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.”
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 If federal matching funds are withdrawn, most states will likely return to the more restrictive eligibility rules for Medicaid eligibility ― effectively wiping out the coverage gains, leaving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.
— by Thomas Huelskoetter and Emily Gee Recent reports indicate that the emerging Senate version of the American Health Care Act (AHCA) may not include the House version’s provision permitting states to waive the Affordable Care Act’s (ACA) community rating provision, which prevents insurers from charging sick people higher premiums than healthy people.
Even without community rating waivers, the Senate bill would still critically weaken protections for people with pre-existing conditions. By allowing states to waive the ACA’s essential health benefits (EHB) requirements, it would enable insurers to effectively screen out sick people by excluding certain services.
As a result, people with pre-existing conditions in waiver states would face significantly higher costs and find it much harder to find insurance plans that actually covered treatment for even relatively common conditions such as mental health problems or diabetes. The Center for American Progress estimates that in the individual market, 5.3 million enrollees with pre-existing conditions would live in states that waive EHBs and thus see their protections eroded.
In addition, the problem would be particularly acute for older Americans, who would face much higher premiums under the AHCA, as well as for millions of low-income Medicaid enrollees, who would lose comprehensive coverage due to the AHCA’s $834 billion in cuts to that program.
Essential health benefits waivers would raise costs for people with pre-existing conditions
The ACA’s EHB standards ensure that insurance plans in the individual and small-group markets cover a comprehensive set of medical benefits, including mental health care, maternity care, hospitalizations, and prescription drugs. Prior to the ACA, significant percentages of plans in the individual market failed to cover many of these services.
The emerging Senate repeal bill would allow states to waive EHB requirements and replace them with a narrower set of benefits. In waiver states, many insurers would drop coverage for more expensive conditions that were no longer required. The consequence of this would be significant cost increases for people who need these services. As the Congressional Budget Office (CBO) explains:
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.
Additionally, EHB waivers would substantially weaken the ACA’s ban on annual and lifetime dollar limits on coverage, since this ban only applies to essential health benefits. Thus, even people who found insurers willing to cover benefits that were no longer required would still be affected, since those insurers would be free to impose annual or lifetime limits on those benefits. Patients with expensive pre-existing conditions that required treatment would then be at risk of hitting these limits and being forced to pay out of pocket.
The effects of the EHB waivers would be widespread. Although the CBO did not attempt to guess which states would pursue waivers, its score of the final House bill projects that about half of the population would be in states that would choose to waive EHBs. Enrollment in the individual market currently consists of 12.2 million people on the marketplace and an estimated 6.9 million off of the marketplace, totaling about 19.1 million enrollees. Under the CBO’s projection, half of this, or about 9.6 million individual market enrollees, would live in waiver states. Since data show that 55 percent of individual market enrollees have pre-existing conditions, this would translate to about 5.3 million enrollees with pre-existing conditions living in waiver states.
EHB waivers would lead to a race to the bottom on benefits
In EHB waiver states, people with pre-existing conditions would see their protections drastically eroded. Insurers would still be formally banned from rejecting sick people and charging them different rates. However, the lack of comprehensive EHB requirements would open the door for insurers to discriminate systematically against sick people.
Enrollees with expensive pre-existing conditions would need more comprehensive benefits and be less likely to buy bare-bones plans, since the latter would force them to pay for many treatments out of pocket or purchase expensive coverage riders. As a result, insurers would know that offering essential benefits would attract sicker enrollees, while offering more bare-bones coverage would be more attractive to healthier enrollees.
Ultimately, this could lead to a downward spiral in plan benefits as insurers competed to attract healthy enrollees and discourage sick people from enrolling. Insurers would not be making decisions on which benefits to cover in a vacuum; they would nervously be expecting their competitors to reduce benefits, which would push sick enrollees toward any insurers still offering more comprehensive benefits. Insurers that did continue to offer comprehensive benefits would be forced to increase their premiums significantly.
Thus, insurers would likely engage in a race to the bottom to avoid attracting the sickest enrollees. This would also affect healthy people, who would see fewer plan options offering comprehensive benefits than prior to the ACA.
Age tax and repeal of Medicaid expansion would compound these effects
The House version of the AHCA would also have loosened the ACA’s age rating band to permit insurers to charge older enrollees five times more than younger enrollees. The emerging Senate plan would reportedly also allow states to waive the ACA’s current 3-to-1 age rating band. In other words, the AHCA would effectively impose an age tax on older Americans, who would need to pay much more to obtain coverage than they would under current law.
In states that opted for both of these waivers under the Senate bill, the effects of this age tax on premiums would compound the negative impact of the EHB waivers, since older enrollees are more likely to have pre-existing conditions.
There are an estimated 5.1 million enrollees ages 55 to 64 covered through the individual market, both on the ACA marketplace and outside it, and estimates show that 84 percentof enrollees in this age group have at least one pre-existing condition that would have resulted in them being denied coverage or being charged more prior to the ACA.* Nationally, CAP estimates that 4.3 million people ages 55 to 64 would be at risk from both the age tax and the loss of pre-existing conditions protections; under the CBO’s projection, about 2.2 million of these would live in waiver states.
Similarly, people with pre-existing conditions who were made newly eligible for Medicaid under the ACA’s Medicaid expansion would also be worse off under the Senate bill. The Senate repeal bill calls for Medicaid expansion funding to be phased out over time, forcing financially strapped states to cut back eligibility for the program. Millions of people with pre-existing conditions in the expansion population could find themselves uninsured and unable to obtain affordable insurance that covers their pre-existing conditions or covered by plans that leave them exposed to high out-of-pocket costs for needed services.
More than 11 million people are currently enrolled in Medicaid thanks to the ACA expansion, which extended Medicaid eligibility to people with incomes up to 138 percent of the federal poverty level, and survey data show that about 48 percent of people in that income range have pre-existing conditions. Thus, CAP estimates that nationwide, about 5.4 million newly eligible Medicaid expansion enrollees have pre-existing conditions; under the CBO’s projection, about 2.7 million of these would live in waiver states.
In addition, CAP has previously estimated that 900,000 elderly people who receive coverage through both Medicaid and Medicare would lose Medicaid due to the AHCA’s caps on federal funding for traditional Medicaid. Without Medicaid, these beneficiaries would receive fewer benefits and face higher cost sharing—making it harder to afford treatment for pre-existing conditions.
The House version of the AHCA would gut protections for people with pre-existing conditions in multiple, interconnected ways. Even without waivers for community rating, the emerging Senate repeal bill would still undermine protections and trigger a race to the bottom as insurers in EHB waiver states reduced their benefits in order to discourage sick people from enrolling. Millions of people with pre-existing conditions in these states would face higher costs and struggle to find affordable plans that cover the services and treatments they need.
Thomas Huelskoetter is the policy analyst for the Health Policy team at the Center for American Progress. Emily Gee is the health economist for the Health Policy team.
* Data from the Centers for Medicare & Medicaid Services show that 3.3 million people ages 55 to 64 enrolled in marketplace coverage for 2017 and accounted for 27 percent of total enrollment. We assume that 27 percent of people enrolled outside the marketplace are also in that age range. The U.S. Department of Health and Human Services estimated that 6.9 million people are enrolled in individual market coverage outside the marketplace.
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
With health care being at the forefront of our agenda this week in the House, I think it’s important to continue focusing on the salient facts. Following extensive coordination and discussions with Nevada Medicaid officials and House leadership staff about the Medicaid portion of the American Health Care Act (AHCA), I’ve been left with the following conclusions:
21% of Nevada’s insured population is insured through Medicaid;
The national average is 20%.
Based on numbers supplied from Governor Sandoval’s Administration which I believe to be credible, if this bill were to become law, after 48 months, there will be a nearly $240 million funding shortfall for Medicaid in Nevada. Additionally, it does nothing to make the proposed Medicaid reforms (which impact three times that many Nevadans) more workable for Nevada.
It’s no surprise to businesses or taxpayers that the tax climate in Nevada has been challenging over the last several legislative sessions. Therefore, I will not vote for a bill that leaves the 2019 Legislative Session and Nevada’s new Governor with a nearly quarter of a billion dollar loss in funding. My resolve is further strengthened by President Trump’s recent tax proposal which his Administration has expressly said “pays for itself”. I’m wondering why we need to take nearly $1 trillion out of Medicaid nationwide to pay for a “self-funded” tax proposal.
With respect to the private market reforms, I’ve been left with the following conclusions:
Those who purchase their health insurance on the private market represent 7% of the Nevada insurance market;
The nationwide average is 7%.
My analysis of the latest revisions to the private market provision of the American Health Care Act is as follows:
States would be able to submit waivers to Health and Human Services (HHS) on certain Essential Health Benefit (EHB) Requirements. Under this amendment, there is no way to estimate how much premiums would be reduced nationwide because it would be dependent upon which EHB requirements the states choose to waive. Considering the Nevada State Legislature recently passed a bill which reiterated its commitment to essential health benefits as understood under the Affordable Care Act (SB 394), it is unlikely the state would soon waive any EHB requirements making certain that the amendment has no premium impact on Nevada.
My staff and I will continue to evaluate any and all suggestions and changes in regards to the American Health Care Act. It’s important to note that most health care reform issues must be resolved through legislation that requires 60 votes in the Senate and extensive regulatory work by HHS Secretary Tom Price. While I will continue to keep an open mind, if the current plan is the bill that comes to the Floor for a vote – I will not be supporting it.
Position on May 4, 2017
“Since the convening of the 115th Congress four months ago, my office has been conducting extensive research into the various AHCA proposed reforms.
“The notions that healthcare in general, and the seven-year-old Affordable Care Act in particular, needed further legislative action, are in my opinion – valid.
“With Speaker Paul Ryan’s proposal – the AHCA – introduced several months ago, my primary focus in evaluating that proposal was, and remains, the impacts on Nevada’s second largest insurance group – those on Medicaid (21%).
“When speaking on the Medicaid issue, I break Nevadans on Medicaid into two groups. Those on traditional Medicaid: children, pregnant women, disabled, and the elderly. And those Nevada Medicaid enrollees whose eligibility was established through Medicaid expansion and by the Affordable Care Act.
“I am happy to indicate to Nevada traditional Medicaid enrollees, that my review of the current version of the AHCA will make no changes in current enrollee eligibility and will likely increase federal funding to Nevada’s traditional Medicaid program based on Nevada’s historical per capita growth rate, versus the growth rate provided in the bill.
“With respect to Nevada’s expanded Medicaid enrollees, my overriding concern was that the AHCA would leave Nevada with a nearly $245 million shortfall by cutting federal Medicaid funding to the states over the coming four years. So long as that potential deficit was a possibility for Nevada – I was a “no” vote. The prospect of either kicking Nevada Medicaid expansion enrollees off of Medicaid, or forcing the 2019 Legislature to make up a nearly quarter of a billion dollar loss in federal Medicaid funding was, and is not, acceptable to me.
“As a result of extensive discussions, further research, and the involvement of present and former Nevada Medicaid officials, Secretary Tom Price of the U.S. Department of Health and Human Services, Administrator Seema Verma of the Centers for Medicare and Medicaid Services, Vice President Mike Pence, and the House Republican Leadership – I have identified language in the present version of H.R. 1628 which establishes the following facts:
“Any Nevadan who has enrolled in the expanded Medicaid program from its inception in 2014 through the end of 2019 is free to remain in the program so long as their income does not exceed 138% of the national poverty level. This is current law under the Affordable Care Act;
“Nevada will continue to receive enhanced federal Medicaid funding for enrollees that it is currently receiving for as long as that enrollee stays in that program;
“Present expanded enrollees lose eligibility only if they exceed income of 138% of the national poverty level, or if they elect to take employer provided or private health insurance;
“Included in the bill are tax credits paid in advance (available even if the individual doesn’t owe taxes) and additional cost-sharing mechanisms to ensure those recently leaving Medicaid can have access to insurance on the private market;
“These conclusions are based on the language contained in the bill, which you may find below.
Expansion ACA v. AHCA
1. As amended by the ACA, Section 1905(y)(1) of the Social Security Act lists the FMAP rates for the ACA Expansion population:
(NOTE of explanation: Federal Medical Assistance Percentages (FMAP) are the percentage rates used to determine the matching funds rate allocated annually to certain medical and social service programs in the United States of America.)
(y)Increased FMAP for Medical Assistance for Newly Eligible Mandatory Individuals.—
(1) Amount of increase.—Notwithstanding subsection (b), the Federal medical assistance percentage for a State that is one of the 50 States or the District of Columbia, with respect to amounts expended by such State for medical assistance for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i), shall be equal to—
(A) 100 percent for calendar quarters in 2014, 2015, and 2016;
(B) 95 percent for calendar quarters in 2017;
(C) 94 percent for calendar quarters in 2018;
(D) 93 percent for calendar quarters in 2019; and 90 percent for calendar quarters in 2020 and each year thereafter.
(E) 90 percent for calendar quarters in 2020 and each year thereafter.
2. AHCA Section 112(b) modifies this section such that this rate only applies to individuals enrolled before 12/31/219 who do not have a break in eligibility for more than one month:
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended— (1) in subsection (y)(1), in the matter preceding subparagraph (A), by striking ‘‘with respect to’’ and all that follows through ‘‘shall be’’ and inserting “with respect to amounts expended before January 1, 2020, by such State for medical assistance for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i) who are enrolled under the State plan (or a waiver of the plan) before such date and with respect to amounts expended after such date by such State for medical assistance for individuals described in such subclause who were enrolled under such plan (or waiver of such plan) as of December 31, 2019, and who do not have a break in eligibility for medical assistance under such State plan (or waiver) for more than one month after such date, shall be…”
“Accordingly, I have concluded that the potential for Nevada deficits or expanded Medicaid enrollees being kicked off of Medicaid will be avoided. While I know anything to do with American healthcare is incredibly controversial, we need to continue the process of improving healthcare in America. I fully expect the Senate to continue what has been a raucous discussion to say the least. Nevertheless, American healthcare badly needs work. With my vote today, I am supporting a start of that newest work chapter, while attempting to protect Nevadan’s healthcare interests.”
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?
Have you noticed of late, that one Republican after another is proclaiming that “if only” we remove federal impediments and allow Insurance Companies to “sell insurance across state lines” costs for insurance will magically go down? UHHH, NO!
Let me be very clear here.
There is NOT one U.S. federal law that prohibits health insurance policies from being sold across state lines. Insurance companies, should they choose to do so, can do that today.
Doing so will NOT miraculously lower the cost of insurance. It will however, most likely increase the size and expense of Insurance company bureaucracies.
Declaring that any insurance company can sell whatever policies they want in any state they want, technically stomps the crap out of States’ Rights, since State Insurance Commissioners regulate insurance policies sold in their states.
Two things come into play for insurance being sold today and everyday across state lines: rules established by State Insurance Commissioners and Networks established by Insurance Companies.
Let’s start with State Insurance Commissioners. They’re charged with protecting the rights of consumers and the public’s interest in dealing with the insurance industry and are responsible for regulating the insurance industry in their State. They review insurance policies proposed to be offered for purchase within the state to ensure compliance with Nevada insurance laws and regulations. They make sure insurance companies are solvent and have the ability to pay claims. And, when you’re unable to resolve a conflict as to coverage or billing with your Insurer, they’re the ones we turn to for help in resolving the issue.
None of those functions are performed by the Federal Government! Those are State functions and for Republicans to be putting forth arguments that are ludicrous and stomp the crap out of clear States’ responsibilities for their constituencies is pure hypocrisy on their parts.
Secondly, let’s talk about the insurance companies themselves.
For those of us who are familiar with employer insurance, we know that the line “if you like your insurance, you can keep your insurance” was pure bumpkiss at best. We’ve been hostage to whatever policies our HR department can obtain through negotiation with various insurance companies for our pool of employees. If our small pool has a number of catastrophic health events, our premium rates will be going up as well as our deductibles. We might also find ourselves in a restrictive network where any services provided by those outside of that network can be outrageously expensive.
Insurance companies establish relationships with various doctors, hospitals, labs, clinics, etc. and group them into “provider networks.” Urban areas have much larger and more inclusive networks service-wise, that do rural areas which frequently have mostly general or family practice physicians and fewer specialists like endocrinologists, gastroenterologists, oncologists, etc. Urban networks may include all hospitals in the urban area or may include just one, while rural areas may have no hospital and merely a local clinic.
Our rural town is lucky to have a rural hospital which may see some serious challenges under the GOP’s “American Health Care Act (AHCA)” given it will cut all support to “rural” hospitals. Some of the improvements we’ve seen of late with its ability to pull in “specialists” from our State’s urban centers might be in jeopardy. If your AHCA “network” should include only our local hospital, but the surgery or the treatment you need is not available locally as “in-network,” it’s going to cost you big time when you get charged for “out of network” care you seek from that urban center hospital up or down the road.
We have limited Insurance providers in Rural America because insurance companies don’t want to the bother of serving us. They don’t want to have to span across America and try to establish relationships with providers spread across vast areas and devise appropriate networks of providers. It’s more convenient for them to concentrate on the the competitive urban centers.
So NO, the GOP’s AHCA is not going to magically increase the number of policy options for those of us in Rural America as they claim. It does absolutely nothing to encourage “across state line” availability of insurance policies. AND, it does nothing to reduce the costs of either insurance policies or fees for services rendered. It may, however, actually make it worse for many of us who live in Rural America who are actively seeking medical services and/or insurance at costs we can actually afford.
The American Health Care Act (AHCA), released by Congress this week, is intended to repeal and replace the Affordable Care Act (ACA). But as introduced, it does not align with the health reform objectives that the AMA set forth in January to protect patients. While the ACA is imperfect, the current version of the AHCA is not legislation we can support.
The replacement bill, as written, would reverse the coverage gains achieved under the ACA, causing many Americans to lose the health care coverage they have come to depend upon.
In a letter sent today to leaders of the House committees that will mark up the AHCA, AMA CEO and Executive Vice President James L. Madara, MD, wrote that the proposed changes to Medicaid would limit states’ ability to respond to changes in service demands and threaten coverage for people with low incomes. Dr. Madara also noted that the proposed changes in tax credits and subsidies to help patients purchase private health insurance coverage are expected to result in fewer Americans with insurance coverage.
It is unclear the exact impact this bill will have on the number of insured Americans, and review by the nonpartisan Congressional Budget Office is still pending. The ratings and analytics firm S&P Global Ratings has already estimated that as many as 10 million Americans could lose coverage if this bill becomes law, saying that between 2 million and 4 million people could lose the insurance they purchased in the individual health exchanges under the ACA, and between 4 million and 6 million could lose their coverage under Medicaid.
That just won’t do.
We all know that our health system is highly complex, but our core commitment to the patients most in need should be straightforward. As the AMA has previously stated, members of Congress must keep top of mind the potentially life-altering impact their policy decisions will have.
We physicians often see patients at their most vulnerable, from the first time they set eyes on a newborn child to the last time they squeeze a dying loved one’s hand. We don’t want to see any of our patients, now insured, exposed to the financial and medical uncertainties that would come with losing that coverage.
That is, above all, why physicians must be involved in this debate.
I find it depressing that Speaker Ryan actually said: “The whole idea of Obamacare is … the people who are healthy pay for the … sick. It’s not working, and that’s why it’s in a death spiral.”
Ummm … that’s the way Insurance is supposed to work! Maybe someone should ask the GOP’s jihadist Speaker “WHY then does government mandate that we by car insurance?” The same principle applies, but instead of sick and not sick, it’s good driver and bad driver. Insurance is a “pool” where we all contribute to assure we can each get the care we need when we get sick and need treatment. It may be me this month, but you the next. Where just one of us may not be able to pony up the full cost for breast cancer treatment, but the pool can. We all don’t get breast cancer or prostate cancer or have a heart attack all at the same time.
The orchestrated “Death Spiral” is being created by actions taken by the Gang of Predators to orchestrate the demise of the Affordable Care Act. Here’s the actual timeline of events published on the Speaker’s website detailing the activities they have taken over the last year to take down the accessibility to insurance for ordinary Americans.
Here’s some food for thought as to Ryan’s point #5: A federal judge has ruled that Aetna was NOT being truthful when the health insurer said last summer that its decision to pull out of most Obamacare exchanges was strictly a business decision triggered by mounting losses. U.S. District Judge John Bates concluded this week that Aetna’s real motivation for dropping Obamacare coverage in several states was “specifically to evade judicial scrutiny” over its merger with Humana. Aetna’s temper tantrum to pull out of Obamacare exchanges in 11 states last August, including 17 counties in Florida, Georgia and Missouri where the Department of Justice argued the merger would wipe out competition and blocked Aetna’s $34 billion merger with Humana on antitrust grounds.
Please note that in #6, the Speaker rales about how premiums spiked … uh … might their budgetary activities that continually cut Disproportionate Share Hospital (DSH) financial support to hospitals that serve the nation’s most vulnerable populations – Medicaid beneficiaries, low-income Medicare beneficiaries, the uninsured and under-insured. I in 2013 alone, hospitals provided $46 billion of uncompensated (DSH) care. Facilities have to be maintained. Supplies need to be purchased. Doctors and nurses need to get paid for their services. The money for that just doesn’t get picked off of some magical tree planted on the Hospital front lawn. It gets charged to the rest of us in the form of higher rates for services rendered, which in turn gets transformed into HIGHER insurance premiums to be able to pay for such services.
We don’t know all the details of Donald Trump’s plans for America yet but one thing’s clear: If you’re not male, wealthy or heterosexual, Trump’s extreme right-wing administration won’t have your back when it comes to accessing health care.
Soon, the Senate will begin committee hearings to confirm Trump’s nominee for Secretary of Health and Human Services, Georgia Rep. Tom Price. Anti-woman, anti-gay Price wants to repeal the Affordable Care Act, cut Medicaid, end Medicare and defund Planned Parenthood.
Putting Price in charge of important programs that keep millions of women, LGBTQ people, low-income families and the elderly healthy is irresponsible and dangerous.
A vote is expected soon, so we must act now to urge Senate Democrats to do everything in their power to stop Price’s confirmation as HHS secretary before it’s too late.
There is no reason to give a hate-group candidate who did not win the majority vote a free pass to appoint anti-woman, anti-gay extremists to leading positions in government. Price is just one of Trump’s many cabinet nominees that Democrats will need to resist and block in order to protect their constituents from Trump’s regime of hate.
If the Senate confirms Price as HHS secretary, it will put the health care of more than 100 million people at risk:
Price will help right-wing extremists like Paul Ryan end Medicare. Medicare is a fundamental tool of economic security – a guarantee that seniors will not be denied health care just because they can’t afford it. Price is a leading proponent of destroying Medicare by privatizing the program.
Price will take health insurance away from millions of people covered under the ACA. He wants to roll back the Medicaid expansion and replace the Affordable Care Act with a plan that primarily benefits people who have high incomes, leaves people with pre-existing conditions behind and makes it more difficult for people to purchase health plans that include abortion coverage.
Price will continue to push for drastic Medicaid cuts that could strip tens of millions of low-income families and children of their health insurance. If Republicans in Congress succeed at repealing the ACA and pass Price’s proposed Medicaid cuts, funding for Medicaid and the State Children’s Health Insurance Program would decrease by more than 40 percent over the next 10 years.
He will take away women’s health care. Price is an anti-woman extremist who supported legislation to defund Planned Parenthood and opposed the ACA birth control benefit that gave women access to contraception without a copay.
Price will hurt the LGBTQ community. As a legislator, Price has supported constitutional amendments banning same-sex marriage and voted against a bill that prohibited employers from discriminating against LGBTQ employees. While the ACA prohibits LGBTQ discrimination, Price’s ACA alternative provides no such protections.
He belongs to a fringe group of physicians who still question whether HIV causes AIDS. As the head of HHS, Price will have control of the country’s national HIV/AIDS strategy, which includes funding for research, education and treatment to combat the disease. The decisions he makes could mean life or death for many of the 1.2 million people living with HIV in the United States.
Right-wing Republicans say that Price’s experience as chair of the House Budget Committee and expertise as a former orthopedic surgeon make him uniquely qualified for the job of HHS secretary. But Price’s record shows that he’s just another out-of-touch extremist who will gladly fleece low-income and elderly people of their health insurance under the guise of fiscal responsibility while lining his own pockets. Over the last four years, Price has traded more than $300,000 in shares of health-related companies while sponsoring and advocating for legislation that could potentially affect those companies’ stocks.11
Senate Democrats must stand their ground and resist confirming all members of Trump’s crony cabinet, and they need to start now by blocking Price’s HHS confirmation.
Tell Senate Democrats: Block Price and protect access to health care for millions of people. Click the Credo button below to sign their petition. Even better, call Sen. Dean Heller’s office [ 202-224-6244 (DC) / 702-388-6605 (LV) / 775-686-5770 (Reno) / 775-738-2001 (Elko) ] and personally tell him you do NOT support Rep. Tom Price’s confirmation as HHS Secretary.
For all those middle class voters who “wanted a change” and “someone to shake up the system,” they’re about to get what they wished for. The only problem is that now that the Republicans have complete control of government, they’re getting ready to take down programs Trump literally swore he wouldn’t touch. Their first priority is doing a complete repeal of “Obamacare” … something Trump voters love and thought that what he was saying was just bluster and that it would never happen. Well …….. surprise!
According to Speaker Paul Ryan (R-WI), in his press release today —
Once Obamacare is repealed, we will make sure there is a stable transition period so that people don’t have the rug pulled out from under them. One key to ensuring a smooth transition is getting House Budget Committee Chairman Tom Price, M.D. (R-GA) confirmed as Secretary of Health and Human Services. Working together, we will focus on delivering relief and a better system for people struggling under Obamacare.
Instead of a government-centered system like Obamacare, our goal is a patient-centered system that gives every American access to quality, affordable health care.
What does that look like? Well, last spring, as part of the Better Way agenda, House Republicans offered a unified health care plan to show the American people what we would do differently. It included a number of common-sense ideas and principles, such as:
Moving health care decisions away from Washington to patients, families, and doctors,
Giving patients the right tools, like Health Savings Accounts, to make health insurance more portable and affordable,
Breaking down barriers that restrict choices and prevent Americans from picking the plan that is best for them and their family,
Real protections and peace of mind—regardless of age, income, medical conditions, or circumstances,
Empowering small businesses to provide the kind of affordable health coverage that meets your needs.
Here’s what some experts and editorial boards had to say about these ideas when we put them forward earlier in the year:
“The overriding theme of the plan’s many reforms is consumer-directed health care. The ACA moved substantial power and authority over the insurance marketplace and the care delivery process to the federal government. The House GOP wants to reverse this shift of authority by giving consumers and states more control over important decisions in the health sector.” (James Capretta and Joseph Antos, AEI)
“…shows that Republicans understand that a better health care system requires the repeal of Obamacare. Admirably, it proposes a number of patient-centered reforms to the employer and individual market…” (Michael Needham, Heritage Action)
“…it is better economic policy because it makes the health sector look like the rest of the economy — built on competition, rewarding quality and low-costs, and evolving flexibly to meet the needs of the customer base. It is a far cry from the top-down, industrial-age Obamacare spigot of federal dollars and regulations.” (Douglas Holtz-Eakin, American Action Forum)
“…builds on successful reforms of the past and points us toward a more market-oriented, consumer-driven model, while addressing many of the complaints and fears that Americans have about their health-care system.” (National Review)
“…their vision in broad terms of how to deliver quality health care for Americans without entangling them in red tape and federal mandates. …would help Americans get insurance without handing over all control to the federal government.” (Chicago Tribune)
The American people know the status quo is unsustainable: 80% want some kind of major changes. We will act to bring relief to people struggling under Obamacare.
I ask you, after reading Mr. Ryan’s vague description of what he thinks is wrong and how to help ordinary Americans, what planet does he go home to each evening? He certainly does NOT live in a community such as those in which most Americans life.
Individual families, not the Federal Government, make their own decisions about where to seek care and from which companies to buy their insurance, from those insurance companies/doctors/pharmacies/etc., that provide services in their communities.
The problem is the cost and the fact that wages have been pretty much flat or declining for a decade or more, while prices for services and drugs have skyrocketed. How is a health savings account going to remedy that? The major “barrier” most Americans have in selecting the “best” plan for them and their family is not that it’s offered in a state three states away, but that they can’t afford to buy that “best” plan and all too frequently end up settling for a plan that oft times bankrupts their budget when a serious injury or disease strikes a member of their family.
How the hell is repealing the ACA without replacement going to provide “real protections and peace of mind”? That’s what the ACA attempted to do by setting a minimum standard for what insurance plans must carry and prohibiting insurance companies from denying coverage. As an example under the ACA, insurance companies can no longer deny coverage to a new born infant who was covered from the instant of conception until birth because they have some mysterious pre-existing (?) condition.
Consumer-directed health care? What does that even mean? Employers don’t offer a wide variety of insurance plans from which their employees can be “consumer-directed.” Mr. Ryan and his caucus want employers to continue to be the means via which employees would access insurance coverage (which continues to tether the employee to the employer). The only “consumer-driven” control over what is or is not available to meet his/her and family needs would continue to be to find another employer who’s negotiated better policies and premium rates, and hope he/she and the family won’t be denied coverage under the next employer because of some insurance-company-declared “pre-existing condition.”
The change that Mr Ryan refers to, that “80% of Americans” want, is not to return to what we didn’t have before enactment of the ACA, but improvements to the ACA to make healthcare options even more accessible and affordable.
Please note, the only thing Republicans are still talking about is “repeal.” We have yet to see any form of comprehensive bill to “replace” the Affordable Care Act (Obamacare). What we have seen is a bill to restrict how much an injured party can sue for as compensation (tort reform) for that doctor’s malpractice, restricting compensational sums to amounts that may not allow injured individuals to fully recover from their loss. Another Republican bill proposes to stomp the crap out of states rights by opening up markets and allowign insurance policies to be sold across state lines (meaning good luck getting any help from your state’s insurance commissioner if you bought an out of state policy that’s underperforming). Lastly, they’ve proposed that individuals should just take responsibility for their own health care using healthcare savings accounts through their employer (if even offered by their employer and which aren’t currently portable from one employer to no employer to a next employer).
None of the proposals by the Republican leadership address the root causes of the out of control costs Americans face for healthcare across our nation. In reality, what would truly help control the costs are what other nations are doing — regulating the costs of services and pharmaceuticals — but given the free market enthusiasm of the Republican corporatists in Congress, and that they hold majorities in both Houses and hold the office of the president, you can expect charges for services/pharmaceuticals to continue to rise at astronomical rates, unabated. They should also be taking a serious look at medical/pharmaceutical patent abuse to prevent drug prices from being jacked up 5000% when some punk hedge fund CEO buys the rights to a drug decides it would be a great little money maker for him (e.g., Martin Shkreli, the hedge fund manager and drug company CEO who became a poster boy for Wall Street greed when he raised the cost of a life-saving pill from $13.50 to $750).
Stay tuned to this one. Repeal (without replacement) of the Affordable Care Act (Obamacare) will be the Republican Congress’ #1 priority when the 115th Congress convenes.
In Congress, Dr. Joe Heck introduced legislation to “fully repeal” (without any replacement) what he claims is “the unsustainable ACA.” He also voted 37 times to eliminate the Affordable Care Act altogether.
Congressman Joe Heck recently met with the Reno Gazette Journal’s Editorial Board, where, in addition to reminding Nevadans of his loyalty to his climate-change denying benefactors, the Koch brothers, he tried to hide his record of working to take away health insurance from thousands of Nevadans. Just 5 months ago, Congressman Heck was touting that he “introduced and cosponsored legislation…to fully repeal the unsustainable ACA,” a perfect complement to his 37 votes to repeal the law. Yet today, Heck made a blatant attempt to muddy the waters saying that he doesn’t think a full repeal is possible. Say what?
“As he’s shown us throughout this entire campaign, Joe Heck has perfected the art of speaking out of both sides of his mouth and trying to have it both ways,” said Mairead Lynn, spokesperson for the Nevada Democratic Party. “But for Joe Heck, the votes don’t lie. He voted 37 times with his Party to repeal the Affordable Care Act, and introduced legislation that would fully repeal the law. Repealing the Affordable Care Act would mean insurance companies could deny health insurance to people with pre-existing conditions, women would lose access to preventative screenings, and almost 300,000 Nevadans would be stranded without health insurance. This is just another example of how wrong Joe Heck is for Nevada.”
On March 24, the Congressional Budget Office, or CBO, published data that surprised even the staunchest advocates for health care reform: New estimates show that total federal spending in fiscal year 2016 for major health care programs will be lower than was projected back in January 2009. Why is this shocking? The January 2009 projections did not include the Affordable Care Act, or ACA, which was not signed into law until March 2010. This means that federal health programs are covering more people while spending less money.
Though the ACA coverage expansion added new costs, total spending for federal health programs is still less than what the CBO projected in January 2009 because of huge savings from Medicare. In fact, the CBO’s projections for FY 2016 Medicare spending have fallen $107 billion since January 2009. A portion of the Medicare savings can be unambiguously attributed to the ACA.