By George, the Republicans have done it. They have taken the health out of Health and Human Services. They propose, and if Mitch Mcconnell has anything to do with it will turn the clock way, way back to a time when you hoped your employer provided medical insurance and if they didn’t, you were hard pressed to buy even barebones coverage unless you were in Congress or made a 6 figure salary. The Senate bill does a niftier job of getting the federal government out of the health care business, both private and public using a slightly longer timetable, all the better to avoid blowback before the 2020 elections.
While the public thought the gang of 13 gray-haired men was secreted away to craft a health care bill, they were designing legislation to accomplish two objectives 1) deliver tax cuts to those in high income brackets and 2) to restructure Medicaid. Those were not afterthoughts or side issues; they were the central premise under the guise of addressing health care insurance programs. The use of Medicaid expansion for Obamacare really sticks in Republican craws. As one Republican said, “we’ve got to get able bodied people off Medicaid; the program was intended as a safety net for the disabled, mothers and children.” The Senate bill has found a way to obliterate Medicaid by capping federal payments which will blow a big hole in state budgets. Private health insurance is collateral damage.
Currently, both the state and federal government share the cost of Medicaid, with federal funding based on differential state formula, but limited only by the state’s needs. In states with Medicaid expansion programs, the federal government pays 90% of the state’s portion compared with around 50% of customary funding, scheduled to incrementally decrease beginning in 2018. Traditional Medicaid programs pay for 64% of nursing home residents, over 50% of all births, 60% of children with disabilities and 40% of children’s medical care. Now, states spend funds as needed, with the ability to respond to increased needs.
This bill will restructure Medicaid to use a formula to determine maximum payment for each program enrollee, with state funds left to fill the gap between what is actually spent. While the tax cuts will take effect immediately, these changes are scheduled to take effect in 2020, notably after both midterm elections of 2018 as well as the presidential. By 2024, federal and state governments will split all Medicaid costs but only until the federal cap is reached, when the state will be responsible for any remaining expenditures. That sleight of hand should create significant federal budget deficits. Governors will have to chose between the elderly in nursing homes, pregnant women, children, the disabled, able bodied adults and road maintenance, or employee salaries. Essentially Republicans are dropping the problem in the laps of the states who are struggling with budgets trying to meet current needs.
The Senate bill, unlike the House bill, retains the Obamacare prohibition against discrimination against those with preexisting conditions, but states are free to allow insurers to offer those customers less coverage. Also, retention of children on a parent’s policy remains; both features were popular and sparked popular outrage. But by eliminating the medical device tax, touted by Republicans as important for business development and the taxes levied on wealthy individuals used to fund Obamacare, the bill creates a windfall that will put a skip in their step. For those making a million bucks annually, there is a $50,000 tax cut at the end of the rainbow.
Despite the official line that the Senate bill would be different from the House’s, the bill retains the essential characteristics with few modifications. Subsidies, albeit lower than those provided with Obamacare, are still to be provided to lower income Americans, but based on age rather than income. Older Americans will have higher premiums with lower subsidies, which Republicans contend is appropriate because older people are more frequent users of health care services. Unfortunately that approach will discourage preventive maintenance care, like mammograms, annual medical exams with testing for diabetes and cholesterol, prostate exams etc. These are part of required coverage under Obamacare, but Republicans would allow states to determine the range of plans with more limited coverage, higher deductibles and annually capped expenditures, supposedly cheaper although that is totally under the purview of insurance companies. If none of the cheap plans cover cancer care, then that’s not a choice for a woman battling breast cancer. States can also opt of online exchanges.
There are a couple of new features. They added back a ban on federal reimbursement for Planned Parenthood medical services, a darling issue of the conservative right, but only for a year. It turns out, longer than that will actually cost Medicaid more, because the strangling of access to contraception to hundreds of thousands of women will result in more babies who will be covered by Medicaid. And they added a six month block on eligibility for insurance coverage after a one month lapse in coverage in order to discourse people from waiting until they’re sick to pay insurance.
Undoubtedly, private health care spending is being dramatically shifted to the consumers. The Republicans can talk about cheaper plans and lower premiums that are supposed to materialize under Better Care, but that will come at the cost of less coverage. You get what you pay for; you get less product when you pay less. Inevitably, the difference between covered costs will come out of family pockets, through co-pays, co-insurance, higher deductibles, non covered drug costs, annual caps and excluded services. The bottom line is that health insurance is expensive because healthcare is expensive and the cost goes up continually. No matter how you slice it someone has to pay for it and if it’s not the insurance company, it will be you. Ultimately, it’s another way Republicans have found to eat away at middle and working class budgets.
How could the Senate bill have been anything other than a tweak to the House bill? If the main objective is to get the ball rolling on tax cuts, the Senate version had to be crafted so it would be passed the House again in record time as well, without hearings or conference reconciliation.
McConnell is a skillful and ruthless Senate Majority Leader; he would not have announced a vote on the bill if he didn’t know he had the votes. The release of the bill is the first salvo in his strategy. The outliers have emerged; this will lead to further tweaking by negotiation in order to eliminate introduction of pesky amendments when the bill reaches the floor for a vote so that McConnell can use Senate rules to shut debate down. The publication of the bill also allows the onus of fulfilling the Repeal Obamacare Promise to fall squarely on outlier shoulders. A vote against the bill will make that Senator a victim of the wrath of the GOPand more importantly, Conservative PACs fired by the billionaires in their next electoral race. Both are far more frightening than the constituents in their state. Republicans believe wholeheartedly that their current majority position was the destination of the Repeal Obamacare train and if they don’t deliver, their brand is damaged, maybe irreparably.
The anticipated CBO score is unlikely to make a difference; it’s a formality. There’s no way the score will be better for Americans than it was for the House bill, because both are draconian. But it will cough up some spin points for Republicans, not that they seem to care much; they haven’t spent much time on rationale because frankly, they don’t give a damn what the public thinks. They’re betting the TrumpPack will follow wherever he goes, and that that will be enough. The reasons to pass this bill are purely political: delivery on an 8 year promise, even if the majority of Americans (65%) don’t want it, the GOP brand, the first piece of meaningful legislation to emerge from the CelebrityPresident’s administration, and most importantly, a necessary first item on the tax cuts for the rich menu.
The Republicans are simply kissing goodbye to a federal role in dealing with real problems with health outcomes in the country. Look for the US to slide downward from number 40, it’s current ranking in global health outcomes and for the life expectancy of white men to fall even more. The bottom line is that if you get sick or have an accident or have ongoing chronic illness or are addicted to drugs or are elderly without funds or family or are handicapped or disabled, you are on your own. Good luck, suckers.
Now that the Donald is on board with Russian interference in US elections, what’s his next step beyond the Twitter swarm to dis Obama. If it’s bad enough to dis Barack, then it must be worth of major action. If Barack fucked up, where will 45 plant his shaft? Ok, so he’s signed that proclamation, I mean executive order, to create some commission or division or some such to look into responses to foreign hacking, whatever the source, back in the day when he wasn’t copin’ to Russia as the enemy. You remember, when it could have been China or a 400 lb man. The command is snugly placed in Jared’s capable hands, maybe sitting just under Middle East Peace on his to-do list. And Trump’s got that commission on voter fraud, headed by Kris Kobach, the Kansas Tsar of minority voter disenfranchisement, but he’s really into cracking on domestic voting rights, not so much foreign cyber intrusion. Of course, Kelleyanne trotted him out as proof of Trump action, because both have the subject “election” in common. So, it sounds like nothing too serious so far is happening. But the clock is ticking. We’re only a year away from 2018 campaigning.
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The possibility that the administration has been responsible for the persistent press leaks about the investigation cannot be excluded. Presidents have long used press leaks to further their objectives. It is not a contradiction that the leaks appear to injure 45. First and foremost, they feed the perception for the TrumpPack that their fearless leader is under siege. This continually gooses the right wing conservative media mill about the “deep state” in the federal bureaucracy and “Washington elites” as well as a platform for patriotic tirades against attempts to derail the Trumpian revolution in government. It also advances the rationale for the siege paranoia that allows 45 to increase the opacity surrounding his administration and to cut off press access, for example, most recently the Spicer press briefing where audio and video recording was banned. Additionally, the pretense of fighting back against the press undermines the legitimacy of the free press in its pursuit of an objective truth. Truth itself is yet another casualty being constantly bandied about by administration and conservative right. All of these are tactics to keep Trump’s base firing on all cylinders to support Trump’s continuing need for adulation. The leaks also produce the media whirlwind to distract news organizations from other administration actions, centered primarily in Cabinet departments engaged in erasing Obama, while scampering around to cover Trump tweets. There is only so much space for news coverage in people’s’ lives and titillating items grab top billing. As a consequence, the general population is unable to gauge exactly what changes in federal policies and how it will affect their lives. 
After denial, came the Twitter offensive to divert the conversation from anything significant. A smear campaign, also reminiscent of the oft used defense attack on the reputation of the rape victim, was launched to belittle the former FBI director as a chronic leaker – “
When J Edgar Hoover ran the FBI, the agency carried out Hoover’s agenda, sometimes including blackmail of both politicians and civilians. Hoover infamously wiretapped Martin Luther King, under the pretext of anti-communist activity, long after the original authorization expired. He sent an FBI tape of King in flagrante with another woman to Coretta, in hopes of disrupting his marriage. While that is harmful precedent for independence of the FBI director, after agency reforms, that independence is bolstered by a 10 year term to span presidential terms.
oleblacklady 