Friday, April 02, 2010

ObamaCare Survivor



HSAs: Revenue-hungry Democrats have spared a choice tax break — one available even to the rich — and preserved one of the GOP's favorite plans. Could real health care reform be advancing under the radar?

By all political and fiscal logic, health savings accounts should be on their way out. That's what we once expected, and that's what liberal critics of HSAs wanted. But ObamaCare is now the law of the land and HSAs, enacted and promoted by a Republican Congress and President George W. Bush, are still here.

Democrats changed only two aspects of these plans in their quest for revenue. Holders of health savings accounts can no longer use the money to pay for over-the-counter drugs, and the tax penalty for spending HSA money on nonallowables rises to 20%. Neither revision alters the HSA basics, which in the current political climate are remarkably generous to high-income taxpayers.

An HSA holder can still deduct up to $6,150 ($7,150 if over 55) this year for a family high-deductible insurance plan. Unlike most other deductions or credits, this one doesn't phase out as income rises. The money grows tax-free and is not subject to tax when spent, as long as it goes toward medical expenses. As the New York Times' personal finance columnist Ron Lieber notes, the HSA "is a rare triple play in the world of tax breaks."

HSAs aren't a big-ticket budget item, at least not yet. Congress' Joint Committee on Taxation estimates they'll cost $6.5 billion in lost revenue from 2009 through 2013. But if their popularity continues to grow, they could cost far more in later years. Even now, they should have cost enough to rate notice by revenue-hungry Democrats, who left no seat cushion unturned in their quest for small change to pay for ObamaCare.

These were the people who voted with a straight face to squeeze out a paltry (by D.C. standards) $2.7 billion over 10 years with a tax on tanning salons. That's just a bit more revenue than what the JCT estimates will be lost to HSAs ($2.1 billion) in 2013 alone.

Money aside, HSAs are unpopular with liberal health care reformers because they require the purchase of high-deductible insurance plans, which require out-of-pocket payment for most routine medical costs. That, of course, is their main selling point as a market-oriented reform.

High-deductible plans are meant to turn patients into cost-conscious consumers, who are rewarded for their frugality by being able to save tax-free in an HSA. Critics on the left argue that patients need a more paternalistic approach, and that HSA holders will save money by forgoing needed medical care.

So why, against all these head winds, did HSAs survive? On-the-ball lobbying was part of the answer. As Lieber notes, the American Bankers Association's HSA Council got wind of anti-HSA sentiment among Obama's advisers during the presidential campaign; the group was buttonholing members of Congress as soon as Obama took office.

But it wasn't just that the HSA Council wouldn't leave Congress alone. It also had an objectively strong case to make — essentially, that HSAs and the relatively cheap high-deductible plans linked to them were just the ticket to attract healthy, high-paid workers into the risk pool and make ObamaCare work.

Now that ObamaCare is on the books, that argument is now a likely scenario. Mandates on employers and individuals to buy insurance will push them to look for the cheapest plans that meet legal requirements. As long as high-deductible plans are available, they will get plenty of takers.

This ironic turn of events is more than a consolation prize for conservatives. It is a chance for them to lead American health care toward a consumer-based market model instead of the Democrats' single-payer dream.

The core case for HSAs and high-deductible insurance — that  they put the cost-cutting decision in the hands of individual patients, not private insurers or the government — remains as strong as ever. It will get that much stronger as health costs inevitably rise.

Opponents will do all they can to choke off the consumer-driven health care revolution, perhaps by claiming that the high-deductible plans aren't actuarially sound. You could say that a long fight is just beginning. But that's far better than saying that it has already ended in defeat.

Wednesday, March 31, 2010

Red Flags in Hawaii By Butterdezillion


January 11, 2010

People are asking how so many terrorist red flags could be overlooked by so many.  The same way these “birther” red flags were not only overlooked but ridiculed:

1.       DOH Director Fukino  illegally hid until Nov 2009 the DOH Administrative Rules showing that election officials could have received a copy of Obama’s original birth certificate without his permission. The DOH has said they can’t release any records without Obama’s permission. But HRS 338-18(a) allows state laws and DOH rules to govern the disclosure of vital records, and the current rules -Chapter 8b, 2.5(A)(1)(f) -would allow any election officer transacting the placement of Obama’s name on the ballot to receive a certified copy.


2.       The DOH has falsely said that HRS 338-18 prohibits disclosure of government processing records. There are 2 kinds of records – records of the vital events themselves, and records of the government’s handling ( of those records.

Certificates are the record of the vital events. HRS 338-18(a) says that information about the actual birth, death, marriage, and divorce events may only be released according to the provisions set by law or Department of Health rules, thus referring everyone to the DOH Administrative Rules to see how information on actual certificates may be disclosed and to whom. Far from barring “any disclosure” as claimed by the DOH, current Administrative Rules allow a non-certified abbreviated copy of a birth (Chapter 8b, 2.5B), marriage (Ch 8b, 2.8C), or death (Ch8b, 2.6C) certificate to be released to anyone who asks for it. However, a public statement of where someone was born – such as Fukino’s July 27, 2009 statement about Obama – is not allowed by the rules (Ch 8b, 2.1A).

All other records are public, except that neither direct viewing nor certified copies are allowed unless the requestor has a direct and tangible interest. Non-certified copies, abstracts,  and disclosure of information from the documents are not prohibited – which, according to Hawaii’s “Sunshine Law” (UIPA) means they must be disclosed upon request, except for certain exemptions, such as for information having privacy interest that outweighs the public interest in disclosure: date of birth, gender, and address .


Since a damaging disclosure of records processing was made in September (see #3), The DOH has been denying access to these records by claiming that ANY DISCLOSURE is forbidden.


3.       Though ridiculing “birthers” publicly, the DOH has PRIVATELY confirmed Obama’s online COLB’s as forgeries – a fact the DOH has known since the beginning. Because processing information is subject to disclosure, the DOH was forced in Sept 2009 to reveal that Obama’s birth certificate has been amended  (OIP interpretation) and that Obama or his representative has paid a fee to have his certificate amended at the very time he was considering a run for the presidency. Amendments must be noted on the certificate (Ch 8b, 3.1), so the DOH has known this entire time that both the Factcheck and Fight the Smears COLB’s are forgeries, since they have no amendment noted.

When asked point-blank on Feb 22, 2010 whether the denial of access confirmed the existence of Obama’s amendment documents, the OIP refused to refute that understanding, saying (after 2 e-mails asking clarification) that they were too busy to address the question.


4. The combination of certificate number and filing date on the Factcheck COLB is not possible. The DOH has confirmed that the certificate number is assigned by them when they file the certificate. Observed certificate numbers corroborate this as well. The Factcheck COLB says it was filed at the DOH 3 days before the Nordkye twins’ certificates but has a later number than theirs. The DOH has refused to release the certificate number for Obama even though they are required by UIPA to do so.


5.       Every government agency in Hawaii contacted thus far has explicitly denied that they have a responsibility to report known forgery and/or have refused to report suspected forgery to law enforcement.  This includes the Department Of Health, Office of Information Practices (OIP), lieutenant governor’s office, and every member of Hawaii’s House and Senate. Janice Okubo of the DOH seems to have stated that law forbids her to disclose ANYTHING about a birth certificate– even that it’s a critical, very public forgery. The Ombudsman’s Office has said they don’t investigate crimes and only report evidence they uncover themselves. See no evil…


6.       The amendment made to Obama’s birth certificate renders it insufficient evidence for legal purposes.  Minor administrative errors (such as typos) don’t remove the prima facie evidentiary value of a birth certificate, but such no-fault errors don’t result in a fee (Ch 8b 3.5C, 3.11, 3.1,  & HRS 338-17) and Obama was charged a fee – as the DOH confirmed again on March 23, 2010. Legal name changes also don’t affect the evidentiary value, but the lieutenant governor’s office has confirmed that there has been no legal name change for anyone named Obama, Dunham,  Soetoro, or Sutoro.


7.       Kapiolani Hospital received a letter signed by Obama on White House stationery and with raised seal claiming Obama was born there, even though that could only be true if Obama’s amendment contradicted the doctor’s testimony. If he had been born in a Hawaii hospital the hospital itself would have been responsible for the content on the birth certificate and the DOH responsible for any clerical typos. The only way Obama would be charged for an amendment is:

             a)       if he or his representative claimed to have filled out the certificate themselves and erred, or

             b)      if Obama claimed the doctor’s testimony was wrong.


8.       The DOH has broken Hawaii law to make rule changes (see July 11 addendum at bottom) that would protect Obama.  In mid-June of 2009 the DOH stated that they will no longer issue long-form birth certificates. This is in direct violation of the current rules, without following HRS 91-3 mandates for an open process for rule changes – the first of several such violations within the past year. 


9.       Fukino stated on July 27, 2009 that Obama’s records verify his birth in Hawaii, but Hawaii law forbids her to conclude that, since all the DOH has is legal hearsay. According to PHR Chapter 8b and HRS 338-17, only a judicial or administrative person or group can evaluate the accuracy of the claims when an amended document is presented as evidence. Obama has had many, many opportunities to present his birth certificate as evidence in lawsuits. He has refused – even going so far as rescinding military orders rather than risk a judge seeing his birth certificate. There is no process by which Obama would present his records to Fukino as evidence.


10.       Having made the illegal statement, Fukino refused to obey UIPA which required her to release the documents on which her statement was based.


11.   The DOH has deleted documents required to be stored for at least 2 years. The DOH says it no longer has the UIPA request or invoices showing Obama’s birth certificate was amended. The DOH’s own “Rules of Practice & Procedure”  (11-1-30) say that documents must be stored as long as the case can be contested –  August 2011 in this case.

12.   Fukino averted discipline against herself by promoting the OIP director, who was replaced by the attorney who has designed the DOH’s deceptive responses. Six days after Leo Donofrio’s  blog said he would ask OIP Director Tsukiyama for disciplinary action against Fukino and Okubo for their deception, Tsukiyama resigned  from the OIP to take a promotion to a company on whose board of directors Fukino sits. He granted Cathy Takase’s request to have control of all DOH matters and asked her to replace him.

Now OIP is leaving HRS 338-18 rulings up to the DOH. All DOH responses contain deceptions #1&2, including disobeying their own rules for non-certified abbreviated copies of birth, marriage, and death certificates.  They deny that documents exist which are required by law, such as descriptions of their forms,  procedures,  and instructions which are mandated in HRS 91, etc..

13. Apparently in response to this blog post and a request for a legislative investigation of these matters, Hawaii State Senator Will Espero has introduced a bill that would allow the OIP to label people who ask too many questions as “vexatious requestors” who are then blacklisted from access to government records for 2 years. The net effect of the bill would be to overturn UIPA. They also want to fine “vexatious requestors”…

14. The DOH is falsifying the communication logs in e-mails to frame the requestor as what Cathy Takase calls ”mentally ill” - thus fit to label as a “vexatious requestor” and blacklist for 2 years.

Red flags. This information has been given to every lawmaker in Hawaii, the OIP, DOH, Ombudsman’s office, HI lieutenant governor’ and governor’s offices, Nebraska’s US attorney (who says they won’t take reports from citizens), and Hawaii’s director of the Department of Public Safety, as well as to multiple news organizations.  The FBI thrice said they don’t investigate document fraud. All refused to act. Red flags.