Should the Trumpcare bill pass this evening, residents in the following Nevada Counties can expect changes in their premiums after tax credits: From $2400 to $3700 — Humboldt, Elko, Pershing, Esmeralda, Lander, Churchill, Esmeralda, and Mineral counties. (Source: Kaiser Family Foundation)
Tag Archives: ACA
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…
We might go for the Ryan budget bill in regard health insurance directly, but others have already noted that either (a) he doesn’t have a clue how insurance works, or (b) he’s trying to pull a fast one on the American public. At any rate, the phase I of the ACA repeal is essentially a gigantic giveaway to health insurance and pharmaceutical corporations, a tax boon to those in the upper 0.1% income bracket, and a dismantling of the Medicaid program. The contents of Phase II have been tipped. It’s on the Speaker’s website, but requires a bit of unpacking:
“Administration actions, notably by HHS Secretary Price, to stabilize the health insurance market, increase choices, and lower costs…”
Translation: The content of health insurance policies, currently listed as “essential provisions” for all policies, is under a head on assault.
If a corporation is going to offer a comprehensive health insurance policy for sale to customers, it must include “ambulatory care for patients in a hospital or not,” “emergency services,” “hospitalization,” “pregnancy, maternity, and newborn care,” “mental health and substance abuse treatment,” “prescription drugs,” “rehabilitation,” “laboratory services,” “preventive and wellness care,” “pediatric care including vision and oral care,” and “birth control and breastfeeding coverage.”
Now, just guess what parts of this coverage the GOP finds objectionable? If you guessed anything having to do with WOMEN give yourself the prize of the day.
Why, the guys grouse, do I have to have a policy covering maternity and neo-natal care, birth control prescriptions, and pediatric care? It’s because of how insurance works.
Aside from the obvious part wherein it requires both men and women to create a ‘maternity situation,’ the whole idea of insurance is encapsulated in the word POOL.
“When you buy insurance, you join many others who pay money to an insurance company. The insurance company uses the money collected to pay claims that are submitted by those who have purchased insurance. The money is “pooled” and losses and expenses are shared. An important aspect is the members of a pool share similar risk characteristics.” [HIW]
In the case of health insurance, the “shared characteristic” of note is that everyone who buys a policy is a human being, who at some point will need health care. The more people (policies) in the pool the wider the risk can be shared. And, that’s the point of insurance — spreading the risk among as many policy holders as possible.
Creating ‘cafeteria’ policies might be profitable for the insurance corporations, but it doesn’t make health care affordable for most people. If we carve out special coverage for maternity care and remove this from the larger pool (which includes men) all this serves to do is to increase costs for those remaining in a smaller pool. Similarly, if prostate cancer screening and treatment is carved out from comprehensive coverage, this serves to increase costs as the overall pool is diminished.
Got it? If not, think of your auto insurance. 10 people buy GenZ Insurance, 9 of them never file a claim, 1 does. The costs related to the one claim are shared among those who bought into the pool and paid premiums to maintain their insurance. We require all automobile owners in this state to have at least minimal insurance. In Nevada, this means you have to have a policy covering $15,000 for bodily injury or death in an accident for one person, $30,000 for bodily injury or death of two persons in an accident, and $10,000 to cover property damage. Thus, all Nevada drivers must have at least minimal participation in the auto insurance pool. Again, the larger the pool the greater sharing of risk, the entire point of having insurance.
Back to health insurance, if we thought Phase I is a disaster, Phase II should be even worse. Phase III is the ‘portability canard.” Has it occurred to anyone in the GOP hierarchy that nothing that really prevents insurance corporations from selling their policies across state lines — IF they agree to accept the standards set by state insurance commissions for the protection of their consumers. More on this later — if necessary.
Nevada’s two Republican representatives to the 115th Congress, Senator Dean Heller, and Representative Mark Amodei (R-NV2) are now proposing not to have town hall style sessions with constituents until they have something to say. We might assume this applies to the threats to repeal the Affordable Care Act, without having something concrete to say to the voters. Representative Paul Ryan is touting the GOP “Better Way” (pdf download) as a set of talking points for Republican members of the 115th.
First, there isn’t anything really new here. It’s the same proposal a person might have downloaded last June (June 22, 2016). The foundation is Unleashing the power of choice and competition is the best way to lower health care costs and improve quality. One way to immediately empower Americans and put them in the driver’s seat of their health care decisions is to expand consumer-driven health care. Consumer-driven health care allows individuals and families to control their utilization of health care by providing incentives to shop around. This ultimately lowers costs and increases quality.”
Problem: “Consumer-driven health care” makes for lovely free market rhetoric, but it boils down to the same old High Deductible Health Policy/Health Savings Account proposal the GOP has rolled out since time out of mind.
“This insurance arrangement— in which a person is protected against catastrophic expenses, can pay out-of-pocket costs using tax-free dollars, and in turn takes responsibility for day-to-day health care expenses—is an excellent option for consumers. HSAs tied to HDHPs are popular tools that lower costs and empower individuals and families. This type of coverage also helps patients understand the true cost of care, allows them to decide how much to spend, and provides them with the freedom to seek treatment at a place of their choosing.” (page 13)
This is an elegant way to tell people (1) you’re on your own; (2) that you might expect some tax credits, but the expenses are going to come immediately out of your pocket; (3) and you’ll be able to address ‘catastrophic’ illness or injury expenses out of what you’ve put into an HSA. Good luck with that. Health Savings Accounts are great for the healthy and wealthy, for everyone else – not so much.
Worried about those expenses out of your pocket? Well there are HRA’s on offer and more “defined benefit” possibilities. In short, instead of having several comprehensive health care plans to choose from, a person could also ‘choose’ to be involved in HDHP/HSAs and HRAs and other privatization schemes.
Question for Congressional Representatives: What in this plan insures that the health care insurance will be truly comprehensive? Affordable? Affordable for those families having Nevada’s median income around $50,000 per year?
Secondly, there is still the question of what portability means in practical terms.
“…our proposal is like a health care “backpack” that provides every American access to financial support for an insurance plan chosen by the individual and can be taken with them job-to-job, home to start a small business or raise a family, and even into retirement years.”
Problem: What’s going to be “portable?” If a health care plan is to be truly national, then does this mean that there will be a lowest common denominator for all health care insurance plans? Will the plan acceptable in a state with little or no oversight and consumer protections become the national standard? And, if not, then what IS the standard supposed to be?
Another problem: What elements of a health insurance policy must be included for the plan to be acceptable? One of the advantages of the ACA requirements is that some coverages (mental health, pregnancy, etc.) don’t apply to all consumers – however, if we start cutting out elements of comprehensive coverage where does it end?
Questions for Congressional Representatives:
(1) If a health care plan is portable across state lines, then do the consumer protections in place remain enforceable?
(2) If a health care plan is considered “junk insurance” in one state can it be enforced in another state with higher consumer standards?
Third, there’s the Medicare, Medicaid issue.
Depending on who is doing the talking from the Republican side these programs are either failed or failing. Neither is true. However, nothing is preventing Speaker Ryan from offering Coupon Care in place of the Medicare program, and from proposing turning the Medicaid support into a block grant program with formulaic funding.
Questions for the Congressional Representative:
(1) The ACA actually extended the viability of the Medicare program, what in the GOP plan will insure this viability is extended?
(2) If funding for Medicaid is turned into a block grant program what provisions in your plan would prevent this funding from being cut?
Senator Heller and Representative Amodei may be waiting for the GOP to come up with a rational and comprehensive plan to replace the ACA and Patient’s Bill of Rights – I’d advise them not to withhold breathing. Or, if they are assuming there’s nothing on offer from the GOP side since June 2016 – sort of a budget without numbers in health care terms – they may never have to have anything to say to their constituents.
The Trumpster promised that if President Obama would release his birth certificate he would release his tax returns. So, as of April 27, 2011 Trumpster was on record … Not that keeping his word is of much importance. It’s been 2092 days since the promise was made and subsequently ignored.
It’s not just the returns. Build a wall? Well, maybe a bit of fencing. Mexico will pay for it? No, that would be the American taxpayers. Now, the Trumpster announces health insurance for everyone, Everyone! Well not unless the old ideas like health savings accounts, portability, high risk pool can do the job. That these haven’t worked in the past is conveniently omitted.
It appears the only words which tend to hold are the Kremlin talking points. NATO is obsolete. (Unless you happen to be in Estonia, Latvia, Lithuania, Poland…) The European market is failing. (Unless you happen to be in Germany, France, Spain…)
At least some questions might be addressed by releasing the tax returns, but until such time as they appear in public the obvious conclusion is that there are “foreign entanglements” enveloping the president-elect.
2092 and counting.
The Senate yesterday began the process of dismantling the Affordable Care Act. With no replacement on offer. With no publication of a plan to make it possible for every American to purchase health care insurance. Please write or call your Congressional Representatives.
The Trumpster said Director Clapper called him to denounce the release of information about his possible compromise by Russian agencies. No, the Director called to say the agencies had issued no conclusions. Another day another lie. We need a select committee investigation into Russian activities in the 2016 election. Please write or call your Congressional Representatives.
Please keep writing. Please keep calling.
The Republicans are all but giddy over repealing the Deathly Obamacare! The “Failure,” which isn’t failing by any stretch of the imagination; the “Socialized Medicine,” which in fact subsidizes the private marketplace for health insurance coverage… And what of those subsidies which help pay for health insurance plans in Nevada?
Nevada has 79,876 enrolled in the ACA marketplace. 71,472 of them are receiving Advance Premium Tax Credits, that would be 85%. 48,736 policy holders in Nevada are receiving Cost Sharing Reductions; 61%. [KFF]
Shouldn’t it be interesting when 85% of the Nevadans who are enrolled in marketplace health insurance plans find out that with “repeal” comes the prospect of getting no help to pay the premiums for the family health insurance policy?
What are the options? Buy cheap policies, some of which meet the Consumer Reports standard for Junk? Drop coverage and let medical problems wait until it’s time to take a trip to the ER?
Let us remind ourselves that there are some 751,165 households in the state of Nevada, and 79,876 of them are enrolled in an ACA marketplace private health insurance plan. That’s about 11% of the households in the state standing to lose assistance securing affordable health insurance policies.
We also need to remember that these households are those which do not have employer provided health insurance for their family members – like small business owners, independent contractors, low wage contract laborers…
Next time the GOP rants on about “helping the Working People of America,” or “protecting small family businesses” remind them they didn’t mind shoving the props out from under these people when it came time to help them get affordable health insurance. Is this OK for Senator Heller and Representative Amodei?