Nel's New Day

May 4, 2017

Make America Suffer Again

The House passed its “We Don’t Care” bill this morning to take health insurance away from tens of millions of people in the United States. The 217-213 had 20 GOP “no” votes from those smart enough to know how furious their constituents would be with a “yes” vote. Only one of them belonged to the scorched-earth Freedom Caucus. Voters didn’t even have an analysis from the Congressional Budget Office to help them make a decision.

In their race to the bottom, the GOP also ignored the impact the 100+ million people who get insurance from employers. Because the bill allows large employers to offer the same benefits as state requirements, companies can skimp on benefit standards in states that get waivers to opt out of current ACA regulations. The same employers can also bypass any limits on out-of-pocket expenses for expensive illnesses and impose lifetime limits of cost. Premiums may cost less, as Republicans promised, people would have little health care covered. Congressional members and staff are lucky: the new bill exempts them from losing quality insurance.

In the time of DDT and the GOP, governance means voting for a bill that has a life-or-death impact with no information on costs and other affects. The legislators who voted for it hadn’t even read it and don’t want to know the outcome of their legislation that affects one-sixth of the U.S. economy. Republicans leaders didn’t let anyone read the legislation in advance. All people know about the bill is that gives massive tax breaks to the wealthiest in the nation and guts protections for everyone else. Now that it’s passed, people know what’s in the bill, and it looks even worse than previously believed.

Trumpcare winners:

  • The rich and corporations getting $600 billion in tax breaks.
  • Millionaires getting a $50,000 tax break each year for a total of $275 billion to the richest two percent.
  • The 400 richest families each getting an average $7 million each year.
  • Insurance companies getting $145 billion in tax breaks over ten years.
  • Drug companies rewarded with $25 million in tax breaks over ten years.
  • The richest two percent getting a $117 billion tax cut.

Trumpcare losers are the 24+ million low-income sometimes DDT supporters who lose health care (24 million) or people who will pay up to $13,000 more for premiums. No one will have protection from huge increases in drug costs, and the loss of $117 billion in revenue shortens Medicare’s ability to pay full benefits by at least three years.

Eight years ago, Rep. Paul Ryan (R-WI) said this about the Affordable Care Act on MSNBC:

“I don’t think we should pass bills that we haven’t read, that we don’t know what they cost.”

At the same time, Mike Pence ridiculed the Democrats:

“Don’t blame us, we didn’t read the bill we voted for.”

In 2009, House Republicans had a fit about the possibility of voting for the ACA without a CBO score, and Ryan demanded that the CBO analysis be expedited before a vote. In fact, Congress and President Obama and spent 14 months writing that bill in 2009 and 2010 with dozens of hearings, committee markups, and consultation with the health care system that won support from hospitals and doctors while waiting for multiple CBO scores. No one in the health care system wants Trumpcare, and Republicans’ only rationale for voting in favor of the bill is that they promised to do it. Oh yes, and it gives massive cuts to the wealthy.

Perhaps most prescient is DDT’s 2014 tweet:

“It’s Thursday. How many people have lost their healthcare today?”

Today is Thursday, and we don’t know the affect of the House vote, but it’s sure to be tens of millions of people if the House bill passes the Senate.

According to DDT’s statements last Sunday, he hasn’t read the revised plan to satisfy the scorched-earth Republicans. On Face the Nation, DDT told John Dickerson that the bill keeps pre-existing conditions and “I mandate it.” Pressed for clarification, DDT added, “We actually have a clause that guarantees [protections to those with pre-existing conditions].” [No, “we” don’t.] The GOP bill clears the way for states to remove this benefit. DDT said that “Obamacare” “doesn’t cover pre-existing conditions.” [Yes, it does.] Even VP Mike Pence said that Republican policymakers are “keeping our promises to protect people who have pre-existing conditions.” Of course, he believed that Michael Flynn didn’t have anything to do with the Russians.

According to a Harvard study about the health care bill, Trumpcare would “effectively end enrollment in the insurance markets for families that make less than $75,000 a year.” In 2015, that was over 70 percent of the people in the United States.

Another population that would suffer from Trumpcare are students needing special education help. Medicaid provides schools districts with such services as physical therapists and feeding tubes as well as preventative care like vision and hearing screenings. Republicans voting to do away with these services may not know about this issue because the House did not allow any public testimony before the vote.

If DDT and Congress are successful in repealing the ACA, discrimination can be the law of the land. One section is the ACA stops federal funds from going to anyone or any group discriminating on the basis of race, skin color, national origin, sex, age, or disability. That includes pregnancy, sex stereotyping, gender identity; religious-connected providers could deny contraception, sterilization, in vitro fertilization, or anything else against “religious” beliefs. People could be turned away from emergency rooms for any reason. At this time, 20 percent of the hospitals in the nation have an affiliation with religion—up 50 percent since 2010, and many times small communities have only these hospitals. At the same time, the federal and state governments are rapidly closing non-religious clinics such as those operated by Planned Parenthood.

In addition to ethical reasons to keep and repair the ACA, its loss will result in the loss of 1.8 billion jobs.

Oregon’s only GOP representative was a leader in destroying the ACA. Greg Walden is now proud of his part in doing away with the small hospitals in his rural district and losing insurance for the largest number of people in his state. DDT acknowledged the part that Ryan and Walden played in taking insurance from Walden’s constituent when he said, “This is the group.” Walden’s district added more Medicaid recipients than any other GOP district and more than all except three Democrat-held districts. That makes it fourth out of 435 districts in helping people under the ACA.  One of Walden’s colleagues pointed out that 640,000 people with pre-existing conditions could lose their insurance, but Walden claimed, “We are protecting people with pre-existing conditions. Those conditions continue to be protected.” Either he has not read the bill, or he lies. People have said he’s a nice man. So sad.

The GOP is backing a losing horse with its argument for less government. A recent NBC News/Wall Street Journal poll finds that a majority of people, 57 percent, thinks that government should do more—not less—to help solve the nation’s problems. That’s an increase of 14 percent in just two years and almost double the percentage since 1996. In that time the number of people who think that the government should do less has dropped by over one-third. A study from Baylor University has also found that more government enhances human happiness.

Last month the New York Times’ hired climate denier Bret Stephens. Now the NYT equates Ryan’s lie (“under no circumstance can people be denied coverage because of a pre-existing condition”) and Pelosi’s statement (“up to 17 million children … who have pre-existing conditions can no longer be denied coverage by insurers” thanks to the ACA) as both “misleading.” It may be possible that Rupert Murdoch bought the newspaper while I wasn’t paying attention.

Speaker of the House Paul Ryan (R-WI) (3rd L)  after signing legislation to repeal the Affordable Care Act, also known as Obamacare, and to cut off federal funding of Planned Parenthood at the U.S. Capitol January 7, 2016 in Washington, DC.

The bill that passed today and moved on to the Senate was even more draconian that the earlier bill, and that one got only 17 percent approval. Yet Republicans are celebrating their success at taking insurance away from 24 million people and allocating much higher charges for people with pre-existing conditions with cases of Bud Light rolled into the Capitol. House Speaker Paul Ryan (R-WI) and the other GOP leaders are even giddier than they were over a repeal in January 2016. Following their beer-bust in the Capitol, Republicans took buses for more celebration in the White House Rose Garden, historically a place where bills are signed into law. Never before have House Republicans reveled in passing a bill that may not survive the Senate. And certainly not a bill designed to create misery for millions of people in the United States.

It’s a new time: Make America Suffer Again.

May 3, 2017

Trumpcare, A ‘Moral Monstrosity’

Filed under: Health Care — trp2011 @ 11:18 PM
Tags: , , ,

Sarah Palin’s warnings about “death panels” in government health care are coming to fruition with the GOP version, supposedly up for a vote in the House tomorrow right before congressional members disappear for another two-week vacation. The difference from what she said a few years ago, however, is that her own party, not the Democrats, is creating the death panels. In House Speaker Paul Ryan’s (R-WI) desperation to pass the “repeal and replace” of the Affordable Care Act, he has blatantly lied about what’s in the Trumpcare bill.

Unlike Ryan’s claims, these are the facts:

  • The GOP plan would raise out-of-pocket costs.
  • The GOP plan will hurt people between the ages of 40 and 65.
  • The GOP plan will remove the ACA benefits to Medicare.
  • The GOP plan will strip coverage from some of the 24 million who got it under the ACA.
  • The GOP plan allows states to strip pre-existing conditions from health insurance.

In every congressional district, at least tens of thousands will lose coverage while the rest of the people will face premium hikes of 15 to 20 percent and deductible increases of 60 percent.

GOP North Carolina Rep. Robert Pittenger told people who live in states that deny pre-existing conditions through waivers that they should move to another state.  Last year he said that protests in Charlotte were caused by people who “hate white people” after the police fatally shot a black man.

Rep. Mo Brooks (R-AL) said that “good people” don’t have serious or life-threatening pre-existing conditions. These people “lead good lives”—they’ve “done things the right way.” These people are also half the population, those who can be denied health care because of any medical condition existing before enrolling in health insurance—like asthma or pregnancy.  Some of his constituents wrote him about being some of these “bad people“—such as being born with cerebral palsy or being in an automobile accident.

Rep. Fred Upton (MI) opposed the bill until he sold out for $1.6 billion a year in a high-risk pool, at least 90 percent less than necessary to make it viable. High-risk pools, recommended for the sickest five percent of people insured in small-group and individual markets, have a history of failure. States limited people from enrolling in them or using the coverage. People in these pools also face much higher premiums—up to twice as much—as people in the individual market and very high deductibles. High-risk pools can allow annual or lifetime limits on coverage, something not permitted in the ACA and have coverage exclusions for up to 12 months, meaning that people have no insurance for that time. California’s plan had only a three-month waiting period for coverage for pre-existing conditions but had a $75,000 annual limit and a $750,000 lifetime limit. Florida’s high-risk pool was such a disaster that it froze new enrollment in 1991, a situation that lasted for almost two decades. Before the full implementation of the ACA in 2011, these pools in 35 states covered only 226,600 people with net losses of $1.2 billion. Of nonelderly adults, 52 million people in the nation have pre-existing conditions which would make them uninsurable. And these pools don’t help the other 90 percent of the people forced to pay hundreds of thousands of dollars in premium “surcharges.”

People on Medicare may also be affected by Trumpcare.  The ACA provided free preventative screenings such as mammograms and colonoscopies as well as an annual free wellness visit. Another provision closed the “doughnut” hole, the coverage gap in prescription drugs that beings when insurer’ and beneficiaries’ combined costs for drugs reached $3,700 and ends at $4,950 for catastrophic coverage. By this year, people have to pay 40 percent for brand-name drugs and 51 percent for generics in that hole which was scheduled to close by 2020 when beneficiaries would be responsible for 25 percent of the cost after the deductible. A repeal without replacement could eliminate this help for people on Medicare.

The ACA helped Medicare become more solvent because of its cost-cutting provisions, including a reduction of federal payments to Medicare Advantage plans. Keeping ACA would keep Medicare would be in the black for 11 years longer than before ACA’s enactment, but its repeal would add $80 billion a year to Medicare spending. The government may make up the losses with higher Medicare premiums, deductibles, and cost sharing for beneficiaries.

The GOP bill still exempts congressional members and their staffs from losing popular aspects of the Affordable Care Act. Rep. Tom MacArthur (R-NJ) claimed that there would be a later vote about the exemption.The fast-track consideration came without posting the bill text and without a Congressional Budget Office analysis about the bill’s effects.

House Minority Chair Nancy Pelosi (R-CA) said today before the vote:

“Forcing a vote without a CBO score shows that Republicans are terrified of the public learning the full consequences of their plan to push Americans with pre-existing conditions into the cold. But tomorrow, House Republicans are going to tattoo this moral monstrosity to their foreheads, and the American people will hold them accountable.”

With its provision to eliminate ACA taxes on the wealthy, Trumpcare is the first move to drastically cut taxes for the few percent.

Trumpcare would also

  • Tie subsidies to age instead of income and geographic location.
  • Charge higher premiums to people in the 50s and early 60s, as compared to younger consumers—at least five times but more if states get waivers for a higher ratio.
  • Cut $800 billion from Medicaid support.
  • Permit states to require able-bodied adults to work for Medicaid.
  • Give waivers to states to exempt people with pre-existing conditions and allow insurers to provide insurance without the 10 essential health benefits—most of the parts of health insurance.
  • Allow caps on some of the health benefits.
  • Repeal tax credits in 2020 that help some people pay deductibles and make co-payments.
  • Stop the requirement for larger companies to provide affordable insurance to their employees.
  • Permit high-risk pools (see above).

An unwritten part of the GOP platform is that poor people are to blame for their poverty, and the rest of the population, which shrinks daily, can thrive without them. Uninsured people actually cost the system more than when they are covered. Even worse, however, the GOP belief is totally unethical. The current president promised all these people that he would take care of them. These people voted for him because they believed his promises. Now he’s thrown them away while continuing his lies that he will “mandate” coverage for pre-existing conditions and provide subsidies.

The GOP members of the House who are getting out of Washington immediately after the vote might want to avoid their constituents in their home districts. Although the House can avoid a CBO analysis of the Trumpcare effects, Senate budgetary rules require a score before they vote. At that time, people will find out the estimated impact of the measure.

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.

March 25, 2017

Health Care Won—At Least for Now

Eighteen days ago, House Speaker Paul Ryan (R-WI) talked to reporters about the newly introduced health plan written behind closed doors, probably by aides:

 “We will have 218 votes. This is the beginning of the legislative process. We’ll have 218 when this thing comes to the floor. I can guarantee you that.”

Yesterday, just seven years and one day after the Affordable Care Act was passed, the GOP plan, distorted during the past few days by providing even fewer services than the original, died. House Republicans had entered over 50 bills to kill the ACA, many of them passing after the GOP gained a majority in the chamber, but Ryan was positive that the GOP takeover of both Congress and the executive branch would guarantee his success. Yet the Party of No is helpless in the face of Yes. Their work involved no stakeholders, and Dictator Donald Trump (DDT) followed his usual pattern of bullying threats instead of actually selling the bill.

Massive loud protests against the repeal of the health plan, steadily growing in popularity, pushed more moderate representatives to vote against the bill for fear of retaliation in their own district from people who would lose coverage. The Koch brothers’ promised to defend anyone voting no when they ran for re-election after DDT said that no voters would lose the next election. By the end of the debacle, only 17 percent of voters supported Ryan’s plan.

DDT blinked and lost the game of chicken. He canceled the vote rather than suffer the embarrassment of losing, but it’s obvious that he lost. With no experience or clout to lead his party, DDT lobbied 120 congressional members, “left everything on the field” in negotiations, and lost. In his ghost-written book The Art of the Deal, DDT claimed, “You have to be very rough and very tough with most contractors or they’ll take the shirt right off you’re back.” He repeats that the negotiator needs “to be willing to walk away or, more precisely, convince the people you’re negotiating with that you are.” DDT didn’t realize that legislators aren’t contractors. Sen. Rand Paul (R-KY) did a training session for the House Freedom Caucus on DDT’s book, complete with poster.

During his campaign, DDT managed to con voters into believing that he knows “the art of the deal,” that he can be the closer. Ezra Klein explains why DDT as president is a loser:

“Trump is not a guy who makes particularly good deals so much as a guy who makes a lot of deals — many of which lash his name and reputation to garbage products…. He licenses his brand and lets others worry about the details of the products. Trump’s partners often end up going out of business and his customers often end up disappointed, but Trump makes some money, and he gets his name out there, and it’s all good.”

DDT wasn’t alone in the Trumpcare con; he had company from Ryan, who Paul Krugman called “The Flimflam Man.” Ryan lied when he said that Trumpcare would lower premiums, end the “death spiral,” and increase choice. Premiums would have skyrocketed unless people chose junk insurance plans with no coverage, and the extra 24 million people without insurance, along with people who couldn’t afford full coverage, would cause a death spiral. Ryan proposed a tax plan for the rich under the name of health care and failed.

The bill began with a high “age tax”—raising premiums and expenses for older, working adults—and added the “mommy tax” that greatly added expenditures for maternity coverage while diminishing its availability. Asked about people living in a state that doesn’t require maternity coverage in insurance, OMB Director Mick Mulvaney said, “Then you can figure out a way to change the state that you live in.” He clarified his statement by saying he didn’t mean move out of the state but to change the law. Republicans also ridiculed other insurance benefits for over half the nation’s population. For example, Alice Ollstein tweeted about her Kansas senator:

“I asked Sen. Roberts if he supports scrapping Essential Health Benefits. “I wouldn’t want to lose my mammograms,” he snarked.”

Ollstein survived breast cancer discovered during a mammogram for preventative care. These are the people–no estrogen and largely white–who met to decide what services should be cut for women.

[A bit of humor….]

Trumpcare was so bad that Ryan’s only solution in getting it passed was speed. The cruel additions to woo ultra-conservatives by eliminating Essential Health Benefits was added only the day before Ryan hoped to call a vote. Among the items as unnecessary health care are maternity and newborn care, emergency room services, hospitalization, prescription drugs, mental illness care, laboratory services and pediatric services.

DDT’s “skill” is to always blame someone else. Finger-pointing shifted so fast that digits blurred. DDT with DDT’s his chief of staff Reince Priebus and Ryan, accusing them of faulty content and bad timing. Secretary of Health and Human Services Tom Price also got blamed because he was put in the job to pass Trumpcare—although DDT assigned that job to Mulvaney. DDT claimed he wanted to start with tax reform that would have been “far less controversial.” (We’ll see!) Ryan was a popular scapegoat on the Fox network. The Wall Street Journal blamed the House Freedom Caucus for their “insisting on the impossible over the achievable,” and DDT took after this group too, telling them that he would tell their constituents that they were voting in favor of Planned Parenthood.

Despite 34 no votes from Republican representatives, DDT ultimately settled on the Democrats publicly when he whined that not one of them voted for Trumpcare, despite his failure to ask them for support. DDT and the GOP will continue to exaggerate any problems of the ACA, and the media will most likely focus on problems rather than the successes because a train-wreck films better than a satisfied person.  The GOP may also try to sabotage efforts to improve the ACA.

DDT is failing in office for the same reason that he succeeded in his campaign—weak party leadership. In a little over a day, he took a bill that no one likes and made it worse while alienating more members of his own party. In addition, he may have broken the law in his last-ditch try to save it. Tweets asking DDT supporters to call their representatives to save Trumpcare were sent by White House social media director Dan Scavino Jr, the official @POTUS account, and DDT’s personal account. The use of federal dollars, including paid White House Staff, in directly lobbying Congress to support or oppose a bill is against federal law. Press Secretary Sean Spicer used the Nixonian approach toward law by saying that the law is “not applicable to the president.” Scott Amey, general counsel at the Project on Government Oversight, disagrees because of the direct appeal to contact representatives in support of Trumpcare.

Hillary Clinton had a grand time tweeting the victories of people who need and like the “Obamacare” that DDT has daily excoriated in his daily message. Watching her is a reminder of how close the United State was to having a president who could “keep America great.”

DDT, Ryan, and the far-right Republicans aren’t the only losers with the downfall of Trumpcare. The wealthy won’t get their billions in tax cuts, and Wall Street won’t get the wealthy’s extra money. Insurance companies are also the losers, outside keeping funding for Medicaid. Big corporations would rejoice over getting rid of consumer protection rules that would have allowed them to vastly increase sales, marketing, and IRS deductions while selling junk insurance that wouldn’t have those “essential benefits”—like hospitalization.

One winner is DDT because Trumpcare would have lost over 1.2 million jobs—some people say as many as two million—that would have hurt his desire to be seen as the “jobs president.” GOP senators are winners because they don’t have to cast any votes on health care, at least in the immediate future. And constituents of Rep. Greg Walden, leader of the committee trying to destroy health care, are winners. In his rural district comprising two-thirds of Oregon, Trumpcare would have taken health insurance from 64,300 of his 684,200 constituents, almost ten percent of the people he represents. The remaining residents would have had far less access to the rural hospitals that need ACA money to stay open.

The next step is for Democrats to fight DDT’s “tax reform” shifting millions to himself and his wealthy friends. Meanwhile Democrats can introduce bills for improving ACA. The GOP won’t vote for them, but people will see that it can be fixed—and maybe vote blue in the next election.

March 14, 2017

Trumpcare: The GOP Killer Plan

The Congressional Budget Office has come out with the numbers for Trumpcare (excuse me, The American Health Care Act), and here’s the good news. The deficit could be lowered by $33.7 billion a year. Of course, that accomplishment come from moving costs to the state as well as taking people off Medicaid and government subsidies. For example, Oregon will have to pay 35 percent of health costs instead of the 95 percent that the federal government now covers.

The bad news for Trumpcare by the numbers:

  • 54 million individuals uninsured in ten years, double projections for ACA, according to a leaked White House analysis.
  • 24 million fewer people with coverage by next year.
  • 14 million more uninsured people in one year.
  • 14 million fewer people with Medicaid coverage in 10 years.
  • 7 million fewer people with employer-sponsored coverage in 10 years.
  • 2 million fewer people not buying health insurance each year.
  • 15-20 percent higher premiums in the first year than with ACA.
  • $880 billion cut from Medicaid over 10 years.
  • 15 percent of low income people without services to help women avert pregnancy because of defunding Planned Parenthood that results in thousands of more births. (Savings of $178 million for no care for these women would be offset by increase in Medicaid that pays for 45 percent of all U.S. births.)

Older Americans pay “substantially” more. At the same time, Trumpcare also takes away from the Medicare fund, causing it to become insolvent three or four years earlier than formerly projected unless positive action is taken.

Health insurance companies are encouraged to pay CEOs more because Trumpcare removes the ACA limit on corporate tax deductions for compensation. Under ACA, health insurance companies could deduct only $500,000 of the pay for each top executive making deductions for the companies only 27 percent instead of 96 percent. This limitation has been enough to buy dental insurance under the ACA for 262,000 people or pay the silver plan deductibles for 28,000. The 10 biggest insurance companies paid their top 57 executives a total of $300 in 2013. The provision to give them back the 96 percent was buried in six lines on p. 67, and even Tom Price, Secretary of Health and Human Services, seemed unaware of it until reporters inquired.

Republicans, claiming to be the part of smaller government, also have a provision in Trumpcare that employees without genetic testing as part of their workplace wellness programs can face large penalties in premiums. Existing federal laws don’t have this power because genetic privacy is protected. For example, the Kaiser Family Foundation could charge an additional $5,443 in annual premiums employer-sponsored family health coverage.

An oddity in Trumpcare is its obsession with lottery players, mentioned 11 times, the same number as Medicaid. Six of the 67 pages in the replacement plan focus on lottery winnings. Anyone getting at least $80,000 from the lottery or lotto would be kicked off Medicaid. To give you an idea of the savings, Michigan’s plan, withholding part of lotto winnings over $1,000 and not $80,000—saved $2 million.

Republicans have spent lots of time and energy criticizing the mandate that everyone purchase insurance. Trumpcare’s new system allows insurance companies to charge a 30-percent penalty after a break in purchasing coverage. It’s still a penalty: the only difference is that the money goes to insurance companies and not to the government. It also threatens destabilization of the individual insurance market.

Geographically, Trumpcare is disastrous for DDT supporters. The plan’s elimination of 0.9 percent for additional Medicare tax on wages and 3.8 percent surtax on investment income are only people in the top income stratum. John McCormick’s independent analysis of House Speaker Paul Ryan’s (R-WI) plan for Bloomberg states:

“Counties that backed him would get less than a third of the relief that would go to counties where Hillary Clinton won. The two individual tax cuts contained in the Republican plan to replace Obamacare apply only to high-earning workers and investors, roughly those with incomes of at least $200,000 for individuals and $250,000 for married couples. Taxpayers in counties that backed Trump would see an annual windfall of about $6.6 billion, (an) analysis of Internal Revenue Service data shows. In counties that backed Clinton, it’d be about $21.9 billion.”

The refund of this tax to the wealthy is what keeps the deficit reduction only $33.7 million when the massive cuts to benefits, including Medicaid, should come to much more. Getting rid of ACA’s taxes and annual fees would reduce revenues to the federal government by $592 billion over ten years. Just one person in the top 0.01 percent, for example, will get an extra $197,000 if the bill passes, and people in the top one percent will each get $33,000.

How Trumpers—and people at the same income level—will suffer from Trumpcare: A 64-year-old person with an annual income of $26,500 pays $1,700 a year in annual insurance premiums. Trumpcare will change that annual premium to $14,600 for equivalent insurance. The math makes it an increase of $12,900.

Ryan has made two strategic problems. He tried to push the bill through the House in three weeks; the ACA took over 16 months to pass after four months of groundwork. He also failed to involve any stakeholders. To pass ACA, Democrats developed support by convening health-care groups, largely the same groups that now strongly oppose Trumpcare. In retaliation, Dictator Donald Trump (DDT) is trying to minimize opposition from the American Association of Retired Persons (AARP) as just another flawed interest group. Their 37 million members comprise over one-third of the U.S. population over 50 years of age and are likely to be DDT voters. Bush’s 2005 struggle to privatize Social Security failed after AARP’s opposition.

http://www.msnbc.com/rachel-maddow-show/why-the-white-house-isnt-sharing-health-care-numbers-its-own?cid=eml_mra_20170314   The White House has its own analysis of Trumpcare. A leaked report from Office of Management and Budget (OMB) shows numbers are even grimmer than those from CBO with 26 million people losing coverage within the next decade instead of CBO’s 24 million. Although the White House called that report wrong, it hasn’t released anything in its place. GOP-confirmed OMB Director Mick Mulvaney, in charge of the health care legislation instead of the Secretary of Health, called the CBO estimates “just absurd” and said that “I don’t believe facts are correct.” DDT may have moved Price because Mulvaney, a founding member of the far-right House Freedom Caucus and former South Carolina U.S. representative, is more conservative than either Ryan or Price.

Congress may also take both health insurance and pensions from retired coal miners. After 22,600 miners retired, the company in charge of their health care gave it to another company that declared bankruptcy and was relieved of responsibility for retiree health care. Both companies finally agreed to pay into a special fund for retiree health care benefits, but one of them stopped contributing. In addition, UMWA’s multi-employer pension plan, serving more than 90,000 retirees and their widows, became severely underfunded. The Miners Protection Act (MPA) uses federal funds to pay for threatened health benefits and strength the pension plan, but Senate Majority Leader Mitch McConnell (R-KY) blocked its inclusion for his own constituents in an omnibus budget bill. The four-month extension of health benefits is due to expire on May 1, 2017 if Congress doesn’t act on the bill. Democrats wrote DDT for support in January, but he didn’t respond.

Yesterday Sen. Bernie Sanders (I-VT) talked to some of these miners during a panel discussion in West Virginia. One of them thanked Sanders for his support regarding the bill and said to applause:

“I never dreamt that I’d get to thank you personally for the bill that you are co-sponsoring. I’m one of those miners that will lose his health care at the end of April if they don’t pass that law. I think it’s kind of ironic that a senator from the northeast takes care of my benefits better than someone like Mitch McConnell.”

Sanders told the crowd:

“The Republican bill, it should not be seen as a health care bill, because throwing millions of people off of health care [is not] health care legislation. What it should be seen as is a huge tax break for the wealthiest people in this country.”

Two months ago, DDT promised “insurance for everybody.” He and other Republicans claim insurance access to all—probably the same way that everyone has access to buy a Mercedes-Benz but don’t have the money. Price claimed that Trumpcare would “cover more individuals at a lower cost.” The only way that they can be right is for people to be consigned to crappy insurance plans that may not even cover hospital costs, just as they were before the ACA. To show how obvious DDT is about killing ACA, he sent out an email asking people to “share your Obamacare disaster story.” They have no interest in any success stories or needs from “hard-working Americans like you,” but people have been sending them anyway.

The clearest description of Trumpcare has been provided by comedian John Oliver..

 

February 28, 2017

Whither Health Care?

Filed under: Health Care — trp2011 @ 8:29 PM
Tags: , , ,

House Speaker Paul Ryan (R-WI) swears that he has unity among the GOP Congress and executive branch for the proposed health care plan, but reality shows a different picture. Dictator Donald Trump (DDT) said that he will have his own plan in two weeks although tonight’s speech gave the feeling that he agreed in someways with the GOP program. GOP Sens. Rand Paul (KY), Ted Cruz (TX), and Mike Lee (UT) want only a full repeal of Obamacare, and Paul called GOP plans “Obamacare lite.” The three senators met with House Freedom Caucus Chairman Mark Meadows (R-NC) and Republican Study Committee Chairman Mark Walker (R-NC) who also vigorously opposed colleagues’ plans, especially on the tax credits. Members of Freedom Caucus and the Republican Study Committee had met with the far-right Heritage Foundation in early February and agreed that the solution was the 2015 repeal bill without any replacement plans. Meadows and Walker announced that they could not recommend votes for the proposed bill without “substantial changes.”

Republicans from the DDT on down have consistently promised the people of the United States a better deal for health care than the Affordable Care Act (ACA), and after years of meaningless repeals, the rubber is hitting the road. What are their plans? Drop coverage, raise prices, and take out every advantage of the health insurance now on the books. And drop all the taxes the raise funds for the ACA.

The replacement as of late February:

Replace subsidies with tax credits based on age instead of income. Under age 30, the credit would be $2,000 and double for those over 60. Wealthy elders, such as Bill Gates worth $83 billion, would get twice as much as poor young people. The ACA tax credit was adjusted by income, age, and the average price of insurance in a person’s market. An example of the importance of the ACA system is Alaska, where people receive double the tax credits as those in the rest of the country because of its scarcity of coverage in a frontier population. Other problematic areas are the rural counties and states in the interior and western frontier, DDT land.

Replace the existing Medicaid expansion in 2020 with capped state payments based on the number of Medicaid enrollees. The current plan provides for eligibility expansion for people who make up to 138 percent of the federal poverty line. The elimination of federal funds would damage the abilities of states to cope with populations in health crises, such as coal miners in Kentucky and West Virginia; deal with natural catastrophes and outbreaks such as 9/11 and Hurricane Katrina; and combat human-caused disasters such as the HIV outbreak in southern Indiana after Republicans, including then Gov. Mike Pence refused a clean needle exchange. The GOP plan would also jeopardize coverage for 11 million people who have gained it under the ACA.

Democratic governors and the GOP governors who accepted the expansion are opposed to this measure. The Republican governors who didn’t take the expansion are afraid they’ll get less under the plan than the states that did—and they may be right. At any rate, the plan will cost states billions of dollars that they don’t have.

Provide $100 billion in “state innovation grants” for extremely expensive enrollees. The intent is to cover some of the “pre-existing condition” population without the protections as in the Affordable Care Act.

Leave decisions about mandatory or essential benefits to the states. They could eliminate insurance for such health needs as mental health services, annual exams, prenatal and maternity care, pediatric care, and birth control.

Cap the tax exemption for employer sponsored insurance at the 90th percentile of current premiums and tax amounts above that benefit. This sounds like a good idea until you figure that employees will just pass their costs on to their employees without giving them a wage increase.

Allow insurers to charge older customers up to five times as much as their younger counterparts, an increase from the existing three times as much in premiums.

Assess penalties for people who let their coverage lapse and then decide to enroll with a 30-percent boost in premiums for a year. People who cannot afford to keep paying premiums if they suffer sudden hardship would be punished by this part of the bill. This would also allow people to not buy health insurance and then have no money for health care no matter what happens.

Defund Planned Parenthood to make more women get pregnant.

Allow people to decide if they want health insurance.

On Last Week Tonight, comedian John Oliver broke down an explanation of the GOP plan into four categories: refundable tax credits, high risk pools, block grants, and health savings accounts. None of these ideas will actually work, Oliver argues, breaking them down in financial terms—they all share the same “thong problem.” His view of the GOP’s plan—and pitfalls—is well worth watching.

Missing from the Republican plan is the provision that health care insurance remain “affordable.” The plan benefits people with good health and wealth as well as penalizing areas with disasters or emerging health problems. Rural areas would suffer more because this population relies more heavily on public insurance than people in cities.

Former House Speaker John Boehner (R-OH) doubts that the GOP can manage a full repeal and replace of Obamacare. He predicts a few fixes to the existing ACA, not a bad idea if the fixes help people:

“In the 25 years that I served in the United States Congress, Republicans never, ever, one time agreed on what a health care proposal should look like. Not once. And all this happy talk that went on in November and December and January about repeal, repeal, repeal—yeah, we’ll do replace, replace—I started laughing, because if you pass repeal without replace, first, anything that happens is your fault. You broke it.”

Basically, “GOPcare” supports the “coastal elites” over Middle America that voted for Dictator Donald Trump. Until faced with reality, DDT claimed that his health care would be far better than the existing program. His meeting with governors and insurance CEOs provided insight into his confusion. “Nobody knew that health care could be so complicated.” Actually almost everyone except the current president understood the complexity of health care.

DDT’s current solution is to allow Obamacare to “implode” and then blame the Democrats and President Obama. As DDT continues to declare the ACA a “failed disaster,” popularity for the program is steadily increasing. A poll in mid-February shows that 54 percent of people surveyed approve of the law while only 43 percent disapprove. And of those who disapprove of the ACA, one-fourth of them want the current law to be changed while only 17 percent want to completely get rid of ACA.

A common Republican claim is that “Obamacare” shackles people to government, and repeal of the health care plan will make them free. Almost 242 years ago, Patrick Henry said some version of “Give me liberty or give me death.” That is the choice that Republicans are pushing onto many people into the United States. The “freedom” of no health care will definitely give many of them death—but legislators aren’t talking about their own death. They’re the ones who already have health care and are wealthy enough that they always have. Almost 30 million people count on the ACA, and that doesn’t include the young people under 26 on their parents’ policies and the people on Medicare who have some benefits from the ACA. These are the people who will suffer from the congressional decision to give them “freedom.”

January 14, 2017

GOP Health Care Plan: Take from the Poor, Give to the Rich

Filed under: Health Care — trp2011 @ 10:17 PM
Tags: , ,

Without a replacement plan for the Affordable Care Act (ACA), 24 million people who gained health insurance under the law may lose it. Donald Trump (DT) has promised that no one will lose any health insurance, but GOP members of the Congress aren’t backing up his guarantee.

While the Republicans plan to take health care from the poor, they give tax cuts to the rich. The top 1 percent of earners would get an average tax cut of $33,000 if the ACA is repealed, and those in the top 0.1 percent would get an average cut of $197,000. Repealing ACA’s taxes removes the 0.9 percent Medicare payroll surtax on wages above $200,000 ($150 billion) and the 3.8 percent surtax on investment income above the same threshold ($250 billion). That $800 billion increase in the deficit is about half the loss.

Another quarter of the revenue loss comes from repealing various fees on insurance companies, medical device companies, and drug manufacturers. About $450 billion of the $1.10 trillion of costs in repealing the ACA’s Medicare comes from reversing Medicare Advantage cuts. Another $500 billion would come from ending reductions in the growth of provider payments in fee-for-service Medicare. This is just for future cuts. If past cuts are reversed, about $200 billion to $250 billion more would be lost. In addition, Paul Ryan is struggling to pay for his planned $6 trillion tax cut for the wealthy.

Major losers from an ACA repeal are small business owners. With self-employed people, they represent 50 percent out of ACA customers.

While the GOP wants to repeal the ACA within a month, DT said at a news conference Wednesday in New York City that a plan to replace the Affordable Care Act would wait until after Secretary of Health and Human Services nominee Rep. Tom Price of Georgia wins confirmation.

But the chairman of a key committee involved in both repeal-replace and confirming Price said his confirmation may not take place until around the President’s Day recess in February. Sen. Lamar Alexander (R-TN) also doesn’t want to make decisions until he consults with governors who will be in town around Presidents’ Day. Several GOP governors are joining Democrats to oppose the repeal.

health-chart

As Republicans blithely refer to Obamacare repeal, they probably don’t know how many people are covered by the ACA. The above chart shows the health status of people in the U.S. a year ago. Since then, Medicaid has increased from 71 million to about 74.4 million, largely from Louisiana expanding the program.

  • Green sections covering 46 percent of the nation are for government employees, including the military.
  • Orange sections are for Medicare—also threatened—plus Medicaid Advantage and Disability (under 65 years old).
  • Burgundy sections are NON-ACA Medicaid: Adults, Children and CHIP.
  • Blue sections are the greatest areas impacted by the ACA: Medicaid/CHIP expansion, the subsidized individual market exchange enrollees, and BHP enrollees in New York & Minnesota.
  • Yellow sections are the unsubsidized individual market. These people are enrolled in the ACA exchange but paying full price and off-exchange.
  • Gray/silver section is miscellaneous: the Indian Health Service, Student plans, NY’s ‘Child Health Plus’ program, etc.
  • Red sections are those still uninsured, down to about  27 million people. It includes people ineligible for either Medicaid or the exchange in 19 GOP states and undocumented immigrants. Others earn too much for ACA subsidies or cannot get them because of their employers.

In December House Speaker Paul Ryan (R-WI) said, “We will give everyone access to affordable health-care coverage.” He added that pre-existing conditions are “a very important feature of any health-care system.” DT’s counselor Kellyanne Conway promised that DT will keep the pre-existing conditions. That, of course, was before the GOP senators voted against it along with other health care provisions to help people. Ryan also promised that the GOP will ensure that “no one is worse off.”

At his press conference this week, DT described his replacement model:

“They can say what they want, they can guide you anyway they wanna guide you. In some cases, they guide you incorrectly. In most cases, you realize what’s happened, it’s imploding as we sit.”

He also made the promise that “we’re going to have a health care that is far less expensive and far better.” He didn’t answer the question about whether everyone covered now will continue to have coverage.

In a letter to the Oregonian (January 14, 2017), Terry Weiss of Philomath superbly explained the idiocy of the proposed health care repeal:

“If a little old lady in Oregon can figure this out, why can’t someone in Washington? Medicare, Medicaid, and Obamacare account for thousands of jobs and billions of dollars to healthcare providers and suppliers. If any or all are removed, many thousands of living wage jobs will be lost and millions of dollars in income will vanish. Tax losses will be huge to federal and state budgets. If you can’t wrap your mind around the human aspect—letting people die or go untreated for illnesses and injuries—surely the enormous negative effect on the economy should make you pause.

“Spend billions of dollars dismantling a functional and economical system with only three percent overhead to administer Medicaid and medicare. Then spend more billions putting together another system that is untested and unknown and will take place to put in place. This is efficient government spending?

“I can’t figure out why the first order of business for this Congress and president is to tank the economy and take aay living-wage jobs. The opposite of the promises made by one and all. I known campaign promises tend to be less than truthful, but this is unbelievable. Where are the political commentators, representatives of the medical industrial complex, DEOs, and decent human beings?”

As another “little old lady” in Oregon, I worry about the IQ and common sense of the people who are leading our government. For example, Rep. Bill Huizenga (R-MI) suggested that people shouldn’t go to the doctor immediately with an illness or injury. He proudly cited his own experience by making his son wait a day to go to the emergency room for an arm injury. He saved money, but the arm was broken. According to Huizenga, that’s the reason that people shouldn’t get money for health care. Without necessary insurance, they could just wait until the next day—or perhaps longer.

This level of stupidity is not new. Former House Majority Leader dick Armey (R-TX), leader and instigator of the Tea Party, said, “The largest empirical problem we have in health care today is too many people are too over-insured.” That was when almost 40 million people lacked health insurance.

People who complain about the high cost of insurance refuse to accept the fact that the private market is driving up costs. Medicare, a government program, saw its costs rise by an average of 1.4 percent from 2010 to 2015, less than half the cost increase for private insurers even after the ACA forced them to charge less for “administrative costs.” As the above letter stated, these costs are three percent while the ACA allows private insurers to spend up to 20 percent–and that’s less than in the past.

A year ago Paul Ryan signed legislation to repeal the ACA and cut off federal funding to Planned Parenthood. The bill didn’t succeed, but Ryan and his colleagues had a good time taking away health care for 24 million people. Chip Somodevilla/Getty Images [visual]

WASHINGTON, DC - JANUARY 07:  Speaker of the House Paul Ryan (R-WI) (3rd L) shares a laugh with Republican members of Congress after signing legislation to repeal the Affordable Care Act, also known as Obamacare, and to cut off federal funding of Planned Parenthood during an enrollment ceremony in the Rayburn Room at the U.S. Capitol January 7, 2016 in Washington, DC. President Barack Obama has promised to veto the bill.  (Photo by Chip Somodevilla/Getty Images) *** BESTPIX ***

Obamacare has been a success: fewer people are uninsured; hospitals’ uncompensated care costs have fallen by over 50 percent;  overall national health spending as a share of GDP has dropped faster than predicted; the growth in spending on health needs has slowed to one-third of the average in the early 2000s; the increase in premiums is only 60 percent of the average during the ten years before the ACA; and “Obamacare” is more popular. Even little old ladies know that.

January 13, 2017

So How’s That Obamacare Repeal Going?

Why did people hate the Affordable Care Act, a law that helped people have better health care and live longer? Conservative leadership fed lies to their constituents—like this one from House Speaker Paul Ryan (R-WI) at a town-hall event this week–because they feared a Democratic plan would be popular. Ryan’s mistake was taking a question from a man who owns a small business in a red state, worked for the Reagan and Bush campaigns, and opposed the ACA. That was before the ACA saved his life after his life-threatening cancer was treated, thanks to “Obamacare.” Jeff Jeans said, “I want to thank President Obama from the bottom of my heart because I would be dead if it weren’t for him.”

Ryan’s response? The flat-out lie that the ACA is a “death spiral” because people won’t buy insurance when it gets too expensive.  If Ryan were right, enrollment numbers would be dropping. But instead they’re skyrocketing. The proportion of young adults is steady, proving that the mix of people enrolling this year is less likely to be sicker and more expensive. And this is happening despite the uncertainty about the future of health care for the people in the United States, thanks to the unhealthy obsession in the GOP Congress about a repeal.  Lies are failing with the public, however, because 75 percent object to repealing if there isn’t even a replacement.

Today, the U.S. House began their process of destroying health care for the millions and millions of people in the United States. A vote of 227-198 with only nine GOP defectors approved the budget resolution that the Senate passed in the dark of night earlier this week. The bill doesn’t specifically address the ACA, but the passed “budget reconciliation” is needed to kill off the ACA because of the danger from a Senate filibuster.

Rep. Charlie Dent (R-PA) warned that their action could send insurance markets into a collapse. Rep. Justin Amash (R-MI) tweeted, “Most massive budget in U.S. history passed 227-198. It adds more than $9 TRILLION to the debt over the next decade.” House Majority Whip Steve Scalise (R-LA) argued that the House had to pass the bill because they had campaigned on it.

The Senate vote allowed non-binding amendments showing the chamber’s position. These are positions that the GOP Senate oppose:

Protect people with pre-existing conditions: 52 million people in the U.S.—25 percent of non-elderly people—have pre-existing conditions. Before ACA, they were frequently denied any coverage. Only two Republicans voted in support of keeping these conditions in a health care plan.

Let young adults stay on their parents’ plan: Over six million young people 26 years old and younger have gained health insurance since this plan went into effect in 2010. Surveys show 85-percent approval of this provision. Again only two Republicans support this condition.

Maintain access to contraceptive coverage: The ACA has caused spending on contraceptive health care to drop 20 percent. Only two Republicans vote in favor of this amendment.

Ensure Medicaid expansion stays in place: 11 million low-income people benefited from this provision in 2015, and thousands of jobs were created for direct care workers.  Republicans unanimously defeated this amendment.

Protect children on Medicaid or CHIP: GOP Senators blocked this amendment.

Protect veterans’ health care: Republicans blocked an amendment to make it harder to restrict veterans’ access to VA health care.

Republicans demonstrated that they oppose insurance that requires pre-existing conditions, puts children up through age 26 on the parents’ policy, provides free contraceptive care, helps low-income people and children, and protects veterans. These are the leaders who want to take people’s health care: Vice President-elect Mike Pence with Senate Majority Leader Mitch McConnell and Sen. John Barrasso (AP Photo/Cliff Owen).

health-care-killers

The public opposition to ACA repeal began when more and more people understood that the congressional goal was to take away health care without any new plan. Sen Bob Corker warned that repeal without replacement would be “not very appealing.” Even ultra-conservative Sen. Ron Johnson (R-WI) asked for a replacement “game plan.” Passing the repeal/replacement also requires 60 votes in the Senate because of the filibuster.

The derailing of the grand repeal plan began just four days after the GOP Congress took over the country. That’s when Republicans determined that the GOP project to Make America Sick Again would cost more than four times than the extremely expensive Iraq War while it kills millions of private sector jobs. Republicans had a solution: hide the cost of their repeal. Page 25 of the new rules package passed by GOP House members stated that the Congressional Budget Office (CBO) should estimate the cost over $5 trillion—except Obamacare. Unfortunately, that plan didn’t work either: the word got out that what the GOP calls an “appropriate” level of public debt is actually an unnecessary anti-job debt spike.

Add to that problem Ryan’s decision to defund Planned Parenthood through a bill to repeal Obamacare, and the bill riled more conservatives. Two moderate female GOP senators opposed this suggestion, and the program is highly popular throughout the nation.

Some of the most conservative senators—Rand Paul (R-KY), Bob Corker (R-TN), and Tom Cotton (R-AR) for example—are reluctant to vote for the repeal because of the increasing deficit. Paul wants an immediate repeal but isn’t happy about the $10 trillion dollars added to the deficit. Even ultra-conservative Sen. Lamar Alexander (R-TN), chairman of the Health Committee, declared that it’s not smart to repeal without a replacement.  Sens. Susan Collins (R-ME) and John McCain (R-AZ) don’t like Repeal without Replace. Six dubious senators will put the 48 Democrats opposing the repeal to a majority of the chamber. Lisa Murkowski (R-AK) might join them because she, like Collins, doesn’t like the idea of defunding Planned Parenthood.

The repeal is rapidly coming to a head because GOP leadership wants to force the development of legislation by January 27. Wanting to postpone the deadline until March 3 are at least five GOP senators: Bill Cassidy (LA ), Susan Collins (ME), Bob Corker (TN), Lisa Murkowski (AK), and Rob Portman (OH).

Congressional Republicans are also facing opposition from GOP governors. John Kasich (OH) and Rick Snyder (MI) have already complained about the loss of Medicaid. Kasich said the hospitals need Medicaid that “has worked very well in this state.” He said that the program covers 700,000 of his residents; Snyder agreed when talking about his 642,000 people in Michigan. Other GOP governors opposing the repeal thus far are Charlie Baker (MA),  Asa Hutchinson (AR), and Brian Sandoval (NV).

Kasich eloquently expressed his concern:

“Let’s just say they just got rid of it, didn’t replace it with anything.” What happens to the 700,000 people [in Ohio]? What happens to drug treatment? What happens to mental health counseling? What happens to these people who have very high cholesterol and are victims from a heart attack? What happens to them?”

The GOP desire to balance the federal budget occurs only with Democratic presidents. Republican legislators showed no longing for “fiscal responsibility” during the Reagan/Bush years. Under Clinton, their need for zero deficit returned, but unfortunately for them, Clinton showed a surplus by the end of his two terms. In the two following Bush/Cheney terms, Republicans asserted that “deficits don’t matter.” They ran up trillions of costs for two wars, two tax-cut packages, Medicare expansion, and the Wall Street bailout.

During the two terms of Democratic President Obama, conservatives screamed about the ballooning deficit set in place by his predecessor. The GOP even lowered the credit rating of the United States and then closed down the country because of their demand for a balanced budget. With a prospective GOP president, the majority of GOP Congressional legislators started to repeal a law vastly increasing the deficit, a law that keeps people alive. Their plans would put the public debt to at least $29.1 trillion by 2016, according to the budget resolution they passed.

People are already losing jobs because of the GOP’s declaration that they will “repeal Obamacare.” The loss of health care for millions of people is already sending shock waves throughout the $3 trillion-a-year health system. Hospitals estimate that the repeal will cost them $165 billion within five years and trigger “an unprecedented public health crisis” if sick people can’t get care. The Advisory Board Company, providing services to health care firms, has already laid off 200 people partly because hospitals vastly decreased spending after the election.

With much lower health coverage, hospitals and health providers could find themselves on the hook for up to $1.1 trillion for uncompensated care in the next decade, causing the collapse of finances in hospitals serving needy populations. Their only solution would be to curtail services and reduce workforce, impacting health care access even for the insured. Illinois alone would suffer a loss of 95,000 jobs and $13.1 billion. Forty percent of the state’s hospitals are already in the red or close to it.

The question is whether the GOP can get over its gridlock and lack of bipartisanship to pass a “repeal and replace” law. I wouldn’t bet on it.

December 8, 2016

FDA’s Losses

I’m addicted to The Rachel Maddow Show, as anyone who knows me can tell you. She’s one of the very few bright lights since November 9, 2016. Last night she had a particularly spectacular segment on Donald Trump’s (DT) proposal for the head of the Food and Drug Administration. As we’ve watch the attempted destruction of the United States through DT’s nominees, this one—hard as it may be to believe—seems to stand out.

The transition team is considering Jim O’Neill, a managing director for Silicon Valley billionaire Peter Thiel’s Capital Management. Thiel himself is an interesting figure who believes that the United States was destroyed in the 1920s when women got the vote. Last summer he was the first openly LGBT person to speak at the GOP convention and endorsed the platform that opposes hate-crime laws, HIV funding, and appropriate bathroom use by transgender people, calling it a “distraction.” At the same time, he supports laws to deny services to LGBT people.

Thiel pays students to drop out of college and sponsored Hulk Hogan’s lawsuit against the Gawker that outed Thiel almost ten years ago. The lawsuit was an objection to the “damaging way of getting attention by bullying people even when there was no connection with the public interest”—odd when one considers that this is DT’s MO. The co-founder of PayPal donated $1.25 million to DT’s campaign and was appointed to the highly homophobic transition team where he worked with Ken Blackwell who compares homosexuals to arsonists.

But I digress. Back to Jim O’Neill. As a board member of the Thiel-backed Seasteading Institute, he supports creating mini-cities at the bottom of the ocean to save the world from the devastating place that the United States has become. In a 30-minute speech, O’Neill said, “We can all wish that existing governments will somehow stumble into freedom, but if we want to achieve freedom, seasteads are by far the best prospect.” The video of this speech has magically disappeared from the Seasteading website since he was considered for the FDA position but is still available here. Thiel’s reason for Seasteading is to avoid taxes because he could use the “cities” to morph offshore companies into offshore countries with no responsibility or accountability to any government.

With no medical or scientific background, O’Neill thinks that drugs don’t need to be independently tested before they go on the market. Two years ago, he announced that his idea to reform the FDA was “approving drugs after their sponsors have demonstrated safety—and let people start using them, at their own risk, but not much risk of safety. Let’s prove efficacy after they’ve been legalized.” When he was in George W. Bush’s Health and Human Services Department, he opposed the regulation of companies that perform laboratory-developed drug tests with algorithms. Another of O’Neill’s beliefs is that anti-aging medication will reverse aging and that people can live forever.

The FDA has control over regulations for food, drugs, medical devices, dietary supplements, cosmetics, and tobacco—much of the consumption in the U.S. O’Neill claims that the lack of a free market in health care causes negative health consequences that would not occur in a free market. At the same time DT is attacking the free market system. Republicans decry DT’s interference that brought $7 million to Indiana’s Carrier as “crony capitalism” as well as his pride in dropping stock prices for Boeing with one tweet. DT also claims that he will “bring down drug prices,” against causing drops in pharmaceutical stocks.

O’Neill has also said that organ donors should be allowed to be paid. “There are plenty of healthy spare kidneys walking around, unused,” he said in a speech at a 2009 Seasteading conference.

This week, Congress readied the weakening of the FDA for DT by passing the 21st Century Cures Act. On the surface—and from the mainstream media—the public may believe that it should embrace the bill. To do so would ignore the ability of ineffective or dangerous medicines to easily reach people without reining in drug prices. Passing the bill, however, was a given because it funds Vice-President Joe Biden’s “Cancer Moonshot” initiative which covers all the rank stench of its other effects.

Some of the bill’s promises are already in existence, for example a six to ten month turnaround for evaluations of almost all new drug applications. There is also no evidence that current requirements cause higher drug prices. These are some of the negative provisions:

  • The funding for such programs such as addressing the opioid addition is not guaranteed for next year or after that.
  • The promised “patient-focused” drug development merely means that a brief statement about this experience will be made public.
  • Earlier provisions helping the public have disappeared from the final bill: (1) requiring third parties to certify the safety of medical devices after modification by companies; and (2) granting permission for shorter or smaller clinical trials for medical devices.
  • A provision allowing the FDA to use “real world evidence” for drug testing relies on the Secretary’s discretion. (Consider O’Neill’s “discretion” as Secretary of the FDA.)
  • The act eliminates “informed consent” when “the proposed clinical testing poses no more than minimal risk to the human subject and includes appropriate safeguards to protect the rights, safety, and welfare of the human subject.” The FDA gets to decide “minimal risk.”
  • Stem-cell therapies are slightly expedited through cutting back testing and permitting these in the marketplace before they have been proved effective and safe. This provision benefits wealthy Texan Ed Bosarge, who runs a stem-cell firm, gave $3 million to GOP Mitch McConnell’s super PAC, the Senate Leadership Fund and donated another $4.7 million to other GOP super PACs since Citizen United.
  • The bonus for the pharmaceutical company is their new ability to promote “off-label” uses of drugs, widely expanding their markets and avoiding the requirement of FDA approval for new indications.
  • The act cuts $3.5 billion, or about 30%, from Obamacare’s Prevention and Public Health Fund, which fosters work to prevent Alzheimer’s disease, hospital-acquired infections and other conditions.

Promoters of the act complained that the FDA acted as a bottleneck for drug companies, but the agency usually acts as a rubber stamp for them: it approved 89 percent of last year’s applications for new drug uses. Lessened scrutiny is demonstrated by such events as the need to pull Merck’s Vioxx, a painkiller and arthritis drug the FDA approved in 1999, five years later because it raised the risk of heart attacks. By then, 88,000 people in the U.S. suffered from heart attacks, and 38,000 of these people died.

Essure, a device implanted in women’s fallopian tubes as an alternative to permanent surgical sterilization and marketed by Bayer, received expedited approval in 2002 based on “two nonrandomized, nonblinded, prospective studies that lacked a [control] group and enrolled a total of 926 women.” Since then, research shows serious potential side effects and concerns that it is not safer than tubal ligations as well as appearing less effective in preventing pregnancy. Essure is still on the market but is required to have health risks warnings on the label.

Winners of the bill are the drug companies, medical device manufacturers, the National Institutes of Health, and Joe Biden. Losers are the FDA, aging and deteriorating labs, randomized clinical trials, customer advocacy groups, and regenerative medicine that would expand treatments for stroke victims and people suffering from Alzheimer’s, Parkinson’s and diabetes. The final draft does not permit new regenerative medicine products to skip the Phase 3 trials.

About 1,455 lobbyists on behalf of over 400 companies and other organizations at a cost of $500,000 succeeded in pushing through the legislature. It offers “something for everyone,” funding important projects while adding danger and unnecessary expenditures that benefit drug companies. If O’Neill is nominated and confirmed as the FDA Secretary, he will create more danger for people in the United States.

The bill passed the House in 392-to-26 with my representative, Kurt Schrader, in the majority and preening about his “success.” The Senate supported it in a 94-5 vote, and I’m proud of both my Oregon senators who voted in the minority, agreeing with Sen. Elizabeth Warren (D-MA) who said that she knows “the difference between compromise and extortion.” She called the NIH funding a fig leaf, “and most of that fig leaf isn’t even real. Most of the money won’t really be there unless future Congresses pass future bills in future years to spend those dollars.” Warren knows that most of her Democratic colleagues were bought off with false promises.

August 12, 2016

Equal Pay for Women’s Soccer Team; ACA Makes People Healthier

The U.S. Women’s National Soccer Team has won three World Cup titles and four Olympic gold medals, but they are still get paid just 72 percent per game as the U.S. men’s team—that didn’t even qualify for the current Olympics. The women’s team generated almost $20 million more in revenue than the men’s team, and their World Cup final last year was the most watched soccer game in history. Liza Bayless wrote:

“The US women’s national team collectively earned $2 million for their 2015 World Cup win. The US men’s national team — who has not made it past the quarterfinals of a World Cup in more than eight decades, and has never won — earned $9 million for their loss in the round of 16 at the 2014 Men’s World Cup in Brazil. Germany, the winning team, collected $35 million….

“The women’s team brought in more revenue in the 2016 fiscal year (granted, a World Cup year) and is also projected to outperform the men in revenue and profit in 2017, when neither team is playing a World Cup. US Soccer expects they will bring in almost twice as much as the men–$17.6 million versus $9 million. And yet the federation pays its female players $1,350 for winning an exhibition match while the men receive up to $17,625 for doing the same. For a loss, men receive $5,000. Women receive nothing. For making the World Cup roster, a male player makes $68,750 while a woman makes $15,000.

“The women do receive a base salary of $72,000 for playing on the national team and some benefits that the men do not. However, if both teams were to win all 20 exhibition games–the matches they play outside of tournaments–in a year, a female player would be paid $99,000 total (including base salary) while a male player would be paid $263,320. Additionally, sponsors compensate men hundreds of dollars more per game appearance.”

If you think that the women deserve equal pay for their winning as the men do for their losing, please sign this petition.

_____________________________________________________________________________________

While Republican candidates march around claiming that they will do away with the Affordable Care Act, ACA has provided health insurance to about 20 million people and made people healthier.

  • People are less likely to have medical debt or postpone care because of care.
  • People are more likely to have a regular doctor and get preventative health services.
  • Low-income people in Arkansas and Kentucky, which expanded Medicaid insurance to everyone below a certain income threshold, are healthier than peers in Texas, which did not expand.

These are the findings from a study during the last two years. A 2015 survey found that the people in Arkansas and Kentucky, states with Medicaid expansion, are almost five percent more likely than peers in Texas, a state without Medicaid expansion, to say they are in excellent health, a bigger difference than the 2014 survey. Another study in Oregon tracked people for two years who received Medicaid insurance and those who remained uninsured. People with insurance were much more likely to be in good or excellent health as well as more financially secure. The most recent state to expand its health care program, Louisiana, became the 31st in the nation.

Trump - New Yorker - leftTrump Watch: Two covers reflect Trump’s downward trajectory since the GOP convention only three weeks ago. The New Yorker shows rain falling on Trump to indicate the increasing disaster of his campaign. Time is considering Trump as “person of the year,” defined as a person, group, idea or object that “for better or for worse…has done the most to influence the events of the year.”

 

Trump - Time cover

 

Message to Republicans and Bernie supporters who plan to vote for Trump: The risk of having Donald Trump for president is far worse than Hillary Clinton’s nominating liberals to the Supreme Court. That message comes from conservative legal scholars. They claim that Trump is totally unfit to deal with “foreign affairs and domestic crises”—much of a president’s job—and that it’s doubtful that he’ll keep his word about his justice nominees.

According to Ilya Somin, Trump’s picks could undermine the constitution and turn the country into “a big-government xenophobic party hostile to civil liberties and opposed to most constitutional constraints on government power–much like the far-right nationalist parties of Western Europe, whose platforms are very similar to his.”

Republicans who defiantly defended Donald Trump’s statement that President Obama is the “founder of ISIS” found themselves thrown under the bus after Trump said that he was just joking—two days after he repeated the statement over and over. It the same thing that he says after many of  his statements bringing negative publicity–yelling at a baby to leave his rally, calling violence on Hillary Clinton and her supporters, etc.

Trump may have listened to Clinton’s criticism that his entire economic team is male; he has added nine names to the group, eight of them female. Still no people of color, however. And still as conservative.

People who listen to Trump touting his program for child care need to realize that this is only for guests at his resorts. Although he said that he provides on-site child-care service for employees, called Trump Kids, no one can find evidence of such programs. Yet this service, also called Trumpeteers, caters to his hotel and gold club patrons.

For the people who believe that Trump will stop outsourcing, here’s a list of countries where Trump product are manufactured: furniture – Turkey; shirts – Bangladesh and other Asian countries; vodka – Netherlands; suits – Mexico; tie clips – china; barware – Slovenia; glass and building materials – China; elevator parts – Japan; shampoo – Hong Kong; beach furniture – China; artificial turf – United Kingdom; marble – Italy; pens – Norway; slippers and cutlery – China. Trump could make all these things in the U.S., as this website shows. Yet Trump swore he would never eat Oreo cookies again after Nabisco moved to Mexico and said, “Our people should have more pride in buying made in the USA.”

Repeating his accusation that he might lose Pennsylvania because the voting is rigged, Trump told his audience that the people need to “go down to certain areas … and make sure other people don’t come in and vote five times.” Donald Trump declared today that there’s only one way he could lose the state of Pennsylvania: if he’s cheated out of it. At this time, Clinton is ahead of Trump in Pennsylvania polls by ten points.

A team at the conservative Washington Post will publish Trump Revealed: An American Journey of Ambition, Ego, Money, and Power on August 23. Amazon is offering pre-orders, and it’s sure to instantly hit the best-seller list! An excerpt is available on-line for impatient readers.

What makes Trump the angriest? The media repeating his words. His description for journalists doing their job makes them “the lowest form of life.” He said, “I tell you, the lowest.”They are the lowest form of humanity.”

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