Congressional Budget Office Scores House Health Bill with an “F”

Oakland    The Congressional Budget Office finished its nonpartisan, objective evaluation of the costs and impacts of their recently passed bill to replace the Affordable Care Act, and channeling Gertrude Stein found that there was “no there, there,” at least if any of us were looking for health insurance, especially when we have health problems.

Begin with the fact that they estimate that 23 million Americans will lose health insurance. I say “begin,” because there is no way to get an accurate view on how high that number could rise. The Republican bill, as written, gives states the ability to ask for waivers from an anti-healthcare Department of Human Services, which would rubber stamp the ability of states to eviscerate care for the individuals with preexisting conditions, women’s health needs, and allow skinnier and skinnier requirements from the plans, thereby eliminating the minimum health provisions of Obamacare for everyone on the program. Analysts report that the CBO usually consults with states in making its estimates, so the 23 million may include some, but this number would likely swell in the red states with “red” now not referring to the color of a map on election night, but instead standing for the blood draining out of these states’ dying people.

Furthermore in the CBO score, they reject the argument that Republicans have made that such miserly benefits will bring happy days with lower premiums and therefore more participation. The CBO flatly argues that the Republican House plan will end up with higher prices, especially because of the Medicaid cuts, and will collapse insurance markets because of the reduction of subsidies. Young people will get cheaper insurance though that will only be good news in the flower of youth, because if, and when, faced with any healthcare needs, young people will be as screwed as everyone else.

The CBO also totally dismissed the Republicans’ argument that “risk pools” would cover take care of Americans with preexisting conditions. If you read between the lines the CBO believes they will pretty much die as soon as they run out of money, and it won’t take long. The “risk pools” are inadequately funded in their view, and they have never worked. The dustbin of history is calling, but the House Republicans are determined to sell the scam. At least they are if they can keep their tempers when asked to defend their votes in favor of this trash, which wasn’t the case for the Montana Republican Congressional candidate facing a tough contest, who decided to body slam a British reporter for the nerve of asking him about his vote.

Some Senate Republicans might notice that one of the groups being slammed the hardest is older people. The New York Times analysis noted that “The cost of insurance for a 64-year-old earning about $27,000 would increase to more than $13,000, from $1,700 under the Affordable Care Act, even for states that pared back insurance rules.” Bad news, these folks actually vote and even with diminishing basic math skills, all of them will figure out that their bill would be almost half of their income.

There are some winners though, but in the Republican plan that’s the folks with the fatter wallets, especially if they are neither old nor poor. The Times reports, that “The bill makes big cuts to taxes on payroll and investment income for those earning more than $200,000, and provides more subsidies to buy insurance for people earning between about $50,000 and $150,000.”

There is no irony here, though their could be. Fewer subsidies for the poor, but more for wealthier families? How can anyone rationalize that? There’s a clue to their thinking though. Perhaps they are channeling HUD Secretary Ben Carson, and want us all to believe that health insurance is like poverty, “just a state of mind.”

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Trump’s Budget Wants USA to be Kansas, Meanwhile Reality Calls

Oakland   The devil is in the details, not on Saturday Night Live, and his footprints are becoming clearer as the top notes become louder on the Trump Administration’s true plans for the country as revealed by their more detailed budget proposal. Tremendous cuts are being proposed for entitlements, some $800 billion over ten years in Medicaid, because, hey, they have to take money from poorer Americans in order to propose huge tax cuts to richer Americans and cut down taxes for corporations now enjoying record profits. Food stamps, which are now called SNAP, will have forced work requirements. States will be given more flexibility to lard on other impediments to receiving actual benefits and making the process of accessing benefits even more draconian. Hardest hit may be people on SSI disability payments. Trump promised not to cut Medicare or Social Security, but SSI for some reason seem like fair game to them, even though these payments are lifelines for many. Early, rough estimates are that 10 million poor people will be hammered by the budget, if it actually emerges in this form.

What’s the rationale? Well, if corporations and the rich are given carte blanche then supposedly jobs will be created and that will solve everything.

Where have we heard that recently? Yes, Kansas, which is on most lists in the USA of what counts as a “failed state.” Former Senator Brownback became governor of Kansas several years ago and with a whooping, red state legislature, cut state taxes to the bone with the same rationale. Jobs were going to grow in like wheat in Kansas and the volume of new jobs and business would replace the lost revenue. We can only wish that President Trump and his people had looked at how this had worked out in Kansas. State revenue plummeted. Cutbacks to public education forced one court action after another with the state legislature now under court order by the Kansas Supreme Court to come up with the money to fund the schools under constitutional mandate or face the consequences. People are being hurt in Kansas and the economy is a wreck, but “message to the men from Mars,” there is a political backlash. Some legislators who touted the plan have been defeated. Even Republicans are wary of Brownback’s proposals, and the rare Democrats in the state of Kansas are in resurgence. There are lessons that could be learned in Kansas, if anyone at the White House bothered.

But, there are also lessons that could be learned everywhere, if the President and his people, actually talked to people in the neighborhoods. Yesterday, our Home Savers Campaign team was again on the doors in Detroit. We were focusing on Vision Property Management, and the visits were grim. A Latino family had bought a Vision rent-to-own next door to where they lived for their mother to live in. They were now coming to decision point on the agreement where they have to either make a $15,000 balloon payment, sign another long term extension of their agreement, or walkaway. They were unsure where to go next. Another family had successfully negotiated a change with Vision from rent-to-own to a land contract, but then the roof had collapsed on them within months after they signed and they were also uncertain. Other families had no clue what was in their agreements.

These are all working families with jobs trying to find affordable housing, and often depending on SSI, food stamps, subsidized school lunches, and the expansion of Medicaid under the Affordable Care Act. Why are their lives not as valuable as the rich? Why can’t they get a break?

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Please enjoy Oxford, MS from Davy Knowles. Thanks to KABF.org.

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White House and Rightwing Creating a Red State Healthcare Kill Zone

Pittsburgh   When someone is elected president, they used to actually believe the words their speechwriters would scribble on the line that they were the president of all of the people in America. It is becoming clearer under the Trump Administration that even though he and the White House might parrot those words, they clearly no longer believe them at all. The problem probably starts with the fact that when you are elected by the states through the weirdness of the archaic pro-slavery roots of the Electoral College, rather than the majority of the actual voters, as was the case for Trump, then you may easily slide to the incorrect understanding that you mandate is in the states.

Looking at the wrongheaded, feeble, and gutless concessions that the White House is offering to the Freedom Caucus, the 30-odd member secret cabal in the House of Representatives, it is hard to escape this theme that the President no long believes we are one united government with a national vision and program, but a patchwork quilt of states doing their own thing. What is really confusing to me though is why he would be willing to make his red state base a killing zone of his supporters.

The lead balloon floated to the Freedom Caucus by Vice-President Pence and Trump’s chief of staff would give states the ability to waive the crucial life and death protections that were part of the fabric of a national healthcare plan. According to the New York Times,

According to the so-called Freedom Caucus the White House is pitching a healthcare evisceration that would involve the following: States would have the option to jettison two major parts of the Affordable Care Act’s insurance regulations. They could decide to opt out of provisions that require insurers to cover a standard, minimum package of benefits, known as the essential health benefits. And they could decide to do away with a rule that requires insurance companies to charge the same price to everyone who is the same age, a provision called community rating.

Yes, you get it. The President’s offer to the cabal was that the full force and strength of the United States government would allow the far right and their allies and supporters in the states to eviscerate any semblance of health care coverage to allow insurance companies, soon to be their largest campaign contributors, to do whatever they want to whomever can’t pay the price. So, gone would be the bar against not insuring people with preexisting conditions, if they state said so be it. Gone would go the basic protections. Gone would be bars against pricing discrimination, and who knows what might be left. Once the White House says that they are going to greenlight any crazy waiver that comes their way, and leave that state’s people on bleeding and dying on the emergency room floor, then who knows what might go next.

Were this gutting of healthcare to proceed, it’s not really just about red states and blue states, but mainly about rich and poor. Besides this healthcare proposal being a huge giveaway to the rich on tax breaks, it would also further divide rich and poor based on their ability to pay the insurance piper whatever price they set as they establish the divide between their profit and loss as the same as the divide between life and death based on your wallet size.

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Healthcare Lives Another Day, but Does Trump Have a Way to Win?

New Orleans   The Trump Tower has now been reduced to rubble. Ryan’s House is a shambles. Obamacare is now with us “for the foreseeable future,” according to the Speaker.

Right now the Affordable Care Act is better than nothing, but it could be nothing better.

The best news of the Trumpcare debacle and the inability of all of the concessions and arm twisting producing nothing is that it may have taught the President to write off the so-called Freedom Caucus, committee of no way. After having given away the store of all of the essential guarantees of the ACA, even the inclusion of children on parents’ policies until 26, which reportedly even the President understood was past the pale, the no-birds were still flying and demanding more, more and more. They had already pulled the bill so far right that what remains of moderates in the House of Representatives were forced to run from the bill and declare they would vote no. One lesson we can hope that Trump has learned is that these folks don’t negotiate in good faith, and it is worth walking away from their demands and their skinny 30 odd votes in their secret caucus, if you have a job that you want done.

Given the obstinence of the Republicans to countenance any fixes over the last seven years – and, yes, many are needed, as we have argued continually, especially capping deductibles – there might be an opportunity to get something good done if the President, the moderate Republicans, and the Democrats in the House and the Senate finally looked at “repair,” rather than “repeal and replace.” The polling on this recent abomination of a bill, thankfully pulled off the calendar, had indicated only 17% support and 56% opposition with 26% undecided. The Republican effort was failing most miserably among the so-called Trump base where as conservative Wall Street Journal columnist Peggy Noonan wrote that it was 26% “underwater” among non-college educated whites and an amazing 46% “underwater” in the 50 to 64 year old age group where people are more likely to forget to take their pills that day than they are to forget to vote. Trump couldn’t threatened to punish Congressman by mobilizing his base because they were in the bathroom losing lunch at the prospect that they would lose the healthcare they had gained under the Affordable Care Act.

If Trump wants to govern and we want to live through these next couple years, the President needs to stop all of this alt-right baloney and crazy flirting with the far right wing, and get closer to the where real deals are made. Even his former Breitbart Rasputin Stephen Bannon was reportedly disgusted with the concessions and bargaining posture of the far right, and that’s saying a mouthful.

I can remember presidents in Peru getting so low in popularity that they were hardly making it to two-digits. Trump is on his way there and the slope is no longer slippery, but fully greased unless he figures out a way to put the brakes on. Experts estimate that any new Congress only has about 200 days to get anything done for good or evil until mid-term elections suck the votes out of the room. For Trump and his gang 60 of those days are already gone, and we’ll all be counting on the death watch now.

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Trump’s Broken Promise, Cavalier Giveaway of Basic Healthcare to the Rightwing

New Orleans   Incredibly after all of the promises of a better healthcare program, all the President wants now is a sale, no matter how shoddy the merchandise. This is the short con. Meeting with the so-called Freedom Caucus, he agreed to get rid of the Affordable Care Act’s “essential health benefits” guaranteed to everyone as part of the basic health plan regardless of cost. This doesn’t include the caps on senior pay, the ability to cover children under parents policies until 26, or the waivers for pre-existing benefits all of which this bill is also giving away or the fact that his concession bargaining has now lowered the supposed savings by more than half.

Regardless, let’s just review the ten essential benefits that all Americans stand to lose as a reminder of why this entire package should be dead-on-arrival to the Senate, if it ever makes it there.

The Affordable Care Act’s Ten Essential health benefits include:

  • Ambulatory patient services (Outpatient care). Care you receive without being admitted to a hospital, such as at a doctor’s office, clinic or same-day (“outpatient”) surgery center. Also included in this category are home health services and hospice care.
  • Emergency Services (Trips to the emergency room). Care you receive for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness. Typically, this is a trip to the emergency room and includes transport by ambulance. You cannot be penalized for going out-of-network or for not having prior authorization.
  • Hospitalization (Treatment in the hospital for inpatient care). Care you receive as a hospital patient, including care from doctors, nurses and other hospital staff, laboratory and other tests, medications you receive during your hospital stay, and room and board. Hospitalization coverage also includes surgeries, transplants and care received in a skilled nursing facility, such as a nursing home that specializes in the care of the elderly.
  • Maternity and newborn care. Care that women receive during pregnancy (prenatal care), throughout labor, delivery, and post-delivery, and care for newborn babies.
    Mental health services and addiction treatment. Inpatient and outpatient care provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder. This includes behavioral health treatment, counseling, and psychotherapy.
  • Prescription drugs. Medications that are prescribed by a doctor to treat an illness or condition. At least one prescription drug must be covered for each category and classification of federally approved drugs.
  • Rehabilitative services and devices – Rehabilitative services (help recovering skills, like speech therapy after a stroke) and habilitative services (help developing skills, like speech therapy for children) and devices to help you gain or recover mental and physical skills lost to injury, disability or a chronic condition (this also includes devices needed for “habilitative reasons”). Plans have to provide 30 visits each year for either physical or occupational therapy, or visits to the chiropractor. Plans must also cover 30 visits for speech therapy as well as 30 visits for cardiac or pulmonary rehab.
    Laboratory services. Testing provided to help a doctor diagnose an injury, illness or condition, or to monitor the effectiveness of a particular treatment. Some preventive screenings, such as breast cancer screenings and prostrate exams, are provided free of charge.
  • Preventive services, wellness services, and chronic disease treatment. This includes counseling, preventive care, such as physicals, immunizations, and screenings, like cancer screenings, designed to prevent or detect certain medical conditions. Also, care for chronic conditions, such as asthma and diabetes.
  • Pediatric services. Care provided to infants and children, including well-child visits and recommended vaccines and immunizations. Dental and vision care must be offered to children younger than 19. This includes two routine dental exams, an eye exam and corrective lenses each year.

Read and weep. Listen and pick up the phone and call Washington. Now!

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Please enjoy Blondie’s Long Time.

Thanks to KABF.

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Pork Barreling and Horse Trading with Ryan’s Healthcare Disaster

New Orleans  They might have the votes, and they might not have the votes to get this mess of a healthcare abomination out of hardcore ideologue and Speaker Paul Ryan’s House, but all signs point to a squeaker that will smell like it crawled out of a dumpster by the time it gets to the Senate.

We already know that the President and his people will say virtually anything without regard to fact or fantasy, and they seem to be using that proclivity in hyper-fashion with recalcitrant House of Representative moderates, saying that the Senate will fix and modify the mess. Most folks on the used car lot that Congress has become would walk away from that lemon.

For the suicidal, largely anonymous so-called Freedom Caucus, they have bent over backwards to take something terrible and make it even more horrid. They want work mandates for Medicaid despite all evidence that establishes that not only are these ineffective, punitive, and needless, but that people need healthcare to get well, so that they can work. Ok, here you go! Some of them want funding of some programs to stop immediately rather than in 2018, so, hey, let’s accelerate the death spiral for another vote or two. Anything goes these days.

And, talk about pork barreling and horse trading for votes in this district or that, and any principles go out the window. Congressman from upstate New York want to push the share of the Medicaid bill from the county coffers to the state for a billion or more, no problem, if these couple of Congressman are Republican and the Governor of New York is a Democrat. Heck, make him pay up. Some coal miners with black lung realizing that they could be hammered by cutbacks in Medicaid that are keeping them alive, no problem, write in an exception for coal miners with black lung.

Are you seeing a pattern here? Even if something emerges, it is going to be jerry-rigged like a Rube Goldberg contraption. They are already asking the American people to pretend this will be some kind of viable health plan, and now they are going to ask us to pretend it will actually work.

No one likes this thing. Republican and Democratic governors are aghast. Doctors, hospitals and the elderly associations are up in arms.

This is clearly no longer an exercise in healthcare policy. This is all about big league politics now. They need to prove on the first bill coming out of the Trump barn that they can win. No matter what or how bad the smell.

Whatever happens in this first vote, no one can believe anymore that this is going to end well.

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Please enjoy Big Boys  from the late great Chuck Berry.

Preservation Hall Jazz Band Santiago.

Thanks to KABF.

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