Humpty Dumpty Health Care

Paris   Nothing like a couple of weeks on the road, three countries, a half-dozen or so cities, and the siren song of home, heat, and humidity all sounds better and better. Of course there’s no escaping the headlines or the occasional questions from random people from all walks of life about what thoughts we might have on Trump. As excited as people around the world were about Obama as president, they are mystified by Trump. They are not alone.

The Republican Senate’s efforts to not just repeal-and-replace Obamacare, but to cap entitlements for Medicaid and pretty much kick the teeth out of the poor, elderly, disabled, and others seems to have alienated a couple of senators, while others wanted a chance to run up and kick harder and go for the kill. The New York Times reported that Senator Portman from Ohio has been a huge problem behind-the-scenes for the Republican majority leader and his efforts to pull together the votes. Seems he was concerned about what might happen to 700,000 people in Ohio that had gained coverage under the Affordable Care Act. Wow! That’s a good question for a lot of politicians from a lot of states it would seem. Turns out that when you push Humpty Dumpty off the wall, it really is hard to put the pieces back again.

And, in fact as the votes collapsed on the latest Senate version, there was an even greater implosion on the latest Trump twitter tantrum urging just repeal and deal a couple of years down the road. Seems immediately three Republican women in the Senate from West Virginia, Maine, and Alaska said the equivalent of “what are you pulling my leg,” saying that it would be reckless and irresponsible to simply repeal and blow the Act up.

Many of the Republican governors with shorter terms and quicker elections who are forced to be closer to their constituents also got their back up on these draconian cuts and caps in Nevada, Ohio, and elsewhere. They have earned some thanks as well.

I wish there were a lesson learned on the order of “don’t mess with entitlements,” but we know better. Like a bad dream, they’ll be back with more mischief and other attempts, and one way or another, they will have to do something now, we might hope, to fix some of the pieces of Obamacare that are broken.

Will they reach out to Democrats? Do they really have a choice?

Maybe this will be a twist on the old story, that if you break it, you own it. In this case, the message to the Senate might be, if you can’t break it, then do your job, and fix it.

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When National Healthcare is Not Mean, but Vindictive, Not Policy, but Politics

New Orleans  Healthcare is a huge part of the overall US economy and, arguably, of critical importance to every American. Regardless of the cliché, it is in fact a question of life and death. Yet we are watching a horror show spectacle of a White House that is clueless about anything but whether or not it can claim a “win,” and a Congress that is cunning and calculating without any field of vision that can see past 2018 and the midterm elections.

Meanwhile the public is treated to media coverage that, rather than focusing on the complexity of the bill and its evisceration of any semblance of public policy, treats the whole affair as if this were an extra innings baseball game and the only real issue was whether or not Majority Leader Mitch McConnell can get enough votes to pass the Senate version before the totally arbitrary deadline of July 4th. Well, perhaps not totally arbitrary, since McConnell is worried that when his caucus goes home for the recess their constituents will kick their asses so badly his whole secret legislative architecture will collapse.

Remember Kellyanne Conway, so discredited as a Trump aide that we’ve been spared her doublespeak recently. Well, she was back on this bill with the outrageous claim that no one can support, that, oh, no, there are no cuts to Medicaid in the Senate bill, which everyone knows is wrong. Good try, Kellyanne, now go hide out again, because this time there weren’t even any headlines following such an outrageous claim.

How about we look at how the Senate went from mean to downright vindictive? Their bill restored funding for what is known as “disproportionate share” money to hospitals. Pay attention in class now, friends, this is important. In places like Louisiana where I live we know a bit about “disproportionate share” payments because in their heyday they figured so prominently in statewide political scandals. Ever popular, former multi-term Governor Edwin Edwards did court and prison time on the issue of having unduly helped some friends get such money to build hospitals in poorly served and lower income areas of the state. Indeed, disproportionate share payments were designed to subsidize health care costs in lower income and ill-served areas originally in order to assure communities that these institutions could survive, because a “disproportionate share” of their patient base was poor. Obama’s Affordable Care Act flipped the script here. By assuring that everyone would have to get insurance and providing subsidies for lower income families and Medicaid expansion, disproportionate share payments would be phased out to pay for Obamacare. In fact now is the time when $43 billion would be reduced between 2018 and 2025.

What did the Senate do in their bill? They buckled to the lobbyists and restored these disproportionate share payments, but, now get this, only to states that had not expanded Medicaid coverage. This allows them to punish those states and their people by cutting the subsidies to Medicaid in their bill and rewarding the scofflaws by restoring the disproportionate share payments.

Now it’s politics that inflicts real pain and terrible consequences. Need a vote in Alaska or Maine, then sweeten the pot on opioid money even though states throughout the country are reeling under such a crisis. Take away support for mental health coverage, but throw some dollars out here and there to get a vote. Cutback money for the elderly poor on Medicaid, but kick the can down the road past 2018 so that you can keep the votes with a wink and a nod until the oldsters figure out the con.

None of this is good policy, and, frankly, I’ll be darned if I even understand how it is good politics, when all of these repeal bills are wildly unpopular in every poll of the American people. The public wants to live, not die, at the hands of government. Why isn’t that news everyone understands?

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