Category Archives: Heller

The Great Community Health Center Scam portion of the ACA Repeal

We have the House version of a repeal bill, such as it is. Why it took some seven years to compile a batch of pre-existing Republican conditions remains a mystery. However, there is a section which calls for the defunding of Planned Parenthood, and the “cover” for so-called ‘moderate’ Republicans is the “community health center” scam.  Gee, the argument goes, we could be funding community health centers instead of providing support for an organization that may provide abortion services.

First, a hat tip to Vox for an excellent summary of Planned Parenthood funding and its sources and uses.  There’s no reason to replicate the argument here when it is well presented elsewhere.  Further, the community health centers are not the answer to PPA services for several reasons.

About two years ago the Republicans distributed a “map” showing some 13,540 clinics which purportedly could perform the medical services provided by Planned Parenthood. Not. So. Fast.

Those who compiled the list did not specify their criteria for a replacement clinic, so most of the clinics listed on the map didn’t have an ob/gyn on staff. Nor did most have the equipment and staff on board to provide reproductive health care services.

Not only were they not staffed and equipped for reproductive health care services many were not set up to take on a massive influx of patients transferred from PPA to the community clinics.  Private clinics would also have to accept Medicaid patients, which many do not because of the reimbursement rate. Mother Jones summarized the situation:

“Additionally, the Congressional Budget Office estimated in a report issued earlier this month that if Planned Parenthood were defunded, as many as 650,000 women “in areas without access to other health care clinics or medical practitioners who serve low-income populations” would lose their reproductive health care. And a survey by the Guttmacher Institute found that women often value specialized family planning clinics such as Planned Parenthood over primary care clinics for reasons such as affordability, increased confidentiality, and a greater range of contraceptive options. Guttmacher also reports that in 103 counties, Planned Parenthood is the only “safety net” family planning service, meaning that a large portion of their patients are either uninsured or reliant on Medicaid.”

Many Republican members of the Congress, Senator Dean Heller included, are relying on the community health care clinic argument to deflect the contention that they are opposing contraception and family planning services.  The community health clinic as a replacement for Planned Parenthood reproductive health care medical services is founded on mischaracterizations of both the actions of PPA and the capacity of the community clinics. It is also a deflection from the real argument about the necessity of family planning services — in short, it is a way to say the individual opposes family planning services without coming right out and saying, “I am opposed to the prescription of contraceptives and other reproductive health care services by Planned Parenthood without having to say I am against Planned Parenthood.”

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Filed under Health Care, health insurance, Heller, Medicaid, Politics, Women's Issues, Womens' Rights

The Not Quite So Better Way

Nevada’s two Republican representatives to the 115th Congress, Senator Dean Heller, and Representative Mark Amodei (R-NV2) are now proposing not to have town hall style sessions with constituents until they have something to say.  We might assume this applies to the threats to repeal the Affordable Care Act, without having something concrete to say to the  voters.  Representative Paul Ryan is touting the GOP “Better Way” (pdf download) as a set of talking points for Republican members of the 115th.

First, there isn’t anything really new here. It’s the same proposal a person might have downloaded last June (June 22, 2016).  The foundation is Unleashing the power of choice and competition is the best way to lower health care costs and improve quality. One way to immediately empower Americans and put them in the driver’s seat of their health care decisions is to expand consumer-driven health care. Consumer-driven health care allows individuals and families to control their utilization of health care by providing incentives to shop around. This ultimately lowers costs and increases quality.”

Problem: “Consumer-driven health care” makes for lovely free market rhetoric,  but it boils down to the same old High Deductible Health Policy/Health Savings Account proposal the GOP has rolled out since time out of mind.

“This insurance arrangement— in which a person is protected against catastrophic expenses,  can pay out-of-pocket costs using tax-free dollars, and in turn takes responsibility for day-to-day health care expenses—is an excellent option for consumers. HSAs tied to HDHPs are popular tools that lower costs and empower individuals and families. This type of coverage also helps patients understand the true cost of care, allows them to decide how much to spend, and provides them with the freedom to seek treatment at a place of their choosing.” (page 13)

This is an elegant way to tell people (1) you’re on your own; (2) that you might expect some tax credits, but the expenses are going to come immediately out of your pocket; (3) and you’ll be able to address ‘catastrophic’ illness or injury expenses out of what you’ve put into an HSA.  Good luck with that.  Health Savings Accounts are great for the healthy and wealthy, for everyone else – not so much.

Worried about those expenses out of your pocket? Well there are HRA’s on offer and more “defined benefit” possibilities.   In short, instead of having several comprehensive health care plans to choose from, a person could also ‘choose’ to be involved in HDHP/HSAs and HRAs and other privatization schemes. 

Question for Congressional Representatives:  What in this plan insures that the health care insurance will be truly comprehensive? Affordable? Affordable for those families having Nevada’s median income around $50,000 per year?

Secondly, there is still the question of what portability means in practical terms.

“…our proposal is like a health care “backpack” that provides every American access to financial support for an insurance plan chosen by the individual and can be taken with them job-to-job, home to start a small business or raise a family, and even into retirement years.”

ProblemWhat’s going to be “portable?”  If a health care plan is to be truly national, then does this mean that there will be a lowest common denominator for all health care insurance plans?  Will the plan acceptable in a state with little or no oversight and consumer protections become the national standard? And, if not, then what IS the standard supposed to be?

Another problem: What elements of a health insurance policy must be included for the plan to be acceptable?  One of the advantages of the ACA requirements is that some coverages (mental health, pregnancy, etc.) don’t apply to all consumers – however, if we start cutting out elements of comprehensive coverage where does it end?

Questions for Congressional Representatives:

(1) If a health care plan is portable across state lines, then do the consumer protections in place remain enforceable?

(2) If a health care plan is considered “junk insurance” in one state can it be enforced in another state with higher consumer standards?

Third, there’s the Medicare, Medicaid issue.

Depending on who is doing the talking from the Republican side these programs are either failed or failing.  Neither is true.  However, nothing is preventing Speaker Ryan from offering Coupon Care in place of the Medicare program, and from proposing turning the Medicaid support into a block grant program with formulaic funding.

Questions for the Congressional Representative:

(1) The ACA actually extended the viability of the Medicare program, what in the GOP plan will insure this viability is extended?

(2) If funding for Medicaid is turned into a block grant program what provisions in your plan would prevent this funding from being cut?

Senator Heller and Representative Amodei may be waiting for the GOP to come up with a rational and comprehensive plan to replace the ACA and Patient’s Bill of Rights – I’d advise them not to withhold breathing.  Or, if they are assuming there’s nothing on offer from the GOP side since June 2016 – sort of a budget without numbers in health care terms – they may never have to have anything to say to their constituents. 

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Filed under Amodei, Health Care, Heath Insurance, Heller, Nevada politics, Politics

They can run, but they can’t hide: Me’thinks there’s a pattern here

It seems to be getting warm in those venerable town hall meetings, the ones in which the Congressional Representatives bask in the warm glow of their constituent’s adulation, until, of course things get TOO warm. There’s nothing unusual about Representatives and Senators taking meetings with groups of constituents, for example Republicans meeting with corporate leadership, Democrats with leaders of civic and labor organizations.  However, there’s a point at which larger gatherings are appropriate, unless, of course, the Representative can apply some of the following dodges.

The Ostrich Strategy

The strategy is simplicity itself: Insert head into sand, cover ears and wait for the danger to subside. It appears this strategy is in current vogue. Consider the following information, in the first two months of the 115th Congress 292 Republicans have scheduled just 88 in person town hall events (35 of these are accounted for by Rep. Jim Sensenbrenner, Wisconsin). In the first two months of the previous Congress Republicans held 222 in person town hall events. [vice]* a subscription to Legistorm provides basic information on Congressional activities.

The Venue Shell Game

Senator Tom Cotton appears to be managing a version of this dodge.

“The meeting was first scheduled to take place at The Jones Center in Springdale on Wednesday, Feb. 22. Due to the high number of people to attend, the venue was changed to the Arend Arts Center at Bentonville High School.

On Monday, Bentonville Public Schools said the “tentatively” scheduled Town Hall with Cotton will not be at the Arend Arts Center due to “insufficient time to make arrangements for the visit.” [nwahome]

If they can’t find you…they can’t find you. Works every time.

The Long Distance Runner Game

Representative Mark Amodei (R-NV2) scheduled a town hall meeting a short while ago, with perhaps an eye towards minimizing the possible aural damage, in Winnemucca, NV. Now this is nothing against Winnemucca, it’s a nice town, it is also conveniently located some 166 miles from the Reno-Sparks metropolitan area, and 123 miles from Elko.

We can guess that Representative Amodei isn’t the only one adopting this strategy. He may also have been applying another element, as described below.

The Private Audience

There’s nothing so comforting as a meeting among friends.  So, invite only your friends. Again, timing is important here. Private sessions are absolutely nothing new, and nothing uncommon.  However, optics and timing are important.  If the times call for open town halls and imaginary Representative Bilgewater fears for his ears, then it’s time to call a session with the local Chamber of Commerce; should hypothetical Senator Sludgepump fear for his, then it’s time to meet with the Conservative Pet Lovers of East Deer Breath.

Senator Heller and Representative Amodei are reported to have a Chamber meeting in Carson City tomorrow, and a signage demonstration is planned for 10:30 am at the Gold Dust West.  Notice, this is in Carson City, 31 miles from the Reno-Sparks area.  What can’t be ignored is that there are no reports of Heller and Amodei open town halls in that Reno-Sparks area (the majority of voters in District 2) and in Las Vegas, the largest metropolitan area in the state Heller represents.

The Telephone Town Hall Scam

Senator Heller has employed this one in the not so distant past.  It goes like this.  Have a telephone conference call from which questions are solicited from the public.  However, the fog descends almost immediately. Are the questions pre-screened?  There’s no way to know with absolute certainty, but someone has to be taking the calls like a radio call-in broadcast so chaos doesn’t happen.  Thus, it isn’t too hard to imagine that some pre-screening is happening.

These town halls can also be re-cycled.  The contact with the constituent begins with “You are invited to participate in Senator Sludgepump’s telephone town hall. If you have a question for the Senator press (number) and give your name and address…)

It doesn’t take too many conversations to figure out that if Constituent A heard the town hall on Monday evening, and Constituent B heard the same town hall on Tuesday evening, then we can assume people have been listening to a canned recycling of a political campaign pitch.  Hardly a town hall.

A truly creative Representative might avoid town hall settings until (1) forced to announce a venue, subject to immediate change because of the response, and (2) change the venue enough times to challenge the social media capability of constituents to respond. Then (3) settle upon a venue in beautiful downtown Moose Butt Butte miles and miles and miles from the nearest metropolitan area. Should this not work (4) set up those old phone bank lines, record, lather, rinse, repeat. Lather, blather, rinse, and repeat.

There are work-arounds

If the Congressional members won’t host a meeting DIY. Schedule a venue, invite the Congressional representative, advertise, publicize, inviting members of the local press. If the representative won’t turn up, then have the meeting anyway, recording all the speakers who had questions. Share with the local press, and social media.  Why not?

Call the Congressional representative’s office.  Leave your message.  Politely ask the staffer to leave your message of the day – and yes there’s nothing wrong with doing it daily. After all, how is your Representative supposed to know what you’re thinking if you don’t communicate, and surely there’s enough fodder for at least one phone call per day.

Representative Amodei’s  local phone numbers are: Reno 775-686-5760; the Elko office number 775-777-7705. Heller’s phone numbers are: Las Vegas 702-388-6605, Reno 775-686-5729.

Phones can go to voice mail, and voice mail can be “full,” but never fear, the mail will always get through. Since after the anthrax attacks of yore regular snail mail is very slow, but post cards are much faster:

Amodei: 5310 Kietzke Lane, Suite 103, Reno, NV 89511 and 905 Railroad Street #104D, Elko, NV 89801.

Heller: 8930 West Sunset Road #230, Las Vegas, NV 89148, or Reno: Thompson Federal Building Suite 738, 400 South Virginia St, Reno, NV 89501

For more suggestions and guidance go to Indivisible! Sign up. Enjoy.

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Filed under Amodei, Heller, Nevada politics, Politics

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.

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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?

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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?

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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.

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