Category Archives: Health Care

Trump’s BIA Budget Massacre

1.6% of Nevada’s population is Native American, not a major demographic group when measured against the majority white (75%) and Hispanic populations (26.5%), or even the African American population (9.6%). [Census] However, that doesn’t mean this group doesn’t have some significant housing, health, education, and law enforcement needs on behalf of the Washoe, Paiute, Shoshone, and Utes (among others) who live in this State.  Worse still, the proposed Trump Budget stands to make their situation definitely more difficult.

“Overall, Trump’s proposal increases defense spending significantly and cuts deeply most programs for the poor. Trump’s budget slashes federal Indian country appropriations by more than 10 percent. For example, at $2.488 billion, Trump’s request for the U.S. Department of Interior’s Indian Affairs budget alone is a $300 million cut from Obama’s FY 2016 budget, which was the last full year appropriation (we have since operated on continuing resolutions). Trump’s proposal also cuts more than $50 million for the Indian country housing programs at the U.S. Department of Housing and Urban Development and zeroes out $8 million from the BIA budget for housing. For the Indian Health Service, Trump’s budget eliminates roughly $150 million.”  [IndC]

Consider for a moment the effects of a $300 million cut for the Bureau of Indian Affairs.  Drilling down, let’s look at the situation in Native American Housing, from which the administration seeks to cut some $58 million.  According to a HUD report issued in January 2017, housing needs are particularly acute in tribal areas in three major categories: System deficiencies (plumbing/electrical), physical condition, and overcrowding.

“Physical housing problems have declined enough to be negligible for the United States, on average—incidences typically of 1 to 2 percent—but not for American Indians and Alaska Natives in tribal areas. For example, 2013 American Housing Survey data show the U.S. average share of households with plumbing deficiencies was 1 percent, but this study’s household survey shows the share for AIAN populations in tribal areas was 6 percent; the share with heating deficiencies was 2 percent for the United States but 12 percent for AIANs in tribal areas; the share that was overcrowded was 2 percent for the United States but 16 percent for AIANs in tribal areas (exhibit ES.2). The only problems in which the incidences were nearly the same were electrical deficiencies (about 1 percent for both) and cost burden (36 percent for the United States versus 38 percent in tribal areas).” [HJ pdf] (emphasis added)

In summary, physical housing issues? 1-2% for most of the US population; but 16% for Native Americans.  “Heating deficiencies?” 2% for most of the US population; but 12% for Native Americans.  These numbers don’t appear to indicate a rationale for a $58 million slash in available funding.

Indeed, if we look at efforts of Native Americans to keep the furnace running in the winter is on the administration chopping block:

“The budget would eliminate programs like the Low-Income Home Energy Assistance Program, which helps low-income households pay to heat or cool their homes. In 2016, 150 tribal groups and more than 43,000 Native households received LIHEAP funds.”

There’s nothing like a cold house in the fall and winter to create an environment for disease, but again, Native Americans are on the losing end of the administration budget.

“The chronically underfunded Indian Health Service (IHS) offers care through a network of hospitals, clinics and health stations managed by IHS, tribes or tribal organizations, and urban Indian health programs. If the proposed budget passes, Medicaid, the national and state program that covers low-income individuals, could see its budget cut by $610 billion over the next 10 years. Mark Trahant, a journalist, academic and member of the Shoshone-Bannock tribes who has covered NA/AN affairs for 30 years, is concerned.

“In Indian Country, more than half of all Indian kids who go through Indian Health Service have their insurance through Medicaid,” he said. “Thirteen percent of Medicaid is Indian care.” [VOA]

Medicaid is not just an issue in terms of the national health care insurance proposals, but obviously has profound implications for health care services for Native Americans.   The proposed budget is not merely “austere,” but in relation to Native Americans it is downright cruel.

“The cutbacks to tribal programs are cutting into the bone and fail to recognize very real and critically important needs,” Fawn Sharp, the president of the Affiliated Tribes of Northwest Indians, said Tuesday at a tribal conference in Portland, Oregon. “It is so severe that it’s absolutely illogical and unreasonable.”

Logic and reason have only a very tenuous connection to the administration’s budget proposals for the Bureau of Indian Affairs and associated programs which benefit Native Americans.

There’s something particularly egregious about a budget which presumes that programs for those in need, as the case of many Native Americans, should be slashed right into the bone so that tax cuts for the top 2% of income earners in the United States can be implemented. [CNNmoney]

This is the Trickle Down Hoax on steroids.  By some magical manipulation of the tax code in favor of the wealthiest among us, “jobs” are supposed to be created in remote reservation areas; exactly those regions not favored with infrastructure, transportation, education, and resources favorable to investment.   The TDH advocates argue that the economic development problems are the result of tribal land ownership patterns, a lack of natural resource exploitation, and government “interference.”

It’s hard for a white person to understand the relationship of Native Americans to land.  To the average white person land is real estate, it can be bought, sold, transferred, and allocated at will.  It’s just another ‘thing.”  There’s no single definitive Native American perspective about land, but this comment is at least illustrative:

“Us women have been taught that this Mother Earth has taken care of us, so we have to be like her essence. She never abandoned us, she is here, she nurtures us every day, she protects us, she feeds us, she clothes us.” [ICMN]

Tribal lands can be allocated for the use of tribal members, but it’s still tribal land.  It still has “essence;” it is nurturing, protective, and sustaining.  Perhaps as close as a white person can come to understanding this concept is to imagine one is living in a church, or some sanctified property.  The property may be inhabited by specific people for specific reasons, but it is still a communal sanctified place.  Further, while the majority in our society see wealth as a measure of personal worth, this isn’t a value prized among Native Americans who frown on that which is self-serving and avaricious.  There are enterprise activities on tribal lands, but again, these are tied to the benefit perceived to accrue to the tribe, and not individuals.

The glories of the Profit Motive as maintained by the TDH advocates and other “free-marketeers” are as foreign to many Native Americans as the idea that a child should come into the world while the family conducts its ceremonies would be to them.

For all intents and purposes, the administration’s proposed budget flies in the face of basic Native American values.  While purporting to encourage ‘individual initiative’ it guts those social programs that sustain the lives of the individuals who have difficulty amassing “wealth” in the white sense of the term.  While supposing that the budget encourages ‘economic development,’ it slashes funding for communal needs (housing, health services, education, nutrition) which underpin development of any kind.  As for ‘natural resource exploitation:

It’s highly unlikely one of the TDH advocates would fully appreciate the following:

“We must protect the forests for our children, grandchildren and children yet to be born. We must protect the forests for those who can’t speak for themselves such as the birds, animals, fish and trees.” – Qwatsinas (Hereditary Chief Edward Moody), Nuxalk Nation

Nor would they understand the concept expressed in this quotation, which they might even dismiss with scorn:

“Once I was in Victoria, and I saw a very large house. They told me it was a bank and that the white men place their money there to be taken care of, and that by and by they got it back with interest. We are Indians and we have no such bank; but when we have plenty of money or blankets, we give them away to other chiefs and people, and by and by they return them with interest, and our hearts feel good. Our way of giving is our bank.”  – Chief Maquinna, Nootka

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Filed under Health Care, Native Americans, Politics, privatization, public health, Rural Nevada

Heller at the President’s Right: Lunch Time At The White House

Nothing like watching Senator Dean Heller (R-NV) sitting next to POTUS, smiling and applauding as the remarks from the President replicate every standard talking point made by every Republican since the passage of the Affordable Care Act.  Including such wonderful clichés as:

You’ll pay lower premiums (Oh, such lower premiums you won’t believe) — Any fool can sell low premium policies, the ones with high deductibles and co-pays, limited benefits, and caps.  Worse still, these junk policies will be sold across state lines so that consumer standards and protections of the worst level of protection will be the standard.

The states will have control over Medicaid (smaller units will be better for individual needs)  Nothing like blowing a big wide ‘beautiful’ hole in the Nevada budget!  Cutting $770B from Medicaid will have effects far beyond Nevada’s capacity to support its elderly, its children, its rural health care facilities, its support for low income working families.  That was the point of Medicaid — expenses far beyond the capacity of individual states could be shared nationwide, allowing medical care and services for the greatest good for the greatest number.

Some counties only have one insurance corporation offering policies in the individual market.  Did the president recall that before the ACA there were some counties that had no insurance corporations offering policies in the individual market.  There’s a solution to this problem — one the president didn’t mention — establish a public option.

Then there flowed the usual barrel of platitudes and campaign rhetoric, freedom and flexibility, low cost with high coverage,  everyone can get better insurance, reduce burdensome taxation, burdensome regulation….

And there was Senator Dean Heller, smiling as though siding with the president isn’t going to be a major political problem for him in the 2018 campaign season.  It makes a person wonder.

Senator Heller can be reached at 202-224-6244, 775-686-5770; 702-388-6605

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Filed under Health Care, health insurance, Heller, Politics

Embattled Bill Entangled Senator

While the Russians are in, or not in, meetings which are, or aren’t important, and which do or don’t offer trade-craft dangles — there’s a Senate version of the health insurance bill as egregious as its predecessors.  The hold music of the morning on Senator Dean Heller’s DC office phone is a static infused version of The Battle Hymn of the Republic while a person waits for an opportunity for leave a message for the Senator urging opposition to the health care insurance bill.

There’s a reason no one likes this bill — it puts insurance corporations back into the bifurcated market  with high premiums for those older and lower premiums (with higher co-payment and deductible out of pocket expenses) for younger, or less affluent, customers.  It puts state budgets at extreme risk. It slashes Medicaid funding (in conjunction with the proposed budget), thus placing services for children and the elderly in peril.

Senator Heller is described as being wedged into a hard place — between the desires of the hard right (and perhaps the bounteous coffers of Sheldon Adelson) and the hopes of his constituents and the Governor who want reasonable access to affordable health care insurance.

“Heller, in other words, has backed himself into a corner. Either he honors the concerns he raised just a few weeks ago, or reverses course and completes a very public betrayal – the year before his re-election campaign.” [NBC]

It’s time to offer Senator Heller a way out of this box — encouraging his continued opposition to the health insurance bill — call 202-224-6244; or 702-388-6605; or 775-686-5770.

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Filed under Health Care, health insurance, Heller, Politics

ICYMI: In Case You Missed It, Instant Summer Reading Recommendations

The Nevada Independent has several excellent articles about the health insurance ‘reform’ battle in the state,  I’d recommend starting with ‘Senator Cortez-Masto’s denunciation of the Senate health bill,” and move on to ‘Dispatches from Washington.’

The Reno Gazette Journal reports (video) on Rep. Jacky Rosen’s (D-NV3) decision to run for Senator Dean Heller’s seat.

Please note TPM’s report from the conference of Secretaries of State concerning election data security.  If this conclusion doesn’t disturb us, it should:

“But both Republican and Democratic Secretaries of State, who are responsible for carrying out elections in many states, said they have been frustrated in recent months by a lack of information from federal intelligence officials on allegations of Russian meddling with the vote. They say that despite the best efforts by federal officials, it may be too late in to make substantive changes.”

Interestingly enough, vote suppression advocate Chris Kobach was a no-show at the meeting.  Perhaps this is because some election experts have identified major flaws in Kobach’s “election integrity” plans.

And, now we get to “muddle time” during which the current administration tries to muddy the waters about the  other election problem — Russian interference.  Spokespersons and advocates are on the air-waves saying that “Gee, it’s not 17 intelligence agencies, it’s actually just a handful of people who reached the conclusion that the Russians meddled,”  which is one tactic to discredit the reports that are unequivocal in their assessment that, yes, the Russians interfered.   Following this comes the Gee Whiz moment in which the apologist who says that “we’ve not actually seen the evidence of this.”  A statement such as this is simply a variation on the previous talking point:  We’ve investigated this enough, there’s nothing there, move along please.

Speaking of elections, please take a look at the bill introduced by Rep. Mark Amodei (R-NV2) HR 2101, the Prior Approval Reform Act:  To amend the Federal Election Campaign Act of 1971 to expand the ability of trade associations to solicit contributions from the stockholders and executive or administrative personnel of their member corporations, and for other purposes.  The effective date, January 1, 2018, would allow more “corporate” money in politics just in time for 2018 campaign season.   The Associated General Contractors would be pleased to see this enacted. [pdf]  Those disturbed by the dark, and darker money, flowing into our campaigns should track this bill.

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Filed under Amodei, Health Care, health insurance, Heller, Nevada politics, Politics, Vote Suppression, Voting

Health, Wealth, and Senator Heller: Recommended Reading

Health care continues as a high priority item for Nevadans, and Greg Sargent’s article for the Washington Post points out how the “GOP Stunt Backfired…and why,” is highly recommended for pulling the tarpaulin off the GOP obfuscation concerning the Affordable Care Act.  The New York Times reports on the impact of the health insurance battle on other elements of the GOP agenda.  Ian Millhiser warns us that if we stop paying attention, the GOP wins.  Meanwhile,…

Senator Dean Heller continues to spout the party lines (the part under the tarp) while ostensibly opposing the repeal bill:

“Under the ACA, premiums have increased 7 times faster than wages, and federal regulations under the law’s employer mandate have cut workers’ hours, wages, or both.”

Nothing like tossing one’s apples and oranges together and expecting to get grape juice.  Some significant elements are missing from this pithy bit of prose.  First, premiums have increased, but not at an equal pace in all states. Secondly, the rate of premium increases have slowed during the implementation of the ACA.  Third, wages have been stagnant during the past decade, but that has little to do with the enactment of health care insurance reform — in fact, lower wage working Americans were included in the Medicaid expansion– the very program the GOP wants to slash in order to provide tax cuts to wealthy Americans.

Senator Heller believes that re-importation of prescription drugs and allowing insurance purchases across state lines are part of the solution.  Notice that he’s not in favor of so much competition as to allow Medicare to negotiate drug prices in the manner allowed to the Veterans Administration.  Also notice that he’s not mentioning that some states have rather more lax requirements for the sale of comprehensive health insurance than others.  The “across state lines,” or “portability argument” sounds good until we recall that states build in consumer protections into their regulatory frameworks.  If we could be guaranteed that portability would be a function of the most rigorous consumer protections there’s something to be discussed herein; if not, it’s simply a formula for a race to the bottom.

This is no time to remove our attention to the decimation of health insurance affordability —

Senator Heller can be reached in Las Vegas at 702-388-6605; Reno at 775-686-5770; and DC at 202-224-6244.

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

It Ain’t Over Until The Fat Golfer Sings

Senator McConnell’s Secret Health Insurance Shop is still working, with the Lobbyists/Elves seeking a way to offer goodies acceptable to the wavering and the wanton.  Keep calling!  and if you’d like more information to substantiate your comments there are some excellent sources.

Kaiser Family Foundation:   Your one stop center for research and analysis on health insurance issues.  Definitely a “bookmark this” recommendation.  Today, KFF notes that before the implementation of the ACA individual insurance plans for health care did not cover delivery and maternity care  in 75% of the policies; 45% of the policies didn’t cover substance abuse treatment; and 38% failed to cover any mental health care services.

If terms like “risk adjustment,” “re-insurance,” and “risk corridors” seem like something written in Minoan Linear A, the KFF has an excellent summation of these technical terms in easily understood American English.

There are also some analytical pieces on the impact of Republican suggestions for health care insurance “reform” as they relate to rural health care in the following:

Human Rights Watch — Senate Health Care Bill A Swipe At Rural United States.

MSNBC/Scarborough – Rural Health Care Would Be Savaged By This Bill.

There’s a narrative going around that Democrats haven’t brought anything to the table, which depends on whether we’re taking the long or short term view.  In the short term this would be true — because the McConnell Secret Health Insurance Shop didn’t invite any Democratic participation,  for that matter there seems to have been some Republican Senators who were left in darkness.  The longer view would note some of the following:

Senator Franken’s “Rural Health Care Quality Improvement Act of 2016” (pdf) S. 3191 (114th Congress) was introduced in July 2016 and “died” in the Senate Finance Committee.  The bill would have amended two titles of the Social Security Act to improve health care in rural areas of the United States.

There is Representative Jan Shakowsky’s CHOICE Act, H.R. 635, which would establish a public option under the ACA.  See also S. 194, Senator Sheldon Whitehouse’s CHOICE Act.  There’s Rep. Gene Green’s HR 2628 to stabilize Medicaid and the Children’s Insurance program.  Rep. John Conyers introduced his form of “single payer” in his Medicare for All bill, HR 676.  On the topic of making pharmaceuticals more affordable:  Senator Sanders – Affordable and Safe Prescription Drug Importation Act S. 469.  Senator Klobuchar has a bill “… to allow for expedited approval of generic prescription drugs and temporary importation of prescription drugs in the case of noncompetitive drug markets and drug shortages.” S. 183. Rep. Kurt Schrader introduced H.R. 749 to increase competition in the pharmaceutical industry.  Senator Ron Wyden introduced S. 1347, RxCap Act of 2017.

Senator Klobuchar has also introduce a bill supporting Alzheimer’s caregivers in S.311.  Rep. Derek Kilmer’s bill, H.R. 1253, seeks to improve access to treatment for mental health and substance abuse issues.   This is by NO means an exhaustive list of what can be gleaned from Gov.Track, but it does illustrate that the Democrats are not without suggestions — negotiating drug prices for Medicare, stabilizing the current system, public options, single payer — it’s just that these bills won’t get out of Republican controlled committees and they didn’t make it into Senator McConnell’s Secret Shop.

Indulge in no victory dance, we’ve seen this movie before … don’t believe that some minor blandishment won’t be enough to lure Senator Heller from his current position …don’t think that the products of McConnell’s Secret Shop have stopped coming off their assembly line.

Senator Heller can be reached at 202-224-6224;  702-388-6605;  775-686-5770

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Filed under Health Care, health insurance, Medicaid, Medicare, nevada health, Pharmaceuticals, Politics, public health

48 Hours: The Health Care Bill

If a person hasn’t found the reason to call Senator Heller’s office and advise him to vote NO on the Republican version of a health care bill, consider the following:

(1)  One in three residents of skilled nursing facilities in Nevada are supported by Medicaid. Now, apply a simple calculator test — if a person was born in 1946 (the beginning of the Baby Boom) he or she will hit 80 in 2026.  In short, the Baby Boomers will be in the age range to need such care just as the major cuts to Medicaid kicks in.  About 65,000,000 children were born in this country between 1945 and 1961.  Cuts to the Medicaid program in this context is essentially create a crisis which we could easily have avoided.

(2) The Republicans are fond of focusing on “premium increases.”  That’s only a part of the story.  Anyone can devise insurance policies with low premiums — raise the deductibles, cut the coverage, increase co-pays,  insert lifetime benefit limits, and Voila! lower premiums.   The problems begin when a person tries to use the insurance — the reason the person bought the policy in the first place — “We’re so sorry, but this policy doesn’t cover immunizations. Or, mammograms, or prostate cancer screening, or the expenses related to the birth of your first child…”

(3) Speaking of lower premiums,  if a person has insurance from an employer then there should be no surprise when the coverage decreases compliments of the waivers included in the Senate bill — “We’re sorry, but we no longer cover wellness screenings for men and women, maternity care, or other elements that used to be included as Essential Benefits.” If a person thought that employer sponsored policies were “safe” from “reforms,” please think again.

(4) This isn’t a health care bill, it’s a tax cut bill.  Those whose income is in the top 0.1% level would receive a lovely $250,000 tax savings gift in 2026. Those earning more than $875,000 (top 1%) would get tax savings of $45,500.  [CNN]  All this at the expense of working Americans.

(5) The buzz word “patient centered” is nonsense.  At bottom, it’s a euphemistic way of saying “You are On Your Own.” A person can “choose” to buy what he or she can afford — and for lower income Americans this means lower coverage and higher out of pocket expenses.  The problem with applying classic market principles to health care is that much of what is covered isn’t a matter of Choice.  No one chooses to be in a traffic accident, any more than a person chooses to get cancer or have a heart attack.   The Republican argument seems to boil down to “live a perfect life and make excellent choices” and you are ‘worthy’ of having insurance.  This argument only works IF a person has no familial risk factors, IF a person isn’t exposed to other people (who might have an infectious disease), and IF a person can afford to build a residence in which there are no places to fall and no way to have an accident with a garage door.  In short, it’s fantasy land.

The next few hours are crucial — that’s right — HOURS. Please call Senator Heller’s office at 702-388-6605;  or 775-686-5770; or 202-224-6244.  Your health care services are at stake.

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