Archive for the ‘#aca’ Tag

Confessions of an Uninsured Graduate | Marianne March   Leave a comment

A few days ago I donned my gown and my cap with its little gold tassel, and I graduated with highest honors from my college. Now that I am transitioning out of student life, I have many decisions to make. What will I do? Where will I work? What am I going to do without my generous Obamacare stipend?

Image result for image of the happily uninsuredImmediately following high school, I entered the working world as a retail manager. I enjoyed the hard work, the promotions, and the encouragement I received from my supervisors. I was making just enough money to live in a rented 2-bedroom townhouse with a roommate, and my full-time status qualified me for healthcare coverage through the company. At the same time, I longed for work that would be more meaningful for me. I was disinterestedly interviewing to be the manager of my own store when I decided to pursue my education.

My passion for politics steered me towards a degree in policy and economics. For over four years I diligently prepared for exams, listened to several hundred hours of lectures, and participated in group projects that made me wish I could strangle my classmates without repercussions. I also worked part-time jobs, volunteered, interned at three different organizations, and attended a semester abroad.

When I turned 27, I was no longer covered by Mom’s insurance plan. As a student with a low-wage part-time job and the occasional unpaid internship, my tiny income allowed me to qualify for bodacious healthcare stipends. As a wage-earner in the lowest tax bracket, over 90% of my Obamacare costs were covered by a so-called premium tax credit. In 2017, things will be more complicated.

Related imageAs a recent graduate, I imagine myself carving a path in the world with the same patience that the Colorado River took to erode the Grand Canyon: slow and tedious, but not when you think of the intensity of the rapids and the roar of water as the waves pummel through the canyons and stone is forced to make way for water. I am taking a chance and accepting a temporary apprenticeship which excites me and will give me an opportunity to test-drive a career of passion.

At least one person looked me in the eye and urged me to reconsider. After all, I’m 28, I live in my parent’s basement, and I had a post-graduation plan that included dental and a 401k, not a benefit-free six-month gig. I admit it, this choice is a gamble. What am I going to do about money and healthcare? I have six months before student loan collectors come a-knockin’. Sure, there are many jobs that will provide for a closet full of clothes, a pile of bricks, and a matching storage unit. However, this opportunity just might be the onramp to a life that I long for and that I didn’t think was possible.

Unfortunately, as a temporary employee, I am not eligible for benefits like a 401k or employer-generated healthcare. I will receive compensation for my work, but my modest income will render my healthcare stipend to nearly evaporate. I will be earning too much money to keep my government assistance, but earning too little to comfortably afford the monthly premiums. Of course, there is always a choice to make: I can go back to work that is completely unfulfilling but will allow me to pay for healthcare coverage, or I can try to earn less money so that I qualify for support.

I can even shove my fists in my eyes and out-ugly Kim Kardashian’s cry-face, or I can be grateful that my organization is taking a chance on me. I can be happy that, although my financial future is questionable, delayed gratification is the very hallmark of adulting. I can’t know the future, but I believe this is the best move I can make at present.

And so, when the enrollment deadline for HealthCare.gov rolled around, I had another choice to make. My decision is to go without health insurance.

For weeks, I have received emails, automated phone calls, and voicemails, sternly reminding me, “Don’t wait for your monthly health care costs to increase by 50 percent or more in January,” and, “Come back to HealthCare.gov and try to find a less expensive plan.” But the plans are already outrageous. So, last night, at the zero-hour for signing up for healthcare, I decided to go without.

It makes me nervous. I fear the penalty. It seems ridiculous that my choice to pay out of pocket for medical visits will be punished later, and at a rate of 2.5% of my income. I think we can all agree that a monetary penalty would be better spent compensating a doctor, nurse, or dentist for their skills. The incentives are completely out of whack.

Weaning off the government teat is painful, I don’t enjoy the sensation, but there are no satisfying alternatives. So pass the vitamins and kale chips, I can’t afford any illnesses for at least six more months.

Source: Confessions of an Uninsured Graduate | Marianne March

ObamaCare House of Cards   Leave a comment

The Congressional Budget Office scored the American Health Care Act and claimed the bill will reduce deficits by $119 billion over the next decade and result in 23 million fewer people being insured by 2026. So clearly, people would be better off if Obamacare were unchanged. This new report from the Department of Health and Human Services dispels that myth.

Reality Bites

The DHHS report shows that premiums in the individual market exchanges increased by 105% in the 39 states using Healthcare.gov from 2013 to 2017. This is equivalent to $244 per month ($2,928 per year) in additional premium payments for people buying insurance through the exchanges. People not eligible for exchange subsidies are fully exposed to these increases, while taxpayers will bear the brunt of subsidies for eligible enrollees.

Despite the promises that Obamacare would “cut the cost of a typical family’s premium by up to $2,500 a year,” average premiums on the exchanges more than doubled over this period. In some states, such as Alabama and Alaska, the average premium more than tripled. Welcome to my world.

B-b-but, Alaska is a small-population state with a huge land mass and people who have to travel long distances to medical care. Surely ….

No, the high average increase is not driven by a few outliers. Twenty-three out of the 39 states included in the analysis experienced premium increases in excess of 105%. Only three states, North Dakota, New Hampshire, and New Jersey, had cumulative premium increases below 50%.

 

As the report acknowledges, the composition of the population enrolling in plans through the exchanges has changed over time due to the adverse selection problems created by the law’s subsidy and regulation frameworks.

Example?

The community rating age bands, which dictate how much more companies can charge older, higher-risk enrollees, were set at 3:1 under Obamacare. A recent study by Milliman estimated that relaxing these age bands to 5:1 would reduce premiums for people aged 20-29 by 15% while increasing premiums for older enrollees.

Lower premiums for younger, healthier people would encourage more of them to enroll through the exchanges instead of foregoing health insurance because it is too expensive for them. Older, less healthy people make up a larger share of the exchange population now than in earlier years, which exacerbates the premium increases on that population.

Due to data limitations, the report does not deal with the population getting plans on the individual market but not through the exchanges. These people accounted for more than a third of the total individual market. They are not eligible for the law’s subsidies, so there is likely less adverse selection for the off-exchange population, but these enrollees have to bear the entirety of the costs of those increases.

Families choosing a plan through the exchanges have seen their premiums more than double since 2013. Alabama and Alaska, which have seen the two highest cumulative premium increases, are both down to only one insurer. In the entire country, only Virginia saw the number of participating insurers increase from 2016 to 2017. Just today, Blue Cross Blue Shield of Kansas City announced it would be exiting the exchange, leaving 25 counties in Missouri without a participating insurer for now.

The trend is absolutely unsustainable.

The lack of choices and competition in a growing number of places makes it unlikely that there will be an end to rapid premium growth without reform. While the CBO estimates will provide some insight into the effects of the bill in its current form, a working group of Senators is crafting a revised bill with major alterations.

Getting the design of replacement legislation right is important, and the CBO score will give the working group more information about which aspects of the bill that passed the House need the most adjustment. Provisions that allow for more competition and choice for people trying to get insurance through the individual market should help bring down annual premium increases.

How the Market Is Already Repealing Obamacare | Stewart Jones   Leave a comment

There’s a common misconception that if you’re opposed to government services, programs and/or departments, then you’re opposed to building roads, education, people getting affordable health care and even people taking care of the sick and elderly. These misconceptions are becoming more apparent as the free market offers solutions and options using innovation and technology, as the government continues to fall in on itself.

doc-patient teamSix months into the pregnancy, we received a letter explaining that due to the changes in the law, our policy would no longer cover maternity services.

I continue to be amazed at the ingenuity of people and individuals working toward solutions in the marketplace, in spite of government. Over time government has assumed more and more control over medical decisions that individuals make everyday.

My Own Experience

I have paid my dentist out of pocket for many years and had private insurance for major medical only. In 2011, my wife and I were expecting our first child and had private health insurance which was slowly being limited more and more by regulations from the Affordable Care Act and Patient Protection Act. It was dreadful!

Six months into the pregnancy, we received a letter explaining that due to the changes in the law, our policy would no longer cover maternity or OB-GYN services. This meant that our insurance would no longer pay for anything related to the birth of our daughter. We searched and shopped for insurance that would help cover the cost of the hospital and birth, but the more government regulations and controls were placed on the market, the more difficult it became to actually get affordable medical insurance and health care.

We spoke with our doctor about it and found that by avoiding insurance altogether and paying the doctor directly, it reduced all costs associated with pregnancy by 60%. We avoided the government-burdened insurance market and paid the doctor directly.

This model of doctors and patients actually working out agreements and paying a flat fee in exchange for medical services is actually very effective. If we could only bypass the government regulations and laws on health care, more people would get better service at a more affordable rate.

Market-Based Medicine

One awesome example of markets finding ways around the government’s stronghold on medical services is the Surgery Center of Oklahoma. In order to run their own practice with the least amount of government interference as possible, two doctors formed this practice 15 years ago. The goal was to eliminate the inefficiencies that accompany hospital networks and Medicare/Medicaid networks in order to run their own practice. The practice has done so well, that it has grown to over 40 doctors now.

According to them:

It is no secret to anyone that the pricing of surgical services is at the top of the list of problems in our dysfunctional healthcare system. Bureaucracy at the insurance and hospital levels, cost shifting and the absence of free market principles are among the culprits for what has caused surgical care in the United States to be cost prohibitive. As more and more patients find themselves paying more and more out of pocket, it is clear that something must change. We believe that a very different approach is necessary, one involving transparent and direct pricing.”

This has allowed them the ability to perform the best quality surgeries at the lowest and most transparent cost. All of their procedures and costs appear on their website. By bringing this level of transparency to the public, it has forced a price war for surrounding hospitals to post prices for procedures, something that is often hidden. This has brought costs down in surrounding areas.

Exiting the rat race of hospital networks and eliminating acceptance of government payments has allowed them to cut the cost and provide a better service.

In spite of what government does, people around the country are finding ways to lower costs and raise quality in the most competitive and realistic manners.

Flat Fee Memberships

The difficulties with getting health care at affordable rates come not from marketplace inadequacies, but from government regulations.

Another great example, are physician’s offices like Irmo Primary Care, Gold Standard Pediatrics and many others that are starting flat fee pricing for memberships and monthly medical services called Direct Primary Care. These practices are helping to once again bring patients and doctors together without interference from government and bureaucratic middlemen. I love streamlining services!

Dr. Bryan Hill, a South Carolina pediatrician, opened his direct primary care practice in September. “Instead of accepting insurance for routine visits and drugs, these practices charge a monthly membership fee that covers most of what the average patient needs, including visits and drugs at much lower prices.”

It’s sad that most of the difficulties with getting good health care at affordable rates come not from inadequacies in the marketplace, but from the many regulations by central planners in government.

History has shown us that free-market forces have the ability to lower costs and increase quality while fostering new growth and innovation. It puts the power in the hands of consumers, where it should be. If government would just get out of the way, then the free-market can fix the problems with healthcare.

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Source: How the Market Is Already Repealing Obamacare | Stewart Jones

Posted April 25, 2017 by aurorawatcherak in Common sense

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Cultural Attitudes That Harm Us   1 comment

American citizens have several cultural attitudes toward health care and savings that has resulted in an economy that spends one-sixth of the GDP on medical care. Other countries don’t pay so much and many of them have universal medical coverage.

So what’s our problem?

Image result for image of cutting-edge medicalA major issue is that Americans have stopped saving anything. Many of us have retirement accounts, which work because it’s not easy to tap into them, but most of us do not have savings accounts. I recently read an article by a financial guru who spent most of the article ripping into Dave Ramsey for suggesting that paying off debt and having 3-6 months of living expenses in savings made no sense to her. You should be investing those funds, not leaving them in the bank account.

So, naturally, since, they don’t believe in savings, the American middle class does not believe in saving up for medical care expenses. The idea that you should have $10,000 to 15,000 in savings for a potential acute medical episode is ridiculous in most people’s minds. This isn’t pre-World War 2 America, nor are we a 3rd world country. That’s “wasted money” just sitting in a bank.

We object to paying one-sixth of our personal income directly on health-and-medical expenses, but we also resent paying one-sixth of the government’s treasury on health-and-medical expenses. We are less willing to spend public funds to pay for health maintenance than we are to pay for medical services, even though study after study shows that we get better results from getting people to change unhealthy lifestyles than from treating the consequences of those lifestyles. You can’t really blame the American middle class from objecting to paying taxes in order to support people who are very poor or very sick when they themselves work hard to have an income and to take care of their health. Americans are not Scandinavians. We believe in personal responsibility, if only for other people.

 

Americans, especially medical care providers, do not want to think of medical care as a commodity that is bought and sold in an open market subject to supply and demand rules. Providers want to be paid (and paid well), but they don’t want to think of themselves as capitalists selling their services, so they prefer payment that comes from third parties where the price is hidden from consumers.

 

Americans are individualists at heart and object to telling other people how to live their lives or being told by others how to live theirs. This means that the right to live an unhealthy lifestyle is considered sacrosanct in the United States. Under the ACA or universal coverage, that means that healthier individuals pay for the poor choices of less healthy individuals.

Americans also tend to live in a state of denial about some health choices, so that about one-quarter of our population engages in unhealthy lifestyles that have long-term medical care expense consequences, the cost of which are born by people who take care of themselves rather than the poor decision makers who require the expensive long-term care.

Americans enjoy being “early adopters” of new treatments, which are often much more expensive in their early, experimental stages than when they have been available for many years. Forty years ago, when medical care was a smaller share of the economy, we could afford that attitude, but new treatment options now require expensive equipment and highly-trained specialists. Although these treatments promise incredible results, they are expensive to the individuals receiving the treatments … or the group that’s paying the bills.

All of these attitudes conspire to make the “Affordable” Care Act, or any replacement other than the free market, incredibly and increasingly expensive for all of us. Universal coverage will only exacerbate the problems that these cultural attitudes engender, leading inevitably in medical care rationing and resultant lack of availability of care, with the end results being similar to England’s 45% higher mortality rate.

Yes, we could choose universal coverage and then attempt to outlaw everything that makes people unhealthy. Good luck with that! It hasn’t worked in France and England, which is one reason England has a 45% higher mortality rate than the US.

Alternatively, we could work with human nature and return our medical care system to the free market it began in. Lift the government-created restrictions against individuals forming groups to drive down medical insurance costs. Lift the government-created restrictions that prevent us from buying insurance across state lines. Life the government-created monopoly against increasing medical schools and opening clinics.  Yes, that would mean that some people wouldn’t make good health choices and wouldn’t have medical care coverage when those choices require them to seek medical care. That would be the consequence of being a poor-decision maker and it might drive some of this group to make better choices. Additionally, medical care would become less expensive because government-created barriers to care and affordable insurance would no longer be a factor in price.

We have a choice to make in this country. Do we want reduced access to expensive care, but everybody having insurance or do we want improved access to affordable care with some people choosing (for themselves) not to have insurance?

I know which one I prefer and which one I believe would result in improved health results.

Why ACA is Making Us Less Healthy   Leave a comment

I believe sincerely that everyone should have the right to do whatever he wants, provided it doesn’t harm other people or their property. I’m not saying I like it or think it is good for you, but I stand by your right to smoke like a chimney (so long as you don’t do it in my airspace), drink like a fish (but not if I share a household with you), or eat like a hippo (so long as I don’t pay your grocery bill).

Image result for medical careSadly, your lifestyle choices became my problem when the Affordable Care Act was passed. Your poor decisions now cost me money, which is a form of property. Hey, you, with the 50-inch waistline … that’s my kid’s college education in medical expenses that you expect me to pay, so yeah, I have a problem with the Affordable Care Act.

Back in 2009 when the Democratic-dominated government started touting the Affordable Care Act, they assured that the expansion of medical insurance coverage to all Americans would come at no cost to any citizen. A lot of us (about 60% of the electorate) were skeptical and that time and anyone paying even cursory attention to their medical insurance premiums since the go-live date for Obamacare knows our skepticism was well-founded. Medical insurance premiums have dramatically increased for most Americans not in the subsidized classes.

 

It might have seemed like a noble idea – that everyone should be required to have medical insurance just in case, but the Affordable Care Act also required medical insurance providers to cover pre-existing medical conditions.

That means that health-conscious people like me must subsidize medical care costs for people who make poor health choices. These poor health choices lead to diabetes, coronary artery disease, cancer, obesity, COPD, etc., all long-term chronic diseases that require expensive treatment. Coverage of pre-existing medical conditions greatly increased the cost that medical insurance providers were forced to pay out for treatment. This was supposed to be offset by young, healthy adults joining the health insurance pool, but younger, healthier people take one look at the expensive premiums and choose to pay the mandatory fine, because it is less than the premiums. This increases medical insurance premiums even more.

As Rick tried to highlight, individuals are less likely to make wise health choices if it is perceived that they will not have to bear the financial consequences of those choices because insurance paid by others covers the majority of the costs. Medical insurance holders are able to seek out healthcare services without the cost of those services being a major deterrent, which encourages people to go to the hospital and doctor for very minor ailments. After all, you want to get value for what you are paying for. Then doctors are motivated to extract the maximum amount of payment … prescribing expensive and sometimes unnecessary treatments and medications because insurance is covering the cost.

Rick points out that doctors and hospitals are often at the mercy of insurance companies and what gets approved for coverage, so they use a scatter-gun approach toward billing. Patients often demand more expensive treatment because of an impression that it’s better and because cost isn’t an obstacle. This completely undermines doctor-patient relationships where the goal is to choose the best and most sensible treatment options based on a cost-benefit analysis.

All of this has increased the cost of medical insurance. While providing medical coverage to everyone seems very humanitarian, it forces health-conscious people to subsidize the medical care costs of people who make poor choices and is causing employers to drop insurance coverage as it becomes unaffordable. If current trends hold, and there’s no reason to believe they won’t, the Affordable Care Act is going to bankrupt the middle class.

We’re not joking when we call it the UN-Affordable Care Act.

In a perfect world where liberty was still an ideal we upheld, everyone would be able to live their life however they want and be accountable for the personal and financial impact of their choices. The fact that I love bacon even though my family has a history of stomach and bowel cancer would not matter in the least to you because it wouldn’t affect you. Unfortunately, with the ACA, we’re all in this mess together, which means we all affect each other. It becomes absolutely imperative that we all strive to be the healthiest people we can be so as to reduce the economic burden on our neighbors.

Please don’t think I’m down on obese people to the exclusion of smokers or alcoholics or whatever. I’m using obesity as my demonstration condition because of the costs associated with it and it’s lack of social stigmaticism. My Baptist friends who don’t drink or smoke will smugly sit on their ample rears complaining that I’m wrong. “Being overweight is not unhealthy and has no impact on the cost of healthcare,” they will say.

Sorry, folks. You’re wrong. Research demonstrates that obesity and even being moderately overweight are the second leading causes of preventable death, right behind tobacco usage.

Here are some alarming economic implications for obesity:

  • Obese adults spend 42% more on direct medical care costs than adults who are a healthy weight.
  • Per capita medical care costs for severely or morbidly obese adults (BMI >40) are 81% higher than for healthy weight adults. In 2000, around $11 billion was spent on medical expenditures for morbidly obese U.S. adults.
  • Moderately obese (BMI between 30 and 35) individuals are more than twice as likely as healthy weight individuals to be prescribed prescription pharmaceuticals to manage medical conditions.

Did you know that 68.8% of the US citizens are considered overweight and obese? That represents a dramatic impact of overweight and obese individuals upon our medical care system.

Obesity is just one of many other preventable medical conditions that contribute to the cost of medical insurance, but obesity and being overweight are the most widespread.

We would all be personally well-serviced by quitting smoking, drinking less alcohol, exercising more, making better food choices, taking supplements wisely, and getting adequate sleep. There’s the direct positive impact on yourself, but better health habits would have a direct positive impact on the economy, and especially those of us who are forced to bear the cost of our nation’s medical care costs.

Unfortunately, you won’t see a financial benefit to making these changes. Unlike car insurance, where you receive lower premiums if you are a good driver who doesn’t have a lot of accidents, getting healthy doesn’t work the same way. Unlike life insurance, where you receive lower premiums if you’re a healthy individual, the ACA assures you will be paying for others who don’t make the same wise choices.

The result?

A less health population, which is indicated by slipping mortality rates. Although it sounds like such a great idea to provide medical insurance to everyone so they will be “healthier”, the reality is that the United States population has become less healthy as more of us have become covered by medical insurance.

Do Republicans Want to Be Blamed?   Leave a comment

There’s no question that the unAffordable Care Act needs to be replaced. It is an example of why government interventions into the marketplace are not a good thing. Government starts out trying to fix something, but their very intervention necessitates following interventions to fix the problems created by their attempt for fix what they perceived as a problem.

Image result for image of gop blamed for ACA failurePretty much every analyst agrees that the insurance market under the ACA has entered a death spiral. Something must be done. And, the GOP in the House attempted to do just that with the American Health Care Act. The problem is that it was inadequate to the task assigned to it.

The ACA’s provisions are all intertwined. You cannot just tweak one or two and “fix the problem.” To avoid an even larger disaster, all of the provisions must be repealed at once. By the way, this was a known problem with the bill before it was passed.  You were warned, folks. You refused to listen. For highly political and chicken-livered reasons, the Republican establishment chose a compromise bill which keeps the requirements for pre-existing conditions coverage at community ratings, but does away with the individual mandate … sort of … replacing it with a mandatory 30% surcharge, payable to insurance companies, for those who go without coverage for longer than 60 days and then choose to purchase another plan.

Basically, the AHCA removes Obamacare’s funding mechanism while keeping the requirements that made the individual mandate necessary in the first place. Those requirements are what is now driving up the costs of medical insurance to a point where people are dumping insurance altogether. That wasn’t an unexpected outcome of the ACA, either. You were warned. You did not listen. Or, Democrats listened, but only enough to decide to create the individual mandate to punish people for not purchasing insurance … which works only so long as premiums remain less than the tax penalty for not purchasing insurance. We passed that exit some time ago.

Oddly, the surcharge will punish people who decide they now want to buy insurance. That doesn’t provide a lot of incentive for people to continuing paying huge premiums while they’re healthy, which leaves insurance providers unable to remain solvent in a massively distorted market, which will hasten the death spiral.

So, my question to the GOP is … do you WANT to be blamed for this mess?

I ask because … well,  you would have been if you’d passed the AHCA in its current form. The insurance market would have collapsed even more rapidly than it is going to under the ACA and the blowback would be pointed at your face, not the Democrats who caused this mess in the first place. The progressives who were so enthused about the ACA would insist that the chaos that followed was the fault of deregulation and the free market rather than what actually caused the problem — Obamacare.

Grow a spine, GOP! Either repeal it (I don’t care if you replace it) or stand back with your hands in the air and let the ACA fail and let the Democrats be blamed for what they caused. That is likely to happen this fall, when you can make a perfect argument for going back to more free market systems.

The Republicans promised the American people that it would repeal every word of Obamacare. You’ve passed two bills that did that, knowing that Obama would veto them. Now you have a President who has said he wants to repeal the ACA, so dust off one of those full repeal bills and send it to him. DO IT!

A real, full repeal is only the first step in repairing health care. A repeal needs to be followed by true free market reforms, with the goal of a complete separation of the health care industry and government. In the interim, the reforms recently proposed by Senator Rand Paul are a long step in the right direction. Only free markets can provide the cheapest and highest quality medical care to the largest amount of people.

Truth About Obamacare   1 comment

There’s a lot of misinformation floated about Obamacare repeal. For example, the hysteria over how “20 Million people will lose coverage” – absolutely not true.

These figures are from Forbes and the Heritage Foundation, taken from actual government statistics.

Obamacare Meme 1

Posted March 31, 2017 by aurorawatcherak in Common sense, Uncategorized

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