Category Archives: Medicaid

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

What Nevada Loses under Trump-Doesn’t-Care

Here’s what Nevada loses under the egregious Trumpcare Bill:

(1)  138,100 citizens in Nevada will lose their health insurance coverage.

(2) 81,000 Nevadans will lose their Medicaid coverage.

(3) 439,000 Nevadans with pre-existing conditions will be put at risk.

(4) The bill cuts funding for care for 125,056 Nevadans with disabilities.

(5) It would raise the average health insurance premium for Nevadans by $677 in 2018.

(6) $288 million in new costs will be added to Nevadans in order to keep their Medicaid expansion.

Not a very good deal for the Silver State!

Call. Call. Call Senator Dean Heller.  702-388-6605    775-686-5770    202-224-6244

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Filed under health, health insurance, Heller, Medicaid, nevada health, Nevada politics, Politics

Caring for Grandma on the I-80 Corridor

Republican “reforms” of Medicaid, which seem to be composed of stalling funding until the program can be gutted in 2025, could easily have a negative impact on those families trying to find skilled nursing care for elderly relatives along the I-80 corridor in northern Nevada.  As noted in the previous post, health care facilities in northern Nevada have service areas of miles and miles of miles and miles.  The euphemistic term “remote rural” is especially pertinent in this instance.  These may be the “cow counties” but they do include a significant number of individuals over the age of 65.

By The Numbers 

Pershing County (Lovelock) has a total population of 6,560 of which 14.8% are over 65, and 11.1% of those are disabled individuals under the age of 65.  Humboldt County (Winnemucca) population of 16,842 includes 11.9% over 65 and 8.3% under 65 disabled. Lander County (Battle Mountain) has 5,702 people, of whom 13% are over 65 and 6.5% are disabled.  Eureka County (Eureka) is a small entity with 1,917 people of whom 12.9% are over 65, and 6.6% are disabled.  More populous Elko County (Elko) with 52,168 people has an over 65 population of 10.0% and 8.4% disabled individuals.  Churchill County (Fallon) has a population of 24,198 of whom 18.7% are over 65 and 6.5% are disabled.

For the sake of this analysis, let’s assume that the families would like to find skilled nursing facilities for their elderly relatives closer to home than securing similar residences in the Reno/Sparks/Carson City area.  That means finding skilled nursing facilities in the towns listed above.  Elko County has such a unit with room for 110 residents, Fallon has a facility with a capacity for 74 residents.  Lander and Eureka counties are served by a facility in Battle Mountain with a capacity of 18.  Pershing county has one facility with a capacity of 25 residents, and Winnemucca has a skilled nursing facility for up to 26 residents. [Links]  We’re speaking in numbers at present, but it’s important to remember that those numbers are specifically associated with real people, and very real families who are seeking affordable quality care for those individuals.

The cost of skilled nursing care will vary with the level and type of medical or rehabilitative services required, however we can generally assume that the monthly price tag for SNF care in Nevada is about $8,213.  Drilling down a bit deeper, the reported minimum cost per month for Skilled Nursing Care in a semi-private room is about $3,346; the median is $7,128; the maximum is $8,425.  Private rooms come at a minimum of $4,106, a median cost of $8,213, and a maximum cost of $15,452.  [SNF]  At this point another reminder is appropriate — these aren’t price tags, the numbers represent what a family might have to pay for care specific to the needs of their elderly relatives.

And now we return to the numbers.  In the State of Nevada 1 out of every 7 persons over the age of 65 is covered by Medicaid. Medicaid covers 3 out of every 5 nursing home residents. [KFF]  Consider for just a moment what would happen to the fiscal solvency of the residential facilities listed above in the rural counties if Medicaid is cut, then “reformed” into block grants (which can be further cut by Congressional action) and finally all but reformed out of existence by Republican representatives.

Mythology

Let’s work on some of the elements of Republican mythology commonly associated with their efforts to slash the Medicaid program.

(1) It was only originally intended to cover the “really poor.” Republicans have an interesting way of defining “poverty.”  Several reports of recent memory decry the fact that people on various welfare programs have CARS (to get to work) and REFRIGERATORS (which come with most furnished apartments.)  Left to their own devices it’s easy to imagine that unless a person is naked, living rough in the bush, and starved into semi-consciousness the individual wouldn’t qualify as “poor” by some Republican standards.  That said, Medicaid isn’t really a welfare program — it’s essentially a health insurance program.  One way to extend this health insurance coverage was to apply income eligibility standards for publicly subsidized health insurance — for the low income families, for the aged and for the disabled.

(2) The states can do better because they are closer to the problems.   There’s a reason we have a federal system — there are some tasks which the states are not capable of adequately addressing.  Providing health insurance coverage for millions of Americans working at low wage jobs, who have disabled family members, who have aging family members, and have children in need of health care services is one of those objectives best addressed by federal resources.  Imagine if someone said the states can best determine what security is best for them?  Should we block grant the Defense Department budget, send it to the states and let them decide how to fund the elements of their National Guard?  This sounds ridiculous, and doesn’t the Constitution require government prioritization of our mutual defense? Yes, and it also provides that our government provide for our “general welfare.”

(3) We’re really not cutting anything.  No? When the inflation rate for the medical sector exceeds that of the other sectors of the economy, and budgeting or funding proposals don’t meet or exceed that inflation rate the end result is a cut.  It’s not mathematics, it’s just old fashioned arithmetic.  There’s also something disingenuous about continually clamoring for tax cuts (especially at the state level) and then offering that the states should pick up more of “their share” of program expenses.  Finally, it’s always easier to cut funds from “block grants” than it is from specific program budgets.  Yes, the Republicans intend to cut Medicaid; if it’s done slowly or quickly is beside the point — at some date the result will be the same.   Program cuts will affect those real people in those real skilled nursing facilities, both the staff providing the services and the residents who depend on them.

Senator Dean Heller should be aware of these issues, and if he isn’t perhaps he should receive some phone calls this week.  702-388-6605;  775-686-5770; 202-224-6244.

*And we still haven’t discussed the benefits of Medicaid supported home health care programs!

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

Rural Nevada Health Care and the Great Bamboozle AHCA

The state of Nevada consists of 110,567 square miles of miles and miles and miles.  271,985 people live in those miles and miles and miles out of a total population of  2,940,058.  A quick poke at the calculator shows a state in which 93% of the population is urban, while most of the real estate is rural.   This situation poses some easily apparent problems for health care services and the delivery thereof.

Rural health services must literally cover wide spans of territory in which there is a small population.   There is one hospital in Battle Mountain (Lander County, NV) to serve a total population of 5,702.  There is one hospital in Winnemucca (Humboldt County, NV) serving a total population of 16,528.  There is one hospital in Lovelock (Pershing County, NV) with a total population of 6,753.  There is one hospital in Elko (Elko County, NV) serving a population of 48,818.  Two conclusions can be reasonably drawn from this quick view of the northern tier of rural counties: (1) In none of these areas can a hospital draw upon “economies of scale” in terms of hospital services.  The obvious example may be that an expectant mother will usually require the same obstetric services in Battle Mountain, as in Winnemucca, as in Las Vegas or Reno.  (2) These rural hospitals serve populations which are generally not as affluent as in urban areas;  the rural per capita income lagging slightly behind urban areas. [RH] This places the northern tier of counties in a predicament similar to other western states:

“In the rural West, many farmers, ranchers and other agricultural workers are self-employed, so they can’t get coverage through an employer. Hence, a higher percentage of agricultural employees are covered by Medicaid (11 percent) than in non-agricultural industries (8 percent). Before the ACA was enacted in 2010, workers in the agricultural sector had fewer options, so many remained uninsured. But under the Obama-era plan, many states expanded Medicaid, increasing the percentage of those covered. Under the AHCA, that expansion would be significantly scaled back, according to the Joint Economic Committee report.”

Thus, the National Rural Health Association issued this warning:

“Though most rural residents are in non-expansion states, a higher proportion of rural residents are covered by Medicaid (21% vs. 16%). Congress and the states have long recognized that rural is different and thus requires different programs to succeed. Rural payment programs for hospitals and providers are not ‘bonus’ payments, but rather alternative, cost effective and targeted payment formulas that maintain access to care for millions of rural patients and financial stability for thousands of rural providers across the country. Any federal health care reform must protect a state’s ability to protect its rural safety net providers. The federal government must not abdicate its moral, legal, and financial responsibilities to rural, Medicaid eligible populations by ensuring access to care.”

In short,  cuts to the Medicaid program will disproportionately affect rural health care providers serving rural populations.

But, but, but, sputter the advocates of the Republican offering — We’re Giving People A Choice — you can buy what you want!  Not. So. Fast.

“Though some provisions in the modified AHCA bill improve the base bill, NRHA is concerned that the bill still falls woefully short in making health care affordable and accessible to rural Americans. For example, the modified bill contains a decrease in the Medical Expense Deduction threshold from 10% to 5.8% in an attempt to assist Americans between the ages of 50 and 64 who would see their premiums skyrocket under the current plan. However, this deduction is not a credit and therefore would be of little use to low income seniors that are in very low tax brackets or do not pay income tax at all. Additionally, the new amendments to freeze Medicaid expansion enrollment as of Jan. 1, 2018, and reduce the Medicaid per-capita growth rate will disproportionately harm rural Americans.”

Well, that didn’t go well.  What about that “get what you want argument?”  The first question might well be — What can you afford?  The annual earnings of a farm or ranch owner (manager) in Nevada is reported at an annual mean of $91,970.  However, the range runs from 10th percentile $39,850 to 90th percentile $150,410.  The annual mean wage for a farm or ranch worker is $34,520. [BLS]  Nevada’s reported average annual mean for farm and ranch workers is slightly higher at $36,480. [DETR download] Now we have a problem — 138% of the federal poverty level is $16,374 for a single person or $33,534 for a family of four.   Our hypothetical average annual mean earnings for a farm or ranch worker isn’t eligible for Medicaid expansion enrollment, but has an income well below the Nevada average household income average of $52,431, or 63.96% of the annual average household income level.

How to market an insurance policy this hypothetical average family could afford?  Either offer a comprehensive insurance plan and provide premium assistance to make up the difference between what the premium costs and what the family can reasonably afford — or there’s always the Junk Insurance option.   Consumer Reports offered some excellent advice concerning what constitutes Junk Insurance — aka “affordable plans” —  watch out for fixed benefit indemnity plans, and medical discount cards.  Another Consumer Reports bulletin specified the elements of Junk Insurance, your insurance plan could be very hazardous to your physical and financial health if it contains: Limited benefits; Low overall coverage limits; unrealistic “affordable” premiums; No coverage for important health care services; Ceilings on categories of care; No limits on out of pocket costs; Random catches — like covering hospital care after the second day, when it’s known that the first day is usually the most expensive.

The problem at this juncture for rural Nevadans is that those in the agriculture sector may or may not have earnings allowing them to enroll in Medicaid.  If “yes” then a reduction in Medicaid — whether it happens now or just after the 2020 elections — will have a negative impact on many citizens in the northern tier of “cow counties;” similarly, a return to the Bad Old Days pre-ACA makes those who are certainly less than affluent vulnerable to the offerings of Junk Insurance, which is fine as long as they don’t mind paying for a product which will not cover their medical expenses at the time they actually need it.  Exacerbating this issue is the fact that jobs in agriculture (farming and ranching) are listed by Forbes as the 4th most dangerous occupations in the country.

There’s no way to bestow a bright face to the Republican tax cut disguised as a health insurance ‘reform’ bill in terms of what happens to rural Nevadans and their health care providers.  Those it doesn’t cut out completely it leaves vulnerable to incomplete and almost useless “catastrophic coverage” plans — which for too many policy holders leaves them facing health care costs well beyond their ability to pay for out of pocket.  If there were a recipe for increasing the “uncompensated care” costs for local hospitals and clinics this is definitely IT.  Rural hospitals and clinics, already stretched to meet costs, would be especially at greater risk — and we haven’t even touched on the topics of long term care for the aging or home health care services which prevent individuals from having to reside in more expensive residential care facilities in rural areas.

NOW is the time to contact, and continue to contact, our Senators (Heller and Cortez-Masto) and urge their opposition to this assault on medical care for northern Nevada citizens and their health care providers.

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

Heller Has “Concerns,” Let Him Know Ours

Nevada Senator Dean Heller has “concerns” about the TrumpDoesn’tCare bill, he’s had “concerns” before, however if the past is any indication we can expect that there will be some ‘change’ in the measure which will assuage his fretting and he will follow the directions from Senate Majority Leader McConnell and vote in favor of the GOP agenda. Thus far Heller has employed his “If it’s good for Nevada, I’ll vote for it” position — rather like the Yoga Headstand, Crow Position, Whatever — it means relatively little, indicating more often his Invertebrate Emulating A Specimen of Subphylum Vertebrata pose.

This health care bill isn’t good for Nevada.  In fact, it isn’t good for anybody.  Somehow, the dismal bit of legislation put forth after the secret sessions is suppose to address the needs of some 608,960 Nevadans who are currently enrolled in the Medicaid program.  These are people who are (1) aged (2) blind (3) low income, about $16,105 annual income for a single person, the income can be a little higher for (4) pregnant women, and (5) children from families in which the annual earnings are 200% of the poverty rate.   Even at the current level, Nevada still isn’t doing a masterful job of getting adequate health insurance coverage for children; we only have 70.6% of our eligible youngsters enrolled — among the lowest rates in the country.   The result of the GOP bill:

“Nevada’s current total Medicaid spending is about $6.4 billion, but the state only pays $1.1 billion of that; the rest is picked up by the federal government (for the population that was already eligible for Medicaid pre-ACA, the state pays a higher percentage of the cost than they do for the newly eligible population; for people who are newly eligible for Medicaid under the ACA, the federal government paid 100 percent of the cost through 2016, and is now paying 95 percent of the cost).

If Medicaid expansion is repealed and replaced with something that cuts federal funding below what the state currently receives, there are concerns that people could lose coverage or benefits could be cut. House Republicans’ proposal to transition Medicaid to block grants or per-capita allotments would almost certainly result in reduced federal funding.”

Any questions?  No matter if the expansion phase out is 3 years, 10 years, 15 years, a cut in funding is inevitably a cut in benefits (a cut in the insurance coverage) for Nevada citizens.

The analysis is terse and to the point:

“The Senate bill would also cap overall federal spending on Medicaid: States would receive a per-beneficiary allotment of money. The federal payments would grow more slowly than under the House bill starting in 2025. Alternatively, states could receive an annual lump sum of federal money for Medicaid in the form of a block grant.

State officials and health policy experts predict that many people would be dropped from Medicaid because states would not fill the fiscal hole left by the loss of federal money.

“The Senate bill creates an illusion of being less draconian than the House bill, but is arguably more so” on Medicaid, said Sara Rosenbaum, a professor of health law and policy at George Washington University.”

“Illusion” is the correct term, there’s an illusion that Medicaid would not be decimated by Republican health insurance and federal budget proposals, accepting this illusion is delusional.  The AARP succinctly summarized the issues with the Medicaid cuts:

“The proposed legislation would also make huge cuts to Medicaid by taking $880 billion out of the program by 2026. How? By, among other things, fundamentally changing the way the program is funded. Under the AHCA, Medicaid funding would move from a federal guarantee to match all legitimate state expenditures on health care and long-term services and supports (LTSS) for eligible beneficiaries, to a capped payment system that would give states a fixed dollar amount per enrolled beneficiary.[i]  Although per-enrollee caps respond to changes in enrollment, they do not respond to increases in health care costs attributable to medical or pharmaceutical innovation, nor do they respond to other changes in the health care environment that could affect per-enrollee spending. Health care costs, we all know, are notorious for their rapid rise. The result: an ever-widening gap between cost and funding.”

Merely, delaying the onset of this “ever widening gap” is a callous statement that tax cuts for the wealthy are of greater importance to Republicans than extending health insurance coverage for Nevada citizens.

Contact Senator Heller at 202-224-6244, or 702-388-6605, or 775-686-5729

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Filed under Health Care, health insurance, Heller, Medicaid, Politics

Amodei’s Bubbles: Republican Dreams for the AHCA

Nevada Representative Mark Amodei (R-NV2) is eager to let his constituents know that the District will not be negatively impacted by the GOP health insurance/tax cut bill currently being drafted in secret on Capitol Hill.  Not. So. Fast.

First, there will be losses.  Total coverage losses are projected to be felt by 37,500 under the AHCA, and 5,700 of those will be children, another 700 are disabled individuals in District 2.   Representative Amodei is optimistic about what will happen to these constituents —

Any Nevadan who has enrolled in the expanded Medicaid program from its inception in 2014 through the end of 2019 is free to remain in the program so long as their income does not exceed 138% of the national poverty level; …

In short, according to Rep. Amodei, his constituents are to be carefree and happy about their health insurance coverage until the end of 2019.  It’s now 2017.  Thus the recipients are to be reassured for another two years because:

  • Nevada will continue to receive the enhanced federal Medicaid funding for enrollees that it is currently receiving for as long as that enrollee stays in the program;

  • Present expanded enrollees lose eligibility only if they exceed income of 138% of the national poverty level, or if they elect to take employer provided or private health insurance;

Lovely, until we peek into the House version (the basis for the Senate version) and find:

“Medicaid provides coverage for over 70 million individuals and relies on both federal and state funding to continue growing. Under current law, the federal government covers, on average, 57 percent of each state’s total Medicaid costs, no matter the amount. The states pay for the remainder.

In contrast, under the AHCA’s per capita cap Medicaid program, starting in 2020, the federal government would provide states with a flat, capped dollar amount of funding for each person they enroll. The dollar amount is based on states’ 2016-level per-enrollee spending.”

One way to interpret this is that the District’s enrollees will be fine for the moment, but should be aware that the sword labeled ‘the Medicaid Per Capita Lid’ is swinging over head.  This has the potential to burst the first of Amodei’s bubbles.

Secondly, there’s this part of Representative Amodei’s eternal optimism:

“While we understand that Medicaid Expansion will eventually be phased out, we expect the recovery of our economy to continue, giving us reason to believe we will not need as robust of a safety net as we once needed at the height of the recession.  Additionally, with Nevada leading the nation in job growth in 2016, we also can expect employer-based coverage to become available to more people.”

A bit of confusion reigns here — don’t worry about Medicaid expansion cuts because Nevadans will be covered — but notice that the Medicaid expansion will “eventually be phased out.” One really doesn’t get to have it both ways.  But, there’s more.

Yes, the Gallup 2016 Job Creation Index gives Nevada top marks for job creation, but remember that this polling is based on asking workers if the employer is increasing hiring.   It is also statewide.  If we drill down we find positive news, but an incomplete picture.

“Employment increased in Nevada’s two large counties from September 2015 to September 2016, the U.S. Bureau of Labor Statistics reported today. (Large counties are defined as those with 2015 annual average employment of 75,000 or more.) Washoe County’s employment rose 5.0 percent and Clark County’s employment rose 3.7 percent.” [BLS]

What we are required to believe  is that employment increases in District 2 will be sufficient to cover some 37,500 people who will need to find employer paid insurance coverage by 2020.  Exactly how this is supposed to happen isn’t all that clear.

There are too many “ifs” in the proposition to adopt it with any enthusiasm.  IF there is continued employment increases — in the face of the financial deregulation legislation in the House and Senate which threaten to recreate the Wall Street Casino environment that wrecked Nevada’s economy in 2007-2008.  IF the employment increases in the rural portions of District 2 are sufficient to put Medicaid expansion enrollees into employer plans.

And then, there are the problems intrinsic in the AHCA in the employer sponsored insurance plans.  Those believing that the AHCA will deliver the same level of health insurance coverage in employer sponsored plans as the ACA may be in for a rude shock.

“The amendment (to the AHCA) would allow states to apply for waivers to rescind two major regulations of Obamacare, if the state can prove that healthcare costs would decrease as a result. That has led to concerns about its potential effects on the individual insurance market, but it could also change insurance for people that get coverage through their employers.

One of those Affordable Care Act-implemented protections — called essential health benefits (EHB) — requires insurers to cover a baseline of 10 health procedures and items including emergency-room visits, prenatal care, mental-health care, and some prescriptions.

Under Obamacare, employer plans could not place a lifetime limit on the amount that the plans pay out on EHBs, and required plans to limit the amount of out-of-pocket costs an employee had to pay annually, according to The Journal. That made plans more costly for employers but also provided better coverage for employees.”

Thus, there are three problems — junk plans might be back in the market; essential benefits can be reduced; and lifetime and annual benefit limits could be reintroduced.  We can safely assume that Representative Amodei’s analysis contains the usual measure of Trickle Down Happy Talk (if only the tax cuts are big enough all employers will hire enough people to make the magic happen! — See Kansas) and assumptions which sound superficially rationale but don’t hold up to much scrutiny.

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Filed under Amodei, health insurance, Medicaid, nevada health, Nevada politics, Politics

It’s Going to be Fabulous!

If the question is: “What’s going to be fabulous?” The answer is probably nothing.  Thus far the administration hasn’t delivered on much.  Sights! Sounds! Drama! notwithstanding, it’s Shakespearean “Sound and fury, signifying nothing.”

The Muslim Travel Ban met yet another defeat on its way to the Supreme Court.  Supposedly it needed to be enacted Immediately to prevent the Threat of foreign terrorists, but time has passed (along with the time the Muslim travel ban was supposed to be in effect, during a study period) and behold a plethora, a horde, of heretical fanatics didn’t launch an assault.  Nothing there.

The wall seems like a distant memory,  as much fantasy as the idea the Mexican government was going to pay for it — IT, the wall, fence, river boundary, natural obstacles, or whatever.  Nothing there

The President’s first executive order called for the repeal of the Affordable Care Act, and authorized agencies to grant waivers, but pointedly did NOT offer to infringe on “authority granted by law to an executive department or agency, or the head thereof.” Other Executive Orders follow the same pattern. Call for the study of some topic, require a report, and then infer that the report would be fodder for legislation. Perhaps the closest analogy to these orders might be a Christmas List — “Dear Santa, please bring us justification for the following rule changes or legislative priorities.” Lots of smoke and mirrors, without much there there.

An important point to note in terms of the Republican version of health insurance “reform” is that it is far more about tax cuts for those earning over $200,000 than it is about making health insurance affordable for average Americans.  See also: Vox and Atlantic, Forbes.  The median household income in Nevada is $52,431.

And speaking of Nevada — what can we expect?

“371,000 Nevadans stand to lose their health coverage.1

Nevada stands to lose $16 billion in federal assistance to help provide health coverage to its residents.2

Approximately 71,000 Nevadans who currently get financial assistance to help pay for their health coverage will lose this help and will no longer have affordable coverage options. In 2016, Nevadans receiving financial assistance saw their monthly premiums reduced on average $268 thanks to this help.3

The now-historically low rate of uninsured people will spike, with the number of uninsured in Nevada increasing 95 percent by 2019.4 This will reverse the immense progress that has been made to expand coverage. Between 2013 and 2015″

And there’s more:

“187,000 people stand to lose health coverage, most of whom are working.6 The Medicaid expansion has extended health coverage to lower-income Nevadans who hold down jobs that are the backbone of the state’s economy—from fast food workers to home care attendants to construction workers to cashiers. Repeal will leave these hard working Nevadans out in the cold.

Nevada will lose billions in federal Medicaid funding. Over the course of a year and a half alone, Medicaid expansion brought $1 billion in federal dollars into the state economy.7 The impact of that lost federal Medicaid funding will have a ripple effect throughout the state economy, affecting hospitals, other health care providers, and businesses.”

And More!

“The Medicare donut hole will re-open. This will leave Nevada’s seniors and people with disabilities with a gap in prescription drug coverage and forced to pay thousands of dollars more in drug costs.

  • Seniors and people with disabilities in Nevada have saved approximately $123 million on drug costs thanks to the ACA’s closing the Medicare donut hole.14

  • In 2015 alone, approximately 34,000 seniors and people with disabilities in Nevada saved on average $967 on drug costs.15″

Nothing in this truncated list of horror makes it sound like Republican health insurance legislation will be Fabulous.  Unless, of course, we mean “fabulous” in the sense of some gory fable designed to send small children to the floor while checking for monsters under the bed.

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Filed under Health Care, health insurance, Medicaid, nevada health, Politics, Taxation