Archive for the ‘Healthcare’ Category
Kevin Drum blogs at Mother Jones:
Earlier this morning I sketched out a possible compromise between Obamacare and Trumpcare that might have a chance of getting through Congress if everyone agrees to a plan that would rely on both Republican and Democratic votes. I consider the odds of such a thing small, but nevertheless it’s worth looking at why nearly everyone should find this idea attractive:
- Donald Trump gets a big win. Paul Ryan couldn’t get his plan through Congress, but then Trump steps in and pulls off a huge deal. His presidency is back on track.
- Republicans in Congress get an albatross off their backs. Right now, health care is a loser for them, and the Freedom Caucus is riding high. But if they pass a bipartisan plan, it sticks a finger in the eye of the FC ultras. And if they’re worried about their base, they don’t have to be. Trump will sell the hell out of the plan, and his fans will buy it.
- Democrats have to make some concessions, but in return they get stability and permanence—and the possibility of future enhancements—for a social welfare program they’ve been trying to get enacted for decades.
- The health care industry gets some certainty about the future, along with a system that promises to be a moneymaker for them.
Who are the losers in this deal? Hardly anyone. The ultras lose, but everyone wants them to lose. Rich people lose a bit because they continue paying a modest tax, but frankly, I haven’t noticed that rich people are all that upset about it. They care more about capital gains taxes and top marginal rates. Talk radio shouters lose a reliable audience pot stirrer, but they’ll support Trump in the end. And they have plenty of other ways of keeping their listeners at a fever pitch of outrage anyway.
Oh, and I almost forgot: . . .
Nothing easier: reassign people, underfund, and delay. Kevin Drum has an interesting post on how the Republican “No” votes were all over the map, and he includes this in the post:
. . . here’s how the Journal’s article begins:
With the collapse of Republicans’ health plan in the House on Friday, the Trump administration is set to ramp up its efforts to weaken the Affordable Care Act in one of the few ways it has left—by making changes to the law through waivers and rule changes.
Obamacare won’t implode on its own, but it might after Trump does everything he can to sabotage it.
Kevin Drum is on a roll. His new post includes a chart:
Excellent column. Read it now. Good take.
UPDATE: And read this one too, which begins:
It’s laughable watching President Trump whine endlessly this afternoon about how his health care bill didn’t get any Democratic votes. Not one! The Democrats just wouldn’t work with him to craft a bill! Boy, that sure makes things tough.
Needless to say, neither Trump nor Paul Ryan ever tried to bring Democrats into this bill. It was purely a Republican plan from the start, and neither of them wanted any Democratic input. That’s just the opposite of Obamacare, where Democrats tried mightily to get Republican buy-in, and still ended up getting no Republican votes in the end. Not one!
Anyway, Trump’s plan now is to wait for Obamacare to implode and then Democrats will have to do a deal. I guess it hasn’t occurred to him that he could do a deal with Democrats right now if he were really serious about fixing health care. But no. Trump says he intends to move on to tax reform, because that’s something he actually cares about.
In the meantime, it’s very unclear what will happen to Obamacare. With so much uncertainty surrounding it, it’s hard to say how insurance companies will respond. They might give up and pull out. Or they might stick it out and wait. It’s pretty close to a profitable business now, so there’s probably no urgency one way or the other for most of them. . .
Read the whole thing.
It’s pretty much as you expect, given the GOP’s proclivities:
That’s from a NY Times article by Haeyoun Park and Margot Sanger-Katz, which begins:
An average family making more than $200,000 a year would gain $5,640 while a family making less than $10,000 a year would lose $1,420 if Congress passes the health care plan proposed by House Republicans, according to a new analysis.
The analysis, from the Urban Institute’s Health Policy Center and the Urban-Brookings Tax Policy Center, looked at the combined impact of changes proposed under the Republican plan, including repealing Obamacare taxes, cutting Medicaid funding and changing the system of government subsidies for people who buy their own insurance.
Taxes would decrease for families earning $50,000 or more a year in 2022, when most of the law’s provisions would be in full effect. Families with incomes above $1 million a year would pay about $50,000 less in taxes.
The cuts to Medicaid would hit the poorest families hard. Even though some would be able to take advantage of new subsidies to buy health insurance, the researchers found that, on average, their benefits would decline substantially. Those making less than $30,000 a year would take three-quarters of the total losses.
More than 70 percent of the tax cuts, however, would go to families with incomes above $200,000 a year, and more than 46 percent would go to those making more than $1 million a year.
The Republican plan eliminates taxes Obamacare imposed mostly on the rich, including taxes on investment income and wages above $200,000. (Cuts to other Obamacare taxes, including ones on medical devices, prescription drugs, and indoor tanning, benefit the population more broadly.) . . .
The GOP seems to actively hate the poor, for reasons that are unclear to me. Chauncey DeVega looks at this in Salon:
Republican Paul Ryan, like most other members of the U.S. Congress, is a millionaire.
Christa Patton is 68 years old. She is frail and no longer able to leave her home. She lives on a fixed income. Patton told Van Jones on a recent episode of his CNN show “The Messy Truth” that she would not be able to eat without the Meals on Wheels program.
Paul Ryan is the speaker of the U.S. House of Representatives. By his own account, in college he used to hang out with his friends and drink beer while sharing his dreams of cutting Medicaid. When Ryan was 15 years old, his father died from a heart attack affected by alcoholism. Ryan and his family then received his father’s Social Security survivor’s benefits. Ryan used that money to attend college. This was not the only money that Paul Ryan received from the federal government. His family built its wealth from receiving government contracts.
Like his idol Ayn Rand (who argued against the very idea of government and the commons yet received Social Security and Medicare), Paul Ryan has combined meanness, cruelty and callousness toward the weak and the vulnerable with gross and unapologetic hypocrisy.
Republicans like Ryan — along with the millionaires and billionaires who comprise Donald Trump’s Cabinet and inner circle — literally want to take food, shelter and health care away from poor people like Christa Patton. Today’s Republicans view these Americans as useless eaters to be disposed of by means both passive and active.
It is normal to feel aghast at and disgusted by the Republican Party’s war on the poor. The more challenging and perhaps even more disturbing task is to ask why today’s conservatives feel such antipathy, disregard and hostility toward poor and other vulnerable Americans. Certainly greed and a slavish devotion to a revanchist right-wing ideology are part of the answer. But they may not be sufficient
Conservatives are more likely to exhibit social dominance and bullying behavior. This is a function of their authoritarian tendencies. The election of Donald Trump exemplifies this phenomenon.
American political elites often use language that robs poor and other marginalized people of their individuality, humanity and dignity. This language also creates a type of social distance between “middle class” or “normal” Americans and those with economic disadvantages.
Conservatism is a type of motivated social cognition that by its very nature is hostile to members of groups on the lower rungs of the social hierarchy.
And conservatives are more likely than liberals or progressives to believe in what is known as the “just world fallacy,” whereby people who suffer misfortune are viewed as somehow deserving their fates. Conservatives are also more likely than liberals or progressives to not use . . .
And the letters are full of lies. This is, I contend, a very bad sign. Charles Ornstein reports in ProPublica:
When Louisiana resident Andrea Mongler wrote to her senator, Bill Cassidy, in support of the Affordable Care Act, she wasn’t surprised to get an email back detailing the law’s faults. Cassidy, a Republican who is also a physician, has been a vocal critic.
“Obamacare” he wrote in January, “does not lower costs or improve quality, but rather it raises taxes and allows a presidentially handpicked ‘Health Choices Commissioner’ to determine what coverage and treatments are available to you.”
There’s one problem with Cassidy’s ominous-sounding assertion: It’s false.
The Affordable Care Act, commonly called Obamacare, includes no “Health Choices Commissioner.” Another bill introduced in Congress in 2009 did include such a position, but the bill died — and besides, the job as outlined in that legislation didn’t have the powers Cassidy ascribed to it.
As the debate to repeal the law heats up in Congress, constituents are flooding their representatives with notes of support or concern, and the lawmakers are responding, sometimes with form letters that are misleading. A review of more than 200 such letters by ProPublica and its partners at Kaiser Health News, Stat and Vox, found dozens of errors and mischaracterizations about the ACA and its proposed replacement. The legislators have cited wrong statistics, conflated health care terms and made statements that don’t stand up to verification.
It’s not clear if this is intentional or if the lawmakers and their staffs don’t understand the current law or the proposals to alter it. Either way, the issue of what is wrong — and right — about the current system has become critical as the House prepares to vote on the GOP’s replacement bill Thursday.
“If you get something like that in writing from your U.S. senator, you should be able to just believe that,” said Mongler, 34, a freelance writer and editor who is pursuing a master’s degree in public health. “I hate that people are being fed falsehoods, and a lot of people are buying it and not questioning it. It’s far beyond politics as usual.”
Cassidy’s staff did not respond to questions about his letter.
Political debates about complex policy issues are prone to hyperbole and health care is no exception. And to be sure, many of the assertions in the lawmakers’ letters are at least partially based in fact.
Democrats, for instance, have been emphasizing to their constituents that millions of previously uninsured people now have medical coverage thanks to the law. They say insurance companies can no longer discriminate against millions of patients with pre-existing conditions. And they credit the law with allowing adults under age 26 to stay on their parents’ health plans. All true.
For their part, Republicans criticize the law for not living up to its promises. They say former President Obama pledged that people could keep their health plans and doctors and premiums would go down. Neither has happened. They also say that insurers are dropping out of the market and that monthly premiums and deductibles (the amount people must pay before their coverage kicks in) have gone up. All true.
But elected officials in both parties have incorrectly cited statistics and left out important context. We decided to take a closer look after finding misleading statements in an email Sen. Roy Blunt, R-Mo., sent to his constituents. We solicited letters from the public and found a wealth of misinformation, from statements that were simply misleading to whoppers. More Republicans fudged than Democrats, though both had their moments. . .
Continue reading. Good examples of bad faith.
Margo Sanger-Katz reports in the NY Times:
The Congressional Budget Office recently said that around 24 million fewer Americans would have health insurance in 2026 under the Republican repeal plan than if the current law stayed in place.
That loss was bigger than most experts anticipated, and led to a round of predictable laments from congressional Democrats — and less predictable ones from Republican senators, including Bill Cassidy of Louisiana and John Thune of South Dakota, who told reporters that the bill needed to be “more helpful” to low-income people who wanted insurance.
But one piece of context has gone little noticed: The Republican bill would actually result in more people being uninsured than if Obamacare were simply repealed. Getting rid of the major coverage provisions and regulations of Obamacare would cost 23 million Americans their health insurance, according to another recent C.B.O. report. In other words, one million more Americans would have health insurance with a clean repeal than with the Republican replacement plan, according to C.B.O. estimates.
The C.B.O. estimated what would happen after a simple repeal when it considered a bill that Congress passed last year. (President Obama later vetoed that bill.) The bill left parts of Obamacare in place, so the 23 million estimate didn’t come with the kind of detailed analysis that accompanied last week’s score of the American Health Care Act. But the similarity of the two estimates highlights some of the difficulties of the current proposal, both for Democrats, who are strongly criticizing potential coverage losses, and for the repeal-or-die crowd, who hate the structure of this new bill.
“It’s reaffirmed how exceedingly complicated and convoluted the approach the House leadership took,” said Dan Holler, the vice president for communications and government relations at Heritage Action, an advocacy group firmly in the repeal-or-die camp.
Late Monday, House leadership revealed a set of amendments to the bill, which will be considered when the bill comes up for a vote. But, if they are adopted, the changes are unlikely to have major effects on overall coverage numbers. If anything, the changes might lead to a larger increase in the number of Americans without health insurance.
The people who would end up without health insurance are slightly different in the two cases. The current bill would cause more people to lose employer insurance, while a straight repeal bill would most likely cause more people who buy their own coverage to become uninsured. . .