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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Healthcare Plan is a Killer

Little Rock   How many of us have heard from our mothers that “if we can’t say something good, then don’t say anything at all.” I wish that were the case with the Ryan and some Republicans’ healthcare bill. So far, I’m failing to find any silver lining, other than it’s not a total repeal where we have nothing, but that’s too thin a reed to grab.

There are still no Congressional Budget Office tabulations on the cost of this proposal or the number of people likely to lose healthcare. Some Republicans are even wary and unhappy about being forced to vote on this thing without even that meager level of information. Reporting by the New York Times finds Standard & Poor’s in a report has estimated that 2 to 4 million people would drop out of the individual insurance market, largely people in their 50s and 60s who are too young to qualify for Medicare because of higher costs. Why? One feature of the new proposal is that it would allow insurance companies to increase the gap for older Americans from three times the young to five times the young causing premiums to soar to unaffordable levels.

Several researchers listed the predictable outcomes of transferring these decisions to the states by citing not theories, but the facts on the ground based on what states had done where they have had discretion in the past and get caught with budget shortfalls similar to the ones faced in the 2008 Great Recession. They talked about the blood on Arizona governor Brewer’s hands when that state stopped paying for transplants and allowed people to die. They talked about how states had dealt with billions of dollars from the smoking settlements with tobacco companies and the meager percentage of the funds that had gone to cessation programs as opposed to budget shortfalls, capital expenditures, and a bit of whatever.

Unbelievably there are some Republican Senators who still bridle at any plan at all. More troubling have been some arguments that some are starting to make that we might be better with nothing at all, though that strains credibility as well.

You know it’s bad when we aren’t even getting into the weeds on things like the impact on women. The ban on Planned Parenthood funding just seems like a bizarre, mean spirited outlier which must just drip with questionable legality. Past the first mention, the fact that people would be barred from buying insurance with governmental support that paid for abortions also seems like a flashpoint that hasn’t gotten much attention. Props though to Planned Parenthood for having pushed away the offers for not only continued funding at half-a-billion bucks but an increase, if they were just willing to make a deal and stop doing abortions anywhere, regardless of the fact that no federal money funds any part of their abortion service anyway. Comforting to know that a least one major national nonprofit is unwilling to abandon its mission for money. That must have been something of a shock to the Trumpsters, though the so-called offer was likely something of a wink-and-nod, and never serious anyway.

Or how about mental health services? Will they continue to be supported? Believe me our partners in Alaska with the Mental Health Consumers Action Network (MCAN) are having emergency meetings and deep discussions about this.

The list is endless. The pain tremendous. The death count will be astronomical.

Here’s my point in a nutshell: all of this is bad, and we still don’t know the half of it.

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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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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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