The Affordable Care Act -In the Rear View Mirrow

Affordable Care Act (Belle)
The Affordable Care Act (ACA) of 2010 has broad implications. However, the fundamental premise is that this expansive health care coverage is based on the assumption that some 43 million uninsured Americans will be covered with health insurance. In order to meet this lofty goal, the federal government created state health exchanges. As a result of creating these state health exchanges, the Feds are hoping to ensure that its goal is achieved. The underlining policy objective is that the state exchanges will somehow evolve into a sustainable insured health insurance market. The one way that this policy objective could possible be met is to create competition among health care insurers, resulting in a decrease in costs of health premiums and subsequent reduction in overall healthcare costs.

From a efficiency perspective, a central question is whether the exchanges will attract enough good risks to avoid an adverse [d]eath spiral? From a pure economic policy aspect, this question raises other question as to how much of financial incentives it will a take for major private sector players to buy into this government mandate? For example, In Massachusetts, Governor Dukakis developed a compressive health plan. Even with financial incentives, ultimately the health plan was legislated but never implemented, due to the same zero-sum corporate conflict( Martin, 2008, p. 296). Consequently, like Medicaid, ACA is a 1000-pound gorilla of health care bathing in a pool of bureaucratic inefficiency and rising costs.

Now, from a cost-effectiveness perspective, the costs of the ACA is enormous. The notion that market competition will drive prices down is a political contradiction due to the fact that “extensive regulation of the health insurance market needed to achieve the social values of managed competition, and the proposed subsidies for lower income patients, are inconsistent with the laissez faire political values”( Rosenblatt, 2008, p.140). ACA ‘s state exchanges model opposes redistributive subsidies and pro-consumer market regulation and favors unprecedented tax cuts and redistribution upwards towards wealthy healthcare companies. Consequently, there has been much political debate and state reluctance to participate.

As Kraft and Furlong (2013) asserted, ” reducing the deficit by cutting entitlement programs may raise the strongest ethical argument, especially since it relates to Social Security and Medicare” (p. 266). At what point does fairness and responsibility intercept? I contend that both fairness and responsibility intercepts at the point of freedom. Freedom of choice or perhaps freedom to pursue life, liberty and happiness! ” In 2006, the United States spent $2.1 trillion on health care, more than twice what the nation spent on food and more than China’s citizens consumed on all goods and services. Now, putting ACA in perspective, at a time when the nation has nearly $17 trillion in national debt and is running annual trillion-dollar budget deficits, largely attributed to existing entitlements, Obamacare creates two new entitlements projected to cost nearly $1.8 trillion over the next decade (Heritage Foundation, 2013). So the prevailing question is-do we as a nation have the courage to take the responsibility to ensure the health of citizens while ensuring the fiscal responsibility of our country? Perhaps the words of Benjamin Franklin provides a temporary degree of equanimity-“The secret to happiness is freedom. The secret to freedom is courage.”

Center for Medicare and Medicaid, Office of the Actuary (2013). Retrieved from on January 1, 2014.

Custer, W. S. (2013). Risk Adjustment and the Affordable Care Act. Journal Of Financial Service Professionals, 67(6), 25-26. Retrieved from EBSCO host database on January 1, 2014.

Kraft, M.E. & Furlong, S.R. (2013). Public Policy: Politics, Analysis, and Alternatives (4th ed.). Thousand Oaks, CA: Sage Publications.

Long, P., & Gruber, J. (2011). Projecting the impact of the affordable care act on california. Health Affairs, 30(1), 63-70. Retrieved from

Nanda, U., PhD., Malone, Eileen,R.N., M.S.N., & Joseph, A., PhD. (2013). The impact of the affordable care act on healthcare design. Contract, 54(8), 84-85. Retrieved from

Rosenblatt, R. (2008). Health politics and policy (4th ed.). Clifton Park, NY: Delmar Cengage Learning.


In a League of Their Own: Life Lessons from Big City African-American Mayors

Jeff Belle welcomes your comments on his new Book: “IN A League of Their Own: Leadership Lessons from Big City African-American Mayors.”

After researching and interviewing ten of the greatest big-city mayors, Jeff invites you to comment on each chapter’s lesson. Additional excerpts will be released in the next few months. Current book release date is Christmas Day 2014. However, there is much writing and editing left. Nonetheless, your input is appreciated and welcomed.

Section I-The League: Big Time Mayors Playing in the Big League
The lesson: In life as in politics, you get one shot at the Big Leagues. So, Be Prepared, Be Persistent, Be Polite, Be Positioned, Be Patient, and Be Prayerful. Who knows, today could just be that day when you get that fleeting opportunity to play in the Big Leagues whether its politics or professional sports or your dream job. Lessons from Big City African-American Mayors will be of value to you.

Chapter One- The Players and Their Positions
The Lesson: Know your position, play your position and support other positions.

Chapter Two- The Texas Connection
The Lesson: Never forget where you come from, but keep your eyes on where you are going. In order to reach home, you must take some strikes, pass on balls, run the bases and get hits.

Chapter Three-The Church Connection
The Lesson: If God is the umpire, a fair ball is always in play. Although life isn’t always fair, keep playing the game you never know when you may get thrown out or called safe; but play anyway. Love never fails…God is love!

Chapter Four- The Education Connection
The Lesson: Because the game is sometimes played under the disguised of light at night, it doesn’t give you a reason to play with your eyes half-opened and your mind closed. Keep vigilante for your enemy often appears as an angel of light.

Chapter Five- Their Fans
The Lesson: Life is a game played by players, enjoyed by a few, and oppose by many; always be loyal to your fans, family, friends, and faith. The 12th man in Seattle led to the Seahawks to 2013 Super Bowl championship.

Chapter Six- Their Opponents
The Lesson: Adversity is to Success as Night is to Day; One always precede the other. Never fear your opponents. In fact you should keep them close and your friends at distance. You never make an enemy of your opponent just because you won or lost the election. Winning like losing is never permanent except on paper. Fortunately, voters have short memories but long recollections. Be Strong and courageous….

Chapter Seven-Their Allies
The Lesson: In politics as in life, every one loves you when you are winning. The real test is who’s still standing with you when you are losing? As sure as it was when Joshua and Caleb stood with Moses, so it was with these mayors.

Chapter Eight- Their Elections
The Lesson: Just like great hitters, politicians must keep on swinging in order to not only get elected , but to stay in office once elected.

Chapter Nine- Their Defeats
The Lessons: Just like victories, defeats are short-lived, but long-remembered. In life just like politics, you lose as much as you win. Defeats are often temporary; but never lose sight of the lesson nor hold on to the setback. It too shall pass.

Chapter Ten- Their Victories
The Lessons: Celebrate even in small victories because tomorrow’s problems will arrive on your doorstep much too soon. Be grateful during the moments of celebrations, for they too are borrowed time of sand running through your fingers. Enjoy the moment by all means!

Chapter Eleven- Their Wisdom
The Lessons: Wisdom is the first step in recognizing that there are limits to trying to be everything to everybody. Courage and self-discipline are the next steps to guarding you from your greatest enemies: fear and self. One keeps you in the game and the other allows you to win the game.

Chapter Twelve- Their Legacy
The lesson: If elections were just about an office then it would be much cheaper renting one than running for one. Rather, elections are about meeting the needs for a people today while perpetuating their dreams for tomorrow. This is accomplish by keeping your heart on the issues, your mind on the solutions and your actions on leaving a legacy.
Remember: You are leaving a legacy whether you choose too or not. As sure as you can’t stop the tick of time, nor can you erase the footprints of your legacy. So, walk slower but never backwards, think bigger but never doubt, and work harder but never underestimate the value of play. For legacies are etched in the hearts and minds of future generations not yet born. For certain, these life lessons will help the next generations of Great Leaders to act in a way that their legacies will live on and on and on….as the league continues….

Jeff Belle lives in Northern California with his wife, Carmen. He enjoys sailing, golf, classical music and traveling. Jeff was raised in Edmond, Oklahoma and born in Louisiana. When Jeff isn’t writing, speaking, or consulting, he is serving in the community on boards or as an advisor to Mayors, Senators, Congressmen and future political leaders.


Health Disparity (Belle)

There are many factors to consider when discussing the overall quality of health care in America. However, according to an Agency for Healthcare Research and Quality (AHRQ) 2012 report on health disparity, ” overall quality of health care is improving, access is getting worse and disparities are not improving.” Nonetheless, when the overall quality of health care in America is examined in the light of the definition of quality health care, one might take a closer look, if not, then certainly take a second look at the overall quality of health care in America.

According to the National Committee for Quality Assurance ( NCQA), a private, non-profit organization, quality care is defined as ” the extent to which patients get the care they need in a manner that most effectively protects or restores their health.” The words ” protect or restores their health are significant. They are significant because quality in the context of this definition. However, what isn’t provided is clear methods to eliminate barriers to access such as stereotyping, language barriers, socioeconomic barriers, lack of respect and improper diagnosis or treatment ( Grady & Edgar, 2001, pp. 392-398).

In the defense of quality health care, the United States is constantly expanding, innovating, launching new technology, and services-all with the intent of improving quality of health care for all Americans. Unfortunately, the costs to provide quality care for Americans consumes 17 percent of our GDP. In spite of this enormous outlay of federal and private funds, the U. S. Ranks 31st in life expectancy among economic developed countries (CBO, 2007).
Now, in regards to all Americans having the same access to quality health care, the answer is yes. However, all Americans should not have the same access to select health care services unless they can pay for it. Again, if quality is measured in terms of protect and restore, then access is currently in place. However, there are both perceived and real in equality in terms of treatment. But, from a systematic point, our current system providers are accessible-emergency departments, Medicare, Medicaid, and private insurance.

In summary, the overall quality of health care is a two-edged sword: technological and pharmaceutical advances offer an opportunity to further enhance the quality of life, while clear and convincing evidence supports the need to develop new strategies to eliminate barriers to access, especially among the minority and the poor. The words of John F. Kennedy echoes my resolve-” There are risks and costs to a program of action. But they are far less than the long-range risk and costs of comfortable inaction.”


CBO reports on health care spending outlook. (2007). AHA News, 43(24), 6. Retrieved from EBSCO database on December 3, 2013.

McKinney, M. (2011). Lacking in equality: AHRQ report shows little change in disparities. Modern Healthcare, 41(10), 14. Retrieved from EBSCO database on December 3, 2013

Meredith Grady &Tim Edgar (2001). Racial Disparities in Healthcare: Highlights from Focus Group Findings. Rockville, MD: Westat Publishing. Retrieved from

Monrone, J.A., Litman, T.J. & Robins, L.S. (2008). Health politics and policy (4th ed.). Clifton Park, NY: Delmar Cengage Learning.

National Healthcare Disparities Report 2012. (2013). Medical Benefits, 30(16), 4-5. Retrieved from EBSCO database on December 3, 2013.

State of the First Amendment

State of the First Amendment (Belle)

In the State of the First Amendment: 2013 national survey, freedom was the single most important issue that citizens enjoy. In fact, the report stated that “47% of those surveyed named freedom of speech as the most important freedom, followed by freedom of religion 10%…” What’s interesting about the two most cherished freedoms- Speech and Religion, unlike any other freedoms as addressed in the First Amendment, speech and religion have both faced many court challenges. In fact, a few of these challenges make their way up to the U.S. Supreme Court annually.

At the heart of the two freedoms are two important clauses of the First Amendment: Establishment Clause and Free Exercise Clause. The Establishment Clause forbids the government from establishing or declaring an official religion. While the clause seeks to prohibit government sponsored activity like prayer in schools, it also protects students from government infringements upon exercising their rights to praying at school (Szypszak, 2011, p. 81).

The Free Exercise Clause prohibits laws which forbids the free exercise of religion. What happens when a government body opens its session in prayer? If indeed the Free Exercise Clause commits government itself to religious tolerance, just how far can the Free Exercise Clause reach into the political process regarding the freedom of prayer, even by a government itself, but not for itself, rather in the spirit of tolerance (p.89).

In the New York Times article, ” Politics and Prayer” the U.S. Court of Appeals for the Forth Circuit ruled that the commissioners of Forsyth County, NC violated the establishment clause of the Constitution by starting its meeting with prayers ” endorsing Christianity to the exclusive of other faith” (New York Times, 2011).

What’s ironic is that the practice of opening sessions of Congress with prayer has continued without interruption for some 200 years-ever since Congress drafted the First Amendment. While historical patterns cannot justify unconstitutional acts, the U.S. Supreme Court dealt with this issue in 1983 in Marsh v. Chambers (No. 82-23) and Held: The Nebraska Legislature’s chaplaincy practice does not violate the Establishment Clause (P. 786-795).

The article was clearly about where are the boundaries between church and state? However, the State of the First Amendment in my opinion, is best described in the words of Fredrick Douglas, ” liberty is meaningless where the right to utter one’s thoughts and opinions has ceased to exist. That, of all rights , is the dread of tyrants. It is the right which they first of all strike down.”

(2011, August 2). Politics and Prayer. New York Times. Retrieved from EBSCO host database on December 20, 2013.

First Amendment Center. State of the First Amendment 2013 Report. Retrieved from the on December 20, 2013.

Szypszak, C. (2011). Understanding law for public administration. Sudbury, MD: Jones and Bartlett Publishers.

Military Retiree Benefits: To Cut or to Keep?

Policy Alternatives (Belle)

Some people in Washington think that it’s wrong to unfairly single out military retirees by cutting their hard-earned retirement benefits. Under the proposal, a Sergeant First Class in the Army who qualifies for retirement at twenty years of service at age 40, and who has most likely deployed multiple times to war, could lose approximately $72,000 between retirement and turning age 62. That’s the result of a provision in the bill that requires a one percent annual reduction in the cost of living adjustment for military retirees (Hansen, 2013).
On the other end of the spectrum , the folk at the Pentagon are balking at calls for cuts in advanced war planes, naval vessels, and shrinking the Army and Marine Corp by more than 100,000 troops, and sharply increasing the size of the nation’s drone fleet and the number of special operations troops (Dreazen & Baron, 2012).
When considering U.S. budget cuts to the military, one must consider the fact that we are in the red and bleeding rather profusely. Unfortunately, cuts must be made which are politically unpopular but could be very political feasible after it’s all said and done. Thus, cuts will have to be made. The question is: how can we do this in an equitable, efficient, and cost-effective manner?
If both parties work together now, we could easily replace these cuts. For starters, over the past three years, the Government Accountability Office has uncovered 162 areas of fragmentation, overlap, and duplication in federal agencies — adding up to hundreds of billions in unnecessary spending (Tom Vanden, (N.d.).
Many veterans have vowed to the finish, but retired service members are the only ones who are seeing their benefits cut midstream in this budget deal. Where’s the so-called “shared sacrifice”? It’s a demoralizing message to send our men and women serving in harm’s way in Afghanistan and around the world.
Given that the non-partisan Congressional Budget Office estimates that the federal government will spend $47 trillion over the next ten years, with just a little effort Congress can ways to find $6 billion to replace these unfair benefit reductions. And with billions in wasteful spending throughout the federal government, it’s a false choice to suggest that the government will shut down unless military retiree benefits are cut (Carney, 2013).
Although Senator Alloye introduced two proposals to replace cuts to military retiree benefits, Senate Majority Leader Harry Reid and Senate Democrats blocked all amendments to the budget deal from being considered and voted on. Saying we should just pass this budget agreement with these offensive cuts in it and fix it later is a cop out and no comfort to our military retirees, who now have to rely on Washington politicians to change a law they voted for (2013).
Senator Alloye asserts that her amendments would have easily replaced these unfair benefit cuts. One proposal would have saved billions by stopping a scheme uncovered by the Treasury Department watchdog in which illegal immigrants fraudulently claim the Additional Child Tax Credit. Another proposal would close a loophole that costs billions in which some states, not including New Hampshire, dole out nominal energy assistance benefits — as low as $1 in some cases — to automatically increase Supplemental Nutrition Assistance Program benefits for households that may otherwise be ineligible for higher benefits. These are just two examples among many of how we could have covered the $6 billion in cuts to military retiree benefits.
Nonetheless, the issue of equity comes to play in relationship to both cost proposals. Moreover, the military’s policies regarding costs, benefits and risk must be weighed against the need for a strong defense?
From a social feasibility, administrative feasibility, and technical feasibility, cuts in the defense budget would probably meet the minimum threshold requirement.
A policy alternative is to wait until a full-report from the Military Compensation and Retirement Modernization Committee-which is expected to look at ways to reform military pay. This report isn’t due until May 2014 (Hansen, 2011).
Possibly the most encouraging part of the forum was Defense Secretary Leon Panetta’s remark about putting “everything on the table.” In the years ahead, the United States will be even more dependent on a strong military than in recent years.
The proposed plan to shift to a 401(k) model would save $250 billion over 20 years. Those savings would be penny smart and pound foolish if they gut the heart of the military, its people. This is a risk we must not take” ( Dreazen & Baron, 2012).


Carney, J. (2013). Republican senators battle budget cuts targeting military retirees. Washington: Atlantic Media, Inc. Retrieved from

Dreazen, Y. J., & Baron, K. (2012). In the recesses of pentagon budget, heated battles loom. Washington: Atlantic Media, Inc. Retrieved from

Hanson, M. A. (2011). BUDGET BATTLE LINES: Military families and retirees could take a hit through budget cuts. Officer, 87(1), 14. ieved from EBSCO host database on December 25, 2013.

Tom Vanden, B. (n.d). Military services battle over shrinking budget. USA Today. Retrieved from EBSCO host database on December 25, 2013.

(n.d). Military retirees deserve better than pension cuts. USA Today. Retrieved from EBSCO host database on December 25, 2013.

Environmental Air Quality: For Better or Worst?

Environmental Air Quality (Belle)

Today, Christmas Day in sunny California. NBC Bay Area just announced-” Warm, Sunny, 67 for the high in San Francisco and 71 in San Jose. Both cities are expected to reach record temperatures. Also, today is ‘Air Alert’ day in the Bay Area.” An Air-Alert in the coast/coastal region-(101–150): Unhealthy for sensitive groups-active children and adults, and people with respiratory disease, such as asthma, should limit outdoor exertion. Outdoor burning is prohibited.

Bay Area Air Quality Index-The Air Quality Index, or AQI, much like an air quality “thermometer,” translates daily air pollution concentrations into a number on a scale between 0 and 500. The numbers in this scale are divided into six color-coded ranges, with numbers from 0 to 300. The daily air quality forecast divides the Bay Area counties into five reporting zones, and reports the AQI level for the particular pollutant anticipated to reach the most unhealthy concentration in each reporting zone. In preparing the daily air quality forecast, Air District meteorologists study weather patterns that influence air pollution, and analyze measurements from the agency’s air quality monitoring network. Two primary causes of poor air quality in the Bay Area are ozone and particulate matter, also called PM or soot. Cars and trucks and other mobile sources are the major sources of ozone in the summertime. In the winter, wood smoke from wood stoves and fireplaces is the major source of PM pollution.

When pollution is bad, it can irritate your eyes, nose, and throat, cause shortness of breath, aggravate asthma and other respiratory conditions, and even affect your heart and cardiovascular system. Breathing polluted air for long periods of time can cause more serious health problems. Take the case of Martha, who awakened one warm. sunny California morning to find her infant son, Jose Miguel, gasping for air, his lips and the skin under his fingernails blue from lack of oxygen. Terrified, she rushed him to her local hospital in Long Beach, Calif., where doctors stabilized the toddler and sent him home with medications to control his fever and an inhaler to help him catch his breath.

In spite of the beautiful weather, movie stars, Silicon Valley, and San Francisco 49ers, California is home to some of the worst air quality in the nation and ninety percent of the state’s population lives in areas that are out of attainment with at least one of the National Ambient Air Quality Standards ( Bedsworth, 2012).
In fact according to a recent scorecard, Contra Costa County ranked in the 90 percentile in the nation in terms of the direst or worst counties in carbon dioxide emissions, nitrogen oxide emissions, suffer dioxide emissions and ranked in the 50 percentile in Air Quality among counties in the nation.

My assessment of the environmental impact that industry and progress has brought to California is a double-edged sword. On one hand, California has grown industry and downtown developments including new stadiums and arenas. On the other hand, California is among the dirtiest /worst states in the nation. So, the question is: at what point does economic progress becomes a major health concern? What are some public policy alternatives to this dilemma? These and other questions remain to be answered and offer future challenges to public health, public policy, and business development communities.


Bedsworth, L. (2012). Air quality planning in California’s changing climate. Climatic Change, 111(1), 101-118. doi:10.1007/s10584-011-0244-0. Retrieved from EBSCO host database on December 24, 2013.

Contra Costa County Air Quality Scorecard ( 2013). Retrieved from…on December 24, 2013.

MARSA, L. (2013). Breathless. Discover, 34(6), 79-85. Retrieved from EBSCO host database on December 24, 2013.

NBC Bay Area News, December 25, 2013.