Nel's New Day

April 25, 2017

Zombie Health Care Bill Returns

Filed under: Health Care — trp2011 @ 9:40 PM
Tags: , , , ,

After petulantly demanding his “beautiful wall” for the past week, Dictator Donald Trump (DDT) blinked and withdrew his demand last night. That leaves the specter of his health care—if at first you don’t succeed, try try again—and make it worse. That’s the case with DDT’s latest incarnation he wants for at least one legislative notch on his first 100 days.

The deal tries to bring in the ultra-right wing of the House by allowing waivers for states that want to charge higher—far higher—premiums to the 52 million people with pre-existing conditions that can include depression, obesity—even pregnancy. This is a partial list of how much could be added to regular health insurance premiums for different conditions. [Note: These costs aren’t the premiums; they’re the extra!]

  • Breast Cancer: $28,660
  • Pregnancy: $17,060
  • Rheumatoid Arthritis: $26,180
  • Lung cancer: $71,880
  • Diabetes: $5,510
  • Drug dependence: $20,140
  • Asthma: $4,270
  • Metastatic cancer : $142,650

With the new bill, states could also exempt the Essential Health Benefits from insurance if they could show that it would lower premiums, increase the number of people insured, or “advance another benefit to the public interest in the state.” Essential Health Benefits: care outside the hospital, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehab services, lab services, preventive care and chronic disease management, and pediatric services. These covers almost all health care needs, meaning that insurers can disallow all health care in health insurance or make it so expensive that people would choose to go without the insurance.

Another waiver available to the states under the proposed law would loosen restrictions on higher premium charges for older people over those for younger people. In addition, the bill would provide high-risk pools for people who couldn’t afford insurance, but these have been proved failures, underfunded by government with poor coverage and high costs.

DDT has promised everyone that “Obamacare” is a disaster, and he has plans to make sure that he’s right. Instead of leaving it alone, he is working on regulations that help the insurance companies and hurt the consumers.

  • The sign-up period is cut in half, from Nov. 1 to Dec. 15, 2017 instead of lasting until Jan. 31, 2018.
  • Insurance companies can refuse to sell policies to consumers who fail to make all their premium payments this year instead of a 90-day grace period before losing their insurance.
  • People who need to obtain coverage after the open enrollment must provide documentation that they have had such life changes as marriage, having a child, or moving.
  • The IRS stopped its plans rejecting tax returns if people did not say whether they had coverage.
  • Advertising for the Affordable Care Act, available until January 31, 2017, was pulled immediately after DDT’s inauguration: although enrollment was ahead of the previous year through mid-January, the final 2017 enrollment was down four percent.
  • Coverage may be less comprehensive with less coverage, lowering the value of tax credit subsidies for premiums.
  • Tax subsidies may be reduced so that premiums won’t be affordable for low- and middle-income people.

DDT has also threatened to cut off cost-sharing reductions paid to insurers covering the poorest enrollees. In addition to great instability, DDT’s “plan” will cause premium costs to skyrocket in addition to increased costs for taxpayers.

And DDT can do worse:

  • Broaden or narrow the definitions of some of the 10 broad benefit categories  which de facto eliminates them.
  • Depress enrollment by drastically expanding the definition of “hardship” which exempts people from the individual mandate.
  • Drop the former administration’s legal defense of an ACA rule mandating contraception coverage.
  • Impose work requirements on low-income people on Medicaid expansion.
  • Carry through with the promised 17.9 percent cut in the HHS budget.
  • Let the software and personnel architecture crumble.
  • Allow disastrous waivers to states for “experiments.”

An example of the last problem could happen in Kentucky. The state developed an exemplary health care system, but it lost many of its gains with a GOP governor, Matt Bevin, who wants to administer vision and dental Medicaid through punishment. Desperate to gain back the bad publicity he received with his threat to take health care from 18 percent of his residents, he set up “MyRewards Accounts” in which poor people will be required to meet a list of prorated behavioral requirements for their health care. People on Medicaid will lose their vision and dental care with paying premiums and a $1,000 deductible. Bevin says that they can earn back these costs with such good behavior as job training, health screening, smoking cessation, volunteering, and educational programs.

Linking accounts to work comes from a misconception about people who need Medicaid that Bevin and millions of others hold. In Kentucky, only 15 percent of people on Medicaid are abled adults—in fact, almost 50 percent are children—and most of these adults are already working, looking for work, or in school. Of the others, three-fourths are caretakers for a family member. That’s a small number of people for a massive expensive and invasive database which will be privatized.

Bevin’s plan would give negative “MyRewards” chits, actually fines, for going to the emergency room too often. For example, the first visit would cost $20 and would go up to $75 by the third visit. The ER can be the only health care for a person who cannot find a provider who accepts Medicaid. The plan also fails to understand the loop of how less-covered people are sicker and sicker people are less able to work.

The cockamamie idea comes from Medicaid restrictions by Vice President Mike Pence when he was governor of Indiana. Pence got his idea from Seema Verma, the current administrator of Medicare and Medicaid Services. Although some employers use wellness incentive programs, they are positive and not punitive like Pence’s and Verma’s plan that keeps people from any health care if they don’t accomplish the goals.

Insurers must set their premiums in the market exchanges for 2018 by June 21, 2017. Dana Milbank wrote:

“’The evidence is strong that the ACA is not dying of natural causes, but with the president’s recent comments it’s clear that it could die of suspicious causes,’ says Larry Levitt, a senior vice president at the Kaiser Family Foundation, a nonpartisan outfit that studies health care. In the current environment, insurers ‘are just not going to stick around and take big risks,’ Levitt tells me. ‘They’ll just take their marbles and invest elsewhere. It would be a very rational decision.’”

Before DDT put his little hands on the health care system, it was healthy. The credit-rating agency Standard & Poor found “marked improvement” in the individual market for most Blue Cross Blue Shield insurers that were forecast to be “close to break-even margins” in 2017. Disruptive actions, however, block the market’s stability and cause insurers to either raise their prices or just leave it.

DDT may be playing a dangerous game. A Kaiser poll revealed that 61 percent would blame DDT and the GOP for any upcoming problems with the Affordable Care Act, compared with 31 percent who would blame President Obama and the Democrats. DDT’s new regulations make it “Trumpcare.”

The end result of DDT’s new regulations is like a teacher telling students that they will fail a class and then changing their answers to make sure it happens. And a majority of people in the U.S. disagree with destroying “Obamacare”: 61 percent want “Obamacare” kept and fixed, and a larger number—79 percent–want DDT to make the current law work and not fail. In addition, 62 percent want nationwide minimum insurance coverage standards, and 70 percent want mandatory protection for pre-existing conditions. These figures show a marked increase after the GOP’s pitch for “Trumpcare” since DDT’s inauguration.

The conservative Freedom Caucus may be on board with DDT’s new plan. Tomorrow we may find out what the other Republicans in the House think of taking health care away from their constituents.

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1 Comment »

  1. Horrible horrible people.

    Like

    Comment by Lee Lynch — April 25, 2017 @ 10:40 PM | Reply


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