Tag Archives: Medicaid

In the immortal words of President Biden as VP when President Obama signed the Affordable Care Act (Obamacare) into law, this is a big f—kg deal.

For the first time, thanks to President Biden’s Inflation Reduction Act – the historic law lowering health care costs – Medicare is able to negotiate the prices of prescription drugs.

Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced the first 10 drugs covered under Medicare Part D selected for negotiation. The negotiations with participating drug companies will occur in 2023 and 2024, and any negotiated prices will become effective beginning in 2026. Medicare enrollees taking the 10 drugs covered under Part D selected for negotiation paid a total of $3.4 billion in out-of-pocket costs in 2022 for these drugs.

“For far too long, pharmaceutical companies have made record profits while American families were saddled with record prices and unable to afford life-saving prescription drugs. But thanks to the landmark Inflation Reduction Act, we are closer to reaching President Biden’s goal of increasing availability and lowering prescription drug costs for all Americans,” said HHS Secretary Xavier Becerra. “Although drug companies are attempting to block Medicare from being able to negotiate for better drug prices, we will not be deterred. The Biden-Harris Administration will continue working to ensure that Americans with Medicare have access to innovative, life-saving treatments at lower costs.”

The Biden-Harris Administration has made lowering prescription drug costs and improving access to innovative therapies a key priority. Alongside other provisions in the new law that increase the affordability of health care and prescription drugs, allowing Medicare to negotiate prescription drug prices will strengthen the program’s ability to serve people with Medicare now and for generations to come. The negotiation process will consider the selected drug’s clinical benefit, the extent to which it fulfills an unmet medical need, and its impact on people who rely on Medicare, among other considerations, such as costs associated with research and development as well as production and distribution for selected drugs. As a result of negotiations, people with Medicare will have access to innovative, life-saving treatments at lower costs to Medicare.

The selected drug list for the first round of negotiation is:

Eliquis
- Jardiance
- Xarelto
- Januvia
- Farxiga
- Entresto
- Enbrel
- Imbruvica
- Stelara
- Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill

These selected drugs accounted for $50.5 billion in total Part D gross covered prescription drug costs, or about 20%, of total Part D gross covered prescription drug costs between June 1, 2022 and May 31, 2023, which is the time period used to determine which drugs were eligible for negotiation. CMS will publish any agreed-upon negotiated prices for the selected drugs by September 1, 2024; those prices will come into effect starting January 1, 2026. In future years, CMS will select for negotiation up to 15 more drugs covered under Part D for 2027, up to 15 more drugs for 2028 (including drugs covered under Part B and Part D), and up to 20 more drugs for each year after that, as outlined in the Inflation Reduction Act.

“We’ve reached this milestone because of the Inflation Reduction Act– one of the most significant laws ever enacted, and one that passed with the leadership of Democrats in Congress,” President Biden stated. “We took on Big Pharma and special interests, overcoming opposition from every Republican in Congress, and the American people won.”

When implemented, prices on negotiated drugs will decrease for up to 9 million seniors. These seniors currently pay up to $6,497 in out-of-pocket costs per year for these prescriptions. In addition, the nonpartisan Congressional Budget Office reports that this will save taxpayers $160 billion by reducing how much Medicare pays for drugs through negotiation and inflation rebates.

“This plan is a key part of Bidenomics, my economic vision for growing the economy from the middle out and the bottom up – not the top down. And it’s working.,” Biden stated. “That’s why Big Pharma has already filed eight lawsuits against my Administration, and spent nearly $400 million last year to try to stop our progress. Let me be clear: I am not backing down. There is no reason why Americans should be forced to pay more than any developed nation for life-saving prescriptions just to pad Big Pharma’s pockets. For many Americans, the cost of one drug is the difference between life and death, dignity and dependence, hope and fear. That is why we will continue the fight to lower healthcare costs – and we will not stop until we finish the job.”

HHS Announces First Set of Drugs Selected for Medicare Price Negotiation

For the first time ever, HHS announced ten drugs selected for Medicare drug price negotiation:

Drug Name	Commonly Treated Conditions	Total Part D Gross Covered Prescription Drug Costs from June 2022-May 2023	Number of Medicare Part D Enrollees Who Used the Drug from June 2022-May 2023	Average Part D Covered Prescription Drug Costs Per Enrollee
Eliquis	Prevention and treatment of blood clots	$16,482,621,000	3,706,000	$4,448
Jardiance	Diabetes; Heart failure	$7,057,707,000	1,573,000	$4,487
Xarelto	Prevention and treatment of blood clots; Reduction of risk for patients with coronary or peripheral artery disease	$6,031,393,000	1,337,000	$4,511
Januvia	Diabetes	$4,087,081,000	869,000	$4,703
Farxiga	Diabetes; Heart failure; Chronic kidney disease	$3,268,329,000	799,000	$4,091
Entresto	Heart failure	$2,884,877,000	587,000	$4,915
Enbrel	Rheumatoid arthritis; Psoriasis; Psoriatic arthritis	$2,791,105,000	48,000	$58,148
Imbruvica	Blood cancers	$2,663,560,000	20,000	$133,178
Stelara	Psoriasis; Psoriatic arthritis; Crohn’s disease; Ulcerative colitis	$2,638,929,000	22,000	$119,951
Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill	Diabetes	$2,576,586,000	777,000	$3,316

[Source: CMS, https://www.cms.gov/files/document/fact-sheet-medicare-selected-drug-negotiation-list-ipay-2026.pdf]

These ten drugs are among those with highest total spending in Medicare Part D – $50 billion in total part D gross covered drug cost s- or 20% of total part D gross covered drug costs june 1, 2022, may 31, 2023. More than 8 million Part D enrollees depend on these vital treatments to treat life-threatening conditions including diabetes, heart failure, and cancer, but many struggle to access their medications because of prohibitive costs.

Medicare drug price negotiation will result in lower out-of-pocket costs for seniors and will save money for American taxpayers. Negotiations for the first group of selected drugs will begin in 2023, with negotiated prices going into effect in 2026.

Out-of-Pocket Costs for Drugs Covered Under Part D Selected for Drug Price Negotiation, by State

Today HHS also released a report showing that 9 million Medicare Part D enrollees took the drugs covered under Part D selected for negotiation and paid a total of $3.4 billion in out-of-pocket costs for these drugs in 2022. For enrollees without additional financial assistance, average annual out-of-pocket costs for these drugs were as high as $6,497 per enrollee in 2022.

To view a state-by-state breakdown of the number of Medicare enrollees who use the prescription drugs selected for negotiation and their out-of-pocket costs, visit HHS’s website.

Continuing to Lower Prescription Drug Costs

Every day, millions of seniors are saving money on prescription drug costs because of the Biden Administration’s actions. People with Medicare are saving an average of $70 in out-of-pocket costs on vaccines like shingles and Tdap because President Biden’s Inflation Reduction Act made recommended vaccines free for beneficiaries starting this past January. Nearly four million seniors and others on Medicare with diabetes started to see their insulin costs capped at $35 per month this past January, saving some seniors hundreds of dollars for a month’s supply. And some seniors taking drugs covered under Part B for which manufacturers have hiked prices faster than inflation are saving up to $449 in lower coinsurance this quarter thanks to the new Medicare inflation rebates.

People with Medicare will continue to see their prescription drug costs go down as more provisions of the Inflation Reduction Act go into effect in the coming years. Part D enrollees will no longer pay 5% co-insurance when they reach the catastrophic phase of their benefit starting in 2024. Nearly 19 million seniors and other Part D beneficiaries are projected to save $400 per year on prescription drugs when the out-of-pocket cap drops to $2,000 in 2025, and 1.9 million enrollees with the highest drug costs will save an average of $2,500 per year. And the lower prices negotiated for the high-spend drugs selected today will go into effect in 2026.

The President’s Budget for Fiscal Year 2024 builds upon the Inflation Reduction Act to continue lowering the cost of prescription drugs. For Medicare, this includes further expanding the newly established negotiation authority by extending it to more drugs and bringing drugs into negotiation sooner after they launch. The Budget also includes proposals to curb inflation in prescription drug prices and cap the prices of insulin products at $35 for a monthly prescription in the commercial market to lower drug costs for all Americans.

The ability to negotiate drug prices is historic. For decades, Big Pharma lobbyists (three for every one member of Congress) and Congressional Republicans stopped Medicare from saving taxpaying, hardworking families money by negotiating lower drug costs.

The result of that blockade was that Americans were forced to pay the highest prices for medicines in the world, despite the fact that taxpayers subsidize Big Pharma’s research and development.

“This is a game-changer for Americans who are being overcharged for medicines they need and a game-changer for Medicare because it will spend less taxpayer money to deliver the same benefits,” stated Deputy Press Secretary and Senior Communications Adviser Andrew Bates.

“This comes after President Biden also beat Big Pharma by capping the price of insulin at $35 per month for Medicare recipients. Big Pharma has spent nearly $400 million lobbying to stop these reforms.”

However, as the Biden Administration takes these newest historic actions to lower drug costs for Americans and strengthen Medicare, Congressional Republicans continue to side with Big Pharma’s price gouging and cuts to Medicare benefits instead.

Not only do congressional Republicans want to take the new benefits being announced today away from Americans with repeal legislation (just as they spent years trying to repeal the Affordable Care Act – Obamacare) – they are even siding with Big Pharma’s lawsuits to stop them in their tracks, Bates said.

Congressman Morgan Griffith endorsed their suits, saying, “every drug manufacturer probably ought to sue because it is, on its face, an unconstitutional taking.”

And reporters have frequently noted that in their opposition to this breakthrough for seniors, congressional Republicans are parroting Big Pharma’s talking points and “echoing arguments the pharmaceutical industry has made for years.”

After unsuccessfully voting to block President Biden’s plan to let Medicare negotiate lower drug costs, Congressional Republicans have sought to repeal it, in alignment with Big Pharma. In the midterms, they campaigned on repealing Medicare’s new power but shut their ears to voters’ message back to them.

This summer alone, the Republican Study Committee, which represents over three quarters of House Republicans, unveiled yet another repeal plan.

The handouts Congressional Republicans are pursuing for Big Pharma would explode our deficit, weaken Medicare, and subject more American seniors and families to price gouging for life-saving medicines, Bates said.

“Across the board, the hallmark of congressional Republicans’ trickle-down economic agenda is to increase costs and financial burdens shouldered by hardworking Americans in exchange for welfare payoffs to the super rich and multinational corporations. In this case, Big Pharma.

“Their philosophy is the polar opposite of Bidenomics, which is based on rewarding hard work and growing our economy by growing the middle class. Not leaching off the middle class for an extreme rightwing scheme to redistribute income upward.

“We should be bolstering Medicare’s ability to lower drug costs for families, instead of trying to erase them.

“This fight is far from over. President Biden is pushing to expand Medicare’s capacity to negotiate lower drug costs, which he released a concrete plan for in his budget,” Bates said.

Economy, Health Care, Obamacare

Congressional Republicans Push to Repeal the Affordable Care Act and Slashing Medicaid – Here’s How You Would Be Impacted if They Succeed

February 28, 2023 krubin

The White House is piercing the secrecy, backroom plans of Congressional Republicans to yet again, repeal the Affordable Care Act (Obamacare) and slash Medicaid, under the guise of “balancing the budget”. Instead, the Republicans’ agenda would add $3 trillion to the national debt while leaving hundreds of millions living with the anxiety and insecurity of being without access to health care or destroyed by medical debt. The Republicans’ policy goes against the grain of Americans who overwhelmingly support Obamacare, which has delivered record numbers of Americans who have health insurance. Repealing the ACA would thrust millions into the life-and-death insecurity of not having health insurance at all or finding health insurance unaffordable, the 100 million people who have “pre-existing conditions” (now likely 200 million because of COVID), also being uninsurable by the for-profit insurance industry. Likewise, slashing Medicaid would not only leave millions, including millions of children, without health care, but result in more hospitals shutting down. This fact sheet from the White House is issued in advance of President Joe Biden’s remarks from Virginia Beach:–Karen Rubin/news-photos-features.com

Speaker McCarthy and congressional Republicans have committed to balance the budget while adding $3 trillion or more to the deficit through tax cuts skewed to the wealthy and large corporations. As a matter of simple math, that requires trillions in program cuts. Congressional Republicans have yet to disclose to the American people where these cuts will come from. But past Republican legislation, budgets, and litigation, along with recent statements, proposals, and budget plans, provide clear evidence that health care will be on the chopping block for severe cuts.

Virtually every Republican budget or fiscal plan over the last decade has included repeal of the Affordable Care Act (ACA) and deep cuts to Medicaid. That would mean: higher health care costs for tens of millions of Americans; ending critical protections for people with pre-existing conditions; millions of people losing health coverage and care; and threats to health care for seniors and people with disabilities, including growing home care waiting lists and worse nursing home care.

The American people deserve to see congressional Republicans’ full and detailed budget plan, including what it cuts from the ACA and Medicaid, Social Security and Medicare, and other critical programs, and should have the chance to compare it with the President’s budget plan, which he will release March 9.

If Republicans are successful in repealing the Affordable Care Act and making deep cuts to Medicaid:

Millions of Americans Will Have Higher Health Care Costs

More than 100 million people with pre-existing health conditions could lose critical protections. Before the ACA, more than 100 million Americans with pre-existing health conditions could have been denied coverage or charged more if they tried to buy individual market health insurance. Republican repeal proposals either eliminate these protections outright or find other ways to gut them.
Up to 24 million people could lose protection against catastrophic medical bills. Before the ACA, insurance plans were not required to limit enrollees’ total costs, and almost one in five people with employer coverage had no limit on out-of-pocket costs, meaning they were exposed to tens of thousands of dollars in medical bills if they became seriously ill.
Tens of millions of people could be at risk of lifetime benefit caps. Prior to the ACA, 105 million Americans, mostly people with employer coverage, had a lifetime limit on their health insurance benefits, and every year up to 20,000 people hit that cap and saw their benefits exhausted just when they needed them most.
Millions of people could lose free preventive care. The ACA requires private health insurers to cover preventive services, like cancer screenings, cholesterol tests, annual check-ups, and contraceptive services, at no cost. Before these requirements were in place, millions of Americans with health insurance faced cost sharing – sometimes high costs – for these services, which is part of why the ACA resulted in increased use of critical preventive care.
Over $1,000 average increase in medical debt for millions covered through Medicaid expansion. Repealing the ACA, in particular the expansion of Medicaid to low-income adults, would reverse major gains in financial security. Within the first two years of the ACA’s expansion of Medicaid, medical debt sent to collection agencies dropped by $3.4 billion, and there were 50,000 fewer medical bankruptcies. Among people gaining coverage through expansion, medical debt fell by an average of over $1,000. Expansion states also saw significant drops in evictions compared to non-expansion states.
Tens of millions of people could see their prescription drug coverage scaled back. Prescription drug coverage is an optional benefit under Medicaid. If states faced large cuts to their federal Medicaid funding, millions of Medicaid enrollees could see their coverage scaled back or have a harder time getting their prescriptions because of extra red tape.

Millions of Americans Will Lose Their Health Insurance

40 million people’s health insurance coverage would be at risk. Over 16 million people have signed up for ACA marketplace coverage for 2023, over 22 million people are enrolled in Medicaid expansion coverage available due to the ACA, and another 1 million people have coverage through the ACA’s Basic Health Program. The total number of people with some form of ACA coverage has risen significantly since 2017, when the Congressional Budget Office estimated the House-passed repeal bill would grow the ranks of the uninsured by 23 million.
An additional 69 million people with Medicaid could lose critical services, or could even lose coverage altogether. Slashing federal funding for Medicaid would force states to make Medicaid eligibility changes that would make it harder to qualify for and enroll in Medicaid coverage. States would also likely consider capping or limiting enrollment, cut critical services, and cut payments rates, making it harder for people with Medicaid to access care.
Thousands more preventable deaths each year. The ACA Medicaid expansion is preventing thousands of premature deaths among older adults each year, research finds, likely because it improves access to care, including medications to control chronic conditions and preventive care such as cancer screenings. ACA marketplace coverage also prevents premature deaths.

Worse Care for Seniors and People With Disabilities

Over 7 million seniors and people with disabilities could receive worse home care, with ballooning wait lists for those still in need. The number of people on home care wait lists has dropped by 20 percent since 2018. This progress would likely be reversed under a block grant or per-capita cap because there would be fewer dollars available for home care services, an optional benefit in Medicaid. Faced with large federal funding cuts, states would almost certainly ration care. That would likely mean wait lists for home care in the 13 states and DC that don’t currently have them, and skyrocketing wait lists in 37 states that do.
Hundreds of thousands of nursing home residents would be at risk of lower quality of care. Over 60 percent of nursing home residents are covered by Medicaid. With large cuts in federal funding, states would be forced to cut nursing home rates to manage their costs, as many states have done during recessions. Research shows that when nursing homes are paid less, residents get worse care.

Millions of People Will Lose Access to Opioid Treatment and Mental Health Care

Millions of people could lose access to substance use treatment or mental health care. Across the country, the ACA, especially its expansion of Medicaid, has dramatically expanded access to opioid treatment and other substance use disorder care, including increases in medication assisted treatment prescriptions for opioid and other substance use treatment and improved access to mental health care.
34 million children at risk of losing guaranteed access to mental health care. Past Republican plans proposed ending Medicaid’s guarantee of comprehensive health coverage for children. This would jeopardize children’s access to mental health care at a critical point in efforts to address the burgeoning youth mental health crisis. It would also cause children to go without other services, like annual check-ups and speech and physical therapy. And Republican proposals could endanger schools’ ability to bill Medicaid for mental health care, speech therapy, or physical therapy for students.

Rural Hospitals Would Be Forced to Close

More of the over 500 rural hospitals at risk of closure could close. The ACA, especially its expansion of Medicaid, helped cut hospital uncompensated care by about $12 billion, helping hospitals, especially rural hospitals, stay afloat. Between 2010 and 2021, nearly three-fourths of rural hospital closures were in states that have not adopted Medicaid expansion, with research finding that expansion disproportionately improved rural hospital margins and helped avert rural hospital closures. If the ACA is repealed, and millions lose coverage, closures among at-risk hospitals could increase significantly.

Separate from all these quantifiable harms, Republican ACA and Medicaid plans propose abrupt, unprecedented upheaval, with consequences for the entire health care system. In 2017, patient groups, physicians, hospitals, insurers, insurance regulators, health care experts, and governors from both parties all expressed alarm that ACA repeals could have far-reaching consequences for the stability of health insurance markets and availability of affordable coverage and care.

House Republicans commit to radical ultra MAGA budget that takes health care from millions and increases costs:

Confirming President Biden’s warning that House Republicans are threatening to cause an unforced economic catastrophe unless they can make disastrous cuts that increase millions of American’s health care costs, the top House Republican on the Budget Committee now says outright that they are using a ultra MAGA plan to do just that.

House Budget Chairman Jodey Arrington says Republicans are modeling their budget off of a hard right proposal from former Trump OMB Director Russell Vought – a plan that calls for draconian cuts to the Affordable Care Act and Medicaid. This would deprive countless Americans of their health coverage, make the costs of health care skyrocket cross the board, cause a spike in the price of prescription drugs, and devastate rural hospitals.

What sacrifices does Vought’s budget ask of rich special interests? None. And House Republicans simultaneously back enormous tax giveaways to the wealthy that economists warn would aggravate inflation.

President Biden and the American people want to go in the opposite direction, building on the historic deficit reduction he has led by having the rich and big corporations pay their fair share and reduce the deficit by a further $2 trillion.

“In their own words, Congressional Republicans keep proving President’s Biden’s warnings to the middle class right,” said White House spokesperson Andrew Bates. “The House Republican leading their budget process now admits that the foundation of their approach will be a radical, ultra MAGA plan that takes health coverage away from millions of middle class families, causes health care and prescription drug costs to skyrocket, and devastates rural hospitals. And they’re threatening to intentionally plunge our economy into chaos and kill millions of jobs and businesses if they don’t get their way. Meanwhile, Republicans are pushing exorbitant tax welfare for rich special interests that would increase the deficit and worsen inflation. This is the definition of trying to force our economy to work from the top-down, when they should be joining with President Biden to keep rebuilding the American middle class.”

Climate Action, Donald Trump, Economy, Education, Environmental Protection, Federal Budget, Foreign Relations, Global Affairs, GOP Watch, Government spending

Trump Budget is Criminal; Ryan & Republicans are Accomplices

May 31, 2017 krubin

Donald Trump delivers his joint address to Congress, as Mike Pence and Paul Ryan cheer him on. Trump’s 2018 budget may be unbelievably cruel and callous, but it mimics the principles that Ryan and the Republicans have been crusading for © 2017 Karen Rubin/news-photos-features.com

By Karen Rubin, News & Photo Features

It doesn’t matter that Trump’s preposterously named “A New Foundation for American Greatness” budget is “dead on arrival” according to even staunch Republican, Texas Senator John Cornyn. Much of it is the long-time wet dream of Paul Ryan and Republicans whose singular ambition has been to destroy the New Deal, Square Deal, Great Society. They would eliminate the minimum wage, child labor laws, food and product safety, Clean Air & Water protections, Social Security and Medicare and most notably Medicaid, sell off national parks and monuments to mining and oil and gas industrialists. And this is before taking into account tax “reform” that would take $2 trillion out of the national budget to put into the pockets of the wealthiest and corporations, so they have even more extra pocket change to spend on political campaigns.

Indeed, the Trump budget is everything that the Republicans have been dying to do, but didn’t dare. But Trump doesn’t care. He has shown that it really isn’t hard atall to cut the budget when you really don’t care what the numbers represent,when you have no clue and no interest.

The Trump Budget is built on “Trumponomics, as Office of Management and Budget Director Mike Mulvaney proudly exclaimed, “It’s a taxpayer-first budget, going line by line through the budget, trying to put yourself in the shoes of the people who are paying for those lines….What Trumponomics is and what this budget is a part of is an effort to get to sustained 3 percent economic growth in this country again..And by the way, we do not believe that that is something fanciful.”

Indeed, this is a “tough love” approach to force malingerers off things like food stamps – it’s not non-living wages paid by companies pocketing record profits that keep workers below the poverty line that’s the problem.

“Getting people back to work. Create an environment where people more comfortable staying at …We no longer measure compassion by the number of programs or number of people on programs. We measure success by how many get off programs and have success in lives.”

But the figures don’t actually add up.

Economists from across the spectrum say that the math that underlies the main selling point for Trump’s budget, that it will “balance the budget” in 10 years, is a crock. It doesn’t take into account the $1 trillion or so in tax cuts that will go entirely to the wealthiest and to corporations that Trump sketched out; it assumes a 3% rate of annual economic growth, which would mean 50% more economic activity, which everyone says is beyond pie-in-the-sky; and it actually double-counts $2 trillion, prompting headlines like this one from Slate, “Donald Trump’s budget is based on a hilarious accounting fraud” and “The dumb accounting error at the heart of Trump’s budget “ from Vox.

Health care a right, not a privilege? Trump’s budget projects a 28.3% DROP in spending for health services, $2 trillion less spending, over a 10-year period – despite the aging and increase in population. This includes a 27% decrease in spending for the Centers for Disease Control & Prevention (imagine another Ebola, Zika or Swine Flu outbreak); 25% drop in Substance Abuse and Mental Health Services Administration (even as Trumpcare will no longer include mental health or addiction), 25% less spending for research and training, including 25% cut for the National Institutes of Health (no interest in finding therapies or cures for Zika, Alzheimers or “orphan” diseases that wouldn’t be profitable enough for Big Pharma); 40% cut for the Food & Drug Administration (let Big Pharma do what they will); 15% drop in food safety and inspection; 17% cut to the Consumer Product Safety Commission, 16% cut in already strapped Occupation and Mine Safety and Health spending even as he overturned regulations.

$1.4 trillion gap in infrastructure spending to repair decaying roads, bridges airports? Trump would cut Transportation spending by 25% cut (65% cut to National Infrastructure Investments; 50% cut to air transportation which is already woefully in need of upgrades); 28% cut to Education, Training, Employment and Social Services.

His cuts to environmental protection – on top of slashing regulations that give communities a fighting chance to protect their air, water and public health – amount to Hague Tribunal level of war criminality for what he will do to the planet, let alone our communities. The allocation is cut 27.1% – $132 billion worth – including a 34% cut in Pollution control and abatement, 42% cut in Regulatory, enforcement and research programs, 37% cut in Hazardous substance superfund ($330 million less in 2018).

Trump would end funding for the Clean Power Plan, international climate change programs, climate change research and partnership programs, and related efforts—“saving” over $100 million in 2018. He cuts out $129 million in funding for the EPA’s Office of Enforcement. He cuts out $233 million in 2018 for the EPA’s Research & Development (ie. climate change science). It eliminates more than 50 EPA programs, $347 million worth in 2018; and ends funding for specific regional efforts such as the Great Lakes Restoration Initiative and the Chesapeake Bay, amounting to $427 million in 2018.

Trump would cut General Science, Space & Technology spending by 14.7%, including 18.9% cut to General Science and basic research.

International Affairs would be cut nearly in half, including 26% cut in spending for Global Health programs; 74% cut in Refugee programs; 66% percent cut in International Disaster Assistance, 83% cut in “other” development and humanitarian assistance.”

(See the New York Times, “How Trump’s Budget Would Affect Every Part of Government”).

Setting aside for a moment that Trump and his billionaire friends don’t actually pay their fare share of taxes, nor do many profitable American companies which have stashed $2 trillion in offshore accounts, the Republicans’ approach is what Hillary Clinton correctly observed, “trickle down economics on steroids.” It didn’t work with Reagan or George W. Bush. And this is even worse.

No matter: the extremity of Trump’s proposed budget, the callousness of it, will give cover to Ryan and the House Republicans and make anything they do seem “moderate”, even “compassionate.” So they cut Medicaid by $600 billion instead of $866 billion and call it a “win” for the little people; they cut the State Department by 20% instead of 30% and pat themselves on the head; they cut the EPA by 25% instead of 31%.

Here’s what Senator Elizabeth Warren (D-Massachusetts) wrote: “Speaker of the House Paul Ryan says that Donald Trump’s new budget is ‘right on the target.’ That’s all you need to know about just how devastating Trump’s budget will be for working families in Massachusetts and across this country.

“It’s obscene:

$5 billion in cuts to public education
$73 billion in cuts to Social Security
$191 billion in cuts to food stamps
$610 billion in cuts to Medicaid (and that’s in addition to the $880 billion the House Republicans are slashing in their so-called “health care” bill)

“Those are just a few of the highlights. What else gets cut? Money for children’s health care, money to combat the opioid epidemic, money for medical research, money for the Corporation for Public Broadcasting, and so much more.

“This budget is ‘right on the target’ only if the target is to sucker-punch kids, seniors, the poor and the sick. If the Republicans make good on this budget, they could deliver the final blow to America’s working families.

“We don’t build a future by ripping health care away from tens of millions of people. We don’t build a future by starving education, by letting our roads crumble and our bridges collapse, and by shutting down the big pipeline of medical and scientific research in this country.

“We build a future by making the investments in ourselves and all of our people – so the next kid can get ahead, and the kid after that, and the kid after that. We’ve done this before in our country, and we can do it again.

”Budgets aren’t just about dollars and cents. Budgets are about our values, and this budget is morally bankrupt,” Warren wrote.

Trump and the Republicans would cut out all the things that have “made America great,” and a world leader in innovation and entrepreneurship, not to mention the main tools for spreading democracy and human rights across the globe (through capitalist investment, which is what China and Russia are now doing).

This is the midst of an actually strong economy, near “full employment” and as we keep hearing, a record stock market.

The Trump budget is the essence of everything that Trump is doing to weaken the US as an economic power, a world power, and its ability to be a moral leader, that Reaganesque “beacon on a hill” of political righteousness.

As we marked Memorial Day this past weekend, a New York Times book review of “The Allure of Battle: A History of How Wars Have Been Won and Lost,” by Cathal J. Nolan, pointed out that “Generally, one side, usually the one with a smaller economy and population, becomes exhausted, and gives up. Talk about élan and audacity all you like, he counsels, but what wins wars is demography and economic strength.” That is to say, winning a war is more a matter of “hearts and minds” vs. “bombs and brigades” as we have been seeing in America’s longest wars, in Afghanistan and Iraq.

Everything that Trump has done so far (putting aside the fact that he is an illegitimate occupier of the Oval Office by selling out to an adversary government), will weaken the US as an economic power, a world power, and its ability to be a moral leader, that Reaganesque “beacon on a hill” of political righteousness.

Indeed, Trump, who cozied up to the Saudis while hectoring NATO allies and the G7, on his “epic” overseas trip, came back declaring “a home run”, while Germany’s Angela Merkel told Europe, “We can no longer depend on the US or UK. We are on our own.”

New York State, along with other “blue” states like California, already send way more income tax money to Washington than we get back while the “red” states, which so pride themselves in low state taxes and low wages get far more than they send. Like tenants with a legal fight against their landlord, I would propose that New Yorkers collect their federal income tax money in an escrow account, to pay for services that should be paid by the federal government, such as police and security protection (which Trump is threatening to cut to New York and other states that don’t cooperate in his roundup of undocumented individuals), environmental restoration, health care for those whose subsidies have been eliminated, public schools, infrastructure repair, food stamps and school lunch program.

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

Anti-Trump Activism, Democrats, Health Care, Obamacare

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

March 21, 2017 krubin

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

By Karen Rubin, News & Photo Features

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Health Care, Obamacare

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

March 9, 2017 krubin

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

By Karen Rubin, News & Photo Features

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The other prime elements:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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