Archive for the ‘ACA’ category

A Week Of Eye Opening

March 26, 2017

This past week has been an eye opener for what a new Republican Congress stands for. How about “for everything” and “for nothing”? Or, maybe “for effective government” and “for ineffective” government? Or, maybe “for sincere government” and “for insincere government”? Hmmm.

This first revelation was striking. Republicans had passed legislation to repeal Obamacare about 80 times during the past 6 years and had campaigned in 2016 for the complete repeal and replacement of Obamacare. Yet when the opportunity was there, Republicans had no replacement plan.

The GOP had many plans, all disingenuous, but there was no one plan Republicans could agree upon. Hint: do you realize GOP candidates lied about their intentions?

The most popular refrain the GOP used was lowering the premium costs which “Americans” are experiencing. To some degree, in some places, this claim seems justified but Republicans were happy to leave this claim unclear. Americans receiving healthcare coverage from their employer, Medicare, or Medicaid, received no staggering premium price increases. These Americans were shielded from the increases some individuals in certain areas experienced.

So why would Republicans make such a claim? Could it be that most all Americans experience some form of uncontrolled healthcare cost increases (as they did yearly before Obamacare) and don’t understand why hospitals, doctors, and drugs cost so much?

Few, if any of our politicians called out for a universal, single payer system to replace Obamacare. Shamefully, Republicans instead called for changes to Obamacare which were designed to reduce cost increases pressure by insuring less people! How do those politicians sleep at night?

But simply reducing coverage was not good enough for some Republicans. The “Freedom Caucus” members sought to change Medicaid from an entitlement for the most needy to a capped block grant which would become the sole responsibility of States in a few years.

The “Freedom Caucus” wants to deconstruct the Federal Government and healthcare seemed an opportune way to begin the process. “Freedom Caucus” members represent a clear and present danger to modernity.

Most Americans have little skin directly in the healthcare game. Next up on Congress’ docket is likely to be “tax reform” where almost all Americans have an opinion.

While there is much good that can be achieved (like eliminating or vastly reducing the number of tax loopholes, exemptions, and deductions), changes which will lower the overall tax revenue or the progressive nature of the tax code, are sinisterly designed to reward the wealthy and to starve the Federal Government and its ability to function.

With tax reform, even more than with healthcare, it will be critical to study what any proposed changes might accomplish before voting upon any bills. The devil will almost certainly be in the details.

This past week revealed a White House and a Congress whose intentions are hidden.   On one hand, the Republicans seem unfit to govern and on the other hand, seem not a friend to the average American.

I wonder whether this GOP leadership will have learned anything that might restore faith in their intentions? I really wonder whether the White House or the Freedom Caucus care?

Free Market Health Care

March 23, 2017

The Republican sponsored “American Health Care Act” is floundering in Congress. The replace portion (as in repeal and replace Obamacare) is in trouble for curious reasons given that Congress and the Presidency are both in Republican hands. The political farce which is unfolding casts a sharp light on the undeniable fact that there is no Republican Party united around a core set of principles. Rather today’s Republican Party is a party of convenience which unite around not being Democrat or progressive.

The shallowness of this union shows through in the Republican argument over repealing Obamacare and trying to agree upon a replacement. Maintaining “no pre-existing condition” or “no life time benefit limits” exclusions along with keeping children on parent’s policies until age 26 showed the world Republicans were caring and compassionate (or so they said).

But doing away with the individual mandate and dropping certain taxes has brought into focus the difficult task of how to pay for these benefits and keep the same number of Americans on the insured roles. The inescapable GOP conclusion is that insurance costs will not come down unless, Republicans say, the free market kicks in. If this mysterious free market does not bring down the cost of insurance, then individuals and Medicaid will see large increases in cost.

The most conservative Republicans, true believers in everyone should have access to the best healthcare they can afford, are now proposing to eliminate the 10 healthcare benefits mandated in Obamacare. Hmmm.

  1.  Outpatient care—the kind you get without being admitted to a hospital
  2. Trips to the emergency room
  3.  Treatment in the hospital for inpatient care
  4.  Care before and after your baby is born
  5.  Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
  6.  Your prescription drugs
  7.  Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
  8.  Your lab tests
  9.  Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
  10.  Pediatric services: This includes dental care and vision care for kids

It shouldn’t take a genius to realize that without some requirement like these 10, insurance companies can price policies high and steer customers to stripped down version such as  catastrophic coverage. Moderate Republicans, especially those representing poor or inner city districts, see a huge backlash coming in the next election if the ultra conservatives prevail.

Conservatives are quick to counter, “doesn’t everyone have the right to buy only as much insurance as they want? Why would a single young man want to pay for pre and post natal coverage if he is not married?”

That strikes right to the heart of the matter. Healthcare costs, are generated by hospitals, doctors, and drug companies and don’t change simply because of insurance changes. The number of pre- and post natal visits will be the same regardless of whether a young man chooses to carry broad coverage or just a stripped down policy. The implication, however, should not be lost, everyone else will pay more if the young man is allowed to buy stripped down policies. That is the definition of insurance.

Republicans are ringing their hands over this dilemma. Conservatives say they will vote against the American Health Care Act if the bill looks too similar to Obamacare and Moderates say without certain coverage and federal assistance (like tax credits and Medicaid) they will vote against it.

Congress members appear to be living in a make believe world. If somehow Congressional leaders along with President Trump can work out a compromise and pass the American Health Care Act, then just looking at the reduce insured numbers and the fewer services many Americans want (and need), Republicans will lose in 2018.

“Americans” Expect Us To Act

March 22, 2017

How many times have you heard GOP leaders repeat ad nauseam the mantra “the American people elected us to X or Y”, or “the American people want this or that”? The correct terminology  would be “Some American people…” with emphasis on “some”.

This type of honesty and absence of hyperbole would diminish the pomposity and self importance GOP elected officials want to present. (I fear this is a Republican disease today simply because Republicans are in the majority and in truth, Democrat leaders might fall under the same spell if roles were reversed.)

No better example of the misleading nature of “Americans expect” is the current healthcare debate. Republican Congressional leaders are moaning about those Republican Congress members who are threatening to vote against the American Health Care Act (the replace plan for Obamacare). “Americans expect us to pass this bill” leaders cry while all sorts of non-partisan studies point out that the replacement bill will maintain some popular Obamacare benefits but at the end of the day provide less coverage and insure fewer people.  No more appropriate subject does “some Americans” apply than here.  “Most Americans” are not impacted as a benefit recipient by Obamacare

For some Republican Congress members, the AHCA does go far enough in rolling back entitlements and for others, it goes too far. Hmmm, I wonder what Americans really want?

Senator Rand Paul elaborated today on his proposal which could gradually eliminate Medicare expansion and streamline the individual market. Paul has proposed creating a pool of all uninsured and the allowing the “free market” to drive down price through competition amongst insurers.  As lower policy prices emerged,  government supports would decrease until they disappeared. Hmmm.

Paul deserves credit for proposing a clever way out of the box Republicans have created for themselves. His proposal, of course, has it own set of pitfalls, the most obvious of which is whether “for profit” insurance companies will want to offer policies at prices the pool will demand and people can afford. None the less, Paul proposal deserves a careful review.

The irony of the current healthcare repeal and replace drama is that greedy Republicans are far more interested in diving into “tax reform”. We will hear again that “Americans expect us to lower taxes” when in fact “some Americans”, like the top 1 or 2% wealthiest Americans will alone reap huge benefits. Most American will see little impact and no benefit. More insidious will be the knock on effects of such a large tax cut. Where will the Government get revenues to pay its expenses?  Think there will be more cut in government services?

The Republican tax reform odyssey will make “searching for a free lunch” dinner time conversation.

Supreme Decision

February 1, 2017

With the nomination of Federal Appeals Court Judge, Neil Gorsuch, a difficult decision lies in front of Democrat Senators. Do they oppose his confirmation at all costs or do they object but in the end allow him to be confirmed? And more to the point, why in either case?

Judge Gorsuch claims to be someone who interprets the Constitution as the framers intended and reads laws in the context of how they were created, not how they would impact the future. Judge Gorsuch as been described as “Scalia-esq” without the bombastic-ness Antonin Scalia employed. So does Judge Gorsuch deserve a hearing?

It should be very understandable if Democrats chose a “tit for tat” response reflecting Mitch McConnell’s decision to not even give hearings to Merritt Garland. On this basis alone, a logical refusal to confirm could be based.

Over time, however, political sentiment shifts back and forth from conservative to progressive and back. It should therefore not be overlooked that in the future as the recent past, progressives have been nominated. (Judge Garland’s treatment, unfortunately, hurts this argument).  Never the less, a complete stonewall of Gorsuch would only serve to dignify McConnell’s dysfunctional behavior.

Assuming there is a hearing, what questions should be asked? And what type of answers will indicate Judge Gorsuch is not “out of the mainstream”?

Judge Gorsuch calls himself an “originalist” in the Antonin Scalia mold.  Questions around social issues and religious rights represent places where (IMO) “originalists” are the furtherest out on the limb and may be seen as out of the mainstream.

For example, supporting the Little Sisters of the Poor’s or Hobby’s decision not to provide all of Obamacare’s benefits to women for religious reasons runs dead smack into the 14th Amendment (equal protection). The Affordable Care Act required no one to use any birth control method, ACA simply made it available to any woman who so chose. Does Judge Gorsuch believe exercising religious liberty can over ride the 14th Amendment?

Another social issue involves individual gay rights such as employment discrimination and same sex marriage. Does freedom of religion allow someone with “deeply held religious beliefs” to fire or refuse to hire someone, or to withhold services to a customer on the basis of sexual orientation?

And of course, does any government have the right to interfere with a women’s choices on her reproductive health, and by extension, does a person with deeply held religious views or any religious institution have standing in denying any women such rights?

Judge Gorsuch’s beliefs in other areas such as tort, tax, and corporate law, while important, are less relevant since the Judge’s opinions are well known to be the conservative side.

It is instead the social issues which are dividing the country and are not to be found in thoughts of our founding fathers.

A simple principle might be, “believe what you want, live personally your beliefs, do not require others to follow your beliefs”.

Equal Protection Under The Law

March 24, 2016

Yesterday the Supreme Court heard oral arguments on Zubik v Burwell, or better said the Catholic Church against women’s right to reproductive health.

The legal argument briefly stated is that Catholic (or any religious) affiliates should not be forced to violate their deeply held religious beliefs if so required by some Federal law. In this case the issue is Obamacare and its requirement to provide cost free birth control methods as part of an employee’s healthcare plan.

The Sisters of the Poor said “we can’t” and Health and Human Services Secretary Burwell said there is a “work around”, use it. Legal counsel, of course, used more complicated arguments but the plaintiffs argue that their religious rights were “hijacked”. Hmmm.

There is no question that the Catholic Church (other religious organizations) have a perfect right to hold whatever beliefs it deems important. And there should be no question that the Catholic dogma has consistently opposed birth control, even though most Catholic women today welcome and use birth control.

The question before the court is whether the Sisters in observing the Church’s ban on contraception can overlook the ACA’s birth control requirements. Please note the law does not require anyone to use birth control.

This conflict need not have been necessary. When the Affordable Care Act was being constructed, a strategic decision was made to retain the array of private health care insurance companies and to attempt to use employers as the major means to underwrite the cost of health care. A single payer, universal healthcare could have taken the Catholic Church out of the equation (although the Church probably would have lobbied against such a universal health plan simply because birth control was available.)

In news reports it is striking how little attention is being given to the rights of employees being denied birth control coverage, many of whom are not even catholic.

The Catholic Church’s position does not reflect the behavior of its parishioners and is socially and medically out of date. Clinging to the Constitution’s provisions on religious freedoms while the Court closing its eyes to equal protection under the law is difficult to explain.

Pundits predict the Court will vote 4-4 and ironically the lower Court ruling (affirming Burwell) will hold. Regrettably other lower Court rulings against Burwell will also be allowed.

What a national mess a 4-4 Supreme Court decision would present.  The law of the land is not the law of the land.

Anyone Home?

July 4, 2015

The dust has hardly settle on the Supreme Court decision affirming one more time the Affordable Care Act. Never the less, the US healthcare delivery system’s wheels seem to be coming off the cart.

Two huge signals occurred this week which should inform the simplest of minds that the current US healthcare delivery system, yes Obamacare, is obsolete and needs serious modification. Hmmm.

The Affordable Care Act, to its credit, fixed the immoral and unethical (but not illegal) practice of US healthcare insurance companies who would deny healthcare coverage to individuals.  Their targets were individuals who used “too much” healthcare services, or who had “pre-existing conditions” and might use too many services. The previous system also allowed individuals to avoid insurance all together and simply wait until they needed care and then visit a Hospital Emergency Room (and pass the cost onto everyone else). ACA fixed those faults and added an estimated 30 million more Americans to the healthcare rolls.

This past week financial news reported Aetna and Humana will merge operation and Cigna and Anthem were in discussions about merging. If these deals go through the big will have gotten bigger.

Now, all by itself, this merger news might not be that interesting. But there is more. Across the country, health care insurance companies are requesting/announcing huge rate increases (20-40%!!!). These companies claim that the new enrollees (thanks to Obamacare) were sicker than they thought and now there needs to be relief in the form of higher premiums.

Hmmm. And again why do the companies want to merge and get bigger in a business where they claim they are losing money?

The US healthcare system is structurally defective if one assumes healthcare should be available to everyone. The current system, including Obamacare, in essence separates the population into high risk and low risk pools. The high risk Americans cannot afford the premiums which unregulated hospitals, doctors, and drug companies want to charge. The consequence will be either poorer healthcare or the government will need to pick up even more of the tab. The winners will be insurance companies and the providers of medical services.

All of this might be understandable if it were not for so many other successful healthcare delivery models around the world which produce healthcare outcomes equal to or better than the US, insure all residents, and costs about half as much as the US spends.

Mergers and rate hikes could not be a louder signal that ACA has not solved the fundamental US healthcare problem.