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.

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.

January 3, 2017

Day One of the 115th Congress, Its Stumbles

Filed under: Congress — trp2011 @ 10:22 PM
Tags: , , ,

The 115th Congress is one day old, and a strange thing happened: some Republicans seemed to exhibit shame—or perhaps just fear of constituents. Their embarrassment began yesterday when GOP members of the House voted in a closed session to put the House in charge of ethics charges for House members. The process seems to be a redux of the 2004 GOP decision to weaken ethics rules in the GOP-controlled House, led by then House Majority Leader Tom DeLay (R-TX) who was later convicted of violating election law. Vice-president Mike Pence, a representative at that time, strongly supported the move.

After the vote to weaken the ethics procedures, a large number of House members, almost all Republicans, were caught in illegal scandals—one of these the Abramoff affair—that put some of them in prison. When Democrats ran against this “culture of corruption” in 2006, they won both congressional chambers and set up an independent committee to take care of House ethics matters.

History repeated itself yesterday when GOP House members voted 119-74 to put the Office of Congressional Ethics under the control of the House Ethics Committee despite opposition for leadership House Speaker Paul Ryan and Majority Whip Kevin McCarthy. Yet the majority had decided to keep investigations from public view and allow the House committee to stop investigating at any time, based on a House vote. Anonymous tips would not be investigated, and crimes could not be sent to law enforcement, a practice not only unethical but also unconstitutional. The full House would have to agree to move forward on an investigation, but the committee had no ability to search for evidence to get the approval.

The decision was not a done deal: the entire House had to vote on this change as part of the rules package today. Judicial Watch, the conservative group which pushed to get the release of Hillary Clinton’s emails, described the change as “shady and corrupt, a “drive by effort.” Phones lit up and tweets flew. Donald Trump (DT) sensed the disturbance and tweeted that the House should do other things first that favored him personally. After all, he thinks he cannot be investigated:

“With all that Congress has to work on, do they really have to make the weakening of the Independent Ethics Watchdog, as unfair as it may be, their number one act and priority. Focus on tax reform, healthcare and so many other things of far greater importance!”

DT’s staff disagreed with him. His counselor, Kellyanne Conway praised the weakening of ethics, saying that it will cut down on “overzealousness.” She lost. Only a few of the 119 supporters were willing to go public or admit that they were in favor of it. GOP constituents constantly supported the change until an emergency GOP conference meeting reversed yesterday’s vote by unanimous consent. DT took credit for this action, but one representative said that the strong public opposition had killed it before DT wrote anything.

One conclusion from Day One of the 115th Congress suggests that shame works. Without public outcry, the Republicans would have moved ahead to hide all their illegal activities. This reversal could even set a precedent when the GOP tries to eliminate health care, Social Security, Wall Street regulations, taxes for the wealthy, etc. Protest!

Of course, it’s not over. The GOP can revert to their idea when they think no one is watching or hide it inside a major bill. House Ethics Chair Susan Brooks (R-IN) said that the ethics panel will review the proposal make recommendations in late summer or early fall—probably hoping that people will be on vacation then.

A major question is whether the GOP House leadership has any more control over their members. Despite top-level arguments against weakening the ethics rules, the caucus decided to move forward on it—briefly. The Republicans in Congress have been badly split since the Tea Party revolution of 2010, creating a dilemma on negotiation. Who does Senate Majority Leader Mitch McConnell or DT work with if Ryan and McCarthy don’t agree with the underlings.

While the House was dithering about ethics, the Senate, with less attention, bragged about repealing “Obamacare.” Today they put together an introduction to the “reconciliation process” to out-maneuver a Democratic filibuster against any health care repeal bills. The process can be used only in bills affecting spending and revenue and must be approved by the Senate Parliamentarian before the vote can move forward.

Last year, the GOP passed the Restoring Americans’ Healthcare Freedom Reconciliation Act (RAHFRA, which probably can’t be pronounced) using the reconciliation process. Budget parts of the Affordable Care Act such as insurance subsidies, Medicaid expansion, tax increases, and the mandate to buy coverage were approved to be covered by reconciliation. Left standing was covering young people through age 26 on their parents’ policies and pre-existing conditions.

The process cannot be used for legislation increasing the deficit in ten years or more. That’s the reason that George W. Bush’s tax cuts, passed by reconciliation, had to expire in 2011.

Afraid of protests from people losing their health care or charged more for insurance, Congress wants to move quickly and hope that no one will notice the problems. Two thirds of the people in the U.S. think that the ACA either didn’t affect the number of people with health insurance or caused more people to be uninsured. With no replacement, ACA repeal will leave 22 million people without coverage and millions others suffering from the havoc in the individual insurance market.

Conway, DT’s counselor, promises that no one with health insurance will lose their coverage.  GOP legislators will most likely not live up to her promise. The half-hearted suggestions for replacement go from almost nothing to keeping the ACA marketplaces, in general disadvantaging older, sick people and offering less financial help to people who use more insurance. Costs can skyrocket for people who need more health care.

With no replacement, the loss of the ACA can drastically drop coverage even if the planned repeal is years from now. Conway said that DT doesn’t have a plan ready because Rep. Tom Price (R-GA) has not been confirmed as Secretary for the Health and Human Services Department. Price wants a fixed tax credit starting at $1,200 a year for buying insurance on the private market and state high-risk pools—the ones that miserably failed in Florida and 33 other states.

Another way that the GOP is hiding its increase in deficit by repealing the ACA came from the rules package requiring the director of the budget office to prepare an estimate of whether any bill would cause a boost in spending in excess of $5 billion over the next four decades. Any bill, that is, except a bill, joint resolution or amendment that would repeal Obamacare. A major advantage of ACA was its reduction of the deficit so repealing the law would increase the deficit. To avoid the issue, the reconciliation bill keeps cuts to Medicare doctor payments, thereby scoring the bill as reducing the deficit.

Today’s budget proposal from the Republicans raises the national deficit from about $600 billion next year to a $10 trillion increase within the next decade. The bill has to pass both chambers of Congress; the question is how long Republicans can hide the increase in the deficit under the pretense that the bill concerns the repeal of Obamacare. This bill covers no specific spending. Other bills will have to do that–expenditures such as repealing the ACA, building the wall, cutting taxes for the wealthy, etc., all acts that vastly increase the deficit.  Lawrence O’Donnell explains the situation here, beginning about Minute 32.

Like a dog chasing a bus, the GOP has been chasing the repeal of health care for six years. What happens when they catch it?

The GOP House members did approve a rules package that fines members who take pictures or video from the House floor. Evidently transparency is not high on their list, especially after their embarrassment from the 26-hour sit-in protesting Ryan’s refusal to allow any votes on gun safety bills.

December 23, 2015

New Gov. Bevin Gives Kentucky Lumps of Coal

 

 

MinWageIncrease2016

US_minimum_wage_map.svgEighteen states are raising the minimum wage in 2016, 14 on January 1 and four others later in the year. At $10 an hour, California and Massachusetts the highest rates; Arkansas has the lowest increase, going up $7.50, $.25 over the federal rate in 21 states, last changed in 2009. Eight states are indexed to the cost of living which did not increase this year.

Of the 21 states that must follow the federal rate because they have no minimum wage or law puts it below federal rate, most are in the South.  [Map for 2015: Green – higher than federal rate; blue – same as federal rate; red – lower than federal rate; yellow – no minimum wage; Arkansas created minimum wage since map was published.]

Kentucky Governor-elect Matt Bevin responds to a question during a press conference in the Kentucky State Capitol Rotunda, Friday, Nov. 6, 2015, in Frankfort, Ky. (AP Photo/Timothy D. Easley)

 (AP Photo/Timothy D. Easley)

Kentucky and its newly elected Tea Party governor belong to the bottom 21 states. Some of the approximately 16 percent of eligible voters who elected Matt Bevin as governor, only the third Republican since World War II, will soon going to suffer from buyer’s remorse if they aren’t already doing so. Bevin’s actions show what can happen if the United States elects a Republican president.

One of five orders Bevin issued on December 22, two weeks after his inauguration, was to lower the minimum wage for state workers and contractors to $7.25. Rent on an average one-bedroom apartment in the state would require a person to work a 60-hour week. He also stated that he doesn’t believe in minimum wage, that “wage rates ideally would be established by the demands of the labor market instead of being set by the government.” The top one percent could make even more by dropping their wages to the dollar-a-day that “free market” sets in the Third World. The danger there is that people couldn’t buy their products—even food.

Tipped state workers are even worse off. Last summer, the former governor raised the hourly wage for waiters and waitresses at state parks from $2.19 to $4.90. Bevin put them back at $2.19 an hour.

In addition to declaring a moratorium on hiring state employees, Bevin reversed Beshear’s practice of requiring merit employee actions be approved by the secretary of the governor’s Executive Cabinet. Bevin’s order also requires a review of all vacant positions in any agency to determine their necessity. In addition, he eliminated the Governor’s Employee Advisory Council, which advised the governor’s office on merit employee wages and terms of employment. The council was established by Democratic Gov. Paul Patton, disbanded by his successor Republican Ernie Fletcher and re-established by Beshear.

When former Democratic Gov. Steve Beshear restored voting rights to at least 140,000 with felony convictions, Kentucky was one of just three states that permanently disenfranchised all people with felony convictions. An early action by Bevin was to again disenfranchise all these people after they have paid their debt to society. Bevin had campaigned last year on restoring these people’s rights, but he reversed his earlier opinion. In Kentucky, one in five blacks lost their voting rights after conviction, compared with one in 13 nationally.

In another order, Bevin saved Rowan County Clerk Kim Davis from future jail terms by ordering the state to remove names of county clerks from marriage licenses. Fayette County Clerk Don Blevins, whose office serves the state’s second largest city, Lexington, said Bevin may have exceeded his authority because these licenses, a civil transaction, require clerks’ names for historical record. Another legal issues comes from the altered marriage licenses issued to couples in Rowan County since September that don’t include Davis’ name or the name of the county. Because of a question about their legality, the ACLU has asked U.S. District Judge David Bunning to order Davis to reissue the licenses, but Bunning has not yet made a ruling.

Nationally, the most controversial of Bevin’s actions comes from his declaration that he would eradicate health care for Kentucky residents. The state has been touted as an icon of improvement in health care, but Bevin pulled all ads for the state health exchange, Kynect. The earliest that he could shut down Kynect would be in 2017 because the law requires a 12-month notice to the government. Changing to the federal health care exchange, as Bevin has suggested as a possibility, would be more expensive than Kynect. Its annual budget of $28 million is funded by a one-percent assessment on health premiums. A federal exchange requires 3.5 percent in assessment, and dismantling Kynect would cost the state an estimated $23 million.

Some of the people who voted for Bevin are worried about the loss of their health care, but others think that people don’t deserve Medicaid. One of the latter is Angel Strong, an unemployed nurse, who went on Medicaid after she lost her job. “I had never had Medicaid, because I had insurance at my job,” said Strong. “Now I am out of a job and I am looking for another job, but in the meantime I had no income.” Medicaid recipient Strong doesn’t want other people to get Medicaid. She says that they need “tough love” because “[people] want everything they can get for free.” Most of Strong’s neighbors in Jackson County also need financial help for health insurance coverage, but most of these people didn’t consider their loss when they voted.

Rick Prario, 54, found he was eligible for Medicaid after losing his longtime job at a hardware store, but he’s angry because he had to pay the law’s tax penalty for going uninsured in 2014 when he was still working. During that time he skipped treatment for diabetes, high blood pressure, and arthritis, treatment that he now receives on Medicaid. His plan now is to quality for disability that he sees as a surer thing than Medicaid.

During two terms with former Gov. Beshear, the unemployment fell to a 14-year low, and the state’s uninsured rate dropped by over 40 percent. The new GOP governor was exposed as a “con man” and a “pathological liar” during his failed senatorial primary run against Mitch McConnell earlier this year. Among other actions, he failed to pay taxes, got a $200,000 federal grant for a fire in his Connecticut business, told people that he was unaware that he was actually attending a cockfight, claimed graduation from MIT—the list goes on and on. The GOP was so disenchanted with Bevin that they failed to support him for the governor’s race.

Bevin’s lies don’t end there. He’s accused Beshear of leaving Kentucky “burdened with a projected biennial budget shortfall of more than $500 million” despite the million in surplus.

The new governor won’t have an easy term. He has to deal with the only state House of Representatives in a Southern state controlled by Democrats. His first strategy was to appoint Democratic legislators to other positions that paid more, but Speaker Greg Stumbo is fighting Bevin’s takeover in all the issues that drive Kentucky backward. For example, Bevin has promised to repeal state taxes on inventory and inheritances with no plans to replace the revenue.  Bevin’s secretary of state and attorney general are both elected Democrats. AG Andy Beshear is the former governor’s son.

coalBevin may have won because he isn’t a “career politician” (although rigging the voting computers may have had some influence). Kentucky will now have a “laboratory experiment” for people who think that people with no experience and education in a profession will do a better job. By now, however, people may be learning that their Christmas stockings contain lumps of coal instead of something to make their lives better. As the website for Kentucky for Kentucky state, “Nothing says ‘I do not approve of you,’ like a real live chunk of Kentucky’s filthiest export.” It’s too late for this year, however, because they’re sold out, but there’s probably enough lying around in the state that the new governor can find.

Today, December 23, is Festivus Day, made famous by scriptwriter Dan O’Keefe, who wrote for Seinfeld. Celebrated with an aluminum Festivus pole, the holiday includes “Airing of Grievances.” People living in Kentucky will have lots to air for this year’s Festivus Day and most likely much more by Festivus Day 2016, especially those 400,000 people who may lose health care because of Matt Bevin. And the 140,000 who lose the right to vote. And the people who lose salaries and pensions. And ….

August 11, 2015

‘Obamacare’ Good for the Country

Another federal ruling has come down on the Affordable Care Act, and we can only hope that this one is the last. After the Supreme Court once again decided in favor of the ACA, the entire Circuit Court of Appeals for D.C. refused to rehear Sissel v. Department of Health and Human Services. Over a year ago, a three-judge panel had turned down a lawsuit that attempt to strike down the ACA based on a procedural issue that the law should have originated in the House rather than the Senate. Judge Brett Kavanaugh disagreed. That loss led Sissel to ask for the entire court to hear the case. He lost in a unanimous decision.

The D.C. circuit court is split between seven Democrat-appointed judges and four of the most conservative judges nominated by Republican presidents. Sissel might have expected to get a ruling in his favor at least from the conservative judges because the release of a decision took a long time. Instead, the lengthy time before a ruling came from a disagreement about why the court wouldn’t hear the case. Judges disagreed only on academic grounds.

It is unlikely that the Supreme Court will take up Sissel’s case, and the conservative nature of the judges ruling in favor of the ACA may discourage other people from going to court. For example, Judge Janice Rogers Brown, who ruled against Sissel, called the New Deal a “socialist revolution” and claimed that Social Security is a kind of intergenerational cannibalism because of all the “free stuff” that “the political system will permit [Social Security recipients] to extract.”

As time goes one, the ACA continues to get stronger.

A Forbes report by Bruce Japsen, who has covered healthcare and healthcare policies for over 20 years, indicates that unpaid hospital bills drastically declined, both in number and cost, after ACA went completely into effect. Steve Filton, CEO of Universal Health Services (UHS), said that uncompensated care in the company’s hospitals has been on the decline for six quarters. The company’s cost for “doubtful accounts” declined some 17 percent over the first six months of 2015, compared to the same time period in 2014. In 2015, UHS acute care hospitals have seen a “decrease in the aggregate of charity care, uninsured discounts and provision of doubtful accounts as a percentage of gross charges.”

Filton reported something that is obvious to everyone except Republicans. Of the six states with UHC acute care hospitals, two of them—California and Nevada—show a greater participation in Medicaid expansion. The other four states are Florida, Oklahoma, South Carolina, and Texas. A bonus of the ACA is that healthcare stocks are going up, with a surge after the Supreme Court issued its positive ruling in June.

Florida, one of the states that refused Medicaid expansion, denies health insurance to almost one million working poor people. Senate Republicans were in favor of accepting the expansion because the funding would come from the federal government, but Gov. Rick Scott persuaded the House to vote against the working poor. Legislators do understand, however, how important health insurance is: they also voted to keep their own low-cost health insurance. Almost 30,000 state workers, including Scott and Attorney General Pam Bondi (who sued the government over the Affordable Care Act), each pay just $8.34 a month for individual coverage or $30 a month for family coverage. Members of the House, Senate and rank-and-file state employees pay $50 a month for themselves or $180 for family coverage. Their insurance rates are frozen through 2016.

Another Forbes report shows that the ACA has added almost one million jobs in health-related fields through June 2014. The first of over 67 attempts to repeal ACA was called “Repealing the Job-Killing Health Care Law Act.”

A new report in The Journal of the American Medical Association shows that the ACA is a great success especially for minorities previously without healthcare. Over the first two enrollment periods, 10.2 million Americans have received private coverage through Obamacare, and another 12.2 million have been covered by Medicaid and the Children’s Health Program. Costs for Medicaid have dramatically dropped, and the program is fully funded for the next thirty years.

Six measures were used in the survey: self-reported rates of being uninsured, no personal physician, difficult access to medications, inability to afford needed care, overall health status, and health-related activity limitations. Five of these measures improved after people were able to purchase insurance on ACA exchanges; only days limited by poor health didn’t improve.

The study concluded:

“As states continue to debate whether to expand Medicaid under the ACA, these results add to the growing body of research indicating that such expansions are associated with significant benefits for low-income populations.”

An ACA provision mandating that insurers must pay 80 percent of the premiums on health care saved individuals or their employers $5 billion in rebates or premium adjustments for 2011 and 2012. Unlike dire predictions, few—if any—insurers went out of business.

Despite the overwhelmingly positive news about the ACA, the GOP continues to waste its time trying to repeal the law—the last time at the end of July. Majority Leader Mitch McConnell says that he is prepared to hold another vote “to bring an end to the nightmare of Obamacare.” This is a dream that patients, investors, and healthcare companies want to preserve.

In mid-June, the nonpartisan Congressional Budget Office reported that a ACA repeal would “probably increase budget deficits with or without considering the effects of macroeconomic feedback.” The deficit could increase up to $353 billion over a decade. The repeal would also add 19 million people to those uninsured by 2016 and grow by several million in the following years.

Media and candidates are constantly criticizing Donald Trump for not having specifics in carrying out his ideas, but Republicans have the same problem with healthcare reform. After five years of claiming that they will have a plan, it still doesn’t exist. At this time, their only plan is to add billions to the deficit while denying health care to millions of people.

Each state is allowed to set the income level at which people can no longer get Medicaid. In Texas, for example, a family of four must make less than 20 percent of the poverty level to qualify. That’s $4,531 in total annual income. If the family makes $4,532, then they can’t get Medicaid. In Alabama, the cutoff is $4,293. In a Catch-22 a family of four that makes over one-fourth the poverty level in Texas can’t get subsidies for health insurance until it hits 100 percent of the poverty level–$18,128 a year. In addition, childless adults cannot get any Medicaid in all the 19 states without expansion except for Wisconsin.

Two years after ACA became the law of the land, only one state has a rate of uninsured citizens over 20 percent—Texas with 21 percent of its residents lacking health insurance. Before ACA, 14 states were 20 percent or above. California halved its uninsured rate, and both Arkansas and Kentucky dropped their rates from 20 percent to 9 percent in these two years. The national average went from 20 percent uninsured to 13.2 percent with the highest rates for states with Republican governors. New England has insured 95 percent of its population; Rhode Island has only 2.7 percent uninsured.

As of now, 31 states have accepted the Medicaid expansion and its accompanying federal funding, an increase from 26 states a year ago. Time is gradually changing perspectives as more people demand health care and people continue to die without health insurance. In the same year, approval of the ACA has gone up 10 points while disapproval has gone down 12 points. The 47-percent approval is almost triple the 17-percent approval rate of Congress.

approval

During the first GOP presidential candidate debate, Ohio Gov. John Kasich said that the state’s Medicaid expansion cut down the prison population. He said, “Eighty percent of the people in our prisons have addictions or problems,” Kasich added. “We now treat them in the prisons, release them in the community and the recidivism rate is 10 percent….” The average rate in the United State is 52 percent. Ohio is one of 31 states saving money and keeping people alive with Medicaid expansion.

March 23, 2015

Happy Birthday, ‘Obamacare’

Today is the Affordable Care Act’s fifth birthday. For five years, most of the GOP legislators have been making predictions about the law’s leading the entire country to wrack and ruin. The following dozen failed predictions show how all these people have been wrong:

happy birthday Failed Prediction #1 – Americans won’t enroll in the ACA: The demand was so great that the website sometimes crashed from the heavy usage. About 8 million people signed up for private insurance coverage in 2014, and the number rose to 11.4 million in 2015. While it was hard to sign up for health care on the exchanges last year, it was harder to be uninsured or underinsured.

Failed Prediction #2 – The ACA won’t meet its enrollment goals: In its first two years, enrollment totals exceeded preliminary projections.

Failed Prediction #3 – Insurers will want no part of the ACA system: Many insurers see the ACA as a major growth opportunity that lets them expand in the individual market.

Failed Prediction #4 – The ACA will cause the economy to suffer and kill jobs: In one press conference, House Speaker John Boehner (R-OH) used the phrase “job-killing” an average of every two minutes while talking about the ACA. Yet the U.S. has had 59 consecutive months of job growth since October 2010, the longest stretch of time in history.  National data also shows no indication of employers hiring people under 30 hours a week to avoid the ACA insurance mandate. The average length of the work-week, which dropped during the recession, recently matched pre-2010 levels. Using interviews with major U.S. employers, Bloomberg found that the law “is putting such a small dent in the profits of U.S. companies that many refer to its impact as “not material” or “not significant.” It decided that “the biggest entitlement legislation in a generation is causing barely a ripple in corporate America.”

Failed Prediction #5 – People who enrolled wouldn’t pay their premiums: Again the GOP was wrong. Five months into last year, over 91% of the 8 million consumers who enrolled through an ACA exchange marketplace paid their premiums.

Failed Prediction #6: People would see exorbitant premiums: Those who qualify for tax credits through the insurance exchange pay an average of $82 per month for premiums—one-fourth of the expenditure without financial help. More people who changed from individual insurance to exchanges have lower premiums.

Failed Prediction #7 – Premiums will shoot up next year: State-by-state information shows that more insurers coming to the market are pressuring prices to go down. In 2015, premiums for the ACA’s mid-level plans rose by an average of 2 percent. In 48 major cities, prices for these benchmark plans actually fell by 0.2 percent, compared to the 10-percent increases before the ACA.

Failed Prediction #8 – The ACA helps only those with coverage: Republicans are wrong.

Failed Prediction #9 – The ACA will lead to a “net loss” on overall coverage: Boehner argued that fewer people had health insurance after the health law’s insurance expansion than prior to it, but the uninsured rate has dropped by one-fourth. In Minnesota it’s gone down by 40 percent, and in some cities the number will shrink by 60 percent in cities with expanded Medicaid. People who would not get subsidies still got the same insurance plans by going to an insurance broker. Boehner also ignored the expansion of 9.1 million enrollees on Medicaid.

Failed Prediction #10 – The ACA will lead to higher deficits and a weaker fiscal footing for the nation: The GOP, the party that actually raises the deficit, told the country that “Obamacare” would “bankrupt” the country. In April 2014, the Congressional Budget Office reduced its budget forecast by $100 billion, less than it expected to spend during the first projection in January 2010. The CBO reduced its 10-year estimate of ACA cost by 20 percent and its Medicaid costs attributable to the law by 8 percent, partly because people with health insurance no longer rely on the emergency room for health care.

Failed Prediction #11 – Americans will end up hating the coverage they receive through the ACA: A new Gallup poll shows that 71 percent find their coverage through exchanges to be good or excellent, and another 19 percent said the coverage was fair. Only 9 percent gave it a poor rating.

Failed Prediction #12 – “Obamacare” will mostly sign up people who already have insurance:  A Kaiser Family Foundation survey finds that 57 percent of enrollees previously lacked insurance.

More failed projections: there is no “death spiral,” or “death panels,” or “rate shock.” Not one prediction has lived up to scrutiny. And not one prominent Republican is willing to admit the failed predictions or even explanations for these mistakes and misjudgments. Instead, they’re still busy trying to repeal the law.

Facts will not change the minds of many in opposition, as Jonathan Chait pointed out:

“Suppose you strongly objected to the idea that your city should own a bunch of buildings where people can go borrow books for free. (Some people do!) If you couldn’t persuade a majority of fellow citizens of your conceptual objections to libraries, you might try arguing that the library scheme was doomed to collapse in cost overruns, or that nobody would ever use them, or that shelves of heavy books would be routinely toppling over and killing small children. But the fact is that running buildings where people can check out books, and running exchanges where people can purchase basic health insurance packages, are both things that governments can do.”

One GOP complaint is that “Obamacare” helps only the poor. It is true that the poorest people get free Medicaid, and those up to an income of $94,000 a year for a family of four can get tax credits. People who receive insurance from their employees are having their coverage paid by “other people’s money.”

Employer-sponsored insurance get tax deductions, giving the largest benefits to those who earn the most money as compared to the ACA which gives the most to those who earn the least. For example, newly-announced presidential candidate Sen. Ted Cruz’s (R-TX) premiums, up to $40,000 for the year for his family, were paid by his wife’s employer, Goldman Sachs. Cruz will be shopping for health insurance because his wife has taken an unpaid leave while he runs for president.

Sen. John Barrasso (R-WY) may have summarized the GOP complaints with this comment on the floor of the Senate: “It’s time for the White House to stop celebrating [the ACA] and start thinking about the people.” Huh?

What’s ahead for the Affordable Care Act?  After voting dozens of time to repeal the ACA, the GOP is trying to pass a budget that would double the uninsured rate and eliminate $1 trillion in tax revenue that pays for the law. Republicans have no plan to help the millions of families losing affordable medical care if they succeed. Rep. Paul Ryan (R-WI) has only one suggestion: he urged state lawmakers to stop state insurance exchanges if the Supreme Court rules that this as a requirement for the ACA. That’s what he told state legislators last week during a conference call organized by the conservative think tank Foundation for Government Accountability.

If the Supreme Court were to rule for mandated state exchanges, subsidies in the mostly blue states would continue while millions of consumers in GOP-run states would go without. Michigan and Ohio are intending to set up the exchanges that Ryan warns against because no one should do what the White House wants, even if it puts constituents in jeopardy.

Missouri is a prime example of problems with GOP legislators. GOP legislators have threatened to filibuster any Medicaid expansion bill and Bob Onder, a new state senator, has proposed a bill to keep an insurance company from selling policies in the state if it accepts federal subsidies sold on the federal health exchange. The state refuses to accept billions of federal dollars to offer Medicaid coverage to approximately 300,000 uninsured residents. Onder said, “To expand Medicaid would only put further stress on a system that’s already strained,” Onder said. A single mother with two children must make less than $3,700 to get Medicaid, and rural hospitals are facing either huge cutbacks or closure because the state refuses Medicaid expansion.

aca cowThe GOP-led legislature, however, has passed a bill to insure cows in the state. It would subsidize up to 70 percent of farmers’ premium payments for dairy insurance. The House passed it by 110 to 49, and the Senate did better at 31-2. Rep. Jeremy LaFaver (D-MO) called it the “Affordable Cow Act” because insurance subsidies for cows are fine but “not for people.”

Maybe some day, Republicans will figure out that “Obamacare” should be called “GOP Cares.”

Republican_Obamacare

May 13, 2014

Spread the Word! ACA Works!

Filed under: Uncategorized — trp2011 @ 10:34 PM
Tags: , ,

What do Republicans think of the Affordable Care Act now? My centrist friend said that is was a nice idea but …. There’s been a lot of mellowing in the past year. At the same time, the House has gone quiet about the ACA.

After over 50 votes against ACA, the House has no scheduled votes or hearings about ACA and moved its focus to Benghazi. Only one panel of jurisdiction commented on the ACA to The Hill even after a number of inquiries, and GOP campaign committees refuse to say whether they have plans for any new efforts. The chart shows that the leading conservative network, Fox, joined lawmakers in ignoring the ACA.

benghaziobamacare550

National Republican Senatorial Committee spokeswoman Brook Hougesen didn’t notice that the focus had changed from ACA to Benghazi. In a statement, she wrote, “There is absolutely zero evidence that any Republican is talking about ObamaCare less.”

Reasons that the GOP shies away from the ACA:

  • Insurance companies have had to rebate over $1.5 billion because the new law mandates insurance companies send 80 percent of premiums to pay for treatment and medical costs.
  • Health insurance executives summoned to a House hearing testified that the law had not resulted in a government takeover of the industry and that their stock prices had increased since the law was passed. They also refused to agree with the GOP position that insurance premiums would sharply increase next year.
  • Over 8 million people in the United States have used the federal exchange to sign up for coverage.
  • Most of the people who signed up for the open enrollment period have paid their premiums.
  • Twelve million more nonelderly people will have health insurance in 2014 because of the ACA.
  • The ACA will cost $104 billion less over the next decade than projected according to nonpartisan budget analysists because premiums will require a lower subsidy than previously thought.

As the uninsurance rate drops to record lows, it is declining the fastest among the communities that usually lack health care, non-white and lower-income people. Between the last quarter of 2013 and the first one of 2014, the uninsurance rate fell by 7.1 percent among black adults. The uninsurance rate was down by 5.5 points with both Hispanics and people with an annual household income of under $36,000. The 13.4 percent rate in April is the lowest since Gallup began tracking monthly data six years ago. The decline occurred with the first open enrollment period starting last October.

percentage by uninsured new

Because most the GOP-led states have refused ACA’s optional Medicaid expansion, those states continued to have higher uninsurance rates than those who don’t deny health care for millions of the working poor. A report from the Kaiser Family Foundation rating health using 42 different issues from insurance coverage to cancer deaths shows the serious problems primarily in the South. As an example, a black man living in Mississippi has a shorter life expectancy than the average person living in the United States in 1960. Sixteen states in the bottom half of the rankings have refused to expand Medicaid. In Mississippi, a family of four making more than $6,800 a year is ineligible for Medicaid. Adults without dependent children are completely ineligible despite the level of their income. The cutoffs for Alabama at $3,221 and Texas at $3,737 are worse.

worst states for health care

The Massachusetts healthcare plan, similar to the ACA, shows how the law will save lives. The state passed its law in 2006; in the first four years of the law 320 fewer people in the state died than would have been predicted. That’s one life for every 830 newly insured residents. The state’s death rate dropped 2.9 percent when compared to similar places outside Massachusetts that did not expand health coverage.

White residents are living longer, but the biggest improvement is the 4.6 percent drop for blacks, Asians, and Latinos. The lead author said the most significant decline was in conditions that could be prevented or delayed with medical care including cancer, infections, and heart disease. No statistical differences were in deaths from causes such as car crashes, homicide, and suicide.

Some conservative responsed to the report from Massachusetts by saying that saving people’s lives is all very nice but it’s not the government’s role. These are the same people who are willing to give up their privacy if they think if will make them safer. These are the same people who are willing to spend trillions of dollars to kill people in other countries. I cannot understand why these people think that saving lives from accessible health care is wrong.

Kentucky is a classic case of the healthcare dilemma for the GOP. Gov. Steve Beshear, a Democrat, embraced the law with a state exchange called Kynect. He now has a 55 percent approval rating. The result was enrollment of 413,410 people, 9.6 percent of the state population. About three-fourths of these people had not had any health insurance, and over half of enrollees are under 35. The irony is that the majority of them don’t like “Obamacare” although they are pleased with the Affordable Care Act—a confusion that the GOP has promoted.

One of Kentucky’s senators, Minority Leader Mitch McConnell, hates both Obamacare and the ACA. Pushed into a corner about what would happen to the 300,000 previously uninsured people if he succeeded in repealing the law, he resorted to a high-risk pool, but only at the state level. In the past, Kentucky Access helped provide private insurance for people in the state who couldn’t get insurance because of pre-existing conditions. The program started in 2001 and closed because the ACA made it redundant.

Kentucky Access was too expensive for most people, and in 2013 only 3,988 Kentuckians had coverage through this program that was far inferior to the ACA.  The average premium was $680 per month, and the popular plan with a pharmacy rider cost a 64-year-old man a monthly premium of $1,118. These costs may be more than ten times as much as ACA premiums for low-income workers.

A conservative with a 32-percent approval rating is running on the position that he would take almost 300,000 off of insurance and give the remaining few thousand worse coverage for a lot more money. This is the Republican plan.

March 22, 2014

GOP Approach to Health Care

Did you hear that the House GOP members have a new health care reform plan. A couple of months ago Majority Leader Eric Cantor (R-VA) said, “This year, we will rally around an alternative to ObamaCare and pass it on the floor of the House.” The House has already passed at least 51 bills about the Affordable Care Act, all of which have gone nowhere. In a more cautious approach a month later, House Speaker John Boehner (R-OH) said that his GOP leaders would have “conversations” about alternatives.

“A Stronger Health Care System: The GOP Plan for Freedom, Flexibility, & Peace of Mind” proposes expanding high-risk insurance pools, promoting health savings accounts, and inducing small businesses to combine coverage purchasing. To help the insurance companies make more money, the GOP wants the ability to buy insurance across state lines. The bill would include guaranteed policy renewability and changes in medical-malpractice regulations. Five years of secret meetings have led to this grand idea.

House Majority Whip Kevin McCarthy (R-CA) said that the new plan would provide a side-by-side comparison of their idea with the existing one. Hopefully it will show which approach covers more uninsured, offers more consumer protections, improve the economy, and help lower costs without sacrificing the quality of care. As I said, it’s been five years ….

 The major problem of the GOP comparison may be that they don’t know any facts about the ACA. Boehner used his “simple math” to determine that fewer people have health care under ACA. As his proclamation stated, “I believe ….” Unfortunately, beliefs aren’t always the same as facts.

The people who he “believes” lost their insurance moved automatically into other policies with the same companies. The Washington Post, not known for a liberal bent, has figures showing that almost 9 million people were added to the insurance roles:

 

  • 3.4 million — healthcare.gov sign-ups, assuming 80 percent paid, though February
  • 2.4 million — lowest estimate for new Medicaid enrollment through January
  • 2.2 million — young adults added to parents’ plans (2010 average to first two quarters of 2013)
  • 500,000 — off-exchange enrollments

 

In tracking state-by-state numbers, blogger Charles Gaba calculates the actual number of people adding insurance through mid-March at 14 million. More conservative approaches end up with at least 13 million.

Giving Boehner the benefit of the doubt that he’s not lying about the statistics, people can see that he doesn’t care about details of his information to the press. He’s pushing election-year rhetoric, and some media buy it without fact-checking. That includes his false “belief” that “tens of millions of Americans are going to lose their policies next year and the year after.”

Boehner knew he was in trouble when a journalist asked him about ACA, and he changed the subject to “jobs”—another area that the GOP is notoriously bad in addressing. He tries to attach “Obamacare” to the shortage of employment. The GOP can’t run against affordable medical care for families, so they just declare that the ACA is responsible for every problem in the country—stagnant wages, economy, etc. There’s no connection, but the GOP is working hard to make people believe this.

Meanwhile the GOP proposes one after another story about the high costs of ACA that are consistently debunked. For example, former New Hampshire GOP chair, Fergus Cullen, a free-lance writer and owner of a private company, wrote a piece for the New Hampshire Union Leader trying to show how his premiums would increase almost 20 percent in just one year of ACA. His visit to the healthcare exchange surprised him: it was easy to use, took little time, and, most amazing, saved him over $1,000 a month. And that’s without tax credits that he may be able to get for himself, his wife, and his three children.

Anyone saving this much money might be grateful and clarify the misinformation that he passed onto the public, but not Cullen. He proceeded to complain that the website knew too much about him. The ACA exchanges use the same technology that credit agencies use to provide instant credit approval—like Target that suffered information breeches for about 40 percent of the people in the United States.  If he’s shocked by the information now, wait until he signs up for Medicare and Social Security.

The fake stories about the excessive premium costs from Koch-financed Americans for Prosperity are disappearing and replaced by more vague statements. But that change, there was Wanda of Marion, Arkansas, featured front and center in $700,000 of ads. At least Wanda’s complaint about a cancellation from Blue Cross Blue Shield was more moderate than the Michigan ad falsely stating that ACA endangers the lives of cancer patients.

Not one person in Arkansas is having a private health care plan canceled. That’s because the state’s insurance providers follow federal guidelines allowing people with non-compliant plans to stay them until October 2017. Only the 100,000 people who signed up for federally-funded Medicaid, only to have the state reverse its decision to take the money, lost their health care. Only the state has cancelled anyone’s plans because they refused the ACA.

People who really care about saving money on health care would vote for universal health care, a plan promoted by the conservatives two decades ago. People in the U.S. spend an average of $8,233 a year. That’s more than two and a half times more than in most developed countries throughout the world, including France, Sweden, and the United Kingdom.

Yet the U.S. has lower life expectancy and higher infant mortality than most high-income countries. People in this country are less healthy during their entire lives than people in 16 other wealthy nations. Each year it gets worse as the gap widens.

The ACA, which conservatives accuse of being “socialist,” still leaves private companies in control for those without Medicare, Veterans Care, or Medicaid, companies making more money through administrative costs and profit. A comparison of access to care, quality of care, and costs found all three are superior in Canada as compared to the United States. The U.S. pays an average of 31 percent for administrative costs; Canada pays 1.3 percent, not counting costs for private supplemental plans available to Canadians. Denmark’s administrative costs are 4.3 percent of total health care spending.

Private companies are those with staff to determine whether medical care, sometimes a matter of life and death, should be provided. Medicare, a government controlled health insurance, doesn’t do this.

Leave it to Jon Stewart to show how bad health care is in the United States.  The Daily Show is billed as a comedy show, but its interviews inexplicably succeed in uncovering the truth. A classic example is Aasif Mandvi’s interview of Fox commentator Todd Wilemon that left the conservative speechless.

Wilemon begins with the standard conservative argument:

 “The U.S. healthcare system is the best in the world. But now with Obamacare our choices have been limited. You know, people are going to be seeing this cost more. I am getting less. I am not going to be happy.”

Wilemon described a worst-case scenario:

“We have longer lines. You may have to bring your own sheets. In Russia they reuse syringes. The scenario where we could slip into Third World status would be slow, probably.”

Mandvi travels with founder of Remote Area Medical (RAM) Stan Brock, to find one of these horrible Third World places where people receive free medical services because they cannot afford healthcare. Together they find a location with shockingly poor health care, still reeling from Civil War and suffering high rates of cancer and heart disease. One-fourth of the people live in poverty. He describes these conditions to Wilemon who said:

“This is how bad it could get. If we keep going down the path of more government control, less innovation. I don’t know if we can be that place unless a great catastrophe happens in this country.”

The speechless part came when Mandvi explained that he had gone with Brock to Knoxville (TN). About 90 percent of RAM work is in the United States because of the dire conditions in this country. The speechless part lasts for 13 seconds before Wilemon came up with his answer: “If you are poor, stop being poor.” Check out the entire clip here.

The U.S. ranks 37th in the world in health care. The conservatives want to put it lower.

December 10, 2013

The Poor on Human Rights Day

Sixty-five years ago, the United Nations adopted the UN Universal Declaration of Human Rights; its drafting committee was chaired by Eleanor Roosevelt because of her expertise. The document, celebrated every December 10’s Human Rights Day, defines the world’s commitment to human rights as “the foundation of freedom, justice and peace in the world.” Human rights standards for everyone include “the right to life, liberty and nationality, to freedom of thought, conscience and religion, to work, to be educated, [and] to take part in government.”

From the beginning of years of the 21st century, the United States has been increasingly negligent about human rights as the government supported torture, unjustified imprisonment, and other unethical and illegal violence. Within this country, however, the government has failed millions of people in poverty as Congress has increasingly failed to support a safety net while creating an economy that promotes this poverty.

Because of  bad or nonexistent legislation and a president who struggled to compromise with recalcitrant, extortionist lawmakers in the House, the poor are in the midst of a losing game. The sequester that further puts the screws to the poor digs deeper on January 1, one week after the Christian holiday that celebrates a compassionate Jesus. Here are a few experiences, the poor can expect, thanks to GOP House members:

Homelessness: Budget cuts from increased sequestration will take rental assistance vouchers away from 140,000 low-income families by the beginning of next year, making housing more expensive as agencies raise costs to offset the budget cuts. About three million disabled seniors and families will be affected to save the $2 billion that the government shutdown cost in back-pay to federal workers.

Cold: Those who can stay in their homes may not be able to heat it. Sequester cuts to the Low Income Home Energy Assistance Program (LIHEAP) meant that 300,000 low-income families in 2013 were denied government support for energy costs. 

Hunger: The recent reduction in Supplemental Nutrition Assistance Program (SNAP) benefits, affecting more than 47 million Americans, is the largest wholesale cut in the program since Congress passed the first Food Stamps Act in 1964. Those cuts were made on November 1, but the House isn’t satisfied. Their goal is to take $39 billion from SNAP during the next decade. The result is loss of benefits for 3.8 million low-income people in the upcoming year. An additional 2.8 million will lose benefits each year. Last year alone, SNAP kept 4 million people out of poverty.

Cutting SNAP is just a start in creating more hunger. Cuts to Meals on Wheels will cost poor seniors 4 to 18 million meals next year.  The Women, Infants, and Children program (WIC), which provides health care referrals and nutrition to poor pregnant and postpartum women and children up to age five, took cuts of $500 million this year with far more next year.

Lack of Education: Head Start started to take children out of its program last March and removed 57,000 children from their classrooms in September. More than half of the public schools fired personnel because of cuts. Forty percent of children who don’t receive early childhood education are more likely to become a parent as a teenager, 25 percent are more likely to drop out of school, and 70 percent are more likely to be arrested for a violent crime.

Joblessness: The unemployment program in the United States is one of the worst in the developed world, and it’s getting worse. People out of work for 27 weeks or more–40 percent of the unemployed –have already begun and will continue to lose a large portion of their benefits between January and March. Eight percent of this year’s sequestration cuts are coming from unemployment insurance.

Sen. Rand Paul (R-KY) has given the party line that the GOP is doing unemployed people a favor by taking away their benefits because that will force them to get jobs. Evidence shows that government assistance helps the job searches of 4.4 million people. On January 1, 1.3 million will lose the extended jobless benefits if Congress doesn’t take action—which looks highly unlikely. Cuts to the Temporary Assistance for Needy Families program (TANF, or welfare) means even less of safety net.

A proposed shift in Social Security would keep fewer jobs available for the unemployed. President Obama proposes cuts in this program for 2014 through a new formula called Chained CPI. Instead of building an economy that contributes more taxes to the Social Security program, the government plans to keep more money out of circulation, causing more joblessness from fewer consumers.

Sickness: In the 25 states where GOP governors have refused to accept federal funding for Medicaid, a gap between the state’s version of Medicaid and the level for exchanges leaves more than 5 million people in poverty without health insurance. The U.S. Supreme Court rejected the part of the Affordable Care Act requiring all states to extend Medicaid to people with household income up to 133 percent of the federal poverty level despite the federal government picking up the entire tab for the first three years and then gradually phased back to 90 percent.

The law states that people over 100 percent of the poverty line can go to exchanges, but those under 100 percent are ineligible. It was assumed that Medicaid would take care of them. The GOP governors changed all that. Coverage in Texas is almost non-existent for the poor: Medicaid is available to only these making less than 25 percent of the poverty level. A family of three cannot participate on the exchange if they make over $4,000, the state’s level for Medicaid, and $19,500, 100 percent poverty level.

Today, a bipartisan Congressional committee chaired by Rep. Paul Ryan (R-WI) and Sen. Patty Murray (D-WA) released a two-year budget plan that they hope will pass both chambers. The poor is sure to not benefit from Paul’s work. He continues to believe that poverty can be cured by “spiritual redemption” as he again said in a speech last week at the Heritage Foundation. There were no specifics of how religion will put food on the table.

A missing part of the budget deal is any tax reform. Former Republican presidential nominee Mitt Romney’s low tax rate is a prime example of the nation’s tax abuses. The “carried-interest loophole” allows investors to have their entire income taxed as if they were capital gains, saving them 19.6 percent on income over $400,000. Using the 20-percent capital gain tax rate instead of the 39.9-percent income rate takes $25 billion from the government and lowers the percentage of taxes paid by the wealthy below those in the middle class.

The refusal of 25 GOP governors to accept federal Medicaid funding is both driving up rates in their own states’ exchanges by 15 percent and returning billions of dollars back to the federal government. That means that everyone on exchanges have to pay much more, and the state doesn’t have the jobs resulting from improved economy that the federal infusion would provide. Just 15 of these states, including Texas, have turned down $8.4 billion in assistance.

The estimate of reduction to the deficit from the ACA has increased since the original projections. In 2020, Medicare spending will be $137 billion lower than thought in 2010, and Medicaid spending will be 16 percent, $85 billion, lower. Private health insurance premiums are expected to be about 9 percent lower. These projections are assuming a temporary slowdown, but the savings could actually be $750 billion over a decade.

The proposed deal is split between revenues through fees and spending cuts. Travelers will pay higher prices on airline tickets, and federal workers will have to contribute more to pensions. Millionaires and billionaires are safe from higher taxes. Defense spending takes half reduction of sequestration for 2014 of $45 billion, and non-defense discretionary spending takes the rest. The sequester’s cuts to mandatory spending are not affected. There is no chance of an extension for unemployment benefits.

As of today, the House plans to vote on Friday to pass the budget deal and delay the SGR’s cuts to Medicare’s doctor pay. There are no changes to Social Security and Medicare in the deal, but amendments can always change that. If conservatives have their way there will be another “continuing resolution” for a few days so that Republicans can avoid talking about issues such as jobs.

 

The struggle will be between the Republicans who are afraid that they will lose their next elections because the country knows they are unreasonable and the extremists who believe that no one can defeat. Three years ago, the mainstream Republicans thought the Tea Party would save them. Now they see them as a menace.

cartoon snake tea party

Later this week, the fight begins as conservative Republicans push to inflict the poor with more homelessness, cold, hunger, lack of education and jobs, and sickness because they think the poor deserve to suffer. Even if today is Human Rights Day.

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