As the fate of Americans’ health care falls in the hands of 13 Republican Senators conferring in secret without input from Democrats let alone health care experts or patients, deciding how much of the “harsh” House plan they incorporate into their own bill, it may well fall to states to take matters into their own hands. Indeed, New York State may provide the model for health care, just as California has dictated pollution standards to the auto manufacturing industry, exceeding federal standards.
New York State Governor Andrew M. Cuomo has directed the New York State Department of Financial Services to promulgate new emergency regulations mandating health insurance providers do not discriminate against New Yorkers with preexisting conditions or based on age or gender, in addition to safeguarding the 10 categories of protections guaranteed by the Affordable Care Act. The new first-in-the-nation measures will ensure that essential health services are protected and covered for all New Yorkers regardless of efforts at the federal level to strip millions of Americans of their healthcare.
At the Governor’s direction, the Department of Health will ban all insurers who withdraw from offering Qualified Health Plans on the State Health Marketplace from future participation in any program that interacts with the marketplace, including Medicaid, Child Health Plus, and the Essential Plan. New York is home to one of the most robust health marketplaces in the country, and insurers who do not comply will lose access to such profitable programs. The Governor will also direct state agencies and authorities to ban insurers who withdraw from the State Health Marketplace from contracting with the state and to consider all available actions to protect New Yorker’s access to quality healthcare.
Furthermore, the administration finalized regulations that will ensure that contraceptive drugs and devices are covered by commercial health insurance policies without co-pays, coinsurance, or deductibles no matter federal action. The regulations also ensure all medically necessary abortion services are covered by commercial health insurance policies without co-pays, coinsurance, or deductibles.
“We will not stand idly by as ultra-conservatives in Washington try to roll back the progress we have made to expand access quality, affordable health care, putting our most vulnerable New Yorkers at risk,” Governor Cuomo said. “As long as I am Governor, New Yorkers will not be subject to price discrimination based on age, gender, or pre-existing conditions, and essential health benefits will continue to be the rule, not the exception. These aggressive actions will make certain that no matter what happens in Congress, the people of New York will not have to worry about losing access to the quality medical care they need and deserve.”
Under the new regulations, DFS will require that individual and small group accident and health insurance policies, which provide hospital, surgical, or medical expense coverage, as well as student accident and health insurance policies cover the same categories of essential health benefits and be subject to the same benchmark plan rules that currently apply through the Affordable Care Act. Insurers must comply with the new regulations as a requirement of their license in New York.
Ambulatory patient services, such as office visits, ambulatory surgical services, dialysis, radiology services, chemotherapy, infertility treatment, abortion services, hospice care, and diabetic equipment, supplies and self-management education;
Emergency services, such as emergency room, urgent care services, and ambulance services;
Hospitalization, such as preadmission testing, inpatient physician and surgical services, hospital care, skilled nursing facility care, and hospice care;
Maternity and newborn care, such as delivery, prenatal and postnatal care, and breastfeeding education and equipment;
Mental health and substance use disorder services, including behavioral health treatment, such as inpatient and outpatient services for the diagnosis and treatment of mental, nervous and emotional disorders, screening, diagnosis and treatment for autism spectrum disorder, and inpatient and outpatient services for the diagnosis and treatment of substance use disorder;
Prescription drugs, such as coverage for generic, brand name and specialty drugs, enteral formulas, contraceptive drugs and devices, abortifacient drugs, and orally administered anti-cancer medication;
Rehabilitative and habilitative services and devices, such as durable medical equipment, medical supplies, prosthetic devices, hearing aids, chiropractic care, physical therapy, occupational therapy, speech therapy, and home health care;
Laboratory services, such as diagnostic testing;
Preventive and wellness services and chronic disease management, such as well child visits, immunizations, mammography, gynecological exams including cervical cytology screening, bone density measurements or testing, and prostate cancer screening; and
Pediatric services, including oral and vision care, such as preventive and routine vision and dental care, and prescription lenses and frames.
The Superintendent of the Department of Financial Services may issue model contract language identifying the coverage requirements for all individual and small group accident and health insurance policies that provide hospital, surgical, or medical expense coverage and all student accident and health insurance policies delivered or issued for delivery in New York State.
DFS will also mandate under existing New York law that health insurers:
Provide coverage for all contraceptive drugs and devices and cover at least one form of contraception in each of the FDA-approved contraceptive delivery methods without co-pays, coinsurance, or deductibles, regardless of the future of the Affordable Care Act.
Provide coverage for the dispensing of an initial three-month supply of a contraceptive to an insured person. For subsequent dispensing of the same contraceptive covered under the same policy or renewal, an insurer must allow coverage for the dispensing of the entire prescribed contraceptive supply, up to 12 months, at the same time.
Provide coverage for abortion services that are medically necessary without co-pays, coinsurance, or deductibles (unless the plan is a high deductible plan).
Provide full and accurate information about coverage, enforced in a letter available here.
Under the Republican American Health Care Act, 2.7 million New Yorkers would lose coverage and the state’s budget would take a $6.9 billion hit, including $2.3 billion as a direct result of an amendment that targets New York State specifically. It would be devastating to New Yorkers, and the Congressional Budget Office’s report confirms that. Just how bad? New York State Governor Andrew M. Cuomo issued this statement:
“The Congressional Budget Office’s report confirms what we already knew to be true—ultra-conservatives in Washington have declared war on New York’s health care system. What’s worse is that Republican members of our own Congressional delegation have aided and abetted in Washington’s war against New York, cutting taxes for millionaires while jeopardizing care for seniors, women, the middle class and the disabled.
“The radical Republican health plan will devastate New York’s health care system, strip 2.7 million New Yorkers of their health care coverage, and roll back the progress we have made to protect vulnerable Americans. This bill will cost New York State a total of $6.9 billion, including $2.3 billion as a direct result of the disastrous amendment introduced by Congressmen Faso and Collins.
“As radical ideologues race to impose their extremist agenda on Americans, New Yorkers say no. In New York, we will stand up for our progressive principles and protect the right to affordable and quality health care for all. I will continue to work with our Congressional delegation and New York’s health care leaders to defeat this reckless legislation.”
The American Health Care Act will leave 23 million more Americans uninsured and be disastrous for New York:
The plan will leave 2.7 million New Yorkers without health care coverage.
It will cost New York a total of $6.9 billion.
It will put at risk a total of 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.
Steep cuts would force New York State to increase taxes, slash coverage to millions of New Yorkers, or devastate health care providers. As a result of the AHCA bill:
Hospital payments would be cut by $944 million in total
Nursing Home payments would be cut by $819 million in total
Home care payments would be cut by $734 million in total
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.
But here’s the thing: even though the Senate Republicans have said they are drafting its own health care law, they are still not bothering to confer with health care providers, health care insurers, patients or state and local officials. It is likely that even if the impacts are softened, any proposal which is designed to cater to healthy, young Americans (by allowing them to not buy insurance), and empower insurance companies to charge whatever they like to cover separate items like maternity, mental illness, addiction, pre-existing conditions (life is a pre-existing condition), to charge penalties for lapses in coverage and to charge older Americans up to five times what younger people pay, and no longer pay for wellness or preventive services, will result in tens of millions of Americans being unable to afford health insurance, being underinsured (making the policies useless), will bankrupt families of their ability to save for college or retirement or home ownership. Americans will find themselves trapped in horrible jobs or abusive marriages because they can’t afford to lose health insurance. It isn’t just the 20% of Americans who must purchase on the individual market: lifting the mandates will mean that employers will be free to stop offering health benefits altogether, or will require hefty pay-ins, or will offer bare-bones policies that leave people without protection and care. Children who are born with health issues will be faced with lifetime caps. A family will again face the insecurity of being just one medical emergency away from bankruptcy. Hospitals, especially in rural communities, will shut down. Tens of thousands of people a year will die prematurely and needlessly for lack of access to health care, and tens of thousands more will suffer for lack of care. Society will suffer lost productivity while paying more money to cover those who are forced to use emergency rooms for medical care, leaving the rest of us to pick up the tab.
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.
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.
