Tag Archives: Paul Ryan

I’m Watching a Basketball Game (Instead of the DACA drama)

Yes, in the midst of the Soap Opera that is the Federal Government of these United States this political junkie is watching a basketball game I recorded yesterday. Why? Because I received just about all the news I need for the next couple of days in perhaps less than 15 minutes this morning.   The rest will be noise.

Every pundit ever hired by every cable broadcast network will expend altogether too much energy “explaining” what the machinations of the past week “mean.”  Since I’ve come to believe they aren’t significantly better at prognostication than your average ground hog, octopus, or other member of the animal kingdom, I’ll stick to my own interpretation.

The Republicans are eventually going to own the mess they’ve made.  The DACA program was working in September 2017 when the Big Dealer in Chief stuck his foot in it.  Why? I’m going to go with the explanation that it was in support of the rather egregious House version of a Bridge Act introduced on January 12, 2017.  (HR 496 for those keeping score) There is no path to citizenship in the House version, and the bill essentially treats Dreamers as cheap labor, to be exploited by both employers and the federal government in terms of an endless assessment of fees.  It would also cover precious few Dreamers.

In today’s dispatches from delusion-ville, the White House wants an immigration bill that is “good for America.”  I think we can safely assume this means no path to citizenship for young people who’ve known no other country but this one, a “merit-based” immigration plan (which really isn’t similar to Canada’s any more than it’s similar to the Canadian health care system the Republicans were quick to malign), and it eliminates family reconciliation.   A miserable, un-American plan though it may be, I am of the opinion the House “Bridge Act” [text] is what Stephen Miller and the other racists in the West Wing have in mind.  The timing looks a bit suspicious to me, Trump signed the executive order eliminating the DACA program on September 5th, the same day there was a discharge petition in the House — which promptly went nowhere.

And now we do have a major mess.   The Big Dealer in Chief doesn’t have a position on much of anything, much less immigration.  However, that state of affairs doesn’t mean he won’t attach himself to whatever buzzwords and banners will help keep his radical base in line.  Thus we can assume he will order another Diet Coke while twittering on about “immigrants and crime” (a truly faulty proposition) or “immigrants versus citizens” (without bothering to notice the connection between immigrants and their contributions to the American economy — the economy benefiting citizens; and, giving us all to understand that the Norwegians (82.3% white) are preferable to those from those **hole places which send us an in-ordinary number of people with advanced degrees.

So, the herd on Capitol Hill has until February 8, 2018 to clean up.  Senate Majority Leader McConnell is now without one of his more important hostages — CHIP beneficiaries, and Senator McCaskill knocked the legs out from under his Military hostages when she offered an measure to pay members of the Armed Forces and Sen. McConnell objected.  What McConnell did secure was the capacity to put House Speaker Ryan into a soup largely of his own concoction.

Speaker Ryan, has a problem — he has to come up with a DACA fix acceptable to the Senate, a solution not currently available in legislative language on his side of the building.  If the House does move toward a compromise bill his Freedom (for us but not anyone else) Caucus will scream to the heavens.  If the House stays put with its current version, the Senate Democrats can shut down the government funding for round two, and this time on more solid ground.  A compromise bill will likely not please either side of the divide, however the House alternative will cement the reputation of Republicans as the Party of Racists.

Thus, the Party which has promulgated the notion that allowing anyone at any time to march down the road to full citizenship is “amnesty,”  is now fettered with a label they’ve sought to avoid since the sainted Ronald Reagan gave his “state’s rights” speech at the Neshoba County Fair on August 3, 1980 giving voice and heft to the Southern Strategy.

Popcorn anyone?

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Filed under anti-immigration, Immigration, Politics, racism

To Our GOP Friends Who Don’t Seem To Have A Clue How Insurance Works

We might go for the Ryan budget bill in regard health insurance directly, but others have already noted that either (a) he doesn’t have a clue how insurance works, or (b) he’s trying to pull a fast one on the American public.  At any  rate, the phase I of the ACA repeal is essentially a gigantic giveaway to health insurance and pharmaceutical corporations, a tax boon to those in the upper 0.1% income bracket, and a dismantling of the Medicaid program. The contents of Phase II have been tipped.  It’s on the Speaker’s website, but requires a bit of unpacking:

“Administration actions, notably by HHS Secretary Price, to stabilize the health insurance market, increase choices, and lower costs…”

Translation: The content of health insurance policies, currently listed as “essential provisions” for all policies, is under a head on assault.

If a corporation is going to offer a comprehensive health insurance policy for sale to customers, it must include “ambulatory care for patients in a hospital or not,” “emergency services,” “hospitalization,” “pregnancy, maternity, and newborn care,” “mental health and substance abuse treatment,” “prescription drugs,” “rehabilitation,” “laboratory services,” “preventive and wellness care,” “pediatric care including vision and oral care,” and “birth control and breastfeeding coverage.”

Now, just guess what parts of this coverage the GOP finds objectionable?  If you guessed anything having to do with WOMEN give yourself the prize of the day.

Why, the guys grouse, do I have to have a policy covering maternity and neo-natal care, birth control prescriptions, and pediatric care?  It’s because of how insurance works.

Aside from the obvious part wherein it requires both men and women to create a ‘maternity situation,’ the whole idea of insurance is encapsulated in the word POOL.

“When you buy insurance, you join many others who pay money to an insurance company.  The insurance company uses the money collected to pay claims that are submitted by those who have purchased insurance.  The money is “pooled” and losses and expenses are shared.  An important aspect is the members of a pool share similar risk characteristics.” [HIW]

In the case of health insurance, the “shared characteristic” of note is that everyone who buys a policy is a human being, who at some point will need health care.  The more people (policies) in the pool the wider the risk can be shared. And, that’s the point of insurance — spreading the risk among as many policy holders as possible.

Creating ‘cafeteria’ policies might be profitable for the insurance corporations, but it doesn’t make health care affordable for most people.  If we carve out special coverage for maternity care and remove this from the larger pool (which includes men) all this serves to do is to increase costs for those remaining in a smaller pool.  Similarly, if prostate cancer screening and treatment is carved out from comprehensive coverage, this serves to increase costs as the overall pool is diminished.

Got it? If not, think of your auto insurance.  10 people buy GenZ Insurance, 9 of them never file a claim, 1 does. The costs related to the one claim are shared among those who bought into the pool and paid premiums to maintain their insurance.  We require all automobile owners in this state to have at least minimal insurance. In Nevada, this means you have to have a policy covering $15,000 for bodily injury or death in an accident for one person, $30,000 for bodily injury or death of two persons in an accident, and $10,000 to cover property damage. Thus, all Nevada drivers must have at least minimal participation in the auto insurance pool. Again, the larger the pool the greater sharing of risk, the entire point of having insurance.

Back to health insurance, if we thought Phase I is a disaster, Phase II should be even worse. Phase III is the ‘portability canard.”  Has it occurred to anyone in the GOP hierarchy that nothing that really prevents insurance corporations from selling their policies across state lines — IF they agree to accept the standards set by state insurance commissions for the protection of their consumers.  More on this later — if necessary.


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Filed under Economy, Health Care, health insurance, Insurance, Politics

Ryan’s Time Wasting Titivation

salchowThe latest version of the House GOP budget proposal in Congress looks very much like previous renditions — lower the tax rates for the top 0.1% of American income earners, and replace the current Medicare program with a coupon/voucher plan. [TPM]   “Re-litigation” comes to mind.   The curious part comes as Representative Ryan, who vilified the $716 billion in savings in the Affordable Care Act (Obamacare) during the last presidential election, now incorporates those same savings into his budget proposal — while calling for the repeal of the ACA which contains those savings…  This rhetorical contortion looks less like a 360° turn and more like a quadruple salchow.  [more at Business Insider]

Former House Speaker Rep. Nancy Pelosi, called the scheme “fuzzy math and budget gimmicks.” [TPM] The point of this budget exercise, is not really to address the long term stabilization of U.S. indebtedness — it IS an exercise in sophomoric political economy; simplistic in form and regressive in nature. Ezra Klein nails it:

“Ryan’s budget is intended to do nothing less than fundamentally transform the relationship between Americans and their government. That, and not deficit reduction, is its real point, as it has been Ryan’s real point throughout his career.”

Or, more specifically:

“Here is Paul Ryan’s path to a balanced budget in three sentences: He cuts deep into spending on health care for the poor and some combination of education, infrastructure, research, public-safety, and low-income programs. The Affordable Care Act’s Medicare cuts remain, but the military is spared, as is Social Security. There’s a vague individual tax reform plan that leaves only two tax brackets — 10 percent and 25 percent — and will require either huge, deficit-busting tax cuts or increasing taxes on poor and middle-class households, as well as a vague corporate tax reform plan that lowers the rate from 35 percent to 25 percent.”  (emphasis added)

Now, why would those be “vague?”  First, it is much easier to dodge criticism of a proposal when the details aren’t available.  Offering a “vague” proposition allows for the “I didn’t really mean that” rationalization when push comes to the inevitable shove.  Secondly, when the arithmetic is fuzzy the extrapolations, of necessity, must also grow furry. What should give the audience room for some trepidation is that this offering from Representative Ryan isn’t the first time he’s run this flag up the pole.  Why could not more rational, detailed, and precise numbers be provided as the budget plan moves through its various incarnations?

The answer may very well be that he can’t be more precise without (a) offending major segments of the electorate, and/or (b) demonstrating that the numbers simply don’t add up to what he is claiming for his project.

In Representative Ryan’s blinkered vision of America, government is more to be feared than the level of indebtedness [Ezra Klein] but this ideological perspective obfuscates the very real role our government plays in this mixed economy.   Programs which provide automatic stabilizers in the economy to mitigate the impact of business cycle volatility, and those which provide citizens with opportunities to increase their standards of living have an impact across the economic spectrum.

CBPP concludes:

“As policymakers embark on the necessary work of further reducing long-term budget deficits, their approach could have important consequences for tens of millions of low- and moderate-income Americans.  If policymakers take an even-handed approach, one that combines spending cuts with an adequate mix of new revenues, they can reduce deficits without increasing poverty and the ranks of the uninsured or weakening efforts to ensure that children have more opportunity to succeed in the classroom and later in the labor market.  If, however, policymakers cut deeply into programs that assist low-income individuals and families, we will likely see more poverty and hardship as well as fewer paths to opportunity.”

The essential problem with perceiving government as a threat to “freedom” is that those programs which keep people from becoming dependent on government assistance in the long run, are those which the Meat Cleaver Republicans would assert in the first wave of cuts in the short term.

For example,  there are significant omissions in Ryan’s latest offering:

“It won’t create jobs this year, and will likely cost jobs in the years to come by putting the economy on a steep austerity ramp. There’s no housing policy for the millions of families in foreclosure and no way to read Ryan’s budget without assuming massive cuts to student-loans programs. That may mean fewer families watching student loans pile up, but only because they didn’t get any in the first place.” [Klein WaPo]

Jobs?  Jobs generate income, income generates both consumer spending and tax revenue.  The impetus may come from federal spending, but the results would be seen initially in local economies.  Paychecks get spent on housing, clothing, groceries, and transportation.  A family with an income sufficient to support the purchase of an automobile generates not only good numbers for the automobile manufacturers, but pays state sales taxes on the purchase, pays gasoline taxes to keep the beast running, and pays license fees to keep highways operating functionally.

Housing?  The “housing market” is a mid-stream economic activity.  Building a housing unit, whether detached or communal, requires raw materials, manufactured materials, and financing.  In short, housing is in the midst of the economic stream of activity, and as we discovered to our collective horror in 2007 when things start to go badly in this milieu the ripples can become tsunamic.  That there is not even a passing nod given to the issues associated with current housing market fragility and the continuing foreclosure issues in Representative Ryan’s budget ought to be demonstrative of his detachment from real economic forces at work.

Foreclosed properties wreak havoc on the homeowners, bring down housing values in neighborhoods, cause a loss in property tax revenue for local governments, and create law enforcement issues where abandoned properties are all too prevalent.  One might have thought that Representative Ryan would at least given cursory acknowledgement to the issues associated with the housing market in his budget priorities?

Education?  There is a link between income, unemployment, and education.

Educations Pays

If we truly want to move people out of poverty, or up the economic ladder, the graph above from the Bureau of Labor Statistics shows how the rungs of that ladder are constructed.  Note that when the graph was drafted the national unemployment rate was 14.1% for those with less than a high school diploma, but only 6.8% for those with an associates’ degree.  If we look to the more recent numbers the picture doesn’t change much.

The February 2013 unemployment rate for those with a high school diploma stood at 7.9%; for those with an associates’ degree or some college the unemployment rate was 6.7%.  Those holding a college degree experienced an unemployment rate of 3.8%.  [BLS]

Given this information it would seem logical to conclude that if we want to improve the overall health of the American economy it would be seemly to enhance the opportunities for education, especially post-secondary educational programs.  That’s not what Representative Ryan and his Republican colleagues have on offer:

Ryan would stop increasing the size of Pell Grants to adjust for inflation. Instead, they would stay at the current level, $5,645, for 10 years. Ryan would also change the way the government calculates how much a student’s family is expected to pay to make it less generous.”  [Atlantic]  …

Ryan’s proposal doesn’t spend much time on a key reason Pell Grant awards have increased: rising education costs. Average costs for a four-year institution have risen 250% since 1980 and nearly doubled in the last 20 years. Pell Grant allocations have increased rapidly over the last decade — but that increase isn’t tied to the change for education costs.” [Atlantic]

Education is a labor intensive occupation.  The process can be assisted with technology, but since time out of mind the means by which human beings transmit knowledge — vocational, cultural, economic, etc. — is from human being to human being.  As states cut funding to educational institutions the colleges, tech schools, and universities raised tuition and fees to the “customers.”  The greater the increase in fees, the greater the problem for middle class parents who want to see their offspring move up the educational (and economic) ladder.   Young people are asked to take on a staggering amount of indebtedness to earn a degree, which in turn limits their capacity to participate more fully in the economic life of this nation.  Too much student loan debt means more difficulty purchasing a vehicle, or much of anything else.

The bottom line is that Representative Ryan has simply re-cycled his political document, with its ideological baggage and called it a budget.  While it’s an improvement over the Republican budget document which arrived without numbers in 2009, it’s still an homage to Ayn Rand and her Cult of Selfishness…and very little else, except time wasting titivation.

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Filed under Economy, Federal budget, tax revenue, Taxation

Playing Percentages With Grandma? Romney-Ryan Medicaid Budget Cuts in NV

The median annual household income in Nevada is $55,726. [Census]  The total population estimate for 2011 is 2,723,322 and of these approximately 12.5% are over 65 years of age.  Some simple arithmetic shows that about 340,415 Nevadans are over 65 years old.   So what?

The question is important because some of these individuals will need home care services to deal with infirmities, some will need assisted living to remain independent, and others will require institutional care, aka nursing facilities.

As we can see from the Kaiser Family Foundation graph above,  more Medicaid resources have been allocated for home and community based care since 1995.  Long term care, which prior to 1995 meant institutional care for the most part, is now 43% home/community based health care services.   The issue now becomes do we want to fund the Medicaid program at a level which will allow more low income  Nevada residents over the age of 65 to remain at home, or do we cut program services such that we cope with only the most medically fragile?

The family issue, for that household earning the $55,726 annually, is how to provide care for an elderly relative who requires medical assistance beyond the financial capacity of the family to provide but who doesn’t need institutional care?  There is no answer to this inquiry from the Romney/Ryan budget.

In fact, if as Senator Heller and some of his colleagues recommend,  we repeal the Affordable Care Act (Obamacare) and do what the Republican ticket suggests — transform the Medicaid program into a block grant scheme — we cut approximately 38% from Medicaid services. [KFF pdf]  If we drill down into state by state statistics, if Obamacare were repealed and the Ryan Budget was adopted our Medicaid program in Nevada stands to lose about 44% of its funding. [KFF pdf]

No one would (or should) be so callous as to suggest we slash funding for those with the most serious medical needs, especially those who need nursing facility care.  However, if we’re looking down the line at a 44% reduction in Medicaid funding for state services then the obvious cuts would come “at the margins.”

Who’s marginal?  Are low income single mothers with two dependent children under the age of 6 marginal?  Are low income elderly persons who can still function — albeit barely —  independently marginal?

The Medicaid program in Nevada* is an insurance program which pays servicers to perform some or all of the following tasks:

-Adult Day Care
-Assistance Shopping for Essentials
-Caregiver Respite
-Case Management
-Companion Care
-Meal Preparation
-Personal Care
-Personal Emergency Response System (PERS)

* In order to qualify for the Nevada Home and Community Based Waiver as of 2012, the applicant’s monthly income must be less than $2,094.  Their countable assets must be valued at less than $2,000.

Now, how many families can afford privately financed adult day care, companion care, housekeeping help, meal preparation, personal care, and shopping assistance? On $55,726 a year?  On an income of approximately $2,000 per month?

The obvious conclusion is that perhaps the Republicans are advocating for Crowded Housing?  If they bemoan the fact that recent college graduates are staying home with parents in a tight economy, think how much more familial the entire living situation becomes when the grandparents — or Uncle Festus or Aunt Minerva — move in?  Especially when the elderly relatives are simply in need of the kinds of home or community based services likely to be declared marginal in cost cutting binges?

While this might all sound a little facetious, the fact is that most houses in the U.S. ( some 67%) have two or three bedrooms. [Census] Every parent’s dream for when the offspring depart, be it the new guest room, the man cave, the sewing room — whatever — fails when a no long total independent older relative needs a safe place to live.

A modicum of concern for middle income families who are struggling to maintain their standard of living might be in order.   If we can assist middle income families with the costs associated with the care of a low income elderly relative; if we can chip in a bit so that a low income  elderly person can remain independent as long as possible — then why is is necessary to cut 44% of the Medicaid program in Nevada so that millionaires and billionaires won’t have to revert to paying the income taxes they were paying back in the Clinton years —  39.6%.  (They are current paying 35%.   All this for 4.6%. )

Let’s guess that the hedge fund managers and Wall Street wizards won’t be decimated by a 4.6% tax increase, but a 44% reduction in Medicaid funding in Nevada will have a profound effect on the other 99.99%.

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Filed under 2012 election, Health Care, health insurance, Heck, Heller, income tax, Medicaid, Nevada economy, Nevada politics, Romney, Taxation

The Crisis That Isn’t: The Romney/Ryan Campaign in Whopperville

Whopperville, U.S.A.At rally in Lima, Ohio, GOP VP Candidate Paul Ryan says Pres Obama not doing anything about the debt crisis & is making it worse.” via Mark Knoller.

Not doing anything? First, it’s hard to understand why a sitting member of Congress could miss the information that federal government spending has flat-lined during the Obama Administration.  Marketwatch explains:

“Although there was a big stimulus bill under Obama, federal spending is rising at the slowest pace since Dwight Eisenhower brought the Korean War to an end in the 1950s.  Even hapless Herbert Hoover managed to increase spending more than Obama has.”

For the arithmetically challenged, Marketwatch provides a chart:

How does Marketwatch substantiate the contention that spending increases during the Obama Administration are slower than even the Hoover Administration?

If spending increases are at the slowest rate in decades, AND federal spending has flat-lined during the Obama Administration — then how does one conclude the Obama Administration isn’t doing anything about the budget deficit and is actually “making it worse?”

One doesn’t … unless you are a resident of Whopperville in a Brave New World:

“One hundred repetitions three nights a week for four years, thought Bernard Marx, who was a specialist on hypnopaedia. Sixty-two thousand four hundred repetitions make one truth.”  – Brave New World (Aldous Huxley)

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Filed under 2012 election, Economy, Federal budget, Politics

Republican YOYO Home Economics: Medicaid Slashed, Other Support Burned

Former President Clinton advised the delegates to the 2012 Democratic Convention to listen carefully to what the Republicans were offering in regard to Medicaid, and those of us in Nevada should be “listening with both ears.”  Here’s the description of the Medicaid program as stated by the Nevada Department of Health and Human Services, the program:

“Provides health care coverage for many people including low income families with children whose family income is at or below 133% percent of poverty, Supplemental Security Income (SSI) recipients, certain Medicare beneficiaries, and recipients of adoption assistance, foster care and some children aging out of foster care. The DHCFP also operates five Home or Community-Based Services waivers offered to certain persons throughout the state. The Division of Welfare and Supportive Services (DWSS) determines eligibility for the Medicaid program.”

Listing those categories focuses on the aims of the program — it is to serve (1) low income families with children; (2) elderly Nevadans; (3) low income Nevadans over 65 years of age; (4) families receiving assistance for adopted children; (5) children in foster care.  Who was enrolled in Nevada’s Medicaid program as of fiscal year 2009:

What services were provided to those enrolled in Nevada’s Medicaid program?

During fiscal year 2010, 68.1% of the spending from the Medicaid program went for acute care, 25.6% was allocated for long term care, and 6.3% was used for “disproportionate care – hospital payments.”

The spending for long term care breaks down as illustrated in the following chart:

11.1% of the long term care funding was allocated to facilities for the intellectually disabled, 2.9% went to services for the mentally ill — and notice — 86% was used to provide home health & personal care, and nursing facility care.  In other words, 86% of Nevada’s Medicaid expenses for long term care went toward serving those least able to care for themselves.  The other 14% was used to provide intermediate and long term care for those unable to care for themselves because of intellectual limits or mental illness.

Here is exactly why President Clinton told his audience to “listen up:”

My view is get the federal government out of Medicaid, get it out of health care. Return it to the states.” – Romney, South Carolina GOP Primary Debate, Jan. 20, 2012.

In case anyone is remotely confused about what that statement from the former Massachusetts Governor means, he’s speaking about transforming the Medicaid program into Block Grants.

More specifically, the former Governor is adopting the block grant proposal for Medicaid set forth in his running mate’s “Path to Prosperity” budget plan:

“The plan also would repeal health system reform law provisions that will expand Medicaid coverage starting in 2014. Instead, states would receive block grants, which would free states “to tailor their Medicaid programs to the unique needs of their own populations,” the budget says.”  [AMA]

The tailoring is to be done with less cloth:

The Ryan budget would cut $2.4 trillion from Medicaid and other health programs. Reduced spending would increase the number of uninsured dramatically, Park* said. “Those who retain coverage will have benefits scaled back and have higher cost-sharing.” [AMA] (emphasis added)

We can drill down further into what Governor Romney and Representative Ryan have in mind for the Medicaid program by looking at the Congressional Budget Office’s analysis of the Ryan position:  Medicaid and the Children’s Health Insurance Program (CHIP)—from 2 percent of GDP in 2011 to 1¼ percent in 2030 and 1 percent in 2050.

Now is the moment to recall that 58% of those who receive Medicaid assistance for their health care needs in Nevada are children, and the AAP isn’t thrilled at cuts to that constituency:

“American Academy of Pediatrics President Robert W. Block, MD, said the proposal would undo investments in health programs for children. More than half of Medicaid recipients are children, but their care accounts for up to only one-quarter of the program’s costs.

“Whether considering fiscal year 2013 federal spending bills or reviewing long-term budget proposals, Congress must seize this opportunity to invest in the future of our country by protecting children’s health,” Dr. Block said.” [AMA]

Dr. Block has reason to be concerned, if we return to the Congressional Budget Office’s analysis we can see why.  In two paragraphs from their analysis of the Ryan “Path” the non-partisan office explains why the proposal would make deep cuts, and place greater burdens on the states:

“The specified path (Ryan Plan) would cause federal spending on Medicaid and CHIP to decline relative to GDP in coming decades, rather than to rise sharply as in the other policy scenarios that CBO has analyzed, and would include no exchange subsidies (see Figure 3). As a result, by 2050, such spending would be 76 percent below what would occur for Medicaid, CHIP, and exchange subsidies under the baseline scenario and 78 percent below what would occur under the alternative fiscal scenario. Because spending on CHIP and exchange subsidies represents a relatively small share of the amounts in the baseline and alternative fiscal scenarios, most of the reduction would have to come from the Medicaid program.” [CBO] (emphasis added)

The Republicans do, indeed seem serious about eliminating Medicaid as a federal program and shifting the expenses for health care access to low income elderly, the disabled, the intellectually disabled, elders in nursing facilities, and children in poverty to the states.  The CBO explains the nature of this shift:

The responses of the states would be of particular importance. If states were given additional flexibility to allocate federal funds for Medicaid and CHIP according to their own priorities, they might be able to improve the efficiency of those programs in delivering health care to low-income populations. Nevertheless, even with significant efficiency gains, the magnitude of the reduction in spending relative to such spending in the other scenarios means that states would need to increase their spending on these programs, make considerable cutbacks in them, or both. Cutbacks might involve reduced eligibility for Medicaid and CHIP, coverage of fewer services, lower payments to providers, or increased cost-sharing by beneficiaries—all of which would reduce access to care. (emphasis added)

Translation: Even if the states were able to achieve all the vaunted efficiencies a “flexible” plan might provide — the cuts proposed are so deep and so drastic that citizens in the United States who are lower income elderly or the disabled in nursing homes, and those who are low income and living in foster care, or families in poverty — would have reduced access to care. Period.

These aren’t generic numbers and pie in the sky statistics we’re talking about, we’re speaking of 25,841 elderly Nevadans, 40,898 disabled Nevadans, 55,626 adult Nevadans – mostly women, and 168,070 Nevada children.

So, here’s a question for Governor Romney and Representative Ryan — If no matter how much efficiency the state of Nevada squeezes from your block grants for Medicaid, Nevada and the other states will still have to either appropriate significantly more revenue, or drastically reduce services — how is your plan anything other than a proposal to shift the burden of health care costs, for the least able among us, from the federal treasury to the state treasuries and the pockets of low income Americans?

Where, Governor Romney and Representative Ryan, does the Nevada Legislature start cutting? From the acute care services for adopted or foster children? From the acute care for pregnant women? From acute care for children in poverty who have asthma, autism, broken arms, or sprained ligaments?  From the long term care for the elderly who need home health care services and personal care to avoid institutional living?  From the long term care for the indigent mentally ill?  From elderly residents of nursing facilities?  From disabled children who need home health care? Where?

Perhaps cuts aren’t the only option. Must the Nevada government raise the eligibility standards such that only those living at “25%” of the official federal poverty level can receive assistance?  Here are the 2012 guidelines from the Department of Health and Human Services —

How much more should a family of four living on $1,920.83 per month  have to pay for basic health care?  How much more should a young man and his pregnant wife living on $1,260.83 per month have to pay for pre-natal care, and expenses associated with the birth of their first child?  For a political party which lauds its “Pro-Life” stance — asking low income families to dig deeper to pay for health care to make up for federal and state budget issues (while proposing more tax cuts for the top 1% of American income earners), makes it sound as though the GOP is the Pro-Birth, not Pro-Life party.

How much more should a young family have to pay for health care before the cost of health care begins to impinge on the capacity to put a roof over their heads?

Or their ability to put food on the table?  It’s likely going to cost our young family with two children under the ages of 19 approximately $366.40 to $578.40 per month to keep everyone fed. [USDA] Our hypothetical family might be lucky to have $764.43 per month remaining after housing and food for utilities, clothing, transportation costs (auto payments or bus fare) — that $764.43 translates to about $25.48 per day to cover ALL the basic family needs listed previously… including Health Care.  But wait, the Romney/Ryan budget cuts nutrition assistance too, drawing fire from the U.S. Conference of Catholic Bishops:

“Cuts to nutrition programs such as the Supplemental Nutrition Assistance Program (SNAP) will hurt hungry children, poor families, vulnerable seniors and workers who cannot find employment. These cuts are unjustified and wrong.” [The Hill]

And what other program do the Republicans fantasize about turning into a Block Grant Program and then cutting?  Housing subsidies. [TO.org]  There was some discussion of the Ryan proposal on this topic at the March 21, 2012 House Budget Committee hearing:

“Rep. David Price (D-NC) asked Donovan what the implication of the Ryan budget cuts would be on HUD programs such as public housing, Choice Neighborhoods, HOME and others.  Donovan responded that, under the proposed Ryan budget, approximately one million households could lose their housing.  Of the one million households at risk under the Ryan budget, Donovan estimated that 585 thousand would come from the Housing Choice Voucher Program, 425 thousand from the Project-Based Voucher Program, and 110-180 thousand from homeless assistance programs.  He also mentioned that an estimated 17 thousand jobs would be lost from CDBG, and cuts to the HOME program would mean tens of thousands of new affordable housing units would not be built.”  [CLPHA] (emphasis added)

So, no help for financially fragile families for health care, or housing, or food — or anything, but tax payers in the top 1% of all our income brackets will get more, yet more generous, tax breaks.  Little wonder the Bishops were annoyed.  Less wonder Sister Simone Campbell from Nuns on the Bus received a standing ovation at the Democratic National Convention.

A person doesn’t have to be Roman Catholic to find the Republican proposals supported by Governor Romney and created by Representative Ryan astonishing in their parsimony and appalling in their avarice.

Perhaps one has to be incited by the fact that a family in Las Vegas might have an air-conditioner, or a DVD player, or a functional motor vehicle — “Look,” cry the miserly, “They have nice stuff, and they got it by doing nothing.” Not. So. Fast.   As of 2010 not that many Nevadans were receiving public  assistance. [Census] In fact, about 3% of Nevadans were receiving public assistance. [Census pdf]

Thus much for the Miserly Myth that “They’re all sitting around collecting welfare, and learning to be dependent on Guv’mint.”  Perhaps we should add the usual follow up, “and they’re doing it on my hard earned tax dollars.”  The latter portion is correct, we do pay taxes which support assistance programs for fragile families.  However, the Grinches among us appear to believe they are the only ones chipping in.

S’cuse me Mr. Grinch, but I really don’t mind paying a fractional portion of my income to insure NO child goes to bed hungry, NO elderly person with dementia is left alone, NO foster child is left with an untreated case of pneumonia, NO pregnant woman is without pre-natal care, NO family is homeless, NO mentally ill person is abandoned, NO disabled child is without care.

This is what Democrats mean when we say, “Just Say No.”

References and Resources:  * Edwin Park, CBPP.  Congressional Budget Office, Ryan’s Specified Paths, March 2012. (pdf) “House Republican Budget Seeks to Slow Medicare, Slash Medicaid,” American Medical Association, April 2, 2012.   Kaiser Family Foundation, State Health Facts, Database.  “Public Assistance Relief,” Census, Department of Commerce, pdf.  “HUD Secretary Defends FY13 Budget Before House Appropriators,” CLHPA.   “Four Ways Romney and Ryan Would Roll Back the 20th Century ,” Jake Blumgart, AlterNet, September 5, 2012.  “What Paul Ryan’s Budget Actually Cuts,” Brad Plumer, Washington Post, August 12, 2012.  USDA, Cost of Food Plans, Center for Nutrition Policy and Promotion, May 2011 (pdf).  ASPE, Department of Health and Human Services, HHS Poverty Guidelines 2012. Congressional Budget Office, “The Long-Term Budgetary Impact of Paths for Federal Revenues and Spending Specified by Chairman Ryan,” March 2012, pdf.   Kaiser Family Foundation, link to interactive database for state health care statistics.

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Filed under 2012 election, Economy, family issues, Health Care, health insurance, Medicaid, Nevada budget, Nevada child welfare, nevada health, Nevada politics, Politics, public health, Republicans, Romney

Pretty Simple, Pretty Snappy: Paul Ryan in Sparks, NV

Representative Paul Ryan attended a rally in Sparks, NV long enough for his fellow Representative Mark Amodei (R-NV2) to insert his foot in his mouth.  “We want to start with kind of a uniquely Republican thing, we want to start with the pledge of allegiance,” Amodei said.” [LV Sun] Well, starting a campaign event would be a “uniquely Republican thing,” except that the Democrats did it — with former Rep. Gabrielle Giffords leading it on Thursday night.  [HuffPo]   Unsolicited advice: If one’s foot has to go into one’s mouth, at least make it for doing or saying something original?

Remember former President Bill Clinton saying, “In Tampa … the Republican argument against the president’s re-election was pretty simple, pretty snappy,” Clinton said. “‘We left him a total mess, he hasn’t cleaned it up fast enough, so fire him and put us back in.'” [MST]  Prescient, given Rep. Ryan’s talking point to the 2,500 gathered in Sparks: “Are we going to have a country in debt, in doubt, in decline? Or are we going to do what we need to do to get people back to work, to fix the mess in Washington, and to get this country back on the right track.” [NNB]

Senator by appointment only™  Dean Heller (R-NV)  chimed in with this contribution:

“Paul Ryan is the vice presidential pick who can lead this country in a substantive discussion about the most pressing issues of the day,” he said. “When many in Washington wanted to play politics and preserve their own political ambitions, Paul Ryan faced head-on the enormous challenge of bringing our nation’s fiscal house in order. This conversation is long overdue, and I look forward to more of Paul Ryan and Mitt Romney’s leadership moving forward.” [NNB] (emphasis added)

Let us parse.  About that “substantive discussion,” indeed we would all benefit from a substantive discussion of fiscal policy — IF the Republicans would like to bring something substantive to the party.   First, they offer us a tax plan which would cut taxes for the top 1%, increase taxation on middle income families, and these cuts would be paid for by closing tax loopholes they refuse to identify.   Secondly, the Ryan budget numbers don’t add up, and former Governor Romney’s already stated that his taxation plan can’t be scored by the Congressional Budget Office.   If the CBO can’t score “it” and the numbers don’t add up — now what was it former President Clinton said about Arithmetic?

We could talk of putting the country’s “fiscal house in order,”  except that the Congressional GOP has made that rather difficult.

“A budget plan introduced by House Budget Committee Chairman Paul Ryan (R-Wis.) would add more to the deficit over 10 years than if Congress kept the status quo, undermining claims of its fiscal impact.  Ryan’s blueprint, “The Path to Prosperity,” would add $3.127 trillion to the deficit during the decade spanning 2013 to 2022, according to a table on page 88 of the plan.” [The Hill] (emphasis added)

The non-partisan CBO number crunchers did score the so-called Path to Prosperity, and determined it would add MORE to the deficit than if we did absolutely nothing.  This hardly sounds like putting the fiscal house in order, it sounds rather more like throwing out the old furniture and putting a truck load of new furnishings on the credit card.  I think we’ve seen this movie before.

Arithmetic: If there were 2,500 attending the Ryan rally in Sparks, and one African American there was Secret Service agent (photograph) and there was one African American photographed in the crowd,  what percentage of those photographed attending the Ryan rally were African American?  Including the Secret Service agent? Not including the Secret Service Agent?  Make the former President proud — do your own arithmetic.  Showing your work is not required.  Mostly Democrats read this blog — so I’m assuming a high proficiency in arithmetic.

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Filed under 2012 election, Amodei, Heller, Nevada politics

Suppressed Information: Muddling Medicare Part 2

Analyzing what the Romney-Ryan ticket would actually DO to the Medicare system as we know it is difficult because there’s a big difference between speechifying and informing.  The Republican proposals are a fact-checker’s nightmare because the GOP campaign refuses to be nailed down to many specifics.

The Romney Plan is just like the Ryan Plan — almost, nearly identical. No, completely different! [Salon] The Romney/Ryan plan would ultimately cost seniors some $60,000? [TP] No, maybe not, because the public is looking at the numbers from the “old” plan.  Well, what numbers should we be looking at?

Perhaps we’re supposed to look at the White Board?

“The whiteboard had four quadrants, with a column for his plan and another for Obama’s plan, and a row for how the two plans would affect “seniors” and the “next gen.” Under Obama’s plan, Romney wrote “$716 billion cut” next to current seniors and “bankruptcy” next to next generation. For his plan, he wrote “no change” for current seniors and “solvent” for future generations.”  [Salon]

First, we know the charge that the Obama Administration cut $716 from Medicare is bogus.  We also know that under at least one of the incarnations of the Ryan Budget almost the same savings were found in the current Medicare program.  We know that under the Administration’s plan the savings are returned to the Medicare program, part of them fill in the infamous Do-Nut hole in prescription drug coverage.  We’re left guessing if the Romney “plan” — whatever it might turn out to be — would keep the savings for the benefits side of Medicare program or follow the Ryan Plan and have the savings revert to the Treasury to pay down the federal deficit.

I’m not the only one who finds the various expressions of Governor Romney’s position confusing.

“First, there is the issue of the $716 billion the president’s health care law will take from Medicare to cover costs across the board. Ryan’s budget cuts the same amount from Medicare, but rather than re-investing the money, it is used – or not used – to ease the deficit.” [Salon]

Romney is less clear about where the cuts would go, or if there would be cuts at all.

“Governor Romney believes Obamacare was a terrible mistake and has repeatedly made clear he believes it must be repealed in its entirety. This includes,” a campaign official said, “repeal of President Obama’s $716 billion in cuts that slash provider payments and Medicare Advantage and threaten seniors’ access to care.”  [ABC]

The last line approaches word salad but contain a kernel of truth.  The Obama Administration does cut payments to providers — NOT beneficiaries, and cuts the subsidies to insurance corporations for Medicare Advantage policies.  Whether this “threatens seniors’ access to care” is highly debatable.

David Horsey of the Los Angeles Times opens his article on the contortions of the Romney campaign with regard to the Ryan plan with a cartoon showing Romney in “Olympic Flip Flop Mode.”   Horsey may have also found the core of the problem:

“Not that he would stick with it if it brings him political heat. Almost daily, Mitt Romney reinforces the perception of himself as a man with no deep political convictions. There seems to be no position he will not give up if it has become a political liability. Much has been said about his switcheroos on healthcare, immigration, gay rights and Planned Parenthood since he was governor of Massachusetts. Anyone who thinks he really knows what Romney would do as president regarding Medicare or any number of other major issues, must be using a top-notch crystal ball.” [LAT]

Why be so coy about the specific proposals to change the Medicare program, why hide the details?   Perhaps we are in Romney Land now in which details and specifics are to be kept hidden lest they be criticized?  As in what happened when Romney was about to discuss his energy proposals?

“I know that we have members of the media here right now, so I’m not going to go through that in great detail,” Romney said, according to a pool report from the event.”  [HuffPo]

OK, we could think former Governor Romney didn’t want reporters letting his cat out of the bag before the big roll out.  However, when the big roll out day came — poof!  The Secret Energy Plan was little more than an extension of Drill Baby Drill [WaPo] as if the reporters in the room couldn’t have figured that out for themselves.

There’s a pattern developing with the Romney Campaign which a convention isn’t going to ameliorate.   The Romney Campaign is going for style points over substance, with a serious case of obfuscation in the process.

No, “you people” don’t need to see my tax returns because you’ll just pick over them and find things with which to attack me.”

No, “you people” don’t need to hear the specifics of my Medicare proposals, which are almost identical, very close to, and completely different from the Ryan Plan because you’ll just pick them apart and use the specifics to attack me.

No, “you people” don’t need to hear more about what tax loopholes I would close to make up for the revenue lost by maintaining tax breaks for the top 2%, “I’ll get there when the time comes.”

No, “you people” don’t need to know about which cabinet departments I would eliminate because if that information is released to the public then there will be serious issues raised, and I’ll be attacked.

No, “you people” don’t need to know the specifics of my budgeting plans to reduce the deficit, because they “can’t be scored.”

No, “you people” don’t need to know the specifics of my immigration policy, my education policy, my trade policy, my fill in the blank policy… because what you don’t know won’t come back to bite me. And, “I Will Not Be Bitten.”

There’s something ironic about the  Etch-A-Sketch candidate using a White Board to “explain” his Medicare policy — both can be erased.  What’s a fact checker to do when the “facts” about policy proposals can be altered, changed, hidden, and erased whenever it is politically expedient to do so?

What are voters supposed to do?  There’s a patronizing tone to all this, “Now, children, you sit quietly and don’t whine. Daddy will always do what’s best for you.   … Trust him.”

Reagan was right on one point: Trust but Verify.

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Filed under 2012 election, Health Care, health insurance, Medicare, Republicans, Romney

H.R. 212: The Ectopic Pregnancy Death Sentence Act for Women

There is nothing subtle about H.R. 212, the “Sanctity of Life Act,” sponsored by Rep. Paul Broun (R-GA) and co-sponsored by 64 other Republicans in the House of Representatives, including Rep. Todd Akin (R-MO) and Rep. Paul Ryan (R-WI).   The CRS summary of the bill is short and to the point:

“Sanctity of Human Life Act – Declares that: (1) the right to life guaranteed by the Constitution is vested in each human and is the person’s paramount and most fundamental right; (2) each human life begins with fertilization, cloning, or its functional equivalent, at which time every human has all legal and constitutional attributes and privileges of personhood; and (3) Congress, each state, the District of Columbia, and all U.S. territories have the authority to protect all human lives.”

Got that? Personhood begins with fertilization. Period.   Someone didn’t read the next chapter in the science book.

The Ectopic Pregnancy

Any family that’s endured the trauma of a detected ectopic pregnancy (or worse still an undetected instance) has a “dog in this fight.”  This is not an insignificant number. The American Academy of Family Physicians reports: “Ectopic pregnancy occurs at a rate of 19.7 cases per 1,000 pregnancies in North America and is a leading cause of maternal mortality in the first trimester.”  (2000)  The National Institutes of Health report ectopic pregnancies in a range of 1 in every 40 to 100 pregnancies. [NIH]

And, there is something else the author and the co-sponsors of the bill should be aware of:

An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus).  It is a life-threatening condition to the mother. The baby (fetus) cannot survive.”  [NCBI]

An ectopic pregnancy most often occurs in the fallopian tube, hence the expression “tubal pregnancy,” and about 1% of fertilized eggs — or “persons” as the sponsors of H.R. 212 would have it — implant outside the uterine cavity and become extrauterine pregnancies which can occur anywhere along the reproductive tract.

It is a medical FACT that an ectopic pregnancy is perilous to the life of the mother. It is not inconvenient, uncomfortable, unpleasant, or unsatisfying — it can be deadly. Death is most often caused by a rupture leading to internal bleeding and shock.  The treatment is also crystal clear: “Ectopic pregnancies is a life-threatening condition. The pregnancy cannot continue to birth (term). The developing cells must be removed to save the mother’s life.”  [NCBI]

What’s confusing about “the developing cells must be removed to save the mother’s life?”  The confusion is created when Congressional Republicans define a “fertilized egg” as a “person,” and thereby make it illegal for a physician to “remove the developing cells.”   Under H.R. 212 the “person” will continue to develop in the fallopian tube until there is a rupture, internal bleeding, shock, and death — of both the fetus and the mother.

Perhaps one of the 65 members of the House of Representatives who sponsored this legislation, now assigned to the House Judiciary Committee, would like to explain how it is “Pro-Life” to make the removal of the developing cells (which will never become a child) illegal thereby creating a situation in which the mother faces one of the leading causes of death in pregnant women during the first trimester?

Thankfully, about 68% to 77% of ectopic pregnancies resolve without medical intervention, however there are no clear indicators to define which women with small (less than 3.5 cm) ectopic pregnancies can safely survive the problem.  The APA estimates there are approximately 64,000 ectopic pregnancies in the U.S. annually, if the optimistic estimation that 77% of these will resolve naturally holds, then some  14,720 women will be in danger of dying from the lack of appropriate medical treatment.  Nevertheless, Rep. Paul Ryan, the GOP vice presidential candidate, is perfectly willing to allow this deadly game of Pregnancy Roulette to continue.

When speaking to the legislation on the incorrectly labelled  “partial birth abortion ban,”  Rep. Ryan said of exceptions to abortion bans based on the health needs of the mother:

“This is not a political issue, this is a human issue. And let me just say this — to all of my colleagues who are about to vote on this issue, on the motion to recommit — the health exception is a loophole wide enough to drive a mack truck through it. The health exception would render this ban virtually meaningless. […] [H]undreds of OB/GYNs have told us that this is not medically necessary.”  [TP]  (emphasis in orginal)

Terminating an ectopic pregnancy, especially the 23% to 32% which do not resolve naturally, isn’t a political issue either.  It is a medical issue profoundly affecting the health of the mother and the viability of the family.

The failure to acknowledge the medical necessity of removing those “developing cells” isn’t a political issue either. It is a clear and uncomplicated statement of how little regard many current members of the Republican Party have for women.  All women of child bearing age.   Is it really “pro-life” to advocate for the possible death of a mother from internal bleeding and shock in order to save a fertilized egg which will never become a child?

I don’t understand this mentality, and I don’t want to.


Recommended ReadingPubMed Health, “Ectopic Pregnancy,” NCBI, National Library of Medicine. AFFP, “Ectopic Pregnancy,” Feb. 2000.  WebMD, “Ectopic Pregnancy.”  Mayo Clinic Online, “Ectopic Pregnancy.”  The American Pregnancy Association estimates that there are approximately 64,000 ectopic pregnancies in the U.S. per year.  Centers for Disease Control, “Ectopic Pregnancy Surveillance.”   ACOBG, “Suspected Ectopic Pregnancy,” February 2006 (pdf).


Filed under abortion, Women's Issues, Womens' Rights

Medicare Disadvantage

The level of misinformation concerning the Affordable Care Act and the Medicare program is approaching Shark Jumping Territory, and therefore it is probably high time for some serious, fact based, commentary.

The total cost of the Medicare Program, Part A, Part B, Part C, and Part D was $549 billion in FY 2011.  [Trustees Report 2012 pdf]  The specific numbers are as follows:

Medicare Part A pays for hospitalization, skilled nursing facility care, hospice care, and some home health care services.

Medicare Part B pays for physician’s services, outpatient care, medical supplies, and preventative services.

Medicare Part D pays for prescription drug plans.

Medicare Part C is not part of the original Medicare program, and covers Medicare Advantage Health Insurance, described by the DHHS as follows:

“A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.”  [Medicare.Gov]

If we take the spreadsheet out one more column and show the percentage of the expenditures for Medicare for each part the numbers look like this:

The Cuts are Coming! The Cuts are Coming!

My nomination for the most confusing and obfuscating charge made by the Romney-Ryan Campaign is that “cuts in Medicare go to pay for Obamacare.” This first relies on a visceral reaction disassociated from reality that Medicare is Good and Obamacare is Bad.  In fact, what the Affordable Care Act DID was to cut over-payments to private health insurance corporations in Part C in order to cover the expenses (notably the infamous do-nut hole in Part D coverage).

In short, the Affordable Care Act (Obamacare) cut funding for over-payments to private health insurance corporations in order to apply those funds to …. Medicare.   A more complete explanation is provided by Medicare Advocacy:

“The greatest amount of savings in Medicare, about $130 billion over 10 years, [iv] will be achieved by reducing overpayments to private Medicare Advantage (MA) plans. These are the insurance plans that contract with the Centers for Medicare & Medicaid Services (CMS) under Medicare Part C to provide benefits to those who voluntarily enroll. MA plans must provide all of the guaranteed benefits under Part A and Part B; they may provide additional benefits with moneys they receive in excess of the cost of providing the guaranteed benefits.

For all intents and purposes, the Medicare Advantage programs were an experiment by the private health insurance companies to say, “The Private Sector can offer the same benefits as Medicare — only better, and the Market will prove it.”  Except that it didn’t.

One advocacy group for seniors enrolled in Medicare Advantage health insurance plans summarized the problems:

“The idea behind the plans is to provide better services and lower out-of-pocket costs. However, it doesn’t always work that way, according to the Medicare Rights Center. While the plans must provide a benefit “package” that is at least as good as original Medicare’s and cover everything Medicare covers, the plans do not have to cover every benefit in the same way. For example, plans may pay less for some benefits, like skilled nursing facility care, and offset this by offering lower copayments for doctor visits.”

The results? Problems such as —  (1) Care can cost more than it would under original Medicare.  (2)  Private plans are not stable and may suddenly cease coverage.  (3)  Members may experience difficulty getting emergency or urgent care.  (4) Because plans only cover certain doctors, the continuity of care is often broken when the plan drops a provider.  (5)  Members have to follow plan rules to get covered care. (6)  Members are restricted in their choices of doctors, hospitals, and other providers.  (7)  It can be difficult to get care away from home.  (8) The extra benefits offered often turn out to be less than promised.  (9) People with both Medicare and Medicaid can encounter higher costs. [ElderLaw]

Despite the obvious problems listed above, and the disparity between administrative costs between the original Medicare and the Medicare Advantage private plans, Congress barreled along offering incentives and allowing accounting advantages to encourage enrollment in the privatized “Medicare” experiment. [HealthBeat]  However, the practical problems aside, the major fiscal problem with the Medicare Advantage experiment came with over-payments associated with MA plans.

Under the funding mechanism in effect before enactment of the Affordable Care Act, MA plans were paid, on average, 9 – 13% more than the traditional Medicare program to provide the same coverage. These extra payments resulted in Medicare Part B premiums being $3.35 higher per month for all beneficiaries in 2009, and resulted in the federal government (and taxpayers) spending $14 billion more than it would have had Medicare Advantage plan enrollees remained in the traditional Medicare program.”  [Medicare Advocacy] (emphasis in original)

No one should be arguing that paying 9-13% more for the Same Thing is sound financial thinking.   Nor should taxpayers be footing the bill for an experiment that costs $14 billion more than it would have if people had remained in the traditional Medicare program.  So, how does Obamacare (ACA) fix this problem?

“The Affordable Care Act phases in changes to the MA overpayments, starting with a freeze in payments to MA plans for 2011. Payments will be based on national county benchmarks, with plans being paid a fixed percentage of traditional Medicare costs. As a result of this payment formula, plans in some lower-paid counties, generally rural and suburban areas, will continue to receive payments that exceed the traditional Medicare amount, while plans in higher paid counties, many of them large cities, may see substantial reductions.[vi] Rebates (an amount plans receive if they bid less than the county benchmark) will also be reduced. The new payment structure also provides for an increase in payments by up to 5% for plans that receive four or more stars on the CMS star rating system. [Medicare Advocacy] (emphasis added)

In other words, IF a Medicare Advantage insurance plan measures up to what would be available to seniors under the traditional Medicare program, and IF it avoids the nine issues listed above — the corporation would be subsidized for offering the plan — if not, then there’s no reason for taxpayers to be subsidizing plans that fail to meet the criteria.  Further, the ACA (Obamacare) requires that Medicare Advantage insurance policies sold must use premiums paid in to provide health care services:

“It also requires Medicare Advantage plans to pay at least 85 percent of the premium dollars they collect for medical claims. However, it also makes it possible for Medicare Advantage plans to receive higher payments if they demonstrate that they are providing high-quality care to enrollees.” [HealthAffairs.Org]

Thus, when a health care insurance corporation sells a Medicare Advantage policy, 85% of the premiums paid in must pay for — health care.  Not executive compensation, not advertising, not corporate sponsored retreats, not executive entertainment, not administrative expenses, not towels for the executive washroom, or fuel for the corporate jet — health care.  If the traditional Medicare program can function on a rate of 1.42% administrative costs for expenses, then it seems reasonable that a private corporation could administer its MA programs for 15%.


Get a grip.  Obamacare (ACA) will not send doctors leaving their practices in droves.  Nor will it leave Granny to the mercies of an imaginary Death Panel.  Why, for example, would hospitals agree to savings from cuts to their reimbursement under the Obamacare (ACA) provisions?  Jon Healey explains in the Los Angeles Times:

“The Affordable Care Act also tries to slow the growth of Medicare by prodding healthcare providers to deliver higher-quality care. Two examples: It reduces payments to hospitals that readmitted Medicare patients shortly after they’d been discharged, and that had an excessive rate of hospital-acquired maladies. And it cuts the extra Medicare payments to hospitals that treat a lot of patients who can’t pay their bills, on the reasonable assumption that the act will extend insurance coverage to millions of uninsured Americans.”

More people covered (so fewer very expensive visits to the Emergency Room) and more quality control so that patients aren’t re-admitted for the treatment of bed sores they incurred during the initial admittance, and everybody wins.   More patients get better care, and the hospital isn’t out the expenses of people who land in emergency rooms sans insurance and run up bills the hospital has to swallow.

For the umpteenth time — the Affordable Care Act (Obamacare) saves some $700 billion over the next decade or so, and uses that money to SUSTAIN MEDICARE PROGRAMS FOR BENEFICIARIES.   The cuts, the savings, whatever we will to call them are on the “providers” side — like not paying insurance corporations to sell MA policies which may or may not be as good as traditional Medicare enrollment, or not paying hospitals for sloppy care which results in Granny going in again.

Jon Healey’s final assessment is on target:

“In other words, the Affordable Care Act reduces the amount that Medicare takes from the Treasury for the sake of subsidizing a different group: the non-elderly working poor and lower middle class. Ryan can argue that we shouldn’t help those people afford insurance, but he can’t honestly say the law steals anything from the Medicare trust funds.

In fact, the law brings more money into the Medicare Hospital Insurance trust fund — an estimated $318 billion over 10 years — by hitting upper-income households with a 0.9% payroll-tax surcharge and a 3.8% tax on investment income. As someone with an intimate knowledge of the federal budget and the way money flows in and out of the Treasury, Ryan knows this. But he’s hardly the first pol to let the facts get in the way of a good applause line.”

Amen.  A little Fact-Checking provides immediate refutation:

  “The idea, however, that the Affordable Care Act struck a dangerous blow to Medicare that will change the program in fundamental ways is untrue. Under the new law, Medicare will remain a wildly popular, public single-payer health insurance system that provides comprehensive coverage to millions of Americans.”  [Time]

So, hold your applause for the Romney-Ryan Line.

References and Related Reading:  The 2012 Annual Report of the Trustees of the Federal Hospital Insurance Federal Supplemental Medical Insurance Trust Funds, (pdf) Annual Report, April 23, 2012.  “The Trouble With Medicare Advantage,” Health Beat, July 9, 2008.  Medicare Rights Center, “Medicare Advantage – Some Plans Too Good To Be True,” Elder Law Answers, summary.  “Health Care Reform Does Not Cut Medicare Benefits,” Medicare Advocacy, October 28, 2010.   “What Is Medicare,” Department of Health and Human Services, summary information.  Jon Healey, “Obamacare ‘raids’ Medicare, not exactly,” Los Angeles Times, August 21, 2012.  Ezra Klein (Sarah Kliff post) , “Obamacare won’t cut benefits,” Washington Post, August 15, 2012. David Pinar, “MediScare,” Tucson Citizen, August 15, 2012.

Fact Checking the Romney-Ryan attack on Medicare:  Kate Pickert, “Fact checking Obama’s Medicare cuts,” Time Magazine, August 16, 2012.  Adwatch, “Obama defends Medicare policy,” Boston Globe, August 17, 2012.

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Filed under 2012 election, Health Care, health insurance, Medicare, Obama, Romney