Tag Archives: health care insurance

Let’s Review and Make Some Conjectures

Senator McConnell couldn’t have made himself more clear to the Republican leadership — let’s please have less drama from the White House so we can get along with our agenda.  Less tactfully phrased, McConnell and his myrmidons such as Representative Mark Amodei (NV2) and Senator Heller (R-NV) isn’t going to do anything about the dolt in the Oval Office until after they get what they want.  They want two things: (1) to return the control of the health insurance market back to the insurance companies; and (2) to dismantle the financial and consumer protections enacted in the Dodd Frank Act, and the Sarbanes Oxley Act.  Not sure about this, then please consider the current push for the Choice Act:

“At a time when too many hard-working American families are still recovering from the devastating impact of the 2008 financial crash, deregulating Wall Street’s biggest firms again makes no sense. Yet the Financial CHOICE Act threatens to do exactly that.

It would allow the biggest Wall Street banks to opt-out of significant financial protection rules, while those banks that remain in the regulatory system would be blessed with watered down versions of once-tough protections, like living wills and stress tests. Perhaps most worryingly, the CHOICE Act would cripple two of the most important post-crash reforms: the Financial Stability and Oversight Council (FSOC) and the Consumer Financial Protection Bureau (CFPB).” [the Hill]

Review: The CFPB was the agency which brought to light, and then levied fines against Wells Fargo for egregious violations of their customers’ privacy and financial interests.  Little wonder the banks aren’t happy with those “bureaucrats.” Less wonder why the Republicans aren’t going to do anything about the President who had to fire his National Security Adviser — until the Choice Act is safely delivered to his desk.

We should also recall that the Republican version of the healthcare reform act is much less about health insurance reform than it is about bestowing tax cuts for the wealthiest among us, to the tune of close to $765 billion over the next ten years.  We can easily conjecture that the GOP will do nothing about the man in the office who fired the US Attorney in the Southern District of New York, and then the emissary from the Department of Justice who warned him about the dangers presented by the presence of General Flynn.  At least nothing will be done, until the Republicans can cut Medicaid to the barest of bones:

His (Trump’s) promise would be violated by House GOP bill, as it seeks to freeze Medicaid expansion money for states in 2020 by withhold funding at the enhanced match rate for any new enrollees after that point. Other beneficiaries are at risk with the more long-term transformation that program stands to undergo under the GOP bill. The legislation would overhaul the program—now an unlimited federal match rate—into a per capita cap system, meaning that states would get a fixed amount of funding per enrollee. The Congressional Budget Office, analyzing an initial version of the legislation, predicted out of the 24 million Americans who would lose coverage under the earlier GOP bill compared to current law, 14 million were due to its changes to Medicaid. [TPM]

Given there is no CBO scoring on the current edition, we can’t be certain that States like Nevada which expanded Medicaid enrollment in order to make health care access affordable, won’t be left in the lurch — Congressman Amodei’s tortured logic to the contrary.  So, nothing is likely to be done about the executive who fired the Director of the FBI who was supervising the investigation of Russian meddling in our elections (and possible Trump connections to that meddling) until Medicaid cuts are also tucked into the President’s portfolio for a signing ceremony.

When will Republicans address the Leaker-in-Chief’s discussions with the Russian visitors to the White House?  Probably not until the budget cuts to the Department of the Interior, the Environmental Protection Agency, Medicare, Health and Human Services, and the Department of Education come to fruition.  Do we have a situation in which the following is true?  If the Trumpian honeymoon isn’t over, it soon will be.

That sentiment was echoed by a prominent GOP consultant I spoke to who asked not to be named to offer a candid assessment of Trump and congressional Republicans.
“The question for Republicans is whether this is the straw that breaks the camel’s back,” said the source. “Forty percent approval is not the issue; an erratic, rudderless, leaderless White House is.” [CNN]

The camel’s back may not bend until the Republicans have seen their agenda realized, their Randian Dreams made true, and their Austerity Government imposed on the American people.   The damage of this administration and the Republicans in Congress who enable and excuse him is only starting to come to fruition.


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Filed under Amodei, Comey, conservatism, corporate taxes, financial regulation, Health Care, health insurance, Heller, income tax, McConnell, Medicaid, nevada health, Nevada politics, Politics, public health

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

Bits and Pieces: Tesla, Titus, Heller, and Amodei

Jig Saw Puzzle ** It’s a done deal. TESLA’s coming to Nevada, brought to us by $1.2 billion worth of ‘incentives.’ [RGJ]  Meanwhile, watch that multiplier! The state is assuming a 2.5 multiplier for revenue generation, i.e. for every one direct job with TESLA there will be 2.5 ancillary jobs created – that’s a big multiplier. [RGJ] See also [LVRJ]

**  Representative Dina Titus (D-NV1) asked the VA to move its regional office from Reno to Las Vegas. [LVRJ]  Much as it might pain a northern Nevadan to say so, but the Las Vegas metropolitan area does have more of the 246,000 Nevada veterans than those living in the north, [VA] and the northern office hasn’t covered itself in glory. [LVRJ]  I’d not want to hang by my hair waiting for a definitive answer from the new VA leadership.

** From the Department of No Surprises:  Senator Dean Heller (R-American Bankers Association) voted against the cloture motion to consider S.J. Res. 19, a bill to propose a Constitutional amendment to allow the Congress to enact meaningful campaign finance reform.  Senator Heller was one of 42 (all Republican) votes to continue to filibuster any attempt to overturn the decision in Citizens United.  [roll call 261]

Representative Mark Amodei (R-NV2) voted in favor of H.R. 3522, a bill which would allow insurance corporations to offer small businesses group  insurance plans which DO NOT meet the standards for comprehensive health insurance coverage for their employees under the terms of the ACA.  [RC 495]  One organization summed up the problem with the bill:

“This legislation would allow health insurers to continue offering coverage outside of the insurance marketplaces established by the health law even if those plans do not comply with its coverage requirements. In addition, the inferior plans that would be allowed to continue under Representative Cassidy’s bill discriminate against people with pre-existing conditions, force women to pay more than men for the same coverage and impose annual caps on the amount of care received by enrollees.” [NCPSSM]  (emphasis added)

Those three issues, pre-existing condition discrimination, gender discrimination, and junk policies with capped coverage are some of the main reasons the ACA was necessary in the first place.

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Filed under Amodei, Health Care, health insurance, Heller, Nevada economy, Nevada legislature, Nevada politics, nevada taxation, Titus

Bits and Pieces

Jig Saw Puzzle** Interesting the Republicans would keep referring to the unpopularity of the Affordable Care Act, and then report technical glitches in the roll out as people — who supposedly don’t want “Obamacare” — try to sign up. The first day in Nevada saw 3,385 accounts created at Nevada Health Link, and the exchange received 1,536 phone calls.  The executive director of Silver State Insurance Exchange notes this roll out was one massive technical challenge, [LVRJ]and with massive computer projects come glitches and gremlins.  The best advice appears to be the old standard: Be Patient.  At least the Exchange will tell you that the gremlins are being grouchy, and advise you to check back later — unlike a popular  mapping program which leads drivers onto a Fairbanks, Alaska taxi way at their airport.

** Poor Old Rush Limbaugh, telling his listeners that ACORN is providing the navigators for the health insurance exchange in California.  Ole’ Rushbo must be getting his news from the antique magazines in his doctor’s office because ACORN disbanded in March, 2010 and shut down its state affiliates as of April 1, 2010. [Politico]

** One popular line from the Right is that President Obama will negotiate with Syria and Iran but not with the House Republicans, leading to one of my favorite Jon Stewart rants, culminating in a classic line: “If President Obama can make a deal with the most intransigent mullahs in the world but not with House Republicans, maybe he is not the problem.”

** Bookmark this –> GOP’s 21 Demands inserted into the House proposals to keep the government in operation.  Defunding the implementation of the Affordable Care Act wasn’t the only thing on the House Republican wish list.  There were items that didn’t get much media play, but they were hauled out and attached to the Republican banner, and we should expect their flag to be hauled out for the upcoming battle over raising the debt ceiling.

“For a long-term deal, one that gives Treasury borrowing authority for three and a half years, Obama would have to agree to premium support. The plan to privatize Medicare, perhaps the most controversial aspect of the Ryan budget, is the holy grail for conservatives who say major deficit-reduction can only be achieved by making this type of cut to mandatory spending. “If the president wants to go big, there’s a big idea,” said Scalise.” [NatlJrnl]

In short, if the President doesn’t agree to the old Ryan Budget Coupon-Care as a replacement for the current Medicare program, we’re looking at GOP intransigence over raising the debt ceiling later this month.

** If we thought the Citizens United decision was a bad idea, there might be another blow coming, Demos explains:

“A new report from Public Campaign shows what could happen if the Supreme Court deals another blow to campaign finance reform in McCutcheon v. FEC. The case is a challenge to aggregate contribution limits, i.e. limits on the overall amount of money a donor can contribute to federal candidates, parties, and political action committees. Currently, no one person can contribute over $117,000 in total. Given that’s already more than twice the average American’s annual income, the contribution cap is not exactly limiting the ability of people to donate.”

** Meanwhile we have dueling headlines. “GOPers Insist Americans Will Eventually Back Them on Shutdowns,” and “With Traditional GOP Allies Defecting, Big Business Takes Sides With Obama.”

** Highly recommended reading: “The Reign of Morons” from Charles Pierce, Esquire Magazine. “What History Will Say,” Michael Tomasky, The Daily Beast.  “The Captain Ahabs of the House,” Charles Blow, New York Times.

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Filed under Economy, Politics

For THIS we waited 21 hours?

Cruz Vote Enough said?

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Filed under Politics

Suppressed Laughter: Muddling the Medicare Issue

There are those who find the Democratic charge that the Republicans would end Medicare as we now know it risible, but there are some very practical reasons for stifling the guffaw.

Let’s start with the proposition that the current Medicare program is a very popular single-payer system for providing health insurance coverage to individuals in the United States who are over 65 years of age.   Let’s also accept that a single payer system like Medicare has helped reduce the financial strain on our elderly.  [CMS pdf]

Additionally we can find historical data indicating that those elderly citizens who have annual incomes of $40,000 or less spend a higher percentage of their income on health care than those more affluent: [CMS pdf]

We also know that the elderly have moved from a demographic group less likely to have health insurance coverage to the one in 2000 most likely to be covered:

“Prior to Medicare’s enactment, about half of America s seniors did not have hospital insurance. By contrast, 75 percent of adults under 65 had such coverage, primarily through their employer. For the uninsured, needing hospital services could mean going without health care or turning to family, friends and charity to cover medical bills. More than one in four elderly were estimated to have gone without medical care due to cost concerns (Harris, 1966). Today, Medicare covers nearly all of the elderly (approximately 97 percent), making them the population group most likely to have health insurance coverage.”  [CMS pdf]

At this point it ought to be reasonable clear that if (1) we want elderly Americans to have affordable health care insurance, and (2)  especially want those at the lower end of the income scale to secure affordable health care insurance, then by those standards the current program is successful.

If It Ain’t Broke Why Fix It?

Across the philosophical divide:   One important facet of current conservative thinking holds that any government program which offers services to individuals  in the form of a social safety net “creates dependency.”   The proponents of this argument rely on philosophic arguments almost as arcane as the extensions of Anselm of Canterbury’s Scholasticism before Abelard arrived to rescue the scholars.

Theoreticians are invited to weigh in on discussions bounded by such definitional perimeters as the following from the libertarian Cato Institute:

“The central idea behind the theory is that government officeholders, as individuals, have strong incentives to alter important political transaction costs facing the public and facing others in government in order to secure more of what they want with less resistance. As economists use the term, transaction costs are costs to individuals of negotiating and enforcing market exchange agreements, including information costs, negotiation costs, enforcement costs, and the like.”

One is pretty much left to imagine what “and the like” might mean.  However, the message is clear – government office holders have an incentive to promote their programs and to minimize the resistance to those projects.  This assumes that people are naturally resistant to efforts by their own government to assist them, and that all government services must be resisted.  In other words, in order for this argument to work in general terms we’d have to assume that everyone is naturally a radical libertarian.

We’d also have to assume that the populace doesn’t want the government to “alter important transaction costs” on its behalf.   This is a hard point to sustain given that most citizens don’t appear to be enthusiastic supporters of personally negotiating defense contracts — which if we were to extrapolate the localism of the initial argument to its illogical extreme would be required to reduce “Constitutional level political transaction costs.”

Culturing Dependency:   The current arguments from the radical Right, framed philosophically as described above, march to the next milepost — that citizens are naturally “free” (individualistic) and any government programs which provide services to the elderly (or indeed anyone else) create a dependency on government action at the expense of individual “freedom.”

All we have to do to subscribe to this position is to completely ignore the preface to Robert’s Rules of Order:   “Where there is no law, but every man does what is right in his own eyes, there is the least of real Liberty.” (Henry M. Robert)

There are also some uncomfortable questions raised by this proposition.  Does hiring a local police force create a dependency on my part for the protection of my life and property?  Does having a local fire department make me dependent on government for fire suppression, rescue, and EMT services?  Does having a Department of State make me dependent upon government for the implementation of foreign policy?   Does having a Department of Commerce make me dependent upon government for statistical reports on my economic environment?

Splitting Differences:  If the answers to the questions above are equivocal, then it’s probably because there are some definitions of “legitimate” and “illegitimate” government services involved.  If a person defines government as only responsible (legitimate) for national defense and foreign policy, then only government programs in those realms are legitimate.  If, however, we see government as formulated for We The People, life gets a bit more complicated:

 “…of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

Now we add “establish Justice, insure domestic Tranquility, … promote the general Welfare…” to the list of legitimate concerns of our government.  It’s time to come back around to the main argument.  If Medicare is a popular single payer system for promoting the availability of health insurance coverage to elderly individuals, and if it is successful in that regard, then why argue that it’s illegitimate?

The Magic Market:  The “market” in whatever form it may take is supposed to be the ultimate form of human transaction — the most efficient, the most efficacious, the most Free.  Except when it isn’t.   We’ve had an unpleasant taste of what happens in unregulated, or poorly regulated, financial markets.  Unfortunately, the after-taste is still lingering.  We are now told by the radical Right that an unregulated health insurance market will meet the needs of elderly Americans for their health insurance coverage.  Probably not.

The first point to acknowledge is that the Romney/Ryan plan for Medicare essentially changes the Medicare program from a single payer system to a voucher plan which “incentivizes health insurance corporations to provide coverage for elderly people.”    This is not “Medicare as we know it,” it is Medicare as the Insurance Corporations would like to have it.

The insurance corporation argument is underpinned by the notion that medical care is a commodity which can be purchased by a consumer from a provider, and this is true up to a point, but it’s a point that is very quickly reached.   The problem, as Professor Krugman points out, is that medical care isn’t bought and sold like a loaf of bread.   A person making up a list of groceries may include bread, but if the price of a loaf is too high then it’s logical to skip the purchase or substitute another commodity.  The market works.  However, if a quintuple  by-pass is needed then price is not the determinant of the “purchase.”  The result of “gee, I don’t think I can afford that right now” is poor health or even death.  The Magic Market doesn’t work in this instance.

The second problem with the Magic Market solution is that no one is shopping in the ambulance.   The victim of a motor vehicle accident or a heart attack, even if fully conscious, isn’t saying “Get me to the cheapest Emergency Room,” he’s saying, “Get me to the nearest Emergency Room.”

The third problem with the Magic Market solution is that the health insurance corporations themselves aren’t subject to it.  Under the terms of the McCarran-Ferguson Act of 1945 health insurance corporations are exempt from anti-trust laws.  This is both good and bad news; the bad news is  they may collude to limit access to their products or divvy up regions as sales territories.   The good news is that they are able to share information which might serve in some cases to reduce premium costs.  [KaiserNews]  Either way, the policy purchaser is dealing with a provider which is not subject to the same “free market” forces as the consumer.

The fourth problem inherent in the current privatization of the Medicare program is that it hasn’t worked.  Medicare Advantage was supposed to be the insurance industry version of the original Medicare program, and IF the free market worked the way the ideologues on the Right predicted, then we’d expect massive consumer shifts to the privatized version.  Hasn’t happened.  Altogether too many Medicare Advantage policy holders are there because their employers, many in the public sector, have been pressured into adopting Medicare Advantage plans.  [HealthBeat]*   If the Free Market worked as predicted, then the pressure would not be necessary.

Finally, the “free market” Medicare Advantage plans can hardly be called “private” when the companies offering them are getting an $8.9 billion subsidy from the Medicare program.  [TP]  Further, if the private market-driven plans can produce lower health care costs, then why haven’t they? [Incidental Economist]

Stop Laughing

If the current Republican calls to eventually replace the original Medicare program with a “market-driven” plan are (1) philosophically dubious, (2) politically questionable, (3) grounded in doubtful Constitutional theory, (4)  and premised upon illogical and indemonstrable market behavior; then why would challenging the practicality of such a plan be laughable?

Arguing that Medicare will still be existent even if privatized into a program run by insurance corporations is roughly analogous to contending that an orange is still an orange after it has been reduced to juice and pulp.   The result may be many things — but it’s not an orange.   Nor, would our original Medicare program be the same Medicare which now serves half of our elderly citizens who live on $21,000 per year or less.  [AARP]  Still suppressing that guffaw?

References: “Medicare – A Profile, 35 years of Medicare,” HCFA, July 2000. (pdf)  Charlotte Twight, “Medicare’s Origin,” Cato Journal, Volume 16, No. 3.   Kenneth J. Arrow, “Uncertainty and the Welfare Economics of Medical Care, American Economic Review, December 1963 (pdf).  Paul Krugman, “Why Markets can’t cure healthcare,” New York Times, July 25, 2009.  *Desert Beacon, “Medicare Disadvantage,” August 22, 2012.  AARP Fact Sheet: Who Relies on Medicare – Profile of the Medicare Population (pdf).

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Filed under Health Care, health insurance, Medicare, Politics, Republicans