Welcome to the Richardson High School Message Forum.
The Message Forum is an ongoing dialogue among classmates. The goal is to encourage friendly interaction, including interaction among classmates who really didn't know each other. Experience on the site has revealed that certain topics tend to cause friction and hard feelings, especially politics and religion.
Although politics and religion are not completely off-limits, classmates are asked to be positive in their posts and not to be too repetitive or allow a dialog to degenerate into an argument.
Forums work when people participate - so don't be bashful! Click the "Post Response" button to add your entry to the forum.
While watching Mark Levin's show tonight, I heard the interview with Atty. Gen. Barr, who was expressing his deep concern about voter fraud being committed this year, due to mail-in ballots. He said the systems that will be used in several states are bound to produce questionable results, which is exactly what Pres. Trump has been saying for the last two months, warning states NOT to use the widespread mail-out of ballots. He says to request an absentee ballot instead, so that the ballot can be properly traced, and confirmation will be possible.
Nevada Dems rushed a fundamental change to their state's election system through in 72 hours, just in time to favor a Democrat victory, having their Democrat governor sign it into law at the last minute. Why do you suppose they made that sudden change?
Their new system will now be a universal vote-by-mail system that will send a ballot to every address on NV voter rolls, rolls that are outdated and unchecked recently, allowing for dead citizen's names to still be on the rolls, as well as citizen's addresses remaining, even though some of those citizens have moved to new locations without notification to the voter registrar's office. Furthermore, the law includes a provision stating ballots rec'd in the 3 days after the election would be counted, even if the ballot is not postmarked to prove the vote was cast before Nov. 3rd.
The NV law says that ballots will be mailed to addresses on the voter rolls with a pre-paid return envelope. US Postal Service regulations reveal that pre-paid envelopes are not required to be postmarked, meaning that if Nevadans mail their ballots back in the pre-paid envelopes, those envelopes will probably not have a date stamped upon them. It will not be known just exactly WHEN those envelopes were mailed back, as we can clearly surmise.
Mercedes Schlapp revealed this info to a CNN interviewer, who promptly dismissed it all as needless concern, as she said voter fraud was rare and inconsequencial, just as we have heard so many times before.
In general, I am against elimination of the payroll tax for a couple of reasons. I don't like the SS and Medicare systems to be financially undermined or to be viewed as a part of the main budget of the US. Indeed, I would like to see those systems shored up rather than undermined and/or used as a tool.
However, cutting the payroll tax has an immediate effect. Current employees have more money to spend and that goes into the economy. People who are underemployed will have an increased level of income. For employers, for every 14 employees (under the employee wage base of $130+K), elimination of the payroll tax frees up enough capital to hire or hire back one more person. Hopefully, by the time the economy warms up, the businesses will generate enough revenue to absorb the (gradual?) increase in the payroll tax.
The biggest objection to eliminating the payroll tax seems to be that President Trump is for it.
The executive order, as I understand it, defers payroll taxes for a few months, or after the election. Deferred means that both the employee and the employer must pay this back at some point. I would expect that if Trump is reelected he would press to not hav these taxes ever paid back and make the change permanent. Trump, Steven Miller and Mitch McConnell would love it if Social Security and Medicare was gone.
I believe in 1972, to eliminate their national debt, Canada imposed a 6% capital tax on all corporations in business in Canada with 50,000,000 in value. It was to be a temporary tax.
I am pretty sure it coninued until 2007. The federal part of the tax expired, or was eliminated. The tax is still in effect in some provinces....actually, most provinces.
Stopping or starting taxes usually seems reasonable and purposeful, but over time, that purpose gets lost in the budget.
Just like SS is considered part of the US budget and hunting and licensing fees in Texas as well as the lottery tax go into the "general fund." That's how they twist our State budget into being "balanced."
They actually take a vote on wheter a budget is "balanced" or not here in Texas. It's really a joke.
I wonder how the next session is going to manipulate the balanced budget rule here in Texas.
Janalu, Thank you. Great points made. "Spreading the Wealth"...hmmm, I would think Dems would be applauding Pres Trump for "Spreading his Salary around as he donates it to a variety of groups/causes. I only remember the Obamas spreading our tax money around by taking extravagant vacations...don't forget Granny...hmmmm Again, I see this messy state of affairs in our beloved country (rioting, Hawaii and California governors FORBIDDING Churches to open their doors while bars and favored establishments remain open...considered to be "essential". Persecution in America...who would've "thunk" it. I hope John Macarthur in California (No COVID cases in his church so far), as well as other pastors will stand strong against the tyranny that assauults them. "In God we Trust" is still our motto. We need to show that indeed, we do...trust God. #stillsovereignonhisthrone
1) On day 2 did the self test for Covid-19 cure the headache?
2) Corp taxes. Is it fair to say when it comes final taxes they actually do not pay taxes they act as a middleman/collector because they have to increase their prices to make a profit and pay the taxes so in the end all taxes come from individuals? Tax money comes from direct individual taxes, sales tax and increased cost of goods and services.
Since its introduction in 1965, Medicare’s most sweeping changes came about with the Medicare Prescription Drug Improvement and Modernization Act of 2003, otherwise known as MMA 2003. MMA 2003 greatly expanded Medicare, providing individuals with more choices and options for the delivery of their Medicare services. Most notably, MMA 2003 expanded Part C of the program (renaming it Medicare Advantage) and created Medicare Part D—Prescription Drug coverage.
MMA 2003 did not solve all the problems, but it did provide a way for the elderly to pay for prescription medication in a time when rising drug prices were running far ahead of inflation. Those on fixed incomes were faced with a choice of paying for day-to-day necessities and going without necessary but expensive drugs, or paying for the drugs and getting further behind with living expenses. Through Part D, Medicare beneficiaries have broad access to prescription drug coverage.
This benefit notwithstanding, the act was not without its critics. Both the renaming of Medicare+Choice to Medicare Advantage and the nature of the Part D program itself were criticized for a variety of reasons. Medicare Part C established alternatives to the traditional Medicare+Choice programs and the coordinated care approaches of health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Private fee-for-service (PFFS) plans were also introduced.
Making the general public uneasy was the fact that Medicare Advantage and Part D were introduced nearly at the same time, and they were also implemented within a relatively short time (two years).
Many people were confused about the benefits of Part D and were dissatisfied with the marketing methods of Part C. The confusion and unease has subsided, however, and today, both programs have become standard fixtures in national health care. As such, both programs will continue to be revised and revamped.
In July 2008, Congress enacted the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA 2008). This act provided for general improvements in the Medicare program but more particularly addressed changes to Medicare Advantage and Medicare Part D problems that had surfaced after MMA 2003. Most of the changes dealt with low-income subsidy qualification, private fee-for-service plan restructuring, Special Needs Plans redefinition, physician payments, and Medicare Advantage plan payment reductions.
A significant portion of MIPPA 2008 was dedicated to defining required marketing practices and standards for Medicare Advantage and Medicare Part D plans. The directives that had been passed down from the Centers for Medicare and Medicaid Service (CMS) to Medicare Advantage companies, to Medicare Advantage prescription drug companies, and to “stand alone” prescription drug plan companies (and their producers) were elevated to legal status, thus increasing the ability for CMS to rely on laws and statutes to prevent marketing problems in MA and Part D solicitations.
Even though MIPPA 2008 corrected much of the marketing abuse problem, CMS distributed further “guidances” during 2008 and 2009. One was the creation of a “Scope of Appointment” form, which all MA and Part D providers and their representatives are required to complete before having any sales meeting or appointment with a prospect.
Another important development was the way referrals must now be treated by Medicare Advantage producers. No longer can a representative simply call a referral. The referral must contact the agent, and then a Scope of Appointment form must be completed before the appointment can begin.
Centers for Medicare and Medicaid Services has continued to pass down to Medicare Advantage and prescription drug plan companies additional marketing rules and will undoubtedly continue to provide guidances throughout the existence of the two programs.
In March 2010, Congress passed a comprehensive (and, some would say, confusing) piece of legislation titled the Patient Protection and Affordable Care Act (PPACA). Several changes were made in the Medicare program, with much of the change involving Medicare Advantage and Medicare Part D.
One of the more significant changes was the expansion of the “Star Rating System” which CMS instituted with regard to Medicare Advantage and Medicare Part D plans effective January 1, 2012. Under the star system, MA and PD plans are assigned one to five stars, based on specific performance measures: five stars represent the highest ranking (“excellent”); one star signifies the lowest rating (“poor”). The purpose is to help consumers in their search for healthcare plans and options that best suit their needs.
FUNDING MEDICARE
The answer to “How is Medicare funded?” may seem complicated, but in reality, it is not. Even with the addition of Medicare Part D, the basics are fairly simple. Following is a brief explanation of how the funding for each part of the Medicare program is derived.
Part A—Hospital Insurance (HI)
Part A Hospital Insurance (HI) is financed largely from payroll taxes paid by workers and their employers. These taxes are withheld from workers’ paychecks—from each worker’s paycheck, 1.45 percent is deducted to help fund this program. The employer pays the same amount per each employee. Thus, for every $100 an individual earns, $2.90 is “contributed” to the federal hospital insurance trust fund. Monies paid into this fund are used to cover the costs and benefits associated with Medicare Part A.3 Unfortunately, the strength and stability of the hospital insurance fund are of concern to many as the swell of baby boomers enter retirement, as medical costs rise, as current Medicare expenditures continue to erode the fund, and as the “pay ahead” concept drifts toward a “pay as you go” proposition.
Part B—Supplementary Medical Insurance (SMI)
Part B Supplementary Medical Insurance (SMI), the medical expense portion of Medicare, is financed primarily by general revenues appropriated by the U.S. government. Another portion is paid by Part B recipients through monthly Part B premiums paid into the program. Traditionally, the Part B funding has been on a 75/25 basis, with SMI general revenue allocations covering about 75 percent of the program’s costs, and the recipients paying about 25 percent of the costs.
As costs of medical care rise, so do the Medicare Part B premiums. Part B premiums rose significantly during the early part of the decade. In 2000, the basic monthly premium was $45.50; by 2013 it had climbed to $104.90, and held steady for a few years and then began to rise again. As noted, in 2020, the monthly premium was set at $144.60 for most enrollees.
Part C—Medicare Advantage (MA)
Funding for Medicare Advantage plans comes directly from Medicare in the form of lump-sum payments to the plan. The payment is based on a “capitated” payment formula, using benchmark levels for services in each county in America. Simply put, in exchange for providing Medicare services, the MA plan receives a monthly per-enrollee payment from Medicare. Enrollees must continue to pay their Part B premium unless they qualify for one of the Medicare Savings Plans that pay for it.
Benchmark Levels
Benchmark levels are the amounts that Medicare will pay a plan in a specific geographic area, based on Medicare’s fee-for-service schedules and definitions of “reasonable” costs for services. The MA company may then bid to provide services at a cost above or below the benchmark level. The plan bid is the cost at which the plan is willing to deliver Part A and Part B services to each of its enrollees. (Many MA organizations bid below their benchmark level.)
If a plan’s bid is above the Medicare benchmark, enrollees must pay the difference in the form of a base premium. If a plan’s bid is below the benchmark, 75 percent of the difference (the “rebate”) must be passed along to plan enrollees in the form of cost sharing or premium reductions, lower co-pays, lower coinsurance responsibility, or increased covered services. (The extra 25 percent is retained by the federal government.)
The term capitated comes into play when the benchmark allows for increasing anticipated expenses for the MA company due to the advanced age or chronic conditions of each enrollee. It is significant to note that an enrollee cannot be declined on an MA application because of pre-existing conditions (except for those with end-stage renal disease). Therefore, the MA company must be allowed to receive additional monies (called “risk allowances”) from Medicare for such instances, knowing that the upper limits will be capitated.
Example
To better explain the financing of Medicare Advantage plans, let’s consider a per month example. Assume that MA Plan #1 Company submits a bid of $600—the per capita (or per enrollee) payment for which it is willing to provide Part A and Part B benefits. The benchmark level for Plan #1’s region is $700. The formula for Medicare’s payment to Plan #1 is calculated as follows:
Benchmark:
$700
Plan #1 bid:
$600
Difference:
$100
Medicare’s payment to Plan #1:
$600 + (.75 × $100):
$675
Base premium enrollee must pay for the MA plan:
$0
Now assume that MA Plan #2 Company submits a bid of $750. The benchmark level for Plan #2’s region is also $700. The formula for Medicare’s payment to Plan #2 is as follows:
Benchmark:
$700
Plan #2 bid:
$750
Difference:
($50)
Medicare’s payment to Plan #2:
$700
Base premium enrollee must pay for the MA plan:
$50
Again, if the plan’s bid is below the benchmark determined by Medicare, the plan must return 75 percent of the difference to beneficiaries as additional benefits or as a rebate of the Part B or Part D premiums. (This is where part of the funding for Part D premiums in an MA plan that includes Part D comes into play.) If the bid is above the benchmark, Medicare pays the benchmark amount, and the plan is required to charge enrollees the difference between the bid and what Medicare pays.
MA Plan Operations
Medicare pays the MA company directly for the amount of its bid on a per-enrollee, per-month basis. It is then up to the MA company to manage its business affairs and costs—administrative, acquisition (advertising, commissions), claims, profitability, etc.—accordingly.
If the funding from Medicare is sufficient, then the MA company will remain in business. If not, then the company must:
cut extra benefits afforded by MA law (such as dental and vision)
buy time to “rebid” its efforts with Medicare for the next year
end its contract with Medicare, or
close its doors
Involuntary Disenrollments
During the early 2000s, these events were not uncommon. Several MA plans were dissolved, and their sponsoring companies were required to close down. This forced about 1.5 million enrollees to return to Original Medicare. As a result, several laws were initiated to protect Medicare recipients and Part C enrollees by allowing them to return to Original Medicare (as well as to certain Medicare supplement plans) on a guaranteed issue basis should their Part C plan or Part C provider close down. This process came to be known as involuntary disenrollment.
In addition, the effect of MIPPA 2008, which required MA plans to provide regional or national networks in their private fee-for-service (PFFS) plans, resulted in subsequent terminations (involuntary disenrollment) for over 600,000 enrollees. In effect, MIPPA 2008 caused many plan providers to terminate their PFFS plans and turn them into PPO plans for plan year 2010. In the meantime, hundreds of thousands of MA enrollees were involuntarily terminated from existing plans. At the end of 2010, a similar event occurred as more providers terminated their PFFS plans. Estimates ran as high as one million enrollees who lost their coverage and had to find another MA plan or go back to Original Medicare. Those people, as “involuntarily disenrolled,” were allowed to return to a guaranteed issue Medicare supplement plan under the 63-day guaranteed issue provision and were also guaranteed the purchase of a stand-alone Part D plan.
For that reason, MA, MAPD, and Part D plans change each year, and when plans change, enrollees can remain with their original plan, or they can switch to another plan during the annual enrollment period (October 15 through December 7). This is not insignificant. All plans must notify each enrollee of any changes that will go into effect for the following year.
Medicare Advantage plans must comply with a part of the Affordable Care Act which requires them to have medical loss ratios no lower than 85 percent. This means that 85 percent of every dollar the MA company takes in must be returned to policyholders (enrollees) in the form of benefits.
Part D—Medicare Prescription Drugs
A Medicare Part D Prescription Drug program, known as a PDP, is available to senior consumers in two ways:
as a stand-alone plan for those who are enrolled in Part A and/or Part B or
as part of a Medicare Advantage plan, known as an MAPD plan (Medicare Advantage Prescription Drug plan)
A stand-alone plan is an insurance plan offered by private companies that simply covers prescription drugs through a single policy. Alternatively, Part D benefits may also be available with an MA plan as part of its broad managed care benefits. Part D is a voluntary plan, separate and distinct from Part A and Part B.
Part D plans are financed in two ways:
(1) by government appropriations created in MMA 2003
(2) by premiums paid by Part D participants
If prescription drug coverage is included in an MA plan, the funding for that portion of the plan is a combination of both, because the bidding process of the MA company sets the amount it will receive from Medicare, whether above or below the Part C benchmark level. In turn, as explained earlier, this bid determines whether money is available to the MA company to be used by the company for Part D benefits or premiums.
Part D Plans Are Private Plans
Producers must understand that the prescription drug plans are private plans, and premiums are based on several factors. The first factor relates to the plan’s deductibles, co-payments, and treatment of the “coverage gap” (explained later in the course). Another factor is whether a drug is covered and, if so, under which of the plan’s “formularies” (also explained later in the course). Other factors are name brand and generic drugs and the price differences between the two. All of these factors affect the cost of Part D benefits, whether as a private, stand-alone policy or as part of an MA plan.
The financing of Part D is a combination of both Medicare (government) payments, beneficiary payments and, in the case of MA plans that offer prescription drug benefits, the cost of the plan. In practice, the producer need not worry about such financing formulae. But in fairness to proponents of Part D and to the various financial techniques employed by the program, the program’s first decade has shown financial success. This success must be attributed to the competitiveness of the system—that of several Part D plans competing for “best buys” with the drug industry.
3 An additional Medicare tax went into effect on January 1, 2013. Individuals will pay an additional 0.9 percent surtax on wages and self-employment income that exceeds certain thresholds ($200,000 for singles; $250,000 for joint filers).
Was just listening to Limbaugh on the radio, and he was saying that using the theme of "your Social Security and your Medicare are in danger of being taken away," is just the same old scare tactic that the Democrats always return to, when they want to make older folks nervous, thereby encouraging those seasoned citizens to vote for the Democrat candidate, rather than the Republican candidate.
This tactic has not been used as widely recently, because the Dems realized they had used the method so much previously, citizens were beginning to ignore it. However, in the past few days, the tactic has again been drug out of the closet to frighten those who actually believe it; so predictable!
One thing that was lost in the media. When Bush 43 won Pelosi and other Dems were counght on tape with their statigy to win back the House, Senate and White House was to be against anything the Republicans and Pres Bush they proposed. A very good example of it was the Dems were for moving our troops overseas and in Korea. When Bush announced the Pentagon had suggested some reassignment of troops overseas. Pelosi and Sen Clinton did not say Bush agreed with them. What they said is no change in force deployment. So Pelosi and Clinton helped to form the divide between Dems and Republicans. Another show of their unwillingness to work with the Republicans. The months before Oboma Care was introduced for a vote several committees held hearings and came up with a bi-partisan plan then broke for a recess. When Congress came back Pelosi announced she had a bill of her own at 4:00AM and there would be a vote at 9:00AM. She suspended the rules requiring a printed copy of any bill to be presented in front of the Dias and a time for the members to be able to read it. the bill was not printed but on the House computer. She told here party to vote to approve the bill then read it later. They voted approval and once the members read the bill they discovered there were a number of changes to be bill were needed. Pelosi said any changes could be made after the bill was signed into law. When it went to the Senate the Dem. senators were pressed to approve the bill as presented to them so Republicans would not any input in the bill which they did. Then Dems have blocked any changes to the ACA. Even changes they wanted from the beginning
The expanded Medicaid paid for by the Feds was only for a few years. Then the fed share decreased and the States had to pick up the increase. It was a carrot to get states to increase Medicaid.
My husband does our investing and likes long term mutual funds mostly. We also get advice from my youngest brother who studied finance at UT Austin, and at one time did financial planning for clients. We have a variety of accounts, which I understand minimally, being a person who tries to stay away from figuring. Numbers are just not my forte. I wish I had been a better student of math in my younger years! I spent too much time admiring handsome young dudes and writing silly notes to my friends.
Unfortunately I am probably described as a speculator rather than an investor. I got too old before I realized the value of letting money and stocks compound over time like Warren Buffet. Now I must speculate to try and make up for the 40 years of investing I should have conscientiously done.
Thanks for checking. At this point, I am feeling very good. This is a procedure that I need to have done. I have had multiple surgeries at Duke and usually if I'm going to be uptight it's two nights before the surgery. We are scheduled to begin at 11 tomorrow morning, and typically the night before I am more relaxed because I know the time is here and it's time to be positive. As a former Strength Training Coach, I have studied this procedure and it is rather interesting how they do a reverse shoulder replacement. Our classmate Bob Brown, just recently retired as President and owner of a company that dealt with all the different prosthesis for knees, shoulder, etc. Bob contacted me yesterday to assure me the reverse shoulder procedure is a good technique. I will update you all in a few days.
You sound great Mike...comfortable and well prepared.
It also sounds like this is not your 1st rodeo having a serious surgery procedure.
I've had no surgeries until 2020, and then 2 surgeries this Spring.
Today my knee surgeon gave me a shot in the right knee, in hopes it will prolong my use 4 several more months to come.
I told him I was depressed over the whole surgery issue...so for encouragement, he told me a 40 year old patient has already replaced both knees and a hip!
I left feeling depressed and somewhat fortunate.
All the best tomorrow for a quick recovery...plus good looking nurses to administer an excellent cocktail of meds to alleviate the pain!
My left knee is bone on bone. I have been administered two injections over the past 12 months and it has helped greatly to at least stall the knee replacement. It takes a couple of days for the Cortisone to kick in. My right knee was replaced in 2006 and still works well.
