Tag Archives: Patients Bill of Rights

GOP Air Balls: ACA Repeal would increase Nevada uninsured by 95%

Trump Favorite Picture This ought to be just a little chilling:

If Republicans go through with their plan to dismantle the Affordable Care Act using a similar model as their failed 2015 Obamacare repeal, the number of uninsured would double, a new report by the Urban Institute report warns. (pdf)  Taking into account the two or so year delay GOP lawmakers say they will include in the repeal bill, the non-partisan think tank estimates that in 2019 the number of uninsured nonelderly people would rise from about 29 million to nearly 59 million.  [TPM]

And the numbers represent what? Answer:

Eighty-two percent of the people becoming uninsured would be in working families, 38 percent would be ages 18 to 34, and 56 percent would be non-Hispanic whites. Eighty percent of adults becoming uninsured would not have college degrees. [UrbanInst. pdf]

Percentages have a way of sounding bland, so some clicking on the Plastic Brain results in approximately 33,040,000 of those people who would lose their health insurance by 2019  being non-Hispanic white people.  47,200,000 would be those without a college education, and thus presumably not in a position to secure the kind of employment providing the resources to find individual health plans.

If the 2015 bill is used as the framework or model, then the Urban Institute projects that there will be 762,000 uninsured individuals in Nevada only 18% of whom would be eligible for assistance; causing a 95% increase in the number of uninsured in Nevada.   Those Nevada politicians who have been denouncing the Affordable Care Act (read Rep. Mark Amodei R-NV2) may want to pause before “taking credit” for creating a 95% increase in the number of Nevadans without health insurance.

It’s important to recall that the Big Lie about the Affordable Care Act is that it is “socialized medicine.”  In reality it’s an Insurance Law. It doesn’t create a nationalized health care system – it merely increases the number of people who have “access” to health care by providing more people with the capability of purchasing health insurance policies.

Senate Democrats have already signaled that should the “Straight Out Of The Gate Repeal and Replace” come from the majority Republicans the GOP can expect no assistance from the Democratic side of the chamber. [TPM]

And, then there’s the politics of the repeal.  If the GOP decides to use the Reconciliation Process (needing only 51 votes for repeal) then Senator Dean Heller (R-NV) raises a question:  “What we are trying to figure out is what the restrictions on reconciliation,” Sen. Dean Heller (R-NV) told TPM. “Does reconciliation allow for a replacement? And it may or may not.” [TPM]

If the process doesn’t allow for “replacement” then the Republicans have chucked the insurance for those with pre-existing medical conditions, insurance coverage for mental health, insurance coverage maternity care, protections from junk insurance policies with maximum limits, and other popular features of the ACA.  They may also be chucking hospitals under the bus.

One private equity spokesperson noted last November, “… hospitals, especially those in rural areas, could be tremendously hard hit if the replacement rolls back the progress made under the ACA to insure patients and incentivize them to get care before their illnesses require emergency room visits or hospitalization.”

Thus, with the lack of any specificity from Republicans about the nature of the “replacement” we could posit some serious problems for the members of the Nevada Rural Hospital Partners – in Winnemucca, Fallon, Battle Mountain, Boulder City, Carson Valley, Ely, Winnemucca, Incline Village, Hawthorne, etc.   A 2016 report for the American Hospital Association provides some general conclusions from which we can contemplate the effect on Nevada’s rural health providers:

”The loss of coverage would have a net impact on hospitals of $165.8 billion  with the restoration of Medicaid DSH reductions; The ACA Medicare reductions are maintained and hospitals will suffer additional losses of $289.5 billion from reductions in their inflation updates; Full restoration of Medicare and Medicaid Disproportionate Share Hospital  (DSH) payment reductions embedded in ACA would amount to $102.9 billion.”  [AHA pdf] 

The technical term for these losses might be “ouch?”   There is a point at which rhetoric meets the road.  It’s all well and good to bellow “Repeal and Replace?” Or, “Get Rid of Socialized Medicine.”  It’s another thing entirely to puzzle out the impact of repeal on all the stakeholders in this issue – the customers and patients, the health care providers, the hospitals and clinics, the insurance companies, and the investors who have an increasing stake in privatized health care in this country.

There are some elements of the Affordable Care Act which could be improved.  However, the Burn the Barn Down political pandering on full display among Republicans isn’t leading to any current and serious discussions of how to make these improvements viable.  And, this is chilling for policy holders, insurance companies, health care providers, hospitals and clinics, and the investors therein.

Perhaps the Pottery Barn rule applies to Republicans: If you break it you own it.

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Filed under Amodei, Health Care, health insurance, Heller, Nevada politics, Politics, public health, Republicans, Rural Nevada

Replace the ACA with What??

Take Two Aspirin

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

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

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

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

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

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

The Replacement is Worse Than The Current System

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

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

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

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

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

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

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

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

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

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

Heck’s Votes on the ACA

Heck ACA votes

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

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

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

Supreme Court Rules In Favor Of ACA: Heller Kicks The Gator Ade Bucket

Senator Dean Heller (R-NV), or as the Fine Wordsmith The Gleaner calls him, “The Senator By Appointment Only,”  wants us all to know that he is not pleased by the Supreme Court’s ruling on the Affordable Care Act and Patients’ Bill of Rights.

“Nevada families and businesses are already struggling in this current economic environment, and the President’s job-killing healthcare law is making a difficult situation worse. Congress spent more than a year debating healthcare legislation while Nevadans were losing their jobs and their homes. Obamacare made sweeping changes to Medicare, impacting thousands of Nevada’s seniors, and cut the program by a half trillion dollars.

“This law has now been affirmed as a colossal tax increase on the middle class, and its excessive regulations are stripping businesses of the certainty they need to hire at a time when Nevadans and the rest of the country are desperate for jobs. The President should work with Congress to find real solutions to healthcare reform so the excessive mandates and taxes in this law do not further add to our national debt or continue to stifle economic growth. This onerous law needs to be repealed and replaced with market-based reforms that will provide greater access, affordability, and economic certainty to our nation,” said Senator Dean Heller.

Let us parse:

Heller:Nevada families and businesses are already struggling in this current economic environment, and the President’s job-killing healthcare law is making a difficult situation worse.”

Coupling “job-killing” and “healthcare” is a Republican construction which doesn’t do anything more than seek to associate a change in health care statutes with something (anything) negative.  If unemployment in Nevada were at 2%, and the nation’s major problem was smog, then it would be easy to imagine that the ACA and Patients Bill of Right would be “pollution producing.”  That’s speculative, so let’s drill down a bit further.

Let’s go to that bastion of liberal thinking, Forbes, to see if the ACA/PBR is actually “job killing?”  The answer: No.  In fact, when we go to the Urban Institute’s Study the Massachusetts health care reform enacted under Governor Romney’s administration did NOT produce “job killing” results:

The graphic reduction is difficult to read, so click on the image for the full sized version in the Urban Institute’s original study.  What happens when we take a look at the right hand side of the chart?

While the U.S. was experiencing a decline in full time jobs during the Recession of 3.6%, Massachusetts saw a 2.8% drop.  While the U.S. witnessed a 0.8% increase in part time employment, Massachusetts saw a 0.9% increase.  Whether Governor Romney wants to admit it or not, the Massachusetts plan is the closest statutory comparison to the Affordable Care Act we have, and the numbers about “job losses” in Massachusetts don’t make the Republican point.

Neither do the national numbers: “Since the Affordable Care Act was signed into law, the economy has created 3.5 million private sector jobs, including 488,000 jobs in the health care industry. The unemployment rate is 8.3%, lower than it was in March 2010.”  [Hoyer] And this: “360,000 small businesses have taken advantage of tax credits that are making health insurance more affordable for 2 million workers.  As many as four million small businesses are eligible for these credits.” [Hoyer] And, again, this: “…over 2,800 employers are participating in the Early Retiree Reinsurance Program, which is helping provide coverage to 13 million early retirees who are not yet eligible for Medicare.”  [Hoyer]   Whether we look at national numbers or state numbers, or both — the health care reforms enacted in Massachusetts and in the United States are NOT job killing.

Heller:Congress spent more than a year debating healthcare legislation while Nevadans were losing their jobs and their homes.”

Yes, many things happened while foreclosure rates in Nevada were leading the nation,  and during this time what was the GOP agenda on financial reform and mortgage relief?

On October 12, 2010 Representative Eric Cantor (R-VA) laid out the GOP position on the foreclosure crisis: “Republican leader Eric Cantor chose to break his silence on the foreclosure crisis, with other Republicans quickly picking up the talking points.  And his position should come as no surprise.  Rep. Cantor came to the defense of the housing industry and laid blame squarely on the feet of the American homeowner.” [C2C]

Then, there was the infamous comment from current GOP standard bearer Governor Romney on home foreclosures: “Don’t try to stop the foreclosure process. Let it run its course and hit the bottom,” Romney said when asked what he would do to jump-start the floundering housing market.” [WashMonthly Oct 2011]

Thus, while Congress was debating, the President was signing, and then the Department of Health and Human Services was implementing the provisions of the Affordable Care Act and Patients Bill of Rights, the Republicans were blaming homeowners for the foreclosure debacles and the leader among the GOP presidential candidates was asserting that Nevadans who were in the foreclosure process should close their eyes and Think of the Free Market.  In other words, the Congress could have been debating the desirability of regulating Sea Horse Races, and the GOP wouldn’t have been much interested in legislating solutions to the housing crisis.

Heller:Obamacare made sweeping changes to Medicare, impacting thousands of Nevada’s seniors, and cut the program by a half trillion dollars.”  We won’t go into the part in which the Ryan Budgets in their various incarnations cut massive amounts from Medicare AND sought to turn the program into a voucher/coupon program.  Let’s just deal with the blatantly misleading statement about cuts to Medicare, and see what the professional fact checkers had to say:

“Under the act, Congress voted to reduce $500 billion in projected Medicare spending over the next 10 years, not in one substantial chunk. The reductions are aimed at eliminating parts of the Medicare program seen as ineffective or wasteful. For example, the plan phases out payments to the Medicare Advantage program, an optional program set up under the George W. Bush administration, where seniors could opt to enroll in a private insurance program and the federal government would subsidize a portion of their premium.”  [PolitiFact.com, 5/10/11] (emphasis added)

Under the Affordable Care Act the savings were reinvested in the Medicare program itself, not simply cut from the budget and the program privatized.  And note — some cuts were made to the taxpayer subsidies to insurance companies offering highly profitable optional insurance.  The cuts were in areas considered wasteful, and were NOT related to basic Medicare services.

Heller:This law has now been affirmed as a colossal tax increase on the middle class, and its excessive regulations are stripping businesses of the certainty they need to hire at a time when Nevadans and the rest of the country are desperate for jobs.”   This statement is straight out of the GOP Talking Point Random Generator.

Interesting how Republicans like Senator Heller become really engaged in the problems of the Middle Class when taxes or fees might be increased, but rarely (if ever) when said Middle Class is getting pounded by corporate raiders, union busters, private equity Giant Squids, and stagnating wages.   Be that as it may, if the middle class wants a colossal tax increase — it’s more likely to come from the Republicans.

There is, for example, the tax proposal set forth by Governor Romney, about which the Christian Science Monitor reported:

“In any case, not extending the 2009 tax cuts still in effect in 2012 means that Romney’s plan would, on average, raise taxes for households in the bottom two quintiles, relative to what they’re paying this year.  Mitt Romney’s tax plan would cut taxes, by about $180 billion in 2015 alone, relative to current tax policy. And, despite all arguments to the contrary, a disproportionate share of the savings would go to households with the highest incomes.”  (emphasis added)

Ezra Klein, Washington Post columnist, added this analysis of Governor Romney’s plan:

“Note that the Tax Policy Center could only conduct a partial analysis of Romney’s tax plan. That’s because Romney’s proposal itself is incomplete. He’s said that he wants to scrap various deductions in the tax code, particularly for high earners, in order to broaden the tax base. But he hasn’t offered any details about which deductions he’d scrap or how, so there wasn’t anything for the Tax Policy Center to analyze.

Based on the details Romney has provided so far, his plan would lower tax rates for the top quintile by 5.4 percent, saving the wealthiest an average of $16,134. (The top 1 percent of earners, meanwhile, would save an average of $149,997.) The lowest fifth of earners, by contrast, would see a small tax increase of 1.3 percent under Romney’s plan, owing the federal government an additional $143 extra on average.

Obama’s tax proposal, meanwhile, would keep tax rates roughly the same except for married couples making over $250,000 per year (or single earners making more than $200,000 per year). On average, under Obama’s plan, the top 1 percent would be paying about $87,173 more per year.”

Klein offers the following illustration:

There are many “ifs” involved in the Romney tax proposal, incomplete as it is, but there are some deductions which if eliminated would have a definitely negative impact on middle income level Americans:

“Most middle-class families would get little help. About 18 million working families would actually pay higher taxes because Romney would end the American Opportunity Tax Credit for college and cut tax credits for taxpayers with children and earned income.”  [OCCD]

In fine, if one would like to see a tax structure which bestows the greatest advantages on those who already have great advantages — Governor Romney and the Republicans are your kind of people.

There’s nothing quite like tossing in a phrase like Excessive Regulations to stir the hearts of the financial and insurance sectors, both of whom dislike being told, for example, that using premium payments for CEO compensation and advertising aren’t the best use of consumer dollars.   And, the phrase tickles those who think the EPA is merely a professional thorn in the side of the energy sector — Deep Water Horizon notwithstanding.  It’s often notable that when expounding on the “excessive regulations” in the ACA, very few — if indeed any — examples are offered.

Ah, the now hoary and hirsute talking point “uncertainty and hiring” comes back for yet another encore.   The “uncertainty” allegation is a one size fits all gob-lob at any legislation or legislative proposal which might cause corporations to THINK about what they’re doing.

We’ve been told that implementing the provisions of the Dodd Frank Act on financial regulation reform creates “uncertainty.”  In this instance there’s something to be said for a bit of uncertainty — no bank should believe that it “certainly” has the latitude to use depositors funds to play around in proprietary trades, or has blanket permission to bet against the interests of its own clients, or has leave to arbitrarily play with interest rate reporting because it wants to make its own books look better.

And for the umpteenth time — small business hiring won’t increase until small businesses (not to be confused with Washington, DC lobby shops and hedge funds) see the demand for their goods and services increase such that their current staffing levels are insufficient to meet customer needs.   The only thing that is Certain is that middle class income and middle class jobs need to advance in order to improve aggregate demand.  This has precious little to do with the desires of the Wall Street Wizards to play cowboy with depositors dollars.

Heller:The President should work with Congress to find real solutions to healthcare reform so the excessive mandates and taxes in this law do not further add to our national debt or continue to stifle economic growth.”

Now what could be adding to the national debt?

So, if we are really serious about reducing the federal deficit — then we get rid of the Bush Tax Cuts! And, we do something to get more “growth” into the economy.  Hardly the austerity prescription being touted by Senator Heller and his Republican cohorts.

Heller:This onerous law needs to be repealed and replaced with market-based reforms that will provide greater access, affordability, and economic certainty to our nation,” said Senator Dean Heller.”

Yes, the House will make another symbolic move at “repealing” the Affordable Care Act during the week of July 9th.  Meanwhile, what are “market based reforms?”

Representative Paul Ryan has suggested some “market based” reforms which mean that Medicare recipients will get a “coupon” or voucher toward paying their private health insurance premiums.   This is essentially a government subsidy for health insurance corporations to give them an “incentive” to offer health insurance for the elderly.  Meanwhile back in the real world — the reason we have Medicare in the first place was that insurance corporations do not want to offer plans for elderly people — they get sick, and old, and old and sick.

This might be a good time to remind ourselves that it’s not a “free market” when some corporations are being subsidized by the taxpayers to offer services and products they don’t otherwise want to sell.  For those keeping score, “market based solutions” is GOP-Speak for privatization.

Not to belabor the point much further, but the GOP response to the ACA ruling as evidenced by Senator Heller is simply to offer no solutions to demonstrated problems, and demonstrations about issues of primary interest to the upper 1% of the American income earning public.  It is a tale bedecked with focus group tested buzz words and talking points, which can mean almost anything to their devoted listeners, and almost nothing to anyone seeking solutions to real American problems.

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Filed under 2012 election, Bush Administration, conservatism, Economy, employment, family issues, Federal budget, financial regulation, Foreclosures, Health Care, health insurance, Heller, Insurance, Medicare, national debt, Nevada politics, Politics, privatization, Republicans, Taxation, unemployment