Sunday, April 21, 2013

An Obamacare Loophole For Early Retirees?

This entry was written on April 21, 2013, way before Obamacare took effect. Here is an update concerning my situation dated July 26, 2014: .

I didn’t expect to write about anything today, especially not about politics. But this is not about politics but rather about retirement. After I finished reading about buying health insurance with Obamacare, I just had to share a surprising discovery that could affect me and perhaps you. The main I concern I’ve had about retiring early (if I could), was getting affordable health insurance. I was already dreading the thought of having to work until I reach 65 when I would be eligible for Medicare, or stop working earlier and move to the Philippines. Of course you can always buy coverage from private insurance companies, but they are very expensive and if you have a pre-existing condition, your premiums could be higher or you could be denied coverage. So I decided to do some research on how Obamacare would affect the cost of health insurance coverage for early retirees, who won’t be eligible for Medicare until age 65, and found some interesting things about the Affordable Healthcare Act of 2010.
First I went to this website: to check out how Obamacare would work in California. I read through pages of information but they didn’t clearly indicate how early retirees would qualify. The main criteria they had was income. Where would early retirees get their income and how is that calculated? The website didn’t clearly say. So I asked Mr. Google this question: “Do early retirees qualify for medicaid?” A whole bunch of financial and news websites came up explaining a glitch or loophole in Obamacare. Here are a couple of examples: and
Basically, what is says is that early retirees can qualify for subsidized health insurance starting in 2014 or if you fall under a certain income level, then you qualify for Medicaid and don’t have to pay for health insurance. Interesting! If this is the case, then I hope the law isn’t overturned by the powers that be in Washington, D.C.
So hypothetically, if I am able to pay off my mortgage, then I won’t be requiring too much monthly income to cover my day to day expenses and utility bills. Let’s just say I only need $1,000 a month to survive ( I can actually subsist on less). That’s what I have to withdraw from my savings and would make my income $12000 a year which would qualify me for Medi-Cal (California’s Medicaid). So if anybody ever reads this and is familiar with the subject, please correct me if I’m wrong. Based on the California program, I will not have to start paying for health insurance until my income goes over 15,850. If I understand what I read correctly and I actually have to buy subsidized insurance, that would give me a Silver Level coverage. Until the open enrollment starts later this year, I won’t know how much the Gold or Platinum Level coverage would cost, which is the highest tier of coverage available. That means more out of pocket to pay for the insurance monthly, but lesser to pay when you get treatment.
Then I realized, I was actually wrong about withdrawing from my savings as income. Regular banks savings actually don’t qualify as income because they had already been taxed beforehand. Now if I start withdrawing from my regular IRA or 401K at age 59 ½ , that would actually be considered taxable income. So while withdrawing from savings until it runs dry, my taxable income would actually be zero. Right? I don't have enough savings to last until I turn 59 ½ though :( .
If that Obamacare loophole is for real, then it’s almost too good to be true. Will the law be amended to fix this loophole? Because it is to my advantage, then I hope not. You mean to say I could possibly afford to retire in the U.S. and not have to do it in the Philippines?!

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Thursday, April 18, 2013

Questions and Concerns at Pacific Hospital

Good lord, what have the owners and administrators of Pacific Hospital done now? As you may know, that is my place of work. Two weeks ago, the FBI and other federal authorities descended upon the place and inspected computer files. The local newspaper reported that the hospital was being investigated for fraud. This usually means insurance fraud and that doesn't bode well because in past years, hospitals have been closed for that reason. Is Pacific Hospital financially stable enough to absorb the penalties that may be imposed upon it? I'm surmising that this is the least that the government can do. The worst of course is to order the hospital to cease operations. So the question of many is how is this situation going to affect the people who work there, especially the nursing staff. This uncertainty is giving us a lot of angst. Will we be joining the unemployment rolls in the next few days? It was bad enough that 4 other hospitals unrelated to Pacific Hospital had to close the previous week for fraudulent activities. Those 4 had sizable psychiatric units so if PHLB closes, there would be a glut of psych workers out of a job and a dwindling number of psych units in LA County. No psych units equals no jobs for psych workers. And where would all those psych patients go?
When things like these happen, rumors fly and one of them is that the hospital had applied for bankruptcy a few days later. Was it a Chapter 7 or Chapter 11 bankruptcy? Nobody knew. I later found out this wasn't true but due to a knee jerk reaction, I believed it was initially. But nobody else other than the person who texted me knew about it and it became apparent the next day that the rumor was unsubstantiated. When I heard who the source was, I should have doubted it already, because I knew that this person was unreliable. Where he got it from initially, I don’t know. For me, bad information is worst than no information.
A few days after the raid, the president of the hospital had an open forum where she told the employees that she still doesn’t know what the Feds were looking for. In an article in the Wall Street Journal three years ago, it was mentioned that the owner of Pacific Hospital had gone into some kind of spinal surgery business arrangement with somewhat of a shady character who had previously been incarcerated for fraud in his dealings with another hospital for the same type of business. So I brought this up at the open forum and asked if the FBI may be checking up on the hospital’s spine surgery operations. As the president mentioned beforehand, she did not know. The owner’s and shady character’s names were mentioned, so I followed up and asked if those two names were on the list of people the Feds were looking for. The president told me that she was not at liberty to answer my question but she admired my boldness for asking it, after which she mentioned that she was the daughter of the hospital owner. I was appalled because I would not have asked my follow up question had I known she was related to the owner! After all I have more discretion than that. I was anxious enough on asking my first question that I could feel my blood pressure rise and the additional embarrassment didn’t help any.
So where do we go from here? The president told us to continue taking care of our patients because the hospital is not closing down. It was one of the stipulations in the subpoena that the hospital will continue operating. Of course, questions persist. If worse comes to worst, what will happen to us? What will happen to our accrued vacation time? Will it be paid out or will we lose it forever? I'm concerned about this because I consider this my emergency money. How about health insurance. Do we qualify for COBRA? If we lose our jobs, do we qualify for unemployment benefits? Will there even be severance pay available? I’m also a contributor in the 401K plan but this should not be affected because the funds deducted from our paychecks are forwarded to a separate investment company. And my biggest fear is that I don’t have any other marketable skills anymore. I've been working in psych since 1981 and it's the only job I know. Even though I’d like to retire, it’s too soon and I don’t feel that I’ve saved enough. For now, we can only hope for the best in spite of the uncertainties. One of those hopes would be for my paycheck to clear tomorrow. WILL IT???
The views and opinions expressed here are not necessarily those of Pacific Hospital of Long Beach, its agents, or affiliates.
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Wednesday, April 17, 2013

Surviving The Loss of Running Muscle Memory

Well here I go again trying something I had not done since last December. I would like to say that I have given up running altogether because of my ankle tendon problems and myopathy stricken thighs due to Atorvastatin, but I broke that non-running habit again last Thursday. Any semblance of running nowadays may be worth writing about because of the glaring absence of it in my exercise logs. So this is what happened last Thursday: I jogged to the bank and back home. Not like what I did a couple of weeks before when I jogged 1 minute and walked 1 minute, but one continuous, non-stop jog other than stopping to withdraw money from the ATM and for stop lights. One might call it a slow jog but jogging already implies slow, so perhaps it was more like shuffling my feet forward and backward. Nevertheless I thought it was faster than my fastest walking pace. So how did it feel? Hmm, very, very different. It felt like I had never ran before because the muscle memory that I had  from decades of running had developed Alzheimer’s disease. The unfamiliar strides I took were the shortest I had ever taken, which was probably helpful because I landed less heavily. What was surprising to me was that I was anticipating for the myopathy to act up, but it never did, so I just kept on plugging along.
Another surprise awaited me on the way home. I ran into Katherine with her dog who also happened to be running to and from her bank. The muscle memory might be gone but at least I remember my neighbor Katherine whom I trained with for years. I may have mentioned her before in one or two of my posts and I'd like to lay to claim that I contributed to her marathon PR in L.A. (correctly or otherwise), because of the workouts we did together especially the ones on the track in Long Beach City College. For two people who supposedly don’t run anymore, it was funny to have met on the street while running to and from different banks. We separated ways after exchanging a few pleasantries.
A couple of blocks from home, I had to do a double take in a strip mall because I noticed that the video store I used to rent DVD’s from had closed down, no doubt due to lack of customers who have probably since switched to Netflix, Red Box, or at worst, illegal downloading. I was sad to see it go. I was there so frequently in recent years that the managers knew my membership number by heart. Another thing that tells you is that I haven’t exercised outdoors much so it was the first time I noticed the video store was gone. A few more minutes later, I was back home from the unexpected 42 minute jaunt through the neighborhood with not much or any permanent damage done to both muscles or tendons.
A couple of days later, I logged another run, but this time it was on the treadmill, which lasted 50 minutes. It almost felt like my running muscles were slowly regaining their memory.  I'm so glad the Press Telegram fixed their Android app (there was a problem with it for a couple of weeks) and it made for better reading while running on the machine.  Okay, this can't be right. What's this showing up in my workout log? Two runs for the week? Highly unusual nowadays. My body has learned to live without running but after a couple of these recent experiences, I'm feeling the craving again. It's like a damn drug! Is that normal?
From that running high came the downer two days later – the tragedy of Boston Marathon 2013. WHY???!!!

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Monday, April 8, 2013

Workout Notes - Spring 2013

          About three times a week, I do abdominal workouts usually consisting of sit ups, crunches, twists , or sit ups with a 15 pound weight which I hold against my chest. All of those without anchoring my ankles to anything. Occasionally, I also do leg lifts. With the weighted sit ups, I could normally do 30 to 32 reps. Then I discovered another variation of the weighted sit ups a couple of weeks ago. That time, I held the 15 pound weight against the back of my head then tried to raise my upper body off the mat. I managed half a crunch and a huge grunt, but no sit up. Wow, that was way harder than I thought! I couldn't help but laugh at myself when that happened. I then tried a 10 pound weight with similar results. Down to 5 pounds I went, and was finally able to lift my torso from the ground and managed to do it 16 times. Remember, this was without anchoring my ankles to anything so by the 14th repetition, I couldn't keep my feet on the floor due to the forced reps. I could feel my stomach muscles burning. So that was  surprising sit ups discovery - lesser weight but more resistance and lesser repetitions required. I think I may add that to my routine.
          One Saturday morning, I planned on driving to the bank to get some money from the ATM machine. It was not cold outside so I decided to do a 1 minute jog with 1 minute walk to the bank and back. Just to remind you, I haven't done a run in months because of the myopathy problems I have been having while taking generic Lipitor for my high cholesterol. When I was still running fairly well, that round trip would have taken about 25 to 26 minutes. That Saturday, it took 35. Well, my legs generally felt slightly but pleasantly sore after doing that jog/walk. Delayed Onset Muscle Soreness (DOMS), the pleasant soreness I had is however totally different from statin myopathy which feels more like a cutting pain. This time it affected my right thigh muscle as opposed to the left side a few months ago. To add to that, this run didn't even hit the pleasure areas of my brain and left me dissatisfied. Maybe the reason is because I don't do it as often as I want or can anymore. What was good though was that the afterburn of that brief workout kept my weight down the next day even after eaten a lot of red velvet cookies with white chocolate chunks.
          A couple of weeks after that 1 minute jog/1 minute walk workout, I went to have an oil change for my car and instead of waiting around while the mechanic did it, I walk/jogged around the area. I didn't keep track of how long the jogging and walking parts were but did it by feel. That way, I was jogging more than I was walking and the whole workout lasted 45 minutes.
          I did a rowing machine workout one morning while watching a Japanese documentary film called Jiro Dreams of Sushi. Since the wind resistance machine makes a lot of noise, it helped that the movie had subtitles. You would think that after watching that movie, I would be craving for sushi. Well, I did not.
          And finally, my workouts before and after my colonoscopy. On the day of the procedure, I felt so weak from the clear liquid diet and the trips to the bathroom so I had no choice but take it easy on my 30 minute workout on the recumbent bike. My discharge instructions after the colonoscopy said no vigorous workouts for 24 hours after the procedure. So it was more of the same the next day on the recumbent bike. Two days later, I did a somewhat vigorous uphill walking workout on the treadmill for 45 minutes then a full body weight training workout using rubber tubing. Don't even say I don't follow doctor's orders.
          So there it is folks - dreary descriptions of what it takes to stay in shape: a little bit of this and that which even included some running.

Sunday, April 7, 2013

Colonoscopy - Second Edition. What?!!! it's that time again already???

Either this is my colon or my semi-colon or THE BLOB
          I never got the chance to write about the first edition since I wasn't blogging yet five years ago, but time does fly when you're not eagerly anticipating another visit to the gastroenterologist knowing what's going to come up next. In this case, a tube that comes up from under and inside your body. But we do what we must because of our family history. Oh, the horrors of getting old: high blood pressure from my father, colon cancer from my mother, and anxiety from who knows where.
          It's has been five years since I had the first de-virginization of my rear end and since then, my mother had died of colon cancer. So it is a necessity for me to have this procedure done every five years instead of the usual ten years. Shall I call this de-virginization part 2 even though that's not technically possible? Call it what you may but it still involves inserting an endoscope up where the sun don't shine and in my mind it feels like I'm going to be violated. Perhaps that's why it's called an ENDoscope. And to think that they blow air inside your intestines and shine a light where I previously said "the sun don't shine", so the doctor can see what he is doing. Good thing I'm unconscious through all that, thanks to Michael Jackson's sleeping drug of choice - Propofol.
          Shall we backtrack a little bit though? Because it's not just a matter of going directly to being violated, you have to prepare for it first. It's the so-called dreaded PREP. For all of you who have gone through this, you already know what it's like: a clear liquid diet the day before the colonoscopy (Wait, did you say clear liquid diet? Does white wine or vodka count?), drinking a liter of an electrolyte concoction in the evening, in my case it was something called MoviPrep,  which after you finish, you are primed for BLAST OFF! The purgative literally blasts off whatever you have hiding in the nooks and crannies of your chitterlings and sends it down the drain in several installments. You might as well keep your pants and undies off for the duration to save time between toilet visits so you don't accidentally soil yourself. Because just when you think you had ejected everything, another spasm makes you sprint faster than a leopard in the savanna, back to the crapper. Then after you exhaust yourself with all the sprinting, you try to get some sleep before the alarm wakes you up at 4:30 in the morning so you can repeat the electrolyte drinking process and subsequent bathroom dashes all over again. To paraphrase Dave Barry: it's as if you are ejecting whatever you might have eaten tomorrow. Never in the annals of mankind has anyone used so much toilet paper as I have in such a short period of time.
MoviPrep Blast Off Drink
          Now for the boring and mundane stuff. It was time to go to the surgery center. Five years ago, I had my colonoscopy at Lakewood Regional Medical Center which was three miles from home, but this time, due to the dictates of the insurance company, I had to travel more than 15 miles to Los Alamitos to a building called the Reagan Street Surgery Center, which is located on, um... Reagan Street, just a stone's throw away from Los Alamitos Medical Center. Last time, my Auntie Beth who used to live in Long Beach, drove me to and from the hospital, but she has since moved to the Temecula area. So I had to find someone to drive me, or take a cab. With a taxi, it would have cost more than $80 round trip with tips. I called the insurance company, my gastroenterologist, the surgery center, and my internist to find out if they had some kind of free or affordable shuttle service for patients. Alas, they had none. My last resort would have been to call my Uncle and Aunt from Cerritos and ask if they could drive me. But since they are now in their 70's, I hesitated. Instead I posted my dilemma on FACEBOOK (hey, that's what social networking is all about, isn't it?), offering $40 to take me to and from the surgery center, using my stick shift car or theirs, and they didn't have to wait while my procedure was being done. Then I can call them whenever I was ready to go home. I didn't expect very much from it, but within minutes, my cousin Jeanette, who works in L.A. but lives in Thousand Oaks, offered to adjust her work schedule and drive me. I was hoping for someone closer to Long Beach who would not be inconvenienced too much, so I declined her generous offer. A couple of hours later, a friend from my running club (AREC), sent me a Facebook email message offering to drive me. Since Nancy is a real estate agent, she said she could also adjust her schedule. After exchanging a few messages, I took her up on her offer, with the promise of buying her and her husband Johan, a good bottle of wine. Believe me, I don't know good wine from bad, and Nancy used to sell wine before she went to real estate, so I had to ask another friend of hers - Bennett, who works at the Wine Country in the city of Signal Hill, what he thought Nancy would like. After a few suggestions at the store, I picked out a French red. I don't know if it's good, but I hope Nancy and Johan will enjoy it. Nancy, thanks so much again for driving me. You are a Godsend :)
          So after verifying my address and destination, Nancy picked me up and dropped me off at the surgery center. I signed in, signed a few consent forms and was sent to the GI lab in a few minutes. I was asked to change into a gown, then this Filipina nurse who also happened to have graduated from my alma mater (University of the Philippines), and whose husband is from Zamboanga City, inserted an IV in my right arm and hooked me up to a blood pressure machine. Well, it seemed like taking my blood pressure medication and an anxiety pill earlier(which were the only solids I was allowed to take) kept my blood pressure within normal limits. Thank goodness for that because my BP usually goes sky high when I'm anxious. Then another nurse and the anesthesiologist introduced themselves, and in short time, my bed was wheeled into the surgery area. Dr. Weiss asked me if I was ready and I responded - " well, I'm here", and he said - "so am I". I guess we were both ready. I was asked to turn on my left side, then the anesthesiologist placed an oxygen mask on my face and told me to breath deeply. All I can remember was taking two or three breathes, and then my name being called to wake me up. And just like that, the violation, I mean the examination was over. Over and done with for another five years. I asked Dr. Weiss if a video of the procedure was available, but he said the computers they had didn't have enough storage. I also asked him about withdrawal time or how long he takes to slowly withdraw the endoscope while examining the length of the colon (the slower, the better). He said that time was a good criteria for doctors who were new at doing colonoscopies. Having done more than 30,000 of them, he said he already knows what exactly to look for. My preliminary results indicated: no polyps, no cancer. Yipee! As a consolation prize, they gave me a photocopy of the pictures they took of my colon and some apple juice. Then they called Nancy to pick me up. She actually had to go upstairs to where I was and sign my discharge instructions so the staff was certain that I wasn't driving myself. After Nancy dropped me off at home, my wobbly legs managed to take me back to my condo without falling or passing out.
Preliminary Results
          I had been without solid food for almost 40 hours by then. Why so long? Well, starting at 12:01 a.m. on Wednesday, I was on clear liquid diet until the evening, then nothing to eat or drink at all after that except the second dose of MoviPrep on Thursday morning. Then the procedure was done at 1:30 p.m. and I was back home at 4 p.m. and that was when I had some noodle soup. So if the Propofol hasn't clouded my brain so much, that adds up to 40 hours of no solid food. Right? Right?!
          I followed the discharge instructions as closely as possible, namely: no driving, no alcohol (darn it!), and no vigorous exercise for 24 hours after the procedure. The next day, I got a follow up call from Jean, the Filipino nurse, to find out how I was doing and I said everything went well and that I already mailed the feedback form that came with my discharge instructions. Of course, I checked Excellent in all categories. My question is - was that colonoscopy procedure really done on me? Because my butt doesn't even hurt and I don't even feel violated!
          For a more humorous account about colonoscopies, I present Dave Barry's version: