Tag Archives: Health Care

Heller at the President’s Right: Lunch Time At The White House

Nothing like watching Senator Dean Heller (R-NV) sitting next to POTUS, smiling and applauding as the remarks from the President replicate every standard talking point made by every Republican since the passage of the Affordable Care Act.  Including such wonderful clichés as:

You’ll pay lower premiums (Oh, such lower premiums you won’t believe) — Any fool can sell low premium policies, the ones with high deductibles and co-pays, limited benefits, and caps.  Worse still, these junk policies will be sold across state lines so that consumer standards and protections of the worst level of protection will be the standard.

The states will have control over Medicaid (smaller units will be better for individual needs)  Nothing like blowing a big wide ‘beautiful’ hole in the Nevada budget!  Cutting $770B from Medicaid will have effects far beyond Nevada’s capacity to support its elderly, its children, its rural health care facilities, its support for low income working families.  That was the point of Medicaid — expenses far beyond the capacity of individual states could be shared nationwide, allowing medical care and services for the greatest good for the greatest number.

Some counties only have one insurance corporation offering policies in the individual market.  Did the president recall that before the ACA there were some counties that had no insurance corporations offering policies in the individual market.  There’s a solution to this problem — one the president didn’t mention — establish a public option.

Then there flowed the usual barrel of platitudes and campaign rhetoric, freedom and flexibility, low cost with high coverage,  everyone can get better insurance, reduce burdensome taxation, burdensome regulation….

And there was Senator Dean Heller, smiling as though siding with the president isn’t going to be a major political problem for him in the 2018 campaign season.  It makes a person wonder.

Senator Heller can be reached at 202-224-6244, 775-686-5770; 702-388-6605

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Filed under Health Care, health insurance, Heller, Politics

ICYMI: In Case You Missed It, Instant Summer Reading Recommendations

The Nevada Independent has several excellent articles about the health insurance ‘reform’ battle in the state,  I’d recommend starting with ‘Senator Cortez-Masto’s denunciation of the Senate health bill,” and move on to ‘Dispatches from Washington.’

The Reno Gazette Journal reports (video) on Rep. Jacky Rosen’s (D-NV3) decision to run for Senator Dean Heller’s seat.

Please note TPM’s report from the conference of Secretaries of State concerning election data security.  If this conclusion doesn’t disturb us, it should:

“But both Republican and Democratic Secretaries of State, who are responsible for carrying out elections in many states, said they have been frustrated in recent months by a lack of information from federal intelligence officials on allegations of Russian meddling with the vote. They say that despite the best efforts by federal officials, it may be too late in to make substantive changes.”

Interestingly enough, vote suppression advocate Chris Kobach was a no-show at the meeting.  Perhaps this is because some election experts have identified major flaws in Kobach’s “election integrity” plans.

And, now we get to “muddle time” during which the current administration tries to muddy the waters about the  other election problem — Russian interference.  Spokespersons and advocates are on the air-waves saying that “Gee, it’s not 17 intelligence agencies, it’s actually just a handful of people who reached the conclusion that the Russians meddled,”  which is one tactic to discredit the reports that are unequivocal in their assessment that, yes, the Russians interfered.   Following this comes the Gee Whiz moment in which the apologist who says that “we’ve not actually seen the evidence of this.”  A statement such as this is simply a variation on the previous talking point:  We’ve investigated this enough, there’s nothing there, move along please.

Speaking of elections, please take a look at the bill introduced by Rep. Mark Amodei (R-NV2) HR 2101, the Prior Approval Reform Act:  To amend the Federal Election Campaign Act of 1971 to expand the ability of trade associations to solicit contributions from the stockholders and executive or administrative personnel of their member corporations, and for other purposes.  The effective date, January 1, 2018, would allow more “corporate” money in politics just in time for 2018 campaign season.   The Associated General Contractors would be pleased to see this enacted. [pdf]  Those disturbed by the dark, and darker money, flowing into our campaigns should track this bill.

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Filed under Amodei, Health Care, health insurance, Heller, Nevada politics, Politics, Vote Suppression, Voting

It Ain’t Over Until The Fat Golfer Sings

Senator McConnell’s Secret Health Insurance Shop is still working, with the Lobbyists/Elves seeking a way to offer goodies acceptable to the wavering and the wanton.  Keep calling!  and if you’d like more information to substantiate your comments there are some excellent sources.

Kaiser Family Foundation:   Your one stop center for research and analysis on health insurance issues.  Definitely a “bookmark this” recommendation.  Today, KFF notes that before the implementation of the ACA individual insurance plans for health care did not cover delivery and maternity care  in 75% of the policies; 45% of the policies didn’t cover substance abuse treatment; and 38% failed to cover any mental health care services.

If terms like “risk adjustment,” “re-insurance,” and “risk corridors” seem like something written in Minoan Linear A, the KFF has an excellent summation of these technical terms in easily understood American English.

There are also some analytical pieces on the impact of Republican suggestions for health care insurance “reform” as they relate to rural health care in the following:

Human Rights Watch — Senate Health Care Bill A Swipe At Rural United States.

MSNBC/Scarborough – Rural Health Care Would Be Savaged By This Bill.

There’s a narrative going around that Democrats haven’t brought anything to the table, which depends on whether we’re taking the long or short term view.  In the short term this would be true — because the McConnell Secret Health Insurance Shop didn’t invite any Democratic participation,  for that matter there seems to have been some Republican Senators who were left in darkness.  The longer view would note some of the following:

Senator Franken’s “Rural Health Care Quality Improvement Act of 2016” (pdf) S. 3191 (114th Congress) was introduced in July 2016 and “died” in the Senate Finance Committee.  The bill would have amended two titles of the Social Security Act to improve health care in rural areas of the United States.

There is Representative Jan Shakowsky’s CHOICE Act, H.R. 635, which would establish a public option under the ACA.  See also S. 194, Senator Sheldon Whitehouse’s CHOICE Act.  There’s Rep. Gene Green’s HR 2628 to stabilize Medicaid and the Children’s Insurance program.  Rep. John Conyers introduced his form of “single payer” in his Medicare for All bill, HR 676.  On the topic of making pharmaceuticals more affordable:  Senator Sanders – Affordable and Safe Prescription Drug Importation Act S. 469.  Senator Klobuchar has a bill “… to allow for expedited approval of generic prescription drugs and temporary importation of prescription drugs in the case of noncompetitive drug markets and drug shortages.” S. 183. Rep. Kurt Schrader introduced H.R. 749 to increase competition in the pharmaceutical industry.  Senator Ron Wyden introduced S. 1347, RxCap Act of 2017.

Senator Klobuchar has also introduce a bill supporting Alzheimer’s caregivers in S.311.  Rep. Derek Kilmer’s bill, H.R. 1253, seeks to improve access to treatment for mental health and substance abuse issues.   This is by NO means an exhaustive list of what can be gleaned from Gov.Track, but it does illustrate that the Democrats are not without suggestions — negotiating drug prices for Medicare, stabilizing the current system, public options, single payer — it’s just that these bills won’t get out of Republican controlled committees and they didn’t make it into Senator McConnell’s Secret Shop.

Indulge in no victory dance, we’ve seen this movie before … don’t believe that some minor blandishment won’t be enough to lure Senator Heller from his current position …don’t think that the products of McConnell’s Secret Shop have stopped coming off their assembly line.

Senator Heller can be reached at 202-224-6224;  702-388-6605;  775-686-5770

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Filed under Health Care, health insurance, Medicaid, Medicare, nevada health, Pharmaceuticals, Politics, public health

48 Hours: The Health Care Bill

If a person hasn’t found the reason to call Senator Heller’s office and advise him to vote NO on the Republican version of a health care bill, consider the following:

(1)  One in three residents of skilled nursing facilities in Nevada are supported by Medicaid. Now, apply a simple calculator test — if a person was born in 1946 (the beginning of the Baby Boom) he or she will hit 80 in 2026.  In short, the Baby Boomers will be in the age range to need such care just as the major cuts to Medicaid kicks in.  About 65,000,000 children were born in this country between 1945 and 1961.  Cuts to the Medicaid program in this context is essentially create a crisis which we could easily have avoided.

(2) The Republicans are fond of focusing on “premium increases.”  That’s only a part of the story.  Anyone can devise insurance policies with low premiums — raise the deductibles, cut the coverage, increase co-pays,  insert lifetime benefit limits, and Voila! lower premiums.   The problems begin when a person tries to use the insurance — the reason the person bought the policy in the first place — “We’re so sorry, but this policy doesn’t cover immunizations. Or, mammograms, or prostate cancer screening, or the expenses related to the birth of your first child…”

(3) Speaking of lower premiums,  if a person has insurance from an employer then there should be no surprise when the coverage decreases compliments of the waivers included in the Senate bill — “We’re sorry, but we no longer cover wellness screenings for men and women, maternity care, or other elements that used to be included as Essential Benefits.” If a person thought that employer sponsored policies were “safe” from “reforms,” please think again.

(4) This isn’t a health care bill, it’s a tax cut bill.  Those whose income is in the top 0.1% level would receive a lovely $250,000 tax savings gift in 2026. Those earning more than $875,000 (top 1%) would get tax savings of $45,500.  [CNN]  All this at the expense of working Americans.

(5) The buzz word “patient centered” is nonsense.  At bottom, it’s a euphemistic way of saying “You are On Your Own.” A person can “choose” to buy what he or she can afford — and for lower income Americans this means lower coverage and higher out of pocket expenses.  The problem with applying classic market principles to health care is that much of what is covered isn’t a matter of Choice.  No one chooses to be in a traffic accident, any more than a person chooses to get cancer or have a heart attack.   The Republican argument seems to boil down to “live a perfect life and make excellent choices” and you are ‘worthy’ of having insurance.  This argument only works IF a person has no familial risk factors, IF a person isn’t exposed to other people (who might have an infectious disease), and IF a person can afford to build a residence in which there are no places to fall and no way to have an accident with a garage door.  In short, it’s fantasy land.

The next few hours are crucial — that’s right — HOURS. Please call Senator Heller’s office at 702-388-6605;  or 775-686-5770; or 202-224-6244.  Your health care services are at stake.

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

Myths and Legends: The Medicaid Issue in Nevada

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

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

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

The program is meant to help people with low incomes.

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

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

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

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

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

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

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

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

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

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

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

 

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Filed under Economy, Health Care, health insurance, Politics

The Not Quite So Better Way

Nevada’s two Republican representatives to the 115th Congress, Senator Dean Heller, and Representative Mark Amodei (R-NV2) are now proposing not to have town hall style sessions with constituents until they have something to say.  We might assume this applies to the threats to repeal the Affordable Care Act, without having something concrete to say to the  voters.  Representative Paul Ryan is touting the GOP “Better Way” (pdf download) as a set of talking points for Republican members of the 115th.

First, there isn’t anything really new here. It’s the same proposal a person might have downloaded last June (June 22, 2016).  The foundation is Unleashing the power of choice and competition is the best way to lower health care costs and improve quality. One way to immediately empower Americans and put them in the driver’s seat of their health care decisions is to expand consumer-driven health care. Consumer-driven health care allows individuals and families to control their utilization of health care by providing incentives to shop around. This ultimately lowers costs and increases quality.”

Problem: “Consumer-driven health care” makes for lovely free market rhetoric,  but it boils down to the same old High Deductible Health Policy/Health Savings Account proposal the GOP has rolled out since time out of mind.

“This insurance arrangement— in which a person is protected against catastrophic expenses,  can pay out-of-pocket costs using tax-free dollars, and in turn takes responsibility for day-to-day health care expenses—is an excellent option for consumers. HSAs tied to HDHPs are popular tools that lower costs and empower individuals and families. This type of coverage also helps patients understand the true cost of care, allows them to decide how much to spend, and provides them with the freedom to seek treatment at a place of their choosing.” (page 13)

This is an elegant way to tell people (1) you’re on your own; (2) that you might expect some tax credits, but the expenses are going to come immediately out of your pocket; (3) and you’ll be able to address ‘catastrophic’ illness or injury expenses out of what you’ve put into an HSA.  Good luck with that.  Health Savings Accounts are great for the healthy and wealthy, for everyone else – not so much.

Worried about those expenses out of your pocket? Well there are HRA’s on offer and more “defined benefit” possibilities.   In short, instead of having several comprehensive health care plans to choose from, a person could also ‘choose’ to be involved in HDHP/HSAs and HRAs and other privatization schemes. 

Question for Congressional Representatives:  What in this plan insures that the health care insurance will be truly comprehensive? Affordable? Affordable for those families having Nevada’s median income around $50,000 per year?

Secondly, there is still the question of what portability means in practical terms.

“…our proposal is like a health care “backpack” that provides every American access to financial support for an insurance plan chosen by the individual and can be taken with them job-to-job, home to start a small business or raise a family, and even into retirement years.”

ProblemWhat’s going to be “portable?”  If a health care plan is to be truly national, then does this mean that there will be a lowest common denominator for all health care insurance plans?  Will the plan acceptable in a state with little or no oversight and consumer protections become the national standard? And, if not, then what IS the standard supposed to be?

Another problem: What elements of a health insurance policy must be included for the plan to be acceptable?  One of the advantages of the ACA requirements is that some coverages (mental health, pregnancy, etc.) don’t apply to all consumers – however, if we start cutting out elements of comprehensive coverage where does it end?

Questions for Congressional Representatives:

(1) If a health care plan is portable across state lines, then do the consumer protections in place remain enforceable?

(2) If a health care plan is considered “junk insurance” in one state can it be enforced in another state with higher consumer standards?

Third, there’s the Medicare, Medicaid issue.

Depending on who is doing the talking from the Republican side these programs are either failed or failing.  Neither is true.  However, nothing is preventing Speaker Ryan from offering Coupon Care in place of the Medicare program, and from proposing turning the Medicaid support into a block grant program with formulaic funding.

Questions for the Congressional Representative:

(1) The ACA actually extended the viability of the Medicare program, what in the GOP plan will insure this viability is extended?

(2) If funding for Medicaid is turned into a block grant program what provisions in your plan would prevent this funding from being cut?

Senator Heller and Representative Amodei may be waiting for the GOP to come up with a rational and comprehensive plan to replace the ACA and Patient’s Bill of Rights – I’d advise them not to withhold breathing.  Or, if they are assuming there’s nothing on offer from the GOP side since June 2016 – sort of a budget without numbers in health care terms – they may never have to have anything to say to their constituents. 

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Filed under Amodei, Health Care, Heath Insurance, Heller, Nevada politics, Politics

St. Paul (Laxalt) and the ACA: NV joins anti-choice case

birth control pills Heaven help us. Paul Laxalt, Attorney General of the State of Nevada, has proudly announced he’s filed an amicus brief in the U.S. Supreme Court in Little Sisters of the Poor v. Burwell

“Little Sisters of the Poor is an organization of Roman Catholic women dedicated to serving the poor. The Little Sisters and co-petitioners sued the U.S. Department of Health and Human Services in response to the Affordable Care Act’s contraceptive mandate. The mandate requires religious nonprofits such as the Little Sisters to provide employees with all available forms of contraception at no cost. Facing hefty fines for non-compliance, a number of these groups have sought U.S. Supreme Court review of their case.

    “Religious organizations serve our communities in countless ways, and their contributions should be supported, not impeded by the government,” said Laxalt. “These organizations should not be fined for living in accordance with their sincerely held religious convictions. This brief encourages the Supreme Court to take the necessary steps toward ensuring that our government and our courts do not force people of faith to violate their religious beliefs.” [Laxalt]

    Here’s what he’s jumping into:

    “On July 14, 2014, the 10th Circuit Court of Appeals issued a decision denying the Little Sisters of the Poor and other religiously affiliated nonprofits’ request for a stay. The Court found: “The accommodation relieves Plaintiffs from complying with the Mandate and guarantees they will not have to provide, pay for, or facilitate contraceptive coverage. Plaintiffs do not “trigger” or otherwise cause contraceptive coverage because federal law, not the act of opting out, entitles plan participants and beneficiaries to coverage. Although Plaintiffs allege the administrative tasks required to opt out of the Mandate make them complicit in the overall delivery scheme, opting out instead relieves them from complicity. Furthermore, these de minimis administrative tasks do not substantially burden religious exercise for the purposes of RFRA.” In July 2015, the plaintiffs appealed this case to the Supreme Court.” [KFF.org]

    In short, the Little Sisters have a Church Plan. The Church Plan doesn’t cover contraception. This is accommodated under the exemptions to the Affordable Care Act.  Their plan does not have to “provide, pay for or otherwise facilitate contraceptive coverage.”  What’s the question?  They can opt out of the ACA provisions – but, they argue the mere act of opting out makes them “party to the scheme?”

    This gets even better – because entangled in the case is the question of whether or not the Little Sisters of the Poor (or the Christian Brothers) can prevent their employees from getting insurance covering contraception from a third party. [AU]

    The Kaiser Foundation offers this handy chart on the exemptions from the provisions of the Affordable Care Act:

    Religious Freedom Court Chart

    Thus far the provisions of the ACA have been upheld. Contrary to the anti-contraceptionists, the courts have held that the law doesn’t unduly burden anyone, and they can opt out by requesting an exemption. Period. Of course, that didn’t prevent the Little Sisters from availing themselves of the funding and efforts of the arch-conservative Becket Fund.

    Making this entire case even more incredible is the fact that as of August 2014, the government provided a second accommodation for religious non-profit organizations which as of that date only needed to “write a letter to the government in order to be relieved of any obligation to provide contraceptive coverage.” [AU]  A letter.  One single letter.

    So that an exempt religious organization doesn’t have to write one single, one paragraph letter,  the Attorney General of the state of Nevada signed on to an exceptionally spurious, often downright illogical amicus brief with his fellow Tea Party, Radical Right, Ultra-Right Wing anti-contraception amigos.

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    Filed under Health Care, health insurance, nevada health, Nevada politics, Women's Issues, Womens' Rights