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2022 Inflation Reduction Act

Cigna Health Insurance Company recently put out their summary of the Inflation Reduction Act and an overview of the provisions mostly related to health policy. Below is a great summary of the provisions which can be found here on their website. Here is their summary below:

August 16, 2022

Inflation Reduction Act to be Signed into Law, Includes Multiple Medicare Drug Pricing Reforms

On Aug. 12, the Inflation Reduction Act of 2022 (IRA) passed the U.S. House by a vote of 220-207, and President Biden is expected to sign it into law today. First passed by the U.S. Senate on Aug. 7, the $740 billion budget reconciliation package includes policies on Medicare drug pricing, Affordable Care Act (ACA) subsidies, energy, climate, and taxes. This update provides high-level details on the notable health care-related provisions in the IRA. 

Allowing Medicare to Negotiate Drug Prices

With the goal of improving affordability for high-priced drugs in Medicare Parts B and D, the IRA directs the Department of Health and Human Services (HHS) to establish a drug price negotiation program for certain high-priced, single-source drugs and biological products. Under this program, the HHS Secretary will publish a list of selected drugs that meet certain criteria, then negotiate (and renegotiate as needed) maximum fair prices with manufacturers of those drugs. Drugs eligible for negotiation include the 50 Part B and 50 Part D single-source drugs with the highest total expenditures during the most recent 12-month period; however, negotiation is limited to Part D drugs for 2026 and 2027. Negotiated prices must take effect for 10 eligible drugs in 2026, increasing to 20 drugs in 2029. For 2026, the expenditure period to be reviewed is June 1, 2022 through May 31, 2023, and the selected drug list publication date will be Sept. 1, 2023.

Redesigning the Medicare Part D Program, Including Capping Annual Out-of-Pocket Costs for Beneficiaries

The IRA significantly reforms the Medicare Part D benefit design, including capping maximum out-of-pocket (OOP) costs at $2,000 annually, with a copay smoothing component; capping annual premium growth at 6%; and expanding eligibility in the Low-Income Subsidy (LIS) program. 

Beneficiary Cost-Sharing Changes:Beginning in 2024, beneficiaries will be responsible for $0 in the catastrophic benefit phase. There are no changes to the initial coverage phase or coverage gap phase.Beginning in 2025, the coverage gap phase will be eliminated, and a new $2,000 OOP cap will be applicable with the option to spread OOP payments out over the course of the year. The initial coverage phase remains unchanged.
Part D Benefit Design: The bill restructures plan, manufacturer, and federal government liabilities for the different benefit phases beginning in 2025: 

Initial PhaseCatastrophic PhaseBeneficiary: 25%Plan: 65% for brands, 75% for genericsManufacturer: 10% for brands, 0% for genericsBeneficiary: 0%Plan: 60%Manufacturer: 20% for brands, 0% for genericsFederal Government: 20% for brands, 40% for generics
Premium Stabilization: For 2024 through 2029, any increase in the Part D base beneficiary premium is limited to the lesser of a 6% increase from the previous year or the premium that would have been applied if the stabilization program was not established. In 2030 and subsequent years, the HHS Secretary is authorized to make adjustments necessary to the base Part D premium to ensure that premium is increased by the lesser of 6% or what the premium would have been if the stabilization program was not established.
Expanded LIS Eligibility: The bill expands eligibility for the Part D LIS program from 135% of the federal poverty level to 150% beginning in 2024.

Capping Insulin Cost-Sharing in Medicare

For 2023 through 2025, the bill caps beneficiary cost-sharing at $35 a month for Medicare Part D or Medicare Advantage Prescription Drug Plan (MA-PD) covered insulin products. In 2026 and beyond, it caps cost-sharing at the lesser of $35 or 25% of the maximum fair price or 25% of the plan’s negotiated price. The cost-sharing is capped regardless of where the beneficiary is in the benefit phase, and Part D and MA-PD plans are eligible for a retroactive subsidy in 2023 equal to the aggregate reduction in cost-sharing and deductible due to implementing this provision.

Implementing Drug Manufacturer Inflationary Rebates in Medicare

The legislation requires drug manufacturers to pay rebates to the government if drug prices in Medicare Part B and Part D rise faster than inflation, with rebates equaling the rate at which the price of the drug exceeds inflation. This rebate provision goes into effect Jan. 1, 2023 for Part B rebatable drugs and Oct. 1, 2022 for Part D rebatable drugs. Drugs with an average cost of less than $100 are excluded. Additionally, HHS is instructed to reduce or waive the rebate amount for a Part D rebatable drug if it is on the drug shortage list, per the Federal Food, Drug, and Cosmetic Act.

Requiring Vaccine Coverage in Medicare Part D

Beginning in 2023, Part D plans are required to cover all adult vaccines recommended by the Advisory Committee on Immunization Practices, without cost-sharing or the application of a deductible (other than vaccines covered under Part B). Part D and MA-PD plans are eligible for a retroactive subsidy in 2023 equal to the aggregate reduction in cost-sharing and deductible due to implementing this provision.

Extended Delay of the Medicare Part D Rebate Rule

The legislation includes an additional five-year delay of the implementation of a rule that would prohibit manufacturer rebates in Part D, to Jan. 1, 2032. 

Extending Enhanced ACA Subsidies Through 2025

Originally set to expire at the end of this year, the IRA extends the enhanced American Rescue Plan Act (ARPA) ACA premium tax credit subsidies through 2025. 

Cigna Federal Government Affairs is continuing to review the IRA and the wide impacts of the legislation. Our expert team remains committed to helping you successfully navigate current and future health policy issues. We will provide additional information and resources in the near term.

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Ribbon Cutting at Family Care Center

We had a great time with the South Metro Denver Chamber helping to celebrate the opening of a new office in Lone Tree for the Family Care Center. It’s been great to see a lot of recent expansion for mental health services throughout the community. We look forward to partnering with them to make sure insured members get the support they need!

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Ribbon Cutting at Ent Credit Union

We had a great time connecting with some new partners at Ent Credit Union and their new, wonderful location off of Quebec & C-470 in Highlands Ranch! We look forward to collaborating with the management there and holding some Medicare 101 meetings at their location soon. Stay tuned!

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Ribbon Cutting at Denver Springs

Jenna and I had a great time with the South Metro Denver Chamber and Denver Springs at the ribbon cutting of their new facility in Englewood. They’re doing some great work in increasing the availability of mental healthcare access through their locations. I was very impressed with their staff and their new facility. Their services have unfortunately seen a lot more demand the last few years, but we recommend reaching out to them if you know anyone who needs their assistance. Best wishes. Bret

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Kevin Kelly’s 103 Bits of Advice I Wish I Had Known

Kevin Kelly is the founding Editor of Wired Magazine. Many, including Tim Ferriss, call him The Most Interesting Man in the World. On his 70th birthday he released 103 Bits of Advice I Wish I Had Known. These were just a fraction of them that I enjoyed:

– About 99% of the time, the right time is right now.

– Don’t ever work for someone you don’t want to become.

– Forgiveness is not something we do for others; it is a gift to ourselves.

– If your opinions on one subject can be predicted from your opinions on another, you may be in the grip of an ideology. When you truly think for yourself your conclusions will not be predictable.

– Efficiency is highly overrated; Goofing off is highly underrated. Regularly scheduled sabbaths, sabbaticals, vacations, breaks, aimless walks and time off are essential for top performance of any kind. The best work ethic requires a good rest ethic.

– When you lead, your real job is to create more leaders, not more followers.

– Criticize in private, praise in public.

– Your growth as a conscious being is measured by the number of uncomfortable conversations you are willing to have.

– Speak confidently as if you are right, but listen carefully as if you are wrong.

– Denying or deflecting a compliment is rude. Accept it with thanks, even if you believe it is not deserved.

– The consistency of your endeavors (exercise, companionship, work) is more important than the quantity. Nothing beats small things done every day, which is way more important than what you do occasionally.

– When someone tells you about the peak year of human history, the period of time when things were good before things went downhill, it will always be the years of when they were 10 years old — which is the peak of any human’s existence.

– When speaking to an audience it’s better to fix your gaze on a few people than to “spray” your gaze across the room. Your eyes telegraph to others whether you really believe what you are saying.

– Habit is far more dependable than inspiration. Make progress by making habits. Dont focus on getting into shape. Focus on becoming the kind of person who never misses a workout.

– When you have some success, the feeling of being an imposter can be real. Who am I fooling? But when you create things that only you — with your unique talents and experience — can do, then you are absolutely not an imposter. You are the ordained. It is your duty to work on things that only you can do.

– When public speaking, pause frequently. Pause before you say something in a new way, pause after you have said something you believe is important, and pause as a relief to let listeners absorb details.

– Ask anyone you admire: Their lucky breaks happened on a detour from their main goal. So embrace detours. Life is not a straight line for anyone.

– The advantage of a ridiculously ambitious goal is that it sets the bar very high so even in failure it may be a success measured by the ordinary.

– When you don’t know how much to pay someone for a particular task, ask them “what would be fair” and their answer usually is.

– You will be judged on how well you treat those who can do nothing for you.

– You can’t reason someone out of a notion that they didn’t reason themselves into.

– Your best job will be one that you were unqualified for because it stretches you. In fact only apply to jobs you are unqualified for.

– The only productive way to answer “what should I do now?” is to first tackle the question of “who should I become?”

– Purchase the most recent tourist guidebook to your home town or region. You’ll learn a lot by playing the tourist once a year.

– If you repeated what you did today 365 more times will you be where you want to be next year?

– Your time and space are limited. Remove, give away, throw out things in your life that don’t spark joy any longer in order to make room for those that do.

– If you loan someone $20 and you never see them again because they are avoiding paying you back, that makes it worth $20.

– Aim to die broke. Give to your beneficiaries before you die; it’s more fun and useful. Spend it all. Your last check should go to the funeral home and it should bounce.

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Why You Should Be Very Wary of Selecting a Non-Qualified Health Plan

A recent article in the Wall Street Journal found here highlighted many of the reasons that as a health insurance broker, I have never opted to provide non-Affordable Care Act Qualified Health Insurance Plans.  You will see these plans such as US Health, Freedom Life, and even the religious based medical share plans leave people on the hook for thousands of dollars of exposure to bills.  

Hospitals and providers still work off of contracted rates with the insurance companies, or can charge the highest rate if someone doesn’t have insurance.  According to this analysis by the Journal, the non-qualified plans such as Freedom Life use rented network rates which often can even be MORE expensive than someone who doesn’t have insurance.  Also, plans like indemnity options that only pay out a certain amount of money for each plan area does not cap the costs to the insured member, therefore balance billing the rest to the individual.  Because the providers will balance bill the unpaid amounts to the patient, it can leave them on the hook for a bill sometimes totaling in the hundreds of thousands of dollars.  Most of the time, people don’t have that kind of money, which is why they bought insurance in the first place, and the bills are sent to collections, ruining that person’s credit.  

Be very careful in selecting a plan from a non-qualified health insurance coverage, and definitely work with someone who knows about these issues and can navigate the plans appropriately with you.

The following are some of the quotes from the article I think are worth highlighting but I would recommend reading the entire article if you’re interested:

“Health insurers typically build their plans around confidential deals that lock in prices for hospitals and doctors within their provider networks. Insurers negotiate the rates for different services covered by their plans—rates that started becoming public this year under a new federal rule for hospitals. The Journal has used the data to illuminate the widely varying rates paid for the same service, at the same hospital; the high prices often charged to the uninsured; and the unpredictability of prices even for those with insurance.”

According to the article, the plan “paid to use a rental network called PHCS, which had the highest negotiated rates at Baptist Health’s flagship Miami hospital, according to pricing data—even higher than the cash rates for those with no insurance at all.”

“The Journal’s review, including data for 836 hospitals, found the rates of some of the biggest rental networks were consistently among the highest prices that hospitals negotiate.

More than half of the time, one of the rental networks had the highest overall rate in the analysis. The rental networks, on average, had rates that ranked in the most-expensive third of negotiated prices, higher than any of the national insurers, the Journal found. In some cases, they were even higher than hospitals’ rates for uninsured patients.”

““Those rental networks are cobbled into products that don’t really protect you,” said Cindi Gatton, owner of Pathfinder Patient Advocacy Group in Atlanta. “You really get caught between a bad plan design and discounts that aren’t as good as you would be able to negotiate on your own.””

“The rental networks are used by some plans that aren’t traditional health insurance and don’t have to meet requirements set in the Affordable Care Act, such as coverage of pre-existing conditions and limits on patients’ out-of-pocket costs.”

“That includes some plans offered by organizations with religious affiliations, known as healthcare sharing ministry plans. They aren’t insurance, but they are set up to allow subscribers to share each other’s medical expenses. About 1.5 million Americans are members, according to the Alliance of Health Care Sharing Ministries, a trade group.”

“Arthur Saroughian, 55, a pharmacist in Glendale, Calif., said his family enrolled in Medi-Share, a healthcare sharing organization, in 2018, because its Christian values and message of sharing appealed to them, and he thought it would cover them much like traditional insurance. His Medi-Share card had the PHCS network logo and listed what appeared to be an out-of-pocket charge of $35 for a hospital visit.

After a July 2019 angiogram at Huntington Hospital in Pasadena, Calif., Dr. Saroughian was billed considerably more: $21,465, the PHCS network rate. Pricing data shows that PHCS’s rates are usually among the highest the hospital has negotiated. For Dr. Saroughian’s heart procedure, the current PHCS rate of $11,148 is the hospital’s highest negotiated price. A Cigna health-maintenance organization plan’s rate is $4,083.

According to documents viewed by the Journal, Medi-Share deemed his procedure related to a pre-existing condition, which it wouldn’t cover.”

“Dr. Saroughian said his cardiologist believed he had authorization from Medi-Share for the angiogram, and he ordered it because of recent chest pain, rather than an ongoing issue with irregular heartbeats. The bill was sent to a collections agency. Dr. Saroughian said he offered to pay a portion of the total.”

“On Sept. 16, 2020, Ms. Colón was awakened early in the morning by her 2-year-old granddaughter and discovered that she couldn’t move the left side of her body. Her husband quickly realized she had had a stroke.

Surgeons at Baptist Hospital of Miami removed four clots from her brain. She was discharged on Sept. 21. Weeks later, the bills started to arrive.

She paid some individual doctors’ bills, but the hospital bill came to $211,872. The PHCS rental-network discount took off 10%, or $21,187. The Freedom Life policy paid $15,000. That left her owing $175,685.”

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Centers for Medicare & Medicaid Announces 2022 Medicare Costs

From their post:

“Each year the Medicare Part B premium, deductible, and coinsurance rates are determined according to the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $170.10 for 2022, an increase of $21.60 from $148.50 in 2021. The annual deductible for all Medicare Part B beneficiaries is $233 in 2022, an increase of $30 from the annual deductible of $203 in 2021.”

You can find the full article as well as the 2022 IRMAA amounts (adjustments due to higher incomes) in the article here.

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Health Insurance & The American Rescue Plan

Hello everyone,
I hope 2021 has been a better year than last, and that everyone is so far having a happy, healthy year!


I wanted to share some details about the American Rescue Plan passed into law last month, and how it may help some with your yearly medical costs.  I’ve identified you as someone who may benefit from the new law.


The first thing to know is that due to President Biden’s Executive Order, there is currently an Uninsured Enrollment Period going on.  Anyone who DOES NOT have insurance is eligible to enroll into a plan from now until August 15th.  That probably does not affect anyone on this email, but may help your friends or family.

THE AMERICAN RESCUE PLAN

  1. Beginning April 15th, you may qualify for higher tax credits.  The law is providing some increased benefits for those who are eligible for federal tax credits to help lower the premiums further.  Everyone eligible will get these in the form of a higher tax credit when you file taxes for 2021 in April of 2022 – leading to a higher tax return.  Alternatively, we can rerun your Eligibility in the Connect for Health CO system, and if you are tracking to make what we initially estimated for 2021, then you should qualify for an increased tax credit and lower premium.  If you are making MORE money than expected and are likely to make MORE than what you originally estimated, we should likely NOT re-run your Eligibility, and your tax credit will probably come out about the same, provided your income isn’t SIGNIFICANTLY higher than estimated.  Everything will reconcile when you file your taxes for 2021 next year regardless.
  1. (This one could be BIG for some) If anyone has received unemployment benefits for at least 1 week in 2021, then you will qualify for FULL tax credits and possibly increased Cost Sharing Reduction in your plan, and we should definitely rerun that in the system.  The exception to this would be if the member is eligible for employer coverage that is considered affordable.
  1. This likely might result in a change in benefit and plan options.  If it makes sense, and you’d like to change plans, you can do so, and credit you’ve paid toward your deductible will be credited towards the new plan provided you stay with the same insurance carrier.  If you change carriers, credit towards a deductible will NOT apply and you will start your deductible over.  If your tax credits are not going to change and you’re not rerunning Eligibility for a lowered premium, then you will still be able to change plans after May 15th until August 15th if you’d like.

Due to the number of clients I’ll be speaking with that this might effect, I would request that you review your income projections we probably discussed during Open Enrollment and let me know:

  1. If you will be at similar to lower income for 2021 as prior projections (in which case we will likely want to apply for the lowered premium for you).
  1. Provide me with the income estimates for EACH income area.  (An example would be:  “I’m making $12,200 in Social Security this year, my wife will make $25,300 from her job for a total of $37,500 for 2021.”  – Please be specific as I have a lot of clients and don’t always save these breakdowns, and this helps us make sure we have accurate numbers so no one has a problem with their tax credit when they do their taxes.)  You can always log into your Connect for Health CO account and look at your My Eligibility application to see the income projection used for 2021.
  1. Let me know if you’ve been on UNEMPLOYMENT this year at all (in which case we will likely re-run your Eligibility for lowered premiums).  Only 2021 Unemployment benefits would apply.

If your income will be as previously estimated, and you’re happy with your plan and current tax credit (and/or would prefer to receive a higher tax return anyway), NO ACTION NEEDED!


If you have friends who are enrolled OFF EXCHANGE on individual health insurance, they may now qualify for tax credits due to the increased funds.  They may qualify for assistance to lower their insurance premiums to at least below 8.5% of their household income with expanded Eligibility.  If anyone needs to evaluate further, have them give me a call or shoot me an email.


Connect for Health CO and The CO Division of Insurance are releasing more information on April 15th and throughout the week.  Hopefully we will have some more details after that and can begin running new Eligibility then for those who need it and over the coming weeks.


I hope this helps, and again, wish everyone a happy, healthy year!


Best regards,
Bret

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Amazon’s Leadership Principles

Jeff Bezos announced this week he was stepping down as CEO of Amazon.com. He’s an amazing creator and business leader, and often, he’s able to articulate principles in a very beautiful way. These are the Leadership Principles posted on the Amazon website. They’re SO good.

“Leadership Principles

We use our Leadership Principles every day, whether we’re discussing ideas for new projects or deciding on the best approach to solving a problem. It is just one of the things that makes Amazon peculiar.Customer ObsessionLeaders start with the customer and work backwards. They work vigorously to earn and keep customer trust. Although leaders pay attention to competitors, they obsess over customers.

Ownership

Leaders are owners. They think long term and don’t sacrifice long-term value for short-term results. They act on behalf of the entire company, beyond just their own team. They never say “that’s not my job.”

Invent and Simplify

Leaders expect and require innovation and invention from their teams and always find ways to simplify. They are externally aware, look for new ideas from everywhere, and are not limited by “not invented here.” As we do new things, we accept that we may be misunderstood for long periods of time.

Are Right, A Lot

Leaders are right a lot. They have strong judgment and good instincts. They seek diverse perspectives and work to disconfirm their beliefs.

Learn and Be Curious

Leaders are never done learning and always seek to improve themselves. They are curious about new possibilities and act to explore them.

Hire and Develop the Best

Leaders raise the performance bar with every hire and promotion. They recognize exceptional talent, and willingly move them throughout the organization. Leaders develop leaders and take seriously their role in coaching others. We work on behalf of our people to invent mechanisms for development like Career Choice.

Insist on the Highest Standards

Leaders have relentlessly high standards — many people may think these standards are unreasonably high. Leaders are continually raising the bar and drive their teams to deliver high quality products, services, and processes. Leaders ensure that defects do not get sent down the line and that problems are fixed so they stay fixed.

Think Big

Thinking small is a self-fulfilling prophecy. Leaders create and communicate a bold direction that inspires results. They think differently and look around corners for ways to serve customers.

Bias for Action

Speed matters in business. Many decisions and actions are reversible and do not need extensive study. We value calculated risk taking.

Frugality

Accomplish more with less. Constraints breed resourcefulness, self-sufficiency, and invention. There are no extra points for growing headcount, budget size, or fixed expense.

Earn Trust

Leaders listen attentively, speak candidly, and treat others respectfully. They are vocally self-critical, even when doing so is awkward or embarrassing. Leaders do not believe their or their team’s body odor smells of perfume. They benchmark themselves and their teams against the best.

Dive Deep

Leaders operate at all levels, stay connected to the details, audit frequently, and are skeptical when metrics and anecdote differ. No task is beneath them.

Have Backbone; Disagree and Commit

Leaders are obligated to respectfully challenge decisions when they disagree, even when doing so is uncomfortable or exhausting. Leaders have conviction and are tenacious. They do not compromise for the sake of social cohesion. Once a decision is determined, they commit wholly.

Deliver Results

Leaders focus on the key inputs for their business and deliver them with the right quality and in a timely fashion. Despite setbacks, they rise to the occasion and never settle.”

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Washington: A Life by Ron Chernow

I finally finished one of the great biographies of George Washington by Ron Chernow.  Chernow is best know for his biography of Alexander Hamilton which inspired and was the basis for the Broadway musical Hamilton that he consulted for.  This is the second biography I’ve finished by Chernow, the first being about John D. Rockefeller.  I have to say that they have been two of the most enjoyable, and well-written biographies I’ve ever finished.  Chernow is a master of bringing the subjects to life and letting you into the intricate details of their lives that give you a true sense of the person, without getting into anything too boring or mundane.  He strikes a great balance between extreme details about their lives, while tying that to the big picture on how it affected them, or events surrounding them.  

I’ve long wanted to learn more about Washington.  I feel he’s one of those characters we learn about in school and all know the basics or the mystique of.  We all know how respected he was and generally how he was chosen as the General to lead the Continental Army as well as elected the first President of the US, the “Father” of our country.  But I’ve always wondered if much of the reverence for Washington was due to people looking through rose colored glasses at history, or lionizing him among some of the other Founders into a story to sell to the country.  History often gets things wrong or is reinterpreted through the years to fit a particular narrative.  I wanted to know the why and how behind the man in more detail. 

Here are some things I either didn’t know, or were perhaps more crystallized for me about Washington.

Character & Personality

I would say that the character of the man and reputation that we all grew up hearing about Washington was absolutely true.  Washington was a very dutiful man and a true servant of the country.  When he was a young soldier, he perhaps had a bit of ego about him, but that seemed to fade the more he grew up into the man we learned about.  Washington was very against bragging about himself, and would almost go out of his way to do the opposite or give no opinion on his actions.  He preferred to let his actions speak for themselves.  He didn’t really lobby for most of the positions we would come to know about him.  He wanted to be General of the Continental Army, but again would not vocalize it, and wouldn’t lobby for it.  And he was very humble in accepting the role saying that he hoped he would carry out the position with honor and excellence.

Washington was the type of General who was literally in the heat of battle with his men.  He slept outside generally with them, taking on all of the same experiences, and was often begged by his captains to take cover and protect himself more, as he seemed unfazed exposing himself to great danger on a regular basis.  He was also not above playing games with the common soldier, choosing to be around and socialize with them, but he also commanded great respect among the troops:  they knew who the boss was at the end of the day, mainly because of the way Washington conducted himself and his actions of discipline, but also being inspiring to them by practicing what he preached so to speak.  He didn’t ask them to do anything that he wouldn’t do himself, such as suffering through the horrible conditions, famine, and sickness at Valley Forge.

After the war, Washington wanted one thing:  to retire to Mount Vernon and take care of his farm.  He was begged to become the President of the Continental Congress, and begged to run for and become the first President of the country.  He actually felt both of these were great burdens that he didn’t really want to do, but he acquiesced as most people convinced him that he was the only figure who most of the country would trust to be a neutral party and caretaker for the country.  If he didn’t do it, then the new Constitution would have a really high chance of failing and the country dissolving.  Washington wanted to resign the Presidency after 2 years to go back to Mount Vernon but kept getting convinced if he left, and didn’t run for a second term, that again the country would dissolve.  Washington was a great believer that the Federal government had to be powerful, so he of course reluctantly (and mostly unhappily) stayed into and completed a second Term.

Washington was surprisingly a very passionate man as well.  He wrote a lot of subtle and forthright love letters in his day.  He loved to dance, and even as he was aging and was President, he loved being around younger women and would delight by dancing with every lady in the room for hours at parties.  He of course would never think of cheating on his wife Martha though.  He would also forthrightly tell friends that he loved them, and would sometimes cry in their presence, like at the last meeting of his officers after the Revolutionary War.

Washington was a very practical man and politician, preferring to hear both sides of an argument – actually more like all sides of an argument or debate, and then think on it for a LONG time.  But once he had made a decision, he was all in in defending it or doing the things necessary to make the decision work.  He was not much of a philosopher, but more of a practical decision maker.  He was very humble, and would never say that he was the smartest man in the room.  He preferred to surround himself with the smartest people he could find and ask them their opinions to form his own judgment.  His humility shined throughout the biography.

The Burdens of Service

One of the most fascinating things I found I didn’t know was how burdensome running his plantation while trying to serve the country was.  Washington actually wasn’t a very wealthy man even though he had inherited great wealth, land, and yes, slaves.  The best analogy I can give for him would be the business owner today that has a business making $5M per year today, but the business say loses $500K per year or breaks even.  And the business owner has to borrow money every year just to get by and never makes a profit.  That was Washington.  Mount Vernon was never very profitable but he had hundreds of slaves and other workers managing it.  He had great trouble with planting, getting the right crops planted at the right times, figuring out how to rotate them etc. He also had vast dilapidation on Mount Vernon while he was at war for 8 years, and the 8 years of his Presidency, as the caretakers of course weren’t as disciplined as he would have been had he been there.  

Washington also had other business needs that were quite costly.  He had squatters on much of his other lands who refused to pay rents, and he spent significant amounts taking people to court to try to get money out of them.  People who owed him money would pay him back in colonial coin that was eaten up by inflation during the war.  After the war, a seeming endless flood of guests would show up out of the blue to be entertained by Washington at Mount Vernon and hear about the war, and these guests were extremely costly as Washington always took them in, fed them, and begrudgingly entertained them if possible for a day or two.  He had almost no time to himself during this period and seemed to be frustratingly shelling out money to feed and entertain guests, run his farm, and collect on debts, usually unsuccessfully.  Sometimes friends would ask him for loans and Washington would have to let them know that even though people thought he was rich, that he actually had no money, and would have to turn them away.  Often though he would scrounge up a way to help people, like his mother, (whom he basically disliked and had a tense relationship with), who would write him begging for and complaining that she had no money.  He often found a way to help people who asked for it.

The long and short is, Washington was a hard working man managing a large business that pretty much lost money or broke even every year, and the burdens of him serving the country as General and as the first President certainly didn’t help that at all.  Many of the letters during his time as General and as President are him lamenting that the only thing he wanted to do was go back to Mount Vernon and live a peaceful life and take care of his farm.  He somewhat dreaded the position he was in of having to serve while leaving his own happiness and business aside.  Alas, the duty to the country called on him to begrudgingly serve and do the best he could.

Slave-Owner

Washington was a slave owner through inheritance.  Pretty much all of Washington’s wealth and property came from inheriting it from his deceased father, his deceased older brother, and from Martha’s deceased ex-husband who was very wealthy.  Interestingly though, under law, much of the wealth from Martha’s previous marriage he was not allowed to touch and he had to be a steward of and file documents with the courts demonstrating he was a good conservator.  He and Martha didn’t have their own children, so legally, Martha’s children with her previous husband owned a lot of property, but Washington had to manage it for them and not touch it.  

I only knew that Washington was a slave owner, but did not know the circumstances and how he dealt with this.  As far as slave owners go, he was definitely not on the brutal or cruel end of the spectrum.  He expected his slaves to work and be productive and would be upset if he felt that they weren’t.  He wasn’t one to resort quickly to physical abuse and would prefer to try to verbalize his anger or discontent if he felt a slave wasn’t working productively.  But he was also not above telling his conservators while he was President for them to issue “corrections” to slaves who were not obeying.  It could be said though that Washington also issued “corrections” and even executions to some soldiers under his command that deserted etc. He could be a harsh disciplinarian at times.

Washington overall, could be argued, gave more freedom to his slaves than most other slave owners did.  He made sure that they certainly were all fed and cared for, ensuring that if any of them were sick that they were cared for and received medical attention (for what medical attention was in those days).  He also let them hunt and fish and then sell their catches in town to pocket extra money for themselves.  He was ADAMANTLY against ever breaking up families, and he would allow his slaves to have relationships and marriages with slaves from other plantations if they wanted to.  And he would do his best to accommodate a way to bring relationships together and families the ability to be together the best he could.  Washington was always a sucker for giving advice to others in relationships btw.

His personal aide was the slave Billy Lee, and repeatedly Washington showed great affection for Billy Lee’s long years of service, as he was with him all through the war and even into the Presidency.  Even when Lee became crippled during his Presidency, Washington bent over backwards to hire personal escorts to get him to the Capitol so he could be with them, even though his health didn’t allow for him to be as useful and vigorous as he once was.  This also went for some others who were Martha’s personal aides.  Billy Lee always had a place in Washington’s heart, and upon his death, Washington willed him a lifetime pension payment along with his freedom.  Interestingly, when some of the other slaves who were serving the family personally ran away, the Washingtons couldn’t understand why they would leave them, feeling a bit astonished that they weren’t happy to be there.  Clearly, they fully didn’t understand why a slave of theirs would want to be free.

Washington greatly struggled with the issue of slavery, and through the years mostly agreed that it should be abolished when talking to close friends.  One of his best friends, almost a son to him, the Marquis de Lafayette, the famous Frenchman who fought in the Revolution and would make a name for himself during the French Revolution also, was a staunch anti-slavery advocate and lobbied Washington to oppose it and free his slaves.  Washington agreed with him, however, he often felt hand tied because he relied on slavery to maintain his Mount Vernon estate and farm.  He often felt that the farm, and in extension he, did not make any money from the farm as it was, and he often said that it barely made enough in order to feed and house all of the slaves and workers there as it was, especially over the years as his slave population grew due to natural child births.  So he always felt hand tied often saying that in his heart he wanted to set all his slaves free but didn’t know how either they would make their own living, or how his money losing farm could possibly survive without them.  He felt both needed each other.  Clearly he justified this in his own mind to justify the horror of slavery that he was by extension perpetuating.

At the end of his life however Washington set out in his will to set all of his slaves free.  Legally as I mentioned, he only owned about half of the slaves under his conservatorship, as he legally didn’t own Martha’s nor her children’s inherited slaves.  But in his will, he directed to set all of them that he owned personally free.  He was adamant about this as on his death bed he made it clear that the will he wrote stating so be carried out after he died.

Jeffersonians vs Hamiltonians

One of the most illuminating parts of the biography was how sharply divided the country was even during his Presidency, and also how insidious Thomas Jefferson could be – he gets a major downgrade from me after this book.  I’m almost surprised how much history seems to revere Jefferson after hearing about a lot of his schemes.

It’s funny to hear people say how divided the country is today.  But in the time of the Revolutionary War and the founding of the country, it was just as divided, perhaps more so, and probably along sharper, more consequential lines than today.  

During the war, Washington had a very mixed, if not leaning bad, record of commanding battles and strategy.  Several times he had to deal with other commanders trying to undermine him with the Congress, or vie for his job, recommending his firing. But Washington’s character ultimately prevailed in peoples’ faith that he was the man for the job.  As I said, he preferred to let his actions speak for themselves, so he really didn’t angrily react to a lot of this infighting, and didn’t try to admonish the character of others who were trying to admonish his character or fitness for the job.   Also, the Torries all throughout the colonies were people who sympathized with the British and didn’t believe in breaking away.  Pretty sure we don’t really have that problem today!

During his Presidency there were bitter debates on the role of Federal power, and Washington would be the one to set these precedents for the country.  Hamilton, his Treasury Secretary, believed in a strong federal government and banking system – Jefferson believed this was a breach of Federal power and that it would help lead to a monarchy in the US.  It’s amazing how underhanded Jefferson was in trying to undermine Washington and spread the rumors that he was trying to install a monarchy – writing pseudonymously with James Madison under a publication that they would distribute trying to spread these rumors.  For years, their publication was circulated and was critical of Washington and Hamilton’s policies, and insinuated that they were trying to install a monarchy in the US.  This while Jefferson dealt with Washington all the time as his Secretary of State, and would say verbally that he believed Washington had the highest character of any man he knew.  The secret undermining Jefferson engaged in, along with him being a complete fanboy in believing how great the French Revolution was, turning a blind eye to its atrocities, showed Jefferson to be very wrong on some of the most important historical issues of the time.  Jefferson was brilliant though most people, including Washington, agreed.  And the fact that Washington kept both Hamilton and Jefferson close to him in his cabinet, while they were locked in such intense psychological political gamesmanship, speaks to his credit as being able to manage both massive personalities.  Both men would say how much they both greatly respected his character and leadership, even if they disagreed with him on some issues or tactics from time to time.  

Some other interesting tidbits.  Washington was the only President to personally command troops in the field as he marched troops into western Pennsylvania as a show of force during the Whiskey Rebellion, as many people protested and used violence, angry at the imposed whiskey tax.  Upon arrival, the rebellion ceased, and Washington harmoniously handled the aftermath of the uprising.  But he felt it was very important to show that the Federal government could enforce its taxes and laws to not set a bad precedence for the country.

After Washington’s Presidency, President Adams called on Washington to become the General for the country yet again as they were afraid the French Revolution would spill over into the US and that there would maybe be an invasion.  Washington began mobilizing and organizing his captains and the army fairly enthusiastically, surprising to me for how unhappy he was being away from Mount Vernon during his service.  He delegated a lot of responsibilities but served for 17 months in the post until his death.  A pretty fascinating return to service at an old age and after all he had been through.

Washington was an amazing person, and seemed to be the right person in history at the right time.  His character really unified the country during the Revolutionary War and into the implementation of the Constitution.  Any other person in those roles would quite possibly have led to the country dissolving, but because everyone could trust Washington was doing his best to do the right thing and govern fairly, the country would go onto succeed.  During his Presidency, Washington seemed to strike the perfect balance in demonstrating that the Federal Government was the authority in the country, while not trying to overstep his bounds as President – showing that it was NOT a monarchy.  It was a great biography that I highly recommend, and Washington definitely is highly upgraded in my view after living with him everyday for a couple of months or so finishing the biography.