NY Times: ACA working mostly, with exceptions, but it caused a political backlash

http://www.nytimes.com/interactive/2014/10/27/us/is-the-affordable-care-act-working.html?

Cut and paste on your browser:.  New York Times analysis: Is the ACA working? Mostly, with exceptions and it caused a political backlash

Cory Gardner is a red flag for Colorado's political and income middle

Cory Gardner is a red flag for Colorado’s political and income middle. 

Cory Gardner, opposing Democratic Senator Mark Udall in Colorado, is ranked as the 10th most conservative member of Congress.  Colorado is hardly the 10th most conservative state in the union.  Gardner sounds and looks moderate, but his legislative positions were, are, and would align closely to his Tea Party House colleagues.  This election is also about electing a senator for the next six years who will represent your views and will be voting to determine Supreme Court vacancy  replacements.

Gardner’s and Udall’s visions of freedom are very different.  Udall promotes freedom for individuals from an intrusive government, a maverick leader in the Senate against overreaching NSA surveillance.  He is a strong advocate for the ability for women and men to choose their reproduction schedules and whom they marry.  Freedom for Udall also means freedom from worry about affording health care and college for their kids.

 Gardner’s vision of freedom is to gut environmental laws and favor tax policies for business while supporting greater government interference in choices individuals can make.  His position on reproductive rights and marriage equality are the most extreme of any, even criminalizing abortions and doctors, opposes birth control practices that interfere with his belief that life begins at conception.

The U.S. unemployment rate is now back to pre-crash levels and in Colorado it is below the national average. The deficit has been cut in half and the national economy is growing at 3%.  Colorado has the highest economic growth in the nation which is not only due to an improving national economy, but to a booming energy sector.  Science denier Gardner is not even sure humans cause global warming. Mark Udall prizes a balanced approach to natural resource development and Colorado’s growth is evidence that approach can work.

Gardner, unlike Udall, has voted in Congress to make it even more difficult for the middle income earners to recover from the Great Recession. He has voted to cut Pell grants and opposed decreasing interest rates on student loans or refinancing student loans to lower rates.   Most Colorado families depend upon women working, but Gardner has voted against raising the minimum wage or furthering equal pay for women in the workforce.

One of the most underrated boosts to middle income earners is the ACA (Obamacare), which both the GOP and Gardner still want to repeal.  Gardner offers no alternative, no fixes no workable way to pay for covering preexisting conditions. He has no viable plans to make health insurance affordable for 30 million Americans, mostly middle income, who once again would have to choose between losing their home or health care treatment because they could not qualify for or afford insurance. 

 No traditional Medicare coverage was lost due to the ACA (contrary to a very misleading Gardner ad), and the ACA added 14 years to the life of Medicare.  Gardner supports changing the efficiently administered Medicare program to provide a voucher system and block grants to states that upends a system that now guarantees coverage that keeps up with costs and gives stability to co-pays.

A version of this appeared in the www.skyhidailynews.com October 30 2014

Crossroads Skips Context in Colorado

Crossroads Skips Context in Colorado  Perfect example of how an out of context quote can skew the election.  This is the ad Crossroads GPS is running in Colorado attempting to scare women about Udall, claiming he is soft of ISIS...."not an imminent danger".  This is factcheck.org  checking out the ad and if the Udall campaign has failed is to counter this with more vigor. He has run ads quoting generals praising him, but that one ad is just not enough.   Udall does believe that ISIS will be a danger to the US if we do not act now.  That's a whole different take.

If Obama is viewed as a failure, then the GOP Congress is viewed as more of a failure.

GOP candidates claim the Obama administration is a “failure.”  A recent NBC/Wall Street Journal poll concluded, though, that the American people were “fed up” with Washington, and they were 20% more fed up with Congress than they were with President Obama.  If Obama is viewed as a failure, then the GOP Congress is viewed as more of a failure.  

If the measure is how much Obama achieved of his own agenda, the answer is most of it has been successful.  His major failure so far is not passing comprehensive immigration reform, not from lack of trying.  Most of his domestic accomplishments, such as economic recovery and health care reform, were enacted before the obstructionist Tea Party took over the House.  Perhaps the greatest success Democrats had was keeping the economy from going over the brink into another Great Depression, using passage of stimulus spending and tax cuts and also clever fiscal policy.  The unemployment rate is now back to pre-crash levels, and the economy is showing a 3% growth rate.  Austerity measures (which the GOP pushed for the U.S., too) are threatening to force Europe into recession or deflation, and also into continuing high unemployment.

The GOP Congress still wants to repeal Obamacare, but offers no alternative, no workable way to pay for covering preexisting conditions, and has no plans to make it more affordable for 30 million Americans. 

Gardner, ranked as the 10th most conservative member of Congress and opposing Mark Udall for Senate in Colorado, wants to repeal Obamacare.  Obamacare ends discrimination against higher women’s premiums, and it also covers birth control and cancer screenings.  Gardner also pushes federal laws that not only criminalize abortion from the time of conception, but cripples in vitro fertilization, bans IUDs and some other birth control methods, and Gardner wants women to pay out of their own pockets for the few over-the-counter methods left that are legal.  (Ending Obamacare ends insurance coverage of the pill, too.)  All federal laws, including Obamacare, are already currently forbidden from covering any abortions, so that's not happening.

Armageddon as predicted by the GOP did not happen to Obamacare (ACA).  More signed up for coverage and paid premiums than forecast.  Early indications are that 2015 average premiums within exchanges will show little change from 2014.  The American Medical Association in their July journal found that the ACA is successfully working as designed.  Medicare cuts?  No traditional coverage was lost, and 14 years were added to the life of Medicare.

Energy policy?  The GOP Congress wants to ditch environmental protection laws to boost energy production.  However, while protecting the environment, Democratic “all of the above” energy policies, including promoting alternative energy sources, have permitted the U.S. to become the largest producer of natural gas in the world, and the U.S. will begin having enough oil production very soon to begin exporting. Gardner is still denying humans are responsible for global warming against the proof provided by scientists held in high esteem in the field.

Ebola?  We should not forget that the GOP congressional budget priorities were to reduce funding to the CDC.  Officials confirmed this caused a slowdown in the search for vaccines.  The president's choice for Surgeon General has also been blocked by the GOP members of Congress, which is why a "czar" had to be chosen to provide some guidance and continuity during this time.

Promoting the middle class?  The GOP congressional policies cut Pell grants, oppose decreasing interest rates on student loans, and oppose raising the minimum wage or furthering equal pay for women in the workforce.

For more, visit www.mufticforumblog.blogspot.com

http://kff.org/private-insurance/report/survey-of-non-group-health-insurance-enrollees/

http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-july-2014/

http://www.denverpost.com/election2014/ci_26665118/republican-cory-gardner-defends-conservative-record-senate-bid

America's Fed Up: Obama Approval Rating Hits All-Time Low, Poll Shows - NBC News
  "The frustration carries over to the nation’s political leaders, with President Barack Obama’s overall approval rating hitting a new low at 40 percent, and a mere 14 percent of the public giving Congress a thumbs up."

http://www.nytimes.com/interactive/2014/09/16/us/politics"  Yet, congressional Republicans are viewed more negatively than congressional Democrats.....

Congressional Job approval ratings

Approve

Disapprove

No Answer

Congressional Republicans

Congressional Democrats

19%

70

11

30

61

9

Despite the Republican advantages over all, Americans continue to broadly disapprove of congressional Republicans even more than congressional Democrats. "

http://wallstcheatsheet.com/politics/do-people-really-think-obama-is-the-worst-president-since-wwii.html/?ref=YF
http://www.coloradohealthinstitute.org/blog/detail/modest-price-increases-in-store-for-second-year-of-online-marketplace
http://www.dailykos.com/story/2014/10/13/1336238/-NIH-Director-Budget-cuts-delayed-Ebola-vaccine-nbsp-treatement#

Number of uninsured admissions drops: Report says uncompensated care will cost hospitals $5.7B less this year - Mohave Daily News: News

Number of uninsured admissions drops: Report says uncompensated care will cost hospitals $5.7B less this year - Mohave Daily News: News

This is not a local story; it is an Associated Press national story.  What it does show is that when Obamacare is implemented fully (none of this refusal to expand Medicaid as many red states have done), hospitals get stuck less with covering the expenses of the uninsured or those who cannot pay their medical bills. They cover it by raising their charges to those insured, which in turn causes insurance premiums to go up.  The estimate is that this cost shifting pre Obamacare resulted in the insured families paying $1000 more per year in health insurance premiums. The question  now becomes: will the insurers pocket the savings or will they pass it on in the form of lower premiums to the insured.

Whether the slowdown in current health care costs per family is happening now because of the recession or Obamacare is open to discussion. With less spending money and loss of employer provided insurance due to layoffs, consumers cut back or delayed health care treatment.  There for sure has been a very significant decrease in the cost of Medicare, extending its life 14 years.  The administration is claiming the per family costs have already been $1600 or more...but that is not in premium costs, but in the cost of health care in general per family.  The Washington Post gave that claim two pinocchios, but it took a lot of discussion to reach that conclusions, mostly because the impact of the recession is not figured into the equation. http://www.washingtonpost.com/blogs/fact-checker/wp/2014/10/17/

 My thought is that the impact of Obamacare is more likely to be felt more in the future since the program is not yet fully implemented, including the failure of nearly half of the states to expand Medicaid coverage and the penalties for non coverage (the mandate) will only begin to increase this next year. Cost shifting impact has not yet been fully felt yet though  medical  provider cost reduction measures had been taken a couple of years in advance of its implementation.

The challenges to covering more in Colorado and having more sign up to Obamacare were explored in an Oct. 15, report
From the report: "

Flying Solo: Why Uninsured Coloradans Go Without Health Insurance October 15, 2014 The Colorado Health Institute released a report today analyzing the reasons given by uninsured Coloradans for not having health insurance. "Flying Solo: Why Uninsured Coloradans Go Without Health Insurance" is based on data from the Colorado Health Access Survey (CHAS), the premier source of information about coverage across the state. The report, written by Research Analyst Natalie Triedman, comes as Colorado prepares for the second open enrollment period under the Affordable Care Act. Beginning November 15, it will run through February 15, 2015. The biggest barrier, by far, is cost. Four of five uninsured residents say they don’t have coverage because it costs too much. No surprises there, but it speaks to the importance of affordability, as well as communicating the value of health insurance. The second most common reason for being insured was that a person lost their job or changed employers. This “churn” will be an important consideration moving forward. The most dramatic change in reasons cited for being uninsured came from uninsured Coloradans who said they don’t need health insurance. The percentage more than doubled between 2009 and 2013, increasing from 11.1 percent to 24.9 percent, the biggest shift among the reasons cited. This could reflect a number of factors, including objections to “Obamacare” and its individual mandate." https://us-mg4.mail.yahoo.com/neo/launch?.rand=26d85c6418ea5#8881185274 http://www.coloradohealthinstitute.org/blog/detail/flying-solo-why-uninsured-coloradans-go-without-health-insurance http://www.coloradohealthinstitute.org/blog/detail/modest-price-increases-in-store-for-second-year-of-online-marketplace

Playing for the long term in November 2014

This election, 2014, is much more about the next president than it is about the current one. The longer game will have a far greater impact on our country’s direction than the shorter one.

Our vote this November is  mostly about  what happens post Obama presidency, because those we are electing will influence  a very likely  Supreme Court vacancy filling and legislative deadlocks. Any elected Senator has 6 years to warm a Senate seat.

The future Senate will have the opportunity to decide on whatever this Court punted, from Roe v Wade,  same sex marriage, to affirmative action, to  election finance laws, to health care and the ACA, and the overreach  and unconstitutionality of  actions  either by the President or Congress or various states.

Here is the short term.

This November election appears to be a referendum on a lame duck president as candidates look like they are rerunning  2012.

If the GOP takes  over the Senate , we are on track for a mammoth case of deadlock and stalemate  for two more years, the remainder of the President’s term.

If we fear  the President will become more “imperial”, the only way left for him  to  overcome  stalemate and deadlock  is to issue more executive orders . Court challenges for his orders  will likely be decided after he leaves office.  Since he is term limited,  ticking  off one special interest, party,  or others  will not affect his prospects of re-election.  

President Obama will only be constrained by concern for his “legacy” and so far he has shown little regard for that. He seems to be  doing “what he thinks is right “ or is doggedly  pursuing the agenda he promised six years ago.

The President will wear out his veto pen  if the GOP controls the Senate but GOP Senate will not have enough seats to override it.  The House is stuck in a role of continued obstructionism, as predictions are the GOP will still hold its majority.

The state of Colorado is not immune to any of this.

Colorado governors have four year terms.   For the next four years the Colorado Governor will be  faced with using vetoes or cheerleadership over a most likely Democratic controlled  state legislature (either both or one of the houses) . A governor who cannot compromise or walk a center line as Governor Hickenlooper has done, will just put us into a deadlock funk. His opponent, Bob Beauprez, is running on a platform of trying to overturn  or change any environmental or consumer protection law , rule or regulation that does not favor business interests.   Beauprez is no middle of the roader, nor is he one with compromise in mind.

A version of this column appeared in the Sky Hi Daily news , Oct. 23-24, 2014 www.skyhidailynews.com

FactChecking the Colorado Senate Race

FactChecking the Colorado Senate Race



This one takes the Senate Campaign in Colorado, Republican Cory Gardner v Mark Udall. Gardner ads come out with a lot of egg on faces.  Read it. Fact Checking.org has not been kind to Udall, but when you put it all together, Gardner ads are twisted.  www.factcheck.org

ACOG Statement on “Personhood” Measures

February 10, 2012

Washington, DC -- The American Congress of Obstetricians and Gynecologists (ACOG) is unequivocally opposed to the so-called "personhood" laws or amendments being considered in several states. These measures erode women's basic rights to privacy and bodily integrity; deny women access to the full spectrum of preventive health care including contraception; and undermine the doctor-patient relationship. ACOG firmly believes that science must be at the core of public health policies and medical decision-making that affect the health and life of women.

Like Mississippi's failed "Personhood Amendment" Proposition 26, these misleading and ambiguously worded "personhood" measures substitute ideology for science and represent a grave threat to women's health and reproductive rights that, if passed, would have long-term negative outcomes for our patients, their families, and society. Although the individual wording in these proposed measures varies from state to state, they all attempt to give full legal rights to a fertilized egg by defining "personhood" from the moment of fertilization, before conception (ie, pregnancy/ implantation) has occurred. This would have wide-reaching harmful implications for the practice of medicine and on women's access to contraception, fertility treatments, pregnancy termination, and other essential medical procedures.

These "personhood" proposals, as acknowledged by proponents, would make condoms, natural family planning, and spermicides the only legally allowed forms of birth control. Thus, some of the most effective and reliable forms of contraception, such as oral contraceptives, intrauterine devices (IUDs), and other forms of FDA-approved hormonal contraceptives could be banned in states that adopt "personhood" measures. Women's very lives would be jeopardized if physicians were prohibited from terminating life-threatening ectopic and molar pregnancies. Women who experience pregnancy loss or other negative pregnancy outcomes could be prosecuted in some cases.  

So-called "personhood" measures would have a negative impact on fertility treatments, including in vitro fertilization (IVF), that allow otherwise infertile couples to achieve pregnancy and create their families. Such proposals would also invariably ban embryonic stem cell research, depriving all of society potential lifesaving therapies.

ACOG supports guaranteed access to the full array of clinical and reproductive services appropriate to each individual woman's needs throughout her life. These "personhood" measures must be defeated in the best interest of women's health.  

Closing arguments: We need a better balance, not the GOP tilt to the right

Reflecting on the 2012 Presidential election, the turning point was GOP candidate Mitt Romney disdaining the 47% as dependent upon government and feeling entitled for the government to care for them.  At the same time Congressman Bob Beauprez, now running for Colorado governor, was recorded dissing the 47% who did not pay taxes, and he defended the same attitude again in 2014.

    .     

Why did 47% hit such a nerve?   So many were hurting from the Great Recession and did not make enough income to pay taxes.  They resented the GOP’s lack of empathy and understanding of the plight of nearly half the country.

Two years later, unemployment has decreased to pre-crash levels and the stock market is robust.  Colorado has the fastest growth in the nation, unemployment below the national level, and is rated among the top four states in the nation to make a living.  However, to make a case for change, GOP attack ads make sure Democrats’ success does not go unpunished, and  Democrats fail to toot their horns enough.

Clearly there are still those who have not felt the recovery trickle down to them, but voters should not be asking whom to blame. They should be asking themselves who is more likely to let them share in recovery going forward.  Since 2008, the only improvement to the struggling middle-class family pocketbooks has been Obamacare, which made their health care affordable  and added 14 years to the life of Medicare.

Congressional Republican obstruction, enforced by government shutdowns, was overcome only by compromises on tax structure and budgets.  Compromise is usually a good thing, but these compromises mostly benefited the top income levels, and income gap has gotten worse.  It would have been worse by another 15% except for the social safety nets, per a recent Stanford University study.  The U.S. has one of the most unequal income distributions in the developed world even after taxes and social welfare policies are taken into account.

The great ideological debate is whether and how much of a role does government have. The GOP is conflicted.  It is determined for the government to tell women whether to control or which control to use for their reproduction, or who can get married, but they oppose the government maintaining current  social services.  Would be libertarians should  also read the preamble to the Constitution again and search key words “insure domestic tranquility” and “promote the general welfare“ to seek legitimacy and responsibility for those roles.

The Great Society, the original safety net, was a response to social unrest fueled by anger with racial and economic inequality in the late 1960s.  The GOP is trying to dismantle it, piece by piece, by weakening food stamps, Medicaid, health care, and fighting raising the minimum wage.  Reform is  always needed to meet  changing times and fix bad practices, but weakening  would only increase the gap between the richer and the middle class and poor.  Income equality is not the answer either, because fuel for ambition needs goals to reach and rewards for efforts.  Long term deficits are indeed a problem, and what we pay for is what we get, but above all we need is better balance, not a greater tilt to the right as the GOP proposes.

A version of this appeared in the www.skyhidailynews.com October 16, 17 2014

http://www.pewresearch.org/fact-tank/2013/12/19/global-inequality-how-the-u-s-compares/
http://web.stanford.edu/group/scspi/sotu/SOTU_2014_CPI.pdfhttp://www.money-rates.com/research-center/best-states-to-make-a-living/2014-complete-list.htm  andhttp://www.forbes.com/sites/kathryndill/2014/06/09/the-best-and-worst-states-to-make-a-living-in-2014/
https://www.youtube.com/watch?v=rlPWULnF8fg


https://www.youtube.com/watch?v=rlPWULnF8fg  (Bob Beauprez's 47% moment; 2014)

Over a year ago, I hit the GOP for what they proposed to do regarding the approval of the farm bill: The statistics in it are work repeating.  It addresses the food stamp/ school lunch program importance and limitations and refutes much of the GOPs arguments to reduce the food stamp program.  Many critics from media and religious leaders called this 2013 proposal cruel. It gives an indication of what the GOP would do if they could regarding the safety net.

Also, what it means to live on food stamps and hunger in Grand County was reported in an October  Sky Hi Daily News article October 2, 2014.  http://www.skyhidailynews.com/news/13251520-113/colorado-2014-2013-assistance   It was no picnic.  In a Granby Rotary club presentation of their experiences, one of the participants in the attempt to live on a food stamp and food pantry budget reported that the average recipient is on food stamps for an average of 10 months and usually does so because of loss of a job or divorce or health problems.   

Excerpts from my July 1, 2013 column:

Shame on the conservative members of the House of Representatives for trying to insert into a House farm bill a very cruel provision, to cut the food stamp program by nearly 30%.. Defeat means the cuts will not occur for now.  Democrats and even some Republicans could not support the bill. It died  and rightly so.

All of these cuts would have come when more than 25% of working families in Colorado do not have enough food to meet their basic needs, according to the Census Bureau’s  American Community Survey 2011.

 The House bill would have cut  spending in farm and nutrition programs by nearly $40 billion over the next 10 years nationwide. $20.5 billion  of that total would have come from cuts to the $75 billion food stamp program known as the Supplemental Nutrition Assistance Program, SNAP.

Politifact, a respected fact checker of the Tampa Bay Times examined Democrats’ claims  cuts in the House farm bill would leave 2 million people without food stamps and remove 210,000 children from the school breakfast and lunch program. The fact checker concluded that “Ultimately, both numbers go back to the Congressional Budget Office, which is generally seen as impartial. …  We rate the statement Mostly True”

In the debate over the farm bill spanning the past two years,  members of the House who wanted the kill SNAP  dusted off  the same time worn  complaint used to object  to food stamps in years past, that  welfare queens abused the program so can the program..   Times have changed and those old views are  fossils.

 “So make these welfare slackers get a job”, a conservative friend of mine grouched.” Get  yourself  current” , I retorted. Families receiving food stamps  now hold jobs three time more than those who rely solely on welfare benefits according to  a July 2010 report from the Center on Budget and Policy Priorites. That is a significant reversal from 1989 when  only 20% of food stamp recipients held jobs.

Most recipients who can work are working, but their income is so low, they cannot afford enough food and their rent, too.  Cigarettes and alcohol have long been ineligible for food stamp purchase.

So who gets food stamps now? In 2013  most are kids and elderly. Per the US Department of Agriculture which administers the programs,  three-quarters of food stamp recipients are families with children. Nearly half (47 percent) were under age 18 and another 8 percent were age 60 or older. Even in the recession, the numbers of food stamp recipients have not increased.

In the 2012 presidential campaign, some members of the GOP  called for even cutting nutrition and school lunch programs and some of those funds were part of the farm bill cuts.  Who would they hurt?. Of the nutrition programs for the poor (8.7 million recipients), 4.3 million are women with children, 2.2 million with infants. National school lunch programs: 30.5 million kids benefit, per the Department of Agriculture.   

 What is the solution other than federal government programs for those who are concerned. Food banks provided by charitable and church organizations make up some of the difference often on the local level, serving even those  who also  receive food stamps. Think what the size  the need would be if food stamp programs were cut by 30%.

 

Attack ad against Udall on health care heaps fibs on top of alleged fibs

Once in a while a series of negative and political attack ads are so off base, outrageous, and offensive that they just cannot go unchallenged.  These attack ads are fibs about alleged fibs.  There are such ads running against Mark Udall, Democrat running for Senate, that accuse him of virtually lying about Medicare and insurance premium costs.  In fact, bottom line, no benefits have been removed from Medicare, insurance premiums have not increased but slightly decreased, and Obamacare has extended Medicare’s life.  Yes, some had to find a new insurance plan, but nearly all found another plan that had better benefits than their old one.

How Gardner would vote in the Senate on Obamacare: to repeal, and he has offered no plans to replace, which means if the GOP had its way, millions would be back to scrambling again to change plans and be back to being overcharged, capped, no way to cover preexisting conditions, most would be unable to afford any insurance, and everyone would be SOL if they lost employer insurance.

Some fact-checking: One ad attacks Udall for his support of Obamacare because Udall said Obamacare would strengthen Medicare.  Instead, the ad continues, Obamacare removes over $1,000 plus from seniors' benefits. No traditional Medicare benefits are affected by Obamacare.  Period.  What the attack ads do not disclose is that instead of weakening Medicare, Obamacare has added at least 14 years to its solvency, and Gardner would reverse that.

What is affected is Medicare Advantage, which combines Medicare and supplemental policies.  Insurance companies had been raking in excess profits with Advantage by overcharging and hiking prices above what government Medicare costs.  Those subsidies have been removed and applied to funding health care.

Also what attack ads do not disclose is that Udall’s opponent Gardner consistently has voted in Congress in lockstep with the rest of his GOP caucus to privatize Medicare (premium support) to let seniors under 55 buy private insurance and to give block grants to states to fund it, eliminating Medicare federal  government direct payments to the rest of seniors with no assurance increases would keep up with  future increases in health care costs.  

Another attack ad related to Obamacare is that Udall misleads us about Obamacare reducing the costs of insurance.  While not all of the October rates for Obamacare insurance in all states are in, that has not happened on the average in states with their own exchanges, including Colorado.  A Kaiser Family Foundation report came to that conclusion, though there are variations per state and per plan.

States like Colorado (unlike most red states) also permit Medicaid expansion that reduces having hospitals shoulder unpaid charity bills and then shift costs to premiums of paying customers.  If all states expanded Medicaid as Obamacare permits, a move fought tooth and nail by the GOP, we would all begin to see less cost shifting to all of our premiums nationwide.

A version of this appeared in the Sky Hi Daily News Thursday/Friday 10/9/2014 www.skyhidailynews.com

http://www.washingtonpost.com/blogs/wonkblog/wp/2014/07/29/wonkbook-obamacare-is-giving-medicare-a-new-lease-on-life/

www.forbes.com/.../trustees-medicare-will-go-broke-in-2016-if-y..(forecast made in 2012)

http://kaiserfamilyfoundation.files.wordpress.com/2014/09/8627-analysis-of-2015-premium-changes1.pdf