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Tag: "health care"

Finally, the Poor Will Have the Freedom to Die

[ 46 ] June 25, 2017 |

While officiating Secretary of the Treasury Jay Gould’s third wedding, Vice-President Torquemada found time to tweet a picture of the wedding of a bunch of millionaires (sitting at the distant tables no doubt) and billionaires and use this as the message:

Class war, indeed. Anyway, what’s the kind of personal responsibility the party of mass murder is talking about?

Senate Republicans are expected to revise their health bill early next week, adding in a provision that could lock Americans out of the individual market for six months if they fail to maintain continuous insurance coverage.

Miss a payment, no health care for 6 months! Sounds like freedom to me!

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Our Qualified, Intelligent Political Leaders

[ 19 ] May 26, 2017 |

Mark Meadows, (Lunatic-NC) and critical player in TrumpCare passing the House:

Freedom Caucus Chairman Mark Meadows (R-N.C.), — who played a pivotal role in including state waiver options in AHCA — hadn’t read the full report yet, but initially said he saw it as “good news.”

When reporters pointed out the portion of the CBO report saying individuals with preexisting conditions in waiver states would be charged higher premiums and could even be priced out of the insurance market — destabilizing markets in those states — under AHCA, Meadows seemed surprised.

“Well, that’s not what I read,” Meadows said, putting on his reading glasses and peering at the paragraph on the phone of a nearby reporter.

The CBO predicted:

“…the waivers in those states would have another effect: Community-rated premiums would rise over time, and people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive non-group health insurance at premiums comparable to those under current law, if they could purchase it at all — despite the additional funding that would be available under H.R. 1628 to help reduce premiums.”

Republicans insisted in the days after AHCA’s passage that the health care bill would not weaken protections for preexisting conditions, citing the plan’s high-risk pools for sick people.

Critics argue those high-risk pools are not adequately funded, though. The Center for American Progress projected, before House Republicans passed AHCA in May, that its high-risk pools “would fall short by at least $19.7 billion per year, or by about $200 billion over 10 years.”

The CBO analysis was likewise adamant that AHCA’s current high-risk pool funding isn’t enough to cover sick people if states use the mandate waivers.

After reading the paragraph, Meadows told reporters he would go through the CBO analysis more thoroughly and run the numbers, adding he would work to make sure the high-risk pools are properly funded.

Meadows, suddenly emotional, choked back tears and said, “Listen, I lost my sister to breast cancer. I lost my dad to lung cancer. If anybody is sensitive to preexisting conditions, it’s me. I’m not going to make a political decision today that affects somebody’s sister or father because I wouldn’t do it to myself.”

He continued:

“In the end, we’ve got to make sure there’s enough funding there to handle preexisting conditions and drive down premiums. And if we can’t do those three things, then we will have failed.”

Meadows indicated he would support less-conservative changes to provide more funding for high-risk pools in the Senate, if needed.

The man literally has no idea what it is his own bill or how it will affect people, despite people talking about this ever since this horrible idea began. But, hey, those people were liberals. And so are those CBO hippies so I’m sure the magic math behind TrumpCare will totally work. That’s Jesus math right there.

Calling Republicans

[ 56 ] May 4, 2017 |

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Marshall makes sense here on how to deal with Republican representatives on this vote to kill millions of Americans, whether they vote yes or no.

It matters just as much if your GOP rep is voting against this bill. To call and say “Hey thanks”? Not remotely.

If your Republican Rep is voting ‘no’, it’s still their vote and their seat which makes Paul Ryan the Speaker. That’s making this possible. If their seat was held by a Democrat (and obviously a number of seats more, not just that one) this wouldn’t be happening. So it’s not just about their vote. They make the majority possible. And that’s why this is happening. So really, they are just as responsible as the Republicans are voting “yes”. That’s true as a factual matter. As a matter of political strategy, if you want to protect the coverage of those 24 million people, you should let them know that you plan to hold them responsible for this. The heat on them will matter a lot because they have little real incentive to try to stop the train if they think they’re off the hook because they voted “no”. This is very important.

I guarantee you there are many conversations between ‘no’ voting Republican Reps and House leadership in which it’s a very straightforward arrangement. “I wish you guys the best but I need to vote ‘no’. It won’t fly in my district.” For a certain number, the leadership says, “We understand. We’ll give you a pass. We have the votes.” So the “no” voting Rep thinks he or she is covered. I’m in the clear. They shouldn’t be for the reasons I’ve stated above. In many cases, they are perfectly happy to see the 24 million go to the butcher block. Because it’s not on them. Or they don’t think it will be. It’s important for constituents to let them know that is not how they see it.

If your Rep is a diehard “yes” in a safe district, you should still call. Why? First, no one is ever that safe. But the more important point is that when people in safe seats hear more than they expected, they will rightly get the sense that other people in their caucus might go down to defeat. So they may no longer be in the majority. Especially today, parties operate as units. No representative is an island.

Another point to consider is that this seems likely to pass by maybe as little as one or two votes. What does that mean? That means that every Republican “yes” on their own could have made the difference. Let’s say this literally passes by one vote. That means your Republican Rep, alone, could have saved coverage for 24 million people. And so could that other Republican Rep who represents your cousin in other state. Funny how that works, isn’t it? But it’s true. That’s powerful. That’s the making of 30 seconds ads.

I could rattle off a list of other scenarios. But the point is that you should call basically no matter what. The utility and impact may not be as obvious. But often, the impact is almost as great as it would be if you were calling someone who was actually wavering. Sometimes greater. The over-arching point is don’t fall for the silliness of vote count literalism. Call. It matters.

The main takeaway from this horrid bill is this tweet from last night. And the central point that I have made over and over–the threat this nation faces is at most 20% Trump. The threat is at least 80% the Republican Party and what it stands for. And I don’t know really know if our freedoms can survive decades of this.

Drain That Swamp!

[ 45 ] April 26, 2017 |

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Congressional Republicans are really going to sell the public on keeping themselves on the ACA while they continue attempting dooming millions of Americans to early and painful deaths.

House Republicans appear to have included a provision that exempts Members of Congress and their staff from their latest health care plan.

The new Republican amendment, introduced Tuesday night, would allow states to waive out of Obamacare’s ban on pre-existing conditions. This means that insurers could once again, under certain circumstances, charge sick people higher premiums than healthy people.

Republican legislators liked this policy well enough to offer it in a new amendment. They do not, however, seem to like it enough to have it apply to themselves and their staff. A spokesperson for Rep. Tom MacArthur (R-N.J.) who authored this amendment confirmed this was the case: members of Congress and their staff would get the guarantee of keeping these Obamacare regulations. Health law expert Tim Jost flagged me to this particular issue.

A bit of background is helpful here. Obamacare requires all members of Congress and their staff to purchase coverage on the individual market, just like Obamacare enrollees. The politics of that plank were simple enough, meant to demonstrate that if the coverage in this law were good enough for Americans than it should be good enough for their representations in Washington.

That’s been happening for the past four years now. Fast-forward to this new amendment, which would allow states to waive out of key Obamacare protections like the ban on pre-existing conditions or the requirement to cover things like maternity care and mental health services.

If Congressional aides lived in a state that decided to waive these protections, the aides who were sick could be vulnerable to higher premiums than the aides that are healthy. Their benefits package could get skimpier as Obamacare’s essential health benefits requirement may no longer apply either.

I appreciate wanting to keep your staff healthy. Too bad it doesn’t apply to all Americans. I guess being a College Republican who gets a staff job out of college with a fireeating Republican makes you the member of a superior class, unlike those people.

Meanwhile, the Trump tax plan sure looks great!

Reduction of the corporate tax rate from 35 percent to 15 percent, a cut which sounds like it will indeed apply to “pass-through” companies like the Trump Organization.

Reduction of the top individual tax rate from 39.6 percent to 35 percent and reduction in the number of individual tax brackets from seven to three.

Doubling the standard deduction.

Repeal of the estate tax.

Repeal of the Alternative Minimum Tax.

Repeal of the “Net Investment Income” tax that helps pay for Obamacare.

It would also eliminate nearly every deduction except for mortgage. Among many other things, this would effectively mean the end of freelancing as a career choice.

How would this affect Herr Trump? Secretary of the Treasury Jay Gould:

How will the president’s own tax bill be affected by the plan? “I can’t comment on the president’s tax situation since I don’t have access to that.”

I’m sure that Trump will make this clear soon enough by releasing his taxes!

The Next Step in the Health Care Debates

[ 57 ] March 25, 2017 |

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Above: Hells yeah!

Yesterday was a great day. But let’s be clear–Trump and Ryan will treat the ACA as well as they treat any other part of the government, which means trying to undermine its effectiveness. And given how insurance companies are dropping out of the exchanges, there are real problems that need to be fixed. It’s not really on Democrats to defend the ACA as a static program because they originally passed it. What they should be saying is that the ACA was the best that could be in 2010 and yes it does have problems that need fixing. And they should be saying that the way to fix those problems is universal Medicare. And while I get that single-payer has been simplified on the left as the only possible solution for health care when in reality there are many possible roles, expanding Medicare into a single-payer type system does have certain advantages.

It also makes an excellent organizing signpost. Medicare for all is simple, easy to understand, and hard to argue against or distort. Most people know someone on Medicare who can testify to the generally good care, or who is counting the days until they can enroll and have the peace of mind that comes with quality coverage. Fabricated agitprop like the mythical ObamaCare “death panels” will be a much harder sell.

As Republicans do their level best to make sure as many poor people as possible go bankrupt from medical debt or die of preventable diseases, a single-payer counter-offer makes perfect policy and political sense. Even if you think it’s a bit hasty on the merits, it’s still a splendid way for the Democrats to demonstrate, loudly and clearly, that they are for quality health care for all.

That makes plenty of sense to me.

Also, organizing works. Keep doing it. If you flooded congressional phone lines for everything like for this bill, or even 10% of like this bill, we would have a far better nation.

Dumbasses of America

[ 323 ] March 19, 2017 |

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The genre of “let’s talk to idiotic white voters who support Trump even though he will decimate their lives” is already more stale than bread baked on November 8. However, it does lead to the occasional special anecdote that truly sums up the stupidity of many white people.

Blake Yelverton is taking a break with a burger that doesn’t cut any corners. Cheese and bacon and everything. He’s 23, a burly young man with a big red beard, and he works on his father’s cow farm.

“I don’t believe it’s the federal government’s job to provide health care,” he said. “It’s communism, socialism anyway.”

Yelverton hopes Trump trashes the whole thing, and he’s not too fond of the GOP plan being discussed in Congress either. “They’re doing a lesser evil of Obamacare,” he said.

His insurance?

“I’m on my parents’ plan,” he said.

So, Yelverton, it turns out, benefits from Obamacare. That’s because the law allows parents to keep kids on their insurance until age 26 — a widely-popular element of Barack Obama’s signature health law that Republicans intend to keep in their replacement plan.

Confronted with that information, he pauses for a moment.

“I haven’t been to the doctor in four or five years,” he said.

Smart kid.

Who Knew?

[ 211 ] February 27, 2017 |

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The last person to understand a basic fact is of course our president.

President Donald Trump told a bipartisan group of governors at a White House reception Monday morning that GOP tax reform would have to wait for lawmakers to move on repealing Obamacare, cautioning that, “Nobody knew that health care could be so complicated.”

“I have to tell you, it’s an unbelievably complex subject,” Trump said.

OK.

Who Uses the ACA? Trump Voters.

[ 216 ] February 6, 2017 |

1in4WA

As this story on Washington demonstrates, one of the many sad ironies of the election is that the counties most reliant upon the ACA for health care are also the counties most likely to vote for the fascist Trump.

The ACA and the Republican War on the Arts

[ 145 ] January 19, 2017 |

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Repealing the ACA would decimate the lives of musicians who rely on it to stay healthy. This is of course part of the point for Republican “governance” that is launching a head-on attack on the arts.

For much of his life, Andrew Savage, the 30-year-old singer-guitarist for New York indie-rock band Parquet Courts, went without health insurance. The musician suffers from epilepsy and suffers two or three seizures a year, the most severe of which have resulted in head trauma. He quit his day job six years ago to tour with the band, which was just starting to take off, but that meant no insurance to pay for his daily medication. He spent years shuffling payments on credit cards; once, he openly wept when a pharmacist told him a generic drug was available for $40 instead of $400.

The ACA would have helped, but by the time it took effect in 2013, the members of Parquet Courts were big enough, like most successful bands, to form a Limited Liability Company and purchase group insurance. “We were worried that if we got Obamacare, there would be a lot of limitations — the bill, when it was first conceived, was very different from the one that made it through because so many things got taken away from Obama and his original vision of the plan,” Savage says from his Brooklyn home. “Of all the cynical things promised by Donald Trump, this has got to be one of the most scoundrel-ish — this is taking things away from people who definitely need it.”

Even musicians who haven’t purchased insurance through the exchanges have benefited from Obamacare. Insurance companies can no longer raise rates for customers who have pre-existing conditions. That means sick people have an easier time than ever getting coverage.

Members of Drive-By Truckers, the veteran southern-rock band, run an LLC and share a group health-insurance plan. But 52-year-old Patterson Hood, one of the band’s lead singers, says the central Obamacare provision that prevents insurance companies from raising rates due to members’ pre-existing conditions has helped his family immeasurably. His wife and 12-year-old daughter have scoliosis, or curvature of the spine, and his 7-year-old son has growth hormone deficiency that requires an expensive shot every day for the next decade.

“My son’s shots are in the thousands per month. I mean, it’s a lot of money. And we do not have it,” he tells Rolling Stone just before a Conan appearance in Los Angeles. “We’re paying $2,000 a month as it is just for the insurance. I’m lucky I’m gainfully employed — my band, we’re not stars, but we’re successful enough to where I can make ends met. But it terrifies me. It literally woke me up in the middle of the night last night.”

You ain’t the only one Patterson. You ain’t the only one.

But hey, I bet Pat Boone has the best health insurance. And that’s all the music we need in the new White Christian America.

Repeal and Replace…With Manly Suffering and Life Lessons

[ 136 ] December 19, 2016 |

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GOP health care in a nutshell:

A Republican congressman outlined the way he would like to see the health care system operate if Obamacare is repealed, as GOP lawmakers are promising. It is a brave new world in which parents would wait and think about it before bringing in their sick or injured kids for costly treatments.

The example Rep. Bill Huizenga (R-MI) gave in an interview with MLive.com was from his own experience when he waited until the morning after to take his youngest son to the doctor with an injured arm, because he did not want to waste money on an expensive emergency room visit. The arm, it turned out, was broken.

“We weren’t sure what was going on. It was in the evening, so I splinted it up and we wrapped it up, and the decision was, okay, do we go to the ER? We thought it was a sprain, but weren’t sure,” Huizenga said, adding that he and his wife “took every precaution and decided to go in the next morning.”

“When it [comes to] those type of things, do you keep your child home from school and take him the next morning to the doctor because of a cold or a flu, versus take him into the emergency room? If you don’t have a cost difference, you’ll make different decisions,” he said.

Explaining to your kid that you could relieve his pain immediately, but then poor people would have health coverage and become horrible welfare slackers driving around in their Cadillac after ordering their t-bone steaks is simply good parenting. Preventive care? Well, that’s preventing our kids from being losers as adults by simply not treating their illnesses.

Sick Leave

[ 36 ] November 5, 2016 |

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The national conversation about the social safety net is in terrible shape, far behind where it was in the 1970s. There are of course sharp structural reasons for this, as the rise of the conservative movement and the reestablishment of corporate control over politics makes the passage of even basic legislation like keeping the government running is extremely contentious. That’s sad because in the 1970s, it seemed like we were about to make whole new leaps into a social safety net something like in western Europe. Today, we are just hoping to gain enough momentum to provide some fixes to the ACA, which while an improvement on the terrible state of health care in the United States, is a very flawed and limited program. A national child care program, the forgiveness of trillions in student debt, free public higher education, and other obviously beneficial programs are either not on the table today at all, only in the dreams of the liberal left, or just getting off the ground. Another of these is a vigorous national sick leave program. The Family and Medical Leave Act was a slight step forward, but any program that only provides unpaid leave is obviously quite flawed. Yet the costs of not having a real sick leave program are quite real.

Low-income mothers are particularly likely to work while sick. Another study, by LeaAnne DeRigne of Florida Atlantic University and colleagues, explains why. It found that families with less ability to afford unpaid time off are more likely to lack paid sick leave. According to the study, published in Health Affairs, 65 percent of families with incomes below $35,000 had no paid sick leave, while the same was true of only 25 percent of families with annual incomes above $100,000.

Paid sick leave slows the spread of disease. Cities and states that require employers to offer paid sick leave — Washington, D.C.; Seattle; New York City; and Philadelphia, as well as Connecticut, California, Massachusetts and Oregon — have fewer cases of seasonal flu than other comparable cities and states. Flu rates would fall 5 percent if paid sick leave were universal. According to one estimate, an additional seven million people contracted the H1N1 flu virus in 2009 because employees came to work while infected. The illnesses led to 1,500 additional deaths.

Paid sick leave has other benefits besides reducing flu deaths. For example, workers may use it for preventive care, forestalling subsequent, more disruptive health problems. Workers lacking paid sick leave are more likely to delay needed medical care, a finding that holds for both insured and uninsured workers. In other words, though health insurance helps people pay for health care, it does nothing to help them afford to take time off to get it.

Sicker workers may be more prone to job-related injuries. One study found that even within industries in which accidents and injuries are relatively more likely — like forestry, mining and construction — workers with paid sick leave experienced fewer of them than workers without it. Another study found that employees who work while sick are more likely to have heart attacks than those who take time off.

Unfortunately, like so much in the United States, the unwillingness of the government to provide social services means that risk gets placed on the individual, in this case disease spreading through society unnecessarily and at great cost.

Building on Obamacare

[ 116 ] August 23, 2016 |

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The Affordable Care Act is arguably the biggest progressive legislative victory since the Johnson administration. It’s also deeply flawed and in need of update in many areas. These two statements are not contradictory. The question, as Jim Newell asks, is whether Democrats are ready to build upon that great victory and improve the law.

First, some of the issues, which have been more in the news lately because of Aetna deciding to play the villain.

But it’s becoming clearer that the Affordable Care Act, for all its advances, is due for the sort of legislative maintenance that most major laws require after implementation. Two temporary federal programs, reinsurance and risk corridors, designed to cushion losses for insurers as they determined sustainable premium price points in new markets, expire in 2017 as the exchanges enter their fourth year of operation. Carriers serving sicker-than-expected pools or rural areas find that their options are either to sharply increase premiums or to leave the exchanges altogether. Average premium increase requests from insurers on the individual exchanges are well into the double digits across much of the country. And a Kaiser estimate in May projected the number of counties that could have a single exchange insurer in 2017 to be 664—70 percent of which are mostly rural—up from 225 in 2016. That number will increase following Aetna’s withdrawal and could reach roughly a quarter of all counties in the country. Alabama, Alaska, South Carolina, and Wyoming are set to have just one insurer offering coverage on their exchanges in 2017. Most of North Carolina, except for the Raleigh metropolitan region, will be down to one insurer as well.

One problem with legislative redress for Obamacare is that the legislators who are supposed to do the redressing seem less than eager to return to the front where not long ago they’d declared victory. The second problem is that, once again, the fight will almost certainly involve the public option.

So what about the public option and what, if anything, are Democrats ready to do if they have a big win in November? Newell correctly notes that most Democratic politicians see the fight as protecting the ACA from Republicans and therefore really not articulating any changes. He does have a slight bit of hope that Hillary Clinton will push toward something like the public option.

There is one Democratic figure who might be in office in 2017 who has treated the law’s shortcomings seriously and put together a bevy of health care proposals—and she happens to be the party’s presidential nominee.

In the beginning of the campaign, Hillary Clinton, too, suffered from the “everything is fine!” bug, going so far as to red-bait Sen. Bernie Sanders over his Medicare-for-all plan. Sanders’ specific proposal suffered from some fuzzy math. But he understood that though the ACA was a vast improvement on an untenable status quo, its flaws really were flaws, and it made little sense to avoid confronting them just because doing so would be a pain. One staple of Sanders’ events during the campaign was to ask members of his crowds to raise their hands if they were facing sharp premium increases, and then to say how large the increase was. There was never a shortage of volunteers.

Eventually Clinton put together a series of health care proposals. It wasn’t the overhaul Sanders wanted, but he gave his enthusiastic endorsement anyway. Clinton would add a Medicare “buy-in” option for those 55 and older, and she also committed to doubling the money for community health centers from the funding mark set in the original ACA, an important provision won by Sanders in 2009. She offered further inducement for states that haven’t already accepted the Medicaid expansion to do so and would grant the HHS secretary additional “authority to block or modify unreasonable health insurance premium rate increases,” increase resources for enrollment outreach, and expand existing exchange subsidies.

And yes, she’s also pledged to “pursue efforts to give Americans in every state in the country the choice of a public-option insurance plan.”

It’s unclear how high a public option, and the political fight that will come with it, ranks atop Clinton’s list of priorities. But if 2017 open enrollment goes poorly and more insurers flee the exchanges, the public option—which has always polled well—would be an obvious go-to solution for restoring competition. The idea doesn’t rely on hand-holding private insurers until they feel properly incentivized to perform their societal function. It is a direct delivery of health insurance plans to health insurances exchanges. “Health care markets will inevitably differ from region to region,” Jacob Hacker, the Yale professor and so-called “father of the public option,” wrote in Vox on Thursday, “but there’s no reason every one of the existing marketplaces couldn’t offer a Medicare-like plan—a plan that’s stable; a plan with predictable costs; a plan that gives patients a broad choice of providers just as Medicare does.” It would also save money—$158 billion over 10 years, according to a 2013 Congressional Budget Office estimate.

There’s another problem that Newell does not discuss, but that I feel. The ACA was a big win but the Tea Party’s rise and McConnell destroying the historical norms of the Senate has meant that it’s now been 7 years since we have seen a major progressive bill become law. The victories of the last 7 years have been in the courts (especially in the last few months) and through the executive branch. There are a lot of other priorities that have been ignored or put aside. If Clinton wins and has the ability to pass any legislation (just play along here), I think her top two priorities should be an immigration bill with a path to citizenship for undocumented Americans and a sizable minimum wage increase. Both of these have significant political support and are fairly simply to articulate. After that, maybe health care comes back on the table, but so does a climate bill, college tuition and debt issues, a revived Employee Free Choice Act, and a whole lot of other things. Given all of this, to what extent should Democrats fight to improve Obamacare?

Which, in other words, means that this could serve as a thread on what you think Clinton’s top legislative priorities should be, in particular keeping in mind what is actually possible, even if she does have 55 senators and a narrow House majority for the precisely 2 years that will probably last.

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