Quick Phone Call Fodder for Nevada District 2

Should the Trumpcare bill pass this evening, residents in the following Nevada Counties can expect changes in their premiums after tax credits: From $2400 to $3700 — Humboldt, Elko, Pershing, Esmeralda, Lander, Churchill, Esmeralda, and Mineral counties. (Source: Kaiser Family Foundation)

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Filed under Amodei, Health Care, health insurance, Politics

Caveats and The Unspoken Big Lie

So, we have two sources telling us that approximately 24 to 26 million people will lose their health care insurance if the Republicans are successful in jamming through their tax shift proposal masquerading as a ‘replacement’ for the Affordable Care Act.  Therefore, it’s now time for a new ‘talking point’ from the GOP, especially since some Republicans like Rep. Mark Amodei are on record saying:

When asked what his plan for a change to Obamacare would be, Heller said, “If you like your health care, you can keep it,” a statement that echoes a promise from Obama that later ended up being false.  Amodei said he would not vote for any plan that resulted in reduced coverage for anyone.  “No, I don’t think you can say forget it, we’re going to let them be uninsured because as a practical solution, that’s not an answer and somebody ends up paying in the end anyhow,” Amodei said. [RGJ 2/22/17]

Well, now we know with some certainty that the GOP replacement bill will result in reduced coverage, and some people and families will be uninsured.  How to escape this trap? A new talking point!

“No one will lose their coverage.” 

The HHS Secretary Tom Price, whose replacement would have cost some 18 million their insurance, opined:

“Success, it’s important to look at that,” he said. “It means more people covered than are covered right now at an average cost that is less. I believe that we can firmly do that with the plan that we’ve laid out there.”  Not exactly.

Then, there was Pete Sessions, a Republican from Dallas, telling his listeners:

“Nobody is going to lose their coverage,” Sessions, chairman of the House Rules Committee, told CNN. “You’ll be able to keep your same doctor, you’ll be able to keep your same plan.”

A spokeswoman for the congressman later explained that Sessions meant Americans will have the choice whether to obtain or maintain coverage — not that the GOP bill would take coverage away. The American Health Care Act would nix the ACA mandates requiring Americans to have health insurance.” [DMN]

And, there it is, the Big Caveat, which makes taking health insurance away from working American all AOK.  You can “choose” to keep your health insurance! IF and ONLY IF you can afford it. ?

However, even IF you can afford it, the policy you can purchase may not be truly comprehensive. A young person may have to get additional insurance if he or she marries and there is a pregnancy in the plans. More cost. A plan may not cover preventative care? Or mandatory coverage for cancer screenings?  More cost.  It doesn’t take too long to add up the extras until what has been basic coverage becomes optional coverage. Then the risk pool is reduced and the premiums go up. That is how insurance works. The larger the risk pool the lower the premium costs.

Thus, “you can keep your health insurance” IF:

  • You can afford it in the first place, not likely if you are among the low wage workers in this country.
  • You can afford it and are willing to accept lower levels of coverage, and you don’t mind having to pay for additional services for additional  premiums.
  • You are willing to shop for insurance coverage every time the circumstances of your life changes; as in pregnancies, pre-natal care, caring for a special needs child, a family member needs rehabilitation or mental health care.
  • You are willing to see your local, and especially rural, hospitals see higher levels of uncompensated care.
  • You are willing to accept that your doctors and other health care professionals will see less reimbursement for services rendered.
  • You are willing to forego coverage for preventative screening and treatment for medical conditions.

Access to health insurance isn’t the same as having health care insurance.  As the now commonplace tweet has it: “I have access to a Mercedes Benz dealership — that doesn’t mean I can afford to buy something of their lot.”

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Filed under Amodei, Health Care, health insurance, nevada health, Nevada politics, Politics

Beware The Artful Codger

One congressional Representative for our northern neighbor, Idaho, has a problem in his Lewiston office: Too many artful codgers showing up there around lunch time with complaints about his political philosophy.

“A spokesman for U.S. Rep. Raul Labrador’s office in Lewiston has filed a complaint alleging a threat from a group of local citizens who routinely visit congressional offices.

Scott Carlton reported the issue to the U.S. Capitol Police early last month. Carlton, who works out of the congressman’s downtown Lewiston office, declined to comment when contacted by the Tribune and referred all questions to Doug Taylor, Labrador’s spokesman in Meridian, Idaho.

The citizen group, LC Valley Indivisible, is comprised of mostly older residents of the Lewiston-Clarkston Valley, according to its members. The organization is loosely affiliated with the national Indivisible groups that call for town hall meetings with members of Congress to raise issues regarding President Donald Trump’s administration.” [SR]

The group members recall a civil engagement with Scott Carlton, Labrador’s spokesperson. Carlton told people at a Chamber of Commerce gathering that the group was “aggressive,” and reported that he (Carlton) had contacted Capitol Police who have jurisdiction over congressional offices. [Spokesman pdf]

Not that those in Nevada’s 2nd congressional district can complain about this issue too strenuously, Mark Amodei (R-NV2) hasn’t scheduled a public performance since venturing out to Carson City recently. It is noteworthy that Amodei told the Reno Gazette Journal: “… he would not vote for any plan that resulted in reduced coverage for anyone. “No, I don’t think you can say forget it, we’re going to let them be uninsured because as a practical solution, that’s not an answer and somebody ends up paying in the end anyhow,” Amodei said.”

Now, Representative Amodei has a GOP plan before him that does precisely that — reduces health insurance coverage for people in his district, and the amendments to the bill recently announced make the situation even worse, dismantling Medicaid protection for seniors in record time.  However, Representative Amodei doesn’t appear to want to pencil in a town hall meeting in a major metropolitan area in his district — like Reno/Sparks?  Perhaps some of those artful codgers, similar to the Lewiston lunch bunch, might show up?

However, there are other ways to get the attention of elected representatives. I am particularly fond of the Empty Suit Town Hall. Let’s hear it for Lexington, Kentucky:

“…voters in Lexington, Ky., have been clamoring for the state’s congressional representatives — Senate Majority Leader Mitch McConnell, Sen. Rand Paul and Rep. Garland “Andy” Barr — to tackle constituents’ questions in person. They even booked a venue for Saturday and hand-delivered town hall invites to the politicians’ offices.  The legislators were a no-show, but that didn’t stop things. Instead of McConnell, Paul and Barr, organizers propped up three mannequins wearing suits.” [WaPo]

Perhaps not the best optics for a congressional delegation? At least it’s better to be an empty suit than to sic the Capitol Police on office visitors?

There are other ways to contact GOP representatives like Mark Amodei — and this should be done before the vote on the Repeal/Replace bill on Thursday.

For those living in District 2 there’s Amodei’s contact form for quick e-mail messages. Simply scroll down the page to the “e-mail link.”  The page also has the phone numbers for Amodei’s offices in Reno Phone: (775) 686-5760, Elko Phone: (775) 777-7705 , and Washington, D.C Phone: (202) 225-6155.

This is as good a time as any to remind Representative Amodei what he said to the Gazette Journal: “… he would not vote for any plan that resulted in reduced coverage for anyone. “No, I don’t think you can say forget it, we’re going to let them be uninsured because as a practical solution, that’s not an answer and somebody ends up paying in the end anyhow,” Amodei said.”

Now, if only those artful souls in Idaho can get the attention of their Representative…

 

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Filed under Amodei, Health Care, health insurance, Medicaid, Nevada politics, Politics, Republicans

Myths and Legends: The Medicaid Issue in Nevada

There was a Republican politician on my television screen this morning telling me, or trying to tell me, that Medicaid was “meant for mothers, children, and those who couldn’t work…” This is outdated. Then, he tried to convince me that Medicaid was being “abused” by those who work and ‘game the system,’ while spouting platitudes about the Free Market and the Joys of Competition.  Let’s start at the very beginning.

This is the explanation of Medicaid as reported by Nevada’s Division of Health Care Financing and Policy (pdf)

“Medicaid is the nation’s main public health insurance program for people with low incomes and the single largest source of health coverage in the U.S.”

The program is meant to help people with low incomes.

“The PPACA extended coverage to many of the non-elderly uninsured people nationwide. The June 2012 Supreme Court Ruling made Medicaid expansion optional for states, and Nevada elected to join the expansion and maximize federal dollars. Effective January 1, 2014, this move broadened Medicaid eligibility to nearly all adults under age 65 with income at or below 138% of the Federal Poverty Level (FPL). At the end of SFY 2014 that meant that there were an additional 125,989 new enrollees in Nevada Medicaid, and increased expenditures of $154,816,777.00. These new expenditures are 100% federally funded.” [NV med pdf]

Medicaid expansion added those working Americans who were earning 138% of the poverty line and below, (pdf) and more specifically: (1) Those between the ages of 19 and 64 who are earning less than 138% of the FPL. (2) Pregnant women in homes earning less than 165% of the FPL. (3) Children from birth to 19 years of age in homes wherein the earnings are at or below 205% of the FPL, with a small premium required in some cases. Translated into real people with real levels of low income earned, this means a family of four would be eligible for Medicaid in Nevada if the family earnings are less than $2795 per month; for pregnant women if the earnings are at or less than $3341 per month; and families are eligible for the kids’ Check Up program if family earnings are less than $4151 per month.

If we calculate annual earnings, then monthly earnings of $2795 mean an annual income  of $33,540. At $3341 annual earnings of $40,092, and at $4151 annual income of $41,630. Nevada’s median income is $52,431 (2015). To put these numbers in perspective, the average weekly wages of a person working in a private restaurant in this state are $382, or $1528 per month ($18,336 yearly). [DETR] The average rent for a 2 bedroom apartment in Las Vegas, the obvious site for most private restaurants, is $932 per month. [RJ] In short, not only are wages not all that generous in Nevada, the benefits available for Nevada families aren’t all that generous either.

Republicans, however, strenuously oppose benefits for adults capable of working. This would make infinitely more sense IF and ONLY IF they were willing to support a living wage for all employees. One really doesn’t get to have it both ways.  Either you want a reduction in benefits that most working people can afford to purchase on their own because they have the financial resources to do so, or you want lower wages which mean that individuals and families cannot afford those things, like health insurance, and the public benefits are required to make up the difference.  However, at this point we slam into another GOP myth.

Free market competition will make health insurance affordable for everyone, even those who are working in low wage jobs.  Good luck with that. Personally, I have yet to hear anyone explain with any specificity why health insurance corporations will be flocking to Clark, Washoe, or even Esmeralda counties because there is more “free market” applied to the situation. If the insurance companies weren’t wildly excited about selling individual and family health insurance before the enaction of the ACA, why would they do so now? Unless, of course…

They could sell policies that didn’t cover all that much? That cost more for those between the ages of 50 and 64?  That didn’t cover maternity expenses? That didn’t cover preventative care? That didn’t cover drug rehabilitation and mental health services in parity with physical treatments? That only covered the items required in those states with the least consumer protections? And, even then all we have to look to is the situation in Nevada when insurance corporations were free to offer what they were pleased to call comprehensive policies.  Again, if they weren’t interested in selling a plethora of individual and family policies then why believe they would be now?

And that Free Marketeering? It doesn’t work in the health care industry:

“In a free market, goods and services are allocated through transactions based on mutual consent. No one is forced to buy from a particular supplier. No one is forced to engage in any transaction at all. In a free market, no transactions occur if a price cannot be agreed.

The medical industry exists almost entirely to serve people who have been rendered incapable of representing their own interests in an adversarial transaction. When I need health services I often need them in a way that is quite different from my desire for a good quality television or a fine automobile. As I lie unconscious under a bus, I am in no position to shop for the best provider of ambulance services at the most reasonable price. All personal volition is lost. Whatever happens next, it will not be a market transaction.” [Forbes]

The only thing I can say with any certainty is that the Republicans have little idea exactly what constitutes a Free Market, and instead are waving it like a banner crovering their underlying desire to be free from the moral requirements compelling us to be our brother’s keepers.  The range of misanthropic explications are appalling, from “we need not do anything because the poor will always be with us anyway,” to “when Jesus told us to provide for one another he only meant fellow Christians.”

The Repeal and Replace campaign is as void of humanity as it is of understanding of the reality of most family economics, and of the comprehension of what the term ‘free market’ actually means.

 

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The Bully Budget: A Saturday Rant

The proposed budget from the White House is a mean-spirited, minimal, and squalid picture of this administration’s Ideal Government. That, after all, is the function of any budget — the household budget is a plan for the ideal month or the ideal year for expenditures.  So, if this is the administration’s ideal state, it’s pathetic.

At bottom, it’s a massive transfer of wealth from working Americans and small businesses, to the wealthy and multi-national corporations.  It supports the military-industrial complex, but not the workers who build the various machines of war. It supports the fossil fuel industry, but not those who labor in the oil fields, or want to make the family budget stretch to putting more gasoline in the tank. It is a budget which quantified people without adding to the quality of their lives. It is a budget that is all stick and no carrots.

It is a budget which calls for more people to “save” for the exigencies and emergencies in their  lives without granting them the tools needed to secure their own futures. It is a budget which tacitly blames people for circumstances that are beyond their control. It is a budget that assumes the mythology of the fictional Horatio Alger, without bothering to read the book in which our young hero goes from rags to riches by marrying the boss’s daughter.

It is a budget that insults the American public — as if we don’t “need” the documentary films by Ken Burns on PBS, as if we don’t “need” exhibitions of art in our museums, as if we don’t “need” programs like art and music in our schools, as if we don’t appreciate the services of our local libraries. It is a budget that presumes that only the cultured (and rich) who can afford to buy the books, the art, the travel to faraway places, will actually benefit from the accessibility to the arts and humanities.  It is a budget that assumes no quantifiable benefit will accrue to a youngster from a family with limited resources who sits in a library thumbing through a book on dinosaurs, or the planets, or flowers and wildlife.

It is a budget that denigrates the efforts of a mother who takes the kids to the museum on a Saturday, the father who sits with his sons and daughters to watch a PBS documentary on “American Experience” and asks questions of them afterwards to see what they’ve learned.

It is a budget that doesn’t even keep the families safe. It cuts expenditures for promising medical research, for containing the dismal prospects of epidemics, even for the ‘welfare observations’ made by the volunteers from Meals on Wheels who not only deliver food to elderly relatives who want to remain in their homes, but observe and report circumstances that impinge on that person’s safety and health.  What the family wants to know is that an elderly grandparent is Okay today, and tomorrow. There will be a time when independence is no longer an option, but as long as the grandparents, or great-grandparents, can stay in their beloved homes, and the relatives can be assured they are safe; programs for the aging help keep those homes safe and the occupants secure.

It is a budget that doesn’t even keep struggling families safe from food insecurity. A full pantry is to be the responsibility of the family.  Except real life doesn’t quite work like that.  If the family consists of a mother who stays home (the traditionalist Ideal) and a father who has a minimum wage job, filling up the cabinets and refrigerator with food is a daily struggle. Even when both parents are working keeping up with the dietary needs of two children puts the “insecurity” into the food equation.  No one is safe who is unfed. Dietary deficiencies have medical consequences.  The Army found that out during World War II when many draftees had to be rejected for dietary related physical conditions; the result was the school lunch program.

It is a budget that presumes that all police officers and law enforcement agencies operate in a realm reminiscent of Scott Foresman’s Dick and Jane readers. There is no need to fund community policing because every officer walks his beat, knows every family in the neighborhood, and returns silly children to the safety of their living rooms. The founding philosophy of this budget is that parents really don’t have “The Talk” with their POC offspring, ignoring the point that policing services are better and safer when the people in the neighborhood feel secure talking to their law enforcement officers.

It is a budget that threatens the safety of entire cities.  Air and water pollution regulations, decried by ultra-conservatives as destructive of jobs (never specified), are to be relaxed. Smog is really no respecter of neighborhood boundaries. Pollution of ground water resources doesn’t respect city limits or county boundaries.  Chemical spills endanger our very own habitat. Toxic emissions don’t magically evaporate.  There are health implications for all deregulation. There are insurance implications for all deregulation. There are property value implications for all deregulation. As property values decline in neighborhoods susceptible to pollution, so do the revenue prospects of the very cities and counties which rely on property taxes.  Deplete the tax base and we diminish the ability of the community to deal with the results of environmental pollution.

It is a budget by and for bullies.  It is an Ideal Plan for beefing up our military, with all manner of equipment with which we can bully those with whom we share this planet. It is not a budget — an Ideal Plan — for talking to our allies, approaching our foes, and addressing the concerns of those who are unsure of our motivations. It is a budget which allows the selfish and successful to announce firmly that they don’t intend to pitch in a dime more than they must toward satisfying the needs of their fellow citizens. It is an Ideal Plan for a mean-spirited, minimal, and squalid vision of America.

 

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Meals On Wheels: Canary in the GOP Coal Mine

The entire “skinny budget,” which somehow manages to keep lots of fat on the Pentagon budget, offered up by the current administration is a mass of mischaracterizations packed into a myriad of outright lies.  The assault on programs like Meals on Wheels is a handle providing a way to understand the totality of the right wing Individualism of the GOP. It’s there, blatantly set forth without excuse, and as emblematic of the Culture of Selfishness as can be imagined.

Cast me not off in the time of old age; forsake me not when my strength faileth. Psalms 71:9

“Trump’s proposed budget completely eliminates the Community Development Block Grant, which provides $3 billion every year for, according to The Washington Post, “targeted projects related to affordable housing, community development and homelessness programs.” Among those is the Meals on Wheels program, which provides meals—and vital human contact—for older, impoverished Americans, many of whom are largely home-bound. According to MOW, one in six American seniors struggles with hunger, and the organization claims it saves the nation about $34 billion a year in medical expenses by decreasing the rate of falls for seniors. The program gets the vast majority of its funding from non-government sources, but the proposal still seems unnecessarily harsh.” [Esquire]

And the rationale for all this would be what, please?

“After a reporter brought up the Meals on Wheels controversy, Mulvaney at first tried to subtly evade the question. But then, as is the wont of this administration, he fell head over glutes explaining that while Meals on Wheels “sounds great,” the administration couldn’t keep wasting money on programs like it that “don’t work.” As in, feeding the elderly apparently isn’t showing strong enough empirical benefits to merit continued federal spending by this White House, which is now deeply wedded to evidence-based policymaking.” [Slate]

There are a couple of things to unpack herein. First, empirical benefits are hard to compile without first establishing a matrix of goals.  Benefits are precisely why the program “sounds good,” the goal is to feed people, and people are being fed in their own homes. In fact some 2.4 million elderly persons are participating in the program at a total cost of $1.4 billion. 500,000 of these are veterans of our Armed Forces. A study in New York City reports that the average age of a participant was 80, meaning the person was likely born around 1937, and if the person is a veteran he or she likely saw service during the Cold War into the Vietnam Era. How goals are framed makes a difference.

If the goal is to provide 2.4 million elderly people one meal per day with a minimum of 625 calories, then we can say it’s working.  If our goal is to be that no elderly Americans go a day without a sustenance level meal for a relatively inactive person, then, no the program has too many people on waiting lists to say it’s an unqualified success.

“The need is growing rapidly, and federal funding has not kept pace. The network is already serving 23 million fewer meals now than in 2005, and waiting lists are mounting in every state. At a time when increased funding is needed, we fear that the millions of seniors who rely on us every day for a nutritious meal, safety check and visit from a volunteer will be left behind.”[MOWAm]

At this point it needs to be said that Federal funding is combined with charitable and individual donations to keep the program literally on its wheels.  Further, the only logical way to pronounce the services a failure is to absurdly assert that because seniors get hungry the next day the program isn’t meeting its goals. However, it’s crucial to take a look at the second feature of GOP rationalization for pure selfishness.

Ultra-right wing conservatives are fond of explaining that services like Meals on Wheels could be better done by local charitable institutions, ignoring the fact that as mentioned above the Federal funding is not the primary source, and IN FACT is supplementary to local charitable funding sources. Catholic leadership, for example, is wary of the implications of the administration’s budget priorities, and Catholic Charities of Southern Nevada is providing some 2,000 daily meals to those on its list. Reducing funding for this single program by one third would have a profound, and profoundly negative, impact on its services.   There are times when the intersection of governance and religious institutions illustrates the point that while private donations are the core, when the need overruns the capacity then it’s time for a little help from friends around the country.  This Cult of Selfishness only works in the ethereal world of ideological fantasies, it doesn’t deliver a meal, even one of a minimum of 625 calories, to a single individual anywhere.

What makes the skinny budget so alarmingly obnoxious is that curtailing funding for Meals on Wheels is merely illustrative of a budget building process based on what the rich want to pay, rather than on what our society needs to be a truly great nation. It is a budget process to Make American Mean Again.

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Filed under health, Politics, privatization, public health, Republicans

To Our GOP Friends Who Don’t Seem To Have A Clue How Insurance Works

We might go for the Ryan budget bill in regard health insurance directly, but others have already noted that either (a) he doesn’t have a clue how insurance works, or (b) he’s trying to pull a fast one on the American public.  At any  rate, the phase I of the ACA repeal is essentially a gigantic giveaway to health insurance and pharmaceutical corporations, a tax boon to those in the upper 0.1% income bracket, and a dismantling of the Medicaid program. The contents of Phase II have been tipped.  It’s on the Speaker’s website, but requires a bit of unpacking:

“Administration actions, notably by HHS Secretary Price, to stabilize the health insurance market, increase choices, and lower costs…”

Translation: The content of health insurance policies, currently listed as “essential provisions” for all policies, is under a head on assault.

If a corporation is going to offer a comprehensive health insurance policy for sale to customers, it must include “ambulatory care for patients in a hospital or not,” “emergency services,” “hospitalization,” “pregnancy, maternity, and newborn care,” “mental health and substance abuse treatment,” “prescription drugs,” “rehabilitation,” “laboratory services,” “preventive and wellness care,” “pediatric care including vision and oral care,” and “birth control and breastfeeding coverage.”

Now, just guess what parts of this coverage the GOP finds objectionable?  If you guessed anything having to do with WOMEN give yourself the prize of the day.

Why, the guys grouse, do I have to have a policy covering maternity and neo-natal care, birth control prescriptions, and pediatric care?  It’s because of how insurance works.

Aside from the obvious part wherein it requires both men and women to create a ‘maternity situation,’ the whole idea of insurance is encapsulated in the word POOL.

“When you buy insurance, you join many others who pay money to an insurance company.  The insurance company uses the money collected to pay claims that are submitted by those who have purchased insurance.  The money is “pooled” and losses and expenses are shared.  An important aspect is the members of a pool share similar risk characteristics.” [HIW]

In the case of health insurance, the “shared characteristic” of note is that everyone who buys a policy is a human being, who at some point will need health care.  The more people (policies) in the pool the wider the risk can be shared. And, that’s the point of insurance — spreading the risk among as many policy holders as possible.

Creating ‘cafeteria’ policies might be profitable for the insurance corporations, but it doesn’t make health care affordable for most people.  If we carve out special coverage for maternity care and remove this from the larger pool (which includes men) all this serves to do is to increase costs for those remaining in a smaller pool.  Similarly, if prostate cancer screening and treatment is carved out from comprehensive coverage, this serves to increase costs as the overall pool is diminished.

Got it? If not, think of your auto insurance.  10 people buy GenZ Insurance, 9 of them never file a claim, 1 does. The costs related to the one claim are shared among those who bought into the pool and paid premiums to maintain their insurance.  We require all automobile owners in this state to have at least minimal insurance. In Nevada, this means you have to have a policy covering $15,000 for bodily injury or death in an accident for one person, $30,000 for bodily injury or death of two persons in an accident, and $10,000 to cover property damage. Thus, all Nevada drivers must have at least minimal participation in the auto insurance pool. Again, the larger the pool the greater sharing of risk, the entire point of having insurance.

Back to health insurance, if we thought Phase I is a disaster, Phase II should be even worse. Phase III is the ‘portability canard.”  Has it occurred to anyone in the GOP hierarchy that nothing that really prevents insurance corporations from selling their policies across state lines — IF they agree to accept the standards set by state insurance commissions for the protection of their consumers.  More on this later — if necessary.

 

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Filed under Economy, Health Care, health insurance, Insurance, Politics