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  If federal matching funds are withdrawn, most states will likely return to the more restrictive eligibility rules for Medicaid eligibility ― effectively wiping out the coverage gains, leaving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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Debunking the GOP Myth: Selling Insurance Across State Lines

— by Vickie Rock

Graphic credit: MomemtBloom at VectorArt

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.

  1. 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.
  2. Doing so will NOT miraculously lower the cost of insurance.  It will however, most likely increase the size and expense of Insurance company bureaucracies.
  3. 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.

Even Without CBO Score, the Republican Healthcare Plan Gets Bad Marks

Multiple American Healthcare Act (AHCA) analyses show millions losing coverage while costs increase for vulnerable Americans

At least 15 million people risk losing health coverage under the Republican plan, according to one estimate. (Photo: Thomas Altfather Good/flickr/cc)

As the Trump administration continued on Friday to downplay a forthcoming cost analysis of the GOP’s healthcare plan, independent assessments of the proposal revealed the likelihood of large coverage losses and cost increases to hit voters who supported President Donald Trump the hardest.

The Congressional Budget Office (CBO) is expected to release its report on the American Healthcare Act (AHCA) on Monday. In advance of that, top administration officials including press secretary Sean Spicer have been “questioning the agency’s track record,” in what some described as “a preemptive effort to undermine faith in the agency’s assessment, which—when it finally appears—is unlikely to validate GOP boasts that their plan will provide better access to care.”

Health and Human Services Secretary Tom Price joined the chorus on Friday morning, telling “Fox & Friends” that the CBO has “been woefully underperforming when it comes to evaluating health systems. And that’s not because they’re bad folks. It’s because it’s challenging stuff.”

But should the CBO report indeed reflect poorly on AHCA, that assessment will be supported by separate analyses of the legislation that came out this week.

A report from the Center for Health Policy at the Brookings Institution and the University of Southern California’s Schaeffer Center for Health Policy and Economics released Thursday drew upon prior CBO estimates and analysis to assess how CBO will likely expect this legislation to impact insurance coverage.

Pointing to widespread “coverage losses associated with curtailing federal funding to Medicaid expansion states” in addition to other factors, it predicts the CBO “will likely estimate that at least 15 million people will lose coverage under [AHCA] by the end of the ten-year scoring window. Estimates could be higher, but it is unlikely they will be significantly lower.”

What’s more, according to data journalist Nate Cohn of the New York Times, the system of tax credits established under the GOP plan leaves rural, older, and white working-class voters—many of whom voted for Trump—the most financially vulnerable.

Citing data from the Kaiser Family Foundation and the Cooperative Congressional Election Study (CCES), a large survey of tens of thousands of Americans on healthcare and voting, Cohn reported Friday:

[T]he Republican plan offers less assistance to older and lower-income Americans, especially in rural areas, according to the Kaiser data. These groups generally backed Mr. Trump. Most of all, President Trump’s white working-class supporters often make enough money to be ineligible for Medicaid, but not enough to afford costly health insurance that might even become more expensive under the Republican plan.

The plan would hit older and rural Americans hardest because it wouldn’t provide a larger tax credit to people with more expensive plans. Older Americans pay the highest premiums, and the law would allow insurers to raise premiums for older customers even further.

And Cohn’s analysis didn’t even take into account the direct impact on those benefiting from the Affordable Care Act’s (ACA) Medicaid expansion—though Cohn notes that “Trump led by 49-46 percent among Medicaid beneficiaries in the nine red expansion states that have voted Republican in the last two presidential elections.”

Reporting on Cohn’s analysis for the Washington Post, Greg Sargent said the numbers leave “little doubt” that Trump “scammed many of his working-class supporters.”

“Trump strongly indicated” to those voters “that he would not adopt a typical Republican’s ideological stance on healthcare that would leave many of them stranded,” Sargent wrote. “But now he has.”

And he has done so while handing a giant tax break to wealthy individuals and insurance and drug companies and greatly expanding tax-sheltering opportunities for high-income people through health savings accounts (HSAs), as the Center on Budget and Policy noted in one of several AHCA analyses it published this week. Those changes, the group noted, come at a cost of almost $600 billion.

“At the same time,” the center’s Chye-Ching Huang wrote Wednesday, “the plan would seek to offset the cost of these windfall tax breaks by ending the ACA’s Medicaid expansion, radically restructuring the entire Medicaid program by converting it to a per capita cap, and dramatically scaling back the subsidies that low- and moderate-income families use to purchase affordable healthcare, as well as other coverage changes that would undermine the health and financial security of millions of households.”

Ummm — That’s How “Insurance” is Supposed to Work!

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.

#TrumpedUpCare Losers: Those Using Long-Term Care Under Medicaid

Rep. Joe Kennedy III speaking at 4:15AM this morning on the impact of the Republican’s #TrumpedUpCare bill on those who receive Medicaid benefits for #LongTermCare ….so much for Republicans NOT picking “winners and losers” … about 6.9 MILLION seniors across America who could find themselves turfed out of care when there’s no way to pay the bill for their care.