Category Archives: Heller

And so it begins

The Senate yesterday began the process of dismantling the Affordable Care Act.  With no replacement on offer.  With no publication of a plan to make it possible for every American to purchase health care insurance.  Please write or call your Congressional Representatives.

The Trumpster said Director Clapper called him to denounce the release of information about his possible compromise by Russian agencies.  No, the Director called to say the agencies had issued no conclusions.  Another day another lie. We need a select committee investigation into Russian activities in the 2016 election. Please write or call your Congressional Representatives.

Please keep writing. Please keep calling.

Comments Off on And so it begins

Filed under Congress, Health Care, health insurance, Heller, nevada health, Politics

There they go again! GOP assault on Medicaid

It’s no secret the Republicans in Congress want to slash the social safety net. It’s also no secret Medicaid has been one of the favored targets for years.  The not-so-new-idea of late is to fund the program based on block grants.  There are some strong arguments against this:

(1) Block grant funding is set. Should a state have program costs exceeding the block grant funding one of two options are available – either appropriate state funds to make up the difference, or cut back on services or eligibility.

(2) The traditional match rate has been 50%, meaning that the state is insulated to some extent from unexpected cost increases and thus can ensure health insurance coverage for low income residents.

(3) When baffled by actual numbers, Republicans often return to the high-flying rhetoric about making the program more “flexible” under state control.  No. In reality the states already have that “flexibility” in terms of services covered, ways providers are paid for those services, the delivery of services, and eligibility levels.  [FUSA pdf]

Those who could see their health care access cut if Medicaid becomes a block grant program are those in Nevada who are earning $16,105 per year for an individual, or $32,913 for a family of four. (2014)  The ACA expansion of Medicaid allowed the state to add approximately 187,100 low income workers to the benefits.  Repeal of the ACA would obviously jeopardize this expansion, and cost the state approximately $1 billion in federal funds. [KFF and FUSAorg]

Consider for a moment that about 160,700 people in Nevada are employed in “accommodation and food services” jobs in which the average (mean) wages are $25,360 per year, the 10th percentile wages are approximately $16,450.   Or, we could look at health care support services with 18,860 employed at average (mean) wages of $33,900 with $22,470 at the 10th percentile and $26,500 at the 25th percentile.  [DETR]  Not to put too fine a point to it, but slashing Medicaid in Nevada would quite possibly have a negative effect on the ability of those employed in “accommodation and food services” to access health care, and these are the people who  work in one of Nevada’s major industries.  Home health care personnel wouldn’t fare much better.

When all else fails the Republicans haul out the “bankrupt system” allegations.  To the contrary, the Medicaid expansion has been a definite benefit to Nevada and other states:

    • CBO estimates show that the federal government will bear nearly 93 percent of the costs of the Medicaid expansion over its first nine years (2014-2022).  The federal government will pick up 100 percent of the cost of covering people made newly eligible for Medicaid for the first three years (2014-2016) and no less than 90 percent on a permanent basis.
    • The additional cost to the states represents a 2.8 percent increase in what they would have spent on Medicaid from 2014 to 2022 in the absence of health reform, the CBO estimates indicate.
    • This 2.8 percent figure significantly overstates the net impact on state budgets because it does not reflect the savings that state and local governments will realize in other health care spending for the uninsured.  The Urban Institute has estimated that overall state savings in these areas will total between $26 and $52 billion from 2014 through 2019.  The Lewin Group estimates state and local government savings of $101 billion in uncompensated care.  [CBPP]

A further note about uncompensated care, we need to look at the example of Pennsylvania and its latest report on the impact of expanded Medicaid and the Affordable Care Act:

“For the first time in a decade, Pennsylvania’s 170 general acute care hospitals in 2015 saw a drop in charity care spending, saving the average hospital about $200,000 over 2014, according to state data obtained by the Pittsburgh Post-Gazette.

Coupled with a nearly $300,000 drop in bad debt at the typical hospital, hospitals saved about $500,000 on uncompensated care in 2015, according to data from the Pennsylvania Health Care Cost Containment Council.

The state hospital association and patient advocates alike believe the drop in spending on charity care and bad debt is due to the impact of the Affordable Care Act, which is what experts said they believed caused a similar drop for the 24 states that adopted the ACA in 2014, as reported in the Post-Gazette series, Counting Charity Care, last year.”  [PPG]

Thus, in their ardor to repeal the Affordable Care Act and slash Medicaid support by turning the program into a block grant disaster, Representative Amodei (R-NV2) and Senator Dean Heller (R-NV) may need to explain:

(1) Why reducing support for a program which serves the least well remunerated among us – especially in one of our major industries – is a bright shining idea?

(2) Why eliminating programs which reduce uncompensated care costs to local hospitals and health care providers is also such a great notion?

Comments Off on There they go again! GOP assault on Medicaid

Filed under Amodei, Health Care, health insurance, Heller, Medicaid, nevada health

Heller Takes The Easy Road: Cadillac Health Plan Target

Nevada Senator Dean Heller (R-NV) took aim at one of the more vulnerable (and questionable) parts of the Affordable Care Act as his contribution to the Republican Repeal – and eventually replace with something we don’t know what – plan.   [LVSun]

First, a “cadillac plan” is an exceptionally generous health care plan offered by some employers.  There’s good and bad news herein.  On the bright side, the plans offer very full coverage.  On the darker side, maybe there’s a bit too much coverage, and that has implications for restraining health care costs.

At this point it’s necessary to focus on what’s is important for the employees. Is it the continuation of the generous health care coverage OR is it health care cost containment. 

The Herring & Lentz report (2011) describes the cost and tax issues involved in summary form:

“One controversial aspect of the Patient Protection and Affordable Care Act is the provision to impose a 40% excise tax on insurance benefits above a certain threshold, commonly referred to as the “Cadillac tax.” We use the Employer Health Benefits Survey, sponsored by the Kaiser Family Foundation and Health Research and Educational Trust, to examine the number and characteristics of plans that likely will be affected. We estimate that about 16% of plans will incur the tax upon implementation in 2018, while about 75% of plans will incur the tax a decade later due to the indexing of the tax thresholds with the Consumer Price Index. If the Cadillac tax is ultimately implemented as written, we find that it will likely reduce private health care benefits by .7% in 2018 and 3.1% in 2029, and will likely raise about $931 billion in revenue over the ensuing 10-year budget window from 2020 to 2029.”

Senator Heller calls this “onerous,” however the Senator has often called any form of regulation on the insurance and banking sectors “onerous.”  Thus, it’s helpful to remember why this element was inserted in the bill in the first place.

Consider the following examples:

1) A patient with an extravagant health plan, often dubbed a Cadillac plan, goes to the doctor’s office. She’s told by her doctor that she should take a bunch of tests, even though the tests seem unnecessary. The patient knows most the tests are unnecessary, but she figures that since her health insurance covers everything, it’s better to be safe than sorry — it’s not like it’s costing her anything except a little time, anyway.

2) Another patient with a less generous health plan goes to the doctor’s office. She’s also told by her doctor that she should take a bunch of tests, even though the tests seem unnecessary. But this time the patient also knows her health insurance will charge her a bunch of extra fees for each test. Wanting to avoid a lot of costs, she decides to talk to her doctor about what tests are actually necessary, and she declines to take any of the tests that she and her doctor decide are unnecessary.

The Cadillac tax attempts to move more health plans from example No. 1 to example No. 2. [Vox]

The Cadillac Plans are popular – why not? Most medical costs are covered.  And, therein, as the examples suggest, lies the problem.  The employer can boast to prospective employees that “everything’s covered” in our health care plan; the employee can spend as much on medical care as is practical and then some; and, unions representing employees can boast about their prowess in gaining exemplary health care insurance coverage.  However, none of these positions suggests any form of health care cost containment.

There is no incentive built into the Cadillac  health insurance plans to contain rising health care costs. 

There are a couple of ways to address health care cost containment – none of which are evident in the Cadillac plans — (1) there could be limits on coverage, the bug-bear of the junk insurance policies sold before the ACA which put a lifetime limit on health care insurance coverage; met quickly if the person had a serious illness or accident; (2) there could be limits on the type of coverage sold to policy holders – unpopular with those who want (and can afford) the addition of vision, dental, etc. etc. (3) put an excise tax on the Cadillac plans to encourage employers and other policy holders to move from over-generous plans to more cost sharing models.  The third option was the intent of the ACA.

Repealing the excise tax on the Cadillac plans would completely remove any incentive for cost controls in this part of the ACA.

One of the trickier issues the Republicans will have to address in their Repeal and Replace operations is how to contain rising health care costs.  Repealing the “onerous” excise tax will eliminate one element of health care cost containment in the ACA. So, what do Senator Heller and other Republicans want as a way of replacement?  Junk insurance? Surely not. Limits on policy provisions for individual policy holders? Doesn’t sound very “freedom” or “customer oriented” to me at least.

Thus, the question Senator Heller, and others in his party, must face is how to “repeal” the ACA without opening the floodgates to rising health care costs?  Has anyone ask him about the implications of his suggestion?

Comments Off on Heller Takes The Easy Road: Cadillac Health Plan Target

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

Shuffling the Deck and Hiding the Cards: House Guts Buy American rules

Just in case we all missed it, and I suspect we were supposed to, the House of Representatives recently gutted the rules for Buying American products for federal projects.  [DWT] What was all that palaver about ‘saving American jobs,’ and ‘promoting American manufacturing?’  Evidently it’s meaningless to Nevada Representatives Amodei, Hardy (happily on his way out) and Heck (happily on his way out) – all of whom voted in favor of the Water and Energy bill (H.R. 2028) from which the HOUSE REPUBLICAN LEADERSHIP  had stripped the “Buy American” provisions.

It might also be interesting to hear from Senator Dean Heller on the Russian interference with the 2016 presidential election?  Yes, 17 US intelligence agencies – not just the CIA – said Russia was behind the hacking. [USAT]  There’s no “confusion” over this conclusion. There’s no “false flag” operation – that’s the province of fake news and conspiracy theorists.  There’s just no question – and yet Senator Dean Heller (R-NV) has yet to join the bipartisan call for Congressional investigation of this important matter?   If a foreign country can hack in and seek to manipulate a U.S. election, what’s to say it can’t gather blackmail-bait on the Republicans as well as Democrats?

And, what’s the Senator’s stance on GOP plans to cut Social Security? Here’s the first draft of that plan.   The basics:

Those measures include gradually raising the retirement age for receiving full benefits from 67 to 69 and adopting a less generous cost of living index than the current one. The proposal would also inaugurate means testing by changing the benefits formula to reduce payments to wealthier retirees. It would also eliminate the annual COLA adjustments for wealthier individuals and their families. [Financial Times]

It would be easier to sit back and pretend this is a normal political season but it isn’t, and when Teen Vogue does a better job of explaining the Gaslighting of America than the D.C. press, then we ought to figure we’re in trouble – from lies about manufacturing jobs to lies about election hacking to lies about Social Security —

“To gas light is to psychologically manipulate a person to the point where they question their own sanity, and that’s precisely what Trump is doing to this country. He gained traction in the election by swearing off the lies of politicians, while constantly contradicting himself, often without bothering to conceal the conflicts within his own sound bites. He lied to us over and over again, then took all accusations of his falsehoods and spun them into evidence of bias.”  [Teen Vogue]

And that sums up the beginnings of the Trumpster’s administration.

Comments Off on Shuffling the Deck and Hiding the Cards: House Guts Buy American rules

Filed under Amodei, Economy, elections, Heck, Heller, Nevada politics, Politics

GOP Air Balls: ACA Repeal would increase Nevada uninsured by 95%

Trump Favorite Picture This ought to be just a little chilling:

If Republicans go through with their plan to dismantle the Affordable Care Act using a similar model as their failed 2015 Obamacare repeal, the number of uninsured would double, a new report by the Urban Institute report warns. (pdf)  Taking into account the two or so year delay GOP lawmakers say they will include in the repeal bill, the non-partisan think tank estimates that in 2019 the number of uninsured nonelderly people would rise from about 29 million to nearly 59 million.  [TPM]

And the numbers represent what? Answer:

Eighty-two percent of the people becoming uninsured would be in working families, 38 percent would be ages 18 to 34, and 56 percent would be non-Hispanic whites. Eighty percent of adults becoming uninsured would not have college degrees. [UrbanInst. pdf]

Percentages have a way of sounding bland, so some clicking on the Plastic Brain results in approximately 33,040,000 of those people who would lose their health insurance by 2019  being non-Hispanic white people.  47,200,000 would be those without a college education, and thus presumably not in a position to secure the kind of employment providing the resources to find individual health plans.

If the 2015 bill is used as the framework or model, then the Urban Institute projects that there will be 762,000 uninsured individuals in Nevada only 18% of whom would be eligible for assistance; causing a 95% increase in the number of uninsured in Nevada.   Those Nevada politicians who have been denouncing the Affordable Care Act (read Rep. Mark Amodei R-NV2) may want to pause before “taking credit” for creating a 95% increase in the number of Nevadans without health insurance.

It’s important to recall that the Big Lie about the Affordable Care Act is that it is “socialized medicine.”  In reality it’s an Insurance Law. It doesn’t create a nationalized health care system – it merely increases the number of people who have “access” to health care by providing more people with the capability of purchasing health insurance policies.

Senate Democrats have already signaled that should the “Straight Out Of The Gate Repeal and Replace” come from the majority Republicans the GOP can expect no assistance from the Democratic side of the chamber. [TPM]

And, then there’s the politics of the repeal.  If the GOP decides to use the Reconciliation Process (needing only 51 votes for repeal) then Senator Dean Heller (R-NV) raises a question:  “What we are trying to figure out is what the restrictions on reconciliation,” Sen. Dean Heller (R-NV) told TPM. “Does reconciliation allow for a replacement? And it may or may not.” [TPM]

If the process doesn’t allow for “replacement” then the Republicans have chucked the insurance for those with pre-existing medical conditions, insurance coverage for mental health, insurance coverage maternity care, protections from junk insurance policies with maximum limits, and other popular features of the ACA.  They may also be chucking hospitals under the bus.

One private equity spokesperson noted last November, “… hospitals, especially those in rural areas, could be tremendously hard hit if the replacement rolls back the progress made under the ACA to insure patients and incentivize them to get care before their illnesses require emergency room visits or hospitalization.”

Thus, with the lack of any specificity from Republicans about the nature of the “replacement” we could posit some serious problems for the members of the Nevada Rural Hospital Partners – in Winnemucca, Fallon, Battle Mountain, Boulder City, Carson Valley, Ely, Winnemucca, Incline Village, Hawthorne, etc.   A 2016 report for the American Hospital Association provides some general conclusions from which we can contemplate the effect on Nevada’s rural health providers:

”The loss of coverage would have a net impact on hospitals of $165.8 billion  with the restoration of Medicaid DSH reductions; The ACA Medicare reductions are maintained and hospitals will suffer additional losses of $289.5 billion from reductions in their inflation updates; Full restoration of Medicare and Medicaid Disproportionate Share Hospital  (DSH) payment reductions embedded in ACA would amount to $102.9 billion.”  [AHA pdf] 

The technical term for these losses might be “ouch?”   There is a point at which rhetoric meets the road.  It’s all well and good to bellow “Repeal and Replace?” Or, “Get Rid of Socialized Medicine.”  It’s another thing entirely to puzzle out the impact of repeal on all the stakeholders in this issue – the customers and patients, the health care providers, the hospitals and clinics, the insurance companies, and the investors who have an increasing stake in privatized health care in this country.

There are some elements of the Affordable Care Act which could be improved.  However, the Burn the Barn Down political pandering on full display among Republicans isn’t leading to any current and serious discussions of how to make these improvements viable.  And, this is chilling for policy holders, insurance companies, health care providers, hospitals and clinics, and the investors therein.

Perhaps the Pottery Barn rule applies to Republicans: If you break it you own it.

Comments Off on GOP Air Balls: ACA Repeal would increase Nevada uninsured by 95%

Filed under Amodei, Health Care, health insurance, Heller, Nevada politics, Politics, public health, Republicans, Rural Nevada

Obstruction By Blue Slip: GOP assault on Federal Courts

Heller Blue Slip

Senator Dean Heller’s (R-NV) slip is showing, or rather it isn’t showing up. President Obama nominated Ann Rachel Traum to the Federal District Court (Nevada) on April 28, 2016.  So, where’s the blue form from the Senator’s office indicating the Judiciary Committee should move forward with this nomination?

One theory has it that not only are Senate Republicans blocking a Supreme Court nomination but they’re doing it down the line, right down to the overworked, understaffed federal district courts level.

“There are lots of GOP senators doing this. Sen. Dan Coats (Ind.) hasn’t turned in his blue slip for his judicial nominee, Myra Selby. Sens. Richard Shelby (Ala.) and Jeff Sessions (Ala.) haven’t turned in their blue slips for their nominee, Abdul Kallon. Sens. Lindsey Graham (S.C.), Tim Scott (S.C.), Dean Heller (Nev.), Richard Burr (N.C.), Thom Tillis (N.C.), Pat Toomey (Pa.) and Rand Paul (Ky.) haven’t turned in blue slips for their nominees, either. And Senate Majority Leader Mitch McConnell (R-Ky.) hasn’t turned in his blue slip for his nominee, Lisabeth Hughes.”  [HuffPo]

It isn’t like the current nominee isn’t qualified. The resume is remarkable:

“Anne Rachel Traum is a Professor of Law at the University of Nevada-Las Vegas William S. Boyd School of Law.  She is currently on leave from the law school and serving as Special Counsel in the Office for Access to Justice at the United States Department of Justice.  Professor Traum joined the University of Nevada-Las Vegas William S. Boyd School of Law faculty in 2008, and she has served as the Director of the Appellate Clinic since 2009.  She also served as the Associate Dean for Experiential Legal Education from 2013 to 2015.  From 2002 to 2008, Professor Traum served as an Assistant Federal Public Defender in the Federal Public Defender’s Office in Las Vegas, Nevada.  She served as an Assistant United States Attorney in the United States Attorney’s Office for the District of Nevada from 2000 to 2002, while on detail from the Environmental and Natural Resources Division of the United States Department of Justice, where she worked from 1998 to 2000.  She began her legal career as a law clerk to the Honorable Stanwood R. Duval, Jr. of the United States District Court for the Eastern District of Louisiana.  Professor Traum received her J.D. Order of the Coif and cum laude from the University of California, Hastings College of Law in 1996 and her A.B. with honors from Brown University in 1991.” [WH

This obstructionism is egregious on so many levels.  Politically, it’s the equivalent of a toddler’s temper tantrum – if we can’t have exactly the courts we want then we don’t want any.  This, in turn leads to the next layer of political idiocy.

It doesn’t do to complain about the time and expense required to litigate cases and at the same time keep courts short handed such that they cannot schedule hearings on a timely basis. This affects both plaintiffs and defendants in both civil and criminal cases.  Nor, are we merely speaking of the vacancies at the top of the judicial roster.

“While Senate battles over nominees to the Supreme Court and appeals courts draw more headlines, the less-noticed openings are increasing workloads and delaying trials in federal courts that take in hundreds of thousands of cases a year — compared with the 80 or so cases heard by the nation’s highest court.

Of 673 U.S. district court judgeships, 67 — or 10 percent — are vacant under President Obama, nearly twice as many as at this point of Republican George W. Bush’s presidency and 50 percent higher than at this time under Bill Clinton (D) or George H.W. Bush (R), according to data kept by the Administrative Office of the U.S. Courts.

The number of federally designated district court “judicial emergencies” — where seats carry particularly heavy caseloads or have been open for an extended period — is also roughly double what it was in May 2008 and May 2000, according to the administrative office.

Heavy caseloads in some places slow resolution of everything from commercial disputes to workplace discrimination claims to federal regulatory challenges, in which district court rulings are often the last word because most are not appealed.” [JDnom] (emphasis added)

Consider this last paragraph carefully.  “Commercial disputes” is one category worthy of attention – someone, somewhere, who is engaged in interstate commerce may not be getting paid in a timely fashion because there is no judge with docket time available to hear the case?  Someone, somewhere would like to challenge a federal regulation, but hasn’t the “float” required to engage in protracted litigation because of the docket backlog?

We do have a constitutional guarantee of a “speedy and public trial,” under the provisions of the 6th Amendment, but this applies only to criminal prosecutions – not to those commercial disputes, discrimination claims (and defenses), regulatory challenges, and other civil litigation.  We have a backlog, and it’s getting deeper:

“Combined filings for civil cases and criminal defendants in the U.S. district courts decreased by 28,836 (down 7 percent) to 361,689. Terminations once again held steady, declining by 2,634 (down less than 1 percent) to 347,828. Because filings exceeded terminations, the total for pending cases and defendants rose by 12,268 (up 3 percent) to 438,808.” [UScourts.gov] (emphasis added)

Pending civil cases are reported up by 5%, to 340,925 nationwide.  And, still the Senate Republicans will not act.

Senator Heller, Where is your blue slip?

Comments Off on Obstruction By Blue Slip: GOP assault on Federal Courts

Filed under Heller, Judicial, Nevada politics, Politics

And They Voted To What? House GOP wants to drop the new fiduciary rule

Money Pile 2

The Republican leadership of the U.S. House of Representatives did try to do some business in the midst of the Democratic representatives’ sit in, and a miserable bit of business it was.

“House Republicans on Wednesday failed to muster the two-thirds majority needed to block the Obama administration’s controversial standards for financial advisers.  The House voted 239-180 to block the fiduciary rule, well more than 40 votes short of the total needed.

Wednesday night’s vote came as Democrats staged a sit-in on the House floor, starting around nearly 12 hours earlier, to push for a vote on legislation to prevent terror suspects from buying guns.”  [TheHill]

There’s a little story about priorities herein.  While the Democrats were trying to get the leadership to schedule votes on gun safety legislation, the Republicans were trying to make it easier for financial advisers to rip people off. [TP]

Let’s try to make this as simple as humanly possible.  “Fiduciary” /fəˈdooSHēˌerē,-SHərē/, “ involving trust, especially with regard to the relationship between a trustee and a beneficiary.”   Think of that pile of money in the graphic above as your savings. You have trusted a financial adviser to tell you the best investments you can make to get a good return on your savings, especially for your retirement account.   You are trusting that what your investment and/or financial adviser is telling you is in your best interest.

The Department of Labor has drafted a rule to require your financial adviser to act in your best interest regarding your investments – and not to give you advice on financial products that will do more for the investment advisers than they will do for you.  In short, it’s a matter of trust —  you should be able to trust what your financial adviser is telling you. You should be able to trust that the advice isn’t intended to feather the nests of the investment advisers instead of yours.

So, what have the Republicans been doing?  Return with us now to the Senate side of the Capitol building.  On May 24, 2016 the Republican controlled Senate voted to kill the Labor Department rule. [vote 84]  The vote was 56-41, obviously not sufficient to over-ride the promised veto.  And, who voted along with other Republicans to kill the rule? None other than our own Bankers’ Boy, Senator Dean Heller (R-NV).

HJ Res 88 Senate Vote

Now, let’s return to the House side of the Capitol Building.  HJ Res 88, “ On disapproving the rule submitted by the Department of Labor relating to the definition of the term “Fiduciary,” on passage, the objections of the President to the contrary notwithstanding… [vote 338] And who from the great state of Nevada voted to kill the rule?  Representatives Mark Amodei (R-NV2), Cresent Hardy (R-NV4), and Joe Heck (R-NV3).  Who as a member of Nevada’s congressional delegation did NOT vote to allow financial advisers to act in their own best interests rather than yours – Representative Dina Titus (D-NV1). The attempt to overturn the Labor Department rule failed 239-180.  The Republicans needed a 2/3rds majority to get rid of the rule, and thanks to Representative Titus and 179 other members of the House they didn’t get it.

In spite of the Republicans’ best efforts – your financial adviser will now have to offer investment advice based on what is in YOUR best interests – and not peddle financial products that will garner fees, kickbacks, and other “revenue enhancement” for the advisers.

And, THIS is what the Republicans thought was more important than scheduling votes on gun safety in America.

Comments Off on And They Voted To What? House GOP wants to drop the new fiduciary rule

Filed under Economy, financial regulation, Heck, Heller, Nevada politics, Republicans