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Archive for the ‘Healthcare’ Category

With billions at stake, a federal judge just nullified the GOP’s most cynical attack on Obamacare

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Michael Hiltzik writes in the LA Times:

Moda Health, a small Oregon health insurer, just won a $214-million judgment against the federal government. Normally that wouldn’t be worth reporting, except that in awarding Moda the money, the federal judge in the case dismantled the most cynical attack on the Affordable Care Act that congressional Republicans had devised.

The issue was the Affordable Care Act’s risk corridor program, which was devised to shelter insurers from unexpected losses in covering Affordable Care Act customers from 2014 through 2016. To encourage insurers to enter an entirely novel market, the program aimed to balance risks by taking funds from insurers that turned out to be unexpectedly profitable and use the money to cushion others’ losses. The model was provisionally written into Medicare’s prescription drug program, Part D, which went into effect in 2006 and worked well to attract insurers.

Initially, economists expected the Affordable Care Act version to be in the black overall — the Congressional Budget Office forecast that the government would collect $16 billion from successful insurers and pay out only $8 billion to struggling companies over the program’s three years. But if it turned out that there wasn’t enough, the Department of Health and Human Services was authorized to pay out funds from general government revenues.

Although Medicare Part D had been a Republican program, this time around the GOP railed against the same risk corridor arrangement as a “bailout” of insurers. They inserted a provision in a 2014 spending bill forbidding Health and Human Services from using any money other than what came from profitable insurers. As it happened, the program ran deeply in the red. The accumulated losses for 2014 and 2015 alone are up to $8.3 billion; some estimates place the total owed over the three years at nearly $15 billion.

Because it’s hamstrung to pay the full claims, Health and Human Services has paid out only 12.6% of all claims for 2014, and nothing so far for 2015 or 2016. Moda’s lawsuit claimed that it’s due $214 million. It argued that the government essentially promised that the money would be paid, and that promise can’t be nullified just because Congress decided to tamper with where the money came from.

Judge Thomas C. Wheeler of the U.S. Court of Federal Claims agreed with Moda on every point. “There is no genuine dispute that the Government is liable to Moda,” he ruled in a decision issued Thursday. “The Government made a promise in the risk corridor program that it has yet to fulfill.” He directed the government “to fulfill that promise. After all, to say to [Moda], ‘The joke is on you. You shouldn’t have trusted us,’ is hardly worthy of our great Government.”

Wheeler also told the government where to find the money: in its Judgment Fund, which pays plaintiffs who win claims against the government in his court.

A ruling like Wheeler’s was long expected by many legal experts. As Nicholas Bagley of the University of Michigan observed following the ruling: “It was only a matter of time before a court entered a money judgment against the United States.” Two other lawsuits are pending in the Court of Federal Claims. One brought initially by two Oregon health insurance co-ops has been certified as a class action. Another, brought by the Illinois insurer Land of Lincoln, was dismissed in November, but is already under appeal.

That said, even if the insurers eventually get paid, the GOP attack on the risk corridor program, and by extension on the Affordable Care Act in general, did a lot of damage. In a survey for the New England Journal of Medicine in November, Bagley wrote that the GOP measure “hit particularly hard” at new co-op health plans, which were thinly capitalized but supported by Affordable Care Act loans. Deprived of full risk-corridor payments, “by the end of summer 2016, just seven of 23 co-ops were still in business. As the co-ops collapsed, almost a million people were forced to look elsewhere for coverage.” That contributed to “a sharp reduction in competition on the [Obamacare] exchanges.”

That underscores the cynicism of the Republican attack. GOP politicians such as House Speaker Paul Ryan (R-Wis.) talk continually about a lack of competition on the Affordable Care Act exchanges as though that’s a structural flaw in Obamacare. They don’t admit that much of that lack of competition is their own handiwork.

One remarkable feature of this attack is that, even though it helped destroy some low-income insurers and harmed their customers, Republicans in Congress jostled with each other to take credit for it.

Sen. Marco Rubio (R- Fla.) made his championing of the provision a linchpin of his presidential campaign, claiming that . . .

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Written by LeisureGuy

13 February 2017 at 9:15 pm

GOP fights ObamaCare PR war, finds actions harder than words

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Jesse Hellmann reports in The Hill:

Republicans are facing a new public relations war in their effort to repeal and replace ObamaCare.

The GOP Congress has repeatedly approved legislation to repeal ObamaCare, but those proposals went nowhere with President Obama in the White House.

Now that Republicans also hold the White House, the challenge for the GOP is taking the long-promised action in a way that won’t backfire politically.

And that’s turning out to be harder than many anticipated.

Polls show the public is divided on whether to repeal ObamaCare, which doesn’t make the task of unraveling one of the largest social programs passed in recent history any easier.

Republicans say the key to winning the public relations battle is for their party to highlight the weaknesses of ObamaCare, a law even most Democrats admit could improve from legislative changes.

“I think the thing that, simply from a Republican standpoint, is to point out it’s a failing system,” said GOP Rep. Tom Cole (R-Okla.), who pointed to rising insurance premiums and fewer choices for consumers as significant problems that will spur public support for the GOP’s plans.

The GOP arguments are being made to a politically polarized population on edge after the 2016 presidential election. Democrats are doing everything they can to make it tougher for Republicans to take action on ObamaCare.

Senate Minority Leader Chuck Schumer (D-N.Y.) says Republicans want to “Make America Sick Again,” playing off of President Trump’s campaign slogan.

Other Democratic senators have said repealing ObamaCare will lead to the deaths of thousands of people.

Republicans have faced angry crowds at some town halls, where people have expressed their displeasure at possibly losing health benefits.

While Republicans contend that much of the opposition at the local events is being ginned up by Democrats, it appears to have had an effect.

Rep. Tom McClintock (R-Calif.) tells upset constituents that Republicans are aware that repealing ObamaCare must result in a “much-improved health system.”

“We will be judged on our success in doing so,” he said.  . .

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Written by LeisureGuy

11 February 2017 at 1:16 pm

Slavitt: Obamacare Should Be Profitable This Year if Republicans Don’t Blow It Up

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Very interesting column by Kevin Drum at Mother Jones.

Written by LeisureGuy

9 February 2017 at 5:19 pm

A bit wonky, but very important: The GOP’s sleight-of-hand with health insurance

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Now you see it, now (after the legislation is passed) now you don’t.

Simon Maloy reports in Salon:

In a weird spasm of issue-based programming, CNN elected to host a debate on Tuesday night between Sen. Bernie Sanders, D-Vt., and Sen. Ted Cruz, R-Texas, on the topic of health care. Given the ongoing storm and stress over the Affordable Care Act and the shambolic Republican crusade to “repeal and replace” it, an extended public discussion about health care policy between two prominent elected officials is not the worst thing in the world. The debate actually produced some revelatory moments, particularly with regard to the GOP’s plans for people with pre-existing conditions.

At one point early on in the debate, a woman in the audience who had been diagnosed with breast cancer voiced her concern over what will happen if the Affordable Care Act’s pre-existing conditions protections are repealed. She asked Cruz, “What can you do to protect people like me who are alive because of Obamacare?”

Cruz tried to reassure her that with a Republican replacement for Obamacare, people with pre-existing conditions will be protected: “If you look at every proposal that’s been submitted — every significant Republican proposal that’s been submitted to replace Obamacare . . .  all of them protect people in your situation. All of them prohibit insurance companies from canceling someone because they got sick; they prohibit insurance companies from jacking up the insurance rates because they got sick or injured.”

Cruz was pressed on this by Sanders and the moderators, who wanted to know if he would insist that a Republican Obamacare replacement include a mandate that people with pre-existing conditions would be protected. Cruz then recalibrated his answer slightly, but significantly. “What I’ve said is virtually all the Republican legislation that has been filed that the Democrats have opposed maintains a continuity of coverage so that insurance companies can’t cancel policies,” he said.

Sanders nodded knowingly as Cruz said this, having caught what Cruz was trying to do. “If you listen carefully to what he’s saying, if you go to the doctor tomorrow, and you are diagnosed with a terrible illness, the insurance companies do not have to provide you insurance,” Sanders responded. “That is what Ted said. What he also said, if you have an illness, [insurance coverage] has to be kept.”

“Continuity of coverage” is the key phrase in Cruz’s answer, and it’s the policy idea that Cruz, in his earlier answer, tried to frame as a prohibition on insurance companies discriminating against people with pre-existing conditions.

As Sanders pointed out, . . .

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Written by LeisureGuy

8 February 2017 at 5:27 pm

Tom Price, Dr. Personal Enrichment

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Tom Leonhardt writes in the NY Times:

Each year, a publication called Medscape creates a portrait of the medical profession. It surveys thousands of doctors about their job satisfaction, salaries and the like and breaks down the results by specialty, allowing for comparisons between, say, dermatologists and oncologists.

As I read the most recent survey, I was struck by the answers from orthopedic surgeons. They are the highest-paid doctors, with an average salary of $443,000 in 2015 — which, coincidentally, was almost the exact cutoff for the famed top 1 percent of the income distribution.

Yet many orthopedists are not happy with their pay. Only 44 percent feel “fairly compensated,” a smaller share than in almost every other specialty. A lot of orthopedists aren’t even happy being doctors. Just 49 percent say they would go into medicine if they had to make the decision again, compared with 64 percent of all doctors.

I know that many orthopedists have a very different view: They take pride in helping patients and feel fortunate to enjoy comfortable lives. But despite those doctors, it’s clear that orthopedics suffers from a professional culture that does not live up to medicine’s highest ideals. Too many orthopedists are rich and think it’s an injustice that they’re not richer.

Continue reading the main story

This culture helped shape Dr. Tom Price, the orthopedic surgeon and Georgia congressman who is Donald Trump’s nominee for secretary of health and human services.

Price had a thriving practice near Atlanta before being elected to Congress in 2004. His estimated net worth of more than $10 million (and possibly a lot more) makes him one of the House’s wealthier members.

Yet he hasn’t been content to make money in the standard ways. He has also pushed, and crossed, ethical boundaries. Again and again, Price has mingled his power as a congressman with his desire to make money.

So far, the nominee receiving the most attention is Betsy DeVos, Trump’s choice for education secretary, and she definitely deserves scrutiny. Still, I think Democrats have made a mistake focusing so much on her rather than on Price. He could do more damage — and his transgressions are worse than those that have defeated prior nominees.

Last March, Price announced his opposition to a sensible Medicare proposal to limit the money doctors could make from drugs they prescribe their patients. The proposal was meant to reduce doctors’ financial incentives to prescribe expensive drugs. (And, yes, if you’re bothered that your doctor has any stake in choosing one drug over another, you should be.)

One week after Price came out against the proposal, he bought stocks in six pharmaceutical companies that would benefit from its defeat, as Time magazine reported. At the time, those same companies were lobbying Congress to block the change. They succeeded.

It’s a pattern, too. Price has put the interests of drug companies above those of taxpayers and patients — and invested in those drug companies on the side.

Last year, he also bought shares in Zimmer Biomet, a maker of hip and knee implants. Six days later, according to CNN, he introduced a bill that would that have directly helped Zimmer.

In his defense, a spokesman for Price has said that his broker bought the Zimmer stock and Price didn’t find out until later. That’s certainly possible, but still not acceptable. Members of Congress bear responsibility for their personal stock transactions, period.

A third episode may be the worst. Price accepted a special offer from an Australian drug company to buy discounted shares, as The Wall Street Journal and Kaiser Health News reported.

He told the Senate that the offer was open to all investors, although fewer than 20 Americans actually received an invitation to buy at the discounted price. The stock has since jumped in value, and Price underreported the worth of his investment in his nomination filings. It was a “clerical error,” he says.

Even without any larger context, his actions are disqualifying. He’s repeatedly placed personal enrichment above the credibility of Congress. The behavior is substantially worse than giving money to an illegal immigrant (which defeated a George W. Bush nominee) or failing to pay nanny taxes (which scuttled a Bill Clinton nominee).

But of course there is a larger context. Price has devoted much of his political career opposing expansion of health insurance. His preferred replacement of Obamacare would reduce health care benefits for sicker, poorer and older Americans. . .

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Trump’s cabinet choices are revealing.

Written by LeisureGuy

7 February 2017 at 11:10 am

Trump Sabotage of Obamacare a Big Success: Enrollment Down By a Half Million or More

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Kevin Drum points out that, thanks to sabotage by the Trump administration, about 600,000 people head into 2017 lacking health insurance. What a victory! (Though the victory comes at substantial cost to some of the victims.)

he signup period for Obamacare is over, and total enrollment fell short of last year. The Washington Post reports the details:

The lower total…marks a striking turnabout from the trend as the Obama administration neared its end — when sign-ups for coverage under the law were running steadily ahead of a year ago.

The volume plummeted, in particular, during the final week of the three-month enrollment season — falling from nearly 700,000 in 2016 to just over 375,000. That last week traditionally is a peak time when eligible customers race to get ACA health plans, most of them with federal subsidies. This time, however, the Trump White House directed federal health officials to halt all advertising and other enrollment-outreach activities for the last six days of the sign-up period.

Based on data from Charles Gaba, here’s what enrollment looked like throughout the entire signup period:


Signups were running a bit ahead of 2016 during the entire open enrollment period, but then Trump took office. Republicans began talking about repealing Obamacare, Trump signed an executive order telling agencies to do whatever they could to throw sand in the gears, and outreach efforts were halted. The result was a substantial downturn in the second half of January. My estimate is that all these antics lowered enrollment by about 600,000. That’s 600,000 people who now have no medical coverage and run the risk of bankruptcy if anything serious goes wrong. Nice work, folks.

For additional evidence on this score, . . .

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The GOP seems actually to hate regular citizens, as shown by actions like this: stepping in to prevent people from getting health insurance. Another example: the GOP action that will allow mining companies to pollute and destroy mountain streams: great for mining companies, bad for people who live near the streams. All the GOP members of Congress in states that would be most affected were against protecting the environment (probably because they do not themselves live near where the damage will be done).

Written by LeisureGuy

4 February 2017 at 11:01 am

Looking at healthcare, Bernie Sanders makes some good points

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Good points that the Washington Post derides, incorrectly labeling them false. Bernie writes:

The next great struggle that will take place in Congress is literally one of life and death. If the Republicans succeed in repealing the Affordable Care Act (ACA) without a replacement and throw some 20 million people off of their insurance, up to 43,000 Americans each year could die. That’s not Bernie Sanders talking. That’s the evidence from a well-researched study. Further, people with pre-existing conditions could be denied health insurance or be forced to pay unaffordable rates. There would be no cap as to what people with serious illnesses would have to pay. Women will be forced to pay higher rates because they are women. Prescription drug costs for seniors will go up.

The United States is the only major country on earth not to guarantee health care to all as a right. Our job is to move to a Medicare-for-all single payer system, not create a situation where up to 43,000 Americans die unnecessarily.

And then he links to this article by Jim Naureckas at FAIR (Fairness & Accuracy In Reporting):

With the New York Times finally agreeing to name politicians’ lies where they belong—in the headlines of the stories where they first occur—it’s time to end the failed experiment of factchecking columns. Not only do these projects give the false impression that checking facts is a sidelight rather than central to the journalistic mission, they are fatally compromised by  corporate media’s interest in maintaining the illusion of impartiality. As’s Brooks Jackson (Time, 10/9/12) said, in an admission that should have put paid to the whole enterprise:

Even if we could come up with a scholarly and factual way to say that one candidate is being more deceptive than another, I think we probably wouldn’t just because it would look like we were endorsing the other candidate.

Unmoored for commercial reasons from any hard and fast standards for what constitutes a fact, media factologists are free to follow their own political whims (or those of their outlets). Which seems to be what’s going on in a recent Washington Post factchecking effort by Glenn Kessler, “Bernie Sanders’ Claim That ‘36,000 People Will Die Yearly’ if Obamacare Is Repealed” (1/14/17).

The Post, just to set the stage, is a paper with a serious animus against the junior senator from Vermont—once running 16 negative stories on Sanders in 16 hours, and on another occasion squeezing four separate Sanders-bashing articles out of one dubious study. So it isn’t surprising to see Kessler giving “four Pinocchios” (the highest score, reserved for “whoppers”) to Sanders’ warning that “as Republicans try to repeal the Affordable Care Act, they should be reminded every day that 36,000 people will die yearly as a result.”

Sanders’ number came from Think Progress (12/7/16), which in turn derived its forecast of how many people could lose insurance under Obamacare from an Urban Institute report, and its estimate of the effect of insurance on mortality from an Annals of Internal Medicine study (5/6/14). So—a pretty solidly grounded political claim? Ah, sorry, you don’t understand the rules of political speech—as applied by the Washington Post to Bernie Sanders.

You see, Sanders in his tweet didn’t include all the academic qualifiers that occurred in the original Annals study. (It was a study of Massachusetts, not the whole country!) And Sanders’ warning was based on the “pretty big assumption” that the ACA will not be replaced with a brand new GOP-designed program—the barest outlines of which have yet to be described.

This kind of “fuzzy math” generally merits three Pinocchios, Kessler said. What “tips this claim into four-Pinocchio territory,” though, was the fact that Sanders expressed a prediction in the future tense: He said that people “will die” rather than “could die.” I would remind Kessler that every statement about the future is necessarily uncertain, and therefore every use by a politician of the future tense should be awarded an extra Pinocchio. . .

Continue reading.

Written by LeisureGuy

28 January 2017 at 7:27 pm

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