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GOP health care plan would harm NY children, advocates say

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A children's advocacy organization contends the American Health Care Act -- the proposed replacement for Obamacare -- would be devastating for youngsters in New York who are covered through Medicaid and the state's Children's Health Insurance Program. Reported by Newsday 23 hours ago.

Should Americans have the 'freedom' to forgo health insurance — and increase costs for everyone?

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Here’s an example of the deep polarization in politics today: Many liberals and conservatives apparently do not agree on the meaning of the word “freedom.”

In response to a letter published Wednesday that supported the Republican proposal to replace the Affordable Care Act and touted the repeal... Reported by L.A. Times 20 hours ago.

Mental Health Patients Worry They Won't Survive Paul Ryan's War On Medicaid

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President Donald Trump indicated in his first federal budget that his administration is committed to investing in programs that tackle mental illness, but the health care legislation he and Republican lawmakers are championing suggests otherwise.

House Republicans released the American Health Care Act earlier this month. It proposes slashing $880 million to Medicaid, which is the largest payer of mental health services in the country, as well as removing the requirement that Medicaid plans cover mental health and phasing out the program’s expansion under the Affordable Care Act. Health and Human Services Secretary Tom Price has previously advocated for reducing federal funding of the program, too. 

House Speaker Paul Ryan, the architect of AHCA, gushed this week about potentially cutting Medicaid funding.

“We’ve been dreaming of this since you and I were drinking out of a keg,” he said to National Review editor Rich Lowry at a conferenced hosted by the publication. 


House Speaker Paul Ryan to Rich Lowry on capping Medicaid funding: "We’ve been dreaming of this since you and I were drinking out of a keg"

— Adam Cancryn (@adamcancryn) March 17, 2017


“There are a lot of people who have chronic mental health conditions who are dependent on Medicaid, both younger people and adults,” said Victor Schwartz, the chief medical officer for a youth mental health nonprofit called the Jed Foundation. “The people at highest risk for the worst consequences are going to be put in jeopardy.”  

*“I have no doubt that this care keeps me alive.”*

States will undoubtedly have to make cuts to crucial services if they lose federal funding.

Kat H., a 36-year-old single mother from Minnesota who asked not to be identified by her full name because it could affect her employment, is one of the people who stands to lose the most if she can’t keep her Medicaid coverage.

“I have no doubt that this care keeps me alive,” said Kat, who has borderline personality disorder. 

“Without psychiatric care, I sometimes can’t even get out of bed for days,” she said. “With it, I hold down a fulfilling and rewarding job, parent effectively, and maintain relationships with family and friends.”

Kat is a self-employed database contractor who estimates she makes around $20,000 a year. She’s able to afford treatment thanks to Obamacare’s Medicaid expansion, which the GOP bill aims to end in 2020. 

Todd Crouch, 46, has bipolar disorder and benefited from Medicaid expansion in his home state of Michigan. He didn’t have health insurance for years, and said the quality of his health care has great improved since he signed up for Medicaid when Michigan expanded the program.

Without Medicaid, Crouch said he would be “right back where I was five or six years ago, where I was hopeless.”

“I’m barely putting food on my table,” he said. “How am I going to afford health care?” 

*The consequences of untreated mental illness*

Issues related to untreated mental illness tend to snowball.

“If those people don’t have access to care, you lose work days, families break apart,” Schwartz said. “By virtue of not being able to treat people who are mildly troubled, you wind up with people who are sicker.”

And research has shown that mental illness can be harmful to both individuals and society if left untreated.

A 2008 study funded by the National Institute of Mental Health ― before Obamacare took effect ― found that people with mental illness who weren’t able to work cost the U.S. economy nearly $200 billion each year. Incarcerations, homelessness and physical health problems connected to poor mental health only add to that cost. 

“Where do people think the people on the corners asking for money come from?” said Paul Gionfriddo, CEO of the Mental Health America nonprofit. 

“Where do they think people who are chronically homeless come from?” he added. “Where do the think people in county jails and state prions come from? All of those are visual representation ― real life, real time ― of what happens when you have an inadequate system for mental health services and supports.”

The GOP’s plan to replace Obamacare would end up making health care even less accessible to millions of Americans, particularly to low-income people. Around one-third of Medicaid beneficiaries suffer from mental health issues or addiction, according to the Department of Health and Human Services. And Trump’s federal budget plan only makes things worse for the poor, with cuts to key programs such as affordable housing, job training and legal counseling.


If I don’t have my mental health, I’m not able to go to work -- and then what would I do?
Kat H.
Research indicates that there is a direct correlation between poverty and mental health issues. Low-income people are more likely to suffer from mental illness, according to a report from the New York University’s McSilver Institute. This is partly because they’re less likely to be able to afford treatment and partly because the stress of poverty can exacerbate existing mental health problems.

“I’m barely making it happen financially with my situation right now,” Kat said. “There are some days where we have beans and rice for dinner because that’s all I have enough for in my bank account. The stress about it makes me crazy, it makes me lose sleep. If I don’t have my mental health, I’m not able to go to work ― and then what would I do?”  

Gionfriddo said his 32-year-old son, Timothy, has a serious mental illness and relies on disability benefits and affordable housing to stay out of jail and off the streets. 

“He has been making a concentrated effort to come in off the streets,” he said. “But you make that impossible to happen if you cut these other programs.

 

*The GOP has a history of cutting mental health services*

The Affordable Care Act has been seen as a major win for mental health care. The expansion of Medicaid, coupled with increased access to private insurance, filled gaps widened over the years by state and federal cuts to mental health services.

“People with mental illness are an easy target from a purely political perspective,” said the Jed Foundation’s Schwartz. “There’s not a strong lobby, they’re not giving political contributions or in many cases not even voting.”
Mental health services are often among the first issues on the chopping block when budgets get slashed. The mental health care system lost around $4.35 billion after the 2008 financial crisis, according to the National Alliance on Mental Illness. Although much of that money found its way back into budgets, some systems never recovered. Several states, including Florida, Nevada and Michigan, are currently weighing cutting millions more. 
Some Republican lawmakers, though, are fighting to keep the American mental health care system afloat.

In a letter to Senate Majority Leader Mitch McConnell this month, Sens. Rob Portman (R-Ohio), Lisa Murkowski (R-Alaska), Shelley Capito (R-W.Va.) and Cory Gardner (R-Colo.) expressed serious concerns about the AHCA’s effects on mental health.

“Any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services,” the lawmakers said. “We believe Medicaid needs to be reformed, but reform should not come at the cost of disruption in access to health care for our country’s most vulnerable and sickest individuals.”

During the 2016 campaign, Trump pledged to protect Medicaid and Medicare. But he also said he would be open to funding the programs through block grants, which opponents say could lead to reduced benefits. And it appears Trump has shifted further away from his campaign promises since taking office, supporting the House’s health care bill and hinting at dramatic changes for Medicaid recipients.

Although Trump’s budget may claim to want to help people with mental illness, patients advocates aren’t so sure.

“Until we see all the numbers, it’s really hard to understand just how much of a commitment is here beyond the words,” Gionfriddo said.

While politicians tinker with budgets and weigh which cuts will hurt the least, patients are left without answers.

“This is not some hypothetical, academic debate,” Kat said. “This is my real life.”

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-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 20 hours ago.

Budgeting Social Darwinism

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There has been much chatter about President Trump’s proposed “America First” budget as well as the roll out of Trumpcare, which has been designed to replace The Affordable Care Act. Beyond the debatable specifics of these budget and health care proposals, it is clear—at least to me--that they reveal a disturbing back to the future philosophy that applauds the American Social Darwinism of the early 20th century. As an anthropologist who has been thinking about the dynamics and culture and society for more than 30 years, these proposals are nothing less than a blueprint to re-structure our society into a social organism, to cite President Trump’s favorite classification scheme, of winners (the fit) and losers (the unfit), the latter of which will eventually weaken, sicken, die and disappear, ensuring a fine and pure social life for all the winners.

Who are the winners and losers in Trumpcare and the America First Budget?

Some of the Winners:

--the young, the healthy, and the white, who are Christians;

--the corporate elite (also white and Christian, for the most part);

--White Nationalists, racists who want to return America to a pure state (white and Christian);

--The military-industrial complex, which will be showered with billions of additional funds.

In the context of Social Darwinism, the winners protect us from the losers who, if left alone, will pollute and weaken a pure society. That’s what it means to “take our country back.”

Some of the losers:

--the old, whose programs like Meals on Wheels are no longer “productive;”

--the poor, who will lose their health insurance and heat subsidies;

--the infirm of all ages and backgrounds, who will also lose their health insurance and no longer be a “burden” to society;

--immigrants—especially Muslims and Hispanics-- “terrorists and rapists,” who are “bad people;”

--African Americans, genetic polluters who threaten “our way of life;”

--all peoples of color, also genetic polluters who speak and behave differently;

--Jews, who dare to practice openly a non-Christian religion and operate Jewish Community Centers;

--scientists, speakers of inconvenient truths, on climate change, for example;

--social scientists, who engage in social and cultural critique;

--artists and humanists who seek understand the human condition to make life sweeter for everyone;

--journalists, who attempt to rebut an avalanche “alternative facts”

The philosophy that shapes the America First Budget and Trumpcare proposal underscores the notion of “personal responsibility.” If you’re poor or unemployed, you must be lazy or “unfit.” Don’t blame your misery on the rich or on the structural forces that have created and reinforced social inequality. If you work hard, you can be rich. If you don’t, then you’ll be poor and it’s your fault. This line of thinking, in fact, channels Lionel Barrymore’s Mr. Potter in Frank Capra’s classic film, It’s a Wonderful Life, a film that mirrors our contemporary debate about social class, social fitness, and the social contract.

Beneath the surface of this reactionary rhetoric lies a troubling pattern that underscores the Social Darwinist notion that the rich — or the strongest and fittest — should be socially viable, while the poor — or the weakest and least fit — should be allowed to wither and die. Loosely based upon Darwin’s theory of natural selection, Social Darwinists always want nature to take its rightful course in society. In the past the rich and powerful used Social Darwinism to deny workers a decent wage, bash labor unions, and justify the refusal of the economic elite to help the poor. The poor were “unfit” and not worthy of help.

Let the market do its work. Don’t blame the rich for your problems! Blame yourselves for being unemployed. Let nature take its course.

Doesn’t that sound like Tea Party rhetoric? Doesn’t that echo the rhetoric of candidate Trump? Doesn’t this set of ideas give shape and substance to the America First Budget and the Trumpcare proposal?

Before the Great Depression, Social Darwinist beliefs not only expanded American social inequality but also prompted the eugenics movement, which inspired programs in which the genes of the “unfit” were “cleansed” from society. Beliefs in eugenics compelled many American state legislatures to pass laws that sterilized “unfit” people. Inspired by eugenic theories, the US Congress passed a series of Immigration Restriction Acts in the 1920s. These laws severely limited or barred the immigration of peoples deemed “unit.” Fit people came from Northern Europe. They were the winners. Unfit people came from Asia, Eastern or Southern Europe. They were the losers. The American eugenics movement, of course, inspired the Aryan nationalism of Nazi Germany that resulted in The Final Solution and the “cleansing” of six million “unfit” Jews.

That was the horrific past. In the present it seems preposterous that American society might return to a past of scientific racism, anti-immigrant prejudice, and severe social inequality. But from my anthropological vantage, which has been shaped by generations of anthropological opposition to the racism and religious intolerance that fueled American Social Darwinism, that’s what the America First Budget and Trumpcare is all about.

If we do not resist Trump’s social engineering with every fiber of our being, we will not only drift back to a reconfigured form of 19th century economic royalism, but also return to the winner-loser ideology of Social Darwinism. Such a return will tear our society apart.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 5 hours ago.

Trumpcare's Rx: Unwanted babies and no health insurance | Editorial

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Perhaps it's time to rally again outside the offices of N.J. Republicans, or just give them a ring and ask: Will they defend women's health and reproductive rights? Reported by NJ.com 22 hours ago.

Trumpcare’s Rx: Unwanted babies and no health insurance

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Trumpcare’s Rx: Unwanted babies and no health insurance | Editorial The Republican plan to end all federal funding for Planned Parenthood, baked into Trumpcare, would result in thousands of unwanted births. That’s a lesser-noticed but foreboding finding from the same Congressional B... Reported by Raw Story 20 hours ago.

In Sickness And (For The Wealthy) In Health

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President Trump is conducting his presidency like a reality TV show, with all the trappings. But in real life, Trump’s actions—his travel ban, now-debunked wiretapping claims and “skinny” budget proposal—have harmful consequences for our democracy and for people’s lives, including many of the people who voted for him.

Nowhere is that clearer than in healthcare. Trump’s rhetoric about healthcare is crashing up against reality. He promised to repeal the Affordable Care Act and replace it with a plan that would cost less and cover more people. He bragged there would be no cuts to Medicare or Medicaid during his presidency. And he tweeted that the Republican healthcare plan “will result in a beautiful picture.” But the bill released last week is a bleak betrayal of those promises.

The nonpartisan Congressional Budget Office found that under the American Health Care Act, drafted by House Speaker Paul Ryan with Trump’s strong support, 14 million people would lose health insurance by 2018 and 24 million would lose coverage this decade. Americans with the greatest needs would fare the worst under the AHCA. It would strip $880 billion in funding from Medicaid and eliminate $673 billion in tax credits that help low-income people afford health insurance. Healthcare expenses for many Americans would skyrocket—including a huge “age tax” on older Americans—and, in some cases, the cost of coverage could exceed a person’s annual income.

With so many losers under this bill, who wins? The wealthy, big time. Ryan and Trump are racing to repeal the taxes on the wealthy that, under the ACA, subsidized the cost of health insurance for those who couldn’t afford it. The GOP bill would lavish about $600 billion of tax cuts on the wealthy. The 400 richest Americans would get about $7 million each. In fact, the only tax their plan retains from the ACA is the mis-nicknamed “Cadillac tax”—a tax on middle-class Americans who obtain health insurance through their employers.


If the Republican health proposal becomes law, approximately 17,000 people could die in 2018 who otherwise would have lived.

The harsh irony is that many who have benefited the most from the ACA—lower-income older people, in rural, Republican strongholds—gave Trump their vote and their trust yet stand to fare the worst under “Trumpcare.” A 40-year-old earning $30,000 in one of the counties that voted for Trump stands to lose more than $3,600 in tax credits under the GOP plan. A 64-year-old earning $27,000 per year pays $1,700 in premiums annually under “Obamacare.” Under Trumpcare, premiums would rise to $14,600 a year, a 750 percent increase.

The loss of Medicaid funds in the GOP bill would deal a devastating blow to the states that have expanded Medicaid coverage—like Ohio, where the Republican governor has spoken out against the GOP plan. It would be particularly harmful to the 40 million children who are eligible for Medicaid, including students with special needs who receive services in school. And the AHCA shifts $370 billion in Medicaid costs onto state governments, forcing them to choose between rationing healthcare and providing other vital services, like public safety, public education and public works.

The ACA needed to be fixed, like every piece of complex legislation. For instance, the AFT and others fought for a public option as a way to compete with insurance companies, for the ability to negotiate prescription drug costs, and to eliminate the tax on middle-class workers’ plans. Nevertheless, under the ACA, people with pre-existing conditions knew their coverage couldn’t be taken away, students knew they could stay on their parents’ health plans until age 26, and more than 20 million people without health insurance—who could be one illness away from destitution, or worse—gained access to healthcare.

The ACA should be improved, not eliminated. Lives literally depend on it. A new analysis estimates that, if the Republican health proposal becomes law, approximately 17,000 people could die in 2018 who otherwise would have lived. By 2026, the number of people who suffer preventable deaths could grow to 29,000 in that year alone. Those stark numbers represent real people—mothers, babies, breadwinners and best friends.

The “skinny” budget proposal Trump released this week is equally as hard-hearted and harmful as the GOP healthcare plan. It would wipe out 13.5 percent of the federal education budget alone—including after-school and summer programs that provide children living in poverty with a safe, enriching place to be and, sometimes, their only meal of the day.

Trump said he would be “president for all Americans.” But a shameful trend is emerging: tax cuts for the wealthy and service cuts for the needy. Reality is different from reality TV. And Trump’s actions as president are a far cry from his rhetoric feigning populism and concern for the needs of working families.

Have you or your family benefited from the Affordable Care Act? If you’d like to share your story on HuffPost, email us at ACAstories@huffingtonpost.com.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 18 hours ago.

Trump Is Trying To Thread A ‘Fine Needle’ On Health Care, Says Health Secretary

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WASHINGTON ― Health and Human Services Secretary Tom Price said Sunday that the White House has been reaching out to Democrats and welcomes their input on how to replace Obamacare. If true, those conversations were very recent ― as of Wednesday, leading Democrats said the White House hadn’t contacted them to talk health care at all.

Republicans will need Democrats’ help down the line as they seek to repeal and replace the Affordable Care Act, one of former President Barack Obama’s top policy achievements. But they have a long way to go, and their current approach hasn’t won them any support from Democrats.

That’s especially true as Republicans make concessions in the House to win over conservative members, as ABC’s “This Week” host George Stephanopoulos noted during his interview with Price on Sunday.

Price acknowledged it will be challenging to come to an arrangement that pleases both sides.

“It’s a fine needle that needs to be thread, there’s no doubt about it,” he said.

He said they “sure hope” they will be able to work with Democrats on the third piece of their three-pronged approach. Republicans plan to pass a bill gutting Obamacare’s coverage expansion, which could lead to millions more people being uninsured, through a process that wouldn’t require Democratic support.

But to finish the job of rewriting the law’s regulations — something conservatives say is necessary to bring down health insurance premiums — Republicans would need 60 votes in the Senate, which Republicans can’t get to without some Democratic support. Some Republicans, including Sens. Tom Cotton (R-Ark.) and Ted Cruz (R-Texas) have warned that the three-part approach to repealing and replacing Obamacare won’t work because Democrats won’t support it.

Price said they hope Democrats will cooperate, because “they know that the current law doesn’t work.”

“We’ve been reaching out to individuals in both the House and the Senate on the other side of aisle and look forward to their ideas and hopefully their input and their support as we move forward,” he said.

“So we’re asking men and women of goodwill in the legislature, in the legislative branch, to come forward and work with us to solve the challenges that the American people see in their health care system, again so we get a health care system that works for them,” Price added.

The Huffington Post reported on Wednesday that the Trump administration had not reached out to Senate Minority Leader Chuck Schumer (D-N.Y.), House Minority Leader Nancy Pelosi (D-Calif.), House Minority Whip Steny Hoyer (D-Md.) or Senate Minority Whip Dick Durbin (D-Ill.) to discuss health care. A spokesman for Sen. Joe Manchin (D-W.Va.), who is often targeted to vote with Republicans, had not heard from Trump to discuss general health care reform efforts either, according to his spokesman.

A White House spokesperson said at the time that Trump has discussed aspects of reform with some Democratic lawmakers, and that they will press members of the party to support their efforts.

“Obamacare is a disaster that has hurt the middle class,” the aide said, “and we call on all Democrats to put the American people first.”

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 16 hours ago.

White House Admits Trump 'Insurance For Everybody' Guarantee Isn't Going To Happen

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WASHINGTON ― White House Budget Director Mick Mulvaney threw cold water on the promise that “everybody” would get health insurance under GOP legislation ― a promise that was made by none other than President Donald Trump himself. 

“We don’t have universal ― the only way to have universal care, if you stop to think about it, is to force people to buy it under penalty of law,” Mulvaney said Sunday on ABC’s “This Week.”

The expectation of everyone in the nation getting health insurance if Trump took office came from promises he himself made.
“We’re going to have insurance for everybody,” Trump said in January. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” In 2015, Trump similarly told CBS’s “60 Minutes,” “Everybody’s got to be covered.”

But the nonpartisan Congressional Budget Office made clear in its recent analysis that there’s no way everyone will get insurance under the GOP’s American Health Care Act. Instead, 24 million people stand to lose coverage over the next decade.

Last week, White House Press Secretary Sean Spicer started to add caveats to Trump’s promise, saying it was less of a promise and more of a “goal.” He said Trump’s plan would create lower costs and give “more people the option to have health care.”
“Everybody has a choice to get it,” Spicer added, “and I think that’s what we want to do is give everyone who wants to get health care the financial ability to get it.”

Mulvaney, however, was more direct Sunday, just admitting that “insurance for everybody” is impossible, since Republicans refuse to put in place a mandate to buy insurance. (And they’re not interested in a single-payer system, which would also offer universal insurance access.)

“What you’ve got now is we’re forcing people to buy it under Obamacare under penalty of law and people are still looking for a way not to buy it,” he said. “So clearly the government mandate doesn’t work. The better process, the better function is exactly what we’re trying to do now, which is to encourage people and enable them to buy a policy they want and can afford.”

The CBO also took issue with the White House’s claim that health care will suddenly be significantly more affordable. It found, for example, that a 64-year-old person who makes $26,500 could face an increase in his or her premiums from $1,700 now to $14,600 under the GOP bill. 

“The only way to get truly universal care is to throw people in jail if they don’t have it. And we are not going to do that,” Mulvaney added.

Obamacare actually specifically bars the federal government from throwing anyone in jail if they don’t purchase health insurance. People do face a tax penalty, but the law also says the IRS can’t use liens or levies on property as enforcement tools.

*Want more updates from Amanda Terkel? Sign up for her newsletter, Piping Hot Truth, **here**.*

 

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 15 hours ago.

Paul Ryan Reveals Latest Changes To Republican Healthcare Bill

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Paul Ryan Reveals Latest Changes To Republican Healthcare Bill As first discussed on Friday, in order to overcome vocal objections to Obamacare repeal by conservative republicans, the White House won the support of the Republican Study Committee members by agreeing to give states the option to impose work requirements on Medicaid recipients and the option to block grant Medicaid instead of the cap system in the bill.  Today, during the Sunday morning TV circuit, Paul Ryan elaborated further that House Republicans are working on additional changes to the Obamcare repeal bill which seek to provide more generous tax credits for older Americans, while confirming the addition of the work requirement for the Medicaid program for the poor.

Speaking on Fox News Sunday, Paul Ryan said Republican leaders still plan to bring the healthcare bill to a vote on the House of Representatives floor on Thursday, adding that leaders were working to address concerns that had been raised by rank-and-file Republicans to the legislation. * *

*"We think we should be offering even more assistance than the bill currently does," *for lower-income people age 50 to 64, Ryan said of the tax credits for health insurance that are proposed in the legislation, one week after the CBO found it would cause higher premiums for people in their 50s and 60s. Ryan also said Republicans are working on changes that would allow federal block grants to states for Medicaid.

Coming into the weekend, Republicans remained deeply divided over the shape of Obamacare repeal, President Trump's first major legislative initiative which aims to fulfill his core campaign pledge to eliminate Obama's Affordable Care Act. As noted last week, Trump has been "wooing" lawmakers to vote for the bill, Reuters reported. He won the backing of a dozen conservative lawmakers on Friday after an Oval Office meeting in which the president endorsed a work requirement and block-grant option for Medicaid.

Striking an optimistic tone, the Wisconsin Republican said "we feel very good where we are," adding "we're still having conversations with our members. We're making fine-tuning improvements to the bill to reflect people's concerns, to reflect people's improvements."

Ryan said he's also impressed with how President Trump is helping the GOP to "close this bill.""We feel like we're on track," Ryan said, "and we're right where we want to be."

However, holdouts remains.

Even as Ryan said he felt "very good" about the health bill's prospects in the House, *a leading conservative lawmaker told the C-Span "Newsmakers" program that there were currently 40 Republican "no" votes in the House. *While Republicans hold a majority in the chamber, they cannot afford to have more than 21 defections for the measure to pass. Representative Mark Meadows, the chairman of the hardline conservative House Freedom Caucus, said the bill would "absolutely not" pass the way it is now.



Meadows, a North Carolina Republican, also said the changes being considered for the Medicaid program would not go far enough, if they left it up to states to decide whether to put in place a work requirement.

 

*An optional work requirement for Medicaid would be "a step backwards, not a step forwards," *Meadows said in an appearance on C-Span's "Newsmakers."



Furthermore, even if the healthcare bill were to pass the House, it also would face significant challenges in the Senate. There, Senator Tom Cotton, a conservative Arkansas Republican who has been a critic of the legislation, said that the problem with the legislation was that it would not reduce premiums for people on the private insurance market. Lawmakers need to slow down and solve this problem, he said. "It's fixable, but it's going to take a lot of work," Cotton said on CNN's "State of the Union."

Elsewhere, Senator Rand Paul on Sunday said he does not believe proposed Republican healthcare legislation will pass through Congress. "I don't believe so. I think there's enough conservatives that do not want 'ObamaCare lite,' " Paul said on ABC's "This Week." Paul during the interview stressed a clean repeal of ObamaCare. “None of us ran on this plan. We ran on repealing ObamaCare because it doesn’t work,” Paul told ABC’s “This Week.”



Will the GOP health care bill pass Congress? "I don't believe so," @RandPaul tells @GStephanopoulos. https://t.co/WUlDJOw9t3 #ThisWeek pic.twitter.com/BAUcMdId6n

— This Week (@ThisWeekABC) March 19, 2017



Quoted by The Hill, Paul has dubbed the new GOP plan, released earlier this month by House Republicans, “ObamaCare lite,” and has vowed to vote against the measures once they reach the Senate.  “I was elected in 2010 right after it came into place, to repeal it,” Paul said of former President Barack Obama’s signature healthcare legislation.

In addition to conservatives, moderate Republicans have also expressed concerns about the bill, and their worries are often not the same as conservatives'. Speaking on NBC's "Meet the Press," Republican Senator Susan Collins of Maine said she was concerned about the impact of the proposal on older Americans. She also worried the bill would shift Medicaid costs to states -- something critics say a block-grant approach would only make worse.



Collins said coverage issues must also be dealt with, citing a report from the Congressional Budget Office that said 14 million people would lose health coverage under the House bill over the next year and 24 million over the next decade.



While there has been a modest uptick in optimism in recent days, should the upcoming House vote on Thursday fail to pass, Trump will face his first major rebuke by a republican-dominated Congress, which would be a major setback to Trump's entire domestic agenda, leading to a delay not only in Obamacare repeal, but also implementing tax reform, which as we discussed last week, Goldman now anticipates passing no sooner than Fiscal 2018. Reported by Zero Hedge 15 hours ago.

The Story Of 2 Families And The Real-life Impact of Obamacare Repeal

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RALEIGH, N.C. ― Jennifer and Keith Gibbs say the Affordable Care Act has hurt their family, sticking them with soaring premiums and out-of-pocket costs. Claire and Allen Secrist say the law has helped them and their young daughter, making it possible to get life-changing medical care while avoiding financial ruin.

The two families live 30 miles apart, and have never met each other. But their stories show how the 2010 health care law has created both “winners” and “losers” ―  and what Republican repeal efforts, now underway, would mean for each.

The heart of the Republicans’ repeal campaign is a promise to improve things for people, like Jennifer and Keith, who feel the Affordable Care Act has hurt them. “I’ve met with so many victims of Obama­care,” President Donald Trump said this week, during a speech in Nashville, Tennessee. “We will replace Obama­care and make health care better for you and your families.”

But amid questions about what repeal would actually entail, Republicans have also made promises to families like the Secrists, who are among the 20 million people depending on the health care law. “Nobody will be worse off financially,” Tom Price, Trump’s secretary of health and human services, claimed in an interview this past Sunday.

This is not a vow Republicans can fulfill. And there’s a very simple reason for that. In the GOP Obamacare narrative, the Affordable Care Act imposed regulations that made insurance more expensive for families like the Gibbses ― and then it spent a bunch of taxpayer money in ways that don’t actually help them.

That narrative is more or less correct. It is also incomplete. Specifically, it leaves out the part about how those same regulations, and that same government spending, have put decent coverage within reach for families like the Secrists. Take away the rules and the money, as Republicans propose to do, and families like the Gibbses might feel better off. But the Secrists, just as surely, would suffer.

The American Health Care Act, the bill that House Republican leaders hope to bring to a floor vote next week, is the proof. If it were to become law, a family like the Gibbses could end up spending less on their health insurance premiums, in exchange for a policy that would cover less. The family would also benefit from substantial new tax breaks the GOP proposal would make available to them. But a family like the Secrists would struggle to find a policy with the comprehensive benefits they require, and even if they could find one, they would not be able to afford it. They would probably end up uninsured, struggling to get medical care they desperately need.

This outcome isn’t inevitable. There are ways to help the ACA’s “losers” without hurting its “winners.” But those alternatives would involve different choices and trade-offs than Republicans are considering.

Their Premiums Went Up ― And Kept Going Up

The Gibbses are in their 40s, with two teenage daughters. Keith runs a business advising pharmaceutical and biotech companies that he started a few years ago, in part so he could have more control of his schedule and spend time at home. Jennifer works part-time for a nonprofit organization that helps former prisoners. Their neatly decorated, two-story house sits in a fast-growing neighborhood, popular with people who work in the area’s “Research Triangle.”

They buy coverage on their own, rather than through an employer. In 2013, before the main provisions of the ACA took effect, they paid about $7,200 for a policy from Blue Cross Blue Shield of North Carolina. The plan they had was relatively generous, because it included things like inpatient rehabilitative services that employer plans routinely included but many “non-group” plans did not.

But the plan was cheap for a reason. It had limited mental health benefits, and it didn’t cover maternity benefits at all. It also had a lifetime limit on how much it would pay out, which meant that if somebody in the Gibbs family ended up with an illness requiring years of intensive treatment ― say, an aggressive cancer ― it was possible their bills could hit that ceiling, and then they’d be on the hook for the rest.Most important of all, that Blue Cross plan wasn’t available to everybody. At the time, Blue Cross, like other insurers, practiced “medical underwriting.” It would charge higher premiums, withhold benefits or deny coverage to people whose histories suggested they were at high risk of illness. About 1 in 5 people who tried to buy the same policy as the Gibbses got turned down, according to statistics at healthpocket.com. That number almost surely understates the proportion of people who wouldn’t have been able to buy it if they’d tried, because many people with pre-existing conditions knew that applying for coverage was futile.

Back then, the list of conditions that insurers cited to justify higher premiums, benefit exclusions or outright denials included everything from Crohn’s disease and cancer to diabetes and epilepsy. Roughly 27 percent of the population has a condition that qualified as uninsurable under the old criteria, according to a December study from the Henry J. Kaiser Family Foundation. Around 17 percent of people who tried to buy coverage on the individual market in the days before the Affordable Care Act were rejected, according to the same study ― in other words, roughly the same percentage who tried and failed to get the policy that the Gibbses successfully purchased.

The Affordable Care Act’s consumer protections, particularly the promise of coverage for pre-existing conditions, are among its most popular features. They also made insurance a lot more expensive, because it meant insurers were covering large medical expenses for people they never had to cover before.

When Blue Cross announced the new rates, it told subscribers that, taking account of the law’s financial assistance, it expected that about two-thirds of its customers would pay the same or less for insurance, while one-third would face “substantial increases.” In a prepared statement, the company’s chief actuary explained that the law “will make coverage available to many who have never had it and will enhance benefits for most consumers. These are good things, but they come at a cost.”

For the Gibbses, the cost brought their premiums up to $9,600 a year, a hefty increase but not one that seemed outrageous. A year later, however, Blue Cross discontinued the plan altogether. Jennifer shopped on healthcare.gov and found a UnitedHealthcare plan. But it was about $12,000 a year, Jennifer says ― and, one year later, the price went up again.

Like many insurers across the country, North Carolina’s were realizing they had badly misjudged the market. Healthy people weren’t signing up in the numbers they’d hoped, and the newly insured needed more care than they’d anticipated, leading to huge losses. This past year, UnitedHealthcare pulled out of the state altogether, leaving most of North Carolina with just one carrier.

That sent Jennifer back to healthcare.gov, where, she says, plans similar to her old one had premiums of nearly $20,000 a year, which would be more than their mortgage. And that didn’t include out-of-pocket costs that could exceed $10,000 if serious medical problems struck. The cheaper options had networks without their doctors, or they were “bronze” plans with even higher out-of-pocket costs.

“Twenty thousand dollars is a lot of money to us,” Jennifer says. They would have still been able to pay their bills, but it would have meant cutting back or giving up on extras like eating out, taking family vacations or replacing one of the family cars. (Their minivan is 13 years old.) Eventually, they found a way to qualify for a small-business plan, which Blue Cross sold them directly for a premium of $16,000 a year. It was still a lot more money than they had paid before the ACA.

Jennifer knows that her family has been fortunate in many ways, with good health except for one daughter’s asthma. She believes strongly in what the Affordable Care Act was trying to accomplish. “I do like the idea that, if you can’t afford insurance, then you should be able to have it — that is something the government should absolutely provide,” she says. But she feels the administration “went about it the wrong way.” “I really didn’t imagine it would affect us this much,” she said.

They Would Never Have Gotten Coverage

The Secrists live on the other side of Raleigh-Durham, in a townhouse-style apartment that is part of a development alongside one of the area’s main highways. Their living room has all the appurtenances of young parents with a young child, from the stack of compact discs on the floor to the stray crayon marks on the wall. 

The Secrists pay a lot less for their coverage than the Gibbs family does — and they depend on it a lot more. In 2013, Claire Secrist became pregnant and developed pre-eclampsia. She went through a difficult delivery, severely injuring her pelvic bone and losing so much blood that she required a transfusion. Afterward, she needed surgery, rehabilitation and extensive medication. Their 3-year-old daughter, Holly, has battled severe health problems since birth — including retinoblastoma, cancer of the eye. Eventually doctors had to remove Holly’s eye and replace it with a prosthetic. Allen, for his part, has a congenital condition that predisposes him to skin cancer and requires constant monitoring, including semiannual biopsies.

When Claire was pregnant, the Secrists still had employer coverage through the pathology lab where Allen worked as a technical assistant. After she gave birth, he lost the position in a round of layoffs and the Secrists lost their insurance with it. Holly qualified for coverage under North Carolina’s version of the Children’s Health Insurance Program, a federal-state program for kids who live in households with relatively low income. But for the next two years, while Allen was driving for Grubhub and taking on other part-time jobs, and Claire was working for a school-testing company while she studied for a degree in library sciences, the couple got insurance through the Affordable Care Act. At the time, their combined income was around $30,000 ― not nearly enough to pay for a comprehensive policy on their own, given that necessities like food, rent and gas gobbled up most of their disposable income. They were, however, eligible for the Affordable Care Act’s tax credits, which the government applied in advance in order to discount their premiums. By design, the law’s tax credits are greater for people with lower incomes or higher insurance costs. For a family like the Secrists, who had both, it worked out to about $10,000 a year in assistance.

The Secrists’ income also qualified them for assistance with out-of-pocket costs ― money, again, that the federal government paid directly to the insurers. Altogether, Claire figures, they ended up spending less than $3,000 a year on medical care, despite having so many conditions requiring ongoing, otherwise expensive treatment.

The coverage was hardly perfect. Coventry, the insurer they had for the first year, kept refusing to authorize Claire’s surgery. The network for the policy they got the following year didn’t include a therapist she was seeing for postpartum depression. But the plan included all of the family’s other doctors, including several specialists at nearby Duke University Medical Center. More importantly, Claire says, it covered their panoply of medical bills except for small out-of-pocket expenses here and there.

The coverage has been “really helpful,” Claire says ― expressing a sentiment a lot more common than critics of the Affordable Care Act tend to concede. The majority of people buying private policies through the law are satisfied with them, surveys by the Commonwealth Fund and the Kaiser Foundation have found. And the coverage seems to make a difference, improving access to care and reducing financial strain from medical bills, according to several studies published in the last two years.

“We simply wouldn’t be able to maintain our current level of decent health” without the insurance they have now, Claire says. “We would likely try to get some care ― like vaccinations ― at community health centers. But otherwise, I guess we would just be in a lot of trouble.”

Winners And Losers In The Republican Plan

If the American Health Care Act or something like it becomes law, all of this would change.

Republicans want to redirect the financial assistance the Affordable Care Act provides. They would eliminate the ACA’s tax credits, which provide more assistance to people with low incomes or high insurance costs, and replace them with flat credits that would be available to everybody except people with very high incomes. These credits would vary only by age, but not enough to keep up with higher prices that insurers could charge older consumers. Unlike the Affordable Care Act, the American Health Care Act would include no extra assistance with out-of-pocket costs.

Republicans have also made clear they would like to eliminate or at least weaken most of the Affordable Care Act’s insurance regulations ― by allowing insurers to cover a smaller portion of medical bills, and to stop covering services like mental health. Even the bill’s (popular) guarantee of coverage for people with pre-existing conditions is up for debate: Republicans think it should apply only to people who maintain “continuous coverage.” Under the American Health Care Act, people who allow coverage to lapse for more than 63 days would be subject to a 30 percent markup on premiums ― although that provision is one of several that conservative Republicans have proposed revising.

The Republicans’ bill does not include all the regulatory changes they’ve said they want, because inserting those provisions would complicate their effort to push repeal through the budget reconciliation process, where they could pass it without Democratic support. The bill would, however, immediately eliminate the individual mandate, which incentivizes healthy people to sign up for insurance by imposing a financial penalty on people who do not. For that reason, the Congressional Budget Office this week predicted that, for the first two years, the Republican proposal would actually cause premiums to rise.

But afterward, CBO predicted, less comprehensive plans would come to dominate the market, while older people, who would find policies both less generous and more expensive, would drop coverage altogether. As a result, premiums would grow at a slower rate, eventually dipping down below where they would be if the Affordable Care Act had stayed in place. And they’d come down even more if Republicans found a way to further weaken regulations, through either executive action or future legislation ― two things that they have promised.

That still might not produce huge savings for families like the Gibbses, at least right away. But over time, they’d probably be spending less on premiums than they would if the ACA had stayed on the books. Of course, they might also have higher out-of-pocket costs, which could mean bigger bills if somebody got seriously ill.The bigger savings for the Gibbs family would come from the redirection of subsidies. They make just a little too much money to qualify for the Affordable Care Act’s financial assistance. That’s why they are paying full price. But they would be eligible for the tax credits in the Republican plan, because everybody is, regardless of income. The two kids would qualify for $2,000 each, the two parents $3,000 ― and so, altogether, they’d stand to get $10,000 a year, no matter where their premiums ended up. 

Under the Republican bill, many other Americans would end up getting bigger tax subsidies than they would under the Affordable Care Act. That includes people who get only a little financial assistance now, but still face premiums they find difficult to pay. The GOP plan could make those premiums easier to afford -- although, again, those people could also end up with less comprehensive coverage.

For a family like the Secrists, these changes would work out very differently. They need the kind of financial assistance that the Affordable Care Act provides — and that Republicans would take away. Under the Republican bill, Allen and Claire, who are slightly younger than Jennifer and Keith, would each qualify for a $2,500 credit, or $5,000 between the two of them. That’s a lot less than the nearly $10,000 the Affordable Care Act would make available to the couple.

To get the kind of coverage they have today, with the same kinds of benefits, they would probably end up paying about $6,000 a year in premiums. That would be two to three times what they pay now, and almost certainly beyond their ability to pay ― particularly since, without the Affordable Care Act, they wouldn’t have the extra protection from out-of-pocket costs.

A skimpier policy with fewer benefits would be cheaper, and that might be the only kind of policy the market offered them anyway if insurer regulations became weaker. But as heavy users of medical care, the Secrists would almost surely end up owing even more money in out-of-pocket expenses, thereby saddling them with precisely the kind of “unusable” insurance that Republicans insist Obamacare has given everybody.

One other possibility for the Secrists would be a so-called “high-risk pool” ― a special insurance program that, under Republican legislation, the state government could set up to help people with serious medical problems. But high-risk pools existed before the Affordable Care Act and they rarely ended up with many enrollees, either because limited funds forced states to cap enrollment or because the coverage itself was not very attractive. North Carolina had one such program. It had premiums up to twice as high as regular commercial rates, and it wouldn’t pay for treatment of pre-existing conditions for the first year of enrollment.

Faced with those kinds of options, the odds are good that the Secrists would do what families in that situation usually have done ― prioritize other spending, go uninsured and hope for the best. That’s part of why the CBO expects the ranks of the uninsured would swell by 24 million within a decade of the American Health Care Act becoming law.

“We really don’t know what we’d do, honestly,” Claire told mein an email. “What’s worse, is that eventually we’ll get our financial/job situation together, but it’ll certainly will be much harder if our health issues are out of control. That would be bad for us, but I think it would be even worse for Holly. We have to be reasonably healthy if we want to improve all of our lives, and give her what she needs for her unique situation.”

The Alternative To Repeal

Rick Ramey, the Raleigh-based insurance agent who handles coverage for Jennifer and Keith Gibbs, has found that attitudes about the Affordable Care Act are roughly split ― with those getting the subsidies generally a lot happier than those who don’t. He says he understands both points of view. In his experience, the new system really does make coverage available to many more people, and it really has pushed up premiums for people who had cheap coverage before.

Part of the problem, Ramey has found, is that few Americans grasp how much insurance really costs. The standard most people expect is the insurance that large companies provide to workers ― with almost everything covered and moderate out-of-pocket spending. But because employers pay most of those premiums directly, employees don’t realize how much their plans actually cost. When they suddenly have to pay the whole bill on their own, they feel sticker shock*.*

“A high percentage of the population has no idea, I think,” Ramey says. “Here in North Carolina, you can use about $400 per employee per month as a rough figure for a group plan ― maybe $500 if it’s rich, $350 if it’s high deductible with a health savings account... Most people when they see that, they think it’s ridiculous. They think they’ve been paying just $50.”A goal of the Republican repeal plan is to allow the individual market to revert to something like pre-Obamacare prices even if that means accepting pre-Obamacare policies and all the ways they would fail families like the Secrists. That is not the only option, however. State and federal officials have the power to help families struggling with premiums and out-of-pocket costs in ways that wouldn’t hurt the people for whom the law has provided such valuable protection. It’s just a matter of making different policy choices ― and accepting different trade-offs.

One reason that insurance got so expensive for the Gibbses is that they happen to live in North Carolina, a state where premiums for people in the individual market are among the highest in the country. (If the Gibbses lived in suburban Detroit, for example, they could get a comparable policy for between $11,000 and $14,000 a year.) North Carolina’s problems reflect a variety of factors, including its status as one of the more rural states in the country. Rural areas are always tough for insurers, because they can’t play doctors and hospitals off one another in order to negotiate prices.

But some of the problems in North Carolina are a direct result of decisions by state policymakers. High on the list is Republican legislators’ decision not to expand Medicaid. That put more sick people onto North Carolina’s private plans, driving up premiums. Simply expanding Medicaid would probably help stabilize the market and, going forward, keep premium growth in check. The same is true for other states, like Arizona and Tennessee, experiencing similar trouble. Overall, premiums in expansion states are 7 percent higher than in non-expansion states, according to a Department of Health and Human Services study that controlled for factors like demographics.

At the federal level, lawmakers could provide some money that would help insurers cover the costs of their most expensive consumers, so that insurers could stop charging their customers so much. The Affordable Care Act originally had two programs designed to serve this function, but both were temporary and one never paid out the money it owed ― because Republicans, led by Sen. Marco Rubio (R-Fla.), attacked it as a “bailout” and successfully lobbied to kill its funding.

Reinstating those programs, temporarily or permanently, would help keep markets stable and hold premium inflation in check. As it happens, the American Health Care Act actually has such a provision tucked in amid the more radical changes. It’s a “state and patient stability” fund that states can use, among other things, for reinsurance that would essentially reimburse insurers for their most expensive beneficiaries.

An easier, more direct solution would be to make the existing financial assistance more generous and available to slightly more people. This is actually what the architects of the Affordable Care Act originally intended. Early versions of legislation anticipated more generous tax credits and phased them out more slowly, so that people at higher incomes would be eligible for them. Adding that money now would give families a little extra cash to cover premiums, or perhaps out-of-pocket costs, and that would be enough to get more people enrolling. As they did, premiums for all would come down. 

One advantage of this approach is its recognition that, in the world of health care policy, “winners” and “losers” are fluid categories. Healthy people get sick. Young people get old. If the Republicans get their way, people who save money because of lower premiums could end up paying more, later on, because of higher out-of-pocket costs.* *

The complication, as politics and as policy, is that these steps would also require additional government spending — which, as conservatives rightly point out, would mean a bigger burden for America’s taxpayers. The Affordable Care Act has actually come in under budget, though, so there’s an argument that the money was already allocated. Or the federal government could cut spending elsewhere. Or it could always do what Hillary Clinton proposed during her presidential campaign, and pay for new assistance by raising taxes on the very wealthy.

Either way, the precursor for taking these steps would be agreeing to leave Obamacare in place. That is not something Republicans want to do. But strengthening the existing health care law, rather than tearing it down, is the preferred choice even for some people who aren’t happy with it ― and that includes the Gibbses. “I’m all for the Affordable Care Act, which sounds kinda crazy when I’m sitting here complaining about the cost,” Jennifer said to me. “I think it’s absolutely necessary.”

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 11 hours ago.

Understand “The Economics of Family Oral Healthcare” on World Oral Health Day

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* Poor Oral Health Can Be A Risk Factor to Dementia *

 

* Hong Kong * * and Taiwan Dental Experts Introduce "The Ten-Minute Rule" for Perfect Clean Teeth by Chewing Sugar-Free Gums After Each Meal * * *

 

HONG KONG, CHINA - Media OutReach- 20 ^thMarch, 2017  - Maintaining oral health is much more important than most people think. Poor oral hygiene can result in tooth decay that could have significant impact on our general health including cognitive impairment. What's more, dental problems do not only impact one individual and can go as far as affecting the whole family and government dental expenditure. Multiple studies have revealed the lack of dental care awareness among Hong Kong and Taiwanese public -- almost all adults surveyed in Hong Kong have experienced tooth decay (96%)[1] while the tooth decay prevalence rate among Taiwanese adults is close to 90%[2]. Ahead of the World Oral Health Day, the Faculty of Dentistry at the University of Hong Kong invited two dental experts - Professor Ming-Lun Hsu, the Dean of School of Dentistry in National Yang-Ming University in Taiwan, and Professor Edward Chin-Man Lo, Chair Professor of Dental Public Health in Faculty of Dentistry at the University of Hong Kong to share the concept of "The Economics of Family Oral Healthcare" and introduce international data on oral care and oral diseases prevention trend in Hong Kong.

To maximize the effectiveness or protecting teeth, one should stick with "The Ten-Minute Rule" by chewing sugar-free gums within ten minutes after each meal or after drinking which can effectively prevent acid to damage tooth surfaces.

Ahead of the World Oral Health Day, the Faculty of Dentistry at the University of Hong Kong invited two dental experts - Professor Ming-Lun Hsu, the Dean of School of Dentistry in National Yang-Ming University in Taiwan, and Professor Edward Chin-Man Lo, Chair Professor of Dental Public Health in Faculty of Dentistry at the University of Hong Kong to share the concept of "The Economics of Family Oral Healthcare" and introduce international data on oral care and oral diseases prevention trend in Hong Kong.

* "The Economics of Family Oral Healthcare": * * *

* Dental Expenses Can Add Up to The Price of a Brand New Car *

Professor Hsu shared that although tooth decay is not a contagious disease, it is likely to affect more than one member of the family living under the same roof due to similar lifestyle and oral hygiene habits. Besides, even when a single member of the family is suffering from tooth decay or other sickness, the entire family will be affected from the care and attention required by the patient.

 

Professor Hsu further pointed out that chewing sugar-free gums is a recommendation included in the German Government's latest oral health guideline on maintaining oral hygiene and preventing tooth decay. Also, a recent research indicates that developing the habit of chewing sugar-free gums, one could reduce expenses on dental care up to €81 (about HKD$680) per year[3]. Professor Hsu said, "Dental diseases account for about 6.7% of Taiwan's National Health Insurance expense, amounting to NTD$41.8 billion (HKD$ 10.6 billion) a year. If families understand the concept of 'The Economics of Family Oral Healthcare' and incorporate oral health preventive measures into daily routines, people will be able to enjoy a healthier life, avoiding unnecessary family financial burden and even receiving more effective and quality healthcare services. Remember, the healthier the teeth one has, the fewer dental expenses one spares!"

 

Plagued with oral problems such as tooth decay, periodontal disease, tooth loss and dental implants, Ms Lau's family is known as a "toothache family" to many of her friends and relatives. "My son used to cry in the middle of the night without any obvious reasons when he was about one year old. I found out his front teeth had decayed only when I brought him to the dentist. When my child needed to attend dental check-ups, we sometimes even needed help from his grandparents. It costed my family a lot of time and energy every time we pay a visit to the dentist," said Ms Lau. Another family member, Mr Lau added, "I also suffered from severe tooth decay and tooth extraction was the only treatment option. A lot of money went into tooth implant. In addition to the three-month root canal treatment and surgery for my periodontal disease, the amount my family spent on dental treatments could have gotten us a luxury car! It has never occurred to me that our negligence in oral health could give rise to problems lasting a lifetime."

 

* Maintaining Oral Health May Help Reduce Risk of Dementia *

Professor Lo also pointed out that maintaining good oral health can prevent tooth decay and may even help reducing the risk of dementia. "In Hong Kong, the annual expenditure on dental care amounts to about HKD$5 billion[4], which is a significant burden to the city's medical expenditure," said Professor Lo. "Local and international studies have revealed an association between the number of tooth lost and cognitive impairment in the elderly. The loss of chewing ability due to tooth loss could lead to impairment of spatial memory, weakening of learning ability and degenerating of hippocampal neurons in the brain[5]. As maintaining oral hygiene is effective in preventing tooth loss due to tooth decay, subsequently, it may help reducing the risk of cognitive impairment."

 

* Consumers of All Ages to Follow "The Ten-Minutes Rule": Chewing Sugar-Free Gums After Each Meal for Perfect Clean Teeth *

Professor Hsu and Professor Lo reiterated that oral health is fundamental to overall health and wellbeing of a person. They urge people to simply follow "four dental hacks to perfect clean teeth", one can keep the dentist at bay:

1.       Go for regular dental check-ups

2.       Use fluoride toothpaste for tooth brushing in the morning and before bedtime

3.       Use dental floss or mouthwash contains fluoride daily

4.       Chew sugar-free gum after eating or drinking.

 

Professor Hsu also explained that saliva is a natural weapon to neutralize the acid in the mouth and chewing sugar-free gums will increase the secretion of saliva by 10 times (when comparing to stationary state). There are three main benefits of increasing saliva secretion, including lowering the acidity in the mouth, replenishing the lost ions on the tooth surfaces that are damaged by plaque acid and helping remove the residue sweet food on the teeth. The best way to clean the teeth is by brushing it with toothbrush and fluoride toothpaste after each meal. When it is inconvenient to brush teeth, chewing two pieces of sugar-free gums for five to ten minutes is a good alternative to stimulate the secretion of saliva and neutralize the acid in the mouth. By doing so, not only it helps curb the formation of plaque and other acidic substances, it can also clear the food residue in the gaps of the teeth and reduce stickiness on the tooth surfaces. Chewing sugar-free gums also helps remineralization of teeth to maintain oral health. To maximize the effectiveness, one should stick with "The Ten-Minute Rule" by chewing sugar-free gums within ten minutes after each meal or after drinking which can effectively prevent acid to damage tooth surfaces.

  

Chewing gums is often regarded as a fashionable behavior of young adults. In fact, consumers of all ages can also enjoy the benefits of chewing sugar-free gums. Professor Lo added, "Apart from stimulating saliva secretion to neutralize acidity in the mouth and preventing tooth decay by chewing sugar-free gums, the elderly can benefit from the chewing process as it stimulates the brain neuronal activity, which may help slow down cognitive impairment."

* About Mars, Incorporated *

Mars, Incorporated is a private, family-owned business with more than a century of history, approximately $35 billion in sales, and six diverse business segments producing some of the world's best-loved brands: PEDIGREE®, ROYAL CANIN®, IAMS®, BANFIELD® CESAR® (Petcare); M&M'S®, SNICKERS®, DOVE®, GALAXY®, MARS®, MILKY WAY®, TWIX® (Chocolate); DOUBLEMINT®, EXTRA®, ORBIT®, 5™, SKITTLES® (Wrigley); UNCLE BEN'S®, DOLMIO®, MASTERFOODS®, SEEDS OF CHANGE® (Food); ALTERRA COFFEE ROASTERS™, THE BRIGHT TEA COMPANY™, KLIX® FLAVIA® (Drinks); and COCOAVIA® (Symbioscience). Headquartered in McLean, VA, Mars operates in 424 facilities across 78 countries, where our more than 80,000 Associates --all united by the company's Five Principles of Quality, Efficiency, Responsibility, Mutuality and Freedom --strive every day to create relationships with our stakeholders and to deliver growth we are proud of.

For more information about Mars, please visit www.mars.com. Join us on Facebook, Twitter, LinkedIn and YouTube.

 

* About * * Wrigley * * *

Wrigley is a recognized leader in confections with a wide range of product offerings including gum, mints, hard and chewy candies, and lollipops. Wrigley's world-famous brands -- including Extra®, Orbit®, Doublemint®, and 5™ chewing gums, as well as confectionery brands Skittles®, Starburst®, Altoids® and Life Savers® -- create simple pleasures for consumers every day. With operations in more than 50 countries and distribution in more than 180 countries, Wrigley's brands bring smiles to faces around the globe. The company is headquartered in Chicago, Illinois, employs approximately 17,000 associates globally, and operates as a subsidiary of Mars, Incorporated.

 
--------------------

[1] Department of Health, the Government of the Hong Kong Special Administrative Region. Oral Health Survey 2011. 2011. http://www.toothclub.gov.hk/en/en_pdf/Oral_Health_Survey_2011/ Oral_Health_Survey_2011_WCAG_20141112_(EN_Full).pdf

[2]  Reference from a report of Health Promotion Administration of Ministry of Health and Welfare in Taiwan, Investigation of the Oral Health Condition in Taiwanese Adults and Elderly, with a survey conducted by Kaohsiung Medical University, showing that tooth decay prevalence of Taiwanese adults who are 18 or above rates as high as 87.99%, while the elderly aged 65 or above rates as high as 89.36%.

[3] The study was conducted by Wrigley Company Foundation which commissioned the University of Bochum and the University of Witten's specialized scientists to study the impact of oral health on the overall economy, according to the experience of Finland which is the pioneer of European oral care.

[4] Food and Health Bureau, the Government of the Hong Kong Special Administrative Region. Total health expenditure by financing source and function (at current market prices). Estimates of Health Expenditure, 1989/90 -- 2013/14. http://www.fhb.gov.hk/statistics/download/dha/en/tf6_1314.pdf

[5] Zhu J, et al. Multiple tooth loss is associated with vascular cognitive impairment in subjects with acute ischemic stroke, Journal of Periodontal Research, Res. 2015; 50: 683 -- 688. Reported by Media OutReach 4 hours ago.

Ron Paul: Obamacare Repeal Or Obamacare 2.0? – OpEd

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This Thursday, the House of Representatives will vote on a Republican bill that supposedly repeals Obamacare. However, the bill retains Obamacare’s most destructive features.

That is not to say this legislation is entirely without merit. For example, the bill expands the amount individuals can contribute to a health savings account (HSA). HSAs allow individuals to save money tax-free to pay for routine medical expenses. By restoring individuals’ control over healthcare dollars, HSAs remove the distortions introduced in the healthcare market by government policies encouraging over-reliance on third-party payers.

The legislation also contains other positive tax changes, such a provision allowing individuals to use healthcare tax credits to purchase a “catastrophic-only” insurance policy. Ideally, health insurance should only cover major or catastrophic health events. No one expects their auto insurance to cover routine oil changes, so why should they expect health insurance to cover routine checkups?

Unfortunately the bill’s positive aspects are more than outweighed by its failure to repeal Obamacare’s regulations and price controls. Like all price controls, Obamacare distorts the signals that a freely functioning marketplace sends to consumers and producers, thus guaranteeing chaos in the marketplace. The result of this chaos is higher prices, reduced supply, and lowered quality.

Two particularly insidious Obamacare regulations are guaranteed issue and community ratings. As the name suggests, guaranteed issue forces health insurance companies to issue a health insurance policy to anyone who applies for coverage. Community ratings forces health insurance companies to charge an obese couch potato and a physically-fit jogger similar premiums. This forces the jogger to subsidize the couch potato’s unhealthy lifestyle.

Obamacare’s individual mandate was put in place to ensure that guaranteed issue and community ratings would not drive health insurance companies out of business. Rather than repealing guaranteed issue and community ratings, the House Republicans’ plan forces those who go longer than two months without health insurance to pay a penalty to health insurance companies when they purchase new policies.

It is hard to feel sympathy for the insurance companies since they supported Obamacare. These companies were eager to accept government regulations in exchange for a mandate that individuals buy their product. But we should feel sympathy for Americans who are struggling to afford, or even obtain, healthcare because of Obamacare and who will obtain little or no relief from Obamacare 2.0.

The underlying problem with the Republican proposal is philosophical. The plan put forth by the alleged pro-free-market Republicans implicitly accepts the premise that healthcare is a right that must be provided by government. But rights are inalienable aspects of our humanity, not gifts from government.

If government can give us rights, then it can also limit or even take away those rights. Giving government power to enforce a fictitious right to healthcare justifies government theft and coercion. Thievery and violence do not suddenly become moral when carried out by governments.

Treating healthcare as a right leads to government intervention, which, as we have seen, inevitably leads to higher prices and lower quality. This is why, with the exception of those specialties, like plastic surgery, that are still treated as goods, not rights, healthcare is one of the few areas where innovation leads to increased costs.

America’s healthcare system will only be fixed when a critical mass of people rejects the philosophical and economic fallacies justifying government-run healthcare. Those of us who know the truth must continue to work to spread the ideas of, and grow the movement for, liberty.

This article was published by RonPaul Institute. Reported by Eurasia Review 3 hours ago.

With income tax returns filing deadline near, here are 3 major things to do before March 31

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With the income tax returns filing deadline just around the corner, here are three major things you should get out of the way by March 31. 

*1. Filing Your Tax Returns if you have missed it earlier: *

Most of you - whether you are a salaried taxpayer or a businessman - must have already paid taxes in time but doesn't mean you don't need to file tax returns? Just paying taxes is not enough. The law also requires you to file your taxes if your income exceeds the basic exemption limit of Rs. 2,50,000 irrespective of the fact whether your income garners payable tax or not. 

Your credit card payment or investments in mutual funds or shares or buying a property beyond the specified limit makes you liable to file tax returns. The law requires your to file your taxes by the due date which is July 31 every year for the salaried person and for those whose accounts don't need to be audited.

*But what happens if you forget to file your tax returns?*

There is no need to panic -when it comes to filing tax returns, the law is not too stringent because if you have already paid all the taxes due on your total income. The tax has been accordingly deposited with the government, so there's no need to worry. Take for example, the last date to file tax returns for the financial year 2015-16 was July 31, 2016, which was later extended to August 5, 2016. So, if you didn't file your tax returns in the last financial year, you can still do it without any additional penalty or interest provided there is no outstanding tax liability. Unpaid tax incurs a penalty of interest under section 234A/ B & C. 

*What is the governing rule?*

The governing rule provides the leeway to file tax returns within a period of two years from the end of the financial year in question. So you can file your tax returns for the financial year 2014-15 (i.e. Assessment Year 2015-16) till March 31, 2017, and for Financial year 2015-16 (i.e. Assessment Year 2016-17) up to  March 31, 2018.

*Why is it so important to file tax returns on time?*

Apart form incurring interest penalty on outstanding taxes under section 234A/B & C, you will not be allowed to carry forward your business & capital losses to the next assessment years.

*Union Budget 2017 and the new penalty for delayed filing*

Currently there is a provision under section 271F, which levies a penalty of Rs 5,000 for failing to file income tax returns within one year of the end of the relevant financial year. However, this is more of a discretionary penalty which was levied only in rare circumstances. 

In the 2017 Budget, tax filers who have not filed their income tax returns on time, will now have to pay a penalty of up to Rs 10,000 as applicable from Assessment Year 2018-19. A new section 234F has been introduced in the income tax act (I-T Act) which provides for a fee for any delay in furnishing of your tax return in all the cases where the return haven't been filed within the due dates as specified under section 139. There will be two set of penalties, first, a Rs 5,000 penalty in case the tax return is furnished after the due date but on or before December 31 for that assessment year and Rs 10,000 for any other case. However, the government has reduced the penalty amount to Rs 1,000 for small taxpayers whose total income does not exceed Rs 5 lakh.

*2. Pay last instalment of your Advance Tax by March 15, 2017: *

If you are a salaried employee, then taxes applicable on your salary income gets deducted by your employer. But if you have any other source of income other than the salary, like interest on fixed deposits or capital gains from the sale of a property or mutual funds, or shares or from rental income of your flat, then it is necessary to pay the taxes due on the additional income as per then advanced tax payment schedule. The deadline to pay the last instalment of the advance tax for the financial year 2017 is March 15, 2017. This also applies to any self-employed person or a businessman. Timely payments will ensure you're free from interest penalties. 

*3. Make investments on or before 31st March 2017 for Tax Savings u/s 80C & other chapter via deductions:*

If you haven't exhausted the Section 80C limit of Rs 1.5 lakh or 80D limit for medical premiums on health insurance policies, you can still make these investments in Mutual funds ELSS or Life Term Plan or NPS according to your need and comprehensive tax and financial planning. However, it's important not to forget to invest in these instruments to gain tax benefits immediately, depending on your tax slabs. Apart from that, these investments also provide bounty returns. You could also request your employer to give you any tax benefits by lowering the monthly TDS amount.

 

ReportMoneyRishabh Parakh

· Income Tax Returns
· income tax filing
· Income Tax
· Income Tax Notice
· income tax department investment
· Advance Tax
· Tax Deducted at Source (TDS)
· Section 80
· Mutual Funds

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From Print Edition:  Reported by DNA 1 hour ago.

Republicans Have Already Lost the Health-Care Debate

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AP Photo/J. Scott Applewhite

Majority Leader Kevin McCarthy and House Speaker Paul Ryan prepare to face reporters at Republican National Committee Headquarters on Capitol Hill. 

If we had to reduce the philosophical debate over health care to a single question, it would be this: Is health care a right or a privilege? As Donald Trump and congressional Republicans attempt to dismantle the Affordable Care Act and make profound changes to the entire American health-care system, the deep resistance they're encountering has its roots in the fact that they've lost that debate.

Just to be clear, that doesn't mean they won't succeed in passing their legislation. The Republican health-care bill could come up for a vote in the House as early as this week, though its prospects in the Senate are far more dim. Even without the public behind them, they may be able to push a bill through. But everything they do on health care will be judged by the standards Democrats have set, and more particularly, the goals of the ACA itself. Even Republicans themselves admit this, if you listen closely enough to what they say.

You can divide the Republican proposal into the things they want to do and the things they feel they have to do, and it's no mystery which is which. They want to roll back the ACA's taxes on the wealthy, remove the requirement for people to carry insurance, remove regulations on insurers, promote health savings accounts, and transform and then cut back Medicaid. They feel they have to offer some avenue toward coverage for those with pre-existing conditions, offer at least a little help to people who can't afford insurance, and retain popular ACA provisions like the one allowing young people to stay on their parents' plans up to age 26.

"This is sort of the problem of all of this," said Senator Rand Paul in reference to that last provision, showing an admirable candor. "People want the feel-good stuff that was in Obamacare, but they don't want to pay for it." That is indeed a problem, since the "feel-good" features of the ACA are the ones that help large numbers of people and are therefore popular. And unlike Republicans, Democrats never pretended that improving the health insurance system was going to be free. When they wrote the ACA, they paid for every dollar of new benefits with new taxes and savings squeezed from existing programs.

It wasn't cheap, and it was complicated. But the ACA has created a new set of expectations Republicans have to meet.

The first is the problem of those without insurance, which was the largest problem the ACA was meant to solve. Its success on that front has certainly been incomplete: while it reduced the ranks of the uninsured by over 20 million, there are still millions without insurance. Republicans never thought the uninsured was a problem to begin with, so it isn't a surprise that their plan would lead to tens of millions more Americans lacking coverage. But they're forced to scramble to explain why it's OK to put 24 million more Americans (according to the Congressional Budget Office's analysis) off their insurance.

The answer is to pretend that you can substitute universal coverage with something called universal "access," which in practice would mean you are legally permitted to buy insurance, provided you can afford it. "With our whole plan, every single American will have access to coverage," says Secretary of Health and Human Services Tom Price. They even try to claim that the millions of poor Americans they'd like to kick off Medicaid will be better off in the end with their new "access" to private plans they can't afford.

Or look at the ACA's requirement that insurers can't discriminate against the tens of millions of people with pre-existing conditions. This too was something Republicans never particularly cared about, but now they have to pretend they do. So they throw into their bill a way that those people will supposedly be able to have secure coverage, knowing full well that the way they do it—high-risk pools, which concentrate all the most expensive patients to insure in one pool—is doomed to failure.

Their solutions to the complex problems of insuring all Americans are so half-hearted because they've never really bothered to grapple with those problems on a practical level. Their beliefs about health care are purely philosophical, rooted in an antipathy toward government and a belief that any system that provides for everyone regardless of income must be evil at its core.

Yet they know that most Americans don't share those beliefs, particularly not in the doctrinaire version in which they prevail in today's GOP. So they have to claim that they're offering not an ideological solution but a practical one.

So to a skeptical public, they say that they oppose government involvement in health care not because they simply believe government is bad, but because government doesn't work. Any program run by the government must be inefficient and ineffective, therefore the high cost of (private) health care in America and the continued existence of people without coverage must be a product of too much government.

These practical claims are preposterous in almost all their particulars. But if they were right, then everyone, regardless of their political beliefs, could at least in theory agree with them. If a system designed by conservatives—with as little government insurance as possible and some vehicles like health savings accounts that provide tax benefits in the place of direct assistance—actually produced the best practical outcomes, even liberals would have a hard time criticizing it.

Yet conservatives have never been able to provide an explanation for why every other advanced democracy has a health care system with far more government regulation than ours yet is simpler and easier to understand and operate, insures all or nearly all its citizens, produces widespread satisfaction, and costs less than ours does. These systems vary from country to country, but none is as privatized as ours and none is as expensive as ours. If conservatives were right about the pernicious effects of government involvement in health care, then those systems would be dramatic failures while ours, with its reliance on private companies and markets, would be a spectacular success.

And if the Affordable Care Act were really the disaster Republicans claim, then the public would be demanding its opposite. They'd be demanding a smaller role for Medicaid, fewer protections from insurance company abuses, the removal of subsidies to help people buy insurance, and a reversion to the status quo ante in which those with pre-existing conditions could be denied coverage.

That's not what Republicans are promising, at least not out loud. They're saying that their plan will do all the things the ACA does, only better. And if they actually pass a bill, they'll find out the cost of making promises they had no intention of keeping. Reported by The American Prospect 1 day ago.

Taking a Scalpel to Medicaid

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This article appears in the upcoming Spring 2017 issue of The American Prospect magazine. Subscribe here.

As Republicans struggle over how Congress can pass some version of their health-insurance cuts, lost in the debate is the fact that the Affordable Care Act’s greatest achievement was the expansion of Medicaid. The most dire cuts in the proposed GOP legislation would be both to basic Medicaid and to the people who qualified for the ACA expansion.

The bill not only phases out the expansion of Medicaid under the Affordable Care Act; it guts basic Medicaid itself. A core provision converts Medicaid from an entitlement, for which people automatically qualify based on income or other criteria of need, into a fixed per capita block grant to the states, with much-reduced federal aid. The only possible consequence can be to throw millions of people off Medicaid.

When the Congressional Budget Office calculated the impact of the Republican legislation in mid-March, it found that 24 million people will lose coverage by 2026 and 14 million of them will be Medicaid recipients. Of the roughly 20 million people who gained coverage thanks to the ACA, more than half gained coverage thanks to the Medicaid expansion in the law. More than three million were young people who were able to stay on their parents’ plans, and the rest bought insurance on the private market through the ACA-sponsored exchanges. This aspect of the ACA will also be gutted through reduced subsidies.

Medicaid is the largest health insurance program in the United States, covering some 20 percent of Americans—more than are covered by Medicare. Established during President Lyndon Johnson’s Great Society initiatives of the mid-1960s, Medicaid originally was intended to cover people on Aid to Families with Dependent Children (AFDC), the working and elderly poor, people with disabilities, and indigent people needing nursing home care. According to 2015 data, most nonelderly Medicaid recipients are white (42 percent); the rest are Hispanic (31 percent), black (19 percent), or of another race (8 percent).

Subsequent budget cuts excluded most of the working poor, and people on AFDC no longer get automatic coverage since that program, now called Temporary Assistance for Needy Families (TANF), was turned into a block grant in 1996. The original Medicaid program was created as a federal-state match. Today, the basic formula pays 50 percent of the costs in states like Colorado and Massachusetts, up to a 75 percent of the cost in states like Mississippi, and 72 percent in West Virginia. Currently, the federal government adjusts Medicaid payments based on fluctuations in a state’s actual health-care costs.

The 2010 Affordable Care Act included the most dramatic expansion of Medicaid in the program’s history. The law encouraged states to liberalize Medicaid coverage by having Washington pick up nearly all of the costs. The formula expanded eligibility to people who earned up to 138 percent of the poverty level—$16,643 for an individual and $33,948 for a four-person household in 2017. Many of the people who were able to access health insurance under the Medicaid expansion were part-time workers or full-time service or construction workers whose employers did not provide health insurance. The ACA also standardized enrollment and eligibility requirements across states.

(Photo: AP/J. Scott Applewhite)

Health and Human Services Secretary Tom Price speaks during a news conference on Capitol Hill on March 17, 2017, about the GOP's replacement bill for the ACA.

In December 2016, nearly 74 million Americans received Medicaid coverage, with roughly 16.2 million new adults and children having enrolled in Medicaid and CHIP (health coverage for children in poverty) since late 2013 when the program became effective. “That was a pretty significant change in 2010,” says Colleen Grogan, a University of Chicago health-care policy professor. “It was a health-care program for the poor, but it never actually covered all poor people who really needed care.”

The federal expansion, with its generous matching rates of 100 percent in 2016, 95 percent in 2017, and 90 percent in 2020 and subsequent years (originally mandatory but made optional by a Supreme Court decision) was so attractive that most states agreed to the expansion. It had bipartisan appeal: Of the 31 expansion states, 16 have Republican governors.

It is this expansion that would be undone by the Republican bill. The CBO estimates that federal Medicaid spending would decrease by $880 billion over the next decade—states will have to dispense with the expansion and cut other aspects of the Medicaid program since their costs would soon become exorbitant. For people who do remain on Medicaid, the Republican bill has added work requirements, as a capitulation to conservatives who thought it wasn’t tough enough. The GOP bill would also repeal key ACA funding streams, such as the Medicare payroll tax on high-income earners, as well as levies on high-cost employer-sponsored group health plans, pharmaceutical companies, medical device manufacturers, and tanning beds.

 

*HOUSE REPUBLICANS HAVE* tried to finesse the spending cuts by claiming that the new legislation would be a gain for state “flexibility.” States, presumably, would give up resources but in return would get new flexibility to devise their own state programs.

Under closer scrutiny, this contention disintegrates on several fronts. First, the proposed additional funding for new state experimental programs is a pittance compared with the federal funds that are being cut. Second, states are already spending significant sums on their share of Medicaid, and have no discretionary resources to make up the lost federal aid. And third, the existing Medicaid program already provides substantial flexibility though its waiver provisions.

Medicaid makes up nearly 30 percent of total state spending, and already crowds out state priorities like education and infrastructure. To maintain current Medicaid benefit levels for residents, governors and state lawmakers would be forced to cut some recipients loose or find the money elsewhere in already constrained state budgets. Those unappealing choices underscore the no-win scenarios for state leaders who are at the mercy of a Republican Congress determined to finance tax cuts for the wealthy by plundering health care for the poor.

There is no state in the union that can absorb a shock of that scale of reduced federal funding coupled with fast-rising medical costs. The outrage that has greeted the Republican proposal to topple the one of the pillars of the American health-care system reflects the growing realization that the plan jeopardizes the health of millions of people and compromises the economic stability of the states where they live.

(Photo: Harry S. Truman Library)

President Lyndon B. Johnson signs the Medicare bill into law in 1965.

One of the major ways the ACA made the health-care system more efficient was by reducing the number of uninsured people. That development, in turn, reduced the financial stresses on hospitals and clinics by reducing uncompensated care costs—that is, the cost of free medical care that people sometimes seek out in emergency rooms. Moving people onto a standard insurance package that included basic wellness care, immunizations, standards protocols for conditions like diabetes and childhood asthma, and treatment for acute and chronic illnesses means people are being treated more promptly, rather than being forced to seek out expensive alternatives. This increased efficiency of care will be lost, as the Republican bill drives those who lose their insurance back into emergency rooms—or to having no care at all.

President Trump, who pledged to not cut Medicaid on the campaign trail and now supports the House Republicans, emphasized flexibility in his February address to a joint session of Congress. “We should give our great state governors the resources and flexibility they need with Medicaid to make sure no one is left out,” he said. A per capita cap strategy, so the GOP argument goes, would provide states with the flexibility to manage, innovate, and experiment with their Medicaid programs.

Yet funneling fewer dollars to states erodes the built-in flexibility that already exists. Today, states can design health-care programs to fit their own circumstances and experiment with new medical treatment and administrative procedures by using several kinds of waivers that allow states to stretch federal Medicaid rules.

One such tool is the Section 1115 demonstration waiver, known as the “eleven-fifteen” waiver. The provision allows state officials to design and implement programs that expand health-care services; address health-care emergencies like the HIV/AIDS epidemic; craft new administrative, technology, and financial frameworks; and make other refinements that meet the requirements of a state, region, or specific groups of patients.

As of February, 33 states had been granted waivers in five areas, including behavioral health. Oregon officials obtained $2 billion through an 1115 waiver for a program aimed at keeping the growth in Medicaid costs at or below 3.4 percent annually by using regional “coordinated care organizations.” These organizations target low-income patients through networks of providers and programs designed to reduce emergency room visits, minimize hospital readmissions without compromising quality of care, and the like. According to Jesse O’Brien, policy director for the Oregon State Public Interest Research Group, changing the practices of large organizations like hospital and health insurers requires significant dollars that most states cannot deploy without federal funding.

“If the idea is to provide states with flexibility to implement new ways of providing health-care coverage to people through Medicaid, that takes more money up front,” says O’Brien. “You can’t just say, ‘Here’s a smaller amount of money, do with it what you will.’”

Massachusetts undertook the boldest use of the federal dollars provided through the 1115 waiver to establish its successful universal health-care program in 2006, which became the model for the Affordable Care Act. One of the primary drivers for health-care reform in the Bay State was the pressure on hospitals from the costs of the uncompensated-care pool, which provided free health care to low-income people who did not have insurance and relied on emergency room visits.

Establishing an insurance system that provided routine medical care for low-income people and nearly all other state residents dramatically reshaped the state’s health-care landscape. Today, 96 percent of Massachusetts residents are insured. The Bay State received $52.5 billion through the amended 1115 waiver last November, to allow Medicaid patients to use accountable care organizations. These networks bring together hospitals, doctors, and other medical professionals to coordinate care and treatment for Medicaid patients, including substance abuse programs, and provide funds to support care for the indigent.

The challenge of providing care for uninsured people would come roaring back in Massachusetts and elsewhere if Medicaid eligibility narrows, with less money in the system and more people losing coverage. “There’s a waiver process that the Trump administration totally controls that allows states to waive virtually anything in the Medicaid rule book,” says Brian Rosman, the government affairs and research director for Health Care for All, a Massachusetts health-care advocacy group that played a key role in the 2006 reforms. Flexibility “is a Republican talking point not based on reality; it is an alternative fact,” he says.

Some states want to interpret flexibility in a perverse way—as a license to ration health care. Arkansas Governor Asa Hutchinson, a Republican, has already announced that he intends to pursue an 1115 waiver to institute a work requirement for people who became eligible for coverage under the Medicaid expansion—a conservative tenet the Obama administration rejected. In an undated letter to governors, Secretary of Health and Human Services Tom Price and Seema Verma, the Centers for Medicare and Medicaid Services administrator, said the states can use the waivers to create innovative training and employment programs as ways to “improve the long-term health of low-income Americans.” In reality, many of the working poor who receive Medicaid already work multiple part-time jobs, and an overlaid work requirement would destroy their livelihoods by creating income requirements that would push them off the program. Crafting state eligibility requirements quickly becomes political, and in an environment of reduced funding, one recipient group, or one region, gets played off against another.

Medicaid is the largest source of payment to nursing homes. The program pays for 51 percent of all spending on long-term care and related needs, since few people have the financial resources to pay out of pocket for the high cost of nursing home care, and few have long-term care insurance. The elderly poor who require long-term nursing home care—or middle-class elderly who “spend down” their savings and disperse other resources in order to qualify for nursing home care—are one of the most expensive groups to cover. But state officials are unlikely to tinker with the eligibility of elders or the blind and disabled. Greatest Generation elders, backed by their baby-boomer (and soon-to-be elderly) children, remain one of the most powerful voting and lobbying blocs. Even in a politically polarized America, there is a remarkable bipartisan consensus about the use of Medicaid to cover the long-term needs of the elderly.

(Photo: AP/Tom Williams/CQ Roll Call)

Marc Petitpierre holds a sign at a town hall meeting with West Virginia Democratic Senator Joe Manchin in Martinsburg, West Virginia, on March 16, 2017. Much of the discussion at the event was regarding the Republican plan to repeal and replace the Affordable Care Act.

 

Smaller federal Medicaid allocations will disproportionally affect the poor states that lean Republican, according to former Democratic Governor Jim Hodges of South Carolina. “It will be interesting to see [what happens] when people begin to put pen to paper in these Southern states and realize that some of the proposals that are out there would disproportionally impact them in a negative way,” he says. In states like Tennessee that did not expand Medicaid, rural hospitals will close, says Gordon Bonnyman Jr., a Tennessee Justice Center staff attorney and health-care policy expert. The state’s failure to expand has affected dozens of rural hospitals that did not receive increased expansion funding for caring for low-income residents. “It is hard to overstate what this is going to mean in rural America,” says Bonnyman. “It will absolutely hammer the GOP base.”

Bonnyman notes that anywhere from 40 to 50 rural hospitals in Tennessee, which has second-highest rate of rural hospital closings in the country, are already teetering on the verge of shutdown. When a rural hospital closes, it is just the beginning of a downward economic spiral, he says. Rural hospitals are often the largest employer in the region. A small town without a hospital means the remaining employers have trouble recruiting new workers. Jobs dry up and young people leave, hollowing out once self-sufficient communities.

 

*UNDER THE REPUBLICANS'* American Health Care Act framework, beginning in 2019, Medicaid funding would be distributed using a per capita cap model, based on fiscal year 2016 spending on enrolled eligible groups (elderly, blind and disabled, children, adults enrolled in expansion states and those in non-expansion states) plus the Consumer Price Index’s medical care growth rate. States that exceed the cap would have their allocation reduced in the next fiscal year.

“You can do a per capita cap in a way that would be the greatest thing ever, if you, say, double the amount of money going into the program,” says John McDonough, a professor at Harvard’s T.H. Chan School of Public Health and a key player in the Bay State’s 2006 health-care reform effort. “But this is very clearly intended as a strategy to lessen the federal commitment to the 74 million Americans who are in the program.”

After 2019, expansion states would no longer receive the generous Obamacare match, effectively making enrollment of new applicants cost-prohibitive for most states. That provision alone forces seven states—Arkansas, Illinois, Indiana, Michigan, New Hampshire, New Mexico, and Washington—and 3.3 million people out of the Medicaid expansion immediately, because of state laws that end participation in the program if the expansion matches were no longer available. Republican governors also demanded equity with expansion states, so the19 states that did not accept expansion dollars will receive $10 billion over five years for safety net programs and services.

Republican members of Congress did not reckon on the popularity of many ACA provisions, including the Medicaid expansion. For most Americans, the Obamacare debate is about making the health-care and insurance system work better for patients and their families. But for the Republicans, the issue is pure politics. Republicans in Congress have tried four times in the past 40 years to block-grant Medicaid, believing that health-care coverage for the poor should rest largely with states while the federal government steers the newly freed-up funds to tax cuts and defense. “The GOP plan [creates] a dial that Congress can ratchet down every time they are looking for savings in the future,” says Katherine Howitt, an associate policy director for Community Catalyst, a Boston-based national health-care advocacy group.

 

*GOVERNORS FOR THE MOST* part have emerged as fulcrums of opposition to block grants. At the recent National Governors Association winter meeting, few of them could muster enthusiasm for billions of dollars less in federal funding. State leaders have proved to be a deciding factor on Medicaid reforms before. In his first term, President George W. Bush asked the NGA to craft a block-grant proposal that he could send to Congress. But a bipartisan task force could not reach agreement on covering costs for people eligible for both Medicaid and Medicare and declared defeat in 2003.

When the only option in front of them is the federal government abandoning the states, leaving them to struggle with health care for the country’s poorest people, Democratic and Republican governors can find at least one point of agreement: They do not want to deal with political fallout from supporting a bill that erases a popular entitlement.

In a March letter to House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell, four Republican governors—John Kasich of Ohio, Rick Snyder of Michigan, Brian Sandoval of Nevada, and Hutchinson of Arkansas—argued that the current bill “provides almost no new flexibility for states, does not ensure the resources necessary to make sure no one is left out, and shifts significant new costs to states.”

“The budget exercise is very easy for [Congress],” says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities in Washington. “Once they come up with a formula, they don’t have to see the faces of the people who are losing coverage. Those decisions are passed down to the governors, who have to figure it out.”

Many governors prefer an ACA repair-replace framework to the fast-tracked repeal-replace strategy that the congressional Republicans are hell-bent on. And if governors know more about Medicaid than most members of Congress, then Massachusetts Governor Baker, who spent a decade as the CEO of Harvard Pilgrim Health Care and was a state budget chief, knows more about health-care policy than any current governor. In a January letter to House Majority Leader Kevin McCarthy, Baker specifically outlined Medicaid’s existing flexibility and his state’s history with the 1115 waiver, and noted that “a shift to block grants or per capita caps for Medicaid would remove flexibility from states as the result of reduced federal funding.” He continued, “States would most likely make decisions based mainly on fiscal reasons rather that the health care needs of vulnerable populations and the stability of the insurance market.”

“He understands the game is that the feds want to shrink the money going to states,” says McDonough, the Harvard professor, of Baker. The governor, who is up for up for re-election next year, also understands that he must tread carefully in a Democratic state where there is strong support for the existing state health system. While the House Republicans remain inflexible, the opposition of Baker and some other GOP governors, who made the rounds on Capitol Hill during the governors’ Washington confab, may have sown enough doubt among Senate Republicans to help scuttle the bill. (Baker declined a request for an interview through a spokesman.)

In 2016, the Republican Party platform labeled Medicaid “the next frontier of welfare reform,” one reason work requirements have emerged as a touchstone for Medicaid. Congressional Republicans continue to demonize Medicaid recipients, particularly the “able-bodied” who do not work and receive Medicaid coverage, as underserving people who are gaming the system. These new Medicaid code words telegraph stereotypes about urban areas, African Americans, and other minorities and are reminiscent of the GOP’s “welfare queens” pejoratives of decades past—even though far more people on Medicaid, like welfare, are white.

The health-care sector is woefully unprepared to cope with the Pandora’s box of ills that would be unleashed by entitlement cutbacks predicated on demonizing yet another group of Americans. “This is not your uncle’s welfare program,” says Bonnyman, the Tennessee attorney. “This is a cornerstone of the health-care financing system in the United States. If you want to hack away at that, good luck to you.” Reported by The American Prospect 1 day ago.

Morning Roundup: Trumpcare has some Ohio supporters worried | Franklin County lauded for transparency with incentives | The best Blue Jackets team in franchise history

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President Donald Trump's proposal to repeal and replace the Affordable Care Act has some of his supporters worried. The New York Times visited northwest Ohio to talk with some of the nearly 1 million Ohioans who have benefitted from subsidized health insurance obtained through the ACA or who have access to health care through the Medicaid expansion made possible by the law and championed by Ohio Gov. John Kasich. "People in this community are very conservative. They struggle with the federal budget… Reported by bizjournals 22 hours ago.

Critics weigh in on bill seeking genetic information of workers

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Concern is growing over a bill that would let companies request genetic testing and effectively charge employees more for health insurance if they refuse. The bill aims to clarify rules for workplace wellness programs. Employers would able to offer discounts of up to 30 percent to those who participate. Tony Dokoupil reports on why some are calling this a penalty for privacy. Reported by CBS News 21 hours ago.

Cruz:‘Premiums, Premiums, Premiums’ -- 'That's the Central Problem'

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When it comes to health insurance, “The number one issue is premiums – premiums, premiums, premiums,” Sen. Ted Cruz (R-Texas) told CBS’s “Face the Nation” on Sunday.

-- Reported by CNSNews.com 21 hours ago.

Donald Trump's Approval Rating Is In The Toilet

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President Donald Trump’s latest approval rating has sunk to a new low, according to the latest Gallup poll.

Only 37 percent of American approve of the job Trump is doing, and 58 percent disapprove, the daily poll found Sunday. Those are the worst ratings since he took office eight weeks ago. His approval rating stood at 45 percent just nine days ago.

Trump’s approval rating is lower than any other president at this point in his first term since Gallup started tracking the numbers 72 years ago in 1945. Barack Obama’s rating at this point in his presidency was 60 percent.

HuffPost Pollster’s aggregate, which combines publicly available polling data, currently puts Trump’s approval rating slightly higher at 44 percent, with 53 percent disapproving.

It’s not clear which of several issues may have torpedoed the president’s numbers. 

It’s been a tough week for Trump. His health plan was zapped by the Congressional Budget Office, which revealed some 24 million Americans would be cut out of health insurance over the next decade. His revised travel ban was blocked again in court. And he’s being hammered over his insistence that he was wiretapped during the presidential campaign by Obama, despite what his own intelligence officers are saying and the findings of the intelligence committees in both the House and Senate. 

Meanwhile, questions continue about his associates’ connections with Russia. A hearing Monday will address both Trump’s wiretapping allegations and Russian ties. 

Trump also had an awkward meeting Friday with German Chancellor Angela Merkel.

Obama’s lowest approval rating throughout both of his terms was 39 percent in a Zogby Poll, higher than Trump’s now in his early days in office when a young presidency is usually popular. Trump skewered Obama over the 39 percent numbers in 2011.


@BarackObama has a record low 39% Gallup approval rating. Why so high?

— Donald J. Trump (@realDonaldTrump) August 17, 2011


Gallup’s daily poll results are based on telephone interviews with 1,500 people nationwide and have a 3 percent margin of error.type=type=RelatedArticlesblockTitle=Related Coverage + articlesList=58a7fc48e4b037d17d282c92

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