Tag Archives: Health care

A reminder: a political party needs defeating

It’s possible I have readers who remain devastated that federal marshals will not frogmarch Donald Trump and his children out of the White House. I had to talk a white male acquaintance off a Facebook ledge yesterday after he moaned that Donald Trump was good as re-elected.

Put simply, I’m fucking tired of some friends implicitly hoping Trump wins so they can return to moaning about how awful the state of the world is. Those of us who are brown and gay in a state that Ron DeSantis barely won thank you for the leftist solidarity.

At any rate, here’s a reason to keep fighting every GOP candidate running for office between now and 2020, possibly forever: the Trump administration, in a move that surprises no one, has asked a federal court to dump the entire Affordable Care Act, including protections for patients with pre-existing conditions. More:

“The Department of Justice has determined that the district court’s judgment should be affirmed,” three Justice Department lawyers wrote to the 5th Circuit Court of Appeals, which is now considering the case. “[T]he United States is not urging that any portion of the district court’s judgment be reversed.”

Regardless of the outcome, legal experts anticipate that the 5th Circuit’s ruling will be appealed to the Supreme Court. If the courts ultimately strike down Obamacare — over the objections of a group of Democrat-led states, which have spent more than a year defending the health law in court — the consequences could be substantial for patients, health care organizations and other groups that have adapted to the nine-year-old law.

The story mentions the fate of the prescription drug controls for which the administration has theoretically fought, a fate dependent on the ACA, but Donald Trump cares about prescription drug controls like I do about Michael Bolton B-sides. He cares about prescription drug controls like he does about infrastructure. That his most fervent voters depend on the ACA matters not a whit.

Another phenomenon, reported by the paper of record:

Between 2015 and 2018, support for laws aimed at protecting L.G.B.T. individuals from discrimination fell by nearly 10 percentage points among Republicans under the age of 30. This was one of the key findings from a survey of more than 40,000 Americans’ views on L.G.B.T. issues that the Public Religion Research Institute released Tuesday.

One theory: “The ranks of young Republicans are thinning, with more socially liberal individuals opting to identify as independent.” I have my own theory: the Trump administration’s contempt for trans citizens has liberated young men and women from the tyranny of courtesy.

Purge them from public office. All of them.

Obamacare in danger again

Last night’s gleeful ruling from Judge Reed O’Connor of the Federal District Court in Fort Worth, according to Ezra Klein, presents Democrats with, to use that most baleful of modern jargon, an opportunity. “But with Obamacare under constant threat, Republicans have refocused Democrats on building what they failed to build in 2010: a universal health care system simple enough and popular enough that it is safe from constant political and legal assault,” Klein writes. “And that means some version of Medicare-for-all.” His conclusion:

Imagine a world where Judge O’Connor’s ruling is upheld. In that world, a Republican judge cuts tens of millions of people off health insurance mere weeks after Republicans lost a midterm election for merely trying to cut those people off health insurance. The aftermath of that would be a political massacre for the GOP, and a straightforward mandate for Democrats to rebuild the health system along the lines they prefer.

It’s true that states like Virginia that have expanded Medicaid coverage have seen declining enrollment in the ACA. Yet Klein’s arguments are too clever by half. It’s not 2010, Joe Lieberman is gone, therefore Medicare For All isn’t anathema in polite circles. But on what grounds does Klein assume (a) the Joe Manchins in the Senate will embrace Medicare For All (b) the consequences of stripping insurance from millions of people will sober up Republicans because they didn’t want so drastic a decision from the Texas court — a decision, I should note, silly on its face? Congress repealed the individual mandate in 2017; what was left to overrule unless the judge wanted to revel in the “judicial activism” that conservatives have accused liberal judges of?

I gave up accusing the GOP of hypocrisy years ago, and I trust Ruth Bader Ginsberg and Stephen Breyer will still live by the time the Supreme Court grants cert to the appeal.

‘Insurers are figuring out how to make money’

Green shoots spotted in the once fallow Obamacare field:

There are promising signs across the country that Obamacare rate hikes for the 2019 enrollment season won’t approach the eye-popping increases of the past two years, though rates won’t be finalized until the fall. Enrollment reopens Nov. 1, days before the midterm elections.

For example, one year after Tennessee’s market seemed on the verge of collapse, BlueCross BlueShield of Tennessee plans to decrease rates by 10 percent and Cigna wants to lower rates by 5 percent. In Minnesota, all four of the state’s insurers are looking to lower premiums. And in several other states — including the key political battlegrounds of Indiana, Nevada, Michigan and Pennsylvania — proposed rate increases are 5 percent or less.

“The market is starting to stabilize,” said Nate Clark, CEO of Minnesota’s marketplace. “Insurers are figuring out how to make money.”

Those surprisingly positive signs may also complicate Democratic talking points ahead of November’s elections, given their eagerness to attack Republicans for “sabotaging” the marketplaces and driving up premiums. It’s a reversal of roles from the past eight years, when Republicans pilloried Obamacare on their way to winning total control of the federal government.

And the president has once again taken to the Twitter machine in a distraction effort while his Justice Department wants the pre-existing clause in the Affordable Care Act declared unconstitutional.

The effect of repealing the individual mandate

A year ago I said to my friend Mari, “We’re in for it now” enough times that she wanted to kick my teeth in. It’s December 2017, and we’re in it: tax bill signed, GOP congressmen calling for investigations into Robert Mueller’s own investigation and Uranium One, GOP and Donald Trump sewn together so tightly that they’re feeding KFC into the same shared mouth. I like to believe that the vaporizing of the individual mandate has not destroyed the Affordable Care Act.

“President Barack Obama’s signature domestic achievement,” the New York Times observes, “is becoming more like what conservatives despise — government-run health care — thanks in part to Republican efforts that are raising premiums for people without government assistance and allowing them to skirt coverage.” In other words, the poor get some form of access to health care while Americans who can afford or get it through their jobs are off it entirely.

While the marketplaces, or exchanges, have struggled with a series of problems since they opened in 2014, Medicaid, administered by an experienced corps of state officials, has gone from strength to strength. Public appreciation for the program has steadily increased as people come to understand its importance in the health care system, including its central role in combating the opioid epidemic.

And though Congress has effectively repealed the requirement for people to have health insurance, federal subsidies are still available to low- and moderate-income people who want insurance. The federal government pays, on average, about three-fourths of the premium for more than three-fourths of the people who buy insurance through the Affordable Care Act marketplace.

Even officials who work for local health providers have admitted that the subsidies are the incentives, not the mandate or penalty. Nevertheless, four million more Americans will be uninsured by 2019 and thirteen million more by 2027, according to the Congressional Budget Office.

This is why the GOP sticks by Trump

Buried in the Washington Post’s letter section is this reasonable little missive:

I calculated the impact of the Republican Senate and House tax “reform” bills based on my 2016 income tax return and found that my wife’s and my tax liability would rise by 26 percent for 2017 over last year based on the elimination of the personal exemption and the state and local income tax deduction. Eliminating these deductions would increase our taxable income by $20,000. Our tax liability would rise by $5,300. We are in the 25 percent tax bracket. Paying one’s taxes is a cost of living, just as corporate taxes are part of the cost of doing business. With the personal-income-tax increase, our cost of living would rise, so we would adjust our life budget to compensate for the increased expense.

Damon Greer of Bethesda took the time to open his calculator app and do the math. Millions of Americans can’t take that time because they’re working at jobs that won’t give the time. In a few years as their corporate overlords laugh at all the drivel about “reinvesting in jobs” twaddle repeated by Paul Ryan and the GOP Senate, Damon Greer of Bethseda will give more of his money to the federal government so that those corporate overlords can keep their tax cuts.

While the failure to repeal the Affordable Care Act surprised me, the horror of the tax bill for which the Senate is prepared to vote and whose version will get reconciled with the House’s doesn’t, in this sense: this was the horrific legislation I had in mind as a result of the 2016 election results. Donald J. Trump would sign any bill that Ryan McConnell hand him. Remember the brave, uncompromising Susan Collins, Lisa Murkowski, Ron Johnson, and John McCain? They surrendered, and it wasn’t easy. Collins’s reasons for support are particulary moronic:

She also said that Mr. Trump was supportive of backing legislation to help stabilize health insurance markets under the Affordable Care Act, which she said would help mitigate the effects of ending the law’s requirement that most people have insurance, as the tax bill would do.

How Collins think the market will get “stabilized” when the individual “buy-in” is gutted is a problem I hope she and Jessica Fletcher of Cabot Cove, Maine solve together over sherry and biscuits. To quote VOX, the bill creates a health insurance crisis it has no idea how to solve.

But the GOP, no matter the degree to which Trump represents the culmination of Reaganism, renounced Trump until he won the Electoral College, therefore it owes his voters nothing. The tax bill satisfies the donors who pay for those expensive Senate races (note the mention of the Koch frères in the NYT story above).

Everything is awful

Since January I’ve recited Elizabeth Bishop’s line from “The Bight” as if it were a mantra: awful but cheerful. As the worst week of the year inches toward some kind of dignified close, reminders why we’re fucked.

First, Puerto Rico, where a million people or more than eighty percent of the island remains without power. Trash pickup is non-existent. So are essential services. Dengue, chikungunya and Zika epidemics are possibilities:

At the Iniciativa Comunitaria clinic, doctors said they’re seeing a spike in cases of pink eye, skin rashes and diarrhea that often come with lack of cleanliness.

On a recent weekday, Alexandra Hernández was watching her husband pour a bag of lime on a dead cow that had gotten tangled up in a derelict tractor on the day of the storm and remained in their yard.

The mayor’s office said it didn’t have the resources to remove the stinking carcass and suggested Hernández move for the safety of her 3-year-old child. But she was staying put. “I have nowhere else to go,” she explained

But the president, who pronounces “Puerto Rico” as if he learned it from Buster Poindexter, has threatened to withhold FEMA aid, no doubt because nobody on the island voted for him in 2016 unlike Texas and Florida and besides they’re brown skinned people.

Next, the president’s decision to stop paying Affordable Care Act subsidies has sent the insurance markets into a tailspin. Citizens dependent on Obamacare fortunate enough to live in a state with contingencies get the hammer blow deferred another year. For the rest of them?

The subsidy payments are worth an estimated $7 billion this year and go directly to insurers to help offset out-of-pocket costs — such as co-pays and deductibles for low-income Obamacare customers. Without them, Obamacare insurers will still have to provide discounts to customers — they’ll just have to eat the added cost, which most will attempt to recover by increasing premiums.

“The market can only take so many shocks,” said Ceci Connolly, CEO of the Alliance of Community Health Plans. “We had hoped that a business person would have understood the implications to the market, but that seems not to be the case.”

Obamacare customers are already contending with fragile markets. Nearly half of all counties have just a single insurer selling plans, and premiums are skyrocketing in many states. Trump’s decision to cut off the subsidy payments two weeks before open enrollment begins on Nov. 1 for Obamacare’s fifth enrollment season is sure to lead to further uncertainty by consumers as well as insurers.

I had conversations about Bob Corker yesterday. Bob Corker, who voted for every one of World War III enthusiast Donald J. Trump’s Cabinet nominees, will not save us.

If our president didn’t have a couple bats gliding across his belfry, I would say he has loaded the legislative branch with the responsibilities for the sake of running a do-nothing Congress campaign in 2020; the world knows he hates Mitch McConnell and Paul Ryan, who don’t hate him because, at last, their pet projects are getting underway. Tom Cotton, the ghoul from Arkansas, agrees:

The president seemed determined to erase any residual hope that the nuclear deal might form the basis of a new relationship between the United States and Iran. His speech, from the Diplomatic Reception Room of the White House, was perhaps the most hostile of any American leader toward Iran since President George W. Bush placed the country on his “axis of evil” in 2002.

Mr. Trump recited a litany of misdeeds by Iran going back to the 1979 hostage crisis and described it as the world’s leading state sponsor of terrorism, supporting Al Qaeda, Hamas, Hezbollah and the Taliban. He also accused the country of dealing with North Korea, a reference to Pyongyang’s long history of selling missile technology to Iran, and said he had asked the nation’s intelligence agencies to investigate whether the relationship went further.

His tone made clear that Mr. Trump has no interest in what, for the Obama administration, was the biggest gamble of the accord: to provide the basis for two longtime adversaries to find other ways to cooperate.

We’ve got three years, three months, and three-odd weeks left, if my wretched math is correct. The Senate will not recommend impeachment. In 2016 I discovered Aperol. I can’t think what potent potable I can add to my collection that will produce the necessary daze.

Gratuitous cruelty

And so it begins. This is how a presidential administration kills the sick and the poor:

President Trump will scrap subsidies to health insurance companies that help pay out-of-pocket costs of low-income people, the White House said late Thursday. His plans were disclosed hours after the president ordered potentially sweeping changes in the nation’s insurance system, including sales of cheaper policies with fewer benefits and fewer protections for consumers.

The twin hits to the Affordable Care Act could unravel President Barack Obama’s signature domestic achievement, sending insurance premiums soaring and insurance companies fleeing from the health law’s online marketplaces. After Republicans failed to repeal the health law in Congress, Mr. Trump appears determined to dismantle it on his own.

Without the subsidies, insurance markets could quickly unravel. Insurers have said they will need much higher premiums and may pull out of the insurance exchanges created under the Affordable Care Act if the subsidies were cut off. Known as cost-sharing reduction payments, the subsidies were expected to total $9 billion in the coming year and nearly $100 billion in the coming decade.

Although the changes won’t take place until 2019 as federal agencies figure out how to rewrite the rules, the move is gratuitous and cruel — what a nasty piece of work does who is intimidated by the sound of Barack Hussein Obama. The first executive order he signed was as terrible: by allowing insurance companies to create shit insurance plans for healthier employees, the larger pool gets poisoned. In a couple years, Donald Trump will have sent the old and sick to the same fate as Puerto Ricans.

‘Henry Kissinger does not want to pay 116 percent increase in his premiums’

In which the president shows his strategic genius again:

President Trump pointed to the premium hikes a guest of his at the White House Tuesday was facing as his reason to “do something” about the Affordable Care Act — a move that may come in an executive order as soon as this week.

Never mind that the guest Trump cited was former Secretary of State Henry Kissinger, who is 94 years old and thus eligible for Medicare. It is unlikely that Kissinger is getting his insurance from Obamacare’s individual market, yet Trump claimed that he did not want to “pay 116 percent increase in his premiums.”

“Now, we’re going to have to do something with Obamacare because it’s failing. Henry Kissinger does not want to pay 116 percent increase in his premiums, but that’s what’s happening,” Trump said, after hinting at what the “something” he will sign “probably this week” will do.

It will “go a long way, to take care of many of the people that have been so badly hurt on health care,” Trump said.

He’s right, though: give Kissinger cyanide pill instead of his morning Lipitor.

The sordidness of Graham-Cassidy

To quote All About Eve‘s Karen Richards, this beats the record for running, jumping, and standing gall:

The Medicaid delay would potentially apply to Alaska, Wyoming, South Dakota, North Dakota and Montana, based on their low-density populations. Those states would be allowed to opt out from the bill’s fixed payments if certain health spending conditions are met in the prior year or the HHS secretary determines the new funding system is insufficient. The chance to opt out would end in 2026.

It is unclear exactly whether all five states would qualify. A Kaiser Family Foundation analysis assumes Alaska and Montana would meet the requirements for exemption. Those that do would continue to get Medicaid funding in the current fashion.

In 2012, when the government pled for the constitutionality of the Affordable Care Act before the Supreme Court, the late Antonin Scalia sloshed the words “Cornhusker Kickback” as if it were turpentine disguised as scotch. This concession to former Nebraska sentor Ben Nelson got removed eventually from the ACA bill but not before it had become shorthand for DC politics at its most sordid.

Now, I don’t oppose this kind of legislative flimflam. FDR, LBJ, and Reagan’s people wouldn’t have blinked. But to bribe Murkowski is a band aid for a long term problem that will roar to life in the late 2020s, presumably when Murkowski has retired or the arctic ice has melted in sufficient quantitles to set Alaska adrift. Even the White House isn’t pretending they know what the hell will happen to the poor and sick besides dying. Medicaid state directors know:

“The scope of this work, and the resources required to support state planning and implementation activities, cannot be overstated,” the directors said. “States will need to develop overall strategies, invest in infrastructure development, systems changes, provider and managed care plan contracting, and perform a host of other activities. The vast majority of states will not be able to do so within the two-year timeframe envisioned here, especially considering the apparent lack of federal funding in the bill to support these critical activities.”

These lamentations pale beside the need to satisfy a base that wants Congress to pass something lest the chisellers and Mexicans and whatever keep getting the free rides at the cost of jobs that white people would never take.

The return of the evil dead

From the Frankenstein Files: the shitty plan that strips poor people of health care is back, this time with Bill Cassidy of Louisiana and Lindsey Graham of South Carolina as co-sponsors.

Starting in 2020, the Cassidy-Graham bill would eliminate both the Affordable Care Act’s subsidies and the enhanced federal funding that underwrites the expansion of Medicaid in 31 states (plus the District of Columbia). The bill would then establish a “block grant,” handing money directly to the states for helping people to pay for health care. This would produce the best of all worlds, as Cassidy and Graham would say, because it would mean states could stop worrying about the complications of the Affordable Care Act and simply use that money in ways that will work best for them and their citizens.

In reality, the Cassidy-Graham would shrink the federal investment in health care programs dramatically, by somewhere in the neighborhood of $400 billion over the next ten years, or maybe even more, according to a preliminary and rough analysis by the Center on Budget and Policy Priorities. Starting in 2027, the money would vanish altogether. In theory, Congress could appropriate new money then, a possibility Cassidy and Graham have raised in an effort to soothe those nervous about such a dramatic drop-off in funds. In practice, it would take $200 billion each year just to keep pace. That’d be a huge ask for any Congress.

I like the gulp implied in the verb-turned-predicate nominative “ask.” And “block grant” is garlic familiar to Reagan scholars, which means submitting chump change to states for essential service and, inevitably, when the states say it isn’t enough the GOP presidential aspirant can run on a GOVERNMENT IS INEFFICIENT SEE? platform. These people won’t quit until only the rich can afford socialism.

Meanwhile on the Medicaid front…

It’s mid August, which means the Congressional Budget Office has goodies to stuff in your beach bucket to accompany the plastic shovel, coconut oil, and shades:

If Mr. Trump stops payment of the subsidies, the budget office said, insurers will increase premiums for midlevel “silver plans,” and the government will incur additional costs because, under the Affordable Care Act, it also provides financial assistance to low-income people to help them pay those premiums.

Insurers in some states would withdraw from the market because of “substantial uncertainty” about the effects of the cutoff, the budget office said. About 5 percent of the nation’s population would have no insurers in the individual insurance market next year without the subsidies, it said. By contrast, if the subsidies are paid, fewer than one-half of 1 percent of people would be in such areas, the report said.

Meanwhile the Centers for Medicare & Medicaid Services is reviewing proposals that would make employment “a criterion for Medicaid eligibility” in Indiana, Kentucky, and Wisconsin. Republicans want wins on gutting the Affordable Care Act. In the Oval Office lies a cornered snake, ready to stick his venomous fangs into whoever so much as looks at him funny. I can see him withholding the payments out of malice, pure and simple.

The power of an alarmed citizenry

“Yes, Mr. Soto?” the woman on the phone says, in the manner of a restaurant hostess acknowledging a demanding regular. She also sounds like one of my great aunts. Three mornings a week since late January I will call the Miami-Dade office of the Plankton with a Hairpiece, aka Marco Rubio, and lodge a protest. At the beginning I kept a list. The nominations of Betsy DeVos and Scott Pruitt. The firing of James Comey. Bringing any version of a health care bill forward that gives tax breaks to millionaires and starves the poor. Carlos Curbelo’s hometown office gets calls too. Grinding work, but undemanding work too. I’ve tried calling Governor Rick Scott’s office too in the hopes that he can use leverage against Rubio.

Imagine this work duplicated tenfold, a thousandfold — in the offices of Governors Brian Sandoval of Nevada and Doug Ducey of Arizona. Imagine the will of hundreds of wheelchair-bound victims of chronic diseases that the health industry euphemistically calls pre-existing conditions; they showed up to these offices and demanded satisfaction. They spooked their governors, who in turn spooked the likes of John McCain, a man who needs resentment like others need sex. Nevertheless, for quietly extending the rope with which Mitch McConnell hanged himself and his grisly reputation for sharp tactics, he deserves thanks. So do Susan Collins and Lisa Murkowski; the former never wavered, the latter endured calls from truculent Trump thugs. Another courageous legislator: Mazie Herono of Hawaii, living with stage 4 liver cancer, demanding compassion from colleagues more apt to demand it from the liveried server at a Republican retreat in Pennsylvania.

But the primary credit goes to those ordinary citizens. Charles Pierce:

The primary force driving the events of Thursday night and Friday morning was the energy and (yes) persistence of all those people who swamped town hall meetings, who wrote, or called, or e-mailed various congresscritters to show them what real political pressure felt like. I remember watching town halls in Maine, to which people drove hundreds of miles to tell Susan Collins what they thought. Those people bucked up vulnerable Democratic senators so that Chuck Schumer could count on a united Congress.

So we beat on, returning to the task on Monday morning.