Category Archives: Medicaid

Scary Stuff Indeed

Yesterday was an extremely interesting day, replete with all manner of scary stuff compliments of social media platforms and a Special Counsel. However, not all of the frightening items were associated with the Trump Campaign’s eagerness to get the produce of Russian hacking, and Russian assistance.  Here’s some other stuff in the GOP treat basket:

ICE again proves its ultimate heartlessness and horrifying lack of understanding of what it means to “protect” Americans; illustrated by the case of Rosa Maria Hernandez — a ten year old with cerebral palsy undergoing gall bladder surgery.  And, this isn’t the only case — there was the story of parents arrested while their child was having brain surgery, the arrest of an undocumented Iraqi man who was serving as a bone marrow donor for his niece, and a brain tumor patient pulled from a hospital.  ICE thus becomes the ultimate Halloween Scary Story.  Candidates for public office ought to be ask outright how they would assist in the process of getting immigration officials to adhere to their own guidelines on “sensitive locations.’

Nobody in the GOP appears to be all that outraged that the Trump Campaign not only accepted assistance from the Russians, but actively sought to get the goods on Secretary Clinton from Russian sources.  This isn’t normal, or even paranormal — it’s the kind of thing that would make any other campaign (Democratic or Republican) call the FBI if the Russians showed up at the door with treats.  But still, #45 refuses to accept the fact that the Russians at least meddled and at most attacked the US with campaign “assistance” — social media help; opposition research; and, (the part we keep ignoring) attempts to hack into the voting systems of at least 21 and possibly 39 states.  We do need much more attention paid to the last item on the list since the Cult-45 group persists in saying this is a Spook, there’s nothing to see here.

Somehow a tiny company in Montana got a whopper contract, now cancelled, to supply power to the entire island of Puerto Rico.  Nothing puts a place like Whitefish, Montana on the map like having the Secretary of the interior stammering he’s nothing to do with this — and if I believe this then you could easily get me to believe that all the little spookies at the door are Real!

It’s been 30 days since the tragic Las Vegas Shooting, and what has the Congress done to limit high capacity magazines? Bump stocks? Anything?  This month has been a nightmare for the families of the deceased, and the families of the injured.  The nightmare will continue until politicians stop being terrified of the National Rifle Association.

Republicans have been unable to explain away the specter of Opioid Abuse while cutting massive amounts of funding from Medicaid.  The GOP budget calls for cutting some $1.5 trillion from the program over the next decade — while 30% of opioid treatment is covered by Medicaid insurance.   States, already strapped by the crisis will have to either come up with more funding or ration care — speaking of Death Panels…

The Senate of the United States believes that individual Americans are perfectly capable of taking on The Big Banks all by themselves — Super Heroes in Litigation.  So, on October 24, 2017 the Senate voted to dismiss a CFPB rule that would have allowed class action law suits against the Big Banks by ripped off customers; forcing those customers into individual arbitration.  Senator Dean Heller was pleased to vote in favor of this nightmare.

This list seems long enough to send sentient beings into the closet for the Halloween Season, one almost shudders to think what more the Republicans have in mind — like the tax cuts for the 1% and questionable benefits for the rest of the population…

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Filed under anti-immigration, Gun Issues, Immigration, Medicaid, Politics

Senator Heller’s Second Shot at Slashing Medicare and Medicaid

“This morning, the Senate Budget Committee will consider a resolution that instructs lawmakers to find ways to reduce Medicaid spending by $1 trillion (and Medicare spending by $473 billion) over the next decade, according to supporting documentation that Democrats are publicizing.” [WaPo]

Here’s the strategy: “A fast-track “reconciliation” process that would allow for tax cuts costing $1.5 trillion over ten years that require only a simple majority to pass.  The $1.5 trillion cost would not have to be offset by closing tax loopholes or ending unproductive tax breaks, and thus would add to the nation’s deficits, which are already growing as the baby boomers retire.  In addition, the resolution would allow the Senate Finance Committee to cut critical programs under its jurisdiction, including Medicaid, Medicare, and basic assistance for poor seniors and people with disabilities, and then use those savings to make the tax cuts even larger (so that the net cost of the tax cuts and the budget cuts combined equaled $1.5 trillion).  The reconciliation process is the same process that Congress tried to use to repeal the ACA and requires only a simple majority to enact law.”  [CBPP] (emphasis added)

And, there we have it: (1) If it’s a Republican budget, then adding to the federal deficit doesn’t matter; (2) in order to provide for tax cuts to the top 1% of income earners in the United States, the Committee can slash funding for Medicaid, Medicare, basic assistance for senior citizens, and people with disabilities.

The trick is that the Senate Republicans have to pass a “budget” slashing spending for those aforementioned Medicare and Medicaid beneficiaries, elderly people in poverty, and disabled people, in order to create ‘space’ for the “reforms” in their tax legislation.  The buck slashing needs to stop here.

Please contact Senator Dean Heller, and let him know that these are not Nevada priorities.

202-224-6244

702-388-6605

775-686-5770

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Filed under Health Care, Heller, Medicaid, Medicare, Nevada politics, Politics

While We’re Ducking and Dodging

While we’re ducking, dodging, and otherwise attempting to avoid damage from the GOP, they’re still busy with legislation to make our lives just a bit more difficult.  Cases in point:

The House leadership has delayed, but hasn’t promised to discard, a bill, HR 367, to allow the general sale of silencers — which the proponents tell us will mitigate hearing loss for gun owners.  Pro Tip: A nice pair of headset style ear protectors will set you back about $30.00 (if the foamies will do you can buy’em for about 12 cents each in a bucket of 200) as opposed to spending $1300.00 on a suppressor for your AK/AR-some number or another.

The GOP tax cut legislation, which somehow is being titled “reform,” is a walloping giveaway to the top income earners in the U.S.  Not sure about this? See the Institute on Taxation and Economic Policy, that tells us those in the bottom 20% will see 1.3% of the tax benefits while the top 1% will enjoy 67.4%. Bringing this closer to home, the top 1% of income earners (which amounts to about 0.4% of our population) will get a 70.7% share of the tax cuts. For all that chatter about the Middle Class, the plan doesn’t really help middle class Nevadans:

“The middle fifth of households in Nevada, people who are literally the state’s “middle-class” would not fare as well. Despite being 20 percent of the population, this group would receive just 4.6 percent of the tax cuts that go to Nevada under the framework. In 2018 this group is projected to earn between $38,900 and $60,600. The framework would cut their taxes by an average of $380, which would increase their income by an average of 0.8 percent.”

Just to put this in context, a family in Nevada’s middle income range would see a tax cut of about $380…meanwhile back at the home mortgage, if that family is in Reno where the average home loan is about $187,000, the monthly payments are about $855 per month.  Congratulations Middle Class Nevadans, you may receive an annual prize of 44% of one month’s mortgage payment.  Color me unimpressed.

The GOP passed its version of the FY 2018 budget on a 219-206 vote.  Representative Mark Amodei (R-NV2) voted in favor of the bill; Representatives Kihuen, Titus, and Rosen were in Las Vegas attending to their constituents in the wake of the massacre at the music concert.   The AARP was quick to notice that the Republican plan calls for $473 BILLION to be cut from Medicare over the next 10 years.   Expect a cap on the Medicaid program funding; it wouldn’t be too far off to estimate cuts of about $1 TRILLION in that category.   Beware when Republicans speak of “entitlement reform,” that simply means cutting Social Security benefits and Medicare.  When they say “welfare reform,” they often mean cutting Food Stamps, Housing Assistance, and Medicaid.   Representative Amodei might want to explain why he supports cutting Medicare by $473 billion over the next decade?

Those in Nevada’s 2nd Congressional District can reach Representative Mark Amodei at 202-225-6155 (Washington DC) 775-686-5760 (Reno), or 775-777-7705 (Elko);  the office addresses are — 332 Cannon Building, Washington, DC 20515; 5310 Kietzke Lane #103, Reno, NV 89511; 905 Railroad Street, Ste 104D, Elko, NV 89801.

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Filed under Amodei, Economy, Federal budget, Health Care, health insurance, housing, Medicaid, Medicare, Nevada, Nevada economy, nevada health, nevada taxation, Politics, Republicans, Taxation

GOP assault on health care in rural Nevada

There’s a tendency to see social needs as an element of urban living in major cities like New York City, Los Angeles and Chicago, and rural poverty as something that happens in Appalachia.  This perspective obfuscates two features of life in Nevada.  For all intents and purposes Nevada is an urban state.  Not only is Nevada “urban” it is getting more so.  In 1970 about 80.9% of Nevada residents lived in urban areas, in 1990 the percentage was 88.3, and as of 2010 the percentage was 94.2% [ISU.edu]

By contrast, New York state as of 2010 was 87.9% urban, and Illinois 88.5% urban, while Nevada is closer to California’s 95% urban population. [ISU.edu]  However, to perceive rural Nevada as a wonderland of “freedom” and rugged individualism is to miss some crucial figures describing life in the “cow counties.”

For example, Pershing County has an 18.3% poverty rate; the US poverty rate is 12.7% [census] but the county does support a critical care hospital with a skilled nursing facility  with a maximum capacity of 25 residents.  The county’s population also includes 11.1% disabled people under the age of 65.   Given these figures, perhaps some politicians would like to explain why slashing Medicaid now and all but eliminating the national program by 2027 would be a good idea for Pershing County, Nevada.

Neighboring Humboldt County has a lower poverty rate, at 9.4% and a lower rate of disabled individuals under the age of 65 at 8.3%, but reducing the Medicaid program would have a deleterious effect on its 53 bed hospital, with an ICU, Obstetric services, and skilled nursing facility for 30 residents.  What effect of cutting Medicaid might be seen in the county’s ability to care for its aging population, including its hospital’s plans to incorporate a “memory care services unit” in its offerings?  [hgh] Recall that some 60% of all skilled nursing home residents get their health insurance coverage from Medicaid.

More populous Elko County has a poverty rate of 9.9% and an 8.4% rate of individuals with disabilities under the age of 65.  The county is home to a short term acute care hospital with 59 beds, and a resident center for 110 people needing skilled nursing care.   Again, if 60% of those SNF residents rely on Medicaid for their insurance coverage then cutting funds in 2027 then 66 families will be under increased pressure to find suitable and appropriate care for elderly family members.

Now, consider that Nevada is an urban state, and that should the Republicans get their wish for a capped Medicaid system of block grants then the state would be tasked with allocating increasingly spare resources to maintain nursing home and hospital facilities statewide.  Given the 2.115 million people in Clark County contrasted with the 52,168 population of Elko County, the 6,650 in Pershing County, and the 16,842 in Humboldt County — where are the monetary resources likely to go?

If Congressman Mark Amodei (R-NV2) and Senator Dean Heller are truly representing the needs of rural Nevada, then offering platitudes about “freedom,” “free enterprise,” and “individual initiative” are a poor substitute for enacting legislation to maintain and improve the health care facilities and the insurance availability to those facilities for northern Nevada rural citizens.

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

It’s not over until the fat lady sings adios to the current Congress

This is your Monday morning reminder that Republican attempts to kill the Affordable Care Act and Medicaid aren’t history.  The Graham-Cassidy Bill, which would mean a net loss of coverage for 243,000 Nevadans, still lives, and at long as it does so we have to keep those phone lines busy.

Please let Senator Heller know that his latest attempt to foist off a “Repeal and Replace” effort onto Nevadans is actually worse than his last performance on behalf of the Senate’s “skinny bill.”

“Graham-Cassidy’s impact on coverage in 2027 would be similar to that of the Obamacare Repeal Reconciliation Act (ORRA), the so-called “repeal and delay” bill that the Senate failed to pass in July. Under both the ORRA and Graham-Cassidy, these three major policies would be in effect a decade from now:

  • Repeal of the mandates for individuals to obtain health insurance coverage and large employers to offer insurance

  • Elimination of subsidies for nongroup health insurance

  • Elimination federal funding for the ACA’s Medicaid expansion” [CAP]

No individual or employer mandates to stabilize the insurance market, no assistance for those trying to find insurance in the private market, and the loss of Medicaid assistance for working Americans.  And, why all of this effort?

The Republican plan to lower taxes for those in the top 1% of American income earners won’t “add up” without cutting help for average Americans under the ACA and without pulling the rug out from under those (including retirement center residents and children) who are insured by Medicaid.

Senator Heller can be contacted at:  202-224-6244; 702-388-6605; and 775-686-5770

You may also want to thank Senator Catherine Cortez Masto for her support of Nevada families who rely on the ACA and Medicaid for their health care insurance needs.  202-224-3542; 702-388-5020, and 775-686-5750.

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

It’s Official: GOP Hates Women — Scamcare Edition

In case there’s anyone left who thinks the Republican Party is representing the needs of women in this country, the contradiction is right in front of us in the form of the Graham-Cassidy+Heller (tagging along) bill.

Amy Friedrich-Karnik, senior federal policy adviser at the Center for Reproductive Rights, pointed to a statistic from progressive think tank the Century Foundation that estimates 13 million women will lose access to maternity care services if the ACA is repealed. Friedrich-Karnik explained that the bill also blocks Medicaid patients from using Planned Parenthood, which bars access to essential preventative care like birth control, cancer screenings, and STD testing and treatment. “It also slashes Medicaid overall and into the future, and so really impacting particularly low-income women and women of color who rely on Medicaid broadly for their health care,” she said. According to the Kaiser Health Network, Medicaid pays for nearly half of all births in America and covers family planning services for 13.5 million women. [Jez]

Not only is the bill a golf ball shot to the back of the head for Nevada women, it could cost the state some $250 million in funding:

Specifically, the proposal would eliminate the marketplace subsidies and federal dollars that states that chose to opt-in to Medicaid expansion under the ACA, like Nevada, currently receive, replacing them with block grants to be doled out to states, which would be left with the responsibility of deciding how to spend that money. It also converts almost the entire Medicaid program to a per capita cap, under which the federal government would set a limit on how much it reimburses states per enrollee, and allows states to waiver certain provisions from the ACA that require insurance companies to cover certain services and bars them from placing annual or lifetime caps on coverage. [NVInd]

Got that? Nevada gets a per capita cap, AND insurance corporations could refuse to cover pre-existing conditions, maternity care, family planning, women’s health care services, AND the corporations could revert to that wonderful old scam — the lifetime limit on coverage.  This isn’t as bad as the former “skinny” bill — it’s worse.

Senator Heller might have wanted to give this version some thought before he inked his name on the paperwork to co-sponsor the bill, but he didn’t.

It’s understandable that Nevadans are tiring of calling, writing, and sign making, but if Republicans are nothing else they are persistent.  They’re counting on public apathy, ignorance, and fatigue.  Not this time. Not on American health care. Not on our watch.

Senator Heller’s Washington DC office number is 202-224-6244.  Calls are tallied, and at some point the number of calls opposing this iteration of scam-care needs to impinge on the amount of money Republicans are counting on from the Koch Brothers and other right wing radicals.

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

It’s A National Emergency, we think…

Since his attempt to revive Nancy Reagan’s “Just Say No” campaign in the face of a crisis in the increased addiction to opioid drugs in this country fell flat,  Dear Leader appeared to suggest the problem is a matter of law enforcement — a major mistake.  The genesis of the issue comes from the over-prescribing and over use of opioid medication once advertised as “virtually addiction free.”  Indeed, Purdue Pharma is still facing litigation from the state of New Hampshire over its advertising of Oxycontin. This, in addition to the 2007 guilty plea from the corporation for mislabeling the drug, and the payment of  $634.5 million to resolve a DoJ investigation.  Meanwhile, Nevada holds its unfortunate position in the top ten states when counting opioid death rates.  There were 224 overdose deaths in 2014, another 259 in 2015 [CDC] related to natural and semi-synthetic opioids; Nevada’s statistics were more bleak citing some 465 opioid related deaths in 2015.

Since we probably can’t arrest our way out of this mess, in Nevada or anywhere else, the answer in the long run is prevention (better guidance for physicians and tracking, combined with better public education on the nature of opioid addiction) and treatment.  And, for treatment, people have to have a way to afford it.

Medicaid has been a Godsend for many suffering through an opioid addiction.

“The authors of the report (Urban Institute) draw a parallel between the Affordable Care Act’s Medicaid expansion and spending on addiction medications, saying it has brought addiction treatment to previously underserved populations.

“What we saw was this gigantic, rapid, ongoing expansion in treatment,” says co-author Lisa Clemans-Cope. “It was particularly fast after 2014 when the big Medicaid expansion came into play. There’s definitely an effect of people getting access to treatment. That’s the primary driver of growth of spending.”

So, Medicaid spent more on treatment after 2014 – because more people were in a position to afford the treatment programs available to them.  Therefore, the next time a Republican politician stands before us with plans to slash Medicaid spending, and turn the Medicaid program into a block grant lottery for the states, we might well ask:  What does your proposal do to assist the states, like Nevada, deal with the treatment expenses of individuals trying to cope with opioid addiction and who are seeking assistance to make that treatment affordable.

Gee, the states are supposed to “benefit” from greater flexibility?  Would that be the flexibility to choose between supporting special education children with speech and physical therapy and opiate addicts?  Or choosing between the needs of the families of opiate addicts and the severely disabled?  Or choosing between the needs of opiate addicts seeking treatment and women seeking mammograms and other cancer screenings?  Santa doesn’t come without some expense.

Somehow the Republicans have managed to entangle themselves in their own rhetoric.  We can cut taxes, expand the military, all by cutting social safety net programs, and still have money for fighting opioid addiction in this country!  Santa will bring us tax cuts and another Santa will keep Granny in the skilled nursing facility, help cousin Elwood find a job in a new industry, make sure the family can get immunizations, cancer screenings, treatment for acute and chronic medical conditions, and insure that the Interstate Highway System is continually maintained.

It’s Jude Wanniski’s Two Santa Theory — a position only definable as something coming from an opiate induced delusion:

“Unfortunately, Mr. Wanniski opened Pandora’s box when he let loose the two-Santa theory. Republicans are now bound to it, whether they know it or not. As Keynes once put it, “Madmen in authority, who hear voices in the air, are distilling their frenzy from some academic scribbler of a few years back.”

**For more information: See the following excellent articles in the Nevada Independent — “Another side of the opioid heroin crisis,” “For Many Governors…” “As Out of Control opioid epidemic rages..”

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