Tag Archives: Affordable Care Act

Nassau County Democrats Raise Alarms Over Impact of Repealing Affordable Care Act

Nassau County Legislature Minority Democratic Leader Kevan Abrahams, Legislators Laura Curran and Carrie Solages, Planned Parenthood CEO JoAnn Smith, Long Island Progressive Coalition Executive Director Lisa Tyson, and Long Islander Rachel Siehs raise alarm about how repealing the Affordable Care Act will impact residents and the county budget © 2017 Karen Rubin/news-photos-features.com 

By Karen Rubin, News & Photo Features

(MINEOLA, NY) –Nassau County Democrats are raising alarms about what repealing the Affordable Care Act would mean for county residents and appealed to County Executive Ed Mangano to compile a comprehensive report that would quantify the impact on residents and the county’s budget.

Minority Democratic Leader Kevan Abrahams and Legislator Laura Curran stood with their democratic legislative colleagues, along with local healthcare advocates including Long Island Progressive Coalition and Nassau County Planned Parenthood calling upon the Nassau County Executive, commissioners, and administrators to compile a comprehensive report that measures the impact of what looks like the inevitable repeal of the Affordable Care Act (ACA).

According to a report issued by New York State’s Office of the Governor on January 4, 2017, Nassau County stands to lose $17,866,829 in direct funding which “goes directly to counties and helps to lower property taxes”.

Under the ACA, Nassau County saw a 33% decrease in the number of uninsured according to the most recent U.S. Census. The number of uninsured people on Long Island has declined rapidly over the last decade, while the proposed GOP healthcare bill will undo that work by putting 24 million at risk of losing coverage, according to the nonpartisan Congressional Budget Office. The American Health Care Act proposed by the Republican Party may affect more than 1 in 4 Nassau residents. Those at risk of coverage changes include, but are not limited to, the 204,681 Nassau seniors enrolled in Medicare and 133,324 residents who enrolled on the Affordable Care Act’s open marketplace.

“After making inroads for more affordable healthcare access, the proposed law could force counties to choose between supporting low-income residents who rely on Medicaid for health services,” said Minority Legislative Leader, Kevan Abrahams (D-Freeport).

“President Trump is leading us down a very dangerous path and County Government is going to be left holding the bag while taxpayers’ costs could skyrocket. Trumpcare is no longer a campaign talking point but an imminent threat to the financial and physical health of our community, and we must be prepared,” said Legislator Laura Curran (D-Baldwin). “Repealing the Affordable Care Act and replacing it with Trump’s alternative is going to drive a massive hole in the County budget while leaving more residents uninsured and without the benefits of preventative care. So that the County is prepared for these massive changes, County Executive Mangano, County Commissioners, and Department Administrators must immediately start preparing a report that outlines the real impact of losing the Affordable Care Act and what it will mean for Nassau taxpayers.”

Today, Nassau Democratic Legislators called upon the Nassau County Executive, county commissioners and department administrators to prepare an impact study that outlines the real impact losing the affordable care will have on Nassau County residents and the services they receive.

Such a study was just announced by Suffolk County Executive Steve Bellone and is being undertaken by county governments all over the country, Lisa Tyson, Executive Director of the Long Island Progressive Coalition, said.

“The repeal of the Affordable Care Act will deprive Long Islanders’ access to affordable healthcare that can be a matter of life-and-death. Nassau County residents deserve to know how losing the Affordable Care Act might affect their family both financially and physically,” she said.

The repeal of the Affordable Care Act. could be detrimental to citizens of Nassau most in need: low-income families, young adults, seniors and those in need of mental health care and substance abuse treatment. All these programs are at risk of being affected as the legislation currently stands.

“Repealing the Affordable Care Act will have real consequences for our community and we need to know how many of our neighbors will be affected and what costs will fall to the County. Obvious questions are whether our Medicaid costs will rise, and by how much; how increased emergency room visits will affect Nassau University Medical Center; whether the workload and costs of the County’s Department of Health will skyrocket; whether the County’s drug abuse rates are likely to soar due to diminished treatment options; the projected costs that will result; and many more. Governor Cuomo estimates that 133,000 Nassau residents (one out of ten residents) would lose coverage, and that should serve as a chilling wake-up call to every stakeholder in government and healthcare. Our taxpayers deserve to know exactly how much they will be affected by Washington’s costly decisions, and the County’s planning must start now,” said Legislator Curran.

Older residents will see a rise in healthcare premiums, with a projected 20-25% increase for those in their early 60s, given the current proposed GOP tax credit structure, which does not take income into account. For Nassau’s poor and working families, the halting of Medicaid expansion coupled with rising premiums will disintegrate any chance of affordable healthcare.

“Repealing the Affordable Care Act and defunding Planned Parenthood will mean that many women – across the country and right here in Nassau County –who receive their care at Planned Parenthood health centers won’t receive care at all. We are calling on congress to stop these political attacks, but, until they do, Planned Parenthood will leave no stone unturned in fighting back for our patients and ensuring that our doors stay open,” said PPNC President & CEO JoAnn Smith.

For Long Islander Rachel Siehs, not having healthcare at a most crucial time in her life could have been a matter of life-and-death. After Rachel was laid off from her job in October 2015 she battled the very same conflict so many do when they lose their health insurance – in this case, she gotten it from her previous employer. “I was on the fence if I should buy health insurance? I couldn’t afford Cobra. Plus, I am young and healthy and thought I could wait to start a new job and acquire insurance that way,” said Rachel Siehs. “After discussing the issue with my parents, they encouraged me to find coverage on the Affordable Care Act marketplace and thankfully I did – I was diagnosed with Hodgkin’s lymphoma only two months later and would fight cancer for most of 2016.”

Long Islander Rachel Siehs describes how being able to purchase health insurance through the Affordable Care Act saved her life © 2017 Karen Rubin/news-photos-features.com

Since then, Rachel, 28 years old, has successfully fought Hodgkin’s lymphoma. She was able to see doctor because she had health coverage through the Affordable Health Act. Like many Americans, she risks losing health insurance again after the repeal.

“I don’t know if I would be here today if I didn’t seek coverage on the ACA marketplace. I would start a new job in January 2016 but my health insurance would not have kicked in until April. But also, who knows if I would have scheduled the doctor appointments if I would have had to pay completely out of pocket for them. The impact is real here in Nassau. Health care is important. It needs to be well thought out and studied and shouldn’t be a rushed vote. This is people’s lives,” said Rachel Siehs of Melville.

While County Executive Mangano has already indicated his disinterest in undertaking such a study, which he decried as purely political, Governor Andrew M. Cuomo did provide some indication of the impact on New Yorkers of the American Health Care Act – 2.7 million New Yorkers would face substantial loss in their health care coverage from what they have now, while quality and availability of health services across the state would be jeopardized. Also, an amendment just introduced by Chris Collins, an upstate Congressman (and Trump spokesman) and John Fasio, which would apply solely to New York State, would ban federal reimbursement for state Medicaid funds for local governments outside of New York City, cutting Medicaid for these local governments by $2.3 billion. When added to the $4.5 billion cost of the ACHA over the next four years, the total cost to the State would rise to $6.9 billion.

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© 2017 News & Photo Features Syndicate, a division of Workstyles, Inc. All rights reserved. For editorial feature and photo information, go to www.news-photos-features.com, email editor@news-photos-features.com. Blogging at www.dailykos.com/blogs/NewsPhotosFeatures.  ‘Like’ us on facebook.com/NewsPhotoFeatures, Tweet @KarenBRubin

 

Republican Health Care Plan is Prescription for Bankruptcy, Premature Death – And They Don’t Care

At a Save Obamacare rally on Long Island in January, Ron Motta kisses his 11-year-old son, Robbie, who was born with a congenital heart defect. He worries about losing access to affordable health care © 2017 Karen Rubin/news-photos-features.com

By Karen Rubin, News & Photo Features

During the Presidents Week recess when Congressmembers are supposed to meet with constituents, I attended two jam-packed rallies focused on saving Obamacare (this followed the rallies held coast-to-coast in the days before the inauguration). In each of these, desperate people (dismissed by Republicans as “paid professional agitators”) stood up to preserve the Affordable Care Act.

While not perfect (after all, how could it be when Obama had to thread a ridiculously tiny needle to get anything passed the Republican wall of opposition), Obamacare has brought coverage to 20 million previously uninsured people, reducing the percentage of uninsured Americans to a historic low of 8.6%, allowed children up to age 26 stay on their parents’ plan, mandated coverage for preexisting conditions, ended lifetime caps, capped the amount of premium that for-profit insurance pocketed for non-patient purposes at 20% (versus 97% that Medicare spends on patient care ), instituted basic standards of coverage that included, for the first time, wellness visits, coverage for certain regular tests (mammograms, colonoscopy).

The secret sauce? Mandating coverage or else pay a penalty, but if you didn’t earn enough to pay, you would be able to get subsidies from the government Why? Because the whole thing revolved around the idea that young and healthy people would pay into the system, bringing down the insurance premium for everyone. And every policy would cover certain basics, like child birth and prostate cancer, mammogram and colonscopy (ending the higher premiums for a woman).

And it was working: in the first place because if people can go to their doctors earlier, get diagnostic tests and catch illnesses earlier, they are less expensive to treat, let alone reduce the amount of suffering while increasing a person’s productivity during their prime years.

Let’s review: before Obamacare, nearly 50 million people were without health insurance and tens of thousands of families were losing health insurance as they were losing their jobs (and homes) to the Bush/Cheney Great Recession.  20,000 people a year were dying needlessly simply for lack of access to affordable health care.

And, for years, for-profit insurance companies, with a 33% margin, were raising premiums at three to five times the CPI each year; routinely dropping doctors, denying coverage, throwing people off for “preexisting conditions.”  Companies were dropping health benefits for employees.

“Preexisting condition? Life is a preexisting condition, resulting from sexual contact and will invariable end in death,” Dr Martha Livingstone,  vice chair of Physicians for a National Health Program, told an overflow audience at the Universalist Unitarian Church in Huntington. “We all have a preexisting condition. We all need health care because we are human beings. How we will get it?”

Congressman Tom Suozzi, who stood in front of SRO town hall at the JCC in Plainview, and again at the Huntington health care rally, and back in January, with Kathleen Rice, at a massive health care rally, said about Obamacare, “Mend it. Don’t End it.”

Ron Widelec of LI Activists and Congressman Tom Suozzi (D-LI 3) at a packed rally to save Obamacare and support universal health care, Huntington, Long Island, NY © 2017 Karen Rubin/news-photos-features.com

The key problems with Obamacare, people complained, are high deductibles (for the cheapest plans), that premiums rose significantly (after rising at the slowest rate of increase in 50 years and mainly because of the Republican sabotage that prevented the full implementation), and that doctors, and even insurers would change (which happened before, as well).

What Republicans are proposing now, though, doesn’t “fix” any of these problems. In essence, the Republican plan favors the healthy and the wealthy, shifting the burden of payment while providing fewer benefits onto working people, low-income people and the elderly, while – and here is the added bonus – exploding the budget deficit. Millions will lose insurance; costs will skyrocket, and Republicans are ramming it through without “scoring” its impact on the budget or people.

They concocted the bill in secret, are ramming it through without proper analysis, scrutiny or debate, or even “scoring” by the Congressional Budget Office, and here’s the added subterfuge: they are repealing the elements in stages: by 2018 for the first parts (to minimize impact on midterm elections) and by 2020 for the complete repeal (to ease the way for Trump’s reelection).

The Republican plan begins with ending that “freedom killing” mandate, which is the hinge upon which access to affordable health care rests, because by requiring everyone – young, healthy people who might otherwise defray health insurance costs – to purchase, the pool is large enough to keep premiums down for everyone, while covering everything from child birth to mental health to pre-existing conditions.

Instead of a mandate, enforced with a modest tax penalty, to insure that enough healthy, young people are in the pool to lower everyone’s premium while expanding care and access even if there is a pre-existing condition, the Republican plan provides for a 30% “surcharge” if you have let insurance lapse more than 60 days. So if you have lost your job, and therefore your health insurance, and can’t pay, you will only get further and further behind.

NYS Governor Andrew Cuomo warns that 2.7 million New Yorkers would lose health coverage if Republicans repeal Obamacare; the impact on the state’s budget would be $3.7 billion © 2017 Karen Rubin/news-photos-features.com

The other prime elements:

Instead of subsidies for people who don’t earn enough to purchase health insurance, Republicans want to give tax credits, which only are beneficial if you earn enough to pay. What is more, they want tax credits not to be based on income at all, but on age, so a 60 year old  would get $4000 in tax credits while a 30-year old minimum-wage worker would get $2000 –still only a fraction of the cost of a minimally basic health plan – up to $14,000 in credits for a family.

The other big idea to “afford” health care is the Health Savings Account, which Republicans have wanted forever – another scheme to bolster Wall Street donors, and provide yet another device for the wealthiest to shield income from tax. The flaw is that you need to have enough money to stash away in HSA to begin with. But suppose you get a cancer diagnosis or are hit by a car before you have accumulated sufficient funds? Or you contract some illness that blows through your HSA?  Tough luck.

The GOP plan would  end the Medicaid expansion – when the federal government paid 90% instead of 50% of the state’s Medicaid cost — which will result in 10 million people in 31 states losing health insurance.

Another keystone of the GOP health care con is to give states block grants – a fixed amount that has no correlation to actual need. The interesting thing is that Governors tend not to use the money for its purpose (health care for the poorest residents), but for pet priorities like lowering taxes for businesses.

The Republicans say they want to shift “power” back to the states. But states always had the ability, before, to devise their own health care plan, as long as it met basic standards of the Affordable Care Act. What states want is the ability –and the excuse – not to provide universal coverage.

Republicans will claim that their plan will continue to cover pre-existing conditions. But their idea is to stick people with pre-existing conditions into high-risk pools, which could put the cost out of reach.

Indeed, no one has bothered to mention that Obamacare capped the amount that the for-profit insurance companies could charge for non-patient services – it was at 33% (versus a 3% administrative budget for Medicare) before the ACA, which required 80% of the premium to go to patient services. That is out the window.

An added zinger, just for good, is that the plan ends federal funding for Planned Parenthood. Gotcha!

Rallying for Planned Parenthood at a Save Obamacare rally on Long Island in January. The Republican “repeal and replace” plan calls for total defunding Planned Parenthood. © 2017 Karen Rubin/news-photos-features.com

Trump proposes to cure the cost problem making it possible to buy insurance across state lines, without saying how that would actually reduce the cost of the premium, under the pretext that “competition” will lower the cost. Except that the same few companies dominate the market in most states, and like airlines, can just raise premiums as they like. Also, this would negate New York’s ability to set standards on insurance companies. And wouldn’t it also mean that New Yorkers would pay the higher premium for Southern obesity?

Most of the changes are phased in – they don’t get implemented until after the 2018 midterm elections, and Obamacare is not completely repealed until after the 2020 elections.

But what Republicans claim is the “unsustainability” of Obamacare is the result of Republicans efforts to sabotage it from day 1. And the first thing that Trump did? Ended enforcement of the mandate and issue a proposal to cut next year’s enrollment period in half allow insurance companies to easily raise deductibles, limit patients’ choice of doctors, and restrict others from getting covered mid-year — even if they have a child or lose their employer-based insurance. Insurance companies are pulling out because the Republicans are intentionally making it impossible for them to do business.

By immediately repealing the mandate as well as the taxes that support Obamacare, it is truly unsustainable and more insurance companies that are planning premium rates and participation now, will either pull out or hike up premiums to ridiculous levels because essentially, they are only insuring sick, older people.

The taxes that pay for the Obamacare health care benefits are also being immediately repealed which will explode the budget deficit, which somehow, Republicans only care about when a Democrat is in the Oval office.

And here is the stunner: the Republicans, who have worked this up in secret, without any debate or public commentary (they dismiss the millions who have come out to town halls, rallies and protests as “paid professional agitators” instead of people with real concerns), plan to shove the legislation through without even scoring by the Congressional Budget Office.  They can’t say how much health insurance will cost in TrumpWorld, or how many people will wind up losing health insurance or who wind up being woefully uninsured because they can only afford a minimal policy that doesn’t actually cover anything. They can’t say how many more employers (only about half were offering health insurance benefits before ACA) will simply stop providing any health care benefit at all. That’s Freedom! That’s Choice!

“Do we want people to have socialized medicine or individual accountability, personal choice, where businesses decide?” Congressman Chris Collins (R-NY) asked hypothetically.

Obamacare did not just benefit the 30 million people who were able to afford health insurance, 20 million of them for the first time. It benefited every American who also has insurance, and every American who has Medicare, as well. And remember the complaints with Obamacare? That deductibles were too high; premiums went up significantly from the first year (except they had traditionally gone up at 3 to 5 times the CPI, without any limits). That doctors left the plan or insurance companies changed the plan to exited the exchanges? The Republican plan does not improve any of this. Instead, it returns health care to the total control of for-profit companies, who can raise premiums at will, drop doctors at will, set lifetime caps or refuse to cover certain procedures.

Health care should be a right, not a privilege reserved with the means to pay for it.  But the Republican mold would create a system of unequal protection throughout the land. If you happen to live in New York State, you are likely to have better access to life saving, life-affirming care for your family than if you live in Texas.

The Republican plan is a prescription for sicker people who don’t get the checkups, early diagnosis and wellness care to prevent more serious (and costly) and deadly maladies. But they don’t care. Indeed, the rightwingers like Freedom Caucus who are howling mad at the American Health Care Act are upset that it is not draconian enough, that it is “Obamacare Light”.

In TrumpWorld, people are back at the mercy of the for-profit health insurance and health care industry, back under the thumb of employers and abusive spouses. Now that’s freedom-killing, as much as it is a death penalty.

It is as Alan Grayson said early in the Obamacare debate: “The Republican health care plan: don’t get sick. The Republicans have a back-up plan in case you do get sick … Die quickly!”

Rightwingers, conservatives don’t hate Obamacare because it smacks of “socialized medicine.” They hate it because they believe when everyone is entitled to health care, there will be a shortage of doctors, of hospital beds. They will have to wait for appointments. They fear “rationing,” not caring that to avoid that feared scenario, it means that 50 million people will be excluded from health care system altogether.

The solution to having truly universal health care is to reform the health care system – more physicians assistants, nurse practitioners, online diagnosis and triage, more early diagnosis and wellness care.

Dr. Martha Livingstone, vice chair of Physicians for a National Health Program: “Life is a preexisting condition, resulting from sexual contact and will invariable end in death. We all have a preexisting condition. We all need health care because we are human beings.” © 2017 Karen Rubin/news-photos-features.com

Contrary to the rightwing hysteria (death panels!) Obamacare is not socialized medicine because it bent health care into a pretzel in order to retain for-profit health insurance entities as the gatekeeper between patients and health care. But the epic failure of the Republican plan, which more than restores ultimate control over people’s lives and quality of life to for-profit companies and employers and abusive spouses, will likely result in a true universal, Medicare-for-All, single-payer system.

Trouble is, that won’t happen for decades more, and not until after hundreds of thousands of people have suffered miserably, died needlessly, prematurely, for lack of access to timely, affordable, quality health care.

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© 2017 News & Photo Features Syndicate, a division of Workstyles, Inc. All rights reserved. For editorial feature and photo information, go to www.news-photos-features.com, email editor@news-photos-features.com. Blogging at  www.dailykos.com/blogs/NewsPhotosFeatures.  ‘Like’ us on facebook.com/NewsPhotoFeatures, Tweet @KarenBRubin

New Yorkers Mobilize for Single Payer, Medicare-for-All Health Care

Republicans may have overplayed their hand: when they sweep Obamacare away, Progressives like Ron Widelec of Long Island Activists intend to push for universal health care: single-payer, Medicare-for-All © 2017 Karen Rubin/news-photos-features.com

By Karen Rubin, News & Photo Features

With the chaos and uncertainty at the federal level, New York Progressives see an opportunity to push for single-payer health care in the state – a plan that has been approved by the Democratic-controlled Assembly, but has been defeated by the Republican-controlled Senate (with the help of the so-called Independent Democratic coalition of state senators who were elected as Democrats but caucus with Republicans).

Hundreds crammed the Unitarian Universalist Fellowship of Huntington (UUFH), Long Island, under the aegis of Long Island Activists, to build the movement for the state to adopt single-payer health care. (See: Long Island Activists Mobilize to Save Obamacare, Push for Single Payer in NYS)

Long Island Activists rally for universal health care, Huntington, Long Island, Feb. 25, 2017 © 2017 Karen Rubin/news-photos-features.com

Irrespective of what Republicans do in Congress, Ron Widelec, a member of the steering committee of Long Island Activists (LongIslandActivists.org) said, “There is a lot we can do in New York – people forget we can act locally, not everything happens in Congress. Single payer is a real possibility in New York.”

Widelec exposed the lies that are used to beat back universal health care, despite the fact that every other industrialized nation has such a system:

That universal health care is too expensive, will add trillions of dollars to the national debt – but that is belied by the fact that the US spends twice as much on health care as any other industrialized nation, health care amounts to 1/6 of the entire economy, and the outcomes are poor, with the US ranked 32nd among nations, contradicting the claim that the US offers “the best health care in the world.”

Another lie is that universal health care will result in rationing, ”as if 20 million people with no insurance isn’t rationing, or people who have insurance but can’t afford deductibles or copays isn’t rationing, or insurance companies denying care isn’t rationing,” he said.

Janet Green tells of her experience living under Canada’s universal health care system: “We lived it, loved it – you could choose any doctor you like, be rid of billing, deductibles, copays; to be covered regardless of age, job status, preexisting conditions, personal wealth.” © 2017 Karen Rubin/news-photos-features.com

Janet Green, a nurse who lived in Canada for two years and now lives on Long Island, spoke of the difference: “We lived it, loved it – you could choose any doctor you like, be rid of billing, deductibles, copays; to be covered regardless of age, job status, preexisting conditions, personal wealth. No wonder the Canadians love their single payer universal health insurance system with private provision..

“When we moved to Long Island, the unfairness and inefficiency of an increasingly corporatized health care system was increasingly hard to take because I knew another system. I had coverage through husband’s job – but I was angry, not lucky, to be part of such an unfair system.” That included problems with doctors in/out network; merger/replacement of insurance plans, with changing rules, preferred provider lists not once but twice in 4 years. “There is none of that on single payer, no deductibles or copays or networks.

“I saw the misinformation spread by those most affected, the insurance industry –myths about Canadian system.

“North of the border and throughout the rest of the world, it is understood that to be a compassionate, enlightened society, there must be universal health coverage.

Dr. Martha Livingstone, vice chair of Physicians for a National Health Program: “Life is a preexisting condition, resulting from sexual contact and will invariable end in death. We all have a preexisting condition. We all need health care because we are human beings.” © 2017 Karen Rubin/news-photos-features.com

Dr. Martha Livingstone,  vice chair of Physicians for a National Health Program, also spoke from experience about Canada’s health program, because she lived in Canada while getting one of her degrees.

“There are only two reasons we don’t have national health insurance Medicare for All – it is 1/6 of the economy and very powerful people are arrayed against us who will do everything in their power to persuade us we can’t have it. And our failure of imagination.

Indeed, it may well be that Republicans have overplayed their hand and the pendulum will swing back much more forcefully. If they succeed in repealing Obamacare and replacing it with Trumpcare, it can cost Republicans to lose Congress in 2018 and the White House in 2020, just as Obamacare cost Democrats control in 2010. Instead of Obamacare, which was Obama’s attempt to appease conservatives who demand a for-profit health care system, there will be universal health care, single-payer Medicare for All, a socialized health care system.

She told of a Victoria BC woman whose son had to go to five specialists before a rare brain tumor was diagnosed, treated, so he could survive. “In the states, he would have been one of 45,000 Americans dead of treatable medical conditions because he didn’t have access to timely medical care.

“Preexisting condition? Life is a preexisting condition, resulting from sexual contact and will invariable end in death. We all have a  preexisting condition. We all need health care because we are human beings. How we will get it?

“We are the 99%. We don’t mind paying taxes when they provide for things we need. Who doesn’t want to pay taxes? it’s the billionaires – they want us to be uneducated, unhoused, unfed and if sick, they like us to die [and not be a burden on society]. It is a life/death fight.

“We have to protect the Affordable Care Act, but frankly my dears, ACA was written by the Heritage Foundation, a right wing think tank. It is a Republican plan first put into place by then Governor Mitt Romney in Massachusetts.  You have piece a that‘s public, that funds the majority, and the piece that’s private.

“What Romneycare did, then ACA, was to build on the wildly expensive private for-profit sector of the system. We want to build in the wildly successful, inexpensively administered Medicare program…

“There are only two things wrong with Medicare: it doesn’t cover everything, doesn’t cover everybody. So improve it, Medicare for all.”

But regardless of what happens at the federal level, the state can create its own single-payer plan.

“Let New York be the first to have single-payer.  What it will do for us in New York State is save us $50 billion, and save everybody but the very wealthiest New Yorkers money over what paying now for lousy access to care, where we have narrow networks, where some insurance genius can tell us at any moment, ‘Well, if you looked at p 793.’ The bill gets rid of all that – no copays, deductibles for a human right. We have to reinforce that. We know we won’t get it through the New York Senate this year, but 2018 if we hold their feet to the fire.”

Ron Widelec of Long Island Activists is mobilizing push New York State to adopt universal health care: single-payer, Medicare-for-All © 2017 Karen Rubin/news-photos-features.com

“This event left me hopeful,” Widelec said before sending everyone off to their breakout sessions to come up with local actions. “The election of Trump wasn’t a hopeful time, but I am hopeful. I believe this is not a matter of left versus right, this is a matter of right versus wrong. One good thing about the 1%: we outnumber them 99 to 1.

“Everybody forward, not one step back.”

Widelec said that events will be posted on LongIslandActivists.org.

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© 2017 News & Photo Features Syndicate, a division of Workstyles, Inc. All rights reserved. For editorial feature and photo information, go to www.news-photos-features.com, email editor@news-photos-features.com. Blogging at  www.dailykos.com/blogs/NewsPhotosFeatures.  ‘Like’ us on facebook.com/NewsPhotoFeatures, Tweet @KarenBRubin

Long Island Activists Mobilize to Save Obamacare, Push for Single Payer in NYS

Ron Widelec of Long Island Activists and Congressman Tom Suozzi (D-LI 3) at a packed rally to save Obamacare and support universal health care, Huntington, Long Island, NY © 2017 Karen Rubin/news-photos-features.com

By Karen Rubin, News & Photo Features

Hundreds rallied at the Unitarian Universalist Fellowship of Huntington (UUFH), under the aegis of Long Island Activists, to strategize how to save Obamacare from Republicans who are moving swiftly to repeal it and replace it with something that is far more costly, would knock tens of millions off health insurance, would raise taxes for middle class and working Americans, and essentially be more costly for less care. But the Long Islanders went an extra step: to demand single-payer – that is, Medicare for All – beginning with New York State.

The rally was one of 150 across the country last weekend with some coordination of Bernie Sanders’ Our Revolution group.

The activists jammed a main room, overflowed the overflow room, and were lined up outside, producing a kind of echo-effect to cheers and boos inside the hall.

Long Island Activists rally for universal health care, Huntington, Long Island, Feb. 25, 2017.

“Something feels wrong. Public policy in no way reflects public opinion,” said Ron Widelec, a member of the steering committee of Long Island Activists (LongIslandActivists.org).

“We live in the richest country in history, yet 20 million go without health insurance, tens of millions have insurance but can’t afford to use because the deductibles so high – choosing between feeding children or going to a doctor when not feeling well. These are unacceptable choices in a country this wealthy…

“These are life-or-death situations. That’s why people are out here. It turns out, if you try to take away people’s health care, get angry and show up. Tens of thousands die without access to health care, or can’t afford access so that is the same as not having access. People die if they can’t afford an Epipen.

The Affordable Care Act (Obamacare) was not perfect because it was designed to appease conservatives. Indeed, the framework came out of the right-wing think tank, The Heritage Foundation, and was first implemented by Republican Governor Mitt Romney in Massachusetts. Elements such as a public option or a Medicare buy-in were omitted in order to satisfy so-called moderate Republicans like Susan Collins of Maine, who nonetheless voted against the ACA.

“Many members of Congress are dedicated to the idea they can make the situation even worse . Our position is clear: health care is a human right,” he declared to boisterous cheers.

“While no one thinks ACA perfect, it did things we need to fight for,” Widelec said. “ACA didn’t go far enough – a human right doesn’t have co-pays or deductibles.

“On the federal level, there is very little we can do with Congress. We know Republicans want to overthrow ACA… We have to fight to protect Obamacare and put pressure even on those too cowardly to hold town halls [like Long Island Congressmen Peter King and Lee Zeldin].

Long Island Activists rally for universal health care, Huntington, Long Island © 2017 Karen Rubin/news-photos-features.com

But while progressives all along wanted universal health care – that is, single-payer or what is termed Medicare for All – the most immediate goal is to preserve the key elements of Obamacare: covering young people on their parents’ plan until age 26; pre-existing conditions; no lifetime caps; a cap of no more than 20% of the premium going for non-patient spending , and minimal standards for what insurance policies cover – which turns out can only be offered if there is a mandate so that healthy people purchase insurance; otherwise, deductibles or copays or premiums are so high, they are unaffordable.

“It’s not true that the Republicans don’t have a plan,” warned Doreen DiLeonardo, who hosts a progressive radio show. Indeed, the plan that was exposed by Politico is essentially the 2015 bill introduced by then Congressman Tom Price, now the Secretary of Health & Human Services.

According to Politico, the Republican plan would rescind the unpopular individual mandate, subsidies based on people’s income, and all of the law’s taxes. It would significantly roll back Medicaid spending and give states money to create high risk pools for some people with pre-existing conditions. Instead of subsidies to help people with low incomes afford health insurance, it would give tax credits based on age rather than income. That means that multi-millionaire Rex Tillerson, former CEO of Exxon-Mobil and now Trump’s Secretary of State would get a bigger tax credit than the 30-year old who works at Starbucks. In any case, tax credits mainly benefit wealthier people. Meanwhile, the other big Republican idea is for Health Savings Accounts, which once again, benefit wealthier people, while those who are barely affording food and rent will be unable to stash away money in untaxed accounts. (See: Exclusive: Leaked GOP Obamacare replacement shrinks subsidies, Medicaid expansion)

What Democrats point to, though, are provisions that would wind up taxing middle class and working class families for the health insurance benefits they get from their employers, while at the same time ending taxes on the wealthiest Americans that funded the Obamacare subsidies.  

“If it were such a good plan, they wouldn’t be hiding it,” DiLeonardo said.

This plan is moving swiftly, she warned.

Assemblyman Charles Lavine is a sponsor of a single-payer health plan in the New York State legislature © 2017 Karen Rubin/news-photos-features.com

The Republicans’ “destructive, nihilistic policy will ruin the ACA,” Assemblyman Charles Lavine, who has sponsored universal health care in the State Assembly, said. “They attempted to ruin it from beginning, based on lies. Each and every one here today, superheroesque, survivors of the ‘massacre at Bowling Green’, we know 20-30 million Americans would lose insurance, we know the tragedy that will flow from that – we will return to days preexisting conditions rob people of access to health care. You’re on your own. Lifetime caps – if someone had serious condition, cut off, no more insurance., – when that happens we all pay one way or another for their treatment. Women will pay more for identical coverage, young adults up to 26 no longer on parents’ coverage, you’re on your own.

“We know the lies being told. Trump said ACA robbed people of their insurance. We know that is just another lie. More than 20 million were able to get insured because of ACA, we now have a record low percentage of uninsured people, 10.9%.

“Trump said some plans were canceled [using this to accuse Obama of lying about ACA]. But that’s because they  were deficient, illusory plans. What Trump and his confederates want to do, is to allow New Yorkers to go into market and buy insurance from other states. NYS is not going to allow that to happen. We will demand (because NY controls insurance product) that any insurance product sold here has to provide minimum requirements, or else people will get ripped off. Those are the kind of policies people lost because of ACA.”

Senator Chuck Grassley of Iowa lied when he said Obamacare would create death panels that would pull the plug on grandma. But a century ago, the worldwide flu epidemic killed off 50 to 100 million people, and bodies were piled up on street corners in Chicago waiting for the city to pick them up, people were on their own, too.

“That’s not that long ago – a blink in time of human history. We stand together you rebellious Americans to demand the human right of health care, and we stand together (big applause). This is a fight for our families, our communities. We are 36 years since the first days of Reagan Administration into a philosophy that says government isn’t the solution, it’s the problem, your enemy. You and I will fight for our families, communities, and damn well we stand up and fight for our government.”

Recalling that President Theodore Roosevelt, a progressive who busted up trusts and created the first national parks, whose home at Sagamore Hill is just a few miles from where this rally is taking place, Ron Widelec  said, “Once republicans were progressives, put in policies that helped people, now they are wedded to the invisible hand of the American market, not noticing, it is a hand around throats of American people. We will fight back.”

Congressman Tom Suozzi (D-NY3) addressing the Long Island Activists health care rally in Huntington: “Mend it don’t end it. Fix the problems.” © 2017 Karen Rubin/news-photos-features.com

Newly elected Congressman Tom Suozzi, who has pledged to support universal health care once Democrats take back Congress (and held a packed town hall this past week in which support for ACA was a key issue), said “I believe in health care as a human right. This is a matter of life-and-death for many families now. We have to do a couple of things: protect ACA is the first thing. There is great energy behind that. But we need to improve upon ACA because there are problems – insurance companies, drug companies had too much say in writing ACA and we’re paying the price. Mend it don’t end it. Fix the problems.”

Next:  New Yorkers Mobilize for Single Payer Health Care

______________________

© 2017 News & Photo Features Syndicate, a division of Workstyles, Inc. All rights reserved. For editorial feature and photo information, go to www.news-photos-features.com, email editor@news-photos-features.com. Blogging at  www.dailykos.com/blogs/NewsPhotosFeatures.  ‘Like’ us on facebook.com/NewsPhotoFeatures, Tweet @KarenBRubin

 

2.7 Million New Yorkers Would Lose Health Coverage if Republicans Repeal Obamacare

NYS Governor Andrew Cuomo warns that 2.7 million New Yorkers would lose health coverage if Republicans repeal Obamacare; the impact on the state’s budget would be $3.7 billion © 2017 Karen Rubin/news-photos-features.com
NYS Governor Andrew Cuomo warns that 2.7 million New Yorkers would lose health coverage if Republicans repeal Obamacare; the impact on the state’s budget would be $3.7 billion © 2017 Karen Rubin/news-photos-features.com

If Republicans succeed in repealing the Patient Protection and Affordable Care Act (Obamacare), an estimated 2.7 million New Yorkers would lose health coverage, New Yorkers would lose $250 million in Health Care Savings Tax Credits, and New York State would experience a direct state budget impact of $3.7 billion and a loss of nearly $600 million of federal funding that goes directly to counties, which they use to help lower property taxes.

“The cost of a repeal of the Affordable Care Act, to state and local budgets and to the New Yorkers who depend on its health care coverage, is simply too high to justify,” Governor Andrew M. Cuomo said. “Since its implementation, the Affordable Care Act has become a powerful tool to lower the cost of health insurance for local governments and New Yorkers, and it is essential that the federal government does not jeopardize the health and livelihoods of millions of working families.”

The NY State of Health exchange has successfully cut the percentage of uninsured New Yorkers in half, from 10 percent to 5 percent. It has also significantly expanded eligibility and access to health coverage, allowing hundreds of thousands of previously uninsured New Yorkers to achieve economic and healthcare security.

Based on current enrollment levels, the repeal of the Affordable Care Act would result in over 2.7 million New Yorkers losing health coverage. The estimated number of individuals at risk of losing coverage, based on current enrollment levels, is broken down by counties below:

County Individuals at Risk of Losing Coverage
Albany 25,552
Allegany 4,608
Bronx 300,012
Broome 20,231
Cattaraugus 8,310
Cayuga 7,665
Chautauqua 15,270
Chemung 9,160
Chenango 5,184
Clinton 7,787
Columbia 6,827
Cortland 4,606
Delaware 4,461
Dutchess 25,074
Erie 93,403
Essex 3,660
Franklin 5,110
Fulton 6,038
Genesee 5,074
Greene 4,971
Hamilton 522
Herkimer 6,932
Jefferson 10,955
Kings 540,320
Lewis 2,932
Livingston 4,972
Madison 5,861
Monroe 75,512
Montgomery 5,473
Nassau 133,324
New York 218,937
Niagara 21,287
Oneida 24,781
Onondaga 45,682
Ontario 9,355
Orange 37,851
Orleans 4,522
Oswego 12,568
Otsego 5,785
Putnam 7,006
Queens 493,058
Rensselaer 12,540
Richmond 56,882
Rockland 38,526
Saratoga 16,340
Schenectady 16,056
Schoharie 3,079
Schuyler 2,065
Seneca 3,145
St. Lawrence 11,063
Steuben 10,039
Suffolk 152,631
Sullivan 9,668
Tioga 4,560
Tompkins 7,827
Ulster 19,850
Warren 6,796
Washington 6,689
Wayne 9,354
Westchester 91,844
Wyoming 3,700
Yates 2,515
Total 2,715,807

The estimated direct state budget impact of the repeal is $3.7 billion. New York’s counties have been able to use the additional federal Medicaid funding through the Affordable Care Act, which goes to directly to counties and helps to lower property taxes. A repeal of the Affordable Care Act would result in a total loss of $595 million in funding. A county by county breakdown of the allocated annual funding that each county would lose is available below, based on the most recent year:

County 2016-17 Funding
Albany $4,738,862
Allegany $786,300
Broome $3,049,122
Cattaraugus $1,211,333
Cayuga $1,098,606
Chautauqua $2,443,709
Chemung $1,491,573
Chenango $686,373
Clinton $1,292,531
Columbia $833,957
Cortland $786,023
Delaware $666,830
Dutchess $2,974,044
Erie $17,149,148
Essex $400,176
Franklin $681,442
Fulton $879,897
Genesee $691,774
Greene $832,298
Hamilton $68,800
Herkimer $956,261
Jefferson $1,601,068
Lewis $294,378
Livingston $686,242
Madison $842,891
Monroe $13,023,431
Montgomery $797,695
Nassau $17,866,829
Niagara $3,849,704
Oneida $4,169,425
Onondaga $7,871,592
Ontario $1,042,122
Orange $5,021,173
Orleans $667,917
Oswego $2,281,144
Otsego $729,112
Putnam $561,094
Rensselaer $2,307,076
Rockland $3,867,080
St. Lawrence $1,564,073
Saratoga $1,864,638
Schenectady $2,462,377
Schoharie $475,760
Schuyler $312,126
Seneca $369,493
Steuben $1,514,370
Suffolk $18,310,813
Sullivan $1,439,822
Tioga $589,433
Tompkins $1,015,126
Ulster $2,935,566
Warren $787,632
Washington $746,252
Wayne $910,595
Westchester $15,243,258
Wyoming $382,781
Yates $282,426
Upstate Total $162,405,572
New York City Total $433,294,428
New York State Total $595,700,000

“New York’s healthcare workers see the positive impact of the Affordable Care Act every day,” George Gresham, President, 1199SEIU United Healthcare Workers East, said. “Our patients are able to access preventative care instead of coming to emergency rooms in states of advanced illness. Our employers have reduced losses from uncompensated care. Our friends and relatives are relieved of the fear that getting sick equals financial ruin. Repealing the Affordable Care Act without an adequate replacement would have immediate and devastating consequences for millions of our fellow New Yorkers and for state and local budgets. We applaud Governor Cuomo’s leadership in educating New Yorkers about costs and are proud to stand with him to advocate for the health all New Yorkers,”

Greater New York Hospital Association President Kenneth E. Raske said, “These deeply troubling numbers are only the tip of the iceberg if the Affordable Care Act is repealed. It will also severely harm the hospital community. 27 hospitals across New York State are on a ‘watch list’ for financial stress and many more both public and private face similar fiscal challenges. Repealing the Affordable Care Act without an immediate and adequate replacement plan will make things dramatically worse for safety net hospitals and the vulnerable communities they serve. I applaud Governor Cuomo for his leadership and look forward to working with the bipartisan members of the New York Congressional delegation to ensure that the health care of all New Yorkers is protected.”

“In addition to providing care to those in need, hospitals are major employers in communities all across the state,” stated Bea Grause, President of the Healthcare Association of New York. “Repeal of the ACA could have tremendous consequences for the delivery of healthcare and also in terms of jobs and economic activity. It’s imperative that Congress be mindful of this reality. I’m pleased to join the Governor in this important effort to protect New Yorkers.”

Obama Takes Steps to Strengthen Insurance Coverage for Mental Health and Substance Use Disorders

“For too long, Americans paid for health insurance that did not recognize that treatment for mental health and substance use disorders is as essential as other medical treatment,” the White House stated in a Fact Sheet describing steps the Federal Parity Task Force is taking to strengthen indusrance coverage for mental health and substance use disorders. “Untreated mental health and substance use disorders can be debilitating and life-threatening.  These consequences are apparent in the prescription opioid and heroin epidemic, as well as the troubling rates of suicide and severe mental illness in this country.

 

“One of the many important provisions of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act is to ensure that health insurance plans treat mental health and substance use disorders the same way that they treat other health conditions.  In March of this year, President Obama established the Mental Health and Substance Use Disorder Parity Task Force and charged Federal Departments and Agencies to work together to ensure that Americans are benefiting from the mental health and substance use disorder parity protections under the law.  Parity aims to eliminate restrictions on mental health and substance use coverage – like annual visit limits, higher copayments, or different rules on how care is managed such as frequent pre-authorization requirements or medical necessity reviews – if comparable restrictions are not placed on medical and surgical benefits.” 

 

In its final report, the Task Force announced a series of actions and recommendations to help ensure better implementation of parity; to help consumers, providers, and plans understand how parity works; and to ensure appropriate oversight and enforcement of parity protections.  

 

These steps are based on input the Task Force received through a series of listening sessions between March and October held with consumers, providers, employers, health plans, and State regulators, and through the more than 1,100 public comments the Task Force received from individuals with mental health and substance use disorders, families, their providers, advocates, and other stakeholders.  

 

“These recommendations are subject to future budget and policy deliberation,” The White House noted. “Together, today’s steps build on the ongoing work of the Administration to make the treatment of mental health and substance use disorders a priority.  The Affordable Care Act ended insurance discrimination based on pre-existing conditions, including mental health and substance use disorders; required coverage of mental health and substance use disorder services in non-grandfathered plans in the individual and small group insurance markets; ensured that recommended preventive screenings, including for depression and alcohol misuse, are available with no co-pays; and expanded Medicaid to millions of additional Americans, significantly improving coverage for mental health care and substance use disorder treatment.  In addition, the Administration has issued final regulations providing parity protections to individuals covered through the employer and individual insurance markets, people covered through Medicaid managed care organizations and the Children’s Health Insurance Program, and service members and their families covered through TRICARE.

 

“Through these steps, the country has made significant progress in expanding mental health and substance use disorder coverage and parity protections for millions of Americans.  The Task Force report focuses on parity-related actions and recommendations and does not include the provisions in the President’s Budget that would further expand access to care, including new investments in treatment capacity.  The actions and recommendations announced today will continue to advance the Administration’s progress on parity implementation.”

 

The full report is available here: http://www.hhs.gov/parity

 

Here are the actions announced by the Task Force: 

·         The Centers for Medicare & Medicaid Services (CMS) is awarding $9.3 million to States to help enforce parity protections.  CMS funding will help State insurance regulators work to ensure issuer compliance with the mental health and substance use disorder parity protections. 

·         The Department of Health and Human Services (HHS), in partnership with the Department of Labor (DOL) and other Task Force agencies, is releasing the beta version of a new parity website to help consumers find the appropriate Federal or State agency to assist with their parity complaints, appeals, and other actions. The Task Force received many comments about the challenges consumers face in identifying the appropriate agency that regulates their insurance coverage.  The beta site is being released today for public comment.  In the future, the Task Force Departments intend to work together to build out additional functionality on the website related to complaint and data tracking. 

·         The Substance Abuse and Mental Health Services Administration (SAMHSA) and DOL are releasing a Consumer Guide to Disclosure Rights: Making the Most of Your Mental Health and Substance Use Disorder Benefits to help consumers, their representatives, and providers understand what type of information to ask for when inquiring about a plan’s compliance with parity and to explain the various Federal disclosure laws that also require disclosure of information related to parity. The Guide includes 11 scenarios, each with specific suggestions for information consumers have a right to that can help, as well as timing requirements for plans and issuers providing these documents. 

·         DOL is announcing that it will release annual data on closed Federal parity investigations and will report on the findings, including the violations cited to ensure parity compliance and inform future policymaking efforts.  This effort builds on the 1,515 investigations related to the Mental Health Parity and Addiction Equity Act and 171 violations cited by DOL since October of 2010. 

·         To ensure parity compliance in plans required to offer essential health benefits, CMS has added Mental Health Parity and Addiction Equity Act compliance to its review of plans subject to the essential health benefits requirement under the Affordable Care Act, and it expects State regulators to do so as well.  

·         DOL, HHS, and the Department of Treasury (Treasury) are issuing guidance on parity and opioid use disorder treatment to address specific questions the Departments have received related to issues such as the application of parity to opioid treatment access and coverage of court-ordered treatment. 

·         HHS, DOL and Treasury are soliciting feedback on how the disclosure document request process can be improved (input is being sought through the FAQ process), while continuing to ensure consumers’ rights to access all appropriate information and documentation.  The request solicits input on the option of developing model forms for parity-related disclosure requests.  

·         SAMHSA is announcing that it will host two State Policy Academies on Parity Implementation for State Officials in Fiscal Year 2017, including one focused on the commercial market and one on parity in Medicaid and the Children’s Health Insurance Program.  These policy academies will bring together national experts to provide technical assistance to teams of State officials on strategies to advance parity compliance and lessons learned from other States’ implementation efforts.  

·         CMS will undertake a review of mental health and substance use disorder benefits in Medicare Advantage plans and identify any necessary improvements to advance parity protections. 

·         DOL, HHS, and Treasury are issuing a Parity Compliance Assistance Materials Index.  The Departments have issued a total of 44 Frequently Asked Questions (FAQs) over the past six years related to parity, generally as part of larger guidance documents, as well as other parity materials.  Several commenters suggested to the Task Force that putting all the parity-related FAQs and guidance together in one place would make the information easier to find and use for States, plans consumers, and other stakeholders.  

In addition, the Task Force made the following recommendations: 

        Create a one-stop consumer web portal to help consumers navigate parity, which will build out the functionality of the beta parity website released today.  The Task Force recommends that the website should help consumers solve coverage issues, file a complaint, or submit an appeal, and also be used to better inform parity oversight and enforcement efforts.  

        Increase Federal agencies’ capacity to audit health plans for parity compliance.  The Task Force recommends that agencies’ future budgets include funding to expand audit capacity.  Given current resources, Federal parity enforcement efforts to date have generally focused on investigating consumer, provider and other parity complaints.  Agencies’ capacity to expand enforcement activities, including conducting random audits, is limited by their staffing resources.  

        Undertake a detailed review of the non-quantitative treatment limits applicable to substance use disorder benefits in the Federal Employees Health Benefits (FEHB) Program.  The Task Force received comments suggesting that non-quantitative treatment limits in FEHB plans may need examination and modification to ensure full compliance, as well as comments suggesting that consistent definitions of terms relating to residential treatment would provide greater transparency for consumers.  The U.S. Office of Personnel Management has agreed to conduct this review over the coming year, and take corrective action as indicated by the findings. 

        Allow the Department of Labor to assess civil monetary penalties for parity violations.  Civil monetary penalty authority would lead to more meaningful penalties for non-compliance with parity.  The Task Force recommends that Congress provide the Department of Labor with this authority. 

        Develop examples of parity compliance best practices and of potential warning signs of non-compliance.  Building on the 2016 DOL/HHS “Warning Signs” document identifying non-quantitative treatment limitations that require additional analysis to determine if they are in compliance with parity, the Task Force recommends a Warning Signs 2.0 document and encourages the inclusion of network adequacy issues in the document.  The Task Force also recommends developing further examples of parity compliance best practices to illustrate appropriate application of non-quantitative treatment limitations that are comparable between mental health/substance use disorder benefits and medical/surgical benefits. 

        Provide Federal support for State efforts to enforce parity through trainings, resources, and new implementation tools, including model compliance templates.  The Task Force recommends continued Federal efforts to provide training and other resources to States to support compliance efforts including partnerships between State mental health/substance use, Medicaid, and State insurance agencies.  Further, the Task Force recommends that Federal regulators work with the National Association of Insurance Commissioners and the States to develop a standardized template that States might use to help assess parity compliance.  The Task Force also encourages Federal regulators, the National Association of Insurance Commissioners, and other stakeholders to consider a joint effort to develop a model prior authorization form and other model forms.  

        Provide simplified disclosure tools to provide consistent information for consumers, plans and issuers.  To facilitate disclosure, the Task Force recommends that, in coordination with the National Association of Insurance Commissioners, templates and other sample standardized tools be developed to improve consumer access to plan information.  

        Expand consumer education about parity protections.  The Task Force recommends continuing and expanding the work to educate consumers about parity and partnering with consumer groups to increase consumer awareness and understanding of parity protections. 

        Clarify that health plan disclosure requirements include medical and surgical benefits.  The Task Force heard from commenters that it can be challenging to ensure parity compliance when information on medical and surgical benefits is not readily available to allow for comparison to mental health and substance use disorder benefits.  Disclosure of the relevant information used to apply coverage limitations to medical and surgical services is currently required for plans covered under the Employee Retirement Income Security Act (ERISA).  The Task Force recommends that Congress extend this requirement to non-ERISA plans. 

        Implement the Medicaid and Children’s Health Insurance Program (CHIP) parity final rule in a robust manner.  The Task Force recommends that implementation include the development of a parity analysis toolkit to help States assess compliance with the final rules on parity for Medicaid managed care organizations and CHIP programs.  The toolkit will review key considerations for defining and classifying mental health and substance use disorder benefits (including intermediate and long term supports and services), conducting claims-based analyses for quantitative treatment limits, identifying and analyzing non-quantitative treatment limits, and considerations for Alternative Benefit Plans and CHIP. 

        Expand access to mental health and substance use disorder services in TRICARE. The Task Force recommends the Department of Defense’s continued implementation of the TRICARE final rule on mental health and substance use disorders and parity through contract modifications and DOD’s monitoring of access to mental health and substance use disorder care to ensure parity with medical/surgical care. 

        Eliminate the lifetime day limit on Medicare Part A treatment in psychiatric hospitals.  In Medicare Part A (hospital coverage), there is a 190-day lifetime limit on inpatient treatment in psychiatric hospitals while there is no such limit on inpatient medical/surgical hospital treatment.  The Task Force recommends that Congress eliminate the psychiatric hospital lifetime day limit, consistent with the President’s 2017 budget request. 

        Update guidance to address the applicability of parity to opioid use disorder services.  The Task Force recommends issuing guidance clarifying the application of parity to opioid use disorder treatment benefits in response to specific scenarios associated with these benefits raised by consumers and other stakeholders and updating this guidance regularly, as warranted.  

        Eliminate the parity opt-out process for self-funded non-Federal governmental plans. Currently, self-funded non-Federal governmental plans have the ability to elect to not comply with certain Federal provisions including the Mental Health Parity and Addiction Equity Act, which deprives thousands of employees of State and local governments of the mental health and substance use disorder parity protections.  The Task Force recommends that Congress eliminate the ability of these plans to opt out of these protections. 

Dueling Candidates on Health Care: Hillary Clinton Would Improve Upon Obamacare, Donald Trump Would Repeal, Restore Control to Insurance Companies

Donald Trump and Hillary Clinton, during presidential debate, have very different health care proposals © 2016 Karen Rubin/news-photos-features.com
Donald Trump and Hillary Clinton, during presidential debate, have very different health care proposals © 2016 Karen Rubin/news-photos-features.com

Before the Affordable Care Act (ACA, better known as Obamacare), more than 50 million Americans were without any health insurance and 20,000 people were losing their health insurance each month as the Bush Great Recession hemorrhaged 850,000 jobs a month. Though employers for more than a decade have been cutting back on health benefits (making it a Hobson’s choice to leave a terrible job or an abusive marriage), 170 million people get their insurance through their employment, and insurance companies were raising premiums annually at rates five times the rate of inflation, refusing to provide insurance based on pre-existing conditions, charging women higher rates (because they have babies, don’t you know), arbitrarily denying services, capping lifetime claims, throwing people off insurance, and pocketing 25-30% of the premium, with only 70-75% going to patient care. 

The Affordable Care Act, designed to make health insurance accessible to everyone, made improvements that have benefited everyone (as Hillary said), but meant the difference between life and death for the 50 million who could not afford health care at all. But to get it passed Obama had to make compromises, including giving up a public option. Then, chiefly Republican-dominated states rejected ACA, casting millions of their residents into a limbo where they could not qualify for the federally-provided exchange and didn’t have access through an employer. 

Significantly, ACA (Obamacare) was a Hail Mary to get universal access to health care, with some benefits in terms of containing health care costs. But the next round of health care reform would need to address costs. Here, in the words of their own campaigns, are the candidates’ health plans – in essence, Donald Trump pledges to repeal Obamacare and replace it by returning to “market” (that is, for-profit insurance companies) control, while Hillary Clinton is vowing to make necessary improvements to Obamacare to continue the goal of universal health care, correcting the inequities between states which refused Obamacare and possibly with a public option – Karen Rubin, News & Photo Features. 

Trump: Obamacare is a Disaster and Needs to be Repealed

“Obamacare Is A Disaster. You Know It We All Know It.”

During the second presidential debate, the question was asked, “What will you do to bring down the cost of health care? This is the rambling, nonsensical reply to the question, and the Trump campaign is so proud of it, they emailed it out:

trump-debate2-obamacare

TRUMP: “It is such a great question, and it’s maybe the question I get almost more than anything else. Outside of defense. Obamacare is a disaster. You know it we all know it. It is going up at numbers that nobody has ever seen worldwide. No One has ever seen numbers like this for healthcare. It is only getting worse. In seventeen, implodes by itself. Their methods of fixing it is to go and ask Congress for more money. More and more money. We right now have almost twenty trillion dollars in debt. Obama care with mother work. It is very bad, very bad health insurance. Far too expensive, and not only expensive for the person that has it, unbelievably expensive for our country. It’s got to be one of the biggest line items very shortly. We have to repeal it, and replace it with something absolutely much less expensive. And something that works. Where your plan can actually be tailored. We have to get rid of the lines around the state, and official lines. Where we stop insurance companies from coming in and competing because they wanted President Obama and whoever is working on it. They want to leave those lines because that gives the insurance companies, essentially, monopolies. We want competition. You will have the finest healthcare plan there is, she wants to go to a single-payer pan. Which would be a disaster. Somewhat similar to Canada. And if you haven’t noticed the Kitty Indians, when they need a big operations they come into the United States in many cases. Because they are system is so slow, it is catastrophic in certain ways. But she wants to go to single-payer. Which means the government basically rules everything. Hillary Clinton has been after this for years. Obamacare was the first step. Obamacare is a total disaster. And not only are your rates going up by numbers that no one has ever believed, but your deductibles are going up. So that unless you get hit by a truck, you are never going to be able to use it. It is a disastrous plan and it has to be repealed.” (Click To Watch)

Clinton’s Plan To Improve Our Health Care And Build On The Affordable Care Act

“Hillary Clinton will defend and expand on the progress made under Obama Administration toward universal coverage through the Affordable Care Act. The fact is, Hillary has never given up on the fight for universal coverage—and she won’t stop now. As First Lady, she refused to give up when the insurance industry and special interests attacked her and defeated healthcare reform. Instead, she worked with Republicans and Democrats to help create and implement the Children’s Health Insurance Program, which now provides health coverage to more than 8 million children,” Hillary for America campaign stated.

Hillary Clinton, Democratic candidate for President, advocates improving upon Obamacare toward the goal of universal health care © 2016 Karen Rubin/news-photos-features.com
Hillary Clinton, Democratic candidate for President, advocates improving upon Obamacare toward the goal of universal health care © 2016 Karen Rubin/news-photos-features.com

As president, Hillary will build on the Affordable Care Act to expand coverage for millions of Americans.

  • She will  lower-out-of-pocket expenses for consumers purchasing health insurance on the Obamacare exchanges. Hillary believes that in order to expand coverage for families, we need to reduce the cost of purchasing health insurance on the Affordable Care Act exchanges. Her plan will provide enhanced relief for people on the exchanges, and provide a tax credit of up to $5,000 per family to offset a portion of excessive out-of-pocket and premium costs above 5% of their income. She will enhance the premium tax credits now available through the exchanges so that those now eligible will pay less of a percentage of their income than under current law and ensure that all families purchasing on the exchange will not spend more than 8.5 percent of their income for premiums. Finally, she will fix the “family glitch” so that families can access coverage when their employer’s family plan premium is too expensive.
  • She will support new incentives to encourage all states to expand Medicaid. Hillary will fight for health insurance for our lowest income residents living in every state across the nation. Hillary will follow President Obama’s proposal to allow any state that signs up for the Medicaid expansion to receive a 100 percent match for the first three years, and she will continue to look for other ways to incentivize states to expand Medicaid to meet the health needs of their most vulnerable residents.
  • She will invest in navigators, advertising and other outreach activities to make enrollment easier. Today, as many as 16 million people or half of all those uninsured are eligible but not enrolled in virtually free Medicaid coverage or exchange coverage for as little as $100 a month or less. Hillary will ensure anyone who wants to enroll can understand their options and do so easily, by dedicating more funding for outreach and enrollment efforts. She will invest $500 million per year in an aggressive enrollment campaign to ensure more people enroll in these extremely affordable options.
  • She will expand access to affordable health care to families regardless of immigration status. Hillary sponsored the Immigrant Children’s Health Improvement Act in the Senate, which later became law and allows immigrant children and pregnant women to obtain Medicaid and CHIP. She believes we should let families—regardless of immigration status—buy into the Affordable Care Act exchanges. Families who want to purchase health insurance should be able to do so.
  • She will continue to support a “public option”—and work to build on the Affordable Care Act to make it possible. As she did in her 2008 campaign health plan, and consistently since then, Hillary supports a “public option” to reduce costs and broaden the choices of insurance coverage for every American. To make immediate progress toward that goal, Hillary will work with interested governors, using current flexibility under the Affordable Care Act, to empower states to establish a public option choice.

Going forward, Hillary will build on these efforts and fight to ensure that the savings from these reforms benefits families—not just insurance companies, drug companies, and large corporations. She will expand coverage for Americans living in rural areas and continue a lifelong commitment to protecting women’s reproductive rights.

  • Hillary’s plan will reduce the cost of prescription drugs. Prescription drug spending accelerated from 2.5 percent in 2013 to 12.6 percent in 2014. It’s no wonder that almost three-quarters of Americans believe prescription drug costs are unreasonable. Hillary believes we need to demand lower drug costs for hardworking families and seniors and she will hold drug companies accountable for unjustified price hikes with new penalties.
  • Her plan will transform our healthcare system to reward value and quality. Hillary is committed to building on delivery system reforms in the Affordable Care Act that improve value and quality care for Americans.
  • Hillary will also work to expand access to rural Americans, who often have difficulty finding quality, affordable health care. She will explore cost-effective ways to broaden the scope of health care providers eligible for telehealth reimbursement under Medicare and other programs, including federally qualified health centers and rural health clinics. She will also call for states to support efforts to streamline licensing for telemedicine and examine ways to expand the types of services that qualify for reimbursement.

Hillary is continuing a lifelong fight to ensure women have access to reproductive health care. As senator, she championed access to emergency contraception and voted in favor of strengthening a woman’s right to make her own health decisions. As president, she will continue defending Planned Parenthood, which provides critical health services including breast exams and cancer screenings to 2.7 million patients a year. And she will work to ensure that all women have access to preventive care, affordable contraception, and safe, legal abortion—not just in principle, but in practice, by ending restrictions like the Hyde Amendment.

Hillary for America also challenged Trump’s proposals:

Trump Would Rip Away Health Coverage From 20 Million People And Let Insurers Write The Rules

Donald Trump would immediately work to repeal Obamacare–taking health insurance away from at least 20 million people and letting the insurance companies write the rules all over again. Trump even supported shutting down the government in order to defund Obamacare.

  • New York Times: “Millions of low-income people have gained coverage under the Affordable Care Act and could lost it if Congress repealed the law.”
  • Trump saidhe supported Republicans’ efforts to shut down the government over Obamacare and that they should have stuck together.

Trump’s “plan” would cost hundreds of billions more, and does not address people with pre-existing conditions.

  • CNBC: More $$$, More Uninsured: Donald Trump’s Health-Care Plan
  • VOX:  Trump’s Plan Would Take Health Insurance Away From 21 Million People. Sad!
  • Bloomberg: “Trump’s proposal is silent on the subject of preventing insurers from dropping coverage for those with preexisting conditions, a feature of Obamacare that Trump has said he supports.”

Meanwhile, the Trump campaign is making hay, taking a statement that President Bill Clinton made out of context:

FACT CHECK: President Clinton And The Affordable Care Act

“Don’t believe Donald Trump when he distorts what President Clinton said about the Affordable Care Act. Bill Clinton, Hillary Clinton, Tim Kaine and President Obama all agree that we have made tremendous progress because of the Affordable Care Act, delivering coverage to 20 million people who were previously uninsured — but they agree there’s more we can do.”

  • Politifact: “In context, it’s also worth noting that Clinton’s actual comments never mentioned the Affordable Care Act or Obamacare. In fact, as we reviewed the transcript, we noticed that much of what Clinton said addressed issues that pre-dated the 2010 health care law, including concerns about high costs and a lack of guaranteed coverage.”

The bottom line is Hillary will defend and expand on the progress made under Obama Administration toward universal coverage through the Affordable Care Act, while Donald Trump would immediately work to repeal Obamacare, taking health insurance away from 20 million people – and letting the insurance companies write the rules all over again. Trump’s suggested healthcare plan would cost hundreds of billions more, and does not address people with pre-existing conditions.

See also:

By One Measure, Health Care Law Is a Record Success

The Affordable Care Act: Healthy Communities Six Years Later

The Affordable Care Act made it possible for young people, striking out on their own with their own entrepreneurial enterprises, to get affordable health insurance © 2016 Karen Rubin/news-photos-features.com
The Affordable Care Act made it possible for young people, striking out on their own with their own entrepreneurial enterprises, to get affordable health insurance © 2016 Karen Rubin/news-photos-features.com

I’m so sick of Republicans, especially those who would be President and promise to repeal every word of the Affordable Care Act, lying about how Obamacare has harmed jobs creation, and destroyed American freedom. Such a crock. The White House has just issued a fact sheet appraising the Affordable Care Act six years after. Republicans are a fact-free zone, but here are the facts: 

FACT SHEET: The Affordable Care Act: Healthy Communities Six Years Later

President Obama promised that he would make quality, affordable health care not a privilege, but a right. After nearly 100 years of talk and decades of trying by presidents of both parties, that’s exactly what he did.

On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law, putting in place comprehensive reforms that improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. Because of the ACA, 17.6 million previously uninsured people had gained coverage prior to this year’s open enrollment period, and the law has driven the uninsured rate below 10 percent for the first time since we started keeping records. The ability to buy portable and affordable plans on a competitive marketplace is giving Americans the freedom to move, leave an unsatisfying job and start businesses which is especially important as more consumers become entrepreneurs. And thanks in part to the law’s focus on reducing costs and inefficiencies, health care prices have risen at the slowest rate in 50 years since the law passed, which will benefit all of us for years to come.

These access gains are due in large part to the efforts of local and state elected officials, community organizations and leaders, and volunteers who have worked tirelessly to help their neighbors find access to quality, affordable coverage. During the most recent open enrollment period from November 1 through January 31, the Administration and its partners on the ground nationwide undertook an unprecedented local and regional effort to sign up the remaining uninsured who are eligible for Marketplace coverage.

As part of this effort, the White House launched its “Healthy Communities Challenge” to engage 20 key communities with large numbers or high percentages of uninsured in states across the country where strong federal, state, and community collaboration can have a meaningful impact on reaching the uninsured. Last month, the White House announced that the winner of the challenge is Milwaukee, Wisconsin. Under the leadership of Mayor Tom Barrett and County Executive Chris Abele, about 38,000 people in the Milwaukee area newly selected a plan through the Health Insurance Marketplace during this open enrollment period. Together with returning Marketplace consumers, about 89,000 people in the Milwaukee area selected a 2016 Marketplace plan. Nationwide, nearly 13 million Americans signed up for 2016 Marketplace coverage, including people who were previously uninsured, as well as Americans finding coverage as they go through changes in life such as being in between jobs or aging off their parents’ plans.

Because of the Affordable Care Act, This is What Health Care in America Looks Like Today:

  • 17.6 million consumers have gained health insurance thanks to the ACA, prior to this year’s open enrollment period.  From 2010 through the first nine months of 2015, the uninsured rate has fallen by more than 40 percent and, for the first time ever, more than 9 in 10 Americans now have health insurance. In Wisconsin, Gallup recently estimated that the adult uninsured rate in 2015 was 5.9 percent, down from 11.7 percent in 2013.
  • As many as 129 million Americans who have some type of pre-existing health condition, including up to 19 million children, are now protected from coverage denials and reduced benefits – practices that were routine before the law’s enactment.
  • 105 million Americans, including 39.5 million women and nearly 28 million children, have benefited from annual limits on out-of-pocket spending on essential health benefits – and the elimination of lifetime and annual limits on insurance coverage. These are protections that did not exist before the ACA.
  • Americans now have access to critical preventive services at no cost, like flu shots, yearly check-ups, and birth control. These are benefits that did not exist before the ACA.
  • Over 14 million more Americans have received coverage through Medicaid since the ACA’s first open enrollment period in 2013. States have an option to expand Medicaid to all non-eligible adults with incomes under 133 percent of the federal poverty level, and to date, 31 states and the District of Columbia have chosen to expand the program.  In these states that have already expanded Medicaid, 4.4 million uninsured people will gain coverage.  If the remaining states expand Medicaid, over 4 million more uninsured people would gain coverage.
  • The ACA has provided new transparency in how health insurance plans disclose reasons for premium increases and requires simple, standardized summaries so over 170 million Americans can better understand their coverage information and compare plans. These consumer protections did not exist six years ago.
  • 2.3 million young Americans gained coverage between 2010 and October 2013 because they could now stay covered on their parents’ health care plans until they turn 26 – a benefit that did not exist before the law.
  • The ACA created tax credits that, as of September 2015, have helped 7.8 million Americans who otherwise often could not afford it purchase health coverage through the Health Insurance Marketplaces.
  • Health insurers are now required to provide consumers with rebates if the amount they spend on health benefits and quality of care, as opposed to advertising and marketing, is too low.  Last year, 5.5 million consumers received nearly $470 million in rebates.  Since this requirement was put in place in 2011 through 2014, more than $2.4 billion in total refunds will have been paid to consumers.
  • Out-of-pocket costs have been eliminated for preventive services like immunizations, certain cancer screenings, contraception, reproductive counseling, obesity screening, and behavioral assessments for children. This coverage is guaranteed for more than 137 million Americans, including 55 million women.
  • Out-of-pocket costs have been eliminated for 39 million Medicare beneficiaries for preventive services like cancer screenings, bone-mass measurements, annual physicals, and smoking cessation.
  • The ACA expands mental health and substance use disorder benefits and parity protections to over 60 million Americans.
  • The ACA phases out the “donut hole” coverage gap for nearly10.7 million Medicare prescription drug beneficiaries, who have saved an average of $1,945 per beneficiary.
  • Accountable Care Organizations now exist, consisting of doctors and other health-care providers who come together to provide coordinated, high-quality care at lower costs to their Medicare patients. Over 477 ACOs are serving nearly 8.9 million Medicare beneficiaries nationwide.
  • Overpayments through the Medicare Advantage system have been phased out, while Medicare Advantage plans are required to spend at least 85 percent of Medicare revenue on patient care.  Medicare Advantage enrollment has grown by 50 percent to over17.1 million while premiums have dropped by 10 percent since 2009.
  • Hospitals in Medicare now receive incentives to reduce hospital-acquired infections and avoidable readmissions.  A collaborative health-safety learning network, the Partnership for Patients, includes more than 3,200 hospitals to promote best quality practices.

In addition, other legislation and executive actions build on this progress and advance the cause of effective, affordable and accountable health care. This includes:

  • Advancing innovative care delivery models and value-based payments in Medicare and Medicaid.  The Administration set ambitious goals of tying 30 percent of traditional Medicare payments to alternative payment models by the end of 2016 and 50 percent by the end of 2018.
  • Proposals to invest in targeted research and technologies to advance the BRAIN InitiativePrecision Medicine Initiative, and cancer research.
  • A funding pool for Community Health Centers to build, expand and operate health-care facilities in underserved communities.  Health Center grantees served 23 million patients in 2014 and received $11 billion under the health care law to offer a broader array of primary care services, extend their hours of operations, hire more providers, and renovate or build new clinical spaces.
  • Health provider training opportunities, with an emphasis on primary care, including a significant expansion of the National Health Service Corps.  As of September 30, 2015, there were 9,600Corps clinicians providing primary care services, compared to 3,600 clinicians in 2008.

To learn more about the Healthy Communities challenges, visit: https://www.whitehouse.gov/the-press-office/2016/02/12/fact-sheet-announcing-winner-healthy-communities-challenge. For more on the President’s overall record on providing quality, affordable health care for Americans, visit: https://www.whitehouse.gov/the-record/health-care.

 

OMB: Obama Would Veto Latest Effort to Dismantle Obamacare, McConnell’s ‘Restoring Americans’ Healthcare Freedom Reconciliation Act’

 

They’re at it again! For like the 60th time, Republicans are pushing to dismantle Obamacare. 

The latest is the sickly named “Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015” sponsored by none other than that Darth Vader of anything that actually helps people, the Senate Leader himself, Sen. Mitch McConnell. 

The only thing standing in the way is President Obama’s veto, which the Office of Management & Budget (OMB) says he would. 

Here’s how the OMB explains the Administration’s position:

The Administration strongly opposes Senate passage of the Senate amendment to H.R. 3762.  By repealing numerous, key elements of current law, this legislation would take away critical benefits and health care coverage from hard-working middle‑class families.  The bill also would remove policies that are expected to help slow the growth in health care costs and that have improved the quality of care patients receive.  The Senate amendment to H.R. 3762 detracts from the work the Congress could be doing to foster job creation and economic growth.

The Affordable Care Act is working and is fully integrated into an improved American health care system.  Discrimination based on pre-existing conditions is a thing of the past.  And under the law, health care prices have grown at the slowest rate in 50 years, benefiting all Americans.

Repealing key elements of the Affordable Care Act would result in millions of individuals remaining uninsured or losing the insurance they have today.  An estimated 17.6 million Americans gained coverage as several of the Affordable Care Act’s coverage provisions have taken effect – 15.3 million since the beginning of the first open enrollment in October 2013.  The Senate amendment to H.R. 3762 would roll back coverage gains and would cost millions of hard-working middle-class families the security of affordable health coverage they deserve.

Repealing the health care law would have implications far beyond these Americans who have or will gain insurance.  More than 150 million Americans with employer-based insurance would be at risk of higher premiums and lower wages, or losing their coverage altogether.  It would raise taxes on certain middle‑class families.  The Senate amendment to H.R. 3762 also would defund the Prevention and Public Health Fund, limit women’s health care choices, and disproportionately impact low-income individuals.

This legislation is being considered by the Senate just days ahead of the December 15 deadline for Marketplace coverage that starts on January 1, 2016. Rather than refighting old political battles by once again voting to repeal basic protections that provide security for the middle class, Members of Congress should be working together to grow the economy, strengthen middle‑class families, and create new jobs.

If the President were presented with H.R. 3762, as amended by the Senate amendment, he would veto the bill.