Tag Archives: Health Care Reform

Rest and Repair: ACA and market stabilization

Senator Dean Heller (R-NV) might have wished for a kinder, gentler, headline from the Reno Gazette Journal, but he got this one: “After weeks of waffling, Heller votes ‘yes’ on failed ‘skinny repeal’ of Obamacare.”  Rest assured, he’s promised to work on health insurance reform as part of his duties on the Senate Finance Committee.   This would be as good a time as any for him to demonstrate his knowledge of the insurance sector.

Heller Plays the Bail Out Card: Game One 

Let’s track back a couple of paces in time to review how Senator Heller presented his ‘moderate’ credentials on economic concerns.  While Nevada was in the throes of the Great Recession brought on by the Wall Street Casino machinations, Senator Heller was touting his opposition to the Dodd-Frank Act to insert some common sense regulation of the banking industy, casting it as follows: “Heller mentioned he was the only member of the Nevada delegation to vote against the bank bailout. He called the Dodd-Frank bank regulation bill “cover for those who voted for the bank bailout.”  In short,  that “cover” was the regulation of some of the practices that caused the collapse of the investment banks in the United States.  Senator Heller calculated that the use of the phrase “bailout” would be sufficiently negative to thoroughly obscure his support for the deregulation of the banking sector and the Wall Street Casino players therein.  There’s little reason to doubt he’ll try this play again in 2018.

McConnell Tees Up the Bail Out Card: Game Two

After the “skinny bill” failed, Senate Majority Leader Mitch McConnell provided the framework for the next time Senator Heller might want to play the Bail Out card:

“Now, I think it’s appropriate to ask, what are their ideas? It’ll be interesting to see what they suggest as the way forward. For myself I can say — and I bet I’m pretty safe in saying for most on this side of the aisle — that bailing out insurance companies with no thought of any kind of reform is not something I want to be part of. And I suspect there are not many folks over here that are interested in that. But it’ll be interesting to see what they have in mind.”  (emphasis added)

If Senator Heller didn’t mind obfuscating the purpose of the Dodd Frank Act (by calling it a bail out), he’ll certainly not mind playing the same game with the attempts to improve our health insurance system.  It would be very tempting for him to try this play one more time to cover his opposition to the very proposals that would stabilize the individual health care insurance markets in this country.  For the record, I’m assuming that if a proposal helps an insurance corporation, then Senator Heller will be sure to call it a “bail out.”   Or, in the immortal words of President George W. Bush, “There’s an old saying in Tennessee—I know it’s in Texas, probably in Tennessee—that says, ‘Fool me once, shame on…shame on you. Fool me — you can’t get fooled again.’

Making Mountains from Mole Hills

There are justifiable questions about the stability of the individual health insurance market, but before we launch major proposals in this direction it’s important to note that for all the palaver about the collapse, demise, descent or whatever of the Affordable Care Act, that individual market has been stabilizing on its own.  The Kaiser Family Foundation released its report on this market:

“Large premium increases, typically granted by state regulators, in 2017 contributed to the improved financial performance, as insurers adjusted for a sicker-than-expected risk pool, the analysis finds. However, data on hospitalizations suggest that the risk pool was not getting progressively sicker as of 2017, supporting the notion that the large increases were necessary as a one-time market correction.

Slow growth in claims for medical expenses also played a role in insurers’ financial improvements, according to the analysis.”

So far so good, but there are issues to be faced.

“Although the analysis finds the market is stabilizing, it notes that ongoing uncertainty over payment of cost-sharing subsidies to insurers and enforcement of the individual mandate could lead insurers to leave the market or charge higher premiums in 2018.”

We can now safely assert that when Senator McConnell (and perhaps Senator Heller) speak of “bailing out” insurance companies they may be referring to proposals to provide more certainty to the insurance corporations that the administration will, in fact, make good on those promises to come through with cost-sharing subsidies.  That’s truly stretching the definition of a bail out, but it may prove a highly convenient hook on which to hang Republican rhetoric.

The previous post mentioned the Three R’s — risk adjustment, risk corridors, and reinsurance.  Here’s one proposal for the last on the list:

“Senator Kaine and Senator Tom Carper of Delaware on Wednesday introduced legislation to create a reinsurance program to help insurers offset the cost of covering older, less healthy customers. That type of program—which provides payments to insurers that enroll high-cost individuals—was originally part of Obamacare until it expired last year, and Republican legislators in Minnesota and Alaska have embraced the idea as a way to stabilize insurance markets in those states. “That’s something that should have some bipartisan appeal,” Kaine said. [Atlantic]

Reinsurance was in place until 2016 in order to ease any problems with corporations insuring a high number of risky policy holders, such as those with pre-existing medical conditions.  Re-establishing it would serve the same stabilization purposes today.   The Kaiser Family Foundation provides an explanation of risk adjustment and risk corridors which don’t require an MBA to understand. Neither of these constitute any form of “bail out.”

Conflation Projection 

Conflation is too often a vehicle for obfuscation.  For example, one of the Republican objections to the ACA continues to be the incantation: Socialized Medicine!  There’s no hint of socialized medicine in the ACA, it’s a full bore market based system of encouraging  affordable health insurance policies sold by PRIVATE companies to PRIVATE CONSUMERS for use to pay PRIVATE HEALTH CARE PROVIDERS.  However, this doesn’t prevent Republicans from speculating on the ulterior motives of Democratic advocates of expanding access to affordable health insurance policies.

“Soon, they’ll want a public option!” And, then they’ll want Single Payer…and there you have it Socialized Medicine.

Let’s stop here before the fog gets too thick, and explore other options for improving health care access in another post.

*Thanks to @Karoli and Mark Stufflebeam for suggestions and references. 

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Filed under Health Care, health insurance, Heller, McConnell, Medicare, nevada health, Politics

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

Gifts from Gifted Writers

Christmas Gifts Writers

Thanks for your patience – DB was delayed by a good old fashioned head cold which took a couple of days to shake.  Now, the blog’s back in action, at least minimally, and ready to head into the ‘holiday season.’   Some writers have already given us some presents:

From Sally Jenkins, of the Washington Post, “The Rams’ Don’t Shoot Gesture…”  a peak:

“To begin with, the First Amendment only protects free speech against government action. That’s all it does. It doesn’t protect the St. Louis players from NFL owners, or league commissioners, or talk radio hosts who disagree with them. But it does protect them from the government. So the person in danger of abusing the First Amendment here is not the football player with the edgy gesture in a public stadium. Or the NFL owner who might want to tell them to shut up to protect advertising. It’s the governmental agent — like, say, a cop — who seeks to punish someone for expressing certain views.”

From David Palumbo-Liu, writing for Salon:

“It is not unreasonable to infer from the disproportionate rates of black and brown injury, death and incarceration (far more aggressively pursued by the state than in the cases of whites) that there are many more departments that should be investigated along with these 20.  But just 20 federal investigations should be enough to convince us that there is a broad and systemic problem we face with regard to race and police violence.”

From Jamelle Bouie, writing for Slate:

To that point, it’s worth noting the extent to which “what about black-on-black crime” is an evasion, an attempt to avoid the fundamental difference between being killed by a citizen and being killed by an agent of law. And it’s not new.”

Highly Recommended Reading while preparing for the season:

“McConnell confesses: Supreme Court being used to achieve political goals,” Crooks and Liars.

“Police describe Austin shooter as ‘homegrown terrorist’ with hate in his heart,” PoliticusUSA.

“If the Supreme Court reads this study it could end partisan gerrymandering forever,” Think Progress.

“One strike and you’re out: How we can eliminate barriers to economic security and mobility for people with criminal records,” Center for American Progress.

And now it’s break time again. Be back later. DB

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Filed under Health Care, health insurance, Politics, racism

Heller Stalwartly Defends Corporate Bottom…Lines

Nevada’s Senator By Appointment Only™ Dean Heller (R-NV) would have us believe we can’t afford the provisions of the Affordable Care Act. [Heller] Why? Because, evil of all evils — the act raises taxes.  Whoa, now we need to ask the same question which should be raised every time a Republican says “It (whatever IT might be) raises taxes,” — taxes on whom? The GOP controlled House Ways and Means Committee says all the taxes will “cost taxpayers over $675 billion in the next ten years.”  [HouseWM]

“Additional 0.9 percent payroll tax on wages and self-employment income and new 3.8 percent tax on dividends, capital gains, and other investment income for taxpayers earning over $200,000 (singles)/$250,000.”

“2.3 percent excise tax on medical device manufacturers/importers*”

“Annual tax on drug manufacturers/importers *

OK, are you a person earning over $200,000 in adjusted gross income annually? If so you’ll see a 0.9% increase on your payroll taxes — the money you pay into your ‘entitlements’ like Medicare and  Social Security — programs you are entitled to receive because you’ve paid for them.

Are you a person whose income is derived from dividends, capital gains, and other investments?  Assuming you haven’t stashed them behind blockers in the Cayman Islands… If most of your income comes from investments then you’ll see a 3.8% tax increase. If your income comes from your salary or wages, and precious little comes from your Wealth Management Account, then you won’t see an increase here.

Are you a manufacturer or importer of medical devices and equipment?  If so, then you’ll be liable for a 2.3% excise tax — If you aren’t an importer or manufacturer of medical devices and equipment, then this tax doesn’t apply to you.  And, before we start to fee weepy about this sector of the economy, the Department of Commerce has some nice things to say about it:

“The market was valued exceeded $100 billion in 2010, representing about 40 percent of the total medical technologies industry. U.S. exports of medical technologies in key product categories identified by the Department of Commerce (DOC) were valued at approximately $38.09 billion in 2010, exceeding imports valued at $32.73 billion. With new and innovative technologies coming to market, the U.S. medical technologies industry is highly competitive and well-positioned for future growth.”

The arguments against the imposition of this excise tax are generally NOT that the corporations can’t afford to pay it, but that the taxes might impinge on investments in R&D, and the profitability of the corporation.  [CoSpGaz]

Are you a pharmaceutical manufacturing corporation? Are you Pfizer Inc. with a return on equity of 10.66%, and a $178.74 billion market cap? Are you Merck, with an 11.86% return on equity and a $131.21 billion market cap?  If you aren’t a pharmaceutical manufacturing corporation then this tax increase doesn’t apply to you.

Let’s look at some of the other taxes involved in the Affordable Care Act legislation:

“Cadillac tax” on high-cost plans *

Annual tax on health insurance providers *

Limit deduction for compensation to officers, employees, directors, and service providers of certain health insurance providers. [HouseWM]

The taxpayers in these cases are the health insurance corporations.   The first thing requiring some explication is the “Cadillac Health Plan.”  The Kaiser Foundation offers this explanation:

“Sometimes referred to as a “Cadillac” or “gold-plated” insurance plan, a high-cost policy is usually defined by the total cost of premiums, rather than what the insurance plan covers or how much the patient has to pay for a doctor or hospital visit.”  […] “high-cost health plan is defined as costing more than $10,200 for an individual or $27,500 for a family, including worker and employer contributions to flexible spending or health savings accounts.”  (emphasis added)

What Senator Heller forgot (?) to mention is that (1) the tax doesn’t go into effect until 2018, giving the insurance companies time to make adjustments based on savings, and (2) that the thresholds for the tax are flexible in order to allow for pools of high risk policy holders like police officers or firefighters.

Are you a health insurance corporation?  Aetna, Cigna, Anthem Blue Cross? Another major health insurance corporation?  If your answer is NO, then this tax increase doesn’t apply to you.

Are you the CEO, COO, CFO or other corner-office executive with a major health insurance corporation?  Your compensation is deductible as a business expense — but under the terms of the Affordable Care Act the corporation may no longer be able to take an unlimited deduction for your compensation. This item really has nothing to do with YOUR taxes, but it has everything to do with the deductions corporations are allowed for executive compensation.

Here we go again, when Senator Heller and his Republican cohorts speak of raising YOUR taxes they are very careful to keep it generic, as if YOU includes the Top 1% of American income earners, hedge fund managers, medical device manufacturers, pharmaceutical manufacturers, health insurance corporations and the owners thereof.

But, but but but… the corporations will just pass the tax expenses along to the consumers and we’ll all have to pay!  The pass along argument is not a policy decision — it is a corporate decision.  The corporation is not required to pass along the tax — it could reduce executive compensation? It could reduce dividends?  To do so might annoy the shareholders and executives, but if the corporation thinks more of its shareholders and its executives than it does of its customers, then that in itself says much about the company.

At the risk of facetiousness — here’s the one that must have galled Speaker of the House John Boehner (R-OH) — “Impose 10 percent tax on tanning services *”

Are you the owner of a tanning bed salon?  If yes, then after I’ve seen two friends die from skin cancer, I’d like to talk to you some other day.  If no, then this tax doesn’t apply to you either.

Protecting Their Bottom (Lines)

So, Senator Heller may say, “Seven-term Congresswoman Shelley Berkley keeps voting for ObamaCare with no regard for the devastating consequences the law has for Nevadans.”   However, unless those Nevadans are in the Top 1%, are hedge fund and other wealth managers or get most of their income from investments not wages and salaries, are health insurance corporations or their executives, are medical device manufacturers, are pharmaceutical manufacturers, or tanning salons — those “burdensome taxes” aren’t yours.

We could just as easily argue that Nevada’s Senator By Appointment Only™ Dean Heller (R-NV) stands stalwartly by the side of the 1%, the investors and wealth managers, the pharmaceutical manufacturers, the medical device manufacturers, and the salon service owners — defending their corporate bottom lines.

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Filed under 2012 election, Berkley, Health Care, health insurance, Heller, Nevada politics, public health, Republicans

Round Up

Wondering about the level of taxation in Nevada?  The Small Business & Entrepreneurship Council says “We’re Number Three!” (Nationally) for being all sweet and cuddly for businesses disinclined to pay taxes. [NNB] But, we are going to collect sales taxes from Amazon.com for Nevada customers. [NNB] And, all this while Governor Sandoval tells us we don’t need any more taxes since the last batch has been extended. [NNB] So, we don’t have enough taxation to make business owners and corporations howl — and we don’t need any more business taxes — but we’ll happily collect more sales taxes (which obviously have a greater impact on those with lower incomes) on online purchases from the Big A…  The Lesson: It’s Only A Tax Increase If A Special Interest Has To Pay It?


Washoe County, Nevada is still getting some backwash from the Housing Bubble Debacle.  Short-sales are up, wherein mortgage lenders agree to sell a piece of real estate for less than what is owed.  “In Reno, short sales have been accounting for about a third of all sales in the past couple of years, according to the Greater Reno-Tahoe Real Estate Report. Short sales accounted for 116 units sold in March — 31 percent of all home sales in the area. Foreclosures posted 123 unit sales during the same period, which was 34 percent of inventory sold.”  [RGJ]   Meanwhile, back with those Wonderful People Who Brought On The Housing Bubble With Their Insatiable Appetite For MORE Mortgages —

“In case their (derivatives traders/bankers)  lobbying falls short, the industry — largely dealer banks and commodities firms — has been pushing legislation that would pre-empt the rulemaking process and tie the agencies’ hands. So far, no fewer than 10 such derivatives bills have been introduced in the House; two have passed and several more have cleared committee.

Not satisfied with that, influential lawmakers have been not so subtly warning regulators to go easy on derivatives. This is incredibly intimidating: Congress controls the agencies’ budgets, and the increase in workload mandated by Dodd-Frank leaves them woefully short on funds.

And should a derivatives rule unpalatable to the dealers somehow survive this Beltway obstacle course, the agencies face an explicit threat of a lawsuit. This has had a chilling effect. As Bart Chilton, a CFTC commissioner, told me, regulators fear there is “litigation lurking around every corner and down every hallway.”  [Lowenstein, Bloomberg]

Thus we have bankers, who having been bailed out once, have now decided that there is NO reason for any sentient human being to advocate regulation of their shadow system and their “private placement” activities — which got us into this Mess in the first place.  The only good news is that we may have found the bottom of this market. [Bloomberg]


The bottom of the housing market may be upon us, but the litigation lingers on.   A judge has denied AIG’s motion in the Bank of America settlement. [Reuters] A federal judge denied Bank of New York Mellon’s motion to dismiss a lawsuit by investors over the bank’s role as a trustee more mortgage backed securities  in the mess made by Countrywide.  [Reuters]


Maybe the Republicans do have a “health care” plan?

Health care would be “addressed” by disabling the implementation of ObamaCare, which Mitt Romney has repeatedly said he’d do on his first day in office. Even if you believe Romney and other Republicans actually have their own agenda of “health reform,” it’s mostly just a matter of replacing today’s health care deduction for employers with a tax credit for individuals, and then passing one bill allowing interstate insurance sales; the “market” (i.e., the rush of insurers to states with little or no regulation) will take care of the rest, and besides, it’s not the federal government’s job to make sure everyone has health insurance, right? [WashMon]

Yes, and with the rush to those states with little or no restraint on health insurance corporations we can reasonably expect that those corporations will not provide insurance to individuals with pre-existing conditions, not include vaccinations under basic policies, not include wellness screening for prostate, breast, or other cancers, and not include tax breaks for small businesses which provide health care plans for their employees.  It’s the Bush System on Steriods.


Some cheese with that whine?  Presumptive nominee Mitt Romney’s saying Life’s Unfair!

“This America is fundamentally fair,” he said. “We will stop the unfairness of urban children being denied access to the good schools of their choice; we will stop the unfairness of politicians giving taxpayer money to their friends’ businesses; we will stop the unfairness of requiring union workers to contribute to politicians not of their choosing; we will stop the unfairness of government workers getting better pay and benefits than the taxpayers they serve; and we will stop the unfairness of one generation passing larger and larger debts on to the next.”  [TPM]

Translation:  We will provide vouchers for parents to subsidize private schooling for their children.  We will stop assisting manufacturing companies with research and development.  We will attack trade unions.  We will further slash pay for government employees.  We will give tax breaks to the 1% and impose austerity on the remaining 99%.  There’s a good piece about privatizing education here.   H/T to Nevada State Employee Focus, there’s another excellent article on the attacks on public employees here.


Speaking from friends in interesting places: The Soap Opera that’s become the Nevada Republican Party continues apace, and to read the gruesome details click over to The Nevada Progressive.


More dispatches from the War On Women in the Sin City Siren.   Meanwhile anti-abortion activists are urging a “personhood bill” for the state of Oklahoma, the New Hampshire Senate has 6 abortion bills on its agenda, and a move to defund Planned Parenthood in Ohio is on temporary hold, but could reappear at any time.   More restrictive bills are in process in Tennessee, Louisiana, and Iowa.


Political items worth the click and read:  “The Koch Brothers Exposed,” Rolling Stone.   “Mitt Romney’s Attack Dog,” (Larry McCarthy negative ad guru), New Yorker 2/2012. “Don’t Let Business Lobbyists Kill The Post Office,” Rolling Stone.   “Campaign Tips from Cicero,” Foreign Affairs.

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Filed under Economy, financial regulation, Health Care, Heath Insurance, housing, Politics, Sandoval, Taxation, Union busting, unions, Women's Issues, Womens' Rights

Heck’s Lovely and Luxurious Mobile Office Venue

Nevada Representative Joe Heck (R-NV3) has found a lovely place for his next town hall meeting with constituents — he’ll be available at Sun City Anthem for his “mobile office” session on November 16, 2011.  That would be at “2450 Hampton Road, Henderson, Nevada 89052.”

And, what do we find at 2450 Hampton Road?  The top rated luxurious retirement community “Located in Henderson, Nevada, Sun City Anthem boasts over 7,000 luxury homes, three amenity-rich clubhouses, 36 holes of on-site golf at The Revere Golf Club and much more. Close proximity to the Las Vegas Strip furthers the community appeal with countless additional entertainment opportunities.”

What can Representative Heck offer the residents of this “top rated luxurious retirement community?”

Congressman Joe Heck’s District Office is ready to help constituents address problems they have with state and federal agencies. Our office can help navigate red tape, long wait times, and serve as a liaison for you while dealing with various government agencies.

Mobile Office Hours also offer information and resources on social services, and state and federal programs. Additionally, we’re able to help with federal programs like Medicaid, Medicare, immigration, veterans’ affairs and many others.

Really?  How many of these constituents may have problems with Medicaid? Immigration?

The last time Representative Heck used the Sun City venue the event was sponsored by the Sun City Republicans — who evidently had little appetite for allowing “just anyone” to show up amidst their luxurious surroundings.  [Nevada Spectator] Obviously, not everyone is welcome at Hampton Road. [Nevada Progressive]

Others, perhaps those less welcome at this mobile office site, might be wondering about Heck’s vote on H.R. 2 — to repeal the Affordable Health Care and Patients’ Bill of Rights Act, or on H.R. 359 — to repeal the federal contribution to elections option.  Perhaps they might want to address his vote in favor of H.R. 830 — to terminate the Federal Housing Administration Refinance Program? Or, discuss his vote to terminate the Neighborhood Stabilization program (H.R. 861)?

Those less affluent might wonder about Heck’s vote to defund National Public Radio, H.R. 1056 — those at the Hampton Road address have their own entertainment.  Or, his vote in favor of H.Amdt 95 to defund Planned Parenthood? [PVS]

If previous experience is any guide, the latter topics won’t be inserted into the gracious climes of the manicured greens by the “riff raff” 99% at this #1 Rated “luxurious retirement community.”

Representative Heck’s concern for senior citizens is readily apparent — or at least some kind of concern is evident — because his mobile office venue for December 7th is at the Paseo Verde Library located in the Heritage Park Senior Facility Library and is restricted to those 50 and over.  Anyone else should find him at another site — the Boulder City Fellowship also on December 7th.

It seems rather clear from the published schedule that Representative Heck likes restricted venues — preferably ones with plenty of senior citizens for protection from those rowdy 99% under 50?

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