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GOP: Poor Excuses and Paucity of Empathy

By all accounts the Graham-Cassidy+Heller version of health care destruction would yield a net coverage reduction for 243,000 Nevadans. Overall it would mean a 31% cut in Medicaid for children — that’s right — children.  There’s another 15% cut for services for people with disabilities.  And what’s the rationale for this atrocity?

(1) Because we promised!  This is probably the silliest reason to do anything ever.  I may have promised to offer someone a ride to go shopping, but if there’s a blizzard on the way then it’s downright stupid to “keep the promise.”

(2) Because Obamacare is failing!  And why would that be? Because Republicans refused to make some simple fixes (risk corridors, risk sharing, and reinsurance) and the individual health insurance is unstable.  It’s a classic case of tossing the baby out with the bathwater.  Or, of finding some perfectly “fixable” problems with a law and using those to rationalize pitching the entire thing.  Head UP: They’ll try this same approach with the financial sector reforms in the Dodd Frank Act.

And then there’s the part the Republicans aren’t talking about.

(3) Because they’ve wanted to get rid of Medicaid, Medicare, and to privatize Social Security from time out of mind.

This comment sums up the situation:

“The two keys to the Republican attitude are money and ideology. If you view the modern G.O.P. as basically a mechanism to protect the wealthy, Medicaid is an obvious target for the Party. The program caters to low- and middle-income people, and its recent expansion was financed partly by an increase in taxes on the richest households in the country.”

The concept can’t be articulated more simply or directly.

Then there are the sputtered talking points, common among Republican politicians and supporters to hike around the obvious but unspoken issues they have with the Affordable Care Act.

If we don’t pass this we’ll have socialized medicine.  Please.  Even Single Payer (or Medicare for all) isn’t socialized medicine.  Medicare insurance is used to pay PRIVATE providers for medical treatment.  This obviously isn’t a nationalized medical service plan.  Only by artificially conflating medical insurance with medical services can anyone assert that this is “socialism.”

There are no guarantees in life.  So if a family in Minnesota who has a child with muscular dystrophy may be required to pay higher premiums that’s the way the markets work.  It doesn’t get more morally bankrupt than this — especially since the current system does guarantee coverage for families with chronically ill children.

This issue is long past being a public policy issue, it has devolved into pure politics in which ‘points’ are scored by a party desperately hoping to cut taxes for its most generous donors at the cost of Americans’ health care.

So, every few weeks we’ll have to call our Senators to beg them not to destroy the Affordable Care Act and Medicaid for ourselves, our families, our friends, our neighbors, and our fellow citizens.

Call Senator Heller at his Las Vegas Office 702-388-6605; his Reno Office 775-686-5770; or his DC Office 202-224-6244. 

You may also want to call Senator Cortez-Masto to thank her for her support of health care access for Nevadans. 202-224-3542; 702-388-5020; 775-686-5750.

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

It’s Official: GOP Hates Women — Scamcare Edition

In case there’s anyone left who thinks the Republican Party is representing the needs of women in this country, the contradiction is right in front of us in the form of the Graham-Cassidy+Heller (tagging along) bill.

Amy Friedrich-Karnik, senior federal policy adviser at the Center for Reproductive Rights, pointed to a statistic from progressive think tank the Century Foundation that estimates 13 million women will lose access to maternity care services if the ACA is repealed. Friedrich-Karnik explained that the bill also blocks Medicaid patients from using Planned Parenthood, which bars access to essential preventative care like birth control, cancer screenings, and STD testing and treatment. “It also slashes Medicaid overall and into the future, and so really impacting particularly low-income women and women of color who rely on Medicaid broadly for their health care,” she said. According to the Kaiser Health Network, Medicaid pays for nearly half of all births in America and covers family planning services for 13.5 million women. [Jez]

Not only is the bill a golf ball shot to the back of the head for Nevada women, it could cost the state some $250 million in funding:

Specifically, the proposal would eliminate the marketplace subsidies and federal dollars that states that chose to opt-in to Medicaid expansion under the ACA, like Nevada, currently receive, replacing them with block grants to be doled out to states, which would be left with the responsibility of deciding how to spend that money. It also converts almost the entire Medicaid program to a per capita cap, under which the federal government would set a limit on how much it reimburses states per enrollee, and allows states to waiver certain provisions from the ACA that require insurance companies to cover certain services and bars them from placing annual or lifetime caps on coverage. [NVInd]

Got that? Nevada gets a per capita cap, AND insurance corporations could refuse to cover pre-existing conditions, maternity care, family planning, women’s health care services, AND the corporations could revert to that wonderful old scam — the lifetime limit on coverage.  This isn’t as bad as the former “skinny” bill — it’s worse.

Senator Heller might have wanted to give this version some thought before he inked his name on the paperwork to co-sponsor the bill, but he didn’t.

It’s understandable that Nevadans are tiring of calling, writing, and sign making, but if Republicans are nothing else they are persistent.  They’re counting on public apathy, ignorance, and fatigue.  Not this time. Not on American health care. Not on our watch.

Senator Heller’s Washington DC office number is 202-224-6244.  Calls are tallied, and at some point the number of calls opposing this iteration of scam-care needs to impinge on the amount of money Republicans are counting on from the Koch Brothers and other right wing radicals.

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Hellerisms on Parade: Health Care Edition

And then there was this:

“The individual mandate I thought was atrocious, was wrong and shouldn’t have been in Obamacare at all,” he said. “I don’t think your government should tell you to buy something that you can’t afford. And if you can’t afford it you pay a fine. Yet 90,000 Nevadans pay the fine.” — Senator Dean Heller

Let’s start with the assumption that Senator Dean Heller is a capitalist, a firm believer in the free market system.  He’s certainly reinforced this impression given any occasion to do so.  So, why was there an “individual mandate” in the Affordable Care Act?  — The answer is capitalism.

The more precise answer is the “adverse selection” problem in free markets.  The most concise explication I’ve found for this comes from the Economist’s View:

“To explain how the adverse selection problem arises in these markets, note that people purchasing health insurance generally have better information about their health status than the people selling the insurance. If insurance is offered in this market at somewhere near the average cost of care for the group, people will use the superior information they have about their own health status to determine if this is a good deal for them. All of the people expecting to pay less for health care than the price the companies are asking for the insurance will drop out of the market (the young and healthy for the most part; all that is actually needed is that some people are willing to take a chance and go without insurance). With the relatively healthy people dropping out of the insurance pool, the price of insurance must go up, and when it does, more people drop out, the price goes up again, and the result is just like in the used car example above: The market breaks down and nobody (or hardly anybody) can purchase insurance.”

Now, if a person is reasonably conversant with capitalism and the patterns intrinsic to the operation of free markets, then the problem of  ‘adverse selection’ should be part of that person’s lexicon.  Granted it’s not an easy thing to explain, but the Economist’s View post quoted above offers the “used car” analogical example which makes the concept more accessible.   Therefore, if Senator Heller is indeed a capitalist, and if he has better that average economic knowledge base, then his explanation of his opposition to the individual mandate makes absolutely no sense whatsoever.

There’s also the political side of the issue, recall that Obama’s original plan didn’t contain an individual mandate while Secretary Clinton’s proposal did, and the result:

“Once elected, Obama quickly recognized the inescapable truth: An individual mandate was essential to make the plan work. Without that larger pool of premium-payers, there is no feasible way to require insurance companies to cover all applicants and charge the same amount, regardless of their heath status.” [WaPo]

There’s just no way to get around the problem of Adverse Selection, and still have an insurance system based on free market capitalism. 

Those still unsure about their understanding of Adverse Selection and how it operates in a free market system may want to consult some of the following sources:  Investopedia is a good source for short, concise, definitions of economic terms such as Adverse Selection. The Economic Times also has a dictionary style definition.  Risk Management specialists have a more technical definition.  Those wishing to dive a bit deeper into the weeds might want to see the World Bank’s explication.   There’s also an explanation from the National Association of Insurance Commissioners which goes into greater depth. (pdf)

Granted the individual mandate isn’t popular — that part is easy — but anyone who professes to be a free market capitalist (as does Senator Heller) can’t ignore the principle of Adverse Selection and how that concept impacts the insurance markets.

The alternatives to a purely market based insurance system in which the most people possible can obtain health insurance at relatively affordable rates are problematic for the free-marketeers.  A public option (federally sponsored insurance program operating in the general market) is one possibility.  Another alternative simply removes the free from free market — the single payer, or Medicare for All proposal, in which public insurance pays for medical services delivered in the private market.  At the furthest end of the spectrum would be nationalized medical health services such as the British or French systems. The arguments for and against each of these are ideological and political, and not necessarily relevant to the discussion of free market based health care delivery.  However, they do mitigate, from divergent directions, the issue of Adverse Selection.

The problem for Senator Heller is that he can maintain his free market positions OR he can oppose the individual mandate, but in light of the persistent and perpetual issue of Adverse Selection he can’t do both.

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

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

Embattled Bill Entangled Senator

While the Russians are in, or not in, meetings which are, or aren’t important, and which do or don’t offer trade-craft dangles — there’s a Senate version of the health insurance bill as egregious as its predecessors.  The hold music of the morning on Senator Dean Heller’s DC office phone is a static infused version of The Battle Hymn of the Republic while a person waits for an opportunity for leave a message for the Senator urging opposition to the health care insurance bill.

There’s a reason no one likes this bill — it puts insurance corporations back into the bifurcated market  with high premiums for those older and lower premiums (with higher co-payment and deductible out of pocket expenses) for younger, or less affluent, customers.  It puts state budgets at extreme risk. It slashes Medicaid funding (in conjunction with the proposed budget), thus placing services for children and the elderly in peril.

Senator Heller is described as being wedged into a hard place — between the desires of the hard right (and perhaps the bounteous coffers of Sheldon Adelson) and the hopes of his constituents and the Governor who want reasonable access to affordable health care insurance.

“Heller, in other words, has backed himself into a corner. Either he honors the concerns he raised just a few weeks ago, or reverses course and completes a very public betrayal – the year before his re-election campaign.” [NBC]

It’s time to offer Senator Heller a way out of this box — encouraging his continued opposition to the health insurance bill — call 202-224-6244; or 702-388-6605; or 775-686-5770.

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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