Quantcast
Channel: Health Insurance Headlines on One News Page [United States]
Viewing all 22794 articles
Browse latest View live

'TRUMPCARE' JUDGMENT DAY: The GOP's Obamacare replacement is on thin ice

0
0
'TRUMPCARE' JUDGMENT DAY: The GOP's Obamacare replacement is on thin ice· * The House of Representatives will vote on the American Health Care Act on Friday after an ultimatum to GOP lawmakers from President Donald Trump.*
· *The House will go through four hours of debate on the bill. The final vote is expected soon after 4 p.m. ET.*
· *Only 22 Republicans can vote against the bill, but conservatives and moderates have come out against the AHCA. Passage of the bill is in serious doubt.*

Friday is judgment day for the Republican Party's opening bid to repeal and replace the Affordable Care Act.

After President Donald Trump issued an ultimatum to Republicans on Thursday, the House has begun to debate the healthcare bill to repeal and replace Obamacare in the early hours of Friday morning.

The GOP leadership originally wanted to vote on the AHCA on Thursday, the seventh anniversary of the Affordable Care Act being signed into law. But leaders were unable to garner enough support for the bill and delayed the vote.

Office of Management and Budget Director Mick Mulvaney told a group of Republicans on Thursday night that they had to pass the AHCA on Friday — or Trump would move on from the bill and leave them stuck with Obamacare.

This has put the onus on House GOP members. But given reservations from conservatives who do not think the bill goes far enough in its repeal of Obamacare and moderates who think the AHCA does not solve the problems of the healthcare system, the outcome of the vote is unclear.

House Speaker Paul Ryan went to the White House early Friday afternoon to brief Trump on the latest with the healthcare bill.

*The final offer*

The American Health Care Act has been altered considerably from its introduction on March 6.

In an effort to win over conservative members of the House GOP, the final bill will have a provision that would do away with the ACA's "essential health benefits." Those mandate that insurance companies cover certain types of care, such as prenatal care and preventive screenings like mammograms.

*(Read more on the impact of repealing essential health benefits »)*

The effect of these changes on things like the federal budget, health insurance marketplace, and premiums are unknown, since the nonpartisan Congressional Budget Office has not had the time to score the updated bill. Some health policy experts have warned that the recent changes will likely cause a further deterioration of the individual health insurance marketplace.

In fact, despite attacking Democrats for the process in which they passed the ACA, Republicans will likely introduce the completed bill and take a final vote on it in the same day. The vote will come less than three weeks after the introduction of the original AHCA. By contrast, the ACA was introduced five months before the House passed the bill in 2009.

*Losing support on both sides*

The problem facing the AHCA on its crucial day: Even with the concessions, both moderates and conservative Republicans have taken issue with parts of the bill.

Conservative members of the House Freedom Caucus have said the bill does not go far enough in its repeal of Obamacare's insurance regulations, even with the end of essential health benefits.

Freedom Caucus members want to see more of the so-called Title 1 regulations stripped, including provisions preventing insurance companies from denying coverage based on a preexisting conditions and the ability for a child to stay on their parents health insurance until they are 26 years old. Both of these provisions have proved incredibly popular with the American public.

The White House has balked at these demands, which has left Freedom Caucus members at large decidedly against the bill. According to reports, the Freedom Caucus held a meeting on Friday morning and many of its approximately 35-member caucus were still strongly in the "no" camp.

*(Read more on the conservative pushback »)*

At the same time conservatives are asking for more parts of the ACA to be repealed, moderates have been coming out against the bill for going too far in potentially disrupting the healthcare system.

One high-profile moderate defector was Rep. Rodney Frelinghuysen of New Jersey. Frelinghuysen, the chair of the House Appropriations Committee, wrote in a Facebook post that the changes to the essential health benefits convinced him to vote "no" on the bill.

"Unfortunately, the legislation before the House today is currently unacceptable as it would place significant new costs and barriers to care on my constituents in New Jersey," Frelinghuysen wrote. "In addition to the loss of Medicaid coverage for so many people in my Medicaid-dependent state, the denial of essential health benefits in the individual market raise serious coverage and cost issues."

Other moderates have said that the changes to Medicaid will prevent them for voting for the bill.

As of 11:30 a.m., The New York Times estimated that 32 Republicans have come out against the bill and 10 others are leaning against it.

*What to expect*

The White House and GOP leadership will continue to wrangle votes as debate on the AHCA continues for four hours, per the rules set down by the House Rules Committee on Friday morning. The Democrats and Republicans will have two hours apiece to debate the bill, in which House lawmakers can make their closing arguments about the proposal.

After the debate, the plan is for a final vote to be taken. A Republican source close to the process told Business Insider that the GOP leadership expects a final vote on the bill just after 4 p.m. ET.

*SEE ALSO: 'It is one of the worst bills I have seen in my 30 years': Conservatives continue attacks on 'Trumpcare' judgment day*

Join the conversation about this story »

NOW WATCH: Watch Trump surprise the first White House tour group Reported by Business Insider 18 hours ago.

Democrats Find Political Upside But Little Joy In GOP's Health Care Mess

0
0
WASHINGTON ― House Republicans’ struggle to repeal and replace Obamacare has left Democrats in what strategists describe as a conflicted emotional state.

For years, they have borne the brunt of attacks over the Affordable Care Act, on top of the electoral ramifications of the law’s unpopularity. With Republicans now finding out just how difficult it is to revamp the health care system, there is a sense of vindication among those who did it first. There is also a bit of delight over the possibility that the Republican Party will now be responsible for a health care system that has proven politically difficult to own.

But any mildly positive feelings are masked and tempered by fears of what will happen if lawmakers actually do pass a bill ― mainly the havoc it would inflict on people dependent on care and insurance.

“We will certainly hold them accountable in either case,” said Tyler Law, spokesman for the Democratic Congressional Campaign Committee. “But I’d be remiss to say ― I’m not going to describe something as a ‘win’ in which there’s a chance that 24 million people lose their health insurance.” 


Anyone getting joy out of this process has no idea which way is up.
Matt Canter, former DSCC communications director
The repeal and replacement process of Obamacare has, at a fundamentally political level, given Democrats a clear opportunity: Either the Republican Party passes a bill that polls at a paltry 17 percent, or they fail to do so and in the process expose themselves as inept in their ability to govern, even with control of all branches of government.

“There’s no question that it’s a terrible deal for the American people, first and foremost, if it passes,” said Adam Hodge, who previously served as communications director at the Democratic National Committee. “But it’s also made it crystal clear for voters of what the Republican agenda is and what consequences it would have for their ability to get health care. ... The damage to Republicans politically is already bearing fruit.”

When the Affordable Care Act passed in 2010, voters punished Congressional Democrats in the midterms, largely in response to the law. But today, the GOP can’t comfort itself in arguing that the party made a historic policy gain in exchange for electoral losses.

Though they feel increasingly buoyed about their prospects in the 2018 elections, many Democratic activists feel petrified about what will happen to health care in America even if the current GOP bill fails to pass. The Trump White House could still damage Obamacare through administrative decision-making.

“Anyone getting joy out of this process has no idea which way is up,” said Matt Canter, former communications director for the Democratic Senatorial Campaign Committee. “We knew this party could not govern, but they can certainly do a whole lot of damage. And we are just starting to see that. At the end of the day, people will get hurt here. It is just an open question about how and what the mechanism will be.”

The Democrats have kept their gloating over the Republican Party’s difficulty in handling health care reform relatively constrained, though there’s been some schadenfreude. On Thursday, for example, House Minority Leader Nancy Pelosi (D-Calif.) repeatedly referred to Trump ― who prides himself as the best negotiator ― as a “rookie” who couldn’t close a deal, and poked fun at her GOP colleagues for their inability to hold their caucus together.

The Democratic National Committee also took the unusual step Friday of blasting out a story by Breitbart News, playing up the rift between the White House and the news outlet previously run by Trump’s chief strategist Steve Bannon. Breitbart has been outspoken in its opposition to the GOP legislation.

Democrats are already gearing up to make Republicans own their problems, arguing that they are the ones who got themselves into this mess. The DCCC has been hammering 14 vulnerable Republicans who voted to move the repeal legislation forward in committee and has been stockpiling quotes by GOP lawmakers who have made promises to their constituents about how great repealing Obamacare will be for them.

Others have cautioned that Democrats may find themselves in a difficult position of having to help the Republican Party clean up the mess they create, not just because Democrats will continue to take some of the blame for Obamacare’s shortcomings but also because their constituents will be turning to them for help.

“I think it is 75 percent horrifying because tens of millions of people’s lives and insurance are at stake and 25 percent gratifying, which isn’t really the right word,” said Eddie Vale, a longtime activist who has worked on labor issues. “You have to set aside that tens of millions of people’s health care is at stake to get to the point where, from a purely political standpoint, it is a win-win.”

*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 18 hours ago.

Some Republicans Say They Haven't Read The Bill They're About To Vote On

0
0
WASHINGTON ― Rep. Mark Amodei (R-Nev.) is one of the moderate Republicans in the U.S. House of Representatives who plans to vote against his party’s Obamacare replacement bill on Friday ― partly, he says, because the process of drafting the legislation has been too rushed. 

Amodei said he hadn’t even had a chance to read the latest changes to the bill, which House Speaker Paul Ryan (R-Wis.) unveiled on Thursday evening ahead of Friday’s vote. 

“I’m going over to do that right now,” Amodei said in response to a question from The Huffington Post about whether he’d had a chance to read the new part. “When you talk about process, your question speaks for itself.” 

The Republican health care bill introduced earlier this month would cut taxes for the rich and undo many reforms to the health care industry put in place by the Affordable Care Act seven years ago. It also drastically changes the way Medicaid provides health care coverage for poor Americans. The Congressional Budget Office has estimated the bill would result in 24 million fewer Americans having insurance coverage. 

Earlier this week, conservative Republicans won changes to the bill that would give states flexibility to add “work requirements” to Medicaid, among other things. And then Thursday night, Ryan announced yet more changes, including a provision that would eliminate federal standards for the basic benefits health insurance companies would have to cover, instead giving states the responsibility to regulate whether policies must include coverage of things like hospitalizations, prescription drugs and mental health. Republicans say the new provision would allow insurance companies to offer cheaper plans. 

Rep. Leonard Lance (R-N.J.), another moderate against the bill, also said he hadn’t seen the latest changes, though he didn’t like the sound of the health benefits provision. 

“I’m sure it’s on my desk and I am going back to my office to read it,” Lance told reporters just off the House floor. 

Rep. Ted Yoho (R-Fla.), a member of the conservative House Freedom Caucus, a bloc of Republicans that has resisted Ryan’s and President Donald Trump’s pleas to support the bill, also said he hadn’t fully read the new provision. 

“I’m not all the way through it,” Yoho said. “My biggest concern is [the overall bill] leaves the structure, the skeleton of the Affordable Care Act. A future Congress is unlikely to allow these reforms to take effect.”

Rep. Dave Brat (R-Va.), another Republican against the bill, said he didn’t consider Thursday night’s changes to be major, but he was still processing them. 

For Amodei, it wasn’t just the last-minute changes he didn’t like ― it was the whole process, which only started a few weeks ago. The Affordable Care Act, by contract, came about after more than a year of hearings and markups. The fate of the bill in the House is uncertain ahead of Friday afternoon’s vote, which is unusual for a major piece of legislation. 

“The breadth of product you get when you get from going through a regular committee order process wasn’t achieved with listening sessions and workups only,” Amodei said. “There can be no better example of that than where we find ourselves today.” 

-- 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 17 hours ago.

GOP DISASTER: 'TRUMPCARE' VOTE PULLED DESPITE ULTIMATUM

0
0
GOP DISASTER: 'TRUMPCARE' VOTE PULLED DESPITE ULTIMATUM The GOP leadership has pulled the American Health Care Act from what looked almost certain to be a failed vote Friday.

The move comes as it became more clear that Republicans did not have enough votes to pass their bill to repeal and replace Obamacare.

GOP leaders had attempted to wrangle the needed votes to pass the bill in a last-minute effort Friday after delaying the vote on Thursday.

Republican leaders, however, faced opposition from both hardline conservative House lawmakers and moderates.

GOP leaders appeared to concede Thursday that they did not have the necessary votes. But Trump pushed for a vote, even issuing an ultimatum on Thursday night. Trump, via a message delivered by Office of Management and Budget Director Mick Mulvaney to House Republicans, said the caucus could either pass the bill Friday or he would move on to other priorities. The gambit did not appear to convince many to swing their votes.

Conservatives in the House Freedom Caucus maintained that the AHCA did not go far enough in its repeal of Obamacare, asking for popular regulations to be repealed. Moderates, on the other hand, said that the AHCA did not fix the problems of Obamacare and the repeal of the ACA's essential health benefits — a demand of the Freedom Caucus — would be harmful to health insurance.

GOP leaders were ultimately unable to bridge the gap between the two sides.

This is a developing story...

Join the conversation about this story »

NOW WATCH: Watch Trump's budget director explain proposed cuts for after-school programs that feed children Reported by Business Insider 7 hours ago.

A Look At U.S. Health Care Spending As Obamacare Repeal Looms

0
0
U.S. President Donald Trump and fellow Republicans in the House of Representatives have proposed a healthcare law to kick off their promise to repeal and replace Obamacare.

Following are some questions and answers about healthcare spending and health insurance coverage in the United States as Republicans try to throw out President Barack Obama’s signature piece of domestic policy, the 2010 Affordable Care Act.

Who is covered by what insurance?

The majority of America’s 323 million people are covered by either government or private insurance. Less than half of U.S. spending on healthcare is publicly financed, a contrast to the 72 percent average among member countries of the Organisation for Economic Co-operation and Development. A core goal of Obamacare was to cut into the numbers of uninsured and some 20 million people gained coverage under the law.
·
155 million people are covered by employer-based health plans·
70 million people are in the publicly funded Medicaid program for the poor, including 32 million children·
56 million older or disabled people receive Medicare·
15 million people are covered by military healthcare·
12 million people buy individual insurance on the online shopping exchanges created by Obamacare·
9 million people purchase unsubsidized health insurance directly·
6 million people are covered by the Indian Health Service, student health plans and other sources·
About 28 million Americans remain uninsured
The figures are government estimates. They do not add up to a total of 323 million because some people have more than one type of coverage.

How much does the country spend?

Spending on healthcare in the United States is about $3.5 trillion a year, representing about 18 percent of U.S. gross domestic product. Current U.S. government estimates are for that spending to outpace economic growth and rise to 20 percent of GDP by 2025. Healthcare spending has been rising faster than inflation. The government estimated it to have risen 4.8 percent in 2016 and that it will increase at an average rate of 5.6 percent through 2025.

What does America get for its money?

While U.S. healthcare spending as a percentage of GDP ranks higher than for any other OECD country, Americans’ life expectancy is near the bottom in a ranking of other OECD countries, behind countries such as France, Germany and Britain. The country’s obesity rate is the highest.

What was the impact of Obamacare?

As the Affordable Care Act was implemented over the past six years, it made sweeping changes to the health insurance system and implemented new taxes, so gutting the law will affect most Americans at some point.

The law set a series of minimum standards. It introduced free preventive care coverage, mandated most employers to offer insurance and individuals to buy it, expanded the Medicaid program to include people with higher incomes and created income-based subsidies for individuals to draw them into buying insurance. It prevented insurers from denying coverage to people based on their health status and allowed young adults to stay on their parents’ health insurance policies.

What sectors are feeling the impact now?

Republicans will tackle repealing Obamacare in multiple steps because while they control both chambers in Congress, they do not have the 60 seats in the 100-seat Senate needed to simply undo the law.

The first step focuses on insurance sold to individuals and the Medicaid expansion, which could mean diminished payments to hospitals and doctors who benefited from the 20 million people covered by the ACA. They now face uncertain revenues and the possibility of increased bad debt as they lose paying patients.

The impact on insurers is twofold: uncertainty over who will buy insurance could lead to them mispricing insurance plans and suffering financially as soon as this year. In the longer term, the retrenchment is changing the outlook for the growth rate of publicly backed healthcare.

Which publicly traded companies does this affect?

There are only a handful of publicly traded hospital companies, and the biggest one, HCA Holdings Inc, is not focused on states where Medicaid expanded, so it tends not to be involved. Tenet Healthcare Corp and Community Health Systems Inc are smaller hospital chains with high debt loads and their shares do tend to be affected by news about potential cuts to the numbers of Americans with publicly funded healthcare.

The insurers that specialize in Medicaid and government healthcare such as WellCare Health Plans, Molina Healthcare Inc and Centene Corp are small but tend to move on news that the Medicaid expansion may be repealed and on proposed changes in how the federal government pays its share of all Medicaid costs to the states. Anthem Inc is one of the biggest insurers selling plans on the individual exchanges and may see shares affected by news of rules that could affect who enrolls in insurance. 

Sources - Congressional Budget Office, U.S. Census Bureau, Centers for Medicare and Medicaid Services

(Reporting by Caroline Humer; Editing by Frances Kerry and Bill Trott)

-- 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.

Many Insurance Companies Stay Quiet On Health Care Debate

0
0
With AHCA coming to the house floor for a highly anticipated vote, some of the biggest stake holders that are closely following the health care political circus are health insurance companies around the country. NPR's Kelly McEvers talks with Professor Sabrina Corlette of the Center on Health Insurance Reforms at Georgetown University about what she has heard from the health care industry. Reported by NPR 14 hours ago.

A True Republican Health-Care Unraveling

0
0
AP Photo/Andrew Harnik

House Speaker Paul Ryan pauses during a news conference on Capitol Hill in Washington, Friday, March 24, 2017. 

The following article, which appears in the Spring 2017 issue of The American Prospect under the title “The Republican Health-Care Unraveling: Resist Now, Rebound Later,” went to press on Tuesday, March 21, before the Republicans gave up on their health-care bill and pulled it from a vote. But while the first section of the article is now moot (at least for the time being), the second part (“Blocking Trump’s Chaos Option”) and the third (“The Next Progressive Health Agenda”) are pertinent to what happens next. - P.S., March 24, 2017.

Imagine if Donald Trump had been a genuine populist and followed through on his repeated promises to provide health insurance to everybody and take on the pharmaceutical and insurance industries. Populists in other countries have done similar things, and Trump might have consolidated support by emulating them.

Of course, Trump’s promises about health care weren’t any more genuine than his promises about Trump University. But even if he had been in earnest, he would have still faced a problem. Unlike right-wing populists elsewhere, Trump did not come to power with a party of his own or well-developed policies. He came tethered to the congressional Republicans, entirely dependent on them to formulate and pass legislation. That dependence will likely complicate Trump’s ambitions in such areas as trade policy. But nothing so far has made more of a mockery of Trump’s populism than the health-care legislation introduced in early March by Paul Ryan and the House Republican leadership and fully backed by Trump.

The Ryan bill is abhorrent for many reasons. It calls for a massive tax cut for people with high incomes, while costing millions of other Americans—24 million by 2026, according to the Congressional Budget Office—their health coverage. It would turn Medicaid from a right of beneficiaries into a limited grant of funds to the states, and it pays for the tax cuts for the rich with cuts in health care for the poor. The bill’s reduced tax credits for insurance make no adjustment for low income, while some credits would go to people with incomes over $200,000.

But what is most amazing about the bill is how badly it treats constituencies and states that voted for Trump and the GOP. The changes it calls for in the individual insurance market would hammer older people (those between the ages of 50 and 64) and residents of red states and rural areas. Republicans appear to be so determined to cut taxes on top incomes that they are willing to sacrifice the interests not only of the poor—we knew that—but of many of their own voters. The same pattern is evident in the federal budget that Trump has proposed.

While the whole effort to “repeal and replace Obamacare” poses an enormous political risk for Republicans, it presents an equally significant political opportunity for liberal and progressive Democrats. I am not talking only about short-term resistance to the Republican rollback of the Affordable Care Act. Now that Republicans have shown their true hand on health care, they are creating new possibilities for long-term progressive organizing and policy alternatives.

The struggles to achieve health insurance for all in the United States have long suffered from one fundamental political handicap. The uninsured and underinsured (people enrolled in plans riddled with exclusions and limits) have been an inchoate population without any organization or voice of their own. The combination of measures America adopted in the mid-20th century produced a large, protected public: employees with good fringe benefits, seniors and the disabled with Medicare, veterans, and the low-income groups that qualified for Medicaid. The people who were left out—mainly low-wage workers, people in part-time work, the unemployed, and individuals with pre-existing conditions—did not share a common identity or cohere politically.

But the Republican effort to undo the ACA could provide the long-missing organizational impetus. It is one thing to go without health insurance; it is another thing to have that insurance threatened or taken away. It also matters who would be losing coverage. Overall, according to the CBO, the Ryan bill would raise the number of uninsured in 2026 to 52 million, or 19 percent of the nonelderly population (compared with a projected 10 percent under the ACA). But the uninsured under Ryan’s legislation would be concentrated among 50- to 64-year-olds. That’s primarily because the bill would allow insurers to charge 60-year-olds five times as much as 20-year-olds, instead of the 3-to-1 ratio in the ACA. (The adjustments for age in the bill’s tax credits do not come close to offsetting the higher premiums; a last-minute amendment, allowing increased tax deductions for medical expenses, provides little or no benefit to low-income people but may be changed in the Senate.) When twenty-somethings don’t have insurance, many give it little thought because they may not expect to need medical care. But older people aren’t so oblivious. Take away their health insurance, and they are going to be angry.

Besides pushing a lot of older people out of coverage, the Ryan bill is brutal on states with high health costs because it would provide a flat tax credit that doesn’t vary according to geography (unlike the ACA, which provides greater subsidies in high-cost states to make coverage affordable). The Ryan bill’s tax credits are substantially smaller on average than those in the ACA, but people in high-cost states would face especially sharp increases in premiums because of the way the bill structures its tax credits.

According to an analysis by the Center on Budget and Policy Priorities, Ryan’s bill would reduce premium tax credits by more than half in Alaska, North Carolina, Oklahoma, Alabama, Nebraska, Wyoming, West Virginia, Tennessee, Arizona, South Dakota, and Montana. The net cost of insurance would rise dramatically as a result. Notice something about those states? They elect a lot of Republicans—or at least they did.

Within states, rural areas generally have higher premiums than urban areas. So the flat tax credits provide less help in affording insurance there, too. The big Medicaid cuts that Republicans are calling for will also have a severe impact in rural areas. The resulting declines in coverage will force some rural hospitals and clinics to close, with spillover effects on middle-class people who depend on the same facilities and services.

Ryan and other House Republicans have touted one CBO finding: After initially increasing insurance premiums, their bill would reduce premiums after 2020 compared with the ACA. But that’s because their measure would force so many older people to drop coverage that the average age of the insured population would drop. It’s nothing to be proud of. Trump and the Republicans promised more coverage and lower costs when they replaced Obamacare. It is now transparently obvious that they can’t deliver on that promise and that they are willing to deny health insurance even to millions of people who voted for them.

**Blocking Trump’s Chaos Option**

If Trump and the Republican Congress cannot pass legislation this year, they do have a fallback option. They can claim that the ACA is collapsing and make sure that it does. Then they can return to health-care legislation later and say they have no choice except to repeal Obamacare. This is the option Trump at times has seemed to prefer. “Let it be a disaster, because we can blame that on the Dems,” he told the National Governors Association on February 27. “Let it implode, then let it implode in 2018 even worse. … Politically, I think it would be a great solution.”

When Trump talks about Obamacare imploding, he is talking not about the entire program (although he seems to think so), but rather one specific part: the insurance exchanges in the individual market. The danger he and other Republicans invoke is a “death spiral”—a situation where rising premiums drive the healthy out of the market, forcing premiums up and more healthy people out, until the market fails. The exchanges are nowhere near that point. Although rates in the exchanges did rise sharply in 2016, they rose to the level originally projected by the CBO (premiums had come in lower than expected earlier). Moreover, the vast majority of individuals who buy insurance in the exchanges receive subsidies that cap the cost of their premiums; many of them also receive subsidies covering a share of deductibles and co-pays. Consequently, as the CBO and other studies have found, the exchanges have some protection against a death spiral—as long as the subsidies are fully funded and the individual mandate is enforced.

But the insurance exchanges could soon face a dire crisis because the Trump administration has created uncertainty for both insurers and enrollees about the survival of the program and enforcement of the mandate. If the administration doesn’t enforce the mandate—or if Congress eliminates the penalty for failing to insure, as the House bill would do for this year—the incentive for healthy people to pay for coverage will fall, threatening the viability of the market.

Some damage has already been done. As soon as the Trump administration came into office, it canceled outreach efforts in the final phase of the open-enrollment period for 2017. Since individuals who enroll early tend to be those who know they will have high medical costs, while late enrollees are a healthier group, the cutoff of late outreach not only reduced total enrollment but also led to a higher-cost pool. The Trump administration is also proposing to shorten the open-enrollment period for 2018.

Other measures the administration favors could encourage insurers to stay in the market, albeit with mixed effects on enrollees. The administration wants to tighten up special enrollment outside of the open-enrollment period, which may well be justified; it also proposes requiring people to pay any unpaid premiums before enrolling for the next year. In a step that would help keep premiums down, the administration has encouraged states to seek waivers to develop reinsurance programs for the individual market, as Alaska has already done. (Reinsurance spreads the cost of high-cost cases across the entire market.) Alaskans buying insurance individually faced a possible 40 percent rate increase because of 37 very high-cost cases, accounting for one-quarter of claims. The reinsurance measure adopted by the state, using funds from an existing premium tax, kept premium increases by Premera Blue Cross, the sole insurer in Alaska’s exchange, to 9.8 percent.

Insurance companies need to indicate by June whether they will offer coverage in the exchanges for 2018. Uncertainty about the rules is a recipe for chaos. If they believe the mandate will not be enforced, they are likely to jack up premiums or withdraw entirely from the market. About a third of the exchanges, mainly in rural areas, have only one carrier offering coverage this year; additional withdrawals for 2018 could create just the kind of crisis that Trump and the Republicans need as a pretext to undo the ACA.

This problem has a ready solution. If Republicans in Congress do not replace the ACA for the coming year, the Trump administration needs to make clear that it will enforce the law as it stands for 2018 and fully fund the program (including cost-sharing subsidies). Moreover, Republicans cannot plead there is no way to strengthen the individual market. The Ryan bill contains a Patient and State Stability Fund of $100 billion over ten years that the CBO believes states would use largely to cover high-cost enrollees in the individual market and thereby prevent a death spiral. In the absence of comprehensive new legislation, Congress should provide those funds in a separate measure to stabilize the market for 2018. The Republicans cannot blame a collapse on Democrats when they have it in their power to maintain coverage for the millions of people who depend on the market now.

**The Next Progressive Health Agenda**

Even as they resist the Republican rollback of the ACA and Medicaid, Democrats should be thinking about new initiatives in health care. No doubt the next steps will depend in part on what Trump and the Republicans end up doing. In the wake of federal legislation, many of the critical decisions in the short run may move to the states. But Democrats cannot limit themselves to defensive efforts to salvage the ACA at either the federal or the state level. They need to think about a more attractive national agenda in health care that reflects the lessons of the ACA and new political realities.

The coming national Democratic debate is going to focus on extending Medicare—to whom, how quickly, and under what rules will be the questions. The strategy for universal coverage in the ACA relied on the extension of Medicaid for the poor, but the limitations of that approach should now be clear. In its 2012 health-care ruling, the Supreme Court effectively made it impossible to use Medicaid as a foundation for universal coverage. As a mixed federal-state program, Medicaid affords states the opportunity to limit coverage, and the ACA experience has shown how far red states will go in doing that. Republicans may also succeed in eliminating Medicaid’s status as an entitlement, which will be hard to restore.

As a national program with deeper public support as an entitlement and no role for the states, Medicare does not suffer from these problems. When Medicare was enacted in 1965, its backers hoped to use it to cover other groups besides seniors, and in 1972 Congress did extend it to the disabled and patients with end-stage renal disease. (The disabled become eligible for Medicare two years after they qualify for federal disability insurance, a delay that leaves many people with high costs in the individual market.) But the expansion of Medicare then stopped, and in the 1980s Democrats in Congress obtained Republican support for incremental expansions of Medicaid to cover low-income pregnant women and young children. This was the path that led to the ACA’s further Medicaid expansion, a strategy that the Supreme Court and Republicans have now brought to an end.

Many people will equate an expansion of Medicare with a “single-payer” plan. But even Medicare-for-all would not be a single-payer system since about one-third of current Medicare beneficiaries use the program to buy coverage in a private Medicare plan. Medicare today is a marketplace—but a marketplace with a dominant public plan and not just a “public option,” which might turn out, if badly designed and established separately from Medicare, to be a relatively small and weak player in the market.

Medicare-for-all faces two enormous obstacles. Moving everyone under age 65 into Medicare would require a huge increase in taxes; employees who now receive health care as a fringe benefit would inevitably look at those taxes as an additional burden, even if reformers try to assure them that their wages would rise once health care was financed by taxes.

Moreover, many seniors insist that Medicare is their program, and they fear—or can be made to fear—that extending the program to others will jeopardize their coverage. They also see Medicare as an earned benefit, and many of them resist extending it to people who they believe haven’t earned it.

But there is a way forward: create a new part of Medicare for the older population below age 65—the older population who have also earned Medicare coverage by paying taxes and who are directly threatened by current Republican legislation. My name for this new program is “Midlife Medicare,” which would be open to people age 50 to 64 not otherwise insured (for example, by an employer). Seniors would be more likely to accept this extension than any other; for one thing, AARP welcomes as members all Americans 50 years of age and older. Earlier versions of this idea have been referred to as a “Medicare buy-in”; I have in mind a program that would be partly financed by taxes and that would automatically provide a basic level of coverage (no mandate needed), which those in midlife could increase by paying income-related premiums (as seniors do now).

Midlife Medicare would have advantages for both its beneficiaries and those age 49 and below remaining in the individual insurance market. The enrollees in Midlife Medicare would benefit from the countervailing power that Medicare exercises. Medicare pays provider rates that are substantially below those paid by private insurers in the non-Medicare market, yet providers accept Medicare patients, who consequently do not face the “narrow networks” in most plans in the individual and small-group markets. Americans who continue to have employer coverage will have the assurance that if they need to retire early, they will have health insurance as good as they would now get at age 65. Midlife Medicare is also a response to the rising death rates and declining health that economists Anne Case and Angus Deaton have demonstrated among non-Hispanic whites in midlife.

Moreover, by pulling the 50- to 64-year-olds out of the individual insurance pool covering people 49 years of age and under, Midlife Medicare would make coverage for the younger population substantially cheaper. The younger enrollees in the individual market would, in effect, no longer be shouldering part of the cost of the more expensive 50- and 60-year-olds. This is a much better way to reduce rates for 20-year-olds than the Republicans’ proposal to let insurers charge 60-year-olds five times as much as young adults.

An additional step to relieve the burden on the individual market would be to eliminate the two-year delay in the eligibility of the disabled for the existing Medicare program. Combining this step with Midlife Medicare and a strong reinsurance program would stabilize and make coverage in the individual insurance market significantly less expensive. With these measures in place, the system could be more or less workable even if Republicans eliminate the individual mandate in favor of a 30 percent premium surcharge on individuals who fail to maintain continuous coverage (as the Ryan bill would do). Although I don’t think that would be a good thing to do, I also don’t think Democrats want to focus their next health agenda on restoring the individual mandate.

Formulating a new health-care agenda requires acknowledging that although the ACA has done much good, it has not worked out as well as its supporters originally hoped. The Supreme Court and the red states have limited how far the strategy could go in achieving health care for all. High deductibles and narrow networks have meant that many people are unhappy with the coverage they are receiving. Trump and the Republicans cynically played on public dissatisfactions, suggesting they would provide something better when, in fact, their alternatives would intensify the problems Americans face. We need to move in a more promising direction that takes into account the difficulties that progressive reform has long faced in health care. Midlife Medicare could be a big next step toward a system that works better for everyone. Reported by The American Prospect 14 hours ago.

Trump And Master Salesmanship Lose, Facts And Reality Win

0
0
WASHINGTON ― As the dust settles from Friday’s collapse of “Trumpcare” in the House of Representatives and fingers try to point out the various losers, at least one clear winner has emerged: facts.

As in: the realities of the health insurance market, and their resistance to conform to promises made on the campaign trail.

In 2009, President Barack Obama was criticized for failing to schmooze lawmakers sufficiently ― for being an imperious technocrat when the situation called for a glad-handing salesman.

Eight years later, Republicans had precisely that in President Donald Trump ― a self-described dealmaker who neither knew nor cared about the details of health care, but who promised a “terrific” plan to replace “the disaster” of Obamacare by dint of his personality alone.

After fast-tracking a proposal to repeal the Affordable Care Act as the first major legislative item on the agenda of a unified, all-Republican government, Trump and House speaker Paul Ryan pulled their “American Health Care Act” just minutes before a scheduled vote. Too many Republicans ― dozens, both conservative Freedom Caucus members as well as moderates ― were prepared to vote against it.

“That is the growing pains of being a governing party,” Ryan said later.Trump, characteristically, blamed Democrats for not supporting him and declined to discuss any specifics in his own legislation. Asked about what lessons he learned from the episode, Trump answered: “We learned a lot about loyalty. And we learned a lot about the vote-getting process.”

But Trump’s and Ryan’s problems go beyond whipping votes among fellow Republicans. Because for all the bashing Republicans have given the Affordable Care Act as government overreach and “socialized medicine,” Obama’s signature health care law was built upon a Republican, market-based foundation.

Its core principles were dreamed up in a conservative think tank in the 1990s as a way to counter the far more sweeping health-care plan pushed by President Bill Clinton. A version of it was implemented a decade later in Massachusetts under Republican Gov. Mitt Romney.

This, in fact, was the reason so many liberal Democrats were infuriated with Obama in 2009 for proposing a GOP plan to start with, rather than a single-payer scheme like they preferred. Obama, having started with a plan he believed Republicans should have been eager to support, grew frustrated when GOP leaders instead decided to oppose it unanimously and characterize it as a typical liberal entitlement.

Yet Obama’s negotiating strategy, or lack of one, notwithstanding, the ACA in the end was designed to deliver health care using the existing model of private insurance using government subsidies for premiums. The much-derided “individual mandate” to purchase health insurance would not have been necessary had Democrats gone with a “Medicare for all” proposal, but was crucial under the ACA to hold down premiums by spreading the costs of serious illnesses across a wider base.

Republicans who have claimed for seven years that they could replace the law with something that would eliminate the mandate yet cost less and provide better health care ― Trump went so far as to promise coverage to everyone ― are quickly getting a lesson in reality.

Chief among them: Trump himself, who explained something new he had learned ― that making one change in one part of the law has consequences in other parts of the law. “Nobody knew that health care could be so complicated,” Trump said last month.

When House Republicans and Health and Human Services Secretary Tom Price came up with their plan, the non-partisan Congressional Budget Office found that it would cause 26 million to lose insurance compared to the ACA, with premiums skyrocketing particularly for the elderly just below the eligibility age for Medicare.

Several rounds of tweaks designed to pull in factions of unhappy Republicans later, House Speaker Paul Ryan was on the brink of forcing the members of his majority to vote on legislation that would let states eliminate “essential health benefits” from policies. That move to assuage his most conservative members was not at all palatable to moderates worried about their constituents ― that is, voters ― losing coverage entirely.

In other words: When the unaccountable language of political campaigns ran up into the facts of the real world, the facts won. At least for now.

-- 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 12 hours ago.

The IHC Group Acquires PetPartners, Inc., Exclusive Pet Insurance Partner for the American Kennel Club

0
0
The IHC Group acquires PetPartners, Inc., a pet insurance marketing and administration company, establishing full vertically integrated structure for marketing, administering, pricing and retaining risk on IHC’s pet insurance products

New York, NY (PRWEB) March 24, 2017

The IHC Group (IHC) today announced the acquisition of 85% of the stock of PetPartners Inc., a pet insurance marketing and administration company based in Raleigh, North Carolina.

PetPartners markets pet health insurance covering dogs and cats in all 50 states plus D.C. Since 2002, the company has been the exclusive pet insurance partner of the American Kennel Club (AKC), and provides pet insurance to AKC’s registrants through the AKC Pet Insurance brand. Additionally, PetPartners became the exclusive providers of pet insurance to the Cat Fanciers Association in 2004.

“While many of us consider our pets to be members of our families, only a tiny fraction of them have insurance coverage,” said David Kettig, Chief Operating Officer of IHC. “IHC’s goal is to provide better pet health products and increase awareness of pet insurance that benefits both pets and their owners. Together with PetPartners, we will now broaden our audience to include not just pet parents but quality, responsible breeders.”

IHC has named Rick Faucher to serve as President of PetPartners, and John Wycoff, formerly the company’s Director of Marketing and Information Technology, has been promoted to Chief Operating Officer. Stephen Popovich, the incumbent President and Chief Executive Officer of PetPartners will retire after a transition period. Additionally, Sir John D. Spurling, the founder and leading pet insurance innovator will remain on PetPartners’ board of directors.

Later this year, IHC will begin to underwrite policies sold and renewed by PetPartners through its highly rated carrier, Independence American Insurance Company (IAIC), which has been underwriting pet health plans since 2011. IHC also owns http://www.petplace.com (PetPlace), a popular web destination that attracts over 1,000,000 visitors each month with more than 10,000 veterinarian-approved articles for pet parents concerned with their pet’s health and well-being. This latest acquisition further demonstrates IHC’s commitment to strengthening and growing their footprint in the pet health insurance space.

For more information on IHC’s pet health insurance, please contact Rick Faucher at 602-395-7083 or Rick.Faucher@IHCGroup.com. Please visit http://www.ihcgroup.com, http://www.petpartners.com and http://www.akcpetinsurance.com for additional resources.

#

About The IHC Group
Independence Holding Company (NYSE: IHC) is a holding company that is principally engaged in underwriting, administering and/or distributing group and individual specialty benefit products, including disability, supplemental health, pet, and group life insurance through its subsidiaries since 1980. The IHC Group owns three insurance companies (Standard Security Life Insurance Company of New York, Madison National Life Insurance Company, Inc. and Independence American Insurance Company), and IHC Specialty Benefits, Inc., a technology-driven insurance sales and marketing company that creates value for insurance producers, carriers and consumers (both individuals and small businesses) through a suite of proprietary tools and products (including ACA plans and small group medical stop-loss). All products are placed with highly rated carriers.

About Independence American Insurance Company
Independence American Insurance Company is domiciled in Delaware and licensed to write property and/or casualty insurance in all 50 states and the District of Columbia. Its products include short-term medical, hospital indemnity, fixed indemnity limited benefit, group and individual dental, and pet insurance. Independence American is rated A- (Excellent) for financial strength by A.M. Best Company, a widely recognized rating agency that rates insurance companies on their relative financial strength and ability to meet policyholder obligations (an A++ rating from A.M. Best is its highest rating).

About PetPartners Inc.
PetPartners history dates back to the 1980s when British-owner and leading innovator in pet insurance, Sir. John D. Spurling created a pet health insurance company exclusively for the Kennel Club in Great Britain. PetPartners provided pet health insurance to dogs and puppies in the United Kingdom for nearly two decades before its arrival in the United States. Since 2002, PetPartners has been the exclusive provider of pet health insurance protection to registrants of the American Kennel Club through the AKC Pet Insurance. In 2004, PetPartners was selected by the Cat Fanciers' Association, the largest registry of purebred cats, to provide health insurance to CFA registrants. In 2009, PetPartners began to offer its new PetPartners-branded products both to individuals and groups (such as associations, companies and credit unions).

About American Kennel Club
Founded in 1884, the American Kennel Club is a not-for-profit organization, which maintains the largest registry of purebred dogs in the world and oversees the sport of purebred dogs in the United States. The AKC is dedicated to upholding the integrity of its registry, promoting the sport of purebred dogs and breeding for type and function. Along with its more than 5,000 licensed and member clubs and its affiliated organizations, the AKC advocates for the purebred dog as a family companion, advances canine health and well-being, works to protect the rights of all dog owners and promotes responsible dog ownership. More than 22,000 competitions for AKC-registered purebred dogs are held under AKC rules and regulations each year including conformation, agility, obedience, rally, tracking, herding, lure coursing, coonhound events, hunt tests, field and earthdog tests. Affiliate AKC organizations include the AKC Humane Fund, AKC Canine Health Foundation, AKC Reunite and the AKC Museum of the Dog. For more information, visit http://www.akc.org.

AKC, American Kennel Club, the American Kennel Club seal and design, and all associated marks and logos are trademarks, registered trademarks and service marks of The American Kennel Club, Inc.

Become a fan of the American Kennel Club on Facebook, and follow us on Twitter @AKCDogLovers. Reported by PRWeb 12 hours ago.

A scary world: Our reality

0
0
I am not scared of dying in a terrorist attack. I am scared of living without health insurance. Michelle Ryder, Bonney Lake Reported by Seattle Times 11 hours ago.

Republicans Swear They Will Keep Trying To Repeal Obamacare

0
0
WASHINGTON ― Republicans insisted, after their attempt to replace the Affordable Care Act suffered a humiliating public defeat, that they will someday make good on their seven-year promise to repeal Obamacare. 

Republicans had to pull their TrumpCare replacement bill from consideration on the House floor less than half an hour before it was due for a vote Friday because not enough of them liked their own bill.

House Freedom Caucus conservatives hated it because it did not go far enough to dismantle Obamacare. More moderate members hated it because it would leave an additional 24 million Americans without health insurance and would especially hurt rural, older, white voters.

House Speaker Paul Ryan (R-Wis.) told reporters afterward that that’s it, he’s done, the country will have Obamacare for the “foreseeable future.”

Yet, as unhappy-looking Republicans filed from an emergency caucus meeting in the basement of the Capitol on Friday afternoon just before Ryan spoke, they pledged to keep trying.

“We didn’t have the votes, so we’re not going pull it up and just kill it. We’re going to keep working till we get something that does work,” said Rep. Barry Loudermilk (R-Ga).

“This process doesn’t end just because this one bill’s been taken off the table,” said Rep. Bradley Byrne (R-Ala.). “It just shows that our first attempt didn’t work. This is not our last attempt. There will have to be other actions here.”

Fresh on the heels of defeat, there was no consensus among Republicans on steps going forward. Do they try a piecemeal approach and whittle away at the Affordable Care Act? Do they go all in one more time? Do they heed Democrats’ calls to work with them on repairing parts of Obamacare that don’t work well?


There’s a lot of things in American history that failed initially. Persistence is a really important principle.
Rep. Andy Barr (R-Ky.)
The most likely next move will be for Health and Human Services Secretary Tom Price to tinker with the health care law’s implementation. Many Republicans have argued that the law will implode on its own and then Democrats will own the failure.

But the recent Congressional Budget Office analysis of the current law found that it would be stable. To push the Affordable Care Act over the edge, Republicans might have to try to pass smaller bills that chip away at the law, although that will be difficult with only a narrow GOP majority in the Senate. Or they could prevail on Price to undermine enrollment, although administrative shenanigans could draw lawsuits.

The easiest long-term strategy would probably be to work with Democrats, especially on the parts that moderates in both parties would back. Some Republicans said they would try to do that.

No one really had a plan, though, and most of the lawmakers limping away like injured Capt. Ahabs on the way to get their peg legs were sure they had to keep chasing the Obamacare whale.

“I introduced today a bill that would repeal Obamacare,” said Rep. Mo Brooks (R-Ala.).

“There’s a lot of things in American history that failed initially. Persistence is a really important principle,” said Rep. Andy Barr (R-Ky.), even as he pledged to work across the aisle.

“The great movements in our country’s history have been built on persistence,” Barr said. “If you have an optimistic attitude about it, this is a learning experience. I want to learn from this experience, I hope my colleagues learn from this experience, and we try to do a better job building better consensus the next time around.”

Indeed, there was a lot of taking the long view.

“Sometimes these things, if you give ’em time to marinate, we’ll have an opportunity to bring us back together and allow us to regroup and get our mojo again,” said Rep. Steve Womack (R-Ark.).

That mojo didn’t come back over the last seven years, however, and many Republicans are clearly frustrated.

“Why can’t we do this ... when we have a Republican president?” asked Rep. Randy Weber (R-Texas) shortly before the bill went down. “It doesn’t make sense.”

Jennifer Bendery contributed reporting

-- 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.

Trump Says He Should Let Obamacare 'Collapse.' That's Cruel And Irresponsible.

0
0
Before even taking office, and well before the Republican bid to repeal and “replace” the Affordable Care Act, President Donald Trump started saying the best political strategy for his party would be to let the law’s health insurance exchanges “collapse” and then blame Democrats for it.

Immediately after Friday’s colossally embarrassing flameout of the GOP’s American Health Care Act, Trump was at it again.

“I’ve been saying for the last year and a half that the best thing we can do politically speaking is let Obamacare explode,” Trump said at the White House. “I think the losers are Nancy Pelosi and Chuck Schumer, because now they own Obamacare. They own it, 100 percent own it.”

And Trump’s not the only one floating this notion. Here’s Sen. Lindsey Graham (R-S.C.) on Friday:


Next move on health care – #CollapseandReplace.

— Lindsey Graham (@LindseyGrahamSC) March 24, 2017


Let’s be plain about what these politicians are threatening to do.

The president of the United States and members of the party that controls Congress are saying that they see problems in the health care system and their plan is to stand by and do nothing while people suffer.

This is breathtakingly cynical, and reveals the Republican Party’s priorities. Getting rid of the dreaded Obamacare at any cost is more important to Trump and his party than acting to improve the health care system for the people they represent.

Barack Obama is no longer president, but thumbing him in the eye and destroying his biggest accomplishment still outweighs taking even the most basic steps to provide relief to the health insurance consumers whose plight Republicans have so often and so vividly bemoaned.

Whatever its deficiencies, and however Democrats soft-pedaled them, the Affordable Care Act was an effort to make the lives of Americans better by expanding health coverage to millions, and creating new consumer protections against health insurance industry practices like refusing to cover people with pre-existing conditions.

What Trump is proposing is to do the opposite. He’s proposing to bite off your nose to spite Obama’s face.

Rather than try to help people, Trump will actively avoid helping. Even if you accept his highly debatable premise that the Affordable Care Act is irreparable, what he’s saying is that because he and the Congress his party controls failed at the first hurdle, they will now do nothing to solve the problems with the American health care system they themselves have been decrying for seven years.

Indeed, the Trump administration instead has taken steps to suppress health insurance enrollment and make the ACA work worse. More may be coming.

It’s an odd political gambit. What Trump is counting on is that, after he and his party failed to replace the Affordable Care Act with a plan of their own, and after the Trump administration will be in charge of managing the law’s programs, voters in 2018 and 2010 will somehow blame the party that isn’t in power for their problems. That’s not usually how things work.

To be clear, the Affordable Care Act is not functioning as well as Obama and the Democrats who it wrote hoped.

The uninsured rate has never been lower, thanks to the law’s Medicaid expansion and subsidies for private health insurance. Twenty million people who didn’t have coverage before do now, and everyone has guaranteed access to health insurance regardless of their pre-existing conditions.

But enrollment on the health insurance exchanges is lower than expected. Premiums are too high for many households, especially those who qualify for little to no subsidy because even though they aren’t wealthy, their incomes are too high.  

To keep prices as low as possible and to protect themselves from high expenses, insurers designed policies with large deductibles and high cost-sharing that make obtaining care too costly for a segment of the market that buys plans regulated by the Affordable Care Act.

Some insurance companies have lost money because too few healthy customers signed up to offset the costs of covering the sick. As a result, rates rose a lot this year, and may again next year, and some big insurers have abandoned these marketplaces entirely, leaving consumers with fewer choices. Some states are doing much better than others, but the problems in places like Arizona and North Carolina are real and demand attention.

But despite what Trump and other Republicans keep saying, the exchange markets are not in a “death spiral.” Analysts at the Congressional Budget Office and Standard & Poor’s, for example, have concluded that these markets are stable, if imperfect.

Still, Trump insists Obamacare is an unmitigated disaster. “There’s not much you can do about it,” Trump said Friday. “I would love to see it do well, but it can’t.”

This is simply not true. The American Health Care Act was not the final word in health policy. The difficulties facing the Affordable Care Act’s health insurance exchanges in some states ― high prices, insufficient competition between insurers, high deductibles ― are fixable in smaller, more targeted ways. 

While he was in office Obama proposed a slate of improvements both in submissions to Congress and in a Journal of the American Medical Association article. So did Democratic presidential nominee Hillary Clinton. Minnesota and Alaska already have taken steps to alleviate the cost issues that some of their consumers have faced.

One simple solution is just money. Bigger tax credits to make insurance more affordable would work. So would funds to backstop health insurance companies that have higher-than-expected expenses from sick customers. The Affordable Care Act actually included funding mechanisms for that very purpose, but Republicans in Congress rescinded the money, calling it a “bailout.”

When it was their turn to write a health care reform bill, the GOP seemed to recognize the need to support insurers in that way. The American Health Care Act itself even included a big pot of money ― $115 billion ― that would’ve been distributed to states, which could have used the funds to shore up their local health insurance markets.

The collapse of the whole bill doesn’t prevent Congress from taking other, more modest measures like that one to make the health care system better for consumers.

At this point ― seven years and a day after Obama signed the Affordable Care Act into law ― legislating and regulating to make its health insurance markets work better is a responsibility Trump and congressional Republicans accepted when they took their oaths of office.

This isn’t “helping Obamacare,” it’s helping Americans. There’s no such thing as Obamacare anymore. It’s just the health insurance system.

In the words of House Speaker Paul Ryan (R-Wis.) on Friday: “Obamacare’s the law of the land.”

But if you’re one of those people who can’t afford your health insurance or your deductible, Barack Obama can’t help you anymore. Donald Trump can. And he just told you he won’t.

-- 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.

Illinois health care advocates cheer GOP bill's demise, worry about future

0
0
Many health care leaders in Illinois cheered the demise of House Republicans' Obamacare replacement bill Friday — but it didn't take long for reality to quiet the celebration.

Despite the bill's downfall, challenges remain in Illinois and across the U.S. when it comes to health insurance, they... Reported by ChicagoTribune 8 hours ago.

Ralph Nader: Reason And Justice Address Realities – OpEd

0
0
It is not just Donald Trump whose rhetoric is chronically bereft of reality. Politicians, reporters, commentators and academics are often similarly untethered to hard facts, albeit not for narcissistic enjoyment. There are many patterns of fact, relevant to a subject being discussed, that are off the table—either consciously or because they are deemed inconvenient. Rarely are there omissions due to the facts being hard to get or inaccessible.

That in mind, here are a few examples that warrant our scrutiny:

Consider the immense public attention to health insurance and health care and the recent struggles over Obamacare and now Ryancare. Conspicuously absent from the dialogues that pundits, politicians and reporters carry on is that the third leading cause of death in the U.S. is “medical error.” According to a Johns Hopkins University School of Medicine report last May, over 250,000 people lose their lives yearly in U.S. hospitals from “diagnostic errors, medical mistakes and the absence of safety nets” to stop hospital-induced infections, incompetent personnel, dangerous mixes of prescribed drugs and more. Yet in the debate surrounding the health care industry, this huge annual human casualty toll is unmentioned and, for many, intentionally “off the table.”

From a financial perspective, all the coverage of the costs of health insurance and health care excludes at least an estimated $340 billion (according to, among other sources, the leading expert, Professor Malcolm Sparrow of Harvard University)  lost annually as a result of computerized billing fraud and abuses—expenses for which taxpayers and consumers must eventually pay. All of this is “off the table.”

Despite all the attention currently being paid to Trump’s proposed $54 billion increase to the military budget, media coverage nonetheless neglects to mention the immense waste, fraud and redundancies already embedded in the roughly $600 billion that account for the Pentagon’s direct annual budget.

A mass of Government Accountability Office (GAO) reports for the Congress, Pentagon audits, and reports by reliable citizen groups regularly document this immense waste. Specifically, the annual cost of the anti-ballistic missile defense program in the Pentagon is over $9 billion—about the same as the budget of the lifesaving Environmental Protection Agency (EPA) that Trump wants to cut by almost a third.

The anti-missile defense technology taxpayers are paying Raytheon and other defense contractors to work on is unworkable. Who says anti-missile defense programs are ineffective? The American Physical Society—more than a few of whom consult with the Department of Defense—as well as the very knowledgeable MIT professor Theodore A. Postol in his Congressional testimony, and the Union of Concerned Scientists.

Along with numerous other infirmities of this boondoggle, it is too easy to decoy the ballistic missiles, not to mention alternative ways for adversaries to endanger our country without signaling a return address as ballistic missiles would. Yet year after year, starting with Ronald Reagan, the money is automatically doled out uncritically by the Congress, backed by its generous contractors’ lobby, deeply entrenched in a system of unaccountable corporate welfare. For the gigantic Pentagon budget is unauditable, according to the GAO.

The Israeli/Palestinian struggle, when hostilities burst forth, is reported routinely as being one started by Palestinian “terrorists” versus Israeli defenders and retaliators. Little emphasized is the reality that the Israeli government is the illegal occupier, colonizer, invader and resource exploiter of the remaining Palestinian lands. Almost never mentioned is that, since 2000, the overwhelming majority of fatalities and injuries in the conflict have been innocent Palestinian civilians, including many children, at the hands of the powerful Israeli military.

Of course, readers can come up with their own examples arising out of local, state, national and international issues. When constantly subjected to a media and political system driven by distraction, one can’t help but ask the question, “Why are they focusing on this instead of that?” One reliable answer is that the powers-that-be work overtime to exclude such embarrassing realities, to assure that, as with corporate crime waves, they’re often not even counted or measured.

If you want a continuing frenzy of reality-exclusion, look no further than the Republicans and their forked tongues. They’re always complaining about deficits, while cutting taxes for corporations and the wealthy, overlooking real problems they pay lip service to such as “government waste.”

But here is what takes the cake. For six years the Republican House of Representatives has been slicing off more and more of the Internal Revenue Service’s slim budget. With Republicans now controlling both houses of Congress, they want to drive it below $10 billion for next year. Apart from resulting in your waiting forever to get someone from the IRS on the phone to answer your questions, there is the modest result of over $400 billion in yearly uncollected taxes.

When you ration tax collectors, how can you fairly enforce the law, reduce the deficit or, heaven forbid, repair America’s streets, bridges, drinking water systems, public transit and schools?

John Adams said that, “Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passions, they cannot alter the state of facts and evidence.” The verity of our second president’s words should serve as a call to action against the “alternative facts,” lies and myths, which have already come to define the current Trump administration and pose so grave a threat to our weakened democratic society and its level of freedom and justice. Reported by Eurasia Review 8 hours ago.

Trump Is Obama’s Legacy: Will This Break Up Democratic Party? – Analysis

0
0
Nobody yet can tell whether Donald Trump is an agent of change with a specific policy in mind, or merely a catalyst heralding an as yet undetermined turning point. His first month in the White House saw him melting into the Republican mélange of corporate lobbyists. Having promised to create jobs, his “America First” policy looks more like “Wall Street First.” His cabinet of billionaires promoting corporate tax cuts, deregulation and dismantling Dodd-Frank bank reform repeats the Junk Economics promise that giving more tax breaks to the richest One Percent may lead them to use their windfall to invest in creating more jobs. What they usually do, of course, is simply buy more property and assets already in place.

One of the first reactions to Trump’s election victory was for stocks of the most crooked financial institutions to soar, hoping for a deregulatory scythe taken to the public sector. Navient, the Department of Education’s knee-breaker on student loan collections accused by the Consumer Financial Protection Bureau (CFPB) of massive fraud and overcharging, rose from $13 to $18 now that it seemed likely that the incoming Republicans would disable the CFPB and shine a green light for financial fraud.

Foreclosure king Stephen Mnuchin of IndyMac/OneWest (and formerly of Goldman Sachs for 17 years; later a George Soros partner) is now Treasury Secretary – and Trump is pledged to abolish the CFPB, on the specious logic that letting fraudsters manage pension savings and other investments will give consumers and savers “broader choice,” e.g., for the financial equivalent of junk food. Secretary of Education Betsy DeVos hopes to privatize public education into for-profit (and de-unionized) charter schools, breaking the teachers’ unions. This may position Trump to become the Transformational President that neoliberals have been waiting for.

But not the neocons. His election rhetoric promised to reverse traditional U.S. interventionist policy abroad. Making an anti-war left run around the Democrats, he promised to stop backing ISIS/Al Nusra (President Obama’s “moderate” terrorists supplied with the arms and money that Hillary looted from Libya), and to reverse the Obama-Clinton administration’s New Cold War with Russia. But the neocon coterie at the CIA and State Department are undercutting his proposed rapprochement with Russia by forcing out General Flynn for starters. It seems doubtful that Trump will clean them out.

Trump has called NATO obsolete, but insists that its members up their spending to the stipulated 2% of GDP — producing a windfall worth tens of billions of dollars for U.S. arms exporters. That is to be the price Europe must pay if it wants to endorse Germany’s and the Baltics’ confrontation with Russia.

Trump is sufficiently intuitive to proclaim the euro a disaster, and he recommends that Greece leave it. He supports the rising nationalist parties in Britain, France, Italy, Greece and the Netherlands, all of which urge withdrawal from the eurozone – and reconciliation with Russia instead of sanctions. In place of the ill-fated TPP and TTIP, Trump advocates country-by-country trade deals favoring the United States. Toward this end, his designated ambassador to the European Union, Ted Malloch, urges the EU’s breakup. The EU is refusing to accept him as ambassador.

**Will Trump’s victory break up the Democratic Party? **

At the time this volume is going to press, there is no way of knowing how successful these international reversals will be. What is more clear is what Trump’s political impact will have at home. His victory – or more accurately, Hillary’s resounding loss and the way she lost – has encouraged enormous pressure for a realignment of both parties. Regardless of what President Trump may achieve vis-à-vis Europe, his actions as celebrity chaos agent may break up U.S. politics across the political spectrum.

The Democratic Party has lost its ability to pose as the party of labor and the middle class. Firmly controlled by Wall Street and California billionaires, the Democratic National Committee (DNC) strategy of identity politics encourages any identity except that of wage earners. The candidates backed by the Donor Class have  been Blue Dogs pledged to promote Wall Street and neocons urging a New Cold War with Russia.

They preferred to lose with Hillary than to win behind Bernie Sanders. So Trump’s electoral victory is their legacy as well as Obama’s. Instead of Trump’s victory dispelling that strategy, the Democrats are doubling down. It is as if identity politics is all they have.

Trying to ride on Barack Obama’s coattails didn’t work. Promising “hope and change,” he won by posing as a transformational president, leading the Democrats to control of the White House, Senate and Congress in 2008. Swept into office by a national reaction against the George Bush’s Oil War in Iraq and the junk-mortgage crisis that left the economy debt-ridden, they had free rein to pass whatever new laws they chose – even a Public Option in health care if they had wanted, or make Wall Street banks absorb the losses from their bad and often fraudulent loans.

But it turned out that Obama’s role was to prevent the changes that voters hoped to see, and indeed that the economy needed to recover: financial reform, debt writedowns to bring junk mortgages in line with fair market prices, and throwing crooked bankers in jail. Obama rescued the banks, not the economy, and turned over the Justice Department and regulatory agencies to his Wall Street campaign contributors. He did not even pull back from war in the Near East, but extended it to Libya and Syria, blundering into the Ukrainian coup as well.

Having dashed the hopes of his followers, Obama then praised his chosen successor Hillary Clinton as his “Third Term.” Enjoying this kiss of death, Hillary promised to keep up Obama’s policies.

The straw that pushed voters over the edge was when she asked voters, “Aren’t you better off today than you were eight years ago?” Who were they going to believe: their eyes, or Hillary? National income statistics showed that only the top 5 percent of the population were better off. All the growth in Gross Domestic Product (GDP) during Obama’s tenure went to them – the Donor Class that had gained control of the Democratic Party leadership. Real incomes have fallen for the remaining 95 percent, whose household budgets have been further eroded by soaring charges for health insurance. (The Democratic leadership in Congress fought tooth and nail to block Dennis Kucinich from introducing his Single Payer proposal.)

No wonder most of the geographic United States voted for change – except for where the top 5 percent, is concentrated: in New York (Wall Street) and California (Silicon Valley and the military-industrial complex). Making fun of the Obama Administration’s slogan of  “hope and change,” Trump characterized Hillary’s policy of continuing the economy’s shrinkage for the 95% as “no hope and no change.”

**Identity Politics as anti-labor politics**

A new term was introduced to the English language: Identity Politics. Its aim is for voters to think of themselves as separatist minorities – women, LGBTQ, Blacks and Hispanics. The Democrats thought they could beat Trump by organizing Women for Wall Street (and a New Cold War), LGBTQ for Wall Street (and a New Cold War), and Blacks and Hispanics for Wall Street (and a New Cold War). Each identity cohort was headed by a billionaire or hedge fund donor.

The identity that is conspicuously excluded is the working class. Identity politics strips away thinking of one’s interest in terms of having to work for a living. It excludes voter protests against having their monthly paycheck stripped to pay more for health insurance, housing and mortgage charges or education, or better working conditions or consumer protection – not to speak of protecting debtors.

Identity politics used to be about three major categories: workers and unionization, anti-war protests and civil rights marches against racist Jim Crow laws. These were the three objectives of the many nationwide demonstrations. That ended when these movements got co-opted into the Democratic Party. Their reappearance in Bernie Sanders’ campaign in fact threatens to tear the Democratic coalition apart. As soon as the primaries were over (duly stacked against Sanders), his followers were made to feel unwelcome. Hillary sought Republican support by denouncing Sanders as being as radical as Putin’s Republican leadership.

In contrast to Sanders’ attempt to convince diverse groups that they had a common denominator in needing jobs with decent pay – and, to achieve that, in opposing Wall Street’s replacing the government as central planner – the Democrats depict every identity constituency as being victimized by every other, setting themselves at each other’s heels. Clinton strategist John Podesta, for instance, encouraged Blacks to accuse Sanders supporters of distracting attention from racism. Pushing a common economic interest between whites, Blacks, Hispanics and LGBTQ always has been the neoliberals’ nightmare. No wonder they tried so hard to stop Bernie Sanders, and are maneuvering to keep his supporters from gaining influence in their party.

When Trump was inaugurated on Friday, January 20, there was no pro-jobs or anti-war demonstration. That presumably would have attracted pro-Trump supporters in an ecumenical show of force. Instead, the Women’s March on Saturday led even the pro-Democrat New York Times to write a front-page article reporting that white women were complaining that they did not feel welcome in the demonstration. The message to anti-war advocates, students and Bernie supporters was that their economic cause was a distraction.

The march was typically Democratic in that its ideology did not threaten the Donor Class. As Yves Smith wrote on Naked Capitalism: “the track record of non-issue-oriented marches, no matter how large scale, is poor, and the status of this march as officially sanctioned (blanket media coverage when other marches of hundreds of thousands of people have been minimized, police not tricked out in their usual riot gear) also indicates that the officialdom does not see it as a threat to the status quo.”[1]

Hillary’s loss was not blamed on her neoliberal support for TPP or her pro-war neocon stance, but on the revelations of the e-mails by her operative Podesta discussing his dirty tricks against Bernie Sanders (claimed to be given to Wikileaks by Russian hackers, not a domestic DNC leaker as Wikileaks claimed) and the FBI investigation of her e-mail abuses at the State Department. Backing her supporters’ attempt to brazen it out, the Democratic Party has doubled down on its identity politics, despite the fact that an estimated 52 percent of white women voted for Trump. After all, women do work for wages. And that also is what Blacks and Hispanics want – in addition to banking that serves their needs, not those of Wall Street, and health care that serves their needs, not those of the health-insurance and pharmaceuticals monopolies.

Bernie did not choose to run on a third-party ticket. Evidently he feared being accused of throwing the election to Trump. The question is now whether he can remake the Democratic Party as a democratic socialist party, or create a new party if the Donor Class retains its neoliberal control. It seems that he will not make a break until he concludes that a Socialist Party can leave the Democrats as far back in the dust as the Republicans left the Whigs after 1854. He may have underestimated his chance in 2016.

**Trump’s effect on U.S. political party realignment**

During Trump’s rise to the 2016 Republican nomination it seemed that he was more likely to break up the Republican Party. Its leading candidates and gurus warned that his populist victory in the primaries would tear the party apart. The polls in May and June showed him defeating Hillary Clinton easily (but losing to Bernie Sanders). But Republican leaders worried that he would not support what they believed in: namely, whatever corporate lobbyists put in their hands to enact and privatize.

The May/June polls showed Trump and Clinton were the country’s two most unpopular presidential candidates. But whereas the Democrats maneuvered Bernie out of the way, the Republican Clown Car was unable to do the same to Trump. In the end they chose to win behind him, expecting to control him. As for the DNC, its Wall Street donors preferred to lose with Hillary than to win with Bernie. They wanted to keep control of their party and continue the bargain they had made with the Republicans: The latter would move further and further to the right, leaving room for Democratic neoliberals and neocons to follow them closely, yet still pose as the “lesser evil.” That “centrism” is the essence of the Clintons’ “triangulation” strategy. It actually has been going on for a half-century. “As Tanzanian President Julius Nyerere quipped in the 1960s, when he was accused by the US of running a one-party state, ‘The United States is also a one-party state but, with typical American extravagance, they have two of them’.”[2]

By 2017, voters had caught on to this two-step game. But Hillary’s team paid pollsters over $1 billion to tell her (“Mirror, mirror on the wall …”) that she was the most popular of all. It was hubris to imagine that she could convince the 95 Percent of the people who were worse off under Obama to love her as much as her East-West Coast donors did. It was politically unrealistic – and a reflection of her cynicism – to imagine that raising enough money to buy television ads would convince working-class Republicans to vote for her, succumbing to a Stockholm Syndrome by thinking of themselves as part of the 5 Percent who had benefited from Obama’s pro-Wall Street policies.

Hillary’s election strategy was to make a right-wing run around Trump. While characterizing the working class as white racist “deplorables,” allegedly intolerant of LBGTQ or assertive women, she resurrected the ghost of Joe McCarthy and accused Trump of being “Putin’s poodle” for proposing peace with Russia. Among the most liberal Democrats, Paul Krugman still leads a biweekly charge at The New York Times that President Trump is following Moscow’s orders. Saturday Night Live, Bill Maher and MSNBC produce weekly skits that Trump and General Flynn are Russian puppets. A large proportion of Democrats have bought into the fairy tale that Trump didn’t really win the election, but that Russian hackers manipulated the voting machines. No wonder George Orwell’s 1984 soared to the top of America’s best-seller lists in February 2017 as Donald Trump was taking his oath of office.

This propaganda paid off on February 13, when neocon public relations succeeded in forcing the resignation of General Flynn, whom Trump had appointed to clean out the neocons at the NSA and CIA. His foreign policy initiative based on rapprochement with Russia and hopes to create a common front against ISIS/Al Nusra seemed to be collapsing.

**Tabula Rasa Celebrity Politics**

U.S. presidential elections no longer are much about policy. Like Obama before him, Trump campaigned as a rasa tabla, a vehicle for everyone to project their hopes and fancies. What has all but disappeared is the past century’s idea of politics as a struggle between labor and capital, democracy vs. oligarchy.

Who would have expected even half a century ago that American politics would become so post-modern that the idea of class conflict has all but disappeared. Classical economic discourse has been drowned out by their junk economics.

There is a covert economic program, to be sure, and it is bipartisan. It is to make elections about just which celebrities will introduce neoliberal economic policies with the most convincing patter talk. That is the essence of rasa tabla politics.

**Can the Democrats lose again in 2020?**

Trump’s November victory showed that voters found him to be the Lesser Evil, but all that voters really could express was “throw out the bums” and get a new set of lobbyists for the FIRE sector and corporate monopolists. Both candidates represented Goldman Sachs and Wall Street. No wonder voter turnout has continued to plunge.

Although the Democrats’ Lesser Evil argument lost to the Republicans in 2016, the neoliberals in control of the DNC found the absence of a progressive economic program to less threatening to their interests than the critique of Wall Street and neocon interventionism coming from the Sanders camp. So the Democrat will continue to pose as the Lesser Evil party not really in terms of policy, but simply ad hominum. They will merely repeat Hillary’s campaign stance: They are not Trump. Their parades and street demonstrations since his inauguration have not come out for any economic policy.

On Friday, February 10, the party’s Democratic Policy group held a retreat for its members in Baltimore. Third Way “centrists” (Republicans running as Democrats) dominated, with Hillary operatives in charge. The conclusion was that no party policy was needed at all. “President Trump is a better recruitment tool for us than a central campaign issue,’ said Washington Rep. Denny Heck, who is leading recruitment for the Democratic Congressional Campaign Committee (DCCC).”[3]

But what does their party leadership have to offer women, Blacks and Hispanics in the way of employment, more affordable health care, housing or education and better pay? Where are the New Deal pro-labor, pro-regulatory roots of bygone days? The party leadership is unwilling to admit that Trump’s message about protecting jobs and opposing the TPP played a role in his election. Hillary was suspected of supporting it as “the gold standard” of trade deals, and Obama had made the Trans-Pacific Partnership the centerpiece of his presidency – the free-trade TPP and TTIP that would have taken economic regulatory policy out of the hands of government and given it to corporations.

Instead of accepting even Sanders’ centrist-left stance, the Democrats’ strategy was to tar Trump as pro-Russian, insist that his aides had committed impeachable offenses, and mount one parade after another. “Rep. Marcia Fudge of Ohio told reporters she was wary of focusing solely on an “economic message” aimed at voters whom Trump won over in 2016, because, in her view, Trump did not win on an economic message. “What Donald Trump did was address them at a very different level — an emotional level, a racial level, a fear level,” she said. “If all we talk about is the economic message, we’re not going to win.”[4] This stance led Sanders supporters to walk out of a meeting organized by the “centrist” Third Way think tank on Wednesday, February 8.

By now this is an old story. Fifty years ago, socialists such as Michael Harrington asked why union members and progressives still imagined that they had to work through the Democratic Party. It has taken the rest of the country half a century to see that Democrats are not the party of the working class, unions, middle class, farmers or debtors. They are the party of Wall Street privatizers, bank deregulators, neocons and the military-industrial complex. Obama showed his hand – and that of his party – in his passionate attempt to ram through the corporatist TPP treaty that would have enabled corporations to sue governments for any costs imposed by public consumer protection, environmental protection or other protection of the population against financialized corporate monopolies.

Against this backdrop, Trump’s promises and indeed his worldview seem quixotic. The picture of America’s future he has painted seems unattainable within the foreseeable future. It is too late to bring manufacturing back to the United States, because corporations already have shifted their supply nodes abroad, and too much U.S. infrastructure has been dismantled.

There can’t be a high-speed railroad, because it would take more than four years to get the right-of-way and create a route without crossing gates or sharp curves. In any case, the role of railroads and other transportation has been to increase real estate prices along the routes. But in this case, real estate would be torn down – and having a high-speed rail does not increase land values.

The stock market has soared to new heights, anticipating lower taxes on corporate profits and a deregulation of consumer, labor and environmental protection. Trump may end up as America’s Boris Yeltsin, protecting U.S. oligarchs (not that Hillary would have been different, merely cloaked in a more colorful identity rainbow). The U.S. economy is in for Shock Therapy. Voters should look to Greece to get a taste of the future in this scenario.

Without a coherent response to neoliberalism, Trump’s billionaire cabinet may do to the United States what neoliberals in the Clinton administration did to Russia after 1991: tear out all the checks and balances, and turn public wealth over to insiders and oligarchs. So Trump’s his best chance to be transformative is simply to be America’s Yeltsin for his party’s oligarchic backers, putting the class war back in business.

**What a truly transformative president would do/would have done**

No administration can create a sound U.S. recovery without dealing with the problem that caused the 2008 crisis in the first place: over-indebtedness. The only one way to restore growth, raise living standards and make the economy competitive again is a debt writedown. But that is not yet on the political horizon. Obama’s doublecross of his voters in 2009 prevented the needed policy from occurring. Having missed this chance in the last financial crisis, a progressive policy must await yet another crisis. But so far, no political party is preparing a program to juxtapose to Republican-Democratic austerity and scale-back of Social Security, Medicare and social spending programs in general.

Also no longer on the horizon is a more progressive income tax, or a public option for health care – or for banking, or consumer protection against financial fraud, or for a $15-an-hour minimum wage, or for a revived protection of labor’s right to unionize, or environmental regulations.

It seems that only a new party can achieve these aims. At the time these essays are going to press, Sanders has committed himself to working within the Democratic Party. But that stance is based on his assumption that somehow he can recruit enough activists to take over the party from Its Donor Class.

I suspect he will fail. In any case, it is easier to begin afresh than to try to re-design a party (or any institution) dominated by resistance to change, and whose idea of economic growth is a pastiche of tax cuts and deregulation. Both U.S. parties are committed to this neoliberal program – and seek to blame foreign enemies for the fact that its effect is to continue squeezing living standards and bloating the financial sector.

If this slow but inexorable crash does lead to a political crisis, it looks like the Republicans may succeed in convening a new Constitutional Convention (many states already have approved this) to lock the United States into a corporatist neoliberal world. Its slogan will be that of Margaret Thatcher: TINA – There Is No Alternative.

And who is to disagree? As Trotsky said, fascism is the result of the failure of the left to provide an alternative.

*Notes:*

[1] Yves Smith, “Women Skeptical of the Women’s March,” Naked Capitalism, February 10, 2017.

[2] Radhika Desai, “Decoding Trump,” Counterpunch, February 10, 2017.

[3] “Pelosi denies Democrats are divided on strategy for 2018,” Yahoo News, February 10, 2018. https://www.yahoo.com/news/pelosi-denies-democrats-are-divided-on-strategy-for-2018-194337876.html

[4] Ibid. Reported by Eurasia Review 7 hours ago.

Inspector General Probing Trump Move To Pull Obamacare Enrollment Ads

0
0
The inspector general of the Department of Health and Human Services has launched an investigation into the Trump administration’s move to yank ads that encouraged people to sign up for the Affordable Care Act during the enrollment period. By shutting down such outreach, the action could be seen as a stealth way to starve the health plan without legislative authority.

The Trump administration insisted the ads were a waste of money, but Democrats have characterized the action as sabotage.

In response to a request to investigate the actions from Sen. Patty Murray (D-Wash.) and Sen. Elizabeth Warren (D-Mass.), the inspector general said his office is conducting a “fact-finding” review, the Hill reported.

The office will examine exactly what was done and when by the administration, and its effect on enrollment in the health plan, according to a letter written to the senators Thursday. Dwindling numbers of consumers enrolled in any insurance undermines an affordable risk pool

“We will conduct a fact-finding review of HHS’s decision related to halting (and resuming, as applicable) paid advertisements, email, social media, and other outreach efforts related to marketplace enrollment in 2017,” HHS Inspector General Daniel Levinson wrote in the letter to the senators.

Warren welcomed the “independent review of the Trump administration’s decision to cut off efforts to enroll people” in the Affordable Care Act. The health deparment’s “move to halt outreach for ACA enrollment could contribute to weakening healthcare marketplaces and raising costs for hard working people across the country,” she added.

Obamacare remains the “law of the land,” Sen. Paul Ryan (R-Wisc.) said Friday after the GOP health plan was pulled before a vote because Republican leaders did not have the support needed to pass it.

Enrollment may have been hurt when the Trump administration suddenly ended the ads and other outreach in late January just days before the end of open enrollment in Obamacare. Some 12.2 million Americans signed up for the plan during the enrollment period through HealthCare.gov and state insurance markets, but that was lower than expected.

Now that he has lost his fight to pass his own version of a health insurance system, Trump has repeated his plan to let the Affordable Care Act “explode,” which could include further plans to discourage enrollment. Fears about the plan and the Trump administration’s disdain for it could also drive consumers away, which could be seriously damaging to the health plan system.type=type=RelatedArticlesblockTitle=Related Coverage + articlesList=588a9451e4b0230ce61b0b40,58d59c8ee4b03787d358cd76

-- 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 4 hours ago.

Hillary Clinton says Trump's healthcare bill defeat is 'victory for all Americans'

0
0
With Obamacare stay, 24,000,000 people were saved from losing their health insurance. Reported by DNA 4 hours ago.

Friday Talking Points -- On The Wrong Track And Headed For You

0
0
Never were the words of the Grateful Dead so fitting in the world of politics. “Trouble ahead, trouble behind” is indeed a perfect description of the spot Paul Ryan and Donald Trump found themselves in today. Because Casey Jones faced precisely the same no-win situation, and it didn’t work out so good for him, either.

Switchman sleepin’
Train hundred-and-two
Is on the wrong track and
Headed for you


So you’ll have to forgive the rather disjointed (and derailed) nature of today’s column, since it was written in snatches, in between watching Ryancare explode into a million pieces throughout the day.

Because it’s been such an extraordinary day, we’re not even going to attempt writing a normal Friday Talking Points column this week. Instead, we’ve just got an extended rant on the first big failure of the Donald Trump administration (and the Paul Ryan speakership, to boot).

The following was written in fits and starts, which is about as cohesive as was possible today. Because even though legislative death and destruction were in the air, when the collision happened it was almost impossible to tear our eyes away from it. Call us legislative rubberneckers if you will, but we’d bet a fair amount of readers also couldn’t tear themselves away from the news today. So with a few final apt lines from the Dead, we’ll just get started, shall we?

Come ‘round the bend
You know it’s the end
The fireman screams and
The engine just gleams


 

*Casey Jones you better watch your speed*

A trainwreck is a spectacular thing to see, isn’t it?

There’s a reason for this, so I thought I’d open with a little physics, just to lighten the mood a bit. I’ve always thought it ironic that the one physics formula just about everyone recognizes is also one of the most impenetrable concepts, in terms of real-world application. Everyone knows that “E = mc(squared),” but how many understand what it means?

There’s a formula that isn’t nearly as well-known, however, which has all kinds of real-world applications. I speak of “F = ma,” which is actually fairly easy to comprehend even by non-physicists. Written out in full, it becomes: “Force equals mass times acceleration.” What this means is there are two basic ways (or some combination thereof) to create a massive amount of force. You can have a very tiny amount of mass (or “weight”) with a very high amount of acceleration. Like a bullet, for instance. A very small weight, but it can be a deadly force because it’s moving so fast. Or if you have a very large mass, it takes only a small amount of acceleration to create a powerful amount of force. Think of a glacier, which barely moves ― but because it’s so massive, it can permanently change the landscape.

Trainwrecks are a combination of a very large mass and a decent amount of acceleration. When you have a lot of mass and a lot of acceleration, you get a whale of a lot of force. So the results of a trainwreck are pretty spectacular, and can be deadly for anyone unlucky enough to be caught in the wreckage.

Which brings us to the monstrous wreckage of the GOP’s long-awaited replacement plan for Obamacare. The Ryancare train sped towards an immovable Tea Party object on the tracks all week long, while everyone held their breaths waiting for the inevitable disaster. Today, Ryancare hit this solid brick wall of obstruction within the Republican Party alone (no matter how Trump tried to spin it, after the fact).

Even if Ryan had pulled off a miracle and passed the Ryancare bill through the House, it still faced a brick wall of public opposition, which likely would have doomed it to failure in the Senate. Recent polling showed only 17 percent of the public approves of Ryancare. A whopping 56 percent oppose it. And that’s after only three weeks. By comparison, this is far, far worse than Obamacare has ever polled ― before or after its implementation. It’s stunning, in fact ― a ratio of over 3-to-1 against Ryancare.

And that poll was taken before Ryan was forced to tinker with it to make it even worse. The Congressional Budget Office put out a quick score on the first round of changes to the bill, and ― astonishingly ― it showed that Ryan was moving in the direction of making it cost more without covering any additional people. Meaning those 24 million will still be losing their insurance under Ryancare, while it costs almost $200 billion more. And that’s Ryan trying to make it more acceptable to his fellow Republicans, mind you.

 

*Boehner rails*

Stepping back a bit, what’s always amazing is the chutzpah Republicans are capable of, when doing exactly the same things they routinely denounce Democrats for doing ― whether those complaints had any validity or not. Remember the days when Republicans used to complain about Democrats not involving them in important legislation? Remember when they (inaccurately) complained that the Patient Protection and Affordable Care Act had been “too hasty” and “jammed through Congress”?

Allow me to refresh your memory. John Boehner famously gave a very impassioned speech on the House floor right before the Obamacare bill House vote, seven years ago to the week. Here are excerpts from that speech (bonus points if you can spot why his own words give the lie to the “too hasty” GOP talking points):

Today we should be standing together reflecting on a year of bipartisanship and working to answer our country’s call and their challenge to address the rising costs of health insurance in our country. Today, this body, this institution, enshrined in the first article of the Constitution by our Founding Fathers as a sign of the importance they placed on this House, should be looking with pride on this legislation and our work. But it is not so.

No, today we’re standing here looking at a health care bill that no one in this body believes is satisfactory. Today we stand here amidst the wreckage of what was once the respect and honor that this House was held in by our fellow citizens. And we all know why it is so. We have failed to listen to America. And we have failed to reflect the will of our constituents. And when we fail to reflect that will, we fail ourselves, and we fail our country.

Once again, recent polling puts Ryancare at a dismal 17 percent approval rate with the public. Boehner then got extremely worked up (video clips of this segment have been circulating all week, for obvious reasons) at the failures of the legislative process, railing at Democrats for their perfidy:

[L]ook at how this bill was written. Can you say it was done openly, with transparency and accountability? Without backroom deals and struck behind closed doors hidden from the people? Hell, no, you can’t!

Have you read the bill? Have you read the reconciliation bill? Have you read the manager’s amendment? Hell, no, you haven’t!

Boehner was then admonished from the chair that everyone “would do well to remember the dignity of the House.”

Boy, those were the days, eh? Republicans incensed because of backroom deals cut and not enough time to read and understand the bill. Takes you back, doesn’t it?

Boehner builds to a rousing finish, while once again undercutting what would become a regular Republican anti-Obamacare talking point:

My colleagues, this is the People’s House. When we came here, we each swore an oath to uphold and abide by the Constitution as representatives of the people. But the process here is broken. The institution is broken. And as a result, this bill is not what the American people need nor what our constituents want.

Americans are out there making sacrifices and struggling to make a better future for their kids, and over the last year as the damn-the-torpedoes outline of this legislation became more clear, millions of Americans lifted their voices and many, for the first time, asking us to slow down, not to try to cram through more than this system could handle, not to spend money that we didn’t have. In this time of recession, they wanted us to focus on jobs, not more spending, not more government, and certainly not more taxes.

But what they see today frightens them. They’re frightened because they don’t know what comes next. They’re disgusted because what they see is one political party closing out the other from what should be a national solution. And they’re angry. They’re angry that no matter how they engage in this debate, this body moves forward against their will.

Shame on us. Shame on this body. Shame on each and every one of you who substitutes your will and your desires above those of your fellow countrymen.

Strong words indeed. Extraordinarily, though, except for one rather large detail, this same complaint could easily have been made today by just about any Democrat, since everything Boehner lists as being wrong with the Obamacare process was worse ― by several orders of magnitude ― in the Ryancare fiasco. But did you catch how Boehner actually admits the truth ― that large detail ― of what had previously taken place? Here are the two key quotes, with emphasis added:

Today we should be standing together reflecting on *a year* of bipartisanship and working to answer our country’s call and their challenge to address the rising costs of health insurance in our country.

Americans are out there making sacrifices and struggling to make a better future for their kids, and *over the last year* as the damn-the-torpedoes outline of this legislation became more clear, millions of Americans lifted their voices and many, for the first time, *asking us to slow down, not to try to cram through* more than this system could handle, not to spend money that we didn’t have.

Got that? “Cramming” the legislation through took over a year. Boehner even admits it.

Ryancare has existed for three weeks. Three freakin’ weeks, from its public unveiling to the House vote.

No public hearings were held where stakeholders were allowed to offer their input. None. One-sixth of the American economy is being completely changed, and the insurance industry was not consulted. The hospital industry was not consulted. The drug industry was not consulted. Doctors were not consulted. Nurses were not consulted. Pharmacists were not consulted. To say nothing of the patients and other members of the public who would be directly affected. Paul Ryan didn’t even bother to get the buy-in from his own membership. Three weeks doesn’t leave a lot of time for all that sort of thing, does it?

It is more than enough time, however, to stage a rather spectacular trainwreck.

 

*Dealmaker? Hardly. Wonky conciliator? Don’t think so.*

We’re now left with the aftermath. The wreckage is strewn across the countryside, and the search and rescue teams are still looking for possible survivors, but without much hope. Most severely damaged by the Ryancare trainwreck are the political reputations of both Paul Ryan and Donald Trump.

President Trump has always sold himself as the king of the dealmakers, but he couldn’t close this deal no matter how hard he tried. To his credit, he did indeed try. Barack Obama never really enjoyed the schmoozing-with-Congress part of the job of being president, but Trump took to it like a fish to water. He spent hours on the phone with over 100 Republican House members, he invited them up repeatedly to the White House, he even went down to the Capitol and appeared on their turf (a very big deal indeed, in Washington). Trump did everything he could to woo GOP members into giving him a big victory early on in his administration. Everything, that is (according to some Republicans), but actually learn what was in the bill so he could do some dealmaking on the specifics. Trump, according to people in these meetings, made a purely political argument and didn’t seem interested at all in any of the concerns or complaints, or indeed interested in any policy details at all. In the end, Trump’s politics-only appeal failed, because there are so many things wrong with Ryancare that it is a veritable cornucopia of reasons to oppose (no matter where you happen to fall on the Republican political spectrum). In the end, Mister Dealmaker couldn’t close the deal. That’s going to hurt his image with the public in the future, possibly in dramatic fashion.

There’s also going to be a lot of re-examination of Paul Ryan’s political persona as well. The inside-the-Beltway crowd (in both politics and the media) built up Ryan on two separate pedestals. The first was Ryan-as-uberwonk. Ryan was supposed to be the numbers guy who could successfully translate conservative ideology into actual legislation that would then go on to create the conservative dream world. Of course, anyone who ever examined the details of all the past Ryan budgets knows full well he’s never been able to actually live up to his wonky-genius billing, and Ryancare just shined a big, bright spotlight on his own inability to deliver. When the numbers on Ryancare were added up, the sum total was precisely what Democrats have been saying all along ― that it was impossible to reach the goals of more people covered, cheaper costs for both the patient and the government, and better care by following nothing more than orthodox conservative ideology. Democrats all said it couldn’t be done, and Ryancare proved it beyond a shadow of a doubt. Costs would skyrocket for patients, and tens of millions would not be able to afford health insurance ― a long way from the Utopia that Republicans have been promising their voters for seven straight years.

The proof of this fact was even more stark because Ryancare was the Republicans’ only shot. There were no competing House bills. There was no competing Senate bill. Republicans have been terrified to write actual legislation up until this point because they knew the outcome would be worse than Obamacare. They knew the Congressional Budget Office was going to pour the cold water of reality all over their dream fantasies. It was Ryancare or nothing because after seven years, this is all they’ve got. Ryan was supposed to be the wonkiest guy in the party, and even he couldn’t make the numbers add up.

The second part of the Ryan myth that now lies shattered on the ground is that he was going to be the great conciliator, the ultimate go-between for all the various Republican factions. He’d get the Tea Partiers to go along with the moderates, through sheer force of personality. He was going to make the House work again, after the Tea Partiers drove John Boehner crazy for so long. This wasn’t supposed to happen under Ryan, but it just did. Once again, the Tea Partiers showed that saying “No!” is all they’re capable of. Oh, you can add to that list above: “There was no Tea Party bill,” because, as always, there is never a Tea Party bill. They don’t create, their sole power is the power to destroy.

And now, they’re going to be even more powerful. There’s a cheerful thought. Ryancare didn’t fail within the Republican caucus in the House because it was so awful ― it failed because it was not awful enough. Don’t believe this? At the end, the Tea Partiers were trying to strip things like “hospitalization coverage” from health insurance plans. To state the obvious, health insurance that doesn’t pay when you have to go to the hospital is not health insurance. And yet that’s what the Tea Partiers were in there fighting for.

If the Tea Partiers didn’t exist, Ryancare likely would have passed, with a few tweaks. We’ve been saying it for a few weeks now, but today others are starting to speculate about how much longer Ryan will hold the speaker’s gavel. If Ryan can’t get enough Republicans to agree on how much they hate Obamacare, then how is he going to get them to agree on much of anything? Ryancare’s failure may be the harbinger of lots of government shutdowns to come, to put this slightly differently. Somewhere (in Ohio), John Boehner is sipping merlot, smoking a cigarette, and laughing. One can imagine a private text message from Boehner to Ryan, in fact: “Told you so.”

Snark aside, though, if Paul Ryan and Donald Trump are the biggest losers of the death of Ryancare, then the Tea Party certainly has to be seen as the biggest winners by far (other than the obvious winners of “Obamacare and the American people,” of course). The Tea Partiers are now the official tail that wags the Republican dog. Nothing will pass the House without their say-so. Not only have they proven they can stick together even under relentless pressure from a president popular among Republican voters, they’ve also proven they don’t care one whit about his political threats. It’s really tough to picture anyone trying to “primary” a Tea Partier from the right flank, after all. With that option off the table and with comfortably-gerrymandered districts, the Tea Partiers really have nothing to fear, at this point. As Trump and Ryan lose political capital, the Tea Party gains even more. This is going to make Ryan’s already-tough job virtually impossible.

 

*The new third rail*

Healthcare reform is the new third rail of American politics. The old Washington saying needs updating (it used to be: “Social Security is the third rail... touch it, and you die”).

Republicans were so all over the map on Ryancare that they were simultaneously worried about a voter backlash if they passed the bill and worried about a different type of backlash it they didn’t pass it. More correctly, different factions were worried about different backlashes. Republicans from swing districts were terrified of voters reacting to throwing 24 million people back into the ranks of the uninsured and skyrocketing out-of-pocket costs (especially for seniors, who regularly turn out to vote). Republicans from Tea Party districts were worried that conservative talk radio (and powerful conservative donors such as the Koch brothers) were lining up to label Ryancare “Obamacare Lite,” and that their voters might punish them for not repealing enough of Obamacare. Ryan was between this rock and a hard place, because any move he made towards either faction lost him votes with the other.

Even now, many House Republicans are worried that their voters may turn from them in disgust because they once again proved that House Republicans are completely incapable of delivering on their campaign promises. They’ve been swearing they’ll repeal Obamacare for years now, while their voters lapped it up like candy. Now that they’ve failed to do so, how will their voters react?

Democrats already know the lethality of healthcare reform. When they passed Obamacare, they had (depending on how you count) either 59 or 60 seats in the Senate. They now have 48. Nancy Pelosi used to wield the speaker’s gavel. Now she’s merely minority leader. Republicans successfully demonized Obamacare in order to cause that sea change.

Healthcare reform is the new third rail of American politics. It may turn out to be deadly for the Republicans, because no matter what happens next, they’ve already massively disappointed a large segment of their own base.

 

*A Democratic opportunity*

Donald Trump’s spin on the Ryancare trainwreck was downright laughable. “It’s all the Democrats’ fault” ― really? Is that all you’ve got? Wow. Good luck with that one. That and ten bucks will get you a cup of coffee down at Starbucks, Donny. Nobody in their right mind is going to buy this particular spin. Oh, sure, the Republicans can try to parrot Trump’s knee-slapper, but it just ain’t gonna fly. The public’s a little smarter than that.

But Trump did open an interesting door for Democrats today. He threw down a gauntlet in the midst of all the finger-pointing attempts, and if Democrats are smart they’ll call his bluff. More on that in a minute.

The first thing that Democrats really need to frame quickly is that the death of Ryancare should mean the death of the “repeal and replace” slogan from the GOP. Repeal just is not going to happen, because the new bar any replacement plan has to hit is that it must be as good as Obamacare. Period. Democrats are already making this plain, and they need to hammer it ceaselessly. Democrats are open to improving Obamacare, but they will stand as one against any suggestion that it has to be repealed. That should be their initial bargaining position ― “We’ll work with Trump or the Republicans on fixing some problems, but we will not work on any bill that even hints at repealing Obamacare.”

Luckily, Republicans seem to already be pivoting away from the phrase “repeal and replace.” They think they’ve got a brilliant sequel to this: “collapse and replace.” They are so absolutely convinced that Obamacare must (as Trump put it) “explode” soon that their Plan B is to just sit back and wait for it to happen. This is a logical flaw technically known as “starting to believe your own P.R.” What happens to their wonderful slogan when Obamacare fails to explode? Well, they haven’t thought that far ahead ― or they refuse to, since they are so confident of Obamacare’s inevitable demise. Whatever ― Democrats can use the fact that the GOP “repeal” slogan seems to be dead to their advantage.

There was another shift in rhetoric during the debate over Ryancare that was interesting. Both sides started using new metrics to measure what they considered to be acceptable outcomes. Well, that isn’t totally true, both had been around long before Ryancare existed, but these two did seem to be the ones that got the most focus in the past few weeks.

Democrats concentrated on the number of people insured. Obamacare has been wildly successful at bringing people into the insurance market, with 20 million more Americans insured today than when Obamacare passed into law. That impressive statistic is the easiest way to measure the success of Obamacare, especially when the C.B.O. so starkly showed how awful Ryancare was in this regard. Ryancare not only would have booted 24 million off insurance, it would actually have resulted in one million people more not being insured than if Obamacare had never existed. That’s stunning incompetence ― to reach a worse result than if no healthcare reform had ever happened. Obamacare’s obvious success in getting tens of millions more insured coupled with Ryancare’s utter failure in this regard put this metric front and center for Democrats during the debate.

Even more interesting, on the Republican side their biggest complaint was a fairly new one (for them). After all, they couldn’t very well complain about “death panels,” since they never actually existed in the first place. All the rest of their complaints had the same stale flavor, because they were always nothing more than scaremongering which had no basis in reality in the actual Obamacare legislation. Remember, Republicans were predicting that Obamacare would already be dead by now, so it’s a little hard for them to make that argument again. Instead, they focused on the number of places in America which only have one provider on the Obamacare exchanges. People who live in (according to them) “one-third of American counties” only have one choice on the exchanges ― which, in a capitalist marketplace, is really no choice at all. You take it or you leave it, that’s your only choice.

This also leaves an interesting opportunity for Democrats to make a move, at this point.

 

*The public option to the rescue*

Donald Trump just threw down a gauntlet in front of the Democrats (in the midst of laughably trying to pin all the blame for Ryancare’s defeat on them). Trump clearly stated that he was open to any ideas from either party, since Ryancare is no longer viable. So Democrats should immediately put together a plan to bring back the public option, and present it to the White House (in a very public way). They could entice Trump by telling him that their plan would go a long way to allowing all those unrealistic promises Trump made during the campaign actually come true. It could “cover everybody.” Costs could come down. People would have more choices. Health insurance would improve, through competition. If Trump is being serious about considering anyone’s plan, he may actually be tempted by such an offer (especially if Democrats graciously offered to start calling it “Trumpcare” on television).

While the Obamacare bill was being debated, Democrats had their own factions to deal with. Where Republicans now have Tea Partiers, Democrats had Blue Dogs. Their intransigence meant Obamacare was nowhere near as good as it could have been. In particular, Senators Max Baucus and Joe Lieberman forced the entire rest of the Democratic Party to abandon the public option before they’d vote for the bill. To be completely accurate, Baucus and Lieberman should be called ex-senators, since (thankfully) neither one of them holds public office anymore.

The public option was a compromise to begin with, which is why these Blue Dogs are indeed comparable to the Tea Party. Even this compromise was too much for them to agree to. The real progressives were pushing for single-payer, which would have removed the insurance companies from the equation altogether, as most Western democracies have done. But single-payer has always been the Democrats’ bridge too far. They can’t get agreement even among themselves over such a radical redesign, so it is probably not going to be the next step now, either.

Instead of obliterating the private insurance market, though, if the choice of buying in to Medicare was made available to all it would be a lot more politically feasible. Every American, whether insured through their employer or through the Obamacare exchanges (in every county in the country) should have the choice of buying into the Medicare system, no matter what age they happen to be. This could solve multiple problems all at once.

Baucus and Lieberman balked at even the public option because they had accepted so many large donations from the health insurance industry that they did what they were told to do. The insurance industry hated the concept, because it would have meant they would have had to compete with the government to sign people up. They swore that the exchanges would be truly competitive through just the free market alone.

Well, they had their chance. Democrats could even just propose a Medicare buy-in option in places with only one remaining insurer, for starters. If more than one insurance company isn’t interested in the market, then the government will step in to provide a guaranteed level of choice. This would also undermine the biggest talking point Republicans now have, it’s worth pointing out.

Democrats could even be magnanimous and offer Republicans a few of their favored ideas in the mix as well. If you have the safety net of both Medicaid (with the expansion intact) and the Medicare public option, then letting the GOP tinker on the edges wouldn’t be as bad, in other words.

If some Democrats in the Senate sat down with some moderate Republicans (Susan Collins, perhaps), some sort of workable compromise could probably be hashed out. Once you take the inflammatory “repeal and replace” rhetoric out of the equation, then both sides could take a long hard look at Obamacare and try to fix the problems which have arisen now that it has been fully implemented. These problems are not insurmountable, as long as the new ideas don’t kick millions off their health insurance and as long as the individual states don’t get billions less from the federal government. Both were fatal flaws in Ryancare, but both can easily be avoided if “repeal” isn’t the watchword from the Republican side.

Democrats seriously care about outcomes. Most Democrats are willing to make sane and sensible adjustments to Obamacare. While the Tea Party got most of the attention in the Ryancare trainwreck in the House, it might have been even more interesting if it had passed, because most of the pushback from Republicans in the Senate was from the moderate faction, not the hotheads. Some Senate Republicans wanted to see something that worked ― not just some ideological conservative fantasy that didn’t add up to a better outcome.

Pushing any compromise bill will be hard to do, since Democrats are in the minority and don’t control congressional schedules or committees. But they could do an end-run around all of that if they put together a decent plan with a few sensible Republicans and then got Trump on board. Trump could use the power of his Twitter audience to force Paul Ryan and Mitch McConnell to allow such a plan to move forward ― even if many Republicans are against it. Trump’s really the key to all of that, because it’d certainly be an “only Nixon could go to China” moment.

Democrats now have the opportunity to call Trump’s bluff. If they start off with only one dealbreaking demand and a set of core principles, perhaps truly bipartisan agreement could actually be reached, at least in the Senate. The dealbreaking demand would be: “Don’t ever call it a repeal of Obamacare.” The core principles would be: “We have to have at least as many people insured as under the current law, and we must work for a better outcome, not a worse one ― but we’ll consider any suggestion that achieves that.”

In other words: “No more trainwrecks.”

 

Chris Weigant blogs at:

Follow Chris on Twitter: @ChrisWeigant

Full archives of FTP columns: FridayTalkingPoints.com

All-time award winners leaderboard, by rank

 

-- 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.

It’s Time For A Single-Payer Healthcare System

0
0
We have had “Obamacare” and now the Republicans have fallen short in replacing it with “Ryancare” (a.k.a. “Trumpcare”). Both plans have their unforgiving and deep critics and enemies.

I think that it is time to adopt the healthcare system that Canada and most other nations have: a *single-payer healthcare system*.*A single-payer healthcare system will be simpler, more efficient, involve less cost, and satisfy more consumers.* Let’s recognize that today’s U.S. healthcare system is a compromise between the Democrats wish to expand healthcare coverage to more citizens and the Republicans wish to work with private insurance companies that compete by offering different plans.

Let’s first examine the criticisms of Obamacare and then the criticisms of the Republican proposal - “Ryancare” - and finally see what a single-payer healthcare system offers.

**What about Obamacare?**

“Obamacare” is the political name given by Republicans to the healthcare plan passed by Congress and signed by President Barack Obama in March 23, 2010. The technical name is the *Patient Protection and Affordable Care Act* but for short, it is called the *Affordable Care Act (ACA)*.

The ACA sought to correct many problems of the previous “free enterprise” health care system. Here are the problems:

1. About 45 million Americans lacked health insurance coverage. Such persons would have pay their own full medical bill out of their income or rely largely on the emergency room services of local hospitals.

2. Health insurance companies did not have to accept applicants, especially if they had a health problem.

3. Health insurance companies could terminate AIDS patients and many insured persons complained about poor service from the insurance companies.

4. Health care coverage and service varied greatly from area to area. Many rural areas had only one or two health insurance providers.

5. Many patients experienced high and rising costs of health insurance and resented the limits placed on their choice of physicians and procedures.

6. Patients complained about the high prices for medications that were cheaper in many countries.

7. Physicians were unhappy because of falling remuneration, restrictions on their freedom to choose procedures and the high cost of malpractice insurance in an overly litigious society.

8. Employers were unhappy because their medical premiums kept rising.

9. Hospitals faced rising costs of new technology that rapidly needed to be replaced by still newer technology.

Clearly most people and many stakeholders were dissatisfied with the quality, access, and cost of our “free enterprise” healthcare system. Many people argued that health care was a right, not a privilege and that new legislation was needed.

The Obama plan (ACA) set three aims: (1) to increase health insurance quality and affordability, (2) lower the number of uninsured people, and (3) reduce the costs of healthcare. To accomplish this, the ACA set up mandates, subsidies and insurance exchanges. The mandate was the requirement that all persons and families needed to buy insurance coverage. It their income was too low to afford the insurance, they would receive subsidies. Those who could afford to buy insurance coverage but didn’t buy it would pay a fine.

The ACA required all insurers to accept all applicants, cover a specific list of conditions and charge the same rates regardless of pre-existing conditions or sex.

To the great credit of ACA, another 20 to 24 million additional persons had coverage by 2016.

Conservatives criticized the requirement that all eligible people had to buy health insurance. Freedom lovers thought this was unconstitutional, ignoring that all citizens who want to drive a car must buy auto insurance. The requirement was essential if the government was to collect enough money to cover the cost of everyone having healthcare insurance.

Republicans used all their power to drumbeat that Obamacare was a failure. They focused on healthy, financially secure 25-year-olds who were forced to buy health insurance when they had so many other needs they wanted to satisfy. Republicans refused to recognize that this was necessary to make it possible to insure older and lower income people, something these people would appreciate later in life if they fell into the same lack of funds. Ryan proclaimed: “The idea of Obamacare is … that the people who are healthy pay for the people who are sick,” He added. “It’s not working, and that’s why it’s in a death spiral.”

Another criticism was that President Obama promised that no one would have to change his or her present insurance or doctor relationship. Yet about 5 percent of the population found that they had to change their health plan. But 80 percent who got health care through their companies did not have to change their health plan.

There were other critics. Rich people had to pay higher taxes to fund the subsidies. Many hospitals and doctors faced lower earnings as the law tightened up on unnecessary care.

**How About ”Ryancare”? (also called “Trumpcare”)**

When the Republicans came to power with Donald Trump’s election in 2016, GOP House Representative *Paul D. Ryan* had his opportunity to kill Obamacare with an entirely different plan for healthcare delivery. Ryan wanted a healthcare system that would provide full choice and individual responsibility for one’s healthcare. Citizens would establish healthcare savings plans and build up enough savings to meet their ordinary medical needs. Those who lacked income would get a cash subsidy depending on their age. Older persons would receive a higher cash subsidy than younger people, regardless of income.

Paul Ryan's aim was to convert Medicare into a "voucher" program for citizens currently under age 55. People who are now age 55 and older would continue to buy traditional Medicare insurance. Those who didn't meet the age threshold would be given "premium support" from the government when they attain the retirement eligibility age. They would then be free to buy their own insurance coverage from for-profit insurance companies. They would pay any difference between the voucher amount and premiums charged by insurance companies out of their own pocket.

A lot of federal money would be given as block grants to states to use for healthcare as they saw the need. If block grant money was insufficient, the state would have to come up with the difference. However, most states are in a poor financial condition and are not able to add more money beyond the block grant. So healthcare quality is likely to be very uneven from state to state.

Ryan's original proposal called for capping annual increases in the premium support. If medical premium costs continued to rise much faster than the overall economy, seniors would need to kick in more of their own money to pay for medical insurance. This would hurt lower- and middle-income seniors, Ryan modified his proposal to allow for increases in the premium support amount that would track increases in total premium costs.

Supporters of Ryancare can cut their own costs in a number of ways:

1. Restrict eligibility by raising the retirement age
2. Make participants pay more by increasing premiums, copayments or deductibles.
3. Reduce demand for medical care by encouraging preventive care (with no deductible or copayment on these services)
4. Pay less to hospitals, physicians and other medical providers by reducing reimbursement rates
5. Provide incentives to medical providers to improve efficiency
6. Reduce or eliminate unnecessary costs by restricting malpractice awards, reducing fraud and encouraging the use of electronic records

Ryan’s plan is to turn free enterprise loose to pull all the other levers, while limiting government involvement in Medicare. The plan assumes that people would make informed, economically smart choices among a variety of distinct medical plans. The invisible hand of capitalism would then reward innovative medical insurance providers and punish inefficient providers that don't meet Americans' needs.

Ryan assumes that there will be real competition among insurance companies and that consumers will make informed choices about their medical plan. In most geographic areas, there are only handful of insurance companies that offer medical insurance plans. There isn't the kind of intense market competition that relentlessly drives down costs and rewards innovation.

And how can we assume that consumers can make really informed decisions about something as complicated as health insurance? Consumers make awful tradeoffs between spending and saving with a bias toward spending. They invest in fly-by-night stock market tips. They acquire poor health by deciding to smoke, abuse alcohol, take hard drugs, eat sugar, fat and salt-loaded foods. They buy more expensive cars than they can pay for if a recession occurs. How can we be sure that they will make smart decisions on their medical plan coverage.

Ryancare claims that it will make $5.1 trillion in cuts to help bring the government's cost into the black by 2024. The budget legislation promises to serve more as an election-year political and policy statement by House Republicans than a realistic attempt to engage Obama and Democrats in any serious effort to further cut the deficit.

*Free enterprise works well to efficiently deliver most goods and services. It is *not the best system for delivering adequate healthcare. To place Medicare, Medicaid and Social Security in the hands of private enterprise where the aim is to reduce costs and increase investor return, our people are at their mercy. Remember that the first priority of for-profit executives is to their shareholders, not to their customers.

**Negative Reactions to the Ryan Plan**

The Ryan Plan, called the American Healthcare Plan (AHP), calls for $880 million in cuts to Medicaid alone, and it raids $117 billion from Medicare--cutting nearly $1 trillion from both programs that will be used for a massive tax break for the wealthy! This is a case where the poor will be subsidizing the rich.

The Ryan Plan attracted an outpouring of criticism and disparagement. People accused the Republicans as turning their back on the middle and the poorer class. The plan was disparaged by the American Medical Association (AMA), American Hospital Association (AHA), and the American Association of Retired People (AARP), each pointing out the weaknesses that they saw.

The AARP estimates "that the bill’s changes to current law’s tax credits could increase premium costs for a 55-year old earning $25,000 by more than $2,300 a year. For a 64-year old earning $25,000 that increase rises to more than $4,400 a year, and more than $5,800 for a 64-year old earning $15,000.""[I]t appears that the effort to restructure the Medicaid program will have the effect of making significant reductions in a program that provides services to our most vulnerable populations, and already pays providers significantly less than the cost of providing care." The Republican plan would weaken Medicare and largely benefit the young and rich at the expense of the old and poor.

Several smaller or specialty trade associations have also expressed deep concerns with Ryancare, including the American Academy of Pediatrics, the American Psychiatric Association, and the Federation of American Hospitals. Surprisingly, Powerful conservative groups such as Heritage Action, Freedom Works and Club for Growth have all denounced the Republican legislation.

The Democrats charged that the Ryancare would cause at least 11 million person to lose health coverage, cause premium co-pay and deductible increases, deplete the Medicare trust fund, and transfer wealth to the richest. It would decrease the number of health insured people and do nothing to get the millions of uninsured to get health insurance.

*Already 13 Republican Senators are on record as having deep reservations about gutting the Affordable Care Act and enacting Ryancare in its place.*

Even former vice presidential nominee Sarah Palin wrote on her Facebook page that Ryan's budget "is a joke." She said that the block grant program managed by the states, could drive millions of people from the program, including those in nursing homes and children from low-income households.

Ryancare made two classic mistakes. They cut out the support needed by lower-income older people, the very people who voted for Trump, who now wants to hand rich people a big tax cut. It would repeal the $158 billion levy on investment income by people in top brackets, Second, they dramatically overreached by going after not just Obamacare but Medicaid, setting up a huge clash with the hospital industry, the medical industry, the AARP and various governors.

All said, Ryan’s plan would:

- Force Americans to pay more for less coverage
- Cut 24 MILLION Americans off of their healthcare plan by 2026
- And defund Planned Parenthood.

**What about Single-Payer Healthcare?**

We believe that ALL people should have the right to healthcare, that it is not just a privilege, and that good-quality healthcare is not just for the rich.

Single-payer healthcare involves the state, rather than private insurers, paying for healthcare costs. The state can contract for healthcare services from private organizations or can own and employ healthcare resources and personnel. In some single-payer systems, consumers may have the option of contracting for private health insurance. Canada and Taiwan have pure single-payer systems while countries such as Australia, France, Spain, and the United Kingdom have hybrid single-payer/private insurance systems.

In a single-payer system, the government provides all health insurance and collects all medical and insurance fees. The insurance is extended to all citizens and legal residents. The aim is universal healthcare. The system typically bears a name such as the United Kingdom's National Health Service, Australia's Medicare, Canada's Medicare, and Taiwan's National Health Insurance.

The fund can be managed by the government directly or by a publicly owned and regulated agency. The government may employ doctors and own and run hospitals (United Kingdom). Or the government may purchase healthcare services from outside organizations (Canada).

We will describe the single payer system in Canada, because Canada is physically close and close in values to those of U.S. citizens. Canada provides free medical services through private entities. The government sets federal standards to assure quality of care. The individual’s health remains confidential between a person and his or her physician. In each Canadian province, each doctor submits the insurance claim against the provincial insurer. The person who gets healthcare does not get involved in billing and reclaim.

The Canadian government keeps advertising at a minimum. Costs are paid through funding from income taxes. There are no deductibles on basic health care and co-pays are kept extremely low. Provinces issue a health card to each individual who enrolls and everyone receives the same level of care. There is no variety of plans because all essential basic care is covered, including maternity and infertility problems. Dental and vision care may or may not be covered depending on the Province. Some provinces provide private supplemental plans for patients who desire private rooms if hospitalized. Cosmetic surgery and some elective surgery are generally not covered. These can be paid out-of-pocket or through private insurers. One’s health coverage is not affected by loss or change of jobs, as long as premiums are up to date. There are no lifetime limits or exclusions for pre-existing conditions.

Canadians chose their family physician (called a general practitioner or GP). If the person wants to see a specialist, the GP will make a referral. The median wait time to see a specialist physician is a month. The median wait time for diagnostic services such as MRI and CAT scans is two weeks. The median wait time for surgery is four weeks.

Pharmaceutical medications are covered by public funds for the elderly or indigent, or through employment-based private insurance. The Candadian government negotiates drug prices with suppliers to control costs.

Physician incomes in Canada rose initially after the single payer system was implemented. A reduction in physician salaries followed, many fearing this would be a long-term result of government-run healthcare. However, by the beginning of the 21st century, medical professionals were again among Canada's top earners.

The main thing to notice is that *Canada’s healthcare cost to its GDP is 11 percent* whereas the *U.S. cost is 17 percent of the GDP*.

*Past Efforts to Bring a Single-payer Healthcare System into the U.S.*

Several proposals have been made for introducing a single- payer healthcare system in the U.S. or in several individual States. The most recent is the United States National Health Care Act, (popularly known as"Medicare for All"). Representative John Conyers (D-MI) every year since 2002 has introduced an act for a single-payer system. All medical care would be paid for by the Government of the United States, ending the need for private health insurance and premiums, and probably recasting private insurance companies as providing purely supplemental coverage, to be used when non-essential care is sought. But neither his bill or any others succeeded in getting more than 20 percent congressional co-sponsorship.

Several arguments are presented to favor a single-payer healthcare system. More people will see a physician more frequently who might spot lingering or unrecognized medical problems. For example, catching cancer in Stage 1 is much better than catching it in Stage 3 when it involves so much more hospitalization and pain. Preventative healthcare will save expensive dollars later. Consumers and employers would both face lower administrative costs. Good healthcare will be more uniformly available throughout the land.

Experts see much saving realized through preventive care and the elimination of insurance company overhead and marketing costs and hospital billing costs. A 2008 analysis of a single-payer plan estimated immediate savings at $350 billion per year. Another study estimated savings of $570 billion a year.

The Congressional Budget Office (CBO) has scored on a few occasions the cost of a single-payer health care system. Each time the estimate concluded that a single-payer system would cost less than any other system through its savings in administrative costs.

There have been several single-payer state referendums and bills from state legislatures. Bills have been proposed in Vermont, California, Colorado, Hawaii, Illinois, Massachusetts, Minnesota, Montana, New York, and Oregon. All have failed, with the exception of Vermont which canceled its plan in December 2014 for single-payer health care, citing costs and tax increases as too high to implement.

The Veterans Administration healthcare system is a pure form of single-payer system because it is "owned, operated and financed by government.” Researchers of the RAND Corporation reported that the quality of care received by Veterans Administration patients scored significantly higher overall than did comparable metrics for patients currently using United States Medicare.

American citizens have been polled on whether they would favor a single-payer healthcare system like the one in Canada. The polls varied in their findings, much depending on the time of the poll and the wording of the question. The response is different when citizens are asked whether they favor a stronger Medicare system vs. a government-run medical system. There is general support for a “national healthcare plan” but there are also many people who are satisfied with their present healthcare plan.

Among advocates of a single-payer healthcare system are

Physicians for a National Health Program, the American Medical Student Association, Healthcare-NOW! and the California Nurses Association. The Annals of Internal Medicine in 2007 found that 59% of physicians "supported legislation to establish national health insurance" while 9% were neutral on the topic, and 32% opposed it.*What are the major criticisms leveled against a single-payer healthcare system? *

They are:
· Many Americans don’t want to expand the size of government and they distrust government.· Many fear that universal coverage will cost too much and raise taxes too much.· Many fear that waiting times for diagnosis, treatment and surgery will increase too much and they prefer the present system.· Many Americans, especially younger citizens, don’t want to pay higher taxes for something that won’t currently benefit them.· Many Americans fear that others will use the system more than necessary and cause longer wait times and additional cost and end up ordering more medications than necessary.· Many Americans worry about dealing with a government monopoly that sets all the standards and that can arbitrarily cut certain medical services to save money.· Physicians fear that single-payer healthcare will limit their discretion when treating patients, decrease physician salaries, and leave less money to cover more services, thereby reducing, the quality of treatment.
*Singapore’s Single-Payer System that Costs Less*

We must recognize that there are many versions of single payer healthcare systems. We examined the Canada version but it pays to examine how Singapore has designed it single-payer e system. It manages to keep cost down and yet protect Singapore citizens from losing their savings in case they are hit by a major medical problem.

The Singapore Plan guarantees coverage only for expensive medical events, those events that can eat up the family’s savings and lead them into bankruptcy. It is less necessary to provide coverage for more everyday medical expenses. Let market forces cover the latter. Singaporeans pay for much of their own health care out of their own pockets. The major insurance program covers only long-term illnesses and prolonged hospitalizations. Singaporeans experience excellent healthcare costing just *5 percent of their GNP* whereas European countries spend around 10 percent and the U.S. spends 17 percent.

The Singapore Plan does not call upon Singapore citizens to set up a health savings account. Their Medisave program requires a mandatory health-savings account called MediShield to which employers contribute as well. The government maintains a safety net called Medifund for patients who can’t cover their bills, specifically older and poorer citizens. Singapore manages to minimize public spending and third-party payments and maximizes public awareness of what different treatments cost. Everyone is insured for catastrophic events. And the government funds health savings accounts for the working class and poor.

Note: This article has been prepared from a variety of public sources.

*What do you think?* Join the debate. And please tell us what you think in the comments section below.

FIXCapitalism.com is dedicated to saving Capitalism from itself. Visit us at www.fixcapitalism.com to join the debate. Follow us on Twitter and Facebook.

-- 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 13 hours ago.

Market Impact of Health Insurance Fail Still Unclear

0
0
Some may be inclined to predict other failures that would impact forthcoming economic bills, given the erosion of Republicans’ political capital and the Washington blame game that’s sure to play out. But the situation on the ground is a lot more complicated than that. Reported by Newsmax 21 hours ago.
Viewing all 22794 articles
Browse latest View live




Latest Images