John Hanno March 14, 2017
Don’t be bamboozled; this ‘pig in a poke’ health insurance farce is not a ‘health care plan.’ It’s first of all, a ‘tax cut plan’ for the richest Americans and an ‘un-health plan’ for the rest of us. Senator Bernie Sanders believes this (1% er, American Health Care Plan) is simply a “$275 billion tax cut plan, transferring enormous amounts from the poorest and oldest Americans to the very rich.”
These Republi-cons have been lying to voters for the last 8 years. Obamacare is not collapsing; is not in a death spiral. 63% of folks think Obamacare is good, want to keep it and want to improve it, not destroy it. West Virginia, our poorest health care state went from 17.6% uninsured to 7%. A success by anyone’s standards. And dozens of other poor, particularly Red states, have also benefited from the ACA. 45 states had statistically significantly reductions in the uninsured. Arkansas dropped from 23% to 9.6%, Kentucky, with arguably the most successful ACA implementation, dropped from 20.5% to 7.5% and Oregon dropped from 19.5% to 7.3%.
The Republi-cons cried over and over that the Democrats pushed the PPACA (Patient Protection and Affordable Care Act) through without any input from the Republicans; but President Obama, his experts and the Democrats worked extremely hard, through endless Republican obstruction, holding more than 70 meeting over 14 months to cobble together that bill. President Obama begged the Republicans to come up with credible amendments instead of obstructing the process. This high-pocritical Republican crew just held a couple of bull crap closed door hearings and are attempting to rush this bill straight to the House floor with not one hearing with the Democrats.
King Donald repeated throughout the campaign that he would repeal and replace Obamcare on his first day in office and that his replacement plan would be much better and far cheaper, “a beautiful thing.” He said he would do something “unlike any of the other Republicans running,” that “its a very un-Republican thing to say,” but he would make sure everyone was covered, even the bottom 25% of the poorest Americans who can’t afford private health care. He said no one now covered by the ACA would lose their coverage. But during the last few weeks, he’s flipped his rhetoric (no surprise) to now say everyone would have ‘access’ to his health care plan.
Having ‘access’ to health care is not the same as having health care. I have access to Four Seasons Hotels and many exclusive vacation resorts but the only accommodations I can afford is staying with Tom Bodett at the Motel 6 or in a tent at a State Park camp grounds. I have access to some really nice golf clubs, some of which Trump might own, but the only ones I can afford are run by our local park districts. I have access to cars at exclusive Mercedes and Audi auto dealerships, but with my budget restrictions, I shop for 5 or 10 year old used vehicles.
The 50% of American’s who live on $16,000 a year or less would not be able to purchase health insurance under any circumstances, whether they’re able bodied workers or not. They can’t afford even the cheapest insurance unless it’s heavily or fully subsidized.
We already suspected, that under this phony Paul Ryan Republi-con plan, millions of Americans would lose coverage or, as was common before the ACA, pay more for less and less care, while the wealthy haul in billions through tax breaks. Yet the Congressional Budget Office’s (CBO’s) analysis portrays even more punitive consequences than we imagined.
Under the Paul Ryan’s proposed American Health Care Act, supported by billionaire Trump, the CBO claims 24 million Americans would lose their health care by 2026 and 14 million by next year alone. Insurers would be able to substantially raise premiums on older enrollees and could charge them 5 times as much as younger folks. Premiums will rise between 120 and 125% for those between age 50 and 64. And because this plan would also defund Planned Parenthood, clinics that provide critical women’s health services throughout the country would have to close.
The experts believe up to 14 million folks dependent on Medicaid would lose their coverage. 1.5 million of those folks on Medicaid are cancer patients undergoing treatment. This plan will cut 25% ($880 Billion thru 2026) from Medicaid and limit it’s growth. Children, poor people, the elderly receiving long term care, folks with mental health problems and the disabled are the beneficiaries of Medicaid and will suffer so that billionaires and multi-millionaires can get their tax breaks.
More than 50% of American, those low income folks who don’t pay federal income taxes, would not benefit at all from health insurance tax incentives proposed by the Republi-cons.
The Republi-con, con job is in full spin mode, led by ‘Con Man In Chief,’ Donald Trump. The Donald promised the far right skeptics of his plan, that if they vote against Drumpf-care, he will let the ACA go down in flames. Typical Republi-con ‘my way or the highway.’
House Speaker Ryan claims he’s really encouraged by the CBO estimates (he’s the only one), and believes it’s actually better than he thought it would be. He’s become very adept at making these statements with a straight face.
And the Republi-con promise, that merely having the ability to purchase insurance policies across state lines, will make a big difference in costs, is another big lie! There are no Federal restrictions on companies selling across state line! The companies and the states control where they will sell. And the lack of competition, caused by insurance companies leaving the ACA in some states, is because of a backroom deal, by Sen. Rubio and other Republicans, designed to cripple the ACA by cutting reimbursements to insurance companies in the first 3 years of the plan.
The Republi-cons say this plan will reduce costs. Bull Pucky! The 10% reduction scored by the CBO means that policy prices will rise, as always, but the rise will be 10% less than under the ACA. But those savings will be more than offset by large increases in deductibles and out of pocket costs and by large losses in subsidies, especially for those between 50 and 64 years of age. Bottom line-Billionaires will reap a windfall of at least $275 billion (and much more in the future) on the backs of children, women, the poor, the elderly who need extended care, the disabled, the mentally ill, and the 10’s of millions of Americans addicted to legal and illegal drugs and who need life saving treatments.
The Nation’s John Nichols wrote on his Twitter feed about the White House Press Secretary Sean Spicer press briefing spin job that went viral. “White House Press Secretary Sean Spicer appeared to be imitating Melissa McCarthy’s Saturday Night Live imitation of him when he tried to make the argument for replacing Obamacare with Trumpcare by placing a copy of the final version of the 974-page law next to the sketchy Republican substitute. Forget about the contents, argued Spicer. “Our plan, in far fewer pages, 123—much smaller, much bigger—so far we’re at 57 for the repeal plan and 66 pages for the replacement portion. We’ll undo this. And remember, half of it, 57 of those pages, are the repeal part. So when you really get down to it, our plan is 66 pages long, half of what we actually even have there.”
“Say what?” said Nichols.
“[Look] at the size. This is the Democrats, this is us. You can’t get any clearer in terms of this is government, this is not,” said Spicer during Tuesday’s press briefing, as he moved back and forth, hovering over the two stacks of paper. “And I think that part of the reason the visual is important is that when you actually look at the difference, you realize this is what big government does.… I think the greatest illustration of the differences in the approaches is that size.”
As if the most important thing about a bill passed by Congress is the number of pages. I’m so looking forward to this Saturdays SNL skit showing McCarthy’s version of Spicer’s PB. Please, Please, Please!
Alas, every credible health care expert, not paid by insurance companies and or big pharma, believes the only way to improve Obamacare is to make it single payer universal health care. No matter if these Republi-cons are somehow able to repeal the ACA, and against all odds, get some similar ACA replacement clone passed through congress, 5 or 7 years down the road, we will, no doubt, have universal healthcare. Every single developed country has universal health care except the U.S. There is no place in the world where a free market based health care system exists. We’re at the bottom of the list for health care outcomes considering the enormous money we spend. Most developed countries spend half as much with better health outcomes. In this category, America is in the third world neighborhood. The Republi-cons like to say that most Canadians come across the boarder to access health care. All big lies. Canadians love their system, live longer and spend much less for better outcomes.
Agreed, our health care system is too expensive. We have too many folks who must do a better job of staying healthy; they must eat better and stay more active. Obamacare made big strides in attempting to help by emphasizing preventative care. But make no mistake, unless we transition to universal health care, America’s economy will never recover. Living wage jobs will not spring forth in ‘Trump World’, because we will not be able to compete with the rest of the world on a level playing field. We must also force our elected officials, to demand fair treatment from the drug and health care industries benefiting from our out of control health care system, instead of demanding more campaign largess in return for their indifference. There are no checks and balances on drug and medical suppliers. America pays the brunt of these inflated costs for much of the worlds medical research.
Obamacare is not perfect, but an awful lot of smart folks spent a lot of time, effort and capital, on attempting to mitigate America’s bastardized health care calamity. It took a lot of compromise. The Dems had to give up on single payer, and a public option and had to incorporate the Republican idea of a mandate so that the plan wouldn’t blow up the national debt. They had to accommodate health care providers, the insurance industry and big Pharma, in order to drag the plan over the finish line. It wasn’t pretty but they passed a comprehensive health care plan, something most U.S. Presidents have been trying to accomplish since Teddy Roosevelt more than a hundred years ago. It was a start.
The Patient Protection and Affordable Care Act focused on covering as many uninsured Americans as possible and also, at the urging of our best and brightest health care providers like the Mayo and Cleveland Clinics and others, finally focused on preventive health care. Since the ACA was passed, the customary double digit yearly insurance increases, slowed to the lowest rate in 2 decades. It also wrested the insurance industries stranglehold on consumers, which punished women and folks with pre-existing medical conditions and lifetime cap problems. It was a valiant beginning on the road to a universal health care system, already embraced by the rest of the developed world.
But this Republi-con crew in charge, don’t know how to govern. All the conservatives who knew how to legislate and compromise have been drummed out of the party. All that’s left are the bomb throwers who are only good at throwing sand into the gears of American progress.
The Donald finally realized that getting comprehensive health care passed is “complicated.” He could saved a lot of grief and simply placed a call to his predecessor. Trump vows to “come after” congress-folks who vote against Trump-Care. But the Koch brothers pledge to defend them against Trump’s retaliation. Even if this wounded duck stumbles through the House, the Senate will no doubt put it out of it’s misery. The only ones still pushing this bad bill, are those who lied to the voters about being able to fashion a much better alternative to Obamacare. Rubber, meet the road!
Even though this plan has Paul Ryan’s finger prints all over it, the blame will be heaped on Trump. He will, as usual, try to blame someone else, probably the Congress (or the media), but this bogus TrumpCare buck, passed or failed, will stop at the Donald’s desk for sure. John Hanno
Medscape March 15, 2017
State of the Union and Healthcare:
100 Years of Good Intentions
Theodore Roosevelt (1901-1909): The Origins of National Healthcare
We must go back more than 100 years to Theodore Roosevelt’s administration to find the nidus of national healthcare. In his 1907 address, he said, “There is a constantly growing interest in this country in the question of the public health. At last the public mind is awake to the fact that many diseases, notably tuberculosis, are National scourges. The work of the State and city boards of health should be supplemented by a constantly increasing interest on the part of the National Government. The Congress has already provided a bureau of public health and has provided for a hygienic laboratory. There are other valuable laws relating to the public health connected with the various departments. This whole branch of the Government should be strengthened and aided in every way.”
The following slideshow tells the very long, difficult story that defines American healthcare through 70 years of presidential State of the Union addresses, with a final bow to an earlier president. Beginning with FDR’s address, every US president (with one exception), whether Democrat or Republican, has communicated during a State of the Union address a proposal for improving the nation’s health. The purpose of this slideshow is not to debate whether such programs were achieved or are even achievable but to briefly illustrate the typically good — but usually thwarted — intentions of nearly all of our recent presidents and to demonstrate how long the Executive Office has wrestled with this massive challenge.
Franklin D. Roosevelt (1933-1945): Healthcare Is a Right
In his 1944 address, FDR announced “…a second Bill of Rights under which a new basis of security and prosperity can be established for all regardless of station, race, or creed.” Among these rights he included employment, housing, and good education. He also spoke of “the right to adequate medical care and the opportunity to achieve and enjoy good health.” Public health had been a major federal effort since Theodore Roosevelt’s administration, but with this proposal FDR became the first president to explicitly suggest that medical care itself was a right for each American and should be addressed by the federal government.
Harry S. Truman (1945-1953): Advocates a National Healthcare System
During his administration, Harry Truman consistently advocated a national healthcare system, and it was during his time in office that Congress enacted new programs to improve mental health, the health of mothers and children, and hospital construction. In his 1948 State of the Union address, Truman said, “We are rightly proud of the high standards of medical care we know how to provide in the United States. The fact is, however, that most of our people cannot afford to pay for the care they need.” He went on to advocate a “national system of payment for medical care based on well-tried insurance principles. This great Nation cannot afford to allow its citizens to suffer needlessly from the lack of proper medical care. Our ultimate aim must be a comprehensive insurance system to protect all our people equally against insecurity and ill health.”
Dwight D. Eisenhower (1953-1961): Establishes the Department of Health, Education, and Welfare
Dwight Eisenhower continued to advocate for a more comprehensive national plan for healthcare. In his 1956 State of the Union address, he said, “We must aid in cushioning the heavy and rising costs of illness and hospitalization to individuals and families. Provision should be made, by Federal reinsurance or otherwise, to foster extension of voluntary health insurance coverage to many more persons, especially older persons and those in rural areas. Plans should be evolved to improve protection against the costs of prolonged or severe illness. These measures will help reduce the dollar barrier between many Americans and the benefits of modern medical care.” Although such efforts failed to materialize over the course of Eisenhower’s time in office, he strengthened the US Food and Drug Administration and increased funds for medical research.
John F. Kennedy (1961-1963): Calls for Healthcare for the Elderly
Fifty years ago, in his 1961 State of the Union address, Kennedy said, “Medical research has achieved new wonders — but these wonders are too often beyond the reach of too many people, owing to a lack of income (particularly among the aged), a lack of hospital beds, a lack of nursing homes and a lack of doctors and dentists. Measures to provide healthcare for the aged under Social Security, and to increase the supply of both facilities and personnel, must be undertaken…” And he continued to advocate reform in his final address: “Our working men and women, instead of being forced to beg for help from public charity once they are old and ill, should start contributing now to their own retirement health program through the Social Security System.”
Lyndon B. Johnson (1963-1969): Enacts Medicare/Medicaid
It was in 1965, under Lyndon Johnson’s administration, that Social Security Act amendments were passed which resulted in the creation of the Medicare and Medicaid programs. Although snarled in Vietnam, Johnson made a case for health reform in his 1967 State of the Union address: “We have brought medical care to older people who were unable to afford it. Three and one-half million Americans have already received treatment under Medicare since July.” He also sought to improve global health in his 1966 address: “I will also propose the International Health Act of 1966 to strike at disease by a new effort to bring modern skills and knowledge to the uncared-for, those suffering in the world, and by trying to wipe out smallpox and malaria and control yellow fever over most of the world during this next decade.” (This bill was never enacted.)
Richard M. Nixon (1969-1974): An Unexpected Reformer
Although not known for a stand on healthcare reform, in his 1971 address, Richard Nixon, a Republican, proposed major reforms that are echoed in today’s Affordable Care Act, including the following:
- A program to ensure that no American family will be prevented from obtaining basic medical care by inability to pay;
- A major increase in aid to medical schools;
- Incentives to improve the delivery of health services, particularly in low-resource areas;
- Greater use of medical assistants;
- New programs to encourage better preventive medicine;
- Incentives to doctors “to keep people well rather than just to treat them when they are sick”; and
- An additional $100 million to find a cure for cancer.
During his address he asserted, “America has long been the wealthiest nation in the world. Now it is time we became the healthiest nation in the world.”
Gerald R. Ford (1974-1977): Confronts the Growing Costs of Healthcare
Gerald Ford, who inherited the presidency after Nixon’s resignation, wrestled with the problems of illness and individual financial hardship in the face of rising healthcare costs, not only for patients but for the nation as well. In his 1976 address, Ford sought to deal with these issues by proposing “catastrophic health insurance for everybody covered by Medicare.” To finance it, he suggested raising fees for short-term care and lowering costs for senior citizens: “[N]obody after reaching age 65 will have to pay more than $500 a year for covered hospital or nursing home care, nor more than $250 for 1 year’s doctor bills.” But Ford also made clear in his speech that he did not support a national healthcare program, although he suggested that “we combine 16 existing Federal programs, including Medicaid, into a single $10 billion Federal grant. Funds would be divided among States under a new formula which provides a larger share of Federal money to those States that have a larger share of low-income families.”
James “Jimmy” Carter (1977-1981): Pushes Harder for Universal Healthcare Coverage
In his 1891 address, Jimmy Carter pushed even harder than his predecessors “to reach the goal of comprehensive, universal healthcare coverage.” Features that he proposed included:
- Fully subsidized and comprehensive coverage for 15 million additional poor persons;
- Prenatal and delivery services for all pregnant women and coverage for all acute care for infants in their first year of life;
- A limit of $1250 on annual out-of-pocket medical expenses and no limits on hospital coverage for the elderly and disabled;
- Mandated employer coverage of health insurance for all full-time employees and their families, at least for major medical expenses; and
- Medicare and Medicaid combined and expanded into an umbrella federal program.
His proposals for healthcare cost control included voluntary hospital cost guidelines and moving away from the fee-for-service payment model “toward a system of prospective reimbursement, under which healthcare providers would operate within predetermined budgets.”
Ronald W. Reagan (1981-1989): Ignores Healthcare Reform and Focuses on Cost
Ronald Reagan raised the issue of healthcare in 3 of his 8 addresses, but only briefly, and mostly focused on cost cutting, without detailing any programs for extending coverage. His 1982 speech urged a need to reduce Medicare and Medicaid costs, with a focus on weeding out fraud. He also said, “I signed a bill to reduce the growth of these programs by $44 billion over the next 3 years while at the same time preserving essential services for the truly needy.” In 2 other addresses, Reagan briefly acknowledged the problem of catastrophic illness but without outlining any specific ideas. In his 1983 address, he said he would “submit legislation to provide catastrophic illness insurance coverage for older Americans.” And in his 1986 speech, he directed the Secretary of Health and Human Services to recommend how the private sector and government could work together to address the problems of affordable insurance for those threatened with financially catastrophic illness.
George H. W. Bush (1989-1993): Re-Engages the Healthcare Reform Battle
The elder George Bush mentioned healthcare as a problem in 2 of his early speeches, and he tackled the issue in more detail in his last address, which was in 1992. Recognizing the need for reform, he said that there were 2 options: implementing a national healthcare system, which he opposed, or providing insurance security for everyone while preserving choice. To accomplish this, he proposed to make basic health insurance affordable for all low-income persons who were not currently covered by providing a health insurance tax credit of up to $3750 for each family, and to ensure that all Americans had access to basic health insurance even if they changed jobs or developed serious health problems.
William J. Clinton (1993-2001): The Attack Dog for Healthcare Reform
The movement toward true healthcare reform began under Bill Clinton, who proposed significant changes in the healthcare system in every one of his presidential addresses. Despite Hillary Clinton’s failure to achieve consensus on an enactable healthcare plan, Clinton pushed on. In his 1995 address, he said, “[L]ast year we almost came to blows over healthcare, but we didn’t do anything…Let’s do whatever we have to do to get something done. Let’s at least pass meaningful insurance reform.” Congress did extend health coverage to 5 million children, and Clinton ended his administration with a budget surplus, which he hoped would ensure the future of big entitlement programs like Social Security. In his 1999 address, he proposed, “Listen to this: If we set aside 60% of the surplus for Social Security and 16% for Medicare, over the next 15 years, that saving will achieve the lowest level of publicly held debt since right before World War I, in 1917.”
George W. Bush (2001-2009): Keeps the Healthcare Debate Alive
George W. Bush may have had his hands full with preventing terrorism and ongoing wars in Afghanistan and Iraq, but he continued the discussion on healthcare in every presidential address with some very aggressive proposals. In his 2005 address, he urged Congress “to move forward on a comprehensive healthcare agenda with tax credits to help low-income workers buy insurance, a community health center in every poor county, improved information technology, association health plans for small businesses and their employees, expanded health savings accounts, and medical liability reform that will reduce healthcare costs and make sure patients have the doctors and care they need.” He expanded on these ideas in later addresses and continued to push for major changes in healthcare.
Barack Obama has taken ideas from every past president — Republican and Democrat — to try to create a solution to the American healthcare challenge. His signing of the Affordable Care Act has been criticized by the left for not going far enough and by the right for going too far. In his 2011 address, he summed up the current situation: “Now, I have heard rumors that a few of you still have concerns about our new healthcare law. So let me be the first to say that anything can be improved. If you have ideas about how to improve this law by making care better or more affordable, I am eager to work with you…What I’m not willing to do is go back to the days when insurance companies could deny someone coverage because of a preexisting condition…So I say to this chamber tonight: Instead of refighting the battles of the last 2 years, let’s fix what needs fixing, and let’s move forward.”
The Fight to Save the Affordable Care Act Is Really a Class Battle
Starting to mitigate America’s yawning class divide is exactly what the ACA did. And that’s exactly what the Republican plan would undo.
By Angela Bonavoglia March 10, 2017
The escalating battle over the future of the Affordable Care Act—heightened now that House Republicans have released their Obamacare-repeal legislation—is revealing a fundamental fault line in American society. Even the most vociferous opponents of the ACA defend some features of the law, like parents’ ability to keep children under the age of 26 on their insurance and the ban on insurance companies’ refusing coverage for people with preexisting condition. Those defenders include Republican lawmakers, who incorporated both of those features in their repeal bill. What we rarely hear defended is the ACA’s role as an instrument of social justice. Yet, at its most basic, starting to mitigate America’s yawning class divide is exactly what the ACA did. With this proposed legislation, that is exactly what the Republicans are trying to undo.
Prior to passage of the ACA, most low-income adults could not receive Medicaid because income-eligibility limits were downright draconian in most states—well below the current federal poverty level (FPL) of $11,880 a year for an individual. In a blatant gesture of discrimination, federal law excluded non-elderly, non-disabled adults without dependent children entirely from Medicaid eligibility. How sick you were, what health crisis you were facing, did not matter. If you suffered, you suffered. If you died, you died, as an estimated 20,000 to 45,000 Americans did each year because they did not have health insurance. That had become the American way.
The ACA began to change that. With Medicaid expansion, the ACA went a long way toward increasing access to health care for many of America’s forgotten poor, near poor, and disabled. The expansion made 11 million non-elderly adults with incomes up to 138 percent of the federal poverty level ($16,394 a year for an individual) newly eligible for Medicaid, with no or very-low-cost premiums, leaving them responsible only for other nominal health-care costs. It opened the door to Medicaid for adults who had no dependent children. And it expanded Medicaid eligibility for more people with disabilities. That not only made them healthier; it also protected them from lives of forced institutionalization. Medicaid is the primary payer for the cost of long-term support services that are critical to the ability of low-income people with disabilities to live, work, and be active in the community; private insurers and Medicare provide precious little support for these or related services.
The ACA also brought more of the uninsured into the health-care market by giving a financial leg up to people who earned too much to be eligible for Medicaid but still much less than would enable them to buy private insurance independently. It enabled those with incomes from 100 percent to 400 percent of the federal poverty level ($11,880 to $47,520 for individuals, $24,300 to $97,200 for a family of four) to buy health insurance on the public exchanges with the aid of premium tax credits—as long as they didn’t have access to a qualified plan through an employer. An estimated 85 percent of the 11 million people who bought health insurance on the state or federal marketplaces did so with the aid of tax credits that lowered their premiums. In addition, more than 6 million of the lowest-income people, those with incomes from 100 percent to 250 percent of the FPL, also became eligible for cost-sharing reductions, which cap out-of-pocket costs like deductibles and co-pays.
The structure of the ACA extended health insurance to 20 million formerly uninsured low- and moderate-income people, sending our uninsured rate to a record low of less than 9 percent. While that has been an enormous achievement, controversy accompanied the law from the start. It was passed without a single Republican vote. Major computer snafus made the inaugural sign-up for individual policies on the federal exchange a disaster. In time, premiums rose for those buying without credits or subsidies, as high as 145 percent in one location. But premiums on the individual market had been rising pre-ACA too, up 20 percent in 2010 over the previous year. In fact, according an analysis by Brookings researches, average premiums in the individual market actually dropped significantly upon implementation of the ACA, even as coverage improved. The combined amount a person could be responsible for in deductibles and co-pays with the ACA climbed as well: In 2016, the ACA capped those out-of-pocket maximums for all insurance plans on and off the exchanges at $7,150 for an individual and $14,300 for a family. But deductibles had been on the upswing, too; Kaiser reported that more than a quarter (26 percent) of the people who bought their own insurance in 2010 faced a $5,000 or higher annual deductible. Finally, the number of insurers willing to participate in the exchanges dropped precipitously in many locations, and many people could no longer find the doctors they trusted in their networks.
With people just beyond the cutoff for Medicaid or premium subsidies being required to pay full freight for their health care, some resentment was inevitable. One Kaiser survey focusing on the experiences and opinions of those who buy their own health insurance within or outside the exchanges found that the majority of those who got a tax credit (58 percent) were more likely than those who did not get a tax credit to feel they benefited from the law (even though they did, from such features as no-cost preventive care and requirements that insurers cover 10 essential services). Another Kaiser poll found that, while 50 percent of the public thought low-income people were better off under the ACA, only 27 percent thought those who bought their own health insurance were better off.
Newly eligible Medicaid recipients came in for resentment, too. In late December last year, Kaiser held six focus groups with Trump voters in three Rust Belt states (Pennsylvania, Ohio, and Michigan). Three groups were held with those on Medicaid and three with those who had marketplace insurance with subsidies. Some of those with marketplace insurance, especially those battling severe health problems, saw the subsidies as insufficient and felt left behind by the law. Some, wrote Kaiser President Drew Altman in The New York Times, “saw Medicaid as a much better deal than their insurance and were resentful that people with incomes lower than theirs could get it.” But, despite their resentment, reported Kaiser, those participants felt that expanded Medicaid coverage “was important and should be retained.”
An unanticipated consequence of the ACA may be a change in the American mindset about government involvement in healthcare.
In fact, an unanticipated consequence of the ACA may well be a change in the American mindset about government involvement in health-care provision. The American public’s position on Medicaid appears to be gradually shifting from a grudging acceptance of what has been seen as an expensive, unearned handout to a greater recognition of Medicaid’s crucial place in our social safety net. By 2005, pre-ACA, nearly three-quarters (74 percent) of adults said Medicaid was a very important government program, ranking close behind Social Security (88 percent) and Medicare (83 percent). However, as the authors of a seminal review of 25 years of public opinion on health-care policy published in 2006 observed, “Medicaid is often discussed both positively and negatively. It is seen as the country’s safety net program for low-income people, but also a program that is becoming too expensive and is threatening the stability of future federal and state budgets.” As a result, they reported, polling in 2005 found that 61 percent of respondents believed that Medicaid was in a financial crisis or had serious problems; 44 percent favored reducing the number of people qualifying for the program as one solution.
Contrast that to the responses to the ACA’s expansion of Medicaid—a program that today covers over 70 million children, adults, people with disabilities, and seniors, one in five Americans. A just-released Kaiser tracking poll found that 84 percent of those polled believed it was important for states that expanded Medicaid with federal funds to continue to receive those funds, including 69 percent of Republicans. While only 12 percent of Americans said they wanted to see Medicaid funding decreased, nearly half (48 percent) wanted funding to stay the same and more than a third (36 percent) wanted funding increased. Faced with Republican proposals to replace open-ended Medicaid funding to states with limited block grants, nearly two-thirds of Americans (65 percent) said Medicaid “should continue largely as it is today, with the federal government guaranteeing coverage for low-income people, setting standards for who states cover and what benefits people get, and matching state Medicaid spending as the number of people on the program goes up or down.”
As for those premium tax credits based on need, there have been complaints, both from those who make too much to receive them and from those who receive them but feel they are insufficient. Still, no one is suggesting abolishing them. A Kaiser poll from November of last year found that 80 percent of those polled favored providing financial help to low- and moderate-income Americans who don’t get insurance through their jobs to help them purchase coverage—including 67 percent of Republicans.
But an even more telling finding emerged in January from a Pew Research Center Survey. Asked if it is the responsibility of the federal government to make sure that all Americans have health-care coverage, 60 percent of Americans said yes, the highest percentage in nearly a decade. While far more Democrats than Republicans agreed with that statement, there were significant changes by income: A majority of Republicans (52 percent) with incomes under $30,000 agreed with the proposition (up from 31 percent in 2016), as did over a third of Republicans making $30,000 to $74,999 (up from 14 percent in 2016). Those making the most (over $75,000) agreed the least: 18 percent, up from 16 percent the year before. Even though a majority (67 percent) of Republicans said that the government does not have a responsibility to ensure health-care coverage, more than half (56 percent) said it should continue both Medicare and Medicaid.
Despite all of the controversy around the ACA, the most recent polls show that it has reached its highest approval level ever.
Despite all of the controversy that has grown around the ACA, the most recent polls show that the health-care law has reached its highest approval level ever, 54 percent in the latest Pew Research Center poll, and another high, 48 percent, in the latest Kaiser poll. The message may well be that, despite the ACA’s shortcomings, a growing group of Americans don’t want the federal government out of the health-insurance business; they want it to do a better job.
This picture speaks to a powerful coalition in the making. By guaranteeing coverage to a much larger share of the American public through Medicaid, and by convincing Americans of the justice implicit in providing financial assistance to those who cannot afford health insurance on their own, the ACA began to move us closer to a commitment to universal health coverage. While those words have become hopelessly politicized, what they refer to, according to the World Health Organization, is simply a system whereby “all individuals and communities receive the health services they need without suffering financial hardship.” Ours is a patchwork system, but it is a system nonetheless. In terms of paying for that system, interestingly, while there is widespread resistance to the ACA mandate that fines those who don’t sign up for insurance—viewed favorably by only 35 percent of Americans—there has been widespread acceptance of the current system of paying taxes for guaranteed care under Medicare (70 percent in 2015 when the program turned 50).
The Republicans’ new American Health Care Act (contained in two bills, one from the House Energy and Commerce Committee, the other from Ways and Means) would repeal major provisions of the ACA that made health insurance a reality for those 20 million people, while leaving an estimated 28.5 million people who still have no health insurance, mostly low-income families with at least one worker, untouched.
It would greatly diminish opportunities for people to receive Medicaid at all and for that coverage to be adequate. It would end the current federal support for Medicaid expansion in 2020. It would turn Medicaid into a one-size-fits-all program, replacing open-ended federal payments to states with fixed payments capped per person, which may or may not meet a person’s actual health-care needs. And it would make it impossible for Medicaid recipients to use their insurance at Planned Parenthood, because the legislation bans Medicaid payments to “prohibited entities,” a description tailored in the legislation, without naming it, to Planned Parenthood.
The proposed law would end the cost-sharing subsidies that help very-low-income Americans pay deductibles and co-pays. It would replace the ACA credits based on need with credits from $2,000 to $4,000 based on age alone, which would only begin to phase out for earners above $75,000. People could put more money into their health savings accounts, which benefit only higher-income people. Obamacare fees that helped support the health-care expansion would be repealed, like those on health-insurance companies and manufacturers of brand-name prescription drugs. And the legislation would eliminate the requirement that larger companies provide their full-time employees with affordable insurance as well as the individual mandate. However, it would replace the individual mandate with a back-door penalty—a 30 percent surcharge on premiums for anyone who lets their insurance lapse.
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The Congressional Budget Office has not yet provided the numbers; we do not know how many people will gain or lose coverage as a result of this legislation or what the program will cost. Yet the two House committees reportedly plan to vote on the bill even without those estimates, and hope to get it to the full House for a vote before their Easter recess begins on April 7.
At their town-hall meetings and in the streets, Republican lawmakers have witnessed the angry backlash against their disorganized efforts to repeal Obamacare, which led some prominent Republicans these past few months to express grave concerns about the risks to consumers, the insurance industry, and their own political lives. “We’d better be sure that we’re prepared to live with the market we’ve created,” Representative Tom McClintock of California was quoted in the Washington Post saying at a closed-door meeting back in January. “That’s going to be called Trumpcare. Republicans will own that lock, stock and barrel, and we’ll be judged in the election less than two years away.”
We cannot know now if the emerging cross-class coalition will hold, if ordinary people will challenge Republican efforts to protect the wealthy and corporate interests while leaving the poor, near poor, and struggling middle-class to once again fend for themselves. What we do know is that with the ACA we took a few small steps into a future inhabited by the rest of the developed world, which sees health care as a right. To go back to the bad old days when empty pockets meant living in terror of an unexpected illness, unrelenting suffering, and early, preventable death would be nothing if not a national shame.
Angela Bonavoglia, MSW, is a journalist and health communications consultant and the author of Good Catholic Girls: How Women Are Leading the Fight to Change the Church.
Yahoo News –
Why the Republican health care bill is doomed to fail — even if it passes
Matt Bai’s Political World March 16, 2017
The old Superman comic books used to feature a character named Bizarro, who looked exactly like the Man of Steel, except for his blocky, Frankenstein-like features and the fact that everything about him was reversed. Whereas Superman could burn things with his eyes, the lumbering Bizarro could freeze them; while Superman’s X-ray vision couldn’t handle lead, Bizarro’s could penetrate only lead. You get the idea.
That’s the image that kept popping into my head this week as I watched Republicans hurtle their way toward an ill-conceived overhaul of the health care system. In a sense, what Republican leaders are frantically trying to push through Congress is the Bizarro health care plan — a mirror image of the law it would replace, patched together from spare parts and castoff ideas.
They now seem bent on making exactly the same mistakes Democrats did in 2009, but in exactly the inverse way.
At about this time eight years ago, I was hanging around Capitol Hill and the White House, putting together a preview of the looming health care fight for the New York Times Magazine. (The piece holds up pretty well, I think, but judge for yourself.)
The pivotal Democrat on the Hill then was Max Baucus, the Montana senator — and later President Obama’s ambassador to China — who chaired the Senate Finance Committee. Like Obama, Baucus thought CEOs, health care providers and politicians who had once opposed reform could now be persuaded to support it, as long as the plan promised to get soaring costs and federal spending under control.
And Baucus told me that any new law had to have at least some measure of bipartisan support, even if that required painful compromises. That’s because no piece of massive social legislation had ever been perfect from the start, and in order to preserve and fix it, you needed at least a few members of the minority to be invested in its success.
A transformational law of this size, Baucus said, would be “unsustainable” if one party decided to enact it alone.
What Republican leaders are frantically trying to push through Congress is the Bizarro health care plan – a mirror image of the law it would replace, patched together from spare parts and castoff ideas.
The problem for Baucus was that most Democrats, especially in the House, didn’t care at all about corporate competitiveness and public debt. They cared about bringing down the number of poorer Americans who couldn’t afford insurance, and they weren’t open to painful fiscal choices in order to get that done.
So while Obama and his congressional allies sold their plan to industry and the public as an economically necessary reform that would “bend the cost curve,” the law they ultimately passed was really more a wealth transfer program that birthed new regulations and taxes in exchange for expanded coverage for the poor and some middle-class protections — a program very much in the tradition of the Great Society.
The most difficult decisions involving public spending were pushed off years into the future, for some other group of politicians to worry about. And of course, as it turned out, Democrats ended up passing the law along strictly partisan lines, using a budgetary gimmick known as “reconciliation” to help it along.
This wasn’t their call, to be fair; they really weren’t given a whole lot of choice. But what all of this meant, practically speaking, is that Baucus was right — the law was probably politically unsustainable from the start.
What came to be known as “Obamacare” was wildly successful in reducing the number of uninsured Americans by more than 20 million, but the public saw little of the economic benefit it was promised. (Although in truth, health care costs have risen more slowly than they might have otherwise.) Democrats couldn’t make necessary fixes in the sprawling law, because no one on the Republican side had any interest in seeing the law fixed.
Jump ahead now to where congressional Republicans are this week with their American Health Care Act — which is precisely the upside-down version of where Democrats were eight years ago. Whereas Democrats took a bill that was principally about expanding health care and dressed it up as an economic measure, Republicans are taking a plan that’s almost entirely about economics and pretending it has something to do with health care.
They may advertise their bill as a market-based solution to health care inequities, but in fact, what Republicans really care about right now is shedding the new revenue and spending in Obama’s health care law — specifically by repealing taxes and eliminating subsidies for the poor and the Medicaid expansion in the states.
President Trump has promised that “you’ll see rates go down, down, down and you’ll see plans go up, up, up,” and, in distinctly Trumpian terms, that the new system will be “a thing of beauty.”
But the Congressional Budget Office, which is led by a Republican appointee and has a slightly better record than Trump when it comes to veracity, estimates that the plan will cost 24 million Americans their health insurance while saving the government more than $300 billion over the next 10 years.
This time there’s not even a question of bipartisanship. Republicans have been plotting a three-stage legislative process, including a reconciliation measure of their own, to pass their plan without a single Democratic vote — although it’s becoming increasingly unlikely that they will settle anytime soon on a plan that wins over both House conservatives and Senate moderates.
The problem — especially if you’re one of those moderates who actually care about governing and have to get elected statewide — is that the Bizarro health care bill wouldn’t be any more lasting than its predecessor.
Before long, the public would figure out that the law isn’t going to do anything to make coverage more affordable or the choices more vast, as promised, but rather the opposite. Eventually, the popular protections that Republicans say they’ll keep are likely to become unworkable without mandates and subsidies.
Whereas Democrats took a bill that was principally about expanding health care and dressed it up as an economic measure, Republicans are taking a plan that’s almost entirely about economics and pretending it has something to do with health care.
Mostly the bill would spare some small businesses and wealthier Americans from paying additional taxes and cut back the Medicaid rolls. The issue of what to do about the uninsured would roar back into the public debate.
And good luck trying to amend the bill in ways that would mitigate its harshest effects, because Democrats may well gain seats in the ensuing elections, and they’re not going to feel the slightest motivation to help clean up the mess.
In some ways, Republicans are in a more precarious position with the Bizarro bill than Democrats were in 2009. Obama, at least, managed to cobble together support from insurers and providers, which muted some of the criticism when premiums started to rise. Trump and Paul Ryan, the House speaker, haven’t even tried to assemble a coalition.
You have to remember, too, that Republicans are playing with something here that neither party has ever attempted on such a scale before: a rollback of benefits the public already has. It’s one thing to ram through a program with lots of subsidies and new rights attached. It’s an untested proposition to unilaterally take that stuff away.
Here’s what we do know: With a policy area as complicated as this one, and as reliant on theories about how the markets and consumers will respond to various incentives, you’re never going to pass one law and be done with it. Responsible governing in Washington — if we can still conceive of such a thing — means being able and willing to reassess and adjust to reality as time goes on.
Democrats were never going to be able to do that because of the dubious ways in which they sold and enacted their law. And Republicans won’t have that option, either, even if they manage to come up with something that satisfies their dueling factions.
Superman and Bizarro never actually resolve anything. They just retreat to their parallel universes and live to fight again.
Christcare: What Would Jesus Do about the GOP Healthcare Plan?
by Patrick Hudson March 15, 2017
“This sickness will not end in death,” Jesus said of his follower Lazarus, as he heard of the latter’s ailment. Lazarus had fallen ill and subsequently had passed away. Jesus—let’s call him the heroic symbol of universal healthcare—arrived in Bethany near Jerusalem to raise Lazarus from the dead. After Lazarus did reportedly rise four days after his death, he surely never fretted over deductibles or co-pays, nor had he been forced to decide whether to feed his family or live.
The Lazarus tale is one of a number of parables in the Bible where Jesus heals the sick, cures the blind, and saves lepers, all at no cost. I would love to sit here and say that our government stands in agreement and that Jesus’s example of universal healthcare had ossified, but that’s simply not the case.
Just this week House Republicans introduced the American Health Care Act (AHCA), known in some parts as “Trumpcare.” Even though he jumps at the chance to plaster his name on just about anything, Trump distances himself from that moniker, while Breitbart News has nicknamed the plan “Ryancare.” No matter where you look, it seems as though this bill is so bad, its nickname is being passed around like a polio-potato. The Congressional Budget Office (CBO) estimates that twenty-four million people will lose insurance in ten years under the AHCA, with the sixty-five and older age group standing to lose the most. The sad reality is that age group overwhelmingly voted for the individuals who introduced this bill, conned by lies that Obamacare was hurting them and wrapped up in the idea that their values were being attacked by non-Christians. The religious right ensured that Christians headed to the polls, fearful that their lifestyle was under attack from rabid secularists hell-bent on persecuting them.
What’s amazing to me is the religious right’s ability to dismiss certain parts of the Bible, while wholeheartedly accepting other passages. Last week in the Humanist.com we saw how sandwiched in between Leviticus’s two verses condemning homosexuality was a passage urging Christians to accept immigrants and refugees as if they were native-born. How many people were aware of that passage? How many times did conservative politicians and religious right leaders stand before their constituents and congregations and proclaim: “When a foreigner resides among you in your land, do not mistreat them. The foreigner residing among you must be treated as your native-born”? Both the Freedom Caucus and the Liberty Caucus remained silent then, just as they remain silent now, as twenty-four million Americans face losing their insurance under the AHCA. As Liberty Caucus member and chair of the House Oversight Committee Jason Chaffetz (R-UT) said, they’ll have to avoid getting an iPhone to pay for it. This fundamental detachment from the reality of the working class is what drives this bill. Health insurance costs roughly $10,345 a year (though the deviation is quite wide), while the cost of a brand new iPhone 7 costs $729. The reality that Chaffetz does not understand is that the choice is whether to get health insurance or put food on the table.
However, the most damning assertion came from Republican Rep. Roger Marshall, who represents Kansas’s First District (and is an embarrassment to my ancestral home). Marshall affirmed in full confidence that poor people would not only reject “free” healthcare, but would also reject health care altogether, “just like Jesus said.” Now, ignoring the grossly inappropriate manner in which Marshall invoked religion in his official capacity, this argument is fundamentally flawed. Marshall insultingly stated that poor people “just don’t want health care and aren’t going to take care of themselves.” This is verifiably incorrect; as a Harvard study reported last August, Obamacare’s insurance and Medicare expansion led to more working-class people receiving primary and preventative care. Insurance incentivizes people to go to the doctor, as they don’t fear financial repercussions. But lo, Marshall says Jesus said, Harvard is but an academic institution! We must learn about our current system of healthcare from those who lived over 2,000 years ago.
While I won’t go so far as to say that everyone in the GOP holds such disdain for the working class, I do believe there is a fundamental misunderstanding of the working-class experience and a sickening amount of pandering from both political parties. Hillary Clinton attempted to link her father’s business to her understanding of the working-class culture, while Donald Trump feigned empathy. And the GOP has consistently conned the religious working class, pushing a fake “war” on Christianity and Christian values, and instilling a persecution complex within them, all while cutting taxes for the top 1 percent. The religious right will always exist—their fear tactics will always exist. It is up to all American citizens to demand a government that works for us all.
Patrick Hudson is the Communications Assistant at the American Humanist Association.
Sean Spicer Is Lying About Trump’s Health-Care Debacle
The White House falsely claims the Trump/Ryan Obamacare replacement scheme is what “everyone has been asking for.”
By John Nichols Twitter March 2017
White House Press Secretary Sean Spicer appeared to be imitating Melissa McCarthy’s Saturday Night Live imitation of him when he tried to make the argument for replacing Obamacare with Trumpcare by placing a copy of the final version of the 974-page law next to the sketchy Republican substitute.
Forget about the contents, argued Spicer. “Our plan, in far fewer pages, 123—much smaller, much bigger—so far we’re at 57 for the repeal plan and 66 pages for the replacement portion. We’ll undo this. And remember, half of it, 57 of those pages, are the repeal part. So when you really get down to it, our plan is 66 pages long, half of what we actually even have there.”
“[Look] at the size. This is the Democrats, this is us. You can’t get any clearer in terms of this is government, this is not,” said Spicer during Tuesday’s press briefing, as he moved back and forth, hovering over the two stacks of paper. “And I think that part of the reason the visual is important is that when you actually look at the difference, you realize this is what big government does.… I think the greatest illustration of the differences in the approaches is that size.”
Support for the Affordable Care Act has soared, as Americans say they want it expanded—not repealed.
Needless to say, the Spicer “size” video went viral.
But it was another Spicer statement—or, to be more precise, alternative fact—that should have gone viral, that should have been noted by the reporters in the room, and by the commentators on the Republican plan to replace the Affordable Care Act with a scheme that Arizona Congressman Raul Grijalva says “ends affordable healthcare,” and that Congressman Keith Ellison says “hurts nearly all working Americans by gutting Medicaid, defunding Planned Parenthood, stripping protections and benefits and increasing costs.” “At the same time,” notes Ellison, “it provides a huge handout to the wealthy and insurance corporations. Which begs the question: who exactly are the Republicans trying to help with this legislation?”
The Spicer alternative fact that ought to be reported, and addressed, is a repetition of the spin that has been used by President Trump, Vice President Pence, and House Speaker Paul Ryan to peddle their latest scheme to redistribute wealth upward.
“This is the Obamacare replacement plan that everyone has been asking for, the plan that the President ran on, and the plan that will ultimately save the system,” the White House press secretary announced in the takeaway quote of the day.
Apart from the fact that the plan proposed by Trump and Ryan makes things worse (as opposed to saving the system), and apart from the fact that Trump ran on roughly a dozen different health-care platforms (flirting with everything from single-payer to survival-of-the-fittest, but always promising to make things “great”), there is no truth to the statement that “this is the Obamacare replacement plan that everyone has been asking for.”
To be clear, if Donald Trump “ran on” this plan, then it was not the choice of everyone. It was not the choice of the majority of voters. It was not the choice even of a plurality of voters. Fifty-four percent of American voters rejected Trump last November; his main opponent, Democrat Hillary Clinton, beat him by almost 3 million votes.
The claim that everyone was asking for this plan, or even for a replacement of the Affordable Care Act, is an alternative fact. It’s fake news. It’s a lie.
Poll after poll after poll provides an illustration of the truth. And so, since Spicer is so enamored of illustrations, let’s turn to them. Check out the headlines that appeared in the weeks before the Republican plan was released:
NBC News (January 17): “As GOP pushes repeal, Obamacare has never been more popular.”
CNBC (January 20): “New poll shows Obamacare is more popular than Donald Trump.”
Business Insider (February 2): “Obamacare getting more popular.”
Politico (February 22): “Support for Obamacare is rising.”
CNN (February 24): “Support for Obamacare at all-time high.”
The Hill (February 27): “More than 6 in 10 oppose Obamacare repeal.”
Survey research tells us that the popularity of the Affordable Care Act is rising. Rapidly.
New polling from the Pew Research Center finds that 54 percent of Americans approve of the ACA, while 43 percent oppose it. That, reported CNN, is the highest level of support for President Obama’s health care–reform measure ever recorded by Pew. The latest polling data from the Kaiser Family Foundation tells us that the ACA has “the highest level of favorability measured in more than 60 Kaiser Health Tracking Polls conducted since 2010.”
Polling numbers fluctuate. But here is the interesting twist: Surveys frequently show that, among those who favor altering the ACA, most want it to be made stronger—not weaker, as Trump, Pence, Ryan, and Spicer propose.
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A new McClatchy/Marist survey, released a few days before Spicer’s press conference, found that 65 percent of Americans would like to see portions of the Affordable Care Act retained. According to The Hill, “Twenty percent say lawmakers should let the health care law stand as is, while 38 percent want any changes to enable it to do more and 7 percent hope alterations make it capable of less.”
Only 31 percent supported complete repeal.
Why would Spicer peddle the fantasy that Americans called for the Republican plan, when that is clearly not the case?
Maybe Spicer is lying because the truth is inconvenient.
Maybe Spicer is lying to himself.
Whatever the excuse, Spicer is peddling alternative facts and, as Chuck Todd so ably explained on the day that the Trump team first floated the phrase, “Look, alternative facts are not facts. They’re falsehoods.”
John Nichols Twitter John Nichols is The Nation’s national-affairs correspondent. He is the co-author, with Robert W. McChesney, of People Get Ready: The Fight Against a Jobless Economy and a Citizens Democracy, published in March 2016 by Nation Books.
ABC Good Morning America
Major health groups oppose proposed changes in ‘Trumpcare’ bill
GILLIAN MOHNEY, ABC News, March 9, 2017
Physician and hospital groups are voicing opposition to the new health care bill, the American Health Care Act, over concerns that many patients could lose health coverage.
Those opposed to the bill include the American Hospital Association, the American Medical Association and the American Academy of Pediatrics.
In a letter to congressional leaders, Dr. James Madara, the CEO of the AMA, said the bill could harm vulnerable patients in its current form, especially those covered by the expansion of Medicaid under the Affordable Care Act, which provides federal matching funds for states who choose to opt-in and offer Medicaid to adults who are up to 138 percent above the poverty line.
“While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations,” Madara wrote on behalf of the AMA, the largest association of physicians and medical students in the U.S.
He cited concerns about the plan outlined in the AHCA to stop Medicaid expansion in 2020. Under the AHCA, states that offer the Medicaid expansion would continue receiving federal funds for those already enrolled, but would not receive federal funds as of 2020 for new candidates who only qualify for Medicaid under expansion rules.
“Medicaid expansion has proven highly successful in providing coverage for lower income individuals,” Madara said.
The American Hospital Association also sent a letter voicing “significant concerns” about the current bill. Specifically, it believes the bill could lead to “tremendous instability” for people seeking affordable health insurance.
“Absent Congressional Budget Office analysis, our assessment of this legislation as currently drafted is that it is likely to result in a substantial reduction in the number of Americans able to buy affordable health insurance or maintain coverage under the Medicaid program,” officials from the American Hospital Association said in the letter.
The American Academy of Pediatrics, an organization of 66,000 physicians specializing in medical care for children, teens and young adults, opposed the bill in a letter to members of Congress, saying it would undo recent gains in health insurance coverage for children. The group estimated that 95 percent of children are now insured, including those covered through Medicaid, the Children’s Health Insurance Program and the Affordable Care Act.
The AAP opposed Medicaid changes under the American Health Care Act, such as moving away from an entitlement program, with states receiving open-ended federal funds for Medicaid recipients, to block grants, with states receiving per person allotments that cannot exceed designated totals.
“Medicaid has been a crucial source of health care coverage for children for over 50 years,” the group said, reporting that 36 million children are currently covered via Medicaid. “Per capita caps would degrade the quality of care offered in the Medicaid program and would hinder the ability of states to respond to public health crises and other fluctuations in health care costs and the need for services.”
How Marco Rubio is quietly killing Obamacare
By Marc A. Thiessen December 14, 2015
There’s a Cuban American first-term senator running for president who has done more than any Republican to stop Obamacare.
No, I’m not talking about Ted Cruz (R-Tex.).
I’m talking about Marco Rubio (R-Fla.).
The battle against Obamacare has been Cruz’s signature struggle. In 2013, Cruz took to the Senate floor and promised to speak out against Obamacare “until I am no longer able to stand.” To fill the time, he even read Dr. Seuss’s “Green Eggs and Ham.” His filibuster, and the government shutdown over Obamacare it sparked, launched Cruz into the political stratosphere — inspiring conservatives eager for a principled fighter who does not back down.
But while the shutdown may have helped boost Cruz into the top tier of Republican presidential contenders, it had zero impact on undermining Obamacare.
Rubio, by contrast, didn’t read Dr. Seuss on the Senate floor, but he has quietly pushed Obamacare into what may prove to be a death spiral.
When the Obama administration was crafting Obamacare, it came up with a crony capitalist solution to entice reluctant insurers to join the exchanges. Many insurers worried that there would not be enough healthy people paying in to cover the costs of sick people. So the administration created a “risk corridor” program to help prop up insurers who lost money in the first three years of the law. Profitable insurers would pay some of those profits into a pool to help insurers who lost money. If the amount insurers lost exceeded what the companies paid in, the government would step in and make up the difference.
Calling this “a taxpayer-funded bailout for insurance companies,” Rubio last year quietly inserted language into the omnibus government spending bill that barred the Department of Health and Human Services from dipping into general funds to pay failing insurers. “While the Obama administration can still administer the risk-corridor program, for one year at least, they won’t be able to use taxpayer funds to bail out insurance companies,” Rubio said.
His provision sparked little opposition at the time, but it has proved to be a poison pill that is killing Obamacare from within.
Last year, insurers lost $2.9 billion more than expected on Obamacare. But insurers had paid only $362 million into the program — leaving it more than $2.5 billion short. Thanks to Rubio’s provision, the administration was allowed to pay only 13 cents of every dollar insurers requested. Without the taxpayer bailouts, more than half of the Obamacare insurance cooperatives created under the law failed. One, Health Republic of Oregon, was expecting a $7.9 million bailout from the government. Instead, thanks to Rubio, it got only $995,000 — not a penny of it from the taxpayers. The Oregon co-op announced in October it was closing its doors. Soon, two other insurers — WinHealth Partners in Wyoming and Moda Health in Washington state — pulled out of the exchanges. And United Healthcare, one of the nation’s largest insurers, announced that it may leave the Obamacare exchanges in 2016. If that happens, and other insurers follow United’s lead, that could spell disaster for Obamacare.
The Hill newspaper called Rubio’s provision “the biggest blow in the GOP’s five-year war against Obamacare.” The New York Times declared in a front-page story, “For all the Republican talk about dismantling the Affordable Care Act, one Republican presidential hopeful has actually done something toward achieving that goal,” adding that Rubio’s provision has “tangled up the Obama administration, sent tremors through health insurance markets and rattled confidence in the durability of President Obama’s signature health law.”
Now that the Obama administration understands the grave threat Rubio’s provision poses to Obamacare, Democrats are pushing to block it from this year’s omnibus spending bill so that they can bail out the insurers. According to Politico, “HHS officials . . . maintained that insurers will eventually receive the requested payments during the next two years of the temporary program.”
The insurers are joining the fight. In talking points obtained by BuzzFeed, Blue Cross Blue Shield Association’s chief executive, Scott Serota, warned congressional Democrats that Rubio’s provision “will result in massive premium increases and could cause private insurers to become insolvent.” In other words, Rubio’s provision poses a mortal threat to Obamacare.
Rubio maintains that if it takes a taxpayer bailout of big business to save Obamacare, that alone proves the law is unsustainable. He is pushing to keep his bailout ban in the final bill. “Let’s be clear, the reason these health insurance companies are enduring a financial loss is that Obamacare is a disastrous law,” Rubio declared in a letter to House and Senate leaders. “It broke the promise to lower health insurance premiums . . . Now the very architects of this law are attempting to place taxpayers on the hook.”
He’s right — and now it’s up to GOP leaders to back him by refusing to agree to any omnibus spending bill that allows a taxpayer bailout for insurance companies that made a bad bet on Obamacare.
And Rubio deserves credit at Tuesday night’s Republican presidential debate as the only candidate on the stage who has done more than talk about killing Obamacare.
Trump supporter credits Trumpcare — which hasn’t taken effect — for dramatically lower health costs
Travis Gettys March 17, 2017
A Tennessee woman who backs President Donald Trump credits God and the Republican health care bill — which hasn’t been voted into law — for her family’s dramatically lower insurance costs.
Charla McComic’s son recently lost his job, and his health-insurance premium dropped from $567 per month to $88, which she described as “a blessing from God” and a gift from the new president, reported the Washington Post.
The 52-year-old former first-grade teacher thinks the change is due to tax credits that would be offered under the so-called “Trumpcare” law, if and when it’s approved by Congress and signed into law — but the price drop is actually a feature of former President Barack Obama’s Affordable Care Act.
Workers who lose their jobs and employer-based health care coverage may enroll in Obamacare, which offers coverage based on income or possibly Medicaid for those with little or no income — like McComic’s son.
McComic, who attended Trump’s rally this week in Nashville with four family members, told the Post she’s not worried that her 33-year-old son or 3-year-old granddaughter will lose their Medicaid coverage under the GOP plan.
“So far, everything’s been positive, from what I can tell,” she told the newspaper. “I just hope that more and more people and children get covered under this new health-care plan.”
McComic, who campaigned for Trump with some relatives by forming a motorcade and driving through their hometown shouting his name, said she’s never trusted a president as much as the real estate developer and former reality TV star.
“We said: ‘Who else would we do this for, besides Trump?’” McComic said. “We agreed on the Lord. We would stand here for the Lord, but that’s about it.”
Trump Promises Tea Party Groups He Will Punish America: If TrumpCare Fails, He Will Let ACA Fail
By First Amendment March 9, 2017
Title of this diary is stark, but it’s true and we must frame our arguments in these stark terms. Donald Trump literally wants to harm Americans, by sabotaging it’s current healthcare system.
Truly unbelievable. Donald Trump is a President that is willing to harm millions of Americans, because he might not get his way on his disastrous TrumpCare plan.
What’s striking here, Trump has no problem punishing Americans for political gain and yet, he will never, ever criticize Vladimir Putin. He will go out of his way not to criticize his Putin. Even calling Putin “very smart”, yet he treats Americans like they were dumb. This is Trump at his elitist, narcissistic best. I got mine, so I could give a damn about you America.
He would allow our healthcare system to fail, so he can blame Democrats and in turn this would destroy the lives of millions and millions of Americans. Make America Great Again or screw it over constantly?
Make no mistake folks, Trump will attack America and Americans at will every single chance he gets. Whether it’s the enemy press, the enemy former President and now the enemy healthcare system, etc. No other way to put this, but Donald Trump is just pure evil and no other way to spin Trump’s response on healthcare.
This should be a huge story.
‘I grew up in Canada’: MSNBC host whoops GOPer for claiming people hate universal health care
David Edwards March 9, 2017
MSNBC host Ali Velshi clashed with Rep. Jim Jordan (R-OH) over the popularity of universal health care systems.
Jordan argued during a Thursday interview on MSNBC that Republicans should do a “clean” repeal of President Barack Obama’s health care reform law before trying to replace it.
“This is so logical,” Jordan insisted. “We know Obamacare is a mess: fewer choices, higher premiums, higher deductibles. It’s a complete disaster.”
“I hear this talking point all the time,” Velshi interrupted. “There have always been higher premiums. Higher premiums every year. And under Obamacare, the premium increase has been lower. I heard you guys at your press conference yesterday sort of mincing words with that one.”
“We do have to acknowledge that,” the MSNBC host continued. “There were higher premiums before Obamacare, there are higher premiums during Obamacare. But the rate of increase has been slower.”
Deflecting Velshi’s point, Jordan complained that the current law meant “more taxes, more regulations, drive up the cost of insurance, mandate people buy it, and if they don’t they get penalized.”
“There was never affordable insurance,” Velshi observed. “Nowhere on the face of the Earth is there a free health insurance market that works. If you could point me to one and say that a free market works — it’s just one of those areas that a free market doesn’t work.”
“It will work much better than it’s working now under complete government control!” the Ohio Republican promised. “Do you think that people are satisfied now? How about people in the individual market who went from paying $100-200 a month to paying $500-600 a month.”
Velshi, who is from Canada, stepped in to defend the success of universal health care systems throughout the world.
“You know, sir, in all those countries, in all those countries that have single payer systems or universal health care, happiness about health care is actually substantially greater than it is in the United States.”
“Then why do they all come here?” Jordan asked.
“They don’t all come here!” Velshi shot back. “Republicans say that all the time. They don’t all come here. People in Canada, people in Norway, people in the United Kingdom, people in Sweden, people in Denmark — they don’t all come to the United States for health care. Why do you say that?”
“Because you see it all the time,” Jordan opined.
“It’s just not true!” Velshi pointed out.
“People in Canada come her for extensive surgery,” Jordan said. “They come here and get it done in the United States.”
“I grew up in Canada,” Velshi revealed. “I lived in Canada, my entire family is in Canada. And nobody I know ever came to the United States for health care. I’m sure you have a handful of stories about things like that. It’s not actually statistically true.”
“You think Obamacare is great?” Jordan quipped.
“No, I’m not arguing Obamacare,” Velshi noted. “I’m arguing the fact that you keep on saying that a free market works. Just name me one country, one country in the world where a free market system for health care works.”
Instead of answering the question, Jordan said that Republicans have a mandate from voters to repeal the Affordable Care Act.
Watch the video below from MSNBC, broadcast March 9, 2017.
How the House Republicans’ proposed Obamacare replacement compares
On Monday, House leaders released legislation to replace the Affordable Care Act. If it passes, here’s what would change.
By Darla Cameron and Leslie Shapiro March 7, 2017
Who would be covered
Under two plans drafted by separate House committees, the government would no longer penalize Americans for failing to have health insurance.
Enforcement of the individual mandate requiring coverage
30 percent surcharge on premiums that insurers would be able to impose on consumers who purchase a new plan after letting their previous coverage lapse — a strategy to encourage people to remain insured
Employer mandate on larger companies to offer affordable coverage
How they would pay for coverage
The plans would replace federal insurance subsidies with a new form of annual individual tax credits.
Income-based premium subsidies to lower- and moderate-income consumers would end as of 2020.
Age- and income-based refundable tax credits
How the new tax credits would work
The new legislation would break people into five age groups, each receiving a different amount in tax credits to purchase health insurance: Age Tax credit 20 – 29: $2,000 30 – 39: $2,500 40 – 49: $3,000 50 – 59: $3,500 60 and older: $4,000
These credits begin to phase out for individuals making more than $75,000 and joint filers making over $150,000. Other restrictions include:
- For each $1,000 in additional income above the limits, a person would be entitled to $100 less in credit.
- Credits would be limited to a maximum $14,000 per family.
- Credits could be used for any health plan allowed in a state, including ones providing only catastrophic coverage.
- Credits could not be used to buy health plans that cover abortion.
Insurers can charge older customers up to three times what they charge younger customers.
Insurers would be able to charge older customers up to five times what they charge younger customers.
Individuals can contribute up to $3,400 and families up to $6,750 to pre-tax health savings accounts.
Starting in 2018, individuals could contribute up to $6,550 and families could contribute up to $13,100 to pre-tax health savings accounts.
Cost-sharing subsidies, which were provided to insurers to help their ACA customers cover deductibles and co-payments (ending in 2020)
States would receive $100 billion over 10 years through a new Patient and State Stability Fund for safety-net needs and possible “high-risk pools” for consumers with expensive medical conditions.
Proposed changes to Medicaid
Here’s how the legislation would address Medicaid.
Medicaid as an entitlement program with open-ended, matching federal funds for anyone who qualifies
Medicaid would be funded by giving states a per-capita amount based on how much each state was spending for the fiscal year that ended in September.
How Medicaid expansion would be affected
Under Obamacare, 31 states broadened their Medicaid programs to cover people making up to 138 percent of poverty-level income.
Under the GOP plans, the states would continue getting enhanced federal funding until 2020. After that, the government would keep paying 90 percent for beneficiaries already on the rolls as long as they remain eligible.
After 2020, new beneficiaries would be funded at a lower level.
NM IN KY LA AR OH WV MI NJ CO MN IL NY IA ND MT WA OR CA AK HI AZ NV PA MA NH VT RI CT DE MD DC
Other key elements of the plans
The legislation would preserve some of the most popular features of the 2010 health-care law, while targeting Planned Parenthood.
Insurers would still be banned from denying coverage based on preexisting conditions.
Dependents would still be able to stay on parents’ insurance plans until age 26.
Caps on annual or lifetime coverage would still be banned.
Insurers would still have to cover certain categories of specified benefits first covered by the ACA.
Planned Parenthood is eligible for Medicaid reimbursements or federal family-planning grants (but federal money cannot fund abortions)
Planned Parenthood would face a one-year funding freeze
Source: The American Health Care Act, House Republican briefing.
The GOP’s Obamacare replacement is going to disproportionately affect one group
Lydia Ramsey and Andy Kiersz, Business Insider March 13, 2017
The Congressional Budget Office on Monday released its report on the American Health Care Act, the healthcare bill proposed by House Republicans.
The CBO estimated that under the Republican healthcare bill as many as 24 million more people could be uninsured and the federal budget deficit would shrink by more than $300 billion over the next decade.
As part of the report, the nonpartisan agency also detailed its estimates for what premiums might look like under the proposed legislation.
The net premiums — that’s accounting for tax credits — for different age groups might look quite different under the proposed AHCA compared to the Affordable Care Act.
Under the AHCA, premium tax credits would solely account for age, rather than factoring in both age and income as it exists under the ACA. The effect, according to the CBO, is that older people with lower incomes would see a significant increase in their net premiums.
(Business Insider/Andy Kiersz, data from CBO)
How the Republican plans to replace Obamacare could affect you
Michael Phelan Social Security Works
Many analysts doubt whether the plans Republicans put forward would have provided coverage that was adequate or available to enough people.
More Americans are insured than ever before. But the political consequences for both sides may not have been worth it.
Republicans have wasted little time declaring war on seniors.
The new GOP plan to gut the Affordable Care Act will give massive tax breaks to the wealthy at the expense of the poor, elderly and sick. It does this by raiding $346 billion from the Medicare trust fund to pay for giveaways to the wealthy, and in turn intentionally weakens Medicare’s finances.
Immediately after Election Day, Paul Ryan “justified” his plan to gut Medicare by saying, “because of Obamacare, Medicare is going broke.” Of course this couldn’t be further from the truth. ACA has in fact extended the lifespan of the Medicare Trust Fund. But the GOP’s plan is a self-fulfilling prophecy: Weaken Medicare in order to destroy the program through privatization.
The bill removes protections that limit the amounts health insurance companies can charge older Americans. This would be particularly devastating to people in their fifties and early sixties, who aren’t yet eligible for Medicare.
The bill also threatens the financial security of millions of families due to cuts in Medicaid. About 10 million seniors are dually eligible for both Medicare and Medicaid―with Medicaid covering the majority of long-term nursing home costs for low-income seniors. Cuts to Medicaid would deprive millions of seniors of needed nursing home coverage, forcing families to scramble to either make up the difference or provide in-home care instead. The bottom line is that this bill would make insurance more expensive and lower quality for millions of Americans―starting with seniors.
Together we must fight any attempt to destroy Medicare and Medicaid―threatening the healthcare and financial security of millions of Americans.
Texas woman changes homeless man’s life after he stood on same street corner for three years
Loulla-Mae Eleftheriou-Smith,The Independent March 2017
A woman has helped to change a homeless man’s life in a matter of months by setting up a Facebook page, after discovering why he stood on the same street corner every day.
Ginger Sprouse, who runs Art of the Meal in Clear Lake, Texas, drove past 32-year-old Victor Hubbard on the corner of El Camino Real and Nasa Road 1 four times a day, no matter the weather.
The corner was the last place Mr Hubbard saw his mother and he would wait there for her to return. He was homeless and suffering from mental health issues when Ms Sprouse first started first started to offer him help, and had been waiting on the corner for three years.
“I began to get more and more concerned as I knew winter was coming and I thought, ‘So what’s going to happen now?’” Ms Sprouse told MyBayArea Radio, explaining that she had started visiting Mr Hubbard on her lunch break and they had struck up a friendship. “So he and I started talking about maybe how would he feel about sometimes coming to my house to get out of the bad weather, and that’s how we started.
“It’s been quite the journey,” she said.
She created a Facebook page called “This is Victor” as a way for the community to get to know Mr Hubbard better and to take part in getting him the help he needed. In her first post Ms Sprouse wrote: “I drove by Victor’s corner at least four times a day. I listen to people talking around town and keep hearing, ‘Someone needs to do something about that guy’. So, I will be the organiser and hope that we as a community can be ‘someone’ together.”
Since taking action in December, Ms Sprouse has managed to get Mr Hubbard into mental health clinics, helped him off the streets and has given him a job in her business’s kitchen. A GoFundMe page raising money to help with Mr Hubbard’s living costs has seen more than $15,400 (£12,700) donated and over 200 people showed up to a recent block party to show their support for the man they had seen on the same corner every day.
The Facebook page has been liked by more than 15,000 people and has a stream of comments from locals expressing their relief that Mr Hubbard is receiving care, while updates are regularly posted by Ms Sprouse, including videos about his improvements and messages he has recorded for his friends.
The community has also responded by helping Mr Hubbard get clothes, eye tests and to be seen by doctors, and the local fire station has vowed to oversee his medication needs. Ms Sprouse and her family are currently working to get him sheltered accommodation.
Since the publicity of the Facebook page and community project, Ms Sprouse was able to get in touch with one of Mr Hubbard’s uncles and was eventually able to help him see his mother again.
“I got to talk to her and I really feel like I accomplished something,” Mr Hubbard told the TV station.