Nel's New Day

July 26, 2017

GOP Can’t Create

Filed under: Health Care — trp2011 @ 11:31 PM
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Debate started today on Trumpcare in the senate after 50 GOP senators voted yesterday to move forward with the process. That motion passed because Sen. John McCain (R-AZ) returned after surgery last week for a brain tumor. George Zornick laid out the process. The Senate will have several votes on different bills—with those voting not knowing what is in them. Understanding of the bills is not important for Republicans; their goal is to get anything passed. Any success will continue the secrecy as Senate leaders hide with House leaders to get anything to Dictator Donald Trump (DDT) before his 200th day.

Under consideration are the House health care bill (the AHCA); some version of the Senate health care bill (the BCRA) with changes pushed by Sen. Ted Cruz (R-TX); a straight repeal vote pushed by Sen. Rand Paul (R-KY); and one called a “skinny repeal” bill. The first failure was the Better Care Reconciliation Act with Sen. Ted Cruz’s provision was the first to lose in a vote by 43 to 57. This one needed 60 votes because it didn’t meet the requirements for the reconciliation process. Nine GOP senators opposed the bill. The next bill to fail was the amendment from Sen. Rand Paul (R-KY) similar to the 2015 bill to completely repeal the Affordable Care Act. Paul’s amendment lost by 45-52 as seven GOP senators joined Democrats in opposition.

This chart shows the divergence of GOP senators between the first two options.

The most popular bill among Republicans may be what’s called the “skinny repeal.” Measures of this include repeal of the mandates for individual insurance and requirements for larger employers providing insurance for their workers. It would also end some taxes, including on medical device makers.  The CBO has issued its score that the bill will eradicate insurance for 16 million people and increase premiums by 20 percent. Earlier the CBO concluded that loss of the individual mandate negatively impacts the insurance market. Most Republicans don’t care: they just want to get something passed so that they can meet in secret with the House to have a bill that they can get through Congress. The content doesn’t matter. As VP Mike Pence said, “Inaction is not an option.”

McCain filed amendments today about Medicaid in support for Arizona, one of 31 states that expanded Medicaid under the ACA. He wants the phase out to extend ten years and increase the growth rate for payments to reflect health care inflation. Later this week, senators will endure a “vote-a-rama” with rapid-fire votes on all amendments. Democrats have stopped putting up amendments because no one knows what is in any of the bills. As Sen. Ben Cardin (D-MD) pointed out, how can anyone prepare amendments to legislation without knowing what’s being amended?

One amendment planned by Sen. Steve Daines (R-MT) is for a single-payer plan. He doesn’t want the plan; he just wants to play off the split among Democrats for this type of health care. Although Sen. Bernie Sanders (I-VT) supports “Medicare for All,” he has said that he will not be voting in favor of this amendment because “the Democratic caucus will not participate in the Republicans’ sham process.” He added that “no amendment will get a vote until we see the final legislation and know what bill we are amending.”

Blue Cross/Blue Shield told senators that a repeal of the ACA insurance mandate would be a serious problem if it doesn’t have a replacement that ensures people get and maintain insurance coverage. That puts the giant insurance company against the “skinny repeal.”

Some GOP governors also virulently oppose the “skinny” approach, and their opinion could sway at least one senator toward no. Earlier Rep. Dean Heller (R-NV) had said that he would support a bill that didn’t cut Medicaid although he’s smart enough to worry about cuts in Medicaid after the bill goes to conference. He also said that he will support his GOP governor, Brian Sandoval, who opposes the bill. That could make him the third no, if Sens. Susan Collins (R-ME) and Lisa Murkowski (R-AK) stick to their no votes to even proceed. Heller is up for re-election next year, and DDT had pushed his buddies, billionaire casino moguls and GOP donors Sheldon Adleson and Steve Wynn, to twist Heller’s arm. The question is which side Heller picks.

Before he lost his election to a Tea Partier, former House Majority Leader Eric Cantor (R-VA) led the charge to repeal “Obamacare.” He promised voters that Republicans would eliminate the Affordable Care Act if they were elected. Not being in Congress has given Cantor the freedom to tell the truth: he said that the GOP used “that anger working for you,” that they never intended to follow through. About the ACA repeal, Cantor said:

“To give the impression that if Republicans were in control of the House and Senate, that we could do that when Obama was still in office — I never believed it.”

Cantor feels partially responsible for the current mess surrounding the health care debate and the negative part of his party “that says if it’s not everything, then it can’t be conservative.” He prefers working in the private sector because of “the deliberateness and the thoughtfulness.” Too bad that Congress now chooses an opposite path. The fight has turned vicious. Rep. Buddy Carter (R-GA) said somebody needs to go to the Senate and “snatch a knot in their ass,” referring to Murkowski. The folksy statement means to beat up or badly injure. Rep. Blake Farenthold (R-TX) said that he would “settle this Aaron-Burr style” if they were men, referring to Murkowski and Collins (ME) who voted against proceeding with Trumpcare. Vice President Burr mortally wounded Treasury Secretary Alexander Hamilton in a duel.

DDT has been very clear that he has no idea how health care works. He even talked to the NYT about how young people could buy coverage for $12 a year. Before his interview, DDT also said that Trumpcare would offer “better coverage for low-income Americans” than the ACA, a complete fantasy, and that the GOP plan is “more generous than Obamacare.” He promised that “premiums will be down 60 and 70 percent” when they would skyrocket. Sen. Bill Cassidy (R-LA) may be echoing many GOP legislators when he claims that DDT is “about broad principles,” not specifics. All DDT needs to understand, according to Cassidy, is “the principle … that there would be a replace associated with repeal. In one week, DDT tweeted support for a bipartisan repeal and replace plan, failure of Obamacare, and a senate sales pitch for Trumpcare that strips coverage from over 20 million people. DDT’s sole principle is passing a bill, any bill.

The senators accompany DDT in ignorance. Asked last week which bill will be up for a vote, Sen. John Cornyn (R-TX) replied, “I suspect it will be anything senators want to vote on. If a senator wants to offer an amendment that’s the 2015 [Obamacare repeal] bill, they can do that.” And indeed Paul did. In answer to a question about whether senators should know the content of the bill before the vote, Cornyn said, “That’s a luxury we don’t have.”

The CBO scoring for the “repeal and replace” plan indicates that a deductible for a standard insurance plan in 2026 would be $13,000. Under current law, an individual making $56,800 would have a deductible of $5,000, while someone making $26,500 would have an $800 deductible. The GOP plan tries to have lower premiums which equates much high deductibles.

Polls oppose the GOP drive to not provide health care for people. A recent poll shows that 62 percent think that the federal government is responsible for healthcare for all, a number up from 52 percent just three months ago. Only 13 percent want the ACA repealed without a replacement. And 80 percent of people think that Republicans should work with Democrats, something that the GOP has stalwartly refused to do. Patrick Murphy is one example of this majority. He said, “Everybody needs some sort of health insurance. They’re trying to repeal Obamacare but they don’t have anything in place. I can’t remember why I opposed it.”

Everyone agrees that the Affordable Care Act needs fixing. That was a consensus when it became law. The Democrats weakened the plan when they catered to the Republicans to get their support, and the Republicans turned tail and refused to vote for the ideas that they provided. But something that needs fixing should be fixed. A house that needs a new roof doesn’t need to be burned down, but that’s what the GOP wants to do with the ACA. The party that has spent decades saying no can’t figure out how to create something—it just wants to burn everything down.

The GOP is the only major party in any advanced democracy on the planet to oppose health care as a core benefit of citizenship, and people are terrified that Republicans will be successful in achieving their goal.

January 14, 2017

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

Filed under: Health Care — trp2011 @ 10:17 PM
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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.

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