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Devastating CBO report on ACA repeal leaves GOP scrambling

Protestors rally against ACA repeal in downtown Klamath Falls, Oregon

The CBO just released the numbers on the impact of repealing the Affordable Care Act without any replacement, and they’re ugly. According to the report, 18 million will lose their insurance in the first year, with up to 32 million losing insurance in the years following. Worse yet, the CBO expects premiums to double under the… Continue Reading →

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What they plan to do to Medicare

Tom Price (R-Ga.) and chairman of the House Budget Committee speaks at the Brookings Institution

They’re putting a doctor in charge of how much doctors should get paid for seeing Medicare patients? What could go wrong?

You know the drill: Read up on what they want to do, and call ALL your representatives to say you’re opposed.

I worry about this unfortunate tendency our voters have to simply write this off: “My congressman is a wingnut, what’s the point?” The point is, if he or she gets enough call against, they report it back to the Republican caucus. It matters.

Please, now more than ever, politics is not a spectator sport. You can’t sit transfixed and watch like it’s a disaster movie. Get up off your butt, call or write letters.

Balance billing

This really is the kind of thing you should be calling your reps about:

Tom Price wants to “reform” Medicare by allowing “balance billing” of Medicare-eligible patients by doctors without requiring them to exit the Medicare program entirely, the practical effect of which, as Ryan Cooper, writing for The Week explains, would “[allow] doctors and hospitals to devour the nest eggs of thousands of American seniors:”

Permanently obliterating the financial security of helpless families with no or bad insurance as a loved one dies slowly and painfully of a chronic illness is a nice little profit center for providers. But it pales in comparison to the gravy train they might get if they can bring balance billing to Medicare.

Physicians For a National Health Care Program describes the practical implications of the Price proposal:

Even though we often hear threats that physicians will stop seeing Medicare patients, most really can’t afford to give up their Medicare revenues, and, besides, too many Medicare beneficiaries do not have adequate resources to pay large medical bills in full. The current law provides leverage to ensure that physicians will be there when Medicare patients need them.

The [Price] legislation would no longer require physicians to exit the Medicare program entirely should they enter agreements to independently bill the patients for the balance of their fees. Also Medicare would still have to pay the allowed charges. As a further insult, the physician can require the patient to do their own Medicare billing. The physician gets the full fee, in cash, including the disallowed charges, and the patient has to do the paperwork.

PNHP also notes there would be no limit on prices medical providers choose to “negotiate” with otherwise Medicare-eligible patients under the Price plan.

Cooper observes that 55 million Seniors, many with significant retirement savings, provide a perfect target for medical providers to exploit.  In 2011, Tom Price, Trump’s now-designated overseer of Medicare introduced a “Medicare reform” package designed to do just that.  It received the AMA’s imprimatur of approval, since it allowed physicians to require their patients to pay the full balance of their unrestricted fees, even if far in excess of Medicare allowable charges, thus benefitting the physicians and providers that organization represents.

In 2011 we had a President Obama to assure such a plan to bankrupt Seniors through onerous medical bills would go nowhere. And many physicians, even some within the ranks of the AMA, are vehemently opposed to it.

Chuck Schumer to GOP: If you repeal Obamacare, you’re on your own

Schumer, Cuomo Call On Feds to Close Terror Gap

Greg Sargent, who blogs for the Post and who, by the way, is a really good reporter, talks to Chuck Schumer about Obamacare repeal:

The emerging GOP plan to repeal Obamacare on a delayed schedule — and then maybe kinda sorta replace it later — has raised a big question: Will Democrats help Republicans pass a replacement that is far less generous and comprehensive than the health law is, allowing Republicans an escape from the political fallout from repeal?

In an interview with me, Senate minority leader Chuck Schumer answered this question with a resounding No. Under no circumstances, he vowed, would Democrats throw Republicans such a political lifeline.

“We’re not going to do a replacement,” Schumer said of the Senate Democratic caucus. “If they repeal without a replacement, they will own it. Democrats will not then step up to the plate and come up with a half-baked solution that we will partially own. It’s all theirs.”

[…] Asked directly if Democrats would refuse to support anything that falls significantly short of the ACA in terms of expanding social welfare, Schumer said: “The odds, after they repeal without any replacement, of us sitting at the table to do something that will chop one arm off instead of two is very small.”

Good. Dems are going to the mattresses. Let’s see if they stick to their guns this time. Because this will be a real disaster, no matter what.

Scrambling to get a handle on Obamacare

AON1

Josh Marshall on the GOP realizing how much shit they’re going to be in:

This will get dark, comical and ridiculous. Republicans – particularly Marco Rubio – did significant damage to Obamacare by getting rid of the so-called ‘risk corridors’ in Obamacare by labeling them bailouts. They were not ‘bailouts’ but systems to cushion the transition to the Obamacare system, given the inability to make perfect guesses about the risk pools in the system. Now, according to The Hill, Republicans are looking at giving vast sums of money to insurance companies to give them a way to ride out the market collapse that the repeal of Obamacare would likely trigger – that is, ride it out until Republicans can think up something to replace Obamacare with.

The more I read about this mess, the more cautiously optimistic I am. They will do everything they can to kick the football down the field for at least two years, after the 2018 midterms.

Won’t you step inside Bizarro World?

The Heritage Foundation just sent out this email:

Fellow Conservative,

Repealing Obamacare can now become a reality.

Republicans campaigned on repealing this awful law, and come January they will control both houses of Congress and the White House.

Congress should send an Obamacare repeal bill to Donald Trump’s desk on January 20.

The time for excuses is over. The time for repealing Obamacare is now.

But the fight isn’t over yet. And The Heritage Foundation — America’s leading conservative policy organization has the plan Donald Trump can use to replace Obama’s terrible health care plan.

Heritage has led the fight for repeal, including the fight to stop the law in 2013. We kept up the pressure when the Establishment told us to quit.

And now we want to finish the job. Get the inside scoop on the plan to make the future of health care in America bright again. Download the plan to repeal Obamacare now.

Together we can win amazing victories for your conservative principles.

Jim DeMint
President

Except Romneycare in Massachusetts was based on a Heritage Foundation proposal, and Obamacare is modeled on Romneycare. (Back then, they took credit. Now they deny it.)

We know the right wing is shameless, but this particular topic really takes the cake:

Moffit’s op-ed is Heritage’s third attempt at damage control. “For us,” Moffit explains, “the health insurance exchange is to be designed by the states [italics mine].” The federalist argument that health exchanges are good if created by states but bad if created by Washington is one Romney’s tried, too. Moffit had better hope it sounds more plausible to the Conintern coming from him than it does from the former Massachusetts governor. Anyway, the idea that Heritage has never advocated a health exchange created by the federal government simply isn’t true. As recently as Nov. 2008, Heritage’s Stuart Butler describedthe exchange as “a nonprofit organization chartered by the government.” The “government” Butler referred to was clearly the federal government. A 1993 Heritage paper by Butler offering an alternative to the Clinton plan (“Why Conservatives Need a National Health Plan“) was similarly focused at the federal level.

The cavity in health insurance coverage: oral health

2016.8.30 榮總看牙醫

By Susan Sered, Suffolk University

When we talk about the successes and shortcomings of the Affordable Care Act (ACA) – and health care in the U.S. in general – little attention is given to dental care.

While the ACA defines dental coverage as an essential benefit for those under 18, insurers aren’t required to offer dental coverage for adults. Medicare, the nation’s largest insurer, doesn’t cover routine dental work. And coverage for adults through Medicaid varies from state to state.

It is estimated that 108 million Americans have no dental insurance, and that one in four nonelderly Americans has untreated tooth decay.

Oral health isn’t just about nice teeth. As the surgeon general noted in a 2000 report, oral health is intimately connected to general health and can be implicated in or exacerbate diabetes, heart disease and stroke, and complications during pregnancy.

The absence of comprehensive dental care exacts a toll on millions of Americans in terms of poor health, pain and the social stigma associated with bad teeth.

People receive dental treatment at the Care Harbor/LA free clinic in Los Angeles, September 27, 2012.
Lucy Nicholson/Reuters

People desperately need dental care

In 2003 and 2004 (pre-Obamacare), I conducted a national study of uninsured Americans in southcentral Illinois, northern Idaho, the Mississippi delta, the Rio Grande Valley of Texas and in eastern Massachusetts.

I asked nearly 150 interviewees: “If President Bush were to declare universal health care for everyone starting tomorrow, what is the first problem you would take care of?” The most common answer by a landslide echoed this respondent’s: “I’ll be waiting outside the dentist’s office at 5:00 in the morning waiting for it to open.”

Many of the people I interviewed lived with untreated diabetes, asthma or even cancer, yet their oral health problems presented the greatest challenges to their quality of life.

Recently I returned to these communities to reinterview the people I’d met over a decade earlier. Very little has changed. While the majority of the people I interviewed now had health care coverage of some sort (for nearly 20 percent of them, it was as a consequence of becoming sufficiently disabled to be eligible for Social Security), very few had managed to secure dental coverage.

Then and now, people told me about visiting emergency rooms in hopes of alleviating pain or using addictive pain medications to make it through the day. People even told me that they had resorted to pulling out their own teeth.

Take Misty, for instance. When I met her 12 years ago in Mississippi, she was a “dirt poor” (her words) married mother of five, and she was living with diabetes, domestic violence and excruciating headaches. Despite all of these quite serious problems, she told me that she was more troubled by her bad teeth than by anything else. In fact, Misty told me that she’d had such bad toothaches that she pulled her own teeth. When I asked her how she can face the pain of pulling out her own teeth, she said:

[the infected tooth] hurts so bad… it’s a relief just to get it out of there.… I’ve gone two weeks with just being able to eat soup, because they are just so bad.

By 2016 Misty had left her abusive husband, moved to Arkansas and was accepted onto disability (SSI), which allowed her to get health care coverage through Medicaid. Still, however, she suffered because of her teeth.

It can be very hard to find dentists who accept Medicaid, and when Misty finally did, she had the rest of her teeth – 25 in all – pulled in one day.

Misty’s situation isn’t uncommon. I have met women and men of various ages who, like Misty, have pulled their own teeth. I’ve also met people who were able to get part of their dental needs taken care of during brief periods of Medicaid coverage but then were left with unfinished treatment when the coverage ended.

Teeth aren’t included in health insurance policies.
Dental x-ray image via www.shutterstock.com.

Insurance stops at the teeth

Even though the link between dental health and overall health is clear, insurance plans tend to ignore teeth.

As health insurance began to appear to appear in the U.S. – initially in the 1920s and then more widely during World War II and in the postwar era – dentistry wasn’t part of the standard package of covered services.

As the nation’s largest insurer, Medicare plays an important role in shaping health care coverage norms. Medicare does not cover dental care. Today, according to government estimates, 70 percent of seniors lack dental coverage.

Since Medicare doesn’t cover dental, Dr. David Kroll, senior program officer at the Robert Wood Johnson Foundation, argues that this “inertia spilled over into the ACA.”

Americans who purchase dental plans typically find that the plans aren’t cheap, and often don’t cover much beyond routine preventative care. Plans often require hefty copays for procedures beyond preventative care and no or very limited coverage for dentures, bridges or periodontic work.

And, in recent years, the cost of dental care has increased faster than the cost of other medical care. For those without dental insurance, there are few low-cost services available.

The ACA provided for an expansion of Medicaid eligibility, though not all states accepted the offer of federal funding to expand Medicaid coverage. Even in the states that expanded Medicaid under the ACA, strict limits on oral health care remain for most low- and moderate-income Americans.

There is one bright spot: children’s dental coverage is a required benefit included on all ACA compliant plans, and Medicaid as well. According to national calculations of the Health Policy Institute and the American Dental Association, dental care utilization among Medicaid-enrolled children increased from 35.3 percent in 2005 to 48.3 percent in 2013.

Not just about nice teeth.
Shannon Stapleton/Reuters

Oral health isn’t just about nice teeth

In the absence of coherent oral health services, too many Americans end up like Gina, a young Idaho woman who holds her hand in front of her mouth while she talks so that no one will see her rotted teeth. She can’t even get a job as a telemarketer because she cannot speak distinctly enough to be hired.

Many Americans incorrectly assume that rotten teeth are the product of bad decision-making; if someone had just brushed and flossed then they’d have nice teeth. But routine dental care – think of the twice-yearly checkups that are routine for people with dental insurance – keeps teeth healthy and can catch problems when they are easy to treat.

The reality is that tooth decay signifies poverty in pernicious ways. Without expanding insurance to cover oral health, millions of Americans will continue to live with pain, stigma and the risks of systemic diseases that could be averted through an accessible and integrated system of dental care.

The Conversation

Susan Sered, Professor of Sociology, Suffolk University

This article was originally published on The Conversation. Read the original article.

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