Tag Archives: Affordable Care Act

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

11% of Nevada Households could lose affordable health insurance plans

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?

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Happy New Year Nevada: Here’s what we lose if the ACA is repealed

Perhaps we should now speak of two varieties of what was formerly known as the “Fog Of War.”  The older form is often attributed to Carl von Clausewitz (but never verified), the Nebel des Krieges, or the “uncertainty in situational awareness experienced by those engaged in military combat.”  Then there seems to be a more modern form, in which the Republicans fight against “Obamacare” and promise to Repeal and Replace it without inconvenience to anyone.  Or, the uncertainty of what to do when the fight stops being strategic and starts being ever so inconveniently tactical.

One of the elements that is truly popular is the ACA provision forbidding insurance companies from denying coverage because of a person’s medical history (the pre-existing condition provisions in policies).  69% of the country favors this provision including 75% of Democrats, 65% of Republicans, and 63% of independent voters. [KKF]

Perhaps this is a popular feature of the Affordable Care Act because 25% of Nevada’s non-elderly population, or 439,000 people  could be denied health insurance coverage if the pre-2010 rules were re-established for health insurance companies. [KFF]  If a person is without health insurance the problems are well documented.

“Lack of health coverage, even for short periods of time, results in decreased access to care.  Adults with gaps in their health insurance coverage in the previous year were less likely to have a regular source of care or to be up to date with blood pressure or cholesterol checks than those with continuous coverage.16 Children who are uninsured for part of the year have more access problems than those with full-year public or private coverage.17” [KFF] (emphasis in the original)

The pattern from this point on is predictable.  No health insurance, less likelihood of consistent care, less care begets more serious health problems, and more serious health problems are more expensive, especially if treatment is deferred until the emergency room is required.    MEPS has some 2013 data which is on point:

“Average expenses for people who had one or more visits to the Emergency Room were $1423 in 2013, according to the Medical Expenditure Panel Survey (MEPS). Median, or typical, cost was $703. For people ages 45 to 64, the cost was substantially higher on average ($1840). Uninsured people under age 65 averaged $1627 in expenses ($572 median), of which they paid almost 1/3 out of pocket. While average cost for those age 65 and up was about $1500, Medicare recipients paid only about 5% out of pocket. Median charges for children under age 18 were $471 to $477.”  (Full chart here)

The standard Republican response is that people ought to have Health Savings Accounts, and/or pay more out of pocket. [PUSA]  Therefore, our 439,000 Nevadans would be on the hook for emergency room treatment of approximately in the range of $703 to $1423.  Uninsured children? The parents would be liable for costs of at least $471 for that rash, laceration, abrasion…whatever the little critter managed to do to itself.  It’s all well and good to babble on about some theoretical notion of Personal Responsibility, but …

Health Savings Accounts and High Deductible Health Plans aren’t for everyone.  For example, the median household income in Nevada is $51,847 and the average household has 2.72 people.  The average mortgage payment is $1,442, and average gross rent is $973. [Census] Those in Clark County can expect to pay out $177.22 per month on utilities, and another $352.74 on groceries (at least) per month. 

We played with some of the numbers back in 2015, and the pressure on average families in the Silver State was obvious then:

“For the sake of the argument let’s propose that the family has one car, which means  ownership costs of $517.00, and operating costs in the western region of $236.00 per month. [IRS] Subtract another $753 from the monthly budget. Now we have $1,848 left for the remaining expenses.

Basic utilities in Las Vegas run about $175.56, and in Reno about $130.00; let’s call it in the middle and estimate monthly utility bills of $150.00; now we have $1,698 in the check book.

Now for the groceries.  A family of four can just get by on about $146 per week and eat healthier on about $289 on the higher end. [USDA pdf] Let’s settle for the “moderate” plan which will cost our average family of four about $1,062 per month if the kids are over 6 years of age.  Now there’s $636.00 left.”  [DB]

Without too much more arithmetic it should be clear that High Deductible Health Plans and Health Savings Accounts are a nice idea if (1) a person is generally healthy with no family history of serious illnesses; and (2) a person is wealthy enough to afford to put aside “extra” money each month for the Health Savings Account.  Return with us now to elementary school arithmetic.

We’ve been speaking of households in terms of their Median household income. So, we know that half the households in Nevada are earning less than $51,847 per year.  We also know that 14.7% of Nevadans have incomes below the poverty line ($24,250 for a family of four in 2015).  We also know that 22.8% of Nevadans under the age of 65 and below 138% of the poverty line did not have health insurance at any time during 2015. [TP.org]  Speaking about an HSA to those whose households are trying to function with incomes below the median and barely above the poverty line seems almost cruel.  It doesn’t do to bellow “personal responsibility” when the individuals and households in question don’t have the “personal resources” to meet this exalted standard.

It’s perhaps even more cruel to imagine the days when an insurance company in this or any other state could decline coverage for previous treatment of: alcohol or drug abuse Alzheimer’s or dementia, arthritis, cancer, cerebral palsy, congestive heart failure, coronary artery disease, Crohn’s disease, pulmonary disease, diabetes, epilepsy, hemophilia, hepatitis, kidney disease or renal failure, lupus, mental illness, multiple sclerosis, muscular dystrophy, obesity, organ transplant, paraplegia, paralysis, Parkinson’s disease, pending surgery or hospitalization, pneumocystic pneumonia, pregancy, sleep apnea, or strokes. [KFF]

Yet, this is precisely what the Republican Congress has in mind … repealing the Affordable Care Act, with it’s protections for those with pre-existing conditions and replacing it with … something…. somehow … some way… in some form… when the only two definitive responses have been “using the emergency room,” and “HDHP + health savings accounts.”  In short, back to the bad old days.

No more light on the subject, just more Nebel des Krieges from the Republicans, including Representative Mark Amodei (R-NV2) and Senator Dean Heller.  It would be well for them to blow off some of the fog and illuminate precisely what they want to do.

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Filed under Health Care, health insurance, nevada health

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

Don’t Grab Your Pearls: ACA Exchange Premium Increase in Nevada 6%

Premium Increase Map

Far from it. First, these are REAL numbers, not Trumpian hyperbole about ACA exchange purchased premium increases.  Secondly, increases in insurance premiums whether exchange purchased or privately purchased are going up.  The insurance companies set the premium prices; and if a person used the exchange to buy personal health insurance, and qualifies for a subsidy, then the increase will be felt less than if the insurance isn’t subsidized.

However, this is an excellent argument FOR a PUBLIC OPTION, which would provide competition for the private insurance corporations (and thereby could cause some cost-containment not now built into the system).  We could, for example, allow private citizens who don’t have health insurance provided by their employers to buy into the Medicare system.

Why the increases? Business Insider explained last May:

“However, the most important factors associated with lowest-cost silver plan premiums and premium increases are those defining the contours of competition in the market,” the report concluded. “Rating areas with more competitors had significantly lower premiums and lower rates of increase than those that did not.”

“The paper also found that there was one player that had more of an effect on prices than any other provider.

“Those rating areas with a Medicaid insurer competing in the marketplace also have lower premiums and lower rates of increase than those regions without a Medicaid insurer competing,” Blumberg, Holahan, and Wengle said.

This is an issue as insurance companies evaluate the profitability of the state exchanges. With considerable political pushback against expanding Medicaid, private insurers will have to carry most of the load and provide competition.”

Or, to put it more succinctly – Republican opposition to the expansion of the Medicaid programs helps drive UP health insurance premium costs.  Full. Stop.

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Filed under Health Care, health insurance

Replace the ACA with What??

Take Two Aspirin

It’s pearl clutching time for the opponents of the Affordable Care Act and Patient’s Bill of Rights.  The premiums are going up.  Yes, and what did a rational person think was going to happen in a system based on private health insurance corporations selling policies?  Further, before swallowing all the hyperbole there needs to be a bit fact checking.

First: This is far from a Nationwide Crisis – calm down – as Think Progress advises

“Although some news outlets are characterizing the news about rising premiums as a “November surprise” that could have a big impact on how Americans feel about the upcoming election, the reality is that these price hikes won’t affect the majority of the country. Most Americans get their insurance either through their employer or through a safety net program like Medicaid. A much smaller portion of the population — about 6 percent — buys private insurance plans on Obamacare’s marketplaces.”

Second:  If the premiums go up so do the subsidies. Again, Think Progress explains —

“Critically, Americans won’t need to shoulder Obamacare’s premium increases on their own. Most people who are insured through Obamacare’s state-level marketplaces don’t pay for the full price of their premiums because they get an assist from the government in the form of subsidies. These federal subsidies to help offset the cost of buying insurance are also going to rise. According to the Obama administration, even with the projected increases, more than 70 percent of people buying insurance on the marketplaces will be able to get a plan for less than $75 a month next year — provided they take advantage of the subsidies available to them and select a low-cost plan with more limited benefits than other options.”

If a person is covered under the terms of an employer’s health insurance plan, Medicare, or private insurance purchased on his or her own – this is not an unexpected increase, nor is the increase in premium costs essentially any more than what other policy premiums will see.  There is no need to grab the pearls, hit the fainting couch, or even to have to take two aspirin.

The Replacement is Worse Than The Current System

If one is inclined to take on headaches, none may be more miserable than what the Republicans have in mind for replacing the Affordable Care Act. If clutching pearls and twisting open the adult-proof cap on the painkillers is desired then by all means – support the Health Savings Account idea.

There is nothing new about this idea, and nothing particularly good about it.

‘A creation of the 2003 Medicare act, HSAs do offer employers the hope of curbing their insurance expense. Under the law, the accounts, which enable workers to set aside pre-tax dollars they can later use toward their out-of-pocket medical expenses, must be offered in tandem with a high-deductible health plan (HDHP).” [cfo]

As originally envisioned the HSA is combined with a high-deductible policy.  Thus for any employee there’s a double whammy.  More money out of the paycheck for the HSA and more money out of pocket for the health insurance plan.  But, doesn’t this make the consumer more cost conscious? Yes, and that isn’t necessarily a good thing.

“Studies have recently confirmed the worst fears about such plans: They can induce beneficiaries to stint on health care that they truly need. According to the Employee Benefit Research Institute study, 35 percent of the people in CDHPs and 31 percent in HDHPs “reported delaying or avoiding care, as opposed to 17 percent of those in comprehensive plans.” [cfo]

Avoiding treatment is NOT a desired outcome of any wellness plan.  If you need more convincing that HSA’s are not the answer, look to Five Reasons Not To Enroll In An HSA —  no drug copays; no immediate financing; high deductibles, 213(d) confusion over what’s covered; and an “education gap” about these products.

Seeking more information about this rather bad idea compliments of the Republican Party and their allies in the corporate insurance and financial markets?  There’s The Truth About HSA’s; Here’s Exactly How Terrible Paul Ryan’s Obamacare Replacement Plan Is; HSAs mostly benefit high income taxpayersGAO study confirms HSAs primarily benefit high income individuals; Making Health Care Worse.

The Health Savings Account is another idea for a nice tax shelter, for young healthy, wealthy people.  It is not an answer for addressing general health care cost containment, especially not if people tend to put off medical treatment until their situation is serious or dire.  In less polite terms, it’s the 0.01% answer to a problem affecting the other 99.99%

Previously in Desert Beacon: All Right Everyone, Gird Your Loins! The GOP’s Coming For Health Insurance Reform Repeal (four years ago)

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

One Great Distraction: Guns, GOP, and Mental Health

blood money The GOP response to gun violence in America is getting tiresome, and no diversion or distraction more so than when its members cite “mental health” as a topic for discussion.

The Republican Party really shouldn’t get anywhere near this distraction, not with their record on making mental health care available to American citizens. [AmerBlg]   It doesn’t do to blather on about Guns and Mental Health in one breath and then take 50+ votes to repeal the Affordable Care Act in the next.

Before the passage of the Affordable Care Act about 1/3rd of those who did have health insurance in the individual market had no coverage for substance use disorder to services, and 1/5th had no coverage for mental health services, including outpatient therapy, and inpatient crisis intervention and stabilization.  Additionally, even when a person did have coverage there was no guarantee mental health services would be covered comparably to medical and surgical care.   The situation in the small group market was a bit better, coverage for substance abuse and mental health services was more common, but many states did not have “parity” laws requiring comparable coverage with medical and surgical treatment.  Then, there were those 47.5 million Americans who didn’t have any health insurance, and the 25% of uninsured adults who have a mental health condition, a substance abuse problem, or both. [ASPE]

After the passage of the Affordable Care Act mental health and substance abuse are categories covered as part of the package of Essential Health Benefits.  With the finalization of rules as of January 1, 2014 consumers buying health insurance policies can be confident that the health plan will cover mental health services, and importantly, that there will be parity for mental health and substance abuse treatment coverage. [ASPE]

And what was the Republican reaction?  “Repeal.. Repeal.. Repeal…” at least 50+ times. [WaPo]  

January 8, 2011:  There was a mass shooting in Tucson, AZ  six were killed, eleven others wounded including a member of Congress, Rep. Gabby Giffords.   January 19, 2011: The House votes to repeal the Affordable Care Act.  On February 19, 2011 the House passed an FY 2011 continuing appropriations bill with several amendments to “severely limit” the implementation of the Affordable Care Act. The measure passed with no Democratic support.  Further votes were taken to carve up and diminish the provisions of the Affordable Care Act on March 3, 2011, April 13, 2011, and April 14, 2011.  On April 14, 2011 a House resolution advised the Senate to defund all mandatory and discretionary spending associated with the Affordable Care Act.  April 15, 2011 the Republican controlled House passed its version of the budget repealing and defunding the Affordable Care Act.  During the four months after the Tucson Shooting the Republican controlled Congress spent much of its time trying to defund, limit, or outright repeal the law requiring health insurance companies to include mental health services as an “Essential Benefit” and on par with coverage for medical and surgical treatment.  And, they weren’t finished.  Republicans tried to gut the Affordable Care Act provisions on May 3, 2011; May 4, 2011May 24, 2011; and on August 1, 2011 the Budget Control Act cut some mandatory and discretionary funding tied to the Affordable Care Act.

October 12, 2011:  Eight people were killed and another critically wounded by a shooter in Seal Beach, California.  Ironically, on October 13, 2011 the House passed the “Protect Life Act” preventing any funding from be applied to abortion procedures.  More Congressional incursions were made on the Affordable Care Act on November 16, 2011, December 13, 2011, and December 16, 2011.  On February 1, 2012 Congress voted to repeal a long term care insurance program (CLASS).  February 17, 2012 the House voted to cut funding for Louisiana’s Medicaid program by $2.5 billion, and cut $11.6 billion including $5 billion from the Public Prevention and Health Fund.  The cut to the Medicaid program was significant because Medicaid is the insurance provider for low income people, some of whom might be in need of substance abuse or mental health care treatment.  On March 29, 2012 the House version of the FY 2013 budget called for repealing and defunding the Affordable Care Act.

April 2, 2012:  A former student at Oakland’s Oikos University opened fire in a classroom, seven were killed and three wounded.  The House attacked the Affordable Care Act again on April 27, 2012, and more significantly voted on May 10, 2012 to replace the automatic budget cuts to the Defense Department by defunding and repealing portions of the Affordable Care Act. June 7, 2012 the House voted to repeal the medical device tax, and limit the reimbursements for over the counter medications.  On July 11, 2012 the House voted to repeal the Affordable Care Act.

July 20, 2012: 12 people were killed and another 58 were injured in the shooting at the Aurora, Colorado movie theater.  Yet again, opponents of gun safety regulations noted that the shooting was the result of mental illness.

August 8, 2012: A shooter gunned down six people and injured three others at a Sikh Temple in Oak Creek, WI.

September 28, 2012: Six were killed and two injured in a workplace shooting in Minneapolis, MN.

October 21, 2012:  Three died and four were injured in a shooting in Brookfield, WI.

December 14, 2012:  Newtown, CT; 27 died including 20 first grade children. On December 20, 2012 the House voted once more to replace discretionary spending cuts enacted as part of sequestration by defunding and repealing several provisions of the Affordable Care Act.  On January 1, 2013 the “fiscal cliff deal” passed the House including the repeal of the CLASS Act and cutting funds for the Consumer Operated and Oriented Plan. 

On May 16, 2013 the House voted to repeal the entire Affordable Care Act. 

June 7, 2013: Five people were killed in a shooting incident in Santa Monica, CA which ended on the campus of Santa Monica College.  On July 17, 2013 the House voted to delay the implementation of the Affordable Care Act for employers by one year.  Also on July 17, 2013, the House voted to delay the implementation of the individual mandate.  On August 2, 2013 the House voted to prevent the IRS from implementing or enforcing any portion of the Affordable Care Act.

September 16, 2013:  12 were killed and 3 injured in a shooting at the Washington, DC Naval Yard.  On September 20, 2013 the House voted to approve a short term FY 2014 continuing resolution in which the Affordable Care Act was fully defunded, including the prohibition of all discretionary and mandatory spending, and rescinding all of its unobligated balances.  On September 29, 2013 the House voted again to repeal the medical device tax, and to delay the implementation of the Affordable Care Act by another year.  September 30, 2013, the House voted to delay the individual mandate, an action which would effectively render the law inoperable.

Votes were taken in the House on October 17, 2013; November 15, 2013; January 10, 2014; January 16, 2014, March 5, 2014 to weaken the enforcement of the Affordable Care Act.  More such votes were taken on March 11, 2014; March 12, 2014; and, March 14, 2014. [LAT]

April 2, 2014: Three were killed, sixteen injured in Fort Hood, TX, scene of a previous shooting in 2009.

On January 28, 2015 Rep. Bradley Byrne (R-AL) introduced H.R 596, a bill to repeal the Affordable Care Act.  The measure passed the House on February 3, 2015. [RC 58]*

May 23, 2015: Six dead, seven wounded in Isla Vista, CA. June 18, 2015: Nine dead at the Emanuel AME Church, Charleston, SC.  October 1, 2015: Nine dead, nine injured in Roseburg, OR.   Meanwhile, the Huffington Post asked Senators what might be done about the carnage:

“If there’s one issue that these senators wanted to talk about when asked about gun violence, it was the mental health component. Nearly all of those who were interviewed said their attention is on that aspect of the problem, instead of on gun laws.

“What I’ve been focused on, and I think it very much relates to, unfortunately, too many of these mass shootings, is improving our early intervention mental health system,” said Sen. Kelly Ayotte (R-N.H.). “Hopefully we can take some immediate action and find common ground.” [HuffPo]

Improving our “early intervention mental health system?”   What appears to be more than slightly inane (if not outright insane)  is to believe that repealing the Affordable Care Act — such that we cannot assure health insurance coverage for substance abuse and mental health problems, on par with coverage for medical and surgical treatment – is going to augment our attempts at “early intervention,” – or for that matter, for intervention at any stage.

Unless, and until, the Republicans are willing to stop trying to repeal the law that requires mental health treatment coverage as part of an Essential Benefit package, and stop attempting to repeal the provisions saying that the coverage must be on par with other medical and surgical treatment benefits, the noise about “doing something about mental health” is just that – a distracting noise.

Unless, and until, the Republicans are willing to put legislation into the hopper (and bring it to the floor for a vote) increasing (1) federal support for mental health care services, and (2)  increasing the number of low income people in the Medicaid program who have access to expanded coverage, then they’ll have to pardon those who say the “mental health” rhetoric is a hollow, shallow, attempt to distract the nation from any serious and substantive discussion of gun violence as a public health issue.

References: Congressional Research Service, “Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act, July 8, 2015. (pdf) Los Angeles Times, Deadliest Shooting Rampages, October 1, 2015.  Washington Post, House has voted 54 times in four years on Obamacare,” March 21, 2014.  AmericaBlog, “Republicans are using mental health as an excuse to do nothing about gun violence.” October 6, 2015.  International Business Times, “Republicans’ Mass Shooting Response Focuses Not On Gun Control But On Mental Health Reform,: October 5, 2015.  Huffington Post, “Despite Mass shootings, Republicans won’t touch gun laws,” October 6, 2015.

*Nevada Representatives Amodei, Hardy, and Heck, voted in favor of H.R. 596.  Representative Titus voted no.

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Filed under H.R. 1591, Mental Health, Nevada politics, Politics, public health

Bits and Pieces: Misleading headlines, and other matters in Nevada Politics

Jig Saw Puzzle Sometimes the headline doesn’t quite fit the story. Here’s an example: “Millions in the red an Obamacare insurer has failed” compliments of the Las Vegas Review Journal.   You have to read a few paragraphs down to get the basics of the story.  In addition to poor administration and long repayment waiting periods, “the co-op made a critical mistake: Only Nevada allows enrollment in non-exchange plans outside of the federal sign-up period, which runs from Nov. 1 to Jan. 31. Most insurers require a 90-day wait to discourage people from going without a plan until they get sick, but the co-op started with no waiting period, then added a 30-day window in late 2014. That created a sicker — and pricier — member pool,..”  [LVRJ]  These aren’t issues with the Affordable Care Act, nor is this indicative of any flaws in the overall system. What this illustrates is that the reason most firms go under is poor administration and management.

Speaking of management:  Is Waste Management Inc. living up to the terms of the contract it signed with Washoe County?  The Reno Gazette Journal reports on a crucial point: “One central issue is whether Waste Management has fulfilled the requirement to build an Eco-Center in Reno to sort its single-stream recycling and provide other services to customers. The city allowed Waste Management to raise rates, in part, to finance the construction of the Eco-Center.”  Back in March, 2013, The RGJ reported that the Eco-Center was supposed to streamline recycling in the area, noting that there were still some “kinks” to be worked out. Evidently, the kinks are winning?

The Washoe County Democrats have a quiz for us.  How do you score on a test of Rep. Joe Heck’s statements on Medicare? Social Security? Immigration?  I’ll give you one – yes, he’s called Social Security a “pyramid scheme,” and called for it to be privatized.  By July 2012 he’d called the basic social safety net program a Pyramid Scheme at least four times. [NVDems]

One win for Solar Power:  Perhaps not a long term one, but for now the efforts of NV Energy Inc to slap down the solar power industry in Nevada have been thwarted in the short term. [LVSun]  The power company is all for solar, except: “NV Energy’s proposed plan would reduce the value of credits paid to consumers and add a new fees. In filings with the PUC, the company said that the current structure unfairly shifts costs to customers without solar. The rooftop solar industry expects that the utility-backed proposal would reduce the rate of adoption of solar power.”  Original NV Energy filing here (warning: slow loading PDF)  and here (warning: slow loading PDF).  There’s the Solar Energy’s proponent statement to the PUC August 18, 2015 which makes interesting reading – again a warning: slow loading PDF.

All this in time for the Valley Electric Association to build a 15 mega-watt solar project in the northern part of Pahrump. [PVT]

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Filed under ecology, energy, energy policy, health insurance, Heck, Nevada energy, Nevada politics, Social Security

Heck’s Votes on the ACA

Heck ACA votes

The Chamber of Commerce has been “on my TV” telling me how much I should like Representative Joe Heck (R-NV3), possibly because Rep. Heck doesn’t have much name recognition in the hinterlands.  He’s just full to the brim with Integrity! and Experience, or something. At any rate he’s not all that full of the milk of human kindness which is required when discussing other peoples’ need for health insurance. Especially the kind of health insurance that covers preventive medical treatment, or covers women for the same premium costs as men, or provides insurance for approximately 17 million Americans who might otherwise go without.

The record is clear.  Rep. Heck is one of those consistent soldiers answering the call of the Insurance Corporations.  For more on Rep. Heck’s record click on this link.   Sorry, but this kind of “integrity” I can do without, thank you very much.

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