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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Is There a Resistance Movement or Resistance Moment?

Bristol   I definitely don’t want to be standing at the station when the whistle blows that the train is moving out. I have to admit that I have my ears perked up at every sound to try to hear whether it’s the thundering feet of a movement or just the sharp cry of a moment.

I’m too jaded in this work to see Congressional town halls as the birthplace of the next revolution, but I don’t want to be blind to history either, and a snippet of the news like the one that follows makes me sit up straight and stand at total attention:

In fact, some of the most formidable and well-established organizing groups on the left have found themselves scrambling to track all of the local groups sprouting up through social media channels like Facebook and Slack, or in local “huddles” that grew out of the women’s marches across the country the day after the inauguration.

When the people are moving and established organizations and institutions are having to work overtime to catch up with them, that’s a very, very interesting sign. In a time of movement, it may be difficult for this kind of activity and anger to be channeled in the way that these same organizations and institutions are hoping to move the stream. It’s good news though for the 30 million lower income families taking advantage of the Affordable Care Act that there are many of the flags being waved as elected representatives slink home from the Congressional chaos are focusing on saving health care.

There are other signs too. When seasoned organizers report that they expected 200 at a meeting, and 1000 showed up, as my generation said, “you don’t need a weatherman to see which way the wind is blowing.” The Times also reported on other barometers that people were in motion:

Anti-abortion demonstrations in some cities this month were met with much larger crowds of abortion rights supporters. At a widely viewed town-hall-style meeting held by Representative Gus Bilirakis in Florida, a local Republican Party chairman who declared that the health care act set up “death panels” was shouted down by supporters of the law.

And, perhaps more interestingly, an organizer for Planned Parenthood posed the question plainly as she tries to ride this wave of momentum:

“It doesn’t work for organizations to bigfoot strategy; it’s not the way organizing happens now,” said Kelley Robinson, the deputy national organizing director for Planned Parenthood, which is fighting the defunding of its health clinics. “There are bigger ideas coming out of the grass roots than the traditional organizations.”

If she’s right, that’s a call to arms for all of us to get ready to move, because grassroots activity needs formation, planning, resources, and direction in order to win. That’s not bigfoot, that’s soft touch, listening, and work on the ground that takes a moment and helps make a movement and births new organizations and great social change.

When that whistle blows, we have to all be on the train.

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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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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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