Tag Archives: Affordable Care Act

Caveats and The Unspoken Big Lie

So, we have two sources telling us that approximately 24 to 26 million people will lose their health care insurance if the Republicans are successful in jamming through their tax shift proposal masquerading as a ‘replacement’ for the Affordable Care Act.  Therefore, it’s now time for a new ‘talking point’ from the GOP, especially since some Republicans like Rep. Mark Amodei are on record saying:

When asked what his plan for a change to Obamacare would be, Heller said, “If you like your health care, you can keep it,” a statement that echoes a promise from Obama that later ended up being false.  Amodei said 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. [RGJ 2/22/17]

Well, now we know with some certainty that the GOP replacement bill will result in reduced coverage, and some people and families will be uninsured.  How to escape this trap? A new talking point!

“No one will lose their coverage.” 

The HHS Secretary Tom Price, whose replacement would have cost some 18 million their insurance, opined:

“Success, it’s important to look at that,” he said. “It means more people covered than are covered right now at an average cost that is less. I believe that we can firmly do that with the plan that we’ve laid out there.”  Not exactly.

Then, there was Pete Sessions, a Republican from Dallas, telling his listeners:

“Nobody is going to lose their coverage,” Sessions, chairman of the House Rules Committee, told CNN. “You’ll be able to keep your same doctor, you’ll be able to keep your same plan.”

A spokeswoman for the congressman later explained that Sessions meant Americans will have the choice whether to obtain or maintain coverage — not that the GOP bill would take coverage away. The American Health Care Act would nix the ACA mandates requiring Americans to have health insurance.” [DMN]

And, there it is, the Big Caveat, which makes taking health insurance away from working American all AOK.  You can “choose” to keep your health insurance! IF and ONLY IF you can afford it. ?

However, even IF you can afford it, the policy you can purchase may not be truly comprehensive. A young person may have to get additional insurance if he or she marries and there is a pregnancy in the plans. More cost. A plan may not cover preventative care? Or mandatory coverage for cancer screenings?  More cost.  It doesn’t take too long to add up the extras until what has been basic coverage becomes optional coverage. Then the risk pool is reduced and the premiums go up. That is how insurance works. The larger the risk pool the lower the premium costs.

Thus, “you can keep your health insurance” IF:

  • You can afford it in the first place, not likely if you are among the low wage workers in this country.
  • You can afford it and are willing to accept lower levels of coverage, and you don’t mind having to pay for additional services for additional  premiums.
  • You are willing to shop for insurance coverage every time the circumstances of your life changes; as in pregnancies, pre-natal care, caring for a special needs child, a family member needs rehabilitation or mental health care.
  • You are willing to see your local, and especially rural, hospitals see higher levels of uncompensated care.
  • You are willing to accept that your doctors and other health care professionals will see less reimbursement for services rendered.
  • You are willing to forego coverage for preventative screening and treatment for medical conditions.

Access to health insurance isn’t the same as having health care insurance.  As the now commonplace tweet has it: “I have access to a Mercedes Benz dealership — that doesn’t mean I can afford to buy something of their lot.”

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

Myths and Legends: The Medicaid Issue in Nevada

There was a Republican politician on my television screen this morning telling me, or trying to tell me, that Medicaid was “meant for mothers, children, and those who couldn’t work…” This is outdated. Then, he tried to convince me that Medicaid was being “abused” by those who work and ‘game the system,’ while spouting platitudes about the Free Market and the Joys of Competition.  Let’s start at the very beginning.

This is the explanation of Medicaid as reported by Nevada’s Division of Health Care Financing and Policy (pdf)

“Medicaid is the nation’s main public health insurance program for people with low incomes and the single largest source of health coverage in the U.S.”

The program is meant to help people with low incomes.

“The PPACA extended coverage to many of the non-elderly uninsured people nationwide. The June 2012 Supreme Court Ruling made Medicaid expansion optional for states, and Nevada elected to join the expansion and maximize federal dollars. Effective January 1, 2014, this move broadened Medicaid eligibility to nearly all adults under age 65 with income at or below 138% of the Federal Poverty Level (FPL). At the end of SFY 2014 that meant that there were an additional 125,989 new enrollees in Nevada Medicaid, and increased expenditures of $154,816,777.00. These new expenditures are 100% federally funded.” [NV med pdf]

Medicaid expansion added those working Americans who were earning 138% of the poverty line and below, (pdf) and more specifically: (1) Those between the ages of 19 and 64 who are earning less than 138% of the FPL. (2) Pregnant women in homes earning less than 165% of the FPL. (3) Children from birth to 19 years of age in homes wherein the earnings are at or below 205% of the FPL, with a small premium required in some cases. Translated into real people with real levels of low income earned, this means a family of four would be eligible for Medicaid in Nevada if the family earnings are less than $2795 per month; for pregnant women if the earnings are at or less than $3341 per month; and families are eligible for the kids’ Check Up program if family earnings are less than $4151 per month.

If we calculate annual earnings, then monthly earnings of $2795 mean an annual income  of $33,540. At $3341 annual earnings of $40,092, and at $4151 annual income of $41,630. Nevada’s median income is $52,431 (2015). To put these numbers in perspective, the average weekly wages of a person working in a private restaurant in this state are $382, or $1528 per month ($18,336 yearly). [DETR] The average rent for a 2 bedroom apartment in Las Vegas, the obvious site for most private restaurants, is $932 per month. [RJ] In short, not only are wages not all that generous in Nevada, the benefits available for Nevada families aren’t all that generous either.

Republicans, however, strenuously oppose benefits for adults capable of working. This would make infinitely more sense IF and ONLY IF they were willing to support a living wage for all employees. One really doesn’t get to have it both ways.  Either you want a reduction in benefits that most working people can afford to purchase on their own because they have the financial resources to do so, or you want lower wages which mean that individuals and families cannot afford those things, like health insurance, and the public benefits are required to make up the difference.  However, at this point we slam into another GOP myth.

Free market competition will make health insurance affordable for everyone, even those who are working in low wage jobs.  Good luck with that. Personally, I have yet to hear anyone explain with any specificity why health insurance corporations will be flocking to Clark, Washoe, or even Esmeralda counties because there is more “free market” applied to the situation. If the insurance companies weren’t wildly excited about selling individual and family health insurance before the enaction of the ACA, why would they do so now? Unless, of course…

They could sell policies that didn’t cover all that much? That cost more for those between the ages of 50 and 64?  That didn’t cover maternity expenses? That didn’t cover preventative care? That didn’t cover drug rehabilitation and mental health services in parity with physical treatments? That only covered the items required in those states with the least consumer protections? And, even then all we have to look to is the situation in Nevada when insurance corporations were free to offer what they were pleased to call comprehensive policies.  Again, if they weren’t interested in selling a plethora of individual and family policies then why believe they would be now?

And that Free Marketeering? It doesn’t work in the health care industry:

“In a free market, goods and services are allocated through transactions based on mutual consent. No one is forced to buy from a particular supplier. No one is forced to engage in any transaction at all. In a free market, no transactions occur if a price cannot be agreed.

The medical industry exists almost entirely to serve people who have been rendered incapable of representing their own interests in an adversarial transaction. When I need health services I often need them in a way that is quite different from my desire for a good quality television or a fine automobile. As I lie unconscious under a bus, I am in no position to shop for the best provider of ambulance services at the most reasonable price. All personal volition is lost. Whatever happens next, it will not be a market transaction.” [Forbes]

The only thing I can say with any certainty is that the Republicans have little idea exactly what constitutes a Free Market, and instead are waving it like a banner crovering their underlying desire to be free from the moral requirements compelling us to be our brother’s keepers.  The range of misanthropic explications are appalling, from “we need not do anything because the poor will always be with us anyway,” to “when Jesus told us to provide for one another he only meant fellow Christians.”

The Repeal and Replace campaign is as void of humanity as it is of understanding of the reality of most family economics, and of the comprehension of what the term ‘free market’ actually means.

 

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Filed under Economy, Health Care, health insurance, Politics

Questions for District 2’s Representative should we ever see a town hall session

Representative Mark Amodei (R-NV2) was pleased to spend his 2016 campaign season supporting the candidacy of one Donald J. Trump.  Now that the campaign is over — there are some pertinent questions the District 2 Representative might address should he ever have one of those ‘town hall’ things.Carter Page

#1. Do the constituents in your district deserve a full and complete explication of the ties between the present administration and the Russian government, its agents, and its affiliated operatives? How likely is it that there will be a full explanation without an independent commission investigation?

We have some hints at the extent of Russian meddling with our elections and administration in chart form here,  Mr. Trump’s connections in Russia here, and the implications here. And, Politifact’s explication here.   There’s the Carter Page  connection. The Roger Stone connection.  More about Wilbur Ross, the administration’s Secretary of Commerce here. A bit of the Russian reactions recently in this article. What of the activities of Paul Manafort?  The names, in the post Flynn flood, keep coming up and out. It seems necessary to have a full, independent, and comprehensive investigation to determine the extent and implications of the Trump ties to the Russians.

#2. How do you explain support for a health care  act which replaces the Affordable Care Act with legislation that doesn’t offer a route to affordable health insurance plans for working Americans? And, which looks for all the world like a whopper tax cut for millionaires, billionaires, and insurance corporations? 

This topic has been explored in the Washington Post, in the Fortune Magazine, and in Slate.

Will the replacement bill require insurance plans to cover mental health services on par with physical health coverage?

Will the replacement bill require insurance plans to cover pre-natal, maternity, and post-natal expenses for American families?

Will the replacement bill require that consumer protections provided by state insurance commissions be retained?

How will be the replacement make health care policies more ‘affordable’ without going back to the days when insurance companies could sell low coverage/high deductible policies which left families with massive medical debt?

How will the replacement bill maintain the fiscal health of rural hospitals and clinics?

Now, all we have to do is wait for Representative Mark Amodei to hold a meeting with constituents to address these, and other issues.  I’d not like to hang by my hair for as long as this might take.

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

The GOP Assault on the Affordable Care Act

There’s no reason to re-invent the wheel or to rewrite the analysis. Here’s a list of recommended reading:

Why the Emerging Bill…will fail. Center for American Progress.  See also CAP Republicans still have no plan. h/t Andy Slavitt 

 

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Filed under Health Care, Politics

Repeal and Replace with stale and fail

There is a sort of, kind of, GOP pn to replace the Affordable Care Act, it’s the set of proposals from Tom Price. [Some discussion available at Forbes] Essentially this version of the ‘replacement’ is a collection of the frail, the failed, and the stale. Some items of note:uran

  • It gives the insurance companies a loophole to reintroduce exclusions for preexisting conditions.
  • It encourages health savings accounts, another way of giving the well to do another tax break.
  • It offers subsidies which would likely only help with the low coverage health insurance plans that could be advertised as ‘comprehensive’ before the ACA.
  • Just about anything on a piece of paper would qualify as an insurance policy, opening loopholes for the creation of ‘place holder policies,’ and the life time limit junk insurance which could be sold before the ACA.
  • Portability is shorthand for the elimination of consumer protection enforced by state insurance officials. If almost anything qualifies as an insurance policy then such policies would be allowable in all states, regardless of state requirements.

This, of course, isn’t the only set of proposals out there. However, it does contain some common GOP ideas about how to get back to those not so wonderful days when junk insurance could pass for the real thing, and when insurance corporations could use all the premium money they wanted on executive compensation or other shenanigans.

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Filed under Health Care, health insurance, Politics

Unanswered Questions

It’s lovely to listen to melodic phrases like “patient centered care” and “freedom of choice,” as well as all manner of other Republican catch all incantations…but none of these address practical questions Representative Mark Amodei  (RNV2) needs to answer about the replacement of the Affordable Care Act.  A few examples:

The extension of health care insurance and Medicaid helped reduce the level of uncompensated care for which hospitals could ultimately be liable. How will a GOP plan reduce the level of uncompensated care? How will rural hospitals be affected? How will hospitals in Lander, Pershing, and Humboldt counties be affected?

Prior to the Affordable Care Act there was only one health insurance company selling individual policies in large swaths of District 2. How will the GOP replacement legislation insure competition for those seeking to purchase individual health insurance policies for their families?

Prior to the Affordable Care Act insurance companies could market policies with lifetime limits.  These were certainly cheaper than comprehensive policies, however they never seemed to be adequate for serious and chronic illnesses or very serious accidents with long term recovery and rehabilitation.  In fact, many respected consumer advocates called these “junk insurance.” What will the GOP replacement do to prevent the reintroduction of junk insurance?

Before the Affordable Care Act Republicans touted health savings accounts as an alternative. How would a GOP replacement for the Affordable Care Act address the health care needs of those whose wages and salaries are insufficient to sustain the contributions needed to establish an adequate health savings account level?

Prior to the Affordable Care Act insurance corporations could refuse policies for those with preexisting conditions and to those engaged in what the companies categorized as high risk occupations.  How will a GOP replacement prevent a reintroduction of these practices?

Before the Affordable Care Act insurance corporations were allowed to charge higher premiums for policies sold to women, or which covered female members of families. How will the GOP replacement address this issue?

The Affordable Care Act extended the viability of Medicare.  How will a GOP replacement extend the capacity of Medicare?

These are but a few of the questionsame raised by the GOP calls for repeal. They cannot be answered by pious recitals of Republican rhetorical flourishes. They cannot be addressed by reiterating Republican buzz words and phrases. They have to be addressed in the real world, of real people, with real health care needs.

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Filed under Health Care, health insurance, Politics

And so it begins

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.

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Filed under Congress, Health Care, health insurance, Heller, nevada health, Politics