Welcome to the No-Insurance Emergency Rooms as Long as They Last

New Orleans  The Congressional Budget Office has released its score on the cost and impact of the Senate Republicans version of healthcare coverage. The bottom lines have gotten wide publicity. 22 million will lose insurance by 2026, 15 million almost immediately. 15 million lower income people will lose Medicaid coverage. It wasn’t big news that this will be an income transfer from the poor to the rich, because we had already known that was coming in all the Republican bills.

Elderly people hoping to live long enough to qualify for Medicare will have to run the gauntlet, unless they are wealthy. The New York Times gave two examples from the CBO report that were appalling.

for a typical 64-year-old with an annual income of $26500, the net premium in 2026 for a midlevel silver plan – after subsidies – would average $6500, compared with $1,700 under the Affordable Care Act. And the insurance would cover less of the consumer’s medical costs. Likewise, the report said, for a 64-year-old with an annual income of $56,800, the premium in 2026 would average $20,500 a year, or three times the amount expected under the Affordable Care Act.

Yes, you understand the math. In the first example that’s a quarter of the person’s income and in the second it’s more than one-third, 36% to be exact.

The Senate added an amendment at the request of the insurance industry recently that anyone not on insurance more than 60 days would have to wait 6-months to get coverage and pay 30% more on their premiums. The industry recognized that as bad as this bill is, no one is going to get coverage until they are sick, so they wanted to try and put some boulders in the road.

And, of course they are right. With no mandate and no penalties for not having insurance most people will not get insurance for the plain and simple reason that they won’t individually be able to afford it unless their employer is providing it for them. Young people on insurance will be rare. For the rest of the population, health insurance will be the American version of Russian roulette. How long can you wait before getting insurance? People will be arbitraging their family fiances against their lives.

What if you are diagnosed with cancer or something and have to wait 6-months for treatment? In the short term survival for you and tens of millions of others will mean throwing yourself on the mercy of the hospital emergency room, as long as the law doesn’t allow them to refuse service, and until so many of these hospitals go bankrupt from providing care without government support or private insurance payments.

There’s a reason why hospitals, doctors, nurses, and everyone connected to providing health care services have opposed these bills. It’s not because many will lose their jobs as healthcare facilities go under, which they certainly will. They aren’t politicians. They’ll see the people dying at their door, too late to save, and too poor for the insurance, yet too rich for any assistance. Who wants to live through that?

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I’m Not Complaining, but What a Week

New Orleans  Returning exhausted from stops in Shreveport, Louisiana, Little Rock, Arkansas, and Greenville, Mississippi, somehow I can’t get these weird signposts of the times and odd ends out of my mind. Normally, I would let them go, but somehow this Chief Organizer Report is going to be a report on the chief organizer, so bear with me.

Bargaining four nursing home contracts in Shreveport, the company already wants to include language making the Affordable Care obligations moot, even while the whole operation continues forward in the stalemate of Congress and presidential politics.

A studio chair and some folding chairs for WAMF, the new low power FM radio station that we just got on the air in New Orleans, was donated to us in Bossier City across the river (thanks Butlers and Clarks!). In a pleasant middle income suburb between a mall and an expressway, I parked my big truck, doors wide open in the driveway of the unoccupied house waiting for Local 100 organizer, Toney Orr from Arkansas, to help me load it all in. Neighbors drove by and up and down the driveway next door. No questions asked, even as we hauled the furniture out. Is that weird?

In Little Rock, despite six months of work on the Home Savers Campaign and running PSAs on KABF referring calls to Arkansas Community Organizations, the former Arkansas ACORN, that yielded little, we finally broke through and within 48 hours found a trove of both Vision Property Management and Harbour Portfolio rent-to-own and contract to purchase houses throughout central Arkansas. We had boomed out to visit victims in Ohio, Michigan, and Pennsylvania and here they were right under our noses! The lesson, even when the spirit is willing, we have to shore up the capacity to account for how often the flesh of our operations need more underwire. Capacity matters, even a little can make a huge difference, and that’s worth remembering. Oh, and, a Home Savers organizer, Dine’ Butler, was the big finish of the well-regarded Reveal podcast, home visiting a victim in Detroit.

Capacity, capacity, capacity, it comes up again and again, and amazingly we stumble around trying to find it even when it is kicking us in the knees and pushing us to the ground. One kingdom after another lost for lack of a horse. Our biggest underwriting partner at KABF was being stymied on promoting its great work, because we had never pressed hard enough for the spots for them to realize if they gave us copy we could produce them quickly or allow hosts to do “reads.” Ouch!

Visiting radio station WDSV in Greenville for the 7th month, it was the same story with a different verse. Frustrated and stalled in achieving their mission after 5 years on-the-air as the voice of the people in the Delta, they were being held hostage by technology too large and complicated for them to easily access to master the ladder to the heaven they sought. The magic and miracle is not that we can fix that, but that it takes so long for us to marry problems to solutions, so that we can move forward in our work.

Sometimes I’m racing so fast that I miss how easily it is to stumble on the simplest steps. I wish it were just me!

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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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Where are the Citizen and Patient Protests to Protect Affordable Care?

New Orleans   In the activist moment with cries for resistance, I wonder why the healthcare issue is being left behind by many, as well as the current Obamacare beneficiaries, and why we are not all massing in protest at the threats and head fake proposals to replace care?

Don’t misunderstand me, I’m aware of the moving stories at some of the Congressional town hall meetings where some of the sick and infirm along with others have asked their electeds the hard, life-or-death questions, involved in eliminating healthcare insurance. I know the risks to the Affordable Care Act and the fear it has stirred has increased support for the Act past 50% in the polls. I know the Koch Brothers are trying to rekindle their grasstips base to demand repeal or else. I know the Freedom Caucus, concerned Republicans, and others are pointing out the costs and naked emperor-has-no-clothes aspects of Speaker Paul Ryan’s so-called secret plan demonstrating their divisions. I know the President has discovered that health care is complex. I know various sides, pro and con, are on the airwaves with video and sound bites.

What I don’t know is why we aren’t seeing people in motion in serious numbers?

With more than 20 million people on Obamacare and many of them on the highly threatened expanded Medicaid coverage the ACA triggered, that would seem a big and bad base ready for action. If our neighbors and friends in this group are just scared and confused, how about the many millions in schoolhouse door states that stubbornly refused to expand care, take Texas for example? Or, Florida, Georgia, North Carolina, and Wisconsin? Don’t tell me there aren’t millions in that number caught in the gap between low income qualification and not enough income to afford insurance. And, how about all of the service workers in nursing homes, home care, food service and elsewhere with company provided play pretend policies with $5000 and more deductibles who want reform so that they can finally have coverage?

Don’t tell me there are not millions mad and desperate for care?

Where is the campaign that moves people state to state in this fight, like the effort that helped win the fight in the first place? Where are the community organizations that are listening to their members and making this the issue they are moving on right now?

Is the issue too complex as Trump claims? The tactics are numerous, so are the targets the problem? Sure the distance is huge between us and DC, both physically and philosophically, but how about state legislators and governors, those are closer, and every report seems to say, governors are on their knees begging the White House not to cut and run on Obamacare, dumping the problem to them without enough money to fix it. How about hospitals? If we start hitting them hard on charity care that they are supposed to be providing, but aren’t and their tax exemptions, maybe they would get in gear. A couple of thousands of them according to IRS reports are making more than a million a year, so they might move to the feet and voices of patients’ protests and demands?

The problem with resistance is that it’s reactive. We need offense, not just defense. We need it now before our weaknesses devour our strengths.

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Is There a Resistance Movement or Resistance Moment?

Bristol   I definitely don’t want to be standing at the station when the whistle blows that the train is moving out. I have to admit that I have my ears perked up at every sound to try to hear whether it’s the thundering feet of a movement or just the sharp cry of a moment.

I’m too jaded in this work to see Congressional town halls as the birthplace of the next revolution, but I don’t want to be blind to history either, and a snippet of the news like the one that follows makes me sit up straight and stand at total attention:

In fact, some of the most formidable and well-established organizing groups on the left have found themselves scrambling to track all of the local groups sprouting up through social media channels like Facebook and Slack, or in local “huddles” that grew out of the women’s marches across the country the day after the inauguration.

When the people are moving and established organizations and institutions are having to work overtime to catch up with them, that’s a very, very interesting sign. In a time of movement, it may be difficult for this kind of activity and anger to be channeled in the way that these same organizations and institutions are hoping to move the stream. It’s good news though for the 30 million lower income families taking advantage of the Affordable Care Act that there are many of the flags being waved as elected representatives slink home from the Congressional chaos are focusing on saving health care.

There are other signs too. When seasoned organizers report that they expected 200 at a meeting, and 1000 showed up, as my generation said, “you don’t need a weatherman to see which way the wind is blowing.” The Times also reported on other barometers that people were in motion:

Anti-abortion demonstrations in some cities this month were met with much larger crowds of abortion rights supporters. At a widely viewed town-hall-style meeting held by Representative Gus Bilirakis in Florida, a local Republican Party chairman who declared that the health care act set up “death panels” was shouted down by supporters of the law.

And, perhaps more interestingly, an organizer for Planned Parenthood posed the question plainly as she tries to ride this wave of momentum:

“It doesn’t work for organizations to bigfoot strategy; it’s not the way organizing happens now,” said Kelley Robinson, the deputy national organizing director for Planned Parenthood, which is fighting the defunding of its health clinics. “There are bigger ideas coming out of the grass roots than the traditional organizations.”

If she’s right, that’s a call to arms for all of us to get ready to move, because grassroots activity needs formation, planning, resources, and direction in order to win. That’s not bigfoot, that’s soft touch, listening, and work on the ground that takes a moment and helps make a movement and births new organizations and great social change.

When that whistle blows, we have to all be on the train.

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