6 critical ways Trump slashing Obamacare subsidies could impact you

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President Trump’s promised rollback of Obamacare has officially begun. But what does it all mean? And will it affect you?

The federal government will cut billions of dollars in health-care subsidies to low-income households that were introduced under Barack Obama’s Affordable Care Act, the White House announced last week.

These $7 billion in “cost-sharing subsidies” are the payments the government makes to health insurance companies to offset the discounts on co-payments that low-income consumers have received under Obamacare. The subsidies repay health insurers for the higher cost of the “silver plan” through HealthCare.gov — the individual insurance marketplace operated by the federal government and set up under Barack Obama.

The cuts in subsidies may actually hit the middle class the most

Insurers already put insurance premiums up 20% this year in anticipation of the President’s decision to end these subsidies. However, in several states, including Indiana, insurance companies spread their rate increases, so middle-class people on individual plans will likely see a double-digit increase in their premiums next year.

“People who don’t qualify for premium subsidies for cost-sharing reductions, but are also in the individual market because they don’t have employer-sponsored coverage — early retirees who aren’t yet eligible for Medicare or higher-earning freelancers — will be negatively affected by higher premium costs,” Susan Nash, partner at Winston & Strawn LLP in Chicago, Ill.

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The stark difference between Republicans and Democrats on health care couldn’t be clearer

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Attendees hold signs while waiting for a health-care bill news conference to begin on Capitol Hill in Washington on Sept. 13. (Andrew Harrer/Bloomberg News)

“When they go low, we go high,” Michelle Obama told the Democratic National Convention in her electrifying address last year. That phrase summarizes the stark contrast between Republicans and Democrats on the fundamental question of affordable health care. Republicans want you to have all the health care you choose to afford, even if you can’t afford much. Democrats understand that affordable health care should be a fundamental right.

Having failed to pass four different bills to repeal and replace Obamacare, Republicans are back at it again. Backers of the new bill — labeled Graham-Cassidy after Sens. Bill Cassidy (R-La.) and Lindsey O. Graham (R-S.C.) — claim to have 48 or 49 votes for this effort. Senate Majority Leader Mitch McConnell (R-Ky.) has asked the Congressional Budget Office to make the bill’s assessment a priority. The 141-page bill was only made public on Sept. 13, but Republicans are pushing for a vote by the end of the month.

The millions of Americans who were appalled by previous Republican efforts to gut affordable health care should be alarmed once more. Graham-Cassidy employs classic conservative packaging to dress up what it is peddling. It turns health care over to the states, allowing Republicans to posture about getting “closer to the people.” Its cuts are phased in, delaying the effects until 2020 and the most destructive effects until 2027 and thereafter.

But it is the same old poison in a new bottle. The block grants to the states terminate the health-care law’s subsidies for moderate- and low-income families and make deep cuts in Medicaid — not only reversing the Medicaid expansion but also cutting into the core program itself. Because the block grants don’t keep up with projected inflation, they grow more inadequate over time. The bill leaves states free to let insurance companies charge higher premiums to people with preexisting conditions or to not require core benefits required under current law such as maternity care or prescription drugs. The cuts in the core Medicaid program will impact millions of seniors, people with disabilities and mothers with children. The CBO scoring is not in, but as the Center on Budget and Policy Priorities summarizes, while the CBO estimated that the last repeal-without-replace approach would deprive 32 million people of health insurance, Graham-Cassidy would likely strip an even higher number of coverage in its second decade.

Graham-Cassidy tells us much about the Republican majority. GOP legislators don’t mind that millions go without health insurance. They assume low-wage and moderate-income families should have less health-care protection than the wealthy. You get what you can afford, and you won’t be able to afford much because you’ll have to pay the rip-offs of the private insurance companies and the obscene drug prices of the drug lobby.

While Republicans were going low once more, Democrats were going high. Sen. Bernie Sanders (I-Vt.) introduced his Medicare-for-all bill last week. For Sanders, health care is a right, not a privilege. “We remain the only major country on earth that allows chief executives and stockholders in the health care industry to get incredibly rich, while tens of millions of people suffer because they can’t get the health care they need,” he wrote. “This is not what the United States should be about.”

His bill would provide universal coverage for all, expanding Medicare benefits to include eye and tooth care. It would eliminate the private-insurance-company and drug-company rip-offs. Businesses would be free of the burden of providing health care; workers would not have to fight against constant increases in co-pays and cutbacks in coverage. Sanders would phase his coverage in over four years. To pay for it, he proposes a range of progressive taxes. The wealthy would end up paying more for health care; the vast majority about the same or less — with greater security and more benefits. Sanders is also savvy enough to realize this won’t happen overnight. With Medicare for all as the clear and aspirational goal, he supports steps that would move toward that end.

Four years ago, Sanders introduced a similar bill without a co-sponsor. This week, 16 Democratic senators joined him, including presidential hopefuls such as Elizabeth Warren (Mass.), Kirsten Gillibrand (N.Y.), Kamala D. Harris (Calif.), Cory Booker (N.J.) and others. A majority of the House Democratic Caucus has endorsed a similar bill introduced by Rep. John Conyers Jr. (D-Mich.).

Democratic congressional leaders are wary. Moderate and conservative Democrats are uneasy in the face of Republican salvos about the “government takeover of health care.” Polling shows that Medicare for all has significant popularity, but that can wilt under attack. But even Hillary Clinton, who said Medicare for all would “never” happen during the campaign, now agrees, as she wrote in her recent book “What Happened,”that Sanders was right about the popularity of universal programs: “Democrats should redouble our efforts to develop bold, creative ideas that offer broad-based benefits for the whole country.”

The Sanders bill is closer to the beginning than the end of the push for making health care a universal right in this country. With Democrats a minority in both chambers, it isn’t near passage. Unlike the Republican bills, it will go through public hearings and extensive amendments. Passage will require fighting off the powerful insurance and drug lobbies.

More and more Americans understand that health care should be a basic right, not a commodity that you purchase if you can afford it. We understand that the grip of private insurance companies and oligopolistic drug companies is a far remove from a competitive marketplace. And now the contrast is as clear as day. Republicans want to strip millions of health insurance, including seniors in the last days of life, the disabled and women with infants. Democrats want everyone to have the right to affordable health care. There is a choice.

By Katrina vanden Heuvel/WashingtonPost

Posted by The NON-Conformist

Every Democrat in America Should Support Medicare for All

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I agree with Shaun King, why in the hell aren’t they all on board… Democrats… creating Independents every…single…day.

 Libergirl

In a recent poll from the health insurance industry, only 8% of Americans actually want the United States Senate to pass the terrible Trumpcare bill, also known as the Affordable Health Care Act, that the House passed a few weeks ago.

That’s about as bad as it gets — not just for a health care poll, but for anything. Have you ever seen a movie on Rotten Tomatoes with a score of 8%? Hell, even the new Baywatch movie has a 20% on Rotten Tomatoes. In fact, there’s not a major movie out in theaters right now with a Rotten Tomatoes score of less than 10%. Nobody likes Trumpcare. Tens of millions of everyday people will lose their health insurance, rates will skyrocket for America’s seniors, and pre-existing conditions will become a problem again.

Republicans, so hell-bent on destroying Obamacare for the past eight years, never really bothered to do the hard work of coming up with a better plan that lowers costs and insures more people. They’ve got nothing. In fact, what they are proposing is worse than nothing.

Every single Democrat in the country would be smart to divert at least half of their energy away from blasting Trumpcare to fighting for Medicare for All. If it becomes law in California, that will change the game for the entire country. For the third year in a row, a similar Medicare for All bill has passed the New York State Assembly. Nevada is getting closer to its own plan to open up Medicare for All there.

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More Proof Republicans Are Just Lying About Trumpcare

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Your continuous coverage won’t save you.

Rep. Jason Chaffetz (R-Utah), moments before voting to undo Obamacare’s preexisting condition protections

 

When Republican lawmakers face criticism over their plan to allow states to dismantle protections for people with preexisting conditions, they have a pretty standard response. Their Obamacare repeal bill, they insist, would only allow insurers to jack up prices on sick people if those people haven’t maintained continuous health coverage. “For individuals with preexisting conditions, once you are in the system, every proposal that I’ve heard so far says you stay in the system,” Sen. Mike Rounds (R-S.D.) told NPR Thursday. “And if you do have a serious illness, you can’t run out of coverage.”

But we now know that isn’t really accurate. As Mother Jones‘ Kevin Drum points out, Wednesday’s Congressional Budget Office analysis of the bill suggests that anyone with a preexisting medical condition—even people who already have health insurance—could face steep premium hikes.

“The nongroup markets in those states would become unstable for people with higher-than-average expected health care costs.”

Part of what Republicans are saying is technically true: The bill does, in fact, bar insurance companies from singling out individuals for price hikes if they have maintained continuous coverage. But the CBO notes that insurers would have—and likely would use—a workaround that would effectively jack up rates on every sick person they cover in the non-group market.

The exact mechanism is a bit complicated. In essence, insurance companies would entice healthy people out of the community-rated market—which mandates that everyone pay the same rate, with no differences based on health status—by offering plans with cheaper premiums. Those new plans would be subject to underwriting, which means that they’d likely be unaffordable for people with preexisting conditions. Sick people would remain in the community-rate plan, where prices would skyrocket. That, in turn, would drive more healthy folks away from the community-rated plans, creating a downward spiral.

The Brookings Institution’s Matthew Fiedler flagged this possibility before the CBO report came out. “With healthy enrollees opting out of the community-rated pool,” Fiedler wrote, “community-rated premiums would need to be extremely high, forcing sicker individuals—including those with continuous coverage—to choose between paying the extremely high community-rated premium or being underwritten themselves. Either way, people with serious health conditions would face prohibitively high premiums.”

The CBO is surprisingly frank about the effects the GOP bill would have on people preexisting conditions. The report predicts that about 15 percent of Americans will live in a state that obtains a waiver to end the ban against price discrimination. According to the report, “The nongroup markets in those states would become unstable for people with higher-than-average expected health care costs.” Premiums would become far more expensive, and possibly so expensive that people with preexisting conditions would essentially be excluded entirely from the market.

According to the Kaiser Family Foundation, about 27 percent of people under the age of 65 have serious enough preexisting conditions that they would have been denied coverage prior to Obamacare. Those people would be left struggling to pay higher premiums in the states that opt out of the Obamacare protections. Republicans have promised government-funded high-risk pools as a fallback option, but they have wildly exaggerated the amount of money that the bill would provide for these pools. Just $8 billion over 5 years is earmarked for high-risk pools (with no future money promised). According to the CBO, that amount “would not be sufficient to substantially reduce the large increases in premiums for high-cost enrollees.”

By PATRICK CALDWELL/MotherJones

Posted by The NON-Conformist

Why Won’t More American Corporations Support Single-Payer Health Care?

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Warren Buffett is rare among CEOs in publicly recognizing the economic benefits of Medicare for All.

Talk of single-payer health care in the United States popped up in an unexpected place recently: the most recent Berkshire Hathaway annual meeting. “The whole system is cockamamie,” the company’s vice chair, Charlie Munger, declared. “I think we should have single-payer medicine eventually.” As for partner Warren Buffett, the man known by his fans as the Sage of Omaha, he called health-care costs “the tapeworm of American economic competitiveness” and claimed he “personally” supported a single-payer system.

Those of us who cover individual investing know that the utterings of Buffett and Munger are generally repeated, and repeated again. They turn into aphorisms—how many times have you heard it said of the stock market, “It’s only when the tide goes out that you learn who’s been swimming naked?” But when it comes to health care, it’s something else. There is a day or so of attention, and then it’s nothing but crickets.

What’s going on? You can thank a toxic stew of ideological blindness, fear of controversy, and rampant cost shifting for the silence. The size and power of the industry is a factor too. Healthcare “is the military industrial complex of the 21st century,” says Richard Master, the chief executive officer of MCS Industries, a supplier of picture frames based in Pennsylvania, and the rare C-suiter to publicly support single-payer.

The United States spends more than $3.3 trillion on health care annually. Employer-based insurance covers about half the non-elderly population. The cost is not unsubstantial. Medicare spends less than 2 percent of its budget on administration vs. 18 percent for private insurers. According to the Kaiser Family Foundation, the average premium for a family was $18,142 in 2016. The typical employer picked up about two-thirds of that total. The numbers are adding up, and the politically vaunted small-business sector is yowling. The National Federation of Independent Business’s 2016 Problems and Priorities survey found more than half of those they polled claimed the cost of health insurance was “a critical issue,” they faced.

Healthcare costs also eat away at American business competitiveness. Prior to the Great Recession, General Motors claimed that providing health-care coverage adds another $1,500 onto the sticker price of every new model sold. Starbucks reported around the same time it spent more on health care than on coffee beans. The Affordable Care Act has slowed the overall pace of health-care spending, which nonetheless still exceeds the rate of inflation.

Buffett’s economic point—one he’s made for a number of years—is that corporate honchos obsess about the weight of taxes on their bottom line when they should be pondering the impact of skyrocketing health-care costs instead. For years, he’s pointed out that health-care expenditures were approximately 5 percent of the gross domestic product in the 1960s. Now they are at about 17 percent. Other countries spend significantly less. Healthcare costs make up 11 percent of Canada’s gross domestic product. In Australia—about which Donald Trump recently said, “you have better health care than we do”—it’s approximately 9 percent.

But all this spending isn’t exactly doing wonders. About one in ten American adults still doesn’t have health insurance. Our reputation for world-class care might be a tad exaggerated; our maternal mortality rate has increased substantially since 2000. Never mind the moral argument for health care for a moment. Pay more money for lesser results? Surely, no sane businessman or businesswoman would want to deal with this, not for one blasted moment. In this environment, business and corporate support for single-payer/Medicare For All/whatever you want to call it should be the proverbial no brainer.

But it’s not. Many in the United States business world remain in thrall to a marketplace ideology, mixed with a whiff of self-help. The glory of the market is paramount, and any attempt to enhance the role of government—even when it is in the best interests of the players to do so—is looked on with suspicion. For example, when runaway medical costs caused mass business agita, former Safeway CEO Steve Burd founded a group called the Coalition to Advance Health Care Reform. It endorsed universal coverage but argued it needed to be “market-based” and offer “universal coverage with individual responsibility.” These days, people needing insurance or medical care are routinely referred to as “shoppers” who should compare the price of medical services like they would a can of peas.

The American Sustainable Business Council, a left-leaning business trade group, is now seeking to change things. It recently debuted, in conjunction with a documentary Big Pharma: Market Failure, an action group called Business Leaders Transforming Healthcare that is making the case for single-payer as a business imperative. More than 150 businesses have signed on to the campaign, including Richard Masters’s MCS Industries, who is also in the film. But it’s going to be a battle. Many of the American Sustainable Business Council’s most recognizable corporate partners have yet to join in.

In an effort to find out why, I contacted Ben & Jerry’s, Eileen Fisher, Patagonia, Seventh Generation, Dansko, Etsy, and The Honest Company—all members of the council who have yet to sign onto the healthicare campaign. A spokeswoman for Ben & Jerry’s told me, “We all know the US health-care system is broken,” adding, “We believe strongly that everybody should have access to quality care” and that the company could not make a decision on whether or not to sign on to the initiative “until we have formulated our position.”

Jessica Alba’s The Honest Company—a self-described “mission-driven company” dedicated to, among other things, “corporate social responsibility” and “taking selfless actions that benefit others”—wrote back that they work with the American Sustainable Business Council on “issues related to chemical safety and ingredient disclosure” and aren’t “currently engaged” in other initiatives with them.

The others ignored me. I can’t say I am surprised. Corporations are notoriously loath to endorse controversial positions, especially ones that have the potential to put them in the firing line of activists on one side or the other. Then there is the power of the health-care industry, which is responsible for the largest number of jobs added since the last economic downturn. Business leaders stick to the powerful until it’s all but unsupportable.

In lieu of asking for government help, many American corporations are dealing with the health-care expense in a time honored capitalist fashion: they’re sticking it to the workers. A majority of those with employer provided health insurance now have a deductible of at least $1,000, which partly explains why out-of-pocket health-care spending for someone with employer provided health insurance has increased by more than 50 percent since the beginning of the decade. Little wonder recent Congressional Town Halls feature many plaintive pleas for single-payer or a Medicare expansion.

Masters told me he thinks the comments at the Berkshire Hathaway meeting are a game changer. “It’s a remarkable green light for business leaders to start thinking about single-payer.” Maybe he’s on to something: The week that began with Munger endorsing single-payer ended with Aetna Healthcare’s chief executive officer Mark Bertolini saying the United States needed to “debate” single-payer but stopping short of endorsing it. “If the government wants to pay all the bills, and employers want to stop offering coverage, and we can be there in a public-private partnership,” he told a group of Aetna employees in a private conversation subsequently leaked to Vox, “then let’s have that conversation.”

By Helaine Olen/TheNation

Posted by The NON-Conformist

Many Doctors Prefer Single-Payer Health Care Because of Demands by Insurance Companies

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After the House bill defunding Obamacare and Medicaid failed, progressives in Congress and activists have been pushing for what they’ve wanted all along—to open up Medicare enrollment as a step toward a single-payer health system.

A new poll of 500 physicians by the business networking website LinkedIn found that nearly half, 48 percent, were in favor of a single-payer system, with 32 percent opposed and 21 percent undecided. What’s stunning about LinkedIn’s survey was not just the show of support for single-payer, but the comments and explanations from physicians about their industry’s greed-driven codependent relationship to insurers.

“As a doctor, it’s really against my best interest to support single-payer healthcare,” said Sean Kivlehan, the associate director of the international emergency medicine fellowship at Boston’s Brigham and Women’s Hospital, in LinkedIn’s report about the poll by Beth Kutcher. “It reduces my earning potential. At the same time, it’s about human rights and taking care of people that need help—that is why I do this work.”

Anyone who’s been surprised by medical insurance bills, high deductibles or spoken to the non-medical specialists after seeing physicians to try to find less expensive ways to access new drugs has crossed paths with this often-hidden codependent relationship. What’s never discussed by caregivers or insurance companies is how insurers rely on physicians’ offices as collection agents—and then in turn, pay these providers more money than they might otherwise earn in a single-payer system.

Kutcher reported that many medical professionals said they would accept earning less if it meant fewer dealings with insurers (which averages four hours a week), less insurance bureaucracy, more time with patients, and a freer conscience as a result.
“Even though doctors acknowledged that they might take a financial hit under a single-payer system, many respondents said it would be more than mitigated by getting out of the collection business,” she writes. “In other words, even if they earned less, there would be more patient care and less of the aggravation that comes with negotiating with and tracking down payment from multiple insurance companies.”

What’s stopping more physicians from supporting single payer? Some cited the political arguments about free markets, saying that competition and financial rewards in medicine have driven new advances and that could be stymied. More telling, however, was a trap awaiting medical school graduates. Many owe $100,000 or more in student loans, and partnering with private insurers as collection agents helps them get out of debt.

“Unlike other countries with single payer healthcare, medical school in the United States is very expensive—79% of med students were graduating with more than $100,000 in debt, according to the Association of American Medical Colleges,” Kutcher writes. “U.S. doctors need to generate a substantial income to pay that off—something that doctors in other countries don’t need to worry about.”

The way this ends up working goes to the heart of why for-profit healthcare is bad for physicians, bad for their staffs and bad for patients—bad for everyone except insurers and others whose profits come from pressuring doctors to collect more in fees.

Incredibly, the poll’s interviews with doctors suggest this nasty cycle is getting worse.

“While commercial insurance providers may be the most lucrative payers, they’re increasingly moving toward plans that require doctors to collect more money from patients before they can even submit a claim for reimbursement,” Kutcher wrote. “As many as 29% of people with employer-sponsored health insurance are enrolled in a high-deductible plan, according to the Kaiser Family Foundation. And people with high-deductible plans are more likely to delay care for financial reasons.”

The way patients see this system is when they interact with the billing staff at doctor’s offices. A study in the peer-reviewed journal, BMC Health Services Research, found that billing and insurance expenses totaled $70 billion for medical practices in 2012. The poll found two-thirds of the 500 doctors surveyed “implemented measures” to collect from patients with high-deductible plans. A fifth said they had to hire financial counselors.

It’s not new to hear doctors complain about arguing with insurers after their treatments are rejected or health plans don’t cover certain drugs. It’s also not new to hear doctors complain that it’s hard to get to know patients after they change insurers and medical records get lost in that transition process.

But the reality is a stunning snapshot of healthcare in America: Private insurers are increasingly treating physicians’ offices as their collection agents, pushing medical office front desks to grab more money from patients, while doctors have little choice but to go along to pay off their student debts, or accept it as the way to earn a six-figure income.

No wonder the prescription from nearly half of the physicians surveyed by LinkedIn is to get private insurers out of the healthcare field. The for-profit system is sick and isn’t allowing too many doctors to practice medicine the best way they know how.

By Steven Rosenfeld / AlterNet

Posted by The NON-Conformist

Speaker Ryan dispatched a security team to block delivery of a massive PP petition

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In their first week back on the job, House Speaker Paul Ryan and his non-uterus-having Republican congressmen have announced an extremist effort to defund Planned Parenthood, a healthcare provider used by 1 in 5 American women in their lifetime:

House Speaker Paul Ryan announced last week that Republicans will move to strip all federal funding for Planned Parenthood as part of the process they are using early this year to dismantle Obamacare.

Image: Planned Parenthood via Twitter

Planned Parenthood volunteers lined up  at Speaker Ryan’s office to deliver the signatures of 87,000 men and women who stand with Planned Parenthood. Instead of accepting the petition delivery and moving on with his day, Paul Ryan instead dispatched a team of security. Although he had been greeting other constituents, his office was suddenly closed for business.

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