Category Archives: public health

The Moderate Heller Myth: Health Insurance Edition

Senator Dean Heller (R-NV) has cultivated his “moderate” image to the point that this adjective is attached to him with remarkable consistency — when if a person does even a perfunctory piece of research on his actual voting record what emerges is the model of a hard line conservative.  There is a pattern.  The Senator expresses “concerns” with a bill; then announces with ranging degrees of fanfare his opposition to a bill “in its current form,” then when the rubber grinds on the road surface the Senator votes along with the Republican leadership.

Why would anyone seriously believe he would support fixing the Affordable Care Act’s problems and not ultimately support what is now being called the “skinny repeal” version in the Senate based on the following voting record:

In 2007 then Representative Heller voted against the Medicare Prescription Drug Price Negotiation Act (HR 4).  Then on August 1, 2007 he voted against HR 3162, the State Children’s Health Insurance Program reauthorization.  The next day he voted against HR 734, the Prescription Drug Imports bill.  On March 5, 2008 he voted against HR 1424, the Mental Health Coverage bill.  Further into 2008 he voted “no” on HR 5501, the bill to fund programs fighting AIDS, Malaria, and Tuberculosis, and “no” again on the concurrence version of the bill in July.   If he had a ‘flash’ of moderation during this period it happened in the summer of 2008 when he voted in favor of HR 5613 (Medicaid extensions and changes), HR 6631 (Medicare), the latter including a vote to override the President’s veto.  By November 2009 he was back in full Conservative mode.

He voted against HR 3962 (Health Care and Insurance Law amendments) on November 8, 2009, and HR 3961 (Revising Medicare Physician Fee Schedules and re-establishing PAYGO) on November 19, 2009.

In March 2010 Heller voted against HR 4872 (Health Care Reconciliation Act), and HR 3590 (Patient Protection and Affordable Care Act).  He also voted against the concurrence bills.

January 19, 2011 he voted in favor of the Repealing the Health Care bill (HR 2).  He also signaled his stance on Planned Parenthood when he voted in favor of H.Amdt. 95 (Prohibiting the use of Federal funds for Planned Parenthood) on February 18, 2011.    He was in favor of repealing the individual mandate (HR 4), of repealing the Prevention and Public Health Fund (HR 1217).  May 4, 2011 he voted to repeal funding of the construction of school based health centers (HR 1214).

There was another “soft” period in some of his initial Senate votes in 2011, especially concerning the importation of medication from Canada (interesting since many prescription drugs are manufactured in other overseas sites).  See S. Amdt 769, S. Amdt 2111, and S. Amdt 2107 in May 2012.  On March 31, 2014 he voted in favor of HR 4302 (Protecting Access to Medicare).

He was back riding the Republican rails in September 2015, supporting an amendment to defund Planned Parenthood, (S. Amdt 2669) which failed a cloture vote.   Then on December 3, 2015 he voted in favor of another ACA repeal bill (HR 3762).    If we’re looking for patterns in this record they aren’t too difficult to discern. (1) Senator Heller can be relied upon to vote in favor of any legislation which deprives Planned Parenthood of funding for health care services, (2) Senator Heller can be relied upon to vote in favor of repealing the Affordable Care Act, and (3) Senator Heller’s voting record, if it illustrates any ‘moderation’ at all, comes in the form of dealing with prescription drug prices, but even that is a mixed bag of votes.

Thus, when he makes comments like the following:

“Obamacare isn’t the answer, but doing nothing to try to solve the problems it has created isn’t the answer either,” the statement read. “That is why I will vote to move forward and give us a chance to address the unworkable aspects of the law that have left many Nevadans — particularly those living in rural areas — with dwindling or no choices.

“Whether it’s my ideas to protect Nevadans who depend on Medicaid or the Graham-Cassidy proposal that empowers states and repeals the individual and employer mandates, there are commonsense solutions that could improve our health care system and today’s vote gives us the opportunity to fight for them. If the final product isn’t improved for the state of Nevada, then I will not vote for it; if it is improved, I will support it.”

We should examine them with some caution.   If he is referring to rural Nevada voters as ‘victims’ of the Affordable Care Act he might want to note that before the ACA there was one insurer in the northern Nevada rural market and if there is only one now that’s really not much of a change, much less a “nightmare.”  Nor is he mentioning that the proposed cuts to Medicaid will have a profoundly negative effect on rural Nevada hospitals. [DB previous]

That Graham-Cassidy proposal isn’t exactly a winner either:

“The new plan released Thursday morning and written by Republican Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.) would block grant about $500 billion of federal spending to the states over 10 years to either repeal, repair or keep their ObamaCare programs.”

We have no idea if the number is an accurate estimate of what would keep the health care systems of all 50 states afloat — no one seems to want to ‘score’ anything these days.  Additionally, Americans should be aware by now that when Republicans chant “Block Grant” they mean “dump it on the states, wash our hands, and walk away” while the states struggle to keep up with demands to meet needs and provide services, operating on budgets which cannot function on deficits.

Then, there’s that perfectly typical Hellerian comment: “If it is improved, I will support it,” leaving the issue entirely up to Senator Heller’s subjective assessment if “it” has improved his re-election chances enough to go along with it while not upsetting his very conservative base.  Meanwhile, the media persists in repeating the “Moderate Heller” mythology, and we haven’t even begun to speak of his actions to thwart and later repeal any common sense regulations on the financial sector.

 

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Filed under conservatism, Health Care, health insurance, Heller, Medicaid, Medicare, Nevada Test Site, Politics, public health, Republicans, Rural Nevada, SCHIP

Trump’s BIA Budget Massacre

1.6% of Nevada’s population is Native American, not a major demographic group when measured against the majority white (75%) and Hispanic populations (26.5%), or even the African American population (9.6%). [Census] However, that doesn’t mean this group doesn’t have some significant housing, health, education, and law enforcement needs on behalf of the Washoe, Paiute, Shoshone, and Utes (among others) who live in this State.  Worse still, the proposed Trump Budget stands to make their situation definitely more difficult.

“Overall, Trump’s proposal increases defense spending significantly and cuts deeply most programs for the poor. Trump’s budget slashes federal Indian country appropriations by more than 10 percent. For example, at $2.488 billion, Trump’s request for the U.S. Department of Interior’s Indian Affairs budget alone is a $300 million cut from Obama’s FY 2016 budget, which was the last full year appropriation (we have since operated on continuing resolutions). Trump’s proposal also cuts more than $50 million for the Indian country housing programs at the U.S. Department of Housing and Urban Development and zeroes out $8 million from the BIA budget for housing. For the Indian Health Service, Trump’s budget eliminates roughly $150 million.”  [IndC]

Consider for a moment the effects of a $300 million cut for the Bureau of Indian Affairs.  Drilling down, let’s look at the situation in Native American Housing, from which the administration seeks to cut some $58 million.  According to a HUD report issued in January 2017, housing needs are particularly acute in tribal areas in three major categories: System deficiencies (plumbing/electrical), physical condition, and overcrowding.

“Physical housing problems have declined enough to be negligible for the United States, on average—incidences typically of 1 to 2 percent—but not for American Indians and Alaska Natives in tribal areas. For example, 2013 American Housing Survey data show the U.S. average share of households with plumbing deficiencies was 1 percent, but this study’s household survey shows the share for AIAN populations in tribal areas was 6 percent; the share with heating deficiencies was 2 percent for the United States but 12 percent for AIANs in tribal areas; the share that was overcrowded was 2 percent for the United States but 16 percent for AIANs in tribal areas (exhibit ES.2). The only problems in which the incidences were nearly the same were electrical deficiencies (about 1 percent for both) and cost burden (36 percent for the United States versus 38 percent in tribal areas).” [HJ pdf] (emphasis added)

In summary, physical housing issues? 1-2% for most of the US population; but 16% for Native Americans.  “Heating deficiencies?” 2% for most of the US population; but 12% for Native Americans.  These numbers don’t appear to indicate a rationale for a $58 million slash in available funding.

Indeed, if we look at efforts of Native Americans to keep the furnace running in the winter is on the administration chopping block:

“The budget would eliminate programs like the Low-Income Home Energy Assistance Program, which helps low-income households pay to heat or cool their homes. In 2016, 150 tribal groups and more than 43,000 Native households received LIHEAP funds.”

There’s nothing like a cold house in the fall and winter to create an environment for disease, but again, Native Americans are on the losing end of the administration budget.

“The chronically underfunded Indian Health Service (IHS) offers care through a network of hospitals, clinics and health stations managed by IHS, tribes or tribal organizations, and urban Indian health programs. If the proposed budget passes, Medicaid, the national and state program that covers low-income individuals, could see its budget cut by $610 billion over the next 10 years. Mark Trahant, a journalist, academic and member of the Shoshone-Bannock tribes who has covered NA/AN affairs for 30 years, is concerned.

“In Indian Country, more than half of all Indian kids who go through Indian Health Service have their insurance through Medicaid,” he said. “Thirteen percent of Medicaid is Indian care.” [VOA]

Medicaid is not just an issue in terms of the national health care insurance proposals, but obviously has profound implications for health care services for Native Americans.   The proposed budget is not merely “austere,” but in relation to Native Americans it is downright cruel.

“The cutbacks to tribal programs are cutting into the bone and fail to recognize very real and critically important needs,” Fawn Sharp, the president of the Affiliated Tribes of Northwest Indians, said Tuesday at a tribal conference in Portland, Oregon. “It is so severe that it’s absolutely illogical and unreasonable.”

Logic and reason have only a very tenuous connection to the administration’s budget proposals for the Bureau of Indian Affairs and associated programs which benefit Native Americans.

There’s something particularly egregious about a budget which presumes that programs for those in need, as the case of many Native Americans, should be slashed right into the bone so that tax cuts for the top 2% of income earners in the United States can be implemented. [CNNmoney]

This is the Trickle Down Hoax on steroids.  By some magical manipulation of the tax code in favor of the wealthiest among us, “jobs” are supposed to be created in remote reservation areas; exactly those regions not favored with infrastructure, transportation, education, and resources favorable to investment.   The TDH advocates argue that the economic development problems are the result of tribal land ownership patterns, a lack of natural resource exploitation, and government “interference.”

It’s hard for a white person to understand the relationship of Native Americans to land.  To the average white person land is real estate, it can be bought, sold, transferred, and allocated at will.  It’s just another ‘thing.”  There’s no single definitive Native American perspective about land, but this comment is at least illustrative:

“Us women have been taught that this Mother Earth has taken care of us, so we have to be like her essence. She never abandoned us, she is here, she nurtures us every day, she protects us, she feeds us, she clothes us.” [ICMN]

Tribal lands can be allocated for the use of tribal members, but it’s still tribal land.  It still has “essence;” it is nurturing, protective, and sustaining.  Perhaps as close as a white person can come to understanding this concept is to imagine one is living in a church, or some sanctified property.  The property may be inhabited by specific people for specific reasons, but it is still a communal sanctified place.  Further, while the majority in our society see wealth as a measure of personal worth, this isn’t a value prized among Native Americans who frown on that which is self-serving and avaricious.  There are enterprise activities on tribal lands, but again, these are tied to the benefit perceived to accrue to the tribe, and not individuals.

The glories of the Profit Motive as maintained by the TDH advocates and other “free-marketeers” are as foreign to many Native Americans as the idea that a child should come into the world while the family conducts its ceremonies would be to them.

For all intents and purposes, the administration’s proposed budget flies in the face of basic Native American values.  While purporting to encourage ‘individual initiative’ it guts those social programs that sustain the lives of the individuals who have difficulty amassing “wealth” in the white sense of the term.  While supposing that the budget encourages ‘economic development,’ it slashes funding for communal needs (housing, health services, education, nutrition) which underpin development of any kind.  As for ‘natural resource exploitation:

It’s highly unlikely one of the TDH advocates would fully appreciate the following:

“We must protect the forests for our children, grandchildren and children yet to be born. We must protect the forests for those who can’t speak for themselves such as the birds, animals, fish and trees.” – Qwatsinas (Hereditary Chief Edward Moody), Nuxalk Nation

Nor would they understand the concept expressed in this quotation, which they might even dismiss with scorn:

“Once I was in Victoria, and I saw a very large house. They told me it was a bank and that the white men place their money there to be taken care of, and that by and by they got it back with interest. We are Indians and we have no such bank; but when we have plenty of money or blankets, we give them away to other chiefs and people, and by and by they return them with interest, and our hearts feel good. Our way of giving is our bank.”  – Chief Maquinna, Nootka

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Filed under Health Care, Native Americans, Politics, privatization, public health, Rural Nevada

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

All Quiet on the Humboldt

When last we heard from Rep. Mark Amodei (R-NV2) it was in early May at which time he smoothly flipped his vote on the disastrous ACA replacement bill, with a convoluted explanation that “it” wouldn’t hurt Nevada…and then came the CBO scoring.  The District 2 Congressional representative has kept his head down like a ground squirrel in his burrow by the side of the highway.  This prevents him from dashing into the roadway, or as constituents might call it — holding an in person town hall meeting.

Tossing statistics about like so much confetti doesn’t remove the cold fact that the bill for which Amodei voted cuts $839 Billion with a B from the Medicaid expansion.  Cue the GOP lament that there are “able bodied” people who benefit from the Medicaid program, a program initially meant to serve the desperately poor.  The expansion aided people who may not be homeless without a tent but who were certainly desperate in terms of their ability to afford health insurance for themselves and their families.  These are the people who waited until the medical situation was so dire expensive emergency room treatment was required; who used the emergency rooms as a form of walk in clinic for the lack of any more available alternative; who went without any medical attention whatsoever — 48,000 who died according to the Harvard study because health insurance was unaffordable.

Representative Amodei may not have believed the ACA replacement bill would have profound impacts on Rural health services, but other politicians from other states have pointed this out with remarkable clarity.

Missouri, for example, refused the Medicaid expansion, and the results aren’t positive, as described by Missouri Senator Claire McCaskill:

“Well, we have, first, more than 2 million Missourians live in rural areas of our state. And 41 percent of our state’s hospitals are in rural areas. We know that they are under particular stress right now, particularly in states like Missouri that have refused the money that has been offered them for their Medicaid program under the Affordable Care Act. We know that there’ve been 78 rural hospitals closed, including three in Missouri. We know that 74 percent of those hospitals were actually in states that refused to accept the Medicaid money that was offered by the federal government back to the federal taxpayers in those states.”

Arkansas which accepted the Medicaid expansion also has some issues related to its rural hospitals:

“The ACA’s crafters essentially made a deal with hospitals: The ACA cut Medicare reimbursements, but the reduction in uncompensated care through the Medicaid expansion helped offset some of those cuts. Without that offsetting boost, some of the state’s smaller rural hospitals might not be able to survive. A hospital like Baxter — the fifth most Medicare-reliant hospital in the nation, according to Moody’s, thanks to the community’s significant proportion of retirees — would be forced to make dramatic cuts in services without the Medicaid offset. “The expansion of Medicaid through Arkansas Works is one of the key components that’s been able to help us through the change in the ACA,” Peterson said. “Not just Baxter, but it helps all of rural Arkansas.”

What is true of Missouri and Arkansas is true for rural health care in general:

Of the more than 11 million people who have gained Medicaid coverage through the ACA expansion, nearly 1.7 million live in rural America, according to new CBPP estimates (see Appendix Table 1).  The expansion population is more rural than the population as a whole: rural residents make up 12.1 percent of the population of expansion states but 14.1 percent of expansion enrollees in these states.  In at least eight expansion states, more than one-third of expansion enrollees live in rural areas: Alaska, Arkansas, Iowa, Kentucky, Montana, New Hampshire, New Mexico, and West Virginia.

The Medicaid expansion has been a lifeline for rural areas in other ways.  The ACA coverage expansions, especially the Medicaid expansion, have substantially reduced hospital uncompensated care costs: uncompensated care costs as a share of hospital operating budgets fell by about half between 2013 and 2015 in expansion states.[8] Reductions in uncompensated care and increases in the share of patients covered by Medicaid have been especially important for rural hospitals.

Nevada hasn’t been immune from the problems associated with a lack of access to affordable health insurance and uncompensated care:

“Rural residents are themselves a public health challenge, as they are generally older, more isolated and less likely to be covered by insurance than their urban counterparts. They’re also more likely to smoke, suffer from obesity and hypertension and die from complications of diabetes.

But preventive care that could head off medical emergencies is hard to come by in many areas. Nevada’s rural and “frontier” counties – a term used for the state’s most-remote and sparsely populated regions – and reservations face severe shortages not just of doctors and primary care services, but also nurses, EMTs, dentists and substance abuse and mental health professionals. And in some areas, the numbers are dwindling, despite efforts to reverse the trend.”

 

And so, there are rural hospitals in Representative Amodei’s district — Elko, Lovelock, Battle Mountain, Yerington, Winnemucca, Ely, Fallon and others — wondering what effects will be felt if the GOP adopts the framework in the House bill for which Amodei voted.   Residents in Tonopah watched as their hospital closed in August 2015, an unfortunate testament to the perils of privatization.  The question which might, and should be raised, to Representative Amodei in some town hall (should he ever emerge) is how does the Republican version of health care insurance “reform” protect rural hospitals from financial pressures endangering rural hospital administration.

Ah, but all this is “old news” now that the Representatives voted on an unscored bill in their haste to get something, anything, done and have tossed the blazing ball into the lap of the Senate — in which we might expect Senator Dean Heller to lament the inadequacies of the measure to the Heavens, and then vote along with Senate leadership for the final (probably dismal) result.

Let’s guess that Senator Heller will announce his ‘profound misgivings and questions’ and then after consultations with some officials, reverse his position and do what he has always done — vote against any augmentation of health insurance affordability for his constituents (see his votes on SCHIP on multiple occasions.)

And so it remains — all quiet on the Humboldt — as Representative Amodei and Senator remain quiet (unless we count Heller’s scripted telephone town hall) on an issue of profound significance to District 2’s health care service providers.

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Filed under Amodei, health insurance, Heller, Medicaid, Medicare, nevada health, Nevada politics, Politics, public health, Rural Nevada

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

Meals On Wheels: Canary in the GOP Coal Mine

The entire “skinny budget,” which somehow manages to keep lots of fat on the Pentagon budget, offered up by the current administration is a mass of mischaracterizations packed into a myriad of outright lies.  The assault on programs like Meals on Wheels is a handle providing a way to understand the totality of the right wing Individualism of the GOP. It’s there, blatantly set forth without excuse, and as emblematic of the Culture of Selfishness as can be imagined.

Cast me not off in the time of old age; forsake me not when my strength faileth. Psalms 71:9

“Trump’s proposed budget completely eliminates the Community Development Block Grant, which provides $3 billion every year for, according to The Washington Post, “targeted projects related to affordable housing, community development and homelessness programs.” Among those is the Meals on Wheels program, which provides meals—and vital human contact—for older, impoverished Americans, many of whom are largely home-bound. According to MOW, one in six American seniors struggles with hunger, and the organization claims it saves the nation about $34 billion a year in medical expenses by decreasing the rate of falls for seniors. The program gets the vast majority of its funding from non-government sources, but the proposal still seems unnecessarily harsh.” [Esquire]

And the rationale for all this would be what, please?

“After a reporter brought up the Meals on Wheels controversy, Mulvaney at first tried to subtly evade the question. But then, as is the wont of this administration, he fell head over glutes explaining that while Meals on Wheels “sounds great,” the administration couldn’t keep wasting money on programs like it that “don’t work.” As in, feeding the elderly apparently isn’t showing strong enough empirical benefits to merit continued federal spending by this White House, which is now deeply wedded to evidence-based policymaking.” [Slate]

There are a couple of things to unpack herein. First, empirical benefits are hard to compile without first establishing a matrix of goals.  Benefits are precisely why the program “sounds good,” the goal is to feed people, and people are being fed in their own homes. In fact some 2.4 million elderly persons are participating in the program at a total cost of $1.4 billion. 500,000 of these are veterans of our Armed Forces. A study in New York City reports that the average age of a participant was 80, meaning the person was likely born around 1937, and if the person is a veteran he or she likely saw service during the Cold War into the Vietnam Era. How goals are framed makes a difference.

If the goal is to provide 2.4 million elderly people one meal per day with a minimum of 625 calories, then we can say it’s working.  If our goal is to be that no elderly Americans go a day without a sustenance level meal for a relatively inactive person, then, no the program has too many people on waiting lists to say it’s an unqualified success.

“The need is growing rapidly, and federal funding has not kept pace. The network is already serving 23 million fewer meals now than in 2005, and waiting lists are mounting in every state. At a time when increased funding is needed, we fear that the millions of seniors who rely on us every day for a nutritious meal, safety check and visit from a volunteer will be left behind.”[MOWAm]

At this point it needs to be said that Federal funding is combined with charitable and individual donations to keep the program literally on its wheels.  Further, the only logical way to pronounce the services a failure is to absurdly assert that because seniors get hungry the next day the program isn’t meeting its goals. However, it’s crucial to take a look at the second feature of GOP rationalization for pure selfishness.

Ultra-right wing conservatives are fond of explaining that services like Meals on Wheels could be better done by local charitable institutions, ignoring the fact that as mentioned above the Federal funding is not the primary source, and IN FACT is supplementary to local charitable funding sources. Catholic leadership, for example, is wary of the implications of the administration’s budget priorities, and Catholic Charities of Southern Nevada is providing some 2,000 daily meals to those on its list. Reducing funding for this single program by one third would have a profound, and profoundly negative, impact on its services.   There are times when the intersection of governance and religious institutions illustrates the point that while private donations are the core, when the need overruns the capacity then it’s time for a little help from friends around the country.  This Cult of Selfishness only works in the ethereal world of ideological fantasies, it doesn’t deliver a meal, even one of a minimum of 625 calories, to a single individual anywhere.

What makes the skinny budget so alarmingly obnoxious is that curtailing funding for Meals on Wheels is merely illustrative of a budget building process based on what the rich want to pay, rather than on what our society needs to be a truly great nation. It is a budget process to Make American Mean Again.

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Filed under health, Politics, privatization, public health, Republicans

GOP Air Balls: ACA Repeal would increase Nevada uninsured by 95%

Trump Favorite Picture This ought to be just a little chilling:

If Republicans go through with their plan to dismantle the Affordable Care Act using a similar model as their failed 2015 Obamacare repeal, the number of uninsured would double, a new report by the Urban Institute report warns. (pdf)  Taking into account the two or so year delay GOP lawmakers say they will include in the repeal bill, the non-partisan think tank estimates that in 2019 the number of uninsured nonelderly people would rise from about 29 million to nearly 59 million.  [TPM]

And the numbers represent what? Answer:

Eighty-two percent of the people becoming uninsured would be in working families, 38 percent would be ages 18 to 34, and 56 percent would be non-Hispanic whites. Eighty percent of adults becoming uninsured would not have college degrees. [UrbanInst. pdf]

Percentages have a way of sounding bland, so some clicking on the Plastic Brain results in approximately 33,040,000 of those people who would lose their health insurance by 2019  being non-Hispanic white people.  47,200,000 would be those without a college education, and thus presumably not in a position to secure the kind of employment providing the resources to find individual health plans.

If the 2015 bill is used as the framework or model, then the Urban Institute projects that there will be 762,000 uninsured individuals in Nevada only 18% of whom would be eligible for assistance; causing a 95% increase in the number of uninsured in Nevada.   Those Nevada politicians who have been denouncing the Affordable Care Act (read Rep. Mark Amodei R-NV2) may want to pause before “taking credit” for creating a 95% increase in the number of Nevadans without health insurance.

It’s important to recall that the Big Lie about the Affordable Care Act is that it is “socialized medicine.”  In reality it’s an Insurance Law. It doesn’t create a nationalized health care system – it merely increases the number of people who have “access” to health care by providing more people with the capability of purchasing health insurance policies.

Senate Democrats have already signaled that should the “Straight Out Of The Gate Repeal and Replace” come from the majority Republicans the GOP can expect no assistance from the Democratic side of the chamber. [TPM]

And, then there’s the politics of the repeal.  If the GOP decides to use the Reconciliation Process (needing only 51 votes for repeal) then Senator Dean Heller (R-NV) raises a question:  “What we are trying to figure out is what the restrictions on reconciliation,” Sen. Dean Heller (R-NV) told TPM. “Does reconciliation allow for a replacement? And it may or may not.” [TPM]

If the process doesn’t allow for “replacement” then the Republicans have chucked the insurance for those with pre-existing medical conditions, insurance coverage for mental health, insurance coverage maternity care, protections from junk insurance policies with maximum limits, and other popular features of the ACA.  They may also be chucking hospitals under the bus.

One private equity spokesperson noted last November, “… hospitals, especially those in rural areas, could be tremendously hard hit if the replacement rolls back the progress made under the ACA to insure patients and incentivize them to get care before their illnesses require emergency room visits or hospitalization.”

Thus, with the lack of any specificity from Republicans about the nature of the “replacement” we could posit some serious problems for the members of the Nevada Rural Hospital Partners – in Winnemucca, Fallon, Battle Mountain, Boulder City, Carson Valley, Ely, Winnemucca, Incline Village, Hawthorne, etc.   A 2016 report for the American Hospital Association provides some general conclusions from which we can contemplate the effect on Nevada’s rural health providers:

”The loss of coverage would have a net impact on hospitals of $165.8 billion  with the restoration of Medicaid DSH reductions; The ACA Medicare reductions are maintained and hospitals will suffer additional losses of $289.5 billion from reductions in their inflation updates; Full restoration of Medicare and Medicaid Disproportionate Share Hospital  (DSH) payment reductions embedded in ACA would amount to $102.9 billion.”  [AHA pdf] 

The technical term for these losses might be “ouch?”   There is a point at which rhetoric meets the road.  It’s all well and good to bellow “Repeal and Replace?” Or, “Get Rid of Socialized Medicine.”  It’s another thing entirely to puzzle out the impact of repeal on all the stakeholders in this issue – the customers and patients, the health care providers, the hospitals and clinics, the insurance companies, and the investors who have an increasing stake in privatized health care in this country.

There are some elements of the Affordable Care Act which could be improved.  However, the Burn the Barn Down political pandering on full display among Republicans isn’t leading to any current and serious discussions of how to make these improvements viable.  And, this is chilling for policy holders, insurance companies, health care providers, hospitals and clinics, and the investors therein.

Perhaps the Pottery Barn rule applies to Republicans: If you break it you own it.

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Filed under Amodei, Health Care, health insurance, Heller, Nevada politics, Politics, public health, Republicans, Rural Nevada