Category Archives: Medicaid

Let’s Review and Make Some Conjectures

Senator McConnell couldn’t have made himself more clear to the Republican leadership — let’s please have less drama from the White House so we can get along with our agenda.  Less tactfully phrased, McConnell and his myrmidons such as Representative Mark Amodei (NV2) and Senator Heller (R-NV) isn’t going to do anything about the dolt in the Oval Office until after they get what they want.  They want two things: (1) to return the control of the health insurance market back to the insurance companies; and (2) to dismantle the financial and consumer protections enacted in the Dodd Frank Act, and the Sarbanes Oxley Act.  Not sure about this, then please consider the current push for the Choice Act:

“At a time when too many hard-working American families are still recovering from the devastating impact of the 2008 financial crash, deregulating Wall Street’s biggest firms again makes no sense. Yet the Financial CHOICE Act threatens to do exactly that.

It would allow the biggest Wall Street banks to opt-out of significant financial protection rules, while those banks that remain in the regulatory system would be blessed with watered down versions of once-tough protections, like living wills and stress tests. Perhaps most worryingly, the CHOICE Act would cripple two of the most important post-crash reforms: the Financial Stability and Oversight Council (FSOC) and the Consumer Financial Protection Bureau (CFPB).” [the Hill]

Review: The CFPB was the agency which brought to light, and then levied fines against Wells Fargo for egregious violations of their customers’ privacy and financial interests.  Little wonder the banks aren’t happy with those “bureaucrats.” Less wonder why the Republicans aren’t going to do anything about the President who had to fire his National Security Adviser — until the Choice Act is safely delivered to his desk.

We should also recall that the Republican version of the healthcare reform act is much less about health insurance reform than it is about bestowing tax cuts for the wealthiest among us, to the tune of close to $765 billion over the next ten years.  We can easily conjecture that the GOP will do nothing about the man in the office who fired the US Attorney in the Southern District of New York, and then the emissary from the Department of Justice who warned him about the dangers presented by the presence of General Flynn.  At least nothing will be done, until the Republicans can cut Medicaid to the barest of bones:

His (Trump’s) promise would be violated by House GOP bill, as it seeks to freeze Medicaid expansion money for states in 2020 by withhold funding at the enhanced match rate for any new enrollees after that point. Other beneficiaries are at risk with the more long-term transformation that program stands to undergo under the GOP bill. The legislation would overhaul the program—now an unlimited federal match rate—into a per capita cap system, meaning that states would get a fixed amount of funding per enrollee. The Congressional Budget Office, analyzing an initial version of the legislation, predicted out of the 24 million Americans who would lose coverage under the earlier GOP bill compared to current law, 14 million were due to its changes to Medicaid. [TPM]

Given there is no CBO scoring on the current edition, we can’t be certain that States like Nevada which expanded Medicaid enrollment in order to make health care access affordable, won’t be left in the lurch — Congressman Amodei’s tortured logic to the contrary.  So, nothing is likely to be done about the executive who fired the Director of the FBI who was supervising the investigation of Russian meddling in our elections (and possible Trump connections to that meddling) until Medicaid cuts are also tucked into the President’s portfolio for a signing ceremony.

When will Republicans address the Leaker-in-Chief’s discussions with the Russian visitors to the White House?  Probably not until the budget cuts to the Department of the Interior, the Environmental Protection Agency, Medicare, Health and Human Services, and the Department of Education come to fruition.  Do we have a situation in which the following is true?  If the Trumpian honeymoon isn’t over, it soon will be.

That sentiment was echoed by a prominent GOP consultant I spoke to who asked not to be named to offer a candid assessment of Trump and congressional Republicans.
“The question for Republicans is whether this is the straw that breaks the camel’s back,” said the source. “Forty percent approval is not the issue; an erratic, rudderless, leaderless White House is.” [CNN]

The camel’s back may not bend until the Republicans have seen their agenda realized, their Randian Dreams made true, and their Austerity Government imposed on the American people.   The damage of this administration and the Republicans in Congress who enable and excuse him is only starting to come to fruition.

 

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Filed under Amodei, Comey, conservatism, corporate taxes, financial regulation, Health Care, health insurance, Heller, income tax, McConnell, Medicaid, nevada health, Nevada politics, Politics, public health

Beware The Artful Codger

One congressional Representative for our northern neighbor, Idaho, has a problem in his Lewiston office: Too many artful codgers showing up there around lunch time with complaints about his political philosophy.

“A spokesman for U.S. Rep. Raul Labrador’s office in Lewiston has filed a complaint alleging a threat from a group of local citizens who routinely visit congressional offices.

Scott Carlton reported the issue to the U.S. Capitol Police early last month. Carlton, who works out of the congressman’s downtown Lewiston office, declined to comment when contacted by the Tribune and referred all questions to Doug Taylor, Labrador’s spokesman in Meridian, Idaho.

The citizen group, LC Valley Indivisible, is comprised of mostly older residents of the Lewiston-Clarkston Valley, according to its members. The organization is loosely affiliated with the national Indivisible groups that call for town hall meetings with members of Congress to raise issues regarding President Donald Trump’s administration.” [SR]

The group members recall a civil engagement with Scott Carlton, Labrador’s spokesperson. Carlton told people at a Chamber of Commerce gathering that the group was “aggressive,” and reported that he (Carlton) had contacted Capitol Police who have jurisdiction over congressional offices. [Spokesman pdf]

Not that those in Nevada’s 2nd congressional district can complain about this issue too strenuously, Mark Amodei (R-NV2) hasn’t scheduled a public performance since venturing out to Carson City recently. It is noteworthy that Amodei told the Reno Gazette Journal: “… he would not vote for any plan that resulted in reduced coverage for anyone. “No, I don’t think you can say forget it, we’re going to let them be uninsured because as a practical solution, that’s not an answer and somebody ends up paying in the end anyhow,” Amodei said.”

Now, Representative Amodei has a GOP plan before him that does precisely that — reduces health insurance coverage for people in his district, and the amendments to the bill recently announced make the situation even worse, dismantling Medicaid protection for seniors in record time.  However, Representative Amodei doesn’t appear to want to pencil in a town hall meeting in a major metropolitan area in his district — like Reno/Sparks?  Perhaps some of those artful codgers, similar to the Lewiston lunch bunch, might show up?

However, there are other ways to get the attention of elected representatives. I am particularly fond of the Empty Suit Town Hall. Let’s hear it for Lexington, Kentucky:

“…voters in Lexington, Ky., have been clamoring for the state’s congressional representatives — Senate Majority Leader Mitch McConnell, Sen. Rand Paul and Rep. Garland “Andy” Barr — to tackle constituents’ questions in person. They even booked a venue for Saturday and hand-delivered town hall invites to the politicians’ offices.  The legislators were a no-show, but that didn’t stop things. Instead of McConnell, Paul and Barr, organizers propped up three mannequins wearing suits.” [WaPo]

Perhaps not the best optics for a congressional delegation? At least it’s better to be an empty suit than to sic the Capitol Police on office visitors?

There are other ways to contact GOP representatives like Mark Amodei — and this should be done before the vote on the Repeal/Replace bill on Thursday.

For those living in District 2 there’s Amodei’s contact form for quick e-mail messages. Simply scroll down the page to the “e-mail link.”  The page also has the phone numbers for Amodei’s offices in Reno Phone: (775) 686-5760, Elko Phone: (775) 777-7705 , and Washington, D.C Phone: (202) 225-6155.

This is as good a time as any to remind Representative Amodei what he said to the Gazette Journal: “… he would not vote for any plan that resulted in reduced coverage for anyone. “No, I don’t think you can say forget it, we’re going to let them be uninsured because as a practical solution, that’s not an answer and somebody ends up paying in the end anyhow,” Amodei said.”

Now, if only those artful souls in Idaho can get the attention of their Representative…

 

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

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

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

Medicare Fraud and the Public Images

Loretta Lynch

You go! Attorney General Loretta Lynch’s announcement about Medicare fraud prosecutions isn’t getting the play accorded to more “hot topic” issues, but it’s an important step in doing two things – actually getting fraud out of the Medicare system; and, two dispelling the GOP inference that fraud in social and health care systems is something done by imaginary welfare queens and ne’er do wells.

Who’s getting prosecuted?

U.S. law enforcement officials have charged 301 suspects with trying to defraud Medicare and other federal insurance programs in 2016, marking the “largest takedown” involving health care fraud allegations, the Justice Department said on Wednesday.

The national sweep resulted in charges against doctors, nurses, pharmacists and physical therapists accused of fraud that cost the government $900 million, the department said. The cases involved an array of charges, including conspiracy to commit health care fraud, money laundering and violations of an anti-kickback law. [NatMemo] (emphasis added)

That gives us a general idea that no, the fraudsters weren’t those so often maligned by conservatives as the “undeserving” poor who take advantage of “sacred tax dollars.”  These are professionals, presumably unwilling to settle for professional earnings, income derived professionally.  We can get a bit more specific.

“One group of defendants controlled a network of clinics in Brooklyn that they filled with patients through bribes and kickbacks.  These patients then received medically unnecessary treatment, for which the clinic received over $38 million from Medicare and Medicaid – money that the conspirators subsequently laundered through more than 15 shell companies.” [Lynch DoJ]

How many “undeserving poor” launder money through 15+ shell corporations?

Detroit clinic billed Medicare for more than $36 million, even though it was actually a front for a narcotics diversion scheme.” [Lynch DoJ]

“…another defendant took advantage of his position in a state agency in Georgia by accepting bribes and recommending the approval of unqualified health providers.” [Lynch DoJ]

Lovely.  Another Department of Justice public statement offers a few more details.

“According to court documents, the defendants participated in alleged schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided.  In many cases, patient recruiters, Medicare beneficiaries and other co-conspirators allegedly were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.  Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of conspiring to submit a total of approximately $712 million in fraudulent billing.”  [HCFU DoJ]

What’s been the nature of the Congressional interest in the Health Care Fraud Unit’s efforts?  In 2013 it was to cut funding for Medicare and Medicaid fraud prosecution efforts. [CNBC] [WaPo] We might also want to remember that any additional mandatory funding beyond 2013 levels did not start  until 2015. [HHS]

The notion that “waste, fraud, and abuse” are associated with government employees and the undeserving – is directly challenged by the efforts of the Departments of Health and Human Services and the Department of Justice, and their findings that the fraudsters are among the professional civilian population – ready and willing to line their own pockets with tax dollars.

But don’t necessarily trust me, listen to the Inspector General:

“Health care fraud drives up health care costs, wastes taxpayer money, undermines the Medicare and Medicaid programs, and endangers program beneficiaries,” said Inspector General Levinson.  “Today’s takedown includes perpetrators of prescription drug fraud, home health care fraud, and personal care services fraud, three particularly harmful types of fraud plaguing our health care system.  This record-setting takedown sends a message to would-be perpetrators that health care fraud is a risky way to line your pockets.  Our agents and our law enforcement partners stand ready to protect these vital programs and ensure that those who would steal from federal health care programs ultimately pay for their crimes.” [DoJ]

Health care fraud investigators and prosecutors should be among the nation’s heroes, not castigated as ‘gum’int bureaucrats,’ and should have budget and resource support commensurate with the importance of what they are trying to accomplish.

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Filed under Medicaid, Medicare

“Small Government,” my lady parts!

Happy Hour Debate

For a political party to stake its flag in “No Big Government” territory and then countenance government interference between a woman and her physician is just about as far into the Hamlet of Hypocrisy as one can inhabit.  And, there they went again, as expected, into the manufactured poutrage over the debunked Planned Parenthood video.  First, the Happy Hour:

“This is absolutely disgusting, and revolts the conscience of the nation,” Louisiana Gov. Bobby Jindal said of secretly-recorded videos of Planned Parenthood executives discussing fetal tissue research. “We just, earlier this week, kicked them out of Medicaid in Louisiana as well, canceled their provider contract,” Jindal said. Then, seemingly undermining his case that the undercover videos related to his decision, Jindal added, “They don’t provide any abortions in Louisiana.” [MSNBC]

Yes, what’s “absolutely disgusting” and “revolts the conscience of the nation,” is that anyone would fall for the manufactured propaganda piece in the first place.  Additionally, to blunder into the questions associated with fetal tissue research AND note that PPA doesn’t provide abortion services in Louisiana is about as silly as it gets.  However, Jindal’s found a way to cut Medicaid in his state by canceling their provider contract – which means that the 80% of PPA clients who avail themselves of PPA medical services won’t be getting any help avoiding unwanted pregnancies.  Nor will they be getting STD/HIV/AIDS screening, or cervical cancer screenings, or breast cancer screenings. [PPA]

Former NY Governor George Pataki should have known better:

“You know, Hillary Clinton’s always saying how Republicans don’t follow science? Well, they’re the ones not listening to the scientists today, because doctors say that at 20 weeks that is a viable life inside the womb,” Pataki said. “And at that point, it’s a life that we have the right to protect, and I think we should protect.” [MSNBC]

Not so fast!   The science is a bit different than what Gov. Pataki is asserting. The New York Times reported the latest research results:

The study, of thousands of premature births, found that a tiny minority of babies born at 22 weeks who were medically treated survived with few health problems, although the vast majority died or suffered serious health issues. Leading medical groups had already been discussing whether to lower the consensus on the age of viability, now cited by most medical experts as 24 weeks.” 

Get the “tiny minority” and “vast majority” observations?  And, the part about “leading medical groups” citing 24 weeks as a minimum.  The American Academy of Pediatrics adds, “Determining the survival prognosis for the infant of a pregnancy with threatened preterm delivery between 22 and 25 completed weeks of gestation remains problematic.”    There are at least 8 pre-natal screening tests [ACOG]  There’s a reason for the problems, an ultra-sound ‘fetal anatomy survey’ is a test used at 17 to 20 weeks.  If a woman opts for blood screening tests the ‘sequential integrated screen’ is done at 10-13 weeks, and the second blood test is performed between 15 and 20 weeks.  The ‘serum integrated screen” is performed at 10 to 13 weeks, and the second between 15 and 20 weeks.  [Healthline] Noticing a pattern here? It should be noted that the “anomaly ultrasound” is usually completed around 18-20 weeks. [CDC] Most of the second tests are performed at or around 20 weeks, the results may be in the works when the clock runs out if the forced-birth folks have their way. 

No one is contending that a woman must have an abortion if a fatal defect is discovered in the second trimester.  Perhaps it would help the politicians to remind them that 0-13 weeks is considered the first trimester, 14-26 weeks the second, and 27 – 40 the third.  What rational people are asking is that the woman and her family be the ones who decide if between 20 and 26 weeks  an abortion is necessary to prevent the woman from having to carry a fetus with a fatal birth defect to term.  Governor Pataki should review some of the medical information easily available online before buying into the Radical Right Anti-Choice propaganda.

And then there was Senator Lindsay Graham.

“I don’t think it’s a war on women for all of us as Americans to stand up and stop harvesting organs from little babies,” he said, referring to a legal process by which women can donate the fetal remains after abortion for the purpose of medical research.” [MSNBC]

No, Senator, this isn’t Harvest Time.  We are talking about fetal tissue, donated by women voluntarily for medical research. Tissue which helped find a vaccine for polio, and which is assisting researchers find cures and treatments for such conditions as  Parkinson’s Disease, Lou Gehrig’s Disease (ALS),  and macular degeneration. [See previously DB]

Senator Graham is a lucky man – he was born July 9, 1955,  after the (inactivated) injected polio vaccine was developed by Dr. Jonas Salk (1953) and after about 2 million children participated in the 1954 field trials, and after the April 12, 1955 Ann Arbor, MI, press conference announcing the success of those trials.  Between 1955 and 1957 the incidence of polio declined in the United States by 85% to 90%. [AmHistSci]  There would be no more reports, as there were in the 1940’s and early 1950’s of some 35,000 children and adults contracting the dread disease every year. [CDC] And this, because some courageous and compassionate women donated fetal tissue for medical research.

And then there was former Senator Rick Santorum. Who sidestepped the question and went straight for promoting a Partial Birth Abortion Ban law, heedless of the fact that this is NOT a birth, that survival rates for infants actually born weighing 500 grams or less is 14%, [Slate] and that “partial birth” isn’t a medical term, it’s a political term coined by anti-abortion activists. [NPR]

Once the Happy Hour was complete, the main show included Wisconsin Republican Governor Scott Walker proudly announcing that he’d closed down Planned Parenthood in his state four years ago.   Correction: He still has 22 PPA centers in the state, but five did have to close after the state withdrew $1 million in funding from any facility that provided abortion services. [CBS]

The true danger to himself and others is former Governor Mike Huckabee, who wants to apply the 5th and 14th Amendment guarantees to the unborn. Somehow, Mr. Huckabee has invented his own new pseudo-medical term: “DNA schedule.” There is NO DNA schedule. Much less is there a unique DNA schedule for every human being at conception. [CBS] But then, we have to remember that this is the same man who lashes out at any hint of equal protection (under the 5th and 14th amendments) for members of the LBGT community, but finds the Duggar Quiverfull folks perfectly acceptable.

Moving right along:

“Sen. Marco Rubio was on the defensive after debate moderator Megyn Kelly suggested that the Florida Republican would “favor a “rape and incest exception” to abortion bans.

“I have never said that,” Rubio objected. “And I have never advocated that. What I have advocated is that we pass law in this country that says all human life at every stage of its development is worthy of protection.” [CBS]

Really?  Because CBS news did a bit of fact checking:

“But he appears to be wrong about never having advocated the exception. In 2013, Rubio cosponsored a Senate bill with wide-ranging Republican support called the Pain-Capable Unborn Child Act, which would have banned abortions after 20 weeks, and that bill had exceptions for rape, incest, and in cases when the mother’s life was threatened.”

Who’s arguing? Yes, all human life is worthy of protection, but most sentient beings include the mother in that equation.  So, Senator Rubio, are you now contending that the health and well being of the mother is of no consequence in the formulation of laws concerning abortions?  Are you perfectly willing to orphan the remaining children in the family in order to save a fetus?

And The Donald? Who knows. He jabbered for 10 minutes and 30 seconds. [HuffPo]

None of this should be surprising, other than offering “Repeal and Replace” rhetoric tossing some 19 million working men and women out of their health insurance coverage, and allowing the Banksters to avoid all those pesky regulations which might help ease if not prevent the next financial calamity (Sarbanes-Oxley, Dodd-Frank), and tossing more funding into the next glorious war – they really don’t have anything on offer for climate change and voting rights…. So we’re back to the same old Trickle Down Economic Hoax, and “wedgie issues.”

Now we have 65 weeks before the 2016 general election…. Not quite long enough to cover the 91 week gestational period of an African Elephant…

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Filed under abortion, Health Care, health insurance, Lindsey Graham, Medicaid

The Republican Unicorn: The Replacement Plan

UnicornOH! the horror… more Nevadans are now getting health care insurance thanks to the Affordable Care Act.  The Reno Gazette Journal reports:

“Nevada Medicaid enrollments under federal health care reform have surpassed initial projections and are on pace to reach 500,000 by summer, a mark initially not expected to be reached until the end of the 2015 fiscal year, a state official said.”

Prior to the enactment of the Affordable Care Act there were approximately 642,000 Nevadans without health insurance.  The expansion of Medicaid allows those who are earning  below 138% of federal policy guidelines to sign up for Medicaid.

For two person family the members of which are U.S. citizens between the ages of 19 and 65, who are not eligible for Medicare, the income line would be $21,404 per year, the income eligibility level for a single individual would be $15,856. [ME2014 pdf] A person working for $7.50/hr for a 50 week year would earn $15,000.

Since this is an election year, the Republicans will no doubt tell us all that they have an alternative, and indeed they did craft one earlier this year.

A side by side comparison of the Affordable Care Act and the Republican alternative:

ACA and GOP health plansIn the Republican “alternative du jour” people who don’t get health care insurance from their employers would end up paying more because in the GOP proposal the tax credit increases only by age and not by need.  This means that lower income individuals would be paying more for health care insurance.  [See example here]

Would those who have endured some of the questionable practices of insurance administration be protected under the Republican alternative?  Not really.  Under the Affordable Care Act an insurance corporation may only charge a 64 year old person 3 times what they would charge a 21 year old. Under the provisions of the Republican alternative they could charge 5 times more.

Then there’s the issue of a “coverage gap.”  If a person were to lose a job the compensation for which included health care insurance, the subsequent “gap” in coverage would allow the corporation to exclude the person from coverage because of a pre-existing medical condition if the individual did not purchase a private plan immediately.

In sum, the Republican alternative isn’t really “patient centered” a better term might be insurance corporation centered:

“There are many other problematic things the Republican plan does, like eliminate the health law’s taxes on health insurance, drug and device companies; allow insurance companies to sell plans that don’t cover maternity, mental health or other types of care; and allow insurance companies to impose annual limits on benefits.” [NYT]

Before we get too excited about the Republicans actually offering up an alternative to the Affordable Care Act and Patients’ Bill of Rights, we should remember that 2014 is an election year.  A person could waste precious moments in this life counting the number of Republican “working groups” which have developed GOP health insurance reform plans.  However, that exercise would expend synaptic effort unnecessarily because the GOP has yet to form any viable legislative strategy for enacting their ‘reforms.’

Harken back to January 30, 2014 — House Majority Leader Eric Cantor (R-VA) announced to the GOP conclave that “This year, we will rally around an alternative to ObamaCare and pass it on the floor of the House,” Cantor said during a presentation in which he outlined four areas — healthcare, jobs, helping the middle class and creating opportunities — where Republicans would offer “big, bold ideas.” [The Hill]   Now, hold this thought, because something happened to those “big, bold ideas” between January and March.

No sooner did the House Majority Leader pronounce, “This year, we will rally around an alternative to Obamacare and pass it on the floor of the House..” then the silent fog of actual inactivity enveloped the House Republicans.  By February 21, 2014 those big, bold ideas apparently disintegrated into a host of piece-meal bits of proposed legislation: “In a memo to members laying out the House agenda for the remainder of the winter, Cantor noted that the replacement is being finalized, and said that in the meantime, Republicans will work to target parts of the law with which they disagree.” [Roll Call]  Repeal and Replace, appears to be getting fuzzier by the month, a point not lost on columnist Jonathan Chait:

“Carping from the sidelines is a great strategy for Republicans because status quo bias is extremely powerful. It lets them highlight the downside of every trade-off without owning any downside of their own. They can vaguely promise to solve any problem with the status quo ante without exposing themselves to the risk any real reform entails. Republicans can exploit the disruption of the transition to Obamacare unencumbered by the reality that their own plans are even more disruptive.”

Meanwhile, more people are finding affordable private health care plans on the state and national insurance exchanges and more lower income citizens are signing up for the expanded Medicaid program.  And, the calendar marches on:
House Calendar 2014

And so, what has the House been working on?  On January 9 and 10, 2014 the GOP toyed with some headline generating legislation (H.R. 2279) delaying the implementation of the ACA and calling for ‘transparency.’   On January 23rd they launched on the ‘security’ of the health care exchange. (H.R. 3362).  Then they were back to the Ban The Abortion theme in the consideration of H.R. 7 on January 28, 2014, as if the Hyde Amendment has somehow been misplaced.

Do we see all that legislation to Repeal and Replace so avidly promised in January and then all but forgotten by March?  The Health and Technology Committee didn’t even meet during the month. [docs.house]

The lovely thing about a Unicorn is that it can be any color which delights a person’s imagination.  The same can be said of the Republican alternative to the Affordable Care Act — it can contain just about anything the audience wants to hear, because “facts are still being gathered,” or “provisions are still being drafted,” or “committees are still giving it consideration,” or “the dog ate my homework.”

Until the Republicans unveil their comprehensive alternative to the Affordable Care Act the Repeal and Replace slogan is just that — sloganeering.  And until the Republicans can demonstrate their capacity to LEGISLATE (read govern) there is no reason to take their propositions seriously.  While we wait for the Republicans to chase their Unicorn, we can applaud the fact that more of our fellow citizens have health insurance coverage, and wonder what the Republican Party will be able to do for the next five years.

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Filed under Economy, Health Care, health insurance, Medicaid, Nevada politics, Politics