Posted tagged ‘American Health Care Act’

The Smell Of Coffee

July 5, 2017

Six months does not make a year, and a year does not make a four year term. President Trump (and his advisors), however, are waking up to the reality of governing. Much of President Trump campaign’s boastful rhetoric have already been exposed as misguided myths. Too little time has passed to fairly pass judgement upon what President Trump has done or what he has not. A quick look is not encouraging, however.  Maybe his staff and advisors are saying “pass the coffer”.

On the domestic front, President Trump has continuously blustered about both creating and retaining American jobs. There is little evidence of either, and as important, his budget proposals have circled thousands of current Federal jobs for elimination. I wonder whether the President is using “new math”?

And just in case the Administration has not been looking, internet giants such as Amazon have been marching forward with “job eliminating” new efficiencies. If Trump’s advisors are honest with themselves they should marvel at how resilient the economy they inherited really was.

The Obamacare “repeal and replace” has not turned out to be a “walk in the park”, done, and mark that one off the list type of initiative. Funny but most Americans want the benefits of Obamacare. Further, once fact checked, Republican criticisms melt under a healthy dose of facts and transparency. And best of all, voters have seen what was always there. Republicans are only interested in the tax cut which will accrue for the wealthy. The specific American Health Care Act benefits, if enacted, will be the bare minimum necessary to pass the AHCA.

The campaign’s vitriolic immigration slogans have also been shot full of holes. The top priority Mexican border wall has gone no where after just about everyone involved has declined to endorse the efficacy of addition fencing. Congress has twice chosen not to appropriate money. And, more telling is that there are no indications that illegal immigration has increased.   Even more telling is that business leaders are calling for more temporary labor since they cannot find enough American citizens to fill jobs ranging from technology to agriculture to domestic occupations.

Foreign affairs, probably, best characterizes the Trump Administration ineptness. Trump’s shoot from the hip style has proven to be grossly ineffective. Foreign leaders who possess much less power (ships, soldiers, and planes), have learned to survive employing long term strategies and short term diplomacy. Countries such as Germany, France, Japan, China, and India have over the years cleverly closed large parts of their economies to American companies. These leaders are not going to concede these advantages to President Trump’s taunts and threats.

The President’s decision to withdraw from the TPP and the Paris Climate Accord, both actions were designed to appeal to Trump supporters domestically, simply convinced leaders around the world to say little, work together, and forget about the US until it regains its senses.

His claims of “bombing the S**t out of ISIS and quickly ending the conflict has been shown bogus, but what will he do with what follows ISIS? In Afghanistan, the Trump Administration appears on the verge of increasing troop strength with no known strategy for ending the conflict.

North Korea was to have melted away after President Trump became “buddy-buddy” with China’s President Xi. Today, after North Korea demonstrated ICBM capability President Trump looks to more people, simply a king with no clothes.

There is, of course, plenty of time for future world events to prove President Trump’s blustering prescient.  I wonder whether his staff will up their coffee intake in order to get a real grip on reality?

Living Ones Priorities

June 25, 2017

The “repeal and replace” saga, brought to America by the Grand Old Party (GOP) clearly underscores the priorities of Party leaders, and dare I say, the big money interests who make it all happen. So why are Republicans against healthcare?

The answer is Republicans are not against healthcare, healthcare just gets in the way of what they seek.

The Affordable Care Act is only a slight variant of what the US has had for decades. Health insurance companies are the same, hospitals are the same, doctors are the same, and drug companies ditto. ACA changed the individual market’s healthcare delivery model by specifying “essential” healthcare services which must be covered for a healthcare policy to be eligible for government subsidies. (No more catastrophic only policies).

ACA defined what “basic” healthcare might be. For non-group policy holders, these individual consumer could purchase one of three types of policies, each differing only in price and amount of co-pay/deductible.

ACA also added a new route to providing healthcare insurance coverage. ACA expanded the eligibility definition for Medicaid and found millions of Americans who previously could not afford basic healthcare and had not qualified for Medicaid.

What could be so wrong about ACA (Obamacare) to drive Republicans to focus so strongly on repeal and replace efforts?

We hear much about the price of individual policies with year over year huge increases in premiums. But for those who earn more than certain amounts and do not qualify for subsidies, that is a problem. Surely, however, there are other means to convince insurers to set more reasonable rates. (Remember these same insurers who are announcing their withdrawal from certain States’ individual policies market are still quite happy to cover “group” plans in the same States.)

We also hear about returning healthcare to “patient centered” insurance and removing “government” from the place between the patient and their doctor. Hmmm. And what is the difference in substituting a for-profit insurance company as the middle person?

The American Heath Care Act negotiations are illustrative. With control of both the House and the Senate and the White House, Republicans have looked impotent in passing a replacement law. Why?

Well, it turns out that Americans overall have found Obamacare a step forward versus what preceded it. As the debate has unfolded. Americans are learning that Republicans are more intent on sharply reducing Medicaid both as an adjunct to Obamacare and as a stand alone program. It is beginning to dawn on Americans that Medicaid is very important program paying for about half of all births.  I wonder why so many Americans cannot afford healthcare insurance with pregnancy benefits? Medicaid is also critical to treating the Opioid crisis and for nursing home assistance for the elderly. And yet the Republicans are pressing on. Why?

Could it be the GOP is single-mindedly focused upon tax cuts?

Replacing Obamacare comes with a $200 million tax cut for the wealthy. The Trump/GOP’s tax reform (code for tax cuts), a separate piece of legislation, will represent billions in savings for the wealthy. Hmmm.

Back to the current Senate AHCA debate. Most Senators are aware that cuts to benefits (like eliminating pre-existing condition coverage) are very unpopular with constituents. They are now learning that critical health services are tied to Medicaid coverage. So, if AHCA keeps most or all of ACA benefits and ends the individual mandate while eliminating the associated taxes, the AHCA will cost the government more than ACA now does. Hmmm.

At this hour, the Washington soap opera is still underway. There are more than enough “no” votes to preclude Senate passage of AHCA 1.5. No matter how many times President Trump tweets that “it’s a great plan”, “people will love it”, or “AHCA is another campaign pledge kept”, certain facts remain.

Any ACA replacement which includes tax breaks for the wealthy will by budget necessity, also bring Americans less benefits at higher costs and fewer insured. Hmmm.

I guess if you number one priority is tax cuts for wealthy individuals and corporations, healthcare doesn’t really matter.

Memorial Pause

May 29, 2017

As is the custom, zip code 08202 celebrated Memorial Day, once again, with a home town parade and lots of speeches by local officials. The ceremony might have appeared a little hokey, especially when compared to parades featured on television, but zip code 08202’s celebration was totally genuine.

The parade’s theme, not surprisingly, was thanks and remembrance for the deeds of those who came before.

This piece of Americana (and others just like it across the country) stands in sharp contrast to the complex and convoluted games on display in Washington, DC. Instead of simple words paying honor and tribute to those whose sacrifices Made America Great, we hear words we know not to be true or a steady stream of answers to questions not asked.  Washington speak honors no one save the quick buck.

President Trump has just returned from his first foray onto the international stage. Pundits are struggling to find positive words to characterize the trip.  Congress, on the other hand, is in recess, licking its self inflicted “repeal and replace” wounds. Tomorrow, the vacation ends and the Washington games begin again.

What will the fall out be over the President’s threat to exit the Paris Climate Agreement or what did the President mean about NATO member nations “paying their fair share? For US based Trump supporters, his words will be hailed as another example of keeping a campaign promise forgetting of course to first answer the question, is either issue wise foreign policy? For European countries President Trump must have reinforced their worst expectations.

Republicans’ worst dream is that the electorate will turn on them during the mid-terms. So far, with majorities in both house and a President of the same party, Republicans have almost nothing to show in terms of legislative accomplishments. And the American Health Care Act passed by the House may not survive the Senate leaving Republicans with nothing. (Of course if the AHCA were to pass, Republicans might inherit an even greater problem… being seen as father of less healthcare coverage with no noticeable decrease in premium cost.

On Memorial Day, Americans pause and pay tribute to those who fought and died in earlier wars. These sacrifices and efforts were made to secure freedom and a better way of life for all Americans. As we pause, we cannot help but think why the President and Congress is so set upon providing less healthcare coverage, granting huge tax cuts for the wealthy, and making “immigrant” a bad word when this country was built by the hard work of immigrants?

Memorial Day in 08202 recalls a simpler time, a more respectful time, and a more honest time.

Death Spiral

May 9, 2017

A “go to” line through out Donald Trump’s campaign was to characterize the Affordable Care Act as caught in a death spiral. (House speaker Paul Ryan likes that line too.) The inference was that insurance companies were losing money and would need to raise rates so much that individuals could not afford to purchase coverage. At some point candidate Trump predicted insurance companies would simply stop participating and there would be no insurance available in the exchanges. Hmmm.

As normal for the course, Trump and other Republicans failed to mention that the GOP had consistently opposed any further government aide for insurers, as envisioned in ACA. Now, the use of “death spiral” is serving as a handy crutch to divert attention from the GOP House debacle, the American Health Care Act.

Over the weekend, several GOP Congress members tried to put a positive spin on the House AHCA by pointing out that Obamacare was about to fail (Death Spiral) and AHCA would come to the rescue. When listeners complained about the AHCA’s weakened “pre-existing condition” coverage and huge Medicaid funding reduction, GOP speakers reminded listeners that most Americans would not be in jeopardy of AHCA.

These Congress members said that most Americans had employer provided healthcare (group plans with no denials for pre-existing conditions), Medicare, and Medicaid.
While this is a true statement, I wonder what these Republicans really meant?

  • Does the GOP think Americans shouldn’t worry about the other 20-50 million without healthcare coverage?
  • Does the GOP think Americans are naive enough to overlook the possibility that even if employed today, in a recession or just normal course of business, they might be furloughed and suddenly have no healthcare insurance?
  • And what exactly does the GOP think are “pre-existing conditions”?

Libertarian GOP members are intellectually the most honest GOP faction. Libertarians reject government welfare in all forms and providing at tax payers expense healthcare insurance just doesn’t cut it with real libertarians. Then again, Social Security, Medicare, and Medicaid don’t make the Libertarian cut either. Hmmm.

The GOP is moving into dangerous voter territory. While not of their making, the continued, rise in healthcare costs (greater than the rate of inflation) will not suddenly change if Republicans prevail and pass the watered down AHCA.

The US healthcare delivery system is seriously flawed. EpiPens did not increase 400% in price due to the Affordable Care Act. Mylin’s decision to raise prices was a pure exercise of capitalism in the healthcare market. And Mylin’s actions are not an isolated exception. Almost all drug companies are driving up prices to see what the market will bare. And why is it one can buy the same prescription drugs substantially cheaper in Canada than in the US?

As frustration continues to mount, sooner or later, Americans are going to ask, “do other countries have this same cost problem?” Most Republicans know this, yet many Republicans continue to march further out on a limb, probably blinded by the tax cut appeal associated with the repeal of ACA.

ACA has opened Americans eyes to how precarious their insurance coverage is and how the widening income distribution inequity combined with rising healthcare premiums are putting the American dream further out of reach.

Will the current fight over ACA be a death spiral or a rebirth of hope for universal healthcare?

Assessment After The House Vote

May 5, 2017

Yesterday the Republican controlled House of Representatives voted narrowly (217-213) to pass the American Health Care Plan which in their eyes is a “repeal and replace” healthcare option. Amazingly, the House rushed to vote with no “official” (CBO) estimate of the cost or impact.  Hmmm.

When the vote was announced, Republican leaders including Vice President Pence stood before photographers applauding each other. Was it a day of rejoicing or a day which will bring telling consequences?

The AHCA retains much of Obamacare but has reduced its benefits and scope. Senator Rand Paul has aptly called AHCA “Obama-lite”. What the AHCA is not light about is the individual mandate and the mix of revenue offsetting taxes designed to make the keep federal budget revenue neutral, they are gone. I wonder whether that is what the GOP leaders were cheering about?

There will be passionate speeches about what the House AHCA version does and does not do. And, until the bill actually goes into effect, no one can be 100% sure. What can be sure is that without the additional income generated by the individual mandate and the special taxes, is that the GOP replacement will (1) swell the deficit since the government must make the insurers whole in some way, (2) Republicans will be content to allow the marketplace to price some Americans out of the market bragging that these fellow Americans made patient centered choices, or (3) some combination of both.  The AHCA is less coverage for more money for fewer people.  Hmmm.

Do the math. Minimum wage is $7.50 per hour, 40 hours (if one is lucky to find work) per week is $300. Therefore in a year this low wage American is earning $15,600. According to published reports, individual purchased family insurance cost $1021 per month, or $12252 per year. Hmmm, $15,600 before food and shelter, and healthcare of $12,252 which must come off the top. Do you think there will be incentives to offer less insurance coverage in order to get the yearly individual market coverage decreased?

How can a major party sleep knowing that its proposal will treat Americans of limited financial means (which could include full time, minimum wage earners) destine for less basic healthcare than more wealthier Americans? Would anyone think that we should ration basic sustenance for water or food based upon ability to pay?

The House vote marks a dark day for Republicans. All the masterful rhetoric the GOP will surely muster will not change the directional outcome. The American Health Care Act now heads to the Senate where it will meet another test.

Some GOP Senators think the House version is far too rich and would advocate an even stingier act. Others are more moderate and find the House version onerous. Regrettably most Republican Senators are likely to find the House bill as no obstacle to a good nights rest.

With a two seat Senate majority, the outcome is too close to call.

Will It Be This Week, What Republicans and Democrats Won’t Tell

May 3, 2017

Here it comes again. More hints (maybe even boasts) about the repeal of the Affordable Care Act and the replacement with the American Health Care Act. The spotlight remains on the House of Representatives where Republicans hold a firm majority so one might be excused not understanding what obstacles lies before an easy Republican victory. Here’s what a closer look reveals.

Republicans have campaigned against the “job killing”, “train wreck”, “big government” healthcare law known as Obamacare (the ACA). Being against things has become a Republican art form and while Republicans have advocated lustily for many things, they have not been for anything for which they would actually be responsible implementing and having to deal with the consequences. Times have changed.

The Affordable Care Act (Obamacare) is far from perfect legislation. In concept, Obamacare represents a noble step forward by sharing America’s wealth with those less fortunate, specifically providing health insurance to more Americans. (“Noble might be too literary a word since over two dozen other modern countries already provide all their residents healthcare at half the US per capita expenditure with better outcomes!!!). Never the less, Obamacare did represents a giant step forward for the US.

Healthcare is not free. So, Obamacare had to find ways to help Americans “buy” insurance coverage. A combination of mandatory enrollment (for those who game the system by not buying insurance when they are young and healthy), “exchanges” where Americans could buy basic insurance coverage even with pre-existing conditions, a complex system of subsidies the government could provide exchange members, and Medicaid expansion to catch the remainder.

So how would this program be paid for?

Democrats had to come up with a dog’s breakfast of taxes to cover the portion of insurance the new insurance holders could not afford. The individual mandate and these new taxes became the rallying cry for Republicans. Take away the taxes, the additional expense necessary to add coverage to 20+ million more Americans, the cost would flow straight to America’s credit card, the Federal Deficit.

Republicans stood tall, said they had a better plan, and said they would give Americans their freedom back. Hmmm.

Back to this week. Republicans have offered the American Health Care Act to replace Obamacare. Almost unbelievably, the Republicans have discovered that those previously without health insurance like Obamacare’s features (like pre-existing condition coverage, basic services coverage, children on parent’s policies until age 26, and for many, financial assistance to subsidize buying coverage). The American Health Care Act offers much less insurance protection while giving generous tax cuts to the wealthy (not the Americans needing coverage). Hmmm.

To make matters worse for Republicans, they recognize that if they offer the same benefits as Obamacare (and just rename it), there is still the problem of paying for the expanded coverage. Moderate Republicans and conservative budget hawk Republicans cannot agree upon cuts which would lower the AHCA cost nor can they agree upon how to fund an Obamacare look-alike. Hmmm.

Democrats have chosen to hold their fire until the House passes AHCA and fight it in the Senate. Most pundits do not see the current AHCA passing a Senate vote. Time will tell.

The bedrock issue that is not being discussed by either party is whether basic healthcare is a right or a privilege. (Apparently, this comparison does not poll well, republicans do not want to be associated with denying healthcare coverage to Americans. Republicans would prefer to say some Americans choose not to buy insurance or prefer to buy a stripped down policy, and that is their right. Hmmm.)

Astute GOP leaders must be thinking how they can minimize a loss on this issue. Republicans are simply on the wrong side of history. Too much of the modern world has already solved the healthcare problems, and it is unlikely Republicans will wish to boast, “Among third world countries, American offers the best healthcare coverage”.

The issues at hand are not Obamacare versus AHCA because Obamacare has some serious shortcomings and frankly does not insure all Americans. And, the AHCA covers less Americans with less coverage. That doesn’t make it either.

Democrats and Republicans appear content to remain silent on the real elephant in the room.

Republican Healthcare Secret

April 6, 2017

Today there were reports that the unofficial  second effort to repeal and replace Obamacare had collapsed. It appears that potential changes to the initial failed repeal and replace (American Health Care Act), while encouraging to the Freedom Caucus was unacceptable to moderate Republicans. In other words original no votes that were willing to change to yes votes were offset by original yes votes who would now vote no. Hmmm.

These healthcare deliberations speak volumes about the Republican Party. For the better part of seven years the standard Republican Obamacare line has been “job killer”, “a disaster”, and “we will fix healthcare”. Through the buzz of political speak, one can see that there never was a Republican Plan. Many different Republicans may have had plans but as a Party there was never agreement on anything other than the value of insinuating that the Affordable Care Act was in someways defective and by association, Democrats were also defective. Hmmm.

Republicans are now revealing (1) they are not a party of one mind, and (2) the Freedom Caucus hold views which are mean spirited, ill informed about basic healthcare, and really represent a third party, not a faction of the larger Republican Party.

Around the world, other modern countries have settled on healthcare models which provide basic healthcare to their residents. These countries have found that preventive care and reasonable controls on healthcare provider’s profit incentives produce superior health outcomes for their residents and much much lower costs to boot.

The Freedom Caucus is claiming they won’t agree to any Obamacare changes unless there is a reason to believe healthcare premiums will decrease. On the surface this sounds reasonable. But when one considers the Freedom Caucus approach (eliminate Federal mandates over what services healthcare policies must cover), one suddenly realizes that the Freedom Caucus is comfortable with insurance companies reestablishing pre-existing condition limits and embracing stripped down policies (like catastrophic care only) which provide no access to basic preventative healthcare. The Freedom Caucus has written the book on “the best healthcare money can buy”.

The Republican Healthcare Secret is much more about the party itself than healthcare. The Freedom Caucus would also seek to not just roll back (or moderate) recent gains in civil rights, human rights, and environmental protections, the Freedom Caucus would seek to deny there is any basis for these rights to exist or protections to be implemented.

One might think the right thing for Republicans to do would be to expel the FC from the Party. But the Freedom Caucus has been beneficial to the GOP also. Caucusing with the Republican Party, the combination has been able to “control” Congress, and thereby chair the major committees. While the GOP was the Party in opposition, there was always a greater danger than ideology, the other Party. Now the Republican Party has control of the executive and Congress and can no longer ignore the role of responsible governance.

Damn that Freedom Caucus.