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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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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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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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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