The experts on healthcare

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Jinx
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7:55a, 9/22/17
Defenders of the new Trumpcare the Graham-Cassidy bill are telling Jimmy Kimmel to be quiet and leave the health policy debate to the experts. So I wanted to give you a quick rundown this morning of what the experts are saying about the bill:

It "violates the precept of 'first do no harm'" and "would result in millions of Americans losing their health insurance coverage." American Medical Association, which represents doctors.

It is "the worst healthcare bill yet." American Nurses Association.

It "would erode key protections for patients and consumers." American Hospital Association.

The "process [in the Senate] is just as bad as the substance. ... Most Americans wouldn't buy a used car with this little info." AARP.

The bill will "weaken access to the care Americans need and deserve." American Heart Association, jointly with the American Cancer Society Cancer Action Network, the American Diabetes and Lung associations, the Cystic Fibrosis Foundation, the March of Dimes and others.

"This bill harms our most vulnerable patients." American Psychiatric Association.

It would hurt "consumers and patients by further destabilizing the individual market; cutting Medicaid; pulling back on protections for pre-existing conditions." America's Health Insurance Plans.

It "would lead to a loss of health insurance for at least 32 million people after 2026. ... By repealing the ACA's coverage expansions and cutting deeply into the Medicaid program, the Graham-Cassidy bill threatens the health care of as many as 100 million people, from newborns to the elderly." Sara Collins, The Commonwealth Fund.

Take that, Jimmy Kimmel. You're nothing but a late-night talk show host trying to prevent your fellow citizens from losing access to decent medical care.

In today's Times, Paul Krugman brings back the three-legged stool to explain Graham-Cassidy.

From David Leonhardt's news roundup for the NYTimes.
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Doc Holliday
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9:39a, 9/22/17
Does it make you mad that it's Obama's healthcare plan that insurance companies are dropping and it has nothing to do with Trump?
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Forest Bueller
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10:11a, 9/22/17
I've read it. It absolutely sucks as a bill.

For the liberals that have had a lovefest with Lindsay Graham, this bill should put an end to that.

The only thing I like about it is that it does get rid of the mandate.

Beyond that it seems to be a pork barrel bill for some states with the block grants, and a debilitating bill for other states, basically ripping apart the health care delivery system they have in place.

Republicans forwarding these types of bills must really really want to lose control of the House and Senate so they won't be expected to legislate and can hide in the aisles of congress drawing a big check and doing nothing.

That's my only explanation.
By the grace of the Lord Jesus Christ we shall be saved.
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fadskier
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11:35a, 9/22/17
Obamacare should be repealed and healthcare should be a true free-market.
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Jinx
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In reply to fadskier • 12:17p, 9/22/17
fadskier said:
Obamacare should be repealed and healthcare should be a true free-market.
Seriously, Fad, what else is a free market in the U.S. or anywhere else?

Should healthcare be singled out?

It would be kind of fun to ask the senators and congressmen from agricultural states who are huffing and puffing about the need for free-market healthcare if all the ag subsidies and support should be discontinued in favor of the free market.

Or how about the energy industry? I don't really want to subsidize the oil, gas and coal industries or to pay for the clean-up when BP slimes the Gulf Coast or Exxon slimes the Alaskan coast. Or pay for eminent domain for pipelines, while at the same time forcing people who don't want a pipeline running through their land to accept a pittance or an easement that makes their property less usable and valuable. Let the free market sort energy out.

When everything is subject to the free market free-for-all, we can lump healthcare in there.

Until then, I prefer to err on the side of making sure old people and children in this country have some access to healthcare.
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bubbadog
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In reply to Doc Holliday • 12:22p, 9/22/17
BEAR RAMMAGE said:
Does it make you mad that it's Obama's healthcare plan that insurance companies are dropping and it has nothing to do with Trump?
Would I like to see something different than Obama's plan? Yes. But it would look a lot different than both Obamacare and anything the Republicans are pushing.

With that out of the way, it's actually not true at all that insurers are dropping Obama's plan. That's a myth, and here's why.

Insurance companies didn't really want to have to offer affordable coverage to sick and poorly insured populations like you find in places like West Virginia and other areas where health status is poor and the opioid epidemic (and meth epidemic) are rampant. It was going to be hard for them to price it, for one thing. And it's expensive to cover these people if they haven't had coverage for years, because their utilization will be high.

To compensate for this, Obamacare included complicated subsidies for companies that were willing to work in these "risk corridors."

Then, 2-3 years ago, Marco Rubio led a GOP effort to sabotage this part of Obamacare. He introduced an amendment that the Senate passed in an appropriations bill that defunded these risk corridor subsidies. Ever since then, the insurance companies involved have been trying to get funds restored. I believe several of them are suing the federal government. Meanwhile, removing these subsidies changed the whole model for them and made it unprofitable to remain in some of these markets. That's why you have seen them pull out. It's not because of Obamacare per se; it's because of what was done to keep Obamacare from working as intended.

BTW, if you thought the markets were in chaos now, wait until they pass Graham-Cassidy. Some of the Republicans had been talking about shoring up the marketplaces, and the insurance companies have been waiting to see what they were going to do. If this new bill passes, the insurers have no reason to remain in some of these market areas, and the exodus will accelerate. Republicans will try to blame Obamacare. Meanwhile, you'll see a jump in the number of people without insurance.
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Jinx
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12:30p, 9/22/17
Cassidy gets 3 Pinoccios for his rebuttal of Jimmy Kimmel's criticisms:

Fact-checking Sen. Cassidy's rebuttal to late-night host Jimmy Kimmel about the Obamacare repeal bill
This week, late-night host Jimmy Kimmel attacked Sen. Bill Cassidy (R-La.) over a new plan to replace the Affordable Care Act, or "Obamacare."

Kimmel claimed the bill "will kick about 30 million Americans off insurance." (That's a high-end estimate.)

Firing back, Cassidy said "more people will have coverage. There are more people who will be covered through this bill than under the status quo."

But that's quite misleading. Under the Cassidy bill, federal health-care funding will be reduced significantly in many states. Cassidy says innovation would flourish as states make their own choices, and that will help bring down costs and expand coverage. That's possible but unlikely, given just how much funding the bill slashes.
No credible analyst has been willing to venture an estimate on coverage because no one knows how states would react.

Still, the expert consensus is that Cassidy's funding formula makes his claim all but impossible to achieve. Cassidy earned Three Pinocchios.

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bubbadog
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12:39p, 9/22/17
Turns out that there's an association of Medicaid directors from the various states. It's called NAMD, the National Association of Medicaid Directors. Since these are appointed by governors, and Republicans control about 2/3 of the governorships, most of these directors are Republicans.

They are issuing a statement in opposition to Graham-Cassidy that has broad support from their membership, including the Republicans. I've pasted part of it below. The gist is that the plan is (a) unworkable and (b) represents the largest transfer of risk from the Feds to the states in history. It's also something of an unfunded mandate, since healthcare funding will be cut over the next decade. That will put the states in the position of either figuring out how to do the same services with a whole lot less money, or will mean that they have to cut off a lot of people who are now receiving subsidies or other benefits.

Here is the excerpt from the NAMD statement:

"How these block grants will be utilized, what programs they may fund, and the overall impact they will have on state budgets, operations, and citizens are all uncertain. Taken together, the per-capita caps and the envisioned block grant would constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country's history.

The Graham-Cassidy legislation would require states to operationalize the block grant component by January 1, 2020. The scope of this work, and the resources required to support state planning and implementation activities, cannot be overstated. States will need to develop overall strategies, invest in infrastructure development, systems changes, provider and managed care plan contracting, and perform a host of other activities. The vast majority of states will not be able to do so within the two-year timeframe envisioned here, especially considering the apparent lack of federal funding in the bill to support these critical activities."
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bubbadog
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12:41p, 9/22/17
Here's what Republican governor Brian Sandoval of Nevada says about Graham-Cassidy:

"Flexibility with reduced funding is a false choice. I will not pit seniors, children, families, the mentally ill, the critically ill, hospitals, care providers, or any other Nevadan against each other because of cuts to Nevada's health-care delivery system proposed by the Graham-Cassidy amendment."
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Jinx
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1:07p, 9/22/17
McCain just released a written statement indicating that he "cannot in good conscience" vote for the Cassidy Graham bill.
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cms186
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In reply to Doc Holliday • 1:09p, 9/22/17
BEAR RAMMAGE said:
Does it make you mad that it's Obama's healthcare plan that insurance companies are dropping and it has nothing to do with Trump?
It tells you something when the resident Right wing loonies just go straight to "WAAH, WAAH, WAAH, OBAMMMMMMMMMMMMMMMMMMMMMAAAAAAAAAAAAAAAAAAAAAAAA" and dont actually say anything pertinent to the discussion
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Forest Bueller
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In reply to bubbadog • 1:26p, 9/22/17
bubbadog said:
Here's what Republican governor Brian Sandoval of Nevada says about Graham-Cassidy:

"Flexibility with reduced funding is a false choice. I will not pit seniors, children, families, the mentally ill, the critically ill, hospitals, care providers, or any other Nevadan against each other because of cuts to Nevada's health-care delivery system proposed by the Graham-Cassidy amendment."
I just hope that Republicans can gather together 3 Senators brave enough to go against this atrocious bill that is being pushed.

Sometimes I thing some of those folks are decent people and really care about the lesser among us, then they go co-sponsor a bill like this and realize they too are playing a game.

By the grace of the Lord Jesus Christ we shall be saved.
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bubbadog
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In reply to Forest Bueller • 1:43p, 9/22/17
Forest Bueller said:
bubbadog said:
Here's what Republican governor Brian Sandoval of Nevada says about Graham-Cassidy:

"Flexibility with reduced funding is a false choice. I will not pit seniors, children, families, the mentally ill, the critically ill, hospitals, care providers, or any other Nevadan against each other because of cuts to Nevada's health-care delivery system proposed by the Graham-Cassidy amendment."
I just hope that Republicans can gather together 3 Senators brave enough to go against this atrocious bill that is being pushed.

Sometimes I thing some of those folks are decent people and really care about the lesser among us, then they go co-sponsor a bill like this and realize they too are playing a game.

It's possible but not a done deal. McCain now says he will vote no. Susan Collins came out today and says she is close to voting no but isn't quite there yet (I suspect she'll get there). Murkowski hasn't said yet how she'll vote, but her state's governor (an independent) is against the bill, and Alaska will be one of the losers under the plan.
Rand Paul says he'll vote no but for entirely different reasons, and I don't really trust his word on this because he made noises about opposing the other bills but did not consistently follow through.
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Bona Fide Bear
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In reply to Jinx • 1:54p, 9/22/17
Jinx said:
McCain just released a written statement indicating that he "cannot in good conscience" vote for the Cassidy Graham bill.
For those that are interested in full quotes, and not just selective quotes, here is what McCain said, "I cannot in good conscience vote for Graham-Cassidy. A bill impacting so many lives deserves a bipartisan approach." That doesn't mean he thinks it's a bad bill, he just thinks it's bad politics to vote and pass a bill that impacts every American without bipartisan support. I wish the Democrats would have had this mentality when the ACA was originally passed.
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bubbadog
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In reply to Bona Fide Bear • 1:58p, 9/22/17
Bona Fide Bear said:
Jinx said:
McCain just released a written statement indicating that he "cannot in good conscience" vote for the Cassidy Graham bill.
For those that are interested in full quotes, and not just selective quotes, here is what McCain said, "I cannot in good conscience vote for Graham-Cassidy. A bill impacting so many lives deserves a bipartisan approach." That doesn't mean he thinks it's a bad bill, he just thinks it's bad politics to vote and pass a bill that impacts every American without bipartisan support. I wish the Democrats would have had this mentality when the ACA was originally passed.
Speaking of selective, that would describe your memory if you think the Dems didn't try to get Republican support when the ACA was being crafted. That was a big reason the process took so long. And, hell, the biggest overture to Republicans was the decision to use a framework that a Republican governor had passed in Massachusetts and that had been championed by no less than the Heritage Foundation.
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cinque
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In reply to Doc Holliday • 2:42p, 9/22/17
BEAR RAMMAGE said:
Does it make you mad that it's Obama's healthcare plan that insurance companies are dropping and it has nothing to do with Trump?
If Republicans are gutting major provisions of OCare, greedy insurance companies aren't left with many options if they want to continue in the for profit health care model.
Make Racism Wrong Again
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Doc Holliday
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4:15p, 9/22/17
Not a single person would be "kicked off" his or her insurance. Rather, the Congressional Budget Office review of the AHCA found that of the 24 million Americans who would no longer have health insurance after an Obamacare repeal, 14 million would choose not to buy insurance in 2018 in the absence of a penalty. And if Obamacare were not repealed, the CBO projects another 6 million people would voluntarily leave the Obamacare markets. Now, if you don't believe Americans should be afforded the choice to leave or not buy insurance, just say that. No one is being kicked off.
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Jinx
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In reply to Doc Holliday • 8:03a, 9/23/17
BEAR RAMMAGE said:
Not a single person would be "kicked off" his or her insurance. Rather, the Congressional Budget Office review of the AHCA found that of the 24 million Americans who would no longer have health insurance after an Obamacare repeal, 14 million would choose not to buy insurance in 2018 in the absence of a penalty. And if Obamacare were not repealed, the CBO projects another 6 million people would voluntarily leave the Obamacare markets. Now, if you don't believe Americans should be afforded the choice to leave or not buy insurance, just say that. No one is being kicked off.
If you choose not to buy insurance because it's totally unaffordable, it doesn't cover your preexisting condition or that of your spouse or children, or the policies you can afford don't cover essential services--like prenatal care or emergency care--it's not much of a choice.

Letting the "free market" loose on healthcare doesn't mean you have more choice. It means "the market" chooses for you. Not to cover pre-existing conditions. Not to cover maternity care. Not to cover birth control, because sex is elective for both married and unmarried couples. Not to cover treatment for mental illness or addiction, because some people believe those conditions are elective, too.

I really don't want healthcare by AT&T, Xfinity, Verizon, DirectTV and other market player who dictate my choices based on profit alone and force me to take channels like World Greatest Vacuum because those channels pay THEM for access to my TV set. I don't even want to think about what the healthcare version of that scenario would be.

And if I'm trying to sort out what's covered and what's not after my kid has been severely injured in a car accident,
I don't want to wind up talking to someone on the other side of the world who lacks basic English skills while trying to figure out what my insurance will pay for and what I'm going to have to pay--and suggests, as the Sears line did when I called to schedule a service appointment for my washer, that I hang up and try to fix it myself first, and if that doesn't work, call them back in a few days. That's not choice; it's abdication of responsibility by everybody.

And if it comes to pass, a lot of people will either choose or be forced to opt out of care for ourselves and die sooner rather than bankrupt our families or spend down the money we've saved for retirement or our children's college. Which seems to be the purpose of the various Republican plans.
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cinque
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In reply to Jinx • 12:46p, 9/23/17
Jinx said:
BEAR RAMMAGE said:
Not a single person would be "kicked off" his or her insurance. Rather, the Congressional Budget Office review of the AHCA found that of the 24 million Americans who would no longer have health insurance after an Obamacare repeal, 14 million would choose not to buy insurance in 2018 in the absence of a penalty. And if Obamacare were not repealed, the CBO projects another 6 million people would voluntarily leave the Obamacare markets. Now, if you don't believe Americans should be afforded the choice to leave or not buy insurance, just say that. No one is being kicked off.
If you choose not to buy insurance because it's totally unaffordable, it doesn't cover your preexisting condition or that of your spouse or children, or the policies you can afford don't cover essential services--like prenatal care or emergency care--it's not much of a choice.

Letting the "free market" loose on healthcare doesn't mean you have more choice. It means "the market" chooses for you. Not to cover pre-existing conditions. Not to cover maternity care. Not to cover birth control, because sex is elective for both married and unmarried couples. Not to cover treatment for mental illness or addiction, because some people believe those conditions are elective, too.

I really don't want healthcare by AT&T, Xfinity, Verizon, DirectTV and other market player who dictate my choices based on profit alone and force me to take channels like World Greatest Vacuum because those channels pay THEM for access to my TV set. I don't even want to think about what the healthcare version of that scenario would be.

And if I'm trying to sort out what's covered and what's not after my kid has been severely injured in a car accident,
I don't want to wind up talking to someone on the other side of the world who lacks basic English skills while trying to figure out what my insurance will pay for and what I'm going to have to pay--and suggests, as the Sears line did when I called to schedule a service appointment for my washer, that I hang up and try to fix it myself first, and if that doesn't work, call them back in a few days. That's not choice; it's abdication of responsibility by everybody.

And if it comes to pass, a lot of people will either choose or be forced to opt out of care for ourselves and die sooner rather than bankrupt our families or spend down the money we've saved for retirement or our children's college. Which seems to be the purpose of the various Republican plans.
Health care dollars in the hands of Texas Republicans would be a scandal. They'll treat everybody much as they they treat poor uninsured children in this state.
Make Racism Wrong Again
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