Why It’s Important to Vote in Mid-Term Elections!

I don’t know what Sen. Dean Heller has done (or not done) in Washington, but clearly, he’s not just disliked at home in Nevada. On Sunday’s 60 Minutes, Breitbart’s Steve Bannon let the world know that he has put Heller first and foremost on his “Enemies List” pretty much making him the #1 most vulnerable Senator in the 2018 race for re-election.

While a number of Democrats are considering a run for the seat, including Rep. Dina Titus and Rep. Jacky Rosen, Nevada’s perennial candidate, Danny Tarkanian has stepped up to the plate yet again.  If anything, Tarkanian has proven yet again WHY it’s important that every single Democrat makes it to the polls in 2018 to vote for someone who will actually represent Nevadans, not every whim of President Trump.

Tarkanian appeared on “The Beat with Ari Melber” on MSNBC on Monday, 9/11/2017.  Take a moment to watch his performance.  I don’t know about you, but that’s NOT who I want representing my interests in the U.S. Senate:

NV GOP Apparently Believes — When You Can’t Win, Stoop to Gutter Politics!

— An “ask” from Sen. Catherine Cortez Masto

What Nevada Republicans are doing right now is disgusting. Truly an all-time low.

The people of Nevada made their voices heard loud and clear last November. In fact, Nevada was one of the few bright spots on Election Day. Because of your hard work, you sent me to the U.S. Senate – which I am eternally grateful for – and you also flipped both chambers in the state legislature back to a Democratic majority, including winning key battleground districts.

But right now, Republicans in Nevada are so desperate to gain control back, they have stooped to an all-time low by completely disregarding the will of Nevada’s hardworking families. Republicans have filed recall petitions against three women in the Senate Democratic caucus: Joyce Woodhouse, Nicole Cannizzaro, and Patricia Farley – all in extremely competitive districts. And now, I need your help to fight back.

At this very moment, right-wing special interests are funneling incredible amounts of money into Nevada to pay folks to collect the petition signatures they need to get these recalls on the ballot.

Let me be clear: This recall effort is a scam. It is pathetic and it is wrong. The election was nearly 10 months ago, and the people of Nevada have spoken. They want a Democratic majority in the state legislature.

If Nevada Republicans get the number of signatures they need, Democrats will have a tiny window to challenge it in court. This is not good. And we’re running out of time. Please consider stepping up and giving $25 or more to the Nevada State Democratic Party right now so we can fight back against this Republican scam to roll back our Democratic majority?  If you can’t afford giving funds, consider calling NSDP headquarters (702-737-8683) and giving of your time to participate in phone-banking southern Nevada residents in the affected districts and asking them NOT to sign the GOP’s recall petitions.

Thank you for your support and for standing up for our hard-fought Democratic majorities. We will not let Nevada’s Republicans fool us.

¡La lucha sigue!
The fight continues!


Note: The citizens of Nevada are granted the authority to perform a recall election by Section 9 of Article II of the Nevada Constitution, which says:

“Every public officer in the State of Nevada is subject, as herein provided, to recall from office by the registered voters of the state, or of the county, district, or municipality which he represents.”

This broad right of recall in Nevada applies to all elective “State” officers (not Members of Congress, as they’re Federal officers) after the first six months of the term to which the incumbent was elected and does not require a “reason” in order to start a recall petition. For the GOP to get to a recall election, they need gather signatures from 25% of those people who actually voted in the election for that member of the legislature.

  • For Farley — Need to gather more than 7,100 signatures from people who voted in Nevada’s 8th Senate district in 2014 (a low turnout mid-term election) by Nov. 9.
  • For Woodhouse — Need to gather more than 13,000 signatures from people who voted last year in the Senate District 5 race by Oct. 31.
  • For Cannizzaro — Need to gather more than 14,975 of the people who voted in District 6 in 2016 by Nov. 14.

You should also note that GOP “conservatives” are attempting force the State to pay for a repeat election at taxpayer expense for “no stated good reason.” It is NOT “conservative” to force an election just because they don’t like the fact that the voters chose Democrats to represent them in the State Legislature.  Such actions consume vital tax dollars that should be spent on vital infrastructure, education, healthcare, etc.

Also worthy of noting is that should the GOP be successful in a recall, it would shake up the powerful Nevada Legislative Commission. That commission handles the Legislature’s business when it is not in session and when constituents have little input into decisions being made.

Mid-Term Senate Races Matter: Heller’s High Water

U.S. Senator Dean Heller (R-NV) released the below statement after a right-leaning federal judge in Texas nullified the Obama Administration’s Department of Labor overtime rule.

“The former Obama Administration’s expansion of the federal overtime rule would have devastated Nevada’s business owners and job creators. Since the rule was issued last year, I have been strongly concerned about its impact because it would fundamentally change how employers compensate their workers, reducing Nevadans’ work hours and benefits. I’m pleased to see that a federal judge acknowledged the regulation’s harmful consequences and ruled it invalid today,” Heller said. “Today’s news is a relief for countless Nevada businesses and employers, and I commend Nevada Attorney General Adam Laxalt for his leadership in this fight.”

Heller has worked tirelessly at undermining the Obama-era overtime rule aimed at leveling the playing field for workers. Instead, he’s worked to bolster the bottom line of his corporate benefactors. Don’t believe me?  As evidence —

  • In February 2016 he wrote to Department of Labor Secretary Tom Perez about this rule and what he claimed would be its negative impacts on corporations in the state of Nevada.
  • In March 2016, he followed up with yet another letter highlighting his concerns over the new policy change.
  • In the Senate, Heller expressed concerns with his Senate colleagues by writing to Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and related Agencies Chairman Roy Blunt and Ranking Member Patty Murray.

Heller also cosponsored S. 2707, the Protecting Workplace Advancement and Opportunity Act, in the 114th Congress, legislation that would have cancelled the proposed DOL regulation to increase the salary threshold for workers eligible to receive overtime pay and require impact studies for future proposals of related rules.

Protecting Workplace Advancement and Opportunity Act

S.2707 declared that the proposed or the final rule of the Department of Labor entitled “Defining and Delimiting the Exemptions for Executive, Administrative, Professional, Outside Sales and Computer Employees” shall cease to have any force or effect. The rule revises the “white collar” exemption of executive, administrative, professional, outside sales, and computer employees from minimum wage and maximum hour, or overtime, requirements of the Fair Labor Standards Act of 1938 (FLSA).

If the proposed rule is a final rule on the date of enactment of S.2707:

  • the Dept of Labor would have been prohibited from enforcing it based on conduct occurring before that enactment date,
  • an employee would not have any right of action against an employer for the employer’s failure to comply with the final rule at any time before that enactment date,
  • any regulations that were amended by the final rule would have been restored and revived as if the final rule had never taken effect, and
  • nothing in S.2707 would have been construed to create a right of action for an employer against an employee for the recoupment of any payments made to the employee before the enactment of this bill that were in compliance with that final rule.

It also specified that the Dept of Labor could promulgate any substantially similar rule only if it had completed certain required actions; but any new rule could not contain any automatic updates to the salary threshold for purposes of exemptions to minimum wage and maximum hour requirements under the FLSA (Fair Labor Standards Act).

The requirement that definitions applicable for such exemptions be defined and delimited from time to time by Labor regulations would have been construed to:

  • require Labor to issue a new rule through notice and comment rule-making for each change in any salary threshold it has proposed (creating more expensive and elongated rule-making processes); and
  • exclude any rule that would result in changes to any salary threshold for multiple time periods, including through any automatic updating procedure.

The Dept of Labor was also prohibited from promulgating any final rule that included any revision to duties tests for exemption from minimum wage and maximum hours requirements unless specific regulatory text for the provision was proposed in the proposed rule.

For clarity, here is the background on that “Final Rule” and what it did for WORKERS:

In 2014, President Obama directed the Department of Labor to update and modernize the regulations governing the exemption of executive, administrative, and professional (“EAP”) employees from the minimum wage and overtime pay protections of the Fair Labor Standards Act (“FLSA” or “Act”). The Department published a notice of proposed rulemaking on July 6, 2015, and received more than 270,000 comments. On May 18, 2016, the Department announced that it will publish a Final Rule to update the regulations. The full text of the Final Rule will be available at the Federal Register Site.

Although the FLSA ensures minimum wage and overtime pay protections for most employees covered by the Act, some workers, including bona fide EAP employees, are exempt from those protections. Since 1940, the Department’s regulations have generally required each of three tests to be met for the FLSA’s EAP exemption to apply:

  1. the employee must be paid a predetermined and fixed salary that is not subject to reduction because of variations in the quality or quantity of work performed (“salary basis test”);
  2. the amount of salary paid must meet a minimum specified amount (“salary level test”); and
  3. the employee’s job duties must primarily involve executive, administrative, or professional duties as defined by the regulations (“duties test”).

The Department last updated these regulations in 2004, when it set the weekly salary level at $455 ($23,660 annually) and made other changes to the regulations, including collapsing the short and long duties tests into a single standard duties test and introducing a new exemption for highly compensated employees.

This Final Rule updates the salary level required for exemption to ensure that the FLSA’s intended overtime protections are fully implemented, and to simplify the identification of overtime-protected employees, thus making the EAP exemption easier for employers and workers to understand and apply. Without intervening action by their employers, it extends the right to overtime pay to an estimated 4.2 million workers who are currently exempt. It also strengthens existing overtime protections for 5.7 million additional white collar salaried workers and 3.2 million salaried blue collar workers whose entitlement to overtime pay will no longer rely on the application of the duties test.

* Key Provisions of the Final Rule *
The Final Rule focused primarily on updating the salary and compensation levels needed for EAP workers to be exempt. Specifically, the Final Rule:

  1. Set the standard salary level at the 40th percentile of earnings of full-time salaried workers in the lowest-wage Census Region, currently the South, which is $913 per week or $47,476 annually for a full-year worker;
  2. Set the total annual compensation requirement for highly compensated employees (HCE) subject to a minimal duties test to the annual equivalent of the 90th percentile of full-time salaried workers nationally, which is $134,004; and
  3. Established a mechanism for automatically updating the salary and compensation levels every three years to maintain the levels at the above percentiles and to ensure that they continue to provide useful and effective tests for exemption.

Additionally, the Final Rule amended the salary basis test to allow employers to use non-discretionary bonuses and incentive payments (including commissions) to satisfy up to 10 percent of the new standard salary level. The Final Rule made no changes to the duties tests.

Effective Date
The effective date of the Final Rule is December 1, 2016. The initial increases to the standard salary level (from $455 to $913 per week) and HCE total annual compensation requirement (from $100,000 to $134,004 per year) will be effective on that date. Future automatic updates to those thresholds will occur every three years, beginning on January 1, 2020.

Frankly, it wouldn’t surprise me to see Senator Heller espouse and promote a nationwide move such as that just made by the Missouri GOP-led legislature which lowered the minimum wage from $10/hr to $7.70/hr (or, from $20, 800/yr to $16,016/yr for Missouri citizens.

Afterall, Senator Heller has made it exceedingly clear that he represents only his corporate benefactors and is a firm believer and double-downer in a failed trickle-down philosophy.

“Congress is ready to address tax reform, and that’s why I’m encouraged by the President’s comments today about bringing tax relief to all Americans. Nevada’s hardworking families and small business owners have been waiting for a simpler, fairer tax code for years now, and Congress and the White House are poised to make that happen,” Heller said. “I was honored to host Secretary Mnuchin earlier this week in Las Vegas for a meeting with Nevada employers and the message we received from these business leaders was clear – lowering rates will help boost the economy, create jobs and increase wages. As a member of the Senate Finance Committee, I’m looking forward to working with the Administration on this issue and having a seat at the table to make sure that the final product is what’s best for Nevada.”

Mid-term elections matter and we cannot let Dean Heller get re-elected to the Senate, nor can we let AG Laxalt get elected to the Governorship of Nevada.

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NOW is THE Time!

We’re in danger of losing our health care. The Senate is inching closer to passing a devastating health care bill. If they do, then millions of people will see their health care coverage disappear. But you can do something about it.

Nevada is particularly important in the fight to save our health care. Why? Because our senator, Dean Heller, is a deciding vote on the Senate bill.

You have a critical part to play, and there is no time to waste. As a constituent, you have the power to influence Senator Heller’s vote on health care.

The over 600,000 Nevadans who rely on Medicaid would be most adversely affected as Nevada is poised to lose approximately $5 billion in federal Medicaid funds by 2028 if the Senate health care bill passes. This would harm 300,000 children, 13,000 seniors, and 42,000 people with disabilities in Nevada.

But that’s only what we actually know today.  Are you insured through an employer plan?  You do know that employers shop insurers country-wide for the best policy prices they can find, right?  Have you heard this bill allows States to seek waivers of  EHBs (Essential Health Benefits, like maternity coverage, ER visits, Xrays,  cancer screenings, etc.)?  What do you think will happen to the healthcare insurance coverage you now have once your employer, like everyone else’s employer starts shopping “EHB-waivered” states for their insurance policies to save money, while holding what you pay constant or even charging you a larger percentage of the cost, all to pad their bottom line?

  • Read the over-glorious summary from the Senate Budget Committee glossing over the dreadful impacts.
  • Browse the actual bill text.
  • View a section by section summary by the Congressional Research Service here.

TrumpedUpCare harms us all and we can’t let that happen!  The clock is ticking with an expected vote no later than next  Thursday.  Call Senator Heller’s offices today and often (call all of them).  Let him know that if he takes a meat cleaver to our healthcare, he might as well take a meat cleaver to his 2018 campaign, because he’s done!

202-224-6244 (DC)
702-388-6605 (LV)
775-686-5770 (Reno)
775-738-2001 (Elko)

Term: 2013-2018

Heller’s High (or should I say Low) Water on Healthcare

In case you haven’t heard, Senator Dean Heller supports MASSIVE cuts to Medicaid.  In fact, Senator Heller has drug the proverbial tea and has expressed his support for PHASING OUT the Medicaid expansion over the next 7 years.

After weeks of denying, fudging and wriggling, Heller is finally admitting he’s ready to end the Medicaid expansion covering more than 138,000 Nevadans—including children—since Obamacare became law.  THAT is unacceptable. Senator Heller was elected to look out for Nevadans, but he’s instead ripping the rug out from those who count on Medicaid.

“I support seven, I support seven,” Heller told reporters on his way into a healthcare working group meeting in the Capitol. “So do a number of us, including [Sen. Rob] Portman [R-Ohio] and others who have been working on this.”

Full story here.

Apparently Heller figures blame won’t fall back on him if they just “slowly” take Medicaid away from over 130,000 Nevadans and millions across the U.S.  … over a 7 year time frame. What folks need to understand is, that without Federal “matching funds” which enable States to open up the Medicaid insurance program to those whose incomes are below or just above the poverty line, it will be detrimentally consequential. Thirty-one states chose to expand Medicaid, and, as a result, 11 million to 12 million newly eligible people were finally able to obtain health insurance.  If federal matching funds are withdrawn, most states will likely return to the more restrictive eligibility rules for Medicaid eligibility ― effectively wiping out the coverage gains, leaving millions of low-income Americans with worse access to health care and more exposure to crushing medical bills.  In other words, it’s the equivalent of legislating a “death panel” where access is denied or expensive procedures/surgeries are denied as funding will not be available and people WILL die.

At a time when the Nevada Legislature is seriously considering a “Medicaid for All” healthcare delivery model that would let Nevadans buy into a “public” delivery system to assure Nevadans can more effectively access healthcare coverage, it appears that Senator Heller has chosen to throw his constituents under the first bus he can find.  Even Governor Brian Sandoval, a Republican who doesn’t support blocking healthcare coverage access for so many Nevadans, has shared his concern about rolling back the Medicaid expansion.

We can’t let Heller and his spokespeople get away with playing loose with the truth, calling this “fake news,” and blaming it on Democrats.  He made the comment and it’s on tape!

We must defeat Senator Heller in 2018. Nevadans can’t afford to lose the Medicaid expansion.

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CBO Rpt on H.R. 1628—American Health Care Act of 2017

 CBO and the staff of the Joint Committee on Taxation (JCT) estimate that enacting the legislation—which would repeal or modify many provisions of the Affordable Care Act—would reduce federal deficits by $119 billion over the coming decade.

CBO and JCT estimate that in 2018, 14 million more people would be uninsured under the legislation than under current law. After additional changes to subsidies for insurance purchased in the nongroup market and to the Medicaid program took effect, the increase in the number of uninsured people would rise to 19 million in 2020 and then to 23 million in 2026.

 CBO and JCT estimate that enacting the American Health Care Act would reduce federal deficits by $119B over the coming decade and increase the number of people who are uninsured by 23 million in 2026 relative to current law.

 

View Document (1.03 MB)


Summary:

CBO and the staff of the Joint Committee on Taxation (JCT) have completed an estimate of the direct spending and revenue effects of H.R. 1628, the American Health Care Act of 2017, as passed by the House of Representatives. CBO and JCT estimate that enacting that version of H.R. 1628 would reduce the cumulative federal deficit over the 2017-2026 period by $119 billion. That amount is $32 billion less than the estimated net savings for the version of H.R. 1628 that was posted on the website of the House Committee on Rules on March 22, 2017, incorporating manager’s amendments 4, 5, 24, and 25. (CBO issued a cost estimate for that earlier version of the legislation on March 23, 2017.)

In comparison with the estimates for the previous version of the act, under the House-passed act, the number of people with health insurance would, by CBO and JCT’s estimates, be slightly higher and average premiums for insurance purchased individually—that is, nongroup insurance—would be lower, in part because the insurance, on average, would pay for a smaller proportion of health care costs. In addition, the agencies expect that some people would use the tax credits authorized by the act to purchase policies that would not cover major medical risks and that are not counted as insurance in this cost estimate.

Effects on the Federal Budget

CBO and JCT estimate that, over the 2017-2026 period, enacting H.R. 1628 would reduce direct spending by $1,111 billion and reduce revenues by $992 billion, for a net reduction of $119 billion in the deficit over that period. The provisions dealing with health insurance coverage would reduce the deficit, on net, by $783 billion; the noncoverage provisions would increase the deficit by $664 billion, mostly by reducing revenues.

The largest savings would come from reductions in outlays for Medicaid and from the replacement of the Affordable Care Act’s (ACA’s) subsidies for nongroup health insurance with new tax credits for nongroup health insurance (see figure below). Those savings would be partially offset by other changes in coverage provisions—spending for a new Patient and State Stability Fund, designed to reduce premiums, and a reduction in revenues from repealing penalties on employers who do not offer insurance and on people who do not purchase insurance. The largest increases in the deficit would come from repealing or modifying tax provisions in the ACA that are not directly related to health insurance coverage—such as repealing a surtax on net investment income, repealing annual fees imposed on health insurers, and reducing the income threshold for determining the tax deduction for medical expenses.

Pay-as-you-go procedures apply because enacting H.R. 1628 would affect direct spending and revenues. CBO and JCT estimate that enacting H.R. 1628 would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2027. CBO has not completed an estimate of the potential impact of the legislation on discretionary spending, which would be subject to future appropriation action.

Effects on Health Insurance Coverage

CBO and JCT broadly define private health insurance coverage as consisting of a comprehensive major medical policy that, at a minimum, covers high-cost medical events and various services, including those provided by physicians and hospitals. The agencies ground their coverage estimates on that widely accepted definition, which encompasses most private health insurance plans currently offered in the group and nongroup markets. The definition excludes policies with limited insurance benefits (known as mini-med plans); “dread disease” policies that cover only specific diseases; supplemental plans that pay for medical expenses that another policy does not cover; fixed-dollar indemnity plans that pay a certain amount per day for illness or hospitalization; and single-service plans, such as dental-only or vision-only policies. In this estimate, people who have only such policies are described as uninsured because they do not have financial protection from major medical risks.

CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under H.R. 1628 than under current law. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 23 million in 2026. In 2026, an estimated 51 million people under age 65 would be uninsured, compared with 28 million who would lack insurance that year under current law. Under the legislation, a few million of those people would use tax credits to purchase policies that would not cover major medical risks.

Stability of the Health Insurance Market

Decisions about offering and purchasing health insurance depend on the stability of the health insurance market—that is, on the proportion of people living in areas with participating insurers and on the likelihood of premiums’ not rising in an unsustainable spiral. The market for insurance purchased individually with premiums not based on one’s health status—that is, nongroup coverage without medical underwriting—would be unstable if, for example, the people who wanted to buy coverage at any offered price would have average health care expenditures so high that offering the insurance would be unprofitable.

Under Current Law. Although premiums have been rising under current law, most subsidized enrollees purchasing health insurance coverage in the nongroup market are largely insulated from increases in premiums because their out-of-pocket payments for premiums are based on a percentage of their income; the government pays the difference between that percentage and the premiums for a reference plan. The subsidies to purchase coverage, combined with the effects of the individual mandate, which requires most individuals to obtain insurance or pay a penalty, are anticipated to cause sufficient demand for insurance by enough people, including people with low health care expenditures, for the market to be stable in most areas.

Nevertheless, some areas of the country have limited participation by insurers in the nongroup market under current law. Several factors could lead insurers to withdraw from the market—including lack of profitability and substantial uncertainty about enforcement of the individual mandate and about future payments of the cost-sharing subsidies to reduce out-of-pocket payments for people who enroll in nongroup coverage through the marketplaces established by the ACA.

Under the Legislation. CBO and JCT anticipate that, under H.R. 1628, nongroup insurance markets would continue to be stable in many parts of the country. Although substantial uncertainty about how the new law would be implemented could lead insurers to withdraw from or not enter the nongroup market, several factors would bring about market stability in most states before 2020. In the agencies’ view, those key factors include subsidies to purchase insurance, which would maintain sufficient demand for insurance by people with low health care expenditures, and grants to states from the Patient and State Stability Fund, which would lower premiums by reducing the costs to insurers of people with high health care expenditures.

The agencies expect that the nongroup market in many areas of the country would continue to be stable in 2020 and later years as well, including in some states that obtain waivers from market regulations. Even though the new tax credits, which would take effect in 2020, would be structured differently from the current subsidies and would generally be less generous for those receiving subsidies under current law, other changes (including the money available through the Patient and State Stability Fund) would, in the agencies’ view, lower average premiums enough to attract a sufficient number of relatively healthy people to stabilize the market.

However, the agencies estimate that about one-sixth of the population resides in areas in which the nongroup market would start to become unstable beginning in 2020. That instability would result from market responses to decisions by some states to waive two provisions of federal law, as would be permitted under H.R. 1628. One type of waiver would allow states to modify the requirements governing essential health benefits (EHBs), which set minimum standards for the benefits that insurance in the nongroup and small-group markets must cover. A second type of waiver would allow insurers to set premiums on the basis of an individual’s health status if the person had not demonstrated continuous coverage; that is, the waiver would eliminate the requirement for what is termed community rating for premiums charged to such people. CBO and JCT anticipate that most healthy people applying for insurance in the nongroup market in those states would be able to choose between premiums based on their own expected health care costs (medically underwritten premiums) and premiums based on the average health care costs for people who share the same age and smoking status and who reside in the same geographic area (community-rated premiums). By choosing the former, people who are healthier than average would be able to purchase nongroup insurance with relatively low premiums.

CBO and JCT expect that, as a consequence, the waivers in those states would have another effect: Community-rated premiums would rise over time, and people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all—despite the additional funding that would be available under H.R. 1628 to help reduce premiums. As a result, the nongroup markets in those states would become unstable for people with higher-than-average expected health care costs. That instability would cause some people who would have been insured in the nongroup market under current law to be uninsured. Others would obtain coverage through a family member’s employer or through their own employer.

Effects on Premiums and Out-of-Pocket Payments

CBO and JCT projected premiums for single policyholders under H.R. 1628 (before any tax credits were applied) and compared those with the premiums projected under current law for policies purchased in the nongroup market. H.R. 1628, as passed by the House, would tend to increase such premiums before 2020, relative to those under current law—by an average of about 20 percent in 2018 and 5 percent in 2019, as the funding provided by the act to reduce premiums had a larger effect on pricing.

Starting in 2020, however, average premiums would depend in part on any waivers granted to states and on how those waivers were implemented and in part on what share of the funding available from the Patient and State Stability Fund was applied to premium reduction. To facilitate the analysis, CBO and JCT examined three general approaches states could take to implement H.R. 1628. Because a projection of a specific state’s actions would be highly uncertain, the agencies’ estimates reflect an assessment of the probabilities of different outcomes, without any explicit predictions about which states would make which decisions. CBO and JCT estimate the following:

  • About half the population resides in states that would not request waivers regarding the EHBs or community rating, CBO and JCT project. In those states, average premiums in the nongroup market would be about 4 percent lower in 2026 than under current law, mostly because a younger and healthier population would be purchasing the insurance. The changes in premiums would vary for people of different ages. A change in the rules governing how much more insurers can charge older people than younger people, effective in 2019, would directly alter the premiums faced by different age groups, substantially reducing premiums for young adults and raising premiums for older people.
  • About one-third of the population resides in states that would make moderate changes to market regulations. In those states, CBO and JCT expect that, overall, average premiums in the nongroup market would be roughly 20 percent lower in 2026 than under current law, primarily because, on average, insurance policies would provide fewer benefits. Although the changes to regulations affecting community rating would be limited, the extent of the changes in the EHBs would vary widely; the estimated reductions in average premiums range from 10 percent to 30 percent in different areas of the country. The reductions for younger people would be substantially larger and those for older people substantially smaller.
  • Finally, about one-sixth of the population resides in states that would obtain waivers involving both the EHBs and community rating and that would allow premiums to be set on the basis of an individual’s health status in a substantial portion of the nongroup market, CBO and JCT anticipate. As in other states, average premiums would be lower than under current law because a younger and healthier population would be purchasing the insurance and because large changes to the EHB requirements would cause plans to a cover a smaller percentage of expected health care costs. In addition, premiums would vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums, despite the additional funding that would be available under H.R. 1628 to help reduce premiums. Over time, it would become more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly. As a result of the narrower scope of covered benefits and the difficulty less healthy people would face purchasing insurance, average premiums for people who did purchase insurance would generally be lower than in other states—but the variation around that average would be very large. CBO and JCT do not have an estimate of how much lower those premiums would be.

Although premiums would decline, on average, in states that chose to narrow the scope of EHBs, some people enrolled in nongroup insurance would experience substantial increases in what they would spend on health care. People living in states modifying the EHBs who used services or benefits no longer included in the EHBs would experience substantial increases in out-of-pocket spending on health care or would choose to forgo the services. Services or benefits likely to be excluded from the EHBs in some states include maternity care, mental health and substance abuse benefits, rehabilitative and habilitative services, and pediatric dental benefits. In particular, out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for the nongroup enrollees who would use those services. Moreover, the ACA’s ban on annual and lifetime limits on covered benefits would no longer apply to health benefits not defined as essential in a state. As a result, for some benefits that might be removed from a state’s definition of EHBs but that might not be excluded from insurance coverage altogether, some enrollees could see large increases in out-of-pocket spending because annual or lifetime limits would be allowed. That could happen, for example, to some people who use expensive prescription drugs. Out-of-pocket payments for people who have relatively high health care spending would increase most in the states that obtained waivers from the requirements for both the EHBs and community rating.

Uncertainty Surrounding the Estimates

The ways in which federal agencies, states, insurers, employers, individuals, doctors, hospitals, and other affected parties would respond to the changes made by the legislation are all difficult to predict, so the estimates discussed in this document are uncertain. In particular, states would have a wide range of options—notably, the optional waivers discussed above that would allow them to modify the minimum set of benefits that must be provided by insurance sold in the nongroup and small-group markets and that would permit medical underwriting for people who did not demonstrate continuous coverage. The array of market regulations that states could implement makes estimating the outcomes especially uncertain. But, throughout, CBO and JCT have endeavored to develop estimates that are in the middle of the distribution of potential outcomes.

Macroeconomic Effects

Because of the magnitude of its budgetary effects, this legislation is “major legislation,” as defined in the rules of the House of Representatives. Hence, it triggers the requirement that the cost estimate, to the greatest extent practicable, include the budgetary impact of its macroeconomic effects. However, because of the limited time available to prepare this cost estimate, quantifying and incorporating those macroeconomic effects have not been practicable.

Intergovernmental and Private-Sector Mandates

JCT and CBO have determined that H.R. 1628, as passed by the House, would impose no intergovernmental mandates as defined in the Unfunded Mandates Reform Act (UMRA). JCT and CBO have determined that the legislation would impose private-sector mandates as defined in UMRA. On the basis of information from JCT, CBO estimates the aggregate cost of the mandates would exceed the annual threshold established in UMRA for private-sector mandates ($156 million in 2017, adjusted annually for inflation).

So — What Did It Take to Buy Rep. Mark Amodei’s Vote FOR passage of #AHCA

It’s amazing the difference a week can make.  Last week Rep. Mark Amodei was a “NO” on passage of the American Health Care Act (AHCA), H.R. 1628. I’m not sure what he was offered to buy is “YEA” vote, but it must have been good, for him that is, because it certainly is good for any of us:

Position on April 28, 2017

Position on May 4, 2017

Rep. Amodei’s flip is morally reprehensible and opprobrious. 

Rep. Amodei clearly looked at nothing except how the insurance industry might be affected.  He did little if anything to explore how passage might impact those Nevadans who have what that same insurance industry calls “pre-existing conditions” and who the insurance industry don’t want to have to insure.  Senator Sherrod Brown of Ohio masterfully took to time to detail how that impacts real people:

So what is a pre-existing condition? Let’s put it like this – you may pay more for healthcare under their plan if you’ve been affected by:

AIDS/HIV, acid reflux, acne, ADD, addiction, Alzheimer’s/dementia, anemia, aneurysm, angioplasty, anorexia, anxiety, arrhythmia, arthritis, asthma, atrial fibrillation, autism, bariatric surgery, basal cell carcinoma, bipolar disorder, blood clot, breast cancer, bulimia, bypass surgery, celiac disease, cerebral aneurysm, cerebral embolism, cerebral palsy, cerebral thrombosis, cervical cancer, child-bearing age, colon cancer, colon polyps, congestive heart failure, COPD, Crohn’s disease, cystic fibrosis, DMD, depression, diabetes, disabilities, Down syndrome, eating disorder, enlarged prostate, epilepsy, female, glaucoma, gout, heart disease, heart murmur, heartburn, hemophilia, hepatitis C, herpes, high cholesterol, hypertension, hysterectomy, kidney disease, kidney stones, kidney transplant, leukemia, lung cancer, lupus, lymphoma, mental health issues, migraines, MS (muscular schlerosis), muscular dystrophy, narcolepsy, nasal polyps, obesity, OCD, organ transplant, osteoporosis, pacemaker, panic disorder, paralysis, paraplegia, Parkinson’s disease, pregnancy, restless leg syndrome, schizophrenia, seasonal affective disorder, seizures, sickle cell disease, skin cancer, sleep apnea, sleep disorders, stent, stroke, thyroid issues, tooth disease, tuberculosis, and ulcers. To name a few. And chances are, you or someone you know has dealt with something (or multiple things) on this list.

If this bill were to become law (which hopefully the Senate will prevent), many people with “pre-existing conditions” will become ineligible to participate in the ordinary insurance programs which they’ve been accustomed to purchasing or participating in.  They’ll be instead, relegated to “sick people plans” which are called “high risk pools.”  Since all the people in those pools will be “sick people” — people who have one or more serious conditions with more expensive drug and treatment costs —premium costs to join such a pool will be much more costly and actual, deliverable benefits will be limited or even rationed.

Rep. Amodei also failed to consider how premium costs will be calculated —> by age.  Claiming that the older one gets, the more likely one is to require receipt of benefits for all those premiums you’ve paid over the years.  So, once you hit your 50s, the bill allows insurance companies to you FIVE times more for the same policy they sell to a 25 year old.  That’s not just going to impact the “individual insurance market” — that’s also going to massively impact the “employer-provided insurance market.”  How do you realistically think that’s going to impact an employer’s aging workforce members.  One of two things are going to happen.  (1) Employers will stop providing insurance altogether (and pocket the money they used to used to subsidize your insurance as their profit without raising your wage/salary a dime. Or (2), they’ll work at making the workplace so hostile for older workers they’ll quit.

Rep. Amodei also didn’t consider that by allowing States to “waiver out” of all kinds of things — like what is covered and whether limits can be placed on deliverable benefits.  What that essentially means is that we could see a race to the bottom as some States wishing to capitalize on the employer-provided market could create all kinds of “waivered plans” that make the ‘junk insurance plans” of the pre-ACA years look like premium plans.  It’s not inconceivable that we could see plans that don’t cover maternity care, or contraception, or emergency room visits or seriously restricted networks.  So when they say … “Hey, don’t worry, you’ll be able to keep your doctor” … Worry!

Then there’s those ACA subsidies that many folks used to be able to purchase insurance.  Those have been flattened to limit the Federal Govt’s liability going forward.  On the surface, that doesn’t necessarily sound all that bad, but if you make $50K/yr, that flat amount is one thing, but if you make minimum wage or less, say $15K/yr or less that flat-rate subsidy won’t come close to enabling them to purchase healthcare insurance and they’re not going to qualify for Medicaid.

To pay for Medicaid, it requires $200B+.  The House GOP allocated a whole romping, stomping $8B in their bill to cover Medicaid.  What that means is they’ll be forcing States to “ration” health care and in the process, become death panels by denying healthcare to the sickest of the sick to be able to pay for healthcare for the less sick.

This bill is supposedly a “reconcilliation” bill, which means it MUST be scored by the Congressional Budget Office (CBO) as to it’s costs.  The CBO has not yet completed a rescoring of this latest iteration of the bill.  Thus, Rep. Amodei voted on a bill for which he had no idea as to it’s costs OR it’s impact on his Nevada constituents.  

Lastly, Rep. Amodei ignored the massive tax breaks that will be doled out to those who make well over $200,000/yr.  Basically, they’re cutting benefits to older and poor  Americans to give BILLIONS of dollars to the rich, making America sicker and putting many in graves prematurely in the process.  This bill does absolutely NOTHING to improve healthcare, it’s delivery, or it’s efficacy.  It does however, pad the wallets of the rich at our peril.

Oh … and I almost forgot … none of what the GOP alone passed in this bill would apply to members of Congress.

What do you say we terminate Mr. Amodei’s employment in 2018 and see if he can get insurance on his own?

Press Releases from NV Dems

Getting straight — A rough week for Dean Heller
Dean Heller Still Wants to Repeal the ACA
Heller getting a bit bipolar about Planned Parenthood funding
Heller Cheerleading Trump Attacks on Nevada’s National Monuments
How Does the Senator Explain That?
A complete and total disaster

Not Prepared to Govern

There’s an excellent piece in today’s Washington Post regarding the tracking for key appointments filled thus far by the Trump administration.  I can’t help but compare and contrast Trump with his Republican majorities in both houses with Obama’s 2008 Democrat majorities in both houses and the lackluster performance by the Trump and his Republican majorities.  Clearly, their lackluster performance is yet more proof that Republicans are not only not prepared to govern, but may not know how to govern for ALL Americans.

*Totals above include some posts that are not being tracked as ‘key positions’ in the appointee database.

As of late Tuesday, his 96th day in office, Trump had nominated an estimated 66 officials, just over a third of the 190 President Barack Obama selected in his first 100 days, according to Partnership data. The 100-day number for President George W. Bush was 85; Bill Clinton, 176; and George H.W. Bush, 95.  These positions include Cabinet secretaries, deputy and assistant secretaries, chief financial officers, general counsel, heads of agencies, ambassadors and other critical leadership positions. These are just a portion of the roughly 1,200 positions that require Senate confirmation, but it doesn’t stop there.  There are approximately 4100 appointments the administration will need to make.

Here’s another striking statistic from the Partnership for Public Service: “The pending number of appointees to clear federal ethics requirements is striking compared to that of the Obama administration. As of April 17, Trump had only submitted 41 percent of the nominee reports that his predecessor submitted in 2009, according to Office of Government Ethics data.”

The Senate can only act on nominations that have been formally submitted by the Trump administration. Those marked “awaiting nomination” above have been announced but not yet submitted, while those marked “formally nominated” are awaiting action by the Senate.

Think about their slow progress thus far, and then compound it with the fact that Trump fired all the Ambassadors upon his oath of office.  Trump fired all the US Attorneys.  Trump/Tillerson fired all the career folks at the State Department.  Of 556 key positions requiring Senate confirmation … Trump has no nominee for 468 positions, only 40 are awaiting confirmation, and 24 have actually been confirmed as of April 26th.

So, at this point, he appears to be running the US Government by the seat of his pants whose seat is stained with the stench of Russia.

The article on the Washington Post is a a “tracking post” which means it identifies all the positions to be filled and the status of each position.  You might want to bookmark it for your future reference.

GOP Is In Chaos—and 2018 is just around the corner

70 days in and it’s already been pretty rough for residents of Trumpland.

  • The “Obamacare” repeal? Couldn’t get a vote.
  • The Muslim ban 1.0 and then 2.0? Laughed out of court.
  • The budget? “Dead on arrival,” at least, according to Senator Lindsey Graham.
  • “You’re fired” seems to have taken over as the mode of operation, thus far: every US Ambassador effective upon his inauguration (without a single identified replacement to date),  every high-level State Department employee,
    46 District Attorneys General, Acting US Attorney General, National Security Advisor Mike Flynn, Deputy Chief of Staff Katie Walsh 
  • The president thinks it’s a great idea to threaten and mount primary challenges against ultra conservative Republican Freedom Caucus members who defy his will. (He might want to look back in history.  That tactic didn’t work so well, even for a very popular FDR.)
  • This is supposed to be the presidential “honeymoon” period.  Uh — not with ratings in the mid-thirties and dropping like a rock!
  • House Intelligence Committee chairman Devin Nunes, who was also a member of the trump transition team, flunked the “smell test” and appears to have completely derailed the House’s efforts to investigate Russian interference in the 2016 election and whether the trump campaign colluded in any way with the Russians.
  • Then there’s our Internet Privacy? ISPs are now free to sell your browsing history to the highest bidder without our permission.
  • Via executive fiat, climate change is now collectively being ignored across the board in every governmental department and LGBT statistics have been wiped from the 2020 census.
  • And what’s next? Passage of an actual budget and the need to once again raise the debt ceiling to pay for government spending Congress has already authorized.  Is yet another government shutdown on the near horizon? Will that force Democrats to vote for passage of a horrific budget just to keep the United States afloat?

The corruption of this administration is both brazen and incompetent. Case in point: Trump’s son-in-law, Jared Kushner, is about to sell his debt-laden Manhattan office tower to a bank owned by the Chinese government —> for several billion dollars above fair market value.

And if that’s not bad enough, it appears there might be evidence of Trump’s campaign coordination with Russian intelligence, strong enough that Mike Flynn won’t testify  before Congress without immunity.  Isn’t that the same Flynn who raled about if  one needs immunity, that’s an indication of being guilty?  The same guy who went on an on about that throughout the campaign?

Surprisingly, the Republican congressional delegation continues to insist that the emperor is fully clothed and has all his real hair. They are going to go down with this ship.  Once again, the Republican party is destroying itself.

Now the question is: Are progressives ready with a positive vision of a just society and the policies?  Are you ready to step up and run against the void?  Are you ready to step up to the plate and throw your hat in the ring?  Let us know, we’re listening and ready to step up and support your campaign run.  Need training?  Need folks willing to contribute or provide shoe leather for door-to-door canvassing?  We can help with that!  We just need to know who you are and how we can help.

Looking forward to hearing from you!