Republicans’ Healthcare Bill: Is it Loving the Rich or Hating the Old, Poor, and Disabled?

U.S. Capitol Police arrest a health care protester outside the office of Senate Majority Leader Mitch McConnell on June 22, 2017.(Photo: Saul Loeb, AFP/Getty Images)

New Orleans  Ok, it’s alright if you admit it. Deep down, way deep, way down, some of you hoped that the Senate would really write a healthcare bill that looked and tasted a little bit like Obama’s Affordable Care Act. When President Trump said that he thought the House Republicans’ bill was “mean,” some of you felt a glimmer of hope that maybe the Senate Republicans would get the message and come up with something less draconian. You knew that Majority Leader Mitch McConnell’s strategy of doing everything behind closed doors in secret was a bad omen, but still, this is America, hope springs eternal, you thought maybe it would not be god awful, run-to-the-bathroom-sick at first sight terrible. Bad news, all hope has been dashed. The Senate version of a “mean” bill was a we-can-top-this even meaner bill.

The raw elements have emerged. The mandate for everyone to get health care is history of course. Tax increases for the rich that had funded much of Obamacare and transferred those taxes into increased coverage for poorer Americans were also eliminated. The Senate added a couple of years to the phase down, which might for a minute seem like a better deal until you realize that they shrank Medicaid even more than the House had done. The Senate believes they have compromised by allowing states to keep expanded Medicaid which benefited millions, but staying or going is up to the states, and staying also means that in the coming years they will pay a larger and larger share of the cost of Medicaid and any subsidies that are also timed out. Oh, and for good measure, so much for some of the guaranteed national benefits for those needing maternity care or mental health support.

Somehow the Senate sees this whole Obamacare as a two-fer. Not only do they want to repeal the Affordable Care Act and sock it to the poor while re-feathering the nest of the rich, but they also want to cap Medicaid on the federal level, rather than allowing it to continue as an entitlement. By ending the entitlement they also want to punish seniors who exhaust their savings before they are old enough for Medicare as well as the disabled who depend on Medicaid for their health care in addition to SSI payments for their support. This isn’t a war on the poor, but a wholesale massacre on almost any group of people not standing in line with a contribution and a ticket to some Republican’s fundraiser.

And, get this, for some of the Senators, none of this is enough. Four or five of them are claiming this bloodletting didn’t go far enough so they won’t vote to carry this garbage until it smells even worse. There are also a couple of moderates who seem slightly perturbed that some of this might stick on their shoes, but it is unclear that they are willing to crawl out on the limb.

What’s really going on here? Do they really love the rich that much? Do they really hate women, the poor, the old, and the differently abled so much?

What can people do now to keep this horror from happening later?

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Please enjoy The Deslondes – Hurricane Shakedown

Thanks to WAMF.

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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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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!

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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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