Affordable Care Act

Undercutting Health Care In America

Published by Anonymous (not verified) on Fri, 06/10/2017 - 8:23am in

Since Donald Trump became president, the Republican majorities in the House and Senate have twice failed to repeal and replace the Affordable Care Act (ACA). Consequently, Obamacare remains the law of the land. And, by law, the job of overseeing the health care exchanges falls to the Department of Health and Human Services (HHS). But now it appears HHS itself is doing its best to sabotage the process.

 
Anti-Obamacare Messaging
Last summer, The New York Times outlined three ways the department has used our tax dollars to launch a campaign against Obamacare: 1) HHS released dozens of video testimonials, all were critical of Obamacare. 2) Tom Price, the now-former head of HHS, tweeted at least 48 anti-Obamacare infographics to support efforts to repeal the bill; and 3) perhaps most obstructionist of all — the department began deleting useful information and enrollment guidance from its website as soon as Trump was inaugurated. “Here, it’s an agency trying to destroy its own program because it opposes it,” Kathleen Clark, a government ethics expert and professor of law at Washington University, told The Times, “It is inconsistent with the constitutional duty to take care that the law is faithfully executed.”


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Thwarting Community Assistance
The Trump administration is also cutting back on its grants to contractors who train health care exchange “navigators.” The navigators are located in libraries, businesses and nonprofits to help people shop for plans. At the end of August, Kaiser Health News reported that the Centers for Medicare & Medicaid Services was cutting funding for navigators in 38 states by 40 percent, down to $36.8 million; and cutting advertising by 90 percent down to $10 million. By contrast, California budgeted $111.5 million to advertise Obamacare this year. Earlier in the summer the Associated Press reported that the administration canceled $23 million worth of contracts in 18 cities. As Elizabeth Hagan, who works for the advocacy group Families USA told the AP, “It’s not letting the law fail, it’s making the law fail.”

Navigators — if they survive the budget cuts — must complete an online certification course. A number of groups are reporting that the training software seems to have more bugs this year. “Chief among the complaints,” according to reporting from Kaiser Health News, “are repeated error messages and lost or unsaved work.” Moreover, when trainees call the Centers for Medicare & Medicaid Services, which is responsible for the training, people are noticing that they appear much less helpful than in prior years.

 
Closing the Window of Opportunity
During the first four years of the federal exchange, Healthcare.gov, the open enrollment ran for three months, from Nov. 1 through the end of January. This year the open enrollment ends on Dec. 15 — that’s less than half the time. If you thought that HHS would go out of its way to let people know there’s less time to sign up, remember the budget for advertising was cut by 90 percent. HHS is also cutting back on website hours. A shutdown will take place for 12 hours on all but one Sunday from midnight to noon ET.

Critics say that is precisely the time that many working people — a key target for the federal insurance — might shop for a plan. A Utah-based health care navigator, Jason Stevenson, told Kaiser Health News that 10 p.m. MT is a popular time locally. He foresees the shutdown making it hard to complete an application in a timely fashion. “Health insurance is complicated, and in the past couple of years we had an administration that made it easier to sign up, but that has really changed in the past six months, with more hurdles not only for consumers but for those whose job it is to help them.” But a spokesperson for Medicare & Medicaid Services, which oversees the exchanges, disagreed, saying the outages were scheduled for low-traffic time periods.

 
Parting Shot
Former Health Human Services Secretary Tom Price resigned after squandering at least $1 million in taxpayers’ dollars on his extravagant travel on private planes. But just before he stepped down, HHS regional directors were told not to participate in the open enrollment events that are held in their regions across the country according to a report by BuzzFeed News. Roy Mitchell the executive director of a health advocacy program in Mississippi told BuzzFeed that for the past four years, representatives from HHS helped him coordinate enrollment. This year HHS canceled at the last minute.

In a notice informing participants they would be canceling the events, Mitchell said HHS’ “destructive actions will ultimately reduce enrollment, increase costs and drive up the uninsured rate in Mississippi.”

“I didn’t call it sabotage,” Mitchell told BuzzFeed News. “But that’s what it is.”

The future of Obamacare still hangs in the balance. While Trump and the Republicans majority in Congress have been unable to kill the law, they are now trying to cheat consumers of reliable and informed access to the federal exchange. Whomever is chosen as the new secretary of Health and Human Services can choose to play by the rules, or not. The New York Times reports that the two of the top candidates are Scott Gottlieb, the current commissioner of the Food and Drug Administration, and Seema Verma, the current administrator of the Centers for Medicare and Medicaid Services. Choosing Verma, according to The Times, promises more of the same:

Ms. Verma, an ally of Vice President Mike Pence, worked closely this year with Republicans in Congress on their proposals to undo the law and to cut Medicaid, the program for more than 70 million low-income people.

Choosing Gottlieb, according to The Times sends a different message, that perhaps the administration wants to find ways to change:

In his first months at the FDA, he has deftly balanced the concerns of patients and pharmaceutical companies, while taking steps to combat the opioid epidemic and speed access to lower-cost generic drugs.

In the meantime, a career official, Don Wright, M.D., MPH, was appointed as Acting Secretary of Health and Human Services. He has a small window of opportunity to steady the helm, or he can continue to steer the the Affordable Care Act into the ground.

The post Undercutting Health Care In America appeared first on BillMoyers.com.

The Clock is Running Out on Health Care for 9 Million Kids

Published by Anonymous (not verified) on Tue, 26/09/2017 - 4:24am in

This post originally appeared at The Conversation.

Since the inauguration of President Trump, health care has been front and center in American politics. Yet, attention has almost exclusively been focused on the Affordable Care Act, most recently in the form of Graham-Cassidy. With Congress preoccupied with a series of Republican efforts to repeal and replace the ACA, little attention has been paid to a long-running bipartisan program providing insurance coverage to millions of American children: the Children’s Health Insurance Program, often referred to simply as CHIP, which provides coverage to 9 million American children.


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Single mother Monique Burton picks up her 2-year-old daughter, Jalayna Elam, and her 6-year-old son (not pictured) from the Greenbelt Children's Center day care in Greenbelt, Maryland on Dec. 20, 2016. (Photo by Linda Davidson / The Washington Post via Getty Images)

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BY Michelle Chen | March 16, 2017

Since its creation by a bipartisan coalition under the Clinton administration, CHIP has been crucial for the health and well-being of millions of American children, their families and their communities.

Yet funding for CHIP is running out at the end of September, leaving both state governments and families with great uncertainty. On Sept. 18, Sens. Orrin Hatch (R-UT) and Ron Wyden (D-OR) announced an agreement to continue funding for the program, albeit at greater costs to the states because it would phase out the additional funding provided by the ACA. Yet the renewed efforts by Republicans to repeal the ACA could derail this agreement.

 
What Is CHIP?

Today, CHIP serves about 9 million children at a cost just below US$14 billion. Together with Medicaid, it serves as the source of insurance for more than 46 million children annually. CHIP has been crucial in ensuring that more than 95 percent of American children are covered by health insurance today. This compares to 89 percent at the time the program was created.

Like most other health care programs, CHIP is a collaborative program between the federal government and the states. Indeed, states have the option to use the CHIP funding to expand their Medicaid program, create a standalone program or establish a hybrid arrangement.

Almost all CHIP children live in households where at least one parent is working. Ninety percent live in households 200 percent below the federal poverty line.

CHIP fills in the gap for those children who fall just above the Medicaid threshold, determined by family income, but still do not have access to affordable, employer-sponsored insurance. Indeed, almost all CHIP children live in households where at least one parent is working. Ninety percent live in households 200 percent below the federal poverty line.

Created on a bipartisan basis in the late 1990s, the program has been popular with both parties. It has been renewed multiple times and eligibility and federal support have been increased multiple times. Indeed, the most recent extension made the federal government the sole funder of the program in 11 states.

States have been given significant leeway in implementing the program. For one, states have been able to set a diverse range of eligibility guidelines, ranging from just below 200 percent of the federal poverty line in states like North Dakota and Wyoming to more than 400 percent in New York.

They also have a significant amount of flexibility in terms of benefit design, copayments, premiums, enrollment and administrative structure. At the same time, the federal matching rate, or the financial contribution of the federal government, is significantly above the Medicaid match, ranging from 88 to 100 percent, making participation particularly enticing for states. Not surprisingly, with large amount of flexibility and generous financial support, states have long looked favorably toward the program.

CHIP is complementary to Medicaid but differs from it in several respects. Most crucially, it is not an entitlement but rather a block grant. This means that qualifying individuals who meet all the requirements are not legally entitled to receive the benefits provided by program in case no funding is available. Once federal funding is spent down for a given year, no more funds are available unless states choose to pay for the program in its entirety.

 
Why is CHIP so important?

The benefits for families and communities of CHIP are many. For one, CHIP is crucial in providing financial security and prevents families from suffering catastrophic losses.

Inequality and the American Child

BY Joseph E. Stiglitz | December 30, 2014

Moreover, the program’s benefit design does a tremendous job at ensuring that children’s health needs are met comprehensively. Healthier children are more likely to attend school and graduate from high school and college. Healthier children also prevent parents from forgoing their own care or missing time at work. CHIP also serves a large number of children with special and costly health needs, such as ADHD and asthma.

The crucial role of CHIP has been repeatedly emphasized by health policy experts. Most recently, MACPAC, the congressionally chartered commission that provides Congress with advice on Medicaid and CHIP, recommended the continuation and further enhancement of the program.

 
How should we move forward?

As a block grant, CHIP requires periodic appropriation of funding to maintain the program. The most recent extension, the Medicare and CHIP Reauthorization Act, funded the program through September 2017.

Without additional funding, states will run out of money over the next few months. Moreover, without a quick congressional action, states will be confronted with daunting administrative and planning challenges on how to possibly maintain or phase out the program. Indeed, several states will automatically terminate their programs in case federal funding for the program falls below a certain threshold. Moreover, state budgets have assumed that the program will be continued in its current form. Failure to reauthorize the program at current levels would pose tremendous problems for all states.

The agreement announced by Sens. Hatch and Wyden to provide CHIP funding for the next five years brought hope to America’s children, their families and child advocates. Yet it has also raised concerns. While the proposal leaves the eligibility threshold untouched, it begins to reduce federal support for states from the aforementioned 88 to 100 percent to the original 65 to 82 percent in 2020. Perhaps must crucially, the reemergence of Republican efforts to abolish the ACA seems to have put all CHIP efforts on hold.

Moreover, it is unclear whether the Republican majority in Congress supports the program as it is currently implemented. Indeed, President Trump in his first budget proposed a reduction in both federal support and eligibility.

Between the Medicaid expansions of the 1990s, the creation of CHIP and the ACA, America has made great strides in providing health insurance to its most vulnerable, including America’s children. Indeed, insurance enrollment rates for children are at historic highs, currently hovering around 95 percent.

However, the reduced federal funding may pose a significant challenge for states like West Virginia and Arizona, which may move to reduce or eliminate the program as a result. Indeed, concerns led MACPAC to recommend against any federal funding cuts. It may be that these very cuts will eliminate some of the historic gains made in children’s coverage. Yet, the Hatch-Wyden compromise, given the current political situation in Washington, DC, could well be the most beneficial outcome for child advocates.

The post The Clock is Running Out on Health Care for 9 Million Kids appeared first on BillMoyers.com.

An Ohio Community Confronts the Opioid Crisis Head On

Published by Anonymous (not verified) on Sat, 23/09/2017 - 12:36am in

Devon Applegate’s life in Scioto County, Ohio, has paralleled one of the worst drug epidemics this nation has ever seen. During his 19 years, he’s watched as opioid pills, dispensed by doctors to seemingly anyone who walked through their doors, destroyed the lives of many people in his community and throughout Ohio.

The problem grew to a scale that it is now part of a nationwide crisis, leading the Trump administration to contemplate declaring a state of emergency. Southern Ohio is one of the opioid epidemic’s epicenters, and the problem continues to grow. In 2016, 4,050 Ohioans died from unintentional drug overdoses — a thousand more than the year before.

In late August, Applegate skipped his first class of the semester to hear Vermont Sen. Bernie Sanders speak on the campus of Shawnee State University in Portsmouth, Scioto County’s largest town, sitting on the bank of the Ohio river. The independent democratic socialist and former Democratic presidential primary candidate was entering potentially unwelcome territory. In Scioto County, Trump won two-thirds of the votes in the general election.

“I am here,” Sanders said, “because I am an old-fashioned guy who really does not believe in red states and blue states. I believe that the issues raised here… are exactly the same issues that are being raised in Democratic communities all over America. And I think it is high time we focused on the most important issues facing our country and do not allow people to divide us.”


Sen. Bernie Sanders (I-VT) at Shawnee State University on Aug. 22, 2017 in Portsmouth, Ohio. (Photo by Maddie McGarvey/Getty Images)

Applegate said he was excited that someone of Sanders’ stature was coming to Portsmouth — during the last election cycle neither Trump nor Clinton came to his county. But Applegate was hoping for more than just Sen. Sanders’ presence in his community: He wanted to hear how Sanders would address the crisis facing it.

So about halfway through the event, when Sanders asked for public comment about the opioid epidemic, Applegate felt moved to speak. In front of hundreds of strangers, he told his story — how he lost his father to an overdose in 2008; how his mother still suffers from addiction. He explained that when he was younger his parents were unemployed and “had a sense of hopelessness.” His grandparents raised him and he’s now a healthy, inquisitive 19-year-old. He told me after the event that he felt nervous sharing his story in public but that if anyone has a connection to the epidemic, he does — it has shaped who he is today.

Portsmouth became widely associated with the opioid crisis after journalist Sam Quinones described the town’s struggles in his 2015 book Dreamland. He wrote how by 2010, 9.7 million doses of opiates were dispensed in Scioto County — 123 doses each for every person in the community, child and adult alike. Portsmouth fought back and, in 2011, the DEA helped it shut down the “pill mills.” But that didn’t solve the problem: Once the pill mills closed, addicted persons switched to heroin and, now, synthetic opioids.

“Nobody here has a magical solution for the problem, but I think the fundamental question we have got to ask ourselves is what is going on in our country when so many people seek solace in drugs and addiction, when many of them know that the only things that happen with dependency on opiates are death or jail?” Sanders told those who came to hear him speak. “It has a lot to do with hopelessness, with lack of community, with people feeling isolated and alone.”

When Sanders asked the audience if they knew anyone who had been affected by the epidemic, nearly every hand in the room went up. These are people who have seen a lot. Parents who’ve watched children struggle. Grandparents who have had to raise their grandchildren. And children, like Devon Applegate, who have lost parents.

 
A crisis decades in the making

The hopelessness that Sen. Sanders spoke of, and that Applegate saw in his parents, grew with the area’s economic decline in recent decades, driving joblessness and poverty.

Portsmouth rests on a dramatic bluff overlooking the Ohio River — the cliffs of Kentucky shoot skyward on the opposite side. This location and abundant natural resources made Portsmouth an industrial giant, manufacturing everything from steel to shoes. By the 1980s, much of that manufacturing work had disappeared — especially after Armco Steel purchased the Empire Detroit Steel Works. Rather than updating the facility, they shut it down, laying off 1,300 people.

The shocks of deindustrialization have resonated throughout the community. Portsmouth’s population peaked at 42,560 in 1930. Today there are only 20,266 residents. People have moved out of the city proper and into the suburbs, while others have moved in search of work.

In 2000 the poverty rate for Scioto County was 18.5 percent; by 2014, it had risen to 27.2 percent, though it has declined slightly in recent years. In Portsmouth proper, though, the number is even higher — 35.8 percent of people in the city are living below the poverty level, according to the most recent Census Data, up from 23.6 percent in 1999.

Jason Kester, executive director of the Southern Ohio Port Authority, told me that he would like to see more living wage jobs in Portsmouth and Scioto County. Good jobs are necessary, he said, “There’s a direct link between having a job and having hope and not getting on drugs.”

He has seen some progress. The unemployment rate for Scioto County was 9.3 percent in 1990 and grew to 13.3 percent in 2010. As of August 2017, it was 7.1 percent — a tremendous improvement, but still higher than the state and national rates.

Last year, he said, Portsmouth, Ohio, was ranked number 10 for new economic development among 100 small cities in the nation by Site Selection magazine. Kester says the story has raised the community’s profile and given the work they are doing “credibility.” Most recently, a polypropylene products manufacturer announced a new facility in Portsmouth that will bring 100 jobs.

But this progress, Kester said, is often overshadowed by the drug epidemic — and some of the press coverage that comes with it. Kester pointed to a recent story in The Guardian that referred to Portsmouth as the “pill mill of America.” If you read that story, he said, you would believe “everyone’s driving around shooting up heroin in their neck.” Kester penned a forceful response to the story in the local newspaper.

Kester told me he knows the epidemic is bad. And he should — he has worked as a volunteer firefighter and EMT for 20 years in Scioto County and has seen his share of overdoses. But he’s mindful of hyperbole. He wishes outsiders would acknowledge the efforts people are making to transform this community.

Indeed, this community has hit back hard. Last June, days after Ohio announced a lawsuit against five opioid painkiller manufacturers, Scioto County and the City of Portsmouth announced their own lawsuits against wholesale distributors. Small city is taking on Big Business.

More immediately, though, community health officials have made significant strides. At one time, Scioto County led the state in fatal overdoses, but no longer does. And, in part due to a weekly needle exchange — one of only seven in all of Ohio — there has been a 40 percent drop in new Hepatitis C cases since 2012.

 
Portsmouth fights back

Lisa Roberts, of the Portsmouth Health Department, explained that while much has been done, there is much work ahead. Roberts has been with the department for 30 years and has worked on the drug epidemic exclusively for eight years. She was also an important figure in Quinones’ book.


Lisa Roberts in her office in Portsmouth, Ohio. (Photo by Jack Shuler)

From her office, blocks away from the campus of Shawnee State, Roberts organizes many efforts to address the addiction crisis in her community. For instance, the Portsmouth Health Department has long distributed Narcan, a medication used to block opioids’ effects and prevent overdoses, and trained people to use it. Narcan, Roberts said, has become “a household word here.”

Roberts is a diminutive woman with bright eyes and a quick mind. It’s these qualities, and perhaps her uncompromising demeanor, that help her advocate for interventions that are controversial, but known to be effective and research-based, that she says can give health officials better information for fighting the epidemic.

“We have great things going on,” she said. “But we have shortcomings. Some of it is attitude, but an awful lot of it is just inaccessibility.”

Roberts wants greater access to medically assisted addiction treatment using methadone, vivitrol or buprenorphine. Right now, she said, these drugs are over-regulated. “We can’t work around federal regulations that restrict things like methadone.” It’s a shame, she said, “Because you can’t argue with the data — it works.”

Roberts’ daughter has used vivitrol. “It worked like a charm for her,” she said. “In other countries, people are praised for being on methadone and they don’t even really think it’s a big deal. They dose in pharmacies on their way to work. Our country does not accept medically assisted treatment, and it doesn’t even really see addiction as an illness, on the large scale. We still look at the epidemic from this drug-war mentality.”

The needle exchange gives the health department a bird’s-eye view of what’s going on. When the pill mills closed, they were the first to know that heroin had arrived. More recently she says there’s been a significant increase in overdoses involving fentanyl and carfentanil in Scioto County and throughout Ohio.

She told me that while right now opioids are the problem, there must be a long-term solution for dealing with addiction.

She explained that most opioid epidemics are followed by stimulant epidemics. Scioto County, she believes, is seeing that now, as ice, a form of methamphetamine, becomes more prevalent. “We just keep fighting, and we keep fighting. I don’t know if it’s going to get any better or not.”

 
The federal response that’s not coming

As I spoke to people in Portsmouth, the same theme continued to surface. The problem wasn’t the opioid epidemic in itself, it was the decades of economic distress that lay beneath it. The people of Portsmouth are working to combat this issue, but as many of them point out, the issue is bigger than this one city. As Roberts told me, “I wish that the heartland could have an economic boom because that is probably the only thing that’s going to fix this. Drugs are a symptom, really.”

It will take a concerted national effort to support the people on the ground in the many communities like Portsmouth across this country. Drug overdoses are now the leading cause of death for those 50 and under in the US — it’s estimated that nearly 60,000 Americans died from drug overdoses last year.


Summer Kirby outside of Sen. Bernie Sanders’ event at Shawnee State University. (Photo by Jack Shuler)

Some federal policies have made a difference. According to local health officials, the Medicaid expansion, a component of the Affordable Care Act, has helped. Summer Kirby, the CEO of Compass Community Health in Portsmouth, noted during the Sanders event that now many people have access to a range of services — “primary care, mental health, recovery services” — that they wouldn’t have otherwise. One addiction rehabilitation facility in the area, The Counseling Center, had been able to serve 1,100 men they not have seen before.

The Trump administration has pledged to tackle the opioid crisis head-on, but so far has been slow to implement the Opiate Task Force’s recommendations. If the White House were to declare a state of emergency, it could make a difference. Doing so would free up federal disaster funds and allow federal agencies to waive certain rules and regulations so they could respond more quickly to the crisis. But while that possibility has been much discussed, it has not been implemented.

Attorney General Jeff Sessions, meanwhile, has signaled his intention to reverse Obama-era criminal justice reforms and fight the drug problem through incarceration, a solution that will further crowd already overcrowded prisons.


Drew Carter speaks during Sanders’ event at Shawnee State University. (Photo by Marcus Burroughs)

As Drew Carter, a Shawnee State alum who attended Sanders’ speech, told the crowd, locking people up wasn’t fixing the underlying economic issues. “I worked in the chemical dependency field for five years,” he said. “I’ve worked with addicts. I’ve known drug dealers many who have been arrested and spent time in prison, but they never had passports and they never owned boats or planes. These are poor people that are getting arrested and going to jail.”

“We have to deal with the drugs,” Sanders agreed, “but we can’t ignore why people are using.”

As long as the policy focus is on the drug problem and not the root causes of the problem, the United States will likely trade one drug problem for another.

Sen. Sanders’s “informal discussion dealing with reality” in Portsmouth, while putting the opioid epidemic in the spotlight and offering immediate solutions, including expanded Medicaid and Medicare for All, addressed the need for long-term solutions.

Sanders asked, “What kind of nation do you want to live in? Are you satisfied to live in a country where so few have so much and so many have so little?”

Answering his own question, Sanders said Americans need “economic justice,” access to health care, and tuition-free college education. These three “rights,” he said, would go along the way to addressing the addiction epidemic.

 
“We’ve had way more that don’t die”

In the meantime, the people of Portsmouth continue to address the reality in their community. Applegate told me that the hopelessness Sanders acknowledged is fed by the stereotypes that people have about the place where he lives. “Southern Ohio is seen as ‘hillbillyish,’ like there’s not much down here, not much hope, not much going on.”

But he’s here, he said. So when he hears people talk about leaving Portsmouth, there’s a big part of him “that cares about this place and wants to stay and help.”

He’s not the only one.

Roberts speaks of her community health work matter-of-factly; she continues, like a bulldog, nonplussed by the patina of sadness that surrounds it.

“I don’t have a choice; somebody has to do it. Even though we’ve had a lot of deaths, we’ve had way more that don’t die. Last year, we know that 155 of the people that we trained to give Narcan used it and they lived.”

She stood up and walked over to a painting just outside the door of her office. “We talk about this painting all the time because we think it has a serious meaning,” she said, half-joking.

“Someone bought it at Big Lots and just put it up.”

A blue colored map of the world is covered in cracks and rust with a tiny bird’s nest at the top — a mother and her egg.

“I think the bird is saying, look at those crazy people down there on earth; they’re going to destroy it. It’s a good thing we’re up here.”

The post An Ohio Community Confronts the Opioid Crisis Head On appeared first on BillMoyers.com.

Last-Ditch Effort By Republicans to Replace ACA: What You Need to Know

Published by Anonymous (not verified) on Thu, 21/09/2017 - 5:51am in

This post originally appeared at Kaiser Health News.

Republican efforts in Congress to “repeal and replace” the federal Affordable Care Act are back from the dead. Again.

While the chances for this last-ditch measure appear iffy, many GOP senators are rallying around a proposal by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA), along with Sens. Dean Heller (R-NV) and Ron Johnson (R-WI)

They are racing the clock to round up the needed 50 votes — and there are 52 Senate Republicans.


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Mary Mayhew, commissioner of Maine's Dept. of Health & Human Services (left) and Gov. Paul LePage answer questions during a news conference to announce changes to the MaineCare system in Augusta, Maine, on Dec. 6, 2011. (Photo by Joe Phelan/Portland Press Herald via Getty Images)

The War on Medicaid Is Moving to the States

BY Greg Kaufmann | September 5, 2017

An earlier attempt to replace the ACA this summer fell just one vote short when Sens. Susan Collins (R-ME), Lisa Murkowski (R-AK) and John McCain (R-AZ) voted against it. The latest push is setting off a massive guessing game on Capitol Hill about where the GOP can pick up the needed vote.

After Sept. 30, the end of the current fiscal year, Republicans would need 60 votes ­— which means eight Democrats — to pass any such legislation because special budget rules allowing approval with a simple majority will expire.

Unlike previous GOP repeal-and-replace packages that passed the House and nearly passed the Senate, the Graham-Cassidy proposal would leave in place most of the ACA taxes that generated funding to expand coverage for millions of Americans. The plan would simply give those funds as lump sums to each state. States could do almost whatever they please with them. And the Congressional Budget Office has yet to weigh in on the potential impact of the bill, although earlier estimates of similar provisions suggest premiums would go up and coverage down.

“If you believe repealing and replacing Obamacare is a good idea, this is your best and only chance to make it happen, because everything else has failed,” said Graham in unveiling the bill last week.

Here are five things to know about the latest GOP bill:

1. It would repeal most of the structure of the ACA.


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A July 2017 protest against the Republican health care bill in Milwaukee, Wisconsin. (Joe Brusky/Flickr cc 2.0)

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The Graham-Cassidy proposal would eliminate the federal insurance exchange, healthcare.gov, along with the subsidies and tax credits that help people with low and moderate incomes — and small businesses — pay for health insurance and associated health costs. It would eliminate penalties for individuals who fail to obtain health insurance and employers who fail to provide it.

It would eliminate the tax on medical devices. 

2. It would eliminate many of the popular insurance protections, including those for people with pre-existing conditions, in the health law.

Under the proposal, states could “waive” rules in the law requiring insurers to provide a list of specific “essential health benefits” and mandating that premiums be the same for people regardless of their health status. That would once again expose people with pre-existing health conditions to unaffordable or unavailable coverage. Republicans have consistently said they wanted to maintain these protections, which polls have shown to be popular among voters.

3. It would fundamentally restructure the Medicaid program.

Medicaid, the joint-federal health program for low-income people, currently covers more than 70 million Americans. The Graham-Cassidy proposal would end the program’s expansion under the ACA and cap funding overall, and it would redistribute the funds that had provided coverage for millions of new Medicaid enrollees. It seeks to equalize payments among states. States that did not expand Medicaid and were getting fewer federal dollars for the program would receive more money and states that did expand would see large cuts, according to the bill’s own sponsors. For example, Oklahoma would see an 88 percent increase from 2020 to 2026, while Massachusetts would see a 10 percent cut.

The proposal would also bar Planned Parenthood from getting any Medicaid funding for family planning and other reproductive health services for one year, the maximum allowed under budget rules governing this bill. 

4. It’s getting mixed reviews from the states.

Sponsors of the proposal hoped for significant support from the nation’s governors as a way to help push the bill through. But, so far, the governors who are publicly supporting the measure, including Scott Walker (R-WI) and Doug Ducey (R-AZ), are being offset by opponents including Chris Sununu (R-NH), John Kasich (R-OH) and Bill Walker (I-AK).

On Tuesday 10 governors — five Democrats, four Republicans and Walker — sent a letter to Senate leaders urging them to pursue a more bipartisan approach. “Only open, bipartisan approaches can achieve true, lasting reforms,” said the letter.

Bill sponsor Cassidy was even taken to task publicly by his own state’s health secretary. Dr. Rebekah Gee, who was appointed by Louisiana’s Democratic governor, wrote that the bill “uniquely and disproportionately hurts Louisiana due to our recent [Medicaid] expansion and high burden of extreme poverty.”

5. The measure would come to the Senate floor with the most truncated process imaginable.

The Senate is working on its Republican-only plans under a process called “budget reconciliation,” which limits floor debate to 20 hours and prohibits a filibuster. In fact, all the time for floor debate was used up in July, when Republicans failed to advance any of several proposed overhaul plans. Senate Majority Leader Mitch McConnell (R-KY) could bring the bill back up anytime, but senators would immediately proceed to votes. Specifically, the next order of business would be a process called “vote-a-rama,” where votes on the bill and amendments can continue, in theory, as long as senators can stay awake to call for them.

Several senators, most notably John McCain, who cast the deciding vote to stop the process in July, have called for “regular order,” in which the bill would first be considered in the relevant committee before coming to the floor. The Senate Finance Committee, which Democrats used to write most of the ACA, has scheduled a hearing for next week. But there is not enough time for full committee consideration and a vote before the end of next week.

Meanwhile, the Congressional Budget Office said in a statement Tuesday that it could come up with an analysis by next week that would determine whether the proposal meets the requirements to be considered under the reconciliation process. But it said that more complicated questions like how many people would lose insurance under the proposal or what would happen to insurance premiums could not be answered “for at least several weeks.”

That has outraged Democrats, who are united in opposition to the measure.

“I don’t know how any senator could go home to their constituents and explain why they voted for a major bill with major consequences to so many of their people without having specific answers about how it would impact their state,” said Senate Minority Leader Chuck Schumer (D-NY) on the Senate floor Tuesday.

 
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

The post Last-Ditch Effort By Republicans to Replace ACA: What You Need to Know appeared first on BillMoyers.com.

The Jimmy Kimmel test

Published by Anonymous (not verified) on Wed, 20/09/2017 - 1:30pm in

Word.

The cynical, possibly winning 25-state strategy behind the Cassidy-Graham ACA repeal bill

Published by Anonymous (not verified) on Tue, 19/09/2017 - 1:16am in

Me at healthinsurance.org.

“When Senators McCain, Collins, and Murkowski cast their fateful votes, pretty much everyone assumed that ACA repeal had reached its politically ignominious end. The klieg lights, cable TV, and the front page shifted to hurricanes Harvey and Irma. President Trump announced he would let DACA expire. Democratic leaders Chuck Schumer and Nancy Pelosi negotiated what appeared to be a tactically brilliant three-month extension of the debt ceiling. Senator Sanders released his single payer plan. The Senate HELP committee began the process of discussing a much less ambitious, bipartisan bill. The world kind of moved on.

Only a cloud no bigger than a man’s hand was still up there, called the Cassidy-Graham bill. At first, it seemed like a bit of a joke. Arcane Senate rules impose a final deadline of September 30 to pass an ACA repeal based on a simple Republican majority vote. For weeks, no one in Washington took Cassidy-Graham very seriously.

Until late last week….”

Basic strategy: Impose punishing cuts on California and New York. That frees up a lot of cash to buy up small red-state Senate votes..

What can you do? Call your Senator and your Republican governor.

The Trumpcare toolkit is very useful in showing you how.

My Sister Served in the Army. The Biggest Threat to Her Survival is Congress.

Published by Anonymous (not verified) on Fri, 15/09/2017 - 4:00am in

This post originally appeared at Talk Poverty.


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Mary Mayhew, commissioner of Maine's Dept. of Health & Human Services (left) and Gov. Paul LePage answer questions during a news conference to announce changes to the MaineCare system in Augusta, Maine, on Dec. 6, 2011. (Photo by Joe Phelan/Portland Press Herald via Getty Images)

The War on Medicaid Is Moving to the States

BY Greg Kaufmann | September 5, 2017

My older sister, Lynn, was always getting into trouble when we were kids. I was the goody two-shoes in the family, but if I did ever get myself in trouble, she’d get in even more trouble to help me out. She was a good sister in that way — always looking out for me. When I was little, I didn’t like to sleep by myself during thunderstorms, and she’d let me crawl into bed with her because she knew I was afraid.

Now, in some ways, I’m her big sister. I do my best to take care of her.

Lynn — a 62-year-old army veteran — cannot walk. Her dementia makes it impossible for her to remember to take her medicine. Her forgetfulness has life-or-death implications, since she has diabetes, high blood pressure and high cholesterol. As a result, Lynn has been in a nursing home for the past four years. Medicaid pays the bills for that — just like it does for most people who need nursing home care — and I’m terrified of what would happen without it.

She’s not trying to take more than her fair share of the pie.

Lynn joined the army right out of high school. When she was in boot camp, she had a traumatic head injury during basic training. The military doctors held her for observation, diagnosed her with a concussion and then released her. She served her time as a private, then was honorably discharged and got married.

A few years later, she was struck by a car. She was at a crosswalk, and the car in front of her stopped to let her cross. But the car behind it was impatient, so it swerved around the first car, plowing into the crosswalk and hitting my sister. That left her with her another traumatic head injury, as well as the beginning of hip problems that will plague her for the rest of her life.


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An elderly woman shows her gratitude to President Lyndon B. Johnson for his signing of the Medicare health care bill in July 1965. (Photo by © CORBIS/Corbis via Getty Images)

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BY Bill Moyers | July 30, 2017

Over time the hip problems worsened, until she finally had a hip replacement in her mid-50s. She was able to walk without pain for a while, but she then contracted a MRSA infection in her new hip joint. That can happen with artificial joints — it’s rare, but once you have the infection it’s hard to remove. Lynn’s infection spread quickly, and it almost killed her. Doctors tried to treat her with some very powerful drugs at first, which made her thoughts so fuzzy that she said her brain was buzzing.

Eventually, doctors had to remove her hip bone to control the MRSA. Medicaid paid for this surgery, too — otherwise, we wouldn’t have been able to afford it.

Just four years ago, Lynn was working multiple jobs to put her daughter through college: in the cafeteria at her daughter’s school, at Walmart and at a deli. Now Lynn can no longer walk, or work. The doctors say the drugs impaired her brain and made her dementia onset much more quickly.

But this isn’t a sob story. I don’t want you to feel bad for her, or take pity on her. Lynn is still the same person I’ve always known, full of life and warmth. She can break the tension in a moment better than anyone I know. I still remember a moment a few years ago, when she was recovering from her first hip surgery. She flew into Washington, DC, to visit us, and we were trying to get her out of baggage claim and into the elevator in her wheelchair. The doors started to close, and nobody wanted to hold them — she was far away, and she was moving so slowly. But she shouted, “I’m coming as fast as I can!” across the airport. They actually held the door for her. In the elevator, she chatted with them amicably, asking how their Christmas was going. Strangers were smiling and talking to her — that’s a rare sight in DC.

Lynn would be lost without Medicaid. She served her country and worked hard to provide for her family. She’s not trying to take more than her fair share of the pie. She’s just somebody who needs care — and she didn’t expect to need the care that she needs as young as she is.

When our elected representatives decide to cut Medicaid — whether through repeated attempts to repeal the Affordable Care Act or a budget that cuts $3.6 trillion from services such as Medicare and Medicaid — they should think about what this means to people like me and my family. They should think about Lynn, and the millions of other veterans who have turned to Medicaid.

The post My Sister Served in the Army. The Biggest Threat to Her Survival is Congress. appeared first on BillMoyers.com.

Reports of Obamacare's death are greatly exaggerated: All counties to be covered for 2018

Published by Anonymous (not verified) on Fri, 25/08/2017 - 5:09pm in

Obamacare has now obtained an insurer for every county in the country, defying Republican claims that the program is collapsing. As reported by The Hill, "At one point or another over the past year, more than 80 counties have been at risk of having no ObamaCare insurer on the exchanges in 2018." On Thursday (Aug. 24), the last "bare" county, in Ohio, was covered by insurer CareSource. Insurance companies have until September 27 to sign contracts, so it is not yet guaranteed there will be no bare counties for 2018.

As you no doubt remember, Chicken Little Republicans have proclaimed the sky to be falling ever since the Patient Protection and Affordable Care Act was passed in 2010. We were subject to ridiculous predictions about "death panels," skyrocketing premiums, predictions of no fall in the uninsured, horror stories that weren't, and of course the ever-popular "job killing" meme.

Instead, three years of the ACA (Q4 2013 to Q4 2016) brought the uninsured rate for adults 18-64 down from 20.8% to 13.1% (but an increase to 14.2% in Q2 2017) while unemployment fell from 6.7% in December 2013 to 4.7% in December 2016 (and 4.3% in July 2017). In addition, personal bankruptcies fell from 1.5 million in 2010 to just 771,000 in 2016, according to Consumer Reports.

As the recent increase in the uninsured rate shows, the ACA is still vulnerable to sabotage by the Republicans. Given that the increase occurred disproportionately among younger adults, Gallup speculates that uncertainty about the consequences for disregarding the individual mandate may explain a large amount of the change. There remain several routes for sabotage to take place. At the same time, there is a bipartisan effort in the Senate to stabilize the individual marketplace, potentially with explicit funding for individual subsidies.

Constant vigilance!

h/t David Ayon

Doctors Are Warming Up to Single-Payer Health Care

Published by Anonymous (not verified) on Wed, 23/08/2017 - 4:33am in

This post first appeared at Kaiser Health News.

Single-payer health care is still a controversial idea in the US, but a majority of physicians are moving to support it, a new survey finds.

Fifty-six percent of doctors registered either strong support or were somewhat supportive of a single-payer health system, according to the survey by Merritt Hawkins, a physician recruitment firm. In its 2008 survey, opinions ran the opposite way — 58 percent opposed single-payer. What’s changed?

Physicians long for the relative clarity and simplicity of single-payer.

— Phillip Miller, vice president at physician recruitment firm Merritt Hawkins

Red tape, doctors tell Merritt Hawkins. Phillip Miller, the firm’s vice president of communications, said that in the thousands of conversations its employees have with doctors each year, physicians often say they are tired of dealing with billing and paperwork, which takes time away from patients.

“Physicians long for the relative clarity and simplicity of single-payer. In their minds, it would create less distractions, taking care of patients — not reimbursement,” Miller said.

In a single-payer system, a public entity, such as the government, would pay all the medical bills for a certain population, rather than insurance companies doing that work.

A long-term trend away from physicians owning their practices may be another reason that single-payer is winning some over. Last year was the first in which fewer than half of practicing physicians owned their practice — 47.1 percent — according to the American Medical Association’s surveys in 2012, 2014 and 2016. Many doctors are today employed by hospitals or health care institutions, rather than working for themselves in traditional solo or small-group private practices. Those doctors might be less invested in who pays the invoices, Miller said.

There’s also a growing sense of inevitability, Miller said, as more doctors assume single-payer is on the horizon.

“I would say there is a sense of frustration, a sense of maybe resignation that we’re moving in that direction, let’s go there and get it over with,” he said.

Merritt Hawkins emailed its survey August 3 and received responses from 1,003 doctors. The margin of sampling error is plus or minus 3.1 percentage points.


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Why a Single-Payer Health Care System is Inevitable

BY Robert Reich | August 24, 2016

The Affordable Care Act established the principle that everyone deserves health coverage, said Shawn Martin, senior vice president for advocacy at the American Academy of Family Physicians. Inside the medical profession, the conversation has changed to how best to provide universal coverage, he said.

“That’s the debate we’re moving into, that’s why you’re seeing a renewed interest in single-payer,” Martin said.

Dr. Steven Schroeder, who chaired a national commission in 2013 that studied how physicians are paid, said the attitude of medical students is also shifting.

Schroeder has taught medicine at the University of California-San Francisco Medical Center since 1971 and has noticed students’ increasing support for a single-payer system, an attitude they likely carry into their professional careers.

“Most of the medical students here don’t understand why the rest of the country doesn’t support it,” said Schroeder.

The Merritt Hawkins findings follow two similar surveys this year.

In February, a LinkedIn survey of 500 doctors found that 48 percent supported a “Medicare for all” type of system, and 32 percent opposed the idea.

The second, released by the Chicago Medical Society in June, reported that 56 percent of doctors in that area picked single-payer as the “best care to the greatest number of people.” More than 1,000 doctors were surveyed.

Since June 2016, more than 2,500 doctors have endorsed a proposal published in the American Journal of Public Health calling for single-payer to replace the Affordable Care Act. The plan was drafted by the Physicians for a National Health Program (PNHP), which says it represents 21,600 doctors, medical students and health professionals who support single-payer.

Clare Fauke, a communications specialist for the organization, said the group added 1,065 members in the past year and membership is now the highest since PNHP began in 1987.

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

The post Doctors Are Warming Up to Single-Payer Health Care appeared first on BillMoyers.com.

You know where they really need the public option? Trump Country.

Published by Anonymous (not verified) on Thu, 17/08/2017 - 7:34am in

I don’t know why people are focused on President Trump, when I have cool cartograms of which U.S. counties are down to only one ACA marketplace plan.


Map produced by Todd Schuble. Red and blue shades indicate governor’s party affiliation as of Election Day, 2016.

 


Cartogram produced by Todd Schuble. Red and blue shades indicate governor’s party affiliation as of Election Day, 2016.

The cartogram is weighted by population, and illustrates four important facts about America and health reform:

  • The standard U.S. map does not accurately reflect the experience of most people. Americans cluster on the coasts and in densely-populated metropolitan areas. Sparsely-populated areas such as northern Nevada or Montana that cover many square miles are over-represented in the standard maps. And these maps distort our understanding. If cattle and corn fields bought health insurance, we’d have a reasonable fear that ACA is collapsing. That’s not the reality.
  • Democrats are terrible at winning down-ballot elections away from the bicoastal liberal states. That’s a huge political consequence of the Obama era.
  • Republicans are terrible at operating successful ACA exchanges. Only one big blue metropolitan area-Philadelphia, PA, was down to one plan. Basically, every other major struggling area is in a red state. Huge sections of the deep south, Arizona, Oklahoma, and the mountain states are down to one marketplace plan.
  • Rural areas such as northern Nevada are terrible places for marketplace competition. They are too sparsely populated to support real competition.

ACA marketplaces may never work very well in sparsely-populated rural areas. Hence a great irony. Trump country may be the locale in greatest need of a Medicare or Medicaid alternative to private plans. Democrats would face a knife fight to enact a public option. Once it’s enacted, I suspect Trump country would never let it go.

More from me here, at healthinsurance.org.

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