Category: Healthcare

Week 15 In Trump

Posted on May 8, 2017 in Healthcare, Politics, Trump

I had to bring back the Stupid Things Politicians Say category this week… because you know when healthcare reform gets hot, people say some pretty stupid stuff. Here’s that and everything else that happened last week.

Climate/EPA:

  1. The EPA starts firing members of one of its main scientific advisory boards, releasing 5 scientists this week. Scott Pruitt says he wants to replace those empty positions with people from the very industries that the EPA is tasked with regulating.
  2. Emmanuel Macron, President Elect of France, has a message for U.S. scientists. France welcomes you and we’ll be spending money on scientific research, specifically in the area of climate change. Look for a little brain drain in the future.
  3. Flint notifies around 8,000 Flint residents that are risking tax liens on their homes for unpaid water bills.

Russia:

  1. Comey testifies to the Senate Judiciary Committee about events before last year’s election. Specifically about his announcement a week before the election, Comey says “This was terrible. It makes me mildly nauseous to think we might have had some impact on the election.” Thanks for that—it makes a bunch of us more than mildly nauseous.
  2. Here are a few take always from Comey’s testimony:
    • He said that he had no choice about breaking the news of the newly found emails in the last week of the election, even though he knew he was affecting the election.
    • He wanted to go public with the Russian meddling last summer, but the Obama administration prevented it. The administration only made the info public after 17 agencies came forward in October.
    • He confirmed that Russia was behind the DNC hack.
    • He said that Russia will continue to meddle in our elections and politics because the outcome of the election showed that their methods work.
    • He confirmed that he is being investigated for his role in the email probe and the elections.
    • He confirmed that the FBI is investigating whether active FBI agents leaked info to Giuliani in the run-up to the elections.
    • He also said that Huma Abedin had forwarded classified material to her husband’s server (Anthony Weiner).
  1. Hackers break into the campaign servers of French presidential candidate Macron (now President Elect) and dump 9 gigs of campaign documents just hours before the traditional media blackout France imposes in the 44 hours around an election. Macron wins the election handily anyway.
  2. A month before Michael Flynn was caught on tape talking with Russian Ambassador Sergey Kislyak about lifting U.S. sanctions, Flynn was warned about U.S. surveillance of Kislyak’s conversations. Maybe he just forgot?
  3. It turns out that Obama had warned Trump against hiring Flynn during the transition period, though Spicer continues to blame the Flynn problem on the Obama administration.
  4. Trump criticizes Susan Rice for refusing to testify in the Russia hearings, though she says her reason is that it was a partisan request. The leading Republican on the committee wants her to testify; the leading Democrat disagrees.
  5. Trump ends an interview abruptly when pushed on his accusation that Obama was spying on him.

Healthcare:

  1. Early in the week, moderate Republicans have concerns over the new healthcare bill, and say it needs to be rewritten. The primary concerns are:
    • Deep cuts to Medicaid.
    • Higher premiums for older Americans.
    • Insufficient protections for people with pre-existing conditions.
  1. The bill’s authors add an $8 billion fund for the high-risk pool to bring moderate Republicans on board.
  2. In an interview with CBS, Trump’s answers indicate he doesn’t know what’s actually in the latest version of the healthcare bill.
  3. In the middle of the week, Ryan doesn’t have enough Republicans committed to a yes vote on the healthcare bill. 20 Republicans are a definite no.
  4. By Thursday, the House finally feels confident to move ahead with a vote on the new bill. It narrowly passes 217-213, with 20 Republicans voting no and 1 not voting. Here’s how the new bill changes the ACA:
    • Replace existing subsidies with refundable tax credits based mostly on age and partially on income.
    • Remove cost sharing subsidies for people making less than $30,000.
    • End Medicaid expansion and place a cap on federal Medicaid spending.
    • Repeal the ACA tax on individuals making more than $200,000 or families making more than $250,000.
    • Remove age-based premium limits, allowing older people to be charged up to 5x the premiums of someone younger .
    • Remove guarantees for people with pre-existing conditions and other coverages mandated by the ACA (by giving states waivers, but states then have to provide an alternative).
    • Implement more generous HSAs.
    • Eliminate the individual and employer mandate (but still fine people whose insurance lapses).
  1. On Friday, the House unanimously passed a bill that would not let them be exempt from the AHCA.
  2. Democrats warn that the House bill contains certain provisions that don’t comply with special budget rules, which could allow for a filibuster if it comes to that.
  3. Some Senate Republicans are in such disagreement with the House-passed healthcare bill that they say they’ll write their own from scratch. They form a group of 13 (all men) to start the process.
  4. Hospitals, physicians, and insurers all criticize the bill saying people will lose coverage and some won’t get the care they need.
  5. On the day the House passes the bill estimated to cause millions to lose insurance, Trump praises the House Republicans’ efforts on this. Seconds later, he praises Australia’s universal healthcare system. So as we move our healthcare system further away from universal care, Trump says universal care is far better than ours.

International:

  1. Reports came out this week that the Trump administration is discontinuing the ″Let Girls Learn″ global program sponsored by Michelle Obama, but according to the White House, there are no changes to the program. Something to keep an eye on.
  2. South Korea’s missile defense system is up and running.
  3. Trump says he’d be ″honored″ to meet with Kim Jung Un.
  4. Trump and Putin have a tepid phone call, where they discuss Syria, North Korea, and a possible meeting this summer.
  5. Commerce Secretary Wilbur Ross recalls how Trump told Chinese President Xi about the Syrian bombing over desert, saying it was “free after dinner entertainment.”
  6. McMaster says that Trump’s foreign policy approach is disruptive, and thinks that could help stabilize things in the Mideast.
  7. Trump hosts Palestinian leader Mahmoud Abbas at the White House.
  8. Trump announces a visit to Israel, the Vatican, and Saudi Arabia in an effort to unite the world’s three leading faiths in the fight against terror.
  9. Emmanuel Macron, who founded his own ″En Marche!″ party, is elected President of France over far-right candidate Marine Le Pen.

Legislation:

  1. An Alabama judge rules to allow a mostly white city to secede from a more racially diverse school district, even though she also found the reasons for the move to be racially biased. The city must meet certain conditions regarding desegregation, but it’s likely to be caught up in lawsuits before they can even get that far.
  2. Trump signs a religious liberties executive order that the ACLU says will have ″no discernible policy outcome.″ While not changing any laws, it does the following:
    • Reiterates the governments support for freedom of religion and religious speech.
    • Essentially gives the IRS permission to relax enforcement of a rule restricting political actions and advocacy on the part of religious entities (by the way, the IRS has never prosecuted a religious entity based on this rule).
    • Directs agencies to explore avenues of relief for religious organizations in providing healthcare.
    • Gives the DoJ more freedom to interpret religious liberty protections versus civil rights.
  1. 1,330 clergy members took out a full-page ad against the executive order.
  2. Alabama’s governor, Kay Ivey, signs a law that gives adoption agencies the freedom to refuse to adopt out to parents based on religious beliefs. This is an obvious move toward allowing discrimination against gay parents. South Dakota, Michigan, North Dakota, and Virginia also have similar adoption laws.

Travel Ban/Immigration/Discrimination:

  1. Spicer gives the press a brief presentation of proposals for the wall, which appear to downgrade the wall to a series of fences and leads to a debate during the press briefing of the definition of a wall.
  2. Border agents have been turning away asylum seekers over the past several months. Under both U.S. and international law, asylum seekers are supposed to be allowed in to plead their case; it’s not up to border agents to decide.
  3. The number of refugees coming to the U.S. plummets to only 2,070 refugees in March and 3,316 in April, the lowest numbers since 2013.

Budget/Economy:

  1. The temporary spending measure signed by Congress to keep the government running allocates $120 million to help cover the increased security costs of protecting the first family, with about half going to the Secret Service and half going to reimburse the costs imposed on the municipalities they visit, like Palm Beach. This is just to get them through to September—5 months worth.
  2. The spending bill funds protections for refugees, H-2B visas, and the threatened Pell grants, NEA, NEH, ARC, EPA, Planned Parenthood, ACA subsidies, and Obama’s cancer moonshot at NIH. It doesn’t fund the border wall, not does it reduce funding for sanctuary cities. It does expand the military and border protection budgets. Democrats won concessions to keep Puerto Rico’s Medicaid program, while Republicans won on D.C.’s school choice program.
  3. Corn and soy farmers are now worried that Trump was serious about pulling out of NAFTA, and are concerned that renegotiating or pulling out completely could negatively affect the market for their crops.
  4. The budget Trump released in March would cut funding to programs under the Partnerships for Opportunity and Workforce and Economic Revitalization (POWER). These Obama-era programs work together at revitalizing coal communities with things like new business development and job and skills training. The approximately $1.13 billion cut would affect 7 of the 12 programs.
  5. In what appears to be an openness to suggestions from people in the trenches, Tillerson asks his staff for feedback on the budget cuts to the State Department.
  6. The economy adds 211,000 jobs this month and the unemployment rate edges down to 4.4%. Labor force participation is also down, but this is still good news.

Miscellaneous:

  1. Though Trump promised to drain the swamp, including barring his transition staff from lobbying for six month, at least nine people who worked on the transition have already registered as lobbyists.
  2. Transfers of cash from the U.S. to Mexico jumped 15% in the last month due to uncertainty around travel to the U.S. and relations with Mexico.
  3. Trump returns to New York City for the first time since taking office, to be greeted by protests and angry chants.
  4. The administration begins removing the staffers that they had installed to serve as Trump’s eyes and ears in various agencies (AKA, internal spies). Tensions have been growing between these monitors and the heads of the agencies.
  5. Hillary Clinton gives Christianne Amanpour a blistering interview where she takes responsibility for losing but also blames Comey’s timing of the email announcement along with Russian meddling. She also criticizes Trump’s performance so far and says she’s part of the resistance.
  6. According to 538, the letter Comey sent to Congress the week before the election probably did cost her the election. At a maximum, they estimate it might have shifted the race by 3 or 4 percentage points in states where she lost by less than 1 percentage point. And before you start up with how inaccurate the polls were, the final popular results was well within the margin of error of most reliable polls.
  7. It sounds like Trump wants to change the rules of passing a bill, not seeming to understand the system of checks and balances our usually slow-moving government applies. He called the system rough and archaic, and called Congressional rules bad for the country, saying that they should be changed.
  8. Trump launches a series of campaign ads singing the praises of his first 100 days in office, starting with a 30-second TV ad along with a series of more targeted online ads. It is an early return to campaigning for any sitting president. Usually they take this time to push through their most important policy changes.
  9. CNN refuses to air one of Trump’s campaign ads because it has a graphic with “Fake News” plastered across images of some familiar journalists. CNN says they aren’t fake news, therefore the ad is false and does not comply with their guidelines. Trump says this is censorship, but experts say CNN is within their rights not to air it.
  10. North Dakota is requesting $38 million from the federal government to pay for the DAPL protests.
  11. Thousands gather across the country for May Day marches and strikes. May Day, also called International WorkersDay, originated when U.S. trade unions declared the work day would be an 8-hour day, which united several groups and mobilized the workforce to fight for workers’ rights. Two years later, this movement brought about the first May Day strike on May 1, 1886.
  12. Trump’s nominee for Secretary of the Army, Mark Green, withdraws from consideration over controversies around past comments on gender, Islam, and evolution.
  13. Sonny Perdue ends nutritional standards at schools, reducing whole-grain requirements, allowing higher sodium levels, and restoring high-fat, sweetened milk. Because childhood obesity isn’t a problem here in the states, right?

Stupid Things Politicians Say:

  1. From Donald Trump: “I also applaud the Palestinian Authority’s continued cooperation with Israel. They get along unbelievably well… They work together beautifully.”
  2. Trump wonders why we had to fight the Civil War and surmises that if Andrew Jackson would’ve still been in power, he would’ve nipped it in the bud. History lesson: Unlike Lincoln, Andrew Jackson owned many slaves. And isn’t Lincoln supposed to be the big Republican hero? Here’s the full quote:

I mean, had Andrew Jackson been a little later, you wouldn’t have had the Civil War. He was a very tough person, but he had a big heart. And he was really angry that — he saw what was happening with regard to the Civil War. He said, “There’s no reason for this.” People don’t realize, you know, the Civil War — if you think about it, why? People don’t ask that question, but why was there the Civil War? Why could that one not have been worked out?″

  1. Arizona House Majority Leader John Allen, on teachers who have to work two jobs to make ends meet: “They’re making it out as if anybody who has a second job is struggling. That’s not why many people take a second job. They want to increase their lifestyles… They want to pay for a boat. They want a bigger house.”
  2. Wow. Just… wow. Rep. David Eastman (R-Wasilla) thinks that women in Alaska are getting abortions for the exciting travel opportunity, saying, “You have individuals who are in villages and are glad to be pregnant, so that they can have an abortion because there’s a free trip to Anchorage involved.”
  3. Rep. Robert Pittenger (R-NC) on pre-existing conditions: “People can go to the state that they want to live in. States have all kinds of different policies and there are disparities among states for many things: driving restrictions, alcohol, whatever. We’re putting choices back in the hands of the states.” As if moving to another state to get the care you need is a viable option for most people.
  4. Health and Human Services Secretary Tom Price says people who are sicker and riskier have to pay more for health insurance, and that it’s “pricing for what an individual’s health status is.” In reality, the reason we don’t rely on free-market pricing for health care is that the older and sicker would be charged higher insurance premiums because they’re more likely to cost more, and the younger and healthier would be charged less because they’re likely to cost less. Except you can’t predict when you’ll get sick.
  5. Rep. Raúl R. Labrador (R-Idaho): “Nobody dies because they don’t have access to health care.” Prior to the ACA, around 45,000 Americans died annually because of lack of health insurance (according to a 2009 Harvard study). Additional studies back this up.
  6. Jimmy Kimmel’s son is born with a heart condition, and he makes an emotional plea on live TV to make sure that nobody loses healthcare and that every baby is covered. Joe Walsh, former Republican Congressman tweets this response: “Sorry Jimmy Kimmel: you’re [sic] sad story doesn’t obligate me or anybody else to pay for somebody else’s health care.”
  7. Rep. Mo Brooks (R-AL), defending an amendment that would require sicker people to pay more insurance costs: “My understanding is that it will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool that helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, you know, they are doing the things to keep their bodies healthy.” Because, you know good people who live healthy lives never get sick.

Repeal And Replace, Week 1

Posted on March 13, 2017 in Healthcare, Politics

This week, the GOP released their version of the replace part of replace-and-repeal of the ACA. “Trumpcare” has received a lot of criticism, though some say it only differs from Obamacare in a few, but very key, ways. The LA times has a great side-by-side breakdown of the changes the bill would enact. Here’s a list of reactions and analyses from the past week.

  1. To recap, here’s a list of some primary changes:
    • Remove the tax on high-income earners
    • Reverse the Medicaid expansion of the ACA
    • Move from subsidies to tax credits
    • Remove the mandate that everyone purchase insurance
    • Remove the requirement that employers offer coverage for full-time employees
    • Remove requirements for mental health benefits
    • Defund Planned Parenthood
  2. We don’t have a CBO analysis of new the bill yet, and that tends to be the most accurate analysis.
  3. Democrats want to delay any vote on the healthcare proposal until the CBO has completed their analysis. Republicans don’t want to wait.
  4. According to the latest CBO analysis, Obamacare is costing a third less than expected (due to lower enrollment and 19 states not expanding Medicaid).
  5. UPDATE: The CBO issues a report saying that 24 million would lose insurance under the GOP plan, but the federal deficit would be reduced by $337 billion over the next decade.
  6. Republican legislators begin undermining the CBO before they even get a chance to score the healthcare bill.
  7. Here’s what Trump says about the new plan: “This will be a plan where you can choose your doctor. This will be a plan where you can choose your plan. And you know what the plan is — this is the plan. And we’re going to have a tremendous — I think we’re going to have a tremendous success. It’s a complicated process, but actually it’s very simple. It’s called good healthcare.”
  8. The bill removes the ACA mandate for covering addiction treatment. This reneges on Trump’s promise to bring an end to the opioid abuse epidemic, unless he comes up with a new plan for treatment. Deaths from opioid overdoses have been skyrocketing.
  9. The cuts to Medicaid will eliminate the current requirement that it cover mental health services, leaving it up to the states to decide whether to include coverage.
  10. The White House pushes for an end to the ACA Medicaid expansion earlier than the bill currently states (2020). This reneges on Trump’s promise to leave Medicaid alone.
  11. The healthcare bill would accelerate the depletion of the Medicare fund.
  12. The AMA, AARP, and American Hospital Association, among others, come out in opposition to the new healthcare bill.
  13. The new bill proposes removing all taxes implemented in the ACA, which would cut taxes for people with incomes of $1 million or more by around $144 billion over the next decade.  For those making $200,000 or more, that tax cuts would total around $274 billion.
  14. The tax break for insurance companies could save them more than $500 million over the next 10 years due to a new tax break around executive compensation.
  15. According to the Kaiser Family Foundation, the new bill would hurt people living in rural areas and people with lower incomes. Their estimates also say that a 60-year-old making $30K would receive a $4K tax credit under the new plan, or about $8K less than under the ACA.
  16. According to the AARP, a 64-year-old making $15K would pay $8,500 more under the new plan.
  17. Experts question why the subsidies aren’t based on means instead of age. Even though health costs are higher for older citizens, that doesn’t mean that someone making $30,000 a year has the same means to pay for healthcare as someone making $150,000 a year. Or $500,000 a year, for that matter.
  18. Public health advocates fear the bill will reduce CDC funding by $1 billion for preventing things like disease outbreaks and lead poisoning.
  19. Anthem comes out in favor of passing the new healthcare law as soon as possible in order to stabilize insurance markets (they don’t like the uncertainty of not knowing what changes will be made).
  20. America’s Health Insurance Plans and the Blue Cross and Blue Shield Association, while seeing a few positives in the new bill, say the tax credits need to be more robust and fear the cap on Medicaid will lead to loss of coverage.
  21. One thing the GOP has been really pushing for is the ability to sell insurance across state lines. This would come in a different phase of healthcare reform. However, this is actually already legal and enabled by the ACA, which is something I can only assume Republicans are aware of already. That insurance companies aren’t taking advantage of this yet indicates a lack of interest to create the required networks for this.
  22. Obviously, there is strong Democratic backlash against the bill, and many individuals are now wondering if they will lose their healthcare.
  23. There is conservative backlash against the bill as well. Some call it nothing more than Obamacare Lite, some fiscal conservatives are worried that it will increase the deficit, and some want to keep the Medicaid expansion and Planned Parenthood funding.
  24. At the outset, four Republican senators say they won’t approve the bill in its current form because their constituents would be adversely affected. Rob Portman, Shelley Moore Capito, Cory Gardner, and Lisa Murkowski all say they will vote against any ACA replacement that doesn’t include protections for their constituents.
  25. In response to the backlash, Paul Ryan and Donald Trump say Republicans need to get in line behind the bill or risk being the ones who are blamed for breaking the GOP promise to repeal and replace.
  26. In addition to the above, at an Oval Office meeting, Trump says if the plan doesn’t pass, he’ll allow the ACA to fail and let Democrats take the blame (according to what sources at the meeting told CNN).
  27. Tom Price says that no one will be hurt by Trumpcare (financially or health-wise) and that even more people will be insured, though this conflicts with most analyses so far.
  28. The House Ways and Means Committee and the House Energy and Commerce Committee approve the new healthcare measure, so it is moving full-steam ahead.

 

And finally, here are a few of the worst comments of the week about healthcare reform:

    1. Congressman Ron DeSantis (R.-FL): Cancer patients can go to the ER for treatment.
    2. Congressman Jason Chaffetz (R.-UT): Low-income Americans should prioritize health insurance over purchasing iPhones.
      Even though the value of an iPhone won’t even cover one month of insurance, right? In fairness, Obama did say a few years ago that people making $40-50K could prioritize their budgets to better afford healthcare, but Chaffetz could’ve worded that better.
    3. Congressman John Shimkus (R-Ill.): Why should men pay for prenatal care?
      He’s obviously not understanding that the insurance is basically a risk pool, where everyone pays in so that everyone can be covered for their specific needs. He’s also possibly not understanding that women don’t get pregnant by themselves.
    4. Paul Ryan: If people lose their healthcare with the new bill, it’ll be because they didn’t want it.
      This completely ignores the fact that some people will just be unable to afford it.