Category Archives: Nevada politics

GOP: Poor Excuses and Paucity of Empathy

By all accounts the Graham-Cassidy+Heller version of health care destruction would yield a net coverage reduction for 243,000 Nevadans. Overall it would mean a 31% cut in Medicaid for children — that’s right — children.  There’s another 15% cut for services for people with disabilities.  And what’s the rationale for this atrocity?

(1) Because we promised!  This is probably the silliest reason to do anything ever.  I may have promised to offer someone a ride to go shopping, but if there’s a blizzard on the way then it’s downright stupid to “keep the promise.”

(2) Because Obamacare is failing!  And why would that be? Because Republicans refused to make some simple fixes (risk corridors, risk sharing, and reinsurance) and the individual health insurance is unstable.  It’s a classic case of tossing the baby out with the bathwater.  Or, of finding some perfectly “fixable” problems with a law and using those to rationalize pitching the entire thing.  Head UP: They’ll try this same approach with the financial sector reforms in the Dodd Frank Act.

And then there’s the part the Republicans aren’t talking about.

(3) Because they’ve wanted to get rid of Medicaid, Medicare, and to privatize Social Security from time out of mind.

This comment sums up the situation:

“The two keys to the Republican attitude are money and ideology. If you view the modern G.O.P. as basically a mechanism to protect the wealthy, Medicaid is an obvious target for the Party. The program caters to low- and middle-income people, and its recent expansion was financed partly by an increase in taxes on the richest households in the country.”

The concept can’t be articulated more simply or directly.

Then there are the sputtered talking points, common among Republican politicians and supporters to hike around the obvious but unspoken issues they have with the Affordable Care Act.

If we don’t pass this we’ll have socialized medicine.  Please.  Even Single Payer (or Medicare for all) isn’t socialized medicine.  Medicare insurance is used to pay PRIVATE providers for medical treatment.  This obviously isn’t a nationalized medical service plan.  Only by artificially conflating medical insurance with medical services can anyone assert that this is “socialism.”

There are no guarantees in life.  So if a family in Minnesota who has a child with muscular dystrophy may be required to pay higher premiums that’s the way the markets work.  It doesn’t get more morally bankrupt than this — especially since the current system does guarantee coverage for families with chronically ill children.

This issue is long past being a public policy issue, it has devolved into pure politics in which ‘points’ are scored by a party desperately hoping to cut taxes for its most generous donors at the cost of Americans’ health care.

So, every few weeks we’ll have to call our Senators to beg them not to destroy the Affordable Care Act and Medicaid for ourselves, our families, our friends, our neighbors, and our fellow citizens.

Call Senator Heller at his Las Vegas Office 702-388-6605; his Reno Office 775-686-5770; or his DC Office 202-224-6244. 

You may also want to call Senator Cortez-Masto to thank her for her support of health care access for Nevadans. 202-224-3542; 702-388-5020; 775-686-5750.

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Filed under Health Care, health insurance, Heller, nevada health, Nevada politics, 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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GOP Gubernatorial Candidate Fastens Onto Public Funds For Private Schools

Nevada gubernatorial candidate Dan Schwartz has planted his pennon securely on the so-called “Educational Savings Account” hill.  [RGJ] Schwartz’s enthusiasm hasn’t waned even though ESAs are of highly questionable constitutionality.

“Schwartz, a Republican who currently holds the office of state treasurer, told reporters in Las Vegas while announcing his candidacy that, if elected, he would not sign any bills from the Legislature without first seeing an “acceptable” ESA bill on his desk.” [RGJ]

The ESA program failed to secure enough support for enhancement in the last session of the legislature, which instead enacted tax credits for scholarships.  The “school choice” advocates saw this as a blow to their advocacy goals — specifically to the proposition that private schools are ‘better’ than public ones.  Perhaps it’s time to review the issues raised by the opponents?

The narrative, as framed by the proponents, is that private education is (1) better and (2) parents should have a choice to send their children to private schools.  The first proposition is dubious.  Private schools do send more of their students to college, but the reason may well be (and often is) that the schools themselves are selective in the first place.  When considering NCES reports on achievement the following caveat is of extreme importance, which is why it is reprinted here in full:

“When interpreting the results from any of these analyses, it should be borne in mind that private schools constitute a heterogeneous category and may differ from one another as much as they differ from public schools. Public schools also constitute a heterogeneous category. Consequently, an overall comparison of the two types of schools is of modest utility. The more focused comparisons conducted as part of this study may be of greater value. However, interpretations of the results should take into account the variability due to the relatively small sizes of the samples drawn from each category of private school, as well as the possible bias introduced by the differential participation rates across private school categories.

There are a number of other caveats. First, the conclusions pertain to national estimates. Results based on a survey of schools in a particular jurisdiction may differ. Second, the data are obtained from an observational study rather than a randomized experiment, so the estimated effects should not be interpreted in terms of causal relationships. In particular, private schools are “schools of choice.” Without further information, such as measures of prior achievement, there is no way to determine how patterns of self-selection may have affected the estimates presented. That is, the estimates of the average difference in school mean scores are confounded with average differences in the student populations, which are not fully captured by the selected student characteristics employed in this analysis.”  (emphasis added)

Those “patterns of self-selection” are “not fully captured” when the results of testing are reported, or this can be stated as: How private schools select attendees and the population from which they are drawn leaves some wide open questions about the conclusions offered on the effectiveness of instruction in private vs. public schools.

Secondly, the notion that there is no “school choice” at present is misleading in itself.  There is school choice, any parent may send a child to a public school, a private school, or choose to home school — the question is who pays for this.  What the “choice advocates” are saying is that taxpayers should fund the choice of a family to send children to private schools. A tangential argument is often raised that we should ‘expand the number of families who can choose to send children to private schools.’  Left unspoken are some of the practical issues — private schools can limit their enrollment, and if enrollment is limited then what of that “choice” being offered to their parents? Unlike public schools, private ones may select who is accepted for enrollment.  The decision not to offer special educations services is essentially self-selective.  There are some rural areas in which private education at the elementary and secondary level is non-existent or very limited.  In these instances there are few if any choices to be had.  Previous posts, here and here have addressed this issue in more detail.  (See also “Testing Turmoil,” and more on Schwartz’s previous advocacy here.)

Schwartz appears ready to ride this well worn draft horse throughout the campaign season.  It has some appeal — to those who sincerely wish to provide a religiously based curriculum for their offspring as well as to those who sincerely wish their children didn’t have to attend schools with members of other communities with whom they have little in common.  Compared to the economy, taxation, and other more relevant issues, this isn’t usually at the top of any voter’s list of primary concerns and Schwartz’s selection of it is more dog whistle (to ultra-conservatives) than a bull horn to the majority of Nevada voters.

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Immigration Myths and Legends and NV gubernatorial candidates

Nevada Republicans apparently have managed to recruit not one but two profoundly flawed candidates for Governor — Dubious Dan Schwartz, author of an alternative budget so far out in right field it found itself in the parking lot, and Adam Laxalt, The Adelson candidate du jour.  AG Laxalt joins the bevy of Republican officials who find no reason to challenge the Trumpian decision on DACA.  Better still, he’s an associate of notorious ex-sheriff Joe Arpaio:

“To date, Laxalt has shown zero interest in protecting Nevada’s DREAMers. In 2015, Laxalt added the State of Nevada to a lawsuit opposing President Obama’s immigration executive action with the goal of deporting DREAMers and tearing immigrant families apart. Laxalt is currently scheduled to appear this month at an event with disgraced former Sheriff Joe Arpaio, a criminal and notorious bigot who racially profiled Latinos in Arizona.”

Laxalt and Schwartz do illustrate the topics Republicans want to talk about — immigrants, tax cuts, and the wedgies (guns and gays.)   Let’s focus on immigration for the moment.  Nevadans have been treated to a surfeit of salacious “alternative facts” on DACA, and some of the myths appear to have taken hold.  DACA encouraged child migration! — No, it didn’t.  DACA beneficiaries have taken jobs away from Americans — only if one buys into the Lump of Labor Fallacy.  Nor do DACA beneficiaries cost the American taxpayers much of anything — they aren’t eligible for federal means tested welfare, Medicaid, health care tax credits, or anything else.   Republicans sputter that ending DACA will keep us safer — however DACA requires a background check, no felonies, no serious misdemeanors, and only 2,139 of the 800,000 beneficiaries have lost permits because of criminal activity. The handy plastic brains show this amounts to 0.267%. [WaPo]

Looming on the dark horizon of GOP visions is the ever present phantasmagorical presence of More Immigrants.  Interesting isn’t it, that the danger always comes from (1) Mexico or Central America, or (2) Muslims.  However, as of 2015 about 15% of green card recipients were from Mexico, 7% came from China, 6.1% from India, 5.4% from the Philippines, and 5.2% from Cuba. [CNN] [see also DHS]  Little notice is given to the 4,765,000 immigrants of European origin. [MPO]

Enter the other conversation Republicans don’t want to have — racism in all its systemic, institutional, and individual forms.  The ultimate exercise in otiosity is to attempt to get a Republican candidate to admit that beneath their rhetoric about immigration is a deep layer of good old fashioned prejudice and racism.  European immigrants are ‘productive,’ Central American immigrants are ‘gang members.’  European immigrants ‘take opportunities,’ while Central American immigrants ‘take jobs.’  European and Asian immigrants are hard working, but Central American ones are potential criminals — as if Russian and Chinese organized crime operations are minimized by excluding discussion of their activities.

Who were the gangsters associated with the following?

“The suspects (+30) also face charges of extortion, gambling, narcotics trafficking, wire fraud, credit card fraud, and identity theft, according to law enforcement sources. Some of the charges carry a maximum penalty of decades in prison.”

No, not from Mexico, Central America, not MS 13 — they’re members of Russian organized crime in NYC.   There was some mention about the Chinese immigrants attempting to enter the US without documentation last August 27th. [ChicagoABC] Not much, nor is much said about Chinese organized crime moving into south eastern Asia.  For coverage of Australian-Chinese cooperation interdicting drug trafficking in the area one has to head to Australian or Chinese news sources.  Lets guess that the latest 13 tons of drugs captured weren’t all destined for Sydney and Melbourne?

However, broadening the focus on criminal activity to include a more global perspective doesn’t serve the purposes of the anti-immigration far right in the US, which voraciously consumes any and all news of Mexican and Central American criminal activity while minimizing the capacity of Asian and Russian gangs and cartels to wreak havoc.

Thus far candidate Schwartz has demonstrated his capacity to parrot talking points from the Trickle Down Hoax book of imaginary economics, while Laxalt has aligned himself with the Arpaio clan (a word carefully chosen) of racists and bigots.  Both are flawed, and both leave room for a centrist Democrat to make an effective run for Governor.

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Hellerisms on Parade: Health Care Edition

And then there was this:

“The individual mandate I thought was atrocious, was wrong and shouldn’t have been in Obamacare at all,” he said. “I don’t think your government should tell you to buy something that you can’t afford. And if you can’t afford it you pay a fine. Yet 90,000 Nevadans pay the fine.” — Senator Dean Heller

Let’s start with the assumption that Senator Dean Heller is a capitalist, a firm believer in the free market system.  He’s certainly reinforced this impression given any occasion to do so.  So, why was there an “individual mandate” in the Affordable Care Act?  — The answer is capitalism.

The more precise answer is the “adverse selection” problem in free markets.  The most concise explication I’ve found for this comes from the Economist’s View:

“To explain how the adverse selection problem arises in these markets, note that people purchasing health insurance generally have better information about their health status than the people selling the insurance. If insurance is offered in this market at somewhere near the average cost of care for the group, people will use the superior information they have about their own health status to determine if this is a good deal for them. All of the people expecting to pay less for health care than the price the companies are asking for the insurance will drop out of the market (the young and healthy for the most part; all that is actually needed is that some people are willing to take a chance and go without insurance). With the relatively healthy people dropping out of the insurance pool, the price of insurance must go up, and when it does, more people drop out, the price goes up again, and the result is just like in the used car example above: The market breaks down and nobody (or hardly anybody) can purchase insurance.”

Now, if a person is reasonably conversant with capitalism and the patterns intrinsic to the operation of free markets, then the problem of  ‘adverse selection’ should be part of that person’s lexicon.  Granted it’s not an easy thing to explain, but the Economist’s View post quoted above offers the “used car” analogical example which makes the concept more accessible.   Therefore, if Senator Heller is indeed a capitalist, and if he has better that average economic knowledge base, then his explanation of his opposition to the individual mandate makes absolutely no sense whatsoever.

There’s also the political side of the issue, recall that Obama’s original plan didn’t contain an individual mandate while Secretary Clinton’s proposal did, and the result:

“Once elected, Obama quickly recognized the inescapable truth: An individual mandate was essential to make the plan work. Without that larger pool of premium-payers, there is no feasible way to require insurance companies to cover all applicants and charge the same amount, regardless of their heath status.” [WaPo]

There’s just no way to get around the problem of Adverse Selection, and still have an insurance system based on free market capitalism. 

Those still unsure about their understanding of Adverse Selection and how it operates in a free market system may want to consult some of the following sources:  Investopedia is a good source for short, concise, definitions of economic terms such as Adverse Selection. The Economic Times also has a dictionary style definition.  Risk Management specialists have a more technical definition.  Those wishing to dive a bit deeper into the weeds might want to see the World Bank’s explication.   There’s also an explanation from the National Association of Insurance Commissioners which goes into greater depth. (pdf)

Granted the individual mandate isn’t popular — that part is easy — but anyone who professes to be a free market capitalist (as does Senator Heller) can’t ignore the principle of Adverse Selection and how that concept impacts the insurance markets.

The alternatives to a purely market based insurance system in which the most people possible can obtain health insurance at relatively affordable rates are problematic for the free-marketeers.  A public option (federally sponsored insurance program operating in the general market) is one possibility.  Another alternative simply removes the free from free market — the single payer, or Medicare for All proposal, in which public insurance pays for medical services delivered in the private market.  At the furthest end of the spectrum would be nationalized medical health services such as the British or French systems. The arguments for and against each of these are ideological and political, and not necessarily relevant to the discussion of free market based health care delivery.  However, they do mitigate, from divergent directions, the issue of Adverse Selection.

The problem for Senator Heller is that he can maintain his free market positions OR he can oppose the individual mandate, but in light of the persistent and perpetual issue of Adverse Selection he can’t do both.

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Amodei: Several Days Late and More Dollars Short

So, Representative Mark Amodei (R-NV2) spent time with reporters to talk about (1) Race relations in America? — uh, that would be “no.” Or, (2) American strategy in the Middle East and South Asia? — no, not that either. Perhaps it was (3) Infrastructure investment and jobs programs?  — no, that didn’t form a major part of his remarks. Maybe it was (4) tax reform, or at least tax cuts?  — well, that wasn’t a focal point either.  He wanted to talk about health insurance, “repeal and replace,” as if the GOP hadn’t bungled its strategy and tactics to an extent that was truly remarkable in modern politics.

Never one to climb out on even the sturdiest branch and get ahead of the game, or even to keep up with the topics at hand, Representative Amodei continues to play the “repeal and replace” tune without acknowledging that his party had seven years to come up with a viable, specific, and practical PLAN to replace the Affordable Care Act.  Not to put too fine a point to it:  They Blew It.   However, this doesn’t prevent the Representative from belaboring the issue, rather like listening to someone who persists in telling us what he did on Labor Day during the New Year’s Eve party.

 

 

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Heller’s Dipsy Doodle on Health Care: Centene Edition

Here we have Senator Dean Heller’s comments on access to health care insurance in Nevada — and some translation.

“I welcome Centene’s announcement that it will offer plans on the Nevada exchange, providing Nevadans with additional health care options so that no county in our state is bare. I was proud to work with Governor Sandoval to make sure that people living in all of Nevada’s 17 counties have the option to purchase coverage on the exchange next year,” said Senator Dean Heller. “Nevadans have been left with dwindling choices when it comes to their health care coverage, and it’s more evidence that Obamacare is failing. That’s why I continue to work for health care solutions – like the Graham-Cassidy-Heller plan – that return power to the states, protect Nevada’s most vulnerable, and repeal Obamacare’s onerous mandates that continue to squeeze hardworking Nevadans who can least afford it.”

Huh?  Working with Governor Sandoval to make sure people can purchase health insurance plans in the individual market certainly wasn’t in evidence when Senator Heller voted in favor of the last Senate version of the risible ‘repeal and replace with nothing’ bill.

And, no, the ‘dwindling choices” aren’t the product of failing ACA provisions — the choices are dwindling because insurance corporations are facing unpredictable (anathema to insurance) situations created by the President’s threat to cut the cost sharing provisions, which Senator Heller persists in inferring are “insurance company bailouts.”

And, there’s that Graham-Cassidy amendment to which Senator Heller amended himself, which turns Medicaid into a block grant program with an altered formula and which cuts lower income family’s access to affordable insurance plans in the individual market.  That, to put it mildly, isn’t a solution.

And so it goes…into the 2018 election.

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