The Republican contrived American Health Care Act would repeal the Affordable Care Act (Obamacare) which made great strides in making access to health insurance more affordable for millions of Americans and slowing the annual increases in premiums which had been rising at rates 3 to 5 times faster than inflation. Obamacare was designed to work within the for-profit health insurance industry, rather than do what every other industrialized nation does and offer universal health care. Some continued to complain that premiums and deductibles were too high, but rather than solve that problem, Republicans have sought to repeal Obamacare 60 times, going so far as to shut down the government in 2013 rather than accept a budget that provided for the subsidies that make health insurance affordable for tens of millions of Americans.
Trump has made it a defining issue to get repeal, no matter the damage or loss of health insurance which is quite literally a life-and-death issue. But the AHCA is more than just a matter of Trump’s ego, it is also about reducing taxes for the wealthiest – who are assessed a small surcharge to fund ACA – and crucial to Trump’s other massive giveaway to the wealthiest and corporations, his tax “plan.”
It’s remarkable that this act, which would completely rework health care, representing one-sixth of the US economy and impacting every single person, is being pushed through without any hearings, input from medical professionals or even health insurance companies, without scoring from the Congressional Budget Office as to its true cost or how many people would find health insurance unaffordable or inaccessible.
But Governor Andrew Cuomo spells out how AHCA would affect millions of New Yorkers, and specifically attacks an amendment foisted by two New York Republican Congressmen that exclusively targets New York:
“The Republican health care bill is an assault on women and an assault on New York. It would allow insurance companies to discriminate against Americans based on pre-existing conditions, force millions of New Yorkers to lose coverage, and slash Medicaid by hundreds of billions of dollars.
“As a direct result of the amendment introduced by Congressmen Faso and Collins, this provision alone would cut Medicaid funding for New York by $2.3 billion and cripple hospitals, nursing homes, and assisted living facilities across the state.
“Most disturbingly, this bill penalizes New Yorkers because we believe in reproductive rights and ensure by law that medically necessary abortions are covered by insurance carriers. I’m calling on all of New York’s Congressional delegation—Republican and Democrat alike—to stand up for New York values and vote against this terrible bill.”
The American Health Care Act will be disastrous for New York:
The plan will leave 2.7 million New Yorkers without health care coverage
It will cut $4.7 billion from the state’s Medicaid budget.
It will put at risk 7 million people who rely on Medicaid services and other programs created under the Affordable Care Act
And it threatens the entire New York State health care system, which serves 19.5 million New Yorkers.
The Collins/Faso amendment, which targets only New York, stops counties from paying a share of Medicaid. It would have a devastating effect on New Yorkers:
It will cut $2.3 billion in Medicaid funding to the State. When added to the $4.7 billion cost of the ACHA over the next four years, the total cost to the State would rise to $6.9 billion
Steep cuts would force New York State to increase taxes, slash coverage to millions of New Yorkers, or devastate health care providers:
Nursing Home payments would be cut by $401 million
Home care payments would be cut by $360 million
Hospital payments would be cut by $355 million
The bill punishes New York for its support for women’s reproductive rights by threatening to take away citizens’ access to tax credits that are intended to make health insurance more affordable:
New York requires that all commercial insurance policies cover abortion services. In January, Governor Cuomo took new action to ensure that contraceptive drugs and devices are covered by commercial health insurance policies without co-pays, coinsurance, or deductibles
The Republican health care bill would prohibit the use of tax credits to support the purchase of insurance plans that cover abortion services.
As a result, the bill would effectively defund the Essential Plan, forcing 685,000 low-income people, half of whom are women, to lose their insurance and denying them $1.5 billion in tax credits.
In addition, roughly 143,000 lower-income New Yorkers whose income is just above the threshold for the Essential Plan, half of whom are women, would be denied $400 million more in tax credits that help them afford insurance.
This bill also includes an amendment that will enable insurers to charge more for people with preexisting conditions in some states, rolling back a key achievement of the Affordable Care Act.
In New York, 8.4 million people under the age of 65 have preexisting conditions.
The MacArthur amendment would allow states to opt out of provisions that restrict providers from raising prices on people with preexisting conditions.
Removing protections for people with pre-existing conditions will result in the sick paying high premiums and would force those who cannot afford it to lose coverage.
The health plan would also permit states to charge older people more, which would also force people who cannot afford it to lose coverage.
(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.”
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.
Pool Reporter Alex Leary, Washington Bureau Chief for the Tampa Bay Times, brings us into the inner sanctum of the White House to learn how Donald Trump and Mike Pence are manipulating the debate over the repeal and replacement of the Affordable Care Act (Obamacare) with the Republicans’ American Health Care Plan (Ryancare).
On March 13, he hosted a group of Obamacare “victims”, followed by his first-ever meeting of his Cabinet which featured remarks by Health & Human Services (HHS) Secretary Tom Price’s dismissal of the Congressional Budget Office (CBO) scathing report projecting that 24 million people would lose health care under the Republican plan:
This is Leary’s report:
POTUS entered the room at 11:26 a.m. and pool was inside for roughly 33 minutes.
POTUS thanked the participants for sharing their stories about “the very, very failed and failing Obamacare law.”
Several times POTUS complained about news media coverage of the debate. “The press is making Obamacare look so good suddenly. I’m watching the news. It looks so good. … First of all, it covers very few people and it’s imploding. And ’17 will be the worst year.”
POTUS cast the coverage as nostalgia. “It’s a little bit like President Obama. When he left, people liked him. When he was here, people didn’t like him so much. That’s the way life goes. That’s human nature. The fact is, Obamacare is a disaster.”
The best political play, POTUS said, would to let the law collapse on its own over the coming year – “because it’s going to blow itself off the map. But that’s the wrong thing to do for the country. It’s the wrong thing to do for our citizens.”
POTUS said his administration and “a lot of people in the Senate and a lot of people in the House are committed to repealing and replacing this disastrous law with a health care plan that lowers costs, expands choice and ensures access for everyone. You represent the millions of Americans who have seen their Obamacare premiums increase by double-digit and even triple-digits …”
POTUS said the House bill would provide “far” more choices at lower costs. “Americans should pick the plan they want. Now they’ll be able to pick the plan. They’ll be able pick the doctor they want. They’ll be able to do a lot of things that the other plan was supposed to give and it never gave. …”
“You’re not going to have one-size-fits-all. Instead, we’re going to be working to unleash the power of the private marketplace to let insurers come in and compete for your business and you’ll see rates go down, down, down and you’ll see plans go up, up, up. You’ll have a lot of choices. You’ll have plans that nobody is even thinking of today.”
Seated across the table in the Roosevelt Room was VPOTUS. At one head of the table was HHS Secretary Tom Price; at the other. Gary Cohn, director of the White House’s National Economic Council.
The rest of the table was filled out by individuals (see list below) invited to tell their stories.
A collection of Obamacare “victims” from across the country shared their stories. (names below as provided by WH).
But first, more from POTUS, who said the Obamacare repeal and replacement must come in three steps, due to working with Congress. “I’d love to do it all in one package, but if you did it that way, it can’t get done.”
As pool was led out, a reporter asked POTUS if he had “any message” for people worried about losing coverage if Obamacare goes away.
“It’ll get better. If we’re allowed to do what we want to do, it will get better. Much better.,” POTUS replied. “Hopefully it will get very good.”
Carrie Couey, from Colorado, said her rates are “three times” higher than when Obamacare began and that has hurt her family cattle ranching business. “We can’t afford our equipment if we’re paying these rates year after year after year. Our food source is in jeopardy because of this health care law.”
Brittany Ivey, Georgia, said she left a full-time job in 2009 to raise her two children. She said a family plan for four cost them $650 per month and by 2015, it had gone up “102 percent.” She said her husband’s employer dropped the family from coverage so she looked for a new job but couldn’t find one that offered insurance. At that point, the family got Obamacare. “We believed the sales pitch that if you like your doctor, you can keep your doctor. Even though we were going to have to pay $1,300 a month for Obamacare, we thought we’d still be ok with our doctors.” But she said doctors would not accept the coverage. “We paid them $8,000 in five months and were never able to use it.” She and her husband earn a combined $74,000 a year, Ivey said, but health care is too burdensome. “It’s almost put our family in financial ruin.”
Elias Seife, Florida, said his individual plan was canceled. He said his parents came from Communist Cuba. “They know what socialism is all about. I know what socialism is … and this whole system was meant to have one single provider.”
Kim Sertich, Arizona, said her premium last year was $365 a month and it had risen to $809 a month this year, with a deductible of $6,800. “It just didn’t seem like a good use of my money,” she said, adding she had opted out and went into a faith-based program.
Louis Brown, Virginia, said he worked for the Democratic National Committee when the Affordable Care Act was going through Congress in 2009 and that he later resigned, citing opposition to abortion. He supported Trump in the election and said that he was on hand to support efforts to place people “at the center of our American health care system, not the government.”
Manny Sethi, Tennessee, says he runs nonprofit called Healthy Tennessee and that he’s noticed that people can’t afford rising premiums. “So what they are doing is, effectively, they’re paying the tax penalty because it’s cheaper and works out better than paying for the insurance. That’s been a big problem that we’re seeing across the state.”
Joel Brown, Tennessee, said he’s in farming and he considered paying the penalty for not carrying insurance. He said there is only one option for coverage, Blue Cross Blue Shield Tennessee and the premium is $540 a month with a $7,000 deductible. “You’ve got to pay a high premium for a plan that I don’t need or don’t want.”
Robin Armstrong, Texas, said a lot of patients are not adequately covered by Obamacare and are hit with high premiums and deductibles. “I actually read the bill that’s been produced, that’s coming out of the House now and I really like a lot of the changes in it. I think this is going to correct a lot of issues that Obamacare has had.”
Gina Sell, Wisconsin, said she’s a nurse and mother and had to get a full-time position to pay the costs. “We could not afford a premium of $1,200 per month and a deductible that didn’t cover anything.” She said now the deductible is $6,500 “and so if I have a child who is extremely sick, it’s going to cost me hundreds of dollars.” Last week, she said, her daughter had a fever and she sent her to school for “three days straight because I had to work to afford our insurance” and couldn’t pay for a trip to the doctor. “It has been devastating for our family.”
Greg Knox, Ohio, began by giving POTUS a note and drawing from his 11-year-old son. The note was written on the back of a cutout face with orangeish hair. “Looks nothing like you,” Knox said to laughter. POTUS flashed a big smile and said, “I wish I looked that good.” Knox said he had meet with Secretary Price and Vice President Pence during a recent roundtable in Cincinnati. “We have the best health care system in the world. We do. But it needs to be fixed. Small business owners like myself — I’m a manufacturer — what we’d like to see is not a government-operated market but a free market.”
Stan Summers, Utah, said his son was born premature 26 years ago and they had good insurance but it deteriorated over time. Enter the ACA. “I’m not going to call it the other word. I call it the last president’s health care bill. I don’t need to say that name.” (POTUS: “Other than that, you like him a lot.” Laughter.) Summers said he has three businesses and drives a school bus to provide coverage for his family. He said he expects to meet a $6,000 deductible in April.
Secretary Price gave brief remarks about the stories. “This is about real people, about real patients.” He said he was “really excited” to help install a replacement.
POTUS then again bemoaned what he deemed “wonderful press” about Obamacare. “It’s a horrible thing, actually, and getting worse.”
VPOTUS thanked the participants. “These people are emblematic of the Americans that Obamacare has failed.”
Trump Convenes His First Cabinet Meeting
Later, at 3:48 pm, Trump convened the first-ever meeting of his Cabinet, lamenting that, “We have four empty seats, which is a terrible thing.
“Because the Senate Democrats are continuing to obstruct the confirmation of our nominees for the Department of Labor, the Department of Agriculture, the director of national intelligence and the United States Trade Representative, somebody I want very badly. … The main victim of this very partisan obstruction is the American public.”
POTUS began by giving an update on the approaching storm…
He then touted actions by the nascent administration, including stripping away “job crushing” regulations, and alluded to the coming executive order to “begin the process of reorganizing the executive branch to make it less wasteful and more productive.”
POTUS reiterated his earlier remarks about Obamacare and talked about the replacement plan on Capitol Hill. “It’s a big, fat beautiful negotiation,” he said, drawing snickers. “Hopefully we’ll come up with something that’s going to be really terrific.” He thanked “Paul Ryan” and “Mitch.”
POTUS said he’d be sending a budget request with the major increase in defense spending. “And it will be fully paid for,” POTUS said, Secretary James Mattis on his left. “I saved a lot of money on those jets, didn’t I? Did I do a good job?”
POTUS talked about immigration and enhancing vetting. “We will not rest until the job is done.”
“This is our first Cabinet meeting,” POTUS said. “I hope this is going to be a historic Cabinet meeting, historic in the sense that we’re going to do a fantastic job for the American people, for our country and for the future of our country.”
He did not respond to a request for comment on the “wiretapping.”
A number of officials were on hand, including Jared Kushner, Steve Bannon and Kellyanne Conway.
HHS Secretary Price ‘Disagrees Strenuously” With CBO Report on GOP Health Care Plan
“We disagree strenuously with the report that was put out,” HHS Secretary Tom Price told reporters at the White House after the CBO score was released on the GOP health care plan.
Price argued that the CBO report looked “at a portion of our plan, but not the entire plan.” He explained that HHS can employ the “regulatory apparatus” to “make certain that patients are helped and that costs are decreased.”
Price said CBO ignored other legislative action.
“We believe that our plan will cover more individuals at a lower cost and give them the choices that they want for the coverage that they want for themselves and their family, not that the government forces them to buy.”
OMB Director Mick Mulvaney said he had not read the entire CBO report but found a bright spot. “The numbers that I’ve seen in the first glance is that CBO says that premiums will go down by at least 10 percent.”
A reporter noted that CBO got to that figure by estimating that fewer older Americans would get coverage but Price waved that away, again saying CBO did not take into account the full plan for repeal and replace. “The fact of the matter is, we’re working on the regulations right now.”
Asked about the report’s finding that 14 million more people would be left without insurance next year, Price said it’s “virtually impossible to have that number occur.”
Reporter: So CBO is wrong, they are not credible?
“Well, you just look at the numbers,” Price said. “There are 8-9 million people who are on the exchange currently. I’m not sure how they are going to get 14 million people uninsured, if that’s what they say, with only 8 million people on the exchange.
“They are individuals, I guess that they assume that are on Medicaid who aren’t paying anything in the Medicaid system who are not going to take the Medicaid policy just because the mandate ended or something happened. It’s just not believable is what we would suggest. We’ll look at the numbers and see.”
Reporter: Without that mandate to buy coverage, wouldn’t you concede there will be millions of uninsured?
“No, I wouldn’t concede that at all,” Price said. “The fact of the matter is they are going to be able to a coverage policy that they want for themselves and for their family. They are going to have the kind of choices that they want. … So we think that CBO simply has it wrong.”
Mulvaney echoed those points, criticizing CBO for assuming Medicaid changes will happen “on day one. It’s just absurd.”
Governor Andrew Cuomo, in response to a question posed by Mark Halperin on MSNBC, said:“Obviously the consequences for a state like New York could be devastating. Depending on what they do, you have 3 million people who are insured under Obamacare. What are you going to do with the 3 million people? Medicaid is a big piece of our budget. They talk about block grants, turning it over to the state. That sounds great. The question is when they block grant it, do they actually transfer the money? Remember the old expression, passing the buck without passing the bucks. Governor of New York, my fear is the rhetoric of give it back to the states sounds great, but if they give it back to the states and they cut the funding, you put the states in a really terrible situation. So I get the political appeal of repeal Obamacare, but you know, be careful what you ask for and I think this is the dog that chases the car. What are they going to do? And you have millions and millions of people who are affected and you could devastate the budget. I just did my budget. I said, “Look, I don’t have a contingency plan.” Because I don’t know what they’re going to do, and frankly, they could take an action for which there is no contingency plan. There are rumors that they could cut the state of New York 2, 3 billion dollars. I can’t make up 2, 3 billion dollars. It would wreak havoc in this state. So it’s their move and I want to see what they come up with.”
Lt. Governor Kathy Hochul, commenting on a proposed amendment from Congressman Collins (R-NY), said:
“Our Founding Fathers warned us this day would come. Partisan politics would overtake good government for the people. The Medicaid changes being proposed in Washington would cut taxes for wealthy special interests while devastating New York State’s finances and all but eliminating health care for the most vulnerable New Yorkers.
“What’s worse, a New York Republican Congressman, Chris Collins is offering an amendment that would wreak havoc on the state. While I understand that the Democrats in Washington are attacking Collins on ethics issues and are having a heated political fight, they shouldn’t be played out at the expense of everyday New Yorkers.
“Here are the facts: The overall Medicaid plan would cost the state billions of dollars of lost federal funds and jeopardize hospital stability. As if that were not enough, Rep. Collins would have the state assume the counties’ share of Medicaid expenses outside of New York City. The current breakdown is 13 percent county, 36 percent state, and 51 percent federal. This ill-conceived plan would cost his home state approximately $2.3 billion. Unbelievably, that’s on top of the cost of the Republican Affordable Care Act repeal plan – another $2.4 billion.
“Translation: Rep. Collins is proposing a tax increase on New Yorkers to the tune of $4.7 billion. This one-two punch would destroy all the hard work the Governor and Legislature have accomplished in the last six years to lower taxes across the board and achieve the lowest spending increases in recorded history. New Yorkers will be at risk of losing their healthcare, hospitals will be forced to lay off workers, and our vulnerable elderly will find it much harder to afford nursing home care.
“On the merits, the counties have no right to claim this is an undue burden. They paid a percentage of health care costs even before Medicaid – and in fact, currently have a more favorable agreement than in decades.
“In 1960 – well before New York State and most counties had any sales tax revenue to pay for it – Congress passed the Kerr-Mills Act, which created a national role in funding health care for the elderly. Under this program, the counties in New York paid approximately 44 percent of the cost of care, the state paid about 38 percent, and the federal government paid around 18 percent.
“In 1965, Medicaid replaced that program and the counties paid 25 percent. That same year, the state began giving counties the option of collecting sales tax on their behalf. Every county in New York has subsequently agreed to this option. Many counties in the nation don’t get sales tax, and most of those receive less than our counties. Moreover, the state recently agreed to give the counties additional help – after hearing the counties’ complaints of the growing Medicaid costs, the state has held them harmless for any increases since 2011.
“As a result, the counties’ share for Medicaid is down from 25 percent to 13 percent, and the state assumed this cost while still living within the 2 percent spending cap, and all while cutting taxes. The state is not asking the counties to do anything more than we have done ourselves. In fact, the state has done far more. If the Collins amendment passed, the state would need to raise income taxes or the counties would have to forego their share of sales tax in exchange for the state picking up the additional Medicaid costs.
“In short, Rep. Collins’ amendment and the Affordable Care Act repeal would transfer $4.7 billion in costs to the state which would translate into a new tax for New Yorkers. I know firsthand that the people of the 27th Congressional District face enough challenges in their lives – they don’t need to worry about increasing health care costs or new taxes.
“Rep. Collins should stop prioritizing his wealthy friends and start helping his home state by protecting the most vulnerable from losing their healthcare and putting the state budget at risk. Remember, as my mentor Sen. Daniel Patrick Moynihan used to always point out, New York is a donor state – we pay more in federal taxes than we receive back.
“Mr. Collins, try practicing good government rather than partisan politics.”
Donald Trump and Mike Pence are only courting right-wing conservatives on policies that impact all Americans’ lives, including health care and women’s reproductive health.
The only ones the Trump/Pence/Ryan/McConnell Administration care about, speak to are the ultra-rightwing conservatives. This from the White House, Friday, March 10:
READOUT OF THE VICE PRESIDENT’S LISTENING SESSION WITH CONSERVATIVE LEADERS
Vice President Mike Pence and Secretary of Health and Human Services Tom Price assembled dozens of conservative leaders today at the White House to discuss the multi-faceted effort to repeal and replace Obamacare. The Vice President and the Secretary highlighted the work being accomplished through legislative and regulatory efforts to end Obamacare’s government takeover of healthcare and provide market-based reforms that will lower costs and provide more choice to Americans. They also invited conservative groups to continue offering their ideas for improving healthcare in America and agreed to keep communication channels open as the President and Congress work to fulfill the promise of repealing and replacing the flawed Obamacare law.
The following individuals participated:
Thomas Binion, Heritage Foundation
Melissa Ortiz, Able Americans
Mia Heck, ALEC
Jason Pye, FreedomWorks
Brian McManus
Matthew Schlapp, American Conservative Union
Nan Swift, National Taxpayers Union
Richard Manning, Americans for Limited Government
Grace Turner, Galen Institute
Kenneth Cuccinelli, Senate Conservatives Fund
Jennifer Butler, State Policy Network
Daniel Schneider, American Conservative Union
John McKechnie, ABA Health Savings Account (HSA) Council
Stephen Keen, National Federation of Independent Business
Lisa Nelson, ALEC
Jennifer Hatten, ABA Health Savings Account (HSA) Council
David Bozell, ForAmerica
Phil Kerpen, American Commitment
Peter Sepp, National Taxpayers Union
Timothy Chapman, Heritage Action
Bradley Close, National Federation of Independent Business
Kent Lassmam, Competitive Enterprise Institute
Jennifer Martin, Tea Party Patriots
Shonda Kalra, Tea Party Patriots
Amanda Moorhead, National Federation of Independent Business
Bill Pascoe, Tea Party Patriots
Christopher Jacobs, Texas Public Policy Foundation
Adam Brandon, FreedomWorks
Michael Cannon, CATO
Bob Carlstrom, Association of Mature American Citizens
Andy Roth, Club for Growth
Heather Curry, CATO
More than one million New Yorkers may lose their health care coverage if the House Republican’s American Health Care Act is enacted. That is the assessment of the state’s Department of Health analysis.
“Health care is a human right, not a luxury,” Governor Andrew M. Cuomo stated. “After seven years of progress under the Affordable Care Act, the Republican Congress has proposed an inadequate, ill-conceived and unacceptable plan that places the coverage of more than 1 million New Yorkers in jeopardy and, once fully phased in, would shift more than $2.4 billion in costs onto taxpayers and hospitals each year.
“Healthcare experts across the Country have rejected the Republican plan outright citing the devastating impact on patients and provides. The AARP says it will weaken Medicare and hike premiums for everyone over 50. Millions of seniors could lose home care and nursing home coverage. Hospital leaders say staffing and services will be cut.
“Furthermore, this plan is a direct assault on New York values – defunding Planned Parenthood, restricting access to abortion and reproductive health services, and eliminating $400 million in means tested credits that lowered insurance costs for low-income New Yorkers, while slashing taxes on the wealthy.
“In the end, people who will still have insurance will fall into two groups under this plan: older Americans andlower-income people who will pay more for coverage or lose it altogether, and higher-income people who will pay less.
“As bad as this bill is, it may get worse. Far-right opponents of the bill in Congress are demanding changes. As disturbing and devastating as the proposed cuts would be, the final result could be downright bone chilling.
“Affordable healthcare is not a partisan issue. New York’s entire delegation – democrats and republicans – need to stand up and they need to fight, stand against this regressive plan, and protect the people they are sworn to represent. There is no going back.”
Over 1 million New Yorkers would face a significant loss in health care coverage under the plan.
Over $4.5 billion in costs would be shifted to state, counties, and safety net hospitals over the next four years increasing the tax burden on residents and putting countless healthcare providers in jeopardy.
At least $2.4 billion of these costs will be shifted annually beginning in 2020. This burden could grow even larger when the impact of Medicaid block grants is taken into account.
$400 million in tax credits used by New Yorkers to purchase health insurance on the New York State of Health insurance exchange would be lost and replaced in some cases with alternative subsidies which are not related ability to pay.
Wide range of benefits provided for under the Affordable Care Act are removed and savings are shifted to wealthy individuals and corporations.
The Republican controlled Congress is pushing full-steam ahead to “repeal and replace” Obamacare before the nonpartisan Congressional Budget Office has had a chance to “score” it for the cost and the impacts.
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.”
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.
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!
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.
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.
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).
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, 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, 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.”
“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.
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].
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.
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.”
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
“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 Obamaestablishedthe 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 itsfinal 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 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 aConsumer Guide to Disclosure Rights: Making the Most of Your Mental Health and Substance Use Disorder Benefitsto 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 releaseannual data on closed Federal parity investigations and will report on the findings, including the violations citedto 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.
·Toensure 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 issuingguidance on parity and opioid use disorder treatmentto 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 aresoliciting 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 hosttwo State Policy Academies on Parity Implementation for State Officialsin 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 areview of mental health and substance use disorder benefits in Medicare Advantage plansand identify any necessary improvements to advance parity protections.
·DOL, HHS, and Treasury are issuing aParity 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.
•Undertakea 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.
