Tag Archives: Affordable Care

An Open Letter to Some Senators from Robert Frost

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Warning: Naiveté will be on display here.

This “letter” is directed primarily at U.S. Senators McCain, Collins and Murkowski although there are a few others who should be paying close attention to the implications for their states, and their constituents, of the Graham-Cassidy legislation that would replace the Affordable Care Act with a temporary set of block grants and the individual discretion to limit covered services, including pre-existing conditions and many basic regular services now covered by the ACA.

For you three Senators in particular, you have arrived yet again at one of those moments when history is going to judge you. It will not judge you for all the other things you may have accomplished, or even for your other failures. No, history is going to judge you for the action you are preparing to take – to vote ‘yes’ or ‘no’ on Graham-Cassidy.

Senator McCain, all of your well-known heroism and sacrifice will be dashed into dust if you vote to take away meaningful and affordable health insurance from the more than 32 million people now estimated to be impacted by Graham-Cassidy. You will be remembered instead for this one vote. Your choice – still hero or goat.

The same for the two female Senators from Maine and Alaska. You have come a long way, accomplished much for women in politics, served as an example of positive achievement for young women. I say that even though I disagree with much of your Republican politics. You too must face the judgment of history, and that of your constituents when they realize that you have, if you vote ‘yes,’ stripped them of the fair opportunity to secure health insurance for themselves and their children.

There is no escaping this crossroads for each of you. The President and the leadership of your party in Congress are so determined to remove the Affordable Care Act that they will sacrifice themselves and you as well on the ideological altar of state empowerment. Just look at the state-by-state consequences of Graham-Cassidy. Center for American Progress at http://ampr.gs/2fbzykY; Commonwealth Fund at http://bit.ly/2hhZpIE; The Atlantic at http://theatln.tc/2hjTsLw.

The Congressional Budget Office final score for Graham-Cassidy will likely not be ready by the time the vote, with no meaningful hearings or formal input process, occurs. Why the rush? It’s solely so that the Republicans can pass the bill with a bare majority of one under the “50 votes wins” rule that expires September 30. You thus can go along to get along, or you can do something else.

You are at the point of Robert Frost’s famous poem, the one that ends with

I shall be telling this with a sigh

Somewhere ages and ages hence:

Two roads diverged in a wood, and I—

I took the one less traveled by,

And that has made all the difference.

 

Can you truthfully say that, in your considered judgment and based on your experience with state and federal government and after a careful evaluation of the impacts, that Graham-Cassidy is good for the American people, a substantial majority of who favor retention of an improved Affordable Care Act approach? Will you be able to explain your vote to the parents of a disabled child who is denied health care because the family can no longer afford the costs? Is it clear to you, beyond reasonable doubt, that Graham-Cassidy is the best way to address the health insurance problem that plagues this country and which many other civilized nations seem to have solved without draconian denials of medical care to their citizens?

Time is short. Why don’t you just bring this insane charade to a close right now, by telling the Congressional leadership and the President that “the answer is ‘NO,’ I will not lend my name, my reputation and my honor to this disgraceful legislation that will harm tens of millions of Americans”? Take the road less traveled. The only honorable thing to do.

Once More into the Breach, Dear Friends

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Unchastened by multiple past failures of leadership and intellect, the Republicans in Congress have signaled their intention to bring one more piece of “repeal Obamacare” legislation to a vote before the month is out, so as to secure the benefit of a 50-votes-wins procedure. This time it’s the Graham-Cassidy version that would replace the Affordable Care Act with block grants to the states which would then be free, individually, to permit insurers to effectively price out of existence the coverage for pre-existing conditions that is now mandated by federal law. They will do this even without scoring of the impact by the Congressional Budget Office.

Thus, each state that chooses to support the Republican goal of undermining access to health insurance for Americans in order to secure some vague idea of “fiscal responsibility” and, more truthfully, to stamp out perceived federal support for such practices as abortion, can do whatever it wants with access to health insurance. This, notwithstanding that all polling shows a substantial majority of Americans favor key elements of Obamacare protections, including coverage for pre-existing conditions.

This effort is urged on the Republican Party by its putative leader, Donald Trump, who hates everything associated with Barack Obama and is determined to remove all vestiges of Obama’s presidency from the face of the earth. Trump thinks he can’t lose here because he promised his so-called political “base” that he would get rid of Obamacare. If he succeeds, and the base delusionally concludes it’s a victory for them, Trump is a hero. If Congress cannot deliver the bill to him for signature, Trump still sees himself as the winner because it is Congress’s failure, yet again, that has denied him fulfillment.

And nothing is more important to Trump than winning. So far, his presidency has failed in almost every significant initiative it has attempted, so Trump is desperate to accomplish something, anything, regardless of the consequences.

It is time, once again, for the people to rise up and reject this outrage by demanding in the clearest way possible that every member of the Republican Party in Congress vote against this monstrosity. Almost all of them will disrespect the will of the people, of course, because in the end they don’t give a damn about the people. But there are a few, literally only a few, Republicans who have previously shown the courage and humanity to stand apart from the rest of the drones.

Here we have Senators McCain (Arizona), Collins (Maine) and Murkowski (Alaska). It comes down to the same three people to demonstrate the moral fiber and independence of thought and action that history now demands of them. Senator Paul of Kentucky has already said he is opposed to the bill, but you can’t count on him to stay that course. He hates the Affordable Care Act almost as much as Trump does.

Everyone who cares about this should lay down a barrage of calls, emails, tweets and posts calling on those three to stand, once more, as the bulwark against the depravity of the Republican Party and its attempt to deny tens of millions of Americans any modicum of real access to health insurance.

They Are Coming for Your Health Insurance

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Well, not actually yours. Readers of this blog probably get their health insurance through employers. But millions of other Americans are at risk. I warned about this on March 26 in a post entitled “When You Rest on Your Laurels, You Become a Stationary Target.” Now a major Washington Post story by Robert Costa and Paige Cunningham, who usually get this stuff right, states that “Freedom Caucus leaders near deal on health-care plan.” http://wapo.st/2q5zRlF

It appears that the essence of the deal being negotiated will make it appear that the Affordable Health Care provisions on essential benefits will remain intact, while permitting any state to seek individual waivers to enable them to eliminate those benefits for insured people in that state. Moreover, while insurers would still be required to cover people with preexisting conditions, the insurers would be empowered to charge those people higher premiums.

One of the more telling observations reported in this story is this:

“Top GOP aides said that text of the new bill probably won’t be posted until House Republicans feel confident that they have enough votes to pass the bill.”

You couldn’t make this stuff up. The apparent plan is to negotiate the terms in secret, subject to the inevitable leaks by negotiators who love seeing their names in print, and then bring the bill to the floor for a quickie vote.

In another post, on March 24, I asked the question: “What is the Democratic Alternative to the American Health Care Act?” Still waiting. If the Republicans are successful in this latest maneuver, it will, of course, be up to the Senate, where, one hopes, something resembling a superior alternative will be put up by the Democratic leadership. Otherwise, the Democrats play the role of the Party of No and likely lose the fight.

One final, for now, observation. There should be no mistaking what the Republicans are up to with this new scheme. Turning over the question of benefits coverage to the states and letting the insurers charge higher premiums to people with pre-existing conditions will have several virtually certain effects:

  • Republican-dominated states will rush to screw over consumers by reducing the mandatory benefits coverages (why else are they so anxious to turn this issue over to the states?)
  • In many states, patients with the worst medical problems will be priced out of the insurance market altogether
  • Because of the effects of gerrymandering, the realization of populations in Red states that they have been “had” by the Republican-dominated Congress and their choice of President will have little effect
  • Contributions from insurance companies to Republican politicians supporting this emasculation of the medically-suffering population will reflect the companies’ gratitude

There is, of course, still the possibility that the malodorous negotiations will fail to satisfy the far-right or the “moderates” and no bill will be brought to the floor. But little is being heard from the opposition to these moves. Time will shortly tell. I continue to ask: where is the Democratic alternative?

P.S. It has also been reported that the Republicans like an amendment to their new version of health care insurance that exempts Congressmen and their staffs from being subjected to a state waiver of essential benefits! http://bit.ly/2q3pONP  Nice. Always watching out for the little guy. Makes your heart swell with patriotic pride.

 

Trumpcare – National Nightmare in the Making

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I do not pretend to be an expert in the art/science of health care programs. I have been fortunate enough to not have to deal with the Affordable Care Act (“ACA”) personally and remain somewhat unschooled in all of its details.

But I know this much. The Republican “repeal and replace” plan, as thus far revealed, has been evaluated by the non-partisan Congressional Budget Office (“CBO”) as depriving 14 million people of health insurance in Year One, 21 million in 2020 and 24 million in 2026, compared to the number insured under the ACA. https://www.cbo.gov/publication/52486.

If you’ve been following the news, you now know that the Republican managers of this fiasco do not have the votes in the House of Representatives, assertedly the legislators “closest to the people,” to pass the American Health Care Act (“AHCA”) being promoted by Speaker Paul Ryan. There are two main sources of opposition, one a group of extreme-right ultra-conservatives who contend that the AHCA leaves too much of the ACA in place and demand more cutting of benefits. The other group is labeled “moderate Republicans,” a term that I don’t pretend to understand but they apparently think the AHCA goes too far.

Faced with apparent deadlock between those groups, the AHCA bill managers are trying, with the help of Not-My-President Trump, to negotiate with the ultra-conservatives. If such an arrangement is struck without the ultras completely caving in, which is unlikely, this approach necessarily means that the legislation will be worse than the AHCA in its present form and thus likely to deprive even more Americans of health insurance.

Note, however, that we will not know for sure by the time the bill passes. The Republicans managers are in such a rush to get this gruel passed and on to the Senate that, if some deal is struck, they may vote as early as tomorrow or Monday. This in turn means it is assured that CBO evaluation of the amended legislation will not be available to the House when it votes on what then would presumably be a “done deal” and passed.

Of course, there is the Senate and another procedural morass and fight over the governing procedures, but everyone should be clear that if the present course continues, the U.S. House of Representatives will vote on one of the most consequential pieces of legislation affecting the welfare of tens of millions without the benefit of the one neutral source of cost-benefit evaluation.

If this analysis is correct, there are no words to adequately describe the outrage being perpetrated against the American people by their elected representatives. Everyone who votes for this legislation should be turned out of office in 2018.

Update: Speaker Ryan Doesn’t Know, Doesn’t Care

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Last night I posted a piece that argued the Republicans were blindly adhering to a political philosophy at the expense of depriving some of America’s most vulnerable people of their health insurance now provided through the Affordable Care Act (Obamacare). I woke today to learn that the Republican Speaker of the House, when asked yesterday how many people may lose coverage under the Republican plan, responded with “I can’t answer that question. It’s up to people…. People are going to do what they want to do with their lives because we believe in individual freedom in this country.” http://wapo.st/2nwDKOA See that and other similar quotes from key Republicans, some of whom apparently believe in magic and argue that the Republican replacement legislation, ridiculously call the American Health Care Act, will result in more people being covered than under Obamacare and for lower costs, just like Trump promised during the campaign and subsequently.

Ryan’s “I don’t know and it doesn’t matter as long as people have freedom to choose” comment confirms my earlier point that the replacement legislation is about a point of political philosophy and its proponents could care less who is hurt.

We will know shortly, as the Congressional Budget Office is due to release its analysis of the Republican bill today or tomorrow. Of course, anticipating the worst, the Republicans are ready. They say “you can’t believe what those people say; they’re wrong all the time; health care is very complicated.” No doubt Trump would agree, having already intoned that “nobody knew” how complicated it was. Ryan is saying, in effect, “take some medicine; it’s good for you because you get to choose it and, trust us, it will cost less, though we can’t say what it will actually do for you. But at least you were free; no one forced you to take it and that’s what’s most important.”

We are in a scenario now where sitting on the sidelines will result in fundamental changes in the American way of life. It is very hard to see who will benefit. Trump promised to help coal miners, steelworkers and automobile workers but there is no evidence so far that he has any concept of how to deliver on those promises. I urge all who believe what I am saying to look closely at the websites for PeoplePower.org, MoveOn.org and ACLU.org to see ways you can take action, lawfully and peacefully, to resist the Republican plan to move America backward.

Speed Kills – The Republican Rush to Eviscerate the Affordable Care Act

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Republicans in Congress are rushing to “repeal and replace” the Affordable Care Act, known as Obamacare. No hearings have been held to receive public inputs. Why not? The Republican managers have now declared that the Congressional Budget Office “scoring” of the replacement bill is unnecessary because the CBO always “gets it wrong so who cares what it says?” That is a total reversal of previous positions taken by Republicans when objecting to federal spending under Democratic administrations. Why?

Republicans claim to care about the welfare of the people and of the country as a whole but after seven years of complaining about the ACA, they now are desperate to prevent public input into the legislation they cobbled together. Why is it always party before country with these people? Why the secrecy and the resistance to thorough and thoughtful analysis and examination of the elements of their alternative? What are they afraid of? Do they not hear the cries across the country from even their political base that =the replacement for the ACA is going to deprive millions of people of their health insurance in exchange for what …  a tax credit? If the replacement bill is so good for everyone and consistent with Trump’s campaign promises, as he routinely claims, why are Republicans afraid to give the legislation full exposure to expert analysis?

It’s not that the Republican bill is completely without redeeming elements. Trump’s desire to allow create a single national marketplace for competition among insurance companies may be sound or at least worth an in-depth examination. If so, why not let that and other elements of the legislation be fully examined on the public record? Is there a gift to the insurance companies hiding in the complex economics of this legislation?

The almost certain answer to all these questions is that the Republicans want this legislation at all costs, regardless of the very high probability, if not certainty, that it will destroy so much of the health care on which many millions rely. Taken as a whole, which is what the Republicans are insisting on, the “replace” legislation is an outrageous attack against many of our most vulnerable citizens while conferring a huge tax break for the very well off. The Republicans claim it’s all about giving people more choice and avoiding government mandates. In other words, the real-world impacts don’t matter as long as the Republican philosophy of “individual choice” is the centerpiece of the new system.

Trump promised his supporters a cheaper health insurance system that would cover all the same people as the ACA, with more choices and at lower costs. This turns out to be just another lie. In fact, the Republican alternative will not cover millions who were covered under the ACA, it will not provide meaningful choices for millions whose new Republican-approved choice will only be “no insurance” and the costs will ultimately be infinite for those with no insurance and thus no access to essential health care services.

Along the way, the Republican alternative will defund Planned Parenthood. Republicans hate PP primarily because they believe it pays for abortions. So they want to take a financial meat ax to it … again in the name of Republican philosophy. Curiously, to put it mildly, it seems not to have occurred to the congressional Republicans that their core philosophy of avoiding government intervention in the lives of Americans is being used to justify telling women what they can and can’t do with their bodies, while Republican-dominated science-denying legislatures around the country obsess over which bathrooms transgender individuals use.

It is a fair conclusion that the Republican approach to health insurance is going to result in denial of critical health care to large numbers of Americans and deaths will result … deaths that could have been avoided. Yes, the Republicans are moving very fast to get rid of Obamacare and in the process are signing death warrants for many vulnerable Americans.

“Nobody knew that health care could be so complicated.”

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Statement by the President of the United States, February 27, 2017. http://nyti.ms/2ltf0pN.

Nobody?

We knew.

The law known as the Affordable Care Act was signed in March, 2010. The Republican Party hated it. Still does. The RP has had seven years to comprehend how “complicated” health care is. Now the President is shocked to learn that it is complicated. What more is there to say?

Perhaps someone – Kellyanne Conway? – will now explain that “nobody” doesn’t really mean nobody, at least when Trump uses the term. It’s just an adjective, like “military” in relation to deportation activities. That must be it: the “alternative fact” is that “nobody” doesn’t mean “no” body; it means, as Humpty Dumpty famously said, “”just what I choose it to mean—neither more nor less.”

It’s all so … complicated.