Saturday, May 6, 2017

A Party without a Heart

 “Nobody dies because they don’t have access to health care.” 
Raoul Labrador R Idaho

Too bad members of Congress get some amazing healthcare coverage. I wonder what their lives would be like if they had to live with any healthcare bill they want to pass. Ah, but then they do have a six figure income to pay those higher premiums they are fighting for even if they did not have luxurious coverage. The people who will suffer the most under the currently-proposed “repeal and replace” health care package are clearly less affluent Americans – subsidies and Medicaid get slammed – older Americans (before Medicare kicks in) and anyone with a preexisting condition. “Technically, the deal would still prevent insurers from denying coverage to people with a history of illness. But without [Obamacare designated] community rating, health plans would be free to charge those patients as much as they wanted.” New York Times, April 27th. Some have envisioned six figure premiums as a result.
Indeed, the President has repeatedly threatened to force the Affordable Care Act (Obamacare) to fail by telling Health and Human Services to stop Congressionally-approved, critical funding (the Cost-Sharing Reduction subsidy in particular, discussed further below), a threat that has forced some of the biggest insurance carriers to state that should such payments stop – an event they will consider to be a breach of the federal government’s commitment to them – they will pull out of the relevant healthcare exchanges. That may not be horrible to states with many carriers, but for those with only one carrier in their exchange (a flaw that does have to be fixed under the ACA), that withdrawal will simply kill coverage entirely in that state.
The April edition of New York Magazine notes: “A heavy-handed effort by the president to take hostage insurer subsidies critical to the proper functioning of Obamacare — with the demand that Democrats cooperate to salvage Trump’s own failed health-care initiative — seems to be backfiring loudly. Soon after Trump made it clear (first via a statement from the Department of Health and Human Services, and then in his own words, in an interview with The Wall Street Journal) that he was indeed threatening to stop payment of the so-called Cost-Sharing Reduction subsidies (amounting to $7 billion in 2017 and an estimated $10 billion in 2018),” Democrats are now trying to force a full Cost-Share Reduction Congressional appropriation into his spending program as a condition of kicking that budget can down the road.
But if Trump does force Obama to fail, will he be able to blame Democrats for the result? Or will he own it? Will those disenfranchised voters at the bottom of the economic ladder, older voters and his supporters with pre-existing conditions stand steadfast with their “leader” (his base, according to polls, is 96% intact)? The GOP plan, what little of it has even been locked down, simply does not work. It is ill-conceived and still threatens to derail healthcare coverage for tens of millions of Americans. Whether you believe the non-partisan Congressional Budget Office or the United Nations. Unless you only accept fake news.
“The United Nations warned the Trump administration earlier this year that repealing ObamaCare without providing an adequate replacement would be a violation of multiple international laws, according to a new report… Though the Trump administration is likely to ignore the U.N. warning, The Washington Post reported the Office of the U.N. High Commission on Human Rights in Geneva sent an ‘urgent appeal’ on Feb 2. 
“The Post reported that the confidential, five-page memo cautioned that the repeal of the Affordable Care Act would put the U.S. ‘at odds with its international obligations.’… The warning was sent to the State Department and reportedly said the U.N. expressed ‘serious concern’ about the prospective loss of health coverage for 30 million people, that in turn could violate ‘the right to social security of the people in the United States.’”, April 26th. But even as House Speaker Paul Ryan delayed yet another vote to resurrect this amazingly under-thought “repeal and replace” plan – one that more than a few GOP Congress people know could threaten their reelection efforts – the legislators working on the bill seem simply to be digging themselves deeper into a hole that could derail GOP efforts to maintain their control of Congress.
The April 28th Los Angeles Times (Noam Levey) reports on this lemming-like march into abysmal stupidity: “President Trump and House Republicans, in their rush to resuscitate a bill rolling back the Affordable Care Act, are increasingly isolating themselves from outside input and rejecting entreaties to work collaboratively, according to multiple healthcare officials who have tried to engage GOP leaders.
“The White House and its House GOP allies are hoping to reschedule a vote on their overhaul plan in the coming days, following last [March’s] embarrassing retreat when the bill was pulled shortly before a vote… But they continue to refuse to reach out to Democrats. Even Senate Republicans have been largely sidelined, though their support will be crucial to putting a measure on Trump’s desk.
“And senior House Republicans and White House officials have almost completely shut out doctors, hospitals, patient advocates and others who work in the healthcare system, industry officials say, despite pleas from many healthcare leaders to seek an alternative path that doesn’t threaten protections for tens of millions of Americans.
“‘To think you are going to revamp the entire American healthcare system without involving any of the people who actually deliver healthcare is insanity,’ said Sister Carol Keehan, president of the Catholic Health Assn., whose members include many of the nation’s largest medical systems.
“Health insurers, who initially found House Republicans and Trump administration officials open to suggestions for improving insurance markets, find it increasingly difficult to have realistic discussions, according to numerous industry officials… ‘They’re not interested in how health policy actually works,’ said one insurance company official, who asked not to be identified discussing conversations with GOP officials. ‘It’s incredibly frustrating.’
“Another longtime healthcare lobbyist, who also did not want to be identified criticizing Republicans, said he’d never seen legislation developed with such disregard for expert input. ‘It is totally divorced from reality,’ he said… The result may be a short-term victory for House leaders and the White House as Trump nears his 100-day mark, assuming they muster the votes this time. But prospects for final passage of a healthcare overhaul bill remain dim.” That reality might be the good news for the GOP. They just might be saved from their biggest enemy – themselves.
The push-pull, between those who care versus the conservative GOP House Freedom Caucus who simply want to eviscerate healthcare support for the bottom and middle of the economic ladder in order to create the savings they need to implement massive tax cuts for the rich, derailed GOP passage last time around. And that Caucus is still very much pressing its cause. As May rolled forward, as Trump pressed for a House vote, the selling of the bill far exceeded what it really delivered: “‘I want it to be good for sick people,’ Mr. Trump said in an interview with Bloomberg News. ‘It’s not in its final form right now. It will be every bit as good on pre-existing conditions as Obamacare.’
“Representative Billy Long, Republican of Missouri, said on Monday [5/1]: ‘I have always stated that one of the few good things about Obamacare is that people with pre-existing conditions would be covered.’ The Republicans’ latest version ‘strips away any guarantee that pre-existing conditions would be covered and affordable,’ he said…
“[A] coalition of 10 advocacy groups — including the American Heart Association, the American Lung Association, the March of Dimes and the American Cancer Society’s Cancer Action Network — urged a ‘no’ vote.
“‘As Congress considers this legislation, we challenge lawmakers to remember their commitment to their constituents and the American people to protect lifesaving health care for millions of Americans, including those who struggle every day with chronic and other major health conditions,’ the groups said.
“Since Sunday [4/30], Mr. Trump has repeatedly insisted that the Republican health legislation would not allow discrimination against people with pre-existing conditions. Which bill Mr. Trump was referring to is not clear.” New York Times, May 1st. Indeed, as of this writing, the proposed legislation is anything but affordable for those with pre-existing conditions… even assuming the states you live in create the risk pool covers that is completely ill-defined. D-I-S-A-S-T-E-R!
But the GOP denial – the embrace of fake news – is overwhelming: “Trump and senior House Republicans have steadfastly defended their bill, however, promising it will lower healthcare costs while preserving protections for vulnerable Americans… ‘The plan gets better and better and better,’ Trump said [in late April] at the White House. ‘And it’s gotten really, really good. And a lot of people are liking it a lot.’” LA Times. And I’m the Easter Bunny!!!! Hippity Hop! Hippity Hop!
I’m Peter Dekom, and if any semblance of this GOP “repeal and replace” law is passed, you can expect the American healthcare system to crack at the seams and millions of Americans to face untreated serious ailments and medical bankruptcies at tsunami-levels never seen before.

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