Quick Hits

** The Las Vegas Sun has a quick list of bills that made it past the “Tuesday Deadline” for consideration in the Nevada Legislature.  Looking for bills that failed to meet the deadline? It’s here.  For information on other bills start with this link.

** Heads up: The Reno Gazette Journal will run an article on Sunday concerning the closing of the ATF office in Reno, NV, and how this has impacted the efforts to stop gun trafficking.  The Leahy-Collins amendment to curtail gun trafficking in the U.S. failed in the Senate on a 58-42 vote during which Republicans sustained their filibuster of the amendment. [TheHill] Senator Dean Heller (R-NV) voted to sustain the GOP filibuster. [Vote 99]

** Did we know? “Sixty-six Americans were killed in mass shootings by non-Muslims in 2012 alone, twice as many fatalities as from Muslim-American terrorism in all 11 years since 9/11.” [Politicususa] And, did we know that the NRA and Conservatives in Congress have made it more difficult to track or monitor non-Muslim extremists in this country since 2001?  Crooks and Liars posts a list of recent “eliminationist” attacks.

** It’s been a bad week for the Austerians.  First, comedian Stephen Colbert launched a devastating critique on the economic theorists.  Additionally, many others have piled on.  There’s Austerity as Flim-Flam.   There’s Who is Defending Austerity Now?  There’s rethinking austerity.   There’s the EU calling for diminishing austerian policies.  And, for good measure, there’s the choking effects of austerity policies in the UK.  Thus the House GOP budget plan is based on a seriously flawed study.

** What economic recovery? For 7% of this country it’s been a nice rebound, for the remaining 93% not so much.

“During the first two years of the nation’s economic recovery, the mean net worth of households in the upper 7% of the wealth distribution rose by an estimated 28%, while the mean net worth of households in the lower 93% dropped by 4%, according to a Pew Research Center analysis of newly released Census Bureau data.” [PewResearch]

Graph it out and it looks like this:

** Watch H.R. 1549 carefully. It would “Give sick people without insurance temporary access to crappy private plans at exorbitant rates as part of a strategy aimed at pulling the rug out from under them entirely at the end of the year, all the while mewling about one’s concern for sick people.” [WashMon]  When astro-turf organizations like Freedom Works and AMAC line up for something it’s time to head the other direction.  The best description for this legislation is “ruse and trap.”

** Republicans Behaving Badly.  Let’s start with the Tennessee legislator who thinks pressure cooker bombs are humorous.  Followed, of course, by his non-apology-apology.  His rationale is that advocates of sensible gun safety legislation should have stayed quiet after Newtown…  Then there’s the Conservative group that photo-shopped ethnic minority people from its mailer about voting restrictions.  And who could have missed GOP behemoth, Rush Limbaugh, comparing the Boston bombers to Trayvon Martin?  That Arkansas legislator who called for using “2nd Amendment” solutions to Medicaid expansion, “Most likely won’t kill lawmakers who support Medicaid expansion.”  Most likely? How nice.

** Lady’s Days:  Ann Coulter, scourge of all operative grey cells residing in every cerebral cortex, calls for women to to prosecuted for wearing the hijab.  So, do we tell nuns to refrain from wearing their habits?  A Washington state pastor tells women to submit to their husbands and not nag “like Chinese water torture.”  The adherents of the Church of Perpetual Intolerance (aka the Family Research Council) are trying to convince us that “many” experts believe Plan B contraceptives should not be available over the counter — there are a few critics, and those critiques tend to be based on religiosity not science.  Rebuffed last year, Ohio Republicans are taking another swipe at funding for Planned Parenthood women’s health care services in that state.

Heller’s Helpers: Ralph Reed’s Ruminations

The latest flyer in my mail box encourages me to vote for Senator By Appointment Only® Dean Heller in the Nevada senate race because he opposes Obamacare.  The Faith and Freedom Coalition of Duluth, GA assures me that Senator Heller would “repeal Obamacare.”  I’m not surprised, after all this is Jack Abramoff’s former buddy Ralph Reed’s outfit — he, the refuge from the defunct Christian Coalition, would like me to believe that his Koch Brothers financed FFC has my lily-white interests at heart.

So, let me review, it’s supposed to be in my interest to repeal provisions which:

1. Require the posting of health insurance policy information online for easier access by customers?
2. Prohibit health insurance corporations from denying health insurance policy coverage for children with pre-existing medical conditions?
3. Prohibit health insurance corporations from abusing rescission clauses to deny claims for medical treatment?
4. Eliminate those junk insurance policies sold with defined life time benefit limits?
5. Restrict health insurance corporations’ use of annual limits on health insurance coverage?
6. Allow a policy holder to appeal health care insurance corporation decisions in an external review process?
7. Establish consumer assistance services to help people select from a variety of health insurance plans in their area?
8. Provide tax breaks for small businesses which offer health care insurance as part of their employee benefits?
9. Offer relief for about 4 million senior citizens threatened by the infamous Medicare Part D “donut hole?”
10. Provide that cancer screenings, like mammograms or prostate exams, be offered without charging a co-pay or deductible?
11. Fund programs which seek to promote anti-obesity, and anti-smoking campaigns?
12. Fund efforts to crack down on, and prosecute, instances of Medicare fraud?
13. Provides access for individuals to purchase affordable health care insurance policies even if they have pre-existing medical conditions?
14. Extend health insurance policy coverage for young adults?
15. Expand health insurance coverage for early retirees?
16. Fund training programs for primary care physicians, physicians assistants, and nurses?
17. Require that health insurance corporations justify their policy premium increases?
18. Help states offer extended Medicaid coverage for low income, blind, aged, or disabled persons?
19. Fund increased health care resources for rural areas?
20. Funds to construct and maintain community health care centers in under-served areas?
21. Offer prescription drug discounts for senior citizens?
22. Provide wellness visits for elderly Americans?
23. Improve health care services for senior citizens after hospitalization?
24. Assist states toward providing more independent living and assisted care for disabled persons?
25. Require corporations selling health care insurance policies to use at least 80% to 85% of the premiums they collect on — health care?
26. Cut over-payments to health insurance corporations offering Medicare Advantage policies?
27. Offer financial incentives to hospitals that improve the care they provide to their patients?
28. Encourage integrated health care delivery to reduce the need for re-admission to a hospital?
29. Reduce paperwork and administrative costs in health care services?
30. Expand preventative health care services.
31. Initiate pilot programs which bundle health care service billing, to replace the current fragmented billing systems?
32. Increase Medicaid payments to physicians?
33. Provide funding for the Children’s Health Insurance Program?
34. Prohibit the sale of health insurance policies which discriminate on the basis of gender?
35. Eliminate the annual limits on insurance coverage?
36. Provide for health insurance coverage for individuals who are participating in clinical trials?
37. Establish affordable health insurance exchanges in all states?
38. Increase the Small Business Tax Credit for employers who offer health insurance coverage.
39. Promote individual responsibility for health insurance coverage?
40. Increase access to Medicaid services for newly eligible individuals?

I don’t think so.

Senator Heller would probably like to generalize his opposition to Obamacare, it makes for nice soundbites  — but how many of its individual provisions would he really like to repeal?  Perhaps we can guess they’d be the ones putting a crimp in the health insurance corporations’ style — and bottom lines?

Senator Rubio Comes To Nevada Bearing News From The Scarlett O’Hara School of Business Administration

Bill Clinton summarized the GOP theme for 2012: “We left him a total mess, he hasn’t cleaned it up fast enough, so fire him and put us back in.” [MST]  Now Sen. Marco Rubio (R-FL) is pushing the theme in Las Vegas:

Obama “doesn’t understand the free enterprise system,” Rubio said, arguing government is too big and is hurting small business and job growth with too many regulations and taxes.  [LVRJ]

Fact check time.  Actually in terms of the total number of regulations adopted, the Obama Administration is well behind the administration of President George W. Bush.  President Bush approved 931 regulations in his first three years, President Obama has approved 886.  [FC]  So, what would those “too many regulations” concern?

Investment Sector Regulations

The first, and most obvious source of Republican distress over regulations are those which seek to curtail the antics of the investment sector.  Implementation of the Dodd Frank Act means that financialists, eager to pick up where they left off before their pipe dreams of exploiting securitization in the housing market exploded like a pipe bomb, don’t care to have any restrictive oversight of their transactions in the derivatives market.   The MegaBanks would ever so much like to go back to the days before the Volcker Rule and be able to use insured deposits as a back stop for their proprietary trading.  And, the MegaBanks don’t want to write ‘living wills‘ in case their trading desks get out of hand (again) and bring the bank down into insolvency or illiquidity.

The banking sector is also feeling the heat from the Consumer Financial Protection Bureau — which is (to their horror) protecting consumers.   Most recently American Express felt the hammer come down on their illegal practices:

“The Consumer Financial Protection Bureau (CFPB) today announced an enforcement action with orders requiring three American Express subsidiaries to refund an estimated $85 million to approximately 250,000 customers for illegal card practices. This action is the result of a multi-part federal investigation which found that at every stage of the consumer experience, from marketing to enrollment to payment to debt collection, American Express violated consumer protection laws.” [CFPB]

Federal regulators also fined American Express $27.5 million for the illegal activities, and about 250,000 American Express customers will be getting refund checks.

Back in September 2012, the FDIC and CFPB ordered Discover to pay $200 million to 3.5 million card holders and fork over a $14 million civil penalty for deceptive practices. Discover also agreed to stop its deceptive marketing, to make restitution to customers who made purchases, provide refunds to customers without requiring more consumer actions, and to submit to an independent audit.  [CFPB]

Further, what may have the financial sector’s panties in a bunch are the proposed rules from the CFPB on home mortgages.  The CFPB explains:

Mortgage Terms: Under the proposed rule, creditors would have to make available to consumers a loan without discount points or origination points or fees, unless the consumers are unlikely to qualify for such a loan. These options would enable a consumer buying or refinancing a home to better compare competing offers from different creditors, better able to compare loan offers from a particular creditor, and decide whether they would receive an adequate reduction in monthly loan payments in exchange for the choice of making upfront payments.

Interest rates and points: Consumers can pay points, which are expressed as a percentage of the loan amount, and fees to covers costs associated with origination or prepaid interest charges. While these points and fees come in many different names and combinations, they all should function similarly to reduce the interest rate and thus a consumer’s monthly loan payments.

Qualifications for mortgage initiators: Under state law and the federal Secure and Fair Enforcement for Mortgage Licensing Act, loan originators currently have to meet different sets of standards, depending on whether they work for a bank, thrift, mortgage brokerage, or nonprofit organization. The CFPB is proposing rules to implement Dodd-Frank Act requirements that all loan originators be qualified. The proposal would help level the playing field for different types of loan originators so consumers could be confident that originators are ethical and knowledgeable.

Steering: In 2010, the Federal Reserve Board issued a rule that was designed to curtail the practice of loan originators directing consumers into higher priced loans based not on the consumer’s interest, but on the possibility that the loan originator could earn more money. The Dodd-Frank Act included a similar provision banning the practice of varying loan originator compensation based on interest rates or other loan terms. The CFPB’s rule would implement the Dodd-Frank Act provision and clarify certain issues in the existing rule that have created industry confusion.

Mandatory arbitration: The proposal implements Dodd-Frank Act provisions that, for both mortgage and home equity loans, prohibit including mandatory arbitration clauses in loan documents and increasing loan amounts to cover credit insurance premiums.

OK, now who wants to go back to a system in which mortgage terms were intentionally incomprehensible, when a homeowner could pay points and be essentially paying for nothing, when homeowners were steered into mortgage deals in the interest of the bankers, when there were no background checks of any kind on mortgage sellers and no required training, and when if serious problems arose there was no way for the “little guy”  homeowner to have his day in court?

Does anyone really want to go back to the “say anything” days of credit card marketing?  Money kept in the pockets of middle class working Americans by not allowing mortgage manipulation and credit card rip offs is money they could be saving or spending on their families — a far better way to grow this economy than by allowing the rip-off artists to game the system for their own benefit.

Health Care Regulations

Contrary to right wing radio talkers, there has been no government take over of health insurance in this country, and contrary to the hopes of the Single Payer advocates there is no government sponsored health care for anyone other than people over 65 who are enrolled in Medicare.

What we did get in the Affordable Care Act were requirements that health insurance corporations selling group or individual policies provide comprehensive health care insurance coverage.

Under the terms of the Affordable Care Act when the insurance corporation says it is selling you or your business a “comprehensive” or “basic” policy, the policy must include coverage of preventative health care services, inoculations, cancer screenings,  and between 80% and 85% of what they take in as premiums must be used to pay for HEALTH care — NOT executive compensation, advertising campaigns, or other non-medical administrative expenses.

So, would we like to go back to the bad old days of denial of coverage for pre-existing conditions (like being born with a food allergy, or having chicken pox), or for autism screening, for mental health care services, or when the insurance corporations could charge more for women’s policies just because they were women?

We could, for the sake of the MegaBanks and the large health insurance corporations, shave many of the Obama Administration’s new regulations, but the ultimate loser would be 99% of Americans who can’t afford to be ripped off, and shouldn’t be paying health insurance policy premiums for basic services they aren’t getting.

About Those Taxes

Let’s haul out this chart again, illustrating the point that the federal tax rates at their lowest rate at least since 1979.

The chart doesn’t conform to the received wisdom of some in the corporate media and many in the Republican Party — but that’s where we are.  There have also been some 18 tax breaks for American small businesses.  The President has also suggested a tax reform package which would cut taxes for those earning less than $200,000 per year.  [WH] The median income for a family in Nevada was $48,927 in 2011. [DoN]

So, where are all those regulations and taxes ‘hurting’ American small business owners?  The garage owners, the beauty shop operators, the small independent retailers, the lawn care services, the framing subcontractors, the dry cleaning companies, the small hardware store owners, the local lumber yard?

The Republicans need a cover story.  If a regulation impinges on the bottom line of Merger Mania Wealth Management LLC, then they decry all regulations as an impediment to economic growth.  If a regulation requires Bleedem Health Inc. to report a higher “medical loss ratio” then all regulations are detrimental to our economic growth rate.   It’s the old “de-regulation mythology” of the last three decades — and we saw where it got us in 2007-2008.

The Republicans need a narrative.  “Tax and spend” Democrats has served nicely.  No matter that the tax rates are the lowest since the Eisenhower Days, no matter that the rates can be graphed to illustrate the point.  The narrative remains because it serves the interests of large corporations and major banking operations.   Tax dollars appropriated to subsidize multi-national oil corporations are ‘beneficial,’ but tax dollars expended to train workers for 21st century jobs or veterans who seek college degrees ‘create a culture of dependency?’

We DO understand the free enterprise system, and we understand that it works best when there’s a level playing field, with rational controls to prevent exploitation, and consideration given to our entrepreneurs and our labor force of the future.   The short-term vision of the current GOP leadership mirrors the myopia of our current corporate titans — what works to increase the Quarterly Earnings Report is good.  Tomorrow we’ll leave for later.

This Scarlett O’Hara School of Business Administration combined with the  Mr. Magoo Department of Finance perspective is more destructive of American economic progress than the tepid regulations of the Dodd Frank Act and the implementation of the Affordable Care Act provisions combined.

Perhaps they just don’t understand the free enterprise system?

Chalkboard Talk: Obama – Romney and Medicare

Sources and References:  An Economic Sense, “Romney’s and Ryan’s Confusion on Basic Accounting: Medicare Costs,” August 16, 2012.   The Hill, “Gibbs: Ryan should thank Obama for strengthening Medicare,” August 19, 2012.  Christian Science Monitor, “Romney says Obama robbed Medicare,” August 16, 2012.  New York Times, “Patients would pay more if Romney restores Medicare savings,” August 21, 2012.  Washington Post, “Van Hollen: The Romney Ryan Plan Medicare Plan would have immediate cost increases for Seniors,” August 18, 2012.  Kaiser Health News, “CBO: Seniors Would Pay Much More For Medicare Under Ryan Plan,” April 5, 2011.   Washington Post, “Paul Ryan’s budget keeps Obama’s Medicare cuts – full stop,” August 14, 2012.

The Vague Factor: “

On “60 Minutes,” Romney said: “I don’t want any change to Medicare for current seniors or for those that are nearing retirement. So the plan stays exactly the same.”

Still, it’s unclear if that means a guarantee of no future cuts for those remaining in traditional Medicare, or if Romney is merely saying that the overall design of the program will stay the same.”

Good question, especially since Governor Romney has managed to turn vague political rhetoric into a form of modern performance art.

Republican YOYO Home Economics: Medicaid Slashed, Other Support Burned

Former President Clinton advised the delegates to the 2012 Democratic Convention to listen carefully to what the Republicans were offering in regard to Medicaid, and those of us in Nevada should be “listening with both ears.”  Here’s the description of the Medicaid program as stated by the Nevada Department of Health and Human Services, the program:

“Provides health care coverage for many people including low income families with children whose family income is at or below 133% percent of poverty, Supplemental Security Income (SSI) recipients, certain Medicare beneficiaries, and recipients of adoption assistance, foster care and some children aging out of foster care. The DHCFP also operates five Home or Community-Based Services waivers offered to certain persons throughout the state. The Division of Welfare and Supportive Services (DWSS) determines eligibility for the Medicaid program.”

Listing those categories focuses on the aims of the program — it is to serve (1) low income families with children; (2) elderly Nevadans; (3) low income Nevadans over 65 years of age; (4) families receiving assistance for adopted children; (5) children in foster care.  Who was enrolled in Nevada’s Medicaid program as of fiscal year 2009:

What services were provided to those enrolled in Nevada’s Medicaid program?

During fiscal year 2010, 68.1% of the spending from the Medicaid program went for acute care, 25.6% was allocated for long term care, and 6.3% was used for “disproportionate care – hospital payments.”

The spending for long term care breaks down as illustrated in the following chart:

11.1% of the long term care funding was allocated to facilities for the intellectually disabled, 2.9% went to services for the mentally ill — and notice – 86% was used to provide home health & personal care, and nursing facility care.  In other words, 86% of Nevada’s Medicaid expenses for long term care went toward serving those least able to care for themselves.  The other 14% was used to provide intermediate and long term care for those unable to care for themselves because of intellectual limits or mental illness.

Here is exactly why President Clinton told his audience to “listen up:”

My view is get the federal government out of Medicaid, get it out of health care. Return it to the states.” – Romney, South Carolina GOP Primary Debate, Jan. 20, 2012.

In case anyone is remotely confused about what that statement from the former Massachusetts Governor means, he’s speaking about transforming the Medicaid program into Block Grants.

More specifically, the former Governor is adopting the block grant proposal for Medicaid set forth in his running mate’s “Path to Prosperity” budget plan:

“The plan also would repeal health system reform law provisions that will expand Medicaid coverage starting in 2014. Instead, states would receive block grants, which would free states “to tailor their Medicaid programs to the unique needs of their own populations,” the budget says.”  [AMA]

The tailoring is to be done with less cloth:

The Ryan budget would cut $2.4 trillion from Medicaid and other health programs. Reduced spending would increase the number of uninsured dramatically, Park* said. “Those who retain coverage will have benefits scaled back and have higher cost-sharing.” [AMA] (emphasis added)

We can drill down further into what Governor Romney and Representative Ryan have in mind for the Medicaid program by looking at the Congressional Budget Office’s analysis of the Ryan position:  Medicaid and the Children’s Health Insurance Program (CHIP)—from 2 percent of GDP in 2011 to 1¼ percent in 2030 and 1 percent in 2050.

Now is the moment to recall that 58% of those who receive Medicaid assistance for their health care needs in Nevada are children, and the AAP isn’t thrilled at cuts to that constituency:

“American Academy of Pediatrics President Robert W. Block, MD, said the proposal would undo investments in health programs for children. More than half of Medicaid recipients are children, but their care accounts for up to only one-quarter of the program’s costs.

“Whether considering fiscal year 2013 federal spending bills or reviewing long-term budget proposals, Congress must seize this opportunity to invest in the future of our country by protecting children’s health,” Dr. Block said.” [AMA]

Dr. Block has reason to be concerned, if we return to the Congressional Budget Office’s analysis we can see why.  In two paragraphs from their analysis of the Ryan “Path” the non-partisan office explains why the proposal would make deep cuts, and place greater burdens on the states:

“The specified path (Ryan Plan) would cause federal spending on Medicaid and CHIP to decline relative to GDP in coming decades, rather than to rise sharply as in the other policy scenarios that CBO has analyzed, and would include no exchange subsidies (see Figure 3). As a result, by 2050, such spending would be 76 percent below what would occur for Medicaid, CHIP, and exchange subsidies under the baseline scenario and 78 percent below what would occur under the alternative fiscal scenario. Because spending on CHIP and exchange subsidies represents a relatively small share of the amounts in the baseline and alternative fiscal scenarios, most of the reduction would have to come from the Medicaid program.” [CBO] (emphasis added)

The Republicans do, indeed seem serious about eliminating Medicaid as a federal program and shifting the expenses for health care access to low income elderly, the disabled, the intellectually disabled, elders in nursing facilities, and children in poverty to the states.  The CBO explains the nature of this shift:

The responses of the states would be of particular importance. If states were given additional flexibility to allocate federal funds for Medicaid and CHIP according to their own priorities, they might be able to improve the efficiency of those programs in delivering health care to low-income populations. Nevertheless, even with significant efficiency gains, the magnitude of the reduction in spending relative to such spending in the other scenarios means that states would need to increase their spending on these programs, make considerable cutbacks in them, or both. Cutbacks might involve reduced eligibility for Medicaid and CHIP, coverage of fewer services, lower payments to providers, or increased cost-sharing by beneficiaries—all of which would reduce access to care. (emphasis added)

Translation: Even if the states were able to achieve all the vaunted efficiencies a “flexible” plan might provide — the cuts proposed are so deep and so drastic that citizens in the United States who are lower income elderly or the disabled in nursing homes, and those who are low income and living in foster care, or families in poverty — would have reduced access to care. Period.

These aren’t generic numbers and pie in the sky statistics we’re talking about, we’re speaking of 25,841 elderly Nevadans, 40,898 disabled Nevadans, 55,626 adult Nevadans – mostly women, and 168,070 Nevada children.

So, here’s a question for Governor Romney and Representative Ryan — If no matter how much efficiency the state of Nevada squeezes from your block grants for Medicaid, Nevada and the other states will still have to either appropriate significantly more revenue, or drastically reduce services — how is your plan anything other than a proposal to shift the burden of health care costs, for the least able among us, from the federal treasury to the state treasuries and the pockets of low income Americans?

Where, Governor Romney and Representative Ryan, does the Nevada Legislature start cutting? From the acute care services for adopted or foster children? From the acute care for pregnant women? From acute care for children in poverty who have asthma, autism, broken arms, or sprained ligaments?  From the long term care for the elderly who need home health care services and personal care to avoid institutional living?  From the long term care for the indigent mentally ill?  From elderly residents of nursing facilities?  From disabled children who need home health care? Where?

Perhaps cuts aren’t the only option. Must the Nevada government raise the eligibility standards such that only those living at “25%” of the official federal poverty level can receive assistance?  Here are the 2012 guidelines from the Department of Health and Human Services –

How much more should a family of four living on $1,920.83 per month  have to pay for basic health care?  How much more should a young man and his pregnant wife living on $1,260.83 per month have to pay for pre-natal care, and expenses associated with the birth of their first child?  For a political party which lauds its “Pro-Life” stance — asking low income families to dig deeper to pay for health care to make up for federal and state budget issues (while proposing more tax cuts for the top 1% of American income earners), makes it sound as though the GOP is the Pro-Birth, not Pro-Life party.

How much more should a young family have to pay for health care before the cost of health care begins to impinge on the capacity to put a roof over their heads?

Or their ability to put food on the table?  It’s likely going to cost our young family with two children under the ages of 19 approximately $366.40 to $578.40 per month to keep everyone fed. [USDA] Our hypothetical family might be lucky to have $764.43 per month remaining after housing and food for utilities, clothing, transportation costs (auto payments or bus fare) — that $764.43 translates to about $25.48 per day to cover ALL the basic family needs listed previously… including Health Care.  But wait, the Romney/Ryan budget cuts nutrition assistance too, drawing fire from the U.S. Conference of Catholic Bishops:

“Cuts to nutrition programs such as the Supplemental Nutrition Assistance Program (SNAP) will hurt hungry children, poor families, vulnerable seniors and workers who cannot find employment. These cuts are unjustified and wrong.” [The Hill]

And what other program do the Republicans fantasize about turning into a Block Grant Program and then cutting?  Housing subsidies. [TO.org]  There was some discussion of the Ryan proposal on this topic at the March 21, 2012 House Budget Committee hearing:

“Rep. David Price (D-NC) asked Donovan what the implication of the Ryan budget cuts would be on HUD programs such as public housing, Choice Neighborhoods, HOME and others.  Donovan responded that, under the proposed Ryan budget, approximately one million households could lose their housing.  Of the one million households at risk under the Ryan budget, Donovan estimated that 585 thousand would come from the Housing Choice Voucher Program, 425 thousand from the Project-Based Voucher Program, and 110-180 thousand from homeless assistance programs.  He also mentioned that an estimated 17 thousand jobs would be lost from CDBG, and cuts to the HOME program would mean tens of thousands of new affordable housing units would not be built.”  [CLPHA] (emphasis added)

So, no help for financially fragile families for health care, or housing, or food — or anything, but tax payers in the top 1% of all our income brackets will get more, yet more generous, tax breaks.  Little wonder the Bishops were annoyed.  Less wonder Sister Simone Campbell from Nuns on the Bus received a standing ovation at the Democratic National Convention.

A person doesn’t have to be Roman Catholic to find the Republican proposals supported by Governor Romney and created by Representative Ryan astonishing in their parsimony and appalling in their avarice.

Perhaps one has to be incited by the fact that a family in Las Vegas might have an air-conditioner, or a DVD player, or a functional motor vehicle — “Look,” cry the miserly, “They have nice stuff, and they got it by doing nothing.” Not. So. Fast.   As of 2010 not that many Nevadans were receiving public  assistance. [Census] In fact, about 3% of Nevadans were receiving public assistance. [Census pdf]

Thus much for the Miserly Myth that “They’re all sitting around collecting welfare, and learning to be dependent on Guv’mint.”  Perhaps we should add the usual follow up, “and they’re doing it on my hard earned tax dollars.”  The latter portion is correct, we do pay taxes which support assistance programs for fragile families.  However, the Grinches among us appear to believe they are the only ones chipping in.

S’cuse me Mr. Grinch, but I really don’t mind paying a fractional portion of my income to insure NO child goes to bed hungry, NO elderly person with dementia is left alone, NO foster child is left with an untreated case of pneumonia, NO pregnant woman is without pre-natal care, NO family is homeless, NO mentally ill person is abandoned, NO disabled child is without care.

This is what Democrats mean when we say, “Just Say No.”

References and Resources:  * Edwin Park, CBPP.  Congressional Budget Office, Ryan’s Specified Paths, March 2012. (pdf) “House Republican Budget Seeks to Slow Medicare, Slash Medicaid,” American Medical Association, April 2, 2012.   Kaiser Family Foundation, State Health Facts, Database.  “Public Assistance Relief,” Census, Department of Commerce, pdf.  “HUD Secretary Defends FY13 Budget Before House Appropriators,” CLHPA.   “Four Ways Romney and Ryan Would Roll Back the 20th Century ,” Jake Blumgart, AlterNet, September 5, 2012.  “What Paul Ryan’s Budget Actually Cuts,” Brad Plumer, Washington Post, August 12, 2012.  USDA, Cost of Food Plans, Center for Nutrition Policy and Promotion, May 2011 (pdf).  ASPE, Department of Health and Human Services, HHS Poverty Guidelines 2012. Congressional Budget Office, “The Long-Term Budgetary Impact of Paths for Federal Revenues and Spending Specified by Chairman Ryan,” March 2012, pdf.   Kaiser Family Foundation, link to interactive database for state health care statistics.

Heller Stalwartly Defends Corporate Bottom…Lines

Nevada’s Senator By Appointment Only™ Dean Heller (R-NV) would have us believe we can’t afford the provisions of the Affordable Care Act. [Heller] Why? Because, evil of all evils — the act raises taxes.  Whoa, now we need to ask the same question which should be raised every time a Republican says “It (whatever IT might be) raises taxes,” — taxes on whom? The GOP controlled House Ways and Means Committee says all the taxes will “cost taxpayers over $675 billion in the next ten years.”  [HouseWM]

“Additional 0.9 percent payroll tax on wages and self-employment income and new 3.8 percent tax on dividends, capital gains, and other investment income for taxpayers earning over $200,000 (singles)/$250,000.”

“2.3 percent excise tax on medical device manufacturers/importers*”

“Annual tax on drug manufacturers/importers *

OK, are you a person earning over $200,000 in adjusted gross income annually? If so you’ll see a 0.9% increase on your payroll taxes — the money you pay into your ‘entitlements’ like Medicare and  Social Security — programs you are entitled to receive because you’ve paid for them.

Are you a person whose income is derived from dividends, capital gains, and other investments?  Assuming you haven’t stashed them behind blockers in the Cayman Islands… If most of your income comes from investments then you’ll see a 3.8% tax increase. If your income comes from your salary or wages, and precious little comes from your Wealth Management Account, then you won’t see an increase here.

Are you a manufacturer or importer of medical devices and equipment?  If so, then you’ll be liable for a 2.3% excise tax — If you aren’t an importer or manufacturer of medical devices and equipment, then this tax doesn’t apply to you.  And, before we start to fee weepy about this sector of the economy, the Department of Commerce has some nice things to say about it:

“The market was valued exceeded $100 billion in 2010, representing about 40 percent of the total medical technologies industry. U.S. exports of medical technologies in key product categories identified by the Department of Commerce (DOC) were valued at approximately $38.09 billion in 2010, exceeding imports valued at $32.73 billion. With new and innovative technologies coming to market, the U.S. medical technologies industry is highly competitive and well-positioned for future growth.”

The arguments against the imposition of this excise tax are generally NOT that the corporations can’t afford to pay it, but that the taxes might impinge on investments in R&D, and the profitability of the corporation.  [CoSpGaz]

Are you a pharmaceutical manufacturing corporation? Are you Pfizer Inc. with a return on equity of 10.66%, and a $178.74 billion market cap? Are you Merck, with an 11.86% return on equity and a $131.21 billion market cap?  If you aren’t a pharmaceutical manufacturing corporation then this tax increase doesn’t apply to you.

Let’s look at some of the other taxes involved in the Affordable Care Act legislation:

“Cadillac tax” on high-cost plans *

Annual tax on health insurance providers *

Limit deduction for compensation to officers, employees, directors, and service providers of certain health insurance providers. [HouseWM]

The taxpayers in these cases are the health insurance corporations.   The first thing requiring some explication is the “Cadillac Health Plan.”  The Kaiser Foundation offers this explanation:

“Sometimes referred to as a “Cadillac” or “gold-plated” insurance plan, a high-cost policy is usually defined by the total cost of premiums, rather than what the insurance plan covers or how much the patient has to pay for a doctor or hospital visit.”  [...] “high-cost health plan is defined as costing more than $10,200 for an individual or $27,500 for a family, including worker and employer contributions to flexible spending or health savings accounts.”  (emphasis added)

What Senator Heller forgot (?) to mention is that (1) the tax doesn’t go into effect until 2018, giving the insurance companies time to make adjustments based on savings, and (2) that the thresholds for the tax are flexible in order to allow for pools of high risk policy holders like police officers or firefighters.

Are you a health insurance corporation?  Aetna, Cigna, Anthem Blue Cross? Another major health insurance corporation?  If your answer is NO, then this tax increase doesn’t apply to you.

Are you the CEO, COO, CFO or other corner-office executive with a major health insurance corporation?  Your compensation is deductible as a business expense — but under the terms of the Affordable Care Act the corporation may no longer be able to take an unlimited deduction for your compensation. This item really has nothing to do with YOUR taxes, but it has everything to do with the deductions corporations are allowed for executive compensation.

Here we go again, when Senator Heller and his Republican cohorts speak of raising YOUR taxes they are very careful to keep it generic, as if YOU includes the Top 1% of American income earners, hedge fund managers, medical device manufacturers, pharmaceutical manufacturers, health insurance corporations and the owners thereof.

But, but but but… the corporations will just pass the tax expenses along to the consumers and we’ll all have to pay!  The pass along argument is not a policy decision — it is a corporate decision.  The corporation is not required to pass along the tax — it could reduce executive compensation? It could reduce dividends?  To do so might annoy the shareholders and executives, but if the corporation thinks more of its shareholders and its executives than it does of its customers, then that in itself says much about the company.

At the risk of facetiousness — here’s the one that must have galled Speaker of the House John Boehner (R-OH) — “Impose 10 percent tax on tanning services *”

Are you the owner of a tanning bed salon?  If yes, then after I’ve seen two friends die from skin cancer, I’d like to talk to you some other day.  If no, then this tax doesn’t apply to you either.

Protecting Their Bottom (Lines)

So, Senator Heller may say, “Seven-term Congresswoman Shelley Berkley keeps voting for ObamaCare with no regard for the devastating consequences the law has for Nevadans.”   However, unless those Nevadans are in the Top 1%, are hedge fund and other wealth managers or get most of their income from investments not wages and salaries, are health insurance corporations or their executives, are medical device manufacturers, are pharmaceutical manufacturers, or tanning salons — those “burdensome taxes” aren’t yours.

We could just as easily argue that Nevada’s Senator By Appointment Only™ Dean Heller (R-NV) stands stalwartly by the side of the 1%, the investors and wealth managers, the pharmaceutical manufacturers, the medical device manufacturers, and the salon service owners — defending their corporate bottom lines.

Medicare Disadvantage

The level of misinformation concerning the Affordable Care Act and the Medicare program is approaching Shark Jumping Territory, and therefore it is probably high time for some serious, fact based, commentary.

The total cost of the Medicare Program, Part A, Part B, Part C, and Part D was $549 billion in FY 2011.  [Trustees Report 2012 pdf]  The specific numbers are as follows:

Medicare Part A pays for hospitalization, skilled nursing facility care, hospice care, and some home health care services.

Medicare Part B pays for physician’s services, outpatient care, medical supplies, and preventative services.

Medicare Part D pays for prescription drug plans.

Medicare Part C is not part of the original Medicare program, and covers Medicare Advantage Health Insurance, described by the DHHS as follows:

“A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.”  [Medicare.Gov]

If we take the spreadsheet out one more column and show the percentage of the expenditures for Medicare for each part the numbers look like this:

The Cuts are Coming! The Cuts are Coming!

My nomination for the most confusing and obfuscating charge made by the Romney-Ryan Campaign is that “cuts in Medicare go to pay for Obamacare.” This first relies on a visceral reaction disassociated from reality that Medicare is Good and Obamacare is Bad.  In fact, what the Affordable Care Act DID was to cut over-payments to private health insurance corporations in Part C in order to cover the expenses (notably the infamous do-nut hole in Part D coverage).

In short, the Affordable Care Act (Obamacare) cut funding for over-payments to private health insurance corporations in order to apply those funds to …. Medicare.   A more complete explanation is provided by Medicare Advocacy:

“The greatest amount of savings in Medicare, about $130 billion over 10 years, [iv] will be achieved by reducing overpayments to private Medicare Advantage (MA) plans. These are the insurance plans that contract with the Centers for Medicare & Medicaid Services (CMS) under Medicare Part C to provide benefits to those who voluntarily enroll. MA plans must provide all of the guaranteed benefits under Part A and Part B; they may provide additional benefits with moneys they receive in excess of the cost of providing the guaranteed benefits.

For all intents and purposes, the Medicare Advantage programs were an experiment by the private health insurance companies to say, “The Private Sector can offer the same benefits as Medicare — only better, and the Market will prove it.”  Except that it didn’t.

One advocacy group for seniors enrolled in Medicare Advantage health insurance plans summarized the problems:

“The idea behind the plans is to provide better services and lower out-of-pocket costs. However, it doesn’t always work that way, according to the Medicare Rights Center. While the plans must provide a benefit “package” that is at least as good as original Medicare’s and cover everything Medicare covers, the plans do not have to cover every benefit in the same way. For example, plans may pay less for some benefits, like skilled nursing facility care, and offset this by offering lower copayments for doctor visits.”

The results? Problems such as –  (1) Care can cost more than it would under original Medicare.  (2)  Private plans are not stable and may suddenly cease coverage.  (3)  Members may experience difficulty getting emergency or urgent care.  (4) Because plans only cover certain doctors, the continuity of care is often broken when the plan drops a provider.  (5)  Members have to follow plan rules to get covered care. (6)  Members are restricted in their choices of doctors, hospitals, and other providers.  (7)  It can be difficult to get care away from home.  (8) The extra benefits offered often turn out to be less than promised.  (9) People with both Medicare and Medicaid can encounter higher costs. [ElderLaw]

Despite the obvious problems listed above, and the disparity between administrative costs between the original Medicare and the Medicare Advantage private plans, Congress barreled along offering incentives and allowing accounting advantages to encourage enrollment in the privatized “Medicare” experiment. [HealthBeat]  However, the practical problems aside, the major fiscal problem with the Medicare Advantage experiment came with over-payments associated with MA plans.

Under the funding mechanism in effect before enactment of the Affordable Care Act, MA plans were paid, on average, 9 – 13% more than the traditional Medicare program to provide the same coverage. These extra payments resulted in Medicare Part B premiums being $3.35 higher per month for all beneficiaries in 2009, and resulted in the federal government (and taxpayers) spending $14 billion more than it would have had Medicare Advantage plan enrollees remained in the traditional Medicare program.”  [Medicare Advocacy] (emphasis in original)

No one should be arguing that paying 9-13% more for the Same Thing is sound financial thinking.   Nor should taxpayers be footing the bill for an experiment that costs $14 billion more than it would have if people had remained in the traditional Medicare program.  So, how does Obamacare (ACA) fix this problem?

“The Affordable Care Act phases in changes to the MA overpayments, starting with a freeze in payments to MA plans for 2011. Payments will be based on national county benchmarks, with plans being paid a fixed percentage of traditional Medicare costs. As a result of this payment formula, plans in some lower-paid counties, generally rural and suburban areas, will continue to receive payments that exceed the traditional Medicare amount, while plans in higher paid counties, many of them large cities, may see substantial reductions.[vi] Rebates (an amount plans receive if they bid less than the county benchmark) will also be reduced. The new payment structure also provides for an increase in payments by up to 5% for plans that receive four or more stars on the CMS star rating system. [Medicare Advocacy] (emphasis added)

In other words, IF a Medicare Advantage insurance plan measures up to what would be available to seniors under the traditional Medicare program, and IF it avoids the nine issues listed above — the corporation would be subsidized for offering the plan — if not, then there’s no reason for taxpayers to be subsidizing plans that fail to meet the criteria.  Further, the ACA (Obamacare) requires that Medicare Advantage insurance policies sold must use premiums paid in to provide health care services:

“It also requires Medicare Advantage plans to pay at least 85 percent of the premium dollars they collect for medical claims. However, it also makes it possible for Medicare Advantage plans to receive higher payments if they demonstrate that they are providing high-quality care to enrollees.” [HealthAffairs.Org]

Thus, when a health care insurance corporation sells a Medicare Advantage policy, 85% of the premiums paid in must pay for — health care.  Not executive compensation, not advertising, not corporate sponsored retreats, not executive entertainment, not administrative expenses, not towels for the executive washroom, or fuel for the corporate jet — health care.  If the traditional Medicare program can function on a rate of 1.42% administrative costs for expenses, then it seems reasonable that a private corporation could administer its MA programs for 15%.

Hysteria

Get a grip.  Obamacare (ACA) will not send doctors leaving their practices in droves.  Nor will it leave Granny to the mercies of an imaginary Death Panel.  Why, for example, would hospitals agree to savings from cuts to their reimbursement under the Obamacare (ACA) provisions?  Jon Healey explains in the Los Angeles Times:

“The Affordable Care Act also tries to slow the growth of Medicare by prodding healthcare providers to deliver higher-quality care. Two examples: It reduces payments to hospitals that readmitted Medicare patients shortly after they’d been discharged, and that had an excessive rate of hospital-acquired maladies. And it cuts the extra Medicare payments to hospitals that treat a lot of patients who can’t pay their bills, on the reasonable assumption that the act will extend insurance coverage to millions of uninsured Americans.”

More people covered (so fewer very expensive visits to the Emergency Room) and more quality control so that patients aren’t re-admitted for the treatment of bed sores they incurred during the initial admittance, and everybody wins.   More patients get better care, and the hospital isn’t out the expenses of people who land in emergency rooms sans insurance and run up bills the hospital has to swallow.

For the umpteenth time — the Affordable Care Act (Obamacare) saves some $700 billion over the next decade or so, and uses that money to SUSTAIN MEDICARE PROGRAMS FOR BENEFICIARIES.   The cuts, the savings, whatever we will to call them are on the “providers” side — like not paying insurance corporations to sell MA policies which may or may not be as good as traditional Medicare enrollment, or not paying hospitals for sloppy care which results in Granny going in again.

Jon Healey’s final assessment is on target:

“In other words, the Affordable Care Act reduces the amount that Medicare takes from the Treasury for the sake of subsidizing a different group: the non-elderly working poor and lower middle class. Ryan can argue that we shouldn’t help those people afford insurance, but he can’t honestly say the law steals anything from the Medicare trust funds.

In fact, the law brings more money into the Medicare Hospital Insurance trust fund — an estimated $318 billion over 10 years — by hitting upper-income households with a 0.9% payroll-tax surcharge and a 3.8% tax on investment income. As someone with an intimate knowledge of the federal budget and the way money flows in and out of the Treasury, Ryan knows this. But he’s hardly the first pol to let the facts get in the way of a good applause line.”

Amen.  A little Fact-Checking provides immediate refutation:

  “The idea, however, that the Affordable Care Act struck a dangerous blow to Medicare that will change the program in fundamental ways is untrue. Under the new law, Medicare will remain a wildly popular, public single-payer health insurance system that provides comprehensive coverage to millions of Americans.”  [Time]

So, hold your applause for the Romney-Ryan Line.

References and Related Reading:  The 2012 Annual Report of the Trustees of the Federal Hospital Insurance Federal Supplemental Medical Insurance Trust Funds, (pdf) Annual Report, April 23, 2012.  “The Trouble With Medicare Advantage,” Health Beat, July 9, 2008.  Medicare Rights Center, “Medicare Advantage – Some Plans Too Good To Be True,” Elder Law Answers, summary.  “Health Care Reform Does Not Cut Medicare Benefits,” Medicare Advocacy, October 28, 2010.   “What Is Medicare,” Department of Health and Human Services, summary information.  Jon Healey, “Obamacare ‘raids’ Medicare, not exactly,” Los Angeles Times, August 21, 2012.  Ezra Klein (Sarah Kliff post) , “Obamacare won’t cut benefits,” Washington Post, August 15, 2012. David Pinar, “MediScare,” Tucson Citizen, August 15, 2012.

Fact Checking the Romney-Ryan attack on Medicare:  Kate Pickert, “Fact checking Obama’s Medicare cuts,” Time Magazine, August 16, 2012.  Adwatch, “Obama defends Medicare policy,” Boston Globe, August 17, 2012.

Romney-Ryan 2012: Be Very Quiet! Be Very Very Quiet!

The Romney-Ryan campaign keeps adding to the impression that it is run by Elmer Fudd who has mistaken his opponents for the rascally rabbits.  Elmer would like for everyone to be Very Quiet, but periodic outbursts of honesty keep impeding his adventures.  Example Number Whatever:  Hedger funder John Taylor on CNBC:

“Hedge funder John Taylor is on CNBC and expressing major disappointment in Romney for selecting Paul Ryan for being his running mate.  Why? Because he’s too open about wanting to cut Medicare, and that will cost the election.

Taylor thinks Romney would have been better for the economy, but that now he blew it.

Taylor even thinks that the budget cutting needs to be done, but that it’s a mistake to be so open about it.

“I agree that we have to do this stuff… but you don’t want to do it in public,” he said.”  [Business Insider] (emphasis added)

No, it would definitely be counter-productive to tell the American voting public you want to end the Medicare program as we know it, end assistance for nursing home residents under Medicaid, or — cut Pell Grants for students from middle class families, gut clean air and clean water regulations, end urban redevelopment programs under HUD, or cut funding for WIC programs for women and infants….

Be Quiet, Be Very Very Quiet!  The Republican plan gives every appearance of being entirely composed of vague generalities, unspecified numbers, soaring rhetoric, carefully crafted talking points, and lots of Flags and references to freedom.   The first step is to get elected, the second is to (do what?)

End Medicare as we know it for future generations, and cut every social safety net program to shreds so that there aren’t any economic  stabilizers left the next time unshackled Wall Street enthusiasm creates the next crash.

Be Very Quiet.  The Romney-Ryan Budget Plan doesn’t really reduce the federal deficit.  Ezra Klein ran the numbers:

“The question then is how should we in the media report on Ryan’s plan? Do we use the revenue numbers he tells us to assume, despite the fact that he offers no path for reaching those numbers, and despite the fact that he and his party have a long history of choosing tax cuts over deficit reduction? Or do we use the policy changes on the page, in which case Ryan’s plan is wildly fiscally irresponsible? [...]

At the very least, people should know that when they hear about the Ryan plan’s deficit reduction, those numbers are assuming that Ryan, who has thus far refused to name even one tax break that he would get rid of, has either eliminated almost every expenditure in the tax code, including the capital gains tax break and the home mortgage interest deduction, or he’s sacrificed his tax cuts.”  [WaPo]

And, there we have the formula: Don’t specify what tax breaks would be eliminated!  Get the votes and then happily revert to the Voodoo Economics of the Bush Administration which got us into the current mess in the first place.

Be Very Quiet! The Romney-Ryan Ticket promises to dismantle financial regulation.   OK, the President certainly isn’t talking about dismantling financial regulation or de-regulating the Wall Street Wizards, and Governor Romney definitely doesn’t want to say much beyond making his new regulations “modern” and “streamlined.”   Whatever on Earth that might mean.   We’re all supposed to be very very quiet and accept that the Romney-Ryan ticket promises “freedom,” “prosperity,” “employment,” and all those other buzz words associated with happy feelings.

We are not supposed to ask tricky questions like:

(1) Would former Governor Romney eliminate the Consumer Financial Protection Bureau which protects customers from invidious practices by unethical lender, mortgage scam artists, and seeks to prevent lenders from practicing predatory lending practices on members of our Armed Forces?

(2) Would former Governor Romney repeal the provisions of the Dodd Frank Act which require large banks to create a plan for their orderly liquidation in case of bankruptcy?

(3) Would former Governor Romney repeal the provisions of the Dodd Frank Act which grant the Commodity Futures Trading Commission authority to regulate and oversee the derivatives markets?

If we’re all very very very quiet, then the Romney-Ryan ticket can be elected and then they can “do all that stuff…without having to DO it in PUBLIC.”

Dean Heller The Insurance Corporation’s BFF

Some down-ticket candidates may be running away from the Romney/Ryan budget, but Senator By Appointment Only™  Dean Heller (R-NV) isn’t one of them.

“The Fix surveyed Senate candidates in some top races — a few of which we highlighted Monday as states where Ryan’s V.P. nomination and his proposal to turn Medicare into a voucher program could matter. A couple of candidates in blue-leaning states have balked at tying themselves to Ryan, while Sen. Dean Heller (R-Nev.), Rep. Denny Rehberg (R-Mont.), and Rep. Rick Berg (R-N.D.) said they would welcome Ryan to the trail.”  [WaPo]

Heller’s opponent, Rep. Shelley Berkley (D-NV1) has, as expected, a very different take:

“While Senator Dean Heller may be ‘proud’ to have voted twice to end Medicare by turning it over to private insurance companies, nothing  makes me prouder than standing up for the Nevada seniors depending on their Social Security and Medicare to be there when they retire,” said U.S. Senate candidate Shelley Berkley.  ”Unfortunately, with Mitt Romney and Paul Ryan on the presidential ticket — and one of their biggest supporters, Dean Heller, seeking a US Senate seat, — Medicare is facing its biggest threat since its creation in 1965.   The Heller-Ryan-Romney plan would dismantle Medicare by putting private insurance company bureaucrats in between patients and their doctors while increasing premiums by $6,000 a year.  These are the wrong priorities for Nevada’s middle-class and seniors.”

There appears to be a bifurcated GOP assault on the popular Medicare program, one line of argument proposes that Medicare is “going broke” and it must be “reformed” to sustain it, and the other asserts that the Obama Administration has “cut” some $7 billion from the program and the Romney/Ryan Plan will “save” it.  There are several words in quote marks in this paragraph because the Republican talking points are massaged to the point of obfuscation.

The Broken Back Argument: First, one of the heaviest fiscal  pressures on the Medicare program is the prescription drug segment, or Part D.   The Medicare Modernization Act of 2003 established Part D, but with a significant provision favorable to the pharmaceutical industry:  The Department of Health and Human Services was forbidden to negotiate with the drug manufacturers for lower prices.  Former Nevada Representative Jim Gibbons (R-NV2) voted in favor of H.R. 1 (June 27, 2003) at 2:33 in the morning. [roll call 332]  The controversial bill passed in questionable procedural circumstances, and didn’t clear all the legislative hurdles until November 2003.

In January 2007 Nevada Representative Dean Heller had the opportunity to improve the MMA when a bill came to the floor of the House to allow the Department of Health and Human Services to negotiate with the pharmaceutical manufacturing corporations for lower prescription drug prices.  Representative Heller voted NO on H.R. 4, January 12, 2007 on roll call vote 23.

It really doesn’t quite do to argue that Medicare must be restructured as a voucher program to “save” it when measures which were intended to reduced the costs, such as allowing negotiated drug prices, were rejected by the Republicans, including Representative Heller,  in the 110th Congress.

Cuts and Savings: The popular flaming pants theme du jour is that Medicare must be ‘saved’ and the Romney/Ryan voucher program is the way to accomplish this end.   The issues here are both substantive and semantic.

The Republican National Committee issued its talking point guidelines for down-ticket candidates:  “Do not say: ‘entitlement reform,’ ‘privatization,’ ‘every option is on the table,’” the National Republican Congressional Committee said in an email memo. “Do say: ‘strengthen,’ ‘secure,’ ‘save,’ ‘preserve, ‘protect.’” [Politico]

One talking point alleges that Medicare must be ‘saved’ because the Affordable Care Act supposedly cut $500 billion*  from Medicare.  The RNC may not wish to have the public analyze this contention too carefully.  A little scrutiny demonstrates that the $500 billion reduction in the ACA comes from reducing taxpayer subsidies to health insurance corporations as a inducement to offer highly profitable Medicare Advantage insurance policies.   Other savings are gained by reducing waste, fraud, and abuse of the Medicare program.  It is very important to know that the $700 billion in savings DO NOT AFFECT ANY MEDICARE COVERAGE FOR THE ELDERLY.

On the other hand, the Romney/Ryan budget maintains the same numbers, “The Ryan budget assumes that very same $500 billion cut. Well, “cut” isn’t the right word; “savings” is more accurate. The reality is that in real dollars, Medicare spending will keep rising — just not by as much.” [NPR] The difference is that in the Affordable Care Act the savings are returned to the Medicare program, in the Romney/Ryan Budget plan the savings are used to protect lower tax rates for the 1%.

He Got The Memo

We should notice that Senator Heller got the RNC memo, note the “strengthens Medicare” language below:

“Dean believes the current health care law should be replaced with a plan that expands access and lowers costs for businesses, allows for purchasing of insurance across state lines, strengthens Medicare, protects individuals with pre-existing conditions and high medical costs, and preserves the doctor-patient relationship.”  [Heller]

There is a bit of code to be translated in this campaign rhetoric.   One way to lower costs for businesses is to simply require that all health insurance be procured by individuals, or to put it another way — no incentives should be offered businesses to provide health insurance benefits.  The ACA includes tax breaks for small businesses to encourage and assist in the inclusion of health care benefits for their employees.  Repealing the ACA would remove these tax credits.

The insurance corporations have long wanted the across state lines provisions because if enacted this would allow the corporations to offer policies based on the least restrictive regulatory environment.   If State X did NOT include basic coverage for immunizations, pre-natal care, cancer screenings, mental health care, or autism screening and coverage, then States Y and Z would have to drop their requirements that these elements be covered in their states.

Here comes the memo language: strengthens Medicare.   The Romney/Ryan proposal would ‘strengthen’ Medicare only so far as it transforms it from the current system into one in which senior citizens are supposed to shop for individual insurance plans and the health insurance corporations would be subsidized by taxpayers in the from of vouchers.  A reality check from the Berkley camp:

“In April 2011, Heller voted for the House Republican budget blueprint drafted by Paul Ryan, H Con Res 34, that the Wall Street Journal said “would essentially end Medicare.” According to the Associated Press, “The GOP proposal passed 235-193, with every Democrat voting “no.” The nonbinding plan lays out a fiscal vision cutting $6.2 trillion over 10 years from the budget submitted by President Barack Obama. It calls for transforming Medicare from a program in which the government directly pays medical bills into a voucher-like system that subsidizes purchases of private insurance plans.” [Berkley]

In short, the Romney/Ryan plan so enthusiastically endorsed by Senator Heller is a reversion to the pre-Medicare system in which individuals 65 and over would be required to shop for insurance plans on their own, only this time there’s a bonus voucher for the health insurance corporations.  There are a couple of problems with all this “individual choice.”

Having personal choices makes for a lovely campaign sound bite, but in the real world elderly Americans would face some of the same practical problems consistently faced by anyone trying to buy health insurance policies.  (1) There may be no real competition between or among health insurance companies in specific geographical regions.  (2) Insurance corporations would be allowed to sell junk policies with artificial lifetime limits on coverage.  (3) Insurance corporations would be free to restrict patient access to medical service providers outside their group.

Not to put too fine a point to it, but the insurance corporations would be the ones inserted between a patient and his or her physician — unlike the current Medicare (ACA) system in which the patient is free to choose among any health care provider accepting patients.

It appears that the GOP has given up trying to attack the Democratic argument that pre-existing conditions were abused by the insurance industry to arbitrarily rescind policies for vacuous, but profitable, reasons.

Translation

Senator Heller’s espousal of the Romney/Ryan budget and his statement quoted above essentially mean:

Small businesses should be offered no incentives to offer health care plans for their employees and should be free to eliminate such coverage, thus requiring that each individual purchase a his or her own insurance policy.

Insurance corporations should not have to follow guidelines for basic coverage which provides for any medical condition or treatment not offered in the state having the least requirements.

Health insurance corporations should be free to devise plans which have artificial limits on lifetime coverage, which restrict patient choice to health care providers associated with the health insurance corporation, and which have no limits on policy premiums for senior citizens.

* In some stump speeches the number increases to $700 billion.

Amodei’s Five Parrot Performance on Health Care

Leave it to Nevada’s entry in the Karl-Rove-Look-And-Sound-Alike Contest, Representative Mark Amodei (R-NV2), to keep chucking out the talking points long after the parade has turned the corner.

“ObamaCare fails to accomplish real reform and instead harms health care, job creation, and the federal deficit at a time when our country can ill-afford such government-inflicted damage.   [Amodei]

Debunk: “To date, 360,000 businesses that employ 2 million workers have already benefited from the small business tax cuts in the law.  And once the Affordable Care Act takes full effect, about 18 million individuals and families will get tax credits for health insurance coverage averaging about $4,000 apiece.”  [Fact Sheet] (emphasis added)

So, what businesses might be affected? There are a few, some 2.6% of the business operations in this country, which will pay the Free Rider Penalty because they do not offer health care plans and thereby force their employees into the subsidized coverage under the insurance exchange plans.  [TNR] It’s interesting that Congressman Amodei opposes provisions in the Affordable Care Act that promote individual responsibility, and seek to minimize the number of people receiving subsidized insurance?

Attaching the unsubstantiated epithet “Job Killing” to any and all legislation to which one objects doesn’t mean it will stick.

Debunk:  About that deficit – the Congressional Budget Office and Joint Committee on Taxation cranked out new estimates after the Supreme Court’s ruling:

“CBO and JCT now estimate that the insurance coverage provisions of the ACA will have a net cost of $1,168 billion over the 2012–2022 period—compared with $1,252 billion projected in March 2012 for that 11-year period—for a net reduction of $84 billion. (Those figures do not include the budgetary impact of other provisions of the ACA, which in the aggregate reduce budget deficits.)”  [CBO]

The usual right wing think tanks and astro-turf organizations continue to beat the old drum head, manipulating assumptions and recalibrating the inputs to get the desired results — but, the CBO/JCT numbers are as accurate and genuinely conservative as we’re likely to get.  The current score is Affordable Care Act 1 – Amodei 0.

The next section of Amodei’s tiny tantrum is replete with talking points unsubstantiated by anything in the real world.

“ObamaCare will cause premiums to skyrocket, forcing millions of Americans off of their current coverage and putting unelected Washington bureaucrats between patients and their doctors. With respect to the uninsured, ObamaCare drives up the cost of health care and takes us further away from real solutions to improve health care access.”  [Amodei]

Debunk:  About those skyrocketing premiums?  The information from the survey on which these claims are made came from BEFORE the act was passed.  The premium reductions may not meet the President’s optimistic predictions, but ” that’s no excuse for the RNC to cherry pick a single year of data out of the Kaiser report and suggest the law, which largely has not gone into effect, is already responsible for a rise in premiums.” [Kessler]

Debunk: Forced off your coverage? No.  The HHS rules are clear on this point:

“The rule announced today preserves the ability of the American people to keep their current plan if they like it, while providing new benefits, by minimizing market disruption and putting us on a glide path toward the competitive, patient-centered market of the future.  While it requires all health plans to provide important new benefits to consumers, it allows plans that existed on March 23, 2010 to innovate and contain costs by allowing insurers and employers to make routine changes without losing grandfather status.” [DHHS] (emphasis added)

What part of “keep your current plan if you like it” is incomprehensible to Congressman Amodei?

But wait, the Congressman isn’t finished:

“According to a survey by the non-partisan Doctor Patient Medical Association, 83 percent of American physicians have considered leaving their practices over ObamaCare, which would worsen the existing doctor shortage and threaten access for those who need it most, particularly in rural areas.”

Debunk:  Really non-partisan?  That DPMA cited by Amodei is associated with the National Tea Party Federation and American Grassroots Coalition. The DPMA is also a member of the American Legislative Exchange Council (ALEC).  [SourceWatch]  OK, the DPMA is about as “non-partisan” as 4th of July stump speaker, but what about the survey?

The trick to getting the results one wants is to ask a really vague question and then interpret the data to taste.  The DPMA survey was classic: “How do current changes in the medical system affect your desire to practice medicine?“  Well now — that leaves a couple of barn doors wide open for a variety of interpretations!  Whether the “current changes” are federal, state, local, regional, economic, social… is left unspecified; the results then must be equally intangible, and for purposes of credible reporting — worthless.

How many people actually responded to the survey?  The methodology is a classic study in how NOT to conduct statistically credible opinion research.  The DPMA got 36,000 clinical FAX numbers, and sent out 16,227 faxes.  Out of the 16,227 faxes only 699 were completed, for a survey response rate of a less than dazzling 4.3%.  Not only is the “result” culled from a poor response rate, but most of the actual respondents were from the South.  [MMA]

Most researchers would advocate for a much better return rate in order to maintain a statistically representative sample size. [MIP pdf]  This doesn’t mean we always toss small responses out — there are at least six major factors which may relate to response levels — however, what a really small response level does mean is  that “Nonrespondents are often different from respondents, so their absence in the final sample can make it difficult to generalize the results to the overall target population.” [Relevant Insights/Small Business] *

The methodological problems alone would get this report tossed into the medical waste receptacle at once had not Fox News and other right wing sources picked up “the story,” and thus the National Tea Party Federation fable is incorporated into Congressman Amodei’s repertoire of parroted talking points.

Debunk: The Congressman also has a bit of misleading information to impart of his own. “CBO analysis also estimates that ObamaCare could cause 20 million people to lose their employee-sponsored insurance by 2019.”  Representative Amodei has left out just one little thing — like the other 75% of the analysis by the CBO.  The CBO analysis to which he refers was one of FOUR possible scenarios explored by the CBO analysts as a “worst case” instance.  A more rational estimate might be about 3 million, some of whom may voluntarily opt out of employer sponsored insurance plans.  [Fact Check]  Congressman Amodei, who is increasingly sounding like a person who has never had an original thought, is parroting the U.S. Chamber of Commerce in this instance.

Congressman Amodei is winding down when he gets to this part:

“As if these consequences were not bad enough, you hear every day in Nevada and across the country of small business owners who cannot hire and expand because of the increased regulatory costs and red tape of ObamaCare.” (emphasis added)

Debunk: We do? This would be amazing since much of the Affordable Care Act isn’t in place yet.  The insurance exchanges are just now in the works.  Some small business owners may have very reasonably waited for the outcome of the Supreme Court decision, while others may in fact need assistance getting information about getting those tax credits for providing employer sponsored plans.

Small business owners who need assistance or information will find the Internal Revenue Service’s pages of interest – in very readable and clear prose.  The Department of Health and Human Services also makes simplified fact sheets and explanatory information available.

Debunk: Finally, Representative Amodei rationalizes his vote to repeal the Patients Bill of Rights and Affordable Care Act: “It is making things worse, which is why I voted to repeal ObamaCare and will continue to work for patient-centered solutions to lower costs and to improve quality health care access for all Nevadans.“

What’s a “patient centered solution?”   The phrase is the spawn of the Republican Study Committee, and is essentially a tax deduction for privately purchased health care insurance, capped at $5000 per family.  Hint: a $450 monthly premium for 12 months would be $5,400.  All those with previously existing medical conditions would be served by high risk pools — not individual or employer sponsored plans.   Not to put too fine a point to it, the Republican Study Committee proposal is a lovely gift wrapped present to the health insurance corporations of America.

And thus we have Representative Mark Amodei (R-NV) parroting the U.S. Chamber of Commerce, the ALEC member DMPA, Fox News and the Drudge Report, and the Republican Study Committee.  That’s a Five Parrot Performance!
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* There are some very useful resources on surveys and sampling available online.  See also:  Gardner-Bonneau, University of Michigan – Kalamazoo Medical Center, Office of Research.  Ellison Research, Sample Size Questions.  The Government of Queensland, Australia has a simplified guide to survey research that touches most of the basics.