auto-enrolled because they were presumed eligible through a database.
If an applicant or someone who has been bumped or auto-enrolled in Medicaid is not satisfied with the terms of the Medicaid contract, lack of another health insurance option that is in the best interest of low-income earners represents undue and unconscionable advantage being taken of this segment of the population under a law that mandates health insurance or a penalty.
Do the health insurance policies enjoyed by lawmakers on Capitol Hill and paid for by taxpayers include an estate recovery program?
Medicaid is poor, underfunded, overstretched and constantly bombarded by state budget cuts – even before an ACA expansion. It offers a low quality of care in many states, and, in general, represents inequities in care. Office-based doctors typically refuse to accept Medicaid patients, thus, millions thrust into this plan will have difficulty finding a primary-care doctor or a specialist.
A perfect example is the December 2012 federal appeals court decision that allowed California to cut reimbursements by 10 percent to doctors, pharmacies and others who serve low-income residents under the state’s Medi-Cal plan (a version of Medicaid) due to state budget issues. California was already at the bottom of the rate-reimbursement heap which made finding doctors difficult for residents in Medi-Cal. This decision will further reduce the number of health care providers willing to take new Medi-Cal patients, thus jeopardizing their access to primary and specialized care. Under the ACA’s expansion of Medicaid, state budget crises across the nation will exacerbate the ongoing problems regarding access to care for Medicaid patients, particularly in states that have a high low-income population. http://www.sfgate.com/health/article/Medi-Cal-cuts-upheld-by-appellate-court-4116971.php
6. INSURANCE PLANS AT THE EXCHANGES
Below are the 4 plan levels that will be offered at Exchanges for people between 138 and 400 percent FPL. Each one has government- approved benefits including prescription coverage. You will be entitled to one free preventive visit each year. Per the most recent study commissioned by the Kaiser Family Foundation, several cost-sharing options were estimated for non-group (individual and family) Bronze and Silver plans. Cost-sharing is the amount you must pay to use your insurance. Your share of the premium is not part of cost-sharing. http://www.kff.org/healthreform/upload/8303.pdf
The way this works is you will pay for all your medical care until you reach the annual deductible. Then you’ll pay the applicable percent- age of coinsurance until you reach the annual out-of-pocket spending cap which will be set on a sliding scale. Annual means these amounts start again the following year, and if they change, you will find out when you re-apply for insurance. There will also be copays – an amount you will pay to the doctor for an office visit.
Here are the current estimates:
Bronze: cheapest and dry as dust with 60/40 coverage – a win-win for insurers
a) annual deductible of $4,375 for an individual (double for a family) with 20 percent coinsurance, b) annual deductible of $3.475 for an individual (double for a family) with 40 percent coinsurance
Silver: next cheapest – offers an illusion of coverage at 70/30
a) annual deductible of $2,050 for an individual (double for a family) with 20 percent coinsurance, b) annual deductible of $650 for an individual (double for a family) with 40 percent coinsurance
Gold: expensive – 80/20 – better coverage
Platinum: most expensive – 90/10 – most comprehensive coverage

A fifth plan will be available for the under-30 crowd and people who have been granted a hardship exemption. See topic 8 in this lesson. Coverage in this plan will be less comprehensive than the Bronze – it is primarily for major-medical expenses except that it has a free preventive visit. Cost-sharing for people at 138 to 200 percent FPL is estimated to be a bit less than the Bronze and Silver estimates mentioned above.

The high deductibles in all but the two most expensive plans could saddle you with mounting bills for routine care and may stop you from seeking necessary treatment for illness or injuries. Many of you will find that the promise of access to affordable health care really means access to inadequate coverage at a price the government has decided you can afford to pay.

The number of drugs in each plan at an Exchange will vary from state to state. In some states, plans will offer up to 99 percent of available drugs and others only 45 percent which means you may not have access to the specific drugs you need. Perhaps Big Pharma will change its stance on this before 2014.
The cost of plans at an Exchange will vary from state to state based on where you live and your age. The ACA allows insurers to charge older customers up to three times more for a plan, even if they are in good health, as long as the state in which an Exchange is located doesn’t have a law that caps age-rating. Some Exchanges will tuck an administrative fee of 2 to 4 percent into premiums to help cover operating expenses.
Cost-sharing tax credits will be available if you are below 250 percent FPL to protect you from high deductibles and copays – but only if you purchase a Silver plan. If you buy the cheaper Bronze plan, you won’t be eligible for these credits, which are, by the way, direct federal payouts to private health insurance companies.
Obamacare has no cost controls. There is nothing stopping the insurance companies from increasing their rates, and Washington has already estimated higher premium costs at the Exchange for 2016 which doesn’t mean that 2015 won’t have an increase. Sounds like 2014 prices will be an Introductory Offer. Get ‘em while their hot!
7. PENALTY FOR BEING UNINSURED
The ACA requires that people who have been deemed able to purchase health insurance but decide not to buy it starting in 2014 will owe a penalty (a tax) to the IRS. Here’s what this looks like:
a) In 2014, the annual penalty will be $95 per adult and $47.50 per child, up to a family maximum of $285 or 1 percent of family income, whichever is greater.
b) In 2015, the penalty will be $325 per adult and $162.50 per child, up to a family maximum of $975 or 2 percent of family income, whichever is greater.
c) In 2016, the penalty will be $695 per adult and $347.50 per child, up to a family maximum of $2,085 or 2.5 percent of family income, whichever is greater.
The IRS collects the penalty, but the ACA stipulates that taxpayers shall not be subject to any criminal prosecution or penalty, tax liens, seizure of bank accounts or garnishment of wages for failure to pay it and no accumulation of interest on the unpaid balance. So, it appears that all the IRS can do is deduct the penalty from a refund it owes you, and if you’re not due a refund, then you’ll have an out- standing tax obligation.
Keep in mind that the penalty is described in annual amounts but is really monthly. So, if you are uninsured for only part of the year, you will accrue only 1/12 of the total for each month you are uninsured unless you qualify for an exemption.
8. EXEMPTIONS FROM THE PENALTY
You may be eligible for official permission that excuses you from having to pay the penalty for being uninsured. The requirements are:
a) If the cheapest health care plan available costs more than 8 percent of your MAGI after subtracting the tax credit or employer contribution, whichever is applicable.
b) Your income is so low that you aren’t required to file federal income taxes.
c) You are between jobs and without insurance for up to three months.
d) You have a sincerely-held religious belief that prevents you from seeking and obtaining medical care.
e) You are in jail.
f) You are an undocumented immigrant.
g) You are a member of an Indian tribe or a religious group currently exempt from paying Social Security tax.
If item d) is the case, you must file a sworn statement as part of your tax return, and should you obtain care during the tax year, the exemption will no longer apply and you will have to pay a penalty for being uninsured. Per H.R. 6597, medical care is defined as acute care at a hospital emergency room, walk-in clinic or similar facilities. Medical care excludes treatment not administered or supervised by a medical doctor such as chiropractic, dental, midwifery, personal care assistance, optometry, physical exams or treatment where required by law or third parties such as an employer, and vaccinations.

If you think you can’t afford the amount the government has decided you can afford to pay for your insurance plan, and you don’t fit into any of the categories described above, you can apply for a Hardship Waiver. Details have not yet been provided regarding hardship eligibility requirements under the ACA, but, for an idea of what they might look like, let’s check out what the deal is in Massachusetts which already has a mandated health insurance law – Romneycare! In fact, Romneycare was the model for Obamacare. That’s why some people call Obamacare, Obamneycare.
To qualify for a Certificate of Exemption under Romneycare, a Massachusetts resident must demonstrate that health insurance is not affordable due to one of the following: 1) homelessness; 2) eviction or foreclosure notice; 3) domestic violence-related medical trauma; 4) major long-term illness of a child; 5) death of your spouse; 6) your house burned down; or 7) “you can establish that the expense of purchasing health insurance would cause you to experience serious deprivation of food, shelter, clothing or other necessities.”
Ya gotta luv number 7. And in Massachusetts, exemptions come with an expiration date, so you have to clean up your act in short order. Under the ACA, the Secretary of Health and Human Services will determine if, indeed, you have suffered a hardship that keeps you from being able to pay for coverage.
9. OTHER TIDBITS
There is much more in the ACA including all kinds of rules and penalties for employers, employees and the self employed as well as the Accountable Care Organization (ACO) model which will be mandated starting in 2014. The latter works as follows: under the simplest option available, a small group of doctors and hospitals – an ACO – will manage your care and be graded and paid based on the outcome of all patients who seek treatment with that ACO. The ACO will also be rewarded with a share of the savings in health costs it achieves by following best treatment practices and reaching specific benchmarks set by CMS. The second option, “shared savings plus risk,” is for larger ACOs. Providers will receive a lump-sum payment to treat their patients and assume a portion of the risk for above target spending but are eligible to keep a greater portion of the savings.
Either of these options reduce patient care to numbers and paperwork because doctors are essentially controlled and incentivized by an administrator in some far-flung office. The ACO model is the insurance industry’s version of “budgeting” the cost of health care which ultimately benefits insurers at the expense of doctors and their patients.
Doctors say that basing their pay on treatment outcomes creates an incentive for them to avoid tough cases whose outcomes could “kill my numbers.” “Paradoxically,” writes Dr. G. Keith Smith, “doctors who are doing sham surgery will be the ones with the best outcomes, as their patients, many of whom don’t need surgery in the first place, will exhibit great, basically perfect outcomes. Physicians who don’t do unnecessary surgery will be pushed to do so to improve their ‘scores.’ ‘Pay for performance’ trends in medicine are not a good idea in my opinion. Paying based on patient outcomes will have perverse effects, not the least of which will be the complete denial of care to the very sick.” http://www.medibid.com/blog/2012/10/your-disease-can-kill-you-in-more-than-one-way/?utm_source=Registered+Physicians&utm_campaign=8f9028ddaf-October_Physician_Newsletter11_17_2012&utm_medium=email
The ACA also requires Health Insurance Exchanges to establish a navigator program to inform the uninsured about the availability of government-approved subsidized plans at an Exchange and to facilitate enrollment in these plans, but it leaves the design of the program up to each Exchange.
Depending how an Exchange sets up its program, some Navigators will sell plans offered by an Exchange while others will be responsible for maintaining the existing market but may also be allowed to sell Exchange plans. All seller Navigators will be compensated either by Exchanges or insurance carriers for the plans they sell. Many options are being considered by Exchanges including using insurance agents. Hopefully, Navigators and insurance agents will not be knocking on your door or contacting you by phone. That would be over the top. Here’s a link to read what the California Exchange is pondering with regard to its Navigation program. http://www.healthexchange.ca.gov/StakeHolders/Documents/CHBE,DHCS,MRMIB_StatewideAssistersProgramDesignOptionsRecommendationsandWorkPlan_6-26-12.pdf
10. ENROLL AMERICA, HERNDON ALLIANCE & THE EXCHANGES – MASTERS OF SPIN
Since many Americans don’t know about the ACA, somehow the word has to get out and people must be encouraged to purchase health insurance either in the open market or at an Exchange. And who better to do this?
Enter “Enroll America” – a nonprofit 501(c)3, financially backed by Aetna, Blue Cross Blue Shield, UnitedHealth, America’s Health Insurance Plans, hospitals, associations that represent drug manufacturers and nonprofits with vested interests. For insurers and pharma, the ACA is manna from heaven – scratch that – manna from Capitol Hill – and the dollar signs in their eyes are on fire! These profit seekers and connected nonprofits will be using every avenue possible to maximize their bottom lines.

The mission of Enroll America per its website is to “ensure that all Americans are enrolled in and retain health coverage.” It’s Board of Directors and Avisory Council reads like a Who’s Who in the Medical Industry Cartel – CEOs, presidents, vice presidents and directors of such entities as the American Hospital Association, Express Scripts, Medicaid Health Plans of America, Kaiser Permanente and many others – the list is long. If you would like to donate to these mega-profit vultures, you can do so on the Enroll America home- page. The goal is $100 million by 2014.

http://www.enrollamerica.org

In its publication, “Ten Ways to Make Health Coverage Enrollment and Renewal Easy,” Enroll America has recommended availability of web-based applications to increase the places where people can enroll in coverage: at home, at grocery stores, community health centers, state fairs, sporting events, places of worship, and more. Gee, you can apply for insurance while you pray. How thoughtful. http://www.enrollamerica.org/best-practices-institute

The strategy for insurers and state Exchanges to persuade you to purchase insurance and warn you about the penalties includes using ads, social media, blogs, YouTube, Flickr, Twitter, hospitals, health centers, McDonald’s, in-store radio announcements, ballparks, county fairs, libraries, laundromats, community events, libraries, county fairs and drugstores – you name it. Blue Cross Blue Shield has partnered with H & R Block. Health insurers are already setting up shop inside some supermarkets so they can answer your questions and sign you up for coverage while you do your grocery shopping. They will likely be showing up in shopping malls – maybe even in parking lots, on street corners and at church fairs. And, their aim is to recreate themselves from the bloodsucking leeches that they are to your new, cool-dude friends.
We’ll be living in Occupied Territory.
Let’s connect some dots. The executive director of Enroll America is Ron Pollack, also president of Families USA – a nonprofit and friend of the industry. On its website, Families USA bills itself as “a national non-partisan organization dedicated to the achievement of high quality, affordable health care for all Americans.” Philippe Villers and Robert Crittenden, M.D. are on Families USA Board of Directors. Mr. Villers is also on the BOD of Herndon Alliance, Bob Crittenden is a Herndon staff member and Ron Pollack is a Herndon founder. http://www.familiesusa.org
Herndon Alliance is an influential health care spinmeister creating messaging to change public opinion and tweaking each message to reach particular groups.
Herndon has close ties to Capitol Hill and helped market the ACA providing words politicians and supporters should use to promote the bill. For example, during the national health care debacle a few years ago, you heard Mr. Obama et al continually talk about ‘choice,’ ‘we need a uniquely American solution,’ ‘fair rules,’ ‘investing in America’s future’ and ‘high-quality, affordable healthcare.’ That last one is used in Families USA mission statement. The Council for Affordable Health Insurance, a frontgroup for the industry, gets right to the point – its name. Ron Pollack worked with the Obama administration to help reshape public opinion of Mr. Obama’s unpopular health care bill. Leading up to 2014 when the Exchanges are scheduled to open, there will most likely be a blitz of TV ads in which you will hear many of these same nebulous, feel-good words. And, you’ll undoubtedly read or hear plenty of Herndon spin from your Exchange and throughout your state in the immediate future.
In the interest of coming up with messaging, Enroll America held a few focus groups and commissioned a nationwide survey in fall 2012. Research was provided by Celinda Lake from Lake Research Partners, a national public opinion and political strategy research firm. One takeaway was when a monthly premium cost was given, the majority of people polled thought that it was too expensive and the ACA would not provide affordable and comprehensive coverage even with the government tax credits (subsidies). So, Lake Research Partners advised Enroll America not to mention specific costs but to use the phrase ‘free or low-cost plans.’ http://www.nytimes.com/2012/12/20/us/officials-confront-skepticism-over-health-law.html?ref=us&_r=0&pagewanted=all
Herndon has been working on messaging various parts of the ACA that will be used by outreach partners, insurers and state Exchanges. Its messaging is not based on truth or evidence – Herndon actually stays away from any mention of facts as you read above regarding the cost of plans. Instead, its messaging is designed to mislead an uninformed public.
A few of Herndon’s target populations include voters, people of color, red states, skeptical audiences, and you’ll love this one – Elevator Language with a list of succinct scripts to use based on the person you’re speaking to during the ride. You must check out Herndon’s website and read the many instructions of what to say and what not to say. You’ll either get very annoyed or laugh yourself silly. http://herndonalliance.org/resources/research/communications-tips-exchange-talking-with-voters.html
http://herndonalliance.org/resources/implementation-basics/communications-tips-to-use-with-skeptical-audiences.html
Here are some examples of Herndon spin regarding the ACA:
— Use “family values” when talking to the public about the expansion of Medicaid. Is estate recovery a family value? http://herndonalliance.org/resources/what-s-new/talking-about-medicaid-connecting-with-the-public.html
— When talking about the ACA’s required Accountable Care Organization (ACO) model that will pay doctors according to patient outcomes and reward them for savings they achieve, Herndon says to call this “Coordinated Patient Care” and “do not connect pricing with rewards or incentives for doctors” or “with lump-sum payments for medical care” and do not mention “payment based on positive patient outcomes.” Why not? The three do-nots are how ACOs work. (ACOs are described in topic 9.) http://herndonalliance.org/resources/system-change/payment-reform-quality-care-pricing.html http://herndonalliance.org/resources/system-change/coordinated-patient-care.html

— Here’s an award winner: “Members of Congress will purchase their insurance at the Exchange. If members of Congress are part of the marketplace then it’s got to offer quality plans and protections.” http://herndonalliance.org/resources/research/communications-tips-exchange-talking-with-voters.html

— Stressing that under the ACA insurers won’t be able to deny coverage for pre-existing diseases is a Herndon biggie. In fact, you heard this many times over from Mr. Obama and other politicians. But a loophole in the law allows insurers to rescind (cancel) your policy if you intentionally put false or incomplete information on your application. The ACA says you must be given at least 30 days’ notice before your coverage can be rescinded, giving you time to appeal the decision or find new coverage. So, if your care becomes costly for the insurer and you didn’t mention you had a rash on your arm when you were 15, that’ll work. How can you prove if leaving this out was intentional or not? It’s them against you.

Enroll America’s Best Practices Institute is publishing a series of briefs on the best way to write and design websites and marketing materials, no doubt, using Herndon messaging. PR and marketing firms are helping various state Exchanges come up with appealing branding such as using a name everyone will like and spiffy logos with cool type styles in colors that will appeal to all audiences. Branding lessons include advising Exchanges which words to ‘embrace’ such as emphasizing choice, control, transparency and competition. Other messaging includes, “the Exchange should be viewed as an educator, not an enforcer” and using the word ‘marketplace’ instead of Exchange is a must. Tennessee Health Care Campaign will be telling potential customers “. . . the exchange offers us more choices, greater control over our health care, and more competition to control costs.” It’s all Herndon’s handywork in one form or another. http://dhmh.maryland.gov/exchange/pdf/Brand_Recommd_may182012_final.pdf http://www.thcc2.org/PDFs/rtm_exchange_talking_point.pdf
More choice means choice of insurance companies, not choice of doctors and hospitals. In rural areas, there may be only one insurer offer- ing plans which means one network and doctors may not be taking new patients. This happened in MA under Romneycare, and on top of that, many doctors would not accept people in the subsidized plans because of time-consuming red tape and low reimbursement rates. Under the ACA, insurers are planning to limit networks in the cheaper plans at the Exchanges. Having too few doctors in a network is a means of suppressing the use of health care which increases an insurer’s profits. Further on in this lesson, you’ll learn that the Maryland Exchange has been advised to ignore negative problems such as not enough doctors to serve the newly insured. http://www.kaiserhealthnews.org/Stories/2013/January/23/HMO-limited-networks-comeback-in-exchanges.aspx
Choice is definitely a non starter for people found eligible for Medicaid – the ACA allows no other choice for this segment of the popula- tion and many doctors do not accept Medicaid. As for giving you greater control, considering all the rules about income and FPL, not to mention the data-mining to monitor your income during the year and those nasty tax credit paybacks, it’s you who is being controlled. And competition? Read this stunning op-ed by Nomi Prins: “Real Danger of “Obamacare” Insurance Company Takeover of Health Care.” http://www.nationofchange.org/real-danger-obamacare-insurance-company-takeover-health-care-1352648027
In Enroll America’s January 15, 2013 press release, Executive Director Rachel Klein says the ACA offers the promise of “access to comprehensive, affordable health coverage.” That is a false promise. As you learned in this lesson, coverage in the plans that will be offered at the Exchanges, with the exception of the two most expensive, is anything but comprehensive – the cheaper plans are unafford- able to use. Furthermore, how can she claim that the cost of the plans are affordable? Ms. Klein should be well aware of the nationwide survey Enroll America commissioned in which the majority of people polled said that the plans are too expensive. http://files.www.enrollamerica.org/news-room/press-releases/Enroll_America_Plans_Major_Affordable_Care_Act_Enrollment_Campaign_1-15-13.pdf
http://www.nytimes.com/2012/12/20/us/officials-confront-skepticism-over-health-law.html?ref=us&_r=0&pagewanted=all
Currently PR firms are working with some state Exchanges to develop effective communications plans and advertising campaigns. Names include Mintz & Hoke, Hill & Company Communications and Weber Shandwick just to name a few. Ask the Massachusetts Health Insurance Connector – the prototype of an Exchange in the land of Romneycare – how much it spent on PR contracts over the years. In 2007, board members signed off on a two-year contract with Weber Shandwick for $1.85 million the first year with nearly $3 million for advertising – commission on media buys not included. And, by the way, the MA Connector upper management boasts six-figure salaries. Former MA Connector Executive Director Jon Kingsdale’s salary in 2007 was $225,000 and increased in 2008 to $231,750. In 2007, Deputy Director Rosemary Day alternated between a four-day and five-day work week to the tune of $175,000. These are only two examples of the many high-flying salaries at the MA Connector, an operation run by politicians and unelected political appointees and influenced by executives from the private insurance industry, http://www.wickedlocal.com/cambridge/news/x497793387/Connector-re-ups-contract-with-Cambridge-based-Weber-Shandwick http://www.boston.com/yourlife/health/other/articles/2007/01/27/6_figure_pay_for_care_plan_overseers/?page=full http://www.highbeam.com/doc/1G1-166773095.html
Add up pay scales like that for every Exchange in the country, throw in some bennies, a PR contract for each Exchange, campaign costs and compensation paid by Exchanges to Navigators for plans they sell – a grand and costly effort to push more people into America’s for-profit health care system. Your tax dollars at work and mega bucks that could be used for actual hands-on medical care.

The Maryland Exchange has three campaign funding levels – Basic, Plus and Full-Scale – with a total for year one, two and three. Basic funding for year one is $2,450,000, Plus is $4,000,000 and Full-Scale is $6,300,000. See p.137 at this link for years two and three. http://www.dhmh.maryland.gov/exchange/pdf/FinalAdvertisingReportWeber.pdf

The following, from the maryland link above, gives you an idea of some of the strategies that will be in play, most likely in all states. The Maryland Exchange has been advised by Weber Shandwick to “establish a system to monitor newspaper, radio, TV and online conversations about the Exchange and the program and to establish procedures and priorities for responding to negative media stories, op-eds, blogs and reports.” You can find this in the Risk Management and Responses section of Maryland’s strategic marketing plan.

In the Earned Media/Public Relations section, advice includes “ . . . putting out stories on the first effective enrollees, enrollment number milestones, and enrollee testimonials. Each of these becomes the focus for positive, brand-reinforcing stories. There will also be the risk of negative stories, including potential topics such as enrollment snafus, delays in issuing insurance cards, the cost of Qualified Health Plans [government-approved plans], claims of ‘shoddy’ Bronze coverage, incidents of physicians refusing to accept enough new patients to serve the uninsured and other negative topics.” “While coverage is bound to include some level of criticism it can be success- fully countered by putting a human face on heatlh reform.”
The Social and Digital Media section advises an invasion of the Internet including social media to market health insurance by “delivering the right messages to the right audience at the right time,” (probably using Herndon spin) to “help drive enrollment in the Exchange,” and also flooding newspapers with op-eds to contradict reported adverse effects of the ACA.
More details can be found at the Maryland pdf link below. It’s worth looking at this presentation to grasp the big business approach of Exchanges which is clearly profit-driven. The Maryland Exchange strategy is just one example. The goal of Exchanges is sell, sell, sell. http://www.dhmh.maryland.gov/exchange/pdf/FinalAdvertisingReportWeber.pdf
Exchanges certainly have a lofty goal – promote success stories only and be ready to contradict and cover up the bad stuff as quickly as possible. Massachusetts residents have been there. The Connector and state politicians including the governor made sure that anyone being harmed by Romneycare would not be heard in spite of statewide survey reports put together by outreach agencies advising state legislators and powerplayers that low-income people were not faring well under this law. Various issues were spelled out and testimonials were included, but residents’ concerns about the adverse effects of Romneycare were ignored. MA national legislators also went along with this agenda as did the mainstream media.
When $130 million was needed in 2009 to balance the Massachusetts state budget, the Connector – with the blessing of MA Gov. Deval Patrick and the MA legislature – removed about 28,000 legal immigrants – working people paying taxes – from their insurance plans. Another 8,000 or so were barred from enrolling in insurance plans because the MA legislature voted to cap enrollment in the subsidized plans. This took place at the same time Mr. Obama was trying to sell the ACA to the nation, so, under pressure from Washington, the MA legislature restored some of the money, and the Connector dumped these people, without their consent, into an out-of-state plan with higher copays, less comprehensive coverage and next to no doctors or safety net hospitals in its network. http://www.huffingtonpost.com/iyah-romm/lessons-from-massachusett_b_380718.html
This has huge implications for the ACA. If legal immigrants can be removed from their plans and others denied enrollment when a state budget is squeezed, which vulnerable segment of the population is next in line? The good news is these legal immigrants in MA sued the Connector and its then-Executive Director, Jon Kingsdale, and the Massachusetts Supreme Judicial Court ruled unanimously that the state could not violate their right to equal protection under the state and federal constitutions and fiscal considerations alone can not justify a state’s invidious discrimination against them. As a result of this decision, the state had to come up with some bucks, and the Connector was forced to put the plaintiffs back into their original plans.
http://www.healthlawadvocates.org/priority-areas?id=0015
Getting back to Enroll America, Herndon Alliance and some of the less-than-honorable Exchange strategies – it’s one thing to inform Americans about the ACA and Exchanges that offer the possibility of either purchasing high-deductible or catastrophic coverage with a loan from the government to help pay for it or being tossed into expanded Medicaid – but, mounting a costly, massive campaign to purposely deceive and manipulate the public with the unstated goal of more profit for the already extremely lucrative health insurance industry is disgraceful.
Is the ACA a fair law if it helps only one small segment of the population but hurts and exploits a larger number to do so? The way this law works is fundamentally unfair and will not bring medical care to the many, but, instead will progress to greater personal debt for individuals and families who can’t afford the “affordable” insurance as well as those who must keep an eye on their income to avoid the many traps and false ends this law creates. At their expense, the forced purchase of health insurance will bring increased revenue to the industry, not to mention more kickbacks to Congress, and in the very near future, the health insurance industry will be “too big to fail.”
The ACA is most definitely a “uniquely American solution” which has little to do with reforming this country’s barbaric health care system. It merely controls peoples’ finances and choices while leaving insurance companies in charge and does virtually nothing to end their abuses. It will leave many millions of Americans uninsured and millions more underinsured at a staggering cost to taxpayers.

Politicians, health care policy wonks and vested interests will brush aside the ACA’s adverse effects. You’ll hear that some have fallen through the cracks of health care reform but the problems can be easily tweaked. You will also witness the usual dog-and-pony show on Capitol Hill in which the two parties play the blame game. The bought-and-paid-for mainstream media will regurgitate whatever Washington feeds it, and TV talking heads will chime in, inviting their “experts” to analyze the situation while real people in the real world struggle to get by under this law or fall by the wayside.
Good luck everyone and watch out for the folding chairs.
addendum:
Obamacare architect leaves White House for pharmaceutical industry job
http://www.guardian.co.uk/commentisfree/2012/dec/05/obamacare-fowler-lobbyist-industry1

Physician payments based on outcomes
http://www.medibid.com/blog/2012/10/your-disease-can-kill-you-in-more-than-one-way/?utm_source=Registered+Physicians&utm_campaign=8f9028ddaf-October_Physician_Newsletter11_17_2012&utm_medium=email

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