Rand Paul’s “Repeal-and-Delay” boondoggle of a bill failed in the Senate, going down in flames 45-55. Senators Collins, Capito, Murkowski, Alexander, McCain, Portman and Heller voted against it. All other Republicans voted for the bill, which would have ripped health insurance away from 32 million people and cut Medicaid by $800 billion immediately while putting lots… Continue Reading →
God, this is gorge-inducing. Alone, he could’ve stopped the process he so dislikes in its tracks. He could’ve done it in a way that echoed through the ages. But he said, “yes.”
The Obama administration and congressional Democrats shouldn’t have forced through Congress without any opposition support a social and economic change as massive as Obamacare. And we shouldn’t do the same with ours.
Alas, this is an absolute lie, and an embarrassing one, and the Straight Talk Express is in the ditch. The Affordable Care Act was the product of endless hearings and at least 100 amendments proposed by Republicans. It was scored by the CBO. The Senate debated it for almost a month, and the senators knew what was in it. Right now, the bill that John McCain facilitated likely will be one that isn’t scored by the CBO, and the Freedom Caucus crackpots in the House are trying to defund the CBO and hand the job of scoring legislation to the Heritage Foundation. I would bet a substantial number of buffalo nickels that John McCain votes for whatever bill finally comes before him, no matter how many people’s lives that bill makes miserable.
I wanted this to be different. In 2000, I thought McCain might be the person to lead his party back to marginal sanity at least. But he wanted to be president, so he became like all the rest of them. Yes, he scolded that person who said Barack Obama was a Muslim, but he chose as his running mate a nutty person who still may believe he is. Yes, he put his name on a campaign finance reform bill, but he also voted for every member of the Supreme Court who subsequently eviscerated that law, and others like it, and he’s been absent from that fight ever since. There have been very few senators as loyal to the party line as John McCain. He has been a great lost opportunity to the country. Now, he will end his career as the face of whatever wretchedness is brought on the country by whatever the bill finally is.THERE HAVE BEEN VERY FEW SENATORS AS LOYAL TO THE PARTY LINE AS JOHN MCCAIN.
By the end of the afternoon, the Democrats had taken over one of the wide marble staircases outside the Capitol. They had walked across the piazza and onto the East Lawn of the Capitol to talk to some protesters, many of whom are struggling with diseases and disabilities that would be covered under the Affordable Care Act, and certainly under the Cadillac healthcare plan enjoyed by John McCain. It was a nice gesture, and they were warmly received, but there was something of the stunt to it.
The Republicans have the votes now. Dean Heller and Rob Portman and Shelley Moore Capito have lined up with their party once, and the likelihood is their respective prices will be met again because this is not a policy issue any more, it is pure politics now, a promise made by an extremist majority to its unthinking base. That’s what the end of this ugly day looked like, a day on which the final bloody death of Barack Obama’s legacy was placed on the fast track by people who know better, and on which Susan Collins of Maine was more of a maverick than John McCain ever was. It was an ugly day in the U.S. Senate, and there was nothing but ruin everywhere you looked.
I wish John McCain a long and painful death, the kind morphine doesn’t touch:
After high drama in the Senate beginning with protesters in the galleries shouting “Kill the Bill!” and being ejected, they proceeded to a vote to open debate on repealing Obamacare without knowing what was in the bill or what the actual outcome of the bill might be. As staged as a Trump rally, all Republicans voted… Continue Reading →
When Senate Majority Leader Mitch McConnell released his new version of the Republican health care bill July 13, he relied on a favorite Republican device to solve the nation’s health care woes – Health Savings Accounts.
Health Savings Accounts (HSAs) were established by the same legislation that created the Medicare Part D prescription drug benefit in 2003. HSAs allow individuals to make tax-deductible contributions, withdraw money tax-free to pay for qualified medical expenses and avoid taxes on the money invested in the account.
Enrollment in HSAs has skyrocketed to nearly 20 million people, but there’s a catch. Very few, if any, of those 20 million people are poor. The HSAs allow individuals to use tax-protected funds for medical purposes for years to come. Some have even called them the “new 401(k)‘s.”
While these savings accounts can be good for people of a certain income level, I have concerns that they will overlook the needs of the poor, who not only stand to gain very little from the tax advantages but who also are unlikely to have thousands of dollars to contribute to such plans.
Tax savings and a dose of financial responsibility
Currently, individuals are allowed to make annual contributions of US$3,400, while families are allowed to contribute up to $6,750. Unlike so-called health Flexible Spending Accounts, or FSAs, left-over assets in the account carry over from year to year. In 2015, the average balance was just over $1,800.
Individuals are able to establish HSAs only when they obtain coverage through so-called High-Deductible Health Plans (HDHPs), which are currently defined as plans with a deductible of at least $1,300 for single people, or at least $2,600 for family coverage. The maximum out-of-pocket cost for individuals and families are $6,450 and $12,900, respectively.
This means that individuals with these plans are responsible for a significant amount of costs before their insurance benefits kick in. There are no data that show how many people of lower income could afford to fund these plans.
In larger employers, 53 percent of employers offer HSAs, and about a quarter of employees are covered. About half of individuals obtaining insurance in the individual market do so via a high-deductible plan. This number is expected to continue to grow in the future.
Why are conservatives enamored of HSAs?
When it comes to conservative ideology, HSA checks off a number of boxes.
For one, they are supposed to empower the individual to take charge of their own health care decisions. With more “skin in the game,” individuals will be incentivized to make better, more prudent choices when it comes to their health care. This should not only reduce premiums for individuals and families, but equally important, rein in the growth of U.S. healthcare expenditures.
Lower premiums, in turn, would then allow more Americans to obtain insurance coverage. They would also ease the tremendous burden on American companies seeking to provide health insurance to their employees.
HSAs also reduce the tax burden of Americans, albeit mostly for the wealthier part of society. Moreover, the funds in HSAs will provide investment capital to America’s economy and lead to further economic growth.
Disadvantages of HSAs?
A handful of studies have been able to provide some insights into potential benefits and problems of HSAs and HDHPs. Most of the studies confirm the general findings of the famous RAND Health Insurance Experiment: Higher deductibles lead to a reduction in the quantity of medical care consumed. The experiment also showed that, on average, this reduction was not detrimental to individuals’ health status.
However, there was one significant exception: Low-income individuals with chronic conditions saw a significant drop in health status.
More recent studies have shown that HDHPs and HSAs lead to spending about 5-7 percent less on medical care per enrollee. Most of these reductions come from reducing the amount of care consumed – not from shopping for cheaper providers. There is also evidence that individuals delay care, do not comply with doctors’ treatment plans and are unaware of free preventive services.
None of these findings is surprising.
We know that many Americans do not have enough savings to account for an emergency, medical or otherwise. The wealthiest Americans disproportionately benefit from these insurance arrangements. Indeed, families making in excess of $100,000 make up 70 percent of HSA contributions.
CNN Money called HSAs “the best tax-free investment account you’ll be able to find.”
We know that American health care consumers are notoriously bad at understanding the U.S. insurance and health care system. They also have problems understanding provider quality. Shopping around, already challenging in the health care field – in case of an emergency or when there is only a limited number of providers – is hardly possible in these conditions.
The recent Senate bill
The most recent revision of the Senate’s Better Care Reconciliation Act makes four significant changes to HSAs and HDHPs.
First, it almost doubles the amount individuals are allowed to contribute, to $6,550 and $13,100 for individuals and families, respectively.
Second, it further increases these limits for Americans 55 and older in order to allow them to prepare for retirement.
Third, it also reduces the penalty individuals incur for withdrawing funds from their HSAs for nonqualified expenditures.
Fourth, and this is a significant departure from federal policy since the 1940s, it allows individuals and families to use money in HSAs to pay for insurance premiums. Previously, only individuals with employer-provided insurance were subject to preferential tax treatment.
The rich can get richer?
Under criticism from advocates and even members of his own party, Senate Majority Leader Mitch McConnell’s (R-KY) most recently released Senate repeal-and-replace effort maintained many of the Affordable Care Act’s taxes. However, well-to-do Americans may have obtained an even better replacement in the form of Health Savings Accounts. We should also not forget that these taxes could be subject to repeal during the upcoming efforts at tax reform or the budget process.
We know very little about the long-term effects of high-deductible plans. However, scholarly findings on delayed care, reduced preventive care and avoidance of medical care are cause for concern with potentially significant detrimental effects for the American health care system and Americans.
We also know that these arrangements further segregate the risk pool and divide Americans based on their income and health status. Richer and healthier individuals will seek out these plans to shelter their assets. Poorer and sicker Americans will not be able to reap these benefits.
More than 50 years ago, Nobel Prize-winning economist Kenneth Arrow prominently pointed out that the health care field is filled with striking market failures. While HSAs and HDHP may sound like a good solution, they are unlikely, I would argue, to be viable and equitable solutions to what ails the American health care system.
This story was co-published with NPR’s Shots blog. The box of prescription drugs had been forgotten in a back closet of a retail pharmacy for so long that some of the pills predated the 1969 moon landing. Most were 30 to 40 years past their expiration dates — possibly toxic, probably worthless. But to Lee Cantrell,… Continue Reading →
This story was co-published with NPR’s Shots blog. No corner of the health care system would be harder hit than Medicaid, the federal-state health insurance program for the poor, if Republican leaders in Congress round up the votes to repeal major portions of the Affordable Care Act. GOP lawmakers have proposed winding down the Medicaid expansion… Continue Reading →
Be civil. Tell the intern how this bill affects you and the people you care about. TURN THE SCREWS.
They are telling themselves since they won the election, the rest of us are malcontents. They are fools, as far as the long-time effects are concerned.
See what McConnell did? He listed only $2B for opioid treatment. That means Rob Portman and Shelly Capito will publicly ask for a big increase and maybe a delay in Medicaid reduction.
Then they will call a press conference and announce how hard they fought for their constituent. And of course now they’ll vote for the whole mess.
Then they announce how brave and tough they are to win their ask and thus, now satisfied, they will vote for the bill.
As long as Collins and Murkowski are the only two left, they’ll be allowed to vote against it, and Mike Pence breaks the tie.
The House will pass whatever the Senate sends them, and the rest of us are fucked.
Like this woman, whose daughter has cancer. She confronted Sen. Shelly Capito (WV) over health care bill:
A woman whose daughter has cancer confronted her senator over the new healthcare bill.
This is heart breaking.😓 pic.twitter.com/OADLueJc6V
— Qasim Rashid, Esq. (@MuslimIQ) June 22, 2017
Did you call your senators about Trumpcare?
By Simon Haeder, Assistant Professor of Political Science, West Virginia University. Nurse Jane Kern administers medicine to patient Lexi Gerkin in Brentwood, New Hampshire. Lexi is one of thousands of severely disabled or ill children covered by Medicaid, regardless of family income. Charles Krupa/AP Despite many assertions to the contrary, Senate leaders are now saying they… Continue Reading →
Well, here we go. Trump’s new budget will be announced today, and it features massive cuts to Social Security disability. They are selling this to the media as “disability, not real Social Security,” and it’s up to us to stop them:
We pointed out back in March that Trump budget direct Mick Mulvaney displayed an alarming ignorance about Social Security disability benefits during an appearance on the CBS program “Face the Nation.”
Now it turns out that there was method to his muttering. In effect, Mulvaney was telegraphing that the Trump White House was planning to cut disability benefits sharply. Axios reported Sunday that the Trump budget due out Tuesday will include $1.7 trillion in cuts to major social insurance and assistance programs, including food stamps, the Children’s Health Insurance Program, and Social Security disability.
Any cut to disability would be a major violation of Trump’s oft-repeated campaign pledge not to cut Social Security, Medicaid or Medicare. Trump also broke that promise, by the way, by endorsing the American Health Care Act, the House Republican Obamacare repeal plan that incorporates a stunning $880 billion in Medicaid cuts.
It turns out that Mulvaney was setting up a flagrant deception during that “Face the Nation” appearance. He asked moderator John Dickerson, “Do you really think that Social Security disability insurance is part of what people think of when they think of Social Security? I don’t think so.”
Dickerson let the remark, which we described then as “a drive-by shooting” aimed at some of the nation’s neediest and most defenseless people, slide without comment.
But Mulvaney was tapping into a knowledge vacuum that appears to extend more deeply into the Washington press corps. Politico, which reports that the budget document will “avoid revamping Social Security and Medicare,” and the Associated Press, which says the budget “won’t touch Social Security or Medicare,” get snowed by the implication that a cut in disability isn’t a cut to Social Security.
This is a very persuasive piece about the bias medical policy has against handling dependence with medication. It would be nice if our national policies were grounded in actual research instead of punishment:
Decades of research show that these medications dramatically reduce the risk of death, HIV infection, and recurrence of drug use. (A recent review of the scientific literature involving more than 100,000 patients found that death rates were two to three times lower for people in methadone or buprenorphine treatment, compared to people not taking medication). No other method — including abstinence-only residential rehab — has such strong support.
Yet the common myth is that people taking these medications are “still addicted” and that residential treatment is a better option. Failure to understand that addiction is not dependence leads many — including family members and people with addiction themselves — to avoid lifesaving care.
Mistaking dependence for addiction can also harm patients with chronic pain. Those who benefit from opioid therapy can be mislabeled as addicted, when, in fact, they are physically dependent. This can lead to cessation of an effective treatment — and sometimes even suicide.
If, as a society, we really believe that addiction is a disease, we can’t exempt it from the standards we use to discuss other illnesses. That means dropping inaccurate medical terms from the past. It also means that addiction physicians must do a much better job of educating the public and even other doctors — especially non-specialists like Tom Price — about how our understanding of addiction has changed and why using medication to treat it is not just continuing the problem.
The language that we use about addiction helps determine what we do about it and how we treat people who are affected. People with addiction won’t get appropriate, evidence-based care until both addiction physicians and the media explain in up-to-date and unbiased terms what that really means and why it matters.