Beaten down on health care

I started writing this post four days ago. I had trouble getting a handle on just where repeal and replace was going. And I’m not the only one…

I started writing this post four days ago.

I had trouble getting a handle on just where repeal and replace was going. And I’m not the only one.

The saga of repeal and replace has had more twists and turns than a LeCarré novel. And while it’s unlikely to bring down this Western democracy, repeal and replace will have a dramatic effect on the 1/6 of the US economy that is healthcare. More importantly, it will undercut the health of millions of Americans whose poorer health will send a shock wave through our society and the rest of our economy.

During this past week procedural questions came up. Did all of the original bill qualify under the Byrd Amendment or did parts of it need 60 votes to pass?

One bill under consideration became four. Drafts were not available for review. Senate Whip John Cornyn was quoted as saying we might not have the “luxury” of seeing the bills before the vote. And the CBO couldn’t sore ghost bills so we might not have the “luxury” of knowing their impact before the vote. But it’s estimated that somewhere between 22 and 32 million Americans would loose their health insurance if any of the repeal and replace schemes that have been discussed are enacted.

There was supposed to be a vote last week.

But then there were defections and the Republicans didn’t have the votes to pass the bill, not even with Vice President Pence’s tie breaking vote.

Trump pulled back support for Obamacare sign ups in 18 cities.

And then Senator McCain went home to Arizona for surgery.

Everything came to a halt in the Senate, at least in public. The vote was delayed. Senator John McCain was diagnosed with gliobastoma.

And those reporting on Capitol Hill warned their readers to not get distracted, the repeal and replace effort wasn’t dead. Vox published a flowchart showing the many steps ahead.

Vox - repeal and replace flowchart
Source: Vox.com

 

Yesterday, Senator McCain returned to the Senate floor and gave a rousing speech taking his colleagues to task for partisan bickering and calling for a bi-partisan approach to creating true healthcare reform.

It was too little, too late.

McCain then joined the Republicans in a vote along party lines that, with the vice president’s tie breaking vote, restarted consideration of repeal and replace.

Today the Senate is voting on health care bills and amendments.

Voting blind. With little information about what’s in those bills and amendments. And with no independent analysis.

We deserve better than this.

Call your Senators and let them know what you think about the job they’re doing on healthcare reform.

Please.

Trumpcare, it wasn’t supposed to go like this…

Where do we go with healthcare reform after months of partisan bickering? We cannot simply ignore one-sixth of the economy and its impact on people’s lives.

This was supposed to be the week when the GOP came back from July recess, ready to vote for the AHCA or the BCRA or whatever they’re calling Trumpcare these days.

REPEAL AND REPLACE DERAILED

But then this happened.

New York Times: Donald Trump, Jr. makes the Russian connection

A meeting during the presidential election between Donald Trump, Jr. and a Russian lawyer came to light. It might have been about the election. It might have been about adoptions. It might have been collusion, or corruption, or something else. Donald Jr. kept changing his story. Then he tweeted out a series of emails about this meeting.

Needless to say everyone’s attention in the news media and Washington, was drawn to Russia and its attempts to influence the last presidential election.

rEVISIONS MADE, BUT ARE THERE ENOUGH VOTES?

So healthcare reform got pushed to the background. But it didn’t go away completely.

After a July recess where GOP Senators and Representatives continued avoiding town hall meetings, Senate Majority Leader Mitch McConnell announced that the August recess was being pushed out two weeks. They simply hadn’t gotten enough work done. One of the things they hadn’t gotten done: repealing and replacing Obamacare.

Today, as expected, the GOP released a revised healthcare bill that includes the Cruz Amendment which they hope will get enough votes to pass.

The initial read of the revised bill is that it’s a lot of the same with some funding to address opioid addiction and fewer tax cuts.

Whether they have the votes, after twisting arms, pulling out some of the tax breaks and softening the coverage requirements, remains a question as the vote on the bill is still expected next week.

PROMISES, ARE THEY MADE TO BE BROKEN?

It is possible that the Republicans won’t be able to keep their promise to get rid of Obamacare.

I wonder what the fallout will be, political and otherwise, of dragging people through these procedural shenanigans. Where do we go with healthcare reform after months of secret bill writing, no public hearings, contentious constituent calls, and plenty of public protest?

Our healthcare system needs reform. We cannot simply ignore one-sixth of the economy and its impact on people’s lives. With Obamacare progress has been made: more people have health insurance and the rate of cost increases has been slowed. But there are people and places in this country where those effects aren’t being felt.

Alice M. Rivlin, senior fellow at the Brookings Institute offers us what I think is a reasonable path. She writes:

In the face of that frightening electoral prospect, they [the Republicans] should abandon their tortured attempt to use the arcane reconciliation process to pass major health reform on a strictly partisan basis and work with Democrats to craft a bill that moderates in both parties can support and defend.

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The political theater of Trumpcare

The battle over the latest version of Trumpcare promises all the drama, tragedy, and irony political theater can muster.

After more than a month of hurry up and wait the Senate Republicans released their version of Trumpcare. It’s called the Better Care Reconciliation Act (BCRA). On the fast track for a full Senate vote within a week, it’s name foreshadows all the drama, tragedy, and irony that political theater can muster. And every American, who chooses to to pay attention, has a front row seat.

What happens now?

Act 1, in which everyone rushes to judgement.

A flurry of action takes place across the media landscape.

The news media is screaming out headlines like these.

Winners and losers from the Senate repeal bill

Republican Senators pretend people who get kicked off of Medicaid will just start buying insurance

Poll: Trump’s approval at 40%, only 16% support House’s health care bill

Senators are tweeting and posting to Facebook and broadcasting on Facebook Live their readings of the bill.

Various health organizations have launched campaigns urging people to tell their Senators to vote “no” on the bill.

After taking in the news and social media I’ve come to the conclusion that some people hate the BCRA. Some people really hate the BCRA. And some people just want to spin it. But no one is saying it will provide better care.

Therein lies the irony.

Act 2, in which the people respond.

The people affected take to the political stage and raise their voices.

This response is taking many forms: calling Senators’ offices (again!), taking to social media with the hashtag #HealthcareMatters, and physical protests.

As the BCRA was being released a group of disabled people and their advocates staged a die-in at Senator Mitch McConnell’s office. Dozens of protesters were arrested as they chanted in the hallway “Our lives and liberty shouldn’t be stolen to give a tax break to the wealthy.” Video of Capitol Police forcibly removing disabled people from outside Senator Mitch McConnell’s office, some in wheelchairs others being physically dragged or carried down the hall, made national news.  It’s a video that will likely haunt many Senators in political ads for many election cycles to come.

One of the protest organizers stated that “To say people will die under this law is not an exaggeration.

Meanwhile, the Kaiser Family Foundation Health Tracking Poll shows that Republicans see Medicaid as welfare while most Americans don’t.

Therein lies the tragedy.

Act 3, in which the Senate takes direct action.

The Senate convenes.

So, just what is in the BCRA? Pretty much all the same stuff that was in the House’s American Health Care Act (AHCA). Cuts to Medicaid. but this time they’re rumored to be to the tune of $800 billion. Opt-out options for States to eliminate or reduce essential healthcare benefits and insurance marketplaces. Elimination of coverage mandates. Cuts to taxes on the wealthy, also rumored to be to the tune of $800 billion. Interesting how the cuts balance out.

Will Senators debate for longer than the minimum requirement? Will Senators make procedural moves like introducing amendments to delay action or yield back their time to shorten the debate? Will Senators vote before going on 4th of July recess? Will the Vice President have to cast a tie-breaking vote?

What will be the ultimate political cost to be paid by Senators and by the American people?

We won’t know until that day comes.

Therein lies the drama.

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If Senate Republicans write the healthcare bill in the dark…

Will the healthcare bill ever see the light of day?

How can you vote on a bill that will affect health insurance coverage for 24 million people without reading it first?

It’s been just over a month since Trumpcare (formally known as the American Health Care Act of 2017 or AHCA) passed out of the House and landed in the Senate.

During this time there hasn’t been much to write about because no one has seen the Senate Republicans’ bill. They have a select group of Senators writing the bill, in private, with no discernible input from anyone.

This isn’t how these things normally go.

Needless to say, the lack of information has made a lot of people nervous. Not just Senate Democrats, but also major healthcare organizations, governors, and even insurers. The President himself called the Senate’s bill “mean” and told Senate Republicans to be “more generous.”

In their rush to pass a healthcare bill, Senate Republicans might have killed it.

Senate Democrats are resorting to using procedural rules to slow down, not just the progress of this bill, but the all of the Senate’s work. Democrats hope this tactic will get enough Senate Republicans to change their votes that the bill goes down to defeat.

More importantly, the New York Times is reporting that “not one state supports the Republican health bill” because Senators need to be mindful of their constituents’ feelings. Don’t they?

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What now, that Trumpcare is on its way to the Senate?

Can we talk about single payer now?

A week ago my head was swirling with the news that Trumpcare had passed out of the House by the slimmest of margins. Not only had the Republicans revived the AHCA, but they got the votes needed by adding the draconian MacArthur amendment.

And then Congress went on recess, returned to their home districts, and faced their constituents. Things didn’t go smoothly for everyone.

Rep. Labrador’s (R-ID) town hall went viral when he was filmed claiming that “Nobody dies because they don’t have access to health care.

Rep. MacArthur (R-NJ) had a five-hour town hall meeting where the crowd was hostile and the news media well represented. Kind of hard to blame his constituents for their strong reaction. After all, the amendment that bares Rep. MacArthur’s name is expected to make healthcare for prohibitively expensive for millions of people. People who didn’t realize that giving birth or having gone through a c-section or experiencing postpartum depression put them among those with preexisting conditions. People who rely on expanded medicaid coverage that could be undermined by their state opting out of some provisions. People who are in their 50s or 60s, or one day will be. People who now fear that they won’t be able to afford health insurance for themselves or their families. They’re not happy about that. And they’re letting their members of congress know that.

Just yesterday Budget Director Mick Mulvaney suggested that people should pass the “Jimmy Kimmel test” to get health insurance. He also suggested that people with diabetes wouldn’t pass this test.

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It’s one thing to deny someone a right or privilege. It’s a whole other thing to take away a right or privilege after it’s been given.

Obamacare, which remains the law of the land, gave Americans the right to access health care.  It doesn’t matter if you are living with a preexisting condition, you cannot be denied or priced out of coverage. It doesn’t matter if you’re a man or a woman, you cannot be charged more for insurance just because of your gender. You can expect to have the ten essential health benefits covered.

We’ve been living with these assurances for a couple of years now. Long enough to feel the effects on our personal health. But not so long that we’ve forgotten what it’s like to be denied health insurance because you were unlucky enough to be labeled with a preexisting condition, like diabetes. Not long enough to forget how expensive prescriptions can be when you have to buy them retail. Not long enough to forget how a single trip to the emergency room can put you on the road to bankruptcy.

The argument for the AHCA is an economic one: the country can’t afford to pay for everyone to have health insurance. Healthcare costs are on an upward trajectory. Chronic illness is epidemic.

The argument against AHCA is an economic one: the country can’t afford to have its productivity and GDP undermined by a chronically ill population. Chronic illness is epidemic.

Where these two sides diverge is in their preferred solution. One wants the individual to pay. The other wants the group to pay. The result is stalemate.

So, where do we go from here?

Can we discuss single payer now?

I think we’re going to have to ask the thirteen male GOP senators who are writing the Senate’s version of the healthcare bill.

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