Tag Archives: ACA

Amodei’s Bubbles: Republican Dreams for the AHCA

Nevada Representative Mark Amodei (R-NV2) is eager to let his constituents know that the District will not be negatively impacted by the GOP health insurance/tax cut bill currently being drafted in secret on Capitol Hill.  Not. So. Fast.

First, there will be losses.  Total coverage losses are projected to be felt by 37,500 under the AHCA, and 5,700 of those will be children, another 700 are disabled individuals in District 2.   Representative Amodei is optimistic about what will happen to these constituents —

Any Nevadan who has enrolled in the expanded Medicaid program from its inception in 2014 through the end of 2019 is free to remain in the program so long as their income does not exceed 138% of the national poverty level; …

In short, according to Rep. Amodei, his constituents are to be carefree and happy about their health insurance coverage until the end of 2019.  It’s now 2017.  Thus the recipients are to be reassured for another two years because:

  • Nevada will continue to receive the enhanced federal Medicaid funding for enrollees that it is currently receiving for as long as that enrollee stays in the program;

  • Present expanded enrollees lose eligibility only if they exceed income of 138% of the national poverty level, or if they elect to take employer provided or private health insurance;

Lovely, until we peek into the House version (the basis for the Senate version) and find:

“Medicaid provides coverage for over 70 million individuals and relies on both federal and state funding to continue growing. Under current law, the federal government covers, on average, 57 percent of each state’s total Medicaid costs, no matter the amount. The states pay for the remainder.

In contrast, under the AHCA’s per capita cap Medicaid program, starting in 2020, the federal government would provide states with a flat, capped dollar amount of funding for each person they enroll. The dollar amount is based on states’ 2016-level per-enrollee spending.”

One way to interpret this is that the District’s enrollees will be fine for the moment, but should be aware that the sword labeled ‘the Medicaid Per Capita Lid’ is swinging over head.  This has the potential to burst the first of Amodei’s bubbles.

Secondly, there’s this part of Representative Amodei’s eternal optimism:

“While we understand that Medicaid Expansion will eventually be phased out, we expect the recovery of our economy to continue, giving us reason to believe we will not need as robust of a safety net as we once needed at the height of the recession.  Additionally, with Nevada leading the nation in job growth in 2016, we also can expect employer-based coverage to become available to more people.”

A bit of confusion reigns here — don’t worry about Medicaid expansion cuts because Nevadans will be covered — but notice that the Medicaid expansion will “eventually be phased out.” One really doesn’t get to have it both ways.  But, there’s more.

Yes, the Gallup 2016 Job Creation Index gives Nevada top marks for job creation, but remember that this polling is based on asking workers if the employer is increasing hiring.   It is also statewide.  If we drill down we find positive news, but an incomplete picture.

“Employment increased in Nevada’s two large counties from September 2015 to September 2016, the U.S. Bureau of Labor Statistics reported today. (Large counties are defined as those with 2015 annual average employment of 75,000 or more.) Washoe County’s employment rose 5.0 percent and Clark County’s employment rose 3.7 percent.” [BLS]

What we are required to believe  is that employment increases in District 2 will be sufficient to cover some 37,500 people who will need to find employer paid insurance coverage by 2020.  Exactly how this is supposed to happen isn’t all that clear.

There are too many “ifs” in the proposition to adopt it with any enthusiasm.  IF there is continued employment increases — in the face of the financial deregulation legislation in the House and Senate which threaten to recreate the Wall Street Casino environment that wrecked Nevada’s economy in 2007-2008.  IF the employment increases in the rural portions of District 2 are sufficient to put Medicaid expansion enrollees into employer plans.

And then, there are the problems intrinsic in the AHCA in the employer sponsored insurance plans.  Those believing that the AHCA will deliver the same level of health insurance coverage in employer sponsored plans as the ACA may be in for a rude shock.

“The amendment (to the AHCA) would allow states to apply for waivers to rescind two major regulations of Obamacare, if the state can prove that healthcare costs would decrease as a result. That has led to concerns about its potential effects on the individual insurance market, but it could also change insurance for people that get coverage through their employers.

One of those Affordable Care Act-implemented protections — called essential health benefits (EHB) — requires insurers to cover a baseline of 10 health procedures and items including emergency-room visits, prenatal care, mental-health care, and some prescriptions.

Under Obamacare, employer plans could not place a lifetime limit on the amount that the plans pay out on EHBs, and required plans to limit the amount of out-of-pocket costs an employee had to pay annually, according to The Journal. That made plans more costly for employers but also provided better coverage for employees.”

Thus, there are three problems — junk plans might be back in the market; essential benefits can be reduced; and lifetime and annual benefit limits could be reintroduced.  We can safely assume that Representative Amodei’s analysis contains the usual measure of Trickle Down Happy Talk (if only the tax cuts are big enough all employers will hire enough people to make the magic happen! — See Kansas) and assumptions which sound superficially rationale but don’t hold up to much scrutiny.

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

It’s Going to be Fabulous!

If the question is: “What’s going to be fabulous?” The answer is probably nothing.  Thus far the administration hasn’t delivered on much.  Sights! Sounds! Drama! notwithstanding, it’s Shakespearean “Sound and fury, signifying nothing.”

The Muslim Travel Ban met yet another defeat on its way to the Supreme Court.  Supposedly it needed to be enacted Immediately to prevent the Threat of foreign terrorists, but time has passed (along with the time the Muslim travel ban was supposed to be in effect, during a study period) and behold a plethora, a horde, of heretical fanatics didn’t launch an assault.  Nothing there.

The wall seems like a distant memory,  as much fantasy as the idea the Mexican government was going to pay for it — IT, the wall, fence, river boundary, natural obstacles, or whatever.  Nothing there

The President’s first executive order called for the repeal of the Affordable Care Act, and authorized agencies to grant waivers, but pointedly did NOT offer to infringe on “authority granted by law to an executive department or agency, or the head thereof.” Other Executive Orders follow the same pattern. Call for the study of some topic, require a report, and then infer that the report would be fodder for legislation. Perhaps the closest analogy to these orders might be a Christmas List — “Dear Santa, please bring us justification for the following rule changes or legislative priorities.” Lots of smoke and mirrors, without much there there.

An important point to note in terms of the Republican version of health insurance “reform” is that it is far more about tax cuts for those earning over $200,000 than it is about making health insurance affordable for average Americans.  See also: Vox and Atlantic, Forbes.  The median household income in Nevada is $52,431.

And speaking of Nevada — what can we expect?

“371,000 Nevadans stand to lose their health coverage.1

Nevada stands to lose $16 billion in federal assistance to help provide health coverage to its residents.2

Approximately 71,000 Nevadans who currently get financial assistance to help pay for their health coverage will lose this help and will no longer have affordable coverage options. In 2016, Nevadans receiving financial assistance saw their monthly premiums reduced on average $268 thanks to this help.3

The now-historically low rate of uninsured people will spike, with the number of uninsured in Nevada increasing 95 percent by 2019.4 This will reverse the immense progress that has been made to expand coverage. Between 2013 and 2015″

And there’s more:

“187,000 people stand to lose health coverage, most of whom are working.6 The Medicaid expansion has extended health coverage to lower-income Nevadans who hold down jobs that are the backbone of the state’s economy—from fast food workers to home care attendants to construction workers to cashiers. Repeal will leave these hard working Nevadans out in the cold.

Nevada will lose billions in federal Medicaid funding. Over the course of a year and a half alone, Medicaid expansion brought $1 billion in federal dollars into the state economy.7 The impact of that lost federal Medicaid funding will have a ripple effect throughout the state economy, affecting hospitals, other health care providers, and businesses.”

And More!

“The Medicare donut hole will re-open. This will leave Nevada’s seniors and people with disabilities with a gap in prescription drug coverage and forced to pay thousands of dollars more in drug costs.

  • Seniors and people with disabilities in Nevada have saved approximately $123 million on drug costs thanks to the ACA’s closing the Medicare donut hole.14

  • In 2015 alone, approximately 34,000 seniors and people with disabilities in Nevada saved on average $967 on drug costs.15″

Nothing in this truncated list of horror makes it sound like Republican health insurance legislation will be Fabulous.  Unless, of course, we mean “fabulous” in the sense of some gory fable designed to send small children to the floor while checking for monsters under the bed.

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Filed under Health Care, health insurance, Medicaid, nevada health, Politics, Taxation

Please, No More Mr. Moderate

Here’s the beltway narrative du jour:

“Majority Leader Mitch McConnell has proposed phasing out higher federal payments for people who sign up for Medicaid under the health law’s expansion in three years. Ohio Republican Rob Portman and others such as Nevada’s Dean Heller are pushing for a seven-year phaseout ending in 2027. Senators also are debating how much to reduce federal funding for Medicaid as compared to current law.”

Cutting to the chase, there’s nothing “moderate” about support for dropping federal payments for Medicaid — in three years, in seven years, or even in ten years.  It’s almost tantamount to arguing that Poison X is better than Poison Y because X won’t kill you for another 7 years.

There’s also a pattern to Senator Heller’s carefully crafted media image.  First, he expresses “great concern” about Republican legislation; then, he comes out against the legislation “in its present form.”  When the time comes for a vote on the bill Senator Heller suddenly finds his “concerns” have been addressed and he can support the measure.  There are clocks in this house that don’t function with this kind of regularity.

On May 4, 2017 Senator Heller is reported by the Reno Gazette Journal as “opposed to the Obamacare repeal in its present form.”  Notice that prescient loophole — “in its present form,” because it’s guaranteed that the “form” will change just enough for Senator Heller to announce his support when the roll is called.   McConnell is pushing for a vote before the end of the month:

“McConnell and his leadership team hope to have a preliminary framework submitted to CBO by the end of the week and a floor vote by month’s end, Republican sources said. On Tuesday, the Senate Budget Committee said the House bill cleared the Senate’s stringent reconciliation rules, allowing the House to formally send the bill to the Senate. Otherwise, the House would have had to vote again on a modified bill, further derailing the repeal effort.”

There are some ironic touches in the GOP controlled Senate — the Republicans once cried into their towels that the Affordable Care Act was jammed through the Congress, this has been thoroughly debunked:

“This is a bizarre description of a bill that spent a year working through Congress, eventually passing numerous committees, two full House majority votes, one Senate supermajority vote and, in fact, many, many, many hearings. While the law did use a budget-reconciliation bill to enact minor fiscal adjustments, a maneuver that Republicans decried as akin to a death blow to the Republic, in fact its major provisions all received 60 votes in the Senate. The bill was evaluated by the independent Congressional Budget Office, and the projected premium levels in the new exchanges turned out to be accurate, and its predictions of overall federal health spending turned out to be too pessimistic, as the federal government is now spending less on health care with Obamacare than it was projected to spend without it. The bill was enacted in a democratic, deliberate, transparent, and excruciatingly slow fashion.”

In contrast to the “excruciatingly slow” enactment of the ACA the current Senate is (1) seen to be fond of that budget reconciliation procedure; (2) holding the work sessions on the bill behind closed doors; and (3) has not scheduled any hearings on the bill to date. Not to put too fine a point to it, the Republicans are doing exactly what they falsely accused the Democrats of doing — and thus far getting away with it.

Senator Heller’s constituents can contact his office at 202-224-6244 (DC office); 702-388-6605 (Las Vegas Office), or 775-686-5729 (Reno Office)  Senator Heller’s aide assigned to health care issues is Rachel Green.

 

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

Disinformation Dismay

Perhaps Representative Mark Amodei (R-NV2) would like to apply his talent for taking simple GOP talking points and putting them through the Amodei X600 Syntax Degenerator to the Trumpian version of why it was necessary to take the US out of a VOLUNTARY climate improvement agreement? Vox explains the 5 biggest bits of disinformation in the Rose Garden jazz concert and diplomatic disaster. Want more fact checking? Politifact provides more.

And, we hear that Senator Dean (Moderate in Name Only) Heller (R-NV) wants to get to “yes” on replacing the Affordable Care Act with some GOP approved insurance scheme that actually replaces affordable health insurance with a major tax cut for those who enjoy an income level in the top 2%.  How do we get to “yes” with this scenario?

“However, under the AHCA, currently under consideration in the Senate, the tax credit will be a flat rate based on age. Korbulic said a 40-year-old making $30,000 a year could see a more than $400 increase in premiums because of the flat rate, but a person over the age of of 60 making the same amount could see a $6,000 jump in premium costs.”

“I think you’re looking at a scenario where consumers are going to have less affordable access, and so that will likely mean they’re going to be priced out of the market,” Korbulic said. “

Meanwhile, the Trump Chicken put in an appearance at Senator Heller’s Las Vegas office. Senator Heller has a relatively predictable pattern. (1) Publicly announce “concern” or “trouble” with Republican legislation.  (2) Receive some nebulous assurance that the result of the Republican legislation won’t be the obvious. (3) Revert to standard GOP platitudes and clichés like “free market,” “freedom,” “personal choice,” and “individual responsibility,” and then (4) Vote right along with the GOP leadership as he had intended to all along.  (Examples?  SCHIP votes.  Financial Reform.)  There’s no particular reason to believe his performance on this matter will be any different.

Representative Amodei emerged from hiding to explain his chances for a statewide office are slim to none.   There is no indication yet in these parts that the tag team of Heller and Amodei will conduct town hall meetings with constituents in any populated area of the Silver State with lights, cameras, and real questions.

 

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Filed under Amodei, ecology, Health Care, health insurance, Heller, Politics

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

Quick Phone Call Fodder for Nevada District 2

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)

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Filed under Amodei, Health Care, health insurance, Politics

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