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 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!

***

Please enjoy Blondie’s Long Time.

Thanks to KABF.

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Republicans Red-Circle and Two-Tiered Medicaid Provision Won’t Work on Obamacare 2.0

Kaiser Family Foundation

New Orleans   The Republicans in the House of Representatives introduced their whatchamacallit healthcare bill which some other Republicans are calling Obamacare 2.0, and you can bet that’s not a compliment. The rest of us might take some small measure of comfort in that, but this is more of a “hold your breath and hope for the best” moment than a relief. Before anyone jumps off a cliff or heads for Canada, it’s important to understand that this hodgepodge of a bill is kind of a rough draft. The House Committees in fact are planning to try and move this bill forward without a firm estimate on the number of people it will cover or, more importantly practically and politically, the number it will not cover. Even more surprisingly, this thing breaks a cardinal rule of all card carrying Republicans: it lacks a price tag!

So, let’s take some deep breaths and a couple of pain pills and look at some of the hidden explosives in their attempt to put their finger in the wind and see what kind of gale force comes back at them. I’m going to avoid some of the easy shots, like the fact that governmental leverage on private insurers and costs seems to be going out the window or that a 30% penalty on any break in coverage is many magnitudes worse than the Obamacare 1.0 penalties or that much of the coverage is going to be catastrophic. We’ll have plenty of time to watch all that unravel as this bill is pulled in on one gurney after another into legislative emergency rooms. We’ll pass on by the deliberate and discriminatory attack on Planned Parenthood or the fact their bill seems to allow no insurance that will cover any voluntary abortion, because we’ll have to address those issues separately and soon.

I’m just going to focus on one of the more egregious and blatantly political and deliciously chicken chirping pieces of this bill. They realize that the major advance in healthcare coverage has been to lower income people through expanded Medicaid, and they recognize that politically they can’t handle the blood on their hands of just throwing people off of insurance without any alternatives. So, their proposal is that they will continue to pay the full federal freight as promised to the states through 2019, so for almost three years. Beginning in 2020 though they would red-circle those enrollees and continue to pay full sticker price for them, but for all new enrollees after 2020 they would two-tier them to a lower level of federal financing. Those of us with experience with labor contracts are very familiar with these kinds of tactics. The goal is see the red circled group gradually diminish or in this case, die, and pay less, often much less for the newcomers. As most companies could share with the Republican legislators, this is a prescription for pretty much universal unhappiness and a political gift to organizers and progressives since it creates a huge, semi-permanent second-class constituency ready to constantly demand first-class status which is the American way.

The Republicans will then be forced to defend something that is their worst nightmare: an entitlement. No matter what lipstick they try to put on this pig, funded high or funded low, it will still be an entitlement, but to their horror it will be an entitlement where the recipients aren’t grateful, but mad as wet hens.

Furthermore, just to see the whole scenario rollout here, what will keep all of the schoolhouse door governors who have been unwilling to expand Medicaid because they weren’t sure what would happen after the first couple of years to the federal-state costs from now jumping into Obamacare 2.0 while the window is open until 2020 so that their state’s citizens aren’t the last ones left behind the door when the health insurance was being given out.

The good news for poor people in the United States is that millions more would be covered, and entitled. The sweet irony would be that the cost of Obamacare 2.0 going into the 2020 election for President would be even higher, the Republicans would have to defend it, candidates would claim they were going to get rid of the two-tiered proposal if elected, and some form of publicly funded healthcare in the United States would be set in stone.

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A Good Checklist for Grading an Obamacare Replacement

Greenville   In the chaotic back and forth over what may be about to happen to the Affordable Care Act, it is becoming almost impossible to follow the real issues as the bull passes our knees and rises towards our chin on all sides of the debate. We know something bad is about to happen, but we need a good checklist to measure the extent of the disaster even as we know the pain is likely to be terrible.

Harold Pollack from the University of Chicago and Timothy Jost from Washington and Lee University School of Law did all of us a favor in an op-ed in the Times by listing what they called “seven important questions that Congress must answer before repealing the Affordable Care Act.” Many of their questions are also clearly benchmarks for measuring the minimum standards for equity and justice that should be demanded by all Americans for any so-called replacement coming from Congress.

Here’s their list in brief:

1. How many millions of Americans will lose coverage? They also make the point often lost in the debate that tax credits and deductions are “nearly worthless” to lower income filers who would likely be priced out without direct subsidies.
2. Will people over 55 pay higher health premiums for the same coverage? This is a critical equity and cost issue for senior citizens with fixed incomes. The current Act limits the premium for older Americans to no more than three times that for younger citizens. Speaker Ryan has proposed going five times, which would be a budget buster for seniors.
3. Will the new plan let insurers charge women higher premiums than men while offering them less coverage? Obamacare in a critical reform banned this practice? Will the Republicans attack and penalize women for being women?
4. What other services are likely to be cut? Before Obamacare a third of the market policies did not cover addiction treatment and “nearly 20 percent lacked mental health coverage.” Will Republicans embrace the tragedy and roll this back along with other benefits?
5. Will the new plan let insurers reinstate annual or lifetime limits on coverage? Will Republicans allow a life-threatening illness to bankrupt victims and families while giving insurers a free-ride? We have to ask what insurance is for if there’s no coverage?
6. What will happen to the more than 130 million Americans with pre-existing conditions? This is huge and Congress needs to have the right answer because this was a critical reform of Obamacare and one that was popular enough that Trump even echoed its promise during the campaign.
7. How much more will those with costly illnesses or injuries have to pay in out-of-pocket costs? Costs are now capped at $7150 for individuals and $14,300 for families, and that’s way too much. Current Republican proposals thus far offer no cap to either deductibles, which are already leaving lower income workers outside of coverage in healthcare and service jobs, or cost sharing. You could drive a truck over people unless this loophole is closed.

This list of questions is really only the starting point, but any replacement at the least needs to answer these questions correctly to even pretend to be called a national healthcare protection plan. Keep them handy to grade the outcome in the common debate.

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Doctors Can’t Be Trusted About Healthcare

Cancun   Of all of the bad nominations coming our way, the notion of Georgia Congressman Tom Price running the Health and Human Services has the most impact on millions of people because of the impact of his virulent opposition to the Affordable Care Act and the jeopardy it places not only on 30 million beneficiaries there, but also on millions more because of additional threats to Medicare for the elderly and cutbacks in Medicaid for the poor generally. Some hold out a sliver of hope because Price keeps saying that he’s a doctor, and he wants that to mean something along the lines that he cares about peoples’ health. He’s taken the Hippocratic Oath, so he’ll “do no harm.”

James Surowiecki points out in the current New Yorker, that in fact the record of doctors and the American Medical Association has been to oppose virtually every governmental medical program providing health security for Americans for a century now. Doctors organized to oppose universal health care when it came to the ballot in California in 1917 during the First World War, claiming it was a “dangerous device imported from Germany.” The AMA in the 30’s opposed pre-paid medical groups where customers paid a flat fee in exchange for care and was fined for anti-trust violations. The AMA campaigned against the creation of Medicare, and hired Ronald Reagan to go on the air and warn us about so-called “socialized medicine.” The AMA was in the thick of the fight to oppose the Clinton health plan during his first term and only supported Obamacare after the so-called “public option” was off the table.

Ten thousand doctors have already organized in opposition to Price and his plan to scuttle the Affordable Care Act, and though the AMA has endorsed his nomination as a former member of their delegate board and a long-time friend in Congress, there is a schism mounting within the AMA over its stand as harmful to patients. Most hospital associations have been silent over Price’s nomination, but have come out strongly in opposition to the plans to end Obamacare as catastrophic in terms of patient care, hospital closings, job loss, and economic ruin within the healthcare industry. Nurses’ unions have been pretty unanimous in opposing the end of Obamacare.

Price is likely to hide behind the public’s assumption that as a doctor he’s an expert on healthcare. Reading Michael Lewis’ new book, The Undoing Project: A Friendship That Changed Our Minds, might take away any notion that doctors should be seen as our modern day priests. Experiments conducted under the influence of work by Daniel Kahneman and Amos Tversky found that fairly simply algorithms outperformed doctors in making diagnoses of many medical conditions, largely because of the unchecked biases of doctors for the way they are used to seeing and working. That’s scary, but true.

And, as Surowiecki points out repeatedly, the AMA is little more than a very effective special interest group, a closed shop union for doctors, if you will, and their own reports indicate repeatedly that their primary purpose is protecting the income security of doctors. Putting money in doctors’ pockets should never be confused with providing basic healthcare for Americans. We don’t need an algorithm to know the facts about that.

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Sorting out Obamacare Problems Now

obamacare-premium-mapAmersfoort   To the degree that the final version of the Affordable Care Act was neither fish nor fowl and represented a compromise between those that hated the entire concept and those that were trying to make the best of whatever slices of the original loaf were left, we all knew that problems were inevitable. Over the last five years we have been treated to regular and confusing reports from the battlefront, but nothing that ever fixes any problems, some of which are normal and predictable in a huge, new program. Without progress many fall out of love with Obamacare, even as more than ten million have enrolled with huge positive health impacts. Now consensus is building that any new president will have to fix the plan in the coming year, though no one seems sure about the fix or how to come to agreement on a cure.

What to do?

Some notions are almost simple-minded. One I saw said the quick fix was essentially a minor tune-up. Raise the amount of the subsidies for lower income families so that they can absorb the higher premium costs, and raise the level of the penalties to force more of the young and able into the program.

I’m all for raising the level of subsidies, if there can be agreement on that from whoever emerges as the new Congress, but raising the level of penalties is not a real solution to anything. The quick fix folks think that the fact that 260 million Americans or covered by healthcare on their jobs means no problems there, but that’s wrong too. Or, at least it isn’t the whole story.

Many penalty payers are not necessarily just the young and healthy, but also lower waged workers caught in so-called company coverage that ostensibly is offered, but because of the combination of premium cost and exorbitant, almost no-limit deductible charges, means that almost whatever the penalty level might be, it will still be cheaper than paying a premium of 9% of your pay and then having to pay many thousands of dollars in deductibles before you get any real benefit from the so-called insurance. This is really not medical insurance but catastrophe insurance, meaning if you know you need a major operation, maybe you pay. If not, you take your chances and pay the piper. Luckily, it’s taken out of your IRS tax refund, so you can pretend it hurts you less.

A lower waged worker caught in the service industry by these kinds of premium plus high deductible policies would need to be making more than $20 per hour for full-time 40-hour per week work to make it worth taking the insurance rather than paying the penalty. In some healthcare companies where we have contracts, like the service contractor giant ResCare for example, there are literally no takers out of more than 400 workers. I know people who are literally saving up for a CT scan because they don’t have insurance and are paying the penalty, making their health care “cash-on-the-barrel.” The quick, simple fix does nothing for any of these people and pretends that the United States is not dominated now by the service economy and its workforce.

The argument for a public option, a government-funded insurance of last resort, for these workers and others that can offer real competition and leverage to the private insurers makes sense, as Jacob Hacker, the political scientist and health care experts has argued. That’s still not single-payer or any kind of a system that takes private insurers out of the market, but the last years have already established that there’s no free enterprise in this marketplace. There are private insurances still waiting for subsides — $2 billion from the government – and there are regular folks getting subsidies and more that need them who are caught in the bind. Either the government needs to let workers and families caught by corporate insurance gimmicks that technically qualify under the Act, but are worthless in reality, come into the marketplace and get subsidies if qualified, or set up a public option that offers real coverage for this huge segment of the population.

The justice of raising penalties to catch the scofflaws doesn’t work when we still need a lot more mercy or stiff requirements on corporations to provide real insurance coverage.

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