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FAQ

Is it legal to have an unregistered off-the-grid (no birth certificate) baby in the USA?
I was actually roommates with someone in College whose parents decided to have him “off-grid”. Let me just say this: Stop even entertaining the idea of having a baby off-grid. It really makes your child’s life unnecessarily hard and your kid will forever resent you for putting that pain on them.I’ll get into the details in a moment, but first let me address the question proposed above. Yes, technically speaking it is not a crime to have your baby off-the-grid in the U.S.A. However, a lot of details surrounding the event would be illegal. First of all, any licensed midwife or doctor is required by law to file a birth certificate or they actually risk losing their license and getting a misdemeanor. If you forced them or threatened them to not file the birth certificate that would make you a likely accomplice and would not go over well with the authorities.But let’s ignore that for a moment and just assume you know how to birth a child on your own and can do it in your basement without any professional medical physician there to oversee you (which would be the only way you could pull this off). In this case you wouldn’t get thrown in jail for failing to get a birth certificate and no crime would have been committed. However you just set up a very difficult life for your child.These are some of the things I was told from by my roommate who didn’t have a social security number until he was 20 years old.No, he could not get a (legal) jobQuite literally he didn’t qualify to get even a job at McDonalds. If you remember the last job you got no matter how prestigious or demeaning it was, you had to fill out a bunch of paperwork. Most of these forms require you to have a SSN (social security number) to properly fill them out. However the important one is the form labeled I-9. This form is required to be submitted by every employer after hiring a new employee. This form serves only one purpose, to determine that you are eligible to work in the United States. Your child (and my roommate) would not be able to complete this form which every employer must get filled out before starting employment with a new employee. Your child will not be able to get a job because of this.Yes, he can evade paying taxes.Okay, so this sounds like a perk I guess. But my roommate did not have to pay taxes. The government basically didn’t know he existed, so they never knew he was not paying. But then again he didn’t have a job. So would you rather have a job and pay some taxes or not ever be able to work except under the table for below minimum wage? Given that choice, taxes sound pretty awesome! Keep in mind that this also means your child is not eligible for any tax benefits or credits such as those that students get while going to college.No, You as the parent can not claim him as a dependent on your taxesYou’re already dealing with a child, wouldn’t it be great to get that child tax credit? Every year you'll basically be paying out of pocket for deciding not to get them a SSN.Yes, he can attend public school through 12th gradeHe would be able to attend school through high school without a social security number.No, he can not attend collegeWhile high school and lower education is okay, your child will never be able to attend collegeYes, he can go to the doctorThe doctor will still see your child and prhim his shots. However…No, he will not be covered under your family insurance (or qualify for Medicare/Medicaid)So you’ll need to plan on paying for all doctor appointments out of pocket.No, he can not travel abroad (even to Canada)You’d best hope none of your child’s friends decide to go to Cancun for spring break. Your child will not be eligible to leave the country or return to the US if he manages to leave (unless he plans to climb Trump’s wall)No, he will not be able to drive a carOkay, well nothing is stopping him from physically driving a car, but he would not be able to get a driver’s license and thus, can not LEGALLY drive. Hope he doesn’t get pulled over.No, he will not be able to voteOnce old enough he will not be able to register to vote.Yes, he can avoid the draftWell the good news is that like taxes, he can skirt the requirement to join the draft when he turns 18.No, he can’t get a loanThis means no credit cards, no car loan, no home, nothing. I’m sure plenty of people will claim these are all evil anyway, but these have powerful impacts on someone’s life. There might be times he needs it. (and when used properly none of these are bad things).No, he will not have a credit scoreThis goes with the above one, but he will not be able to work on this which affects your entire life/future. This also will disqualify him from renting most homes or apartments he is looking at.Basically your child will be treated as an illegal immigrant. Why put them through this when they are entitled to the benefits that the United States provides its citizens? There are people in other countries dying to get what your child is entitled to and you are (considering) denying your child those abilities? It just doesn’t make sense.Get them a SSN and if your child decides at 20 that he wants to live off-the-grid than he can burn his Social Security Card and go in the woods and hide from the government. But don’t be selfish enough to make that decision for them.My roommate resents his parents for not giving him a SSN. While all his friends in high school were driving, he couldn’t. While his friends go to Cancun for spring break, he had golden handcuffs in the U.S. and can’t leave. And worst of all he said was that while all his friends were earning money from jobs in high school, he couldn’t get a job.The job part was the hardest for him. He couldn’t leave the house or move out when he turned 18. He was stuck at home.Him working on getting a social security number was difficult and took him two years. He started when he turned 18 to get one once he realized he couldn’t go to college, he couldn’t get a job, he couldn’t rent an apartment, and thus will never really be able to be independent from his parents. It took two years and then at 20 he was able to get one and start working and going to school.He forever resented his parents. Don’t be those parents…
How many days does Medicaid require you to wait between filling out the Concerta XR?
Since Concerta is a schedule 2 controlled substance, Medicaid will only fill it as the prescription was written. If you had it filled for 30 days, you have to wait until the 30 days are up to get it refilled. They will not fill it earlier, unless the doctor has told you to take more. In that case, you must have your doctor contact the pharmacy to update them on the change so Medicaid will cover it.
Will TennCare (medicaid) pay for a controlled substance ℞ out of state, if I have a valid prescription and the pharmacy is willing to fill it?
It usually isn’t a matter of whether the pharmacy or insurance will fill it, it’s usually that they cannot use the insurance in a different state. Our pharmacy is located in PA just a few miles away from the Ohio line, and we often have customers from Ohio come in with Ohio medicaid. Our system will not let it process. The PA system just doesn’t take MOH. Some states are different, but that’s my experience here.With that being said, I would talk to your insurance company and your doctor, and see what they can do about possibly filling early to ensure you don’t run out. Sometimes we have patients who get doctors‡ notes and proof of travel, and if the patient is upstanding and easily passes an inspection of their controlled substance use (the pharmacist goes online and looks through their pickup history - if they’re regular users and pick up on time, not early, and don’t use multiple substances, they are usually cleared) then we’ll fill it.Alternatively, the insurance company may also be able to let you fill it and pay for it without insurance, but reimburse you upon submission of a few forms.
Why can't the Republicans replace Obamacare?
I originally commented on Habib Fanny’s answer, and his response motivated me to write my own answer rather than continue in the comments thread.My comment was to this effect: I thought Habib’s answer was excellent, but I disagree with his conclusion, i.e. that the GOP will successfully repeal and replace the bill. Here’s my reasoning.Nine senators oppose the bill at the time of writing, and it will be difficult to make concessions that win over seven of them. They are:Jerry Moran (Kansas)Shelley Capito (West Virginia)Rob Portman (Ohio)Mike Lee (Utah)Ted Cruz (Texas)Ron Johnson (Wisconsin)Rand Paul (Kentucky)Dean Heller (Nevada)Susan Collins (Maine)As I began researching this answer, I found a great assessment from Five Thirty Eight on this exact question. I highly recommend reading it. So that I’m not covering the same ground, I’ll put my own spin on the same question, using a (very) simplified assessment of political costs and benefits.Simple OverviewEach Republican senator has a choice: support the bill or not. In game theory parlance, they can choose to “defect” or not. Each senator’s incentives depend on the choices of the other senators. Plus, each senator has reasons to conceal and prspecific information about his or her intentions. So: each senator has to make a decision based on the limited information provided.Senators can “signal” their intent, in order to try to get other senators to make decisions by providing information. The issue is that talk is cheap: a senator can say something in public, but it’s not easy for other senators to know if he or she really means that or not.Lastly, I’m following the conventional wisdom: senators‡ primary goal is to get re-elected. Their political futures depend to some degree on their party leadership - which is pushing them toward compliance - but their primary motivation is to appeal to their voters in their home states.(Where does this change? For folks like Ted Cruz, who has presidential aspirations. We’ll come back to that.)Nuts and BoltsThe bill fails if three senators vote against it. There are 52 Republican senators, and if 50 vote for it, Mike Pence can break the tie in favor. So, losing three senators means that the bill won’t pass.The basic calculus facing senators is thus:Factor #1: If the bill is popular or unpopular in their home states, or if it is likely to become so between now and their next election. This isn’t identical with the economic benefits and costs that repeal would create, but it’s strongly related, i.e. if a relatively high percentage of constituents are dependent on Medicaid, a senator is less likely to vote for the bill.#2: The degree of pressure that Senate leadership can exert on them. It’s hard, for both personal and professional reasons, to resist the leadership’s call to “fall in line” and vote for repeal. Plus, Senate leadership can offer to modify the bill to mollify individual senators and their states. (Anybody remember former Senator Ben Nelson and Obamacare?)#3: Personal views. These aren’t always easy to tell - again, “cheap signaling” plays a role here - but they’re not invisible, either.#4: Intangible factors. For example: keeping promises you’ve made in the past. It turns out that politicians actually try hard to keep their promises.#5: What everyone else does. Some senators would like the repeal bill to pass or fail, but don’t want to take the political risks of voting for or against repeal. If you can get your preferred outcome without paying for it, that’s the ideal scenario. The challenge, as mentioned above, is that each individual senator feels this way.There are at least two senators who are very likely to vote against the bill, regardless of what the others do (point #5). Their individual cost-benefit calculations, based on the above, are likely to pra “No” vote.Let’s take a closer look at these two senators:A Closer LookMike Lee (Utah): Mike Lee is a member of the Freedom Caucus. (So is Ted Cruz.) Mike Lee is also pretty steadfast in his positions. (Unlike Ted Cruz).Senator Lee won re-election in 2021. so he doesn’t have to worry about being re-elected for another five years. That’s a lifetime in politics. What happens in 2021 will matter a lot more for his re-election chances.That said‡ Poll: 49% of Utahns say they oppose Obamacare replacement. Only 36% are in favor of the Senate bill. Based on this alone, we would assume Sen. Lee would like to vote against the bill.What about #3 and #4? Here’s an op-ed from the good Senator himself. This could be “cheap signaling”, but Lee has been quite consistent in both his opposition to Obamacare and his desire that “repeal” be an actual, genuine rollback of Obamacare as it stands.Why I could be wrong: Sen. Lee’s op-ed suggests that he really does want to see a repeal - he just doesn’t think the bill goes far enough.If the bill moves to the right to appease him/Cruz/Paul - which is the right strategy from a game theory perspective - it’s going to lose Susan Collins for sure, and probably Lisa Murkowski as well. Dean Heller is going to vote against it no matter what (he’s up next). It’s possible that Mitch McConnell can buy off Murkowski with a massive exception for Alaska, and probably one for Rob Portman in Ohio as well. I don’t think it’s likely. But it might be enough to get Mike Lee on board.Dean Heller (Nevada). Dean Heller is running for re-election next year. He is the most vulnerable Republican running for re-election, and he’s doing so in a state that Hillary Clinton won in 2021. The Democrats are desperate for some wins, and they’re going to spend all the $$$ necessary to get some, so his opponent will be very well-funded. And repeal is unpopular in Nevada.If more proof were needed, the stats tell it all. Sen. Heller has a 31/44 split on approval vs. disapproval, in polling today (or almost), he loses a matchup against a generic Democrat, and 51% of voters polled disapprove of the House repeal bill, vs. 31% in favor.Why I could be wrong: I mean, Trump is President, so anything can happen. But barring a massive shift in public opinion in Nevada, no way is Sen. Heller voting for this bill in anything approaching its current form.What About Everyone Else?If I am right and Sen. Lee and Sen. Heller both vote “No”, the Senate could still pass the bill. But that would mean holding onto every other Republican vote.Let me group the other senators into buckets:2021 Wannabes: Ted Cruz and Rand Paul. Both are far-right, and both have presidential aspirations. This makes it difficult to predict their motivations, as they are balancing national appeal with appeal to their voters. That said, I don’t think they’ll vote for this bill unless it moves further to the right. If it does, it risks losing…Moderates. Lisa Murkowski and Susan Collins fit this bill. If the bill goes further right, they probably won’t vote for it. Simple as that. I do say “probably”, as it’s possible they could be enticed by means of a massive dole-out from the GOP leadership for their respective states. If the bill passes, I think that’s how it’s going to happen. But I don’t think it’s going to happen.Similarly, if the bill goes toward the center to attract these two, it will almost certainly lose Rand Paul’s vote. (Cruz might go along with it if he feels it will serve his future ambitions.) Kentucky benefited a LOT from the Medicaid expansion. As the 538 piece points out, Rand Paul knows that. It’s reasonable to suspect that he wants the repeal bill to fail for that reason, but he can’t say so because of his past statements (and possibly because of his ideological bent.)Senators Who Want To Go With the Leadership, But Whose States Will Suffer A Lot From Repeal: Rob Portman and Shelley Moore Capito. Portman is close with Mitch McConnell, but Ohio’s got a serious problem with opiods, and Governor Kasich hates the repeal bill. Portman’s in a tough spot. Likewise with Sen. Capito, because West Virginia is going to get hammered if the bill goes through. She’s another great example of someone who probably wants this bill to fail, but doesn’t want to be on record saying so.People I Know Nothing About: Ron Johnson and Jerry Moran. I don’t have a clue what they’ll do.SummaryA closer look at the incentives suggests that Mike Lee and Dean Heller aren’t going to vote for this repeal bill. Sen. Lee isn’t facing electoral pressure, and his state doesn’t like the bill, so he’s free to “vote his conscience” with an eye to his voters. He’s been consistently saying that the bill doesn’t go far enough, and I don’t think he’ll change his tune.Sen. Heller is the opposite. Political exigencies will ensure that he does not vote for repeal.Can the GOP hold onto the other seven votes? It’s possible, but it would require satisfying both the most conservative and the most moderate members of the GOP. That’s tough sledding, especially when folks in Ohio and West Virginia have benefited as much as they have from the expansion of Medicaid.Ultimately, of course, I could be wrong about this. Maybe Mike Lee, in the absence of strong political pressure, comes around. Maybe a large enough aid package for West Virgina, Ohio and Alaska goes through to win those votes. Maybe they strip out the Planned Parenthood amendment and the conservatives don’t revolt. Maybe Ted Cruz and Rand Paul decide that their political futures are best served by voting to repeal, rather than claiming they want to repeal it but also claiming the mantle of ideological purity.Maybe.But I wouldn’t bet on it. I’d bet against it.
What's the most difficult situation you've ever had to deal with while working under President Obama?
I worked at the Call Center for the Affordable Care act on first and second enrollment.Honestly most of my job was fine, I signed up the better part of 18'000+ people in the two years. Only once did I get a call from a person that could not afford health care that actually got fined. (That was mostly because he seemed to have massively over extended his money)But it was very difficult getting calls from people in states that did not expand Medicaid. Because I had to tell them they would not get health care, and could not get help paying for health care. (Because they should have been covered under Medicaid) And many where convinced they would be fined for not having medical care. (They would not, you are exempt it the cheapest care will cost more then 8% of your income)My worst call. (I will cut out and collapse some of it, it was a 90+ min Call)Me: "Welcome to the health care market place, my Name is William Moore how can I help you today."Caller: "Ya that N*GG*R Said I had to get insurance and I got this number to call."-At this point I should make a note, I am a man with a not so light Kentucky Accent, this called was a man with a not so light Alabama Accent, and sounded to be a older man-Me: -Long pause- "Sir are you referring to the President?"Caller: "Ya! That N*GG*R."Me: -Long Pause- "Sir I would love to help you with your health care, but I'm going to have to ask you to please stop using that kind of language."Caller: -Stars crying openly over the phone- "I'm sorry, I just don't know what to do. I don't have any money, I live by my self. I can't afford Insurance and I can't pay a fine, I don't want to go to jail."Me: -I had to spend the next 15 minutes calming him down by telling him that I was going to help him, and I was not going to hang up or even go home before I helped him."Me: "Sir I'm very sorry but your state has not expanded medicaid so you won't be covered. But you don't make any money to your income is $0. Eight percent of Zero is Zero. So you are exempt, you don't have to pay a fine."Caller: "They're gonna throw me in jail!"Me: "NO Sir, no one is going to throw you in Jail."Caller: "But they said they were gong to!"Me: -Frustrated pause- "Who? Who Said that?"Caller: "The News."Me: -Flabbergasted sound- "WHAT news?" -Pause- "Don't Answer that sir, I don't need to know or care. Let me read you the law sir."Me: -I spent the next 15 minutes reading the exemption part of the law word for word for the man, and finally convinced him that he was fine. Then directed him to a local library, which I called and asked to help him fill out a exemption form... which he did not have to do, but I wanted him to have the piece of paper to make him feel better. I Then directed him to a local hospital program so he could have yearly checkups-Caller: -The whole call ended with him thanking me, and apologizing again, saying that he didn't hate the president and he didn't mean to call him those things, But he was just so frightened and mad.-There you go.